2012-04-13T15:54:59-05:00 2011-06-30 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2010-07-01 010211503 Franklin Memorial Hospital FRAN 2077792500 111 Franklin Health Commons Farmington ME 04938 Wayne Bennett 2077792500 2012-04-07 1 Barbara J McGuan CPA 2077752387 2012-04-07 2010 2016-02-24 21:20:13Z Rebecca Ryder 111 Franklin Health Commons Farmington ME 04938 88842687 0 X www.fchn.org X 1926 ME Community Hospital 19 14 957 201 0 0 278062 559721 85277281 88209148 164817 -40911 -9846 23610 85710314 88751568 178421 420103 0 0 48015931 50844233 0 0 0 34788722 36090392 82983074 87354728 2727240 1396840 71632680 71470727 31893484 30225199 39739196 41245528 X To provide high-quality, cost-effective, patient-centered healthcare to our west central Maine community. We work with our community and other healthcare providers to integrate services and ensure the health of our community. 0 0 73785106 420103 88209148 Franklin 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, orthopaedics, behavioral services, occupational health, dermatology, pulmonology, pain management, pediatric endocrinology, physical rehabilitation, sports medicine and wound care. During the fiscal year 2011 there were 2,850 discharges, 1,880 outpatient surgeries, 208,000 outpatient lab tests, 36,000 outpatient imaging procedures and 16,600 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 womens care. During the year Franklin Memorial Hospital provided 68,750 primary care visits and 23,550 specialty care visits in the Franklin Health physician practices. 73785106 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 155 0 1 957 1 0 0 0 0 0 0 0 0 0 0 X 19 14 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 ME X Wayne Bennett 2077792613 111 Franklin Health Commons Farmington ME 04938 Rebecca Ryder 40.00 X X 0 346641 30757 Joseph Bujold 1.00 X X 0 0 0 Jef Howell 1.00 X X 0 0 0 Waine Whittier 1.00 X 0 0 0 Dr Wil Eastman 1.00 X 0 0 0 Tim Wallace 1.00 X 0 0 0 Carol Timberlake 1.00 X X 0 0 0 Meredith Tipton 1.00 X 0 0 0 Gilly Hitchcock 1.00 X 0 0 0 Darryl Brown 1.00 X 0 0 0 Doug Walrath 1.00 X 0 0 0 Shannon Smith 1.00 X 0 0 0 Peter Judkins 1.00 X 0 0 0 Tom Saviello 1.00 X 0 0 0 Dr Peter Cordner 40.00 X 309227 0 14330 Sheena Bunnell 1.00 X 0 0 0 Ronald Aseltine 1.00 X 15824 0 0 Dr Connie Adler 40.00 X X 169209 0 18015 Dr David Hyde 40.00 X X 267726 0 20586 Gerald Cayer 40.00 X 0 191942 18214 Eric Martinsen 40.00 X 0 176086 17986 Nancy Cummings 40.00 X 425989 0 23890 Richard Batstone 40.00 X 476241 0 11228 Eric Gunther 40.00 X 342876 0 22459 Joshua D Sparling 40.00 X 411364 0 18806 Larry Michael Fraley 40.00 X 331327 0 13765 Dr Armand Auger 40.00 X 189678 0 17606 2939461 714669 227642 61 1 1 0 Cianbro PO Box 8372 Woburn MA 01813 Construction 2692371 Weatherby Locums PO Box 972633 Dallas TX 75397 Physician Contract Staffing 688080 Synernet Inc 222 St John Street Portland ME 04102 Transcription 642052 Quest Diagnostics 5763 Collection Center Drive Chicago IL 60693 Lab Diagnostic Services 463765 Maine Medical Center 22 Bramhall Street Portland ME 04102 PACS/E-ICU 413841 21 213198 138538 207985 559721 Patient Services 621990 168401934 168401934 Other 621990 877825 877825 Ambulance Subsidies 621910 866247 866247 Cafeteria Revenue 621990 130721 130721 Contractual/Char. Adj. 621990 -82067579 -82067579 88209148 7883 7883 56090 32480 23610 23610 23610 9845 58639 -48794 -48794 -48794 88751568 88209148 0 -17301 420103 420103 814917 799093 15824 40291191 34702704 5588487 1350145 1163192 186953 5597378 4831006 766372 2790602 2410576 380026 1098117 1098117 99231 99231 60665 60665 5953 5953 7207583 4819978 2387605 10338 10338 2143467 844480 1298987 2296146 1983456 312690 2376903 2070979 305924 150223 126456 23767 411566 271936 139630 1096903 947525 149378 4876192 4222325 653867 1507882 1502118 5764 Medical Supplies 7078049 7078049 Provision for Bad Debt 3206173 3206173 Hospital Tax and Match 1839445 1839445 Other 625556 539559 85997 87354728 73785106 13569622 0 4687 4722 10929929 9778896 8927992 10001878 1156595 1270140 1288234 1309548 79293269 43546733 35929604 35746536 2170709 2507643 283134 261950 10941796 10589414 71632680 71470727 6781663 5861337 23295288 22444495 1816533 1919367 31893484 30225199 X 37564349 38736147 773717 1063840 1401130 1445541 39739196 41245528 71632680 71470727 X 1396840 109492 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5953 5953 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 2007058 12117 335279 13144 2341310 1903822 60144 135979 93491 2007058 1895540 120033 -66109 45642 1903822 0.00000 0.62000 0.38000 0 1 1 1083333 1083333 41430405 18345344 23085061 52674 52674 0 30246883 22918270 7328613 6479974 2230445 4249529 35746536 Estimated Settlements from MaineCare 9801030 Deferred Compensation Asset 628979 Due from Related Parties 159405 10589414 Deferred Compensation 628979 Estimated Third-Party Payor Settlements 1290388 1919367 88751568 87354728 1396840 109492 109492 1506332 88483437 366733 366733 88116704 634864 634864 88751568 86977105 32480 32480 86944625 410103 410103 87354728 Description of Intended Use of Endowment Funds: Part V, Line 4: The Organization's endowment funds are held by the Franklin Community Health Network and are intended to support various programs offered by the Organization, such as the charity program, community outreach, education, medical library, Martha B. Webber Breast Care Center, and others. Part XI, Line 8 - Other Adjustments: Change in Net Assets of Affiliate 289,842. Net Change in Perpetual Trust 44,411. Equity Transfers from Affiliates -224,761. Part XII, Line 2d - Other Adjustments: Change in Net Assets of Affiliate 289,842. Net Change in Perpetual Trust 44,411. Rental Expenses 32,480. Part XII, Line 4b - Other Adjustments: Grants and Other Assistance 410,103. Equity Transfers to Affiliate 224,761. Part XIII, Line 2d - Other Adjustments: Rental Expenses 32,480. Part XIII, Line 4b - Other Adjustments: Grants and Other Assistance 410,103. 1 1 1 X 1 X 0 1 1 0 1 1 3177487 3177487 0.03780 17398322 16431890 966432 0.01150 20575809 16431890 4143919 0.04930 671452 26668 644784 0.00770 305755 305755 0.00360 8884667 6221051 2663616 0.03170 470456 470456 0.00560 10332330 6247719 4084611 0.04860 30908139 22679609 8228530 0.09790 3500 3500 0.00000 3500 3500 1 1479198 295000 20242268 22945336 -2703068 X 1 0 1 Western Maine PHO Physician Hospital Organization 0.50000 0.00000 0.00000 2 Scorekeeper LLC Wellness Software 0.40000 0.00000 0.00000 1 1 Franklin Memorial Hospital

111 Franklin Health Commons Farmington ME 04938

X X X Franklin Memorial Hospital 1 19 Franklin Hlth Livermore Falls Fam Pract

38 Union Street Livermore Falls ME 04254

Family Practice Franklin Health Wilton Family Practice

75 Allen Street Wilton ME 04294

Family Practice Franklin Hlth Farmington Family Practice

111 Franklin Health Commons Farmington ME 04938

Family Practice Franklin Health Internal Medicine

131 Franklin Health Commons Farmington ME 04938

Internal Medicine Practice Franklin Health Pediatrics

111 Franklin Health Commons Farmington ME 04938

Pediatrician Practice Franklin Health Orthopaedics

111 Franklin Health Commons Farmington ME 04938

Orthopaedic Practice Franklin Health Surgery

111 Franklin Health Commons Farmington ME 04938

General Surgery Practice Franklin Health Urology

111 Franklin Health Commons Farmington ME 04938

Urology Practice Rangeley Region Physical Rehabilitation

25 Dallas Hill Road Rangeley ME 04970

Outpatient Physical Therapy Outpatient Services at Livermore Falls

76 Main Street Livermore Falls ME 04254

Outpatient Clinic NorthStar

15 School Street Rangeley ME 04970

Ambulance Base NorthStar

138C Park Street Phillips ME 04966

Ambulance Base NorthStar

119 Federal Road Livermore ME 04254

Ambulance Base NorthStar

1001 Carriage Road Carrabasset Valley ME 04947

Ambulance Base NorthStar

111 Franklin Health Commons Farmington ME 04938

Ambulance Base Franklin Health Women's Care

111 Franklin Health Commons Farmington ME 04938

OB/GYN Franklin Health Child Developmental Prog

131 Franklin Health Commons Farmington ME 04938

Child Developmental Program Franklin Health Behavioral Services

131 Franklin Health Commons Farmington ME 04938

Behavioral Health Practice Franklin Health Dermatology

111 Franklin Health Commons Farmington ME 04938

Dermatology Practice Part I, Line 7: 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 I, L7 Col(f): Amount of bad debt expense included on Form 990, Part IX, line 25 but subtracted for purposes of calculating the percentage in column 7f: $3,206,173. 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 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 6: 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. Provided Safe Voices, a Women's Advocacy Program with low cost rental space.2. Perform disaster drills with the community 1-2 times a year3. Community Dental (provide low cost rental space)During 2011, Franklin Memorial Hospital donated two vacated buildings to local organizations in support of their services provided to the community. One of the buildings was donated to Safe Voices, a 501(c)(3) not for profit organization providing services to victims of domestic abuse. Another building was donated to the Town of Farmington to house the police department which was in need of larger space to support their operations. Both buildings were vacated by physician practices which were moved to the newly constructed Medical Arts Building located on hospital campus.Coalition building:1. Provided by HCC 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.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: Since August 15 hospitals including FMH, and more than 2,000 health care providers 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. Part VI, Line 7: 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. 1 Town of Farmington 153 Farmington Falls Road Farmington ME 04938 016000163 Government 271233 Book Value Donated Building To support community services Safe Voices PO Box 713 Auburn ME 04212 010352658 501(c)(3) 138870 Book Value Donated Building To support community services LifeFlight Foundation PO Box 940 Bangor ME 044020940 522377085 501(c)(3) 10000 Organizational Support 3 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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. X X X X X X 0 0 0 0 0 0 0 0 0 Rebecca Ryder 0 324641 0 22000 0 0 0 22013 0 8744 0 377398 0 0 Dr Peter Cordner 302380 0 6847 0 0 0 5219 0 9111 0 323557 0 0 0 Dr Connie Adler 160327 0 8882 0 0 0 9196 0 8819 0 187224 0 0 0 Dr David Hyde 267726 0 0 0 0 0 8272 0 12314 0 288312 0 0 0 Gerald Cayer 0 191942 0 0 0 0 0 5907 0 12307 0 210156 0 0 Eric Martinsen 0 159586 0 0 0 16500 0 7308 0 10678 0 194072 0 0 Nancy Cummings 418039 0 7950 0 0 0 9800 0 14090 0 449879 0 0 0 Richard Batstone 419719 0 56522 0 0 0 613 0 10615 0 487469 0 0 0 Eric Gunther 313661 0 29215 0 0 0 9800 0 12659 0 365335 0 0 0 Joshua D Sparling 328509 0 82855 0 0 0 5190 0 13616 0 430170 0 0 0 Larry Michael Fraley 331327 0 0 0 0 0 613 0 13152 0 345092 0 0 0 Dr Armand Auger 161259 0 28419 0 0 0 9070 0 8536 0 207284 0 0 0 Maine Health & Higher Ed Facilities Authority 010314384 560425G20 2006-09-07 15270692 MRI, Medical Office Building 0 0 0 15270692 1775346 221065 13274282 2008 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 Form 990, Part VI, Section A, line 6 The 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 7a The 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 A, line 7b The Member has the following rights and powers: 1. To amend or restate the Articles of Incorporation and Bylaws of the Organization 2. To approve any merger or consolidation of the Organization 3. To approve the dissolution of the Organization 4. To authorize any sale of all, or substantially all, of the assets of the Organization 5. To approve any mortgage, lien, pledge or security interest in all or substantially all, of the assets of the Organization 6. To annually establish the number of seats on the board of directors within the range established by the Articles of Incorporation and to elect or remove directors of the Organization 7. To approve any fundraising activity conducted by the Organization 8. To designate the auditor, corporate counsel and registered agent for the Organization 9. To approve the commencement of any new venture, or major capital acquisitions, by the Organization 10. To approve any capital or operating budgets of the Organization 11. To approve the selection or dismissal of the President of the Organization and establish the compensation and other terms and conditions of employment of the President 12. To make and revoke any elections available under Section 501(h) of the Internal Revenue Code of 1986 Form 990, Part VI, Section B, line 11 The Organization reviewed the Form 990 with the officers of the board of directors prior to filing the tax return in a form of a presentation and a Q&A session to address any questions or concerns. Form 990, Part VI, Section B, line 12c On an annual basis board members and officers are required to submit a conflict of interest statement which is then reviewed by the compliance committee. The compliance committee is responsible for regularly and consistently monitoring and enforcing compliance with the conflict of interest policy. Form 990, Part VI, Section B, line 15 Executive 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 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Change in Net Assets of Affiliate 289,842. Net Change in Perpetual Trust 44,411. Equity Transfers from Affiliates -224,761. Total to Form 990, Part XI, Line 5: 109,492. Oversight of Audit Form 990, Part XI, Line 2c: The audit process has not changed from the prior year. Franklin Community Health Network 111 Franklin Health Commons Farmington ME 04938 223209406 Supporting Organization ME 501(c)(3) Line 11b, II N/A 0 Healthy Community Coalition 105 Mt Blue Circle Suite 1 Farmington ME 04938 223305743 Community Outreach ME 501(c)(3) Line 7 Franklin Community Health Network 0 Pine Tree Medical Associates 131 Franklin Health Commons Farmington ME 04938 010469478 Community Health Agency ME 501(c)(3) Line 9 Franklin Community Health Network 0 Evergreen Behavioral Services 131 Franklin Health Commons Farmington ME 04938 010492747 Mental Health Agency ME 501(c)(3) Line 9 Franklin Community Health Network 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0