2019-11-07T13:12:56-06:00 2018-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2018-01-01 010545327 Penobscot Valley Hospital PENO 2077943321 7 Transalpine Road Box 368 Lincoln ME 04457 Crystal Landry CEO 2077943321 2019-11-06 1 Joseph R Byrne CPA P01289281 2077752387 2019-11-06 69.49.157.66 2019-11-06 16:47:58 ES P FD764483AA263AFE8AB46477EA327BFBBE809DCF 4325644121B434A7DDEA38392197C5174BA1E390 2018 2020-03-31 21:24:44Z Crystal Landry 7 Transalpine Road Box 368 Lincoln ME 04457 18739951 0 X www.pvhme.org X 1973 ME Critical Access Hospital 9 9 214 37 0 0 71317 24684 20504774 18702103 40965 -15505 -760 -2396 20616296 18708886 0 0 0 0 11168874 8646393 0 0 0 11098129 11046328 22267003 19692721 -1650707 -983835 9429307 8314043 10800371 10668942 -1371064 -2354899 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 1 14390471 18702103 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 2018, 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. 14390471 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 22 0 1 214 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Crystal Landry 2077943321 7 Transalpine Road Box 368 Lincoln ME 04457 Phillip Dawson Jr President 1.50 X X 0 0 0 Richard Wyman Vice President 1.50 X X 0 0 0 Bea Szantyr Treasurer 1.50 X X 0 0 0 Judith Doore Board Member 1.50 X 0 0 0 Robert Genest Board Member 1.50 X 0 0 0 Bonnie Gray Board Member 1.50 X 0 0 0 Annette Haynes Board Member 1.50 X 0 0 0 Patricia Nobel MD Board Member 1.50 X 0 0 0 H Joseph Thibodeau DMD Board Member 1.50 X 0 0 0 Amanda Dunn Past Board Member 1.50 X 0 0 0 Patty Houghton Past Board Member 1.50 X 0 0 0 Penelope Kneeland Past Board Member 1.50 X 0 0 0 Earlene Young Past Board Member 1.50 X 0 0 0 Gary Poquette CEO 50.00 X 235723 0 14960 Ann Marie Rush Past CFO 50.00 X 40190 0 1437 Glenn Deyo Surgeon 40.00 X 324839 0 52901 Paul Turnquist ER Physician 30.00 X 236336 0 2878 Carl Alessi Physician 40.00 X 176467 0 34023 Crystal Landry Sr. Dir. Clinical & Administrative 40.00 X 122379 0 21874 Holly Mault Nurse Practitioner 40.00 X 107004 0 20831 1242938 0 148904 6 0 1 1 Emcare Inc 7032 Collection Center Drive Chicago IL 60693 ER Physician Services 2485823 Nurse Anesthesia of Maine LLC 141 North Main Street Suite 205 Brewer ME 04412 Nursing Services 407023 Comprehensive Pharmacy Services LLC PO Box 638316 Cincinnati OH 45263 Pharmacy 215071 NEHE MRI LLC PO Box 19532 Irvine CA 92623 MRI Services 209262 Dahl Chase Diagnostic Services 417 State Street Bangor ME 04401 Laboratory Services 169651 10 12650 3069 1048 7917 24684 Patient Revenue 622000 33639006 33639006 Cafeteria & Other 900099 312545 286752 25793 Provision for Bad Debts 622000 -1875117 -1875117 Contractual/Char. Adj. 622000 -13374331 -13374331 18702103 10959 10959 1501 27965 -26464 -26464 -26464 3793 12650 3100 693 693 Earnings from Subsidiary 900099 14298 14298 Gain(loss) Affiliate Investment 900099 -17387 -17387 -3089 18708886 18676310 0 7892 X 292310 292310 6933932 4873448 2060484 915564 661691 253873 504587 334542 170045 94159 94159 54580 54580 5891050 4954015 937035 7845 7845 754752 381166 373586 800690 756924 43766 34714 25092 9622 269967 221327 48640 603610 603610 328936 97955 230981 Medical Supplies 1592094 1480701 111393 Service Provider Tax 591752 591752 Miscellaneous Expenses 22179 22179 19692721 14390471 5302250 0 X 728549 208371 528092 544829 2781444 2766771 440578 426352 226597 201965 18315536 14250312 4617407 4065224 74792 71703 11144 8668 20704 20160 9429307 8314043 2687050 2143887 468965 353188 4811316 4755822 2833040 3416045 10800371 10668942 X -1532062 -2530914 84449 99466 76549 76549 -1371064 -2354899 9429307 8314043 -983835 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4818 4818 0 Part II-B, Line 1: The Organization pays dues to the Maine Hospital Association and the American Hospital Association. A portion of dues paid to the Maine Hospital Association ($4,603) and American Hospital Association ($215) were attributable to lobbying expenses. 28897 28897 8062598 5650778 2411820 433876 433876 0 9370167 7756936 1613231 419998 408722 11276 4065224 Estimated Third-Party Payor Settlements 3395885 Deferred Compensation 20160 3416045 18711986 3100 3100 18708886 0 18708886 19695821 3100 3100 19692721 0 19692721 Part XI, Line 2d - Other Adjustments: Special Event Expenses 3,100. Part XII, Line 2d - Other Adjustments: Special Event Expenses 3,100. Golf Tournament 16443 12650 3793 850 2080 170 16443 12650 3793 850 2080 170 3100 693 1 1 1 X 1 X 225.000000000000 1 1 0 1 1 558868 558868 0.02840 3443475 3001646 441829 0.02240 6854883 6191813 663070 0.03370 10857226 9193459 1663767 0.08450 7968 7968 0.00040 7968 7968 0.00040 10865194 9193459 1671735 0.08490 1 1079571 6288607 6288607 X 1 1 1 1 Penobscot Valley Hospital 7 Transalpine Road Lincoln ME 04457 www.pvhme.org 38340 X X X X Penobscot Valley Hospital 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X www.pvhme.org/publications.aspx X 1 16 1 www.pvhme.org/publications.aspx 0 1 X 150.000000000000 225.000000000000 X 1 1 X X X 1 X www.pvhme.org/billing.aspx X www.pvhme.org/billing.aspx X www.pvhme.org/resources/billing.aspx 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: Penobscot Valley Hospital participated in the Maine Shared Health Needs Assessment & Planning Process for the first time in 2015-2016 to develop this report. The report was prepared by the research teams at Market Decisions Research of Portland, Maine, Hart Consulting Inc. of Gardiner, Maine, and the Maine Center for Disease Control and Prevention. Substantial segments of the narrative sections were adapted from the 2012 Maine State Health Assessment and significant analysis and research was conducted by epidemiologists at the Maine CDC and the University of Southern Maine's Muskie School of Public Service.Qualitative data was collected through a statewide stakeholder survey conducted in May and June 2015 with 1,639 people representing more than 80 organizations and businesses in Maine. The survey was developed using a collaborative process including Maine SHNAPP partners, Market Decisions Research, and Hart Consulting, and a number of other stakeholders and health experts. In Penobscot County, a total of 185 stakeholders responded to the survey.The object of the survey was to produce qualitative data of the opinions of health professionals and community stakeholders on the health issues and needs of the communities across the state. The survey used a snowball sampling approach by inviting leaders of member organizations and agencies to invite their members and employees to participate. Survey respondents represented public health and healthcare organizations as well as behavioral health, business, municipalities, education, public safety, and nongovernmental organizations. More than 80 organizations agreed to send the survey to their members. The survey asked all respondents a basic set of questions to rate the importance of health issues and impact of health factors. It then allowed respondents to provide answers to probing questions on the three issues and factors they were most interested in or had the most knowledge about. The Market Decisions Research/Hart Consulting team reviewed, coded and cleaned all open-ended comments for similar and recurrent themes.Stakeholders who work in Penobscot County listed the following health issues as their top five concerns:1. Drug and alcohol abuse2. Obesity3. Physical activity and nutrition4. Mental Health5. Cardiovascular diseases Penobscot Valley Hospital Part V, Section B, Line 6a: *Central Maine Healthcare*EMHS*Maine General Health*Maine Health*Maine Center for Disease Control and Prevention, an office of Department of Health and Human Services*Health Access Network Penobscot Valley Hospital Part V, Section B, Line 6b: *Maine Center for Disease Control and Prevention, an office of Department of Health and Human Services*Health Access Network Penobscot Valley Hospital Part V, Section B, Line 11: The five top health issues identified in the 2016 CHNA were:1. Drug and alcohol abuse2. Obesity3. Physical activity and nutrition4. Mental Health5. Cardiovascular diseases.The following are steps that have been taken to address these needs.Drug and Alcohol Abuse:1. Feasibility has been discussed for options of bed usage at PVH as potential.2. Joint meeting held between PVH and HAN to provide medical staff education on new prescribing laws.3. PVH has implemented prescribing guidelines for the Emergency Department.4. Continued recruitment efforts for quality advanced clinicians at both PVH and HAN. Ongoing process.5. Ongoing efforts by PVH Rehab and Pain Management program to provide alternative pain options to patients and community.6. Continue monthly Save-A-Life meetings to identify areas where educational opportunities exist.Obesity, Physical Activity and Nutrition:1. PVH offers the Community Fitness Center and Independent Gym to the public for a nominal monthly fee.2. PVH staff created the free monthly Healthy Me weight loss program to teach the community about healthy eating, and safe exercising.3. Efforts are being made to adopt and promote 5-2-1-0 Let's Go program.4. PVH collects health food items for Lincoln Regional Food Cupboard weekend backpack program to provide students in need with healthy food options on the weekends.Mental Health:1. PVH has expanded access to mental health services through psychiatric telemedicine program, and a crisis prevention program in the emergency department. Treats and refers emergency department patients for psychiatric care.2. PVH Case Management holds monthly luncheons to coordinate efforts with agencies to share information on services provided within the hospital's service area.3. Assist HAN in promoting their school based health centers at Lee Academy and Mattanawcook Academy, where counseling services are provided to high school students.Cardiovascular Disease:1. PVH participates in the Breathe Easy Coalition and Maine Tobacco Free Hospital Network programs. PVH received the Gold Star Status Award in 2017 for their efforts to implement best practices for a smoke-free campus.2. PVH partners with the Tobacco-Free Maine CDC program offering free resources to the public through the Maine Tobacco Helpline. 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 diseases may go untreated. Often this results in poor health with high emergent or inpatient costs. At PVH, we strive 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 health and well-being of those we serve. Throughout 2018, we 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, Health Access Network, Husson University, Katahdin Shared Services, Katahdin Valley 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, PVH Cancer Support Group, Save-A-Life Substance Abuse Task Force, the University of Maine, University of New England, University of Vermont, and more. By employing about 160 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 1.1174 jobs created in supporting industries. Penobscot Valley Hospital supports 330 jobs.PVH does not turn away people who need vital care, regardless of their ability to pay. Each person we treat receives the same high-quality care with 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 provided to the communities that we serve:Education/Scholarships:1. Promoted National Donor Month in May to commemorate those who have given the gift of life and to raise awareness about registering as an organ donor.2. Published educational articles in the Lincoln News and on social media on topics such as hand hygiene, disease prevention, and nutritional advice.3. Staff created educational displays in our lobby. 4. Laboratory staff made weekly visits to area nursing homes to collect specimens from residents.5. PVH is a clinical site for Northern Penobscot Tech Region III and several colleges and universities. During 2018, 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 provided emergency medicine training of family medicine residents from Eastern Maine Medical Center. We serve as a rotation site for physician assistants and medical students from University of New England, University of Vermont, and Yale University. Time spent with the students varies from a couple of hours to the entire semester of hands-on education. The demand for students to utilize PVH as a clinical site has increased over the last several years. 6. Professionals at PVH often visit local schools to share information on health-related topics with young people. These range from our infection prevention officer teaching students the importance of good hand washing to staff teaching children about their career field. Penobscot Valley Hospital volunteers, staff and providers are committed to providing quality healthcare services to the people in our community. In 2018, staff and volunteers provided:1. Free educational programs to seniors.2. Holiday gifts for area nursing home residents.3. The Auxillary provided Kids Activity Packs for children visiting the ED.4. Books for pediatric patients at well child checkups through Raising Readers.5. Free screenings for blood pressure at the Howland Community Events.6. Vaccinations through the Maine Impact Program. 7. Artwork projects with the students in the Mattanawcook Academy Community Integration Progam.8. Hosted two Red Cross Blood Drives.9. School Supply Drive through Penquis Cap.10. Substance Abuse prevention education.11. Community Service provider meetings for networking.12. Free meeting space for area non-profits.13. Leadership to the Lincoln Economic Development Community & Lincoln Lakes Region Chamber of Commerce.14. Collected donations for the Lincoln Food Cupboard's Healthy Snack Backpack program, reaching approximately 50 students per week for 12 weeks. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. In evaluating the collectibility of accounts receivable, the Hospital analyzes past results 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 in evaluating the sufficiency of the allowance for doubtful accounts. 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 provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. 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 2013 was 43.3 years. Lincoln is located in a modest area of the State, where the median resident income in 2013 was $44,649. Maine's average income for that same time period was $46,288. Part VI, Line 7, Reports Filed With States ME X X X X 0 0 0 0 0 0 0 0 0 Gary Poquette CEO 231488 0 0 0 4235 0 0 0 14960 0 250683 0 0 0 Ann Marie Rush Past CFO 39890 0 0 0 300 0 0 0 1437 0 41627 0 0 0 Glenn Deyo Surgeon 324839 0 0 0 0 0 0 0 52901 0 377740 0 0 0 Paul Turnquist ER Physician 236336 0 0 0 0 0 0 0 2878 0 239214 0 0 0 Carl Alessi Physician 176467 0 0 0 0 0 0 0 34023 0 210490 0 0 0 Part VII Section B Line 5: Gary Poquette, CEO, and Ann Marie Rush, Past CFO, are compensated by Quorum Health Resources, an unrelated organization, for services rendered to the Organization. A breakdown of their 2018 compensation is as follows: Gary Poquette, CEO: Salary: $138,487 Benefits: $13,483 Automobile Allowance: $4,235 Ann Marie Rush, Past CFO: Salary: $26,495 Benefits: $1,437 Automobile Allowance: $300 Additionally for a portion of calendar year 2018, Ms. Rush was employed and compensated by Millinocket Regional Hospital, an unrelated organization, for services rendered to the filing Organization. The Organization paid $13,395 to Millinocket Regional Hospital for services rendered to the filing Organization by Ms. Rush. The $13,395 is currently reflected in the compensation reported on Form 990 for Ms. Rush for this arrangement. The filing Organization is not aware of the actual amount of comepnsation paid to Ms. Rush by Millioncket Regional Hospital. A Maine Health and Higher Educational Facilities Authority Revenue Bonds 010314384 560427EU4 2012-06-28 1117769 To refinance Series 2002A bond 0 0 1 A 764581 1117769 132031 24765 960973 2012 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 Form 990, Part III, line 3 The Organization is no longer operating its Nuclear Medicine program. 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 controller will then review the Form, and also compare it with the previous year's 990. Once the 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 & CFO - Quorum Health Resources, an unrelated organization, does an extensive national compensation analysis. Ranges are presented to the finance/personnel committee of the board by QHR, and the wage is set. Other officer's wages are set using the 2018 Northern New England Healthcare Compensation Survey by Gallagher. 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 3,179,641. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,179,641. Purchased Services: Program service expenses 1,774,374. Management and general expenses 856,251. Fundraising expenses 0. Total expenses 2,630,625. Consulting Fees: Program service expenses 0. Management and general expenses 80,784. Fundraising expenses 0. Total expenses 80,784. 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). 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Alpine Health Services Inc C 3069 Cash