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Penobscot Bay Medical Center: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
Penobscot Bay Medical Center (EIN 01-0285286)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-12
IRS object ID
201302249349302155
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-12T14:04:09-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MAINEHEALTHBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1110 FREE STAddressLine1
CityPORTLANDCity
StateMEState
ZIP Code041013908ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN010285286EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PENOBSCOT BAY MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPENONameControl
Phone2075946747Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line14 WHITE STREETAddressLine1
CityROCKLANDCity
StateMEState
ZIP Code048412953ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMAURA KELLYName
TitleVP OF FISCAL SERVICESTitle
Phone2075946747Phone
Date Signed2013-08-06DateSigned
Authorize Third PartyfalseAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Date Prepared2013-08-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMAURA KELLYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14 WHITE STAddressLine1
CityROCKLANDCity
StateMEState
ZIP Code048412953ZIPCode
FieldValueIRS element (for citing)
Gross Receipts106454970GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PENOBSCOTBAYMEDICALCENTER.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1969YearFormation
State Legal DomicileMEStateLegalDomicile
Activity Or Mission DescriptionPENOBSCOT BAY MEDICAL CENTER IS AN ACUTE CARE HOSPITAL THAT OFFERS INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE SERVICES, PATIENT AND COMMUNITY EDUCATION, AND A FULL RANGE OF SPECIALTY SERVICES THROUGH THE EMERGENCY DEPARTMENT, SPECIAL CARE UNIT, SURGICAL SERVICES DEPARTMENT, OBSTETRICS AND GYNECOLOGY DEPARTMENT, AND THE PSYCHIATRIC ADDICTION & RECOVERY CENTER.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees1285TotalNbrEmployees
Total Nbr Volunteers178TotalNbrVolunteers
Total Gross UBI285274TotalGrossUBI
Net Unrelated Business Txbl Income41475NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year659161ContributionsGrantsPriorYear
Contributions Grants Current Year2962464ContributionsGrantsCurrentYear
Program Service Revenue Prior Year54518919ProgramServiceRevenuePriorYear
Program Service Revenue CY100591607ProgramServiceRevenueCY
Investment Income Prior Year186395InvestmentIncomePriorYear
Investment Income Current Year552293InvestmentIncomeCurrentYear
Other Revenue Prior Year359719OtherRevenuePriorYear
Other Revenue Current Year2348606OtherRevenueCurrentYear
Total Revenue Prior Year55724194TotalRevenuePriorYear
Total Revenue Current Year106454970TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year26081168SalariesEtcPriorYear
Salaries Etc Current Year55771949SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year28058632OtherExpensePriorYear
Other Expenses Current Year54138457OtherExpensesCurrentYear
Total Expenses Prior Year54139800TotalExpensesPriorYear
Total Expenses Current Year109910406TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1584394RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-3455436RevenuesLessExpensesCY
Total Assets BOY101037451TotalAssetsBOY
Total Assets EOY109517352TotalAssetsEOY
Total Liabilities BOY45060505TotalLiabilitiesBOY
Total Liabilities EOY55586952TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY55976946NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY53930400NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPENOBSCOT BAY MEDICAL CENTER IS AN ACUTE CARE HOSPITAL THAT OFFERS INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE SERVICES, PATIENT AND COMMUNITY EDUCATION, AND A FULL RANGE OF SPECIALTY SERVICES THROUGH THE EMERGENCY DEPARTMENT, SPECIAL CARE UNIT, SURGICAL SERVICES DEPARTMENT, OBSTETRICS AND GYNECOLOGY DEPARTMENT, AND THE PSYCHIATRIC ADDICTION & RECOVERY CENTER.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense79909018Expense
Revenue79086322Revenue
DescriptionINPATIENT & OUTPATIENT HOSPITAL CARE: PENOBSCOT BAY MEDICAL CENTER PROVIDES QUALITY MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF PENOBSCOT BAY MEDICAL CENTER, NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. IN KEEPING WITH THIS HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, WE PROVIDE FREE CARE AND SUBSIDIZED CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS FOR THE COMMUNITY. (CONTINUED AT SCHEDULE O) (CONTINUED FROM PART III, LINE 4A) PENOBSCOT BAY MEDICAL CENTER SERVED 3,634 INPATIENTS, INCLUDING NEWBORNS AND 160,782 OUTPATIENTS INCLUDING ER VISITS, DURING FY 12. TWENTY FOUR HOUR MEDICAL EMERGENCY SERVICE IS PROVIDED IN THE EMERGENCY ROOM, STAFFED BY FULL-TIME ATTENDING PHYSICIANS. PATIENTS ARE SEEN REGARDLESS OF ABILITY TO PAY. THERE WERE 21,888 VISITS TO THE EMERGENCY ROOM DURING FY 12. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE & MAINECARE PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, PENOBSCOT BAY MEDICAL CENTER RECOGNIZES THESE AMOUNTS AS CONTRACTUAL ADJUSTMENTS. THE UNREIMBURSED COST OF PROVIDING CARE TO THESE PATIENTS WAS 85,962,394. DURING FY 12, APPROXIMATELY 58% OF SERVICES WERE TO PATIENTS COVERED BY THESE GOVERNMENTAL PROGRAMS. ADDITIONALLY, PENOBSCOT BAY MEDICAL CENTER PROVIDED 4,312,959 IN FREE CARE TO PATIENTS NOT COVERED BY GOVERNMENTAL PROGRAMS. PBMC PROVIDES FREE CONFERENCE ROOM AND MEETING SPACE FOR A VARIETY OF HEALTH RELATED GROUPS INCLUDING ALCOHOLICS ANONYMOUS, AL ANON, MIDCOAST CANCER SUPPORT GROUP, HEART TO HEART, CARDIAC SPOUSE SUPPORT GROUP, CROHN'S DISEASE SUPPORT GROUP, VISUALLY IMPAIRED AND BLIND SUPPORT GROUP, PEDIATRIC ASTHMA SUPPORT GROUP, OSTOMY GROUP, MIDCOAST MASTECTOMY SUPPORT GROUP, NORTHEAST HEALTH CONSORTIUM FOR INTEGRATED CARE, BREAST CANCER INTERVENTION PROJECT, MID-COAST COALITION FOR DOMESTIC ABUSE, TEEN PARENTING, WOMEN'S AND CHILDREN'S COMMUNITY CARE PROJECT. ASSISTANCE IS PROVIDED TO EDUCATORS THROUGH OUR WORK WITH MEDICAL STUDENTS, STUDENT NURSES, PHYSICAL THERAPY INTERNS, EMERGENCY MEDICAL TECHNICIANS, MEDICAL RECORDS AND SOCIAL SERVICE STUDENTS. THROUGH AN ARRANGEMENT WITH THE UNIVERSITY OF MAINE - ORONO, OUR EDUCATION AND TRAINING DEPARTMENT OFFERS NURSES WITH CERTIFICATE DEGREES THE OPPORTUNITY TO WORK TOWARD A BACCALAUREATE DEGREE IN THE LOCAL AREA. THE HOSPITAL MAINTAINS A RESEARCH LIBRARY WHICH IS OPEN 24 HOURS A DAY AND AVAILABLE TO THE GENERAL PUBLIC. DURING FY 12, THE COMMUNITY CONTRIBUTED APPROXIMATELY 10,535 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTH CARE NEEDS OF THE COMMUNITY. THE VALUE OF THIS CONTRIBUTION IS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS IN BOTH PATIENT SERVICES AND OTHER WELLNESS PROGRAMS SUCH AS THOSE DESCRIBED ABOVE.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense11153151Expense
Revenue11038325Revenue
DescriptionPHYSICIAN PRACTICES: PEN BAY PHYSICIAN AND ASSOCIATES, A GROUP OF DEPARTMENTS OF PENOBSCOT BAY MEDICAL CENTER, IS COMPOSED OF 18 PRACTICES COVERING MANY SPECIALITIES.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense7220223Expense
Revenue7145888Revenue
DescriptionTHE KNOX CENTER FOR LONG TERM CARE IS AN 84-BED LONG-TERM NURSING CARE AND SKILLED REHABILITATION CENTER. SINCE 1975, THE KNOX CENTER FOR LONG TERM CARE HAS BEEN CARING FOR MEMBERS OF MID-COAST FAMILIES AND PROVIDING THEM WITH A LOVING HOME WHERE THEY RECEIVE BOTH THE SOPHISTICATED TECHNICAL CARE THEY REQUIRE AND THE DIGNITY AND RESPECT THEY DESERVE.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense3355619Expense
Revenue3321072Revenue
DescriptionPEN BAY BEHAVIORAL HEALTH PHYSICIANS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp3355619TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev3321072TotalOfOtherProgramServiceRev
Total Program Service Expense101638011TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109685NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1285NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonLYNN SOUCYNamePerson
Telephone Number2075946747TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14 WHITE STREETAddressLine1
CityROCKLANDCity
StateMEState
ZIP Code048412953ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
BETH KOESTER MD
MEDICAL STAF1.00XX023896810202
GREGORY A DUFOUR
SECRETARY1.00XX000
DAVID R WILLIAMS CPA
TREASURER1.00XX000
JACOB GERRITSEN MD
TRUSTEE1.00X000
EVERETT L SPEAR III
CHAIRMAN1.00XX000
DANA GOLDSMITH MD
VP & CHIEF M40.00X2509926412822839
MAURA KELLY
VP FISCAL SE40.00X187501016426
ERIC WATERS
CHIEF OPERAT40.00X147985019311
REGINALD ALBERT
VP PHYSICIAN40.00X140135015715
PAULA DELAHANTY
VP NURSING S40.00X11839908175
WADE JOHNSON
PRESIDENT &40.00X000
NADIA RAMDIN MD
PHYSICIAN40.00292615017001X
MCKENZIE ABENDROTH MD
ER PHYSICIAN40.00274368011985X
CHRISTOPHER MICHALAKES MD
ER MEDICAL D40.00272802014191X
JAMES CURTIS MD
ER PHYSICIAN40.00221720026502X
RICHARD CHANDLER MD
ER PHYSICIAN40.00214029016812X
ROY A HITCHINGS JR
FORMER PRES.0.00030143626775X
JOEL D LAFLEUR MD
FORMER CHAIR272072026541X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2392618TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs604532TotalReportableCompFrmRltdOrgs
Total Other Compensation232475TotalOtherCompensation
Number Individuals GT100 K32NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ATTORNEY CARL TRYNOR
PO BOX 4290PORTLANDME04101COLLECTIONS184306
PEN BAY PATHOLOGY ASSOC
PO BOX 1849LEWISTONME04240SERVICES183375
DAVID HALL MD
905 BARNSTOWN RDHOPEME04847SERVICES109980
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants2541163GovernmentGrants
All Other Contributions421301AllOtherContributions
Total Contributions2962464TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
INPATIENT & OUTPATIENT CARE6241007908632279086322
PEN BAY PHYSICIANS & ASSOC.6211101103832511038325
KNOX CENTER FOR LT CARE62300071458887145888
OTHER62410033210723321072
FieldValueIRS element (for citing)
Total Program Service Revenue100591607TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column572783TotalRevenueColumn
Related Or Exempt Function Income572783RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other-20490Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-20490Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-20490TotalRevenueColumn
Related Or Exempt Function Income-20490RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OTHER62199011378991137899
HEALTH CONNECTIONS624100380420380420
MRI REVENUE624410365909365909

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column464378TotalRevenueColumn
Related Or Exempt Function Income179104RelatedOrExemptFunctionIncome
Unrelated Business Revenue285274UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue2348606TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column106454970TotalRevenueColumn
Related Or Exempt Function Income103207232RelatedOrExemptFunctionIncome
Unrelated Business Revenue285274UnrelatedBusinessRevenue

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total901091Total
Program Services862595ProgramServices
Management And General38496ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total42179393Total
Program Services40377446ProgramServices
Management And General1801947ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1036903Total
Program Services992605ProgramServices
Management And General44298ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

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Total9015485Total
Program Services8630334ProgramServices
Management And General385151ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2639077Total
Program Services2526333ProgramServices
Management And General112744ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total99538Total
Management And General99538ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total30570Total
Management And General30570ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total12821Total
Management And General12821ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total10493169Total
Program Services10044890ProgramServices
Management And General448279ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total199Total
Program Services190ProgramServices
Management And General9ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total584525Total
Program Services559553ProgramServices
Management And General24972ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total248057Total
Program Services237460ProgramServices
Management And General10597ManagementAndGeneral

Occupancy Occupancy

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Total4425554Total
Program Services4236490ProgramServices
Management And General189064ManagementAndGeneral

Travel Travel

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Total403651Total
Program Services386407ProgramServices
Management And General17244ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1402684Total
Program Services1342760ProgramServices
Management And General59924ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5637443Total
Program Services5396606ProgramServices
Management And General240837ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1448317Total
Program Services1386443ProgramServices
Management And General61874ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES1222865412228654
MEMBER FEES44630394463039
PROVISION FOR BAD DEBTS43449694344969
HEALTH CARE PROVIDER TAX26209192620919

All Other Expenses AllOtherExpenses

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Total5694348Total
Program Services5463357ProgramServices
Management And General230991ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total109910406Total
Program Services101638011ProgramServices
Management And General8272395ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

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BOY1282851BOY
EOY11259EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

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BOY1309160BOY
EOY5437202EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY74577EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY14948020BOY
EOY15590086EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY238322BOY
EOY853402EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

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BOY1755849BOY
EOY1722468EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

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BOY1191440BOY
EOY1548334EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis120115425LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec79044004LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY42908886BOY
EOY41071421EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY16921398BOY
EOY18527830EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY20481525BOY
EOY24680773EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY101037451BOY
EOY109517352EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY11697764BOY
EOY11454431EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY24603231BOY
EOY23075905EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
EOY418599EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY1939430BOY
EOY1526714EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6820080BOY
EOY19111303EOY

Total Liabilities TotalLiabilities

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BOY45060505BOY
EOY55586952EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

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BOY48417949BOY
EOY45529901EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

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BOY2660447BOY
EOY3182704EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

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BOY4898550BOY
EOY5217795EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY55976946BOY
EOY53930400EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY101037451BOY
EOY109517352EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-3455436ReconcilationRevenueExpenses
Reconcilation Other Changes1408890ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

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Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
Form1120 Pol FiledfalseForm1120PolFiled
Form4720 FiledfalseForm4720Filed
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$12,821OtherActivitiesAmount
Total Lobbying Expenditures IIB12821TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax
Substantially All Dues NondeductfalseSubstantiallyAllDuesNondeduct
Only In House LobbyingfalseOnlyInHouseLobbying
Agree To Carryover Prior YearfalseAgreeToCarryoverPriorYear

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
Return ReferenceSCHEDULE C, PART II-B, LINE 1ReturnReference
ExplanationA PORTION OF THE MEMBERSHIP DUES PAID TO THE MAINE HOSPITAL ASSOCIATION REPRESENT LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance4898550BeginningOfYearBalance
Investment Earnings Or Losses319245InvestmentEarningsOrLosses
End Of Year Balance5217795EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance5320145BeginningOfYearBalance
Investment Earnings Or Losses-421596InvestmentEarningsOrLosses
End Of Year Balance4898550EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5120364BeginningOfYearBalance
Investment Earnings Or Losses199781InvestmentEarningsOrLosses
End Of Year Balance5320145EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4475854BeginningOfYearBalance
Investment Earnings Or Losses644510InvestmentEarningsOrLosses
End Of Year Balance5120364EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis951091OtherCostOrOtherBasis
Book Value951091BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis49870273OtherCostOrOtherBasis
Depreciation27494732Depreciation
Book Value22375541BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1333609OtherCostOrOtherBasis
Depreciation1415252Depreciation
Book Value-81643BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis65169249OtherCostOrOtherBasis
Depreciation50134020Depreciation
Book Value15035229BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2791203OtherCostOrOtherBasis
Book Value2791203BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings41071421TotalOfBookValueLandBuildings

Other Assets OtherAssets (9 entries)

DescriptionDescriptionBook ValueBookValue
ESTIMATED AMOUNTS FROM THIRD PARTY14054058
PREPAID CAPITAL COSTS4412730
INVESTMENT IN PINETREE INSURANCE CO.3748017
TRUSTEE HELD FUNDS809059
OTHER703507
DUE FROM AFFILIATES541077
BOND ISSUANCE COSTS398929
RESIDENT ACCOUNT DEPOSITS13396
PREPAID LIFE INSURANCE
FieldValueIRS element (for citing)
Total Book Value Other Assets24680773TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
DUE TO MAINEHEALTH AND MEMBERS$16,928,690
ESTIMATED AMOUNTS DUE TO THIRD PARTY$1,299,656
DUE TO AFFILIATES$869,561
RESIDENT ACCOUNTS & DEPOSITS$13,396
FieldValueIRS element (for citing)
Total Of Amounts19111303TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
INTENDED USES FOR ENDOWMENT FUNDSSCHEDULE D, PAGE 2, PART V, LINE 4TO BE INVESTED IN PERPETUITY TO PROVIDE A PERMANENT SOURCE OF INCOME.
LIABILITY UNDER FIN 48 FOOTNOTESCHEDULE D, PAGE 3, PART XPENOBSCOT BAY MEDICAL CENTER IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage1.75000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage2.25000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4643639TotalCommunityBenefitExpense
Net Community Benefit Expense4643639NetCommunityBenefitExpense
Percent Of Total Expense0.04220PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense20533292TotalCommunityBenefitExpense
Direct Offsetting Revenue15980122DirectOffsettingRevenue
Net Community Benefit Expense4553170NetCommunityBenefitExpense
Percent Of Total Expense0.04140PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense25176931TotalCommunityBenefitExpense
Direct Offsetting Revenue15980122DirectOffsettingRevenue
Net Community Benefit Expense9196809NetCommunityBenefitExpense
Percent Of Total Expense0.08370PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense4178319TotalCommunityBenefitExpense
Net Community Benefit Expense4178319NetCommunityBenefitExpense
Percent Of Total Expense0.03800PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense133242TotalCommunityBenefitExpense
Direct Offsetting Revenue201811DirectOffsettingRevenue
Net Community Benefit Expense-68569NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4311561TotalCommunityBenefitExpense
Direct Offsetting Revenue201811DirectOffsettingRevenue
Net Community Benefit Expense4109750NetCommunityBenefitExpense
Percent Of Total Expense0.03800PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense29488492TotalCommunityBenefitExpense
Direct Offsetting Revenue16181933DirectOffsettingRevenue
Net Community Benefit Expense13306559NetCommunityBenefitExpense
Percent Of Total Expense0.12170PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense143586TotalCommunityBuildingExpense
Direct Offsetting Revenue143586DirectOffsettingRevenue

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense82319TotalCommunityBuildingExpense
Net Community Building Expense82319NetCommunityBuildingExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense225905TotalCommunityBuildingExpense
Direct Offsetting Revenue143586DirectOffsettingRevenue
Net Community Building Expense82319NetCommunityBuildingExpense
Percent Of Total Expense0.00070PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$2,037,790BadDebtExpenseAmount
Amount Reimbursed By Medicare24904964AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare35215190CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-10310226MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CarefalseProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1PENOBSCOT BAY MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line16 GLEN COVE DRIVEAddressLine1
CityROCKPORTCity
StateMEState
ZIP Code04856ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1PENOBSCOT BAY MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent175.0FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent225.0FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities7NumberOfOtherFacilities

Other Facilities OtherFacilities (7 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
PEN BAY PHYSICIANS & ASSOCIATES
4 GLEN COVE DRIVEROCKPORTME04856PHYSICIAN PRACTICES
THE KNOX CENTER FOR LONG TERM CARE
6 WHITE STREETROCKLANDME04841LONG TERM CARE
PEN BAY SLEEP CENTER
7 MADELYN LANEROCKPORTME04856SLEEP CENTER
PEN BAY PHYSICAL THERAPY
4 GLEN COVE DRIVEROCKPORTME04856PHYSICAL THERAPY
PEN BAY OCCUPATIONAL THERAPY
4 GLEN COVE DRIVEROCKPORTME04856OCCUPATIONAL THERAPY
PEN BAY PHYSICAL THERAPY
116 UNION STREETROCKPORTME04856PHYSICAL THERAPY
PEN BAY PHYSICAL THERAPY
40 WASHINGTON ROADWALDOBOROME04572PHYSICAL THERAPY

