2020-11-13T08:46:01-06:00 2019-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2019-01-01 010212444 York Hospital YORK 2073634321 15 Hospital Drive York ME 03909 Robin LaBonte CFO 2073634321 2020-11-10 1 Nicholas E Porto P01310283 2078792100 2020-11-10 208.105.168.164 2020-11-10 09:24:44 ES P B261A341A0332E9128504FBF56C59783CA685530 DA1D1F22D002DE74304CAE64996AD19EA354FE22 2019 2021-01-29 14:40:06Z Jud Knox 15 Hospital Drive York ME 03909 218192392 0 X www.yorkhospital.com X 1904 ME Community Hospital 30 22 1521 250 3944050 0 700797 2169223 183695635 192126381 4631878 5306260 148544 97481 189176854 199699345 159045 235984 0 0 101760094 109313075 0 0 828532 84730862 90821669 186650001 200370728 2526853 -671383 132172646 128368248 52543856 52750995 79628790 75617253 Community Hospital 0 0 176435870 235984 188281074 York Hospital is a not-for-profit health care center established to provide health care services to the York county area. It offers both inpatient and outpatient acute services and has 79 licensed acute beds. The Hospital has outpatient satellite services in Wells, Kittery, Berwick, South Berwick, Sanford, and Kennebunk.York Hospital is committed to providing exceptional care to patients and their families. All efforts must be thoughtful, kind, and loving. York Hospital is dedicated to creating and nurturing a fabric of compassionate relationships among physicians, caregivers, patients, and families to offer sensitive, understandable, high-quality medical care experiences. 176435870 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 50 0 1 1521 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 30 22 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 1 0 X X Robin LaBonte CFO 2073634321 15 Hospital Drive York ME 03909 Peter Dourdoufis MD Cardiologist 40.00 0.00 X 886261 0 36746 Jeffrey Colnes MD Cardiologist 40.00 0.00 X 707663 0 28966 Richard Gray MD Radiologist 40.00 0.00 X 584226 0 36698 Jeffrey Lockhart MD Trustee/Anesthesiologist 40.00 0.00 X 540173 0 43868 Erin Kinsler MD Obstetrician 40.00 0.00 X 552421 0 23001 Jonathan Bridges MD Cardiologist 40.00 0.00 X 529444 0 25791 Jennifer Cutts MD Trustee/Radiologist 40.00 0.00 X 486093 0 35760 Jud Knox Trustee/President/Leader 40.00 0.00 X X 404932 0 96775 Nathan Jean DO Trustee/Physician 40.00 0.00 X 340938 0 35769 Robin LaBonte CFO/Leader 40.00 0.00 X 318718 0 42232 Lawrence Petrovich MD Trustee/Cardiologist 40.00 0.00 X 287390 0 28523 Erich Fogg PA-C Trustee/Physician Assistant 40.00 0.00 X 248256 0 35889 James Gilroy MD FACP Trustee/Physician 40.00 0.00 X 167414 0 28043 Meghan Brandt RN Trustee/RN 36.00 0.00 X 88627 0 13660 Douglas Bracy Trustee 1.00 0.00 X 0 0 0 Rebecca Brink Trustee 1.00 0.00 X 0 0 0 Lorraine Boston Trustee 1.00 0.00 X 0 0 0 Amy Bush Trustee (start 10/2019) 1.00 0.00 X 0 0 0 Mark Eves Trustee 1.00 0.00 X 0 0 0 Ken Fellows MD Trustee 1.00 0.00 X 0 0 0 Mark Foster Trustee 1.00 0.00 X 0 0 0 John Houlihan Trustee 1.00 0.00 X 0 0 0 Ann Lee Hussey Trustee 1.00 0.00 X 0 0 0 Connie James Trustee 1.00 0.00 X 0 0 0 Deborah Pease Trustee 1.00 0.00 X 0 0 0 Suzi Raeside Trustee 1.00 0.00 X 0 0 0 Brett Rankin MD Trustee 1.00 0.00 X 0 0 0 Gary Samia Trustee 1.00 0.00 X 0 0 0 Dianne Smallidge EdD RDH Trustee 1.00 0.00 X 0 0 0 David Speert MD Trustee 1.00 0.00 X 0 0 0 Robert Sullivan Trustee 1.00 0.00 X 0 0 0 Henry F Warner Jr Trustee 1.00 0.00 X 0 0 0 Ala Reid Trustee/Chairman (part-year) 1.00 0.00 X X 0 0 0 Wendy Cote Trustee/Vice Chair/Chair (part-year) 1.00 0.00 X X 0 0 0 Chris Kehl Trustee/Treasurer 1.00 0.00 X X 0 0 0 Daniel Morrison Trustee/Vice Treasurer 1.00 0.00 X X 0 0 0 6142556 0 511721 167 0 1 0 Medifis PO Box 5068 New York NY 10087 Locum tenums services 1670990 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Locum tenums services 1019024 Seacoast Pathology Inc PO Box 100519 Atlanta GA 30384 Contract pathology services 783842 Quest Diagnostics Inc 12436 Collection Center Drive Chicago IL 60693 Contract laboratory services 723996 CompHealth PO Box 972651 Dallas TX 753972651 Locum tenums services 659997 33 14050 70135 208593 1876445 12030 2169223 Patient services 621400 145395770 145395770 Diagnostic and reference labs 621500 38352035 37800149 551886 Pharmacies and drug stores 446110 5701115 2308951 3392164 Miscellaneous program services 621400 1638986 1638986 Cafeteria and dietary 722210 954996 954996 83479 83479 192126381 420426 420426 127655 0 127655 127655 127655 23336224 18193296 257094 5142928 -257094 4885834 4885834 41395 70135 42657 -1262 -1262 Loss on bond refinancing 522298 -28912 -28912 -28912 199699345 188281074 3944050 5304998 235984 235984 3243060 3070529 172531 85391618 77149388 7886274 355956 1187628 1078730 103613 5285 13962813 12625810 1279742 57261 5527956 5002743 502922 22291 150845 150845 139736 139736 18665 18665 16059453 