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Waldo County General Hospital: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
Waldo County General Hospital (EIN 01-0177170)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-13
IRS object ID
201202269349300730
Schema version
2010v3.7
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)
Timestamp2012-08-13T08:47:41-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MAINEHEALTHBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1110 FREE STAddressLine1
CityPORTLANDCity
StateMEState
ZIP Code041013908ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN010177170EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WALDO COUNTY GENERAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWALDNameControl
Phone2073382500Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1118 NORTHPORT AVENUEAddressLine1
CityBELFASTCity
StateMEState
ZIP Code04915ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLINDA B DRINKWATERName
TitleCFOTitle
Phone2073382500Phone
Date Signed2012-08-13DateSigned
Authorize Third PartyfalseAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Date Prepared2012-08-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLINDA B DRINKWATERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 287AddressLine1
CityBELFASTCity
StateMEState
ZIP Code04915ZIPCode
FieldValueIRS element (for citing)
Gross Receipts87523340GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WCHI.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1901YearFormation
State Legal DomicileMEStateLegalDomicile
Activity Or Mission DescriptionWALDO COUNTY GENERAL HOSPITAL'S MISSION IS TO BE THE BEST - BETTER, EMPATHY, SERVICE AND TEAMWORK. OUR GOAL IS TO ENSURE QUALITY, ACCESSIBLE AND AFFORDABLE HEALTH CARE SERVICES AND TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. PLEASE SEE ATTACHED COMMUNITY BENEFITS REPORT.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees683TotalNbrEmployees
Total Nbr Volunteers120TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year517278ContributionsGrantsPriorYear
Contributions Grants Current Year610050ContributionsGrantsCurrentYear
Program Service Revenue Prior Year64606145ProgramServiceRevenuePriorYear
Program Service Revenue CY75278011ProgramServiceRevenueCY
Investment Income Prior Year1140541InvestmentIncomePriorYear
Investment Income Current Year1599128InvestmentIncomeCurrentYear
Other Revenue Prior Year1277559OtherRevenuePriorYear
Other Revenue Current Year1222604OtherRevenueCurrentYear
Total Revenue Prior Year67541523TotalRevenuePriorYear
Total Revenue Current Year78709793TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year20615GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY282810GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year37281642SalariesEtcPriorYear
Salaries Etc Current Year40681802SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year25483388OtherExpensePriorYear
Other Expenses Current Year28447825OtherExpensesCurrentYear
Total Expenses Prior Year62785645TotalExpensesPriorYear
Total Expenses Current Year69412437TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4755878RevenuesLessExpensesPriorYear
Revenues Less Expenses CY9297356RevenuesLessExpensesCY
Total Assets BOY82473154TotalAssetsBOY
Total Assets EOY90900586TotalAssetsEOY
Total Liabilities BOY20633231TotalLiabilitiesBOY
Total Liabilities EOY22069268TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY61839923NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY68831318NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionWALDO COUNTY GENERAL HOSPITAL'S MISSION IS TO BE THE BEST - BETTER, EMPATHY, SERVICE AND TEAMWORK. OUR GOAL IS TO ENSURE QUALITY, ACCESSIBLE AND AFFORDABLE HEALTH CARE SERVICES AND TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. PLEASE SEE ATTACHED COMMUNITY BENEFITS REPORT.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense52616509Expense
Grants282810Grants
Revenue67066436Revenue
DescriptionWALDO COUNTY GENERAL HOSPITAL PROVIDES QUALITY AND AFFORDABLE HEALTH CARE SERVICES TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITIES IT SERVES, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. A BROAD SPECTRUM OF SERVICES ARE PROVIDED INCLUDING HOSPITAL ACUTE INPATIENT CARE; ANCILLARY OUTPATIENT DIAGNOSTIC SERVICES INCLUDING LABORATORY AND RADIOLOGY; THERAPEUTIC SERVICES INCLUDING PHYSICAL THERAPY, SPEECH, AUDIOLOGY, SLEEP,AND RESPIRATORY THERAPY; ONCOLOGY CLINICS; EMERGENCY SERVICES; INPATIENT HOSPITALIST CARE, INPATIENT HOSPICE; AND SURGICAL INPATIENT AND OUTPATIENT SERVICES. THE HOSPITAL PROVIDED 6,323 DAYS OF ADULT, NEWBORN, SWING BED, AND HOSPICE INPATIENT CARE, AND 70,717 OUTPATIENT VISITS INCLUDING 530,596 OUTPATIENT PROCEDURES AND EXAMS. SEE ATTACHED COMMUNITY BENEFITS REPORT.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense6708010Expense
Revenue6766150Revenue
DescriptionWALDO COUNTY GENERAL HOSPITAL EMPLOYS MANY HOSPITAL-BASED PHYSICIANS AND PROVIDES THE FOLLOWING SPECTRUM OF PHYSICIAN PATIENT CARE SERVICES: FAMILY MEDICINE, GENERAL SURGERY, INTERNAL MEDICINE, ORTHOPEDICS, NEUROLOGY, OB/GYN, PODIATRY, CARDIOLOGY, OTOLARYNGOLOGY, AND PULMONOLOGY. OUR PHYSICIANS PROVIDED CARE TO PATIENTS DURING 36,538 PHYSICIAN-OFFICE PATIENT VISITS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense2179873Expense
Revenue1860831Revenue
DescriptionWALDO COUNTY GENERAL HOSPITAL OFFERS THE COMMUNITY IT SERVES FIVE HEALTH CENTERS: ARTHUR JEWELL COMMUNITY HEALTH CENTER, STOCKTON SPRINGS REGIONAL HEALTH CENTER, DONALD S. WALKER HEALTH CENTER, LINCOLNVILLE REGIONAL HEALTH CENTER AND SEARSPORT HEALTH CENTER. WE PROVIDED HEALTHCARE SERVICES TO PATIENTS DURING 18,408 HEALTH CENTER VISITS.Description
FieldValueIRS element (for citing)
Total Program Service Expense61504392TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096113NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees683NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledMEStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonLINDA B DRINKWATERNamePerson
Telephone Number2073382500TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1118 NORTHPORT AVENUEAddressLine1
CityBELFASTCity
StateMEState
ZIP Code04915ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
D KENT CLARK MD
DIRECTOR/EMP35.00X312309024588
ANN HOOPER
DIRECTOR/EMP35.00X117525015806
JAMES C DELEHANTY MD
DIRECTOR1.00X688000
JENNESS ROBBINS
PRESIDENT1.00X000X
PETER D HADDOCK
DIRECTOR1.00X000
JOHN D WORTH III
SECRETARY1.00X000X
FRANK MORONG
TREASURER1.00X000X
DALE KUHNERT
VICE PRES.1.00X000X
GREGOR DAVENS
DIRECTOR1.00X000
WAYNE HAMILTON
DIRECTOR1.00X000
LEE WOODWARD JR
DIRECTOR1.00X000
REP JANE CROSBY GILES
DIRECTOR1.00X000
JAMES PATTERSON PHD
SECRETARY1.00X000X
DAVID TASSONI
DIRECTOR1.00X000
CATHERINE REYNOLDS
DIRECTOR1.00X000
MARK BISCONE
CEO30.003132697823029553X
LINDA DRINKWATER
CFO35.0015473207777X
OWEN NELSON MD
ORTHOPEDIC.32.00403585012023X
RICHARD BOWER MD
ORTHOPEDIC M30.00392282027847X
CARL PILLITTERI MD
OB/GYN40.00342978023801X
JAMES DORSCH MD
ANESTH. MD40.00340309023853X
TERRANCE SMITH MD
ANESTH. MD40.00335074026826X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2718943TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs78230TotalReportableCompFrmRltdOrgs
Total Other Compensation192074TotalOtherCompensation
Number Individuals GT100 K48NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensationAddress Line2AddressOfContractor/AddressUS/AddressLine2
MAINE CENTER FOR CANCER MEDICINE
100 CAMPUS DRIVE UNIT 308SCARBOROUGHME04074MED. STAFFING292063
BAKER NEWMAN NOYES
280 FORE STREETPORTLANDME04112AUDITING152915PO BOX 507
FREYS' CARPENTRY
661 SWANLAKE AVENUEBELFASTME04915CONSTRUCTION147242
WEATHERBY LOCUMS INC
PO BOX 972633DALLASTX75397MED. STAFFING137897
ON ASSIGNMENT STAFFING
FILE 50730LOS ANGELESCA90074MED. STAFFING100002
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants367033GovernmentGrants
All Other Contributions243017AllOtherContributions
Total Contributions610050TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REVENUEDescription
Business Code623000BusinessCode
Total Revenue Column75278011TotalRevenueColumn
Related Or Exempt Function Income75278011RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue75278011TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1303213TotalRevenueColumn
Exclusion$1,303,213ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real169882Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real169882Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column169882TotalRevenueColumn
Related Or Exempt Function Income169882RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities8881312Securities
Other228150Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities8679227Securities
Other134320Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities202085Securities
Other93830Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column295915TotalRevenueColumn
Related Or Exempt Function Income295915RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MISCELLANEOUS REVENUE576914576914
MANAGEMENT FEE REVENUE261840261840
CAFETERIA REVENUE213968213968
FieldValueIRS element (for citing)
Total Other Revenue1052722TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column78709793TotalRevenueColumn
Related Or Exempt Function Income76796530RelatedOrExemptFunctionIncome
Exclusion$1,303,213ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total266300Total
Program Services266300ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total16510Total
Program Services16510ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total775258Total
Program Services111957ProgramServices
Management And General663301ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total32245263Total
Program Services28680340ProgramServices
Management And General3564923ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total731145Total
Program Services637193ProgramServices
Management And General93952ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4801782Total
Program Services4188602ProgramServices
Management And General613180ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2128354Total
Program Services1854861ProgramServices
Management And General273493ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total487602Total
Management And General487602ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total17501Total
Management And General17501ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total162305Total
Management And General162305ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4866489Total
Program Services4498932ProgramServices
Management And General367557ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1242Total
Management And General1242ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9089986Total
Program Services8881123ProgramServices
Management And General208863ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total940607Total
Program Services794701ProgramServices
Management And General145906ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1645840Total
Program Services1434350ProgramServices
Management And General211490ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total106900Total
Program Services78424ProgramServices
Management And General28476ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total209250Total
Program Services190667ProgramServices
Management And General18583ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total403887Total
Program Services351988ProgramServices
Management And General51899ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3147893Total
Program Services2743389ProgramServices
Management And General404504ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1200650Total
Program Services736601ProgramServices
Management And General464049ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PROVISION FOR BAD DEBTS40333754033375
STATE OF ME HOSPITAL TAX12622931262293
MISCELLANEOUS EXPENSES461608332389129219
DUES410397410397

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total69412437Total
Program Services61504392ProgramServices
Management And General7908045ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3685BOY
EOY3715EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3095209BOY
EOY8295540EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY38438EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4811411BOY
EOY6696824EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1876650BOY
EOY2005526EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY623333BOY
EOY206944EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis56090791LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec34213416LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY23370955BOY
EOY21877375EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY28355005BOY
EOY31572037EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY152653BOY
EOY153534EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY20184253BOY
EOY20050653EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY82473154BOY
EOY90900586EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7089585BOY
EOY6881754EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY7018289BOY
EOY7103807EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6525357BOY
EOY8083707EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY20633231BOY
EOY22069268EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY48545647BOY
EOY56172692EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1546298BOY
EOY1456389EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY11747978BOY
EOY11202237EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY61839923BOY
EOY68831318EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY82473154BOY
EOY90900586EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses9297356ReconcilationRevenueExpenses
Reconcilation Other Changes-2305961ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

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)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
Form1120 Pol FiledfalseForm1120PolFiled
Form4720 FiledfalseForm4720Filed
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$4,922OtherActivitiesAmount
Total Lobbying Expenditures IIB4922TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax
Substantially All Dues NondeductfalseSubstantiallyAllDuesNondeduct
Only In House LobbyingfalseOnlyInHouseLobbying
Agree To Carryover Prior YearfalseAgreeToCarryoverPriorYear

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
Return ReferenceSCHEDULE C, PART II-B, LINE 1IReturnReference
ExplanationPERCENTAGE OF ANNUAL MAINE HOSPITAL ASSOCIATION DUES ALLOCATED TOWARDS LOBBYING EXPENSES: 4,922.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance646826BeginningOfYearBalance
Contributions15070Contributions
Investment Earnings Or Losses-9373InvestmentEarningsOrLosses
End Of Year Balance652523EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance697111BeginningOfYearBalance
Contributions14173Contributions
Investment Earnings Or Losses-64458InvestmentEarningsOrLosses
End Of Year Balance646826EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance606116BeginningOfYearBalance
Contributions106512Contributions
Investment Earnings Or Losses-15517InvestmentEarningsOrLosses
End Of Year Balance697111EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgstrueEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis230009OtherCostOrOtherBasis
Book Value230009BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis27284086OtherCostOrOtherBasis
Depreciation11895841Depreciation
Book Value15388245BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis26802053OtherCostOrOtherBasis
Depreciation21450349Depreciation
Book Value5351704BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1774643OtherCostOrOtherBasis
Depreciation867226Depreciation
Book Value907417BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings21877375TotalOfBookValueLandBuildings

Other Assets OtherAssets (7 entries)

DescriptionDescriptionBook ValueBookValue
BENEFICIAL INTERESTS IN PERP TRUST10789686
ASSETS LIMITED TO USE - INVEST DEPR5185481
THIRD PARTY SETTLEMENTS1600000
SUNDRY RECEIVABLES1184180
BENEFICIAL INTERESTS IN CHARIT TRUST975977
OTHER CURRENT ASSETS235604
DEFERRED FINANCING FEES79725
FieldValueIRS element (for citing)
Total Book Value Other Assets20050653TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
DUE TO THIRD PARTIES$5,901,459
INSURANCE RESERVE PAYABLE$1,310,000
DUE TO RELATED PARTIES$872,248
CAPITALIZED LEASE
OTHER L/T LIABILITES
FieldValueIRS element (for citing)
Total Of Amounts8083707TotalOfAmounts
Total Revenue78709793TotalRevenue
Total Expenses69412437TotalExpenses
Excess Or Deficit For Year9297356ExcessOrDeficitForYear
Net Unrealized GL On Investments-709251NetUnrealizedGLOnInvestments
Other-$1,596,710OtherAmount
Total Adjustments-2305961TotalAdjustments
Excess Or Deficit Per FS6991395ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt75988422TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-709251NetUnrealizedGainsInvestments
Other Revenues-1596710OtherRevenues
Revenue Not Rptd F990-2305961RevenueNotRptdF990
Revenue Subtotal78294383RevenueSubtotal
Other Revenues Not Included415410OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt415410RevenueNotRptdOnFinStmt
Total Revenue Per Form99078709793TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt68997027TotExpensesEtcAuditedFinclStmt
Expenses Subtotal68997027ExpensesSubtotal
Other Expenses Not Included415410OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt415410ExpensesNotRptdOnFinStmt
Total Expenses Per Form99069412437TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
INTENDED USES FOR ENDOWMENT FUNDSSCHEDULE D, PAGE 2, PART V, LINE 4TWO OF THE ENDOWMENT FUNDS ARE INTENDED FOR THE EARNINGS TO BE USED IN THE GENERAL OPERATIONS OF THE HOSPITAL. OTHERS ARE INTENDED FOR THE EMERGENCY DEPARTMENT, INPATIENT HOSPICE, CANCER PATIENTS, CRIPPLED CHILDREN, AND NEEDY RESIDENTS.
LIABILITY UNDER FIN 48 FOOTNOTESCHEDULE D, PAGE 3, PART XTHE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THERE IS NO PROVISION FOR INCOME TAXES WITHIN THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS EVALUATED THE POSITIONS TAKEN ON ITS FILED TAX RETURNS AND HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT SEPTEMBER 30, 2011. THE ORGANIZATION'S TAX YEARS FROM 2008 THROUGH 2011 ARE OPEN AND SUBJECT TO EXAMINATION.
RECONCILIATION OF CHANGES - OTHERSCHEDULE D, PAGE 4, PART XI, LINE 8CHANGE IN VALUE OF PERPETUAL AND CHARITABLE TRUSTS -655,230 EQUITY TRANSFERS TO AFFILIATES -941,480 GRANT REVENUE -415,410 GRANT EXPENSES 415,410
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHERSCHEDULE D, PAGE 4, PART XII, LINE 2DCHANGE IN VALUE OF PERPETUAL AND CHARITABLE TRUSTS -655,230 EQUITY TRANSFERS TO AFFILIATES -941,480
REVENUE AMOUNTS INCLUDED ON RETURN - OTHERSCHEDULE D, PAGE 4, PART XII, LINE 4BGRANT REVENUE 415,410
EXPENSE AMOUNTS INCLUDED ON RETURN - OTHERSCHEDULE D, PAGE 4, PART XIII, LINE 4BGRANT EXPENSES 415,410

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2028070TotalCommunityBenefitExpense
Net Community Benefit Expense2028070NetCommunityBenefitExpense
Percent Of Total Expense0.03100PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense13253256TotalCommunityBenefitExpense
Direct Offsetting Revenue11183477DirectOffsettingRevenue
Net Community Benefit Expense2069779NetCommunityBenefitExpense
Percent Of Total Expense0.03170PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense15281326TotalCommunityBenefitExpense
Direct Offsetting Revenue11183477DirectOffsettingRevenue
Net Community Benefit Expense4097849NetCommunityBenefitExpense
Percent Of Total Expense0.06270PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense196867TotalCommunityBenefitExpense
Direct Offsetting Revenue14495DirectOffsettingRevenue
Net Community Benefit Expense182372NetCommunityBenefitExpense
Percent Of Total Expense0.00280PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense81581TotalCommunityBenefitExpense
Net Community Benefit Expense81581NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense11393670TotalCommunityBenefitExpense
Direct Offsetting Revenue7990029DirectOffsettingRevenue
Net Community Benefit Expense3403641NetCommunityBenefitExpense
Percent Of Total Expense0.05200PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense28558TotalCommunityBenefitExpense
Net Community Benefit Expense28558NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11700676TotalCommunityBenefitExpense
Direct Offsetting Revenue8004524DirectOffsettingRevenue
Net Community Benefit Expense3696152NetCommunityBenefitExpense
Percent Of Total Expense0.05640PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense26982002TotalCommunityBenefitExpense
Direct Offsetting Revenue19188001DirectOffsettingRevenue
Net Community Benefit Expense7794001NetCommunityBenefitExpense
Percent Of Total Expense0.11910PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,468,022BadDebtExpenseAmount
Amount Reimbursed By Medicare22587450AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare22587450CostOfCareReimbursedByMedicare
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities6NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (6 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalCritical Access HospitalCriticalAccessHospitalEr24 HoursEr24Hours
WALDO COUNTY GENERAL HOSPITAL
1118 NORTHPORT AVENUEBELFASTME04915XXXX
ARTHUR JEWELL COMMUNITY HEALTH CTR
255 REYNOLDS ROADBROOKSME04921X
DONALD S WALKER HEALTH CENTER
343 WEST MAIN STREETLIBERTYME04949X
LINCOLNVILLE HEALTH CENTER
42399 ATLANTIC HIGHWAYLINCOLNVILLEME04849X
SEARSPORT HEALTH CENTER
537 MORTLAND ROADSEARSPORTME04974X
STOCKTON SPRING REG HEALTH CENTER
611 CAPE JELLISON ROADSTOCKTON SPRINGSME04981X

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (6 entries)

Hospital Facility NumberHospitalFacilityNumber
WALDO COUNTY GENERAL HOSPITAL
1
ARTHUR JEWELL COMMUNITY HEALTH CTR
2
DONALD S WALKER HEALTH CENTER
3
LINCOLNVILLE HEALTH CENTER
4
SEARSPORT HEALTH CENTER
5
STOCKTON SPRING REG HEALTH CENTER
6

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUBSIDIZED HEALTH SERVICES EXPLANATIONPART I LINE 7GPHYSICIAN CLINIC COSTS WERE INCLUDED AS SUBSIDIZED HEALTH SERVICES IN THE AMOUNT OF 11393670
COSTING METHODOLOGY EXPLANATIONPART I LINE 7THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE WORKSHEETS PROVIDED IN THE SCHEDULE H INSTRUCTIONS THE COSTTOCHARGE RATIO WAS USED AS THE COSTING METHODOLOGY AND WAS ALSO CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS
COMMUNITY BUILDING ACTIVITIESPART IISEE ATTACHED COMMUNITY BENEFITS STATEMENT
BAD DEBT EXPENSE EXPLANATIONPART III LINE 4THE ORGANIZATION USES A COSTTOCHARGE RATIO METHODOLOGY THE AMOUNT REPORTED ON PART III LINE 2 WAS DETERMINED USING WORKSHEET A PROVIDED IN THE SCHEDULE H INSTRUCTIONS DISCOUNTS PROVIDED TO PATIENTS ARE NOT INCLUDED IN BAD DEBT EXPENSE AN AMOUNT THAT COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITALS CHARITY CARE POLICY IF SUFFICIENT INFORMATION HAD BEEN AVAILABLE TO MAKE A DETERMINATION OF THEIR ELIGIBILITY COULD NOT BE REASONABLE DETERMINED PART III LINE 4 BAD DEBT FOOTNOTE IN THE ORGANIZATIONS FINANCIAL STATEMENTS CHARGES FOR SERVICES RENDERED TO INDIVIDUALS FROM WHOM PAYMENT IS EXPECTED AND ULTIMATELY NOT RECEIVED ARE WRITTEN OFF AND INCLUDED IN EXPENSES AS PART OF THE PROVISION FOR BAD DEBTS BAD DEBT EXPENSE REPRESENTS HEALTHCARE SERVICES WALDO COUNTY GENERAL HOSPITAL HAS PROVIDED WITHOUT COMPENSATION AS A TAXEXEMPT HOSPITAL WALDO COUNTY GENERAL HOSPITAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES A PORTION OF THE HOSPITALS BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE THAT FOR A VARIETY OF REASONS DO NOT COMPLETE THE FINANCIAL ASSISTANCE APPLICATION PROCESS WALDO COUNTY GENERAL HOSPITAL CANNOT DETERMINE THE AMOUNT OF BAD DEBT EXPENSE THAT COULD BE REASONABLY ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITALS FREE CARE POLICY IN ADDITION BAD DEBT EXPENSE ALSO INCLUDES AMOUNTS FOR SERVICES PROVIDED TO INDIVIDUALS EXPERIENCING DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES RELATED TO A PORTION OF OUR COMMUNITY BASED PATIENT POPULATION THEIR MEDICAL BILLS OFTEN PLACE THESE INDIVIDUALS IN UNTENABLE POSITIONS WHERE THEY ARE NOT ABLE TO HANDLE THEIR PERSONAL DEBT AND THEN THEIR NEW MEDICAL DEBT HOWEVER BECAUSE OF THEIR INCOME LEVEL THEY DO NOT QUALIFY FOR FREE CARE BY PROVIDING NECESSARY HEALTHCARE SERVICES TO THOSE INDIVIDUALS WHO EITHER FAIL TO APPLY FOR FINANCIAL ASSISTANCE OR WHO ARE EXPERIENCING DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES WALDO COUNTY GENERAL HOSPITAL BELIEVES THAT BAD DEBT EXPENSE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT
MEDICARE EXPLANATIONPART III LINE 8THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE HOSPITALS MEDICARE COST REPORT IS THE MEDICARE COSTTOCHARGE RATIO WHICH INCORPORATES MEDICARE ALLOWABLE COST THE HOSPITAL HAS MADE A CLEAR MISSION COMMITMENT TO SERVING ELDERLY PATIENTS
COLLECTION PRACTICES EXPLANATIONPART III LINE 9BONCE A PATIENT HAS BEEN DETERMINED TO QUALIFY FOR FREE CARE THE PATIENT IS NOT BILLED FOR SERVICES PROVIDED NOR IS THE PATIENT BILLED FOR AMOUNTS NOT PAID BY AN INSURER
NEEDS ASSESSMENTPART VISEE ATTACHED COMMUNITY BENEFITS STATEMENT
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VISEE ATTACHED COMMUNITY BENEFITS STATEMENT
COMMUNITY INFORMATIONPART VISEE ATTACHED COMMUNITY BENEFITS STATEMENT
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VISEE ATTACHED COMMUNITY BENEFITS STATEMENT
AFFILIATED HEALTH CARE INFORMATIONPART VISEE ATTACHED COMMUNITY BENEFITS STATEMENT

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
SPRING HARBOR COMM SERVICE
78 ATLANTIC PLACESOUTH PORTLANDME04106010524835501196300SUB MENTAL HEALTH
UNIVERSITY OF MAINE
PO BOX 370ORONOME0447301600076950160000SUPPORT NURSING
HOSPICE VOLUNTEERS OF WALDO COUNTY
PO BOX 772BELFASTME0491522266830750110000SUPPORT HOSPICE
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPS TO STUDENTSTypeOfGrant
Number Of Recipients13NumberOfRecipients
Amount Of Cash Grant16510AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierADDITIONAL INFORMATIONIdentifier
Return ReferenceSCHEDULE I, PAGE 4, PART IVReturnReference
ExplanationSCHOLARSHIPS ARE AWARDED TO STUDENTS RESIDING IN WALDO COUNTY AND PURSUING A CAREER IN A HEALTHCARE RELATED PROGRAM. THERE IS A SCHOLARSHIP APPLICATION PROCESS OVERSEEN BY THE SCHOLARSHIP COMMITTEE. RECIPIENTS MUST HAVE COMPLETED ONE SEMESTER OF SCHOOLING WITH A PREDETERMINED MINIMUM GPA, BE ENROLLED IN THE SECOND SEMESTER, AND HAVE A FINANCIAL NEED. PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL OR AS REIMBURSEMENT TO THE RECIPIENT WHEN APPROPRIATE DOCUMENTATION IS PROVIDED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgs
D KENT CLARK MD
26079551514735017238336897
MARK BISCONE
21896172308735022203342822782302200078230
LINDA DRINKWATER
15403369946483129162509
OWEN NELSON MD
40358512023415608
RICHARD BOWER MD
3854246858735020497420129
CARL PILLITTERI MD
2412601218735016451366779100500
JAMES DORSCH MD
31651923790735016503364162
TERRANCE SMITH MD
3309994075735019476361900

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990 - ORGANIZATION'S MISSIONWALDO COUNTY GENERAL HOSPITAL'S MISSION IS TO BE THE BEST - BETTER, EMPATHY, SERVICE AND TEAMWORK. OUR GOAL IS TO ENSURE QUALITY, ACCESSIBLE AND AFFORDABLE HEALTH CARE SERVICES AND TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. PLEASE SEE ATTACHED COMMUNITY BENEFITS REPORT.
CLASSES OF MEMBERS OR STOCKHOLDERSFORM 990, PAGE 6, PART VI, LINE 6WALDO COUNTY HEALTHCARE, INC. (WCHI)-(EIN 22-2864961)IS THE SOLE MEMBER OF WALDO COUNTY GENERAL HOSPITAL. MAINEHEALTH (EIN 01-0431680), IS THE SOLE MEMBER OF WCHI. AS SOLE MEMBER OF WCHI, MAINEHEALTH HAS THE RIGHT TO APPROVE SIGINIFICANT DECISIONS OF THE GOVERNING BODY OF WCHI AND ITS SUBSIDIARIES.
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7AMAINEHEALTH (EIN 01-0431680) MAY ELECT MEMBERS OF THE BOARD OF DIRECTORS FROM A SLATE OF NOMINEES SUBMITTED BY THE CORPORATION.
DECISIONS SUBJECT TO APPROVAL OF MEMBERSFORM 990, PAGE 6, PART VI, LINE 7BDECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS STRATEGIES, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION, AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL BY MAINEHEALTH (EIN 01-0431680).
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTHE FINANCE COMMITTEE PERFORMS A DETAILED REVIEW OF THE FORM 990. THE FORM 990 IS THEN PRESENTED TO THE FULL BOARD. THE CFO PERFORMS A DETAIL REVIEW OF THE FORM 990 PRIOR TO SIGNING AND FILING THE RETURN.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CWALDO COUNTY GENERAL HOSPITAL'S CONFLICT OF INTEREST POLICY IS INCORPORATED AS PART OF THE BY-LAWS OF THESE CORPORATIONS. THE ORGANIZATION CONSISTENTLY REVIEWS ALL TRANSACTIONS TO ASSURE COMPLIANCE IN ACCORDANCE WITH THE BY-LAWS.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE PROCESS FOLLOWED FOR DETERMINING COMPENSATION OF THE EXECUTIVE DIRECTOR IS A FORMAL PROCESS PERFORMED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THIS COMMITTEE USES THE SULLIVAN COTTER ANNUAL EXECUTIVE COMPENSATION ANALYSIS TO COMPARE MARKET ANALYSIS IN SETTING THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AS WELL AS THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BTHE PROCESS FOLLOWED FOR DETERMINING COMPENSATION OF THE EXECUTIVE DIRECTOR IS A FORMAL PROCESS PERFORMED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THIS COMMITTEE USES THE SULLIVAN COTTER ANNUAL EXECUTIVE COMPENSATION ANALYSIS TO COMPARE MARKET ANALYSIS IN SETTING THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AS WELL AS THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST.
RELATED ORGANIZATIONSFORM 990, PAGE 7, PART VIID. KENT CLARK, MD 5 HOURS ANN HOOPER 5 HOURS MARK BISCONE 10 HOURS LINDA DRINKWATER 5 HOURS
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 5NET UNREALIZED LOSSES ON INVESTMENTS -709,251 CHANGE IN VALUE OF PERPETUAL AND CHARITABLE TRUSTS -655,230 EQUITY TRANSFERS TO AFFILIATES -941,480

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
WALDO COUNTY HEALTHCARE INC
PO BOX 287BELFASTME04915222864961COMM. EDUCME501C311BMEHLTHfalse
COASTAL MEDICAL CARE
PO BOX 287BELFASTME04915010487091MED. SERV.ME501C39WCHIfalse
BELFAST PUBLIC HEALTH NURSING
PO BOX 287BELFASTME04915043359810PUB. HLTH.ME501C39WCHIfalse
WALDO COUNTY HOME HEALTHCARE SERV
PO BOX 287BELFASTME04915222864960HOSPICEME501C39WCHIfalse
MAINEHEALTH
110 FREE STREETPORTLANDME04101010431680HEALTHCAREME501C311CNAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1WALDO COUNTY HEALTHCARE MGMT COBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 287AddressLine1
CityBELFASTCity
StateMEState
ZIP Code04915ZIPCode
FieldValueIRS element (for citing)
EIN010485133EIN
Primary ActivityMGMT SVCSPrimaryActivity
Legal Domicile StateMELegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg