Community Benefit Insight - Tax-exempt hospital

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Gifford Medical Center Inc

Gifford Medical Center

44 South Main Street
Randolph, VT 05060

Bed count	52	Medicare provider number	471301	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 030179418

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

10.14%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 1,232,429 1.76 %
Medicaid as % of operating expenses	$ 5,543,513 7.90 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 34,705 0.05 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 192,880 0.27 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 109,956 0.16 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 0 0 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 56867468 including grants of $ 109956) (Revenue $ 70587246)
"Gifford Medical Center Inc. (""Gifford"") operates a not-for-profit, 25 bed critical access hospital whereby medical providers and nurses provide around the clock care to patients. Inpatient care services include a medical/surgical unit, a birthing center, and end of life care. Gifford also offers a range of clinical and ancillary services: diagnostic imaging, laboratory testing, anesthesiology, cardiology, chiropractic care, hospitalists, neurology, oncology, orthopedics, pathology, podiatry, sports medicine, general surgery, and urology.Gifford Medical Center's caring and knowledgeable surgery team offers general surgery services including skin lesion and cyst removal, comprehensive breast care, diagnosis and treatment of all forms of cancer, wound care, pill endoscopy, colonoscopies and appendix removal. General surgeons provide a wide range of procedures (primarily focusing on the abdominal organs as well as diseases of the skin, breast, soft tissue and hernias) in both office and operating room settings.Gifford Medical Center offers various other health care services to the central Vermont area. Other services available include radiology, laboratory, respiratory therapy, physical therapy, occupationaltherapy, speech pathology, electro cardiology, chemotherapy, emergency, skilled nursing, labor and delivery, nursery, radioisotope, and electroencephalography."

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Gifford Medical Center
Part V, Section B, Line 5: Gifford Medical Center partnered with the Randolph Executive Community Council (RECC), which is comprised of community partners and serves as the Community Collaborative for the Randolph service area, to identify the significant health needs of our community. A survey was conducted to assess the most prevalent health and social needs within the community Gifford serves. 530 respondents completed the survey.The hospital facility gained input from representatives of the following organizations:- Gifford Health Care- Central Vermont Council on Aging - Capstone Community Action - Clara Martin Center - Bi-State Primary Care Association - Randolph Area Community Development / SASH- Visiting Nurse & Hospice for Vermont and New Hampshire- Stagecoach Transportation Services- South Royalton Health Center - Vermont Foodbank - BAYADA

Gifford Medical Center
Part V, Section B, Line 11: Gifford has strategically worked to address the community's need within its role as a health care provider. Areas identified as health challenges include: mental health services, substance abuse counseling, nutrition/obesity, and dental care.Mental health services: In partnership with Gifford Healthcare, we have continued to strengthen our mental health services. This has included adding a behavioral health support group that focuses on post-partum mental health. Additionally, Gifford has actively sought out counselors with a wide variety of clinical skills to add to our behavioral health team, including those with expressive arts, marriage and family counseling, and youth focused mental heath care.Substance abuse counseling: In partnership with our parent corporation, Gifford Healthcare, Inc., 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. Our addiction medicine program offers ongoing Suboxone treatment for patients with complex needs, Suboxone provider support, education, consultation, and therapy to help patients rebuild lives affected 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 began a partnership with Veggie Van Go, a program of the Vermont Foodbank. Once a month all area community members with any food insecurities are invited to Gifford to pick up healthy food items.Dental care: Gifford Healthcare'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.

Gifford Medical Center
Part V, Section B, Line 16j: 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, Part V, Line 18d:
Currently, Gifford has an outdated credit and collections policy that makes reference to legal procedures. Gifford does not actively engage in any legal action for nonpayment. Gifford is in the process of updating this policy to more accurately reflect actual processes and practices.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
The cost to charge ratio calculated on IRS worksheet 2 was used in the calculation of cost on IRS worksheets 1 and 6.

Part III, Line 2:
The Organization used the cost-to-charge ratio as its costing methodology to calculate bad debt expense at cost.

Part III, Line 4:
Please refer to pages 11-14 and 18 of the attached audited financial statements.

Part III, Line 8:
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.

Part III, Line 9b:
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.

Part VI, Line 2:
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.

Part VI, Line 3:
Gifford's Financial Assistance Program is available on our website. Patients are encouraged to seek assistance and speak with one of our advocates, who will provide one-to-one financial counseling to address patient financial needs in the most appropriate manner. Additionally, information is posted throughout the facility regarding patient rights and responsibilities, which states that a patient has the right to receive medical treatment regardless of their ability to pay and financial assistance is encouraged and available.

Part VI, Line 4:
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/Braintree area provides the most visits and is located in Orange County, Vermont.

Part VI, Line 5:
Gifford Medical Center strives to improve the health of its patients 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.Gifford collaborates and partners with local and state agencies to provide fresh produce to our community at no charge. Gifford provides education to the community regarding healthy eating, supports initiatives that promote responsible physical activity for all ages, provides continued prevention education for smoking cessation, vaping, and other higher risk behaviors. Gifford continues to focus on reducing the use of antibiotics through its Antibiotic Stewardship Program. The goal of the program is to reduce the reliance on antibiotics to assist in preventing the creation of super bugs that are resistant to commonly used antibiotics.Surplus funds that may be generated in a given year are used to support infrastructure improvements, the purchase of new or routine replacement of equipment, investments in technology, or other resources and services that are required to meet the needs of the community we serve. Gifford's governing body is comprised of community members who reside within its service area and dedicate a portion of their time to ensuring Gifford Medical Center meets the needs of its community.

Part VI, Line 6:
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.

Operating expenses	$ 70,165,288
Total amount spent on community benefits as % of operating expenses	$ 7,113,483 10.14 %