2014-08-13T10:00:12-05:00 2013-09-30 010494526 BAKER NEWMAN & NOYES BOX 507 PORTLAND ME 04112 990 2012-10-01 010215911 Mid Coast Hospital MIDC 2077290181 123 Medical Center Drive Brunswick ME 04011 Lois N Skillings 2077290181 2014-08-13 1 Nicholas E Porto P01310283 2078792100 2012 2015-11-30 17:44:51Z Lois N Skillings 123 Medical Center Drive Brunswick ME 04011 140295912 0 X www.midcoasthealth.com X 1991 ME Acute and specialty care hospital 20 17 1285 500 0 0 1612976 2256197 123422722 132145006 1097814 2078490 27124 14883 126160636 136494576 21643 9588 0 0 66643916 70398524 0 0 0 56416545 60220079 123082104 130628191 3078532 5866385 147788861 160736113 50646641 56420671 97142220 104315442 X To provide quality health care and health-related services directed toward continually improving the health and wellbeing of the patients and communities we serve. We will provide compassionate, humanistic, accessible, personal, professional, efficient, cost-effective and quality services. 0 0 112593633 9588 132159889 Acute and specialty health care services were provided to residents of the Mid-Coast Maine area. Charity care was provided to those patients who did not have the ability to pay for medical services. 112593633 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 126 0 1 1285 1 0 0 0 0 0 1 1 0 0 0 0 X 20 17 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X Michael Perry 2073736000 123 Medical Center Drive Brunswick ME 04011 X Lenora Burke 0.30 X 0 0 0 Charles Frizzle 0.30 X 0 0 0 William S Gardiner 0.30 X 0 0 0 Donald Gerrish 0.30 X 0 0 0 Susan Gillies 0.30 X 0 0 0 Jill Haer 0.30 X 0 0 0 Patrice Hennin 0.30 X 0 0 0 Connie Jones 0.30 X 0 0 0 Steven Levesque 0.30 X 0 0 0 Lloyd Van Lunen MD 0.30 X 0 0 0 Anne Marsh 0.30 X 0 0 0 Daniel Morgenstern MD part year 0.30 X 0 0 0 Douglas Niven 0.30 X 0 0 0 Abigail Manny part year 0.30 X X 0 0 0 Ellen Hutchinson 0.30 X X 0 0 0 James Mullen MD 0.30 X X 17448 0 0 James Rines MD 41.80 X X 170879 0 29179 Ervin Snyder 0.30 X X 0 0 0 Dean Patterson 0.30 X X 0 0 0 Glenn L Hutchinson 0.30 X X 0 0 0 Charles Bridge 0.30 X X 0 0 0 Lois N Skillings 30.50 9.50 X X 0 354884 70580 Robert McCue 30.50 9.50 X 0 254844 57286 Jonathan Telsey MD 41.50 X 462454 0 35080 Robert Livingston MD 41.50 X 438250 0 24739 R Scott Schafer MD 41.50 X 316850 0 35800 Paul Burns MD 41.50 X 323785 0 30931 John Van Orden MD 41.50 X 305623 0 27670 2035289 609728 311265 70 0 1 0 Coastal Maine Emergency Physicians PO Box 270 South Freeport ME 04078 ER Facility Coverage 1096452 Midcoast Pediatrics 121 Medical Center Drive Suite 260 Brunswick ME 04011 Physician Coverage 712280 Mid Coast Anesthesia PA 121 Medical Center Drive Box 6 Brunswick ME 04011 Anesthesiology Services 488477 Spectrum Medical Group PO Box 590 Portland ME 04112 Physician Coverage 418231 CompHealth Med Staff PO Box 972670 Dallas TX 753972670 Physician Coverage 405677 25 15640 1528378 712179 33178 2256197 Net Patient Service Revenue 621400 127454468 127454468 Miscellaneous Revenue 621400 2843210 2843210 Electronic Health Records Revenue 621400 1847328 1847328 132145006 1287261 1287261 14883 0 14883 14883 14883 4564130 15538 3782395 6044 781735 9494 791229 791229 12897 15640 12897 0 136494576 132159889 0 2078490 9588 9588 242011 233028 8983 58223900 51334045 6889855 