TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(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) John Benson MD...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(2) Stewart Brecher...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(3) Stuart Davidson MD...................................................................... Trustee/Medical Staff Pres	40.00 ................. 0.00	X		491,919	46,312
(4) David Einhorn Esq...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(5) Sarah Fina...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(6) Elsie Flemings...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(7) Patricia Hand PhD...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(8) Julius Krevans MD...................................................................... Trustee (part year)	1.00 ................. 0.00	X		0	0
(9) Lawrence Legutko...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(10) Beverly Paigen PhD...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(11) Dean Read...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(12) William Rudolf...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(13) Martha Wagner PhD...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(14) Noelle Wolf...................................................................... Trustee	1.00 ................. 0.00	X		0	0
(15) Vince Messer PhD...................................................................... Board Chair	5.00 ................. 0.00	X	X	0	0
(16) James R Bright...................................................................... 1st Vice Chair	3.00 ................. 0.00	X	X	0	0
(17) Julian Kuffler MD...................................................................... 2nd Vice Chair/Physician	40.00 ................. 0.00	X	X	256,103	45,901

(A) Name and business address	(B) Description of services	(C) Compensation
Therapy Partners LLC 7 Hillview Drive Bangor,ME04401	Physical Therapy Services	581,817
Comprehensive Pharmacy Services Inc PO Box 638316 Cincinnati,OH452638316	Pharmacy Management Services	509,755
J&D Imaging Inc PO Box 213 Bar Harbor,ME04609	Radiology Services	356,374
Rao Surapeneni P Ramanadha MD, 358 Broad Street Bangor,ME04401	Urology Services	343,000
Hancock Community Health LLC PO Box 8 Bar Harbor,ME04609	Dental Services	281,614
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 31

- TIN:

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.
right arrow

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

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

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 described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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. See section 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 in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. If the organization did not check a 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—2015. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. 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 VI 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) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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—2014. 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) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

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, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) 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), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled 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 totaling $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 its Form 990PF, Part I, line 2, 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Mount Desert Island Hospital

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization Mount Desert Island Hospital		Employer identification number 01-0211797

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization Mount Desert Island Hospital			Employer identification number 01-0211797
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ 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) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 SchCMd Bullet

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 SchCMd Bullet

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable 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) 2015

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 on 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? ..........................................................

Yes

8,241

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

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

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

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

8,241

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

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	A portion of dues paid to the Maine Hospital Association and the American Hospital Association are available for lobbying. For the filing period, the amount paid to MHA available for lobbying was $5,344 and for AHA the amount was $2,897.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

Part I

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

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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 section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on 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 XIII, 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)

Revenue included on 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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

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

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	6,133,933	6,987,538	6,591,431	6,300,481	8,117,020
b	Contributions ...	479,781	250,000	25,000
c	Net investment earnings, gains, and losses	-340,076	372,871	625,391	588,719	-421,691
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	860,000	1,450,000	225,000	270,000	1,366,000
f	Administrative expenses ....	23,379	26,476	29,284	27,769	28,848
g	End of year balance ......	5,390,259	6,133,933	6,987,538	6,591,431	6,300,481

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

Board designated or quasi-endowment SchDMd Bullet

88.360 %

Permanent endowment SchDMd Bullet

11.640 %

Temporarily restricted endowment SchDMd Bullet

0 %

The percentages on 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)

Yes

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

3a(ii)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	3,802,848		3,802,848
b	Buildings	27,883,953	14,752,013	13,131,940
c	Leasehold improvements	235,558	160,347	75,211
d	Equipment ...	17,610,484	13,297,193	4,313,291
e	Other ...	246,343		246,343
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				21,569,633

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Due from Affiliates				4,811,698
(2) Aetna Deposit				98,000
(3) Other Receivables				540,201
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				5,449,899

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Deferred Compensation	2,595,364
Estimated Third Party Settlements	4,438,340
Due to Affiliate	400,146
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	7,433,850
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	54,664,881
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-578,321
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-141,704
e	Add lines 2a through 2d .....................			2e	-720,025
3	Subtract line 2e from line 1..................			3	55,384,906
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	33,424
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c	33,424
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	55,418,330

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	55,116,203
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 XIII.) ............	2d
e	Add lines 2a through 2d....................			2e	0
3	Subtract line 2e from line 1...................			3	55,116,203
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	33,424
b	Other (Describe in Part XIII.) ............	4b	141,704
c	Add lines 4a and 4b.....................			4c	175,128
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	55,291,331

Part XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Part V, Line 4:	Endowment amounts restricted by the Board of Directors are released by the Board as needed for special projects supplying benefit to the community at large. These funds are intended solely for the use of expanding services, and not for sustaining current operations.
Part X, Line 2:	The Hospital and BBRV are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code (Code). MDMC is a for-profit entity and is, therefore, subject to income taxes. Income taxes are recorded based upon the asset and liability method as prescribed by Financial Accounting Standards Board (FASB) Accounting Standards Coalition (ASC) 740, Income Taxes. At April 30, 2016 and 2015, MDMC has certain net operating loss carryforwards which have been reduced by a valuation allowance of an equal amount as it is not presently considered likely that the deferred tax assets will be realized.
Part XI, Line 2d - Other Adjustments:	Fundraising Expenses Netted with Revenue on AFS -141,704.
Part XII, Line 4b - Other Adjustments:	Fundraising Expenses Netted with Revenue on AFS 141,704.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
Mount Desert Island Hospital

Employer identification number

01-0211797

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Farmhouse Dinner (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	39,000	39,000
2	Less: Contributions . . . .	26,520	26,520
3	Gross income (line 1 minus line 2) . . . . . .	12,480	12,480

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .	17,729	17,729
7	Food and beverages . . .	11,603	11,603
8	Entertainment . . . .
9	Other direct expenses . . .	4,976	4,976
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		34,308
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		-21,828

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	4,976	4,976

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

Part I

Financial Assistance 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) as a factor in determining eligibility for providing free care?

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

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

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

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

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? . . . . . .

Yes

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

Financial Assistance and Means-Tested Government Programs		(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) . . .	607,637	0	607,637	1.180 %
b	Medicaid (from Worksheet 3, column a) . . . . .	4,070,093	3,260,271	809,822	1.570 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	4,677,730	3,260,271	1,417,459	2.750 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	111,053	0	111,053	0.220 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	12,313,442	6,962,559	5,350,883	10.370 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	12,424,495	6,962,559	5,461,936	10.590 %
k	Total. Add lines 7d and 7j .	17,102,225	10,222,830	6,879,395	13.340 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,256,375

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

13,585,272

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

17,018,399

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

-3,433,127

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(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Mount Desert Island Hospital 10 Wayman Lane PO Box 8 Bar Harbor,ME045090008 www.mdihospital.org 37457	X	X	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	Mount Desert Island Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): see Part V, Section C

Other website (list url): see Part V, Section C

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): see Part V, Section C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Mount Desert Island Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 150.000000000000% and FPG family income limit for eligibility for discounted care of 250.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

see Part V, Section C

The FAP application form was widely available on a website (list url):

see Part V, Section C

A plain language summary of the FAP was widely available on a website (list url):
see Part V, Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	Mount Desert Island Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Mount Desert Island Hospital	Part V, Section B, Line 5: Mount Desert Island Hospital participated in the Maine State Statewide Community Health Needs Assessment that focused on individual counties within the State, and during fiscal year 2016 also collaborated with Healthy Acadia to perform a service area CHNA. The CHNA for Hancock County provided an avenue to look at State of Maine surveillance data and validate our implementation plan and evaluation plan. MDIH felt that our community and service area would best be served by a more focused and representative CHNA. MDIH collaborated with Healthy Acadia to perform a focused CHNA for our services area commencing in September 2015. Additionally, Mount Desert Island Hospital partnered with a number of other medical and community organizations to prepare a county-wide CHNA that was completed in February 2016. The CHNA presents the combined findings of three separate studies and surveys, which together consider the responses from a broad cross section of the community, including health care professionals from a variety of backgrounds and people who work at other types of nonprofits, the private sector, education, and social services.
Mount Desert Island Hospital	Part V, Section B, Line 6b: The 2016 CHNA was conducted in partnership with Healthy Acadia, a 501(c)(3) non-profit organization dedicated to empowering people and organizations to build healthy communities and making it possible for all people to lead healthier lives.
Mount Desert Island Hospital	Part V, Section B, Line 11: The Hospital, working with our community and our implementation plan, continues to move strategies forward for a healthy community. While there were two strategies that were outside of the main purview of the Hospital, the organization committed to provide feedback and support to help start a Farmers' Market and created walking maps of the community to encourage healthy activities. The Hospital is continuing with the implementation strategies that were first adopted in 2011 with its current CHNA as they are again recognized as ongoing initiatives in the Hancock County wide CHNA. The Hospital is using the strategies from the 2014 county-wide CHNA survey as well. The Hospital completed its CHNA in partnership with Healthy Acadia, the results were approved by the Planning Committee of the Board of Trustees and ratified by the Board of Trustees in March of 2016.
Mount Desert Island Hospital	Part V, Section B, Line 16i: The policy was provided, in writing, to patients on admission to the Hospital facility.The Hospital works with community service organizations to post the Plain Language Summary in public libraries, local municipality facilities, local YMCA/YWCA, and the Healthy Acadia website.
Part V, Line 7a, Hospital's website:	https://www.mdihospital.org/wp-content/uploads/2016/01/Final-MDIH_HA-2016-CHNA-and-Action-Plan.pdf
Part V, Line 7b, Other website:	https://healthyacadia.org/resources/documents/Final-MDIH_HA-2016-CHNA-and-Action-Plan.pdf
Part V, Line 10a, Implementation Plan:	CHNA Implementation Guide: https://www.mdihospital.org/wp-content/uploads/2016/01/CHNA-Mount-Desert-Island-Hospital-Organization-Implementation-Guide.pdfCHNA Implementation Plan: https://www.mdihospital.org/wp-content/uploads/2016/01/CHNA-Strategic-Planning-Public-Presentation-Copy.pdf
Schedule H, Part V, Section B, Line 16a-16c:	Financial Assistance Policy URL:https://www.mdihospital.org/wp-content/uploads/2017/01/MDIHO-Financial-Assistance-Policy-FC-Approved-01-2017.pdfFinancial Assistance Policy Application URL:https://www.mdihospital.org/wp-content/uploads/2014/08/FAPApplication.pdfFinancial Assistance Plain Languange Summary URL:https://www.mdihospital.org/wp-content/uploads/2017/01/Plain-Language-Summary-of-Financial-Assistance-Program-1557-01-2017.pdf

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?13
Name and address		Type of Facility (describe)
1	1 - Community Health Center 16 Community Lane Southwest Harbor,ME04679	Outpatient Clinic
2	2 - Trenton Health Center 394 Bar Harbor Road Trenton,ME04605	Outpatient Clinic
3	3 - Behavioral Health Center 322 Main Street Bar Harbor,ME04609	Outpatient Clinic
4	4 - Cooper Gilmore Health Center 17 Hancock Road Bar Harbor,ME04609	Outpatient Clinic
5	5 - Cadillac Family Practice 322 Main Street Bar Harbor,ME04609	Outpatient Clinic
6	6 - Family Health Center 9 Hancock Road Bar Harbor,ME04609	Outpatient Clinic
7	7 - Lisa Stewart Women's Health Center 8 Wayman Lane Bar Harbor,ME04609	Outpatient Clinic
8	8 - MDI Orthopedics 10 Wayman Lane Bar Harbor,ME04609	Outpatient Clinic
9	9 - MDI Dermatology Health Center 322 Main Street Bar Harbor,ME04609	Outpatient Clinic
10	10 - MDI Urology 322 Main Street Bar Harbor,ME04609	Outpatient Clinic
11	11 - MDI General Surgery 17 Hancock Road Bar Harbor,ME04609	Outpatient Clinic
12	12 - Northeast Harbor Health Center Kimball Road Northeast Harbor,ME04679	Outpatient Clinic
13	13 - MDI Podiatry 10 Wayman Lane Bar Harbor,ME04609	Outpatient Clinic

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 7:	The costing methodology utilized for this table was derived from Worksheet 2, Ratio of patient care cost to charges with data from filed cost reports for the filing fiscal year.
Part I, Line 7g:	The Hospital provides to the community several provider based physician and specialty practices to serve this rural island population. These practices are listed on Part V of this schedule. The facility subsidizes their operating costs to maintain access and coordination of care to our population.
Part I, Line 7, Column (f):	The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 3,702,221.
Part III, Line 2:	The estimated cost of bad debt expense as reported is derived from the accounting systems and software the organization uses to calculate the cost-to-charge ratio from the as-filed Medicare Cost Reports.Mount Desert Island Hospital (MDIH) estimates the cost of bad debt expense using accounting systems and software from our organization to calculate the cost of care from the as filed Medicare Cost Reports. This estimate best represents the value of providing care for those services that will be considered or deemed uncollectible. The value of these services at cost are estimated to be $2,256,375. This is the amount the hospital must forgive as a benefit to the community for providing services.
Part III, Line 3:	The Hospital's financial assistance policy provides administrative and accounting guidelines for the identification, classification, and reporting of patients receiving financial assistance as distinguished from bad debts. Accordingly, the Hospital has estimated that no amount of bad debt expense at cost is attributable to patients eligible under the organization's financial assistance policy.
Part III, Line 4:	See Footnote 2 on Page 8 of the attached audited financial statements.
Part III, Line 8:	The IRS Form 990, Schedule H instructions and guidance provide a template in Worksheet 2 as a way to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost. Where applicable, we have utilized the Worksheet 2 template calculation. The only area where we did not utilize this template calculation was in Schedule H, Part III, Section B, Line 6, Medicare allowable costs and payments related to the subsidized health services. Instead, the Hospital utilized the Medicare cost report estimated cost and payment for these services. The Hospital believes that provider based clinics listed in above should be considered a community benefit due to the fact that without the Hospital subsidizing and offering the services that these clinics offer, the community-at-large would have to travel 45 minutes or more to the nearest hospital and those who live on the outer islands in our service area would need to travel over 2 hours to obtain services. As such, Mount Desert Island Hospital believes that by offering and subsidizing these clinics within its community, and thus enabling community members to have easy access and an easier commute for these services, this benefits the entire community at large.
Part III, Line 9b:	The Hospital does not initiate collection efforts against a patient that qualified for a sliding fee scale unless that patient failed to meet his or her obligation under a mutually agreed upon payment arrangement. After determining the patient did not qualify for a readjustment to his or her payment terms, the Hospital would follow normal notification practices dictated by our collection policy, which is in compliance with the 501(r) regulations. If the collection agency suspects or gains knowledge that someone may need to apply for one of the programs, the agency sends out a financial assistance application to the patient or guarantor and proceeds to notify MDIH of the outreach. Information about our free and sliding scale programs are on our website, on our account statements, and posted in public areas and at our provider clinics. We also make available a Patient Financial Counselor to help navigate the process.
Part VI, Line 2:	Mount Desert Island Hospital assesses the health needs of the community through the use of a collaborative Community Health Needs Assessment. As a key participant in the CHNA process, our institution is able to further address and identify those areas of most concern and need in our community. A community needs assessment is a point-in-time effort to measure the health and wellbeing of the community. It serves as a constructive tool to and basis for Mount Desert Island Hospital's strategic and subsequent action planning to develop health policy advocacy, allocate resources, improve or expand existing services, implement new programs and collaborate with other community health care providers. A community health needs assessment also serves as a benchmark for future assessment of measured progress toward established community health objectives. The Mount Desert Island Hospital's Community Health Needs Assessment provides an opportunity to gain insight into the needs and assets that are served. It also provides a measure to identify and address the needs of the vulnerable populations within our community. The Mount Desert Island Hospital process was a partnership with Healthy Acadia, a comprehensive community health coalition that was formed in 2001 with the public health funding provided by the Maine Center for Disease Control and Prevention. The Community Health Improvement Plan and Health Needs Assessment were performed using the Mobilizing for Action through Planning and Partnerships process, which utilized a broad cross-section of our demographic and service area. This process delivered the basis for the assessment which demonstrated the strengths and opportunities for our plan. This process involved the gathering of quantitative data such as demographics, health indicators, and local statistical information as well as qualitative data from public surveys, focus groups, and community stakeholders. The data helps support short-term and long-term decisions about allocation of community human and capital resources. Participants included members of the Hospital's medical staff, nursing staff, board of trustees and administration. Focus groups were used to gain feedback from diverse and remote populations, as we are an institution that serves the rural and coastal community of Mount Desert Island and the other islands off the Coast of Hancock County. This feedback was essential to continue to develop strategies that meet the needs of our residents. This collaborative effort developed several themes for strategic initiatives and goals. The organization reviewed the overarching needs and validated those to the health needs of the community. This process was reviewed and prioritized through the Board Designated Planning Committee of the organization, which develops and maintains oversight of the Hospital's official Community Health Needs Assessment and Implementation and Evaluation Plans. The Implementation Plan is reviewed periodically and updated as strategies and initiatives are completed or modified. Those items that were not achievable are reviewed and documented as to the barrier for successful implementation and/or alternatives. MDI Hospital is currently continuing its action on the items from the 2011 plan as there are several broad reaching programs that will continue to be a focus for our organization, using supplemental data from the Maine Shared Health Needs and Planning Process (Maine SHNAPP). They are outlined on our adopted implementation plan under the evaluation process. The plan was first adopted in 2011 and the continuation has been approved by the Hospital's CHNA planning committee who has been authorized by the Hospital's board of directors to oversee the CHNA process on the board's behalf. The supplemental plan was approved as well while the Hospital engaged in a comprehensive update to its CHNA in partnership again with Healthy Acadia. The results are available upon request and through www.mdihospital.org.The Hospital's county-wide Community Health Needs Assessment, which aligns many state and county partners in Hancock County, was led primarily by Eastern Maine Health Systems and identified several health initiatives that MDI Hospital developed within their adopted implementation plan.The implementation and evaluation plans and CHNA are located on the Hospital's public website along with a notice to solicit comments from the community regarding any questions, suggestions or concerns regarding the CHNA and the implementation plan.
Part VI, Line 3:	The Financial Assistance Policy (FAP) information is sent with all account statements and is printed on the back of the statement. A Plain Language Summary of the FAP is also available on our Hospital website, provided to all inpatient and observation patients upon discharge, posted in public areas, and available within the departments and clinics of our organization. The Hospital provides a patient financial representative to help navigate the process to ensure that our patients have access to the care and services they need. MDIH is committed to providing access to quality healthcare services with compassion, dignity, and respect for those we serve, particularly the poor, indigent, and underserved in our communities, regardless of their ability to pay. We assist our patients who cannot afford to pay for part or all of the services received by working with our community to identify those in need and find the financial resources that may be made available to them. MDIH has adopted guiding principles when handling billing, collections, and financial support functions for our patients. We provide effective communications with patients regarding hospital bills and make affirmative efforts to help patients apply for public and private financial support programs, including providing resources to perform the application process on behalf of the patient. We have implemented policies and procedures for assisting low income patients in a consistent manner that is in compliance with the State of Maine Chapter 150 Guidelines for Free and Reduced Care. A patient financial representative is also available to assist with triaging patient needs and working with our patients to align resources. This representative is available to explain and review patient payment obligations as well we have a patient advocate to facilitate issues that arise during the course of this process. Information about hospital based financial support polices and external support programs that provide coverage for services are made available to patients during the pre-registration and registration processes and/or through communications with patients seeking financial assistance. MDI Hospital and Health Centers provide interpreter services to all patients and families as well. Support is available to uninsured and underinsured patients who do not qualify for public programs or other means of assistance. Notification about financial assistance programs at MDIH, including contact information, is available through messaging included on patient bills and at discharge, in physician offices, public areas, care management staff, registration areas, billing support staff, and reception in the Hospital and at our clinics. Patient brochures describing the financial counseling services, our financial assistance policies, financial assistance application, and the applicable services which are available in these areas as well as this information may be found on our public website.
Part VI, Line 4:	Mount Desert Island Hospital is a 25-bed; critical access hospital located in Bar Harbor, Maine providing acute, swing, obstetrics, and nursery services. The Hospital is licensed by the State of Maine. The mission is to provide compassionate care and strengthen the health of our community by embracing tomorrow's methods and respecting time-honored values. Its services include acute inpatient, swing bed, 24-hour emergency center, diagnostic services, lab, physical therapy, pharmacy, and surgical services. Along with hospital services, the Hospital employs the majority of primary and specialty care physicians in the area. The Hospital provides the only behavioral health clinic services in Hancock County, which has been identified as a need in the CHNA for mental and substance use treatment availability. Hancock and Washington County are considered rural by the State of Maine and the United States Census Bureau, under guidelines set forth by the Office of Management and Budget (OMB). The Hospital service area (HSA) as defined by the Maine Health Data Organization (MHDO) uses the statistical method where the greatest proportion of residents received their inpatient care. The Hospital's primary service area is Mount Desert Island and the towns it supports as well as the outer islands off the coast of Bar Harbor, Northeast Harbor, and Southwest Harbor. Also included in our service area are the towns of Trenton and Lamoine, Maine. The Hospital entered into a collaboration to bring dental and oral health services to Mount Desert Island which is defined as a federally underserved location for dental health and identified as a need in the Hospital's CHNA. MDI Hospital opened a dental center in Southwest Harbor to address the community's needs for oral health, collaborating with another Hancock County Hospital to provide the services in this region to those who were in need of access to oral healthcare.
Part VI, Line 5:	Mount Desert Island Hospital is committed to improving health and quality of life in the Mount Desert Island region. Through innovation and effort, we strive to meet the evolving needs of our community with a compassionate, patient-centered approach to care. Our dedication to excellence has been recognized with national awards for patient satisfaction and for the delivery of care in a rural setting. Today, MDI Hospital is a beacon of quality care for residents and visitors and a model of rural care delivery for the nation.As one of the largest employers on Mount Desert Island, MDIH provided approximately 500 jobs in fiscal year 2016. Our network of island health centers are our frontline, providing the community with top quality, individualized primary care where they feel most at home. Our Hospital network offers seven primary care facilities in Bar Harbor, Northeast Harbor, Southwest Harbor, and Trenton as well as a new full service dental clinic, a nationally recognized Breast Health Center, and comprehensive behavioral health services. Mount Desert Island Hospital Organization Services: Breast Health Center at MDI Hospital, Cadillac Family Practice, Cooper Gilmore Health Center, Community Health Center, Community Dental Center, Family Health Center, Lisa Stewart Women's Health Center, MDI Behavioral Health Center, Northeast Harbor Clinic (seasonal), Trenton Health Center, 24-7 emergency room, acute care (swing beds), behavioral health services, breast health services, cardiac rehabilitation, dental/oral health services, dermatology, digital mammography, diabetes education, general surgery, imaging/radiology, infusion center, laboratory services, neurology, nutrition education, obstetrical services, occupational therapy, oncology-hematology, orthopedics, pediatrics, physical therapy, podiatry, primary care, pulmonology, skilled rehabilitation, speech therapy, sports medicine, surgical services, urology, and women's health services.In fiscal year 2016, our healthcare professionals offered skilled services to the Downeast Region including free and uncompensated care. Mount Desert Island Hospital and Health Centers do not turn away those in need of medical care, regardless of their ability to pay. The organization provided $4.7 million in free and uncompensated care during the fiscal year. Community PartnershipsDuring fiscal year 2016, Mount Desert Island Hospital partnered with many area organizations to reach a broad range of community members. These community partnerships included the MDI YMCA, Healthy Acadia, Connors Emerson School, Havana Restaurant, the Jesup Memorial Library, the Southwest Harbor Public Library, Hancock County Emergency Management, MDI Search and Rescue, Acadia National Park, Life Flight, Eastern Maine Medical Center, Maine Coast Memorial Hospital, Emergency Medical Service personnel throughout Hancock County, the Bar Harbor Chamber of Commerce, MDI Rotary, MDI Lioness Club, MDI YWCA and the MDI Marathon. These partnerships allow MDI Hospital and Health Centers to provide education, services, training and informational materials to individuals and organizations throughout Downeast Maine.Dedicated StaffIn fiscal year 2016, MDI Hospital's dedicated staff contributed countless hours of volunteer time and donations to groups such as Hospice Volunteers of Hancock County, the Bar Harbor Food Pantry, and the Bar Harbor Housing Authority, the MDI Marathon, the Maine Alzheimer's Association, MDI Rotary, Island Connections, the MDI YMCA, Island Housing Trust, the Bar Harbor Chamber of Commerce, the MDI Lioness Club, and the Healing Hands Quilt Group.Community Health ServicesOral Health Services: MDI Hospital was proud to partner with the American Dental Association (ADA) to host the Island's second annual Give Kids a Smile Day in February 2016 at our Community Dental Center in Southwest Harbor. This event was founded by the ADA to raise awareness of the critical need for access to oral health care. Children were provided with oral hygiene instruction, cleanings and fluoride varnish from registered dietitians. MDI Hospital is committed to providing greater access to and quality dental health services in our community. Childbirth Education Classes: MDI Hospital's obstetrics department provides low-cost classes for new families on labor and delivery, breast-feeding, newborn care, sibling issues, and infant and child CPR.Flu Shot Clinics: MDI Hospital conducts low-cost public flu clinics each year at several locations throughout the community. A total of 224 people took advantage of these convenient clinics in Fall 2015.Diabetes Education: MDI Hospital's Diabetes Education program provides guidance and support to help people manage their disease.Telemedicine Services: Using two-way telecommunications technology, MDI Hospital is able to connect clinicians in the ICU, ER, and on outer islands with providers located miles away.Nutrition Education: MDI Hospital dietitians provide a variety of educational and outreach services to the community each year. In fiscal year 2016, these efforts included: - Education on healthy eating for older adults on Swan's Island, - Health coaching as part of the Jackson Laboratory's Health and Fitness Program, - Food safety education for the Jackson Laboratory Safety Fair, - Nutrition education for the Diabetes Prevention Program classes, - Facilitating surgical weight loss support groups for surgical weight loss patients/candidates, - Participation in the MDI Hospital Health Fair, - Health coaching for MDI Hospital employees, - Nutrition education to our veterans at the Veteran's Health Fair, - Mentoring college and high school students, - Nutrition education for the Food Revolution Day for elementary school students, - Working with Hannaford Supermarkets to help the community make healthy selections and offering cooking classes.Palliative Care Team: MDI Hospital's Hospice and Palliative Care Committee meets monthly to discuss how to raise awareness of palliative care within the community, how to improve upon the end-of-life care at MDI Hospital, and how to better support the emotional needs of everyone involved. The committee believes in creating an environment that nurtures the physical, intellectual, social, and spiritual well-being of those in the Hospital's care, and continues to foster a close relationship with Hospice Volunteers of Hancock County and Eastern Maine Homecare, which provide hospice care at home for patients. More recently, the Committee has spearheaded community forums that encourage open discussion on end-of-life issues, quality of life, and education on advance care directives.Coastal Care Team: MDI Hospital's Coastal Care Team (CCT) works side-by-side with patients and their families to improve health, wellness, and quality of life. In order to meet the needs of our patients and our community, CCT works with our health centers to identify patients at high risk who may need additional support at home, in the community, or within the healthcare environment. By meeting patients where they are, CCT is able to improve the quality of their care and their access to care. Since its inception, CCT has served nearly 2,245 patients referred by 15 medical practices throughout Hancock, Waldo, and Washington counties.School Based Nurse Program - MDI Hospital provides nursing services to the following schools: Trenton, Lamoine, Tremont, Pemetic Schools, MDI High School and College of the Atlantic. Emergency Services Training and Support: MDI Hospital provides oversight and training to all island emergency medical services. MDI Hospital's Emergency Department is led by Nathan Donaldson, DO, MHA, FACEP. Dr. Donaldson serves as the Medical Director for all Bar Harbor, Northeast Harbor, and Southwest Harbor emergency medical services (EMS). Dr. Donaldson is a board-certified emergency physician with a background in sports medicine. As an EMS director, Dr. Donaldson facilitates quarterly education reviews and protocol updates for all Mount Desert Island EMS professionals.MDI High School: Dr. Nathan Donaldson is named the Medical Director of the High School and oversees the management of sport injuries and provides to parents, students, faculty, coaches, and staff educational sessions about injury and concussion management protocols. During Fall 2015 and Spring 2016, these sessions reached over 200 families.MDI Marathon: MDI Hospital has provided medical support and organizes volunteers for miles 8 and 10 for the MDI Marathon for the past 12 years. (continued)
Part VI, Line 6:	N/A
Part VI, Line 7, Reports Filed With States	ME
Schedule H, Part VI, Line 5 (continued)	Pharmaceutical Support for EMS Crash Boxes: The local EMS and the Mount Desert Island Hospital pharmacy have an ongoing relationship where the Hospital pharmacy provides the medications for the ambulance services at no cost. This service allows the EMS crews to have the needed lifesaving medications on hand for MDI residents. EMS and the pharmacy work closely to ensure compliance and ensure that the best medications are available for any emergency.YES (Your Exercise Solution) class in Bar Harbor: MDI Hospital's free Wellness program provided two classes per week for fifty weeks to a total of 1,400 participants.Free Blood Pressure Clinics: MDI Hospital's Wellness Department provided free blood pressure clinics throughout Mount Desert Island, serving 84 people.Community Walking Program: A total of 192 participants participated in the Hospital's free spring and fall walking programs.Prescription Assistance Program: At no cost, MDI Hospital's Prescription Assistance Program helps those who lack prescription coverage access free or reduced cost medications available through programs sponsored by pharmaceutical companies. Between May 2015 and April 2016, the program helped 104 new patients receive free prescriptions valued at $137,000 wholesale. Since 2007, the program has saved eligible participants over $1,935,000.Chronic Disease Prevention Programs: MDI Hospital continues to provide support for programs operated by Healthy Acadia for the management of chronic disease.Free Cancer Support Group: With sponsorship from the MDI Hospital Auxiliary and MDI Behavioral Health Center, and in collaboration with the Beth C. Wright Cancer Resource Center, MDI Hospital provides free monthly support groups for patients, survivors, and their families.Affordable Care Act Education: During fiscal year 2016, MDI Hospital offered fourteen community based education and health insurance enrollment sessions designed to help community members explore their health insurance options on the Health Insurance Marketplace. In addition, the eight hospital employees certified as application counselors during fiscal year 2016 offered individual appointments, phone, internet and social media support, totaling 341.7 hours.

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- 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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

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 on 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 of the expenses described above? If "No," complete Part III to explain .........

Yes

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

Yes

Indicate which, if any, of the following the filing organization used 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 on 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? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

For persons listed on 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 ............

Yes

Were any amounts reported on 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" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 (E) amounts for that individual.

(A) Name and Title		(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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(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)
1Stuart Davidson MDTrustee/Medical Staff Pres	(i) (ii)	457,118 ------------- 0	150 ------------- 0	34,651 ------------- 0	0 ------------- 0	46,312 ------------- 0	538,231 ------------- 0	0 ------------- 0
2Julian Kuffler MD2nd Vice Chair/Physician	(i) (ii)	248,981 ------------- 0	0 ------------- 0	7,122 ------------- 0	0 ------------- 0	45,901 ------------- 0	302,004 ------------- 0	0 ------------- 0
3Arthur J BlankPresident & CEO	(i) (ii)	282,072 ------------- 0	14,106 ------------- 0	31,080 ------------- 0	0 ------------- 0	24,257 ------------- 0	351,515 ------------- 0	0 ------------- 0
4Christina Maguire-HardingVP Finance/Treasurer/Clerk	(i) (ii)	169,452 ------------- 0	325 ------------- 0	0 ------------- 0	6,987 ------------- 0	26,501 ------------- 0	203,265 ------------- 0	0 ------------- 0
5Michael Heniser DOPhysician	(i) (ii)	346,774 ------------- 0	0 ------------- 0	26,868 ------------- 0	0 ------------- 0	49,623 ------------- 0	423,265 ------------- 0	0 ------------- 0
6Nathan Donaldson DO MHA FACEPPhysician	(i) (ii)	253,501 ------------- 0	20,000 ------------- 0	32,878 ------------- 0	0 ------------- 0	76,816 ------------- 0	383,195 ------------- 0	0 ------------- 0
7Michelle Kinbrook MDPhysician	(i) (ii)	265,601 ------------- 0	0 ------------- 0	5,735 ------------- 0	0 ------------- 0	29,940 ------------- 0	301,276 ------------- 0	0 ------------- 0
8Mary Dudzik MDPhysician	(i) (ii)	262,200 ------------- 0	0 ------------- 0	5,285 ------------- 0	0 ------------- 0	49,683 ------------- 0	317,168 ------------- 0	0 ------------- 0
9Tanya Hanke DOPhysician	(i) (ii)	223,415 ------------- 0	0 ------------- 0	30,735 ------------- 0	0 ------------- 0	49,683 ------------- 0	303,833 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
Part I, Line 1a	The Hospital provides the President & CEO's fitness membership, which is approximately $399 per year. The Hospital reimburses all other benefitted employees, including other employees listed in Part VII, $100 annually toward a health club membership with appropriate supporting documentation.
Part I, Line 7	Performance-based variable compensation which is subject to review annually.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- 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

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Mount Desert Island Hospital

Employer identification number
01-0211797

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	MHHEFA 2006F Bond	01-0314384		07-03-2005	707,200	Replacement of central chiller		X		X		X
B	MHHEFA 2007B Bond	01-0314384		07-03-2007	4,427,988	Clinic construction, office and clinic space		X		X		X
C	MHHEFA 2010B Bond	01-0314384		07-01-2010		Reinfinancing of 1998A bond for renovation of outpatient service area		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 ..................	707,200		4,427,988		1,200,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	707,200		4,427,988
11 Other spent proceeds .............					1,200,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2008		2009		1999
	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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

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 .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 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 the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...	X			X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......				X		X
b Exception to rebate? ........				X		X
c No rebate due? .........			X		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X
4a 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 ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X			X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
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?	X		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: MHHEFA 2007B Bond Date the Rebate Computation was Performed: 12/29/2012 Issuer Name: MHHEFA 2010B Bond Date the Rebate Computation was Performed: 08/21/2015

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- 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, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting 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 assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

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) Dr John Benson	Trustee	322,066	John Benson, MD is the proprietor of J&D Imaging, Inc. which is contracted with MDI Hospital to preform radiology and imaging services. The equipment is under lease from J&D Imaging, Inc. Although Dr. Benson is a member of the Board of Trustees, he abstains from any motion or situation which may be deemed a conflict of interest and duly reports and completes all required disclosure documents. All transactions are at arms-length.		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Information about Schedule M (Form 990) and its instructions is at www.irs.gov/form990

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	4	32,334	Stock Exchange Value
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that

it must hold for at least three years from the date of the initial contribution, and which is not required to be used

for exempt purposes for the entire holding period? ..................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2015)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Line 32b:	The Hospital gift acceptance policy stipulates that stock donations are sold by their third-party investment advisors as soon as administratively possible.

Schedule M (Form 990) (2015)

Additional Data

Software ID:
Software Version:

- 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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

Return Reference	Explanation
Form 990, Part VI, Section A, line 4	The Hospital's bylaws, amended in June 2015, establish an Audit Committee separate from the Finance Committee. Previously, the Finance Committee was responsible for "Recommending to the Board the auditors for the Corporation, securing and overseeing any necessary financial audits (including the appointment, compensation, retention, oversight, and partner rotation of any financial auditors), and assisting the Board with its review of annual audits." The Audit Committee is now responsible for these items. The Audit Committee is made up only of members who "are not employees of the organization or an immediate family member of an employee of the organization. Immediate family members refer to a person's spouse (including partners from same sex marriages or civil unions), children, parents, grandparents, siblings, as well as one's in-laws. It also includes adopted children and stepchildren. In addition members are not eligible if they engage in any private business transaction with the organization or receive compensation from an entity that has material business relationships with the organization." The Chair of the Finance Committee serves on the Audit Committee.
Form 990, Part VI, Section B, line 11	The Form 990 is prepared by an outside independent accounting firm with input and assistance from Finance Department staff. The initial review of the Form 990 is performed by the Finance Committee of the Hospital's Board of Directors. Members are provided with an electronic copy of the Form 990 and all supporting schedules (printed versions are also available upon request). Once the Finance Committee has completed its review, all Board of Trustees members are provided with a copy of the Form 990 and supporting schedules. Board Members are given the opportunity to comment and review before the Form 990 is filed with the IRS. The President & CEO and the VP of Finance & CFO are available to answer any inquiries from Board members. Board Members are also provided with a copy of the final Form 990 as it is filed.
Form 990, Part VI, Section B, line 12c	Mount Desert Island Hospital monitors and enforces compliance with the conflict of interest policy by requiring all Trustees, officers, and committee members to annually sign a statement affirming that each person has received, read, and understands the conflict of interest policy and that no such conflict exists. Additionally, interested persons have a duty to disclose any actual or possible conflicts of interest at the time they arise. After disclosing a potential conflict of interest and answering any questions that might be asked concerning such interest, the affected person shall withdraw from any meetings, deliberations, votes, or other matters concerning the conflict. To ensure that the Hospital does not engage in activities that could jeopardize its tax exempt status, the Board or a committee appointed by the Board, periodically reviews compensation and similar arrangements to ensure they are reasonable and are the result of arms-length bargaining. In conducting these reviews the Board may use outside advisors.
Form 990, Part VI, Section B, line 15	The process used by Mount Desert Island Hospital for determining the President & CEO's compensation includes a review and approval by the governing body of the Organization. The governing body uses market data from an independent source to compare compensation models of similarly sized organizations within like demographic and geographic areas to align compensation packages. The compensation of other officers and key employees is reviewed by the Human Resources Department using the same market data guidelines to compare and establish compensation for these positions.
Form 990, Part VI, Section C, line 19	The annual report and Form 990 are available to the public on the Hospital's website. Governing documents, the conflict of interest policy, and the financial statements are available upon request.
Form 990, Part VII, Section A, Line 1:	Dr. Stuart Davidson and Dr. Julius Kuffler are employees and/or independent contractors affiliated with Mount Desert Island Hospital. Compensation paid to them is for their services in these roles, and not for their services as Trustees.
Form 990, Part IX, line 11g	Consulting: Program service expenses 0. Management and general expenses 107,341. Fundraising expenses 0. Total expenses 107,341. Purchased Services: Program service expenses 5,397,390. Management and general expenses 1,972,334. Fundraising expenses 0. Total expenses 7,369,724. Physician Fees: Program service expenses 745,044. Management and general expenses 43,280. Fundraising expenses 0. Total expenses 788,324. Outside Lab Fees: Program service expenses 463,944. Management and general expenses 0. Fundraising expenses 0. Total expenses 463,944.
Form 990, Part XII, Line 2c:	The Hospital established an Audit Committee separate from the Finance Committee during the fiscal year. The newly established committee assumed the responsibility of overseeing the audit of the financial statements and the selection of an independent accountant firm.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mount Desert Island Hospital

Employer identification number

01-0211797

Part I

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

(a) Name, address, and EIN (if applicable) 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 entity?
(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)Birch Bay Retirement Village PO Box 8 10 Wayman Lane Bar Harbor,ME046090008 01-0481696	Retirement Community	ME	501(c)(3)	Line 11a, I	Mount Desert Island Hospital	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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 V-UBI 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 V-UBI 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)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(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)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) Mount Desert Management Company PO Box 8 10 Wayman Lane Bar Harbor,ME04609 01-0538776	Real Estate Development	ME	N/A	C				No

Schedule R (Form 990) 2015

Page 3

Part V

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

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

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, or (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 Dividends from related organization(s) ............................

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

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

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

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

Yes

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

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

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

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

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

Yes

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

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

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

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

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Birch Bay Retirement Village	A	3,000	Actual Cash Value

Schedule R (Form 990) 2015

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 V-UBI 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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Critical access hospital, providing medical & healthcare services located in Bar Harbor, ME.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	499
6	Total number of volunteers (estimate if necessary) .............	6	211
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,319,028	1,413,911
9	Program service revenue (Part VIII, line 2g) .........	52,450,688	53,807,800
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	155,981	210,657
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	27,800	-14,038
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	53,953,497	55,418,330
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	30,997,961	31,843,846
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 141,704
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	22,258,637	23,447,485
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	53,256,598	55,291,331
19	Revenue less expenses. Subtract line 18 from line 12.......	696,899	126,999
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	49,324,045	48,075,250
21	Total liabilities (Part X, line 26).............	28,334,373	27,536,900
22	Net assets or fund balances. Subtract line 21 from line 20.....	20,989,672	20,538,350

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 44,071,876 including grants of $ 0 ) (Revenue $ 53,820,400 )
	In fiscal year 2016, MDI Hospital provided $4,749,616 in services for which no compensation was expected or received. Financial Assistance Policies exist to provide relief for those who cannot pay for medical care. MDI Hospital provides care to persons covered by governmental programs including Medicare, Medicaid, VA, and CHAMPUS. The unreimbursed value for providing care to these patients approximates $1,417,459. The Hospital continues to provide a number of health services and preventative health programs to the community. Available programs include cardiac pulmonary rehabilitation, wellness programs, diabetes education, annual wellness exams, nutrition counseling, parenting, pregnancy and sibling classes, physical and occupational therapy programs, speech therapy, medication therapy management, health coaching, care management, coagulation management and our oral health program which included education and outreach to the community, schools and service providers. Throughout the year, staff from the Hospital makes presentations to area school children regarding smoking cessation, wellness, health, activity, nutrition, and oral health, including a Give Kids a Smile day in which free or reduced cost screenings are available. Additionally, community groups such as Alcoholics Anonymous, Cancer Support, and Palliative Care use the Hospital's conference rooms for their meetings. Many hospital staff members serve other nonprofits in capacities such as volunteer hours, and board of directors' memberships, as well as memberships in service organizations such as the local Healthy Acadia, Rotary, and Lions clubs.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses44,071,876

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(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) Arthur J Blank........................................................................ President & CEO	40.00 .......................2.00	X	X		327,258	0	24,257
(19) Christina Maguire-Harding........................................................................ VP Finance/Treasurer/Clerk	40.00 .......................1.00		X		169,777	0	33,488
(20) Audrey Leavitt........................................................................ Secretary	40.00 .......................0.00		X		40,673	0	30,114
(21) Michael Heniser DO........................................................................ Physician	40.00 .......................0.00			X	373,642	0	49,623
(22) Nathan Donaldson DO MHA FACEP........................................................................ Physician	40.00 .......................0.00			X	306,379	0	76,816
(23) Michelle Kinbrook MD........................................................................ Physician	40.00 .......................0.00			X	271,336	0	29,940
(24) Mary Dudzik MD........................................................................ Physician	40.00 .......................0.00			X	267,485	0	49,683
(25) Tanya Hanke DO........................................................................ Physician	40.00 .......................0.00			X	254,150	0	49,683

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,758,722	0	435,817

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	28,820
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,385,091

g	Noncash contributions included in lines 1a-1f:$ 32,334
h Total.Add lines 1a-1f.......		1,413,911

		Business Code
2a	Patient Services	621990	50,408,706	50,408,706
b	Pharmacy	621400	1,273,087	1,273,087
c	Other Operating	621400	1,076,682	1,076,682
d	Meaningful Use	621400	529,622	529,622
e	Healthcare Administration	621400	320,861	320,861
f	All other program service revenue.			198,842	198,842
g Total.Add lines 2a–2f.....			53,807,800

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			266,658			266,658
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		12,600
b	Less: rental expenses		0
c	Rental income or (loss)		12,600
d	Net rental income or (loss)......			12,600	12,600
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		4,776,196
b	Less: cost or other basis and sales expenses	46,333	4,785,864
c	Gain or (loss)	-46,333	-9,668
d	Net gain or (loss).....			-56,001			-56,001
8a	Gross income from fundraising events (not including $ 28,820of contributions reported on line 1c). See Part IV, line 18 ....
	a		14,545
b	Less: direct expenses ...b		41,183
c	Net income or (loss) from fundraising events..			-26,638			-26,638
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..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See Instructions......			55,418,330	53,820,400	0	184,019

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,822,176	1,196,608	625,568
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	21,902,609	17,557,621	4,245,256	99,732
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	502,633	361,830	140,803
9	Other employee benefits .......	6,025,497	4,308,780	1,716,717
10	Payroll taxes ...........	1,590,931	1,129,561	461,370
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	104,492		104,492
c	Accounting ...........	153,144		153,144
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	33,424		33,424
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	8,729,333	6,606,378	2,122,955
12	Advertising and promotion ....	68,635		68,635
13	Office expenses .......	4,346,262	4,183,533	120,757	41,972
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	867,449	704,850	162,599
17	Travel ............	73,605	52,509	21,096
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	280,492	132,423	148,069
20	Interest ...........	751,700	600,011	151,689
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	1,610,958	1,288,767	322,191
23	Insurance ...	384,309	274,433	109,876
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Bad Debt Expense	3,702,221	3,702,221
b	Hospital Provider Tax	1,125,762	1,125,762
c	Equipment Rental/Mainte	310,920	272,430	38,490
d	Food and Nutrition	196,165	196,165
e	All other expenses	708,614	377,994	330,620
25	Total functional expenses. Add lines 1 through 24e	55,291,331	44,071,876	11,077,751	141,704
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).

1	Cash–non-interest-bearing ........			2,039	1	2,290
2	Savings and temporary cash investments .........			84,378	2	1,772,351
3	Pledges and grants receivable, net ......			1,167,013	3	154,775
4	Accounts receivable, net .............			6,791,636	4	7,700,678
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			609,760	8	711,591
9	Prepaid expenses and deferred charges ......			246,500	9	452,808
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	49,779,186
b	Less: accumulated depreciation	10b	28,209,553	22,661,093	10c	21,569,633
11	Investments—publicly traded securities .			10,970,434	11	8,335,471
12	Investments—other securities. See Part IV, line 11 .....			1,902,127	12	1,801,125
13	Investments—program-related. See Part IV, line 11 ..			40,000	13	80,000
14	Intangible assets ...............			55,412	14	44,629
15	Other assets. See Part IV, line 11 ...........			4,793,653	15	5,449,899
16	Total assets. Add lines 1 through 15 (must equal line 34)...			49,324,045	16	48,075,250

17	Accounts payable and accrued expenses .....	7,327,256	17	9,158,634
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	3,091,925	20	2,622,786
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other 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 ..	7,016,390	23	6,120,738
24	Unsecured notes and loans payable to unrelated third parties ..	2,995,656	24	2,200,892
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	7,903,146	25	7,433,850
26	Total liabilities. Add lines 17 through 25..	28,334,373	26	27,536,900

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	16,473,244	27	16,702,491
28	Temporarily restricted net assets ...........	2,450,152	28	1,831,059
29	Permanently restricted net assets	2,066,276	29	2,004,800
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........	20,989,672	33	20,538,350
34	Total liabilities and net assets/fund balances ........	49,324,045	34	48,075,250