2011-05-13T11:26:34-05:00 2010-06-30 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2009-07-01 010212444 YORK HOSPITAL YORK 2073634321 15 HOSPITAL DRIVE YORK ME 03909 ROBIN LABONTE 2073634321 2011-05-10 2078792100 2009 2016-02-24 21:20:13Z JUD KNOX 15 HOSPITAL DRIVE YORK ME 03909 154481988 0 X www.yorkhospital.com X 1904 ME COMMUNITY HOSPITAL 30 22 1156 274 2217266 122876 2870633 1953529 137749577 144479219 -412535 596291 1657640 1762564 141865315 148791603 100366 139403 0 74622326 77601876 181978 0 502527 63205649 65672062 138110319 143413341 3754996 5378262 97132766 106584493 45025960 48170067 52106806 58414426 COMMUNITY HOSPITAL 0 0 130914546 139403 144021066 YORK HOSPITAL IS A NOT-FOR-PROFIT HEALTH CARE CENTER ESTABLISHED TO PROVIDE HEALTH CARE SERVICES TO THE YORK COUNTY AREA. IT OFFERS BOTH INPATIENT AND OUTPATIENT ACUTE SERVICES AND HAS 79 LICENSED ACUTE BEDS AND 13 LICENSED SKILLED NURSING CARE BEDS. THE HOSPITAL HAS OUTPATIENT SATELLITE SERVICES IN WELLS, KITTERY, BERWICK AND SOUTH BERWICK.IT IS THE MISSION OF THE HOSPITAL TO PROVIDE EXCEPTIONAL CARE TO ALL ITS PATIENTS. THIS IS ACCOMPLISHED BY BEING COMPASSIONATE, PROMPT AND FOCUSED ON THE INDIVIDUAL'S NEEDS AND DESIRES. THE HOSPITAL AND MEDICAL STAFF WORK AS ONE TO SERVE OUR PATIENTS. EACH STAFF MEMBER'S CONTRIBUTIONS ARE EQUALLY IMPORTANT.THE HOSPITAL IS RESPONSIBLE TO ITS COMMUNITY. WE MUST LISTEN AND RESPOND. WE MUST BE INNOVATIVE, OUR COSTS FAIR AND OUR SERVICES OFFERED TO ALL. NO PERSON SHALL BE DENIED MEDICALLY NECESSARY SERVICES REGARDLESS OF THEIR ABILITY TO PAY. 130914546 1 1 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 84 0 1 1156 1 1 1 0 0 0 0 0 0 0 0 30 22 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 1 0 X X ROBIN LABONTE CFO 2073634321 15 HOSPITAL DRIVE YORK ME 03909 JUD KNOX 40.00 X X 373975 0 32731 LORRAINE BOSTON 1.00 X X 0 0 0 DAVID COUSINEAU 1.00 X 0 0 0 THOMAS ALBRIGHT MD 40.00 X 366505 0 27757 TONY CILLUFFO 1.00 X 0 0 0 CRYSTAL BUTLER RN 34.00 X 55335 0 22821 JAY BARROWS 1.00 X 0 0 0 JENNIFER EATON DO 40.00 X 281076 0 33778 JOAN GOODRICH 1.00 X 0 0 0 STEPHEN JENDZEJEC DO 20.00 X 21000 0 0 MICHAEL E MCGRATH 1.00 X 0 0 0 SUZI RAESIDE 1.00 X 0 0 0 DOUG GRAY DDS 1.00 X 0 0 0 MARK FOSTER 1.00 X X 0 0 0 DOUG BRACY 1.00 X 0 0 0 ALICE EMERY 1.00 X 0 0 0 KEN FELLOWS MD 1.00 X 0 0 0 ANN HUSSEY 1.00 X 0 0 0 LEISA SMITH 40.00 X X 68432 0 13040 OSCAR STONE 1.00 X 0 0 0 ALA REID 1.00 X 0 0 0 HUNT WALTON 1.00 X 0 0 0 HENRY F WARNER JR 1.00 X X 0 0 0 DANAL EPSTEIN 1.00 X 0 0 0 RICHARD BROWN 1.00 X 0 0 0 WARREN SPENCER 1.00 X 0 0 0 CHRISTOPHER CRANE 1.00 X 0 0 0 JEFFREY THURLOW 40.00 X 604557 0 28895 JEFFREY LOCKHART MD 40.00 X 483555 0 30921 ROBIN LABONTE 40.00 X 219685 0 33613 TADHG O'GARA MD 40.00 X 436024 0 26780 ALLEN HAYMAN 40.00 X 396850 0 29176 NINA EDWARDS 40.00 X 430882 0 28622 JOHN LIDDY MD 40.00 X 388240 0 29318 KIRA WENDORF MD 40.00 X 424198 0 11180 4550314 0 348632 85 0 1 0 HUTTER CONSTRUCTION 810 TURNPIKE RD NEW IPSWICH NH 03071 CONSTRUCTION 1192726 HEALTH PLANS PO BOX 257 WESTBOROUGH MA 01581 HEALTH INSURANCE ADMINISTER 911690 SEACOAST CARDIOLOGY ASSOCIATES 12 HOSPITAL DR YORK ME 03909 PHYSICIAN FEES 865495 DAVID POPLAWSKI 16 LONG SANDS RD YORK ME 03909 PHYSICIAN COVERAGE 577030 QUEST DIAGNOSTIC 415 MASSACHUSETTS AVE CAMBRIDGE MA 02139 LAB SERVICES 305621 28 39067 18900 531178 1364384 94844 1953529 PATIENT SERVICES 900099 114539587 114539587 LAB 621500 26273320 25617314 656006 PHARMACY 446110 3666312 2105052 1561260 144479219 599816 599816 163845 163845 163845 163845 5661774 7150 5665970 6479 -4196 671 -3525 -3525 21387 18900 17936 3451 3451 CAFETERIA 722210 649471 649471 LIFELINE 621990 171036 171036 GIFT SHOP 453220 124148 124148 650613 650613 1595268 148791603 144021066 2217266 599742 139403 139403 2697676 2565675 132001 58036461 55432068 2504525 99868 3202067 3059308 137430 5329 9639051 9207137 415681 16233 4026621 3845413 174562 6646 75322 75322 93911 37564 56347 12710783 5381295 7329488 28513480 28139613 373867 1766933 1501893 265040 1009331 908398 100933 5264080 4474468 789612 2050116 2034205 15327 584 PROVISION FOR BAD DEBT 6331654 6331654 HEALTH CARE PROVIDER TA 2184442 2184442 EXTINGUISHMENT OF DEBT 99994 99994 5572016 5572016 143413341 130914546 11996268 502527 7494006 7469727 1541115 1570984 12596241 16189290 3398312 3639243 675654 863592 98337016 54402321 40824482 43934695 18872438 21869061 6338174 6835672 5392344 4212229 97132766 106584493 13107747 13173533 19036244 18689424 3268576 3156552 9613393 13150558 45025960 48170067 X 44260679 49930421 5726621 6201608 2119506 2282397 52106806 58414426 97132766 106584493 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18183 18183 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: MAINE HOSPITAL ASSOCIATION DUES AND AMERICAN HOSPITAL ASSOCIATION DUES TOTALED $65,162 OF WHICH $12,120 WERE AVAILABLE FOR LOBBYING. A LAW FIRM WAS PAID $6,063 TO LOBBY FOR 2010 TAX & MATCH LEGISLATION. 7846127 1098494 625885 1086501 8484005 7623514 2000053 -881917 895523 7846127 0.00000 0.73090 0.26910 0 0 50762978 19233157 31529821 3041749 2125865 915884 42462221 33043299 9418922 2070068 2070068 43934695 OTHER INVESTMENTS 1142835 F ALTERNATIVE INVESTMENTS 5692837 F 6835672 ASSETS HELD ON BEHALF OF THIRD PARTY 771412 PENSION OBLIGATION 10952211 ESTIMATED 3RD-PARY PAYOR SETTLEMENTS 1426935 13150558 148791603 143413341 5378262 2410776 -1481418 929358 6307620 151220315 2410776 17936 2428712 148791603 0 148791603 144902502 1489161 1489161 143413341 0 143413341 Part V, Line 4: Description of Intended Use of Endowment Funds: Temporarily Restricted Funds Biewend (12/82)- Principal and income restricted for purchase of new equipment (at Board discretion which must be approved by a family member) and the acquisition of land and buildings other than an addition to the present hospital buildings. Page (1945) - To be used for support and maintenance of district visiting nurses. Palmer/Perkins Nursing Scholarship - See Perm Restricted for description. Rose Voignier Scholarship - Fund to remain in endowment until the value is $100,000, at that time the funds are to be used to provide training and instruction for staff @ York Hospital, as well as health care training for the public. Baldwin Fund for Nursing Excellence - Financial support for nurses who need to be re-certified and current in their health care skills, including advanced training or change of focus. Scholarships for support staff, who are interested in entering the field of nursing. Financial assistance to help defray the costs of ongoing orientation, classroom instruction and clinical training of new York Hospital nurses. To help defray the costs associated with the York Hospital's Summer Intern program for young nursing students who are currently enrolled in a nursing school. Winkler Fund - Funds to be used for Nursing Education. Rose Voignier Education Fund - Funds to be used for staff education. Permanently Restricted Funds Elizabeth B. Perkins - Principal to remain in perpetuity, the income for the care of patients who are unable to pay for proper treatment. Gerrity - 80% of income is unrestricted. 20% is to be reinvested as Principle YH Memorial Fund - Principal to be kept intact and the income to be used @ the board discretion Cowey - Income and gains to be used for pediatrics (Corpus only to be kept intact) Forristall - To be used for SNF (Corpus only to be kept intact) Mason - To be used for free work provided to patients who cannot afford to pay (Corpus only to be kept intact) Brewster - Income and gains to be used for any form of diabetes research and care (Corpus only to be kept intact. Palmer/Perkins Endowment - Principal to be kept intact and the income to be used for nursing education for the staff. Hospice - Principal to be reinvested and the income to be used to offset expenses of the Hospice. Sidelinger - (6/88) Principal to be kept intact and the income to be used for general purposes of the support, upkeep and maintenance of the hospital as determined by the Board. Oncology Fund - Income to be used for support programs for patients, their families and caregivers. Part XI, Line 8 - Other Adjustments: ADJUSTMENTS TO LONG-TERM PENSION OBLIGATIONS: -1,471,225 OTHER: -10,193 Part XII, Line 2d - Other Adjustments: SPECIAL EVENTS EXPENSES: 17,936 Part XIII, Line 2d - Other Adjustments: SPECIAL EVENTS EXPENSES: 17,936 ADJUSTMENT TO LONG-TERM PENSION OBLIGATIONS: 1,471,225 GOLF TOURNAMENT 33376 16950 16426 8266 4822 1120 966 5KM ROAD RACE 6911 1950 4961 717 310 1735 40287 18900 21387 8983 4822 1430 2701 17936 3451 1 1 1 X 0 1 1 0 0 1 759 2293406 0 2293406 0.01670 1 4599 8190719 5360926 2829793 0.02070 2 5358 10484125 5360926 5123199 0.03740 441132 11993 429139 0.00310 36519367 19496586 17022782 0.12430 36960499 19508579 17451921 0.12740 2 5358 47444624 24869505 22575120 0.16480 1 2960359 0 28884238 37196320 -8312082 X 0 YORK HOSPITAL

15 HOSPITAL DR YORK ME 03909

X X X HEART HEALTH INSTITUTEONCOLOGY SERVICES

127 LONG SANDS RD YORK ME 03909

X WELLS MEDICAL SERVICES

112-114 SANFORD RD WELLS ME 04090

X SOUTH BERWICK MEDICAL SERVICES

57 PORTLAND ST SOUTH BERWICK ME 03908

X BERWICK MEDICAL SERVICES

4 DANA DR BERWICK ME 03901

X KITTERY MEDICAL SERVICES

75 US RT 1 KITTERY ME 03904

X YORK OUTPATIENT PHYSICAL THERAPY

16 LONG SANDS RD YORK ME 03909

X Part V: 1.a)Part I, Line 3 c - The hospital uses the federal poverty guidelines.b)Part I, Line 6a - Not applicablec)Part I, Line 7g - York Hospital has several hospital clinical services and hospital owned physicians practices. Per the instructions for IRS form 990H, worksheet 6, we are allowed to include any applicable physician practice that the hospital subsidizes (i.e., operates at a loss). As such, we have included the following hospital clinical services and hospital owned physician practices that operate at a loss (i.e., subsidized by the hospital) and the associated costs of these practices.a.Diabetes Educationb.Berwick Walk-In Clinicc.Kittery Family Practice d.Emergency Room (the hospital has emergency rooms at the main hospital campus and also in Wells)e.Home Health Agencyf.Chemical Dependency Clinic g.Coastal OB/GYN Practice h.Surgical Practicei.Rheumatology Practicej.Neurology Practicek.Orthopedics Practicel.Urology Practicem.Physical Therapy Practicen.Pulmonary Practiceo.Great Works Family Practicep.Gynecology Practiceq.York Plastic Surgery Practicer.York Family Practices.Webhannett Internal Medicine Practicet.Pediatrics AssociatesThe above listed hospital clinical services and hospital owned physician practices have a community benefit (i.e., aggregate loss or subsidy from the hospital) of approximately $17.0 million. In addition, the community benefit also does not take into account bad debts, charity care and contractual adjustments. Thus this community benefit of approximately $17.0 million is a conservative figure that reconciles to the community benefit reported on IRS form 990H, Part I, Line 7g, column e.d)Part I, Line 7, Column F - As part of the hospital's total expenses, there are $6,331,654 of bad debts. This amount has been removed from the Part I, Line 7 Column F calculation per the IRS instructions. e)Part I, Line 7 - the IRS 990H instructions/guidance provide a template (Worksheet 2 template) as a way to determine the overall cost to charge ratio that could be applied throughout the IRS 990H form in order to convert charges to cost. Where applicable, we have utilized the Worksheet 2 template calculation. The only areas where we did not utilize this template calculation were the following:a.IRS 990H Worksheet 6 - Subsidized health services - (which is the supporting schedule for Part I, Line 7g) we did not utilize the Worksheet 2 percentage when we were determining the profit/loss of each of our provider based clinics. In addition, when we were compiling the subsidized hospital clinical services and hospital owned physician practices listed in 1c above, we utilized the actual estimated costs on the modified Medicare cost report we prepared instead of applying the Worksheet 2 cost to charge percentage. b. IRS 990H Worksheet 3 - Unreimbursed Medicaid and Other Means Tested Government Programs (which is the supporting schedule for Part I, Lines 7b and 7c) and Worksheet 6 Medicaid allowable costs for the subsidized health services listed in line 1c above (which is part of the line 7g costs) - We did not utilize the Worksheet 2 percentage when calculating the Medicaid allowable cost. Instead we utilized the actual Medicaid filed cost report for the allowable costs.f)The allowance for uncollectible accounts 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 uncollectible accounts. Accounts deemed uncollectible are charge off against the established allowance.g)Part III, Line 8 - Part I, Line 7 - the IRS 990H instructions/guidance provide a template (Worksheet 2 template) as a way to determine the overall cost to charge ratio that could be applied throughout the IRS 990H form in order to convert charges to cost. Where applicable, we have utilized the Worksheet 2 template calculation. The only areas where we did not utilize this template calculation were the following: a.IRS 990H Worksheet B, Line 2 & 6 - Medicare allowable costs and payments related to the subsidized health services - We utilized the Medicare cost report estimated cost and payment for these services. The hospital believes its hospital clinical services and hospital owned physician practices, along with the emergency room and the home health agency listed in 1c above, should be and are considered a community benefit. York Hospital believes that by offering and thus subsidizing these hospital clinical services and hospital owned physician practices within its community, the community at large benefits by having easy access and an easy commute for these services.h)Part III, Line 9b - Not Applicablei)Part V - See 990H Part V2 York Hospital assesses the healthcare needs of the community through participation in the "Healthy York County Maine - Mobilizing for Action through Planning and Partnerships Visioning and Assessment Report (June 2010)"3. A description of the York Hospital Financial Assistance Program is listed on the back of all patient statements. The York Hospital Assistance Program guidelines are posted at patient registration areas. The Charity Care program is listed on the York Hospital website.4. York Hospital primary service area includes the following communities in Southern York County Maine: Berwick, Eliot, Kittery, North Berwick, Ogunquit, South Berwick, Wells and York. The Hospitals secondary service area includes: Kennebunk and Lebanon, Maine, and Portsmouth, Dover, Rollinsford and Somersworth, New Hampshire. Approximately 6% of York Hospital patients utilize Medicaid and 60% of York Hospital patients utilize Medicare. The population of southern York County with income under 200% of federal poverty guidelines is 20%, 33.3% of York County children received MaineCare in 2009 and more than 5,000 or 11.8% lived in poverty. 5. Not Applicable6. The board of trustees is made up of members from all communities served by York Hospital. All medical staff are eligible to participate if they meet privileging criteria. All hospital income gains are reinvested in the facilities, equipment and services for the communities.7. Not Applicable8. Not Applicable 1 SCHOLARSHIPS 6 20333 ORIENTATION PROGRAM 6 29895 CONTINUING EDUCATION/SEMINARS & WORKSHOPS 146 89175 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The scholarship fund is monitored by a committee which manages the funds in accordance with the donor's wishes. The committee does this by allocating a portion for seminars and workshops or Continuing Education, allocating a portion for an Orientation Program, and allocating funds for folks who want to attend Nursing School or Primary Education. Continuing Education funds are allocated to each department head responsible for nurses and each is then responsible for spending funds in accordance with the donor's wishes. The Orientation Program is directly administered by some of the members of the Committee. For Nursing Scholarships, folks must apply to the Committee through an application process and then report back to the committee on their progress. All amounts spent are also tracked and reviewed in accounting to ensure that the monies are used in accordance with the donor's wishes. Annually, the Director of Development reports fund activity directly to the donor. X 0 1 X X X 0 0 0 0 0 0 0 1 0 JUD KNOX 367627 0 0 0 6348 0 5951 0 26780 0 406706 0 0 0 THOMAS ALBRIGHT MD 364027 0 2478 0 0 0 977 0 26780 0 394262 0 0 0 JENNIFER EATON DO 281076 0 0 0 0 0 6998 0 26780 0 314854 0 0 0 JEFFREY THURLOW 406200 0 198357 0 0 0 2115 0 26780 0 633452 0 0 0 JEFFREY LOCKHART MD 483555 0 0 0 0 0 4141 0 26780 0 514476 0 0 0 ROBIN LABONTE 219685 0 0 0 0 0 6833 0 26780 0 253298 0 0 0 TADHG O'GARA MD 428739 0 0 0 7285 0 0 0 26780 0 462804 0 0 0 ALLEN HAYMAN 396850 0 0 0 0 0 2396 0 26780 0 426026 0 0 0 NINA EDWARDS 299744 0 131138 0 0 0 1842 0 26780 0 459504 0 0 0 JOHN LIDDY MD 388240 0 0 0 0 0 2538 0 26780 0 417558 0 0 0 KIRA WENDORF MD 424198 0 0 0 0 0 0 0 11180 0 435378 0 0 0 Part I, Line 1a MINIMAL ROTARY DUES FOR PRESIDENT Part I, Line 7 PERFORMANCE-BASED VARIABLE COMPENSATION WHICH IS SUBJECT TO REVIEW ANNUALLY. MHHEFA 010314384 560425NW6 2003-07-24 6988265 FOR MRI UNIT 0 0 MHHEFA 010314384 560425UT5 2004-12-09 42196950 CT SCANNER, NUCLEAR ME, RADIOLOGY, MAMMO UNIT 0 0 MHHEFA 010314384 560425G20 2006-09-07 91723676 CT SCANNER, DIGITAL MAMMO EQUIP, PAC'S EQUIPMENT 0 0 MHHEFA 010314384 560425L40 2007-07-18 97716087 REFINANCE 1999B ER PROJECT & 2000C WELLS REGIONAL 0 0 MHHEFA 010314384 560525Z78 2008-06-19 48451841 IMAGING EQUIPMENT 0 0 1179561 137879 39017 1002665 2003 0 0 1 1 1941005 135325 31950 1773730 2005 0 0 1 1 2318380 291200 37906 1989274 2006 0 0 1 1 7437938 547568 7368244 97896 2007 1 1 1 1 1707209 162330 28044 42816 1474018 2008 0 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 1 0 0 1 FSA 23.000000000000 1 0 0 0 0 0 1 FSA 24.000000000000 1 0 0 0 0 0 1 FSA 26.000000000000 1 0 0 0 0 0 1 TRANS AMERICA 20.000000000000 1 0 0 0 0 0 1 GEFCM 28.000000000000 1 0 0 MHHEFA 010314384 5604253L2 2008-12-03 41658395 SURGERY CENTER ADDITION 0 0 MHHEFA 010314384 560427GE0 2009-12-10 93040181 NEW CT AND OTHER EQUIPMENT 0 0 MHHEFA 010314384 560427JA5 2010-06-24 113477369 REFINANCE 1993, 1998, 1999A & 2001D 0 0 2788576 341545 46861 2400170 2010 0 0 1 1 1827960 194925 527137 29377 1076521 2010 0 0 0 1 4001877 607056 5418358 51237 2010 1 1 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 94844 STOCK EXCHANGE PRICE 0 0 0 Form 990, Part VI, Section B, line 11 THE 990 IS DISTRIBUTED TO THE BOARD OF TRUSTEES FOR THEIR REVIEW AFTER IT IS FILED. Form 990, Part VI, Section B, line 12c ANNUALLY THE BOARD OF TRUSTEES AND THE OFFICERS SIGN A CONFLICT OF INTEREST FORM. Form 990, Part VI, Section B, line 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES UTILIZES AN OUTSIDE FIRM'S DATA BASE OF CEO SALARIES TO DETERMINE THE CEO'S COMPENSATION. THE CEO DETERMINES THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES USING AN OUTSIDE FIRM'S DATA TO MAKE SURE THE COMPENSATION IS WITHIN THE MARKET. Form 990, Part VI, Section C, line 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, SCHEDULE K, PART I: THESE TAX-EXEMPT BONDS ARE PART OF A POOLED BOND ISSUE. YORK HEALTH SERVICES 15 HOSPITAL DR YORK ME 03909 020469065 HEART HEALTH ME 501(C)(3) 9 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0