2013-08-14T07:14:58-05:00 2012-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2011-10-01 223245434 Valley Medical Association VALL 2078343155 194 East Main Street Fort Kent ME 04743 Peter J Sirois 2078343155 2013-08-13 1 Barbara J McGuan CPA P00219457 2077752387 2013-08-13 2011 2016-02-24 21:20:13Z Peter J Sirois 194 East Main Street Fort Kent ME 04743 7609181 0 X www.nmmc.org X 1993 ME Medical Care - Physician Practices. 11 8 47 9 0 0 0 0 8518999 7609181 0 0 0 0 8518999 7609181 0 0 0 0 7808086 7271163 0 0 0 710913 338018 8518999 7609181 0 0 0 644187 0 644187 0 0 To provide the highest quality, comprehensive medical care to all patients. 0 0 7203518 7609181 Third party providers, consisting of physicians and midlevel staff, located in a rural setting which covers the great St. John Valley Region (Northern Maine). Providers provide care to all residents of the region (approximately 14,500) regardless of income, race, or creed. 7203518 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 14 0 1 47 1 0 0 0 0 0 0 0 0 0 0 X 11 8 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Cindy Daigle 2078343155 194 East Main Street Fort Kent ME 04743 Dan Vaillancourt 1.00 X X 0 0 0 Ronald Daigle 0.50 X X 0 0 0 Clifford Ouellette 0.50 X X 0 0 0 Frances LaBrie 0.50 X X 0 0 0 Glenn Lamarr 0.50 X 0 0 0 Guy Raymond MD 0.50 X 0 409042 25824 John Ezzy 0.50 X 0 0 0 Norman Fournier 0.50 X 0 0 0 James Thibodeau 0.50 X 0 0 0 Mark Morneault 0.50 X 0 0 0 Robert Bellefleur 0.50 X 0 3015 0 Peter J Sirois 0.50 X 0 198204 25020 Cindy L Daigle 0.50 X 0 23574 1917 Khalid Husain MD 50.00 X 516101 0 26708 James Harris MD 50.00 X 405916 0 23574 Sotirios Papafragkou MD 50.00 X 399838 0 8839 Myriam Beniamin MD 50.00 X 364551 0 0 Alexander Andrianov MD 50.00 X 310022 0 23997 Martin Bernstein 0.50 X 0 151225 5652 1996428 785060 141531 23 1 1 0 Barton & Associates Inc 10 Dearborn Road Peabody MA 09160 Temporary Medical Staff 255648 D&Y PO Box 635715 Cincinnati OH 452635715 Temporary Medical Staff 158187 2 NMMC Reimbursement 621110 7609181 7609181 7609181 7609181 7609181 0 0 6919724 6573738 345986 26968 25620 1348 54697 51962 2735 269774 256285 13489 40727 40727 1378 1378 295913 295913 7609181 7203518 405663 0 0 644187 0 644187 644187 0 644187 X 0 0 0 0 0 0 0 0 0 644187 0 0 X 0 1 1 X 1 1 X 0 Due from Affiliate 644187 644187 0 0 0 0 0 0 0 1 0 Guy Raymond MD 0 398642 0 0 0 10400 0 3639 0 22185 0 434866 0 0 Peter J Sirois 0 158204 0 40000 0 0 0 1607 0 23413 0 223224 0 0 Khalid Husain MD 466101 0 50000 0 0 0 4679 0 22029 0 542809 0 0 0 James Harris MD 184709 0 204707 0 16500 0 1990 0 21584 0 429490 0 0 0 Sotirios Papafragkou MD 261615 0 138223 0 0 0 0 0 8839 0 408677 0 0 0 Myriam Beniamin MD 364551 0 0 0 0 0 0 0 0 0 364551 0 0 0 Alexander Andrianov MD 292780 0 17242 0 0 0 2942 0 21055 0 334019 0 0 0 Martin Bernstein 0 141687 0 0 0 9538 0 1125 0 4527 0 156877 0 0 Part I, Line 7 The Association pays bonuses to its physicians based on the revenues they generate quarterly and/or annually. At September 30, unpaid/anticipated bonuses are accrued. Form 990, Part VI, Section A, line 2 Peter Sirois and Glenn Lamarr have a family relationship. Form 990, Part VI, Section A, line 4 During the November 11, 2011 board meeting, it was voted to revise the Valley Medical Association Bylaws to formally make all members of the NMMC Board of Trustees members of the Valley Medical Association Board. Form 990, Part VI, Section A, line 6 Northern Maine Medical Center, a corporation duly organized under the laws of the State of Maine, is the sole member of the Association. Form 990, Part VI, Section A, line 7a Northern Maine Medical Center, the sole corporate member of the Association, shall have the power to elect or remove trustees of the Association. During the November 11, 2011 board meeting, it was voted to revise the Valley Medical Association Bylaws to formally make all members of the NMMC Board of Trustees members of the Valley Medical Association Board. Form 990, Part VI, Section A, line 7b Northern Maine Medical Center, the sole corporate member of the Association, shall have the following powers: A. To ammend or restate the articles of incorporation of the Association; B. To ammend or restate the corporate bylaws of the Association; C. To approve any merger or consolidation involving the Association, or to approve the dissolution of the Association; D. To approve any sale, mortgage, lien, pledge, or security itnerest in all, or substantially all, of the assets of the Association; E. To approve any fund-raising activity conducted by the Association; F. To approve the selection of an auditor for the Association; G. To approve the commencement of any new venture or major capital acquisitions by the Association; H. To approve any capital or operating budgets of the Association. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by the Organization's independent public accounting firm and thoroughly reviewed by the CFO and Controller. The completed form was sent electronically to Board members prior to the form being filed. Form 990, Part VI, Section B, line 12c The enforcement of the conflict of interest policy is achieved through annual reporting and ongoing monitoring. Form 990, Part VI, Section B, line 15 The Board of Directors of Northern Maine Medical Center determines the compensation of the CEO using compensation studies and comparability data. The CEO determines the compensation of other officers and key employees in a similar manner. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of iterest policy, and financial statements available to the public upon request. Reason for Public Charity Status Schedule A, Part I, Line 3 The Organization's tax exemption is based upon the classification as a hospital or cooperative hospital service organization described in Section 170(b)(1)(A)(iii). Since the Organization is not licensed in the State of Maine as a hospital, Schedule H is not required. Northern Maine Medical Center 194 East Main Street Fort Kent ME 04743 010234189 Acute Care & Long Term Care Hospital ME 501(c)(3) Line 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1