PENOBSCOT VALLEY HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- PENOBSCOT VALLEY HOSPITAL (EIN 01-0545327)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-13
- IRS object ID
- 201513179349306996
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-13T14:35:24-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 041041100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010545327 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PENO | BusinessNameControlTxt |
| Phone | 2077943321 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7 Transalpine Road Box 368 | AddressLine1Txt |
| City | Lincoln | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04457 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Gary Poquette | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2077943321 | PhoneNum |
| Signature | 2015-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Barbara J McGuan CPA | PreparerPersonNm |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2015-11-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Gary Poquette | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7 Transalpine Road Box 368 | AddressLine1Txt |
| City | Lincoln | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04457 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,436,941 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pvhme.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 263 | TotalEmployeeCnt |
| Total Volunteers | 34 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $46,876 | PYContributionsGrantsAmt |
| CY Contributions Grants | $86,814 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $26,157,943 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,973,107 | CYProgramServiceRevenueAmt |
| PY Investment Income | $75,588 | PYInvestmentIncomeAmt |
| CY Investment Income | $68,618 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$5,836 | PYOtherRevenueAmt |
| CY Other Revenue | $16,692 | CYOtherRevenueAmt |
| PY Total Revenue | $26,274,571 | PYTotalRevenueAmt |
| CY Total Revenue | $25,145,231 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,140,242 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,981,895 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,544,831 | PYOtherExpensesAmt |
| CY Other Expenses | $11,011,866 | CYOtherExpensesAmt |
| PY Total Expenses | $26,685,073 | PYTotalExpensesAmt |
| CY Total Expenses | $25,993,761 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$410,502 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$848,530 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,908,408 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,378,530 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,694,537 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,998,207 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,213,871 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,380,323 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Penobscot Valley Hospital exists to provide quality healthcare and to serve as an educational and referral resource that meets our customer's needs by providing appropriate services, providing health related information, and making arrangements for additional health services. PVH provides vital services to the community which are not accessible in any other way to many of our patients due to geographical or transportation issues. See Schedule H for additional details. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $21,529,673 | ExpenseAmt |
| Revenue | $24,973,107 | RevenueAmt |
| Desc | 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 2014, 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. | Desc |
| Total Program Service Expenses | $21,529,673 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 37 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 263 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | ME | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ann Marie Rush | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2077943321 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7 Transalpine Road Box 368 | AddressLine1Txt |
| City | Lincoln | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04457 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Richard Wyman | |||||||
| Board Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Phillip Dawson Jr | |||||||
| Vice President | 1.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Pam Hoxie | |||||||
| Board Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Michael McFalls | |||||||
| Board Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Hervey Clay | |||||||
| Board Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| H Joseph Thibodeau DMD | |||||||
| Board Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Gilberte Mayo | |||||||
| Treasurer | 1.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Frederick Woodman Jr | |||||||
| President | 1.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Ed Woolley | |||||||
| Board Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Annette Haynes | |||||||
| Board Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Amanda Dunn | |||||||
| Board Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| David Shannon | |||||||
| Past CEO | 50.00 | $86,536 | $0 | $6,305 | Yes (X) | ||
| Ann Marie Rush | |||||||
