TY 2013 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) DEBRA ACHRAMOWICZ........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(2) KRISHNA BHATTA MD........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(3) DAVID RICHARDSON........................................................................ VICE CHAIR	1.00 .......................0.00	X	X	0	0
(4) STACEY FITTS........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(5) STEPHEN GEORGE........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(6) MICHAEL GALLAGHER........................................................................ Chairman	1.00 .......................0.00	X	X	0	0
(7) BETTY LOU MITCHELL........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(8) MOHAMMAD NIAYESH........................................................................ CHIEF MED STAFF	40.00 .......................0.00	X	X	303,095	16,511
(9) LINDA WOOLEY........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(10) ANDREW GIBSON........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(11) MICHAEL HODGINS........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(12) TERESA P VIEIRA........................................................................ President & CEO	40.00 .......................0.00	X	X	214,169	25,742
(13) SHARON FOSTER........................................................................ BOARD MEMBER	.50 .......................0.00	X		0	0
(14) GAIL LAMB........................................................................ VC MEDICAL STAF	39.00 .......................0.00		X	325,997	10,793
(15) ROBERT SCHLAGER........................................................................ CMO	40.00 .......................0.00		X	208,313	22,894
(16) RANDALL CLARK........................................................................ CFO	40.00 .......................0.00		X	166,265	33,259
(17) MICHAEL D PETERSON........................................................................ COO	40.00 .......................0.00		X	155,446	21,115

(A) Name and business address	(B) Description of services	(C) Compensation
CIANBRO BRASFIELD AND GORRIECIANBRO SQUAREPITTSFIELDME04967	SERVICE CONTRACT	1,691,650
EASTERN MAINE HEALTHCARE43 WHITTEN ROADBREWERME04412	SERVICE CONTRACT	1,737,113
NEHE MRI LLCP O BOX 6600NEWPORT BEACHCA92658	SERVICE CONTRACT	564,021
EASTERN MAINE MEDICAL CENTER769 ESSEX STREETBANGORME04401	SERVICE CONTRACT	480,827
NURSE ANESTHESIA OF MAINE141 N MAIN STREET STE 205BREWERME04412	SERVICE CONTRACT	371,116
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 9

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,637,234	1,423,905	213,329
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	14,953,400	11,962,720	2,990,680
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	332,047	249,785	82,262
9	Other employee benefits .......	2,532,396	2,487,693	44,703
10	Payroll taxes ...........	1,078,933	909,168	169,765
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	6,550		6,550
c	Accounting ...........	174,130		174,130
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	201		201
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	0
12	Advertising and promotion ....	137,382	1,924	135,458
13	Office expenses .......	534,320	476,735	57,585
14	Information technology ......	497,341	497,341
15	Royalties ..	0
16	Occupancy ...........	962,676	778,259	184,417
17	Travel ............	81,233	39,288	41,945
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	128,096	83,564	44,532
20	Interest ...........	311,353	311,353
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	1,818,727	1,444,319	374,408
23	Insurance ..............	197,123	197,123
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Contractual adjustments	18,912,577	18,912,577
b	Purchase Services	3,612,330	2,724,262	888,068
c	Bad Debt Expense	2,913,829	2,913,829
d	Medical Supplies	2,547,631	2,547,631
e	All other expenses	4,311,930	4,021,382	173,649	116,899
25	Total functional expenses. Add lines 1 through 24e	57,681,439	51,982,858	5,581,682	116,899
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	653	1	-2,344
2	Savings and temporary cash investments .........	4,476,729	2	6,334,587
3	Pledges and grants receivable, net ...........	651,978	3	528,944
4	Accounts receivable, net .............	2,595,300	4	3,205,069
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6	0
7	Notes and loans receivable, net .............		7	0
8	Inventories for sale or use ..............	221,869	8	260,168
9	Prepaid expenses and deferred charges ..........	348,185	9	355,570
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	42,202,635
b	Less: accumulated depreciation .....	10b	20,095,277	21,921,367	10c	22,107,358
11	Investments—publicly traded securities ..........		11	0
12	Investments—other securities. See Part IV, line 11 .....		12	0
13	Investments—program-related. See Part IV, line 11 .....		13	0
14	Intangible assets ...............		14	0
15	Other assets. See Part IV, line 11 ...........	13,871,449	15	11,555,784
16	Total assets. Add lines 1 through 15 (must equal line 34)......	44,087,530	16	44,345,136
	17	Accounts payable and accrued expenses .........	3,657,537	17	3,708,683
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	10,340,510	20	9,752,283
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	8,363,974	25	6,448,401
26	Total liabilities. Add lines 17 through 25.........	22,362,021	26	19,909,367
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	20,504,464	27	23,373,473
28	Temporarily restricted net assets ...........	851,187	28	688,598
29	Permanently restricted net assets ...........	369,858	29	373,698
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	21,725,509	33	24,435,769
34	Total liabilities and net assets/fund balances ........	44,087,530	34	44,345,136

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SCHEDULE A
(Form 990 or 990EZ)

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. right arrow

See separate instructions.
right arrow

Information about Schedule A (Form 990 or 990-EZ) 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

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

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).

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 ..................................................

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

and (iii) below, the governing body of 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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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 monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2013

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

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................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. 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 ....................... right arrow

33 1/3% support test—2012. If the organization did not check a 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2013. 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 ..................................................... right arrow

10%-facts-and-circumstances test—2012. 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 ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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.)..

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............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. 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 ........ right arrow

33 1/3% support tests—2012. 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 ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 4

Part IV

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

EASTERN MAINE HEALTHCARE SYSTEMS-SVH
SEBASTICOOK VALLEY HEALTH

Employer identification number

01-0263628

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization EASTERN MAINE HEALTHCARE SYSTEMS-SVH SEBASTICOOK VALLEY HEALTH

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization EASTERN MAINE HEALTHCARE SYSTEMS-SVH SEBASTICOOK VALLEY HEALTH

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
EASTERN MAINE HEALTHCARE SYSTEMS-SVH
SEBASTICOOK VALLEY HEALTH

Employer identification number

01-0263628

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions. SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

EASTERN MAINE HEALTHCARE SYSTEMS-SVH
SEBASTICOOK VALLEY HEALTH

Employer identification number

01-0263628

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2013

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2013

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

6,255

Total. Add lines 1c through 1i ...............................

6,255

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1i - Other Activities Description	NON DEDUCTIBLE DUES

Schedule C (Form 990 or 990EZ) 2013

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions. SchDMd Bullet

Information about Schedule D (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

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2013

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	108,495	105,995	103,495	103,495	103,495
b	Contributions ........
c	Net investment earnings, gains, and losses		2,500	2,500	-1,616	13,493
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........				-1,616	13,493
f	Administrative expenses ....
g	End of year balance ......	108,495	108,495	105,995	103,495	103,495

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	433,067		433,067
b	Buildings ................	23,345,663	5,981,741	17,363,922
c	Leasehold improvements ............	113,585	52,244	61,341
d	Equipment ................	17,499,060	13,405,726	4,093,334
e	Other .................	811,260	655,566	155,694
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				22,107,358

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Assets Whose Use is Limited				990,534
(2) Beneficial Interest in Perpetual Trusts				265,203
(3) Board Designated Investments				7,150,986
(4) Bond Issuance Costs				91,916
(5) Endowment fund Investment				309,738
(6) Est Prof liab claims rec				1,643,051
(7) Other Assets				8,344
(8) Third Party Settlements				1,096,012

Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				11,555,784

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
Accrued for Self-Ins Post Employee Benef		10,950
Estimated Third Party Settlements		4,794,400
Reserve for Prof. Liab. Self Ins.		1,643,051






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		6,448,401
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................

Schedule D (Form 990) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	37,107,641
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	159,657
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-23,706,917
e	Add lines 2a through 2d .....................			2e	-23,547,260
3	Subtract line 2e from line 1.....................			3	60,654,901
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	217,384
c	Add lines 4a and 4b.......................			4c	217,384
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	60,872,285

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	33,974,522
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................			2e
3	Subtract line 2e from line 1.....................			3	33,974,522
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	23,706,917
c	Add lines 4a and 4b.......................			4c	23,706,917
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	57,681,439

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Part V, Line 4: Intended uses of the endowment fund.	Endowment funds are designated for purposes that align within this organizations exempt purpose
Part X : FIN48 Footnote	The Hospital has been determined by the Internal Revenue Service to be a tax-exempt charitable organization as described in Section 501(c)(3) of the Internal Revenue Code, whereby, only unrelated business income, as defined by Seciton 512(a)(1) of the Code, is subject to federal income tax. Accordingly, no provision for federal income taxes has been recorded in the financial statements
Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S	Restricted Contributions from Fund Balan $258825 Restricted Expense from Fund Balance $-41441
Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S	Contractual expense reclass from revenue $18912577 Charity care reclass from revenue $1865323 Fundraising expense reclass from revenue $15188 Bad Debt reclass from revenue $2913829

Schedule D (Form 990) 2013

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: .........

200% 250% 300% 350% 400% Other %

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.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

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? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

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		17	1,199	520,859	3,376	517,483	1.520 %
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)	(c) Total community building expense	(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

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,585,123

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

12,617,064

Enter Medicare allowable costs of care relating to payments on line 5.....

13,007,919

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-390,855

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

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

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						Other (Describe)
1	Sebasticook Valley Health 447 North Main Street Pittsfield,ME04967 sebasticookvalleyhealth.org 38277	X	X	X	X	Licensed Hospital

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

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

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....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 14

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 ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): http://www.emhs.org/community-benefit/CH

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

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):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

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 ........

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)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

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

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	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
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	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

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? ............................

If "Yes," explain in Part VI.

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? .........................

If "Yes," explain in Part VI.

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

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

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 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

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (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

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Yes

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2013

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)BRIAN GRETTAPHYSICIAN	(i) (ii)	239,523	5,000		3,750	21,991	270,264
(2)GAIL LAMBVC MEDICAL STAF	(i) (ii)	306,497	7,000	12,500	8,323	2,470	336,790
(3)JO-NELL MARTINPHYSICIAN	(i) (ii)	293,635	1,700	12,500	8,500	22,800	339,135
(4)LIISA HAAPENEN-JANELCHIEF HR OFFICER	(i) (ii)	14,231		21,602	1,089	1,220	38,142
(5)MAXIME COLESSURGEON	(i) (ii)	393,653	1,800		8,925	14,295	418,673
(6)MICHAEL D PETERSONCOO	(i) (ii)	151,446	4,000		5,454	15,661	176,561
(7)MICHAEL LEMIEUXCARDIOLOGIST	(i) (ii)	395,453			8,925	18,380	422,758
(8)MOHAMMAD NIAYESHCHIEF MED STAFF	(i) (ii)	301,295	1,800		8,925	7,586	319,606
(9)RANDALL CLARKCFO	(i) (ii)	142,519	4,000	19,746	3,293	29,966	199,524
(10)ROBERT SCHLAGERCMO	(i) (ii)	198,313	10,000		7,371	15,523	231,207
(11)TERESA P VIEIRAPresident & CEO	(i) (ii)	194,034	6,000	14,135	7,719	18,023	239,911
(12)TODD TRITCHPHYSICIAN	(i) (ii)	292,968	5,000			24,312	322,280
(13)VICTORIA ALEXANDER-LCEO	(i) (ii)	109,527	25,325	178,881	3,906	6,767	324,406

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference

Explanation

Part III, Additional Information

Part I,6a: Victoria Alexander-Lane, Performance Bonus $25,324 Victoria Alexander-Lane, Severance Pay $167,034.60 Teresa Vieira, President CEO,Performance Bonus $6,000 Randall L. Clark, CFO,Performance Bonus $4,000 Michael D. Peterson, COO, Performance Bonus $4000 Robert Schlager, CMO, Performance Bonus $10,000 Mohammad Niayesh, Surgeon, Incentive Bonus $1,800 Gail Lamb, Physician, Incentive Bonus $7,000 Jo-Nell Martin, Physician, Incentive Bonus $1,700 Maxime Coles, Orthopedic Surgeon, Incentive Bonus $1,800 Brian Gretta, Physician, Incentive Bonus $5000 Todd Tritch, Physician, Incentive Bonus $5000

Schedule J (Form 990) 2013

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.
SchKMediumBullet

Information about Schedule K (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

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Maine Health & Higher Education Facilities Authority	01-0314384	560425UB4	12-09-2004	807,075	Construction		X		X	X
B	Finance Authority of ME	01-0392006		01-17-2013	6,000,000	Construction		X		X		X
C	Finance Authority of ME	01-0392006		01-17-2013	2,025,000	Construction		X		X		X
D	Finance Authority of ME	01-0392006		01-17-2013	2,475,000	Construction		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	710,000		140,694		117,533		527,497
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	807,075		6,000,000		2,025,000		2,475,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .	57,035
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	14,529
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	735,511		6,000,000		2,025,000		2,475,000
11 Other spent proceeds . . . . . . . . . . . . . .
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .	2005		2013		2013		1991
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X		X		X	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2013

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .
6 Total of lines 4 and 5 . . . . . . . . . . . . .
7 Does the bond issue meet the private security or payment test? . . . . .
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .	X		X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .	X			X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .
b Exception to rebate? . . . . . . . .
c No rebate due? . . . . . . . .
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider . . . . . . . . .
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was the hedge terminated? . . . . . .

Schedule K (Form 990) 2013

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .	X			X		X		X
b Name of provider . . . . . . . . .	FSA Cap mGMT both funds
c Term of GIC . . . . . . . . . .	27.0000
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .	X
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation

Schedule K (Form 990) 2013

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

- 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.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) 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

Return Reference	Explanation
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Sebasticook Valley Health (the "Corporation") is a Maine nonprofit corporation. Eastern Maine Healthcare Systems (the "Member"), also a Maine nonprofit corporation, is the sole corporate member of the Corporation.
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	The Member has authority to elect directors of the Corporation.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	The Member has authority to approve amendments to the Corporation's articles of incorporation and to its bylaws.
Form 990, Part VI, Line 11b: Form 990 Review Process	Form 990 is reviewed by the CFO of Sebasticook Valley Health. Form 990 was provided to each board member electronically on May 12,2015 prior to filing with the IRS.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	The organization requests updates of potential conflicts and relationships from the officers and Board members on an annual basis. The request requires disclosure of all business relationships, board memberships, and family relationships. A database is maintained that is compared to payroll records and the accounts payable vendor list to identify any potential conflicts of interest. Transactions are reviewed for reasonableness as an arm's length transaction. The first agenda item for board meetings and board committee meetings is for members to declare any conflict of interest with upcoming agenda items or deliberations. At any point when consideration is being given to purchase/contract with a party in interest, the member with the conflict is either excused from the discussion and consideration process or abstains from voting on the matter. All transactions identified with parties in interest are disclosed within the Form 990. All are deemed to be arm's length transactions.
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management	The Sebasticook Valley Health Executive Committee is comprised of independent Board members. The Executive Committee works with the President and CEO to establish the performance evaluation for the ensuing year. The Committee develops the compensation program for the President and CEO, to coincide with the current job description. The Committee sets the annual compensation of the President and CEO.The Committee:Assures that the value of compensation provided by SVH does not exceed the value of services provided by the President & CEO.Reviews periodic compensation survey information and provides input into the executive compensation program.Reviews incentive compensation criteria and associated pay schedules for officers and key employees.15b.Compensation of other officers and key employees of the organization are established by the President and CEO and the Human Resources department; utilizing external market research to establish compensation ranges for specific positions.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees	Compensation of other officers and key employees of the organization are established by the President and CEO and the Human Resources department; utilizing external market research to establish compensation ranges for specific positions.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Sebasticook Valley Health makes its governing documents, conflict of interest policy and financial statements available to the public upon request.
Other Changes In Net Assets Or Fund Balances - Other Increases	Change in beneficial Interest Trust = $3841
Other Changes In Net Assets Or Fund Balances - Other Decreases	Transfer to exempt parent - Eastern Maine Healthcare Systems = -$644225

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (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

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Eastern Maine Healthcare Systems EMHS 43 Whiting Hill Road Brewer,ME04412 01-0527066	Supporting organization for healthcare affiliates	ME	501 (c)(3)	11 TYPE 111 Func Int	N/A	Yes
(2) Eastern Maine Medical Center EMMC PO BOX 404 489 State Street Bangor,ME044020404 01-0211501	Provide Healthcare Services	ME	501(c) (3)	3	EMHS	Yes
(3) Eastern Maine Healthcare Real Estate 43 Whiting Hill Road Brewer,ME04412 01-0391036	leases real estate	ME	501(c)(2)		EMHS	Yes
(4) Rosscare 43 Whiting Hill Road Brewer,ME04412 01-0391038	provide services to elderly	ME	501(c)(3)	PF	EMHS	Yes
(5) Rosscare Nursing Homes Inc 43 Whiting Hill Road Brewer,ME04412 01-0430751	Operation of Nursing Homes	ME	501(c)(3)	9	Rosscare	Yes
(6) Eastern Maine Medical Center Auxiliary 43 Whiting Hill Road Brewer,ME04412 01-0377901	Fund raising for exempt Eastern Maine Medical Center	ME	501(c)(3)	9	EMMC	Yes
(7) Acadia Healthcare Inc 43 Whiting Hill Road Brewer,ME04412 22-3183888	Provide Healthcare Services	ME	503(c)(3)	9	AHC	Yes
(8) EMHS Foundation 43 Whiting Hill Road Brewer,ME04412 22-2514163	Raise and manage funds for exempt organizations	ME	501(c)(3)	11 Type II	EMHS	Yes
(9) Norumbega Medical Specialists LTD 43 Whiting Hill Road Ste 400 Brewer,ME04412 01-0465231	Provide Patient care and education	ME	501(c)(3)	9	EMMC	Yes
(10) Inland Hospital 200 Kennedy Memorial Drive Waterville,ME04901 01-0217211	Provide Healthcare Services	ME	501(c)(3)	3	EMHS	Yes
(11) Lakewood A Continuing Care Center 220 Kennedy Memorial Drive Waterville,ME04901 01-0421234	Provide Skilled and long-term nursing care	ME	501(c)(3)	3	Inland Hospital	Yes
(12) CADean Memorial Hospital Pritham Avenue PO Box 1129 Greenville,ME044411129 04-3341666	Provide Healthcare Services	ME	501(c)(3)	3	EMHS	Yes
(13) The Aroostook Medical Center TAMC PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0372148	Provide healthcare services	ME	501(c)(3)	3	EMHS	Yes
(14) TAMC Endowments PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0389222	Raise funds for exempt organizations	ME	501(c)(3)	11 Type I	TAMC	Yes
(15) Horizons Health Services PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0504393	Provide Patient Care	ME	501(c)(3)	3	TAMC	Yes
(16) Eastern Maine HomeCare PO BOX 688 Caribou,ME04736 01-0328442	Provide Home health & hospice services	ME	501(c)(3)	9	EMHS	Yes
(17) TAMC Title Corp PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0389226	Real Estate Holding Company	ME	501(c)(2)		TAMC	Yes
(18) ME Institute for Human Genetics & Health 43 Whiting Hill Road Brewer,ME04412 55-0894346	Biomedical research & development	ME	501(c)(3)	9	EMHS	Yes
(19) Blue Hill Memorial Hospital BHMH 57 Water Street Blue Hill,ME046145231 01-0227195	Provide Healthcare Services	ME	501(c)(3)	3	EMHS	Yes
(20) Meadow Wood LLC 43 Whiting Hill Road Brewer,ME04412 27-2935243	Provide Patient Care	ME	501 (c)(3)	9	AHI	Yes
(21) Sebasticook Valley Family Practice Assoc 447 North Main Street Pittsfield,ME04967 01-0357854	Provide Patient Care	ME	501 (c)(3)	9	SVH	Yes
(22) Sebasticook Valley Work Health LLC 447 North Main Street Pittsfield,ME04967 45-3359446	Provide Patient Care	ME	501(c)(3)	3	SVH	Yes
(23) Restoration Health LLC 43 Whiting Hill Road Brewer,ME04412 35-2449986	Provide Mental Health & Behavioral hlth	ME	503(c)(3)	9	AHI	Yes
(24) Mercy Hospital 144 State Street Portland,ME04101 01-0211534	Provide Healthcare Services	ME	501(c)(3)	3	EMHS	Yes
(25) Mercy Health System of Maine 144 State Street Portland,ME04101 01-0484074	Supporting org for healthcare affiliates	ME	501(c)(3)	11 TYPE III, func in	EMHS	Yes
(26) VNA Home Health & Hospice 50 Foden Road South Portland,ME04106 01-0246804	Provide Home Health & Hospice Service	ME	501(c)(3)	9	EMHS	Yes
(27) Acadia Hospital Corp AHC 43 Whiting Hill Road Brewer,ME04412 01-0459837	Provide Healthcare Services	ME	501(c)(3)	3	EMHS	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Beacon Health LLC 43 Whitting Hill Road Brewer,ME04412 45-2967056	Accountable care organization	ME	EMHS				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) Affiliated Healthcare Systems AHS PO BOX 940 Bangor,ME044020940 01-0385322	Holding Co.	ME	EMHS	C			Yes
(2) Affiliated Healthcare Management POBOX 811 Bangor,ME044020811 01-0349339	Healthcare Management	ME	AHS	C			Yes
(3) Affiliated Laboratory Inc PO BOX 638 Bangor,ME044020638 01-0381283	Clinical Lab	ME	AHS	C			Yes
(4) Affiliated Materiel Services PO BOX 1300 Bangor,ME044021300 01-0381189	purchasing	ME	AHS	C			Yes
(5) Affiliated Pharmacy Services 917 Union Street Suite 7 Bangor,ME04401 01-0587230	Pharmacy	ME	AHS	C			Yes
(6) Meridian Mobile Health LLC 931 Union Street PO Box 940 Bangor,ME044020940 01-0512673	Ambulance	ME	AHS	C			Yes
(7) Maine Network for Health PO BOX 2813 Bangor,ME044022813 01-0496352	Support Service	ME	EHMS	C			Yes
(8) Dirigo Pines Retirement Community LLC 9 Alumni Drive Orono,ME04473 01-0537924	Holding Co	ME	AHS	C			Yes
(9) Dirigo Pines Inn LLC 9 Alumni Drive Orono,ME04473 02-0547749	Continuing Care	ME	ROSSCARE	C			Yes
(10) Dirigo Funding LLC 9 Alumni Drive Orono,ME04473 01-0599996	Providing Finance	ME	AHS	C			Yes
(11) Dirigo Pines Development Co LLC 9 Alumni Drive Orono,ME04473 01-0537924	Ret Cottage	ME	AHS	C			Yes
(12) Miller Drug LLC P O BOX 1779 Bangor,ME044021779 27-2175482	Pharmacy	ME	AHS	C			Yes
(13) Alliance Health Documentation LLC 9 Central Street Suite 205 Bangor,ME04401 46-2751855	Trnascription	ME	AHS	C			Yes

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Eastern Maine Healthcare Systems EMHS	m	496,217	FMV
(2) Eastern Maine Healthcare Systems EMHS	p	2,845,468	FMV
(3) Eastern Maine Healthcare Systems EMHS	r	644,225	FMV
(4) Eastern Maine Medical Center EMMC	m	490,241	FMV
(5) EMHS Foundation	m	84,000	FMV
(6) Inland Hospital	m	141,300	FMV
(7) Beacon Health LLC	s	238,116	FMV
(8) Affiliated Laboratory Inc	m	255,200	FMV
(9) Affiliated Materiel Services	p	556,475	FMV
(10) Alliance Health Documentation LLC	m	177,838	FMV

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2013

Additional Data

Software ID:	13000170
Software Version:	2013v4.0

1	Briefly describe the organization’s mission or most significant activities: Sebasticook Valley Health is a critical access hospital whose mission is to be the regional leader in meeting the health needs of our communities, providing quality care,always treating people with dignity and respect.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	386
6	Total number of volunteers (estimate if necessary) .............	6	5
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,163,725	657,615
9	Program service revenue (Part VIII, line 2g) .........	53,780,534	59,227,680
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	306,769	624,967
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	482,490	362,023
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	55,733,518	60,872,285
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	19,875,601	20,534,010
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 116,899
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	33,443,299	37,147,429
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	53,318,900	57,681,439
19	Revenue less expenses. Subtract line 18 from line 12.......	2,414,618	3,190,846
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	44,087,530	44,345,136
21	Total liabilities (Part X, line 26).............	22,362,021	19,909,367
22	Net assets or fund balances. Subtract line 21 from line 20.....	21,725,509	24,435,769

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 50,571,257 including grants of $ ) (Revenue $ 59,473,396 )
	SEBASTICOOK VALLEY HEALTH is a nonprofit hospital, providing service for all that needs care, regardless of their ability to pay. In the 2014 fiscal year, SVH provided free care of $1,865,324 and recorded $2,913,829 in bad debts. Our hospital provides 24-hours-a-day emergency services with annual visits of 12,129. SVH provides many free services and programs that are designed to improve the health and well being of our surrounding communities.Free/Reduced Cost Programs To Our CommunitiesCourtesy VanDiabetes Awareness/Support Group Meeting MonthlyBreast Cancer Awareness, Education, and Free MammogramsBlood Pressure ScreeningsBusiness Lunch and LearnsTobacco-readiness to Quit ProgramBone Densitometry ScreeningsSchool & Community Organization hospital toursParticipation in ad provision of bone density screenings at Sebasticook Valley Chamber Trade ShowHeart Health EducationCaregiver Support GroupFall Flu ClinicsMS Support GroupBlood Drives (twice yearly)CPR/First Aide ClassesSupper sitter workshops (three times a year)Move and Improve SiteMove and improve Community WalksLiving WellOversight of student experience processes including:job shadows,practicums, and clinical rotations.Community Health FairNutrition and Cooking EducationSubstance Abuse PreventionWorksite WellnessRural Active Living AssessmentsMunicipal and School Tobacco PolicyAdditional Statistics:Total Admissions of 643Emergency Room Visits 12,129Surgical Cases 652Clinic Visits 9960Physician Practice visits of 15,201

4b	(Code: ) (Expenses $ 1,020,746 including grants of $ ) (Revenue $ )
	Charity Care provided (at cost)429 persons served.

4c	(Code: ) (Expenses $ 390,855 including grants of $ ) (Revenue $ )
	Medicare Shortfalls (at cost) 4,007 persons served.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses51,982,858

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) CHARLES W KLEIN........................................................................ CNO	40.00 .......................0.00	X			103,304	0	4,572
(19) BRIAN GRETTA........................................................................ PHYSICIAN	39.00 .......................0.00		X		244,523	0	25,741
(20) TODD TRITCH........................................................................ PHYSICIAN	39.00 .......................0.00		X		297,968	0	24,312
(21) JO-NELL MARTIN........................................................................ PHYSICIAN	39.00 .......................0.00		X		307,835	0	31,300
(22) MICHAEL LEMIEUX........................................................................ CARDIOLOGIST	40.00 .......................0.00		X		395,453	0	27,305
(23) MAXIME COLES........................................................................ SURGEON	40.00 .......................0.00		X		395,453	0	23,220
(24) VICTORIA ALEXANDER-L........................................................................ CEO	0.00 .......................0.00			X	313,733	0	10,673
(25) LIISA HAAPENEN-JANEL........................................................................ CHIEF HR OFFICER	0.00 .......................0.00			X	35,833	0	2,309

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,467,387	279,746

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		5,260
e	Government grants (contributions)1e		407,754

f	All other contributions, gifts, grants, and similar amounts not included above1f		244,601

g	Noncash contributions included in lines 1a-1f:$		20,442
h	Total. Add lines 1a-1f.......			657,615
			Business Code
2a	CRITICAL ACCESS HOSPITAL		621990	59,227,680	59,227,680
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			59,227,680
3	Investment income (including dividends, interest, and other similar amounts).......			216,145			216,145
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	3,630,889	4,478
b	Less: cost or other basis and sales expenses	3,221,512	5,033
c	Gain or (loss)	409,377	-555
d	Net gain or (loss)..........			408,822			408,822
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	Cafeteria Revenue		621990	116,307			116,307
b	Meaningful Use		621990	205,493	205,493
c	Misc Revenue		621990	27,143	27,143
d	All other revenue ....			13,080	13,080
e	Total. Add lines 11a–11d ......			362,023
12	Total revenue. See Instructions......			60,872,285	59,473,396		741,274


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			653	1	-2,344
2	Savings and temporary cash investments .........			4,476,729	2	6,334,587
3	Pledges and grants receivable, net ...........			651,978	3	528,944
4	Accounts receivable, net .............			2,595,300	4	3,205,069
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6	0
7	Notes and loans receivable, net .............				7	0
8	Inventories for sale or use ..............			221,869	8	260,168
9	Prepaid expenses and deferred charges ..........			348,185	9	355,570
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	42,202,635
b	Less: accumulated depreciation .....	10b	20,095,277	21,921,367	10c	22,107,358
11	Investments—publicly traded securities ..........				11	0
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 .....				13	0
14	Intangible assets ...............				14	0
15	Other assets. See Part IV, line 11 ...........			13,871,449	15	11,555,784
16	Total assets. Add lines 1 through 15 (must equal line 34)......			44,087,530	16	44,345,136
17	Accounts payable and accrued expenses .........			3,657,537	17	3,708,683
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			10,340,510	20	9,752,283
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			8,363,974	25	6,448,401
26	Total liabilities. Add lines 17 through 25.........			22,362,021	26	19,909,367
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			20,504,464	27	23,373,473
28	Temporarily restricted net assets ...........			851,187	28	688,598
29	Permanently restricted net assets ...........			369,858	29	373,698
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			21,725,509	33	24,435,769
34	Total liabilities and net assets/fund balances ........			44,087,530	34	44,345,136