2014-04-04T12:20:03-05:00 2013-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2012-07-01 010223482 Millinocket Regional Hospital MILL 2077235161 200 Somerset Street Millinocket ME 04462 Christine McLaughlin 2077235161 2014-04-02 1 Barbara J McGuan CPA P00219457 2077752387 2014-04-02 2012 2015-11-30 17:44:51Z Marie Vienneau 200 Somerset Street Millinocket ME 04462 31138098 0 X www.mrhme.org X 1952 ME Critical Access Hospital 15 8 283 13 0 0 146101 181679 27163666 27112248 270536 590961 -9637 72713 27570666 27957601 39800 2301 0 0 17103221 17409296 0 0 0 10601799 10229103 27744820 27640700 -174154 316901 23423125 23588914 8949790 8546823 14473335 15042091 X Millinocket Regional Hospital is a 25 bed critical access hospital that serves as the primary care facility for the communities of Millinocket, Milo, Sherman, Staceyville, Patten, Island Falls and their surrounding territories. 0 0 25801778 2301 27077485 Millinocket Regional Hospital provides inpatient and outpatient services to the Katahdin region including; 783 inpatients served, 1,325 operating room patients served, 13,208 laboratory patients served, 11,190 radiology patients served, 3,667 pharmacy patients served, 2,021 therapy patients served, 16,430 clinic patients served, 6,905 emergency room patients served.The following seminars, promotions, advertisements, and clinics were provided to the community throughout fiscal 2013:1. MRH held an open house October 3, 2012 to recognize Breast Cancer Awareness Month.2. MRH medical staff sponsored three high school scholarships June 14, 20133. MRH sponsored the Katahdin area snowmobile map.4. MRH sponsored a Rehab & Wellness Open House on October 25, 2012, part of October therapy month.5. MRH held multiple flu shot and H1N1 flu shot clinics from October 26, 2012 through December 20126. MRH sponsored the Stearns-Schenck Musical (Hello Dolly Fall Musical program)7. MRH sponsored the 2013 Life Style Fitness Center open New Years day.8. MRH sponsored a community Weight Watchers 12 week program - January 2013.9. MRH sponsored a Jr. Pro Hoop Classic in January of 2013.10. MRH paid a sponsorship to Millinocket Little League in May of 2013 which paid for a team, the Yankees, and also a scoreboard sign.11. MRH sponsored a cardiac support group the first Wednesday of each month.12. MRH sponsors a diabetes support group, the first Tuesday of every month beginning November 3, 200913. MRH's Hospital Auxiliary sponsored charismas luncheon for staff.14. MRH sponsored the Millinocket Community Blood Drive - April 27, 201315. MRH purchased ad space to raise money for multiple causes including: Schenck and Stearns High School yearbooks, Millinocket Historical Society 2012 Calendars, VFW Convention Ad Book, and also ads for Special Sections of the Bangor Daily News that covered area Football and Basketball Teams.16. MRH operates a grant funded Healthy Maine Partnership organization which provided education services to the community on alcohol misuse, tobacco cessation, proper nutrition and physical activity. The staff works with businesses, clubs and the schools to extend the message of healthy living and good wellness choices. The Organization uses local media to reach the large region.17. MRH provides meeting space for non-profits at no cost, for example to American Cancer Society, Eastern Area on Aging, Martin's Point, Diabetic Support Group, Caring Connections, AA, and Weight Watchers. Rotary, ALA-NON, Cub Scout Meeting, Penquis C.A.P., & MRH Hospital Auxiliary.18. MRH participates in disaster preparedness regional committee with several other agencies including doctors' groups, other hospitals, local police and fire departments, schools and other organizations. The goal is to prepare for pandemic flu, natural disasters or other incidents that could affect our communities and work together to share resources to protect the community.19. Millinocket Regional Hospital announced the efforts of staff earning three major awards for 2012. They are: Well Work Place Gold Award from the Wellness Council of America, VHA 2012 Leadership Award of Clinical Excellence in the category of critical access, acute care hospitals, and The Avatar patient Satisfaction Award.20. MRH departments acknowledge, recognize and celebrate staff professional days/week, and National Hospital week for their continued accomplishments of service in health care. 25801778 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 82 0 1 283 1 0 0 0 0 0 0 0 0 0 0 X 15 8 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 ME X Christine McLaughlin 2077235161 200 Somerset Street Millinocket ME 04462 Ronald Brown 5.00 X 0 0 0 Thomas Malcolm 5.00 X X 0 0 0 Mellissa Edwards 5.00 X X 0 0 0 Don Casko 5.00 X X 0 0 0 Herbert Clark 5.00 X 0 0 0 Jack Dinsmore 5.00 X 0 0 0 Gail Fanjoy 5.00 X 0 0 0 Joyce Given 5.00 X 0 0 0 Patrick Hunt Esq 5.00 X 0 0 0 Lee Lamson 5.00 X X 0 0 0 Fred Lewis 5.00 X 0 0 0 Wallace Tapley 5.00 X 0 0 0 Mark Kowalski 60.00 X X 432157 0 34038 Edward Dunstan 60.00 X X 184683 0 28196 Venkataraman Munusamy 60.00 X X 193511 0 30526 Marie Vienneau 40.00 X 200625 0 35075 Christine McLaughlin 40.00 X 102806 0 26721 Daniel Herbert MD 60.00 X 261702 0 25707 Kwaku Owusu-Abrokwa MD 60.00 X 187948 0 16640 Nilesh Patil 60.00 X 442712 0 25528 Jason Campbell 60.00 X 262277 0 28994 Joseph Aquilina 48.00 X 178238 0 23766 2446659 0 275191 19 0 1 0 Katahdin Shared Services Inc 200 Somerset Street Millinocket ME 04462 Ultrasound Services 437173 NEHE-MRI LLC PO Box 6600 Newport CA 92658 MRI Radiology 373603 CPSI PO Box 850309 Mobile AL 36685 Computer Services 336797 Eastern Maine Medical Center 489 State Street Bangor ME 04401 Professional Services 216428 Quest Diagnostics Incorporated 5763 Collection Center Dr Chicago IL 60693 Referral Testing 138812 10 155387 26292 181679 Ancillary Services 621400 42056069 42056069 Routine Services 621400 2475640 2475640 Miscellaneous Income 621400 417849 383086 34763 Provision for Bad Debts 621400 -1489878 -1489878 Contractual/Char. Adj. 621400 -16347432 -16347432 27112248 222217 222217 36000 19525 16475 16475 16475 3497997 31719 3160972 0 337025 31719 368744 368744 Gain on Investment of Affiliate 531120 56238 56238 56238 27957601 27077485 0 698437 X 2301 2301 1268338 903111 365227 12596771 12000855 595916 343177 331327 11850 2311473 2228942 82531 889537 831188 58349 46158 46158 18487 18487 41601 41601 3019465 2644817 374648 41036 41036 379889 299306 80583 583256 566598 16658 46259 27636 18623 258396 258396 870933 870933 281158 281158 Medical Supplies 3902249 3820647 81602 Medicaid Tax 661384 661384 Dues & Subscriptions 56236 56236 Miscellaneous Expenses 22596 16943 5653 27640700 25801778 1838922 0 930 930 2658392 2167161 2609103 3071470 70941 14553 404073 421206 476887 298287 19085714 12509092 6712945 6576622 8681763 9378479 1600469 1464160 28820 15439 178802 180607 23423125 23588914 2860539 3023961 1443780 1238611 4645471 4284251 8949790 8546823 X 14365302 14928633 103033 108458 5000 5000 14473335 15042091 23423125 23588914 316901 251855 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 8088 8088 0 Explanation of Lobbying Activities: Part II-B, Line 1: The Organization pays dues to various organizations, a portion of which are attributable to lobbying expenses. 49951 49951 9109535 5565037 3544498 9283781 6435619 2848162 642447 508436 134011 6576622 Investment in First Millinocket Regional Investment Corp 1416833 C Investment in Katahdin Shared Services 47327 C 1464160 1 1 1 X 1 X 1 1 1 0 0 1187317 1187317 0.04300 2901021 249720 2651301 0.09590 4088338 249720 3838618 0.13890 1421550 781906 639644 0.02310 2301 2301 0.00010 1423851 781906 641945 0.02320 5512189 1031626 4480563 0.16210 1 640441 11917747 11818699 99048 X 1 0 1 1 Millinocket Regional Hospital

200 Somerset Street Millinocket ME 04462

X X X Millinocket Regional Hospital 1 1 X X X X X X X X 11 1 1 1 X X 1 0 1 1 150.000000000000 1 400.000000000000 1 X 1 1 X X X X X 1 0 X X X X 1 X 0 0 Part I, Line 3c: Income guidelines as set by Hospital Finance Rules will be used in determining eligibility. Percentage of balance discounted will be determined based on patient's income level relative to the Federal Poverty Level guidelines. These guidelines are updated annually by the Financial Counselor.Up to 150% FPL 100% Balance Discounted151% to 200% FPL 50% Balance Discounted201% to 250% FPL 25% Balance Discounted251% to 300% FPL 10% Balance Discounted301% to 400% FPL 5% Balance Discounted Part I, Line 7: Expenses calculated on Lines 7a & 7b were calculated using a cost-to-charge ratio while actual expenses were used in calculating the amount reported on line 7i. Part I, Line 7g: Subsidized health services include laboratory and physician services. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding, after management has used reasonable collection efforts, are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for each major payor source of revenue for the purposes of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established at varying levels based on the age of the receivables and payor source. For receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Part III, Line 8: The Organization used accounting methodology prescribed by the Medicare cost report as its costing methodology to determine the amount of Medicare allowable costs. Millinocket Regional Hospital Part V, Section B, Line 3: The OneMaine Health Collaborative, which was formed by EMHS/Maine General Health and Maine Health, contracted with the University of New England's Center for Community and Public Health (CCPH) to conduct a Statewide Community health needs Assessment (CHNA). The assessment conducted in collaboration with the University of Southern Maine and Market Decisions, Inc, was designed to identify the most important health issues in the state, both overall and by county, using scientifically valid health indicators and comparative information. The assessment also identifies priority health issues where better integration of public health and healthcare can improve access, quality, and cost effectiveness of services to residents of Maine. OneMaine shared this information with its fellow stakeholders so it can lead to improved health status and quality of care available to Maine residents, while building upon and strengthening Maine's existing infrastructure of services and providers.The four objectives of the OneMaine Community Health Needs Assessment were:1. Develop a comprehensive profile of health status, quality of care and care management indicators for residents of Maine overall and for residents by county.2. Identify a set of priority health needs (public health and health care) for follow-up.3. Provide recommendations on strategies that can be undertaken by healthcare providers, public health staff, communities, policy makers and others to follow-up on the information provided with actions that may improve the health status of Maine people. 4. Provide access to the CHNA data and assistance to stakeholders who are interested in using it.The methodology for the CHNA was a modified version of CCPH's Community and Institutional Assessment Process (CIAP). The CIAP is a comprehensive planning process that identifies salient healthcare related issues in the community through a systematic analysis of scientifically derived health indicators and comparative and best practice information. Indicators are computed from an extensive set of health-related data and a community household telephone survey.The CIAP starts with a comprehensive epidemiological-based health profile organized by health domain or condition such as cardiovascular health, respiratory health, cancer health, etc. Indicators for most domains are further organized by risk factors, prevalence or incidence of disease or condition, care management indicators and care outcomes. The analysis of indicators within each domain provides information to identify, and subsequently explore, which aspects of the healthcare delivery system may be over-or under-performing for that particular domain (e.g. primary prevention, secondary prevention, etc.)Community health needs assessments are designed, in part, to identify issues where changes in the healthcare delivery system can improve both patient care and preventive services for those at risk for health problems. Findings and recommendations:1. Maine has several underlying socio-demographic characteristics that impact many of the health indicators, for example, Maine has the oldest population in the U.S., a very high proportion of elderly (65+) compared to the U.S. Being older does not equate to poor health, the reality is that aging populations use more health services than younger populations.2. Maine has a lower median income than the U.S. but the proportion of Maine residents living below the Federal poverty line is slightly lower than the rest of the country. However, in Northern Maine the proportions of residents live below the Federal poverty line than the state as a whole or the U.S.3. Unemployment is an important demographic predictor of health and compared to the rest of the U.S., Maine has a lower unemployment rate, but several Maine counties individually have high rates of unemployment, many well over 10%.On May 26, 2011, Eastern Maine Health Systems (EMHS) presented the OneMaine Health Collaborative Community Health Needs Assessment to community leaders, which was hosted by Millinocket Regional Hospital and Penobscot Valley Hospital.Access to Health Care and ED UtilizationMRH received Rural Health Clinic status to stabilize primary care reimbursement. MRH has recruited a mid-level provider and is in the process of recruiting a part time family practitioner. MRH provided a sliding fee and charity care in practices to mirror the hospital to encourage access. The RHCs are seeking Patient Centered medical Home status which will encourage expanded coverage hours. Currently participating in MaineCare ED utilization project and implemented follow-up call on ED visits to question if primary care was sought.Obesity & Chronic Disease ManagementMRH employs a Wellness Coordinator and has a worksite wellness program. MRH incentivizes employee health and wellness via health plan. MRH subsidizes and runs only fitness facility north of Bangor. MRH supports and employ staff for healthy Maine Partnership. Physicians do community talks on nutrition. MRH hired a primary care Case Manager whose focus is on diabetes, heart disease, HTN, and COPD. MRH maintains a Cardiac Rehab, Diabetes Self-Management Training, and ADEF program.Behavioral HealthcareMRH has an ongoing relationship with CHCS Crisis Services for crisis evaluation. MRH developed Tele-Psychiatry Program with Acadia Hospital for emergent psychiatric assessment. MRH is developing plans to integrate Behavioral healthcare into primary care as part of Patient Centered Medical Home Project. MRH petitioned CMS to allow reimbursement of telemedicine in Metropolitan Statistical Areas to allow further expansion of Tele-Psychiatry. Millinocket Regional Hospital Part V, Section B, Line 4: Statewide community health needs assessment "OneMaine Health Collaborative" sponsored by Eastern Maine Health System, MaineGeneral Health, and MaineHealth. Millinocket Regional Hospital Part V, Section B, Line 20d: The Hospital billed amounts to individuals who did not have insurance at cost and applied a 10% discount to private pay patients. Part VI, Line 2: A formal community needs assessment is done every 2-3 years. These assessments are conducted to obtain information on successes, failures, weaknesses and strengths to be used for guidance in the vision for the future of healthcare delivery in our service areas. Part VI, Line 3: Inpatients: In order to identify those patients who would be eligible for financial assistance, all uninsured inpatients are referred to the Financial Counselor by pre-registration or registration personnel. The Financial Counselor will do an initial screening for payment options prior to the patient leaving the hospital, if possible. If the patient has left the hospital, the Financial Counselor will attempt to contact the patient for information. All inpatients are given a copy of Patient Free Care and Discount Arrangements guidelines at time of admission.Surgical outpatients: The Financial Counselor will provide information about Patient Free Care, Discount Arrangements and term payment arrangements to all uninsured surgical outpatients. All surgical outpatients are provided a copy of Patient Free Care and Discount Arrangements guidelines at time of registration. Emergency room patients: All emergency room patients are provided a copy of Patient Free Care and Discount Arrangements guidelines at time of registration. All other outpatients: All other outpatients are provided a copy of the Patient Free Care/Discount Arrangements guidelines at time of registration. All patients will receive notice of availability of financial assistance included in their first-time statement. Patient Financial Services employees and Physician Practice employees receive training on patient free care and discount arrangements guidelines and are expected to be able to provide contact information about free care and discount arrangements. Part VI, Line 4: Millinocket Regional Hospital has three communities in its primary service area, Millinocket, East Millinocket and Medway. There are multiple smaller communities in the secondary service area including, Brownville, Stacyville, Sherman, Patten and Island Falls. The area has struggled and realized an unemployment rate in the teens for the past ten years and community outmigration. The population of the primary service area is approximately 7500 people. The hospital has realized this population change by large volume declines in 2013. The average median household income is 22% behind the state average. The average resident age is 14% older than the state median age. X X X X X 0 0 0 0 0 0 0 0 0 Mark Kowalski 432157 0 0 0 0 0 10950 0 23088 0 466195 0 0 0 Edward Dunstan 184683 0 0 0 0 0 5336 0 22860 0 212879 0 0 0 Venkataraman Munusamy 193511 0 0 0 0 0 7929 0 22597 0 224037 0 0 0 Marie Vienneau 200625 0 0 0 0 0 8681 0 26394 0 235700 0 0 0 Daniel Herbert MD 229602 0 32100 0 0 0 9497 0 16210 0 287409 0 0 0 Kwaku Owusu-Abrokwa MD 187948 0 0 0 0 0 7673 0 8967 0 204588 0 0 0 Nilesh Patil 442712 0 0 0 0 0 2450 0 23078 0 468240 0 0 0 Jason Campbell 262277 0 0 0 0 0 6134 0 22860 0 291271 0 0 0 Joseph Aquilina 178238 0 0 0 0 0 7475 0 16291 0 202004 0 0 0 A Maine Health and Higher Educational Facilities Authority 010314384 560427WV4 2013-05-23 1423837 Refinancing of 2003 D bond issue 0 0 1 A 185226 1423837 15439 2013 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 Julie Brown Family Member of Ronald Brown, member of Board of Directors 37392 Employment 0 Rose Ann Hunt Family Member of Patrick Hunt, member of Board of Directors 125564 Employment 0 Dale McLaughlin Family Member of Christine McLaughlin, CFO of Organization 94640 Employment 0 Ona McAvoy Family Member of Mellissa Edwards, Board President 67622 Employment 0 Cynthia Morneault Family Member of Joyce Given, member of Board of Directors 28866 Employment 0 Form 990, Part VI, Section B, line 11 Prior to the document's filing, the Organization's finance department reviews the inital draft. After any necessary changes, the Organization's board members are presented with a copy. The finalized document is subject to the board's approval. Form 990, Part VI, Section B, line 12c Each board member is required to sign a conflict of interest disclosure form on an annual basis. In connection with any actual or possible conflicts of interest, an interested individual must disclose the existence of his or her conflict annually and whenever the conflict arises for action at a meeting. After receiving all annual attestations, the CEO will provide the signed statements to the Hospital's attorney for review. After review, the attorney will determine if a conflict exists and inform the CEO and Board chair of the conflicted individuals. There is a listing of Board, Medical Staff and Manager conflicts available at all meetings for reference. The Agenda for every Board, Medical Staff or Department meeting will clearly list the discussion items that require action during the meeting. At the beginning of the meeting, the President will ask the members to review the list of action items and declare whether or not they have a conflict. All conflicted members will be required to excuse themselves and leave the room during the discussion and vote. If the board or committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. Form 990, Part VI, Section B, line 15 The Organization works with an independent compensation consultant to determine appropriate compensation levels. The Organization's executive committee reviews data used to determine compensation for its respective members. Any compensation related changes must be approved by the board of directors or the executive board. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Other Fees Form 990, Part IX, line 11g Purchased Services: Program service expenses 1,820,832. Management and general expenses 374,648. Fundraising expenses 0. Total expenses 2,195,480. Service Contracts: Program service expenses 366,891. Management and general expenses 0. Fundraising expenses 0. Total expenses 366,891. Professional Services: Program service expenses 438,935. Management and general expenses 0. Fundraising expenses 0. Total expenses 438,935. Outside Services: Program service expenses 18,159. Management and general expenses 0. Fundraising expenses 0. Total expenses 18,159. First Millinocket Regional Investment Corp 200 Somerset Street Millinocket ME 04462 010396196 Physician Program Operations ME Millinocket Regional Hospital C 273301 1418343 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 First Millinocket Regional Investment Corp K 173660 FMV First Millinocket Regional Investment Corp Q 173660 FMV