2022-11-02T05:36:20-05:00 2021-12-31 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-01-01 010545327 Penobscot Valley Hospital PENO 2077943321 7 Transalpine Road Box 368 Lincoln ME 04457 Crystal Landry CEO 2077943321 2022-10-31 1 Crystal Landry 999009999 Joseph R Byrne P01289281 2077752387 2022-10-31 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Crystal Landry 7 Transalpine Road Box 368 Lincoln ME 04457 23492900 0 X www.pvhme.org X 1973 ME Critical Access Hospital 10 10 234 10 0 0 2099744 3317854 17519780 20200477 13518 8385 46745 -51360 19679787 23475356 0 0 0 0 8638423 9731479 0 0 0 9918065 11877490 18556488 21608969 1123299 1866387 10887412 10665595 13544550 7441599 -2657138 3223996 X Penobscot Valley Hospital Mission Statement:To be our community's first choice in healthcare, known for a culture of compassion, quality, and safety. To be an excellent community partner, working together every day to improve the health and well-being of those we serve. Penobscot Valley Hospital Vision Statement:To be recognized by the community, employees, and the medical staff as:* The best place to receive care* The best place to work* The best place to practice medicine. 0 0 17997919 20200477 Penobscot Valley Hospital is a 25 bed critical access hospital in Lincoln, ME. The Hospital provided a wide range of medical services to its patients in 2021, some of the largest being Emergency Room Services, Laboratory Services, Pharmacy Services, & Radiology Services. Please refer to Schedule H for a more comprehensive list of services provided. 17997919 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 64 0 1 234 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Crystal Landry 2077943321 7 Transalpine Road Box 368 Lincoln ME 04457 Phillip Dawson Jr President 1.50 0.00 X X 0 0 0 Richard Wyman Vice President 1.50 0.00 X X 0 0 0 Bea Szantyr Treasurer 1.50 0.00 X X 0 0 0 Judith Doore Board Member 1.50 0.00 X 0 0 0 Robert Genest Board Member 1.50 0.00 X 0 0 0 Bonnie Gray Board Member 1.50 0.00 X 0 0 0 Annette Haynes Board Member 1.50 0.00 X 0 0 0 Patricia Nobel MD Board Member 1.50 0.00 X 0 0 0 Whitney Sourers Board Member 1.50 0.00 X 0 0 0 H Joseph Thibodeau DMD Board Member 1.50 0.00 X 0 0 0 Crystal Landry CEO 40.00 0.00 X 191599 0 28685 Glenn Deyo Surgeon 40.00 0.00 X 340085 0 28031 Carl Alessi RHC Physician 40.00 0.00 X 174973 0 29624 Paul Turnquist ER Physician 22.00 0.00 X 225909 0 842 Amy Theriault COO 40.00 0.00 X 109689 0 24525 Randy Tallman Ultrasound Tech 40.00 0.00 X 109877 0 9440 1152132 0 121147 11 0 1 0 Emcare Inc 7032 Collection Center Drive Chicago IL 60693 ER Physician Services 1280607 Nurse Anesthesia of Maine LLC 141 North Main Street Suite 205 Brewer ME 04412 Nurse Anesthesia Services 369552 Physician Services Inc 126 Osborne Road Farmington ME 04398 Hospitalist 327600 Begelow Healthcare Inc 348 Bigelow Hill Rd Skowhegan ME 04976 Hospitalist 316680 Todd Tritch PO Box 67 Lincoln ME 04457 Hospitalist 282360 13 3312704 5150 3317854 Patient Revenue 622000 35425520 35425520 Cafeteria & Other 900099 422572 398420 24152 Contractual/Char. Adj. 622000 -15647615 -15647615 20200477 2049 2049 23880 17544 6336 6336 6336 Loss from Subsidiary 900099 -10430 -10430 Gain(loss) Affiliate Investment 900099 -40930 -40930 -51360 23475356 20176325 0 -18823 X 220284 220284 8041598 6896984 1144614 896395 746013 150382 573202 471030 102172 269266 269266 41000 41000 6965672 6542148 423524 801871 533927 267944 782266 575973 206293 38135 22619 15516 296092 296038 54 433877 237667 196210 275169 245432 29737 Medical Supplies 1480655 1428533 52122 Service Provider Tax 460286 460286 Miscellaneous Expenses 33201 1555 31646 21608969 17997919 3611050 0 X 3794010 3592653 727569 421580 2036815 1738691 431144 454853 210662 161808 18612148 15479225 3483649 3132923 172469 121109 3714 0 27380 1041978 10887412 10665595 3426456 2061179 208816 0 4519119 3810081 5390159 1570339 13544550 7441599 X -2878236 2997757 221098 226239 -2657138 3223996 10887412 10665595 X 1866387 4014747 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3474 3474 0 Part II-B, Line 1: The Organization pays dues to the Maine Hospital Association (MHA) and American Hospital Association (AHA). A portion of dues paid to the MHA and AHA are attributable to lobbying expenses. 28897 28897 8069998 6469516 1600482 436056 436056 9654449 8638001 1016448 422748 371708 51040 3132923 Deferred Compensation 30064 Estimated Third-Party Payor Settlements 1011914 1041978 Deferred Compensation 30064 CARES Act Funding 1540275 1570339 1 1 1 X 1 X 225.000000000000 1 1 0 1 1 183996 183996 0.00850 5161072 4417508 743564 0.03440 5345068 4417508 927560 0.04290 83772 83772 0.00390 83772 83772 0.00390 5428840 4417508 1011332 0.04680 1 4907362 4907362 X 1 1 1 1 Penobscot Valley Hospital 7 Transalpine Road Lincoln ME 04457 www.pvhme.org 39471 X X X X Penobscot Valley Hospital 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X https://pvhme.org/ X 1 19 1 https://pvhme.org/ 0 1 X 150.000000000000 225.000000000000 X 1 1 X X X 1 X https://pvhme.org/patient-resources/billing-help/ X https://pvhme.org/patient-resources/billing-help/ X https://pvhme.org/patient-resources/billing-help/ X X X X X X X 1 X 0 X X X X 1 X 0 0 Penobscot Valley Hospital Part V, Section B, Line 5: Per the Maine Shared CHNA charter, the effort was conducted by the Steering Committee, Metrics Committee, and Community Engagement Committee. These committees worked in partnership with the Maine CDC and contracted vendor, JSI. Maine CDC and its epidemiology contractor, University of Southern Maine, provided a significant amount of data analyses, technical support, and website development. The Maine Shared CHNA process was rolled out in three stages:Data Analysis:- County Health Profiles were released in September 2018. Two Hundred indicators were selected.- District Health Profiles were released in November 2018.- City Health Profiles for Lewiston/Auburn, Bangor, and Portland were released in January 2019.Outreach and Engagement:- Community outreach was conducted between September 2018 and January 2019. Community forums were conducted with residents and service providers in all 16 counties. The pur ose of this outreach was to gather feedback on data and to identify health priorities, community assets, and gaps in resources to be used in health improvement planning.Final Reports:- Reports for the state, each county, and districts were released in the spring of 2019. These reports included information from the health data profiles, summaries of qualitative information gathered from engagement activities, and a presentation of community health needs. Health priorities for the county, public health district, and the state were developed through community participation and voting at community forums. The Penobscot County Community Forum was an opportunity for review of the Penobscot County Health Profile, discussion of community needs, and prioritization in small break-out sessions followed by a forum session vote. Ten priorities arose from the break-out sessions. The top five became the areas to work on.1. Mental Health 19%2. Social Determinants of Health 18%3. Substance Abuse 15%4. Access to Care 14%5. Physical Activity, Nutrition, and Weight 12%Penobscot Valley then searched to define how they can respond to these needs within the community it resides in. Penobscot Valley Hospital Part V, Section B, Line 6a: - Central Maine Healthcare (CMHC)- Maine General Health (MGH)- Maine-Health (MH)- Northern Light Health (NLH) Penobscot Valley Hospital Part V, Section B, Line 6b: Maine Center for Disease Control and Prevention (Maine CDC) Penobscot Valley Hospital Part V, Section B, Line 11: As outlined, PVH has continued to move forward with increasing access to mental health services. Many pieces of the plan have been hindered by COVID. One of our largest community resources for mental health services, Health Access Network, no longer accepts referrals from outside entities. They report that the wait list for services to be one year long. PVH refers outpatients in its primary care practice to services in other locations; the wait list can be up to 3 months long. PVH utilizes Acadia for emergent patients with mental health crisis needs via tele psych. PVH continues to work to bring services to the Medical Arts Building and awaits Acadia Hospital finalizing the contract when a mental health provider can be found for the position. PVH continues to forge partnerships around the state to improve the lives of the public in Penobscot County. Assisting patients to find shelter, food, and transportation. PVH actively participates with the American Red Cross to assist with blood drives. PVH promotes health related topics on its social media to help educate the public. In 2021, Penobscot Valley Hospital collaborated with Health Access Network to provide COVID-19 vaccines clinics, which helped to vaccinate thousands of Mainers. PVH has addressed Substance Use Disorder through 2021 by building community partnerships with Bella's house, Save a life, among others. Patients with a need to substance use disorder detox are being referred to Bella's house when appropriate. The Penobscot Valley Hospital substance use disorder coordinator work to assist substance use disorder patients who are in need of shelter, medication assisted treatment, shelter, food, or any other need. Access to care has been identified as another need in Penobscot County. PVH has continued to recruit for primary care providers throughout 2021 to increase access to care for patients in Penobscot County. Penobscot Valley Hospital Part V, Section B, Line 13h: State Regulation Penobscot Valley Hospital Part V, Section B, Line 16j: The FAP application is sent with all first time statements. A notice of the FAP and a copy of the FAP application is also posted in the Billing Help section of the Organization's website. Notices are also posted at all patient entrances to the Hospital and at various locations within the building. Part II, Community Building Activities: Many families rely on Penobscot Valley Hospital (PVH) for a comprehensive range of services. Without access to these services including primary and preventative care, chronic dieses may go untreated. Often this results in poor health with high emergent or inpatient costs. At PVH, we strive to be out Community's first choice in healthcare, known for a culture of compassion, quality, and safety: to be an excellent community partner, working together every day to improve the health and well-being of those we serve.Throughout 2021, the hospital partnered with many other organizations to reach people within our communities to educate, train, and inform, including Colonial Healthcare, Cummings Nursing Home, Eastern Maine Community College, Lincoln Economic Development Committee, Lincoln Lakes Region Chamber of Commerce, LifeFlight, Lincoln Police & Fire Departments, Maine Breast & Cervical Health Program, Maine Centers for Disease Control and Prevention, Maine Department of Transportation, Mayo Regional Hospital, Millinocket Regional Hospital, New England Organ Bank, Northern Penobscot Tech Region III, Raising Readers Program, Red Cross, RSU #67, SAD #30, SAD #31, PVH Auxiliary, Save-A-Life Substance Abuse Task Force, the University of Maine, University of New England, University of Vermont, Husson University, and more.By employing about 180 people in the community, PVH is a leader in creating good paying jobs, and attributing to a positive economy in the region. With the "ripple effect" (jobs the hospital helped create, and dollars spent in the area), the U.S. Department of Commerce's Bureau of Economic Analysis determined the multiplier for employment in Maine to be 2.1174, meaning for every employed person in a hospital in Maine, there is another 1.174 jobs created in supporting industries.PVH does not turn away people who need vital care, regardless of their ability to pay. Each person the hospital treats receives the same high-quality care with the utmost compassion from our staff. Our hospital is providing more Free Care, which includes charity care and bad debts, than ever before. Other direct impacts that PVH provides to the community that are served:Education/Scholarships:1. Published educational articles on social media on topics such as hand hygiene, disease prevention, COVID-19, and nutritional advice.2. Staff create educational displays in our lobby.3. Laboratory staff made weekly visits to area nursing homes to collect specimens from residents.4. Trained RN's from Community Health and Counseling to draw blood.5. Trained incoming CNA's and RN's to draw blood, do some CLIA-waived testing.6. Taught students from Region III to draw blood.7. PVH is a clinical site for Northern Penobscot Tech Region III, and several colleges and universities. During 2021, PVH had students conducting clinical rotations here for certifications with Medical Assistant, Certified Nursing Assistant and Phlebotomy. Husson University sent students to the PVH pharmacy and nursing departments for their rotations. PVH has also worked with the University of Maine School of Nursing and Kennebec Valley Community College Radiology Program. PVH has also provided emergency medicine training of family medicine residents from Eastern Maine Medical Center. The hospital serves as a rotation site for physician assistants, and medical students from the University of New England, University of Vermont, and Yale University. Time spent with students varies from a couple of hours to the entire semester of hands-on education. The demand to utilize PVH as a clinical site has increased over the last several years.Promote Organ Donation from October to April. PVH provides information regarding organ donation with social media posts, and the Lincoln News. For National donor month in April, PVH flies the organ donor flag for the month, plus have a display with information for the public. PVH has won HRSA awards for the work that the employees do for organ donation.Penobscot Valley Hospital volunteers, staff, and providers are committed to providing quality healthcare services to the people in our community. In 2020, staff and volunteers provided:1. Free educational programs to seniors.2. The Auxiliary provides Kids Activity Packs and blankets for children visiting the hospital.3. Books for pediatric patients at well child checkups for through Raising Readers.4. Vaccinations through the Maine Impact Program.5. Substance Abuse prevention education.6. Free meeting space for area non-profits.7. Leadership to Lincoln Economic Development Community & Lincoln Lakes Region Chamber of Commerce.8. Holiday gifts for area nursing home residents. Part III, Line 4: Please refer to pages 8-11 of the attached audited financial statements. Part III, Line 8: The Organization uses its Medicare Cost Report to obtain the amounts reported above. Part III, Line 9b: The Hospital would not initiate collection efforts against a patient that qualified for a sliding fee scale unless that patient failed to meet their obligation under payment arrangement agreed to by both parties. After it was determined that the patient did not qualify for a readjustment to their payment terms, the Hospital would follow normal notification practices dictated by our collection policy until the account eventually ended up in collections. Part VI, Line 2: The Organization took a comprehensive approach to assess community health needs. Several independent data analyses were performed based on secondary source data, augmented with local survey data, and any data inconsistency or discrepancies are resolved from the combined opinions formed from local experts. PVH relies on secondary source data, and most secondary sources use the county as the smallest unit of analysis. We asked our local expert area residents to note if they perceived the problems or needs identified by secondary sources to exist in their portion of the county. Most data used in the analysis is available from public internet sources. Critical data needed to address specific regulations or developed by the individuals cooperating with us in this study is displayed in the report of the appendix. Part VI, Line 3: Notices regarding PVH's charity care policy are posted at Registration and Emergency Room. Our employees also know to refer patients to the registration or billing offices of the hospital if they have questions. Part VI, Line 4: Lincoln is a rural community of approximately 5,700 people located in north central Maine. Our service area consists of many small towns that use Lincoln as a hub. The hospital, school system, and logging companies, are the major employers in town. Life and industry primarily revolve around the woods of central Maine. It is an area rich with history for making paper. Maine is one of the oldest states in the nation according to the latest US Census report, and Lincoln reflects that demographic. The median resident age in 2020 was 44.8 years. Lincoln is located in a modest area of the State, where the median resident income in 2020 was $52,128. Maine's average income for that same time period was $59,489. Part VI, Line 7, Reports Filed With States ME X X X X 0 0 0 0 0 0 0 1 0 Glenn Deyo Surgeon 339335 0 750 0 0 0 0 0 28031 0 368116 0 0 0 Paul Turnquist ER Physician 225409 0 500 0 0 0 0 0 842 0 226751 0 0 0 Crystal Landry CEO 190849 0 750 0 0 0 0 0 28685 0 220284 0 0 0 Carl Alessi RHC Physician 174223 0 750 0 0 0 0 0 29624 0 204597 0 0 0 Part I, Line 7 During 2021, all full-time and part-time employees received retention bonuses. Form 990, Part VI, Section B, line 11b Once Form 990 is prepared by the certified public accounting firm, a draft copy is e-mailed to the controller. The CFO & Controller will then review the Form, and also compare it with the previous year's 990. Once the CFO & Controller is satisfied with the draft copy, it is forwarded to the CEO. The CEO will then review the document. Any questions will either be answered by the controller or the accounting firm. Once the CEO approves the draft 990, a copy is provided to the board of directors for their review. Once the board has approved the draft, the accounting firm is notified and the final version is prepared for filing. Form 990, Part VI, Section B, line 12c It is the expectation of Penobscot Valley Hospital that our board of directors, medical staff, regular and contracted employees, and our volunteers avoid activities that may involve, or appear to involve, a conflict of interest. This is a standard of conduct communicated through Administrative Policy 109 "Code of Ethics," our code of conduct and ethics, and our medical by-laws. These documents are drafted and signed off by the president of the board of directors, the chief executive officer, chief of medical staff and the compliance officer as appropriate. Every individual employed by, or otherwise representing the Hospital, is responsible for complying with this standard. It is the responsibility of the compliance officer and the chief executive officer to ensure that this standard is communicated, maintained and enforced within the Organization. Administrative Policy 127 "Compliance Reporting" outlines the expectation for reporting non-compliance, the mechanisms in place to do so, and the investigative process. Such mechanisms include a 24-hour confidential reporting hotline. Education on Penobscot Valley Hospital's code of conduct and ethics is provided during orientation or at the beginning of the business relationship. Reinforcement of this education is provided annually and upon any business contract renewal. Form 990, Part VI, Section B, line 15 CEO's wages come from the 2018 Northern New England Healthcare Compensation Survey by Gallagher. Ranges are presented to the finance/personnel committee of the board and the wage is set by the board. Other officers wages are also set by utilizing the survey. Wages are set by evaluating the position in conjunction with the job description listed in the survey. Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. Form 990, Part IX, line 11g Physician Fees: Program service expenses 3,636,346. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,636,346. Purchased Services: Program service expenses 2,905,802. Management and general expenses 423,524. Fundraising expenses 0. Total expenses 3,329,326. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Penobscot Valley Hospital 7 Transalpine Road, Box 368 Lincoln, ME 04457 EIN 01-0545327 Penobscot Valley Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Gain on Bankruptcy Reorganization 4,014,747. Alpine Health Services Inc PO Box 460 West Enfield ME 04493 222533280 Support to provide health services in underserved areas of Maine. ME 501(c)(3) Line 10 Penobscot Valley Hospital 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0