2021-11-15T11:26:44-06:00 2020-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2020-01-01 010211783 Calais Regional Hospital CALA 2074547521 24 Hospital Lane Calais ME 04619 Mark Stickney Plan Officer 2074547521 2021-11-12 1 Mark Stickney 999009999 Joseph R Byrne P01289281 2077752387 2021-11-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Mark Stickney 24 Hospital Lane Calais ME 04619 30190392 0 X www.calaishospital.org X 1938 ME Critical Access Hospital 11 11 280 40 0 0 29643 4668820 28783486 25440238 146973 81334 0 0 28960102 30190392 0 0 0 0 16785644 14667317 0 0 0 13258923 12185288 30044567 26852605 -1084465 3337787 20154881 21440962 25917231 23823022 -5762350 -2382060 Calais Regional Hospital exists to provide and plan patient care, educational and restorative services that meet our customer's expectations, commensurate with available resources. 0 0 2435806 3106590 Inpatient Services: Patients Admitted: 413 Acute: 298 Swing: 115 Average Stay: 3.12 days 16546626 21103309 Outpatient Services: Emergency Room Visits: 6,993 Laboratory Procedures: 101,175 Rehab Services: 9,632 Radiology Exams: 11,691 Respiratory Care: 1,516 Cardiac Rehab Visits: 2,213 Home Health Visits: 2,042 Primary Care Visits: 15,372 Surgical and Orthopedic Visits: 403 964681 1230339 Swing Bed, Cafeteria & Other Services 19947113 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 69 0 1 280 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Lynnette Parr 2072550269 24 Hospital Lane Calais ME 04619 Ronald McAlpine Chair 6.00 0.00 X X 0 0 0 Everett Libby Vice Chair 6.00 0.00 X X 0 0 0 Merritt Loring Treasurer 6.00 0.00 X X 0 0 0 Michael Todd Smith Secretary 6.00 0.00 X X 0 0 0 Lawerence Clark Director 4.00 0.00 X 0 0 0 Sussan Coley Director 4.00 0.00 X 0 0 0 Robert Fitzsimmons Director 4.00 0.00 X 0 0 0 Britani Holloway Director 4.00 0.00 X 0 0 0 Ian Pratt Director 4.00 0.00 X 0 0 0 Susan Rowley Director 4.00 0.00 X 0 0 0 James Thompson Director 4.00 0.00 X 0 0 0 Dennis Mahar Past Treasurer 6.00 0.00 X X 0 0 0 Herbert Clark Past Director 4.00 0.00 X 0 0 0 Linda Gralenski Past Director 4.00 0.00 X 0 0 0 Rodney Boula CEO 40.00 0.00 X 279959 0 38408 Mark Smith CFO 40.00 0.00 X 54925 0 0 Jennifer Griffey Past CFO 40.00 0.00 X 116153 0 20294 Galen Dickinson Past CFO 40.00 0.00 X 36000 0 0 Peter Wilkinson DO Medical Staff Representation 40.00 0.00 X 358074 0 15558 Mohammad Niayesh MD Physician 40.00 0.00 X 291207 0 26501 Nima Moghaddas DPM Physician 40.00 0.00 X 245350 0 43097 Elizabeth Eliacin MD Physician 40.00 0.00 X 231856 0 16841 Robert Leatherman DO Physician 40.00 0.00 X 403635 0 25595 2017159 0 186294 12 0 1 0 EmCare Physician Services LLC 7032 Collection Center Drive Chicago IL 60693 Emergency Room Physicians 1124527 Medefis Consolidated PO Box 5068 New York NY 100875068 Staffing Agency 944439 Murray Plumb & Murray 75 Pearl Street Portland ME 04104 Legal Services 380674 CPS LLC PO Box 638316 Cincinnati OH 45263 Pharma Services 364787 Nurse Anesthesia of Maine 141 N Main Street Suite 205 Brewer ME 04412 Nurse Anesthesia Services 332468 12 4637321 31499 4668820 Patient Services 622100 38130000 38130000 Other Revenue 622100 1260940 1215254 45686 Contractual/Char. Adj. 622100 -13950702 -13950702 25440238 23976 23976 57358 0 57358 57358 57358 30190392 25394552 0 127020 X 545739 545739 10596536 8422943 2173593 2688930 2135856 553074 836112 649947 186165 599942 599942 68731 68731 5884442 5163576 720866 288966 164906 124060 490193 47717 442476 26855 25199 1656 861916 670005 191911 298478 298478 Supplies 1548608 1137216 411392 Healthcare Provider Tax 827282 827282 Repairs and Maintenance 747808 333809 413999 Miscellaneous Expenses 542067 70179 471888 26852605 19947113 6905492 0 X 712431 1699649 3020232 2616077 3091674 2150626 377122 359344 226437 299879 31040807 20532350 11354634 10508457 1372351 3806930 20154881 21440962 8141996 7212334 16082627 15875005 1692608 735683 25917231 23823022 X -7545824 -4217262 1783474 1835202 -5762350 -2382060 20154881 21440962 3337787 42503 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3904 3904 0 Part II-B, Line 1: The Organization pays dues to local associations, a portion of which are attributable to lobbying activities. 206221 206221 18959667 10269046 8690621 9195135 8387870 807265 2679784 1875434 804350 10508457 Beneficial Interest in Perpetual Trust 443514 Investments to Fund Deferred Compensation 735683 Estimated Third-Party Payor Settlements 2627733 3806930 Deferred Compensation Liability 735683 735683 30232895 42503 42503 30190392 0 30190392 26852605 0 26852605 0 26852605 1 1 1 X 1 X 225.000000000000 1 1 1 0 1 1 867844 867844 0.03230 4915795 1000 4914795 0.18300 5783639 1000 5782639 0.21530 12000 12000 0.00040 42500 42500 0.00160 30000 30000 0.00110 84500 84500 0.00310 5868139 1000 5867139 0.21840 1 8686768 8686768 X 1 1 1 1 Calais Regional Hospital 24 Hospital Lane Calais ME 04619 www.calaishospital.org 39044 X X X X Calais Regional Hospital 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X www.calaishospital.org X See Part V, Section C X 1 19 1 www.calaishospital.org 1 0 1 X 150.000000000000 225.000000000000 1 1 X X X 1 X www.calaishospital.org X www.calaishospital.org X www.calaishospital.org X X X X X X 1 X 0 X X X X 1 X 0 0 Calais Regional Hospital Part V, Section B, Line 5: See page 6 of attached Community Health Needs Assessment Calais Regional Hospital Part V, Section B, Line 6b: See page 4 of attached Community Health Needs Assessment Calais Regional Hospital Part V, Section B, Line 7d: The URL of the other website where the CHNA can be found is https://www.maine.gov/dhhs/mecdc/phdata/MaineCHNA/final-CHNA-reports.shtml Calais Regional Hospital Part V, Section B, Line 11: See attached Implementation Strategy Calais Regional Hospital Part V, Section B, Line 16j: Notices of the Free Care program are posted at the front desk in the main lobby, in the registration areas, patient billing department, Surgical Services department, Orthopedic Department, Baileyville Clinic, and Rural Health Care Clinic. Applications are available at all of these points. Assistance in completing the applications is provided by the Patient Financial Advocate. Part III, Line 4: Patient service revenue is reported at the amount that reflects the consideration to which the Hospital expects to be entitled in exchange for providing patient care. These amounts are due from patients, third-party payors (including health insurers and government programs), and others and includes variable consideration for retroactive revenue adjustments due to settlement of audits, reviews, and investigations. Generally, the Hospital bills the patients and third-party payors several days after the services are performed or the patient is discharged. Revenue is recognized as performance obligations are satisfied.Patient accounts receivable are stated at the amount management expects to collect from outstanding balances.The Hospital has elected the practical expedient allowed under FASB ASC 606-10-32-18 and does not adjust the promised amount of consideration from patients and third-party payors for the effects of a significant financing component due to the Hospital's expectation that the period between the time the service is provided to a patient and the time that the patient or a third-party payor pays for that service will be one year or less. However, the Hospital does, in certain instances, enter into payment agreements with patients that allow payments in excess of one year. For those cases, the financing component is not deemed to be significant to the contract.Performance obligations are determined based on the nature of the services provided by the Hospital. Revenue for performance obligations satisfied over time is recognized based on actual charges incurred in relation to total expected (or actual) charges. The Hospital believes that this method provides a faithful depiction of the transfer of services over the term of the performance obligation based on the inputs needed to satisfy the obligation. Generally, performance obligations satisfied over time relate to patients in hospitals receiving inpatient acute care services or patients receiving services in outpatient centers or in their homes. The Hospital measures the performance obligation from admission into the hospital or the commencement of an outpatient service, to the point when it is no longer required to provide services to that patient, which is generally at the time of discharge or completion of the outpatient services.Because all of its performance obligations relate to contracts with a duration of less than one year, the Hospital has elected to apply the optional exemption provided in FASB ASC 606-10-50-14(a) and, therefore, is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period.As a result of the adoption of the above, the Organization is not recording any bad debt expense for 2020. Part III, Line 8: The Organization used the Hospital's as-filed cost reports to obtain Medicare and Medicaid costs and expected reimbursement. Part III, Line 9b: Self-pay accounts receive a minimum of 3 statements and a final notice. Patients must complete an application for Free Care and provide necessary qualifying support in order to receive Free Care. Applications are kept on file and tracked in a log. The log of patients who are eligible for Free Care is maintained electronically and is available at registration points to simplify the application of Free Care for current services. Part VI, Line 2: Healthcare Community Needs Surveys are completed every three years. The Hospital conducts interviews with various community groups, trustees and staff and conducts an annual community survey. In addition, the Hospital participates in joint efforts with other healthcare providers to analyze and act upon regional health status indicators and data. Part VI, Line 3: Notices of the Free Care program are posted at the front desk in the main lobby, in the registration areas, patient billing department, Surgical Services department, Orthopedic Department, Baileyville Clinic, and Rural Health Care Clinic. Applications are available at all of these points. Assistance in completing the applications is provided by the Patient Financial Advocate. Part VI, Line 4: We serve a rural population of approximately 14,000 (40 miles North, South and West). Part VI, Line 5: The Hospital participates in programs for community support, including health walks and local fairs and conferences. The Hospital supports economic development through participation in Chamber of Commerce, and economic development organizations. The Hospital enhances coalition building by participating in community outreach activities and working with local and regional agencies and organizations to improve access to services. The Hospital works to improve the health status in our communities by participating in blood drives, cancer, diabetic support groups, providing blood pressure screenings, flu clinics, health fairs, and wellness programming. The Hospital encourages workforce development through job shadowing, preceptorships, and mentoring programs and participating in career fairs and in area youth coaching programs.The Hospital has an open medical staff. The Board of Directors are community members from throughout the service area. X X 0 0 0 0 0 0 0 1 0 Robert Leatherman DO Physician 368111 0 0 0 35524 0 0 0 25595 0 429230 0 0 0 Peter Wilkinson DO Medical Staff Representation 332308 0 4611 0 21155 0 0 0 15558 0 373632 0 0 0 Rodney Boula CEO 249830 0 0 0 30129 0 0 0 38408 0 318367 0 0 0 Mohammad Niayesh MD Physician 291207 0 0 0 0 0 0 0 26501 0 317708 0 0 0 Nima Moghaddas DPM Physician 245350 0 0 0 0 0 0 0 43097 0 288447 0 0 0 Elizabeth Eliacin MD Physician 227605 0 0 0 4251 0 0 0 16841 0 248697 0 0 0 Part I, Line 7 Peter Wilkinson, physician, received an RVU based bonus of $4,611 during 2020. Form 990, Part VI, Section A, line 7a A Board of Trustees elects members of the Board of Directors at an annual meeting of the Board of Trustees. Form 990, Part VI, Section A, line 7b At the annual meeting of the Board of Trustees, actions of the Board of Directors during the year are acted on and ratified. Form 990, Part VI, Section B, line 11b The Board of Trustees was disbanded effective March 24, 2021 and replaced with the Plan Officer. The Plan Officer will review and approve the 990. Form 990, Part VI, Section B, line 12c An interested party has a duty to disclose an actual or possible conflict of interest to the CEO or governing body Chairperson. The governing board of directors will determine whether a conflict of interest exists. If a conflict is determined, the interested party may make a presentation to the governing body but then leave during discussion of and vote on the involved transaction. The Chairperson, if deemed appropriate, shall appoint a disinterested person to investigate alternatives. After exercising due diligence the governing body shall determine whether the hospital can obtain with reasonable efforts a more advantageous transaction that would not give rise to a conflict of interest. If a more advantageous transaction is not reasonably possible the governing board shall determine by majority vote whether the transaction is in the Hospital's best interest and whether it is fair and reasonable. Minutes of all meetings regarding the transaction will be maintained. Form 990, Part VI, Section B, line 15 The Executive Committee of the Board of Directors serves as an Executive Compensation Committee. Performance review is completed and is presented, along with comparative salary information to the Committee by the Hospital's management company. After consideration of the comparative information and performance review, the Executive Committee determines and authorizes an appropriate compensation level. Form 990, Part VI, Section C, line 19 The Hospital prepares and circulates via US Postal Service an Annual Report, which goes to every household in what is defined as the Hospital Service Area. The Annual Report is also available on the Hospital website at: http://www.calaishospital.com. Additionally, at the annual meeting of the Trustees, copies of the audited financial statements are shared with all present including representatives of the press in attendance. Other documents as appropriate would be available upon request. Form 990, Part IX, line 11g Other Fees: Program service expenses 2,096,934. Management and general expenses 77,214. Fundraising expenses 0. Total expenses 2,174,148. Purchased Services: Program service expenses 1,503,138. Management and general expenses 643,652. Fundraising expenses 0. Total expenses 2,146,790. Physician Fees: Program service expenses 1,563,504. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,563,504. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Calais Regional Hospital 24 Hospital Lane Calais, ME 04619 EIN: 01-0211783 Calais Regional Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). William & Allison Goode Memorial Trust co US Trust PO Box 830269 Dallas TX 75283 Charitable Trust ME T 42503 443514 0.62500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0