2013-05-14T14:34:16-05:00 2012-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2011-07-01 010130427 BRIDGTON HOSPITAL % PHIL MORISSETTE BRID 2077952972 10 HOSPITAL DRIVE BRIDGTON ME 04009 R DAVID FRUM 2013-04-23 true Brian D Todd 4178658701 2011 2016-02-24 21:20:13Z R DAVID FRUM 10 HOSPITAL DRIVE BRIDGTON ME 04009 48544399 false X WWW.BRIDGTONHOSPITAL.ORG X 1917 ME BRIDGTON 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. 9 7 375 100 0 0 179797 192698 48310331 47137299 302959 222436 9886 11114 48802973 47563547 7874 14673 0 0 17617092 19047252 0 0 0 23601458 26590950 41226424 45652875 7576549 1910672 46363338 48917397 12382959 13256505 33980379 35660892 TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES IN A SAFE AND TRUSTFUL ENVIRONMENT THROUGH THE EXPERTISE, COMMITMENT, AND COMPASSION OF OUR FAMILY OF CAREGIVERS. false false 36965022 14673 47137299 BRIDGTON HOSPITAL IS A CRITICAL ACCESS HOSPITAL SERVING 20 SURROUNDING COMMUNITIES PLUS THE MOUNT WASHINGTON VALLEY COMMUNITIES OF NEW HAMPSHIRE. THE HOSPITAL HAS A MEDICAL / SURGICAL UNIT, CRITICAL CARE UNIT, AND OBSTETRICAL UNIT WITH TWO BIRTHING SUITES. OUR TWO OPERATING ROOMS HANDLE GENERAL, ORTHOPEDIC, AND AMBULATORY SURGERY. THE HOSPITAL HAS A 24 HOUR EMERGENCY DEPARTMENT AND NUMEROUS PROFESSIONAL SERVICES INCLUDING CT SCANNING, MRI, NUCLEAR MEDICINE SPECT SCANNING, TREADMILL INCLUDING THALLIUM ONCOLOGY CLINIC, INPATIENT AND OUTPATIENT PHYSICAL THERAPY AND MEDICAL SCIENCES LIBRARY. 36965022 true true false true false false false false false true true false false false false false false true false false false false false false true false true true false true true false false false false false false false false false false false false false true false false false false true 51 0 true 375 true false false false false false true true false false false false X 9 7 false 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 X 0 811982 439996 WILLIAM CHALMERS 1.0 X RONALD CILLEY MD 55.0 X 81040 0 7454 NEAL GRAFFAM 1.0 X X WAYNE KUVAJA 1.0 X PAUL LABAND MD 55.0 X X 178247 0 14110 PHILIP LIBBY 1.0 X X 0 AUDREY MACINTYRE 1.0 X X CAROL SUDDUTH 1.0 X HOLLY DVORAK 1.0 X 0 0 R DAVID FRUM 55.0 X 0 279318 43650 LISA KLEINART 55.0 X 217054 0 28052 BRUCE LASTRA MD 55.0 X 268528 0 26365 CRAIG SMITH MD 55.0 X 328520 0 12877 DEBORAH SURETTE MD 55.0 X 292998 0 13960 JENNIFER SMITH DO 55.0 X 220859 0 23340 HANS BOEDECKER MD 55.0 X 211954 0 8918 1799200 1091300 618722 27 false true false WEATHERBY LOCUMS INC MEDICAL STAFFING 341156 CPS INC PHARMACY SERVICES 463886 INSIGHT HEALTH CORP MEDICAL STAFFING 487155 HERBERT CONSTRUCTION CONSTRUCTION 261009 ARUP MEDICAL SERVICES 217290 9 19140 17239 156319 192698 NET PATIENT SERVICE REVENUE 900099 46333771 46333771 CAFETERIA REVENUE 722210 89984 89984 OTHER REVENUE 900099 713544 713544 47137299 135810 135810 0 0 7964 7964 7964 7964 1044188 16540 968461 5641 75727 10899 86626 86626 9900 19140 6750 3150 3150 0 0 0 47563547 47137299 233550 5000 5000 9673 9673 0 0 442062 245570 196492 0 0 15560046 11899888 3660158 0 2022399 1553167 469232 1022745 777286 245459 0 53055 53055 24844 24844 0 0 19445 19445 8472346 6438983 2033363 300980 228745 72235 1337599 1016815 320784 679933 516749 163184 0 1250473 950359 300114 150495 114376 36119 0 29307 22273 7034 491982 373906 118076 0 1408950 1070802 338148 1566786 1190757 376029 BAD DEBT 5198463 5198463 MEDICAL SUPPLIES & DRUGS 4547617 4547617 REPAIRS & MAINTENANCE 845899 642883 203016 LICENSES, DUES, SUBSCRIPTIONS 150877 114667 36210 61899 47043 14856 45652875 36965022 8687853 0 274802 235658 19011088 24158402 44150 44141 5727732 5783338 72 0 0 0 0 0 296908 307630 106525 1028896 34263625 18150168 15776737 16113457 4518592 388623 0 0 0 0 0 0 606732 857252 46363338 48917397 3256848 3123610 0 0 26994 45614 8048809 7843645 0 0 0 0 1050308 2243636 0 0 0 0 12382959 13256505 X 30415399 32098206 2443485 2449681 1121495 1113005 33980379 35660892 46363338 48917397 X 1910672 -230159 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 6950 6950 false false OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1I PORTION OF DUES FOR PROFESSIONAL ASSOCIATIONS ATTRIBUTED TO LOBBYING EXPENSES - $6,950. 3564980 72940 -20998 54236 3562686 3341734 56905 207021 40680 3564980 3236168 50626 86204 6169 25095 3341734 3151153 354034 -236483 2836 29700 3236168 0.31241 0.68759 false true true 674722 674722 18091409 6121565 11969844 6767 5112 1655 14034936 11557479 2477457 1455791 466012 989779 16113457 47563547 45652875 1910672 -221569 -8590 -230159 1680513 47315693 -221569 -33035 -254604 47570297 -6750 -6750 47563547 45635180 6750 6750 45628430 19445 5000 24445 45652875 USE OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 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 MEDICAL EDUCATION, OR FREE CARE. OTHERS ARE DESIGNATED TO SUPPORT SPECIFIC DEPARTMENTS OF THE HOSPITAL. UNCERTAIN TAX POSITIONS 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 RECONCILING CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 $ (8,590) CHANGE IN BENEFICIAL INTEREST OF PERPETUAL TRUST OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D $ (19,445) INVESTMENT EXPENSE (8,590) CHANGE IN BENEFICIAL INTEREST OF PERPETUAL TRUST (5,000) GRANT EXPENSE ----------- $ (33,035) OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $ (6,750) SPECIAL EVENT EXPENSE OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D $ 6,750 SPECIAL EVENT EXPENSE OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 SCHEDULE D, PART XIII, LINE 4B $ 5,000 GRANT EXPENSE GOLF TOURNEY 29040 19140 9900 0 1500 4305 525 0 420 0 29040 19140 9900 0 1500 4305 525 0 420 6750 3150 true true X true X false true true true false false 1711474 1711474 0.04230 6528750 5837990 690760 0.01710 8240224 5837990 2402234 0.05940 14673 14673 0.00040 14673 14673 0.00040 8254897 5837990 2416907 0.05980 false 2562323 327977 14820040 14219860 600180 X true true 1 1 BRIDGTON HOSPITAL

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OUTPATIENT PHYSICIAN CLINIC NAPLES FAMILY PRACTICE

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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 ($45,652,875) WAS REDUCED BY BAD DEBT EXPENSE ($5,198,463). COSTING METHODOLOGY SCHEDULE H, PART I, LINE 7G 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 PATIENTS 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. COMMUNITY BENEFIT SCHEDULE H, PART III, SECTION B, LINE 8 THE COSTING METHODOLOGY USED FOR LINE 6 IS INFORMATION PULLED FROM THE MEDICARE COST REPORT FILING. THE SHORTFALL REPORTED ON LINE 7 COULD BE CONSIDERED COMMUNITY BENEFIT TO A LEVEL PROPORTIONAL TO THE POVERTY LEVELS INDICATED BY CENSUS BUREAU DATA. IN 2010, DATA INDICATES THAT 59.2% OF MAINE RESIDENTS, AGE 65 OR OLDER, ARE BELOW THE 300% FPG LEVEL. IF THESE PATIENTS WERE NOT COVERED BY MEDICARE THEY WOULD QUALIFY UNDER CMMC'S FREE CARE POLICY. UNDER THAT CIRCUMSTANCE, THESE PATIENTS WOULD THEN APPEAR AS PART OF THE STATISTICS ON PART I, LINE 7A. 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. OTHER METHODS USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY SCHEDULE H, PART V, LINE 13G 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 PATIENTS FOR EMERGENCY CARE SCHEDULE H, PART V, LINE 19D 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 BRIDGTON HOSPITAL ATTEMPTS TO PROVIDE ANY NEEDED HEALTH CARE SERVICES NECESSARY TO TREAT THE POPULATION OF THIS RURAL AREA OF MAINE. ADDITIONALLY BRIDGTON 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 BRIDGTON 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 BRIDGTON HOSPITAL, LOCATED IN BRIDGTON, MAINE, SERVES 21 TOWNS IN THE "LAKES REGION" OF WESTERN MAINE, AS WELL AS THE WESTERN MOUNTAINS OF MAINE AND THE MOUNT WASHINGTON VALLEY REGION OF NEW HAMPSHIRE. THE REGION IS RURAL IN NATURE AND IS PRIMARILY MADE UP OF WESTERN CUMBERLAND AND SOUTHERN OXFORD COUNTIES IN MAINE, AS WELL AS CARROLL COUNTY IN NEW HAMPSHIRE. THE REGION IS PRIMARILY MADE UP OF CAUCASIAN PERSONS AND HAS A VARIABLE POPULATION. THE REGION IS A SUMMER TOURIST DESTINATION AND THE POPULATION SWELLS DRAMATICALLY DURING THAT SEASON, MAKING DEMOGRAPHICS SOMEWHAT FLUID. APPROXIMATELY 14% OF THE YEAR ROUND POPULATION IS BELOW THE POVERTY LEVEL. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 AS A MEMBER OF THE CENTRAL MAINE HEALTHCARE SYSTEM, BRIDGTON 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 BRIDGTON AREA ON A REGULAR SCHEDULE. THE SYSTEM PARENT, CENTRAL MAINE HEALTHCARE, PROVIDES STREAMLINED ADMINISTRATIVE FUNCTIONS AND BACKROOM SERVICES, ALLOWING BRIDGTON HOSPITAL TO PERFORM AT A COST EFFICIENT LEVEL WHICH WOULD NORMALLY BE UNACHIEVABLE IN A SMALL, RURAL HOSPITAL, ALLOWING FOR A BROADER RANGE OF SERVICES PROVIDED. true EDUCATIONAL SCHOLARSHIPS 12 9673 GRANTS SCHEDULE I, PART I, LINE 2 THE COMMITTEE REVIEWS ELIGIBILITY BEFORE AWARDING THE SCHOLARSHIPS. THE FUNDS ARE NOT DISBURSED UNTIL THE COURSEWORK IS COMPLETED AND GRADE REQUIRMENTS ARE SUBSTANTIATED. false true false false false false false false false PETER E CHALKE 0 558067 0 112822 0 141093 0 428229 0 11767 0 1251978 0 127213 PAUL LABAND MD 142966 0 24240 0 11041 0 4355 0 9755 0 192357 0 0 0 BRUCE LASTRA MD 256857 0 7750 0 3921 0 7069 0 19296 294893 0 0 0 CRAIG SMITH MD 207741 0 101750 0 19029 0 6377 0 6500 341397 0 0 0 DEBORAH SURETTE MD 280380 0 2731 0 9887 0 7144 0 6816 0 306958 0 0 0 JENNIFER SMITH DO 148514 0 58633 0 13712 0 4417 0 18923 0 244199 0 0 0 HANS BOEDECKER MD 211118 0 0 0 836 0 2460 0 6458 0 220872 0 0 0 R DAVID FRUM 0 241508 0 27600 0 10210 0 26058 0 17592 0 322968 0 0 LISA KLEINART 168440 0 36170 0 12444 0 5153 0 22899 0 245106 0 0 0 EXECUTIVE COMPENSATION SCHEDULE J, PART I, LINE 3 THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT, R. DAVID FRUM, 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 PARTICIPANTS ENTITLEMENT TO 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. $ 127,213 PETER CHALKE (PAYOUT) 405,206 PETER CHALKE (DEFERRAL) 23,000 R. DAVID FRUM (DEFERRAL) 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. 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, PROVIDED HOWEVER, THAT (I) THE MEMBER MAY NOT REMOVE WITHOUT CAUSE MORE THAN ONE-THIRD (1/3) OF THE DIRECTORS OF THE CORPORATION IN ANY ONE YEAR, AND (II) THE MEMBER MAY NOT REMOVE ANY DIRECTOR WITH OR WITHOUT CAUSE WITHOUT PROVIDING AN OPPORTUNITY FOR ONE OR MORE REPRESENTATIVES OF THE CORPORATION TO APPEAR BEFORE THE MEMBERS BOARD OF DIRECTORS TO COMMENT ON THE PROPOSED REMOVAL, 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. 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 POLICY FORM 990, PART VI, SECTION B, LINE 15A & 15B CENTRAL MAINE HEALTHCARE (CMHC) HAS ESTABLISHED AND FOLLOWS A DELIBERATIVE TRANSPARENT PROCESS WHICH MEETS IRS REGULATIONS FOR "REBUTTABLE" PRESUMPTION OF REASONABLENESS. 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, 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 ATTORNEY'S FACTORS USED IN DETERMINING COMPARABILITY TO THE ORGANIZATION INCLUDES GEOGRAPHY, ORGANIZATIONAL COMPLEXITY, FACILITY TYPE, OWNERSHIP TYPE, AND ANY OTHER FACTORS DEEMED RELEVANT BY THE COMMITTEES CONSULTANTS, OR ITS ATTORNEY'S. USING THIS INFORMATION, THE ECC ANNUALLY REVIEWS THE EXECUTIVE'S 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. HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, LINE 1A, COLUMN B THE CENTRAL MAINE HEALTHCARE SYSTEM, WHICH INCLUDES THE FOLLOWING ENTITIES REPORTABLE AS RELATED ORGANIZATIONS ON SCHEDULE R OF THE FORM 990, SHARES EXECUTIVE MANAGEMENT AND GOVERNING BOARD MEMBERS: CENTRAL MAINE HEALTHCARE CORPORATION, CENTRAL MAINE MEDICAL CENTER, CENTRAL MAINE MEDICAL CENTER COLLEGE OF NURSING AND HEALTH PROFESSIONS, RUMFORD HOSPITAL, RUMFORD COMMUNITY FAMILY HEALTH CENTER, RUMFORD COMMUNITY HOME CORPORATION, BRIDGTON HOSPITAL, BRIDGTON HOSPITAL PHYSICIAN'S GROUP, CENTRAL MAINE COMMUNITY HEALTH CORPORATION, CENTRAL MAINE REAL ESTATE MANAGEMENT CORPORATION, CENTRAL MAINE HEART AND VASCULAR INSTITUTE, GARD W. TWADDLE NURSES ENDOWMENT, ELIAS E TUCKER TRUST FUND, CENTRAL MAINE HEALTH VENTURES AND SUBSIDIARIES, AND CWM INSURANCE, LTD. THE PRESIDENT OF CENTRAL MAINE HEALTHCARE SYSTEM, PETER E. CHALKE, AND THE PRESIDENT OF BRIDGTON AND RUMFORD HOSPITALS, R. DAVID FRUM, ALSO SERVE ON THE BOARDS OF OTHER RELATED ORGANIZATIONS. MOST BOARD MEMBERS SERVE ON THE BOARDS OF MULTIPLE RELATED ORGANIZATIONS. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 $ (221,569) UNREALIZED LOSSES (8,950) CHANGE IN BENEFICIAL INTEREST OF PERPETUAL TRUST ---------- $ (230,159) 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 AND HEALTH PROF PO BOX 4500 LEWISTON ME 04243 010356077 EDUCATION ME 501(C)(3) 2 CMMC false CENTRAL MAINE REAL ESTATE MANAGEMENT COR 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 RUMFORD HOSPITAL 420 FRANKLIN STREET RUMFORD ME 04276 010215227 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 MAIN 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 016042343 NURSING ED ME 501(C)(3) 11 A I CMMC false CENTRAL MAINE HEALTH VENTURES INC 300 MAIN STREET LEWISTON ME 04240 010430016 HEALTHCARE ME NA C CORP. CWM INSURANCE LTD GENESIS BUILDING PO BOX 1363 GRAND CAYMAN CJ B.W.I. 980220891 INSURANCE CJ NA C CORP. false false false false false false false false false true false true false true true true false false