SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
Northern Maine Medical Center
 
Employer identification number

01-0234189
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

 

No
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    174,439   174,439 0.300 %
b Medicaid (from Worksheet 3, column a) . . . . .     2,598,539 2,169,988 428,551 0.730 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     2,772,978 2,169,988 602,990 1.030 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).            
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .     24,445,878 20,323,768 4,122,110 7.050 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     24,445,878 20,323,768 4,122,110 7.050 %
k Total. Add lines 7d and 7j .     27,218,856 22,493,756 4,725,100 8.080 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
967,758
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
19,143,273
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
19,223,517
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-80,244
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Northern Maine Medical Center
194 East Main Street
Fort Kent,ME04743
www.nmmc.org
38986
X X         X      
2 Forest Hill
20 Bolduc Avenue
Fort Kent,ME04743
              X Licensed Hospital Related Facility  
Schedule H (Form 990) 2018
Page 4
Schedule H (Form 990) 2018
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Northern Maine Medical Center
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 17
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.nmmc.org/community-health-needs-assessment
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2018
Page 5
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Northern Maine Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
http://www.nmmc.org/billing/
b
http://www.nmmc.org/billing/
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Page 6
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
Northern Maine Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Page 7
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Northern Maine Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
Page 8
Schedule H (Form 990) 2018
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Northern Maine Medical Center Part V, Section B, Line 3j: The Community Health Needs Assessment was developed by the Eastern Maine Health System (EMHS) utilizing a consulting firm called JSI to support member organizations and community partners' work to conduct the needs assessments and to develop strategies to improve the health of the people we serve. The consultants who developed the survey tool worked with individuals from a broad spectrum of backgrounds as follows: the Maine Center for Disease Control and Prevention, the District Public Health Liaisons, Federally Qualified Health Centers, Public Health and Community Services across the state of Maine and others who provided generous support and insights. Target audience was anyone with a vested interest in public health and healthcare including medical staff, community board members, volunteers, donors and members of the general public. The surveys were conducted across the eight participating Maine Counties of Aroostook, Cumberland, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington by 17 partnering Maine Hospitals, 5 local Public Health Districts and 11 Healthy Maine Partnerships. The following sectors were represented: - Healthy Aroostook- Northern Maine Medical Center- Public Health Nursing- Aroostook Mental Health Services- Wabanaki Public Health- Town of Madawaska- UMFK Student- Power of Prevention- Fish River Rural Health - Maine Quality Counts- U. Maine Cooperative Extension- Visiting Nurses of Aroostook- Town of Fort Kent- The Aroostook Medical Center- Fiddlehead Focus News- Maine CDC- Pines Health Services- University of Maine at Fort Kent- Northern Maine Development Commission- Community Voices- Community Members
Northern Maine Medical Center Part V, Section B, Line 5: Attention was taken to include a broad representation from the community. This took place in two ways. First, the stakeholders were invited to participate in public forums. Second, four work groups were convened to address each of the four priorities selected. A facilitator was identified for each group to lead the ongoing discussion and work to address strategies and action plans for each of the priorities. The following sectors were represented:- AMHC- UMFK Nursing Division- NMMC Director of Nursing- NMMC Pharmacist- Life by Design- Agency on Aging- NMMC Care Manager- Valley School Substance Abuse Counselor- UMFK Behavioral Health- U. Maine Cooperative Extension- NMMC Social Worker- NMMC NDPP Trainer PA - Hope & Justice- NMMC Financial Counselor- NMMC Practice Coordinator- NMMC Community Educator- Power of Prevention- FK High School Wellness- NMMC Psych Unit Leader- FK Recreation Director- UMFK Student- NMMC Communications- Catholic Charities- FK Community Development
Northern Maine Medical Center Part V, Section B, Line 6a: The following hospitals were included in the collaborative community health assessment: Cary Medical Center, Down East Community Hospital, Houlton Regional Hospital, Maine Coast Memorial Hospital, Mayo Regional Hospital, Millinocket Regional Hospital, Mount Desert Island Hospital, Northern Maine Medical Center, and Redington-Fairview General Hospital.
Northern Maine Medical Center Part V, Section B, Line 6b: Aroostook Mental Health Center - St. John Valley Public Schools - University of Maine, Fort Kent, Behavioral Health and Nursing Divisions - Fish River Rural Health Center - Healthy Maine Partnerships - University of Maine Cooperative Extension Service - Town Government and Recreation Departments - Life by Design Mental Health - Clergy - Aroostook Agency on Aging
Northern Maine Medical Center Part V, Section B, Line 7d: The St. John Valley assessment has been posted on the NMMC website since late 2014, as soon as it became available. The report is also available free upon request. Each year, thereafter, 2015-2016, 2016-2017, 2017-2018, an updated report was posted on the Northern Maine Medical Center website with instructions on how to access the updates. For the newest identified priorities for the start of the new cycle: 2017-2021, the same process will be used to keep the public apprised of the priorities and the actions. The hospital's Community Liaison Committee of the Board of Trustees is also provided a summary on an annual basis. In addition, contact information is provided on the website for individuals who wish to request a free paper copy. Individuals may also call NMMC to request a free copy.
Northern Maine Medical Center Part V, Section B, Line 11: The CHNA cycle completed in 2017 reported several successes related to the three priorities from the previous CHNA cycle of: substance abuse, healthy food and nutrition and cardiovascular health. With similar priorities, with the addition of a new priority in the area of mental health, requiring continued strategies for improvement, actions will be expanded based on need, community interaction and lessons learned. The NMMC Board of Trustee approved high level action plan has begun moving forward as follows:Priority #1 Physical Activity, Nutrition and Weight- Focus on gaps identified to provide physical activity opportunities and develop a plan to engage local students- Expand food insecurity assessments in order to identify and serve a greater portion of the population- Create a mechanism to better communicate available physical activity and nutrition programsPriority #2 Mental Health and Access- Create community partnerships to support the school age population dealing with mental illness- Promote public education through interagency collaboration- Develop a framework of agency resources- Utilize local university for grant writing resources- Create more opportunities to screen for mental illness- Develop community-wide speaker's bureauPriority #3 Substances and Alcohol Use (includes tobacco use)- Collaborate with the National Alliance on Mental Health for services not currently in place- Funnel community events through a central point to reach more of the public- Offer an annual retreat to convene community partners for brainstorming and strategic planning to address substance and alcohol usePriority #4 Cardiovascular Disease- Create a network of public education using multiple formats- Implement a collaborative tobacco cessation program- Implement a feasibility study for reintroducing cardiac rehabilitation- Promote heart health in conjunction with American Heart Association initiativesPriority #1 Physical Activity, Nutrition and Weight2018-2019 Actions1. Through an education outreach program at a hospital owned community retail pharmacy, monthly education is provided to the public, free of charge, on topics that included: selecting herbal and natural supplements 6/25/19, summer health and wellness 7/16/19, healthy holiday eating on 11/19/19, healthy eating and understanding food labels 12/17/19. 2. Community events were hosted to encourage physical activity at all age levels: Superhero 5K walk and run event and Summer Rally in the Valley mountain bike festival. 3. NMMC participated in Rumpus for Reading with the local elementary school. The event focused around physical activity to raise money for books. 4. An additional site (in St. Agatha, ME) was added to offer free Bone Builder classes. NMMC provided the instructor training and the weights (at no cost) for all participants. 5. Access to diabetes education classes was expanded using available technology to make it easier for more participants to attend the classes, removing the barrier of travel to attend classes. To support diabetes awareness, weekly diabetes education segments were posted on NMMC social media. Priority #2 Mental Health and Access2018-2019 Actions1. Through an education outreach program at a hospital owned community retail pharmacy, monthly education is provided to the public, free of charge, on topics that included mental health wellness.2. An NMMC mental health provider was the guest speaker at a hospital Guild meeting in March 2019 where she spoke on mental health wellness. 3. In June 2019, NMMC Psychiatrist, Dr. Mark Overton and Nurse Practitioner, Ryan Conley, taught a mental health class for the nursing students at the University of Maine at Fort Kent. 4. NMMC social workers hosted the annual Suicide Awareness Walk on 9/7/19. 5. In April of 2019, NMMC, along with community partners, launched the Yellow Tulip Project, community-wide. The event was covered by local media and will continue annually. The purpose of the project is to raise awareness for suicide prevention and to 'smash the stigma' of mental illness. 6. Mental health Nurse Practitioner, Melissa Stoliker, offered a free public presentation on Seasonal Affective Disorder in partnership with the University of Maine at Fort Kent Student Nurses Organization. Priority #3 Substances and Alcohol Use (includes tobacco use)2018-2019 Actions1. On March 11, 2019, Family Practitioner, Dr. Silwana Sidorczuk and Licensed Substance Abuse Counselor, Katia Sirois, were part of a guest panel at the University of Maine at Fort Kent. The topic for the free program to educate the public covered the topic of the opioid epidemic. 2. Through an education outreach program at a hospital owned community retail pharmacy, monthly education is provided to the public, free of charge, on topics that included opioid resources and tobacco cessation 7/23/19.3. NMMC partnered with the local schools to host a presentation for school aged children about the dangers of the opioid epidemic. 4. The head of Maine's opioid program, Gordon Smith, was a guest speaker on 9/9/19 when he spoke with the medical community on the status of the epidemic and strategies to stem the increasing epidemic.5. Medical student from the Frank Netter Medical School visited the Madawaska high school to speak with students on the dangers of vaping. 6. NMMC's Opioid Committee created a comprehensive booklet of resources for patients on the effects of opioids along with resources available in Aroostook County.7. NMMC partnered with the University of Maine at Fort Kent and the local mental health agency, AMHC, to host a recovery event to coincide with National Recovery Month in September 2019. The event was free to the public and included activities for individuals of all ages to attend the event. Priority #4 Cardiovascular Disease2018-2019 Actions1. On 1/5/19, Beat the Pack tobacco cessation classes were offered to the public free of charge. 2. Through an education outreach program at a hospital owned community retail pharmacy, monthly education is provided to the public, free of charge, on topics that included heart health and knowledge about how to identify one's risks in February 2019, free blood sugar screening during National Diabetes Month in November 2019.3. One of NMMC's ED physicians provided free Citizen CPR classes to the public in June 2019. The use of automated defibrillator devices was also included in the education. 4. NMMC clinical personnel had a presence at a health and safety fair held at the Madawaska high school. 5. In May of 2019, NMMC clinical staff and providers were provided training in tobacco intervention skills by Karina Alexander. 6. On 9/16, 9/18 and 9/30/19, NMMC Community Educator, Erin Pelletier and Family Practice provider, Dr. Silwana Sidorczuk launched the annual Tar Wars tobacco awareness program in all St. John Valley schools at the fifth-grade level. The program includes continues work in the classroom after the initial presentations and a poster project to follow which is recognized at the state of Maine level.7. Third year medical students from the Netter School of Medicine participated in a large health and wellness event geared toward school age children. The day-long program promoted fun with physical activity, facts about sugary drinks and the effects of tobacco. The program was held in partnership with the Student Nurses Organization of the University of Maine at Fort Kent. Other areas of need identified for the most recent CHNA cycle, besides the top four priorities listed above, will remain on the table to be addressed as resources become available. These are: cancer care, diabetes and elder health. In terms of cancer care, the data reported reduced cases. Related to diabetes, priority #1 indirectly addresses this area with the education and resources on healthy eating and physical activity. Lastly, elder health was not specifically listed, however, several of the physical activity and healthy eating initiatives do address the older population so although it was not selected as a top priority, it is being addressed on multiple fronts.
Northern Maine Medical Center Part V, Section B, Line 24: Individuals are billed at gross amounts and charges are adjusted accordingly, if they qualify for assistance.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
Page 9
Schedule H (Form 990) 2018
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2018
Page 10
Schedule H (Form 990) 2018
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 7: The amounts reported on Lines 7a & 7b were computed using a cost-to-charge ratio. Amounts on line 7g are derived from internal financial/cost accounting systems.
Part I, Line 7g: Subsidized health services on line 7g include physician clinics, rural health centers, a skilled nursing facility, and emergency room.
Part II, Community Building Activities: N/A
Part III, Line 4: In evaluating the collectibility of accounts receivable, the Medical Center analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for doubtful accounts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Medical Center analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for doubtful accounts, if necessary. For receivables associated with self-pay patients (which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Medical Center records a provision for doubtful accounts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts.
Part III, Line 9b: Our collection policy stipulates that NMMC makes reasonable efforts to identify those individuals that may qualify for assistance. In the first 120 days, patients may request to begin the Financial Assistance process and collection activity is put on hold until the process is completed. If the patient qualifies, no further collection activity will occur going forward for that account. If patient does not qualify, collection activity resumes from point it was put on hold.
Part VI, Line 2: Please see Schedule H, Part V, Section B, Line 5 for a description of NMMC's assessment process.
Part VI, Line 3: We notify patients and customers about access to assistance in various ways. The simplest way is the signage, pamphlets, and educational material located around the Organization and in various offices. In every patient access/patient financial services area is a sign explaining the availability of free/discounted care and the Federal Poverty Guidelines. There are also pamphlets located in the outpatient areas explaining free/discounted care and providing information on Mainecare. For inpatients, there is a book in each room which provides all the information on all programs available.Through the patient accounting department, we provide information aboutthese statements. We also counsel patients on the phone about all theprograms available whether it is Medicaid or a hospital program.
Part VI, Line 4: Northern Maine Medical Center is a 94 licensed bed (29 A&P which includes swing beds, 6 ICU beds, 14 Psych beds, and 45 SNF beds), full-service, acute-care, not-for profit hospital located in Fort Kent, Maine (Aroostook County). The Hospital is accredited by the joint commission and its mission is to serve its communities with excellence in health care. Its services include acute inpatient, psych inpatient, SNF, 24-hour emergency center, diagnostic, and surgical services. Along with these hospital services, the Hospital employs/contracts with the majority of primary and specialty care physicians in the area.
Part VI, Line 5: Northern Maine Medical Center is a local, not-for-profit hospital that serves its local communities and people regardless of their ability to pay. Northern Maine provides financial assistance and sliding scale discounts to self-pay and low-income patients. Also the Hospital participates in government-sponsored health care programs including Medicare, Medicaid, VA, and Tricare. The volunteer board of trustees sets the strategic direction for the Hospital and is comprised of community members from the Hospital's service area. This group is made up of local business owners, professionals, and retirees. Northern Maine's non-profit status allows the Hospital to reinvest any excess of revenues over expense back into the Hospital to continuously improve the medical care it delivers. The Hospital allows access to healthcare that would otherwise be difficult. The Hospital is the main employer for the local physicians, including specialty physicians that would otherwise have to be accessed out of the area.
Schedule H (Form 990) 2018
Additional Data


Software ID:  
Software Version: