Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PARKVIEW ADVENTIST MEDICAL CENTER
Employer identification number
01-0244035
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
PARKVIEW ADVENTIST MEDICAL CENTER
Employer identification number
01-0244035
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART 1, LINE 1
PARKVIEW ADVENTIST MEDICAL CENTER, IN OUR COMMITMENT TO THE COMMUNITY WE SERVE, EXISTS TO REFLECT THE LOVING COMPASSIONATE LIFE AND WORK OF JESUS CHRIST, WHOSE TOTAL MISSION WAS TO OFFER WHOLENESS TO PEOPLE PHYSICALLY, EMOTIONALLY AND SPIRITUALLY. THE ENHANCEMENT OF EACH PERSON'S TOTAL WELL BEING AND THE ADVANCEMENT OF HUMAN DIGNITY AND WORTH TO THE FULLEST POTENTIAL IS THE HIGHEST PRIORITY OF THE HOSPITAL.
WELLNESS SERVICES
FORM 990, PART III, LINE 4C
PAMC'S WELLNESS DEPARTMENT REFLECTS THE SHIFT IN HEALTHCARE FOCUS FROM TREATMENT TO PREVENTION. THE CONCEPT OF WELLNESS IS TO MAKE SICK PEOPLE WELL AND TO KEEP WELL PEOPLE FROM GETTING SICK. RESEARCH IS PROVIDING THAT EXERCISE AND PROPER DIET CAN HELP REVERSE MANY CHRONIC DISEASES AND REDUCE TUE USE OF MEDICATION IN MANY ILLNESSES. HEALTH TALKS HAVE BEEN GIVEN TO SCHOOLS, INDUSTRIES, SOCIAL AND CIVIC GROUPS. HEALTH INFORMATION, COUNSELING, AND AUDIOVISUALS HAVE BEEN PROVIDED TO THE COMMUNITY.
OTHER PROGRAM SERVICES
FORM 990, PART III, LINE 4D
PAMC HAS AN ACTIVE VOLUNTEER PROGRAM. DURING 2010, THERE WERE VOLUNTEERS WHO GAVE MANY HOURS TOWARD THE COMMON PURPOSE OF MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY. THE VALUE OF THIS PROGRAM IS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS FOR PATIENT SERVICES AND HEALTH EDUCATION.
MANAGEMENT DUTIES
FORM 990, PART VI, SECTION A, LINE 3
THE POSITION OF PRESIDENT OF THE ORGANIZATION IS OUTSOURCED TO CENTRAL MAINE HEALTHCARE CORPORATION (CMHC). THE PRESIDENT IS EMPLOYEED BY CMHC, UNDER A CONTRACT APPROVED BY THE ORGAZNAITION'S BOARD OF DIRECTORS. THE BOARD OF DIRECTORS MAINTAINS OVERSIGHT OF THIS POSITION, BUT DAY TO DAY OPERATIONS ARE MANAGED AND SUPERVISED BY THE PRESIDENT.
MEMBERS
FORM 990, PART VI, SECTION A, LINE 6, 7A, & 7B
THERE SHALL BE TWO CLASSES OF MEMBERS, EX OFFICIO AND REGULAR. EX-OFFICIO MEMBERS SHALL CONSIST OF: (A) THE PRESIDENT OF THE NORTHERN NEW ENGLAND CONFERENCE OF SEVENTH-DAY ADVENTISTS, WHO SHALL SERVE AS THE CHAIR OF THE MEMBERSHIP; (B) THE TREASURER OF THE NORTHERN NEW ENGLAND CONFERENCE OF SEVENTH-DAY ADVENTISTS, WHO SHALL SERVE AS THE VICE CHAIR OF THE MEMBERSHIP; (C) THE PRESIDENT OF THE ATLANTIC UNION CONFERENCE OF SEVENTH-DAY ADVENTISTS, OR HIS OH HER DESIGNEE; (D) THE PASTOR OF THE BRUNSWICK, MAINE SEVENTH-DAY CHURCH; AND (E) THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION. EACH EX OFFICIO MEMBER SHALL HOLD OFFICE UNTIL HIS OR HER RESIGNATION. THE EX OFFICIO MEMBERS SHALL DE ENTITLED TO ELECT A TOTAL OF FOUR REGULAR MEMBERS. EACH REGULAR MEMBER SHALL: (A) BE A RESIDENT OF THE STATE OF MAINE, NEW HAMPSHIRE, OR VERMONT; (B) BE MORE THAN EIGHTEEN YEARS OF AGE; (C) HAVE AN INTEREST IN HEALTH CARE MATTERS; (D) UNDERSTAND AND SUPPORT THE OPERATIONAL PHILOSOPHY OF SEVENTH-DAY ADVENTIST HEALTH CARE FACILITIES; (E) SUPPORT THE PHILOSOPHY AND OBJECTIVES OF THE CHURCH AND ITS MEDICAL MINISTRY; AND (F) BE A MEMBER TN GOOD STANDING OF THE CHURCH. EXCEPT AS OTHERWISE PROVIDED IN THIS ARTICLE, NO DIRECTOR, EMPLOYEE, OR MEMBER OF THE CORPORATION'S MEDICAL STAFF SHALL SERVE AS A MEMBER.
FORM 990 REVIEW PROCESS
FORM 990, PART VI, SECTION B, LINE 11B
THE MEDICAL CENTER'S FINANCE DEPARTMENT WORKS WITH A PUBLIC ACCOUNTING FIRM TO POPULATE AND COMPLETE THE FORM 990 AND ALL APPLICABLE SCHEDULES. AFTER THE ACCOUNTING FIRM REVIEWS THE FIRST DRAFT FOR ACCURACY AND COMPLETENESS, THE MEDICAL CENTER'S FINANCE DEPARTMENT REVIEWS FOR ACCURACY AND COMPLETENESS. THE RETURN IS THEN SENT BACK TO THE ACCOUNTING FIRM FOR FINAL COMPLETION AND REVIEW. THE MEDICAL CENTER'S BOARD OF DIRECTORS THEN REVIEWS THE COMPLETED RETURN. APPROVAL IS REQUIRED BY THE BOARD PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE.
CONFLICT OF INTEREST POLICY MONITORING
FORM 990, PART VI, SECTION B, LINE 12C
EACH YEAR THE BOARD CHAIR ASKS THE PRESIDENT TO SEND OUT AN ANNUAL DISCLOSURE AND ACKNOWLEDGEMENT FORM TO EACH BOARD MEMBER. THIS FORM REQUIRES INFORMATION FROM THE BOARD MEMBER RELATED TO ANY POSSIBLE CONFLICTS OF INTEREST IN ACCORDANCE WITH THE BY-LAWS OF THE CORPORATION. THE FORMS ARE REVIEWED BY THE EXECUTIVE COMMITTEE TO ENSURE COMPLIANCE, AND IF THERE ARE QUESTIONS OR CONFLICTS OF INTEREST THAT ARISE, A MEMBER OF THE EXECUTIVE COMMITTEE WILL INTERACT WITH THE BOARD MEMBER IN QUESTION, AND REPORT ANY FINDINGS TO THE BOARD FOR RESOLUTION. ANY DISCLOSURE OF POSSIBLE OR ACTUAL CONFLICTS OF INTEREST, BEFORE OR AFTER A TRANSACTION HAS OCCURRED, IS CONVEYED IN A REPORT TO THE FULL BOARD, BY THE EXECUTIVE COMMITTEE. AFTER REVIEW OF THE POSSIBLE CONFLICT, THE BOARD WOULD TAKE ACTIONS IT DEEMED APPROPRIATE IN ADDRESSING THE POSSIBLE OR ACTUAL CONFLICTS, WHICH COULD INCLUDE RESTRICTIONS, OR DISMISSAL FROM THEIR POSITION.
COMPENSATION REVIEW
FORM 990, PART VI, SECTION B, LINE 15B
THE BOARD OF DIRECTORS HAS A CEO COMPENSATION COMMITTEE THAT REVIEWS THE COMPENSATION OF ALL PARKVIEW EXECUTIVES AT THE VP LEVEL AND ABOVE. RECENT MARKET SALARY AND COMPENSATION INFORMATION FOR THE RESPECTIVE VP POSITION, WHICH COMES FROM THE STATE OF MAINE AND NEW ENGLAND STATES, IS PRESENTED BY THE PRESIDENT. THE COMMITTEE REVIEWS THE RECOMMENDATIONS OF THE PRESIDENT FOR EACH VP POSITION AND DETERMINES WHETHER THE RECOMMENDATION IS APPROPRIATE OR NOT APPROPRIATE. IF DEEMED NOT APPROPRIATE, THE PRESIDENT WILL AMEND THE RECOMMENDATION TO MEET WITH THE COMMITTEE'S APPROVAL.
DOCUMENT DISCLOSURE
FORM 990, PART VI, SECTION C, LINE 19
THE APPROVED AND FILED IRS FORM 990 IS AVAILABLE TO THE PUBLIC AS REQUESTED. THE MEDICAL CENTER'S ARTICLES 0F INCORPORATION ARE FILED WITH THE STATE GOVERNMENT, ITS CONFLICT OF INTEREST POLICY IS MADE AVAILABLE IN THE ADMINISTRATIVE OFFICES ON REQUEST, AND ITS AUDITED FINANCIAL STATEMENTS ARE SUBMITTED TO THE MAINE HEALTH DATA ORGANIZATION, WHICH WILL MAKE PUBLIC THE INFORMATION IF REQUESTED BY INTERESTED PARTIES.
OTHER CHANGES IN NET ASSETS
FOMR 990, PART XI, LINE 5
DURING 2010, THE ORGANIZATION RETROACTIVELY CHANGED ITS ACCOUNTING METHOD TO ESTIMATE THE AMOUNT OF NET REALIZABLE VALUE OF PATIENT ACCOUNTS AND AMOUNTS DUE TO AND DUE FROM THIRD PARTY PAYERS BASED ON ACTUAL ACTIVITY AND CONSIDERING ADDITIONAL RELEVENT FACTORS. THE ORGANIZATION ALSO RETROACTIVELY CHANGED ITS ACCOUTNING METHOD TO EVAULATE LEASES TO DETERMINE THE APPROPRIATE ACCOUTNING TREATMENT AND TO ACCRUE LIABILITIES IN THE PERIOD INCURRRED. $(1,204,732) CHANGE IN ESTIMATE FOR ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS 5,758,255 CHANGE IN ESTIMATE DUE FROM THIRD PARTY PAYERS (140,819) UNRECORDED CAPITAL LEASES 396,284 OVERALL ACCRUAL OF MISCELLANEOUS EXPENSES ------------ $ 4,808,988 RESTATEMENT OF PRIOR FINANCIAL STATEMENTS
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.