PENOBSCOT VALLEY HOSPITAL: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- PENOBSCOT VALLEY HOSPITAL (EIN 01-0545327)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-10-31
- IRS object ID
- 202423059349300342
- Schema version
- 2023v5.1
- 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 H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-10-31T16:11:05-05:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2211 Congress St | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010545327 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PENO | BusinessNameControlTxt |
| Phone | 2077943321 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 368 | AddressLine1Txt |
| City | Lincoln | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04457 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Melissa Pelkey | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2077943321 | PhoneNum |
| Signature | 2024-10-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Melissa Magoon CPA | PreparerPersonNm |
| PTIN | P01712842 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2024-10-30 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Melissa Pelkey | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 368 | AddressLine1Txt |
| City | Lincoln | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04457 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,640,176 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pvhme.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 254 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,920,448 | PYContributionsGrantsAmt |
| CY Contributions Grants | $495,663 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,318,536 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $23,108,754 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,676 | PYInvestmentIncomeAmt |
| CY Investment Income | $12,256 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,122 | PYOtherRevenueAmt |
| CY Other Revenue | $23,503 | CYOtherRevenueAmt |
| PY Total Revenue | $24,248,782 | PYTotalRevenueAmt |
| CY Total Revenue | $23,640,176 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,205,745 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,096,857 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,094,205 | PYOtherExpensesAmt |
| CY Other Expenses | $11,335,641 | CYOtherExpensesAmt |
| PY Total Expenses | $24,299,950 | PYTotalExpensesAmt |
| CY Total Expenses | $25,432,498 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$51,168 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,792,322 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,912,217 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,718,433 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,680,418 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,271,417 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,231,799 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,447,016 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To be our community's first choice in healthcare, known for a culture of compassion, quality and safety. To be an excellent community partner working together every day to improve the health and well-being of those we serve. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $22,286,053 | ExpenseAmt |
| Revenue | $23,108,754 | RevenueAmt |
| Desc | Penobscot Valley Hospital is a 25 bed critical access hospital in Lincoln, ME. The Hospital provided a wide range of medical services to its patients in 2023, some of the largest being Emergency Room Services, Laboratory Services, Pharmacy Services, Rehabilitation Services, Surgical Services & Radiology Services. Please refer to Schedule H for a more comprehensive list of services provided. | Desc |
| Total Program Service Expenses | $22,286,053 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 85 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 254 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | ME | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Elisa Blethen | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2077943321 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 368 | AddressLine1Txt |
| City | Lincoln | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04457 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Phillip Dawson Jr | ||||||||
| President | 1.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| J Bea Szantyr MD | ||||||||
| Vice President | 1.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Judith Doore | ||||||||
| Board Member | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Bonnie Gray | ||||||||
| Board Member | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Patricia Nobel MD | ||||||||
| Board Member | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kristen Sciolino DDS | ||||||||
| Board Member | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Whitney Souers | ||||||||
| Board Member | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| H Joseph Thibodeau DDS | ||||||||
| Board Member | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Richard Wyman | ||||||||
| Board Member | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Robert Genest | ||||||||
| Past Treasurer | 1.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Annette Haynes | ||||||||
| Past Board Member | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Amy Theriault | ||||||||
| COO | 40.00 | 0.00 | Yes (X) | $118,097 | $0 | $21,255 | ||
