2012-05-15T09:30:56-05:00 2011-06-30 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2010-07-01 010198331 Maine Coast Regional Health Facilities MAIN 2076645303 50 Union Street Ellsworth ME 04605 Charles Therrien 2076645303 2012-05-11 1 Barbara J McGuan CPA 2077752387 2012-05-11 2010 2016-02-24 21:20:13Z Maine Coast Memorial Hospital Charles Therrien 50 Union Street Ellsworth ME 04605 92653395 0 X www.mcmhospital.org X 1964 ME The hospital provides health care services through its acute care facilities. 19 15 858 188 0 0 2887751 714791 82802501 90654272 380364 466102 271782 -45158 86342398 91790007 0 0 0 0 52215504 52749855 64358 0 150703 32483648 33462853 84763510 86212708 1578888 5577299 71114704 74385385 31628313 28857886 39486391 45527499 X The hospital is a not-for-profit entity established to provide health care services through its acute care facilities. 0 0 80364538 90657272 Admissions 3,745Patient Days 10,817Average Stay 2.89 DaysClinic Visits:Eleanor Widener Dixon Clinic 10,586S.W. Harbor Medical Center 5,125Emergency Room Visits 18,405Surgical Cases- Inpatient 875Surgical Cases- Outpatient 3,308Laboratory Tests: 294,310Radiology Exams:Diagnostic Radiology 18,173Ultrasound 4,867CT Scan 5,559Mammography 4,059Nuclear Medicine 2,438MRI 2,206Physical Therapy 53,133Births 309 80364538 1 1 0 1 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 65 0 1 858 1 0 0 0 0 0 1 1 0 0 0 0 X 19 15 1 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 ME X X Charles Therrien President & CEO 2076645303 50 Union Street Ellsworth ME 04605 Michelle H Beal 1.00 X 0 0 0 Edith R Dixon 0.50 X 0 0 0 Thomas J Fernald 1.00 X 0 0 0 Alan J Goldstein 0.50 X 0 0 0 Daniel A Hurley III 1.00 X 0 0 0 Adin M Tooker 1.00 X X 0 0 0 Jeffrey R Dow 1.00 X 0 0 0 Nicholas S Vachon DPM 1.00 X 0 0 0 Robert J Williams 1.00 X X 0 0 0 John P Edwards 1.00 X 0 0 0 Debra A Ehrlenbach 1.00 X 0 0 0 Robert A Beekman MD 50.00 X 178303 0 27519 Alan H Nauss MD 1.00 X 0 0 0 Katheryn Rensenbrink MD 55.00 X 215678 0 35279 Rebecca J Sargent 10.00 X X 0 0 0 Robert D Merrill 10.00 X X 0 0 0 Sean T Maloney 50.00 X 213055 0 34880 Charles D Therrien 60.00 X X 165787 0 10341 Christopher B Brown 1.00 X 0 0 0 Kevin Sedgwick 50.00 X 189031 0 26040 Sterling C Williamson 50.00 X 492693 0 37903 Thomas H Crowe 50.00 X 403462 0 35961 Bradley Goldstein 50.00 X 404892 0 32715 Martin R Curlick 50.00 X 412955 0 6304 Kerry Crowley 50.00 X 370338 0 34796 John McCormack 50.00 X 121542 0 0 Douglas T Jones 0.00 X 187536 0 8992 3355272 0 290730 64 1 1 0 Transcend Services Inc PO Box 740209 Atlanta GA 303740209 Transcription Svcs. 333590 Eastern Maine Medical Center 43 Whiting Hill Road Brewer ME 04412 Medical Services 289311 Baker Newman & Noyes LLC PO Box 507 Portland ME 04112 Audit/Consult. Svcs. 245286 Vista Staffing Solutions Inc 275 East 200 South Salt Lake City UT 841112002 Nursing & Physician Staff 219387 Blue Hill Laundry Services Inc PO Box 258 Surry ME 04684 Laundry Services 214607 8 129120 103988 481683 24304 714791 Net Patient Service Re 900099 89542432 89542432 Other Medical Service 621990 705632 705632 Cafeteria/Vending 621990 313246 313246 Rehabilitation 621990 84905 84905 Ellsworth Internal Med 621110 8057 8057 90654272 353686 353686 3000 3000 3000 3000 899136 4700 773275 18145 125861 -13445 112416 112416 23810 129120 71968 -48158 -48158 91790007 90341026 0 734190 1110681 626918 483763 40519026 38861827 1553208 103991 720647 319839 400808 7684406 7344603 322669 17134 2715095 2571681 135949 7465 125544 81 125463 168844 168844 11694 11694 64075 64075 4392143 4035116 357027 137222 1932 130420 4870 2084285 1555232 529053 849308 771996 77259 53 1245268 1217958 27310 55395 53585 1776 34 333271 282264 50710 297 906381 843099 60288 2994 3520868 3147904 372089 875 1107733 658912 448821 Medical Supplies 9144363 9111565 32797 1 Bad Debts 5255791 5255791 Health Care Prov. Tax 1854852 1854852 Repairs & Maintenance 1483426 1455709 22347 5370 Other 722390 393674 321097 7619 86212708 80364538 5697467 150703 4280 4335 17445631 17645714 197251 7534940 7111606 711988 713309 874618 1224277 58533614 25195028 35134739 33338586 4423040 6634129 319049 304003 4666419 7212175 71114704 74385385 10195970 9307744 13391775 13126775 3646275 2913557 4394293 3509810 31628313 28857886 X 38153521 44255901 663955 588127 668915 683471 39486391 45527499 71114704 74385385 X 5577299 463809 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12219 12219 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Portion of dues from Maine Hospital Association and American Hospital Association used for lobbying. 3349752 7664082 710004 11628 11712210 2953215 27935 383779 15177 3349752 4701120 52994 -689342 68360 1043197 2953215 0.80000 0.20000 0.00000 0 0 361138 361138 38530010 11597190 26932820 245055 121073 123982 19397411 13476765 5920646 33338586 Construction in Progress 426226 Other Assets 43647 Estimated 3rd Party Payor Settlements 5999094 Due from Related Parties 44238 Deferred Compensation 698970 7212175 Deferred Compensation 698970 Estimated Third-Party Payor Settlements 2810840 3509810 Part V, Line 4: The intended uses of the endowment funds are funded depreciation, the oncology clinic and the breast clinic. During the year, approximately 7 million dollars of board-designated funds were contributed to the endowment fund. Poinsettia Ball 78665 69100 9565 9975 29805 Chef's Gala 74265 60020 14245 5659 26529 152930 129120 23810 15634 56334 71968 -48158 1 1 1 X 1 X 1 1 0 1 1 1727796 0 1727796 0.02130 13167099 7945541 5221558 0.06450 14894895 7945541 6949354 0.08580 118489 2123 116366 0.00140 3000 3000 14310477 8989401 5321076 0.06570 7623 0 7623 0.00010 14439589 8994524 5445065 0.06720 29334484 16940065 12394419 0.15300 1 2420292 0 16090210 17692151 -1601941 1 1 1 1 Maine Coast Memorial Hospital

50 Union Street Ellsworth ME 04605

X X X Maine Coast Memorial Hospital 1 15 Ellsworth Internal Medicine

32 Resort Way Ellsworth ME 04605

Physician Practice Ellsworth Family Practice

32 Resort Way Ellsworth ME 04605

Physician Practice Maine Coast Pediatrics

32 Resort Way Ellsworth ME 04605

Physician Practice Eleanor Widener Dixon Memorial Clinic

37 Clinic Road Ellsworth ME 04605

Physician Practice Southwest Harbor Medical Center

45 Herrick Road Ellsworth ME 04605

Physician Practice Maine Coast Specialty Clinic

306 Main Street Ellsworth ME 04605

Physician Practice Maine Coast Urology

50 Union Street Ellsworth ME 04605

Physician Practice Maine Coast Rheumatology

50 Union Street Ellsworth ME 04605

Physician Practice Down East Dermatology

50 Union Street Ellsworth ME 04605

Physician Practice Maine Coast General Surgery

50 Union Street Ellsworth ME 04605

Physician Practice Maine Coast Women Care

50 Union Street Ellsworth ME 04605

Physician Practice Maine Coast Hand & Shoulder

50 Union Street Ellsworth ME 04605

Physician Practice Frenchman Bay Orthopedics

50 Union Street Ellsworth ME 04605

Physician Practice Maine Coast Otolaryngolgy

50 Union Street Ellsworth ME 04605

Physician Practice Maine Coast Memorial Hospital Nocturnist

50 Union Street Ellsworth ME 04605

Physician Practice 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. Urology ClinicL. Otolaryngology ClinicM. Dermatology ClinicN. General SurgeryThe above listed provider based physician practices have a community benefit (i.e., aggregate loss or subsidy from the hospital) of approximately $5.3 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 $5.3 million is a conservative figure that reconciles to the community benefit reported on IRS form 990H, Part I, Line 7G, Column E. Part I, L7 Col(f): As part of the hospital's total expenses, there is $5,225,791 of bad debts. This amount has been removed from the Part I, Line 7 Column F calculation per the IRS instructions. Community Benefit Report Schedule H, Part I, Line 6a: 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. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to provision for bad debts and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.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 costs 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 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 staff are generally available to assist any patient inquiring about programs when presenting for services. Through the patient accounting dept, 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 portion 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 MDT 40 MDT41 MDThe following demographics represent the counties served by Maine Coast Memorial Hospital: - Population: Hancock County 54,418; Washington County 32,856; State of Maine 1,328,361 - Persons < 5 yrs: Hancock County 5.0%; Washington County 5.4%; State of Maine 5.4% - Persons < 18 yrs: Hancock County 18.6%; Washington County 20.1%; State of Maine 20.6% - Persons 65 yrs & over: Hancock County 17.3%; Washington County 18.7%; State of Maine 15.6% - Median Household Income: Hancock County $47,849; Washington County $31,856; State of Maine $46,419 - Persons below poverty level: Hancock County 10.8%; Washington County 20.1%; State of Maine 12.6% Part VI, Line 7: 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. X 0 1 X X X X 1 0 0 0 0 0 0 1 0 Robert A Beekman MD 177011 0 500 0 792 0 4149 0 23370 0 205822 0 0 0 Katheryn Rensenbrink MD 213831 0 1667 0 180 0 4999 0 30280 0 250957 0 0 0 Sean T Maloney 212375 0 500 0 180 0 4932 0 29948 0 247935 0 0 0 Charles D Therrien 145713 0 0 0 20074 0 0 0 10341 0 176128 0 0 0 Kevin Sedgwick 188515 0 0 0 516 0 4360 0 21680 0 215071 0 0 0 Sterling C Williamson 325806 0 149964 0 16923 0 5512 0 32391 0 530596 0 0 0 Thomas H Crowe 358108 0 28095 0 17259 0 5513 0 30448 0 439423 0 0 0 Bradley Goldstein 346989 0 57783 0 120 0 5512 0 27203 0 437607 0 0 0 Martin R Curlick 412439 0 0 0 516 0 5513 0 791 0 419259 0 0 0 Kerry Crowley 311507 0 58315 0 516 0 5513 0 29283 0 405134 0 0 0 John McCormack 120211 0 0 0 1331 0 0 0 0 0 121542 0 0 0 Douglas T Jones 187140 0 0 0 396 0 0 0 8992 0 196528 0 0 0 Part I, Line 4a Douglas Jones, Former CEO, received $196,528 in severance payments during the year. Supplemental Information Part III Part 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 and Thomas Crowe are RVU incentive payments. MHHEFA 010314384 560425NW6 2003-07-24 5695000 Construction of ICU/ Cafeteria/ OR 0 0 0 MHHEFA 010314384 5604253L2 2008-12-03 6960000 Construction of Emergency Dept. 0 0 0 5875000 368171 119201 5387628 2005 0 0 1 1 6960000 937875 131414 5890711 2009 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 Daniel A Hurley Trustee Mr. 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. 0 Form 990, Part VI, Section A, line 2 Rebecca Sargent and Debra Ehrlenbach have a business relationship. Form 990, Part VI, Section A, line 6 Maine Coast Healthcare Corporation is the sole member of the Organization. Form 990, Part VI, Section A, line 7a The Member shall have the right to elect trustees and honorary trustees to the board of trustees. Form 990, Part VI, Section A, line 7b The 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 11 Prior 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 12c Examples 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 15 Executive 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 19 Government documents and conflict of interest policy are available upon request. The financial statements are made public through the annual report. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 449,253. Change in Value of Trust 14,556. Total to Form 990, Part XI, Line 5: 463,809. Oversight of Audit Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Maine Coast Medical Realty Inc 50 Union Street Ellsworth ME 04605 010390918 Furnishing Medical Facilities ME 501(c)(3) Line 11a, I Maine Coast Regional Health Facilities 0 Maine Coast Healthcare Corporation 50 Union Street ellsworth ME 04605 223176167 Parent Organization for Hospital ME 501(c)(3) Line 11b, II N/A 0 Maine Coast Healthcare Foundation 50 Union Street ellsworth ME 04605 262344952 Raise and hold donations for hospital ME 501(c)(3) Line 11a, I Maine Coast Regional Health Facilities 0 Maine Coast Physician Affiliates 50 Union Street Ellsworth ME 04605 010479952 Inactive ME Maine Coast Healthcare Corporation C 0 1 1 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 Maine Coast Medical Realty P 145278 FMV