981882 789011 192871 8094141 6504210 1589931 2856590 2295470 561120 75904 75904 61100 61100 12406047 9969134 2436913 401285 322461 78824 8856436 7116771 1739665 5472155 4397262 1074893 53425 42931 10494 1706926 1371635 335291 5359816 4306990 1052826 1672656 1344097 328559 Patient and Non Patient 8560592 8317480 243112 Provision for Bad Debts 6431743 6431743 Pharmacy Expenses 5988807 4812429 1176378 Revenue Tax 2267831 2267831 905356 727517 177839 130628191 112593633 18034558 0 3161304 5581029 13507857 25668602 11940926 16023706 2026841 2149927 2456698 2589367 107833835 54022423 56037286 53811412 37940259 42832550 327155 309958 20390535 11769562 147788861 160736113 13125853 12470072 31789380 31460200 5731408 12490399 50646641 56420671 X 80970585 86576067 8569246 9960251 7602389 7779124 97142220 104315442 147788861 160736113 X 5866385 1317692 -10855 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 17599 0 0 0 17599 0 Explanation of Lobbying Activities: Part II-B, Line 1: Mid Coast Hospital paid dues to Maine Hospital Association totaling $46,628, of which 18.8% ($8,766) was available for lobbying; dues to American Hospital Association totaling $24,155 of which 23.65% ($5,713) was available for lobbying; dues to Maine Medical Association of $20,800, 15% ($3,120) of which was available for lobbying. 21128741 176735 1220014 232306 22293184 20613770 71499 611529 168057 21128741 19263606 89457 1420387 159680 20613770 18850981 85217 500960 173552 19263606 18696946 61289 360571 267825 18850981 0.38690 0.34830 0.26480 0 0 329281 329281 56184251 16259452 39924799 4417135 1972656 2444479 46903168 35790315 11112853 53811412 Construction in Progress 561836 L-T Asset (Deferred Comp Plan) 7083248 Due from Affiliates 3291830 Other Assets 832648 11769562 Deferred Compensation Plan 7083248 Estimated Third-Party Payor Settlements 5407151 12490399 X 137825165 1317692 12897 1330589 136494576 0 136494576 130651943 23752 23752 130628191 0 130628191 Description of Intended Use of Endowment Funds: Part V, Line 4: Endowment funds are invested and used in a manner that provides predictable streams of funding to the programs supported by the endowed funds, all while seeking to maintain the purchasing power of the endowment assets. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Hospital is a not-for-profit corporation and is tax-exempt under Section 501(c)(3) of the Internal Revenue Code. 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 Hospital has evaluated the position taken on its filed tax returns. The Hospital has concluded no uncertain income tax positions exist at September 30, 2013. The Hospital's tax years from 2010 through 2013 are open and subject to examination. Part XI, Line 2d - Other Adjustments: Fundraiser Expenses 12,897. Part XII, Line 2d - Other Adjustments: Fundraiser Expenses 12,897. Equity Transfer to Affiliates 10,855. Golf Tournament 28537 15640 12897 871 7620 4406 28537 15640 12897 871 7620 4406 12897 0 1 1 1 X 1 X 1 1 1 0 0 5039222 839967 4199255 0.03380 11825972 10865531 960441 0.00770 16865194 11705498 5159696 0.04150 703444 32534 670910 0.00540 27222756 21082415 6140341 0.04940 27926200 21114949 6811251 0.05480 44791394 32820447 11970947 0.09630 1 3240612 27611099 32015330 -4404231 X 1 1 1 1 Mid Coast Hospital

123 Medical Center Drive Brunswick ME 04011

www.midcoasthealth.com X X X Mid Coast Hospital 1 1 X X X X X X X X X 10 1 0 1 X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X X X 1 0 1 X 0 0 10 Mid Coast Hospital

121 Medical Center Drive Brunswick ME 04011

General Medical & Surgical Mid Coast Hospital

81 Medical Center Drive Brunswick ME 04011

General Medical & Surgical Mid Coast Hospital

11 Medical Center Drive Brunswick ME 04011

General Medical & Surgical Mid Coast Hospital

310 Bath Road Brunswick ME 04011

General Medical & Surgical Mid Coast Hospital

430 Bath Road Brunswick ME 04011

General Medical & Surgical Mid Coast Hospital

66 Baribeau Drive Brunswick ME 04011

General Medical & Surgical Mid Coast Hospital

30 So Bristol Road Damariscotta ME 04543

General Medical & Surgical Mid Coast Hospital

1356A Washington Avenue Bath ME 04530

General Medical & Surgical Mid Coast Hospital - Mid Coast Med Group

1 Bowdoin Mill Island Topsham ME 04086

General Medical & Surgical Mid Coast Hospital

22 Maine Street Station Brunswick ME 04011

General Medical & Surgical Part I, Line 7: Based on the IRS Form 990, Schedule H, a worksheet was provided to determine the overall cost to charge ratio that could be used to apply throughout Schedule H of Form 990. Where applicable, the Organization utilized this worksheet to convert charges to costs. The Organization did not use the Worksheet 2 percentage for the IRS Form 990, Schedule H, Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs, or Worksheet 6, Subsidized Health Services, for the Medicaid allowable costs. Instead, the Organization utilized the actual Medicaid filed cost report for the Medicaid allowable costs. Additionally, the Organization used the modified Medicare allowable costs and payments related to these services in regards to the cardiopulmonary community program and psychiatric unit. For our provider based clinics, in this same section we used the actual costs for each clinic. In addition, for its addiction resource center and access health service, the Organization used the estimated costs calculated based on actual clinic costs estimated from reporting on these centers to the State of Maine. Part I, Line 7g: Mid Coast Hospital has clinical services and hospital-owned physician practices. Mid Coast Hospital has included these practices in this section of the 990, Schedule H of subsidized health services if they are operating at a loss. The Hospital has included the following clinical services and hospital-owned physician practices that operate at a loss and the corresponding costs of these practices: primary care practice, OB/GYN practice, pulmonary practice, urology practice, primary care clinics, walk-in clinic, nephrology practice, orthopedics practice, gastroenterology practice, diabetes & endocrinology practice, general surgery practice, rheumatology practice, psychiatric department, cardiopulmonary community program, addiction resource center, access health service, and chemical dependency services. The above listed hospital clinical services and hospital-owned physician practices have a community benefit of approximately $6.1 million. In addition, the community benefit does not take into account bad debts, charity care, and contractual adjustments. Thus, this community benefit of approximately $6.1 million is a conservative number that reconciles to the community benefit on the IRS Form 990, Schedule H. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 6431743. Part II: N/A Part III, Line 4: Payments for services rendered to individuals from whom payment is expected and ultimately not received are written off and included as part of the provision for bad debts.In accordance with generally accepted accounting principles, the allowance for doubtful accounts and bad debt expense is provided based on an analysis by management of the collectibility of outstanding balances. Management considers the age of outstanding balances and past collection efforts in determining the allowance for doubtful accounts and bad debt expense. Accounts deemed uncollectible are charged off against the established allowance. Part III, Line 8: The Hospital believes all of the clinical areas included in the Form 990, Schedule H should be and are considered a community benefit. Mid Coast Hospital believes that by offering and thus subsidizing these clinical services within the community, the community benefits by having easy access to these services. If these services were not available from Mid Coast Hospital there would be a greater burden on the community and many, if not all, of these services would not be available with such easy access. Based on the IRS Form 990, Schedule H, a worksheet was provided to assist in determining the overall cost-to-charge ratio that could be used to apply throughout the Schedule H of the Form 990 in order to convert charges to costs. Where applicable, we have utilized this worksheet to convert charges to costs. We did not use this worksheet percentage on the calculation of Medicare costs in this section. We used the Medicare allowable costs and payments related to the subsidized health service and we used the Medicare cost report estimated cost and payment for these services. Part III, Line 9b: The Hospital currently starts with gross charges for all patient billing. Federal poverty guidelines are utilized in the determination of charity care eligibility. Patients who are unable to pay and have exhausted all sources of payment may qualify for charity care. Those patients that qualify and have income levels below 200% of the federal poverty guidelines can receive 100% charity care. A sliding scale is used for patients with income levels between 200% and 400% of the federal poverty guidelines. The amount considered for charity will be based upon the evaluation of the patients' ability to pay. Patients who qualify for partial financial assistance are responsible for any remaining balance after the charity care adjustment and third party payments. Once an account has been processed through an internal routine collection process, it may be assigned to an attorney/agency for collection. Mid Coast Hospital Part V, Section B, Line 3: Mid Coast Hospital, engaged in an assessment of the health needs of the mid coast community and this was the most comprehensive health needs assessment ever performed in our community. All told, over 1,000 community members attended one of many focus groups to discuss the current and future health needs in our region. In the process of developing priorities and a plan for how to operate over the next decade, Mid Coast Health Services listened and learned from the community - patients and families, faith community, municipal leaders, legislators, experts in public health, local businesses, employees, medical staff, hospital volunteers, auxiliary, Board members, and Corporators for guidance. Mid Coast Hospital Part V, Section B, Line 20d: The Hospital currently starts with gross charges for all patient billing. Federal poverty guidelines are utilized in the determination of charity care eligibility. Patients who are unable to pay and have exhausted all sources of payment may qualify for charity care. Those patients that qualify and have income levels below 200% of the federal poverty guidelines can receive 100% charity care. A sliding scale is used for patients with income levels between 200% and 400% of the federal poverty guidelines. The amount considered for charity will be based upon the evaluation of the patients' ability to pay. Patients who qualify for partial financial assistance are responsible for any remaining balance after the charity care adjustment and third party payments. Once an account has been processed through an internal routine collection process, it may be assigned to an attorney/agency for collection. Part VI, Line 2: Mid Coast Hospital assesses the health care needs of the community on an ongoing basis. Mid Coast Hospital's strategic plan is a road map as to where and how to deliver services to the surrounding communities. This process of how to provide these services included listening and learning to/from the community - patients and families, faith community, municipal leaders, legislatures and local businesses. Mid Coast also looked inward, calling upon board members, corporators, medical staff, volunteers, auxiliary, and employees since they are all part of the community Mid Coast Hospital serves. Part VI, Line 3: Mid Coast Hospital will notify patients about access to various financial assistance needs in different ways. We have postings in various departments as well has handouts informing patients how to access these programs if a need for financial assistance is required. There are signs and pamphlets in the Hospital settings indicating the poverty guidelines and how to obtain assistance to obtain free or discounted care. All of our patients can speak to one of the Hospital's employees on how to obtain financial assistance; and, if there is assistance needed, the employee will inform our patient financial services department who will then work with the patient to either help them apply for MaineCare or discuss options for free or discounted care. Part VI, Line 4: Mid Coast Hospital's primary service area includes the following communities in the Mid Coast Maine: Arrowsic, Bailey Island, Bath, Bowdoin, Bowdoinham, Brunswick, Dresden, Durham, Freeport, Georgetown, Harpswell, Lisbon, Litchfield, North Yarmouth, Perkins Township, Phippsburg, Pownal, Richmond, Sabattus, Topsham, West Bath, Westport, Wiscasset, Woolwich, Yarmouth. Approximately 13% of Mid Coast Hospital patients utilize Medicaid and 42% of Mid Coast Hospital patients utilize Medicare. The population of the communities supported by Mid Coast Hospital with income under 200% of the poverty guidelines is about 21%. Part VI, Line 5: Mid Coast Hospital is a local, not-for-profit, community hospital that serves the local communities and the people regardless of their ability to pay. The members on the board of directors and corporators are all members of the communities that Mid Coast Hospital serves. All Hospital net income gains are reinvested into the facilities, equipment and services for the community. Part VI, Line 6: Mid Coast Hospital has a clinical affiliation with Maine Health to provide the best patient care to all of the communities that Mid Coast Hospital and Maine Health serves. 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: During the tax year, the Organization only granted funds to local municipal school systems, further monitoring is not deemed necessary. 0 1 0 0 0 0 0 0 0 James Rines MD 170879 0 0 0 0 0 17896 0 11283 0 200058 0 0 0 Lois N Skillings 0 354884 0 0 0 0 0 60000 0 10580 0 425464 0 0 Robert McCue 0 254844 0 0 0 0 0 46638 0 10648 0 312130 0 0 Jonathan Telsey MD 462454 0 0 0 0 0 24500 0 10580 0 497534 0 0 0 Robert Livingston MD 438250 0 0 0 0 0 20371 0 4368 0 462989 0 0 0 R Scott Schafer MD 316850 0 0 0 0 0 24500 0 11300 0 352650 0 0 0 Paul Burns MD 323785 0 0 0 0 0 24500 0 6431 0 354716 0 0 0 John Van Orden MD 305623 0 0 0 0 0 21339 0 6331 0 333293 0 0 0 Part I, Line 3 Mid Coast Hospital's CEO, Lois Skillings, and CFO, Robert McCue, are compensated by a related organization, Mid Coast Health Management Corp & Sub (MCHMC). MCHMC uses an independent compensation consultant, compensation survey or study, and approval by the board or compensation committee to establish their annual compensation. Part I, Line 4b The Hospital has a deferred compensation arrangement under a nonqualified defined contribution plan to provide supplemental retirement benefits to certain employees. Lois Skillings and Robert McCue, who are officers of the Organization, participated in this plan and received $52,500 and $39,138, respectively. A Maine Health and Higher Ed Fac Auth (MHHEFA) 010314384 560425L40 2007-07-18 97716087 Refinance Series 1998B Revenue Bond 0 0 0 B Maine Health and Higher Ed Fac Auth (MHHEFA) 010314384 560425362 2008-12-03 41658395 Hospital Facility Expansion Project 0 0 0 A 28930803 1984500 26651099 290758 4446 2002 1 1 1 1 B 12393996 892731 138784 11362143 338 2009 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 1 Trans America 20.000000000000 1 0 0 B 0 0 0 1 0 0 0 0 0 A 0 B 0 Schedule K Part IV, Arbitrage, Line 2c Date Rebate Computation Performed Issuer Name: Maine Health and Higher Ed Fac Auth (MHHEFA) Date the Rebate Computation was Performed: 07/18/2012 Issuer Name: Maine Health and Higher Ed Fac Auth (MHHEFA) Date the Rebate Computation was Performed: 12/03/2013 Schedule K, Part III, Line 9, Part IV, line 7 and Part V: At the time of this filing, the Hospital does not have written procedures to ensure that violations of federal tax requirements are timely identified and corrected. However, the Hospital does have a policy in place to accomplish these purposes. On an annual basis, the Hospital's controller and CFO review bond documents and bond covenants to ensure the Hospital is in full compliance. Currently, the Hospital is considering having these procedures in a formal, written policy going forward. Lois Skillings Member of board of directors of Medical Mutual Insurance Company 1437718 The amount paid to Medical Mutual and identified in this section is for malpractice insurance coverage for the Hospital. Ms. Skillings serves on the board of directors for Medical Mutual and is the CEO of Mid Coast Hospital. Ms. Skillings was paid a nominal fee to serve on Medical Mutual's board of directors.The amount included in column c represents the total amount paid to Medical Mutual. The amounts paid during the time specifically relating to Ms. Skillings's tenure on the board are not easily determinable. 0 X 1 33178 Market Value 0 1 1 Third Party Use: Part I, Line 32b: The Organization sells contributions of securities through its investment broker. All gifts of securities are sold as soon as administratively possible. Form 990, Part VI, Section A, line 2 Board of Directors members Glenn Hutchinson and Ellen Hutchinson have a family relationship. Form 990, Part VI, Section A, line 6 Mid Coast Health Services (MCHS) shall be the Organization's sole member with all rights and responsibilities of membership, including all voting rights. Form 990, Part VI, Section A, line 7a At each annual meeting of the sole member, the sole member shall elect directors to hold office until the election and qualification of their respective successors. The directors shall be persons who have demonstrated an interest in the Organization's goals and objectives and, to the extent reasonably feasible, shall represent the Mid-Coast area. To the extent feasible, fifty percent of all directors serving on the Organization's board of directors shall be persons who also serve on the board of directors of MCHS. Form 990, Part VI, Section A, line 7b The business and affairs of the Organization shall be conducted and managed by its board of directors which shall exercise all of the powers of the Organization. The board of directors shall approve an annual operating budget, develop a long-term capital expenditure plan and, through its own committees or the committees of its sole member, monitor the implementation of the plan. Notwithstanding the foregoing, the directors shall not submit any application for a certificate of need to the Maine Department of Health and Human Services, or incur any long-term debt without the approval of MCHS as the sole member. The board of directors may delegate such powers as it sees fit to committees and officers of the Organization. Form 990, Part VI, Section B, line 11 A draft of the return is reviewed by an officer of the Hospital prior to it being filed with the IRS. Form 990, Part VI, Section B, line 12c The Hospital has a compliance committee that meets on a quarterly basis to review any compliance issues that may arise. Form 990, Part VI, Section B, line 15 An independent consultant prepares a market analysis at the regional level for all officers and key employees of the Organization. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy and audited financial statements available to the public upon request. Form 990, Part VII, Section A: Dr. James Rines receives compensation for his services to the Organization in his capacity as a physician. His salary and benefit amounts disclosed in Part VII do not reflect payments made to him for his services as a member of the board. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Equity Transfer to Affiliates -10,855. Oversight of Audit: Form 990, Part XI, Line 2c The audit process has not changed from the prior year. Mid Coast Health Services 123 Medical Center Drive Brunswick ME 04011 010430069 Health Services ME 501(c)(3) 7 N/A 0 Mid Coast Geriatric Services Corporation 123 Medical Center Drive Brunswick ME 04011 010496221 Geriatric Services ME 501(c)(3) 9 Mid Coast Health Services 0 Community Health and Nursing Services 60 Baribeau Drive Brunswick ME 04011 010211546 Hospice Services ME 501(c)(3) 9 Mid Coast Health Services 0 Mid Coast Medical Group 123 Medical Center Drive Brunswick ME 04011 010484592 Medical Services ME Mid Coast Health Services C 0 Midcoast Health Management Corporation 123 Medical Center Drive Brunswick ME 04011 010429598 Management of Health Services ME Mid Coast Health Services C 0 Thornton Oaks Development Corporation 123 Medical Center Drive Brunswick ME 04011 010448411 Management of Health Services ME Mid Coast Health Services C 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 0