STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

Franklin Memorial Hospital: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
Franklin Memorial Hospital (EIN 01-0211503)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-13
IRS object ID
201131339349303038
Schema version
2009v1.7
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)
Timestamp2011-05-13T12:48:04-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2009-07-01TaxPeriodBeginDate

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)
NameEric MartinsenName
TitleCFOTitle
Phone2077792500Phone
Date Signed2011-05-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBarbara J McGuan CPAName
Phone2077752387Phone
Date Prepared2011-05-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts85931678GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.fchn.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1926YearFormation
State Legal DomicileMEStateLegalDomicile
Activity Or Mission DescriptionCommunity HospitalActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees953TotalNbrEmployees
Total Nbr Volunteers215TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1623091ContributionsGrantsPriorYear
Contributions Grants Current Year278062ContributionsGrantsCurrentYear
Program Service Revenue Prior Year83040780ProgramServiceRevenuePriorYear
Program Service Revenue CY85277281ProgramServiceRevenueCY
Investment Income Prior Year35753InvestmentIncomePriorYear
Investment Income Current Year164817InvestmentIncomeCurrentYear
Other Revenue Prior Year-27273OtherRevenuePriorYear
Other Revenue Current Year-9846OtherRevenueCurrentYear
Total Revenue Prior Year84672351TotalRevenuePriorYear
Total Revenue Current Year85710314TotalRevenueCurrentYear
Grants And Similar Amnts CY178421GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year45617075SalariesEtcPriorYear
Salaries Etc Current Year48015931SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year36053832OtherExpensePriorYear
Other Expenses Current Year34788722OtherExpensesCurrentYear
Total Expenses Prior Year81670907TotalExpensesPriorYear
Total Expenses Current Year82983074TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3001444RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2727240RevenuesLessExpensesCY
Total Assets BOY68901888TotalAssetsBOY
Total Assets EOY71632680TotalAssetsEOY
Total Liabilities BOY32049371TotalLiabilitiesBOY
Total Liabilities EOY31893484TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY36852517NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY39739196NetAssetsOrFundBalancesEOY
Mission DescriptionFranklin Memorial Hospital provides high quality, cost effective, patient-centered health care to our West Central Maine Community. We work with our community and other health care providers to integrate services and ensure the health of our community.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense71217852Expense
Grants178421Grants
Revenue85277281Revenue
DescriptionThe 70-bed Hospital is fully qualified and accredited to handle a broad range of medical, surgical, pediatric, women's care, and diagnostic services. Top quality specialty care is offered including: cardiology, oncology and hematology, orthopaedics, occupational health, pain management, pediatric endocrinology, physical rehabilitation, pulmonology, sleep disorders, sports medicine, and wound care. FMH is noted for innovation. This was Maine's first hospital to offer prenatal nurse home visits to all first-time parents, the first to perform laparoscopic gall-bladder surgery, the first rural Maine hospital to install a 64-slice CT scanner, and the first in the state to declare itself smoke-free. National attention has focused on its efforts to improve access to health care services and preventative health programs. For these reasons, FMH and FCHN have been awarded three of the nation's highest honors for hospital systems from the American Hospital Association: the Living the Vision Award, Foster G. McGaw Finalist Award, and the NOVA Award.The Franklin ScoreKeeper System is credited with contributing to Franklin County's distinction of having the state's lowest "excess preventable death" rate for cardiovascular disease.FMH created and is now an affiliate of the Franklin Community Health Network, an integrated network of providers that includes Franklin Health (a multi-specialty group medical practice), Healthy Community Coalition (a health education, outreach, wellness, prevention organization), Evergreen Behavioral Services (a mental-health services provider), and the Western Maine Physicians-Hospital Organization, a negotiating entity made up of physicians and the hospital.Franklin Memorial Hospital is a member of the American Hospital Association and the Maine Hospital Association.Emergency ServicesThe Hospital provides 24-hour emergency services. The Emergency Department is staffed by full-time attending physicians, nursing and support staff. Patients are seen regardless of ability to pay.Charity CareThe Hospital accepts all patients regardless of their ability to pay.Description
Total Program Service Expense71217852TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
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
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
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096136NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees953NumberOfEmployees
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
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
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 Approval1DecisionsSubjectToApproval
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 Line1Eric MartinsenBusinessNameLine1
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 (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationFormerFormerHighest Compensated EmployeeHighestCompensatedEmployee
Rebecca Ryder
President/CEO40.00XX031574129155
Joseph Bujold
Chair1.00XX000
Dr Allen Berger
Vice Chair1.00XX000
Dr Armand Auger
Secretary40.00XX192325017073
Jef Howell
Treasurer1.00XX000
Dr David Hyde
President of Med. Staff40.00X256334020059
Rhonda Wiles-Rosell
Director1.00X000
Waine Whittier
Director1.00X000
Richard Batt
Former President40.00020061314031X
Dr Wil Eastman
Director1.00X000
Tim Wallace
Director1.00X000
Carol Timberlake
Director1.00X000
Meredith Tipton
Director1.00X000
Gilly Hitchcock
Director1.00X000
Darryl Brown
Director1.00X000
John Bogar
Director1.00X000
Doug Walrath
Director1.00X000
Shannon Smith
Director1.00X000
Peter Judkins
Director1.00X000
Gerald Cayer
Executive VP40.00X019141216048
Eric Martinsen
CFO40.00X018880414610
Carmen Crofoot
Ortho Surgeon40.0049033607159X
Nancy Cummings
Ortho Surgeon40.00395774023202X
Richard Batstone
Urologist40.00495385010908X
Eric Gunther
General Surgeon40.00323145019700X
Heather DeCarolis
Anesthesiologist40.00321712017890X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2475011TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs896570TotalReportableCompFrmRltdOrgs
Total Other Compensation189835TotalOtherCompensation
Number Individuals GT100 K56NumberIndividualsGT100K
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
Cianbro
PO Box 8372WoburnMA01813Construction821880
Synernet Inc
222 St John StreetPortlandME04102Transcription809875
Weatherby Locums
PO Box 972633DallasTX75397Contract Staffing484538
Maine Medical Center
22 Bramhall StreetPortlandME04102PACS/E-ICU465553
BMS Cat Inc
303 Arthur StreetFt WorthTX76107Fire Remediation Services392808
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Related Organizations17252RelatedOrganizations
Government Grants75558GovernmentGrants
All Other Contributions185252AllOtherContributions
Noncash Contributions6500NoncashContributions
Total Contributions278062TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Services621990169309438169309438
Other621990974578974578
Ambulance Subsidies621910840717840717
Insurance Remibursemen621990325385325385
Contractual/Charity Ad621990-86172837-86172837
FieldValueIRS element (for citing)
Total Program Service Revenue85277281TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column8038TotalRevenueColumn
Exclusion$8,038ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real76430Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real86276Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-9846Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-9846TotalRevenueColumn
Exclusion-$9,846ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other291867Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other135088Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other156779Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column156779TotalRevenueColumn
Exclusion$156,779ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column85710314TotalRevenueColumn
Related Or Exempt Function Income85277281RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$154,971ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total178421Total
Program Services178421ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total485791Total
Program Services485791ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total38615953Total
Program Services34170039ProgramServices
Management And General4445914ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1225931Total
Program Services1084518ProgramServices
Management And General141413ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5011887Total
Program Services4439153ProgramServices
Management And General572734ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2676369Total
Program Services2371773ProgramServices
Management And General304596ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2049371Total
Management And General2049371ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total185498Total
Management And General185498ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total54995Total
Management And General54995ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total6100Total
Program Services6100ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5555467Total
Program Services4051317ProgramServices
Management And General1504150ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total8674Total
Management And General8674ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9666944Total
Program Services8377324ProgramServices
Management And General1289620ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1906371Total
Program Services1689408ProgramServices
Management And General216963ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2262784Total
Program Services2053992ProgramServices
Management And General208792ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total109532Total
Program Services100711ProgramServices
Management And General8821ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total391261Total
Program Services305438ProgramServices
Management And General85823ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1122315Total
Program Services994585ProgramServices
Management And General127730ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4596161Total
Program Services4100357ProgramServices
Management And General495804ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1357121Total
Program Services1357121ProgramServices

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Provision for Bad Debt36157863615786
Hospital Tax and Match13414841341484
Other55885849453464324

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total82983074Total
Program Services71217852ProgramServices
Management And General11765222ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4337BOY
EOY4687EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY8035567BOY
EOY10929929EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY10205081BOY
EOY8927992EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1126231BOY
EOY1156595EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY962453BOY
EOY1288234EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis75676399LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec39746795LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY37531872BOY
EOY35929604EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2054374BOY
EOY2170709EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY304318BOY
EOY283134EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY8677655BOY
EOY10941796EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY68901888BOY
EOY71632680EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6312707BOY
EOY6781663EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY24119583BOY
EOY23295288EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1617081BOY
EOY1816533EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY32049371BOY
EOY31893484EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY34839051BOY
EOY37564349EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY627795BOY
EOY773717EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1385671BOY
EOY1401130EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY36852517BOY
EOY39739196EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY68901888BOY
EOY71632680EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
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 Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$6,100OtherActivitiesAmount
Total Lobbying Expenditures IIB6100TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationThe 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 Balance1847619BeginningOfYearBalance
Contributions60144Contributions
Investment Earnings Or Losses132478InvestmentEarningsOrLosses
Other Expenditures33786OtherExpenditures
End Of Year Balance2006455EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1895540BeginningOfYearBalance
Contributions70033Contributions
Investment Earnings Or Losses-72312InvestmentEarningsOrLosses
Other Expenditures45642OtherExpenditures
End Of Year Balance1847619EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.70000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.30000TermEndowmentEOYBalance
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 Basis1157133OtherCostOrOtherBasis
Book Value1157133BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis40411992OtherCostOrOtherBasis
Depreciation16668353Depreciation
Book Value23743639BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis73680OtherCostOrOtherBasis
Depreciation73680Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis28642284OtherCostOrOtherBasis
Depreciation21030683Depreciation
Book Value7611601BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5391310OtherCostOrOtherBasis
Depreciation1974079Depreciation
Book Value3417231BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings35929604TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Estimated Settlements from MaineCare10280992
Deferred Compensation Asset275855
Insurance Advances384949
FieldValueIRS element (for citing)
Total Book Value Other Assets10941796TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Due to Affiliates$143,725
Deferred Compensation$275,855
Estimated Third-Party Payor Settlements$1,396,953
FieldValueIRS element (for citing)
Total Of Amounts1816533TotalOfAmounts
Total Revenue85710314TotalRevenue
Total Expenses82983074TotalExpenses
Excess Or Deficit For Year2727240ExcessOrDeficitForYear
Other$159,439OtherAmount
Total Adjustments159439TotalAdjustments
Excess Or Deficit Per FS2886679ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt85956029TotRevenueEtcAuditedFinclStmt
Other Revenues245715OtherRevenues
Revenue Not Rptd F990245715RevenueNotRptdF990
Revenue Subtotal85710314RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99085710314TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt83069350TotExpensesEtcAuditedFinclStmt
Other Expenses Included86276OtherExpensesIncluded
Expenses Not Rptd F99086276ExpensesNotRptdF990
Expenses Subtotal82983074ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99082983074TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:The Organization's endowment funds are intended to support operations of various programs offered by the Franklin Community Health Network, such as 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: 143980. Net Change in Perpetual Trust: 15459.
Part XII, Line 2d - Other Adjustments:Change in Net Assets of Affiliate: 143980. Net Change in Perpetual Trust: 15459. Rental Expenses: 86276.
Part XIII, Line 2d - Other Adjustments:Rental Expenses: 86276.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2041692TotalCommunityBenefitExpense
Net Community Benefit Expense2041692NetCommunityBenefitExpense
Percent Of Total Expense0.02570PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense15121995TotalCommunityBenefitExpense
Direct Offsetting Revenue12186051DirectOffsettingRevenue
Net Community Benefit Expense2935944NetCommunityBenefitExpense
Percent Of Total Expense0.03700PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense17163687TotalCommunityBenefitExpense
Direct Offsetting Revenue12186051DirectOffsettingRevenue
Net Community Benefit Expense4977636NetCommunityBenefitExpense
Percent Of Total Expense0.06270PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense771526TotalCommunityBenefitExpense
Direct Offsetting Revenue82493DirectOffsettingRevenue
Net Community Benefit Expense689033NetCommunityBenefitExpense
Percent Of Total Expense0.00870PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense420319TotalCommunityBenefitExpense
Direct Offsetting Revenue67405DirectOffsettingRevenue
Net Community Benefit Expense352914NetCommunityBenefitExpense
Percent Of Total Expense0.00440PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense12827602TotalCommunityBenefitExpense
Direct Offsetting Revenue8674840DirectOffsettingRevenue
Net Community Benefit Expense4152762NetCommunityBenefitExpense
Percent Of Total Expense0.05230PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense178421TotalCommunityBenefitExpense
Net Community Benefit Expense178421NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense14197868TotalCommunityBenefitExpense
Direct Offsetting Revenue8824738DirectOffsettingRevenue
Net Community Benefit Expense5373130NetCommunityBenefitExpense
Percent Of Total Expense0.06760PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense31361555TotalCommunityBenefitExpense
Direct Offsetting Revenue21010789DirectOffsettingRevenue
Net Community Benefit Expense10350766NetCommunityBenefitExpense
Percent Of Total Expense0.13030PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense2750TotalCommunityBuildingExpense
Net Community Building Expense2750NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense2750TotalCommunityBuildingExpense
Net Community Building Expense2750NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,627,104BadDebtExpenseAmount
Amount Attributable To520000AmountAttributableTo
Amount Reimbursed By Medicare20303724AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare22960775CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2657051MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy0WrittenDebtCollectionPolicy

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
Western Maine PHO
Physician Hospital Organization0.500000.000000.00000
Scorekeeper LLC
Wellness Software0.400000.000000.00000

Form990 Schedule H Part V Form990ScheduleHPartV (18 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursOtherOther
Franklin Memorial Hospital
111 Franklin Health CommonsFarmingtonME04938XXX
Franklin Hlth Livermore Falls Fam Pract
38 Union StreetLivermore FallsME04254Family Practice
Franklin Health Wilton Family Practice
75 Allen StreetWiltonME04294Family Practice
Franklin Hlth Farmington Family Practice
116 Franklin AvenueFarmingtonME04938Family 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
Franklin Health Urology
111 Franklin Health CommonsFarmingtonME04938Urology Practice
Rangeley Region Physical Rehabilitation
25 Dallas Hill RoadRangeleyME04970Outpatient Physical Therapy
Outpatient Services at Livermore Falls
76 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
111 Franklin Health CommonsFarmingtonME04938Child Developmental Program

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedPart 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.CostingMethodUsed
Subsidized Health Services ExplnPart I, Line 7g: The Organization has included costs associated with primary care (Family practice, Pediatrics, Internal Medicine and Women's Care), surgical practices (Urology, Orthopaedics and General Surgery), and physical therapy services provided in Rangeley, ME as subsidized health services.SubsidizedHealthServicesExpln
Percent Of Total Expense ExplnPart I, Line 7f: Amount of bad debt expense included on Form 990, Part IX, line 25 but subtracted for purposes of calculating the percentage in column 7f: $3,615,786PercentOfTotalExpenseExpln
Bad Debt FootnotePart 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 32% of the bad debt accounts belong to charity care. This estimate is based on the number of charity care accounts that were originally in bad debt status and later adjusted to charity care.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: The Medicare Principles of Reimbursement were used to determine the Medicare inpatient and outpatient costs based on the CMS 2552-96 cost report.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: There is currently no written debt collection policy, but the practice is to get the patients in touch with Franklin Memorial Hospital's financial counselors.DebtCollectionPolicy
Needs AssessmentPart 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.NeedsAssessment
Patient Education AssistancePart 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.PatientEducationAssistance
Community InformationPart 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.CommunityInformation
Community Building ActivitiesPart VI, Line 5: Physical 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. 2. Tufts Medical School House - completed FY 2011 to bring new physicians to the area 3. Feasibility study for the Livermore Falls Medical Arts Center to revitalize downtown LF and expand services in Livermore FallsEconomic Development: 1. Livermore Falls Medical Arts Center to be built downtown Livermore Falls 2. Member of Greater Franklin Development Corporation - an organization committed to economic developmentCommunity Support: 1. Provided Advanced Women's Advocacy Program (now called Safe Voices) (provide low cost rental space) 2. Perform disaster drills with the community 1-2 times a year 3. Community Dental (provide low cost rental space)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 for health careers in our vast rural catchment area. Becoming an AHEC center allows us to partner with youth programs, public schools, multiple colleges, adult education, a local career center and other health career programs to offer community members, displaced workers and current healthcare employees the opportunity to continue or pursue careers. 3. HealthInfoNet: 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. Community Health improvement: 1. Community Dental - provide low cost space to provide/keep dental services in the area2. Advanced Women's Advocacy Program - provide low cost space to provide services in the community.3. Franklin Health Card The Franklin Community Health Network HealthCard Program was started in 1995 to address and impact our community health needs. Franklin Community Health Network offers HealthCard holders a 10% discount on the patient's part of the bill, if paid within 10 days of receipt of the first bill. Your HealthCard will also be honored for discounts at participating area businesses listed four times a year in the newspaper insert Hands on Health. The HealthCard supports and promotes businesses within our region. More than 250 businesses are enjoying the benefits of belonging to the HealthCard Business Program. These businesses in turn offer HealthCard holders exciting discounts and benefits. As a service to HealthCard enrollees, Franklin Community Health Network offers educational materials and reminders designed to assist HealthCard holders in making informed personal decisions about their health care.CommunityBuildingActivities
Affiliated Health Care SystemPart VI, Line 7: Franklin Communith Health Network: Supporting OrganizationFranklin Memorial Hospital: Community hospital Healthy Community Coalition: A subsidiary of FCHN - HCC's mission is to measurably improve the health and well-being of all people in Greater Franklin County using a coordinated approach of education, health promotion, and outreach. HCC offers health screenings, health information, and programs and events to support healthy lifestyles that prevent disease and improve quality of life. Evergreen Behavioral Services: Mental health provider, Crossroads school an alternative day treatment program for children with serious emotionaland behavioral problems; emergency mental health program to ensure access to individuals in crisis.AffiliatedHealthCareSystem

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Town of Farmington
153 Farmington Falls RoadFarmingtonME04938016000163Government13500Recognition of services provided
Franklin Community Health Network
111 Franklin Health CommonsFarmingtonME04938223209406501(c)(3)91821To fund child development program
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

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: The use of funds is monitored through a memorandum of understanding process. Prior to disbursement of funds, an MOU is signed that outlines the purpose and restrictions of the funds awarded. In addition, informal communication takes place on a regular basis to ensure compliance with the grant requirements and appropriate use of the funds.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 (11 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
0315741000002140007755034489600
Dr Armand Auger
1472250451000008705083680209398000
Dr David Hyde
2563340000079080121510276393000
Richard Batt
020061300000850805523021464400
Gerald Cayer
0191412000004322011726020746000
Eric Martinsen
016230401000001650004245010365020341400
Carmen Crofoot
35428601360500000071590497495000
Nancy Cummings
38534901042500098000134020418976000
Richard Batstone
4212020741830006130102950506293000
Eric Gunther
212273011087200076000121000342845000
Heather DeCarolis
3217120000049000129900339602000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuer
Maine Health & Higher Ed Facilities Authority
0103143845604254692006-02-021573197CT Scanner & Renovations00
Maine Health & Higher Ed Facilities Authority
010314384560425G202006-09-0715270692MRI, Medical Office Building00

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
157319732350054343119535420060011
1527069217753462210651327428220080011

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
000000.000000.000000.000001
000000.000000.000000.000001

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
000000
000000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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 A, line 7bThe 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 11The 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 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 hired an independent executive search firm that assisted with 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 executed a written contract with the CEO after final approval of the CEO compensation package.
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 2c:The audit process has not changed from the prior year.Oversight of Audit
Form 990, Part I, Lines 8-18:Prior year numbers have been restated to present revenue net of contractual and charity care adjustments.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNABusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Franklin Community Health Network
111 Franklin Health CommonsFarmingtonME04938223209406Supporting OrganizationME501(c)(3)Line 11b, IIN/A
Healthy Community Coalition
105 Mt Blue Circle Suite 1FarmingtonME04938223305743Community OutreachME501(c)(3)Line 7Franklin Community Health Network
Pine Tree Medical Associates
131 Franklin Health CommonsFarmingtonME04938010469478Community Health AgencyME501(c)(3)Line 9Franklin Community Health Network

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Carrabassett Valley Clinic IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1111 Franklin Health CommonsAddressLine1
CityFarmingtonCity
StateMEState
ZIP Code04938ZIPCode
FieldValueIRS element (for citing)
EIN760840047EIN
Primary ActivitySki ClinicPrimaryActivity
Legal Domicile StateMELegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Franklin Community Health NetworkBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
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 Org1LoansOrGuaranteesFromOtherOrg
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