2021-08-12T11:34:08-05:00 2020-09-30 990 2019-10-01 020222156 Memorial Hospital MEMO 6033565461 3073 White Mountain Highway North Conway NH 03860 Art Mathisen President 6033565461 2021-08-04 2019 2022-09-23 18:48:47Z Art Mathisen 3073 White Mountain Highway North Conway NH 03860 81332481 0 X www.memorialhospitalnh.org X 1910 NH Critical Access Hospital 11 7 554 68 0 0 273207 4427573 74756817 71038653 -301547 325777 123327 125442 74851804 75917445 0 21863 0 0 36393857 36969870 0 0 128244 38326247 38093621 74720104 75085354 131700 832091 91169798 104466558 45735905 54145534 45433893 50321024 Memorial Hospital provides healthcare services to the residents and visitors of the Mount Washington Valley area of New Hampshire as well as Western Maine. 0 0 69477743 21863 71225975 Memorial Hospital provides healthcare services to the residents and visitors of the Mount Washington Valley area of New Hampshire and the Western Region of Maine. Memorial Hospital is a 25 Bed Critical Access Hospital. The Hospital provides Acute Inpatient Services including general medical and surgical, Obstetrics and Intensive Care Units. The Hospital had 3,192 Acute Patient Days in 2020. The Hospital also provides a variety of outpatient services such as Imaging, Laboratory, Diabetes, Oncology, Physical Rehab, Emergency Medicine, Primary Care, Orthopedics and General Surgery. The Hospital had 38,310 Outpatient Visits and 51,233 Clinic Visits in 2020. 69477743 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 554 1 0 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Diana McLaughlin 6033560613 3073 White Mountain Highway North Conway NH 03860 Laura Jawitz Former Board Member 1.00 0.00 X 0 0 0 Barbara Hopkins Former Board Member 1.00 0.00 X 0 0 0 Ed Kelly Treasurer 1.00 0.00 X X 0 0 0 Michelle O'Donnell Secretary 1.00 0.00 X X 0 0 0 Mary DeVeau Board Chair 1.00 0.00 X X 0 0 0 Bob Irwin Vice Chair 1.00 0.00 X X 0 0 0 Mary Vigeant Medical Staff President 50.00 0.00 X 200384 0 22616 Corinne Ray Board Member 1.00 0.00 X 0 0 0 Linda Terry Board Member 1.00 0.00 X 0 0 0 Art Mathisen President 50.00 0.00 X X 228930 0 9008 Angus Badger Former Medical Staff President 50.00 0.00 X 314606 0 34179 Richard W Petersen President, MaineHealth 1.00 50.00 X 0 1810862 113239 Zach Chase Board Member 50.00 0.00 X 244846 0 34787 Tim Scott Board Member 1.00 0.00 X 0 0 0 Matthew Dunn CMO 50.00 0.00 X 363414 0 22937 John Cox Former Regional CFO 1.00 50.00 X 0 273298 34159 Kristine Dascoulias Chief Nursing Officer 50.00 0.00 X 107940 0 32975 Diana McLaughlin CFO 50.00 0.00 X 190613 0 42041 Morice Dennery MD Surgeon 50.00 0.00 X 457745 0 41916 Victor Lazaron MD Physician 50.00 0.00 X 358880 0 35358 Douglas Taylor MD Orthopaedic Surgeon 50.00 0.00 X 563896 0 43752 Raymond Rabideau MD Physician; Former CMO 50.00 0.00 X 467855 0 42053 Marni Madnick MD Physician 50.00 0.00 X 368502 0 41586 Scott McKinnon Former President 50.00 0.00 X 266269 0 0 Lee Myles Former Interim President 0.00 50.00 X 0 135377 0 Ethnee Garner Former Chief Nursing Officer 50.00 0.00 X 172312 0 21139 4306192 2219537 571745 53 1 1 0 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 022417844 Locum Tenens 218584 MAINE RECOVERY SERVICES INC 37 DOUGLAS RD LIMINGTON ME 04049 Billing/Coding 173795 2 4360727 66846 4427573 Net patient service revenue 621110 68632675 68632675 Other revenue 621110 2405978 2405978 71038653 263897 263897 167602 42160 125442 125442 125442 5434756 5335814 37062 98942 -37062 61880 61880 75917445 71225975 0 263897 X 21863 21863 2348885 1985391 363494 27641265 25022790 2516945 101530 732115 665205 66910 4429443 4024622 404821 1818162 1651994 166168 75586 75586 71965 71965 9141524 8306050 835474 10942 8082 813 2047 691378 608290 61185 21903 1189582 1080861 108721 141975 128472 12923 580 816919 742258 74661 4943570 4491761 451809 1157165 1051408 105757 Medical Supplies 9341705 9341705 MMC Integrated Services 5582303 5582303 Medicaid Tax 3152780 3152780 Other 1776227 1611908 162135 2184 75085354 69477743 5479367 128244 7451762 26510475 16318143 16458948 8822178 8725805 2422314 1945157 460318 306570 88536176 58545682 32177847 29990494 10944743 12372111 12572493 8156998 91169798 104466558 3858349 15531160 136465 2101690 13876906 13343453 1144274 1046776 26719911 22122455 45735905 54145534 X 45433893 50321024 45433893 50321024 91169798 104466558 X 832091 1089540 2965500 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16232 16232 0 SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION PAYS DUES TO THE NEW HAMPSHIRE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING EXPENSES. 27262886 1385162 28648048 21050013 6000000 212873 27262886 11944584 10000000 -894571 21050013 12273762 -329178 11944584 11560341 713421 12273762 1.00000 0.00000 0.00000 0 1 1 4545066 4545066 53477707 34472056 19005651 30440065 24073626 6366439 73338 73338 29990494 Other receivables 418810 Receivable from affiliate 881555 Estimated insurance recoveries 835952 Investment in MHACO LLC 231645 SeHR and systemwide assets 5789036 8156998 Estimated third party settlements 18903171 Professional insurance payable 1834564 Due to affiliates 1384720 22122455 X Part X, Line 2: FIN 48 FOOTNOTE THE HOSPITAL AND ITS SUBSIDIARIES ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. 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 (FASB), 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 NOT TO MEET THE "MORE-LIKELY-THAN-NOT" THRESHOLD, BASED UPON THE TECHNICAL MERITS OF THE POSITION. ESTIMATED INTEREST AND PENALTIES, IF APPLICABLE, RELATED TO UNCERTAIN TAX POSITIONS ARE INCLUDED AS A COMPONENT OF INCOME TAX EXPENSE. THE HOSPITAL HAS EVALUATED THE POSITION TAKEN ON ITS FILED TAX RETURNS. THE HOSPITAL HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT SEPTEMBER 30, 2020. PART V, LINE 4 - INTENDED USES FOR ENDOWMENT FUNDS The endowed funds support community health initiatives for the Memorial Hospital service area and patients. They provide support for the Diabetes and Oncology Programs and assist purchasing capital assets for clinical areas of the Hospital. 1 1 1 X 0 1 1 0 1 1 625000 625000 0.00830 14506134 11743709 2762425 0.03680 15131134 11743709 3387425 0.04510 674091 674091 0.00900 7687399 3198660 4488739 0.05980 8361490 3198660 5162830 0.06880 23492624 14942369 8550255 0.11390 0 2730797 22912878 23684917 -772039 X 1 1 1 1 Memorial Hospital 3073 White Mountain Highway North Conway NH 03860 mainehealth.org/Memorial-Hospital #00009 X X X X Memorial Hospital 1 0 0 1 X X X X X X X X X 19 1 1 0 1 X See Pt V, Sec C, "Part V, Sec B, Line 7a" 1 19 1 See Pt V, Sec C, "Part V, Sec B, Line 7a" 0 1 X 200.000000000000 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 Memorial Hospital Part V, Section B, Line 5: THE PLANNING COMMITTEE INCLUDED TWO REPRESENTATIVES FROM POPULATION HEALTH AT MEMORIAL HOSPITAL AND ONE REPRESENTATIVE FROM MAINEHEALTH SERVICES. ADDITIONAL UNRELATED MEMBERS OF THE COMMITTEE INCLUDED REPRESENTATIVES FROM THE FOLLOWING ENGAGED ORGANIZATIONS: -WHITE MOUNTAIN COMMUNITY HEALTH CENTER: PRIMARY CARE SERVICES AND HEALTH EDUCATION REGARDLESS OF ABILITY TO PAY-NORTHERN HUMAN SERVICES: MENTAL HEALTH CARE AND INDIVIDUALIZED SERVICES FOR DEVELOPMENTALLY DISABLED OR SUBSTANCE ABUSE COUNSELING-T MURRAY WELLNESS CENTER: DIET, EXERCISE, NUTRITION, AND TREATMENT SERVICES-CARROLL COUNTY COALITION FOR PUBLIC HEALTH-VISITING NURSE HOME CARE & HOSPICE OF CARROLL COUNTY & WESTERN MAINE: PERSONAL CARE, SKILLED NURSING, REHABILITATION, AND PALLIATIVE CARE AND HOSPICE SERVICES.-MINERAL SPRINGS: LONG-TERM CARE, ASSISTED LIVING, AND REHABILITATION CENTERTHE PLANNING COMMITTEE HELD A FORUM REPRESENTING THE FOLLOWING SECTORS: PUBLIC HEALTH, HEALTHCARE PROVIDERS, LOCAL/STATE GOVERNMENT, MEDICALLY UNDERSERVED, COMMUNITY HEALTH COALITION, NON-PROFIT AGENCIES, LOW INCOME, BUSINESS/CIVIC LEADERSHIP, COLLEGE/UNIVERSITY, PROFESSIONAL MEMBER ORGS, MINORITIES (RACIAL/ETHNIC), AND PUBLIC SCHOOLS. A NUMBER OF ADDITIONAL ENGAGEMENT ACTIVITIES WERE HELD IN SMALLER GROUPS. IN ADDITION TO THE ABOVE, AN ONLINE STAKEHOLDER SURVEY WAS DISSEMINATED TO CAPTURE OPINIONS OF HEALTH PROFESSIONALS AND COMMUNITY STAKEHOLDERS ON HEALTH ISSUES AND NEEDS OF COMMUNITIES ACROSS THE STATE. Memorial Hospital Part V, Section B, Line 6a: THE CHNA WAS CONDUCTED THROUGH A PARTNERSHIP BETWEEN MAINEHEALTH SERVICES, CENTRAL MAINE HEALTHCARE, NORTHERN LIGHT HEALTH, MAINEGENERAL HEALTH, MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND THE NEW HAMPSHIRE DIVISION OF PUBLIC HEALTH SERVICES. Memorial Hospital Part V, Section B, Line 11: FOR THE 2019-2021 CHNA, THE ORGANIZATION HAS IDENTIFIED PRIORITIES AND DEVELOPED STRATEGIES TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND PROVIDED REASONS IF IDENTIFIED NEEDS ARE NOT BEING ADDRESSED. PLEASE SEE THE 2019-2021 CHNA AND ANNUAL IMPLEMENTATION UPDATE FY20 AT www.MaineHealth.org/chnaFOR DETAILS OF THE ACTIVITIES UNDERTAKEN BY THE ORGANIZATION. PART V, SECTION B, LINE 7a: THE CHNA AND IMPLEMENTATION STRATEGY ARE POSTED ON THESE WEBSITES: www.MaineHealth.org/chna PART V, SECTION B, LINES 16a,b,c: THE FINANCIAL ASSISTANCE POLICY (FREE CARE POLICY AND BILLING AND COLLECTION POLICY), FREE CARE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ON THE FOLLOWING WEBSITE: https://mainehealth.org/patients-visitors/billing-insurance/financial-assistance/free-care. PART V, SECTION B, LINE 16i: THE ORGANIZATION HAS ESTABLISHED AN ANNUAL PROCESS TO EVALUATE ITS PATIENT DEMOGRAPHIC INFORMATION TO ENSURE THAT THE REQUIRED DOCUMENTS ARE TRANSLATED INTO THE NECESSARY LANGUAGES FOR 501(R)(4) COMPLIANCE. THE FY20 REVIEW DID NOT IDENTIFY ANY LIMITED PROFICIENCY POPULATIONS THAT COMPRISED OF THE LESSER OF 1,000 OR 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. Part I, Line 6a: MEMORIAL HOSPITAL'S COMMUNITY BENEFIT DATA IS CONTAINED IN A REPORT PREPARED BY MAINEHEALTH SERVICES (EIN 01-0431680), THE ORGANIZATION'S SOLE MEMBER. THE REPORT CAN BE FOUND AT THE LINK BELOW:https://annualreport.mainehealth.org/#community Part I, Line 7: A COST REPORTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED INTHE TABLE. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS. ACOST-TO-CHARGE RATIO WAS USED. PART I, LINE 3C: CHARITY CARE LEVELS ARE DETERMINED BY A THREE PRONG TEST FOR ELIGIBILITY. RESIDENCY, INCOME LEVEL, AND HOUSEHOLD SIZE ARE EXAMINED TO DETERMINE LEVEL OF ELIGIBILITY. DISCOUNTED CARE IS REQUIRED BY NEW HAMPSHIRE STATE LAW FOR ALL UNINSURED SELF-PAY PATIENTS. THE DISCOUNT WAS 33% DURING THE TAX YEAR. Part III, Line 2: SEE PART III, LINE 4 - BAD DEBT EXPENSE FOOTNOTE TO FIN STATEMENTS Part III, Line 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. MEMORIAL HOSPITAL BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE MEMORIAL HOSPITAL HAS A CLEAR MISSION COMMITMENT TO SERVING ELDERLY PATIENTS AND ADULTS WITH DISABILITIES THROUGH THE PROVISION OF SPECIFIC SUBSIDIZED PROGRAMS DEVELOPED TO HELP IMPROVE THE HEALTH STATUS OF THESE PATIENTS. IF THESE CRITICAL SUBSIDIZED PROGRAMS WERE NOT PROVIDED BY MEMORIAL HOSPITAL, THEY WOULD BECOME THE OBLIGATION OF THE FEDERAL GOVERNMENT. Part III, Line 9b: PATIENTS WHO QUALIFY FOR FREE CARE HAVE THEIR ACCOUNT BALANCE ADJUSTED ACCORDINGLY ONCE FREE CARE HAS BEEN APPROVED. AS A TAX EXEMPT HOSPITAL, MEMORIAL HOSPITAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. PART III, LINE 4: MEMORIAL HOSPITAL DOES NOT HAVE A SPECIFIC FOOTNOTE IN THE FINANCIALSTATEMENTS THAT DESCRIBES "BAD DEBT EXPENSE." HOWEVER, REFERENCE ISMADE WITHIN THE FOOTNOTES TO THE TREATMENT OF BAD DEBT. WITHIN THE FOOTNOTE DESCRIBING "PATIENT ACCOUNTS RECEIVABLE", THE FOLLOWING EXPLAINS THE PROVISION FOR BAD DEBTS:PATIENT ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF.WHEN THE HOSPITAL HAS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED SELF-PAY ALLOWANCES THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE. THE AMOUNT OF EXPENSE ASSOCIATED WITH THE PROVISION OF SERVICES, ULTIMATELY WRITTEN OFF AS BAD DEBT AT MEMORIAL, HAS BEEN CALCULATED AT$4,831,725 FOR THE CURRENT FISCAL YEAR. BAD DEBT EXPENSE REPRESENTS HEALTHCARE SERVICES MEMORIAL HAS PROVIDED WITHOUT COMPENSATION. AS A TAX-EXEMPT ORGANIZATION, MEMORIAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. MEMORIAL CANNOT DETERMINE THE AMOUNT OF BAD DEBT EXPENSE THAT COULD BE REASONABLY ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES RELATED TO A PORTION OF OUR COMMUNITY BASED PATIENT POPULATION. THEIR MEDICAL BILLS OFTEN PLACE THESE INDIVIDUALS IN UNTENABLE POSITIONS WHERE THEY ARE NOT ABLE TO HANDLE THEIR PERSONAL DEBT AND THEN THEIR NEW MEDICAL DEBT. HOWEVER, BECAUSE OF THEIR INCOME LEVEL, THEY DO NOT QUALIFY FOR FREE CARE. BY PROVIDING NECESSARY HEALTHCARE SERVICES TO THOSE INDIVIDUALS EITHER WHO FAIL TO APPLY FOR FINANCIAL ASSISTANCE OR WHO ARE EXPERIENCING DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES, MEMORIAL BELIEVES THAT BAD DEBT EXPENSE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. Part VI, Line 2: THE ORGANIZATION PREPARES A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS. SEE www.MaineHealth.org/chna Part VI, Line 6: MAINEHEALTH SERVICES IS A NOT-FOR-PROFIT FAMILY OF LEADING HIGH-QUALITY PROVIDERS AND OTHER HEALTHCARE ORGANIZATIONS WORKING TOGETHER SO THEIR COMMUNITIES ARE THE HEALTHIEST IN AMERICA. RANKED AMONG THE NATION'S TOP 100 INTEGRATED HEALTHCARE DELIVERY NETWORKS, MAINEHEALTH SERVICES IS GOVERNED BY A BOARD OF TRUSTEES CONSISTING OF COMMUNITY AND BUSINESS LEADERS FROM ITS SOUTHERN, CENTRAL, AND WESTERN MAINE, AS WELL AS CARROLL COUNTY, NEW HAMPSHIRE REGIONAL SERVICE AREAS. THE COLLABORATION OF MAINEHEALTH SERVICES MEMBERS MAKES IT POSSIBLE TO OFFER AN EXTENSIVE RANGE OF CLINICAL INTEGRATION AND COMMUNITY HEALTH PROGRAMS, MANY AIMED AT IMPROVING ACCESS TO PREVENTIVE AND PRIMARY CARE SERVICES. MAINEHEALTH SERVICES INCLUDES THE FOLLOWING MEMBER ORGANIZATIONS: THE MEMORIAL HOSPITAL AT NORTH CONWAY, N.H., MAINEHEALTH CARE AT HOME, NORDX, AND MAINEHEALTH ACCOUNTABLE CARE ORGANIZATION. THE STRATEGIC AFFILIATES OF MAINEHEALTH SERVICES ARE MAINEGENERAL MEDICAL CENTER, MID COAST HOSPITAL AND ST. MARYS REGIONAL MEDICAL CENTER. Part VI, Line 7, Reports Filed With States ME,NH PART VI, LINE 4: THE CHNA DESCRIBES THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS ITSERVICES. SEEwww.MaineHealth.org/chna PART VI, LINE 3: MEMORIAL HOSPITAL'S POLICY OF CHARITY CARE AND FINANCIAL ASSISTANCE ISEASILY UNDERSTOOD, PROMINENTLY POSTED, AND PUBLICLY AVAILABLE. APROCESS EXISTS FOR OFFERING CHARITY CARE OR FINANCIAL ASSISTANCE TOPATIENTS WHO ARE UNABLE TO PAY AFTER THEY HAVE ALREADY BEEN BILLED. INADDITION TO MONITORING COLLECTION PRACTICES, COPIES OF THE CHARITY CAREPOLICY ARE MADE AVAILABLE TO PATIENTS AT ALL ENTRY POINTS(REGISTRATION, ED, ETC.) AND WITH BILL/COLLECTION NOTICES. MEMORIALHOSPITAL USES SIMPLE APPLICATION PROCEDURES FOR CHARITY CARE ORFINANCIAL ASSISTANCE THAT DO NOT INTIMIDATE OR CONFUSE APPLICANTS.MEMORIAL HOSPITAL'S EMPLOYEES WHO WORK IN ADMISSIONS, BILLING, ACCOUNTSRECEIVABLE, OR PATIENT SERVICES ARE FULLY INFORMED AND EDUCATED ABOUTALL FINANCIAL ASSISTANCE POLICIES. THESE STAFF MEMBERS IDENTIFY UNPAIDBILLS WHERE PERSONS ARE UNABLE TO PAY, AND SEPARATE THESE POTENTIAL"CHARITY CARE" BILLS FROM OTHER BAD DEBT ACCOUNTS. ON A CASE-BY-CASE BASIS, WE HAVE GRANTED ASSISTANCE TO INDIVIDUALS THAT MAY EARN ABOVE 200% OF THE FEDERAL POVERTY GUIDELINES BUT HAVE MET THE CATASTROPHIC ILLNESS PARAMETERS. PART VI, LINE 5: THE TAX EXEMPT PURPOSE OF THE ORGANIZATION TO IMPROVE THE HEALTH OF THECOMMUNITY IS PROMOTED AND ENHANCED IN THE FOLLOWING WAYS:- THE MAJORITY OF THE GOVERNING BODY IS COMPOSED OF PERSONS LIVINGWITHIN THE HOSPITAL SERVICE AREA THAT ARE NEITHER EMPLOYED BY, NOR HAVECONTRACTUAL RELATIONSHIPS WITH, THE HOSPITAL OR ITS AFFILIATES.- MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS INTHE COMMUNITY.- SOLICITATION OF COMMUNITY INPUT IN THE STRATEGIC PLANNING PROCESS.- COMMON GOVERNANCE OF THE HOSPITAL, LONG-TERM CARE AND PHYSICIANSERVICES PROVIDED IN THE COUNTY TO PROMOTE COMMON HEALTH CARE ANDIMPROVEMENT PLANNING AND CONTROL COSTS.- VOLUNTARY CAP ON INCOME FROM OPERATIONS TO RESTRAIN PRICES AND TOFUND HEALTH CARE AND HEALTH IMPROVEMENT ACTIVITIES.- SURPLUS FUNDS ARE REINVESTED IN CAPITAL EQUIPMENT AND IMPROVEMENTS TOENSURE HIGH QUALITY CARE. 1 Children's Unlimited Inc 182 W Main Street Conway NH 03818 020399161 501c3 7446 To provide weekly classes under the "Parenting from Prison" curriculum. Saco River Medical Group PC 7 Greenwood Avenue Conway NH 03818 020487818 14417 The funding of a physician to support and provide medical assisted treatment services to an additional 60 - 80 patients with opioid dependence. 1 1 Part I, Line 2: The monitoring process included a committee consisting of representation from all grant recipients and met routinely throughout the funding cycle (generally monthly). Discussions included progress, barriers and shared information and resources. Reports of accomplishments and progress were also provided at the larger quarterly meetings which consisted of all the organizations who received funding and/or were involved in any of the grant's work and initiatives. The recipients submitted progress reports with supporting documentation. Payments were not released until this supporting documentation was received and reviewed. 1 0 0 0 0 0 0 0 0 Mary Vigeant Medical Staff President 189188 0 300 0 10896 0 6190 0 16426 0 223000 0 0 0 Art Mathisen President 173508 0 18000 0 37422 0 5999 0 3009 0 237938 0 0 0 Angus Badger Former Medical Staff President 313364 0 0 0 1242 0 8400 0 25779 0 348785 0 0 0 Richard W Petersen President, MaineHealth 0 927273 0 270000 0 613589 0 81636 0 31603 0 1924101 0 0 Zach Chase Board Member 221190 0 20000 0 3656 0 7113 0 27674 0 279633 0 0 0 Matthew Dunn CMO 327508 0 22816 0 13090 0 8400 0 14537 0 386351 0 0 0 John Cox Former Regional CFO 0 244157 0 25500 0 3641 0 5599 0 28560 0 307457 0 0 Diana McLaughlin CFO 189282 0 0 0 1331 0 3535 0 38506 0 232654 0 0 0 Morice Dennery MD Surgeon 456503 0 0 0 1242 0 8400 0 33516 0 499661 0 0 0 Victor Lazaron MD Physician 356558 0 0 0 2322 0 8400 0 26958 0 394238 0 0 0 Douglas Taylor MD Orthopaedic Surgeon 560282 0 0 0 3614 0 8400 0 35352 0 607648 0 0 0 Raymond Rabideau MD Physician; Former CMO 281665 0 125000 0 61190 0 8400 0 33653 0 509908 0 0 0 Marni Madnick MD Physician 367279 0 300 0 923 0 8400 0 33186 0 410088 0 0 0 Scott McKinnon Former President 0 0 0 0 266269 0 0 0 0 0 266269 0 0 0 Lee Myles Former Interim President 0 97356 0 38021 0 0 0 0 0 0 0 135377 0 0 Ethnee Garner Former Chief Nursing Officer 89783 0 0 0 82529 0 3220 0 17919 0 193451 0 0 0 Part I, Line 4a Scott McKinnon received severance payments totaling $266,269 during calendar year 2019. Ethnee Garner received severance payments totaling $70,602 during calendar year 2019. PART 1, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION TOP MANAGEMENT OFFICIALS ARE COMPENSATED BY RELATED ORGANIZATIONS. THESE ORGANIZATIONS USED ONE OR MORE OF THE METHODS SHOWN AT PART 1, LINE 3 TO ESTABLISH THE COMPENSATION OF TOP MANAGEMENT SEE DESCRIPTION OF PROCESS IN SCHEDULE O - FORM 990, PART VI, LINE 15A - COMPENSATION FOR TOP OFFICIAL A New Hampshire Health & Ed Facilities Auth 020279866 64461XAF2 2016-12-22 15795685 Refund bonds issued 06/14/2006 0 0 0 A 1885000 15795685 315914 15479771 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 Jacqueline Martin See Part V 46079 See Part V 0 Sch L, Part IV, Business Transactions Involving Interested Persons: Jacqueline Martin, daughter of Mary Vigeant (board member), is employed by Memorial Hospital. FORM 990, PART V, LINE 1a - MaineHealth (EIN 01-0238552), acting on behalf of the MaineHealth System filed 1,687 Form 1099s for the calendar year 2019. Form 990, Part VI, Section A, line 6 THE SOLE MEMBER OF THE ORGANIZATION IS MAINEHEALTH SERVICES (EIN# 01-0431680). Form 990, Part VI, Section A, line 7a THE SOLE MEMBER OF THE ORGANIZATION ELECTS THE TRUSTEES OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7b DECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS AND MARKETING STRATEGIC PLANS, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION, AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL BY MAINEHEALTH SERVICES (EIN# 01-0431680). Form 990, Part VI, Section B, line 11b HIGHLIGHTS OF THE 990 ARE REVIEWED WITH THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE 990 IS REVIEWED IN DETAIL BY THE CFO AND MADE AVAILABLE TO THE FULL BOARD OF DIRECTORS PRIOR TO FILING. Form 990, Part VI, Section B, line 12c CONFLICT OF INTEREST DECLARATION FORMS ARE SUBMITTED IN JANUARY BY MEMBERS OF THE BOARD OF TRUSTEES AND ARE SHARED WITH THE FULL BOARD FOR INFORMATION PURPOSES AND REVIEWED IN DEPTH BY THE GOVERNANCE COMMITTEE. IT IS THE MEMBER'S RESPONSIBILITY TO NOTIFY THE BOARD OF ANY CONFLICTS THAT THEY BECOME AWARE OF AND TO RECUSE THEMSELVES FROM DISCUSSIONS AND VOTES ON THE ISSUE. Form 990, Part VI, Section B, line 15 The process followed for determining compensation of the CEO compensated by this or other related organization is a formal process performed annually by the Executive Committee of the Board of Directors. A related organization uses an outside firm, Sullivan Cotter, to perform an independent benchmark analysis for the CEO of Memorial Hospital, along with other executives in the MaineHealth Services system. The firm meets with the Executive Committee to review each executive's benchmark report. The Committee then deliberates on MaineHealth Services' written salary and incentive plan philosophy before making a final decision. All decisions and meetings are captured in minutes and there are appropriate approvals at all levels. Form 990, Part VI, Section C, line 19 DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. Form 990, Part IX, line 11g Consulting: Program service expenses 18,989. Management and general expenses 1,910. Fundraising expenses 0. Total expenses 20,899. Contractual Services: Program service expenses 3,722,618. Management and general expenses 374,444. Fundraising expenses 0. Total expenses 4,097,062. Labs: Program service expenses 12,675. Management and general expenses 1,275. Fundraising expenses 0. Total expenses 13,950. Physician Recruitment: Program service expenses 46,845. Management and general expenses 4,712. Fundraising expenses 0. Total expenses 51,557. Purchased Services: Program service expenses 4,504,923. Management and general expenses 453,133. Fundraising expenses 0. Total expenses 4,958,056. Form 990, Part XI, line 9: Net equity transfers from controlled entities 2,875,500. Released to property, plant & equipment 90,000. MaineHealth 22 Bramhall Street Portland ME 04102 010238552 Hospital ME 501(c)(3) Line 3 MaineHealth services 0 MaineHealth Care at Home 15 Industrial Park Saco ME 04072 222571902 Home health ME 501(c)(3) Line 10 MaineHealth Services 0 Memorial Hospital Foundation 3073 White Mountain Highway North Conway NH 03860 462137291 Fundraising NH 501(c)(3) Line 12a, I The Memorial Hospital 1 NorDx 301A US Route One Scarborough ME 04074 010511356 Lab ME 501(c)(3) Line 10 MaineHealth Services 0 MaineHealth Services 110 Free Street Portland ME 04101 010431680 Healthcare ME 501(c)(3) Line 12c, III-FI N/A 0 Memorial Elder Health Services 3073 White Mountain Highway North Conway NH 03860 813653215 Nursing Home NH 501(c)(3) Line 10 The Memorial Hospital 1 Mid Coast Parkview Health 123 Medical Center Drive Brunswick ME 04011 010430069 Health Services ME 501(c)(3) Line 12a, I MaineHealth Services 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 Memorial Hospital Foundation S 5265500 Cash Memorial Elder Health Services R 2300000 Cash