2012-07-24T08:48:08-05:00 2011-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2011-01-01 010211551 ST MARY'S REGIONAL MEDICAL CENTER STMA 2077778546 CAMPUS AVENUE PO BOX 0291 LEWISTON ME 042430291 LEO MYLES CEO 2077778802 2012-07-16 1 MICHAEL A BARBARITA CPA P00801253 6036228881 2011 2016-02-24 21:20:13Z LEO MYLES CAMPUS AVENUE PO BOX 0291 LEWISTON ME 042430291 158234801 0 X WWW.STMARYSMAINE.COM X 1967 ME ST. MARY'S REGIONAL MEDICAL CENTER IS A 233-BED ACUTE CARE FACILITY THAT OFFERS THE BEST OF MEDICAL TECHNOLOGY, PREVENTIVE SERVICES AND A "WHOLE PERSON APPROACH" IN MEETING THE NEEDS OF THE ANDROSCOGGIN COUNTY AREA. 16 13 1535 191 191779 54207 601080 661698 141024829 156798268 29858 521952 238279 235274 141894046 158217192 0 0 0 0 51786774 84317673 0 0 168432 84132694 70966574 135919468 155284247 5974578 2932945 152706428 157535163 63915591 64526953 88790837 93008210 X ST. MARY'S REGIONAL MEDICAL CENTER IS A 233 BED ACUTE CARE FACILITY THAT OFFERS THE BEST OF MEDICAL TECHNOLOGY, PREVENTIVE SERVICES AND A "WHOLE PERSON APPROACH" TO MEETING THE NEEDS OF THE ANDROSCOGGIN COUNTY AREA.ST. MARYS REGIONAL MEDICAL CENTER OFFERS A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES TO MEET THE GROWING AND CHANGING NEEDS OF THE COMMUNITY. OUR PROFESSIONAL, QUALIFIED STAFF ARE ABLE TO DELIVER CARDIOPULMONARY, LABORATORY, NURSING, PHYSICAL THERAPY, RADIOLOGY, SOCIAL AND SURGICAL SERVICES WITH THE PERSONALIZED TOUCH DESIGNED TO MAKE OUR PATIENTS FEEL MORE RELAXED AND AT HOME. 0 0 9385203 24766543 SURGICAL CARE: PROVIDES ALL SERVICES (EXCEPT OPEN HEART) TO PATIENTS RANGING FROM INFANT TO GERIATRICS WHO NEED SURGICAL INTERVENTION. TOTAL HOURS = 5,098 7832005 11726283 BEHAVIORAL HEALTH: ST. MARYS OFFERS THE MOST ADVANCED BEHAVIORAL HEALTHCARE DIAGNOSTIC AND TREATMENT SERVICES FOR CHILDREN, ADOLESCENTS AND ADULTS IN BOTH INPATIENT AND OUTPATIENT PROGRAMS. INPATIENT AND OUTPATIENT TREATMENTS INCLUDE COMPREHENSIVE PSYCHIATRIC ASSESSMENT AND EVALUATIONS, EDUCATION, INDIVIDUAL AND GROUP THERAPY, INDIVIDUALIZED BIO-PSYCHOSOCIAL TREATMENT PLAN AND DISCHARGE AND AFTERCARE PLANNING.TOTAL PATIENT DAYS = 17,956 8419499 10129890 EMERGENCY CARE: ST. MARY'S REGIONAL MEDICAL CENTER OFFERS A 24-HOUR PER DAY LEVEL II EMERGENCY CARE FACILITY. SERVICES PROVIDED INCLUDE MEDICAL, SURGICAL, ETC. TOTAL VISITS = 29,240 101816568 110175552 101816568 110175552 127453275 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1535 1 1 1 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X X X CAROLYN M KASABIAN 2077778546 96 CAMPUS AVE LEWISTON ME 04240 JUDITH ANDRUCKI 2.00 X 0 0 0 MARK ANTHOINE 2.00 X 0 0 0 PATRICIA FINNIGAN 2.00 X 0 0 0 MARTIN EISENSTEIN 2.00 X 0 0 0 JOHN ISAACSON 2.00 X 0 0 0 CAROLYN KASABIAN 40.00 X X 269457 0 32371 DONALD FOURNIER 2.00 X 0 0 0 SHARON MILLETT 2.00 X 0 0 0 SR DOROTHY COOPER 2.00 X 0 0 0 SIDNEY STEINKELER MD 40.00 X 398534 0 40208 WILLIAM SCHULTZ 2.00 X 0 0 0 MICHAEL KELLEY MD 40.00 X 0 376800 27732 CRAIG GUNDERSON 2.00 X X 0 0 0 LEO MYLES 40.00 X X 530405 0 30157 J PAUL SPELLMAN 2.00 X 0 0 0 DONNA STECKINO 2.00 X X 0 0 0 CAROLYN LEPAGE 2.00 X 0 0 0 ANNE SCHUETTINGER 2.00 X 0 0 0 JUSTIN CLARK MD 40.00 X 310085 0 22896 SUSAN KEILER 40.00 X 250259 0 33196 RALPH HARDER 40.00 X 386592 0 27922 IRA SHAPIRO 40.00 X 0 262632 30861 SANJAY GODARA 40.00 X 449012 0 3076 MARC CHRISTENSEN 40.00 X 1363504 0 13814 WAYNE MOODY 40.00 X 1059272 0 21426 MARIA IKOSSI 40.00 X 853647 0 15161 MICHAEL PARKER 40.00 X 448209 0 2858 6318976 639432 301678 89 0 1 0 COVENANT HEALTH SYSTEM INC 100 AMES POND ROAD TEWKSBURY MA 01876 MANAGEMENT SERVICES 2310434 ST MARY'S ANESTHESIA PO BOX 1823 LEWISTON ME 04240 HEALTH CARE PROFESSIONAL 990570 VISTA STAFFING FILE 50834 LOS ANGELES CA 900740834 STAFFING AGENCY 865371 ST MARY'S D'YOUVILLE PAVILION 100 CAMPUS AVE LEWISTON ME 04240 LAUNDRY SERVICE 629929 THE OUTSOURCE GROUP 39867 TREASURER CENTER CHICAGO IL 606949800 COLLECTION AGENCY 608434 13 661698 661698 NET PATIENT SERVICE RE 621300 146976438 146976438 OTHER OPERATING INCOME 621300 9821830 9821830 156798268 519552 519552 63504 20009 43495 43495 43495 -2400 2400 2400 2400 LAB REVENUE 621500 191779 191779 191779 158217192 156798268 191779 565447 X 1758740 708619 1050121 66362260 59599834 6762426 977037 864984 112053 15219636 13474152 1745484 240623 13778 226845 68612 68612 2197027 378116 1818911 65484 62304 3180 354617 265108 89509 2162256 2162256 4992516 2811270 2181246 2555482 2547840 7642 SUPPLIES 18997340 17641330 1356010 PURCHASED SERVICES 10016334 9358515 489387 168432 BAD DEBT EXPENSE 6925527 6925527 OUTSIDE LABOR 3423157 2885829 537328 18967599 9916069 9051530 155284247 127453275 27662540 168432 1410255 2893612 12749282 14748578 1270826 1172520 768496 1227355 106497210 47160947 54607850 59336263 81899719 78156835 152706428 157535163 13004453 12980100 477133 432638 24334170 22913516 26099835 28200699 63915591 64526953 X 86821201 90616251 1278625 1695930 691011 696029 88790837 93008210 152706428 157535163 X 2932945 1284428 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10775 10775 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: ST. MARY'S REGIONAL MEDICAL CENTER IS A MEMBER OF THE MAINE HOSPITAL ASSOCIATION AND A PORTION OF THE DUES PAID IN THE AMOUNT OF $10,775 IS USED FOR LOBBYING. 1969636 570518 14238 162432 2391960 1877705 469782 24648 402501 1969634 3069142 656993 24713 1873143 1877705 3353022 1539784 17453 1841117 3069142 0.29000 0.71000 0 0 922346 922346 67007009 20438330 46568679 1124693 263312 861381 36881687 26459305 10422382 561475 561475 59336263 LTD USE ASSETS 36263446 DUE FROM AFFILIATES 22336289 OTHER ACCOUNTS RECEIVABLE 878918 SETTLEMENTS W/ THIRD PARTIES 18678182 78156835 158217192 155284247 2932945 -358512 1642940 1284428 4217373 157261038 -358512 -358512 157619550 597642 597642 158217192 153001094 0 153001094 2283152 2283152 155284246 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: CONTINUING EDUCATION CAPITAL PURCHASES FOR SPECIFIC SPECIALITIES PART XI, LINE 8 - OTHER ADJUSTMENTS: NET TRANSFERS 1,642,940. PART XII, LINE 4B - OTHER ADJUSTMENTS: TEMPORARILY RESTRICTED INVESTMENT INCOME 14,238. DONATIONS 570,518. SMR OCCUPANCY 12,886. PART XIII, LINE 4B - OTHER ADJUSTMENTS: NOI ADMINISTRATION INCOME GUARANTEE 2,270,264. SMR OCCUPANCY 12,888. NORTH AMERICA 1 69821 0 1 0 0 0 1 69821 0 69821 0 0 0 0 0 0 1 1 1 X 1 X 0 1 1 0 1 1 4361138 4361138 0.02810 31316958 26504434 4812524 0.03100 35678096 26504434 9173662 0.05910 383578 383578 0.00250 880261 31982 848279 0.00550 339281 339281 0.00220 1603120 31982 1571138 0.01020 37281216 26536416 10744800 0.06930 4232 34711 34711 0.00020 1359 52793 52793 0.00030 16 7978 7978 0.00010 294 6589 6589 0.00000 24 6199 6199 0.00000 693684 693684 0.00450 5925 801954 801954 0.00510 1 6298917 100000 45194413 47752804 -2558391 X 1 1 1 UNITED AMBULANCE AMBULANCE SERVICE 0.50000 0.00000 0.00000 1 1 ST MARY'S REGIONAL MEDICAL CENTER

93 CAMPUS AVE LEWISTON ME 042430291

X ST MARY'S REGIONAL MEDICAL CENTER 1 11 1 1 200.000000000000 1 300.000000000000 1 X X 1 1 X X 1 0 1 X 1 0 PART II: IN RESPONSE TO THE SIGNIFICANT NEEDS AROUND NUTRITION, POVERTY AND FOOD ACCESS FOR THE COUNTY, ST. MARYS HEALTH SYSTEM FOUNDED THE NUTRITION CENTER OF MAINE IN 2006. THROUGH ORGANIZING, ADVOCACY AND EDUCATION, THE CENTER IS A LOCAL AND STATEWIDE RESOURCE, PROMOTING OVERALL COMMUNITY WELLNESS THROUGH NUTRITION, YOUTH DEVELOPMENT AND SUSTAINABLE URBAN AGRICULTURE PROGRAMS. MANY OF THE CONSTITUENTS ARE AT HIGH RISK FOR HUNGER, OBESITY AND NUTRITION-RELATED DISEASES. IN 2011 THE FOOD PANTRY DISTRIBUTED 12,350 BOXES OF FOOD, PROVIDING ENOUGH FOOD FOR 21,167 PEOPLE AND PROVIDED NUTRITIOUS SNACKS TO DAYCARE AND SCHOOL-BASED HEALTH CENTERS IN LEWISTON. TWELVE COMMUNITY GARDENERS SUPPORTED 99 COMMUNITY GARDENERS IN GROWING THEIR OWN FOOD. ONE HUNDRED TWENTY-TWO CHILDREN PARTICIPATED IN THE WEEKLY KIDS COOKING CLUB. FORTY-THREE TEENAGERS CONTRIBUTED 3286 HOURS TO THEIR COMMUNITY AND THEIR OWN DEVELOPMENT AS YOUTH GARDENERS PARTICIPATING IN UNIQUE LEADERSHIP, EDUCATION AND TRAINING PROGRAMS. ONE HUNDRED CHILDREN PARTICIPATED IN GARDEN-BASED LEARNING PROGRAMS. AS AN INAUGURAL FOOD CORPS SITE, WE STARTED OUR FIRST SHCOOL GARDEN PROGRAM WHERE 98% OF STUDENTS QUALIFY FOR FREE AND REDUCED MEALS. FIVE HUNDRED TWENTY-FOUR TEENS AND ADULTS PARTICIPATED IN HANDS-ON COOKING AND NUTRITION EDUCATION CLASSES. IN ADDITION, SMHS LEADERSHIP MEMBERS SERVE ON THE LOCAL CHAMBER OF COMMERCE AND OTHER COMMUNITY COALITIONS RELATED TO COMMUNITY HEALTH SUCH ASE THE MAINE HEALTHCARE ACTION TEAM AND THE MAINEHEALTH ELDER CARE TEAM, AS WELL AS WORKFORCE DEVELOPMENT PROGRAMS SUCH AS THE COLLEGE FOR ME STEERING COMMITTEE, AND THE HEALTHCARE WORKFORCE FORUM WHICH REPORTS ITS EFFORTS TO ASSURE AVAILABILITY OF A HEALTHCARE WORKFORCE TO THE STATE LEGISLATURE. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE AMOUNTS REPORTED ABOVE ARE CALCULATED BASED ON A RATIO OF COST TO CHARGES. PART III, LINE 8: APPROXIMATELY 33% OF MEDICARE PATIENTS ALSO QUALIFY FOR MEDICAID. COSTING ON LINE 6 IS BASED ON RATIO OF COST TO CHARGE FROM WORKSHEET 2. PART III, LINE 9B: ST. MARY'S REGIONAL MEDICAL CENTER WILL MAKE A REASONABLE EFFORT TO DETERMINE WHETHER AN INDIVIDUAL QUALIFIES FOR FINANCIAL ASSISTANCE PRIOR TO INITIATING ANY COLLECTION ACTIVITY. ST. MARY'S REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 13G: THE FREE CARE AND SELF-PAY DISCOUNT PROGRAM POLICY IS SUMMARIZED IN THE FINANCIAL ASSISTANCE APPLICATION WHICH IS AVAILABLE ON THE MEDICAL CENTER'S WEBSITE ST. MARY'S REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: ST. MARY'S REGIONAL MEDICAL CENTER OFFERS TWO SELF-PAY DISCOUNT LEVELS UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY (FAP) FOR INDIVIDUALS WHO CANNOT AFFORD TO PAY AND WHO DO NOT QUALIFY FOR FREE CARE. THE 40% SELF-PAY DISCOUNT IS BASED ON THE FEDERAL POVERTY LEVEL FROM 200% TO 250%. THE 20% SELF-PAY DISCOUNT IS BASED ON THE FEDERAL POVERTY LEVEL FROM 250% TO 300%. THE PROGRAM IS BASED ON THE FAMILY SIZE AND THE HOUSE HOLD INCOME ST. MARY'S REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 20: THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY PROVIDES FOR FREE CARE FOR PATIENTS WITH FINANCIAL MEANS UP TO 200% OF THE POVERTY LIMIT. THE POLICY ALSO PROVIDES A 40% DISCOUNT FOR SELF-PAY PATIENTS FALLING BETWEEN 200% AND 250% OF THE POVERTY LEVEL; AND A 20% DISCOUNT FOR SELF-PAY PATIENTS FALLING BETWEEN 250% AND 300% OF THE POVERTY LEVEL. IN 2011, THE MEDICAL CENTER HAD AGREEMENTS WITH INSURANCE COMPANIES THAT PROVIDED FOR DISCOUNTS OF APPROXIMATELY 40% OF CHARGES. EFFECTIVE IN 2012 THE MEDICAL CENTER WILL REVISE ITS BILLING PRACTICE TO ENSURE THAT NO PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE WILL BE BILLED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS COVERED BY INSURANCE. PART VI, LINE 2: IN ORDER TO ENSURE OUR EFFORTS ADDRESS IDENTIFIED NEEDS IN THE COMMUNITY, ST. MARY'S HEALTH SYSTEM AND ITS SUBSIDIARIES ELICITED THE VOICE OF THE COMMUNITY IN SEVERAL WAYS. THE INSTITUTION HOSTED FOCUS GROUPS AS WE DEVELOPED OUR NEW STRATEGIC PLAN. OUR COMUNITY HEALTH RISK SCREENING PROGRAM ASSESSES PHYSICAL ACTIVITY, BLOOD PRESSURE, OBESITY, TOBACCO USE, BLOOD GLUCOSE LEVELS AND OTHER RISK FACTORS FOR LOCAL RESIDENTS. ST. MARY'S LEADERS SERVE ON BOARDS IN MANY COMMUNITY HEALTH ORGANIZATIONS AND THE BOARD MEMBERS INVITED TO SERVE WITH ST. MARY'S ARE STRATEGICALLY SELECTED. PATIENT SATISFACTION SURVEYS ALSO PROVIDE VALUABLE INFORMATION IN COMMUNITY BENEFIT PLANNING. A FEEDBACK LOOP HAS BEEN ESTABLISHED FOR EMPLOYEES TO IDENTIFY UNMET NEEDS OF PATIENTS. IN ADDITION, WE UTILIZED DATA THAT IDENTIFIES KEY HEALTH ISSUES FOR THE DEMOGRAPHIC AREAS WE SERVE. DATA WAS COMPILED FROM A VARIETY OF SOURCES INCLUDING A STATEWIDE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2010 AND PUBLISHED IN 2011 BY THE ONEMAINE HEALTH COLLABORATIVE, HEALTHY MAINE 2010 GOALS, STATEWIDE INITIATIVES FROM THE MAINE HOSPITAL ASSOCIATION, AND COMMUNITY PARTNERSHIPS SUCH AS THE UNITED WAY, THE LEWISTON-AUBURN PUBLIC HEALTH INITIATIVE AND HEALTHY ANDROSCOGGIN.ANDROSCOGGIN COUNTY HAS SEVERAL MAJOR PUBLIC HEALTH CONCERNS. POVERTY-RELATED PROBLEMS HAVE A SIGNIFICANT IMPACT ON THE AREA, AND SOME ISSUES SUCH AS POOR NUTRITION, INFANT MORTALITY, UNEMPLOYMENT, CHILDREN LIVING IN POVERTY AND TEEN PREGNANCY OCCUR AT A HIGHER PERCENTAGE RATE IN THIS COUNTY THAN OTHER PARTS OF THE STATE OF MAINE.THE LEADING CAUSES OF MORTALITY IN THE ST. MARY'S SERVICE AREA ARE HEART DISEASE, CANCER AND STROKE. ACCESS TO HEALTH CARE, BEHAVIORAL RISK FACTORS, CARDIOVASCULAR HEALTH, RESPIRATORY HEALTH, DIABETES, CANCER HEALTH, SUBSTANCE ABUSE AND MENTAL HEALTH AND YOUTH HEALTH WERE THE IDENTIFIED NEEDS FROM ONE MAINE HEALTH NEEDS ASSESSMENT, HEALTHY MAINE 2010 DATA, COMMUNITY HEALTH CARE PARTNERSHIP REPORTS AND PHYSCIAN FEEDBACK.A COMMUNITY BENEFIT PLAN WAS DEVELOPED IN CONJUNCTION WITH THE COMMUNITY BENEFIT STAFF, MISSION ADVISORY COMMITTEE, SYSTEM LEADERSHIP AND SENIOR LEADERSHIP AND WAS ENDORSED BY THE BOARD OF DIRECTORS. PART VI, LINE 3: ST. MARY'S REGIONAL MEDICAL CENTER PROVIDES FINANCIAL EDUCATION AT THE POINT OF REGISTRATION BY HAVING BROCHURES AVAILABLE. THESE BROCHURES PROVIDE INFORMATION ABOUT THE HOSPITAL BILL AND VARIOUS OPTIONS ON FINANCIAL ASSISTANCE. ON THE BACKSIDE OF THE MONTHLY PATIENT STATEMENTS ALSO PROVIDES EDUCATION OF THE FINANCIAL ASSISTANCE AVAILABILITY AND OPTIONS TO THOSE WHO NEED IT. PART VI, LINE 4: ST. MARYS SERVICE AREA INCLUDES MOST OF ANDROSCOGGIN COUNTY IN CENTRAL MAINE, WHICH IS APPROXIMATELY 43,490 HOUSEHOLDS (JUST OVER 107,000 PEOPLE). ACCORDING TO THE 2010 CENSUS BUREAU, THE DEMOGRAPHIC DISTRIBUTION IS: AGE GROUP0 TO 18 YEARS 29%18 TO 64 YEARS 57%65 YEARS AND OVER 14%15% OF FAMILIES LIVE BELOW THE POVERTY LEVEL (IN LEWISTON TEH FIGURE IS 25% AND FOR CHILD POVERTY IN LEWISTON THE FIGURE IS 41%)RACE/ETHNICITYWHITE 87.7%BLACK/AFRICAN-AMERICAN 8.7%*OTHER 3.6%LANGUAGE SPOKEN AT HOMEENGLISH 85%OTHER THAN ENGLISH 15% PART VI, LINE 5: COMMUNITY BENEFIT REPORT 2011COMMUNITY HEALTH IMPROVEMENT SERVICES (CATEGORY A): OBJECTIVES 1,2 AND 3ST. MARY'S PROVIDED MANY COMMUNITY HEALTH IMPROVEMENT SERVICES TO ADDRESS THE PUBLIC HEALTH NEEDS IDENTIFIED IN ANDROSCOGGIN COUNTY. THESE INCLUDED HEALTH SCREENINGS AND SELF-HELP PROGRAMS TARGETED FOR WELLNESS AND PREVENTION. COMMUNITY EDUCATION ABOUT IDENTIFIED PUBLIC HEALTH NEEDS IS AN INTEGRAL PART OF THIS CATEGORY. IN ORDER TO ENSURE ACCESS TO CARE, ST. MARY'S ALSO OFFERS ASSISTANCE FOR PEOPLE TO ENROLL IN PUBLIC PROGRAMS THROUGH MEDASSIST. OUR CASE MANAGEMENT PROGRAM FOR HIV OFFERS SERVICES BEYOND ROUTINE CASE MANAGEMENT TO ENSURE THAT CLIENTS' BASIC NEEDS ARE MET, AS WELL AS SUPPORT IN COPING WITH THEIR DISEASE. ST. MARY'S BEHAVIORAL SERVICE HELPED TO DEVELOP AND PARTICIPATES IN THE GREAT FALLS COLLABORATIVE, A COMMUNITY PARNERSHIP OF MENTAL HEALTH PROVIDERS TO IMPROVE COORDINATION OF CARE FOR MENTAL HEALTH SERVICES. WE SUBSIDIZE A COMMUNITY SCHOOL COOPERATING WITH LEWISTON AND AUBURN SCHOOL SYSTEMS TO SERVE AT RISK YOUTH WITH EDUCATION, OCCUPATIONAL THERAPY AND SPEECH PATHOLOGY.ST. MARY'S ALSO ADDRESSED THE NEEDS OF MINORITY COMMUNITIES AND THE "NEW MAINER" POPULATION BY EXPANDING OUR SCHOOL BASED HEALTH CENTER INTO AN ELEMENTARY SCHOOL IN LEWISTON TO ACCOMODATE THE SIGNIFICANT NEW MAINER POPULATION.HEALTH PROFESSIONS EDUCATION (CATEGORY B): OBJECTIVE 2HELPING PREPARE FUTURE HEALTHCARE PROFSSIONALS IS A DISTINGUISHING CHARACTERISTIC OF NOT-FOR-PROFIT HEALTH CARE. ST. MARY'S IS PROOUD TO SERVE AS A CLINICAL SETTING FOR UNDERGRADUATE TRAINING AND INTERNSHIPS FOR MANY HEALTH CARE DISICIPLINES. THE TIME EMPOLYEES SPEND MENTORING THESE STUDENTS IS INCLUDED IN THIS CATEGORY. SOME OF THE STAFF INVOLVED IN THIS SUPERVISION HAVE BEEN INVITED TO SERVE AS ADJUNCT FACULTY FOR ST. JOSEPH'S COLLEGE AND OTHER LOCAL COLLEGES IN RESPONSE TO THE FEEDBACK FROM STUDENTS.IN 2011 WE PARTICIPATED IN A UNIQUE OPPORTUNITY FOR SECOND YEAR MEDICAL STUDENTS THROUGH TUFTS MEDICAL SCHOOL. IT WAS A LONGITUDINAL CURRICULUM WHERE MEDICAL STUDENTS ACTUALLY LIVED ON ST. MARY'S CAMPUS FOR 9 MONTHS AND FOLLOWED PATIENTS FOR THE LENGTH OF THEIR STUDIES SO THEY EXPERIENCED A VERY COMPREHENSIVE VIEW OF HEALTH CARE. ST. MARY'S HOUSED AND FED THE TWO STUDENTS IN THIS PROGRAM. CASH AND IN-KIND CONTRIBUTIONS (CATEGORY E): OBJECTIVES 1,2,3 AND 4THIS CATEGORY INCLUDES FUNDS AND IN-KIND SERVICES DONATED TO INDIVIDUALS, COMMUNITY GROUPS AND OTHER NOT-FOR-RPOFIT ORGANIZATIONS NOT AFFILIATED WITH THE ORGANIZATIONS. IN-KIND CONTRIBUTIONS INCLUDE HOURS CONTRIBUTED BY STAFF TO THE COMMUNITY WHILE ON HEALTH CARE ORGANIZATION WORK TIME, OVERHEAD EXPENSES OF SPACE DONATED TO NOT-FOR-PROFIT COMMUNITY GROUPS AND THE DONATION OF FOOD, EQUIPMENT AND SUPPLIES.ONE EXPAMPLE OF A CASH DONATION IS TO CENTRAL MAINE COMMUNITY COLLEGE TO ALLOW THE COLLEGE TO HIRE AN ADDITIONAL NURSING INSTRUCTOR TO INCREASE OPPORTUNITIES FOR NURSING STUDENTS. LEADERSHIP SERVES ON MANY COMMUNITY HEALTH-RELATED BOARDS SUCH AS THE UNITED WAY, THE RED CROSS, THE LOCAL HOSPICE AND LEWISTON-AUBURN PUBLIC HEALTH. ST. MARY'S IS ALSO GENEROUS IN OFFERING HOSPITALITY FOR LOCAL COMMUNITY GROUPS BY PROVIDING MEETING ROOMS AT NO CHARGE FOR OTHER NOT-FOR-PROFIT ORGANIZATIONS. SUBSIDIES FOR OUR FOOD PANTRY ARE ASLO INCLUDED HERE. COMMUNITY-BUILDING ACTIVITIES (CATEGORY F): OBJECTIVE 4ST. MARY'S IS VERY ACTIVE IN PROGRAMS THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS AND ENVIRONMENTAL PROBLEMS. LEADERSHIP IS INVOLVED IN LOCAL ECONOMIC DEVELOPMENT AND COALITION BUILDING TO ADDRESS THESE ISSUES. SINCE LEWISTON, ME IS A FEREALLY DESIGNATED MEDICALLY UNDERSERVED AREA, PHYSICIAN RECRUITMENT IS A SIGNIFICANT PART OF THIS CATEGORY. SUBISDIES TO THE COMMUNITY GARDENING PROGRAMS AND YOUTH LEADERSHIP PROGRAMS AT THE NUTRITION CENTER ARE INCLUDED IN THE THIS CATEGORY. IN 2011 ST. MARY'S SPONSORED A HUMANTRAFFICKING CONFERENCE AND ST.MARY'S LEADERSHIP PARTICIPATED IN PLANNING THE CONFERENCE. COMMUNITY PARTNERSHIPS: AMERICAN CANCER SOCIETY, ANDROSCOGGIN CHAMBER OF COMMERCE, ANDROSCOGGIN HOME CARE AND HOSPICE, ANDROSCOGGIN WELLNESS COUNCIL, BATES COLLEGS, CENTRAL MAINE COMMUNITY COLLEGE, COMMON TIES, COMMUNITY CONCEPTS, HEALTH ANDROSCOGGIN, LANGUAGE ACCESS FOR NEW AMERICANS (LANA), LEWISTON/AUBURN ALLIANCE FOR SERVICES TO THE HOMELESS, LEWISTON-AUBURN PUBLIC HEALTHINITIATIVE, MAINE OFFICE FOR MINORITY HEALTH, TRI-COUNTY MENTAL HEALTH.COMMUNITY BENEFIT OPERATIONS (CATEGORY G): OBJECTIVE 4COMMUNITY BENEFIT OPERATIONS INCLUDED COSTS ASSOCIATED WITH ASSIGNED STAFF AND COMMUNITY HEALTH NEEDS, COMMUNITY BENEFIT STRATEGY AND OPERATIONS. ST. MARY'S USES LYONS SOFTWARE TO RECORD AND REPORT COMMUNITY BENEFIT EFFORTS. THIS IS THE SOFTWARE SYSTEM RECOMMENDED BY THE CATHOLIC HEALTH ASSOCIATION. IN ADDIITON, THE VP FOR MISSION INTEGRATION MEETS WITH LEADERSHIP TO EDUCATE THEM ABOUT THE IMPORTANCE OF SOCIAL ACCOUNTABILTY AND DETAILS ABOUT REPORTING. COST FOR FUNDRAISING FOR HOSPITAL-SPONSORED COMMUNITY BENEFIT PROGRAMS (SUCH AS OUR NUTRITION CENTER) ARE INCLUDED IN THIS CATEGORY. PART VI, LINE 6: ST. MARY'S HEALTH SYSTEM, A MEMBER OF COVENANT HEALTH SYSTEMS, INCLUDES ST. MARY'S REGIONAL MEDICAL CENTER, A 233-BED ACUTE CARE FACILITY; ST. MARY'S PHYSICIAN NETWORK, WITH PRIMARY CARE AND SPECIALTY PHYSICIANS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, AND MIDWIVES; COMMUNITY CLINICAL SERVICES, WITH PRIMARY CARE AND BEHAVIORAL PHYSICIANS, AND NURSE PRACTITIONERS; ST. MARY'S DYOUVILLE PAVILION, ONE OF THE LARGEST NURSING HOMES NORTH OF BOSTON, WITH 210 BEDS DEDICATED TO LONG-TERM CARE, A SECURE ALZHEIMERS UNIT, AND A REHAB CENTER; ST. MARY'S RESIDENCES, AN INDEPENDENT LIVING CENTER; AND ST. MARY'S WORKMED, OCCUPATIONAL HEALTH SERVICES, WHICH PROVIDES COMPREHENSIVE WORKSITE SERVICES TO BUSINESSES IN ANDROSCOGGIN COUNTY AND BEYOND. OUR MISSION IS TO CONTINUE THE HEALING MINISTRY OF THE CATHOLIC CHURCH IN THE SPIRIT OF ST. MARGUERITE D'YOUVILLE BY PROVIDING PREVENTIVE, CURATIVE, RESTORATIVE, AND SUPPORTIVE SERVICES WITH COMPASSION AND RESPECT FOR EVERYONE. WE TAKE SERIOUSLY THE PREVENTIVE ASPECT OF THE MISSION STATEMENT BY OFFERING PREVENTION AND WELLNESS PROGRAMS FOR THE COMMUNITY, OFFER HEALTH SCREENINGS AND WORKING TO PROVIDE ACCESS TO HEALTHY FOOD THROUGH THE NUTRITION CENTER. THE NURSING HOME OFFERS EDUCATION TO THE COMMUNITY ABOUT FALL PREVENTION, GRIEF SUPPORT AND CAREGIVER SUPPORT. HEALTH SYSTEM LEADERSHIP PARTICIPATE IN VARIOUS COMMUNITY GROUPS TO CONDUCT HEALTH CARE NEEDS ASSESSMENTS AND TO DEVELOP COMMUNITY INTERVENTIONS TO IMPROVE HEALTH. X X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 CAROLYN KASABIAN 255058 0 0 0 14399 0 6369 0 26002 0 301828 0 0 0 SIDNEY STEINKELER MD 354034 0 22500 0 22000 0 7350 0 32858 0 438742 0 0 0 MICHAEL KELLEY MD 0 309898 0 61389 0 5513 0 2756 0 24976 0 404532 0 0 LEO MYLES 327808 0 0 0 202597 0 7350 0 22807 0 560562 0 0 0 JUSTIN CLARK MD 296140 0 13945 0 0 0 0 0 22896 0 332981 0 0 0 SUSAN KEILER 235559 0 0 0 14700 0 7350 0 25846 0 283455 0 0 0 RALPH HARDER 290516 0 74076 0 22000 0 7350 0 20572 0 414514 0 0 0 IRA SHAPIRO 0 208022 0 32610 0 22000 0 6590 0 24271 0 293493 0 0 SANJAY GODARA 435774 0 0 0 13238 0 2648 0 428 0 452088 0 0 0 MARC CHRISTENSEN 1347004 0 0 0 16500 0 0 0 13814 0 1377318 0 0 0 WAYNE MOODY 740146 0 297126 0 22000 0 0 0 21426 0 1080698 0 0 0 MARIA IKOSSI 613948 0 217699 0 22000 0 7350 0 7811 0 868808 0 0 0 MICHAEL PARKER 430440 0 0 0 17769 0 0 0 2858 0 451067 0 0 0 PART I, LINE 1A THE PRESIDENT/CEO OR THE CFO MAY AUTHORIZE PAYMENT OF SPOUSAL TRAVEL EXPENSES. THE PAYMENT OF SUCH AMOUNTS ARE TREATED AS TAXABLE COMPENSATION AND REPORTED ON FORM W-2 OR 1099 AS REQUIRED. THE PRESIDENT/CEO RECEIVED TAX INDEMNIFICATION PAYMENTS RELATED TO A SUPPLEMENTAL RETIREMENT PLAN. THE PAYMENTS ARE REPORTED AS TAXABLE COMPENSATION AND INCLUDED IN THE REASONABLENESS REVIEW OF COMPENSATION. PART I, LINE 4B LEO MYLES RECEIVED A SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN CONTRIBUTION OF $182,000. THE AMOUNT IS INCLUDED IN TAXABLE WAGES IN 2011. PART I, LINE 7 IN CONJUNCTION WITH ITS SOLE MEMBER, COVENANT HEALTH SYSTEMS, THE ORGANIZATION MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY COVENANT HEALTH SYSTEM'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS THAT ARE SET AT THE BEGINNING OF THE YEAR. MHHEFA REVENUE BOND SERIES 2004A 010314384 560425TL4 2004-06-03 17835000 ADVANCED REFUNDING 0 0 0 MHHEFA REVENUE BOND SERIES 2007A 010314384 560425V80 2007-11-01 6685000 CONSTRUCTION 0 0 0 MHHEFA REVENUE BOND SERIES 2010B 010314384 560427JA5 2010-06-24 7825000 REFINANCE OF 2001 AND 2004 TAX-EXEMPT BONDS 0 0 0 2770203 1615380 237062 2004 1 0 1 1 6853065 444500 89925 6318640 2009 0 0 1 1 9077696 603175 96465 2004 1 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 0 0 1 FSA 30.000000000000 1 0 0 0 0 0 1 FSA 30.000000000000 1 0 0 1 0 0 1 FSA 20.000000000000 1 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER WHO MAY APPOINT OR REMOVE ONE OR MORE OF THE BOARD OF DIRECTORS FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD OF DIRECTORS ARE SUBJECT TO APPROVAL BY THE MEMBERS FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED AT THE JUNE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THIS PROCESS IS THE RESONSIBILITY OF THE COMPLIANCE OFFICER. A FORM IS SUBMITTED TO ALL LEADERSHIP, BOARD MEMBERS, BOARD COMMITTEE MEMBERS, EMPLOYED PHYSICIANS, MEDICAL DIRECTORS AND CERTAIN EMPLOYEES IN KEY POSITIONS ANNUALLY TO BE COMPLETED. REMINDERS ARE SENT TO MAKE CERTAIN THAT ALL CONFLICT OF INTEREST FORMS ARE RETURNED. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH SYSTEMS' BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 18 FORM 990 IS AVAILABLE ON OUR WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES FORM 990, FORM 990-T AND FORM 1023 TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT CURRENTLY PROVIDE ACCESS TO GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OF FINANCIAL STATEMENTS. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART X, LINE 24E TAXES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,911,582. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,911,582. EQUIPMENT RENTAL & MAINTENANCE: PROGRAM SERVICE EXPENSES 2,094,902. MANAGEMENT AND GENERAL EXPENSES 794,080. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,888,982. DUES: PROGRAM SERVICE EXPENSES 85,414. MANAGEMENT AND GENERAL EXPENSES 2,468,407. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,553,821. CCS SUBSIDY: PROGRAM SERVICE EXPENSES 2,270,264. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,270,264. OUTSIDE WORK: PROGRAM SERVICE EXPENSES 2,233,759. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,233,759. COMPUTER SERVICES: PROGRAM SERVICE EXPENSES 248,468. MANAGEMENT AND GENERAL EXPENSES 1,298,305. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,546,773. RECRUITMENT: PROGRAM SERVICE EXPENSES 984,514. MANAGEMENT AND GENERAL EXPENSES 115,516. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,100,030. ADMIN FEES: PROGRAM SERVICE EXPENSES 552,894. MANAGEMENT AND GENERAL EXPENSES 190,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 743,694. ADVERTISING & MARKETING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 602,309. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 602,309. TELEPHONE: PROGRAM SERVICE EXPENSES 389,935. MANAGEMENT AND GENERAL EXPENSES 2,163. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 392,098. CONSULTANTS: PROGRAM SERVICE EXPENSES 153,110. MANAGEMENT AND GENERAL EXPENSES 158,363. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 311,473. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 276,036. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 276,036. SUNDRY: PROGRAM SERVICE EXPENSES 205,338. MANAGEMENT AND GENERAL EXPENSES 16,638. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 221,976. PRINTING AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 113,838. MANAGEMENT AND GENERAL EXPENSES 101,081. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 214,919. POSTAGE & SHIPPING: PROGRAM SERVICE EXPENSES 19,517. MANAGEMENT AND GENERAL EXPENSES 177,195. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 196,712. BANK CHARGES & FINANCE FEES: PROGRAM SERVICE EXPENSES 40. MANAGEMENT AND GENERAL EXPENSES 173,634. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 173,674. STAFFING AGENCIES: PROGRAM SERVICE EXPENSES 120,594. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,594. MICROFILMING: PROGRAM SERVICE EXPENSES 71,696. MANAGEMENT AND GENERAL EXPENSES 38,021. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 109,717. CERTIFICATION: PROGRAM SERVICE EXPENSES 33,612. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,612. LICNESES: PROGRAM SERVICE EXPENSES 22,541. MANAGEMENT AND GENERAL EXPENSES 3,436. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,977. LAUNDRY: PROGRAM SERVICE EXPENSES 20,273. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,273. PROFICIENCY TESTS: PROGRAM SERVICE EXPENSES 19,324. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,324. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET TRANSFERS 1,642,940. UNREALIZED GAINS -358,512. TOTAL TO FORM 990, PART XI, LINE 5: 1,284,428. AUDIT COMMITTEE FORM 990 PART XI, LINE 2C THE AUDIT COMMITTEE OF COVENANT HEALTH SYSTEM ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT AUDITOR. ST MARY'S HEALTH SYSTEM PO BOX 7291 CAMPUS AVENUE LEWISTON ME 04240 222504349 PARENT COMPANY ME 501(C)(3) 509(A)(3) COVENANT HEALTH SYSTEMS 0 COMMUNITY CLINICAL SERVICES PO BOX 7291 CAMPUS AVENUE LEWISTON ME 04240 010409788 PHYSICIAN PRACTICE ME 501(C)(3) 509(A)(2) ST MARY'S HEALTH SYSTEM 0 ST MARY D'YOUVILLE PAVILION 102 CAMPUS AVE LEWISTON ME 04240 010211558 NURSING HOME ME 501(C)(3) 509(A)(2) ST MARY'S HEALTH SYSTEM 0 ST MARY'S RESIDENCES PO BOX 7291 CAMPUS AVENUE LEWISTON ME 04240 222504356 LOW INCOME HOUSING ME 501(C)(3) 509(A)(2) ST MARY'S HEALTH SYSTEM 0 NEIGHBORHOOD HOUSING INITIATIVE PO BOX 7291 CAMPUS AVENUE LEWISTON ME 04240 010539730 AFFORDABLE HOUSING ME 501(C)(3) 509(A)(1) ST MARY'S HEALTH SYSTEM 0 COVENANT HEALTH SYSTEMS 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ADMINISTRATION MA 501(C)(3) 509(A)(2) 0 CAMPUS HOLDING PO BOX 7291 CAMPUS AVENUE LEWISTON ME 04240 010406049 HOLDING COMPANY ME ST MARY'S HEALTH SYSTEM C 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 1 0 ST MARY'S D'YOUVILLE PAVILION K 244496 FAIR MARKET VALUE ST MARY'S D'YOUVILLE PAVILION L 4210462 ACTUAL EXPENSE ST MARY'S D'YOUVILLE PAVILION J 24168 FAIR MARKET VALUE ST MARY'S D'YOUVILLE PAVILION N 895008 ACTUAL EXPENSE ST MARY'S D'YOUVILLE PAVILION P 8272 ACTUAL EXPENSE ST MARY'S D'YOUVILLE PAVILION I 21000 FAIR MARKET VALUE COMMUNITY CLINICAL SERVICES G 55701 FAIR MARKET VALUE COMMUNITY CLINICAL SERVICES I 482568 FAIR MARKET VALUE COMMUNITY CLINICAL SERVICES L 429488 ACTUAL EXPENSE COMMUNITY CLINICAL SERVICES K 60000 ACTUAL EXPENSE COMMUNITY CLINICAL SERVICES P 38252 ACTUAL EXPENSE ST MARY'S HEALTH SYSTEM H 480872 ACTUAL EXPENSE ST MARY'S HEALTH SYSTEM P 1787494 ACTUAL EXPENSE ST MARY'S HEALTH SYSTEM L 2403875 ACTUAL EXPENSE ST MARY'S HEALTH SYSTEM N 649895 ACTUAL EXPENSE ST MARY'S HEALTH SYSTEM J 540113 FAIR MARKET VALUE ST MARY'S HEALTH SYSTEM Q 1001802 ACTUAL EXPENSE ST MARY'S HEALTH SYSTEM K 6983 ACTUAL EXPENSE COVENANT HEALTH SYSTEMS K 2310434 ACTUAL EXPENSE ST MARY'S RESIDENCE O 141347 ACTUAL EXPENSE ST MARY'S RESIDENCE J 78888 FAIR MARKET VALUE ST MARY'S RESIDENCE N 366120 ACTUAL EXPENSE ST MARY'S RESIDENCE P 1110 ACTUAL EXPENSE