2016-05-16T14:13:22-05:00 2015-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2014-07-01 010198331 Maine Coast Regional Health Facilities MAIN 2076645303 50 Union Street Ellsworth ME 04605 Charles Therrien CEO 2076645303 2016-05-16 1 Joseph R Byrne CPA P01289281 2077752387 2016-05-16 2014 2016-08-17 19:52:53Z Maine Coast Memorial Hospital Charles Therrien 50 Union Street Ellsworth ME 04605 98741208 0 X www.mcmhospital.org X 1964 ME The Hospital is a not-for-profit entity established to provide health care services through its acute care facility and physician practices. 18 14 725 82 0 0 852421 1215362 75275764 73592488 975465 1582576 -49319 -48137 77054331 76342289 10000 10000 0 0 48198006 48363615 0 0 160427 32128696 32556335 80336702 80929950 -3282371 -4587661 71050757 64724729 26327933 26267867 44722824 38456862 X The Hospital is a not-for-profit entity established to provide health care services through its acute care facility and physician practices. 0 0 73836517 10000 73592488 Admissions 2,645Patient Days 8,208Average Stay 3.2 DaysClinic Visits:Eleanor Widener Dixon Clinic 11,987S.W. Harbor Medical Center 4,487Emergency Room Visits 16,075Surgical Cases- Inpatient 570Surgical Cases- Outpatient 3,332Laboratory Tests: 264,630Radiology Exams:Diagnostic Radiology 16,418Ultrasound 5,622CT Scan 5,008Mammography 3,720Nuclear Medicine 2,655MRI 1,993Physical Therapy 70,877Births 289 73836517 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 104 0 1 725 1 0 0 0 0 0 1 1 0 0 0 0 X 18 14 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 ME X X Chris Frauenhofer CFO 2076645304 50 Union Street Ellsworth ME 04605 Robert A Beekman MD Trustee/Physician 50.00 0.00 X 167767 0 34502 Edith R Dixon Trustee 0.50 0.00 X 0 0 0 Jeffrey R Dow Treasurer 1.00 0.50 X X 0 0 0 Debra A Ehrlenbach Vice Chairman 10.00 0.50 X X 0 0 0 Alan J Goldstein Trustee 0.50 0.00 X 0 0 0 Scott S Hammond Trustee 1.00 0.00 X 0 0 0 Daniel A Hurley III Trustee 1.00 0.00 X 0 0 0 Sally J Hutchins Trustee 1.00 0.00 X 0 0 0 Scott A Kimball Trustee 1.00 0.00 X 0 0 0 Sean T Maloney MD Trustee/Physician 50.00 0.00 X 247276 0 50622 Alan H Nauss MD Trustee 1.00 0.00 X 0 0 0 Daniel J Reinke MD President of Medical Staff 50.00 0.00 X 324043 0 51106 Karen W Stanley Trustee 1.00 0.00 X 0 0 0 Kevin B Tesseo Trustee 1.00 0.00 X 0 0 0 Charles D Therrien CEO 60.00 1.50 X X 314180 0 38241 Adin M Tooker Chairman 10.00 1.00 X X 0 0 0 Nicholas S Vachon DPM Trustee 1.00 0.00 X 0 0 0 Robert J Williams Secretary 1.00 1.00 X X 0 0 0 Michelle H Beal Past Trustee 1.00 0.00 X 0 0 0 Chris D Frauenhofer CFO 60.00 0.00 X 221589 0 37993 Sterling C Williamson MD Physician 50.00 0.00 X 544873 0 45584 Davor G Sklizovic MD Physician 50.00 0.00 X 462084 0 22875 Martin R Curlik MD Physician 50.00 0.00 X 419599 0 45020 Paul M Denoncourt MD Physician 50.00 0.00 X 383146 0 38209 Kerry Crowley MD Physician 50.00 0.00 X 345779 0 26728 3430336 0 390880 70 0 1 0 Eastern Maine Medical Center 43 Whiting Hill Rd Brewer ME 04412 Medical Services 489999 Dahl Chase Diagnostic Services 417 State St Bangor ME 04401 Medical Services 479248 CHG Companies Inc PO Box 972651 Dallas TX 75397 Medical Services 443874 Medical Information Technology Inc 1 Meditech Circle Westwood MA 02090 Consulting Services 371958 Siemens Healthcare Diagnostics Inc 1717 Deerfield Rd Deerfield IL 60015 Medical Services 370836 57 159025 132748 79800 843789 35059 1215362 Patient Service Rev. 621990 160333325 160333325 Other Medical Services 621990 2286288 2286288 Cafeteria/Vending 621990 243662 243662 Bad Debt 621990 -6282515 -6282515 Contractual/Char. Adj. 621990 -82988272 -82988272 73592488 429963 429963 23470915 22318302 1152613 1152613 1152613 32480 159025 80617 -48137 -48137 76342289 73348826 0 1778101 10000 10000 1487319 875316 612003 37846202 35514483 2228102 103617 786220 743856 40148 2216 5725939 5430231 279513 16195 2517935 2338249 172112 7574 283364 283364 136897 136897 72060 72060 7525301 6313330 1211971 129848 127687 2161 1848867 1275784 571263 1820 242957 223481 13118 6358 1803655 1739877 63778 65372 41881 23491 90582 64145 26187 250 648484 648484 3355301 3019186 334972 1143 1053048 554573 498475 Medical Supplies 9991516 9953647 37869 Repairs & Maintenance 2142824 2106855 35969 Health Care Prov. Tax 1859362 1859362 Other 1306897 1123777 164027 19093 80929950 73836517 6933006 160427 X 4155 2532 5250084 3175888 6203 5548 9982229 9974102 503588 679830 1051882 1615070 66416096 37223266 31623363 29192830 19750250 17017761 191155 180744 2687848 2880424 71050757 64724729 8584652 9426228 11955931 11511889 926340 746725 4861010 4583025 26327933 26267867 X 43529851 36810212 491325 945390 701648 701260 44722824 38456862 71050757 64724729 X -4587661 -1677913 -388 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14461 14461 0 Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which are attributable to lobbying expenses. 21537888 -98438 3599400 17840050 12887926 10000000 1829422 3179460 21537888 12362378 904112 378564 12887926 11712210 135584 536573 21989 12362378 3349752 7664082 710004 11628 11712210 0.96000 0.04000 0.00000 0 0 361138 361138 42740713 17559346 25181367 257863 232588 25275 23056382 19431332 3625050 29192830 Deferred Compensation 986650 Estimated Third-Party Payor Settlements 3596375 4583025 Part V, Line 4: The intended uses of the endowment funds are funded depreciation, the oncology clinic and the breast clinic. Poinsettia Ball 100766 84406 16360 11447 31348 Chef's Gala 90739 74619 16120 7971 29851 191505 159025 32480 19418 61199 80617 -48137 1 1 1 X 1 X 1 1 1 0 1 1 1364946 1364946 0.01690 8981887 5797865 3184022 0.03930 10346833 5797865 4548968 0.05620 64472 29085 35387 0.00040 73500 73500 0.00090 13086107 8645448 4440659 0.05490 10000 10000 0.00010 13234079 8674533 4559546 0.05630 23580912 14472398 9108514 0.11250 17277 8500 8777 0.00010 453 453 0.00000 11730 1800 9930 0.00010 42464 42464 0.00050 24152 24152 0.00030 96076 10300 85776 0.00100 1 3073438 19066557 22235332 -3168775 X 1 1 1 1 Maine Coast Memorial Hospital 50 Union Street Ellsworth ME 04605 www.mcmhospital.org X X X Maine Coast Memorial Hospital 1 0 0 1 X X X X X X X X X 14 1 1 0 1 X See Part VI X 1 14 1 See Part VI 0 0 1 X 150.000000000000 250.000000000000 X X 1 1 X 1 X See Part VI, line 3 Explanation X See Part VI, line 3 Explanation X See Part VI, line 3 Explanation X X X X X 1 X 0 X X X 1 X 0 1 Maine Coast Memorial Hospital Part V, Section B, Line 5: EMHS, the regional tertiary center, routinely conducts a community health needs assessment across the service area. The most recent assessment, published in 2014, was conducted under a contract with the University of New England Center for Health Planning, Policy and Research (CHPPR) and the University of Southern Maine Muskie School for Public Health. Using a methodology developed by CHPPR over decades of work, the assessment integrates primary data from random phone calls to heads of households with secondary data retrieved from state databases (ED usage, Mortality, Cancer Registry, etc.). This data is reviewed in the context of multiple health related domains to develop a composite view of access, risk and barriers to care. This composite is compared to national and state benchmarks to produce priorities and recommendations as prepared by the consultants.Information Sources: 1. Maine Coast Memorial Hospital and its related physician practices utilize extensive electronic medical records, including disease registries, which provide a vast amount of data relative its patients. 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 environmental and social measures are part of the community dissemination process.Input from Person's Representing the Broad Interests of the Community: On a statewide basis, the research consultants developed an advisory committee that met several times during the assessment research and drafting of the publication. These individuals represented a broad spectrum of backgrounds, and they are named below:Carol Bell, Healthy Maine Partnership DirectorKelly Bentley, Healthy Maine Partnership DirectorGail Dana-Sacco, Wabanaki Center (.serving tribal populations)Patricia Hart, Maine Development FoundationBarbara Leonard, MPH, Maine Health Access Foundation(philanthropic foundation focused on access to care in Maine)Becca Matisovich, Maine Center for Disease ControlLisa Miller, Binghrun Foundation (philanthropic foundation)Dora Ann Mills, MD, Maine Center for Disease ControlElizabeth Mitchell, Maine Health Management Coalition(representing the state's major employers, insurers and providers)Trish Riley, Governor's Office of Health Policy and Finance (GOHPF)Brian Rines, Advisory Committee for Health System Development(overseen by GOHPF)Rachel Talbot-Ross, Maine Chapter, NAACPTed Trainer, Public Health Coordinating CouncilShawn Yardley, City of Bangor, Department of Health and WelfareIn June 2011, EMHS in conjunction with Maine Coast Memorial Hospital hosted a community forum to present an overview of local assessment results and recommendations. Invitees included:Other area hospitals, Physician leaders, Federally Qualified Health Centers, Healthy Maine Partnerships, District liaisons linked to Maine CDC Social Service Agencies, Business leaders, Representatives of the State Administration Home Health and Long Term Care leaders Leaders of the tribal communities legislative leadersAttendees were provided an executive summary of the assessment as well as a summary table of data reflective of the service area. A presentation was made by EMHS staff who led the assessment, providing sample data, trends over time and the priorities and recommendations as suggested by the research consultants. Maine Coast Memorial Hospital Part V, Section B, Line 6a: The needs assessment was developed as a statewide collaborative between the state's three largest health systems: EMHS (in central, eastern and northern Maine), Maine General (in central Maine) and MaineHealth (in Southern Maine). Multiple collaborators were involved in the dissemination of the assessment findings and establishment of priorities.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 systems and the Maine CDC signed a memorandum of understanding in effect between June 2014 and December 2019 committing resources to the Maine SHNAPP Project. Maine Coast Memorial Hospital Part V, Section B, Line 11: Please refer to the implementation strategy at the following link:http://www.emhs.org/Document-library/Reports/CHNA/2015-Shared-CHNA/Maine-Shared-CHNA-HANCOCK-County-Report-11-3-15_EM.aspx Maine Coast Memorial Hospital Part V, Section B, Line 24: All patients are billed/charged an amount equal to gross charges and then depending on their insurance payment, prompt pay discounts or discounted care are balance billed the unpaid or adjusted amount.Individuals were billed gross charges with the option for a 10% discount for prompt payments. In addition, the hospital offered a 20% discount for patients who paid prior to receiving services. Schedule H, Part V, Section B, Line 7a & 10a: The most recent statewide CHNA and Implementation Strategy can be found at the following URL:http://www.emhs.org/community-benefit/chna/2014-chna-reports.aspxSpecifically to Maine Coast and Hancock County, which we are located in, here is the URL for our CHNA and Implementation Strategy:http://www.emhs.org/document-library/reports/chna/2014/hancock-county-chna-2014.aspx Part V, Section B, Line 16 Financial Assistance Policy Website Availability Maine Coast Memorial Hospital Part V, Section B, line 16a website: See Part VI, line 3 Explanation Maine Coast Memorial Hospital Part V, Section B, line 16b website: See Part VI, line 3 Explanation Maine Coast Memorial Hospital Part V, Section B, line 16c website: See Part VI, line 3 Explanation 18 Ellsworth Internal Medicine 32 Resort Way Ellsworth ME 04605 Physician Practice Ellsworth Family Practice 32 Resort Way Ellsworth ME 04605 Physician Practice Maine Coast Pediatrics 32 Resort Way Ellsworth ME 04605 Physician Practice Eleanor Widener Dixon Memorial Clinic 37 Clinic Road Ellsworth ME 04605 Physician Practice Southwest Harbor Medical Center 45 Herrick Road Ellsworth ME 04605 Physician Practice Maine Coast Specialty Clinic 306 Main Street Ellsworth ME 04605 Physician Practice Maine Coast Urology 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Rheumatology 50 Union Street Ellsworth ME 04605 Physician Practice Down East Dermatology 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast General Surgery 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Women Care 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Hand & Shoulder 50 Union Street Ellsworth ME 04605 Physician Practice Frenchman Bay Orthopedics 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Otolaryngology 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Memorial Hospital Nocturn 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Neurology Clinic 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Cardiology Clinic 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Psychiatry Clinic 32 Resort Way Ellsworth ME 04605 Physician Practice Part I, Line 3c: Maine Coast Regional Health Facilities uses the Federal poverty guidelines to determine eligibility. Part I, Line 7: The IRS 990H instructions/guidance provide a template (Worksheet 2 template) as a way to determine the overall cost to charge ratio that could be applied throughout the IRS 990H form in order to convert charges to cost. Where applicable, we have utilized the Worksheet 2 template calculation. The only areas we did not utilize this template calculation were the following.a. IRS 990H Worksheet 6 - Subsidized health services - (the supporting schedule for Part I, Line 7g) we did not utilize the Worksheet 2 percentage when we were determining the profit/loss of each of our provider based clinics. In addition, when we were compiling the subsidized provider based clinics listed in 1c above, we utilized the actual estimated costs on the modified Medicare cost report we prepared instead of applying the Worksheet 2 cost to charge percentage. b. IRS 990H Worksheet 3 - Unreimbursed Medicaid and Other Means Tested Government Programs (the supporting schedule for Part I, Lines 7b and 7c) and Worksheet 6 Medicaid allowable costs for the subsidized health services listed in line 1c above (part of the line 7g costs) - We did not utilize the Worksheet 2 percentage when calculating the Medicaid allowable cost. Instead we utilized the actual Medicaid filed cost report for the allowable costs. Part I, Line 7g: Maine Coast Regional Health Facilities has several provider based physician practices. Per the instructions for IRS form 990H, worksheet 6, we are allowed to include any applicable physician practice that the hospital subsidizes (i.e., operates at a loss). As such, we have included the following provider based physician practices that operate at a loss (i.e., are subsidized by the hospital) and the associated costs of these practices.a. Southwest Harbor Clinic b. Ellsworth Internal Medicine c. Pediatrics d. Cardiologye. Family Practice f. Frenchmans Bay Clinic g. Womens Care Clinic h. Hand & Shoulder Clinici. Gouldsboro Clinic j. Otolaryngology Clinic k. General Surgery l. PsychiatryThe above listed provider based physician practices have a community benefit (i.e., aggregate loss or subsidy from the hospital) of approximately $4.8 million. This community benefit does not include any hospital overhead allocated to these clinics. In addition, the community benefit also does not take into account bad debts, charity care and contractual adjustments. Thus this community benefit of approximately $4.8 million is a conservative figure that reconciles to the community benefit reported on IRS Form 990, Schedule H, Part I, Line 7g, column e.Community Building ActivitiesMaine Coast Regional Health Facilities provides a variety of resources for several different types of community building activities. These resources include, but are not limited to:-Free monthly education sessions-CPR classes-Free Mammograms-Volunteer and Pet Therapy Program-Speaking engagements relative to prevalence of cancer in the area by the Oncology Director-Heart Healthy Community Wellness Program-Physician Referral phone system-Disease Management-Cardiac Rehab exercise program-Nursing education for local students Part I, Ln 7 Col(f): Bad debt expenses are no longer part of the expense grouping on the income statement of the audited financial statements. They are included as a deduction from revenue. As such, the Part I, Line 7 Column F calculation, per the IRS instructions, are already net of bad debt expenses. Schedule H, Part I, Line 6a: Maine Coast Regional Health Facilities prepares a community benefit report through its annual report process. The annual report is available three months after fiscal year end. Within the annual report the Hospital describes community benefit in financial terms and a summary of services provided. This includes the losses from: subsidized physician practices; subsidized community health and wellness programs; the cost of patients who cannot afford to pay; Medicaid and Medicare shortfalls; and patients who do not pay or are unable to pay. Part III, Line 4: Maine Coast Regional Health Facilities, in compliance with accounting guidelines, classify bad debts as a deduction from revenue. The hospital follows the Medicare guidelines for allowable bad debts. It uses the following criteria:a. Establishing that reasonable collection efforts were madeb. Establishing that the accounts were uncollectiblec. Establishing that there is no likelihood of recovery at anytime in the futureThe bad debt adjustment is at cost and is the total write-offs reduced by the ratio of patient care cost to charges. Part III, Line 8: The IRS 990H instructions/guidance provide a template (Worksheet 2 template) as a way to determine the overall cost to charge ratio that could be applied throughout the IRS 990H form in order to convert charges to cost. Where applicable, we have utilized the Worksheet 2 template calculation. The only area where we did not utilize this template calculation was in Form 990H Worksheet B, Line 2 & 6 - Medicare allowable costs and payments related to the subsidized health services - We utilized the Medicare cost report estimated cost and payment for these services.The hospital believes that provider based clinics listed in 1c above should be and are considered a community benefit due to the fact that without the hospital subsidizing and offering the services that these clinics offer, the community at large would have to travel at least 45 minutes to the nearest like hospital and that hospital's service offerings. As such, Maine Coast believes that by offering and subsidizing these clinics within its community and thus enabling community members to have easy access and an easier commute for these services, that this benefits the whole community at large. Part III, Line 9b: When a patient is referred out to collections but then applies for free or discounted care, we pull the account back from collections when it is determined they qualify for one of the programs. If the collection agency suspects that someone may need to apply for one of the programs, they send out an application and notify us. We make every effort to screen as many people as possible before we send them to collections. Part VI, Line 2: Maine Coast Regional Health Facilities assessed the medical needs of the community as part of the process for establishing the medical staff development plan. The new medical staff and services were identified in the strategic planning process brought forth from the provider community. It then was determined and prioritized what services the Hospital could comfortably address and implement. 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 the 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 Care/Discounted Care and providing information on MaineCare. For inpatients, there is a book in the room which provides all the information on all programs available.All information related to our financial assistance policy (FAP)can be found at the following URL:http://www.mcmhospital.org/Patients-Visitors/Billing-Financial Services/Financial-Aid.aspxOur FAP application can be found at the following URL:http://emmc.org/emmc/files/82/8288d00d-3440-429e-92ab-e2d58d42b888.pdfScheduled Medical Imaging, Surgery patients and Inpatients all generally speak with a Hospital employee who can provide information on available programs. Inpatients are also offered the services of Unicare to assist them with applying for Medicaid. Patient Accounting staff are available to assist any patient inquiring about programs when presenting for services. Through the Patient Accounting Department, we provide the information on the patient's billing statements. We also counsel patients on the phone about all the programs available whether it is a hospital program or Medicaid. Part VI, Line 4: Maine Coast Regional Health Facilities services, d/b/a Maine Coast Memorial Hospital, is a 48 staffed bed full service acute care not-for profit hospital located in Ellsworth, Maine (Hancock 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, 24 hours emergency center, and diagnostic and surgical services. Along with Hospital services, the hospital employs the majority of primary and specialty care physicians in the area. It is the only full service hospital located in either Hancock or adjacent Washington County. The hospital is regularly used as referral facility by the four (4) critical access hospitals located in these two counties as well. Hancock and Washington County is considered rural by the State of Maine and the United States Census Bureau, under the guidelines set forth by the Office of Management and Budget (OMB). The hospital service area (HSA) as defined by the Maine Health Data Organization (MHDO) uses the statistical method where the greatest proportion of residents received their inpatient care. The following towns make up the Maine Coast Memorial Hospital HSA as defined by the MHDO:EastbrookBeddingtonDebloisCherryfieldEllsworthFranklinMilbridgeGouldsboroHancockLamoineMariavilleOsbornOtisSteubenSorrentoSullivanSurryTrentonWalthamWinter HarborOqiton TwpT3 NDT7 SDT8 SDT9 SDT10 SDT16 MDT22 MDT28 MDT34 MDT35 MDT39 MDT40 MDT41 MDThe following estimated 2014 demographics represent the counties served by Maine Coast Memorial Hospital (per the United States Census Bureau website):- Population: Hancock County 54,418; Washington County 32,856; State of Maine 1,329,328- Persons < 5yrs: Hancock County 4.8%; Washington County 5.2%; State of Maine 4.9%- Persons < 18 yrs: Hancock County 18.6%; Washington County 20.5%; State of Maine 19.5%- Persons 65 yrs & over: Hancock County 18.2%; Washington County 19.4%; State of Maine 18.3%- Median household income: Hancock County $45,747; Washington County $38,239; State of Maine $48,804- Persons below poverty level: Hancock County 12.9%; Washington County 18.5%; State of Maine 14.1% Part VI, Line 5: Maine Coast Regional Health Facilities is a local not for profit hospital that serves its local communities and people regardless of their ability to pay. Maine Coast 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. Maine Coast'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) 10000 Operational Support 1 0 Part I, Line 2: The Organization makes payments only to other 501(c)(3) organizations. Therefore, additional monitoring was not deemed necessary. X 0 1 X X X X X 0 0 0 0 0 0 0 1 0 Robert A Beekman MD Trustee/Physician 166243 0 0 0 1524 0 3940 0 30562 0 202269 0 0 0 Sean T Maloney MD Trustee/Physician 247000 0 0 0 276 0 5730 0 44892 0 297898 0 0 0 Daniel J Reinke MD President of Medical Staff 323767 0 0 0 276 0 5850 0 45256 0 375149 0 0 0 Charles D Therrien CEO 313664 0 0 0 516 0 5850 0 32391 0 352421 0 0 0 Chris D Frauenhofer CFO 221410 0 0 0 179 0 1644 0 36349 0 259582 0 0 0 Sterling C Williamson MD Physician 318589 0 197783 0 28501 0 5850 0 39734 0 590457 0 0 0 Davor G Sklizovic MD Physician 422736 0 38832 0 516 0 3250 0 19625 0 484959 0 0 0 Martin R Curlik MD Physician 392858 0 25949 0 792 0 5850 0 39170 0 464619 0 0 0 Paul M Denoncourt MD Physician 315583 0 67047 0 516 0 5850 0 32359 0 421355 0 0 0 Kerry Crowley MD Physician 220003 0 124984 0 792 0 5583 0 21145 0 372507 0 0 0 Part I, Line 1b Travel for companions: The Board of Directors for the Hospital are not compensated. In lieu of compensation, meals are supplemented for their spouses when they are required to attend forums and seminars on behalf of the Hospital. The amount involved is very minimal. Form 990, Schedule J, Part I, Line 7: The bonus payments for Sterling C. Williamson, Davor G. Sklizovic, Martin R. Curlik, Paul M. Denoncourt, and Kerry Crowley are RVU incentive payments. A MHHEFA 010314384 5604253L2 2008-12-03 6960000 Construction of Emergency Dept. 0 0 0 B MHHEFA 010314384 560427NM4 2011-11-30 1865000 Refunding Series 2001B 0 0 0 C MHHEFA 010314384 560427WV4 2013-05-23 4395000 Refunding Series 2003C 0 0 1 A 1008869 6960000 498869 439006 131414 5890711 2009 0 0 1 1 B 634099 1865000 210238 35050 1619712 2011 0 0 1 1 C 65143 4395000 341913 52407 4000680 2013 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 0 B 0 0 1 0 0 1 0 0 0 0 0 C 0 0 1 0 0 0 0 0 0 A 0 B 0 C 0 X 2 35059 Stock Market Value 0 0 1 Part I, Line 32b: The Organization sells contributions of securities through its investment broker. All gifts of securities are sold as soon as administratively possible. Form 990, Part VI, Section A, line 6 Maine Coast Healthcare Corporation is the sole member of the Organization. Form 990, Part VI, Section A, line 7a The Member shall have the right to elect trustees and honorary trustees to the board of trustees. Form 990, Part VI, Section A, line 7b The following decisions are subject to approval by the Member of the Organization: 1. The removal of members of the Board of Trustees; 2. The change of the number of Trustees constituting the Board of Trustees with the limitations prescribed in the Articles of Incorporation; 3. The amendment, restatement, or modification of the Bylaws or Articles of Incorporation of the Corporation; 4. The approval of the sale, mortgage, lease, or other dispositions of all, or substantially all, of the assets and property of the Organization, the dissolution of the Organization, or its merger with or consolidation into another Organization; 5. The right to approve the donation, unfunded directly from, or other expenditure of corporate assets, whether principal or income; 6. The right to approve corporate strategic planning goals, objectives, and capital expenditure plans; 7. The right to approve substantial program changes, including health services; 8. The right to approve the Organization's cumulative annual borrowings in any amount exceeding one percent of the annual gross revenues of the Organization as set forth in the most recent annual financial statements of the Organization; 9. The right to approve the appointment of an auditor for the Organization; and 10. Upon recommendation of the Board of Trustees, the right to appoint or remove the President and Treasurer. Form 990, Part VI, Section B, line 11 Prior to filing, a presentation on the Form 990 was provided to the leadership of the board of trustees, and a copy of the form was provided to the entire board. Form 990, Part VI, Section B, line 12c MCMH's policies and procedures require that all board members, senior leaders, department managers, and medical staff members disclose any potential conflicts of interest in writing. These forms are reviewed by the Board Chair, the Human Resource Director, or the compliance officer, depending on the disclosing individual's role. Examples of how potential conflicts are managed include disclosing the conflict when applicable, (e.g., during discussions at the board meeting) and excusing the party with the potential conflict from participation and voting. Form 990, Part VI, Section B, line 15 Executive Committee with the help of the search firm and Maine Hospital Association salary survey was used to set the compensation levels for the CEO. The MHA survey was primarily used to set the compensation levels for the top management officials. Form 990, Part VI, Section C, line 19 Government documents and conflict of interest policy are available upon request. The financial statements are made public through the annual report. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Maine Coast Regional Health Facilities 50 Union Street Ellsworth, ME 04605 EIN 01-0198331 Maine Coast Regional Health Facilities is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Value of Beneficial Interest in Perpetual Trust -388. Maine Coast Medical Realty Inc 50 Union Street Ellsworth ME 04605 010390918 Furnishing Medical Facilities ME 501(c)(3) Line 11a, I Maine Coast Regional Health Facilities 1 Maine Coast Healthcare Corporation 50 Union Street Ellsworth ME 04605 223176167 Parent Organization for Hospital ME 501(c)(3) Line 11b, II N/A 0 Maine Coast Healthcare Foundation 50 Union Street Ellsworth ME 04605 562344952 Raise and hold donations for hospital ME 501(c)(3) Line 11a, I Maine Coast Regional Health Facilities 1 Maine Coast Physician Affiliates 50 Union Street Ellsworth ME 04605 010479952 Inactive ME Maine Coast Healthcare Corporation C 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 Maine Coast Healthcare Foundation C 132748 FMV Maine Coast Healthcare Foundation Q 58447 FMV