2012-03-07T12:42:33-07:00 2010-04-30 990 2009-05-01 010211797 MOUNT DESERT ISLAND HOSPITAL MOUN 2072885081 PO Box 8 10 Wayman Lane Bar Harbor ME 046090008 Christina Harding 2072885082 2010-12-01 2009 2016-02-24 21:20:13Z X Arthur Blank 10 Wayman Lane Bar Harbor ME 046090008 52700798 0 X www.mdihospital.org X 1897 ME Mount Desert Island Hospital's mission is to provide compassionate care and strengthen the health of our community by embracing tomorrow's methods and respecting time-honored values. 19 12 500 149 0 0 2011991 1393948 42966262 46369370 182580 960875 383460 814995 45544293 49539188 0 0 0 0 25349786 28241495 0 0 189946 18602496 20243340 43952282 48484835 1592011 1054353 37897319 41225229 19263996 20859087 18633323 20366142 Mount Desert Island Hospital's mission is to provide compassionate care and strenthen the health of our community by embracing tomorrow's methods and respecting time-honored values. 0 0 37001623 0 46369370 Patient Care: Mount Desert Island Hospital's mission statement is described in Part II, Line 1 above. In Fiscal Year 2010, MDI Hospital provided $912,931 in services for which no compensation was expected or received. Policies exist to provide relief for those who cannot pay for medical care. MDI Hospital provides care to persons covered by governmental programs including Medicare, Medicaid and Champus. The unreimbursed value for providing care to these patients approximates $10,528,658. The Hospital provides a number of health services and preventative health programs to the community. Most of these programs are either covered by insurance, are offered at very low costs or are free to the community. Available programs include: cardiac pulmonary rehabilitation, wellness program, diabetes education, nutrition counseling, parenting, pregnancy and sibling classes and physical and occupational therapy programs. Throughout the year staff from the hospital make presentations to area school children regarding smoking cessation and health nutrition. Additionally, community groups such as Alcoholics Anonymous use the hospital's conference rooms for their meetings. 0 0 0 37001623 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 0 0 1 90 0 1 500 1 0 0 0 0 0 19 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X X X Arthur Blank 2072885081 10 Wayman Lane Bar Harbor ME 046090008 Terry Musson 5 X X 0 0 0 John Adams MD 3 X X 0 0 0 O Lee Haynes MD 40 X X X 187342 0 19617 Arthur J Blank 40 X X X X 236903 0 24548 John Benson MD 1 X 0 0 0 Michael Bonsey 1 X 0 0 0 Stewart Brecher 1 X 0 0 0 Mary Dudzik MD 40 X X 158474 0 16237 David Einhorn Esq 1 X 0 0 0 Kathleen Field 1 X 0 0 0 Julius Krevans MD 1 X 0 0 0 Julian Kuffler MD 40 X X X 227314 0 25324 Dean Read 1 X 0 0 0 Mickey Shattow 1 X 0 0 0 Robert Shea 1 X 0 0 0 Robert Stanwood 1 X 0 0 0 Patricia Hand PhD 1 X 0 0 0 Elsie Flemings 1 X 0 0 0 Jeannine Ross 1 X 0 0 0 Brad Perkins 40 X X 122843 0 15996 Edward Gilmore MD 40 X 194189 0 18389 Ronald Prokopuis MD 40 X 260388 0 22828 William Kenausis 40 X 189734 0 21770 Edward White MD 40 X 258855 0 19023 Michael Heniser MD 40 X 295497 0 10874 2131539 0 194606 36 0 1 0 Berry Dunn McNeil and Parker 100 Middle Street PO Box 1100 Portland ME 04104 Audit and consulting 183678 Bay View Physical Therapy 125 Oak Street Ellsworth ME 04605 Physical Therapy 578523 Aureus Radiology LLC PO Box 3037 Omaha NE 681030037 Radiology staffing 236701 Maine Coast Memorial Hospital 50 Union Street Ellsworth ME 04605 Shared physician 235984 Meridian Medical Staffing PO Box 29680 Phoenix AZ 850389680 Staffing 127338 10 0 0 0 0 9748 1384200 196691 1393948 Patient Service Revenue 900099 23407087 23407087 0 0 Medicare/Medicaid Payments 900099 22962283 22962283 0 0 0 0 0 0 46369370 224382 0 0 224382 2655 0 0 2655 0 0 0 0 30000 0 0 0 30000 0 30000 0 0 30000 3895448 0 3161610 0 733838 0 733838 0 0 733838 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cafeteria Sales 900099 175902 175902 0 0 Miscellaneous Income - Eden 900099 77334 77334 0 0 Miscellaneous Income-HC A 900099 123504 123504 0 0 408255 408255 0 0 784995 49539188 47154365 0 990875 0 0 0 0 0 0 0 0 845017 0 845017 0 0 0 0 0 20532467 15659174 4748277 125016 758704 555757 198510 4437 4655281 3410030 1218027 27224 1450026 1062155 379391 8480 0 0 0 0 52088 0 52088 0 107058 0 107058 0 0 0 0 0 0 0 25675 0 25675 0 0 0 0 0 107695 0 107695 0 4267913 4153806 114107 0 0 0 0 0 0 0 0 0 690897 552718 138179 0 51852 34785 17067 0 0 0 0 0 294377 153283 141094 0 391937 313550 78387 0 0 0 0 0 1762812 1410250 352562 0 685795 606809 78986 0 Purchased Services 5379520 3685000 1694520 0 Bad debt expense 2835620 2835620 0 0 Physician fees 1035559 1010559 25000 0 Tax & match 706276 706276 0 0 Space rental 517834 517834 0 0 1330432 334017 971626 24789 48484835 37001623 11293266 189946 0 0 98632 47719 641983 269981 5676210 4367952 0 0 0 0 0 0 578267 530874 89848 125848 37585908 20631483 16860918 16954425 9130360 11683245 0 0 0 0 0 4821101 7245185 37897319 41225229 9452823 10048082 0 0 0 0 6411571 5880655 0 0 0 0 2310952 1978084 0 0 1088650 2952266 19263996 20859087 X 15282327 16861433 1693522 1608714 1657474 1895995 18633323 20366142 37897319 41225229 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6681 6681 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 This amount represents a portion of dues determined expended for specific lobbying purposes. These expenditures are defined as direct communications with certain members of federal, state, or local government to influence legislation. These dues support the organizations advocacy and representation in its broadest sense, activities that are well beyond the scope of defined lobbying activities. For the American Hospital Association total dues 11478 of which 23 percent are lobbying expense or 2727 dollars. Maine Hospital Association total Dues are 23817 of which 16.6 percent are lobbying expense or 3954 dollars. Total lobbying expense included in dues is 6681 dollars. 0 404568 404568 0 17398353 9514499 7883854 0 191013 110959 80054 0 16112645 10846592 5266053 0 3479329 159433 3319896 16954425 0 0 0 Due from affiliates 3711189 Deferred financing costs, net 99776 Estimated third party settlements - due from MaineCare 2218752 Investments to fund deferred compensation 977248 Other assets 238220 7245185 0 Deferred compensation 977248 Due to affiliates 309807 Estimated third party settlements - due to 1665211 2952266 49539188 48484835 1054353 811947 0 0 0 -133481 678466 1732819 47239907 0 0 0 0 0 47239907 0 2299281 2299281 49539188 48309356 0 0 0 0 0 48309356 0 175479 175479 48484835 SchD_P10_S00_L00 Schedule D, Part X Not applicable SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Change in pledges receivable is -372002. Change in value of beneficial interest in perpetual trust is 238521. Total Other Part XI, Line 9 is -133,481 SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Total represents items recorded as revenue below Loss from Operations on audited financial statements. Net assets released is -18265. Gifts and bequests is 322542. Temporary restricted contributions is 1061658. Interest income on investments is 201363. Investment management fees on Schedule IX Life 11f is 25675. Realized gain or loss on sale of investments is 733838. Other revenue below operating gain or loss is -27530. Total Other Part XII Line 4b is 2299281. SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b Fundraising expenses and investment management fees recorded on audited financial statements as Other income or expense includes Fundraising expense of 149804 and investment management fees of 25675. Total Other Part XIII Line 4b is 175479. 1 1 1 X 1 X 1 1 1 0 1 1 718314 718314 0.0148 4965153 3880554 1084599 0.0224 0 0 5683467 3880554 1802913 0.0372 104276 104276 0.0022 0 0 104276 0 104276 0.0022 0 0 5787743 3880554 1907189 0.0394 1 2835620 0 14124706 16616278 -2491572 X 1 1 Mount Desert Island Hospital

10 Wayman Lane PO Box 8 Bar Harbor ME 046090008

X X X X In Part I Line 7 costing methodology utilized for this table were derived from Worksheet 2, Ratio of patient care cost to charges with data from our fiscal year 2010 filed cost reports. In Part I Line 7 Column F bad debt expense of 2835620 on Form 990 Part IX line 24b column A was excluded from line 7a through 7f as required. It is reported on Part III Section A Line 2 at the cost of 2835620. Audit Footnote number 2. Accounts Receivable. Accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probably uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collections efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable. The bad debt expense of 2835620 has been caculated utilizing data from our fiscal year 2010 filed cost report to produce the cost to charge ratio for Worksheet 2 Ratio of Patient Care Cost to Charges. Bad debt expense per audited financial statements is 2835620. Bad debts are a community benefit as services are provided regardless of the patient's ability to pay. The Medicare shortfall of 2491572 would be considered as a community benefit as it is the cost of providing quality acute and primary care services while maintaining careful stewardship of resources with a commitment to service excellence. This was calculated utilizing Medicare net patient revenue with associated Medicare costs per the filed fiscal year 2010 cost report. Collection practices follow the free care policy of insuring those patients who are eligible for federal or state medical assistance programs are covered. If not eligible for these programs, charity care eligibility is determined. The cost share plan guidelines of the free care policy are clearly stated to insure proper collection policy and practice. Part I Line 6b. Mount Desert Island Hospitals Community Benefits Report is available on hospitals website or upon request. Community Health Services Provided include Childbirth Education classes, flu clinics, diabetes education, smoking cessation, telemedicine services, Your Excercise Solution classes, free blood pressure clinics, community walking program, school based clinics, free cancer support groups, Prescription assistance program, Chronic disease prevention programs, Mass Casualty preparation, event sponsorships, and donated space. MDI Hospital's dedicated staff contributed countless hours of volunteer time to groups such as Hospice of Hancock County, the Maine Alzheimer's Association, Island Connections, the MDI Marathon, and the Healing Hands Quilt Group. MDI Hospital assesses the health care needs of its communities utilizing various sources including Healthy Acadia, a community based group, along with other community groups and organizations, Board members, local businesses, Hospital personnel, and our patients. As the needs assessment information is utilized to prepare MDI Hospitals strategic plan, it is updated bi-annually and pertinent information is reflected in the Hospitals annual report on its website. There are two committees that gather, compile, review, present, and disseminate information to the governing Board. The Scope of Care Committee determines clinical capabilities and community need. This information is presented to the Planning Committee, which compiles all needs assessment data for Board review and ultimate approval. MDI Hospital informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs or the Hospitals charity care and cost share policy. This information is distributed via brochures available in admissions areas emergency department and other areas throughout the hospital and health centers, documented on the back of patient statements and included in the Free Care and Cost Share policy. Additionally all third parties including collection agencies and law firms working on behalf of MDI Hospital to collect fees are required to follow the hospitals policies regarding patient notification about the availability of financial assistance. The Hospital patient representative is accessible to discuss the availability of various government benefits and or hospital assistance with patients. If a patient is admitted through the Emergency Room, the social worker will coordinate activities to identify and assist eligible patients. The Hospital utilizes a third party contracted firm, APA, to assist patients with the completion of necessary forms and documentation required for various government benefits and or hospital assistance. As stated above, MDI Hospital provides services to Mount Desert Island and coastal Maine designated as a Critical Access Hospital, in Hancock County, southeastern Maine. Mount Desert Island is comprised of 108 square miles and is the 6th largest island in the continental United States and second largest island (Long Island, NY being the largest) on the eastern seaboard. The primary geographic area serviced consists of Mount Desert Island along with the outer islands of Swans, Frenchboro, and Cranberry Isles, with a total permanent year round population of approximately 10000. Mount Desert Island is a destination for tourists from all over the world. Cruise ships are in the harbor from May through October and most often in September. The summer residents increase the island population by at least 30000. Also, many thousands of additional tourists visit the island annually. It is reported that as many as 2.5 million people visit Acadia national park on Mount Desert Island annually, many of whom will reside on island during their visit. This population swelling results in a significant increase in medical services provided by Mount Desert Island Hospital and its health centers located throughout the community. While tourism continues to be one of the largest industries, the Jackson Laboratory, boat building, fishing, and aquaculture are also a large part of the economy on MDI. Based on demographic data, approximately 9 percent of the permanent population is below the poverty line. The demographics support an aging population as demonstrated by the 49 percent Medicare utilization at MDI Hospital. MaineCare, the state government program, accounted for 8 percent of the Hospitals gross patient service revenue for the fiscal year. While additional workers are needed to service the significant seasonal influx, the majority is under and or uninsured resulting in increased charity care and bad debts. Although the majority of Mount Desert Islands permanent population is Caucasian the additional tourists seasonal workers and summer residents are a very diverse population. The governing Board and committee members of MDI Hospital are all local residents of the community serviced by the Hospital. The Hospitals Board is part of the tapestry of the community. They are people who understand the history and culture of the community all helping the Hospital keep pace with the needs of their friends and neighbors. The array of community memebers helps MDI Hospitals Board balance its need for financial stewardship with its caring mission. As the board is comprised of people who live and work on the Island it also ensures that MDI Hospital maintain its uniquely personal connection and intimacy to the communities it serves. Medical staff privileges are extended to all qualified physicians in the community. As MDI Hospital is located on an island, additional specialty services are made available on the island by medical staff from the mainland, thus providing many specialty services which would otherwise be unavailable in the community. Patients would still have access to these specialties. They would have to travel off the island to other communties or cities to receive these services. The organization applies surplus funds to patient care improvements through its capital expenditure program, employee and medical staff education, community benefits programs, to remain viable and technologically current. Advocacy initiatives for promoting community wide, state, or national efforts to improve health of the population and increase access. Community involvement is key as MDI Hospitals ability to provide high quality health care is directly affected by the policies that are adopted in Augusta and Washington. As competing interests are at work in these venues it is necessary for the community to advocate for the Hospital to insure its health which is essential to the quality of life in the community. MDI Hospital is a sole community hospital designated as a critical access hospital which participates in all federal state and local government programs including Medicare, MaineCare (Medicaid), and Champus. MDI Hospital provides acute and primary care services, including a 24 hour emergency room, serving all patients regardless of their ability to pay. Patients are informed of Federal State and local government benefits as well as the Hospitals financial assistance and sliding scale discounts. Information is also available to patients in various areas of the Hospital as well as written on the back of their bill. While MDI Hospital may not be directly involved in clinical research, the Jackson Laboratory, an independent non-profit organization and leading genetics research laboratory focusing on mammalian genetics research with a strong research program investigating cancer and other genetic diseases, is a vital member of the Mount Desert Island communtiy as well as its largest employer. ME X 1 1 X X X 0 0 0 0 0 0 0 1 0 O Lee Haynes MD 187342 0 0 0 0 0 0 0 19617 0 206959 0 Mary Dudzik MD 158474 0 0 0 0 0 0 0 16237 0 174711 0 0 Arthur J Blank 227281 0 9622 0 0 0 0 0 24548 0 261451 0 0 Julian Kuffler MD 227314 0 0 0 0 0 0 0 25324 0 252638 0 0 0 Brad Perkins 119714 0 3129 0 0 0 0 0 15996 0 138839 0 0 0 Edward Gilmore MD 194189 0 0 0 0 0 0 0 18389 0 212578 0 0 0 Michael Heniser MD 295497 0 0 0 0 0 0 0 10874 0 306371 0 0 0 William Kenausis 178890 0 10844 0 0 0 0 0 21770 0 211504 0 0 0 Ronald Prokopuis MD 260388 0 0 0 0 0 0 0 22828 0 283216 0 0 0 Edward White MD 258855 0 0 0 0 0 0 0 19023 0 277878 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a The Hospital provides the CEO's fitness membership which is approxiamately $399 per year. MDI Hospital reimburses all other benefitted employees up to $100 per year towards the YMCA or other health club membership with appropriate supporting documentation. SchJ_P01_S00_L07 Schedule J, Part I, Line 7 Part I, 1a. The hospital provides the CEOs fitness membership, which is approximately 399 dollars per year. MDI Hospital reimburses all other benefitted employees up to 100 dollars per year towards the YMCA or other health club membership with appropriate supporting documentation. Part I, line 7. Hospital provides a performance incentive system for Directors and Vice Presidents who are employees in good standing during the entire fiscal year. The program is based on the organization maintaining top 12 status in overall patient satisfaction, meeting its financial target, as well as individual financial performance and quality improvement objectives. MHHEFA 98A Bond 1998-07-01 2145000 Renovation of outpatient service area 0 0 MHHEFA 92 Bond 1992-07-01 1300000 Construction and renovation of hospital departments 0 0 MHHEFA 2006F Bond 2005-07-03 707200 Replacement of central chiller 0 0 MHHEFA 2007B Bond 2007-07-03 4427988 Clinic construction, office & clinic space 0 0 2145000 2145000 1999 0 0 1 1 1300000 1300000 1993 0 0 1 1 707200 704200 2008 0 0 1 1 4427988 2009 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 John Benson MD Board Member 535609 J&D Imaging equipment lease 0 X 9 196691 Fair Market Value 0 0 1 1 SchM_P01_S00_L32b Schedule M, Part I, Line 32b Per MDI Hospitals Donations Policies and Guidelines, Policy Number 1.1.121, upon receipt of marketable securities, as a general policy, the securities will be sold immediately upon receipt through a broker selected by the treasurer or his orher designee. The First Advisory Group is the recipient of the stock and is responsible for stock liquidation. F990_P00_S00_L0B Form 990, Header, Line B Part IX Functional Expenses, was revised to correct the listing of Director salaries. Directors had been incorrectly defined in the previous filing. These same individuals were removed from Part VII, as they did not qualify as key employees or highly compensated employees under the IRS definition. F990_P04_S00_L38 Form 990, Part IV, Line 38 The answer to this questions should be yes. The software will not allow the answer to be changed from the No response, although the required explanations have been provided in Schedule O. F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 As MDIH is located in a small community, it is inevitable the business relationships intertwine. Any relationships to MDIH are governed by its policies and procedures. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 The Board of Directors of Mount Desert Island Hospital was presented with a copy of the completed and printed 990 approximately one month prior to the electronic filing of the form. Board Members were given the opportunity to ask questions of the CEO and the VP of Finance regarding the forms and schedules. Board Members are also given the opportunity to request a printed copy of the final form after it is filed. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Per the Conflict of interest policy, the organization monitors and enforces disclosure compliance of interests that could give rise to conflicts by officers, directors or trustees, and key employees. Disclosures are completed and submitted to the CEO. Board members will abstain from discussions or approval if there is even any appearance of possible conflict of interest during meetings. F990_P06_S0B_L13 Form 990, Part VI, Section B, Line 13 The whistleblower policy is part of Employee Information and Education Regarding Fraud and Abuse Compliance, Policy number 3.22A. It is reviewed during orientation, in the employee handbook and on our website. The Board orientation also reviews policies and procedures including Compliance and Conflict of Interest. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The compensation for CEO, other officers and key employees of MDI Hospital is reviewed and approved by the governing body. Utilization of data as to comparable compensation for similarly qualified persons in functionally comparable positions at similarly situated organizations is gathered and analyzed to determine compensation for these positions. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The annual report including financial information is available to the public through our website. Additional financial information is available on federal and state governmental websites for required reporting. Governing documents, conflict of interest poolicy are available upon request, as are the financial statements. Birch Bay Retirement Village 10 Wayman Lane Bar Harbor ME 04609 010481696 Retirement Community ME 501(c)(3) 170(b)(1)(A)(iii) Mount Desert Island Hospital Mount Desert Management Company PO Box 8 10 Wayman Lane Bar Harbor ME 04609 010538776 Real Estate Development ME Birch Bay Retirement Village C -21620 1211801 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Birch Bay Retirement Village q 766668 Mount Desert Management Company r 68358 Extension was filed