2015-05-14T14:57:00-05:00 2014-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2013-07-01 010198331 Maine Coast Regional Health Facilities MAIN 2076645311 50 Union Street Ellsworth ME 04605 Charles Therrien CEO 2076645311 2015-05-14 1 Barbara J McGuan CPA P00219457 2077752387 2015-05-14 2013 2016-02-25 16:41:14Z Maine Coast Memorial Hospital Charles Therrien 50 Union Street Ellsworth ME 04605 80375096 0 X www.mcmhospital.org X 1964 ME The Hospital is a not-for-profit entity established to provide health care services through its acute care facility and physician practices. 21 17 744 84 0 0 837009 852421 80005055 75275764 453973 975465 -45919 -49319 81250118 77054331 10000 10000 0 0 50024480 48198006 0 0 162096 30549801 32128696 80584281 80336702 665837 -3282371 77286213 71050757 30015187 26327933 47271026 44722824 X The Hospital is a not-for-profit entity established to provide health care services through its acute care facility and physician practices. 0 0 74405143 10000 75275764 Admissions 2,638Patient Days 7,936Average Stay 3.10 DaysClinic Visits:Eleanor Widener Dixon Clinic 11,796S.W. Harbor Medical Center 4,915Emergency Room Visits 16,205Surgical Cases- Inpatient 587Surgical Cases- Outpatient 3,259Laboratory Tests: 264,657Radiology Exams:Diagnostic Radiology 17,107Ultrasound 5,234CT Scan 4,983Mammography 3,731Nuclear Medicine 2,812MRI 2,026Physical Therapy 70,342Births 311 74405143 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 91 0 1 744 1 0 0 0 0 0 1 1 0 0 0 0 X 21 17 1 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 ME X X Chris Frauenhofer CFO 2076645311 50 Union Street Ellsworth ME 04605 Michelle H Beal Trustee 1.00 X 0 0 0 Robert A Beekman MD Trustee/Physician 50.00 X 174690 0 42182 Christopher B Brown Trustee 1.00 X 0 0 0 Edith R Dixon Trustee 0.50 X 0 0 0 Jeffrey R Dow Treasurer 1.00 0.50 X X 0 0 0 Debra A Ehrlenbach Vice Chairman 10.00 0.50 X X 0 0 0 Thomas J Fernald Trustee 1.00 X 0 0 0 Alan J Goldstein Trustee 0.50 X 0 0 0 Scott S Hammond Trustee 1.00 X 0 0 0 Daniel A Hurley III Trustee 1.00 X 0 0 0 Sally J Hutchins Trustee 1.00 X 0 0 0 Scott A Kimball Trustee 1.00 X 0 0 0 Sean T Maloney MD Trustee/Physician 50.00 X 246204 0 50887 Alan H Nauss MD Trustee 1.00 X 0 0 0 Karen W Stanley Trustee 1.00 X 0 0 0 Kevin B Tesseo Trustee 1.00 X 0 0 0 Charles D Therrien CEO 60.00 0.50 X X 336109 0 37816 Adin M Tooker Chairman 10.00 0.50 X X 0 0 0 Nicholas S Vachon DPM Trustee 1.00 X 0 0 0 Sheena E Whittaker MD President of Medical Staff 55.00 X 250727 0 44351 Robert J Williams Secretary 1.00 0.50 X X 0 0 0 Rebecca J Sargent Past Chair 10.00 0.50 X X 0 0 0 Matthew C Worthen Past Trustee 1.00 X 0 0 0 Chris D Frauenhofer CFO 60.00 X 145711 0 37816 Richard Jeffcote Past Interim CFO 50.00 X 108500 0 0 Sterling C Williamson Physician 50.00 X 634341 0 61117 Davor G Sklizovic Physician 50.00 X 439215 0 50373 Martin R Curlik Physician 50.00 X 416466 0 43478 Paul M Denoncourt Physician 50.00 X 474587 0 38985 Kerry W Crowley Physician 50.00 X 368402 0 54979 3594952 0 461984 67 0 1 0 Novia Strategies Inc 13029 Danielson St Suite 200 Poway CA 92064 Consulting Services 1064050 Eastern Maine Medical Center 43 Whiting Hill Rd Brewer ME 04412 Medical Services 483181 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Locum Services 460319 Innovative IT Consultants Inc 730 Sentry Ridge Crossing Suwanee GA 30024 Consulting Services 439965 Spectrum Medical Group 324 Gannett Drive South Portland ME 04106 Medical Services 362262 20 146811 123449 582161 20092 852421 Patient Service Rev. 621990 164281145 164281145 Other Medical Services 621990 3141564 3141564 Cafeteria/Vending 621990 252977 252977 Bad Debt 621990 -5266803 -5266803 Contractual/Char. Adj. 621990 -87133119 -87133119 75275764 370287 370287 3822639 22225 3239686 0 582953 22225 605178 605178 31760 146811 81079 -49319 -49319 77054331 75022787 0 1179123 10000 10000 1474993 513964 961029 37711405 36353452 1253901 104052 822525 792907 27349 2269 5653399 5449824 187975 15600 2535684 2389765 138455 7464 126573 126573 125059 125059 63470 63470 7686228 6886921 799307 128801 123640 5161 2411502 1787883 616051 7568 904417 823806 74778 5833 1243432 1218478 24954 71124 66977 3322 825 251889 217493 33867 529 695184 695184 3376713 3026396 349174 1143 1174097 607094 567003 Medical Supplies 9689069 9676425 12644 Health Care Prov. Tax 1859362 1859362 Repairs & Maintenance 1364955 1344811 20144 Other 956821 684401 260768 11652 80336702 74405143 5769463 162096 4105 4155 10810216 5250084 8868070 9982229 594493 503588 1059027 1051882 65501739 33878376 33206102 31623363 8664783 19750250 201566 191155 13877851 2694051 77286213 71050757 8611806 8584652 12259477 11955931 1342421 926340 7801483 4861010 30015187 26327933 X 46193661 43529851 387488 491325 689877 701648 47271026 44722824 77286213 71050757 X -3282371 945304 -211135 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13439 13439 0 Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which are attributable to lobbying expenses. 12887926 10000000 1829422 3179460 21537888 12362378 904112 378564 12887926 11712210 135584 536573 21989 12362378 3349752 7664082 710004 11628 11712210 2953215 27935 383779 15177 3349752 0.97000 0.03000 0.00000 0 0 361138 361138 42596114 15977088 26619026 257863 232243 25620 22286624 17669045 4617579 31623363 Deferred Compensation 1076284 Estimated Third-Party Payor Settlements 3784726 4861010 Part V, Line 4: The intended uses of the endowment funds are funded depreciation, the oncology clinic and the breast clinic. Poinsettia Ball 99911 83151 16760 11179 28579 Chef's Gala 78660 63660 15000 473 40848 178571 146811 31760 11652 69427 81079 -49319 1 1 1 X 1 X 1 1 0 1 1 1809556 1809556 0.02410 9555372 6441156 3114216 0.04150 11364928 6441156 4923772 0.06560 115737 27958 87779 0.00120 89651 89651 0.00120 11230640 7401212 3829428 0.05100 0 10000 10000 0.00010 11446028 7429170 4016858 0.05350 22810956 13870326 8940630 0.11910 4800 4800 0.00010 19417 10796 8621 0.00010 1635 1635 0.00000 14415 1200 13215 0.00020 22675 14068 8607 0.00010 36160 36160 0.00050 25297 25297 0.00030 124399 26064 98335 0.00130 1 2485874 18610562 20610137 -1999575 X 1 1 1 1 Maine Coast Memorial Hospital 50 Union Street Ellsworth ME 04605 X X X Maine Coast Memorial Hospital 1 1 X X X X X X X X X 11 1 1 1 X www.mainehospital.org X X X X X X X X X 1 0 1 1 150.000000000000 1 250.000000000000 1 X X X 1 1 X X X 0 0 X X X 1 X 0 0 Maine Coast Memorial Hospital Part V, Section B, Line 3: On a statewide basis, the research consultants developed an advisory committee that met several times during the assessment research and drafting of the publication. These individuals represented a broad spectrum of backgrounds, and they are named below:Carol Bell, Healthy Maine Partnership DirectorKelly Bentley, Healthy Maine Partnership DirectorGail Dana-Sacco, Wabanaki Center (serving tribal populations)Patricia Hart, Maine Development FoundationBarbara Leonard, MPH, Maine Health Access Foundation (philanthropic foundation focused on access to care in Maine)Becca Matisovich, Maine Center for Disease ControlLisa Miller, Bingham Foundation (philanthropic foundation)Dora Ann Mills, MD, Maine Center for Disease ControlElizabeth Mitchell, Maine Health Management Coalition (representing the state's major employers, insurers and providers)Trish Riley, Governor's Office of Health Policy and Finance (GOHPF)Brian Rines, Advisory Committee for Health System Development (overseen by GOHPF)Rachel Talbot-Ross, Maine Chapter, NAACPTed Trainer, Public Health Coordinating Council Shawn Yardley, City of Bangor, Department of Health and Welfare In the local area served by the assessment, multiple parties were engaged in dissemination of the assessment findings and establishment of priorities. Dissemination and prioritizing process, as well as needs identified and prioritized: In June 2011, EMHS in conjunction with Maine Coast Memorial Hospital hosted a community forum to present an overview of local assessment results and recommendations. Invitees included:1. Other area hospitals2. Physician leaders3. Federally Qualified Health Centers4. Healthy Maine Partnerships5. District Liaisons linked to Maine CDC6. Home Health and Long Term Care leaders7. Social Service Agencies8. Leaders of the tribal communities9. Business leaders10. Legislative leaders11. Representatives of the State administration Attendees were provided an executive summary of the assessment as well as a summary table of data reflective of the service area. A presentation was made by EMHS staff who led the assessment, providing sample data, trends over time and the priorities and recommendations as suggested by the research consultants. Maine Coast Memorial Hospital Part V, Section B, Line 4: The needs assessment was developed as a statewide collaborative between the state's three largest health systems: EMHS (in central, eastern and northern Maine), Maine General (in central Maine) and MaineHealth (in southern Maine). Multiple collaborators were involved in the dissemination of the assessment findings and establishment of priorities. Maine Coast Memorial Hospital Part V, Section B, Line 20d: All patients are billed/charged an amount equal to gross charges and then depending on their insurance payment, prompt pay discounts or discounted care are balance billed the unpaid or adjusted amount. 18 Ellsworth Internal Medicine 32 Resort Way Ellsworth ME 04605 Physician Practice Ellsworth Family Practice 32 Resort Way Ellsworth ME 04605 Physician Practice Maine Coast Pediatrics 32 Resort Way Ellsworth ME 04605 Physician Practice Eleanor Widener Dixon Memorial Clinic 37 Clinic Road Ellsworth ME 04605 Physician Practice Southwest Harbor Medical Center 45 Herrick Road Ellsworth ME 04605 Physician Practice Maine Coast Specialty Clinic 306 Main Street Ellsworth ME 04605 Physician Practice Maine Coast Urology 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Rheumatology 50 Union Street Ellsworth ME 04605 Physician Practice Down East Dermatology 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast General Surgery 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Women Care 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Hand & Shoulder 50 Union Street Ellsworth ME 04605 Physician Practice Frenchman Bay Orthopedics 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Otolaryngology 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Memorial Hospital Nocturn 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Neurology Clinic 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Cardiology Clinic 50 Union Street Ellsworth ME 04605 Physician Practice Maine Coast Psychiatry Clinic 50 Union Street Ellsworth ME 04605 Physician Practice Part I, Line 3c: Maine Coast Regional Health Facilities uses the Federal poverty guidelines to determine eligibility. Part I, Line 7: The IRS 990H Instructions/Guidance provide a template (Worksheet 2 Template) as a way to determine the overall cost to charge ratio that could be applied throughout the IRS 990H form in order to convert charges to cost. Where applicable, we have utilized the worksheet 2 template calculation. The only areas we did not utilize this template calculation were the following. A. IRS 990H worksheet 6- Subsidized Health Services- (The supporting schedule for Part I, Line 7G) we did not utilize the worksheet 2 percentage when we were determining the profit/ loss of each of our provider based clinics. In addition, when we were compiling the subsidized provider based clinics listed in 1C above, we utilized the actual estimated costs on the modified Medicare cost report we prepared instead of applying the worksheet 2 cost to charge percentage. B. IRS 990H Worksheet 3- Unreimbursed Medicaid and other means tested government programs (the supporting schedule for Part I, Lines 7B and 7C) and worksheet 6 Medicaid allowable costs for the subsidized health services listed in line 1C above (part of the line 7G costs) - we did not utilize the worksheet 2 percentage when calculating the Medicaid allowable cost. Instead we utilized the actual Medicaid filed cost report for the allowable costs. Part I, Line 7g: Maine Coast Regional Health Facilities has several provider based physician practices. Per the instructions for IRS Form 990H, Worksheet 6, we are allowed to include any applicable physician practice that the Hospital subsidizes (i.e., operates at a loss). As such, we have included the following provider based physician practices that operate at a loss (i.e., are subsidized by the Hospital) and the associated costs of these practices.A. Southwest Harbor ClinicB. Ellsworth Internal MedicineC. PediatricsD. Cardiology E. Family PracticeF. Frenchmans Bay ClinicG. Womens Care ClinicH. Hand & Shoulder ClinicI. Specialty ClinicJ. Gouldsboro ClinicK. Otolaryngology ClinicL. General SurgeryM. Psychiatry N. NeurologyThe above listed provider based physician practices have a community benefit (i.e., aggregate loss or subsidy from the Hospital) of approximately $4.4 million. This community benefit does not include any hospital overhead allocated to these clinics. In addition, the community benefit also does not take into account bad debts, charity care and contractual adjustment. Thus this community benefit of approximately $4.4 million is a conservative figure that reconciles to the community benefit reported on IRS form 990H, Part I, Line 7G, Column E.Community Building ActivitiesMaine Coast Regional Health Facilities provides a variety of resources for several different types of community building activities. These resources include, but are not limited to:-Free monthly education sessions-CPR classes-Free mammograms-Volunteer and pet therapy program-Speaking engagements relative to prevalence of cancer in the area by the oncology director-Heart healthy community wellness program-Physician referral phone system-Disease management-Cardiac rehab exercise program-Nursing education for local students Part I, Ln 7 Col(f): Bad debt expenses are no longer part of the expense grouping on the income statement of the audited financial statements. They are included as a deduction from revenue. As such, the Part I, Line 7 column f calculation, per the IRS instructions, are already net of bad debt expense. Schedule H, Part I, Line 6a: Maine Coast Regional Health Facilities prepares a community benefit report through its annual report process. The annual report is available three months after fiscal year end. Within the annual report the Hospital describes community benefit in financial terms and a summary of services provided. This includes the losses from: subsidized physician practices; subsidized community health and wellness programs; the cost of patients who cannot afford to pay; Medicaid and Medicare shortfalls; and patients who do not pay or are unable to pay. Part III, Line 4: Maine Coast Regional Health Facilities, in compliance with accounting guidelines, classify bad debts as a deduction from revenue. The Hospital follows the Medicare guidelines for allowable bad debts. It uses the following criteria:a. Establishing that reasonable collection efforts were madeb. Establishing that the accounts were uncollectiblec. Establishing that there is no likelihood of recovery at anytime in the futureThe bad debt adjustment is at cost and is the total write-offs reduced by the ratio of patient care cost to charge. Part III, Line 8: The IRS 990H instructions/guidance provide a template (worksheet 2 template) as a way to determine the overall cost to charge ratio that could be applied throughout the IRS 990H form in order to convert charges to cost. Where applicable, we have utilized the worksheet 2 template calculation. The only area where we did not utilize this template calculation was in form 990H worksheet B, Line 2 & 6- Medicare allowable costs and payments related to the subsidized health services- we utilized the Medicare cost report estimated cost and payment for these services. The Hospital believes that provider based clinics listed in 1C above should be and are considered a community benefit due to the fact that without the Hospital subsidizing and offering the services that these clinics offer, the community at large would have to travel at least 45 minutes to the nearest like hospital and that hospital's service offerings. As such, Maine Coast believes that by offering and subsidizing these clinics within its community and thus enabling community members to have easy access and an easier commute for these services, that this benefits the whole community at large. Part III, Line 9b: When a patient is referred out to collections but then applies for free or discounted care, we pull the account back from collections when it is determined they qualify for one of the programs. If the collection agency suspects that someone may need to apply for one of the programs, they send out an application and notify us. We make every effort to screen as many people as possible before we send them to collections. Part VI, Line 2: Maine Coast Regional Health Facilities assessed the medical needs of the community as part of the process for establishing the medical staff development plan. The new medical staff and services were identified in the strategic planning process brought forth from the provider community. It then was determined and prioritized what services the Hospital could comfortably address and implement. 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 the 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 care/ discounted care and providing information on Mainecare. For inpatients, there is a book in the room which provides all the information on all programs available.Scheduled medical imaging, surgery patients and inpatients all generally speak with a hospital employee who can provide information on available programs. Inpatients are also offered the services of unicare to assist them with applying for Mainecare. Patient accounting staffs are generally available to assist any patient inquiring about programs when presenting for services. Through the patient accounting department, we provide the information on the statements. We also counsel patients on the phone about all the programs available whether it is a hospital program or Medicaid. Part VI, Line 4: Maine Coast Regional Health Facilities Services, D/B/A Maine Coast Memorial Hospital, is a 48 staffed bed full service acute care not-for profit hospital located in Ellsworth, Maine (Hancock 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, 24 hours emergency center, and diagnostic and surgical services. Along with hospital services, the Hospital employs the majority of primary and specialty care physicians in the area. It is the only full service hospital located in either Hancock or adjacent Washington County. The Hospital is regularly used as referral facility by the four (4) critical access hospitals located in these two counties as well.Hancock and Washington county is considered rural by the state of Maine and the United States Census Bureau, under guidelines set forth by the office of Management and Budget (OMB). The Hospital service area (HSA) as defined by the Maine Health Data Organization (MHDO) uses the statistical method where the greatest proportion of residents received their inpatient care. The following towns make up the Maine Coast Memorial Hospital HSA as determined by the MHDO:EastbrookBeddingtonDebloisCherryfieldEllsworthFranklinMilbridgeGouldsboroHancockLamoineMariavilleOsbornOtisSteubenSorrentoSullivanSurryTrentonWalthamWinter HarborOqiton TWPT3 NDT7 SDT8 SDT9 SDT10 SDT16 MDT22 MDT28 MDT34 MDT35 MDT39 MDT40 MDT41 MDThe following estimated 2014 demographics represent the counties served by Maine Coast Memorial Hospital(per the United States Census Bureau website): - Population: Hancock County 54,690; Washington County 31,808; State of Maine 1,330,000 - Persons < 5 yrs: Hancock County 4.4%; Washington County 4.8%; State of Maine 4.9% - Persons < 18 yrs: Hancock County 17.6%; Washington County 18.9%; State of Maine 19.7% - Persons 65 yrs & over: Hancock County 20.7%; Washington County 21.4%; State of Maine 17.7% - Median Household Income: Hancock County $47,461; Washington County $37,236; State of Maine $48,453 - Persons below poverty level: Hancock County 14.0%; Washington County 19.5%; State of Maine 13.6% Part VI, Line 5: Maine Coast Regional Health Facilities is a local not for profit hospital that serves its local communities and people regardless of their ability to pay. Maine Coast 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. Maine Coast'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. 1 LifeFlight Foundation PO Box 899 Camden ME 04843 522377085 501(c)(3) 10000 Operational Support 1 0 Part I, Line 2: The Organization makes payments only to other 501(c)(3) organizations. Therefore, additional monitoring was not deemed necessary. X 0 1 X X X X X 0 0 0 0 0 0 0 1 0 Robert A Beekman MD Trustee/Physician 173166 0 0 0 1524 0 4082 0 38100 0 216872 0 0 0 Sean T Maloney MD Trustee/Physician 244671 0 1353 0 180 0 5687 0 45200 0 297091 0 0 0 Charles D Therrien CEO 306633 0 22000 0 7476 0 5737 0 32079 0 373925 0 0 0 Sheena E Whittaker MD President of Medical Staff 231670 0 15505 0 3552 0 4788 0 39563 0 295078 0 0 0 Chris D Frauenhofer CFO 124600 0 10500 0 10611 0 5737 0 32079 0 183527 0 0 0 Sterling C Williamson Physician 314165 0 272929 0 47247 0 5737 0 55380 0 695458 0 0 0 Davor G Sklizovic Physician 370261 0 68398 0 556 0 3188 0 47185 0 489588 0 0 0 Martin R Curlik Physician 393427 0 22523 0 516 0 5738 0 37740 0 459944 0 0 0 Paul M Denoncourt Physician 302327 0 81588 0 90672 0 5738 0 33247 0 513572 0 0 0 Kerry W Crowley Physician 243676 0 123904 0 822 0 5393 0 49586 0 423381 0 0 0 Form 990, Schedule J, Part I, Line 1b: Travel for companions: The Board of Directors for the hospital are not compensated. In lieu of compensation meals are supplemented for their spouses when they are required to attend forums and seminars on behalf of the hospital. The amount involved is very minimal. Form 990, Part VII, Line 5: Richard Jeffcote, Past Interim CFO, received compensation from Leaders for Today (an unrelated third party) for services rendered to the Organization in calendar year 2013. His compensation was as follows: Compensation: $108,500 Form 990, Schedule J, Part I, Line 7: The bonus payments for Sterling C. Williamson, Davor G. Sklizovic, Martin R. Curlik, Paul M. Denoncourt, Kerry Crowley, Sheena Whittaker and Sean Maloney are RVU incentive payments. The bonus payments for Charles D. Therrien, CEO & Chris D. Frauenhofer, CFO, are fixed payments, made in accordance with their respective employment contracts. The Hospital also provided minimal holiday bonus payments to its employees based on their full-time, part-time and per diem status A MHHEFA 010314384 5604253L2 2008-12-03 6960000 Construction of Emergency Dept. 0 0 0 B MHHEFA 010314384 560427NM4 2011-11-30 1865000 Refunding Series 2001B 0 0 0 C MHHEFA 010314384 560427WV4 2013-05-23 4395000 Refunding Series 2003C 0 0 1 A 873869 6960000 498869 439006 131414 5890711 2009 0 0 1 1 B 477656 1865000 210238 35050 0 0 1 1 C 4395000 341913 52407 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 0 B 0 0 1 0 0 1 0 0 0 0 0 C 0 0 1 0 0 0 0 0 0 A 0 B 0 C 0 Bar Harbor Bank & Trust An entity of which Daniel Hurley, current Trustee serves as an officer Mr. Hurley is an officer of a bank with which the Hospital does business. All transactions between the Hospital and the bank are at arm's length and for fair value. It is not possible to readily determine the monetary amount that the bank derives from this relationship. 0 Form 990, Part VI, Section A, line 2 Rebecca Sargent and Debra Ehrlenbach have a business relationship. Form 990, Part VI, Section A, line 6 Maine Coast Healthcare Corporation is the sole member of the Organization. Form 990, Part VI, Section A, line 7a The Member shall have the right to elect trustees and honorary trustees to the board of trustees. Form 990, Part VI, Section A, line 7b The following decisions are subject to approval by the Member of the Organization: 1. The removal of members of the Board of Trustees; 2. The change of the number of Trustees constituting the Board of Trustees with the limitations prescribed in the Articles of Incorporation; 3. The amendment, restatement, or modification of the Bylaws or Articles of Incorporation of the Corporation; 4. The approval of the sale, mortgage, lease, or other dispositions of all, or substantially all, of the assets and property of the Organization, the dissolution of the Organization, or its merger with or consolidation into another Organization; 5. The right to approve the donation, unfunded directly from, or other expenditure of corporate assets, whether principal or income; 6. The right to approve corporate strategic planning goals, objectives, and capital expenditure plans; 7. The right to approve substantial program changes, including health services; 8. The right to approve the Organization's cumulative annual borrowings in any amount exceeding one percent of the annual gross revenues of the Organization as set forth in the most recent annual financial statements of the Organization; 9. The right to approve the appointment of an auditor for the Organization; and 10. Upon recommendation of the Board of Trustees, the right to appoint or remove the President and Treasurer. Form 990, Part VI, Section B, line 11 Prior to filing, a presentation on the Form 990 was provided to the leadership of the board of trustees, and a copy of the form was provided to the entire board. Form 990, Part VI, Section B, Line 12C: MCMH's policies and procedures require that all board members, senior leaders, department managers, and medical staff members disclose any potential conflicts of interest in writing. These forms are reviewed by the Board Chair, the Human Resource Director, or the compliance officer, depending on the disclosing individual's role. Form 990, Part VI, Section B, line 12c Examples of how potential conflicts are managed include disclosing the conflict when applicable, (e.g., during discussions at the board meeting) and excusing the party with the potential conflict from participation and voting. Form 990, Part VI, Section B, line 15 Executive Committee with the help of the search firm and Maine Hospital Association salary survey was used to set the compensation levels for the CEO. The MHA survey was primarily used to set the compensation levels for the top management officials. Form 990, Part VI, Section C, line 19 Government documents and conflict of interest policy are available upon request. The financial statements are made public through the annual report. Form 990, Part XI, line 9: Change in Value of Trust 11,771. Intercompany Equity Transfer -222,906. Maine Coast Medical Realty Inc 50 Union Street Ellsworth ME 04605 010390918 Furnishing Medical Facilities ME 501(c)(3) Line 11a, I Maine Coast Regional Health Facilities 1 Maine Coast Healthcare Corporation 50 Union Street Ellsworth ME 04605 223176167 Parent Organization for Hospital ME 501(c)(3) Line 11b, II N/A 0 Maine Coast Healthcare Foundation 50 Union Street Ellsworth ME 04605 262344952 Raise and hold donations for hospital ME 501(c)(3) Line 11a, I Maine Coast Regional Health Facilities 1 Maine Coast Physician Affiliates 50 Union Street Ellsworth ME 04605 010479952 Inactive ME Maine Coast Healthcare Corporation C 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 Maine Coast Healthcare Foundation C 123449 FMV Maine Coast Medical Realty Inc Q 75000 FMV Maine Coast Healthcare Foundation Q 51691 FMV