TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) Alan C Keiller Trustee/Chair (thru 1/21)/Vice Chair (eff. 2/21)	1.0 ................. 0.1	X	X	0	0	0
(2) John Tansey Trustee/Vice Chair (thru 1/21)/Chair (eff. 2/21)	1.0 ................. 0	X	X	0	0	0
(3) Joseph L Perras MD President/CEO/Ex-officio	40.0 ................. 0.5	X	X	423,728	0	16,015
(4) Pamela Brown Trustee/Secretary	1.0 ................. 0	X	X	0	0	0
(5) Richard Marasa MD Trustee / Medical Staff President (eff. 1/21)	40.0 ................. 0	X	X	200,777	0	38,856
(6) Vincent Fusca III Trustee/Treasurer	1.0 ................. 0	X	X	0	0	0
(7) Annice Mason Trustee/Physician (through 12/20)	40.0 ................. 0	X		239,256	0	10,001
(8) Deanna Howard Trustee	1.0 ................. 0	X		0	0	0
(9) John Gerstmayr Trustee	1.0 ................. 0	X		0	0	0
(10) John Gilman Trustee	1.0 ................. 0.5	X		0	0	0
(11) Matthew Houde Trustee	1.0 ................. 40.0	X		0	236,996	52,672
(12) Michael Kilcullen Trustee (through 3/21)	1.0 ................. 0	X		0	0	0
(13) Patrick F Jordan III MBA Trustee	0.5 ................. 56.5	X		0	756,581	59,599
(14) Ralph Jean-Mary Trustee (eff. 10/20 through 4/21)	1.0 ................. 0	X		0	0	0
(15) Steve Crihfield Trustee	1.0 ................. 0	X		0	0	0
(16) Steven Smith MD Trustee	1.0 ................. 40.0	X		0	208,074	61,444
(17) Steven Surgenor MD Trustee	1.0 ................. 40.0	X		0	499,275	66,907

(A) Name and business address	(B) Description of services	(C) Compensation
MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON,NH03756	Healthcare Services	2,562,872
EMERGENCY SERVICES OF NE INC PO BOX 12 Chester,VT05143	Healthcare Services	1,583,240
Dartmouth-Hitchcock Clinic ONE MEDICAL CENTER DRIVE LEBANON,NH03756	Healthcare Services	905,289
CERNER CORPORATION PO Box 959156 ST Louis,MO631959156	Healthcare Services	651,998
AMERICAN HEALTHCARE SERVICES ASSOCIATION PO BOX 670529 Dallas,TX752670529	Healthcare Services	484,908
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 11

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

Windsor Hospital Corporation

Employer identification number

03-0183721

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2020

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2019. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2019. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2020

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2020

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2020

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

Windsor Hospital Corporation

Employer identification number

03-0183721

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization Windsor Hospital Corporation

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization Windsor Hospital Corporation		Employer identification number 03-0183721

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization Windsor Hospital Corporation			Employer identification number 03-0183721
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Windsor Hospital Corporation

Employer identification number

03-0183721

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2020

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2020

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

9,260

Total. Add lines 1c through 1i ....................................................................................................

9,260

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Mt. Ascutney Hospital and Health Center pays dues to various organizations related to its exempt mission. The amount reported under other activities in line 1i refers to the amount of lobbying activities identified in dues payments to these outside organizations.

Schedule C (Form 990 or 990EZ) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Windsor Hospital Corporation

Employer identification number

03-0183721

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2020

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	5,256,278	5,052,695	5,060,299	4,958,242	4,667,571
b	Contributions ...
c	Net investment earnings, gains, and losses	1,496,142	404,533	188,211	289,494	475,456
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	204,924	200,950	195,815	187,437	184,785
f	Administrative expenses ....
g	End of year balance ......	6,547,496	5,256,278	5,052,695	5,060,299	4,958,242

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

64.43 %

Term endowment SchDMd Bullet

35.57 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .......................

3a(i)

(ii) Related organizations .......................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	410,000		410,000
b	Buildings ....	18,883,262	10,943,747	7,939,515
c	Leasehold improvements
d	Equipment ....	12,171,125	8,734,417	3,436,708
e	Other .....	12,720,080	9,095,891	3,624,189
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				15,410,412

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) Investment in Pooled Funds	30,262,935	F
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	30,262,935

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)Rental Deposits				13,278
(2)Equity in subsidiary				2,855,571
(3)Other receivables				514,466
(4)Right of use assets, net				5,671,580
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				9,054,895

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	25,268,399
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2020

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Schedule D, Part V, Line 4 Intended uses of endowment funds

The intended use of the endowment funds is to promote and advance the following mission-related programs: healthcare services, charity care, community outreach and advocacy, and equipment purchases.

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

The Organization's parent company and subsidiaries are exempt from income tax under Section 501(c)(3) of the Internal Revenue Code. However, the Organization is subject to federal income tax on any unrelated business taxable income. ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes, addresses the accounting uncertainty of income taxes recognized in an enterprise's financial statements and prescribes a threshold of "more-likely-than-not" for recognition and derecognition of tax positions taken or expected to be taken in a tax return. Subtopic 740-10 also provides guidance on measurement classification, interest and penalties and disclosure. The Organization has determined that the provisions of Subtopic 740-10 do not have a material effect on the Organization's financial statements.

Schedule D (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Windsor Hospital Corporation

Employer identification number

03-0183721

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 22500 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			203,616	0	203,616	0.34 %
b	Medicaid (from Worksheet 3, column a) . . . . .			6,702,558	1,393,380	5,309,178	8.74 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			0	0	0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	6,906,174	1,393,380	5,512,794	9.08 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			1,964,945	1,687,252	277,693	0.46 %
f	Health professions education (from Worksheet 5) . . .			371,655	0	371,655	0.61 %
g	Subsidized health services (from Worksheet 6) . . . .			3,850,090	1,328,937	2,521,153	4.15 %
h	Research (from Worksheet 7) .			0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			2,180	0	2,180	0 %
j	Total. Other Benefits . .	0	0	6,188,870	3,016,189	3,172,681	5.22 %
k	Total. Add lines 7d and 7j .	0	0	13,095,044	4,409,569	8,685,475	14.30 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	0	0	0	0

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

23,892,651

Enter Medicare allowable costs of care relating to payments on line 5.....

24,447,261

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-554,610

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)						Other (describe)
1	Windsor Hospital Corporation 289 County Road Windsor,VT05089 https://www.mtascutneyhospital.org 863	X	X	X	X	Distinct Part Rehab Unit

Schedule H (Form 990) 2020

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Windsor Hospital Corporation
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): https://www.mtascutneyhospital.org/about/community-health-needs

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): https://www.mtascutneyhospital.org/about/community-health-needs

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Windsor Hospital Corporation
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 225.0%
and FPG family income limit for eligibility for discounted care of 300.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

https://www.mtascutneyhospital.org/your-visit/billing-and-financial-assistance

The FAP application form was widely available on a website (list url):

https://www.mtascutneyhospital.org/your-visit/billing-and-financial-assistance

A plain language summary of the FAP was widely available on a website (list url):
https://www.mtascutneyhospital.org/your-visit/billing-and-financial-assistance

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	Windsor Hospital Corporation
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Windsor Hospital Corporation
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2020