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
COSTING METHODOLOGY EXPLANATIONPART I LINE 7RATIO OF PATIENT CARE COSTS TO CHARGES PER WORKSHEET 2 OF THE INSTRUCTIONS
COMMUNITY BUILDING ACTIVITIESPART IICOMMUNITY HEALTH IMPROVEMENT ADVOCACY PICKER FAMILY RESOURCE CENTER THE PICKER FAMILY RESOURCE CENTER PROMOTES BUILDING COMMUNITY BY PROVIDING HEALTH RESOURCES AND SUPPORT THAT SERVE THE NEEDS FOR WOMEN AND THEIR FAMILIES THROUGHOUT THEIR LIVES THE RESOURCE CENTER SERVES PATIENTS WHO WANT TO LEARN ABOUT A DISEASE CONDITION OR TREATMENT COMMUNITY MEMBERS WHO NEED HEALTHY LIVING TIPS AND RESOURCES AND HEALTHCARE PROVIDERS LOOKING FOR HEALTH EDUCATION MATERIALS AND RESOURCES WORKFORCE DEVELOPMENT NURSING EDUCATION PBMC PARTNERED WITH THE UNIVERSITY OF MAINE AT AUGUSTA TO PROVIDE COMMUNICATIONS TRAINING FOR NURSES AND OTHER EMPLOYEES
BAD DEBT EXPENSE EXPLANATIONPART III LINE 4PEN BAY HEALTHCARE PBHC PARENT COMPANY OF PENOBSCOT BAY MEDICAL CENTER ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY A PATIENT IS CLASSIFIED AS A FREE CARE PATIENT BY REFERENCE TO CERTAIN ESTABLISHED POLICIES OF PBHC THESE POLICIES DEFINE FREE CARE SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED IN ASSESSING A PATIENTS ELIGIBILITY FOR FREE CARE PBHC UTILIZES FEDERALLY ESTABLISHED POVERTY GUIDELINES FREE CARE PROVIDED IS NOT INCLUDED IN NET PATIENT SERVICE REVENUE AND IS MEASURED BASED ON PBHCS CHARGES COSTS AND EXPENSES INCURRED IN PROVIDING THESE SERVICES ARE INCLUDED IN OPERATING EXPENSES SERVICES RENDERED TO INDIVIDUALS FROM WHOM PAYMENT IS EXPECTED AND ULTIMATELY NOT RECEIVED IS WRITTEN OFF AND INCLUDED AS PART OF THE PROVISION FOR BAD DEBTS BY PROVIDING NECESSARY HEALTHCARE SERVICES TO THOSE INDIVIDUALS EITHER WHO FAIL TO APPLY FOR FINANCIAL ASSISTANCE OR WHO ARE EXPERIENCING DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES PMBC BELIEVES THAT BAD DEBT EXPENSE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT
MEDICARE EXPLANATIONPART III LINE 8COST REPORT INFORMATION PBMC BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL HAS A CLEAR MISSION COMMITMENT TO SERVING ELDERLY PATIENTS AND ADULTS WITH DISABILITIES THROUGH THE PROVISION OF SPECIFIC SUBSIDIZED PROGRAMS DEVELOPED TO HELP IMPROVE THE HEALTH STATUS OF THESE PATIENTS IF THESE CRITICAL SUBSIDIZED PROGRAMS WERE NOT PROVIDED BY THE HOSPITAL THEY WOULD BECOME THE OBLIGATION OF THE FEDERAL GOVERNMENT
COLLECTION PRACTICES EXPLANATIONPART III LINE 9BPATIENTS ARE NOTIFIED OF ASSISTANCE OPPORTUNITIES VIA 1 PATIENT ADVOCATE 2 HOSPITAL FINANCIAL COUNSELOR 3 HOSPITAL POSTINGS IN VARIOUS OPTIONS 4 ON THE BACK OF EVERY BILL 5 COMMUNICATION WHEN CALLING OUR OFFICES
NEEDS ASSESSMENTPART VIPEN BAY MEDICAL CENTER IS A MEMBER OF MAINEHEALTH WHICH CONDUCTS A THOROUGH COMMUNITY NEEDS ASSESSMENT AND DIRECTS ITS MEMBER ORGANIZATIONS TO RESPOND TO THE NEEDS IDENTIFIED MAINEHEALTH MEMBERS ALSO PARTICIPATE IN VARIOUS INITIATIVES TO KEEP THOSE ASSESSMENTS UP TO DATE SOME OF THESE INITIATIVES INCLUDE CLINICAL STRATEGIC PLANNING FINANCIAL STRATEGIC PLANNING FACILITY PLANNING HUMAN RESOURCE PLANNING STAFF DEVELOPMENT PLANNING PHYSICIAN RECRUITMENT STRATEGIC PLANNING EMERGENCY PREPAREDNESS PLANNING IN ADDITION TO THESE INTERNAL ASSESSMENTS MAINEHEALTH MEMBER ORGANIZATIONS ALSO REVIEW AND ACT ON MANY OF THE RECOMMENDATIONS PROVIDED BY EXTERNAL GROUPS AND STATE HEALTH PLANNING INITIATIVES SUCH AS THE MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTHY MAINE 2010 AND AUTISM SPECTRUM DISORDERS REPORT THE MAINE CENTER FOR DISEASE CONTROL AND PREVENTION AND THE STATE HEALTH PLAN CREATED BY THE ADVISORY COMMITTEE FOR HEALTH SYSTEMS DEVELOPMENT
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VISEE PART III LINE 9B COLLECTION OF PRACTICES EXPLANATION FOR METHODS BY WHICH PATIENTS ARE NOTIFIED OF ASSISTANCE OPPORTUNITIES
COMMUNITY INFORMATIONPART VIPENOBSCOT BAY MEDICAL CENTER IS A FULL SERVICE 99 BED COMMUNITY HOSPITAL SERVING THE PEOPLE OF MIDCOAST MAINE
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VISEE PROGRAM SERVICE ACCOMPLISHMENTS
AFFILIATED HEALTH CARE INFORMATIONPART VIPENOBSCOT BAY MEDICAL CENTER IS AN ACUTE CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT HOSPITAL SERVICES AS WELL AS EMERGENCY ROOM SERVICES PHYSICIANS PRACTICES AND LONG TERM CARE QUARRY HILL PROVIDES LONG TERM CARE SERVICES KNOWALLIN HOME HEALTH CARE PROVIDES INHOME HEALTH CARE AND HOSPICE SERVICES KNOWALLIN HELP AT HOME PROVIDES HOMEMAKER SERVICES
ADDITIONAL INFORMATIONPART VIPART I LINE 3B PENOBSCOT BAY MEDICAL CENTER USES FEDERAL POVERTY GUIDELINES FPG FOR PROVIDING DISCOUNTED CARE TO LOW INCOME INDIVIDUALS THE FAMILY INCOME FOR ELIGIBILITY FOR DISCOUNTED CARE IS 176 225
PENOBSCOT BAY MEDICAL CENTER LINE NUMBER 1 PART V LINE 19DPART V LINE 19DGROSS CHARGES ARE USE IN ALL SITUATIONS
PENOBSCOT BAY MEDICAL CENTER LINE NUMBER 1 PART V LINE 21PART V LINE 21THIS HOSPITAL CHARGES AT GROSS FOR ALL PAYORS PRIVATE PAY PATIENTS HAVE ALWAYS BEEN BILLED AT GROSS CHARGES AND ARE OFFERED A 5 DISCOUNT WHEN PAYMENT IS MADE PROMPTLY

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Related OrgsBonusRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgBonus Filing OrgBonusFilingOrg
BETH KOESTER MD
23896810202249170
DANA GOLDSMITH MD
5693734016877525099271914879124613313269184
MAURA KELLY
187501494811478203927
ERIC WATERS
147985386115450167296
REGINALD ALBERT
14013529415421155850
NADIA RAMDIN MD
292615612510876309616
MCKENZIE ABENDROTH MD
2659441648103372863538424
CHRISTOPHER MICHALAKES MD
264378980043912869938424
JAMES CURTIS MD
2136209800167022482228100
RICHARD CHANDLER MD
2065416125106872308417488
ROY A HITCHINGS JR
301436169753282119800
JOEL D LAFLEUR MD
272072980016741298613

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
MHHEFA SERIES 2003D
010314384560425QS22003-10-1636540048BUILDINGS & FACILITIESfalsefalsefalse
MHHEFA SERIES 2004A
010314384560425TL42004-06-0374141027BUILDINGS & FACILITIESfalsefalsefalse
MHHEFA SERIES 2006F
010314384560425G202006-09-0791723676BUILDINGS & FACILITIESfalsefalsefalse
MHHEFA SERIES 2007B
010314384560425V802007-11-0172040461BUILDINGS & FACILITIESfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
36540048987662004falsefalsetruetrue
74141027762622006falsefalsetruetrue
91723676225032007falsefalsetruetrue
72040461637602007falsefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsEngage Bond Counsel ResearchEngageBondCounselResearchPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsefalsetrue

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
FSA
truefalsefalsetrue19.7truefalsefalse
FSA
truefalsefalsetrue21.1truefalsefalse
FSA
truefalsefalsetrue29.8truefalsefalse
FSA
falsefalsefalsetrue29.7truefalsefalse

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
MHHEFA SERIES 2003D
010314384560425QS22003-10-1636540048BUILDINGS & FACILITIESfalsefalsefalse
MHHEFA SERIES 2004A
010314384560425TL42004-06-0374141027BUILDINGS & FACILITIESfalsefalsefalse
MHHEFA SERIES 2006F
010314384560425G202006-09-0791723676BUILDINGS & FACILITIESfalsefalsefalse
MHHEFA SERIES 2007B
010314384560425V802007-11-0172040461BUILDINGS & FACILITIESfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
36540048987662004falsefalsetruetrue
74141027762622006falsefalsetruetrue
91723676225032007falsefalsetruetrue
72040461637602007falsefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsEngage Bond Counsel ResearchEngageBondCounselResearchPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsefalsetrue

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
FSA
truefalsefalsetrue19.7truefalsefalse
FSA
truefalsefalsetrue21.1truefalsefalse
FSA
truefalsefalsetrue29.8truefalsefalse
FSA
falsefalsefalsetrue29.7truefalsefalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990 - ORGANIZATION'S MISSIONPENOBSCOT BAY MEDICAL CENTER IS AN ACUTE CARE HOSPITAL THAT OFFERS INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE SERVICES, PATIENT AND COMMUNITY EDUCATION, AND A FULL RANGE OF SPECIALTY SERVICES THROUGH THE EMERGENCY DEPARTMENT, SPECIAL CARE UNIT, SURGICAL SERVICES DEPARTMENT, OBSTETRICS AND GYNECOLOGY DEPARTMENT, AND THE PSYCHIATRIC ADDICTION & RECOVERY CENTER.
FIRST ACCOMPLISHMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4A(CONTINUED FROM PART III, LINE 4A) PENOBSCOT BAY MEDICAL CENTER SERVED 3,634 INPATIENTS, INCLUDING NEWBORNS AND 160,782 OUTPATIENTS INCLUDING ER VISITS, DURING FY 12. TWENTY FOUR HOUR MEDICAL EMERGENCY SERVICE IS PROVIDED IN THE EMERGENCY ROOM, STAFFED BY FULL-TIME ATTENDING PHYSICIANS. PATIENTS ARE SEEN REGARDLESS OF ABILITY TO PAY. THERE WERE 21,888 VISITS TO THE EMERGENCY ROOM DURING FY 12. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE & MAINECARE PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, PENOBSCOT BAY MEDICAL CENTER RECOGNIZES THESE AMOUNTS AS CONTRACTUAL ADJUSTMENTS. THE UNREIMBURSED COST OF PROVIDING CARE TO THESE PATIENTS WAS 85,962,394. DURING FY 12, APPROXIMATELY 58% OF SERVICES WERE TO PATIENTS COVERED BY THESE GOVERNMENTAL PROGRAMS. ADDITIONALLY, PENOBSCOT BAY MEDICAL CENTER PROVIDED 4,312,959 IN FREE CARE TO PATIENTS NOT COVERED BY GOVERNMENTAL PROGRAMS. PBMC PROVIDES FREE CONFERENCE ROOM AND MEETING SPACE FOR A VARIETY OF HEALTH RELATED GROUPS INCLUDING ALCOHOLICS ANONYMOUS, AL ANON, MIDCOAST CANCER SUPPORT GROUP, HEART TO HEART, CARDIAC SPOUSE SUPPORT GROUP, CROHN'S DISEASE SUPPORT GROUP, VISUALLY IMPAIRED AND BLIND SUPPORT GROUP, PEDIATRIC ASTHMA SUPPORT GROUP, OSTOMY GROUP, MIDCOAST MASTECTOMY SUPPORT GROUP, NORTHEAST HEALTH CONSORTIUM FOR INTEGRATED CARE, BREAST CANCER INTERVENTION PROJECT, MID-COAST COALITION FOR DOMESTIC ABUSE, TEEN PARENTING, WOMEN'S AND CHILDREN'S COMMUNITY CARE PROJECT. ASSISTANCE IS PROVIDED TO EDUCATORS THROUGH OUR WORK WITH MEDICAL STUDENTS, STUDENT NURSES, PHYSICAL THERAPY INTERNS, EMERGENCY MEDICAL TECHNICIANS, MEDICAL RECORDS AND SOCIAL SERVICE STUDENTS. THROUGH AN ARRANGEMENT WITH THE UNIVERSITY OF MAINE - ORONO, OUR EDUCATION AND TRAINING DEPARTMENT OFFERS NURSES WITH CERTIFICATE DEGREES THE OPPORTUNITY TO WORK TOWARD A BACCALAUREATE DEGREE IN THE LOCAL AREA. THE HOSPITAL MAINTAINS A RESEARCH LIBRARY WHICH IS OPEN 24 HOURS A DAY AND AVAILABLE TO THE GENERAL PUBLIC. DURING FY 12, THE COMMUNITY CONTRIBUTED APPROXIMATELY 10,535 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTH CARE NEEDS OF THE COMMUNITY. THE VALUE OF THIS CONTRIBUTION IS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS IN BOTH PATIENT SERVICES AND OTHER WELLNESS PROGRAMS SUCH AS THOSE DESCRIBED ABOVE.
ALL OTHER ACCOMPLISHMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4DPEN BAY BEHAVIORAL HEALTH PHYSICIANS.
CLASSES OF MEMBERS OR STOCKHOLDERSFORM 990, PAGE 6, PART VI, LINE 6PEN BAY HEALTHCARE (PBHC) IS THE SOLE MEMBER OF PEN BAY MEDICAL CENTER. MAINEHEALTH (EIN 01-0431680), AS THE SOLE MEMBER OF PBHC, HAS THE RIGHT TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY OF PBHC AND ITS SUBSIDIARIES.
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7ATHE SOLE MEMBER, PEN BAY HEALTHCARE MAY ELECT THE BOARD OF DIRECTORS FROM A SLATE OF NOMINEES SUBMITTED BY THE CORPORATION. THE OFFICERS ARE ELECTED BY THE BOARD OF TRUSTEES.
DECISIONS SUBJECT TO APPROVAL OF MEMBERSFORM 990, PAGE 6, PART VI, LINE 7BDECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS STRATEGIES, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION, AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL BY PEN BAY HEALTHCARE & MAINEHEALTH.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTHE FORM 990 IS REVIEWED IN DETAIL WITH THE FINANCE COMMITTEE. IT IS THEN MADE AVAILABLE TO THE FULL BOARD. A FINAL DETAILED REVIEW OF THE FORM 990 IS PERFORMED BY THE VP OF FISCAL SERVICES BEFORE SIGNING AND PRIOR TO FILING.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CAT THE BEGINNING OF BOARD SERVICE, MEMBERS ARE REQUIRED TO DOCUMENT ANY CONFLICT OF INTEREST THAT MAY EXIST, THEY ARE REQUIRED TO REPORT ANY ADDITIONAL CONFLICTS THAT MAY ARISE. BOARD MEMBER CONFLICT OF INTEREST FORMS ARE UPDATED AND REVIEWED ANNUALLY.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15APEN BAY MEDICAL CENTER BOARD OF DIRECTORS ARE RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. FOR THOSE KEY ADMINISTRATIVE EMPLOYEES THAT ARE SHARED WITH PBHC, COMPENSATION IS EVALUATED BY THE PBHC GOVERNANCE COMMITTEE AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BTHE MEMBER IS RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. COMPENSATION IS EVALUATED BY THE COMPENSATION COMMITTEE APPOINTED BY THE MEMBER, AND THE ORGANIZATION'S BOARD OF TRUSTEES MUST APPROVE OF THE COMPENSATION. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTING FIRM AND INDUSTRY SURVEY.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR THE PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST.
ADDITIONAL INFORMATIONFORM 990, PART VIICOLUMN B - AVERAGE HOURS PER WEEK AT RELATED ORGANIZATIONS ROY HITCHINGS WAS THE PRESIDENT & CEO OF PEN BAY HEALTHCARE (PBH) AND ITS AFFILIATES. HE DIVIDED HIS TIME AMONG ALL OF THE PBH ENTITIES. WADE JOHNSON IS THE PRESIDENT & CEO OF PBH AND ITS AFFILIATES. HE DIVIDES HIS TIME AMONG ALL OF THE PBH ENTITIES.
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 5OTHER CHANGES TO NET ASSETS INCLUDE THE FOLLOWING: 927,476 - INCREASE IN MV OF INVESTMENTS 244,059 - OTHER INCOME 146,669 - GAIN ON SALE OF TR INVESTMENTS 109,396 - INV. INCOME ON TR NET ASSETS (17,010) - MISC. FEES (1,700) - TRANSFER TO AFFILIATE 1,408,890 - TOTAL OTHER CHANGES IN NET ASSETS
ADDITIONAL INFORMATIONFORM 990, PART XIIA-133 AUDIT - THE ORGANIZATION DID NOT HAVE A SEPARATE A-133 AUDIT. IT WAS PART OF THE CONSOLIDATED A-133 AUDIT OF ITS PARENT COMPANY, PEN BAY HEALTHCARE (EIN 22-2494475).

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
QUARRY HILL
4 WHITE STREETROCKLANDME04841010213976LT CAREME501C39PEN BAY HCfalse
PEN BAY HEALTHCARE
4 WHITE STREETROCKLANDME04841222494475ADMIN.ME501C311CMAINEHLTHfalse
PEN BAY BEHAVIORAL HEALTH
4 WHITE STREETROCKLANDME04841010277794BHV HLTHME501C39PEN BAY HCfalse
KNO-WAL-LIN HEALTH CARE INC
4 WHITE STREETROCKLANDME04841010340947HOME HCME501C39PEN BAY HCfalse
KNO-WAL-LIN HELP AT HOME
4 WHITE STREETROCKLANDME04841222968726HM MKR SVCME501C39PEN BAY HCfalse
PEN BAY HEALTHCARE FOUNDATION
4 WHITE STREETROCKLANDME04841222482325FNDRAISINGME501C37PEN BAY HCfalse
PENOBSCOT BAY PHYSICIANS & ASSOC
4 WHITE STREETROCKLANDME04841010530517PHYS. SVCSME501C311CPB MED CNTtrue
MAINEHEALTH
110 FREE STREETPORTLANDME04101010431680HEALTHCAREME501C311CNAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1NEH MANAGEMENT COMPANYBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14 WHITE STREETAddressLine1
CityROCKLANDCity
StateMEState
ZIP Code04841ZIPCode
FieldValueIRS element (for citing)
EIN010537278EIN
Primary ActivityMANAGEMENTPrimaryActivity
Legal Domicile StateMELegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PEN BAY HCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CORPTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1PEN BAY PHYSICIANS & ASSOCIATESBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeLTransactionType
Amount Involved14598116AmountInvolved
Method Of Amt DeterminationFAIR MARKET VALUEMethodOfAmtDetermination