2016-05-16T11:22:16-05:00 2015-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2014-07-01 010223482 Millinocket Regional Hospital MILL 2077235161 200 Somerset Street Millinocket ME 04462 Robert Peterson Chief Executive Officer 2077235161 2016-05-13 1 Joseph R Byrne CPA P01289281 2077752387 2016-05-13 2014 2016-08-17 19:52:53Z Robert Peterson 200 Somerset Street Millinocket ME 04462 30273462 0 X www.mrhme.org X 1952 ME Critical Access Hospital 12 5 286 10 0 0 8877 20585 24974746 25292432 1027004 698404 13625 -17041 26024252 25994380 0 1000 0 0 17644553 16256085 0 0 0 9639342 9894863 27283895 26151948 -1259643 -157568 24726055 24118519 10221431 9752035 14504624 14366484 X Millinocket Regional Hospital is a 25 bed critical access hospital that serves as the primary care facility in the Katahdin region including the towns of of Millinocket, East Millinocket, Medway, Sherman, Stacyville, Patten, Island Falls, Woodville, and Brownville. 0 0 24144829 25292430 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. During this reporting period, MRH cared for 730 inpatients, 16,687 clinic patients, and 6,214 emergency room patients. In addition, MRH provided 1,221 surgical services, 19,549 laboratory services, and 10,033 radiology services.The following events represent some of the major community activities Millinocket Regional Hospital sponsored, supported, and participated in throughout fiscal year 2015:1. Battle for a Cure softball tournament fundraiser2. Relay for Life fundraiser3. Food drive for local food pantries4. Dance Your Heart Out fundraiser5. Books for Bikes6. Toys for Tots7. Annual Craft Fair8. Veterans Healthcare at MRH9. Katahdin Area Chamber of Commerce (KACC) Trails End Festival10. KACC Snowmobile Map11. KACC Visitors Guide12. MRH Auxiliary Love Light Tree13. MRH scholarships for high school seniors 24144829 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 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 81 0 1 286 1 0 0 0 0 0 0 0 0 0 0 X 12 5 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 X Catherine LeMay 2077235161 200 Somerset Street Millinocket ME 04462 Ronald Brown Director 5.00 X 0 0 0 Patrick Hunt Esq Director 5.00 X 0 0 0 Herbert Clark Director 5.00 X 0 0 0 Gail Fanjoy Director 5.00 X 0 0 0 Fred Lewis Director 5.00 X 0 0 0 Thomas Malcolm Board Secretary/Treasurer 5.00 X X 0 0 0 Joyce Given Hospital Aux. President 5.00 X 0 0 0 Daniel Herbert MD Medical Staff AD HOC 60.00 X X 277619 0 28001 Nilesh Patil MD Medical Staff President 60.00 X X 442679 0 28215 Mellissa Edwards President 5.00 X X 0 0 0 Lee Lamson Vice President 5.00 X X 0 0 0 Stylianos Tsintzilonis MD Medical Staff VP/Sec/Treasurer 60.00 X X 273402 0 20451 Wallace Tapley Past Director 5.00 X 0 0 0 Robert Peterson CEO 40.00 X 113886 0 13432 Christine McLaughlin Past VP of Finance 40.00 X 118616 0 20781 Barbara Polizotti Past Interim CFO 40.00 X 0 0 0 Catherine LeMay CFO 40.00 X 0 0 0 Joseph Aquilina Internal Med PA 48.00 X 178126 0 14090 Kwaku Owusu-Abrokwa MD Hospitalist 60.00 X 225729 0 19075 Edward Dunstan Family Practice MD 60.00 X 214606 0 31999 Mark Kowalski Surgeon 60.00 X 463690 0 42753 Bruce Rioux Anesthesiologist 60.00 X 161561 0 29102 2469914 0 247899 22 0 1 0 Katahdin Shared Services Inc 200 Somerset Street Millinocket ME 04462 Ultrasound Services 307497 CPSI PO Box 850309 Mobile AL 36685 Computer Services 301596 NEHE-MRI LLC PO Box 6600 Newport Beach CA 92658 MRI Radiology 229466 BE Smith Dept 300 PO Box 219241 Kansas City MO 641219241 Contract Services 224683 Synernet Inc 110 Free Street Portland ME 04101 Contract Services 224288 8 20585 20585 Ancillary Services 621400 39601009 39601009 Routine Services 621400 2865553 2865553 Miscellaneous Income 621400 169149 130679 38470 Provision for Bad Debts 621400 -1374495 -1374495 Contractual/Char. Adj. 621400 -15968784 -15968784 25292432 225813 225813 31520 18641 12879 12879 12879 4733032 4260175 266 472857 -266 472591 472591 Loss on Investment of Affiliate 531120 -29920 -29920 -29920 25994380 25253962 0 719833 X 1000 1000 1337082 1070367 266715 11802441 11110291 692150 343777 326279 17498 1927455 1810105 117350 845330 785336 59994 30958 30958 52257 52257 48833 48833 3190130 2699268 490862 32508 32508 528116 467950 60166 523294 499470 23824 17430 5330 12100 197817 197817 823843 823843 321866 321866 Medical Supplies 3417566 3319273 98293 Medicaid Tax 602880 602880 Dues & Subscriptions 58879 58879 Miscellaneous Expenses 48486 44875 3611 26151948 24144829 2007119 0 X 930 4475 2574596 1284589 2822362 3028866 87884 70103 502768 518715 407646 273301 19725516 14008971 5983972 5716545 10934616 11880019 1397245 1329274 14036 12632 24726055 24118519 3284840 3709475 1126289 998968 3909551 3553221 1900751 1490371 10221431 9752035 X 14388444 14252585 111180 108899 5000 5000 14504624 14366484 24726055 24118519 -157568 19428 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 8040 8040 0 Part II-B, Line 1: The Organization pays dues to various organizations, a portion of which are attributable to lobbying expenses. 49951 49951 9253271 6006564 3246707 9473499 7440854 2032645 948795 561553 387242 5716545 Investment in First Millinocket Regional Investment Corp 1277275 C Investment in Katahdin Shared Services 51999 C 1329274 Estimated Third-Party Payor Settlements 1490371 1490371 1 1 1 X 1 X 1 1 1 0 0 1253029 1253029 0.04790 3168002 52709 3115293 0.11910 4421031 52709 4368322 0.16700 1755 1755 0.00010 1755 1755 0.00010 4422786 52709 4370077 0.16710 1 804136 10111402 10035312 76090 X 1 0 1 1 Millinocket Regional Hospital 200 Somerset Street Millinocket ME 04462 X X X Millinocket Regional Hospital 1 0 0 1 X X X X X X X X 11 1 1 0 1 X 1 11 0 1 0 1 X 150.000000000000 400.000000000000 X 1 1 1 X 1 0 X X X X 1 X 0 0 Millinocket Regional Hospital Part V, Section B, Line 5: The OneMaine Health Collaborative, which was formed by EMHS/Maine General Health and Maine Health, contracted with the University of New England's Center for Community and Public Health (CCPH) to conduct a Statewide Community Health Needs Assessment (CHNA). The assessment conducted in collaboration with the University of Southern Maine and Market Decisions, Inc, was designed to identify the most important health issues in the state, overall, by county and by region, using scientifically valid health indicators and comparative information. The assessment also identifies priority health issues where better integration of public health and healthcare can improve access, quality, and cost effectiveness of services to residents of Maine. OneMaine shared this information with its fellow stakeholders to develop strategies to improve health status and quality of care available to Maine residents, while building upon and strengthening Maine's existing infrastructure of services and providers.The four objectives of the OneMaine Community Health Needs Assessment were:1. Develop a comprehensive profile of health status, quality of care and care management indicators for residents of Maine overall and for residents by county.2. Identify a set of priority health needs (public health and health care) for follow-up.3. Provide recommendations on strategies that can be undertaken by healthcare providers, public health staff, communities, policy makers and others to follow-up on the information provided with actions that may improve the health status of Maine people. 4. Provide access to the CHNA data and assistance to stakeholders who are interested in using it.The methodology for the CHNA was a modified version of CCPH's Community and Institutional Assessment Process (CIAP). The CIAP is a comprehensive planning process that identifies salient healthcare related issues in the community through a systematic analysis of scientifically derived health indicators and comparative and best practice information. Indicators are computed from an extensive set of health-related data and a community household telephone survey.The CIAP starts with a comprehensive epidemiological-based health profile organized by health domain or condition such as cardiovascular health, respiratory health, cancer health, etc. Indicators for most domains are further organized by risk factors, prevalence or incidence of disease or condition, care management indicators and care outcomes. The analysis of indicators within each domain provides information to identify, and subsequently explore, which aspects of the healthcare delivery system may be over-or under-performing for that particular domain (e.g. primary prevention, secondary prevention, etc.)Community health needs assessments are designed, in part, to identify issues where changes in the healthcare delivery system can improve both patient care and preventive services for those at risk for health problems. Findings and recommendations:1. Maine has several underlying socio-demographic characteristics that impact many of the health indicators, for example, Maine has the oldest population in the U.S., a very high proportion of elderly (65+) compared to the U.S. Being older does not equate to poor health, the reality is that aging populations use more health services than younger populations.2. Maine has a lower median income than the U.S. but the proportion of Maine residents living below the Federal poverty line is slightly lower than the rest of the country. However, in Northern Maine the proportions of residents live below the Federal poverty line than the state as a whole or the U.S.3. Unemployment is an important demographic predictor of health and compared to the rest of the U.S., Maine has a lower unemployment rate, but several Maine counties individually have high rates of unemployment, many well over 10%.On May 26, 2011, Eastern Maine Health Systems (EMHS) presented the OneMaine Health Collaborative Community Health Needs Assessment to community leaders, which was hosted by Millinocket Regional Hospital and Penobscot Valley Hospital.Access to Health Care and ED UtilizationMRH received Rural Health Clinic status to stabilize primary care reimbursement. MRH has recruited a mid-level provider and is in the process of recruiting a part time family practitioner. MRH provided a sliding fee and charity care in practices to mirror the hospital to encourage access. The RHCs are seeking Patient Centered medical Home status which will encourage expanded coverage hours. Currently participating in MaineCare ED utilization project and implemented follow-up call on ED visits to question if primary care was sought.Obesity & Chronic Disease ManagementMRH employs a Wellness Coordinator and has a worksite wellness program. MRH incentivizes employee health and wellness via health plan. MRH subsidizes and runs only fitness facility north of Bangor. MRH supports and employ staff for healthy Maine Partnership. Physicians do community talks on nutrition. MRH hired a primary care Case Manager whose focus is on diabetes, heart disease, HTN, and COPD. MRH maintains a Cardiac Rehab, Diabetes Self-Management Training, and ADEF program.Behavioral HealthcareMRH has an ongoing relationship with CHCS Crisis Services for crisis evaluation. MRH developed Tele-Psychiatry Program with Acadia Hospital for emergent psychiatric assessment. MRH is developing plans to integrate Behavioral Healthcare into primary care as part of Patient Centered Medical Home Project. MRH petitioned CMS to allow reimbursement of telemedicine in Metropolitan Statistical Areas to allow further expansion of Tele-Psychiatry. Millinocket Regional Hospital Part V, Section B, Line 6a: Statewide community health needs assessment "OneMaine Health Collaborative" sponsored by Eastern Maine Health System, MaineGeneral Health, and MaineHealth. Millinocket Regional Hospital Part V, Section B, Line 11: Please refer to attached Community Health Needs Assessment/Implementation Strategy. Millinocket Regional Hospital Part V, Section B, Line 22d: The Hospital billed amounts to individuals who did not have insurance at cost and applied a 10% discount to private pay patients. 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 Discounted151% to 200% FPL 50% Balance Discounted201% to 250% FPL 25% Balance Discounted251% to 300% FPL 10% Balance Discounted301% to 400% FPL 5% Balance Discounted Part I, Line 7: Expenses calculated on Lines 7a & 7b were calculated using a cost-to-charge ratio while actual expenses were used in calculating the amount reported on line 7i. Part III, Line 4: 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 each 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 8: The Organization used accounting methodology prescribed by the Medicare cost report as its costing methodology to determine the amount of Medicare allowable costs. Part VI, Line 2: A formal community needs assessment is done every 2-3 years. These assessments are conducted to obtain information on successes, failures, weaknesses and strengths to be used for guidance in the vision for the future of healthcare delivery in our service areas. 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 community outmigration. The population of the primary service area is approximately 7500 people. The hospital has realized this population change by large volume declines 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. X X X X X 0 0 0 0 0 0 0 1 0 Daniel Herbert MD Medical Staff AD HOC 245519 0 32100 0 0 0 10548 0 17453 0 305620 0 0 0 Nilesh Patil MD Medical Staff President 442679 0 0 0 0 0 4500 0 23715 0 470894 0 0 0 Stylianos Tsintzilonis MD Medical Staff VP/Sec/Treasurer 273402 0 0 0 0 0 11000 0 9451 0 293853 0 0 0 Joseph Aquilina Internal Med PA 178126 0 0 0 0 0 1861 0 12229 0 192216 0 0 0 Kwaku Owusu-Abrokwa MD Hospitalist 225729 0 0 0 0 0 9223 0 9852 0 244804 0 0 0 Edward Dunstan Family Practice MD 214606 0 0 0 0 0 8509 0 23490 0 246605 0 0 0 Mark Kowalski Surgeon 463690 0 0 0 0 0 19004 0 23749 0 506443 0 0 0 Bruce Rioux Anesthesiologist 161561 0 0 0 0 0 5074 0 24028 0 190663 0 0 0 Part I, Line 7 A bonus was paid to Daniel Herbert as an incentive for entering into an employment agreement with the Hospital. If the agreement is terminated by the physician, a pro rata amount of the bonus is to be repaid to the Hospital. A Maine Health and Higher Educational Facilities Authority 010314384 560427WV4 2013-05-23 1423837 Refinancing of 2003 D bond issue 0 0 1 A 424869 1423837 15439 1408398 2013 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 Julie Brown Family Member of Ronald Brown, member of Board of Directors 40204 Employment 0 Rose Ann Hunt Family Member of Patrick Hunt, member of Board of Directors 134326 Employment 0 Dale McLaughlin Family Member of Christine McLaughlin, CFO of Organization 95555 Employment 0 Ona McAvoy Family Member of Mellissa Edwards, Board President 65691 Employment 0 Cynthia Morneault Family Member of Joyce Given, member of Board of Directors 34796 Employment 0 Form 990, Part VI, Section B, line 11 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 Purchased Services: Program service expenses 1,707,264. Management and general expenses 490,862. Fundraising expenses 0. Total expenses 2,198,126. Service Contracts: Program service expenses 461,911. Management and general expenses 0. Fundraising expenses 0. Total expenses 461,911. Professional Services: Program service expenses 523,429. Management and general expenses 0. Fundraising expenses 0. Total expenses 523,429. Outside Services: Program service expenses 6,664. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,664. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Millinocket Regional Hospital 200 Somerset Street Millinocket, ME 04462 EIN 01-0223482 Section 1.263(a)-3(n) Election: Millinocket Regional Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). First Millinocket Regional Investment Corp 200 Somerset Street Millinocket ME 04462 010396196 Physician Program Operations ME Millinocket Regional Hospital C 192514 1278833 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 First Millinocket Regional Investment Corp K 173660 FMV First Millinocket Regional Investment Corp Q 173660 FMV