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 3E	The significant health needs are a prioritized description of the significant health needs of the community and identified through the CHNA.
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - Windsor Hospital Corporation. Methods employed in the assessment included a survey of area residents made available through the electronic mail, physical printed surveys distributed throughout the communities and by website links, a survey of key community stakeholders who are agency, municipal or community leaders, a series of community discussion groups convened in the Mt. Ascutney Hospital service area, and a review of available population demographics and health status indicators. At the beginning of the survey, respondents were asked to indicate the region they primarily serve or are most familiar with. A total of 57 key stakeholder respondents indicated that their responses were reflective of the greater Windsor area. Respondents represented the following sectors: - Human Service/Social Service - EDUCATION/YOUTH SERVICES - COMMUNITY MEMBER/VOLUNTEER - PUBLIC HEALTH - MUNICIPAL/COUNTY/STATE GOVERNMENT - MEDICAL CARE/HOSPITAL - FAITH ORGANIZATION - LONG-TERM CARE - MENTAL HEALTH/BEHAVIORAL HEALTH - CIVIC/CULTURAL ORGANIZATION - FIRE/EMERGENCY MEDICAL SERVICE - HOME HEALTH CARE - BUSINESS/OTHER
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - Windsor Hospital Corporation. The CHNA was conducted with other hospital facilities including Mary Hitchcock Memorial Hospital (MHMH), Alice Peck Day Memorial Hospital, New London Hospital, and Valley Regional Hospital. USING SIMILAR COMMUNITY HEALTH NEEDS ASSESSMENT TOOLS AND APPROACHES, ALLOWED US TO COMPARE COMMUNITY HEALTH NEEDS ACROSS A BROAD GEOGRAPHIC, MULTI-HOSPITAL REGION.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - Windsor Hospital Corporation. ORGANIZATIONS, OTHER THAN HOSPITALS WHO PARTICIPATED WITH MAHHC TO CONDUCT THE CHNA, INCLUDED LAKE SUNAPEE REGION VNA AND HOSPICE, VISITING NURSE AND HOSPICE FOR VT AND NH, along with TECHNICAL SUPPORT FROM THE NEW HAMPSHIRE COMMUNITY HEALTH INSTITUTE/JSI. COMMUNITY PARTNERS WHO ASSISTED IN DISSEMINATING THE CHNA THROUGH THEIR NETWORKS INCLUDED WINDSOR SOUTHEAST SUPERVISORY UNION, WINDSOR CENTRAL SUPERVISORY UNION, HUMAN SERVICE AGENCIES FROM THE GREATER UPPER VALLEY INTEGRATED SERVICES TEAM, MAHHC IMMUNIZATION CLINICS, LOCAL BLACK LIVES MATTER/JEDI COMMITTEE, PARENT-CHILD CENTERS, VERMONT STUDENT ASSISTANCE CORPORATION, SOUTH EASTERN VERMONT COMMUNITY ACTION, ECONOMIC SERVICES, WISE, VEGGIE VAN GO, LOCAL TOWN GOVERNMENT'S, AND WINDSOR ROTARY.
Schedule H, Part V, Section B, Line 7 Facility , 1	Facility , 1 - Windsor Hospital Corporation. A CHNA REPORT WAS PREPARED AND MADE AVAILABLE AND DISTRIBUTED THROUGH PRESENTATIONS MADE TO THE HOSPITAL'S BOARD OF TRUSTEES, THE MT. ASCUTNEY COMMUNITY HEALTH COMMITTEE, AS WELL AS THE BLUEPRINT COMMUNITY HEALTH TEAM, WINDSOR CONNECTION RESOURCE CENTER, PATCH TEAM, WINDSOR HSA COMMUNITY COLLABORATIVE, GREATER UPPER VALLEY INTEGRATED SERVICES TEAM, MAHHC COMMUNITY HEALTH COMMITTEE AND A REGIONAL CONVENING OF ALL NETWORKS AND WORKGROUPS OF THE COMMUNITY HEALTH IMPLEMENTATION PLAN. AN ELECTRONIC COPY WAS DISSEMINATED TO THE LOCAL TOWN SELECTBOARDS OF WINDSOR, HARTLAND, WEATHERSFIELD, BROWNSVILLE, AND WOODSTOCK. The CHNA and all information in the needs assessment is available for stakeholders. The CHNA is also available, upon request, via paper copy at the hospital's main information desk.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - Windsor Hospital Corporation. The mission of Mt. Ascutney Hospital and Health Center (MAHHC) is to improve the lives of those we serve. To accomplish this, we and our community partners regularly reach out to engage in dialogue with people across our area about pressing health needs. The result of this work is a comprehensive local community health needs assessment (CHNA). This assessment is designed to identify community health concerns and priorities and opportunities to improve community health and healthcare delivery systems. The geographic area covered by the assessment includes 13 municipalities in Vermont and New Hampshire that comprise the Mt. Ascutney Hospital and Health Center service area. The CHNA leads to a local community health improvement plan (CHIP) with strategies and metrics to improve health and reduce risks leading to chronic disease not only for individuals, but for the entire community. This CHNA-CHIP process, which incorporates input from people who represent the community's broad interests, is an essential part of creating an accountable community for health. It is not only the law for tax-exempt hospitals, as part of the patient protection and affordable care act, but it is also sound medicine. The assessment process fosters engagement, and the results help us to understand the specific issues facing our communities so that we can develop effective, collective impact solutions. IN FISCAL YEAR 2021, WE IMPLEMENTED THE FOLLOWING PROGRAMS WITHIN OUR COMMUNITY HEALTH IMPROVEMENT PLAN DESIGNED TO ADDRESS THE PRIORITY HEALTH NEEDS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. COVID-19 IS A COMMUNITY HEALTH PRIORITY. SIGNIFICANT ENERGY, EXPERTISE, AND TIME WAS DEVOTED TO MOUNT AND SUSTAIN A COMMUNITY RESPONSE TO REDUCE THE IMPACT OF THE PANDEMIC AND SUPPORT OUR COMMUNITY USE THROUGH THE PANDEMIC. THE HOSPITAL RESPONSE INCLUDED ESTABLISHING A RESPIRATORY CLINIC, MODIFYING THE PHYSICAL PLANT, ALLOCATING STAFFING, CHANGING WORK FLOWS AND PROVIDING TESTING AND CARE TO THE ILL THROUGH OUR EMERGENCY DEPARTMENT, CLINIC AND INPATIENT UNIT. MAHHC LED A COMMUNITY RESPONSE TO MITIGATE THE POPULATION HEALTH EFFECTS OF COVID-19 AND PROTECT THE VULNERABLE IN OUR COMMUNITIES. THIS WORK INCLUDED RECRUITING AND VOLUNTEERS TO MEET SPECIFIC NEEDS. THE FOOD SECURITY COMMITTEE WORKED WITH THE SCHOOL AND RESTAURANTS TO PROVIDE MEALS TO FAMILIES, INCREASED SUPPORT FOR THE ELDERLY THROUGH THE MEALS ON WHEELS PROGRAMS, AND SUPPORTED FOOD SHELVES WITH VOLUNTEERS, DONATIONS AND FOOD DRIVES. VEGGIEVANGO SERVED AN AVERAGE OF 335 FAMILIES EACH MONTH WHICH IS A SIGNIFICANT INCREASE OVER THE 150 FAMILIES A MONTH PRIOR TO COVID. WE PROMOTED GARDENS AND WORKED WITH RESTAURANTS. ECONOMIC SUPPORT INCLUDED ADMINISTERING GRANTS AND WORKING IN PARTNERSHIP WITH LOCAL HEALTH AND HUMAN SERVICE AGENCIES AS WELL AS OUR COMMUNITY HEALTH TEAM TO LINK THOSE IN NEED WITH RESOURCES. WE PROVIDED INFECTION PREVENTION, EDUCATION TO FAMILIES AND ASSISTED WITH RESOURCES TO DECREASE ANXIETY AND IMPROVE COPING. WE RECEIVED AND DISTRIBUTED COVID-19 RELIEF FUNDING FROM DARTMOUTH-Hitchcock TO HELP ADDRESS THE NEEDS OF THE COMMUNITY IMPACTED BY THE PANDEMIC. VOLUNTEERS IN ACTION, UNDER THE LEADERSHIP OF MAHHC, HELPED TO ORGANIZE AND COORDINATE A NEIGHBOR HELPING NEIGHBOR COVID RESPONSE TEAM THAT RESPONDED TO EMERGENCY REQUESTS, E.G., PET CARE FOR THE HOSPITALIZED, GROCERY PICK-UP FOR THOSE QUARANTINING, AND MUCH MORE. ACCESS TO MENTAL HEALTH ACCESS TO MENTAL HEALTH WAS OUR #1 COMMUNITY HEALTH NEED. DURING 2021,WE INCREASED OUR PSYCHIATRY PROGRAM TO INCLUDE 3 PSYCHIATRISTS AND 2 COUNSELORS, AS WELL AS A MENTORED MSW PROVIDING SERVICES AS PART OF OUR PATIENT CENTERED MEDICAL HOME. WE CONTINUED A CONTRACTUAL AGREEMENT WITH MONTHLY PEDIATRIC PSYCHIATRY CONSULTATION. OUR WORK WITH THE WINDSOR CONNECTION RESOURCE CENTER PROVIDED MENTAL HEALTH COUNSELING SESSIONS. WE UTILIZED CHAPLAINCY SERVICES TO PROVIDE STAFF AND PATIENT SUPPORT. WE DESIGNED AND IMPLEMENTED 6 TRAUMA INFORMED CARE CLASSES TO EDUCATE STAFF AND BETTER REACH OUT TO AND CARE FOR OUR COMMUNITY. WE WORKED WITH THE FAMILY WELLNESS PROGRAM TO PROVIDE COPING STRATEGIES TO ALL FAMILIES IN OUR PEDIATRIC PRACTICE. OUR FAMILY WELLNESS THERAPIST DEVELOPED A MENTAL HEALTH ACCESS TEAM. ACCESS TO THIS SERVICE HAS INCREASED OVER 30% AND THE NUMBER OF VISITS HAS MORE THAN DOUBLED. OUR FAMILY WELLNESS COACH TAPED A VIDEO "FOR YOUR HEALTH" TELEVISION SHOW HELPING FAMILIES WITH COPE DURING THE COVID-19. OUR WELLNESS COACH DEVELOPED A BRIDGE TO THERAPY PROGRAM SO THAT ASSESSMENTS AND SUPPORT COULD BE GIVEN TO INDIVIDUALS REFERRED FOR MENTAL HEALTH COUNSELING WHILE THEY WAITED TO BE INITIATED INTO THERAPY. A MENTAL HEALTH COUNSELOR FROM HCRS, OUR DEEMED MENTAL HEALTH AGENCY, PROVIDED CARE AS AN EMBEDDED CLINICIAN IN BOTH OUR ADULT AND PEDIATRIC CLINICS. AN HCRS CLINICIAN JOINED OUR BLUEPRINT FOR HEALTH COMMUNITY HEALTH TEAM TO PROVIDE MENTAL HEALTH CONSULTATION IN CARE COORDINATION. OUR PEDIATRIC TEAM AND PSYCHIATRISTS ESTABLISHED A PROCESS FOR CASE SUPERVISION FOR BEHAVIORAL HEALTH PATIENTS THIS YEAR. THIS GROUP ALSO ESTABLISHED A PROCESS TO BE ABLE TO PROVIDE GROUP VISITS. ALCOHOL AND SUBSTANCE MISUSE ALCOHOL AND SUBSTANCE MISUSE WAS OUR #2 COMMUNITY HEALTH NEED. DURING 2021 IN THE AREA OF PREVENTION, THROUGH THE PREVENTION NETWORK GRANT, WE SUB-AWARDED $138,000 TO 10 COMMUNITY ORGANIZATIONS TO IMPLEMENT PREVENTION STRATEGIES AT THE LOCAL LEVEL. WE ALSO PROVIDED ONGOING MAINTENANCE OF SUB-AWARDING PROCESSES, MONITORED GRANTEE PERFORMANCE, AND UPDATED RESOURCE PAGE WWW.MAPPVT.ORG/PNGGRANT, AND PROVIDED CONTRACTED EXPERTISE TO SUPPORT A SCHOOL DISTRICT IN SETTING UP RESTORATIVE PRACTICES POLICIES/PROCEDURES RELATED TO SUBSTANCE MISUSE PREVENTION. OUR WORK WITH LOCAL REGIONAL PLANNING COMMISSION, TRORC, WAS HIGHLIGHTED AT THE VERMONT YOUTH CANNABIS CONFERENCE. WE ALSO PROVIDED PREVENTION POLICY OUTREACH TO TOWNS REGARDING HEALTH PROMOTION IN 3 TOWNS AND PROVIDED CANNABIS RETAIL POLICY SUPPORT IN 6 TOWNS, CONDUCTING MULTIPLE PRESENTATIONS AND OFFERING CANNABIS RETAIL LEASE POLICY SUPPORT TO LOCAL BUSINESS IN 1 TOWN. WE PARTNERED WITH TRORC TO MAINTAIN HEALTH POLICY CLEARINGHOUSE- A RESOURCE FOR DECISION MAKERS, TOWNS, SCHOOLS, PLANNING COMMISSIONS, ETC. TO VIEW BEST-PRACTICE POLICY SOLUTIONS TO BUILDING LOCAL CULTURES OF HEALTH AND PREVENT SUBSTANCE MISUSE. WE UPDATED A HEALTH DISPARITY DATA REPORT. WE MAINTAINED A SUPPLY OF MEDICATION RETURN ENVELOPES IN OVER 30 KIOSKS ACROSS THE REGION; SUPPORTED APRIL AND OCTOBER 2021 DRUG TAKE BACK DAY EVENTS. IN THE AREA OF TREATMENT, WE LED A CROSS-SECTOR WORKGROUP FOR ALCOHOL AND SUBSTANCE MISUSE TO ADDRESS BARRIERS TO TREATMENT OPTIONS. THIS 25-MEMBER GROUP MET MONTHLY. A PARTICULAR OUTCOME WAS THE DEVELOPMENT OF AN ANTI-STIGMA CAMPAIGN. WE DEVELOPED SPOTIFY RADIO, SOCIAL MEDIA, PRINT MATERIALS, BUS STOP POSTERS, AND DISSEMINATED CAMPAIGN MATERIALS THROUGH COMMUNITY PARTNER ORGANIZATIONS. LASTLY, WE PLANNED PUBLIC TRANSPORTATION SIGNS FOR WWW.WEAREWORTHWHILE.ORG. A TOTAL OF 12 RECOVERY INCLUSIVE COMMUNITY EVENTS WERE ORGANIZED AND HOSTED. MAHHC LEADS A SPOKE PROGRAM IN 4 SITES SERVING 181 MEDICATION ASSISTED THERAPY (MAT) PATIENTS WITH COUNSELING, CARE COORDINATION, HEALTH COACHING AND EDUCATION. MAHHC PEDIATRIC PRIVATE PRACTICE SERVES A SMALL POPULATION OF MOTHERS OF PEDIATRIC PATIENTS WITH MAT, AND COUNSELING. OUR PROVIDERS AND CLINICIANS CONDUCTED SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT (SBIRT) FOR ALL NEW PATIENTS AND ANNUAL PHYSICALS AND WELLNESS EXAMS. WE MAINTAINED A MULTIDISCIPLINARY CHRONIC PAIN CONSULT TEAM IN SERVICE TO SUPPORT PROVIDERS DEALING WITH DIFFICULT CHRONIC PAIN PATIENTS. IN JUNE 2021, WE DESIGNED AND ORGANIZED A SUMMIT OF ALL COUNTY-WIDE STAKEHOLDERS, SUCH AS TREATMENT PROVIDERS, PRIMARY CARE PROVIDERS, PROBATION AND PAROLE, PREVENTION SPECIALISTS, TURNING POINT RECOVERY CENTERS, POLICE, EMS, SYRINGE SERVICE, GOVERNMENT AND HEALTHCARE PROVIDERS. THE PURPOSE OF THIS SUMMIT WAS TO ADDRESS THE ISSUE OF OPIOID FATALITIES IN OUR COUNTY. AT THIS TWO PART SUMMIT WE PRESENTED RECENT DATA ABOUT OPIOID FATALITIES. WE REVIEWED THE TOTALITY OF INITIATIVES, PROJECTS, AND SERVICES THAT HAVE BEEN CREATED AND IMPLEMENTED. WE ADDRESSED GAPS AND BARRIERS TO SERVICES FROM THE WISDOM AND INSIGHT OF THE GROUP. WE IDENTIFIED NEW NEEDED SERVICES. WE COMMITTED TO CONTINUE TO COLLABORATE AND INTEGRATE OUR WORK. BLUEPRINT FOR HEALTH SELF-MANAGEMENT PROGRAMS OFFERED CHRONIC PAIN SELF-MANAGEMENT WORKSHOPS. WE WORKED TIRELESSLY TO PREVENT OPIOID DEATHS. INITIATIVES IN THIS AREA INCLUDED IMPLEMENTATION OF RAPID ACCESS TO MEDICATION (RAM) PROGRAM IN MAHHC'S EMERGENCY DEPARTMENT (ED) AND SPRINGFIELD MEDICAL CENTER ED. (Continued in Part VI of Schedule H)
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - Windsor Hospital Corporation. Patients whose family income exceeds 300% of FPL may be eligible to receive a discount based on the self-pay balance. Discounts will be granted such that the total self-pay bill does not exceed 10% of 2 years gross income, plus 10% of assets in excess of the sheltered asset calculation as described in the policy. Any discounts for patients whose family exceeds 300% of FPL must be approved by the financial assistance appeals committee based on a written appeal from the patient or responsible party.
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - Windsor Hospital Corporation. MAHHC applies a discount, calculated annually, to the FAP eligible patient's gross charges and balances where there is no insurance, or to medically necessary services processed by insurance carriers resulting in a balance, which the patient is expected to pay. This assures a patient is not billed at an amount greater than generally billed to patients with insurance. This policy is reference in the Financial Assistance for Healthcare Services policy (FAP).
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - Windsor Hospital Corporation. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON MAHHC'S WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY PLAIN-LANGUAGE SUMMARY. MAHHC PROVIDES THE PLAIN-LANGUAGE SUMMARY BROCHURE TO ALL INPATIENTS, EMERGENCY DEPARTMENT INTAKES, UNINSURED, AND SELF-PAY INDIVIDUALS. MAHHC CONTINUES TO NOTIFY PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABLE TO THEM. ADDITIONALLY, MAHHC POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITIES INCLUDING ADMISSION OFFICES, PUBLIC AREA BOARDS THROUGHOUT THE FACILITIES, THE EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE POLICY BROCHURES IN PATIENT AREAS. MAHHC SCREENS 100% OF UNINSURED INPATIENT AND SAME-DAY PATIENTS PRIOR TO ADMISSION. AS PART OF THIS PROCESS, MAHHC CHECKS ALL STATE AND FEDERAL PROGRAMS TO SEE IF INDIVIDUALS ARE ELIGIBLE FOR ASSISTANCE. PATIENTS ARE ALSO SCREENED TO DETERMINE QUALIFICATION FOR FINANCIAL ASSISTANCE AND THE APPLICATION IS PROVIDED AND/OR COMPLETED AT THIS TIME.

Schedule H (Form 990) 2020

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?0
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2020

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part VI, Line 7 State Filing of Community Benefit Report	The state of Vermont does not administer any community benefit reporting regulations.
Schedule H, Part V, Section B, Line 11 Addressing needs identified in CHNA	(Continued from Schedule H, Part V, Line 11, Section C) WE TRACKED TIME FROM ED TO TREATMENT. OUTCOME STUDIES AVAILABLE PER REQUEST. SIMILAR TO THE PARRI PROJECT, WE DEVELOPED TEAMS IN WINDSOR AND HARTFORD OF POLICE/EMS/RECOVERY COACHES/MENTAL HEALTH WORKERS WHO RESPOND AFTER AN OVERDOSE TO THE PATIENT AND FAMILY WITH SUPPORT, EDUCATION, RESOURCES AND REFERRAL TO TREATMENT. WE ARE COLLABORATING WITH THE EXISTING PROGRAM IN SPRINGFIELD FOR A COUNTY-WIDE APPROACH. MAHHC ED IS A NARCAN DISTRIBUTION SITE FOR THE COMMUNITY. WE HAVE WORKED WITH THE SYRINGE SERVICE PROGRAM AND CONNECTICUT VALLEY ADDICTION RECOVERY (CVAR) TO INCREASE EDUCATION AND ACCESS TO NARCAN. WE COMPLETED A NARCAN EDUCATIONAL BOOKLET THAT WAS WIDELY DISTRIBUTED THROUGHOUT OUR COMMUNITIES AS WELL AS TARGETED OUTREACH TO PHARMACIES. WE ALSO CONDUCTED MANY NARCAN EDUCATION PRESENTATIONS. WE WORKED WITH COMMUNITY PARTNERS TO DEVELOP SYSTEMS FOR STAFF TO CARRY NARCAN IN READINESS OF NEED TO SAVE A LIFE IN EVENT OF AN OVERDOSE. THREE YOUTUBE VIDEOS WERE CREATED AND PROMOTED IN COLLABORATION WITH THE GREEN PEAK ALLIANCE, OUR ED, SYRINGE SERVICE PROGRAM AND STATES ATTORNEY ON NARCAN EDUCATION THE GOOD SAMARITAN LAW AND RAPID ACCESS TO MEDICATION FOR TREATMENT OF OPIOID USE DISORDER IN THE ED. IN THE AREA OF RECOVERY, MAHHC ENTERED IN AN AGREEMENT WITH SPRINGFIELD TURNING POINT RECOVERY CENTER TO LINK PATIENTS TO RECOVERY COACHES 7 DAYS A WEEK 24 HOURS A DAY. ONCE THE PATIENT CONSENTS, THE RECOVERY COACH MEETS WITH THE PATIENT IN THE EMERGENCY DEPARTMENT. THEY ALSO FOLLOW THE PATIENT TO PROVIDE SUPPORT IN THE FIRST 10 DAYS AND BEYOND AFTER THE EMERGENCY DEPARTMENT VISIT. RECOVERY COACHES HAVE PROVIDED REAL AND MEANINGFUL SUPPORT TO OUR PATIENTS STRUGGLING WITH ADDICTION. RECOVERY COACHES HAVE BECOME ACTIVE MEMBERS IN OUR ALCOHOL AND SUBSTANCE MISUSE WORKGROUP FOR THE COMMUNITY HEALTH IMPROVEMENT PLAN. THEY HAVE ALSO ATTENDED COMMUNITY MEETINGS, SUCH AS THE PATCH MEETINGS, BRINGING VALUABLE EXPERTISE AND INSIGHT IN THIS PROCESS. ACCESS TO AFFORDABLE HEALTH INSURANCE AND PRESCRIPTION MEDICATION ACCESS TO AFFORDABLE HEALTH INSURANCE AND PRESCRIPTION MEDICATION WAS OUR #3 COMMUNITY HEALTH NEED. WE CONTINUED TO PROVIDE ACCESS TO HEALTH INSURANCE THROUGH THE WINDSOR COMMUNITY HEALTH CLINIC IN OUR PATIENT CENTERED MEDICAL HOME AND THE THOMPSON SENIOR CENTER IN WOODSTOCK. WE HAVE HELPED PATIENTS NAVIGATE AND RECEIVE SERVICES TO VERMONT HEALTH CONNECT DURING THE EMERGENCY SPECIAL ENROLLMENT AND THROUGHOUT THE YEAR. WE UTILIZED THE INDIGENENT PATIENT PHARMACY PROGRAMS, GRANT FUNDS AND PRIVATE FOUNDATIONS TO PROVIDE MEDICATIONS TO THOSE IN NEED WHO COULD NOT AFFORD THEM. STRENGTHENING FAMILIES OUR #4 COMMUNITY HEALTH NEED, INCLUDED WORK IN CONJUNCTION WITH THE PEDIATRIC CLINIC AND THE COMMUNITY TO OVERCOME POVERTY AND FAMILY STRESS BY INCREASING SKILLS AND CAPACITY FOR POSITIVE RELATIONSHIPS IN THE FAMILY UNIT. THE FAMILY WELLNESS COACH HAD VISITS WITH 141 CHILDREN/CAREGIVERS (18% INCREASE) IN A TOTAL OF 244 SESSIONS (1% INCREASE). ONE QUARTER OF SESSIONS WERE UNIVERSAL PREVENTION APPOINTMENTS WITH FAMILIES OF CHILDREN 3 AND YOUNGER, WITH 74% RETURN APPOINTMENTS. THE FAMILY WELLNESS THERAPIST MET WITH 238 INDIVIDUAL PATIENTS (49% INCREASE) IN 865 SESSIONS (62% INCREASE); SOME SESSIONS HELD VIA TELEHEALTH DUE TO COVID-19. THE FAMILY WELLNESS PROGRAM SERVED 379 PATIENTS, IN 1109 SESSIONS. REACHING FAMILIES FROM 20 TOWNS IN VT AND 8 TOWNS IN NH. THE FAMILY WELLNESS COACH CONSULTED AND ADVOCATED FOR UNIVERSAL AND FAMILY BASED PRACTICE AT REGIONAL MEETINGS OF UV STRONG CHILD CARE COMMITTEE, EARLY CHILDHOOD SERVICE DELIVERY INTEGRATION, WHOLE SCHOOL COMMUNITY CHILD (& FAMILY) HEALTH COMMITTEE OF WSESU, BUILDING BRIGHT FUTURES COUNCILS - SPRINGFIELD & NORTHERN WINDSOR /ORANGE COUNTY, LEADERSHIP FOR STRENGTHENING FAMILIES NETWORK ACTION TEAMS. WE PROVIDE LEADERSHIP FOR MONTHLY PEDIATRIC MENTAL HEALTH PROVIDER MEETING FAMILY WELLNESS THERAPIST AND LEADERSHIP WITHIN THE MAHHC SYSTEM TO OFFER GROUP THERAPY, CLINICAL SUPERVISION FOR MAH COMMUNITY HEALTH TEAM MSW TO ADVANCE TOWARDS LICENSURE RECRUITMENT AND SUPERVISION OF UVM MSW CANDIDATE INTERN. SURVEYS OVER THE PAST THREE YEARS INDICATE 95% FAMILIES AGREED OR STRONGLY AGREED: - THEIR EXPERIENCE WITH THE FAMILY WELLNESS PROGRAM WAS VALUABLE. - THEY LEARNED POSITIVE WAYS TO INTERACT AND GUIDE BEHAVIOR FOR THEIR CHILDREN. - THEY WERE ABLE TO GET AN APPOINTMENT IN A TIME FRAME THAT WORKED FOR THEM. - STATED THEY WOULD RECOMMEND THE FAMILY WELLNESS PROGRAM TO OTHER FAMILIES. WE INVESTED TIME AND EXPERTISE IN CIRCLE OF SECURITY CAPACITY BUILDING IN SUMMER/FALL 2021, 24 MORE FACILITATORS WERE TRAINED. THIS REPRESENTS AN ADDITIONAL 5 AGENCIES/PROGRAMS IN THE NEW TRAINEE GROUP, (TOTAL OF 9 AGENCIES NOW REPRESENTED IN THE FACILITATOR GROUP). AN MOU WAS SIGNED A PART OF BEING TRAINED, SO ALL PROGRAMS HAVE AGREED TO BE INVOLVED IN THE REGIONAL APPROACH IN SOME CAPACITY. A REGIONAL CALENDAR FOR 2021/2022 IS IN DEVELOPMENT, WITH COLLABORATIONS FOR 2022 (WAYPOINT AND TLC) SCHEDULED, AND OTHER ORGANIZATIONS HAVE EXPRESSED CONTINUED AND/OR INTEREST NEW COLLABORATIONS. THIS APPROACH ALLOWS FOR INTERAGENCY REFERRALS TO OCCUR TO INCREASE ACCESS WHEN SUPPORT IS NEEDED. STRENGTHENING FAMILIES NETWORK AND PROJECT LAUNCH HAVE COLLABORATED ON A DATA COLLECTION TOOLS FOR FACILITATORS TO COLLECT RESULT BASED ACCOUNTABILITY (RBA) MEASURES, INCLUDING QUESTIONS FOCUSED ON SOCIAL CONNECTEDNESS. WE INVESTED TIME AND EXPERTISE IN DEVELOPING PLAYGROUP CONNECTIONS. THE ACTION TEAM COLLABORATIVELY DEVELOPED A PLAYGROUP STANDARDS DOCUMENT, A TOOL TO DEVELOP OR ASSESS A PLAYGROUP BASED ON BEST PRACTICE, WITH EXAMPLES AND RESOURCES FOR SUPPORT. DATA COLLECTION & EVALUATION TOOLS, BASED ON RBA, COMPLETED WITH CONSULTANT JSI. WITH INITIATIVE AND DESIGN CONTRIBUTIONS FROM OF A PARENT MEMBER, A STRENGTHENING FAMILIES NETWORK LOGO WAS CREATED, AND CAN BE ADAPTED FOR BOTH PLAYGROUP CONNECTIONS AND CIRCLE OF SECURITY. WE IMPLEMENTED A DULCE (DEVELOPMENTAL UNDERSTANDING AND LEGAL COLLABORATION FOR EVERYONE) PROGRAM IN CONJUNCTION WITH 2 PARENT-CHILD CENTERS. THIS PROGRAM INCLUDES TWO FULL-TIME FAMILY SPECIALISTS WHO WERE PARED WITH PEDIATRICIANS FOR THE FAMILIES OF NEWBORNS THROUGH THEIR 6 MONTHS OF LIFE. IN THIS UNIVERSALLY AVAILABLE PROGRAM. DULCE IS ENTERING ITS 3RD YEAR WITH MT ASCUTNEY PEDIATRICS. 55 FAMILIES ARE ENGAGED IN THE DULCE ELEMENT OF PEDIATRICS AT THE OHC. 68 FAMILIES ENGAGED IN THE DULCE ELEMENT OF PEDIATRICS AT MAHHC. WE DEVELOPED AND ENHANCED PROCESS MAPS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH. WE OFFERED 4TH TRIMESTER GROUP TO ADDRESS THE UNIQUE NEEDS OF YOUNG PARENTS DURING THE PANDEMIC. PARTNERS IN THIS ENDEAVOR INCLUDE THE VERMONT DEPARTMENT OF HEALTH, ONECARE VERMONT, TWO PARENT-CHILD CENTERS AND VERMONT LEGAL AID. WE DEVELOPED A COMMUNITY HEALTH IMPROVEMENT PLAN WORKGROUP WITH DIVERSE MULTISECTOR AGENCIES IN INDIVIDUALS TO ENHANCE SOCIAL CONNECTEDNESS FOR CHILDREN AND FAMILIES. USING A COLLECTIVE IMPACT APPROACH. THE STRENGTHENING FAMILIES WORKGROUP INITIATED A REGIONAL CIRCLE OF SECURITY COLLABORATION AND A STRENGTHENING FAMILIES PLAYGROUP. WE CONTINUE TO WORK WITH THE WINDSOR CONNECTION RESOURCE CENTER AND PROVIDE LEADERSHIP FOR THE COLLABORATION OF HEALTH AND HUMAN SERVICE AGENCIES CALLED PATCH. WE WORKED WITH LOCAL CITIZENS AND A COMMUNITY GROUP CALLED SLED DOG DISCO TO CREATE DEVELOPMENTAL ASSET ACTIVITIES, HELPING TO BUILD A FLOURISHING COMMUNITY. WE WORKED WITH EACH SURROUNDING SCHOOL TO DEVELOP SCHOOL SUPPLY LISTS AND RAISED $4,999 TO PURCHASE ALL NEEDED SCHOOL SUPPLIES FOR 347 STUDENTS WHO QUALIFY FOR FREE AND REDUCED LUNCHES. ACCESS TO PRIMARY CARE ACCESS TO PRIMARY CARE, OUR #5 COMMUNITY HEALTH NEED, CONTINUED IN OUR 11TH YEAR AS A NCQA RECOGNIZED PATIENT CENTERED MEDICAL HOME DEMONSTRATING MEETING ALL THE STANDARDS. MUCH WORK HAS BEEN DONE TO RECRUIT AND RETAIN PRIMARY CARE PROVIDERS. OUR COMMUNITY HEALTH TEAM CONTINUES TO WORK WITH COMMUNITY PARTNERS TO PROVIDE CARE COORDINATION, EDUCATION, AND INTERVENTIONS TO IMPROVE THE QUALITY OF CARE IN THE CONTINUUM OF CARE FOR VERY HIGH RISK CHRONIC CARE PATIENTS TO PREVENTATIVE CARE. MAHHC CONTINUES TO PROVIDE LEADERSHIP TO THE MULTISECTOR NETWORK OF HEALTH AND HUMAN SERVICES IN THIS CARE COORDINATION EFFORT. WE PROVIDED SELF-MANAGEMENT CARE WORKSHOPS THROUGH THE BLUEPRINT FOR HEALTH IN AN EFFORT TO PREVENT DISEASE, REDUCE COMPLICATIONS AND IMPROVE THE QUALITY OF LIFE FOR THOSE WITH CHRONIC CONDITIONS. WE WILL MEET WEEKLY AND AS NEEDED WITH COMMUNITY PARTNERS TO SHARE RESOURCES, PROBLEM SOLVE AND COORDINATE CARE. QUALITY INITIATIVES IN 2021 INCLUDED IN THE AREA OF IMMUNIZATIONS, REORGANIZED AND IMPLEMENTED VACCINE CLINICS IN 9 AREA SCHOOLS AND 6 ASSISTED LIVING FACILITIES AND A FOOD SHELF. 999 CHILDREN AND ADULTS WERE VACCINATED IN THIS EFFORT. QUALITY INITIATIVES TO IMPLEMENT BEST PRACTICE APPROACH WERE ALSO IMPLEMENTED (Continued below)
Schedule H, Part V, Section B, Line 11 Addressing needs identified in CHNA (Continued)	(Continued from above) IN DIABETES CARE, SUBSTANCE USE DISORDER AND PREVENTATIVE CARE. IN 2021 WE PROVIDED 17 WORKSHOPS ATTENDED BY 144 PARTICIPANTS WITH AN 86% COMPLETION RATE (4 DIABETES PREVENTION PROGRAMS, 6 DIABETES MANAGEMENT, 3 CHRONIC DISEASE MANAGEMENT, 1 HYPERTENSION MANAGEMENT, 3 CHRONIC PAIN MANAGEMENT). SENIOR HEALTH SENIOR HEALTH IS OUR #6 COMMUNITY HEALTH NEED. WE DEVELOPED A COMMUNITY HEALTH IMPLEMENTATION PLAN WORKGROUP. THIS WORKGROUP, WITH MULTISECTOR REPRESENTATION, BROUGHT TOGETHER ALL AREA AGING IN PLACE GROUPS. WE DEVELOPED A QUICK GUIDE REFRIGERATOR MAGNET WITH PHONE NUMBERS FOR LOCAL HEALTH RELATED RESOURCE AGENCIES. WE PROVIDED STARTUP FUNDING THROUGH A GRANT FOR A COMMUNITY NURSE POSITION WITH READING-WESTWINDSOR AGING IN PLACE. WE BROUGHT TOGETHER ON A MONTHLY BASIS AGING IN PLACE GROUPS TO SHARE BEST PRACTICES AND COLLABORATE TO SUPPORT ELDERS IN THE COMMUNITY. A SERIES OF INFORMATIONAL/EDUCATIONAL SESSIONS WERE PRESENTED WITH INFORMATION ON VARIOUS TOPICS OF STARTING AND MAINTAINING AN AGING-IN-PLACE ORGANIZATION. THIS SERIES WAS WELL RECEIVED BY PARTICIPANTS. ONE OF THE TOPICS OF THE SERIES WAS ABOUT COMMUNITY NURSING AND INCLUDED REPRESENTATIVES FROM THE UPPER VALLEY NURSING PROJECT. WE PROVIDED SUPPORT TO SCOTLAND HOUSE, AN AREA ADULT DAY AND WELLNESS PROGRAM, THROUGH LEADERSHIP AND GUIDANCE TO THEIR BOARD OF DIRECTORS. WE WORKED WITH SUPPORT AND SERVICES AT HOME (SASH) AND HOUSING AND SUPPORT SERVICES (HASS) TO PROVIDE CARE IN WINDSOR VILLAGE AND THE COMMUNITY FOR APPROXIMATELY 100 HIGH RISK ELDERS. THIS WORK INCLUDES STAFFING, CARE COORDINATION AND PROGRAM DEVELOPMENT. IN 2021, MAHHC SPEARHEADED A COLLABORATION BETWEEN EVER NORTH, STEWART PROPERTIES, SENIOR SOLUTIONS, HASS, MAHHC, AND SASH TO IMPROVE QUALITY OF LIFE FOR THE RESIDENTS OF WINDSOR VILLAGE THROUGH INTRODUCING COMPUTER TECHNOLOGY AND WIFI. BY BUILDING AN ELECTRONIC INFRASTRUCTURE RESIDENTS CAN NOW PARTICIPATE IN TELEHEALTH, DECREASE SOCIAL ISOLATION, AND ENGAGE IS SELF-MANAGEMENT GROUP CLASSES, ETC. IN THE PROCESS WE DISTRIBUTED 12 FREE COMPUTERS TO RESIDENTS PROVIDED BY SENIOR SOLUTIONS. FOUR RESIDENTS WERE FAIRLY COMPUTER SAVVY, THE REST, OUR SASH COORDINATOR OFFERED TO PROVIDE ONE-ON-ONE EDUCATION. SHE PROVIDED ONE-ON-ONE WORK WITH THREE OF THE FOUR RESIDENTS ON HOW TO USE DIFFERENT PROGRAMS AND SHOWED THEM HOW TO CHECK THEIR EMAIL. THIS IS A WONDERFUL PROJECT WITH FAR-REACHING IMPLICATIONS TO DECREASE SOCIAL ISOLATION, IMPROVE ACCESS TO TELEHEALTH AND DECREASE COSTS FOR RESIDENTS. OUR WELLNESS NURSE WORKED WITH THE SASH PROGRAM TO SERVE AN AVERAGE OF 80 PATIENTS. SHE ORGANIZED MONTHLY BP CLINICS WITH AND EDUCATIONAL COMPONENT. SHE PROVIDED HEART HEALTHY RECIPES IN A FORMAT THAT ALLOWED RESIDENTS TO SAMPLE THE FOOD. RITA RICE, RN, OUR EXCELLENT WELLNESS NURSE, ALSO SERVED AS A LINK TO THE CLIENTS PCP'S AND THE COMMUNITY HEALTH TEAM. IN 2021, WITH THE ASSISTANCE OF BETSY BURGHARDT FROM OUR CARE MANAGEMENT DEPARTMENT AND A COMMITTED VOLUNTEER, WE WERE ABLE TO RESTART A WEEKLY ADVANCED DIRECTIVE CLINIC WHICH PROVIDES FREE INDIVIDUALIZED SUPPORT FOR INDIVIDUALS TO OFFER AND DISSEMINATE THEIR ADVANCED DIRECTIVE. IN THE 2021 TAX YEAR WE WORKED WITH SEVCA TO PROVIDE TAX ASSISTANCE TO 250 AREA RESIDENTS. AFFORDABLE HOUSING AFFORDABLE HOUSING IS OUR #7 COMMUNITY HEALTH NEED. WE CONVENED A MULTISECTOR WORKGROUP, COMMUNITY HEALTH IMPLEMENTATION PLAN AFFORDABLE HOUSING, TO ADDRESS THE LACK OF AFFORDABLE HOMES IN OUR COMMUNITIES. IN 2021, A MULTISECTOR WORKGROUP INCLUDING THOMPSON SENIOR CENTER WORKED WITH HOME SHARE VERMONT TO ESTABLISH A PILOT OF THE HOME SHARE PROGRAM. EDUCATION WAS DONE AMONG MEMBERS IN PREPARATION OF THE PILOT. THOMPSON SENIOR CENTER TOOK LEAD OF THIS PILOT AND THE WORK GROUP PROVIDED SOME SUPPORT IN TERMS OF A VOLUNTEER. MAHHC ORGANIZED COMMUNITY TEAM TO ADDRESS THE RISING NEEDS OF HOMELESSNESS IN OUR AREA. THROUGH GENEROUS GRANT SUPPORT FROM THE BYRNE FOUNDATION WE WERE ABLE TO PURCHASE TENTS AND CAMPING SUPPLIES FOR THOSE IN NEED DURING THE SUMMER. WE RALLIED KEY STAKEHOLDERS BRINGING TOGETHER CHURCHES, HEALTHCARE PROVIDERS TOWN OFFICIALS, VOLUNTEERS, TO ORGANIZE A COMMUNITY SUPPORT PROGRAM FOR THE HOMELESS DURING THE WINTER INCLUDING AN ORGANIZED TRANSPORTATION SYSTEM TO SHELTERS AND HOTELS. WORKING WITH COMMUNITY PARTNERS, WE CREATED, PRODUCED AND DISSEMINATED HOUSING RESOURCE GUIDES, HOMELESS RESOURCE GUIDES AND POSTERS TO REACH OUT DIRECTLY TO THOSE EXPERIENCING HOMELESSNESS. DENTAL CARE DENTAL CARE IS THE #8 COMMUNITY HEALTH NEED, WHICH OUR COMMUNITY HEALTH TEAM AND WINDSORCOMMUNITY HEALTH CLINIC LINKED PATIENTS AND NEED WITH DENTAL HOMES. WE COME THROUGH GENEROUS GRANTS AND DONATIONS, PROVIDED $20,058 IN DENTAL VOUCHERS TO ELIGIBLE PATIENTS FOR DENTAL CARE. WE PARTNERED WITH AREA DENTAL PRACTICES INCLUDING A NEW PARTNER IN CLAREMONT TO PROVIDE DONATION BASED FACTORS AND ASSIST OUR PATIENTS TO LINK TO DENTAL HOMES. THROUGH GENEROUS DONATIONS FROM NORTHEAST DELTA DENTAL , MAHHC PROVIDED TOOTHBRUSHES AND TOOTH PASTE TO SENIOR SOLUTIONS (48), HARTLAND ELEMENTARY SCHOOL (96), STAFFORD COMMONS, WEST WOODSTOCK AND MELLISH WOOD (48), BRADFOR PSYCHIATRIC ASSSOCIATES (25), BELLOWS FALLS/PARKS PLACE SUD (50), TRANSITIONAL LIVING IN SPRINGFIELD SUD (12), THE HAVEN - HOMELESS SHELTER (144) AND SPRINGFIELD JUSTICE CENTER AND SPRINGFIELD SUPPORTED HOUSING (144). FOOD SECURITY FOOD SECURITY WAS IDENTIFIED AS A PRIORITY WITHIN OUR COMMUNITY HEALTH IMPLEMENTATION PLAN. MEALS ON WHEELS WERE PROVIDED THROUGH VOLUNTEERS IN ACTION. OUR MEALS ON WHEELS VOLUNTEERS DELIVERED OVER 350 MEALS PER WEEK OVER AN ESTIMATED 18,000 TOTAL MILES COLLECTIVELY. THROUGHOUT THE ENTIRE PANDEMIC, OUR COURAGEOUS AND GENEROUS VOLUNTEERS HAVE CONTINUED TO BAG AND DELIVER MEALS ON WHEELS WITH NO INTERRUPTION IN SERVICE. WORKING WITH SENIOR SOLUTIONS, WE ORGANIZED AND WORKED WITH THE VERMONT FOOD BANK ON THE VEGGIEVANGO MONTHLY PROGRAM WHICH DISTRIBUTES FREE PRODUCE SERVING 150 FAMILIES PRIOR TO COVID-19 AND 335 FAMILIES IN 2021. WE WORKED WITH THE SCHOOLS TO PROVIDE VOLUNTEERS TO DISTRIBUTE FOOD TO FAMILIES POST COVID-19 AND THROUGH THE SUMMER. WE DEVELOPED A FOOD SECURITY MULTISECTOR WORKGROUP. THIS WORKGROUP WORKED TO INCREASE ACCESS TO FOOD FOR PEOPLE IN THE COMMUNITY. RISEVT OPERATES THROUGH OUR STAFF WORKING IN CONJUNCTION WITH ONECARE VERMONT. RISEVT DISTRIBUTED AMPLIFY GRANTS TO BUILD CAPACITY AND WE SUPPORTED CHIP WORKGROUP MESSAGING CAMPAIGNS TO REDUCE BARRIERS TO ACCESSING FOOD RESOURCES, INCLUDING COVID RELIEF PROGRAMS, VEGGIEVANGO, LOCAL FOOD SHELVES, AND THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC). WITH THE WINDSOR FOOD SHELF, WE CO-LED THE PORCH GARDEN PROJECT TO DISTRIBUTE SUPPLIES AND STARTER PLANTS TO 100 FOOD SHELF CLIENT FAMILIES. PARTICIPATING FOOD SHELVES INCLUDED HARTLAND, WEATHERSFIELD, AND READING-WEST WINDSOR. PLANTS AND SUPPLIES WERE DONATED BY CEDAR MOUNTAIN FARM, DEEP MEADOW FARM, CROSSROAD FARM, AND HONEY FIELD FARM. WE PROVIDED RISEVT AMPLIFY GRANT FUNDING TO EXPAND THE WINDSOR COMMUNITY GARDEN AND ESTABLISH RAISED BEDS AT THE CHILDREN'S PLACE PRESCHOOL IN WINDSOR. WE SUPPORTED WINDSOR FOOD SHELF WITH A RISE AMPLIFY GRANT TO PURCHASE A DIGITAL DISPLAY TO HELP LOW LITERACY AND OLDER PATRONS ACCESS INFORMATION ABOUT AVAILABLE RESOURCES IN THE REGION. A SVTAHEC INTERN WAS HOSTED TO DEVELOP A SERIES OF SLIDES WITH AUDIO FOR THE FOOD SHELF. SMOKING/TOBACCO USE/VAPING WORKING IN CONJUNCTION WITH THE VERMONT DEPARTMENT OF HEALTH, WE LAUNCHED A MONTHLY VAPING DIGEST TO KEEP SCHOOL, COMMUNITY AND HEALTH CARE PARTNERS AWARE OF THE NUMBER OF CASES OF VAPING ASSOCIATED LUNG DISEASE. THIS DIGEST ALSO EXPANDED TO INCLUDE ADDITIONAL PREVENTION RESOURCES. WE CREATED AND MARKETED A VISUAL, LOCKED DISPLAY CASE OF OLDER AND NEWER STYLES OF VAPING DEVICES TO EDUCATE SCHOOL PERSONNEL AND PARENTS. WE CONTINUED TO DISTRIBUTE ITEMS DESIGNED TO BUILD AWARENESS OF VAPING QUIT RESOURCES TO MAHHC, SCHOOLS, RECREATION DEPARTMENTS, MULTI-UNIT HOUSING, EARLY CHILDCARE CENTER, HCRS, TURNING POINT RECOVERY CENTER, AS WELL AS THE WINDSOR PRIDE EVENT. AS A RESULT OF STUDENT FEEDBACK, ITEMS TO PROMOTE VAPING QUIT RESOURCES WERE UPDATED. IN ADDITION, A VAPING ASSESSMENT WAS CREATED AND DISTRIBUTED TO THE SCHOOLS IN WCSU AND WSESU. WE CONTINUE TO PARTNER WITH REGIONAL PLANNING COMMISSIONS AROUND TOWN HEALTH CHAPTERS. WE PARTNERED WITH THE VERMONT DEPARTMENT OF HEALTH TO RECOGNIZE TWO AREA EARLY CHILDCARE CENTERS FOR THEIR 3-4-50 GOLD STATUS. WE CONTINUED TO PARTICIPATE ON THE HARTLAND AND WINDSOR SCHOOL WELLNESS COMMITTEES AND THE WHOLE SCHOOL, WHOLE CHILD, WHOLE COMMUNITY SUPERVISORY COMMITTEE WHERE PREVENTION INFORMATION AND EDUCATION IS SHARED. WE FACILITATE CHECK-IN MEETINGS WITH TWO SCHOOL SAPS TO GET UPDATES ON EMERGING PRODUCTS AND TO OFFER RESOURCES. (Continued Below)
Schedule H, Part V, Section B, Line 11 Addressing Needs Identified in CHNA (continued)	(continued from above) ACCESS TO TRANSPORTATION BETWEEN WHEN VOLUNTEERS IN ACTION REOPENED, VOLUNTEER TRANSPORTATION IN MAY 2021 UNTIL THE END OF SEPTEMBER 2021, WE PROVIDED 134 SAFE, FREE, AND FRIENDLY VOLUNTEER RIDES TO MEDICAL APPOINTMENTS, SHOPPING, AND MORE COVERING OVER 1,750 MILES.
Schedule H, Part I, Line 7g Subsidized Health Services	The organization did not include any subsidized health service costs attributable to a physician clinic on part I, line 7G.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation	0
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	A cost accounting system which addresses all patients' segments was used to calculate the amounts reported in the table. A cost-to-charge ratio is used in calculating Medicare allowable cost of care.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	AS A RESULT OF NEW ACCOUNTING GUIDANCE (STATEMENT 15 AND ASC 606), EFFECTIVE FY21 BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	Bad Debt is no longer treated as an expense effective FY21 as a result of new accounting guidance (Statement 15 and ASC 606). As a result, an amount attributable to patients eligible under the organization's financial assistance policy is unable to be reasonably estimated.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	AS A RESULT OF ACCOUNTING CHANGES (ASC 606), BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDE AS A REDUCTION IN NET PATIENT REVENUE. THEREFORE, THERE IS NO SEPARATE FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	The shortfall represents the PPS reimbursement difference of the rehab units. Since the reimbursement does not cover the costs of these units, a subsidy is created. Because the hospital determined that these services are important to the service area, the hospital covers the subsidy. The costing methodology used in the calculation was the cost to charge ratio.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	MAHHC's collection policy and charitable care policies are consistently applied to all patients. Our collection policy applies to any balance owed by the patient whether it is a balance after insurance, a balance with no insurance, or a balance after an adjustment for partial charitable care. Statements and write-off criteria are the same for all like balances, regardless of the reason for the balance and regardless of whether it is a balance after charitable care or not. Patients for financial assistance receive the appropriate adjustment on their bill. If a balance remains after that adjustment, they are billed according to the collection policy for it.
Schedule H, Part V, Section B, Line 16a FAP website	- Windsor Hospital Corporation: Line 16a URL: https://www.mtascutneyhospital.org/your-visit/billing-and-financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website	- Windsor Hospital Corporation: Line 16b URL: https://www.mtascutneyhospital.org/your-visit/billing-and-financial-assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- Windsor Hospital Corporation: Line 16c URL: https://www.mtascutneyhospital.org/your-visit/billing-and-financial-assistance;
Schedule H, Part VI, Line 2 Needs assessment	In the first half of 2021 a Community Health Needs Assessment was completed by Mt. Ascutney Hospital and Health Center in partnership with Dartmouth-Hitchcock, Alice Peck Day Memorial Hospital, Valley Regional Health Care, New London Hospital, Visiting Nurse and Hospice of Vermont and New Hampshire, and the John Snow Institute. The purpose of the assessment was to identify community health needs, priorities and opportunities for community health and health care delivery system improvement. For the purpose of the assessment the geographic area for Mt. Ascutney Hospital and Health Center was 13 municipalities in Vermont and New Hampshire with a total resident population of 44,035 people. Methods employed in the assessment included surveys of community residents made available online and on paper placed in numerous locations throughout the region. We did a direct email survey of key stakeholders and community leaders representing multiple community sectors. We organized and delivered a set of community discussion groups. We compiled the results from the assessment activities and focused specifically on behavioral health needs and gaps and a review of population demographics and health status indicators. All information from the collective activities were analyzed to produce the assessment which lead us in focusing our work to serve vulnerable and disproportionally served populations in the region including populations that experience limited healthcare to health related services or resources due to income, age, disability and social or physical isolation.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	PATIENTS who are identified as without insurance at registration or referred to by a physician/provider are provided with information as to available local, state and Federal services by dedicated staff. Patients are also assisted in applying for health insurance, whether on the commercial exchange or with governmental insurers. Information and the application for financial assistance is provided, along with assistance in completing the application if needed. The applications are reviewed to assure that all required information is provided. THE WEBSITE, PATIENT STATEMENTS, AND FINANCIAL BROCHURES ALL INCLUDE INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY.
Schedule H, Part VI, Line 4 Community information	MAHHC's primary service area includes Bridgewater, Brownsville, Hartland, Reading, Weathersfield, Windsor, and Woodstock (VT) as well as Claremont, Cornish, and Plainfield (NH). MAHHC is the largest employer in the Town of Windsor, with many of its residents having lower than average paying jobs and who struggle with financial stability, which includes transportation difficulties.
Schedule H, Part VI, Line 5 Promotion of community health	The hospital supports a Director of Community Health, the Mt. Ascutney Prevention Program (MAPP) and a Community Health Committee which is a subcommittee of the Board of Trustees. Our staff continue to organize, lead and implement population health programs, health promotion and prevention programs that address high risk behavior such as alcohol, tobacco and drug misuse. We promote exercise and nutrition programs. We organized and implemented the Community Health Implementation Plan. We serve as an integrator and leader of community health by chairing and leading the following community collaborations; the Windsor HSA Community Collaborative, the Windsor PATCH Team, the Blueprint for Health care coordination team, the 6 multisector work groups resulting from the Community Health Needs Assessment.
Schedule H, Part VI, Line 6 Affiliated health care system	The Hospital's Director of Community Health an active participant in the regional Community Health Committee which is lead and organized by Dartmouth-Hitchcock. The hospital is affiliated, formally, with Dartmouth-Hitchcock as are the other local hospitals, Alice Peck Day Memorial Hospital, New London Hospital, and Valley Regional Hospital. These hospital representatives collaborate and compare solutions and offer support to each other in our community health programs.

Schedule H (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
Graphic Arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Windsor Hospital Corporation

Employer identification number

03-0183721

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2020

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Joseph L Perras MD President/CEO/Ex-officio	(i) (ii)	415,704 ------------- 0	0 ------------- 0	8,024 ------------- 0	14,250 ------------- 0	1,765 ------------- 0	439,743 ------------- 0	0 ------------- 0
2Richard Marasa MD Trustee / Medical Staff President (eff. 1/21)	(i) (ii)	197,963 ------------- 0	0 ------------- 0	2,814 ------------- 0	9,928 ------------- 0	28,928 ------------- 0	239,633 ------------- 0	0 ------------- 0
3Patrick F Jordan III MBA Trustee	(i) (ii)	0 ------------- 707,368	0 ------------- 0	0 ------------- 49,213	0 ------------- 21,615	0 ------------- 37,984	0 ------------- 816,180	0 ------------- 0
4Annice Mason Trustee/Physician (through 12/20)	(i) (ii)	238,997 ------------- 0	0 ------------- 0	259 ------------- 0	9,118 ------------- 0	883 ------------- 0	249,257 ------------- 0	0 ------------- 0
5Matthew Houde Trustee	(i) (ii)	0 ------------- 236,452	0 ------------- 0	0 ------------- 544	0 ------------- 17,588	0 ------------- 35,084	0 ------------- 289,668	0 ------------- 0
6Steven Smith MD Trustee	(i) (ii)	0 ------------- 195,844	0 ------------- 0	0 ------------- 12,230	0 ------------- 19,617	0 ------------- 41,827	0 ------------- 269,518	0 ------------- 0
7Steven Surgenor MD Trustee	(i) (ii)	0 ------------- 471,805	0 ------------- 0	0 ------------- 27,470	0 ------------- 27,315	0 ------------- 39,592	0 ------------- 566,182	0 ------------- 0
8David Sanville CFO	(i) (ii)	235,535 ------------- 0	0 ------------- 0	11,032 ------------- 0	12,436 ------------- 0	19,780 ------------- 0	278,783 ------------- 0	0 ------------- 0
9Paul Calandrella Chief Operating Officer (through 8/21)	(i) (ii)	215,713 ------------- 0	0 ------------- 0	1,441 ------------- 0	10,793 ------------- 0	25,958 ------------- 0	253,905 ------------- 0	0 ------------- 0
10Peter Rauert Anesthesiologist	(i) (ii)	412,694 ------------- 0	0 ------------- 0	1,441 ------------- 0	14,250 ------------- 0	20,176 ------------- 0	448,561 ------------- 0	0 ------------- 0
11Christopher Connor Ophthalmologist	(i) (ii)	343,837 ------------- 0	5,000 ------------- 0	1,523 ------------- 0	14,250 ------------- 0	11,244 ------------- 0	375,854 ------------- 0	0 ------------- 0
12Dennis Heibein CRNA	(i) (ii)	279,805 ------------- 0	0 ------------- 0	2,814 ------------- 0	13,688 ------------- 0	2,958 ------------- 0	299,265 ------------- 0	0 ------------- 0
13Alden Hall Physician	(i) (ii)	291,488 ------------- 0	0 ------------- 0	509 ------------- 0	14,231 ------------- 0	1,193 ------------- 0	307,421 ------------- 0	0 ------------- 0
14Herbert Ip Physician	(i) (ii)	241,895 ------------- 0	0 ------------- 0	177 ------------- 0	12,220 ------------- 0	21,126 ------------- 0	275,418 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2020

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation

THE CEO'S COMPENSATION AMOUNT IS DETERMINED BY A RELATED ORGANIZATION, WHICH USES A COMPENSATION COMMITTEE, AN INDEPENDENT CONSULTANT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE MAHHC BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CEO'S COMPENSATION.

Schedule J, Part II NOTE REGARDING COMPENSATION

FORM 990, SCHEDULE J, PART II COLUMN B, PARTS I, II, AND III REPRESENT ACTUAL AMOUNTS PAID TO EMPLOYEES BY MAHHC AND RELATED ORGANIZATIONS. THESE AMOUNTS ARE REPORTED TO EMPLOYEES ON THEIR ANNUAL W-2 FORMS AS COMPENSATION. COLUMNS C AND D REPRESENT ITEMS EARNED, HOWEVER, NOT PAID DIRECTLY TO THE EMPLOYEE AS CASH PAYMENTS DURING THE CALENDAR YEAR. COLUMN C INCLUDES RETIREMENT BENEFITS IN A CALENDAR YEAR. COLUMN D REPRESENTS NONTAXABLE BENEFITS SUCH AS THE COST OF HEALTHCARE COVERAGE PROVIDED BY MAHHC ON BEHALF OF ITS EMPLOYEES.

Schedule J (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

Windsor Hospital Corporation

Employer identification number

03-0183721

Return Reference	Explanation
Form 990, Part VI, Line 1a Delegate broad authority to a committee	An Executive Committee, consisting of the Chair, Vice-Chair, Secretary and Treasurer, Immediate Past Chair, and such other trustees elected by the board as may be necessary to make a committee of not less than five members. This committee shall, in the interim between meetings of the board, exercise all of the power of the body, but in accordance with the general power of the hospital and direction of the board.
Form 990, Part VI, Line 6 Classes of members or stockholders	Dartmouth-Hitchcock Health (D-HH), a New Hampshire voluntary corporation, is the sole corporate member of Mt. Ascutney Hospital and Health Center.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	Dartmouth-Hitchcock Health (D-HH), a New Hampshire voluntary corporation, is the sole corporate member of Mt. Ascutney Hospital and Health Center. D-HH has the power to appoint 1/3 of the members of the Mt. Ascutney Hospital and Health Center board of trustees.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	The sole member has the right to ratify Mt. Ascutney Hospital and Health Center's nomination of 2/3 of the members of the board of trustees; remove trustees after consultation with the chairperson of the board; approve the dissolution or liquidation of Mt. Ascutney Hospital and Health Center; appoint, evaluate, terminate, and approve the compensation of the president and ceo; and other governance decisions.
Form 990, Part VI, Line 11b Review of form 990 by governing body	The Form 990 is reviewed by external tax advisors and the chief financial officer before the filing of the return. In addition, once the return has been fully prepared, a final 990 is sent to each board member and time is allocated for comments and responses prior to the official filing of the forms.
Form 990, Part VI, Line 12c Conflict of interest policy	Mt. Ascutney Hospital and Health Center's BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. The Compliance and audit services department of an affiliate, Dartmouth-Hitchcock, CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS AND TRUSTEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION-MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS OF SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CURCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	The compensation committee of Mt. Ascutney Hospital and Health Center's board meets annually to review and approve compensation for the president/CEO,, which is recommended by the compensation committee of a related organization. The compensation is determined using an outside consultant and comparability survey and/or study including contemporaneous substantiation. This process was last undertaken in FY21. The compensation committee consists of the executive committee and a D-HH representative.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	COMPENSATION FOR OFFICERS AND KEY EMPLOYEES IS EVALUATED BY INTERNAL HUMAN RESOURCES STAFF USING NATIONAL BENCHMARKING DATA (ALONG WITH ONGOING EVALUATIONS BY AN INDEPENDENT THIRD-PARTY FIRM FOR REASONABLENESS). THE LAST FORMAL PROCESS WAS COMPLETED IN 2020. EXTERNAL BENCHMARKING FROM AN INDEPENDENT THIRD PARTY HAS BEEN USED FOR ANY OFFICER WHO WAS HIRED OR RECEIVED A COMPENSATION ADJUSTMENT SINCE THE LAST FORMAL PROCESS. COMPENSATION RATES ARE DETERMINED BY FOLLOWING THE GUIDELINES OF THE COMPENSATION COMMITTEE CHARTER AND PHILOSOPHY DOCUMENTS AND A FORMAL REVIEW BY COMPENSATION COMMITTEE MEMBERS. Included in this process is the CFO and the chief operating officer.
Form 990, Part VI, Line 19 Required documents available to the public	Mt. Ascutney Hospital and Health Center makes governing documents, conflict of interest policy, and financial statements available to members of the public upon request.
Form 990, Part IX, Line 11g Other Fees	Medical & Health Related Services - Total Expense: 5631318, Program Service Expense: 4390378, Management and General Expenses: 1240940, Fundraising Expenses: ; Professional Consultants & Other - Total Expense: 5161672, Program Service Expense: 4016059, Management and General Expenses: 1137447, Fundraising Expenses: 8166;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	Amount of fund asset transfers - 2122591; Gain on pension plan termination - 30022; Equity in subsidiary income - 196803;

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Windsor Hospital Corporation

Employer identification number

03-0183721

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)HISTORIC HOMES OF RUNNEMEDE INC 40 MAXWELL PERKINS LANE WINDSOR,VT05089 23-7396147	ASSISTED LIVING FACILITY	VT	501(c)(3)	10	WINDSOR HOSPITAL CORPORATION	Yes
(2)MOUNT ASCUTNEY HOSPITAL COMMUNITY HEALTH FOUNDATION 289 COUNTY ROAD WNDSOR,VT05089 03-0300481	INACTIVE	VT	501(c)(3)	3	WINDSOR HOSPITAL CORPORATION	Yes
(3)DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON,NH03756 26-4812335	PARENT ORG	NH	501(c)(3)	7	NOT APPLICABLE		No
(4)MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON,NH03756 02-0222140	HOSPITAL	NH	501(c)(3)	3	DARTMOUTH-HITCHCOCK HEALTH		No
(5)DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON,NH03756 22-2519596	PHYSICIAN SERVICES	NH	501(c)(3)	10	DARTMOUTH-HITCHCOCK HEALTH		No
(6)THE NEW LONDON HOSPITAL ASSOCIATION INC 273 COUNTY ROAD NEW LONDON,NH03257 02-0222171	HOSPITAL	NH	501(c)(3)	3	DARTMOUTH-HITCHCOCK HEALTH		No
(7)CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE,NH03431 02-0354549	HOSPITAL	NH	501(c)(3)	3	DARTMOUTH-HITCHCOCK HEALTH		No
(8)ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DRIVE LEBANON,NH03766 02-0222791	HOSPITAL	NH	501(c)(3)	3	DARTMOUTH-HITCHCOCK HEALTH		No
(9)VISITING NURSE AND HOSPICE FOR VERMONT AND NEW HAMPSHIRE 88 Prospect Street White River Junction,VT05001 03-6006494	HOSPICE	VT	501(c)(3)	10	DARTMOUTH-HITCHCOCK HEALTH		No
(10)DARTMOUTH -HITCHCOCK MEDICAL CENTER ONE MEDICAL CENTER DRIVE LEBANON,NH03756 22-2715483	SUPPORTING ORG.	NH	501(c)(3)	Type I	NOT APPLICABLE		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2020

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) Mount Ascutney Professional Center Owners Assoc 289 County Road Windsor,VT05089 03-0320283	Real Estate Management	VT	Windsor Hospital Corporation	C Corporation	747	13,965	100 %	Yes

Schedule R (Form 990) 2020

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Historic Homes of Runnemede Inc	Q	167,458	FMV
(2) Mount Ascutney Professional Owners Assoc	K	95,503	FMV

Schedule R (Form 990) 2020

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2020

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

1	Briefly describe the organization’s mission or most significant activities: To improve the lives of those we serve. We provide high-quality healthcare.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	551
6	Total number of volunteers (estimate if necessary) .............	6	90
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	-13,033
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,992,986	1,709,607
9	Program service revenue (Part VIII, line 2g) .........	52,028,106	64,775,631
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	564,367	126,040
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,893,716	349,531
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	57,479,175	66,960,809
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	34,727,511	37,308,078
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 69,372
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	21,165,587	23,417,668
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	55,893,098	60,725,746
19	Revenue less expenses. Subtract line 18 from line 12.......	1,586,077	6,235,063
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	67,806,425	81,085,123
21	Total liabilities (Part X, line 26).............	38,443,947	39,998,206
22	Net assets or fund balances. Subtract line 21 from line 20.....	29,362,478	41,086,917

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 50,210,622 including grants of $ 0 ) (Revenue $ 65,102,450 )
	Mt. Ascutney Hospital and Health Center (MAHHC) Operates a not-for-profit critical access hospital which provides primary and secondary health care. MAHHC primary service area includes Bridgewater, Brownsville, Hartland, Reading, Weathersfield, Windsor, & Woodstock (VT) as well as Claremont, Cornish, and Plainfield (NH). The hospital provides essential health care services including emergency department/medical/surgical inpatient, and ancillary diagnostic tests, imaging/radiology procedures, and wellness/prevention services. MAHHC staffs a total of 25 acute medical/surgical beds and 10 acute rehabilitation beds. During the year, there were 1,010 discharges, 1,805 surgeries, 70,566 lab tests, and 14,196 imaging procedures. MAHHC identified access to primary care as a central community need and is committed to providing the physician services of family practice, internal medicine and pediatrics in Windsor and Woodstock. MAHHC provides free care to patients who meet certain criteria. Foregone charges furnished under MAHHC's free care policy amount to $607,209 in FY21.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses50,210,622

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) David Sanville CFO	36.0 .......................0.5	X		246,567	0	32,216
(19) Paul Calandrella Chief Operating Officer (through 8/21)	40.0 .......................0	X		217,154	0	36,751
(20) Alden Hall Physician	40.0 .......................0		X	291,997	0	15,424
(21) Christopher Connor Ophthalmologist	40.0 .......................0		X	350,360	0	25,494
(22) Dennis Heibein CRNA	40.0 .......................0		X	282,619	0	16,646
(23) Herbert Ip Physician	40.0 .......................0		X	242,072	0	33,346
(24) Peter Rauert Anesthesiologist	40.0 .......................0		X	414,135	0	34,426

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,908,665	1,700,926	499,797

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	25,000
e	Government grants (contributions)		1e	866,751

f	All other contributions, gifts, grants, and similar amounts not included above		1f	817,856

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		1,709,607

		Business Code
2a	Patient Service Revenue	622110	59,669,671	59,669,671
b	Health care Reform Payments	622110	1,987,078	1,987,078
c	Program and miscellaneous	622110	3,118,882	3,118,882
d
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		64,775,631

3 Investment income (including dividends, interest, and othersimilar amounts) ......			126,819		-13,033	139,852
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		22,712	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	22,712	6c
d	Net rental income or (loss).......			22,712			22,712
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	13,060		7a
b	Less: cost or other basis and sales expenses	13,839		7b
c	Gain or (loss)	-779	0	7c
d	Net gain or (loss).........			-779			-779
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Other Income		622110	241,298	241,298
b	Purchase Discounts		622110	85,521	85,521
c
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			326,819
12	Total revenue. See instructions.....			66,960,809	65,102,450	-13,033	161,785

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,344,998	968,399	376,599
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	27,498,854	22,909,158	4,552,188	37,508
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,290,834	1,075,387	213,686	1,761
9	Other employee benefits .......	5,258,695	4,380,992	870,530	7,173
10	Payroll taxes ...........	1,914,697	1,595,124	316,961	2,612
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	8,209		8,209
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	25,665		25,665
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	10,792,990	8,406,437	2,378,387	8,166
12	Advertising and promotion ....	135,174	105,173	29,787	214
13	Office expenses .......	146,892	114,290	32,370	232
14	Information technology ......	418,316	325,472	92,182	662
15	Royalties ..
16	Occupancy ...........	1,311,387	1,292,722	18,609	56
17	Travel ............	17,613	13,704	3,881	28
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	499,335	388,509	110,036	790
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,571,574	2,000,823	566,683	4,068
23	Insurance ...	825,379	642,189	181,884	1,306
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical and other supplies	3,958,844	3,886,603	71,726	515
b	Dues, Fees, and Taxes	2,218,942	1,726,457	488,975	3,510
c	Miscellaneous Expenses	487,348	379,183	107,394	771
d
e	All other expenses	0	0	0	0
25	Total functional expenses. Add lines 1 through 24e	60,725,746	50,210,622	10,445,752	69,372
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			5,720,700	1	9,274,389
2	Savings and temporary cash investments .........			12,015,078	2	7,521,023
3	Pledges and grants receivable, net ......			504,425	3	442,019
4	Accounts receivable, net .............			5,331,022	4	5,886,624
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			421,300	8	482,707
9	Prepaid expenses and deferred charges ......			384,861	9	500,656
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	44,184,467
b	Less: accumulated depreciation	10b	28,774,055	16,761,354	10c	15,410,412
11	Investments—publicly traded securities .			1,949,047	11	2,249,463
12	Investments—other securities. See Part IV, line 11 .....			19,050,433	12	30,262,935
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			5,668,205	15	9,054,895
16	Total assets. Add lines 1 through 15 (must equal line 33)...			67,806,425	16	81,085,123

17	Accounts payable and accrued expenses .....	7,246,002	17	8,084,722
18	Grants payable ...	0	18
19	Deferred revenue .........	8,692,787	19	6,102,542
20	Tax-exempt bond liabilities .........	0	20
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	542,543
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	22,505,158	25	25,268,399
26	Total liabilities. Add lines 17 through 25..	38,443,947	26	39,998,206

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	21,568,085	27	31,751,946
28	Net assets with donor restrictions ...........	7,794,393	28	9,334,971
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	29,362,478	32	41,086,917
33	Total liabilities and net assets/fund balances ........	67,806,425	33	81,085,123