2014-05-12T10:20:50-05:00 2013-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2012-07-01 010215227 RUMFORD HOSPITAL % PHIL MORISSETTE RUMF 2077952972 420 FRANKLIN STREET Suite RUMFORD ME 04276 R DAVID FRUM 2077952972 2014-04-25 true Brian D Todd 4178658701 2012 2015-11-30 17:44:51Z R DAVID FRUM 420 FRANKLIN STREET RUMFORD ME 04276 41600224 false X WWW.RUMFORDHOSPITAL.ORG X 1974 ME RUMFORD HOSPITAL STRIVES TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES. THE HOSPITAL DEPENDS ON THE EXPERTISE OF ITS CAREGIVERS IN ADDITION TO THE COMMITMENT AND COMPASSION THEY PROVIDE TO FULFILL ITS MISSION. 10 9 354 9 0 0 125819 55786 37475529 36221486 116143 186375 -38948 -23687 37678543 36439960 10000 0 0 0 16722232 16927578 0 0 0 21181377 19822342 37913609 36749920 -235066 -309960 26151909 30408979 7453217 12025243 18698692 18383736 TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES IN A SAFE AND TRUSTFUL ENVIRONMENT THROUGH THE EXPERTISE, COMMITMENT AND COMPASSION OF OUR FAMILY OF CAREGIVERS. false false 28478425 36221486 RUMFORD HOSPITAL IS A CRITICAL ACCESS HOSPITAL, PROVIDING COMPREHENSIVE PRIMARY CARE & SOPHISTICATED DIAGNOSTIC SERVICES, INCLUDING CT SCANNING, ULTRASOUND AND NUCLEAR MEDICINE. THE HOSPITAL OFFERS MEDICAL SURGICAL NURSING SERVICES, A BIRTHING CENTER, WOMEN'S HEALTH SERVICES & AMBULATORY SURGERY. THE SWING BED PROGRAM PROVIDES CARE FOR PATIENTS WHO NEED SKILLED NURSING SERVICES. RUMFORD HOSPITAL ALSO MAINTAINS A 24 HOUR EMERGENCY DEPARTMENT AND STAFFS AN INTENSIVE CARE UNIT. 28478425 true false false true false false false false false true true false false true true false false true false false false false false false false false true true false false true false false false true false false false false false false false false false true false false false true 43 0 true 354 true false false false false false false false false false false X 10 9 true false false false true true true true true false false true true true true true true false false false ME X PHIL MORISSETTE 2077952972 29 LOWELL STREET LEWISTON ME 04240 X PETER E CHALKE 1.0 60.0 X X 0 1819657 16326 STUART R COOPER 1.0 1.0 X 0 0 0 JOLAN IPPOLITO 1.0 X X 0 0 0 ROGER ARSENAULT 1.0 X 0 0 0 RICHARD LOVEJOY 1.0 1.0 X X 0 0 0 ROBERT STICKNEY 1.0 X X 0 0 0 LINDA CAMERON OD 1.0 X X 0 0 0 DAVID DUGUAY 1.0 X 0 0 0 JANET HALL 1.0 X 0 0 0 JERROLD COHEN 1.0 X 0 0 0 R DAVID FRUM 27.5 29.5 X 0 285233 40062 JOHN KROGER MD 55.0 X 198145 0 17996 JACOB LEDESMA MD 55.0 X 398952 0 18717 THOMAS DELUCA MD 55.0 X 323598 0 19312 SAID DAOUD MD 55.0 X 289752 0 20509 JEFFREY LYNDS MD 55.0 X 328470 0 11050 LARRY HOPPERSTEAD MD 55.0 X 364962 0 19193 1903879 2104890 163165 18 false true false CPS INC PHARMACY SERVICES 464370 LOCUMTENENSCOM LLC MEDICAL STAFFING 387478 WEATHERBY LOCUMS INC MEDICAL STAFFING 215184 TRI COUNTY MENTAL HEALTH SERVICES MEDICAL STAFFING 197069 HERBERT CONSTRUCTION LLC CONSTRUCTION 156608 8 55786 55786 NET PATIENT SERVICE REVENUE 900099 35072682 35072682 CAFETERIA REVENUE 722514 77042 77042 OTHER REVENUE 900099 1071762 1071762 36221486 60822 60822 0 0 5575 29262 -23687 0 -23687 -23687 5256555 5131002 125553 125553 125553 0 0 0 0 36439960 36221486 162688 X 0 0 0 0 216141 216141 0 0 13539957 9886364 3653593 382784 279641 103143 1894782 1387429 507353 893914 656181 237733 0 16863 16863 12716 12716 0 0 6156 6156 7264230 5332337 1931893 96822 71073 25749 2089917 1534113 555804 543152 398703 144449 0 666818 489480 177338 173294 127207 46087 0 0 55195 40516 14679 0 1115156 818585 296571 1078634 791776 286858 MEDICAL SUPPLIES & DRUGS 2938426 2938426 BAD DEBT 2807964 2807964 REPAIRS & MAINTENANCE 790718 580430 210288 LICENSES, DUES, SUBSCRIPTIONS 87104 63939 23165 79177 58120 21057 36749920 28478425 8271495 0 120379 131865 3095535 9213440 0 0 4216652 4036644 0 16106 0 0 0 0 226045 246917 849693 731154 31429817 18514919 12874857 12914898 227743 0 0 0 0 0 0 0 4541005 3117955 26151909 30408979 5585047 6234553 0 0 33107 60961 0 0 0 0 0 0 1835063 1629794 0 0 0 4099935 7453217 12025243 X 18196491 17892062 247626 237935 254575 253739 18698692 18383736 26151909 30408979 X -309960 -4160 -836 X false true X true false X false false false false false false false false true 7444 7444 false LOBBYING EXPENSES SCHEDULE C, PART II-B, LINE 1I PORTION OF DUES FOR PROFESSIONAL ASSOCIATIONS ATTRIBUTED TO LOBBYING EXPENSES - $7,444 502201 6910 -836 16601 491674 491734 12735 -2068 200 502201 499320 9000 10970 27556 491734 463891 13532 23747 1850 499320 536730 11068 -79304 4603 463891 0.51607 0.48393 false true true 89148 89148 14425278 6099424 8325854 15288842 12173389 3115453 1626549 242106 1384443 12914898 INVESTMENT IN CHARITABLE TRUST 64404 OTHER RECEIVABLES 166325 DEPOSITS 1125 EST AMT DUE FROM 3RD PARTIES 2886101 3117955 0 DUE TO AFFILIATES 4099935 4099935 36458070 -4160 -6992 -11152 36469222 -29262 -29262 36439960 36773026 29262 29262 36743764 6156 6156 36749920 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ENDOWMENT FUNDS ARE USED TO SUPPORT THE ORGANIZATION IN A VARIETY OF WAYS, DEPENDING UPON THE STATED PURPOSE OF EACH FUND. MANY OF THESE FUNDS HELP TO COVER COSTS OF CAPITAL EQUIPMENT PURCHASES, CONTINUING EDUCATION, OR FREE CARE. OTHERS ARE DESIGNATED TO SUPPORT SPECIFIC DEPARTMENTS OF THE HOSPITAL. UNCERTAIN TAX POSITION SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XI, LINE 2D $ (6,156) INVESTMENT MANAGEMENT FEES (836) CHANGE IN BENEFICIAL INTEREST OF PERPETUAL TRUST ----------- $ (6,992) OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XI, LINE 4B $ (29,262) RENTAL EXPENSES OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XII, LINE 2D $ 29,262 RENTAL EXPENSES true true X true X false true true false false 590433 590433 0.01740 6691258 3636110 3055148 0.09000 7281691 3636110 3645581 0.10740 7281691 3636110 3645581 0.10740 false 2807964 373459 12987359 12508678 478681 X true true 1 1 RUMFORD HOSPITAL

420 FRANKLIN STREET RUMFORD ME 04276

X X X X OUTPATIENT PHYSICIAN CLINIC RUMFORD HOSPITAL 1 true X X X X X X X X X 12 true false true X X X X X X X X X false false true true 150. false true X true true X X X X X X true false X X true X false false 5 DIXFIELD CLINIC

146 WEL STREET DIXFIELD ME 04224

OUTPATIENT PHYSICIAN CLINIC SWIFT RIVER CLINIC

430 FRANKLIN STREET RUMFORD ME 04276

OUTPATIENT PHYSICIAN CLINIC RIVER VALLEY INTERNAL MEDICINE

431 FRANKLIN STREET RUMFORD ME 04276

OUTPATIENT PHYSICIAN CLINIC RUMFORD SPECIALTY SUITES

431 FRANKLIN STREET RUMFORD ME 04276

OUTPATIENT PHYSICIAN CLINIC RUMFORD SURGICAL SPECIALISTS

431 FRANKLIN STREET RUMFORD ME 04276

OUTPATIENT PHYSICIAN CLINIC PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN F TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990, WAS REDUCED BY BAD DEBT EXPENSE OF $2,807,964. COSTING METHODOLOGY SCHEDULE H, PART I, LINE 7 THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED TO CALCULATE AMOUNTS ON IRS WORKSHEETS 1 AND 3. ALL OTHER WORKSHEETS USED THE ORGANIZATION'S COST ACCOUNTING SYSTEM. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: THE CORPORATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE CORPORATION PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE CORPORATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. LINE 2 REPORTS BAD DEBT EXPENSE FROM THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. BAD DEBT ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY FOR LINE 3 WAS DETERMINED USING A COMPARISON OF EXPERIENCED CHARITY CARE COVERAGE AND US CENSUS BUREAU DATA FOR THE MOST RECENT YEAR AVAILABLE WHEN CHARITY CARE CONVERGE EXCEEDS THE CENSUS DATA, A MINIMAL AMOUNT OF BAD DEBT IS ASSUMED TO BE ELIGIBLE FOR CHARITY CARE TO ACCOUNT FOR THOSE PATIENTS WHO REFUSE TO PROVIDE INFORMATION DOCUMENTING ELIGIBILITY FOR THE PROGRAM. THESE ESTIMATES ARE BASED ON STATE-WIDE DATA AND DO NOT ACCOUNT FOR DIFFERENCES IN GEOGRAPHIC LOCATIONS WITHIN THE STATE. AS THIS AMOUNT IS RELATED TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY, IT IS INCLUDED AS A COMMUNITY BENEFIT. MEDICARE COSTING METHODOLOGY SCHEDULE H, PART III, SECTION B, LINE 8 THE COSTING METHODOLOGY USED FOR LINE 6 IS INFORMATION PULLED FROM THE MEDICARE COST REPORT FILING. COLLECTION POLICY SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION PRACTICES FOR PATIENTS KNOWN TO BE ELIGIBLE FOR CHARITY CARE ARE LIMITED TO COLLECTING FROM ANY AVAILABLE PAYMENT SOURCES SUCH AS MEDICARE OR MEDICAID. IF A PATIENT IS ELIGIBLE, BUT HAS NOT APPLIED FOR MEDICAID COVERAGE, THE PATIENT IS REQUESTED TO APPLY. ASSISTANCE IS AVAILABLE TO HELP THE PATIENT WITH THE MEDICAID APPLICATION PROCESS. COMMUNITY INPUT SCHEDULE H, 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 THEY ARE NAMED: 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); RACHEL TALBOT-ROSS, MAINE CHAPTER, NAACP; TED 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. IMPLEMENTATION STRATEGY SCHEDULE H, PART V, SECTION B, LINE 6 IN RESPONSE TO THE RESULTS OF RUMFORD HOSPITAL'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY CAN BE FOUND AT THE FOLLOWING URL: HTTP://WWW.RUMFORDHOSPITAL.ORG/COMMUNITY-BENEFITS ADDRESSING IDENTIFIED NEEDS SCHEDULE H, PART V, SECTION B, LINE 7 RUMFORD HOSPITAL IS NOT DIRECTLY ADDRESSING MENTAL HEALTH AS THIS IS WIDELY COVERED BY MENTAL HEALTH AGENCIES IMBEDDED WITHIN OUR PRIMARY CARE PRACTICES. OTHER METHODS USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY SCHEDULE H, PART V, LINE 14G THE FAP IS POSTED IN ALL OUTPATIENT DEPARTMENTS INCLUDING PROVIDER BASED PHYSICIANS' OFFICES, PATIENT FINANCIAL SERVICES, AND IS OFFERED TO ANY PATIENTS INDICATING A FINANCIAL NEED WHEN THEY CALL CUSTOMER SERVICE OR PRESENT THEMSELVES IN THE PATIENT FINANCIAL SERVICES DEPARTMENT. MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS SCHEDULE H, PART V, SECTION B, LINE 20D FAP-ELIGIBLE PATIENTS ULTIMATELY RECEIVE FREE CARE. IF THE PATIENT HAS INSURANCE, THE INSURANCE COMPANY WOULD BE BILLED AND ONLY THE PATIENT RESPONSIBILITY PORTION, UNDER THAT CARRIER'S CONTRACT, WOULD BE BILLED TO THE PATIENT. IF THE PATIENT IS UNINSURED, THE PATIENT WOULD BE BILLED WITH A 20% UNINSURED DISCOUNT FROM GROSS CHARGES. ONCE A PATIENT'S ELIGIBILITY IS CONFIRMED THROUGH THE FAP'S APPLICATION PROCESS, A FAP ADJUSTMENT WOULD BE APPLIED TO THE PATIENT'S ACCOUNT, BRINGING THE BALANCE TO ZERO. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 AS A CRITICAL ACCESS HOSPITAL, RUMFORD HOSPITAL ATTEMPTS TO PROVIDE ANY NEEDED HEALTH CARE SERVICES NECESSARY TO TREAT THE POPULATION OF THIS RURAL AREA OF MAINE. ADDITIONALLY, RUMFORD HOSPITAL FOCUSES ON STATE-WIDE INITIATIVES, SUCH AS HEART DISEASE AND DIABETES, AS WELL AS ORGANIZATIONAL INITIATIVES BASED ON NEEDS OBSERVED WITHIN ITS PATIENT POPULATION. MANY FORMS OF EDUCATION, PREVENTION AND EARLY DETECTION ARE ALSO PART OF ITS COMMUNITY HEALTH CARE PLAN. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 RUMFORD HOSPITAL PROVIDES NOTICES ABOUT ITS FREE CARE POLICY IN ALL CLINICAL DEPARTMENTS AND MAJOR PATIENT AREAS. AN INPATIENT FINANCIAL COUNSELOR VISITS WITH ALL UNINSURED PATIENTS TO DISCUSS OPTIONS, INCLUDING GOVERNMENTAL PROGRAM ELIGIBILITY AND FREE CARE ASSISTANCE IS AVAILABLE TO HELP PATIENTS WITH COMPLETION OF MEDICAID APPLICATIONS. ALL PATIENT FINANCIAL SERVICES STAFF ARE TRAINED TO OFFER FREE CARE AS AN OPTION TO PATIENTS WHO INDICATE AN INABILITY OR DIFFICULTY IN PAYING FOR SERVICES. INFORMATION ABOUT FINANCIAL ASSISTANCE AVAILABILITY IS INCLUDED ON THE BACK OF EVERY PATIENT STATEMENT. ADDITIONALLY, UNINSURED PATIENTS RECEIVE A SEPARATE INFORMATION SHEET WITH THEIR STATEMENTS, FURTHER INFORMING THEM ABOUT THE AVAILABLE OPTIONS. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 RUMFORD HOSPITAL, LOCATED IN RUMFORD, MAINE, SERVES CENTRAL OXFORD COUNTY ALONG THE WESTERN BORDER OF MAINE. A LIGHTLY POPULATED, RURAL AREA, THE REGION HAS A PRIMARILY CAUCASIAN POPULATION WITH 16% OF PERSONS AGED 65 OR OVER AND 14% OF THE POPULATION BELOW THE POVERTY LEVEL. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 RUMFORD HOSPITAL HAS AN OPEN MEDICAL STAFF, ALLOWING ANY NON-EMPLOYED OR AFFILIATED PHYSICIANS TO HAVE ADMITTING PRIVILEGES TO THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF A MAJORITY OF LOCAL COMMUNITY MEMBERS ALONG WITH SOME REPRESENTATION BY DIRECTORS FROM CENTRAL MAINE HEALTHCARE, THE PARENT OF THE HEALTHCARE SYSTEM WHICH RUMFORD HOSPITAL BELONGS TO, HELPING TO BRING TOGETHER THE VISIONS OF THE LOCAL COMMUNITY WITH THE CAPABILITIES AND VISION OF THE SYSTEM AS A WHOLE FOR THE BENEFIT OF RUMFORD AND SURROUNDING COMMUNITIES. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 AS A MEMBER OF THE CENTRAL MAINE HEALTHCARE SYSTEM, RUMFORD HOSPITAL PROVIDES HIGH QUALITY HEALTH CARE IN A RURAL SETTING WITH LIMITED HEALTH CARE OPTIONS. ITS AFFILIATION WITH CENTRAL MAINE MEDICAL CENTER PROVIDES ACCESS TO A MUCH LARGER, TERTIARY CARE HOSPITAL, INCLUDING TRAUMA CARE, NEONATAL INTENSIVE CARE, AND A SPECIALIZED CARDIAC CARE UNIT. ADDITIONALLY, CENTRAL MAINE MEDICAL CENTER PROVIDES ACCESS TO SPECIALIST PHYSICIANS FOR OUTPATIENT CARE IN THE RUMFORD AREA ON A REGULAR SCHEDULE. THE SYSTEM PARENT, CENTRAL MAINE HEALTHCARE, PROVIDES STREAMLINED ADMINISTRATIVE FUNCTIONS AND BACKROOM SERVICES, ALLOWING RUMFORD HOSPITAL TO PERFORM AT A COST EFFICIENT LEVEL WHICH WOULD NORMALLY BE UNACHIEVABLE IN A SMALL, RURAL HOSPITAL, ALLOWING FOR BROADER RANGE OF SERVICES AVAILABLE. false true false false false false false false false PETER E CHALKE 0 592553 0 0 0 1227104 0 11066 0 5260 0 1835983 0 1186628 JACOB LEDESMA MD 346579 0 41040 0 11333 0 6250 0 12467 0 417669 0 0 0 THOMAS DELUCA MD 284187 0 35009 0 4402 0 6365 0 12947 0 342910 0 0 0 SAID DAOUD MD 257955 0 20593 0 11204 0 3542 0 16967 0 310261 0 0 0 JEFFREY LYNDS MD 158346 0 160322 0 9802 0 6250 0 4800 0 339520 0 0 0 JOHN KROGER MD 195011 0 0 0 3134 0 5049 0 12947 0 216141 0 0 0 R DAVID FRUM 0 259024 0 0 0 26209 0 27115 0 12947 0 325295 0 10602 LARRY HOPPERSTEAD MD 347690 0 9100 0 8172 0 6250 0 12943 0 384155 0 0 0 EXECUTIVE COMPENSATION SCHEDULE J, PART I, LINE 3 THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT IS DETERMINED BY THE PARENT CORPORATION'S BOARD OF DIRECTORS' EXECUTIVE COMPENSATION COMMITTEE USING THE FOLLOWING: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B A PARTICIPANT'S ENTITLEMENT TO BENEFITS WILL VEST ON THE PARTICIPANT'S VESTING DATE PROVIDED THE PARTICIPANT HAS REMAINED IN CONTINUOUS EMPLOYMENT IN THE SAME POSITION WHILE PARTICIPATING IN THIS PLAN. A PARTICIPANT WILL HAVE ONLY ONE VESTING DATE FOR ALL ELECTIVE DEFERRALS AND OTHER PLAN CONTRIBUTIONS MADE ON THE PARTICIPANT'S BEHALF DURING ALL PLAN YEARS. A PARTICIPANT'S ENTITLEMENT TO BENEFITS WILL ALSO VEST (A) IF THE PARTICIPANT DIES WHILE STILL EMPLOYED BY THE EMPLOYER, (B) IF THE PARTICIPANT'S EMPLOYMENT TERMINATES DUE TO TOTAL DISABILITY, OR (C) IF THE EMPLOYER TERMINATES THE PARTICIPANT'S EMPLOYMENT FOR ANY REASON OTHER THAN FOR "CAUSE". ANY PORTION OF THE PARTICIPANT'S ENTITLEMENT BENEFITS THAT IS NOT VESTED WHEN THE PARTICIPANT'S EMPLOYMENT WITH THE EMPLOYER TERMINATES, INCLUDING ELECTIVE DEFERRALS, WILL BE FORFEITED. THE EMPLOYER WILL DISTRIBUTE A PARTICIPANT'S BENEFITS UNDER THE PLAN AS SOON AS PRACTICABLE AFTER THE PARTICIPANT'S ENTITLEMENT BECOMES VESTED. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH CENTRAL MAINE HEALTHCARE CORPORATION, A RELATED ENTITY. $ 21,000 R. DAVID FRUM (DEFERRAL) 10,602 R. DAVID FRUM (PAYOUT) 1,186,628 PETER CHALKE (PAYOUT) COMPENSATION REPORTED IN PRIOR FORM 990 SCHEDULE J, PART II, COLUMN F COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS VESTED OR PAID TO THE INDIVIDUAL. JEFFREY LYNDS EMPLOYEE ADVANCE X 25000 16106 false false true 16106 MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINES 6, 7A AND 7B THE MEMBER OF THE CORPORATION SHALL BE CENTRAL MAINE HEALTHCARE CORPORATION, A CORPORATION DULY ORGANIZED UNDER THE LAWS OF THE STATE OF MAINE. THE MEMBER SHALL HAVE THE RIGHT TO (A) APPROVE THE ELECTION OF MEMBERS OF THE BOARD OF DIRECTORS, (B) REMOVE MEMBERS OF THE BOARD OF DIRECTORS, AND (C) APPROVE CERTAIN DECISIONS OF THE BOARD OF DIRECTORS, AS DETAILED IN THE BYLAWS OF THE CORPORATION. THERE SHALL BE NINE (9) DIRECTORS OF THE CORPORATION WHO SHALL BE ENTITLED TO VOTE ONE (1) OF THE NINE (9) VOTING DIRECTORS SHALL BE APPOINTED BY THE MEMBER, AND THE BALANCE OF VOTING DIRECTORS SHALL BE ELECTED BY THE BOARD OF DIRECTORS. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B ALL AFFILIATED FORM 990's AND APPLICABLE SCHEDULES ARE PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM IN COOPERATION WITH THE FINANCE DEPARTMENT. THE COMPLETED RETURNS ARE REVIEWED WITH THE DIRECTOR OF FINANCE THEN WITH THE CFO FOLLOWING THAT REVIEW; THEY ARE PRESENTED TO THE FINANCE COMMITTEE OF THE CENTRAL MAINE HEALTHCARE BOARD OF DIRECTORS, WHICH HAS REPRESENTATIVES FROM ALL AFFILIATED BOARDS. ONCE THIS REVIEW IS COMPLETED, ANY NECESSARY CHANGES ARE MADE AND THE FINAL RETURN IS PRESENTED TO ITS RESPECTIVE BOARD WITH THE FINANCE COMMITTEE MEMBER TAKING AND ANSWERING QUESTIONS. A FINANCE DEPARTMENT REPRESENTATIVE, KNOWLEDGEABLE OF THE RETURN, IS AVAILABLE TO ASSIST DURING PRESENTATIONS, IF REQUESTED BY THE FINANCE COMMITTEE MEMBER. IN THE EVENT THAT THE NEXT BOARD MEETING IS NOT SCHEDULED UNTIL AFTER THE FILING DATE, THE FINAL RETURN IS MAILED TO ALL BOARD MEMBERS AND THE PRESENTATION OCCURS AT THE NEXT SCHEDULED BOARD MEETING. MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND DIRECTORS COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT WHICH IS REVIEWED BY THE CHAIRMAN OF THE BOARD AND CONFORMS TO THE CONDITIONS CONTAINED WITHIN THE CORPORATION'S BYLAWS, WHICH MEET OR EXCEED THE CURRENT IRS REPORTING THRESHOLDS. IN AREAS OF CONFLICT BY THE CHAIRMAN, THE VICE-CHAIRMAN REVIEWS. ADDITIONALLY, AS PART OF THE ANNUAL FORM 990 PREPARATION PROCESS, A SEPARATE QUESTIONNAIRE IS PROVIDED, WHICH INCLUDES DISTRIBUTION TO KEY EMPLOYEES, COVERING REPORTING AREAS OF LOANS, GRANTS, BUSINESS RELATIONSHIPS, AND OTHER CONFLICTS. THESE QUESTIONNAIRES ARE REVIEWED BY THE FINANCE DEPARTMENT FOR REPORTABLE ITEMS FOR THE FORM 990. IN THE CASE OF A POSSIBLE CONFLICT, THE BOARD WOULD REVIEW THE SITUATION AND TAKE ACTIONS DEEMED APPROPRIATE FOR THE POSSIBLE OR ACTUAL CONFLICTS OF MEMBERS OF THE BOARD OR THE EXECUTIVE OFFICERS. IN THE CASE OF KEY EMPLOYEES, THE REVIEW AND ACTIONS TAKEN WOULD BE PERFORMED BY THEIR DIRECT SUPERVISOR. EXECUTIVE COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & 15B A STANDING EXECUTIVE COMPENSATION COMMITTEE (ECC), COMPRISED OF INDEPENDENT MEMBERS OF BOARD LEADERSHIP, EXISTS TO UNDERTAKE THE PROCESS OF DETERMINING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER, PRESIDENT OF CENTRAL MAINE MEDICAL CENTER, PHYSICIAN PRACTICE EXECUTIVE, AND PRESIDENT OF RUMFORD AND BRIDGTON HOSPITALS. THE PROCESS GUIDELINES AND AUTHORITY OF THE ECC ARE SET OUT IN THE EXECUTIVE COMPENSATION PHILOSOPHY AND RESPONSIBILITIES CHARTER WHICH WAS APPROVED BY THE CMHC BOARD. THE ENTIRE CMHC BOARD PARTICIPATES IN THE ANNUAL PERFORMANCE EVALUATION OF EACH EXECUTIVE, INCLUDING A REVIEW OF ACCOMPLISHMENTS RELATIVE TO GOALS AND OBJECTIVES DERIVED FROM THE STRATEGIC PLAN. THE ECC REVIEWS THE RESULTS OF THE ANNUAL PERFORMANCE EVALUATION AND APPROPRIATE COMPARABILITY DATA BASED ON SEVERAL FACTORS RECOMMENDED BY AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT, WHO SPECIALIZES IN NOT-FOR-PROFIT HOSPITALS AND HEALTH SYSTEMS, AND OUR ATTORNEYS. FACTORS USED IN DETERMINING COMPARABILITY TO THE ORGANIZATION INCLUDE SIZE, GEOGRAPHY, ORGANIZATIONAL COMPLEXITY, FACILITY TYPE, OWNERSHIP TYPE, AND ANY OTHER FACTORS DEEMED RELEVANT BY THE COMMITTEE, ITS CONSULTANTS, OR ITS ATTORNEYS. USING THIS INFORMATION, THE ECC ANNUALLY REVIEWS THE EXECUTIVES' COMPENSATION TO DETERMINE IF MODIFICATION TO BASE SALARY IS WARRANTED, AND REVIEWS THE EXECUTIVES' ACCOMPLISHMENTS TO DETERMINE IF ANY VARIABLE PAY IS TO BE AWARDED. THE ENTIRE PROCESS IS THEN DOCUMENTED CONTEMPORANEOUSLY WITH THE DECISION-MAKING PROCESS AND APPROVED THEREAFTER IN ACCORDANCE WITH THE REQUIREMENTS OF THE IRS. THE COMPENSATION PAID TO KEY EMPLOYEES IS REVIEWED BY THE VICE PRESIDENT OF HUMAN RESOURCES AND ORGANIZATIONAL DEVELOPMENT. DURING THE REVIEW PROCESS, THE CENTRAL MAINE HEALTHCARE COMPENSATION MANAGER PROVIDES MARKET DATA ON COMPARABLE POSITIONS FROM COMPARATIVE GROUPS OF HEALTHCARE ORGANIZATIONS THAT ARE APPROPRIATELY SIMILAR IN TERMS OF THEIR REVENUE, GEOGRAPHIC LOCATION, NUMBER OF EMPLOYEES, NUMBER OF STAFFED HOSPITAL BEDS, ETC. HUMAN RESOURCES PROVIDES AT A MINIMUM FOUR SETS OF COMPARABILITY DATA FROM THE MOST RECENT NATIONAL HEALTHCARE SPECIFIC COMPENSATION SURVEYS (E. G. WATSON & WYATT, SULLIVAN & COTTER, THE HAY GROUP, MERCER, ETC) FOR REFERENCE. THESE SURVEYS REPORT PAY RATE DATA THAT IS TYPICALLY AGED LESS THAN 6 MONTHS. CENTRAL MAINE HEALTHCARE AND AFFILIATES STRIVE TO PAY AT THE MARKET AVERAGE OR SLIGHTLY ABOVE IT FOR KEY EMPLOYEES. ONCE THE COMPENSATION MANAGER AND THE VICE PRESIDENT OF HUMAN RESOURCES AND ORGANIZATIONAL DEVELOPMENT HAVE FINALIZED RECOMMENDATIONS BASED ON THIS EMPIRICAL DATA, THEY ARE PRESENTED TO THE PRESIDENTS OF EACH HOSPITAL THAT SUPERVISE THE KEY EMPLOYEES, AND THE CEO OF CENTRAL MAINE HEALTHCARE, FOR REVIEW, EDITS, AND APPROVAL. THIS PROCESS TYPICALLY OCCURS DURING THE LAST MONTH OF THE FISCAL YEAR IN PREPARATION FOR THE NEXT FISCAL YEAR CENTRAL MAINE HEALTHCARE DOCUMENTS THE BASIS FOR ITS DETERMINATION OF KEY EMPLOYEES' COMPENSATION AND MAINTAINS THIS CONTEMPORANEOUSLY SUBSTANTIATED MATERIAL IN THE HUMAN RESOURCES DEPARTMENT. PUBLIC DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST IN THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE FINANCIAL STATEMENTS OF THE ORGANIZATION ARE INCLUDED IN THE MOST RECENTLY FILED FORM 990 AND PROVIDED, UPON REQUEST, IN THAT FORMAT UNLESS THE SPECIFIC REQUEST DEEMS A DIFFERENT FORMAT MORE APPROPRIATE. BOARD MEMBER COMPENSATION FORM 990, PART VII, SECTION A, COLUMN B NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. PETER CHALKE IS EMPLOYED AS PRESIDENT OF CENTRAL MAINE HEALTHCARE CORPORATION. HIS COMPENSATED TIME IS SPENT IN THAT CAPACITY. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G $ 3,680,312 PURCHASED LABOR 1,883,702 LABOR SERVICES 1,070,918 OUTSIDE SERVICES 604,001 PURCHASED SERVICES 13,351 INTERPRETING SERVICES 8,515 CONSULTING SERVICES 3,431 PROFESSIONAL FEES ------------- $ 7,264,230 OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 $ (836) CHANGE IN BENEFICIAL INTEREST OF PERPETUAL TRUST CENTRAL MAINE COMMUNITY HEALTH CORP PO BOX 4500 LEWISTON ME 04243 010386912 PUBLIC ED ME 501(C)(3) 7 CMHC false CENTRAL MAINE MEDICAL CENTER PO BOX 4500 LEWISTON ME 04243 010211494 HEALTHCARE ME 501(C)(3) 3 CMHC false CMMC COLLEGE OF NURSING & HEALTH PROF PO BOX 4500 LEWISTON ME 04243 010356077 EDUCATION MH 501(C)(3) 2 CMMC false CENTRAL MAINE REAL ESTATE MGMT CORP PO BOX 4500 LEWISTON ME 04243 010387674 REAL ESTATE ME 501(C)(2) CMHC false CENTRAL MAINE HEALTHCARE CORPORATION PO BOX 4500 LEWISTON ME 04243 010386913 HEALTHCARE ME 501(C)(3) 11 B II NA false RUMFORD COMMUNITY FAMILY HEALTH CENTER 430 FRANKLIN STREET RUMFORD ME 04276 010481000 HEALTHCARE ME 501(C)(3) 3 CMHC false RUMFORD COMMUNITY HOME CORPORATION 11 JOHN F KENNEDY LANE RUMFORD ME 04276 222844951 NURSING HOME ME 501(C)(3) 9 CMHC false BRIDGTON HOSPITAL 10 HOSPITAL DRIVE BRIDGTON ME 04009 010130427 HEALTHCARE ME 501(C)(3) 3 CMHC false BRIDGTON HOSPITAL PHYSICIANS GROUP SOUTH HIGH STREET BRIDGTON ME 04009 010493083 HEALTHCARE ME 501(C)(3) 9 CMHC false CENTRAL MAINE HEART AND VASCULAR INST 300 MAINE STREET LEWISTON ME 04240 542078282 HEALTHCARE ME 501(C)(3) 9 CMHC false ELIAS E TUCKER TRUST FUND C/O CMMC 300 MAIN STREET LEWISTON ME 04240 010493083 NURSING ED ME 501(C)(3) 11 A I CMMC false CENTRAL MAINE HEALTH VENTURES INC 300 MAINE STREET LEWISTON ME 04240 010430016 HEALTHCARE ME CMHC C CORP false CWM INSURANCE LTD GENESIS BUILDING PO BOX 1363 GRAND CAYMAN B.W.I. CJ 980220891 INSURANCE CJ CMHC C CORP false false false false false false false false false false false true false true false true true true false false