MILLINOCKET REGIONAL HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- MILLINOCKET REGIONAL HOSPITAL (EIN 01-0223482)
- Tax period
- 2018-07-01 to 2019-06-30
- Filed
- 2020-05-11
- IRS object ID
- 202041329349302409
- Schema version
- 2018v3.1
- 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 K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-05-11T15:55:50-05:00 | ReturnTs |
| Tax Period End | 2019-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E 10TH ST STE 500 | AddressLine1Txt |
| City | SIOUX FALLS | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 571046375 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010223482 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLINOCKET REGIONAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MILL | BusinessNameControlTxt |
| Phone | 2077235161 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOMERSET STREET | AddressLine1Txt |
| City | MILLINOCKET | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04462 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MELLISSA MCAVOY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2077235161 | PhoneNum |
| Signature | 2020-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAURIE HANSON | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2020-05-11 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.130.171.59 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-05-11 | IPDt |
| IP Tm | 11:28:24 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C5ADF3E96DC5FD5E5884512D59AB882B10EDFEC1 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | F7BA031C655DF5D2BE7843B8A6CBF62E51E7FB61 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-04-17 16:48:07Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT PETERSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOMERSET STREET | AddressLine1Txt |
| City | MILLINOCKET | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04462 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $34,675,134 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MRHME.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1952 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | CRITICAL ACCESS HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 281 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $457,490 | PYContributionsGrantsAmt |
| CY Contributions Grants | $170,808 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $30,556,088 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $31,620,797 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,020,041 | PYInvestmentIncomeAmt |
| CY Investment Income | $535,202 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $32,033,619 | PYTotalRevenueAmt |
| CY Total Revenue | $32,326,807 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,147 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,515 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,649,844 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,866,542 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,987,458 | PYOtherExpensesAmt |
| CY Other Expenses | $14,850,010 | CYOtherExpensesAmt |
| PY Total Expenses | $36,638,449 | PYTotalExpensesAmt |
| CY Total Expenses | $33,718,067 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,604,830 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,391,260 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,070,674 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,058,805 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,633,411 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,408,235 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,437,263 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,650,570 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ACCESS TO EXCELLENCE IN HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,570,105 | ExpenseAmt |
| Grant | $1,515 | GrantAmt |
| Revenue | $31,620,797 | RevenueAmt |
| Desc | 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 FEATURE HIGHLY SKILLED STAFF AND INCLUDE DIAGNOSTIC IMAGING, CARDIOPULMONOLOGY, LABORATORY, REHABILITATION, AND WELLNESS. MRH FEATURES A STRONG, COHESIVE MEDICAL STAFF CONSISTING OF FAMILY PRACTICE, INTERNAL MEDICINE, GENERAL SURGERY, GASTROENTEROLOGY, ORTHOPEDICS, EARS NOSE & THROAT, UROLOGY, PODIATRY, CARDIOLOGY, ONCOLOGY, OPHTHALMOLOGY, PODIATRY, PULMONOLOGY, RADIOLOGY, AND UROLOGY.DURING THIS REPORTING PERIOD, MRH CARED FOR:INPATIENTS - 884CLINIC PATIENTS - 26,199EMERGENCY ROOM PATIENTS - 5,941IN ADDITION, MRH PROVIDED:SURGICAL SERVICES - 1,250LABORATORY SERVICES - 86,524RADIOLOGY SERVICES - 11,044THERAPY SERVICES (PHYSICAL, SPEECH, AND OCCUPATIONAL) - 13,787 | Desc |
| Total Program Service Expenses | $29,570,105 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 38 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 281 | 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 |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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 | MELLISSA MCAVOY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2077235161 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOMERSET STREET | AddressLine1Txt |
| City | MILLINOCKET | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04462 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| MELLISSA MCAVOY EDWARDS | |||||||
| BOARD PRESIDENT/CFO | 29.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THOMAS MALCOLM | |||||||
| PAST PRES, BOARD SEC/TRES | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LEE LAMSON | |||||||
| BOARD VICE PRESIDENT | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANIEL HERBERT MD | |||||||
| DIRECTOR, CMO, INTERNIST | 40.00 | Yes (X) | $325,759 | $0 | $5,616 | ||
| JOYCE GIVEN | |||||||
| DIRECTOR, HOSP. AUXILIARY PRESIDENT | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| HERBERT CLARK | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| GAIL FANJOY | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| PATRICK E HUNT ESQ | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| FRED LEWIS | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| TINA JAMO | |||||||
| DIRECTOR UNTIL 08/2018 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT PETERSON | |||||||
| CEO | 50.00 | Yes (X) | $251,693 | $0 | $2,152 | ||
| CATHERINE LEMAY | |||||||
| CFO UNTIL 09/2018 | 40.00 | Yes (X) | $134,365 | $0 | $1,887 | ||
| JOHN GLUSCIC | |||||||
| PHYSICIAN | 40.00 | $593,351 | $0 | $28,200 | Yes (X) | ||
| KWAKU OWUSU-ABROKWA MD | |||||||
| HOSPITALIST | 40.00 | $249,846 | $0 | $2,307 | Yes (X) | ||
| MARK KOWALSKI | |||||||
| SURGEON | 40.00 | $510,424 | $0 | $29,940 | Yes (X) | ||
| MUHAMMAD RAUF MD | |||||||
| SURGEON | 40.00 | $273,408 | $0 | $24,092 | Yes (X) | ||
| EDWARD DUNSTAN | |||||||
| PHYSICIAN | 40.00 | $273,067 | $0 | $5,592 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,611,913 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $99,786 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 32 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| JIL A BEAUPAIN DPM | |||||
| PO BOX 130 | SHERMAN | ME | 04776 | PODIATRY | $280,100 |
| VISION CARE OF MAINE | |||||
| 1 RIDGEWOOD DRIVE | BANGOR | ME | 04401 | OPHTHALMOLOGIST | $228,858 |
| DAHL CHASE DIAGNOSTIC SERVICES | |||||
| 417 STATE STREET | BANGOR | ME | 04401 | DIAGNOSTIC SERVICES | $206,653 |
| MAHAVIR SHRIDHARANI MD EA CP | |||||
| 58 WEST 58TH STREET | NEW YORK | NY | 10019 | HOSPITALIST | $189,000 |
| QUEST DIAGNOSTICS | |||||
| PO BOX 844226 | BOSTON | MA | 02284 | DIAGNOSTIC SERVICES | $173,146 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $170,808 | AllOtherContributionsAmt |
| Total Contributions | $170,808 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $30,885,479 | $30,885,479 |
| OTHER SUPPORTING REVENUE | 621400 | $827,930 | $827,930 |
| INVESTMENT IN SUBSIDIARY | 621400 | -$92,612 | -$92,612 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $31,620,797 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $64,068 | TotalRevenueColumnAmt |
| Exclusion | $64,068 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,811,936 | SecuritiesAmt |
| Other | $7,525 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,348,327 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $463,609 | SecuritiesAmt |
| Other | $7,525 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $471,134 | TotalRevenueColumnAmt |
| Exclusion | $471,134 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,326,807 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $31,620,797 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $535,202 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,515 | TotalAmt |
| Program Services | $1,515 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $656,619 | TotalAmt |
| Program Services | $181,917 | ProgramServicesAmt |
| Management And General | $474,702 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,318,294 | TotalAmt |
| Program Services | $13,415,556 | ProgramServicesAmt |
| Management And General | $902,738 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $292,276 | TotalAmt |
| Program Services | $273,745 | ProgramServicesAmt |
| Management And General | $18,531 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,636,149 | TotalAmt |
| Program Services | $2,428,049 | ProgramServicesAmt |
| Management And General | $208,100 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $963,204 | TotalAmt |
| Program Services | $876,904 | ProgramServicesAmt |
| Management And General | $86,300 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,661 | TotalAmt |
| Management And General | $38,661 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,968 | TotalAmt |
| Management And General | $57,968 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,098 | TotalAmt |
| Management And General | $6,098 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,784,902 | TotalAmt |
| Program Services | $3,310,416 | ProgramServicesAmt |
| Management And General | $1,474,486 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,577 | TotalAmt |
| Program Services | $1,287 | ProgramServicesAmt |
| Management And General | $12,290 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $503,086 | TotalAmt |
| Program Services | $473,942 | ProgramServicesAmt |
| Management And General | $29,144 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,965 | TotalAmt |
| Program Services | $4,965 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $630,421 | TotalAmt |
| Program Services | $605,898 | ProgramServicesAmt |
| Management And General | $24,523 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,408 | TotalAmt |
| Program Services | $8,225 | ProgramServicesAmt |
| Management And General | $4,183 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,491 | TotalAmt |
| Program Services | $84,354 | ProgramServicesAmt |
| Management And General | $15,137 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,533 | TotalAmt |
| Management And General | $149,533 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $550,157 | TotalAmt |
| Program Services | $550,157 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415,843 | TotalAmt |
| Management And General | $415,843 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $4,218,086 | $4,180,139 | $37,947 |
| BAD DEBT EXPENSE | $2,378,489 | $2,378,489 | |
| MEDICAID TAX ASSESSMENT | $573,162 | $573,162 | |
| DUES AND SUBSCRIPTIONS | $132,567 | $42,402 | $90,165 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $280,596 | TotalAmt |
| Program Services | $178,983 | ProgramServicesAmt |
| Management And General | $101,613 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,718,067 | TotalAmt |
| Program Services | $29,570,105 | ProgramServicesAmt |
| Management And General | $4,147,962 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $772,641 | BOYAmt |
| EOY | $735,281 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,957,599 | BOYAmt |
| EOY | $3,242,012 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600,159 | BOYAmt |
| EOY | $608,014 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $256,637 | BOYAmt |
| EOY | $315,200 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,218,579 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,638,761 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,877,863 | BOYAmt |
| EOY | $4,579,818 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,091,846 | BOYAmt |
| EOY | $3,790,597 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,303,570 | BOYAmt |
| EOY | $1,238,958 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,626 | BOYAmt |
| EOY | $7,018 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,733 | BOYAmt |
| EOY | $541,907 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,070,674 | BOYAmt |
| EOY | $15,058,805 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,749,089 | BOYAmt |
| EOY | $5,065,395 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $727,004 | BOYAmt |
| EOY | $594,683 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,125,835 | BOYAmt |
| EOY | $2,998,669 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,031,483 | BOYAmt |
| EOY | $1,749,488 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,633,411 | BOYAmt |
| EOY | $10,408,235 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,027,002 | BOYAmt |
| EOY | $4,253,214 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $405,261 | BOYAmt |
| EOY | $392,311 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
| EOY | $5,045 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,437,263 | BOYAmt |
| EOY | $4,650,570 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,070,674 | BOYAmt |
| EOY | $15,058,805 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,391,260 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$395,433 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 | $6,098 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,098 | 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 | THE ORGANIZATION PAYS DUES TO THE MAINE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE ATTRIBUTABLE TO LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $49,951 | OtherCostOrOtherBasisAmt |
| Book Value | $49,951 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,403,117 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,693,434 | DepreciationAmt |
| Book Value | $2,709,683 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $725,068 | OtherCostOrOtherBasisAmt |
| Depreciation | $656,417 | DepreciationAmt |
| Book Value | $68,651 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,943,796 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,288,910 | DepreciationAmt |
| Book Value | $1,654,886 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $96,647 | OtherCostOrOtherBasisAmt |
| Book Value | $96,647 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,579,818 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (3 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INVESTMENT IN SUBSIDARY | $1,129,935 | F |
| INVESTMENT IN KATAHDIN SHARED SERVICES, INC. | $90,566 | F |
| INVESTMENT IN MAINE RURAL HEALTH COLLABORATIVE, LLC | $18,457 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,238,958 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION LIABILITY | $1,392,292 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $357,196 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,749,488 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | 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 |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| 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 | $439,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $439,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,819,193 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,624,228 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $194,965 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00620 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,258,193 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,624,228 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $633,965 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02020 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $526,917 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $176,594 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $350,323 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $526,917 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $176,594 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $350,323 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,785,110 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,800,822 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $984,288 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03140 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,378,489 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,955,253 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,096,623 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$141,370 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | MILLINOCKET REGIONAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOMERSET STREET | AddressLine1Txt |
| City | MILLINOCKET | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04462 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MRHME.ORG | WebsiteAddressTxt |
| State License | 38579 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLINOCKET REGIONAL 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 |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| 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 7D | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE 7D | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE 10A | 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 | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 | SEE PART V | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| 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 Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MILLINOCKET REGIONAL HOSPITAL | PART V, SECTION B, LINE 5: THE MAINE SHARED COMMUNITY HEALTH NEEDS ASSESSMENT (MAINE SHARED 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, MAINEGENERAL HEALTH, MAINEHEALTH, AND NORTHERN LIGHT HEALTH. |
| MILLINOCKET REGIONAL HOSPITAL | PART V, SECTION B, LINE 6B: MAINE CENTER FOR DISEASE CONTROL AND PREVENTION, AN OFFICE OF THE MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES. |
| MILLINOCKET REGIONAL HOSPITAL | PART V, SECTION B, LINE 7D: COMMUNITY HEALTH NEED ASSESSMENT REPORT:PART V, SECTION B, LINE 7AHTTP://WWW.MRHME.ORG/WP-CONTENT/UPLOADS/2015/03/CHNA-PENOBSCOT-COUNTY-REPORT.PDFPART V, SECTION B, LINE 7BHTTPS://WWW.PENQUIS.ORG/WP-CONTENT/UPLOADS/2019/09/2019PENQUISCOMMUNITYNEEDSASSESSMENT.PDFPART V, SECTION B, LINE 10A:MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY:HTTP://WWW.MRHME.ORG/WP-CONTENT/UPLOADS/2020/04/MRH-STRATEGIC-PLAN-FISCAL-2020-21-.PDF |
| MILLINOCKET REGIONAL HOSPITAL | PART V, SECTION B, LINE 11: CONTINUE TO MEET THE CHANGING NEEDS OF OUR COMMUNITY. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PRIORITY AREAS ARE: MENTAL HEALTH, SOCIAL DETERMINANTS OF HEALTH (SDOH), ACCESS TO CARE, AND SUBSTANCE USE. THE WAY MRH IS WORKING TO MEET THESE MAJOR AREAS OF CONCERN ARE: MENTAL HEALTH -PARTNER WITH PROVIDERS WHO OFFER MH SERVICES IN OUR COMMUNITIES AND DEVELOP WORKING RELATIONSHIP 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 HEALTHMAINTAIN USE OF FOOD INSECURITY SCREENING TOOL IN THE ED, 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 MAINER'S FEEDING MAINER'S 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 CAREDETERMINE 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 EFFORTS (THE GRANT FUNDED PUBLIC HEALTH ARM OF MRH) 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 ED AND DETERMINE IF FURTHER SITE DISTRIBUTION IS WARRANTED. -RESEARCH THE FEASIBILITY OF INITIATING AND PROVIDING MEDICATION ASSISTIVE THERAPY AT OUR HOSPITAL AND /OR IN PARTNERSHIP WITH AN FQHC. ADDITIONAL NEEDS FOR HEALTH ORGANIZATION IDENTIFIED INCLUDE GROWTH AND INNOVATION AND FINANCIAL STABILITY:GROWTH & INNOVATION-INVEST IN TECHNOLOGY BY A TWO-YEAR BUDGET REQUIREMENTS FOR UPGRADED TECHNOLOGY. -CONTINUE TO FURTHER STREAMLINE PROCESSES .-DECREASE # 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 FINANCIAL ASSISTANCE. APPLICATIONS ARE AVAILABLE AT THE REGISTRATION DESK. |
| MILLINOCKET REGIONAL HOSPITAL | PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. |
| PART V, LINE 7, COMMUNITY HEALTH NEEDS ASSESSMENT | DESCRIPTION OF FAILURETYPE OF FAILURE: 501(R)(3) THE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT WAS NOT APPROVED BY THE BOARD OF DIRECTORS PRIOR TO JUNE 30, 2019. THE HOSPITAL DID NOT POST ITS 2019 CHNA REPORT TO THEIR WEBSITE ON OR BEFORE JUNE 30, 2019. THE CHNA REPORT IS A COMBINED REPORT FOR PENQUIS DISTRICT, MAINE, AND WAS AVAILABLE ON THE FOLLOWING WEBSITE AS OF JUNE 30, 2019: HTTPS://WWW.PENQUIS.ORG/WP-CONTENT/UPLOADS/2019/09/2019PENQUISCOMMUNITYNEEDSASSESSMENT.PDFCAUSE OF THE FAILURE: THE HOSPITAL WAS FOLLOWING THE TIMELINE ESTABLISHED BY THE MAINE SHARED COMMUNITY HEALTH NEEDS ASSESSMENT, A COLLABORATION BETWEEN THE MAINE CDC, CENTRAL MAINE HEALTHCARE, NORTHERN LIGHT HEALTH, MAINE GENERAL HEALTH, AND MAINE HEALTH. THIS TIMELINE CALLED FOR BOARD APPROVAL OF CHNA'S BY ALL PARTICIPANTS BY DECEMBER 31, 2019. THE HOSPITAL WAS UNCLEAR THAT BOARD APPROVAL WAS TO ALSO COINCIDE WITH THE END OF THE HOSPITAL'S FISCAL YEAR. BOARD APPROVAL WAS SECURED PRIOR TO DECEMBER 31, 2019. FACILITY OR FACILITIES WHERE THE FAILURE OCCURRED: THE FAILURE OCCURRED AT MILLINOCKET REGIONAL HOSPITAL.THE DATE(S) OF THE FAILURE AND ITS DISCOVERY: JUNE 30, 2019 AND DECEMBER 3, 2019DESCRIPTION OF THE CORRECTION OF THE FAILUREMETHOD OF CORRECTION: THE COMMUNITY HEALTH NEEDS ASSESSMENT HAS BEEN APPROVED BY THE BOARD OF DIRECTORS AND MADE AVAILABLE ON THE WEBSITE.DATE OF CORRECTION: FOLLOWING BOARD APPROVAL IN DECEMBER 2019, THE CHNA WAS POSTED TO THE HOSPITAL'S WEBSITE IN JANUARY 2020. DESCRIPTION OF THE PRACTICES OR PROCEDURES PUT INTO PLACETHE COMMUNITY HEALTH NEEDS ASSESSMENT WAS POSTED ON THE WEBSITE AT: HTTP://WWW.MRHME.ORG/WP-CONTENT/UPLOADS/2015/03/CHNA-PENOBSCOT-COUNTY-REPORT.PDF |
| PART V, LINE 11, IMPLEMENTATION STRATEGY | DESCRIPTION OF FAILURETYPE OF FAILURE: 501(R)(3) - THE HOSPITAL DID NOT ADOPT ITS IMPLEMENTATION STRATEGY BY THE 15TH DAY OF THE FIFTH MONTH FOLLOWING YEAREND. THE HOSPITAL FAILED TO POST ITS 2019 IMPLEMENTATION STRATEGY TO THEIR WEBSITE ON OR BEFORE NOVEMBER 15, 2019.CAUSE OF THE FAILURE: AS STATED, THE HOSPITAL WAS MISTAKENLY WORKING OFF THE DECEMBER 31, 2019 DEADLINE. THE IMPLEMENTATION PLAN WAS APPROVED BY THE BOARD AND POSTED SHORTLY THEREAFTER. FACILITY OR FACILITIES WHERE THE FAILURE OCCURRED: THE FAILURE OCCURRED AT MILLINOCKET REGIONAL HOSPITAL.THE DATE(S) OF THE FAILURE AND ITS DISCOVERY: NOVEMBER 15, 2019 AND DECEMBER 3, 2019DESCRIPTION OF THE CORRECTION OF THE FAILUREMETHOD OF CORRECTION: THE IMPLEMENTATION STRATEGY WAS ADOPTED AND APPROVED BY THE BOARD. THE COMMUNITY HEALTH NEEDS ASSESSMENT HAS BEEN MADE AVAILABLE ON THE WEBSITE.DATE OF CORRECTION: DECEMBER 30, 2019 AND APRIL 3, 2020, RESPECTIVELYDESCRIPTION OF THE PRACTICES OR PROCEDURES PUT INTO PLACETHE IMPLEMENTATION STRATEGY WAS POSTED ON THE WEBSITE AT: HTTP://WWW.MRHME.ORG/WP-CONTENT/UPLOADS/2020/04/MRH-STRATEGIC-PLAN-FISCAL-2020-21-.PDF |
| PART V, LINE 16 A-C | THE FAP WAS WIDELY AVAILABLE ON A WEBSITE:HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/THE FAP APPLICATION FORM WAS WIDELY AVAILABLE ON A WEBSITE:HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE ON A WEBSITE:HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/ |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO FPG, THE ORGANIZATION 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 EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7B AND LINE 7G WERE DETERMINED USING THE MEDICAID AND MEDICARE COST REPORTS, RESPECTIVELY. |
| PART I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATIONS WAS $2,378,489. |
| 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: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES CAN BE FOUND ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2019.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 7500 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DANIEL HERBERT MD | ||||||||||||||
| DIRECTOR, CMO, INTERNIST | $285,659 | $0 | $0 | $0 | $40,100 | $0 | $0 | $0 | $5,616 | $0 | $331,375 | $0 | $0 | $0 |
| ROBERT PETERSON | ||||||||||||||
| CEO | $235,347 | $0 | $0 | $0 | $16,346 | $0 | $0 | $0 | $2,152 | $0 | $253,845 | $0 | $0 | $0 |
| JOHN GLUSCIC | ||||||||||||||
| PHYSICIAN | $593,351 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $20,350 | $0 | $621,951 | $0 | $0 | $0 |
| KWAKU OWUSU-ABROKWA MD | ||||||||||||||
| HOSPITALIST | $242,692 | $0 | $7,154 | $0 | $0 | $0 | $0 | $0 | $2,307 | $0 | $252,153 | $0 | $0 | $0 |
| MARK KOWALSKI | ||||||||||||||
| SURGEON | $508,429 | $0 | $0 | $0 | $1,995 | $0 | $8,250 | $0 | $22,090 | $0 | $540,764 | $0 | $0 | $0 |
| MUHAMMAD RAUF MD | ||||||||||||||
| SURGEON | $263,061 | $0 | $10,347 | $0 | $0 | $0 | $18,500 | $0 | $5,592 | $0 | $297,500 | $0 | $0 | $0 |
| EDWARD DUNSTAN | ||||||||||||||
| PHYSICIAN | $234,409 | $0 | $0 | $0 | $38,658 | $0 | $0 | $0 | $5,592 | $0 | $278,659 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAINE HEALTH AND HIGHER EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 010314384 | BondIssuerEIN |
| CUSIP | 560427WV4 | CUSIPNum |
| Bond Issued | 2013-05-23 | BondIssuedDt |
| Issue Price | $1,423,837 | IssuePriceAmt |
| Purpose | REFINANCING OF 2003 D BOND ISSUE | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | Yes (1) | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $890,762 | RetiredAmt |
| Total Proceeds | $1,423,837 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $15,439 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $1,408,398 | OtherSpentProceedsAmt |
| Substantial Completion | 2013 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | ISSUER NAME: MAINE HEALTH AND HIGHER EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/25/2018 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| ROSE ANN HUNT PA | |||
| FAMILY MEMBER OF PATRICK HUNT, MEMBER OF BOD | $133,030 | EMPLOYMENT | 0 |
| LAURIE VICKERS-HERBERT RN | |||
| FAMILY MEMBER OF DANIEL HERBERT | $88,943 | EMPLOYMENT | 0 |
| CYNTHIA MORNEAULT | |||
| FAMILY MEMBER OF JOYCE GIVEN, MEMBER OF BOD | $60,678 | EMPLOYMENT | 0 |
| LAURIE JAMO | |||
| FAMILY MEMBER OF TINA JAMO, MEMBER OF BOD | $114,611 | EMPLOYMENT | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT OF THE BOARD AS AN EX OFFICIO MEMBER AND CHAIRMAN, AND TWO OR MORE ADDITIONAL TRUSTEES. THE PRESIDENT SHALL BE ENTITLED TO VOTE AS A MEMBER OF THE EXECUTIVE COMMITTEE. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. IN PARTICULAR, THE EXECUTIVE COMMITTEE SHALL NOT HAVE AUTHORITY TO AMEND THE ARTICLES OF INCORPORATION, ADOPT A PLAN OF MERGER OR CONSOLIDATION, RECOMMEND TO THE TRUSTEES THE SALE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION OTHER THAN IN THE USUAL COURSE OF BUSINESS, RECOMMEND TO THE TRUSTEES VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOCATION OF SUCH DISSOLUTION, OR AMEND THE BYLAWS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL CONTRACTED WITH CALCULATIONS, INC. TO PROVIDE CFO SERVICES. CALCULATIONS, INC. WAS PAID $39,100 DURING THE FISCAL YEAR FOR SERVICES PROVIDED BY MELISSA MCAVOY. THE CONTRACT PROVIDES FOR 24 HOURS OF WORK PER WEEK PERFORMING CFO DUTIES. |
| FORM 990, PART VI, SECTION B, LINE 11B | PRIOR TO THE DOCUMENT'S FILING, THE ORGANIZATION'S FINANCE DEPARTMENT REVIEWS THE INITIAL DRAFT. AFTER ANY NECESSARY CHANGES, 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 DIRECTORS 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 VII | THE BOARD OF DIRECTORS HAS CONTRACTED WITH CALCULATIONS, INC., MELISSA MCAVOY'S COMPANY, FOR CFO SERVICES. MELISSA IS ALSO PRESIDENT OF THE BOARD, AND RECUSES HERSELF FROM VOTING ON ALL MATTERS THAT MAY BE A CONFLICT OF INTEREST. CALCULATIONS, INC. IS NOT COMPENSATED FOR MELISSA'S TIME SERVED ON THE BOARD AS PRESIDENT. |
| FORM 990, PART IX, LINE 11G | OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 35,660. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,660. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,697,279. MANAGEMENT AND GENERAL EXPENSES 1,469,511. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,166,790. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 390,789. MANAGEMENT AND GENERAL EXPENSES 4,975. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 395,764. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,186,688. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,186,688. |
| FORM 990,PART XII, LINE 2C | THE FINANCE COMMITTEE RECOMMENDS AND THE BOARD OF TRUSTEES SELECTS THE INDEPENDENT ACCOUNTANT FOR THE AUDIT. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIRST MILLINOCKET REGIONAL INVESTMENT CO | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOMERSET ST | AddressLine1Txt |
| City | MILLINOCKET | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04462 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010396196 | EIN |
| Primary Activities | PHYSICIAN PROGRAM OPERATIONS | PrimaryActivitiesTxt |
| Legal Domicile State | ME | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLINOCKET REGIONAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $121,745 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,101,385 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIRST MILLINOCKET REGIONAL INVESTMENT CO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | K | TransactionTypeTxt |
| Involved | $116,880 | InvolvedAmt |
| Method Of Amount Determination | COST | MethodOfAmountDeterminationTxt |