Community Benefit Insight - Tax-exempt hospital

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Mercy Hospital Northern Light Mercy Hospital

Mercy Hospital

144 State Street
Portland, ME 04101

Bed count	230	Medicare provider number	200008	Member of the Council of Teaching Hospitals	YES	Children's hospital	NO

EIN: 010211534

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

6.21%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 1,293,161 0.48 %
Medicaid as % of operating expenses	$ 13,850,692 5.15 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 1,547,788 0.58 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 9,691 0.00 %
Community building* as % of operating expenses	$ 534,994 0.20 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	1
Physical improvements and housing	0
Economic development	0
Community support	1
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 534,994 0.20 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 534,994 100 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 2,416,341 0.90 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 188442026 including grants of $ 0) (Revenue $ 245721796)
Provide healthcare services regardless of ability to pay as well as education, research and promotion of health. Provided other uncompensated care (at cost) of $2,416,341

4B (Expenses $ 32642239 including grants of $ 0) (Revenue $ 0)
Medicare shortfalls (at cost) 40,842 persons served

4C (Expenses $ 13850692 including grants of $ 0) (Revenue $ 0)
Medicaid shortfalls (at cost) 37,769 persons served

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Facility: Northern Light Mercy Hospital - Part V, Section B, Line 5
The Maine Shared CHNA research team conducted a statewide qualitative assessment among stakeholders to identify and prioritize significant health issues in communities across the state. The assessment, coordinated with the Maine CDC, engaged public health expertise throughout the process. Community outreach was conducted between September 2021 and January 2022. All forms of engagement included public forums, community sponsored events, and oral surveys. The purpose of these outreach efforts was to gather feedback on data and to identify health priorities, community assets, and gaps in resources to be used in health improvement planning. Virtual community forums with residents and service providers were held in the county in partnership with the Maine CDC to solicit input from individuals representing populations with health disparities including medically underserved, low-income, or minority populations. The following organizations attended the October 5 & 26, 2021 Cumberland County Shared CHNA Community Engagement Forum and provided valuable feedback on the Maine Shared CHNA.Persons representing broad interests of the community who were consulted during the engagement process (the following list was extracted from the Cumberland County CHNA report, page 22): Bridgton Hospital, Central Maine Healthcare, City of Portland, City of Portland - Public Health Division, Hospital Community Representative, Cumberland County Government, Cumberland Public Health District, From the First Tooth, Gateway Community Services, Good Shepherd Food Bank, Greater Portland Health, Healthcare Coalition of Maine, Healthy Androscoggin, Lake Region Community Health Committee, Macdonald Motors, Maine Access Immigrant Network, Maine Access Points, Maine Behavioral Healthcare, Maine Medical Center, Maine Medical Center Research Institute, Maine Medical Partners, Maine Medical Partners Pediatrics, MaineHealth, Northern Light Beacon Health, Northern Light Health, Northern Light Home Care & Hospice, Northern Light Mercy Hospital, Northern New England Poison Center, Planned Parenthood of Northern New England, Portland Public Schools, Protech Solutions / Good Grid, Rural Health & Primary Care Program; Department of Health and Human Services, Spring Harbor Hospital, The Opportunity Alliance, The Opportunity Alliance WIC, The Opportunity Alliance; Lake Region Community Health Committee, Through These Doors, Town of Raymond, United Way of Southern Maine. New this cycle was an expanded effort to reach those who may experience systemic disadvantages and therefore experience a greater rate of health disparities. Two types of outreach were piloted in this effort.One effort included nine community sponsored events hosted by organizations having statewide reach representing the following communities: Black or African Americans; people who are homeless or formerly homeless; older adults; people who are deaf or hard of hearing; people who define themselves or identify as lesbian, gay, bisexual, transgender, and queer and/or questioning (LGBTQ+); people with a disability; people with a mental health diagnosis; people with low income; and youth.Another effort included conducting oral surveys in collaboration with eight ethnic-based community organizations community health workers in order to better reach Maines immigrant population that included: 1,000 surveys were conducted in either English (32%), Somali, (24%), Arabic (23%), French (8%), Spanish (5%), Lingala (3%), and other languages including Swahili, Maay Maay, Portuguese, Oromo, Eretria, Kirundi, and Amara. When asked for their countries of origin, respondents most commonly cited the United States (212), Iraq (205), Somalia (157), The Democratic Republic of Congo (81), Djibouti (70), Kenya (30), and Mexico (29). Other countries of origin mentioned included Rwanda, Ethiopia, Angola, Syria, Guatemala, South Africa, Palestine, Puerto Rico, Morocco, Afghanistan, El Salvador, Nigeria, Canada, Burundi, Eritrea, France, Honduras, Uganda, Jamaica, Mali, Gabon, Sudan, Nicaragua, Peru, and Brazil.

Facility: Northern Light Mercy Hospital - Part V, Section B, Line 6a
The Maine Shared CHNA was conducted through a collaborative effort among Maines four largest health-care systems Central Maine Healthcare, Northern Light Health (legal name Eastern Maine Healthcare Systems), MaineGeneral Health, MaineHealth and the Maine Center for Disease Control and Prevention, an office of the Maine Department of Health and Human Services (DHHS). Northern Light Health member organizations participating in the Shared CHNA included Acadia Hospital, AR Gould Hospital, Blue Hill Hospital, CA Dean Hospital, Eastern Maine Medical Center, Inland Hospital, Maine Coast Hospital, Mayo Hospital, Mercy Hospital, and Sebasticook Valley Hospital. See Line 5s response for a comprehensive list of participating organizations, including other non-Northern Light Health hospitals who were consulted during the engagement process.

Facility: Northern Light Mercy Hospital - Part V, Section B, Line 11
Northern Light Health recently conducted their 2022 Shared Community Health Needs Assessment that will inform priority work for implementation in FY23 FY25. In FY22, Northern Light Mercy Hospital developed our plan to address significant needs identified in our 2022 Community Health Strategy (aka, implementation strategy). Though priority work from the 2022 Shared CHNA wont begin until FY23, Mercy Hospital will be prepared to implement priority work from our 2022 strategy with no gap in implementation efforts between the two CHNA cycles. While conducting the 2022 Shared CHNA research and outreach, Mercy Hospital continued to implement priority work from the final year, FY22, of the three-year 2019 Community Health Strategy (implementation years FY20, FY21, and FY22). Below reflect these efforts related to the 2019 Community Health Strategy.The data gathered from the 2019 Shared Community Health Needs Assessment (Shared CHNA) informed Mercy Hospitals Community Health Strategy (Implementation Strategy) developed with input from community stakeholders including those who serve priority populations, the local Public Health District Liaison, local business leaders, and community advocates. Priorities were selected after weighing the severity of each priority area, availability of known and effective interventions, determination that the priority area was un-addressed or under-addressed, and community collaborations underway with Mercy Hospital. A hospital task force considered the data and identified areas of significant need including priority concerns, intended actions to address the need, programs and resource allocation, planned collaborations, and population of focus. The implementation strategy was presented and adopted by the hospitals governing board. Northern Light Mercy Hospital identified five priority areas of focus addressing the significant needs identified in its 2019 CHNA as follows:Social determinants of healthActions taken by Mercy Hospital to address this priority in FY22: Northern Light Health made significant progress in Social Determinants of Health (SDOH) screening and intervention. The Northern Light Health SDOH team defined completed SDOH screening and established a system policy for minimum SDOH screening standards to provide consistency in screening guidelines. During the course of FY22, the SDOH team worked with Information Systems to continually improve the SDOH screening tool based on user recommendations and will continue to manage user requests moving forward. SDOH team leaders worked with members of Northern Light Health Quality to develop an SDOH screening dashboard that provides real-time screening rates by member organization, practice, provider, and payor type, as well as prevalence of SDOH need from positive screening results. The dashboard is undergoing validation and is anticipated to be available in FY23. Northern Light Health achieved a significant milestone in responding to social health needs when the Findhelp platform went live on September 13, 2022. Findhelp is a national social care network that will make it easier for patients and providers to find and connect with local resources. The platform is embedded within our electronic health record so that care teams can find and refer patients to resources. Community members can also access Findhelp at any time via a public portal.Substance useActions taken by Mercy Hospital to address this priority in FY22: Northern Light Mercy Hospital delivered training that allows primary care providers to obtain their x-waiver and prescribe Suboxone for opioid use disorder. This commitment ensures that all five primary care sites at Northern Light Mercy Hospital are well prepared to serve patients with substance use disorder.Access to careActions taken by Mercy Hospital to address this priority in FY22: Northern Light Mercy Hospital continued to support work at local housing authorities with outreach activities at 100 State Street and testing and vaccination at the Fore River Campus Pharmacy and within primary care offices. A survey was administered at 100 State Street to ensure that transportation was not a barrier to services offered at the Fore River Campus. Health Promotion Clinics and Urgent Care Services were offered for New Mainers at local hotels in South Portland and Yarmouth with follow up care occurring in Primary Care, Womens Health, Pediatrics, and Specialty Care. Transportation, access to medication, housing insecurity, and lack of case management added complexity for Mercys care teams.Mental health Actions taken by Mercy Hospital to address this priority in FY22: Northern Light Mercy Hospital provided trainings for nurses and providers specific to tactics to successfully engage patients with severe and persistent mental illness. These trainings were developed in response to requests from nursing staff, who were seeking greater insight, expected behaviors, proven engagement tactics, and treatments available for persons with complex trauma, personality disorders, and substance use disorders. This has a promoted dialogue and ongoing requests for education resources and training for clinical teams.Older adult health/healthy agingActions taken by Mercy Hospital to address this priority in FY22: Northern Light Mercy Hospital offered training for all primary care practices with medical leaders of Northern Light Healths Palliative Care Program on advance care planning and palliative care. In FY22, each practice was provided educational materials and specific tools to engage patients and families in advance care planning conversations. Northern Light Mercy Hospital also acquired a geriatrics practice that increased our capacity to provide care for older adults and medical direction for local nursing homes.Additional information related to actions taken by Northern Light Mercy Hospital on the above priorities can be found in their FY22 Progress Report to Our Community at https://northernlighthealth.org/2019-Community-Health-Strategy. Northern Light Mercy Hospital considered all priorities identified in the Shared CHNA, as well as other sources, through an extensive review process. Northern Light Mercy Hospital opted to work on all top five priorities as identified in the Shared CHNA.

Facility: Northern Light Mercy Hospital - Part V, Section B, Line 16j
"Response for 7a (list URL) is: https://northernlighthealth.org/Mercy-HospitalResponse for 7b (list URL) is: https://northernlighthealth.org/Community-Health-Needs-Assessment/2022-CHNA-ReportsResponse for 10a (list URL) is:https://northernlighthealth.org/Community-Health-Needs-Assessment/2022-Community-Health-StrategyResponse for 16a, 16b, 16c (list URL) is https://northernlighthealth.org/Mercy-Hospital under ""Pay My Bill"""

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 6a - Related Organization Community Benefit Report
The Northern Light Mercy Hospital community benefit report is contained in an annual community benefit report prepared by Northern Light Health which is the parent organization of all related organizations.

Part I, Line 7 - Explanation of Costing Methodology
Ratio of Patient Care Cost-to-Charges is used in calculations.

Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense
The costing methology used to determine the amount is cost to charge ratio.

Part III, Line 4 - Bad Debt Expense
Patient and trade accounts receivable are stated at the amount management expects to collect from outstanding balances. See Footnote 2 of the attached financial statements, page 16 to 19 - Patient Service Revenue and Accounts Receivable section.

Part III, Line 8 - Explanation Of Shortfall As Community Benefit
Medicare losses should be treated as a community benefit because the losses are incurred in performing an important public service, and Maine hospitals experience one of the lowest Medicare reimbursement rates in the country.

Part III, Line 9b - Provisions On Collection Practices For Qualified Patients
All account guarantors who express an inability to pay inpatient and outpatient services will be screened for eligibility for charity care using an application and guidelines established by Northern Light Mercy Hospital. An account may be reconsidered for charity care at any time when new information is available about a patient's inability to pay.

Part VI, Line 3 - Patient Education of Eligibility for Assistance
Northern Light Health Financial Counselors screen patients for federal, state or government programs and brochures are displayed at all Northern Light locations. Financial Assistance is widely publicized within the community by the following methods:Offered by receiving a conspicuous written notice on their billing statementsListed on the Northern Light Health web portal www.northernlighthealth.org/billing Posters are displayed in public locations in each hospital facilityCommunity posters are displayed outside of the organization (Food Cupboards, Libraries, Auditoriums, Churches, Banks)Packets are provided at all check in locations which include an application, instructions, and a Financial Assistance Policy (FAP) Plain Language Summary

Part VI, Line 4 - Community Information
Located in Portland, Maine, Northern Light Mercy Hospital has a service area comprised of both primary and secondary service areas, together referred to as the total service area. Total service areas (TSAs) are developed by the Northern Light Health Planning department based on neighboring zip codes from which a majority of a hospitals inpatient admissions originate. TSAs can sometimes overlap due to hospital locations or because of the specialty services provided by the hospitals.Towns representing Mercy Hospitals primary service area include: Buxton, Cape Elizabeth, Casco, Cornish, Cumberland, East Baldwin, Falmouth, Freeport, Gorham, Gray, Hollis, Limington, North Yarmouth, Old Orchard Beach, Portland, Pownal, Raymond, Saco, Scarborough, South Portland, Standish, Steep Falls, West Baldwin, Westbrook, Windham, and Yarmouth. Towns representing Mercy Hospitals secondary service area include: Acton, Alfred, Bath, Biddeford, Bridgton, Brownfield, Brunswick, Denmark, Durham, East Waterboro, Fryeburg, Harpswell, Harrison, Hiram, Kennebunk, Kennebunkport, Lebanon, Limerick, Lovell, Naples, New Gloucester, North Waterboro, Parsonsfield, Poland, Porter, Sanford, Sebago, Shapleigh, Springvale, Topsham, Waterboro, Waterford, and West Newfield.Cumberland Countys race/ethnicity and selected demographics are provided below for Mercy Hospital based on the hospitals physical location in Cumberland County.Cumberland County - Race/Ethnicity: American Indian/Alaskan Native 0.2% (578), Asian 2.2% (6,350), Black/African American 3.0% (8,863), Native Hawaiian or Pacific Islander 0.0% (34), White 91.7% (268,151), Some other race 0.4% (1,091), Two or more races 2.5% (7,240), Hispanic 2.1% (6,061), Non-Hispanic 97.9% (286,246), Total county population 292,307.Cumberland County - Selected Demographics: Median household income $73,072, Unemployment rate 5.3%, Individuals living in poverty 9.0%, Children living in poverty 9.2%, 65+ living alone 29.8%, Veterans 7.2%, Gay, lesbian, and bisexual (high school students) 12.1%, Gay, lesbian and bisexual (adults) 4.4%, Transgender youth (high school students) 1.7%, Persons with a disability 11.4%.Other hospitals serving the Northern Light Mercy Hospital community: Based on the State of Maines definition of hospital service area, Northern Light Mercy Hospitals community is served by an additional two other hospitals, New England Rehabilitation Hospital and Maine Medical Center per Hospital Service Area (HSA) designation. Additionally, the Health Resources & Services Administration designated Mercy Hospitals service area as having a total of 22 medically underserved populations.

Part VI, Line 4 - Community Building Activities
Northern Light Mercy Hospitals community building activities include Garys House that provides affordable housing for families of patients in Portland area hospitals.

Part VI, Line 6 - Affilated Health Care System
The 2022 Maine Shared Community Health Needs Assessment (CHNA) was conducted by Northern Light Health in collaboration with several member/affiliated hospitals, non-affiliated hospitals as well as public health and community organizations across the state. The Maine Shared CHNA informs initiatives to promote community health across the system as well as within each member hospitals local service area. Each member hospital adopted a local implementation strategy referred to as a Community Health Strategy and annual community health improvement plans, tailored to meet local needs.Northern Light Mercy Hospital participated two CHNA public forums to garner feedback and insights from local community members.

Part VI, Line 7 - States Filing of Community Benefit Report
N/A

Part VI, Line 5 - Promotion of Community Health
Northern Light Mercy Hospital furthers its exempt purpose by promoting the health of the community through the following grant activity in FY22:Health Care Support Services: Maine Cancer Foundation piloting Uber Health provide reliable transportation for cancer patients in the Portland area; Medication-Assisted Treatment Mercy Medical Neighborhood & Improving access to quality Care Social and Environmental Improvement Activities: McAuley Bangor Residence (OSA) - Develop housing-based programs employing evidence-based strategies in a holistic approach to recovery for vulnerable families affect by substance abuse. Program must treat mother affected by substance abuse with at least one child under 10 years of age.The majority of Northern Light Mercy Hospitals Board of Directors resides in the primary service area and is not employees or independent contractors. Mercy also has an open medical staff. Northern Light Mercy Hospital donates food weekly as part of a food rescue program to local food pantries and soup kitchens. Northern Light Mercy Hospital also provides money to the City of Portlands Minority Health Department each year in support of the Community Health Outreach Workers, whose role is to provide health education, outreach, and patient navigation for vulnerable populations.

Operating expenses	$ 268,910,031
Total amount spent on community benefits as % of operating expenses	$ 16,701,332 6.21 %