SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
GIFFORD MEDICAL CENTER INC
 
Employer identification number

03-0179418
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
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? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
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) . . .
    276,714   276,714 0.520 %
b Medicaid (from Worksheet 3, column a) . . . . .     11,973,748 8,852,906 3,120,842 5.880 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     12,250,462 8,852,906 3,397,556 6.400 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     621,442 319,378 302,064 0.570 %
f Health professions education (from Worksheet 5) . . .     77,161 4,400 72,761 0.140 %
g Subsidized health services (from Worksheet 6) . . . .     5,139,733 4,058,381 1,081,352 2.040 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     7,465   7,465 0.010 %
j Total. Other Benefits . .     5,845,801 4,382,159 1,463,642 2.760 %
k Total. Add lines 7d and 7j .     18,096,263 13,235,065 4,861,198 9.160 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
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
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     219,755 50,142 169,613 0.320 %
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     219,755 50,142 169,613 0.320 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
2,317,389
3
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. ......
3
236,374
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
18,648,516
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
18,838,455
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-189,939
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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) 2017
Schedule H (Form 990) 2017
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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 GIFFORD MEDICAL CENTER
P O BOX 2000
RANDOLPH,VT05060
WWW.GIFFORDHEALTHCARE.ORG
829
X X     X   X      
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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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)
GIFFORD MEDICAL CENTER
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):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 17
5 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 ................. 5 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.................................. 6a   No
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
GIFFORD MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, SECTION C
b
SEE PART V, SECTION C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Billing and Collections
GIFFORD MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
GIFFORD MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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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, 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 5 COMMUNITY INPUT: THE 2015 SURVEY FORM WAS REVIEWED AND MINOR REVISIONS WERE MADE FOR 2017-2018. TO REACH A BROADER DEMOGRAPHIC SAMPLE, THE SURVEY WAS ADMINISTERED ONLINE THROUGH SURVEY MONKEY AND A LINK WAS DISTRIBUTED VIA EMAIL AND FACEBOOK TO REACH STAFF AND COMMUNITY MEMBERS. THE SURVEY WAS ALSO SHARED ON FRONT PORCH FORUM, A SOCIAL NETWORKING SITE DESIGNED TO CONNECT PEOPLE WITH OTHERS IN THEIR NEIGHBORHOODS. MEMBERS OF THE RANDOLPH EXECUTIVE COMMUNITY COUNCIL WERE PROVIDED WITH PAPER COPIES TO DISTRIBUTE TO CLIENTS EITHER DIRECTLY OR BY PLACING THEM IN AGENCY WAITING ROOMS. COMMUNITY HEALTH TEAM (BLUEPRINT) PARTNER AGENCIES WERE ALSO ASKED TO DISTRIBUTE PRINTED COPIES, AND PRINTED COPIES WERE PUT IN ALL OF GIFFORD PRIMARY CARE CLINICS.
SCHEDULE H, PART V, SECTION B, LINES 7A & 10A CHNA & IMPLEMENTATION STRATEGY WEBSITE: HTTPS://GIFFORDHEALTHCARE.ORG/ABOUT-US/COMMUNITY-REPORTS/
SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING IDENTIFIED NEEDS: GIFFORD'S MISSION IS TO PROVIDE ACCESSIBLE, QUALITY LOCAL HEALTH CARE TO EVERY PERSON WHO WALKS THROUGH OUR DOORS. IN 2018, AS PART OF THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT, WE PERFORMED A COMMUNITY HEALTHCARE NEEDS ASSESSMENT IN PART THROUGH SURVEYING COMMUNITY MEMBERS IN MULTIPLE AREA TOWNS. GIFFORD HAS STRATEGICALLY WORKED TO ADDRESS THE COMMUNITY'S NEED WITHIN ITS ROLE AS A HEALTH CARE PROVIDER. AREAS INITIALLY IDENTIFIED AS HEALTH PROBLEMS INCLUDE: PREVENTATIVE HEALTH CARE, SUBSTANCE ABUSE COUNSELING, NUTRITION/OBESITY, AND DENTAL CARE. THIS UPDATE OUTLINES AREAS OF ONGOING FOCUS IN 2018: PREVENTATIVE HEALTHCARE/ACCESS TO HEALTHCARE: TO FACILITATE AN INCREASED FOCUS ON PREVENTATIVE HEALTH CARE AND IMPROVE ACCESS TO CARE, GIFFORD HAS IMPLEMENTED A NEW PRIMARY CARE TEAM MODEL THAT PAIRS A PHYSICIAN WITH NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS WHO ARE SPECIALLY TRAINED TO HELP PATIENTS WITH PREVENTATIVE AND PRIMARY CARE. SUBSTANCE ABUSE COUNSELING: AS A FEDERALLY QUALIFIED HEALTH CENTER GIFFORD'S BEHAVIORAL HEALTH AND BLUEPRINT FOR HEALTH TEAM SPECIALISTS OFFER COUNSELING AND ONE-ON-ONE PATIENT CARE AT ALL GIFFORD PRIMARY CARE LOCATIONS. A NEWLY-CREATED ADDICTION MEDICINE PROGRAM, FULLY STAFFED WITH A BOARD CERTIFIED PSYCHIATRIST CERTIFIED IN ADDICTION MEDICINE, AND A LICENSED ALCOHOL AND DRUG COUNSELOR, OFFERS ONGOING SUBOXONE TREATMENT FOR PATIENTS WITH COMPLEX NEEDS, SUBOXONE PROVIDER SUPPORT, EDUCATION, CONSULTATION, AND THERAPY TO HELP PATIENTS REBUILD LIVES DAMAGED BY OPIOID USE DISORDER. OBESITY: GIFFORD'S PRIMARY CARE TEAM HAS LONG BEEN A PROPONENT OF HEALTHY LIFESTYLE CHOICES FOR GOOD HEALTH AND THE PREVENTION OF DISEASE AND OBESITY. BMIS ARE DETERMINED AT ANNUAL HEALTH SCREENINGS AND PATIENTS ARE GUIDED BY PROVIDERS AND GIFFORD'S REGISTERED DIETITIANS ON HEALTHY DIETS AND PORTION CONTROL. DISCUSSIONS IN SUPPORT GROUP SETTINGS (SUCH AS DIABETES AND OTHER CHRONIC CONDITIONS) OFTEN FOCUS ON HEALTHY CHOICES TO REDUCE AND PREVENT DISEASE. PATIENTS ARE STRONGLY ENCOURAGED TO BE PHYSICALLY ACTIVE. IN 2019 GIFFORD WILL BEGIN A PARTNERSHIP WITH VEGGIE VAN GO, A PROGRAM OF THE VERMONT FOODBANK. ONCE A MONTH ALL AREA COMMUNITY MEMBERS WITH ANY FOOD INSECURITIES WILL BE INVITED TO GIFFORD TO PICK UP VEGETABLES AS NO COST. DENTAL CARE: GIFFORD'S FEDERALLY QUALIFIED HEALTH CENTER DESIGNATION HAS BROUGHT RESOURCES THAT HELP US SUPPORT LOCAL DENTISTS AS THEY STRIVE TO BETTER CARE FOR THE UNDERSERVED AND UNINSURED. TO INCREASE AWARENESS OF DENTAL HEALTH, WE HAVE PARTNERED WITH HEALTHHUB, A LOCAL NONPROFIT WITH A MOBILE DENTAL TRAILER. THE TRAILER TRAVELS TO A VARIETY OF LOCATIONS, INCLUDING AREA SCHOOLS AND GIFFORD, TO OFFER SCREENINGS, X-RAYS, EXAMINATIONS AND CLEANINGS BY A DENTAL HYGIENIST.
SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C FAP, FAP APPLICATION, AND PLS WEBSITE: HTTPS://GIFFORDHEALTHCARE.ORG/SERVICE/AFFORDABLE-CARE-PROGRAM/
SCHEDULE H, PART V, LINE 16J MEASURES TO PUBLICIZE THE POLICY: GIFFORD MEDICAL CENTER CONTACTS ANY UNINSURED PATIENTS THAT WILL REGISTER WITH THE HOSPITAL TO SEE IF THEY ARE IN NEED OF FINANCIAL ASSISTANCE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 9
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?5
Name and address Type of Facility (describe)
1 GIFFORD HEALTH CARE AT BERLIN
82 EAST VIEW LANE
BERLIN,VT05641
RURAL HEALTH CENTER
2 ADVANCE PHYSICAL THERAPY
331 OLCOTT DRIVE
WHITE RIVER JUNCTION,VT05001
RURAL HEALTH CENTER
3 KINGWOOD HEALTH CENTER
1422 ROUTE 66
RANDOLPH,VT05060
RURAL HEALTH CENTER
4 SHARON HEALTH CENTER
12 SHIPPEE LANE
SHARON,VT05065
RURAL HEALTH CENTER
5 TWIN RIVER HEALTH CENTER
108 N MAIN STREET
WHITE RIVER JUNCTION,VT05001
RURAL HEALTH CENTER
6
7
8
9
10
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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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 I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE OF $2,317,389.
SCHEDULE H, PART I, LINE 7G SUBSIDIZED SERVICES: THE ORGANIZATION HAS INCLUDED COSTS ASSOCIATED WITH RURAL HEALTH CENTERS (RHS) IN THE CALCULATION OF SUBSIDIZED SERVICES ON LINE 7G, WHICH A NET SUBSIDY FROM RCHS OF $807,018. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. GIFFORD MEDICAL CENTER CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED.
SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEET 1 AND 6.
SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: INCLUDED IN PART II AS COMMUNITY BUILDING ACTIVITIES ARE LOCAL HIGH SCHOOL LECTURES, JOB SHADOWING, AND AFTER SCHOOL PROGRAMS. THESE ACTIVITIES PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSE OF HEALTH PROBLEMS, INCLUDING POVERTY, HOMELESS, AND UNEMPLOYMENT.
SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE ORGANIZATION CALCULATED BAD DEBT USING THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS PER THE AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU.
SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBLE OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAY SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY: THE APPLICATION FOR AND APPROVAL OF FINANCIAL ASSISTANCE CAN OCCUR BEFORE, DURING OR AFTER TREATMENT SO LONG AS THE ACCOUNT HAS NOT BEEN WRITTEN OFF TO BAD DEBT PRIOR TO RECEIPT OF A COMPLETED APPLICATION AND THE NECESSARY DOCUMENTATION. ACCOUNTS SENT TO BAD DEBT AFTER REQUIRED INFORMATION HAS BEEN RECEIVED CAN BE RETURNED FROM COLLECTIONS FOR PROCESSING WITHOUT PENALTY TO THE APPLICANT. GIFFORD MEDICAL CENTER, INC., ENCOURAGES THE APPLICATION PROCESS TO BEGIN AS EARLY AS POSSIBLE.
SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: IDENTIFYING AND MEETING THE COMMUNITY'S HEALTH CARE NEEDS WOULD NOT BE POSSIBLE WITHOUT INPUT FROM THE PUBLIC. GIFFORD MEDICAL CENTER PROVIDES AMPLE OPPORTUNITIES FOR THE PUBLIC TO PROVIDE BOTH INPUT AND ACTIVELY PARTICIPATE IN MEDICAL CENTER ACTIVITIES. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, ANNUAL HOSPITAL REPORT CARD MEETINGS, PATIENT SATISFACTION SURVEYS AND ONE-ON-ONE COMMENTS TO HOSPITAL STAFF AND BOARD MEMBERS HELP DIRECT STRATEGIC PLANNING AND OPERATIONAL DECISIONS. EVERY THREE YEARS, GIFFORD ENGAGES IN AN EXTENSIVE STRATEGIC PLANNING PROCESS THAT RESULTS IN THE IDENTIFICATION AND IMPLEMENTATION OF A LIST OF INITIATIVES THE HOSPITAL STRIVES TO ACHIEVE OVER THE COMING THREE YEARS. SUCCESS AT ACHIEVING THOSE INITIATIVES THROUGHOUT, AND BY THE CONCLUSION OF THE THREE-YEAR PERIOD IS EXTENSIVELY MONITORED BY THE HOSPITAL'S LEADERS, INCLUDING ITS VOLUNTEER BOARD OF TRUSTEES.
SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PATIENTS ARE ADVISED OF COMMUNITY OUTREACH AND ARE ENCOURAGED TO SET UP AN APPOINTMENT TO MEET WITH THE APPROPRIATE GIFFORD MEDICAL CENTER PERSONNEL. THE PATIENTS ARE ALSO DIRECTED TO GMC'S WEBSITE FOR AN EXPLANATION OF THE FREE CARE POLICY PROCESS.
SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: IN ADDITION TO THE CLINICAL OFFICES LOCATED ON THE ORGANIZATION'S MAIN CAMPUS IN RANDOLPH, VERMONT, THE ORGANIZATION OPERATES COMMUNITY HEALTH CARE CENTERS LOCATED IN SHARON, BERLIN, RANDOLPH, AND WHITE RIVER JUNCTION, VERMONT. THE RANDOLPH/BAINTREE AREA PROVIDES THE MOST VISITS AND IS LOCATED IN ORANGE COUNTY, VERMONT. ORANGE COUNTY DEMOGRAPHICS SHOW APPROXIMATELY 21.2% OVER THE AGE OF 65 AND 18.3% UNDER 18 YEARS. OVER 96.8% ARE WHITE, WITH 49.9% FEMALE. THE AVERAGE HOUSEHOLD INCOME IS $56,584 WITH THE POVERTY LEVEL AT 10.4%, COMPARED TO THE STATE'S 12.3%.
SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: AS A COMMUNITY HOSPITAL, GIFFORD MEDICAL CENTER'S MISSION TO IMPROVE THE HEALTH OF THE PEOPLE BY PROVIDING AND ASSURING ACCESS TO AFFORDABLE AND HIGH QUALITY HEALTH CARE, AND BY PROMOTING THE HEALTH AND WELLBEING OF EVERYONE IN OUR SERVICE AREA. WE OFFER DIAGNOSTIC TECHNOLOGIES THAT INCLUDE A 64-SLICE CT SCANNER, A MOBILE MRI UNIT, A FILMLESS RADIOLOGY SYSTEM, 3D MAMMOGRAPHY AND STEREOTACTIC BREAST BIOPSIES. OUR 25-BED CRITICAL ACCESS HOSPITAL HAS A BIRTHING CENTER THAT IS RECOGNIZED AROUND THE STATE. WE HAVE A 24-HOUR EMERGENCY DEPARTMENT, A CHILDCARE CENTER AND SO MUCH MORE. THE FOLLOWING ARE THE ACTIVITIES FOR 2018: TWO NEW SURGEONS JOINED THE GIFFORD GENERAL SURGERY TEAM. THE GENERAL SURGERY TEAM PROVIDED FREE SKIN CANCER SCREENINGS. GIFFORD'S PHYSICAL THERAPY TEAM CONTRACTED WITH AREA SCHOOL AND ATHLETIC TEAMS TO PROVIDE ATHLETIC TRAINING SERVICES TO REDUCE THE RISK OF INJURY DURING SPORTING EVENTS. PT STAFF ALSO MET WITH COACHES TO ASSIST THEM IN UNDERSTANDING PROPER TAPING TECHNIQUE FOR STUDENT ATHLETES. THE ORTHOPEDIC DEPT. OFFERED TALKS REGARDING JOINT REPLACEMENTS, PODIATRY HELD "HAPPY FEET" EDUCATION TALKS TO EDUCATE THE COMMUNITY ON HOW TO BETTER CARE FOR THEIR FEET. GIFFORD HELD A 6 WEEK "DOSE OF REALITY" EDUCATION SERIES WHICH COVERED THE MANY ASPECTS OF ADDICTION AND RESOURCES AVAILABLE. GIFFORD HOSTED A VIEWING OF "HEROIN" WITH DISCUSSION. BEING MORTAL MOVIE VIEWING TO ADDRESS THE CONCERNS OF END OF LIFE CARE. GIFFORD OFFERED EDUCATION ON BULLYING, TICK SAFETY, NUTRITION, INJURY PREVENTION WITH A LOCAL NOT FOR PROFIT SCHOOL THAT MOVED INTO THE AREA. GIFFORD HOSTED AN AREA BLOOD DRIVE WITH THE RED CROSS. ATTENDING THE TUNBRIDGE WORLDS FAIR TO EDUCATE THE PUBLIC ON HEALTH CONCERNS THEY MAY HAVE AND AVAILABLE RESOURCES. GIFFORD PROVIDED FREE COMMUNITY BREAKFASTS AND LUNCHES WITHIN THE SERVICE AREA AS A WAY OF PROVIDING FOR AND GATHERING COMMUNITY MEMBERS TOGETHER WHICH PROVIDES SOCIAL OPPORTUNITIES TO THE COMMUNITY.
SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THE GIFFORD HEALTH CARE SYSTEM INCLUDES GIFFORD HEALTH CARE, INC. (GHC), GIFFORD MEDICAL CENTER, INC. (GMC), AND GIFFORD RETIREMENT COMMUNITY, INC. (GRC). GHC IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC). GIFFORD MEDICAL CENTER, INC. IS A 25-BED CRITICAL ACCESS HOSPITAL (CAH) PROVIDING GENERAL AND SPECIALTY SERVICES. GIFFORD RETIREMENT COMMUNITY, INC. HAS A 30-BED NURSING HOME UNIT, ADULT DAY SERVICES AND INDEPENDENT LIVING FACILITY.
Schedule H (Form 990) 2017
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