2012-04-09T13:28:16-05:00 2011-05-31 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2010-06-01 010078060 HENRIETTA D GOODALL HOSPITAL INC HENR 2074907337 25 JUNE STREET SANFORD ME 04073 PATRICIA APRILE 2074907337 2012-03-19 1 JEFFREY T ROGERS 6177427788 2012-03-19 2010 2016-02-24 21:20:13Z PATRICIA APRILE 25 JUNE STREET SANFORD ME 04073 89034399 0 X WWW.GOODALLHOSPITAL.ORG X 1927 ME HENRIETTA D. GOODALL HOSPITAL, INC.'S MISSION IS TO SERVE AS A LEADER IN IMPROVING THE HEALTH AND WELL-BEING OF ITS COMMUNITY. 13 10 1052 83 637980 44607 1551088 886119 78388437 84756137 505858 392370 935761 480981 81381144 86515607 0 0 0 0 44020030 48293479 0 0 44466 36806772 38067590 80826802 86361069 554342 154538 84336393 87795787 37018987 37442858 47317406 50352929 X 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. 0 0 52959453 63567757 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 21,684 EMERGENCY ROOM VISITS, 48,669 RADIOLOGY PROCEDURES, 389,153 LABORATORY PROCEDURES, 67,687 THERAPY PROCEDURES, 190 INFANTS BORN AND 2,585 SURGERY CASES. GOODALL HOSPITAL PROVIDED $1,457,760 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. 8360604 8382439 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. THE NUMBER OF PATIENTS SEEN WERE 14,709 FOR A TOTAL NUMBER OF VISITS OF 54,019. 6550394 7957160 GOODALL HOSPITAL ELDERCARE SERVICES PROVIDE LONG-TERM CARE, MEDICAL SERVICES AND DAYCARE TO OUR SENIOR CITIZENS. ELDERCARE HAD ADMITTED 303 RESIDENTS FOR A TOTAL OF 39,025 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. 6642193 5434037 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 NUMBER OF PATIENTS SEEN WERE 9,179 FOR A TOTAL NUMBER OF VISITS OF 35,315. 6642193 5434037 74512644 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 64 0 1 1052 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 ME X DANIEL FORGUES CFO 2074907327 25 JUNE STREET SANFORD ME 04073 X LORI ANN BLACK 2.00 X 0 0 0 ANN M BROOKS MD 2.00 X 0 0 0 GEORGE E HISSONG JR 2.00 X 0 0 0 MARK MICKERIZ 2.00 X X 0 0 0 DAVID C NICKERSON 2.00 X 0 0 0 MERILEE MAPES PERKINS 2.00 X 0 0 0 MICHAEL L RALSTON 2.00 X 0 0 0 ROBERT REINKEN 2.00 X 0 0 0 SUSAN T ROBERTS 2.00 X 0 0 0 WILLIAM FRANK 2.00 X X 18675 0 0 DARLENE STROMSTAD 40.00 X X 416547 0 13635 PATRICIA APRILE 40.00 X X 200487 0 19034 RONALD BRYANT 40.00 X X 123130 0 15000 CHARLES CARUSO 40.00 X X 161469 0 22052 DANIEL FORGUES 40.00 X X 0 0 0 KATHLEEN MORRIS MD 2.00 X X 197940 0 12813 DAVID EAGLESON 2.00 X 0 0 0 BECKY BRINK 2.00 X 0 0 0 MUKESH BHARGAVA MD 16.00 X X 150127 0 0 ADAM SCHLAGER 40.00 X X 19539 0 101 FRANK GOUDREAU 40.00 X 444944 0 26816 JOHNATHAN SHILL 40.00 X 293871 0 13774 KENT HALL 40.00 X 347140 0 20655 NINA SHERVIN 40.00 X 396205 0 16296 JOHN THOMPSON 40.00 X 413702 0 26010 LORRAINE D MASURE 2.00 X 0 0 0 MARK RAUTENBERG MD 2.00 X 0 0 0 WEBER SHILL 40.00 X 0 0 0 DAVID HAMLIN 40.00 X 0 0 0 ROBERT I HARDISON 2.00 X 0 0 0 3183776 0 186186 48 1 1 0 MAK ANESTHESIA INC 156 COUNTRY CLUB ROAD SANFORD ME 04073 ANESTHESIA SERVICES PROVIDED TO HENRIETT 574527 LEONID TEMKIN MD PA 239 ARUNDEL ROAD KENNEBUNK ME 04046 ANESTHESIA SERVICES PROVIDED TO HENRIETT 521309 THOMAS MOORE MD 17 MERRILL BROOK DR SCARBOTOURHG ME 04074 PHYSICIAN SERVICES PROVIDED TO HENRIETTA 287302 MARK RAUTENBERG MD 300 SLIGO ROAD ROLLINGSFORD NH 03869 PHYSICIAN SERVICES PROVIDED TO HENRIETTA 266131 EDWARD BURZON PC 1 SARAH PAUL HILL MADBURY NH 03823 PHYSICIAN SERVICES PROVIDED TO HENRIETTA 263900 12 697353 188766 886119 NET PATIENT SERVICE RE 900099 