NORTHERN MAINE MEDICAL CENTER: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN MAINE MEDICAL CENTER (EIN 01-0234189)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-08-11
- IRS object ID
- 201532239349300503
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-11T07:15:19-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1 |
| City | Portland | City |
| State | ME | State |
| ZIP Code | 041041100 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010234189 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northern Maine Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 2078343155 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Main Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Peter J Sirois | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2078343155 | PhoneNum |
| Signature | 2015-08-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Barbara J McGuan CPA | PreparerPersonNm |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2015-08-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Peter J Sirois | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Main Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $45,545,177 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.nmmc.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1948 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | Acute care & long term care hospital and mental health services facility. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 578 | TotalEmployeeCnt |
| Total Volunteers | 49 | TotalVolunteersCnt |
| Total Gross UBI | $25,628 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$18,547 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $661,490 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,493,063 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $44,712,601 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $45,079,671 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$379,803 | PYInvestmentIncomeAmt |
| CY Investment Income | -$28,811 | CYInvestmentIncomeAmt |
| PY Other Revenue | $909,087 | PYOtherRevenueAmt |
| CY Other Revenue | -$1,102,134 | CYOtherRevenueAmt |
| PY Total Revenue | $45,903,375 | PYTotalRevenueAmt |
| CY Total Revenue | $45,441,789 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $26,308,386 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,081,024 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,074,245 | PYOtherExpensesAmt |
| CY Other Expenses | $17,003,967 | CYOtherExpensesAmt |
| PY Total Expenses | $44,382,631 | PYTotalExpensesAmt |
| CY Total Expenses | $45,084,991 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,520,744 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $356,798 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $46,612,884 | TotalAssetsBOYAmt |
| Total Assets EOY | $42,813,880 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $21,562,847 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,399,129 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,050,037 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,414,751 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $38,535,156 | ExpenseAmt |
| Revenue | $43,837,464 | RevenueAmt |
| Desc | Medical care & ancillary services, nursing home & skilled services, physician services. | Desc |
| Total Program Service Expenses | $38,535,156 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 96 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 578 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | ME | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Cindy Daigle | PersonNm |
| Phone | 2078343155 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Main Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Norman Fournier | ||||||||
| President | 2.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| John Ezzy | ||||||||
| Vice President | 1.00 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Glenn Lamarr | ||||||||
| Treasurer | 1.00 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| James Thibodeau | ||||||||
| Secretary | 1.00 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Ronald Daigle | ||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Dan Vaillancourt | ||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Mark Morneault | ||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Robert Bellefleur | ||||||||
| Director | 1.00 | 0.50 | Yes (X) | $3,180 | $0 | $0 | ||
| Mark Chamberland | ||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Michael Sullivan MD | ||||||||
| Director | 50.00 | 0.50 | Yes (X) | $636,415 | $0 | $29,141 | ||
| Frances Labrie | ||||||||
| Past Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Peter J Sirois | ||||||||
| CEO | 50.00 | 1.00 | Yes (X) | $224,661 | $0 | $28,117 | ||
| Cindy L Daigle | ||||||||
| CFO | 50.00 | 1.00 | Yes (X) | $144,579 | $0 | $25,761 | ||
| Mark Overton MD | ||||||||
| Psychiatrist | 50.00 | 0.00 | $645,740 | $0 | $19,491 | Yes (X) | ||
| James Harris MD | ||||||||
| Physician | 50.00 | 0.00 | $465,720 | $0 | $29,141 | Yes (X) | ||
| David Coffman MD | ||||||||
| Surgeon | 50.00 | 0.00 | $413,077 | $0 | $14,083 | Yes (X) | ||
| David Jones MD | ||||||||
| ER Physician | 50.00 | 0.00 | $336,470 | $0 | $29,141 | Yes (X) | ||
| Rodney Lahren MD | ||||||||
| Surgeon | 50.00 | 0.00 | $293,770 | $0 | $17,662 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,163,612 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $192,537 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 36 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| The Sheridan Corporation | |||||
| PO Box 359 | Fairfield | ME | 04937 | Building Contractor | $1,143,097 |
| Erik St Pierre MD | |||||
| 194 East Main St | Fort Kent | ME | 04743 | ER Physician | $398,643 |
| Quest Diagnostics | |||||
| 12436 Collections Center Drive | Chicago | IL | 606932436 | Off-Site Laboratory Services | $371,081 |
| Radiology 247 LLC | |||||
| 5820 Oberlin Drive 205 | San Diego | CA | 92121 | Off-Site Radiologist Coverage | $276,948 |
| Thayer Corp | |||||
