2012-08-13T09:05:30-05:00 2011-09-30 BAKER NEWMAN & NOYES BOX 507 PORTLAND ME 04112 990 2010-10-01 010215911 Mid Coast Hospital MIDC 2077290181 123 Medical Center Drive Brunswick ME 04011 Robert McCue 2077290181 2012-08-09 1 Nicholas E Porto 2078792100 2012-08-09 2010 2016-02-24 21:20:13Z Lois Skillings 123 Medical Center Drive Brunswick ME 04011 134234149 0 X www.midcoasthealth.com X 1991 ME Acute and specialty care hospital 20 18 1141 500 0 0 1750288 1757517 108209426 119216128 688605 1907781 25361 19416 110673680 122900842 7700 11675 0 0 56030771 59523676 0 0 0 51472643 54948897 107511114 114484248 3162566 8416594 134698531 139681202 50185494 48796139 84513037 90885063 X To provide quality health care and health-related services directed toward continually improving the health and wellbeing of the patients and communities we serve. We will provide compassionate, humanistic, accessible, personal, professional, efficient, cost-effective and quality services. 0 0 96218142 11675 119230138 Acute and specialty health care services were provided to residents of the Mid-Coast Maine area. Charity care was provided to those patients who did not have the ability to pay for medical services. 96218142 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 1 100 0 1 1141 1 0 0 0 0 0 1 1 0 0 0 0 X 20 18 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X Michael Perry 2077290181 123 Medical Center Drive Brunswick ME 04011 X James Ashe 0.30 X 0 0 0 William S Gardiner 0.30 X 0 0 0 Donald Gerrish 0.30 X 0 0 0 Susan Gillies 0.30 X 0 0 0 Jill Haer 0.30 X 0 0 0 Partice Hennin 0.30 X 0 0 0 Steven Levesque 0.30 X 0 0 0 Abigail Manny 0.30 X 0 0 0 Anne Marsh 0.30 X 0 0 0 Daniel Morgenstern MD 0.30 X 0 0 0 Douglas Niven 0.30 X 0 0 0 Loren Wright 0.30 X 0 0 0 Charles Frizzle 0.30 X X 0 0 0 Ervin Snyder 0.30 X X 0 0 0 Glenn L Hutchinson 0.30 X X 0 0 0 Charles Bridge 0.30 X X 0 0 0 James Mullen MD 0.30 X X 0 0 0 James Rines MD 0.30 X X 145245 0 37571 Lois Skillings 15.20 X X 0 243720 58252 Carolyn Gibson 0.30 X X 0 0 0 Robert McCue 30.50 X 0 234007 56523 Herbert Paris 15.20 X 0 405609 98504 Jonathan Telsey MD 41.50 X 506987 0 33472 John Taylor MD 41.50 X 278061 0 23435 Elaine Secskas MD 41.50 X 260578 0 36625 Stephanie Grohs MD 41.50 X 254900 0 36157 Paul Leprad MD 41.50 X 250076 0 37258 1695847 883336 417797 46 0 1 0 Mid Coast Anesthesia PA 121 Medical Center Drive Box 6 Brunswick ME 04011 Anesthesiology Services 1059788 Midcoast Pediatrics 121 Medical Center Drive Suite 260 Brunswick ME 04011 Physician Coverage 698321 Vista Staffing SOL Inc File 5834 Los Angelos CA 900740834 Physician Coverage 694873 Coastal Maine Emergency Physicians PO Box 270 South Freeport ME 04078 ER Facility Coverage 690380 Mayo Collaborative SVC Inc PO Box 9146 Minneapolis MN 554809146 Laboratory Services 656732 23 16418 1082294 658805 80854 1757517 Net Patient Service Re 621400 115957179 115957179 Miscellaneous Revenue 621400 1941579 1941579 Electronic Health Reco 621400 1317370 1317370 119216128 1251071 1251071 14010 14010 14010 14010 11955378 27000 11266204 59464 689174 -32464 656710 656710 13045 16418 7639 5406 5406 122900842 119230138 0 1913187 11675 11675 182816 175503 7313 49268423 42350426 6917997 903806 700389 203417 6463509 5039354 1424155 2705122 2109995 595127 62029 62029 54210 54210 11798209 9185042 2613167 340231 264874 75357 8294583 6457428 1837155 4413475 3435941 977534 32007 24918 7089 1740332 1354869 385463 5837906 4544877 1293029 1616816 1258710 358106 Patient Medical Expense 6832780 6832780 Provision for Bad Debts 5141859 5141859 Pharmacy Expenses 4855301 3779908 1075393 Revenue Tax 2215458 2215458 Non-Patient Medical Exp 1070161 833133 237028 643540 501003 142537 114484248 96218142 18266106 0 7260630 4715779 14591507 14996767 8424478 8689651 2060130 2116406 2035417 3881385 103497692 45564973 59504691 57932719 30321908 32321195 361548 344351 10138222 14682949 134698531 139681202 11887869 11130536 33920115 32877247 4377510 4788356 50185494 48796139 X 70036682 76895478 7036575 6460695 7439780 7528890 84513037 90885063 134698531 139681202 X 8416594 -2044568 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12897 12897 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The Organization paid dues to MHA totaling $46,628, of which 15.5% was used for lobbying. The Organization also paid dues to AHA totaling $23,217, of which 24.42% was used for lobbying. 19263606 89457 1420387 159680 20613770 18850981 85217 500960 173552 19263606 18696946 61289 360571 267825 18850981 0.35830 0.36460 0.27710 0 0 329281 329281 55512373 13242736 42269637 3800304 1383642 2416662 43855734 30938595 12917139 57932719 Estimated Third-Party Payor Settlements 6006201 Construction in Progress 170870 L-T Asset (Deferred Comp Plan) 4788356 Due from Affiliates 3148373 Other Assets 569149 14682949 Deferred Compensation Plan 4788356 4788356 122900842 114484248 8416594 -1404568 -640000 -2044568 6372026 121503913 -1404568 7639 -1396929 122900842 0 122900842 115131887 647639 647639 114484248 0 114484248 Description of Intended Use of Endowment Funds: Part V, Line 4: Endowment funds are invested and used in a manner that provides predictable streams of funding to the programs supported by the endowed funds, all while seeking to maintain the purchasing power of the endowment assets. Description of Uncertain Tax Positions Under FIN 48: Part X: The Hospital is a not-for-profit corporation and is tax-exempt under Section 501(c)(3) of the Internal Revenue Code. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The Hospital has evaluated the position taken on its filed tax returns. The Hospital has concluded no uncertain income tax positions exist at September 30, 2011. The Hospital's tax years from 2008 through 2011 are open and subject to examination. Part XI, Line 8 - Other Adjustments: Equity Transfer to Affiliates -640,000. Part XII, Line 2d - Other Adjustments: Golf Tournament Expenses 7,639. Part XIII, Line 2d - Other Adjustments: Golf Tournament Expenses 7,639. Equity Transfer to Affiliates 640,000. Golf Tournament 29463 16418 13045 619 7020 29463 16418 13045 619 7020 7639 5406 1 1 1 X 1 X 1 1 1 0 0 3869736 1198463 2671273 0.02440 12989574 8142440 4847134 0.04430 0 0 16859310 9340903 7518407 0.06870 554508 21609 532899 0.00490 0 0 16114620 12964080 3150540 0.02880 0 0 0 0 16669128 12985689 3683439 0.03370 33528438 22326592 11201846 0.10240 1 2617333 0 25818147 26897547 -1079400 X 0 12 1 Mid Coast Hospital