12526373 3372485 160595 914206 429676 457104 27426 8977462 4521431 4280174 175857 4168 1959 2084 125 6384420 4660627 1723793 259914 122160 129957 7797 55779 26216 27890 1673 495619 495619 4388403 3061382 1314964 12057 3312821 2301702 1011119 Medical supplies/fees 27877926 27877926 Pharmacy supplies 9074780 9074780 Provision for bad debt 9027740 9027740 Healthcare provider tax 3606114 3606114 73618 15935 55474 2209 200370728 176435870 23106326 828532 874070 911429 3017725 4981436 52792 35648 23733608 23219856 4971473 5745350 1171839 1371955 136950963 87315374 50997459 49635589 37786662 33477376 2892268 3050024 6674750 5939585 132172646 128368248 16328176 17487339 7639523 10579840 6803366 6338100 21772791 18345716 52543856 52750995 X 67070415 59500541 12558375 16116712 79628790 75617253 132172646 128368248 X -671383 1081686 -4421840 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 18665 0 0 0 18665 0 Part II-B, Line 1: Part II-B, Line 1f: York Hospital partners with various like-minded trade associations which support public policies and initiatives that focus on improving health outcomes and the experience of health care, while also aiming to reduce the overall cost of receiving that care. To maintain these partnerships, the Hospital is required to pay membership dues back to these various trade associations. A portion of the dues paid to these associations has been designated as available for lobbying expenditures. Any lobbying expenditures paid by the associations are incurred in order to help track and discuss legislation affecting health care policy. The specific dues paid by York Hospital to the trade associations in 2019, as well as the portion of the dues that were available for lobbying expenditures, are detailed below: Maine Hospital Association - Total 2019 dues: $54,922 - Portion of dues available for lobbying: $8,513 American Hospital Association - Total 2019 dues: $17,108 - Portion of dues available for lobbying: $2,652 Additionally, the Hospital made a grant of $7,500 directly to the Coalition to Protect America's Healthcare, a 501(c)(4) organization that provides education and information to the broader public and to policy-makers on issues surrounding health care. The entirety of this payment is expected to be used for lobbying expenditures. 12558375 1507759 2583038 532460 16116712 13337701 247972 -474485 552813 12558375 11703343 367880 1864700 598222 13337701 11395935 269308 762506 724406 11703343 11333784 1030609 -113275 855183 11395935 0.00000 0.26250 0.73750 0 0 3904522 3904522 72493253 38467472 34025781 3331478 2791152 540326 55000632 46056750 8943882 2221078 2221078 49635589 Pension obligation 15052606 Estimated professional liability losses 3293110 18345716 X 188070803 1081686 42657 1124343 186946460 12752885 12752885 199699345 192082340 739352 739352 191342988 9027740 9027740 200370728 Part V, Line 4: Temporarily Restricted Funds are classified and sorted by the following groups and purposes: Capital Campaign Funds are to be used for operating costs related to fundraising campaigns, as well as to help cover the costs associated with the Cardiac Cath Lab Campaign. Biewend (12/82) - Funds from which the original principal and any incurred income are to be restricted for the purchase of new equipment (at Board discretion which must be approved by a family member). Biewend Funds can also be used for the acquisition of land and buildings other than an addition to the present hospital buildings. Page (1945) - Funds that are to be used for support and maintenance of district visiting nurses. Baldwin Fund for Nursing Excellence - Funds to be used to provide financial support for nurses who need to be re-certified and stay current in their health care skills. This includes support for advanced training or changing professional focus. These funds are also used to provide scolarships for support staff who are interested in entering the field of nursing, as well as to offer financial assistance to help defray the costs of ongoing orientation, classroom instruction, and clinical training of new York Hospital nurses. Lastly, this account is used to help defray the costs associated with the York Hospital's Summer Intern program for young nursing students who are currently enrolled in a nursing school. Winkler Fund - Funds that are to be used for Nursing Education. Rose F. Voignier Education Fund - Funds that are to be used for education for all with exception of physicians. Rose Voignier Education Fund - Funds to be used for staff education. Breast Cancer Living Well Fund - Funds to be used for breast cancer patients. Cancer Living Well Fund - Funds are to be used for cancer patients. Hancock Healthy Aging Fund - Funds are to be used to support programs and services that promote and benefit the physical, emotional, spiritual, and overall health and well-being of our community as they age. Womens Heart Health Fund - Funds are to be used for the support of the York Hospital Cardiology Center program "Heart Care for Women", an initiative specializing in women's heart care and diagnostics where the approach is to treat a health of women as a whole, minimizing the risk of heart disease and keeping the heart healthy. Permanently Restricted Funds are classified and sorted by the following groups and purposes: Elizabeth B. Perkins - The Perkins' Funds Principal is to remain restricted in perpetuity. The income generated from the Funds are restricted for the care of patients who are unable to pay for proper treatment. Gerrity - Princpal Gerrity Funds are to be maintained in perpetuity. 80% of income generated by the funds are considered unrestricted, to be used on general operations, while 20% is to be reinvested as Principal. Cowey - and gains generated by the Funds are to be used for pediatrics (Corpus only to be kept in tact). Forristall - Income and gains generated by the Funds are to be used for SNF (Corpus only to be kept in tact). Mason - Income and gains generated by the Funds are to be used to provide free care to patients who cannot afford to pay (Corpus only to be kept in tact). Brewster - Income and gains generated by the Funds are to be used for any form of diabetes research and care (Corpus only to be kept in tact). Rose F. Voignier Education Fund - Income and gains generated by the Funds are to be used for education for all with the exception of physicians (Corpus only to be kept in tact). Palmer/Perkins Endowment - Income and gains generated by the Funds are to be used for education for nursing education for the staff (Corpus only to be kept in tact). Sidelinger - (6/88) Income and gains generated by the Funds are to be used for general support, upkeep and maintenance of the Hospital as determined by the Board (principal only to be kept in tact). Oncology Fund - Income and gains generated by the funds are to be used for support programs for patients, their families, and their caregivers. Part X, Line 2: The Hospital is a not-for-profit corporation and is tax-exempt under Section 501(c)(3) of the Internal Revenue Code. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The Hospital has evaluated the positions taken on its filed tax returns. The Hospital has concluded no uncertain income tax positions exist at December 31, 2019. Part XI, Line 2d - Other Adjustments: Special events expenses 42,657. Part XI, Line 4b - Other Adjustments: Adjustment to long-term pension obligations 3,725,145. Provision for bad debts 9,027,740. Part XII, Line 2d - Other Adjustments: Special events expenses 42,657. Net Periodic Pension Costs 696,695. Part XII, Line 4b - Other Adjustments: Provision for bad debts 9,027,740. Hancock Gala 2019 93575 60585 32990 0 172 11913 12977 3184 3992 5K Road Race 17955 9550 8405 1050 1067 1619 150 350 6183 111530 70135 41395 1050 1239 13532 13127 3534 10175 42657 -1262 1 1 1 X 0 1 1 1 0 0 1 532 806351 806351 0.00420 1 5967 15148277 11236145 3912132 0.02040 2 6499 15954628 11236145 4718483 0.02460 829242 59338 769904 0.00400 65387989 28393413 36994576 0.19330 10562 10562 0.00010 66227793 28452751 37775042 0.19740 2 6499 82182421 39688896 42493525 0.22200 1 3911537 0 32764055 43820497 -11056442 X 1 1 1 1 York Hospital 15 Hospital Drive York ME 03909 www.yorkhospital.com 38066 X X X York Hospital 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X Please see Part V X 1 18 1 Please see Part V 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X Please see Part V X Please see Part V X Please see Part V X X X X X X X 1 X 0 X X X X X 1 0 0 York Hospital Part V, Section B, Line 3j: A shared vision of a healthy Southern York County; socio-economic characteristics by town, and a community themes and strengths assessment. York Hospital Part V, Section B, Line 5: Beginning in early 2018 and published in December of 2018, York Hospital undertook a Community Health Needs Assessment (CHNA) to identify the health needs of those living in the Hospital's entire service area. The assessment updated the one completed in December 2015. The Hospital partnered with the Choose to be Healthy Coalition (CTBH), a comprehensive community health coalition. CTBH has a membership purposefully comprised of those representing diverse community sectors such as education, law enforcement, behavioral health care, social service agencies, municipalities, and business. The advisory board provided guidance within its regular monthly meeting. Members included representation from:Superintendent of Kittery SchoolsFaith representative York Faith representative KitteryFormer school nurse, YorkSchool Health Coordinator, NobleSchool Nurse, WellsClinical Director ofSweetser Mental Health Services at York Hospital Director of York Community Services AssociationFinancial Advisor, Business Rep. Fund Development Healthcare, parentAssistant District Attorney York CountySRO South Berwick PoliceRecovery Advocate York Hospital Part V, Section B, Line 6b: York Hospital's CHNA was conducted with Choose To Be Healthy (CTBH), a community health coalition with a membership purposefully comprised of those representing diverse community sectors, such as education, health care, business, municipalities, law enforcement, and other similar community and public-service based institutions. York Hospital Part V, Section B, Line 11: Please see the attached Community Health Needs Assessment Action Plan Progress Report for details on how York Hospital is addressing the significant needs identified in its most recently conducted CHNA. York Hospital Part V, Section B, Line 13b: In addition to providing free care to patients with household income at or below 200% of the FPG, during 2019 York Hospital also offered a 30% discount to self-pay patients and a HELP Financial Assistance Program, which is provided to patients who had no insurance or who were underinsured. Any reduction of these patients' hospital bills was based on the applicable patients' household income and the amount owed the Hospital. York Hospital Part V, Section B, Line 16j: All patient billing statements list the Hospital's financial assistance program's applicable phone number and website-address, which the patient may then use to acquire more information or receive additional assistance. York Hospital Part V, Section B, Line 20e: The collection agency working for York Hospital is aware of the Hospital's financial assistance policy. Therefore, in the unlikely event that a patient eligible for financial assistance is not identified before their account is sent to outside collections, the collection agency itself has the ability to identify these patients who will be unable to pay their hospital bills, and who may also qualify for the assistance program. York Hospital will not impose extraordinary collection actions, such as wage garnishments, liens on residences, or other legal action, on any patient without first making reasonable efforts to determine whether that patient is eligible for financial assistance under the Hospital's policy. Schedule H, Part V, Section B, Line 7a York Hospital's 2018 Community Health Needs Assessment can be found on its website at the following web address:https://www.yorkhospital.com/wp-content/uploads/2019/07/York_Hospital_CHNA_Report-plan-2018-update.pdf Schedule H, Part V, Section B, Line 16a: York Hospital's Financial Assistance Policy is available on their website at the following web address: https://www.yorkhospital.com/financial-assistance-program/financial-assistance-policy/ Schedule H, Part V, Section B, Line 16b: York Hospital's FAP Application is available on their website at the following web address:https://www.yorkhospital.com/financial-assistance-program/free-medical-care/https://www.yorkhospital.com/wp-content/uploads/2020/01/FAP_2020_-01142020.pdf Schedule H, Part V, Section B, Line 16c: York Hospital's FAP Plain Language Summary is available on their website at the following web address:https://www.yorkhospital.com/financial-assistance-program/ Schedule H, Part V, Section B, Line 10: The Hospital's Implementation Plan for the 2018 CHNA is available at the following web address: https://www.yorkhospital.com/wp-content/uploads/2019/10/York-Hospital-CHNA-2018-2019-Executive-Summary-and-Plan-.pdfThe full 2018 CHNA is available at the following web address:https://www.yorkhospital.com/wp-content/uploads/2020/09/York_Hospital_CHNA_Report-plan-2018-update-.pdf Schedule H, Part V, Section B, Line 16i: 501(r) Regulations require that hospitals translate their financial assistance policy (FAP) into primary languages spoken by limited English proficient (LEP) populations in their hospital service area. Should a LEP population demographic exceed 5% of the community residents or 1,000 individuals, whichever is less, a hospital must make available translated copies of its FAP. The York Hospital website allows its users to automatically translate the language of the Hospital FAP into English, French, or Spanish, as is preferred and applicable to the user. The Hospital website allows this functionality through a Select Language drop-down box, located in the upper left-hand corner of the Hospital home-page (https://www.yorkhospital.com/); at the user's selection, the Hospital website will automatically translate into the desired language of choice. Schedule H, Part V, Section B, Line 22: Individuals who qualify under the Hospital's financial assistance policy receive a 100% write off of charges. Accordingly, no box has been checked to indicate how the Hospital determines the maximum amount that may be charged to FAP-eligible patients. 16 1 - York Hospital in Wells 112-114 Sanford Road Wells ME 04090 See Description in Part VI 2 - York Hospital Long Sands 127 Long Sands York ME 03909 See Description in Part VI 3 - York Hospital in Kittery 35 Walker Street Kittery ME 03909 See Description in Part VI 4 - York Hospital in South Berwick 57 Portland Street South Berwick ME 03908 See Description in Part VI 5 - York Hospital Neurology Associates 223 York Street York ME 03909 See Description in Part VI 6 - York Hospital in Berwick 4 Dana Drive Berwick ME 03901 See Description in Part VI 7 - York Hospital Kittery Medical Services 75 US Route 1 Kittery ME 03909 See Description in Part VI 8 - York Hospital Route 1 York 343 US Route 1 York ME 03909 See Description in Part VI 9 - York Hospital 12 Hospital Drive 12 Hospital Drive York ME 03909 See Description in Part VI 10 - Psychiatric Associates of York Hospital 32 York Street York ME 03909 See Description in Part VI 11 - York Hospital in Sanford 1474 Main Street Sanford ME 04073 See Description in Part VI 12 - York Hospital in Kennebunk 2 Independence Drive Kennebunk ME 04043 See Description in Part VI 13 - Cardiovascular Care in Newington 2064 Woodbury Avenue Suite 103 Newington NH 03801 See Description in Part VI 14 - Cardiovascular Care in Portsmouth 333 Borthwick Avenue Suite 401 Portsmouth NH 03801 See Description in Part VI 15 - York Hospital 16 Hospital Drive 16 Hospital Drive York ME 03909 See Description in Part VI 16 - Webhannett Internal Medicine 277 Post Road Moody ME 04054 See Description in Part VI Part I, Line 3c: In addition to its financial assistance program, during 2019 York Hospital offered a 30% discount to self-pay patients and a HELP Financial Assistance Program offered to patients that had no insurance or were underinsured. Reduction of their hospital bills was based on household income and the amount owed. Part I, Line 7: York Hospital has several hospital clinical services and hospital-owned physician practices. Per instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practice that the Hospital subsidizes (i.e., operates at a loss) in the completing of Schedule H. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operate at a loss (i.e., are subsidized by the Hospital) and the associated costs of these practices:a. Endocrinology Practiceb. Adult House Callc. Kittery Family Practice d. Emergency Room (the Hospital has ER facilities located at the main hospital campus and also in Wells)e. Home Health Agencyf. Kennebunk Walk-Ing. OB/GYN Practice h. Wells Walk-Ini. Rheumatology Practicej. Neurology Practicek. Psychiatry Practicel. Urology Practicem. Berwick Walk-Inn. Pulmonary Practiceo. Great Works Family Practicep. Family Medicine in Wellsq. York Family Practicer. Webhannet Internal Medicine Practices. Pediatric Practicet. York Walk-Inu. Surgical Associatesv. Cardiovascular Practicew. Kittery Walk-Inx. Sanford Walk-Iny. Wells Primary Carez. Center for Older Adultsaa. York Hospital Recovery CenterThe above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $36.99 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $36.99 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.Form 990, Schedule H instructions/guidance contains a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part 1, Line 7 were the following:a. Schedule H Worksheet 6, Subsidized Health Services (the supporting worksheet for Part I, Line 7g), the Hospital did not utilize Worksheet 2 when calculating the percentage used when determining the profit/loss of each hospital clinical service and hospital-owned physician practice. Instead, when compiling the subsidized hospital clinical services and hospital-owned physician practices listed in 1c above, the Hospital utilized the actual estimated costs on the modified Medicare cost report instead of applying the Worksheet 2 cost to charge percentage. b. Schedule H Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs (the supporting schedule for Part I, Lines 7b and 7c), and Worksheet 6, Medicaid Allowable Costs for Subsidized Health Services, listed in line 1c above (which is part of the line 7g costs). The Hospital did not utilize the Worksheet 2 percentage when calculating the Medicaid allowable cost. Instead, the Hospital utilized the actual Medicaid filed cost report for the allowable costs. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 9,027,740. Part II, Community Building Activities: While the Hospital does not explicitly report cost and revenue reports related to Community Building Activities on its Schedule H, Part II, the Hospital does engage in various activities that improve the community's health and safety. For example, the Hospital offers numerous scholarships and financial assistance programs to staff and students, to lessen the burden of higher education and to increase the total number of train and qualified professional health care providers in the area. The Hospital also offers transportation services within its operating area to help patients get to and from their medical appointments or to deliver prescription medications; without the Hospital's intervention, many of these patients would not be able to access health care services. Additionally, York Hospital collaborates with many local social service agencies to design and deliver year-round programs to meet the basic needs of the Hospital's community, and to promote stronger physical, emotional, spiritual, and financial health. These are just a few of the many ways in which the Hospital is engaging with its community to promote health, safety, and general well-being. Part III, Line 2: The Hospital utilized Worksheet 2 from the IRS Schedule H instructions/guidance to determine the ratio of patient care cost to charge (43.33% for fiscal year 2019) and multiplied this ratio by the Hospital's total bad debt expense of $9,027,740 to determine the Part II, Line 2 bad debt expense of $3,911,537. Part III, Line 3: Patients who qualify for financial assistance have 100% of their liability written off, so no portion of it is included in the Hospital's bad debt expense. Part III, Line 4: See Footnote 2 on page 10 of the attached audited financial statements. Part III, Line 8: Form 990, Schedule H instructions/guidance contains a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part III, Line 8 was Schedule H, Worksheet B, Line 2 & 6, Medicare Allowable Costs and Payments Related to Subsidized Health Services. The Hospital utilized the Medicare cost report estimated cost and payment for these services. The Hospital believes that its hospital clinical services, hospital-owned physician practices, emergency room, and home health agency listed above should be considered a community benefit, as community members benefit by having easy access to these services, facilities, and programs which are both offered and subsidized. These facilities and programs are offered and thus subsidized through the Hospital. Part III, Line 9b: Accounts with self-pay balances that show no evidence of patient payments or eligibility for financial assistance that have completed a patient dunning cycle (120 days approximately) may be transferred to a collection agency. Any patient account that has applied for any of York Hospital's financial assistance programs and supplied all required documentation will be held in a pending status until a determination is made. Part VI, Line 2: York Hospital has focused on four goals identified in its Community Health Needs Assessment: 1. Mental Health2. Substance Use and Misuse3. Healthy Aging4. Food InsecurityYork Hospital has posted the most current CHNA, Implementation Plan, and Implementation Plan Progress Report for the following CHNA goals at the following address: https://www.yorkhospital.com/990-chna/The Hospital's most recent CHNA identifies a number of core objectivies as part of its overall community assistance goals, which are detailed below.Mental Health:- Increase access to mental health services and improve collaboration between service providers, especially in helping youth and young adults.- Build capacity of York Hospital staff to understand mental health and increase ability to provide support for each other and patients.- Build capacity of families and professionals to understand mental health and increase ability to provide support and access services.- Help reduce stigma through regular training and public awareness campaigns.Substance Use and Misuse:- Increase capacity to provide medication assisted treatment through the YH Recovery Center.- Provide intervention, treatment, and recovery services to adolescents.- Support the Choose To Be Healthy Coalition (CTBH) in preventing youth substance use disorders with evidence based strategies. - Introduce community based recovery supports.- Provide regular community education.Healthy Aging:- Improve access to health care and social services for older populations,especially those affected by isolation and financial stress.- Provide opportunities for pro-social and healthy multi-generationalactivities.- Increase access to healthy meals for elderly and homebound populations.- Provide regular community education to our aging population, focused on topics of interest surrounding health and well-being.Food Insecurity:- Increase access to healthy meals for elderly and homebound populations.- Increase access to healthy foods for families, especially those at living with a higher risk for poor nutrition. Part VI, Line 3: The patients' billing statement lists the phone number and website address to use for more information regarding the Financial Assistance Program. The York Hospital financial assistance guidelines are posted at patient registration areas. Additionally, information regarding financial assistance is available on the Hospital's website. Part VI, Line 4: York Hospital's primary service area includes the following communities in Southern York County Maine: Berwick, Eliot, Kittery, North Berwick, Ogunquit, South Berwick, Wells, Sanford, Kennebunk and York. Additionally, the Hospital's secondary service area includes includes the following communities: Lebanon, Maine, and Portsmouth, Dover, Rollinsford, and Somersworth, New Hampshire.Approximately 5% of York Hospital patients utilize Medicaid and approximately 51% of York Hospital patients utilize Medicare. According to the United States Census Bureau, in 2019, 9.0% of York County Residents lived in poverty (http://www.census.gov/). Part VI, Line 5: The board of trustees is made up of members from all communities served by York Hospital. All medical staff are eligible to participate if they meet privileging criteria. All hospital profits are reinvested in the facilities, equipment and services for the communities. Part VI, Line 6: Not Applicable Schedule H, Part V, Section D: Non-Hospital Facility Services Offered:1. York Hospital in Wells: Urgent Care, Walk-In Clinic, Lab, Imaging, Cardiology, Breast Care, Wound Care, Physical Therapy, Oncology, OB/GYN practice, Pediatric Associates, Cardiovascular Practice, Primary Care.2. York Hospital @ Long Sands: Family Practice, Physical Therapy, Oncology, Home Care, Cardiovascular Care.3. York Hospital in Kittery: Family Practice, Walk-In Clinic, Lab, Imaging, OB/GYN Practice.4. York Hospital in South Berwick: Family Practice, Imaging, Physical Therapy, OB/GYN Practice.5. York Hospital Neurology Associates: Neurology6. York Hospital in Berwick: Walk-In Clinic, Retail Pharmacy, Imaging, Lab.7. York Hospital Kittery Medical Services: Oncology, Physical Therapy.8. York Hospital @ Route 1 York: Walk-In Clinic, Lab, Imaging, Pediatric Rehab.9. York Hospital @ 12 Hospital Drive: Internal Medicine, Cardiovascular, Urology, Diabetes, Endocrinology. 10. Psychiatric Associates of York Hospital: Psychiatric Care.11. York Hospital in Sanford: Walk-In Clinic, Lab, Imaging, Family Practice.12. York Hospital in Kennebunk: Walk-In Clinic, Lab, Imaging. 13. Cardiovascular Care in Newington: Cardiovascular Care.14. Cardiovascular Care in Portsmouth: Cardiovascular Care.15. York Hospital at 16 Hospital Drive: Surgery Associates, Pediatric Associates, Pulmonary Associates, OB/GYN Practice, Rheumatology Associates. 16. Webhannett Internal Medicine: Internal Medicine. 1 Continuing Education/Seminars and Workshops 149 40234 New Graduate Nursing Orientation 8 125000 Health Stream Online Learning Library 1000 20931 Service behaviors training 730 49819 Part I, Line 2: The scholarship funds are monitored by the Education Committee, which manages the funds in accordance with the donor's wishes. The committee does this by determining what the spending policy is at the beginning of the year by fund category. Some funds are restricted to nursing education, others to non-nursing education. The funds can be used for those who want to attend workshops or seminars or to further their education through a post-secondary accredited school. Funds are also used for orientation programs. Requests for funding must be made through a formal process. Each person requesting funds must prepare an application which must be approved by a director or leader. The form is then submitted to the Education Committee for review and approval. All amounts are also tracked and reviewed in accounting to ensure that the monies are used in accordance with the donor's wishes. Annually, the Director of Development reports fund activity directly to donors that request it. X 0 1 X X X 0 1 0 0 0 0 0 1 0 Peter Dourdoufis MD Cardiologist 494205 0 392056 0 0 0 6244 0 30502 0 923007 0 0 0 Jeffrey Colnes MD Cardiologist 472813 0 234850 0 0 0 12500 0 16466 0 736629 0 0 0 Richard Gray MD Radiologist 420141 0 164085 0 0 0 6250 0 30448 0 620924 0 0 0 Jeffrey Lockhart MD Trustee/Anesthesiologist 540173 0 0 0 0 0 12500 0 31368 0 584041 0 0 0 Erin Kinsler MD Obstetrician 412789 0 139632 0 0 0 5506 0 17495 0 575422 0 0 0 Jonathan Bridges MD Cardiologist 462479 0 66965 0 0 0 12459 0 13332 0 555235 0 0 0 Jennifer Cutts MD Trustee/Radiologist 464318 0 21775 0 0 0 4747 0 31013 0 521853 0 0 0 Jud Knox Trustee/President/Leader 404932 0 0 0 0 0 66058 0 30717 0 501707 0 0 0 Nathan Jean DO Trustee/Physician 262009 0 78929 0 0 0 6845 0 28924 0 376707 0 0 0 Robin LaBonte CFO/Leader 318718 0 0 0 0 0 12054 0 30178 0 360950 0 0 0 Lawrence Petrovich MD Trustee/Cardiologist 194618 0 92772 0 0 0 5818 0 22705 0 315913 0 0 0 Erich Fogg PA-C Trustee/Physician Assistant 237055 0 11201 0 0 0 7508 0 28381 0 284145 0 0 0 James Gilroy MD FACP Trustee/Physician 150166 0 17248 0 0 0 4690 0 23353 0 195457 0 0 0 Part I, Line 1a Minimal rotary dues for president. Part I, Line 4b Jud Knox, President, has a SERP Defined Benefit plan. Contributions and the increase in actuarial value during 2019 was $53,558 and is included in Schedule J, Part II, Column C. The total obligation of the Hospital under this agreement was $2,972,680 December 31, 2019. The obligation is included in long-term pension and other obligations on the balance sheet and amounts funded for the plan are included in investments. Part I, Line 7 Performance-based variable compensation which is subject to review annually. A MHHEFA 010314384 560425UT5 2004-12-09 42196950 CT scanner, nuclear me, radiology, MAMMO unit 0 0 0 B MHHEFA 010314384 560525Z78 2008-06-19 48451841 Imaging equipment 0 0 0 C MHHEFA 010314384 5604253L2 2008-12-03 41658395 Surgery center addition 0 0 0 D MHHEFA 010314384 560427GE0 2009-12-10 93040181 New CT and other equipment 0 0 0 A 1774675 1941005 135325 31950 1773730 2005 0 0 1 1 B 1707209 1707209 162330 42816 1474018 28044 2008 0 0 1 1 C 2885240 2788576 341545 46861 2400170 2010 0 0 1 1 D 1745000 1827960 194925 29377 1603658 2010 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0 0 0 A 0 1 0 0 0 0 1 FSA 24.000000000000 1 0 0 B 0 0 0 1 0 0 1 GEFCM 28.000000000000 1 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 Date Rebate Computation Performed Issuer Name: MHHEFA Date the Rebate Computation was Performed: 06/19/2013 Form 990, Schedule K, Part III, Line 9, IV, Line 7, and Part V: Although formal, written policies are not in place to ensure that violations are timely identified and corrected, the bonds issuer, Maine Health & Higher Educational Facilities Authority (MHHEFA), monitors Section 148 requirements for York Hospital until funds are spent down enough to ensure none of the Hospital's tax exempt bonds become arbitrage bonds. Bond proceeds are placed in low yield investments and no funds are released to York Hospital until expenses have been incurred and receipts are provided to MHHEFA. Furthermore, the Hospital works closely with MHHEFA to ensure that safeguards are in place to take appropriate and timely remedial action should any violations of federal tax requirements occur. A MHHEFA 010314384 560427JA5 2010-06-24 113477369 Refinance 1993, 1998, 1999A & 2001D 0 0 0 B MHHEFA 010314384 56042RLG5 2017-06-27 5004813 Refinance 2007A 0 0 0 C MHHEFA 010314384 56042RTR3 2019-07-31 54640000 Refinance 2008C, 2008D, 2009A, 2010A, and 2017A bonds 0 0 0 D MHHEFA 010314384 56042RUP5 2019-11-06 36415000 Imaging and surgical equipment; compounding and cath lab renovation 0 0 0 A 2600000 6081252 607056 5418358 55838 2010 1 1 1 1 B 565000 5908558 483431 5360081 65045 2017 1 1 1 1 C 3119187 542055 2542023 35110 2019 1 1 1 1 D 4338016 291650 55176 3991190 2019 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 0 A 0 Form 990, Part VI, Section B, line 11b The Hospital's Form 990 is prepared with the assistance of an independent public accounting firm and thoroughly reviewed by the Hospital's finance staff before it is filed. The 990 is distributed to the Board of Trustees for their review after it is filed. Form 990, Part VI, Section B, line 12c Annually the Board of Trustees and the officers sign a conflict of interest form. Form 990, Part VI, Section B, line 15 The executive committee of the Board of Trustees utilizes an outside firm's database of CEO salaries to determine the CEO's compensation. The CEO determines the compensation of other officers or key employees using an outside firm's data to make sure the compensation is market based. Form 990, Part VI, Section C, line 19 The Hospital's governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part VI, Section A, Line 16b: While York Hospital does not have a formal joint venture policy that is written, it does have procedures in place to ensure that hospital-related assets are not misappropriated which includes periodic review of any joint venture related activity. Furthermore, the Hospital's joint venture arrangements better enable it to provide health-care related services to the community it serves. Form 990, Part XI, line 9: Adjustment to long-term pension obligations -3,725,145. Net periodic pension cost -696,695. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. York Health Services 15 Hospital Drive York ME 03909 020469065 Heart health ME 501(c)(3) Line 10 N/A 0 Shields Imaging at York Hospital 700 Congress Street Suite 204 Quincy MA 02169 815066570 Imaging ME York Hospital Related 81297 86768 0 1 0.50000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Shields Imaging at York Hospital LLC R 75000 Actual per books