2012-08-09T13:38:53-05:00 2011-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2011-01-01 010212435 St Joseph Hospital STJO 2072621000 360 Broadway PO Box 403 Bangor ME 044020403 Kevin Sedgwick 2072621000 2012-07-30 E Drew Cheney P00182972 2078792100 2011 2016-02-24 21:20:13Z Edwin Clift 360 Broadway PO Box 403 Bangor ME 044020403 101223193 0 X www.stjoseph-me.org X 1960 ME Community Hospital committed to wellness promotion, holistic healing & healthcare sevices 16 14 964 115 53503 28523 25894 25408 93265916 96211654 1193715 652196 75683 48605 94561208 96937863 0 0 0 0 42111715 41892683 0 0 0 46403075 46362793 88514790 88255476 6046418 8682387 54361823 55078752 30953685 34131081 23408138 20947671 X "St. Joseph Healthcare-committed to wellness promotion and holistic healing-provides healthcare services which embody compassion, competence and community." ... not just words, but a way of life - a noble statement of what we are, meticulously crafted after thoughtful consideration, study and examination of all the things we do, big and small, day and night, caring for our patients. These are the words we live by, each and every one of us who comprise the caring community of St. Joseph Healthcare. We take our Mission seriously. Those we serve depend on it.St. Joseph Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to operation and stability, it is recognized that not all individuals possess the ability to purchase essential medical services and further that our mission is to serve the community with respect to providing healthcare services. 0 0 8302251 20433915 St. Joseph Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of St. Joseph Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services and further that our mission is to serve the community with respect to providing healthcare services and healthcare education.St. Joseph Hospital served 4,227 inpatients representing 20,066 patient days and served more than 79,714 outpatients representing more than 3,363,931 tests and procedures performed. St. Joseph Hospital provides care to persons covered by governmental programs at below cost. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients is $78,996,801. In addition, St. Joseph Hospital provided charity care totaling $2,593,374 and provided $5,780,363 in services to those unable to pay. Charity care is also provided through many reduced price services and fee programs offered throughout the year based upon activities and services which St. Joseph Hospital believes will serve a bona fide community health need.For more information regarding the services and programs provided at St. Joseph Hospital and the hospital's commitment to serve all members of the community please visit our website at www.stjoeshealing.org or contact the Public Affairs office at (207)262-1720. 1) Surgical Department - Our Surgery Center was the first hospital-based day surgery facility in Maine. It features a caring staff, including its own dedicated anesthesia team, in the modern surroundings of our surgical center, which has six spacious suites. 1741414 15301040 2) Endoscopy Department - Our physicians are committed to provide the highest quality digestive disease health care in Northern and Eastern Maine including the performance of life-saving endoscopic screenings and procedures. 3116276 19043738 3) Emergency Room - 16-bed Emergency Department is open 24 hours a day, seven days a week. It includes seven cardiac care rooms, including three critical care rooms, and rooms for treatment of emergency cases in Obstetrics/Gynecology, Orthopedics and Ophthalmology (conditions and injuries of the eyes). There are also several suture rooms and a digital X-ray unit. The Emergency Department is staffed around the clock by physicians, physician assistants, registered nurses, CNAs and a secretary. Emergency Department greeters are also available from 7 a.m. to 11:30 p.m. Greeters help patients with registration and provide comfort to them during their visit. 57729140 0 38178810 Other healthcare services 57729140 38178810 70889081 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 102 0 1 964 1 1 1 0 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Kevin Sedgwick 2079071200 360 Broadway Bangor ME 04402 Braverman Melvin 0.10 X 0 0 0 Clift Erwin 0.10 X X 0 0 0 Renedo MD David 0.10 X 0 0 0 Marie Sr Nancy 0.10 X 0 0 0 Smith Vaughn 0.10 X 0 0 0 Cyr Joseph 0.10 X 0 0 0 Woodford Wayne 40.00 X X 220092 0 20866 Jennings Ned 0.10 X 0 0 0 Demaso William 0.10 X 0 0 0 Durgin Nelson 0.10 X X 0 0 0 Ryckman Lee 0.10 X X 0 0 0 Norberta Sr Mary CSSF 40.00 X X 341292 0 9255 Prybylo Mary 40.00 X X 97252 0 6146 Welch Robert 0.10 X 0 0 0 Wlodarski Frederick 0.10 X 0 0 0 Pechinski Sheila 0.10 X 0 0 0 Dubois Monsignor Andrew 0.10 X 0 0 0 Buckley MD PhD Paul 40.00 X 276073 0 12659 Renzi MD Richard 40.00 X 297773 0 24585 Pattavina MD Charles 40.00 X 345051 0 13796 Dancoes Thomas 40.00 X 292950 0 28234 Markowitz MD Charles 40.00 X 254511 0 27908 2124994 0 143449 26 0 1 0 Spectrum Medical Group 324 Gannett Drive So Portland ME 04106 Anesthesia services 1698527 King's Medical Company 1894 Georgetown Road Hudson OH 44236 MRI Services 727180 Dahl-Chase Diagnostic Services 417 State Street Bangor ME 04401 Pathology services 665292 Sunbury Medical Associates 133 Corporate Drive Bangor ME 04401 PT/OT Services 630389 Synernet Inc 222 St John Street Portland ME 04102 Transcription services 554419 16 25408 25408 Net Patient Services 621110 92957503 92957503 Medical/Laboratory 621500 2601577 2548074 53503 Services to Affiliates 541200 652574 652574 96211654 628420 628420 4212657 67791 4235164 21508 -22507 46283 23776 23776 44763 28658 16105 16105 GIFT SHOP 453000 32500 32500 32500 96937863 96190651 53503 668301 1038556 814228 224328 33367971 26160489 7207482 199947 156758 43189 4867946 3816470 1051476 2418263 1895918 522345 170850 133946 36904 86121 67519 18602 128846 101015 27831 7460595 5849106 1611489 121800 95491 26309 17127926 13428294 3699632 1379969 1081896 298073 2500697 1960546 540151 9637 7555 2082 136374 106917 29457 771105 604546 166559 3652816 2863808 789008 1729482 1355914 373568 Provision for bad debt 5780362 5780362 State tax 2075115 2075115 Maintenance & repairs 1656316 1298552 357764 Gift shop 33019 33019 1541763 1201617 340146 88255476 70889081 17366395 0 1861 1861 5892454 124950 6149071 7391509 1012980 758317 1169830 1765636 62809816 40891089 23017796 21918727 13052858 17963368 1603616 4064973 3550768 54361823 55078752 7890761 6177949 14559121 13651816 2207421 1095392 6296382 13205924 30953685 34131081 X 21119338 18839746 2288800 2107925 23408138 20947671 54361823 55078752 X 8682387 -11142854 X 0 1 1 X 0 X 0 0 0 0 0 0 0 0 1 14253 14253 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: American Hospital Association dues paid was $24,834, of which 24.6% was allocated for lobbying activities. Maine Health Association dues paid was $52,543, of which 15.5% was allocated for lobbying activities. 2288800 -180875 2107925 2072249 216551 2288800 1869854 202395 2072249 2478837 -608983 1869854 0.00000 1.00000 0.00000 0 0 47578 47578 27155070 16891957 10263113 3184846 2005734 1179112 30898168 21993398 8904770 1524154 1524154 21918727 Deferred financing costs, net 151719 Beneficial interest in perpetual trust 2106860 Malpractice claims reserve 1292189 3550768 Pension obligations 7333398 Estimated 3rd party payor settlements 4247840 Professional liability loss reserves 1624686 13205924 96937863 88255476 8682387 -600954 -10541900 -11142854 -2460467 96320804 -600954 -600954 96921758 16105 16105 96937863 88277983 22507 22507 88255476 0 88255476 Description of Intended Use of Endowment Funds: Part V, Line 4: Ensure the long-term financial viability of the organization. Description of Uncertain Tax Positions Under FIN 48: Part X: Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. The System has evaluated the positions taken on its filed tax returns. The System has concluded no uncertain income tax positions exist at December 31, 2011. Part XI, Line 8 - Other Adjustments: Transfers to affiliates -7,401,205. Adjustment to long-term pension obligations -3,140,695. Total to Schedule D, Part XI, Line 8: -10,541,900. Part XII, Line 2d - Other Adjustments: Unrealized losses -600,954. Part XII, Line 4b - Other Adjustments: Fundraising event direct expenses 16,105. Part XIII, Line 2d - Other Adjustments: Realized losses 22,507. Marlene's 30619 30619 13731 Coach Trip 6508 6508 3731 2 7636 7636 11196 44763 44763 28658 28658 16105 1 1 1 X 1 X 1 1 0 1 1 2085 1153241 1153241 0.01400 6543 13039970 5254102 7785868 0.09440 8628 14193211 5254102 8939109 0.10840 9 562 17531 17531 0.00020 16 805 955631 955631 0.01160 16 1573 121202 121202 0.00150 41 2940 1094364 1094364 0.01330 41 11568 15287575 5254102 10033473 0.12170 1 2630065 27261606 33458964 -6197358 X 1 1 1 1 St Joseph Hospital

360 Broadway PO Box 403 Bangor ME 04401

X X X St Joseph Hospital 1 1 1 200.000000000000 1 350.000000000000 1 X X 1 1 X X X 1 X 0 X X X X 1 X 0 0 Part I, Line 3c: The organization does utilize FPG to determine eligibility. Part I, Line 6a: The community benefit report is based on the Catholic Health Association guidelines and utilizes the association's CBISA software to record the benefits. Part I, Line 7: The cost to charge ratio was derived from Worksheet 2 and the Bad Debt Expense from Part IX, line 25, column A of $5,780,362 has been removed from the denominator. Part II: Community building activities consisted of physical improvements, community support and environmental improvements. Physical improvements were a result of employees assisting the local elderly population in a variety of projects through the Eastern Area Agency on Aging. Community support consisted of American Red Cross blood drives, sending supplies to troops overseas, maintaining a community vegetable stand and providing pastoral care to the community. Part III, Line 4: Costs are from the accounting system using cost-to-charge ratios from the as filed Medicare Cost Report. St. Joseph Hospital does not factor in discounts and payments in determining Bad Debt Expense. Charges for services rendered to individuals from whom payment is expected and ultimately not received are written off and in 2011 included as an operating expense as part of the provision for bad debts. Part III, Line 8: Costs are from the accounting system using cost-to-charge ratios from the as filed Medicare Cost Report, but none of these costs are being claimed as a community benefit in Part I, line 7. Part III, Line 9b: Our collection policy R.019 does address patients who have benevolence. If they qualify for free care, then their balance is written off. If they qualify for cost share, then their balance follows the same billing and collection process as any other self pay account. St. Joseph Hospital Part V, Section B, Line 19d: For patients with income less than 200% of FPL the patient has no financial responsibility. For patients up to 300% FPL, the hospital uses a sliding fee scale which is substantially less than all negotiated commercial insurance rates. Part VI, Line 2: The Hospital participated in the Community Statewide Health Needs Assessment which was conducted during 2010 and published in 2011. The major findings for the area the Hospital serves included a high level of obesity, diabetes, smoking, urological services, breast care services, hip procedures and geriatrics. The Hospital is also a participant in a Beacon Grant and as such has been focused on managing patients with chronic issues through a care management program in our primary care practice. Part VI, Line 3: Each inpatient receives a packet upon admission that includes a description of the Hospital's Free Care Policy. If an inpatient has any questions during the stay, a patient ombudsman is available to assist. Signage is placed in all outpatient registration sites and applications are available. Staff is available to answer questions. Upon billing, included with the statement is a notification that free care is available, the poverty guidelines and a number for assistance.The policy is also posted on the hospital's website. Part VI, Line 4: St. Joseph Healthcare treats patients from a seven county area north of Waterville with a population of 421,616, 31.7% of Maine's population (based on 2010 census data) which encompasses a land area of 22,846 square miles. The Hospital's immediate primary and secondary areas include Penobscot County, the towns of Bucksport and Ellsworth in Hancock County, and the town of Milo in Piscataquis County. In 2011, 42.2% of our admissions were less than 65 years old and 57.8% were older than 65 years old. The 2010 U.S. Census reports that within the population of St. Joseph Healthcare's primary service area (Penobscot County) was 95.4% white and 51.1% female. 89.2% graduated from high school, 70.5% owned a home, and the median household income was $40,301. Part VI, Line 5: In response to public health needs, St. Joseph provides numerous free services including blood drives, pulmonary rehabilitation services to the Bangor Y, and free blood pressure and stroke screening. The organization also provides numerous educational opportunities which helped enhance community health. Among them were influenza education, health education for seniors through the Hammond Street Senior Center and the St. Joseph's Senior Wise program, patient education through the Maine Breast and Cervical Health program, ongoing donations of meeting space for numerous support groups and educational activities and continuing support of clinical education for nursing and medical students. Part VI, Line 6: St. Joseph Healthcare is comprised of St. Joseph Hospital (an acute care hospital), St. Joseph Ambulatory Care, Inc, (physician group that provides primary and specialty care), and Alternative Health Serves, Inc. (which provides home health and hospice services). By joining Covenant Health System, St. Joseph Healthcare is now aligned with two other acute care hospitals and multiple skilled nursing and assisted living facilities. Reports Filed With States Part VI, Line 7 ME X X X 0 0 0 0 0 0 0 1 0 Woodford Wayne 220092 0 0 0 0 0 750 0 20116 0 240958 0 0 0 Norberta Sr Mary CSSF 341292 0 0 0 0 0 0 0 9255 0 350547 0 0 0 Buckley MD PhD Paul 240829 0 34450 0 794 0 3404 0 9255 0 288732 0 0 0 Renzi MD Richard 245563 0 51340 0 870 0 0 0 24585 0 322358 0 0 0 Pattavina MD Charles 318271 0 25859 0 921 0 4541 0 9255 0 358847 0 0 0 Dancoes Thomas 219421 0 52820 0 20709 0 3649 0 24585 0 321184 0 0 0 Markowitz MD Charles 229448 0 24240 0 823 0 3323 0 24585 0 282419 0 0 0 Part I, Line 7 Charles Pattavina, Thomas Dancoes, Richard Renzi, Paul Buckley and Charles Markowitz received incentive bonuses. MHHEFA 010314384 2010-06-24 16207915 Refinance Series 1998B, 1999A and 2001A revenue bonds 0 0 0 16207915 1260488 1480903 137832 565 2010 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 Form 990, Part VI, Section B, line 11 There is a formal presentation of the 990 to the Finance Committee and copies are provided to all board members. Form 990, Part VI, Section B, line 12c Each member is required to complete a form disclosing any conflicts of interest. These conflicts are known; any member with a conflict of interest is asked to leave the meeting or abstain from voting or both. Form 990, Part VI, Section B, line 15 Through compensation surveys/studies and employment contracts compensations are determined by the compensation committee and approved by the board. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, policies and financial statements available to the public upon each individual request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -600,954. Transfers to affiliates -7,401,205. Adjustment to long-term pension obligations -3,140,695. Total to Form 990, Part XI, Line 5: -11,142,854. St Joseph Healthcare Foundation 360 Broadway Bangor ME 044020403 222480149 Diversified holistic health care services ME 501(C)(3) Line 11a, I Covenant Health Systems Inc 1 St Joseph Ambulatory Care Inc 360 Broadway Bangor ME 044020403 222480373 Ambulatory care and clinical services ME 501(C)(3) Line 11a, I St Joseph Healthcare Foundation 1 Alternative Health Services 360 Broadway Bangor ME 044020403 010422885 Home health agency ME 501(C)(3) Line 3 St Joseph Healthcare Foundation 1 M & J Company 360 Broadway Bangor ME 044020403 222480150 Real Estate holding company ME 501(C)(2) St Joseph Healthcare Foundation 1 Covenant Health Systems Inc 100 Ames Pond Dr Tewksbury MA 01876 222484505 Sponsoring & operating a health care system MA 501(c)(3) Line 9 N/A 0 Strauss Inc 360 Broadway Bangor ME 044020403 010391369 Medical transcription ME St Joseph Healthcare Foundation C 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 M & J Company J 1057249 Actual amount transferred M & J Company K 102228 Actual amount transferred