| Elisa Blethen | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $168,459 | $0 | $28,423 | ||
| Crystal Landry RN | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $231,953 | $0 | $28,141 | ||
| Dr Carl Alessi | ||||||||
| Physician | 40.00 | 0.00 | $188,377 | $0 | $7,006 | Yes (X) | ||
| Glenn Deyo | ||||||||
| Surgeon | 40.00 | 0.00 | $343,491 | $0 | $23,279 | Yes (X) | ||
| Todd Tritch MD | ||||||||
| ED Physician and Medical Director | 40.00 | 0.00 | $618,320 | $0 | $18,651 | Yes (X) | ||
| Christopher M Fallon MD | ||||||||
| Physician | 40.00 | 0.00 | $462,097 | $0 | $10,986 | Yes (X) | ||
| Stratton J Shannon | ||||||||
| Physician | 40.00 | 0.00 | $315,268 | $0 | $1,044 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,446,062 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $138,785 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Lotus Medical & Aesthetics | |||||
| PO Box 382 | Mount Desert | ME | 04660 | ED Physician | $429,413 |
| Todd Tritch MD | |||||
| PO Box 67 | Lincoln | ME | 04457 | Hospitalist | $415,155 |
| Fusion Medical Staffing LLC | |||||
| PO Box 30131 | Omaha | NE | 681031231 | Nurse Staffing | $404,021 |
| Nurse Anesthesia of Maine LLC | |||||
| 455 Harlow Street | Bangor | ME | 04401 | Anesthesiologist staffing | $388,025 |
| Mountain Medicine PC | |||||
| L-64 6012 Niblick Way | Carrabassett Valley | ME | 04947 | ED Physician | $297,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $386,365 | GovernmentGrantsAmt |
| All Other Contributions | $109,298 | AllOtherContributionsAmt |
| Total Contributions | $495,663 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Revenue | 621400 | $22,858,887 | $22,858,887 | |
| Cafeteria & Other | 900099 | $249,867 | $226,112 | $23,755 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $23,108,754 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,256 | TotalRevenueColumnAmt |
| Exclusion | $12,256 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Gain from Subsidiary | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $23,503 | TotalRevenueColumnAmt |
| Exclusion | $23,503 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $23,503 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,640,176 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,084,999 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $59,514 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $596,328 | TotalAmt |
| Management And General | $596,328 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,524,052 | TotalAmt |
| Program Services | $10,532,957 | ProgramServicesAmt |
| Management And General | $991,095 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,139,990 | TotalAmt |
| Program Services | $974,276 | ProgramServicesAmt |
| Management And General | $165,714 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $836,487 | TotalAmt |
| Program Services | $721,751 | ProgramServicesAmt |
| Management And General | $114,736 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,464 | TotalAmt |
| Management And General | $22,464 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,645 | TotalAmt |
| Management And General | $61,645 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,817,683 | TotalAmt |
| Program Services | $6,385,814 | ProgramServicesAmt |
| Management And General | $431,869 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,491 | TotalAmt |
| Program Services | $89,753 | ProgramServicesAmt |
| Management And General | $59,738 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $639,539 | TotalAmt |
| Program Services | $434,550 | ProgramServicesAmt |
| Management And General | $204,989 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,653 | TotalAmt |
| Program Services | $44,223 | ProgramServicesAmt |
| Management And General | $7,430 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,805 | TotalAmt |
| Program Services | $98,332 | ProgramServicesAmt |
| Management And General | $9,473 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $495,630 | TotalAmt |
| Program Services | $252,318 | ProgramServicesAmt |
| Management And General | $243,312 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $288,863 | TotalAmt |
| Program Services | $278,624 | ProgramServicesAmt |
| Management And General | $10,239 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $1,686,872 | $1,650,200 | $36,672 |
| Repair & Maintenance | $583,362 | $462,925 | $120,437 |
| Service Provider Tax | $249,136 | $249,136 | |
| Miscellaneous Expenses | $181,498 | $111,194 | $70,304 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,432,498 | TotalAmt |
| Program Services | $22,286,053 | ProgramServicesAmt |
| Management And General | $3,146,445 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,372,355 | BOYAmt |
| EOY | $985,319 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $424,945 | BOYAmt |
| EOY | $430,251 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,444,346 | BOYAmt |
| EOY | $2,028,265 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $438,203 | BOYAmt |
| EOY | $436,718 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $183,613 | BOYAmt |
| EOY | $132,489 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,129,748 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,597,204 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,211,792 | BOYAmt |
| EOY | $3,532,544 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,231 | BOYAmt |
| EOY | $147,734 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $712,732 | BOYAmt |
| EOY | $25,113 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,912,217 | BOYAmt |
| EOY | $7,718,433 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,588,899 | BOYAmt |
| EOY | $1,949,827 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,688 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,962,718 | BOYAmt |
| EOY | $4,132,876 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,113 | BOYAmt |
| EOY | $188,714 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,680,418 | BOYAmt |
| EOY | $6,271,417 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,002,072 | BOYAmt |
| EOY | $1,211,661 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,727 | BOYAmt |
| EOY | $235,355 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,231,799 | BOYAmt |
| EOY | $1,447,016 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,912,217 | BOYAmt |
| EOY | $7,718,433 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,792,322 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $7,539 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,362 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,362 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization pays dues to the Maine Hospital Association (MHA) and American Hospital Association (AHA). A portion of dues paid to the MHA and AHA are attributable to lobbying expenses. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $28,897 | OtherCostOrOtherBasisAmt |
| Book Value | $28,897 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,781,856 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,098,351 | DepreciationAmt |
| Book Value | $1,683,505 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,080 | OtherCostOrOtherBasisAmt |
| Depreciation | $218 | DepreciationAmt |
| Book Value | $15,862 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,792,082 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,232,406 | DepreciationAmt |
| Book Value | $1,559,676 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $510,833 | OtherCostOrOtherBasisAmt |
| Depreciation | $266,229 | DepreciationAmt |
| Book Value | $244,604 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,532,544 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $25,113 |
| Estimated Third-Party Payor Settlements | $163,601 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $188,714 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 225.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $116,595 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $116,595 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,225,697 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,864,282 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $361,415 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01420 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,598,104 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,771,418 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $826,686 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03250 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,940,396 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $23,635,700 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,304,696 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05130 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,382 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $32,382 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,500 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $400 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $36,100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,606 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,606 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $70,488 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $400 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $70,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,010,884 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $23,636,100 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,374,784 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05410 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Reimbursed By Medicare | $5,573,969 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,573,969 | CostOfCareReimbursedByMedcrAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 368 | AddressLine1Txt |
| City | Lincoln | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04457 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.pvhme.org | WebsiteAddressTxt |
| State License | 39815 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | pvhme.org/community-health-needs-assessment/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | pvhme.org/community-health-needs-assessment/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 225.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://pvhme.org/patient-resources/billing-help/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://pvhme.org/patient-resources/billing-help/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://pvhme.org/patient-resources/billing-help/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Penobscot Valley Hospital | Part V, Section B, Line 5: Per the Maine Shared CHNA charter, the effort was governed by the Steering Committee. The Metrics Committee and Community Engagement Committee provide input. The Maine CDC and its epidemiology contractor, University of Southern Maine, provided a significant amount of data analysis. The 2021-2022 Maine Shared CHNA process was rolled out in three stages:Data Analysis:220 indicators were selected for the State of Maine, the 16 counties, Public Health districts, cities which were selected and in some cases selected demographics. Outreach and Engagement:Community outreach was conducted in 2021. Community forums were conducted with residents and service providers in all 16 counties. The purpose of this outreach was to gather feedback on data and to identify health priorities, community assets, and gaps in resources to be used in health improvement planning.Final Reports:Reports for the state, each county, and districts were developed in the spring of 2022. These reports included information from the health data profiles, summaries of qualitative information gathered from engagement activities, and a presentation of community health needs. Health priorities for the county, public health district, and the state were developed through community participation and voting at community forums.The Penobscot County Community Forum was an opportunity for review of the Penobscot County Health Profile, discussion of community needs, and prioritization in small break-out sessions followed by a forum session vote. Ten priorities arose from the break-out sessions. The top four became the areas to work on.1. Mental Health 59%2. Substance and Alcohol Abuse 46%3. Access to Care 42%4. Social Determinants of Health 40% |
| Penobscot Valley Hospital | Part V, Section B, Line 6a: - Central Maine Healthcare (CMHC)- Maine General Health (MGH)- Maine-Health (MH)- Northern Light Health (NLH) |
| Penobscot Valley Hospital | Part V, Section B, Line 6b: Maine Center for Disease Control and Prevention (Maine CDC) |
| Penobscot Valley Hospital | Part V, Section B, Line 11: In 2023 PVH began offering access to mental health services with Behavioral Health counseling at the Medical Arts Building. One of our largest community resources for mental health services, Health Access Network, no longer accepts referrals from outside entities. They report that the wait list for services to be six months long. PVH utilizes Acadia for emergent patients with mental health crisis needs via tele psych. PVH took part in the Substance Use Disorder Grant Program in 2023 offered by the Department of Health and Human Services. The purpose of this program is to link individuals in Penobscot County with substance use disorders to services, strengthened networks, referral services and trainings. PVH has addressed substance use disorder through 2023 by building community partnerships with Save A Life Recovery Resource Center, among others. Patients with a need to substance use disorder detox are being referred to services in Bangor, ME when appropriate. The Penobscot Valley Hospital substance use disorder coordinator work to assist substance use disorder patients who are in need of shelter, medication assisted treatment, food, or any other need.Access to care has been identified as another need in Penobscot County. PVH has continued to recruit for primary care providers throughout 2023 to increase access to care for patients in Penobscot County. A nurse practitioner accepting new patients was added to the RHC in 2023.PVH continues to forge partnerships around the state to improve the lives of the public in Penobscot County. Assisting patients to find shelter, food, and transportation. A screening process for social determinants of health as well as a referral system have been implemented. PVH actively participates with the American Red Cross to assist with blood drives. PVH promotes health related topics on its social media to help educate the public. PVH collects new winter outerwear to donate to area schools and Christmas gifts for area Nursing home resident's that may not have family. |
| Penobscot Valley Hospital | Part V, Section B, Line 13h: State Regulation |
| Penobscot Valley Hospital | Part V, Section B, Line 16j: The FAP application is sent with all first time statements. A notice of the FAP and a copy of the FAP application is also posted in the Billing Help section of the Organization's website. Notices are also posted at all patient entrances to the Hospital and at various locations within the building. |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part II, Community Building Activities: | Many families rely on Penobscot Valley Hospital (PVH) for a comprehensive range of services. Without access to these services including primary and preventative care, chronic diseases may go untreated. Often this results in poor health with high emergent or inpatient costs. At PVH, we strive to be our Community's first choice in healthcare, known for a culture of compassion, quality, and safety: to be an excellent community partner, working together every day to improve the health and well-being of those we serve.Throughout 2023, the hospital partnered with many other organizations to reach people within our communities to educate, train, and inform, including Colonial Healthcare, Cummings Healthcare, Lakeview Terrace, Care Ridge Estates, Eastern Maine Community College, Husson College, LifeFlight, Lincoln Police & Fire Departments, Maine Breast & Cervical Health Program, Maine Centers for Disease Control and Prevention, Maine Department of Transportation, Mayo Regional Hospital, Millinocket Regional Hospital, New England Organ Bank, Northern Penobscot Tech Region III, Raising Readers Program, Red Cross, RSU #67, SAD #31, Save-A-Life Substance Abuse Task Force, the University of Maine, University of New England, University of Vermont, Husson University, and more.By employing about 200 people in the community, PVH is a leader in creating good paying jobs, and contributing to a positive economy in the region. With the "ripple effect" (jobs the hospital helped create, and dollars spent in the area), the U.S. Department of Commerce's Bureau of Economic Analysis determined the multiplier for employment in Maine to be 2.1174, meaning for every employed person in a hospital in Maine, there is another 1.174 jobs created in supporting industries.PVH does not turn away people who need vital care, regardless of their ability to pay. Each person the hospital treats receives the same high-quality care with the utmost compassion from our staff. Our hospital is providing more Free Care, which includes charity care and bad debts, than ever before. Other direct impacts that PVH provides to the community that are served:Education/Scholarships:1. Published educational articles on social media on topics such as hand hygiene, disease prevention, COVID-19, and nutritional advice.2. Staff create educational displays in our lobby.3. Laboratory staff made weekly visits to area nursing homes to collect specimens from residents.4. Trained RN's from Community Health and Counseling to draw blood.5. Trained incoming CNA's and RN's to draw blood, do some CLIA-waived testing.6. PVH is a clinical site for Northern Penobscot Tech Region III, and several colleges and universities. During 2023, PVH had students conducting clinical rotations here for certifications with Medical Assistant, Certified Nursing Assistant and Phlebotomy. Husson University, Eastern Maine Community College and the University of Maine sent students to the PVH nursing departments for their rotations. PVH has also worked with the Eastern Maine Community College Radiology Program. PVH has also provided emergency medicine training of family medicine residents from Eastern Maine Medical Center. Time spent with students varies from a couple of hours to the entire semester of hands-on education. The demand to utilize PVH as a clinical site has increased over the last several years.Promote Organ Donation from October to April. PVH provides information regarding organ donation with social media posts, and the Lincoln News. For National donor month in April, PVH flies the organ donor flag for the month, plus have a display with information for the public. PVH has won HRSA awards for the work that the employees do for organ donation.In 2023 Penobscot Valley Hospital was awarded the 2023 Performance Leadership Award for Quality. Penobscot Valley Hospital volunteers, staff, and providers are committed to providing quality healthcare services to the people in our community. In 2023, staff provided:1. Free educational programs to seniors.2. Partnered with Hospice to provide a Grief Support Group3. Books for pediatric patients at well child checkups for through Raising Readers.4. Vaccinations through the Maine Impact Program.5. Substance Abuse prevention education.6. Free gym visits to community.7. Collect pet supplies for area animal shelters.8. Holiday gifts for area nursing home residents.9. Donate food to families in the local school district at the holidays. |
| Part III, Line 4: | Please refer to pages 9-13 of the attached audited financial statements. |
| Part III, Line 8: | The Organization uses its Medicare Cost Report to obtain the amounts reported above. |
| Part III, Line 9b: | The Hospital would not initiate collection efforts against a patient that qualified for a sliding fee scale unless that patient failed to meet their obligation under payment arrangement agreed to by both parties. After it was determined that the patient did not qualify for a readjustment to their payment terms, the Hospital would follow normal notification practices dictated by our collection policy until the account eventually ended up in collections. |
| Part VI, Line 2: | The Organization took a comprehensive approach to assess community health needs. Several independent data analyses were performed based on secondary source data, augmented with local survey data, and any data inconsistency or discrepancies are resolved from the combined opinions formed from local experts. PVH relies on secondary source data, and most secondary sources use the county as the smallest unit of analysis. We asked our local expert area residents to note if they perceived the problems or needs identified by secondary sources to exist in their portion of the county. Most data used in the analysis is available from public internet sources. Critical data needed to address specific regulations or developed by the individuals cooperating with us in this study is displayed in the report of the appendix. |
| Part VI, Line 3: | Notices regarding PVH's charity care policy are posted at Registration, Emergency Room and the hospital's website: www.pvhme.org. Our employees also know to refer patients to the registration or billing offices of the hospital if they have questions. |
| Part VI, Line 4: | Lincoln is a rural community of approximately 4,900 people located in north central Maine. Our service area consists of many small towns that use Lincoln as a hub. The hospital, school system, and logging companies, are the major employers in town. Life and industry primarily revolve around the woods of central Maine. It is an area rich with history for making paper. Maine is one of the oldest states in the nation according to the latest US Census report, and Lincoln reflects that demographic. The median resident age in 2022 was 60.2. Lincoln is located in a modest area of the State, where the median resident income in 2022 was $41,080. Maine's average income for that same time period was $75,740. |
| Part VI, Line 7, Reports Filed With States | ME |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Todd Tritch MD | ||||||||||||||
| ED Physician and Medical Director | $617,054 | $0 | $0 | $0 | $1,266 | $0 | $0 | $0 | $18,651 | $0 | $636,971 | $0 | $0 | $0 |
| Christopher M Fallon MD | ||||||||||||||
| Physician | $444,163 | $0 | $16,342 | $0 | $1,592 | $0 | $0 | $0 | $10,986 | $0 | $473,083 | $0 | $0 | $0 |
| Glenn Deyo | ||||||||||||||
| Surgeon | $330,105 | $0 | $10,395 | $0 | $2,991 | $0 | $0 | $0 | $23,279 | $0 | $366,770 | $0 | $0 | $0 |
| Stratton J Shannon | ||||||||||||||
| Physician | $305,187 | $0 | $8,550 | $0 | $1,531 | $0 | $0 | $0 | $1,044 | $0 | $316,312 | $0 | $0 | $0 |
| Crystal Landry RN | ||||||||||||||
| CEO | $226,151 | $0 | $5,581 | $0 | $221 | $0 | $0 | $0 | $28,141 | $0 | $260,094 | $0 | $0 | $0 |
| Elisa Blethen | ||||||||||||||
| CFO | $168,339 | $0 | $0 | $0 | $120 | $0 | $0 | $0 | $28,423 | $0 | $196,882 | $0 | $0 | $0 |
| Dr Carl Alessi | ||||||||||||||
| Physician | $170,539 | $0 | $15,918 | $0 | $1,920 | $0 | $0 | $0 | $7,006 | $0 | $195,383 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 7 | FormAndLineReferenceDesc |
| Explanation | Per Diem employees who worked at least 1040 hours during the previous 365 days are paid $500 for every 200 hours worked during one quarter of the year. This bonus is not new and is based on time worked, but not related to the hospitals revenue. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | Behavioral health services began in March 2023. |
| Form 990, Part VI, Section B, line 11b | Once Form 990 is prepared by the certified public accounting firm, a draft copy is e-mailed to the Finance Reporting Manager. The CFO & Finance Reporting Manager will then review the Form, and also compare it with the previous year's 990. Once the CFO & Finance Reporting Manager are satisfied with the draft copy, it is forwarded to the CEO. The CEO will then review the document. Any questions will either be answered by the Finance Reporting Manager or the accounting firm. Once the CEO approves the draft 990, a copy is provided to the board of directors for their review. Once the board has approved the draft, the accounting firm is notified and the final version is prepared for filing. |
| Form 990, Part VI, Section B, line 12c | It is the expectation of Penobscot Valley Hospital that our board of directors, medical staff, regular and contracted employees, and our volunteers avoid activities that may involve, or appear to involve, a conflict of interest. This is a standard of conduct communicated through Administrative Policy 109 "Code of Ethics," our code of conduct and ethics, and our medical by-laws. These documents are drafted and signed off by the president of the board of directors, the chief executive officer, chief of medical staff and the compliance officer as appropriate. Every individual employed by, or otherwise representing the Hospital, is responsible for complying with this standard. It is the responsibility of the compliance officer and the chief executive officer to ensure that this standard is communicated, maintained and enforced within the Organization. Administrative Policy 127 "Compliance Reporting" outlines the expectation for reporting non-compliance, the mechanisms in place to do so, and the investigative process. Such mechanisms include a 24-hour confidential reporting hotline. Education on Penobscot Valley Hospital's code of conduct and ethics is provided during orientation or at the beginning of the business relationship. Reinforcement of this education is provided annually and upon any business contract renewal. |
| Form 990, Part VI, Section B, line 15 | CEO's wages come from the 2018 Northern New England Healthcare Compensation Survey by Gallagher. Ranges are presented to the finance/personnel committee of the board and the wage is set by the board. Other officers wages are also set by utilizing the survey. Wages are set by evaluating the position in conjunction with the job description listed in the survey. |
| Form 990, Part VI, Section C, line 19 | The Organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. |
| Form 990, Part IX, line 11g | Physician Fees: Program service expenses 2,911,411. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,911,411. Purchased Services: Program service expenses 3,474,403. Management and general expenses 431,869. Fundraising expenses 0. Total expenses 3,906,272. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Penobscot Valley Hospital PO Box 368 Lincoln, ME 04457 EIN 01-0545327 Penobscot Valley Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
| Form 990, Part XI, line 9: | Gain on Bankruptcy Reorganization 7,539. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alpine Health Services Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 460 | AddressLine1Txt |
| City | West Enfield | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04493 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222533280 | EIN |
| Primary Activities | Support to provide health services in underserved areas of Maine. | PrimaryActivitiesTxt |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 10 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Penobscot Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments