2019-11-04T13:57:59-06:00 2018-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2018-01-01 010212444 York Hospital YORK 2073634321 15 Hospital Drive York ME 03909 Robin LaBonte CFO 2073634321 2019-10-30 1 Nicholas E Porto P01310283 2078792100 2019-10-30 208.105.168.164 2019-10-30 16:15:27 ED P 3452BD8595D9AC820B41F271E29CE8BF50AD3EDC 86AD5A998A217BD7885303F5109AB5202568ED7D 2018 2020-03-31 21:24:44Z Jud Knox 15 Hospital Drive York ME 03909 206888362 0 X www.yorkhospital.com X 1904 ME Community Hospital 29 21 1521 249 3298579 0 1598645 700797 175260130 183695635 2742244 4631878 146246 148544 179747265 189176854 159407 159045 0 0 99563066 101760094 0 0 552009 79221499 84730862 178943972 186650001 803293 2526853 143822446 132172646 58354955 52543856 85467491 79628790 Community Hospital 0 0 165985578 159045 180536179 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. 165985578 1 1 0 1 0 0 0 0 0 1 1 0 0 1 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 58 0 1 1521 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 29 21 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 1 1 0 X X Robin LaBonte CFO 2073634321 15 Hospital Drive York ME 03909 Douglas Bracy Trustee 1.00 X 0 0 0 Meghan Brandt RN Trustee/RN 36.00 X 85755 0 17515 Rebecca Brink Trustee (start 9/18) 1.00 X 0 0 0 Lorraine Boston Trustee 1.00 X 0 0 0 Jennifer Cutts MD Trustee/Chief Medical Officer 40.00 X 531557 0 41985 Mark Eves Trustee (start 9/18) 1.00 X 0 0 0 Ken Fellows MD Trustee 1.00 X 0 0 0 Erich Fogg PA-C Trustee/Physician Assistan 40.00 X 212813 0 47172 Mark Foster Trustee 1.00 X 0 0 0 James Gilroy MD FACP Trustee/Physician 40.00 X 174327 0 47308 John Houlihan Trustee 1.00 X 0 0 0 Ann Lee Hussey Trustee 1.00 X 0 0 0 Connie James Trustee 1.00 X 0 0 0 Nathan Jean DO Trustee/Physician (start 7/18) 40.00 X 265481 0 53195 Jeffrey Lockhart MD Trustee/Anesthesiologist 40.00 X 542435 0 62023 Michael O'Keefe Trustee (end 8/18) 1.00 X 0 0 0 Deborah Pease Trustee 1.00 X 0 0 0 Lawrence Petrovich MD Trustee/Cardiologist 40.00 X 440808 0 57364 Suzi Raeside Trustee 1.00 X 0 0 0 Brett Rankin MD Trustee 1.00 X 0 0 0 Gary Samia Trustee 1.00 X 0 0 0 Dianne Smallidge EdD RDH Trustee (start 9/18) 1.00 X 0 0 0 David Speert MD Trustee 1.00 X 0 0 0 Robert Sullivan Trustee (start 9/18) 1.00 X 0 0 0 Henry F Warner Jr Trustee 1.00 X 0 0 0 Jud Knox Trustee/President/Leader 40.00 X X 405516 0 181406 Ala Reid Trustee/Chairman 1.00 X X 0 0 0 Wendy Cote Trustee/Vice Chairman 1.00 X X 0 0 0 Chris Kehl Trustee/Treasurer 1.00 X X 0 0 0 Daniel Morrison Trustee/Vice Treasurer 1.00 X X 0 0 0 Robin LaBonte CFO/Leader 40.00 X 317986 0 61534 Peter Dourdoufis MD Cardiologist 40.00 X 870896 0 52478 Jeffrey Colnes MD Cardiologist 40.00 X 788922 0 62879 John Fani Srour MD Cardiologist 40.00 X 664726 0 44497 Paul Chesis MD Radiologist 40.00 X 629432 0 39364 Jonathan Bridges MD Radiologist 40.00 X 571357 0 33175 6502011 0 801895 140 0 1 0 Medifis PO Box 5068 New York NY 10087 Locum Tenums Services 1420435 Quest Diagnostics Inc 12436 Collection Center Drive Chicago IL 60693 Contract Laboratory Services 1097073 Seacoast Pathology Inc PO Box 100519 Atlanta GA 30384 Contract Pathology Services 786364 CPSI PO Box 850309 Mobile AL 36685 Collection Services 515273 Sports Medicine Atlantic Orthopedics 1900 LaFayette Road Suite F Portsmouth NH 03801 Orthopedic Physician Coverage 495000 26 12500 48313 165365 474619 10348 700797 Patient Services 621400 141018647 141018647 Lab 621500 34538369 34373589 164780 Pharmacy 446110 5683263 2549464 3133799 Miscellaneous Program Services 621400 1730964 1730964 Cafeteria 722210 643927 643927 80465 80465 183695635 486269 486269 139123 0 139123 139123 139123 21798777 2000 17645340 9828 4153437 -7828 4145609 4145609 64761 48313 55940 8821 8821 1000 400 600 600 189176854 180536179 3298579 4641299 4400 4400 154645 154645 3546396 3352892 193504 80087487 73308632 6564303 214552 1159288 1075982 79825 3481 11754035 10762308 960382 31345 5212888 4778384 421039 13465 124876 124876 123265 49306 73959 14706 14706 13647490 9553243 4094247 675689 641904 27028 6757 8190031 5298637 2756387 135007 5703 5133 570 6038320 4226824 1811496 259446 246474 10378 2594 49700 42245 7455 599274 599274 4891674 3533933 1338655 19086 1750870 716540 1034330 Medical Supplies/Fees 26928284 26928284 Provision for bad debt 9416903 9416903 Pharmacy Supplies 8492841 8492841 Healthcare provider tax 3396068 3396068 125722 125722 186650001 165985578 20112414 552009 604770 874070 2269539 3017725 131855 52792 22024268 23733608 4568888 4971473 1090335 1171839 134949765 83952306 53288517 50997459 43462400 37786662 5426738 2892268 10955136 6674750 143822446 132172646 15375434 16328176 8795478 7639523 7359177 6803366 26824866 21772791 58354955 52543856 X 72129790 67070415 9573340 9001785 3764361 3556590 85467491 79628790 143822446 132172646 X 2526853 -7090816 -1274738 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 14706 0 0 0 14706 0 Part II-B, Line 1: In its 2018 tax year, York Hospital paid dues and membership fees to various professional organizations. A portion of these payments are determined to be available for lobbying expenditures. The Hospital paid dues to the Maine Hospital Association totaling $53,845, of which $10,931 was available for lobbying. The Hospital also paid dues to the American Hospital Association totaling $16,610, of which $3,775 was available for lobbying. 13337701 247972 -474485 0 552813 0 12558375 11703343 367880 1864700 598222 13337701 11395935 269308 762506 724406 11703343 11333784 1030609 -113275 855183 11395935 10896475 601780 170465 334936 11333784 0.00000 0.28320 0.71680 0 0 3904522 3904522 72358845 36566244 35792601 3310233 2657627 652606 53665173 44728435 8936738 1710992 1710992 50997459 Medical Malpractice Insurance Recoveries Receivable 6060011 Other Receivables 614739 6674750 Assets Held on Behalf of 3rd Party 1015209 Pension Obligation 13144118 Estimated 3rd-Party Payor Settlements 977936 Estimated Professional Liability Losses 6635528 21772791 X 182115869 -7090816 56340 -7034476 189150345 26509 26509 189176854 187954570 1304569 1304569 186650001 0 186650001 Part V, Line 4: Temporarily Restricted Funds: Biewend (12/82) - Principal and income restricted for purchase of new equipment (at Board discretion after consultation with certain members of the family) and the acquisition of land and buildings other than an addition to the present hospital buildings. Page (1945) - To be used for support and maintenance of district visiting nurses. Palmer/Perkins Nursing Scholarship - See Permanently Restricted Funds section for description. Baldwin Fund for Nursing Excellence - Financial support for nurses who need to be re-certified and current in their health care skills, including advanced training or change of focus. Scholarships for support staff who are interested in entering the field of nursing. Financial assistance to help defray the costs of ongoing orientation, classroom instruction and clinical training of new York Hospital nurses. 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 to be used for Nursing Education. 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 to be used for cancer patients. Hancock Healthy Aging Fund - Funds to be used for support of 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 to be used for the support of the York Hospital cardiology center, Heart Care for Women, specializing in women's heart care and diagnostics where the approach is to treat health of women as a whole, minimizing the risk of heart disease and keeping the heart healthy. Permanently Restricted Funds: Elizabeth B. Perkins - Principal to remain in perpetuity, the income for the care of patients who are unable to pay for proper treatment. The intent of the donor is that appreciation on the fund (realized and unrealized) will remain with the donated principal. Gerrity - 80% of income is unrestricted. 20% is to be reinvested as principal. The intent of the donor is that appreciation on the fund (realized and unrealized) will remain with the donated principal. Cowey - Income and gains to be used for pediatrics (corpus only to be kept intact). Forristall - To be used for SNF (corpus only to be kept intact). Mason - To be used for free work provided to patients who cannot afford to pay (corpus only to be kept intact). Brewster - Income and gains to be used for any form of diabetes research and care (corpus only to be kept intact). Palmer/Perkins Endowment - Principal to be kept intact and the income to be used for nursing education for the staff. Sidelinger - (6/88) Principal to be kept intact and the income to be used for general purposes of the support, upkeep and maintenance of the hospital as determined by the Board. Oncology Fund - Income to be used for support programs for patients, their families and caregivers. Capital gains are to stay intact. York Health Foundation - Principal and income to be reinvested. These funds are held for a third party, York Health Foundation. York Health Foundation may make contributions to the Hospital and when this is done the funds are transferred from this fund into the respective York funds (all others above) as deemed adequate depending on restriction, if any. 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 position taken on its filed tax returns. The Hospital has concluded no uncertain income tax positions exist at December 31, 2018. The Hospital's tax years from 2015 through 2018 are open and subject to examination. Part XI, Line 2d - Other Adjustments: Special events expenses 56,340. Part XI, Line 4b - Other Adjustments: Adjustment to Long-Term Pension Obligations 26,509. Part XII, Line 2d - Other Adjustments: Special events expenses 56,340. Net Periodic Pension Costs 1,248,229. Hancock Gala 2016 72198 27963 44235 0 140 19169 500 1000 3384 Golf Tournament 21130 10350 10780 0 5594 9171 5800 0 0 1 19746 10000 9746 1025 3442 1619 276 250 4570 113074 48313 64761 1025 9176 29959 6576 1250 7954 55940 8821 1 1 1 X 0 1 1 1 0 0 1 759 1698541 1698541 0.00960 1 5174 11822039 10917115 904924 0.00510 2 5933 13520580 10917115 2603465 0.01470 470377 27672 442705 0.00250 60523099 27548864 32974235 0.18600 4404 4404 0.00000 60997880 27576536 33421344 0.18850 2 5933 74518460 38493651 36024809 0.20320 1 4031744 31227640 42778793 -11551153 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 15 1 0 1 1 X Please see Part V X 1 15 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: Between October and December 2015, 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 June 2013. 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:Faith CommunityHigh School Nurse (York)Parent (York) with degree in Community HealthMiddle & High School Parent (SAD 60)Behavioral Health CounselorHigh School Nurse (Wells) & ParentOut-patient Clinical Care representativeYork Hospital Community Health Patient-Centered Medical Home DevelopmentPhD in Public HealthDirector of York Community Action Services & Town of York General Assistance ProgramYork Hospital RepresentativeEliot community member 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, etc. 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 2018 York Hospital also offered a 25% 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. York Hospital Part V, Section B, Line 16j: The patients' billing statement lists the phone number and website address to use for more information regarding the Financial Assistance Program. York Hospital Part V, Section B, Line 20e: In the unlikely event that a patient eligible for financial assistance may not have been identified before being sent to outside collections the collection agency working for York Hospital is aware of our financial assistance policy so that they may also identify these accounts with the inability to pay. York Hospital will not impose extraordinary collections actions such as wage garnishments, liens on residences, or other legal action for any patient without first making reasonable efforts to determine whether that patient is eligible for financial assistance under this policy. Schedule H, Part V, Section B, Line 7a York Hospital's 2015 Community Health Needs Assessment can be found on its website at:https://3in582vhz3idyvmvbcxnd14u-wpengine.netdna-ssl.com/wp-content/uploads/York_Hospital_CHNA_Report_2015-1.pdf Schedule H, Part V, Section B, Line 16a: York Hospital's Financial Assistance Policy is available on their website at: 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:www.yorkhospital.com/financial-assistance-program/free-medical-care/ Schedule H, Part V, Section B, Line 16c: York Hospital's FAP Plain Language Summary is available on their website at:https://www.yorkhospital.com/financial-assistance-program/ Schedule H, Part V, Section B, Line 10: The Hospital's Implementation Plan is included on pages 33-36 of the 2015 CHNA, available here: https://3in582vhz3idyvmvbcxnd14u-wpengine.netdna-ssl.com/wp-content/uploads/York_Hospital_CHNA_Report_2015.pdfThe 2018 Implementation Plan Progress Report can also be found here: https://www.yorkhospital.com/wp-content/uploads/2019/07/YH-CHNA-Implementation-Plan-Progress-Report-2018-1.pdfhttps://3in582vhz3idyvmvbcxnd14u-wpengine.netdna-ssl.com/wp-content/uploads/2019/10/York-Hospital-CHNA-2018-2019-Executive-Summary-and-Plan-.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 hospital provides for the tranlsation of its FAP into French and Spanish. This translation is performed via the ability of the user to select on the https://www.yorkhospital.com/ website (in the upper lefthand corner) to select the applicable language translation. 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 2018 York Hospital offered a 25% 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. Berwick Walk-In Clinicc. 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. Recovery Centerg. OB/GYN Practice h. Wells Walk-Ini. Rheumatology Practicej. Neurology Practicek. Psychiatry Practicel. Urology Practicem. Physical Therapy Practicen. 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. Internal Medicine, York Practicey. Sanford Walk-Inz. Kennebunk Walk-Inaa. Adult House CallThe 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 $32.97 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $32.97 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 $ 9,413,903. Part II, Community Building Activities: Not Applicable 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 (42.81% for fiscal year 2018) and multiplied this ratio by the Hospital's total bad debt expense of $9,416,903 to determine the Part II, Line 2 bad debt expense of $4,031,744. 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 three goals identified in its Community Health Needs Assessment: lowering the % of overweight and obese community members in the service area by the end of 2018, decrease the number of opiate poisoning (ED Visits) per 100,000 population by 25% by December 2019, and reduce the number of York Hospital Primary Care Practice patients who are current smokers by 5% by December 2019.York 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/Obesity Goal:- Continue to offer a healthy weight management program at least 5 times per year. - Develop an evaluation plan that tracks participants at 6 months, one year after participation.- Support the expansion of the Eastern Trail through towns of Wells, North Berwick, South Berwick, Eliot, and Kittery.- Sponsor a series of six "Walk with the Doc" community walks with York Hospital Family Practice physicians, on local land trust properties. Opiate Poisoning Goal- Expand outpatient addiction treatment services to include Medication Assisted Treatment including buprenorphine and naltrexone.- Expand obstetrical services to include Medication Assisted Treatment (buprenorphine) for pregnant women who abuse opiates.- Enact a responsible opioid prescribing policy throughout the York Hospital system including physician practices, emergency department, and impatient care.- Continue to implement Student Intervention and Reintegration (SIRP) in partnership with area high schools and Sweetser, Inc. at least quarterly.- Partner with Choose to Be Healthy Coalition to support youth substance abuse prevention activities. This will include in-kind support for the Drug Free Communities grant such as rent, bookkeeping, and HR department support, etc.Tobacco Usage Goal:- Work with the Center for Tobacco Independence to allow for electronic referrals of patients who smoke directly to CTI from our EMRs.- Implement EMR changes to help support the use of brief interventions and referrals for tobacco users.- Promote resources on Choose To Be Healthy Coalition and hospital websites.- Promote tobacco addiction treatment resources on Choose To Be Healthy Coalition and hospital websites.- Make Tobacco Helpline materials available in all York Hospital physician offices. 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. The Hospital's secondary service area includes: 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 2018, 7.8% 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, Surgery 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, Oncology.4. York Hospital in South Berwick: Family Practice, Imaging, Physical Therapy, Surgery.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, 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 771 24645 New Graduate Nursing Orientation 5 80000 Health Stream Online Learning Library 900 50000 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 Jennifer Cutts MD Trustee/Chief Medical Officer 484175 0 47382 0 0 0 1077 0 40908 0 573542 0 0 0 Erich Fogg PA-C Trustee/Physician Assistan 206847 0 5966 0 0 0 6473 0 40699 0 259985 0 0 0 James Gilroy MD FACP Trustee/Physician 174327 0 0 0 0 0 5534 0 41774 0 221635 0 0 0 Nathan Jean DO Trustee/Physician (start 7/18) 180253 0 85228 0 0 0 6099 0 47096 0 318676 0 0 0 Jeffrey Lockhart MD Trustee/Anesthesiologist 542435 0 0 0 0 0 12250 0 49773 0 604458 0 0 0 Lawrence Petrovich MD Trustee/Cardiologist 327472 0 113336 0 0 0 10172 0 47192 0 498172 0 0 0 Jud Knox Trustee/President/Leader 405516 0 0 0 0 0 132250 0 49156 0 586922 0 0 0 Robin LaBonte CFO/Leader 317986 0 0 0 0 0 11860 0 49674 0 379520 0 0 0 Peter Dourdoufis MD Cardiologist 582182 0 288714 0 0 0 6125 0 46353 0 923374 0 0 0 Jeffrey Colnes MD Cardiologist 581557 0 207365 0 0 0 12250 0 50629 0 851801 0 0 0 John Fani Srour MD Cardiologist 484423 0 180303 0 0 0 2760 0 41737 0 709223 0 0 0 Paul Chesis MD Radiologist 393937 0 235495 0 0 0 0 0 39364 0 668796 0 0 0 Jonathan Bridges MD Radiologist 498848 0 72509 0 0 0 9250 0 23925 0 604532 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 2018 was $120,000 and is included in Schedule J, Part II, Column C. The total obligation of the Hospital under this agreement was $2,919,122 December 31, 2018. 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 1735000 1941005 135325 31950 1773730 2005 0 0 1 1 B 1098102 1707209 162330 42816 1474018 28044 2008 0 0 1 1 C 955000 2788576 341545 46861 2400170 2010 0 0 1 1 D 1220000 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 0.00000 0.00000 0.00000 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 A 2385000 4001877 607056 5418358 55838 2010 1 1 1 1 B 285000 5004813 483431 5360081 65045 2017 1 1 1 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 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 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 -26,509. Net Periodic Pension Cost -1,248,229. 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 52225 81320 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 125000 Actual per books