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Franklin Memorial Hospital: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
Franklin Memorial Hospital (EIN 01-0211503)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-02-05
IRS object ID
201320369349300952
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-02-05T15:57:07-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN010523282EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Berry Dunn McNeil & Parker LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1100AddressLine1
CityPortlandCity
StateMEState
ZIP Code041041100ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN010211503EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Franklin Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFRANNameControl
Phone2077792500Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1111 Franklin Health CommonsAddressLine1
CityFarmingtonCity
StateMEState
ZIP Code04938ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWayne BennettName
TitleCFOTitle
Phone2077792500Phone
Date Signed2013-01-31DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBarbara J McGuan CPAName
PTINP00219457PTIN
Phone2077752387Phone
Date Prepared2013-01-31DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRebecca RyderNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1111 Franklin Health CommonsAddressLine1
CityFarmingtonCity
StateMEState
ZIP Code04938ZIPCode
FieldValueIRS element (for citing)
Gross Receipts90080837GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.fchn.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1926YearFormation
State Legal DomicileMEStateLegalDomicile
Activity Or Mission DescriptionCommunity HospitalActivityOrMissionDescription
Nbr Voting Members Governing Body19NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees986TotalNbrEmployees
Total Nbr Volunteers155TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year559721ContributionsGrantsPriorYear
Contributions Grants Current Year761215ContributionsGrantsCurrentYear
Program Service Revenue Prior Year85002975ProgramServiceRevenuePriorYear
Program Service Revenue CY89240432ProgramServiceRevenueCY
Investment Income Prior Year-40911InvestmentIncomePriorYear
Investment Income Current Year-17445InvestmentIncomeCurrentYear
Other Revenue Prior Year23610OtherRevenuePriorYear
Other Revenue Current Year3244OtherRevenueCurrentYear
Total Revenue Prior Year85545395TotalRevenuePriorYear
Total Revenue Current Year89987446TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year420103GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY20000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year50844233SalariesEtcPriorYear
Salaries Etc Current Year56453831SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year32884219OtherExpensePriorYear
Other Expenses Current Year33510034OtherExpensesCurrentYear
Total Expenses Prior Year84148555TotalExpensesPriorYear
Total Expenses Current Year89983865TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1396840RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3581RevenuesLessExpensesCY
Total Assets BOY71470727TotalAssetsBOY
Total Assets EOY76169004TotalAssetsEOY
Total Liabilities BOY30225199TotalLiabilitiesBOY
Total Liabilities EOY34936190TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY41245528NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY41232814NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTo 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense74578169Expense
Grants20000Grants
Revenue89240432Revenue
DescriptionFranklin Memorial Hospital is a progressive, friendly, non-for-profit community hospital which provides high-quality, cost-effective, patient-centered 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 oncology, hematology, cardiology, otolaryngology, orthopaedics, behavioral services, occupational health, dermatology, pulmonology, pain management, pediatric endocrinology, physical rehabilitation, sports medicine and wound care. During the fiscal year 2012 there were 2,850 discharges, 1,880 outpatient surgeries, 208,000 outpatient lab tests, 36,000 outpatient imaging procedures and 16,650 emergency room visits. 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. During the year Franklin Memorial Hospital provided 59,200 primary care visits and 23,500 specialty care visits in the Franklin Health physician practices.Description
Total Program Service Expense74578169TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096178NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees986NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members19NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMEStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Wayne BennettBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2077792613TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1111 Franklin Health CommonsAddressLine1
CityFarmingtonCity
StateMEState
ZIP Code04938ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Rebecca Ryder
President/CEO40.00XX351125031178
Joseph Bujold
Chair1.00XX000
Jef Howell
Treasurer1.00XX000
Waine Whittier
Director1.00X000
Dr Wil Eastman
Director1.00X000
Tim Wallace
Director1.00X000
Carol Timberlake
Vice Chair1.00XX000
Meredith Tipton
Director1.00X000
Gilly Hitchcock
Director1.00X000
Darryl Brown
Director1.00X000
Doug Walrath
Director1.00X000
Shannon Smith
Past Director1.00X000
Peter Judkins
Director1.00X000
Tom Saviello
Past Director1.00X000
Dr Peter Cordner
Director40.00X21802007115
Sheena Bunnell
Director1.00X000
Ronald Aseltine
Director1.00X1402200
Dr Connie Adler
Secretary40.00XX204534022244
Dr David Hyde
Director40.00X264235022455
Paul Soucie
Director1.00X000
Dr Robert O'Reilley
Medical Staff President40.00X177822019810
Gerald Cayer
Executive VP40.00X224837022764
Eric Martinsen
Past CFO40.00X181857019509
Wayne Bennett
CFO40.00X000
Nancy Cummings
Ortho Surgeon40.00444661025442X
Joshua D Sparling
Dermatologist40.00491519020230X
Larry Michael Fraley
Anesthesiologist40.00332577020253X
Stephen P Zanella
Emergency Medicine40.00336202029335X
Heather DeCarolis
Anesthesiologist40.00332563024401X
Dr Armand Auger
Former Trustee40.00213000020637X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3786974TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation285373TotalOtherCompensation
Number Individuals GT100 K65NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Hebert Construction LLC
9 Gould RoadLewistonME04240Construction2070695
Weatherby Locums
PO Box 972633DallasTX75397Physician Contract Staffing766037
Quest Diagnostics
5763 Collection Center DriveChicagoIL60693Lab Diagnostic Services430414
Developers Collaborative Predevelopment
17 Chestnut StPortlandME04101Real Estate Development390897
Balanced Healthcare Receivables LLC
141 Burke StreetNashuaNH03060Billing and Collections271520
FieldValueIRS element (for citing)
Number Of Contractors GT100 K22NumberOfContractorsGT100K
Related Organizations474996RelatedOrganizations
Government Grants149199GovernmentGrants
All Other Contributions137020AllOtherContributions
Total Contributions761215TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Services621990175789240175789240
Meaningful Use Revenue62199034916333491633
Other62199016316081631608
Ambulance Subsidies621910883197883197
Contract/Char./Bad Dbt621990-92555246-92555246
FieldValueIRS element (for citing)
Total Program Service Revenue89240432TotalProgramServiceRevenue

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real36241Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real32997Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real3244Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column3244TotalRevenueColumn
Exclusion$3,244ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other42949Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other60394Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-17445Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-17445TotalRevenueColumn
Exclusion-$17,445ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column89987446TotalRevenueColumn
Related Or Exempt Function Income89240432RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$14,201ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total20000Total
Program Services20000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1781528Total
Program Services792890ProgramServices
Management And General988638ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total43803159Total
Program Services37388139ProgramServices
Management And General6415020ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1435714Total
Program Services1258514ProgramServices
Management And General177200ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6357573Total
Program Services5456869ProgramServices
Management And General900704ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3075857Total
Program Services2625394ProgramServices
Management And General450463ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total121219Total
Management And General121219ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total88011Total
Management And General88011ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total5953Total
Management And General5953ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8771913Total
Program Services6978533ProgramServices
Management And General1793380ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total165589Total
Management And General165589ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1811403Total
Program Services1278198ProgramServices
Management And General533205ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2618831Total
Program Services2371178ProgramServices
Management And General247653ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2192087Total
Program Services1866221ProgramServices
Management And General325866ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total174551Total
Program Services152138ProgramServices
Management And General22413ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total482594Total
Program Services323260ProgramServices
Management And General159334ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1150298Total
Program Services981836ProgramServices
Management And General168462ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4684359Total
Program Services3998330ProgramServices
Management And General686029ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1406591Total
Program Services1341920ProgramServices
Management And General64671ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies70543547054354
Hospital Tax and Match17404201740420
Other1041861690395351466

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total89983865Total
Program Services74578169ProgramServices
Management And General15405696ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4722BOY
EOY3580EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY9778896BOY
EOY5553570EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY10001878BOY
EOY10470970EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1270140BOY
EOY1219194EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1309548BOY
EOY2459056EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis85165647LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec46544522LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY35746536BOY
EOY38621125EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2507643BOY
EOY2497648EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY261950BOY
EOY306316EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY10589414BOY
EOY15037545EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY71470727BOY
EOY76169004EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5861337BOY
EOY6293976EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY22444495BOY
EOY21905514EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY3763867EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1919367BOY
EOY2972833EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY30225199BOY
EOY34936190EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY38736147BOY
EOY38723155EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1063840BOY
EOY1077560EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1445541BOY
EOY1432099EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY41245528BOY
EOY41232814EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY71470727BOY
EOY76169004EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3581ReconcilationRevenueExpenses
Reconcilation Other Changes-16295ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$2,337DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$5,953OtherActivitiesAmount
Total Lobbying Expenditures IIB8290TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationRebecca Ryder, President/CEO of the Organization, spent time meeting with members of the congressional delegation. A proportional amount of her time spent engaging in these activities has been calculated to arrive at the total lobbying expense amount. In addition, The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2341310BeginningOfYearBalance
Contributions216215Contributions
Investment Earnings Or Losses-63416InvestmentEarningsOrLosses
Other Expenditures169094OtherExpenditures
End Of Year Balance2325015EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance2007058BeginningOfYearBalance
Contributions12117Contributions
Investment Earnings Or Losses335279InvestmentEarningsOrLosses
Other Expenditures13144OtherExpenditures
End Of Year Balance2341310EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1903822BeginningOfYearBalance
Contributions60144Contributions
Investment Earnings Or Losses135979InvestmentEarningsOrLosses
Other Expenditures93491OtherExpenditures
End Of Year Balance2007058EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1895540BeginningOfYearBalance
Contributions120033Contributions
Investment Earnings Or Losses-66109InvestmentEarningsOrLosses
Other Expenditures45642OtherExpenditures
End Of Year Balance1903822EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.62000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.38000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1268949OtherCostOrOtherBasis
Book Value1268949BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis47984193OtherCostOrOtherBasis
Depreciation20042227Depreciation
Book Value27941966BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis10517OtherCostOrOtherBasis
Depreciation10517Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis30642913OtherCostOrOtherBasis
Depreciation24012012Depreciation
Book Value6630901BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5259075OtherCostOrOtherBasis
Depreciation2479766Depreciation
Book Value2779309BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings38621125TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Estimated Settlements from MaineCare14155887
Deferred Compensation Asset858472
Due from Related Parties23186
FieldValueIRS element (for citing)
Total Book Value Other Assets15037545TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Deferred Compensation$858,472
Estimated Third-Party Payor Settlements$2,114,361
FieldValueIRS element (for citing)
Total Of Amounts2972833TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDescription of Intended Use of Endowment Funds:Identifier
Return ReferencePart V, Line 4:ReturnReference
ExplanationThe 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.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3492000TotalCommunityBenefitExpense
Net Community Benefit Expense3492000NetCommunityBenefitExpense
Percent Of Total Expense0.03880PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense17846985TotalCommunityBenefitExpense
Direct Offsetting Revenue15251828DirectOffsettingRevenue
Net Community Benefit Expense2595157NetCommunityBenefitExpense
Percent Of Total Expense0.02880PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense21338985TotalCommunityBenefitExpense
Direct Offsetting Revenue15251828DirectOffsettingRevenue
Net Community Benefit Expense6087157NetCommunityBenefitExpense
Percent Of Total Expense0.06760PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense501007TotalCommunityBenefitExpense
Direct Offsetting Revenue85369DirectOffsettingRevenue
Net Community Benefit Expense415638NetCommunityBenefitExpense
Percent Of Total Expense0.00460PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense401372TotalCommunityBenefitExpense
Net Community Benefit Expense401372NetCommunityBenefitExpense
Percent Of Total Expense0.00450PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense10253219TotalCommunityBenefitExpense
Direct Offsetting Revenue6503606DirectOffsettingRevenue
Net Community Benefit Expense3749613NetCommunityBenefitExpense
Percent Of Total Expense0.04170PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense20000TotalCommunityBenefitExpense
Net Community Benefit Expense20000NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11175598TotalCommunityBenefitExpense
Direct Offsetting Revenue6588975DirectOffsettingRevenue
Net Community Benefit Expense4586623NetCommunityBenefitExpense
Percent Of Total Expense0.05100PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense32514583TotalCommunityBenefitExpense
Direct Offsetting Revenue21840803DirectOffsettingRevenue
Net Community Benefit Expense10673780NetCommunityBenefitExpense
Percent Of Total Expense0.11860PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense2000TotalCommunityBuildingExpense
Net Community Building Expense2000NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense2000TotalCommunityBuildingExpense
Net Community Building Expense2000NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,718,221BadDebtExpenseAmount
Amount Attributable To344000AmountAttributableTo
Amount Reimbursed By Medicare22027961AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare24236438CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2208477MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 Western Maine PHO
Physician Hospital Organization0.500000.000000.00000
2 Scorekeeper LLC
Wellness Software0.400000.000000.00000
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Franklin Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1111 Franklin Health CommonsAddressLine1
CityFarmingtonCity
StateMEState
ZIP Code04938ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Franklin Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities19NumberOfOtherFacilities

Other Facilities OtherFacilities (19 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Franklin Hlth Livermore Falls Fam Pract
21 Main StreetLivermore FallsME04254Family Practice
Franklin Health Wilton Family Practice
75 Allen StreetWiltonME04294Family Practice
Franklin Hlth Farmington Family Practice
111 Franklin Health CommonsFarmingtonME04938Family Practice
Franklin Health Internal Medicine
131 Franklin Health CommonsFarmingtonME04938Internal Medicine Practice
Franklin Health Pediatrics
111 Franklin Health CommonsFarmingtonME04938Pediatrician Practice
Franklin Health Orthopaedics
111 Franklin Health CommonsFarmingtonME04938Orthopaedic Practice
Franklin Health Surgery
111 Franklin Health CommonsFarmingtonME04938General Surgery Practice
Rangeley Region Physical Rehabilitation
25 Dallas Hill RoadRangeleyME04970Outpatient Physical Therapy
Outpatient Services at Livermore Falls
21 Main StreetLivermore FallsME04254Outpatient Clinic
NorthStar
15 School StreetRangeleyME04970Ambulance Base
NorthStar
138C Park StreetPhillipsME04966Ambulance Base
NorthStar
119 Federal RoadLivermoreME04254Ambulance Base
NorthStar
1001 Carriage RoadCarrabasset ValleyME04947Ambulance Base
NorthStar
111 Franklin Health CommonsFarmingtonME04938Ambulance Base
Franklin Health Women's Care
111 Franklin Health CommonsFarmingtonME04938OB/GYN
Franklin Health Child Developmental Prog
131 Franklin Health CommonsFarmingtonME04938Child Developmental Program
Franklin Health Behavioral Services
131 Franklin Health CommonsFarmingtonME04938Behavioral Health Practice
Franklin Health Dermatology
111 Franklin Health CommonsFarmingtonME04938Dermatology Practice
Franklin Health Ear Nose & Throat
111 Franklin Health CommonsFarmingtonME04938ENT

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationIdentifierIdentifier
Part I, Line 7: The Organization used an overall cost to charge ratio for lines 7a and 7b. A cost to charge ratio using the internal financial accounting of the practices by group was used to calculate the amount reported on line 7g.
Part I, Line 7g: The Organization has included costs associated with primary care (Family practice, Pediatrics, Internal Medicine and Women's Care), Behavioral Services, Child & Adolescent Developmental Pediatrics and physical therapy services provided in Rangeley, ME as subsidized health services.
Part II: See 990, Schedule H, Part VI, line 5.
Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.Franklin Memorial Hospital used the RCC calculated from Worksheet 2 and multiplied it by the bad debts expense per the financials. 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. FMH has estimated that approximately 20% of the bad debt accounts is attributable to patients who are likely to qualify for charity care. This estimate is based on discussion with financial counselors regarding the number of denied applications due to incomplete documentation as well as overall demographic situation in the service area.
Part III, Line 8: The Medicare Principles of Reimbursement were used to determine the Medicare inpatient and outpatient costs based on the Organization's cost report.
Part III, Line 9b: Patient balances are screened for eligibility for financial assistance by outside collection agency and are transferred back to Franklin Memorial Hospital for follow up with a counselor 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 V, Section B, Line 13g: 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 uninsured inpatients are visited by an Advanced Patient Advocacy representative 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 & Financial Assistance Applications are located throughout the Hospital & physician practices6. Hospital booklets are available in all patient rooms with there is a section regarding Financial Assistance7. Business office staff and contracted third party collection agency notify all patients with self pay balances about Hospital's financial assistance resources and encourages them to apply for such assistance.Franklin Memorial Hospital
Part VI, Line 2: 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: 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 financial counselor 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 financial counselors when a patient is identified as needing assistance. The Organization's pre-collection and collection agencies also educate patients and help to set them up with financial assistance when needed.
Part VI, Line 4: Franklin Memorial Hosptial'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: Community BuildingPhysical Improvements and Housing:1. Development and maintenance of the rail trail which is on FMH property - available to the public to encourage health and wellness. Economic Development:1. Member of Greater Franklin Development Corporation - an organization committed to economic developmentCommunity Support:1. Perform disaster drills with the community 1-2 times a year2. 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 measurably 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 8,000 individuals benefited from the outreach activities of the Coalition with 3,572 seeking services of the 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 analyzation, 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 include 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 forhealth 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: Twenty-six out of thirty-nine Maine hospitals, including FMH, and more than 240 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. ScoreHealth Screenings - ScoreHealth is a health risk assessment program that helps individuals evaluate many different areas affecting their health, including but not limited to diabetes, cancer, asthma and osteoporosis. The screenings are offered part of the mobile health outreach program conducted by the Healthy Community Coalition of Greater Franklin County and offer cholesterol, blood pressure, BMI and bone density assessments along with counseling on tobacco use and exposure, benefits of physical activity, healthy nutrition and stress management.5. Health Works! Worksite Wellness Award Program is a new and free aware program offered by Healthy 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: Franklin Communith Health Network: Supporting OrganizationFranklin Memorial Hospital: Community hospitalHealthy 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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1LifeFlight FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 940AddressLine1
CityBangorCity
StateMEState
ZIP Code044020940ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient522377085EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant20000AmountOfCashGrant
Purpose Of GrantOrganizational SupportPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: All assistance is given to either 501(c)(3) public charities or governmental units and their affiliates. Therefore, additional monitoring is not deemed necessary.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Rebecca Ryder
33912501200000022013091650382303000
Dr Peter Cordner
218020000002890042250225135000
Dr Connie Adler
1959930854100095240127200226778000
Dr David Hyde
2642350000085700138850286690000
Dr Robert O'Reilley
1778220000050250147850197632000
Gerald Cayer
2223410249600086360141280247601000
Eric Martinsen
16535700016500075280119810201366000
Nancy Cummings
42556101910000098000156420470103000
Joshua D Sparling
3109370164098016484055130147170511749000
Larry Michael Fraley
3325770000055130147400352830000
Stephen P Zanella
33620200000147000146350365537000
Heather DeCarolis
3325630000098000146010356964000
Dr Armand Auger
17960003340000090690115680233637000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
Maine Health & Higher Ed Facilities Authority
010314384560425G202006-09-0715270692MRI, Medical Office Building001
Maine Health & Higher Ed Facilities Authority
010314384560427NM42011-11-3010452958Refunding of Series 2001A001

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
1952929152706926223632210651327428220080011
186520710452958687452117007963396320021011

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
100000
000000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part I, Lines 8-18:Prior year numbers have been restated to present revenue net of Bad Debt Expense.
Form 990, Part VI, Section A, line 6The Organization consists of one Member, Franklin Community Health Network. Action of the Member shall be evidenced by written consents that are executed on its behalf by any officer of the Member who is authorized so to act by the board of directors of the Member. The written consent evidencing the annual meeting of the Member shall be adopted and effective as of a date immediately following the annual meeting of the board of directors of the Member or such later date as may be set forth in such written consent. The effective date set forth in such written consent shall be the date of the annual meeting of the year in question.
Form 990, Part VI, Section A, line 7aThe Member has rights and powers to establish the size of the board of directors of the Organization within the limits prescribed by the Articles of Incorporation and to elect and remove certain directors of the Organization in accordance with the Articles of Incorporation and Bylaws.
Form 990, Part VI, Section B, line 11A 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 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, Part VI, Section B, line 12cOn 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, Part VI, Section B, line 15Executive compensation is determined by the compensation committee which consists of the Board Chair and several board members. The compensation committee uses an independent executive search firm that assists with executive salary determination by providing compensation survey results, along with review of executive compensation reported by other health care organizations on their Form 990. The compensation committee approves the executive compensation package prior to contract execution.
Form 990, Part VI, Section C, line 19The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request.
Form 990, Part XI, line 5:Change in Net Assets of Affiliate -2,853. Net Change in Perpetual Trust -13,442. Total to Form 990, Part XI, Line 5: -16,295.Changes in Net Assets or Fund Balances:
Form 990, Part XI, Line 2c:The audit process has not changed from the prior year.Oversight of Audit

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Franklin Community Health Network
111 Franklin Health CommonsFarmingtonME04938223209406Supporting OrganizationME501(c)(3)Line 11b, IIN/A0
Healthy Community Coalition
105 Mt Blue Circle Suite 1FarmingtonME04938223305743Community OutreachME501(c)(3)Line 70Franklin Community Health Network
Pine Tree Medical Associates
131 Franklin Health CommonsFarmingtonME04938010469478Community Health AgencyME501(c)(3)Line 90Franklin Community Health Network
Evergreen Behavioral Services
131 Franklin Health CommonsFarmingtonME04938010492747Mental Health AgencyME501(c)(3)Line 90Franklin Community Health Network
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg