2014-08-13T10:50:06-05:00 2013-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2012-10-01 010234189 Northern Maine Medical Center NORT 2078343155 194 East Main Street Fort Kent ME 04743 Peter J Sirois 2078343155 2014-08-12 1 Barbara J McGuan CPA P00219457 2077752387 2014-08-12 2012 2015-11-30 17:44:51Z Peter J Sirois 194 East Main Street Fort Kent ME 04743 46875759 0 X www.nmmc.org X 1948 ME Acute care & long term care hospital and mental health services facility. 11 7 563 16 30477 -39967 326474 661490 51508846 44712601 13679 -379803 532772 909087 52381771 45903375 0 0 0 0 20365008 26308386 0 0 0 23459225 18074245 43824233 44382631 8557538 1520744 41506381 46612884 17987370 21562847 23519011 25050037 The mission of Northern Maine Medical Center is to provide, coordinate, or support access to high quality, affordable health care and to positively impact our communities' quality of life by improving health status. 0 0 36948463 45314363 Medical care & ancillary services, nursing home & skilled services, physician services. 36948463 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 75 0 1 563 1 1 1 0 0 0 0 0 0 0 0 0 X 11 7 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Cindy Daigle 2078343155 194 East Main Street Fort Kent ME 04743 X Dan Vaillancourt 1.00 0.50 X 0 0 0 Ronald Daigle 2.00 1.00 X X 0 0 0 Clifford Ouellette 1.00 0.50 X X 0 0 0 Frances LaBrie 1.00 0.50 X X 0 0 0 Glenn Lamarr 1.00 0.50 X X 0 0 0 Guy Raymond MD 50.00 0.50 X 374180 0 27253 John Ezzy 1.00 0.50 X 0 0 0 Norman Fournier 1.00 0.50 X X 0 0 0 James Thibodeau 1.00 0.50 X 0 0 0 Mark Morneault 1.00 0.50 X 0 0 0 Robert Bellefleur 1.00 0.50 X 1115 0 0 Michael Sullivan MD 50.00 0.50 X 461783 0 25401 Mark Chamberland 1.00 0.50 X 0 0 0 Peter J Sirois 50.00 0.50 X 178915 0 25834 Cindy L Daigle 50.00 0.50 X 133328 0 20412 David Jones 50.00 0.00 X 340562 0 18859 Eve Wolinsky 50.00 0.00 X 207223 0 9246 Mark Overton 50.00 0.00 X 181859 0 19702 William Rand 50.00 0.00 X 176722 0 3472 David Coffman 50.00 0.00 X 140766 0 3546 2196453 0 153725 12 0 1 0 Quest Diagnostics 12436 Collections Center Drive Chicago IL 606932436 Off-Site Laboratory Services 457798 Erik St Pierre MD PO Box 32 Fort Kent ME 04743 ER Physician Coverage 449352 Cary Medical Center 163 Van Buren Road Suite 1 Caribou ME 04736 Off-Site Laboratory Services 389253 Synernet Inc 110 Free Street Portland ME 04101 Off-Site Transcription Services 351039 QIR 105 Continental Place Brentwood TN 370271018 Management & Consulting Services 266726 9 575000 86490 661490 Patient Service Revenue 623000 71911300 71911300 Meaningful Use Revenue 623000 1048878 1048878 Miscellaneous Revenue 623000 518411 361135 30477 126799 Provision for Bad Debt 623000 -1354273 -1354273 Contractual/Char. Adj. 623000 -27411715 -27411715 44712601 14207 14207 113849 0 113849 113849 113849 562000 956010 -394010 -394010 -394010 52574 16374 36200 36200 Insurance Captive 900099 759038 759038 759038 45903375 45314363 30477 -102955 1248221 888617 359604 21131404 16988617 4142787 303196 243203 59993 2179820 1769676 410144 1445745 1156596 289149 164066 131253 32813 62529 50023 12506 306407 245126 61281 63751 51001 12750 5031677 4038441 993236 1652951 1322361 330590 238124 190499 47625 314021 251217 62804 2134192 1707353 426839 960236 768189 192047 Medical Supplies 4023374 4023374 Valley Medical Associat 1956056 1956056 Health Care Provider Ta 1166861 1166861 44382631 36948463 7434168 0 1429127 308223 5155387 11811311 5956715 5792616 16096 67585 76856 785292 716381 264800 272240 43727619 24486596 16681782 19241023 73287 109488 226141 515861 10866265 7752789 41506381 46612884 5326367 6767375 8525281 8565946 4135722 6229526 17987370 21562847 X 23131004 24674605 388007 375432 23519011 25050037 41506381 46612884 1520744 10282 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11110 11110 0 Explanation of Lobbying Activities: Part II-B, Line 1: The Hospital pays dues to various organizations, a portion of which is attributable to lobbying expenses. 196477 196477 21869699 8655138 13214561 1065483 956024 109459 18765152 14875434 3889718 1830808 1830808 19241023 Deferred Compensation 682904 Cash Surrender Value of Life Insurance 227164 Interest in Synernet Reinsurance 1913030 Meaningful Use Receivables 636607 Estimated Third-Party Payor Settlements 2615084 Insurance Claim Receivable 1678000 7752789 Deferred Compensation 682904 Estimated Third-Party Payor Settlements 5471429 Due to Affiliate 75193 6229526 Part X, Line 2: The Medical Center and VMA are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Medical Center's tax positions and concluded the Medical Center has maintained its tax-exempt status, does not have any significant unrelated business income and has taken no uncertain tax positions that require adjustment or disclosure in the consolidated financial statements. 2013 Cancer Fund Tour 15155 15155 1991 607 1375 Mammography Fund Raising 37419 37419 760 4340 2750 3021 1530 52574 52574 760 6331 2750 3628 2905 16374 36200 1 1 X 1 X 1 X 0 1 1 0 0 558721 558721 0.01260 3735838 1954392 1781446 0.04010 4294559 1954392 2340167 0.05270 21517099 17938240 3578859 0.08060 21517099 17938240 3578859 0.08060 25811658 19892632 5919026 0.13330 1 815504 15024121 15929950 -905829 X 1 0 2 1 Northern Maine Medical Center

194 East Maine Street Fort Kent ME 04743

X X X 2 Forest Hill

20 Bolduc Avenue Fort Kent ME 04743

X Licensed Hospital Related Facility Northern Maine Medical Center 1 1 X X X X X X X X X 11 1 1 1 X X X X X X 0 0 1 1 200.000000000000 1 250.000000000000 1 X 1 1 X X X 1 0 X X X X 1 X 0 0 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. Form 990, Part I, Line 3c: Northern Maine Medical Center uses the Federal Poverty Guidelines to determine eligibility. Part II: 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. 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 (HSA) as defined by the Maine Health Data Organization (MHDO) uses the statistical method to determine where the greatest proportion of residents received their inpatient care. The following towns make up the NMMC HSA as defined by the MHDO: Allagash, Eagle Lake, Fort Kent, Frenchville, Grand Isle, Madawaska, New Canada, St. Agatha, St. Francis, St. John Plt, Wallagrass, Winterville Plt., Big Twenty Twp and several surrounding 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 engaged multiple health resource leaders in the community forum invitation list. Additional resources and leaders needed were identified in the breakout sessions. 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 2011, was conducted under a contract with the University of New England Center for Health Planning, Policy and Research (CHPPR) and the University of Southern Maine's Muskie School for Public Health. Using a methodology developed by CHPPR over decades of work, the assessment integrates primary data from a telephone survey to heads of households with secondary data retrieved from state databases (ED usage, Mortality, Cancer Registry, etc.). That data is reviewed in the context of multiple health related domains to develop a composite view of health status, behavioral risks, and barriers to access and care. Results are compared to national and state benchmarks to produce priorities and recommendations as prepared by the consultants. Northern Maine Medical Center Part V, Section B, Line 3: On a statewide basis, the research consultants developed an advisory committee that met two times during the assessment research and drafting of the publication. These individuals represented a broad spectrum of backgrounds, and include: Carol Bell, Healthy Maine Partnership director; Kelly Bentley, Healthy Maine Partnership director; Gail Dana-Sacco, Wabanaki Center (serving tribal populations); Patricia Hart, Maine Development Foundation; Barbara Leonard, MPH, Maine Health Access Foundation(philanthropic foundation focused on access to care in Maine); Becca Matusovich, Maine Center for Disease Control; Lisa Miller, Bingham Foundation (philanthropic foundation); Dora Ann Mills, MD, Maine Center for Disease Control; Elizabeth 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); RachelTalbot-Ross, Maine Chapter, NAACP; and, Ted Trainer, Public HealthCoordinating Council Shawn Yardley, City of Bangor, Department of Healthand Welfare. Northern Maine Medical Center 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), MaineGeneral (in central Maine) and MaineHealth (in southern Maine). Multiple collaborators were involved in the dissemination of the assessment findings and establishment of priorities. Northern Maine Medical Center Part V, Section B, Line 5c: In conjunction with EMHS, Northern Maine Medical Center co-hosted a community forum with The Aroostook Medical Center and Cary Medical Center to present an overview of local assessment results and recommendations. Invitees included: other area hospitals, physician leaders, federally qualified health centers, healthy Maine partnerships, district liaisons linked to Maine CDC, home health and long term care leaders, social service agencies, leaders of the tribal communities, business leaders, legislative leaders, and representatives of the State administration.Attendees were provided an executive summary of the assessment as well asa summary table of data reflective of the service area. A presentation wasmade by EMHS staff who were members of the assessment development steeringcommittee providing selected data results, trends over time and thepriorities and recommendations as suggested by the research consultants.In addition to the community forums, the entire statewide assessment (bothnarrative and data sets) was posted to the EMHS website. After the forums,power point presentations used at the forum, as well as input collected inthe breakout sessions, were also posted on the website. Forum participantswere encouraged to go to the website to review the assessment in detail,and access the data for local planning. Media releases were also sent tolocal news outlets in combination with the forums, encouraging newarticles on the forum and inviting all members of the public to view thereport on the website.Instructions on the website assist viewers to download and/or print sections of the report. Individuals without computer or printer access were provided a phone number where they can request a printed assessment. Northern Maine Medical Center Part V, Section B, Line 6i: Northern Maine Medical Center made progress on the following initiatives that were undertaken to meet the prioritized needs identified by the community needs assessment:-NMMC continues its consideration of a workplace wellness program. There were issues with the way the baseline health assessment was initially made available by a third-party, which in turn resulted in questionable results. NMMC is contemplating other means of obtaining reliable baseline results. NMMC will be able to use the overall results to develop a wellness program appropriate to the needs of its employees.-NMMC has obtained certification of its diabetes education program and continues to make strides in rebuilding its diabetes education programs and support group. We have introduced new monitoring technology to some of our patients. We are evaluating referral sources since our volumes seem low compared to the demand documented in the Community Health Needs Assessment.-NMMC has implemented an electronic medical record in its physician practices. The software has the ability to generate reports to better monitor patients with chronic conditions and the completion/status of recommended treatment plans. The staff have recently received training on how to generate those reports and is starting to use them to improve management of these patients with chronic conditions. In addition, the hospital has entered into an Accountable Care Strategic Contractor Agreement whereby the ACO has entered into a contract with a payor to perform population health management services for covered lives some of which receive services at NMMC. NMMC is working to address care gaps identified in the ACO reports.-NMMC has collaborated with other local hospitals and providers to ensure the necessary specialty services are available. The following specialty services were obtained through agreements with other hospitals either on an interim basis or on-going: Anesthesia Director Services, Sleep Medicine professional and technical services, oncologist coverage, neurologist services, and radiologist services. NMMC continues to look for opportunities to work with other hospitals to provide specialty services in our community.-NMMC continues to make other health care providers aware of the mental health services it offers on both an inpatient and outpatient basis. Additional mid-level providers were recruited to allow NMMC to expand access to outpatient mental health services.-NMMC has signed a contract with Health Info Net, Maine's Health Information Exchange to improve quality and effectiveness through better information exchange. At this time, NMMC and Health Info Net continue working on integration between NMMC's information system and Health Info Net. NMMC also has entered into an agreement with the closest tertiary facility, EMMC, for certain access to their PowerChart, which can benefit the transition of care from the tertiary back to the local, primary care providers. Northern Maine Medical Center Part V, Section B, Line 7: Northern Maine Medical Center was unable to address all needs identified due to limited staff and financial resources. Certain needs, such as increased insurance coverage and improved Medicaid reimbursement for dental services, have not been addressed since NMMC can only be a portion of the solution; other entities will need to be involved to address all of the needs. NMMC continues to evaluate the feasibility of rebuilding its patient education component, so certain needs, such as community level prevention programs and primary care and ED education tools can be addressed once the education framework is in place again. 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. 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. X X X 0 0 0 0 0 0 0 0 1 1 Guy Raymond MD 357180 0 0 0 17000 0 6219 0 21034 0 401433 0 0 0 Michael Sullivan MD 458269 0 0 0 3514 0 3700 0 21701 0 487184 0 0 0 Peter J Sirois 178203 0 0 0 712 0 3287 0 22547 0 204749 0 0 0 Cindy L Daigle 133328 0 0 0 0 0 0 0 20412 0 153740 0 0 0 David Jones 323892 0 0 0 16670 0 5727 0 13132 0 359421 0 0 0 Eve Wolinsky 185360 0 5000 0 16863 0 0 0 9246 0 216469 0 0 0 Mark Overton 181859 0 0 0 0 0 0 0 19702 0 201561 0 0 0 William Rand 126722 0 50000 0 0 0 0 0 3472 0 180194 0 0 0 Part I, Line 8 Eve Wolinsky & William Rand each received a sign-on bonus pursuant to their respective employment contracts. Mark Overton Employee Purchase of home X 27900 16096 0 0 1 16096 Daigle Oil Company Entity of which Dan Vaillancourt, Board President, is an officer 384705 Independent Contractor Arrangement 0 Nola Sirois Family member of Peter Sirois, Hospital CEO 25605 Employment 0 Michelle L Plourde Family member of Peter Sirois, Hospital CEO 62254 Employment 0 Nicole Marquis Family member of Peter Sirois, Hospital CEO 38094 Employment 0 Robin Werntgen Family member of Glenn Lamarr, Board Treasurer 55989 Employment 0 Form 990, Part I, Lines 8-18: Prior Years numbers have been restated to present revenue net of bad debt expense. 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: Guy Raymond & Michael Sullivan show reportable compensation on Form 990, Part VII, Section A for services performed in their capacity as employees of Northern Maine Medical Center. Their compensation does not reflect payment for services as a board members of the Hospital or any related organization. Valley Medical Association 194 East Maine Street Fort Kent ME 04743 223245434 Medical Physician Practice ME 501(c)(3) Line 3 Northern Maine Medical Center 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 Valley Medical Association R 1956056 Actual Outlay