| CFO | 50.00 | $162,627 | $0 | $17,817 | Yes (X) | ||
| Lynn Beasley | |||||||
| Past CEO | 50.00 | $107,428 | $0 | $11,561 | Yes (X) | ||
| Gary Poquette | |||||||
| CEO | 50.00 | $66,154 | $0 | $7,534 | Yes (X) | ||
| Samer Sbayi | |||||||
| Surgeon | 40.00 | $356,703 | $0 | $26,322 | Yes (X) | ||
| Michael Lescord | |||||||
| ED Physician | 40.00 | $434,492 | $0 | $23,549 | Yes (X) | ||
| Glenn Deyo | |||||||
| Surgeon | 40.00 | $353,717 | $0 | $24,373 | Yes (X) | ||
| David L Ettinger | |||||||
| ED Physician | 40.00 | $326,925 | $0 | $30,406 | Yes (X) | ||
| David H Dumont | |||||||
| Hospitalist | 40.00 | $279,159 | $0 | $16,614 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,173,741 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $164,481 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Nurse Anesthesia of Maine LLC | |||||
| 141 North Main Street Suite 205 | Brewer | ME | 04412 | Nursing Services | $638,341 |
| Emcare Inc | |||||
| 7032 Collection Center Drive | Chicago | IL | 60693 | ER Physician Services | $400,899 |
| NEHE MRI LLC | |||||
| PO Box 6600 | Newport Beach | CA | 92658 | MRI Services | $351,866 |
| Quorum Health Resources LLC | |||||
| 105 Continental Place | Brentwood | TN | 37027 | Hospital Management Svcs. | $330,605 |
| Comprehensive Pharmacy Services LLC | |||||
| PO Box 638316 | Cincinnati | OH | 452638316 | Pharmacy | $322,105 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $14,116 | FundraisingAmt |
| Government Grants | $6,148 | GovernmentGrantsAmt |
| All Other Contributions | $66,550 | AllOtherContributionsAmt |
| Total Contributions | $86,814 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Revenue | 621400 | $36,695,215 | $36,695,215 | |
| Cafeteria & Other | 722210 | $167,731 | $65,020 | $102,711 |
| Meaningful Use Revenue | 621400 | $35,974 | $35,974 | |
| Provision for Bad Debts | 621400 | -$1,766,554 | -$1,766,554 | |
| Contractual/Char. Adj. | 621400 | -$10,159,259 | -$10,159,259 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,973,107 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,183 | TotalRevenueColumnAmt |
| Exclusion | $24,183 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $329,416 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $284,939 | SecuritiesAmt |
| Other | $42 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $44,477 | SecuritiesAmt |
| Other | -$42 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,435 | TotalRevenueColumnAmt |
| Exclusion | $44,435 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $7,842 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $14,116 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $6,729 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,113 | TotalRevenueColumnAmt |
| Exclusion | $1,113 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Earnings from Subsidiary | 900099 | $12,781 | $12,781 |
| Earnings from Investment | 900099 | $2,798 | $2,798 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $15,579 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,145,231 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,870,396 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $188,021 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,961 | TotalAmt |
| Management And General | $465,961 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,642,704 | TotalAmt |
| Program Services | $10,766,549 | ProgramServicesAmt |
| Management And General | $876,155 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,222 | TotalAmt |
| Program Services | $81,402 | ProgramServicesAmt |
| Management And General | $9,820 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,012,321 | TotalAmt |
| Program Services | $1,897,652 | ProgramServicesAmt |
| Management And General | $114,669 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $769,687 | TotalAmt |
| Program Services | $686,827 | ProgramServicesAmt |
| Management And General | $82,860 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,156 | TotalAmt |
| Program Services | $71,851 | ProgramServicesAmt |
| Management And General | $26,305 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,000 | TotalAmt |
| Management And General | $54,000 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,561 | TotalAmt |
| Management And General | $6,561 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,075,034 | TotalAmt |
| Program Services | $4,018,722 | ProgramServicesAmt |
| Management And General | $1,056,312 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,056 | TotalAmt |
| Management And General | $25,056 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $890,001 | TotalAmt |
| Program Services | $371,240 | ProgramServicesAmt |
| Management And General | $518,761 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $770,007 | TotalAmt |
| Program Services | $723,910 | ProgramServicesAmt |
| Management And General | $46,097 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,349 | TotalAmt |
| Program Services | $64,043 | ProgramServicesAmt |
| Management And General | $35,306 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274,603 | TotalAmt |
| Program Services | $4,653 | ProgramServicesAmt |
| Management And General | $269,950 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $864,609 | TotalAmt |
| Program Services | $864,609 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $282,187 | TotalAmt |
| Program Services | $19,072 | ProgramServicesAmt |
| Management And General | $263,115 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $1,959,143 | $1,959,143 | |
| Service Provider Tax | $612,242 | $612,242 | |
| Physician Events | $918 | $918 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,993,761 | TotalAmt |
| Program Services | $21,529,673 | ProgramServicesAmt |
| Management And General | $4,464,088 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,153,912 | BOYAmt |
| EOY | $1,711,046 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $722,862 | BOYAmt |
| EOY | $747,883 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $22,681 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,662,957 | BOYAmt |
| EOY | $2,693,406 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,985 | BOYAmt |
| EOY | $44,976 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $675,089 | BOYAmt |
| EOY | $746,891 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,231 | BOYAmt |
| EOY | $210,920 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,728,347 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,535,098 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,508,900 | BOYAmt |
| EOY | $6,193,249 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $756,469 | BOYAmt |
| EOY | $833,352 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,844 | BOYAmt |
| EOY | $36,423 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,050 | BOYAmt |
| EOY | $18,574 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,109 | BOYAmt |
| EOY | $119,129 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,908,408 | BOYAmt |
| EOY | $13,378,530 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,755,851 | BOYAmt |
| EOY | $2,516,841 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $882,073 | BOYAmt |
| EOY | $786,296 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,071,162 | BOYAmt |
| EOY | $5,292,284 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $985,451 | BOYAmt |
| EOY | $1,402,786 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,694,537 | BOYAmt |
| EOY | $9,998,207 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,967,287 | BOYAmt |
| EOY | $3,138,413 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $170,035 | BOYAmt |
| EOY | $165,361 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,549 | BOYAmt |
| EOY | $76,549 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,213,871 | BOYAmt |
| EOY | $3,380,323 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,908,408 | BOYAmt |
| EOY | $13,378,530 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$848,530 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $14,982 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,276 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,276 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization pays dues to the Maine Hospital Association and the American Hospital Association. A portion of dues paid to the Maine Hospital Association ($4,700) and American Hospital Association ($576) were attributable to lobbying expenses. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $28,897 | OtherCostOrOtherBasisAmt |
| Book Value | $28,897 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,066,187 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,984,786 | DepreciationAmt |
| Book Value | $3,081,401 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $433,876 | OtherCostOrOtherBasisAmt |
| Depreciation | $433,876 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,765,204 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,750,185 | DepreciationAmt |
| Book Value | $3,015,019 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $434,183 | OtherCostOrOtherBasisAmt |
| Depreciation | $366,251 | DepreciationAmt |
| Book Value | $67,932 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,193,249 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated Third-Party Payor Settlements | $1,283,657 |
| Deferred Compensation | $119,129 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,402,786 | TotalLiabilityAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $12,005 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $8,310 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $3,695 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $3,062 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $1,352 | OtherDirectExpensesEvent1Amt |
| Event2 | Holiday Extravaganza | Event2Nm |
| Gross Receipts Event2 | $9,953 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $5,806 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $4,147 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $477 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $1,073 | FoodAndBeverageEvent2Amt |
| Entertainment Event2 | $350 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $415 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $21,958 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $14,116 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $7,842 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $3,539 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $1,073 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $350 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,767 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $6,729 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $1,113 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 225.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,013,955 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,013,955 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03900 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,681,487 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,390,310 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $291,177 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,066,895 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,446,259 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$379,364 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,762,337 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,836,569 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $925,768 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05020 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,521 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $244 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $30,277 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,521 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $244 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $30,277 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,792,858 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,836,813 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $956,045 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05140 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,257,956 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $9,864,301 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,864,301 | CostOfCareReimbursedByMedcrAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7 Transalpine Road | AddressLine1Txt |
| City | Lincoln | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04457 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.pvhme.org | WebsiteAddressTxt |
| State License | 38340 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.pvhme.org/About-Us/Newsletters-Publications.aspx | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 225.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Penobscot Valley Hospital | Part V, Section B, Line 5: Local Expert Advisors included the Community Health Educator and Nutritian Education Coordinator from Partnership for Healthy Northern Penobscot, the owner of Select Designs, the Manager of Clinical Operations from Community Health & Counseling Services, CEO and Penquis District Public Health Liaison of the PV Hospital, Director of Community Services from Eastern Area Agency on Aging, the school nurse from the local school district SAU31, clinician from Clinical Consultation & Counseling PA, FNP and CEO from Health Access Network, and Town Manager of Lincoln.When the analysis was complete, the information and summary conclusions were put before a local group of experts, who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions with additional statements of need, and new needs did emerge from this exchange. Consultation with local experts occurred again via an internet-based survey during the period beginning October 4, 2013, and ending October 10, 2013.With the prior steps identifying potential community needs, the local experts participated in a structured communication technique called a Delphi method, originally developed as a systematic, interactive forecasting method that relies on a panel of experts. Experts answer questionnaires in a series of rounds. We contemplated and implemented one round as referenced during the above dates. After each round, we provided an anonymous summary of the experts' forecasts from the previous round, as well as reasons provided for their judgments. The process encouraged experts to revise their earlier answers in light of the replies of other members of their panel. Typically, this process decreases the range of answers and moves the expert opinions toward a consensus "correct" answer. The process stops when we identify the most pressing, highest priority, community needs. In the PVH process, each local expert allocated 100 points among all identified needs, having the opportunity to introduce needs previously unidentified and challenge conclusions developed from the data analysis. A rank order of priorities emerged, with some needs receiving none or virtually no support, and other needs receiving identical point allocations. |
| Penobscot Valley Hospital | Part V, Section B, Line 11: Smoking was identified as a significant need in our 2013 CNHA. PVH provides some services to respond to this need - including Pulmonary Function testing, providing smoking cessation educational packets to patients, providing smoking cessation tools to our employees free of charge, and providing a 100% smoke free campus to our patients and community. However, PVH does not intend to develop an implementation plan to address this need because we have a local organization that was developed to address this topic. Sprint for Life (River Coalition), as part of the Healthy Maine Partnership, are working to address this problem. Physician practices in the community also work towards addressing this problem. |
| Penobscot Valley Hospital | Part V, Section B, Line 13h: State Regulation |
| Penobscot Valley Hospital | Part V, Section B, Line 16i: 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 FAQ section of the Organization's website. Notices are also posted at all entrances to the Hospital and at various locations within the building. |
| Penobscot Valley Hospital | Part V, Section B, Line 22d: The Hospital applied the determined discount to the gross charge amount for self pay patients. The Hospital applied the determined discount to the remaining balance after insurance payment, if applicable. |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Penobscot Valley Hospital Part V, Section B, line 16b website: | www.pvhme.org/billing.aspx |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part II, Community Building Activities: | Many families rely on us 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 meet the health needs of all people, and take pride in providing for those who may not be able to afford care. Throughout 2014, we partnered with many other organizations to reach people within our communities to educate, train and inform, including: Bangor Savings Bank, Colonial Healthcare, Eastern Maine Community College, Golden Key Senior Center, Health Access Network, Husson University, Katahdin Shared Services, Katahdin Valley Community College, 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, Maine Medical Partner's Women's Health Division of Maternal Fetal Medicine, Mayo Regional Hospital, Millinocket Regional Hospital, New England Organ Bank, Northern Penobscot Tech Region III, Quorum Health Resources, Raising Readers Program, RSU #67, SAD #30, SAD #31, PVH Auxiliary, PVH Cancer Support Group, SPRINT for Life, the University of Maine, University of New England, University of Vermont, WomenHeart, Yale University, and more. By employing over 210 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. 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. Auxiliary provided scholarships to non-traditional students pursuing a degree in healthcare.2. Cancer Support Group meetings twice a month for survivors and caregivers. Hosted physician education on hyperbaric oxygen therapy with Marian Benner, MD from St. Joseph Hospital in May 2014.3. Promoted National Donor Month in May to commemorate those who have given the gift of life and to raise awareness about registering as a donor.4. Published educational articles weekly in the Lincoln News on topics such as hand hygiene, disease prevention, and nutritional advice.5. The Quality Improvement department conducted two lectures to the University of Maine nursing students on quality and service issues. 6. Our Pharmacist provided seniors with education on medication safety and the Physical Therapy department demonstrated safe stretching and exercise techniques at the Golden Key Senior Center.7. Staff created educational displays in our lobby which have included health and nutrition pieces created by students at Hichborn Middle School to promote healthy choices among our staff and community. 8. In February, WomenHeart hosted a display to educate staff and community members about heart disease in women. 9. PVH offered educational tours where students learn age-specific healthcare information like proper hand hygiene, x-ray processing, laboratory testing, and facility tours.10. Our Falls Team provided education on falls risks and measures that can be taken at home to decrease a patient's risk of falls and injury. 11. Laboratory staff made weekly visits to four area nursing homes to collect specimens from residents and technologists offered free educational sessions to nursing home staff members on specimen collection. 12. Participated in the March Lincoln Expo with surgical equipment to entertain the crowd. We also provided information from our imaging department on breast cancer prevention, preventative care with Penobscot Valley Primary Care, swing beds and hand hygiene.13. PVH is a clinical site for Northern Penobscot Tech Region III and several colleges and universities. During 2014, PVH had over 30 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. 14. 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. 15. At the end of each school year, PVH awards scholarships to three graduating seniors from Lee Academy, Mattanawcook Academy and Penobscot Valley High School. Each recipient is selected by the schools and must be pursuing a healthcare-related degree. They are awarded $500 each with the hospital giving a total of $1,500 annually. Community Contributions:1. Auxiliary volunteers organized fundraisers and blood drives, visited patients, provided activity packs for children and special gifts for patients on the holidays.2. Hosted a Red Cross Blood Drive3. Organized disaster preparedness drill in May 2014 to prepare for an incident involving hazardous materials that could affect our communities. The drill was effective in determining shared resources with local agencies and implementing methods to protect the community. 4. Donated to the Lincoln Regional Food Cupboard, which supplies food, clothing, and other necessities to people in need. 5. LifeFlight relies on private donations to help fund advanced medical equipment on board each helicopter and they are currently fundraising to purchase another helicopter and airplane to their fleet. In 2014, PVH donated $3,000 toward this worthy cause. 6. PVH is a member and proud supporter of the Lincoln Lakes Region Chamber of Commerce. We understand the importance of supporting our local business community and make it a point to buy locally whenever possible.7. Members of the PVH senior leadership team serve in the Lincoln Economic Development Council which is working to rebrand the town, revitalize Main Street, enhance recreational offerings, and entice a younger generation to relocate to our town. 8. In the summer, PVH employees held a school supply drive in collaboration with Penquis CAP. Collection sites were set up throughout our facilities during the month of August. Penquis CAP then distributed the items to area K-12 students in need. 9. Each month, PVH hosted a networking lunch time meeting for social workers and others who do similar work in the community. PVH provided education for the participants and facilitated discussions about social work-related issues. |
| 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 around the hospital. We also have information in each patient room, and our employees 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, logging companies, and paper mill 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 |
| Form 990, Schedule H, Part VI, Line 5: | Program OfferingsThrough Penobscot Valley Hospital:1. CPR/AED/First Aid classes - available to the community throughout the year at a low cost2. Internships/Job Shadowing - The hospital works closely with students of all ages from across New England. PVH has hosted many job shadow opportunities with students from area high schools and colleges. 3. Teddy Bear Clinics - designed to familiarize children ages 4-10 with hospital surroundings and equipment. During the Clinics, staff register the bears for treatment of their "boo-boos" and then they proceed through the operating room introducing the children to medical equipment and procedures. The goal is that the children will have an increased level of comfort in the emergency room or during a surgical procedure. PVH hosted one clinic in May 2014 and had around 40 children attend.Through Penobscot Valley Primary Care:1. ImPACT program - PVH has provided Mattanawcook Academy with a software program to help prevent long-term brain injuries in student athletes through the Maine Concussion Management Initiative, a program created by Dr. William Heinz, a Portland orthopedist, and Dr. Paul Berkner, director of health services at Colby College. Family practice physician Dr. Carl Alessi oversees the program in our rural health center.2. Maine Breast and Cervical Health Program - PVPC helps provide breast and cervical cancer screening and diagnosis services to underserved women, to provide public and professional education, and to support community partnerships to enhance statewide cancer control activities.3. Maine Immpact program - providing a lifetime of good health with vaccines regardless of the patient's ability to pay4. From the First Tooth - we participate in this prevention initiative whose goal is to improve the oral health of Maine children. Children receive fluoride varnish at well child visits with their healthcare provider from approximately 6 months to 42 months. At this time, the healthcare providers will assist the family in transitioning the child to a local dentist. 5. Raising Readers - pediatric patients at PVPC will have a library of over 12 books by the time they enter school thanks to this great program. Raising Readers provides participating hospitals and medical practices with quality, hardcover books. They are selected by Maine people who know about children's literature: doctors, librarians, child development experts, and parents. Our pediatrician, Dr. Patricia Nobel serves on the Raising Readers board and says she is honored to be able to choose quality reading materials for Maine children.Through SPRINT, our Healthy Maine Partnership:Tobacco prevention:1. No BUTS (Blocking Underage Tobacco Sales) program educated area retailers on blocking underage tobacco sales. 35 of the 68 retailers in our area have participated in this training course2. Implemented municipal policies and ordinances to prohibit tobacco use at public events, including: Run/Walk for Wellness, Lincoln Trail System and Springfield Fair GroundsObesity prevention:1. Increased municipal policies and ordinances to promote healthy living, currently working in the Town of Lee to complete the Rural Active Living Assessment2. Increased the number of public access sites for physical activity which currently include Lincoln Trail Systems, Springfield Fairgrounds, Lee/Winn walking club, and the Walking School Bus.Education in schools:1. Implemented comprehensive tobacco policies at Lee Academy and Mattanawcook Academy.2. Established wellness policies at all area school systemsSubstance abuse prevention:1. Local Area Underage Drinking Enforcement Task Forces have been established in Lincoln2. Save-A-Life Task Force was created in Lincoln3. TipSoft was promoted and utilized by police departments4. Party Patrols and/or Compliance Checks conducted by police departments5. Party Smarter; Parents Who Host, Lose the Most; Find out More Do More materials were disseminated via print, social media, radio, lawn signs, and table tents by community partners6. Prescription Monitoring Program information was distributed to all identified providers7. "Lock Your Meds" and "Up and Away" Campaign materials were distributed to seniors throughout the service area. 8. National Take Back Day was promoted on local radio, print and social media, Chamber listserv's, provider offices, pharmacies and the local EAAA. 9. Safe Storage and Disposal of Medication resources were included in patient discharge packets at local hospitals, in provider offices and at funeral homes. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| David Shannon | ||||||||||||||
| Past CEO | $84,721 | $0 | $0 | $0 | $1,815 | $0 | $0 | $0 | $6,305 | $0 | $92,841 | $0 | $0 | $0 |
| Ann Marie Rush | ||||||||||||||
| CFO | $159,027 | $0 | $0 | $0 | $3,600 | $0 | $0 | $0 | $17,817 | $0 | $180,444 | $0 | $0 | $0 |
| Lynn Beasley | ||||||||||||||
| Past CEO | $103,867 | $0 | $0 | $0 | $3,561 | $0 | $0 | $0 | $11,561 | $0 | $118,989 | $0 | $0 | $0 |
| Gary Poquette | ||||||||||||||
| CEO | $63,920 | $0 | $0 | $0 | $2,234 | $0 | $0 | $0 | $7,534 | $0 | $73,688 | $0 | $0 | $0 |
| Samer Sbayi | ||||||||||||||
| Surgeon | $356,703 | $0 | $0 | $0 | $0 | $0 | $3,900 | $0 | $22,422 | $0 | $383,025 | $0 | $0 | $0 |
| Michael Lescord | ||||||||||||||
| ED Physician | $434,492 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $23,549 | $0 | $458,041 | $0 | $0 | $0 |
| Glenn Deyo | ||||||||||||||
| Surgeon | $353,717 | $0 | $0 | $0 | $0 | $0 | $3,900 | $0 | $20,473 | $0 | $378,090 | $0 | $0 | $0 |
| David L Ettinger | ||||||||||||||
| ED Physician | $309,425 | $0 | $0 | $0 | $17,500 | $0 | $3,900 | $0 | $26,506 | $0 | $357,331 | $0 | $0 | $0 |
| David H Dumont | ||||||||||||||
| Hospitalist | $261,659 | $0 | $0 | $0 | $17,500 | $0 | $3,900 | $0 | $12,714 | $0 | $295,773 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part VII Section B Line 5 | FormAndLineReferenceDesc |
| Explanation | Dave Shannon, Past CEO, Lynn Beasley, Past CEO, Gary Poquette, CEO, & Ann Marie Rush, CFO, are compensated by Quorum Health Resources, an unrelated organization, for services rendered to the Organization. The amounts listed below are not included in the total reported on Form 990, Part VII, Section B for Quorum Health Resources, LLC. A breakdown of their 2014 compensation is as follows: Dave Shannon, Past CEO: Salary: $84,721 Benefits: $6,305 Automobile Allowance: $1,815 Lynn Beasley, Past CEO: Salary: $103,867 Benefits: $11,561 Automobile Allowance: $3,561 Gary Poquette, CEO: Salary: $63,920 Benefits: $7,534 Automobile Allowance: $2,234 Ann Marie Rush, CFO: Salary: $159,027 Benefits: $17,817 Automobile Allowance: $3,600 | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Maine Health and Higher Educational Facilities Authority Revenue Bonds | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 010314384 | BondIssuerEIN |
| CUSIP | 560427EU4 | CUSIPNum |
| Bond Issued | 2012-06-28 | BondIssuedDt |
| Issue Price | $1,117,769 | IssuePriceAmt |
| Purpose | To refinance Series 2002A bond | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | Yes (1) | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $331,473 | RetiredAmt |
| Total Proceeds | $1,117,769 | TotalProceedsAmt |
| In Reserve Fund | $132,031 | InReserveFundAmt |
| Issuance Costs From Proceeds | $24,765 | IssuanceCostsFromProceedsAmt |
| Substantial Completion | 2012 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | Yes (1) | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Glenn Deyo | PersonNm |
| Relationship With Org | Employee of the Organization | RelationshipWithOrgTxt |
| Loan Purpose | Sign-On Loan | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $118,054 | OriginalPrincipalAmt |
| Balance Due | $44,976 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $44,976 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Debbie Rancourt | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family member of Frederick Woodman, Jr., Board President | RelationshipDescriptionTxt |
| Transaction | $82,143 | TransactionAmt |
| Transaction | Employment | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | 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 CFO. The CFO will then review the document. Any questions she has will either be answered by the controller or the accounting firm. Once the CFO 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 a state-wide wage survey conducted annually by the Maine Society for Healthcare Human Resources Administration. 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 1,475,163. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,475,163. Purchased Services: Program service expenses 2,543,509. Management and general expenses 1,056,312. Fundraising expenses 0. Total expenses 3,599,821. Consulting: Program service expenses 50. Management and general expenses 0. Fundraising expenses 0. Total expenses 50. |
| 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). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alpine Health Services Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 460 | AddressLine1Txt |
| City | West Enfield | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04493 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222533280 | EIN |
| Primary Activities | Support to provide health services in underserved areas of Maine. | PrimaryActivitiesTxt |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 9 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |