2013-04-29T07:00:50-05:00 2012-06-30 010494526 Baker Newman Noyes 280 Fore Street Portland ME 04101 990 2011-07-01 043369649 MaineGeneral Health MAIN 2076261000 6 East Chestnut Street Augusta ME 043305717 Michael Koziol 2076261000 2013-04-05 E Drew Cheney P00182972 2078792100 2011 2016-02-25 16:41:14Z Scott B Bullock 6 East Chestnut Street Augusta ME 043305717 15869417 0 9706 X www.mainegeneral.org X 1997 ME MaineGeneral Health exercises general supervision over tax-exempt subsidiaries and develops and implements overall goals and strategies for the system-wide delivery of necessary health care services in an efficient and coordinated manner. 19 14 132 21 0 0 42109 59330 12784851 14326284 572661 771588 0 0 13399621 15157202 17771 44097 0 0 10005509 10391913 0 0 1057363 2992149 4080826 13015429 14516836 384192 640366 16898576 16417099 10245563 11279024 6653013 5138075 X MaineGeneral Health's primary mission is to enhance, every day, the health of the people of the greater Kennebec Valley Region. MaineGeneral Health follows this mission with a forward-looking vision of focusing on clinical excellence, customer satisfaction, financial stability, and positively impacting the health of the community each day. 0 0 6317720 44097 14326284 MaineGeneral Health exercises general supervision over and provides administrative services for tax-exempt subsidiaries. MaineGeneral Health develops and implements overall goals and strategies for the system-wide delivery of necessary health care services in an efficient and coordinated manner. MaineGeneral Health keenly focuses on preventive care and supports many ongoing health services throughout surrounding communities. 6317720 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 673 0 1 132 1 0 0 0 0 0 0 0 0 0 0 X 19 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Mary Griswold Controller 2076261289 6 East Chestnut Street Augusta ME 043305717 Peter Alfond 1.00 X 0 0 0 Conrad Ayotte 2.00 X 0 0 0 Douglas Boyink MD 10.00 X 0 266417 28755 Scott Bullock 50.00 X X 601967 0 223927 Stephanie Calkins MD 1.00 X 0 24000 1020 Diane Campbell MD 1.00 X 0 143347 22045 Douglas Cutchin 1.00 X 0 0 0 Charles Danielson MD MPH 1.00 X 0 0 0 Mark Ford 2.00 X 0 0 0 Peter Guzzetti DO DDS 1.00 X 0 27083 0 Jeffrey Hubert 2.00 X 0 0 0 Robert Marden Esq 2.00 X X 0 0 0 Barbara Mayer 2.00 X 0 0 0 Roy Miller MD 1.00 X 0 0 0 Elizabeth Mitchell Esq 1.00 X 0 0 0 Gordon Pow 2.00 X 0 0 0 Tobi Schneider Esq 1.00 X 0 0 0 William Sprague 1.00 X X 0 0 0 Douglas Terp 2.00 X 0 0 0 Brian Rines 1.00 X 0 0 0 Barbara Woodlee EdD 1.00 X 0 0 0 Karen Tobias 45.00 X 55438 0 12707 Michael Koziol 50.00 X 283197 0 19107 Barbara Crowley MD 50.00 X 330116 0 36537 Charles Hays 50.00 X 312203 0 16874 Steven Diaz MD 50.00 X 261317 0 35916 Gail Evans 50.00 X 199297 0 20735 Sharon Woodward 50.00 X 193807 0 26882 2237342 460847 444505 17 0 1 0 IMA Consulting 3 Christy Drive Suite 100 Chadds Ford PA 19317 Consulting 653074 Pricewaterhouse Coopers PO Box 7247-8001 Philadelphia PA 191708001 Auditing 329401 Baker Newman Noyes 280 Fore Street Portland ME 04112 Consulting 230214 Baker Healthcare Consulting Inc 4251 Reliable Parkway Chicago IL 606860042 Consulting 219751 Pierce Atwood LLP One Monument Square Portland ME 04101 Legal 210196 11 59330 59330 Management fee revenue 561000 14228296 14228296 Rental revenue 532000 97988 97988 14326284 160498 160498 1323305 710563 1652 612742 -1652 611090 611090 15157202 14326284 0 771588 44097 44097 1240447 1240447 7340534 4091416 2632658 616460 661806 368872 237355 55579 659389 367525 236488 55376 489737 272966 175643 41128 199359 199359 325115 325115 22495 22495 1593653 106961 1375849 110843 57546 57487 59 248829 155250 67567 26012 418651 225587 147946 45118 75919 37728 29375 8816 129252 56637 53926 18689 74358 74358 89635 72680 13298 3657 10381 10381 Professional Membership 445072 155016 290056 Recruitment 116198 115631 567 Educational Assistance 84727 84727 Special Projects 71715 71715 117921 30782 83169 3970 14516836 6317720 7141753 1057363 505626 439076 3073330 2470153 563 439 26767 40967 777568 331034 738711 460917 362190 277794 6483303 6200595 5669229 6657041 16898576 16417099 2600925 3047804 1598020 938020 6046618 7293200 10245563 11279024 X 5945744 4440785 177890 165402 529379 531888 6653013 5138075 16898576 16417099 X 640366 -2155304 X X 0 1 1 X 1 1 X X X 0 0 0 MaineGeneral Medical Center 043369653 3 1 0 1 0 HealthReach Network 010524384 9 1 0 1 0 MaineGeneral Rehabilitation & Nursing Care 222789192 9 1 0 1 0 MaineGeneral Health Associates 222516766 9 1 0 1 0 MaineGeneral Retirement Community 010627194 9 1 0 1 0 5 0 5589796 24845 -76577 27690 137758 0 5372616 5600320 23144 1033434 17771 1049331 0 5589796 4909719 189201 697657 0 196257 0 5600320 6099484 127387 -1103372 17018 196762 0 4909719 0.87000 0.09900 0.03100 0 0 148779 34033 114746 589932 426884 163048 277794 Due from affiliates 5745053 Intercompany notes receivable 911988 6657041 Self-insurance reserve - health 2788322 Self-insurance reserve - dental 161084 Workers compensation accrual 53613 Other long-term liabilities 373943 Accrued pension costs 3222376 Accrued deferred compensation 693862 7293200 Description of Intended Use of Endowment Funds: Part V, Line 4: MaineGeneral Health's intended uses of endowment funds are as follows: 1. to provide funds for scholarships; 2. to fund educational programs; 3. to provide a source of funds for an executive deferred compensation plan; and 4. to self-fund workers compensation claims and related expenses. Description of Uncertain Tax Positions Under FIN 48: Part X: All entities included in the consolidated financial statements have been determined to be tax-exempt organizations as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and, accordingly, are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Accordingly, no provision for income taxes has been recorded in the accompanying consolidated financial statements for these tax-exempt organizations. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. The Company has concluded no uncertain income tax positions exist at June 30, 2012. The Company's tax years from 2009 through 2012 are open and subject to examination. 1 Scholarships 57 27690 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: MaineGeneral Health offers several different types of scholarships, which are awarded based on requirements established by the donors funding the scholarships. Any individual in MaineGeneral Health's service area may apply for a scholarship by completing a required application, including school transcripts, a statement of need, financial disclosures, and other information. The majority of these scholarships are offered to students pursuing a career in nursing or another healthcare related field of study. Before scholarship funds are disbursed to a student, the student must provide documented evidence of the successful completion of the required coursework at the end of each term. MaineGeneral Health retains complete files for each scholarship award as substantiation of the amount of scholarship funding for each individual. X 1 1 X X X X 0 1 0 0 0 0 0 1 0 Douglas Boyink MD 0 244739 0 19020 0 2658 0 20137 0 8618 0 295172 0 0 Scott Bullock 457537 0 25000 0 119430 0 202970 0 20957 0 825894 0 0 0 Diane Campbell MD 0 133683 0 4969 0 4695 0 4516 0 17529 0 165392 0 0 Michael Koziol 281997 0 0 0 1200 0 10625 0 8482 0 302304 0 0 0 Barbara Crowley MD 323909 0 0 0 6207 0 24860 0 11677 0 366653 0 0 0 Charles Hays 306513 0 0 0 5690 0 13475 0 3399 0 329077 0 0 0 Steven Diaz MD 260936 0 0 0 381 0 13249 0 22667 0 297233 0 0 0 Gail Evans 188180 0 10000 0 1117 0 10833 0 9902 0 220032 0 0 0 Sharon Woodward 192053 0 0 0 1754 0 18461 0 8421 0 220689 0 0 0 Part I, Line 1a Scott B. Bullock $4,825 Treated as taxable compensation Barbara Crowley, M.D. $4,004 Treated as taxable compensation Part I, Line 4b Supplemental nonqualified retirement plan - Scott Bullock - Amounts paid $181,320. Benefits are fully vested and nonforfeitable under a 2000 Supplemental Retirement Plan and a 2005 Supplemental Retirement Plan. Under a new 2010 Supplemental Retirement Plan, benefits have vested/will vest in accordance with the following schedule: (1) the amounts credited to the account for the first two contract years and the earnings thereon vested and were distributed on January 15, 2012 and (2) the amounts credited to the account for the third, fourth, and fifth contract years and the earnings thereon shall vest on December 31, 2014 if still employed. Interest in the account balance shall become fully vested in the event of death or disability. Part I, Line 7 A portion of compensation is at risk and variable and is based on the quality of job performance. Form 990, Part VI, Section B, line 11 All Forms 990 and related attachments were reviewed by appropriate members of senior management, the Finance Committee, and the Board of Directors before the filings were sent to the Internal Revenue Service. Final drafts of Forms 990 were available thirty days prior to the filing deadline in order to be formally reviewed by the Senior Vice President and Chief Financial Officer, the Compliance Officer, the entire senior management team, the Finance Committee, and the Board of Directors. Forms 990 and related attachments were provided to and reviewed by the Finance Committee in March 2013 and by the Board of Directors in April 2013. In addition, both the Finance Committee and Board were provided formal education on the contents and layouts of Forms 990 and of organizational policies and procedures related to Form 990. Form 990, Part VI, Section B, line 12c MaineGeneral Health's Conflict of Interest Policy requires disclosure of any actual or potential conflict of interest to the Board Chair. Interested persons are prohibited from participating in the governing body's deliberations and decisions regarding any transactions when they have a conflict of interest. If the Board or Committee has reasonable cause to believe that a member has failed to disclose actual or possible conficts of interest, the Board or Committee shall investigate and then determine by a majority vote whether a conflict of interest exists and whether the violation is grounds for removal from the Board or Committee. There are formal records of these proceedings. In addition, each director, officer, and member of the Board is required to annually complete and sign a Conflict of Interest Disclosure Statement. Employees must disclose in writing to their supervisors any conflicts of interest prior to engaging in transactions or taking positions with MaineGeneral Health. In addition, these disclosures must be approved by the supervisor's manager or, as applicable, the Board Chair, in conjunction with the Human Resources Compliance Officer. If management has reasonable cause to believe that an employee has intentionally failed to disclose a conflict of interest, appropriate disciplinary or corrective action up to and including termination shall be taken. In addition, upon hire or promotion to a management position, all management employees shall complete a Conflict of Interest Disclosure Statement, which will be submitted to the Ethics and Compliance Department for review and reporting to the Chief Compliance Officer, who will record and report each validated conflict of interest to the Board. Form 990, Part VI, Section B, line 15 The Board of Directors is responsible for determining the compensation package for the Chief Executive Officer. An independent compensation consultant advises the Board using comparability data, expert compensation studies and other means. Paid executives who hold voting privileges may not vote or participate in discussions regarding their compensation; however, they may answer questions that will help the Board in its deliberations. For other officer and key employee positions, salary structures are developed and maintained based on national compensation data for healthcare organizations. The Chief Executive Officer's compensation was last reviewed in October 2012. Form 990, Part VI, Section C, line 18 The three most recent Forms 990 (Annual Information Returns) and 990T (Exempt Organization Business Income Tax Returns), along with a copy of the application for a group exemption submitted to the IRS by MaineGeneral Health on behalf of its affiliates, is made available for public inspection without charge at each organization's principal offices during regular business hours (Monday through Friday, 8:00 a.m. until 4:30 p.m.). In addition, when a request for copies of any of these documents is made in person, copies are made available to the requester without charge on the day the request is made. If a written request for a copy of any of these documents is received, the requested documents are mailed without charge within two weeks from the date the request is received. MaineGeneral Health also makes its most recently filed annual information returns widely available by posting the documents on its website. Form 990, Part VI, Section C, line 19 MaineGeneral Health makes its governing documents, conflict of interest policy and financial statements, whether or not audited, available to the general public by providing copies immediately upon request. The latest two fiscal years of audited financial statements are available on the company's website at www.mainegeneral.org. In addition, the Controller distributes financial statements and budgets on a quarterly and annual basis to designated third parties. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -735466. Additional pension liability -1419838. Total to Form 990, Part XI, Line 5: -2155304. Change in oversight or selection process during the tax year: Form 990, Part XII, Line 2c MaineGeneral Health did not change its oversight process or selection process during the tax year. MaineGeneral Medical Center 6 East Chestnut Street Augusta ME 04330 043369653 Hospital ME 501(c)(3) Line 3 MaineGeneral Health 1 HealthReach Network 6 East Chestnut Street Augusta ME 04330 010524384 Provider of home care, hospice, and community support services ME 501(c)(3) Line 9 MaineGeneral Health 1 MaineGeneral Rehabilitation & Nursing Care 6 East Chestnut Street Augusta ME 04330 222789192 Provider of long-term and residential care services ME 501(c)(3) Line 9 MaineGeneral Health 1 MaineGeneral Health Associates 6 East Chestnut Street Augusta ME 04330 222516766 Provider of primary and specialty care physician services ME 501(c)(3) Line 9 MaineGeneral Health 1 MaineGeneral Retirement Community 6 East Chestnut Street Augusta ME 04330 010627194 Provider of assisted and residential living services ME 501(c)(3) Line 9 MaineGeneral Health 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 MaineGeneral Medical Center A 54793 Fair market value MaineGeneral Rehabilitation & Nursing Care A 11263 Fair market value MaineGeneral Medical Center K 13876216 Fair market value MaineGeneral Rehabilitation & Nursing Care K 70000 Fair market value MaineGeneral Retirement Community K 20000 Fair market value HealthReach Network K 279503 Fair market value