PENOBSCOT VALLEY HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PENOBSCOT VALLEY HOSPITAL (EIN 01-0545327)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201303189349305385
- Schema version
- 2012v2.1
- 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 I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T14:52:16-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010523282 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1 |
| City | Portland | City |
| State | ME | State |
| ZIP Code | 041041100 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010545327 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PENO | NameControl |
| Phone | 2077943321 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7 Transalpine Road Box 368 | AddressLine1 |
| City | Lincoln | City |
| State | ME | State |
| ZIP Code | 04457 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | David Shannon | Name |
| Title | CEO | Title |
| Phone | 2077943321 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Barbara J McGuan CPA | Name |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | Phone |
| Date Prepared | 2013-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | David Shannon | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7 Transalpine Road Box 368 | AddressLine1 |
| City | Lincoln | City |
| State | ME | State |
| ZIP Code | 04457 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 26860037 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.pvhme.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1973 | YearFormation |
| State Legal Domicile | ME | StateLegalDomicile |
| Activity Or Mission Description | Critical Access Hospital | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 277 | TotalNbrEmployees |
| Total Nbr Volunteers | 34 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 100430 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 53589 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 25044297 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 26448876 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 72409 | InvestmentIncomePriorYear |
| Investment Income Current Year | 52151 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -3102 | OtherRevenuePriorYear |
| Other Revenue Current Year | -14678 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25214034 | TotalRevenuePriorYear |
| Total Revenue Current Year | 26539938 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 14229 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 9935 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 14172619 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 13470965 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10497163 | OtherExpensePriorYear |
| Other Expenses Current Year | 13094211 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 24684011 | TotalExpensesPriorYear |
| Total Expenses Current Year | 26575111 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 530023 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -35173 | RevenuesLessExpensesCY |
| Total Assets BOY | 16723968 | TotalAssetsBOY |
| Total Assets EOY | 15970607 | TotalAssetsEOY |
| Total Liabilities BOY | 12132873 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 11406094 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4591095 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4564513 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 22312386 | Expense |
| Grants | 9935 | Grants |
| Revenue | 26448876 | Revenue |
| Description | 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 2012, 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. | Description |
| Total Program Service Expense | 22312386 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 33 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 277 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | ME | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ann Marie Rush | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2077943321 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7 Transalpine Road Box 368 | AddressLine1 |
| City | Lincoln | City |
| State | ME | State |
| ZIP Code | 04457 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Frederick Woodman Jr | |||||||
| President | 1.50 | X | X | 0 | 0 | 0 | |
| Gilberte Mayo | |||||||
| Treasurer | 1.50 | X | X | 0 | 0 | 0 | |
| Lynn Sanderson | |||||||
| Past Board Member | 1.50 | X | 0 | 0 | 0 | ||
| Carl Alessi MD | |||||||
| Past Board Member/Current Physician | 1.50 | X | 169805 | 0 | 29352 | ||
| Hervey Clay | |||||||
| Board Member | 1.50 | X | 0 | 0 | 0 | ||
| Phillip Dawson Jr | |||||||
| Vice President | 1.50 | X | X | 0 | 0 | 0 | |
| Victor Jipson | |||||||
| Past Treasurer | 1.50 | X | X | 0 | 0 | 0 | |
| Michael McFalls | |||||||
| Board Member | 1.50 | X | 0 | 0 | 0 | ||
| Ed Woolley | |||||||
| Board Member | 1.50 | X | 0 | 0 | 0 | ||
| Richard Wyman | |||||||
| Board Member | 1.50 | X | 0 | 0 | 0 | ||
| Annette Haynes | |||||||
| Board Member | 1.50 | X | 0 | 0 | 0 | ||
| H Joseph Thibodeau | |||||||
| Board Member | 1.50 | X | 0 | 0 | 0 | ||
| Amanda Dunn | |||||||
| Board Member | 1.50 | X | 0 | 0 | 0 | ||
| Pam Hoxie | |||||||
| Board Member | 1.50 | X | 0 | 0 | 0 | ||
| David Shannon | |||||||
| CEO | 50.00 | X | 220360 | 0 | 24211 | ||
| Ann Marie Rush | |||||||
| CFO | 50.00 | X | 148734 | 0 | 16788 | ||
| David L Ettinger | |||||||
| ED Physician | 40.00 | 284643 | 0 | 25352 | X | ||
| David H Dumont | |||||||
| Hospitalist | 40.00 | 272907 | 0 | 14299 | X | ||
| Samer Sbayi | |||||||
| Surgeon | 40.00 | 334209 | 0 | 26357 | X | ||
| Phillip Scaglione | |||||||
| Orthopedic Surgeon | 40.00 | 301484 | 0 | 12499 | X | ||
| Paul E Turnquist | |||||||
| ED Physician | 40.00 | 276358 | 0 | 23763 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2008500 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 172621 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Emcare Inc | |||||
| 7032 Collection Center Drive | Chicago | IL | 60693 | ED Physician Services | 1009089 |
| Nurse Anesthesia of Maine LLC | |||||
| 141 North Main Street Suite 205 | Brewer | ME | 04412 | Nursing Services | 629701 |
| CompHealth | |||||
| PO Box 972651 | Dallas | TX | 753972651 | Physician Services | 466360 |
| NEHE MRI | |||||
| PO Box 6600 | Newport Beach | CA | 92658 | MRI Services | 366968 |
| Quorum Health Resources LLC | |||||
| 105 Continental Place | Brentwood | TN | 370271018 | Hospital Management Svcs. | 344688 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 17 | NumberOfContractorsGT100K |
| Fundraising Events | 17993 | FundraisingEvents |
| Government Grants | 13000 | GovernmentGrants |
| All Other Contributions | 22596 | AllOtherContributions |
| Noncash Contributions | 6407 | NoncashContributions |
| Total Contributions | 53589 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Patient Revenue | 621400 | 37597006 | 37597006 | |
| Meaningful Use Revenue | 621400 | 426779 | 426779 | |
| Cafeteria & Other | 722210 | 208689 | 90972 | $117,717 |
| Provision for Bad Debts | 621400 | -1641335 | -1641335 | |
| Contractual/Char. Adj. | 621400 | -10142263 | -10142263 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 26448876 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 23878 | TotalRevenueColumn |
| Exclusion | $23,878 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 338319 | Securities |
| Other | 500 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 301170 | Securities |
| Other | 9376 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 37149 | Securities |
| Other | -8876 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28273 | TotalRevenueColumn |
| Exclusion | $28,273 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 4430 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 17993 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 9553 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -5123 | TotalRevenueColumn |
| Exclusion | -$5,123 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Earnings from Subsidiary | 900099 | 21523 | $21,523 |
| Earnings from Investment | 900099 | -4532 | -$4,532 |
| Loss on Early Extinguishment of D | 900099 | -26546 | -$26,546 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | -9555 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26539938 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26331159 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $155,190 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9935 | Total |
| Program Services | 9935 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 608250 | Total |
| Program Services | 198157 | ProgramServices |
| Management And General | 410093 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10210819 | Total |
| Program Services | 9483657 | ProgramServices |
| Management And General | 727162 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72538 | Total |
| Program Services | 65141 | ProgramServices |
| Management And General | 7397 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1860943 | Total |
| Program Services | 1750715 | ProgramServices |
| Management And General | 110228 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 718415 | Total |
| Program Services | 645151 | ProgramServices |
| Management And General | 73264 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55087 | Total |
| Program Services | 7972 | ProgramServices |
| Management And General | 47115 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66416 | Total |
| Management And General | 66416 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5460 | Total |
| Management And General | 5460 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6749072 | Total |
| Program Services | 5722460 | ProgramServices |
| Management And General | 1026612 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23720 | Total |
| Management And General | 23720 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1607551 | Total |
| Program Services | 476733 | ProgramServices |
| Management And General | 1130818 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 755775 | Total |
| Program Services | 706061 | ProgramServices |
| Management And General | 49714 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 128510 | Total |
| Program Services | 82070 | ProgramServices |
| Management And General | 46440 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 302029 | Total |
| Management And General | 302029 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1061163 | Total |
| Program Services | 1061163 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 299996 | Total |
| Program Services | 64906 | ProgramServices |
| Management And General | 235090 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 2038265 | 2038265 | |
| Physician Events | 1167 | 0 | 1167 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26575111 | Total |
| Program Services | 22312386 | ProgramServices |
| Management And General | 4262725 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3158145 | BOY |
| EOY | 1410836 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 768291 | BOY |
| EOY | 661768 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2819117 | BOY |
| EOY | 3382218 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 51394 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 479893 | BOY |
| EOY | 607544 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 215373 | BOY |
| EOY | 228030 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 17661042 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10936605 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6818159 | BOY |
| EOY | 6724437 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 556665 | BOY |
| EOY | 644090 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6588 | BOY |
| EOY | 23579 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13334 | BOY |
| EOY | 23527 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1888403 | BOY |
| EOY | 2213184 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16723968 | BOY |
| EOY | 15970607 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2838986 | BOY |
| EOY | 2821343 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1024908 | BOY |
| EOY | 982850 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5060075 | BOY |
| EOY | 5182020 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3208904 | BOY |
| EOY | 2419881 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12132873 | BOY |
| EOY | 11406094 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4361605 | BOY |
| EOY | 4352302 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 152941 | BOY |
| EOY | 135662 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76549 | BOY |
| EOY | 76549 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4591095 | BOY |
| EOY | 4564513 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16723968 | BOY |
| EOY | 15970607 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -35173 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 8591 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,330 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4330 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1: | ReturnReference |
| 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 ($3,738) and American Hospital Association ($592) were attributable to lobbying expenses. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 28897 | OtherCostOrOtherBasis |
| Book Value | 28897 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7762559 | OtherCostOrOtherBasis |
| Depreciation | 4469845 | Depreciation |
| Book Value | 3292714 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 433876 | OtherCostOrOtherBasis |
| Depreciation | 406628 | Depreciation |
| Book Value | 27248 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8752334 | OtherCostOrOtherBasis |
| Depreciation | 5573835 | Depreciation |
| Book Value | 3178499 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 683376 | OtherCostOrOtherBasis |
| Depreciation | 486297 | Depreciation |
| Book Value | 197079 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 6724437 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Estimated Third-Party Payor Settlements | 2175613 |
| Deferred Compensation | 37571 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2213184 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Estimated Third-Party Payor Settlements | $2,382,310 |
| Deferred Compensation | $37,571 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2419881 | TotalOfAmounts |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 15960 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 12030 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 3930 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 3920 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 1987 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Fashion Show | NameOfEvent2 |
| Gross Receipts Event2 | 6463 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 5963 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 500 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 569 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 2070 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 1008 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 22423 | GrossReceiptsTotal |
| Charitable Contributions Total | 17993 | CharitableContributionsTotal |
| Gross Revenue Total Events | 4430 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 4489 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 2070 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 2995 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 9554 | DirectExpenseSummaryEvents |
| Net Income Summary | -5124 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 275.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1061696 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1061696 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04000 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5754455 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5461387 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 293068 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01100 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6816151 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5461387 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1354764 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05100 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6541 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 666 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5875 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6541 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 666 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5875 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6822692 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5462053 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1360639 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05120 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,141,169 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 10584905 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10584905 | CostOfCareReimbursedByMedicare |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7 Transalpine Road | AddressLine1 |
| City | Lincoln | City |
| State | ME | State |
| ZIP Code | 04457 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 275.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to earnings and a credit to a valuation allowance based on its assessment of the current status of individual accounts. Balances that are outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable. | ||
| 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 V, Section B, Line 14g: The FAP application is sent with all first time statements. A notice of the FAP 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 20d: 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. | Penobscot Valley Hospital | |
| Part VI, Line 2: In 2010, PVH joined three other healthcare organizations in performing a joint community needs assessment for all of our service areas in northern Penobscot County. This group retained professional help to do the research, community focus groups, surveys, data manipulation, and report writing. We looked to identify gaps in services for the entire area, and also to try and identify opportunities for collaboration in providing those services to our communities. In addition to this assessment, the three largest hospitals in the state conducted a state-wide needs assessment that was broken down by county and service area. This too has provided us with information to use in our hospital planning sessions. We continually ask our patients if there are things that we could do better, or if there are services that they need that are not currently being offered locally. If something is identified that we have the capability to do, then we try to meet the needs of our community. One example would be expanding the hours available for walk-in services at our laboratory and x-ray departments. This was done in response to feedback from a survey done by the staff. | ||
| 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 2008 was 40.7 years. Lincoln is located in a modest area of the State, where the median resident income in 2008 was $32,229. Maine's average income for that same time period was $46,581. | ||
| Part VI, Line 5: Penobscot Valley Hospital in Lincoln, Maine provides a substantial range of free or low-cost services, care, and educational opportunities to the Lincoln Lakes Region in northern Maine. PVH is one of the largest employers in the area and provides careers for more than 225 people in a region in which people struggle to find full-time, good paying employment. PVH is also the only rural health center with emergency care in the region for many of our patients and clients. The nearest Critical Access Hospital is 30 minutes away, and the nearest full service hospital is more than 45 minutes away from PVH. Sustaining PVH's longevity not only means vital services remain nearby for our patients but also that the economic vitality of the region is better secured. During 2012, PVH partnered with many agencies to reach a broad range of people. Some of those agencies included 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, the Lincoln Police Department, the Lincoln Fire Department, Maine Centers for Disease Control and Prevention, Maine Department of Transportation, Millinocket Regional Hospital, R.S.U. #67, SAD #30, SAD #31, PVH Auxiliary, PVH Cancer Support Group, SPRINT for Life, the University of Maine, WomenHeart and more. These partnerships allowed PVH to provide education, services, training and informational materials to people in our region.AuxiliaryThe PVH Auxiliary is a group of men and women who work as a team to volunteer for hospital-related events, greet patients and their families, and supply certain items to patients as needed. One of their biggest focuses is "baby bags" - a goody bag that each new mother receives with helpful items for her and the new baby. They also provide scholarships to non-traditional students pursuing a degree in the healthcare industry.Blood DrivesPVH held two American Red Cross blood drives in 2012 - one in June and another in December, both at the Lincoln Knights of Columbus Hall. The blood drives resulted in over 100 units of blood being collected for those in need.Cancer Support GroupThis group meets twice a month at PVH with two survivors leading the group. All area cancer survivors and their caregivers are invited to attend for help in dealing with cancer. Discussion topics include finances, transportation, cancer centers, and occasional guest speakers. The group helps to fund education, transportation and other care costs for area cancer patients that are in need. Childbirth Education and Obstetric CareEach quarter, PVH provides education at low or no cost to expectant mothers and families. These classes are typically held on the weekends and teach breastfeeding, comfort during pregnancy, relaxation techniques, pain control, baby care, and much more. For those families delivering at PVH, they are showered with gifts from the PVH Auxiliary, enjoy the baby's first birthday cake made special by our Food Services Staff, and receive books through the Raising Readers program.Disaster PreparednessPVH participates in a regional disaster preparedness committee with several other agencies including doctors' groups, other hospitals, local police and fire departments, schools, and other organizations. The goal of these monthly meetings is to prepare for pandemic flu, natural disasters, or other incidents that could affect our communities as well as to find ways to work together to share resources and protect the community. Economic ImpactPVH is one of the largest employers in the Lincoln Lakes Region. By employing more than 240 people in the community, PVH is a critical leader in creating and maintaining jobs and livelihoods in the region.EducationEach week, the PVH staff places articles and ads in the local paper, the Lincoln News, the PVH website, PVH Facebook page, and other nearby publications covering topics that are helpful to the general public. These include topics such as hand hygiene, disease prevention, and nutritional advice. The hospital also produces a variety of brochures and educational materials covering a wide range of health-related topics which are handed out to the public. Our Quality Improvement department conducted two lectures to the University of Maine nursing students on quality and service issues. Our Pharmacist provided members of the Golden Key Senior Center with education on medical safety. Staff have worked to create educational displays in our lobby which have included a "bug" display of artwork created by students at Ella P. Burr elementary school to promote proper hand hygiene and infection prevention among our staff and community. In February, WomenHeart hosted a display to educate staff and community members about heart disease in women. Educational ToursStudents from local schools throughout the region, as well as Boy and Girl Scout troops, were given tours of PVH during 2012. During the tours, students learn age-specific healthcare informationlike proper hand hygiene, ambulance tours, x-ray processing, and laboratory testing.Falls RisksPVH is also providing education on fall risks and measures that can be taken at home to decrease a patient's risk of falls and injury. The hospital provides patients with a handout that teaches ways to make their home safe and other tips to avoid falls. There is an active Falls Team who works on projects to make the hospital and our community a safer place. Food Cupboard SupportThroughout the year, staff and visitors to the PVH Cafeteria place change in a special container by the checkout counter. Periodically, this change is removed and donated to the Lincoln Area Food Cupboard, which supplies food, clothing, and other necessities to people in need. In 2012, PVH collected over $400 for the Lincoln Area Food Cupboard. ImPACT Program at Mattanawcook AcademyPVH has provided MA with software to help prevent long-term brain injuries 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 in Waterville. During the month of August, about 160 student-athletes at MA took the ImPACT testing. ImPACT stands for Immediate Post-Concussion Assessment and Cognitive Testing and is a computerized neurocognitive testing program used as a standard tool used in comprehensive clinical management of concussions for athletes of all ages. Dr. Carl Alessi oversees the program at PVH and will monitor any student athlete presenting signs of a concussion or head injury during the sports season.InfluenzaOur clinicians and support staff held multiple influenza vaccination clinics for our community in Penobscot Valley Primary Care and the PVH Specialty Clinic. On October 24, the Maine Center for Disease Control and Prevention stopped by PVH to recognize our extraordinary efforts to vaccinate staff from influenza. During 2011-2012 flu season, over 90% of staff at PVH had received the influenza vaccination. Internships/Job Shadowing/Job SkillsThe hospital works closely with students from across the state. PVH has hosted many job shadow opportunities from local high school and college students. Northern Penobscot Tech Region III had students complete their clinical rotations for Medial Assistant, Certified Nursing Assistant and Phlebotomy at the hospital. Husson University sent students to the PVH Pharmacy for their rotations. PVH has also worked with the University of Maine School of Nursing and Kennebec Valley Community College Radiology Program.PVH also partnered with the University of Maine Business School students in the American Marketing Association to conduct a community awareness and perception study. The students gained valuable, real-life education skills through survey implementation, data collection, analysis, and business presentation. Laboratory ServicesMedical Laboratory Technologists in the PVH Laboratory make weekly visits to four area nursing homes to collect specimens from residents. The technologists have also provided free educational sessions to nursing home staff members on specimen collection. LifeFlight of MaineThe LifeFlight helicoptors are known for transporting critical patients to the care they need quickly and safely. Though not talked about as often, the crew and equipment on board are just as important to the patient's survival and recovery as the helicopter itself. LifeFlight relies on private donations to help fund the more than $175,000 of advanced medical equipment on board each helicopter. In 2012, PVH donated $4,500 toward this worthy cause. | ||
| ME | Reports Filed With States | Part VI, Line 7 |
| Lincoln Chamber of CommerceIn May, PVH hosted a Business After Hours event with the Lincoln Lakes Region Chamber of Commerce. At the event, business members were introduced to hospital staff and visited stations around the hospital including surgical services, tele-trauma and tele-medicine in the emergency room, orthopedics, urology, and the new patient beds. Lincoln ExpoIn April, staff at PVH volunteered their time to teach the community about services offered at PVH. Attendees at the Lincoln Expo had the opportunity to learn about the ambulance units. The EMS crew was teaching the difference between a heart attack and a stroke. They also had the Seatbelt Enforcer on loan from the Maine Department of Transportation, which demonstrates the impact of a 5mph collision and why it's so important to wear your seatbelt. Other education was provided on hand hygiene and infection, imaging and radiology services, general and orthopedic surgery.Meeting Space for Non-ProfitsPVH offers conference room space to local non-profit organizations. This space is offered when it does not interfere with hospital business, at no cost to the organizations.Nursing Home PresentsEach year, the PVH staff collects presents for local nursing home residents. These gifts are given to local residents of nursing and boarding homes, who may not have received holiday gifts otherwise. The staff and residents truly look forward to each holiday season. Our two dozen presents were distributed to area nursing home residents in time for the holidays. Primary Care Penobscot Valley Primary Care is located in the hospital's Medical Arts Building at 252 Enfield Road and provides primary care services for patients.Public CPR, First Aid, and Babysitting ClassesPVH staff makes several classes available to the community throughout the year at low or no cost to teenagers and adults.School VisitsProfessionals 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 handwashing, laboratory technicians teaching kids about their career field, to our laparoscopic surgeon explaining surgical procedures to kids on their level. Normally, students are given something to help retain the material, such as coloring books, posters, informational materials for parents, or small promotional items such as hand sanitizer or bandage containers. New this year, our registered dietitian visited students involved in the Carleton Project at Northern Penobscot Tech Region III and taught a session on Cooking Matters to help diversify the students' skills.Social Work NetworkingEach month, PVH hosts a networking luncheon for social workers and others who do similar work in the community. PVH provides education for them and facilitates discussions about social work-related issues.SPRINT for LifePVH also supports a grant-funded community health coalition in collaboration with Millinocket Regional Hospital and the River Coalition in Old Town. SPRINT for Life is part of a statewide system of public health organizations called Healthy Maine Partnerships that bring people and resources together to improve the health of Maine residents. 1. 5K Run/Walk for Wellness: Nearly 80 participants raced in the 5K organized by SPRINT during the Lincoln Homecoming celebration. The walk raises awareness of the importance of living a healthy lifestyle.2. Providing Opportunities to Dispose of Unwanted Medications: Promoted the national and statewide Prescription and Drig Take Back event on September 29 with the Lincoln Police Department. In addition to the events, SPRINT purchased a drug drop box for the Lincoln Public Safety Building so that community members can dispose of medications on an ongoing basis.3. Raising Readers: Staff worked with Health Access Network to develop a process to disseminate 5-2-1-0 Let's Go materials to families. As a result, 5-2-1-0 bookmarks on healthy eating and active lifestyles are being given to all children with the books they receive through the "Raising Readers" program at well child visits.4. Substance Abuse Prevention: Staff worked with SAD #30 to help them host an underage drinking/substance abuse town hall forum in April. Chief Deputy Troy Morton along with staff facilitated a training session for school faculty and staff during their in-service regarding youth signs and symptoms of substance abuse. He also facilitated the evening forum along with staff. There was a great turnout for the evening presentation for this small community with over 40 people attending. "Parents Who Host Lose the Most" table tents were distributed to businesses in the Lincoln area. Approximately 74 table tents were disseminated to 14 businesses such as restaurants and convenience stores. A press release was printed in the 5/17 edition of the Lincoln News talking about "Parents Who Host Lose the Most" and describing the table tent project. 5. Tobacco Cessation: The town of Lincoln's homecoming festival was promoted as smoke free, and portable signage was placed throughout the community to remind attendees not to smoke. Signs were used by many local vendors to promote a smoke-free area around their site.6. Tobacco Prevention: Staff worked with Penobscot Valley Hospital to address compliance with their tobacco free policy. Media outreach materials were created and used to remind the community that PVH is tobacco free, in and around its facilities. Reminders appeared in the local newspaper, the Lincoln News. Staff also consulted with the Maine Tobacco-Free Hospital Network and began the process to implement some strategies to curb tobacco use by patients, visitors, and staff.7. Walking School Bus: Staff and coalition members implemented a Walking School Bus program for elementary school students in Lincoln for the month of October. The walks took place every Wednesday during the month and averaged 60 participants. Vital ServicesPVH provides vital services to the community, of which most are paid for through individuals, insurance companies, MaineCare and Medicare. In 2012, the hospital handled or performed:1. 42,793 patient visits2. 8,089 visits to the emergency room3. 892 operating room cases4. 77 newborns5. 1,530 ambulance runs6. 3,210 EKGs7. 27,539 respiratory therapy treatments8. 82,503 lab tests9. 13,189 physical therapy modalities10. 2,883 speech therapy treatments11. 3,332 occupational therapy treatments12. 430 cases involving nuclear medicine13. 1,530 mammograms14. 1,705 CT scans15. 189 bone density tests16. 760 MRIs17. 4,846 primary care visits18. 1,791 ultrasounds19. 321 vascular exams20. 7,189 X-rays | Continuation of Schedule H, Part VI, Line 5 | Form 990, Schedule H, Part VI, Line 5: |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alpine Health Services | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 460 | AddressLine1 |
| City | West Enfield | City |
| State | ME | State |
| ZIP Code | 04493 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 222533280 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 9935 | AmountOfCashGrant |
| Purpose Of Grant | To fund operations | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Once a month the controller for Alpine prepares a spreadsheet listing cash on hand, expenses for the month, and balance needed. If Alpine is short on cash for that month the spreadsheet is printed and attached to a Check Request for the hospital for the amount that is needed to fund Alpine's expenses for that month. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Carl Alessi MD | ||||||||||||||
| Past Board Member/Current Physician | 169805 | 0 | 0 | 0 | 0 | 0 | 1000 | 0 | 28352 | 0 | 199157 | 0 | 0 | 0 |
| David Shannon | ||||||||||||||
| CEO | 207200 | 0 | 5900 | 0 | 7260 | 0 | 0 | 0 | 24211 | 0 | 244571 | 0 | 0 | 0 |
| Ann Marie Rush | ||||||||||||||
| CFO | 145134 | 0 | 0 | 0 | 3600 | 0 | 0 | 0 | 16788 | 0 | 165522 | 0 | 0 | 0 |
| David L Ettinger | ||||||||||||||
| ED Physician | 282043 | 0 | 0 | 0 | 2600 | 0 | 3675 | 0 | 21677 | 0 | 309995 | 0 | 0 | 0 |
| David H Dumont | ||||||||||||||
| Hospitalist | 255907 | 0 | 0 | 0 | 17000 | 0 | 3675 | 0 | 10624 | 0 | 287206 | 0 | 0 | 0 |
| Samer Sbayi | ||||||||||||||
| Surgeon | 334209 | 0 | 0 | 0 | 0 | 0 | 2600 | 0 | 23757 | 0 | 360566 | 0 | 0 | 0 |
| Phillip Scaglione | ||||||||||||||
| Orthopedic Surgeon | 301484 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 12499 | 0 | 313983 | 0 | 0 | 0 |
| Paul E Turnquist | ||||||||||||||
| ED Physician | 276358 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 23763 | 0 | 300121 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | Dave Shannon, 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 2012 compensation is as follows: Dave Shannon, CEO: Salary: $207,200 Bonus: $5,900 Benefits: $24,211 Automobile Allowance: $7,260 Ann Marie Rush: Salary: $145,134 Benefits: $16,788 Automobile Allowance: $3,600 | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 010314384 | IssuerEIN |
| CUSIP Number | 560427EU4 | CUSIPNumber |
| Date Issued | 2012-06-28 | DateIssued |
| Issue Price | 1117769 | IssuePrice |
| Description Of Purpose | To refinance Series 2002A bond | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 1 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 2888 | AmountRetired |
| Total Proceeds | 1117769 | TotalProceeds |
| Amount In Reserve Fund | 132031 | AmountInReserveFund |
| Issuance Costs From Proceeds | 24765 | IssuanceCostsFromProceeds |
| Other Spent Proceeds | 960973 | OtherSpentProceeds |
| Year Of Subst Completion | 2012 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 1 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II, Line 3 | Identifier |
| Return Reference | Bond Issue Proceeds | ReturnReference |
| Explanation | The total proceeds of issue listed on line 3 differ from the issue price listed on Part I due to the amount of the premium on the bond. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable (2 entries)
| Relationship With OrganizationRelationshipWithOrganization | Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|---|
| Samer Sbayi | |||||||
| Employee of the Organization | Sign-On Loan | X | $100,000 | 45561 | 0 | 1 | 1 |
| Phillip Scaglione | |||||||
| Employee of the Organization | Sign-On Loan | X | $50,000 | 5833 | 0 | 1 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 51394 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Amy Woodman | |||
| Family member of Frederick Woodman, Jr., Board President | 40290 | Employment | 0 |
| Debbie Rancourt | |||
| Family member of Frederick Woodman, Jr., Board President | 74743 | Employment | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part I, Lines 8-18: | Prior year numbers have been restated to present revenue net of bad debt expense. | |
| 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 Dix Consulting. 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 2,701,400. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,701,400. Purchased Services: Program service expenses 3,021,060. Management and general expenses 1,026,612. Fundraising expenses 0. Total expenses 4,047,672. | Other Fees |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alpine Health Services Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 460 | AddressLine1 |
| City | West Enfield | City |
| State | ME | State |
| ZIP Code | 04493 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222533280 | EIN |
| Primary Activities | Support to provide health services in underserved areas of Maine. | PrimaryActivities |
| Legal Domicile State | ME | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | Line 9 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |