2014-11-17T08:43:05-06:00 2013-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2013-01-01 010545327 Penobscot Valley Hospital PENO 2077943321 7 Transalpine Road Box 368 Lincoln ME 04457 Gary Poquette CEO 2077943321 2014-11-13 1 Barbara J McGuan CPA P00219457 2077752387 2014-11-13 2013 2015-11-30 17:44:51Z Gary Poquette 7 Transalpine Road Box 368 Lincoln ME 04457 26577820 0 X www.pvhme.org X 1973 ME Critical Access Hospital 11 10 272 25 0 0 53589 46876 26448876 26157943 52151 75588 -14678 -5836 26539938 26274571 9935 0 0 0 13470965 14140242 0 0 0 13094211 12544831 26575111 26685073 -35173 -410502 15970607 14908408 11406094 10694537 4564513 4213871 X Penobscot Valley Hospital exists to provide quality healthcare and to serve as an educational and referral resource that meets our customer's needs by providing appropriate services, providing health related information, and making arrangements for additional health services. PVH provides vital services to the community which are not accessible in any other way to many of our patients due to geographical or transportation issues. See Schedule H for additional details. 0 1 22351256 26157943 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 2013, 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. 22351256 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 37 0 1 272 1 0 0 0 0 0 1 1 0 0 0 0 X 11 10 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 Richard Wyman Board Member 1.50 X 0 0 0 Phillip Dawson Jr Vice President 1.50 X X 0 0 0 Pam Hoxie Board Member 1.50 X 0 0 0 Michael McFalls Board Member 1.50 X 0 0 0 Hervey Clay Board Member 1.50 X 0 0 0 H Joseph Thibodeau DMD Board Member 1.50 X 0 0 0 Gilberte Mayo Treasurer 1.50 X X 0 0 0 Frederick Woodman Jr President 1.50 X X 0 0 0 Ed Woolley Board Member 1.50 X 0 0 0 Annette Haynes Board Member 1.50 X 0 0 0 Amanda Dunn Board Member 1.50 X 0 0 0 David Shannon CEO 50.00 X 222510 0 25101 Ann Marie Rush CFO 50.00 X 152180 0 17331 Samer Sbayi Surgeon 40.00 X 352766 0 25396 Paul E Turnquist ED Physician 40.00 X 277150 0 23098 Glenn Deyo General Surgeon 40.00 X 344501 0 23338 David L Ettinger ED Physician 40.00 X 291868 0 27233 David H Dumont Hospitalist 40.00 X 319813 0 16057 1960788 0 157554 10 0 1 1 Emcare Inc 7032 Collection Center Drive Chicago IL 60693 ER Physician Services 819487 Nurse Anesthesia of Maine LLC 141 North Main Street Suite 205 Brewer ME 04412 Nursing Services 635090 Unidine Corp 1000 Washington Street Suite 510 Boston MA 02118 Dietary Services 350640 NEHE MRI LLC PO Box 6600 Newport Beach CA 92658 MRI Services 339864 Quorum Health Resources LLC 105 Continental Place Brentwood TN 37027 Hospital Management Svcs. 303088 16 16978 10266 19632 4309 46876 Patient Revenue 621400 37579347 37579347 Meaningful Use Revenue 621400 324351 324351 Cafeteria & Other 722210 200149 99487 100662 Provision for Bad Debts 621400 -1584329 -1584329 Contractual/Char. Adj. 621400 -10361575 -10361575 26157943 35755 35755 333595 3200 292120 4842 41475 -1642 39833 39833 3186 16978 6287 -3101 -3101 Earnings from Subsidiary 900099 -679 -679 Earnings from Investment 900099 -2056 -2056 -2735 26274571 26057281 0 170414 X 417122 417122 10902548 10143702 758846 103025 92669 10356 1959492 1845078 114414 758055 681859 76196 56943 13230 43713 56973 56973 5753 5753 6140937 5118104 1022833 24481 24481 1673976 490204 1183772 806471 767268 39203 99344 78822 20522 302073 302073 1018700 1018700 348084 93007 255077 Medical Supplies 2008613 2008613 Physician Events 2483 2483 26685073 22351256 4333817 0 1410836 3153912 661768 722862 3382218 2662957 51394 91985 607544 675089 228030 215231 18183782 11674882 6724437 6508900 644090 756469 23579 20844 23527 21050 2213184 79109 15970607 14908408 2821343 2755851 982850 882073 5182020 6071162 2419881 985451 11406094 10694537 X 4352302 3967287 135662 170035 76549 76549 4564513 4213871 15970607 14908408 -410502 59860 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 4773 4773 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 ($4,158) and American Hospital Association ($615) were attributable to lobbying expenses. 28897 28897 7784222 4807850 2976372 433876 432742 1134 9502525 6100008 3402517 434262 334282 99980 6508900 Estimated Third-Party Payor Settlements 906342 Deferred Compensation 79109 985451 Golf Tournament 12723 9857 2866 2300 1179 Mystery Dinner Theatre 7441 7121 320 46 980 1783 20164 16978 3186 2346 980 2962 6288 -3102 1 1 1 X 1 X 225.000000000000 1 1 1 0 1 1 747971 747971 0.02800 5651770 6248898 -597128 0.00000 12864296 12333463 530833 0.01990 19264037 18582361 681676 0.04790 5664 653 5011 0.00020 5664 653 5011 0.00020 19269701 18583014 686687 0.04810 1 1107967 10516729 10516729 X 1 1 1 1 Penobscot Valley Hospital 7 Transalpine Road Lincoln ME 04457 X X X X Penobscot Valley Hospital 1 1 X X X X X X X X X 13 1 0 1 X www.pvhme.org/About-Us/Newsletters-Public X X X X X X X X X 0 0 1 1 150.000000000000 1 225.000000000000 1 X X 1 1 X X 1 0 X X X X 1 X 0 0 Penobscot Valley Hospital Part V, Section B, Line 3: Local Expert Advisors included the Community Health Educator and Nutritian Education Coordinator from Partnership for Healthy Northern Penobscot, the owner of Select Designs, the Manager of Clinical Operations from Community Health & Counseling Services, CEO and Penquis District Public Health Liaison of the PV Hospital, Director of Community Services from Eastern Area Agency on Aging, the school nurse from the local school district SAU31, clinician from Clinical Consultation & Counseling PA, FNP and CEO from Health Access Network, and Town Manager of Lincoln.When the analysis was complete, the information and summary conclusions were put before a local group of experts, who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions with additional statements of need, and new needs did emerge from this exchange. Consultation with local experts occurred again via an internet-based survey during the period beginning October 4, 2013, and ending October 10, 2013.With the prior steps identifying potential community needs, the local experts participated in a structured communication technique called a Delphi method, originally developed as a systematic, interactive forecasting method that relies on a panel of experts. Experts answer questionnaires in a series of rounds. We contemplated and implemented one round as referenced during the above dates. After each round, we provided an anonymous summary of the experts' forecasts from the previous round, as well as reasons provided for their judgments. The process encouraged experts to revise their earlier answers in light of the replies of other members of their panel. Typically, this process decreases the range of answers and moves the expert opinions toward a consensus "correct" answer. The process stops when we identify the most pressing, highest priority, community needs. In the PVH process, each local expert allocated 100 points among all identified needs, having the opportunity to introduce needs previously unidentified and challenge conclusions developed from the data analysis. A rank order of priorities emerged, with some needs receiving none or virtually no support, and other needs receiving identical point allocations. Penobscot Valley Hospital Part V, Section B, Line 7: Smoking was identified as a significant need in our 2013 CNHA. PVH provides some services to respond to this need - including Pulmonary Function testing, providing smoking cessation educational packets to patients, providing smoking cessation tools to our employees free of charge, and providing a 100% smoke free campus to our patients and community. However, PVH does not intend to develop an implementation plan to address this need because we have a local organization that was developed to address this topic. Sprint for Life (River Coalition), as part of the Healthy Maine Partnership, are working to address this problem. Physician practices in the community also work towards addressing this problem. Penobscot Valley Hospital Part V, Section B, Line 14g: 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 FAQ section of the Organization's website. Notices are also posted at all entrances to the Hospital and at various locations within the building. Penobscot Valley Hospital Part V, Section B, Line 20d: The Hospital applied the determined discount to the gross charge amount for self pay patients. The Hospital applied the determined discount to the remaining balance after insurance payment, if applicable. 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.During 2013, the Hospital maintained its estimate of the allowance for doubtful accounts relating to self-pay patients at approximately $1,120,000, and during 2012 the Hospital increased its estimate from $873,799 to $1,121,529. During 2012, self-pay write-offs increased from $979,693 to $1,324,087. During 2013, self-pay write-offs increased to $1,486,791. Such increases resulted from trends experienced in the collection of amounts from patients for which they are financially responsible. 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 around the hospital. We also have information in each patient room, and our employees know to refer patients to the registration or billing offices of the hospital if they have questions. Part VI, Line 4: Lincoln is a rural community of approximately 5,700 people located in north central Maine. Our service area consists of many small towns that use Lincoln as a hub. The hospital, school system, logging companies, and paper mill are the major employers in town. Life and industry primarily revolve around the woods of central Maine. It is an area rich with history for making paper. Maine is one of the oldest states in the nation according to the latest US Census report, and Lincoln reflects that demographic. The median resident age in 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 5: Penobscot Valley Hospital in Lincoln, Maine provides a substantial range of free or low-cost services, care, and educational opportunities to the Lincoln Lakes Region in northern Maine. PVH is one of the largest employers in the area and provides careers for more than 225 people in a region in which people struggle to find full-time, good paying employment. PVH is also the only rural health center with emergency care in the region for many of our patients and clients. The nearest Critical Access Hospital is 30 minutes away, and the nearest full service hospital is more than 45 minutes away from PVH. Sustaining PVH's longevity not only means vital services remain nearby for our patients but also that the economic vitality of the region is better secured. In 2013, PVH celebrated 40 years of exceptional healthcare in our community. In that time, we partnered with many other organizations to reach a broad range of people, including: Bangor Savings Bank, ColonialHealthcare, Eastern Maine Community College, Golden Key Senior Center, Health Access Network, Husson University, Katahdin Shared Services, Katahdin Valley Community College, Lincoln Lakes Region Chamber ofCommerce, LifeFlight, Lincoln Police & Fire Departments, Maine Breast & Cervical Health Program, Maine Centers for Disease Control and Prevention, Maine Department of Transportation, Maine Medical Partner'sWomen's Health Division of Maternal Fetal Medicine, Mayo Regional Hospital, Millinocket Regional Hospital, Northern Penobscot Tech Region III, Quorum Health Resources, Raising Readers Program, RSU #67, SAD#30, SAD #31, PVH Auxiliary, PVH Cancer Support Group, SPRINT for Life, the University of Maine, University of New England, University of Vermont, WomenHeart, Yale University, and more. These partnerships allowed PVH to provide education, services, training and information to people in our region. Anniversary Gathering & Music JamPenobscot Valley Hospital celebrated 40 years of exceptional healthcare in 2013. In October, the hospital hosted a special community celebration and "Music Jam" held at the Lincoln Knights of Columbus Hall. PVH covered admission to the event for all attendees and surprised the crowd of nearly 250 with a free dinner and dessert. Attendees enjoyed great musical entertainment, dancing, a delicious meal, and a true community spirit.AuxiliaryThe PVH Auxiliary is a group of men and women who work as a team to volunteer for hospital-related events like our fundraisers and blood drives, visit patients and their families, and supply certain items to patients as needed. One of their biggest focuses is "baby bags" - a goody bag that each new mother receives with helpful items for her and the new baby. They also provide scholarships to nontraditional students pursuing a degree in the healthcare industry, activity packs for children, and special gifts for patients visiting the hospital over the holidays.Blood DrivesPVH hosted two American Red Cross blood drives in 2013 - one in June and another in December, both at the Lincoln Knights of Columbus Hall. The Knights generously donate the use of their facility for these events. The blood drives resulted in nearly 100 units of blood being collected for those in need.Cancer Support GroupThis group (CSG) meets twice a month at PVH with two survivors leading the group. All area cancer survivors and their caregivers are invited to attend for help in dealing with cancer. Discussion topics include finances, transportation, cancer centers, and occasional guest speakers. The group helps to fund education, transportation and other care costs for area cancer patients that are in need. They also host occasional speakers and educational events for area providers. In April, area girl scouts taught members how to make their own jewelry which they've been selling at fundraising events to help support those battling cancer. In May, they co-hosted Breast Cancer Awareness Day with the PVH Imaging Department to help increase awareness of breast cancer, early detection and prevention. They provided pink manicures, a baked goods sale, jewelry sales, and house wares for sale. The event raised nearly $600 for the CSG who has helped area cancer patients afford transportation, education and other costs for area cancer patients.Childbirth Education and Obstetric CareEach quarter, PVH provides a full day of newborn baby care and delivery education at no cost to expectant mothers and families. These classes are typically held on the weekends and teach breastfeeding, comfort during pregnancy, relaxation techniques, pain control, baby care and much more. Healthcare providers at Health Access Network (HAN) help promote this event with their expectant patients. Special training sessions were hosted for PVH and HAN staff by providers from Portland's Maine Medical Partner's Women's Health Division of Maternal Fetal Medicine. Staff received continuing education training and practical skills sessions while using a patient care simulator to carry out higher risk childbirth experiences. For those mothers and their families delivering at PVH, they are showered with gifts from the PVH Auxiliary and receive books through the Raising Readers program. Pictured are some of the gifts donated by area businesses for the first baby born at PVH in 2013.Disaster PreparednessPVH participates in a regional disaster preparedness committee with several other agencies including doctors' groups, other hospitals, local police and fire departments, schools, and other organizations. The goal of these monthly meetings is to prepare for pandemic flu, natural disasters, or other incidents that could affect our communities as well as to find ways to work together to share resources and protect the community. We participated in the Lincoln community's "Every 15 Minutes" program as part of this year's disaster drill training where staff treated wounds on multiple victims played by high school students, worked with their families, the media, and other agencies to test our skills in an emergency situation.Economic ImpactPVH is one of the largest employers in the Lincoln Lakes Region. By employing over 225 people in the community, PVH is a leader in creating good paying jobs and attributing to a positive economy in the region.We utilize local companies for many of our supplies -- from food prepared in our cafeteria to the PVH vehicles we drive. We recognize the importance of supporting our community and make every effort to keep our business local.EducationEach week, the PVH staff places articles and ads in the local paper, the Lincoln News, the PVH website, PVH Facebook page and other nearby publications covering topics that are helpful to the general public. These include topics such as hand hygiene, disease prevention, and nutritional advice. The hospital also produces a variety of brochures and educational materials covering a wide range of health-related topics which are handed out to the public. In the fall, we partnered with Health Access Network to offer training sessions on the Affordable Care Act for the general public, employees and our partners. Our area's patient navigator, Bjorn Streubel, provided education on the different health plans available in our area as well as how our facility can provide assistance to those seeking help in the exchange. Our Quality Improvement department conducted two lectures to the University of Maine nursing students on quality and service issues. Our Pharmacist provided members of the Golden Key Senior Center with education on medication safety.Staff have worked to create 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. In February, WomenHeart hosted a display to educate staff and community members about heart disease in women.Educational ToursStudents from local schools throughout the region, as well as Boy and Girl Scout troops, were given tours of PVH during 2013. During the tours, students learn age-specific healthcare information like proper hand hygiene, X-ray processing, laboratory testing, and facility tours. Falls Risks PVH is also providing education on falls risks and measures that can be taken at home to decrease a patient's risk of falls and injury. The Hospital provides patients with a handout that teaches ways to make their home safe and other tips to avoid falls. There is an active Falls Team who works on projects to make the hospital and our community a safer place. Part VI, Line 7, Reports Filed With States ME Form 990, Schedule H, Part VI, Line 5: Food Cupboard SupportThroughout the year, staff and visitors to the PVH Cafeteria place change in a special container by the checkout counter. Periodically, this change is removed and donated to the Lincoln Area Food Cupboard, which supplies food, clothing, and other necessities to people in need. In 2013, PVH collected nearly $300 for the Lincoln Area Food Cupboard. We also ran a food drive in collaboration with Bangor Savings Bank collecting donations of peanut butter and jelly, helping to provide a healthy protein for the Food Cupboard.ImPACT Program at Mattanawcook AcademyPVH has provided MA with a software program to help prevent long-term brain injuries through the Maine Concussion Management Initiative (ImPACT), a program created by Dr. William Heinz, a Portland orthopedist, and Dr. Paul Berkner, director of health services at Colby College in Waterville. ImPACT stands for Immediate Post-Concussion Assessment and Cognitive Testing and is a computerized neurocognitive testing program used as a standard tool used in comprehensive clinical management of concussions for athletes of all ages. Dr. Carl Alessi and Physician Assistant Bill Head oversee the program at PVH and will monitor any student athlete presenting with signs of a concussion or head injury during the sports seasons.InfluenzaOur clinicians and support staff held multiple influenza vaccination clinics for our community in Penobscot Valley Primary Care and the PVH Specialty Clinic. We were recognized by the Maine Center for Disease Control and Prevention for our extraordinary efforts to vaccinate staff from influenza. During the 2012 - 2013 flu season, 95% of staff at PVH had received the influenza vaccination! This shows true commitment to the people we serve as we work to prevent the spread of infection to our patients.Internships/Job Shadowing/Job SkillsThe hospital works closely with students of all ages from across New England. PVH has hosted many job shadow opportunities with students from area high schools and colleges. Northern Penobscot Tech Region III had students complete their clinical rotations for Medical Assistant, Certified Nursing Assistant and Phlebotomy at the hospital. 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 provides emergency medicine training of family medicine residents from Eastern Maine Medical Center. We serve as a rotation site for physician assistants and medicalstudents 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.Laboratory ServicesMedical Laboratory Technologists in the PVH Laboratory make weekly visits to four area nursing homes to collect specimens from residents. The technologists have also provided free educational sessions to nursing home staff members on specimen collection.LifeFlight of MaineThe LifeFlight helicopters are known for transporting critical patients to the care they need quickly and safely. In an emergent situation, they can transport a patient from Penobscot Valley Hospital to a Bangor facility in just eleven minutes for specialized care. Though not talked about as often, the crew and equipment on board are just as important to a patient's survival and recovery as the helicopter itself. LifeFlight relies on private donations to help fund the more than $175,000 of advanced medical equipment on board each helicopter. In 2013, PVH donated $3,000 toward this worthy cause.Lincoln Chamber of CommercePVH is a member and proud supporter of the Lincoln Lakes Region Chamber of Commerce. We understand the importance of supporting our local business community and make it a point to buy locally whenever possible. The Chamber provides us with the opportunity to network with area business owners, increase our visibility in the community, and advocate for our area.Lincoln Expo, Howland Appreciation Event and Lee Safety DayIn April, staff at PVH volunteered their time to share the community information about the services offered at PVH. Attendees at the Lincoln Expo and Howland Appreciation Event had the opportunity to test their skills as a general surgeon. Our medical equipment representative from Stryker brought demo equipment to entertain the crowd. Education was also provided on balance as staff from the PVH Rehab & Wellness Center hosted an exercise demonstration. Event goers also learned more about preventative care and our providers presented on recovering close to home through our swing bed program and radiology services. In October, employees participated in the Lee Safety Day promoting hand hygiene, electronic medical records, and even got to visit with Smokey the Bear!Meeting Space for Non-ProfitsPVH offers conference room space to local non-profit organizations. This space is offered when it does not interfere with hospital business, at no cost to the organizations.Primary CareStaff at Penobscot Valley Primary Care (PVPC) located next to the hospital at 252 Enfield Road in Lincoln participate in many efforts to assist the community, including:1. Maine Breast and Cervical Health Program - PVPC helps provide breast and cervical cancer screening and diagnosis services to underserved women, to provide public and professional education, and to support community partnerships to enhance statewide cancer control activities.2. Maine Impact program - providing a lifetime of good health with vaccines regardless of the patient's ability to pay.3. From the First Tooth - we participate in this prevention initiative whose goal is to improve the oral health of Maine children. Children receive fluoride varnish at well child visits with their healthcareprovider from approximately 6 months to 42 months. At this time, the healthcare providers will assist the family in transitioning the child to a local dentist.4. Raising Readers - pediatric patients at PVPC will have a library of over 12 books by the time they enter school thanks to this great program. Raising Readers provides participating hospitals and medicalpractices with quality, hardcover books. They are selected by Maine people who know about children's literature: doctors, librarians, child development experts, and parents. Our pediatrician, Dr. Patricia Nobel serves on the Raising Readers board and says she is honored to be able to choose quality reading materials for Maine children.5. Medication assistance - If patients are having trouble affording their medications, staff at Penobscot Valley Primary Care assist patients in obtaining medications at decreased costs through manufacturers or other assistance sources.Public CPR, AED & First AidPVH staff makes several classes available to the community throughout the year at low or no cost to teenagers and adults on general first aid techniques, how to use an automated external defibrillator (AED), and the basics of cardiopulmonary resuscitation (CPR). School Supplies, Presentations and ScholarshipsIn the summer, PVH employees held a school supply drive in collaboration with Penquis CAP. Collection sites were set up throughout our facilities during the month of August. Penquis CAP then distributed the items to area K-12 students in need. 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. Normally, students are given something to help retain the material, such as coloring books, posters, informational materials for parents, or small promotional items such as hand sanitizer or bandage containers. At the end of each school year, PVH awards scholarships to three graduating seniors from Lee Academy, Mattanawcook Academy and Penobscot Valley High School. Each recipient is selected by the schools and must be pursuing a healthcare-related degree. They are awarded $500 each with the hospital giving a total of $1,500 annually.Social Work NetworkingEach month, PVH hosts a networking lunch time meeting for social workers and others who do similar work in the community. PVH provides education for them and facilitates discussions about social work-related issues.SPRINT for LifePVH also supports a grant-funded community health coalition in collaboration with Millinocket Regional Hospital and the River Coalition in Old Town. SPRINT for Life is part of a statewide system of public health organizations called Healthy Maine Partnerships that bring people and resources together to improve the health of Maine residents. Lincoln Lakes Region Active Community Environment Team (Obesity Prevention) X X X X 0 0 0 0 0 0 0 0 0 David Shannon CEO 213150 0 2100 0 7260 0 0 0 25101 0 247611 0 0 0 Ann Marie Rush CFO 148580 0 0 0 3600 0 0 0 17331 0 169511 0 0 0 Samer Sbayi Surgeon 352766 0 0 0 0 0 2600 0 22796 0 378162 0 0 0 Paul E Turnquist ED Physician 277150 0 0 0 0 0 0 0 23098 0 300248 0 0 0 Glenn Deyo General Surgeon 344501 0 0 0 0 0 3825 0 19513 0 367839 0 0 0 David L Ettinger ED Physician 274368 0 0 0 17500 0 3825 0 23408 0 319101 0 0 0 David H Dumont Hospitalist 302313 0 0 0 17500 0 3825 0 12232 0 335870 0 0 0 Part VII Section B Line 5 Dave Shannon, CEO & Ann Marie Rush, CFO are compensated by Quorum Health Resources, an unrelated organization, for services rendered to the Organization. The amounts listed below are not included in the total reported on Form 990, Part VII, Section B for Quorum Health Resources, LLC. A breakdown of their 2013 compensation is as follows: Dave Shannon, CEO: Salary: $213,150 Bonus: $2,100 Benefits: $25,101 Automobile Allowance: $7,260 Ann Marie Rush: Salary: $148,580 Benefits: $17,331 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 235696 1117769 132031 24765 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 Part II, Line 3 The total proceeds of issue listed on line 3 differ from the issue price listed on Part I due to the amount of the premium on the bond. Samer Sbayi Employee of the Organization Sign-On Loan X 100000 25273 0 1 1 Glenn Deyo Employee of the Organization Sign-On Loan X 118054 66712 0 1 1 91985 Amy Woodman Family member of Frederick Woodman, Jr., Board President 29474 Employment 0 Debbie Rancourt Family member of Frederick Woodman, Jr., Board President 81683 Employment 0 Form 990, Part III, line 3 The Hospital ceased opeartions of its ambulance service effective July 2013. Form 990, Part VI, Section B, line 11 Once Form 990 is prepared by the certified public accounting firm, a draft copy is e-mailed to the controller. The controller will then review the Form, and also compare it with the previous year's 990. Once the controller is satisfied with the draft copy, it is forwarded to the CFO. The CFO will then review the document. Any questions she has will either be answered by the controller or the accounting firm. Once the CFO approves the draft 990, a copy is provided to the board of directors for their review. Once the board has approved the draft, the accounting firm is notified and the final version is prepared for filing. Form 990, Part VI, Section B, line 12c It is the expectation of Penobscot Valley Hospital that our board of directors, medical staff, regular and contracted employees, and our volunteers avoid activities that may involve, or appear to involve, a conflict of interest. This is a standard of conduct communicated through Administrative Policy 109 "Code of Ethics," our code of conduct and ethics, and our medical by-laws. These documents are drafted and signed off by the president of the board of directors, the chief executive officer, chief of medical staff and the compliance officer as appropriate. Every individual employed by, or otherwise representing the Hospital, is responsible for complying with this standard. It is the responsibility of the compliance officer and the chief executive officer to ensure that this standard is communicated, maintained and enforced within the Organization. Administrative Policy 127 "Compliance Reporting" outlines the expectation for reporting non-compliance, the mechanisms in place to do so, and the investigative process. Such mechanisms include a 24-hour confidential reporting hotline. Education on Penobscot Valley Hospital's code of conduct and ethics is provided during orientation or at the beginning of the business relationship. Reinforcement of this education is provided annually and upon any business contract renewal. Form 990, Part VI, Section B, line 15 CEO & CFO - Quorum Health Resources, an unrelated organization, does an extensive national compensation analysis. Ranges are presented to the finance/personnel committee of the board by QHR, and the wage is set. Other officer's wages are set using a state-wide wage survey conducted annually by Dix Consulting. Wages are set by evaluating the position in conjunction with the job description listed in the survey. Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. Form 990, Part IX, line 11g Physician Fees: Program service expenses 2,082,599. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,082,599. Purchased Services: Program service expenses 3,035,505. Management and general expenses 1,022,833. Fundraising expenses 0. Total expenses 4,058,338. 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 9 Penobscot Valley Hospital 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0