2013-05-14T14:43:04-05:00 2012-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2011-07-01 010215227 RUMFORD HOSPITAL % PHIL MORISSETTE RUMF 2077952972 420 FRANKLIN STREET RUMFORD ME 04276 R DAVID FRUM 2013-04-23 true Brian D Todd 4178658701 2011 2016-03-07 17:11:31Z R DAVID FRUM 420 FRANKLIN STREET RUMFORD ME 04276 38302053 false X WWW.RUMFORDHOSPITAL.ORG X 1974 ME RUMFORD HOSPITAL STRIVES TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES. THE HOSPITAL DEPENDS ON THE EXPERTISE OF ITS CAREGIVERS IN ADDITION TO THE COMMITMENT AND COMPASSION THEY PROVIDE TO FULFILL ITS MISSION. 8 7 346 50 0 0 146601 125819 39320253 37475529 155516 116143 -101119 -38948 39521251 37678543 17000 10000 0 0 16060506 16722232 0 0 0 18789164 21181377 34866670 37913609 4654581 -235066 23384186 26151909 4293450 7453217 19090736 18698692 TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES IN A SAFE AND TRUSTFUL ENVIRONMENT THROUGH THE EXPERTISE, COMMITMENT AND COMPASSION OF OUR FAMILY OF CAREGIVERS. false false 30271800 37475529 RUMFORD HOSPITAL IS A CRITICAL ACCESS HOSPITAL, PROVIDING COMPREHENSIVE PRIMARY CARE AND SOPHISTICATED DIAGNOSTIC SERVICES, INCLUDING CT SCANNING, ULTRASOUND AND NUCLEAR MEDICINE. THE HOSPITAL OFFERS MEDICAL SURGICAL NURSING SERVICES, A BIRTHING CENTER, WOMEN'S HEALTH SERVICES AND AMBULATORY SURGERY. THE SWING BED PROGRAM PROVIDES CARE FOR PATIENTS WHO NEED SKILLED NURSING SERVICES. RUMFORD HOSPITAL ALSO MAINTAINS A 24 HOUR EMERGENCY DEPARTMENT AND STAFFS AN INTENSIVE CARE UNIT. 30271800 true true false true false false false false false true true false false true false false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false false true 44 0 true 346 true false false false false false false false false false false X 8 7 true 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 1.0 X X 0 811982 439996 STUART R COOPER 1.0 X 0 0 0 JOLAN IPPOLITO 1.0 X X 0 0 0 ROGER ARSENAULT 1.0 X 0 0 0 RICHARD LOVEJOY 1.0 X X 0 0 0 JOSEPH A POIRIER 1.0 X 0 0 0 ROBERT STICKNEY 1.0 X X 0 0 0 LINDA CAMERON OD 1.0 X 0 0 0 DAVID DUGUAY 1.0 X 0 0 0 R DAVID FRUM 27.5 X 0 279318 43650 JOHN KROGER MD 55.0 X 253182 0 24468 JACOB LEDESMA MD 55.0 X 406407 0 26070 THOMAS DELUCA MD 55.0 X 333298 0 20338 DIETER KRECKEL MD 55.0 X 282063 24599 CAROLYN GARCIA MD 55.0 X 356056 40790 SAID DAOUD MD 55.0 X 291718 18269 JOHN WELSH X 0 242183 31874 1922724 1333483 670054 21 true true false CPS INC MEDICAL SERVICES 432387 GE HEALTHCARE MAINTENANCE SERVICES 373283 VISTA STAFFING SOLUTIONS MEDICAL STAFFING 217642 NURSE ANESTHESIA OF MAINE LLC MEDICAL STAFFING 185324 TRI COUNTY MENTAL HEALTH SERVICES MEDICAL STAFFING 139162 10 31046 94773 125819 NET PATIENT SERVICE REVENUE 900099 36559171 36559171 CAFETERIA REVENUE 722210 84006 84006 OTHER REVENUE 900099 832352 832352 37475529 73786 73786 0 0 1900 40848 -38948 -38948 -38948 611919 13100 578902 3760 33017 9340 42357 42357 0 0 0 0 37678543 37475529 77195 10000 10000 0 0 0 277650 277650 0 0 13598703 10252365 3346338 52328 38800 13528 1896203 1433094 463109 897348 680567 216781 0 70454 70454 22948 22948 0 0 11457 11457 7691058 5833052 1858006 90655 68755 21900 1523165 1155199 367966 771848 585385 186463 0 554601 420620 133981 219713 166635 53078 0 2605 1976 629 56001 42472 13529 0 1198725 909137 289588 1244304 943705 300599 BAD DEBT 3331080 3331080 MEDICAL SUPPLIES & DRUGS 3269104 3269104 REPAIRS & MAINTENANCE 896049 679581 216468 LICENSES, DUES, SUBSCRIPTIONS 98020 74340 23680 129590 98283 31307 37913609 30271800 7641809 0 784555 120379 567468 3095535 0 0 4152812 4216652 65758 0 0 0 0 0 207390 226045 136040 849693 30390973 17516116 12602670 12874857 2644851 227743 0 0 0 0 0 0 2222642 4541005 23384186 26151909 3540246 5585047 0 0 31208 33107 0 0 0 0 0 0 721996 1835063 0 0 0 0 4293450 7453217 X 18599002 18196491 235361 247626 256373 254575 19090736 18698692 23384186 26151909 X -235066 -156978 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 7035 7035 false false OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1I PORTION OF DUES FOR PROFESSIONAL ASSOCIATIONS ATTRIBUTED TO LOBBYING EXPENSES - $7,035. 491734 12735 -2068 200 502201 499320 9000 10970 27556 491734 463891 13532 23747 1850 499320 536730 11068 -79304 4603 463891 0.50692 0.49308 false true true 89148 89148 14313227 5697947 8615280 14896415 11590356 3306059 1092183 227813 864370 12874857 DUE FROM AFFILIATES 2089682 OTHER RECEIVABLES 54130 DEPOSITS 1125 EST AMT DUE FROM 3RD PTY PYRS 2330828 INVESTMENT IN CHARITABLE TRUST 65240 4541005 37678543 37913609 -235066 -126633 -30345 -156978 -392044 37550956 -126633 -28277 -13525 -168435 37719391 -40848 -40848 37678543 37943000 40848 40848 37902152 11457 11457 37913609 USE OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 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 EDUCATION, OR FREE CARE. OTHERS ARE DESIGNATED TO SUPPORT SPECIFIC DEPARTMENTS OF THE HOSPITAL. UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 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. OTHER CHANGES IN NET ASSETS SCHEDULE D, PART XI, LINE 8 $ (28,277) RECOVERY OF PRIOR YEAR GRANT (2,068) CHANGE IN BENEFICIAL INTEREST OF PERPETUAL TRUST ----------- $ (30,345) OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D $ (2,068) CHANGE IN BENEFICIAL INTEREST OF PERPETUAL TRUST (11,457) INVESTMENT MANAGEMENT FEES ----------- $ (13,525) OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $ (40,848) RENTAL EXPENSES OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D $ 40,848 RENTAL EXPENSES true true X true X false true true true false false 698357 698357 0.02020 6463382 6011645 451736 0.01310 7161739 6011645 1150093 0.03330 10000 10000 0.00030 10000 10000 0.00030 7171739 6011645 1160093 0.03360 3331080 426378 15134269 13972289 1161980 X true true 1 1 RUMFORD HOSPITAL

420 FRANKLIN STREET RUMFORD ME 04276

X X X X OUTPATIENT PHYSICIAN CLINIC RUMFORD HOSPITAL 1 X true true 150. false true X true true X X X X X X true false X X true X false false 5 DIXFIELD CLINIC

146 WEL STREET DIXFIELD ME 04224

OUTPATIENT PHYSICIAN CLINIC SWIFT RIVER CLINIC

430 FRANKLIN STREET RUMFORD ME 04276

OUTPATIENT PHYSICIAN CLINIC RIVER VALLEY INTERNAL MEDICINE

431 FRANKLIN STREET RUMFORD ME 04276

OUTPATIENT PHYSICIAN CLINIC RUMFORD SPECIALTY SUITES

431 FRANKLIN STREET RUMFORD ME 04276

OUTPATIENT PHYSICIAN CLINIC RUMFORD SURGICAL SPECIALISTS

431 FRANKLIN STREET RUMFORD ME 04276

OUTPATIENT PHYSICIAN CLINIC PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN F TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 ($37,913,609) WAS REDUCED BY BAD DEBT EXPENSE ($3,331,080). COSTING METHODOLOGY SCHEDULE H, PART I, LINE 7G 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. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 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 PATIENTS 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. LINE 2 REPORTS BAD DEBT EXPENSE FROM THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. 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. COMMUNITY BENEFIT SCHEDULE H, PART III, SECTION B, LINES 8 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. IN 2010, DATA INDICATES THAT 59.2% OF MAINE RESIDENTS, AGE 65 OR OLDER, ARE BELOW THE 300% FPG LEVEL. IF THESE PATIENTS 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. COLLECTION POLICY SCHEDULE H, PART III, SECTION C, LINE 9B 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. OTHER METHODS USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY SCHEDULE H, PART V, LINE 13G 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. MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE PATIENTS FOR EMERGENCY CARE SCHEDULE H, PART V, LINE 19D 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. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 AS A CRITICAL ACCESS HOSPITAL, RUMFORD HOSPITAL ATTEMPTS TO PROVIDE ANY NEEDED HEALTH CARE SERVICES NECESSARY TO TREAT THE POPULATION OF THIS RURAL AREA OF MAINE. ADDITIONALLY, RUMFORD 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 RUMFORD 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. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 RUMFORD HOSPITAL, LOCATED IN RUMFORD, MAINE, SERVES CENTRAL OXFORD COUNTY ALONG THE WESTERN BORDER OF MAINE. A LIGHTLY POPULATED, RURAL AREA, THE REGION HAS A PRIMARILY CAUCASIAN POPULATION WITH 16% OF PERSONS AGED 65 OR OVER AND 14% OF THE POPULATION BELOW THE POVERTY LEVEL. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 RUMFORD 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 RUMFORD 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 RUMFORD AND SURROUNDING COMMUNITIES. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 AS A MEMBER OF THE CENTRAL MAINE HEALTHCARE SYSTEM, RUMFORD 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 RUMFORD AREA ON A REGULAR SCHEDULE. THE SYSTEM PARENT, CENTRAL MAINE HEALTHCARE, PROVIDES STREAMLINED ADMINISTRATIVE FUNCTIONS AND BACKROOM SERVICES, ALLOWING RUMFORD 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. true LIFEFLIGHT FOUNDATION PO BOX 899 CAMDEN ME 04843 522377085 501(C)(3) 10000 OPERATIONS 1 0 MONITORING THE USE OF GRANT FUNDS SCHEDULE I, PART I, LINE 2 THE GRANTS WERE AWARDED TO CHARITABLE ORGANIZATIONS EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, FOR USE IN THEIR EXEMPT PURPOSE. THE MISSION OF THESE ORGANIZATIONS ALSO HELP SUPPORT COMMUNITY HEALTH OR HEALTHCARE, THEREBY HELPING TO FURTHER RUMFORD HOSPITAL'S EXEMPT PURPOSE AS WELL. SINCE THE GRANTS WERE NOT AWARDED WITH A SPECIFIC PURPOSE ATTACHED, NO TRACKING IS REQUIRED. false true false false false false false false false PETER E CHALKE 0 558067 0 112822 0 141093 0 428229 0 11767 0 1251978 0 127213 JOHN WELSH 0 115941 0 0 0 126242 0 21420 0 10454 0 274057 0 108057 JACOB LEDESMA MD 304677 0 86093 0 15637 0 5274 0 20796 0 432477 0 0 0 THOMAS DELUCA MD 262097 0 62529 0 8672 0 3119 0 17219 0 353636 0 0 0 DIETER KRECKEL MD 200602 64183 17278 3676 20923 306662 0 0 CAROLYN GARCIA MD 252809 9150 94097 18583 22207 396846 0 0 JOHN KROGER MD 180416 0 65351 0 7415 0 3672 0 20796 0 277650 0 0 0 SAID DAOUD MD 255728 25966 10024 1050 0 17219 0 309987 0 0 0 R DAVID FRUM 0 241508 0 27600 0 10210 0 26058 0 17592 0 322968 0 0 EXECUTIVE COMPENSATION SCHEDULE J, PART I, LINE 3 THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT 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 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B 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 PARTICIPANT'S ENTITLEMENT 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. $ 21,420 JOHN WELSH (DEFERRAL) 108,057 JOHN WELSH (PAYOUT) 127,213 PETER CHALKE (PAYOUT) 405,206 PETER CHALKE (DEFERRAL) 23,000 R. DAVID FRUM (DEFERRAL) COMPENSATION REPORTED IN PRIOR FORM 990 SCHEDULE J, PART II, COLUMN F 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. FAMILY OR BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 JOSEPH POIRIER, NOW DECEASED, HAS A FAMILY RELATIONSHIP WITH ROBERT STICKNEY. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B 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, 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. IN ADDITION, THE BYLAWS MAY BE AMENDED OR REPEALED ONLY BY VOTE OF THE MEMBER IN ACCORDANCE WITH THE BYLAWS. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B 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. MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C 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. EXECUTIVE COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & 15B 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, AND PRESIDENT OF RUMFORD AND BRIDGTON HOSPITALS. 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 ATTORNEYS. FACTORS USED IN DETERMINING COMPARABILITY TO THE ORGANIZATION INCLUDE SIZE, GEOGRAPHY, ORGANIZATIONAL COMPLEXITY, FACILITY TYPE, OWNERSHIP TYPE, AND ANY OTHER FACTORS DEEMED RELEVANT BY THE COMMITTEE, ITS CONSULTANTS, OR ITS ATTORNEYS. USING THIS INFORMATION, THE ECC ANNUALLY REVIEWS THE EXECUTIVES' 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. PUBLIC DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 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. HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART XVII, SECTION A, LINE 1A, COLUMN B THE CENTRAL MAINE HEALTHCARE SYSTEM, WHICH INCLUDES THE FOLLOWING ENTITIES REPORTABLE AS RELATED ORGANIZATIONS ON SCHEDULE R OF THE FORM 990, SHARES EXECUTIVE MANAGEMENT AND GOVERNING BOARD MEMBERS: CENTRAL MAINE HEALTHCARE CORPORATION, CENTRAL MAINE MEDICAL CENTER, CENTRAL MAINE MEDICAL CENTER COLLEGE OF NURSING AND HEALTH PROFESSIONS, RUMFORD HOSPITAL, RUMFORD COMMUNITY FAMILY HEALTH CENTER, RUMFORD COMMUNITY HOME CORPORATION, BRIDGTON HOSPITAL, BRIDGTON HOSPITAL PHYSICIAN'S GROUP, CENTRAL MAINE COMMUNITY HEALTH CORPORATION, CENTRAL MAINE REAL ESTATE MANAGEMENT CORPORATION, CENTRAL MAINE HEART AND VASCULAR INSTITUTE, GARD W. TWADDLE NURSES ENDOWMENT, ELIAS E TUCKER TRUST FUND, CENTRAL MAINE HEALTH VENTURES AND SUBSIDIARIES, AND CWM INSURANCE, LTD. THE PRESIDENT OF CENTRAL MAINE HEALTHCARE SYSTEM, PETER E. CHALKE, AND THE PRESIDENT OF RUMFORD AND BRIDGTON HOSPITALS, R. DAVID FRUM, ALSO SERVE ON THE BOARDS OF OTHER RELATED ORGANIZATIONS. JOHN WELSH, FORMER PRESIDENT OF RUMFORD HOSPITAL, ALSO SERVED AS AN OFFICER FOR OTHER RELATED ORGANIZATIONS. MOST BOARD MEMBERS SERVE ON THE BOARDS OF MULTIPLE RELATED ORGANIZATIONS. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 $ (126,633) UNREALIZED LOSSES (2,068) CHANGE IN BENEFICAL INTEREST OF PERPETUAL TRUST (28,277) RECOVERY OF PRIOR YEAR GRANT ------------ $ (156,978) CENTRAL MAINE COMMUNITY HEALTH CORP PO BOX 4500 LEWISTON ME 04243 010386912 PUBLIC ED ME 501(C)(3) 7 CMHC false CENTRAL MAINE MEDICAL CENTER PO BOX 4500 LEWISTON ME 04243 010211494 HEALTHCARE ME 501(C)(3) 3 CMHC false CMMC COLLEGE OF NURSING & HEALTH PROF PO BOX 4500 LEWISTON ME 04243 010356077 EDUCATION MH 501(C)(3) 2 CMMC false CENTRAL MAINE REAL ESTATE MGMT CORP 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 BRIDGTON HOSPITAL 10 HOSPITAL DRIVE BRIDGTON ME 04009 010130427 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 MAINE 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 MAINE STREET LEWISTON ME 04240 010430016 HEALTHCARE ME NA C CORP CWM INSURANCE LTD GENESIS BUILDING PO BOX 1363 GRAND CAYMAN B.W.I. CJ 980220891 INSURANCE CJ NA C CORP false false false false false false false false false true false true false true true true false false