SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
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
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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
Yes
 
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) . . . 		  714 1,099,058   1,099,058 2.790 %
b Medicaid (from Worksheet 3, column a) . . . . .            
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     47,207   47,207 0.120 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .   714 1,146,265   1,146,265 2.910 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 18 1,695 332,493 4,027 328,466 0.830 %
f Health professions education (from Worksheet 5) . . . 4 102 27,151 309 26,842 0.070 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     328   328  
j Total. Other Benefits . . 22 1,797 359,972 4,336 355,636 0.900 %
k Total. Add lines 7d and 7j . 22 2,511 1,506,237 4,336 1,501,901 3.810 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
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            
8 Workforce development 1 212 15,746   15,746 0.040 %
9 Other            
10 Total 1 212 15,746   15,746 0.040 %
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
1,569,585
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
13,627,733
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
14,802,114
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-1,174,381
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) 2017
Schedule H (Form 990) 2017
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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		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) 2017
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Schedule H (Form 990) 2017
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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)
Sebasticook Valley Health
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 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 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): See Part V, Line 16j for URL
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, 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) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Sebasticook Valley Health
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
See Part V, Line 16j for URL
b
See Part V, Line 16j for URL
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
Sebasticook Valley Health
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 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
f
19 Did the hospital facility or other authorized 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Sebasticook Valley Health
Name of hospital facility or letter of facility reporting group  
Yes No
22 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
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Part V, Line 5 - Account Input from Persons Who Represent the Community The Maine Shared CHNA research team conducted a statewide survey among stakeholders to identify and prioritize significant health issues in communities across the state. The survey, coordinated with the Maine CDC, engaged public health expertise throughout the process. The survey was administered using a snowball approach where stakeholder agencies agreed to send the surveys to their members and stakeholders for participation. 1,639 people, representing more than 80 organizations and businesses in Maine, completed the survey. Respondents represented health care agencies, public health agencies, law enforcement, municipalities, schools, local businesses, social service agencies, and nongovernmental organizations. In addition to the stakeholder survey, each county conducted a number of community engagement opportunities (forums) to ensure broad interests of the local community were represented; Obtain stakeholder input on identifying significant health needs based on review of shared CHNA data; Solicit stakeholder feedback on prioritizing significant health needs, and; Identify local assets and resources that potentially may address local health priorities. The local forums were conducted in collaboration with the Maine CDC to solicit input from individuals representing populations with health disparities. The following organizations were in attendance at the December 10, 2015 DCC SHNAPP Waterville Shared CHNA Community Enagagement Forum and provided valuable feedback on the Shared CHNA.Details about organizations: Sample of organizations KVCAP, Waterville Main Street, Kennebec Messalonskee Trails, Maine Childrens Home, NAMI Maine, American Lung Assn., Healthy Northern Kennebec, Somerset Public Health, Healthy Sebasticook Valley, MaineGeneral (MG), Inland Hospital, Redington Fairview General Hospital, EMHS, HealthReach Community Health Centers, Kennebec Behavioral Health, MG Community Care, Assistance Plus, MSAD 59, Waterville/Vassalboro before/After School Programs, MG Board of Directors, Maine CDC. Hospitals (MaineGeneral, Inland, EMHS, Redington Fairview), health care providers (HealthReach Community Health Centers), and behavioral health care providers (Kennebec Behavioral Health, MG Community Care) serve low income patients through Medicare/MaineCare and provide low-cost/no- cost services to medically underserved residents. Many public health programs and services (Healthy Northern Kennebec, Somerset Public Health, Healthy Sebasticook Valley), non-profit agencies (KVCAP, Maine Childrens Home, NAMI Maine), and local/state government agencies (Maine CDC) specifically serve low-income and medically underserved residents.The following organizations were in attendance at the January 20, 2016 Sebasticook Valley Hospital Shared CHNA Community Engagement Forum and provided valuable feedback on the Shared CHNA.Details about organizations: Sample of organizations United Way, ME Health Access Foundation, Southern ME Area Agency on Aging, Preble St. Resource Center, legislator, Somali commnity members, USM/UNE/SMCC/Tufts medical School, ME Health Mgt Coalition, MaineMedical Center (hospital facility), Spring Harbor Hospital, Mercy Hospital, Bridgton Hospital, HMP, & Portland Public Health.Hospitals and health care providers serve low income patients through Medicare/MaineCare and provide low-cost/no-cost services to medically underserved residents. Many public health programs and services, social service agencies, funding agencies, and non-profit agencies specifically serve racial/ethnic minorities, low-income, and medically underserved residents. Somali community members attended the forum.
Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment The Shared CHNA was conducted through the Maine Shared Health Needs Assessment Planning Process (SHNAPP) a collaborative effort among Maines four largest health-care systems Central Maine Healthcare, Eastern Maine Healthcare Systems (EMHS), MaineGeneral Health, MaineHealth and the Maine Center for Disease Control and Prevention, an office of the Maine Department of Health and Human Services (DHHS). EMHS member organizations participating in the Shared CHNA included Acadia Hospital, Blue Hill Memorial Hospital, Charles A. Dean Memorial Hospital, Eastern Maine Medical Center, Inland Hospital, Maine Coast Memorial Hospital, Mercy Hospital, Sebasticook Valley Health, and TAMC.
Part V, Line 11 - 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 13h - Other Factors Used in Determing Amounts Charged Patients Income Levels
Part V, Line 16j - Other Means Hospital Facility Publicized the Policy Response for 7a (list URL) is https://northernlighthealth.org/Sebasticook-Valley-HospitalResponse for 7b (list URL) is https://northernlighthealth.org/Community-Health-Needs-Assessment-2016-CHNA-ReportsResponse for 10a (list URL) is https://northernlighthealth.org/Community-Health-Needs-Assessment-2016-CHNA-Reports/Community-Health-StrategyResponse for 16a, 16b, 16c (list url) is https://northernlighthealth.org/Sebasticook-Valley-Hospital under "Bill Pay & Financial Assistance".
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
Page 9
Schedule H (Form 990) 2017
Page 9
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?  
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
130 Leighton Street
Pittsfield,ME04967 		Outpatient Medical Facility
3 SVH Rehabitation Services
118 Moosehead Trail Suite 3
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
9
10
Schedule H (Form 990) 2017
Page 10
Schedule H (Form 990) 2017
Page 10
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 6a - Related Organization Community Benefit Report The Sebasticook Valley Health 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.
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 $2,972,939 of bad debt expense, $2,073,551 of charity care, $20,879,848 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 and trade accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable 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 the applicable patient 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, Line 3 - Patient Education of Eligibility for Assistance Sebasticook Valley Health provides information about financial assistance to every patient who presents for services. Registration staff in all areas notify patients at the time of their visit that financial assistance is available. Contract information for SVH Billing is included in patients bills and is also available in the Patient Accounts Office, Central Registration, and in all primary care locations. Our Patient Accounts staff are knowledgeable in a wide variety of programs and services that can assist patients. Our staff works directly with each patient to educate, determine eligibility and assist in applying for financial assistance as well as other services the patient may be eligible for. In addition, information is posted to the public at our website and on posters throughout our local community.
Part VI, Line 4 - Community Information Sebasticook Valley Health (SVH) is a 25-bed, Joint Commission accredited critical access hospital located in Pittsfield, Maine. SVH offers a wide range of inpatient and outpatient services on the hospital campus as well as primary care offices in Clinton, Newport and Pittsfield (RHC) and access to specialists and surgeons at our Pittsfield and Detroit locations. SVH serves a population of approximately 38,000 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.Since 1999, SVH has served as the fiscal agent for the HealthySV Coalition, serving the Sebasticook Valley area. SVH is an active member of the coalition and twelve sectors are represented on the coalition Steering Committee. The Steering Committee is responsible for several SVH implementation strategies and plays a key role in leading the community health improvement process for SVH.
Part VI, Line 4 - Community Building Activities SVH is actively engaged with offering students opportunities to learn about healthcare careers via hospital tours and job shadows. In 2018, sixty 7th grade students from Warsaw Middle School in Pittsfield participated in a Healthcare Career Day during which they had a tour of SVH, participated in 4 mini education sessions and participated in a healthcare career mapping activity. Seven 8th graders who had toured SVH in 2017 completed a job shadow at SVH in a discipline in which they had interest. Fifty-eight students/adults participated in a 2-4 hour job shadow over the course of the year in an area of interest. Coalition Building - Since 1999, SVH has served as the fiscal agent for HealthySV Coalition and serves the Sebasticook Valley region. SVH is the active member of the coalition, and assists with membership recruitment. We have 12 sectors represented on the Coalition Steering Committee. The Steering Committee meets bi-monthly and plays a key role in leading the community health improvement plan process for SVH.
Part VI, Line 5 - Promotion of Community Health SVH provides education and support groups. SVH hosts two American Red Cross blood drives annually which are open to employees and the public. SVH employees are eligible to donate during work time. The blood drives consistently meet or near goal of 22 units per drive. SVH full and part time employees and spouses/domestic partners are eligible to enroll in Virgin Pulse; an on-line wellness reward system program. Employees and spouses/domestic partners can earn up to $400.00 each per year by engaging in healthy behaviors, wellness offerings and health information focused on improving overall physical and mental health. SVH offered the second annual Back to School Fair in August of 2018, for children in grades Pre K-12. The purpose of the event was to provide resources to children and their parents to get them ready to go back to school. 77 children along with one or more parent/guardian participated in the fair. SVH and EMHS staff and local non-for-profit agencies provided information in the areas of safety, wellness, and physical activity along with games and activities. Children who completed the scavenger hunt were eligible for the drawing of a free backpack filled with school supplies. 145 backpacks with supplies were donated by SVH staff, local businesses, and community members. 76 backpacks were given away to children who completed the scavenger hunt and the remaining backpacks were given to the local school districts to distribute to students who did not have school supplies to start the year. Pre-sports physicals at a discounted fee were available for middle and high school students.
Part VI, Line 7 - States Filing of Community Benefit Report N/A
Part VI - Additional Information Disclosure in accordance with Revenue Procedure 2015-21:Part V Facility Information, Section B Facility Policies and PracticesIn accordance with Revenue Procedure 2015-21, Northern Light Sebasticook Valley Hospital (Sebasticook Valley Hospital) is disclosing the following information with respect to Section 501(r) issues that were discovered during the 2018 tax year and how these have been corrected to satisfy 501(r) requirements.For all items:A good-faith effort was made to implement the requirements of the Section 501(r) regulations. Sebasticook Valley Hospital obtained information about the requirements and sought to implement them accordingly, but later identified a compliance gap.The issue was discovered in fiscal year 2018 during an internal audit of Sebasticook Valley Hospitals compliance with Sections 501(r). To ensure full compliance with Section 501(r) regulations, Northern Light Healths Community Health and Revenue Cycle Departments perform routine reviews to assure Sebasticook Valley Hospital is in compliance with Section 501(r). In addition, Northern Light Health continues to engage Northern Light Health Internal Audit to review Sebasticook Valley Hospitals compliance with Section 501(r).Specific issue and correction:1. Widely Publicizeda. Requirement: In order to ensure the FAP is widely publicized, a hospital must take several actions, one of which is to make the FAP, FAP application form and a plain language summary of the FAP widely available on a Web site.b. Condition: On October 22, 2018, it was discovered that the link from Sebasticook Valley Hospitals Billing Help Web page did not map correctly to the Northern Light Health Financial Assistance page.c. Corrective Action: Northern Light Health Information Technology was contacted to resolve the mapping issue. Northern Light Health has since established a monthly review of all FAP-related mapping to verify functionality.d. Date Corrected: October 30, 2018.
Schedule H (Form 990) 2017
Additional Data


Software ID: 17005038
Software Version: 2017v2.2