TY 2016 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) MELLISSA MCAVOY EDWARDS...................................................................... BOARD PRESIDENT	5.00 ................. 0.00	X	X		0	0
(2) THOMAS MALCOLM...................................................................... PAST PRES, BOARD SEC/TRES	5.00 ................. 0.00	X	X		0	0
(3) LEE LAMSON...................................................................... BOARD VICE PRESIDENT	5.00 ................. 0.00	X	X		0	0
(4) DANIEL HERBERT MD...................................................................... DIRECTOR, CHIEF MEDICAL OFFICER	40.00 ................. 0.00	X			297,366	27,932
(5) JOYCE GIVEN...................................................................... DIRECTOR, HOSP. AUXILIARY	5.00 ................. 0.00	X			0	0
(6) HERBERT CLARK...................................................................... DIRECTOR	5.00 ................. 0.00	X			0	0
(7) GAIL FANJOY...................................................................... DIRECTOR	5.00 ................. 0.00	X			0	0
(8) PATRICK E HUNT ESQ...................................................................... DIRECTOR	5.00 ................. 0.00	X			0	0
(9) TINA JAMO...................................................................... DIRECTOR	5.00 ................. 0.00	X			0	0
(10) FRED LEWIS...................................................................... DIRECTOR	5.00 ................. 0.00	X			0	0
(11) ROBERT PETERSON...................................................................... CEO	50.00 ................. 0.00		X		211,547	9,985
(12) CATHERINE LEMAY...................................................................... CFO	50.00 ................. 0.00		X		131,808	9,465
(13) NILESH PATIL MD...................................................................... SURGEON	40.00 ................. 0.00			X	442,180	25,254
(14) KWAKU OWUSU-ABROKWA MD...................................................................... HOSPITALIST	40.00 ................. 0.00			X	234,728	13,155
(15) EDWARD DUNSTAN DO...................................................................... FAMILY PRACTICE	40.00 ................. 0.00			X	276,959	25,058
(16) MARK KOWALSKI...................................................................... SURGEON	40.00 ................. 0.00			X	500,721	32,930
(17) MUHAMMAD RAUF MD...................................................................... SURGEON	40.00 ................. 0.00			X	137,467	6,779

(A) Name and business address	(B) Description of services	(C) Compensation
CPSI PO BOX 850309 MOBILE,IA36685	INFORMATION SYSTEMS	298,670
KATAHDIN SHARED SERVICES INC 200 SOMERSET STREET MILLINOCKET,ME04462	ULTRASOUND SERVICES	285,942
CORE MEDICAL 3000 GOFFS FALLS RD STE 101 MANCHESTER,NH03103	LOCUM PHYSICIAN SERVICES	279,193
MAYO REGIONAL HOSPITAL 897 WEST MAIN STREET DOVERFOXCROFT,ME04426	CONTRACTED PHYSICIAN SERVICES	247,442
EASTERN MAINE MEDICAL CENTER 489 STATE STREET NEWPORT BANGORBEACH,ME04401	CONTRACTED PHYSICIAN SERVICES	223,977
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 14

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization MILLINOCKET REGIONAL HOSPITAL

Part I Contributors	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization MILLINOCKET REGIONAL HOSPITAL		Employer identification number 01-0223482

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization MILLINOCKET REGIONAL HOSPITAL			Employer identification number 01-0223482
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) (2019)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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|No

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

8,262

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

8,262

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:	THE ORGANIZATION PAYS DUES TO THE MAINE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE ATTRIBUTABLE TO LOBBYING EXPENSES.

Schedule C (Form 990 or 990EZ) 2019

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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)

(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 .....	49,951		49,951
b	Buildings ....	7,126,936	4,319,904	2,807,032
c	Leasehold improvements	695,853	608,265	87,588
d	Equipment ....	12,767,554	10,623,006	2,144,548
e	Other .....	278,252		278,252
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				5,367,371

Schedule D (Form 990) 2019

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) INVESTMENT IN SUB	1,466,353	F
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	1,466,353

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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)OTHER ASSETS				7,313
(2)ESTIMATED THIRD PARTY PAYOR SETTLEMENTS				1,610,000
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				1,617,313

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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,185,970
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) 2019

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
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part 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
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
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part 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 X, LINE 2:

THE HOSPITAL IS ORGANIZED AS A MAINE NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOSPITAL HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED.

Schedule D (Form 990) 2019

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

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? . . . . . .

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) . . .	681,000		681,000	2.210 %
b	Medicaid (from Worksheet 3, column a) . . . . .	3,089,090	2,783,012	306,078	0.990 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	3,770,090	2,783,012	987,078	3.200 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	323,610	112,703	210,907	0.690 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	323,610	112,703	210,907	0.690 %
k	Total. Add lines 7d and 7j .	4,093,700	2,895,715	1,197,985	3.890 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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 Healthcare 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. ......

2,120,423

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).....

10,318,923

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

10,451,069

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

-132,146

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) 2019

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?1Name, 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	MILLINOCKET REGIONAL HOSPITAL 200 SOMERSET STREET MILLINOCKET,ME04462 WWW.MRHME.ORG 38579	X	X	X

Schedule H (Form 990) 2019

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)

	MILLINOCKET REGI0NAL 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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

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

Yes

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): HTTP://WWW.MRHME.ORG/ABOUT-US/

Other website (list url): SEE NARRATIVE AT 7D

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 16

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

Yes

If "Yes" (list url): HTTP://WWW.MRHME.ORG/

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	MILLINOCKET REGI0NAL 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 200.000000000000%

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)

Was widely publicized 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):

HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/

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

HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/

A plain language summary of the FAP was widely available on a website (list url):
HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	MILLINOCKET REGI0NAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	MILLINOCKET REGI0NAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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

Yes

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
MILLINOCKET REGI0NAL HOSPITAL	PART V, SECTION B, LINE 5: THE MAINE SHARED HEALTH NEEDS ASSESSMENT AND PLANNING PROCESS (SHNAPP) PROJECT IS A COLLABORATIVE EFFORT AMONG MAINE'S FOUR LARGEST HEALTHCARE SYSTEMS - CENTRAL MAINE HEALTHCARE, EASTERN MAINE HEALTHCARE SYSTEMS (EMHS), MAINEGENERAL HEALTH (MGH) AND MAINEHEALTH - AS WELL AS THE MAINE CENTER FOR DISEASE CONTROL AND PREVENTION (MAINE CDC), AN OFFICE OF THE MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES (MAINE DHHS). THE CURRENT COLLABORATION EXPANDS UPON THE ONEMAINE HEALTH COLLABORATIVE CREATED IN 2007 AS A PARTNERSHIP AMONG EMHS, MGH AND MAINEHEALTH. THE MAINE CDC AND OTHER PARTNERS JOINED THESE ENTITIES TO DEVELOP A PUBLIC-PRIVATE PARTNERSHIP IN 2012. THE FOUR HOSPITAL SYSTEM AND THE MAINE CDC SIGNED A MEMORANDUM OF UNDERSTANDING IN EFFECT BETWEEN JUNE 2014 AND DECEMBER 2019 COMMITTING RESOURCES TO THE MAINE SHNAPP PROJECT. THIS SHARED CHNA INCLUDES A LARGE SET OF STATISTICS ON HEALTH STATUS AND RISK FACTORS FROM EXISTING SURVEILLANCE AND HEALTH DATASETS AND INCLUDES INPUT FROM A BROAD SET OF STAKEHOLDERS FROM ACROSS THE STATE FROM THE 2015 SHNAPP STAKEHOLDERS' SURVEY. INFORMATION IS REPORTED BY COUNTY AND REGION TO MAKE IT USEFUL FOR APPLICATION BY INDIVIDUAL HOSPITALS AND OTHER HEALTHCARE ORGANIZATIONS ACROSS THE STATE.
MILLINOCKET REGI0NAL HOSPITAL	PART V, SECTION B, LINE 6A: ACADIA HOSPITAL, CHARLES A. DEAN MEMORIAL HOSPITAL, EASTERN MAINE MEDICAL CENTER, MAYO REGIONAL HOSPITAL, PENOBSCOT VALLEY HOSPITAL, MILLINOCKET REGIONAL HOSPITAL
MILLINOCKET REGI0NAL HOSPITAL	PART V, SECTION B, LINE 6B: BANGOR PUBLIC HEALTH AND COMMUNITY SERVICESDOWN EAST AIDS NETWORK AND THE HEALTH EQUITY ALLIANCEEMHSHEALTH ACCESS NETWORKHEALTHY MAINE PARTNERSHIPSMAINE CENTER FOR DISEASE CONTROL AND PREVENTIONPARTNERSHIP FOR A HEALTHY NORTHERN PENOBSCOTPENOBSCOT COMMUNITY HEALTH CAREPENQUIS PUBLIC HEALTH DISTRICT COORDINATING COUNCILPISCATAQUIS PUBLIC HEALTH COALITIONPISCATAQUIS REGIONAL YMCARIVER COALITIONUNITED WAY OF EASTERN MAINEUNIVERSITY OF MAINE COOPERATIVE EXTENSIONWABANAKI PUBLIC HEALTH DISTRICT
MILLINOCKET REGI0NAL HOSPITAL	PART V, SECTION B, LINE 7D: THE CHNA REPORT IS AVAILABLE AT:HTTP://WWW.MAINE.GOV/DHHS/MECDC/PHDATA/SHNAPP/COUNTY-REPORTS.SHTML
MILLINOCKET REGI0NAL HOSPITAL	PART V, SECTION B, LINE 11: MRH IS ADDRESSING ALL IDENTIFIED HEALTH NEEDS, AS LISTED BELOW:MAINTAIN A COMMUNITY BASED HOSPITAL OBESITY, AS MEASURED BY:- INCREASED AWARENESS AND IMPROVEMENT IN PHYSICAL ACTIVITY AND NUTRITION- PHYSICAL ACTIVITY IN ADULTS, AND IN HIGH SCHOOL STUDENTS- FRUIT AND VEGETABLE CONSUMPTION.IMPROVED ACCESS TO BEHAVIORAL CARE / MENTAL HEALTH CARE, AS MEASURED BY:- ANXIETY / DEPRESSION, HOPELESSNESS AND SADNESS- RECEIVING MEDICATIONS FOR ANXIETY / DEPRESSION- COMORBIDITIES- EMERGENCY VISITS FOR MENTAL HEALTH.INCREASED ACCESS FOR NON-URGENT & NON-EMERGENT CARE, AND FAMILY & PEDIATRIC CARE, AS EVIDENCED BY:- INCREASING VOLUME OF NON-URGENT & NON-EMERGENT VISITS IN ED; - COMMUNITY REQUESTS FOR ACCESS TO AFTER-HOURS CARE, EVENINGS AND WEEKENDS AND FAMILY / PEDIATRIC CARE.NEED FOR ADDITIONAL SPECIALTIES IN THE COMMUNITY AS NOTED BY: - MEDICAL STAFF HIGH REFERRAL OUT OF COMMUNITY FOR CONSULTATIONS IN NEUROLOGY, PULMONARY AND SLEEP MEDICINE, ENDOCRINOLOGY AND RHEUMATOLOGY, AND ANTICIPATE ONCOLOGY, IF NOT MAINTAINED. -INCREASE PRIVACY AT REGISTRATION -MORE RESOURCES ARE NEEDED TO SUPPORT THE HEALTHCARE NEEDS OF ADULTS WITH CHRONIC HEALTH CONDITIONS.-POVERTY & EMPLOYMENT -CONTINUOUS IMPROVEMENT IN THE PATIENT EXPERIENCE OF CARE -HCAHPS SURVEY RESULTS IN 7 COMPOSITE AREAS-COMMUNITY WILL NEED OPTOMETRIST WITH LOCAL OPTOMETRIST PLANS FOR RETIREMENT-NEED TO REDUCE COSTS TO CUSTOMERSHOW TO ADDRESS THESE NEEDS IDENTIFIED:-WE HAVE JOINED THE COMMUNITY CARE PARTNERSHIP OF MAINE. WE HAVE LEADERS FROM OUR PHYSICIAN PRACTICES, PHARMACY AND ADMINISTRATION PARTICIPATING REGULARLY. -THE ACO IS COLLABORATING TO MEASURE AND IMPROVE POPULATION HEALTH IN OUR COMMUNITIES SERVED. -MEASUREMENT AND IMPROVEMENTS ARE TAKING PLACE CONCURRENTLY IN THE AREAS OF DEPRESSION AND BEHAVIORAL HEALTH, AND CHRONIC DISEASE MANAGEMENT, INCLUDING DIABETES SCREENING AND TREATMENT, AND BMI ASSESSMENT AND MANAGEMENT.-AS AN ORGANIZATION WE HAVE MADE THE COMMITMENT TO UPGRADE OUR ELECTRONIC HEALTH RECORD (EHR)-LIFE STYLE CHANGES CLASS IS A NEW CLASS OFFERED AT NO CHARGE TO THE COMMUNITY. THE GOAL OF THE PROGRAM IS TO HELP INDIVIDUALS AT RISK FOR TYPE 2 DIABETES LOSE WEIGHT AND BEGIN TO EXERCISE REGULARLY IN AN EFFORT TO PREVENT GETTING TYPE 2 DIABETES. THE PROGRAM INCLUDES 16 CLASSES AND WILL CONTINUE FOR ONE YEAR, INCLUDING MONTHLY CLASSES ONCE THE INITIAL 16 WEEKLY CLASSES ARE COMPLETED. CLASSES WILL BE HELD IN THE MULTIPURPOSE ROOM AT MRH.-BASED ON POSITIVE FEEDBACK AND ENCOURAGEMENT FROM BOARD AND OTHER COMMUNITY MEMBERS, MRH HELD A HEALTH FAIR IN THE SUMMER OF 2017. AS IN PRIOR YEARS, ATTENDEES WERE ASKED TO COMPLETE SURVEYS TO AND GIVE SUGGESTIONS FOR FUTURE FAIRS. -WE HAVE IMPLEMENTED CHANGES IN OUR ORGANIZATION THAT HELP THE STAFF AND VISITORS TO COMPLY WITH THE RECOMMENDATIONS OF THE "LET'S GO! 5-2-1-0". AS EXAMPLES WE HAVE ELIMINATED HIGH SUGAR DRINKS FROM OUR ORGANIZATION, NUTRITION LABELS ARE APPLIED TO SNACKS, WHICH ARE CONTROLLED AND SHOULD BE NO MORE THAN 300 CALORIES. -SPECIALTY CLINICS SET UP OFFICE SPACE FOR WEEKEND TELEMEDICINE CLINICS TO PROVIDE SPECIALTY SERVICES IN SLEEP MEDICINE, NEUROLOGY AND PULMONOLOGY. -MRH CONTINUES TO PARTICIPATE AND PLAY A LEADERSHIP ROLE IN THE "THRIVING IN PLACE" TIP PROJECT. THE ACTIVITY IS ONGOING; PROJECT OBJECTIVES INCLUDE THE FOLLOWING: 1. INCREASE COMMUNITY AWARENESS OF THRIVING IN PLACE (TIP) INITIATIVE BY 11/30/20172. INCREASE THE NUMBER OF PARTNERS INVOLVED IN THE TIP INITIATIVE BY 11/30/20173. INCREASE THE NUMBER OF CONSUMERS INVOLVED IN THE TIP INITIATIVE BY 11/30/2017.4. INCREASE HEALTHCARE AND SOCIAL SERVICE PROVIDER KNOWLEDGE OF AVAILABLE COMMUNITY RESOURCES BY 11/30/2017. 5. PROMOTE AVAILABILITY OF LOCAL RESOURCES FOR TRANSPORTATION TO COMMUNITY MEMBERS ON AN ONGOING BASIS.6. INCREASE THE VOLUNTEER POOL OF DRIVERS THAT PROVIDE RIDES TO INDIVIDUALS IN NEED BY 6/30/2017. THIS NEED HAS BEEN MET.7. COLLABORATE WITH MILLINOCKET AND EAST MILLINOCKET/LINCOLN AMBULANCE TO DEVELOP A PHONE CALLING "CHECK IN" SYSTEM OF CARE FOR PERSONS LIVING ALONE AND IDENTIFIED AS IN POOR HEALTH OR SOCIALLY ISOLATED BY 6/30/2017. THIS NEED HAS BEEN MET.8. DEVELOP A LOCAL FOOD COUNCIL TO ADDRESS FOOD INSECURITY BY 3/1/2017. THIS NEED HAS BEEN MET.9. ESTABLISH THE MILLINOCKET MEMORIAL LIBRARY AS A "COMMUNITY CENTER" TO OFFER ONGOING PROGRAMING FOR TIP CONSUMERS THAT WILL PROVIDE OPPORTUNITIES FOR SOCIAL INTERACTION BY 9/30/2017.10. EVALUATE PROGRAM COMPONENTS TO UNDERSTAND IMPACT AND AREAS FOR STRENGTHENING BY 11/30/2017.-OPTOMETRY CLINIC SERVICES OPENED IN 2017.-AS PART OF THE ONGOING STRATEGIC PLANNING PROCESS, MRH IS ACTIVELY SEEKING WAYS TO ENHANCE COLLABORATION TO MAKE A POSITIVE IMPACT ON DRUG AND ALCOHOL ABUSE. EXAMPLES OF LOCAL GROUPS MRH WILL WORK WITH INCLUDE AA AND ALANON. MRH CURRENTLY PROVIDES "IN KIND" CONTRIBUTIONS BY PROVING A SAFE MEETING SPACE ON A REGULAR BASIS. THE GOAL IS TO TARGET OTHER AREAS OF POSITIVE LIFESTYLE CHANGE AND TO MAKE A POSITIVE IMPACT IN THIS AREA OF NEED IN OUR COMMUNITY.
MILLINOCKET REGI0NAL HOSPITAL	PART V, SECTION B, LINE 16J: MILLINOCKET REGIONAL HOSPITAL USES A NUMBER OF TACTICS TO NOTIFY MEMBERS OF THE COMMUNITY THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE WHO QUALIFY. THE FAP NOTICE, WHICH IS A PLAIN LANGUAGE SUMMARY WRITTEN AT AN 8TH GRADE READING LEVEL, IS POSTED AT ALL REGISTRATION POINTS AND ALSO ON OUR WEBSITE AT HTTP://WWW.MRHME.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/. EACH ACCOUNT STATEMENT SENT TO PATIENTS ALSO INCLUDES A NOTICE REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. FOR PATIENT ACCOUNTS FACING COLLECTIONS DUE TO UNPAID BALANCES RESULTING FROM VISITS TO OUR HOSPITAL OR PHYSICIAN CLINICS, WE INCLUDE THE FAP AND FINANCIAL ASSISTANCE APPLICATION ALONG WITH THEIR COLLECTION LETTER.ALL PATIENT ACCESS STAFF, CLINIC REGISTRATION PERSONNEL, INPATIENT AND OUTPATIENT CASE MANAGERS, FINANCIAL COUNSELOR, AND SOCIAL WORKER ARE FAMILIAR WITH MRH'S FINANCIAL ASSISTANCE POLICY. THESE MRH EMPLOYEES ACTIVELY REACH OUT TO PATIENTS TO ENSURE THEY ARE AWARE OF THE FAP. PROVIDERS AND SUPPORT STAFF IN ALL AREAS OF THE ORGANIZATION ARE PREPARED TO ASSIST INDIVIDUALS IN ACCESSING FAP INFORMATION. THE SOCIAL WORKER AND THE FINANCIAL COUNSELOR ARE READILY AVAILABLE TO SUPPORT ANYONE WHO MAY NEED HELP PURSUING FINANCIAL ASSISTANCE AT MRH.
MILLINOCKET REGI0NAL HOSPITAL	PART V, SECTION B, LINE 24: SERVICES NOT CONSIDERED MEDICALLY NECESSARY WERE BILLED AT GROSS CHARGES. THE POLICY SPECIFICALLY STATES IT DOES NOT COVER NON-MEDICALLY NECESSARY SERVICES.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
PART I, LINE 3C:	INCOME GUIDELINES AS SET BY HOSPITAL FINANCE RULES WILL BE USED IN DETERMINING ELIGIBILITY. PERCENTAGE OF BALANCE DISCOUNTED WILL BE DETERMINED BASED ON PATIENT'S INCOME LEVEL RELATIVE TO THE FEDERAL POVERTY LEVEL GUIDELINES. THESE GUIDELINES ARE UPDATED ANNUALLY BY THE FINANCIAL COUNSELOR.UP TO 150% FPL-100% BALANCE DISCOUNTED.151% TO 200% FPL-50% BALANCE DISCOUNTED.
PART I, LINE 7G:	CHARITY CARE EXPENSE ON LINE 7A WAS CONVERTED TO COST BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINES 7B AND 7G WERE DETERMINED BASED ON THE MEDICAID AND MEDICARE COST REPORTS.
PART I, LN 7 COL(F):	THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATIONS WAS $2,120,423.
PART III, LINE 2:	PATIENT ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF INDIVIDUAL ACCOUNTS AND HISTORICAL ADJUSTMENTS. BALANCES THAT ARE STILL OUTSTANDING, AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS, ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR MAJOR PAYOR SOURCE OF REVENUE FOR THE PURPOSES OF ESTIMATING THE APPROPRIATE AMOUNTS OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR BAD DEBTS. DATA IN EACH MAJOR PAYOR SOURCE ARE REGULARLY REVIEWED TO EVALUATE THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES RELATING TO SERVICES PROVIDED TO PATIENTS HAVING THIRD-PARTY COVERAGE, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CORRESPONDING PROVISION FOR BAD DEBTS ARE ESTABLISHED AT VARYING LEVELS BASED ON THE AGE OF THE RECEIVABLES AND PAYOR SOURCE. FOR RECEIVABLES RELATING TO SELF-PAY PATIENTS, A PROVISION FOR BAD DEBTS IS MADE IN THE PERIOD SERVICES ARE RENDERED BASED ON EXPERIENCE INDICATING THE INABILITY OR UNWILLINGNESS OF PATIENTS TO PAY AMOUNTS FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.
PART III, LINE 4:	PATIENT RECEIVABLES ARE UNCOLLATERALIZED PATIENT AND THIRD-PARTY PAYOR OBLIGATIONS. PAYMENTS OF PATIENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED IN THE REMITTANCE ADVICE OR, IF UNSPECIFIED, ARE APPLIED TO THE EARLIEST UNPAID CLAIM. PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S PROCESS FOR CALCULATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS HAS NOT SIGNIFICANTLY CHANGED FROM JUNE 30, 2016 TO JUNE 30, 2017. THE HOSPITAL DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE OFFS FROM THIRD-PARTY PAYORS. THE HOSPITAL HAS NOT SIGNIFICANTLY CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2017 OR 2016.
PART III, LINE 8:	MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2017.MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.
PART III, LINE 9B:	IN AN EFFORT TO BEST SERVE OUR PATIENTS, ALL FIRST-TIME STATEMENTS INCLUDE INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR QUALIFIED PATIENTS. OUR PATIENT FINANCIAL SERVICES DEPARTMENT USES SEVERAL RESOURCES TO DETERMINE IF A PATIENT MAY BE PRESUMPTIVELY ELIGIBLE FOR FINANCE ASSISTANCE; FOR EXAMPLE, ELIGIBILITY FOR OUT-OF-STATE MEDICAID, ELIGIBILITY FOR OTHER STATE-FUNDED ASSISTANCE PROGRAMS, SUCH AS FOOD STAMPS AND PATIENT HOMELESSNESS. IT IS OUR PRACTICE TO MAKE A REASONABLE ATTEMPT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BEFORE SENDING AN ACCOUNT TO A COLLECTION AGENCY. ANY ACCOUNTS PREVIOUSLY SENT TO COLLECTIONS WILL BE CONSIDERED FOR FINANCIAL ASSISTANCE WHEN AN APPLICATION IS RECEIVED; SO LONG AS THE SERVICES WERE RENDERED NOT MORE THAN 240 DAYS PREVIOUSLY, OR THE PATIENT WAS GIVEN A WRITTEN NOTICE THAT FINANCIAL ASSISTANCE WAS AVAILABLE FOR THOSE SPECIFIC SERVICES WITH A DEADLINE DATED AFTER THE 240 DAY PERIOD.
PART VI, LINE 2:	IT IS ONE OF OUR GOALS TO REMAIN WELL CONNECTED WITH THE COMMUNITY AND THEIR NEEDS, WHICH WE ACHIEVE BY OVERSEEING ONGOING ADVISORY GROUPS AND MEETINGS WHERE OUR ORGANIZATION CAN ASSESS PERCEPTIONS, NEEDS AND RECOMMENDATIONS. IN ADDITION, MRH LEADERS CONDUCT FOCUS GROUPS WITH EMPLOYEES IN LOCAL BUSINESSES TO EVALUATE WHETHER HEALTHCARE NEEDS ARE BEING MET AND TO IDENTIFY HOW MRH CAN BETTER SERVE THE COMMUNITY IN THE FUTURE.
PART VI, LINE 3:	INPATIENTS: IN ORDER TO IDENTIFY THOSE PATIENTS WHO WOULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ALL UNINSURED INPATIENTS ARE REFERRED TO THE FINANCIAL COUNSELOR BY PRE-REGISTRATION OR REGISTRATION PERSONNEL. THE FINANCIAL COUNSELOR WILL DO AN INITIAL SCREENING FOR PAYMENT OPTIONS PRIOR TO THE PATIENT LEAVING THE HOSPITAL, IF POSSIBLE. IF THE PATIENT HAS LEFT THE HOSPITAL, THE FINANCIAL COUNSELOR WILL ATTEMPT TO CONTACT THE PATIENT FOR INFORMATION. ALL INPATIENTS ARE GIVEN A COPY OF PATIENT FREE CARE AND DISCOUNT ARRANGEMENTS GUIDELINES AT TIME OF ADMISSION.SURGICAL OUTPATIENTS: THE FINANCIAL COUNSELOR WILL PROVIDE INFORMATION ABOUT PATIENT FREE CARE, DISCOUNT ARRANGEMENTS AND TERM PAYMENT ARRANGEMENTS TO ALL UNINSURED SURGICAL OUTPATIENTS. ALL SURGICAL OUTPATIENTS ARE PROVIDED A COPY OF PATIENT FREE CARE AND DISCOUNT ARRANGEMENTS GUIDELINES AT TIME OF REGISTRATION.EMERGENCY ROOM PATIENTS: ALL EMERGENCY ROOM PATIENTS ARE PROVIDED A COPY OF PATIENT FREE CARE AND DISCOUNT ARRANGEMENTS GUIDELINES AT TIME OF REGISTRATION.ALL OTHER OUTPATIENTS: ALL OTHER OUTPATIENTS ARE PROVIDED A COPY OF THE PATIENT FREE CARE/DISCOUNT ARRANGEMENTS GUIDELINES AT TIME OF REGISTRATION.ALL PATIENTS WILL RECEIVE NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE INCLUDED IN THEIR FIRST-TIME STATEMENT.PATIENT FINANCIAL SERVICES EMPLOYEES AND PHYSICIAN PRACTICE EMPLOYEES RECEIVE TRAINING ON PATIENT FREE CARE AND DISCOUNT ARRANGEMENTS GUIDELINES AND ARE EXPECTED TO BE ABLE TO PROVIDE CONTACT INFORMATION ABOUT FREE CARE AND DISCOUNT ARRANGEMENTS.
PART VI, LINE 4:	MILLINOCKET REGIONAL HOSPITAL HAS THREE COMMUNITIES IN ITS PRIMARY SERVICE AREA: MILLINOCKET, EAST MILLINOCKET AND MEDWAY. THERE ARE MULTIPLE SMALLER COMMUNITIES IN THE SECONDARY SERVICE AREA INCLUDING BROWNVILLE, WOODVILLE, STACYVILLE, SHERMAN, PATTEN AND ISLAND FALLS. THE AREA HAS STRUGGLED AND REALIZED AN UNEMPLOYMENT RATE IN THE TEENS FOR THE PAST TEN YEARS AND EXPERIENCED COMMUNITY OUT-MIGRATION. THE POPULATION OF THE PRIMARY SERVICE AREA IS APPROXIMATELY 7500 PEOPLE. THE EFFECT ON THE HOSPITAL OF THIS DEMOGRAPHIC AND POPULATION CHANGE HAS BEEN LARGE DECLINES IN PATIENT CARE VOLUMES SINCE 2013. THE AVERAGE MEDIAN HOUSEHOLD INCOME IS MORE THAN 20% LOWER THAN THE STATE AVERAGE. THE AVERAGE RESIDENT AGE IS MORE THAN 10% OLDER THAN THE STATE MEDIAN AGE.
PART VI, LINE 5:	MILLINOCKET REGIONAL HOSPITAL IS THE LARGEST EMPLOYER IN THE AREA AND SOLE COMMUNITY PROVIDER FOR ACUTE CARE. WE OPERATE AN EMERGENCY ROOM AVAILABLE TO ALL PATIENTS; REGARDLESS OF THEIR ABILITY TO PAY. MRH IS INVOLVED IN GOVERNMENT-SPONSORED HEALTH PROGRAMS AS WELL AS THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS, AND WE OFFER VOLUNTEER OPPORTUNITIES TO MEMBERS WITHIN THE COMMUNITY, WHO MAY NOT HAVE A HEALTHCARE BACKGROUND, BUT ARE PASSIONATE ABOUT OUR MISSION.OUR HOSPITAL IS GOVERNED BY A BOARD OF TRUSTEES; ALL OF WHOM RESIDE IN PRIMARY AND SECONDARY SERVICE AREAS. EMPLOYEES MAY PARTICIPATE IN BOARD MEETINGS BUT DO NOT HAVE VOTING CAPABILITIES; WITH THE EXCEPTION OF THE MEDICAL STAFF PRESIDENT, WHO HAS A VOTING MEMBERSHIP ON THE GOVERNING BOARD. BOARD MEMBERS WHOSE FAMILY MEMBERS ARE EMPLOYED BY MRH ARE REQUIRED TO IDENTIFY THE POTENTIAL CONFLICT IN WRITING AND ARE APPROPRIATELY RECUSED FROM ACTING ON MATTERS THAT MAY IMPACT DIRECTLY OR INDIRECTLY THEIR FAMILY MEMBERS. PHYSICIANS WHO WISH TO HAVE PRIVILEGES AT OUR HOSPITAL ARE NOT REQUIRED TO BE AN EMPLOYEE IN ORDER TO BECOME AN ACTIVE MEMBER OF THE MEDICAL STAFF. THEY MUST SEND A WRITTEN REQUEST TO THE MRH MEDICAL STAFF FOR REVIEW. PRIVILEGES ARE GRANTED TO QUALIFIED PHYSICIANS ONLY AFTER THE REQUEST IS REVIEWED AND THE NEEDS AND INTERESTS OF BOTH PARTIES HAVE BEEN EVALUATED. MRH IS AN ACTIVE PARTICIPANT IN THE COMMUNITY CARE PARTNERSHIP OF MAINE, AN ACCOUNTABLE CARE ORGANIZATION MADE UP OF MAINE BASED HOSPITALS AND HEALTHCARE CENTERS, WHICH GUIDES OUR ORGANIZATION TOWARD TRANSFORMING THE DELIVERY OF OUR HEALTHCARE SERVICES TO CENTER AROUND MEANINGFUL SHARING AND ACCOUNTABILITY FOR OUR PATIENTS' HEALTH. AS AN ORGANIZATION, MILLINOCKET REGIONAL HOSPITAL PRIORITIZES SURPLUS FUNDS FOR PROJECTS OR EXPENSES THAT HAVE A DIRECT IMPACT ON PATIENT CARE OR PATIENT AND EMPLOYEE SAFETY. THIS INCLUDES, BUT IS NOT LIMITED TO, TRAINING, TEACHING, AND PURCHASING SPECIALIZED AND IMPROVED EQUIPMENT TO KEEP PATIENTS SAFE.IT IS ONE OF OUR MANY GOALS TO REMAIN WELL CONNECTED WITH THE COMMUNITY AND THEIR NEEDS, WHICH WE ACHIEVE BY OVERSEEING ONGOING ADVISORY GROUPS AND MEETINGS WHERE OUR ORGANIZATION CAN ASSESS PERCEPTIONS, NEEDS AND RECOMMENDATIONS. IN ADDITION, MRH LEADERS CONDUCT FOCUS GROUPS WITH EMPLOYEES IN LOCAL BUSINESSES TO EVALUATE WHETHER HEALTHCARE NEEDS ARE BEING MET AND TO IDENTIFY HOW MRH CAN BETTER SERVE THE COMMUNITY IN THE FUTURE. INFORMATION GATHERED FROM ADVISORY GROUPS AND FOCUS GROUPS, PAIRED WITH THE PENOBSCOT SHARED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND OUR ANNUAL PERIODIC EVALUATION, ASSIST MRH TO ADD NEW SERVICES INCLUDING SLEEP MEDICINE, GASTROENTEROLOGY, ENDOCRINOLOGY, RHEUMATOLOGY, NEUROLOGY, AND OPTOMETRY, OPHTHALMOLOGY, AND WALK-IN CARE. RECOGNIZING THE LARGE ELDERLY POPULATION IN OUR AREA, AND THE NEED FOR MORE SERVICES TO HELP THEM LIVE HEALTHIER LIVES AND REMAIN INDEPENDENT, MRH HAS TAKEN ON THE ROLE OF EXECUTIVE SPONSOR FOR A THRIVING IN PLACE GRANT. MRH IS COMPLETELY COMMITTED TO SERVING OUR PATIENTS, SUPPORTING THEM IN MAINTAINING THEIR HEALTH, AND ASSISTING THEM TO RETAIN THEIR INDEPENDENCE.

Schedule H (Form 990) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

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 on 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 .........

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 on Line 1a? ..

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 nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

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) 2019

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)
1DANIEL HERBERT MD DIRECTOR, CHIEF MEDICAL OFFICER	(i) (ii)	263,766 ------------- 0	33,600 ------------- 0	0 ------------- 0	7,750 ------------- 0	20,182 ------------- 0	325,298 ------------- 0	0 ------------- 0
2ROBERT PETERSON CEO	(i) (ii)	211,547 ------------- 0	0 ------------- 0	0 ------------- 0	1,708 ------------- 0	8,277 ------------- 0	221,532 ------------- 0	0 ------------- 0
3NILESH PATIL MD SURGEON	(i) (ii)	442,180 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	25,254 ------------- 0	467,434 ------------- 0	0 ------------- 0
4KWAKU OWUSU-ABROKWA MD HOSPITALIST	(i) (ii)	234,728 ------------- 0	0 ------------- 0	0 ------------- 0	3,292 ------------- 0	9,863 ------------- 0	247,883 ------------- 0	0 ------------- 0
5EDWARD DUNSTAN DO FAMILY PRACTICE	(i) (ii)	276,959 ------------- 0	0 ------------- 0	0 ------------- 0	3,830 ------------- 0	21,228 ------------- 0	302,017 ------------- 0	0 ------------- 0
6MARK KOWALSKI SURGEON	(i) (ii)	500,721 ------------- 0	0 ------------- 0	0 ------------- 0	7,676 ------------- 0	25,254 ------------- 0	533,651 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

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

Schedule J (Form 990) 2019

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
MILLINOCKET REGIONAL HOSPITAL

Employer identification number
01-0223482

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MAINE HEALTH AND HIGHER EDUCATIONAL FACILITIES AUTHORITY	01-0314384	560427WV4	05-23-2013	1,423,837	REFINANCING OF 2003 D BOND ISSUE		X		X	X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	650,762
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	1,423,837
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	15,439
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	1,408,398
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	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
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

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
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
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 ....	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		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
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

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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........		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
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

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
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
7 Has the organization established written procedures to monitor the requirements of section 148? ...		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

Part Ⅵ

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

Return Reference	Explanation

Schedule K (Form 990) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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 the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-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) 2019

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) ROSE ANN HUNT PA	FAMILY MEMBER OF PATRICK HUNT, MEMBER OF BOD	155,073	EMPLOYMENT		No
(2) LAURIE VICKERS-HERBERT RN	FAMILY MEMBER OF DANIEL HERBERT	107,519	EMPLOYMENT		No
(3) CYNTHIA MORNEAULT	FAMILY MEMBER OF JOYCE GIVEN, MEMBER OF BOD	57,452	EMPLOYMENT		No
(4) DOROTHY FRIEL	FAMILY MEMBER OF TINA JAMO, MEMBER OF BOD	25,727	EMPLOYMENT		No
(5) LAURIE JAMO	FAMILY MEMBER OF TINA JAMO, MEMBER OF BOD	100,505	EMPLOYMENT		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) 2019

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

Return Reference	Explanation
EXPLANATION FOR AMENDED RETURN	THE RETURN IS BEING AMENDED TO INCLUDE THE AUDITED FINANCIAL STATEMENTS AND TO REFLECT CHANGES MADE TO THE FINANCIAL STATEMENTS AFTER THE RETURN WAS ORIGINALLY FILED. CHANGES MADE TO THIS AMENDED RETURN ARE AS FOLLOWS: FORM 990 PART IX, STATEMENT OF FUNCTIONAL EXPENSE LINE 7A AND 7B, OTHER SALARIES AND WAGES DECREASED $73,750 LINE 9A AND 9B, OTHER EMPLOYEE BENEFITS INCREASED $73,750 FORM 990 PART X, BALANCE SHEET - THE FOLLOWING LINES INCREASED BY $4,300,000 DUE TO AN OTHER RECEIVABLE/PAYABLE ADJUSTMENT: LINE 4, ACCOUNTS RECEIVABLE, NET LINE 16, TOTAL ASSETS LINE 17, ACCOUNTS PAYABLE AND ACCRUED EXPENSES LINE 26, TOTAL LIABILITIES LINE 34, TOTAL LIABILITIES AND NET ASSETS/FUND BALANCES SCHEDULE H HAS BEEN UPDATED DUE TO CHANGES TO CALCULATIONS RESULTING FROM AN AMENDED MEDICARE COST REPORT. THE FOLLOWING LINES OF SCHEDULE H HAVE BEEN MODIFIED: PART I LINE 7B, MEDICAID COLUMN (C)DECREASED $81 COLUMN (E) DECREASED $81 PART I LINE 7G, SUBSIDIZED HEALTH SERVICES COLUMN (C) INCREASED $23,536 COLUMN (D) INCREASED $16,030 COLUMN (E) INCREASED $7,506 PART III, SECTION B, MEDICARE: LINE 5 MEDICARE REVENUE INCREASED $66,441 LINE 6 MEDICARE ALLOWABLE COSTS INCREASED $67,329 LINE 7 MEDICARE SHORTALL INCREASED $888
FORM 990, PART III, LINE 2	DURING THE YEAR THE FOLLOWING NEW SERVICES WERE OFFERED BY MRH: GASTROENTEROLOGY - 7/1/16 NEUROLOGY - 9/6/16 PULMONOLOGY - 9/6/16 SLEEP MEDICINE - 9/6/16 ENDOCRINOLOGY - 1/1/17 RHEUMATOLOGY - 1/1/17
FORM 990, PART VI, SECTION A, LINE 1	THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT OF THE BOARD AS AN EX OFFICIO MEMBER AND CHAIRMAN, AND TWO OR MORE ADDITIONAL TRUSTEES. THE PRESIDENT SHALL BE ENTITLED TO VOTE AS A MEMBER OF THE EXECUTIVE COMMITTEE. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. IN PARTICULAR, THE EXECUTIVE COMMITTEE SHALL NOT HAVE AUTHORITY TO AMEND THE ARTICLES OF INCORPORATION, ADOPT A PLAN OF MERGER OR CONSOLIDATION, RECOMMEND TO THE TRUSTEES THE SALE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION OTHER THAN IN THE USUAL COURSE OF BUSINESS, RECOMMEND TO THE TRUSTEES VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOCATION OF SUCH DISSOLUTION, OR AMEND THE BYLAWS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11B	PRIOR TO THE DOCUMENT'S FILING, THE ORGANIZATION'S FINANCE DEPARTMENT REVIEWS THE INITIAL DRAFT. AFTER ANY NECESSARY CHANGES, THE ORGANIZATION'S BOARD MEMBERS ARE PRESENTED WITH A COPY. THE FINALIZED DOCUMENT IS SUBJECT TO THE BOARD'S APPROVAL.
FORM 990, PART VI, SECTION B, LINE 12C	EACH BOARD MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED INDIVIDUAL MUST DISCLOSE THE EXISTENCE OF HIS OR HER CONFLICT ANNUALLY AND WHENEVER THE CONFLICT ARISES FOR ACTION AT A MEETING. AFTER RECEIVING ALL ANNUAL ATTESTATIONS, THE CEO WILL PROVIDE THE SIGNED STATEMENTS TO THE HOSPITAL'S ATTORNEY FOR REVIEW. AFTER REVIEW, THE ATTORNEY WILL DETERMINE IF A CONFLICT EXISTS AND INFORM THE CEO AND BOARD CHAIR OF THE CONFLICTED INDIVIDUALS. THERE IS A LISTING OF BOARD, MEDICAL STAFF AND MANAGER CONFLICTS AVAILABLE AT ALL MEETINGS FOR REFERENCE. THE AGENDA FOR EVERY BOARD, MEDICAL STAFF OR DEPARTMENT MEETING WILL CLEARLY LIST THE DISCUSSION ITEMS THAT REQUIRE ACTION DURING THE MEETING. AT THE BEGINNING OF THE MEETING, THE PRESIDENT WILL ASK THE MEMBERS TO REVIEW THE LIST OF ACTION ITEMS AND DECLARE WHETHER OR NOT THEY HAVE A CONFLICT. ALL CONFLICTED MEMBERS WILL BE REQUIRED TO EXCUSE THEMSELVES AND LEAVE THE ROOM DURING THE DISCUSSION AND VOTE. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE.
FORM 990, PART VI, SECTION B, LINE 15	THE ORGANIZATION WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE APPROPRIATE COMPENSATION LEVELS. THE ORGANIZATION'S EXECUTIVE COMMITTEE REVIEWS DATA USED TO DETERMINE COMPENSATION FOR ITS RESPECTIVE MEMBERS. ANY COMPENSATION RELATED CHANGES MUST BE APPROVED BY THE BOARD OF DIRECTORS OR THE EXECUTIVE BOARD.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 19,330. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,330. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,080,057. MANAGEMENT AND GENERAL EXPENSES 623,470. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,703,527. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 452,081. MANAGEMENT AND GENERAL EXPENSES 19,073. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 471,154. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,098,930. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,098,930.
FORM 990,PART XII, LINE 2C	THE FINANCE COMMITTEE RECOMMENDS AND THE BOARD OF TRUSTEES SELECTS THE INDEPENDENT ACCOUNTANT FOR THE AUDIT.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MILLINOCKET REGIONAL HOSPITAL

Employer identification number

01-0223482

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

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(h) Percentage ownership	(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) FIRST MILLINOCKET REGIONAL INVESTMENT GROUP 200 SOMERSET ST MILLINOCKET,ME04462 01-0396196	PHYSICIAN PROGRAM OPERATIONS	ME	MILLINOCKET REGIONAL HOSPITAL	C	-69,576	1,262,716	100.000 %		No

Schedule R (Form 990) 2019

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

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) .......................

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) .....................

Yes

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) ............................

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

Schedule R (Form 990) 2019

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) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CRITICAL ACCESS HOSPITAL.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	289
6	Total number of volunteers (estimate if necessary) .............	6	12
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 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,120	100,973
9	Program service revenue (Part VIII, line 2g) .........	27,561,641	30,438,921
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	450,185	967,985
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	14,844	-7,273
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	28,027,790	31,500,606
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,856	1,860
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)	17,224,434	19,135,793
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	11,252,726	13,746,708
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	28,480,016	32,884,361
19	Revenue less expenses. Subtract line 18 from line 12.......	-452,226	-1,383,755
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	23,656,614	25,045,003
21	Total liabilities (Part X, line 26).............	10,394,330	13,495,545
22	Net assets or fund balances. Subtract line 21 from line 20.....	13,262,284	11,549,458

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 29,338,124 including grants of $ 1,860 ) (Revenue $ 30,438,921 )
	MILLINOCKET REGIONAL HOSPITAL (MRH) PROVIDES A BROAD SCOPE OF MEDICAL SERVICES TO RESIDENTS AND GUESTS IN THE KATAHDIN REGION. THESE SERVICES SPAN THE CONTINUUM OF CARE AND INCLUDE INPATIENT, OUTPATIENT, EMERGENCY, AND ANCILLARY SERVICES. INPATIENT CARE AT MRH INCLUDES MEDICAL SURGICAL CARE WITH AVAILABILITY OF SWING BED AND SPECIAL CARE SERVICES.THE WIDE RANGE OF SUPPORT SERVICES AVAILABLE AT MRH FEATURE HIGHLY SKILLED STAFF AND INCLUDE DIAGNOSTIC IMAGING, CARDIOPULMONOLOGY, LABORATORY, REHABILITATION, AND WELLNESS. MRH FEATURES A STRONG, COHESIVE MEDICAL STAFF CONSISITING OF FAMILY PRACTIVE, INTERNAL MEDICINE, GENERAL SURGERY, GASTRONENTEROLOGY, ORTHOPEDICS, EARS NOSE & THROAT, UROLOGY, PODIATRY, CARDIOLOGY, ONCOLOGY, OPHTHALMOLOGY, PODIATRY, PULMONOLOGY, RADIOLOGY, AND UROLOGY.DURING THIS REPORTING PERIOD, MRH CARED FOR:INPATIENTS - 754CLINIC PATIENTS - 16,799EMERGENCY ROOM PATIENTS - 6,639IN ADDITION, MRH PROVIDED:SURGICAL SERVICES - 1,568LABORATORY SERVICES - 93,075RADIOLOGY SERVICES - 15,334 THERAPY SERVICES (PHYSICAL, SPEECH, AND OCCUPATIONAL) - 2,592

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 expenses29,338,124

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,232,776	0	150,558

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

f	All other contributions, gifts, grants, and similar amounts not included above		1f	100,973

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		100,973

		Business Code
2a	PATIENT SERVICE REVENUE	621400	30,161,313	30,161,313
b	OTHER SUPPORTING REVENUE	621400	297,158	297,158
c	MISCELLANEOUS INCOME	621110	54,264	54,264
d	INVESTMENT IN SUBSIDIARY	621400	-73,814	-73,814
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		30,438,921

3 Investment income (including dividends, interest, and othersimilar amounts) ......			131,903			131,903
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		7,830	6a
b	Less: rental expenses		15,103	6b
c	Rental income or (loss)		-7,273	6c
d	Net rental income or (loss).......			-7,273			-7,273
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		836,082	7a
b	Less: cost or other basis and sales expenses		0	7b
c	Gain or (loss)		836,082	7c
d	Net gain or (loss).........			836,082			836,082
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
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.....			31,500,606	30,438,921	0	960,712

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,860	1,860
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	727,467	194,262	533,205
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........	14,224,498	13,219,042	1,005,456
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	240,256	234,006	6,250
9	Other employee benefits .......	2,964,182	2,691,739	272,443
10	Payroll taxes ...........	979,390	881,359	98,031
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	53,429		53,429
c	Accounting ...........	80,168		80,168
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	4,292,941	3,650,398	642,543
12	Advertising and promotion ....	18,329	5,597	12,732
13	Office expenses .......	278,950	164,007	114,943
14	Information technology ......	4,468		4,468
15	Royalties ..
16	Occupancy ...........	682,316	661,289	21,027
17	Travel ............	26,286	10,521	15,765
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	98,557	92,212	6,345
20	Interest ...........	168,294	168,294
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	769,771	769,771
23	Insurance ...	420,384		420,384
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	SUPPLIES	3,749,112	3,718,956	30,156
b	BAD DEBT EXPENSE	2,120,423	2,120,423
c	MEDICAID TAX ASSESSMENT	602,880	602,880
d	REPAIRS & MAINTENANCE	119,756	75,167	44,589
e	All other expenses	260,644	76,341	184,303
25	Total functional expenses. Add lines 1 through 24e	32,884,361	29,338,124	3,546,237	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			480,312	2	249,516
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			5,280,435	4	8,411,264
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			577,617	8	637,893
9	Prepaid expenses and deferred charges ......			591,389	9	402,852
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	20,918,546
b	Less: accumulated depreciation	10b	15,551,175	5,656,451	10c	5,367,371
11	Investments—publicly traded securities .			9,551,513	11	6,780,812
12	Investments—other securities. See Part IV, line 11 .....			1,420,168	12	1,466,353
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			11,229	14	111,629
15	Other assets. See Part IV, line 11 ...........			87,500	15	1,617,313
16	Total assets. Add lines 1 through 15 (must equal line 33)...			23,656,614	16	25,045,003

17	Accounts payable and accrued expenses .....	4,258,763	17	8,197,536
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	986,647	20	859,325
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	3,348,448	23	3,252,714
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	1,800,472	25	1,185,970
26	Total liabilities. Add lines 17 through 25..	10,394,330	26	13,495,545

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	13,262,284	32	11,549,458
33	Total liabilities and net assets/fund balances ........	23,656,614	33	25,045,003