HENRIETTA D GOODALL HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- HENRIETTA D GOODALL HOSPITAL INC (EIN 01-0078060)
- Tax period
- 2011-06-01 to 2012-05-31
- Filed
- 2013-03-27
- IRS object ID
- 201330869349300223
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-03-27T14:48:40-05:00 | Timestamp |
| Tax Period End Date | 2012-05-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042684828 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FEELEY & DRISCOLL PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 PORTLAND STREET | AddressLine1 |
| City | BOSTON | City |
| State | MA | State |
| ZIP Code | 02114 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-06-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010078060 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRIETTA D GOODALL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HENR | NameControl |
| Phone | 2074907337 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 JUNE STREET | AddressLine1 |
| City | SANFORD | City |
| State | ME | State |
| ZIP Code | 04073 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PATRICIA APRILE | Name |
| Title | CEO/PRESIDENT | Title |
| Phone | 2074907337 | Phone |
| Date Signed | 2013-02-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFFREY T ROGERS | Name |
| PTIN | P01074284 | PTIN |
| Phone | 6177427788 | Phone |
| Date Prepared | 2013-02-12 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | PATRICIA APRILE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 JUNE STREET | AddressLine1 |
| City | SANFORD | City |
| State | ME | State |
| ZIP Code | 04073 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 96523476 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GOODALLHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1927 | YearFormation |
| State Legal Domicile | ME | StateLegalDomicile |
| Activity Or Mission Description | HENRIETTA D. GOODALL HOSPITAL, INC.'S MISSION IS TO SERVE AS A LEADER IN IMPROVING THE HEALTH AND WELL-BEING OF ITS COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1090 | TotalNbrEmployees |
| Total Nbr Volunteers | 242 | TotalNbrVolunteers |
| Total Gross UBI | 355583 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 57162 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 886119 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2446041 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 84756137 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 87287884 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 392370 | InvestmentIncomePriorYear |
| Investment Income Current Year | 776194 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 480981 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1177360 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 86515607 | TotalRevenuePriorYear |
| Total Revenue Current Year | 91687479 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 48293479 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 49695968 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 38067590 | OtherExpensePriorYear |
| Other Expenses Current Year | 39812989 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 86361069 | TotalExpensesPriorYear |
| Total Expenses Current Year | 89508957 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 154538 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2178522 | RevenuesLessExpensesCY |
| Total Assets BOY | 87795787 | TotalAssetsBOY |
| Total Assets EOY | 85944028 | TotalAssetsEOY |
| Total Liabilities BOY | 37442858 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 36911735 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 50352929 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 49032293 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | HENRIETTA D. GOODALL HOSPITAL, INC. OWNS AND OPERATES H. D. GOODALL HOSPITAL, INC. (ACUTE CARE HOSPITAL), GOODALL HEALTH PARTNERS (A MULTI-SPECIALTY PHYSICIAN AND SURGEON GROUP), THE MEDICAL GROUP (A MULTI-SPECIALTY PHYSICIAN AND SURGEON GROUP), GOODALL OUTPATIENT CLINIC (A FACILITY WHERE A VARIETY OF OUTPATIENT SERVICES ARE PERFORMED), GOODALL OUTPATIENT SERVICES-WATERBORO AND GOODALL ELDERCARE SERVICES (A LONG TERM CARE FACILITY) IN YORK COUNTY. YORK COUNTY CONSISTS OF 18 TOWNS AND CITIES LOCATED ON THE SOUTHERN MAINE COAST WITH A POPULATION OF OVER 200,000. HENRIETTA D. GOODALL HOSPITAL, INC FURTHERS ITS MISSION AS A LEADER IN IMPROVING THE HEALTH AND WELL-BEING OF THE COMMUNITY AND PROVIDES ACCESS TO NEEDED HEALTH CARE SERVICES 365 DAYS A YEAR, 24 HOURS A DAY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 55568114 | Expense |
| Revenue | 65885612 | Revenue |
| Description | GOODALL HOSPITAL IS A 58 BED HOSPITAL WHICH STRIVES TO MEET THE HEALTH CARE NEEDS OF INDIVIDUALS AND FAMILIES THROUGHOUT YORK COUNTY. GOODALL HOSPITAL OFFERS A BROAD RANGE OF MEDICAL, SURGICAL, DIAGNOSTIC, CLINICAL AND REHABILITATION SERVICES, WELLNESS EDUCATION, SUPPORT GROUPS AND OTHER COMMUNITY OUTREACH PROGRAMS. GOODALL HOSPITAL HAS HAD 21,904 EMERGENCY ROOM VISITS, 49,777 RADIOLOGY PROCEDURES, 386,848 LABORATORY PROCEDURES, 70,115 THERAPY PROCEDURES, 190 INFANTS BORN AND 2,696 SURGERY CASES. GOODALL HOSPITAL PROVIDED $2,004,448 IN CHARITY CARE TO THE COMMUNITY. THIS INCLUDES PATIENTS WHO ARE UNDERINSURED OR THOSE WITHOUT ANY INSURANCE. IN ADDITION TO THE CHARITABLE CARE SERVICES, WE ARE CONTINUALLY ABSORBING ALL THE COSTS ASSOCIATED WITH PROVIDING THE COMMUNITY A VARIETY OF SPECIAL COMPLIMENTARY EDUCATIONAL AND INFORMATIONAL SERVICES. GOODALL PROUDLY SPONSORS COMMUNITY ORGANIZATIONS, SCHOOL GROUPS, CIVIC ORGANIZATIONS AND SPECIAL EVENTS (LIKE THE LOCAL BASEBALL TEAM). GOODALL HOSPITAL SPONSORS TWO TO FOUR FREE EDUCATION EVENTS EACH MONTH OF THE YEAR ALONG WITH DOZENS OF SUPPORT GROUPS. GOODALL HOSPITAL ALSO ROUTINELY PARTICIPATES IN HEALTH FAIRS AND BUSINESS EVENTS, PERFORMING BLOOD PRESSURE CHECKS, CHOLESTEROL SCREENINGS AND CPR TRAINING. GOODALL HOSPITAL'S SENIOR ADVOCATE PROVIDES FREE ADVICE AND SERVICES TO ELDERLY MEMBERS OF THE COMMUNITY. SERVICES INCLUDE HELP WITH INSURANCE AND MEDICAL ISSUES, AS WELL AS PERSONAL ISSUES INCLUDING TAX INFORMATION, FINANCES AND HOME NEEDS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 8791177 | Expense |
| Revenue | 8859838 | Revenue |
| Description | GOODALL HEALTH PARTNERS CONSIST OF MANY PHYSICIANS WITH MULTI-SPECIALTY SERVICES IN DIFFERENT LOCATIONS THROUGHOUT YORK COUNTY. THESE PHYSICIANS COMPLIMENT THE HOSPITAL IN MAINTAINING ITS MISSION TO SERVE AS A LEADER IN IMPROVING THE HEALTH AND WELL-BEING OF OUR COMMUNITY BY SERVING THE POPULOUS. THESE SPECIALTIES INCLUDE (BUT ARE NOT LIMITED TO) CARDIOLOGY, ENT, FAMILY PRACTICES, WOMEN' HEALTH, INTERNAL MEDICINE, PEDIATRICS, ORTHO AND GENERAL SURGERY. GOODALL HEALTH PARTNERS PROVIDED $44,692 IN CHARITY CARE TO THE COMMUNITY. THE NUMBER OF PATIENTS SEEN WERE 15,365 FOR A TOTAL NUMBER OF VISITS OF 54,374. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6800747 | Expense |
| Revenue | 8119533 | Revenue |
| Description | GOODALL HOSPITAL ELDERCARE SERVICES PROVIDE LONG-TERM CARE, MEDICAL SERVICES AND DAYCARE TO OUR SENIOR CITIZENS. ELDERCARE HAD ADMITTED 296 RESIDENTS FOR A TOTAL OF 39,001 PATIENT DAYS. WE CONTINUE TO GROW AND ADAPT TO THE NEEDS OF OUR COMMUNITY WITH THIS SERVICE. GOODALL HOSPITAL ELDERCARE PRIDES THEMSELVES BY CREATING A HOME-LIKE, COMFORTABLE ENVIRONMENT FOR THE RESIDENTS AND STAFF. THE NEWTON CENTER FOR REHABILITATION AND NURSING CARE PROMOTES HIGH QUALITY CARE; WITH DEDICATED STAFF FAMILY EDUCATIONAL AND INVOLVEMENT MAKE THIS PROGRAM SPECIAL. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6462671 | Expense |
| Revenue | 5244678 | Revenue |
| Description | THE MEDICAL GROUP CONSISTS OF MANY PHYSICIANS WITH MULTI-SPECIALTY SERVICES THAT EXTEND GOODALL HOSPITAL'S EXISTING SERVICES TO KENNEBUNK, ME. THESE PHYSICIANS COMPLEMENT THE HOSPITAL IN MAINTAINING ITS MISSION TO SERVE AS A LEADER IN IMPROVING THE HEALTH AND WELL-BEING OF OUR COMMUNITY. THESE SERVICES INCLUDE (BUT ARE NOT LIMITED TO) FULL SERVICE PRIMARY CARE, WOMENS'S HEALTH, GASTROENTEROLGY, PULMONARY MEDICINE, ORTHOPEDICS AND PAIN MANAGEMENT. THE MEDICAL GROUP PROVIDED $12,629 IN CHARITY CARE TO THE COMMUNITY. THE NUMBER OF PATIENTS SEEN WERE 9,442 FOR A TOTAL NUMBER OF VISITS OF 33,306. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 6462671 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 5244678 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 77622709 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 74 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1090 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 1 | LocalChapters |
| Policies Reference Chapters | 1 | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | ME | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DANIEL FORGUES CFO | NamePerson |
| Telephone Number | 2074907327 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 JUNE STREET | AddressLine1 |
| City | SANFORD | City |
| State | ME | State |
| ZIP Code | 04073 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| LORI ANN BLACK | |||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||||
| ANN M BROOKS MD | |||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||||
| GEORGE E HISSONG JR | |||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||||
| MARK MICKERIZ | |||||||||
| CHAIR | 2.00 | X | 0 | 0 | 0 | X | |||
| DAVID C NICKERSON | |||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||||
| MERILEE MAPES PERKINS | |||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||||
| ROBERT REINKEN | |||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||||
| SUSAN T ROBERTS | |||||||||
| SECRETARY/CHAIR OF PATIENT | 2.00 | X | 0 | 0 | 0 | ||||
| WILLIAM FRANK | |||||||||
| VICE CHAIR/TREASURER | 2.00 | X | 20800 | 0 | 0 | X | |||
| PATRICIA APRILE | |||||||||
| PRESIDENT FROM 6/1/11 | 40.00 | X | 273843 | 0 | 17773 | X | |||
| DAVID EAGLESON | |||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||||
| CHARLES CARUSO | |||||||||
| CHIEF INFORMATION OFFICER | 40.00 | 170137 | 0 | 22932 | X | ||||
| DANIEL FORGUES | |||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 195941 | 0 | 15806 | X | ||||
| KATHLEEN MORRIS MD | |||||||||
| PRESIDENT OF THE MEDICAL S | 40.00 | 204901 | 0 | 16884 | X | ||||
| MUKESH BHARGAVA MD | |||||||||
| VP OF MEDICAL AFFAIRS | 16.00 | 176154 | 0 | 0 | X | ||||
| FRANK GOUDREAU | |||||||||
| PHYSICIAN | 40.00 | 485699 | 0 | 27637 | X | ||||
| JOHNATHAN SHILL | |||||||||
| PHYSICIAN | 40.00 | 340988 | 0 | 8096 | X | ||||
| NINA SHERVIN | |||||||||
| PHYSICIAN | 40.00 | 363216 | 0 | 22725 | X | ||||
| JOHN THOMPSON | |||||||||
| PHYSICIAN | 40.00 | 467968 | 0 | 27606 | X | ||||
| PETER CLARK | |||||||||
| PHYSICIAN | 40.00 | 363726 | 0 | 26919 | X | ||||
| DARLENE STROMSTAD | |||||||||
| FORMER PRESIDENT THROUGH 5/31/11 | 40.00 | 215316 | 0 | 6913 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3278689 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 193291 | TotalOtherCompensation |
| Number Individuals GT100 K | 57 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MAK ANESTHESIA INC | |||||
| 156 COUNTRY CLUB ROAD | SANFORD | ME | 04073 | ANESTHESIA SERVICES PROVIDED TO HENRIETT | 613805 |
| LEONID TEMKIN MD PA | |||||
| 239 ARUNDEL ROAD | KENNEBUNK | ME | 04046 | ANESTHESIA SERVICES PROVIDED TO HENRIETT | 577003 |
| EDWARD BURZON PC | |||||
| 1 SARAH PAUL HILL | MADBURY | NH | 03823 | PHYSICIAN SERVICES PROVIDED TO HENRIETTA | 316680 |
| THOMAS MOORE MD | |||||
| 17 MERRILL BROOK DR | SCARBOROUGH | ME | 04074 | PHYSICIAN SERVICES PROVIDED TO HENRIETTA | 300000 |
| DONALD P LYON MD PA | |||||
| PO BOX 459 | LIMERICK | ME | 04048 | PHYSICIAN SERVICES PROVIDED TO HENRIETTA | 268157 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 12 | NumberOfContractorsGT100K |
| Government Grants | 2241659 | GovernmentGrants |
| All Other Contributions | 204382 | AllOtherContributions |
| Total Contributions | 2446041 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 87287884 | TotalRevenueColumn |
| Related Or Exempt Function Income | 86935105 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 352779 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 87287884 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 622426 | TotalRevenueColumn |
| Exclusion | $622,426 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 713872 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1199201 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -485329 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -485329 | TotalRevenueColumn |
| Related Or Exempt Function Income | -485329 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3769740 | Securities |
| Other | 20824 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3622503 | Securities |
| Other | 14293 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 147237 | Securities |
| Other | 6531 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 153768 | TotalRevenueColumn |
| Exclusion | $153,768 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| REBATE REVENUE | 900099 | 658985 | 658985 |
| EQUITY IN EARNINGS OF | 900099 | 644427 | 644427 |
| CAFETERIA REVENUE | 900099 | 276348 | 276348 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 82929 | TotalRevenueColumn |
| Related Or Exempt Function Income | 80125 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2804 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1662689 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 91687479 | TotalRevenueColumn |
| Related Or Exempt Function Income | 88109661 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 355583 | UnrelatedBusinessRevenue |
| Exclusion | $776,194 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 801014 | Total |
| Management And General | 801014 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39603621 | Total |
| Program Services | 34455150 | ProgramServices |
| Management And General | 5148471 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6566432 | Total |
| Program Services | 5712796 | ProgramServices |
| Management And General | 853636 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2724901 | Total |
| Program Services | 2370664 | ProgramServices |
| Management And General | 354237 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 272598 | Total |
| Management And General | 272598 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110257 | Total |
| Management And General | 110257 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85388 | Total |
| Management And General | 85388 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6002729 | Total |
| Program Services | 4664685 | ProgramServices |
| Management And General | 1338044 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 217933 | Total |
| Management And General | 217933 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 113861 | Total |
| Program Services | 53503 | ProgramServices |
| Management And General | 60358 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 509023 | Total |
| Program Services | 164480 | ProgramServices |
| Management And General | 344543 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1438823 | Total |
| Program Services | 551873 | ProgramServices |
| Management And General | 886950 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17652 | Total |
| Program Services | 14695 | ProgramServices |
| Management And General | 2957 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 141035 | Total |
| Program Services | 102275 | ProgramServices |
| Management And General | 38760 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 827095 | Total |
| Program Services | 761053 | ProgramServices |
| Management And General | 66042 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3698096 | Total |
| Program Services | 3328286 | ProgramServices |
| Management And General | 369810 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1025638 | Total |
| Program Services | 927418 | ProgramServices |
| Management And General | 98220 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| GENERAL HOSPITAL SUPPLI | 8560504 | 8451171 | 109333 |
| PROVISION FOR DOUBTFUL | 7325314 | 7325314 | |
| MISCELLANEOUS | 3858883 | 3131186 | 727697 |
| PHYSICIAN FEES | 3693113 | 3693113 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1915047 | Total |
| Program Services | 1915047 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89508957 | Total |
| Program Services | 77622709 | ProgramServices |
| Management And General | 11886248 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5575 | BOY |
| EOY | 5277 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3451617 | BOY |
| EOY | 3957864 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9577350 | BOY |
| EOY | 9091776 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 851677 | BOY |
| EOY | 851677 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1481101 | BOY |
| EOY | 1417919 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1548569 | BOY |
| EOY | 1529545 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 75725206 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 42965079 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33827426 | BOY |
| EOY | 32760127 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12582059 | BOY |
| EOY | 11664433 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14607527 | BOY |
| EOY | 13142291 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9862886 | BOY |
| EOY | 11523119 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87795787 | BOY |
| EOY | 85944028 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13116998 | BOY |
| EOY | 14711137 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10610766 | BOY |
| EOY | 9396449 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12924027 | BOY |
| EOY | 12148451 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 791067 | BOY |
| EOY | 655698 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37442858 | BOY |
| EOY | 36911735 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38397945 | BOY |
| EOY | 38367160 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1572577 | BOY |
| EOY | 1506154 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10382407 | BOY |
| EOY | 9158979 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50352929 | BOY |
| EOY | 49032293 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87795787 | BOY |
| EOY | 85944028 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2178522 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -3499158 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 1 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $85,388 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 85388 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | HENRIETTA D. GOODALL HOSPITAL, INC. HAD A CONTRACT FOR GOVERNMENT RELATIONS SERVICES WITH THE GRINNELL ASSOCIATES TO IDENTIFY, RESEARCH AND CHAMPION EFFORTS FOR APPROPRIATION FUNDING OPPORTUNITIES TO MEET THE HOSPITAL'S GOALS AND OBJECTIVES, INCLUDING FACILITY DEVELOPMENT, SYSTEM TECHNOLOGY ENHANCEMENTS, EQUIPMENT ACQUISITION, WELLNESS AND COMMUNITY HEALTH AND EMERGENCY PREPAREDNESS. CONTRACT EXPIRED IN DECEMBER 2011. INCLUDED IS AMOUNTS PAID AS PART OF DUES TO MHA/AHA/MEHCA FOR LOBBYIST ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 21667901 | BeginningOfYearBalance |
| Contributions | 466220 | Contributions |
| Investment Earnings Or Losses | -1610061 | InvestmentEarningsOrLosses |
| Other Expenditures | 1035225 | OtherExpenditures |
| End Of Year Balance | 19488835 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 17085103 | BeginningOfYearBalance |
| Contributions | 1898375 | Contributions |
| Investment Earnings Or Losses | 2691423 | InvestmentEarningsOrLosses |
| Other Expenditures | 7000 | OtherExpenditures |
| End Of Year Balance | 21667901 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 14720200 | BeginningOfYearBalance |
| Contributions | 642735 | Contributions |
| Investment Earnings Or Losses | 1962857 | InvestmentEarningsOrLosses |
| Other Expenditures | 240689 | OtherExpenditures |
| End Of Year Balance | 17085103 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.53000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.47000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2728106 | OtherCostOrOtherBasis |
| Book Value | 2728106 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 45507046 | OtherCostOrOtherBasis |
| Depreciation | 23679076 | Depreciation |
| Book Value | 21827970 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4500636 | OtherCostOrOtherBasis |
| Depreciation | 1889154 | Depreciation |
| Book Value | 2611482 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19690977 | OtherCostOrOtherBasis |
| Depreciation | 15821243 | Depreciation |
| Book Value | 3869734 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3298441 | OtherCostOrOtherBasis |
| Depreciation | 1575606 | Depreciation |
| Book Value | 1722835 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 32760127 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| ALTERNATIVE INVESTMENTS | 2916269 | F |
| BENEFICIAL INTEREST IN PERPETUAL TRUSTS | 8228007 | F |
| INVESTMENT IN REAL PROPERTY | 1998015 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 13142291 | TotalOfBookValueSecurities |
Other Assets OtherAssets (11 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| INVESTMENTS IN SUBSIDIARIES & JOINT VENTURES | 853598 |
| DEFERRED FINANCING COSTS | 150554 |
| DUE FROM AFFILIATES | 1837232 |
| TRUSTEE HELD FUNDS (BOND FUNDS) | 668839 |
| SYNERNET WORKERS' COMPENSATION CAPITAL CONTRIBUTION | 39633 |
| CONTRIBUTION RECEIVABLE FROM REMAINDER TRUST | 32753 |
| ESTIMATED SETTLEMENTS WITH MAINECARE | 7725950 |
| INTANGIBLE ASSET - ORTHO MEDICAL RECORDS | 17892 |
| HDG DUE FROM TEMP NET ASSETS | -250 |
| HDG CAPITAL RESERVE CASH | 86490 |
| INSURANCE CAPTIVE | 110428 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 11523119 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED SETTLEMENTS DUE TO THIRD-PARTY PAYORS | $545,270 |
| INSURANCE CAPTIVE LIABILITY | $110,428 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 655698 | TotalOfAmounts |
| Total Revenue | 91687479 | TotalRevenue |
| Total Expenses | 89508957 | TotalExpenses |
| Excess Or Deficit For Year | 2178522 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -659600 | NetUnrealizedGLOnInvestments |
| Other | -$2,839,558 | OtherAmount |
| Total Adjustments | -3499158 | TotalAdjustments |
| Excess Or Deficit Per FS | -1320636 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 89478172 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -659600 | NetUnrealizedGainsInvestments |
| Other Revenues | -1525706 | OtherRevenues |
| Revenue Not Rptd F990 | -2185306 | RevenueNotRptdF990 |
| Revenue Subtotal | 91663478 | RevenueSubtotal |
| Other Revenues Not Included | 24001 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 24001 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 91687479 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 89508957 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 89508957 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 89508957 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | UNDER THE POLICY OF THE ORGANIZATION, THE ENDOWMENT ASSETS ARE INVESTED CONSERVATIVELY WITH THE INTENT OF PROVIDING A PREDICTABLE STREAM OF FUNDING TO THE ORGANIZATION FOR PURCHASES OF CAPITAL, EXPANSION PROJECTS AND TO SUPPLEMENT GENERAL OPERATIONS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES FOOTNOTE PER THE HENRIETTA D. GOODALL HOSPITAL, INC. AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS: IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE ORGANIZATION ANNUALLY EVALUATES ITS TAX STATUS AND TAX POSITIONS TAKEN WITH RESPECT TO ITS OPERATIONS AND FINANCIAL POSITION. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | DECREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS -1,240,838. UNREALIZED INVESTMENT LOSS ON TEMPORARY NET ASSETS -20,578. LOSS ON EXTINGUISHMENT OF DEBT -230,184. IMPAIRMENT OF GOODWILL -1,347,958. TOTAL TO SCHEDULE D, PART XI, LINE 8: -2,839,558. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | IMPAIRMENT OF GOODWILL -1,347,958. LOSS ON EXTINGUISHMENT OF DEBT -230,184. NET ASSETS RELEASED - USED FOR OPERATIONS 22,412. NET ASSETS RELEASED - USED FOR ACQUISITION OF PPE 30,024. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | TEMPORARY AND PERMANENT CONTRIBUTIONS 24,001. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 974496 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 29332 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 945164 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01060 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21523873 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11106871 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10417002 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11640 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22498369 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11136203 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11362166 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12700 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 957625 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 726848 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 230777 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 957625 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 726848 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 230777 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23455994 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11863051 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11592943 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12960 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 91219 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 82871 | DirectOffsettingRevenue |
| Net Community Building Expense | 8348 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 37058 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 33666 | DirectOffsettingRevenue |
| Net Community Building Expense | 3392 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 31357 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 28487 | DirectOffsettingRevenue |
| Net Community Building Expense | 2870 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 122576 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 111358 | DirectOffsettingRevenue |
| Net Community Building Expense | 11218 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 282210 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 256382 | DirectOffsettingRevenue |
| Net Community Building Expense | 25828 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,038,020 | BadDebtExpenseAmount |
| Amount Attributable To | 579202 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12637149 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14464546 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1827397 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (6 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|---|
| 1 CANCER CARE CENTER OF YORK COUNTY | |||
| SUPPORT AND PERFORM MEDICAL PROCEDURES FOR CANCER PATIENTS | 0.33330 | 0.00000 | 0.00000 |
| 2 GSM REALTOR INC | |||
| REAL ESTATE HOLDING COMPANY | 0.33330 | 0.00000 | 0.00000 |
| 3 GOODALL HOSPITAL REAL ESTATE HOLDING CO LLC | |||
| REAL ESTATE HOLDING COMPANY | 1.00000 | 0.00000 | 0.00000 |
| 4 WATERBORO MEDICAL OFFICE BUILDING LLC | |||
| REAL ESTATE HOLDING COMPANY | 1.00000 | 0.00000 | 0.00000 |
| 5 GOODALL HOSPITAL MEDICAL OFFICE BUILDING LLC | |||
| REAL ESTATE HOLDING COMPANY | 1.00000 | 0.00000 | 0.00000 |
| 6 PINE TREE INSURANCE A RECIPROCAL RISK RETENTION GROUP | |||
| PROVIDE MALPRACTICE INSURANCE FOR A GROUP OF HEALTH CARE PROVIDERS | 0.25410 | 0.00000 | 0.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRIETTA D GOODALL HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 JUNE STREET | AddressLine1 |
| City | SANFORD | City |
| State | ME | State |
| ZIP Code | 04073 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRIETTA D GOODALL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 11 | NeedsAssessmentConducted |
| Take Into Account | 0 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 9 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (9 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| NEWTON CENTER (ELDER CARE) | ||||
| 35 JULY STREET | SANFORD | ME | 04073 | NURSING HOME |
| GOODALL HEALTH PARTNERS | ||||
| 25 JUNE STREET | SANFORD | ME | 04073 | PHYSICIAN PRACTICES |
| WELLNESS CENTER | ||||
| 13 JULY STREET | SANFORD | ME | 04073 | CLINIC |
| GOODALL HEALTH PARTNERS | ||||
| 10 GOODALL DRIVE | EAST WATERBORO | ME | 04070 | PHYSICIAN PRACTICES |
| GOODALL HEALTH PARTNERS | ||||
| 272 COTTAGE STREET | SANFORD | ME | 04073 | PHYSICIAN PRACTICES |
| THE MEDICAL GROUP | ||||
| 2 LIVEWELL DRIVE | KENNEBUNK | ME | 04043 | PHYSICIAN PRACTICES |
| COMMUNITY SERVICES | ||||
| 15 DAIGLE STREET | SANFORD | ME | 04073 | COMMUNITY PROGRAMS |
| OCCUPATIONAL HEALTH SERVICES | ||||
| 2 LIVEWELL DRIVE | KENNEBUNK | ME | 04043 | CLINIC |
| GOODALL HEALTH CLINICS | ||||
| 2 LIVEWELL DRIVE | KENNEBUNK | ME | 04043 | CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: GOODALL HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO ASSISTS AND EDUCATES PATIENTS AND THEIR FAMILIES ON FINANCIAL MATTERS CONCERNING THE HOSPITAL CHARITY CARE POLICY AND ELIGIBILITY FOR STATE AND FEDERAL PROGRAMS. THIS ASSISTANCE CAN BE AS SPECIFIC AS ASSISTING THE PATIENT AND/OR FAMILIES IN COMPLETING THE VARIOUS FORMS REQUIRED BY MEDICAID AND MEDICARE. THE HOSPITAL'S SENIOR ADVOCATE PROGRAM PROVIDES FREE ADVICE AND SERVICES TO ELDERLY MEMBERS OF THE COMMUNITY. THESE SERVICES INCLUDE ASSISTANCE WITH INSURANCE AND MEDICAL ISSUES, TAX INFORMATION, PERSONAL FINANCES AND HOME NEEDS. THE SENIOR ADVOCATE HAS EXTENSIVE KNOWLEDGE OF THE ISSUES FACING SENIORS AND CAN HELP WITH ASSESSMENT OF CURRENT NEEDS AND PROVIDE REFERRALS TO EXISTING SERVICES.GOODALL HOSPITAL ALSO PROVIDES A PRESCRIPTION ASSISTANCE PROGRAM CALLED RX ASSIST. THE PROGRAM IS DESIGNED TO ASSIST THOSE WHO DO NOT QUALIFY FOR TRADITIONAL ASSISTANCE PROGRAMS SUCH AS MEDICARE D OR MAINECARE.FOR FYE 2012 THE COST TO CHARGE RATIO WAS DERIVED BY USING THE IRS 990, SCHEDULE H WORKSHEET 1 & 2 INSTRUCTIONS.IN PRIOR YEARS, THE RATIO OF COST TO CHARGE WAS CALCULATED USING DATA DERIVED FROM THE MEDICARECOST REPORT. | ||
| PART II: GOODALL HOSPITAL PROVIDES NUMEROUS EDUCATIONAL CLASSES FOR THE COMMUNITIES IT SERVICES. THE ORGANIZATION PREPARES A QUARTERLY FLYER CALLED THE "COMMUNITY EDUCATION CALENDAR". THIS LISTING PROVIDES EDUCATIONAL SEMINARS THAT ARE OPEN FOR FREE PUBLIC PARTICIPATION, HELD ON MOST EVENINGS FOR 1 1/2 HOURS, FOR EASE OF COMMUNITY PARTICIPATION. THE SEMINARS ARE LEAD BY KNOWLEDGEABLE GOODALL PROFESSIONALS WHO ARE TRAINED AND EDUCATED IN THE SPECIFIC AREAS. THE EVENTS PRESENTED IN FISCAL YEAR 2012 INCLUDE COLORECTAL CANCER AWARENESS, ASTHMA & ALLERGY AWARENESS, DIABETES SUPPORT, DRUG & ALCOHOL AWARENESS, BREAST CANCER AWARENESS, SEASONAL AFFECTIVE DISORDER, CHRONIC & COMMON PAIN, AND MANY MORE.PARTNERS FOR HEALTHIER COMMUNITIES (PHC) MOBILIZES LOCAL ORGANIZATIONAL REPRESENTATIVES AND INTERESTED COMMUNITY MEMBERS TO PROMOTE AND IMPROVE THE HEALTH AND WELL-BEING OF THE FOLLOWING COMMUNITIES: SANFORD/SPRINGVALE, ACTON, ALFRED, CORNISH, LIMERICK, LIMINGTON, LYMAN, NEWFIELD, PARSONFIELD, SHAPLEIGH, AND WATERBORO.THE HEALTHY MAINE PARTNERSHIPS RECRUITED MULTI-SECTOR PARTNERS TO SERVE ON AN ADVISORY COUNCIL TO SUPPORT WORK OF HEALTHY MAINE PARTNERSHIPS. THIS PARTNERSHIP ACTIVATED THE PHASE 6 OF THE STRATEGIC PLANNING PROCESS WHICH STARTED IN 2007. ACTION PLANS FOR 3 SEPARATE REGIONS WITHIN HEALTHY MAINE PARTNERSHIPS SERVICE AREA. PHC HAS ALSO COLLABORATED WITH THE TOWN OF SANFORD AND SAFE SCHOOLS HEALTHY STUDENTS TO MOBILIZE THE SAFE AND HEALTHY SANFORD COALITION WHICH RESULTED IN A DRUG FREE COMMUNITIES GRANT OF $625,000 FOR 5 YEARS. THIS GRANT WILL ADDRESS YOUTH SUBSTANCE ABUSE PREVENTION EFFORTS. HEALTH PROMOTION COORDINATOR SERVED AS CO-CHAIR FOR THE GRANT AND SUSTAINABILITY TASKFORCE OF THE SAFE AND HEALTHY SANFORD COALITION. THIS COORDINATOR ALSO WAS THE CHAIRPERSON FOR THE SAFE AND HEALTHY SANFORD COALITION.THROUGH DEVELOPMENT TRAINING PROVIDED IN WASHINGTON DC THE HEALTH PROMOTION COORDINATOR HAS TAKEN THE LEAD IN SECURING ACCESS TO FEDERAL RESOURCE DATABASE MANAGED BY THE FOUNDATION CENTER TO BE LOCATED IN SANFORD COMMUNITY. HEALTH PROMOTION COORDINATOR ALSO WORKED WITH THE POLICE DEPARTMENT TO DEVELOP CURRICULUM TO TRAIN CADETS AND INCORPORATE BICYCLE SAFETY PATROLS IN YOUTH CADET PROGRAMS AS WELL AS WORKED WITH THE SANFORD DOWNTOWN LEGACY DESIGN COMMITTEE TO INCREASE BIKE FRIENDLY AND ACTIVE COMMUNITIES ENVIRONMENTAL DESIGN.PHC PARTICIPATED IN BRIDGE TO HOME STRATEGIC PLANNING WITH GOODALL HOSPITAL AND LITERACY VOLUNTEERS OF GREATER SANFORD. | ||
| PART III, LINE 4: FOOTNOTE CONCERNING BAD DEBTS: HENRIETTA D. GOODALL HOSPITAL DOES NOT HAVE A SPECIFIC FOOTNOTE IN THE FINANCIAL STATEMENTS THAT DESCRIBES "BAD DEBT EXPENSE". HENRIETTA D. GOODALL HOSPITAL REPORTS ACCOUNTS RECEIVABLE FOR SERVICES RENDERED NET OF ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS, THIRD PARTY REIMBURSING AGENCIES, FREE CARE AND BAD DEBTS. A BAD DEBT ALLOWANCE IS ESTABLISHED FOR ACCOUNTS THE HOSPITAL BELIEVES WILL BECOME UNCOLLECTIBLE. THE ALLOWANCE IS ESTABLISHED BY EXAMINING HISTORICAL DATA, AGING TRENDS OF COMMERCIAL INSURANCE AND SELF-PAY BALANCES AND ECONOMIC TRENDS. THE OFFSET TO THE ALLOWANCE ACCOUNT IS TO BAD DEBT EXPENSE ON THE STATEMENT OF OPERATIONS. RECOVERIES ON ACCOUNTS PREVIOUSLY WRITTEN OFF ARE ACCOUNTED FOR ON A CASH BASIS AND ARE APPLIED DIRECTLY TO THE PROVISION FOR BAD DEBTS ON THE STATEMENT OF OPERATIONS. AMOUNTS WRITTEN OFF OR RECOVERED FROM BAD DEBTS DURING THE YEAR ARE CHARGED AGAINST THE ALLOWANCE ACCOUNT ON THE BALANCE SHEET. BAD DEBT EXPENSE REPRESENTS HEALTHCARE SERVICES HENRIETTA D. GOODALL HOSPITAL HAS PROVIDED WITHOUT COMPENSATION. AS A TAX-EXEMPT HOSPITAL, HENRIETTA D. GOODALL HOSPITAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. A PORTION OF HENRIETTA D. GOODALL HOSPITAL'S BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE THAT, FOR A VARIETY OF REASONS, DO NOT COMPLETE THE FINANCIAL ASSISTANCE APPLICATION PROCESS. HENRIETTA D. GOODALL HOSPITAL CANNOT DETERMINE THE AMOUNT OF BAD EXPENSE THAT COULD BE REASONABLY ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FREE CARE POLICY. IN ADDITION, BAD DEBT EXPENSE ALSO INCLUDES AMOUNTS FOR SERVICES PROVIDED TO INDIVIDUALS EXPERIENCING DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES RELATED TO A PORTION OF OUR COMMUNITY BASED PATIENT POPULATION. THEIR MEDICAL BILLS OFTEN PLACE THESE INDIVIDUALS IN UNTENABLE POSITIONS WHERE THEY ARE NOT ABLE TO HANDLE THEIR PERSONAL DEBT AND THEN THEIR NEW MEDICAL DEBT. HOWEVER, BECAUSE OF THEIR INCOME LEVEL, THEY DO NOT QUALIFY FOR FREE CARE. BY PROVIDING NECESSARY HEALTHCARE SERVICES TO THOSE INDIVIDUALS EITHER WHO FAIL TO APPLY FOR FINANCIAL ASSISTANCE OR WHO ARE EXPERIENCING DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES, HENRIETTA D. GOODALL HOSPITAL BELIEVES THAT BAD DEBT EXPENSE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. | ||
| PART III, LINE 8: THE COSTING METHODOLOGY CONSISTS OF APPLYING A COST TO CHARGE RATIO TO INPATIENT AND OUTPATIENT REVENUES BASED ON MEDICARE COST REPORT. THE COMPUTED SHORTFALL HAS NOT BEEN INCLUDED IN COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. HENRIETTA D. GOODALL HOSPITAL BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL HAS A CLEAR MISSION COMMITMENT TO SERVING ELDERLY PATIENTS AND ADULTS WITH DISABILITIE THROUGH THE PROVISION OF SPECIFIC SUBSIDIZED PROGRAMS DEVELOPED TO HELP IMPROVE THE HEALTH STATUS OF THESE PATIENTS. IF THESE CRITICAL SUBSIDIZED PROGRAMS WERE NOT PROVIDED BY THE HOSPITAL, THEY WOULD BECOME THE OBLIGATION OF THE FEDERAL GOVERNMENT. | ||
| PART V, SECTION B, LINE 5C: THE ASSESSMENT WAS AVAILABLE THROUGH OTHER NON-HOSPITAL FACILITIES. | HENRIETTA D. GOODALL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 19D: THE HOSPITAL USES COST AS THE BASIS FOR MARKUP. THE MARKUP TO CHARGE INCLUDES DIFFERING PERCENTAGES BASED ON A TIER COSTING SYSTEM. | HENRIETTA D. GOODALL HOSPITAL, INC. | |
| PART VI, LINE 2: GOODALL HOSPITAL'S BOARD OF TRUSTEES IS COMPRISED OF A DIVERSE GROUP OF COMMUNITY MEMBERS. THE BOARD OF TRUSTEES PROVIDES INSIGHT AND DIRECTION TO THE HOSPITAL. FROM NOVEMBER 2007 TO JUNE 2010, THE THREE HEALTHY MAINE PARTNERSHIPS IN YORK COUNTY, ALSO KNOWN AS YORK PUBLIC HEALTH DISTRICT, LED AN ASSESSMENT PROCESS AS THE FIRST STEP TOWARD COMMUNITY-WIDE STRATEGIC PLANNING TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THOSE WHO LIVE HERE. THE HEALTHY MAINE PARTNERSHIPS ARE: COASTAL HEALTHY COMMUNITIES COALITION AT THE UNIVERSITY OF NEW ENGLAND'S COLLEGE OF OSTEOPATHIC MEDICINE; PARTNERS FOR HEALTHIER COMMUNITIES, A PROGRAM OF GOODALL HOSPITAL; AND CHOOSE TO BE HEALTHY AT YORK HOSPITAL. A CORE GROUP OF ORGANIZATIONS THAT JOINED THEM INCLUDED UNITED WAY OF YORK COUNTY, YORK COUNTY FAMILY COMMUNITY ACTION CORPORATION, SOUTHERN MAINE MEDICAL CENTER, NORTHERN YORK COUNTY FAMILY YMCA AND THE YORK DISTRICT TOBACCO COORDINATOR. THE GROUP NAMED THEMSELVES HEALTHY YORK COUNTY. THEY UTILIZED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) PROCESS CREATED BY THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS. A VISIONING PROCESS AND FOUR MAPP ASSESSMENTS WERE COMPLETED IN YORK DISTRICT BETWEEN NOVEMBER 2007 AND JUNE 2010. OVER 3,100 YORK DISTRICT RESIDENTS PARTICIPATED IN THIS PROCESS EITHER BY RESPONDING TO A COUNTY-WIDE SURVEY AND/OR PARTICIPATING IN COMMUNITY MEETINGS TO IDENTIFY KEY HEALTH ISSUES AND COMMUNITY CONCERNS. THIS INFORMATION WAS COLLECTED TO INFORM THE DEVELOPMENT OF COMMUNITY HEALTH IMPROVEMENT PLAN THAT MAXIMIZES RESOURCES, TAKES INTO ACCOUNT UNIQUE CIRCUMSTANCES AND NEEDS, AND FORMS EFFECTIVE PARTNERSHIPS FOR STRATEGIC ACTION.THIS ASSESSMENT HAS BEEN DISTRIBUTED AND DISCUSSED WITH THE COMMUNITIES AND GROUPS SO AS TO BUILD AWARENESS OF THE HEALTH CARE NEEDS OF THOSE AROUND THEM. THE HOSPITAL HAS DISCUSSED AND HAS IMPLEMENTED PROGRAMS TO ADDRESS ISSUES AND EDUCATE PATIENTS APPROPRIATELY.THE HEALTHY MAINE PARTNERSHIPS RECRUITED MULTI-SECTOR PARTNERS TO SERVE ON AN ADVISORY COUNCIL TO SUPPORT WORK OF HEALTHY MAINE PARTNERSHIPS.THE HEALTHY MAINE PARTNERSHIPS INSTITUTED PHASE 6 OF THE STRATEGIC PLANNING PROCESS OF THE COMMUNITY HEALTH IMPROVEMENT WHICH STARTED IN 2007. ACTION PLANS FOR 3 SEPARATE REGIONS WITHIN HEALTHY MAINE PARTNERSHIPS SERVICE AREA. | ||
| PART VI, LINE 3: GOODALL HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO ASSISTS AND EDUCATES PATIENTS AND THEIR FAMILIES ON FINANCIAL MATTERS CONCERNING THE HOSPITAL CHARITY CARE POLICY AND ELIGIBILITY FOR STATE AND FEDERAL PROGRAMS. THIS ASSISTANCE CAN BE A S SPECIFIC AS ASSISTING THE PATIENT AND/OR FAMILIES IN COMPLETING THE VARIOUS FORMS REQUIRED BY MEDICAID AND MEDICARE.POSTING OF THE FINANCIAL ASSISTANCE CONTACT INFORMATION IS PRESENT IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATIONS FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. PATIENT BILLS INCLUDE A SUMMARY OF THE POLICY ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION.GOODALL HOSPITAL WORKS WITH GOODALL'S SELF PAY PATIENTS ADVANCED PATIENT ADVOCACY PROGRAM THAT SCREEN FOR ALL INPATIENTS AND OUTPATIENTS THAT MEET APPROPRIATE CRITERIA. THIS PROGRAM EFFECTIVELY EDUCATE PATIENTS ABOUT THEIR COVERAGE OPTIONS, NAVIGATE COMPLEX PROGRAM CRITERIA AND ENROLL MORE UNINSURED IN PROGRAM(S) THAT BEST MATCH THEIR NEEDS.THE HOSPITAL'S SENIOR ADVOCATE PROGRAM PROVIDES FREE ADVICE AND SERVICES TO THE ELDERLY MEMBERS OF THE COMMUNITY. THIS PROGRAM IS DESIGNED TO BE A CENTRAL POINT OF ACCESS FOR SENIOR CITIZENS TO OBTAIN INFORMATION, RESOURCES AND ADVOCACY. PROGRAM RESOURCES INCLUDE, BUT ARE NOT LIMITED TO, MEDICARE, RETIREMENT PLANNING, HOUSING, FINANCIAL ASSISTANCE, INSURANCE COUNSELING, FRAUD PROTECTION, AS WELL AS COMPREHENSIVE ELIGIBILITY SCREENING FROM A HOST OF GOVERNMENT / STATE ASSISTANCE PROGRAMS AND OTHER LOCAL FUNDING SOURCES.GOODALLS PRESCRIPTION ASSISTANCE PROGRAM IS DESIGNED TO ASSIST THOSE WHO DO NOT QUALIFY FOR OTHER TRADITIONAL ASSISTANCE PROGRAMS SUCH AS MEDICARE D OR MAINECARE, BUT WHOSE FINANCIAL SITUATION QUALIFIES THEM TO RECEIVE SUPPORT. THE COORDINATOR SERVES AS A LIAISON BETWEEN THE HEALTHCARE PROVIDER, PHARMACEUTICAL COMPANIES AND THE PATIENT. THE GOALS OF THIS PROGRAM ARE TO ASSIST INDIVIDUALS WITHOUT PRESCRIPTION DRUG COVERAGE IN NAVIGATING THE SYSTEM, OBTAINING THEIR PRESCRIBED MEDICATIONS AND DEVELOPING LONG-TERM SOLUTIONS TOWARDS ACQUIRING MEDICATIONS IN THE FUTURE. | ||
| PART VI, LINE 4: GOODALL HOSPITAL SERVES THE POPULATION OF WESTERN YORK COUNTY, MAINE. SANFORD IS THE TOWN WITH THE LARGEST POPULATION IN THE HOSPITAL'S SERVICE AREA, WITH A POPULATION OF APPROXIMATELY 21,000 WITH AN ELDERLY POPULATION RATE OF 15% AND FAMILIES REPRESENTING 64% OF THIS POPULATION, WITH 93% BEING WHITE CAUCASIAN.THE HOSPITAL'S MEDICAID VOLUME IS 24% AND IS AMONGST THE HIGHEST IN THE STATE AND REFLECTS THE HIGH PERCENTAGE OF FAMILIES WITH INCOME LESS THAN 100% OF THE FEDERAL POVERTY LEVEL. SANFORD'S POVERTY RATE IS 17%, WHILE THE STATE OF MAINE IS AT 12%. 72% OF SANFORD'S ELEMENTARY SCHOOL CHILDREN ARE ELIGIBLE TO RECEIVE FREE OR SUBSIDIZED MEALS.SANFORD'S UNEMPLOYMENT RATE OF 10% EXCEEDS THE STATE'S OVERALL UNEMPLOYMENT RATE OF 8%. SANFORD HAS BEEN DESIGNATED AS A MEDICALLY UNDERSERVICED AREA. | ||
| PART VI, LINE 5: A MAJORITY OF THE ORGANIZATIONS GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATIONS PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF.OUR DIRECTORS/MANAGERS/COORDINATORS AND EMPLOYEES OF GOODALL HOSPITAL ARE ENCOURAGED TO PARTICIPATE IN THE COMMUNITIES ACTIVITIES AND SUPPORT GROUPS THAT BENEFIT THE COMMUNITY AT LARGE. EXAMPLES OF THESE ACTIVITIES ARE AS FOLLOWS:COLLABORATING WITH TOWN LIBRARY TO PRESENT EVENTS AROUND HEALTH AND SAFETY OF THE PERSONS. SUPPORT, INTRODUCE AND COACH FAMILIES TO PROGRAMS IN WHICH THEY CAN UNDERSTAND THEIR OWN HEALTH AND SAFETY, WHICH RESULT ON A FOCUS ON REDUCING PREVENTABLE ILLNESSES AND INJURIES, THUS REDUCING HEALTH CARE TREATMENT COSTS AND IMPROVING LIVES.LINKING FAMILIES WITH OTHER FAMILIES THAT ARE EXPERIENCING SIMILAR LIFE CIRCUMSTANCES THROUGH COMMUNITY EVENTS THAT INCLUDE THE PARENTS AND CHILDREN PARTICIPATION.LEAD SCREENING AND PREVENTION EDUCATION, TEST KIT MAILERS AND INFORMATION TO ALERT THE COMMUNITIES OF THE IMPORTANCE OF LEAD TESTING AND TREATMENT IF APPROPRIATE AT YOUNG AGES. | ||
| PART VI, LINE 6: N/A | ||
| ME | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PATRICIA APRILE | |||||||||||||
| 243843 | 0 | 30000 | 0 | 0 | 0 | 2450 | 0 | 15323 | 0 | 291616 | 0 | 0 | 0 |
| CHARLES CARUSO | |||||||||||||
| 170137 | 0 | 0 | 0 | 0 | 0 | 1721 | 0 | 21211 | 0 | 193069 | 0 | 0 | 0 |
| DANIEL FORGUES | |||||||||||||
| 195941 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15806 | 0 | 211747 | 0 | 0 | 0 |
| KATHLEEN MORRIS MD | |||||||||||||
| 204901 | 0 | 0 | 0 | 0 | 0 | 3094 | 0 | 13790 | 0 | 221785 | 0 | 0 | 0 |
| MUKESH BHARGAVA MD | |||||||||||||
| 176154 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 176154 | 0 | 0 | 0 |
| FRANK GOUDREAU | |||||||||||||
| 485699 | 0 | 0 | 0 | 0 | 0 | 2450 | 0 | 25187 | 0 | 513336 | 0 | 0 | 0 |
| JOHNATHAN SHILL | |||||||||||||
| 320988 | 0 | 20000 | 0 | 0 | 0 | 3675 | 0 | 4421 | 0 | 349084 | 0 | 0 | 0 |
| NINA SHERVIN | |||||||||||||
| 363216 | 0 | 0 | 0 | 0 | 0 | 2450 | 0 | 20275 | 0 | 385941 | 0 | 0 | 0 |
| JOHN THOMPSON | |||||||||||||
| 467968 | 0 | 0 | 0 | 0 | 0 | 2450 | 0 | 25156 | 0 | 495574 | 0 | 0 | 0 |
| PETER CLARK | |||||||||||||
| 363726 | 0 | 0 | 0 | 0 | 0 | 2865 | 0 | 24054 | 0 | 390645 | 0 | 0 | 0 |
| DARLENE STROMSTAD | |||||||||||||
| 185316 | 0 | 30000 | 0 | 0 | 0 | 2133 | 0 | 4780 | 0 | 222229 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| MAINE HEALTH AND HIGHER EDUCATIONAL FACILITIES AUTHORITY | |||||||
| 010314384 | 560425D49 | 2006-09-07 | 6020317 | RENOVATE HOSPITAL AND PURCHASE EQUIPMENT | 0 | 0 | 0 |
| MAINE HEALTH AND HIGHER EDUCATIONAL FACILITIES AUTHORITY | |||||||
| 010314385 | 560425H37 | 2007-07-18 | 5108908 | REFINANCE MHHEFA REVENUE BOND 1996A | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Amount UnspentAmountUnspent | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|
| 6470000 | 522453 | 82639 | 5836740 | 293000 | 2007 | 0 | 0 | 1 | 1 |
| 78484 | 451093 | 78484 | 0 | 1 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 1 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PETER G BOOTH | NamePerson |
| Purpose Of Loan | TO PROVIDE RETIREMENT FUNDS VIA A SPLIT DOLLAR LIFE INSURANCE POLICY | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $851,677 | OriginalPrincipalAmount |
| Balance Due | 851677 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 851677 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| MARK MICKERIZ | |||
| CHAIR OF GOODALL'S BOARD AND PRESIDENT OF SANFORD INSTITUTE FOR SAVINGS | 4408110 | SANFORD INSTITUTE FOR SAVINGS (SIS) HAS FOUR OUTSTANDING LOANS WITH HENRIETTA D. GOODALL HOSPITAL, INC. THE ORIGINAL AMOUNT OF THE LOAN WAS $7,368,000 AND AS OF MAY 31, 2012, THE REMAINING BALANCE ON THE LOANS WERE $4,408,110. | 0 |
| WEBER SHILL | |||
| FORMER OWNER OF TMG | 1236348 | WEBER SHILL HAS ONE OUTSTANDING LOAN WITH HENRIETTA D. GOODALL HOSPITAL INC. FOR THE PURCHASE OF THE MEDICAL GROUP. THE ORIGINAL AMOUNT OF THE LOAN WAS $1,835,248 AND AS OF MAY 31, 2012, THE REMAINING BALANCE OF THE LOAN WAS $1,236,348. | 0 |
| WILLIAM FRANK | |||
| TREASURER OF GOODALL'S BOARD | 20800 | GOODALL HOSPITAL CONTRACTS WITH DR. FRANK TO PERFORM VARIOUS DUTIES AT THE HOSPITAL, SUCH AS ON CALL, IMPACT COVERAGE, AND SOME COMMITTEES. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | MANAGEMENT REVIEWS THE 990 WITH ITS EXTERNAL AUDITORS PRIOR TO SUBMISSION. MANAGEMENT WILL MAKE THE 990 AVAILABLE FOR BOARD REVIEW PRIOR TO SIGNATURE AND SUBMISSION OF THE RETURN. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE HOSPITAL ENSURES THAT THE CONFLICT OF INTEREST POLICY IS ENFORCED BY REQUIRING BOARD MEMBERS TO SIGN CONFLICT OF INTEREST DOCUMENTS ON A YEARLY BASIS. THESE DOCUMENTS ARE REVIEWED ANNUALLY BY MANAGEMENT TO IDENTIFY ANY CONFLICTS, ACTUAL OR PERCEIVED, AND TO DEVELOP NECESSARY RESOLUTIONS FOR ANY INDENTIFIED CONFLICTS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | 15A: THE BOARD OF DIRECTORS APPROVES THE COMPENSATION FOR THE CEO AFTER CAREFUL REVIEW OF INDUSTRY SALARY COMPENSATION INFORMATION (COMPENSATION STUDY) WITH AN OUTSIDE COMPENSATION CONSULTANT. 15B: UNDER THE GUIDANCE OF PROFESSIONAL COMPENSATION CONSULTANTS, THE HR DIRECTOR REVIEWS THE PAY MODEL WITH THE CEO AND COO TO ENSURE THAT THE ORGANIZATION IS ABLE TO RECRUIT AND RETAIN A HIGHLY QUALIFIED WORKFORCE, WHILE PROVIDING THE NECESSARY STRUCTURE TO EFFECTIVELY MANAGE THE COMPETITIVE ADVANTAGE OF PRODUCTIVITY, TOTAL QUALITY, CUSTOMER SERVICE AND COSTS. | |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION WILL PROVIDE ITS FORMS 1023, 990 AND 990-T UPON WRITTEN REQUEST. IT EVALUATES THE REASON FOR THE REQUEST AND DEEMS WHETHER IT WILL OFFER THESE DOCUMENTS BASED ON THE INTENT AND PURPOSE OF THE REQUEST. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HOSPITAL WILL PROVIDE ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY UPON WRITTEN REQUEST. IT EVALUATES THE REASON FOR THE REQUEST AND DEEMS WHETHER IT WILL OFFER THESE DOCUMENTS BASED ON THE INTENT AND PURPOSE OF THE REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -659,600. DECREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS -1,240,838. UNREALIZED INVESTMENT LOSS ON TEMPORARY NET ASSETS -20,578. LOSS ON EXTINGUISHMENT OF DEBT -230,184. IMPAIRMENT OF GOODWILL -1,347,958. TOTAL TO FORM 990, PART XI, LINE 5: -3,499,158. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|
| GOODALL HOSPITAL REAL ESTATE HOLDING COMPANY LLC | |||||||
| 25 JUNE STREET | SANFORD | ME | 04073 | 010078060 | REAL ESTATE HOLDING COMPANY | ME | HENRIETTA D GOODALL HOSPITAL INC |
| WATERBORO MEDICAL OFFICE BUILDING LLC | |||||||
| 25 JUNE STREET | SANFORD | ME | 04073 | 010078060 | REAL ESTATE HOLDING COMPANY | ME | HENRIETTA D GOODALL HOSPITAL INC |
| GOODALL HOSPITAL MEDICAL OFFICE BUILDING LLC | |||||||
| 25 JUNE STREET | SANFORD | ME | 04073 | 010078060 | REAL ESTATE HOLDING COMPANY | ME | HENRIETTA D GOODALL HOSPITAL INC |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MANOR AT PHILLIPSTOWN PLACE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 JUNE STREET | AddressLine1 |
| City | SANFORD | City |
| State | ME | State |
| ZIP Code | 04073 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010473857 | EIN |
| Primary Activities | PROVIDE CARE TO THE ELDERLY | PrimaryActivities |
| Legal Domicile State | ME | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 9 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRIETTA D GOODALL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 0 | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JUNE STREET PHARMACY LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 JUNE STREET | AddressLine1 |
| City | SANFORD | City |
| State | ME | State |
| ZIP Code | 04073 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020765952 | EIN |
| Primary Activity | PROVIDE PHARMACY SERVICES TO THE COMMUNITY. | PrimaryActivity |
| Legal Domicile State | ME | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRIETTA D GOODALL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | -234623 | ShareOfTotalIncome |
| Share Of EOY Assets | 818185 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (11 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| JUNE STREET PHARMACY LLC | ||
| A | 56768 | ACTUAL INTEREST CHARGED |
| JUNE STREET PHARMACY LLC | ||
| K | 80269 | COST INCURRED HEALTH INSURANCE |
| MANOR AT PHILLIPSTOWN PLACE INC | ||
| K | 184224 | COST INCURRED HEALTH INSURANCE |
| JUNE STREET PHARMACY LLC | ||
| N | 18000 | COST INCURRED FOR MGT SERVICES |
| MANOR AT PHILLIPSTOWN PLACE INC | ||
| N | 33000 | COST INCURRED FOR MGT SERVICES |
| JUNE STREET PHARMACY LLC | ||
| D | 797000 | ACTUAL PRINCIPAL DUE LOC |
| MANOR AT PHILLIPSTOWN PLACE INC | ||
| P | 79290 | ACTUAL COSTS INCURRED |
| MANOR AT PHILLIPSTOWN PLACE INC | ||
| K | 66792 | COST INCURRED OTHER EXPENSES |
| JUNE STREET PHARMACY LLC | ||
| K | 25084 | COST INCURRED OTHER EXPENSES |
| JUNE STREET PHARMACY LLC | ||
| D | 388200 | ACTUAL PRINCIPAL DUE NOTE PAYABLE |
| JUNE STREET PHARMACY LLC | ||
| I | 38904 | COST INCURRED RENT |
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