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.
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OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
GIFFORD MEDICAL CENTER INC
 
Employer identification number

03-0179418
Return Reference Explanation
FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICE ACCOMPLISHMENTS: GIFFORD MEDICAL CENTER OFFERS VARIOUS OTHER HEALTH CARE SERVICES TO THE CENTRAL VERMONT AREA. OTHER SERVICES AVAILABLE INCLUDE ANESTHESIOLOGY, RADIOLOGY, LABORATORY, RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, ELECTROCARDIOLOGY, CHEMOTHERAPY, EMERGENCY, SKILLED NURSING, LABOR AND DELIVERY, NURSERY, RADIOISOTOPE, AND ELECTROENCEPHALOGRAPHY.
FORM 990, PART V, LINE 2A W-2'S FILED: GIFFORD MEDICAL CENTER ALSO FILES W-2'S FOR ITS RELATED ORGANIZATIONS, GIFFORD HEALTH CARE, INC. (GHC) AND GIFFORD RETIREMENT COMMUNITY, INC. (GRC). THE TOTAL NUMBER OF W-2'S FILED INCLUDES THESE W-2'S. THE COMPENSATION, EMPLOYEE BENEFITS AND PAYROLL TAXES ARE THEN ALLOCATED TO GHC AND GRC FOR THE AMOUNTS THAT REPRESENT WORK PERFORMED FOR THOSE ORGANIZATIONS. THEREFORE, THE AMOUNT REPORTED ON PART IX INCLUDES ONLY THOSE AMOUNTS ALLOCATED TO WORK PERFORMED DIRECTLY FOR GIFFORD MEDICAL CENTER. THE HIGHEST PAID EMPLOYEES ARE DETERMINED BY THE WORK PERFORMED FOR EACH ORGANIZATION. THEREFORE, THE FIVE HIGHEST PAID EMPLOYEES LISTED ON PART VII AND SCHEDULE J ARE THOSE EMPLOYEES WHO WORK DIRECTLY FOR GIFFORD MEDICAL CENTER, INC. IN ADDITION, DANIEL BENNETT SERVED AS CEO AND JEFFREY HEBERT SERVED AS CFO OVER GIFFORD MEDICAL CENTER, GIFFORD HEALTH CARE, AND GIFFORD RETIREMENT COMMUNITY. THEIR COMPENSATION HAS BEEN SHOWN IN PART VIII AS PAID BY GIFFORD MEDICAL CENTER ONLY, ALTHOUGH THEIR TIME SPENT IS ATTRIBUTABLE TO ALL THREE ENTITIES.
FORM 990, PART VI, SECTION A, LINE 6, 7A, & 7B ORGANIZATION'S MEMBERS: THE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF THOSE PERSONS SERVING AS CORPORATORS. TO BE ELIGIBLE TO SERVE AS A CORPORATOR, AN INDIVIDUAL MUST SUPPORT THE MISSION AND PURPOSES OF THE ORGANIZATION. CORPORATORS ARE NOMINATED BY THE NOMINATING COMMITTEE AND ELECTED BY MAJORITY VOTE OF THE CORPORATORS PRESENT AT THE ANNUAL MEETING OF THE CORPORATORS, AND SERVE A TERM OF THREE YEARS. THE CORPORATORS SHALL ELECT A MINORITY OF THE TRUSTEES OF THE ORGANIZATION, WHO MANAGE AND CONDUCT THE AFFAIRS OF THE ORGANIZATION. THE CORPORATORS MAKE NO OTHER GOVERNANCE DECISIONS FOR THE ORGANIZATION, NOR ARE THE DECISION OF THE BOARD OF TRUSTEES SUBJECT TO APPROVAL BY THE CORPORATIONS. ADDITIONALLY, THE BOARD OF DIRECTORS OF GIFFORD HEALTH CARE, INC. (GHC), APPOINTS A MAJORITY OF THE DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FIRST REVIEWS THE FORM 990. THEN THE FULL BOARD OF TRUSTEES REVIEWS THE PUBLIC DISCLOSURE COPY OF THE FORM 990 AT ONE OF THE BOARD MEETINGS PRIOR TO FILING. THE PUBLIC DISCLOSURE COPY DOES NOT LIST THE NAMES OR ADDRESSES OF THE DONORS TO RESPECT THE CONFIDENTIALITY OF THE DONORS.
FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: GIFFORD MEDICAL CENTER, INC. REQUIRES BOARD MEMBERS TO COMPLETE A YEARLY CONFLICT OF INTEREST SURVEY. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY DIRECTOR SHALL BE DISCLOSED TO THE OTHER BOARD MEMBERS. ANY TRUSTEE HAVING DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHALL NOT VOTE OR USE HIS PERSONAL INFLUENCE ON THE MATTER, AND SHALL NOT BE PRESENT FOR DISCUSSION OF THE MATTER. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE AND THAT THE DIRECTOR ABSTAINED FROM VOTING AND DISCUSSION.
FORM 990, PART VI, SECTION B, LINE 15A CEO COMPENSATION REVIEW: GIFFORD MEDICAL CENTER USES A BOARD COMPENSATION COMMITTEE WITH INPUT AND DATA FROM A VARIETY OF INDEPENDENT SOURCES. THE EVALUATION AND RECOMMENDATION IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL.
FORM 990, PART VI, SECTION B, LINE 15B OTHER OFFICER & KEY EMPLOYEE COMPENSATION REVIEW: TO EVALUATE THE COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES, THE COMPENSATION REVIEW IS ADMINISTERED BY HUMAN RESOURCES AND THE CEO. THE HUMAN RESOURCES DEPARTMENT HAS SOME INTERNAL AND EXTERNAL SOURCES THAT ARE UTILIZED TO COMPARE COMPENSATION AMOUNTS.
FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE ORGANIZATION'S WEBSITE, ANOTHER'S WEBSITE AND UPON REQUEST.
FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: JOSEPH PELLETIER (MEDICAL STAFF PRESIDENT) AND DANIEL BENNETT (CEO) ARE EMPLOYEES OF GIFFORD MEDICAL CENTER/GIFFORD HEALTH CARE AS WELL AS MEMBERS OF THE BOARD OF DIRECTORS. THEIR COMPENSATION IS RELATED TO THEIR ROLES AS EMPLOYEES. NO TRUSTEES RECEIVE COMPENSATION FOR THEIR ROLES AS TRUSTEES.
FORM 990, PART VI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES: $ 1,061,830 CHANGE IN FV OF INTEREST RATE SWAP AGREEMENT (3,043,300) TRANSFERS TO AFFILIATES ------------ $(1,981,470)
FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:3401591
FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN TOTAL FEES:1403053
FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:944044
FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:883538
FORM 990 PART IX LINE 11G DESCRIPTION:FREIGHT TOTAL FEES:87248
FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:59257
FORM 990 PART IX LINE 11G DESCRIPTION:OTHER CONTRACTED SERVICES TOTAL FEES:20505
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2017


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