2012-05-07T12:19:04-05:00 2011-06-30 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2010-07-01 010223482 Millinocket Regional Hospital MILL 2077235161 200 Somerset Street Millinocket ME 04462 Christine McLaughlin 2077235161 2012-05-02 1 Barbara J McGuan CPA 2077752387 2012-05-02 2010 2016-02-24 21:20:13Z Marie Vienneau 200 Somerset Street Millinocket ME 04462 30458421 0 X www.mrhme.org X 1952 ME Critical Access Hospital 16 9 280 1 0 0 36359 59243 26979955 27934767 236016 202841 15178 3548 27267508 28200399 21864 36900 0 0 16166883 16617176 0 0 0 10124296 10850590 26313043 27504666 954465 695733 21265367 21802981 8360870 7215364 12904497 14587617 X Millinocket Regional Hospital is a 25 bed critical access hospital that serves as the primary care facility for the communities of Millinocket, East Millinocket, Medway and the surrounding territories. 0 0 25426402 36900 27934767 Millinocket Regional Hospital provides inpatient and outpatient services to the Katahdin region including 3,591 inpatient days of service, 34,213 outpatient visits and 7,136 emergency room visits and 21,600 wellness visits. The following seminars, promotions, advertisements, and clinics were provided to the community throughout fiscal 2011:1. MRH Held Multiple Flu Shot and H1N1 Flu Shot Clinics from December 2010 -February 2011.2. MRH sponsored a Jr. Pro Hoop Classic in January of 2011. 3. MRH provided a public awareness program about Mammograms on KAT TV in September of 2010.4. MRH paid a sponsorship to Millinocket Little League in May of 2011 which paid for a team, the Yankees, and also a scoreboard sign.5.MRH Sponsored a Tee for the Katahdin Valley Health Center Golf Tournament in May of 2011.6. MRH sponsors a Diabetes Support Group, the first Tuesday of every month beginning November 3rd 2009.7. MRH paid a sponsorship to the Millinocket Elk's Lodge Halloween Party in October 2010. 8. MRH sponsored the Stearns-Schenck Musical in October of 2010.9. MRH purchased ad space to raise money for multiple causes inclduing: Schenck and Stearns' High School yearbook, Millinocket Historical Society 2011 calendars, VFW Convention Ad Book, and also ads for special sections of the Bangor Daily News that covered area football and basketball teams.10. MRH operates a grant funded Healthy Maine Partnership organization which provides education services to the community on alcohol misuse, tobacco cessation, proper nutrition and physical activity. The staff works with businesses, clubs and the schools to extend the message of healthy living and good wellness choices. The organization uses local media to reach the large region.11. MRH provides meeting space for non-profits at no cost, for example to American Cancer Society, Eastern Area on Aging, Martin's Point, Diabetic Support Group, Caring Connections, AA, and Weight Watchers.11. MRH participates in disaster preparedness regional committee with several other agencies including doctors' groups, other hospitals, local police and fire departments, schools and other organizations. The goal is to prepare for pandemic flu, natural disasters or other incidents that could affect our communites and work together to share resources to protect the community. 25426402 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 66 0 1 280 1 0 0 0 0 0 0 0 0 0 0 X 16 9 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 ME X Christine McLaughlin 2077235161 200 Somerset Street Millinocket ME 04462 Ronald Brown 5.00 X X 0 0 0 Thomas Malcolm 5.00 X X 0 0 0 Mellissa Edwards 5.00 X X 0 0 0 Don Casko 5.00 X X 0 0 0 Sandeep Randwaha MD 60.00 X X 172966 0 30701 Kwaku Owusu MD 60.00 X X 161312 0 28441 Herbert Clark 5.00 X 0 0 0 Barry Davis 5.00 X 0 0 0 Jack Dinsmore 5.00 X 0 0 0 Gail Fanjoy 5.00 X 0 0 0 Joyce Given 5.00 X 0 0 0 Patrick Hunt Esq 5.00 X 0 0 0 Lee Lamson 5.00 X 0 0 0 Fred Lewis 5.00 X 0 0 0 Wallace Tapley 5.00 X 0 0 0 Jason Campbell 60.00 X X 384965 0 67929 Marie Vienneau 40.00 X 192106 0 43325 Christine McLaughlin 40.00 X 108960 0 22225 Daniel Herbert MD 60.00 X 257252 0 42781 David Wexler 60.00 X 424012 0 49079 Mark Kowalski 60.00 X 407472 0 63804 Edward Dunstan 60.00 X 203149 0 50702 Bruce A Rioux 60.00 X 161713 0 38518 2473907 0 437505 18 0 1 0 Sullivan & Merritt Inc 91 Freedom Park Hermon ME 04401 Engineering 760680 NEHE-MRI LLC PO Box 6600 Newport CA 92658 MRI Radiology 330250 Katahdin Shared Services Inc 200 Somerset Street Millinocket ME 04462 Ultrasound Services 280622 CPSI PO Box 850309 Mobile AL 36685 Computer Services 190469 Synernet Inc 110 Free Street Portland ME 04101 Medical Contract Services 180409 9 12925 46318 59243 Ancillary Services 621400 42292960 42292960 Routine Services 621400 2638205 2638205 Miscellaneous Income 621400 144644 144644 Cafeteria Sales 621400 32620 32620 Contractual/Char. Adj. 621400 -17173662 -17173662 27934767 190081 190081 30200 16877 13323 13323 13323 2253905 2221314 19831 32591 -19831 12760 12760 Loss on Investment of 531120 -9775 -9775 -9775 28200399 27902147 0 239009 36900 36900 1212930 846314 366616 12274714 11632210 642504 325360 308905 16455 1928510 1837104 91406 875662 813515 62147 26819 26819 33775 33775 31190 31190 2609210 2214188 395022 61590 61590 4559510 4260070 299440 10799 10799 684941 668846 16095 20091 4503 15588 118522 118522 625278 625278 302624 302624 Provision for Bad Debts 1154101 1154101 Medicaid Tax 591456 591456 Miscellaneous Expenses 20684 11866 8818 27504666 25426402 2078264 0 284 880 7375547 2901353 2383587 2917038 3400 0 64139 436937 454836 386292 453756 17903925 12658606 3138102 5245319 5710218 8049837 1797168 1684497 33832 31326 21265367 21802981 2850828 3122937 1642088 1545434 1770034 1617348 2097920 929645 8360870 7215364 X 12824908 14484815 74589 97802 5000 5000 12904497 14587617 21265367 21802981 X 695733 987387 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 7831 7831 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The Organization pays dues to various organizations, a portion of which are attributable to lobbying expenses. 49951 49951 6675089 5607718 1067371 8295471 6609043 1686428 2883414 441845 2441569 5245319 Investment in First Millinocket Regional Investment Corp 1631808 C Investment in Katahdin Shared Services 52689 C 1684497 Estimated Third-Party Payor Settlements 929645 929645 1 1 1 X 1 X 1 1 1 0 0 1207864 1207864 0.04580 196747 300000 -103253 0.00000 1404611 300000 1104611 0.04580 1345946 883018 462928 0.01760 36900 36900 0.00140 1382846 883018 499828 0.01900 2787457 1183018 1604439 0.06480 1 657980 10953652 10858308 95344 X 1 0 1 1 Millinocket Regional Hospital

200 Somerset Street Millinocket ME 04462

X X X Millinocket Regional Hospital 1 Part I, Line 3c: Income guidelines as set by Hospital Finance Rules will be used in determining eligibility. Percentage of balance discounted will be determined based on patient's income level relative to the Federal Poverty Level guidelines. These guidelines are updated annually by the Financial Counselor.Up to 150% FPL 100% Balance Discounted151% to 200% FPL 50% Balance Discounted201% to 250% FPL 25% Balance Discounted251% to 300% FPL 10% Balance Discounted301% to 400% FPL 5% Balance Discounted Part I, Line 7: Expenses calculated on Lines 7a & 7b were calculated using a cost-to-charge ratio while actual expenses were used in calculating the amount reported on line 7i. Part I, Line 7g: Subsidized health services include laboratory and physician services Part I, L7 Col(f): Amount of bad debt expense subtracted for purposes of calculating percentage: $1,154,101 Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable 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 collection efforts, are written off through a charge to the valuation allowance and a credit to patient accounts receivable. Part III, Line 8: The Organization used accounting methodology prescribed by the Medicare cost report as its costing methodology to determine the amount of Medicare allowable costs. Part VI, Line 2: A formal community needs assessment is done every 2-3 years. These assessments are conducted to obtain information on successes, failures, weaknesses and strengths to be used for guidance in the vision for the future of healthcare delivery in our service areas. Part VI, Line 3: Inpatients: In order to identify those patients who would be eligible for financial assistance, all uninsured inpatients are referred to the Financial Counselor by pre-registration or registration personnel. The Financial Counselor will do an initial screening for payment options prior to the patient leaving the hospital, if possible. If the patient has left the hospital, the Financial Counselor will attempt to contact the patient for information. All inpatients are given a copy of Patient Free Care and Discount Arrangements guidelines at time of admission.Surgical outpatients: The Financial Counselor will provide information about Patient Free Care, Discount Arrangements and term payment arrangements to all uninsured surgical outpatients. All surgical outpatients are provided a copy of Patient Free Care and Discount Arrangements guidelines at time of registration. Emergency room patients: All emergency room patients are provided a copy of Patient Free Care and Discount Arrangements guidelines at time of registration. All other outpatients: All other outpatients are provided a copy of the Patient Free Care/Discount Arrangements guidelines at time of registration. All patients will receive notice of availability of financial assistance included in their first-time statement. Patient Financial Services employees and Physician Practice employees receive training on patient free care and discount arrangements guidelines and are expected to be able to provide contact information about free care and discount arrangements. Part VI, Line 4: Millinocket Regional Hospital serves a tri town community, which consists of Millinocket, East Millinocket and Medway. The total population of these three communities is 8,074 and is projected to decrease 3% by 2012. The communities are rural, aging and economically challenged. The senior population is projected to grow 7.4% for our service area by 2012. The average median household income is 42% behind the state average. The largest employers in the communities are the hospital, paper mill and school system. The percent of population with post secondary education is lower than the state or nation. 1 Health Access Network 175 W Broadway Lincoln ME 04457 113650708 501(c)(3) 31900 FMV Rent Forgiveness Operational Support 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Assistance provided was in the form of rent forgiveness. No additional monitoring of funds was required. X X X X X 0 0 0 0 0 0 0 0 0 Sandeep Randwaha MD 172966 0 0 0 0 0 17667 0 13034 0 203667 0 0 0 Kwaku Owusu MD 161312 0 0 0 0 0 11429 0 17012 0 189753 0 0 0 Jason Campbell 384965 0 0 0 0 0 25918 0 42011 0 452894 0 0 0 Marie Vienneau 192106 0 0 0 0 0 10256 0 33069 0 235431 0 0 0 Daniel Herbert MD 225152 0 32100 0 0 0 14210 0 28571 0 300033 0 0 0 David Wexler 424012 0 0 0 0 0 18040 0 31039 0 473091 0 0 0 Mark Kowalski 407472 0 0 0 0 0 20755 0 43049 0 471276 0 0 0 Edward Dunstan 203149 0 0 0 0 0 18589 0 32113 0 253851 0 0 0 Bruce A Rioux 161713 0 0 0 0 0 8414 0 30104 0 200231 0 0 0 Maine Health and Higher Educational Facilities Authority 010314384 560425QS2 2003-09-01 2320000 To repay balance of outstanding bonds, to fund certain capital expenditures. 0 0 0 2320000 361020 50151 2269849 2003 0 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 Julie Brown Family Member of Ronald Brown, Past Board President 37704 Employment 0 Rose Ann Hunt Family Member of Patrick Hunt, member of Board of Directors 129069 Employment 0 Dale McLaughlin Family Member of Christine McLaughlin, CFO of Organization 74101 Employment 0 Ona McAvoy Family Member of Mellissa Edwards, Board Vice President 54907 Employment 0 Cynthia Morneault Family Member of Joyce Given, member of Board of Directors 26105 Employment 0 Form 990, Part VI, Section B, line 11 Prior to the document's filing, the Organization's finance department reviews the inital draft. After any necessary changes, the Organization's board members are presented with a copy. The finalized document is subject to the board's approval. Form 990, Part VI, Section B, line 12c Each board member is required to sign a conflict of interest disclosure form on an annual basis. In connection with any actual or possible conflicts of interest, an interested individual must disclose the existence of his or her conflict annually and whenever the conflict arises for action at a meeting. After receiving all annual attestations, the CEO will provide the signed statements to the Hospital's attorney for review. After review, the attorney will determine if a conflict exists and inform the CEO and Board chair of the conflicted individuals. There is a listing of Board, Medical Staff and Manager conflicts available at all meetings for reference. The Agenda for every Board, Medical Staff or Department meeting will clearly list the discussion items that require action during the meeting. At the beginning of the meeting, the President will ask the members to review the list of action items and declare whether or not they have a conflict. All conflicted members will be required to excuse themselves and leave the room during the discussion and vote. If the board or committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. Form 990, Part VI, Section B, line 15 The Organization works with an independent compensation consultant to determine appropriate compensation levels. The Organization's executive committee reviews data used to determine compensation for its respective members. Any compensation related changes must be approved by the board of directors or the executive board. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 987,387. Oversight of Audit Form 990, Part XI, Line 2c: The audit process has not changed from the prior year. First Millinocket Regional Investment Corp 200 Somerset Street Millinocket ME 04462 010396196 Physician Program Operations ME N/A C 245923 1635801 1.00000 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 First Millinocket Regional Investment Corp J 187321 FMV First Millinocket Regional Investment Corp P 187321 FMV