2021-11-15T08:35:10-06:00 2020-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2020-01-01 010212444 York Hospital YORK 2073634321 15 Hospital Drive York ME 03909 Robin LaBonte CFO 2073634321 2021-11-10 1 Robin LaBonte 999009999 Nicholas E Porto P01310283 2078792100 2021-11-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Patrick Taylor MD 15 Hospital Drive York ME 03909 194192031 0 X www.yorkhospital.com X 1904 ME Community Hospital 26 20 1473 252 3515725 0 2169223 5319553 192126381 177943241 5306260 3516412 97481 115615 199699345 186894821 235984 80901 0 0 109313075 107277227 0 0 514009 90821669 90914034 200370728 198272162 -671383 -11377341 128368248 150946487 52750995 87489528 75617253 63456959 Community Hospital 0 0 174873837 80901 175263131 York Hospital is a not-for-profit health care center established to provide health care services to the York county area. It offers both inpatient and outpatient acute services and has 79 licensed acute beds. The Hospital has outpatient satellite services in Wells, Kittery, Berwick, South Berwick, Sanford, and Kennebunk.York Hospital is committed to providing exceptional care to patients and their families. All efforts must be thoughtful, kind, and loving. York Hospital is dedicated to creating and nurturing a fabric of compassionate relationships among physicians, caregivers, patients, and families to offer sensitive, understandable, high-quality medical care experiences. 174873837 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 52 0 1 1473 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 26 20 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 1 0 X X Robin LaBonte CFO 2073634321 15 Hospital Drive York ME 03909 Jud Knox Trustee/Pres./Leader (end 3/2020) 40.00 0.00 X X 2457816 0 11391 Peter Dourdoufis MD Cardiologist 40.00 0.00 X 842110 0 46713 Jeffrey Colness MD Cardiologist 40.00 0.00 X 729186 0 24507 Jeffrey Lockhart MD Physician 40.00 0.00 X 548277 0 31407 Daneille Leighton Radiologist 40.00 0.00 X 513648 0 38907 Jonathan Bridges MD Cardiologist 40.00 0.00 X 505258 0 21661 Jennifer Cutts MD CO-CEO/Trustee/Radiologist 40.00 0.00 X 477848 0 43864 Marilyn McLaughlin MD Trustee/Oncologist 40.00 0.00 X 386703 0 9071 Nathan Jean MD Trustee/Physician (end 6/2020) 40.00 0.00 X 319026 0 37765 Robin LaBonte CO-CEO, CFO/Leader 40.00 0.00 X 310924 0 45291 Erich Fogg PA-C Trustee/Physician Assistant 40.00 0.00 X 234861 0 39180 Lawrence Petrovich MD Trustee/Cardiologist 40.00 0.00 X 226755 0 38874 James Gilroy MD Trustee/Physician 40.00 0.00 X 167129 0 32946 Meghan Brandt RN Trustee/RN 36.00 0.00 X 82846 0 16180 Lorraine Boston Trustee 1.00 0.00 X 0 0 0 Douglas Bracy Trustee 1.00 0.00 X 0 0 0 Amy Bush Trustee 1.00 0.00 X 0 0 0 Mark Eves Trustee 1.00 0.00 X 0 0 0 Ken Fellows MD Trustee 1.00 0.00 X 0 0 0 Mark Foster Trustee 1.00 0.00 X 0 0 0 John Houlihan Trustee 1.00 0.00 X 0 0 0 Ann Hussey Trustee 1.00 0.00 X 0 0 0 Connie James Trustee 1.00 0.00 X 0 0 0 Deborah Pease Trustee 1.00 0.00 X 0 0 0 Suzi Raeside Trustee 1.00 0.00 X 0 0 0 Gary Samia Trustee 1.00 0.00 X 0 0 0 Dianne Smallidge EdD RDH Trustee 1.00 0.00 X 0 0 0 David Speert MD Trustee 1.00 0.00 X 0 0 0 Robert Sullivan Trustee 1.00 0.00 X 0 0 0 Henry Warner Trustee 1.00 0.00 X 0 0 0 Ala Reid Trustee/Chairman 1.00 0.00 X X 0 0 0 Chris Kehl Trustee/Treasurer 1.00 0.00 X X 0 0 0 Wendy Cote Trustee/Vice Chairman 1.00 0.00 X X 0 0 0 Daniel Morrison Trustee/Vice Treasurer 1.00 0.00 X X 0 0 0 7802387 0 437757 137 0 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Locum tenums services 2092192 Seacoast Pathology Inc PO Box 100519 Atlanta GA 30384 Contract pathology services 1773763 Quest Diagnostics Inc 12436 Collection Center Drive Chicago IL 60693 Contract laboratory services 784093 Mass General Physicians Org PO Box 3662 Boston MA 022413362 Medical services 569006 Wentworth-Douglas Hospital PO Box 412540 Boston MA 02241 Physician services 552334 25 17000 4168109 1134444 9265 5319553 Patient services 621400 125718100 125718100 Diagnostic and reference labs 621500 42134426 41413408 721018 Pharmacies and drug stores 446110 7737107 5337076 2400031 Miscellaneous program services 621400 1686186 1678551 7635 Cafeteria and dietary 722210 619490 619490 47932 47932 177943241 229863 229863 115615 0 115615 115615 115615 9580955 1002804 7166273 130937 2414682 871867 3286549 332959 387041 2566549 186894821 175263131 3515725 2796412 80901 80901 4938470 4373387 565083 79638198 72126549 7214229 297420 727577 656720 68173 2684 16113873 14558535 1497637 57701 5859109 5298553 539885 20671 596049 596049 161767 161767 11743 11743 9220 9220 17706383 13810979 3895404 361219 169773 191446 7274385 3458970 3692825 122590 200 94 106 6052008 4417966 1634042 201644 94773 106871 9931 4668 5263 517171 517171 4387030 3209366 1164721 12943 3580993 2587474 993519 Medical supplies/fees 29192007 29192007 Provision for bad debt 9085029 9085029 Pharmacy supplies 7914941 7914941 Healthcare provider tax 3816160 3816160 36154 16992 19162 198272162 174873837 22884316 514009 911429 1717769 4981436 6461070 35648 363821 23219856 20240501 5745350 5477026 1371955 1467154 137582998 91445659 49635589 46137339 33477376 36627505 3050024 1626087 5939585 30828215 128368248 150946487 17487339 24594440 10579840 9440641 6338100 6017548 18345716 47436899 52750995 87489528 X 59500541 44884619 16116712 18572340 75617253 63456959 128368248 150946487 X -11377341 2052545 -2835498 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 11743 0 0 0 11743 0 Part II-B, Line 1: Part II-B, Line 1f: York Hospital partners with various like-minded trade associations which support public policies and initiatives that focus on improving health outcomes and the experience of health care, while also aiming to reduce the overall cost of receiving that care. To maintain these partnerships, the Hospital is required to pay membership dues back to these various trade associations. A portion of the dues paid to these associations has been designated as available for lobbying expenditures. Any lobbying expenditures paid by the associations are incurred in order to help track and discuss legislation affecting health care policy. The specific dues paid by York Hospital to the trade associations in 2020, as well as the portion of the dues that were available for lobbying expenditures, are detailed below: Maine Hospital Association - Total 2020 dues: $54,922 - Portion of dues available for lobbying: $7,634 American Hospital Association - Total 2020 dues: $17,621 - Portion of dues available for lobbying: $4,109 16116712 641121 2261257 446750 18572340 12558375 1507759 2583038 532460 16116712 13337701 247972 -474485 552813 12558375 11703343 367880 1864700 598222 13337701 11395935 269308 762506 724406 11703343 0.00000 0.25370 0.74630 0 0 3904522 3904522 72262155 40704105 31558050 3331479 2920243 411236 55779031 47821311 7957720 2305811 2305811 46137339 Medical malpractice insurance recoveries receivable 10800002 Other receivables 1384558 Medicare advances 18643655 30828215 Pension obligation 13950531 Estimated professional liability losses 11500002 Estimated third-party payor settlements 3086917 Madicare service obligations 18643655 Other liabilities 255794 47436899 X 178981734 2052545 2052545 176929189 9220 9956412 9965632 186894821 191142028 1964115 1964115 189177913 9220 9085029 9094249 198272162 Part V, Line 4: Temporarily Restricted Funds are classified and sorted by the following groups and purposes: Capital Campaign Funds are to be used for operating costs related to fundraising campaigns, as well as to help cover the costs associated with the Cardiac Cath Lab Campaign. Biewend (12/82) - Funds from which the original principal and any incurred income are to be restricted for the purchase of new equipment (at Board discretion which must be approved by a family member). Biewend Funds can also be used for the acquisition of land and buildings other than an addition to the present hospital buildings. Page (1945) - Funds that are to be used for support and maintenance of district visiting nurses. Baldwin Fund for Nursing Excellence - Funds to be used to provide financial support for nurses who need to be re-certified and stay current in their health care skills. This includes support for advanced training or changing professional focus. These funds are also used to provide scolarships for support staff who are interested in entering the field of nursing, as well as to offer financial assistance to help defray the costs of ongoing orientation, classroom instruction, and clinical training of new York Hospital nurses. Lastly, this account is used to help defray the costs associated with the York Hospital's Summer Intern program for young nursing students who are currently enrolled in a nursing school. Winkler Fund - Funds that are to be used for Nursing Education. Rose F. Voignier Education Fund - Funds that are to be used for education for all with exception of physicians. Rose Voignier Education Fund - Funds to be used for staff education. Breast Cancer Living Well Fund - Funds to be used for breast cancer patients. Cancer Living Well Fund - Funds are to be used for cancer patients. Hancock Healthy Aging Fund - Funds are to be used to support programs and services that promote and benefit the physical, emotional, spiritual, and overall health and well-being of our community as they age. Womens Heart Health Fund - Funds are to be used for the support of the York Hospital Cardiology Center program "Heart Care for Women", an initiative specializing in women's heart care and diagnostics where the approach is to treat a health of women as a whole, minimizing the risk of heart disease and keeping the heart healthy. Permanently Restricted Funds are classified and sorted by the following groups and purposes: Elizabeth B. Perkins - The Perkins' Funds Principal is to remain restricted in perpetuity. The income generated from the Funds are restricted for the care of patients who are unable to pay for proper treatment. Gerrity - Princpal Gerrity Funds are to be maintained in perpetuity. 80% of income generated by the funds are considered unrestricted, to be used on general operations, while 20% is to be reinvested as Principal. Cowey - and gains generated by the Funds are to be used for pediatrics (Corpus only to be kept in tact). Forristall - Income and gains generated by the Funds are to be used for SNF (Corpus only to be kept in tact). Mason - Income and gains generated by the Funds are to be used to provide free care to patients who cannot afford to pay (Corpus only to be kept in tact). Brewster - Income and gains generated by the Funds are to be used for any form of diabetes research and care (Corpus only to be kept in tact). Rose F. Voignier Education Fund - Income and gains generated by the Funds are to be used for education for all with the exception of physicians (Corpus only to be kept in tact). Palmer/Perkins Endowment - Income and gains generated by the Funds are to be used for education for nursing education for the staff (Corpus only to be kept in tact). Sidelinger - (6/88) Income and gains generated by the Funds are to be used for general support, upkeep and maintenance of the Hospital as determined by the Board (principal only to be kept in tact). Oncology Fund - Income and gains generated by the funds are to be used for support programs for patients, their families, and their caregivers. Part X, Line 2: The Hospital is a not-for-profit corporation and is tax-exempt under 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, 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. 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 positions taken on its filed tax returns. The Hospital has concluded no uncertain income tax positions exist at December 31, 2020. Part XI, Line 4b - Other Adjustments: Adjustment to long-term pension obligations 871,383. Provision for bad debts 9,085,029. Part XII, Line 2d - Other Adjustments: Net periodic pension costs 1,964,115. Part XII, Line 4b - Other Adjustments: Provision for bad debts 9,085,029. 1 1 1 X 0 1 1 1 0 0 1 299 371470 371470 0.00200 1 6223 16978518 15471805 1506713 0.00800 2 6522 17349988 15471805 1878183 0.01000 661159 64463 596696 0.00320 65470424 26291024 39179400 0.20710 21534 21534 0.00010 66153117 26355487 39797630 0.21040 2 6522 83503105 41827292 41675813 0.22040 1 3992296 0 26505049 36689193 -10184144 X 1 1 1 1 York Hospital 15 Hospital Drive York ME 03909 www.yorkhospital.com 38066 X X X York Hospital 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X Please see Part V X 1 20 1 Please see Part V 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X Please see Part V X Please see Part V X Please see Part V X X X X X X X 1 X 0 X X X X X 1 0 0 York Hospital Part V, Section B, Line 3j: A shared vision of a healthy Southern York County; socio-economic characteristics by town, and a community themes and strengths assessment. York Hospital Part V, Section B, Line 5: The local Community Health Needs Assessment process completed in December 2018 helped York Hospital, its partners, and its community members identify four health issues of concern in the local service area: Mental Health; Substance Misuse; Healthy Aging; and Food Insecurity. These concerns were elaborated upon and detailed within the Hospital's 2018/2019 CHNA.York Hospital has a long tradition of asking community members for feedback formally and informally to determine concerns and needs. The Hospital's 2018-2019 CHNA continued this history; in gathering information for the report, the Hospital listened to the communities it serves in order to help improve the health of those living in Southern York County Maine. The 2018-2019 CHNA compiles local, county, and state health data gather through community member input about health issues and the needs and assets community members care about most.Transportation was the biggest barrier to healthcare for many in two consecutive community surveys which led the hospital to establish its now extensive transportation service. The formality of the CHNA requirement helps to ensure community participation, collaboration and follow up. York Hospital is the fiscal agent of and partners with the Choose to Be Healthy Coalition (CTBH) a federal and state funded youth substance use prevention coalition housed at the hospital whose staff make up its Community Health Team. CTBH assisted in engaging the community in the health assessment process. CTBH has a membership and Advisory Board purposefully comprised of those representing from all of its communities and diverse community sectors including education, law enforcement, behavioral health care, social service agencies, municipalities, business, faith, parents and youth. The involvement of these perspectives is necessary to implement successful health improvement initiatives. Guiding the process was the perspective that much of what influences health outcomes happens outside of the health care system. These social factors include poverty, level of education, behavioral health status, age, and social connectedness, among others. Members of CTBH represent populations in the hospital service area with disparate health outcomes including those with low-incomes, the elderly, youth and those with substance use and mental health disorders. Elements of the National Association of City and County Health Officials (NACCHO) community health planning process were used in 2015 and 2018 to help community stakeholders identify a Vision for a Healthy Community and a list of Community Values, and a Community Themes & Strengths Survey was conducted in both years. In addition, a York County Community Health Forum was held on September 27, 2018, with over sixty public health professionals, community members, and decision makers who reviewed the most current county and state data, discussed local health concerns and helped prioritize health issues going forward as a county and as collaborating agencies, coalitions and hospitals.Members of the CTBH Advisory Board provided guidance of the CHNA process through monthly meetings with help from members of the York Hospital Patient Advisory Committee and York Hospital Board Member, Wendy Cote. The CTBH Advisory Board is made up of community members who live or work in all of our communities and represent the following: social services, schools, mental health treatment, law enforcement, the court system, healthcare, faith community, businesses, and parents. They reviewed the Community Vision for a Healthy Southern York County and a list of Community Values. York Hospital Part V, Section B, Line 6b: York Hospital's CHNA was conducted with Choose To Be Healthy (CTBH), a community health coalition with a membership purposefully comprised of those representing diverse community sectors, such as education, health care, business, municipalities, law enforcement, and other similar community and public-service based institutions.Additionally, the current assessment includes the Southern York County Maine towns of Berwick, Eliot, Kittery, Lebanon, North Berwick, Ogunquit, South Berwick, Wells, and York. Two new communities have been added since the last CHNA in 2015. These are Sanford and Kennebunk, where York Hospital opened walk-in clinics since the previous assessment. York Hospital Part V, Section B, Line 11: The York Hospital Community Health Needs Assessment 2020 Implementation Plan Progress Report identifies four priority health issues: Substance Use; Mental Health; Healthy Aging; and Food Insecurity. The Report outlines the Hospital's strategies, activities, progress, and status on each of these core issues.The Hospital is actively working to address each of the priority health issues through improved access to care and health-related resources, community engagement and education initiatives, improved staff capacity and skillsets, increased service-infrastructure, and through additional community, Hospital, clinic, and facility-based programs available to vulnerable populations and the public at-large.Please see the Community Health Needs Assessment Action Plan Progress Report on our website for additional and specific details on how York Hospital is addressing the significant needs identified in its most recently conducted CHNA. The full report can be found at the following web address:https://www.yorkhospital.com/wp-content/uploads/2021/05/York-Hospital-CHNA-Implementation-Plan-Progress-2020-.pdf York Hospital Part V, Section B, Line 13b: In addition to providing free care to patients with household income at or below 200% of the FPG, during 2020 York Hospital also offered a 33% discount to self-pay patients and a HELP Financial Assistance Program, which is provided to patients who had no insurance or who were underinsured. Any reduction of these patients' hospital bills was based on the applicable patients' household income and the amount owed the Hospital. York Hospital Part V, Section B, Line 16j: All patient billing statements list the Hospital's financial assistance program's applicable phone number and website-address, which the patient may then use to acquire more information or receive additional assistance. York Hospital Part V, Section B, Line 20e: The collection agency working for York Hospital is aware of the Hospital's financial assistance policy. Therefore, in the unlikely event that a patient eligible for financial assistance is not identified before their account is sent to outside collections, the collection agency itself has the ability to identify these patients who will be unable to pay their hospital bills, and who may also qualify for the assistance program. York Hospital will not impose extraordinary collection actions, such as wage garnishments, liens on residences, or other legal action, on any patient without first making reasonable efforts to determine whether that patient is eligible for financial assistance under the Hospital's policy. Schedule H, Part V, Section B, Line 7a York Hospital's 2019 Community Health Needs Assessment can be found on its website at the following web address:https://www.yorkhospital.com/wp-content/uploads/2019/07/York_Hospital_CHNA_Report-plan-2018-update.pdf Schedule H, Part V, Section B, Line 16a: York Hospital's Financial Assistance Policy is available on their website at the following web address: https://www.yorkhospital.com/financial-assistance-program/financial-assistance-policy/ Schedule H, Part V, Section B, Line 16b: Information for York Hospital's FAP Application Process is available on their website at the following web address:https://www.yorkhospital.com/financial-assistance-program/free-medical-care/Additionally, the actual Financial Assistance Application Form can be found at the following web address:https://www.yorkhospital.com/wp-content/uploads/2021/03/2021-FAP-01042021.x-1.pdf Schedule H, Part V, Section B, Line 16c: York Hospital's FAP Plain Language Summary is available on their website at the following web address:https://www.yorkhospital.com/financial-assistance-program/ Schedule H, Part V, Section B, Line 10: York Hospital's Community Health Needs Assessment (CHNA) 2020 Implementation Plan Progress Report can be found at the following web address:https://www.yorkhospital.com/wp-content/uploads/2021/05/York-Hospital-CHNA-Implementation-Plan-Progress-2020-.pdfThe full 2018-2019 CHNA is available at the following web address:https://www.yorkhospital.com/wp-content/uploads/2021/05/York-Hospitals-Community-Health-Needs-Assessment-2018-and-2019..pdf Schedule H, Part V, Section B, Line 16i: 501(r) Regulations require that hospitals translate their financial assistance policy (FAP) into primary languages spoken by limited English proficient (LEP) populations in their hospital service area. Should a LEP population demographic exceed 5% of the community residents or 1,000 individuals, whichever is less, a hospital must make available translated copies of its FAP. The York Hospital website allows its users to automatically translate the language of the Hospital FAP into English, French, or Spanish, as is preferred and applicable to the user. The Hospital website allows this functionality through a Select Language drop-down box, located in the upper left-hand corner of the Hospital home-page (https://www.yorkhospital.com/); at the user's selection, the Hospital website will automatically translate into the desired language of choice. Schedule H, Part V, Section B, Line 22: Individuals who qualify under the Hospital's financial assistance policy receive a 100% write off of charges. Accordingly, no box has been checked to indicate how the Hospital determines the maximum amount that may be charged to FAP-eligible patients. 16 1 - York Hospital Long Sands 127 Long Sands York ME 03909 See Description in Part VI 2 - York Hospital in Wells 112-114 Sanford Road Wells ME 04090 See Description in Part VI 3 - York Hospital 16 Hospital Drive 16 Hospital Drive York ME 03909 See Description in Part VI 4 - Cardiovascular Care in Newington 2064 Woodbury Avenue Suite 103 Newington NH 03801 See Description in Part VI 5 - York Hospital in Kittery 35 Walker Street Kittery ME 03909 See Description in Part VI 6 - York Hospital Kittery Medical Services 75 US Route 1 Kittery ME 03909 See Description in Part VI 7 - York Hospital 12 Hospital Drive 12 Hospital Drive York ME 03909 See Description in Part VI 8 - York Hospital in South Berwick 57 Portland Street South Berwick ME 03908 See Description in Part VI 9 - York Hospital Neurology Associates 223 York Street York ME 03909 See Description in Part VI 10 - Cardiovascular Care in Portsmouth 333 Borthwick Avenue Suite 401 Portsmouth NH 03801 See Description in Part VI 11 - York Hospital in Sanford 1474 Main Street Sanford ME 04073 See Description in Part VI 12 - York Hospital Route 1 York 343 US Route 1 York ME 03909 See Description in Part VI 13 - Webhannett Internal Medicine 277 Post Road Moody ME 04054 See Description in Part VI 14 - York Hospital in Berwick 4 Dana Drive Berwick ME 03901 See Description in Part VI 15 - Psychiatric Associates of York Hospital 32 York Street York ME 03909 See Description in Part VI 16 - York Hospital in Kennebunk 2 Independence Drive Kennebunk ME 04043 See Description in Part VI Part I, Line 3c: In addition to its financial assistance program, during 2020 York Hospital offered a 33% discount to self-pay patients and a HELP Financial Assistance Program offered to patients that had no insurance or were underinsured. Reduction of their hospital bills was based on household income and the amount owed. Part I, Line 7: York 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. Endocrinology Practiceb. Adult House Callc. Kittery Family Practice d. Emergency Room (the Hospital has ER facilities located at the main hospital campus and also in Wells)e. Home Health Agencyf. Kennebunk Walk-In (closed 3/31/20)g. OB/GYN Practice h. Wells Walk-Ini. Rheumatology Practicej. Neurology Practicek. Psychiatry Practicel. Urology Practicem. Berwick Walk-Inn. Pulmonary Practiceo. Great Works Family Practicep. Family Medicine in Wellsq. York Family Practicer. Webhannet Internal Medicine Practices. Pediatric Practicet. York Walk-Inu. Surgical Associatesv. Sanford Family Practicew. Kittery Walk-Inx. Sanford Walk-Iny. Wells Primary Carez. Center for Older Adultsaa. York Hospital Recovery Centerab. Sanford Family PracticeThe 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 $39.179 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $39.179 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 $ 9,085,029. Part II, Community Building Activities: While the Hospital does not explicitly report cost and revenue reports related to Community Building Activities on its Schedule H, Part II, the Hospital does engage in various activities that improve the community's health and safety. For example, the Hospital offers numerous scholarships and financial assistance programs to staff and students, to lessen the burden of higher education and to increase the total number of train and qualified professional health care providers in the area. The Hospital also offers transportation services within its operating area to help patients get to and from their medical appointments or to deliver prescription medications; without the Hospital's intervention, many of these patients would not be able to access health care services. Additionally, York Hospital collaborates with many local social service agencies to design and deliver year-round programs to meet the basic needs of the Hospital's community, and to promote stronger physical, emotional, spiritual, and financial health. These are just a few of the many ways in which the Hospital is engaging with its community to promote health, safety, and general well-being. Part III, Line 2: The Hospital utilized Worksheet 2 from the IRS Schedule H instructions/guidance to determine the ratio of patient care cost to charge (43.94% for fiscal year 2020) and multiplied this ratio by the Hospital's total bad debt expense of $9,085,029 to determine the Part II, Line 2 bad debt expense of $3,992,296. Part III, Line 3: Patients who qualify for financial assistance have 100% of their liability written off, so no portion of it is included in the Hospital's bad debt expense. Part III, Line 4: See Footnote 2 on page 10 of the attached audited financial statements. Part III, Line 8: 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 III, Line 8 was Schedule H, Worksheet B, Line 2 & 6, Medicare Allowable Costs and Payments Related to Subsidized Health Services. The Hospital utilized the Medicare cost report estimated cost and payment for these services. The Hospital believes that its hospital clinical services, hospital-owned physician practices, emergency room, and home health agency listed above should be considered a community benefit, as community members benefit by having easy access to these services, facilities, and programs which are both offered and subsidized. These facilities and programs are offered and thus subsidized through the Hospital. Part III, Line 9b: Accounts with self-pay balances that show no evidence of patient payments or eligibility for financial assistance that have completed a patient dunning cycle (120 days approximately) may be transferred to a collection agency. Any patient account that has applied for any of York Hospital's financial assistance programs and supplied all required documentation will be held in a pending status until a determination is made. Part VI, Line 2: York Hospital has focused on four goals identified in its Community Health Needs Assessment: 1. Mental Health2. Substance Use and Misuse3. Healthy Aging4. Food InsecurityYork Hospital has posted the most current CHNA, Implementation Plan, and Implementation Plan Progress Report for the following CHNA goals at the following address: https://www.yorkhospital.com/990-chna/The Hospital's most recent CHNA identifies a number of core objectives as part of its overall community assistance goals, which are detailed below.Mental Health:- Increase access to mental health services and improve collaboration between service providers, especially in helping youth and young adults.- Build capacity of York Hospital staff to understand mental health and increase ability to provide support for each other and patients.- Build capacity of families and professionals to understand mental health and increase ability to provide support and access services.- Help reduce stigma through regular training and public awareness campaigns.Substance Use and Misuse:- Increase capacity to provide medication assisted treatment through the YH Recovery Center.- Provide intervention, treatment, and recovery services to adolescents.- Support the Choose To Be Healthy Coalition (CTBH) in preventing youth substance use disorders with evidence based strategies. - Introduce community based recovery supports.- Provide regular community education.Healthy Aging:- Improve access to health care and social services for older populations, especially those affected by isolation and financial stress.- Provide opportunities for pro-social and healthy multi-generational activities.- Increase access to healthy meals for elderly and homebound populations.- Provide regular community education to our aging population, focused on topics of interest surrounding health and well-being.Food Insecurity:- Increase access to healthy meals for elderly and homebound populations.- Increase access to healthy foods for families, especially those at living with a higher risk for poor nutrition.These priorities were chosen through a process that examined data from state and county sources as well as local data including the York Hospital Community Themes and Strengths Survey results, local forums, discussion groups and one-on-one key informant interviews. In choosing its community's significant health needs and priorities, the Hospital used the following criteria:- Data showing significant problem(s) compared to past and/or to the state numbers- Gaps in existing services and efforts- Concern for issue demonstrated by community members and collaborating partners- Capacity at York Hospital and among partners to implement actions resulting in measurable outcomesThe quantitative data for the CHNA comes primarily from the 2018 Maine Shared Community Health Needs Assessment process and includes multiple secondary sources including the US Census, the Maine Behavioral Risk Factor Surveillance System, the Maine Integrated Youth Health Survey, and several State of Maine departments. The complete reports and data sources for this information can be found at www.mainechna.org.York County and local area data used in the 2018-2019 CHNA include:- Demographic and socio-economic factors;- Health care access;- Health status;- Disease incidence and prevalence; and- Health behaviors and risk factors.Qualitative data was compiled from:- Group discussions with hospital staff and community members;- Key informant interviews with stakeholders and patients;- A Community Themes & Strengths online survey; and,- A York County Community Health Forum.The total amount of information that can be compiled from these data-sets allows the Hospital to assess the health care needs of the community it serves. Part VI, Line 3: York Hospital is a non-profit healthcare provider. York Hospital is committed to providing financial assistance to every person in need of medically necessary treatment even if that person is uninsured, under insured or ineligible for government programs, or unable to pay based on their financial situation. The patients' billing statement lists the phone number and website address to use for more information regarding the Financial Assistance Program. York Hospital will accept a variety of payment methods and will offer resources to assist in resolving outstanding balances. The Hospital will assist patients in applying for known programs of financial assistance that may be applicable. York Hospital will treat all patients with loving-kindness, respect and compassion.The Hospital offers free care to patients whose income is twice the federal poverty income level. For example, an uninsured family of 4 whose total annual income is $51,500 or lower qualify for free care at York Hospital. Based on this program alone, York Hospital provides millions of dollars' worth of free care to patients who utilize our services every year and FAP-eligible individuals can't be charged more than the amounts generally billed (AGB) for an emergency or other medically-necessary care. Additionally, York Hospital's Prescription Assistance Program (PAP) helps qualifying patients without prescription drug coverage get the medicines they need through the program that is right for them. Many can get their medications free or nearly free.Financial assistance is available for any resident of the State of Maine indicating the inability to pay a medically necessary bill. The Hospital will evaluate a patient's ability to pay, their available insurance and health coverage, and their financial status when determining if a patient if eligible for free care or financial assistance. The evaluation process may require a patient to provide verification of their income.Lastly, The Notice of York Hospitals Financial Assistance Policy shall be distributed by means of posting notices in prominent, well-traveled patient locations while also being placed in the information section of patient statements. The Financial Assistance Policy will also be made readily available on the York Hospital website and on brochures in common patient locations. These notices will be posted in the language most commonly spoken by the surrounding community. Part VI, Line 4: York Hospital's primary service area includes the following communities in Southern York County Maine: Berwick, Eliot, Kittery, North Berwick, Ogunquit, South Berwick, Wells, Sanford, Kennebunk and York. Additionally, the Hospital's secondary service area includes the following communities: Lebanon, Maine, and Portsmouth, Dover, Rollinsford, and Somersworth, New Hampshire.Approximately 5.7% of York Hospital patients utilize Medicaid and approximately 51% of York Hospital patients utilize Medicare. According to the United States Census Bureau, as of the July 1, 2019 census data, 7.9% of York County Residents lived in poverty (http://www.census.gov/).The 2018-2019 CHNA reports that the Hospital's immediate service area of eleven towns had a population of just under 100,000 people. York County continues to be one of the healthiest parts of Maine. Across economic measures, York County ranks more positively than the Maine state-average on median household income, unemployment, and poverty.According to the United States Census Bureau, the overwhelming majority of the County's population is white (white alone)(93.9%), with Hispanic (1.8%), Asian (1.4%), Black/African American (1.0%), American Indian (0.4%) or some other race (1.5%) making up the difference.Despite the County's relative economic success and good-health, the region still struggles with health and social issues that are somewhat more hidden in the County's small towns. The Hospital's priority communities see affordable housing and food security as two priorities to improve to make the communities healthier. An aging population and more families living together due to economics and behavioral health issues are factors in some of Hospital's challenges to providing care. Part VI, Line 5: York Hospital is a not-for-profit 79 bed hospital that has been serving the needs of our community, patients and visitors for over 110 years. The Hospital maintains a dual purpose to provide high quality health care services to care for all, and to improve the health of those living in our expanding service area community. Medical services are offered at the Hospital's main campus in York and at satellite locations throughout the Hospital's service area in Southern York County. York Hospital's service area covers an approximately 250 square mile area, with a combined population of just under 100,000 residents. The Hospital's Board of Trustees is made up of members from all communities served by York Hospital. All medical staff are eligible to participate with the Board if they meet privileging criteria. All hospital profits are reinvested in the facilities, equipment and services for the communities.York Hospital is committed to providing care for all, including the under- and uninsured within the Hospital's community. York Hospital has been an integral part of the quality of life in southern Maine for over a century. The Hospital's devotion to its values, and its responsiveness to the community it serves, truly sets it apart and is what makes the Hospital one of the most respected and successful organizations in Maine. York Hospital's success in meeting the needs of the community is based on one simple tenet: provide patients and their families with the highest quality, most accessible, sensitive and compassionate medical care. York Hospital responds to community needs for clinically excellent healthcare, close to home, by partnering with tertiary care hospitals in Boston and Portland. To provide patients with easy access to care, York Hospital has community outpatient medical facilities in Berwick, Kennebunk, Kittery, Sanford, South Berwick, Wells and York. In addition to providing needed medical/healthcare services, the hospital supports its communities in many meaningful ways. For example, the 2018-2019 CHNA reports that York Hospital Transportation Services provided 13,315 rides (over 1,000 rides/month) to help patients get to and from medical appointments or to deliver prescription medications to their homes. This same fleet of vehicles, staffed largely by volunteer drivers, also delivered over 3,000 meals to residents and families who lacked access to fresh, nutritious meals due to illness, injury or other physical barriers.The Hospital collaborates with many local social service agencies to design and deliver year-round programs to meet the basic needs of our community in support of stronger physical, emotional, spiritual, and financial health. York Hospital continues a long history of listening to the communities it serves in order to help improve the health of those living in Southern York County Maine. Part VI, Line 6: Not Applicable Schedule H, Part V, Section D: Non-Hospital Facility Services Offered:1. York Hospital in Wells: Urgent Care, Walk-In Clinic, Lab, Imaging, Cardiology, Breast Care, Wound Care, Physical Therapy, Oncology, OB/GYN practice, Pediatric Associates, Cardiovascular Practice, Primary Care.2. York Hospital @ Long Sands: Family Practice, Physical Therapy, Oncology, Home Care, Cardiovascular Care.3. York Hospital in Kittery: Family Practice, Walk-In Clinic, Lab, Imaging, OB/GYN Practice.4. York Hospital in South Berwick: Family Practice, Imaging, Physical Therapy, OB/GYN Practice.5. York Hospital Neurology Associates: Neurology6. York Hospital in Berwick: Walk-In Clinic, Retail Pharmacy, Imaging, Lab.7. York Hospital Kittery Medical Services: Oncology, Physical Therapy.8. York Hospital @ Route 1 York: Walk-In Clinic, Lab, Imaging, Pediatric Rehab.9. York Hospital @ 12 Hospital Drive: Internal Medicine, Cardiovascular, Urology, Diabetes, Endocrinology. 10. Psychiatric Associates of York Hospital: Psychiatric Care.11. York Hospital in Sanford: Walk-In Clinic, Lab, Imaging, Family Practice.12. York Hospital in Kennebunk: Walk-In Clinic, Lab, Imaging. 13. Cardiovascular Care in Newington: Cardiovascular Care.14. Cardiovascular Care in Portsmouth: Cardiovascular Care.15. York Hospital at 16 Hospital Drive: Surgery Associates, Pediatric Associates, Pulmonary Associates, OB/GYN Practice, Rheumatology Associates. 16. Webhannett Internal Medicine: Internal Medicine. 1 Health Stream Online Learning Library 1000 48355 Continuing Education/Seminars and Workshops 49 21985 BLS-ACLS Training 250 7124 New Graduate Nursing Orientation 1 3437 Part I, Line 2: The scholarship funds are monitored by the Education Committee, which manages the funds in accordance with the donor's wishes. The committee does this by determining what the spending policy is at the beginning of the year by fund category. Some funds are restricted to nursing education, others to non-nursing education. The funds can be used for those who want to attend workshops or seminars or to further their education through a post-secondary accredited school. Funds are also used for orientation programs. Requests for funding must be made through a formal process. Each person requesting funds must prepare an application which must be approved by a director or leader. The form is then submitted to the Education Committee for review and approval. All amounts are also tracked and reviewed in accounting to ensure that the monies are used in accordance with the donor's wishes. Annually, the Director of Development reports fund activity directly to donors that request it. X 0 1 X X X 0 1 0 0 0 0 0 1 0 Jud Knox Trustee/Pres./Leader (end 3/2020) 89607 0 0 0 2368209 0 3203 0 8188 0 2469207 0 1698365 0 Peter Dourdoufis MD Cardiologist 453409 0 388701 0 0 0 5235 0 41478 0 888823 0 0 0 Jeffrey Colness MD Cardiologist 471052 0 258134 0 0 0 6734 0 17773 0 753693 0 0 0 Jeffrey Lockhart MD Physician 548277 0 0 0 0 0 6946 0 24461 0 579684 0 0 0 Daneille Leighton Radiologist 478339 0 35309 0 0 0 0 0 38907 0 552555 0 0 0 Jonathan Bridges MD Cardiologist 465304 0 39954 0 0 0 6396 0 15265 0 526919 0 0 0 Jennifer Cutts MD CO-CEO/Trustee/Radiologist 477848 0 0 0 0 0 2475 0 41389 0 521712 0 0 0 Marilyn McLaughlin MD Trustee/Oncologist 386703 0 0 0 0 0 6270 0 2801 0 395774 0 0 0 Nathan Jean MD Trustee/Physician (end 6/2020) 246731 0 72295 0 0 0 3891 0 33874 0 356791 0 0 0 Robin LaBonte CO-CEO, CFO/Leader 310924 0 0 0 0 0 6488 0 38803 0 356215 0 0 0 Erich Fogg PA-C Trustee/Physician Assistant 234861 0 0 0 0 0 4017 0 35163 0 274041 0 0 0 Lawrence Petrovich MD Trustee/Cardiologist 157461 0 69294 0 0 0 2856 0 36018 0 265629 0 0 0 James Gilroy MD Trustee/Physician 142843 0 24286 0 0 0 2491 0 30455 0 200075 0 0 0 Part I, Line 1a Minimal rotary dues for president. Part I, Line 4b Jud Knox served as the Hospital's President from November 1982 until March, 2020. Jud Knox had a SERP Defined Benefit Plan with the Hospital at that time. As of December 31, 2019, the total obligation of the Hospital under this agreement was $2,972,680. The obligation was included in long-term pension and other obligations on the Hospital's balance sheet, and amounts funded for the plan were included in investments. In March of 2020, Jud Knox entered into a separation agreement with the Hospital, which was fully executed by December 31, 2020. As part of this agreement, Jud Knox's SERP Defined Benefit Plan was settled, and the Hospital was released of this obligation. Mr. Knox received total compensation in settlement of the plan in the amount of $2,210,000. The entire payment was included on his 2020 Form W-2 compensation, and is also incorporated into Mr. Knox's compensation figures reported on this Schedule J, Part II, as part of his column B(iii) wages. The establishment and subsequent payout of this plan is in recognition of Mr. Knox's multiple decades of distinguished service to the Hospital. Part I, Line 7 Performance-based variable compensation which is subject to review annually. A MHHEFA 010314384 560427JA5 2010-06-24 113477369 Refinance 1993, 1998, 1999A & 2001D 0 0 0 B MHHEFA 010314384 56042RLG5 2017-06-27 5004813 Refinance 2007A 0 0 0 C MHHEFA 010314384 56042RTR3 2019-07-31 54640000 Refinance 2008C, 2008D, 2009A, 2010A, and 2017A bonds 0 0 0 D MHHEFA 010314384 56042RUP5 2019-11-06 36415000 Imaging and surgical equipment; compounding and cath lab renovation 0 0 0 A 2429250 6081252 607056 5418358 55838 2010 1 1 1 1 B 865000 5908558 483431 5360081 65045 2017 1 1 1 1 C 430000 3119187 542055 2542023 35110 2019 1 1 1 1 D 80000 4338016 291650 55176 3991190 2019 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 Form 990, Schedule K, Part III, Line 9, IV, Line 7, and Part V: Although formal, written policies are not in place to ensure that violations are timely identified and corrected, the bonds issuer, Maine Health & Higher Educational Facilities Authority (MHHEFA), monitors Section 148 requirements for York Hospital until funds are spent down enough to ensure none of the Hospital's tax exempt bonds become arbitrage bonds. Bond proceeds are placed in low yield investments and no funds are released to York Hospital until expenses have been incurred and receipts are provided to MHHEFA. Furthermore, the Hospital works closely with MHHEFA to ensure that safeguards are in place to take appropriate and timely remedial action should any violations of federal tax requirements occur. Form 990, Part VI, Section B, line 11b The Hospital's Form 990 is prepared with the assistance of an independent public accounting firm and thoroughly reviewed by the Hospital's finance staff before it is filed. The 990 is distributed to the Board of Trustees for their review after it is filed. Form 990, Part VI, Section B, line 12c Annually the Board of Trustees and the officers sign a conflict of interest form. Form 990, Part VI, Section B, line 15 The executive committee of the Board of Trustees utilizes an outside firm's database of CEO salaries to determine the CEO's compensation. The CEO determines the compensation of other officers or key employees using an outside firm's data to make sure the compensation is market based. Form 990, Part VI, Section C, line 19 The Hospital's governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part VI, Section A, Line 16b: While York Hospital does not have a formal joint venture policy that is written, it does have procedures in place to ensure that hospital-related assets are not misappropriated which includes periodic review of any joint venture related activity. Furthermore, the Hospital's joint venture arrangements better enable it to provide health-care related services to the community it serves. Form 990, Part XI, line 9: Adjustment to long-term pension obligations -871,383. Net periodic pension cost -1,964,115. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. York Health Services 15 Hospital Drive York ME 03909 020469065 Heart health ME 501(c)(3) Line 10 N/A 0 Shields Imaging at York Hospital 700 Congress Street Suite 204 Quincy MA 02169 815066570 Imaging ME York Hospital Related 73828 85596 0 1 0.50000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Shields Imaging at York Hospital LLC S 75000 Actual per books