2017-08-09T12:13:31-04:00 2016-09-30 990 2015-10-01 010211503 FRANKLIN MEMORIAL HOSPITAL FRAN 2077792500 111 FRANKLIN HEALTH COMMONS FARMINGTON ME 04938 JOHN COX INTERIM CFO 2077792500 2017-08-03 2015 2021-01-29 14:40:06Z TIMOTHY CHURCHILL 111 FRANKLIN HEALTH COMMONS FARMINGTON ME 04938 76130100 false X WWW.FCHN.ORG X 1926 ME COMMUNITY HOSPITAL 17 11 832 170 0 191801 252360 77961887 75719828 1605 51395 50087 47150 78205380 76070733 0 0 47257671 46486808 0 0 31558782 34526402 78816453 81013210 -611073 -4942477 50797144 46022229 31158241 29494297 19638903 16527932 X 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. false false 44299335 57563810 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. 18804096 10396888 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. 5117671 7810525 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. 68221102 true true false true false false false false false true true false false true true true false true false false false false false false false false true true false false true true false false false false false false false false true false false false false false false true false false false true 141 0 true 832 true false false false false false false false false false false X 17 11 false false false false true true true true true false false true true true true true true true true false ME X JOHN COX INTERIM CFO 2077792265 111 FRANKLIN HEALTH COMMONS FARMINGTON ME 04938 REBECCA ARSENAULT PRESIDENT/CE 50.00 0.00 X X 362134 0 16228 TIMOTHY CHURCHILL INTERIM PRES 1.00 50.00 X X 0 337730 50207 HEIDI DECKER MD MEDICAL STAF 50.00 0.00 X 199575 0 20108 MICHELE MCCORMICK DIRECTOR 50.00 0.00 X 100400 0 0 CONNIE ADLER MD SECRETARY 50.00 0.00 X X 96540 0 5970 CAROL TIMBERLAKE DIRECTOR 1.00 0.00 X 0 0 0 CLINT BOOTHBY CHAIRMAN 1.00 0.00 X X 0 0 0 JOSEPH BUJOLD IMMED. PAST 1.00 0.00 X X 0 0 0 GILLY HITCHCOCK VICE CHAIR 1.00 0.00 X X 0 0 0 MEREDITH TIPTON DIRECTOR 1.00 0.00 X 0 0 0 JOHN BOGAR TREASURER 1.00 0.00 X X 0 0 0 DAVID DIXON MD DIRECTOR 1.00 0.00 X 0 0 0 PETER JUDKINS DIRECTOR 1.00 0.00 X 0 0 0 SHEENA BUNNELL DIRECTOR 1.00 0.00 X 0 0 0 RONALD ASELTINE DIRECTOR 1.00 0.00 X 0 0 0 DARRYL WOOD DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL CORMIER DIRECTOR 1.00 0.00 X 0 0 0 CHRISTINE TROPEANO DIRECTOR 1.00 0.00 X 0 0 0 CONNIE COGGINS DIRECTOR 1.00 0.00 X 0 0 0 JAY NALIBOFF VP MED. AFFA 50.00 0.00 X 235365 0 19648 WAYNE BENNETT CFO 50.00 0.00 X 224943 0 22631 GERALD CAYER VP PHYS. & C 50.00 0.00 X 204555 0 21367 JOSHUA D SPARLING MD DERMATOLOGIS 50.00 0.00 X 558071 0 25123 OSCAR FISCHER MD ANESTHESIOLO 50.00 0.00 X 393342 0 4026 ERIC GUNTHER MD GENERAL SURG 50.00 0.00 X 368526 0 24344 JAMES LANCASTER MD ANESTHESIOLO 50.00 0.00 X 367967 0 24954 HEATHER DECAROLIS MD ANESTHESIOLO 50.00 0.00 X 364154 0 24954 ROBERT O'REILLY MD FMR MED. STA 0.00 0.00 X 215330 0 19850 3690902 337730 279410 62 true true false VISTA STAFFING SOLUTIONS INC 275 EAST 200 SOUTH SALT LAKE CITY UT 841112002 PHYS. STAFFING 757023 WEATHERBY LOCUMS INC 6440 SOUTH MILLROCK DR SUITE 175 SALT LAKE CITY UT 84121 PHYS. STAFFING 723847 SYNERNET INC 110 FREE STREET PORTLAND ME 04101 TRANSCRIPTION 501561 COMPHEALTH 6440 SOUTH MILLROCK DR SUITE 175 SALT LAKE CITY UT 841215027 PHYS. STAFFING 452363 MAINEGENERAL MEDICAL CENTER 33 STONE STREET AUGUSTA ME 04901 PHYS. STAFFING 403996 14 102228 150132 252360 PATIENT SERVICES 621990 72502640 72502640 OTHER 621990 2493505 2493505 AMBULANCE SUBSIDIES 621910 597805 597805 CAFETERIA 722514 125878 125878 75719828 89903 42753 47150 47150 47150 68009 16614 51395 51395 51395 76070733 75771223 47150 1529465 422593 1106872 235180 235180 35385184 31726776 3658408 452022 393593 58429 6439017 5606696 832321 2445940 2129773 316167 98615 98615 73183 73183 11062 11062 5446706 4739656 707050 106763 106763 894499 550072 344427 1117911 695981 421930 1717214 1709739 7475 73231 71889 1342 322620 259837 62783 828673 742998 85675 3694913 3312903 382010 1511202 1483884 27318 INTEGRATED SERVICES 7220532 3575679 3644853 MEDICAL SUPPLIES 7041574 7041574 OTHER 2428512 1583087 845425 HOSPITAL TAX 1939192 1939192 81013210 68221102 12792108 0 3505 3480 1815471 371796 8387622 7901603 1546204 1574206 2714667 1174715 90241452 61476545 29778603 28764907 6551072 6231522 50797144 46022229 9286919 4641164 21394 270937 18805455 17990655 3044473 6591541 31158241 29494297 X 16876394 13608548 1525939 1679687 1236570 1239697 19638903 16527932 50797144 46022229 X -4942477 1831506 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 11062 11062 false SCHEDULE C, PART II-B, LINE 1 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. 2691932 112614 182291 -160443 2826394 2799451 408226 -187776 -327969 2691932 2874474 53718 -71709 -57032 2799451 2604155 11967 316743 58391 2874474 2325015 126671 166297 13828 2604155 0.44000 0.56000 false true true 1252336 1252336 50236388 28168396 22067992 33214558 27944959 5269599 5538170 5363190 174980 28764907 INTEREST IN NET ASSETS OF FCHN 2543080 DEFERRED COMPENSATION ASSET 2034294 EST. THIRD PARTY PAYOR SETTLEMENTS 684951 DUE FROM AFFILIATES 424036 BENEFICIAL INT. IN PERPETUAL TRUST 283313 OTHER ASSETS 191372 GOODWILL 70476 6231522 DUE TO RELATED PARTIES 3658602 DEFERRED COMPENSATION LIABILITY 2034294 MEDICAL MALPRACTICE TAIL LIAB. 600000 INSURANCE CLAIM LIABILITY 298645 LINE OF CREDIT 6591541 X 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. true true true X 1.750000000000 true X 2.250000000000 true true false true true 1339926 1339926 0.01650 12875890 10464841 2411049 0.02980 14215816 10464841 3750975 0.04630 521019 53181 467838 0.00580 317755 102228 215527 0.00270 10035142 4301014 5734128 0.07080 23075 23075 0.00030 10896991 4456423 6440568 0.07950 25112807 14921264 10191543 0.12580 false 2150654 17786965 21686101 -3899136 X true true WESTERN MAINE PHO PHYSICIAN HOSPITAL ORGANIZATION 0.50000 SCOREKEEPER LLC WELLNESS SOFTWARE 0.40000 1 1 FRANKLIN MEMORIAL HOSPITAL 111 FRANKLIN HEALTH COMMONS FARMINGTON ME 04938 WWW.FCHN.ORG/ABOUT ME STATE LIC. 38506 X X X FRANKLIN MEMORIAL HOSPITAL 1 false false true X X X X X X X X 16 true true false true X SEE PART V, SECTION C X true 16 true SEE PART V, SECTION C false true X 175.000000000000 225.000000000000 X X true true X X X true X WWWFCHNORGPAYINGFORCARE X WWWFCHNORGPAYINGFORCARE X X X true X true X X X X true X false false 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. 15 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 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. false false false false false false false false false REBECCA ARSENAULT PRESIDENT/CEO 332634 12000 17500 5300 10928 378362 TIMOTHY CHURCHILL INTERIM PRES / CEO 272901 45000 19829 31749 18458 387937 HEIDI DECKER MD MEDICAL STAFF PRES. 186875 12700 3035 17073 219683 JAY NALIBOFF VP MED. AFFAIRS 235365 4684 14964 255013 WAYNE BENNETT CFO 207443 17500 4600 18031 247574 GERALD CAYER VP PHYS. & COMM. SVC 204555 4192 17175 225922 JOSHUA D SPARLING MD DERMATOLOGIST 430964 109607 17500 5300 19823 583194 OSCAR FISCHER MD ANESTHESIOLOGIST 393342 4026 397368 ERIC GUNTHER MD GENERAL SURGEON 356126 12400 5300 19044 392870 JAMES LANCASTER MD ANESTHESIOLOGIST 367967 5300 19654 392921 HEATHER DECAROLIS MD ANESTHESIOLOGIST 364154 5300 19654 389108 ROBERT O'REILLY MD FMR MED. STAFF PRES. 159164 38666 17500 4515 15335 235180 SCHEDULE J, PAGE 1, PART I, LINE 3 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. A MAINE HEALTH & HIGHER ED FAC AUTH 010314384 560427NM4 2011-11-30 10452958 REF. OF SERIES 2001A false false true B MAINE HEALTH & HIGHER ED FAC AUTH 010314384 56042REW8 2016-06-28 12359721 REF. OF SERIES 2006F false false true A 3689491 10452958 169105 117007 9633963 2002 true false true true B 12359721 192893 58709 12359721 2016 true false true true A false false false false false false false B false false false false false false false A false false false false false false false false false B false false false false false false false false false A false B false REBECCA WOOD FAMILY MEMBER 122504 EMPLOYMENT false SCHEDULE L, PART V 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. 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 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 SUITE 1 FARMINGTON ME 04938 223305743 COMMUNITY ME 501C3 7 22-3209406 false 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 WILLIAM A HOWELL TRUST FUND C/O BANK OF AMERICA NA PO BOX 830269 DALLAS TX 75283 016032170 PERP. TRST ME NA TRUST 291646 1.00000 false false false true false false false false false false true false false false false false false false false true