2018-05-14T07:54:26-05:00 2017-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2016-07-01 010223482 MILLINOCKET REGIONAL HOSPITAL MILL 2077235161 200 SOMERSET STREET MILLINOCKET ME 04462 CATHERINE LEMAY CFO 2077235161 2018-05-11 1 LAURIE HANSON P00851848 6053391999 2018-05-11 198.135.124.203 2018-05-11 15:21:59 CD P 974248CA41D94A414E643A61057C2CD568A63DD6 92FA066E8274E2B577DB6CECDEFB9BF5F3A81194 2016 2021-01-29 14:40:06Z ROBERT PETERSON 200 SOMERSET STREET MILLINOCKET ME 04462 31515709 0 X WWW.MRHME.ORG X 1952 ME CRITICAL ACCESS HOSPITAL. 10 6 289 12 0 0 1120 100973 27561641 30438921 450185 967985 14844 -7273 28027790 31500606 2856 1860 0 0 17224434 19135793 0 0 0 11252726 13746708 28480016 32884361 -452226 -1383755 23656614 20745003 10394330 9195545 13262284 11549458 X ACCESS TO EXCELLENCE IN HEALTH CARE. 1 0 29338124 1860 30438921 MILLINOCKET REGIONAL HOSPITAL (MRH) PROVIDES A BROAD SCOPE OF MEDICAL SERVICES TO RESIDENTS AND GUESTS IN THE KATAHDIN REGION. THESE SERVICES SPAN THE CONTINUUM OF CARE AND INCLUDE INPATIENT, OUTPATIENT, EMERGENCY, AND ANCILLARY SERVICES. INPATIENT CARE AT MRH INCLUDES MEDICAL SURGICAL CARE WITH AVAILABILITY OF SWING BED AND SPECIAL CARE SERVICES.THE WIDE RANGE OF SUPPORT SERVICES AVAILABLE AT MRH FEATURE HIGHLY SKILLED STAFF AND INCLUDE DIAGNOSTIC IMAGING, CARDIOPULMONOLOGY, LABORATORY, REHABILITATION, AND WELLNESS. MRH FEATURES A STRONG, COHESIVE MEDICAL STAFF CONSISITING OF FAMILY PRACTIVE, INTERNAL MEDICINE, GENERAL SURGERY, GASTRONENTEROLOGY, ORTHOPEDICS, EARS NOSE & THROAT, UROLOGY, PODIATRY, CARDIOLOGY, ONCOLOGY, OPHTHALMOLOGY, PODIATRY, PULMONOLOGY, RADIOLOGY, AND UROLOGY.DURING THIS REPORTING PERIOD, MRH CARED FOR:INPATIENTS - 754CLINIC PATIENTS - 16,799EMERGENCY ROOM PATIENTS - 6,639IN ADDITION, MRH PROVIDED:SURGICAL SERVICES - 1,568LABORATORY SERVICES - 93,075RADIOLOGY SERVICES - 15,334 THERAPY SERVICES (PHYSICAL, SPEECH, AND OCCUPATIONAL) - 2,592 29338124 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 54 0 1 289 1 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X CATHERINE LEMAY 2077235161 200 SOMERSET STREET MILLINOCKET ME 04462 MELLISSA MCAVOY EDWARDS BOARD PRESIDENT 5.00 0.00 X X 0 0 0 THOMAS MALCOLM PAST PRES, BOARD SEC/TRES 5.00 0.00 X X 0 0 0 LEE LAMSON BOARD VICE PRESIDENT 5.00 0.00 X X 0 0 0 DANIEL HERBERT MD DIRECTOR, CHIEF MEDICAL OFFICER 40.00 0.00 X 297366 0 27932 JOYCE GIVEN DIRECTOR, HOSP. AUXILIARY 5.00 0.00 X 0 0 0 HERBERT CLARK DIRECTOR 5.00 0.00 X 0 0 0 GAIL FANJOY DIRECTOR 5.00 0.00 X 0 0 0 PATRICK E HUNT ESQ DIRECTOR 5.00 0.00 X 0 0 0 TINA JAMO DIRECTOR 5.00 0.00 X 0 0 0 FRED LEWIS DIRECTOR 5.00 0.00 X 0 0 0 ROBERT PETERSON CEO 50.00 0.00 X 211547 0 9985 CATHERINE LEMAY CFO 50.00 0.00 X 131808 0 9465 NILESH PATIL MD SURGEON 40.00 0.00 X 442180 0 25254 KWAKU OWUSU-ABROKWA MD HOSPITALIST 40.00 0.00 X 234728 0 13155 EDWARD DUNSTAN DO FAMILY PRACTICE 40.00 0.00 X 276959 0 25058 MARK KOWALSKI SURGEON 40.00 0.00 X 500721 0 32930 MUHAMMAD RAUF MD SURGEON 40.00 0.00 X 137467 0 6779 2232776 0 150558 22 0 1 0 CPSI PO BOX 850309 MOBILE IA 36685 INFORMATION SYSTEMS 298670 KATAHDIN SHARED SERVICES INC 200 SOMERSET STREET MILLINOCKET ME 04462 ULTRASOUND SERVICES 285942 CORE MEDICAL 3000 GOFFS FALLS RD STE 101 MANCHESTER NH 03103 LOCUM PHYSICIAN SERVICES 279193 MAYO REGIONAL HOSPITAL 897 WEST MAIN STREET DOVERFOXCROFT ME 04426 CONTRACTED PHYSICIAN SERVICES 247442 EASTERN MAINE MEDICAL CENTER 489 STATE STREET NEWPORT BANGORBEACH ME 04401 CONTRACTED PHYSICIAN SERVICES 223977 14 100973 100973 PATIENT SERVICE REVENUE 621400 30161313 30161313 OTHER SUPPORTING REVENUE 621400 297158 297158 MISCELLANEOUS INCOME 621110 54264 54264 INVESTMENT IN SUBSIDIARY 621400 -73814 -73814 30438921 131903 131903 7830 15103 -7273 -7273 -7273 836082 0 836082 836082 836082 31500606 30438921 0 960712 X 1860 1860 727467 194262 533205 14298248 13292792 1005456 240256 234006 6250 2890432 2617989 272443 979390 881359 98031 53429 53429 80168 80168 4292941 3650398 642543 18329 5597 12732 278950 164007 114943 4468 4468 682316 661289 21027 26286 10521 15765 98557 92212 6345 168294 168294 769771 769771 420384 420384 SUPPLIES 3749112 3718956 30156 BAD DEBT EXPENSE 2120423 2120423 MEDICAID TAX ASSESSMENT 602880 602880 REPAIRS & MAINTENANCE 119756 75167 44589 260644 76341 184303 32884361 29338124 3546237 0 480312 249516 5280435 4111264 577617 637893 591389 402852 20918546 15551175 5656451 5367371 9551513 6780812 1420168 1466353 11229 111629 87500 1617313 23656614 20745003 4258763 3897536 986647 859325 3348448 3252714 1800472 1185970 10394330 9195545 X 13257284 11544458 5000 5000 13262284 11549458 23656614 20745003 -1383755 -329071 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8262 8262 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO THE MAINE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE ATTRIBUTABLE TO LOBBYING EXPENSES. 49951 49951 7126936 4319904 2807032 695853 608265 87588 12767554 10623006 2144548 278252 278252 5367371 INVESTMENT IN SUB 1466353 F 1466353 OTHER ASSETS 7313 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 1610000 1617313 DEFERRED COMPENSATION LIABILITY 1185970 1185970 X PART X, LINE 2: THE HOSPITAL IS ORGANIZED AS A MAINE NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOSPITAL HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. 1 1 X 1 X 1 X 1 1 0 1 1 681000 681000 0.02210 3089171 2783012 306159 0.01000 3770171 2783012 987159 0.03210 300074 96673 203401 0.00660 300074 96673 203401 0.00660 4070245 2879685 1190560 0.03870 1 2120423 0 10252482 10383740 -131258 X 1 1 1 1 MILLINOCKET REGIONAL HOSPITAL 200 SOMERSET STREET MILLINOCKET ME 04462 WWW.MRHME.ORG 38579 X X X MILLINOCKET REGI0NAL HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X HTTP://WWW.MRHME.ORG/ABOUT-US/ X SEE NARRATIVE AT 7D X X 1 16 1 HTTP://WWW.MRHME.ORG/ 0 1 X 150.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/ X HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/ X HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 1 MILLINOCKET REGI0NAL HOSPITAL PART V, SECTION B, LINE 5: THE MAINE SHARED HEALTH NEEDS ASSESSMENT AND PLANNING PROCESS (SHNAPP) PROJECT IS A COLLABORATIVE EFFORT AMONG MAINE'S FOUR LARGEST HEALTHCARE SYSTEMS - CENTRAL MAINE HEALTHCARE, EASTERN MAINE HEALTHCARE SYSTEMS (EMHS), MAINEGENERAL HEALTH (MGH) AND MAINEHEALTH - AS WELL AS THE MAINE CENTER FOR DISEASE CONTROL AND PREVENTION (MAINE CDC), AN OFFICE OF THE MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES (MAINE DHHS). THE CURRENT COLLABORATION EXPANDS UPON THE ONEMAINE HEALTH COLLABORATIVE CREATED IN 2007 AS A PARTNERSHIP AMONG EMHS, MGH AND MAINEHEALTH. THE MAINE CDC AND OTHER PARTNERS JOINED THESE ENTITIES TO DEVELOP A PUBLIC-PRIVATE PARTNERSHIP IN 2012. THE FOUR HOSPITAL SYSTEM AND THE MAINE CDC SIGNED A MEMORANDUM OF UNDERSTANDING IN EFFECT BETWEEN JUNE 2014 AND DECEMBER 2019 COMMITTING RESOURCES TO THE MAINE SHNAPP PROJECT. THIS SHARED CHNA INCLUDES A LARGE SET OF STATISTICS ON HEALTH STATUS AND RISK FACTORS FROM EXISTING SURVEILLANCE AND HEALTH DATASETS AND INCLUDES INPUT FROM A BROAD SET OF STAKEHOLDERS FROM ACROSS THE STATE FROM THE 2015 SHNAPP STAKEHOLDERS' SURVEY. INFORMATION IS REPORTED BY COUNTY AND REGION TO MAKE IT USEFUL FOR APPLICATION BY INDIVIDUAL HOSPITALS AND OTHER HEALTHCARE ORGANIZATIONS ACROSS THE STATE. MILLINOCKET REGI0NAL HOSPITAL PART V, SECTION B, LINE 6A: ACADIA HOSPITAL, CHARLES A. DEAN MEMORIAL HOSPITAL, EASTERN MAINE MEDICAL CENTER, MAYO REGIONAL HOSPITAL, PENOBSCOT VALLEY HOSPITAL, MILLINOCKET REGIONAL HOSPITAL MILLINOCKET REGI0NAL HOSPITAL PART V, SECTION B, LINE 6B: BANGOR PUBLIC HEALTH AND COMMUNITY SERVICESDOWN EAST AIDS NETWORK AND THE HEALTH EQUITY ALLIANCEEMHSHEALTH ACCESS NETWORKHEALTHY MAINE PARTNERSHIPSMAINE CENTER FOR DISEASE CONTROL AND PREVENTIONPARTNERSHIP FOR A HEALTHY NORTHERN PENOBSCOTPENOBSCOT COMMUNITY HEALTH CAREPENQUIS PUBLIC HEALTH DISTRICT COORDINATING COUNCILPISCATAQUIS PUBLIC HEALTH COALITIONPISCATAQUIS REGIONAL YMCARIVER COALITIONUNITED WAY OF EASTERN MAINEUNIVERSITY OF MAINE COOPERATIVE EXTENSIONWABANAKI PUBLIC HEALTH DISTRICT MILLINOCKET REGI0NAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA REPORT IS AVAILABLE AT:HTTP://WWW.MAINE.GOV/DHHS/MECDC/PHDATA/SHNAPP/COUNTY-REPORTS.SHTML MILLINOCKET REGI0NAL HOSPITAL PART V, SECTION B, LINE 11: MRH IS ADDRESSING ALL IDENTIFIED HEALTH NEEDS, AS LISTED BELOW:MAINTAIN A COMMUNITY BASED HOSPITAL OBESITY, AS MEASURED BY:- INCREASED AWARENESS AND IMPROVEMENT IN PHYSICAL ACTIVITY AND NUTRITION- PHYSICAL ACTIVITY IN ADULTS, AND IN HIGH SCHOOL STUDENTS- FRUIT AND VEGETABLE CONSUMPTION.IMPROVED ACCESS TO BEHAVIORAL CARE / MENTAL HEALTH CARE, AS MEASURED BY:- ANXIETY / DEPRESSION, HOPELESSNESS AND SADNESS- RECEIVING MEDICATIONS FOR ANXIETY / DEPRESSION- COMORBIDITIES- EMERGENCY VISITS FOR MENTAL HEALTH.INCREASED ACCESS FOR NON-URGENT & NON-EMERGENT CARE, AND FAMILY & PEDIATRIC CARE, AS EVIDENCED BY:- INCREASING VOLUME OF NON-URGENT & NON-EMERGENT VISITS IN ED; - COMMUNITY REQUESTS FOR ACCESS TO AFTER-HOURS CARE, EVENINGS AND WEEKENDS AND FAMILY / PEDIATRIC CARE.NEED FOR ADDITIONAL SPECIALTIES IN THE COMMUNITY AS NOTED BY: - MEDICAL STAFF HIGH REFERRAL OUT OF COMMUNITY FOR CONSULTATIONS IN NEUROLOGY, PULMONARY AND SLEEP MEDICINE, ENDOCRINOLOGY AND RHEUMATOLOGY, AND ANTICIPATE ONCOLOGY, IF NOT MAINTAINED. -INCREASE PRIVACY AT REGISTRATION -MORE RESOURCES ARE NEEDED TO SUPPORT THE HEALTHCARE NEEDS OF ADULTS WITH CHRONIC HEALTH CONDITIONS.-POVERTY & EMPLOYMENT -CONTINUOUS IMPROVEMENT IN THE PATIENT EXPERIENCE OF CARE -HCAHPS SURVEY RESULTS IN 7 COMPOSITE AREAS-COMMUNITY WILL NEED OPTOMETRIST WITH LOCAL OPTOMETRIST PLANS FOR RETIREMENT-NEED TO REDUCE COSTS TO CUSTOMERSHOW TO ADDRESS THESE NEEDS IDENTIFIED:-WE HAVE JOINED THE COMMUNITY CARE PARTNERSHIP OF MAINE. WE HAVE LEADERS FROM OUR PHYSICIAN PRACTICES, PHARMACY AND ADMINISTRATION PARTICIPATING REGULARLY. -THE ACO IS COLLABORATING TO MEASURE AND IMPROVE POPULATION HEALTH IN OUR COMMUNITIES SERVED. -MEASUREMENT AND IMPROVEMENTS ARE TAKING PLACE CONCURRENTLY IN THE AREAS OF DEPRESSION AND BEHAVIORAL HEALTH, AND CHRONIC DISEASE MANAGEMENT, INCLUDING DIABETES SCREENING AND TREATMENT, AND BMI ASSESSMENT AND MANAGEMENT.-AS AN ORGANIZATION WE HAVE MADE THE COMMITMENT TO UPGRADE OUR ELECTRONIC HEALTH RECORD (EHR)-LIFE STYLE CHANGES CLASS IS A NEW CLASS OFFERED AT NO CHARGE TO THE COMMUNITY. THE GOAL OF THE PROGRAM IS TO HELP INDIVIDUALS AT RISK FOR TYPE 2 DIABETES LOSE WEIGHT AND BEGIN TO EXERCISE REGULARLY IN AN EFFORT TO PREVENT GETTING TYPE 2 DIABETES. THE PROGRAM INCLUDES 16 CLASSES AND WILL CONTINUE FOR ONE YEAR, INCLUDING MONTHLY CLASSES ONCE THE INITIAL 16 WEEKLY CLASSES ARE COMPLETED. CLASSES WILL BE HELD IN THE MULTIPURPOSE ROOM AT MRH.-BASED ON POSITIVE FEEDBACK AND ENCOURAGEMENT FROM BOARD AND OTHER COMMUNITY MEMBERS, MRH HELD A HEALTH FAIR IN THE SUMMER OF 2017. AS IN PRIOR YEARS, ATTENDEES WERE ASKED TO COMPLETE SURVEYS TO AND GIVE SUGGESTIONS FOR FUTURE FAIRS. -WE HAVE IMPLEMENTED CHANGES IN OUR ORGANIZATION THAT HELP THE STAFF AND VISITORS TO COMPLY WITH THE RECOMMENDATIONS OF THE "LET'S GO! 5-2-1-0". AS EXAMPLES WE HAVE ELIMINATED HIGH SUGAR DRINKS FROM OUR ORGANIZATION, NUTRITION LABELS ARE APPLIED TO SNACKS, WHICH ARE CONTROLLED AND SHOULD BE NO MORE THAN 300 CALORIES. -SPECIALTY CLINICS SET UP OFFICE SPACE FOR WEEKEND TELEMEDICINE CLINICS TO PROVIDE SPECIALTY SERVICES IN SLEEP MEDICINE, NEUROLOGY AND PULMONOLOGY. -MRH CONTINUES TO PARTICIPATE AND PLAY A LEADERSHIP ROLE IN THE "THRIVING IN PLACE" TIP PROJECT. THE ACTIVITY IS ONGOING; PROJECT OBJECTIVES INCLUDE THE FOLLOWING: 1. INCREASE COMMUNITY AWARENESS OF THRIVING IN PLACE (TIP) INITIATIVE BY 11/30/20172. INCREASE THE NUMBER OF PARTNERS INVOLVED IN THE TIP INITIATIVE BY 11/30/20173. INCREASE THE NUMBER OF CONSUMERS INVOLVED IN THE TIP INITIATIVE BY 11/30/2017.4. INCREASE HEALTHCARE AND SOCIAL SERVICE PROVIDER KNOWLEDGE OF AVAILABLE COMMUNITY RESOURCES BY 11/30/2017. 5. PROMOTE AVAILABILITY OF LOCAL RESOURCES FOR TRANSPORTATION TO COMMUNITY MEMBERS ON AN ONGOING BASIS.6. INCREASE THE VOLUNTEER POOL OF DRIVERS THAT PROVIDE RIDES TO INDIVIDUALS IN NEED BY 6/30/2017. THIS NEED HAS BEEN MET.7. COLLABORATE WITH MILLINOCKET AND EAST MILLINOCKET/LINCOLN AMBULANCE TO DEVELOP A PHONE CALLING "CHECK IN" SYSTEM OF CARE FOR PERSONS LIVING ALONE AND IDENTIFIED AS IN POOR HEALTH OR SOCIALLY ISOLATED BY 6/30/2017. THIS NEED HAS BEEN MET.8. DEVELOP A LOCAL FOOD COUNCIL TO ADDRESS FOOD INSECURITY BY 3/1/2017. THIS NEED HAS BEEN MET.9. ESTABLISH THE MILLINOCKET MEMORIAL LIBRARY AS A "COMMUNITY CENTER" TO OFFER ONGOING PROGRAMING FOR TIP CONSUMERS THAT WILL PROVIDE OPPORTUNITIES FOR SOCIAL INTERACTION BY 9/30/2017.10. EVALUATE PROGRAM COMPONENTS TO UNDERSTAND IMPACT AND AREAS FOR STRENGTHENING BY 11/30/2017.-OPTOMETRY CLINIC SERVICES OPENED IN 2017.-AS PART OF THE ONGOING STRATEGIC PLANNING PROCESS, MRH IS ACTIVELY SEEKING WAYS TO ENHANCE COLLABORATION TO MAKE A POSITIVE IMPACT ON DRUG AND ALCOHOL ABUSE. EXAMPLES OF LOCAL GROUPS MRH WILL WORK WITH INCLUDE AA AND ALANON. MRH CURRENTLY PROVIDES "IN KIND" CONTRIBUTIONS BY PROVING A SAFE MEETING SPACE ON A REGULAR BASIS. THE GOAL IS TO TARGET OTHER AREAS OF POSITIVE LIFESTYLE CHANGE AND TO MAKE A POSITIVE IMPACT IN THIS AREA OF NEED IN OUR COMMUNITY. MILLINOCKET REGI0NAL HOSPITAL PART V, SECTION B, LINE 16J: MILLINOCKET REGIONAL HOSPITAL USES A NUMBER OF TACTICS TO NOTIFY MEMBERS OF THE COMMUNITY THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE WHO QUALIFY. THE FAP NOTICE, WHICH IS A PLAIN LANGUAGE SUMMARY WRITTEN AT AN 8TH GRADE READING LEVEL, IS POSTED AT ALL REGISTRATION POINTS AND ALSO ON OUR WEBSITE AT HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/. EACH ACCOUNT STATEMENT SENT TO PATIENTS ALSO INCLUDES A NOTICE REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. FOR PATIENT ACCOUNTS FACING COLLECTIONS DUE TO UNPAID BALANCES RESULTING FROM VISITS TO OUR HOSPITAL OR PHYSICIAN CLINICS, WE INCLUDE THE FAP AND FINANCIAL ASSISTANCE APPLICATION ALONG WITH THEIR COLLECTION LETTER.ALL PATIENT ACCESS STAFF, CLINIC REGISTRATION PERSONNEL, INPATIENT AND OUTPATIENT CASE MANAGERS, FINANCIAL COUNSELOR, AND SOCIAL WORKER ARE FAMILIAR WITH MRH'S FINANCIAL ASSISTANCE POLICY. THESE MRH EMPLOYEES ACTIVELY REACH OUT TO PATIENTS TO ENSURE THEY ARE AWARE OF THE FAP. PROVIDERS AND SUPPORT STAFF IN ALL AREAS OF THE ORGANIZATION ARE PREPARED TO ASSIST INDIVIDUALS IN ACCESSING FAP INFORMATION. THE SOCIAL WORKER AND THE FINANCIAL COUNSELOR ARE READILY AVAILABLE TO SUPPORT ANYONE WHO MAY NEED HELP PURSUING FINANCIAL ASSISTANCE AT MRH. MILLINOCKET REGI0NAL HOSPITAL PART V, SECTION B, LINE 24: SERVICES NOT CONSIDERED MEDICALLY NECESSARY WERE BILLED AT GROSS CHARGES. THE POLICY SPECIFICALLY STATES IT DOES NOT COVER NON-MEDICALLY NECESSARY SERVICES. PART I, LINE 3C: INCOME GUIDELINES AS SET BY HOSPITAL FINANCE RULES WILL BE USED IN DETERMINING ELIGIBILITY. PERCENTAGE OF BALANCE DISCOUNTED WILL BE DETERMINED BASED ON PATIENT'S INCOME LEVEL RELATIVE TO THE FEDERAL POVERTY LEVEL GUIDELINES. THESE GUIDELINES ARE UPDATED ANNUALLY BY THE FINANCIAL COUNSELOR.UP TO 150% FPL-100% BALANCE DISCOUNTED.151% TO 200% FPL-50% BALANCE DISCOUNTED. PART I, LINE 7G: CHARITY CARE EXPENSE ON LINE 7A WAS CONVERTED TO COST BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINES 7B AND 7G WERE DETERMINED BASED ON THE MEDICAID AND MEDICARE COST REPORTS. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATIONS WAS $2,120,423. PART III, LINE 2: PATIENT ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF INDIVIDUAL ACCOUNTS AND HISTORICAL ADJUSTMENTS. BALANCES THAT ARE STILL OUTSTANDING, AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS, ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR MAJOR PAYOR SOURCE OF REVENUE FOR THE PURPOSES OF ESTIMATING THE APPROPRIATE AMOUNTS OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR BAD DEBTS. DATA IN EACH MAJOR PAYOR SOURCE ARE REGULARLY REVIEWED TO EVALUATE THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES RELATING TO SERVICES PROVIDED TO PATIENTS HAVING THIRD-PARTY COVERAGE, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CORRESPONDING PROVISION FOR BAD DEBTS ARE ESTABLISHED AT VARYING LEVELS BASED ON THE AGE OF THE RECEIVABLES AND PAYOR SOURCE. FOR RECEIVABLES RELATING TO SELF-PAY PATIENTS, A PROVISION FOR BAD DEBTS IS MADE IN THE PERIOD SERVICES ARE RENDERED BASED ON EXPERIENCE INDICATING THE INABILITY OR UNWILLINGNESS OF PATIENTS TO PAY AMOUNTS FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 4: PATIENT RECEIVABLES ARE UNCOLLATERALIZED PATIENT AND THIRD-PARTY PAYOR OBLIGATIONS. PAYMENTS OF PATIENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED IN THE REMITTANCE ADVICE OR, IF UNSPECIFIED, ARE APPLIED TO THE EARLIEST UNPAID CLAIM. PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S PROCESS FOR CALCULATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS HAS NOT SIGNIFICANTLY CHANGED FROM JUNE 30, 2016 TO JUNE 30, 2017. THE HOSPITAL DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE OFFS FROM THIRD-PARTY PAYORS. THE HOSPITAL HAS NOT SIGNIFICANTLY CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2017 OR 2016. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2017.MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: IN AN EFFORT TO BEST SERVE OUR PATIENTS, ALL FIRST-TIME STATEMENTS INCLUDE INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR QUALIFIED PATIENTS. OUR PATIENT FINANCIAL SERVICES DEPARTMENT USES SEVERAL RESOURCES TO DETERMINE IF A PATIENT MAY BE PRESUMPTIVELY ELIGIBLE FOR FINANCE ASSISTANCE; FOR EXAMPLE, ELIGIBILITY FOR OUT-OF-STATE MEDICAID, ELIGIBILITY FOR OTHER STATE-FUNDED ASSISTANCE PROGRAMS, SUCH AS FOOD STAMPS AND PATIENT HOMELESSNESS. IT IS OUR PRACTICE TO MAKE A REASONABLE ATTEMPT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BEFORE SENDING AN ACCOUNT TO A COLLECTION AGENCY. ANY ACCOUNTS PREVIOUSLY SENT TO COLLECTIONS WILL BE CONSIDERED FOR FINANCIAL ASSISTANCE WHEN AN APPLICATION IS RECEIVED; SO LONG AS THE SERVICES WERE RENDERED NOT MORE THAN 240 DAYS PREVIOUSLY, OR THE PATIENT WAS GIVEN A WRITTEN NOTICE THAT FINANCIAL ASSISTANCE WAS AVAILABLE FOR THOSE SPECIFIC SERVICES WITH A DEADLINE DATED AFTER THE 240 DAY PERIOD. PART VI, LINE 2: IT IS ONE OF OUR GOALS TO REMAIN WELL CONNECTED WITH THE COMMUNITY AND THEIR NEEDS, WHICH WE ACHIEVE BY OVERSEEING ONGOING ADVISORY GROUPS AND MEETINGS WHERE OUR ORGANIZATION CAN ASSESS PERCEPTIONS, NEEDS AND RECOMMENDATIONS. IN ADDITION, MRH LEADERS CONDUCT FOCUS GROUPS WITH EMPLOYEES IN LOCAL BUSINESSES TO EVALUATE WHETHER HEALTHCARE NEEDS ARE BEING MET AND TO IDENTIFY HOW MRH CAN BETTER SERVE THE COMMUNITY IN THE FUTURE. PART VI, LINE 3: INPATIENTS: IN ORDER TO IDENTIFY THOSE PATIENTS WHO WOULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ALL UNINSURED INPATIENTS ARE REFERRED TO THE FINANCIAL COUNSELOR BY PRE-REGISTRATION OR REGISTRATION PERSONNEL. THE FINANCIAL COUNSELOR WILL DO AN INITIAL SCREENING FOR PAYMENT OPTIONS PRIOR TO THE PATIENT LEAVING THE HOSPITAL, IF POSSIBLE. IF THE PATIENT HAS LEFT THE HOSPITAL, THE FINANCIAL COUNSELOR WILL ATTEMPT TO CONTACT THE PATIENT FOR INFORMATION. ALL INPATIENTS ARE GIVEN A COPY OF PATIENT FREE CARE AND DISCOUNT ARRANGEMENTS GUIDELINES AT TIME OF ADMISSION.SURGICAL OUTPATIENTS: THE FINANCIAL COUNSELOR WILL PROVIDE INFORMATION ABOUT PATIENT FREE CARE, DISCOUNT ARRANGEMENTS AND TERM PAYMENT ARRANGEMENTS TO ALL UNINSURED SURGICAL OUTPATIENTS. ALL SURGICAL OUTPATIENTS ARE PROVIDED A COPY OF PATIENT FREE CARE AND DISCOUNT ARRANGEMENTS GUIDELINES AT TIME OF REGISTRATION.EMERGENCY ROOM PATIENTS: ALL EMERGENCY ROOM PATIENTS ARE PROVIDED A COPY OF PATIENT FREE CARE AND DISCOUNT ARRANGEMENTS GUIDELINES AT TIME OF REGISTRATION.ALL OTHER OUTPATIENTS: ALL OTHER OUTPATIENTS ARE PROVIDED A COPY OF THE PATIENT FREE CARE/DISCOUNT ARRANGEMENTS GUIDELINES AT TIME OF REGISTRATION.ALL PATIENTS WILL RECEIVE NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE INCLUDED IN THEIR FIRST-TIME STATEMENT.PATIENT FINANCIAL SERVICES EMPLOYEES AND PHYSICIAN PRACTICE EMPLOYEES RECEIVE TRAINING ON PATIENT FREE CARE AND DISCOUNT ARRANGEMENTS GUIDELINES AND ARE EXPECTED TO BE ABLE TO PROVIDE CONTACT INFORMATION ABOUT FREE CARE AND DISCOUNT ARRANGEMENTS. PART VI, LINE 4: MILLINOCKET REGIONAL HOSPITAL HAS THREE COMMUNITIES IN ITS PRIMARY SERVICE AREA: MILLINOCKET, EAST MILLINOCKET AND MEDWAY. THERE ARE MULTIPLE SMALLER COMMUNITIES IN THE SECONDARY SERVICE AREA INCLUDING BROWNVILLE, WOODVILLE, STACYVILLE, SHERMAN, PATTEN AND ISLAND FALLS. THE AREA HAS STRUGGLED AND REALIZED AN UNEMPLOYMENT RATE IN THE TEENS FOR THE PAST TEN YEARS AND EXPERIENCED COMMUNITY OUT-MIGRATION. THE POPULATION OF THE PRIMARY SERVICE AREA IS APPROXIMATELY 7500 PEOPLE. THE EFFECT ON THE HOSPITAL OF THIS DEMOGRAPHIC AND POPULATION CHANGE HAS BEEN LARGE DECLINES IN PATIENT CARE VOLUMES SINCE 2013. THE AVERAGE MEDIAN HOUSEHOLD INCOME IS MORE THAN 20% LOWER THAN THE STATE AVERAGE. THE AVERAGE RESIDENT AGE IS MORE THAN 10% OLDER THAN THE STATE MEDIAN AGE. PART VI, LINE 5: MILLINOCKET REGIONAL HOSPITAL IS THE LARGEST EMPLOYER IN THE AREA AND SOLE COMMUNITY PROVIDER FOR ACUTE CARE. WE OPERATE AN EMERGENCY ROOM AVAILABLE TO ALL PATIENTS; REGARDLESS OF THEIR ABILITY TO PAY. MRH IS INVOLVED IN GOVERNMENT-SPONSORED HEALTH PROGRAMS AS WELL AS THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS, AND WE OFFER VOLUNTEER OPPORTUNITIES TO MEMBERS WITHIN THE COMMUNITY, WHO MAY NOT HAVE A HEALTHCARE BACKGROUND, BUT ARE PASSIONATE ABOUT OUR MISSION.OUR HOSPITAL IS GOVERNED BY A BOARD OF TRUSTEES; ALL OF WHOM RESIDE IN PRIMARY AND SECONDARY SERVICE AREAS. EMPLOYEES MAY PARTICIPATE IN BOARD MEETINGS BUT DO NOT HAVE VOTING CAPABILITIES; WITH THE EXCEPTION OF THE MEDICAL STAFF PRESIDENT, WHO HAS A VOTING MEMBERSHIP ON THE GOVERNING BOARD. BOARD MEMBERS WHOSE FAMILY MEMBERS ARE EMPLOYED BY MRH ARE REQUIRED TO IDENTIFY THE POTENTIAL CONFLICT IN WRITING AND ARE APPROPRIATELY RECUSED FROM ACTING ON MATTERS THAT MAY IMPACT DIRECTLY OR INDIRECTLY THEIR FAMILY MEMBERS. PHYSICIANS WHO WISH TO HAVE PRIVILEGES AT OUR HOSPITAL ARE NOT REQUIRED TO BE AN EMPLOYEE IN ORDER TO BECOME AN ACTIVE MEMBER OF THE MEDICAL STAFF. THEY MUST SEND A WRITTEN REQUEST TO THE MRH MEDICAL STAFF FOR REVIEW. PRIVILEGES ARE GRANTED TO QUALIFIED PHYSICIANS ONLY AFTER THE REQUEST IS REVIEWED AND THE NEEDS AND INTERESTS OF BOTH PARTIES HAVE BEEN EVALUATED. MRH IS AN ACTIVE PARTICIPANT IN THE COMMUNITY CARE PARTNERSHIP OF MAINE, AN ACCOUNTABLE CARE ORGANIZATION MADE UP OF MAINE BASED HOSPITALS AND HEALTHCARE CENTERS, WHICH GUIDES OUR ORGANIZATION TOWARD TRANSFORMING THE DELIVERY OF OUR HEALTHCARE SERVICES TO CENTER AROUND MEANINGFUL SHARING AND ACCOUNTABILITY FOR OUR PATIENTS' HEALTH. AS AN ORGANIZATION, MILLINOCKET REGIONAL HOSPITAL PRIORITIZES SURPLUS FUNDS FOR PROJECTS OR EXPENSES THAT HAVE A DIRECT IMPACT ON PATIENT CARE OR PATIENT AND EMPLOYEE SAFETY. THIS INCLUDES, BUT IS NOT LIMITED TO, TRAINING, TEACHING, AND PURCHASING SPECIALIZED AND IMPROVED EQUIPMENT TO KEEP PATIENTS SAFE.IT IS ONE OF OUR MANY GOALS TO REMAIN WELL CONNECTED WITH THE COMMUNITY AND THEIR NEEDS, WHICH WE ACHIEVE BY OVERSEEING ONGOING ADVISORY GROUPS AND MEETINGS WHERE OUR ORGANIZATION CAN ASSESS PERCEPTIONS, NEEDS AND RECOMMENDATIONS. IN ADDITION, MRH LEADERS CONDUCT FOCUS GROUPS WITH EMPLOYEES IN LOCAL BUSINESSES TO EVALUATE WHETHER HEALTHCARE NEEDS ARE BEING MET AND TO IDENTIFY HOW MRH CAN BETTER SERVE THE COMMUNITY IN THE FUTURE. INFORMATION GATHERED FROM ADVISORY GROUPS AND FOCUS GROUPS, PAIRED WITH THE PENOBSCOT SHARED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND OUR ANNUAL PERIODIC EVALUATION, ASSIST MRH TO ADD NEW SERVICES INCLUDING SLEEP MEDICINE, GASTROENTEROLOGY, ENDOCRINOLOGY, RHEUMATOLOGY, NEUROLOGY, AND OPTOMETRY, OPHTHALMOLOGY, AND WALK-IN CARE. RECOGNIZING THE LARGE ELDERLY POPULATION IN OUR AREA, AND THE NEED FOR MORE SERVICES TO HELP THEM LIVE HEALTHIER LIVES AND REMAIN INDEPENDENT, MRH HAS TAKEN ON THE ROLE OF EXECUTIVE SPONSOR FOR A THRIVING IN PLACE GRANT. MRH IS COMPLETELY COMMITTED TO SERVING OUR PATIENTS, SUPPORTING THEM IN MAINTAINING THEIR HEALTH, AND ASSISTING THEM TO RETAIN THEIR INDEPENDENCE. X X X X X 0 0 0 0 0 0 0 0 0 DANIEL HERBERT MD DIRECTOR, CHIEF MEDICAL OFFICER 263766 0 33600 0 0 0 7750 0 20182 0 325298 0 0 0 ROBERT PETERSON CEO 211547 0 0 0 0 0 1708 0 8277 0 221532 0 0 0 NILESH PATIL MD SURGEON 442180 0 0 0 0 0 0 0 25254 0 467434 0 0 0 KWAKU OWUSU-ABROKWA MD HOSPITALIST 234728 0 0 0 0 0 3292 0 9863 0 247883 0 0 0 EDWARD DUNSTAN DO FAMILY PRACTICE 276959 0 0 0 0 0 3830 0 21228 0 302017 0 0 0 MARK KOWALSKI SURGEON 500721 0 0 0 0 0 7676 0 25254 0 533651 0 0 0 A MAINE HEALTH AND HIGHER EDUCATIONAL FACILITIES AUTHORITY 010314384 560427WV4 2013-05-23 1423837 REFINANCING OF 2003 D BOND ISSUE 0 0 1 A 650762 1423837 15439 1408398 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 ROSE ANN HUNT PA FAMILY MEMBER OF PATRICK HUNT, MEMBER OF BOD 155073 EMPLOYMENT 0 LAURIE VICKERS-HERBERT RN FAMILY MEMBER OF DANIEL HERBERT 107519 EMPLOYMENT 0 CYNTHIA MORNEAULT FAMILY MEMBER OF JOYCE GIVEN, MEMBER OF BOD 57452 EMPLOYMENT 0 DOROTHY FRIEL FAMILY MEMBER OF TINA JAMO, MEMBER OF BOD 25727 EMPLOYMENT 0 LAURIE JAMO FAMILY MEMBER OF TINA JAMO, MEMBER OF BOD 100505 EMPLOYMENT 0 FORM 990, PART III, LINE 2 DURING THE YEAR THE FOLLOWING NEW SERVICES WERE OFFERED BY MRH: GASTROENTEROLOGY - 7/1/16 NEUROLOGY - 9/6/16 PULMONOLOGY - 9/6/16 SLEEP MEDICINE - 9/6/16 ENDOCRINOLOGY - 1/1/17 RHEUMATOLOGY - 1/1/17 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT OF THE BOARD AS AN EX OFFICIO MEMBER AND CHAIRMAN, AND TWO OR MORE ADDITIONAL TRUSTEES. THE PRESIDENT SHALL BE ENTITLED TO VOTE AS A MEMBER OF THE EXECUTIVE COMMITTEE. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. IN PARTICULAR, THE EXECUTIVE COMMITTEE SHALL NOT HAVE AUTHORITY TO AMEND THE ARTICLES OF INCORPORATION, ADOPT A PLAN OF MERGER OR CONSOLIDATION, RECOMMEND TO THE TRUSTEES THE SALE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION OTHER THAN IN THE USUAL COURSE OF BUSINESS, RECOMMEND TO THE TRUSTEES VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOCATION OF SUCH DISSOLUTION, OR AMEND THE BYLAWS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO THE DOCUMENT'S FILING, THE ORGANIZATION'S FINANCE DEPARTMENT REVIEWS THE INITIAL DRAFT. AFTER ANY NECESSARY CHANGES, THE ORGANIZATION'S BOARD MEMBERS ARE PRESENTED WITH A COPY. THE FINALIZED DOCUMENT IS SUBJECT TO THE BOARD'S APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED INDIVIDUAL MUST DISCLOSE THE EXISTENCE OF HIS OR HER CONFLICT ANNUALLY AND WHENEVER THE CONFLICT ARISES FOR ACTION AT A MEETING. AFTER RECEIVING ALL ANNUAL ATTESTATIONS, THE CEO WILL PROVIDE THE SIGNED STATEMENTS TO THE HOSPITAL'S ATTORNEY FOR REVIEW. AFTER REVIEW, THE ATTORNEY WILL DETERMINE IF A CONFLICT EXISTS AND INFORM THE CEO AND BOARD CHAIR OF THE CONFLICTED INDIVIDUALS. THERE IS A LISTING OF BOARD, MEDICAL STAFF AND MANAGER CONFLICTS AVAILABLE AT ALL MEETINGS FOR REFERENCE. THE AGENDA FOR EVERY BOARD, MEDICAL STAFF OR DEPARTMENT MEETING WILL CLEARLY LIST THE DISCUSSION ITEMS THAT REQUIRE ACTION DURING THE MEETING. AT THE BEGINNING OF THE MEETING, THE PRESIDENT WILL ASK THE MEMBERS TO REVIEW THE LIST OF ACTION ITEMS AND DECLARE WHETHER OR NOT THEY HAVE A CONFLICT. ALL CONFLICTED MEMBERS WILL BE REQUIRED TO EXCUSE THEMSELVES AND LEAVE THE ROOM DURING THE DISCUSSION AND VOTE. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE APPROPRIATE COMPENSATION LEVELS. THE ORGANIZATION'S EXECUTIVE COMMITTEE REVIEWS DATA USED TO DETERMINE COMPENSATION FOR ITS RESPECTIVE MEMBERS. ANY COMPENSATION RELATED CHANGES MUST BE APPROVED BY THE BOARD OF DIRECTORS OR THE EXECUTIVE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 19,330. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,330. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,080,057. MANAGEMENT AND GENERAL EXPENSES 623,470. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,703,527. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 452,081. MANAGEMENT AND GENERAL EXPENSES 19,073. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 471,154. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,098,930. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,098,930. FORM 990,PART XII, LINE 2C THE FINANCE COMMITTEE RECOMMENDS AND THE BOARD OF TRUSTEES SELECTS THE INDEPENDENT ACCOUNTANT FOR THE AUDIT. FIRST MILLINOCKET REGIONAL INVESTMENT GROUP 200 SOMERSET ST MILLINOCKET ME 04462 010396196 PHYSICIAN PROGRAM OPERATIONS ME MILLINOCKET REGIONAL HOSPITAL C -69576 1262716 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0