2017-08-14T10:17:34-05:00 2016-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2015-10-01 010234189 Northern Maine Medical Center NORT 2078343155 194 East Main Street Fort Kent ME 04743 Cindy Daigle CFO 2078343155 2017-08-11 1 Joseph R Byrne CPA P01289281 2077752387 2017-08-11 2015 2021-01-29 14:40:06Z Peter J Sirois 194 East Main Street Fort Kent ME 04743 50118995 0 X www.nmmc.org X 1948 ME Acute care & long term care hospital and mental health services facility. 11 9 572 47 0 0 267936 298263 47112667 49235240 203603 89801 386266 134971 47970472 49758275 0 30000 0 0 29106154 30882899 0 0 0 17611228 18356796 46717382 49269695 1253090 488580 46534755 45106826 19885645 17928818 26649110 27178008 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 44241189 30000 49272847 Medical care & ancillary services, nursing home & skilled services, physician services. 44241189 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 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 156 0 1 572 1 0 0 0 0 0 0 1 1 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 Norman Fournier President 2.00 1.00 X X 0 0 0 John Ezzy Vice President 1.00 0.50 X X 0 0 0 Mark Morneault Treasurer 1.00 0.50 X X 0 0 0 James Thibodeau Secretary 1.00 0.50 X X 0 0 0 Ronald Daigle Director 1.00 0.50 X 0 0 0 Dan Vaillancourt Director 1.00 0.50 X 0 0 0 Robert Bellefleur Director 1.00 0.50 X 0 0 0 Mark Chamberland Past Director 1.00 0.50 X 0 0 0 Michael Sullivan MD Director 50.00 0.50 X 292424 0 4784 David Desjardins Director 1.00 0.50 X 0 0 0 Don Guimond Director 1.00 0.50 X 0 0 0 Erin Soucy Director 1.00 0.50 X 0 0 0 Peter J Sirois CEO 50.00 1.00 X 284078 0 31891 Cindy L Daigle CFO 50.00 1.00 X 158593 0 25373 Mark Overton MD Psychiatrist 50.00 0.00 X 698632 0 21596 John Hallberg MD Orthopedic Surgeon 50.00 0.00 X 523898 0 27371 James Harris MD Physician 50.00 0.00 X 509213 0 30233 Baharak Bagheri MD Radiologist 50.00 0.00 X 507064 0 19140 David Coffman MD Surgeon 50.00 0.00 X 500047 0 17212 3473949 0 177600 42 0 1 0 Medhost of Tennessee Inc 2739 Momentum Place Chicago IL 60689 Software & Support Services 526786 Cary Medical Center 163 Van Buren Rd Suite 1 Caribou ME 04736 Off-Site Laboratory Services 365927 Quest Diagnostics 12436 Collections Center Drive Chicago IL 60693 Off-Site Laboratory Services 286745 Pines Health Services 74 Access Highway Caribou ME 04736 Physician Services 265729 Joseph Chemtob 2401 E 7th Street Brooklyn NY 11223 Physician Services 162390 14 298263 298263 Patient Service Revenue 623000 78556870 78556870 Miscellaneous Revenue 623000 1889608 1749588 140020 Meaningful Use Revenue 623000 119338 119338 Provision for Bad Debt 623000 -1375063 -1375063 Contractual/Char. Adj. 623000 -29955513 -29955513 49235240 81858 81858 60191 0 60191 60191 60191 259083 82518 253724 79934 5359 2584 7943 7943 64235 27062 37173 37173 Insurance Captive 900099 37607 37607 37607 49758275 49132827 0 327185 30000 30000 797142 297208 499934 25218144 22444148 2773996 371100 330279 40821 2902710 2583412 319298 1593803 1418485 175318 82408 73343 9065 58863 52388 6475 9970 9970 1819036 1618942 200094 47608 42371 5237 2234246 1988479 245767 2213220 1969766 243454 78525 69887 8638 344837 306905 37932 2862897 2547978 314919 1178317 1048702 129615 Medical Supplies 6136818 6136818 Health Care Provider Ta 976802 976802 Valley Medical Associat 240769 240769 Dues & Subscriptions 72480 64507 7973 49269695 44241189 5028506 0 X 207129 25722 7753926 9096327 6645339 6097339 24571 0 831013 751903 324342 366304 47424973 27627737 20905950 19797236 2005563 2700589 7836922 6271406 46534755 45106826 7330411 4155168 8239594 8554102 4315640 5219548 19885645 17928818 X 26302703 26724435 346407 453573 26649110 27178008 46534755 45106826 488580 40317 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6987 6987 0 Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which is attributable to lobbying expenses. 145224 145224 29107128 11038906 18068222 18148531 16588831 1559700 24090 24090 19797236 Deferred Compensation 899342 Cash Surrender Value of Life Insurance 266825 Interest in Synernet Reinsurance 943200 Meaningful Use Receivables 119126 Estimated Third-Party Payor Settlements 3401987 Insurance Claim Receivable 150000 Due from Related Parties 490926 6271406 Deferred Compensation 899342 Estimated Third-Party Payor Settlements 4320206 5219548 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. 2016 Cancer Fund Tour 24573 24573 1229 270 1786 Annual Auction 39662 39662 350 13571 2464 7392 64235 64235 350 14800 2734 9178 27062 37173 1 1 X 1 X 1 X 0 1 0 1 1 453283 453283 0.00920 3648429 2296236 1352193 0.02740 4101712 2296236 1805476 0.03660 23329187 17850954 5478233 0.11120 30000 30000 0.00060 23359187 17850954 5508233 0.11180 27460899 20147190 7313709 0.14840 1 813485 18648934 18347989 300945 X 1 1 2 1 Northern Maine Medical Center 194 East Maine 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 13 1 1 1 1 X www.nmmc.org X 1 14 1 www.nmmc.org 0 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 1 X 0 X X X X 1 X 0 0 Northern Maine Medical Center Part V, Section B, Line 3j: Northern Maine Medical Center (NMMC) is located in Fort Kent, Maine (Aroostook County). Aroostook County is considered rural by the State of Maine and the United States Census Bureau. The hospital service area is primarily the St. John Valley. The following towns make up the St. John Valley region: Allagash, Eagle Lake, Fort Kent, Fort Kent Mills, Frenchville, Grand Isle, Madawaska, St. Agatha, St. David, St. Francis, Sinclair, Wallagrass, Winterville Plt., Van Buren and several surrounding towns and unorganized territories. In 2009, the percentage of Fort Kent residents with income below the poverty level was 36.4%. The percentage of children below the poverty level was 36.7% in 2009. The percentage of the population aged 65 and over was 18% in Aroostook County. The unemployment rate in Aroostook County was 9.3% in 2011, which was higher than the State's rate of 7.8%. Of the individuals 25 years or older in Aroostook County, 23% do not have a high school diploma compared to 15% overall in the State.Northern Maine Medical Center utilizes an electronic medical record system and its related physician practices abstract data for reporting to the ACO they are now a part of, which provides a vast amount of data relative to patients in care. The needs assessment provides a much broader picture of the community as a whole, including the health status of individuals not in care, as well as functional health status and social demographics (such as employment, income and education levels). The local units of the State's public health infrastructure (known as "Healthy Maine Partnerships") are also integrated into the process so that their data relative to health, environmental and social measures are part of the community dissemination process.Northern Maine Medical Center distributed the EMHS Qualitative Stakeholder survey link to their employees, volunteers, board members, donors, and other stakeholders. In the Fort Kent service area, key collaborators going forward will include: Northern Maine Medical Center and its owned physician practices, Cary Medical Center, The Aroostook Medical Center, Fish River Rural Health Center, local schools, Aroostook Home Health Services/Valley Home Health Services, Aroostook Mental Health Center, UMFK, and Twin Rivers.EMHS, the primary tertiary center utilized by Northern Maine Medical Center, routinely conducts a community health needs assessment (hereafter referred to simply as "needs assessment") across the service area of all of its member hospitals. The most recent assessment, published in 2014, was developed by EMHS to support their member organizations and community partners in their work to develop strategies that will improve the health of the people they all serve. The report's findings were analyzed and compiled by representatives of Hart Consulting, Inc. The report relates findings from three data sources: The Qualitative Stakeholder Survey conducted by EMHS with its stakeholders (June 2014), the University of Wisconsin Population Health Institute's County Health Rankings (2014), and OneMaine Health's Community Health Needs Assessment (2011). Northern Maine Medical Center Part V, Section B, Line 5: The 2014 Community Health Needs Assessment was developed by the Eastern Maine Health System (EMHS) to support member organizations and community partners' work to develop strategies that will 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, Bangor Public Health and Community Services, Portland Public Health, 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 online survey was distributed as a website link via email 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.On January 7, 2016, the Northern Aroostook Community Engagement Forum was held jointly with the area Public Health District Coordinating Council. A total of 33 individuals participated in the session. The following sectors were represented at the public forum:- 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 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, Redington-Fairview General Hospital. Northern Maine Medical Center Part V, Section B, Line 6b: Local Public Health Coordinating Councils - Aroostook District Coordinating Council for our region. Healthy Maine Partnerships - Health Aroostook for our region. Northern Maine Medical Center Part V, Section B, Line 7d: The St. John Valley assessment was posted on the NMMC website in late 2014, as soon as it became available. The report is also available upon request. In 2015, a news article was published to inform the public that the report is available and how they can access it. The report is on the NMMC website and in addition, contact information is provided on the website for individuals who wish to request a free paper copy. Additionally, individuals may call NMMC to request a free copy. Northern Maine Medical Center Part V, Section B, Line 11: NMMC adopted an implementation strategy to address the health needs of the hospital facility's community and prioritized the health needs of its communities using the St. John Valley and Aroostook County Community Health Needs Assessment of 2014 conducted by EMHS. A Steering Committee composed of Northern Maine Medical Center administrative leadership and governing board was formed to evaluate the findings from the 2014 Community Health Needs Assessment survey for the St. John Valley and Aroostook County. The Committee was educated in the principles to be considered when assessing the survey findings. A summary of the Affordable Care Act provisions aimed at improving community health through direct investments in wellness and prevention at the individual and community level was also provided to members. The Committee identified priorities which were approved by the full governing board that subsequently designated responsibility to two separate work groups to develop a plan to address the prioritized needs over the next three years. 2015 CHNA overarching goals:1. Identify key stakeholders and harness resources to form partnerships with existing St. John Valley and Aroostook County groups who may be sharing similar goals that benefit the communities served.2. Educate members of the communities and other key personnel such as medical providers regarding available resources. Prioritization of health needs in the community:Priority #1: Substance AbuseThe 2014 CHNA survey results for the St. John Valley demonstrated substance abuse as one of the top unmet healthcare needs and so it was chosen as priority number one.a. Affordable options for people who are uninsured or under insuredb. Pain management alternatives to prescription drugs/opioidsc. Substance abuse treatment providersPreventive screenings that survey respondents did not feel were very accessible in this category included: - Alcohol misuse screening - Social concerns in the survey findings included substance abuse. - Gaps were identified by respondents in healthcare services related to substance abuse treatment & detoxification.Action plan for Priority #12015-20161. Actions are being addressed in three distinct categories: prevention, screening and treatment.2. The Hospital Chief Operating Officer, in collaboration with community partners (Power of Prevention and the Aroostook Mental Health Center) is coordinating educational opportunities which will be offered to local schools and civic groups on the effects of substance abuse.3. The Power of Prevention is working with law enforcement to increase checkpoints to screen for drunk driving.4. The Medication Lock Boxes, in collaboration with the Healthy Maine Partnerships, were launched in Madawaska through the Primary Care offices. The program was introduced at a public event in November of 2015. Coordination to provide the boxes in the Fort Kent provider offices is in progress.5. Discussions were held with Power of Prevention representatives to plan for formal training of primary care practice employees on SBIRT, Screening, Brief Intervention, Referral and Treatment. SBIRT is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. The SBIRT model, developed by the Institute of Medicine, is a recommendation that promotes community-based screening for health risk behaviors, including substance abuse. 6. NMMC fosters the community support group AA, Alcoholics Anonymous, in regards to their assistance with aftercare by allowing them to use physical meeting space at Forest Hill to hold meetings. Information about the support group is also provided to surrounding communities and included on NMMC's master list of support groups.Of note, the Aroostook County District Coordinating Council for Public Health has identified substance abuse as a priority and there is collaboration to partner in an action plan.7. Dr. David Jones, Emergency Department physician conducted an on-air television interview in May 2016 around the high risk matter of opioid use in Aroostook County and the perspective of emergency care. Programs or resources to be used to address Priority #1Measure of success for Priority #1 Substance Abuse:1. 32 free locking drug boxes were handed out to individuals across the St. John Valley in 2016 to support drug security in the homes. This action was implemented in partnership with the Power of Prevention program.2. Northern Maine Medical Center's medical staff was educated and trained in managing chronic pain without opioids.Priority #2: Healthy Food and NutritionThe 2014 CHNA survey results for the St. John Valley demonstrated top barriers that prevent healthy eating and thus was chosen as priority number two.a. Affordability of healthy food optionsb. Access to healthy food options in school/work environmentc. knowledge, attitudes and beliefs regarding nutritionPreventive screenings that survey respondents did not feel were very accessible included obesity screening.Action plan for Priority #22015-20161. An informational session was offered to NMMC providers by Let's Go! Program director, Dr. Tory Rogers -Growing and Sustaining Let's Go! In Maine. Pediatrician, Dr. Tory Rogers, provided a CME program on 3/31/16 for NMMC Medical Staff related to the Let's Go! Childhood Obesity Reduction Program. Dr. Rogers also met with the Chief Executive Officer on 3/31/16. In January and February of 2016, a dialogue was initiated with local organizations such as the Cooperative Extension Service, the University of Maine at Fort Kent, Healthy Maine Partnerships, the Power of Prevention, Public Health and the local food coop. The purpose for the dialogue is to explore more local purchasing of fresh foods. On 11/616, NMMC Food Service Director met with Tony Gauvin of USDA out of UMFK and two individuals from the Portland area to continue to explore local buying options.2. The Public Relations Director is a member of the Clinical Community Linkages, a committee of the Power of Prevention. The committee is working on strategies to address food insecurities in the surrounding communities with the support of PICH, Partners in Community Health.3. A partnership was also created with Farm to Institution New England to begin a dialogue with local farmers to discuss strategies for affordability and access to fresh foods. Conference calls were held February 9, 16 & 24th of 2016. These calls were to identify key stakeholders in preparation for a roundtable presentation which was held on March 9, 2016 where local institutions identified needs and discussed strategies to plan to work with local farmers.4. The Nutrition Department Director worked with Kim Parent from the Power of Prevention to develop changes and formalize them in the organization. In 2016, one of the fryers in the kitchen was eliminated. Fried food options offered for lunch in the cafeteria were reduced to only one option. These improvements also impact patient meals.More meal choices are made onsite rather than purchasing pre-made processed foods.a.Example: Italian Wedding Soup b.Example: LasagnaEmployees can make their own salad at the salad bar (includes fruit)Employees can make their own sandwiches where they can make a half sandwich to address portion control. Along that line, two options for soup are now available, small and medium. 5. July and August of 2016, work began to pilot a program which assesses the presence of food insecurity in patients coming to the ED. Work is being done to incorporate assessment questions into the EMR and a process was created to refer patients to Social Work and Case Management when food insecurity is identified. PR Director met with DON, Social Work staff, Case Managers and the ED nursing staff over the summer to provide education. In addition, a CME program was held on September 29, 2016 to engage providers, Medical Assistants, office nurses and Case managers in the work being done to reach out to patients in need of support. The program included data on the link between obesity and chronic disease prevalence with patients who experience food insecurity. 6. Beginning in 2014, NMMC and the Aroostook Area Agency on Aging developed a partnership to better serve the public in support of thriving at home and reducing hospital readmissions, specifically, by providing free meals to eligible patients and performing in-home safety assessments.Programs or resources to be used to address Priority #2:Partners in Community HealthPower of Prevention, Clinical Community LinkagesHealthy Maine PartnershipLet's Go! MaineFarm to Institution Food ProgramSee continuation of Part V, Section B, Line 11 narrative on next page. Northern Maine Medical Center Part V, Section B, Line 22d: Individuals are billed at gross amounts and charges are adjusted accordingly, if they qualify for assistance. 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. Continuation of Form 990, Schedule H, Part V, Section B, Line 11: Measure of success Priority #2 Healthy Food and Nutrition:1. A PICH (Partners in Community Health) Grant was received through collaboration with the Power of Prevention to implement a pilot program in the Emergency Department to screen all patients for food insecurity and to connect them with food sources and Care Management. Data collection begins January 2017.2. The Courtesy Home Visit program was expanded to increase the amount of free meals delivered to patients who were identified to be in need of nutritional support.3. 2015 - period of 8 months = 1176 meals were provided 2016 - period of 12 months = 2247 meals provided4. The NMMC Cafe has implemented changes to encourage and facilitate healthy food choices. Also, food preparation is done using heart healthy ingredients.5. We are beginning to track the impact of developing strategies on obesity numbers. Early baseline data shows: January 2015 to December 2015, patients with a diagnosis of obesity were reported at 3,969. From January 2016 to December of 2016, 3,961 patients were seen with a diagnosis of obesity.Priority #3: Cardiovascular HealthThe 2014 CHNA survey results for the St. John Valley demonstrated top barriers that prevent people from being physically active. Aroostook County has the second highest prevalence of heart disease in Maine and so this need was selected as priority number three.a. Personal barriers (i.e., lack of time, motivation, values and beliefs)b. Weather conditionsc. Insufficient facilities or lack of access to facilities for exercisingAction plan for Priority #3 2015-20161. A partnership was created with the Aroostook Area Agency on Aging to offer a free Bone Builders class to local seniors. Bone Builders is a fitness program for people over the age of 50 which focuses on strength training, balance and includes such topics as fall prevention, osteoporosis, and nutrition. The agreement was signed with the Aroostook Area Agency on Aging in early 2015. NMMC is providing hand and ankle weights free of charge to class participants.Classes began in early May 2016. As of September 2016, we have 6 participants and plan to expand to 10 in Fort Kent. We are entertaining recruiting a volunteer instructor for the Madawaska area. September 2016, a second volunteer instructor was trained to ensure continuity for the classes in Fort Kent. 2. A partnership was created with the Madawaska School system and the Recreation Department to open a Wellness Center which is open to the public. NMMC provided the equipment and start-up funds for renovating the physical space needed for the program. There are currently approximately 80 members.3. There is also a partnership in place with the Fort Kent School for a Wellness Center. The Center was open to the public for a period of time but is temporarily only open to school youth, school system staff and NMMC employees. The obstacle at this time is funding. The intent is to reopen to the public as soon as resources can be accessed. In January of 2017, the Wellness Center was opened to the public. 4. A walking path was cleared at the rear of the hospital to encourage walking. 5. The NMMC Website upgrade was completed in the Spring of 2015. The site now offers a variety of health and wellness resources for members of the community. An electronic newsletter is also now available to subscribers on a quarterly basis. Two newsletters have been published. The NMMC website has over 150 subscribers to the electronic newsletter in addition to the distribution through a chamber of commerce database. An additional resource is also in the planning stages. The resource provides the public access to a user friendly, up to the day health, wellness and disease information site called Your Care Everywhere which links directly with NMMC's website and patient portals. YCE is now in place as of July 2016.6. On a weekly basis, OffUGoAroostook, a service of the Aroostook Power of Prevention, circulates physical activity opportunities to subscribers to assist in broadening the availability of the health and wellness activities available around the St. John Valley and Aroostook County. NMMC's support comes in the form of expanding the circulation of the information to a broader population. 7. A community group was convened to create a partnership that would offer more options to local seniors for free access to exercise facilities, especially for use during winter months. First meeting held 8/23/16. A second meeting is scheduled for the second week of October with additional stakeholders to continue the discussion. Survey findings were compiled with a preliminary listing of resources and a brochure was created. The brochure was posted on NMMC's Facebook page and website. Brochures were also sent to each provider office with a cover letter explaining the program and additional brochures were made available in public areas of the hospital. 8. Outdoor festivals are offered on an annual basis to the children of the St. John Valley in winter and summer. The events promote the combination of fun with physical activity.9. NMMC financially supported the Fort Kent school and community playground project in June 2016. NMMC coordinated a walkathon with the school children and NMMC employees to promote awareness on the importance of physical activity at an early age. 10. NMMC Patient Educator was trained in February of 2015 along with two other RN's by the Pfizer Company to be able to offer 'Beat the Pack' smoking cessation program. The program has been offered twice since the training was completed and is available to both employees and the public. Advertising of the support is posted on the NMMC website and information about the program was offered at two community events in 2015; Twin Rivers Paper Company August 2015 and the Acadia Family Health Center Open House in November where they spoke with the public about smoking cessation opportunities. 11. Train the Trainer program was coordinated with Pfizer Pharmaceuticals so that NMMC could offer a smoking cessation program. Three RN's were trained in to offer 'Beat the Pack' smoking cessation program. The program has been offered to the public and employees twice. Trainers also participated in a health fair at Twin Rivers Paper Company in August of 201512. NMMC Patient Educator was trained in February of 2015 along with two other RN's by the Pfizer Company to be able to offer 'Beat the Pack' smoking cessation program. The program has been offered twice since the training was completed. Advertising of the support is posted on the NMMC website and information about the program was offered at two community events in 2015; Twin Rivers Paper Company August 2015 and the Acadia Family Health Center Open House in November where they spoke with the public about smoking cessation opportunities.Programs or resources to be used to address Priority #3:Aroostook Area Agency on AgingTown of Madawaska School SystemTown of Madawaska Recreation DepartmentTown of Fort Kent School SystemPower of Prevention, Off-U-Go AroostookMeasure of Success Priority #3 Cardiovascular Health:1. Our partnership with the town of Madawaska has resulted in 249 individuals using the Madawaska Wellness Center.2. A similar partnership in Fort Kent has resulted in the participation of 106 individuals from the community.3. A brochure was created in collaboration with multiple community stakeholders to make free indoor walking access available to the public. The brochure has been widely distributed to educate the public on available access.4. The hospital readmission rate is trending downward as a result of the CHNA interventions. We received recognition from CMS for our work in reducing NMMC readmission rates.NMMC believes the following community health needs are important however they were prioritized as secondary level priorities for various reasons. It is also important to note, as will be outlined further in this section, some work is being done to positively impact these needs.1. Social concerns that include:- Unemployment/economic opportunity- Domestic violence- Physical and social isolation -began partnering with the Aroostook Area Agency on Aging's Thrive in Place program for elders. On 1/29/15, clinical staff was trained to broaden their knowledge in the area of home environmental assessments which can also provide some socialization. We are working closely with the Aroostook Area Agency on Aging to address some of the physical and social isolation identified.- Affordable housing Continuation of Form 990, Schedule H, Part V, Section B, Line 11: 2. Preventive screenings and immunizations that survey respondents did not feel were very accessible. Those include:- Oral health- Depression screening - All primary care providers are using the PHQ depression screening tool as a first line depression screening.- Aging related screening - We have begun working with the Power of Prevention, Healthy Aroostook Coalition to address aging related screening and the possibility of educating providers on the use of CMS screening tools.- Tobacco use screening - this screening is done organization wide; the NMMC Patient Educator was trained last year along with two other RN's by the Pfizer Company to be able to offer 'Beat the Pack' smoking cessation program. The program has been offered twice since the training was completed. Advertising of the support is posted on the NMMC website and information about the program was offered at two community events in 2015.3. Gaps in Healthcare Services:- Dental care - 'First Tooth' program has been presented to the Family Practice Team for their consideration of adding this assessment tool to their patient visits.- Behavioral/mental health services for adults4. Issues Preventing Access to Care:- Out of pocket costs associated with insurance plans- Lack of insurance and unable to pay for the care a. A new section was added to the NMMC website to provide more access to information to assist the public. The website includes the Charity Care Eligibility and application and other resources to assist the public. A Patient Financial Counselor position was added as a means of support to patients as well.- Transportation - NMMC is partnering with the Aroostook Area Agency on Aging to address the issue of transportation.- Don't understand or value the importance of seeking care- Negative prior experiences - several initiatives have been undertaken to provide transparency to the people served by NMMC and to encourageopen communication.a. Community Liaison Committee of the Board of Trustees was convenedand is in its second year.b. We're Listening Campaign was launched in 2015 to inform the public of the importance of their feedback directly to NMMC. 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, CHAMPUS, 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. 1 LifeFlight Foundation PO Box 899 Camden ME 04843 522377085 501(c)(3) 30000 Finacial support of organization 1 0 Part I, Line 2: The Hospital granted monies to a public charity exempt under 501(c)(3). Therefore, additional monitoring is not deemed necessary. X X X 0 0 0 0 0 0 0 1 0 Michael Sullivan MD Director 274924 0 0 0 17500 0 0 0 4784 0 297208 0 0 0 Peter J Sirois CEO 264078 0 20000 0 0 0 7685 0 24206 0 315969 0 0 0 Cindy L Daigle CFO 153593 0 5000 0 0 0 3021 0 22352 0 183966 0 0 0 Mark Overton MD Psychiatrist 698632 0 0 0 0 0 0 0 21596 0 720228 0 0 0 John Hallberg MD Orthopedic Surgeon 523898 0 0 0 0 0 7950 0 19421 0 551269 0 0 0 James Harris MD Physician 491713 0 0 0 17500 0 7950 0 22283 0 539446 0 0 0 Baharak Bagheri MD Radiologist 507064 0 0 0 0 0 7950 0 11190 0 526204 0 0 0 David Coffman MD Surgeon 500047 0 0 0 0 0 0 0 17212 0 517259 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. The bonus payment made to Cindy Daigle, CFO, was paid at the discretion of the Organization's CEO. The CEO communicates the bonus and amount directly with the Human Resources Director. Daigle Oil Company Entity of which Dan Vaillancourt, Board Member, is an officer 124056 Independent Contractor Arrangement 0 Nola Sirois Family member of Peter Sirois, Hospital CEO 28110 Employment 0 Michelle L Plourde Family member of Peter Sirois, Hospital CEO 82359 Employment 0 Nicole Marquis Family member of Peter Sirois, Hospital CEO 30739 Employment 0 Robin Werntgen Family member of Peter Sirois, Hospital CEO 67004 Employment 0 Gail Lamarre Family member of Peter Sirois, Hospital CEO 14995 Employment 0 James Daigle Family member of Cindy Daigle, CFO 15278 Employment 0 Form 990, Part VI, Section B, line 11 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 Maine 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 1 0 0 1 0 Valley Medical Association R 240769 Actual Outlay