2011-08-15T11:49:06-05:00 2010-09-30 BAKER NEWMAN & NOYES BOX 507 PORTLAND ME 04112 990 2009-10-01 010215911 Mid Coast Hospital MIDC 2077290181 123 Medical Center Drive Brunswick ME 04011 Robert McCue 2077290181 2011-08-12 1 2078792100 2009 2016-02-24 21:20:13Z Lois Skillings 123 Medical Center Drive Brunswick ME 04011 122951341 0 X www.midcoasthealth.com X 1991 ME Acute and specialty care hospital 20 18 1141 500 0 0 1536353 1750288 105722824 108209426 870900 688605 31622 25361 108161699 110673680 7700 0 53948907 56030771 0 0 50153607 51472643 104102514 107511114 4059185 3162566 133063833 134698531 53159196 50185494 79904637 84513037 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 89920949 7700 108225086 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. 89920949 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 111 0 1141 1 0 0 0 0 0 1 1 0 0 0 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 James Ashe 0.30 X 0 0 0 Elizabeth Cantrell 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 Abigail Manny 0.30 X 0 0 0 Anne Marsh 0.30 X 0 0 0 Daniel Morgernstern MD 0.30 X 0 0 0 John G Morse IV 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 Paul Laprad M D 41.50 X X 258919 0 37386 Robert McCue 41.50 X X 0 223006 56422 Herbert Paris 41.50 X 0 392914 105619 Eleanor Tracy 0.30 X 0 0 0 John Taylor MD 41.50 X 273584 0 16240 Elaine Secskas MD 41.50 X 259022 0 43443 Patrick J Keaney MD 41.50 X 253987 0 13794 Stephanie Grohs MD 41.50 X 255401 0 43358 Hal Sreden MD 41.50 X 252148 0 45163 1553061 615920 361425 46 0 1 0 CSC Technical Management Group PO Box 8500-3115 Philadelphia PA 19178 Computer Tech Services 2165144 HP Cummings PO Box 29 Ware MA 01082 Construction Contractor 1488761 Coastal Maine Emergency Physicians PO Box 270 South Freeport ME 04078 ER Facility Coverage 908979 Mid Coast Anesthesia PA 121 Medical Center Drive Box 6 Brunswick ME 04011 Anesthesiology Services 806433 Kleen Laundry & Dry Cleaning Services 1 Foundry Street Lebanon NH 03766 Laundry Services 355958 23 12500 1195306 542482 39800 1750288 Net Patient Service Re 621400 106375912 106375912 Miscellaneous Revenue 621400 1833514 1833514 108209426 1078785 1078785 15660 15660 15660 15660 11778742 100025 11927981 340966 -149239 -240941 -390180 -390180 18415 12500 8714 9701 9701 110673680 108225086 0 698306 7700 7700 318305 305573 12732 45697439 40072887 5624552 929674 664860 264814 5888114 4229694 1658420 3197239 2302012 895227 101739 101739 47787 47787 11202971 8497076 2705895 261795 198563 63232 6798863 5156709 1642154 4417879 3350812 1067067 61302 46496 14806 695 527 168 1754720 1330896 423824 5687810 4314012 1373798 1323291 1003672 319619 Patient Medical Expense 7297019 7297019 Provision for Bad Debts 4892662 4892662 Pharmacy Expenses 4056565 3076768 979797 Revenue Tax 1934091 1934091 Non-Patient Medical Exp 1188420 901377 287043 445034 337543 107491 107511114 89920949 17590165 0 5962587 7260630 13900449 14591507 8049122 8424478 2067641 2060130 1678904 2035417 99694036 40189345 59635508 59504691 32989267 30321908 8780355 10499770 133063833 134698531 13684517 11887869 34717983 33920115 4756696 4377510 53159196 50185494 X 66449555 70036682 6101568 7036575 7353514 7439780 79904637 84513037 133063833 134698531 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 13019 13019 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: The Organization paid dues to MHA totaling $45,714, of which 16.2% was used for lobbying. The Organization also paid dues to AHA totaling $22,987, of which 24.42% was used for lobbying. 18850981 85217 500960 173552 19263606 18696946 61289 360571 267825 18850981 0.34100 0.38500 0.27400 0 0 329281 329281 55278206 11630286 43647920 3665998 3470746 195252 40420551 25088313 15332238 59504691 Estimated Third-Party Payor Settlements 1923831 Deferred Financing Costs 361548 Construction in Progress 176195 L-T Asset (Deferred Comp Plan) 4377510 Due from Affiliates 3138433 Other Assets 522253 10499770 Deferred Compensation Plan 4377510 4377510 110673680 107511114 3162566 2018834 -573000 1445834 4608400 112701228 2018834 8714 2027548 110673680 0 110673680 108092828 581714 581714 107511114 0 107511114 Part V, Line 4: Description of Intended Use of Endowment Funds: 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. Prior year totals were updated to reflect board designated endowments. Part XI, Line 8 - Other Adjustments: Equity Transfer to Affiliates: -573000. Part XII, Line 2d - Other Adjustments: Golf Tournament Expenses: 8714. Part XIII, Line 2d - Other Adjustments: Golf Tournament Expenses: 8714. Equity Transfer to Affiliates: 573000. Golf Tournament 30915 12500 18415 807 7907 30915 12500 18415 807 7907 8714 9701 1 1 1 X 1 X 1 1 1 0 0 3382079 926887 2455192 0.02390 11409223 5940450 5468773 0.05330 14791302 6867337 7923965 0.07720 471391 18956 452435 0.00440 20313184 16626843 3686341 0.03590 20784575 16645799 4138776 0.04030 35575877 23513136 12062741 0.11750 1 2497587 0 24402374 25890341 -1487967 X 0 Mid Coast Hospital

123 Medical Center Drive Brunswick ME 04011

X X X Mid Coast Hospital

121 Medical Center Drive Brunswick ME 04011

X Mid Coast Hospital

81 Medical Center Drive Brunswick ME 04011

X Mid Coast Hospital

11 Medical Center Drive Brunswick ME 04011

X Mid Coast Hospital

310 Bath Road Brunswick ME 04011

X Mid Coast Hospital

81 Medical Center Drive Brunswick ME 04011

X Mid Coast Hospital

430 Bath Road Brunswick ME 04011

X Mid Coast Hospital

66 Baribeau Drive Brunswick ME 04011

X Mid Coast Hospital

30 So Bristol Road Bath ME 04543

X Mid Coast Hospital

1356A Washington Avenue Bath ME 04530

X Mid Coast Hospital - Mid Coast Med Group

1 Bowdoin Mill Island Topsham ME 04086

X 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 emergency department, 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, emergency department, 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 $3.8 million. In addition, the community benefit does not take into account bad debts, charity care, and contractual adjustments. Thus, this community benefit of approximately $3.8 million is a conservative number that reconciles to the community benefit on the IRS Form 990, Schedule H. Part I, Line 7f: Bad debt expense of $4,892,662 has been removed from the denominator of the calculation in Schedule H, Part I, Line 7, column f. 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 to determine 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 V: See Schedule H, Part V - all facilities listed are recognized under state law. 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 5: N/A 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 X 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 Paul Laprad M D 258919 0 0 0 0 0 0 0 37386 0 296305 0 0 0 Robert McCue 0 223006 0 0 0 0 0 44033 0 12389 0 279428 0 0 Herbert Paris 0 392914 0 0 0 0 0 91722 0 13897 0 498533 0 0 John Taylor MD 273584 0 0 0 0 0 161 0 16079 0 289824 0 0 0 Elaine Secskas MD 259022 0 0 0 0 0 4943 0 38500 0 302465 0 0 0 Patrick J Keaney MD 253987 0 0 0 0 0 0 0 13794 0 267781 0 0 0 Stephanie Grohs MD 255401 0 0 0 0 0 10358 0 33000 0 298759 0 0 0 Hal Sreden MD 252148 0 0 0 0 0 12163 0 33000 0 297311 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 and Robert McCue, both officers of the Organization, participated in this plan and received $76,011 and $34,950 respectively. MAINE HEALTH AND HIGHER ED FAC AUTH (MHHEFA) 010314384 560425L40 2007-07-18 97716087 REFINANCE SERIES 1998B REVENUE BOND 0 0 MAINE HEALTH AND HIGHER ED FAC AUTH (MHHEFA) 010314384 560425362 2008-12-03 41658395 HOSPITAL FACILITY EXPANSION PROJECT 0 0 28930803 1984500 26651099 4446 290758 2002 1 1 1 1 12393996 892731 338 138784 11362143 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 1316837 The amount paid to Medical Mutual and identified in this section is for malpractice insurance coverage for the Hospital. Mr. Paris serves on the board of directors for Medical Mutual and is the CEO of Mid Coast Hospital. Mr. Paris was paid a nominal fee to serve on Medical Mutual's board of directors. 0 X 2 14800 Market Value X Land 1 25000 Appraised Value 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 XI, Line 2c Oversight of Audit: 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 Mid Coast Geriatric Services Corporation 123 Medical Center Drive Brunswick ME 04011 010496211 Geriatric Services ME 501(C)(3) 9 N/A Community Health and Nursing Services 60 Baribeau Drive Brunswick ME 04011 010211546 Hospice Services ME 501(C)(3) 9 N/A 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 1 1 0 0 0 1 0 0 1 0 1 1 1 0 0