2022-05-13T07:07:48-05:00 2021-06-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2020-07-01 010223482 Millinocket Regional Hospital MILL 2077235161 200 Somerset Street Millinocket ME 04462 Mellissa McAvoy Chief Financial Officer 2077235161 2022-05-10 1 Mellissa McAvoy 999009999 Connor Smart P02285543 2078792100 2022-05-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Robert Peterson DSc 200 Somerset Street Millinocket ME 04462 35265326 0 X www.mrhme.org X 1952 ME Critical Access Hospital 10 6 279 15 0 0 2393942 5677401 28381643 28263076 191330 229184 -65694 0 30901221 34169661 0 1500 0 0 17516290 17645892 0 0 0 13272608 12733234 30788898 30380626 112323 3789035 20845103 17691355 16075359 8927895 4769744 8763460 X Millinocket Regional Hospital (MRH) is a critical access hospital that provides access to excellence in healthcare. 0 0 26973024 1500 28263076 Millinocket Regional Hospital (MRH) provides a broad scope of medical services to residents and guests in the Katahdin region. These services span the continuum of care and include inpatient, outpatient, emergency, and ancillary services. Inpatient care at MRH includes medical surgical care with availability of swing bed and special care services.The wide range of support services available at MRH features highly skilled staff and includes diagnostic imaging, cardiopulmonology, laboratory, rehabilitation, and wellness. MRH features a strong, cohesive medical staff consisting of family practice, internal medicine, general surgery, gastroenterology, orthopedics, ear nose & throat, urology, podiatry, cardiology, oncology, ophthalmology, podiatry, pulmonology, radiology, and urology.During this reporting period, MRH cared for:Inpatients - 1,375Clinic patients - 13,890Emergency room patients - 4,635In addition, MRH provided:Surgical services - 1,292Laboratory services - 85,797Radiology services - 10,203Therapy services (physical, speech, and occupational) - 10,897 26973024 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 38 0 1 279 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Mellissa McAvoy CFO 2077235161 200 Somerset Street Millinocket ME 04462 Kelly Gardner PA-C Medical Staff VP/Sec. (end 6/2021) 40.00 0.00 X X 102535 0 10005 Jil Beaupain DPM Medical Staff At-Large (end 6/2021) 40.00 0.00 X 155900 0 0 Mellissa McAvoy Board President, CFO, COO 29.00 1.00 X X 124958 0 0 Daniel Herbert MD Medical Staff President (end 6/2021) 40.00 0.00 X 462906 0 13437 Kevin Olsen PA-C Medical Staff President 48.00 0.00 X 267262 0 8018 Andrea Sewall ANP Trustee 36.00 0.00 X 132056 0 10842 Herbert Clark Trustee 5.00 0.00 X 0 0 0 Gail Fanjoy Trustee 5.00 0.00 X 0 0 0 Patrick E Hunt Esq Trustee 5.00 0.00 X 0 0 0 Fred Lewis Trustee 5.00 0.00 X 0 0 0 Lee Chip Lamson Jr Board Vice President 5.00 0.00 X X 0 0 0 Thomas Malcolm Board Treasurer/Secretary 5.00 0.00 X X 0 0 0 Robert Peterson Chief Executive Officer 50.00 1.00 X 317893 0 9814 Kwaku Owusu-Abrokwa MD Physician 40.00 0.00 X 288453 0 10580 Edward Dunstan DO Physician 40.00 0.00 X 624986 0 13705 John Gluscic MD Physician 40.00 0.00 X 721670 0 11814 Mark Kowalski MD Physician 40.00 0.00 X 912572 0 16248 Julia M Greenwald PA-C Physician Assistant 40.00 0.00 X 259610 0 9739 4370801 0 114202 28 0 1 1 NEHE-MRI LLC 114 Gray Road Easton ME 04740 Medical Laboratory 230792 Quest Diagnostics 319 Longwood Avenue Suite 1 Boston MA 02115 Diagnostic Services 222034 Dahl-Chase Diagnostic Services 417 State Street Suite 439 Bangor ME 04401 Diagnostic Services 194945 Jil Beaupain DPM PO Box 130 Sherman ME 04776 Medical Services 155900 Core Medical Group 655 S Willow Street Manchester NH 03103 Medical Staffing Services 154268 8 5501862 175539 5677401 Patient Service Revenue 621110 27261256 27261256 Other Medical Services 621400 586923 586923 340(b) Program 621990 294127 294127 Nutrition and Wellness 621300 111311 111311 Other Program Services 621990 9459 9459 28263076 101922 101922 1192927 30000 1010691 84974 182236 -54974 127262 127262 34169661 28263076 0 229184 X 1500 1500 1615626 452375 1163251 13325372 13086939 238433 237202 233416 3786 1464656 1228867 235789 1003036 838338 164698 24449 24449 55130 55130 8516 8516 3612318 2492255 1120063 8353 8353 939358 846050 93308 550002 495369 54633 34442 31021 3421 63831 57491 6340 128257 128257 633662 570302 63360 433414 390362 43052 Med./pharm. supplies 3451132 3451132 Provision for bad debt 1528467 1528467 Medicaid Assessment Tax 606024 606024 Equipment expenses 580916 580916 74963 73847 1116 30380626 26973024 3407602 0 382779 435654 8809104 5879923 2834560 2640934 644436 623723 237709 246197 22552450 17299792 5446382 5252658 1486984 1976951 52457 82623 116692 116692 834000 436000 20845103 17691355 2894510 2526282 2299274 0 453726 310340 5914458 3060999 4513391 3030274 16075359 8927895 X 4566613 8484240 203131 279220 4769744 8763460 20845103 17691355 3789035 204681 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 8516 0 0 0 8516 0 Part II-B, Line 1: Millinocket Regional Hospital pays annual dues to the Maine Hospital Association and the American Hospital Association. A portion of these dues is available for lobbying. During fiscal year 2021, the approximate amount of dues paid to MHA that was available for lobbying was $4,113; the approximate amount of dues paid to AHA that was available for lobbying was $4,403. 54551 54551 10514350 7270735 3243615 11440702 10029057 1411645 542847 542847 5252658 Estimated Third Party Payor Settlements 2594274 Medical Malpractice Claims 436000 3030274 X 32845875 204681 204681 32641194 1528467 1528467 34169661 28852159 0 28852159 1528467 1528467 30380626 Part X, Line 2: Millinocket Regional Hospital (MRH) and Legacy Medical Foundation (LMF), a wholly-owned subsidiary of MRH, are organized as Maine nonprofit corporations and have been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. The Hospital has evaluated the positions taken on its filed tax returns. The Hospital has concluded no uncertain income tax positions exist at June 30, 2021. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Provision for Bad Debt 1,528,467. Part XII, Line 4b - Other Adjustments: Provision for Bad Debt 1,528,467. 1 1 1 X 1 X 1 1 0 0 104428 104428 0.00360 3538093 3081216 456877 0.01580 3642521 3081216 561305 0.01940 9501705 4907137 4594568 0.15920 9501705 4907137 4594568 0.15920 13144226 7988353 5155873 0.17860 1 707226 0 6528457 6463758 64699 X 1 1 1 1 Millinocket Regional Hospital 200 Somerset Street Millinocket ME 04462 www.mrhme.org 38579 X X X Millinocket Regional Hospital 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X See Part V, Section C X See Part V, Section C X 1 20 1 See Part V, Section C 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Millinocket Regional Hospital Part V, Section B, Line 5: The Maine Shared Community Health Needs Assessment (CHNA) is a collaborative effort amongst Central Maine Healthcare (CMHC), MaineGeneral Health (MGH), MaineHealth (MH), Northern Light Health (NLH), and the Maine Center for Disease Control and Prevention (Maine CDC), and Maine Department of Health and Human Services. Input was gathered through forums, community events, surveys, focus groups, and interviews during the fall and winter of 2018-2019. Health priorities for the county, public health district, and the state were developed through community participation and voting at community forums. The Maine Shared CHNA is based on what nearly 2,000 people reported to be the biggest health issues facing their community after reviewing the health profiles release in the summer of 2018. Millinocket Regional Hospital Part V, Section B, Line 6a: Central Maine Healthcare (CMHC), MaineGeneral Health (MGH), MaineHealth (MH), Northern Light Health (NLH) Millinocket Regional Hospital Part V, Section B, Line 6b: Maine Center for Disease Control and Prevention (Maine CDC), an office of the Maine Department of Health and Human Services Millinocket Regional Hospital Part V, Section B, Line 11: The Hospital recently published its 2020-2021 Strategic Plan. The purpose of the Strategic Plan is to provide strategic, operational, and financial priorities to guide Millinocket Regional Hospital over the next three years. The 2019-2021 Strategic Plan was developed through the collaborative efforts of MRH board of directors, medical staff, community, and hospital staff and leadership. Data obtained and reviewed in the planning process includes the 2018-19 Community Health Needs Assessment, patient survey trends, and any market/demographic data available.We have identified 5 core areas of strategic importance for growth and success based on current market conditions, regional growth, and local demand for healthcare services. Our strategic objectives will support the development of the strategic priorities for Millinocket Regional Hospital, and meet the health needs of our community. The Strategic Plan identifies the following Five Strategic Priorities to meet the health needs identified in the CHNA:- Increase quality and volume of services- Enhance population health- Become the "employer of choice"- Continue to meet the changing needs of our community- Strive for financial stabilityThe Hospital aims to meet the first three priorities through community partnerships and improvements to public health infrastructure; through preventative health measures and annual wellness checks for community members; and by promoting strong employee retention, engagement, and workplace satisfaction.To meet the changing needs of its community, the Hospital has taken special care to allocate resources, services, and attention to address the following core needs identified in the CHNA: social determinants of health; neighborhood and built environment health impacts; access to healthcare; social and community impacts to health; economic stability; education; substance abuse; and mental health resources. Mental Health:-Partner with providers who offer mental health services in our communities and develop working relationships that will foster continuity and a strong referral relationship for our patients with mental needs;-Provide education tools and materials to providers that will increase comfort level of staff and patients in mental health.Social Determinants of Health (SDOH):-Maintain use of food insecurity screening tool in the emergency department, primary care, family medicine and walk in clinic; -Continue to provide emergency food bags and/or frozen meals and food resource guides as appropriate; -Continue to partner with the Good Shepherd Food Bank through their Community Health and Hunger Initiative and Mainers Feeding Mainers program;-Provide ongoing education to staff and patients about food insecurity by using "food is medicine" language;-Thrive Penobscot will continue to convene the Katahdin Area Food Council to build networks within community sectors that reduce barriers to accessing food resources;-Increase access to transportation by establishing a volunteer driver program with the Millinocket Public Library and promoting current service with Penquis;-Develop community health education calendar to include all health education topics being offered in the communities served by the Hospital.Access to Care:-Determine need for additional staff in scheduling departments to ensure timely diagnostic testing; -Assess current flow of same day access to appointments for sick patient visits in physician offices and determine needs for improving this; -Assess community needs for additional specialty clinics through partnerships, for example pulmonology, dermatology, cardiology, etc.Substance Abuse:-Participate in Thrive Penobscot's (the grant funded public health arm of MRH) efforts to build the Katahdin Response for Substance Use Disorder that will bring treatment, recovery and prevention sectors together;-Begin the distribution of Narcan through the emergency department and determine if further site distribution is warranted;-Research the feasibility of initiating and providing Medication Assistive Therapy at MRH and/or in partnership with an FQHC;Additional needs for health organization identified in the CHNA include growth and innovation and financial stability.Growth and Innovation:-Invest in technology by a two-year budget requirements for upgraded technology;-Continue to further streamline processes;-Decrease the number of platforms or software systems;-Decrease and eliminate paper processes;-Increase utilization of available functions.Strive for Financial Stability:-Increase operational revenue by ensuring fees are in line with costs and encompass consideration contractual allowances;-Manage contracts more effectively; MRH has enrolled in a new GPO to better utilize group benefits and reduce costs-Increase inpatient bed usage; -Work with outpatient facilities to better utilize the swing bed;-Determine cost benefits of additional licensing before other levels of care are introduced;-Increase charitable contributions and other funding opportunities;-Start a fundraising campaign/foundation to help increase individual donors and contributors. Millinocket Regional Hospital Part V, Section B, Line 16j: Signage is posted at all registration sites informing patients of the availability of financial assistance. Applications are available at the registration desk. Part V, Section B, Line 7a and 7b: The CHNA is available on Millinocket Regional Hospital's website at: http://www.mrhme.org/wp-content/uploads/2015/03/chna-penobscot-county-report.pdfThe CHNA is also available on the following websites:https://www.maine.gov/dhhs/mecdc/phdata/MaineCHNA/documents/district-reports/Penquis-Report-Web.pdf Part V, Section B, Line 16a, 16b, and 16c: The Hospital's Financial Assistance Policy can be found on the MRH website at: http://www.mrhme.org/wp-content/uploads/2014/06/Financial-Assistance-Policy-050116.pdfThe Hospital's Financial Assistance Application can be found on the MRH website at: http://www.mrhme.org/wp-content/uploads/2021/01/Free-Care-2021-merged.pdfThe Hospital's Plain Language Summary can be found can be found on the MRH website at: http://www.mrhme.org/wp-content/uploads/2019/02/Financial-Assistance-Policy-Plain-Language-010118.pdf 2 1 - White Birch Medical Center 899 Central Street Millinocket ME 04462 Physical Therapy and Wellness Center 2 - Millinocket Regional Hosp Walk-In Care 87 Main Street East Millinocket ME 04430 Walk-In Care Part I, Line 3c: In addition to FPG, Millinocket Regional Hospital considers a patient's asset level, medical indigency, and insurance status. Presumptive eligibility may be used if all other financial assistance options have been exhausted. Part I, Line 7: Charity care expenses was converted to cost on Line 7a and based on an overall cost-to-charge ratio addressing all patient segments. Lines 7b and 7g were determined using the Medicaid and Medicare cost reports, respectively.The amount of bad debt expense removed from the denominator of the calculations was $1,528,467. Part I, Line 7g: Millinocket Reginal Hospital has several hospital clinical services and hospital-owned physician practices. Per instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practice that the Hospital subsidizes (i.e., operates at a loss) in the completing of Schedule H. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operate at a loss (i.e., are subsidized by the Hospital) and the associated costs of these practices:a - Hospital based rural health clinicb - Outpatient clinicc - Emergency Roomd - Millinocket Surgicale - Orthopedicsf - Urologyg - Wound Careh - Ophthalmologyi - Walk in ClinicThe above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $4.594 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $4.594 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.Form 990, Schedule H instructions/guidance contains a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part 1, Line 7 were the following:a. Schedule H Worksheet 6, Subsidized Health Services (the supporting worksheet for Part I, Line 7g), the Hospital did not utilize Worksheet 2 when calculating the percentage used when determining the profit/loss of each hospital clinical service and hospital-owned physician practice. Instead, when compiling the subsidized hospital clinical services and hospital-owned physician practices listed in 1c above, the Hospital utilized the actual estimated costs on the modified Medicare cost report instead of applying the Worksheet 2 cost to charge percentage. b. Schedule H Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs (the supporting schedule for Part I, Lines 7b and 7c), and Worksheet 6, Medicaid Allowable Costs for Subsidized Health Services, listed in line 1c above (which is part of the line 7g costs). The Hospital did not utilize the Worksheet 2 percentage when calculating the Medicaid allowable cost. Instead, the Hospital utilized the actual Medicaid filed cost report for the allowable costs. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,528,467. Part II, Community Building Activities: Millinocket Regional Hospital (MRH) has a long history of serving citizens in the Katahdin region and those citizens have long supported MRH. Through many difficult times that partnership has sustained both the region and local healthcare services. As the Katahdin region reinvents itself and moves forward MRH is moving forward as well and is excited to announce the establishment of a new foundation - the Legacy Medical Foundation - designed to develop a comprehensive philanthropy and stewardship effort. All foundation initiatives will be focused on expanding access to care and wellness services provided in the Kathadin region.The Hospital offers many volunteer opportunities for community members to get involved and to participate in the Hospital's mission. These opportunities promote civic and community engagement. The Hospital also regularly engages with area schools to promote youth health, education, and wellness initiatives. During the past year, these activities took on special significance, as the Hospital sought to promote COVID-19 vaccination and to quell vaccine hesitancy in its community. MRH devoted much of its time and resources to combatting COVID-19 in its community, from vaccine clinics to public information campaigns. The Hospital also took efforts to teach children and families how they can stay safe and healthy at home, in school, and in the workplace.As a major healthcare provider in Northern Maine near the Katahdin Woods and Waters region, the Hospital actively encourages healthy lifestyles and provides many economic and health care opportunities to its broader community. The Hospital also educates its community on how to avoid healthcare-related scams and financial fraud. Part III, Line 2: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding, after management has used reasonable collection efforts, are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for major payor source of revenue for the purposes of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established at varying levels based on the age of the receivables and payor source. For receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Part III, Line 4: See Footnote 3 of the audited financial statements. Part III, Line 8: Medicare allowable cost of care was calculated from the Medicare cost report for the fiscal year ending June 30, 2021. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.As a critical access hospital, Millinocket Regional Hospital is reimbursed at 101% of Medicare allowable cost. As such, the small "gain" from Medicare shown on Part III, Line 7, is really due in part to the 1% add-on in Medicare cost reimbursements. Part III, Line 9b: In an effort to best serve our patients, all first-time statements include information on the availability of financial assistance for qualified patients. Our patient financial services department uses several resources to determine if a patient may be presumptively eligible for finance assistance; for example, eligibility for out-of-state Medicaid, eligibility for other state-funded assistance programs, such as food stamps and patient homelessness. It is our practice to make a reasonable attempt to determine if a patient qualifies for financial assistance before sending an account to a collection agency. Any accounts previously sent to collections will be considered for financial assistance when an application is received; so long as the services were rendered not more than 240 days previously, or the patient was given a written notice that financial assistance was available for those specific services with a deadline dated after the 240 day period. Part VI, Line 2: It is one of our many goals to remain well connected with the community and their needs, which we achieve by overseeing ongoing advisory groups and meetings where our organization can assess perceptions, needs and recommendations. In addition, MRH leaders conduct focus groups with employees in local businesses to evaluate whether healthcare needs are being met and to identify how MRH can better serve the community in the future. Information gathered from advisory groups and focus groups, paired with the Penobscot Shared Community Health Needs Assessment (CHNA) and our annual periodic evaluation, assist MRH to add new services including sleep medicine, gastroenterology, endocrinology, rheumatology, neurology, and optometry, ophthalmology, and walk-in care. Recognizing the large elderly population in our area, and the need for more services to help them live healthier lives and remain independent, MRH has taken on the role of executive sponsor for a thriving in place grant. MRH is completely committed to serving our patients, supporting them in maintaining their health, and assisting them to retain their independence. Part VI, Line 3: Inpatients: In order to identify those patients who would be eligible for financial assistance, all uninsured inpatients are referred to the financial counselor by pre-registration or registration personnel. The financial counselor will do an initial screening for payment options prior to the patient leaving the hospital, if possible. If the patient has left the hospital, the financial counselor will attempt to contact the patient for information. All inpatients are given a copy of patient free care and discount arrangements guidelines at time of admission.Surgical Outpatients: The financial counselor will provide information about patient free care, discount arrangements and term payment arrangements to all uninsured surgical outpatients. All surgical outpatients are provided a copy of patient free care and discount arrangements guidelines at time of registration.Emergency Room Patients: All emergency room patients are provided a copy of patient free care and discount arrangements guidelines at time of registration.All Other Outpatients: All other outpatients are provided a copy of the patient free care/discount arrangements guidelines at time of registration.All patients will receive notice of availability of financial assistance included in their first-time statement. Patient financial services employees and physician practice employees receive training on patient free care and discount arrangements guidelines and are expected to be able to provide contact information about free care and discount arrangements. Part VI, Line 4: Millinocket Regional Hospital has three communities in its primary service area: Millinocket, East Millinocket and Medway. There are multiple smaller communities in the secondary service area including Brownville, Woodville, Stacyville, Sherman, Patten and Island Falls. The area has struggled and realized an unemployment rate in the teens for the past ten years and experienced community out-migration. The population of the primary service area is approximately 7,500 people. The effect on the Hospital of this demographic and population change has been large declines in patient care volumes since 2013. The average median household income is more than 20% lower than the state average. The average resident age is more than 10% older than the state median age. Part VI, Line 5: Millinocket Regional Hospital is the largest employer in the area and sole community provider for acute care. We operate an emergency room available to all patients, regardless of their ability to pay. MRH is involved in government-sponsored health programs as well as the education and training of healthcare professionals, and we offer volunteer opportunities to Members within the community, who may not have a healthcare background, but are passionate about our mission. Our Hospital is governed by a Board of Trustees, all of whom reside in primary and secondary service areas. Employees may participate in board meetings but do not have voting capabilities, with the exception of the medical staff president, who has a voting membership on the governing Board. Board members whose family members are employed by MRH are required to identify the potential conflict in writing and are appropriately recused from acting on matters that may impact directly or indirectly their family members. Physicians who wish to have privileges at our Hospital are not required to be an employee in order to become an active member of the medical staff. They must send a written request to the MRH medical staff for review. Privileges are granted to qualified physicians only after the request is reviewed and the needs and interests of both parties have been evaluated. MRH is an active participant in the community care partnership of Maine, an accountable care organization made up of Maine based hospitals and healthcare centers, which guides our organization toward transforming the delivery of our healthcare services to center around meaningful sharing and accountability for our patients' health. As an organization, Millinocket Regional Hospital prioritizes surplus funds for projects or expenses that have a direct impact on patient care or patient and employee safety. This includes, but is not limited to, training, teaching, and purchasing specialized and improved equipment to keep patients safe. Part VI, Line 7, Reports Filed With States ME X X X X 0 0 0 0 0 0 0 0 0 Mark Kowalski MD Physician 512864 0 0 0 399708 0 8550 0 7698 0 928820 0 0 0 John Gluscic MD Physician 669885 0 0 0 51785 0 8550 0 3264 0 733484 0 0 0 Edward Dunstan DO Physician 398562 0 0 0 226424 0 8550 0 5155 0 638691 0 0 0 Daniel Herbert MD Medical Staff President (end 6/2021) 314362 0 0 0 148544 0 8550 0 4887 0 476343 0 0 0 Robert Peterson Chief Executive Officer 226066 0 0 0 91827 0 7500 0 2314 0 327707 0 0 0 Kwaku Owusu-Abrokwa MD Physician 287905 0 0 0 548 0 8550 0 2030 0 299033 0 0 0 Kevin Olsen PA-C Medical Staff President 267262 0 0 0 0 0 8018 0 0 0 275280 0 0 0 Julia M Greenwald PA-C Physician Assistant 256148 0 0 0 3462 0 7717 0 2022 0 269349 0 0 0 Jil Beaupain DPM Medical Staff At-Large (end 6/2021) 155900 0 0 0 0 0 0 0 0 0 155900 0 0 0 Form 990, Schedule J, Compensation Paid from Unrelated Organization: Millinocket Regional Hospital contracted with Calculations, Inc., an unrelated organization, to provide CFO services during the fiscal year. Calculations, Inc. was paid $124,958 for services provided by Mellissa McAvoy, who is an officer of Calculations, Inc. and served as Board President of MRH during the filing period. A Maine Health and Higher Educational Facilities Authority 010314384 560427WV4 2013-05-23 1423837 Refinancing of 2002 D Bond Issue 0 0 1 A 890762 1423837 15439 1408398 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: Maine Health and Higher Educational Facilities Authority Date the Rebate Computation was Performed: 06/25/2018 Daniel Herbert Family Member is employee of Hospital 74746 Daniel C. Herbert, MD serves as Chief Medical Officer and a Trustee of Millinocket Regional Hospital. A family member, Laurie Vickers-Herbert, is an employee of the Hospital. 2020 W-2 compensation paid to Laurie Vickers-Herbert was $69,847. As a Hospital employee, Ms. Vicker-Herbert also received deferred compensation in the amount of $2,136 and fringe benefits of $2,763. 0 Patrick E Hunt Esq Family Member is employee of Hospital 237663 Patrick E. Hunt, Esq. serves as a Trustee of Millinocket Regional Hospital. A family member, Rose Ann Hunt, PA, is an employee of the Hospital. 2020 W-2, Box 1 compensation paid to Rose Ann Hunt was $237,215. As a Hospital employee, Ms. Hunt also received deferred compensation in the amount of $415 and fringe benefits of $33. 0 Form 990, Part VI, Section A, line 3 Millinocket Regional Hospital contracted with Calculations, Inc., an unrelated organization, to provide CFO services during the fiscal year. Calculations, Inc. was paid $124,958 for services provided by Mellissa McAvoy, who is an officer of Calculations, Inc. and served as Board President of MRH during the filing period. Form 990, Part VI, Section B, line 11b Prior to the document's filing, the organization's finance department reviews the initial draft, which is prepared by an outside independent accountant. After any necessary changes are made, the organization's board members are presented with a copy. The finalized document is subject to the board's approval. Form 990, Part VI, Section B, line 12c Each board member is required to sign a conflict of interest disclosure form on an annual basis. In connection with any actual or possible conflicts of interest, an interested individual must disclose the existence of his or her conflict annually and whenever the conflict arises for action at a meeting. After receiving all annual attestations, the CEO will provide the signed statements to the hospital's attorney for review. After review, the attorney will determine if a conflict exists and inform the CEO and Board Chair of the conflicted individuals. There is a listing of board, medical staff and manager conflicts available at all meetings for reference. The agenda for every board, medical staff or department meeting will clearly list the discussion items that require action during the meeting. At the beginning of the meeting, the president will ask the members to review the list of action items and declare whether or not they have a conflict. All conflicted members will be required to excuse themselves and leave the room during the discussion and vote. If the board or committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. Form 990, Part VI, Section B, line 15 The organization works with an independent compensation consultant to determine appropriate compensation levels. The organization's executive committee reviews data used to determine compensation for its respective members. Any compensation related changes must be approved by the Board of Trustees or the executive board. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Professional Services : Program service expenses 644,722. Management and general expenses 0. Fundraising expenses 0. Total expenses 644,722. Outside Services : Program service expenses 31,291. Management and general expenses 0. Fundraising expenses 0. Total expenses 31,291. Contract Labor : Program service expenses 394,140. Management and general expenses 43,871. Fundraising expenses 0. Total expenses 438,011. Purchased Services : Program service expenses 1,422,102. Management and general expenses 1,076,192. Fundraising expenses 0. Total expenses 2,498,294. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Legacy Medical Foundation 200 Somerset Street Millinocket ME 04462 852352634 Fundraising ME 501(c)(3) Line 12a, I Millinocket Regional Hospital 1 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 Legacy Medical Foundation D 9000 Actual per book Legacy Medical Foundation E 585 Actual per book Legacy Medical Foundation L 9000 Actual per book Legacy Medical Foundation M 585 Actual per book