SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
EASTERN MAINE HEALTHCARE SYSTEMS-SVH
SEBASTICOOK VALLEY HEALTH
Employer identification number

01-0263628
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
 
No
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		  429 1,020,746 500 1,020,246 3.000 %
b Medicaid (from Worksheet 3, column a) . . . . .            
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     58,997   58,997 0.170 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .   429 1,079,743 500 1,079,243 3.170 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 17 1,199 520,859 3,376 517,483 1.520 %
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . . 1   54,423   54,423 0.160 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 1   886   886  
j Total. Other Benefits . . 19 1,199 576,168 3,376 572,792 1.680 %
k Total. Add lines 7d and 7j . 19 1,628 1,655,911 3,876 1,652,035 4.850 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy 1   4,500   4,500 0.010 %
8 Workforce development            
9 Other            
10 Total 1   4,500   4,500 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,585,123
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
12,617,064
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
13,007,919
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-390,855
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Sebasticook Valley Health
447 North Main Street
Pittsfield,ME04967
sebasticookvalleyhealth.org
38277 		X X     X   X   Licensed Hospital  
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
 
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		 
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 14
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted................. 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities
in Part VI.................................. 		4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public?.............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs........... 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ................................ 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? .......... 8b   No
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.0000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If "Yes," indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12   No
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?........ 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?........ 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual?.......................... 22   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
Part V, Line 1j - Description of Other Needs Assessment a. Sebasticook Valley serves a population of approximately 34,000 people in Southern Penobscot, Southern Somerset, Northern Kennebec, and Western Waldo Counties. The counties where the largest number of patients reside, Penobscot and Somerset, had median annual household incomes of $43,382 and $38,141 respectively. Families living in poverty numbered 17.4% in Penobscot County and 18.2% in Somerset County.1.b. Sebasticook Valley Health and its related physician practices utilize extensive electronic medical records, including disease registries, which provide a vast amount of data relative to patients in care. The needs assessment provides a broader picture of the community as a whole, including the health status and social-demographics (such as employment, income, and education levels). The local units of the State's public health infrastructure (known as Healthy Maine Partnerships) are also itegrated into the process so that their relative to health, environmental and social measures are part of the community dissemination process.1c. In the Somerset County/Sebasticook Valley service area, key collaborators include, Sebasticook Valley Health (Hospital/primary care services/outpatient services), Sebasticook Family Doctors (FQHC), other primary care practices, Healthy SV (public health /HMP) coalition partners , including schools, EMS services, law enforcement, members of the business community, and public officials. 1d-1e-1f EMHS, the parent company of Sebasticook Valley Health, routinely conducts a community health needs assessment (Hereafter needs assessment) across the service area of all of its member hospitals. The most recent assessment, published in 2014, was conducted in partnership with Sebasticook Valley Health, member organizations, district public health coordinating councils, Federally Qualified Health Centers, and the Healthy Maine Partnerships. The final needs assessment report includes aggregate data from the 2014 EMHS Qualitative Stakeholder Survey disseminated in June across eight Maine counties, the University of Wisconsin County Health Rankings (2014), and the 2011 OneMaine Community Health Needs Assessment. Together, the data provide a unique perspective on the health of Maine communities and the population Sebasticook Valley Health serves, with a focus on the social, environmental, and clinical factors that influence the ability of populations to lead healthy lives. 1.g.The data gathered from the 2014 Community Health Needs Assessment (CHNA) allowed Sebasticook Valley Health to identify areas of significant need including priority concerns, gaps in healthcare services, and barriers to care. A hospital task force considered the data and identified areas of significant needs to be addressed, as well as areas of need unable to be addressed by the hospital. An implementation strategy was presented and adopted by the hospitals board of directors. The Implementation Strategy consists of actions the hospital intends to take to address the health need. Programs/resources the hospital plans to commit to address the health need were identified along with planned collaborations with other area organizations.1.h. The 2014 Community Health Needs Assessment findings were presented by the Sebasticook Valley Health Director of Community Health and Education during an annual coalition meeting of community partners. This meeting was open to the public and publicized through electronic communications, including email and Facebook. Attendees included representatives from the hospital, the regional Federally Qualified Health Center, two school districts, chamber of commerce, municipalities, social service providers, and community volunteers. The presentation focused on the needs assessment county data report compared to the state health trends. Attendees were invited to visit the EMHS website to access the full needs assessment report and data analysis. Following the presentation, attendees were asked to participate in small group discussions to discuss the data trends, identify health priorities for the hospitals service area, and brainstorm possible action steps based on current state, capacity, and resources available. The Director compiled the information and drafted a preliminary implementation plan, which was then circulated electronically to meeting attendees seeking additional feedback, revisions, and approval. 1.i The 2014 CHNA report presents findings of three sets of data, by county. The data sets include absolute indicators of health status as gathered in 2010 using BRFSS and other primary source data gathered using empirical methods; A qualitative stakeholder survey conducted in 2014 and 2014 County Health Rankings indicator set. The qualitative stakeholder survey was disseminated broadly to public health and community stakeholders who serve local populations. As such, the Community Health Needs Assessment does not provide for random assignment of survey respondents, nor does it attempt to function as a surveillance instrument. Limitations aside, taken together, the data provide a unique perspective on the health of Maine communities, with a focus on the social, environmental, and clinical factors which influence the ability of populations to lead healthy lives.
Part V, Line 3 - Account Input from Person Who Represent the Community Key collaborators were convened as an advisory committee to review the Needs Assessment and assist in the dissemination of a survey instrument to a broad base of key informants representing healthcare, public health, and community stakeholders to identify issues and opportunities for collaborative community health improvement. These collaborators include: Local Public Health District Officials: Stacy Boucher, Aroostook District Coordinating Council; Paula Thomson, Central District Coordinating Council; Becca Matusovich, Cumberland District Public Health Council; Alfred May, Downeast Public Health Council; Jessica Fogg, Penquis District Coordinating Council; Clarisa Weber, Wabanaki Public Health. Healthy Maine Partnerships (contracted entities functioning as part of the local public health system): Jamie Comstock, Bangor Region Public Health & Wellness; Elsie Flemings, Healthy Acadia; Carol Bell, Healthy Aroostook; Anne Lang, Healthy Casco Bay; Joanne Joy, Healthy Communities of the Capital Area; Zoe Miller, Healthy Lakes; Fran Mullin, Healthy Northern Kennebec; Kristen Dow, Healthy Portland; Lucie Rioux, Healthy Rivers; Karen Hawkes, Healthy Sebasticook Valley; Malissa Boynton, Healthy Wabanaki; Vyvyenne Ritchie, Healthy Waldo County; Jane McGillicuddy, Partnership for a Healthy Northern Penobscot; Robin Mayo, Piscataquis Public Health Council; Ellen Willinghan, Power of Prevention; Bill Primmerman, Somerset Public Health; Eleody Libby, Washington County: One Community. Other Entities: Federally Qualified Health Centers, Bangor Public Health and Community Services, Portland Public Health.
Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment The CHNA was developed and implemented as a collaborative between the EMHS Healthcare System and other independent hospitals serving Maine communities. EMHS Member Organizations: Acadia Hospital, Blue Hill Memorial Hospital, Charles A. Dean Memorial Hospital, Eastern Maine Medical Center, Inland Hospital, Mercy Hospital, Sebasticook Valley Health, and TAMC. Partnering Hospitals: Cary Medical Center, Down East Community Hospital, Houlton Regional Hospital, Maine Coast Memorial Hospital, Mayo Regional Hospital, Millinocket Regional Hospital, Mount Desert Island Hospital, Northern Maine Medical Center, and Redington-Fairview General Hospital.
Part V, Line 5c - Description of Making Needs Assessment Widely Available Instructions on the website assist viewers to download and/or print sections of the report. Individuals without computer or printer access were provided a phone number where they can request a printed assessment.
Part V, Line 6i - Describe Other Needs Identified The 2014 needs assessment health priorities for Sebasticook Valley Health are lack of insurance or an inability to pay for care, hunger and food insecurity, preventive care and self-management, tobacco use, and substance abuse. Initial action steps to be implemented in the coming year(s) to address the health priorities identified include the following:Lack of Insurance/Inability to Pay for Care:Partner with the Federally Qualified Health Center and community partners to educate patients and the general public about the Healthcare Exchange.Link patients without health insurance to Certified Application Counselors for assistance with the Healthcare Exchange application process.Hunger/Food InsecurityCollaborate with school and community partners to implement school and community-based gardens.Collaborate with the Healthy Maine Partnership to increase the number of worksites providing or promoting farm share programs to employees.Partner with the Federally Qualified Health Center and other community partners to promote and sustain the Snack Pack Program.Partner with farmers to facilitate donations of unused food to community partners, such as food pantries, schools, senior housing, and public dinners.Preventive Care & Self-ManagementEngage community partners to establish and implement plan for delivery preventive health screenings in our most rural communities.Convene stakeholders to discuss possibility, barriers, and benefits of extended provider office hours to late day/evening to accommodate working families.Collaborate with community partners to provide patients with local Primary Care Provider information at the time of Emergency Department registration.Tobacco:Provide technical assistant to local worksites to establish tobacco-free policies that include financial assistance/insurance coverage for tobacco cessation products.Collaborate with healthcare partners to coordinate onsite provider tobacco cessation educationPartner with community organizations to educate the general public about local tobacco cessation services and programs. Substance Abuse:Partner with schools to coordinate education sessions for parents and students about the science of addiction.Partner with community organizations, healthcare partners, and local pharmacies to provide patients with safe storage and disposal information.Continue to utilize the Prescription Monitoring Program and provide ongoing education/training opportunities for Providers.Sebasticook Valley Health serves over 34,000 in more than a dozen towns in Central Maine in the counties of Southern Penobscot, Southern Somerset, Northern Kennebec, and Western Waldo Counties. Central Maine serves a significant number of patients who utilize either Medicare or Medicaid (Maine Care) as their primary source of coverage for healthcare. The area has a diverse business and industrial base, however, no large companies or industry are located in the region.Sebasticook Valley Health works with other area healthcare organizations and providers, businesses, and industries, municipalities, civic organizations, communities of faith, schools, and private individuals and families to bring the highest quality of healthcare to the region. SVH also recognizes its role in helping the Sebasticook Valley be a healthy and economically vibrant place to live and work and collaborates with a number of partners to enhance the region's health in the broadest sense. Sebasticook Valley Health provides free transportation to our facilities; this is critical service to connect vulnerable populations, largely the elderly - with care services.
Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why Unemployment/Economic OpportunityDomestic ViolenceAffordable HousingBehavioral/mental health services for children and adultsDental Care/Oral HealthSubstance Abuse TreatmentPrescription Drug AssistanceTransportationWhen selecting health priorities for Sebasticok Valley, community partners took the following factors and questions into consideration:What is the current staffing capacity to lead strategy implementation;What is the current grant and agency funding to support strategy implementation;Is there grant funding likely available that could assist with strategy implementation;Can SVH and the community partners realistically make an impact on the health priority given the current state/context;Is there a measure we can easily identify and track; andIs there existing or emerging energy around a health priority that would assist us with strategy implementation?After a series of small group discussions, taking into account the noted considerations, it was determined that the health priorities listed are not feasible at this time.
Part V, Line 14g - Other Means Hospital Facility Publicized the Policy Signs and individual notices are posted in key public waiting areas in the hospital, Physcian practices and on the website regarding information pertaining to Free Care. These notices inform the patient of the availability of Free Care including the eligibility criteria and instruction on how to apply, obtain additional information or assistance.
Part V, Line 20d - Other Billing Determination of Individuals Without Insurance Hospital charges are discounted at 100% for the patients who qualify for Free Care with income at or below the 200% FPL.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address Type of Facility (describe)
1 SVH Rehabilitation Services
141 Leighton Street
Pittsfield,ME04967 		Outpatient Medical Facility
2 SVH Sleep Center of Maine
114 Chandlet Street
Pittsfield,ME04967 		Outpatient Medical Facility
3 SVH Rehabitation Services
118 Moosehead Trail Suite 4
Newport,ME04953 		Outpatient Medical Facility
4 SVH Speciality Physicians
72 North Main Road
Detroit,ME04929 		Outpatient Medical Facility
5 SVH Family Care
470 Somerset Avenue
Pittsfield,ME04967 		Outpatient Medical Facility
6 SVH Family Care
8 Main Street
Newport,ME04953 		Outpatient Medical Facility
7 SVH Family Care & Speciality Physicians
1309 Main Street Unit 1
Clinton,ME04927 		Outpatient Medical Facility
8 Sebasticook Valley Work Health LLC
125 Main Street
Pittsfield,ME04967 		Outpatient Medical Facility
9
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) SVH uses 200% over the FPG and reviews each patient information on a case by case basis.
Part I, Line 6a - Related Organization Community Benefit Report Leadership: Teresa P. Vieira,CEO and Michael Gallagher,Chair, Location: Pittsfield, Clinton, Detroit, Newport, Palmyra Employees: 343Description: Twenty-five bed critical access hospital with a women's health center; surgical, special care and swing bed units; rehabilitation centers; occupational health services; diagnostics; laboratory; cardiopulmonary services; primary, walk-in, and specialty practices; diabetes and nutrition clinic; sleep study center; and community health services including dental health and transportation.The SVH community benefit report is contained in an annual community benefit report prepared by Eastern Maine Healthcare Systems which is the parent organization of all related organizations.SVH Highlights- Celebrated the completion of the inpatient room modernization with a ribbon cutting ceremony and later sealed a time capsule to be opened in 2038.- In June, celebrated the official close of the successful capital campaign, "Its the right Thing to Do, which raised over 1.1 million from local communities to modernize inpatient rooms.- First Hospital in Maine to be recognized four years in a row for quality excellence bya national organization; in December, received Top Rural Hospital in Maine honors by the Leapfrog Group.- Recognized for the second year as a winner in the sixteenth annual Health Care's Most Wired Survey, conducted by Hospitals & Health Networks, which assesses hospital performance in four facets of information: infrastructure, business and administration management, clinical quality, and safety and clinical integration.- Received 2013 Avatar Solutions awards for Exceeding Patient Expectations and Exemplary Service: Most Improved Physician Office.-Launched comprehensive collaboration with Inland Hospital involving shared specialized services, such as neurology, rheumatology, endocrinology, diabetes and nutrition, and wound care.Sebasticook Valley Health, along with community partners, continues to focus on commuity outreach and access to care in our efforts to align services with health priorities identified in the 2014 statewide Community Health Needs Assessment. The project, nicknamed "Little Beacon" after the Bangor Beacon Community project, brings area providers and care managers together to reduce barriers to care in our community. Currently, "Little Beacon" is making progress in work to help reduce the number of unnecessary emergency department visits. The group looks at reports on ED utilitzation by levels, practice, insurer, time of day, and has developed materials for providers, care coordinators, and families that better meet their needs and addresses issues associated with access and appropriate utilization of medical services.
Part I, Line 7 - Explanation of Costing Methodology Ratio of Patient Care Cost-to-Charges is used in calculation
Part I, Line 7, Column F - Explanation of Bad Debt Expense $2,913,829 of bad debt expense, $1,865,324 of charity care, $18,912,577 of contractual allowances is included on Form 990, Part IX, line 24, column (A)
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense The costing methodology used to determine the amount reported on line 2 is cost to charge ratio.
Part III, Line 4 - Bad Debt Expense Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probably uncollectible amounts through a charge to earnings and a valuation allowance based on its assessment of the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to the applicable patients accounts receivable. Credit is extended without collateral.
Part III, Line 8 - Explanation Of Shortfall As Community Benefit Medicare losses should be treated as a community benefit because the losses are incurred in performing an important public service, and Maine hospitals experience one of the lowest Medicare reimbursement rates in the country
Part III, Line 9b - Provisions On Collection Practices For Qualified Patients All account guarantors who express an inability to pay inpatient and outpatient services will be screened for eligibility for charity care using an application and guidelines established by Sebasticook Valley Hospital. An account may be reconsidered for charity care at any time when new information is available about a patient's inability to pay.
Part VI - Needs Assessment Sebasticook Valley Health utilizes the EMHS Community Health Needs assessment data from the Healthy Maine Partnership/Healthy SV Community Data Profile, and produces an annual environmental needs analysis every year. The SVH community Health data,and information gleaned from AVATAR International patients surveys and quality measurement website data.
Part VI - Patient Education of Eligibility for Assistance Sebasticook Valley Health provides information about financial assistance and the contract information for SVH Billing is included in patients bills and is available at the Patient Accounts Office, Central Registration, and in all primary care locations. Our Patient Accounts staff work directly with each patient to educate, determine eligibility and assist in applying for assistance. In addition, information is posted to the public at our website. They are knowledgeable in a wide variety of programs and services that can help patients.
Part VI - Community Information Sebasticook Valley Health serves over 34,000 in more than a dozen towns in Central Maine in the counties of Southern Penobscot, Southern Somerset, Northern Kennebec, and Western Waldo Counties. Central Maine serves a significant number of patients who utilize either Medicare or Medicaid (MaineCare) as their primary source of coverage for healthcare. The area has a diverse business and industrial base, however, no large companies or industry are located in the region.
Part VI - Community Building Activities Sebasticook Valley Health works with other area heatlhcare organizations and providers, businesses, and industries, municipalities, civic organizations, communities of faith, schools, and private individuals and families to bring the highest quality of healthcare to the region. SVH also recognizes its role in helping the Sebasticook Valley be a healthy and economically vibrant place to live and work and collaborates with a number of partners to enhance the region's health in the broadest sense.
Part VI - Explanation Of How Organization Furthers Its Exempt Purpose Sebasticook Valley Health provides a wide range of services to the community including support groups for cancer, diabetes, and hosting for caregivers. SVH partners with school districts to provide tobacco prevention education, implement evidence-based substance abuse prevention curriculum, and deliver nutrition education to students and staff. SVH also works in collaboration with a number of other area organizations, such as law enforcement and worksites, to help deliver programs and services that address the need for improved nutrition and fitness, and elimination and reduction of tobacco and substance abuse. SVH continues to coordinate and deliver a lunch-and-learn education series for our local business leaders. Lunch-and-learn topics in 2014 included workplace tobacco policy, domestic violence, and ergonomics. This year marked the 20th anniversary for the hospitals Breast Cancer Awareness Walk and the hospital held its third annual Community Health Fair in partnership with the local high school. 177 community members attended the community health fair, which provided the general public with information about local health and social services. During the fair, SVH staff provided free preventive health screenings, had billing staff available to answer inquiries specific to healthcare insurance, and administered the influenza vaccine. Both Sebasticook Valley Health and EMHS, the system, is a member of the Wellness Council of America - SVH with Platinum status and EMHS with Platinum status for employee health. To promote and provide community wellness programs, SVH must walk the walk with employees. As SVH brings system-wide or local programs into the communities, it is done with an understanding of the work needed to help create healthy workplaces and healthy communities. See also Schedule 0
Part VI - Affilated Health Care System Roles and Promotion Both Sebasticook Valley Health and EMHS, the system, are member of the Wellness Council of America - SVH with Gold status and EMHS with Platinum status for employee health. To provote and provide community wellness programs, SVH must walk the walk with employees. As SVH brings system-wide or local programs into the communitities, it is done with an understanding of the work needed to help create healthy workplaces and healthy communities. See also Schedule O
Part VI - States Where Community Benefit Report Filed ME
Part V - Explanation of Number of Facility Type N/A
Schedule H (Form 990) 2013
Additional Data


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Software Version: 2013v4.0