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MAINE COAST REGIONAL HEALTH FACILI DBA NORTHERN LIGHT MAINE COAST HOS: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MAINE COAST REGIONAL HEALTH FACILI DBA NORTHERN LIGHT MAINE COAST HOS (EIN 01-0198331)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201341349349305474
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-14T14:07:23-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN010523282EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Berry Dunn McNeil & Parker LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1100AddressLine1
CityPortlandCity
StateMEState
ZIP Code041041100ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN010198331EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Maine Coast Regional Health FacilitiesBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMAINNameControl
Phone2076645311Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line150 Union StreetAddressLine1
CityEllsworthCity
StateMEState
ZIP Code04605ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCharles TherrienName
TitleCEOTitle
Phone2076645311Phone
Date Signed2013-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBarbara J McGuan CPAName
PTINP00219457PTIN
Phone2077752387Phone
Date Prepared2013-05-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Maine Coast Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCharles TherrienNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line150 Union StreetAddressLine1
CityEllsworthCity
StateMEState
ZIP Code04605ZIPCode
FieldValueIRS element (for citing)
Gross Receipts87738777GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.mcmhospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileMEStateLegalDomicile
Activity Or Mission DescriptionThe hospital provides health care services through its acute care facilities.ActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members17NbrIndependentVotingMembers
Total Nbr Employees811TotalNbrEmployees
Total Nbr Volunteers88TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year714791ContributionsGrantsPriorYear
Contributions Grants Current Year1170012ContributionsGrantsCurrentYear
Program Service Revenue Prior Year90654272ProgramServiceRevenuePriorYear
Program Service Revenue CY85028528ProgramServiceRevenueCY
Investment Income Prior Year466102InvestmentIncomePriorYear
Investment Income Current Year253146InvestmentIncomeCurrentYear
Other Revenue Prior Year-45158OtherRevenuePriorYear
Other Revenue Current Year-40560OtherRevenueCurrentYear
Total Revenue Prior Year91790007TotalRevenuePriorYear
Total Revenue Current Year86411126TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year52749855SalariesEtcPriorYear
Salaries Etc Current Year52339428SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year169628TotalFundrsngExpCurrentYear
Other Expense Prior Year33462853OtherExpensePriorYear
Other Expenses Current Year33831953OtherExpensesCurrentYear
Total Expenses Prior Year86212708TotalExpensesPriorYear
Total Expenses Current Year86171381TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5577299RevenuesLessExpensesPriorYear
Revenues Less Expenses CY239745RevenuesLessExpensesCY
Total Assets BOY74385385TotalAssetsBOY
Total Assets EOY75101936TotalAssetsEOY
Total Liabilities BOY28857886TotalLiabilitiesBOY
Total Liabilities EOY28964521TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY45527499NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY46137415NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe hospital is a not-for-profit entity established to provide health care services through its acute care facilities.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense80158612Expense
Revenue85028528Revenue
DescriptionAdmissions 3,581Patient Days 9,728Average Stay 2.72 DaysClinic Visits:Eleanor Widener Dixon Clinic 10,863S.W. Harbor Medical Center 4,695Emergency Room Visits 18,257Surgical Cases- Inpatient 816Surgical Cases- Outpatient 3,396Laboratory Tests: 286,802Radiology Exams:Diagnostic Radiology 18,200Ultrasound 4,577CT Scan 5,105Mammography 4,022Nuclear Medicine 2,928MRI 2,289Physical Therapy 57,510Births 294Description
Total Program Service Expense80158612TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109657NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees811NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members17NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMEStatesWhereCopyOfReturnIsFiled
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Charles Therrien CEOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2076645311TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line150 Union StreetAddressLine1
CityEllsworthCity
StateMEState
ZIP Code04605ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Michelle H Beal
Trustee1.00X000
Edith R Dixon
Trustee0.50X000
Thomas J Fernald
Trustee1.00X000
Alan J Goldstein
Past Trustee0.50X000
Daniel A Hurley III
Trustee1.00X000
Adin M Tooker
Vice Chairman10.00X000X
Jeffrey R Dow
Trustee1.00X000
Nicholas S Vachon DPM
