2020-11-16T15:50:54-06:00 2019-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2019-01-01 010211783 Calais Regional Hospital CALA 2074547521 24 Hospital Lane Calais ME 04619 Rodney Boula CEO 2074547521 2020-11-16 1 Joseph R Byrne P01289281 2077752387 2020-11-16 69.49.157.66 2020-11-16 15:21:53 ES P 8CB03294F4C8EEE0A7F1275F402B300CCFF6E31F 1C6A01B7255B01236D078AE06947B5C55AB1E31B 2019 2021-01-29 14:40:06Z Rodney Boula 24 Hospital Lane Calais ME 04619 30322028 0 X www.calaishospital.org X 1938 ME Critical Access Hospital 12 11 296 40 0 0 85108 29643 29778115 28783486 47566 146973 0 0 29910789 28960102 0 0 0 0 16313579 16785644 0 0 0 14152059 13258923 30465638 30044567 -554849 -1084465 20093835 20154881 24829273 25917231 -4735438 -5762350 X 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 1 2846201 3555808 Inpatient Services: Patients Admitted: 594 Acute: 399 Swing: 195 Average Stay: 3.36 days Hospitalist Care: 2,215 18672671 23328089 Outpatient Services: Emergency Room Visits: 9,297 Laboratory Procedures: 273,094 Rehab Services: 11,707 Radiology Exams: 14,600 Respiratory Care: 3,946 Cardiac Rehab Visits: 1,067 Home Health Visits: 2,473 Primary Care Visits: 17,050 Surgical and Orthopedic Visits: 2,043 1520502 1899589 Swing Bed, Cafeteria & Other Services 23039374 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 63 0 1 296 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Mark Smith 2074547521 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 Dennis Mahar Treasurer 6.00 0.00 X X 0 0 0 Michael Todd Smith Secretary 6.00 0.00 X X 0 0 0 Hebert Clark Director 4.00 0.00 X 0 0 0 Lawerence Clark Director 4.00 0.00 X 0 0 0 Linda Gralenski Director 4.00 0.00 X 0 0 0 Merritt Loring Director 4.00 0.00 X 0 0 0 Susan Rowley Director 4.00 0.00 X 0 0 0 Sussan Coley Director 4.00 0.00 X 0 0 0 Robert Leatherman DO Director/Physician 40.00 0.00 X 416392 0 30668 James Thompson Director 4.00 0.00 X 0 0 0 Mary Jane Sylvester Past Director 4.00 0.00 X 0 0 0 Rodney Boula CEO 40.00 0.00 X 270833 0 6141 Jennifer Griffey CFO 40.00 0.00 X 36198 0 7410 Diane Maheux Past CFO 40.00 0.00 X 84650 0 19214 Galen Dickenson Past CFO 40.00 0.00 X 67697 0 0 Elizabeth Eliacin Hospitalist 40.00 0.00 X 241571 0 12046 Mohammad Niayesh Physician 40.00 0.00 X 280960 0 31235 Peter Wilkinson DO Medical Staff Representation 40.00 0.00 X 357506 0 19242 Nima Moghaddas Physician 40.00 0.00 X 237170 0 32928 Jodiann Ledford Physician 40.00 0.00 X 207829 0 24143 2200806 0 183027 12 0 1 0 Blue Water Emergency Partners 14 Main Street Brunswick ME 04011 Emergency Room Physicians 1453354 NEHE-MRI LLC 18201 Von Karman Ave Irvine CA 92612 X-Ray Services 312232 CPS LLC PO Box 638316 Cincinnati OH 45263 Pharma Services 284118 Evident 6600 Wall St Mobile AL 36695 Software Services 272337 CompHealth 35 Nutmeg Dr Trumbull CT 06611 Staffing Agency 201345 14 29643 29643 Patient Services 622110 50178498 50178498 Other Revenue 622100 1626902 1569200 57702 Provision for Bad Debts 622100 -1322351 -1322351 Contractual/Char. Adj. 622100 -21699563 -21699563 28783486 142700 142700 1366199 1361926 4273 4273 4273 28960102 28725784 0 204675 X 939203 447060 492143 12052218 9531291 2520927 2894100 2268353 625747 900123 699705 200418 233885 233885 18892 18892 6128376 5489654 638722 806556 319712 486844 581149 57677 523472 47566 38041 9525 601600 496776 104824 974021 757149 216872 330431 330431 Supplies 1795983 1408351 387632 Healthcare Provider Tax 734696 734696 Repairs and Maintenance 694690 347636 347054 Miscellaneous Expenses 311078 112842 198236 30044567 23039374 7005193 0 X 70904 712431 1237027 3020232 3435378 3091674 610496 377122 265119 226437 31025068 19670434 12225300 11354634 1377971 0 871640 1372351 20093835 20154881 5253139 8141996 16547539 16082627 3028595 1692608 24829273 25917231 X -6345610 -7545824 1610172 1783474 -4735438 -5762350 20093835 20154881 -1084465 57553 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 3562 3562 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 9695747 9263920 9179396 8160462 1018934 2679784 1814225 865559 11354634 Beneficial Interest in Perpetual Trust 401011 Investments to Fund Deferred Compensation 641456 Estimated Third-Party Payor Settlements 329884 1372351 Estimated Third-Party Payor Settlements 1051152 Deferred Compensation Liability 641456 1692608 29017655 57553 57553 28960102 0 28960102 30044567 0 30044567 0 30044567 1 1 1 X 1 X 225.000000000000 1 1 1 0 1 1 847790 847790 0.02820 5034955 1000 5033955 0.16750 5882745 1000 5881745 0.19570 11050 11050 0.00040 42005 42005 0.00140 29643 29643 0.00100 82698 82698 0.00280 5965443 1000 5964443 0.19850 1 732770 11369036 11369036 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 accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to earnings and a credit to a valuation allowance based on its assessment of the current status of individual accounts. 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 collectibility of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Data for each major payor source is regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. For receivables relating to 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 Hospital records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. 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 0 0 Robert Leatherman DO Director/Physician 416392 0 0 0 0 0 0 0 30668 0 447060 0 0 0 Rodney Boula CEO 234110 0 0 0 36723 0 0 0 6141 0 276974 0 0 0 Elizabeth Eliacin Hospitalist 241571 0 0 0 0 0 0 0 12046 0 253617 0 0 0 Mohammad Niayesh Physician 280960 0 0 0 0 0 0 0 31235 0 312195 0 0 0 Peter Wilkinson DO Medical Staff Representation 342506 0 0 0 15000 0 0 0 19242 0 376748 0 0 0 Nima Moghaddas Physician 237170 0 0 0 0 0 0 0 32928 0 270098 0 0 0 Jodiann Ledford Physician 207829 0 0 0 0 0 0 0 24143 0 231972 0 0 0 Form 990, Part III, line 3 Surgery for implants were discontinued in 2019. 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 finance committee receives a copy of the 990 for review and votes to approve/disapprove. When approved, the board then accepts the recommendation from the finance committee to approve/disapprove 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 2,123,351. Management and general expenses 34,740. Fundraising expenses 0. Total expenses 2,158,091. Purchased Services: Program service expenses 1,613,881. Management and general expenses 603,982. Fundraising expenses 0. Total expenses 2,217,863. Physician Fees: Program service expenses 1,752,422. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,752,422. 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 57553 401011 0.62500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0