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Next Steps

Now that the Board of Directors for both HAD #4 and Northern Light Health have approved the merger, and public forums have been held in communities throughout HAD #4, and public votes were held in each town making up the District, it is time for the Legislature to take up the issue.

In order for the merger to take place, the Legislature must change the charter. Public votes held in the 13 communities overwhelmingly supported this move, with more than 80% of voters saying “YES” to protecting quality, local care.

Once Legislation has been filed, this page will be updated with new information. Stay tuned!

Votes in Your Community

The 13 communities that make up HAD #4 held public votes throughout the month of April regarding the potential merger between Mayo Regional Hospital and Northern Light Health. 12 of 13 towns in the District voted in favor of the merger, with more than 80% of total votes being cast in favor of the merger. For a complete list of towns and results, click here.

Community Forums

Mayo Regional Hospital held four community forums that provided updates and an opportunity to answer questions regarding the potential merger with Northern Light Health, a statewide health care system. The forums were held in four of the thirteen towns that make up Hospital Administrative District (HAD) #4. Some questions that were asked at that forum are answered on our Frequently Asked Questions page.

This is an important part of the process. It gave officials with Mayo Regional Hospital and Northern Light Health the chance to hear directly from the citizens of HAD #4.

Additional Information


Discussion began about the possibility of joining a larger health system as far back as 2010. After careful analysis and lots of discussion, the decision was made to issue an RFP for a potential merger. Only two health systems responded to the RFP, with Northern Light Health (then known as EMHS) being chosen by the board as the best option.

The basic reason for pursuing a merger with a health system is to ensure stability for Mayo Regional Hospital, and to keep quality care available close to home. With trends showing small, rural hospitals potentially having a number of troubles including financial difficulties, provider supply, and technology resources, the HAD #4 Board of Directors decided to take proactive steps to plan for the future of Mayo Regional Hospital and healthcare needs for the region.

Where we stand now

In late February, HAD #4 voted 15-3 to proceed toward a merger agreement with Northern Light Health. The vote was held citing Mayo’s progressively worsening financial situation, the national challenges being faced by small, rural hospitals, and the reality that Mayo Regional Hospital needs to partner with a larger organization. It followed months of due diligence, planning, and gathering public input, as well as a board review of the agreement negotiated between representatives for Mayo Regional Hospital and Northern Light Health.

In March, the Northern Light Health Board of Directors voted unanimously to move ahead with plans to pursue the merger agreement as well. At the time, Michelle Hood, FACHE, Northern Light Health president and CEO said, “As the major healthcare provider in this part of the state, we feel an obligation to help ensure that the delicate fabric of the delivery system can be maintained.”

In April, legislation was submitted that instructs the towns in HAD #4 to hold votes during town meetings regarding the potential merger. The legislation is currently working its way through Augusta as of April 16. However, towns are in the process of scheduling dates for votes as these would all need to be finished by May 7 in order to allow enough time for the Maine Legislature to submit new legislation to change the HAD #4 charter and allow the merger. For a list of voting dates by town, click here.

In addition to community forums on the topic and community votes, several steps remain for the merger to be permitted. Among those steps: A state review of the merger would be required through a formal Certificate of Need application and analysis process before a final board vote by HAD #4. These multiple steps provide additional opportunities for all stakeholders to examine the proposed restructuring.

Similar to Northern Light Health arrangements with other hospitals, Mayo and its clinics would remain open under the merger, and providers could continue providing quality care to people living in Piscataquis County.

Because Mayo Regional Hospital is owned and operated as a Hospital Administrative District, its board is made up of members who are elected by the communities served by the hospital. HAD #4 is the only HAD left in Maine and is a quasi-governmental agency with taxing power. The effect of the merger would be to transform the HAD into a Maine charitable tax-exempt nonprofit corporation that would have a community-based board but would not have taxing authority. This would relieve the towns in the HAD from potential liability for the certain indebtedness of the hospital.


As a Hospital Administrative District, finances for Mayo Regional Hospital are public. You can find monthly committee meeting updates here and full annual reports here.

The fact is this: small, rural hospitals are struggling. This is a nationwide trend, as proven by study after study. But it hits particularly close to home when we see a small, rural hospital in our state declaring bankruptcy, or when we see a report saying that 8 of Maine’s 20 rural hospitals are at high financial risk.

Mayo Regional Hospital is not immune.

The good news is that Hospital Administrative District #4’s Board of Directors and Mayo Regional Hospital’s leadership team saw the trend, and started early. Research, due diligence, and careful planning has taken place before a critical point was reached.

We all share the same goal: keeping quality care close to home. It is a challenge for small, rural hospitals around the country. But there is an opportunity in our communities to keep that quality care at Mayo Regional Hospital.