2021-05-12T08:42:43-05:00 2020-06-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2019-07-01 010223482 Millinocket Regional Hospital MILL 2077235161 200 Somerset Street Millinocket ME 04462 Mellissa McAvoy Chief Financial Officer 2077235161 2021-05-11 1 Nicholas E Porto P01310283 2078792100 2021-05-11 2019 2022-09-23 18:48:47Z Robert Peterson DSc 200 Somerset Street Millinocket ME 04462 33027136 0 X www.mrhme.org X 1952 ME Critical Access Hospital 10 5 267 19 0 0 170808 2393942 31620797 28381643 535202 191330 0 -65694 32326807 30901221 1515 0 0 0 18866542 17516290 0 0 0 14850010 13272608 33718067 30788898 -1391260 112323 15058805 20845103 10408235 16075359 4650570 4769744 X Millinocket Regional Hospital (MRH) is a critical access hospital that provides access to excellence in healthcare. 0 0 27642698 0 28500260 Millinocket Regional Hospital (MRH) provides a broad scope of medical services to residents and guests in the Katahdin region. These services span the continuum of care and include inpatient, outpatient, emergency, and ancillary services. Inpatient care at MRH includes medical surgical care with availability of swing bed and special care services.The wide range of support services available at MRH features highly skilled staff and includes diagnostic imaging, cardiopulmonology, laboratory, rehabilitation, and wellness. MRH features a strong, cohesive medical staff consisting of family practice, internal medicine, general surgery, gastroenterology, orthopedics, ear nose & throat, urology, podiatry, cardiology, oncology, ophthalmology, podiatry, pulmonology, radiology, and urology.During this reporting period, MRH cared for:Inpatients - 454Clinic patients - 15,401Emergency room patients - 4,965In addition, MRH provided:Surgical services - 1,047Laboratory services - 78,649Radiology services - 11,252Therapy services (physical, speech, and occupational) - 11,090 27642698 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 38 0 1 267 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 5 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Mellissa McAvoy CFO 2077235161 200 Somerset Street Millinocket ME 04462 John Gluscic MD Physician 40.00 0.00 X 612739 0 12337 Mark A Kowalski MD Physician 40.00 0.00 X 524530 0 16314 Edward J Dunstan DO Physician 40.00 0.00 X 423559 0 24668 Daniel C Herbert MD Medical Staff President 40.00 0.00 X 325436 0 37086 Kwaku Owusu-Abrokwa MD Physician 40.00 0.00 X 272624 0 10705 Jil Beaupain DPM Medical Staff At-Large Member 40.00 0.00 X 270000 0 0 Robert Peterson Chief Executive Officer 50.00 0.00 X 247730 0 9770 Lawrence E Hallett CRNA Certified Registered Nurse Anesthetist 40.00 0.00 X 233061 0 15165 Kelly Gardner PA-C Medical Staff VP/Secretary 40.00 0.00 X 109789 0 7200 Mellissa McAvoy Board President, CFO, COO 29.00 0.00 X X 97156 0 0 Herbert Clark Trustee 5.00 0.00 X 0 0 0 Gail Fanjoy Trustee 5.00 0.00 X 0 0 0 Joyce Given Auxiliary President (end 4/20) 5.00 0.00 X 0 0 0 Patrick E Hunt Esq Trustee 5.00 0.00 X 0 0 0 Fred Lewis Trustee 5.00 0.00 X 0 0 0 Lee Chip Lamson Board Vice President 5.00 0.00 X X 0 0 0 Thomas Malcolm Board Treasurer/Secretary 5.00 0.00 X X 0 0 0 3116624 0 133245 25 0 1 1 Dahl-Chase Diagnostic Services 417 State Street Bangor ME 04401 Diagnostic Services 232354 Quest Diagnostics PO Box 844226 Boston MA 02284 Diagnostic Services 197564 NEHE-MRI LLC 114 Gray Road Easton ME 04740 Medical Laboratory 197366 Core Medical Group (fka CMG-CIT Acq LL 655 S Willow Street Manchester NH 03103 Medical Staffing Services 175155 Mahavir Shridharani MD 58 West 58th Street 19F New York NY 10019 Medical Services 148500 7 2107208 286734 2393942 Patient Service Revenue 621110 27458937 27458937 Other Medical Services 621400 542781 542781 340(b) Program 621990 270965 270965 Nutrition and Wellness 621300 97261 97261 Other Revenue 621990 11699 11699 28381643 67016 67016 2069127 176663 1950510 170966 118617 5697 124314 118617 5697 8129 4439 3690 3690 Loss in Affiliate 531120 -69384 -69384 -69384 30901221 28500260 0 7019 X 1104167 309167 795000 13440077 12809066 631011 276929 227623 49306 1784432 1685381 99051 910685 845964 64721 49987 49987 35818 35818 5592 5592 3745952 2690585 1055367 9450 9450 913843 848898 64945 620559 576457 44102 27118 25191 1927 113656 105579 8077 138348 138348 618996 557096 61900 540770 502339 38431 Medical and Pharmaceuti 3276165 3276165 Bad Debt Expense 2283485 2283485 Equipment Expenses 480273 480273 Medicaid Assessment Tax 367470 367470 45126 42509 2617 30788898 27642698 3146200 0 0 382779 735281 8809104 3242012 2834560 608014 644436 315200 237709 22760647 17314265 4579818 5446382 3790597 1486984 1238958 52457 116692 7018 541907 834000 15058805 20845103 5065395 2894510 2299274 594683 453726 2998669 5914458 1749488 4513391 10408235 16075359 X 4253214 4566613 397356 203131 4650570 4769744 15058805 20845103 112323 6851 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 5591 0 0 0 5591 0 Part II-B, Line 1: Millinocket Regional Hospital pays annual dues to the Maine Hospital Association and the American Hospital Association. A portion of these dues is available for lobbying. During fiscal year 2020, the approximate amount of dues paid to MHA that was available for lobbying was $3,776; the approximate amount of dues paid to AHA that was available for lobbying was $1,815. 54551 54551 10470997 6859520 3611477 11729836 10454745 1275091 505263 505263 5446382 Estimated Third Party Payor Settlements 3679391 Medical Malpractice Claims 834000 4513391 X 28629026 6851 4439 11290 28617736 2283485 2283485 30901221 28509852 4439 4439 28505413 2283485 2283485 30788898 Part X, Line 2: The Hospital is organized as a Maine nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, it is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrealized business income tax and has not filed an Exempt Organization Business Income Tax Return (990T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Fundraising Event Expenses 4,439. Part XI, Line 4b - Other Adjustments: Provision for Bad Debt 2,283,485. Part XII, Line 2d - Other Adjustments: Fundraising Event Expenses 4,439. Part XII, Line 4b - Other Adjustments: Provision for Bad Debt 2,283,485. 1 1 X 1 X 1 X 1 1 0 0 247999 247999 0.00870 3321050 2479855 841195 0.02950 3569049 2479855 1089194 0.03820 9854761 5002495 4852266 0.17020 9854761 5002495 4852266 0.17020 13423810 7482350 5941460 0.20840 1 1243026 0 7754163 7811977 -57814 X 1 1 1 1 Millinocket Regional Hospital 200 Somerset Street Millinocket ME 04462 ww.mrhme,org 38579 X X X Millinocket Regional Hospital 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X See Part V, Section C X See Part V, Section C X 1 18 1 See Part V, Section C 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Millinocket Regional Hospital Part V, Section B, Line 5: The Maine Shared Community Health Needs Assessment (CHNA) is a collaborative effort amongst Central Maine Healthcare (CMHC), MaineGeneral Health (MGH), MaineHealth (MH), Northern Light Health (NLH), and the Maine Center for Disease Control and Prevention (Maine CDC), and Maine Department of Health and Human Services. Input was gathered through forums, community events, surveys, focus groups, and interviews during the fall and winter of 2018-2019. Health priorities for the county, public health district, and the state were developed through community participation and voting at community forums. The Maine Shared CHNA is based on what nearly 2,000 people reported to be the biggest health issues facing their community after reviewing the health profiles release in the summer of 2018. Millinocket Regional Hospital Part V, Section B, Line 6a: Central Maine Healthcare (CMHC), MaineGeneral Health (MGH), MaineHealth (MH), Northern Light Health (NLH) Millinocket Regional Hospital Part V, Section B, Line 6b: Maine Center for Disease Control and Prevention (Maine CDC), an office of the Maine Department of Health and Human Services Millinocket Regional Hospital Part V, Section B, Line 11: MRH will continue to meet the changing needs of our community.Community Health Needs Assessment priority areas are: mental health, social determinants of health (SDOH), access to care, and substance use. The ways MRH is working to meet these major areas of need are:Mental Health:-Partner with providers who offer mental health services in our communities and develop working relationships that will foster continuity and a strong referral relationship for our patients with mental needs;-Provide education tools and materials to providers that will increase comfort level of staff and patients in mental health.Social Determinants of Health (SDOH):-Maintain use of food insecurity screening tool in the emergency department, primary care, family medicine and walk in clinic; -Continue to provide emergency food bags and/or frozen meals and food resource guides as appropriate; -Continue to partner with the Good Shepherd Food Bank through their Community Health and Hunger Initiative and Mainers Feeding Mainers program;-Provide ongoing education to staff and patients about food insecurity by using "food is medicine" language;-Thrive Penobscot will continue to convene the Katahdin Area Food Council to build networks within community sectors that reduce barriers to accessing food resources;-Increase access to transportation by establishing a volunteer driver program with the Millinocket Public Library and promoting current service with Penquis;-Develop community health education calendar to include all health education topics being offered in the communities served by the Hospital.Access to Care:-Determine need for additional staff in scheduling departments to ensure timely diagnostic testing; -Assess current flow of same day access to appointments for sick patient visits in physician offices and determine needs for improving this; -Assess community needs for additional specialty clinics through partnerships, for example pulmonology, dermatology, cardiology, etc.Substance Abuse:-Participate in Thrive Penobscot's (the grant funded public health arm of MRH) efforts to build the Katahdin Response for Substance Use Disorder that will bring treatment, recovery and prevention sectors together;-Begin the distribution of Narcan through the emergency department and determine if further site distribution is warranted;-Research the feasibility of initiating and providing Medication Assistive Therapy at MRH and/or in partnership with an FQHC;Additional needs for health organization identified in the CHNA include growth and innovation and financial stability.Growth and Innovation:-Invest in technology by a two-year budget requirements for upgraded technology;-Continue to further streamline processes;-Decrease the number of platforms or software systems;-Decrease and eliminate paper processes;-Increase utilization of available functions.Strive for Financial Stability:-Increase operational revenue by ensuring fees are in line with costs and encompass consideration contractual allowances;-Manage contracts more effectively; MRH has enrolled in a new GPO to better utilize group benefits and reduce costs;-Increase inpatient bed usage; -Work with outpatient facilities to better utilize the swing bed;-Determine cost benefits of additional licensing before other levels of care are introduced;-Increase charitable contributions and other funding opportunities;-Start a fundraising campaign/foundation to help increase individual donors and contributors. Millinocket Regional Hospital Part V, Section B, Line 16j: Signage is posted at all registration sites informing patients of the availability of financial assistance. Applications are available at the registration desk. Part V, Section B, Line 7a and 7b: The CHNA is available on Millinocket Regional Hospital's website at: http://www.mrhme.org/wp-content/uploads/2015/03/chna-penobscot-county-report.pdfThe CHNA is also available on the following websites:https://www.maine.gov/dhhs/mecdc/phdata/MaineCHNA/documents/district-reports/Penquis-Report-Web.pdfhttps://northernlighthealth.org/getattachment/Community-Health-Needs-Assessment/2019-CHNA-Reports/Penobscot_2019-CHNA_FINAL.pdf.aspx?lang=en-US Part V, Section B, Line 16a, 16b, and 16c: The Hospital's Financial Assistance Policy can be found on the MRH website at: http://www.mrhme.org/wp-content/uploads/2014/06/Financial-Assistance-Policy-050116.pdfThe Hospital's Financial Assistance Application can be found on the MRH at: http://www.mrhme.org/wp-content/uploads/2021/01/Free-Care-2021-merged.pdfThe Hospital's Plain Language Summary can be found can be found on the MRH at: http://www.mrhme.org/wp-content/uploads/2019/02/Financial-Assistance-Policy-Plain-Language-010118.pdf 2 1 - White Birch Medical Center 899 Central Street Millinocket ME 04462 Physical Therapy and Wellness Center 2 - Millinocket Regional Hosp Walk-In Care 87 Main Street East Millinocket ME 04430 Walk-In Care Part I, Line 3c: In addition to FPG, Millinocket Regional Hospital considers a patient's asset level, medical indigency, and insurance status. Presumptive eligibility may be used if all other financial assistance options have been exhausted. Part I, Line 7: Charity care expenses was converted to cost on Line 7a and based on an overall cost-to-charge ratio addressing all patient segments. Lines 7b and 7g were determined using the Medicaid and Medicare cost reports, respectively.The amount of bad debt expense removed from the denominator of the calculations was $2,283,485. Part I, Line 7g: Millinocket Reginal Hospital has several hospital clinical services and hospital-owned physician practices. Per instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practice that the Hospital subsidizes (i.e., operates at a loss) in the completing of Schedule H. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operate at a loss (i.e., are subsidized by the Hospital) and the associated costs of these practices:a - Hospital based rural health clinicb - Outpatient clinicc - Emergency Roomd - Millinocket Surgicale - Orthopedicsf - Urologyg - Wound Careh - Opthamologyi - Walk in ClinicThe above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $4.6 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $4.6 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.Form 990, Schedule H instructions/guidance contains a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part 1, Line 7 were the following:a. Schedule H Worksheet 6, Subsidized Health Services (the supporting worksheet for Part I, Line 7g), the Hospital did not utilize Worksheet 2 when calculating the percentage used when determining the profit/loss of each hospital clinical service and hospital-owned physician practice. Instead, when compiling the subsidized hospital clinical services and hospital-owned physician practices listed in 1c above, the Hospital utilized the actual estimated costs on the modified Medicare cost report instead of applying the Worksheet 2 cost to charge percentage. b. Schedule H Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs (the supporting schedule for Part I, Lines 7b and 7c), and Worksheet 6, Medicaid Allowable Costs for Subsidized Health Services, listed in line 1c above (which is part of the line 7g costs). The Hospital did not utilize the Worksheet 2 percentage when calculating the Medicaid allowable cost. Instead, the Hospital utilized the actual Medicaid filed cost report for the allowable costs. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 2,283,485. Part III, Line 2: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding, after management has used reasonable collection efforts, are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for major payor source of revenue for the purposes of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established at varying levels based on the age of the receivables and payor source. For receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Part III, Line 4: See Footnote 2 of the audited financial statements. Part III, Line 8: Medicare allowable cost of care was calculated from the Medicare cost report for the fiscal year ending June 30, 2020. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: In an effort to best serve our patients, all first-time statements include information on the availability of financial assistance for qualified patients. Our patient financial services department uses several resources to determine if a patient may be presumptively eligible for finance assistance; for example, eligibility for out-of-state Medicaid, eligibility for other state-funded assistance programs, such as food stamps and patient homelessness. It is our practice to make a reasonable attempt to determine if a patient qualifies for financial assistance before sending an account to a collection agency. Any accounts previously sent to collections will be considered for financial assistance when an application is received; so long as the services were rendered not more than 240 days previously, or the patient was given a written notice that financial assistance was available for those specific services with a deadline dated after the 240 day period. Part VI, Line 2: It is one of our many goals to remain well connected with the community and their needs, which we achieve by overseeing ongoing advisory groups and meetings where our organization can assess perceptions, needs and recommendations. In addition, MRH leaders conduct focus groups with employees in local businesses to evaluate whether healthcare needs are being met and to identify how MRH can better serve the community in the future. Information gathered from advisory groups and focus groups, paired with the Penobscot Shared Community Health Needs Assessment (CHNA) and our annual periodic evaluation, assist MRH to add new services including sleep medicine, gastroenterology, endocrinology, rheumatology, neurology, and optometry, ophthalmology, and walk-in care. Recognizing the large elderly population in our area, and the need for more services to help them live healthier lives and remain independent, MRH has taken on the role of executive sponsor for a thriving in place grant. MRH is completely committed to serving our patients, supporting them in maintaining their health, and assisting them to retain their independence. Part VI, Line 3: Inpatients: In order to identify those patients who would be eligible for financial assistance, all uninsured inpatients are referred to the financial counselor by pre-registration or registration personnel. The financial counselor will do an initial screening for payment options prior to the patient leaving the hospital, if possible. If the patient has left the hospital, the financial counselor will attempt to contact the patient for information. All inpatients are given a copy of patient free care and discount arrangements guidelines at time of admission.Surgical Outpatients: The financial counselor will provide information about patient free care, discount arrangements and term payment arrangements to all uninsured surgical outpatients. All surgical outpatients are provided a copy of patient free care and discount arrangements guidelines at time of registration.Emergency Room Patients: All emergency room patients are provided a copy of patient free care and discount arrangements guidelines at time of registration.All Other Outpatients: All other outpatients are provided a copy of the patient free care/discount arrangements guidelines at time of registration.All patients will receive notice of availability of financial assistance included in their first-time statement. Patient financial services employees and physician practice employees receive training on patient free care and discount arrangements guidelines and are expected to be able to provide contact information about free care and discount arrangements. Part VI, Line 4: Millinocket Regional Hospital has three communities in its primary service area: Millinocket, East Millinocket and Medway. There are multiple smaller communities in the secondary service area including Brownville, Woodville, Stacyville, Sherman, Patten and Island Falls. The area has struggled and realized an unemployment rate in the teens for the past ten years and experienced community out-migration. The population of the primary service area is approximately 7,500 people. The effect on the Hospital of this demographic and population change has been large declines in patient care volumes since 2013. The average median household income is more than 20% lower than the state average. The average resident age is more than 10% older than the state median age. Part VI, Line 5: Millinocket Regional Hospital is the largest employer in the area and sole community provider for acute care. We operate an emergency room available to all patients, regardless of their ability to pay. MRH is involved in government-sponsored health programs as well as the education and training of healthcare professionals, and we offer volunteer opportunities to Members within the community, who may not have a healthcare background, but are passionate about our mission. Our Hospital is governed by a Board of Trustees, all of whom reside in primary and secondary service areas. Employees may participate in board meetings but do not have voting capabilities, with the exception of the medical staff president, who has a voting membership on the governing Board. Board members whose family members are employed by MRH are required to identify the potential conflict in writing and are appropriately recused from acting on matters that may impact directly or indirectly their family members. Physicians who wish to have privileges at our Hospital are not required to be an employee in order to become an active member of the medical staff. They must send a written request to the MRH medical staff for review. Privileges are granted to qualified physicians only after the request is reviewed and the needs and interests of both parties have been evaluated. MRH is an active participant in the community care partnership of Maine, an accountable care organization made up of Maine based hospitals and healthcare centers, which guides our organization toward transforming the delivery of our healthcare services to center around meaningful sharing and accountability for our patients' health. As an organization, Millinocket Regional Hospital prioritizes surplus funds for projects or expenses that have a direct impact on patient care or patient and employee safety. This includes, but is not limited to, training, teaching, and purchasing specialized and improved equipment to keep patients safe. Part VI, Line 7, Reports Filed With States ME X X X X 0 0 0 0 0 0 0 0 0 John Gluscic MD Physician 541971 0 0 0 70768 0 8400 0 3937 0 625076 0 51786 0 Mark A Kowalski MD Physician 125560 0 0 0 398970 0 8400 0 7914 0 540844 0 398970 0 Edward J Dunstan DO Physician 169798 0 0 0 253761 0 8400 0 16268 0 448227 0 224886 0 Daniel C Herbert MD Medical Staff President 145220 0 0 0 180216 0 8400 0 28686 0 362522 0 148216 0 Kwaku Owusu-Abrokwa MD Physician 272624 0 0 0 0 0 8239 0 2466 0 283329 0 0 0 Jil Beaupain DPM Medical Staff At-Large Member 270000 0 0 0 0 0 0 0 0 0 270000 0 0 0 Robert Peterson Chief Executive Officer 156331 0 0 0 91399 0 7500 0 2270 0 257500 0 91399 0 Lawrence E Hallett CRNA Certified Registered Nurse Anestheti 213060 0 0 0 20001 0 6513 0 8652 0 248226 0 0 0 Mellissa McAvoy Board President, CFO, COO 97156 0 0 0 0 0 0 0 0 0 97156 0 0 0 Schedule J, Part II, Columns B(iii) and F: The Hospital had a 457(b) nonqualified deferred compensation plan which was established for a select group of management or highly compensated employees. The plan's assets were invested in mutual funds and were valued at $1,392,292 at June 30, 2019 and were reported in assets limited as to use and deferred compensation liability in the consolidated balance sheets. During 2020, the deferred compensation plan was terminated and total plan assets of $1,481,644 were disbursed to participants. Payments to officers, directors, and highly compensated employees listed on Form 990, Part VII and Schedule J, include: John Gluscic, MD - $51,785 Mark A. Kowalski, MD - $398,970 Edward J. Dunstan, DO - $224,886 Daniel C. Herbert, MD - $148,216 Robert Peterson, DSc - $97,399 These amounts, which include contributions and investment accurals, are reported on Schedule J, Part II, Column B(iii) and Column F. A Maine Health and Higher Educational Facilities Authority 010314384 560427WV4 2013-05-23 1423837 Refinancing of 2002 D Bond Issue 0 0 1 A 890762 1423837 15439 1408398 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: Maine Health and Higher Educational Facilities Authority Date the Rebate Computation was Performed: 06/25/2018 Joyce Given Family Member is employee of Hospital 50652 Joyce Given served as a Trustee of Millinocket Regional Hospital until April 2020. A family member, Cynthia Morneault, is an employee of the Hospital. 2019 W-2 compensation paid to Cynthia Morneault was $42,807. As a Hospital employee, Ms. Morneault also received deferred compensation in the amount of $1,376 and fringe benefits of $6,469. 0 Daniel Herbert Family Member is employee of Hospital 106718 Daniel C. Herbert, MD serves as Chief Medical Officer and a Trustee of Millinocket Regional Hospital. A family member, Laurie Vickers-Herbert, is an employee of the Hospital. 2019 W-2 compensation paid to Laurie Vickers-Herbert was $75,305. As a Hospital employee, Ms. Vicker-Herbert also received deferred compensation in the amount of $2,311 and fringe benefits of $29,102. 0 Patrick E Hunt Esq Family Member is employee of Hospital 120510 Patrick E. Hunt, Esq. serves as a Trustee of Millinocket Regional Hospital. A family member, Rose Ann Hunt, PA, is an employee of the Hospital. 2019 W-2 compensation paid to Rose Ann Hunt was $116,783. As a Hospital employee, Ms. Hunt also received deferred compensation in the amount of $3,510 and fringe benefits of $217. 0 Schedule L, Part IV: Form 990, Part VI, Section A, line 3 Millinocket Regional Hospital contracted with Calculations, Inc., an unrelated organization, to provide CFO services during the fiscal year. Calculations, Inc. was paid $97,156 for services provided by Mellissa McAvoy, who is an officer of Calculations, Inc. and served as Board President of MRH during the filing period. Form 990, Part VI, Section B, line 11b Prior to the document's filing, the organization's finance department reviews the initial draft, which is prepared by an outside independent accountant. After any necessary changes are made, the organization's board members are presented with a copy. The finalized document is subject to the board's approval. Form 990, Part VI, Section B, line 12c Each board member is required to sign a conflict of interest disclosure form on an annual basis. In connection with any actual or possible conflicts of interest, an interested individual must disclose the existence of his or her conflict annually and whenever the conflict arises for action at a meeting. After receiving all annual attestations, the CEO will provide the signed statements to the hospital's attorney for review. After review, the attorney will determine if a conflict exists and inform the CEO and Board Chair of the conflicted individuals. There is a listing of board, medical staff and manager conflicts available at all meetings for reference. The agenda for every board, medical staff or department meeting will clearly list the discussion items that require action during the meeting. At the beginning of the meeting, the president will ask the members to review the list of action items and declare whether or not they have a conflict. All conflicted members will be required to excuse themselves and leave the room during the discussion and vote. If the board or committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. Form 990, Part VI, Section B, line 15 The organization works with an independent compensation consultant to determine appropriate compensation levels. The organization's executive committee reviews data used to determine compensation for its respective members. Any compensation related changes must be approved by the Board of Trustees or the executive board. 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 IX, line 11g Purchased Services: Program service expenses 1,406,630. Management and general expenses 1,036,929. Fundraising expenses 0. Total expenses 2,443,559. Professional Services: Program service expenses 871,170. Management and general expenses 0. Fundraising expenses 0. Total expenses 871,170. Outside Services: Program service expenses 412,785. Management and general expenses 18,438. Fundraising expenses 0. Total expenses 431,223. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. First Millinocket Regional Investment Company 200 Somerset Street Millinocket ME 04462 010396196 Dissolved as of 6/30/20 ME Millinocket Regional Hospital C 246707 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 First Millinocket Regional Investment Company S 1034425 FMV of Assets