Franklin Memorial Hospital: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- Franklin Memorial Hospital (EIN 01-0211503)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-09
- IRS object ID
- 201712219349300901
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-09T12:13:31-04:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010211503 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANKLIN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FRAN | BusinessNameControlTxt |
| Phone | 2077792500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 FRANKLIN HEALTH COMMONS | AddressLine1Txt |
| City | FARMINGTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04938 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN COX | PersonNm |
| Person Title | INTERIM CFO | PersonTitleTxt |
| Phone | 2077792500 | PhoneNum |
| Signature | 2017-08-03 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIMOTHY CHURCHILL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 FRANKLIN HEALTH COMMONS | AddressLine1Txt |
| City | FARMINGTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04938 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $76,130,100 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FCHN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1926 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | COMMUNITY HOSPITAL | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 832 | TotalEmployeeCnt |
| Total Volunteers | 170 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $191,801 | PYContributionsGrantsAmt |
| CY Contributions Grants | $252,360 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $77,961,887 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $75,719,828 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,605 | PYInvestmentIncomeAmt |
| CY Investment Income | $51,395 | CYInvestmentIncomeAmt |
| PY Other Revenue | $50,087 | PYOtherRevenueAmt |
| CY Other Revenue | $47,150 | CYOtherRevenueAmt |
| PY Total Revenue | $78,205,380 | PYTotalRevenueAmt |
| CY Total Revenue | $76,070,733 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $47,257,671 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $46,486,808 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $31,558,782 | PYOtherExpensesAmt |
| CY Other Expenses | $34,526,402 | CYOtherExpensesAmt |
| PY Total Expenses | $78,816,453 | PYTotalExpensesAmt |
| CY Total Expenses | $81,013,210 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$611,073 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,942,477 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $50,797,144 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,022,229 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $31,158,241 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $29,494,297 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,638,903 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,527,932 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE HIGH-QUALITY, COST-EFFECTIVE, PATIENT-CENTERED HEALTHCARE TO OUR WEST CENTRAL MAINE COMMUNITY. WE WORK WITH OUR COMMUNITY AND OTHER HEALTHCARE PROVIDERS TO INTEGRATE SERVICES AND ENSURE THE HEALTH OF OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $44,299,335 | ExpenseAmt |
| Revenue | $57,563,810 | RevenueAmt |
| Desc | ROUTINE INPATIENT AND ANCILLARY OUTPATIENT SERVICES FRANKLIN MEMORIAL HOSPITAL IS A NON-FOR-PROFIT COMMUNITY HOSPITAL WHICH PROVIDES HIGH-QUALITY, COST-EFFECTIVE, PATIENT-CENTERED INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO THE WEST CENTRAL MAINE COMMUNITY. THE 65-BED HOSPITAL IS FULLY QUALIFIED AND ACCREDITED TO HANDLE A BROAD RANGE OF MEDICAL, SURGICAL, PEDIATRIC, WOMEN'S CARE AND DIAGNOSTIC SERVICES. FRANKLIN MEMORIAL HOSPITAL OFFERS TOP QUALITY SPECIALTY CARE INCLUDING ROUTINE ADULT, PEDIATRIC AND INTENSIVE CARE INPATIENT SERVICES AS WELL AS A VARIETY OF OUTPATIENT SERVICES INCLUDING ONCOLOGY, HEMATOLOGY, CARDIOLOGY, OTOLARYNGOLOGY, ORTHOPEDICS, BEHAVIORAL SERVICES, OCCUPATIONAL HEALTH, (CONTINUED AT SCHEDULE O) (CONTINUED FROM PART III, LINE 4A) DERMATOLOGY, PULMONOLOGY, PAIN MANAGEMENT, PEDIATRIC ENDOCRINOLOGY, PHYSICAL REHABILITATION, SPORTS MEDICINE AND WOUND CARE. DURING THE TWELVE MONTHS ENDING SEPTEMBER 30, 2016 THERE WERE 2,261 INPATIENT DISCHARGES, 1,772 OUTPATIENT SURGERIES, 229,187 OUTPATIENT LAB TESTS AND 39,838 OUTPATIENT IMAGING PROCEDURES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $18,804,096 | ExpenseAmt |
| Revenue | $10,396,888 | RevenueAmt |
| Desc | FRANKLIN HEALTH PHYSICIAN PRACTICES FRANKLIN MEMORIAL HOSPITAL IDENTIFIED ACCESS TO PRIMARY CARE AS A CENTRAL COMMUNITY NEED AND IS COMMITTED TO PROVIDING HIGH QUALITY PHYSICIAN SERVICES OF FAMILY PRACTICE, INTERNAL MEDICINE, PEDIATRICS AND WOMEN'S CARE. IN ADDITION, FRANKLIN MEMORIAL HOSPITAL OFFERS A VARIETY OF SPECIALTY CARE SERVICES INCLUDING DERMATOLOGY, SURGERY, ORTHOPEDICS AND BEHAVIORAL HEALTH SERVICES. DURING THE TWELVE MONTHS ENDING SEPTEMBER 30, 2016 FRANKLIN MEMORIAL HOSPITAL PROVIDED 51,585 PRIMARY CARE VISITS AND 21,466 SPECIALTY CARE VISITS IN THE FRANKLIN HEALTH PHYSICIAN PRACTICES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,117,671 | ExpenseAmt |
| Revenue | $7,810,525 | RevenueAmt |
| Desc | EMERGENCY ROOM FRANKLIN MEMORIAL HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WHICH OPERATES 24 HOURS A DAY SEVEN DAYS A WEEK. THE EMERGENCY DEPARTMENT SERVES AS THE PRIMARY CARE PHYSICIAN FOR A NUMBER OF LOW INCOME AND INDIGENT RESIDENTS OF THE WEST CENTRAL MAINE COMMUNITY. GIVEN FRANKLIN MEMORIAL HOSPITAL'S COMMITMENT TO ACCESS TO CARE REGARDLESS OF THE ABILITY TO PAY, THE EMERGENCY DEPARTMENT SERVES A VITAL ROLE IN THE COMMUNITY'S HEALTH CARE NETWORK. DURING TWELVE MONTHS ENDING SEPTEMBER 30, 2016 FRANKLIN MEMORIAL HOSPITAL HAD 16,214 EMERGENCY ROOM VISITS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $68,221,102 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 141 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 832 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | ME | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN COX INTERIM CFO | PersonNm |
| Phone | 2077792265 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 FRANKLIN HEALTH COMMONS | AddressLine1Txt |
| City | FARMINGTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04938 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| REBECCA ARSENAULT | |||||||||
| PRESIDENT/CE | 50.00 | 0.00 | Yes (X) | Yes (X) | $362,134 | $0 | $16,228 | ||
| TIMOTHY CHURCHILL | |||||||||
| INTERIM PRES | 1.00 | 50.00 | Yes (X) | Yes (X) | $0 | $337,730 | $50,207 | ||
| HEIDI DECKER MD | |||||||||
| MEDICAL STAF | 50.00 | 0.00 | Yes (X) | $199,575 | $0 | $20,108 | |||
| MICHELE MCCORMICK | |||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $100,400 | $0 | $0 | |||
| CONNIE ADLER MD | |||||||||
| SECRETARY | 50.00 | 0.00 | Yes (X) | Yes (X) | $96,540 | $0 | $5,970 | ||
| CAROL TIMBERLAKE | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CLINT BOOTHBY | |||||||||
| CHAIRMAN | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH BUJOLD | |||||||||
| IMMED. PAST | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GILLY HITCHCOCK | |||||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MEREDITH TIPTON | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN BOGAR | |||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DAVID DIXON MD | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| PETER JUDKINS | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SHEENA BUNNELL | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RONALD ASELTINE | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DARRYL WOOD | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL CORMIER | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CHRISTINE TROPEANO | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CONNIE COGGINS | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JAY NALIBOFF | |||||||||
| VP MED. AFFA | 50.00 | 0.00 | Yes (X) | $235,365 | $0 | $19,648 | |||
| WAYNE BENNETT | |||||||||
| CFO | 50.00 | 0.00 | Yes (X) | $224,943 | $0 | $22,631 | |||
| GERALD CAYER | |||||||||
| VP PHYS. & C | 50.00 | 0.00 | Yes (X) | $204,555 | $0 | $21,367 | |||
| JOSHUA D SPARLING MD | |||||||||
| DERMATOLOGIS | 50.00 | 0.00 | $558,071 | $0 | $25,123 | Yes (X) | |||
| OSCAR FISCHER MD | |||||||||
| ANESTHESIOLO | 50.00 | 0.00 | $393,342 | $0 | $4,026 | Yes (X) | |||
| ERIC GUNTHER MD | |||||||||
| GENERAL SURG | 50.00 | 0.00 | $368,526 | $0 | $24,344 | Yes (X) | |||
| JAMES LANCASTER MD | |||||||||
| ANESTHESIOLO | 50.00 | 0.00 | $367,967 | $0 | $24,954 | Yes (X) | |||
| HEATHER DECAROLIS MD | |||||||||
| ANESTHESIOLO | 50.00 | 0.00 | $364,154 | $0 | $24,954 | Yes (X) | |||
| ROBERT O'REILLY MD | |||||||||
| FMR MED. STA | 0.00 | 0.00 | $215,330 | $0 | $19,850 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,690,902 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $337,730 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $279,410 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 62 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| VISTA STAFFING SOLUTIONS INC | |||||
| 275 EAST 200 SOUTH | SALT LAKE CITY | UT | 841112002 | PHYS. STAFFING | $757,023 |
| WEATHERBY LOCUMS INC | |||||
| 6440 SOUTH MILLROCK DR SUITE 175 | SALT LAKE CITY | UT | 84121 | PHYS. STAFFING | $723,847 |
| SYNERNET INC | |||||
| 110 FREE STREET | PORTLAND | ME | 04101 | TRANSCRIPTION | $501,561 |
| COMPHEALTH | |||||
| 6440 SOUTH MILLROCK DR SUITE 175 | SALT LAKE CITY | UT | 841215027 | PHYS. STAFFING | $452,363 |
| MAINEGENERAL MEDICAL CENTER | |||||
| 33 STONE STREET | AUGUSTA | ME | 04901 | PHYS. STAFFING | $403,996 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $102,228 | GovernmentGrantsAmt |
| All Other Contributions | $150,132 | AllOtherContributionsAmt |
| Total Contributions | $252,360 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621990 | $72,502,640 | $72,502,640 |
| OTHER | 621990 | $2,493,505 | $2,493,505 |
| AMBULANCE SUBSIDIES | 621910 | $597,805 | $597,805 |
| CAFETERIA | 722514 | $125,878 | $125,878 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $75,719,828 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $89,903 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $42,753 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $47,150 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,150 | TotalRevenueColumnAmt |
| Exclusion | $47,150 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $68,009 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $16,614 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $51,395 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,395 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $51,395 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,070,733 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $75,771,223 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $47,150 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,529,465 | TotalAmt |
| Program Services | $422,593 | ProgramServicesAmt |
| Management And General | $1,106,872 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,180 | TotalAmt |
| Program Services | $235,180 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,385,184 | TotalAmt |
| Program Services | $31,726,776 | ProgramServicesAmt |
| Management And General | $3,658,408 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $452,022 | TotalAmt |
| Program Services | $393,593 | ProgramServicesAmt |
| Management And General | $58,429 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,439,017 | TotalAmt |
| Program Services | $5,606,696 | ProgramServicesAmt |
| Management And General | $832,321 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,445,940 | TotalAmt |
| Program Services | $2,129,773 | ProgramServicesAmt |
| Management And General | $316,167 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,615 | TotalAmt |
| Management And General | $98,615 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,183 | TotalAmt |
| Management And General | $73,183 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,062 | TotalAmt |
| Management And General | $11,062 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,446,706 | TotalAmt |
| Program Services | $4,739,656 | ProgramServicesAmt |
| Management And General | $707,050 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,763 | TotalAmt |
| Management And General | $106,763 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $894,499 | TotalAmt |
| Program Services | $550,072 | ProgramServicesAmt |
| Management And General | $344,427 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,117,911 | TotalAmt |
| Program Services | $695,981 | ProgramServicesAmt |
| Management And General | $421,930 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,717,214 | TotalAmt |
| Program Services | $1,709,739 | ProgramServicesAmt |
| Management And General | $7,475 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,231 | TotalAmt |
| Program Services | $71,889 | ProgramServicesAmt |
| Management And General | $1,342 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $322,620 | TotalAmt |
| Program Services | $259,837 | ProgramServicesAmt |
| Management And General | $62,783 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $828,673 | TotalAmt |
| Program Services | $742,998 | ProgramServicesAmt |
| Management And General | $85,675 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,694,913 | TotalAmt |
| Program Services | $3,312,903 | ProgramServicesAmt |
| Management And General | $382,010 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,511,202 | TotalAmt |
| Program Services | $1,483,884 | ProgramServicesAmt |
| Management And General | $27,318 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| INTEGRATED SERVICES | $7,220,532 | $3,575,679 | $3,644,853 |
| MEDICAL SUPPLIES | $7,041,574 | $7,041,574 | |
| OTHER | $2,428,512 | $1,583,087 | $845,425 |
| HOSPITAL TAX | $1,939,192 | $1,939,192 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,013,210 | TotalAmt |
| Program Services | $68,221,102 | ProgramServicesAmt |
| Management And General | $12,792,108 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,505 | BOYAmt |
| EOY | $3,480 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,815,471 | BOYAmt |
| EOY | $371,796 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,387,622 | BOYAmt |
| EOY | $7,901,603 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,546,204 | BOYAmt |
| EOY | $1,574,206 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,714,667 | BOYAmt |
| EOY | $1,174,715 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $90,241,452 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $61,476,545 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,778,603 | BOYAmt |
| EOY | $28,764,907 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,551,072 | BOYAmt |
| EOY | $6,231,522 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,797,144 | BOYAmt |
| EOY | $46,022,229 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,286,919 | BOYAmt |
| EOY | $4,641,164 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,394 | BOYAmt |
| EOY | $270,937 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,805,455 | BOYAmt |
| EOY | $17,990,655 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,044,473 | BOYAmt |
| EOY | $6,591,541 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,158,241 | BOYAmt |
| EOY | $29,494,297 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,876,394 | BOYAmt |
| EOY | $13,608,548 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,525,939 | BOYAmt |
| EOY | $1,679,687 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,236,570 | BOYAmt |
| EOY | $1,239,697 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,638,903 | BOYAmt |
| EOY | $16,527,932 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,797,144 | BOYAmt |
| EOY | $46,022,229 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,942,477 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,831,506 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $11,062 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $11,062 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | DUES PAID TO THE MAINE HOSPITAL ASSOCIATION OF 38,405 AND THE AMERICAN HOSPITAL ASSOCATION OF 19,050. THE MAINE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION USED 18% AND 21.78% RESPECTIVELY OF THEIR DUES REVENUE FOR LOBBYING ACTIVITY. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,691,932 | BeginningYearBalanceAmt |
| Contributions | $112,614 | ContributionsAmt |
| Investment Earnings Or Losses | $182,291 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | -$160,443 | OtherExpendituresAmt |
| End Year Balance | $2,826,394 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,799,451 | BeginningYearBalanceAmt |
| Contributions | $408,226 | ContributionsAmt |
| Investment Earnings Or Losses | -$187,776 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | -$327,969 | OtherExpendituresAmt |
| End Year Balance | $2,691,932 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,874,474 | BeginningYearBalanceAmt |
| Contributions | $53,718 | ContributionsAmt |
| Investment Earnings Or Losses | -$71,709 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | -$57,032 | OtherExpendituresAmt |
| End Year Balance | $2,799,451 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,604,155 | BeginningYearBalanceAmt |
| Contributions | $11,967 | ContributionsAmt |
| Investment Earnings Or Losses | $316,743 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $58,391 | OtherExpendituresAmt |
| End Year Balance | $2,874,474 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,325,015 | BeginningYearBalanceAmt |
| Contributions | $126,671 | ContributionsAmt |
| Investment Earnings Or Losses | $166,297 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $13,828 | OtherExpendituresAmt |
| End Year Balance | $2,604,155 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.44000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.56000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,252,336 | OtherCostOrOtherBasisAmt |
| Book Value | $1,252,336 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $50,236,388 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,168,396 | DepreciationAmt |
| Book Value | $22,067,992 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $33,214,558 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,944,959 | DepreciationAmt |
| Book Value | $5,269,599 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,538,170 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,363,190 | DepreciationAmt |
| Book Value | $174,980 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,764,907 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST IN NET ASSETS OF FCHN | $2,543,080 |
| DEFERRED COMPENSATION ASSET | $2,034,294 |
| EST. THIRD PARTY PAYOR SETTLEMENTS | $684,951 |
| DUE FROM AFFILIATES | $424,036 |
| BENEFICIAL INT. IN PERPETUAL TRUST | $283,313 |
| OTHER ASSETS | $191,372 |
| GOODWILL | $70,476 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,231,522 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTIES | $3,658,602 |
| DEFERRED COMPENSATION LIABILITY | $2,034,294 |
| MEDICAL MALPRACTICE TAIL LIAB. | $600,000 |
| INSURANCE CLAIM LIABILITY | $298,645 |
| LINE OF CREDIT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,591,541 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 2, PART V, LINE 4 | THE ORGANIZATION'S ENDOWMENT FUNDS ARE HELD BY THE FRANKLIN COMMUNITY HEALTH NETWORK AND ARE INTENDED TO SUPPORT VARIOUS PROGRAMS OFFERED BY THE ORGANIZATION, SUCH AS THE CHARITY PROGRAM, COMMUNITY OUTREACH, EDUCATION, MEDICAL LIBRARY, MARTHA B. WEBBER BREAST CARE CENTER AND OTHERS. |
| SCHEDULE D, PAGE 3, PART X | THE COMPANY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 1.750000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 2.250000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,339,926 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,339,926 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01650 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,875,890 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,464,841 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,411,049 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02980 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,215,816 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,464,841 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,750,975 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04630 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $521,019 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $53,181 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $467,838 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $317,755 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $102,228 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $215,527 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,035,142 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,301,014 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,734,128 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07080 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,075 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,075 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,896,991 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,456,423 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,440,568 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07950 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,112,807 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,921,264 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,191,543 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12580 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,150,654 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $17,786,965 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $21,686,101 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,899,136 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (2 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct |
|---|---|
| WESTERN MAINE PHO | |
| PHYSICIAN HOSPITAL ORGANIZATION | 0.50000 |
| SCOREKEEPER LLC | |
| WELLNESS SOFTWARE | 0.40000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANKLIN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 FRANKLIN HEALTH COMMONS | AddressLine1Txt |
| City | FARMINGTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04938 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.FCHN.ORG/ABOUT | WebsiteAddressTxt |
| State License | ME STATE LIC. 38506 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANKLIN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 175.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 225.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWWFCHNORGPAYINGFORCARE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWWFCHNORGPAYINGFORCARE | FAPAppAvailableOnWebsiteURLTxt |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, FRANKLIN MEMORIAL HOSPITAL - PART V, LINE 5 | IN 2015, A COLLABORATIVE CALLED THE MAINE SHARED HEALTH NEEDS ASSESSMENT PLANNING PROCESS (SHNAPP) WAS LAUNCHED TO CREATE A FRAMEWORK AND APPROACH FOR A SHARED CHNA THAT CAN: I) ADDRESS COMMUNITY BENEFIT REPORTING NEEDS OF HOSPITALS, II) SUPPORT STATE AND LOCAL PUBLIC HEALTH ACCREDITATION EFFORTS, AND III) PROVIDE VALUABLE POPULATION HEALTH ASSESSMENT DATA FOR VARIOUS ORGANIZATIONS CONCERNED WITH THE HEALTH OF MAINE'S COMMUNITIES AND CITIZENS. MAINEHEALTH, EASTERN MAINE HEALTHCARE SYSTEM, CENTRAL MAINE HEALTHCARE AND THE MAINE CENTER FOR DISEASE CONTROL AND PREVENTION ARE CONTRIBUTING FINANCIAL SUPPORT TO THE STUDY AND REPORTS. IN 2016, MAINE SHNAPP PRODUCED COUNTY-LEVEL CHNA REPORTS AND HELPED COORDINATE COMMUNITY ENGAGEMENT PROCESSES THAT ULTIMATELY RESULTED IN THE PRIORITIZATION OF HEALTH ISSUES BY HOSPITALS, STATE/LOCAL GOVERNMENTS AND OTHER PARTNERS. IN COLLABORATION WITH MAINEHEALTH, EACH MEMBER HOSPITAL PRODUCED A DETAILED CHNA REPORT AND IMPLEMENTATION PLAN COVERING THE TIME PERIOD OF 2016-2018. THESE REPORTS WERE FORMALLY ADOPTED BY EACH MEMBER ORGANIZATION BOARD FOR SUBMISSION WITH THEIR RESPECTIVE FY16 990 FILINGS. IMPORTANTLY, AS OF FY16, THE THREE-YEAR CYCLE OF THE CHNA PROCESS IS ALIGNED WITH MAINEHEALTH MEMBER ORGANIZATIONS' STRATEGIC PLANNING PROCESSES (ALSO THREE-YEAR CYCLES). WE EXPECT THIS ALIGNMENT TO STRENGTHEN THE COORDINATION AND RESOURCE ALLOCATION FOR COMMUNITY HEALTH IMPROVEMENT EFFORTS ACROSS THE MAINEHEALTH ORGANIZATIONS. AT A LOCAL AND REGIONAL LEVEL, FRANKLIN MEMORIAL HOSPITAL CONVENED A DIVERSE PLANNING COMMITTEE TO REVIEW THE DATA COLLECTED FOR THE CHNA REPORT, PLAN COMMUNITY FORUM AND OTHER ENGAGEMENT ACTIVITIES, IDENTIFY PRIORITIES, AND DEVELOP IMPLEMENTATION STRATEGIES. |
| FACILITY 1, FRANKLIN MEMORIAL HOSPITAL - PART V, LINE 6A | SEE PART V, LINE 5 FOR ORGANIZATIONS LISTED |
| FACILITY 1, FRANKLIN MEMORIAL HOSPITAL - PART V, LINE 7D | THE CHNA, WHICH INCLUDES THE IMPLEMENTATION PLAN, IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://MAINEHEALTH.ORG/FRANKLIN-COMMUNITY-HEALTH-NETWORK/ABOUT/COMMUNITY- HEALTH-NEEDS-ASSESSMENT |
| FACILITY 1, FRANKLIN MEMORIAL HOSPITAL - PART V, LINE 11 | THE ORGANIZATION HAS COMPLETED ITS WORK ON ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS 2013-2015 CHNA AND IMPLEMENTATION PLAN. PLEASE SEE THE ATTACHED 2013-15 IMPLEMENTATION PLAN UPDATE FOR DETAILS OF THE ACTIVITIES UNDERTAKEN BY THE ORGANIZATION TO MEET THE IDENTIFIED NEEDS OF ITS COMMUNITY. FOR THE 2016-18 CHNA, THE ORGANIZATION HAS IDENTIFIED PRIORITIES AND DEVELOPED STRATEGIES TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND PROVIDED REASONS IF IDENTIFIED NEEDS ARE NOT BEING ADDRESSED. SEE HTTPS://MAINEHEALTH.ORG/ABOUT/HEALTH-INDEX-INITIATIVE/COMMUNITY- HEALTH-NEEDS-ASSESSMENT FOR DETAILS. |
| FACILITY 1, FRANKLIN MEMORIAL HOSPITAL - PART V, LINE 16I | FRANKLIN MEMORIAL HOSPITAL TAKES A NUMBER OF STEPS TO PUBLICIZE THE AVAILABILITY OF THE FINANCIAL ASSISTANCE TO PATIENTS: 1. NOTICES OF THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN LOCATIONS WITHIN THE HOSPITAL AT WHICH MEMBERS OF THE PUBLIC GENERALLY TRANSACT BUSINESS WITH THE HOSPITAL OR PRESENT THEMSELVES TO RECEIVE OR REQUEST HOSPITAL SERVICES, INCLUDING ADMITTING AREAS, WAITING ROOMS, BUSINESS OFFICES AND OUTPATIENT RECEPTION AREAS. 2. WITH RESPECT WITH INPATIENT ADMISSIONS, INDIVIDUAL WRITTEN NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS PRESENTED TO EACH PATIENT UPON ADMISSION OR IN THE CASE OF EMERGENCY ADMISSION BEFORE DISCHARGE. IN ADDITION, ALL INPATIENTS ARE VISITED BY A PATIENT FINANCIAL ADVOCATE TO DISCUSS AVAILABILITY OF FINANCIAL ASSISTANCE AND GOVERNMENT COVERAGE OPTIONS. 3. AVAILABILITY OF FINANCIAL ASSISTANCE IS PUBLICIZED ON THE PATIENT INVOICES SUPPLYING PATIENTS WITH A CONTACT NUMBER TO OBTAIN FURTHER INFORMATION ABOUT AVAILABLE OPTIONS. 4. FINANCIAL ASSISTANCE OPTIONS ARE OUTLINED ON THE HOSPITALS' WEBSITE AND ARE READILY AVAILABLE TO THE PUBLIC. 5. RACK CARDS AND FINANCIAL ASSISTANCE APPLICATIONS ARE LOCATED THROUGHOUT THE HOSPITAL AND PHYSICIAN PRACTICES. 6. HOSPITAL BOOKLETS ARE AVAILABLE IN ALL PATIENT ROOMS WITH A SECTION REGARDING FINANCIAL ASSISTANCE. 7. PATIENT FINANCIAL ADVOCATES WORK WITH ALL PATIENTS WITHOUT HEALTH INSURANCE COVERAGE TO NOTIFY THEM ABOUT AVAILABLE FINANCIAL ASSISTANCE RESOURCES AND ASSIST WITH MAINECARE APPLICATIONS FOR ELIGIBLE INDIVIDUALS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 15 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| FRANK HLTH LIVERMORE FALLS FAM PRAC | ||||
| 21 MAIN STREET | LIVERMORE FALLS | ME | 04254 | FAMILY PRACTICE |
| FRANKLIN HLTH FARMINGTON FAM PRACT | ||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | FAMILY PRACTICE |
| FRANKLIN HEALTH INTERNAL MEDICINE | ||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | INTERNAL MEDICINE PRACTICE |
| FRANKLIN HEALTH PEDIATRICS | ||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | PEDIATRICIAN PRACTICE |
| FRANKLIN HEALTH ORTHOPAEDICS | ||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | ORTHOPAEDIC PRACTICE |
| FRANKLIN HEALTH SURGERY | ||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | GENERAL SURGERY PRACTICE |
| OUTPATIENT SRVCS AT LIVERMORE FALLS | ||||
| 21 MAIN STREET | LIVERMORE FALLS | ME | 04254 | OUTPATIENT CLINIC |
| NORTHSTAR | ||||
| 15 SCHOOL STREET | RANGELEY | ME | 04970 | AMBULANCE BASE |
| NORTHSTAR | ||||
| 138C PARK STREET | PHILLIPS | ME | 04966 | AMBULANCE BASE |
| NORTHSTAR | ||||
| 119 FEDERAL ROAD | LIVERMORE | ME | 04254 | AMBULANCE BASE |
| NORTHSTAR | ||||
| 1001 CARRIAGE ROAD | CARRABASSET VALLEY | ME | 04947 | AMBULANCE BASE |
| NORTHSTAR | ||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | AMBULANCE BASE |
| FRANKLIN HEALTH WOMEN'S CARE | ||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | OB/GYN |
| FRANKLIN HEALTH BEHAVIORAL SERVICES | ||||
| 131 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | BEHAVIORAL HEALTH PRACTICE |
| FRANKLIN HEALTH DERMATOLOGY | ||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | DERMATOLOGY PRACTICE |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | THE COSTING METHODOLOGY FOR THE AMOUNTS REPORTED IN PART I, LINE 7 OF THE SCHEDULE H IS BASED ON A RATIO OF PATIENT CARE COST TO CHARGES. THIS COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST- TO-CHARGES PROVIDED IN THE INSTRUCTIONS FOR SCHEDULE H. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | FRANKLIN MEMORIAL HOSPITAL USED THE RCC CALCULATED FROM WORKSHEET 2 AND MULTIPLIED IT BY THE BAD DEBTS EXPENSE PER THE FINANCIAL STATEMENTS. BAD DEBTS INCLUDE 100% OF THE CHARGES WRITTEN OFF DUE TO NO PAYMENT. IF A PAYMENT IS MADE ON A BAD DEBT ACCOUNT, THEN THAT PAYMENT REDUCES THE BAD DEBT EXPENSE IN THE YEAR RECEIVED. |
| BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS | BAD DEBT EXPENSE REPRESENTS HEALTHCARE SERVICES THAT FRANKLIN MEMORIAL HOSPITAL HAS PROVIDED WITHOUT COMPENSATION. AS A TAX EXEMPT HOSPITAL, FRANKLIN MEMORIAL HOSPITAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. A PORTION OF FRANKLIN MEMORIAL HOSPITAL'S BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE THAT FOR A VARIETY OF REASONS, DO NOT COMPLETE THE FINANCIAL ASSISTANCE APPLICATION PROCESS. FRANKLIN MEMORIAL HOSPITAL CANNOT DETERMINE THE AMOUNT OF BAD DEBT EXPENSE THAT COULD BE REASONABLY ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FRANKLIN MEMORIAL HOSPITAL'S FREE CARE POLICY. PAGES 8 AND 13 OF THE ATTACHED FINANCIAL STATEMENTS PROVIDE FOOTNOTES RELATED TO BAD DEBT EXPENSE AND BAD DEBT ALLOWANCE. |
| PART III, LINE 8 - MEDICARE EXPLANATION | THE MEDICARE PRINCIPLES OF REIMBURSEMENT WERE USED TO DETERMINE THE MEDICARE INPATIENT AND OUTPATIENT COSTS BASED ON THE ORGANIZATION'S COST REPORT. FRANKLIN MEMORIAL HOSPITAL BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE MEDICAL CENTER HAS A CLEAR MISSION COMMITMENT TO SERVING ELDERLY PATIENTS AND ADULTS WITH DISABILITIES THROUGH THE PROVISION OF SPECIFIC SUBSIDIZED PROGRAMS DEVELOPED TO HELP IMPROVE THE HEALTH STATUS OF THESE PATIENTS. IF THESE CRITICAL SUBSIDIZED PROGRAMS WERE NOT PROVIDED BY THE MEDICAL CENTER, THEY WOULD BECOME THE OBLIGATION OF THE FEDERAL GOVERNMENT. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | COLLECTION AGENCIES WORK WITH PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND REFER PATIENTS WHO INQUIRE ABOUT FINANCIAL ASSISTANCE BACK TO FRANKLIN MEMORIAL HOSPITAL FOR FOLLOW UP WITH A PATIENT FINANCIAL ADVOCATE AS NEEDED. BALANCES THAT ARE OWED TO THE HOSPITAL AFTER APPLYING ANY FINANCIAL ASSISTANCE ARE COLLECTED IN THE SAME MANNER AS ANY OTHER SELF PAY BALANCES. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | THE FRANKLIN MEMORIAL HOSPITAL NETWORK CONDUCTS A HEALTH VISIONING PROCESS EVERY TWO YEARS THAT IS USED TO IDENTIFY NEEDS AND PERCEIVED PRIORITIES IN THE COMMUNITY. A PHYSICIAN SURVEY IS CONDUCTED PERIODICALLY TO ASSIST IN GATHERING INFORMATION ABOUT CLINICAL CARE NEEDS, REFERRAL PATTERNS, SPECIALIST NEEDS, ETC. THE LONG-RANGE PLANNING COMMITTEE, BOARD OF DIRECTORS AND SENIOR LEADERSHIP USE THIS AND OTHER DATA IN DEVELOPING GOALS AND PRIORITIES, MAKING DECISIONS, AND SETTING LONG-TERM GOALS AND STRATEGIES. THE ORGANIZATION SEEKS TO MEET THE NEEDS OF THE POPULATION WHENEVER FEASIBLE THROUGH DIRECT PROVISION OF SERVICES, CONTRACTUAL RELATIONSHIPS, OR THROUGH REFERRAL. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | WHEN PATIENTS ARE REGISTERED THERE ARE BROCHURES AVAILABLE THAT DESCRIBE FRANKLIN MEMORIAL HOSPITAL'S CHARITY CARE PROGRAMS. WHEN A PATIENT IS ADMITTED WITH NO INSURANCE, REGISTRATION SENDS A PATIENT FINANCIAL ADVOCATE UP TO THE PATIENT'S ROOM TO MEET THE PATIENT. EACH BILL PROVIDED TO A PATIENT HAS THE PHONE NUMBER TO CALL IF THE PATIENT NEEDS FINANCIAL ASSISTANCE. THE ORGANIZATION'S BILLERS ALSO REFER PATIENTS TO THE ORGANIZATION'S PATIENT FINANCIAL ADVOCATE WHEN A PATIENT IS IDENTIFIED AS NEEDING ASSISTANCE. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | FRANKLIN MEMORIAL HOSPITAL'S SERVICE AREA COVERS 2,200 SQUARE MILES WHICH EXTENDS TO THE CANADIAN BORDER. IT IS ONE OF THE MOST RURAL AND ECONOMICALLY CHALLENGED REGIONS IN MAINE, INCLUDING SEVERAL AREAS THAT HAVE BEEN FEDERALLY DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AND MEDICALLY UNDERSERVED AREAS. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | COMMUNITY BUILDING PHYSICAL IMPROVEMENTS AND HOUSING: 1. DEVELOPMENT AND MAINTENANCE OF THE RAIL TRAIL WHICH IS ON FMH PROPERTY AND IS AVAILABLE TO THE PUBLIC TO ENCOURAGE HEALTH AND WELLNESS. ECONOMIC DEVELOPMENT: 1. MEMBER OF GREATER FRANKLIN DEVELOPMENT CORPORATION - AN ORGANIZATION COMMITTED TO ECONOMIC DEVELOPMENT. COMMUNITY SUPPORT: 1. PERFORM DISASTER DRILLS WITH THE COMMUNITY 1-2 TIMES A YEAR 2. COMMUNITY DENTAL (PROVIDE LOW COST RENTAL SPACE) COALITION BUILDING: 1. HEALTHY COMMUNITY COALITION OF GREATER FRANKLIN COUNTY, FOUNDED IN 1989, IS ONE OF THE OLDEST HEALTH COALITIONS IN THE COUNTRY. ITS MISSION IS TO MEASUREABLY IMPROVE THE WELL-BEING OF ALL PEOPLE IN GREATER FRANKLIN COUNTY AND NEIGHBORING TOWNS USING A COORDINATED PUBLIC HEALTH APPROACH OF EDUCATION, PROMOTION, AND OUTREACH. WITH ITS QUALIFIED STAFF OF PUBLIC HEALTH PROFESSIONALS, HEALTHY COMMUNITY COALITION OFFERS HEALTH SCREENINGS, HEALTH INFORMATION, AND PROGRAMS AND EVENTS TO SUPPORT HEALTHY LIFESTYLES THAT PREVENT DISEASE AND IMPROVE QUALITY OF LIFE. ITS COMMUNITY OUTREACH EFFORTS APPEAR IN EVERY TOWN AND CORNER OF THE REGION. IN THE PAST YEAR, MORE THAN 2,000 INDIVIDUALS BENEFITED FROM OUTREACH ACTIVITIES PROVIDED THROUGH MOBILE HEALTH UNIT WHERE HEALTH RISK APPRAISALS (HRAS) ARE ROUTINELY OFFERED. HRAS INCLUDE A BLOOD PRESSURE AND CHOLESTEROL CHECK AND INDIVIDUALIZED HEALTH EDUCATION. ADDITIONAL OUTREACH EVENTS WERE HELD THROUGHOUT THE REGION SUCH AS: BONE DENSITY SCREENINGS, FLU IMMUNIZATIONS, BODY COMPOSITION ANALYSIS, FREE CLINICAL BREAST EXAMS, EDUCATION ON TOBACCO, NUTRITION, PHYSICAL ACTIVITY AND SUBSTANCE ABUSE, AND EDUCATION ON THE PREVENTION OF BREAST, CERVICAL, COLON, LUNG, PROSTATE, AND SKIN CANCER. 2. AHEC EDUCATION CENTER - ESTABLISHED IN 2004 THE FRANKLIN AHEC PROGRAM WAS DEVELOPED OUT OF GREAT INTEREST FROM EMPLOYEES AND COMMUNITY MEMBERS REQUESTING LOCAL OPPORTUNITIES TO PURSUE CAREERS IN THE HEALTH FIELD AND EDUCATIONAL PROGRAMS FOR RETENTION AND PROFESSIONAL GROWTH. THE FRANKLIN AHEC ALLOWS US TO MEET THE NEEDS OF THE RURAL POPULATION. IT ALSO BRINGS TO THE MAINE AHEC NETWORK THE RESOURCES OF A LARGE INNOVATIVE RURAL HEALTH SYSTEM THAT INCLUDES A COMMUNITY HOSPITAL, MAINE'S OLDEST HEALTHY COMMUNITY COALITION AND THE BEN FRANKLIN CENTER WHICH HOUSES A STATE OF THE ART EDUCATION CENTER, MEDICAL LIBRARY FACILITIES, AND DISTANCE LEARNING OPPORTUNITIES. THE PROGRAM HAS GREATLY EXPANDED TO INCLUDE MANY ASPECTS AND ACTIVITIES FOR RETENTION AND RECRUITMENT FOR HEALTH CAREERS IN OUR VAST RURAL CATCHMENT AREA. BECOMING AN AHEC CENTER ALLOWS US TO PARTNER WITH YOUTH PROGRAMS, PUBLIC SCHOOLS, MULTIPLE COLLEGES, ADULT EDUCATION, A LOCAL CAREER CENTER AND OTHER HEALTH CAREER PROGRAMS TO OFFER COMMUNITY MEMBERS, DISPLACED WORKERS AND CURRENT HEALTHCARE EMPLOYEES THE OPPORTUNITY TO CONTINUE OR PURSUE CAREERS. 3. HEALTHINFONET: FMH, ALONG WITH ALL OTHER MAINE HOSPITALS AND HUNDREDS OF PHYSICIAN PRACTICES IN MAINE NOW HAVE ACCESS TO A NEW, CONSOLIDATED ELECTRONIC HEALTH RECORD MADE POSSIBLE BY HEALTHINFONET THAT CONTAINS CRITICAL INFORMATION DRAWN FROM RECORDS THAT HAVE TRADITIONALLY BEEN SEPARATELY MAINTAINED IN PHYSICIAN PRACTICES, HOSPITALS AND OTHER SETTINGS. ARMED WITH MORE COMPLETE AND TIMELY INFORMATION ABOUT A PATIENT, CLINICIANS CAN PROVIDE BETTER QUALITY CARE AND IMPROVE THE COORDINATION OF CARE, PARTICULARLY FOR THOSE PATIENTS WHO SEE SEVERAL PROVIDERS AND RECEIVE CARE IN MORE THAN ONE COMMUNITY OR SETTING. 4. HEALTH WORKS: WORKSITE WELLNESS AWARD PROGRAM IS A NEW AND FREE AWARD PROGRAM OFFERED BY HEALTH COMMUNITY COALITION OF GREATER FRANKLIN COUNTY. THE AWARD PROGRAM PROVIDES BUSINESSES AND ORGANIZATIONS WITH THE OPPORTUNITY TO BE RECOGNIZED AS A COMMUNITY LEADER IN HEALTH PROMOTION. THE PURPOSE OF THE HEALTHY MAINE WORKS (HMW) IS TO GUIDE AND SUPPORT MAINE EMPLOYERS IN DEVELOPING WORKSITE WELLNESS PROGRAMS THAT SUPPORT THE HEALTH OF EMPLOYEES. HWM IS A PROJECT OF MAINE'S CENTER FOR DISEASE CONTROL, OFFICE OF SUBSTANCE ABUSE, AND DEPARTMENT OF EDUCATION AND IS DELIVERED IN COLLABORATION WITH LOCAL HEALTHY MAINE PARTNERSHIPS ACROSS THE STATE. |
| PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM | FRANKLIN COMMUNITY HEALTH NETWORK: SUPPORTING ORGANIZATION FRANKLIN MEMORIAL HOSPITAL: COMMUNITY HOSPITAL HEALTHY COMMUNITY COALITION: A SUBSIDIARY OF FCHN - HCC'S MISSION IS TO MEASURABLY IMPROVE THE HEALTH AND WELL-BEING OF ALL PEOPLE IN GREATER FRANKLIN COUNTY USING A COORDINATED APPROACH OF EDUCATION, HEALTH PROMOTION, AND OUTREACH. HCC OFFERS HEALTH SCREENINGS, HEALTH INFORMATION, AND PROGRAMS AND EVENTS TO SUPPORT HEALTHY LIFESTYLES THAT PREVENT DISEASE AND IMPROVE QUALITY OF LIFE. EVERGREEN BEHAVIORAL SERVICES: OPERATES 24/7 EMERGENCY MENTAL HEALTH RESPONSE SERVICES FOR THE GREATER FRANKLIN COUNTY AREA AS WELL AS BORDERING TOWNS OF ANDROSCOGGIN & OXFORD COUNTIES. |
| PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT | MAINE |
| ADDITIONAL INFORMATION | PART I, LINE 7G: THE ORGANIZATION HAS INCLUDED COSTS ASSOCIATED WITH PRIMARY CARE (FAMILY PRACTICE, PEDIATRICS, INTERNAL MEDICINE AND WOMEN'S CARE) AND BEHAVIORAL SERVICES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| REBECCA ARSENAULT | ||||||||||||
| PRESIDENT/CEO | $332,634 | $12,000 | $17,500 | $5,300 | $10,928 | $378,362 | ||||||
| TIMOTHY CHURCHILL | ||||||||||||
| INTERIM PRES / CEO | $272,901 | $45,000 | $19,829 | $31,749 | $18,458 | $387,937 | ||||||
| HEIDI DECKER MD | ||||||||||||
| MEDICAL STAFF PRES. | $186,875 | $12,700 | $3,035 | $17,073 | $219,683 | |||||||
| JAY NALIBOFF | ||||||||||||
| VP MED. AFFAIRS | $235,365 | $4,684 | $14,964 | $255,013 | ||||||||
| WAYNE BENNETT | ||||||||||||
| CFO | $207,443 | $17,500 | $4,600 | $18,031 | $247,574 | |||||||
| GERALD CAYER | ||||||||||||
| VP PHYS. & COMM. SVC | $204,555 | $4,192 | $17,175 | $225,922 | ||||||||
| JOSHUA D SPARLING MD | ||||||||||||
| DERMATOLOGIST | $430,964 | $109,607 | $17,500 | $5,300 | $19,823 | $583,194 | ||||||
| OSCAR FISCHER MD | ||||||||||||
| ANESTHESIOLOGIST | $393,342 | $4,026 | $397,368 | |||||||||
| ERIC GUNTHER MD | ||||||||||||
| GENERAL SURGEON | $356,126 | $12,400 | $5,300 | $19,044 | $392,870 | |||||||
| JAMES LANCASTER MD | ||||||||||||
| ANESTHESIOLOGIST | $367,967 | $5,300 | $19,654 | $392,921 | ||||||||
| HEATHER DECAROLIS MD | ||||||||||||
| ANESTHESIOLOGIST | $364,154 | $5,300 | $19,654 | $389,108 | ||||||||
| ROBERT O'REILLY MD | ||||||||||||
| FMR MED. STAFF PRES. | $159,164 | $38,666 | $17,500 | $4,515 | $15,335 | $235,180 | ||||||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | TOP MANAGEMENT OFFICIALS ARE COMPENSATED BY THIS OR RELATED ORGANIZATIONS. THESE ORGANIZATIONS USE ONE OR MORE OF THE METHODS SHOWN ABOVE TO ESTABLISH THE COMPENSATION OF TOP MANAGEMENT. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| MAINE HEALTH & HIGHER ED FAC AUTH | ||||||||
| A | 010314384 | 560427NM4 | 2011-11-30 | $10,452,958 | REF. OF SERIES 2001A | false | false | Yes (true) |
| MAINE HEALTH & HIGHER ED FAC AUTH | ||||||||
| B | 010314384 | 56042REW8 | 2016-06-28 | $12,359,721 | REF. OF SERIES 2006F | false | false | Yes (true) |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $3,689,491 | $10,452,958 | $169,105 | $117,007 | $9,633,963 | 2002 | Yes (true) | false | Yes (true) | Yes (true) |
| B | $12,359,721 | $192,893 | $58,709 | $12,359,721 | 2016 | Yes (true) | false | Yes (true) | Yes (true) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | false | false | false | false | false | false | false |
| B | false | false | false | false | false | false | false |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | false | false | false | false | false | false | false | false | false |
| B | false | false | false | false | false | false | false | false | false |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | false |
| B | false |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | REBECCA WOOD | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER | RelationshipDescriptionTxt |
| Transaction | $122,504 | TransactionAmt |
| Transaction | EMPLOYMENT | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | REBECCA WOOD IS EMPLOYEED BY FRANKLIN MEMORIAL HOSPITAL AS CHIEF NURSING OFFICER / VP OF PATIENT CARE SERVICES. HER HUSBAND, DARRYL WOOD, IS A BOARD MEMBER. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | TO PROVIDE HIGH-QUALITY, COST-EFFECTIVE, PATIENT-CENTERED HEALTHCARE TO OUR WEST CENTRAL MAINE COMMUNITY. WE WORK WITH OUR COMMUNITY AND OTHER HEALTHCARE PROVIDERS TO INTEGRATE SERVICES AND ENSURE THE HEALTH OF OUR COMMUNITY. |
| FORM 990, PAGE 2, PART III, LINE 4A | (CONTINUED FROM PART III, LINE 4A) DERMATOLOGY, PULMONOLOGY, PAIN MANAGEMENT, PEDIATRIC ENDOCRINOLOGY, PHYSICAL REHABILITATION, SPORTS MEDICINE AND WOUND CARE. DURING THE TWELVE MONTHS ENDING SEPTEMBER 30, 2016 THERE WERE 2,261 INPATIENT DISCHARGES, 1,772 OUTPATIENT SURGERIES, 229,187 OUTPATIENT LAB TESTS AND 39,838 OUTPATIENT IMAGING PROCEDURES. |
| FORM 990, PAGE 6, PART VI, LINE 6 | MAINEHEALTH (EIN: 01-0431680), IS THE SOLE MEMBER OF FRANKLIN COMMUNITY HEALTH NETWORK (FCHN) (EIN: 22-3209406). FCHN IS THE SOLE MEMBER OF FMH. |
| FORM 990, PAGE 6, PART VI, LINE 7A | MAINEHEALTH AND FRANKLIN COMMUNITY HEALTH NETWORK HAVE THE RESPONSIBILITY FOR THE ELECTION OF THE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PAGE 6, PART VI, LINE 7B | DECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS STRATEGIES, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO THE APPROVAL OF THE SOLE MEMBER. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COMPLETE COPY OF THE FORM 990 WAS DISTRIBUTED TO EACH MEMBER OF THE BOARD PRIOR TO FILING WITH IRS. IN ADDITION, THE 990 WAS REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO FILING THE TAX RETURN IN A FORM OF A PRESENTATION AND A Q&A SESSION TO ADDRESS ANY QUESTIONS OR CONCERNS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ON AN ANNUAL BASIS BOARD MEMBERS AND OFFICERS ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST STATEMENT WHICH IS THEN REVIEWED BY THE COMPLIANCE COMMITTEE. THE COMPLIANCE COMMITTEE IS RESPONSIBLE FOR REGULARLY AND CONSISTENTLY MONITORING AND ENFORCING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE MEMBER IS RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. COMPENSATION IS EVALUATED BY THE COMPENSATION COMMITTEE APPOINTED BY THE MEMBER, AND THE ORGANIZATION'S BOARD OF TRUSTEES MUST APPROVE OF THE COMPENSATION. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTING FIRM AND INDUSTRY SURVEY. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE EXPLANATION ABOVE FOR PART VI, LINE 15A. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | CHANGE IN INTEREST OF RELATED PARTY NET ASSETS 131,334 CHANGE IN INTEREST IN PERPETUAL TRUST 3,127 NET TRANSFERS FROM AFFILIATES 1,697,045 TOTAL 1,831,506 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Address Line2USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| FRANKLIN COMMUNITY HEALTH NETWORK | |||||||||||
| 111 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | 223209406 | HEALTHCARE | ME | 501C3 | 11B | 01-0431680 | false | |
| HEALTHY COMMUNITY COALITION INC | |||||||||||
| 105 MT BLUE CIRCLE | FARMINGTON | ME | 04938 | 223305743 | COMMUNITY | ME | 501C3 | 7 | 22-3209406 | false | SUITE 1 |
| PINE TREE MEDICAL ASSOCIATES | |||||||||||
| 131 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | 010469478 | CM HTH AG | ME | 501C3 | 9 | 22-3209406 | false | |
| EVERGREEN BEHAVIORAL SERVICES | |||||||||||
| 131 FRANKLIN HEALTH COMMONS | FARMINGTON | ME | 04938 | 010492747 | MNTL HLTH | ME | 501C3 | 9 | 22-3209406 | false | |
| MAINEHEALTH | |||||||||||
| 110 FREE STREET | PORTLAND | ME | 04101 | 010431680 | HEALTHCARE | ME | 501C3 | 11C | NA | false | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM A HOWELL TRUST FUND | BusinessNameLine1Txt |
| Business Name Line2 | C/O BANK OF AMERICA NA | BusinessNameLine2Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 830269 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75283 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 016032170 | EIN |
| Primary Activities | PERP. TRST | PrimaryActivitiesTxt |
| Legal Domicile State | ME | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | TRUST | EntityTypeTxt |
| Share Of EOY Assets | $291,646 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |