2022-11-15T11:07:03-06:00 2021-12-31 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-01-01 010211783 Calais Regional Hospital CALA 2074547521 24 Hospital Lane Calais ME 04619 Mark Stickney Plan Officer 2074547521 2022-11-14 1 Mark Stickney 999009999 Barbara J McGuan CPA P00219457 2077752387 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z X Mark Stickney 24 Hospital Lane Calais ME 04619 31067013 0 X www.calaishospital.org X 1938 ME Critical Access Hospital X 0 0 222 40 0 0 4668820 90581 25440238 13394554 81334 -9906008 0 17576325 30190392 21155452 0 0 0 0 14667317 5786617 0 0 0 12185288 6892662 26852605 12679279 3337787 8476173 21440962 0 23823022 0 -2382060 0 X Calais Regional Hospital exists to provide and plan patient care, educational and restorative services that meet our customer's expectations, commensurate with available resources. 0 1 9306845 13394554 Calais Regional Hospital is a not-for-profit acute care hospital. Until the divestiture of its business line on June 30, 2021, the Hospital provided inpatient, outpatient, emergency care, and swing bed care, primarily to residents of Washington County, Maine. Since 2001, the Hospital operated as a Critical Access Hospital (CAH). 9306845 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 36 0 1 222 1 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Mark Stickney 2074547521 24 Hospital Lane Calais ME 04619 X Ronald McAlpine Past Chair 4.00 X X 0 0 0 Everett Libby Past Vice Chair 4.00 X X 0 0 0 Merritt Loring Past Treasurer 4.00 X X 0 0 0 Michael Todd Smith Past Secretary 6.00 X X 0 0 0 Lawerence Clark Past Director 4.00 X 0 0 0 Sussan Coley Past Director 4.00 X 0 0 0 Robert Fitzsimmons Past Director 4.00 X 0 0 0 Britani Holloway Past Director 6.00 X 0 0 0 Ian Pratt Past Director 4.00 X 0 0 0 Susan Rowley Past Director 4.00 X 0 0 0 James Thompson Past Director 4.00 X 0 0 0 Rodney Boula Past CEO 40.00 X 73141 0 2185 Mark Smith Past CFO 40.00 X 58848 0 0 Galen Dickinson Past CFO 40.00 X 3600 0 0 Peter Wilkinson DO Past Physician 40.00 X 184044 0 12480 Mohammad Niayesh MD Past Physician 40.00 X 135142 0 20596 Nima Moghaddas DPM Past Physician 40.00 X 120988 0 17980 Elizabeth Eliacin MD Past Physician 40.00 X 114208 0 1164 689971 0 54405 4 0 1 0 EmCare Physician Services LLC 7032 Collection Center Drive Chicago IL 60693 Emergency Room Physicians 1124527 Medefis Consolidated PO Box 5068 New York NY 100875068 Staffing Agency 944439 CPS LLC PO Box 638316 Cincinnati OH 452638316 Pharma Services 364787 Evident PO Box 11407 Dept 6448 Birmingham AL 352466448 Medical Records 199905 NEHE-MRI LLC PO Box 19532 Irvine CA 92623 Imaging Services 186718 8 87504 3077 90581 Patient Services 622100 19125366 19125366 Other Revenue 622100 726640 720530 6110 Contractual/Char. Adj. 622100 -6457452 -6457452 13394554 5553 5553 9911561 -9911561 -9911561 -9911561 Gain from Forgiveness of Indebted 622100 17576325 17576325 17576325 21155452 13388444 0 7676427 X 137775 137775 4769109 3794527 974582 507706 396361 111345 372027 289193 82834 107234 107234 30000 30000 3482419 2803709 678710 47270 22092 25178 455985 119904 336081 17997 16728 1269 63018 63018 421658 421658 210486 210486 Repairs and Maintenance 603606 251407 352199 Supplies 560456 453484 106972 Miscellaneous Expenses 478892 50637 428255 Healthcare Provider Tax 413641 413641 12679279 9306845 3372434 0 X 1699649 0 3351760 0 0 2150626 0 0 0 0 359344 0 299879 0 0 10508457 0 0 0 0 0 3071247 0 21440962 0 7212334 0 15875005 0 735683 0 23823022 0 X -4217262 0 1835202 0 -2382060 0 21440962 0 X 8476173 -1 -6094112 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2051 2051 0 Part II-B, Line 1: The Organization pays dues to local associations, a portion of which are attributable to lobbying activities. 0 20711937 -1 -1 20711938 443514 443514 21155452 12679279 0 12679279 0 12679279 Part XI, Line 4b - Other Adjustments: Relinquishment of Interest in Perpetual Trust 443,514. 1 1 1 X 1 X 225.000000000000 1 1 1 0 1 1 423678 423678 0.03340 4010377 4010377 0.31630 4434055 4434055 0.34970 4434055 4434055 0.34970 1 3604268 3604268 X 1 1 1 1 Calais Regional Hospital 24 Hospital Lane Calais ME 04619 www.calaishospital.org 39044 X X X X Calais Regional Hospital 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X www.calaishospital.org X See Part V, Section C X 1 19 1 www.calaishospital.org 1 0 1 X 150.000000000000 225.000000000000 1 1 X X X 1 X www.calaishospital.org X www.calaishospital.org X www.calaishospital.org X X X X X X 1 X 0 X X X X 1 X 0 0 Calais Regional Hospital Part V, Section B, Line 5: See page 6 of attached Community Health Needs Assessment Calais Regional Hospital Part V, Section B, Line 6b: See page 4 of attached Community Health Needs Assessment Calais Regional Hospital Part V, Section B, Line 7d: The URL of the other website where the CHNA can be found is https://www.maine.gov/dhhs/mecdc/phdata/MaineCHNA/final-CHNA-reports.shtml Calais Regional Hospital Part V, Section B, Line 11: See attached Implementation Strategy Calais Regional Hospital Part V, Section B, Line 16j: Notices of the Free Care program are posted at the front desk in the main lobby, in the registration areas, patient billing department, Surgical Services department, Orthopedic Department, Baileyville Clinic, and Rural Health Care Clinic. Applications are available at all of these points. Assistance in completing the applications is provided by the Patient Financial Advocate. Part III, Line 4: Patient service revenue is reported at the amount that reflects the consideration to which the Hospital expects to be entitled in exchange for providing patient care. These amounts are due from patients, third-party payors (including health insurers and government programs), and others and includes variable consideration for retroactive revenue adjustments due to settlement of audits, reviews, and investigations. Generally, the Hospital bills the patients and third-party payors several days after the services are performed or the patient is discharged. Revenue is recognized as performance obligations are satisfied.Patient accounts receivable are stated at the amount management expects to collect from outstanding balances.The Hospital has elected the practical expedient allowed under FASB ASC 606-10-32-18 and does not adjust the promised amount of consideration from patients and third-party payors for the effects of a significant financing component due to the Hospital's expectation that the period between the time the service is provided to a patient and the time that the patient or a third-party payor pays for that service will be one year or less. However, the Hospital does, in certain instances, enter into payment agreements with patients that allow payments in excess of one year. For those cases, the financing component is not deemed to be significant to the contract.Performance obligations are determined based on the nature of the services provided by the Hospital. Revenue for performance obligations satisfied over time is recognized based on actual charges incurred in relation to total expected (or actual) charges. The Hospital believes that this method provides a faithful depiction of the transfer of services over the term of the performance obligation based on the inputs needed to satisfy the obligation. Generally, performance obligations satisfied over time relate to patients in hospitals receiving inpatient acute care services or patients receiving services in outpatient centers or in their homes. The Hospital measures the performance obligation from admission into the hospital or the commencement of an outpatient service, to the point when it is no longer required to provide services to that patient, which is generally at the time of discharge or completion of the outpatient services.Because all of its performance obligations relate to contracts with a duration of less than one year, the Hospital has elected to apply the optional exemption provided in FASB ASC 606-10-50-14(a) and, therefore, is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period.As a result of the adoption of the above, the Organization is not recording any bad debt expense for 2020. Part III, Line 8: The Organization used the Hospital's as-filed cost reports to obtain Medicare and Medicaid costs and expected reimbursement. Part III, Line 9b: Self-pay accounts receive a minimum of 3 statements and a final notice. Patients must complete an application for Free Care and provide necessary qualifying support in order to receive Free Care. Applications are kept on file and tracked in a log. The log of patients who are eligible for Free Care is maintained electronically and is available at registration points to simplify the application of Free Care for current services. Part VI, Line 2: Healthcare Community Needs Surveys are completed every three years. The Hospital conducts interviews with various community groups, trustees and staff and conducts an annual community survey. In addition, the Hospital participates in joint efforts with other healthcare providers to analyze and act upon regional health status indicators and data. Part VI, Line 3: Notices of the Free Care program are posted at the front desk in the main lobby, in the registration areas, patient billing department, Surgical Services department, Orthopedic Department, Baileyville Clinic, and Rural Health Care Clinic. Applications are available at all of these points. Assistance in completing the applications is provided by the Patient Financial Advocate. Part VI, Line 4: We serve a rural population of approximately 14,000 (40 miles North, South and West). Part VI, Line 5: The Hospital participates in programs for community support, including health walks and local fairs and conferences. The Hospital supports economic development through participation in Chamber of Commerce, and economic development organizations. The Hospital enhances coalition building by participating in community outreach activities and working with local and regional agencies and organizations to improve access to services. The Hospital works to improve the health status in our communities by participating in blood drives, cancer, diabetic support groups, providing blood pressure screenings, flu clinics, health fairs, and wellness programming. The Hospital encourages workforce development through job shadowing, preceptorships, and mentoring programs and participating in career fairs and in area youth coaching programs.The Hospital has an open medical staff. The Board of Directors are community members from throughout the service area. X X 1 0 0 0 0 0 0 1 0 Peter Wilkinson DO Past Physician 171139 0 12905 0 0 0 0 0 12480 0 196524 0 0 0 Mohammad Niayesh MD Past Physician 135142 0 0 0 0 0 0 0 20596 0 155738 0 0 0 Part I, Line 4a Rodney Boula, Past CEO, received severance pay of $62,169 during 2021. Part I, Line 7 Peter Wilkinson, Past Physician, received an RVU based bonus of $12,905 during 2021. Land, Buildings, and Equipment 2021-06-30 10541771 Audited Financial Statements 862728785 Calais Community Hospital 24 Hospital Lane Calais ME 04619 501(c)(3) Accrued Vacation 2021-06-30 -630210 Audited Financial Statements 862728785 Calais Community Hospital 24 Hospital Lane Calais ME 04619 501(c)(3) 1 0 0 0 Part II, Line 2e: Person(s) Involved: Ian Pratt Part II, Line 2e: Explanation of Involvement: Ian Pratt, Past Director of Calais Regional Hospital is a Trustee on the Calais Community Hospital Board of Directors. Form 990, Part III, line 3 On September 17, 2019, the Hospital filed a petition for relief under Chapter 11 of the federal bankruptcy laws in the United States Bankruptcy Court for the District of Maine. On February 19, 2021, Downeast Community Hospital (DECH), the only other hospital in Washington County, filed a motion with the United States Bankruptcy Court District of Maine, together with the creditors' committee, to allow DECH to purchase substantially all of the assets of the Hospital. The United States Bankruptcy Court, District of Maine, approved a plan of liquidation on March 24, 2021, and the Hospital determined liquidation is imminent. As a result, the Hospital changed its basis of accounting on January 1, 2021 from the going concern basis to the liquidation basis. There was no significant impact on the statement of changes in net (deficit) assets in liquidation as a result of changing to the liquidation basis of accounting on January 1, 2021 rather than March 24, 2021. Liquidation is expected to be completed within twelve months of June 30, 2021. Form 990, Part VI, Section A, line 7a A Board of Trustees elects members of the Board of Directors at an annual meeting of the Board of Trustees. On March 24, 2021 the Board of Directors were disbanded and replaced by a Plan Officer. The Hospital was then sold on June 30, 2021. Form 990, Part VI, Section A, line 7b At the annual meeting of the Board of Trustees, actions of the Board of Directors during the year are acted on and ratified. On March 24, 2021 the Board of Directors were disbanded and replaced by a Plan Officer. The Hospital was then sold on June 30, 2021. Form 990, Part VI, Section B, line 11b The Board of Trustees was disbanded effective March 24, 2021 and replaced with the Plan Officer. The Plan Officer will review and approve the 990. Form 990, Part VI, Section B, line 12c An interested party has a duty to disclose an actual or possible conflict of interest to the CEO or governing body Chairperson. The governing board of directors will determine whether a conflict of interest exists. If a conflict is determined, the interested party may make a presentation to the governing body but then leave during discussion of and vote on the involved transaction. The Chairperson, if deemed appropriate, shall appoint a disinterested person to investigate alternatives. After exercising due diligence the governing body shall determine whether the hospital can obtain with reasonable efforts a more advantageous transaction that would not give rise to a conflict of interest. If a more advantageous transaction is not reasonably possible the governing board shall determine by majority vote whether the transaction is in the Hospital's best interest and whether it is fair and reasonable. Minutes of all meetings regarding the transaction will be maintained. On March 24, 2021 the Board of Directors were disbanded and replaced by a Plan Officer. The Hospital was then sold on June 30, 2021. Form 990, Part VI, Section B, line 15 The Executive Committee of the Board of Directors serves as an Executive Compensation Committee. Performance review is completed and is presented, along with comparative salary information to the Committee by the Hospital's management company. After consideration of the comparative information and performance review, the Executive Committee determines and authorizes an appropriate compensation level. Form 990, Part VI, Section C, line 19 The Hospital prepares and circulates via US Postal Service an Annual Report, which goes to every household in what is defined as the Hospital Service Area. The Annual Report is also available on the Hospital website at: http://www.calaishospital.com. Additionally, at the annual meeting of the Trustees, copies of the audited financial statements are shared with all present including representatives of the press in attendance. Other documents as appropriate would be available upon request. Form 990, Part VII: On March 24, 2021 the Board of Directors were disbanded and replaced by a Plan Officer. The Hospital was then sold on June 30, 2021. Form 990, Part IX, line 11g Other Fees: Program service expenses 1,200,213. Management and general expenses 308,752. Fundraising expenses 0. Total expenses 1,508,965. Purchased Services: Program service expenses 795,647. Management and general expenses 369,958. Fundraising expenses 0. Total expenses 1,165,605. Physician Fees: Program service expenses 807,849. Management and general expenses 0. Fundraising expenses 0. Total expenses 807,849. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Calais Regional Hospital 24 Hospital Lane Calais, ME 04619 EIN: 01-0211783 Calais Regional Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Relinquishment of Interest in Perpetual Trust -443,514. Amounts owed and payments made to USDA under the plan of liquidation -5,650,598. Form 990, Part XII, Line 1: The United States Bankruptcy Court, District of Maine, approved a plan of liquidation on March 24, 2021, and the Hospital determined liquidation is imminent. As a result, the Hospital changed its basis of accounting on January 1, 2021 from the going concern basis to the liquidation basis. William & Allison Goode Memorial Trust co US Trust PO Box 830269 Dallas TX 75283 Charitable Trust ME T 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0