2015-08-11T07:15:19-05:00 2014-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2013-10-01 010234189 Northern Maine Medical Center NORT 2078343155 194 East Main Street Fort Kent ME 04743 Peter J Sirois CEO 2078343155 2015-08-10 1 Barbara J McGuan CPA P00219457 2077752387 2015-08-10 2013 2016-02-25 16:41:14Z Peter J Sirois 194 East Main Street Fort Kent ME 04743 45545177 0 X www.nmmc.org X 1948 ME Acute care & long term care hospital and mental health services facility. 10 6 578 49 25628 -18547 661490 1493063 44712601 45079671 -379803 -28811 909087 -1102134 45903375 45441789 0 0 0 0 26308386 28081024 0 0 0 18074245 17003967 44382631 45084991 1520744 356798 46612884 42813880 21562847 17399129 25050037 25414751 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 38535156 43837464 Medical care & ancillary services, nursing home & skilled services, physician services. 38535156 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 0 0 1 0 0 0 1 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 96 0 1 578 1 1 1 0 0 0 0 0 0 0 0 0 X 10 6 1 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 X 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 Glenn Lamarr 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 Mark Morneault Director 1.00 0.50 X 0 0 0 Robert Bellefleur Director 1.00 0.50 X 3180 0 0 Mark Chamberland Director 1.00 0.50 X 0 0 0 Michael Sullivan MD Director 50.00 0.50 X 636415 0 29141 Frances Labrie Past Director 1.00 0.50 X 0 0 0 Peter J Sirois CEO 50.00 1.00 X 224661 0 28117 Cindy L Daigle CFO 50.00 1.00 X 144579 0 25761 Mark Overton MD Psychiatrist 50.00 0.00 X 645740 0 19491 James Harris MD Physician 50.00 0.00 X 465720 0 29141 David Coffman MD Surgeon 50.00 0.00 X 413077 0 14083 David Jones MD ER Physician 50.00 0.00 X 336470 0 29141 Rodney Lahren MD Surgeon 50.00 0.00 X 293770 0 17662 3163612 0 192537 36 0 1 0 The Sheridan Corporation PO Box 359 Fairfield ME 04937 Building Contractor 1143097 Erik St Pierre MD 194 East Main St Fort Kent ME 04743 ER Physician 398643 Quest Diagnostics 12436 Collections Center Drive Chicago IL 606932436 Off-Site Laboratory Services 371081 Radiology 247 LLC 5820 Oberlin Drive 205 San Diego CA 92121 Off-Site Radiologist Coverage 276948 Thayer Corp 1400 Hotel Road Auburn ME 04210 Building Contractor 272421 10 1493063 1406564 1493063 Patient Service Revenue 623000 74971806 74971806 Miscellaneous Revenue 623000 1096113 950651 25628 119834 Meaningful Use Revenue 623000 538291 538291 Provision for Bad Debt 623000 -1879489 -1879489 Contractual/Char. Adj. 623000 -29647050 -29647050 45079671 35337 35337 97334 0 97334 97334 97334 19047 83195 -64148 -64148 -64148 62932 20193 42739 42739 Insurance Captive 900099 -1242207 -1242207 -1242207 45441789 43692002 25628 231096 1091854 665556 426298 22536023 18905817 3630206 328708 280015 48693 2612534 2200981 411553 1511905 1254881 257024 85486 70953 14533 71725 59532 12193 412226 342148 70078 79083 65639 13444 4726764 3939974 786790 1360808 1129471 231337 191255 158742 32513 368723 306040 62683 2812765 2334595 478170 353679 293554 60125 Medical Supplies 4297275 4297275 Valley Medical Associat 1225100 1225100 Health Care Provider Ta 935579 935579 Dues & Subscriptions 83499 69304 14195 45084991 38535156 6549835 0 308223 121350 11811311 9291835 5792616 5881188 16096 6796 76856 60060 716381 742033 272240 214423 44235168 24539851 19241023 19695317 109488 216322 515861 489785 7752789 6094771 46612884 42813880 6767375 4756508 8565946 7895738 6229526 4746883 21562847 17399129 X 24674605 25056693 375432 358058 25050037 25414751 46612884 42813880 356798 7916 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 8487 8487 0 Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which is attributable to lobbying expenses. 196477 196477 25439307 9731398 15707909 17978366 14808453 3169913 621018 621018 19695317 Deferred Compensation 866156 Cash Surrender Value of Life Insurance 269250 Interest in Synernet Reinsurance 670823 Meaningful Use Receivables 451860 Estimated Third-Party Payor Settlements 3311682 Insurance Claim Receivable 525000 6094771 Deferred Compensation 866156 Estimated Third-Party Payor Settlements 3818262 Due to Affiliate 62465 4746883 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. 2014 Cancer Fund Tour 24925 24925 1827 90 535 900 Emergency Room Fundraiser 38007 38007 775 4117 3428 4492 4029 62932 62932 775 5944 3518 5027 4929 20193 42739 1 1 X 1 X 1 X 0 1 1 0 1 1 486813 486813 0.01080 3193800 2027948 1165852 0.02590 3680613 2027948 1652665 0.03670 16606905 14033425 2573480 0.05710 16606905 14033425 2573480 0.05710 20287518 16061373 4226145 0.09380 1 1082667 16849684 17589890 -740206 X 1 0 2 1 Northern Maine Medical Center 194 East Maine Street Fort Kent ME 04743 X X X 2 Forest Hill 20 Bolduc Avenue Fort Kent ME 04743 X Licensed Hospital Related Facility Northern Maine Medical Center 1 1 X X X X X X X X X 13 1 1 1 X www.nmmc.org X X X X X 0 0 1 1 200.000000000000 1 250.000000000000 1 X 1 1 X X X 1 0 X X X X 1 X 0 0 Northern Maine Medical Center Part V, Section B, Line 1j: 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 3: 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 (including Aroostook District Coordinating Council) and 11 Healthy Maine Partnerships (including Health Aroostook). Northern Maine Medical Center Part V, Section B, Line 4: In addition to EMHS Member Organizations, which include 8 hospitals one of which is The Aroostook Medical Center, 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, and Redington-Fairview General Hospital. All four Aroostook County hospital facilities were included. Northern Maine Medical Center Part V, Section B, Line 6i: 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 resourcesNorthern Maine Medical CenterPart V, Section B, Line 6g:Prioritization of health needs in its community:Priority #1 - Substance AbuseActions were identified in three distinct categories: prevention, screening and treatment. 1. Collaborate with community partners to increase number of educational sessions to one per quarter on topics such as social hosting, effects of substance abuse to local schools and civic groups.2. Provide home medication lock boxes to primary care offices. 3. Work with law enforcement to increase checkpoints to screen for drunk driving.4. Adopt the SBIRT (screening, brief intervention, and referral for treatment) process within one year in our primary care offices, ED and inpatient units.5. Adopt an evidence based tool to screen patients for substance abuse in CAPU, (such as ACOK).6. Work in collaboration with other community partners in the development of an algorithm for treatment in the St. John Valley and make it available for all primary care offices and mental health providers. 7. Explore the possibility of having a provider at NMMC specialize in the treatment of co-occurring conditions/diagnoses.8. Foster the community support groups (such as AA) in regards to their assistance with aftercare.9. Reach out to community agencies to explore methods to support agencies currently offering these services. Aroostook Mental Health Center, Life by Design, et al.Priority #2 - Healthy Food and NutritionYear 1 (2015)1. Pursue participation in the Let's Go! Program. A new Northern Aroostook County Let's Go! program coordinator will be onboard by the end of January 2015. A request has been made to meet with the individual to map out a plan for training and implementation of the three Let's Go! modules. The lead person for the Let's Go! Program in the Maine School District #33 will also be consulted for lessons learned in the implementation process.2. Coordinate presentation to NMMC providers by Let's Go! Program director - Growing and Sustaining Let's Go! In Maine3. Partner with Healthy Maine Partnership - AroostookYear 2 (2016)1. Reach out to local restaurants to offer healthy menu options. 2. Develop a partnership with the Cooperative Extension Service to tap into resources for training community members in how to shop and cook for a healthier life. Include local grocers to be part of the plan to identify healthy food choices for shoppers. 3. Meet with local farmers and food coop to discuss strategies for affordability and access to fresh foods. Priority #3 - Cardiovascular HealthYear 1 (2015)1. Partner with other local organizations/businesses to improve access to exercise facilities. 2. NMMC Our Communities Team is working with the community to determine how best to communicate to the public what is available as a starting point. Options being considered to improve communication to the public are use of a digital sign, online newsletter, paper newsletter, patient portals. NMMC website will complete an upgrade in the spring of 2015. The site is more user-friendly and will offer more options to link and inform patients.3. Support OffUGoAroostook by assisting them in expanding the distribution of weekly activities listings to a broader population.4. Educate providers about the resources available to patients. Provide printed informational materials to be used as patient handouts. Year 2 (2016)1. Partner with Fort Kent Power of Prevention coordinator to explore ways we can partner to expand our reach and resources to the St. John Valley Communities.2. Revisit the Wholesome Wave program to determine availability of participation. Northern Maine Medical Center Part V, Section B, Line 7: NMMC believes the following community health needs are important however they were prioritized as secondary level priorities for various reasons, including limited staff and financial resources. It is also important to note, as will be outlined further in this section, that some, but not all of these secondary priorities, are currently receiving some early stage attention.1. Social concerns that include: a. Unemployment/economic opportunity b. Domestic violence c. 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. d. Affordable housing2. Preventive screenings and immunizations that survey respondents did not feel were very accessible. Those include: a. Oral health b. Depression screening - All primary care providers are using the PHQ depression screening tool as a first line depression screening. c. 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. d. Tobacco use screening - NMMC Patient Educator will be trained by the Pfizer Company to be able to offer 'Beat the Pack' program with tentative start date of April 2015.3. Gaps in Healthcare Services: a. 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. b. Behavioral/mental health services for adults4. Issues Preventing Access to Care: a. Out of pocket costs associated with insurance plans b. Lack of insurance and unable to pay for the careNMMC has worked with local pharmacies to implement a cash card program to reduce cost of prescription drugs for eligible individuals.NMMC also is designated as a Certified Application Counselor organization and has representatives that can assist individuals with obtaining coverage through the Health Insurance Exchange. c. Transportation - NMMC is partnering with the Aroostook Area Agency on Aging to address the issue of transportation. d. Don't understand or value the importance of seeking care e. Negative prior experiences Northern Maine Medical Center Part V, Section B, Line 20d: 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 22: Individuals are billed at gross amounts and charges are adjusted accordingly, if they qualify for assistance. 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 VI, Line 2: Please see Schedule H, Part v, Section B, Line 1 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 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. X X X 0 0 0 0 0 0 0 1 1 1 Michael Sullivan MD Director 618915 0 0 0 17500 0 7650 0 21491 0 665556 0 0 0 Peter J Sirois CEO 195868 0 28000 0 793 0 5956 0 22161 0 252778 0 0 0 Cindy L Daigle CFO 139579 0 5000 0 0 0 4270 0 21491 0 170340 0 0 0 Mark Overton MD Psychiatrist 645740 0 0 0 0 0 0 0 19491 0 665231 0 0 0 James Harris MD Physician 448220 0 0 0 17500 0 7650 0 21491 0 494861 0 0 0 David Coffman MD Surgeon 413077 0 0 0 0 0 0 0 14083 0 427160 0 0 0 David Jones MD ER Physician 318970 0 0 0 17500 0 7650 0 21491 0 365611 0 0 0 Rodney Lahren MD Surgeon 283770 0 10000 0 0 0 5678 0 11984 0 311432 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. Part I, Line 8 Rodney Lahren received a sign-on bonus pursuant to his employment contract. Mark Overton Employee Purchase of home X 27900 6796 0 0 1 6796 Daigle Oil Company Entity of which Dan Vaillancourt, Board Member, is an officer 197356 Independent Contractor Arrangement 0 Nola Sirois Family member of Peter Sirois, Hospital CEO 22223 Employment 0 Michelle L Plourde Family member of Peter Sirois, Hospital CEO 59606 Employment 0 Nicole Marquis Family member of Peter Sirois, Hospital CEO 42605 Employment 0 Robin Werntgen Family member of Glenn Lamarr, Board Treasurer 55816 Employment 0 X 1 1406564 Appraisal 1 0 0 0 Form 990, Part VI, Section A, line 2 Peter Sirois and Glenn Lamarr have a family relationship. 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 was sent electronically to Board members prior to the form being filed. Form 990, Part VI, Section B, line 12c The enforcement of the conflict of interest policy is achieved through annual reporting and ongoing monitoring. 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 VII, Section A: Michael Sullivan & Robert Bellefleur show reportable compensation on Form 990, Part VII, Section A for services performed in their capacity as employee and contractor respectively, of Northern Maine Medical Center. Their compensation does not reflect payment for services as a board members of the Hospital or any related organization. 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 1225100 Actual Outlay