2011-08-09T12:46:31-05:00 2010-09-30 MAINEHEALTH 110 FREE ST PORTLAND ME 041013908 990 2009-10-01 010524834 SPRING HARBOR HOSPITAL SPRI 2077612200 123 ANDOVER ROAD WESTBROOK ME 04092 GREG BOWERS 2077612200 2011-08-08 2011-08-09 2009 2016-02-24 21:20:13Z DENNIS P KING 123 ANDOVER ROAD WESTBROOK ME 04092 31958754 false X WWW.SPRINGHARBOR.ORG X 1999 ME SPRING HARBOR HOSPITAL OFFERS PEOPLE IN MENTAL HEALTH CRISIS HIGH-QUALITY, INDIVIDUALIZED TREATMENT TO SUPPORT THEIR ONGOING RECOVERY. 19 16 558 17 0 421564 512270 31891425 31372997 -4023 71479 0 32308966 31956746 0 0 22157730 21606624 0 66003 9726069 9985886 31883799 31592510 425167 364236 33940652 33228255 25267208 25061476 8673444 8166779 SPRING HARBOR HOSPITAL OFFERS PEOPLE IN MENTAL HEALTH CRISIS HIGH-QUALITY, INDIVIDUALIZED TREATMENT TO SUPPORT THEIR ONGOING RECOVERY. false false 13024964 14840200 ADULT SERVICES - ADULT TREATMENT FOCUSES ON RAPID STABILIZATION OF SYMPTOMS AND APPROPRIATE AFTERCARE FOR EACH PATIENT. TREATMENT INCLUDES A COMPREHENSIVE EVALUATION OF PERTINENT PSYCHIATRIC, PSYCHOLOGICAL, DEVELOPMENTAL, AND MEDICAL FACTORS. THE TEAM DEVELOPS AND IMPLEMENTS INDIVIDUALIZED TREATMENT PLANS AND ENLISTS COMMUNITY SUPPORT TO ENSURE APPROPRIATE FOLLOW-UP CARE FOR EACH PATIENT. SEE ATTACHED COMMUNITY BENEFIT REPORT FOR MAINE MENTAL HEALTH PARTNERS & SUBSIDIARIES. 9201061 10483375 CHILD AND ADOLESCENT SERVICES -OUR 28 YOUTH BEDS SERVE CHILDREN AND ADOLESCENTS WHO REQUIRE ACUTE MENTAL HEALTHCARE AND SUBSTANCE ABUSE INTERVENTION. PROGRAMMING INCLUDES COMPREHENSIVE PSYCHIATRIC EVALUATION, INDIVIDUAL AND FAMILY THERAPY, RECREATIONAL AND GROUP THERAPY, MEDICATION MANAGEMENT, PARENT EDUCATION, AND ON-SITE ACADEMIC INSTRUCTION. THE UNITS SPECIALIZE IN THE TREATMENT OF DIAGNOSES COMMON TO YOUTH, INCLUDING ANXIETY,PSYCHOTIC OR DEPRESSIVE DISORDERS, OPPOSITIONAL/DEFIANT DISORDER, ATTENTION DEFICIT/HYPERACTIVITY DISORDER(ADD/ADHD), AND POST-TRAUMATIC STRESS DISORDER (PTSD). 4821536 5493494 DEVELOPMENTAL DISORDERS PROGRAM - THE STATE'S ONLY HOSPITAL PROGRAM FOR YOUTH WITH AUTISM AND MENTAL ILLNESS,THE DEVELOPMENTAL DISORDERS PROGRAM DELIVERS HIGH-QUALITY TREATMENT OUTCOMES THROUGH A COMBINATION OF EXPERT PROGRAMMING, SPECIALLY TRAINED CAREGIVERS, AND THE INDIVIDUAL POTENTIAL OF EACH PATIENT. THE PROGRAM OFFERS INTENSIVE TREATMENT FOR AGGRESSION, SELF-INJURY, IMPAIRMENT IN FUNCTIONING, AND MENTAL HEALTH CHALLENGES IN CHILDREN AGES 2 TO 21 WHO HAVE A DEVELOPMENTAL DISORDER AND CANNOT CURRENTLY FUNCTION SAFELY OUTSIDE THE HOSPITAL SETTING. 487927 555928 CAFETERIA AND VENDING UNITS SALES, OTHER REVENUE FROM MEDICAL RECORDS, RENT FROM A RELATED PARTY, AND EDUCATIONAL SERVICES. 487927 555928 27535488 true true false true false true false false true true false true false false false false false false false false true false false true false false false false false false false false false false false false false true false false false true 11 0 true 558 true false false false false false false false false false 19 16 false false false false true true true true true false false true true true true true true true true false ME X GREG BOWERS CFO 2077612200 123 ANDOVER ROAD WESTBROOK ME 04092 X RICHARD PETERSEN 1.00 X 0 941845 32644 DENNIS P KING 25.00 X X 0 494901 27368 FRANK LAVOIE MD 1.00 X 0 321142 13931 BRIAN RINES PHD 3.00 X X 0 0 0 DAVID LAKARI 3.00 X X 0 0 0 CHERYL LEE RUST 3.00 X X 0 0 0 ROSALYNE BERNSTEIN 1.00 X 0 0 0 SHERI BOULOS 1.00 X 0 0 0 RICHARD CARRIUOLO 1.00 X 0 0 0 JANIS COHEN 1.00 X 0 0 0 JAMES HARNAR 1.00 X 0 0 0 NANCY HASENFUS MD 1.00 X 0 0 0 TRACY HAWKINS 1.00 X 0 0 0 LESTER W HODGDON 1.00 X 0 0 0 LISA C HOOK 1.00 X 0 0 0 NANCY POND 1.00 X 0 0 0 JOHN SHOOS 1.00 X 0 0 0 ANNA H WELLS 1.00 X 0 0 0 ROGER F WOODMAN JR 1.00 X 0 0 0 FRANCIS G MCGINTY 1.00 X 0 621687 32688 GIRARD ROBINSON 12.50 X 0 410084 43335 DONALD E QUIGLEY ESQ 1.00 X 0 345245 32688 RICHARD HANLEY 37.50 X 0 181713 19008 MARY JANE KREBS 17.50 X 0 175652 18329 GREGORY BOWERS 15.00 X 0 161210 18093 JOHN MURPHY MD 40.00 X 207054 0 20217 MARK FULTON MD 40.00 X 204436 0 20025 WILLIAM BRENAN MD PHD 40.00 X 197337 0 19650 MATTHEW SIEGEL MD 40.00 X 190097 0 15746 JAMES RAY DO 40.00 X 183313 0 19103 982237 3653479 332825 14 false true false CARDINAL HEALTH 3763 COLLECTION DRIVE CHICAGO IL 60693 PHARMACEUTICAL 643306 US FOODSERVICE INC PO BOX D 3155 BOSTON MA 022413155 FOOD SERVICE 342541 NORDX 102 CAMPUS DRIVE UNIT 118 SCARBOROUGH ME 04074 LAB PROCESSING 183575 E-PHARM PRO 601 UPLAND AVE STE 223-224 UPLAND PA 19015 PHARMACEUTICAL 111398 4 292 511978 512270 ADULT SERVICES 623000 14840200 14840200 CHILD & ADOLESCENT 623000 10483375 10483375 DEVELOPMENTAL DISORDERS 623000 5493494 5493494 RENT INCOME 531120 264804 264804 CAFETERIA 722210 234238 234238 56886 56886 31372997 73487 73487 2008 -2008 -2008 -2008 31956746 31370989 73487 586211 186481 399730 16818191 16484300 276923 56968 447547 434121 13426 2486881 2412275 74606 1267794 1229760 38034 3065076 3065076 1182 1182 3990 3990 737339 734276 3150 -87 10717 10395 322 421629 397893 16026 7710 7764 7531 233 1905132 1847978 57154 41177 40265 483 429 48753 46334 2419 1038319 1007169 31150 168130 163995 4135 HOSPITAL TAX 672068 672068 PHARMACY SERVICES 616185 616185 PROVISION FOR BAD DEBT 597104 597104 FOOD SERVICES 419318 419085 233 MEMBERSHIP DUES 100077 96347 2980 750 131926 131926 31592510 27535488 3991019 66003 1813 1665 7933763 9178192 9803 9803 2554775 1955577 214953 249042 198884 112803 28190418 7327126 21808031 20863292 417253 613192 801377 244689 33940652 33228255 2471969 2732554 22795239 22188897 140025 25267208 25061476 X 8246388 7753144 77056 63635 350000 350000 8673444 8166779 33940652 33228255 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false false false true 5806 5806 false false false false false SCHEDULE C, PART II-B, LINE 1I A PORTION OF MEMBERSHIP DUES PAID REPRESENTS LOBBYING ACTIVITIES. LOBBYING PORTION OF MAINE HOSPITAL ASSOCIATION DUES: 4,732 LOBBYING PORTION OF AMERICAN HOSPITAL ASSOCIATION DUES: 1,074 TOTAL DUES PAID REPRESENTING LOBBYING ACTIVITIES: 5,806 false false X 1 54 1 false 5 250 false false false false 350000 33229 33229 350000 350000 7350 7350 350000 1.00000 false true true 1212130 1212130 23401632 5092782 18308850 732069 398249 333820 2844587 1836095 1008492 20863292 DUE TO AFFILIATES 140025 140025 ACCOUNTING FOR CONSERVATION EASEMENTS SCHEDULE D, PAGE 1, PART II, LINE 9 IN 2002 SPRING HARBOR HOSPITAL ACQUIRED A 54-ACRE PARCEL OF LAND DESIGNATED AS A CONSERVATION EASEMENT WHICH WAS CONVEYED AS PART OF A LAND PURCHASE UPON WHICH THE HOSPITAL WAS BUILT. INTENDED USES FOR ENDOWMENT FUNDS SCHEDULE D, PAGE 2, PART V, LINE 4 THE INCOME GENERATED FROM THIS PERMANENT ENDOWMENT ARE INTENDED TO BE USED PRIMARILY FOR THE SERVICES PROVIDED BY SPRING HARBOR HOSPITAL'S CHILD AND ADOLESCENT PROGRAMS. true true true X 1.75000 false true true true false true true 3432671 3432671 0.10870 3432671 3432671 0.10870 93300 93300 0.00300 99250 99250 0.00310 12100 12100 0.00040 204650 204650 0.00650 3637321 3637321 0.11510 false 371996 3504015 4576015 -1072000 X true true SPRING HARBOR HOSPITAL

123 ANDOVER ROAD WESTBROOK ME 04092

SPRING HARBOR HOSPITAL DOES NOT PROVIDE DISCOUNTED CARE, ONLY FREE CARE, FOR WHICH THE FPG IS USED TO DETERMINE ELIGIBILITY. SPRING HARBOR'S ANNUAL COMMUNITY BENEFIT REPORT INFORMATION IS CONTAINED IN A REPORT PREPARED BY SPRING HARBOR'S PARENT ORGANIZATION, MAINE MENTAL HEALTH PARTNERS. CHARITY CASE COST DATA PRESENTED IN THIS SECTION HAS BEEN CALCULATED BY ASSIGNING THE AVERAGE OVERALL SPRING HARBOR RATIO OF COST TO CHARGES TO THE ACTUAL GROSS AMOUNT OF CHARITY CARE CHARGES RECORDED BY THE HOSPITAL DURING THE PERIOD. OTHER BENEFIT COST DATA HAS BEEN CALCULATED THROUGH THE USE OF A COMBINATION OF ACTUAL GENERAL LEDGER SPECIFIC COST DATA, AND THE USE OF EMPLOYEE TIME STUDIES. ALL OTHER BENEFIT COST DATA IN PART I, LINE 7 MATCHES THE DATA PRESENTED FOR SPRING HARBOR HOSPITAL IN MAINE MENTAL HEALTH PARTER'S ANNUAL COMMUNITY BENEFIT REPORT. SPRING HARBOR HOSPITAL DOES NOT HAVE A SPECIFIC FOOTNOTE IN THE FINANCIAL STATEMENTS THAT DESCRIBES "BAD DEBT EXPENSE." HOWEVER, REFERENCE IS MADE WITHIN THE FOOTNOTES TO A BAD DEBT POLICY IN A COUPLE OF INSTANCES. WITHIN THE FOOTNOTE DESCRIBING "SIGNIFICANT ACCOUNTING POLICES" IS THE SECTION TITLED "ACCOUNTS RECEIVABLE," WHERE THE FOLLOWING EXPLAINS THE BAD DEBT RESERVE: "THE RESERVE FOR UNCOLLECTIBLE ACCOUNTS IS PROVIDED BASED ON AN ANALYSIS BY MANAGEMENT OF THE COLLECTIBILITY OF OUTSTANDING BALANCES. MANAGEMENT CONSIDERS THE AGE OF OUTSTANDING BALANCES AND PAST COLLECTION EFFORTS IN DETERMINING THE RESERVE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED OFF AGAINST THE ESTABLISHED RESERVE." ALSO WITHIN THE "SIGNIFICANT ACCOUNTING POLICIES" IS THE SECTION TITLED "CHARITY CARE AND BAD DEBTS," WHERE THE FOLLOWING DESCRIBES THE BAD DEBT EXPENSE: "REVENUE FOR SERVICES RENDERED TO INDIVIDUALS FROM WHOM PAYMENT IS EXPECTED AND ULTIMATELY NOT RECEIVED IS WRITTEN OFF AND INCLUDED AS PART OF THE ALLOWANCE FOR BAD DEBTS." THE AMOUNT OF EXPENSE ASSOCIATED WITH THE PROVISION OF SERVICES, ULTIMATELY WRITTEN OFF AS BAD DEBT AT SPRING HARBOR, HAS BEEN CALCULATED AT 371,996 FOR THE CURRENT FISCAL YEAR. THIS AMOUNT WAS CALCULATED BY ASSIGNING THE AVERAGE OVERALL SPRING HARBOR RATIO OF COST TO CHARGES TO THE GROSS AMOUNT OF CHARGES WRITTEN OFF AS BAD DEBT DURING THE FISCAL PERIOD. BAD DEBT EXPENSE REPRESENTS HEALTHCARE SERVICES SPRING HARBOR HAS PROVIDED WITHOUT COMPENSATION. AS A TAX-EXEMPT HOSPITAL, SPRING HARBOR PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. A PORTION OF SPRING HARBOR'S BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR APPLICATION PROCESS. SPRING HARBOR CANNOT DETERMINE THE AMOUNT OF BAD DEBT EXPENSE THAT COULD BE REASONABLY ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES RELATED TO A PORTION OF OUR COMMUNITY BASED PATIENT POPULATION. THEIR MEDICAL BILLS OFTEN PLACE THESE INDIVIDUALS IN UNTENABLE POSITIONS WHERE THEY ARE NOT ABLE TO HANDLE THEIR PERSONAL DEBT AND THEN THEIR NEW MEDICAL DEBT. HOWEVER, BECAUSE OF THEIR INCOME LEVEL, THEY DO NOT QUALIFY FOR FREE CARE. BY PROVIDING NECESSARY HEALTHCARE SERVICES TO THOSE INDIVIDUALS EITHER WHO FAIL TO APPLY FOR FINANCIAL ASSISTANCE OR WHO ARE EXPERIENCING DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES, SPRING HARBOR BELIEVES THAT BAD DEBT EXPENSE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. SPRING HARBOR HOSPITAL IS CURRENTLY REIMBURSED BY MEDICARE PART A (FOR INPATIENT SERVICES) THROUGH A PROSPECTIVE PAYMENT SYSTEM (PPS) DAY RATE METHODOLOGY, WHILE MEDICARE PART B REIMBURSES THE HOSPITAL FOR PROFESSIONAL SERVICES RENDERED THROUGH A FEE SCHEDULE FOR EACH SERVICE PROVIDED. IN BOTH CASES (PART A AND PART B), THE REIMBURSEMENT PROVIDED DOES NOT FULLY COVER THE HOSPITAL'S COSTS TO PROVIDE SERVICES TO MEDICARE BENEFICIARIES. ACTUAL FY10 COSTS TO PROVIDE CARE FOR MEDICARE PATIENTS HAS BEEN CALCULATED AT 4,576,000, WHILE TOTAL ACTUAL MEDICARE REIMBURSEMENT PROVIDED TOTALED 3,504,000. THE COST CALCULATION WAS DETERMINED USING STANDARD MEDICARE PART A COST REPORTING METHODOLOGIES (COST TO CHARGE RATIOS), COUPLED WITH IN-HOUSE SPRING HARBOR ANALYSIS OF PART B COSTS. THE DIFFERENCE BETWEEN ACTUAL COST AND MEDICARE REIMBURSEMENT OF 1,072,000 REPRESENTS THE COST OF ACTUAL UNREIMBURSED CARE PROVIDED TO MEDICARE BENEFICIARIES. SPRING HARBOR HOSPITAL BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL HAS A CLEAR MISSION COMMITMENT TO SERVING ELDERLY PATIENTS AND ADULTS WITH DISABILITIES THROUGH THE PROVISION OF SPECIFIC SUBSIDIZED PROGRAMS DEVELOPED TO HELP IMPROVE THE HEALTH STATUS OF THESE PATIENTS. IF THESE CRITICAL SUBSIDIZED PROGRAMS WERE NOT PROVIDED BY THE HOSPITAL, THEY WOULD BECOME THE OBLIGATION OF THE FEDERAL GOVERNMENT. SPRING HARBOR HOSPITAL OFFERS FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE NO MEANS TO PAY FOR THEIR CARE BY MAINTAINING CHARITY/INDIGENT CARE PROGRAMS. CHARITY CARE IS PROVIDED TO THOSE PATIENTS WHO COMPLETE AN APPLICATION AND WHO OFFER EVIDENCE THAT THEY MEET THE ELIGIBILITY REQUIREMENTS. THOSE PATIENTS WHO REFUSE APPLICATION OR WHO FAIL TO MEET THE REQUIREMENTS FOR UNCOMPENSATED CARE ARE PURSUED FOR COLLECTION. UNSUCCESSFUL ATTEMPTS AT COLLECTION MAY RESULT IN THE ACCOUNT BEING WRITTEN OFF AS BAD DEBT. FOR THOSE PATIENTS THAT DO QUALIFY FOR CHARITY CARE, ACCOUNT BALANCES ARE ADJUSTED ACCORDINGLY ONCE THEIR CHARITY CARE APPLICATION HAS BEEN APPROVED. MORE DETAILS REGARDING THE CHARITY CARE PROCESS AT SPRING HARBOR ARE MAINTAINED IN THE HOSPITAL'S WRITTEN (AND PUBLICLY AVAILABLE) CHARITY CARE POLICY. SPRING HARBOR HOSPITAL IS A MEMBER OF MAINEHEALTH, WHICH CONDUCTS A THOROUGH COMMUNITY NEEDS ASSESSMENT AND DIRECTS ITS MEMBER ORGANIZATIONS TO RESPOND TO THE NEEDS IDENTIFIED. MAINEHEALTH MEMBERS ALSO PARTICIPATE IN VARIOUS INITIATIVES TO KEEP THOSE ASSESSMENTS UP TO DATE. SOME OF THESE INITIATIVES INCLUDE: - CLINICAL STRATEGIC PLANNING - FINANCIAL STRATEGIC PLANNING - FACILITY PLANNING - MANPOWER PLANNING - PHYSICIAN RECRUITMENT STRATEGIC PLANNING - EMERGENCY PREPAREDNESS PLANNING IN ADDITION TO THESE INTERNAL ASSESSMENTS, MAINEHEALTH MEMBER ORGANIZATIONS ALSO REVIEW AND ACT ON MANY OF THE RECOMMENDATIONS PROVIDED BY EXTERNAL GROUPS SUCH AS THE MAINE CENTER FOR DISEASE CONTROL AND PREVENTION AND THE "STATE HEALTH PLAN" CREATED BY THE ADVISORY COMMITTEE FOR HEALTH SYSTEMS DEVELOPMENT. SPRING HARBOR HOSPITAL DISTRIBUTES A PATIENT FINANCIAL POLICIES BROCHURE TO EACH PATIENT UPON ADMISSION, WHICH INCLUDES (BUT IS NOT LIMITED TO) INFORMATION ON HOW TO ACCESS AND APPLY FOR SPRING HARBOR HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, FINANCIAL COUNSELING SERVICES, MAINECARE, MEDICARE AND SOCIAL SECURITY. SPRING HARBOR HOSPITAL'S SERVICE REGION ENCOMPASSES THE SOUTHERNMOST 11 COUNTIES OF MAINE AND ITS APPROXIMATELY 960,000 RESIDENTS (THREE QUARTERS OF THE STATE POPULATION). OF THIS NUMBER, IT IS ESTIMATED THAT 7% OF CHILDREN AND 23% OF ADULTS HAVE A DIAGNOSABLE MENTAL ILLNESS. THIS EQUATES TO A POTENTIAL POPULATION SERVED OF 190,000 MAINE RESIDENTS. SPRING HARBOR HOSPITAL, IN PARTNERSHIP WITH MAINEHEALTH AND MMC MENTAL HEALTH NETWORK, DEVELOPED A PROGRAM TO IMPROVE PRIMARY CARE/MENTAL HEALTH INTEGRATION AND HELPS PEOPLE WITH DEPRESSION AND THOSE WHO CARE FOR AND ABOUT THEM. THE PROGRAM TRAINS PRIMARY CARE PROVIDERS ON THE DIAGNOSIS AND TREATMENT OF PATIENTS, AND MANY PHYSICIANS USE AN ELECTRONIC REGISTRY TO TRACK OUTCOME MEASURES. THE PROGRAM CONDUCTS A COLLABORATIVE "LEARNING COMMUNITY" EXPLORING THE EFFECTIVENESS, EFFICIENCY AND COST/BENEFIT OF INTEGRATION WITH 6 PAIRS OF PRIMARY CARE/MENTAL HEALTH PARTNERS. SPRING HARBOR HOSPITAL IS A MEMBER OF MAINE MENTAL HEALTH PARTNERS. MAINE MENTAL HEALTH PARTNERS MISSION IS TO FACILITATE, PROMOTE, AND MAINTAIN A HIGH-QUALITY, INTEGRATED SYSTEM OF MENTAL HEALTH SERVICES IN THE MAINEHEALTH REGION BY: - PROMOTING INDIVIDUALS' SUCCESSFUL FUNCTIONING IN THE COMMUNITY (I.E., "RECOVERY") - SUPPORTING ACCESS TO SAFE, HIGH-QUALITY CARE DELIVERED AS CLOSE AS POSSIBLE TO AN INDIVIDUAL'S HOME AND AT THE BEST POSSIBLE COST - DESIGNING, DEVELOPING, AND SUPPORTING A CONTINUUM OF CARE THAT FULFILLS EACH REGION'S MENTAL HEALTH NEEDS - ADVOCATING LOCALLY, STATEWIDE, REGIONALLY, AND NATIONALLY TO ENHANCE MENTAL HEALTH FOR MAINE PEOPLE - CREATING A MODEL SYSTEM OF LEADERSHIP, CLINICAL EXCELLENCE, INNOVATION AND EXPERTISE ME X true true X X X X false true false false false false false false false RICHARD PETERSEN 614632 165000 162213 4900 27744 974489 DENNIS P KING 281832 55000 158069 4900 22468 522269 FRANK LAVOIE MD 321142 2450 11481 335073 FRANCIS G MCGINTY 403222 69000 149465 4900 27788 654375 GIRARD ROBINSON 306021 43370 60693 4900 38435 453419 DONALD E QUIGLEY ESQ 257785 35000 52460 4900 27788 377933 RICHARD HANLEY 166713 15000 5570 13438 200721 MARY JANE KREBS 155652 20000 5472 12857 193981 GREGORY BOWERS 142510 18700 5027 13066 179303 JOHN MURPHY MD 207054 6405 13812 227271 MARK FULTON MD 204436 6230 13795 224461 WILLIAM BRENAN MD PHD 197337 5990 13660 216987 MATTHEW SIEGEL MD 190097 1954 13792 205843 JAMES RAY DO 183313 5623 13480 202416 SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 RICHARD PETERSEN 0 150,923 0 DENNIS P. KING 0 144,079 0 FRANCIS G. MCGINTY 0 147,054 0 GIRARD ROBINSON 0 56,890 0 DONALD E. QUIGLEY, ESQ 0 45,208 0 OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III THE NONQUALIFIED PAYMENTS SHOWN ABOVE ARE FROM RELATED ORGANIZATIONS WHERE THE INDIVIDUALS ARE EMPLOYED. PART I, LINE 1A THE ORGANIZATION PAID DUES TO THE CUMBERLAND CLUB, A SOCIAL CLUB. THE CLUB IS USED TO CONDUCT BUSINESS MEETINGS. THE CLUB'S MEMBERSHIP RESTRICTIONS REQUIRE THAT THE MEMBERSHIP BE IN THE NAME OF AN INDIVIDUAL, NOT A BUSINESS. THEREFORE, THE MEMBERSHIP IS UNDER THE NAME OF THE CEO, DENNIS KING. NONE OF THESE DUES ARE TREATED AS A TAXABLE BENEFIT TO THE CEO. ALL OTHER ACHIEVEMENTS DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4D CAFETERIA AND VENDING UNITS SALES, OTHER REVENUE FROM MEDICAL RECORDS, RENT FROM A RELATED PARTY, AND EDUCATIONAL SERVICES. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 MAINE MENTAL HEALTH PARTNERS (MMHP) IS THE SOLE MEMBER OF SPRING HARBOR HOSPITAL. MAINEHEALTH (EIN01-0431680), AS THE SOLE MEMBER OF MMHP, HAS THE RIGHT TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY OF MMHP AND ITS SUBSIDIARIES. ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE SOLE MEMBER, MAINE MENTAL HEALTH PARTNERS MAY ELECT THE BOARD OF DIRECTORS FROM A SLATE OF NOMINEES SUBMITTED BY THE CORPORATION. THE OFFICERS ARE ELECTED BY THE BOARD OF TRUSTEES, EXCEPT THAT THE CFO, COO, CHIEF MEDICAL OFFICER AND CHIEF CLINICAL & NURSING OFFICER ARE APPOINTED BY THE BOARD OF TRUSTEES BASED UPON A RECOMMENDATION OF THE CEO. DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B DECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS STRATEGIES, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION, AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL BY MAINE MENTAL HEALTH PARTNERS & MAINEHEALTH. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11 THE FINANCE COMMITTEE PERFORMS A DETAILED REVIEW OF THE FORM 990. THE FORM 990 IS THEN MADE AVAILABLE TO THE FULL BOARD. A FINAL DETAILED REVIEW OF THE FORM 990 IS PERFORMED BY THE CHIEF FINANCIAL OFFICER BEFORE SIGNING AND PRIOR TO FILING. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE OBTAINED ANNUALLY. THE ORGANIZATION REVIEWS THE RESPONSES TO THESE DOCUMENTS AND ADDRESSES ANY ISSUES IMMEDIATELY. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A SPRING HARBOR HOSPITAL BOARD OF DIRECTORS ARE RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. FOR THOSE KEY ADMINISTRATIVE EMPLOYEES THAT ARE SHARED WITH MMHP, COMPENSATION IS EVALUATED BY THE MMHP GOVERNANCE COMMITTEE AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTING FIRM, AND INDUSTRY SURVEY. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B THE MEMBER IS RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. COMPENSATION IS EVALUATED BY THE COMPENSATION COMMITTEE APPOINTED BY THE MEMBER, AND THE ORGANIZATION'S BOARD OF TRUSTEES MUST APPROVE OF THE COMPENSATION. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTING FIRM, AND INDUSTRY SURVEY. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. ADDITIONAL INFORMATION SCHEDULE R MAINE MENTAL HEALTH PARTNERS IS AWAITING FINAL APPROVAL OF THEIR PUBLIC CHARITY TAX-EXEMPT STATUS FROM THE IRS. ADDITIONAL INFORMATION SCHEDULE O FORM 990, PART XI, LINE 2B THE FINANCIAL RESULTS OF THE ORGANIZATION WERE PART OF A CONSOLIDATED FINANCIAL STATEMENT AUDIT PREPARED FOR MAINE MENTAL HEALTH PARTNERS (EIN 26-3426990) AND ITS SUBSIDIARIES. MAINEHEALTH 110 FREE STREET PORTLAND ME 04101 010431680 HEALTHCARE ME 501 11C NA MAINE MENTAL HEALTH PARTNERS 123 ANDOVER ROAD WESTBROOK ME 04092 263426990 HEALTHCARE ME 501 11C NA SPRING HARBOR COMMUNITY SERVICES 123 ANDOVER ROAD WESTBROOK ME 04092 010524835 HEALTHCARE ME 501 9 NA COMMUNITY COUNSELING CENTER 165 LANCASTER STREET PORTLAND ME 04101 010288362 HEALTHCARE ME 501 7 NA MAINE MEDICAL CENTER 22 BRAMHALL STREET PORTLAND ME 04102 010238552 HOSPITAL ME 501 3 NA NORDX 102 CAMPUS DRIVE 118 SCARBOROUGH ME 04074 010511356 MEDICALLAB ME 501 9 NA LINCOLN COUNTY HEALTH CARE INC C/O CHIEF FINANCIAL OFFICER 6 ST ANDREWS LANE BOOTHBAY HARBOR ME 04538 261475629 HEALTHCARE ME 501 11C NA WESTERN MAINE HEALTH CARE CORP 181 MAIN STREET NORWAY ME 04268 010411788 HEALTHCARE ME 501 11C NA WALDO COUNTY HEALTHCARE INC PO BOX 287 BELFAST ME 049150287 222864961 HEALTHCARE ME 501 11C NA GERIATRIC RESOURCE NETWORK 465 CONGRESS STREET SUITE 600 PORTLAND ME 04101 010542842 HEALTHCARE ME 501 7 NA WEBBER HOSPITAL ASSOC DBA SMMC PO BOX 626 BIDDEFORD ME 040050626 010179500 HOSPITAL ME 501 3 NA HOMEHLTH-VISITING NURSES OF S ME 15 INDUSTRIAL PARK DRIVE SACO ME 04072 222571902 HEALTHCARE ME 501 9 NA MAINE PHYSICIAN HOSPITAL ORG 110 FREE STREET PORTLAND ME 04101 010527540 HEALTHCARE ME N/A SYNERNET INC 110 FREE STREET PORTLAND ME 04101 010539789 HEALTHCARE ME N/A INTEGRATED BEHAVIORAL HEALTH INC 123 ANDOVER ROAD WESTBROOK ME 04092 208736290 HEALTHCARE ME N/A false false false true false false false false true false false true false true false false true false