2024-08-15T10:33:52-05:00 2023-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2022-10-01 237134386 Houlton Regional Hospital HOUL 2075322900 20 Hartford St Houlton ME 04730 Shauna Cameron CEO 2075322900 2024-08-15 1 1 Joseph R Byrne P01289281 2077752387 2024-08-15 2022 2024-08-08 14:25:15Z Shauna Cameron 20 Hartford St Houlton ME 04730 52664301 0 X www.houltonregional.org X 1973 ME Houlton Regional Hospital's purpose is to provide safe, compassionate, quality, cost effective care to communities we serve. We are dedicated to improving the health status of those we support through eduaction, treatment and rehabilitation. 10 7 439 13 9911 0 3328728 30385 52714199 50888871 257565 273670 0 27192 56300492 51220118 0 0 0 0 29219447 28635276 0 0 0 23096848 24690959 52316295 53326235 3984197 -2106117 32044624 28468738 17434442 15422698 14610182 13046040 Houlton Regional Hospital's purpose is to provide safe, compassionate, quality, cost effective care to communities we serve. We are dedicated to improving the health status of those we support through education, treatment and rehabilitation. 0 0 46545348 50888871 Provision of health care services in rural Maine: During the fiscal year ended 9/30/23, 1,026 people had an inpatient stay (including swing beds); 74,277 outpatient services were rendered; 9,904 people served in the emergency room. Of these services, 99 accounts (representing 28 people and $91,312) were written off as charity care. 46545348 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 62 0 1 439 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Vera Schumann 2075322900 20 Hartford St Houlton ME 04730 Solomon Olabiyi Director 40.00 0.00 X 252558 0 32435 Lynette McLaughlin President 1.00 0.00 X X 0 0 0 Hassan Abouleish MD Vice President 40.00 0.00 X X 399875 0 0 Nancy Ketch Treasurer 1.00 0.00 X X 0 0 0 Max Lynds Secretary 1.00 0.00 X X 0 0 0 Scott Allen Director 1.00 0.00 X 0 0 0 Gary Bossie Director 1.00 0.00 X 0 0 0 David Harbison Director 1.00 0.00 X 0 0 0 Karl Woods DMD Director 1.00 0.00 X 0 0 0 Doug Hazlett Director 1.00 0.00 X 0 0 0 Shawn D Anderson CEO 40.00 0.00 X 303766 0 24238 Cynthia Thompson CFO 40.00 0.00 X 172615 0 220 C Regina Brown COO 40.00 0.00 X 145826 0 25960 Jennifer Cavalari Hospitalist 40.00 0.00 X 519993 0 9696 Eric Rau General Surgeon 40.00 0.00 X 430873 0 31281 Maggy Lespinasse Pediatrician 40.00 0.00 X 305767 0 15453 Kimberly Mays De Perez OB/GYN Physician 40.00 0.00 X 272307 0 27102 Jared Onder Chief Anesthetist 40.00 0.00 X 220382 0 29491 3023962 0 195876 34 0 1 1 BlueWater Emergency Partners LLC 14 Maine Street Brunswick ME 04011 Emergency Physicians 3467625 Huron Consulting Services LLC 3005 Momentum Place Chicago IL 606895330 Consulting Services 511099 Medical Solutions LLC PO Box 850737 Minneapolis MN 554850737 Contracted Staffing 453933 Arundel Internal Medicine PC 5 Elm Street Houlton ME 04730 Hospitalists Services 422789 Internal Medicine of Houlton 2 Hemlock Lane Orient ME 04471 Internal Medicine Services 399875 17 30385 30385 Patient Fees 621110 97592755 97592755 Miscellaneous Revenue 621110 1116978 951358 9911 155709 Charity Care & Discounts 621110 -3436312 -3436312 Medicare/Medicaid Allowances 621110 -20347190 -20347190 Other Contractual Allowances 621110 -24037360 -24037360 50888871 147254 147254 29260 2068 27192 27192 27192 1568531 1442115 126416 126416 126416 51220118 50723251 9911 456571 X 1357493 684868 672625 20973044 19138030 1835014 78173 69539 8634 4683114 4207138 475976 1543452 1372980 170472 53757 53757 121157 121157 20030 20030 12392761 11168457 1224304 15449 14299 1150 1624907 613306 1011601 80265 65443 14822 68987 15029 53958 369822 257689 112133 1557219 1344281 212938 370201 91922 278279 Medical Supplies 4734204 4734204 Other Supplies 1889880 1787091 102789 Medicaid Tax 866522 866522 Miscellaneous Expenses 525798 114550 411248 53326235 46545348 6780887 0 X 36801 15264 5772101 1428094 18880 0 6627018 8814843 1101428 1197862 453935 780893 46184257 36377905 11419203 9806352 4148925 4089298 0 618274 2466333 1717858 32044624 28468738 7965235 9390953 3263841 2646175 1333535 1495028 4871831 1890542 17434442 15422698 X 14514940 12969765 95242 76275 14610182 13046040 32044624 28468738 -2106117 541975 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10287 10287 0 Part II-B, Line 1: Other lobbying amounts represent an allocable portion of dues paid to the American Hospital Association and the Maine Hospital Association. 218387 43327 101 261613 253039 -34445 207 218387 203049 50445 455 253039 172422 31127 500 203049 171521 1401 500 172422 0.00000 1.00000 0.00000 0 0 193107 193107 22988963 14174146 8814817 21489608 21019578 470030 1512579 1184181 328398 9806352 457 Plan Assets 746990 Debt Service Fund 169294 Due from Third-Party Payors 762957 Other Assets 38617 1717858 457 Plan Assets 746990 Borrowing Collateralized by Patient Accounts 463637 Lease Liabilities - Finance Leases 679915 1890542 51744131 541975 2068 544043 51200088 20030 20030 51220118 53308273 2068 2068 53306205 20030 20030 53326235 Part V, Line 4: The corpus of the endowment is permanently restricted, with any earnings available to promote the Hospital's exempt purpose. Part XI, Line 2d - Other Adjustments: Rental Expenses 2,068. Part XII, Line 2d - Other Adjustments: Rental Expenses 2,068. 1 1 X 1 X 1 X 150.000000000000 0 1 0 0 1840215 1840215 0.03450 1840215 1840215 0.03450 57791 133 57658 0.00110 9219776 3766510 5453266 0.10230 9277567 3766643 5510924 0.10340 11117782 3766643 7351139 0.13790 1 0 10316854 10389937 -73083 X 1 1 1 1 Houlton Regional Hospital 20 Hartford Street Houlton ME 04730 www.houltonregional.org 39512 X X X Swing Bed Program & 2 RHCS Houlton Regional Hospital 1 0 0 1 X X X X X X 21 1 1 0 1 X www.houltonregional.org/community-health-needs-assessment/ X www.maine.gov/dhhs/mecdc/phdata/MaineCHNA/ X 1 21 1 https://houltonregional.org/community-health-needs-assessment/ 0 1 X 150.000000000000 150.000000000000 X X 1 1 X X X 1 X www.houltonregional.org/billing-2/ X www.houltonregional.org/billing-2/ X www.houltonregional.org/billing-2/ X X X X 1 X 0 X X X 1 X 0 0 Houlton Regional Hospital Part V, Section B, Line 5: The results from the survey were distributed to all involved agencies. Staff from Houlton Regional are part of the Aroostook Public Health Council that is taking the lead to address the needs for our county. We also rely on feedback from our patients, employees, medical staff, and board members regarding service needs. Houlton Regional Hospital Part V, Section B, Line 6a: The Hospital participated in the Maine Shared Community Health Needs Assessment Survey that included Northern Light Health Member Hospitals; Central Maine Healthcare; Maine General Health; Maine Health; State of Maine Centers for Disease Control and Prevention; along with many other collaborating organizations and tribal or public health departments. Houlton Regional Hospital Part V, Section B, Line 11: The Hospital is working to address 4 key areas in response to the most recent Health Needs Assessment: Mental health/substance use; access to care; older adult health; and social determinants of health.Efforts undertaken include: patient education, case management services, collaboration with specialty and community agencies, adjusting office practice hours, and continued review of our service lines.We review the community needs on an ongoing basis against the available resources that we have and also against our scope of license or practice. 2 1 - Sigrid E Tompkins Rural Health Center 22 Hartford Street Houlton ME 04730 Rural Health Center 2 - Houlton Family Practice 22 Hartford Street Houlton ME 04730 Rural Health Center Part I, Line 7: Cost-to-charge ratio was used to derive charity care and discounts at cost in the table. Cost-to charge ratio was also used to derive the cost of Medicaid services, which is included as a portion of the unreimbursed Medicaid community benefit expense. The cost-to-charge ratio was derived from worksheet 2, ratio of patient care cost-to-charge. Part I, Line 7g: HRH contracts with a local behavioral health agency to provide crisis intervention services in our emergency department. This service is used to stabilize emergent patients and then refer or transfer them for future care. This level of service is often not covered by patient insurance, so HRH ends up covering the majority of these costs. This subsidy is calculated by estimating the collection rate from patients or their insurance and then subtracting this from the invoices received from the external agency. Part I, Line 3C - Charity Care Eligibility Criteria (FPG is not used) Dicounted are provided in the RHC setting, begining at 150% of FPG. Part III, Line 4: Please refer to pages 8-12 and pages 16-17 of the attached financial statements. Part III, Line 8: The Hospital bills for various physician services throughout the year. The charges and costs related to those professional services are not reported in the Hospital's cost report.Professional fee reimbursement: when preparing the cost report total charges by department are taken from the general ledger, detail reports by procedure for inpatient/outpatient are generated for those departments that include professional service revenue, and professional service revenue is then subtracted from total revenue to arrive at revenue to report on worksheet C on the cost report. The same reports were run for only Medicare professional service revenue by inpatient and outpatient. Inpatient Medicare professional fee revenue was then reduced by the inpatient Medicare professional fee deductions from revenue on the general ledger to arrive at inpatient professional fee reimbursement. Outpatient Medicare professional fee reimbursement was derived by multiplying the gross reimbursement on the cah-fee reimbursed provider summary report (report type 855) by the percentage of professional charges included in the same report.Professional Fee Costs: Medicare professional fee costs were derived by determining the percentage of professional fee revenue by specialty service related to Medicare and multiplying the specific professional costs summarized by specialty service (A-8-2 support) by the Medicare percentage. Part III, Line 9b: The Hospital has many individual policies that relate to collections. The Hospital has a free care discount policy which specifies the collection practices to be followed for patients who are known to qualify for charity care. When an applicant is received that meets the income eligibility requirements, a search of the billing/accounts receivable is performed to locate all accounts for members of the household. The accounts for household members are then flagged as "Free", balances are written off, and an approval letter is mailed to the applicant. A copy of the application is placed in the free care binder and retained there for three months, which is the length of the application is valid and in effect. The patient is linked in our electronic medical record to a code setup for financial assistance. This requires an account review before any bills are generated to the patient. If they are still within their valid 3 month application, the balance is written-off as charity care and the patient is not billed. A similar process is in place for the sliding fee discounts that are available to patients of the hospital-based rural health clinics. Part VI, Line 2: The Hospital participated in the 2019 Maine shared Health Needs Assessment survey. The results were distributed to all participating agencies, have been reviewed by Hospital leadership and an implementation plan approved. A tab of our website has been devoted to this CHNA and many reports are linked for reference. The Hospital continues to seek improvement in many areas. A more complete explanation is included with our response to Part V, Section B, Question 11. Part VI, Line 3: Patients are made aware of the charity care policy through signage in waiting rooms, direct notification by staff, informational brochures, notices printed on the back of patient bills, and postings on our website. In order to qualify for charity care, the patient is asked to provide a Medicaid denial letter. If the patient does not know how to apply for state assistance programs, they are referred to the local health and human services office. If the patient is an inpatient, the Hospital's social services department will assist the patient in filing state and federal assistance applications. The Hospital also has a financial counselor who meets with both inpatients and outpatients that have billing or assistance related questions. This same staff person administers the Hospital's prescription assistance program. Part VI, Line 4: HRH serves the communities located in southern Aroostook County as well as a few communities in bordering counties. The service area is geographically isolated from the larger population center of Bangor, Maine. Travel within the service area and to out-of-area destinations is further complicated by the harsh Maine winters. The population in Aroostook County is older than the statewide average. Based on 2022 census bureau statistics, 25.1% of the service area population is elderly (65+Years), which is higher than the state % of elderly. This higher concentration of elderly could contribute to a disproportionate utilization of health care services. HRH service area residents are poorer and confronted by a significantly higher unemployment rate than Mainers as a whole. Most income measures for Aroostook County are lower and poverty is higher than statewide averages. 29% of the service area residents are considered to be low-income (less than 200% of the Federal Poverty Level) according to 2022 statistics from the Census Bureau compared to 23% in the United States as a whole. Average unemployment in Aroostook County for 2022 was 4.1% compared to 3.0% for Maine as a whole. With respect to insurance status in comparison to the state, more service area residents are covered by Medicaid and Medicare or are uninsured. Part VI, Line 5: At HRH, all qualified physicians in the community are eligible for medical staff privileges at the Hospital. No qualified physicians have been denied privileges. The Hospital is governed by a community board with board members residing in the Hospital's service area. Board members come from various professional backgrounds. The board meets a minimum of ten times per year. Each meeting starts off with a board education session on topics such as quality improvement, reimbursement methodologies, compliance, and regulatory reporting or changes. The Hospital coordinates continuing medical education (CME) for its medical staff. Many of the sessions are performed in conjunction with the quarterly medical staff meetings and are topics that the medical staff has expressed an interest in. The majority of the sessions are sponsored by the hospital, held in the Hospital conference rooms, and the speakers donate their time. The Hospital provides various medical screening programs to the community, with a focus on offering additional services for our pediatric patients. These include nutritional advice, vision screenings, and dental fluoride varnish. HRH rents office space to the VA on a weekly basis to allow them to hold a clinic in our local area, providing easier access to care for our veterans. Lastly, HRH has allowed Northern Maine community college to use space in our center for community health education to house a nursing class. This has allowed more students to pursue their degree, as they do not have to travel so far to attend classes. Due to the continued COVID-19 pandemic during our year ended 9/30/22, we had to limit some of our community activities for either infection prevention purposes or due to state vaccination mandates. Examples of these activities are: use of our conference room space to host community support groups; phase III cardiopulmonary rehab classes; Lamaze classes; and allowing our staff to go into schools for educational forums or events. It is our plan to reestablish these activities once the pandemic sufficiently ends. X X X 0 0 0 0 0 0 0 0 0 Jennifer Cavalari Hospitalist 519993 0 0 0 0 0 0 0 9696 0 529689 0 0 0 Eric Rau General Surgeon 430873 0 0 0 0 0 0 0 31281 0 462154 0 0 0 Hassan Abouleish MD Vice President 399875 0 0 0 0 0 0 0 0 0 399875 0 0 0 Shawn D Anderson CEO 303766 0 0 0 0 0 0 0 24238 0 328004 0 0 0 Maggy Lespinasse Pediatrician 305767 0 0 0 0 0 0 0 15453 0 321220 0 0 0 Kimberly Mays De Perez OB/GYN Physician 272307 0 0 0 0 0 0 0 27102 0 299409 0 0 0 Solomon Olabiyi Director 252558 0 0 0 0 0 0 0 32435 0 284993 0 0 0 Jared Onder Chief Anesthetist 220382 0 0 0 0 0 0 0 29491 0 249873 0 0 0 Cynthia Thompson CFO 172615 0 0 0 0 0 0 0 220 0 172835 0 0 0 C Regina Brown COO 145826 0 0 0 0 0 0 0 25960 0 171786 0 0 0 Form 990, Part VII, Line 5 During 2022, Dr. Hassan Abouleish was compensated by Internal Medicine of Houlton, an unrelated organization, for services rendered to the Hospital. Amounts paid by the Hospital to Internal Medicine of Houlton for services rendered by Dr. Abouleish total $399,875 during 2022. The Hospital is not made aware of the actual amount of compensation paid to Dr. Abouleish by Internal Medicine of Houlton, and as such, has disclosed and reported the amount paid to the unrelated organization on Form 990, Part VII, Column D and Sch J Part II pursuant to the Form 990 instructions. A Maine Health & Higher Education Financing Authority 010314384 56042RLG5 2017-06-27 1215000 Refinance Existing Debt 0 0 1 B Maine Health & Higher Education Financing Authority 010314384 560427JA5 2010-06-24 2965000 Refinance Existing Debt 0 0 1 C Maine Health & Higher Education Financing Authority 010314384 5604274R4 2015-07-30 820000 Refinance Existing Debt 0 0 1 D Maine Health & Higher Education Financing Authority 010314384 56042RTR3 2019-07-31 2535000 Refinance Existing Debt 0 0 1 A 927683 1215000 27420 1187580 2017 1 0 1 1 B 2941508 2965000 44927 2920073 2010 1 0 1 1 C 723274 820000 23767 796233 2015 1 0 1 1 D 254246 2535000 202750 40320 2291930 2019 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0.00200 0.00200 0 0 0 D 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 0 1 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 Schedule K, Part III, Line 7 and Schedule K, Part V: The Hospital has currently established some of the practices and procedures necessary for post-issuance compliance. The Hospital currently monitors compliance with bond documents through our internal compliance committee. We are also required by the issuer to submit quarterly documents as part of our bond agreements. We are working with our auditors and attorney to improve written policies. Internal Medicine of Houlton Entity more than 35% owned by Hassan Abouleish, Vice President 399875 Physician Servives 0 Sarah Lynds Family member of Max Lynds, Secretary 34278 Employment 0 Form 990, Part VI, Section B, line 11b Copy provided to each Board Member for review, before return was filed. Form 990, Part VI, Section B, line 12c Annually, Directors, Officers, and Key Employees shall complete a conflict of interest statement, in accordance with Hospital's conflict of interest policy. Disclosing any potential business and professional conflicts which may arise. Potential conflicts will be reviewed on an annual basis by the Board of Directors. Should a Director encounter a specific conflict of interest in any meeting of the Board or a Board Committee, that Director will excuse themselves from the meeting, will not participate in discussion of the issue and will not vote. Form 990, Part VI, Section B, line 15 Wages for the CEO, CFO, COO, and CNO are compared against the Northern New England compensation survey on a bi-annual basis by the Executive Committee of the Board of Directors. Physician salaries are compared against two different sets of comparative data - The MGMA Physician Compensation Survey and the Northern New England Compensation Survey. Form 990, Part VI, Section C, line 19 The bylaws of Houlton Regional Hospital are available to the public upon request. The conflict of interest policy and financial statements are not available to the public. Form 990, Part IX, line 11g Purchased Services: Program service expenses 1,424,874. Management and general expenses 440,781. Fundraising expenses 0. Total expenses 1,865,655. Other Professional Fees: Program service expenses 9,743,583. Management and general expenses 783,523. Fundraising expenses 0. Total expenses 10,527,106. Form 990, Part X, Line 10; Land, Building, and Equipment Section 1.263(a)-3(n) Election: Houlton Regional Hospital 20 Hartford St Houlton, ME 04730 EIN 23-7134386 Houlton Regional Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).