Calais Regional Hospital: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- Calais Regional Hospital (EIN 01-0211783)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201233209349304773
- Schema version
- 2011v1.2
- 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 I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T12:46:02-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010523282 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1 |
| City | Portland | City |
| State | ME | State |
| ZIP Code | 041041100 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010211783 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Calais Regional Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CALA | NameControl |
| Phone | 2074547521 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 24 Hospital Lane | AddressLine1 |
| City | Calais | City |
| State | ME | State |
| ZIP Code | 04619 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Nancy Glidden | Name |
| Title | CFO | Title |
| Phone | 2074547521 | Phone |
| Date Signed | 2012-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Barbara J McGuan CPA | Name |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | Phone |
| Date Prepared | 2012-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Michael K Lally | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 24 Hospital Lane | AddressLine1 |
| City | Calais | City |
| State | ME | State |
| ZIP Code | 04619 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 35798101 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.calaishospital.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1938 | YearFormation |
| State Legal Domicile | ME | StateLegalDomicile |
| Activity Or Mission Description | Critical Access Hospital | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 310 | TotalNbrEmployees |
| Total Nbr Volunteers | 146 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 330708 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 46617 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28406425 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 33680483 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -152854 | InvestmentIncomePriorYear |
| Investment Income Current Year | 64831 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 28584279 | TotalRevenuePriorYear |
| Total Revenue Current Year | 33791931 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 32958 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 14061579 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 16611727 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 15599578 | OtherExpensePriorYear |
| Other Expenses Current Year | 17790605 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 29661157 | TotalExpensesPriorYear |
| Total Expenses Current Year | 34435290 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1076878 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -643359 | RevenuesLessExpensesCY |
| Total Assets BOY | 28925376 | TotalAssetsBOY |
| Total Assets EOY | 29993155 | TotalAssetsEOY |
| Total Liabilities BOY | 20409606 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22183488 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8515770 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7809667 | NetAssetsOrFundBalancesEOY |
| Mission Description | Calais Regional Hospital exists to provide and plan patient care, educational and restorative services that meet our customer's expectations, commensurate with available resources. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7187818 | Expense |
| Revenue | 8354444 | Revenue |
| Description | Inpatient Services: Patients Admitted: 870 Average Stay: 3.2 days Births: 61 Hospitalist Care: 3,435 | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 20628872 | Expense |
| Revenue | 23977059 | Revenue |
| Description | Outpatient Services: Emergency Room Visits: 10,989 Laboratory Procedures: 251,488 Rehab Services: 11,669 Radiology Exams: 13,309 Respiratory Care: 3,889 Cardiac Rehab Visits: 3,559 Home Health Visits: 10,293 Primary Care Visits: 16,246 Surgical and Orthopedic Visits: 3,579 | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1160607 | Expense |
| Grants | 32958 | Grants |
| Revenue | 1348980 | Revenue |
| Description | Swing Bed, Cafeteria & Other Services | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 28977297 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | 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 | 1 | 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 | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 78 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 310 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | 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 | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | ME | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Nancy Glidden CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2074547521 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 24 Hospital Lane | AddressLine1 |
| City | Calais | City |
| State | ME | State |
| ZIP Code | 04619 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (26 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 |
|---|---|---|---|---|---|---|---|
| Herbert Clark | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Marshall Hennequin | |||||||
| Treasurer | 6.00 | X | 0 | 0 | 0 | X | |
| John Bloemendaal | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Lawrence Clark | |||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||
| Suzanne Crawford | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Neil Lane | |||||||
| Vice Treasurer | 7.00 | X | 0 | 0 | 0 | X | |
| Aaron Morris | |||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||
| Dennis Brown | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Linda Gralenski | |||||||
| Chair | 8.00 | X | 0 | 0 | 0 | X | |
| Dennis Mahar | |||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||
| G Cecil Moreside | |||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||
| Sharon Weber | |||||||
| Secretary | 4.00 | X | 0 | 0 | 0 | X | |
| Diane Barnes | |||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||
| Robert Chagrasulis MD | |||||||
| Director | 42.00 | X | 302850 | 0 | 0 | ||
| Karen Hadam MD | |||||||
| Past Director | 40.00 | X | 224073 | 0 | 33418 | ||
| Cressey Brazier MD | |||||||
| Director | 40.00 | X | 478518 | 0 | 0 | ||
| Everett Libby | |||||||
| Vice Chair | 9.00 | X | 0 | 0 | 0 | X | |
| Christopher Hayward DO | |||||||
| Director | 41.00 | X | 211628 | 0 | 33158 | ||
| P Bernard McAdam | |||||||
| Past CFO | 40.00 | 83467 | 0 | 9599 | X | ||
| Michael K Lally | |||||||
| CEO | 40.00 | 222166 | 0 | 25549 | X | ||
| Nancy Glidden | |||||||
| CFO | 40.00 | 66500 | 0 | 7647 | X | ||
| Mark DeMasi | |||||||
| Physician | 40.00 | 311627 | 0 | 31791 | X | ||
| Michael Kessler | |||||||
| Physician | 40.00 | 266200 | 0 | 35465 | X | ||
| David Walter | |||||||
| Physician | 40.00 | 230902 | 0 | 3298 | X | ||
| John Tkach | |||||||
| Physician | 40.00 | 210600 | 0 | 33691 | X | ||
| Antoanela Zaharia | |||||||
| Physician | 40.00 | 148812 | 0 | 14921 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2757343 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 228537 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| National Emergency Service | |||||
| 3724 National Drive Ste 109 | Raleigh | NC | 27612 | Emergency Room Physicians | 1314598 |
| Quorum Health Resources | |||||
| 105 Continental Place | Brentwood | TN | 37027 | Management Company | 998734 |
| D&Y Locum Tenens | |||||
| PO Box 635715 | Cincinnati | OH | 45263 | Locum Physician Coverage | 803643 |
| Cardinal Health | |||||
| 3763 Collection Center Drive | Chicago | IL | 60693 | Medical Supplies/Pharmacy Drugs | 555227 |
| Staff Care Inc | |||||
| PO Box 281923 | Atlanta | GA | 30384 | Locum Physician/Staff Coverage | 481377 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 32 | NumberOfContractorsGT100K |
| Government Grants | 22580 | GovernmentGrants |
| All Other Contributions | 24037 | AllOtherContributions |
| Total Contributions | 46617 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Patient Services | 621400 | 56443678 | 56443678 | |
| Meaningful Use Revenue | 621400 | 418037 | 418037 | |
| Other Revenue | 621400 | 375725 | 375725 | |
| Cafeteria Income | 721000 | 69130 | $69,130 | |
| Contractual/Char. Adj. | 621400 | -23626087 | -23626087 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 33680483 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 55442 | TotalRevenueColumn |
| Exclusion | $55,442 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2005059 | Securities |
| Other | 10500 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2004798 | Securities |
| Other | 1372 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 261 | Securities |
| Other | 9128 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9389 | TotalRevenueColumn |
| Exclusion | $9,389 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33791931 | TotalRevenueColumn |
| Related Or Exempt Function Income | 33611353 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $133,961 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32958 | Total |
| Program Services | 32958 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1698573 | Total |
| Program Services | 1283645 | ProgramServices |
| Management And General | 414928 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11576131 | Total |
| Program Services | 9861559 | ProgramServices |
| Management And General | 1714572 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 278992 | Total |
| Program Services | 232916 | ProgramServices |
| Management And General | 46076 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2147300 | Total |
| Program Services | 1834268 | ProgramServices |
| Management And General | 313032 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 910731 | Total |
| Program Services | 766380 | ProgramServices |
| Management And General | 144351 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114985 | Total |
| Program Services | 96760 | ProgramServices |
| Management And General | 18225 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 97133 | Total |
| Program Services | 81737 | ProgramServices |
| Management And General | 15396 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8221557 | Total |
| Program Services | 6918440 | ProgramServices |
| Management And General | 1303117 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2931969 | Total |
| Program Services | 2467252 | ProgramServices |
| Management And General | 464717 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 740677 | Total |
| Program Services | 623280 | ProgramServices |
| Management And General | 117397 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129456 | Total |
| Program Services | 108937 | ProgramServices |
| Management And General | 20519 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 914518 | Total |
| Program Services | 769567 | ProgramServices |
| Management And General | 144951 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1357897 | Total |
| Program Services | 1142670 | ProgramServices |
| Management And General | 215227 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 615405 | Total |
| Program Services | 517863 | ProgramServices |
| Management And General | 97542 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt Expense | 1061262 | 893052 | 168210 |
| Repairs & Maintenance | 661131 | 556342 | 104789 |
| Tax & Match | 622586 | 523906 | 98680 |
| Miscellaneous | 322029 | 265765 | 56264 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34435290 | Total |
| Program Services | 28977297 | ProgramServices |
| Management And General | 5457993 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 970 | BOY |
| EOY | 16603 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2830954 | BOY |
| EOY | 3793304 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4282 | BOY |
| EOY | 2754 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4153365 | BOY |
| EOY | 4395805 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 506973 | BOY |
| EOY | 574608 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 126945 | BOY |
| EOY | 144916 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 34479436 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 15932017 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18467662 | BOY |
| EOY | 18547419 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 827842 | BOY |
| EOY | 702745 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2006383 | BOY |
| EOY | 1815001 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28925376 | BOY |
| EOY | 29993155 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3151828 | BOY |
| EOY | 3587348 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17257778 | BOY |
| EOY | 17470743 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1125397 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20409606 | BOY |
| EOY | 22183488 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7222085 | BOY |
| EOY | 6559157 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 788279 | BOY |
| EOY | 792626 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 505406 | BOY |
| EOY | 457884 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8515770 | BOY |
| EOY | 7809667 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28925376 | BOY |
| EOY | 29993155 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -643359 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -62744 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 | $4,189 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4189 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1: | ReturnReference |
| Explanation | The Organization pays dues to local associations, a portion of which are attributable to lobbying activities. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 206221 | OtherCostOrOtherBasis |
| Book Value | 206221 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12299374 | OtherCostOrOtherBasis |
| Depreciation | 4000363 | Depreciation |
| Book Value | 8299011 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19307792 | OtherCostOrOtherBasis |
| Depreciation | 10813098 | Depreciation |
| Book Value | 8494694 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2666049 | OtherCostOrOtherBasis |
| Depreciation | 1118556 | Depreciation |
| Book Value | 1547493 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 18547419 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Beneficial Interest in Perpetual Trust | 329622 |
| Estimated Settlements Receivable from the State of Maine | 1485379 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1815001 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Estimated Third Party Payor Settlements | Description |
| Amount | $1,125,397 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1125397 | TotalOfAmounts |
| Total Revenue | 33791931 | TotalRevenue |
| Total Expenses | 34435290 | TotalExpenses |
| Excess Or Deficit For Year | -643359 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -62744 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -62744 | TotalAdjustments |
| Excess Or Deficit Per FS | -706103 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 33729187 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -62744 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -62744 | RevenueNotRptdF990 |
| Revenue Subtotal | 33791931 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 33791931 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 34435290 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 34435290 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 34435290 | TotalExpensesPerForm990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1222449 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1222449 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03660 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6961078 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6647855 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 313223 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00940 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8183527 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6647855 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1535672 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04600 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8201 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8201 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 101820 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 101820 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00310 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 194 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 194 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 110215 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 110215 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00330 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8293742 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6647855 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1645887 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04930 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $596,900 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 10537293 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10537293 | CostOfCareReimbursedByMedicare |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Calais Regional Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 24 Hospital Lane | AddressLine1 |
| City | Calais | City |
| State | ME | State |
| ZIP Code | 04619 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Calais Regional Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 165.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Lien On Residence | X | LienOnResidence |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 1 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1061262. | |
| 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 earnings and a credit to a valuation allowance based on its assessment of the current status of individual accounts. 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. | |
| Part III, Line 8: The Organization used the Hospital's as-filed cost reports to obtain Medicare and Medicaid costs and expected reimbursement. | |
| Part III, Line 9b: Self-pay accounts receive a minimum of 3 statements and a final notice. Patients must complete an application for Free Care and provide necessary qualifying support in order to receive Free Care. Applications are kept on file and tracked in a log. The log of patients who are eligible for Free Care is maintained electronically and is available at registration points to simplify the application of Free Care for current services. | |
| Part V, Section B, Line 13g: Notices of the Free Care program are posted at the front desk in the main lobby, in the registration areas, patient billing department, cashier's office, credit manager's office, Surgical Services department, Orthopedic Department, and Rural Health Care Clinic. Applications are available at all of these points. Assistance in completing the applications is provided by the credit manager and staff. | Calais Regional Hospital |
| Part V, Section B, Line 19d: The minimum level of discount for patients eligible for financial assistance is 10%, which approximates the average of the 3 lowest negotiated commercial insurance rates. Most patients qualify for higher level discounts ranging from 25% to 100%. | Calais Regional Hospital |
| Part V, Section B, Line 20: During 2011, because of information system limitations in identifying those patients eligible for financial assistance prior to delivery of emergency services, some patients may have received a bill for services prior to the discount being applied. The Hospital has since developed a way to identify in the information system patients who are eligible for financial assistance at the time of registration, which will allow for discounting to always occur before a patient bill is issued. | Calais Regional Hospital |
| Part V, Section B, Line 21: As noted in response to Part V, Section B, Line 20, during 2011, some patients eligible for financial assistance may have received statements indicating gross charges prior to discount. However, all discounts were applied as appropriate and since 2011, improvements in our information system have allowed us to identify patients earlier in the process to allow for gross charges to be discounted before the patient receives a billing statement. | Calais Regional Hospital |
| Part VI, Line 2: Healthcare Community Needs Surveys are completed every three years. The Hospital conducts interviews with various community groups, trustees and staff and conducts an annual community survey. In addition, the Hospital participates in joint efforts with other healthcare providers to analyze and act upon regional health status indicators and data. | |
| Part VI, Line 3: Notices of the Free Care program are posted at the front desk in the main lobby, in the registration areas, patient billing department, cashier's office, credit manager's office, Surgical Services department, Orthopedic Department, and Rural Health Care Clinic. Applications are available at all of these points. Assistance in completing the applications is provided by the credit manager and staff. | |
| Part VI, Line 4: We serve a rural population of approximately 14,000 (40 miles North, South and West). | |
| Part VI, Line 5: The Hospital participates in programs for community support, including health walks and local fairs and conferences. The Hospital supports economic development through participation in Chamber of Commerce, Rotary Club, economic development organizations, and the Aroostook/ Washington County Workforce Board. The Hospital enhances coalition building by participating in community outreach activities and working with local and regional agencies and organizations to improve access to services. The Hospital works to improve the health status in our communities by participating in blood drives, cancer, cardiac and diabetic support groups, providing blood pressure screenings, flu clinics, health fairs, wellness programming, and senior activities. The Hospital encourages workforce development through job shadowing, preceptorships, and mentoring programs and participating in career fairs and in area youth coaching programs.The Hospital has an open medical staff. The Board of Directors are community members from throughout the service area. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Educational Assistance | TypeOfGrant |
| Number Of Recipients | 5 | NumberOfRecipients |
| Amount Of Cash Grant | 32958 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Educational Assistance is awarded to eligible employees upon receipt of their tuition bills and enrollment verification. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| 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 | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (12 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert Chagrasulis MD | |||||||||||||
| 293000 | 0 | 0 | 0 | 9850 | 0 | 0 | 0 | 0 | 0 | 302850 | 0 | 0 | 0 |
| Karen Hadam MD | |||||||||||||
| 224073 | 0 | 0 | 0 | 0 | 0 | 5983 | 0 | 27435 | 0 | 257491 | 0 | 0 | 0 |
| Cressey Brazier MD | |||||||||||||
| 478518 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 478518 | 0 | 0 | 0 |
| Christopher Hayward DO | |||||||||||||
| 211628 | 0 | 0 | 0 | 0 | 0 | 5723 | 0 | 27435 | 0 | 244786 | 0 | 0 | 0 |
| P Bernard McAdam | |||||||||||||
| 83467 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 9599 | 0 | 93066 | 0 | 0 | 0 |
| Michael K Lally | |||||||||||||
| 214906 | 0 | 0 | 0 | 7260 | 0 | 0 | 0 | 25549 | 0 | 247715 | 0 | 0 | 0 |
| Nancy Glidden | |||||||||||||
| 66500 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7647 | 0 | 74147 | 0 | 0 | 0 |
| Mark DeMasi | |||||||||||||
| 271178 | 0 | 40449 | 0 | 0 | 0 | 4356 | 0 | 27435 | 0 | 343418 | 0 | 0 | 0 |
| Michael Kessler | |||||||||||||
| 263179 | 0 | 3021 | 0 | 0 | 0 | 6888 | 0 | 28577 | 0 | 301665 | 0 | 0 | 0 |
| David Walter | |||||||||||||
| 230902 | 0 | 0 | 0 | 0 | 0 | 1988 | 0 | 1310 | 0 | 234200 | 0 | 0 | 0 |
| John Tkach | |||||||||||||
| 191988 | 0 | 18612 | 0 | 0 | 0 | 3856 | 0 | 29835 | 0 | 244291 | 0 | 0 | 0 |
| Antoanela Zaharia | |||||||||||||
| 146987 | 0 | 1825 | 0 | 0 | 0 | 4399 | 0 | 10522 | 0 | 163733 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 7 | Individuals listed with Incentive Bonus amounts are physicians who under their employment agreements/contracts have a provision for Incentive Bonus based on their individual practice Gross Revenue Production or Relative Value Units (RVU) of services exceeding a target amount. | |
| Part III | Michael K. Lally, CEO, Nancy Glidden, CFO & P. Bernard McAdam, Past CFO, are compensated by Quorum Health Resources, an unrelated organization, for services rendered to the Organization. A breakdown of their 2011 compensation is as follows: Michael K. Lally, CEO: Salary: $214,906 Benefits: $25,549 Automobile Allowance: $7,260 Nancy Glidden, CFO: Salary: $66,500 Benefits: $7,647 P. Bernard McAdam, Past CFO: Salary: $83,467 Benefits: $9,599 | Supplemental Information |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Shelly Bodkin | |||
| Family Member of G. Cecil Moreside, Board Director | 74672 | Employment | 0 |
| Michael Bodkin | |||
| Family Member of G. Cecil Moreside, Board Director | 86451 | Employment | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 3 | The Organization has a management contract with Quorum Health Resources (QHR). The management roles of CEO and CFO are by individuals employed/hired by QHR with individual approval and authorization of and by the Board of Directors. These individuals serve at the will of the Board of Directors. | |
| Form 990, Part VI, Section A, line 7a | A Board of Trustees elects members of the Board of Directors at an annual meeting of the Board of Trustees. | |
| Form 990, Part VI, Section A, line 7b | At the annual meeting of the Board of Trustees, actions of the Board of Directors during the year are acted on and ratified. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 filing is reviewed with the Corporate Board Officers. | |
| Form 990, Part VI, Section B, line 12c | The Organization maintains a "Complaint Hot Line" with a widely published number, which is overseen by the Oganizations Compliance Officer. Any complaints received are promptly investigated and acted upon as appropriate. | |
| Form 990, Part VI, Section B, line 15 | The Executive Committee of the Board of Directors serves as an Executive Compensation Committee. Performance review is completed and is presented, along with comparative salary information to the Committee by the Hospital's management company. After consideration of the comparative information and performance review, the Executive Committee determines and authorizes an appropriate compensation level. | |
| Form 990, Part VI, Section C, line 19 | The Hospital prepares and circulates via US Postal Service an Annual Report, which goes to every household in what is defined as the Hospital Service Area. The Annual Report is also available on the Hospital website at: http://www.calaishospital.com. Additionally, at the annual meeting of the Trustees, copies of the audited financial statements are shared with all present including representatives of the press in attendance. Other documents as appropriate would be available upon request. | |
| Form 990, Part XI, line 5: | Net unrealized losses on investments: -62,744. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XI, Line 2c: | The audit process has not changed from the prior year. | Oversight of Audit |