Trustee1.00X000
Robert J Williams
Secretary1.00X000X
Debra A Ehrlenbach
Treasurer1.00X000X
Robert A Beekman MD
Trustee/Physician50.00X177315038383
Alan H Nauss MD
Trustee1.00X000
Katheryn Rensenbrink MD
Past President Medical Staff55.00X252881042506
Rebecca J Sargent
Chairman10.00X000X
Robert D Merrill
Trustee1.00X000
Sean T Maloney MD
Trustee/Physician50.00X257298042670
Charles D Therrien
CEO60.00X363272043360X
Christopher B Brown
Trustee1.00X000
Scott A Kimball
Trustee1.00X000
Karen W Stanley
Trustee1.00X000
Kevin B Tesseo
Trustee1.00X000
Sheena E Whittaker MD
President Medical Staff55.00X210869043031
Matthew C Worthen
Trustee1.00X000
Kevin Sedgwick
Past CFO50.00169630034637X
Michael A Hendrix Jr
CFO50.00103259040572X
Sterling C Williamson
Physician50.00629727054787X
Bradley Goldstein
Physician50.00423604047430X
Martin R Curlick
Physician50.00413584042678X
Kerry Crowley
Physician50.00368548046502X
Paul M Denoncourt
Physician50.00517331030834X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3887318TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation507390TotalOtherCompensation
Number Individuals GT100 K142NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Transcend Services Inc
One Gleni Suite 1325AtlantaGA30328Transcription Services391013
CompHealth
PO Box 972651DallasTX753972651Orthopedic Locum Services383520
Eastern Maine Medical Center
43 Whiting Hill RoadBrewerME04412Medical Services314420
Neurology Associates of Maine
498 Essex Street Suite 105BangorME04401Neurology; Sleep Study; EEG Professional256778
Blue Hill Laundry Services Inc
PO Box 258SurryME04605Laundry & Linen Services223975
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Fundraising Events152577FundraisingEvents
Related Organizations106636RelatedOrganizations
Government Grants6956GovernmentGrants
All Other Contributions903843AllOtherContributions
Noncash Contributions61484NoncashContributions
Total Contributions1170012TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
Patient Service Rev.621990173013129173013129
Other Medical Services62199013552331355233
Cafeteria/Vending621990293893$293,893
Contractual/Char. Adj.621990-89633727-89633727
FieldValueIRS element (for citing)
Total Program Service Revenue85028528TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column394466TotalRevenueColumn
Exclusion$394,466ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1092695Securities
Other21556Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1186002Securities
Other69569Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-93307Securities
Other-48013Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-141320TotalRevenueColumn
Exclusion-$141,320ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events31520GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events152577CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses72080FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-40560TotalRevenueColumn
Exclusion-$40,560ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column86411126TotalRevenueColumn
Related Or Exempt Function Income84734635RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$506,479ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1819683Total
Program Services1064953ProgramServices
Management And General754730ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total40084476Total
Program Services38704552ProgramServices
Management And General1271361ManagementAndGeneral
Fundraising108563Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total861075Total
Program Services297479ProgramServices
Management And General563596ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6878470Total
Program Services6640834ProgramServices
Management And General219094ManagementAndGeneral
Fundraising18542Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2695724Total
Program Services2559702ProgramServices
Management And General128286ManagementAndGeneral
Fundraising7736Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total140354Total
Program Services14163ProgramServices
Management And General126191ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total115545Total
Management And General115545ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total81328Total
Management And General81328ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4902475Total
Program Services4547437ProgramServices
Management And General355038ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total102938Total
Program Services159ProgramServices
Management And General102779ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2474845Total
Program Services1661864ProgramServices
Management And General800501ManagementAndGeneral
Fundraising12480Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total761345Total
Program Services688983ProgramServices
Management And General72362ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1358501Total
Program Services1332089ProgramServices
Management And General26412ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total52200Total
Program Services51423ProgramServices
Management And General720ManagementAndGeneral
Fundraising57Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total254989Total
Program Services219783ProgramServices
Management And General35028ManagementAndGeneral
Fundraising178Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total835940Total
Program Services835940ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3503554Total
Program Services3135710ProgramServices
Management And General366839ManagementAndGeneral
Fundraising1005Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total1163277Total
Program Services626365ProgramServices
Management And General536912ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Medical Supplies92032549178299249469
Bad Debt Expense52464015246401
Health Care Prov. Tax17596301759630
Repairs & Maintenance12077301180747215585425

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total667647Total
Program Services412099ProgramServices
Management And General239915ManagementAndGeneral
Fundraising15633Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total86171381Total
Program Services80158612ProgramServices
Management And General5843141ManagementAndGeneral
Fundraising169628Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4335BOY
EOY4035EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY17645714BOY
EOY13108606EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY197251BOY
EOY89004EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7111606BOY
EOY9122240EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY713309BOY
EOY685665EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1224277BOY
EOY1274404EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis59632770LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec28450130LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY33338586BOY
EOY31182640EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY6634129BOY
EOY8387848EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY304003BOY
EOY279436EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY7212175BOY
EOY10968058EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY74385385BOY
EOY75101936EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY9307744BOY
EOY8748621EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY13126775BOY
EOY12737200EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2913557BOY
EOY2148368EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3509810BOY
EOY5330332EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY28857886BOY
EOY28964521EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY44255901BOY
EOY44660861EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY588127BOY
EOY789423EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY683471BOY
EOY687131EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY45527499BOY
EOY46137415EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY74385385BOY
EOY75101936EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses239745ReconcilationRevenueExpenses
Reconcilation Other Changes370171ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$9,795OtherActivitiesAmount
Total Lobbying Expenditures IIB9795TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationPortion of dues from Maine Hospital Association and American Hospital Association used for lobbying.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance11712210BeginningOfYearBalance
Contributions135584Contributions
Investment Earnings Or Losses536573InvestmentEarningsOrLosses
Other Expenditures21989OtherExpenditures
End Of Year Balance12362378EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3349752BeginningOfYearBalance
Contributions7664082Contributions
Investment Earnings Or Losses710004InvestmentEarningsOrLosses
Other Expenditures11628OtherExpenditures
End Of Year Balance11712210EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2953215BeginningOfYearBalance
Contributions27935Contributions
Investment Earnings Or Losses383779InvestmentEarningsOrLosses
Other Expenditures15177OtherExpenditures
End Of Year Balance3349752EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4701120BeginningOfYearBalance
Contributions52994Contributions
Investment Earnings Or Losses-689342InvestmentEarningsOrLosses
Grants Or Scholarships68360GrantsOrScholarships
Other Expenditures1043197OtherExpenditures
End Of Year Balance2953215EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.94000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.06000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis361138OtherCostOrOtherBasis
Book Value361138BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis38735012OtherCostOrOtherBasis
Depreciation13044031Depreciation
Book Value25690981BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis245055OtherCostOrOtherBasis
Depreciation121074Depreciation
Book Value123981BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis20291565OtherCostOrOtherBasis
Depreciation15285025Depreciation
Book Value5006540BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings31182640TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
Construction in Progress1972368
Other Assets43647
Long Term Receivable from State of Maine8076331
Due from Related Parties46497
Deferred Compensation829215
FieldValueIRS element (for citing)
Total Book Value Other Assets10968058TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Deferred Compensation$829,215
Estimated Third-Party Payor Settlements$4,501,117
FieldValueIRS element (for citing)
Total Of Amounts5330332TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
ExplanationPart V, Line 4: The intended uses of the endowment funds are funded depreciation, the oncology clinic and the breast clinic. During the year, approximately $135,000 of board-designated funds were contributed to the endowment fund.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Poinsettia BallNameOfEvent1
Gross Receipts Event1113042GrossReceiptsEvent1
Charitable Contributions Event197292CharitableContributionsEvent1
Gross Revenue Event115750GrossRevenueEvent1
Food And Beverage Event111489FoodAndBeverageEvent1
Other Direct Expenses Event131818OtherDirectExpensesEvent1
Name Of Event2Chef's GalaNameOfEvent2
Gross Receipts Event271055GrossReceiptsEvent2
Charitable Contributions Event255285CharitableContributionsEvent2
Gross Revenue Event215770GrossRevenueEvent2
Food And Beverage Event23819FoodAndBeverageEvent2
Other Direct Expenses Event224954OtherDirectExpensesEvent2
Gross Receipts Total184097GrossReceiptsTotal
Charitable Contributions Total152577CharitableContributionsTotal
Gross Revenue Total Events31520GrossRevenueTotalEvents
Food And Beverage Total Events15308FoodAndBeverageTotalEvents
Other Direct Expenses Total Events56772OtherDirectExpensesTotalEvents
Direct Expense Summary Events72080DirectExpenseSummaryEvents
Net Income Summary-40560NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1541885TotalCommunityBenefitExpense
Net Community Benefit Expense1541885NetCommunityBenefitExpense
Percent Of Total Expense0.01900PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense10752065TotalCommunityBenefitExpense
Direct Offsetting Revenue5845973DirectOffsettingRevenue
Net Community Benefit Expense4906092NetCommunityBenefitExpense
Percent Of Total Expense0.06060PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense12293950TotalCommunityBenefitExpense
Direct Offsetting Revenue5845973DirectOffsettingRevenue
Net Community Benefit Expense6447977NetCommunityBenefitExpense
Percent Of Total Expense0.07960PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense115750TotalCommunityBenefitExpense
Direct Offsetting Revenue21501DirectOffsettingRevenue
Net Community Benefit Expense94249NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense142958TotalCommunityBenefitExpense
Direct Offsetting Revenue4560DirectOffsettingRevenue
Net Community Benefit Expense138398NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense15225239TotalCommunityBenefitExpense
Direct Offsetting Revenue9090431DirectOffsettingRevenue
Net Community Benefit Expense6134808NetCommunityBenefitExpense
Percent Of Total Expense0.07580PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense7000TotalCommunityBenefitExpense
Net Community Benefit Expense7000NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense15490947TotalCommunityBenefitExpense
Direct Offsetting Revenue9116492DirectOffsettingRevenue
Net Community Benefit Expense6374455NetCommunityBenefitExpense
Percent Of Total Expense0.07880PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense27784897TotalCommunityBenefitExpense
Direct Offsetting Revenue14962465DirectOffsettingRevenue
Net Community Benefit Expense12822432NetCommunityBenefitExpense
Percent Of Total Expense0.15840PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Total Community Building Expense3211TotalCommunityBuildingExpense
Net Community Building Expense3211NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense698TotalCommunityBuildingExpense
Net Community Building Expense698NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense18443TotalCommunityBuildingExpense
Direct Offsetting Revenue9793DirectOffsettingRevenue
Net Community Building Expense8650NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense2595TotalCommunityBuildingExpense
Net Community Building Expense2595NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense33186TotalCommunityBuildingExpense
Direct Offsetting Revenue12483DirectOffsettingRevenue
Net Community Building Expense20703NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense5454TotalCommunityBuildingExpense
Direct Offsetting Revenue1357DirectOffsettingRevenue
Net Community Building Expense4097NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense36118TotalCommunityBuildingExpense
Net Community Building Expense36118NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense24772TotalCommunityBuildingExpense
Net Community Building Expense24772NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense124477TotalCommunityBuildingExpense
Direct Offsetting Revenue23633DirectOffsettingRevenue
Net Community Building Expense100844NetCommunityBuildingExpense
Percent Of Total Expense0.00120PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,357,021BadDebtExpenseAmount
Amount Reimbursed By Medicare18424600AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare20112241CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1687641MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Maine Coast Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line150 Union StreetAddressLine1
CityEllsworthCity
StateMEState
ZIP Code04605ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Maine Coast Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted11NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities1OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed1AllNeedsAddressed
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent150.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent250.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities15NumberOfOtherFacilities

Other Facilities OtherFacilities (15 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Ellsworth Internal Medicine
32 Resort WayEllsworthME04605Physician Practice
Ellsworth Family Practice
32 Resort WayEllsworthME04605Physician Practice
Maine Coast Pediatrics
32 Resort WayEllsworthME04605Physician Practice
Eleanor Widener Dixon Memorial Clinic
37 Clinic RoadEllsworthME04605Physician Practice
Southwest Harbor Medical Center
45 Herrick RoadEllsworthME04605Physician Practice
Maine Coast Specialty Clinic
306 Main StreetEllsworthME04605Physician Practice
Maine Coast Urology
50 Union StreetEllsworthME04605Physician Practice
Maine Coast Rheumatology
50 Union StreetEllsworthME04605Physician Practice
Down East Dermatology
50 Union StreetEllsworthME04605Physician Practice
Maine Coast General Surgery
50 Union StreetEllsworthME04605Physician Practice
Maine Coast Women Care
50 Union StreetEllsworthME04605Physician Practice
Maine Coast Hand & Shoulder
50 Union StreetEllsworthME04605Physician Practice
Frenchman Bay Orthopedics
50 Union StreetEllsworthME04605Physician Practice
Maine Coast Otolaryngology
50 Union StreetEllsworthME04605Physician Practice
Maine Coast Memorial Hospital Nocturn
50 Union StreetEllsworthME04605Physician Practice

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
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. RheumatologyE. Family PracticeF. Frenchman Bay ClinicG. Women Care ClinicH. Physician ClinicI. Specialty ClinicJ. Gouldsboro ClinicK. Otolaryngology ClinicL. Dermatology ClinicM. General SurgeryN. Urology ClinicO. PsychiatryThe above listed provider based physician practices have a community benefit (i.e., aggregate loss or subsidy from the Hospital) of approximately $6.1 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 $6.1 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-Infant family support-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, L7 Col(f): As part of the Hospital's total expenses, there is $5,246,401 of bad debts. This amount has been removed from the Part I, Line 7 Column F calculation per the IRS instructions.
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.Community Benefit ReportSchedule H, Part I, Line 6a:
Part III, Line 4: Maine Coast Regional Health Facilities classify bad debts as an operating expense. 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 future.The bad debt expense at cost was the total write-offs reduced by the ratio of patient care cost to charges.
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 V, Section B, Line 21: All patient financial classes are charged a uniform rate. Discounts are provided to FAP eligible patients based upon income per the Hospital's board approved and State of Maine approved free care policy. 100% of charges are written off (discounted) for FAP-eligible patients whose income is at or below 150% of the federal poverty limit. Discounts apply on a sliding scale up to 250% of the FPL.Maine Coast Memorial Hospital
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 deferred by the MHDO:EastbrookBeddingtonDebloisCherryfieldEllsworthFranklinMilbridgeGouldsboroHancockLamoineMariavilleOsbornOtisSteubenSorrentoSullivanSurryTrentonWalthamWinter HarborOqiton TWPT3 NDT7 SDT8 SDT9 SDT10 SDT16 MDT22 MDT28 MDT34 MDT35 MDT39 MDT40 MDT41 MDThe following demographics represent the counties served by Maine Coast Memorial Hospital: - Population: Hancock County 54,578; Washington County 32,637; State of Maine 1,329,000 - Persons < 5 yrs: Hancock County 4.5%; Washington County 5.0%; State of Maine 5.1% - Persons < 18 yrs: Hancock County 17.9%; Washington County 19.6%; State of Maine 20.3% - Persons 65 yrs & over: Hancock County 18.9%; Washington County 19.9%; State of Maine 16.3% - Median Household Income: Hancock County $47,421; Washington County $35,272; State of Maine $47,898 - Persons below poverty level: Hancock County 12.4%; Washington County 20.4%; State of Maine 12.1%
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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Written Policy Re T And E Expenses0WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Robert A Beekman MD
1764720510792041310342520215698000
Katheryn Rensenbrink MD
2299810227200180050950374110295387000
Sean T Maloney MD
2426510144670180053960372740299968000
Charles D Therrien
3133450496510276055130378470406632000
Sheena E Whittaker MD
1906740200150180039860390450253900000
Kevin Sedgwick
169114000516039230307140204267000
Sterling C Williamson
3202820284225025220055120492750684514000
Bradley Goldstein
3674030560810120055130419170471034000
Martin R Curlick
3930170200510516055130371650456262000
Kerry Crowley
26755101004810516055130409890415050000
Paul M Denoncourt
3262230120090071018055120253220548165000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental InformationIdentifier
Return ReferencePart IIIReturnReference
ExplanationPart 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. Part I, Line 7: The bonus payments for Sterling C. Williamson, Bradley Goldstein, Kerry Crowley, Katheryn Rensenbrink, Paul M. Denoncourt, Martin R. Curlik, Sean T. Maloney and Sheena E. Whittaker are RVU incentive payments. The bonus payment paid to Charles Therrien, CEO, is determined by an annual CEO performance evaluation conducted by the Board of Trustees. The annual evaluation is administered and presented to the Trustees by an independent third party. The performance evaluation includes 5 components: 1. Quality of Care 2. Patient Satisfaction 3. Financial Management 4. Strategic Objectives 5. Effectiveness Survey/RatingExplanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
MHHEFA
010314384560425NW62003-07-245695000Construction of ICU/ Cafeteria/ OR000
MHHEFA
0103143845604253L22008-12-036960000Construction of Emergency Dept.000
MHHEFA
010314384560427NM42011-11-301865000Refunding Series 2001B000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapitalized InterestCapitalizedInterest
10131715875000368171119201538762820050011
6188696960000498869131414589071120090011439006
150760186500021023835050182995020111011

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminated
000000
000000
00100000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Bar Harbor Bank & TrustBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipAn entity of which Daniel Hurley, current Trustee serves as an officerRelationship
Description Of TransactionMr. 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.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions4NumberOfContributions
Noncash Contribs Rptd F99061484NoncashContribsRptdF990
Method Of Determining RevenuesStock Market ValueMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used1ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierThird Party Use:Identifier
Return ReferencePart I, Line 32b:ReturnReference
ExplanationThe Organization sells contributions of securities through its investment broker. All gifts of securities are sold as soon as administratively possible.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 2Rebecca Sargent and Debra Ehrlenbach have a business relationship.
Form 990, Part VI, Section A, line 6Maine Coast Healthcare Corporation is the sole member of the Organization.
Form 990, Part VI, Section A, line 7aThe Member shall have the right to elect trustees and honorary trustees to the board of trustees.
Form 990, Part VI, Section A, line 7bThe 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 disposition, 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 11Prior to filing, a presentaion 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 12cExamples 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 15Executive 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 19Government 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 5:Net unrealized gains on investments: 366,511. Change in Value of Trust 3,660. Total to Form 990, Part XI, Line 5: 370,171.Changes in Net Assets or Fund Balances:
Form 990, Part XII, Line 2c:The audit process has not changed from the prior year.Oversight of Audit

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Maine Coast Medical Realty Inc
50 Union StreetEllsworthME04605010390918Furnishing Medical FacilitiesME501(c)(3)Line 11a, IMaine Coast Regional Health Facilities0
Maine Coast Healthcare Corporation
50 Union StreetellsworthME04605223176167Parent Organization for HospitalME501(c)(3)Line 11b, II0N/A
Maine Coast Healthcare Foundation
50 Union StreetellsworthME04605262344952Raise and hold donations for hospitalME501(c)(3)Line 11a, IMaine Coast Regional Health Facilities0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Maine Coast Physician AffiliatesBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line150 Union StreetAddressLine1
CityEllsworthCity
StateMEState
ZIP Code04605ZIPCode
FieldValueIRS element (for citing)
EIN010479952EIN
Primary ActivityInactivePrimaryActivity
Legal Domicile StateMELegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Maine Coast Healthcare CorporationBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg