2022-08-11T09:33:43-05:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2020-10-01 010234189 Northern Maine Medical Center NORT 2078343155 194 East Main Street Fort Kent ME 04743 Aaron Teachout CFO 2078343155 2022-08-10 1 Aaron Teachout 999009999 Barbara J McGuan CPA P00219457 2077752387 2022-08-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Jeff Zewe 194 East Main Street Fort Kent ME 04743 71942811 0 X www.nmmc.org X 1948 ME Acute care & long term care hospital and mental health services facility. 11 10 650 12 3802379 0 2996907 9855162 61020775 61744744 209280 -33510 39790 61863 64266752 71628259 2000 2000 0 0 40339303 44288124 0 0 0 21980673 24296901 62321976 68587025 1944776 3041234 80180987 77654286 41344944 35610758 38836043 42043528 The mission of Northern Maine Medical Center is to provide, coordinate, or support access to high quality, affordable health care and to positively impact our communities' quality of life by improving health status. 0 0 59656822 2000 61744744 Medical care & ancillary services, nursing home & skilled services, physician services. 59656822 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 295 0 1 650 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Jeff Zewe 2078343155 194 East Main Street Fort Kent ME 04743 Mark Morneault Chair 1.50 X X 0 0 0 Donald Guimond Vice-Chair 1.50 X X 0 0 0 Douglas Cyr Director 1.50 X 0 0 0 Gisele Dionne Director 1.50 X 0 0 0 Norman Fournier Director 1.50 X 0 0 0 Steven Ouellette Director 1.50 X 0 0 0 Steven Pelletier Director 1.50 X 0 0 0 Dr Erik St Pierre Director 50.00 X 823732 0 35994 Erin Soucy Director 1.50 X 0 0 0 Lucie Tabor Director 1.50 X 0 0 0 Dan Vaillancourt Director 1.50 X 0 0 0 John Ezzy Past Director 1.50 X 0 0 0 Robert Bellefleur Past Director 1.50 X 0 0 0 Peter J Sirois President/CEO 50.00 X 343476 0 34739 Cindy L Daigle Past Treasurer/CFO 50.00 X 231505 0 31429 David Stob Interim CFO 50.00 X 0 0 0 Alain Bois Secretary/COO 50.00 X 202077 0 19649 Dr Mark Overton Psychiatrist 50.00 X 734690 0 24297 Dr Anoushfar Shahriar General Surgeon 50.00 X 673348 0 36718 Dr James Harris Physician 50.00 X 628512 0 33236 Dr John Hallberg Orthopedic Surgeon 50.00 X 584714 0 35921 Dr Michael Sullivan Chief Medical Officer/Hosp 50.00 X 530942 0 36890 4752996 0 288873 67 0 1 0 The Sheridan Corporation PO Box 359 Fairfield ME 04937 Building Contractor 9110597 Cerner Corporation PO Box 959156 St Louis MO 631959156 Software Services 1867024 Medhost Of Tennessee Inc 2739 Momentum Place Chicago IL 60689 Software & Support Services 758520 Northern Light AR Gould Hospital 43 Whiting Hill Rd Brewer ME 04412 Outsourced Physician Services 483082 Cary Medical Center 163 Van Buren Rd Caribou ME 04736 Off-Site Laboratory Services 449387 26 9579634 275528 9855162 Patient Service Revenue 623000 92157459 88355080 3802379 Miscellaneous Revenue 623000 6096524 5883633 212891 Contractual/Char. Adj. 623000 -36509239 -36509239 61744744 139739 139739 43099 0 43099 43099 43099 139947 750 313946 0 -173999 750 -173249 -173249 19370 606 18764 18764 71628259 57729474 3802379 241244 2000 2000 1722600 859726 862874 36150552 32163398 3987154 459631 416848 42783 3676390 3286445 389945 2278951 1991347 287604 42304 42304 99442 84161 15281 2753297 2330218 423079 62308 52734 9574 631506 534467 97039 1462956 1238154 224802 2399130 2030473 368657 61223 51815 9408 412014 371186 40828 2932350 2666319 266031 877991 743077 134914 Medical Supplies 10691905 9048958 1642947 Healthcare Provider Tax 1087053 1087053 Miscellaneous 670165 602589 67576 Dues & Subscriptions 113257 95854 17403 68587025 59656822 8930203 0 X 275463 257526 38784108 20907405 20205 0 6078391 8536471 155000 182545 1333739 1559553 433486 568891 69982083 37535792 27411566 32446291 810563 744289 90024 165143 5171762 4713323 7189529 80180987 77654286 7946644 8585746 14159949 13709059 171477 3185027 19066874 10130926 41344944 35610758 X 38016999 41029521 819044 1014007 38836043 42043528 80180987 77654286 3041234 166251 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 8477 8477 0 Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which is attributable to lobbying expenses. 363800 363800 30568371 17927479 12640892 24019102 18535595 5483507 15030810 1072718 13958092 32446291 Deferred Compensation 2244121 Cash Surrender Value of Life Insurance 420264 Estimated Third-Party Payor Settlements 3025144 Insurance Claims Receivable 1500000 7189529 Deferred Compensation 2244121 Medicare advanced payments 6788309 CARES Act Funding 1098496 10130926 X Part X, Line 2: The Medical Center and VMA are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Medical Center's tax positions and concluded the Medical Center has maintained its tax-exempt status, does not have any significant unrelated business income and has taken no uncertain tax positions that require adjustment or disclosure in the consolidated financial statements. Cancer Fund Tour 19370 19370 106 500 19370 19370 106 500 606 18764 1 1 X 1 X 1 X 0 1 0 1 1 23950 23950 0.00030 9174374 5937802 3236572 0.04720 9198324 5937802 3260522 0.04750 29957363 23464097 6493266 0.09470 29957363 23464097 6493266 0.09470 39155687 29401899 9753788 0.14220 1 0 16264250 17401556 -1137306 X 1 1 2 1 Northern Maine Medical Center 194 East Main Street Fort Kent ME 04743 www.nmmc.org 39318 X X X 2 Forest Hill 20 Bolduc Avenue Fort Kent ME 04743 X Licensed Hospital Related Facility Northern Maine Medical Center 1 0 0 1 X X X X X X X X X 20 1 1 1 1 X www.nmmc.org/community-health-needs-assessment X 1 20 1 www.nmmc.org/community-health-needs-assessment 1 0 1 X 150.000000000000 200.000000000000 1 1 X X X 1 X http://www.nmmc.org/billing/ X http://www.nmmc.org/billing/ X http://www.nmmc.org/billing/ X X X X X X 1 X 0 X X X 1 X 0 0 Northern Maine Medical Center Part V, Section B, Line 3j: The Community Health Needs Assessment was developed by the Eastern Maine Health System (EMHS) utilizing a consulting firm called JSI to support member organizations and community partners' work to conduct the needs assessments and to develop strategies to improve the health of the people we serve. The consultants who developed the survey tool worked with individuals from a broad spectrum of backgrounds as follows: the Maine Center for Disease Control and Prevention, the District Public Health Liaisons, Federally Qualified Health Centers, Public Health and Community Services across the state of Maine and others who provided generous support and insights. Target audience was anyone with a vested interest in public health and healthcare including medical staff, community board members, volunteers, donors and members of the general public. The surveys were conducted across the eight participating Maine Counties of Aroostook, Cumberland, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington by 17 partnering Maine Hospitals, 5 local Public Health Districts and 11 Healthy Maine Partnerships. The following sectors were represented: - Healthy Aroostook- Northern Maine Medical Center- Public Health Nursing- Aroostook Mental Health Services- Wabanaki Public Health- Town of Madawaska- UMFK Student- Power of Prevention- Fish River Rural Health - Maine Quality Counts- U. Maine Cooperative Extension- Visiting Nurses of Aroostook- Town of Fort Kent- The Aroostook Medical Center- Fiddlehead Focus News- Maine CDC- Pines Health Services- University of Maine at Fort Kent- Northern Maine Development Commission- Community Voices- Community Members Northern Maine Medical Center Part V, Section B, Line 5: Attention was taken to include a broad representation from the community. This took place in two ways. First, the stakeholders were invited to participate in public forums. Second, four work groups were convened to address each of the four priorities selected. A facilitator was identified for each group to lead the ongoing discussion and work to address strategies and action plans for each of the priorities. The following sectors were represented:- AMHC- UMFK Nursing Division- NMMC Director of Nursing- NMMC Pharmacist- Life by Design- Agency on Aging- NMMC Care Manager- Valley School Substance Abuse Counselor- UMFK Behavioral Health- U. Maine Cooperative Extension- NMMC Social Worker- NMMC NDPP Trainer PA - Hope & Justice- NMMC Financial Counselor- NMMC Practice Coordinator- NMMC Community Educator- Power of Prevention- FK High School Wellness- NMMC Psych Unit Leader- FK Recreation Director- UMFK Student- NMMC Communications- Catholic Charities- FK Community Development Northern Maine Medical Center Part V, Section B, Line 6a: The following hospitals were included in the collaborative community health assessment: Cary Medical Center, Down East Community Hospital, Houlton Regional Hospital, Maine Coast Memorial Hospital, Mayo Regional Hospital, Millinocket Regional Hospital, Mount Desert Island Hospital, Northern Maine Medical Center, and Redington-Fairview General Hospital. Northern Maine Medical Center Part V, Section B, Line 6b: Aroostook Mental Health Center - St. John Valley Public Schools - University of Maine, Fort Kent, Behavioral Health and Nursing Divisions - Fish River Rural Health Center - Healthy Maine Partnerships - University of Maine Cooperative Extension Service - Town Government and Recreation Departments - Life by Design Mental Health - Clergy - Aroostook Agency on Aging Northern Maine Medical Center Part V, Section B, Line 7d: The St. John Valley assessment has been posted on the NMMC website since late 2014, as soon as it became available. The report is also available free upon request. Each year, thereafter, 2015-2016, 2016-2017, 2017-2018, an updated report was posted on the Northern Maine Medical Center website with instructions on how to access the updates. For the newest identified priorities for the start of the new cycle: 2017-2021, the same process will be used to keep the public apprised of the priorities and the actions. The hospital's Community Liaison Committee of the Board of Trustees is also provided a summary on an annual basis. In addition, contact information is provided on the website for individuals who wish to request a free paper copy. Individuals may also call NMMC to request a free copy. Northern Maine Medical Center Part V, Section B, Line 11: See attached Community Health Needs Assessment and Implementation Strategy. Northern Maine Medical Center Part V, Section B, Line 24: Individuals are billed at gross amounts and charges are adjusted accordingly, if they qualify for assistance. Part I, Line 7: The amounts reported on Lines 7a & 7b were computed using a cost-to-charge ratio. Amounts on line 7g are derived from internal financial/cost accounting systems. Part I, Line 7g: Subsidized health services on line 7g include physician clinics, rural health centers, a skilled nursing facility, and emergency room. Part II, Community Building Activities: N/A Part III, Line 4: See footnote 2 (page 13, paragraph 1) in the attached financial statements. Part III, Line 9b: Our collection policy stipulates that NMMC makes reasonable efforts to identify those individuals that may qualify for assistance. In the first 120 days, patients may request to begin the Financial Assistance process and collection activity is put on hold until the process is completed. If the patient qualifies, no further collection activity will occur going forward for that account. If patient does not qualify, collection activity resumes from point it was put on hold. Part VI, Line 2: Please see Schedule H, Part V, Section B, Line 5 for a description of NMMC's assessment process. Part VI, Line 3: We notify patients and customers about access to assistance in various ways. The simplest way is the signage, pamphlets, and educational material located around the Organization and in various offices. In every patient access/patient financial services area is a sign explaining the availability of free/discounted care and the Federal Poverty Guidelines. There are also pamphlets located in the outpatient areas explaining free/discounted care and providing information on Mainecare. For inpatients, there is a book in each room which provides all the information on all programs available.Through the patient accounting department, we provide information aboutthese statements. We also counsel patients on the phone about all theprograms available whether it is Medicaid or a hospital program. Part VI, Line 4: Northern Maine Medical Center is a 94 licensed bed (27 A&P which includes swing beds, 6 ICU beds, 16 Psych beds, and 45 SNF beds), full-service, acute-care, not-for profit hospital located in Fort Kent, Maine (Aroostook County). The Hospital is accredited by the joint commission and its mission is to serve its communities with excellence in health care. Its services include acute inpatient, psych inpatient, SNF, 24-hour emergency center, diagnostic, and surgical services. Along with these hospital services, the Hospital employs/contracts with the majority of primary and specialty care physicians in the area. Part VI, Line 5: Northern Maine Medical Center is a local, not-for-profit hospital that serves its local communities and people regardless of their ability to pay. Northern Maine provides financial assistance and sliding scale discounts to self-pay and low-income patients. Also the Hospital participates in government-sponsored health care programs including Medicare, Medicaid, VA, and Tricare. The volunteer board of trustees sets the strategic direction for the Hospital and is comprised of community members from the Hospital's service area. This group is made up of local business owners, professionals, and retirees. Northern Maine's non-profit status allows the Hospital to reinvest any excess of revenues over expense back into the Hospital to continuously improve the medical care it delivers. The Hospital allows access to healthcare that would otherwise be difficult. The Hospital is the main employer for the local physicians, including specialty physicians that would otherwise have to be accessed out of the area. X X X 0 0 0 0 0 0 0 1 0 Dr Erik St Pierre Director 768403 0 35639 0 19690 0 8550 0 27444 0 859726 0 0 0 Dr Mark Overton Psychiatrist 626443 0 74267 0 33980 0 0 0 24297 0 758987 0 0 0 Dr Anoushfar Shahriar General Surgeon 578614 0 26061 0 68673 0 8550 0 28168 0 710066 0 0 0 Dr James Harris Physician 546930 0 22495 0 59087 0 8550 0 24686 0 661748 0 0 0 Dr John Hallberg Orthopedic Surgeon 500428 0 45498 0 38788 0 8550 0 27371 0 620635 0 0 0 Dr Michael Sullivan Chief Medical Officer/Hosp 486181 0 24571 0 20190 0 8550 0 28340 0 567832 0 0 0 Peter J Sirois President/CEO 299603 0 41923 0 1950 0 8550 0 26189 0 378215 0 0 0 Cindy L Daigle Past Treasurer/CFO 199513 0 16957 0 15035 0 6406 0 25023 0 262934 0 0 0 Alain Bois Secretary/COO 179664 0 10103 0 12310 0 3700 0 15949 0 221726 0 0 0 Part I, Line 7 The bonus paid to Peter Sirois, CEO, has set point criteria for earning specific bonus levels/amounts. The Board awards points based on the accomplishment of pre-established objectives/targets. Points are tabulated with the final score determining bonus level achieved. The Board meets with the CEO to discuss performance, including those objectives/targets and based on that meeting award the points and derive the bonus amount. Peter also received two one-week bonuses (COVID related). Dr. Erik St. Pierre, Dr. Anoushfar Shahriar, Dr. John Hallberg, Dr. Michael Sullivan, Dr. James Harris and Dr. Mark Overton received annual bonuses based on their performance, as well as two one-week bonuses (COVID related). Dr. Mark Overton also received a Board Certification bonus. Dr. John Hallberg also received a sign-on bonus. Cindy Daigle and Alain Bois received Christmas bonuses, as well as two one-week bonuses (COVID related). A Maine Health and Higher Education Facilities Authority 010314384 56042RUP5 2019-11-06 15820042 To refinance existing debt and fund new construction 0 0 1 A 2110983 15820042 981150 293305 209443 7361187 6974957 2020 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 0 Michelle L Plourde Family member of Peter Sirois, Hospital CEO 100733 Employment 0 Nicole Marquis Family member of Peter Sirois, Hospital CEO 122098 Employment 0 Robin Lamarr Family member of Peter Sirois, Hospital CEO 90895 Employment 0 Nola Sirois Family member of Peter Sirois, Hospital CEO 10647 Employment 0 Form 990, Part VI, Section B, line 11b The Form 990 is prepared by the Organization's independent public accounting firm and thoroughly reviewed by the CFO and Controller. The completed form is sent electronically to Board members prior to the form being filed. In addition, CEO has documents for review prior to sending to the Board members and has opportunity to request any edits. When the forms are sent to Board members, they are instructed to contact CEO or CFO with questions. Any questions are responded to and at the following Finance or Board meetings, CFO provides ability for anyone to ask any additional questions. Finance Committee may request a formal/detailed presentation by consultants if deemed necessary but have not requested that level of review recently. Form 990, Part VI, Section B, line 12c On an annual basis, Board Members must read the Organization's conflict of interest policy, disclose any potential conflicts, and return the signed statement to Administration. If topics arise where a Member has an actual or potential conflict, the group will determine the level to which the individual may be involved in discussions and the member with the conflict will not have a vote. In some instances, the member will be excused from the meeting and can only rejoin when the Board has moved on to a different topic. Form 990, Part VI, Section B, line 15 The Board of Directors determines the compensation of the CEO using compensation studies and comparability data. The CEO determines the compensation of other officers and key employees in a similar manner. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Northern Maine Medical Center 194 East Main Street Fort Kent, ME 04743 EIN: 01-0234189 Northern Maine Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Valley Medical Association 194 East Main Street Fort Kent ME 04743 223245434 Medical Physician Practice ME 501(c)(3) Line 3 Northern Maine Medical Center 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0