TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) C PATRICK MICHAUD Treasurer	.50	X	X	0	0
(2) JOHN DALTON President & CEO	40.00	X	X	301,691	73,156
(3) ROSEMARY WINSLOW Board Member	.50	X		0	0
(4) SUZANNE UHL-MELANSON Board Member	.50	X		0	0
(5) MICHAEL F PHILLIPS JR ESQ Vice Chair	.50	X	X	0	0
(6) DONALD PLOURDE Secretary	.50	X	X	0	0
(7) CATHERINE KIMBALL DO Board Member	.50	X		0	0
(8) DAVID GLENN-LEWIN PhD Board Member	.50	X		0	0
(9) BRIAN GILLIS DO Board Member	.50	X		0	0
(10) CHARLES R GAUNCE Board Member	.50	X		0	0
(11) JOHN M FORTIER Chair	.50	X	X	0	0
(12) THOMAS DAVIS Board Member	.50	X		0	0
(13) LINDA FAY MD Board Member	40.00	X		246,729	15,819
(14) KATHY COREY Board Member	.50	X		0	0
(15) CLARENCE BICKFORD JR Board Member	.50	X		0	0
(16) VAUGHN M COLLETT MD Board Member	40.00	X		242,556	8,497
(17) EE COMP IS FOR ADMIN SVCS NOT BRD RESPONS	0.00	X		0	0

(A) Name and business address	(B) Description of services	(C) Compensation
SHELLEY FALIK PO Box 40 Marion,IL62959	Physician Services	400,153
GEORGE WELCH MD 60 CARROLL ST FALMOUTH,ME04105	Physician Services	425,125
NURSE ANESTHESIA OF MAINE 141 N MAIN ST STE 205 BREWER,ME04412	Professional CRNAs	584,500
NEHE MRI LLC PO Box 6600 Newport Beach,CA92658	Service Contract	615,576
MEDICAL DOCTOR ASSOCIATES INC PO Box 277185 Atlanta,GA303847185	Physician Services	446,079
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 19

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,875,875	1,044,702	831,173
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	34,676,430	31,233,947	3,442,483
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	782,284	611,346	170,938
9	Other employee benefits .......	4,158,975	3,760,866	398,109
10	Payroll taxes ...........	2,189,806	1,932,402	257,404
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	60,844		60,844
c	Accounting ...........	37,086		37,086
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	33,701	26,961	6,740
g	Other ..........	6,470,969	4,599,443	1,871,526
12	Advertising and promotion ....	319,345	2,731	316,614
13	Office expenses .......	1,925,329	1,313,667	611,662
14	Information technology ......	605,955	324,605	281,350
15	Royalties ..	0
16	Occupancy ...........	2,102,381	1,687,742	414,639
17	Travel ............	105,394	66,122	39,272
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	217,411	115,699	101,712
20	Interest ...........	474,564	379,651	94,913
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	2,397,712	1,922,935	474,777
23	Insurance ..............	1,299,397	848,600	450,797
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	Charity Care	2,938,858	2,938,858
b	Provision for uncollectible ac	3,824,593	3,824,593
c	Medical Supplies	5,909,167	5,902,272	6,895
d	Contractual Allowances	45,265,088	45,265,088
e
f	All other expenses	3,329,183	2,278,251	1,050,932
25	Total functional expenses. Add lines 1 through 24f	121,000,347	110,080,481	10,919,866	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	16,089	1	16,179
2	Savings and temporary cash investments .......	1,668,704	2	1,437,674
3	Pledges and grants receivable, net .........	8,140	3	0
4	Accounts receivable, net .........	16,306,172	4	20,275,921
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	21,204	5	95,810
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6	0
7	Notes and loans receivable, net .............	706,620	7	301,579
8	Inventories for sale or use ..............	702,084	8	601,581
9	Prepaid expenses and deferred charges ............	1,288,173	9	818,448
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	37,292,772
b	Less: accumulated depreciation. .....	10b	20,149,809	17,521,196	10c	17,142,963
11	Investments—publicly traded securities ..........		11	0
12	Investments—other securities. See Part IV, line 11 ......		12	0
13	Investments—program-related. See Part IV, line 11 ..		13	0
14	Intangible assets .........	12,311	14	1,304
15	Other assets. See Part IV, line 11 ...........	9,422,491	15	13,046,821
16	Total assets. Add lines 1 through 15 (must equal line 34)...	47,673,184	16	53,738,280
	17	Accounts payable and accrued expenses .	10,612,906	17	12,982,896
18	Grants payable ..........		18
19	Deferred revenue ..........		19	1,886
20	Tax-exempt bond liabilities ..........	4,847,183	20	4,353,489
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	6,161,933	23	6,400,813
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	2,210,895	25	4,241,225
26	Total liabilities. Add lines 17 through 25.....	23,832,917	26	27,980,309
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	22,880,411	27	23,706,280
28	Temporarily restricted net assets .....	356,500	28	1,384,495
29	Permanently restricted net assets .....	603,356	29	667,196
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	23,840,267	33	25,757,971
34	Total liabilities and net assets/fund balances .....	47,673,184	34	53,738,280

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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

INLAND HOSPITAL

Employer identification number

01-0217211

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

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Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

INLAND HOSPITAL

Employer identification number

01-0217211

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization INLAND HOSPITAL
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization INLAND HOSPITAL
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
INLAND HOSPITAL

Employer identification number

01-0217211

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

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SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

INLAND HOSPITAL

Employer identification number

01-0217211

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

9,054

Total. Add lines 1c through 1i ...............................

9,054

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Part II-B, Line 1i	Part II-B, Line 1i - Other Activities Description	Non-deductible portion of dues

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

INLAND HOSPITAL

Employer identification number

01-0217211

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back
1a	Beginning of year balance ....	226,072	147,236
b	Contributions ........	15,810	89,440	133,788
c	Net investment earnings, gains, and losses ...	38,174	-7,087	13,448
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	6,597	3,517
f	Administrative expenses ....
g	End of year balance ......	273,459	226,072	147,236

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

23.000 %

Permanent endowment SchDMd Bullet

77.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	83,162		83,162
b	Buildings ................	16,757,961	9,247,753	7,510,208
c	Leasehold improvements ............	1,427,896	154,797	1,273,099
d	Equipment ................	17,028,886	10,297,848	6,731,038
e	Other .................	1,994,867	449,411	1,545,456
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				17,142,963

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Temporarily Donor Restricted Funds				204,073
(2) Self Insurance and Other Funds				1,766,516
(3) Permanently Donor Restricted Funds				5,000
(4) Interest in net assets held at EMHSF				1,365,031
(5) Estimated Prof. Liab. Claims Receivable				1,851,113
(6) Board Designated Other				1,433,922
(7) Board Designated Funded Depreciation				5,656,115
(8) Beneficial Interest in Perpetual Trusts				477,587
(9) Assets Held Under Trust Indenture				287,464
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				13,046,821

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes
Reserve for Prof. Liab. Self Ins.		1,851,113
Reserve for Asset Disposal Costs		102,636
Liability Under Cap Lease Obligation		348,684
Deferred Compensation		1,938,792





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		4,241,225
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
Part X	Part X : FIN48 Footnote	EMHS, its hospitals, and certain other affiliates have been determined by the Internal Revenue Service to be tax-exempt charitable organizations as described in Section 501(c)(3) or 501(c)(2) of the Internal Revenue Code ("Code") and, accordingly, are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Accordingly, no provision for federal income taxes has been recorded in the accompanying consolidated financial statements for these organizations.Tax-exempt charitable 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 to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The System has evaluated its tax position taken or expected to be taken on income tax returns and concluded the impact to be not material.Certain of the System's affiliates are taxable entities. Deferred taxes related to these entities are based on the difference between the financial statement and tax basis of assets and liabilities using enacted tax rates in effect in the years the differences are expected to reverse. The deferred tax assets and liabilities for these entities are not material.
Part XI, Line 8	Part XI, Line 8: Other Changes in Net Assets or Fund Balances	Change in interest in net assets held @ EMHSF $1015023 Transfer from exempt subsidiary-EMHSF $2177 Contribution to Strategic Planning Pool per Affiliation Agre $ -108864
Part V, Line 4	Part V, Line 4: Intended uses of the endowment fund.	Endowment funds are designated for purposes that align within the organization's exempt purpose.

Schedule D (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

INLAND HOSPITAL

Employer identification number

01-0217211

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria 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, to determine eligibility for free or discounted care.

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"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

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?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(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) ..		871	1,657,883		1,657,883	2.400 %
b Medicaid (from Worksheet 3, column a) .....		17,861	13,532,151	11,434,310	2,097,841	3.040 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .			1,253,777		1,253,777	1.820 %
dTotal Financial Assistance and Means-Tested Government Programs .....		18,732	16,443,811	11,434,310	5,009,501	7.260 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	11	40,843	281,089		281,089	0.410 %
f Health professions education (from Worksheet 5) ..
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	1		4,115		4,115	0.010 %
jTotal Other Benefits ...	12	40,843	285,204		285,204	0.420 %
kTotal. Add lines 7d and 7j. ..	12	59,575	16,729,015	11,434,310	5,294,705	7.680 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

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	1	2,100	3,410	803	2,607
3	Community support	1	5,500	73,550		73,550	0.110 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	1,423	5,218		5,218	0.010 %
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	3	9,023	82,178	803	81,375	0.120 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

2,091,801

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

18,188,561

Enter Medicare allowable costs of care relating to payments on line 5.....

21,760,339

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-3,571,778

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

Yes

Part IV

Management Companies and Joint Ventures

(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) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
0	Inland Hospital 200 Kennedy Memorial Drive Waterville,ME04901	X	X	X

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Inland Hospital

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1	Yes
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3	Yes
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4	Yes
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5	Yes
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7		No
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.0000% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10		No
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: % If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	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 actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	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	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and 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?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. 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?20
Name and address		Type of Facility (describe)
1	Inland Family Practice Assoc 80 Waterville Commons Drive Waterville,ME04901	Medical Office Building - Physician Service
2	Inland Orthopedics 325D Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
3	Inland Medical Associates 180 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
4	New Horizons Family Medicine Associates 10 Washington Street Waterville,ME04901	Medical Office Building - Physician Service
5	Inland Rheumatology 246 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
6	Inland Medical Associates 180 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
7	Waterville Surgical Associates 180 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
8	New Horizons Osteopathic 180 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
9	Inland Medical Associates 174 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
10	Inland Medical Associates 180 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
11	Inland Family Care - Fairfield 121 Main Street Fairfield,ME04937	Medical Office Building - Physician Service
12	Inland Womens Healthcare 395E Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
13	Inland Family Care 264 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
14	Heart First Cardiology Assoc 244 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
15	Inland Womens Healthcare 180 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
16	New Horizons Waterville 180 Kennedy Memorial Drive Waterville,ME04901	Medical Office Building - Physician Service
17	New Horizons North Anson RHC 167 Main Street North Anson,ME04958	Medical Office Building - Physician Service
18	Inland Family Care 74 Water Street Oakland,ME04963	Medical Office Building - Physician Service
19	Inland Family Care - Unity 80 Main Street Unity,ME04988	Medical Office Building - Physician Service
20	New Horizons Madison RHC 344 Lakewood Road Skowhegan,ME04976	Medical Office Building - Physician Service

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments 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.

Identifier	ReturnReference	Explanation
	Part VI - Additional Information	Part II, line 4 - Community Building ActivitiesInland Hospital gets involved and gives back to improve quality of life in Greater Waterville its how we help fulfill our community service mission to care for and serve our community. Whether its sponsoring scholarships to the local colleges, supporting physical activity and nutrition initiatives in our local schools, funding local public transportation, or supporting a cultural or economic development effort, Inland is proud to support and collaborate with groups that foster health and well-being. Our Community Benefit program contributes $50,000+ locally each year towards community-building organziations and initaitives. In addition, we offer regular free health screenings to the public through our numerous health events and community collaborations, professional and community education, and other events with the Chamber of Commerce and Downtown Main Street programs.
	Part V - Explanation of Number of Facility Type	N/A
	Part VI - States Where Community Benefit Report Filed	ME
	Part VI - Affilated Health Care System Roles and Promotion	Inland has been a proud member of EMHS (Eastern Maine Healthcare Systems) since 1998. EMHS is a system of hospitals, physician's practices, extended care facilities, clinics, home health experts and other healthcare services made up of 8,000 dedicated professionals in central, northern and eastern Maine. This integrated relationship benefits our community by bringing specialty services to Inland and connecting patients to advanced care when needed at Eastern Maine Medical Center, our system's tertiary hospital in Bangor. In addition, membership in EMHS offers Inland improved efficiencies through access to resources, best practices, quality initiatives, and purchasing power.
	Part VI - Explanation Of How Organization Furthers Its Exempt Purpose	At Inland we strive to live up to our non-profit mission every day by caring for community members who otherwise would have limited access to quality healthcare. Besides providing charity care and financial assistance, we believe we can also affect the health of the communities we serve beyond care inside our hospital. We agree with the World Health Organization which states, Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. We have a vision to be a responsible corporate citizen whose actions can impact our communitys overall well-being through commitments to:improving access to primary care, especially for the medically underserved/needysupporting, providing and advocating for health education and promotion, and disease prevention especially for identified chronic conditions (such as diabetes and heart disease); malnutrition and obesity; and pneumonia care.collaborating with and supporting other organizations that share missions parallel to ours and are pursuing quality of life (community-building, economic, educational, civic, cultural) or healthy community initiatives. Inland created a Community Benefit program in 2007 with these main goals in mind:Serve documented community needs and deliver measurable results that will improve health and wellness;Demonstrate our commitment to charitable endeavors and community support through responsible stewardship of hospital resources;Provide a systematic approach to philanthropy and community health improvement; to link our charitable giving and partnerships with community needs and our mission of service;Document our benefit to the community and to be accountable to the public we serve.We dedicate at least $50,000 annually for Community Benefit projects in our community. From support of school programs to combat obesity, to funding local public transportation and events that promote physical activity, or contributing to the local Opera House and colleges - our Community Benefit Program contributes to improving the health and wellness of our community in many ways. We accept applications to fund community-building initiatives that can be health & wellness related, educational, cultural, economic and beyond.Our Community Benefit Program Advisory Group oversees the community applications process. The group is a multi-disciplinary team of clinical and administrative professionals from the hospital, and community members, including hospital trustees and volunteers. The advisory group provides guidance, reviews requests for donations/support, makes recommendations to Inlands Administrative Staff and Board of Trustees, and evaluates the effectiveness of our Community Benefit Program. Inland's Community Outreach efforts include the "World of Womens Wellness", the hospitals annual health fair for women. 600 women attended the 16th Annual event in 2012 and received 2400+ free health screenings including, blood pressure, cholesterol, blood glucose, bone density, and breast exams. In an effort to combat the childhood obesity epidemic, in 2012 we established a new year-long program to reach families with children to encourage active lifestyles and healthier eating. Our new "Let's Go! Family Fun Series" offers activities each month to engage families with children to be physically active and eat healthier through free and low cost resources and activites such as hiking, swimming, and ice skating. We continue to maintain the Inland Woods Trail on the hospital campus (developed in 2010). The trails were developed to create a lasting way to impact health, and give residents an easy, free resource for regular activity. The trails are used regularly by residents, hospital staff, and local schools for walking, biking, and snowshoeing. The Inland Hospital Foundation helps by raising funds for everything from capital expansion projects to residential activities to help offset normal operating expenses.Inland Hospital invites men, women, and young adults to volunteer their time to further the hospital's mission. In 2012, volunteers from our community donated 15,700 hours of thier time to Inland and Lakewood, our continuing care center. Some volunteers work in areas with direct contact with patients and families; others are involved in "behind the scenes" activities which enhance the care provided by the hospital.
	Part VI - Community Building Activities	Inland Hospital gets involved and gives back to improve quality of life in Greater Waterville its how we help fulfill our community service mission to care for and serve our community. Whether its sponsoring scholarships to the local colleges, supporting physical activity and nutrition initiatives in our local schools, funding local public transportation, or supporting a cultural or economic development effort, Inland is proud to support and collaborate with groups that foster health and well-being. Our Community Benefit program contributes $50,000+ locally each year towards community-building organziations and initaitives. In addition, we offer regular free health screenings to the public through our numerous health events and community collaborations, professional and community education, and other events with the Chamber of Commerce and Downtown Main Street programs.
	Part VI - Community Information	Inland Hospital is a not-for-profit, community hospital located in Waterville, Maine with a mission to care for and serve our community. We serve 74,000 residents of Kennebec County and Somerset County. We are a 48-bed medical-surgical facility, with Lakewood, our 105-bed continuing care facility on the hospital campus, along with 18 primary and specialty care physician practices in Waterville and surrounding communities (N.Anson, Fairfield, Unity, Oakland, Madison). We also offer our primary care patients a Weekend Care Clinic to help them avoid unnecessary, costly emergency room visits. According to the Maine State Planning Office, the population for the Waterville Hospital Service Area in 2010 was 74,869, with 15.2% over the age of 65, compared to the national percentage of 12.9%. The February 2013 unemployment rate for the Waterville Labor Area was 8.6% (above the state rate of 7.3%.) The median household income in Somerset County is $37,000 and $46,000 in Kennebec County (compared to state average of $47,000.) 18.5% of people in Somerset County live below the poverty level, 12.2% in Kennebec County (compared to the state average of 12.8%.) 45.9% of school children in Kennebec County received free or reduced lunches (compared to the state average of 45.1%). Of those surveyed for our most recent Community Health Needs Assessment (hereafter referred to as CHNA) conducted in 2010 (published in 2011), 15% in Kennebec County and 17% in Somerset County classified their health status as "fair to poor." A higher percentage of our local population suffers from three or more chronic conditions (15%) compared to the rest of the state (13%). Prevalence of adult obesity is higher in Kennebec County (31%) than in Somerset and the state overall (both 28%) with childhood obesity (grades 9-12) at 12% for Kennebec County and 14% in Somerset County. Related chronic diseases such as diabetes are higher than state averages in both counties. Additionally, the diabetes mortality rate in this area (Maine CDCs Central District) is significantly higher (31-33 per 100,000 population) than in the state overall (26 per 100,000). Emergency department visits per 100,000 population in Somerset County were very high (78,252) compared to Kennebec (54,082) and the state rate of 47,665.
	Part VI - Patient Education of Eligibility for Assistance	At Inland Hospital, Patient Account Representatives are available to assist and answer any questions our patients may have regarding free care. Additional interactive strategies are in places that include billing statements that have free care information added for the patient's convenience, providing all uninsured patients with free care packets at point of registration. When a patient states that they are under-insured free care information is provided. For any other patient requests we receive (via emails and phone calls) packets are mailed. All patient accessible areas, such as hospital waiting areas, contain information to direct patients on how to receive financial assistance. Additionally, Inland Hospital provides online resources and tools to assist our patients with the necessary information regarding charity/free care via www.inlandhospital.org. It is the policy of Inland Hospital to treat all patients requiring care without regard for ability to pay and to assist patients in arranging for settlement of their financial obligation. Under this program, medically necessary services will be provided to Maine residents at no cost. If a patient does not qualify for free hospital care, he or she is entitled to ask for a fair hearing.
	Part VI - Needs Assessment	In 2010, One Maine Health, a collaborative of EMHS (Inland's parent company), MaineHealth, and MaineGeneral, commissioned the University of New Englands Center for Health Planning and Policy Research and the Muskie School at the University of Southern Maine to conduct a state-wide Community Health Needs Assessment. The study was conducted to identify the most important health issues in the state and by county, using a scientific method to validate health indicators and to compare results. The assessment identifies priority health issues, which will be best addressed by health providers working collaboratively.Dozens of health and social services professionals, business and government leaders, and concerned citizens gathered in Waterville on August 30, 2011 for a community forum to learn about the priority health issues in Kennebec and Somerset Counties and steps needed to effectively address them. The Community Relations Department conducts a comprehensive review of current programs and projects, as well as prospective projects for consideration as community benefit initiatives. Inland is committed to utilizing evidence-based health and wellness strategies, many of which are outlined in the Center for Disease Controls Report on Community Health Education and Prevention.
Number of Hospital Faciltiy - 0	Part V, Line 19d - Other Billing Determination of Individuals Without Insurance	Hospital charges are discounted at 100% for the patients who qualify for Free Care with income at or below the 200% FPL.
Number of Hospital Faciltiy - 0	Part V, Line 13g - Other Means Hospital Facility Publicized the Policy	Signs and individual notices are posted in key public waiting areas in the hospital and on the website regarding information pertaining to Free Care. These notices inform the patient of the availability of Free Care including the eligibility criteria and instructions on how to apply, obtain additional information or assistance.
Number of Hospital Faciltiy - 0	Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why	Because Inland Hospital has a limited budget and resources, we realize we cannot effectively focus on every health issue raised in the CHNA, and there is no need to duplicate certain services in a community our size. The key areas we have identified that we will not focus on include:-Substance abuse - Because the other hospital and service agencies in our community provide services, our focus will be limited to continued work to enforce our controlled substance prescribing policy, participate in community events that promote proper prescription drug disposal, and work within our health system to establish a multi-disciplinary pain clinic.-Cancer care - Because the other hospital in our community - MaineGeneral and our EMHS partner, EMMC/Cancer Care of Maine, provide adequate services.
Number of Hospital Faciltiy - 0	Part V, Line 6i - Describe Other Needs Identified	6a) ADOPTON OF IMPLEMENTATION STRATEGY:As part of its response to the 2010 CHNA (released in August 2011), Inland formed a Community Health Improvement Task Force to further analyze the CHNA and local needs, research local data, health plans and recommended strategies, inventory current initiatives and service gaps and then create Inland's Community Health Improvement Plan. The Task Force finalized the plan in March, 2013. 6b) EXECUTION OF IMPLEMENTATION STRATEGY:Inland's Community Health Improvement Plan describes Priority Issues, with Goals, Strategies and Tactics around each issue. Priority Issues include: Access to Care; Obesity Prevention; Chronic Disease Management; Women's Health, and Cardiovascular Health. Several of our major initiatives/efforts in 2012 included: -Integrating mental health services into our primary care offices through a partnership with Kennebec Behavioral Health. In addition, we are utilizing Tele-psychiatry services in our emergency department through a partnership with our EMHS sister affiliate and mental health hospital, Acadia Hospital. -Expanding hours for non-emergent care in our primary care practices. -Implementing "Let's Go! 5210", a childhood obesity prevention program in all our primary care practices that see pediatric patients, and in local schools with grants from our Community Benefit Program.-Establishing a new community outreach effort called the "Let's Go! Family Fun Series" which is designed to help families with children adopt more active lifestyles and eat healthier.-Growing attendance at our annual women's health fair. In 2012, 600 women attended the free event where 2400 free health screenings were provided.-Growing our "Care Management" model of care in our family practices - initially focused on Medicare patients with chronic disease. Better care coordination across all continuums of care and a strengthened partnership with the patient is expected to improve the health of patients with chronic disease, (ie helping them avoid Emergency Department visits and other costly healthcare options, as well as connecting them to valuable community resources for support.)-Implementing National Diabetes Prevention Program, currently targeting employees and family members.-Development of an online Patient Portal for our primary care patients. The Portal allows patients to contact their provider online for non-urgent healthcare questions, appointment scheduling, and request prescription refills and tests results.6c & 6d) PARTICIPATION IN DEVELOPMENT and EXECUTION OF COMMUNITY-WIDE COMMUNITY BENEFIT PLAN: In 2007, Inland established a Community Benefit Program which contributes funds and provides volunteers for local health, economic, education, transportation and other community-building initiatives. Inland's Community Benefit Advisory Group is a multi-disciplinary team of clinical and administrative professionals from the hospital and community members, including hospital trustees and volunteers. The Advisory Group provides guidance, reviews requests for donations/support, makes recommendations to Inland's Administrative Staff and Board of Trustees, and evaluates the effectiveness of our Community Benefit Program. In 2012, Inland contributed more than $70,000 through our Community Benefit program to local organizations to improve the overall health of the Greater Waterville area. In addition, in 2012 nearly 150 Inland staff members volunteered time to serve on more than 25 local boards, work groups and committees that are working to improve health and overall quality of life in our community.Inland continues to collaborate with these key community organizations:Alfond Youth Center, Family Violence Project, Friends of Quarry Road Recreation Area, Youth Matter, Healthy Northern Kennebec (our local Healthy Maine Partnership, Kennebec Behavioral Health, Kennebec Messalonskee Trails, Kennebec Valley Community Action Program (KVCAP, Kennebec Valley Dental Coalition, Kiwanis Club, Local schools and colleges in Waterville and the other surrounding communities we serve, Maine CDC, Maine Children's Home, MaineGeneral Health, Mid-Maine Homeless Shelter,Move More, Rotary Club of Waterville, Spectrum Generations, United Way of Mid-Maine, Waterville Area Hospice Volunteers, Waterville Parks & Recreation6e) INCLUSION OF A COMMUNITY BENEFIT SECTION IN OPERATIONAL PLANS:Inland's operations are built and managed around six Pillars of Excellence, one being "Community", so Community Health is an integral part of our day-to-day work. We include funding each year in our Community Relations department budget to provide free health screenings, health fairs, wellness talks and educational activities such as healthy cooking classes and exercise programs. In addition, we fund a full-time Community Wellness Coordinator on staff.Besides our community wellness/outreach efforts, in 2007 we established a Community Benefit Program that contributes funds and provides Inland volunteers for local health, educational, economic, transportation and other community-building efforts. Our Strategic Plan notes several key strategies regarding Community Health including:-Utilize the 2010 Community Health Needs Assessment (CHNA) to identify, prioritize and implement Inland's health improvement initiatives.-Continue to invest in local health initiatives and community building activities through our Community Benefit grant program.In addition, Inland is committed to offer free care and financial assistance programs to those in need. We promote these programs at patient registration, in the emergency department, in waiting areas, in patient bills, and on our website.6f) ADOPTION OF A BUDGET FOR PROVISION OF SERVICES:Community Health efforts are funded through the Community Relations annual budget.6g) PRIORITIZATION OF HEALTH NEEDS: Priority Health Issues Identified in the 2010 CHNA include:-Access to Healthcare (Emergency Department utilization)-Primary Care Quality and Effectiveness (Ambulatory Care sensitive admissions)-Behavioral Risk Factors - Cardiovascular Health (smoking, obesity, sedentary life style)-Medical Risk Factors - Cardiovascular Health (high blood pressure, cholesterol)-Respiratory Health (smoking, asthma, COPD)-Diabetes (prevalence and care management)-Cancer Health (incidence, mortality, especially lung)-Mental Health (risk, incidence, co-morbidity)-Substance Abuse (alcohol, illicit and non-prescription drugs)-Youth Health / Risk Behaviors (depression, obesity, alcohol)-Oral Health (low ratio of providers to population)Inland's Community Health Improvement Plan focuses on five specific Priority Issues, with Goals, Strategies and Tactics attached to each issue. Priority Issues include: -Access to Care-Obesity Prevention -Chronic Disease Management -Women's Health-Cardiovascular Health 6h) PRIORITIZATON OF SERVICES INLAND WILL TAKE TO MEET HEALTH NEEDS:-Improve access to primary care through expanded hours and weekend care-Enhance Diabetes care using national standards-Increase use of Care Management model to help more patients with chronic disease-Broaden community outreach efforts focused on obesity prevention
Number of Hospital Faciltiy - 0	Part V, Line 5c - Description of Making Needs Assessment Widely Available	In conjunction with EMHS, Inland Hospital and OneMaine Health Collaborative partners hosted a Community Forum in Waterville in August 2011 to present an overview of local CHNA results and recommendations. Invitees included:Other area hospitals; Physician leaders; Federally Qualified Health Centers; Healthy Maine Partnerships; District Liaisons linked to Maine CDC; Home Health and Long Term Care leaders; Social Service AgenciesLeaders of the tribal communities; Business leaders; Legislative leaders; Representatives of the State administrationAttendees were provided an executive summary of the CHNA as well as a summary table of data reflective of the service area. A presentation was made by EMHS staff (who were members of the assessment development steering committee.) They provided selected data results, trends over time and the priorities and recommendations as suggested by the research consultants.After the Forum, the entire statewide CHNA (both narrative and data sets) were posted to the EMHS website (www.emh.org). The CHNA and county specific data were also posted on the Inland Hospital website (www.inlandhospital.org). After the Community Forums, Power Point presentations used at the Forums as well as input collected in the breakout sessions were also posted on the EMHS website. Forum participants were encouraged to go online to review the CHNA in detail, and access the data for local planning. Instructions on the EMHS website assist viewers to download and /or print sections of the report. Individuals without computer or printer access were provided a phone number to request a printed assessment. Media releases were also sent to local news outlets in combination with the forums encouraging new articles on the forum and inviting all members of the public to view the report online.Inland also shared the CHNA results with our key community collaborators who were not in attendance at the Community Forum (see Section 6c).
Number of Hospital Faciltiy - 0	Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment	Our community health needs assessment (CHNA) was developed by a statewide collaborative called the OneMaine Health Collaborative which includes the state's three largest health systems: EMHS (Inland's parent organization) in central, eastern and northern Maine, MaineGeneral Health in central Maine and Maine Health in southern Maine.
Number of Hospital Faciltiy - 0	Part V, Line 3 - Account Input from Person Who Represent the Community	On a statewide basis, the research consultants developing the CHNA created an advisory committee that met two times during the CHNA research and drafting of the tool. These individuals represented a broad spectrum of backgrounds:Carol Bell, Healthy Maine Partnership DirectorKelly Bentley, Healthy Maine Partnership DirectorGail Dana-Sacco, Wabanaki Center (serving tribal populations)Patricia Hart, Maine Development FoundationBarbara Leonard, MPH, Maine Health Access Foundation (philanthropic foundation focused on access to care in Maine)Becca Matusovich, Maine Center for Disease ControlLisa Miller, Bingham Foundation (philanthropic foundation)Dora Ann Mills, MD, Maine Center for Disease ControlElizabeth Mitchell, Maine Health Management Coalition (representing the state's major employers, insurers and providers)Trish Riley, Governor's Office of Health Policy and Finance (GOHPF)Brian Rines, Advisory Committee for Health System Development (overseen by GOHPF)Rachel Talbot-Ross, Maine Chapter, NAACPTed Trainer, Public Health Coordinating Council Shawn Yardley, City of Bangor, Department of Health and WelfareOthers who contributed to the development of the CHNA tool included:Maine Health Access Foundation - Wendy Wolf, MD, President and Barbara Leonard, MPH, Vice PresidentPublic Health Infrastructure: Shawn Yardley, City of Bangor, Department of Health and WelfareRural populations: State CDC and rural Healthy Maine Partnership representatives - Dora Mills, MD, and Carol BellNative American: Wabanaki Center - Gail Dana-SaccoLocally, multiple parties were engaged in dissemination of the assessment findings and establishment of priorities (see Section 5).
Number of Hospital Faciltiy - 0	Part V, Line 1j - Description of Other Needs Assessment	1a) DEFINITION OF COMMUNITY SERVED: Inland Hospital in Waterville, Maine primarily serves approximately 74,000 residents in parts of Kennebec and Somerset counties. 1b) COMMUNITY DEMOGRAPHICS: According to the Maine State Planning Office, the population for the Waterville Hospital Service Area in 2010 was 74,869, with 15.2% over the age of 65, compared to the national percentage of 12.9%. The February 2013 unemployment rate for the Waterville Labor Area was 8.6% (above the state rate of 7.3%.) The median household income in Somerset County is $37,000 and $46,000 in Kennebec County (compared to state average of $47,000.) 18.5% of people in Somerset County live below the poverty level, 12.2% in Kennebec County (compared to the state average of 12.8%.) 45.9% of school children in Kennebec County received free or reduced lunches (compared to the state average of 45.1%). Of those surveyed for our most recent Community Health Needs Assessment (hereafter referred to as CHNA) in 2010, 15% in Kennebec County and 17% in Somerset County classified their health status as fair to poor. A higher percentage of our local population suffers from three or more chronic conditions (15%) compared to the rest of the state (13%). Prevalence of adult obesity is higher in Kennebec County (31%) than in Somerset and the state overall (both 28%) with childhood obesity (grades 9-12) at 12% for Kennebec County and 14% in Somerset County. Related chronic diseases such as diabetes are higher than state averages in both counties. Additionally, the diabetes mortality rate in this area (Maine CDC's Central District) is significantly higher (31-33 per 100,000 population) than in the state overall (26 per 100,000). Emergency department visits per 100,000 population in Somerset County were very high (78,252) compared to Kennebec (54,082) and the state rate of 47,665.1c) HEALTH FACILITIES AND RESOURCES AVAILABLE TO MEET HEALTH NEEDS:Eastern Maine Medical Center, Family Violence Project, Youth matter (formerly Greater Waterville Communities for Children & Youth), Healthy Northern Kennebec (our local Healthy Maine Partnership), Inland Hospital/EMHS, Kennebec Behavioral Health, Kennebec Valley Community Action Program (KVCAP), Kennebec Valley Dental Coalition, Maine CDC, MaineGeneral Health, Mid-Maine Homeless Shelter, Spectrum Generations, United Way of Mid-Maine.1d) HOW DATA WAS OBTAINED: EMHS, the parent organization of Inland Hospital, routinely conducts a CHNA across the service area of all of its member hospitals. The most recent CHNA conducted in 2010 was commissioned by the OneMaine Health Collaborative (which includes EMHS, MaineGeneral Health and Maine Health) and published in 2011. The CHNA was conducted under a contract with the University of New England Center for Health Planning, Policy and Research (CHPPR) and the University of Southern Maine's Muskie School for Public Health. Using a methodology developed by CHPPR over decades of work, the CHNA integrates primary data from a telephone survey to heads of households with secondary data retrieved from state databases (Emergency department usage, Mortality, Cancer Registry, etc.). That data is reviewed in the context of multiple health related domains to develop a composite view of health status, behavioral risks, and barriers to access and care. Results are compared to national and state benchmarks to produce priorities and recommendations as prepared by the consultants.1e & 1f) HEALTH NEEDS OF THE COMMUNITY FROM THE 2011 CHNA:CHNA Key Findings for Kennebec and Somerset Counties Included: -Emergency Department use rates are higher than the state and hospitalization rates for many conditions are declining.-Incidence of both obesity and tobacco related diseases are increasing - Diabetes, Heart Disease, Lung Diseases and Cancers.-Prescription drug addiction is an epidemic impacting infants, young families and the community at large.-Admissions rates for mental health and substance abuse disorders continue to be high.-Both Kennebec and Somerset have high rates of mental health disorders.Priority Health Issues Included:-Access to Healthcare (Emergency Department utilization)-Primary Care Quality and Effectiveness (Ambulatory Care sensitive admissions)-Behavioral Risk Factors - Cardiovascular Health (smoking, obesity, sedentary life style)-Medical Risk Factors - Cardiovascular Health (high blood pressure, cholesterol)-Respiratory Health (smoking, asthma, COPD)-Diabetes (prevalence and care management)-Cancer Health (incidence, mortality, especially lung)-Mental Health (risk, incidence, co-morbidity)-Substance Abuse (alcohol, illicit and non-prescription drugs)-Youth Health/Risk Behaviors (depression, obesity, alcohol)-Oral Health (low ratio of providers to population)1g) PROCESS FOR IDENTIFYING & PRIORITIZING HEALTH NEEDS AND SERVICES:In conjunction with EMHS, Inland Hospital and OneMaine Health Collaborative partners hosted a Community Forum in Waterville in August 2011 to present an overview of local CHNA results and recommendations. Invitees included: Other area hospitals, Federally Qualified Health Centers, Physician leaders, Healthy Maine Partnerships, District Liaisons linked to Maine CDC, Home Health and Long Term Care leaders, Social Service Agencies, Leaders of the tribal communities, Business leaders, Legislative leaders, Representatives of the State administration.Attendees were provided an executive summary of the CHNA as well as a summary table of data reflective of the service area. A presentation was made by EMHS staff (who were members of the assessment development steering committee.) They provided selected data results, trends over time and the priorities and recommendations as suggested by the research consultants.As part of its response to the 2010 CHNA (released in our area in August 2011), Inland formed a Community Health Plan Task Force to further analyze the CHNA and local needs, research local data, health plans and recommended strategies, inventory current initiatives and service gaps and then create Inland's Implementation Strategy for a Community Health Plan. In 2012, EMHS and members including Inland together established a Community Health Task Force to inventory local community health priorities across the EMHS territory. The Task Force will develop plans, recruit collaborators and implement initiatives focused on identified priorities. Childhood Obesity has been identified as the first priority.1h) PROCESS FOR CONSULTING WITH PERSONS REPRESENTING THE COMMUNITY'S NEEDS: After the formal presentation of the CHNA results at the August 2011 Community Forum in Waterville, attendees were invited to participate in one of four key issues-breakout sessions: Access, Quality and Effectiveness, Chronic Disease, Mental Health and Substance Abuse, Prevention, Obesity. Besides sharing results at the Community Forum, Inland also provided the CHNA results with our key community collaborators who we will continue to work with on current initiatives and future opportunities: Alfond Youth Center, Family Violence Project, Friends of Quarry Road, Greater Waterville Communities for Children & Youth, Healthy Northern Kennebec (our local Healthy Maine Partnership), Kennebec Behavioral Health, Kennebec Messalonskee Trails, Kennebec Valley Community Action Program (KVCAP), Kennebec Valley Dental Coalition, Kennebec Valley Dental Coalition, Kiwanis Club, Local schools and colleges, Maine CDC, Mid-Maine Homeless Shelter, Move More, Rotary of Waterville, Spectrum Generations, United Way of Mid-Maine, Waterville Parks & Recreation.1i) INFORMATION GAPS:Inland did not identify any information gaps. We accessed multiple resources (ie local Healthy Maine Partnership and Maine CDC Health Plans and Healthy People 2020 Plan, etc) and have compared them to the CHNA data and recommendations.SEE SCHEDULE 0 FOR CONTINUATION OF RESPONSESPart V, Line 2, Indicate the tax year the hospital facility last conducted a Needs Assessment.As a result of a software defect the 2011 tax year is not populating.
	Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	All account guarantors who express an inability to pay inpatient and outpatient services will be screened for eligibility for charity care using an application and guidelines established by Inland Hospital. An account may be reconsidered for charity care at any time when new information is available about a patients inability to pay.
	Part III, Line 8 - Explanation Of Shortfall As Community Benefit	Medicare losses should be treated as a community benefit because the losses are incurred in performing an important public service, and Maine hospitals experience one of the lowest Medicare reimbursement rates in the country.
	Part III, Line 4 - Bad Debt Expense	Patient and trade accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to earnings and a valuation allowance based on its assessment of the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and the applicable patient accounts receivable. Credit is extended without collateral. The costing methodology used to determine the amount reported on line 2 is cost to charge ratio.
	Part I, Line 7, Column F - Explanation of Bad Debt Expense	$3,824,593 of bad debt expense, $2,938,858 of charity care, $45,265,088 of contractual allowances is included on Form 990, Part IX, line 25, column (A).
	Part I, Line 7 - Explanation of Costing Methodology	Worksheet 2, Ratio of Patient Care Cost-to-Charges is used in calculations.
	Part I, Line 6a - Related Organization Community Benefit Report	The Inland Hospital community benefit report is contained in an annual community benefit report prepared by Eastern Maine Healthcare Systems which is the parent organization of all related organizations.

Schedule H (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

INLAND HOSPITAL

Employer identification number

01-0217211

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) WILLIAM K BRADFIELD MD	(i) (ii)	308,866	57,617	39,644	4,900	27,054	438,081
(2) WALTER R BARRY	(i) (ii)	163,745	27,458	10,800	3,299	16,954	222,256
(3) VAUGHN M COLLETT MD	(i) (ii)	188,755	36,547	17,254	1,123	7,374	251,053
(4) MICHAEL PALUMBO DO	(i) (ii)	238,495	27,458	17,938	4,335	20,619	308,845
(5) MICHAEL P DURR MD	(i) (ii)	300,531	465	20,882	4,289	10,261	336,428
(6) MARY M HOOD	(i) (ii)	637,564	235,578	13,325	213,458	17,111	1,117,036
(7) LINDA FAY MD	(i) (ii)	235,347	236	11,146		15,819	262,548
(8) KEVIN M WHITE	(i) (ii)	416,046	55,628	17,971	4,900	15,139	509,684
(9) JOYCE STEIN DO	(i) (ii)	249,992	82,022	24,737	3,267	10,510	370,528
(10) JOHN DALTON	(i) (ii)	252,952	27,508	21,231	60,147	13,009	374,847
(11) DEAN BITHER	(i) (ii)	171,922	29,559	12,278	4,249	23,434	241,442
(12) DANIEL J BOOTH	(i) (ii)	155,190	27,458	20,958	998	10,280	214,884
(13) CRAIG R THOMPSON MD	(i) (ii)	336,623	465	5,633	3,469	19,823	366,013

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation

Schedule J (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
INLAND HOSPITAL

Employer identification number
01-0217211

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	Maine Health and Higher Educational Facilities Authority	01-0314384	560425V80	11-01-2007	3,263,464	ED Expansion & Purchase Prac		X		X	X
B	Maine Health and Higher Educational Facilities Authority	01-0314384	560425YF1	02-02-2006	1,467,531	Medical Lab & OB Renovations		X		X	X
C	Maine Health and Higher Educational Facilities Authority	01-0314384	560425TL4	05-01-2004	4,539,667	To refund the 1993D Bond		X		X	X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . .
2 Amount of bonds legally defeased . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . .	3,263,464		1,467,531		5,300,310
4 Gross proceeds in reserve funds . . . . . . . .	206,349		102,480		477,009
5 Capitalized interest from proceeds . . . . . . . . . .	25,113		25,113
6 Proceeds in refunding escrows . . . . . . . . . . .	505,000				505,000
7 Issuance costs from proceeds . . . . . . . . . . .	62,525		46,325		58,557
8 Credit enhancement from proceeds . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . .	4,457				344
10 Capital expenditures from proceeds . . . . . . . . . .	2,990,033		1,293,613
11 Other spent proceeds . . . . . . . . . . .	4,147,390				4,147,390
12 Other unspent proceeds . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . .	2008		2006		1993
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . .		X		X		X
15 Were the bonds issued as part of an advance refunding issue? . . . .		X		X	X
16 Has the final allocation of proceeds been made? . . . . . .	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . .	X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2011

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .		X		X		X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	%		%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	0%		0%		%		%
6 Total of lines 4 and 5 . . .. . . . . . . . .	0%		0%		%		%
7 Does the bond issue meet the private security or payment test? . . .	X		X		X
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X	X		X
2 Is the bond issue a variable rate issue?		X		X		X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider . . . . . . . .	NA		NA		NA
c Term of hedge . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was a hedge terminated? . . . . .
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .	X		X		X
b Name of provider . . . . . .	FSA CAP MGMT- RESERVE FUND TRANSAMERICA- CONST FUND		FSA CAP MGMT- RESERVE FUND TRANSAMERICA-CONST FUND		FSA CAP MGMT
c Term of GIC . . . . . . .	30.0000		29.0000		21.0000
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .	X		X		X
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .		X		X		X
6 Did the bond issue qualify for an exception to rebate? .		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X		X

Schedule K (Form 990) 2011

Page 3

Part V

Procedures To Undertake Corrective Action

Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . . YesNo

Part VI

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

INLAND HOSPITAL

Employer identification number

01-0217211

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No
(1) Craig Thompson MD physician loan		X	56,078	43,776		No		No	Yes
(2) Joyce Stein DO physician loan		X	40,000	28,464		No		No	Yes
(3) William K Bradfield MD physician loan		X	80,000	23,570		No		No	Yes



Total ............... $				95,810

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Susan Palumbo	spouse of director	45,633	compensation		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
		Susan Palumbo is a family member of an officer of Inland Hospital.

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

INLAND HOSPITAL

Employer identification number

01-0217211

Identifier	Return Reference	Explanation
	Schedule H, Part V, Section B, Facility Policies and Practices	1j) OTHER:About Inland Hospital:Inland Hospital is a not-for-profit organization located in Waterville, Maine with a mission "to care for and serve our community." As a member of EMHS (Eastern Maine Healthcare Systems) Inland is proud to be part of an innovative healthcare system with a Vision is "to be recognized nationally as a model for rural healthcare delivery." At the heart of Inland is our 48-bed community hospital, with Lakewood, our 105-bed continuing care facility on the hospital campus, along with 18 primary and specialty care physician practices in Waterville and surrounding communities (North Anson, Fairfield, Unity, Oakland, Madison). We also provide a Weekend Care Clinic for our primary care patients.Outside the walls of the hospital and physician practices, Inland Hospital has a strong belief and record of contributing to the health and well-being of our community. In fact, the philosophy is an integral part of our Vision:-To be a dynamic healthcare organization where: patients and residents received the right care, are treated with respect and are always safe. -Contributing to the health and well-being of our community is a priority.-"You come first" is our promise. Besides our regular Community Wellness Outreach efforts, which included nearly 2700 free health screenings and health risk-assessments in 2012, two major community health events and many smaller events and collaborations with local health organizations, Inland is also proud of our Community Benefit Program. The program contributes funds and provides volunteers for local health, economic, education, transportation and other community-building initiatives. Inland's Community Benefit Advisory Group is a multi-disciplinary team of clinical and administrative professionals from the hospital, and community members, including hospital trustees and volunteers. In 2012, Inland contributed more than $70,000 to local organizations and schools to improve the overall health of our area. In addition, in 2012 nearly 150 Inland staff members volunteered time to serve on more than 25 local boards, work groups and committees that are working to improve health and overall quality of life in our community.
Form 990, Part VI, Line 19	Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Inland Hospital makes its governing documents, conflict of interest policy and financial statements available to the public upon request.
Form 990, Part VI, Line 15b	Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees	Compensation of other officers and key employees of the organization is established by the Human Resources department who utilize external market research to establish compensation ranges for specific positions. The compensation of officers and key employees are reviewed by the system President/CEO and Inland board of trustees.On an annual basis, the compensation ranges are compared to the updated survey information. The Human Resources department will determine where the employee will fall within the ranges established by the Human Resources department based on experience and credentials.
Form 990, Part VI, Line 12c	Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	The organization requests updates of potential conflicts and relationships from the officers and Board members on an annual basis. The request requires disclosure of all business relationships, board memberships, and family relationships. A database is maintained that is compared to payroll records and the accounts payable vendor list to identify any potential conflicts of interest. Transactions are reviewed for reasonableness as an arm's length transaction. The first agenda item for board meetings and board committee meetings is for members to declare any conflict of interest with upcoming agenda items or deliberations. At any point when consideration is being given to purchase/contract with a party in interest, the member with the conflict is either excused from the discussion and consideration process or abstains from voting on the matter. All transactions identified with parties in interest are disclosed within the Form 990. All are deemed to be arm's length transactions.
Form 990, Part VI, Line 11	Form 990, Part VI, Line 11: Form 990 Review Process	Form 990 is reviewed by the CFO of Inland Hospital. It is provided to each board member either electronically or in hard copy and was reviewed at the July 25, 2013 meeting of the board of trustees prior to filing with the IRS.
Form 990, Part VI, Line 7b	Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	EMHS has authority to approve or disapprove amendments to the Corporation's articles of incorporation, amendments to its bylaws, its budget and its strategic plan, and to appoint and remove the president of the Corporation.
Form 990, Part VI, Line 7a	Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	Each year at their annual meeting, the directors elect replacements for those directors whose terms are expiring. Election of directors is subject to ratification by EMHS.
Form 990, Part VI, Line 6	Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Inland Hospital is a Maine nonprofit corporation. Eastern Maine Healthcare Systems ("EMHS"), also a Maine nonprofit corporation, is the sole corporate member of the Corporation.
Form 990, Part VI, Line 2	Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et	Kathy Corey, trustee and John D. Dalton, trustee/officer are directors of Waterville Development Corporation.Kathy Corey, trustee is Chair of Kennebec Valley Community College Foundation and John D. Dalton, trustee/officer is Vice Chair of Kennebec Valley Community College Foundation.John D. Dalton, trustee/officer and Rosemary Winslow, trustee are directors of Waterville Opera House.Rosemary Winslow, trustee is a member of Waterville Maine Street Forgivable Loan Committee and C. Patrick Michaud, trustee/officer is President of Waterville Main Street.John D. Dalton, trustee/officer and Mary M. Hood, officer are directors of Maine Hospital Association board.
Form 990, Part III, Line 4d	Form 990, Part III, Line 4d : Other Program Services Description	OTHER PROGRAM SERVICES 4: Provided healthcare services regardless of ability to pay as well as education and promotion of health. Provided $2,091,801 other uncompensated care (at cost).Inland Hospital is a 48-bed facility that provides medical-surgical, and acute care. Inland is a non-profit hospital, serving all who need care, regardless of ability to pay. Inland Hospital also has outlying clinics in the region, allowing easier access for patients.Additional Statistics:Total Admissions 1,719Percent Occupancy of Available Beds 26%Emergency Room Visits 14,746Surgery Cases 1,814Services provided to those who could not pay $6,646,905 OTHER PROGRAM SERVICES 5: Please see the following excerpt from the EMHS Annual Report to the Community for details of community benefit projects at Inland Hospital and Lakewood, A Continuing Care Center.Leadership: John D. Dalton, President and CEO, John M. Fortier, Chair Location: Waterville Employees : 720Description: A dynamic healthcare organization with a 48-bed community hospital in Waterville, a 105-bed continuing care center on the hospital campus, and 18 primary and specialty care physician offices in Waterville, Fairfield, Oakland, North Anson, Unity, and Madison/Skowhegan.Inland Hospital Highlights- Named a Top Rural Hospital in America by the Leapfrog Group, a national coalition of public and private purchasers of employee health coverage. - Heart First Cardiology Associates is the first physician practice in Maine to receive the Bridges to Excellence Cardiology Practice Recognition.- Began offering electronic patient portals for primary care patients to give patients secure, convenient access to their medical records. - Began $5.4 million dollar modernization project of the Inland inpatient unit to help make the healing environment more efficient and friendly.- Established the Let's Go! Family Fun Day and series to promote active, healthy families and help combat the childhood obesity epidemic.- Implemented a Barcode Medication Verification System, a state-of-the-art safety method using barcoded wrist bands to ensure medications and dose correspond with patients' orders.Total Community Benefit: $8,947,858Community Health Improvement Services: $62,298Financial and In-Kind Contributions: $4,115Community Building Activities: $81,375Community Benefit Operations: $218,791Unrecoverable interest cost on funds used to subsidize state MaineCare/Medicaid underpayments of $11.8M; $1,253,777Traditional Charity Care: $1,657,883Unpaid Cost of Public Programs: Medicaid: $2,097,841 Medicare: $3,571,778Philanthropy: $166,974

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

INLAND HOSPITAL

Employer identification number

01-0217211

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Sebasticook Valley Work Health LLC 447 North Main Street Pittsfield,ME04967 45-3359446	Provide Patient Care	ME	501(c)(3)	3	SVH	Yes
(2) Beacon Health LLC 43 Whiting Hill Road Brewer,ME04412 45-2967056	Accountable care organization	ME	501(c)(3)	11 Type II	EMHS	Yes
(3) Capitol Convenient Care LLC 43 Whiting Hill Road Ste 500 Brewer,ME04412 27-3671960	Provide patient care	ME	501(c)(3)	11, Type II	EMHS	Yes
(4) Sebasticook Valley Hlth Convenient Care 447 North Main Street Pittsfield,ME04967 27-3129791	Provide patient care	ME	501(c)(3)	3	SVH	Yes
(5) Sebasticook Valley Family Practice Assoc 447 North Main Street Pittsfield,ME04967 01-0357854	Provide patient care	ME	501(c)(3)	9	SVH	Yes
(6) Inland Family Practice Associates LLC 200 Kennedy Memorial Drive Waterville,ME04901 27-2942245	Provide patient care	ME	501(c)(3)	3	Inland Hospital	Yes
(7) Meadow Wood LLC 43 Whiting Hill Road Brewer,ME04412 27-2935243	Provide patient care	ME	501(c)(3)	9	AHI	Yes
(8) Blue Hill Memorial Hospital 57 Water Street Blue Hill,ME046145231 01-0227195	Provide healthcare services	ME	501(c)(3)	3	EMHS	Yes
(9) Maine Institute for Human Genetics and H 43 Whiting Hill Road Brewer,ME04412 55-0894346	Biomedical research and development	ME	501(c)(3)	9	EMHS	Yes
(10) Eastern Maine HomeCare PO Box 688 Caribou,ME04736 01-0328442	Provide home health and hospice services	ME	501(c)(3)	9	EMHS	Yes
(11) Horizons Health Services PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0504393	Provide patient care	ME	501(c)(3)	3	TAMC	Yes
(12) TAMC Endowments PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0389222	Raise funds for exempt organizations	ME	501(c)(3)	11, type I	TAMC	Yes
(13) TAMC Title Corp PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0389226	Real estate holding company	ME	501(c)(2)		TAMC	Yes
(14) The Aroostook Medical Center TAMC PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0372148	Provide healthcare services	ME	501(c)(3)	3	EMHS	Yes
(15) Sebasticook Valley Health SVH 447 North Main Street Pittsfield,ME04967 01-0263628	Critical care hospital	ME	501(c)(3)	3	EMHS	Yes
(16) CA Dean Memorial Hospital Pritham Avenue PO Box 1129 Greenville,ME044411129 04-3341666	Provide healthcare services	ME	501(c)(3)	3	EMHS	Yes
(17) Lakewood A Continuing Care Center 220 Kennedy Memorial Drive Waterville,ME04901 01-0421234	Provide skilled and long-term nursing care	ME	501(c)(3)	3	Inland Hospital	Yes
(18) Norumbega Medical Specialists LTD 43 Whiting Hill Road Brewer,ME04412 01-0465231	Provide patient care and education	ME	501(c)(3)	9	EMMC	Yes
(19) EMHS Foundation 43 Whiting Hill Road Brewer,ME04412 22-2514163	Raise and manage funds for exempt organizations	ME	501(c)(3)	11, type II	EMHS	Yes
(20) Acadia Healthcare Inc AHI 43 Whiting Hill Road Brewer,ME04412 22-3183888	Provide heatlhcare services	ME	501(c)(3)	9	AHC	Yes
(21) Eastern Maine Medical Center Auxiliary 43 Whiting Hill Road Brewer,ME04412 01-0377901	Fund raising for exempt Eastern Maine Medical Center	ME	501(c)(3)	9	EMMC	Yes
(22) Acadia Hospital Corp AHC 43 Whiting Hill Road Brewer,ME04412 01-0459837	Provide healthcare services	ME	501(c)(3)	3	EMHS	Yes
(23) Rosscare Nursing Homes Inc 43 Whiting Hill Road Ste 400 Brewer,ME04412 01-0430751	Operation of nursing homes	ME	501(c)(3)	9	Rosscare	Yes
(24) Rosscare 43 Whiting Hill Road Ste 400 Brewer,ME04412 01-0391038	Provide services to elderly	ME	501(c)(3)	PF	EMHS	Yes
(25) Eastern Maine Healthcare Real Estate 43 Whiting Hill Road Brewer,ME04412 01-0391036	Leases real estate	ME	501(c)(2)		EMHS	Yes
(26) Eastern Maine Medical Center EMMC PO Box 404 489 State Street Bangor,ME044020404 01-0211501	Provide healthcare services	ME	501(c)(3)	3	EMHS	Yes
(27) Eastern Maine Healthcare Systems EMHS 43 Whiting Hill Road Brewer,ME04412 01-0527066	Supporting organization for healthcare affiliates	ME	501(c)(3)	11, Type II	N/A	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) Dirigo Pines Development Company LLC 9 Alumni Drive Orono,ME04473 01-0537924	Retir Cottag	ME	AHS	C
(2) Dirigo Funding LLC 9 Alumni Drive Orono,ME04473 01-0599968	Prov finance	ME	AHS	C
(3) Dirigo Pines Inn LLC 9 Alumni Drive Orono,ME04473 02-0547749	Contin Care	ME	Rosscare	C
(4) Dirigo Pines Retirement Community LLC 9 Alumni Drive Orono,ME04473 01-0537924	Holding Co.	ME	AHS	C
(5) Maine Network for Health PO Box 2813 Bangor,ME044022813 01-0496352	Support srv	ME	EMHS	C
(6) Meridian Mobile Health LLC 931 Union Street PO Box 940 Bangor,ME044020940 01-0512673	Ambulance	ME	AHS	C
(7) DE Collections DBA Affiliated Collecti PO Box 2759 Bangor,ME044022759 01-0366209	Collections	ME	AHS	C
(8) Affiliated Pharmacy Services 917 Union St Suite 7 Bangor,ME04401 01-0587230	Pharmacy	ME	AHS	C
(9) Affiliated Materiel Services PO Box 1300 Bangor,ME044021300 01-0381189	Purchasing	ME	AHS	C
(10) Affiliated Laboratory Inc PO Box 638 Bangor,ME044020638 01-0381283	Clinicl lab	ME	AHS	C
(11) Affiliated Healthcare Management PO Box 811 Bangor,ME044020811 01-0349339	Hlthcr mgmt	ME	AHS	C
(12) Affiliated Healthcare Systems AHS PO Box 940 Bangor,ME044020940 01-0385322	Holding co.	ME	EMHS	C

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved
(1) DE Collections DBA Affiliated Collecti	l	81,464
(2) Affiliated Materiel Services	o	1,211,934
(3) Affiliated Materiel Services	l	70,357
(4) Affiliated Laboratory Inc	l	773,269
(5) Affiliated Healthcare Management	l	72,790
(6) Beacon Health LLC	k	58,446
(7) Sebasticook Valley Health SVH	k	111,784
(8) Lakewood A Continuing Care Center	k	129,213
(9) Lakewood A Continuing Care Center	a	9,000
(10) EMHS Foundation	r	148,377
(11) EMHS Foundation	l	199,000
(12) Eastern Maine Medical Center EMMC	o	50,545
(13) Eastern Maine Medical Center EMMC	l	2,038,574
(14) Eastern Maine Healthcare Systems EMHS	q	108,864
(15) Eastern Maine Healthcare Systems EMHS	o	5,825,640
(16) Eastern Maine Healthcare Systems EMHS	l	1,495,625

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

1	Briefly describe the organization’s mission or most significant activities: Inland Hospital operates a 48-bed non-profit hospital and outlying clinics in the Waterville area, that provides medical, surgical, and acute care to all, regardless of ability to pay.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	12
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	680
6	Total number of volunteers (estimate if necessary) ....	6	140
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	145,198
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-66,653

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	144,730	234,668
9	Program service revenue (Part VIII, line 2g) .........	119,338,160	118,933,272
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	564,341	212,142
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	14,279	2,369,176
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	120,061,510	121,749,258
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	40,719,212	43,683,370
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	76,337,650	77,316,977
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	117,056,862	121,000,347
19	Revenue less expenses. Subtract line 18 from line 12.......	3,004,648	748,911
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	47,673,184	53,738,280
21	Total liabilities (Part X, line 26).............	23,832,917	27,980,309
22	Net assets or fund balances. Subtract line 21 from line 20.....	23,840,267	25,757,971

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 102,754,660 including grants of $ ) (Revenue $ 118,933,510 )
	Provided healthcare services regardless of ability to pay as well as education and promotion of health. Provided $2,091,801 other uncompensated care (at cost).Inland Hospital is a 48-bed facility that provides medical-surgical, and acute care. Inland is a non-profit hospital, serving all who need care, regardless of ability to pay. Inland Hospital also has outlying clinics in the region, allowing easier access for patients.Additional Statistics:Total Admissions 1,719Percent Occupancy of Available Beds 26%Emergency Room Visits 14,746Surgery Cases 1,814Services provided to those who could not pay $6,646,905

4b	(Code: ) (Expenses $ 3,571,778 including grants of $ ) (Revenue $ )
	Medicare shortfalls (at cost). 27,136 persons served.

4c	(Code: ) (Expenses $ 2,097,841 including grants of $ ) (Revenue $ )
	Medicaid shortfalls (at cost). 17,861 persons served.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 1,656,202 including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 110,080,481

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) MICHAEL PALUMBO DO VP-Med Affairs	40.00	X		283,891	0	24,954
(19) DANIEL J BOOTH VPOO/CHRO	40.00	X		203,606	0	11,278
(20) DEAN BITHER VP of Fin/CFO	40.00	X		213,759	0	27,683
(21) WALTER R BARRY VP Pat Care/CNO	40.00	X		202,003	0	20,253
(22) MARY M HOOD EMHS CEO	.50	X		0	886,467	230,569
(23) WILLIAM K BRADFIELD MD Physician	40.00		X	406,127	0	31,954
(24) KEVIN M WHITE Physician	40.00		X	489,645	0	20,039
(25) CRAIG R THOMPSON MD Physician	40.00		X	342,721	0	23,292
(26) JOYCE STEIN DO PHYSICIAN	40.00		X	356,751	0	13,777
(27) MICHAEL P DURR MD Physician	40.00		X	321,878	0	14,550

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,611,357	886,467	515,821

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		146,200
e	Government grants (contributions)1e		20,595

f	All other contributions, gifts, grants, and similar amounts not included above1f		67,873
g	Noncash contributions included in lines 1a-1f:$ 14,007
h	Total. Add lines 1a-1f.......			234,668
			Business Code
2a	PATIENT SERVICE REVENUE		621,990	118,735,251	118,590,053	145,198
b	LIFELINE REVENUE		621,610	43,656	43,656
c	EDUCATION REVENUE		611,710	19,762	19,762
d	CAFETERIA		722,210	134,603	134,603
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			118,933,272
3	Investment income (including dividends, interest
	and other similar amounts).....			215,807			215,807
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	3,903
b	Less: rental expenses
c	Rental income or (loss)	3,903
d	Net rental income or (loss).......			3,903	3,903
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	2,057,058	2,700
b	Less: cost or other basis and sales expenses	1,996,651	66,772
c	Gain or (loss)	60,407	-64,072
d	Net gain or (loss)..........			-3,665	-3,665
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a		42,143
b	Less: cost of goods sold ..b		25,067
c	Net income or (loss) from sales of inventory..			17,076			17,076
Miscellaneous Revenue			Business Code
11a	ROOM DONATION		900,099	120			120
b	MEANINGFUL USE PAYMENTS		621,990	2,348,023			2,348,023
c	CLASS ACTION SETTLEMENT		900,099	54			54
d	All other revenue ....
e	Total. Add lines 11a–11d ......			2,348,197
12	Total revenue. See Instructions....			121,749,258	118,788,312	145,198	2,581,080


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			16,089	1	16,179
2	Savings and temporary cash investments .......			1,668,704	2	1,437,674
3	Pledges and grants receivable, net .........			8,140	3	0
4	Accounts receivable, net .........			16,306,172	4	20,275,921
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			21,204	5	95,810
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6	0
7	Notes and loans receivable, net .............			706,620	7	301,579
8	Inventories for sale or use ..............			702,084	8	601,581
9	Prepaid expenses and deferred charges ............			1,288,173	9	818,448
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	37,292,772
b	Less: accumulated depreciation. .....	10b	20,149,809	17,521,196	10c	17,142,963
11	Investments—publicly traded securities ..........				11	0
12	Investments—other securities. See Part IV, line 11 ......				12	0
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets .........			12,311	14	1,304
15	Other assets. See Part IV, line 11 ...........			9,422,491	15	13,046,821
16	Total assets. Add lines 1 through 15 (must equal line 34)...			47,673,184	16	53,738,280
17	Accounts payable and accrued expenses .			10,612,906	17	12,982,896
18	Grants payable ..........				18
19	Deferred revenue ..........				19	1,886
20	Tax-exempt bond liabilities ..........			4,847,183	20	4,353,489
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			6,161,933	23	6,400,813
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			2,210,895	25	4,241,225
26	Total liabilities. Add lines 17 through 25.....			23,832,917	26	27,980,309
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			22,880,411	27	23,706,280
28	Temporarily restricted net assets .....			356,500	28	1,384,495
29	Permanently restricted net assets .....			603,356	29	667,196
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			23,840,267	33	25,757,971
34	Total liabilities and net assets/fund balances .....			47,673,184	34	53,738,280