2013-08-14T07:14:58-05:00 2012-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2011-10-01 010234189 Northern Maine Medical Center NORT 2078343155 194 East Main Street Fort Kent ME 04743 Peter J Sirois 2078343155 2013-08-13 1 Barbara J McGuan CPA P00219457 2077752387 2013-08-13 2011 2016-02-24 21:20:13Z Peter J Sirois 194 East Main Street Fort Kent ME 04743 53454942 0 X www.nmmc.org X 1948 ME Acute care & long term care hospital and mental health services facility. 11 8 582 19 31093 -32194 183185 326474 45886057 52577591 16282 13679 141455 532772 46226979 53450516 0 0 0 0 20381884 20365008 0 0 0 25786540 24527970 46168424 44892978 58555 8557538 30498280 41506381 15543089 17987370 14955191 23519011 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 35771164 52964853 Medical care & ancillary services, nursing home & skilled services, physician services. 35771164 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 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 74 0 1 582 1 1 1 0 0 0 0 0 0 0 0 0 X 11 8 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 Dan Vaillancourt 1.00 X X 0 0 0 Ronald Daigle 1.00 X X 0 0 0 Clifford Ouellette 1.00 X X 0 0 0 Frances LaBrie 1.00 X X 0 0 0 Glenn Lamarr 1.00 X 0 0 0 Guy Raymond MD 50.00 X 409042 0 25824 John Ezzy 1.00 X 0 0 0 Norman Fournier 1.00 X 0 0 0 James Thibodeau 1.00 X 0 0 0 Mark Morneault 1.00 X 0 0 0 Robert Bellefleur 1.00 X 3015 0 0 Peter J Sirois 50.00 X 198204 0 25020 Cindy L Daigle 50.00 X 23574 0 1917 Michael Sullivan MD 50.00 X 460694 0 22185 David Jones MD 50.00 X 333425 0 9224 Scott Richards 45.00 X 130818 0 23506 Joanne Fortin 45.00 X 122265 0 10417 John Nahas 50.00 X 120005 0 8839 Martin Bernstein 50.00 X 151225 0 5652 1952267 0 132584 9 1 1 0 QIR 105 Continental Place Brentwood TN 370271018 Management & Consulting Services 528094 Quest Diagnostics 12436 Collections Center Drive Chicago IL 606932436 Off-Site Laboratory Services 350942 Cary Medical Center 163 Van Buren Road Suite 1 Caribou ME 04736 Off-Site Laboratory Services 298485 Baker Newman & Noyes 280 Fore Street Portland ME 04101 Consulting and Auditing 277244 Erik St Pierre MD PO Box 32 Fort Kent ME 04743 ER Physician Coverage 267068 9 214755 111719 326474 Patient Service Revenu 623000 72463495 72463495 MaineCare Rural Health 623000 5000000 5000000 Meaningful Use Revenue 623000 1503185 1503185 Miscellaneous Revenue 623000 752343 603104 31093 118146 Contractual/Char. Adj. 623000 -27141432 -27141432 52577591 13679 13679 94029 0 94029 94029 94029 34530 4426 30104 30104 Insurance Captive 900099 536501 536501 Impairment Loss 900099 -127862 -127862 408639 53450516 52964853 31093 128096 686596 434866 251730 15860129 11796491 4063638 130008 96449 33559 2453612 1828649 624963 1234663 913651 321012 121460 89880 31580 95893 70961 24932 627248 464164 163084 29940 22156 7784 8564605 6341082 2223523 1530136 1132301 397835 70868 52442 18426 424862 314398 110464 2181452 1614274 567178 1085024 802918 282106 Valley Medical Associat 7609181 7609181 Health Care Provider Ta 1118556 1118556 Provision for Bad Debts 1068745 1068745 44892978 35771164 9121814 0 1452018 1429127 2046079 5155387 5574399 5956715 25291 67585 701365 785292 484039 264800 40392863 23711081 15729827 16681782 32952 73287 28190 226141 4424120 10866265 30498280 41506381 4402224 5326367 7892499 8525281 3248366 4135722 15543089 17987370 X 14570814 23131004 384377 388007 14955191 23519011 30498280 41506381 X 8557538 6282 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7920 7920 0 Explanation of Lobbying Activities: Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which is attributable to lobbying expenses. 196477 196477 18827319 8245467 10581852 1769734 1115449 654285 16363618 14350165 2013453 3235715 3235715 16681782 Deferred Compensation 617833 Cash Surrender Value of Life Insurance 190196 Interest in Synernet Reinsurance 1339911 Meaningful Use Receivables 1160430 Estimated Third-Party Payor Settlements 7557895 10866265 Deferred Compensation 617833 Estimated Third-Party Payor Settlements 2873702 Due to Affiliate 644187 4135722 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. 2012 Cancer Fund Tour 16775 16775 3322 270 255 119 2012 Tribute to Courage Walk 17755 17755 460 34530 34530 3322 270 255 579 4426 30104 1 1 X 1 X 1 X 0 1 0 0 432025 432025 0.00990 4039492 1881812 2157680 0.04920 4471517 1881812 2589705 0.05910 30801 10026 20775 0.00050 22102257 17513685 4588572 0.10470 22133058 17523711 4609347 0.10520 26604575 19405523 7199052 0.16430 0 625053 18386419 17057157 1329262 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 11 1 1 1 X X X X X X 0 1 1 200.000000000000 1 200.000000000000 1 X 1 1 X X X 1 X X 1 X X X X X X 1 X 0 0 Form 990, Part I, Line 3c: Northern Maine Medical Center uses the Federal Poverty Guidelines to determine eligibility. Part I, Line 7: The amounts reported on Lines 7a & 7b were computed using a cost-to-charge ratio. Amounts on 7e & 7g are derived from internal financial/cost accounting systems. Subsidized health services on line 7g include physician clinics, rural health centers, a skilled nursing facility, and emergency room. 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 $ 1068745. Part II: N/A Part III, Line 4: The allowance for doubtful accounts 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. Accounts deemed uncollectible are charged off against the established allowance. Form 990, Part III, Line 9b: When a patient is referred out to collections but then applies for free or discounted care, the account is pulled back from collections when it is determined that they qualify for one of the programs. If the collection agency suspects that someone may need to apply for one of the programs, it refers the patient back to us. If a patient contacts us after being sent to collections, and qualifies for financial assistance, we then notify the agency to stop the collection process. We make every effort to screen as many people as possible before we send them to collections. Northern Maine Medical Center Part V, Section B, Line 1j: Northern Maine Medical Center (NMMC) islocated in Fort Kent, Maine (Aroostook County). Aroostook County isconsidered rural by the State of Maine and the United States CensusBureau. The hospital service area (HSA) as defined by the Maine HealthData Organization (MHDO) uses the statistical method to determine wherethe greatest proportion of residents received their inpatient care. Thefollowing towns make up the NMMC HSA as defined by the MHDO: Allagash,Eagle Lake, Fort Kent, Frenchville, Grand Isle, Madawaska, New Canada, St.Agatha, St. Francis, St. John Plt, Wallagrass, Winterville Plt., Big Twenty Twp and several surrounding unorganized territories. In 2009, thepercentage of Fort Kent residents with income below the poverty level was36.4%. The percentage of children below the poverty level was 36.7% in2009. The percentage of the population aged 65 and over was 18% inAroostook County. The unemployment rate in Aroostook County was 9.3% in2011, which was higher than the State's rate of 7.8%. Of the individuals25 years or older in Aroostook County, 23% do not have a high schooldiploma compared to 15% overall in the State.Northern Maine Medical Center utilizes an electronic medical recordsystem and its related physician practices abstract data for inclusion indisease registries, which provide a vast amount of data relative topatients in care. The needs assessment provides a much broader picture ofthe community as a whole, including the health status of individuals notin care, as well as functional health status and social demographics (suchas employment, income and education levels). The local units of theState's public health infrastructure (known as "Healthy MainePartnerships") are also integrated into the process so that their datarelative to health, environmental and social measures are part of thecommunity dissemination process.Northern Maine Medical Center engaged multiple health resource leadersin the community forum invitation list. Additional resources and leaders needed were identified in the breakout sessions. 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 MaineMedical Center, routinely conducts a community health needs assessment(hereafter referred to simply as "needs assessment") across the servicearea of all of its member hospitals. The most recent assessment,published in 2011, was conducted under a contract with the University ofNew England Center for Health Planning, Policy and Research (CHPPR) andthe University of Southern Maine's Muskie School for Public Health. Usinga methodology developed by CHPPR over decades of work, the assessmentintegrates primary data from a telephone survey to heads of householdswith secondary data retrieved from state databases (ED usage, Mortality,Cancer Registry, etc.). That data is reviewed in the context of multiplehealth related domains to develop a composite view of health status,behavioral risks, and barriers to access and care. Results are compared tonational and state benchmarks to produce priorities and recommendations asprepared by the consultants. Northern Maine Medical Center Part V, Section B, Line 3: On a statewide basis, the research consultants developed an advisory committee that met two times during the assessment research and drafting of the publication. These individuals represented a broad spectrum of backgrounds, and include: Carol Bell, Healthy Maine Partnership director; Kelly Bentley, Healthy Maine Partnership director; Gail Dana-Sacco, Wabanaki Center (serving tribal populations); Patricia Hart, Maine Development Foundation; Barbara Leonard, MPH, Maine Health Access Foundation (philanthropic foundation focused on access to care in Maine); Becca Matusovich, Maine Center for Disease Control; Lisa Miller, Bingham Foundation (philanthropic foundation); Dora Ann Mills, MD, Maine Center for Disease Control; Elizabeth Mitchell, Maine Health Management Coalition (representing the state's major employers, insurers and providers); Trish Riley, Governor's Office of Health Policy and Finance (GOHPF); Brian Rines, Advisory Committee for Health System Development (overseen by GOHPF); RachelTalbot-Ross, Maine Chapter, NAACP; and, Ted Trainer, Public HealthCoordinating Council Shawn Yardley, City of Bangor, Department of Healthand Welfare. Northern Maine Medical Center Part V, Section B, Line 4: The needs assessment was developed as astatewide collaborative between the state's three largest health systems:EMHS (in central, eastern and northern Maine), MaineGeneral (in centralMaine) and MaineHealth (in southern Maine). Multiple collaborators wereinvolved in the dissemination of the assessment findings and establishmentof priorities. Northern Maine Medical Center Part V, Section B, Line 5c: In conjunction with EMHS, Northern MaineMedical Center co-hosted a community forum with The Aroostook MedicalCenter and Cary Medical Center to present an overview of local assessmentresults and recommendations. Invitees included: other area hospitals,physician leaders, federally qualified health centers, healthy Mainepartnerships, district liaisons linked to Maine CDC, home health and longterm care leaders, social service agencies, leaders of the tribalcommunities, business leaders, legislative leaders, and representatives ofthe State administration.Attendees were provided an executive summary of the assessment as well asa summary table of data reflective of the service area. A presentation wasmade by EMHS staff who were members of the assessment development steeringcommittee providing selected data results, trends over time and thepriorities and recommendations as suggested by the research consultants.In addition to the community forums, the entire statewide assessment (bothnarrative and data sets) was posted to the EMHS website. After the forums,power point presentations used at the forum, as well as input collected inthe breakout sessions, were also posted on the website. Forum participantswere encouraged to go to the website to review the assessment in detail,and access the data for local planning. Media releases were also sent tolocal news outlets in combination with the forums, encouraging newarticles on the forum and inviting all members of the public to view thereport on the website.Instructions on the website assist viewers to download and/or printsections of the report. Individuals without computer or printer accesswere provided a phone number where they can request a printed assessment. Northern Maine Medical Center Part V, Section B, Line 6i: Northern Maine Medical Center made progress on the following initiatives that were undertaken to meet the prioritized needs identified by the community needs assessment:-NMMC continues work towards implementing a wellness program. Once the results of a baseline health assessment of employees on the health insurance is available, NMMC will be able to use the overall results to develop a wellness program appropriate to the needs of the employees.-NMMC has obtained certification of its diabetes education program and has made strides in rebuilding its diabetes education programs and support group.-NMMC has implemented an electronic medical record in its physician practices. The software has the ability to generate reports to better monitor patients with chronic conditions and the completion/status of recommended treatment plans. The staff have recently received training on how to generate those reports and is starting to use them to improve management of these patients with chronic conditions. In addition, the hospital has entered into an Accountable Care Strategic Contractor Agreement whereby the ACO has entered into a contract with a payor to perform population health management services for covered lives some of which receive services at NMMC.-NMMC has collaborated with other local hospitals and providers to ensure the necessary specialty services are available. The following specialty services were obtained through agreements with other hospitals either on an interim basis or on-going: Anesthesia Director Services, Sleep Medicine professional and technical services, orthopedic surgeon coverage, and radiologist services. NMMC continues to look for opportunities to work with other hospitals to provide specialty services in our community.-NMMC continues to make other health care providers aware of the mental health services it offers on both an inpatient and outpatient basis. -NMMC has signed a contract with Health Info Net, Maine's Health Information Exchange to improve quality and effectiveness through better information exchange. At this time, NMMC and Health Info Net have started working on establishing integration between NMMC's information system and Health Info Net. NMMC also has entered into an agreement with the closest tertiary facility, EMMC, for certain access to their PowerChart, which can benefit the transition of care from the tertiary back to the local, primary care providers. Northern Maine Medical Center Part V, Section B, Line 7: Northern Maine Medical Center was unable toaddress all needs identified due to limited staff and financial resources.Certain needs, such as increased insurance coverage and improved Medicaidreimbursement for dental services, have not been addressed since NMMC canonly be a portion of the solution; other entities will need to be involvedto address all of the needs. NMMC is in the process of rebuilding itspatient education component, so certain needs, such as community levelprevention programs and primary care and ED education tools, will beaddressed once the education framework is in place again. Northern Maine Medical Center Part V, Section B, Line 19d: Individuals are billed at gross amounts andcharges are adjusted accordingly, if they qualify for assistance. Northern Maine Medical Center Part V, Section B, Line 21: Individuals are billed at gross amounts andcharges are adjusted accordingly, if they qualify for assistance. Part VI, Line 2: Please see Schedule H, Part v, Section B, Line 1 fora description of NMMC's assessment process. Part VI, Line 3: We notify patients and customers about access toassistance in various ways. The simplest way is the signage, pamphlets,and educational material located around the Organization and in variousoffices. In every patient access/patient financial services area is a signexplaining the availability of free/discounted care and the FederalPoverty Guidelines. There are also pamphlets located in the outpatientareas explaining free/discounted care and providing information onMainecare. For inpatients, there is a book in each room which provides allthe 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 (AroostookCounty). The Hospital is accredited by the joint commission and itsmission is to serve its communities with excellence in health care. Itsservices include acute inpatient, psych inpatient, SNF, 24-hour emergencycenter, diagnostic, and surgical services. Along with these hospitalservices, the Hospital employs/contracts with the majority of primary andspecialty care physicians in the area. Form 990, 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 0 Guy Raymond MD 398642 0 0 0 10400 0 3639 0 22185 0 434866 0 0 0 Peter J Sirois 158204 0 40000 0 0 0 1607 0 23413 0 223224 0 0 0 Michael Sullivan MD 460694 0 0 0 0 0 0 0 22185 0 482879 0 0 0 David Jones MD 317559 0 0 0 15866 0 0 0 9224 0 342649 0 0 0 Scott Richards 130818 0 0 0 0 0 1321 0 22185 0 154324 0 0 0 Martin Bernstein 141687 0 0 0 9538 0 1125 0 4527 0 156877 0 0 0 Part I, Line 7 CEO received bonus payments based on his performance. Daigle Oil Company Entity of which Dan Vaillancourt, Board President, is an officer 128667 Independent Contractor Arrangement 0 Nola Sirois Family member of Peter Sirois, Hospital CEO 21812 Employment 0 Michelle L Plourde Family member of Peter Sirois, Hospital CEO 58230 Employment 0 Robin Werntgen Family member of Glenn Lamarr, Director 54993 Employment 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: Guy Raymond shows reportable compensation on Form 990, Part VII, Section A for services performed in his capacity as an employee of Northern Maine Medical Center. His compensation does not reflect payment for his services as a board member of the Hospital or any related organization. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 6,282. 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 1 0 0 1 0 Valley Medical Association Q 7609181 Actual Outlay