2017-11-14T15:29:55-06:00 2016-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2016-01-01 010545327 Penobscot Valley Hospital PENO 2077943321 7 Transalpine Road Box 368 Lincoln ME 04457 Gary Poquette CEO 2077943321 2017-11-09 1 Barbara J McGuan CPA P00219457 2077752387 2017-11-09 69.49.157.66 2017-11-09 13:55:40 ES P 4A7A9222C8D681BBCE9F1B6E7BF5E3969F273E7D 53CA451596873B86A1E24CFE6767DCEC9A681D0F 2016 2021-01-29 14:40:06Z Gary Poquette 7 Transalpine Road Box 368 Lincoln ME 04457 22063629 0 X www.pvhme.org X 1973 ME Critical Access Hospital 10 9 252 37 0 0 66387 57561 22789956 21376178 53565 80765 31048 12857 22940956 21527361 1500 0 0 0 13755322 13335113 0 0 0 10235758 10123282 23992580 23458395 -1051624 -1931034 12545033 10808215 10267261 10528572 2277772 279643 X Penobscot Valley Hospital Mission Statement: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. Penobscot Valley Hospital Vision Statement:To be recognized by the community, employees, and the medical staff as:* The best place to receive care* The best place to work* The best place to practice medicine. 0 0 19017860 21376178 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 2016, 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. 19017860 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 21 0 1 252 1 0 0 0 0 0 1 1 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Ann Marie Rush 2077943321 7 Transalpine Road Box 368 Lincoln ME 04457 Phillip Dawson Jr President 1.50 X X 0 0 0 Richard Wyman Vice President 1.50 X X 0 0 0 Patty Houghton Treasurer 1.50 X X 0 0 0 Amanda Dunn Board Member 1.50 X 0 0 0 Bonnie Gray Board Member 1.50 X 0 0 0 Annette Haynes Board Member 1.50 X 0 0 0 Patricia Nobel MD Board Member 1.50 X 0 0 0 H Joseph Thibodeau DMD Board Member 1.50 X 0 0 0 Frederick Woodman Jr Board Member 1.50 X X 0 0 0 Earlene Young Board Member 1.50 X 0 0 0 Pam Hoxie Past Board Member 1.50 X 0 0 0 Gilberte Mayo Past Treasurer 1.50 X X 0 0 0 William Thornton Past Board Member 1.50 X 0 0 0 Ed Woolley Past Board Member 1.50 X 0 0 0 Gary Poquette CEO 50.00 X 227260 0 22631 Ann Marie Rush CFO 50.00 X 168926 0 16801 Glenn Deyo Surgeon 40.00 X 361631 0 32699 David Ettinger ED Physician 36.00 X 410572 0 26831 Babar Junaidi Hospitalist 40.00 X 267499 0 32119 Micheal Lescord ED Physician 33.00 X 428759 0 24814 David Rideout Surgeon 40.00 X 336726 0 26927 2201373 0 182822 13 0 1 0 Nurse Anesthesia of Maine LLC 141 North Main Street Suite 205 Brewer ME 04412 Nursing Services 606325 Emcare Inc 7032 Collection Center Drive Chicago IL 60693 ER Physician Services 508860 Quorum Health Resources LLC 105 Continental Place Brentwood TN 37027 Hospital Management Svcs. 340501 NEHE MRI LLC PO Box 6600 Newport Beach CA 92658 MRI Services 318080 Comprehensive Pharmacy Services LLC PO Box 638316 Cincinnati OH 452638316 Pharmacy 247456 11 22686 8591 26284 57561 Patient Revenue 621400 35453703 35453703 Cafeteria & Other 722210 250979 173434 77545 Provision for Bad Debts 621400 -1686079 -1686079 Contractual/Char. Adj. 621400 -12642425 -12642425 21376178 20272 20272 584371 4289 524478 3689 59893 600 60493 60493 10578 22686 8101 2477 2477 Earnings from Subsidiary 900099 16627 16627 Gain(loss) Affiliate Investment 900099 -6247 -6247 10380 21527361 21298633 0 171167 X 435618 435618 10556253 9608910 947343 1653341 1532305 121036 689901 605271 84630 64706 39979 24727 68795 68795 3859 3859 4741782 3618505 1123277 13989 13989 859404 419632 439772 628188 587543 40645 42946 25669 17277 246075 12069 234006 831408 831408 302136 29741 272395 Medical Supplies 1706828 1706828 Service Provider Tax 612242 612242 Physician Events 924 924 23458395 19017860 4440535 0 X 1388457 31781 744177 1733889 2640830 2559615 26365 7754 708900 484182 241624 215048 19121814 13938588 5858790 5183226 779228 352989 68332 78712 16097 13620 72233 147399 12545033 10808215 1984535 2810790 685519 579742 4629070 4487250 2968137 2650790 10267261 10528572 X 2036636 40647 164587 162447 76549 76549 2277772 279643 12545033 10808215 -1931034 -67095 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4595 4595 0 Part II-B, Line 1: The Organization pays dues to the Maine Hospital Association and the American Hospital Association. A portion of dues paid to the Maine Hospital Association ($4,001) and American Hospital Association ($594) were attributable to lobbying expenses. 28897 28897 8066187 5343680 2722507 433876 433876 0 10170600 7765680 2404920 422254 395352 26902 5183226 Estimated Third-Party Payor Settlements 2503391 Deferred Compensation 147399 2650790 21464508 -67095 8101 -58994 21523502 3859 3859 21527361 23462637 8101 8101 23454536 3859 3859 23458395 Part XI, Line 2d - Other Adjustments: Special Event Expenses 8,101. Part XII, Line 2d - Other Adjustments: Special Event Expenses 8,101. Golf Tournament 20912 16386 4526 2089 1405 2461 Fall Event 12352 6300 6052 1800 300 46 33264 22686 10578 3889 1405 300 2507 8101 2477 1 1 1 X 1 X 225.000000000000 1 1 0 1 1 890304 890304 0.03800 4289560 3519268 770292 0.03280 9898199 9199947 698252 0.02980 15078063 12719215 2358848 0.10060 21921 840 21081 0.00090 21921 840 21081 0.00090 15099984 12720055 2379929 0.10150 1 1115694 8887131 8887131 X 1 1 1 1 Penobscot Valley Hospital 7 Transalpine Road Lincoln ME 04457 www.pvhme.org 38340 X X X X Penobscot Valley Hospital 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X www.pvhme.org/About-Us/Newsletters-Publications.aspx X 1 16 1 www.pvhme.org/About-Us/Newsletters-Publications.aspx 0 1 X 150.000000000000 225.000000000000 X 1 1 X X X 1 X www.pvhme.org/billing.aspx X www.pvhme.org/billing.aspx X www.pvhme.org/resources/billing.aspx X X X X X X 1 X 0 X 1 X 0 0 Penobscot Valley Hospital Part V, Section B, Line 5: Penobscot Valley Hospital participated in the Maine Shared Health Needs Assessment & Planning Process for the first time in 2015-2016 to develop this report. The report was prepared by the research teams at Market Decisions Research of Portland, Maine, Hart Consulting Inc. of Gardiner, Maine, and the Maine Center for Disease Control and Prevention. Substantial segments of the narrative sections were adapted from the 2012 Maine State Health Assessment and significant analysis and research was conducted by epidemiologists at the Maine CDC and the University of Southern Maine's Muskie School of Public Service.Qualitative data was collected through a statewide stakeholder survey conducted in May and June 2015 with 1,639 people representing more than 80 organizations and businesses in Maine. The survey was developed using a collaborative process including Maine SHNAPP partners, Market Decisions Research, and Hart Consulting, and a number of other stakeholders and health experts. In Penobscot County, a total of 185 stakeholders responded to the survey.The object of the survey was to produce qualitative data of the opinions of health professionals and community stakeholders on the health issues and needs of the communities across the state. The survey used a snowball sampling approach by inviting leaders of member organizations and agencies to invite their members and employees to participate. Survey respondents represented public health and healthcare organizations as well as behavioral health, business, municipalities, education, public safety, and nongovernmental organizations. More than 80 organizations agreed to send the survey to their members. The survey asked all respondents a basic set of questions to rate the importance of health issues and impact of health factors. It then allowed respondents to provide answers to probing questions on the three issues and factors they were most interested in or had the most knowledge about. The Market Decisions Research/Hart Consulting team reviewed, coded and cleaned all open-ended comments for similar and recurrent themes.Stakeholders who work in Penobscot County listed the following health issues as their top five concerns:1. Drug and alcohol abuse2. Obesity3. Physical activity and nutrition4. Mental Health5. Cardiovascular diseases Penobscot Valley Hospital Part V, Section B, Line 6a: *Central Maine Healthcare*EMHS*Maine General Health*Maine Health*Maine Center for Disease Control and Prevention, an office of Department of Health and Human Services*Health Access Network Penobscot Valley Hospital Part V, Section B, Line 6b: *Maine Center for Disease Control and Prevention, an office of Department of Health and Human Services*Health Access Network Penobscot Valley Hospital Part V, Section B, Line 11: Please see the Hospital's Community Health Needs Assessment & Implementation Strategy located at the following web address:www.pvhme.org/About-Us/Newsletters-Publications.aspx 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 health and well-being of those we serve. Throughout 2016, we 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, Golden Key Senior Center, Health Access Network, Husson University, Katahdin Shared Services, Katahdin Valley 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, Quorum Health Resources, Raising Readers Program, Red Cross, RSU #67, SAD #30, SAD #31, PVH Auxiliary, PVH Cancer Support Group, Save-A-Life Substance Abuse Task Force, the University of Maine, University of New England, University of Vermont, WomenHeart, Yale University, and more. By employing over 200 people in the community, PVH is a leader in creating good paying jobs and attributing to a positive economy in the region. With the "ripple effect" (jobs the hospital helped create and dollars spent in the area), the U.S. Department of Commerce's Bureau of Economic Analysis determined the multiplier for employment in Maine to be 2.1174, meaning for every employed person in a hospital in Maine, there is another 1.1174 jobs created in supporting industries. Penobscot Valley Hospital supports 478 jobs.PVH does not turn away people who need vital care, regardless of their ability to pay. Each person we treat receives the same high-quality care with utmost compassion from our staff. Our hospital is providing more Free Care, which includes charity care and bad debts, than ever before.Other direct impacts that PVH provided to the communities that we serve:Education/Scholarships:1. Auxiliary provided scholarships to non-traditional students pursuing a degree in healthcare.2. Promoted National Donor Month in May to commemorate those who have given the gift of life and to raise awareness about registering as an organ donor.3. Published educational articles monthly in the Lincoln News on topics such as hand hygiene, disease prevention, and nutritional advice.4. Staff created educational displays in our lobby which have included health and nutrition pieces created by students at Hichborn Middle School to promote healthy choices among our staff and community. 5. PVH offered educational tours where students learn age-specific healthcare information like proper hand hygiene, x-ray processing, laboratory testing, and facility tours.6. Laboratory staff made weekly visits to four area nursing homes to collect specimens from residents.7. PVH is a clinical site for Northern Penobscot Tech Region III and several colleges and universities. During 2016, PVH had approximately 32 students conducting clinical rotations here for certifications with Medical Assistant, Certified Nursing Assistant and Phlebotomy. Husson University sent students to the PVH pharmacy and nursing departments for their rotations. PVH has also worked with the University of Maine School of Nursing and Kennebec Valley Community College Radiology Program. PVH provided emergency medicine training of family medicine residents from Eastern Maine Medical Center. We serve as a rotation site for physician assistants and medical students from University of New England, University of Vermont, and Yale University. Time spent with the students varies from a couple of hours to the entire semester of hands-on education. The demand for students to utilize PVH as a clinical site has increased over the last several years. 8. Professionals at PVH often visit local schools to share information on health-related topics with young people. These range from our infection prevention officer teaching students the importance of good hand washing to staff teaching children about their career field. Penobscot Valley Hospital volunteers, staff and providers are committed to providing quality healthcare services to the people in our community. In 2016, staff and volunteers provided:1. Free educational programs to seniors at the Golden Key Senior Center.2. Holiday gifts for area nursing home residents.3. The Auxillary provided Kids Activity Packs for children visiting the ED.4. Books for pediatric patients at well child checkups through Raising Readers.5. Free screenings for blood pressure at the Howland Community Events.6. Vaccinations through the Maine Impact Program. 7. ImPact head injury prevention program provided to area athletes.8. Scholarships for college students obtaining healthcare degrees.9. Artwork projects with the students in the Mattanawcook Academy Community Integration Progam.10. Hosted two Red Cross Blood Drives.11. School Supply Drive through Penquis Cap.12. Substance Abuse prevention education.13. Run/Walk for Wellness for obesity prevention.14. Community Service provider meetings for networking.15. Free meeting space for area non-profits.16. Leadership to the Lincoln Economic Development Community & Lincoln Lakes Region Chamber of Commerce.17. Hosted PVH Healthcare Career Summer Day Camp for 11 students interested in learning more about Healthcare careers. 18. Created free Healthy Me Weight Loss Program to teach community members better eating habits and safe exercise routines with free use of our Rehab & Wellness Center gym helping 23 participants lose an average of 5 pounds each. 19. Donated helmets for 24 area students winning bicycles in the Mason's Bikes for Books Program. 20. Collected donations for the Lincoln Food Cupboard's Healthy Snack Backpack program, reaching approximately 50 students per week for 12 weeks. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. Part III, Line 8: The Organization uses its Medicare Cost Report to obtain the amounts reported above. Part III, Line 9b: The Hospital would not initiate collection efforts against a patient that qualified for a sliding fee scale unless that patient failed to meet their obligation under payment arrangement agreed to by both parties. After it was determined that the patient did not qualify for a readjustment to their payment terms, the Hospital would follow normal notification practices dictated by our collection policy until the account eventually ended up in collections. Part VI, Line 2: The Organization took a comprehensive approach to assess community health needs. Several independent data analyses were performed based on secondary source data, augmented with local survey data, and any data inconsistency or discrepancies are resolved from the combined opinions formed from local experts. PVH relies on secondary source data, and most secondary sources use the county as the smallest unit of analysis. We asked our local expert area residents to note if they perceived the problems or needs identified by secondary sources to exist in their portion of the county. Most data used in the analysis is available from public internet sources. Critical data needed to address specific regulations or developed by the individuals cooperating with us in this study is displayed in the report of the appendix. Part VI, Line 3: Notices regarding PVH's charity care policy are posted at Registration and Emergency Room. 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 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, 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 2013 was 43.3 years. Lincoln is located in a modest area of the State, where the median resident income in 2013 was $44,649. Maine's average income for that same time period was $46,288. Part VI, Line 7, Reports Filed With States ME X X X X 0 0 0 0 0 0 0 0 0 Gary Poquette CEO 220000 0 0 0 7260 0 0 0 22631 0 249891 0 0 0 Ann Marie Rush CFO 165326 0 0 0 3600 0 0 0 16801 0 185727 0 0 0 Glenn Deyo Surgeon 361631 0 0 0 0 0 0 0 32699 0 394330 0 0 0 David Ettinger ED Physician 407110 0 0 0 3462 0 0 0 26831 0 437403 0 0 0 Babar Junaidi Hospitalist 267499 0 0 0 0 0 0 0 32119 0 299618 0 0 0 Micheal Lescord ED Physician 428759 0 0 0 0 0 0 0 24814 0 453573 0 0 0 David Rideout Surgeon 336726 0 0 0 0 0 0 0 26927 0 363653 0 0 0 Part VII Section B Line 5 Gary Poquette, CEO, and 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 2016 compensation is as follows: Gary Poquette, CEO: Salary: $227,260 Benefits: $22,631 Automobile Allowance: $7,260 Ann Marie Rush, CFO: Salary: $168,926 Benefits: $16,801 Automobile Allowance: $3,600 A Maine Health and Higher Educational Facilities Authority Revenue Bonds 010314384 560427EU4 2012-06-28 1117769 To refinance Series 2002A bond 0 0 1 A 538027 1117769 132031 24765 960973 2012 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 Glenn Deyo Employee of the Organization Sign-On Loan X 118054 7754 0 1 1 7754 Debbie Rancourt Family member of Frederick Woodman, Jr., Board President 77802 Employment 0 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 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 & CEO. The CFO & CEO will then review the document. Any questions will either be answered by the controller or the accounting firm. Once the CFO approves the draft 990, a copy is provided to the board of directors for their review. Once the board has approved the draft, the accounting firm is notified and the final version is prepared for filing. Form 990, Part VI, Section B, line 12c It is the expectation of Penobscot Valley Hospital that our board of directors, medical staff, regular and contracted employees, and our volunteers avoid activities that may involve, or appear to involve, a conflict of interest. This is a standard of conduct communicated through Administrative Policy 109 "Code of Ethics," our code of conduct and ethics, and our medical by-laws. These documents are drafted and signed off by the president of the board of directors, the chief executive officer, chief of medical staff and the compliance officer as appropriate. Every individual employed by, or otherwise representing the Hospital, is responsible for complying with this standard. It is the responsibility of the compliance officer and the chief executive officer to ensure that this standard is communicated, maintained and enforced within the Organization. Administrative Policy 127 "Compliance Reporting" outlines the expectation for reporting non-compliance, the mechanisms in place to do so, and the investigative process. Such mechanisms include a 24-hour confidential reporting hotline. Education on Penobscot Valley Hospital's code of conduct and ethics is provided during orientation or at the beginning of the business relationship. Reinforcement of this education is provided annually and upon any business contract renewal. Form 990, Part VI, Section B, line 15 CEO & CFO - Quorum Health Resources, an unrelated organization, does an extensive national compensation analysis. Ranges are presented to the finance/personnel committee of the board by QHR, and the wage is set. Other officer's wages are set using a state-wide wage survey conducted annually by the Maine Society for Healthcare Human Resources Administration. Wages are set by evaluating the position in conjunction with the job description listed in the survey. Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. Form 990, Part IX, line 11g Physician Fees: Program service expenses 1,422,717. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,422,717. Purchased Services: Program service expenses 2,195,788. Management and general expenses 1,066,856. Fundraising expenses 0. Total expenses 3,262,644. Consulting: Program service expenses 0. Management and general expenses 56,421. Fundraising expenses 0. Total expenses 56,421. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Penobscot Valley Hospital 7 Transalpine Road, Box 368 Lincoln, ME 04457 EIN 01-0545327 Penobscot Valley Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). 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