Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 0 | 0 | 0 | 22,613 | 58,176 | 80,789 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 0 | 0 | 0 | 22,613 | 58,176 | 80,789 |
| 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) .. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 80,789 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 0 | 0 | 0 | 22,613 | 58,176 | 80,789 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 163,676 | 32,786 | 196,462 | |||
| 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.).. | 0 | |||||
| 11 | Total support. Add lines 7 through 10 | 277,251 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 | ||||
| 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II | THE ORGANIZATION'S 2020 TAX YEAR REFLECTS OCTOBER 26,2020 THROUGH DECEMBER 31, 2020 ACTIVITY (A SHORT PERIOD). THIS IS DUE TO 2020 BEING THE ORGANIZATION'S INITIAL 990 RETURN. 2021 IS THE FIRST REPORTED YEAR REFLECTING A FULL TWELVE MONTHS. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 1 | INNOVATIVE PAYMENTS MADE (MISSION CON'T) DURING THIS TAX PERIOD, PAYMENTS MADE TO PROVIDERS FOSTERING INNOVATION AND BETTER OUTCOMES INCLUDE FIXED PROSPECTIVE PAYMENTS TO HOSPITALS AND CERTAIN PRIMARY CARE PROVIDERS OF $408M; POPULATION HEALTH MGMT PAYMENTS OF $6.6M; AND MEDICARE BLUEPRINT FUNDING OF $8.7M. ALL OF THESE PAYMENT ARE NETTED OUT ENTIRELY ON THIS RETURN FOR PURPOSES OF FOLLOWING US GAAP. INNOVATIVE PAYMENTS TO THE NETWORK REPORTED ON THIS RETURN INCLUDE COMPLEX CARE COORDINATION PROGRAM PAYMENTS OF $5.4M; VARIOUS NETWORK REFORM PROJECT PAYMENTS TOTALING $2.2M; POPULATION HEALTH MANAGEMENT PAYMENTS OF $2.2M; VALUE BASED INCENTIVE FUND PAYMENTS OF $2.1M; RISK SETTLEMENT RELATED PAYMENTS OF $323K; AND PRIMARY PREVENTION PROGRAMS AND GRANTS OF $89K (SEE SCHEDULE I FOR DETAILS). |
| FORM 990, PART III, LINE 4A | NETWORK PERFORMANCE MANAGEMENT ONECARE SUSTAINED A STATEWIDE NETWORK, WHICH REPRESENTS 14 HOSPITALS AND 82% OF PRIMARY CARE PRACTICES IN VERMONT. ONECARE EXPERIENCED GROWTH IN BOTH MEDICARE AND COMPREHENSIVE PAYMENT REFORM ("CPR") PROGRAM PARTICIPATION. IN 2021, THE ONECARE NETWORK EXCEEDED ALL BUT ONE MEASUREMENT EXPECTATION ON DEFINED CLINICAL PRIORITY AREAS. 2021 IS PROJECTED TO HAVE $6.9M IN NETWORK-WIDE SHARED SAVINGS, OF WHICH $2.5M IS TO BE DISTRIBUTED TO PRIMARY CARE PROVIDERS THROUGH THE ACCOUNTABILITY POOL. ONECARE'S POPULATION HEALTH MODEL RECOGNIZES EACH INDIVIDUAL'S UNIQUE HEALTH NEEDS AND ALIGNS PROGRAMMING AND SUPPORTS THROUGH THE PROVIDER NETWORK AND LOCAL COMMUNITIES. IN 2021, ONECARE HAS CONTINUED TO PROMOTE HIGH-QUALITY SCREENING IN THE MEDICAL HOME, INCLUDING PROACTIVE PANEL MANAGEMENT TO IDENTIFY INDIVIDUALS MISSING THESE HEALTH ASSESSMENTS TO CONNECT THEM TO THESE SERVICES. ONECARE HAS ALSO CONTINUED TO INVEST IN COMMUNITY PROGRAMMING THROUGH RISEVT IN TEN HSAS. |
| FORM 990, PART III, LINE 4B | DATA AND ANALYTICS ONECARE IMPROVED ITS REPORTING AND RESOURCES AND FURTHERED USAGE OF CROSS PAYER/PROVIDER DATA SETS UNIQUE TO ACO TO CONSIDER NEEDS OF NETWORK STRIVING TO SHIFT TO A POPULATION HEALTH MODEL. THROUGH COMMITTEE REVIEW, AS WELL AS MONTHLY AND QUARTERLY REPORTING TO ITS NETWORK AND PAYERS, ONECARE ENSURES SERVICES ARE DELIVERED; IDENTIFIES AND EVALUATES VARIATIONS IN UTILIZATION, COST, AND QUALITY; AND ASSESSES OUTLIERS FOR POTENTIAL IMPROVEMENT OPPORTUNITIES. |
| FORM 990, PART III, LINE 4C | PAYMENT REFORM THE COMPREHENSIVE PRIMARY CARE (CPR) PROGRAM EXPERIENCED CONTINUOUS YEAR OVER YEAR GROWTH IN PROGRAM PARTICIPATION. THE PROGRAM NOW INCLUDES NOT ONLY FLAT, PREDICTABLE PER MEMBER PER MONTH (PMPM) PAYMENTS, BUT ALSO ABOVE MARKET PAYMENTS FOR SOME SERVICES. IN 2021, PRACTICES EARNED ON AVERAGE 29% MORE REIMBURSEMENT THAN MEDICARE FEE-FOR-SERVICE WOULD HAVE PROVIDED. |
| FORM 990, PART VI, LINE 2 | BUSINESS RELATIONSHIPS DR. JOHN BRUMSTED AND TODD KEATING SERVED AS DIRECTORS AND OFFICERS AT THE UNIVERSITY OF VERMONT HEALTH NETWORK, AN UNRELATED ORGANIZATION. DR. JOHN BRUMSTED SERVED AS DIRECTOR AND OFFICER AT THE UNIVERSITY OF VERMONT MEDICAL CENTER, AN UNRELATED ORGANIZATION, WHERE TODD KEATING SERVED AS A KEY EMPLOYEE. ALL ONECARE STAFF ARE EMPLOYED BY UVMC, AN UNRELATED ORGANIZATION. ONECARE VERMONT REIMBURSES UVMC FOR THE FULL ECONOMIC COST OF THE EMPLOYEES' EFFORTS. AN EXCEPTION TO THIS IS UNIVERSITY OF VERMONT HEALTH NETWORK EMPLOYEES WHO WORK PART TIME FOR ONECARE VERMONT EFFORTS UNDER A MASTER SERVICE AGREEMENT BETWEEN THE COMPANIES. UNDER THAT AGREEMENT, ONECARE REIMBURSEES THE UNIVERSITY OF VERMONT HEALTH NETWORK FOR THE APPLICABLE PERCENTAGE OF THE SALARY AND BENEFITS COST INCURRED. |
| FORM 990, PART VI, LINE 4 | CHANGES TO GOVERNING DOCUMENTS ON OCTOBER 1, 2021, THE ORGANIZATION AMENDED ITS OPERATING AGREEMENT SUCH THAT UVM HEALTH NETWORK BECAME ITS SOLE CORPORATE MEMBER. THE CHANGE CONSTITUTED A CHANGE IN THE ACCOUNTING ENTITY OF THE ORGANIZATION, AND AS A RESULT, THE ORGANIZATION QUALIFIED TO APPLY ACCOUNTING GUIDANCE APPLICABLE TO NOT-FOR-PROFIT ORGANIZATIONS EFFECTIVE OCTOBER 1, 2021. |
| FORM 990, PART VI, LINE 6 | MEMBERS ONECARE VERMONT IS A LIMITED LIABILITY CORPORATION, FOUNDED IN 2012. ON SEPTEMBER 30, 2021, DARTMOUTH HITCHCOCK HEALTH ("DHH") SURRENDERED ITS MEMBERSHIP IN ONECARE AND THE UNIVERSITY OF VERMONT MEDICARE CENTER ("UVMMC") TRANSFERRED ITS MEMBERSHIP STATUS TO ITS PARENT ORGANIZATION, UVM HEALTH NETWORK. AS OF OCTOBER 1, 2021, UVM HEALTH NETWORK BECAME THE SOLE CORPORATE MEMBER OF ONECARE. |
| FORM 990, PART VI, LINES 7A | MEMBER APPOINTMENTS TO GOVERNING BODY UVM HEALTH NETWORK, THE SOLE MEMBER OF ONECARE HAS THE RIGHT TO APPOINT THREE MEMBERS OF THE GOVERNING BODY. THE GOVERNING BODY IS COMPRISED OF UP TO TWENTY-ONE MEMBERS IN TOTAL. OTHER MEMBERS OF THE GOVERNING BODY REPRESENT SPECIFIC PROVIDER TYPES REPRESENTED IN ONECARE'S PROVIDER NETWORK, AS SET OUT IN THE ORGANIZATION'S OPERATING AGREEMENT. |
| FORM 990, PART VI, LINE 11B | RETURN PREPARATOIN ONECARE VERMONT'S FORM 990 IS PREPARED BY ONECARE STAFF AND REVIEWED BY PRICEWATERHOUSECOOPERS (PWC). FOLLOWING PWC'S REVIEW, THE RETURN IS REVIEWED BY ONECARE'S SENIOR LEADERSHIP. FINALLY, ONECARE'S MANAGEMENT PRESENTS THE FORM 990 TO THE FINANCE COMMITTEE FOR REVIEW AND COMMENT. THE COMPLETED FORM 990 IS PROVIDED TO ALL MEMBERS OF THE ONECARE BOARD OF MANAGERS PRIOR TO BEING FILED WITH THE IRS. |
| FORM 990, PART VI, LINE 12C | MONITORING OF THE CONFLICT OF INTEREST POLICY THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. IN ACCORDANCE WITH THE POLICY, BOARD OF TRUSTEES, OFFICERS AND CERTAIN OTHER INDIVIDUALS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE AND CERTIFICATION UPON HIRING, AT LEAST ANNUALLY, PRIOR TO PARTICIPATING IN ANY DECISION THAT MAY BE AFFECTED BY A PERSONAL INTEREST, AND WHENEVER A POTENTIALLY CONFLICTING INTEREST FIRST ARISES. THE CONFLICT OF INTEREST POLICY IS ENFORCED BY THE ONECARE COMPLIANCE TEAM, WHO REPORTS AT LEAST ANNUALLY ON CONFLICT OF INTEREST ISSUES TO THE AUDIT COMMITTEE OF THE BOARD OF MANAGERS. CONFLICTS OF INTEREST ARE MANAGED IN ACCORDANCE WITH THE POLICY, WHICH PROVIDES FOR A VARIETY OF REMEDIES TO ADDRESS CONFLICTS OF INTEREST. REMEDIES TO ADDRESS CONFLICTS OF INTEREST MAY INCLUDE THE FOLLOWING: RECUSAL FROM DECISION MAKING, DISCLOSURE TO APPROPRIATE PARTIES, COMMITTEE PARTICIPATION LIMITS AND REQUESTED DIVESTITURE. AN APPEALS PROCESS EXISTS SHOULD THE INDIVIDUAL REQUEST A SECONDARY REVIEW BE PERFORMED. |
| FORM 990, PART VI, LINES 15A AND 15B | COMPENSATION DETERMINATION POLICY ONECARE UTILIZES THE SERVICES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK (THE 'HEALTH NETWORK') IN THE SETTING OF ALL COMPENSATION. COMPENSATION DETERMINATION IS SUBJECT TO THE HEALTH NETWORK'S COMPENSATION FRAMEWORK, WHICH INVOLVES UTILIZATION OF NATIONAL AND REGIONAL PEER GROUPS, TARGETING THE 50TH PERCENTILE, WITH PERFORMANCE BASED VARIABLE PAY OPPORTUNITIES. |
| FORM 990, PART VI, LINE 19 | DOCUMENT DISCLOSURE GOVERNANCE DOCUMENTS CONSIST OF THE ORGANIZATION'S ARTICLES OF INCORPORATION AND OPERATING AGREEMENT. THE ARTICLES OF INCORPORATION ARE FILED WITH THE VERMONT SECRETARY FO STATE AND ARE PUBLICLY AVAILABLE THROUGH THAT OFFICE. THE OPERATING AGREEMENT IS NOT PUBLICLY POSTED, BUT A COPY WOULD BE FURNISHED TO ANY MEMBER OF THE PUBLIC WHO REQUESTED ONE. |
| FORM 990, PART X, ASC 958 | ORGANIZATIONS THAT FOLLOW FASB ASC 958 ON OCTOBER 1, 2021, THE ORGANIZATION AMENDED ITS OPERATING AGREEMENT SUCH THAT UVM HEALTH NETWORK BECAME ITS SOLE CORPORATE MEMBER. THE CHANGE CONSTITUTED A CHANGE IN THE ACCOUNTING ENTITY OF THE ORGANIZATION, AND AS A RESULT, THE ORGANIZATION QUALIFIED TO APPLY ACCOUNTING GUIDANCE APPLICABLE TO NOT-FOR-PROFIT ORGANIZATIONS EFFECTIVE OCTOBER 1, 2021. |
| Software ID: | |
| Software Version: |