2014-05-13T06:11:52-05:00 2013-06-30 010494526 Baker Newman Noyes 280 Fore Street Portland ME 04101 990 2012-07-01 043369649 MaineGeneral Health MAIN 2076261000 35 Medical Center Parkway Augusta ME 04330 Michael Koziol 2076261000 2014-05-07 E Drew Cheney P00182972 2078792100 2012 2015-11-30 17:44:51Z X Charles Hays 35 Medical Center Parkway Augusta ME 04330 12864688 0 9706 X www.mainegeneral.org X 1997 ME To enhance, every day, the health of people in the greater Kennebec Valley. 23 17 124 21 0 0 59330 29962 14326284 12173933 160498 552786 611090 0 15157202 12756681 44097 45844 0 0 10391913 9427413 0 0 923800 4080826 2835299 14516836 12308556 640366 448125 16417099 19082886 11279024 12338427 5138075 6744459 Reported on Page 1 0 0 5416806 45844 12173933 MaineGeneral Health provides administrative services for tax-exempt subsidiaries and develops and implements overall goals and strategies for the system-wide delivery of necessary health care services in an efficient and coordinated manner. 5416806 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 575 0 1 124 1 0 0 0 0 0 0 0 0 X 23 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Mary Griswold Controller 2076261289 35 Medical Center Parkway Augusta ME 04330 Peter Alfond 1.00 0.00 X 0 0 0 Conrad Ayotte 2.00 0.00 X X 0 0 0 Douglas Boyink MD 10.00 0.00 X 0 260377 29345 Scott Bullock 50.00 0.00 X 710814 0 24708 Stephanie Calkins MD 1.00 0.00 X 0 37600 1668 Douglas Cutchin 1.00 0.00 X 0 0 0 Charles Danielson MD MPH 1.00 0.00 X 0 0 0 Mark Ford 2.00 0.00 X 0 0 0 Peter Guzzetti DO DDS 1.00 0.00 X 0 24000 0 David Hay MD 1.00 0.00 X 0 638102 22101 Charles Hays 50.00 0.00 X X 351769 0 16363 Jeffrey Hubert 2.00 0.00 X 0 0 0 Mark Johnston 1.00 0.00 X 0 0 0 James Laliberty 1.00 0.00 X 0 0 0 Robert Marden 2.00 0.00 X 0 0 0 Barbara Mayer 1.00 0.00 X 0 0 0 Roy Miller MD 1.00 0.00 X 0 0 0 Elizabeth Mitchell Esq 1.00 0.00 X 0 0 0 Gary Peachey 1.00 0.00 X 0 0 0 Gordon Pow 2.00 0.00 X 0 0 0 Tobi Schneider Esq 1.00 0.00 X 0 0 0 William Sprague 2.00 0.00 X X 0 0 0 Douglas Terp 2.00 0.00 X 0 0 0 Karen Tobias 45.00 0.00 X 56681 0 13635 Michael Koziol 50.00 0.00 X 296670 0 17913 Barbara Crowley MD 50.00 0.00 X 342102 0 32780 Steven Diaz MD 25.00 25.00 X 148605 128528 25758 Sharon Woodward 50.00 0.00 X 202806 0 27978 Daniel Burgess 50.00 0.00 X 177926 0 24393 Rebecca Lamey 50.00 0.00 X 179591 0 32396 Gail Evans 50.00 0.00 X 227283 0 10415 Kevin Brooks 50.00 0.00 X 198004 0 17664 2892251 1088607 297117 15 1 1 0 IMA Consulting 3 Christy Drive Suite 100 Chadds Ford PA 19317 Consulting 653074 Baker Healthcare Consulting Inc 4251 Reliable Parkway Chicago IL 606860042 Consulting 218970 Baker Newman Noyes 280 Fore Street Portland ME 04112 Auditing, Consulting, Tax 169090 Stroudwater Associates 50 Sewall Street Suite 102 Portland ME 04102 Consulting 151835 Pierce Atwood LLP One Monument Square Portland ME 04101 Legal 130957 5 29962 29962 Management fee revenue 561000 12061855 12061855 Rental revenue 532000 112078 112078 12173933 367826 367826 292967 108007 184960 184960 184960 12756681 12173933 0 552786 45844 45844 1495897 1495897 6339594 3343259 2423395 572940 562696 296744 215768 50184 578153 304895 221008 52250 451073 237880 172427 40766 149533 149533 104500 104500 618284 106111 484058 28115 11786 9786 2000 325023 99076 91436 134511 496260 445734 41338 9188 63392 34214 21053 8125 152063 49437 82016 20610 77922 77922 93195 78800 10988 3407 14289 14289 Professional Membership 475544 159296 313498 2750 Recruitment 153126 110923 42203 Institutional Dues 71442 71442 Minor Equipment 18793 7033 11101 659 10147 9852 295 12308556 5416806 5967950 923800 439076 4560168 2470153 1733457 439 63 40967 70650 331034 496762 702206 517607 277794 184599 6200595 6815845 6657041 5221342 16417099 19082886 3047804 6256897 938020 0 7293200 6081530 11279024 12338427 X 4440785 6009144 165402 201859 531888 533456 5138075 6744459 16417099 19082886 X 448125 286162 872097 X X 0 1 X 1 1 1 X X X 0 0 0 MaineGeneral Medical Center 043369653 3 1 1 1 0 HealthReach Network 010524384 9 1 1 1 0 MaineGeneral Rehabilitation & Long Term Care 222789192 9 1 1 1 0 MaineGeneral Retirement Community 010627194 9 1 1 1 0 MaineGeneral Health Associates 222516766 9 1 1 1 0 5 0 5372616 19144 687203 258297 16213 0 5804453 5589796 24845 -76577 27690 137758 0 5372616 5600320 23144 1033434 17771 1049331 0 5589796 4909719 189201 697657 0 196257 0 5600320 6099484 127387 -1103372 17018 196762 0 4909719 0.87300 0.09200 0.03500 0 0 148779 44100 104679 553427 473507 79920 184599 Due from affiliates 5221342 5221342 Self-insurance reserves - health 2506414 Self-insurance reserves - dental 179526 Workers compensation accrual 62685 Accrued pension costs 2032473 Accrued deferred compensation 848413 Other long-term liabilities 452019 6081530 X Description of Intended Use of Endowment Funds: Part V, Line 4: MaineGeneral Health's intended uses of endowment funds are: 1. to provide funds for scholarships; 2. to fund educational programs; 3. to provide a source of funds for an executive deferred compensation plan and 4. to self-fund workers compensation claims and related expenses. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Company and its affiliates have been determined to be tax-exempt organizations as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and, accordingly, are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Accordingly, no provision for income taxes has been recorded in the accompanying consolidated financial statements for these tax-exempt organizations. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The Company has evaluated the tax positions taken on its filed returns. The Company has concluded no uncertain income tax positions exist at June 30, 2013. The Company's tax years from 2010 through 2013 are open and subject to examination. 1 Scholarships 54 38181 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: MaineGeneral Health offers several different types of scholarships, which are awarded based on requirements established by the donors funding the scholarships. Any individual in MaineGeneral Health's service area may apply for a scholarship by completing a required application, including school transcripts, a statement of need, financial disclosures, and other information. The majority of these scholarships are offered to students pursuing a career in nursing or another healthcare related field of study. Before scholarship funds are disbursed to a student, the student must provide documented evidence of the successful completion of the required coursework at the end of each term. MaineGeneral Health retains complete files for each scholarship award as substantiation of the amount of scholarship funding for each individual. X 1 1 X X X X 1 1 0 0 0 0 0 1 0 Douglas Boyink MD 0 237820 0 19964 0 2593 0 22415 0 6930 0 289722 0 0 Scott Bullock 432546 0 269449 0 8819 0 11964 0 12744 0 735522 0 0 0 David Hay MD 0 384908 0 251456 0 1738 0 11326 0 10775 0 660203 0 0 Charles Hays 346430 0 0 0 5339 0 13587 0 2776 0 368132 0 0 0 Michael Koziol 295391 0 0 0 1279 0 10885 0 7028 0 314583 0 0 0 Barbara Crowley MD 335626 0 0 0 6476 0 25333 0 7447 0 374882 0 0 0 Steven Diaz MD 148386 128330 0 0 219 198 8155 5463 6519 5621 163279 139612 0 0 Sharon Woodward 200954 0 0 0 1852 0 21121 0 6857 0 230784 0 0 0 Daniel Burgess 177926 0 0 0 0 0 9759 0 14634 0 202319 0 0 0 Rebecca Lamey 174568 0 0 0 5023 0 17950 0 14446 0 211987 0 0 0 Gail Evans 227283 0 0 0 0 0 6738 0 3677 0 237698 0 0 0 Kevin Brooks 197704 0 0 0 300 0 8395 0 9269 0 215668 0 0 0 Part I, Line 1a Part I, Line 1a: Scott B. Bullock $4,903 Treated as taxable compensation Barbara Crowley, M.D. $4,346 Treated as taxable compensation Charles Hays $4,815 Treated as taxable compensation Part I, Lines 4a-b Part I, Line 4b: Supplemental nonqualified retirement plan - Scott Bullock - Amounts paid $269,449. Benefits are fully vested and nonforfeitable under a 2000 Supplemental Retirement Plan and a 2005 Supplemental Retirement Plan. Under a 2010 Supplemental Retirement Plan, amounts credited to the account for the first two contract years and the earnings thereon vested and were distributed on January 15, 2012. For the 2012 contract year, the amount credited and the earnings thereon became fully vested and nonforfeitable on December 31, 2012. Severance Payments - Gail Evans - Amounts paid $87,696; Kevin Brooks - Amounts paid $34,905 Part I, Line 7 A portion of compensation is at risk and variable and is based on the quality of job performance. Form 990, Part VI, Section B, line 11 All Forms 990 and related attachments were reviewed by appropriate members of senior management, the Finance Committee, and the Board of Directors before the filings were sent to the Internal Revenue Service. Final drafts of Forms 990 were available thirty days prior to the filing deadline in order to be formally reviewed by the Senior Vice President and Chief Financial Officer, the Compliance Officer, the entire senior management team, the Finance Committee, and the Board of Directors. Forms 990 and related attachments were provided to and reviewed by the Finance Committee in April 2014 and by the Board of Directors in May 2014. Form 990, Part VI, Section B, line 12c MaineGeneral Health's Conflict of Interest Policy requires disclosure of any actual or potential conflict of interest to the Board Chair. Interested persons are prohibited from participating in the governing body's deliberations and decisions regarding any transactions when they have a conflict of interest. If the Board or Committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, the Board or Committee shall investigate and then determine by a majority vote whether a conflict of interest exists and whether the violation is grounds for removal from the Board or Committee. There are formal records of these proceedings. In addition, each director, officer, and member of the Board is required to annually complete and sign a Conflict of Interest Disclosure Statement. Employees must disclose in writing to their supervisors any conflicts of interest prior to engaging in transactions or taking positions with MaineGeneral Health. In addition, these disclosures must be approved by the supervisor's manager or, as applicable, the Board Chair, in conjunction with the Human Resources Compliance Officer. If management has reasonable cause to believe that an employee has intentionally failed to disclose a conflict of interest, appropriate disciplinary or corrective action up to and including termination shall be taken. In addition, upon hire or promotion to a management position, all management employees shall complete a Conflict of Interest Disclosure Statement, which will be submitted to the Ethics and Compliance Department for review and reporting to the Chief Compliance Officer, who will record and report each validated conflict of interest to the Board. Form 990, Part VI, Section B, line 15 The Board of Directors is responsible for determining the compensation package for the Chief Executive Officer. An independent compensation consultant advises the Board using comparability data, expert compensation studies and other means. Paid executives who hold voting privileges may not vote or participate in discussions regarding their compensation; however, they may answer questions that will help the Board in its deliberations. For other officer and key employee positions, salary structures are developed and maintained based on national compensation data for healthcare organizations. The Chief Executive Officer's compensation was last reviewed in December 2012. Form 990, Part VI, Section C, line 18 The three most recent Forms 990 (Annual Information Returns) and 990T (Exempt Organization Business Income Tax Returns), along with a copy of the application for a group exemption submitted to the IRS by MaineGeneral Health on behalf of its affiliates, is made available for public inspection without charge at each organization's principal offices during regular business hours (Monday through Friday, 8:00 a.m. until 4:30 p.m.). In addition, when a request for copies of any of these documents is made in person, copies are made available to the requester without charge on the day the request is made. If a written request for a copy of any of these documents is received, the requested documents are mailed without charge within two weeks from the date the request is received. MaineGeneral Health also makes its most recently filed annual information returns widely available by posting the documents on its website. Form 990, Part VI, Section C, line 19 MaineGeneral Health makes its governing documents, conflict of interest policy and financial statements, whether or not audited, available to the general public by providing copies immediately upon request. The latest two fiscal years of audited financial statements are available on the company's website at www.mainegeneral.org. In addition, the Controller distributes financial statements and budgets on a quarterly and annual basis to designated third parties. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Other pension-related changes 872097. Form 990, Part XII, Line c MaineGeneral Health did not change its oversight process or selection process during the current tax year. Kennebec Risk LLC 35 Medical Center Parkway Augusta ME 04330 455473855 Captive insurance company VT 0 0 MaineGeneral Medical Center MaineGeneral Medical Center 35 Medical Center Parkway Augusta ME 04330 043369653 Hospital ME 501(c)(3) Line 3 MaineGeneral Health 1 HealthReach Network 35 Medical Center Parkway Augusta ME 04330 010524384 Provider of home care, hospice, and community support services ME 501(c)(3) Line 9 MaineGeneral Health 1 MaineGeneral Rehabilitation & Nursing Care 35 Medical Center Parkway Augusta ME 04330 222789192 Provider of long-term and residential care services ME 501(c)(3) Line 9 MaineGeneral Health 1 MaineGeneral Health Associates 35 Medical Center Parkway Augusta ME 04330 222516766 Provider of primary and specialty care physician services ME 501(c)(3) Line 9 MaineGeneral Health 1 MaineGeneral Retirement Community 35 Medical Center Parkway Augusta ME 04330 010627194 Provider of assisted and residential living services ME 501(c)(3) Line 9 MaineGeneral Health 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 MaineGeneral Medical Center A 61585 Fair market value MaineGeneral Rehabilitation & Nursing Care A 4441 Fair market value MaineGeneral Medical Center K 11755112 Fair market value MaineGeneral Rehabilitation & Nursing Care K 75600 Fair market value MaineGeneral Retirement Community K 21600 Fair market value HealthReach Network K 203040 Fair market value