2015-05-12T14:39:13-05:00 2014-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2013-07-01 010130427 BRIDGTON HOSPITAL % PHIL MORISSETTE BRID 2077952972 10 HOSPITAL DRIVE Suite BRIDGTON ME 04009 R DAVID FRUM PRESIDENT 2077952972 2015-04-20 true Brian D Todd P00422601 2077952972 2013 2016-03-07 17:11:31Z R DAVID FRUM 10 HOSPITAL DRIVE BRIDGTON ME 04009 57755717 false X WWW.BRIDGTONHOSPITAL.ORG X 1917 ME BRIDGTON HOSPITAL STRIVES TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES AND DEPENDS ON CAREGIVER EXPERTISE AND THE COMMITMENT AND COMPASSION THEY PROVIDE TO FULFILL ITS MISSION. 9 8 414 20 0 0 165601 144562 47131082 53957983 415242 330703 8143 11011 47720068 54444259 34024 1500 0 0 19979432 21618836 0 0 0 25844134 28908629 45857590 50528965 1862478 3915294 57384658 55845412 19833617 13930304 37551041 41915108 TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES IN A SAFE AND TRUSTFUL ENVIRONMENT THROUGH THE EXPERTISE, COMMITMENT, AND COMPASSION OF OUR FAMILY OF CAREGIVERS. false false 40966437 1500 53957983 BRIDGTON HOSPITAL IS A CRITICAL ACCESS HOSPITAL SERVING 20 SURROUNDING COMMUNITIES PLUS THE MOUNT WASHINGTON VALLEY COMMUNITIES OF NEW HAMPSHIRE. THE HOSPITAL HAS A MEDICAL / SURGICAL UNIT, CRITICAL CARE UNIT, AND OBSTETRICAL UNIT WITH TWO BIRTHING SUITES. OUR TWO OPERATING ROOMS HANDLE GENERAL, ORTHOPEDIC, AND AMBULATORY SURGERY. THE HOSPITAL HAS A 24 HOUR EMERGENCY DEPARTMENT AND NUMEROUS PROFESSIONAL SERVICES INCLUDING CT SCANNING, MRI, NUCLEAR MEDICINE SPECT SCANNING, TREADMILL INCLUDING THALLIUM ONCOLOGY CLINIC, INPATIENT AND OUTPATIENT PHYSICAL THERAPY AND MEDICAL SCIENCES LIBRARY. 40966437 true true false true false false false false false true true false false false true false false true false false false false false false true false true true false false true false false false false false false false false false false false false false true false false false true 45 0 true 414 true false false false false false true true false false false false X 9 8 false false false false true true true true true false false true true true true true true false false false ME X PHIL MORISSETTE 2077952972 29 LOWELL STREET LEWISTON ME 04240 X PETER E CHALKE PRESIDENT OF CMHC 1.0 60.0 X 0 635098 29571 WILLIAM CHALMERS DIRECTOR 1.0 1.0 X 0 0 0 NEAL GRAFFAM DIRECTOR/VICE-CHAIR 1.0 X X 0 0 0 PHILIP LIBBY CHAIRMAN 1.0 X X 0 0 0 AUDREY MACINTYRE DIRECTOR/SECRETARY 1.0 X X 0 0 0 CAROL SUDDUTH DIRECTOR 1.0 X 0 0 0 HOLLY DVORAK DIRECTOR 1.0 X 0 0 0 MATTHEW FRANK DIRECTOR/TREASURER 1.0 X X 0 0 0 SUSAN COLE DIRECTOR 1.0 X 0 0 0 R DAVID FRUM PRESIDENT OF BRIDGTON HOSPITAL 27.5 29.5 X 0 303687 59199 ALAN VERRILL DIVISION CHIEF 55.0 X 264858 0 23651 BRUCE LASTRA MD PHYSICIAN 55.0 X 305318 0 26977 CRAIG SMITH MD PHYSICIAN 55.0 X 407039 0 39897 STEPHEN OLSON MD PHYSICIAN 55.0 X 364988 0 14438 STUART EISENBERG MD PHYSICIAN 55.0 X 335298 0 9699 NARASIMHA SWAMY MD PHYSICIAN 55.0 X 363933 42374 2041434 938785 245806 31 false true false CERNER CORPORATION IT SERVICES 377446 CPS INC PHARMACY SERVICES 590759 INSIGHT HEALTH CORP MEDICAL STAFFING 356446 SODEXO CLINICAL TECHNOLOGY MEDICAL SERVICES 192797 ARUP LABORATORIES MEDICAL SERVICES 194517 14 11982 132580 144562 NET PATIENT SERVICE REVENUE 900099 53042406 53042406 CAFETERIA REVENUE 722514 79058 79058 OTHER REVENUE 900099 836519 836519 53957983 196885 196885 0 0 9117 9117 0 9117 9117 3439225 750 3226622 79535 212603 -78785 133818 133818 7195 11982 5301 1894 1894 0 0 0 54444259 53957983 341714 X 0 1500 1500 0 0 288509 219267 69242 0 0 17774450 13508582 4265868 0 2417667 1837427 580240 1138210 865040 273170 0 4134 4134 20294 20294 0 0 13571 13571 9281967 7054295 2227672 237635 180603 57032 2026078 1539819 486259 684070 519893 164177 0 1260368 957880 302488 186813 141978 44835 0 55490 42172 13318 471548 358376 113172 0 1664015 1264651 399364 1069055 812482 256573 BAD DEBT 5965744 5965744 MEDICAL SUPPLIES & DRUGS 4838184 4838184 REPAIRS & MAINTENANCE 923718 702026 221692 LICENSES, DUES, SUBSCRIPTIONS 142064 107969 34095 63881 48549 15332 50528965 40966437 9562528 0 274066 301182 33218536 20047566 40189 43991 4928257 8967965 0 0 0 0 0 0 321008 345456 867062 679109 35742060 20650970 15592798 15091090 0 8006919 0 0 0 0 0 0 2142742 2362134 57384658 55845412 3474224 3783893 0 0 98223 54941 7628481 7403317 0 0 0 0 1771732 1440913 0 0 6860957 1247240 19833617 13930304 X 33906738 38010845 2504659 2702704 1139644 1201559 37551041 41915108 57384658 55845412 X 3915294 387858 60915 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 7607 7607 false SCHEDULE C, PART II-B, LINE 1I PORTION OF DUES FOR PROFESSIONAL ASSOCIATIONS ATTRIBUTED TO LOBBYING EXPENSES - $7,607 3644303 129433 197906 67379 3904263 3562686 35891 94807 49081 3644303 3564980 72940 -20998 54236 3562686 3341734 56905 207021 40680 3564980 3236168 50626 86204 6169 25095 3341734 0.30776 0.69224 false true true 674722 674722 18185454 7070117 11115337 6767 6015 752 16229456 13089858 3139598 645661 484980 160681 15091090 0 ESTIMATED AMTS DUE TO 3RD PARTIES 1247240 1247240 48659058 387858 -5911936 -5524078 54183136 261123 261123 54444259 44554951 5301 5301 44549650 13571 5965744 5979315 50528965 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS: ENDOWMENT FUNDS ARE USED TO SUPPORT THE ORGANIZATION IN A VARIETY OF WAYS, DEPENDING UPON THE STATED PURPOSE OF EACH FUND MANY OF THESE FUNDS HELP TO COVER COSTS OF CAPITAL EQUIPMENT PURCHASES, CONTINUING MEDICAL EDUCATION, OR FREE CARE. OTHERS ARE DESIGNATED TO SUPPORT SPECIFIC DEPARTMENTS OF THE HOSPITAL. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $ (5,965,744) BAD DEBT EXPENSE (13,571) INVESTMENT MANAGEMENT FEES 67,379 NET ASSETS RELEASED FROM RESTRICTION --------------- $ (5,911,936) SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ (5,301) SPECIAL EVENT EXPENSE 128,433 TRNA CONTRIBUTIONS 136,991 TRNA INVESTMENT RETURN 1,000 PRNA CONTRIBUTIONS -------- $261,123 SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25: $ 5,301 SPECIAL EVENT EXPENSE SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 5,965,744 BAD DEBT EXPENSE GOLF TOURNEY 19177 11982 7195 1500 2600 126 1075 0 19177 11982 7195 1500 2600 126 1075 5301 1894 true true X true X false true true false false 873674 873674 0.01960 7955323 7970500 -15117 8828997 7970500 858557 0.01960 1500 1500 1500 1500 8830497 7970500 860057 0.01960 false 5965744 811341 10545212 12145806 -1600594 X true true 1 1 BRIDGTON HOSPITAL 10 HOSPITAL DRIVE BRIDGTON ME 04009 WWW.BRIDGTONHOSPITAL.ORG 37960 X X X X BRIDGTON HOSPITAL 1 true X X X X X X X X X 12 true false true X HTTP://WWW.BRIDGTONHOSPITAL.ORG X X X X X X X X false false true true 150. false true X X true true X X X X X X true false X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3 COMMUNITY INPUT: ON A STATEWIDE BASIS, THE RESEARCH CONSULTANTS DEVELOPED AN ADVISORY COMMITTEE THAT MET TWO TIMES DURING THE ASSESSMENT RESEARCH AND DRAFTING OF THE PUBLICATION. THESE INDIVIDUALS REPRESENTED A BROAD SPECTRUM OF BACKGROUNDS, AND THEY ARE NAMED: CAROL BELL, HEALTHY MAINE PARTNERSHIP DIRECTOR; KELLY BENTLEY, HEALTHY MAINE PARTNERSHIP DIRECTOR, GAIL DANA-SACCO, WABANAKI CENTER (SERVING TRIBAL POPULATIONS); PATRICIA HART, MAINE DEVELOPMENT FOUNDATION; BARBARA LEONARD, MPH, MAINE HEALTH ACCESS FOUNDATION (PHILANTHROPIC FOUNDATION FOCUSED ON ACCESS TO CARE IN MAINE); BECCA MATUSOVICH, MAINE CENTER FOR DISEASE CONTROL; LISA MILLER, BINGHAM FOUNDATION (PHILANTHROPIC FOUNDATION); DORA ANN MILLS, MD, MAINE CENTER FOR DISEASE CONTROL; ELIZABETH 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, NAACP; TED TRAINER, PUBLIC HEALTH COORDINATING COUNCIL; SHAWN YARDLEY, CITY OF BANGOR, DEPARTMENT OF HEALTH AND WELFARE. IN THE LOCAL AREA SERVED BY THE ASSESSMENT, MULTIPLE PARTIES WERE ENGAGED IN DISSEMINATION OF THE ASSESSMENT FINDINGS AND ESTABLISHMENT OF PRIORITIES. SCHEDULE H, PART V, SECTION B, LINE 6 IMPLEMENTATION STRATEGY: IN RESPONSE TO THE RESULTS OF BRIDGTON HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY CAN BE FOUND AT THE FOLLOWING URL: http://www.bridgtonhospital.org/community-benefits BRIDGTON HOSPITAL HAS CREATED AN IMPLEMENTATION STRATEGY TO DIRECTLY ADDRESS SEVERAL HEATH ISSUES, INCLUDING CANCER, CARDIOVASCULAR DISEASE AND DIABETES. BRIDGTON HOSPITAL INDIRECTLY ADDRESSES MENTAL HEALTH BY EMBEDDING EXTERNAL MENTAL HEALTH AGENCY STAFF WITHIN PRIMARY CARE PRACTICES. SCHEDULE H, PART V, SECTION B, LINE 7 ADDRESSING IDENTIFIED NEEDS: BRIDGTON HOSPITAL IS NOT DIRECTLY ADDRESSING MENTAL HEALTH AS THIS IS WIDELY COVERED BY MENTAL HEALTH AGENCIES IMBEDDED WITHIN OUR PRIMARY CARE PRACTICES. SCHEDULE H, PART V, SECTION B, LINE 14G OTHER METHODS USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY: THE FAP IS POSTED IN ALL OUTPATIENT DEPARTMENTS INCLUDING PROVIDER BASED PHYSICIANS' OFFICES, PATIENT FINANCIAL SERVICES, AND IS OFFERED TO ANY PATIENTS INDICATING A FINANCIAL NEED WHEN THEY CALL CUSTOMER SERVICE OR PRESENT THEMSELVES IN THE PATIENT FINANCIAL SERVICES DEPARTMENT. SCHEDULE H, PART V, SECTION B, LINE 20D MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS: FAP-ELIGIBLE PATIENTS ULTIMATELY RECEIVE FREE CARE. IF THE PATIENT HAS INSURANCE, THE INSURANCE COMPANY WOULD BE BILLED AND ONLY THE PATIENT RESPONSIBILITY PORTION, UNDER THAT CARRIER'S CONTRACT, WOULD BE BILLED TO THE PATIENT. IF THE PATIENT IS UNINSURED, THE PATIENT WOULD BE BILLED WITH A 20% UNINSURED DISCOUNT FROM GROSS CHARGES. ONCE A PATIENT'S ELIGIBILITY IS CONFIRMED THROUGH THE FAP'S APPLICATION PROCESS, A FAP ADJUSTMENT WOULD BE APPLIED TO THE PATIENT'S ACCOUNT, BRINGING THE BALANCE TO ZERO. 10 BRIDGTON INTERNAL MEDICINE 25 HOSPITAL DRIVE BRIDGTON ME 04009 OUTPATIENT PHYSICIAN CLINIC NORTH BRIDGTON FAMILY PRACTICE 14 Wyonegonic Road BRIDGTON ME 04009 OUTPATIENT PHYSICIAN CLINIC FRYEBURG FAMILY MEDICINE 253 BRIDGTON ROAD FRYEBURG ME 04037 OUTPATIENT PHYSICIAN CLINIC NAPLES FAMILY PRACTICE 410 ROOSEVELT TRAIL NAPLES ME 04055 OUTPATIENT PHYSICIAN CLINIC BRIDGTON OBGYN 15 HOSPITAL DRIVE BUILDING B BRIDGTON ME 04009 OUTPATIENT PHYSICIAN CLINIC BRIDGTON PEDIATRICS 25 HOSPITAL DRIVE BRIDGTON ME 04009 OUTPATIENT PHYSICIAN CLINIC BRIDGTON SURGICAL SPECIALISTS 25 HOSPITAL DRIVE BRIDGTON ME 04009 OUTPATIENT PHYSICIAN CLINIC BRIDGTON URGENT CARE CLINIC 10 HOSPITAL DRIVE BRIDGTON ME 04009 OUTPATIENT PHYSICIAN CLINIC PONDICHERRY FAMILY MEDICINE 15 HOSPITAL DRIVE BRIDGTON ME 04009 OUTPATIENT PHYSICIAN CLINIC CENTRAL MAINE GASTROENTEROLOGY 15 HOSPITAL DRIVE BUILDING B BRIDGTON ME 04009 OUTPATIENT PHYSICIAN CLINIC SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990, WAS REDUCED BY BAD DEBT EXPENSE OF $5,965,744. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED TO CALCULATE AMOUNTS ON IRS WORKSHEETS 1 AND 3. ALL OTHER WORKSHEETS USED THE ORGANIZATION'S COST ACCOUNTING SYSTEM. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: LINE 2 REPORTS BAD DEBT EXPENSE FROM THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY FOR LINE 3 WAS DETERMINED USING A COMPARISON OF EXPERIENCED CHARITY CARE COVERAGE AND US CENSUS BUREAU DATA FOR THE MOST RECENT YEAR AVAILABLE WHEN CHARITY CARE CONVERGE EXCEEDS THE CENSUS DATA, A MINIMAL AMOUNT OF BAD DEBT IS ASSUMED TO BE ELIGIBLE FOR CHARITY CARE TO ACCOUNT FOR THOSE PATIENTS WHO REFUSE TO PROVIDE INFORMATION DOCUMENTING ELIGIBILITY FOR THE PROGRAM. THESE ESTIMATES ARE BASED ON STATE-WIDE DATA AND DO NOT ACCOUNT FOR DIFFERENCES IN GEOGRAPHIC LOCATIONS WITHIN THE STATE. AS THIS AMOUNT IS RELATED TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY, IT IS INCLUDED AS A COMMUNITY BENEFIT. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: THE CORPORATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE CORPORATION PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE CORPORATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: THE COSTING METHODOLOGY USED FOR LINE 6 IS INFORMATION PULLED FROM THE MEDICARE COST REPORT FILING. THE SHORTFALL REPORTED ON LINE 7 COULD BE CONSIDERED COMMUNITY BENEFIT TO A LEVEL PROPORTIONAL TO THE POVERTY LEVELS INDICATED BY CENSUS BUREAU DATA. IF THE PATIENTS FALLING UNDER 150% FPG LEVEL WERE NOT COVERED BY MEDICARE THEY WOULD QUALIFY UNDER CMMC'S FREE CARE POLICY. UNDER THAT CIRCUMSTANCE, THESE PATIENTS WOULD THEN APPEAR AS PART OF THE STATISTICS ON PART I, LINE 7A. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY: COLLECTION PRACTICES FOR PATIENTS KNOWN TO BE ELIGIBLE FOR CHARITY CARE ARE LIMITED TO COLLECTING FROM ANY AVAILABLE PAYMENT SOURCES SUCH AS MEDICARE OR MEDICAID. IF A PATIENT IS ELIGIBLE, BUT HAS NOT APPLIED FOR MEDICAID COVERAGE, THE PATIENT IS REQUESTED TO APPLY. ASSISTANCE IS AVAILABLE TO HELP THE PATIENT WITH THE MEDICAID APPLICATION PROCESS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: AS A CRITICAL ACCESS HOSPITAL, BRIDGTON HOSPITAL ATTEMPTS TO PROVIDE ANY NEEDED HEALTH CARE SERVICES NECESSARY TO TREAT THE POPULATION OF THIS RURAL AREA OF MAINE. ADDITIONALLY, BRIDGTON HOSPITAL FOCUSES ON STATE-WIDE INITIATIVES, SUCH AS HEART DISEASE AND DIABETES, AS WELL AS ORGANIZATIONAL INITIATIVES BASED ON NEEDS OBSERVED WITHIN ITS PATIENT POPULATION. MANY FORMS OF EDUCATION, PREVENTION AND EARLY DETECTION ARE ALSO PART OF ITS COMMUNITY HEALTH CARE PLAN. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: BRIDGTON HOSPITAL PROVIDES NOTICES ABOUT ITS FREE CARE POLICY IN ALL CLINICAL DEPARTMENTS AND MAJOR PATIENT AREAS. AN INPATIENT FINANCIAL COUNSELOR VISITS WITH ALL UNINSURED PATIENTS TO DISCUSS OPTIONS, INCLUDING GOVERNMENTAL PROGRAM ELIGIBILITY AND FREE CARE ASSISTANCE IS AVAILABLE TO HELP PATIENTS WITH COMPLETION OF MEDICAID APPLICATIONS. ALL PATIENT FINANCIAL SERVICES STAFF ARE TRAINED TO OFFER FREE CARE AS AN OPTION TO PATIENTS WHO INDICATE AN INABILITY OR DIFFICULTY IN PAYING FOR SERVICES. INFORMATION ABOUT FINANCIAL ASSISTANCE AVAILABILITY IS INCLUDED ON THE BACK OF EVERY PATIENT STATEMENT. ADDITIONALLY, UNINSURED PATIENTS RECEIVE A SEPARATE INFORMATION SHEET WITH THEIR STATEMENTS, FURTHER INFORMING THEM ABOUT THE AVAILABLE OPTIONS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: BRIDGTON HOSPITAL, LOCATED IN BRIDGTON, MAINE, SERVES 21 TOWNS IN THE "LAKES REGION" OF WESTERN MAINE, AS WELL AS THE WESTERN MOUNTAINS OF MAINE AND THE MOUNT WASHINGTON VALLEY REGION OF NEW HAMPSHIRE. THE REGION IS RURAL IN NATURE AND IS PRIMARILY MADE UP OF WESTERN CUMBERLAND AND SOUTHERN OXFORD COUNTIES IN MAINE, AS WELL AS CARROLL COUNTY IN NEW HAMPSHIRE. THE REGION IS PRIMARILY MADE UP OF CAUCASIAN PERSONS AND HAS A VARIABLE POPULATION. THE REGION IS A SUMMER TOURIST DESTINATION AND THE POPULATION SWELLS DRAMATICALLY DURING THAT SEASON, MAKING DEMOGRAPHICS SOMEWHAT FLUID. APPROXIMATELY 14% OF THE YEAR ROUND POPULATION IS BELOW THE POVERTY LEVEL. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: BRIDGTON HOSPITAL HAS AN OPEN MEDICAL STAFF, ALLOWING ANY NON-EMPLOYED OR AFFILIATED PHYSICIANS TO HAVE ADMITTING PRIVILEGES TO THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF A MAJORITY OF LOCAL COMMUNITY MEMBERS ALONG WITH SOME REPRESENTATION BY DIRECTORS FROM CENTRAL MAINE HEALTHCARE, THE PARENT OF THE HEALTHCARE SYSTEM WHICH BRIDGTON HOSPITAL BELONGS TO, HELPING TO BRING TOGETHER THE VISIONS OF THE LOCAL COMMUNITY WITH THE CAPABILITIES AND VISION OF THE SYSTEM AS A WHOLE FOR THE BENEFIT OF BRIDGTON AND SURROUNDING COMMUNITIES. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: AS A MEMBER OF THE CENTRAL MAINE HEALTHCARE SYSTEM, BRIDGTON HOSPITAL PROVIDES HIGH QUALITY HEALTH CARE IN A RURAL SETTING WITH LIMITED HEALTH CARE OPTIONS. ITS AFFILIATION WITH CENTRAL MAINE MEDICAL CENTER PROVIDES ACCESS TO A MUCH LARGER, TERTIARY CARE HOSPITAL, INCLUDING TRAUMA CARE, NEONATAL INTENSIVE CARE, AND A SPECIALIZED CARDIAC CARE UNIT. ADDITIONALLY, CENTRAL MAINE MEDICAL CENTER PROVIDES ACCESS TO SPECIALIST PHYSICIANS FOR OUTPATIENT CARE IN THE BRIDGTON AREA ON A REGULAR SCHEDULE. THE SYSTEM PARENT, CENTRAL MAINE HEALTHCARE, PROVIDES STREAMLINED ADMINISTRATIVE FUNCTIONS AND BACKROOM SERVICES, ALLOWING BRIDGTON HOSPITAL TO PERFORM AT A COST EFFICIENT LEVEL WHICH WOULD NORMALLY BE UNACHIEVABLE IN A SMALL, RURAL HOSPITAL, ALLOWING FOR BROADER RANGE OF SERVICES AVAILABLE. false true false false false false false false false PETER E CHALKE PRESIDENT OF CMHC 0 592913 0 0 0 42185 0 16674 0 12897 0 664669 0 0 ALAN VERRILL DIVISION CHIEF 254373 0 7815 0 2670 0 5029 0 18622 0 288509 0 0 0 BRUCE LASTRA MD PHYSICIAN 267378 0 33500 0 4440 0 6375 0 20602 0 332295 0 0 0 CRAIG SMITH MD PHYSICIAN 252754 0 132844 0 21441 0 15591 0 24306 0 446936 0 0 0 STEPHEN OLSON MD PHYSICIAN 346721 0 0 18267 0 6375 0 8063 0 379426 0 0 0 STUART EISENBERG MD PHYSICIAN 328906 0 0 6392 0 6375 0 3324 0 344997 0 0 0 NARASIMHA SWAMY MD PHYSICIAN 317056 30000 16877 23379 18995 406307 0 R DAVID FRUM PRESIDENT OF BRIDGTON HOSPITAL 0 263929 0 0 39758 0 39375 0 19824 0 362886 0 30351 SCHEDULE J, PART I, LINE 3 EXECUTIVE COMPENSATION: THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT, R. DAVID FRUM, IS DETERMINED BY THE PARENT CORPORATION'S BOARD OF DIRECTORS' EXECUTIVE COMPENSATION COMMITTEE USING THE FOLLOWING: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: A PARTICIPANT'S ENTITLEMENT TO BENEFITS WILL VEST ON THE PARTICIPANT'S VESTING DATE PROVIDED THE PARTICIPANT HAS REMAINED IN CONTINUOUS EMPLOYMENT IN THE SAME POSITION WHILE PARTICIPATING IN THIS PLAN. A PARTICIPANT WILL HAVE ONLY ONE VESTING DATE FOR ALL ELECTIVE DEFERRALS AND OTHER PLAN CONTRIBUTIONS MADE ON THE PARTICIPANT'S BEHALF DURING ALL PLAN YEARS. A PARTICIPANT'S ENTITLEMENT TO BENEFITS WILL ALSO VEST (A) IF THE PARTICIPANT DIES WHILE STILL EMPLOYED BY THE EMPLOYER, (B) IF THE PARTICIPANT'S EMPLOYMENT TERMINATES DUE TO TOTAL DISABILITY; OR (C) IF THE EMPLOYER TERMINATES THE PARTICIPANT'S EMPLOYMENT FOR ANY REASON OTHER THAN FOR "CAUSE". ANY PORTION OF THE PARTICIPANTS ENTITLEMENT TO BENEFITS THAT IS NOT VESTED WHEN THE PARTICIPANT'S EMPLOYMENT WITH THE EMPLOYER TERMINATES, INCLUDING ELECTIVE DEFERRALS, WILL BE FORFEITED. THE EMPLOYER WILL DISTRIBUTE A PARTICIPANT'S BENEFITS UNDER THE PLAN AS SOON AS PRACTICABLE AFTER THE PARTICIPANT'S ENTITLEMENT BECOMES VESTED. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH CENTRAL MAINE HEALTHCARE CORPORATION, A RELATED ENTITY. $ 21,000 R. DAVID FRUM (DEFERRAL) 30,351 R. DAVID FRUM (PAYOUT) SCHEDULE J, PART II, COLUMN F COMPENSATION REPORTED IN PRIOR FORM 990: COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS VESTED OR PAID TO THE INDIVIDUAL. FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B MEMBERS OR STOCKHOLDERS: THE MEMBER OF THE CORPORATION SHALL BE CENTRAL MAINE HEALTHCARE CORPORATION, A CORPORATION DULY ORGANIZED UNDER THE LAWS OF THE STATE OF MAINE. THE MEMBER SHALL HAVE THE RIGHT TO (A) APPROVE THE ELECTION OF MEMBERS OF THE BOARD OF DIRECTORS, (B) REMOVE MEMBERS OF THE BOARD OF DIRECTORS, PROVIDED HOWEVER, THAT (I) THE MEMBER MAY NOT REMOVE WITHOUT CAUSE MORE THAN ONE-THIRD (1/3) OF THE DIRECTORS OF THE CORPORATION IN ANY ONE YEAR, AND (II) THE MEMBER MAY NOT REMOVE ANY DIRECTOR WITH OR WITHOUT CAUSE WITHOUT PROVIDING AN OPPORTUNITY FOR ONE OR MORE REPRESENTATIVES OF THE CORPORATION TO APPEAR BEFORE THE MEMBERS BOARD OF DIRECTORS TO COMMENT ON THE PROPOSED REMOVAL, AND (C) APPROVE CERTAIN DECISIONS OF THE BOARD OF DIRECTORS, AS DETAILED IN THE BYLAWS OF THE CORPORATION. THERE SHALL BE NINE (9) DIRECTORS OF THE CORPORATION WHO SHALL BE ENTITLED TO VOTE. ONE (1) OF THE NINE (9) VOTING DIRECTORS SHALL BE APPOINTED BY THE MEMBER, AND THE BALANCE OF VOTING DIRECTORS SHALL BE ELECTED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW PROCESS: ALL AFFILIATED FORM 990's AND APPLICABLE SCHEDULES ARE PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM IN COOPERATION WITH THE FINANCE DEPARTMENT. THE COMPLETED RETURNS ARE REVIEWED WITH THE DIRECTOR OF FINANCE THEN WITH THE CFO FOLLOWING THAT REVIEW; THEY ARE PRESENTED TO THE FINANCE COMMITTEE OF THE CENTRAL MAINE HEALTHCARE BOARD OF DIRECTORS, WHICH HAS REPRESENTATIVES FROM ALL AFFILIATED BOARDS. ONCE THIS REVIEW IS COMPLETED, ANY NECESSARY CHANGES ARE MADE AND THE FINAL RETURN IS PRESENTED TO ITS RESPECTIVE BOARD WITH THE FINANCE COMMITTEE MEMBER TAKING AND ANSWERING QUESTIONS. A FINANCE DEPARTMENT REPRESENTATIVE, KNOWLEDGEABLE OF THE RETURN, IS AVAILABLE TO ASSIST DURING PRESENTATIONS, IF REQUESTED BY THE FINANCE COMMITTEE MEMBER. IN THE EVENT THAT THE NEXT BOARD MEETING IS NOT SCHEDULED UNTIL AFTER THE FILING DATE, THE FINAL RETURN IS MAILED TO ALL BOARD MEMBERS AND THE PRESENTATION OCCURS AT THE NEXT SCHEDULED BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: OFFICERS AND DIRECTORS COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT WHICH IS REVIEWED BY THE CHAIRMAN OF THE BOARD AND CONFORMS TO THE CONDITIONS CONTAINED WITHIN THE CORPORATION'S BYLAWS, WHICH MEET OR EXCEED THE CURRENT IRS REPORTING THRESHOLDS. IN AREAS OF CONFLICT BY THE CHAIRMAN, THE VICE-CHAIRMAN REVIEWS. ADDITIONALLY, AS PART OF THE ANNUAL FORM 990 PREPARATION PROCESS, A SEPARATE QUESTIONNAIRE IS PROVIDED, WHICH INCLUDES DISTRIBUTION TO KEY EMPLOYEES, COVERING REPORTING AREAS OF LOANS, GRANTS, BUSINESS RELATIONSHIPS, AND OTHER CONFLICTS. THESE QUESTIONNAIRES ARE REVIEWED BY THE FINANCE DEPARTMENT FOR REPORTABLE ITEMS FOR THE FORM 990. IN THE CASE OF A POSSIBLE CONFLICT, THE BOARD WOULD REVIEW THE SITUATION AND TAKE ACTIONS DEEMED APPROPRIATE FOR THE POSSIBLE OR ACTUAL CONFLICTS OF MEMBERS OF THE BOARD OR THE EXECUTIVE OFFICERS. IN THE CASE OF KEY EMPLOYEES, THE REVIEW AND ACTIONS TAKEN WOULD BE PERFORMED BY THEIR DIRECT SUPERVISOR. FORM 990, PART VI, SECTION B, LINES 15A & 15B EXECUTIVE COMPENSATION POLICY: CENTRAL MAINE HEALTHCARE (CMHC) HAS ESTABLISHED AND FOLLOWS A DELIBERATIVE TRANSPARENT PROCESS WHICH MEETS IRS REGULATIONS FOR "REBUTTABLE" PRESUMPTION OF REASONABLENESS. A STANDING EXECUTIVE COMPENSATION COMMITTEE (ECC), COMPRISED OF INDEPENDENT MEMBERS OF BOARD LEADERSHIP, EXISTS TO UNDERTAKE THE PROCESS OF DETERMINING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER, PRESIDENT OF CENTRAL MAINE MEDICAL CENTER, PHYSICIAN PRACTICE EXECUTIVE, PRESIDENT OF RUMFORD HOSPITAL, AND PRESIDENT OF BRIDGTON HOSPITAL. THE PROCESS GUIDELINES AND AUTHORITY OF THE ECC ARE SET OUT IN THE EXECUTIVE COMPENSATION PHILOSOPHY AND RESPONSIBILITIES CHARTER WHICH WAS APPROVED BY THE CMHC BOARD. THE ENTIRE CMHC BOARD PARTICIPATES IN THE ANNUAL PERFORMANCE EVALUATION OF EACH EXECUTIVE, INCLUDING A REVIEW OF ACCOMPLISHMENTS RELATIVE TO GOALS AND OBJECTIVES DERIVED FROM THE STRATEGIC PLAN. THE ECC REVIEWS THE RESULTS OF THE ANNUAL PERFORMANCE EVALUATION AND APPROPRIATE COMPARABILITY DATA BASED ON SEVERAL FACTORS RECOMMENDED BY AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT, WHO SPECIALIZES IN NOT-FOR-PROFIT HOSPITALS AND HEALTH SYSTEMS, AND OUR ATTORNEY'S FACTORS USED IN DETERMINING COMPARABILITY TO THE ORGANIZATION INCLUDES GEOGRAPHY, ORGANIZATIONAL COMPLEXITY, FACILITY TYPE, OWNERSHIP TYPE, AND ANY OTHER FACTORS DEEMED RELEVANT BY THE COMMITTEES CONSULTANTS, OR ITS ATTORNEY'S. USING THIS INFORMATION, THE ECC ANNUALLY REVIEWS THE EXECUTIVE'S COMPENSATION TO DETERMINE IF MODIFICATION TO BASE SALARY IS WARRANTED, AND REVIEWS THE EXECUTIVES' ACCOMPLISHMENTS TO DETERMINE IF ANY VARIABLE PAY IS TO BE AWARDED. THE ENTIRE PROCESS IS THEN DOCUMENTED CONTEMPORANEOUSLY WITH THE DECISION MAKING PROCESS AND APPROVED THEREAFTER IN ACCORDANCE WITH THE REQUIREMENTS OF THE IRS. THE COMPENSATION PAID TO KEY EMPLOYEES IS REVIEWED BY THE VICE PRESIDENT OF HUMAN RESOURCES AND ORGANIZATIONAL DEVELOPMENT. DURING THE REVIEW PROCESS, THE CENTRAL MAINE HEALTHCARE COMPENSATION MANAGER PROVIDES MARKET DATA ON COMPARABLE POSITIONS FROM COMPARATIVE GROUPS OF HEALTHCARE ORGANIZATIONS THAT ARE APPROPRIATELY SIMILAR IN TERMS OF THEIR REVENUE, GEOGRAPHIC LOCATION, NUMBER OF EMPLOYEES, NUMBER OF STAFFED HOSPITAL BEDS, ETC. HUMAN RESOURCES PROVIDES AT A MINIMUM FOUR SETS OF COMPARABILITY DATA FROM THE MOST RECENT NATIONAL HEALTHCARE SPECIFIC COMPENSATION SURVEYS (E. G. WATSON & WYATT, SULLIVAN & COTTER, THE HAY GROUP, MERCER, ETC ) FOR REFERENCE. THESE SURVEYS REPORT PAY RATE DATA THAT IS TYPICALLY AGED LESS THAN 6 MONTHS. CENTRAL MAINE HEALTHCARE AND AFFILIATES STRIVE TO PAY AT THE MARKET AVERAGE OR SLIGHTLY ABOVE IT FOR KEY EMPLOYEES. ONCE THE COMPENSATION MANAGER AND THE VICE PRESIDENT OF HUMAN RESOURCES AND ORGANIZATIONAL DEVELOPMENT HAVE FINALIZED RECOMMENDATIONS BASED ON THIS EMPIRICAL DATA, THEY ARE PRESENTED TO THE PRESIDENTS OF EACH HOSPITAL THAT SUPERVISE THE KEY EMPLOYEES, AND THE CEO OF CENTRAL MAINE HEALTHCARE, FOR REVIEW, EDITS, AND APPROVAL. THIS PROCESS TYPICALLY OCCURS DURING THE LAST MONTH OF THE FISCAL YEAR IN PREPARATION FOR THE NEXT FISCAL YEAR. CENTRAL MAINE HEALTHCARE DOCUMENTS THE BASIS FOR ITS DETERMINATION OF KEY EMPLOYEES' COMPENSATION AND MAINTAINS THIS CONTEMPORANEOUSLY SUBSTANTIATED MATERIAL IN THE HUMAN RESOURCES DEPARTMENT. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST IN THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE FINANCIAL STATEMENTS OF THE ORGANIZATION ARE INCLUDED IN THE MOST RECENTLY FILED FORM 990 AND PROVIDED, UPON REQUEST, IN THAT FORMAT UNLESS THE SPECIFIC REQUEST DEEMS A DIFFERENT FORMAT MORE APPROPRIATE. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: NO MEMBERS OF THE BOARD RECEIVE COMPENSATION FOR THEIR DIRECTOR DUTIES. PETER CHALKE IS EMPLOYED AS PRESIDENT OF CENTRAL MAINE HEALTHCARE CORPORATION. HIS COMPENSATED TIME IS SPENT IN THAT CAPACITY. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: $ 2,307,296 PURCHASED LABOR - PHYSICIANS 4,685,597 PURCHASED LABOR - OTHER 574,897 PURCHASED SERVICES 1,703,299 OUTSIDE SERVICES 8,254 PROFESSIONAL FEES 2,624 CONSULTING SERVICES ------------- $ 9,281,967 FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 60,915 CHANGE IN BENEFICIAL INTEREST OF PERPETUAL TRUST CENTRAL MAINE COMMUNITY HEALTH CORP PO BOX 4500 LEWISTON ME 04243 010386912 PUBLIC ED ME 501(C)(3) 9 CMHC false CENTRAL MAINE MEDICAL CENTER PO BOX 4500 LEWISTON ME 04243 010211494 HEALTHCARE ME 501(C)(3) 3 CMHC false MAINE COLLEGE OF HEALTH PROFESSIONS PO BOX 4500 LEWISTON ME 04243 010356077 EDUCATION ME 501(C)(3) 2 CMMC false CENTRAL MAINE REAL ESTATE MANAGEMENT COR PO BOX 4500 LEWISTON ME 04243 010387674 REAL ESTATE ME 501(C)(2) CMHC false CENTRAL MAINE HEALTHCARE CORPORATION PO BOX 4500 LEWISTON ME 04243 010386913 HEALTHCARE ME 501(C)(3) 11 B II NA false RUMFORD COMMUNITY FAMILY HEALTH CENTER 430 FRANKLIN STREET RUMFORD ME 04276 010481000 HEALTHCARE ME 501(C)(3) 3 CMHC false RUMFORD COMMUNITY HOME CORPORATION 11 JOHN F KENNEDY LANE RUMFORD ME 04276 222844951 NURSING HOME ME 501(C)(3) 9 CMHC false RUMFORD HOSPITAL 420 FRANKLIN STREET RUMFORD ME 04276 010215227 HEALTHCARE ME 501(C)(3) 3 CMHC false BRIDGTON HOSPITAL PHYSICIANS GROUP SOUTH HIGH STREET BRIDGTON ME 04009 010493083 HEALTHCARE ME 501(C)(3) 9 CMHC false CENTRAL MAINE HEART AND VASCULAR INST 300 MAIN STREET LEWISTON ME 04240 542078282 HEALTHCARE ME 501(C)(3) 9 CMHC false ELIAS E TUCKER TRUST FUND C/O CMMC 300 MAIN STREET LEWISTON ME 04240 016042343 NURSING ED ME 501(C)(3) 11 A I CMMC false CENTRAL MAINE HEALTH VENTURES INC 300 MAIN STREET LEWISTON ME 04240 010430016 HEALTHCARE ME CMHC C CORP. false CWM INSURANCE LTD GENESIS BUILDING PO BOX 1363 GRAND CAYMAN CJ B.W.I. 980220891 INSURANCE CJ CMHC C CORP. false false false false false false false false false false false true false true false true true true false false