84756137 84119202 636935 84756137 565661 565661 714880 1255642 -540762 -540762 -540762 1082611 7248 1241441 21709 -158830 -14461 -173291 -173291 REBATE REVENUE 900099 426703 426703 CAFETERIA REVENUE 900099 252318 252318 MISCELLANEOUS REVENUE 900099 243996 243996 98726 97681 1045 1021743 86515607 84599138 637980 392370 933651 933651 38715513 33647710 5033017 34786 5902283 5130671 767297 4315 2742032 2382302 356464 3266 119192 119192 121676 121676 126000 126000 6020446 4551148 1469298 96874 96874 102814 86681 16101 32 506835 119587 387248 1589071 588086 1000985 18306 14711 3595 148307 119751 28192 364 846629 771891 74738 3647794 3283015 364779 1059414 969785 89629 GENERAL HOSPITAL SUPPLI 8045030 7925434 119478 118 PROVISION FOR DOUBTFUL 5914783 5914783 MISCELLANEOUS 3937510 3240180 695745 1585 PHYSICIAN FEES 3911984 3911984 HEALTHCARE PROVIDER TAX 1854925 1854925 86361069 74512644 11803959 44466 5185 5575 5414641 3451617 7753284 9577350 851677 851677 1535788 1481101 2094494 1548569 73409727 39582301 34628970 33827426 8087521 12582059 12710758 14607527 11254075 9862886 84336393 87795787 12651004 13116998 11814439 10610766 12061491 12924027 492053 791067 37018987 37442858 X 36953692 38397945 1451392 1572577 8912322 10382407 47317406 50352929 84336393 87795787 X 154538 2880986 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 0 1 135858 135858 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: HENRIETTA D. GOODALL HOSPITAL, INC. HAS 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. INCLUDED IS AMOUNTS PAID AS PART OF DUES TO MHA/AHA FOR LOBBYIST ACTIVITIES. 17085103 1898375 2691423 7000 21667901 14720200 642735 1962857 240689 17085103 0.52000 0.48000 1 0 2728106 2728106 43978411 21815780 22162631 4521887 1649985 2871902 18902264 14948138 3954126 3279059 1168398 2110661 33827426 ALTERNATIVE INVESTMENTS 2992034 F BENEFICIAL INTEREST IN PERPETUAL TRUSTS 9468845 F INVESTMENT IN REAL PROPERTY 2146648 F 14607527 INVESTMENTS IN SUBSIDIARIES & JOINT VENTURES 493126 DEFERRED FINANCING COSTS 171184 DUE FROM AFFILIATES 1671001 TRUSTEE HELD FUNDS (BOND FUNDS) 1327303 SYNERNET WORKERS' COMPENSATION CAPITAL CONTRIBUTION 39633 CONTRIBUTION RECEIVABLE FROM REMAINDER TRUST 32933 ESTIMATED SETTLEMENTS WITH MAINECARE 4688424 INTANGIBLE ASSET - TMG GOODWILL 1347958 INTANGIBLE ASSET - ORTHO MEDICAL RECORDS 17892 HDG DUE FROM TEMP NET ASSETS 4344 HDG CAPITAL RESERVE CASH 69088 9862886 ESTIMATED SETTLEMENTS DUE TO THIRD-PARTY PAYORS 791067 791067 86515607 86361069 154538 102480 2778506 2880986 3035524 87805322 1289715 1289715 86515607 0 86515607 86361069 0 86361069 0 86361069 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: RELEASES FROM TEMPORARILY RESTRICTED NET ASSETS -20,379. INCREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 1,464,292. UNREALIZED GAIN ON SECURITIES 1,289,715. OTHER CHANGES IN NET ASSETS -3,686. RESTRICTED CONTRIBUTIONS 48,564. 1 1 X 1 X 1 X 1 1 0 1 1 4858211 4858211 0.05630 16033775 11097345 4936430 0.05720 20891986 11097345 9794641 0.11350 1046016 841847 204169 0.00240 1046016 841847 204169 0.00240 21938002 11939192 9998810 0.11590 99204 87947 11257 0.00010 62002 54967 7035 0.00010 31001 27483 3518 0.00000 102304 90695 11609 0.00010 15501 13742 1759 0.00000 310012 274834 35178 0.00030 1 2469304 710475 12992147 14010714 -1018567 X 1 1 1 CANCER CARE CENTER OF YORK COUNTY SUPPORT AND PERFORM MEDICAL PROCEEDURES 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 0.25860 0.00000 0.00000 10 1 HENRIETTA D GOODALL HOSPITAL INC

25 JUNE STREET SANFORD ME 04073

X X X 2 NEWTON CENTER (ELDER CARE)

35 JULY STREET SANFORD ME 04073

NURSING HOME 3 GOODALL HEALTH PARTNERS

25 JUNE STREET SANFORD ME 04073

PHYSICIAN PRACTICES 4 WELLNESS CENTER

13 JULY STREET SANFORD ME 04073

CLINIC 5 GOODALL HEALTH PARTNERS

10 GOODALL DRIVE EAST WATERBORO ME 04070

PHYSICIAN PRACTICES 6 GOODALL HEALTH PARTNERS

272 COTTAGE STREET SANFORD ME 04073

PHYSICIAN PRACTICES 7 THE MEDICAL GROUP

2 LIVEWELL DRIVE KENNEBUNK ME 04043

PHYSICIAN PRACTICES 8 COMMUNITY SERVICES

15 DAIGLE STREET SANFORD ME 04073

COMMUNITY PROGRAMS 9 OCCUPATIONAL HEALTH SERVICES

2 LIVEWELL DRIVE KENNEBUNK ME 04043

PHYSICIAN PRACTICES 10 GOODALL HEALTH CLINICS

2 LIVEWELL DRIVE KENNEBUNK ME 04043

CLINIC HENRIETTA D GOODALL HOSPITAL INC 1 PART I, LINE 6A: PARTNERS FOR HEALTHIER COMMUNITIES HAS COLLABORATED WITH YORK DISTRICT HEALTHY MAINE PARTNERSHIPS, THE GREATER YORK COUNTY UNITED WAY, YORK COUNTY HEAD START, AND THE GREATER YORK COUNTY YMCA TO GUIDE A COUNTY-WIDE COMMUNITY NEEDS ASSESSMENT PROCESS UTILIZING MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). THE ASSESSMENT REPORTS WERE SHARED AT VARIOUS COMMUNITY FORUMS. 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. PART 2 LINE 3: COMMUNITY SUPPORT WAS ACHIEVED BY THE DIRECTOR OF PARTNERS FOR HEALTHIER COMMUNITIES CO-CHAIRING AND PARTICIPATING ON NUMEROUS WORKGROUPS/COMMITTEES WITHIN THE YORK COUNTY. THESE COMMITTEES WORKED WITH PARTICIPATION IN MANY EDUCATION SESSIONS WITHIN THE COMMUNITY BY PROVIDING CONFIDENTIALLY FOR INDIVIDUALS PARTICIPATING IN HEALTH RELATED PROMOTIONS. ALSO, PHC HAS BEEN ACTIVE IN ACTING AS A SPOKESPERSON FOR THE CONTINUED SUPPORT OF THE 211 PROGRAM AS IT PURSUES EXPANSION WITH ON-LINE ASSESSMENT. PHC HAS CONDUCTED ASSESSMENT OF GAPS IN SUPPORT GROUP RESOURCES AND WORKED WITH 211 TO UPDATE THE DATABASE. STROKE HAS BEEN IDENTIFIED AS A GAP TO ADDRESS. PART 2 LINE 4: ENVIRONMENTAL IMPROVEMENTS ARE A VERY IMPORTANT ASPECT OF THE WORKINGS OF PARTNERS FOR HEALTHIER COMMUNITIES THROUGH THE LEAD POISONING PREVENTION SUPPLIES/EDUCATION THAT THE ORGANIZATION OFFERS AND ITS PARTICIPATION IN COMMUNITY EFFORTS. PHC CONTRIBUTED TO THE IMPLEMENTATION OF "MOOSE TRAILS" ON SIDEWALKS IN DOWNTOWN SANFORD TO PROMOTE SAFE PATHS FOR WALKING AS WELL AS BIKING TO SCHOOL. PHC PARTNERED WITH THE SANFORD YMCA TO LAUNCH AN INDOOR WALKING LOOP AT WAL-MART AS WELL AS APPLICABLE EDUCATION. PHC EDUCATED 300 BUSINESSES AND 11 RESTAURANTS ON THE NEW TOBACCO LAWS. PHC PROVIDED ASSISTANCE ON MAKING NECESSARY POLICY AND ENVIRONMENTAL CHANGES TO SUPPORT NEW REQUIREMENTS. PART II LINE 6: PARTNERS FOR HEALTHIER COMMUNITIES WORKED WITH COMMUNITY ADVISORS TO CREATE A VISION FOR MOBILIZING AN ELEVEN TOWN SERVICE AREA. BASED ON THIS CONVERSATION, PHC HAS WORKED TO MOBILIZE OR PARTNER WITH EXISTING TASKFORCES IN 3 REGIONS OF THE SERVICE AREA. RECENT MONTHS HAVE BEEN SPENT RECRUITING ADVISORY BOARD MEMBERS.PARTNERS FOR HEALTHIER COMMUNITIES HAS COLLABORATED WITH YORK DISTRICT HEALTHY MAINE PARTNERSHIPS, THE GREATER YORK COUNTY UNITED WAY, YORK COUNTY HEAD START, AND THE GREATER YORK COUNTY YMCA TO GUIDE A COUNTY-WIDE COMMUNITY NEEDS ASSESSMENT PROCESS UTILIZING MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). THE ASSESSMENT REPORTS WERE SHARED AT VARIOUS COMMUNITY FORUMS. PARTNERS FOR HEALTHIER COMMUNITIES HAVE FACILITATED STRATEGIC PLANNING PROCESSES IN THE SANFORD, WATERBORO, AND SACOPEE VALLEY COMMUNITIES. THE HMP DIRECTOR HAS DEDICATED 40 HOURS TO THIS COMPONENT OF THE COMMUNITY NEEDS PROCESS. THE COMMUNITIES ARE CURRENTLY IN THE ACTION PLANNING PHASE.PARTNERS FOR HEALTHIER COMMUNITIES IS COLLABORATING WITH THE TOWN OF SANFORD AND SAFE SCHOOLS HEALTHY SANFORD TO MOBILIZE THE SAFE AND HEALTHY SANFORD COALITION. AS A RESULT, THE TOWN WAS AWARDED A DRUG FREE COMMUNITIES GRANT OF $625,000 OVER A 5 YEAR PERIOD TO ADDRESS YOUTH SUBSTANCE ABUSE PREVENTION EFFORTS. PHC PARTICIPATED IN 8 PARENTAL/STUDENT INFORMATION NIGHTS RELATED TO SUBSTANCE ABUSE PREVENTION. THE HMP PREVENTION COORDINATOR HAS CONTRIBUTED 32 HOURS TO GRANT WRITING AND PLANNING IN THE SANFORD COMMUNITY AS WELL AS SERVING AS A LEADER IN SECURING THE DRUG FREE COMMUNITIES GRANT.PARTNERS FOR HEALTHIER COMMUNITIES HAS CONDUCTED ASSESSMENT OF GAPS IN SUPPORT GROUP RESOURCES AND WORKED WITH 211 TO UPDATE DATABASE. STROKE HAS BEEN IDENTIFIED AS A GAP TO ADDRESS. PART II LINE 7: COMMUNITY HEALTH IMPROVEMENTS HAVE LEAD GOODALL TO PARTNER WITH YORK DISTRICT HEALTHY MAINE PARTNERSHIPS AND YORK COUNTY COMMUNITY ACTION TO COORDINATE TRAINING OF ALL YORK COUNTY HEAD START SITES ON THE 5-2-1-0 PHYSICAL ACTIVITY AND NUTRITION MODEL. GOODALL CONTINUED TO PROVIDE TECHNICAL ASSISTANCE TO SITES WITHIN THE SERVICE AREA. COMMUNITY HEALTH IMPROVEMENTS WILL LEAD GOODALL IN THE PURSUIT OF WORKING WITH YORK DISTRICT ENGAGED 40 YOUTH IN THE ANNUAL STICKER SHOCK CAMPAIGN TO AFFIX 25,000 STICKERS AT 36 STORES THROUGHOUT THE COMMUNITY TO INFORM ADULTS OF THE CONSEQUENCES ASSOCIATED WITH PURCHASING ALCOHOL FOR MINORS.PARTNERS FOR HEALTHIER COMMUNITIES FUNDED 2 $250 MINI-GRANTS TO AREA YOUTH GROUPS TO WORK ON ANTI-TOBACCO MESSAGING AND ADVOCACY PROJECTS. PHC STAFF WORKED WITH THE GROUPS TO DETERMINE PROJECT AND PROVIDED EDUCATION AND RESOURCES.PHC COORDINATED PRESENTATION BY DISTRICT TOBACCO COORDINATOR FOR 4 YOUTH GROUPS IN THE SANFORD SCHOOL DISTRICT. COORDINATED 8 CLASSES AT NO CHARGE FOR A TOBACCO CESSATION PROGRAM FOR THE COMMUNITY WITH 24 INDIVIDUALS COMPLETING.THE HMP DIRECTOR CONTRIBUTED TO EDUCATING PHYSICIAN PRACTICES AND/OR PATIENTS ON HEALTHY WEIGHT AWARENESS RESOURCES.THE HMP DIRECTOR CONDUCTED 1 COMMUNITY PRESENTATION RELATED TO SIGNS AND SYMPTOMS OF HEART ATTACK AND STROKE.AS A LET'S GO 5-2-1-0 DISSEMINATION PARTNER, PHC HAS PROVIDED LET'S GO CHILDCARE TOOLKITS TO DAYCARE PROVIDERS AND PEDIATRIC OFFICES, PHC HAS ALSO CONDUCTED 3 TRAININGS FOR CHILDCARE PROVIDERS, ATTENDED QUARTERLY STAKEHOLDERS MEETINGS, ENGAGED SANFORD SCHOOL DISTRICT IN REGISTERING AS "READY" 2 SITES FOR THE UPCOMING SCHOOL YEAR.PHC PARTNERED WITH SANFORD DOWNTOWN LEGACY TO LAUNCH DOUBLE YOUR EBT VALUE FOR FRUIT AND VEGGIE PURCHASES. PHC COLLABORATED WITH YORK DISTRICT PUBLIC HEALTH COUNCIL AND YORK COUNTY EMERGENCY MANAGEMENT TO LAUNCH WELL CHECK REGISTRY.PHC COORDINATED AN OUTREACH PRESENTATION TO YORK DISTRICT SUPERINTENDENTS. AS A RESULT, EACH HEALTHY MAINE PARTNERSHIP WILL BE MEETING ONE-ON-ONE WITH SCHOOL DISTRICTS TO DETERMINE HOW TO BEST COORDINATE PREVENTION EFFORTS ACROSS ALL SCHOOLS IN THE COUNTY. PHC WORKED WITH AN AREA FOOD PANTRY TO CREATE HEALTH RELATED INFORMATION PACKETS FOR CLIENTS AND ALSO ASSISTED WITH PLANNING A COMMUNITY OPEN HOUSE.THE HEALTH PREVENTION COORDINATOR CONTRIBUTED 40 HOURS TO COORDINATING THE DEVELOPMENT OF BRIDGE TO HOME HEALTH LITERACY PROGRAM WITH ROTARY, GOODALL HOSPITAL, AND LITERACY VOLUNTEERS. THE HEALTH PREVENTION COORDINATOR COORDINATED AND/OR PARTICIPATED IN THE MANY PARENTAL INFORMATION NIGHTS RELATED TO SUBSTANCE ABUSE PREVENTION INCLUDING IN PARTNERING WITH THE SANFORD AND YORK COUNTY SHERIFF DEPARTMENT IN CONDUCTING COMPLIANCES WITH ALCOHOL SALES. PART II LINE 8: PARTNERS FOR HEALTHIER COMMUNITIES PROVIDED WORKSITE WELLNESS TRAINING WITH THE WABAN ORGANIZATION AS WELL AS HOSTED "SAFE AND RESPONSIBLE BEVERAGE SELLER / SERVER TRAINING" PROGRAMS THROUGHOUT THE YEAR. PART III, LINE 4: FOOTNOTE CONCERNING BAD DEBTS: MANAGEMENT MONITORS AND EVALUATES ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS TO ENSURE THAT RECEIVABLES ARE STATED AT THEIR NET REALIZABLE VALUE. THE COSTING METHODOLOGY CONSISTS OF APPLYING A COST TO CHARGE RATIO TO THE RECORDED PROVISION FOR BAD DEBT (REPRESENTING UNCOLLECTED CHARGES) AND CHARITY CARE REVENUES BASED ON COST REPORT. 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. 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. PARTNERS FOR HEALTHIER COMMUNITIES HAVE FACILITATED STRATEGIC PLANNING PROCESSES IN THE SANFORD, WATERBORO, AND SACOPEE VALLEY COMMUNITIES. THE HMP DIRECTOR HAS DEDICATED 40 HOURS TO THIS COMPONENT OF THE COMMUNITY NEEDS PROCESS. THE HMP PREVENTION COORDINATOR HAS DEDICATED 12 HOURS TO THE PROCESS. THE HMP HEALTH PROMOTION COORDINATOR HAS DEDICATED 12 HOURS TO THE PROCESS. THE COMMUNITIES ARE CURRENTLY IN THE ACTION PLANNING PHASE.PHC HAS WORKED WITH COMMUNITY ADVISORS TO CREATE A VISION FOR MOBILIZING AN ELEVEN TOWN SERVICE AREA. BASED ON THIS CONVERSATION, PHC HAS WORKED TO MOBILIZE OR PARTNER WITH EXISTING TASKFORCES IN 3 REGIONS OF THE SERVICE AREA. RECENT MONTHS HAVE BEEN SPENT RECRUITING ADVISORY BOARD MEMBERS.PHC IS COLLABORATING WITH THE TOWN OF SANFORD AND SAFE SCHOOLS HEALTHY SANFORD TO MOBILIZE THE SAFE AND HEALTHY SANFORD COALITION. AS A RESULT, THE TOWN WAS AWARDED A DRUG FREE COMMUNITIES GRANT OF $625,000 OVER A 5 YEAR PERIOD TO ADDRESS YOUTH SUBSTANCE ABUSE PREVENTION EFFORTS.THE HMP PREVENTION COORDINATOR HAS CONTRIBUTED 32 HOURS TO GRANT WRITING AND PLANNING IN THE SANFORD COMMUNITY AND ALSO SERVED AS A LEADER IN SECURING THE DRUG FREE COMMUNITIES GRANT.PHC CONDUCTED AN ASSESSMENT OF GAPS IN SUPPORT GROUP RESOURCES AND WORKED WITH 211 TO UPDATE THE DATABASE. STROKE HAS BEEN IDENTIFIED AS A GAP TO ADDRESS. 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 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. COMMON TYPES OF ASSISTANCE, IN ADDITION TO ADVOCACY, MAY INCLUDE: MEDICARE D ENROLLMENT; ADVANCE DIRECTIVE PLANNING; ASSISTANCE AND EDUCATION IN PREVENTING FRAUD, EXPLOITATION, AND ABUSE; CONNECTION TO RESOURCES FOR TRANSPORTATION, HOME HEALTH CARE, MEALS, ETC. THE SENIOR ADVOCATE PROGRAM RECEIVED 2,232 INQUIRIES FOR ASSISTANCE THROUGHOUT THE YEAR WITH THE FOLLOWING BREAKDOWN BY CONCERN TYPE (MEDICARE D 20%, INSURANCE 20%, FINANCE ASSIST 15%, OTHER 45%). THE OTHER CONCERN TYPES INCLUDE THE FOLLOWING SUBJECT AREAS (POA/GUARDIANSHIP, FUEL ASSISTANCE, DENTAL, VISION, VA BENEFITS, TRANSPORTATION, HOUSING, SOCIAL SECURITY, DISABILITY, PAPERWORK, DME AND MEDICAL SUPPLIES, SNOW REMOVAL, PLACEMENT, HOME CARE, HOME REPAIR, FOOD RESOURCES, ADV. DIRECTIVES, ETC.). 107 FAMILIES WERE PROVIDED INFORMATION BY THE MAINE FAMILIES PROGRAM ON 144 COMMUNITY EVENTS AND AREA RESOURCES FOR A TOTAL OF 529 REFERRALS.MFYC HELD THE FOLLOWING EVENTS TO HELP LINK FAMILIES WITH OTHER FAMILIES THAT ARE EXPERIENCING SIMILAR LIFE CIRCUMSTANCES WITH RAISING CHILDREN. BREASTFEEDING SUPPORT, NUTRITION, SHAKEN BABY SYNDROME PREVENTION, HOME SAFETY AND LEAD POISONING RISK. THIS PROGRAM PROVIDED 1,377 VISITS WITH 129 FAMILIES IN THE COMMUNITY HEALTH IMPROVEMENT SERVICES, AND SERVES TO CREATE A NATURAL SUPPORT SYSTEM FOR YOUNG FAMILIES.RXASSIST PROGRAM - THE PRESCRIPTION ASSISTANCE PROGRAM PROVIDES HELP TO THOSE WHO CURRENTLY DO NOT HAVE PRESCRIPTION COVERAGE AND HAVE DIFFICULTY AFFORDING THEIR MEDICINES. THE PROGRAM IS DESIGNED TO ASSIST THOSE WHO DO NOT QUALIFY FOR OTHER TRADITIONAL ASSISTANCE PROGRAMS SUCH AS MEDICARE D OR MAINE CARE, BUT WHOSE FINANCIAL SITUATION QUALIFIES THEM TO RECEIVE SUPPORT. FREE OR LOW-COST PRESCRIPTION DRUGS CAN BE OBTAINED DIRECTLY FROM PHARMACEUTICAL COMPANIES IF ELIGIBILITY GUIDELINES ARE MET. THE HOSPITAL RECEIVED 214 APPLICATION REQUESTS FOR SUBMISSION TO THE APPROPRIATE PHARMACEUTICAL PRESCRIPTION ASSISTANCE PROGRAMS, COMPLETED 824 CLIENT CONTACTS, PROCESSED 1645 PRESCRIPTIONS, AND SAVED $836,513 FOR CLIENTS SERVED THROUGH THIS PROGRAM, DURING THE YEAR. 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 THE 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 6: 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 THE EDUCATIONAL SEMINARS THAT ARE OPEN FOR FREE PUBLIC PARTICIPATION. THESE SEMINARS ARE HELD ON MOST EVENINGS (FOR EASE OF COMMUNITY PARTICIPATION) AND ARE TYPICALLY 1 1/2 HOURS IN DURATION. THE SEMINARS ARE LED BY KNOWLEDGEABLE GOODALL PROFESSIONALS WHO ARE TRAINED AND EDUCATED IN THE SPECIFIC AREAS. THE EVENTS INCLUDE THE FOLLOWING AREAS: SPORTS MEDICINE, ALCOHOL AWARENESS, FUN WITH FRUITS & VEGGIES, WATER AEROBICS, WEIGHT MANAGEMENT, MEDICATION REVIEWS, DIABETES, BLOOD PRESSURE CHECKS AND MANY MORE. PART VI, LINE 7: N/A REPORTS FILED WITH STATES PART VI, LINE 7 ME X X X X 0 0 0 0 0 0 0 0 0 DARLENE STROMSTAD 356547 0 60000 0 0 0 2278 0 11357 0 430182 0 0 0 PATRICIA APRILE 197138 0 3349 0 0 0 1216 0 17818 0 219521 0 0 0 RONALD BRYANT CHARLES CARUSO 161469 0 0 0 0 0 861 0 21191 0 183521 0 0 0 DANIEL FORGUES KATHLEEN MORRIS MD 197940 0 0 0 0 0 2460 0 10353 0 210753 0 0 0 MUKESH BHARGAVA MD 150127 0 0 0 0 0 0 0 0 0 150127 0 0 0 ADAM SCHLAGER FRANK GOUDREAU 444944 0 0 0 0 0 2209 0 24607 0 471760 0 0 0 JOHNATHAN SHILL 287328 0 6543 0 0 0 2530 0 11244 0 307645 0 0 0 KENT HALL 254627 0 92513 0 0 0 1873 0 18782 0 367795 0 0 0 NINA SHERVIN 371205 0 25000 0 0 0 288 0 16008 0 412501 0 0 0 JOHN THOMPSON 413702 0 0 0 0 0 2160 0 23850 0 439712 0 0 0 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 6470000 522453 82639 5836740 293000 2007 0 0 1 1 78484 451093 78484 0 1 1 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 PETER G BOOTH TO PROVIDE RETIREMENT FUNDS VIA A SPLIT DOLLAR LIFE INSURANCE POLICY X 851677 851677 0 1 1 851677 MARK MICKERIZ CHAIR OF GOODALL'S BOARD AND PRESIDENT OF SANFORD INSTITUTE FOR SAVINGS 4623278 SANFORD INSTITUTE FOR SAVINGS (SIS) HAS THREE OUTSTANDING LOANS WITH HENRIETTA D. GOODALL HOSPITAL, INC. THE ORIGINAL AMOUNT OF THE LOAN WAS $7,330,000 AND AS OF MAY 31, 2011, THE REMAINING BALANCE ON THE LOANS WERE $4,623,278. 0 WEBER SHILL FORMER OWNER OF TMG 1405483 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, 2011, THE REMAINING BALANCE OF THE LOAN WAS $1,405,483. 0 WILLIAM FRANK CHAIR OF THE FINANCE COMMITTEE 18675 GOODALL HOSPITAL CONTRACTS WITH DR. FRANK TO PERFORM VARIOUS DUTIES AT THE HOSPITAL, SUCH AS ON CALL, IMPACT COVERAGE, AND SOME COMMITTEES. 0 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. DARLENE STROMSTAD CAN BE REACHED AT 377 THREE MILE HILL ROAD, MIDDLEBURY, CT 06762 AND RON BRYAN CAN BE REACHED AT 59 STONE ROAD, KENNEBUNKPORT, ME 04046, (207) 967-2383 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. DESCRIPTION OF BOND ISSUE PRICE SCHEDULE K, PART I, COLUMN E AMOUNTS LISTED AS BOND ISSUE PRICE DO NOT MATCH IRS FORM 8038, PART III, LINE 21(B), AS THE HOSPITAL WAS A PART OF A GROUP OF ORGANIZATIONS PARTICIPATING IN THE REVENUE BONDS ISSUANCE. THUS, THE AMOUNT LISTED IS THE HOSPITAL'S PORTION OF THE TOTAL BOND ISSUE PRICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 102,480. RELEASES FROM TEMPORARILY RESTRICTED NET ASSETS -20,379. INCREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 1,464,292. UNREALIZED GAIN ON SECURITIES 1,289,715. OTHER CHANGES IN NET ASSETS -3,686. RESTRICTED CONTRIBUTIONS 48,564. TOTAL TO FORM 990, PART XI, LINE 5: 2,880,986. 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 MANOR AT PHILLIPSTOWN PLACE INC 25 JUNE STREET SANFORD ME 04073 010473857 PROVIDE CARE TO THE ELDERLY ME 501(C)(3) 9 HENRIETTA D GOODALL HOSPITAL INC 0 JUNE STREET PHARMACY LLC 25 JUNE STREET SANFORD ME 04073 020765952 PROVIDE PHARMACY SERVICES TO THE COMMUNITY. ME HENRIETTA D GOODALL HOSPITAL INC C 159515 860011 1.00000 1 0 0 0 1 0 0 0 1 0 0 0 0 1 0 1 0 0 JUNE STREET PHARMACY LLC A 55388 ACTUAL INTEREST CHARGED JUNE STREET PHARMACY LLC I 934673 ACTUAL COSTS INCURRED MANOR AT PHILLIPSTOWN PLACE INC P 311620 ACTUAL COSTS INCURRED JUNE STREET PHARMACY LLC N 18000 ACTUAL COSTS INCURRED MANOR AT PHILLIPSTOWN PLACE INC N 36000 ACTUAL COSTS INCURRED JUNE STREET PHARMACY LLC E 424708 ACTUAL PRINCIPAL DUE