2012-08-15T11:17:32-05:00 2010-09-30 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2009-10-01 223245434 Valley Medical Association VALL 2078343155 194 East Main Street Fort Kent ME 04743 Peter J Sirois 2078343155 2012-08-14 1 Nicholas E Porto 2078792100 2012-08-14 2009 2016-02-24 21:20:13Z X Peter J Sirois 194 East Main Street Fort Kent ME 04743 8944829 0 X www.nmmc.org X 1993 ME Medical Care - Physician Practices 8 5 45 0 0 0 0 7774221 8944829 0 0 7774221 8944829 0 0 7028867 8297236 0 0 745354 647593 7774221 8944829 0 0 0 0 0 To provide the highest quality, comprehensive medical care to all patients. 0 0 8166561 8944829 Third party providers, consisting of physicians and midlevel staff, located in a rural setting which covers the great St. John Valley Region (Northern Maine). Providers provide care to all residents of the region (approximately 14,500) regardless of income, race, or creed. 8166561 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 1 45 1 0 0 0 0 0 0 0 0 0 8 5 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 0 1 1 1 0 X Peter Sirois 2078343155 194 East Main Street Fort Kent ME 04743 X Fred Wetmore 0.30 X 0 0 0 Dan Vaillancourt 0.30 X 0 0 0 Glenn Lamarr 0.30 X 0 0 0 Ronald Daigle 0.30 X 0 0 0 Norman Fournier 0.30 X 0 0 0 Martin B Bernstein 50.00 X X 0 203744 14079 Peter J Sirois 50.00 X X 0 158419 22045 Roger L Lagasse 50.00 X X 0 141738 10545 Khalid Husain MD 50.00 X 441746 0 19116 James Harris MD 50.00 X 340064 0 18399 Joel Dye MD 50.00 X 283402 0 14824 Alexandre Andrianov MD 50.00 X 276400 0 17976 Simona Suchan MD 50.00 X 238654 0 18064 1580266 503901 135048 24 0 1 0 LocumTenenscom PO Box 405547 Atlanta GA 303845547 Temporary Medical Staff 974053 1 NMMC Reimbursement 621110 8944829 8944829 8944829 8944829 8944829 0 0 7630797 7249257 381540 5103 4848 255 387009 367659 19350 274327 260611 13716 28480 28480 330675 330675 4252 4252 284186 284186 8944829 8166561 778268 0 0 0 0 0 X 0 0 0 0 0 0 0 0 0 0 X 0 1 1 X 0 X 0 8944829 8944829 0 0 0 8944829 0 8944829 0 8944829 8944829 0 8944829 0 8944829 X X 0 0 0 0 0 0 0 1 0 Martin B Bernstein 0 203744 0 0 0 0 0 0 0 14079 0 217823 0 0 Peter J Sirois 0 158419 0 0 0 0 0 0 0 22045 0 180464 0 0 Roger L Lagasse 0 141738 0 0 0 0 0 0 0 10545 0 152283 0 0 Khalid Husain MD 285746 0 156000 0 0 0 0 0 19116 0 460862 0 0 0 James Harris MD 192982 0 147082 0 0 0 0 0 18399 0 358463 0 0 0 Joel Dye MD 235432 0 47970 0 0 0 0 0 14824 0 298226 0 0 0 Alexandre Andrianov MD 191870 0 84530 0 0 0 0 0 17976 0 294376 0 0 0 Simona Suchan MD 227454 0 11200 0 0 0 0 0 18064 0 256718 0 0 0 Part I, Line 7 The Association pays bonuses to its physicians based on the revenues they generate quarterly and/or annually. At September 30, unpaid/anticipated bonuses are accrued. Form 990, Part VI, Section A, line 2 Peter Sirois and Glenn Lamarr have a family relationship. Form 990, Part VI, Section A, line 6 Northern Maine Medical Center, a corporation duly organized under the laws of the State of Maine, is the sole member of the Association. Form 990, Part VI, Section A, line 7a Northern Maine Medical Center, the sole corporate member of the Association, shall have the power to elect or remove trustees of the Association. The number of trustees elected at the annual board meeting shall be two (2) by the member and four (4) ex-officio trustees. When electing trustees, the member shall observe the requirement that both of the elected trustees must be currently serving on the executive committee of Northern Maine Medical Center. The ex-officio trustees shall be president, vice-president, secretary, and treasurer of Northern Maine Medical Center. Form 990, Part VI, Section A, line 7b Northern Maine Medical Center, the sole corporate member of the Association, shall have the following powers: A. To amend or restate the articles of incorporation of the Association; B. To amend or restate the corporate bylaws of the Association; C. To approve any merger or consolidation involving the Association, or to approve the dissolution of the Association; D. To approve any sale, mortgage, lien, pledge, or security interest in all, or substantially all, of the assets of the Association; E. To approve any fund-raising activity conducted by the Association; F. To approve the selection of an auditor for the Association; G. To approve the commencement of any new venture or major capital acquisitions by the Association; H. To approve any capital or operating budgets of the Association. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by the Organization's independent accounting firm and thoroughly reviewed by the CFO and controller. Form 990, Part VI, Section B, line 12c The enforcement of the conflict of interest policy is achieved through annual reporting and ongoing monitoring. Form 990, Part VI, Section B, line 15 The executive committee of the board of directors determines the compensation of the CEO using compensation studies and comparability data. The CEO determines the compensation of other officers and key employees in a similar manner. 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. Form 990, Part XI, Line 2c: The audit process has not changed from the prior year. Form 990, Item B: Explanation of Changes for Amended Return The Organization is amending its 2009 Form 990 to reflect information from audited financials which were released subsequent to the Form's original filing. A summary of changes are as follows: Form 990, Part IV, Line 12A: has been marked "yes" Form 990, Part V, Line 1a: has been updated to reflect calendar year information Form 990, Part V, Line 1c: has been marked "yes" Form 990, Part V, Line 2a: has been updated to reflect calendar year information Form 990, Part VI, Line 1a: was updated to reflect correct number of board members Form 990, Part VI, Line 1b: was updated to reflect correct number of independent board members Form 990, Part VII, Section A: has been updated to reflect the FYE 2009 board members and calendar year compensation Form 990, Part VII, Section B: has been updated to reflect appropriate year information Form 990, Part XI, Line 2b: has been marked "yes" Form 990, Part XI, Line 2c: has been marked "yes" and a narrative added to Schedule O. Form 990, Part XI, Line 2d: "Consolidated basis" has been indicated Schedule D, Part XI: has been prepared Schedule D, Part XII: has been prepared Schedule D, Part XIII: has been prepared Schedule J, Part II: has been updated to reflect calendar year information Northern Maine Medical Center 194 East Main Street Fort Kent ME 04743 010234189 Acute Care & Long Term Care Hospital ME 501(C)(3) 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1