2019-08-14T08:17:23-05:00 2018-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2017-10-01 010234189 Northern Maine Medical Center NORT 2078343155 194 East Main Street Fort Kent ME 04743 Cindy Daigle CFO 2078343155 2019-08-06 1 Barbara J McGuan CPA P00219457 2077752387 2019-08-06 69.49.157.66 2019-08-06 14:30:22 ED P 8137B2580CE35FA01CCDEB6EA4E8E3B48DE58F96 E262D3C9A45A77A46A0A2832CF74466488750570 2017 2019-02-21 02:37:17Z Peter J Sirois 194 East Main Street Fort Kent ME 04743 57610494 0 X www.nmmc.org X 1948 ME Acute care & long term care hospital and mental health services facility. 11 9 597 52 1061740 -24487 96692 190974 59221682 54926458 126499 131272 309494 97063 59754367 55345767 0 0 0 0 33146288 34453237 0 0 0 18338345 20204548 51484633 54657785 8269734 687982 49674896 50508413 14220016 14352224 35454880 36156189 The mission of Northern Maine Medical Center is to provide, coordinate, or support access to high quality, affordable health care and to positively impact our communities' quality of life by improving health status. 0 0 49048749 54926458 Medical care & ancillary services, nursing home & skilled services, physician services. 49048749 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 182 0 1 597 1 1 1 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Cindy Daigle 2078343155 194 East Main Street Fort Kent ME 04743 John Ezzy Chair 1.00 X X 0 0 0 Mark Morneault Vice-Chair 1.00 X X 0 0 0 David Desjardins Director 1.00 X 0 0 0 James Thibodeau Director 1.00 X 0 0 0 Robert Bellefleur Director 1.00 X 0 0 0 Ronald Daigle Past Director 1.00 X 0 0 0 Norman Fournier Director 1.00 X 0 0 0 Donald Guimond Director 1.00 X 0 0 0 Erin Soucy Director 1.00 X 0 0 0 Michael Sullivan MD Past Director 28.00 X 250368 0 30241 Dan Vaillancourt Director 1.00 X 0 0 0 Steven Pelletier Director 1.00 X 0 0 0 Erik St Pierre MD Director 50.00 X 684563 0 28538 Peter J Sirois President/CEO 50.00 X 311771 0 31240 Cindy L Daigle Treasurer/CFO 50.00 X 198488 0 27555 Alain Bois Secretary/COO 50.00 X 175108 0 16050 Rodney Lahren MD General Surgeon 50.00 X 565897 0 29792 John Hallberg MD Orthopedic Surgeon 50.00 X 554571 0 28996 Baharak Bagheri MD Radiologist 50.00 X 552166 0 18404 Mark Overton MD Psychiatrist 50.00 X 516622 0 19738 James Harris MD Physician 50.00 X 503613 0 29971 4313167 0 260525 51 0 1 0 Medhost of Tennessee Inc 2739 Momentum Place Chicago IL 60689 Software & Support Services 496895 CARY Medical Center 163 Van Buren Rd Suite 1 Caribou ME 04736 Off-Site Laboratory Services 436668 Philips Medical Systems PO Box 100355 Atlanta GA 303840355 Equipment & Support Services 410626 IBM Corporation PO Box 676673 Dallas TX 752676673 Equipment & Support Services 346498 Ken L Electric PO Box 291 Saint Agatha ME 04772 Electrical supplies 208238 16 190974 190974 Patient Service Revenue 623000 86828565 85766825 1061740 Miscellaneous Revenue 623000 4195509 4039259 156250 Meaningful Use Revenue 623000 605553 605553 Provision for Bad Debt 623000 -2239750 -2239750 Contractual/Char. Adj. 623000 -34463419 -34463419 54926458 78163 78163 53487 0 53487 53487 53487 2286443 6700 2237444 2590 48999 4110 53109 53109 68269 24693 43576 43576 55345767 53708468 1061740 384585 1753922 993709 760213 27207283 24746369 2460914 458543 420305 38238 3267187 2978357 288830 1766302 1572009 194293 41728 41728 92115 81982 10133 7342 7342 2407183 2177483 229700 75230 67707 7523 2222692 1575203 647489 2448966 2235810 213156 97532 61134 36398 319313 287382 31931 2709958 2438962 270996 1118151 1006336 111815 Medical Supplies 7591175 7340171 251004 Health Care Provider Ta 999833 999833 Dues & Subscriptions 73330 65997 7333 54657785 49048749 5609036 0 X 270285 274615 14492248 17869592 6551035 6324896 27564 796540 1190113 409027 436628 52069348 32619509 19243933 19449839 2578345 639536 0 206429 5333483 4089201 49674896 50508413 4406982 4645752 7938012 7612309 1875022 2094163 14220016 14352224 X 34974068 35550663 480812 605526 35454880 36156189 49674896 50508413 687982 13327 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 8631 8631 0 Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which is attributable to lobbying expenses. 235224 235224 29188749 12854524 16334225 20620134 19064335 1555799 2025241 700650 1324591 19449839 Deferred Compensation 1257732 Cash Surrender Value of Life Insurance 386026 Estimated Third-Party Payor Settlements 2445443 4089201 Deferred Compensation 1257732 Estimated Third-Party Payor Settlements 836431 2094163 X Part X, Line 2: The Medical Center and VMA are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Medical Center's tax positions and concluded the Medical Center has maintained its tax-exempt status, does not have any significant unrelated business income and has taken no uncertain tax positions that require adjustment or disclosure in the consolidated financial statements. 2018 Cancer Fund Tour 27452 27452 1175 270 309 Annual Auction 40817 40817 275 11872 2841 5766 450 1735 68269 68269 275 13047 3111 6075 450 1735 24693 43576 1 1 X 1 X 1 X 0 1 0 1 1 460887 460887 0.00840 2406965 2080938 326027 0.00600 2867852 2080938 786914 0.01440 24197349 20200075 3997274 0.07310 24197349 20200075 3997274 0.07310 27065201 22281013 4784188 0.08750 1 1281572 18486439 18745834 -259395 X 1 1 2 1 Northern Maine Medical Center 194 East Main Street Fort Kent ME 04743 www.nmmc.org 38377 X X X 2 Forest Hill 20 Bolduc Avenue Fort Kent ME 04743 X Licensed Hospital Related Facility Northern Maine Medical Center 1 0 0 1 X X X X X X X X X 17 1 1 1 1 X www.nmmc.org X 1 17 1 www.nmmc.org/about-us/ 0 1 X 150.000000000000 200.000000000000 1 1 X X X 1 X http://www.nmmc.org/billing/ X http://www.nmmc.org/billing/ X http://www.nmmc.org/billing/ X X X X X X 1 X 0 X X X 1 X 0 0 Northern Maine Medical Center Part V, Section B, Line 3j: The Community Health Needs Assessment was developed by the Eastern Maine Health System (EMHS) utilizing a consulting firm called JSI to support member organizations and community partners' work to conduct the needs assessments and to develop strategies to improve the health of the people we serve. The consultants who developed the survey tool worked with individuals from a broad spectrum of backgrounds as follows: the Maine Center for Disease Control and Prevention, the District Public Health Liaisons, Federally Qualified Health Centers, Public Health and Community Services across the state of Maine and others who provided generous support and insights. Target audience was anyone with a vested interest in public health and healthcare including medical staff, community board members, volunteers, donors and members of the general public. The surveys were conducted across the eight participating Maine Counties of Aroostook, Cumberland, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington by 17 partnering Maine Hospitals, 5 local Public Health Districts and 11 Healthy Maine Partnerships. The following sectors were represented: - Healthy Aroostook- Northern Maine Medical Center- Public Health Nursing- Aroostook Mental Health Services- Wabanaki Public Health- Town of Madawaska- UMFK Student- Power of Prevention- Fish River Rural Health - Maine Quality Counts- U. Maine Cooperative Extension- Visiting Nurses of Aroostook- Town of Fort Kent- The Aroostook Medical Center- Fiddlehead Focus News- Maine CDC- Pines Health Services- University of Maine at Fort Kent- Northern Maine Development Commission- Community Voices- Community Members Northern Maine Medical Center Part V, Section B, Line 5: Attention was taken to include a broad representation from the community. This took place in two ways. First, the stakeholders were invited to participate in public forums. Second, four work groups were convened to address each of the four priorities selected. A facilitator was identified for each group to lead the ongoing discussion and work to address strategies and action plans for each of the priorities. The following sectors were represented:- AMHC- UMFK Nursing Division- NMMC Director of Nursing- NMMC Pharmacist- Life by Design- Agency on Aging- NMMC Care Manager- Valley School Substance Abuse Counselor- UMFK Behavioral Health- U. Maine Cooperative Extension- NMMC Social Worker- NMMC NDPP Trainer PA - Hope & Justice- NMMC Financial Counselor- NMMC Practice Coordinator- NMMC Community Educator- Power of Prevention- FK High School Wellness- NMMC Psych Unit Leader- FK Recreation Director- UMFK Student- NMMC Communications- Catholic Charities- FK Community Development Northern Maine Medical Center Part V, Section B, Line 6a: The following hospitals were included in the collaborative community health assessment: Cary Medical Center, Down East Community Hospital, Houlton Regional Hospital, Maine Coast Memorial Hospital, Mayo Regional Hospital, Millinocket Regional Hospital, Mount Desert Island Hospital, Northern Maine Medical Center, and Redington-Fairview General Hospital. Northern Maine Medical Center Part V, Section B, Line 6b: Aroostook Mental Health Center - St. John Valley Public Schools - University of Maine, Fort Kent, Behavioral Health and Nursing Divisions - Fish River Rural Health Center - Healthy Maine Partnerships - University of Maine Cooperative Extension Service - Town Government and Recreation Departments - Life by Design Mental Health - Clergy - Aroostook Agency on Aging Northern Maine Medical Center Part V, Section B, Line 7d: The Maine Shared Community Health Needs Assessment (CHNA) - Aroostook District 2018 dated 9/26/18 is posted on the NMMC website. The report is also available free upon request. Historic CHNA's are also available on Northern Maine Medical Center's website with instructions on how to access the updates. In addition, contact information is provided on the website for individuals who wish to request a free paper copy. Individuals may also call NMMC to request a free copy. Northern Maine Medical Center Part V, Section B, Line 11: The CHNA cycle ending in 2017 reported several successes related to the three priorities from that CHNA cycle of: substance abuse, healthy food and nutrition and cardiovascular health. The measures of success from the prior CHNA are as follows:Measure of success for Priority #1 Substance Abuse: 1. Environmental tobacco smoke exposure in high school students has been reported at nearly 10% lower in 2017 than in the previous reporting period according to the Aroostook County Health Data Profile. 2. A partnership was created between NMMC providers, Jennifer Bresett, FNP and Dr. Guy Raymond, with AMHC Substance Abuse Counselor, Katia Sirois, to offer a Medication Assisted Treatment program for opioid addicted patients. Patients are seen by appointment on a weekly basis.3. NMMC has created a very active Opioid Stewardship and Action Committee comprised of representation from providers, pharmacists, nurses, quality department personnel and managers. As a result, providers have received further education about tapering guidelines, formal protocols and other resources to make available to patients. Among the resources are: use of non chemical management of pain such as acupuncture, use of physical activity and Cognitive Behavioral Therapy. 4. With the support from the Aroostook Power of Prevention office, we have made available hundreds of copies of the local resource book called, The Pathfinder. These books are filled with comprehensive resources available to patients throughout Aroostook County. Power of Prevention is currently working on making the resource available electronically at which time we will post it on our website to reach more people. 5. Resource cards were created to provide information to patients seeking alternatives such as acupuncture and Cognitive Behavioral Therapy to treat their addiction. 6. A food drive was held in May to support the local food pantry. Also, social media was used to encourage the public to donate surplus vegetables from home gardens. Measure of success Priority #2 Healthy Food and Nutrition: 1. The Courtesy Home Visit program was expanded to include more patients in the program. Also, eligibility requirements of the free meal service were expanded to increase the amount of patients serviced with free meals delivered to patients who were identified to be in need of nutritional support after discharge from the hospital. 2016 -period of 12 months = 2247 meals provided 2017 -period of 12 months = 1,053 meals were purchased by NMMC and provided to patients in the home after discharge from the hospital. In previous years, 14 days of meals were provided. At this time, 7 days' worth of meals are provided which explains the reason for the reduced numbers. There are actually more patients being served since the expansion of the home visit program. In 2018, 1,330 meals were provided to patients after discharge from the hospital. A total of 58 patients were referred to Case Management from the ED screening for food insecurity. This is a 100% increase in referrals and the number of patients who were assisted with resources. 2. The NMMC Caf has implemented changes to encourage and facilitate healthy food choices. A new program was launched this year called Free Fruit Friday. The intent of the program is to further encourage healthy snack choices. Also, food preparation is done using heart healthy ingredients. 3. Initially implemented with the support of a grant to Maine Partners in Community Health and with support from a Healthy Maine Partnership, a pilot program in the Emergency Department was launched to screen all patients for food insecurity and to connect them with food sources and Care Management when appropriate. During the assessment period in the Emergency Department, 100% of patients were screened for food insecurity. A total of 23 patients were assessed as food insecure and all 23 patients were provided with resources and referred to Case Management for follow up.Measure of Success Priority #3 Cardiovascular Health: 1. Our partnership with the town of Madawaska Wellness Center continues and the service is active with employees and members of the public. Additionally, the center is now offering Yoga and Zumba classes.2. A similar partnership in Fort Kent continues to exist as well and serves a portion of the service area. 3. The brochure created in collaboration with multiple community stakeholders to make free indoor walking access available to the public was revised to include the opportunities available through the RSVP program. The brochure is widely distributed in public areas of the hospital and it is also available on the hospital website. 4. A total of 115 fifth grade children were exposed to and participated in a tobacco awareness program.5. The number of Bone Builder sites was tripled in the past year as well as the members participating in the free classes. 6. Subscribers to the NMMC e-news increased by 25% in the past year. 7. The implementation of the Better Breathing, Better Living program occurred part way through the year, therefore, outcome data is not yet available. Similar priorities have been identified in this new CHNA cycle, with the addition of a new priority in the area of mental health, requiring continued strategies for improvement, actions will be expanded based on need, community interaction and lessons learned. The NMMC Board of Trustees approved high level action plan has begun moving forward as follows:Priority #1 Physical Activity, Nutrition and WeightFocus on gaps identified to provide physical activity opportunities and develop a plan to engage local students Expand food insecurity assessments in order to identify and serve a greater portion of the populationCreate a mechanism to better communicate available physical activity and nutrition programsPriority #2 Mental Health and AccessCreate community partnerships to support the school age population dealing with mental illnessPromote public education through interagency collaborationDevelop a framework of agency resourcesUtilize local university for grant writing resourcesCreate more opportunities to screen for mental illnessDevelop community-wide speaker's bureauPriority #3 Substances and Alcohol Use (includes tobacco use)Collaborate with the National Alliance on Mental Health for services not currently in placeFunnel community events through a central point to reach more of the publicOffer an annual retreat to convene community partners for brainstorming and strategic planning to address substance and alcohol usePriority #4 Cardiovascular DiseaseCreate a network of public education using multiple formatsImplement a collaborative tobacco cessation programImplement a feasibility study for reintroducing cardiac rehabilitationPromote heart health in conjunction with American Heart Association initiativesOther areas of need identified for the current CHNA cycle, besides the top four priorities listed above, will remain on the table to be addressed as resources become available. These are: cancer care, diabetes and elder health. In terms of cancer care, the data reported reduced cases. Related to diabetes, priority #1 indirectly addresses this area with the education and resources on healthy eating and physical activity. Lastly, elder health was not specifically listed, however, several of the physical activity and healthy eating initiatives do address the older population so although it was not selected as a top priority, it is being addressed on multiple fronts. Northern Maine Medical Center Part V, Section B, Line 24: Individuals are billed at gross amounts and charges are adjusted accordingly, if they qualify for assistance. Part I, Line 7: The amounts reported on Lines 7a & 7b were computed using a cost-to-charge ratio. Amounts on line 7g are derived from internal financial/cost accounting systems. Part I, Line 7g: Subsidized health services on line 7g include physician clinics, rural health centers, a skilled nursing facility, and emergency room. Part II, Community Building Activities: N/A Part III, Line 4: In evaluating the collectibility of accounts receivable, the Medical Center analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for doubtful accounts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Medical Center analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for doubtful accounts, if necessary. For receivables associated with self-pay patients (which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Medical Center records a provision for doubtful accounts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. Part III, Line 9b: Our collection policy stipulates that NMMC makes reasonable efforts to identify those individuals that may qualify for assistance. In the first 120 days, patients may request to begin the Financial Assistance process and collection activity is put on hold until the process is completed. If the patient qualifies, no further collection activity will occur going forward for that account. If patient does not qualify, collection activity resumes from point it was put on hold. Part VI, Line 2: Please see Schedule H, Part V, Section B, Line 5 for a description of NMMC's assessment process. Part VI, Line 3: We notify patients and customers about access to assistance in various ways. The simplest way is the signage, pamphlets, and educational material located around the Organization and in various offices. In every patient access/patient financial services area is a sign explaining the availability of free/discounted care and the Federal Poverty Guidelines. There are also pamphlets located in the outpatient areas explaining free/discounted care and providing information on Mainecare. For inpatients, there is a book in each room which provides all the information on all programs available.Through the patient accounting department, we provide information aboutthese statements. We also counsel patients on the phone about all theprograms available whether it is Medicaid or a hospital program. Part VI, Line 4: Northern Maine Medical Center is a 94 licensed bed (29 A&P which includes swing beds, 6 ICU beds, 14 Psych beds, and 45 SNF beds), full-service, acute-care, not-for profit hospital located in Fort Kent, Maine (Aroostook County). The Hospital is accredited by the joint commission and its mission is to serve its communities with excellence in health care. Its services include acute inpatient, psych inpatient, SNF, 24-hour emergency center, diagnostic, and surgical services. Along with these hospital services, the Hospital employs/contracts with the majority of primary and specialty care physicians in the area. Part VI, Line 5: Northern Maine Medical Center is a local, not-for-profit hospital that serves its local communities and people regardless of their ability to pay. Northern Maine provides financial assistance and sliding scale discounts to self-pay and low-income patients. Also the Hospital participates in government-sponsored health care programs including Medicare, Medicaid, VA, and Tricare. The volunteer board of trustees sets the strategic direction for the Hospital and is comprised of community members from the Hospital's service area. This group is made up of local business owners, professionals, and retirees. Northern Maine's non-profit status allows the Hospital to reinvest any excess of revenues over expense back into the Hospital to continuously improve the medical care it delivers. The Hospital allows access to healthcare that would otherwise be difficult. The Hospital is the main employer for the local physicians, including specialty physicians that would otherwise have to be accessed out of the area. X X X 0 0 0 0 0 0 0 1 0 Michael Sullivan MD Past Director 227108 0 5000 0 18260 0 7706 0 22535 0 280609 0 0 0 Erik St Pierre MD Director 658651 0 7600 0 18312 0 8100 0 20438 0 713101 0 0 0 Peter J Sirois President/CEO 285337 0 25192 0 1242 0 8100 0 23140 0 343011 0 0 0 Cindy L Daigle Treasurer/CFO 194409 0 3750 0 329 0 5953 0 21602 0 226043 0 0 0 Alain Bois Secretary/COO 171900 0 3077 0 131 0 1610 0 14440 0 191158 0 0 0 Rodney Lahren MD General Surgeon 545339 0 18654 0 1904 0 8100 0 21692 0 595689 0 0 0 John Hallberg MD Orthopedic Surgeon 505937 0 28654 0 19980 0 8100 0 20896 0 583567 0 0 0 Baharak Bagheri MD Radiologist 541310 0 9615 0 1241 0 8100 0 10304 0 570570 0 0 0 Mark Overton MD Psychiatrist 482332 0 33000 0 1290 0 0 0 19738 0 536360 0 0 0 James Harris MD Physician 476757 0 7615 0 19241 0 8100 0 21871 0 533584 0 0 0 Part I, Line 7 The bonus paid to Peter Sirois, CEO, has set point criteria for earning specific bonus levels/amounts. The Board awards points based on the accomplishment of pre-established objectives/targets. Points are tabulated with the final score determining bonus level achieved. The Board meets with the CEO to discuss performance including those objectives/targets and based on that meeting award the points and derive the bonus amount. Peter Sirois, Cindy Daigle, Alan Bois, Dr. Michael Sullivan, Dr. Erik St. Pierre, Dr. Rodney Lahren, Dr. John Hallberg, Dr. Baharak Bagheri, Dr. Mark Overton, and Dr James Harris received bonuses equal to one week's pay as appreciation for the hard work employees had been putting in over the past few years. Dr. Rodney Lahren, Dr. John Hallberg, and Dr. Mark Overton received sign on bonuses upon renewal of their contracts. Erik St Pierre Employee and serves on the Board of Directors Purchase of a house X 50000 27564 0 0 1 27564 Daigle Oil Company Entity of which Dan Vaillancourt, Board Member, is an officer 143565 Independent Contractor Arrangement 0 Nola Sirois Family member of Peter Sirois, Hospital CEO 13291 Employment 0 Michelle L Plourde Family member of Peter Sirois, Hospital CEO 92650 Employment 0 Nicole Marquis Family member of Peter Sirois, Hospital CEO 73689 Employment 0 Robin Werntgen Family member of Peter Sirois, Hospital CEO 81245 Employment 0 Gail Lamarre Family member of Peter Sirois, Hospital CEO 4297 Employment 0 James Daigle Family member of Cindy Daigle, CFO 13994 Employment 0 Form 990, Part VI, Section B, line 11b The Form 990 is prepared by the Organization's independent public accounting firm and thoroughly reviewed by the CFO and Controller. The completed form is sent electronically to Board members prior to the form being filed. In addition, CEO has documents for review prior to sending to the Board members and has opportunity to request any edits. When the forms are sent to Board members, they are instructed to contact CEO or CFO with questions. Any questions are responded to and at the following Finance or Board meetings, CFO provides ability for anyone to ask any additional questions. Finance Committee may request a formal/detailed presentation by consultants if deemed necessary but have not requested that level of review recently. Form 990, Part VI, Section B, line 12c On an annual basis, Board Members must read the Organization's conflict of interest policy, disclose any potential conflicts, and return the signed statement to Administration. If topics arise where a Member has an actual or potential conflict, the group will determine the level to which the individual may be involved in discussions and the member with the conflict will not have a vote. In some instances, the member will be excused from the meeting and can only rejoin when the Board has moved on to a different topic. Form 990, Part VI, Section B, line 15 The Board of Directors determines the compensation of the CEO using compensation studies and comparability data. The CEO determines the compensation of other officers and key employees in a similar manner. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Northern Maine Medical Center 194 East Main Street Fort Kent, ME 04743 EIN: 01-0234189 Northern Maine Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Valley Medical Association 194 East Main Street Fort Kent ME 04743 223245434 Medical Physician Practice ME 501(c)(3) Line 3 Northern Maine Medical Center 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0