NORTHERN MAINE MEDICAL CENTER: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN MAINE MEDICAL CENTER (EIN 01-0234189)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2012-08-15
- IRS object ID
- 201232289349302228
- Schema version
- 2009v1.7
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-15T11:17:32-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 507 | AddressLine1 |
| City | PORTLAND | City |
| State | ME | State |
| ZIP Code | 04112 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010234189 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northern Maine Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORT | NameControl |
| Phone | 2078343155 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Main Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Peter J Sirois | Name |
| Title | CEO | Title |
| Phone | 2078343155 | Phone |
| Date Signed | 2012-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Nicholas E Porto | Name |
| Phone | 2078792100 | Phone |
| Date Prepared | 2012-08-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | X | AmendedReturn |
| Name Of Principal Officer Person | Peter J Sirois | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Main Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 44070600 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.nmmc.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1948 | YearFormation |
| State Legal Domicile | ME | StateLegalDomicile |
| Activity Or Mission Description | Acute care & long term care hospital and mental health services facility | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 27 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 25 | NbrIndependentVotingMembers |
| Total Nbr Employees | 625 | TotalNbrEmployees |
| Total Nbr Volunteers | 50 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 400725 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 227660 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 42992442 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 43910006 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -29681 | InvestmentIncomePriorYear |
| Investment Income Current Year | -187032 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 616096 | OtherRevenuePriorYear |
| Other Revenue Current Year | -76212 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 43979582 | TotalRevenuePriorYear |
| Total Revenue Current Year | 43874422 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 21759673 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 20965773 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 23183686 | OtherExpensePriorYear |
| Other Expenses Current Year | 25855470 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 44943359 | TotalExpensesPriorYear |
| Total Expenses Current Year | 46821243 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -963777 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2946821 | RevenuesLessExpensesCY |
| Total Assets BOY | 32557593 | TotalAssetsBOY |
| Total Assets EOY | 29391825 | TotalAssetsEOY |
| Total Liabilities BOY | 14714196 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 14493190 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17843397 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 14898635 | NetAssetsOrFundBalancesEOY |
| Mission Description | The mission of Northern Maine Medical Center is to provide, coordinate, or support access to high quality, affordable health care and to positively impact our communities' quality of life by improving health status. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 37874318 | Expense |
| Revenue | 43591738 | Revenue |
| Description | Medical care & ancillary services; nursing home & skilled services; physician services | Description |
| Total Program Service Expense | 37874318 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 82 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 625 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 27 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 25 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Peter Sirois | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2078343155 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Main Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (34 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Guy Raymond | |||||||
| Director | 52.00 | X | 407187 | 0 | 32938 | ||
| Bob Bellefleur | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Rita C Cannan | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Richard Cost | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Fern Desjardins | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Wally Desjardin | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| John Ezzy | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Roy Gardner | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Nelson Jandreau | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Frances LaBrie | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| John Martin | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Bill Melvin | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dr David Mitchell | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Clifford Ouellette | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Kim Ouellette | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Ronald Paradis | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| David Parent | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| James Roy | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Kathy Roy | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Simona Suchan MD | |||||||
| Member-at-Large | 1.00 | X | 0 | 238654 | 18604 | ||
| Joan Sylvain | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| James Thibodeau | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Fred Wetmore | |||||||
| President | 2.00 | X | 0 | 0 | 0 | X | |
| Dan Vaillancourt | |||||||
| Vice President | 1.00 | X | 0 | 0 | 0 | X | |
| Glenn Lamarr | |||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | X | |
| Ronald Daigle | |||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | X | |
| Norman Fournier | |||||||
| Member-at-Large | 1.00 | X | 0 | 0 | 0 | X | |
| Martin B Bernstein | |||||||
| CEO | 50.00 | 203744 | 0 | 14079 | X | ||
| Roger L Lagasse | |||||||
| CFO | 50.00 | 141738 | 0 | 10545 | X | ||
| Peter J Sirois | |||||||
| Assistant Administrator | 50.00 | 158419 | 0 | 22045 | X | ||
| Scott Richards | |||||||
| Pharmacist | 50.00 | 144729 | 0 | 25428 | X | ||
| Joanne Fortin | |||||||
| D.O.N. | 50.00 | 121405 | 0 | 8680 | X | ||
| Andrew Fletcher MD | |||||||
| ER Physician | 50.00 | 146020 | 0 | 0 | X | ||
| Paul Morin MD | |||||||
| Er Physician | 50.00 | 117600 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1440842 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 238654 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 132319 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Cary Medical Center | |||||
| 163 Van Buren Road Suite 1 | Caribou | ME | 04736 | Lab Test Analysis Services | 245452 |
| Brian Gretta MD | |||||
| 63 Merganser Cove Road | Orrs Island | ME | 04066 | ER Physician Services | 217148 |
| Quest Diagnostics | |||||
| 12436 Collection Center Drive | Chicago | IL | 60693 | Lab Test Services | 213596 |
| Baker Newman Noyes | |||||
| 280 Fore Street | Portland | ME | 04101 | Auditing and Consulting Services | 172801 |
| Comphealth Medical Staffing | |||||
| PO Box 972670 | Dallas | TX | 753972670 | Temp Medical Staff | 138941 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 11 | NumberOfContractorsGT100K |
| Government Grants | 129204 | GovernmentGrants |
| All Other Contributions | 98456 | AllOtherContributions |
| Total Contributions | 227660 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Patient Service Revenu | 623000 | 43306641 | 43306641 | |
| Miscellaneous Revenue | 623000 | 449787 | 449787 | |
| Cafeteria Revenue | 900099 | 153578 | $153,578 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 43910006 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9146 | TotalRevenueColumn |
| Exclusion | $9,146 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 88478 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 88478 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 88478 | TotalRevenueColumn |
| Exclusion | $88,478 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 196178 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -196178 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -196178 | TotalRevenueColumn |
| Exclusion | -$196,178 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Insurance Captive | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | -164690 | TotalRevenueColumn |
| Related Or Exempt Function Income | -164690 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | -164690 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 43874422 | TotalRevenueColumn |
| Related Or Exempt Function Income | 43591738 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $55,024 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 810231 | Total |
| Program Services | 485138 | ProgramServices |
| Management And General | 325093 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16802246 | Total |
| Program Services | 14020023 | ProgramServices |
| Management And General | 2782223 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5103 | Total |
| Program Services | 4206 | ProgramServices |
| Management And General | 897 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2054450 | Total |
| Program Services | 1705459 | ProgramServices |
| Management And General | 348991 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1293743 | Total |
| Program Services | 1066378 | ProgramServices |
| Management And General | 227365 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117379 | Total |
| Program Services | 74563 | ProgramServices |
| Management And General | 42816 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63010 | Total |
| Program Services | 40026 | ProgramServices |
| Management And General | 22984 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134525 | Total |
| Program Services | 85455 | ProgramServices |
| Management And General | 49070 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9000594 | Total |
| Program Services | 5717494 | ProgramServices |
| Management And General | 3283100 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1386346 | Total |
| Program Services | 880656 | ProgramServices |
| Management And General | 505690 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 528430 | Total |
| Program Services | 335677 | ProgramServices |
| Management And General | 192753 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2316549 | Total |
| Program Services | 1471553 | ProgramServices |
| Management And General | 844996 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 879875 | Total |
| Program Services | 558928 | ProgramServices |
| Management And General | 320947 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Valley Medical Associat | 8944829 | 8944829 |
| Provision for Bad Debts | 1327567 | 1327567 |
| Health Care Provider Ta | 1156366 | 1156366 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46821243 | Total |
| Program Services | 37874318 | ProgramServices |
| Management And General | 8946925 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3449017 | BOY |
| EOY | 2446668 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1552899 | BOY |
| EOY | 1336455 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3999675 | BOY |
| EOY | 5067316 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88143 | BOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 29548 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 922999 | BOY |
| EOY | 725624 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 256765 | BOY |
| EOY | 555925 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 36700115 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 19346321 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17840096 | BOY |
| EOY | 17353794 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32759 | BOY |
| EOY | 34953 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 144936 | BOY |
| EOY | 30430 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4270304 | BOY |
| EOY | 1811112 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32557593 | BOY |
| EOY | 29391825 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4686476 | BOY |
| EOY | 5213239 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9706890 | BOY |
| EOY | 8834343 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 320830 | BOY |
| EOY | 445608 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14714196 | BOY |
| EOY | 14493190 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17440996 | BOY |
| EOY | 14506439 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 402401 | BOY |
| EOY | 392196 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17843397 | BOY |
| EOY | 14898635 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32557593 | BOY |
| EOY | 29391825 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $5,622 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5622 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | The Organization paid $34,706 in dues to MHA, of which 16.2% was used for lobbying. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 402401 | BeginningOfYearBalance |
| Contributions | 95643 | Contributions |
| Investment Earnings Or Losses | 5196 | InvestmentEarningsOrLosses |
| Other Expenditures | 111044 | OtherExpenditures |
| End Of Year Balance | 392196 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 719671 | BeginningOfYearBalance |
| Contributions | 81375 | Contributions |
| Investment Earnings Or Losses | 3267 | InvestmentEarningsOrLosses |
| Other Expenditures | 401912 | OtherExpenditures |
| End Of Year Balance | 402401 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 150384 | OtherCostOrOtherBasis |
| Book Value | 150384 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18119422 | OtherCostOrOtherBasis |
| Depreciation | 6160420 | Depreciation |
| Book Value | 11959002 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1712354 | OtherCostOrOtherBasis |
| Depreciation | 981989 | Depreciation |
| Book Value | 730365 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15927829 | OtherCostOrOtherBasis |
| Depreciation | 11807630 | Depreciation |
| Book Value | 4120199 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 790126 | OtherCostOrOtherBasis |
| Depreciation | 396282 | Depreciation |
| Book Value | 393844 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 17353794 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Deferred Compensation | 445608 |
| Cash Surrender Value of Life Insurance | 165235 |
| Construction in Progress | 201012 |
| Estimated Third-Party Payor Settlements | 43844 |
| Interest in Synernet Reinsurance | 955413 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1811112 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Deferred Compensation | Description |
| Amount | $445,608 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 445608 | TotalOfAmounts |
| Total Revenue | 43874422 | TotalRevenue |
| Total Expenses | 46821243 | TotalExpenses |
| Excess Or Deficit For Year | -2946821 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 2059 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 2059 | TotalAdjustments |
| Excess Or Deficit Per FS | -2944762 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 43876481 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 2059 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 2059 | RevenueNotRptdF990 |
| Revenue Subtotal | 43874422 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 43874422 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 46821243 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 46821243 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 46821243 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part V, Line 4: | Identifier |
| Return Reference | Description of Intended Use of Endowment Funds: | ReturnReference |
| Explanation | To help insure the long-term financial health of the Organization. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 323584 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 323584 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00710 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10589584 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7389808 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3199776 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10913168 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7389808 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3523360 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07740 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26969 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18030 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8939 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18523032 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8065192 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10457840 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.22990 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18550001 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8083222 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10466779 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.23010 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 29463169 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 15473030 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 13990139 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.30750 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4643 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 4643 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4643 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4643 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $845,886 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 8170341 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7766536 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 403805 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northern Maine Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Main Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: Northern Maine Medical Center uses the Federal Poverty Guidelines to determine eligibility. | IncomeBasedCriteria |
| Annual Community Benefit Expln | Part I, Line 6a: Northern Maine Medical Center 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. | AnnualCommunityBenefitExpln |
| Costing Method Used | Part I, Line 7: In the IRS Form 990, Schedule H instructions/guidance a template (Worksheet 2) was provided as a way to determine the overall cost-to-charge ratio that could be applied throughout the IRS Form 990, Schedule H. Where applicable, the Hospital has utilized the Worksheet 2 template calculation. The only areas we did not utilize this template calculation was on the following areas:A. IRS Form 990, Schedule H, Worksheet 6, Subsidized Health Services (which is 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 hospital clinical services and hospital-owned physician practices, SNF, RHCs, ER, and Psych. In addition, when we were compiling the subsidized services and practices 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 Form 990, Schedule H, Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs (which is the supporting schedule for Part 1, Lines 7b and 7c), and Worksheet 6, Medicaid allowable costs for the subsidized health services listed on line 1c above (which is part of the line 7g costs), we did not use the Worksheet 2 percentage when calculating the Medicaid allowable costs. Instead, we utilized the actual Medicaid filed cost report for the allowable costs. In addition, for any prior year settlements that were received during the current year, we have netted the settlement against what was filed. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: Northern Maine Medical Center has several provider-based physician practices, a skilled nursing facility (SNF), rural health centers (RHCs), an emergency Room (ER), and an inpatient psychiatric unit (Psych). Per the instructions for IRS Form 990, Schedule H, Worksheet 6, we are allowed to include any applicable physician practice, SNF, RHCs, ER and Psych that the Hospital subsidizes (i.e., operates at a loss). As such, we have included the following provider-based physician practices, SNF, RHCs and Psych units that operate at a loss (i.e., subsidized by the hospital) and the associated costs of these practices: a. Forest Hill Manor - Skilled Nursing Facility b. Northern Maine Medical Center - Inpatient Psych Unit c. Northern Maine Medical Center - Emergency Room d. Valley Medical Associates RHCs i. Fort Kent ii. Acadia Family Health iii. Station Hill iv. Valley Medical Associates e. Endoscopy f. Valley Medical Associates - Orthopedics/Prosthetics g. Diabetes (includes Dietary Consultation) h. Valley Medical Associates - Oncology i. Ophthalmology j. Ear, Nose, and Throat k. Neurology l. Cardiac Rehab m. CPR/EMT Services n. Wellness o. Valley Medical Associates - Several individual physician practices p. Valley Medical Associates - Anesthesiology q. Valley Medical Associates - Clinic at University of Fort Kent r. Valley Medical Associates - UrologyThe above listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e., aggregate loss or subsidy from the Hospital) of approximately $10.4 million. In addition, the community benefit also does not take into account bad debts, charity care, and contractual adjustments. Thus, this community benefit of approximately $10.4 million is a conservative figure that reconciles to the community benefit reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: As part of the Hospital's total expenses, there is $1,327,567 worth of bad debts. This amount has been removed from the Part I, Line 7, Column f calculation per the IRS instructions. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Northern Maine Medical Center classifies bad debts as an operating expense. The Hospital follows the Medicare guidelines for allowable bad debts. It uses the following criteria: a. Reasonable collection efforts were made b. The accounts were uncollectible c. There is no likelihood of recovery at any time in the futureThe bad debt expense at cost was the total write-offs reduced by the ratio of patient care cost to charges. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The IRS Form 990, Schedule H instructions/guidance provided a template (Worksheet 2 template) as a way to determine the overall cost-to-charge ratio that could be applied throughout the IRS Form 990, Schedule H form in order to convert charges to cost. Where applicable, we have utilized the Worksheet 2 template calculation. We did not utilize this template calculation on IRS Form 990, Schedule H, Worksheet B, Lines 2 & 6, Medicare Allowable Costs and Payments Related to the Subsidized Health Services, where we utilized the Medicare cost report estimated cost and payment for these services.The Hospital believes that the clinics and units 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 and units offer the community at large would have to travel at least 45 minutes to the nearest like-hospital and that hospital's service offerings. Additionally, in order to receive inpatient psych services, patients would have to travel at least 4 hours to the nearest inpatient psych unit. As such, Northern Maine believes that by offering, and thus subsidizing, these clinics and units within its community - and thus benefiting the community members by having easy access and commute for these services - it benefits the community at large. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: When a patient is referred out to collections but then applies for free or discounted care, the account is pulled 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, it sends out an application and notifies us. We make every effort to screen as many people as possible before we send them to collections. | DebtCollectionPolicy |
| Number Of Facility Type Expln | Part V: See Form 990, Schedule H, Part V | NumberOfFacilityTypeExpln |
| Needs Assessment | Part VI, Line 2: A community needs assessment is conducted by the Power of Prevention office located at an NMMC location. Input is acquired by organizations, executive board sessions, and other groups. The Power of Prevention is a grant-funded entity that is shared between the Hospital and Cary Medical Center located in Caribou, ME. The project director of this grant-funded organization operates from the NMMC Wellness Center in Fort Kent. | NeedsAssessment |
| Patient Education Assistance | 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 various 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/discounted care and providing information on MaineCare. For inpatients, there is a book in each room which provides all the information on all programs available.Through the patient accounting department, we provide information about these statements. We also counsel patients on the phone about all the programs available whether it is Medicaid or a hospital program. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Northern Maine Medical Center is a 94 staffed bed (29 A&P beds, 6 ICU beds, 14 Psych beds, and 45 SNF beds) full-service, acute-care, not-for profit hospital located in Fort Kent, Maine (Aroostook 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, psych inpatient, SNF, 24-hour emergency center, diagnostic, and surgical services. Along with these hospital services, the Hospital employs/contracts with the majority of primary and specialty care physicians in the area.Aroostook County is considered rural by the State of Maine and the United States Census Bureau, under the 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 Northern Maine Medical Center HSA as defined by the MHDO: Allagash, Eagle Lake, Fort Kent, Frenchville, Grand Isle, Madawaska, New Canada, St. Agatha, St. Francis, St. John Pit, Wallagrass, Winterville Pit, Big Twenty TWP, T9 R7 & R8, T10 R6-8, T11 R7-17, T12 R7-17, T13, R5 & R7-16, T14 R5-16, T15 R5-6 & R8-15, T16 R4-6 & R8-9 & R12-14, T17 R3-5 & R12-14, T18 R10-13, and T19 R11-12.Approximately 17% of Northern Maine Medical Center patients utilize Medicaid and 55% of Northern Maine Medical Center patients utilize Medicare. The population of Fort Kent with income below the Federal Poverty Guidelines is 14.5%, including 13.5% of children under the age of 18 and 18.2% of those over the age of 65. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: N/A | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: Northern Maine Medical Center is a local, not-for-profit hospital that serves its local communities and people regardless of their ability to pay. Northern Maine 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. Northern Maine'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. | OtherInformation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Guy Raymond | |||||||||||||
| 407187 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 32938 | 0 | 440125 | 0 | 0 | 0 |
| Simona Suchan MD | |||||||||||||
| 0 | 227454 | 0 | 11200 | 0 | 0 | 0 | 0 | 0 | 18604 | 0 | 257258 | 0 | 0 |
| Martin B Bernstein | |||||||||||||
| 203744 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 14079 | 0 | 217823 | 0 | 0 | 0 |
| Roger L Lagasse | |||||||||||||
| 141738 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 10545 | 0 | 152283 | 0 | 0 | 0 |
| Peter J Sirois | |||||||||||||
| 158419 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 22045 | 0 | 180464 | 0 | 0 | 0 |
| Scott Richards | |||||||||||||
| 144729 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 25428 | 0 | 170157 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | Peter Sirois and Glenn Lamarr have a family relationship. | |
| 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. | |
| 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 executive committee of the board of directors 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 interest policy, and financial statements available to the public upon request. | |
| Form 990, Part XI, Line 2c: | The audit process has not changed from the prior year. | |
| Form 990, Item B: | The Organization is amending its 2009 Form 990 to reflect information from audited financials which were released subsequent to the Form's original filing. A summary of changes are as follows: Form 990, Part IV, Line 12A: has been marked "yes" Form 990, Part V, Line 1a: has been updated to reflect calendar year information Form 990, Part V, Line 1c: has been marked "yes" Form 990, Part V, Line 2a: has been updated to reflect calendar year information Form 990, Part VII, Section A: has been updated to reflect the FYE 2009 board members and calendar year compensation Form 990, Part VII, Section B: has been updated to reflect appropriate year information Form 990, Part XI, Line 2b: has been marked "yes" Form 990, Part XI, Line 2c: has been marked "yes" and a narrative added to Schedule O. Form 990, Part XI, Line 2d: "Consolidated basis" has been indicated Schedule D, Part XI: has been prepared Schedule D, Part XII: has been prepared Schedule D, Part XIII: has been prepared Schedule J, Part II: has been updated to reflect calendar year information | Explanation of Changes for Amended Return |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Valley Medical Association | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 194 East Main Street | AddressLine1 |
| City | Fort Kent | City |
| State | ME | State |
| ZIP Code | 04743 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 223245434 | EIN |
| Primary Activities | Medical Physician Practice | PrimaryActivities |
| Legal Domicile State | ME | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Valley Medical Association | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | Q | TransactionType |
| Amount Involved | 8944829 | AmountInvolved |