123 Medical Center Drive Brunswick ME 04011

X X X 2 Mid Coast Hospital

121 Medical Center Drive Brunswick ME 04011

X 3 Mid Coast Hospital

81 Medical Center Drive Brunswick ME 04011

X 4 Mid Coast Hospital

11 Medical Center Drive Brunswick ME 04011

X 5 Mid Coast Hospital

310 Bath Road Brunswick ME 04011

X 6 Mid Coast Hospital

81 Medical Center Drive Brunswick ME 04011

X 7 Mid Coast Hospital

430 Bath Road Brunswick ME 04011

X 8 Mid Coast Hospital

66 Baribeau Drive Brunswick ME 04011

X 9 Mid Coast Hospital

30 So Bristol Road Bath ME 04543

X 10 Mid Coast Hospital

1356A Washington Avenue Bath ME 04530

X 11 Mid Coast Hospital - Mid Coast Med Group

1 Bowdoin Mill Island Topsham ME 04086

X 12 Mid Coast Hospital

22 Maine Street Station Brunswick ME 04011

X NA 1 Part I, Line 7: Based on the IRS Form 990, Schedule H, a worksheet was provided to determine the overall cost to charge ratio that could be used to apply throughout Schedule H of Form 990. Where applicable, the Organization utilized this worksheet to convert charges to costs. The Organization did not use the Worksheet 2 percentage for the IRS Form 990, Schedule H, Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs, or Worksheet 6, Subsidized Health Services, for the Medicaid allowable costs. Instead, the Organization utilized the actual Medicaid filed cost report for the Medicaid allowable costs. Additionally, the Organization used the modified Medicare allowable costs and payments related to these services in regards to the cardiopulmonary community program and psychiatric unit. For our provider based clinics, in this same section we used the actual costs for each clinic. In addition, for its addiction resource center, access health service, and senior psychiatric services, the Organization used the estimated costs calculated based on actual clinic costs estimated from reporting on these centers to the State of Maine. Part I, Line 7g: Mid Coast Hospital has clinical services and hospital-owned physician practices. Mid Coast Hospital has included these practices in this section of the 990, Schedule H of subsidized health services if they are operating at a loss. The Hospital has included the following clinical services and hospital-owned physician practices that operate at a loss and the corresponding costs of these practices: neurology practice, OB/GYN practice, pulmonary practice, urology practice, primary care clinic, walk-in clinic, nephrology practice, orthopedics practice, psychiatric department, cardiopulmonary community program, addiction resource center, access health service, senior psychiatric service, and chemical dependency services. The above listed hospital clinical services and hospital-owned physician practices have a community benefit of approximately $3.2 million. In addition, the community benefit does not take into account bad debts, charity care, and contractual adjustments. Thus, this community benefit of approximately $3.2 million is a conservative number that reconciles to the community benefit on the IRS Form 990, Schedule H. Part I, L7 Col(f): Bad debt expense of $5,141,859 has been removed from the denominator of the calculation in Schedule H, Part I, Line 7, column f. Part II: N/A Part III, Line 4: Services rendered to individuals from whom payment is expected and ultimately not received is written off and included as part of the provision for bad debts.In accordance with generally accepted accounting principles, the allowance for doubtful accounts and bad debt expense is provided based on an analysis by management of the collectibility of outstanding balances. Management considers the age of outstanding balances and past collection efforts in determining the allowance for doubtful accounts and bad debt expense. Accounts deemed uncollectible are charged off against the established allowance. Part III, Line 8: The Hospital believes all of the clinical areas included in the Form 990, Schedule H should be and are considered a community benefit. Mid Coast Hospital believes that by offering and thus subsidizing these clinical services within the community, the community benefits by having easy access to these services. If these services were not available by Mid Coast Hospital there would be a greater burden on the community and many, if not all, of these services would not be available with such easy access. Based on the IRS Form 990, Schedule H, a worksheet was provided to assist in determining the overall cost-to-charge ratio that could be used to apply throughout the Schedule H of the Form 990 in order to convert charges to costs. Where applicable, we have utilized this worksheet to convert charges to costs. We did not use this worksheet percentage on the calculation of Medicare costs in this section. We used the Medicare allowable costs and payments related to the subsidized health service; and, we utilized the Medicare cost report estimated cost and payment for these services. Part VI, Line 2: Mid Coast Hospital assesses the health care needs of the community on an ongoing basis. Mid Coast Hospital's strategic plan is a road map as to where and how to deliver services to the surrounding communities. This process of how to provide these services included listening and learning to/from the community - patients and families, faith community, municipal leaders, legislatures and local businesses. Mid Coast also looked inward, calling upon board members, corporators, medical staff, volunteers, auxiliary, and employees since they are all part of the community Mid Coast Hospital serves. Part VI, Line 3: Mid Coast Hospital will notify patients about access to various financial assistance needs in different ways. We have postings in various departments as well has handouts informing patients how to access these programs if a need for financial assistance is required. There are signs and pamphlets in the Hospital settings indicating the poverty guidelines and how to obtain assistance to free or discounted care. All of our patients can speak to one of the Hospital's employees on how to obtain financial assistance; and, if there is assistance needed, the employee will inform our patient financial services department who will then work with the patient to either help them apply for MaineCare or discuss options for free or discounted care. Part VI, Line 4: Mid Coast Hospital primary service area includes the communities in the Mid Coast Maine communities including: Arrowsic, Bailey Island, Bath, Bowdoin, Bowdoinham, Brunswick, Dresden, Durham, Freeport, Georgetown, Harpswell, Lisbon, Litchfield, North Yarmouth, Perkins Township, Phippsburg, Pownal, Richmond, Sabattus, Topsham, West Bath, Westport, Wiscasset, Woolwich, Yarmouth. Approximately 15% of Mid Coast Hospital patients utilize Medicaid and 40% of Mid Coast Hospital patients utilize Medicare. The population of the communities supported by Mid Coast Hospital with income under 200% of the poverty guidelines is about 21%. Part VI, Line 6: Mid Coast Hospital is a local, not-for-profit, community hospital that serves the local communities and the people regardless of their ability to pay. The members on the board of directors and corporators are all members of the communities that Mid Coast Hospital serves. All Hospital net income gains are reinvested into the facilities, equipment and services for the community. Part VI, Line 7: Mid Coast Hospital has a clinical affiliation with Maine Health to provide the best patient care to all of the communities that Mid Coast Hospital and Maine Health serves. 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: During the tax year, the Organization only granted funds to local municipal school systems, further monitoring is not deemed necessary. X X X 0 1 0 0 0 0 0 0 0 James Rines MD 145245 0 0 0 0 0 25445 0 12126 0 182816 0 0 0 Lois Skillings 0 243720 0 0 0 0 0 38250 0 20002 0 301972 0 0 Robert McCue 0 234007 0 0 0 0 0 36719 0 19804 0 290530 0 0 Herbert Paris 0 405609 0 0 0 0 0 78502 0 20002 0 504113 0 0 Jonathan Telsey MD 506987 0 0 0 0 0 21779 0 11693 0 540459 0 0 0 John Taylor MD 278061 0 0 0 0 0 12990 0 10445 0 301496 0 0 0 Elaine Secskas MD 260578 0 0 0 0 0 23850 0 12775 0 297203 0 0 0 Stephanie Grohs MD 254900 0 0 0 0 0 23850 0 12307 0 291057 0 0 0 Paul Leprad MD 250076 0 0 0 0 0 23850 0 13408 0 287334 0 0 0 Part I, Line 4b The Hospital has a deferred compensation arrangement under a nonqualified defined contribution plan to provide supplemental retirement benefits to certain employees. Herbert Paris (effective 10/1/10-6/30/11), Lois Skillings (effective 7/1/11-9/30/11), and Robert McCue, who are officers of the Organization, participated in this plan and received $78,502, $38,250, and $36,719, respectively. Maine Health and Higher Ed Fac Auth (MHHEFA) 010314384 560425L40 2007-07-18 97716087 Refinance Series 1998B Revenue Bond 0 0 0 Maine Health and Higher Ed Fac Auth (MHHEFA) 010314384 560425362 2008-12-03 41658395 Hospital Facility Expansion Project 0 0 0 28930803 1984500 26651099 290758 4446 2002 1 1 1 1 12393996 892731 138784 11362143 338 2009 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 Trans America 20.000000000000 1 0 0 0 0 0 0 0 0 Herbert Paris Member of board of directors of Medical Mutual Insurance Company 1421672 The amount paid to Medical Mutual and identified in this section is for malpractice insurance coverage for the Hospital. Mr. Paris served on the board of directors for Medical Mutual and was the CEO of Mid Coast Hospital from October 1, 2010 until June 30, 2011. Mr. Paris was paid a nominal fee to serve on Medical Mutual's board of directors.The amount included in column c represents the total amount paid to Medical Mutual the amounts paid during the time specifically relating to Mr. Paris's tenure on the board are not easily determinable. 0 Lois Skillings Member of board of directors of Medical Mutual Insurance Company 1421672 The amount paid to Medical Mutual and identified in this section is for malpractice insurance coverage for the Hospital. Ms. Skillings serves on the board of directors for Medical Mutual and, as of July 1, 2011, is the CEO of Mid Coast Hospital. Ms. Skillings was paid a nominal fee to serve on Medical Mutual's board of directors.The amount included in column c represents the total amount paid to Medical Mutual the amounts paid during the time specifically relating to Ms. Skillings's tenure on the board are not easily determinable . 0 X 1 72000 Appraisal X 5 8524 Market Value X 1 330 Actual Cost 1 0 1 1 Third Party Use: Part I, Line 32b: The Organization sells contributions of securities through its investment broker. All gifts of securities are sold as soon as administratively possible. Form 990, Part VI, Section A, line 6 Mid Coast Health Services (MCHS) shall be the Organization's sole member with all rights and responsibilities of membership, including all voting rights. Form 990, Part VI, Section A, line 7a At each annual meeting of the sole member, the sole member shall elect directors to hold office until the election and qualification of their respective successors. The directors shall be persons who have demonstrated an interest in the Organization's goals and objectives and, to the extent reasonably feasible, shall represent the Mid-Coast area. To the extent feasible, fifty percent of all directors serving on the Organization's board of directors shall be persons who also serve on the board of directors of MCHS. Form 990, Part VI, Section A, line 7b The business and affairs of the Organization shall be conducted and managed by its board of directors which shall exercise all of the powers of the Organization. The board of directors shall approve an annual operating budget, develop a long-term capital expenditure plan and, through its own committees or the committees of its sole member, monitor the implementation of the plan. Notwithstanding the foregoing, the directors shall not submit any application for a certificate of need to the Maine Department of Health and Human Services, or incur any long-term debt without the approval of MCHS as the sole member. The board of directors may delegate such powers as it sees fit to committees and officers of the Organization. Form 990, Part VI, Section B, line 11 A draft of the return is reviewed by an officer of the Hospital prior to it being filed with the IRS. Form 990, Part VI, Section B, line 12c The Hospital has a compliance committee that meets on a quarterly basis to review any compliance issues that may arise. Form 990, Part VI, Section B, line 15 An independent consultant prepares a market analysis at the regional level for all officers and key employees of the Organization. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy and audited financial statements available to the public upon request. Form 990, Part VII, Section A: Dr. James Rines receives compensation for his services to the Organization in his capacity as a physician. His salary and benefit amounts disclosed in Part VII do not reflect payments made to him for his services as a member of the board. Form 990, Part VII, Section A: Herbert Paris, CEO (10/1/10 - 6/30/11), Lois Skillings, CEO (effective 7/1/11), and Robert McCue, CFO, provided services as officers to several related organizations. Their hours per week disclosed in Part VII of this Form 990 reflect only time devoted to the Hospital. Their salary and benefit amounts reflect 2010 reportable compensation for their services in the entire Mid Coast network of entities. Form 990, Part VII, Section A: Lois Skillings is the current CEO of Mid Coast Hospital, and started in that capacity during the fiscal year. Compensation represents amounts paid to her in her capacity as a regular employee of a related organization as was her position during calendar year 2010. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -1,404,568. Equity Transfer to Affiliates -640,000. Total to Form 990, Part XI, Line 5: -2,044,568. Oversight of Audit: Form 990, Part XI, Line 2c The audit process has not changed from the prior year. Mid Coast Health Services 123 Medical Center Drive Brunswick ME 04011 010430069 Health Services ME 501(C)(3) 7 N/A 0 Mid Coast Geriatric Services Corporation 123 Medical Center Drive Brunswick ME 04011 010496211 Geriatric Services ME 501(C)(3) 9 N/A 0 Community Health and Nursing Services 60 Baribeau Drive Brunswick ME 04011 010211546 Hospice Services ME 501(C)(3) 9 N/A 0 Mid Coast Medical Group 123 Medical Center Drive Brunswick ME 04011 010484592 Medical Services ME N/A C Midcoast Health Management Corporation 123 Medical Center Drive Brunswick ME 04011 010429598 Management of Health Services ME N/A C Thornton Oaks Development Corporation 123 Medical Center Drive Brunswick ME 04011 010448411 Management of Health Services ME N/A C 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 0