2011-08-15T11:29:28-05:00 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 2011-08-12 1 Nicholas E Porto 2078792100 2009 2016-02-24 21:20:13Z Peter J Sirois 194 East Main Street Fort Kent ME 04743 8944829 0 X www.nmmc.org X 1993 ME Medical Care - Physician Practices 7 4 44 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 0 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 24 0 44 1 0 0 0 0 0 0 0 0 0 7 4 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 Martin B Bernstein 50.00 X X 0 198494 9533 Peter J Sirois 50.00 X X 0 164448 21725 Roger L Lagasse 50.00 X X 0 135879 11538 Alexandre Andrianov MD 50.00 X 327782 0 19583 Paul Henrys MD 50.00 X 357692 0 11583 Khalid Husain MD 50.00 X 502301 0 21736 Sotirios Papfragkou MD 50.00 X 378748 0 8551 James Harris MD 50.00 X 380387 0 21753 1946910 498821 126002 23 0 1 0 LocumTenenscom PO Box 405547 Atlanta GA 303845547 Temporary Medical Staff 1053890 Weatherby Locums PO Box 972633 Dallas TX 75397 Temporary Medical Staff 202471 Barton & Associates Inc 10 Dearborn Road Peabody MA 01960 Temporary Medical Staff 174169 First Citizens Bank (for Onyx Healthcare PO Box 4715 Greensboro NC 274044715 Temporary Medical Staff 124879 4 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 0 0 X X X 0 0 0 0 0 0 0 1 0 Martin B Bernstein 0 198494 0 0 0 0 0 0 0 9533 0 208027 0 0 Peter J Sirois 0 164448 0 0 0 0 0 0 0 21725 0 186173 0 0 Alexandre Andrianov MD 260409 0 67373 0 0 0 0 0 19583 0 347365 0 0 0 Paul Henrys MD 357692 0 0 0 0 0 0 0 11583 0 369275 0 0 0 Khalid Husain MD 363277 0 139024 0 0 0 0 0 21736 0 524037 0 0 0 Sotirios Papfragkou MD 253748 0 125000 0 0 0 0 0 8551 0 387299 0 0 0 James Harris MD 203416 0 176971 0 0 0 0 0 21753 0 402140 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. 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