2018-08-15T11:17:01-05:00 2017-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2016-10-01 010234189 Northern Maine Medical Center NORT 2078343155 194 East Main Street Fort Kent ME 04743 Cindy Daigle CFO 2078343155 2018-08-15 1 Barbara J McGuan CPA P00219457 2077752387 2018-08-15 2016 2022-09-23 18:48:47Z Peter J Sirois 194 East Main Street Fort Kent ME 04743 60461138 0 X www.nmmc.org X 1948 ME Acute care & long term care hospital and mental health services facility. 11 9 580 32 0 0 298263 96692 49235240 59221682 89801 126499 134971 309494 49758275 59754367 30000 0 0 0 30882899 33146288 0 0 0 18356796 18338345 49269695 51484633 488580 8269734 45106826 49674896 17928818 14220016 27178008 35454880 The mission of Northern Maine Medical Center is to provide, coordinate, or support access to high quality, affordable health care and to positively impact our communities' quality of life by improving health status. 0 0 46574715 59221682 Medical care & ancillary services, nursing home & skilled services, physician services. 46574715 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 163 0 1 580 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Cindy Daigle 2078343155 194 East Main Street Fort Kent ME 04743 John Ezzy Chair/Past President 2.00 1.00 X X 0 0 0 Mark Morneault Vice-Chair/Past Vice-President 1.00 0.50 X X 0 0 0 David Desjardins Director/Past Treasurer 1.00 0.50 X X 0 0 0 James Thibodeau Director/Past Secretary 1.00 0.50 X X 0 0 0 Robert Bellefleur Director 1.00 0.50 X 0 0 0 Ronald Daigle Director 1.00 0.50 X 0 0 0 Norman Fournier Director 1.00 0.50 X 0 0 0 Donald Guimond Director 1.00 0.50 X 0 0 0 Erin Soucy Director 1.00 0.50 X 0 0 0 Michael Sullivan MD Director 50.00 0.50 X 277357 0 29389 Dan Vaillancourt Director 1.00 0.50 X 0 0 0 Peter J Sirois CEO/President 50.00 1.00 X 287454 0 28788 Cindy L Daigle CFO/Treasurer 50.00 1.00 X 176594 0 25113 Alain Bois COO/Secretary 50.00 1.00 X 141007 0 14706 Baharak Bagheri MD Radiologist 50.00 X 532820 0 17303 John Hallberg MD Orthopedic Surgeon 50.00 X 509259 0 26760 James Harris MD Physician 50.00 X 508093 0 22386 Mark Overton MD Psychiatrist 50.00 X 490275 0 16485 Erik St Pierre ER Physician 50.00 X 674013 0 18621 3596872 0 199551 45 0 1 0 Medhost of Tennessee Inc 2739 Momentum Place Chicago IL 60689 Software & Support Services 526786 Cary Medical Center 163 Van Buren Rd Suite 1 Caribou ME 04736 Off-Site Laboratory Services 365928 Quest Diagnostics 12436 Collections Center Drive Chicago IL 60693 Off-Site Laboratory Services 286745 Pines Health Services 74 Access Highway Caribou ME 04736 Physician Services 265729 Joseph Chemtob 2401 E 7th Street Brooklyn NY 11223 Physician Services 162390 14 96692 96692 Patient Service Revenue 623000 86101456 86101456 Miscellaneous Revenue 623000 2614842 2457148 157694 Meaningful Use Revenue 623000 191654 191654 Provision for Bad Debt 623000 -1782272 -1782272 Contractual/Char. Adj. 623000 -27903998 -27903998 59221682 129239 129239 65886 0 65886 65886 65886 673495 500 673901 2834 -406 -2334 -2740 -2740 67844 30036 37808 37808 Insurance Captive 900099 205800 205800 205800 59754367 59269788 0 387887 980408 306746 673662 27191085 24471976 2719109 383652 345287 38365 2850240 2565216 285024 1740903 1566813 174090 25354 22819 2535 55536 49982 5554 10281 10281 1441079 1296971 144108 50226 45203 5023 1997444 1797700 199744 2219839 1997855 221984 76749 69074 7675 332604 299344 33260 2677369 2409632 267737 1145489 1030940 114549 Medical Supplies 7177732 7177732 Health Care Provider Ta 1009141 1009141 Dues & Subscriptions 72180 64962 7218 Valley Medical Associat 47322 47322 51484633 46574715 4909918 0 X 25722 270285 9096327 14492248 6097339 6551035 751903 796540 366304 409027 49386311 30142378 19797236 19243933 2700589 2578345 6271406 5333483 45106826 49674896 4155168 4406982 8554102 7938012 5219548 1875022 17928818 14220016 X 26724435 34974068 453573 480812 27178008 35454880 45106826 49674896 8269734 7138 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8908 8908 0 Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which is attributable to lobbying expenses. 145224 145224 28338371 11663711 16674660 19447909 17844882 1603027 1454807 633785 821022 19243933 Deferred Compensation 1095056 Cash Surrender Value of Life Insurance 353295 Interest in Synernet Reinsurance 1149000 Estimated Third-Party Payor Settlements 2232675 Due from Related Parties 503457 5333483 Deferred Compensation 1095056 Estimated Third-Party Payor Settlements 779966 1875022 X Part X, Line 2: The Medical Center and VMA are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Medical Center's tax positions and concluded the Medical Center has maintained its tax-exempt status, does not have any significant unrelated business income and has taken no uncertain tax positions that require adjustment or disclosure in the consolidated financial statements. 2017 Cancer Fund Tour 29232 29232 1080 270 270 1168 Annual Auction 38612 38612 250 12677 4756 6965 450 2150 67844 67844 250 13757 5026 7235 450 3318 30036 37808 1 1 X 1 X 1 X 0 1 0 1 1 407164 407164 0.00790 3439463 2557185 882278 0.01710 3846627 2557185 1289442 0.02500 23412229 19698364 3713865 0.07210 23412229 19698364 3713865 0.07210 27258856 22255549 5003307 0.09710 1 995206 18313714 19655780 -1342066 X 1 1 2 1 Northern Maine Medical Center 194 East Main Street Fort Kent ME 04743 www.nmmc.org 38377 X X X 2 Forest Hill 20 Bolduc Avenue Fort Kent ME 04743 X Licensed Hospital Related Facility Northern Maine Medical Center 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X www.nmmc.org X 1 14 1 www.nmmc.org 0 1 X 150.000000000000 200.000000000000 1 1 X X X 1 X http://www.nmmc.org/billing/ X http://www.nmmc.org/billing/ X http://www.nmmc.org/billing/ X X X X X 1 X 0 X X X 1 X 0 0 Northern Maine Medical Center Part V, Section B, Line 3j: Northern Maine Medical Center (NMMC) is located in Fort Kent, Maine (Aroostook County). Aroostook County is considered rural by the State of Maine and the United States Census Bureau. The hospital service area is primarily the St. John Valley. The following towns make up the St. John Valley region: Allagash, Eagle Lake, Fort Kent, Fort Kent Mills, Frenchville, Grand Isle, Madawaska, St. Agatha, St. David, St. Francis, Sinclair, Wallagrass, Winterville Plt., Van Buren and several surrounding towns and unorganized territories. In 2009, the percentage of Fort Kent residents with income below the poverty level was 36.4%. The percentage of children below the poverty level was 36.7% in 2009. The percentage of the population aged 65 and over was 18% in Aroostook County. The unemployment rate in Aroostook County was 9.3% in 2011, which was higher than the State's rate of 7.8%. Of the individuals 25 years or older in Aroostook County, 23% do not have a high school diploma compared to 15% overall in the State.Northern Maine Medical Center utilizes an electronic medical record system and its related physician practices abstract data for reporting to the ACO they are now a part of, which provides a vast amount of data relative to patients in care. The needs assessment provides a much broader picture of the community as a whole, including the health status of individuals not in care, as well as functional health status and social demographics (such as employment, income and education levels). The local units of the State's public health infrastructure (known as "Healthy Maine Partnerships") are also integrated into the process so that their data relative to health, environmental and social measures are part of the community dissemination process.Northern Maine Medical Center distributed the EMHS Qualitative Stakeholder survey link to their employees, volunteers, board members, donors, and other stakeholders. In the Fort Kent service area, key collaborators going forward will include: Northern Maine Medical Center and its owned physician practices, Cary Medical Center, The Aroostook Medical Center, Fish River Rural Health Center, local schools, Aroostook Home Health Services/Valley Home Health Services, Aroostook Mental Health Center, UMFK, and Twin Rivers.EMHS, the primary tertiary center utilized by Northern Maine Medical Center, routinely conducts a community health needs assessment (hereafter referred to simply as "needs assessment") across the service area of all of its member hospitals. The most recent assessment, published in 2014, was developed by EMHS to support their member organizations and community partners in their work to develop strategies that will improve the health of the people they all serve. The report's findings were analyzed and compiled by representatives of Hart Consulting, Inc. The report relates findings from three data sources: The Qualitative Stakeholder Survey conducted by EMHS with its stakeholders (June 2014), the University of Wisconsin Population Health Institute's County Health Rankings (2014), and OneMaine Health's Community Health Needs Assessment (2011). Northern Maine Medical Center Part V, Section B, Line 5: The 2014 Community Health Needs Assessment was developed by the Eastern Maine Health System (EMHS) to support member organizations and community partners' work to develop strategies that will improve the health of the people we serve. The consultants who developed the survey tool worked with individuals from a broad spectrum of backgrounds as follows: the Maine Center for Disease Control and Prevention, the District Public Health Liaisons, Federally Qualified Health Centers, Bangor Public Health and Community Services, Portland Public Health, and others who provided generous support and insights.Target audience was anyone with a vested interest in public health and healthcare including medical staff, community board members, volunteers, donors and members of the general public. The online survey was distributed as a website link via email across the eight participating Maine Counties (Aroostook, Cumberland, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington) by 17 partnering Maine Hospitals, 5 local Public Health Districts and 11 Healthy Maine Partnerships.On January 7, 2016, the Northern Aroostook Community Engagement Forum was held jointly with the area Public Health District Coordinating Council. A total of 33 individuals participated in the session. The following sectors were represented at the public forum:- Healthy Aroostook- Northern Maine Medical Center- Public Health Nursing- Aroostook Mental Health Services- Wabanaki Public Health- Town of Madawaska- UMFK Student- Power of Prevention- Fish River Rural Health - Maine Quality Counts- U. Maine Cooperative Extension- Visiting Nurses of Aroostook- Town of Fort Kent- The Aroostook Medical Center- Fiddlehead Focus News- Maine CDC- Pines Health Services- University of Maine at Fort Kent- Northern Maine Development Commission- Community Voices- Community Members Northern Maine Medical Center Part V, Section B, Line 6a: The following hospitals were included in the collaborative community health assessment: Cary Medical Center, Down East Community Hospital, Houlton Regional Hospital, Maine Coast Memorial Hospital, Mayo Regional Hospital, Millinocket Regional Hospital, Mount Desert Island Hospital, Northern Maine Medical Center, Redington-Fairview General Hospital. Northern Maine Medical Center Part V, Section B, Line 6b: Local Public Health Coordinating Councils - Aroostook District Coordinating Council for our region. Healthy Maine Partnerships - Health Aroostook for our region. Northern Maine Medical Center Part V, Section B, Line 7d: The St. John Valley assessment was posted on the NMMC website in late 2014, as soon as it became available. The report is also available free upon request. Each year, thereafter, an updated report is posted on the Northern Maine Medical Center website with instructions how to access the updates.In 2017, a news article was published to inform the public that the report is available and how they can access it. The report is on the NMMC website and in addition, contact information is provided on the website for individuals who wish to request a free paper copy. Additionally, individuals may call NMMC to request a free copy. Northern Maine Medical Center Part V, Section B, Line 11: NMMC adopted an implementation strategy to address the health needs of the hospital facility's community and prioritized the health needs of its communities using the St. John Valley and Aroostook County Community Health Needs Assessment of 2014 conducted by EMHS. A Steering Committee composed of Northern Maine Medical Center administrative leadership and governing board was formed to evaluate the findings from the 2014 Community Health Needs Assessment survey for the St. John Valley and Aroostook County. The Committee was educated in the principles to be considered when assessing the survey findings. A summary of the Affordable Care Act provisions aimed at improving community health through direct investments in wellness and prevention at the individual and community level was also provided to members. The Committee identified priorities which were approved by the full governing board that subsequently designated responsibility to two separate work groups to develop a plan to address the prioritized needs over the next three years. 2017 Goals, actions and impact on the health of the community:Prioritization of health needs in its community.Priority #1: Substance AbuseAt the beginning of the current CHNA survey cycle, results for the St. John Valley demonstrated substance abuse as one of the top unmet healthcare needs and so it was chosen as priority number one. a. Affordable options for people who are uninsured or under insuredb. Pain management alternatives to prescription drugs/opioidsc. Substance abuse treatment providersPreventive screenings that survey respondents did not feel were very accessible in this category included:- alcohol misuse screening. - Social concerns in the survey findings included substance abuse. - Gaps were identified by respondents in healthcare services related to substance abuse treatment & detoxification.Action plan for Priority #1 2016 -20171. Actions are being addressed in three distinct categories: prevention, screening and treatment. 2. The Medication Lock Boxes, in collaboration with the Healthy Maine Partnerships, were available for only a partial year due to the termination of funding. 3. NMMC fosters the community support group AA, Alcoholics Anonymous, in regards to their assistance with aftercare by allowing them to use physical meeting space at Forest Hill in Fort Kent and Acadia Health Center in Madawaska to hold meetings. Information about the support group is also provided to surrounding communities and included on NMMC's master list of support groups. 4. Dr. Cameron Grange offered Continuing Medical Education for all Northern Maine Medical Center providers on May 25, 2017. He presented a model for substance abuse treatment to increase awareness of the neurochemical and behavioral components of addiction to assist providers in managing addiction in their patients.5. Dr. Erik St. Pierre participated in a community panel presentation on March 17, 2017. The panel addressed substance abuse and the opioid crisis in Maine from varied perspectives, from prescribing laws to treatment and counseling for addiction. The panel was a collaborative event with the University of Maine at Fort Kent. Programs or resources to be used to address Priority #1Measure of success for Priority #1 Substance Abuse: 1. Northern Maine Medical Center's medical staff was educated and trained in managing chronic pain without opioids.2. Northern Maine Medical Center's medical staff was trained in protocols for managing addiction to better address the complexities of patients with addiction. Priority #2 Healthy Food and NutritionAt the beginning of the current CHNA survey cycle, survey results for the St. John Valley demonstrated top barriers that prevent healthy eating and thus nutrition was chosen as priority number two. a. Affordability of healthy food optionsb. Access to healthy food options in school/work environmentc. knowledge, attitudes and beliefs regarding nutritionPreventive screenings that survey respondents did not feel were very accessible included obesity screening.Action plan for Priority #2 2016 -20171. Options were explored to increase local purchasing of fresh foods. On 11/6/16, NMMC Food Service Director met with Tony Gauvin of USDA out of UMFK and two individuals from the Portland area to continue to explore local buying options. The organization also sought participation of local farmers in the 'buy local' initiative using social media, newspaper ads and a press release. Two farmers came forward to participate. 2. The program which assesses the presence of food insecurity in patients coming to the Emergency Department (ED) continued beyond the pilot program period established in 2016. Food insecurity assessments in the ED are a part of the core assessment for all patients who come through the Emergency Department regardless of their chief complaint. The assessment of patients to determine the presence and degree of food insecurity was incorporated into the Electronic Medical Record or EMR. Patients who screened positive for food insecurity were referred to Social Work and Case Management, utilizing a standardized algorithm to ensure that eligible patients are referred properly.3. Beginning in 2014, NMMC and the Aroostook Area Agency on Aging developed a partnership to better serve the public in support of thriving at home and reducing hospital readmissions, specifically, by providing free meals to eligible patients and performing in-home safety assessments. In 2016 when Aroostook Area Agency on Aging's funding ended, NMMC took over the purchase of the meals in order to continue the project. Balanced frozen meals are provided at no cost to eligible patients as part of the courtesy home visit program.Programs or resources to be used to address Priority #2Partners in Community HealthPower of Prevention, Clinical Community LinkagesHealthy Maine PartnershipFarm to Institution Food ProgramMeasure of success Priority #2 Healthy Food and Nutrition: 1. The Courtesy Home Visit program was expanded to include more patients in the program. Also, eligibility requirements of the free meal service were expanded to increase the amount of patients serviced with free meals delivered to patients who were identified to be in need of nutritional support after discharge from the hospital. 2016 -period of 12 months = 2247 meals provided; 2017 -period of 12 months = 1,053 meals were purchased by NMMC and provided to patients in the home after discharge from the hospital. In previous years, 14 days of meals were provided. At this time, 7 days' worth of meals are provided which explains the reason for the reduced numbers. There are actually more patients being served since the expansion of the home visit program. 2. The NMMC Cafe has implemented changes to encourage and facilitate healthy food choices. A new program was launched this year called Free Fruit Friday. The intent of the program is to further encourage healthy snack choices. Also, food preparation is done using heart healthy ingredients. 3. Initially implemented with the support of a grant to Maine Partners in Community Health and with support from a Healthy Maine Partnership, a pilot program in the Emergency Department was launched to screen all patients for food insecurity and to connect them with food sources and Care Management when appropriate. During the assessment period in the Emergency Department, 4,689 patients were screened for food insecurity. A total of 23 patients were assessed as food insecure and all 23 patients were provided with resources and referred to Case Management for follow up.Priority #3 Cardiovascular HealthAt the beginning of the current CHNA survey cycle, CHNA survey results for the St. John Valley demonstrated top barriers that prevent people from being physically active. Aroostook County has the second highest prevalence of heart disease in Maine and so this need was selected as priority number three. a. Personal barriers (i.e., lack of time, motivation, values and beliefs)b. Weather conditionsc. Insufficient facilities or lack of access to facilities for exercisingSee continuation of Part V, Section B, Line 11 narrative on next page. Northern Maine Medical Center Part V, Section B, Line 24: Individuals are billed at gross amounts and charges are adjusted accordingly, if they qualify for assistance. Continuation of Form 990, Schedule H, Part V, Section B, Line 11: Action plan for Priority #3 2016-20171. The partnership established in 2015 with the Aroostook Area Agency on Aging to offer a free Bone Builders class to local seniors continues not only to exist, but also to thrive. Bone Builders is a fitness program for people over the age of 50 which focuses on strength training, balance and includes such topics as fall prevention, osteoporosis, and nutrition. NMMC provides hand and ankle weights free of charge to class participants and physical space is made available for the Fort Kent class. In 2017, class offerings were expanded to the neighboring town of New Canada and weights were purchased and provided by NMMC to all participants. Also, the new instructor was trained at no cost by one of NMMC's Physical Therapists. The third round of Tai Chi for Arthritis is going well with 10 registered participants. The free classes continue to be offered twice a year. 2. In September of 2017, a Family Practice Physician and a Nurse Educator launched a tobacco reduction awareness program called Tar Wars for 116 students at the fifth grade level in all St. John Valley Schools. The program is interactive and printed materials were provided to parents to include them in awareness efforts. 3. In November 2016, Public Service Announcements were aired to raise awareness about quitting tobacco use to coincide with the national Great American Smokeout. Beat the Pack tobacco cessation classes continue to be available, free to the public, upon request.4. Health and wellness materials were provided for a Maine Department of Transportation health fair. We also had a presence at the Twin Rivers wellness and safety fair in August. 5. A partnership was created in 2016 with the Madawaska School system and the Recreation Department to open a Wellness Center which is open to the public. NMMC provided the equipment and start-up funds for renovating the physical space needed for the program. This year, 2017, free access to the facility was added for individuals 65 years of age and older, expanding access to seniors who may otherwise not be able to afford a membership fee. 6. The partnership with the Fort Kent School to maintain a Wellness Center for employees and the public has remained a strong presence with increasing numbers for participation. 7. The NMMC Website offers a variety of health and wellness resources for members of the community. An electronic newsletter is also now available to subscribers on a quarterly basis. The NMMC website now has nearly 200 subscribers, up from 150 in 2016, to the electronic newsletter in addition to the distribution through a chamber of commerce database. Linked to the NMMC website, the public has access to a user friendly, up to the day health, wellness and disease information through a site called Your Care Everywhere. 8. More options were provided to local seniors for free or low cost access to exercise facilities, especially for use during winter months. The brochure was posted on NMMC's Facebook page and website. Brochures were also sent to each provider office with a cover letter explaining the program and additional brochures were made available in public areas of the hospital. 9. Outdoor festivals are offered on an annual basis, in spring and summer, for the children of the St. John Valley. The events promote a combination of fun with physical activity and healthy snacks.10. NMMC participated in a Fun Day at the start of the school year in the community of Fort Kent. The activity event was a collaboration of multiple community partners offering opportunities to develop healthy relationships and habits in children. Programs or resources to be used to address Priority #3Aroostook Area Agency on AgingTown of Madawaska School SystemTown of Madawaska Recreation DepartmentTown of Fort Kent School SystemMeasure of Success Priority #3 Cardiovascular Health: 1. Our partnership with the town of Madawaska has resulted in increasing participation of individuals over last year using the Madawaska Wellness Center. A total of 348 active memberships are on record for 2017; this is 60% higher than the previous year. In addition, the center is now offering Yoga and Zumba classes which reports 13 and 10 members to each class respectively. A similar partnership in Fort Kent has resulted in the participation of 240 individuals from the community. The membership has more than doubled over the previous year.2. The brochure created in collaboration with multiple community stakeholders to make free indoor walking access available to the public was revised to include the opportunities available through the RSVP program. The brochure is widely distributed in public areas of the hospital and it is also available on the hospital website. NMMC believes the following community health needs are important and has prioritized them as secondary level priorities. It is also important to note, as will be outlined further in this section, some work is being done to positively impact these needs. Factors that impact the work on the secondary priorities are the rural nature of our location and the lack of financial resources. 1. Social concerns that include- Unemployment/economic opportunity- Domestic violence- Physical and social isolation - Affordable housing Continuation of Form 990, Schedule H, Part V, Section B, Line 11: 2. Preventive screenings and immunizations that survey respondents did not feel were very accessible. Those include:- Oral health- Depression screening - All primary care providers are using the PHQ depression screening tool as a first line depression screening. - Aging related screening - Tobacco use screening - This screening is done organization wide; 'Beat the Pack' smoking cessation program is available free to individuals who are interested in quitting tobacco use. Advertising of the support is posted on the NMMC website and information about the program was offered at two community events. 3. Gaps in Healthcare Services:- Dental care - Behavioral/mental health services for adults - Ads were placed in print, digitally and radio messaging to support the seeking of assistance when dealing with mental illness. 4. Issues Preventing Access to Care:- Out of pocket costs associated with insurance plans- Lack of insurance and unable to pay for the care - A new section was added to the NMMC website to provide more access to information to assist the public. The website includes the Charity Care Eligibility and application and other resources to assist the public. A full time Patient Financial Counselor position was added as a means of support to patients as well. - Transportation - Don't understand or value the importance of seeking care -weekly information is published through various media sources to keep the public better informed about the importance of disease prevention.- Negative prior experiences - The changes across the organization to provide consistent and high quality services have resulted in improved patient experiences. This assessment is based on the three top rankings received in the past year: a) Named Top 20 Hospital by the National Rural Health Associationb) Listed by Becker Healthcare Review as one of the Top 100 hospitals in the countryc) Awarded a double 5-star rating by the Centers for Medicare and Medicaid for quality and the patient experience Part I, Line 7: The amounts reported on Lines 7a & 7b were computed using a cost-to-charge ratio. Amounts on line 7g are derived from internal financial/cost accounting systems. Part I, Line 7g: Subsidized health services on line 7g include physician clinics, rural health centers, a skilled nursing facility, and emergency room. Part II, Community Building Activities: N/A Part III, Line 4: In evaluating the collectibility of accounts receivable, the Medical Center analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for doubtful accounts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Medical Center analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for doubtful accounts, if necessary. For receivables associated with self-pay patients (which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Medical Center records a provision for doubtful accounts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. Part III, Line 9b: Our collection policy stipulates that NMMC makes reasonable efforts to identify those individuals that may qualify for assistance. In the first 120 days, patients may request to begin the Financial Assistance process and collection activity is put on hold until the process is completed. If the patient qualifies, no further collection activity will occur going forward for that account. If patient does not qualify, collection activity resumes from point it was put on hold. Part VI, Line 2: Please see Schedule H, Part V, Section B, Line 5 for a description of NMMC's assessment process. Part VI, Line 3: We notify patients and customers about access to assistance in various ways. The simplest way is the signage, pamphlets, and educational material located around the Organization and in various offices. In every patient access/patient financial services area is a sign explaining the availability of free/discounted care and the Federal Poverty Guidelines. There are also pamphlets located in the outpatient areas explaining free/discounted care and providing information on Mainecare. For inpatients, there is a book in each room which provides all the information on all programs available.Through the patient accounting department, we provide information aboutthese statements. We also counsel patients on the phone about all theprograms available whether it is Medicaid or a hospital program. Part VI, Line 4: Northern Maine Medical Center is a 94 licensed bed (29 A&P which includes swing beds, 6 ICU beds, 14 Psych beds, and 45 SNF beds), full-service, acute-care, not-for profit hospital located in Fort Kent, Maine (Aroostook County). The Hospital is accredited by the joint commission and its mission is to serve its communities with excellence in health care. Its services include acute inpatient, psych inpatient, SNF, 24-hour emergency center, diagnostic, and surgical services. Along with these hospital services, the Hospital employs/contracts with the majority of primary and specialty care physicians in the area. Part VI, Line 5: Northern Maine Medical Center is a local, not-for-profit hospital that serves its local communities and people regardless of their ability to pay. Northern Maine provides financial assistance and sliding scale discounts to self-pay and low-income patients. Also the Hospital participates in government-sponsored health care programs including Medicare, Medicaid, VA, and Tricare. The volunteer board of trustees sets the strategic direction for the Hospital and is comprised of community members from the Hospital's service area. This group is made up of local business owners, professionals, and retirees. Northern Maine's non-profit status allows the Hospital to reinvest any excess of revenues over expense back into the Hospital to continuously improve the medical care it delivers. The Hospital allows access to healthcare that would otherwise be difficult. The Hospital is the main employer for the local physicians, including specialty physicians that would otherwise have to be accessed out of the area. X X X 0 0 0 0 0 0 0 1 0 Michael Sullivan MD Director 258670 0 0 0 18687 0 7950 0 21439 0 306746 0 0 0 Peter J Sirois CEO/President 264618 0 20000 0 2836 0 7696 0 21092 0 316242 0 0 0 Cindy L Daigle CFO/Treasurer 171352 0 5000 0 242 0 5458 0 19655 0 201707 0 0 0 Alain Bois COO/Secretary 140330 0 500 0 177 0 1469 0 13237 0 155713 0 0 0 Baharak Bagheri MD Radiologist 520285 0 10000 0 2535 0 7950 0 9353 0 550123 0 0 0 John Hallberg MD Orthopedic Surgeon 487867 0 0 0 21392 0 7950 0 18810 0 536019 0 0 0 James Harris MD Physician 488849 0 0 0 19244 0 7950 0 14436 0 530479 0 0 0 Mark Overton MD Psychiatrist 487750 0 0 0 2525 0 0 0 16485 0 506760 0 0 0 Erik St Pierre ER Physician 673041 0 0 0 972 0 0 0 18621 0 692634 0 0 0 Part I, Line 7 The bonus paid to Peter Sirois, CEO, has set point criteria for earning specific bonus levels/amounts. The Board awards points based on the accomplishment of pre-established objectives/targets. Points are tabulated with the final score determining bonus level achieved. The Board meets with the CEO to discuss performance including those objectives/targets and based on that meeting award the points and derive the bonus amount. The bonus payment made to Cindy Daigle, CFO, and Alain Bois, COO, was paid at the discretion of the Organization's CEO. The CEO communicates the bonus and amount directly with the Human Resources Director. Dr. Baharak Bagheri received a sign on bonus upon renewal of her contract. Daigle Oil Company Entity of which Dan Vaillancourt, Board Member, is an officer 110828 Independent Contractor Arrangement 0 Nola Sirois Family member of Peter Sirois, Hospital CEO 20338 Employment 0 Michelle L Plourde Family member of Peter Sirois, Hospital CEO 81914 Employment 0 Nicole Marquis Family member of Peter Sirois, Hospital CEO 46739 Employment 0 Robin Werntgen Family member of Peter Sirois, Hospital CEO 72976 Employment 0 Gail Lamarre Family member of Peter Sirois, Hospital CEO 10384 Employment 0 James Daigle Family member of Cindy Daigle, CFO 13687 Employment 0 Form 990, Part VI, Section B, line 11b The Form 990 is prepared by the Organization's independent public accounting firm and thoroughly reviewed by the CFO and Controller. The completed form is sent electronically to Board members prior to the form being filed. In addition, CEO has documents for review prior to sending to the Board members and has opportunity to request any edits. When the forms are sent to Board members, they are instructed to contact CEO or CFO with questions. Any questions are responded to and at the following Finance or Board meetings, CFO provides ability for anyone to ask any additional questions. Finance Committee may request a formal/detailed presentation by consultants if deemed necessary but have not requested that level of review recently. Form 990, Part VI, Section B, line 12c On an annual basis, Board Members must read the Organization's conflict of interest policy, disclose any potential conflicts, and return the signed statement to Administration. If topics arise where a Member has an actual or potential conflict, the group will determine the level to which the individual may be involved in discussions and the member with the conflict will not have a vote. In some instances, the member will be excused from the meeting and can only rejoin when the Board has moved on to a different topic. Form 990, Part VI, Section B, line 15 The Board of Directors determines the compensation of the CEO using compensation studies and comparability data. The CEO determines the compensation of other officers and key employees in a similar manner. 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 X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Northern Maine Medical Center 194 East Main Street Fort Kent, ME 04743 EIN: 01-0234189 Northern Maine Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Valley Medical Association 194 East Maine Street Fort Kent ME 04743 223245434 Medical Physician Practice ME 501(c)(3) Line 3 Northern Maine Medical Center 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0