| 1400 Hotel Road | Auburn | ME | 04210 | Building Contractor | $272,421 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $1,493,063 | AllOtherContributionsAmt |
| Noncash Contributions | $1,406,564 | NoncashContributionsAmt |
| Total Contributions | $1,493,063 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| Patient Service Revenue | 623000 | $74,971,806 | $74,971,806 | ||
| Miscellaneous Revenue | 623000 | $1,096,113 | $950,651 | $25,628 | $119,834 |
| Meaningful Use Revenue | 623000 | $538,291 | $538,291 | ||
| Provision for Bad Debt | 623000 | -$1,879,489 | -$1,879,489 | ||
| Contractual/Char. Adj. | 623000 | -$29,647,050 | -$29,647,050 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $45,079,671 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,337 | TotalRevenueColumnAmt |
| Exclusion | $35,337 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $97,334 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $97,334 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $97,334 | TotalRevenueColumnAmt |
| Exclusion | $97,334 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $19,047 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $83,195 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$64,148 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$64,148 | TotalRevenueColumnAmt |
| Exclusion | -$64,148 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $62,932 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $20,193 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,739 | TotalRevenueColumnAmt |
| Exclusion | $42,739 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Insurance Captive | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | -$1,242,207 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$1,242,207 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$1,242,207 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,441,789 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $43,692,002 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $25,628 | UnrelatedBusinessRevenueAmt |
| Exclusion | $231,096 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,091,854 | TotalAmt |
| Program Services | $665,556 | ProgramServicesAmt |
| Management And General | $426,298 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,536,023 | TotalAmt |
| Program Services | $18,905,817 | ProgramServicesAmt |
| Management And General | $3,630,206 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $328,708 | TotalAmt |
| Program Services | $280,015 | ProgramServicesAmt |
| Management And General | $48,693 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,612,534 | TotalAmt |
| Program Services | $2,200,981 | ProgramServicesAmt |
| Management And General | $411,553 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,511,905 | TotalAmt |
| Program Services | $1,254,881 | ProgramServicesAmt |
| Management And General | $257,024 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,486 | TotalAmt |
| Program Services | $70,953 | ProgramServicesAmt |
| Management And General | $14,533 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,725 | TotalAmt |
| Program Services | $59,532 | ProgramServicesAmt |
| Management And General | $12,193 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,226 | TotalAmt |
| Program Services | $342,148 | ProgramServicesAmt |
| Management And General | $70,078 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,083 | TotalAmt |
| Program Services | $65,639 | ProgramServicesAmt |
| Management And General | $13,444 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,726,764 | TotalAmt |
| Program Services | $3,939,974 | ProgramServicesAmt |
| Management And General | $786,790 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,360,808 | TotalAmt |
| Program Services | $1,129,471 | ProgramServicesAmt |
| Management And General | $231,337 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $191,255 | TotalAmt |
| Program Services | $158,742 | ProgramServicesAmt |
| Management And General | $32,513 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,723 | TotalAmt |
| Program Services | $306,040 | ProgramServicesAmt |
| Management And General | $62,683 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,812,765 | TotalAmt |
| Program Services | $2,334,595 | ProgramServicesAmt |
| Management And General | $478,170 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $353,679 | TotalAmt |
| Program Services | $293,554 | ProgramServicesAmt |
| Management And General | $60,125 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $4,297,275 | $4,297,275 | |
| Valley Medical Associat | $1,225,100 | $1,225,100 | |
| Health Care Provider Ta | $935,579 | $935,579 | |
| Dues & Subscriptions | $83,499 | $69,304 | $14,195 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,084,991 | TotalAmt |
| Program Services | $38,535,156 | ProgramServicesAmt |
| Management And General | $6,549,835 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $308,223 | BOYAmt |
| EOY | $121,350 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,811,311 | BOYAmt |
| EOY | $9,291,835 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,792,616 | BOYAmt |
| EOY | $5,881,188 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,096 | BOYAmt |
| EOY | $6,796 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,856 | BOYAmt |
| EOY | $60,060 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $716,381 | BOYAmt |
| EOY | $742,033 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $272,240 | BOYAmt |
| EOY | $214,423 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $44,235,168 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $24,539,851 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,241,023 | BOYAmt |
| EOY | $19,695,317 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,488 | BOYAmt |
| EOY | $216,322 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $515,861 | BOYAmt |
| EOY | $489,785 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,752,789 | BOYAmt |
| EOY | $6,094,771 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,612,884 | BOYAmt |
| EOY | $42,813,880 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,767,375 | BOYAmt |
| EOY | $4,756,508 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,565,946 | BOYAmt |
| EOY | $7,895,738 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,229,526 | BOYAmt |
| EOY | $4,746,883 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,562,847 | BOYAmt |
| EOY | $17,399,129 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,674,605 | BOYAmt |
| EOY | $25,056,693 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $375,432 | BOYAmt |
| EOY | $358,058 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,050,037 | BOYAmt |
| EOY | $25,414,751 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,612,884 | BOYAmt |
| EOY | $42,813,880 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $356,798 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $7,916 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $8,487 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $8,487 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital pays dues to various organizations, a portion of which is attributable to lobbying expenses. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $196,477 | OtherCostOrOtherBasisAmt |
| Book Value | $196,477 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,439,307 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,731,398 | DepreciationAmt |
| Book Value | $15,707,909 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,978,366 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,808,453 | DepreciationAmt |
| Book Value | $3,169,913 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $621,018 | OtherCostOrOtherBasisAmt |
| Book Value | $621,018 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,695,317 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Deferred Compensation | $866,156 |
| Cash Surrender Value of Life Insurance | $269,250 |
| Interest in Synernet Reinsurance | $670,823 |
| Meaningful Use Receivables | $451,860 |
| Estimated Third-Party Payor Settlements | $3,311,682 |
| Insurance Claim Receivable | $525,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,094,771 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $866,156 |
| Estimated Third-Party Payor Settlements | $3,818,262 |
| Due to Affiliate | $62,465 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,746,883 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The 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. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | 2014 Cancer Fund Tour | NameOfEvent1Amt |
| Gross Receipts Event1 | $24,925 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $24,925 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $1,827 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $90 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $535 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $900 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | Emergency Room Fundraiser | NameOfEvent2Amt |
| Gross Receipts Event2 | $38,007 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $38,007 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $775 | CashPrizesEvent2Amt |
| Non Cash Prizes Event2 | $4,117 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $3,428 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $4,492 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $4,029 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $62,932 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $62,932 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $775 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $5,944 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $3,518 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $5,027 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $4,929 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $20,193 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $42,739 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $486,813 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $486,813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01080 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,193,800 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,027,948 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,165,852 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02590 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,680,613 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,027,948 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,652,665 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03670 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,606,905 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,033,425 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,573,480 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05710 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,606,905 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,033,425 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,573,480 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05710 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,287,518 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,061,373 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,226,145 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09380 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,082,667 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $16,849,684 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $17,589,890 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$740,206 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Emergency Room OtherEmergencyRoomOtherInd | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|---|
| Northern Maine Medical Center | |||||||||
| 1 | 194 East Maine Street | Fort Kent | ME | 04743 | Yes (X) | Yes (X) | Yes (X) | ||
| Forest Hill | |||||||||
| 2 | 20 Bolduc Avenue | Fort Kent | ME | 04743 | Yes (X) | Licensed Hospital Related Facility | |||
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northern Maine Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.nmmc.org | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Northern Maine Medical Center | Part V, Section B, Line 1j: 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 3: 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 of Aroostook, Cumberland, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington) by 17 partnering Maine Hospitals, 5 local Public Health Districts (including Aroostook District Coordinating Council) and 11 Healthy Maine Partnerships (including Health Aroostook). |
| Northern Maine Medical Center | Part V, Section B, Line 4: In addition to EMHS Member Organizations, which include 8 hospitals one of which is The Aroostook Medical Center, 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, and Redington-Fairview General Hospital. All four Aroostook County hospital facilities were included. |
| Northern Maine Medical Center | Part V, Section B, Line 6i: 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. 2015 CHNA overarching goals:1. Identify key stakeholders and harness resources to form partnerships with existing St. John Valley and Aroostook County groups who may be sharing similar goals that benefit the communities served.2. Educate members of the communities and other key personnel such as medical providers regarding available resourcesNorthern Maine Medical CenterPart V, Section B, Line 6g:Prioritization of health needs in its community:Priority #1 - Substance AbuseActions were identified in three distinct categories: prevention, screening and treatment. 1. Collaborate with community partners to increase number of educational sessions to one per quarter on topics such as social hosting, effects of substance abuse to local schools and civic groups.2. Provide home medication lock boxes to primary care offices. 3. Work with law enforcement to increase checkpoints to screen for drunk driving.4. Adopt the SBIRT (screening, brief intervention, and referral for treatment) process within one year in our primary care offices, ED and inpatient units.5. Adopt an evidence based tool to screen patients for substance abuse in CAPU, (such as ACOK).6. Work in collaboration with other community partners in the development of an algorithm for treatment in the St. John Valley and make it available for all primary care offices and mental health providers. 7. Explore the possibility of having a provider at NMMC specialize in the treatment of co-occurring conditions/diagnoses.8. Foster the community support groups (such as AA) in regards to their assistance with aftercare.9. Reach out to community agencies to explore methods to support agencies currently offering these services. Aroostook Mental Health Center, Life by Design, et al.Priority #2 - Healthy Food and NutritionYear 1 (2015)1. Pursue participation in the Let's Go! Program. A new Northern Aroostook County Let's Go! program coordinator will be onboard by the end of January 2015. A request has been made to meet with the individual to map out a plan for training and implementation of the three Let's Go! modules. The lead person for the Let's Go! Program in the Maine School District #33 will also be consulted for lessons learned in the implementation process.2. Coordinate presentation to NMMC providers by Let's Go! Program director - Growing and Sustaining Let's Go! In Maine3. Partner with Healthy Maine Partnership - AroostookYear 2 (2016)1. Reach out to local restaurants to offer healthy menu options. 2. Develop a partnership with the Cooperative Extension Service to tap into resources for training community members in how to shop and cook for a healthier life. Include local grocers to be part of the plan to identify healthy food choices for shoppers. 3. Meet with local farmers and food coop to discuss strategies for affordability and access to fresh foods. Priority #3 - Cardiovascular HealthYear 1 (2015)1. Partner with other local organizations/businesses to improve access to exercise facilities. 2. NMMC Our Communities Team is working with the community to determine how best to communicate to the public what is available as a starting point. Options being considered to improve communication to the public are use of a digital sign, online newsletter, paper newsletter, patient portals. NMMC website will complete an upgrade in the spring of 2015. The site is more user-friendly and will offer more options to link and inform patients.3. Support OffUGoAroostook by assisting them in expanding the distribution of weekly activities listings to a broader population.4. Educate providers about the resources available to patients. Provide printed informational materials to be used as patient handouts. Year 2 (2016)1. Partner with Fort Kent Power of Prevention coordinator to explore ways we can partner to expand our reach and resources to the St. John Valley Communities.2. Revisit the Wholesome Wave program to determine availability of participation. |
| Northern Maine Medical Center | Part V, Section B, Line 7: NMMC believes the following community health needs are important however they were prioritized as secondary level priorities for various reasons, including limited staff and financial resources. It is also important to note, as will be outlined further in this section, that some, but not all of these secondary priorities, are currently receiving some early stage attention.1. Social concerns that include: a. Unemployment/economic opportunity b. Domestic violence c. Physical and social isolation - began partnering with the Aroostook Area Agency on Aging's Thrive in Place program for elders. On 1/29/15, clinical staff was trained to broaden their knowledge in the area of home environmental assessments which can also provide some socialization. We are working closely with the Aroostook Area Agency on Aging to address some of the physical and social isolation identified. d. Affordable housing2. Preventive screenings and immunizations that survey respondents did not feel were very accessible. Those include: a. Oral health b. Depression screening - All primary care providers are using the PHQ depression screening tool as a first line depression screening. c. Aging related screening - We have begun working with the Power of Prevention, Healthy Aroostook Coalition to address aging related screening and the possibility of educating providers on the use of CMS screening tools. d. Tobacco use screening - NMMC Patient Educator will be trained by the Pfizer Company to be able to offer 'Beat the Pack' program with tentative start date of April 2015.3. Gaps in Healthcare Services: a. Dental care - 'First Tooth' program has been presented to the Family Practice Team for their consideration of adding this assessment tool to their patient visits. b. Behavioral/mental health services for adults4. Issues Preventing Access to Care: a. Out of pocket costs associated with insurance plans b. Lack of insurance and unable to pay for the careNMMC has worked with local pharmacies to implement a cash card program to reduce cost of prescription drugs for eligible individuals.NMMC also is designated as a Certified Application Counselor organization and has representatives that can assist individuals with obtaining coverage through the Health Insurance Exchange. c. Transportation - NMMC is partnering with the Aroostook Area Agency on Aging to address the issue of transportation. d. Don't understand or value the importance of seeking care e. Negative prior experiences |
| Northern Maine Medical Center | Part V, Section B, Line 20d: Individuals are billed at gross amounts and charges are adjusted accordingly, if they qualify for assistance. |
| Northern Maine Medical Center | Part V, Section B, Line 22: Individuals are billed at gross amounts and charges are adjusted accordingly, if they qualify for assistance. |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 VI, Line 2: | Please see Schedule H, Part v, Section B, Line 1 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 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, CHAMPUS, 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | Yes (1) | InitialContractExceptionInd |
| Rebuttable Presumption Proc | Yes (1) | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michael Sullivan MD | ||||||||||||||
| Director | $618,915 | $0 | $0 | $0 | $17,500 | $0 | $7,650 | $0 | $21,491 | $0 | $665,556 | $0 | $0 | $0 |
| Peter J Sirois | ||||||||||||||
| CEO | $195,868 | $0 | $28,000 | $0 | $793 | $0 | $5,956 | $0 | $22,161 | $0 | $252,778 | $0 | $0 | $0 |
| Cindy L Daigle | ||||||||||||||
| CFO | $139,579 | $0 | $5,000 | $0 | $0 | $0 | $4,270 | $0 | $21,491 | $0 | $170,340 | $0 | $0 | $0 |
| Mark Overton MD | ||||||||||||||
| Psychiatrist | $645,740 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $19,491 | $0 | $665,231 | $0 | $0 | $0 |
| James Harris MD | ||||||||||||||
| Physician | $448,220 | $0 | $0 | $0 | $17,500 | $0 | $7,650 | $0 | $21,491 | $0 | $494,861 | $0 | $0 | $0 |
| David Coffman MD | ||||||||||||||
| Surgeon | $413,077 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $14,083 | $0 | $427,160 | $0 | $0 | $0 |
| David Jones MD | ||||||||||||||
| ER Physician | $318,970 | $0 | $0 | $0 | $17,500 | $0 | $7,650 | $0 | $21,491 | $0 | $365,611 | $0 | $0 | $0 |
| Rodney Lahren MD | ||||||||||||||
| Surgeon | $283,770 | $0 | $10,000 | $0 | $0 | $0 | $5,678 | $0 | $11,984 | $0 | $311,432 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, was paid at the discretion of the Organization's CEO. The CEO communicates the bonus and amount directly with the Human Resources Director. |
| Part I, Line 8 | Rodney Lahren received a sign-on bonus pursuant to his employment contract. |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Mark Overton | PersonNm |
| Relationship With Org | Employee | RelationshipWithOrgTxt |
| Loan Purpose | Purchase of home | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $27,900 | OriginalPrincipalAmt |
| Balance Due | $6,796 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | 0 | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $6,796 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Daigle Oil Company | |||
| Entity of which Dan Vaillancourt, Board Member, is an officer | $197,356 | Independent Contractor Arrangement | 0 |
| Nola Sirois | |||
| Family member of Peter Sirois, Hospital CEO | $22,223 | Employment | 0 |
| Michelle L Plourde | |||
| Family member of Peter Sirois, Hospital CEO | $59,606 | Employment | 0 |
| Nicole Marquis | |||
| Family member of Peter Sirois, Hospital CEO | $42,605 | Employment | 0 |
| Robin Werntgen | |||
| Family member of Glenn Lamarr, Board Treasurer | $55,816 | Employment | 0 |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $1,406,564 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Appraisal | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 1 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Peter Sirois and Glenn Lamarr have a family relationship. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared by the Organization's independent public accounting firm and thoroughly reviewed by the CFO and Controller. The completed form was sent electronically to Board members prior to the form being filed. |
| Form 990, Part VI, Section B, line 12c | The enforcement of the conflict of interest policy is achieved through annual reporting and ongoing monitoring. |
| 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 VII, Section A: | Michael Sullivan & Robert Bellefleur show reportable compensation on Form 990, Part VII, Section A for services performed in their capacity as employee and contractor respectively, of Northern Maine Medical Center. Their compensation does not reflect payment for services as a board members of the Hospital or any related organization. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Valley Medical Association | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Maine Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 223245434 | EIN |
| Primary Activities | Medical Physician Practice | PrimaryActivitiesTxt |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northern Maine Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Valley Medical Association | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | R | TransactionTypeTxt |
| Involved | $1,225,100 | InvolvedAmt |
| Method Of Amount Determination | Actual Outlay | MethodOfAmountDeterminationTxt |