RUMFORD HOSPITAL: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- RUMFORD HOSPITAL (EIN 01-0215227)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-16
- IRS object ID
- 202211369349302796
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T09:01:17-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 S HIGH ST SUITE 100 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010215227 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RUMFORD HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RUMF | BusinessNameControlTxt |
| Phone | 2077952813 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 420 FRANKLIN STREET | AddressLine1Txt |
| City | RUMFORD | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04276 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEVEN LITTLESON | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 2077952813 | PhoneNum |
| Signature | 2022-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | STEVEN | PersonFirstNm |
| Person Last | LITTLESON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY CIMINELLO | PreparerPersonNm |
| PTIN | P00796388 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Preparation | 2022-05-13 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVE LITTLESON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 420 FRANKLIN STREET | AddressLine1Txt |
| City | RUMFORD | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04276 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $52,406,600 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RUMFORDHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | RUMFORD HOSPITAL STRIVES TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES. THE HOSPITAL DEPENDS ON THE EXPERTISE COMMITMENT AND COMPASSION OF ITS CAREGIVERS TO FULFILL ITS MISSION | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 343 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,334,121 | PYContributionsGrantsAmt |
| CY Contributions Grants | $365,856 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $42,824,489 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,714,691 | CYProgramServiceRevenueAmt |
| PY Investment Income | $926,959 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,034,504 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$1,419,480 | PYOtherRevenueAmt |
| CY Other Revenue | $27,253 | CYOtherRevenueAmt |
| PY Total Revenue | $43,666,089 | PYTotalRevenueAmt |
| CY Total Revenue | $46,142,304 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,046,675 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,997,011 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,255,203 | PYOtherExpensesAmt |
| CY Other Expenses | $22,212,040 | CYOtherExpensesAmt |
| PY Total Expenses | $41,301,878 | PYTotalExpensesAmt |
| CY Total Expenses | $42,209,051 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,364,211 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,933,253 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $35,581,182 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,999,903 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,478,282 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,759,423 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,102,900 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,240,480 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES IN A SAFE AND TRUSTFULENVIRONMENT THROUGH THE EXPERTISE, COMMITMENT AND COMPASSION OF OURFAMILY OF CAREGIVERS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $36,195,153 | ExpenseAmt |
| Revenue | $44,714,691 | RevenueAmt |
| Desc | RUMFORD HOSPITAL IS A CRITICAL ACCESS HOSPITAL, PROVIDING COMPREHENSIVE PRIMARY CARE AND SOPHISTICATED DIAGNOSTIC SERVICES, INCLUDING CT SCANNING, ULTRASOUND AND NUCLEAR MEDICINE. THE HOSPITAL OFFERS MEDICAL SURGICAL NURSING SERVICES, A BIRTHING CENTER, WOMEN'S HEALTH SERVICES AND AMBULATORY SURGERY. THE SWING BED PROGRAM PROVIDES CARE FOR PATIENTS WHO NEED SKILLED NURSING SERVICES. RUMFORD HOSPITAL ALSO MAINTAINS A 24 HOUR EMERGENCY DEPARTMENT AND STAFFS AN INTENSIVE CARE UNIT. | Desc |
| Total Program Service Expenses | $36,195,153 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 343 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | ME | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KRISTEN ST PETER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2077952813 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 MAIN STREET | AddressLine1Txt |
| City | LEWISTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JEFF BRICKMAN | ||||||||
| PRESIDENT/DIRECTOR | 3.00 | 55.00 | Yes (X) | Yes (X) | $0 | $945,603 | $219,303 | |
| DAVID SALKO | ||||||||
| DIRECTOR BEG 1/21 | 3.00 | 55.00 | Yes (X) | $0 | $333,577 | $26,982 | ||
| JENNIFER WEINER-SMITH MD | ||||||||
| PHYSICIAN/DIRECTOR | 3.00 | 55.00 | Yes (X) | $0 | $315,310 | $26,723 | ||
| HECTOR TARRAZA | ||||||||
| DIRECTOR BEG 1/21 | 3.00 | 55.00 | Yes (X) | $0 | $233,969 | $0 | ||
| DEBORAH DUNLAP AVASTHI | ||||||||
| CHAIR PERSON/ DIRECTOR END 1/21 | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| AUSTIN ALBERT | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM CLIFFORD | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| DEVORE CULVER | ||||||||
| CHAIR PERSON/ DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| JANET HALL KOSKI | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| GEOFFREY SWIFT | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN MCANUFF | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| KEVIN MORNEAULT | ||||||||
| DIRECTOR END 7/20 | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| SHERWOOD MOODY | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| JOLAN IPPOLITO | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| LOUIS SILVERMAN | ||||||||
| DIRECTOR BEG 1/21 | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| MARNEY CHALMERS | ||||||||
| DIRECTOR BEG 1/21 | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| ANN CONNELLY | ||||||||
| DIRECTOR BEG 1/21 | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN WHITLOCK | ||||||||
| TREASURER END 6/21 | 3.00 | 60.00 | Yes (X) | $0 | $478,758 | $2,850 | ||
| STEVEN LITTLESON | ||||||||
| PRESIDENT CMMC/CMHCC | 3.00 | 60.00 | Yes (X) | $0 | $429,920 | $19,602 | ||
| PETER WRIGHT | ||||||||
| PRESIDENT BRIDGTON HOSPITAL | 55.00 | 3.00 | Yes (X) | $0 | $436,017 | $13,176 | ||
| CORY BAGBY | ||||||||
| SECRETARY | 3.00 | 60.00 | Yes (X) | $0 | $415,621 | $9,842 | ||
| JEFFREY LYNDS | ||||||||
| PHYSICIAN | 55.00 | 0.00 | $385,259 | $0 | $20,106 | Yes (X) | ||
| SAID DAOUD | ||||||||
| PHYSICIAN | 55.00 | 0.00 | $380,377 | $0 | $2,487 | Yes (X) | ||
| STEPHANIE SINCLAIR | ||||||||
| PHYSICIAN | 55.00 | 0.00 | $343,194 | $0 | $26,587 | Yes (X) | ||
| JOHN KROGER | ||||||||
| PHYSICIAN | 55.00 | 0.00 | $308,916 | $0 | $25,033 | Yes (X) | ||
| DIETER KRECKEL | ||||||||
| PHYSICIAN | 55.00 | 0.00 | $326,773 | $0 | $2,977 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,744,519 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,588,775 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $395,668 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SODEXO INC | |||||
| 6451 NORTH FEDERAL HIGHWAY SUITE 70 | FORT LAUDERDALE | FL | 33308 | SUPPORT SERVICES | $1,314,564 |
| QUEST DIAGNOSTICS | |||||
| 500 PLAZA DRIVE | SECAUCUS | NJ | 07094 | MEDICAL SERVICES | $1,131,443 |
| CPS PHARMACY SOLUTIONS | |||||
| 655 METRO PLACE SOUTH SUITE 450 | DUBLIN | OH | 43017 | MEDICAL STAFFING | $571,164 |
| CHG COMPANIES INC | |||||
| 7259 S BINGHAM JUNCTION BLVD | MIDVALE | UT | 84047 | MEDICAL STAFFING | $394,210 |
| MAINE IMAGING SERVICES LLC | |||||
| 700 CONGRESS ST- SUITE 204 | QUINCY | MA | 02169 | MEDICAL IMAGING | $341,204 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $174,838 | GovernmentGrantsAmt |
| All Other Contributions | $191,018 | AllOtherContributionsAmt |
| Total Contributions | $365,856 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $44,714,691 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,714,691 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,714,691 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $107,337 | TotalRevenueColumnAmt |
| Exclusion | $107,337 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,289 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,289 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,289 | TotalRevenueColumnAmt |
| Exclusion | $9,289 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,191,463 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,264,296 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $927,167 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $927,167 | TotalRevenueColumnAmt |
| Exclusion | $927,167 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | TAX REFUNDS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $17,964 | TotalRevenueColumnAmt |
| Exclusion | $17,964 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $17,964 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,142,304 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,714,691 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,061,757 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,380,428 | TotalAmt |
| Program Services | $14,773,364 | ProgramServicesAmt |
| Management And General | $2,607,064 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$159,097 | TotalAmt |
| Program Services | -$135,232 | ProgramServicesAmt |
| Management And General | -$23,865 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,804,723 | TotalAmt |
| Program Services | $1,534,015 | ProgramServicesAmt |
| Management And General | $270,708 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $970,957 | TotalAmt |
| Program Services | $825,313 | ProgramServicesAmt |
| Management And General | $145,644 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,198 | TotalAmt |
| Management And General | $24,198 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,165 | TotalAmt |
| Management And General | $18,165 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,846 | TotalAmt |
| Management And General | $9,846 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,576,109 | TotalAmt |
| Program Services | $9,013,502 | ProgramServicesAmt |
| Management And General | $1,562,607 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190 | TotalAmt |
| Program Services | $141 | ProgramServicesAmt |
| Management And General | $49 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,779 | TotalAmt |
| Program Services | $278,076 | ProgramServicesAmt |
| Management And General | $97,703 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $508,651 | TotalAmt |
| Program Services | $376,402 | ProgramServicesAmt |
| Management And General | $132,249 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $848,697 | TotalAmt |
| Program Services | $628,036 | ProgramServicesAmt |
| Management And General | $220,661 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $409 | TotalAmt |
| Program Services | $303 | ProgramServicesAmt |
| Management And General | $106 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,347 | TotalAmt |
| Program Services | $30,597 | ProgramServicesAmt |
| Management And General | $10,750 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,194 | TotalAmt |
| Program Services | $14,254 | ProgramServicesAmt |
| Management And General | $28,940 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,752,810 | TotalAmt |
| Program Services | $1,034,158 | ProgramServicesAmt |
| Management And General | $718,652 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,421 | TotalAmt |
| Management And General | $190,421 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $6,784,114 | $6,784,114 |
| MEDICAID TAX EXPENSE | $1,038,110 | $1,038,110 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,209,051 | TotalAmt |
| Program Services | $36,195,153 | ProgramServicesAmt |
| Management And General | $6,013,898 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,810 | BOYAmt |
| EOY | $2,490,858 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,206,949 | BOYAmt |
| EOY | $1,339,018 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,137,598 | BOYAmt |
| EOY | $5,264,388 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $455,532 | BOYAmt |
| EOY | $533,521 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,666 | BOYAmt |
| EOY | $276,273 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $38,120,787 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $28,536,117 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,897,135 | BOYAmt |
| EOY | $9,584,670 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,928,943 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $199,196 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $661,353 | BOYAmt |
| EOY | $6,511,175 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,581,182 | BOYAmt |
| EOY | $25,999,903 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,753,384 | BOYAmt |
| EOY | $2,665,032 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,499,253 | BOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $826,713 | BOYAmt |
| EOY | $494,541 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,398,932 | BOYAmt |
| EOY | $9,599,850 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,478,282 | BOYAmt |
| EOY | $12,759,423 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,658,428 | BOYAmt |
| EOY | $12,929,637 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $444,472 | BOYAmt |
| EOY | $310,843 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,102,900 | BOYAmt |
| EOY | $13,240,480 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,581,182 | BOYAmt |
| EOY | $25,999,903 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,933,253 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $72,289 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$41 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$9,867,921 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,773 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,773 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PORTION OF DUES FOR PROFESSIONAL ASSOCIATIONS ATTRIBUTED TO LOBBYING | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $444,472 | BeginningYearBalanceAmt |
| Contributions | $17,469 | ContributionsAmt |
| Investment Earnings Or Losses | $9,392 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $160,491 | OtherExpendituresAmt |
| End Year Balance | $310,842 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $591,558 | BeginningYearBalanceAmt |
| Contributions | $9,277 | ContributionsAmt |
| Investment Earnings Or Losses | $207 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $156,570 | OtherExpendituresAmt |
| End Year Balance | $444,472 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $586,193 | BeginningYearBalanceAmt |
| Contributions | $16,246 | ContributionsAmt |
| Investment Earnings Or Losses | -$881 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $10,000 | OtherExpendituresAmt |
| End Year Balance | $591,558 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $575,743 | BeginningYearBalanceAmt |
| Contributions | $9,356 | ContributionsAmt |
| Investment Earnings Or Losses | $1,094 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $586,193 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $504,309 | BeginningYearBalanceAmt |
| Contributions | $70,344 | ContributionsAmt |
| Investment Earnings Or Losses | $1,090 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $575,743 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.84944 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.15056 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $89,148 | OtherCostOrOtherBasisAmt |
| Book Value | $89,148 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,174,989 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,989,973 | DepreciationAmt |
| Book Value | $6,185,016 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,276,542 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,038,499 | DepreciationAmt |
| Book Value | $3,238,043 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $580,108 | OtherCostOrOtherBasisAmt |
| Depreciation | $507,645 | DepreciationAmt |
| Book Value | $72,463 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,584,670 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM MEDICARE | $304,122 |
| FINANCE LEASE- NET | $2,149 |
| DEBT RESERVE- KEY BANK | $40,203 |
| INTERNALLY DESIGNATED ASSETS | $4,238,568 |
| RESTRICTED ASSETS | $1,751,327 |
| OTHER NONCURRENT ASSETS | $174,806 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,511,175 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| LEASE LIABILITIES- FINANCING | $271,597 |
| PENSION LIABILITIES | $516,388 |
| CONTRACT LIABILTIES | $3,782,822 |
| ASSET RETIREMENT OBLIGATIONS | $503,573 |
| CARES CONTRACT LIABILITY | $327,013 |
| COST REPORT SETTLEMENT | $3,634,642 |
| LONG TERM CHOICE TIME RESERVE | $75,433 |
| DEFERRED SOCIAL SECURITY EMPLOYER PORTION | $488,382 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,599,850 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | ENDOWMENT FUNDS ARE USED TO SUPPORT THE ORGANIZATION IN A VARIETY OF WAYS, DEPENDING UPON THE STATED PURPOSE OF EACH FUND. MANY OF THESE FUNDS HELP TO COVER COSTS OF CAPITAL EQUIPTMENT PURCHASES, CONTINUING EDUCATION, OR FREE CARE. OTHER ARE DESIGNATED TO SUPPORT SPECIFIC DEPARTMENTS OF THE HOSPITAL. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,124,089 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $528,114 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $595,975 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01410 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,128,953 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,192,351 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $936,602 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02220 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,253,042 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,720,465 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,532,577 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03630 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,253,042 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,720,465 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,532,577 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03630 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,586,464 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $735,344 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,131,195 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,062,411 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $68,784 | MedicareSurplusOrShortfallAmt |
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RUMFORD HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 420 FRANKLIN STREET | AddressLine1Txt |
| City | RUMFORD | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04276 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.RUMFORDHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 38727 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | OUTPATIENT PHYSICIAN CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RUMFORD HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, PAGE 8 | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V, PAGE 8 | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.CMHC.ORG/BILLING-AND-FINANCIAL-INFORMATION/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.CMHC.ORG/BILLING-AND-FINANCIAL-INFORMATION/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.CMHC.ORG/BILLING-AND-FINANCIAL-INFORMATION/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| RUMFORD HOSPITAL | PART V, SECTION B, LINE 5: COMMUNITY INPUT:COMMUNITY OUTREACH AND ENGAGEMENT FOR THE MAINE SHARED CHNA INCLUDEDCOORDINATION AT BOTH THE STATEWIDE, PUBLIC HEALTH DISTRICT, AND COUNTYLEVEL. THE STATEWIDE COMMUNITY ENGAGEMENT COMMITTEE MET MONTHLY FROMMARCH 2018 THROUGH JANUARY 2019 TO REVIEW AND PROVIDE INPUT ON EVERYASPECT OF ENGAGEMENT PROCESS.IN ADDITION TO THE STATE-LEVEL COMMUNITY ENGAGEMENT COMMITTEE, A LOCALCOMMUNITY ENGAGEMENT PLANNING COMMITTEE IN EACH OF MAINE'S 16 COUNTIESPLANNED AND IMPLEMENTED THE LOGISTICS OF COMMUNITY FORUMS AND EVENTSWITHIN EACH DISTRICT. THESE COMMITTEES WERE COMPRISED OF HOSPITALS,PUBLIC HEALTH DISTRICT LIAISONS, AND A VARIETY OF ADDITIONAL PARTNERS.THE 2018 COMMUNITY ENGAGEMENT TOOLKIT WAS DESIGNED TO ASSIST THE LOCALCOMMUNITY ENGAGEMENT PLANNING COMMITTEES IN THIS EFFORT.CRITERIA FOR VISUALIZING DATA INCLUDED AREAS IDENTIFIED AS A HEALTHPRIORITY IN THE LAST CHNA, SIGNIFICANT CHANGES IN THE DATA OVER TIME, ORWHERE A COUNTY'S DATA WAS NOTABLY BETTER OR WORSE THAN THE STATE OR THENATION. FORUM AGENDA ITEMS INCLUDED REMARKS FROM HEALTH LEADERS; A REVIEWOF PREVIOUS HEALTH IMPROVEMENT EFFORTS; A REVIEW OF COUNTY-LEVEL DATA,DISCUSSION, AND PRIORITIZATION IN SMALL GROUPS; AND AN OVERALL FORUMWIDEVOTING PROCESS. THE COMMUNITY ENGAGEMENT AND STEERING COMMITTEES CREATEDAND APPROVED A RUBRIC TO GUIDE THE SELECTION CRITERIA FOR THE SUBSET OFDATA TO BE PRESENTED IN EACH FORUM'S POWERPOINT PRESENTATIONS. SMALL GROUPS HAD 35-45 MINUTES TO DISCUSS THE DATA IN THE PRESENTATIONAND THE FULL COUNTY PROFILE, AND TO SHARE THEIR OWN EXPERIENCES IN ORDERTO IDENTIFY THEIR TOP COUNTY HEALTH PRIORITIES. TABLE FACILITATORS GUIDEDTHESE DISCUSSIONS USING KEY QUESTIONS AND WORKSHEETS FOR REPORTINGPURPOSES. HEALTH PRIORITIES IDENTIFIED DURING THESE SMALL GROUPS WERECOLLATED AND PRESENTED TO THE LARGER PLENARY SESSION, WHERE EACH ATTENDEEVOTED FOR THEIR TOP FOUR PRIORITIES. VOTES WERE TALLIED AND A HIERARCHYEMERGED.THE SUMMARY VOTES FOR EACH FORUM WERE USED TO DEVELOP THE COUNTY LEVELPRIORITIES. IF MULTIPLE FORUMS WERE HELD IN A COUNTY, THE FORUM RESULTSFOR FORUMS HELD WITH THE GENERAL COMMUNITY WERE INCLUDED IN THE TOTALVOTES FOR THE COUNTY. IN CASES WHERE A FORUM WAS HELD WITH A SPECIFICPOPULATION, FOR EXAMPLE, LGBTQ YOUTH OR OLDER ADULTS, THEN THE RESULTS OFTHEIR VOTING AND DISCUSSION WERE INCLUDED IN THE SECTION DESCRIBING THENEEDS OF THAT PARTICULAR POPULATION. TO ARRIVE AT THE TOP COUNTYWIDECOMMUNITY HEALTH ISSUES, VOTES FROM THE BROAD COMMUNITY FORUMS WERECOMBINED FOR EACH OF THE PRIORITY AREAS TO IDENTIFY PRIORITY AREAS WHICHFELL WITHIN 70% OF THE COMBINED VOTING TOTAL.THE COMMUNITY FORUM PARTICIPANTS ALSO SHARED KNOWLEDGE ON GAPS AND ASSETSAVAILABLE IN THEIR COMMUNITIES TO ADDRESS EACH OF THE TOP FOUR PRIORITIESIDENTIFIED. THE INFORMATION GATHERED IN THIS REPORT IS A START FORFURTHER ASSET AND GAP MAPPING FOR EACH PRIORITY SELECTED BY THE COUNTY. THREE COMMUNITY ENGAGEMENT ACTIVITIES WERE HELD IN OXFORD COUNTY. THE KEYINFORMANT INTERVIEW GUIDE WAS DEVELOPED WITH INPUT FROM THE COMMUNITYENGAGEMENT AND STEERING COMMITTEE MEMBERS AND CONSISTED OF FIVEQUESTIONS.THIRTY-ONE INTERVIEWS WERE CONDUCTED BY JSI AND 11 BY MEMBERS OF LOCALCOMMUNITY ENGAGEMENT PLANNING COMMITTEES. INFORMATION GATHERED FROM THEKEY INFORMANT INTERVIEWS IS INCLUDED IN DISCUSSIONS WHERE APPLICABLE INTHE COUNTY LEVEL REPORT WITHIN EACH OF THE COUNTY PRIORITIES. FOREXAMPLE, WHEN DISCUSSING SUBSTANCE USE, A DISCUSSION OF THE NEEDS OFVULNERABLE POPULATIONS WITHIN THIS PRIORITY WAS ALSO INCLUDED. THE STATELEVEL REPORT PROVIDES A SUMMARY OF KEY FINDINGS FROM THESE INTERVIEWS FOREACH OF THE TEN VULNERABLE POPULATIONS.ALL OUTCOMES FROM THESE EFFORTS WERE COLLECTED VIA THE COMMUNITY OUTREACHREPORTING TOOL OR THE KEY INFORMANT REPORTING TOOL. BOTH OF THESECOLLECTION TOOLS WERE ONLINE SURVEYS WITHIN SURVEY MONKEY. OTHER DATACOLLECTION TOOLS INCLUDED TABLE FACILITATORS NOTES, FORUM REGISTRATIONS,AND SIGN-INS. |
| RUMFORD HOSPITAL | PART V, SECTION B, LINE 6A: HOSPITAL FACILITIES:OTHER HOSPITAL FACILITIES PROVIDING FUNDING FOR THE MAINE SHARED CHNA ARECENTRAL MAINE HEALTHCARE (INCLUDING CENTRAL MAINE MEDICAL CENTER,BRIDGTON HOSPITAL, AND RUMFORD HOSPITAL), MAINEGENERAL HEALTH, MAINEHEALTH, AND NORTHERN LIGHT HEALTH. |
| RUMFORD HOSPITAL | PART V, SECTION B, LINE 6B: NON-HOSPITAL FACILITIES:OTHER NON-HOSPITAL FACILITIES INVOLVED IN THE MAINE SHARED CHNA ARE THEMAINE CENTER FOR DISEASE CONTROL AND PREVENTION, AN OFFICE OF THEDEPARTMENT OF HEALTH AND HUMAN SERVICES AND COUNTLESS COMMUNITY PARTNERSAND STAKEHOLDER GROUPS. THESE STAKEHOLDER GROUPS INCLUDE THE METRICSCOMMITTEE, DATA ANALYSIS WORKGROUP, COMMUNITY ENGAGEMENT COMMITTEE, LOCALPLANNING COMMITTEES, AND THE STEERING COMMITTEE, MAINE HEALTH DATAORGANIZATION FOR WORKING WITH US TO ACCESS THEIR DATA. SIGNIFICANTANALYSIS WAS CONDUCTED BY EPIDEMIOLOGISTS AT THE MAINE CDC AND THEUNIVERSITY OF SOUTHERN MAINE'S MUSKIE SCHOOL OF PUBLIC SERVICE. JOHNSNOW, INC. PROVIDED ANALYSIS, METHODOLOGY, AND DESIGN SUPPORT. |
| RUMFORD HOSPITAL | PART V, SECTION B, LINE 11: ADDRESSING IDENTIFIED NEEDS:THE COMMITMENT FROM CENTRAL MAINE MEDICAL CENTER AND ITS COMMUNITYPARTNERS WAS TO PRODUCE A DOCUMENT THAT REFLECTS THE VOICE OF OURCOMMUNITY. THE PRIORITIES THAT HAVE EMERGED INCLUDE:- SOCIAL DETERMINANTS OF HEALTH- MENTAL HEALTH- SUBSTANCE USE- ACCESS TO CARE- TOBACCO USETHE NEXT STEP IN THIS PROCESS WAS TO DEVELOP AN IMPLEMENTATION STRATEGYTHAT INCLUDED LONG-RANGE PLANS FOR THE PRIORITIZED NEEDS AND TIED THESPECIFIC IMPLEMENTATION PLANS TO THE STRATEGIC PLAN FOR CENTRAL MAINEMEDICAL CENTER. THIS PROCESS WAS FACILITATED BY THE CMMC LEADERSHIPTEAM, THE COMMUNITY PILLAR STEERING COMMITTEE, AND INCLUDED PARTICIPATIONFROM THE COMMUNITY STAKEHOLDER GROUP AND OTHER COMMUNITY MEMBERS.THE STRATEGIES, ACTIVITIES, ACTIONS TAKEN, PROGRAMS AND RESOURCESCOMMITTED, COLLABORATION WITH OTHER ORGANIZATIONS, AND OUTCOMES CAN BEVIEWED AT WWW.CMMC.ORG/ABOUT-COMMUNITY-BENEFITS. |
| RUMFORD HOSPITAL | PART V, SECTION B, LINE 13H: FAP ELIGIBILITY CRITERIA:PATIENTS MUST APPLY FOR MAINE FREE CARE IN ORDER TO BE CONSIDERED FOR THEHOSPITAL'S FREE CARE PROGRAM. AS PART OF THE APPLICATION, PATIENTS MUSTSUBMIT A COPY OF CURRENT MAINECARE DECISION LETTERS. PATIENTS WILL BEASKED IF THEY HAVE INSURANCE OF ANY KIND TO HELP PAY FOR CARE AND AREALSO ASKED TO SHOW THAT INSURANCE OR A GOVERNMENT PROGRAM WILL NOT PAYFOR YOUR CARE. IF PATIENTS DO NOT QUALIFY FOR FREE HOSPITAL CARE, THEYARE ALLOWED TO ASK FOR A FAIR HEARING OR APPEAL. |
| PART V, SECTION B, LINE 7A | HTTPS://WWW.CMHC.ORG/RUMFORD-HOSPITAL/ABOUT-RUMFORD-HOSPITAL/COMMUNITY-BENEFITS/ |
| PART V, SECTION B, LINE 7B | HTTPS://WWW.MAINE.GOV/DHHS/MECDC/PHDATA/MAINECHNA/ |
| PART V, SECTION B, LINE 10A | HTTPS://WWW.CMHC.ORG/RUMFORD-HOSPITAL/ABOUT-RUMFORD-HOSPITAL/COMMUNITY-BENEFITS/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ELSEMORE DIXFIELD FAMILY MEDICINE | ||||
| 146 WELD STREET PHYSICIAN CLINIC | DIXFIELD | ME | 04224 | OUTPATIENT PHYSICIAN CLINIC |
| 2 - SWIFT RIVER FAMILY MEDICINE | ||||
| 430 FRANKLIN STREET | RUMFORD | ME | 04276 | OUTPATIENT PHYSICIAN CLINIC |
| 3 - RUMFORD SPECIALTY SERVICES CLINIC | ||||
| 431 FRANKLIN STREET | RUMFORD | ME | 04276 | OUTPATIENT PHYSICIAN CLINIC |
| 4 - RUMFORD SURGICAL SPECIALISTS | ||||
| 431 FRANKLIN STREET | RUMFORD | ME | 04276 | OUTPATIENT PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | PATIENTS MUST APPLY FOR MAINE FREE CARE IN ORDER TO BE CONSIDERED FOR THEHOSPITAL'S FREE CARE PROGRAM. AS PART OF THE APPLICATION, PATIENTS MUSTSUBMIT A COPY OF CURRENT MAINECARE DECISION LETTERS. PATIENTS WILL BEASKED IF THEY HAVE INSURANCE OF ANY KIND TO HELP PAY FOR CARE AND AREALSO ASKED TO SHOW THAT INSURANCE OR A GOVERNMENT PROGRAM WILL NOT PAYFOR YOUR CARE. IF PATIENTS DO NOT QUALIFY FOR FREE HOSPITAL CARE, THEYARE ALLOWED TO ASK FOR A FAIR HEARING OR APPEAL.ELIGIBILITY FOR 100% FINANCIAL ASSISTANCE AS STATED IN THE FINANCIAL ASSISTANCE POLICY: A. FINANCIAL ASSISTANCE FOR MEDICALLY NECESSARY CARE IS AVAILABLE TO MAINE RESIDENTS WHO: HAVE NO HEALTH INSURANCE COVERAGE OR HAVE COVERAGE THAT PAYS ONLY PART OF THE BILL; AND MEET THE INCOME CRITERIA SET FORTH BELOW. B. FINANCIAL ASSISTANCE FOR EMERGENCY CARE IS AVAILABLE TO MAINE RESIDENTS AND NON-MAINE RESIDENTS WHO: HAVE NO HEALTH INSURANCE COVERAGE OR HAVE COVERAGE THAT PAYS ONLY PART OF THE BILL; AND MEET THE INCOME CRITERIA SET FORTH BELOW. C. CMH HOSPITALS PROVIDE 100% FINANCIAL ASSISTANCE BASED ON CRITERIA AS DEFINED BELOW: GROSS INCOME IS BELOW 200% OF THE FPL, SUBJECT TO APPROVAL PATIENT IS A RESIDENT OF MAINE NON-MAINE RESIDENT SEEKING EMERGENCY CARE FOR SERVICES OR SUPPLIES THAT ARE A MEDICAL NECESSITY ALL THIRD-PARTY PAYER SOURCES HAVE BEEN EXHAUSTED D. NO INDIVIDUAL ELIGIBLE FOR FINANCIAL ASSISTANCE WILL BE CHARGED MORE FOR EMERGENCY OR OTHERWISE MEDICALLY NECESSARY CARE THAN THE CALCULATED AGB. |
| PART I, LINE 7: | COSTING METHODOLOGY:THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED TO CALCULATE AMOUNTS ON IRS WORKSHEETS 1 AND 3. ALL OTHER WORKSHEETS USEDTHE ORGANIZATION'S COST ACCOUNTING SYSTEM. |
| PART I, LN 7 COL(F): | PERCENT OF TOTAL EXPENSES:THE PERCENT OF TOTAL EXPENSE ON SCHEDULE H, PART I, LINE 7, COLUMN (F),WAS CALCULATED USING TOTAL EXPENSES ON FORM 990, PART IX, LINE 25,COLUMN(A). |
| PART III, LINE 2: | BAD DEBT EXPENSE:THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FORWHICH THE HEALTH SYSTEMS DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROMTHE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROMTHE HEALTH SYSTEM'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUERECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIALSTATEMENTS FOR THE YEAR ENDED JUNE 30, 2020. HOWEVER, THE HOSPITALINTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICESAND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A,LINE 2. |
| PART III, LINE 3: | BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE:BAD DEBT ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CAREPOLICY FOR LINE 3 WAS DETERMINED USING A COMPARISON OF EXPERIENCEDCHARITY CARE COVERAGE AND US CENSUS BUREAU DATA FOR THE MOST RECENT YEARAVAILABLE WHEN CHARITY CARE COVERAGE EXCEEDS THE CENSUS DATA, A MINIMALAMOUNT OF BAD DEBT IS ASSUMED TO BE ELIGIBLE FOR CHARITY CARE TO ACCOUNTFOR THOSE PATIENTS WHO REFUSE TO PROVIDE INFORMATION DOCUMENTINGELIGIBILITY FOR THE PROGRAM. THESE ESTIMATES ARE BASED ON STATE-WIDE DATAAND DO NOT ACCOUNT FOR DIFFERENCES IN GEOGRAPHIC LOCATIONS WITHIN THESTATE. AS THIS AMOUNT IS RELATED TO PATIENTS ELIGIBLE UNDER THE FINANCIALASSISTANCE POLICY, IT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. |
| PART III, LINE 4: | BAD DEBT EXPENSE FOOTNOTE:THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBESBAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBESPATIENTS ACCOUNTS RECEIVABLE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO QUALIFYING INDIVIDUALS AS PART OF THE CORPORATION'S FINANCIAL ASSISTANCE POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO SELF-PAY PATIENTS. ESTIMATES FOR EXPLICIT PRICE CONCESSIONS ARE BASED ON PROVIDER CONTRACTS, PAYMENT TERMS FOR RELEVANT PROSPECTIVE PAYMENT SYSTEMS, AND HISTORICAL EXPERIENCE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE CORPORATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE CORPORATION RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. |
| PART III, LINE 8: | COMMUNITY BENEFIT:THE COSTING METHODOLOGY USED FOR LINE 6 IS INFORMATION PULLED FROM THEMEDICARE COST REPORT FILING. ANY SHORTFALL REPORTED ON LINE 7 COULD BECONSIDERED COMMUNITY BENEFIT TO A LEVEL PROPORTIONAL TO THE POVERTYLEVELS INDICATED BY CENSUS BUREAU DATA. IF THE PATIENTS FALLING UNDER200% FPG LEVEL WERE NOT COVERED BY MEDICARE THEY WOULD QUALIFY UNDERRUMFORD HOSPITAL'S FREE CARE POLICY. UNDER THAT CIRCUMSTANCE, THESEPATIENTS WOULD THEN APPEAR AS PART OF THE STATISTICS ON PART I, LINE 7A. |
| PART III, LINE 9B: | COLLECTION POLICY:COLLECTION PRACTICES FOR PATIENTS KNOWN TO BE ELIGIBLE FOR CHARITY CAREARE LIMITED TO COLLECTING FROM ANY AVAILABLE PAYMENT SOURCES SUCH ASMEDICARE OR MEDICAID. IF A PATIENT IS ELIGIBLE, BUT HAS NOT APPLIED FORMEDICAID COVERAGE, THE PATIENT IS REQUESTED TO APPLY. ASSISTANCE IS AVAILABLE TO HELP THE PATIENT WITH THE MEDICAID APPLICATION PROCESS. |
| PART VI, LINE 2: | NEEDS ASSESSMENT:AS A CRITICAL ACCESS HOSPITAL, RUMFORD HOSPITAL ATTEMPTS TO PROVIDE ANYNEEDED HEALTH CARE SERVICES NECESSARY TO TREAT THE POPULATION OF THISRURAL AREA OF MAINE, ADDITIONALLY, RUMFORD HOSPITAL FOCUSES ON STATE-WIDEINITIATIVES, SUCH AS HEART DISEASE AND DIABETES, AS WELL ASORGANIZATIONAL INITIATIVES BASED ON NEEDS OBSERVED WITHIN ITS PATIENTPOPULATION. MANY FORMS OF EDUCATION, PREVENTION AND EARLY DETECTION AREALSO, PART OF ITS COMMUNITY HEALTH CARE PLAN. |
| PART VI, LINE 3: | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:RUMFORD HOSPITAL PROVIDES NOTICES ABOUT ITS FREE CARE POLICY IN ALLCLINICAL DEPARTMENTS AND MAJOR PATIENT AREAS. AN INPATIENT FINANCIALCOUNSELOR VISITS WITH ALL UNINSURED PATIENTS TO DISCUSS OPTIONS,INCLUDING GOVERNMENTAL PROGRAM ELIGIBILITY AND FREE CARE ASSISTANCE IS AVAILABLE TO HELP PATIENTS WITH COMPLETION OF MEDICAID APPLICATIONS. ALLPATIENT FINANCIAL SERVICES STAFF ARE TRAINED TO OFFER FREE CARE AS ANOPTION TO PATIENTS WHO INDICATE AN INABILITY OR DIFFICULTY IN PAYING FORSERVICES. INFORMATION ABOUT FINANCIAL ASSISTANCE AVAILABILITY IS INCLUDEDON THE BACK OF EVERY PATIENT STATEMENT. ADDITIONALLY, UNINSURED PATIENTSRECEIVE A SEPARATE INFORMATION SHEET WITH THEIR STATEMENTS, FURTHERINFORMING THEM ABOUT THE AVAILABLE OPTIONS. |
| PART VI, LINE 4: | COMMUNITY INFORMATION:RUMFORD HOSPITAL, LOCATED IN RUMFORD, MAINE, SERVES CENTRAL OXFORD COUNTYALONG THE WESTERN BORDER OF MAINE. A LIGHTLY POPULATED, RURAL AREA AGED65 OR OVER AND 14% OF THE POPULATION BELOW THE POVERTY LEVEL. |
| PART VI, LINE 5: | PROMOTION OF COMMUNITY HEALTH:RUMFORD HOSPITAL HAS AN OPEN MEDICAL STAFF, ALLOWING ANY NON-EMPLOYED ORAFFILIATED PHYSICIANS TO HAVE ADMITTING PRIVILEGES TO THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF A MAJORITY OF LOCAL COMMUNITY MEMBERSALONG WITH SOME REPRESENTATION BY DIRECTORS FROM CENTRAL MAINEHEALTHCARE, THE PARENT OF THE HEALTHCARE SYSTEM WHICH RUMFORD HOSPITALBELONGS TO, HELPING TO BRING TOGETHER THE VISIONS OF THE LOCAL COMMUNITYWITH THE CAPABILITIES AND VISION OF THE SYSTEM AS A WHOLE FOR THE BENEFITOF RUMFORD AND SURROUNDING COMMUNITIES. |
| PART VI, LINE 6: | AFFILIATED HEALTH CARE SYSTEM:AS A MEMBER OF THE CENTRAL MAINE HEALTHCARE SYSTEM, RUMFORD HOSPITALPROVIDES HIGH QUALITY HEALTH CARE IN A RURAL SETTING WITH LIMITED HEALTHCARE OPTIONS. ITS AFFILIATION WITH CENTRAL MAINE MEDICAL CENTER PROVIDESACCESS TO A MUCH LARGER, TERTIARY CARE HOSPITAL, INCLUDING TRAUMA CARE,NEONATAL INTENSIVE CARE, AND A SPECIALIZED CARDIAC CARE UNIT.ADDITIONALLY, CENTRAL MAINE MEDICAL CENTER PROVIDES ACCESS TO SPECIALISTPHYSICIANS FOR OUTPATIENT CARE IN THE RUMFORD AREA ON A REGULAR SCHEDULE.THE SYSTEM PARENT, CENTRAL MAINE HEALTHCARE, PROVIDES STREAMLINED ADMINISTRATIVE FUNCTIONS AND BACKROOM SERVICES, ALLOWING RUMFORD HOSPITALTO PERFORM AT A COST-EFFICIENT LEVEL WHICH WOULD NORMALLY BE UNACHIEVABLEIN A SMALL, RURAL HOSPITAL, ALLOWING FOR BROADER RANGE OF SERVICESAVAILABLE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEFF BRICKMAN | ||||||||||||||
| PRESIDENT/DIRECTOR | $0 | $780,191 | $0 | $146,241 | $0 | $19,171 | $0 | $190,423 | $0 | $28,880 | $0 | $1,164,906 | $0 | $0 |
| JOHN WHITLOCK | ||||||||||||||
| TREASURER END 6/21 | $0 | $401,238 | $0 | $36,560 | $0 | $40,960 | $0 | $2,850 | $0 | $0 | $0 | $481,608 | $0 | $0 |
| STEVEN LITTLESON | ||||||||||||||
| PRESIDENT CMMC/CMHCC | $0 | $328,265 | $0 | $35,000 | $0 | $66,655 | $0 | $0 | $0 | $19,602 | $0 | $449,522 | $0 | $0 |
| PETER WRIGHT | ||||||||||||||
| PRESIDENT BRIDGTON HOSPITAL | $0 | $362,649 | $0 | $34,996 | $0 | $38,372 | $0 | $2,709 | $0 | $10,467 | $0 | $449,193 | $0 | $0 |
| CORY BAGBY | ||||||||||||||
| SECRETARY | $0 | $279,318 | $0 | $50,000 | $0 | $86,303 | $0 | $2,980 | $0 | $6,862 | $0 | $425,463 | $0 | $0 |
| JEFFREY LYNDS | ||||||||||||||
| PHYSICIAN | $319,355 | $0 | $63,215 | $0 | $2,689 | $0 | $2,905 | $0 | $17,201 | $0 | $405,365 | $0 | $0 | $0 |
| SAID DAOUD | ||||||||||||||
| PHYSICIAN | $370,108 | $0 | $0 | $0 | $10,269 | $0 | $2,487 | $0 | $0 | $0 | $382,864 | $0 | $0 | $0 |
| STEPHANIE SINCLAIR | ||||||||||||||
| PHYSICIAN | $312,609 | $0 | $28,450 | $0 | $2,135 | $0 | $2,271 | $0 | $24,316 | $0 | $369,781 | $0 | $0 | $0 |
| DAVID SALKO | ||||||||||||||
| DIRECTOR BEG 1/21 | $0 | $259,379 | $0 | $65,637 | $0 | $8,561 | $0 | $2,406 | $0 | $24,576 | $0 | $360,559 | $0 | $0 |
| JENNIFER WEINER-SMITH MD | ||||||||||||||
| PHYSICIAN/DIRECTOR | $0 | $295,035 | $0 | $16,618 | $0 | $3,657 | $0 | $2,422 | $0 | $24,301 | $0 | $342,033 | $0 | $0 |
| JOHN KROGER | ||||||||||||||
| PHYSICIAN | $306,028 | $0 | $0 | $0 | $2,888 | $0 | $1,737 | $0 | $23,296 | $0 | $333,949 | $0 | $0 | $0 |
| DIETER KRECKEL | ||||||||||||||
| PHYSICIAN | $316,736 | $0 | $5,172 | $0 | $4,865 | $0 | $2,209 | $0 | $768 | $0 | $329,750 | $0 | $0 | $0 |
| HECTOR TARRAZA | ||||||||||||||
| DIRECTOR BEG 1/21 | $0 | $229,239 | $0 | $0 | $0 | $4,730 | $0 | $0 | $0 | $0 | $0 | $233,969 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: A PARTICIPANT'S ENTITLEMENT TO BENEFITS WILL VEST ON THE PARTICIPANT'S VESTING DATE PROVIDED THE PARTICIPANT HAS REMAINED IN CONTINUOUS EMPLOYMENT IN THE SAME POSITION WHILE PARTICIPATING IN THIS PLAN. A PARTICIPANT WILL HAVE ONLY ONE VESTING DATE FOR ALL ELECTIVE DEFERRALS AND OTHER PLAN CONTRIBUTIONS MADE ON THE PARTICIPANT'S BEHALF DURING ALL PLAN YEARS. A PARTICIPANT'S ENTITLEMENT TO BENEFITS WILL ALSO VEST ( A) IF THE PARTICIPANT DIES WHILE STILL EMPLOYED BY THE EMPLOYER, ( B) IF THE PARTICIPANT'S EMPLOYMENT TERMINATES DUE TO TOTAL DISABILITY, OR ( C) IF THE EMPLOYER TERMINATES THE PARTICIPANTS EMPLOYMENT FOR ANY REASON OTHER THAN FOR CAUSE ANY PORTION OF THE PARTICIPANT'S ENTITLEMENT BENEFITS THAT IS NOT VESTED WHEN THE PARTICIPANT'S EMPLOYMENT WITH THE EMPLOYER TERMINATES, INCLUDING ELECTIVE DEFERRALS, WILL BE FORFEITED. THE EMPLOYER WILL DISTRIBUTE A PARTICIPANT'S BENEFITS UNDER THE PLAN AS SOON AS PRACTICABLE AFTER THE PARTICIPANT'S ENTITLEMENT BECOMES VESTED. JEFF BRICKMAN PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH CENTRAL MAINE HEALTHCARE CORPORATION, A RELATED ENTITY. THE AMOUNT WAS $185,248. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION SHALL BE CENTRAL MAINE HEALTHCARE CORPORATION ACTING THROUGH THE MEMBER'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE CORPORATION SHALL CONSIST OF THE SAME INDIVIDUALS SERVING AS MEMBERS OF THE MEMBER'S BOARD OF DIRECTORS. THE MEMBER MAY MAKE, AMEND OR REPEAL THE BYLAWS IN A WHOLE OR IN PART. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER OF THE CORPORATION SHALL BE CENTRAL MAINE HEALTHCARE CORPORATION ACTING THROUGH THE MEMBER'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE CORPORATION SHALL CONSIST OF THE SAME INDIVIDUALS SERVING AS MEMBERS OF THE MEMBER'S BOARD OF DIRECTORS. THE MEMBER MAY MAKE, AMEND OR REPEAL THE BYLAWS IN A WHOLE OR IN PART. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER OF THE CORPORATION SHALL BE CENTRAL MAINE HEALTHCARE CORPORATION ACTING THROUGH THE MEMBER'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE CORPORATION SHALL CONSIST OF THE SAME INDIVIDUALS SERVING AS MEMBERS OF THE MEMBER'S BOARD OF DIRECTORS. THE MEMBER MAY MAKE, AMEND OR REPEAL THE BYLAWS IN A WHOLE OR IN PART. |
| FORM 990, PART VI, SECTION B, LINE 11B | ALL AFFILIATED FORM 990'S AND APPLICABLE SCHEDULES ARE PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM IN COOPERATION WITH THE FINANCE DEPARTMENT. THE COMPLETED RETURNS ARE REVIEWED WITH THE VICE PRESIDENT OF FINANCE THEN WITH THE CFO FOLLOWING THAT REVIEW; THEY ARE PRESENTED TO THE FINANCE COMMITTEE OF THE CENTRAL MAINE HEALTHCARE BOARD OF DIRECTORS, WHICH HAS REPRESENTATIVES FROM ALL AFFILIATED BOARDS. ONCE THIS REVIEW IS COMPLETED, ANY NECESSARY CHANGES ARE MADE AND THE FINAL RETURN IS PRESENTED TO ITS RESPECTIVE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS AND DIRECTORS COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT WHICH IS REVIEWED BY THE CHAIRMAN OF THE BOARD AND CONFORMS TO THE CONDITIONS CONTAINED WITHIN THE CORPORATION'S BYLAWS, WHICH MEET OR EXCEED THE CURRENT IRS REPORTING THRESHOLDS. IN AREAS OF CONFLICT BY THE CHAIRMAN, THE VICE-CHAIRMAN REVIEWS. ADDITIONALLY, AS PART OF THE ANNUAL FORM 990 PREPARATION PROCESS, A SEPERATE QUESTIONNAIRE IS PROVIDED, WHICH INCLUDES DISTRUBUTION TO KEY EMPLOYEES, COVERING REPORTING AREAS OF LOANS, GRANTS, BUSINESS RELATIONSHIPS, AND OTHER CONCLICTS. THESE QUESTIONAIRES ARE REVIEWED BY THE FINANCE DEPARTMENT FOR REPORTABLE ITEMS FOR THE FORM 990. IN THE CASE OF POSSIBLE CONFLICT, THE BOARD WOULD REVIEW THE SITUATION AND TAKE ACTIONS DEEMED APPROPRIATE FOR THE POSSIBLE OR ACTUALCONFLICTS OF MEMBERS OF THE BOARD OR THE EXECUTIVE OFFICERS. IN THE CASE OF KEY EMPLOYEES, THE REVIEW AND ACTIONS TAKEN WOULD BE PERFORMED BY THEIR DIRECT SUPERVISOR. |
| FORM 990, PART VI, SECTION B, LINE 15 | CENTRAL MAINE HEALTHCARE (CMHC) HAS ESTABLISHED AND FOLLOWS A DELIBERATIVE TRANSPARENT PROCESS WHICH MEETS IRS REGULATIONS FOR " REBUTTABLE" PRESUMPTION OF REASONABLENESS. A STANDING EXECUTIVE COMPENSATION COMMITTEE (ECC) , COMPRISED OF INDEPENDENT MEMBERS OF BOARD LEADERSHIP, EXISTS TO UNDERTAKE THE PROCESS OF DETERMINING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER, PRESIDENT OF CENTRAL MAINE MEDICAL CENTER, PHYSICIAN PRACTICE EXECUTIVE, PRESIDENT OF RUMFORD HOSPITAL, AND PRESIDENT OF BRIDGTON HOSPITAL. THE PROCESS GUIDELINES AND AUTHORITY OF THE ECC ARE SET OUT IN THE EXECUTIVE COMPENSATION PHILOSOPHY AND RESPONSIBILITIES CHARTER WHICH WAS APPROVED BY THE CMHC BOARD. THE ENTIRE CHMC BOARD PARTICIPATES IN THE ANNUAL PERFORMANCE EVALUATION OF EACH EXECUTIVE, INCLUDING A REVIEW OF ACCOMPLISHMENTS RELATIVE TO GOALS AND OBJECTIVES DERIVED FROM THE STRATEGIC PLAN. THE ECC REVIEWS THE RESULTS OF THE ANNUAL PERFORMANCE EVALUATION AND APPROPRIATE COMPARABILITY DATA BASED ON SEVERAL FACTORS RECOMMENDED BY AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT, WHO SPECIALIZES IN NOT-FOR-PROFIT HOSPITALS AND HEALTH SYSTEMS, AND OUR ATTORNEY'S FACTORS USED IN DETERMINING COMPARABILITY TO THE ORGANIZATION INCLUDING GEOGRAPHY, ORGANIZATIONAL COMPLEXITY, FACILITY TYPE, OWNERSHIP TYPE, AND ANY OTHER FACTORS DEEMED RELEVANT BY THE COMMITTEE'S CONSULTANTS, OR ITS ATTORNEYS. USING THIS INFORMATION, THE ECC ANNUALLY REVIEWS THE EXECUTIVES' COMPENSATION TO DETERMINE IF MODIFICATION TO BASE SALARY IS WARRANTED, AND REVIEWS THE EXECUTIVES' ACCOMPLISHMENTS TO DETERMINE IF ANY VARIABLE PAY IS TO BE AWARDED. THE ENTIRE PROCESS IS THEN DOCUMENTED CONTEMPORANEOUSLY WITH THE DECISION MAKING PROCESS AND APPROVED THEREAFTER IN ACCORDANCE WITH THE IRS GUIDANCE. THE COMPENSATION PAID TO KEY EMPLOYEES IS REVIEWED BY THE VICE PRESIDENT OF HUMAN RESOURCES AND ORGANIZATIONAL DEVELOPMENT. DURING THE REVIEW PROCESS, THE CENTRAL MAINE HEALTHCARE COMPENSATION MANAGER PROVIDERS MARKET DATA ON COMPARABLE POSITIONS FROM COMPARATIVE GROUPS OF HEALTHCARE ORGANIZATIONS THAT ARE APPROPRIATELY SIMILAR IN TERMS OF THEIR REVENUE, GEOGRAPHIC LOCATION, NUMBER OF EMPLOYEES, NUMBER OF STAFFED HOSPITAL BEDS, ETC. HUMAN RESOURCES PROVIDES AT A MINIMUM FOUR SETS OF COMPARABILITY DATA FROM THE MOST RECENT NATIONAL HEALTHCARE SPECIFIC COMPENSATION SURVEYS ( E. G. WATSON & WYATT, SULLIVAN & COTTER, THE HAY GROUP, MERCER, ETC) FOR REFERENCE. THESE SURVEYS REPORT PAY RATE DATA THAT IS TYPICALLY AGED LESS THAN 6 MONTHS. CENTRAL MAINE HEALTHCARE AND AFFILIATES STRIVE TO PAY AT THE MARKET AVERAGE OR SLIGHTLY ABOVE IT FOR KEY EMPLOYEES. ONCE THE COMPENSATION MANAGER AND THE VICE PRESIDENT OF HUMAN RESOURCES AND ORGANIZATIONAL DEVELOPMENT HAVE FINALIZED RECOMMENDATIONS BASED ON THIS EMPIRICAL DATA, THEY ARE PRESENTED TO THE PRESIDENTS OF EACH HOSPITAL THAT SUPERVISE THE KEY EMPLOYEES, AND THE CEO OF CENTRAL MAINE HEALTHCARE, FOR REVIEW, EDITS, AND APPROVAL. THIS PROCESS TYPICALLY OCCURS DURING THE LAST MONTH OF THE FISCAL YEAR IN PREPARATION FOR THE NEXT FISCAL YEAR. CENTRAL MANE HEALTHCARE DOCUMENTS THE BASIS FOR ITS DETERMINATION FOR KEY EMPLOYEES' COMPENSATION AND MAINTAINS THIS CONTEMPORANEOUSLY SUBSTANTIATED MATERIAL IN THE HUMAN RESOURCES DEPARTMENT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST IN THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE FINANCIAL STATEMENTS OF THE ORGANIZATION ARE INCLUDED IN THE MOST RECENTLY FILED FORM 990 AND PROVIDED, UPON REQUEST, IN THAT FORMAT UNLESS THE SPECIFIC REQUEST DEEMS A DIFFERENT FORMAT MORE APPROPRIATELY. |
| FORM 990, PART VII, SECTION A | BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. JEFF BRICKMAN WAS EMPLOYED AS PRESIDENT OF CENTRAL MAINE HEALTHCARE CORPORATION AND NOW STEVEN LITTLESON IS IN THAT POSITION. BOTH JEFF BRICKMAN AND STEVEN LITTLESON WERE COMPENSATED BASED ON THEIR ROLE AS PRESIDENT. |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 9,013,502. MANAGEMENT AND GENERAL EXPENSES 1,562,607. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,576,109. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER -10,554,984. CHANGE IN DEFINED BENEFIT PENSION PLAN GAINS AND LOSSES 820,693. RESTRICTED DONATIONS 17,469. CHANGE IN INTEREST OF RESTRICTED NET ASSETS OF OUTSIDE TRUST 9,392. NET ASSETS RELEASED FROM RESTRICTION -160,491. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CENTRAL MAINE COMMUNITY HEALTH CORP | |||||||||||
| PO BOX 4500 | LEWISTON | ME | 04243 | 010386912 | PUBLIC EDUCATION | ME | 501(C)(3) | LINE 7 | CMHC | 0 | |
| CENTRAL MAINE MEDICAL CENTER | |||||||||||
| PO BOX 4500 | LEWISTON | ME | 04243 | 010211494 | HEALTHCARE | ME | 501(C)(3) | LINE 3 | CMHC | 0 | |
| CENTRAL MAINE HEALTHCARE CORPORATION | |||||||||||
| PO BOX 4500 | LEWISTON | ME | 04243 | 010386913 | HEALTHCARE | ME | 501(C)(3) | LINE 7 | 0 | N/A | |
| MAINE COLLEGE OF HEALTH PROFESSIONS | |||||||||||
| PO BOX 4500 | LEWISTON | ME | 04243 | 010356077 | EDUCATION | ME | 501(C)(3) | LINE 2 | CMMC | 0 | |
| CENTRAL MAINE REAL ESTATE MGMT CORP | |||||||||||
| PO BOX 4500 | LEWISTON | ME | 04243 | 010387674 | REAL ESTATE | ME | 501(C)(2) | CMHC | 0 | ||
| RUMFORD COMMUNITY FAMILY HEALTH CENTER | |||||||||||
| 430 FRANKLIN STREET | RUMFORD | ME | 04276 | 010481000 | HEALTHCARE | ME | 501(C)(3) | LINE 3 | CMHC | 0 | |
| RUMFORD COMMUNITY HOME CORPORATION | |||||||||||
| 11 JOHN F KENNEDY LANE | RUMFORD | ME | 04276 | 222844951 | NURSING HOME | ME | 501(C)(3) | LINE 10 | CMHC | 0 | |
| BRIDGTON HOSPITAL | |||||||||||
| 10 HOSPITAL DRIVE | BRIDGTON | ME | 04009 | 010130427 | HEALTHCARE | ME | 501(C)(3) | LINE 3 | CMHC | 0 | |
| BRIDGTON HOSPITAL PHYSICIANS GROUP | |||||||||||
| SOUTH HIGH STREET | BRIDGTON | ME | 04009 | 010493083 | FUNDING | ME | 501(C)(3) | PF | CMHC | 0 | |
| ELIAS E TUCKER TRUST FUND | |||||||||||
| 300 MAIN STREET | LEWISTON | ME | 04009 | 016042343 | FUNDING | ME | 501(C)(3) | LINE 12A, I | CMMC | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CENTRAL MAINE HEALTH VENTURES INC | |||||||||||||
| 300 MAIN STREET | LEWISTON | ME | 04240 | 010430016 | HEALTHCARE | ME | N/A | C | 0 | ||||
| CWM INSURANCE LTD | |||||||||||||
| 980220891 | INSURANCE | N/A | C | 0 | GENESIS BUILDING PO BOX 1363 BWI | PO BOX BWI | CJ | CJ | |||||
| CENTRAL MAINE ACO | |||||||||||||
| 300 MAIN STREET | LEWISTON | ME | 04240 | 274604314 | ACCOUNTABLE CARE | ME | N/A | C | 0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |