2013-03-15T12:50:27-07:00 2012-04-30 990 2011-05-01 010211797 MOUNT DESERT ISLAND HOSPITAL MOUN 2072885081 PO Box 8 10 Wayman Lane Bar Harbor ME 046090008 Christina Harding 2072885082 2013-03-15 2011 2016-02-25 16:41:14Z Arthur Blank 10 Wayman Lane PO Box 8 Bar Harbor ME 046090008 54021105 0 X www.mdihospital.org X 1897 ME Mount Desert Island Hospital's mission is to provide compassionate care and strengthen the health of our community by embracing tomorrow's methods and respecting time-honored values. 18 15 526 290 0 0 1540806 2017517 49496610 50482649 28647 591026 801092 926297 51867155 54017489 0 0 0 0 30191177 32391277 0 0 217804 21299884 22644074 51491061 55035351 376094 -1017862 52909124 52560561 30019700 31815380 22889424 20745181 Mount Desert Island Hospital's mission is to provide compassionate care and strengthen the health of our community by embracing tomorrow's methods and respecting time-honored values. 0 0 41889300 0 51408946 Patient Care: Mount Desert Island Hospital's mission statement is described in Part II, Line 1 above. In Fiscal Year 2012, MDI Hospital provided $863,130 in services for which no compensation was expected or received. Policies exist to provide relief for those who cannot pay for medical care. MDI Hospital provides care to persons covered by governmental programs including Medicare, Medicaid and Champus. The unreimbursed value for providing care to these patients approximates $12,750,000. The Hospital provides a number of health services and preventative health programs to the community. Most of these programs are either covered by insurance, are offered at very low costs or are free to the community. Available programs include: cardiac pulmonary rehabilitation, wellness programs, diabetes education, nutrition counseling, parenting, pregnancy and sibling classes and physical and occupational therapy programs. Throughout the year, staff from the hospital make presentations to area school children regarding smoking cessation and health nutrition. Additionally, community groups such as Alcoholics Anonymous use the hospital's conference rooms for their meetings. 0 0 0 41889300 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 61 0 1 526 1 0 0 0 0 0 0 X 18 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X X X Arthur Blank 2072885081 10 Wayman Lane Bar Harbor ME 046090008 Arthur J Blank 40 X X 284722 0 42502 John Adams MD 1 X 0 0 0 John Benson MD 1 X 0 0 0 Michael Bonsey 5 X X 0 0 0 Stewart Brecher 1 X 0 0 0 Mary Dudzik MD 40 X 182833 0 26939 David Einhorn Esq 1 X 0 0 0 Kathleen Field 1 X 0 0 0 Julius Krevans MD 1 X 0 0 0 Julian Kuffler MD 40 X 220958 0 27208 Dean Read 1 X 0 0 0 Mickey Shattow 1 X 0 0 0 Patricia Hand PhD 1 X 0 0 0 Elsie Flemings 1 X 0 0 0 Noelle Wolf 1 X 0 0 0 Vince Messer 3 X X 0 0 0 James Bright 1 X 0 0 0 David Painter 40 X 144795 0 29600 Christina M Harding 40 X 46584 0 8612 Bradley Perkins 40 X 116052 0 10389 Audrey Reed 40 X 48755 0 23678 Brian Caine 40 X 218984 0 5262 Michael Heniser 40 X 300837 0 19799 Ronald Prokopius 40 X 299117 0 33096 Edward White 40 X 330069 0 41996 Stuart Davidson 40 X 427848 0 41112 2621554 0 310193 41 0 1 0 Bay View Physical Therapy 125 Oak Street Ellsworth ME 04605 Physical Therapy 642147 NEHE MRI LLC PO Box 415220 Boston MA 022415220 medical testing MRI 411205 J&D Imaging PO Box 213 Bar Harbor ME 04609 Imaging test reading 357145 Rao Surapememi P Ramanadha MD 50 358 Broad st suite 207 Bangor ME 04401 Urologist 357000 Dahl Chase Diagnostic Services 417 State Street Suite 441 Bangor ME 04401 pathology services 161954 7 0 0 0 0 15281 2002236 549196 2017517 Patient Service Revenue 900099 28394834 28394834 0 0 Medicare/Medicaid payments 900099 22087815 22087815 0 0 0 0 0 0 50482649 274589 0 0 274589 3616 0 0 3616 0 0 0 0 0 0 316437 0 3616 0 312821 0 312821 0 0 312821 0 Cafeteria Sales 900099 199021 199021 0 0 Miscellaneous Income-Eden 900099 88119 88119 0 0 Misc income - HC Admin 900099 151757 151757 0 0 487400 487400 0 0 926297 54017489 51408946 0 591026 0 0 0 0 0 0 0 0 868576 0 868576 0 0 0 0 0 22850497 17154841 5570656 125000 628862 454825 170723 3314 6452865 4667107 1751843 33915 1590477 1150314 431781 8382 0 0 0 0 105150 0 105150 0 85487 0 85487 0 0 0 0 0 0 0 -41848 0 -41848 0 0 0 0 0 90218 0 90218 0 4752857 4627244 125613 0 0 0 0 0 0 0 0 0 836689 669351 167338 0 44257 30261 13996 0 0 0 0 0 262178 130101 132077 0 804178 644410 159768 0 0 0 0 0 2170997 1736798 434199 0 921374 831530 89844 0 Purchased Services 5746697 3983157 1763540 0 Bad debt expense 3091286 3091286 0 0 Physician fees 1357714 1332714 25000 0 Hospital provider tax 871620 871620 0 0 1545220 513741 984286 47193 55035351 41889300 12928247 217804 0 0 34647 45798 2976580 2768971 4988287 5020765 0 0 0 515042 533456 148458 172391 44796979 21454862 24091510 23342117 13875549 12789380 0 0 0 0 0 0 6279051 7887683 52909124 52560561 11945764 13236501 0 0 0 38837 5382336 4784067 0 0 0 0 10252880 9806150 0 0 2438720 3949825 30019700 31815380 X 15829167 13622451 5051084 5222565 2009173 1900165 22889424 20745181 52909124 52560561 X -1017862 -1126381 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1797 1797 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 This amount represents a portion of dues determined expended for specific lobbying purposes. These expenditures are defined as direct communications with certain members of federal, state or local government to influcence legislation. These dues support the organizations advocacy and representation in its broadest sense, activites that are well beyond the scope of defined lobbying activities. For the Maine Hospital Association, total dues are 11,593, of which 15.5% are lobbying expenses or $1,797. total lobbying expnses included in dues is $1,797. 8117020 0 -421691 0 1366000 28848 6300481 6997367 17162 1180156 0 46000 31665 8117020 3938882 1801964 1284232 0 7570 20141 6997367 0 5077190 -974551 0 150000 13757 3938882 1 0 0 1 0 0 3322148 3322148 0 21801737 10950594 10851143 0 235558 0 235558 0 14458724 10504268 3954456 0 4978812 0 4978812 23342117 Due from affiliates 4568187 Deferred financing costs 86894 Estimated third party payor settlements 3040009 Deposits held in escrow 98000 Other miscellaneous receivables 94593 7887683 0 Deferred compensation 1420011 Estimated 3rd party payor settlements 2220007 Due to affiliate 309807 3949825 54017489 55035351 -1017862 811947 0 0 0 1318559 2130506 1112644 52497411 0 0 0 -1520078 -1520078 54017489 0 0 0 54017489 54741458 0 0 0 -293893 -293893 55035351 0 0 0 55035351 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The quasi endowment funds are held for Hospital use and restricted by the Board of Directors. Interest may be used to fund operational expenses at the discretion of the Board of Directors. Principal funds are to be held in the quasi endowment to fund future liabilities including Eartned Time Liabilities and Lines of Credit funding. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Changes in pledges receivable 1,318,559 SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Total of 1,520,010 represents items recorded as revenue below "Loss from operations" on audited financial statements: net assets released (941,578) Gifts and bequests (683,677) Interest income on investments (249,356) Investment management fees-now inc w/expenses 41,848 Other revenue (loss) below operating gain 312,821 SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Fundraising expenses and Investment management fees recorded ont he audited financial statements as other income (expense) Fundraising expenses 217,804 Other 34,242 Investment fees 41,848 1 1 X 1 X 1 X 1 1 1 0 1 1 0 0 624918 0 624918 0.0114 0 0 5656636 5193842 462794 0.0084 0 0 0 0 0 0 0 0 6281554 5193842 1087712 0.0198 0 0 0 0 0 0 0 0 12126115 8126050 4000065 0.0727 0 0 12126115 8126050 4000065 0.0727 0 0 18407669 13319892 5087777 0.0925 1 3091286 2238133 15280621 18518945 -3238324 X 1 1 11 1 Mount Desert Island Hospital

10 Wayman Lane PO Box 8 Bar Harbor ME 046090008

X X X X 2 Cadillac Family Practice and Behavioral Health Center

322 Main Street Bar Harbor ME 04609

Outpatient clinic 3 Cooper Gilmore Health Center

17 Hancock Road Bar Harbor ME 04609

Outpatient clinic 4 Trenton Health Center

394 Bar Harbor Road Trenton ME 04605

Outpatient clinic 5 Community Health Center

16 Community Lane Southwest Harbor ME 04679

Outpatient clinic 6 Family Health Center

9 Hancock Road Bar Harbor ME 04609

Outpatient Clinic 7 Women's Health Center

8 Wayman Lane Bar Harbor ME 04609

Outpatient clinic 8 Northeast Harbor Clinic

Kimball Road Northeast Harbor ME 04679

Outpatient clinic 9 MDI Orthopedic clinic

10 Wayman Lane Bar Harbor ME 04609

Outpatient Clinic 10 MDI Dermatology Clinic

322 Main Street Bar Harbor ME 04609

Outpatient Clinic 11 MDI Urology Clinic

322 Main Street Bar Harbor ME 04609

Outpatient Clinic Mount Desert Island Hospital 1 1 X X X X X X X X 11 1 0 1 X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 Cadillac Family Practice and Behavioral Health Center 2 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 Cooper Gilmore Health Center 3 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 Trenton Health Center 4 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 Community Health Center 5 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 Family Health Center 6 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 Women's Health Center 7 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 Northeast Harbor Clinic 8 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 MDI Orthopedic clinic 9 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 MDI Dermatology Clinic 10 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 MDI Urology Clinic 11 1 X X X X X X X X 11 1 0 1 X X X X X X X X X X 0 1 1 150 1 250 1 X X X X X X X 1 1 X X X X X 1 X X 0 X X 1 X 0 0 SchH_P01_S00_L06a Schedule H, Part I, Line 6a The Mount Desert Island Hospital process was a partnership with Healthy Acadia, a comprehensive community health coalition that was formed in 2001 with the public health funding provided by the Maine Center for Disease Control and Prevention. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Costing methodology utilized for this table were derived from Worksheet 2, Ratio of patient care cost to charges with data from our fiscal year 2012 filed cost reports. SchH_P01_S00_L07g Schedule H, Part I, Line 7g IRS 990H Worksheet 6--Subsidized health Services--(The supporting schedule for part I, Line 7g) We did not utilize the Worksheet 2 percentage when determining the profit/loss of each of our provider based clinics. In addition, when we were compiling the subsidized provder based clinics listed in 1C above, we utilized the actual estimated costs on the Medicare cost report we prepared instead of applying towrksheet 2 cost to charge percentage. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Audit Footnote#2. 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. The bad debt expense has been calculated utilizing data from our fiscal year 2012 filed cost report to produce the cost to charge ratio for Worksheet 2 Ratio of Patient Care Cost to Charges. Bad Debt expense per audited financial statements is $3,091,286. Bad debts are a community benefit as services are provided regardless of the patient's ability to pay. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The Medicare shortfall would be considered as a community benefit as it is the cost of providing quality acute and primary care services while maintaining careful stewardshipp of resources with a commitment to service excellence. This was calculated utilizing Medicare net patient revenue with associated Medicare costs per the filed fiscal year 2012 cost report. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Collection practices follow the free care policy of ensuring those patients who are eligible for federal or state medical assistance programs are covered. If not eligible for these programs, charity care eligibility is determined. The cost share plan guidelines of the free care policy are clearly stated to ensure proper collection policy and practice. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 The Community Health Needs Assessment is available to our community members through our problic website and the ongoing implementation and work plan is documented by our Planning and Board committees. SchH_P05_S0B_L07 Schedule H, Part V, Section B, Line 7 The Mount Desert Island Hospital's Community Health Needs Assessment provides an opportunity to gain insight into the needs and assets that are served, it also provides a measure to identify and address the needs of the vulnerable populations with our community. The Mount Desert Island Hospital process was a partnership with Health Acadia, a comprehensive community health coalition that was formed in 2001 with the public health funding provided by the Maine Center for Disease Control and Prevention. The Community Health Improvement Plan and Health Needs Assessment were performed using the Mobilizing for Action through Planning and Partnerships (MAPP) process utilizing a broad cross section of our demographic and service area. This process delivered the basis for the assessment which demonstrated the strengths and opportunities for our plan. This process involved gather of two types of data, quantitative (demographics, health indicators, local statistics, etc.) and qualitative (Public Surveys, Focus Groups and Community Stakeholders). The data helps support short-term and long-term decisions about allocation of community human and capital resources. Participants included members of the Hospital's medical staff, nursing staff, board of trustees' and administration. Focus groups were used to gain feedback from diverse and remote populations, as an institution that serves the rural and coastal community of Mount Desert Island and the other islands off the Coast of Hancock County, this feedback was essential to continue to develop strategies to meet the needs of our residents. This collaborative effort developed the eight themes for strategic initiatives and goals. 1.) How can we ensure that all community members have access to affordable high quality health care? 2.) How can we ensure that all community members have access to health affordable food? 3.) How can we increase physical activity and health transportation in our region? 4.) How can we reduce and prevent substance abuse in our community? 5.) How can we ensure that the children and youth in our region have the best opportunities to grow and thrive? 6.) How can we promote healthy aging for all members of our community? 7.) How do we build an environment that is healthy, free from toxins, and protected for current and future generations? 8.) How can we increase economic opportunities and decrease economic disparities in our region? Mount Desert Island Hospital has reviewed and identified the key strategies of this plan by developing a dimplementation and mapping of current and future strategies. The plan has been vetted through the Board of Trustees of the Hospital and is resourced to the Plannign Committee of the Board of Trustees for continued review and prioritization. The key elements of the Community Health needs Assessment that were not in full alignment with the Hospital's mission and assets were Strategy 2. Although we promote healthy food options, our organization does not have a mechanism in place to distribute or provide food options to our community outside of our cafeteria. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Mount Desert Island Hospital assesses the health needs of the community through the use of a collaborative Community Health Needs Assessment. As a key participant in the CHNA process our institution is able to further address and identify those areas of most concern and need in our community. A community needs assessment is a point in time effort to measure the health and well being of the community. It serves as a constructive tool to and basis for Mount Desert Island Hospital's strategic and subsequent action planning to develop Health Policy Advocacy, allocate resources, improve or expand existing services, implement new programs and collaborate with other community health care providers. A community health needs assessment also serves as a benchmark for future assessment of measured progress toward established community health objectives. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 MDIH is committed to: -Providing access to quality healthcare services with compassion, dignity and respect for those we serve, particularly the poor, indigent, and underserved in our communities. -Caring for all members of our communities or persons needed care, regardless of their ability to pay for services. - Assisting our patients who cannot afford to pay for part or all of the services received by working with our community to address those in need and aid in finding the financial resources available. In accordance with the American Hospital Association Recommendations, MDIH has adopted guiding principles when handling the billing, collections and financial support functions for our patients. - Provide effective communications with patients regarding hospital bills - Make affirmative efforts to help patients apply for public and private financial support programs -Offer financial support to patients with limited means -Implement policies and procedures for assisting low-income patients in a consistent manner -Implement fair and consistent billing and collection practices for all patients with patient payment obligations Communicate effectively and timely with our patients regarding patient payment obligation. Noting that a patient financial representative is available to assist with triaging patient needs and working with our patients to align resources. This representative is available to explain and review patient payment obligations as well we have a patient advocate to facilitate issues that arise in the course of this process. Information about hospital based financial support polices and external support programs that provide coverage for services are made available to patients during the pre-registration and registration processes and/or through communications with patients seeking financial assistance. MDIH offers financial support to patients with limited means. This support is available to uninsured and underinsured patients who do not qualify for public programs or other means of assistance. Notification about financial assistance programs at MDIH, including contact information, is available through messaging included on patient bills, physician offices, public areas, care management staff, registration areas, billing support staff and reception in the hospital, and clinics. Patient brochures describing the financial counseling and assistance services are available in these areas as well as on our public website, mdihospital.org. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 MDI Hospital provides services to Mount Desert Island and coastal Maine designated as a Critical Access Hospital, in hancock County, southeastern Maine. Mount Desert Island is comprised of 108 square miles and is the 6th largest island in the continental United States and second largest island (Long Island, NY being the largest) on the eastern seaboard. The primary geographic area serviced consists of Mount Desert Island along with the outer islands of Swans, Frenchboro, and Cranberry Isles, with a total permanent year-round population of approximately 10,000. Mount Desert Island is a destination for tourists from all over the world. Cruise ships are in the harbor from May through October and most often in September. The summer residents increase the island population by at least 30,000. Also, many thousands of tourists visit the island annually. It is reported that as many as 2.5 million people visit Acadian National Park on Mount Desert Island annually, many of whom will reside on island during their visit. This population swelling results in a significant increase in medical services provided by Mount Desert Island Hospital and its health centers located throughout the communtiy, While tourism continues to be one of the largest industries, the Jackson Laboratory, boat building, fishing and aquaculture are also a large part of the conomy on MDI. Based on demographic data, approximately 9 percent of the permanent population is below the poverty line. The demographics support an aging population as demonstrated by the 44 percent Medicare utilization at MDI Hospital. Mainecare, the state government program, accounted for 10 percent of the Hospitals gross patient service revenue for the fiscal year. While additional workers are needed to service the significant seasonal influx, the majority is under and or uninsured resulting in increased charity care and bad debts. Although the majority of Mount Desert Isalnds permanent popultion is Caucasian the additional tourists seasonal worksers and summer residents are a very diverse population. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The governing Board and committe members of MDI Hospital are all local residents of the community serviced by the Hospital. The Hospital's Board is part of the tapestry of the community. They are people who understand the history and culture of the community all helping the Hospital keep pace accessing the needs of their friends and neighbors. The array of community members helps MDI Hospital's Board balance its need for financial stewardship with its caring mission. As the board is comprised of people who live and work on the Island, it also ensures that MDI Hospital maintains its uniquely personal connection and intimacy to the communities it serves. Medical staff privileges are extended to all qualified physicians in the community. As MDI Hospital is located on an Island, additional specialty services are made available on the island by medical staff from the mainland, thus providing many specialty services which would otherwise be unavilable in the community. Patients would still have access to these specialties; they woudl have to travel off the island to other communities or cities to receive these services. The organization applies surplus funds to patient care improvements through its capital expenditure program, employee and medical staff education, community benefits programs, to remain viable and technologically current. Advocacy initiatives for promoting community wide, state or nataioanl efforts work to improve health of the population and increase access. Community involvement is key as MDI Hospitals ability to provide high quality health care is directly affected by the policies that are adopted in Augusta and Washington. As competing interests are at work in these venues it is necessary for the community toa dvocate for the Hospital to ensure its health which is essential to the quality of life in the community. MDI Hospital is a community hospital designated as a creitcal access hospital which participates in all federal, state and local governement programs including Medicare, MaineCare (Medicaid), and Champus. MDI Hospital provides acute and primary care services, including a 24 hour emergency room, serving all patients regardless of their ability o pay. patients are informed of Federal, State and local government benefits as well as the Hospitals financial assistance and sliding scale discounts. Information is also available to patients in various areas of the Hospital as well as written on the back of their bill. While MDI Hospital may not be directly involved in clinical research, the Jackson Laboratory, an independent non-profit organization and leading genetics research laboratory focusing on mammalian genetics research with a strong research program investigating cancer and other gneetic diseases, is a vital member of the Mount Desert Island community as well as its largest employer. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Maine X 1 1 X X X 0 0 0 0 0 0 0 1 0 Arthur J Blank 278657 0 6065 0 0 0 16500 0 26002 0 327224 0 16500 0 Mary Dudzik MD 158047 0 24786 0 0 0 5850 0 21089 0 209772 0 0 0 Julian Kuffler MD 220958 0 0 0 0 0 0 0 27208 0 248166 0 0 0 David Painter 121810 0 22985 0 0 0 16120 0 13480 0 174395 0 0 0 Brian Caine 172500 0 46484 0 0 0 0 0 5262 0 224246 0 0 0 Michael Heniser 288980 0 11857 0 0 0 0 0 19799 0 320636 0 0 0 Ronald Prokopius 266396 0 32721 0 0 0 0 0 33096 0 332213 0 0 0 Stuart Davidson 427848 0 0 0 0 0 16500 0 24612 0 468960 0 0 0 Edward White 330069 0 0 0 0 0 16073 0 25923 0 372065 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a The Hospital provides the CEO's fitness membership, which is approximately $399 per year. MDI Hospital reimburses all other benefited employees up to $100 per year towards the YMCA or other health club membership with appropriate supporting documentation. SchJ_P01_S00_L07 Schedule J, Part I, Line 7 The Hospital provides a performance incentive system for Division Directors and Vice Presidents who are employees in good standing during the entire fiscal year. The program is based on the organization maintaining top 12 status in overall patient satisfaction, meeting its financial target, as well as individual financial performance and quality improvement objectives. MHHEFA 92 Bond 1992-07-01 1300000 Contruction and renovation of hospital departments 0 0 0 MHHEFA 2006F Bond 2005-07-03 707200 Replacement of central chiller 0 0 0 MHHEFA 2007B Bond 2007-07-03 4427988 Clinic construction, office and clinic space 0 0 0 MHEFFA 2010 Bond 2010-07-01 1200000 Refinancing of 98A Bond for renovation of outpatient service area 0 0 0 0 0 1300000 0 0 0 0 0 0 1300000 0 0 1993 0 0 1 1 0 0 707200 0 0 0 0 0 0 707200 0 0 2008 0 0 1 1 0 0 4427988 0 0 0 0 0 0 4427988 0 0 2009 0 0 1 1 0 0 1200000 0 0 0 0 0 0 0 0 0 1999 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 John Benson MD -- J and D Imaging Board Member 353865 Equipment leasing and radiology services 0 SchL_P04_S00_L00 Schedule L, Part IV John Benson, MD is the proprietor of J&D Imaging Co. J&D Imaging does consulting for MDI Hospital in the form of radiology services performed by Dr. John Benson. MDI Hospital also leases radiology equipment from J&D Imaging. Although Dr. Benson is a member of the Board of Directors of MDI Hospital, he abstains from any situation which may be deemed a conflict of interest, and duly reports and completes on required disclosures. X 7 549196 Fair Market Value 0 0 1 1 SchM_P01_S00_L32b Schedule M, Part I, Line 32b The hospital policy requires that stock donations are immediately sold by the Advisors Account to which they are received. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The inital review of the Form 990 is performed by the Finance Sub-Committee of the Board of Director's of the hospital. The members are provided with an electronic copy of the Form 990 and all supporting schedules (printed versions are also availbe upon request). Once reviewed by the Finance Sub-Committee, all Board of Trustees are provided with a copy of the Form 990 and supporting schedules for review. The Form is provided thirty days in advance of filing giving the Board Members opportunity to comment and review, both the CEO, President and CFO, Vice President are availabe to answer any inquiries. Board Members are also given the opportunity to receive the final copy via an electronic format or a printed copy. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Per the conflict of interest policy, the organization monitors and enforces disclosure compliance of interests that could give rise to conflicts by officers, directors, or trustees, and key employees. Disclosures are completed and submitted to the CEO. Board members will abstain from discussions or approval if there is even an appearance of possible conflict of interest during meetings. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The compensation for CEO, other Officers and Key Employees of MDI Hospital is reviewed and approved by the governing body. Utilization of data as to comparable compensation for similarly qualified persons in functionally comparable positions at similarly situated organizations is gathered and analyzed to determine compensation for these positions. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The annual report and form 990, including financial information, is available to the public through our website at mdihospital.org. Additional financial information is available on federal and state governmental websites for required reporting. Governing documents, conflict of interest policy are availabe upon request, as are audited financial statements. F990_P11_S00_L05 Form 990, Part XI, Line 5 This is made up of Gifts and bequests, interest income on investments, realized gain on sale of investments and other miscellaneous expense. Birch Bay Village Retirement Community 10 Wayman Lane Bar Harbor ME 04609 010481696 Retirement Community ME 501(c)(3) 170(b)(1)(A)(iii) Mount Desert Island Hospital 0 Mount Desert Management Company PO Box 8 10 Wayman Lane Bar Harbor ME 04609 010538776 Real Estate Development ME Birch Bay Village Retirement Community C 37917 1047580 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Birch Bay Village Retirement Community q 405259 Receivable account - a receivable account is maintained on the general ledger of MDI Hospital, as well as an accounts payable account on the general ledger of Birch Bay Village Retirement Community. Transfers to the Birch Bay Village Retirement Community account are recorded as receivables at the time of transfer. A detail of this account is maintained in order to provide this information. This return was filed on 03/15/2013. Extensions were requested and granted, moving the due date for this return to 3/15/2013.