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What Has Happened So Far

  • The Board of Directors for both HAD #4 and Northern Light Health have approved the merger.
  • Public forums were held in communities throughout HAD #4, offering information about the potential merger and offering a chance for people to ask questions about any aspect of it.
  • Public votes were held in each town making up the District, with 12 of the 13 towns voting overwhelmingly to approve it. You can find the vote tallies here.
  • The Maine Legislature voted to allow for changes in the Charter to pave the way for the merger with Northern Light Health.
  • Gov. Janet Mills signed the legislation.
  • A Certificate of Need (CON) application was submitted to the State, and is being reviewed by the Maine Department of Health & Human Services.

What’s next?

A public hearing for the CON has been scheduled from 11-3 on Thursday, Sept. 19 at the Center Theatre in Dover-Foxcroft. It’s another opportunity to ask questions, learn more, and voice support for this merger to take place, which will keep local care close to home for this region at Mayo Regional Hospital.

If the CON is granted, both the HAD #4 Board of Directors and the Northern Light Health Board of Directors will take a final vote on the merger.

While the timeline on these types of things is fluid, if everything lines up correctly and approvals are granted, the entire process might be complete by the end of the year.

How would it work?

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.

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.


The Maine Legislature voted to approve LD 1708 in June. This legislation allows for the charter to be changed to permit the potential merger. The State & Local Government Committee, the local delegation representing the towns that are a part of HAD #4 and the full Legislature did a lot of homework to ensure they were casting the right vote for the people of this region.

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.

Board Votes

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.”