2016-02-23T06:56:34-06:00 2015-06-30 010242373 MACPAGE LLC 30 LONG CREEK DRIVE SOUTH PORTLAND ME 04106 990 2014-07-01 010284446 REDINGTON-FAIRVIEW GENERAL HOSPITAL REDI 2074745121 PO BOX 468 SKOWHEGAN ME 049760468 ELMER DOUCETTE CFO 2074745121 2016-02-18 1 GEORGE RAFUSE P00340697 2077745701 2016-02-18 2014 2016-08-17 19:52:53Z PO BOX 468 SKOWHEGAN ME 049760468 88764244 0 X WWW.RFGH.NET X 1969 ME SEE SCHEDULE O 9 6 764 27 0 0 1981712 3001533 77566822 82127247 1272066 3344706 268405 290758 81089005 88764244 0 0 0 0 45468399 48008281 0 0 0 36835768 39488423 82304167 87496704 -1215162 1267540 101992529 104303179 36796290 46659467 65196239 57643712 X SEE SCHEDULE O 0 0 42499980 55687918 RFGH PROVIDES 24 HOUR SEVEN DAY A WEEK EMERGENCY SERVICES. THESE SERVICES INCLUDE AN EMERGENCY DEPARTMENT STAFFED WITH PHYSICIANS 24 HOURS A DAY AS WELL AS AN AMBULANCE SERVICE WHICH OPERATES 24 HOURS A DAY. DURING FISCAL 2015, RFGH HAD 24,246 EMERGENCY DEPARTMENT VISITS AND 3,772 AMBULANCE RUNS. IN ADDITION TO EMERGENCY SERVICES, THE HOSPITAL PROVIDES A FULL RANGE OF SERVICES, RADIOLOGY, C.T., ULTRASOUND, NUCLEAR MEDICINE, BLOOD BANK, PATHOLOGY, CARDIOLOGY AND LABORATORY SERVICES. IN TOTAL, THESE SERVICES TREATED APPROXIMATELY 57,416 PATIENTS. 18463178 8801353 RFGH OPERATES A NUMBER OF PHYSICIAN OFFICES IN ORDER TO BETTER SERVE THE RESIDENTS OF SOMERSET COUNTY. DURING FISCAL 2015, THESE PHYSICIAN SPECIALTIES INCLUDED INTERNAL MEDICINE,ENDOCRINOLOGY,GENERAL SURGERY, ORTHOPEDICS, PEDIATRICS,FAMILY MEDICINE,OBSTETRICS GASTROENTEROLOGY AND NEUROLOGY. DURING FISCAL 2015, THESE PHYSICIAN SPECIALTIES SERVED 13,890 PATIENTS WHO TOTALLED 57,271 VISITS AT THESE OFFICES. 12596462 17928734 RFGH IS LICENSED AS A CRITICAL ACCESS HOSPITAL OPERATING 25 BEDS. RFGH EMPLOYS HOSPITALISTS WHO ARE PHYSICIANS DEDICATED TO THE TREATMENT OF INPATIENTS. INPATIENT SERVICES INCLUDE MEDICAL AND SURGICAL, SPECIAL CARE, OBSTETRICS AND PEDIATRICS. DURING FISCAL 2015, RFGH PROVIDED INPATIENT SERVICES TO 1,505 PATIENTS WHO STAYED 4,865 PATIENT DAYS. MEDICARE AND MEDICAID PATIENTS REPRESENTED 74% OF RFGH'S INPATIENTS. 1934595 1761160 REDINGTON-FAIRVIEW GENERAL HOSPITAL OPERATES SOMERSET PUBLIC HEALTH, A PROGRAM WHOSE PURPOSE IS TO PROTECT AND IMPROVE THE QUALITY OF LIFE AND HEALTH OF ALL GREATER SOMERSET COUNTY RESIDENTS. 1934595 1761160 75494215 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 75 0 1 764 1 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X RICHARD D WILLETT 2078582315 46 FAIRVIEW AVE SKOWHEGAN ME 049760468 CHRISTOPHER PERKINS PRESIDENT 2.00 X X 0 0 0 L JOSEPH CLARK VICE PRESIDENT 2.00 X X 0 0 0 JEFFREY LLOYD TREASURER 2.00 X X 0 0 0 DONNA FINLEY DIRECTOR 2.00 X 0 0 0 MICHAEL CURRAN MD DIRECTOR 50.00 X 446551 0 0 WILLIAM LANEY DIRECTOR 2.00 X 0 0 0 MICHAEL LAMBKE MD DIRECTOR 50.00 X 234867 0 0 JOHN WITHERSPOON DIRECTOR 2.00 X 0 0 0 GINA GOMEZ MD DIRECTOR 50.00 X 266114 0 0 RICHARD D WILLETT CEO/SECRETARY 50.00 X 353290 0 0 DANA C KEMPTON ASSOCIATE DIRECTOR 50.00 X 263080 0 0 TIRUNELLAI R SHANKAR SURGEON 50.00 X 341293 0 0 AMIR BAIG MD ANESTHESIOLOGIST 50.00 X 333643 0 0 JOHN COMIS MD ER PHYSICIAN 50.00 X 499877 0 0 MANJUNATH BANNUR MD ER PHYSICIAN 50.00 X 304293 0 0 WINOAH HENRY MD GASTROENTEROLOGIST 50.00 X 431909 0 0 3474917 0 0 52 0 1 0 VISTA STAFFING SOLUTIONS 275 EAST 200 SOUTH SALT LAKE CITY UT 84111 CLINICAL STAFFING 1132072 MAINEGENERAL HEALTH 33 STONE STREET AUGUSTA ME 04330 CLINICAL STAFFING 681417 DAHL-CHASE DIAGNOSTIC SERVICES 417 STATE STREET BANGOR ME 04401 LAB TESTING 496380 QUEST DIAGNOSTIC INC 5763 COLLECTION CENTER DR CHICAGO IL 60693 LAB TESTING 475840 COMPHEALTH PO BOX 972651 DALLAS TX 75297 CLINICAL STAFFING 419341 14 824156 2177377 3001533 NET PATIENT REVENUE 622110 82127247 82127247 82127247 3344706 3344706 CAFETERIA 622110 267115 267115 OTHER MISCELLANEOUS 622110 23643 23643 290758 88764244 82150890 0 3611821 1563902 947532 616370 35751785 31576686 4175099 1356845 1138393 218452 6861532 5756825 1104707 2474217 2075868 398349 65326 524 64802 83960 25848 58112 9590 9590 277254 14386 262868 5646871 5439871 207000 155010 155010 7545565 6870068 675497 3148201 972436 2175765 1975734 1772622 203112 102076 99360 2716 211921 178932 32989 1060844 909143 151701 3565095 2814619 750476 777555 632667 144888 BAD DEBT EXPENSE 8321678 8321678 EQUIPMENT & MAINTENANCE 2145103 1729076 416027 MEDICAID PROVIDER TAX 1574204 1574204 PHARMACEUTICALS 1572689 1572689 1249747 1070788 178959 87496704 75494215 12002489 0 1474138 4169519 9541144 6265751 10717369 11813892 486469 494653 1508274 1545444 131158 167866 75096612 48296588 27087478 26800024 50310530 52365408 735969 680622 101992529 104303179 8165135 8622520 22350718 21536247 6280437 16500700 36796290 46659467 X 64116694 56566045 1079545 1077667 65196239 57643712 101992529 104303179 X 1267540 -2852910 -5967157 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9590 9590 9590 9590 87487114 87487114 87496704 87496704 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 9178 9617 10270 9590 38655 250000 250000 250000 250000 1000000 1500000 375711 375711 42485846 22267122 20218724 32235055 26029466 6205589 26800024 LIABILITY FOR PENSION BENEFITS 8217708 ESTIMATED THIRD PARTY SETTLEMENTS 8282992 16500700 X 77589656 -2852910 -2852910 80442566 8321678 8321678 88764244 79175026 0 79175026 8321678 8321678 87496704 PART X, LINE 2: SCHEDULE D - PART X: THE HOSPITAL IS EXEMPT FROM TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MANAGEMENT EVALUATED THE HOSPITAL'S TAX POSITIONS AND CONCLUDED THAT THE HOSPITAL HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRED ADJUSTMENT TO THE FINANCIAL STATEMENTS. THE HOSPITAL HAS PROCESSES PRESENTLY IN PLACE TO ENSURE THE MAINTENANCE OF ITS TAX-EXEMPT STATUS; TO IDENTIFY AND REPORT UNRELATED INCOME AS NECESSARY; DETERMINE ITS FILING AND TAX OBLIGATIONS IN JURISDICTIONS FOR WHICH IT HAS NEXUS; AND TO REVIEW OTHER MATTERS THAT MAY BE CONSIDERED TAX POSITIONS. THE HOSPITAL IS SUBJECT TO U.S. FEDERAL AND STATE EXAMINATIONS BY TAX AUTHORITIES FOR YEARS ENDING JUNE 30, 2012 THROUGH 2015. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 8,321,678. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 8,321,678. 1 1 1 X 1 X 1 1 0 0 1161372 1161372 0.01330 1161372 1161372 0.01330 2004117 2004117 0.02290 18463178 8801353 9661825 0.11040 20467295 8801353 11665942 0.13330 21628667 8801353 12827314 0.14660 1 4229182 28315750 28663587 -347837 X 1 1 1 1 REDINGTON-FAIRVIEW GENERAL HOSPITAL 46 FAIRVIEW AVENUE PO BOX 468 SKOWHEGAN ME 04976 WWW.RFGH.NET 38095 X REDINGTON-FAIRVIEW GENERAL HOSPITAL 1 0 0 1 X X X X X X 14 1 1 0 1 X HTTPS://WWW.RFGH.NET/PORTALS/0/PDFS/COMMUNITY%20HEALTH% X SEE COMPLETE URL IN PART VI X 1 14 1 HTTPS://WWW.RFGH.NET/PORTALS/0/WORKPLAN%20UPDATE%20COMMUNITY%20%20ASSESSMEN 0 0 1 X 150.000000000000 225.000000000000 1 1 X X X 1 X X X X 0 0 X X X X 1 X 0 0 REDINGTON-FAIRVIEW GENERAL HOSPITAL PART V, SECTION B, LINE 5: HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY AND IDENTIFY THE PERSONS THE HOSPITAL CONSULTED:THE ORIGINAL SOURCE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IS THE SOMERSET COUNTY HEALTH COLLABORATIVE WHICH IS COMPOSED OF MANY COMMUNITY ORGANIZATIONS SUCH AS THE POLICE DEPARTMENT, SMALL BUSINESSES, RELIGIOUS GROUPS, BEHAVIORAL HEALTH GROUPS, SCHOOL SYSTEMS, AND OTHER RESOURCE GROUPS. AT THE REGIONAL LEVEL, SOMERSET PUBLIC HEALTH HAS TWO REPRESENTATIVES THAT PARTICIPATE ON THE CENTRAL DISTRICT GROUP WHERE COLLABORATION WITH OTHER HEALTH SYSTEMS OCCURS. REDINGTON-FAIRVIEW GENERAL HOSPITAL PART V, SECTION B, LINE 6A: OTHER HOSPITALS INCLUDED IN CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENT:THE 2014 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH EASTERN MAINE HEALTHCARE SYSTEMS. REDINGTON-FAIRVIEW GENERAL HOSPITAL PART V, SECTION B, LINE 11: HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS.....:SEE ATTACHED RFGH 2015 COMMUNITY HEALTH ANNUAL NEEDS ASSESSMENT & WORKPLAN AND RFGH 2012-2015 COMMUNITY HEALTH WORKPLAN REDINGTON-FAIRVIEW GENERAL HOSPITAL PART V, SECTION B, LINE 22D: HOW HOSPITAL DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED FAP-ELIGIBLE INDIVIDUALS:ALL ACCOUNT GUARANTORS WHO EXPRESS AN INABILITY TO PAY FOR SERVICES ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE USING AN APPLICATION AND GUIDELINES ESTABLISHED BY THE HOSPITAL. UNDER THESE GUIDELINES, ELIGIBLE APPLICANTS MAY QUALIFY FOR 100% CHARITY CARE OR DISCOUNTED CHARGES RANGING FROM 25% TO 100%. PART V, SECTION B, LINE 11 HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED.THE INTENT OF THE COMMUNITY HEALTH ASSESSMENT IS TO USE IT AS A PLANNING TOOL TO ASSIST IN INITIATING STRATEGIC INITIATIVES TO MEET THE NEEDS OF CITIZENS WHOSE HEALTH NEED ARE AT RISK IN OUR COMMUNITY. COMMUNITY HEALTH STRIVES TO PROMOTE HEALTHY BEHAVIORS THROUGH THE SERVICES PROVIDED. RFGH WORKS IN COLLABORATION WITH NUMEROUS ORGANIZATIONS AND COMMUNITY PARTNERS TO WORK ON PREVENTATIVE HEALTH SERVICES IN OUR COMMUNITY. ASSESSMENTS COMPLETED:-"OVER THE PAST EIGHT YEARS, RFGH HAS WORKED TO IMPROVE THE APPROACHES TO THE COMMUNITY ASSESSMENT. ASSESSMENTS WERE COMPLETED IN 2007, 2010, 2012, 2013, AND 2014.-"IN ADDITION, SOMERSET PUBLIC HEALTH, AS PART OF THEIR HEALTHY MAINE PARTNERSHIP WORK, COMPLETED A MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) ASSESSMENT PROCESS IN 2011 AS PART OF THE STRATEGIC APPROACH TO COMMUNITY HEALTH IMPROVEMENT. "BEARING THE FRUITS OF OUR LABOR" IS AN EVALUATION FRAMEWORK FOR SOMERSET PUBLIC HEALTH WAS COMPLETED IN 2013.-"A SOMERSET COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN AUGUST 2014 BY EASTERN MAINE HEALTHCARE SYSTEMS WITH RFGH AS A PARTNERING HOSPITAL.-"IN 2014 RFGH STRATEGIZED OUR HEALTHY COMMUNITY GOALS AS LISTED BELOW: * TO PROMOTE HEALTHY BEHAVIORS (PROMOTE NUTRITION AND WEIGHT STATUS, PROMOTE PHYSICAL ACTIVITY AND FITNESS, REDUCE TOBACCO USE AND REDUCE USE OF ALCOHOL AND OTHER DRUGS) * TO PROMOTE HEALTHY AND SAFE COMMUNITIES (IMPROVE ENVIRONMENTAL HEALTH, INCREASE VACCINATIONS, PREVENT INJURIES, AND PROMOTE EDUCATIONAL AND COMMUNITY BASED PROGRAMS) * TO IMPROVE SYSTEMS (ACCESS TO PRIMARY CARE, SPECIALTY CARE AND EMERGENCY CARE) IMPROVE MATERNAL, INFANT AND CHILD CARE, IMPROVE HEALTH COMMUNICATION AND TECHNOLOGY, IMPROVE PUBLIC HEALTH INFRASTRUCTURE) * TO PREVENT, REDUCE AND MANAGE DISEASES AND DISORDERS (CANCER, CARDIOVASCULAR/HEART DISEASE AND STROKE, CHRONIC DISEASES, INFECTIOUS DISEASES, PULMONARY AND RESPIRATORY HEALTH)"PARTICIPATED IN THE MAINE SHARED CHNA STAKEHOLDER NEEDS ASSESSMENT - 2015.2015 COMMUNITY HEALTH ANNUAL NEEDS ASSESSMENT REPORT & COMMUNITY HEALTH WORK PLAN IS ATTACHED. PART I, LINE 7: METHODOLOGY USED TO ESTIMATE FINANCIAL ASSISTANCE AT COST:CHARITY CARE WRITE-OFFS ARE RECORDED AT GROSS CHARGES. IN ORDER TO COMPUTE THE COST OF THESE SERVICES, THE HOSPITAL ADJUSTED BOTH GROSS CHARGES AND EXPENSES BY EXCLUDING THE GROSS CHARGES AND EXPENSES ASSOCIATED WITH SUBSIDIZED HEALTH SERVICES REPORTED IN SCHEDULE H PART I LINE 7G AND CALCULATED A RATIO OF COST-TO-CHARGES. THE RESULTING RATIO OF 50.82% WAS APPLIED TO THE GROSS CHARGES PERTAINING TO CHARITY CARE WRITE-OFFS.METHODOLOGY USED TO ESTIMATE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS:THESE COMMUNITY BENEFIT EXPENSES REPRESENT THE ACTUAL EXPENDITURES OF OPERATING THE SOMERSET PUBLIC HEALTH COLLABORATIVE WHICH SERVES MOST OF MAINE'S SOMERSET COUNTY. PART I, LINE 7G: METHODOLOGY USED TO ESTIMATE SUBSIDIZED HEALTH SERVICES:THESE COMMUNITY BENEFIT EXPENSES REPRESENT THE DIRECT AND INDIRECT COSTS OF OPERATING PHYSICIAN PRACTICES WHICH OPERATE WITH REVENUES THAT ARE INSUFFICIENT TO COVER THE OVERALL COSTS. INDIRECT COSTS ARE CALCULATED USING AN ALLOCATION METHOD SIMILAR TO MEDICARE COST REPORT METHODS OF ALLOCATING OVERHEAD COSTS. PART III, LINE 2: BAD DEBT EXPENSEBAD DEBT WRITE-OFFS ARE RECORDED AT GROSS CHARGES. IN ORDER TO COMPUTE THE COST OF THESE SERVICES, THE HOSPITAL ADJUSTED BOTH GROSS CHARGES AND EXPENSES BY EXCLUDING THE GROSS CHARGES AND EXPENSES ASSOCIATED WITH SUBSIDIZED HEALTH SERVICES REPORTED IN SCHEDULE H PART I LINE 7G AND CALCULATED A RATIO OF COST-TO-CHARGES. THE RESULTING RATIO OF 50.82% WAS APPLIED TO THE GROSS CHARGES PERTAINING TO BAD DEBT WRITE-OFFS. PART III, LINE 4: FOOTNOTE DESCRIBING BAD DEBTSNOTE 2 - CONCENTRATION OF CREDIT RISKIN FULFILLING ITS CHARITABLE MISSION, THE HOSPITAL GRANTS CREDIT WITHOUT COLLATERAL TO THEIR PATIENTS, MANY OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. AT JUNE 30, 2015 AND 2014, NET ACCOUNTS RECEIVABLE RELATING TO PATIENTS WITHOUT INSURANCE WAS 23.2% AND 24.0%, RESPECTIVELY.ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT THAT MANAGEMENT EXPECTS TO COLLECT. MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO THE CONSOLIDATED STATEMENT OF OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE ALLOWANCE ACCOUNT AND A CREDIT TO ACCOUNTS RECEIVABLE.IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE HOSPITAL DEDUCTED ITS PROVISION FOR UNCOLLECTABLE ACCOUNTS OF $7,322,462 AND $6,554,465 FOR THE YEARS ENDED JUNE 30, 2015 AND 2014 RESPECTIVELY FROM REVENUE.ACCOUNTS RECEIVABLE AT JUNE 30, 2015 AND 2014 ARE COMPRISED OF THE FOLLOWING:_______________________________________2015__________________2014 PATIENT ACCOUNTS___________________$20,891,479______________$19,107,740ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS(4,228,298)____________(3,640,921)ALLOWANCE FOR CONTRACTUAL ALLOWANCES(4,849,288)____________(4,749,449)ACCOUNT RECEIVABLE - NET__________$ 11,813,893_____________$10,717,370 PART III, LINE 8: MEDICARE SHORTFALL METHOD OF CALCULATING:MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B. INPATIENT MEDICARE COSTS ARE CALCULATED BASED UPON A COMBINATION OF ALLOWABLE COST PER DAY MULTIPLIED BY MEDICARE DAYS FOR ROUTINE SERVICES PLUS A COST-TO-CHARGE RATIO MULTIPLIED BY MEDICARE CHARGES BY ANCILLARY DEPARTMENT. OUTPATIENT COST IS CALCULATED BASED ON A COST-TO-CHARGE RATIO MULTIPLIED BY MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS THE GUIDELINES FOR FINANCIAL ASSISTANCE, AND CONTAINS PROVISIONS FOR HOSPITAL STAFF TO EXTEND TO QUALIFIED PATIENTS WHO WOULD LIKELY MEET SLIDING SCALE FEE CRITERIA THE OPPORTUNITY TO APPLY FOR DISCOUNTED CARE. HOSPITAL RESOURCES ARE MADE AVAILABLE TO PATIENTS REQUIRING ASSISTANCE IN COMPLETING APPLICATIONS. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY ARE PROVIDED DISCOUNTS RANGING FROM 25% TO 100% OF CHARGES. ONCE QUALIFIED PATIENTS MAY BE EXTENDED REDUCED FEE FOR HEALTH CARE SERVICES RECEIVED IN THE FUTURE. ALL PATIENTS ARE ASKED TO REAPPLY ANNUALLY TO THE SLIDING FEE PROGRAM. OUTSIDE COLLECTION AGENCIES CONTRACTED WITH THE HOSPITAL MUST SPECIFY THEIR STANDARDS AND SCOPE OF PRACTICES, ALL OF WHICH MUST BE IN COMPLIANCE WITH THE COLLECTION POLICY. PART VI, LINE 2: NEEDS ASSESSMENT: DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED.REDINGTON-FAIRVIEW GENERAL HOSPITAL OPERATES SOMERSET PUBLIC HEALTH (SPH), A PROGRAM WHOSE PURPOSE IS TO PROTECT AND IMPROVE THE QUALITY OF LIFE AND HEALTH OF ALL GREATER SOMERSET COUNTY RESIDENTS. SPH PROVIDES PLANNING AND EVALUATION OF BOTH LONG AND SHORT RANGE STRATEGIES FOR ESSENTIAL PUBLIC HEALTH SERVICES. SPH INVOLVES CITIZENS IN DEVELOPING AND CARRYING OUT CHRONIC DISEASE PREVENTION THROUGH VARIOUS INITIATIVES. SPH MOBILIZES BOTH PUBLIC AND PRIVATE RESOURCES IN SUPPORT OF THESE INITIATIVES AND COORDINATES EFFORTS THROUGHOUT THE COMMUNITY. BY WORKING WITH CITIZENS, SPH SERVES AS ADVOCATES ON MATTERS OF POLICIES THAT AFFECT HEALTH STATUS, WHILE PROMOTING INSTITUTIONAL IMPROVEMENT AND DESIRABLE CHANGES IN SOCIAL POLICY AND ENVIRONMENTAL CHANGE. SPH IMPLEMENTS PROGRAMS FINANCED THROUGH GRANTS, OR DELEGATES IMPLEMENTATION TO OTHER AGENCIES. SPH ALSO IDENTIFIES AND PURSUES OTHER AVAILABLE FUNDS DEEMED IMPORTANT FOR THE HEALTH OF CITIZENS. IN ITS WORK TO IMPROVE AND PROTECT PUBLIC HEALTH AND REDUCE CHRONIC DISEASE, SPH FOCUSES ITS EFFORTS AND FUNDING ON SUBSTANCE ABUSE AND TOBACCO PREVENTION, PHYSICAL ACTIVITY AND NUTRITION PROMOTION, AND WORKSITE WELLNESS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:REDINGTON-FAIRVIEW GENERAL HOSPITAL PROVIDES THE FOLLOWING INFORMATION IN THE FIRST BILL THAT EACH PATIENT RECEIVES:REDINGTON-FAIRVIEW GENERAL HOSPITAL46 FAIRVIEW AVENUEPO BOX 468SKOWHEGAN, ME 04976207-474-5121CATEGORY A & B SLIDING FEE SCALEREDINGTON-FAIRVIEW GENERAL HOSPITAL (RFGH) FOLLOWS MAINE STATE LAW AND PROVIDES FREE HOSPITAL SERVICE TO THOSE INDIVIDUALS WHO CANNOT AFFORD TO PAY UNDER CATEGORY A FREE CARE. RFGH HAS A SLIDING FEE SCALE (CATEGORY B) AND OTHER PROGRAMS AVAILABLE WHICH MAY PROVIDE HOSPITAL SERVICES AT A REDUCED AMOUNT TO THOSE INDIVIDUALS WHO CANNOT AFFORD TO PAY. IF YOU BELIEVE YOU QUALIFY FOR ASSISTANCE, YOU MAY COMPLETE AN APPLICATION AT THE PATIENT ACCOUNTS OFFICE, LOCATED AT 22 JONES STREET-THE WHITE BUILDING IN THE BACK PARKING LOT OF THE HOSPITAL. THE PATIENT ACCOUNTS OFFICE IS OPEN FROM 7:30AM TO 3:00 PM MONDAY THROUGH FRIDAY. IF YOU WOULD LIKE TO SPEAK TO A REPRESENTATIVE REGARDING THE APPLICATION PROCESS AND/OR WOULD LIKE TO MAKE AN APPOINTMENT TO COMPLETE THE APPLICATION PROCESS, PLEASE CALL 858 - 8367 TO COMPLETE THE APPLICATION PROCESS YOU (OR YOUR DESIGNEE) WILL NEED TO PRESENT AND PROVIDE PROOF OF INCOME TO DETERMINE YOUR ELIGIBILITY FOR ASSISTANCE, INCLUDING THE FOLLOWING: YOUR MOST RECENT FEDERAL INCOME TAX RETURN, IF YOU DO NOT FILE TAXES YOU WILL HAVE TO SIGN A DOCUMENT STATING YOU DO NOT FILE INCOME TAXES. YOUR LAST THREE MONTHS WAGE STUBS OR A SIGNED STATEMENT FROM YOUR EMPLOYER VERIFYING YOUR GROSS EARNINGS FOR THE LAST THREE MONTHS. A LIST OF ALL INCOME FROM STOCKS, BONDS, INTEREST INCOME ON SAVINGS ACCOUNTS, ANNUITIES, AND RENTAL INCOME.YOU WILL ALSO BE ASKED TO OBTAIN A DENIAL LETTER FROM THE STATE OF MAINE IF YOU ARE NOT ELIGIBLE FOR MAINECARE ASSISTANCE. {NOTE: THIS DENIAL LETTER IS ONLY GOOD FOR THIRTY (30) DAYS.}TO BE ELIGIBLE FOR FREE CARE (CATEGORY A) OR THE RFGH SLIDING FEE (CATEGORY B), YOUR FAMILY INCOME MUST BE BELOW THE FOLLOWING LEVELS. THE HOSPITAL WILL CONSIDER THE HIGHEST INCOME LEVEL AVAILABLE BASED ON THE NUMBER OF DEPENDENTS THAT YOU HAVE (SEE THE TABLES BELOW). IF YOU DO NOT QUALIFY FOR FREE CARE (CATEGORY A), YOU ARE ALLOWED TO ASK FOR A FAIR HEARING. THE STATE DEPARTMENT OF HUMAN SERVICES WILL TELL YOU HOW TO APPLY FOR A FAIR HEARING. IN ADDITION, RFGH WILL PROVIDE YOU WITH A FINAL DETERMINATION OF YOUR ELIGIBILITY FOR ASSISTANCE WITHIN FIVE (5) WORKING DAYS OF YOUR REQUEST. IF YOU DO NOT QUALIFY FOR A FULL 100% RFGH DISCOUNT (CATEGORY B), A MONTHLY PAYMENT PLAN WILL BE CALCULATED BY THE PATIENT ACCOUNTS REPRESENTATIVE. DURING THE DETERMINATION OF YOUR PAYMENT PLAN YOU WILL ALSO NEED TO HAVE INFORMATION ABOUT YOUR HOUSEHOLD EXPENSES AVAILABLE. YOU WILL NEED TO SIGN A PAYMENT AGREEMENT CONTRACT AND FAITHFULLY COMPLETE YOUR PAYMENT PORTION IN ORDER TO RECEIVE THE NEGOTIATED DISCOUNT. **SERVICES THAT ARE NOT MEDICALLY NECESSARY ARE NOT ELIGIBLE FOR FREE OR DISCOUNTED CARE AND YOU WILL BE REQUIRED TO PAY FOR THEM BEFORE SERVICES ARE RENDERED.**CATEGORY AFREE CARE @ 100%FAMILY SIZE ANNUAL INCOME1_______17,6552_______23,8953_______30,1354_______36,3755_______42,6156_______48,8557_______55,0958_______61,335FOR EACH ADDITIONAL PERSON, ADD $6,240 ANNUALLY.CATEGORY B RFGH SLIDING FEE SCALEDISCOUNT 100% 75% 50% 25% INCOME INCOME INCOME INCOME FAMILY SIZE TO TO TO TO1_____________28,248________32,014_______35,781_______39,5472_____________34,072________37,838_______41,605_______45,3713_____________39,896________43,662_______47,429_______51,1954_____________45,720________49,486_______53,253_______57,0195_____________51,544________55,310_______59,077_______62,8436_____________57,368________61,134_______64,901_______68,6677_____________63,192________66,958_______70,725_______74,4918_____________69,016________72,782_______76,549_______80,315 FOR EACH ADDITIONAL PERSON, ADD $5,824 ANNUALLY PART VI, LINE 4: COMMUNITY INFORMATION:REDINGTON-FAIRVIEW GENERAL HOSPITAL IS AN INDEPENDENT 25-BED CRITICAL ACCESS HOSPITAL LOCATED IN SKOWHEGAN, MAINE. THE HOSPITAL PROVIDES HEALTH CARE TO MORE THAN 51,000 RESIDENTS LIVING IN SOMERSET COUNTY, MAINE. ITS PRIMARY SERVICE AREA EXTENDS FROM SKOWHEGAN TO THE CANADIAN BORDER. A STATE OF THE ART MEDICAL OFFICE BUILDING ADJACENT TO THE HOSPITAL PROVIDES EASY ACCESS TO PRIMARY AND SPECIALTY CARE. A MEDICAL STAFF OF MORE THAN 40 PHYSICIANS SKILLED IN A VARIETY OF FIELDS, AND APPROXIMATELY 650 FULL AND PART-TIME PROFESSIONAL AND TECHNICAL EMPLOYEES ENSURE THE DELIVERY OF PROGRESSIVE HEALTH AND MEDICAL SERVICES. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:THE HOSPITAL IS LOCATED IN A MEDICALLY UNDERSERVED AREA. CONSEQUENTLY, THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF. IN ADDITION TO THE PROGRAMS OUTLINED IN OTHER AREAS OF THE FORM 990, THE HOSPITAL OPERATES A FITNESS FACILITY WHICH OPERATES AT A LOSS. THE FITNESS FACILITY OPERATES MANY PROGRAMS WHICH PROMOTES WELLNESS. OTHER WELLNESS PROGRAMS ARE ALSO PROVIDED THROUGH THE INDOOR POOL THAT THE HOSPITAL OPERATES AT A LOSS. THE POOL PROMOTES WELLNESS AMONG INDIVIDUALS WHO WOULD NOT BE ABLE TO OTHERWISE EXERCISE (DISABLED INDIVIDUALS WITH CHRONIC PAIN, MS AND OTHER DEBILITATING DISEASES). THE HOSPITAL ALSO OPERATES SOMERSET PUBLIC HEALTH, A PROGRAM WHOSE PURPOSE IS TO PROTECT AND IMPROVE THE QUALITY OF LIFE AND HEALTH OF ALL GREATER SOMERSET COUNTY RESIDENTS. X X X X 0 0 0 1 0 0 0 0 0 MICHAEL CURRAN MD DIRECTOR 349267 0 82857 0 14427 0 0 0 0 0 446551 0 0 0 MICHAEL LAMBKE MD DIRECTOR 175998 0 47453 0 11416 0 0 0 0 0 234867 0 0 0 GINA GOMEZ MD DIRECTOR 237710 0 10386 0 18018 0 0 0 0 0 266114 0 0 0 RICHARD D WILLETT CEO/SECRETARY 331713 0 0 0 21577 0 0 0 0 0 353290 0 0 0 DANA C KEMPTON ASSOCIATE DIRECTOR 244209 0 0 0 18871 0 0 0 0 0 263080 0 0 0 TIRUNELLAI R SHANKAR SURGEON 246936 0 79157 0 15200 0 0 0 0 0 341293 0 0 0 AMIR BAIG MD ANESTHESIOLOGIST 316302 0 0 0 17341 0 0 0 0 0 333643 0 0 0 JOHN COMIS MD ER PHYSICIAN 484625 0 0 0 15252 0 0 0 0 0 499877 0 0 0 MANJUNATH BANNUR MD ER PHYSICIAN 290340 0 0 0 13953 0 0 0 0 0 304293 0 0 0 WINOAH HENRY MD GASTROENTEROLOGIST 360598 0 57870 0 13441 0 0 0 0 0 431909 0 0 0 PART I, LINE 5 PHYSICIANS EMPLOYED BY THE HOSPITAL PARTICIPATE IN AN INCENTIVE BASED COMPENSATION PROGRAM. THE PROGRAM IS BASED UPON A REVENUE TARGET WHICH WILL PRODUCE A TARGET COMPENSATION LEVEL, WHICH IS BASED ON BOTH LOCAL AND NATIONAL BENCHMARK INFORMATION. IN ORDER TO ALIGN THE PHYSICIAN WITH THE CHARITABLE MISSION OF THE HOSPITAL THE PROGRAM IS BASED ON THE HOSPITAL'S ACTUAL CHARGES, SO THAT THE PHYSICIAN WILL HAVE AN INCENTIVE TO TAKE ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SUM OF ALL CHARGES FOR SERVICES PERFORMED BY THE PHYSICIAN IS TABULATED ON A QUARTERLY BASIS. THAT TABULATION IS THEN DIVIDED BY THE REVENUE TARGET, WHICH IS MULTIPLIED TIMES THE TARGET COMPENSATION LEVEL. IF A PHYSICIAN'S ACTUAL COMPENATION IS LESS THAN THE CALULATED SALARY, THE PHYSICIAN WILL RECIEVE A BONUS PAYMENT THAT RECOGNIZES THE PHYSICIAN'S CONTIRBUTION TO THE HOSPITAL'S ACHIEVEMENT OF IT'S CHARITABLE MISSION TO PROVIDE HEALTH SERVICES FOR THE BENEFIT OF THE COMMUNITY. A MAINE HEALTH & HIGHER EDUCATION FACILITY AUTHORITY 010314384 560425V80 2007-11-01 72040461 REPLACEMENT OF TWO BOILERS, PURCHASE OF A BACK-UP GENERATOR 0 0 1 B MAINE HEALTH & HIGHER EDUCATION FACILITY AUTHORITY 010314384 560427JA5 2010-06-24 108030000 BOND REFINANCING 1 0 1 A 23882032 1513579 304303 23577729 0 0 1 1 B 4202585 390171 4439445 47690 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 FORM 990, PART I, LINE 1 REDINGTON-FAIRVIEW GENERAL HOSPITAL'S MISSION IS TO DEVELOP, PROVIDE, AND FACILITATE QUALITY, SAFE, COMPREHENSIVE, COST-EFFECTIVE HEALTH SERVICES FOR THE PEOPLE WE SERVE. WE AFFIRM A COMMITMENT TO MAINTAIN OUR UNIQUE COMMUNITY HOSPITAL IDENTITY, OFFERING PERSONALIZED SERVICES. FORM 990, PART III, LINE 1 REDINGTON-FAIRVIEW GENERAL HOSPITAL'S MISSION IS TO DEVELOP, PROVIDE, AND FACILITATE QUALITY, SAFE, COMPREHENSIVE, COST-EFFECTIVE HEALTH SERVICES FOR THE PEOPLE WE SERVE. WE AFFIRM A COMMITMENT TO MAINTAIN OUR UNIQUE COMMUNITY HOSPITAL IDENTITY, OFFERING PERSONALIZED SERVICES. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING THE FORM 990, THE HOSPITAL'S CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER REVIEWED THE FILING IN DETAIL WITH THE HOSPITAL BOARD. THE BOARD FOUND THE REPORT TO BE COMPREHENSIVE AND COMPLETE AND SUPPORTED ITS FILING AS REVIEWED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE CONFLICT OF INTERESTS DISCLOSURE IS REVIEWED WITH THE MEMBERS OF THE BOARD AND DIRECTORS, WHO THEN SIGN THE DISCLOSURE FORM 990, PART VI, SECTION B, LINE 15A SEE SCHEDULE J FORM 990, PART VI, SECTION C, LINE 19 REDINGTON FAIRVIEW GENERAL MAKE ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST FORM 990, PART XI, LINE 9: INCREASE IN TEMPORARILY RESTRICTED ASSETS -1,878. EFFECT OF ASC 715 -5,965,279. SCHEDULE H, PART V, SECTION B, LINE 11 2015 COMMUNITY HEALTH ANNUAL NEEDS ASSESSMENT REPORT & COMMUNITY HEALTH WORK-PLAN RFGH MISSION - TO DEVELOP, PROVIDE, AND FACILITATE HIGH QUALITY, COMPREHENSIVE, COST-EFFECTIVE HEALTH SERVICES FOR THE PEOPLE WE SERVE. WE AFFIRM A COMMITMENT TO MAINTAIN OUR UNIQUE COMMUNITY HOSPITAL IDENTITY, OFFERING PERSONALIZED SERVICES. RFGH COMMUNITY ENGAGEMENT STRATEGIES COMMUNITY HEALTH IMPROVEMENT - DIRECTLY, OR IN COLLABORATION WITH OTHERS, IDENTIFY AND PROVIDE HEALTH, PREVENTION AND EDUCATION SERVICES THROUGHOUT THE COMMUNITY. OFFER COMMUNITY EDUCATION, DISEASE PREVENTION AND WELLNESS INITIATIVES BASED ON COMMUNITY NEED. PUBLIC HEALTH INFRASTRUCTURE DEVELOPMENT - AS A MEMBER AND FISCAL AGENT FOR SOMERSET PUBLIC HEALTH, RFGH WORKS COLLABORATIVELY WITH REGIONAL HEALTH AND WELLNESS PROVIDERS TO DELIVER PUBLIC HEALTH SERVICES. INTRODUCTION & BRIEF HISTORY THE INTENT OF THE COMMUNITY HEALTH ASSESSMENT IS TO USE IT AS A PLANNING TOOL TO ASSIST IN INITIATING STRATEGIC INITIATIVES TO MEET THE NEEDS OF CITIZENS WHOSE HEALTH NEED ARE AT RISK IN OUR COMMUNITY. COMMUNITY HEALTH STRIVES TO PROMOTE HEALTHY BEHAVIORS THROUGH THE SERVICES PROVIDED. RFGH WORKS IN COLLABORATION WITH NUMEROUS ORGANIZATIONS AND COMMUNITY PARTNERS TO WORK ON PREVENTATIVE HEALTH SERVICES IN OUR COMMUNITY. ASSESSMENTS COMPLETED: " OVER THE PAST EIGHT YEARS RFGH HAS WORKED TO IMPROVE THE APPROACHES TO THE COMMUNITY ASSESSMENT. ASSESSMENTS WERE COMPLETED IN 2007, 2010, 2012, AND 2013. " IN ADDITION, SOMERSET PUBLIC HEALTH, PREVIOUSLY KNOWN AS SOMERSET HEART HEALTH AND LATER AS GREATER SOMERSET PUBLIC HEALTH COLLABORATIVE, AS PART OF THEIR HEALTHY MAINE PARTNERSHIP WORK, COMPLETED A MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) ASSESSMENT PROCESS IN 2011 AS PART OF THE STRATEGIC APPROACH TO COMMUNITY HEALTH IMPROVEMENT. "BEARING THE FRUITS OF OUR LABOR" IS AN EVALUATION FRAMEWORK FOR SOMERSET PUBLIC HEALTH WAS COMPLETED IN 2013. " A SOMERSET COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN AUGUST 2014 (EMHS) WITH RFGH AS PARTNERING HOSPITAL. " IN 2014 RFGH STRATEGIZED OUR HEALTHY COMMUNITY GOALS AS LISTED BELOW: " TO PROMOTE HEALTHY BEHAVIORS (PROMOTE NUTRITION AND WEIGHT STATUS, PROMOTE PHYSICAL ACTIVITY AND FITNESS, REDUCE TOBACCO USE AND REDUCE USE OF ALCOHOL AND OTHER DRUGS) " TO PROMOTE HEALTHY AND SAFE COMMUNITIES (IMPROVE ENVIRONMENTAL HEALTH, INCREASE VACCINATIONS, PREVENT INJURIES, AND PROMOTE EDUCATIONAL AND COMMUNITY BASED PROGRAMS) " TO IMPROVE SYSTEMS (ACCESS TO PRIMARY CARE, SPECIALTY CARE AND EMERGENCY CARE) IMPROVE MATERNAL, INFANT AND CHILD CARE, IMPROVE HEALTH COMMUNICATION AND TECHNOLOGY, IMPROVE PUBLIC HEALTH INFRASTRUCTURE) " TO PREVENT, REDUCE AND MANAGE DISEASES AND DISORDERS (CANCER, CARDIOVASCULAR/ HEART DISEASE AND STROKE, CHRONIC DISEASES, INFECTIOUS DISEASES, PULMONARY AND RESPIRATORY HEALTH) " PARTICIPATED IN THE MAINE SHARED CHNA STAKEHOLDER NEEDS ASSESSMENT - 2015 MOVING FORWARD WITH ASSESSMENT AND EVALUATION MOVING FORWARD IN 2015 - 2016, RFGH, SOMERSET PUBLIC HEALTH AND OTHERS ARE WORKING IN SOMERSET COUNTY AND KENNEBEC COUNTY TO SHARE INFORMATION IN THE COMMUNITY AND TO HAVE THE COMMUNITY PROVIDE THEIR INPUT ON PRIORITIES AS WE MOVE FORWARD. THE HOSPITALS IN MAINE HAVE COME TOGETHER TO DO THEIR NEEDS ASSESSMENTS. THE SHARED HOSPITAL NEEDS ASSESSMENT PLANNING PROCESS (SHNAPP) WILL HAVE DISTRICT LEVEL (KENNEBEC AND SOMERSET COUNTIES) INDICATORS (USING SECONDARY DATA) WHICH WILL BE PROVIDED TO THE DISTRICTS IN EARLY NOVEMBER. THE DATA WILL BE PACKAGED TO HIGHLIGHT EACH DISTRICT'S PRIORITY HEALTH ISSUES. "BEARING THE FRUITS OF OUR LABORS" IS THE EVALUATION FRAMEWORK OF SOMERSET PUBLIC HEALTH (FORMALLY KNOWN AS GREATER SOMERSET PUBLIC HEALTH COLLABORATIVE). THE NEXT UPDATE WILL BE AVAILABLE IN SEPTEMBER OF 2015 FOR THE SEPTEMBER 14 ANNUAL MEETING WHERE THE DIRECTOR OF THE HEALTH INDEX INITIATIVE AT MAINE MEDICAL SHALL PRESENT OUR COUNTY HEALTH RANKING INFORMATION AS WELL AS WHAT QUALITATIVE DATA FROM THE SHNAPP FOR OUR COUNTY THAT IS AVAILABLE. THE GOAL: NEXT STEPS FOR CHANGING OUR HEALTH STATUS. IN AUGUST, 2015 RFGH BEGAN TO SEEK OUR DIRECT COMMUNITY MEMBERS INPUT THROUGH A SURVEY THAT ASKS INDIVIDUALS TO RATE HEALTH ISSUES BASED ON HOW THEY FEEL THEY IMPACT THEIR OVERALL HEALTH. TO DATE, JUST OVER 100 SURVEYS HAVE BEEN COLLECTED. WE WILL CONTINUE THE SURVEYING PROCESS WITH EACH SUPPORT GROUP AND COMMUNITY OUTREACH PROGRAM AS APPLICABLE AS A MEANS OF COLLECTING MEANINGFUL INFORMATION FROM OUR COMMUNITY. THE FOLLOWING CHARTS GIVE A PICTURE OF WHAT THE FIRST 100 WHO COMPLETED THE SURVEY HAD TO SAY. MUCH OF THE NEEDS ASSESSMENTS FROM 2007 - 2013 HAVE FOCUSED ON CHRONIC DISEASES. CHRONIC DISEASES INCLUDE CARDIOVASCULAR DISEASES (HEART AND STROKE), CANCER, CHRONIC RESPIRATORY DISEASES, DIABETES, AND BONE AND JOINT DISORDERS SUCH AS ARTHRITIS AND OSTEOPOROSIS. "CHRONIC DISEASE" MAY ALSO BE INCLUSIVE OF ORAL DISEASE AND MENTAL DISORDERS; HOWEVER, RFGH ASSISTS THE COMMUNITY WITH THESE SERVICES THROUGH REFERRALS RATHER THAN DIRECT SERVICE. CAUSES OF CHRONIC DISEASES MAY HAVE UNDERLYING SOCIOECONOMIC, CULTURAL, POLITICAL AND ENVIRONMENTAL DETERMINANTS. VERY OFTEN THERE ARE COMMON MODIFIABLE RISK FACTORS, NON-MODIFIABLE RISK FACTORS, AND INTERMEDIATE RISK FACTORS THAT LEAD TO THE MAIN CHRONIC DISEASES OF HEART DISEASE STROKE, CANCER, DIABETES, AND CHRONIC RESPIRATORY DISEASE. PHYSICAL INACTIVITY, POOR NUTRITION AND TOBACCO USE MODIFIABLE RISK FACTORS MOST INDIVIDUALS CAN ADJUST IN THEIR DAILY LIFE AND OUR COMMUNITY HEALTH PROGRAMMING CAN HAVE AN IMPACT UPON. INTERMEDIATE RISK FACTORS ARE THOSE UNHEALTHY LIFESTYLES THAT ULTIMATELY SHOW UP AS HEALTH CONCERNS IN INDIVIDUALS SUCH AS ELEVATED BLOOD PRESSURE, CHOLESTEROL, OR GLUCOSE LEVEL OR BEING OVERWEIGHT / OBESE. THE THINGS WE ARE UNABLE TO CHANGE ARE AGE AND HEREDITY (NON-MODIFIABLE RISK FACTORS). DEMOGRAPHICS / SOCIOECONOMIC: RFGH SERVICES MOST OF SOMERSET COUNTY. HEALTH STATUS IS IMPACTED BY DISPARITIES SUCH AS INCOME, EDUCATION LEVELS, AND ACCESS TO MEDICAL CARE. ACCORDING TO THE NATIONAL "HEALTH RANKINGS" IN 2015, PUBLISHED BY THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE. SOMERSET COUNTY CURRENTLY RANKS 16 OUT OF 16 FOR HEALTH OUTCOMES AND 15 OUT OF 16 FOR HEALTH FACTORS. THE HEALTH RANKINGS LOOK AT HEALTH OUTCOMES TO SEE HOW HEALTHY A COUNTY IS AND AT HEALTH FACTORS WHICH INFLUENCE THE HEALTH OF A COUNTY. MEASURES USED ARE MORTALITY, MORBIDITY, HEALTH BEHAVIORS, ACCESS TO CARE, QUALITY OF CARE, INCOME, EDUCATION, COMMUNITY SAFETY, AND ENVIRONMENT. REPORTED IN THE 2015 HEALTH RANKINGS ARE THE FOLLOWING STATISTICS: SOMERSET COUNTY HAS A POPULATION OF 51,706, 25% OF CHILDREN IN 2015 ARE LIVING IN POVERTY, 18.3% OF SOMERSET COUNTY ARE 65 YEARS OF AGE OR OLDER AS COMPARED TO 14% IN 2008. VIOLENT CRIMES IN SOMERSET COUNTY ARE 107, LOWER THAN MAINE AT 123 AND THE NATIONAL MEDIUM AT 199. WELLNESS & HEALTH STATUS INDICATORS THE ONE INDICATOR THAT HAS DATA FOR YEARS 2003, 2010, 2012 AND 2015 TO TREND OVER TIME IS % WHO REPORT HEALTH FAIR TO POOR . ACCESS TO CARE ACCESS TO CARE CONTRIBUTES TO ONE'S HEALTH STATUS. BARRIERS TO ACCESS TO CARE MAY INCLUDE TRANSPORTATION, COST, EDUCATION, LACK OF USUAL SOURCE OF CARE, LACK OF INSURANCE, CHILD CARE, OR OTHER BARRIERS MAY EXIST. THE PERCENT OF UNINSURED UNDER THE AGE OF 65 WITHOUT HEALTH INSURANCE IN 2013 REMAINED AT 13 (NO CHANGE IN THE PAST TEN YEARS) ACCORDING TO "BEARING THE FRUITS OF OUR LABOR". CHRONIC DISEASE (S) CHRONIC DISEASES INCLUDE CARDIOVASCULAR DISEASES (HEART AND STROKE), CANCER, CHRONIC RESPIRATORY DISEASES, DIABETES, AND BONE AND JOINT DISORDERS SUCH AS ARTHRITIS AND OSTEOPOROSIS. TOBACCO USE AND EXPOSURE TO TOBACCO, POOR NUTRITION, AND SEDENTARY LIFESTYLE OR PHYSICALLY INACTIVITY ARE THE TOP THREE HEALTH BEHAVIOR RISK FACTORS AFFECTING PEOPLE. THESE RISK FACTORS AFFECT ALL OF THE CHRONIC DISEASES: DIABETES, CARDIOVASCULAR HEALTH, CANCER, CHRONIC LUNG DISEASE AND OTHER HEALTH ISSUES AS WELL AND FREQUENTLY START IN ONE'S YOUTH. THOSE WITH ARTHRITIS THAT ARE INACTIVE OR OVERWEIGHT TEND TO BE MORE SYMPTOMATIC (HAVE INCREASED PAIN AND ARE NOT AS ABLE TO MOVE WITH AS MUCH EASE). BETWEEN 2003 AND 2010 SOMERSET COUNTY WAS ABLE TO DROP THE RATE OF CURRENT ADULT SMOKERS FROM 31% TO 26%. WE ARE WORKING HARD TO DECREASE THIS RATE WITH TOBACCO FREE POLICIES IMPLEMENTED IN MUNICIPALITIES, EDUCATION IN THE SCHOOL SYSTEMS, OTHER SUPPORT PROGRAMS, AS WELL AS ADDITIONAL INITIATIVES WITH RETAILERS. COMMUNITY HEALTH WORK PLAN CONTINUED: NUTRITION AND WEIGHT: SEDENTARY LIFESTYLE, OVERWEIGHT AND OBESITY, AND SMOKING ARE RISK FACTORS FOR MOST OF THE CHRONIC DISEASES. REPORTED IN MAINE HEALTH REPORT, MAINE'S ADULT OBESITY RATES HAVE NEARLY DOUBLED IN THE PAST 16 YEARS. DATA SOURCES VARY SLIGHTLY SOURCE TO SOURCE, BUT THE TAKE HOME MESSAGE IS MAINERS AND AMERICANS ARE TRENDING TO THE OVERWEIGHT AND OBESITY RANGES. ACCORDING TO THE CDC DATA, THE COUNTY'S OBESITY RATE (BMI >30)DOUBLED IN JUST TEN YEARS FROM 2003 - 2013 AND IS STILL ON THE INCREASE. NOTE: THE CDC SOURCES HAVE CAUTIONED THAT CHANGES HAVE BEEN MADE IN AN EFFORT TO IMPROVE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM THAT AFFECT THE OBESITY PREVALENCE ESTIMATES AND THEREFORE DATA COLLECTED FOR 2010 AND PRIOR CAN NOT BE COMPARED TO LATER DATA. CARDIOVASCULAR HEALTH CARDIOVASCULAR DISEASE REFERS TO A GROUP OF DISEASES AND CONDITIONS AFFECTING THE HEART AND BLOOD VESSELS. ACCORDING TO THE MAINE CARDIOVASCULAR HEALTH AND DIABETES PLAN (2011 - 2020) HEART DISEASE IS THE 2ND LEADING CAUSE OF DEATH IN MAINE WITH STROKE THE 4TH LEADING CAUSE OF DEATH. RISKS OF HEART DISEASE AND STROKE ARE 2-4 TIMES GREATER IN PEOPLE WITH DIABETES. ACCORDING TO THE CDC, ABOUT 1 OF 3 U.S. ADULTS-OR ABOUT 70 MILLION PEOPLE-HAVE HIGH BLOOD PRESSURE. ONLY ABOUT HALF (52%) OF THESE PEOPLE HAVE THEIR HIGH BLOOD PRESSURE UNDER CONTROL. THIS COMMON CONDITION INCREASES THE RISK FOR HEART DISEASE AND STROKE, 2ND OF THE LEADING CAUSES OF DEATH FOR AMERICANS. IN LOOKING AT THE DATA FROM 2003 TO 2013, THERE HAS BEEN NO CHANGE IN THOSE BEING TOLD THEY HAVE HIGH CHOLESTEROL. IT REMAINS AT 32%. RESPIRATORY HEALTH / PULMONARY DISEASE RESPIRATORY HEALTH INCLUDES DISEASES SUCH AS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND ASTHMA. AS WITH OTHER CHRONIC DISEASES, RISK FACTORS INCLUDE SMOKING AND SEDENTARY LIFESTYLE. IN ADDITION, EXPOSURE TO NOXIOUS PARTICLES OR GASES, RECURRENT INFECTIONS, GENETIC FACTORS AND DIET MAY BE ADDITIONAL RISK FACTORS FOR COPD. RESPIRATORY HEALTH INCLUDES DISEASES SUCH AS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), PNEUMONIA AND ASTHMA. ASTHMA IS A CHRONIC DISEASE THAT AFFECTS THE LUNGS AND AIRWAYS. THERE IS NO CURE BUT IT CAN BE CONTROLLED. ACCORDING TO THE MAINE CENTER FOR DISEASE CONTROL AND PREVENTION, IN 2010 ONE IN 15 (6.5%) OF CHILDREN UNDER THE AGE OF 18 IN HAVE ASTHMA AND ONE IN 10 (10.8%) ADULTS HAVE ASTHMA IN CENTRAL DISTRICT (SOMERSET AND KENNEBEC COUNTIES. ASTHMA ACCOUNTED FOR > 100 ED VISITS AND FOR > 100 HOSPITALIZATIONS. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IS A CHRONIC INFLAMMATORY LUNG DISEASE THAT CAUSES OBSTRUCTED AIRFLOW FROM THE LUNGS. ACCORDING TO NATIONAL INSTITUTE OF HEALTH (2010), COPD IS THE 3RD LEADING CAUSE OF DEATH IN THE UNITED STATES, IS RESPONSIBLE FOR 1.5 MILLION ED VISITS AND 726,000 HOSPITALIZATIONS PER YEAR ACROSS THE US AND HAS A COST (DIRECT AND INDIRECT) OF AN ESTIMATED $49.9 BILLION. COPD IS A DISEASE THAT IS CAUSED BY LONG-TERM EXPOSURE TO IRRITATING GASES OR PARTICULATE MATTER, MOST OFTEN FROM CIGARETTE SMOKE. MOST PEOPLE WITH COPD CAN ACHIEVE GOOD SYMPTOM CONTROL AND QUALITY OF LIFE WITH PROPER MANAGEMENT, AS WELL AS REDUCED RISK OF OTHER ASSOCIATED CONDITIONS. THE MOST CURRENT DATA IN SOMERSET COUNTY AVAILABLE IS FROM 2010 AND IS 7.9%. THE CENTRAL DISTRICT IMPROVEMENT PLAN OF 2010 CALLED FOR REDUCING THE CURRENT RATE OF ADMISSIONS FOR COPD FROM 181 / 1000,000 IN KENNEBEC AND SOMERSET COUNTIES COMBINED TO 91 (A 50% REDUCTION) IN THE HOPES OF SAVING AN ESTIMATED $1,153,255 BY 2015. THE 2015 INFORMATION HAS NOT YET BEEN RELEASED. DIABETES DIABETES IS A DISEASE THAT AFFECTS THE WAY THE BODY USES FOOD. IT IS CHARACTERIZED BY THE INABILITY TO PRODUCE OR PROPERLY USE INSULIN, A HORMONE THAT HELPS CONTROL BLOOD SUGAR LEVELS. EVERY MINUTE A PERSON'S BLOOD SUGAR IS HIGHER THAN IT SHOULD BE, THE DISEASE DAMAGES THE NERVOUS AND CIRCULATORY SYSTEMS, LEADING TO BLINDNESS, AMPUTATIONS AND INCREASING DISABILITY. DIABETES IS A DISEASE THAT VERY FREQUENTLY CAN BE CONTROLLED. CAREFUL MANAGEMENT OF DIABETES MAKES IT POSSIBLE FOR DIABETICS TO LEAD ACTIVE AND LONG LIVES. RISK FACTORS INCLUDE BEING OVERWEIGHT, PHYSICAL INACTIVITY, AND A FAMILY HISTORY OF DIABETES. COMPLICATIONS OF DIABETES MAY INCLUDE HEART DISEASE, KIDNEY DISEASE, EYE DISEASE, NERVE DISEASE, ATHEROSCLEROSIS, STROKE, BONE OR GUM INFECTIONS, AND BIRTH DEFECTS IN BABIES BORN TO DIABETIC MOTHERS. ACCORDING TO THE SOMERSET COUNTY HEALTH RANKINGS (2015) 88% DIABETIC MONITORING (SAME AS MAINE ) - 2010 ADULTS DIAGNOSED WITH TYPE 2 DIABETES 11 %. CANCER CANCER IS A TERM USED FOR DISEASES IN WHICH ABNORMAL CELLS DIVIDE WITHOUT CONTROL AND CAN INVADE OTHER TISSUES. CANCER CELLS CAN SPREAD TO OTHER PARTS OF THE BODY THROUGH THE BLOOD AND LYMPH SYSTEMS. CANCER IS NOT JUST ONE DISEASE, BUT MANY DISEASES. THERE ARE MORE THAN 100 KINDS OF CANCER. EARLY DETECTION THROUGH SCREENING (FINDING CANCER OR PRE-CANCEROUS CHANGES BEFORE IT CAN GROW AND SPREAD INTO LATE-STAGE DISEASE) MAKES A DIFFERENCE IN HEALTH OUTCOMES FOR MANY CANCERS. NOT ONLY DOES IT SAVE LIVES, PROVIDE QUALITY OF LIFE, IT ALSO SAVES BILLIONS OF DOLLARS OF HEALTHCARE TREATMENT COSTS. OSTEOARTHRITIS IS CHARACTERIZED BY THE BREAKDOWN OF THE JOINT'S CARTILAGE. THE BREAKDOWN OF CARTILAGE CAUSES THE BONES TO RUB AGAINST EACH OTHER, CAUSING STIFFNESS, PAIN AND LOSS OF MOVEMENT IN THE JOINT. RHEUMATOID ARTHRITIS) IS A CHRONIC DISEASE, MAINLY CHARACTERIZED BY INFLAMMATION OF THE LINING, OR SYNOVIUM, OF THE JOINTS. IT CAN LEAD TO LONG-TERM JOINT DAMAGE, RESULTING IN CHRONIC PAIN, LOSS OF FUNCTION AND DISABILITY. IN DECEMBER OF 2014 THE CDC ESTIMATED THAT AN ESTIMATED 52.5 MILLION US ADULTS REPORTED THAT THEIR DOCTOR TOLD THEM THEY HAD ARTHRITIS. AS OUR NATION'S POPULATION AGES, THE PREVALENCE IS EXPECTED TO INCREASE. IN ADDITION, 294,000 U.S. CHILDREN UNDER AGE 18 (OR 1 IN 250 CHILDREN) HAVE BEEN DIAGNOSED WITH ARTHRITIS OR ANOTHER RHEUMATOLOGIC CONDITION. PRIOR ESTIMATES RANGED FROM 80,000 TO 290,000, DEPENDING ON THE DEFINITION OF ARTHRITIS, AGE RANGE AND METHODS USED TO FIND CASES. MANY AFFLICTED WITH THIS DISEASE HAVE LIMITATIONS IN THEIR ABILITY TO DO PHYSICAL ACTIVITY, HAVE WORK LIMITATIONS, AND HAVE SOCIAL PARTICIPATION LIMITATIONS. ACTION: RFGH AND SPH WILL WORK WITH MAINE HOSPITALS AND THE SHARED HOSPITAL NEEDS ASSESSMENT PLANNING PROCESS (SHNAPP) TO DEVELOP STATE AND DISTRICT LEVEL (KENNEBEC AND SOMERSET COUNTIES) INDICATORS (USING SECONDARY DATA). THE DATA WILL BE PACKAGED TO HIGHLIGHT EACH DISTRICT'S PRIORITY HEALTH ISSUES. IMPROVEMENT INITIATIVES ARE TO REDUCE ADMISSION RATES, LONG AND SHORT TERM COMPLICATION RATES, PROPER MANAGEMENT AND APPROPRIATE TREATMENT OF DISEASES. IN ADDITION, CARRY OUT THE INITIATIVES IN THE COMMUNITY HEALTH WORKPLAN. 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