2011-11-14T10:19:57-06:00 2010-12-31 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2010-01-01 010263198 Down East Community Hospital DOWN 2072553356 11 Hospital Drive Machias ME 04654 Lynnette Parr 2072553356 2011-11-08 1 Barbara J McGuan CPA 2077752387 2011-11-07 2010 2016-02-24 21:20:13Z Douglas Jones 11 Hospital Drive Machias ME 04654 36564093 0 X www.dech.org X 1963 ME Critical access hospital 12 11 321 28 0 0 189541 31642 33829468 35417067 20346 239218 0 -131017 34039355 35556910 395428 330342 0 0 17827560 19887757 0 0 0 16783884 16152196 35006872 36370295 -967517 -813385 25677634 25898642 11273369 12512846 14404265 13385796 X Provide access to quality healthcare and promote community wellness through the delivery of primary, emergency and ancillary inpatient and outpatient healthcare. The Hospital strives to improve the overall health of the communities we serve while exceeding customer expectations. 0 0 5279038 5889858 Surgical services to inpatients and outpatients, totaling 2,006 surgeries 3180755 3548790 Care for medical/surgical unit patients. Unit provided care to 1038 admissions for 3,101 patient days. 6501184 7253415 Imaging Services to inpatients and outpatients. 16,678 radiological exams were provided to inpatients and outpatients. 16783087 18725004 Various other medical services supplied to patients. 16783087 18725004 31744064 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 0 1 53 0 321 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 ME X X Lynnette Parr 2072553356 11 Hospital Drive Machias ME 04654 Paul Weston 2.00 X X 0 0 0 Debbie Getchell 2.00 X X 0 0 0 David Rioux DO 2.00 X 313572 0 0 Eric Burke MD 2.00 X 0 0 0 Kara Dwight DO 2.00 X 347301 0 17474 Greg Campbell Ph D 2.00 X 0 0 0 John Church 2.00 X 0 0 0 Nora Dickinson 2.00 X 0 0 0 Dona Emerson 2.00 X 0 0 0 Cynthia Huggins 2.00 X 0 0 0 Mortimer Lockett 2.00 X 0 0 0 Elizabeth Neptune 2.00 X 0 0 0 David Whitney 2.00 X 0 0 0 Carl Aselton MD 2.00 X 219997 0 16474 John Driscoll 2.00 X X 0 0 0 Walter Plaut 2.00 X X 0 0 0 Douglas Jones 40.00 X 328906 3894 0 Lynnette Parr 40.00 X 139496 1651 14769 Victor Parisien 40.00 X 500000 0 19982 Dhanvant Rathod 40.00 X 468615 0 17855 Leonid Brodsky 40.00 X 408782 0 17574 Karen Miller 40.00 X 440824 0 16974 Clifford Peck 40.00 X 384850 0 0 Aziz Massaad MD 0.00 X 163908 0 0 3716251 5545 121102 30 1 1 1 D&Y PO Box 635715 Cincinnati OH 45263 Staffing Services 709485 Eastern Maine Healthcare System 43 Whiting Hill Road Brewer ME 04412 Management Services 639049 Barton & Associates Inc 10 Dearborn Rd Peabody MA 01960 Physician Staffing Services 554557 Dahl-Chase Diagnostic Services 417 State Street Suite 401 Bangor ME 04401 Diagnostic Service 312568 Machias Primary Care Associates PO Box 398 Machias ME 04654 Physician Services 299472 17 1841 26764 3037 31642 Patient Revenue 621400 55273517 55273517 Other Revenue 621400 102482 102482 Cafeteria Income 900099 40232 40232 Vending Income 900099 27068 27068 Contractual/Char. Adj. 621400 -20026232 -20026232 35417067 113457 113457 1132944 997412 9771 135532 -9771 125761 125761 Loss on Early Retireme 900099 -131017 -131017 -131017 35556910 35349767 0 175501 330342 330342 1397817 236471 1161346 15349572 14562130 787442 421705 387173 34532 1683356 1502764 180592 1035307 916473 118834 213771 213771 93097 93097 4958691 4958691 94215 19739 74476 4366847 3760583 606264 532235 532235 22871 18412 4459 346486 346486 1464692 1464692 644472 169836 474636 Bad Debt Expense 1347971 1347971 Temporary Personnel 1105320 1105320 Service Provider Tax 734469 734469 Miscellaneous 227059 84746 142313 36370295 31744064 4626231 0 4169 3148 8088373 6424945 2935527 3651589 8500 209949 174957 466739 492416 358330 355085 26300347 13250872 12087553 13049475 1360986 1602946 52968 51843 104540 92238 25677634 25898642 2647195 2515375 6248707 5960150 769204 607424 1608263 3429897 11273369 12512846 X 14000105 12982742 61825 60719 342335 342335 14404265 13385796 25677634 25898642 X -813385 -205084 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8757 8757 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The Organization pays dues to local associations, a portion of which are attributable to lobbying activities. 90346 90346 14198837 5433479 8765358 11148741 7408130 3740611 862423 409263 453160 13049475 Unfunded Pension Liability 1126271 Estimated Third Party Payor Settlements 2303626 3429897 35556910 36370295 -813385 33767 -238851 -205084 -1018469 35359756 33767 9771 43538 35316218 240692 240692 35556910 36378225 9771 9771 36368454 1841 1841 36370295 Part XI, Line 8 - Other Adjustments: Pension Liability Adjustment -238,851. Part XII, Line 2d - Other Adjustments: Loss on Disposal of Fixed Assets 9,771. Part XII, Line 4b - Other Adjustments: Pension Liability Adjustment 238,851. Transfer from Down East Health Trust 1,841. Part XIII, Line 2d - Other Adjustments: Loss on Disposal of Fixed Assets 9,771. Part XIII, Line 4b - Other Adjustments: Transfer from Down East Health Trust 1,841. 1 1 1 X 0 1 1 1 0 1 1 1 457 1221255 1221255 0.03490 1 457 1221255 1221255 0.03490 102606 102606 0.00290 374095 374095 0.01070 476701 476701 0.01360 1 457 1697956 1697956 0.04850 835742 1 0 1 1 Down East Community Hospital

11 Hospital Drive Machias ME 04654

X X X X Down East Community Hospital 1 Part I, Line 6a: A community benefit committee manages the community benefit activities of the Hospital. An expense budget is identified annually for community benefit activities. Community benefit activities are reported each year in the Hospital's annual report. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1347971. Part III, Line 4: Bad debt expense represents actual and estimated write-offs as identified by the Hospital. Actual write-offs represent accounts that have exceeded 90 days in Accounts Receivable with no payment plans established. Estimated write-offs represent bad debts that are expected based on payment percentage assumptions as determined by the age and payor type of the receivable. Part VI, Line 2: DECH participates with Eastern Maine Health System's needs assessment process. Community meetings are held in the hospital's service area and information is collected and reported in a formalized report that the hospital then uses to evaluate the health needs of its service area. Part VI, Line 3: Each private pay patient that receives a bill from the Hospital will receive a copy of the Hospital's free care guidelines and application with their bill. The free care guidelines are posted throughout the hospital in patient waiting areas and the application is also available on the Hospital's website. At every opportunity, billing personnel will communicate to patients the free care policy and encourage patients to apply.The Hospital also contracts with a collection organization who will review certain private pay patients' eligibility for Mainecare insurance coverage. The Organization will contact the patients and help take them through the Mainecare application process, if applicable. Part VI, Line 4: Down East Community Hospital provides services to rural communities of Washington County, with 82% of its admissions coming from its service area covering 24 towns from Harrington to Lubec (9% come from the HSA for Calais Regional Hospital and 6% come from the HSA for Maine Coast Memorial Hospital). The population of 32,175 for the Hospital Service Area (HSA) has an average household income of $26,081, compared to $45,708 for the State of Maine. Of the HSA population, approximately 18% fall below the poverty line and the average age is 40.2 years. Part VI, Line 6: The Hospital furthers its exempt purpose by promoting the health of the community. The board consists of volunteer community members that are elected annually by the corporators of the Hospital. The Hospital has an open medical staff where all applicants have the opportunity to obtain membership as long as the guidelines as determined by the medical staff bylaws are met. 1 Sunrise Nursing Care Facility 11 Hospital Drive Machias ME 04654 222582949 501(c)(3) 291327 Support to affiliate for operations and capital acquisitions. Down East Health System 11 Hospital Drive Machias ME 04654 200543805 501(c)(3) 8627 Support to affiliate for operations and capital acquisitions. Down East Health Trust 11 Hospital Drive Machias ME 04654 202713763 501(c)(3) 14653 Support to affiliate for operations and capital acquisitions. Women's Health Resource Library PO Box 463 Milbridge ME 04658 550880014 501(c)(3) 9735 To support the Womens' Health Resource Library. Machias Memorial High School 109 Court Street Machias ME 04654 016000249 N/A 6000 To provide funding for after school programs. 5 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The Organization only awards grants to qualifying public charities exempt under 501(c)(3) or municipalities. Additional monitoring is not deemed necessary. 0 0 0 0 0 0 0 0 0 David Rioux DO 313572 0 0 0 0 0 0 0 0 0 313572 0 0 0 Kara Dwight DO 347301 0 0 0 0 0 9800 0 7674 0 364775 0 0 0 Carl Aselton MD 219997 0 0 0 0 0 8800 0 7674 0 236471 0 0 0 Douglas Jones 328906 3894 0 0 0 0 0 0 0 0 328906 3894 0 0 Lynnette Parr 139496 1651 0 0 0 0 7013 83 7584 89 154093 1823 0 0 Victor Parisien 500000 0 0 0 0 0 12308 0 7674 0 519982 0 0 0 Dhanvant Rathod 468615 0 0 0 0 0 10181 0 7674 0 486470 0 0 0 Leonid Brodsky 408782 0 0 0 0 0 9900 0 7674 0 426356 0 0 0 Karen Miller 440824 0 0 0 0 0 9300 0 7674 0 457798 0 0 0 Clifford Peck 384850 0 0 0 0 0 0 0 0 0 384850 0 0 0 Aziz Massaad MD 163908 0 0 0 0 0 0 0 0 0 163908 0 0 0 Supplemental Information Part III Douglas Jones, the Organization's current CEO received compensation from Eastern Maine Health Systems, an unrelated organization, for services as CEO of Down East Community Hospital and affiliates. Eastern Maine Health Systems is paid by Down East Community Hospital for these services. Compensation related to all affiliates included: Wages: $332,800 Non-taxable Benefits: $0 Maine Health and Higher Educational Facilities Authority 010314384 560425V80 2007-11-01 1035000 Finance new Construction and Equipment 0 0 0 Maine Health and Higher Educational Facilities Authority 010314384 560427JA5 2010-06-24 5480000 Refinance 1998 Bond 0 0 0 1040241 46184 29352 2010 0 0 1 1 5865921 344002 62887 2010 1 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 David Rioux Board Member 313572 Dr. David Rioux provided family practice physician services through his organization, Machias Primary Care Services. Dr. Rioux also provided physician utilization services and medical staff president services to the organization for a partial year. 0 Catherine Rioux Wife of Board Member David Rioux 61906 Cathy is employed with Down East Community Hospital. 0 Aziz Massaad Former Board Member 302385 Dr. Aziz Massaad provided on-call, administrative physician services, and staffing and support services through his medical practice, Down East Medical Associates, to the Organization. 0 Rita Ten MD Family member of Dr. Aziz Massaad, former board member 399241 Dr. Rita Ten provided physician anesthesia services to the Organization. 0 Form 990, Part VI, Section A, line 3 On July 2, 2009, Eastern Maine Health Systems was appointed Emergency Receiver for the Hospital in response to investigations of clinical practices by the Centers for Medicare and Medicaid Services (CMS) and threatened disqualification from the Medicare program. EMHS has appointed an Interim Chief Executive Officer to act as their agent. As Emergency Receiver, EMHS at its discretion is authorized to: terminate or modify contracts, hire, manage, and discharge employees of the Hospital, modify or terminate privileges of medical staff. The Hospital board of trustees is divested of governance responsibility and/or management authority. The Emergency Receiver is not required to consult the board of trustees with respect to governance and management affairs but may keep the board informed of the activities and operations of the Hospital during the term of receivership. An inspection by CMS in December 2009 found no violations of federal conditions to participate in the Medicare program. As of December 31, 2010, DECH is still under the Emergency Receivership and is managed by EMHS. Form 990, Part VI, Section A, line 4 See answers to Form 990, Part VI, questions 6 & 7. Form 990, Part VI, Section A, line 6 As of December 31, 2010, the sole member of the Hospital is Down East Health System. Effective January 1, 2011, Down East Health System undertook a corporate restructuring whereby Down East Health System and Down East Health Trust were merged into Down East Community Hospital, leaving the Hospital as the surviving corporation. As a result of this merger, the members of the Organization, known as "Corporators," shall be those individuals who are Corporators of Down East Health System as of January 1, 2011, and such other individuals as may be elected to membership in this Corporation by a majority vote of (i) those Corporators present at the Annual Meeting of this Corporation; or (ii) the Board of Trustees. A Corporator is elected for life, unless (i) the Corporator voluntarily resigns; or (ii) the Corporator fails to attend two (2) successive Annual Meetings of this Corporation. Additionally, those individuals who are appointed as members of the Active Medical Staff of Down East Community Hospital shall serve as Corporators during the period of their appointment to the Active Medical Staff. Form 990, Part VI, Section A, line 7a The Organization's board of corporators elect members to the board of trustees. Effective January 1, 2011, the Corporators shall elect the Trustees of this Corporation from a slate of nominees presented by the Nominating Committee in accordance with the provisions of the Bylaws. Form 990, Part VI, Section A, line 7b As of December 31, 2010, the boards of Down East Health System and Down East Community Hospital meet concurrently. All decisions made by the board of directors is subject to the approval or rejection of the board of directors of Down East Health System, the parent organization. Form 990, Part VI, Section B, line 11 The 990 is reviewed by the CEO and CFO and a copy is provided to the full board before filing. Form 990, Part VI, Section B, line 12c In order to monitor compliance with the conflict of interest policy for the Organization, each member of the board of trustees is required annually to submit a conflict of interest document and the compliance officer verifies the receipt of these documents. The compliance officer also reviews payments issued to the board of trustees and any contracts in effect with board members. Department managers and key personnel are also required to submit a conflict of interest statement annually and new employees sign a conflict of interest statement at the time of hire. Form 990, Part VI, Section B, line 15a Compensation for the Organization's CEO is set by Eastern Maine Health System due to receivership status with Downeast Community Hospital. Form 990, Part VI, Section C, line 19 The financial Statements and annual report are made available to the public upon request. The Organization's governing documents and conflict of interest policy are not made available to the public. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 33,767. Pension Liability Adjustment -238,851. Total to Form 990, Part XI, Line 5: -205,084. Oversight of Audit Form 990, Part XI, Line 2c: Tha audit process has not changed from the prior year. Form 990, Part I, Lines 8-18 Prior year numbers have been restated to present revenue net of contractual and charity care adjustments. Sunrise Nursing Care Facility 11 Hospital Drive Machias ME 04645 222582949 Nursing Care Facility ME 501(c)3 Line 9 Down East Health System 0 Down East Health System 11 Hospital Drive Machias ME 04645 202543805 Parent of an Integrated Health Care Delivery System ME 501(c)3 Line 11b, II N/A 0 Down East Health Trust 11 Hospital Drive Machias ME 04645 202713763 Support of Down East Community Hospital ME 501(c)3 Line 11b, II Down East Health System 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0