2023-11-06T08:28:01-06:00 2022-12-31 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2022-01-01 010545327 Penobscot Valley Hospital PENO 2077943321 PO Box 368 Lincoln ME 04457 Crystal Landry CEO 2077943321 2023-11-02 1 Crystal Landry 999009999 1 Joseph R Byrne P01289281 2077752387 2023-11-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X Crystal Landry PO Box 368 Lincoln ME 04457 24248782 0 X www.pvhme.org X 1973 ME Critical Access Hospital 11 11 233 23 0 0 3317854 1920448 20200477 22318536 8385 6676 -51360 3122 23475356 24248782 0 0 0 0 9731479 11205745 0 0 0 11877490 13094205 21608969 24299950 1866387 -51168 10665595 9912217 7441599 6680418 3223996 3231799 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. 0 0 21749922 22318536 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 2022, 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. 21749922 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 70 0 1 233 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Elisa Blethen 2077943321 PO Box 368 Lincoln ME 04457 Todd Tritch MD ED Physician and Medical Director 40.00 0.00 X 395281 0 9508 Glenn Deyo Surgeon 40.00 0.00 X 338352 0 24957 Crystal Landry CEO 40.00 0.00 X 192819 0 26928 Carl Alessi RHC Physician 40.00 0.00 X 179099 0 29461 Elisa Blethen CFO 40.00 0.00 X 168498 0 1646 Amy Theriault COO 40.00 0.00 X 149348 0 25983 Chris Abbott Hospitalist 40.00 0.00 X 149760 0 0 Paul Turnquist Physician 40.00 0.00 X 135994 0 1057 Phillip Dawson Jr President 1.50 0.00 X X 0 0 0 Richard Wyman Vice President 1.50 0.00 X X 0 0 0 Bea Szantyr MD Treasurer 1.50 0.00 X X 0 0 0 Annette Haynes Board Member 1.50 0.00 X 0 0 0 Bonnie Gray Board Member 1.50 0.00 X 0 0 0 H Joseph Thibodeau DMD Board Member 1.50 0.00 X 0 0 0 Judith Doore Board Member 1.50 0.00 X 0 0 0 Kristen Sciolino DMD Board Member 1.50 0.00 X 0 0 0 Patricia Nobel MD Board Member 1.50 0.00 X 0 0 0 Robert Genest Board Member 1.50 0.00 X 0 0 0 Whitney Souers Board Member 1.50 0.00 X 0 0 0 1709151 0 119540 15 0 1 0 Emcare Inc 7032 Collection Center Drive Chicago IL 60693 ER Physician Services 1101184 Todd Tritch MD PO Box 67 Lincoln ME 04457 Hospitalist 352560 Coyn Enterprises 404 Augusta Road Rome ME 04963 Hospitalist 273600 Physician Services Inc 126 Osborne Road Farmington ME 04398 Hospitalist 237000 Bigelow Hillcare Services LLC 348 Bigelow Hill Rd Skowhegan ME 04976 Hospitalist 229680 7 1913997 6451 1920448 Patient Revenue 622000 37468615 37468615 Cafeteria & Other 900099 256646 236488 20158 Contractual/Char. Adj. 622000 -15406725 -15406725 22318536 6676 6676 Gain from Subsidiary 900099 23316 23316 Loss on Investment in Affiliate 900099 -20194 -20194 3122 24248782 22298378 0 29956 X 565222 565222 8966045 8423392 542653 1003975 845531 158444 670503 564948 105555 24117 24117 57200 57200 8518219 8137988 380231 847906 604535 243371 745666 522541 223125 27050 18892 8158 88029 88029 407060 223883 183177 289157 280274 8883 Medical Supplies 1630860 1595750 35110 Service Provider Tax 442404 442404 Miscellaneous Expenses 16537 1755 14782 24299950 21749922 2550028 0 X 3592653 2372355 421580 424945 1738691 2444346 454853 438203 161808 183613 15861499 12649707 3132923 3211792 121109 124231 1041978 712732 10665595 9912217 2061179 2588899 0 103688 3810081 3962718 1570339 25113 7441599 6680418 X 2997757 3002072 226239 229727 3223996 3231799 10665595 9912217 X -51168 58971 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7023 7023 0 Part II-B, Line 1: 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. 28897 28897 7907206 6008385 1898821 16380 16380 7371862 6357138 1014724 537154 284184 252970 3211792 Deferred Compensation 25113 Estimated Third-Party Payor Settlements 687619 712732 Deferred Compensation 25113 25113 1 1 1 X 1 X 225.000000000000 1 1 0 1 1 85282 85282 0.00350 3952643 3823920 128723 0.00530 4037925 3823920 214005 0.00880 48544 400 48144 0.00200 48544 400 48144 0.00200 4086469 3824320 262149 0.01080 1 5547241 5547241 X 1 1 1 1 Penobscot Valley Hospital PO Box 368 Lincoln ME 04457 www.pvhme.org 39471 X X X X Penobscot Valley Hospital 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X pvhme.org/community-health-needs-assessment/ X 1 22 1 pvhme.org/community-health-needs-assessment/ 0 1 X 150.000000000000 225.000000000000 X 1 1 X X X 1 X https://pvhme.org/patient-resources/billing-help/ X https://pvhme.org/patient-resources/billing-help/ X https://pvhme.org/patient-resources/billing-help/ X X X X X X X 1 X 0 X X X X 1 X 0 0 Penobscot Valley Hospital Part V, Section B, Line 5: 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: As outlined, PVH has continued to move forward with increasing access to mental health services. Many pieces of the plan have been hindered by COVID. 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 one year long. PVH refers outpatients in its primary care practice to services in other locations; the wait list can be up to 3 months long. PVH utilizes Acadia for emergent patients with mental health crisis needs via tele psych. PVH continues to work to bring services to the Medical Arts Building and awaits Acadia Hospital finalizing the contract when a mental health provider can be found for the position. The contract was finalized in 2023. PVH took part in the Substance Use Disorder Grant Program in 2022 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 2022 by building community partnerships with Bella's house, and Save A Life Recovery Resource Center, among others. Patients with a need to substance use disorder detox are being referred to Bella's house 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 2022 to increase access to care for patients in Penobscot County.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. 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. Penobscot Valley Hospital Part V, Section B, Line 13h: State Regulation Penobscot Valley Hospital Part V, Section B, Line 16j: The FAP application is sent with all first time statements. A notice of the FAP and a copy of the FAP application is also posted in the Billing Help section of the Organization's website. Notices are also posted at all patient entrances to the Hospital and at various locations within the building. Part II, Community Building Activities: Many families rely on Penobscot Valley Hospital (PVH) for a comprehensive range of services. Without access to these services including primary and preventative care, chronic diseases may go untreated. Often this results in poor health with high emergent or inpatient costs. At PVH, we strive to be our Community's first choice in healthcare, known for a culture of compassion, quality, and safety: to be an excellent community partner, working together every day to improve the health and well-being of those we serve.Throughout 2022, the hospital partnered with many other organizations to reach people within our communities to educate, train, and inform, including Colonial Healthcare, Cummings Nursing Home, Eastern Maine Community College, Lincoln Economic Development Committee, Lincoln Lakes Region Chamber of Commerce, LifeFlight, Lincoln Police & Fire Departments, Maine Breast & Cervical Health Program, Maine Centers for Disease Control and Prevention, Maine Department of Transportation, Mayo Regional Hospital, Millinocket Regional Hospital, New England Organ Bank, Northern Penobscot Tech Region III, Raising Readers Program, Red Cross, RSU #67, SAD #30, SAD #31, PVH Auxiliary, 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. Taught students from Region III to draw blood.7. PVH is a clinical site for Northern Penobscot Tech Region III, and several colleges and universities. During 2022, PVH had students conducting clinical rotations here for certifications with Medical Assistant, Certified Nursing Assistant and Phlebotomy. Husson University sent students to the PVH pharmacy and nursing departments for their rotations. PVH has also worked with the University of Maine School of Nursing and Kennebec Valley Community College Radiology Program. PVH has also provided emergency medicine training of family medicine residents from Eastern Maine Medical Center. The hospital serves as a rotation site for physician assistants, and medical students from the University of New England, University of Vermont, and Yale University. 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.Penobscot Valley Hospital volunteers, staff, and providers are committed to providing quality healthcare services to the people in our community. In 2022, staff and volunteers provided:1. Free educational programs to seniors.2. The Auxiliary provides Kids Activity Packs and blankets for children visiting the hospital.3. 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. Leadership to Lincoln Economic Development Community & Lincoln Lakes Region Chamber of Commerce.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 8-10 and 14-15 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 2020 was 61.2 years. Lincoln is located in a modest area of the State, where the median resident income in 2020 was $24,921. Maine's average income for that same time period was $40,783.In 2020, Lincoln, ME had a population of 2.61k people with a median age of 61.2 and a median household income of $24,921. Between 2019 and 2020 the population of Lincoln, ME declined from 2,677 to 2,606, a 2.65% decrease and its median household income declined from $32,292 to $24,921, a 22.8% decrease. Part VI, Line 7, Reports Filed With States ME X X X X 0 0 0 0 0 0 0 1 0 Todd Tritch MD ED Physician and Medical Director 395066 0 0 0 215 0 0 0 9508 0 404789 0 0 0 Glenn Deyo Surgeon 329396 0 4771 0 4185 0 0 0 24957 0 363309 0 0 0 Crystal Landry CEO 184235 0 8403 0 181 0 0 0 26928 0 219747 0 0 0 Carl Alessi RHC Physician 156615 0 21530 0 954 0 0 0 29461 0 208560 0 0 0 Elisa Blethen CFO 162490 0 5869 0 139 0 0 0 1646 0 170144 0 0 0 Amy Theriault COO 140199 0 9020 0 129 0 0 0 25983 0 175331 0 0 0 Part I, Line 7 During 2022, all full-time and part-time employees received retention bonuses. 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 3,858,001. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,858,001. Purchased Services: Program service expenses 4,279,987. Management and general expenses 380,231. Fundraising expenses 0. Total expenses 4,660,218. 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 58,971. Form 990, Page 1, Box B: Amended Return Explanation In May 2023, the Hospital inadvertently filed a 2022 Form 990-N for Alpine Health Services, Inc. (a related organization) using the Hospital's employer identification number instead of the identifying number for Alpine Health Services, Inc. Once the error was realized, the Hospital contacted the Internal Revenue Service and was informed that when filing the Hospital's 2022 Form 990, the Hospital should indicate that the 2022 Form 990 filing is an amended return. Thus, the "Amended Return" box on Page 1, Box B of the Form 990 has been checked. Further, the Hospital also re-filed the 2022 Form 990-N filing for Alpine Health Services, Inc. using the correct employer identification number. Alpine Health Services Inc PO Box 460 West Enfield ME 04493 222533280 Support to provide health services in underserved areas of Maine. ME 501(c)(3) Line 10 Penobscot Valley Hospital 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0