2025-08-12T15:20:29-05:00 2024-09-30 990 2023-10-01 020222156 The Memorial Hospital at North Conway NH MEMO 6033565461 3073 White Mountain Highway North Conway NH 03860 Diana McLaughlin Chief Financial Officer 6033565461 2025-07-17 0 2023 2025-03-06 01:10:19Z MaineHealth Memorial Hospital Tricia Costigan 3073 White Mountain Highway North Conway NH 03860 147095277 0 X www.memorialhospitalnh.org X 1910 NH Critical Access Hospital 12 7 596 42 0 0 808473 5352045 109770525 117206820 2496142 3562152 457882 454716 113533022 126575733 0 0 0 0 47575905 54016554 0 0 197193 57758070 59737260 105333975 113753814 8199047 12821919 127146321 134141556 50431324 41871801 76714997 92269755 THE MEMORIAL HOSPITAL AT NORTH CONWAY, N.H. (MEMORIAL HOSPITAL) PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS AND VISITORS OF THE MOUNT WASHINGTON VALLEY AREA OF NEW HAMPSHIRE AS WELL AS WESTERN MAINE. 0 0 110310728 118079594 MEMORIAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS AND VISITORS OF THE MOUNT WASHINGTON VALLEY AREA OF NEW HAMPSHIRE AND THE WESTERN REGION OF MAINE. MEMORIAL HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDES ACUTE INPATIENT SERVICES INCLUDING GENERAL MEDICAL AND SURGICAL, OBSTETRICS AND INTENSIVE CARE UNITS. THE HOSPITAL HAD 5,665 ACUTE PATIENT DAYS IN 2024. THE HOSPITAL ALSO PROVIDES A VARIETY OF OUTPATIENT SERVICES SUCH AS IMAGING, LABORATORY, DIABETES, ONCOLOGY, PHYSICAL REHAB, EMERGENCY MEDICINE, PRIMARY CARE, ORTHOPEDICS AND GENERAL SURGERY. THE HOSPITAL HAD 61,403 OUTPATIENT VISITS AND 63,965 CLINIC VISITS IN 2024. 110310728 1 1 0 1 0 0 0 0 0 1 1 1 0 0 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 1 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 596 1 0 0 0 0 0 0 0 0 0 0 X 12 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NH X Diana McLaughlin 6033560613 3073 White Mountain Highway North Conway NH 03860 Andrew Mueller MD CEO and President, MH/Trustee 1.00 50.00 X 0 2222049 55268 Rachael Brown Trustee 1.00 0.00 X 0 0 0 David Hoeft Physician/Trustee 50.00 0.00 X 262433 0 49539 Mary Vigeant Nurse Practitioner/Trustee 50.00 0.00 X 220952 0 30454 Steve Boyle Trustee 1.00 0.00 X 0 0 0 Christine Thompson Trustee 1.00 0.00 X 0 0 0 Greg Frizzell Former Trustee 1.00 0.00 X 0 0 0 Tim Scott Trustee 1.00 0.00 X 0 0 0 Alec Tarberry Former Trustee 1.00 0.00 X 0 0 0 Jill Berry Bowen Frmr Interim President/Frmr Trustee 50.00 0.00 X X 217645 0 4006 Michelle O'Donnell Board Chair 1.00 0.00 X X 0 0 0 Chris Perley Board Vice Chair 1.00 0.00 X X 0 0 0 Linda Terry Board Treasurer 1.00 0.00 X X 0 0 0 Corinne Ray Board Secretary 1.00 0.00 X X 0 0 0 Bradley Chapman President/Trustee 50.00 0.00 X X 0 0 0 Matthew Dunn Regional CMO - Mountain Region 50.00 0.00 X 508250 0 55144 Diana McLaughlin Chief Financial Officer 1.00 50.00 X 0 267054 58344 Kristine Dascoulias Chief Nursing Officer 50.00 0.00 X 216227 0 45245 Douglas Taylor Physician 50.00 0.00 X 583187 0 57663 Danielle Phinney Physician 50.00 0.00 X 570504 0 47084 Morice Dennery Physician 50.00 0.00 X 478696 0 55921 M Angus Badger Associate Medical Director 50.00 0.00 X 441445 0 47715 Robert Brown Physician - Shift 50.00 0.00 X 438448 0 55903 Art Mathisen Frmr President/Frmr Trustee 50.00 0.00 X 283439 0 15681 4221226 2489103 577967 97 1 1 0 Cross Country Staffing Inc PO Box 404674 Atlanta GA 303844674 Contract labor 2238170 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Locum tenens 639836 North Country Integrated Health PLCC 431 Chase Rd North Sandwich NH 03259 Medical staffing 421735 Derek Chase 15 Winterbird Rd Stowe VT 05672 Medical services 331625 Insight Health Corp PO Box 847689 Dallas TX 752847689 Diagnostic imaging 314400 11 5065323 286722 5352045 Net patient services 622110 117206820 117206820 117206820 3025291 3025291 182229 63426 118803 118803 118803 20991479 1500 20450886 5232 540593 -3732 536861 536861 Other revenue 900099 335913 335913 335913 126575733 118079594 0 3144094 X 1858882 1422735 436147 41173275 39964544 1070980 137751 2924829 2816429 98791 9609 3908560 3760678 135007 12875 4151008 3981281 156388 13339 2743 2743 10702 10702 51500 51500 13957298 13561273 396025 504 485 19 919015 863992 34624 20399 1897154 1825679 71475 31582 29499 1190 893 81307 78244 3063 589991 567763 22228 2849249 2741904 107345 801585 771385 30200 Medical supplies 17341920 17341920 Integrated services 15471646 14888732 582891 23 Medicaid tax 4813338 4813338 Food 433043 415997 16315 731 484683 464850 18260 1573 113753814 110310728 3245893 197193 33561948 31748829 11456629 12148755 37325 27211 11958415 13721666 3149698 3270324 298115 255457 100131422 70333530 28107529 29797892 26052409 31400544 7837225 7362607 4687028 4408271 127146321 134141556 8151591 8258729 295391 305952 11578094 10929641 1604001 875112 28802247 21502367 50431324 41871801 X 76714997 92269755 76714997 92269755 127146321 134141556 X 12821919 3527348 -794509 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21447 21447 0 SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION PAYS DUES TO THE NEW HAMPSHIRE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING EXPENSES. 45346263 5565643 50911906 42305879 3040384 45346263 31681985 15000000 -4376106 42305879 28648048 3033937 31681985 27262886 1385162 28648048 1.00000 0.00000 0.00000 0 1 1 4545066 4545066 57751250 41275169 16476081 37789818 29058361 8731457 45288 45288 29797892 Common/collective trusts 1024313 F Real estate 50913 C Limited partnerships 2482152 F Hedge funds 3805229 F 7362607 Estimated third party settlements 14758864 Due to affiliates 5724670 Professional insurance payable 1018833 21502367 X Part X, Line 2: FIN 48 FOOTNOTE THE HOSPITAL AND ITS SUBSIDIARIES ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. 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. UNDER GUIDANCE ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB), ASSETS AND LIABILITIES ARE ESTABLISHED FOR UNCERTAIN TAX POSITIONS TAKEN OR POSITIONS EXPECTED TO BE TAKEN IN INCOME TAX RETURNS WHEN SUCH POSITIONS ARE JUDGED NOT TO MEET THE "MORE-LIKELY-THAN-NOT" THRESHOLD, BASED UPON THE TECHNICAL MERITS OF THE POSITION. THE HOSPITAL HAS EVALUATED THE POSITION TAKEN ON ITS FILED TAX RETURNS. THE HOSPITAL HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT SEPTEMBER 30, 2024. PART V, LINE 4 - INTENDED USES FOR ENDOWMENT FUNDS THE ENDOWED FUNDS SUPPORT COMMUNITY HEALTH INITIATIVES FOR THE MEMORIAL HOSPITAL SERVICE AREA AND PATIENTS. THEY PROVIDE SUPPORT FOR THE DIABETES AND ONCOLOGY PROGRAMS AND ASSIST PURCHASING CAPITAL ASSETS FOR CLINICAL AREAS OF THE HOSPITAL. 1 1 1 X 0 1 1 1 0 1 1 884974 884974 0.00780 16473501 11485168 4988333 0.04390 17358475 11485168 5873307 0.05170 569306 569306 0.00500 8678692 6035202 2643490 0.02320 9247998 6035202 3212796 0.02820 26606473 17520370 9086103 0.07990 0 2208432 0 50089031 54717914 -4628883 X 1 1 1 1 Memorial Hospital 3073 White Mountain Highway North Conway NH 03860 mainehealth.org/Memorial-Hospital #00009 X X X X Memorial Hospital 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X www.MaineHealth.org/chna X 1 22 1 www.MaineHealth.org/chna 0 1 X 200.000000000000 X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 Memorial Hospital Part V, Section B, Line 5: THE MT. WASHINGTON VALLEY CHNA WAS DEVELOPED AND CONDUCTED BASED ON THE METHODOLOGY OF THE MAINE SHARED CHNA. THE MAINE SHARED CHNA IS GOVERNED BY A STEERING COMMITTEE MADE UP OF REPRESENTATIVES OF EACH MEMBER ORGANIZATION - CENTRAL MAINE HEALTHCARE (CMHC), MAINEGENERAL HEALTH (MGH), MAINEHEALTH (MH), NORTHERN LIGHT HEALTH (NLH), AND MAINE CENTER FOR DISEASE CONTROL AND PREVENTION, A DIVISION OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES (MAINE CDC). IN THE CARROLL COUNTY HEALTH PROFILE, THE NEW HAMPSHIRE DIVISION OF PUBLIC HEALTH SERVICES PROVIDED DATA AND ANALYSIS FOR THE NEW HAMPSHIRE DATA. COMMUNITY OUTREACH AND ENGAGEMENT FOR THE MAINE SHARED CHNA INCLUDED THE FOLLOWING EFFORTS:- COUNTY FORUMS- COMMUNITY SPONSORED EVENTS - ORAL SURVEYS PERSONS FROM THE FOLLOWING ORGANIZATIONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY WHO WERE CONSULTED DURING THE ENGAGEMENT PROCESS: MAINE BEHAVIORAL HEALTHCARE, POPE MEMORIAL LIBRARY, CHILDREN UNLIMITED, INC., TOWN OF CONWAY, ACCESS TO CARE, CARROLL COUNTY COALITION FOR PUBLIC HEALTH PATIENT AND FAMILY ADVISORY COUNCIL (PFAC) AT MEMORIAL HOSPITAL, SENATOR JEANNE SHAHEEN, CONWAY POLICE DEPARTMENT, TOWN OF FREEDOM - NH, MAINEHEALTH, WHITE HORSE RECOVERY, GIBSON CENTER FOR SENIOR SERVICES, VISITING NURSE HOME CARE & HOSPICE OF CARROLL COUNTY, MEMORIAL HOSPITAL, MOUNT WASHINGTON VALLEY ADULT DAY CENTER, SERVICELINK, PRIMARY CARE AT MEMORIAL HOSPITAL, SAU 9, FIRST CHURCH - CONGREGATIONAL UCC, AND NORTHERN HUMAN SERVICES. PLEASE SEE THE 2022 MEMORIAL HOSPITAL AND CARROLL COUNTY (NEW HAMPSHIRE) CHNA REPORTS AND THE 2022-2024 IMPLEMENTATION PLANS AT www.mainehealth.org/chna FOR DETAILS. Memorial Hospital Part V, Section B, Line 6a: MAINEHEALTH, CENTRAL MAINE HEALTHCARE, NORTHERN LIGHT HEALTH, MAINEGENERAL HEALTH. Memorial Hospital Part V, Section B, Line 6b: MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND THE NEW HAMPSHIRE DIVISION OF PUBLIC HEALTH SERVICES. Memorial Hospital Part V, Section B, Line 11: THE ORGANIZATION HAS IDENTIFIED PRIORITIES AND DEVELOPED STRATEGIES TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND PROVIDED REASONS IF IDENTIFIED NEEDS ARE NOT BEING ADDRESSED. PLEASE SEE THE 2022-2024 CHNA IMPLEMENTATION PLAN AND THE FY24 IMPLEMENTATION PLAN UPDATE DESCRIBING THE ORGANIZATION'S PROGRESS IN ADDRESSING ITS IDENTIFIED NEEDS AT www.MaineHealth.org/chna FOR DETAILS. PART V, SECTION B, LINES 16a, 16b, 16c THE FINANCIAL ASSISTANCE POLICY (FREE CARE POLICY AND BILLING AND COLLECTION POLICY), FREE CARE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ON THE FOLLOWING WEBSITE: https://mainehealth.org/patients-visitors/billing-insurance/financial-assistance/free-care. Part I, Line 3c: CHARITY CARE LEVELS ARE DETERMINED BY A THREE PRONG TEST FOR ELIGIBILITY. RESIDENCY, INCOME LEVEL, AND HOUSEHOLD SIZE ARE EXAMINED TO DETERMINE LEVEL OF ELIGIBILITY. DISCOUNTED CARE IS REQUIRED BY NEW HAMPSHIRE STATE LAW FOR ALL UNINSURED SELF-PAY PATIENTS. THE DISCOUNT WAS 53.81% UNTIL FEBRUARY 1, 2024, WHEN THE DISCOUNT DECREASED TO 48% FOR THE REMAINDER OF THE TAX YEAR. Part I, Line 6a: MEMORIAL HOSPITAL'S COMMUNITY BENEFIT DATA IS CONTAINED IN A REPORT PREPARED BY MAINEHEALTH SERVICES (EIN 01-0431680), THE ORGANIZATION'S SOLE MEMBER. THE REPORT CAN BE FOUND AT THE LINK BELOW:https://annualreport.mainehealth.org/#community Part I, Line 7: A COST REPORTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED INTHE TABLE. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS. ACOST-TO-CHARGE RATIO WAS USED. Part III, Line 2: MEMORIAL HOSPITAL DOES NOT HAVE A SPECIFIC FOOTNOTE IN THE FINANCIALSTATEMENTS THAT DESCRIBES "BAD DEBT EXPENSE." HOWEVER, REFERENCE ISMADE WITHIN THE FOOTNOTES TO THE TREATMENT OF BAD DEBT. WITHIN THE FOOTNOTE DESCRIBING "PATIENT ACCOUNTS RECEIVABLE", THE FOLLOWING EXPLAINS THE PROVISION FOR BAD DEBTS:PATIENT ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF.WHEN THE HOSPITAL HAS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE. THE AMOUNT OF EXPENSE ASSOCIATED WITH THE PROVISION OF SERVICES, ULTIMATELY WRITTEN OFF AS BAD DEBT AT MEMORIAL, HAS BEEN CALCULATED AT $5,325,714 FOR THE CURRENT FISCAL YEAR. BAD DEBT EXPENSE REPRESENTS HEALTHCARE SERVICES MEMORIAL HAS PROVIDED WITHOUT COMPENSATION. AS A TAX-EXEMPT ORGANIZATION, MEMORIAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. MEMORIAL 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, MEMORIAL BELIEVES THAT BAD DEBT EXPENSE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. Part III, Line 4: MEMORIAL HOSPITAL DOES NOT HAVE A SPECIFIC FOOTNOTE IN THE FINANCIALSTATEMENTS THAT DESCRIBES "BAD DEBT EXPENSE." SEE PART III, LINE 2 FOR BAD DEBT EXPENSE METHODOLOGY. Part III, Line 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. MEMORIAL HOSPITAL BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE MEMORIAL 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 MEMORIAL HOSPITAL, THEY WOULD BECOME THE OBLIGATION OF THE FEDERAL GOVERNMENT. Part III, Line 9b: PATIENTS WHO QUALIFY FOR FREE CARE HAVE THEIR ACCOUNT BALANCE ADJUSTED ACCORDINGLY ONCE FREE CARE HAS BEEN APPROVED. AS A TAX EXEMPT HOSPITAL, MEMORIAL HOSPITAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. Part VI, Line 2: THE ORGANIZATION PREPARES A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS. SEE www.MaineHealth.org/chna FOR THE COMPLETED CHNA. Part VI, Line 3: MEMORIAL HOSPITAL'S POLICY OF CHARITY CARE AND FINANCIAL ASSISTANCE ISEASILY UNDERSTOOD, PROMINENTLY POSTED, AND PUBLICLY AVAILABLE. APROCESS EXISTS FOR OFFERING CHARITY CARE OR FINANCIAL ASSISTANCE TOPATIENTS WHO ARE UNABLE TO PAY AFTER THEY HAVE ALREADY BEEN BILLED. INADDITION TO MONITORING COLLECTION PRACTICES, COPIES OF THE CHARITY CAREPOLICY ARE MADE AVAILABLE TO PATIENTS AT ALL ENTRY POINTS(REGISTRATION, ED, ETC.) AND WITH BILL/COLLECTION NOTICES. MEMORIALHOSPITAL USES SIMPLE APPLICATION PROCEDURES FOR CHARITY CARE ORFINANCIAL ASSISTANCE THAT DO NOT INTIMIDATE OR CONFUSE APPLICANTS.MEMORIAL HOSPITAL'S EMPLOYEES WHO WORK IN ADMISSIONS, BILLING, ACCOUNTSRECEIVABLE, OR PATIENT SERVICES ARE FULLY INFORMED AND EDUCATED ABOUTALL FINANCIAL ASSISTANCE POLICIES. THESE STAFF MEMBERS IDENTIFY UNPAIDBILLS WHERE PERSONS ARE UNABLE TO PAY, AND SEPARATE THESE POTENTIAL"CHARITY CARE" BILLS FROM OTHER BAD DEBT ACCOUNTS. ON A CASE-BY-CASE BASIS, WE HAVE GRANTED ASSISTANCE TO INDIVIDUALS THAT MAY EARN ABOVE 200% OF THE FEDERAL POVERTY GUIDELINES BUT HAVE MET THE CATASTROPHIC ILLNESS PARAMETERS. Part VI, Line 4: THE CHNA DESCRIBES THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVICES. SEE www.MaineHealth.org/chna FOR THE COMPLETED CHNA. Part VI, Line 5: THE TAX EXEMPT PURPOSE OF THE ORGANIZATION TO IMPROVE THE HEALTH OF THECOMMUNITY IS PROMOTED AND ENHANCED IN THE FOLLOWING WAYS:- THE MAJORITY OF THE GOVERNING BODY IS COMPOSED OF PERSONS LIVINGWITHIN THE HOSPITAL SERVICE AREA THAT ARE NEITHER EMPLOYED BY, NOR HAVECONTRACTUAL RELATIONSHIPS WITH, THE HOSPITAL OR ITS AFFILIATES.- MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS INTHE COMMUNITY.- SOLICITATION OF COMMUNITY INPUT IN THE STRATEGIC PLANNING PROCESS.- COMMON GOVERNANCE OF THE HOSPITAL, LONG-TERM CARE AND PHYSICIANSERVICES PROVIDED IN THE COUNTY TO PROMOTE COMMON HEALTH CARE ANDIMPROVEMENT PLANNING AND CONTROL COSTS.- VOLUNTARY CAP ON INCOME FROM OPERATIONS TO RESTRAIN PRICES AND TOFUND HEALTH CARE AND HEALTH IMPROVEMENT ACTIVITIES.- SURPLUS FUNDS ARE REINVESTED IN CAPITAL EQUIPMENT AND IMPROVEMENTS TOENSURE HIGH QUALITY CARE. Part VI, Line 6: MAINEHEALTH IS A NOT-FOR-PROFIT FAMILY OF LEADING HIGH-QUALITY PROVIDERS AND OTHER HEALTHCARE ORGANIZATIONS WORKING TOGETHER SO THEIR COMMUNITIES ARE THE HEALTHIEST IN AMERICA. RANKED AMONG THE NATION'S TOP 100 INTEGRATED HEALTHCARE DELIVERY NETWORKS, MAINEHEALTH IS GOVERNED BY A BOARD OF TRUSTEES CONSISTING OF COMMUNITY AND BUSINESS LEADERS FROM ITS SOUTHERN, CENTRAL AND WESTERN MAINE REGIONAL SERVICE AREAS. THE COLLABORATION OF MAINEHEALTH MEMBERS MAKES IT POSSIBLE TO OFFER AN EXTENSIVE RANGE OF CLINICAL INTEGRATION AND COMMUNITY HEALTH PROGRAMS, MANY AIMED AT IMPROVING ACCESS TO PREVENTIVE AND PRIMARY CARE SERVICES. MAINEHEALTH INCLUDES THESE MEMBER ORGANIZATIONS: THE MEMORIAL HOSPITAL AT NORTH CONWAY, N.H., MAINEHEALTH CARE AT HOME, NORDX AND MAINEHEALTH ACCOUNTABLE CARE ORGANIZATION. THE STRATEGIC AFFILIATES OF MAINEHEALTH ARE MAINEGENERAL HEALTH AND ST. MARY'S HEALTH SYSTEM. Part VI, Line 7, Reports Filed With States ME,NH X 0 1 0 0 0 0 0 0 0 1 0 Andrew Mueller MD CEO and President, MH/Trustee 0 1371192 0 670196 0 180661 0 13200 0 42068 0 2277317 0 0 Douglas Taylor Physician 571929 0 4400 0 6858 0 16500 0 41163 0 640850 0 0 0 Danielle Phinney Physician 540403 0 20000 0 10101 0 13200 0 33884 0 617588 0 0 0 Matthew Dunn Regional CMO - Mountain Region 375313 0 99770 0 33167 0 16500 0 38644 0 563394 0 0 0 Morice Dennery Physician 477454 0 0 0 1242 0 16500 0 39421 0 534617 0 0 0 Robert Brown Physician - Shift 380143 0 16538 0 41767 0 16757 0 39146 0 494351 0 0 0 M Angus Badger Associate Medical Director 374660 0 26557 0 40228 0 16500 0 31215 0 489160 0 0 0 Diana McLaughlin Chief Financial Officer 0 218258 0 38278 0 10518 0 22114 0 36230 0 325398 0 0 David Hoeft Physician/Trustee 231529 0 0 0 30904 0 11064 0 38475 0 311972 0 0 0 Art Mathisen Frmr President/Frmr Trustee 152203 0 0 0 131236 0 11385 0 4296 0 299120 0 0 0 Kristine Dascoulias Chief Nursing Officer 181207 0 34091 0 929 0 11366 0 33879 0 261472 0 0 0 Mary Vigeant Nurse Practitioner/Trustee 169451 0 4912 0 46589 0 11227 0 19227 0 251406 0 0 0 Jill Berry Bowen Frmr Interim President/Frmr Trustee 217645 0 0 0 0 0 4006 0 0 0 221651 0 0 0 Part I, Line 1a THE FORMER PRESIDENT RECEIVED AN AUTO ALLOWANCE THAT WAS TREATED AS TAXABLE INCOME AND INCLUDED IN OTHER REPORTABLE COMPENSATION ON SCHEDULE J, PART II, COLUMN (B)(iii). Part I, Line 1b THE AUTO ALLOWANCE HAS HISTORICALLY BEEN PROVIDED TO THE MEMORIAL HOSPITAL PRESIDENT AND IS PART OF THEIR OFFER LETTER. THIS IS REVIEWED AS PART OF AN ANNUAL INDEPENDENT COMPENSATION BENCHMARK ANALYSIS PERFORMED BY AN OUTSIDE FIRM, SULLIVAN COTTER. THE COMPENSATION DECISIONS FOR THIS EMPLOYEE ARE APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. Part I, Line 7 MAINEHEALTH ESTABLISHED A PERFORMANCE INCENTIVE PLAN (THE PLAN) TO ENCOURAGE AND REWARD PLAN PARTICIPANTS FOR ACHIEVING DEFINED PERFORMANCE GOALS THAT ARE SUPPORTIVE OF MAINEHEALTH'S MISSION, STRATEGIC INITIATIVES, AND OPERATING OBJECTIVES. THE PLAN IS ADMINISTERED BY THE MAINEHEALTH COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. A COMPONENT OF COMPENSATION FOR CERTAIN MEDICAL PROFESSIONALS IS BASED ON A RVU (RELATIVE VALUE UNIT) CALCULATION. A New Hampshire Health & Ed Facilities Auth 020279866 64461XAF2 2016-12-22 15795685 Refund bonds issued 06/14/2006 0 0 0 A 4205000 15795685 315914 15479771 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 Jacqueline Martin See Part V 78486 See Part V 0 Grace Perley See Part V 14666 See Part V 0 Sch L, Part IV, Business Transactions Involving Interested Persons: Jacqueline Martin, daughter of Mary Vigeant (board member), is employed by Memorial Hospital.Grace Perley, daughter of Chris Perley (board vice chair), is employed as an LNA and compensated by Memorial Hospital. FORM 990, PART V, LINE 1a - MAINEHEALTH (EIN 01-0238552), ACTING ON BEHALF OF THE MAINEHEALTH SYSTEM FILED 1,391 FORM 1099S FOR THE CALENDAR YEAR 2023. Form 990, Part VI, Section A, line 6 THE SOLE MEMBER OF THE ORGANIZATION IS MAINEHEALTH SERVICES (EIN# 01-0431680). Form 990, Part VI, Section A, line 7a THE SOLE MEMBER OF THE ORGANIZATION ELECTS THE TRUSTEES OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7b DECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS AND MARKETING STRATEGIC PLANS, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION, AND ELECTION OF THE PRESIDENT AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL BY MAINEHEALTH SERVICES (EIN# 01-0431680). Form 990, Part VI, Section B, line 11b HIGHLIGHTS OF THE 990 ARE REVIEWED WITH THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE 990 IS REVIEWED IN DETAIL BY THE CFO AND MADE AVAILABLE TO THE FULL BOARD OF DIRECTORS PRIOR ITS TO FILING. Form 990, Part VI, Section B, line 12c MAINEHEALTH'S AUDIT & COMPLIANCE SERVICES SENDS CONFLICT OF INTEREST (COI) DISCLOSURE FORM REQUESTS TO OVER 3,000 CARE TEAM MEMBERS (INCLUDING ALL BOARD MEMBERS, OFFICERS, AND OTHER SENIOR LEADERS) EACH YEAR. AUDIT & COMPLIANCE SERVICES COLLECTS THE DISCLOSURE FORMS AND REVIEWS EACH SUBMISSION FOR POSSIBLE REPORTED CONFLICTS TO DETERMINE IF A MANAGEMENT MITIGATION PLAN IS REQUIRED. THE RESULTS OF THE ANNUAL COI PROCESS ARE REPORTED TO THE MAINEHEALTH EXECUTIVE COMPLIANCE COMMITTEE, THE AUDIT COMMITTEE, LOCAL HEALTH SYSTEM PRESIDENTS, AND THE BOARD OF TRUSTEES CHAIRPERSONS. Form 990, Part VI, Section B, line 15 COMPENSATION PROCESS FOR PRESIDENTS (LINE 15a) MAINEHEALTH, A RELATED ORGANIZATION USES AN OUTSIDE FIRM, SULLIVAN COTTER, TO PERFORM AN INDEPENDENT BENCHMARK ANALYSIS ANNUALLY FOR THE PRESIDENT OF MEMORIAL HOSPITAL. THE FIRM MEETS WITH THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF MAINEHEALTH TO REVIEW THE EXECUTIVE COMPENSATION REPORT. THE EXECUTIVE COMMITTEE THEN DELIBERATES ON MAINEHEALTH'S WRITTEN SALARY AND INCENTIVE PLAN PHILOSOPHY BEFORE MAKING A FINAL DECISION. ALL MEETING DECISIONS ARE CAPTURED IN MINUTES WITH APPROPRIATE APPROVALS AT ALL LEVELS. COMPENSATION PROCESS FOR OFFICERS (LINE 15b) COMPENSATION FOR OFFICERS OF MEMORIAL HOSPITAL IS PART OF THE INDEPENDENT BENCHMARK ANALYSIS PERFORMED ANNUALLY BY SULLIVAN COTTER. ALL COMPENSATION DECISIONS ARE REVIEWED AND APPROVED BY THE MAINEHEALTH CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER AND CHIEF PEOPLE OFFICER. Form 990, Part VI, Section C, line 19 DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. Form 990, Part IX, line 11g Contract labor: Program service expenses 3,943,368. Management and general expenses 154,382. Fundraising expenses 0. Total expenses 4,097,750. Labs: Program service expenses 3,445,658. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,445,658. Purchased services: Program service expenses 3,074,606. Management and general expenses 120,370. Fundraising expenses 0. Total expenses 3,194,976. Contract services: Program service expenses 2,721,773. Management and general expenses 106,557. Fundraising expenses 0. Total expenses 2,828,330. Consulting: Program service expenses 189,722. Management and general expenses 7,428. Fundraising expenses 0. Total expenses 197,150. Physician recruitment: Program service expenses 186,146. Management and general expenses 7,288. Fundraising expenses 0. Total expenses 193,434. Form 990, Part XI, line 9: Net equity transfers to controlled entities -794,509. MaineHealth 22 Bramhall Street Portland ME 04102 010238552 Hospital ME 501(c)(3) Line 3 MaineHealth services 0 MaineHealth Care at Home 15 Industrial Park Saco ME 04072 222571902 Home health ME 501(c)(3) Line 10 MaineHealth Services 0 Memorial Hospital Foundation 3073 White Mountain Highway North Conway NH 03860 462137291 Fundraising NH 501(c)(3) Line 12a, I The Memorial Hospital 1 NorDx 301A US Route One Scarborough ME 04074 010511356 Lab ME 501(c)(3) Line 10 MaineHealth Services 0 MaineHealth Services 110 Free Street Portland ME 04101 010431680 Healthcare ME 501(c)(3) Line 12c, III-FI N/A 0 Memorial Elder Health Services 3073 White Mountain Highway North Conway NH 03860 813653215 Nursing Home NH 501(c)(3) Line 10 The Memorial Hospital 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 Memorial Elder Health Services R 800000 Cash