2011-05-13T12:48:04-05:00 2010-06-30 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2009-07-01 010211503 Franklin Memorial Hospital FRAN 2077792500 111 Franklin Health Commons Farmington ME 04938 Eric Martinsen 2077792500 2011-05-12 1 Barbara J McGuan CPA 2077752387 2011-05-12 2009 2016-02-24 21:20:13Z Rebecca Ryder 111 Franklin Health Commons Farmington ME 04938 85931678 0 X www.fchn.org X 1926 ME Community Hospital 18 15 953 215 0 0 1623091 278062 83040780 85277281 35753 164817 -27273 -9846 84672351 85710314 178421 0 45617075 48015931 0 0 36053832 34788722 81670907 82983074 3001444 2727240 68901888 71632680 32049371 31893484 36852517 39739196 Franklin 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. 0 0 71217852 178421 85277281 The 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. 71217852 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 136 0 953 1 0 0 0 0 0 0 0 0 0 18 15 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 ME X Eric Martinsen 2077792613 111 Franklin Health Commons Farmington ME 04938 Rebecca Ryder 40.00 X X 0 315741 29155 Joseph Bujold 1.00 X X 0 0 0 Dr Allen Berger 1.00 X X 0 0 0 Dr Armand Auger 40.00 X X 192325 0 17073 Jef Howell 1.00 X X 0 0 0 Dr David Hyde 40.00 X 256334 0 20059 Rhonda Wiles-Rosell 1.00 X 0 0 0 Waine Whittier 1.00 X 0 0 0 Richard Batt 40.00 X 0 200613 14031 Dr Wil Eastman 1.00 X 0 0 0 Tim Wallace 1.00 X 0 0 0 Carol Timberlake 1.00 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 John Bogar 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 Gerald Cayer 40.00 X 0 191412 16048 Eric Martinsen 40.00 X 0 188804 14610 Carmen Crofoot 40.00 X 490336 0 7159 Nancy Cummings 40.00 X 395774 0 23202 Richard Batstone 40.00 X 495385 0 10908 Eric Gunther 40.00 X 323145 0 19700 Heather DeCarolis 40.00 X 321712 0 17890 2475011 896570 189835 56 1 1 0 Cianbro PO Box 8372 Woburn MA 01813 Construction 821880 Synernet Inc 222 St John Street Portland ME 04102 Transcription 809875 Weatherby Locums PO Box 972633 Dallas TX 75397 Contract Staffing 484538 Maine Medical Center 22 Bramhall Street Portland ME 04102 PACS/E-ICU 465553 BMS Cat Inc 303 Arthur Street Ft Worth TX 76107 Fire Remediation Services 392808 10 17252 75558 185252 6500 278062 Patient Services 621990 169309438 169309438 Other 621990 974578 974578 Ambulance Subsidies 621910 840717 840717 Insurance Remibursemen 621990 325385 325385 Contractual/Charity Ad 621990 -86172837 -86172837 85277281 8038 8038 76430 86276 -9846 -9846 -9846 291867 135088 156779 156779 156779 85710314 85277281 0 154971 178421 178421 485791 485791 38615953 34170039 4445914 1225931 1084518 141413 5011887 4439153 572734 2676369 2371773 304596 2049371 2049371 185498 185498 54995 54995 6100 6100 5555467 4051317 1504150 8674 8674 9666944 8377324 1289620 1906371 1689408 216963 2262784 2053992 208792 109532 100711 8821 391261 305438 85823 1122315 994585 127730 4596161 4100357 495804 1357121 1357121 Provision for Bad Debt 3615786 3615786 Hospital Tax and Match 1341484 1341484 Other 558858 494534 64324 82983074 71217852 11765222 0 4337 4687 8035567 10929929 10205081 8927992 1126231 1156595 962453 1288234 75676399 39746795 37531872 35929604 2054374 2170709 304318 283134 8677655 10941796 68901888 71632680 6312707 6781663 24119583 23295288 1617081 1816533 32049371 31893484 X 34839051 37564349 627795 773717 1385671 1401130 36852517 39739196 68901888 71632680 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6100 6100 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 1847619 60144 132478 33786 2006455 1895540 70033 -72312 45642 1847619 0.00000 0.70000 0.30000 0 1 1 1157133 1157133 40411992 16668353 23743639 73680 73680 0 28642284 21030683 7611601 5391310 1974079 3417231 35929604 Estimated Settlements from MaineCare 10280992 Deferred Compensation Asset 275855 Insurance Advances 384949 10941796 Due to Affiliates 143725 Deferred Compensation 275855 Estimated Third-Party Payor Settlements 1396953 1816533 85710314 82983074 2727240 159439 159439 2886679 85956029 245715 245715 85710314 0 85710314 83069350 86276 86276 82983074 0 82983074 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. 1 1 1 X 1 X 0 1 1 0 1 1 2041692 2041692 0.02570 15121995 12186051 2935944 0.03700 17163687 12186051 4977636 0.06270 771526 82493 689033 0.00870 420319 67405 352914 0.00440 12827602 8674840 4152762 0.05230 178421 178421 0.00220 14197868 8824738 5373130 0.06760 31361555 21010789 10350766 0.13030 2750 2750 0.00000 2750 2750 1 1627104 520000 20303724 22960775 -2657051 X 0 Western Maine PHO Physician Hospital Organization 0.50000 0.00000 0.00000 Scorekeeper LLC Wellness Software 0.40000 0.00000 0.00000 Franklin Memorial Hospital

111 Franklin Health Commons Farmington ME 04938

X X X 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

116 Franklin Avenue 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

111 Franklin Health Commons Farmington ME 04938

Child Developmental Program 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), surgical practices (Urology, Orthopaedics and General Surgery), and physical therapy services provided in Rangeley, ME as subsidized health services. Part 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: $3,615,786 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 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. Part 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. Part 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. 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: 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. Part 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. 1 Town of Farmington 153 Farmington Falls Road Farmington ME 04938 016000163 Government 13500 Recognition of services provided Franklin Community Health Network 111 Franklin Health Commons Farmington ME 04938 223209406 501(c)(3) 91821 To fund child development program 2 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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. X X X X X X 0 0 0 0 0 0 0 0 0 Rebecca Ryder 0 315741 0 0 0 0 0 21400 0 7755 0 344896 0 0 Dr Armand Auger 147225 0 45100 0 0 0 8705 0 8368 0 209398 0 0 0 Dr David Hyde 256334 0 0 0 0 0 7908 0 12151 0 276393 0 0 0 Richard Batt 0 200613 0 0 0 0 0 8508 0 5523 0 214644 0 0 Gerald Cayer 0 191412 0 0 0 0 0 4322 0 11726 0 207460 0 0 Eric Martinsen 0 162304 0 10000 0 16500 0 4245 0 10365 0 203414 0 0 Carmen Crofoot 354286 0 136050 0 0 0 0 0 7159 0 497495 0 0 0 Nancy Cummings 385349 0 10425 0 0 0 9800 0 13402 0 418976 0 0 0 Richard Batstone 421202 0 74183 0 0 0 613 0 10295 0 506293 0 0 0 Eric Gunther 212273 0 110872 0 0 0 7600 0 12100 0 342845 0 0 0 Heather DeCarolis 321712 0 0 0 0 0 4900 0 12990 0 339602 0 0 0 Maine Health & Higher Ed Facilities Authority 010314384 560425469 2006-02-02 1573197 CT Scanner & Renovations 0 0 Maine Health & Higher Ed Facilities Authority 010314384 560425G20 2006-09-07 15270692 MRI, Medical Office Building 0 0 1573197 323500 54343 1195354 2006 0 0 1 1 15270692 1775346 221065 13274282 2008 0 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 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 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 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part XI, Line 2c: Oversight of Audit The audit process has not changed from the prior year. Form 990, Part I, Lines 8-18: Prior year numbers have been restated to present revenue net of contractual and charity care adjustments. Franklin Community Health Network 111 Franklin Health Commons Farmington ME 04938 223209406 Supporting Organization ME 501(c)(3) Line 11b, II N/A 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 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 Carrabassett Valley Clinic Inc 111 Franklin Health Commons Farmington ME 04938 760840047 Ski Clinic ME Franklin Community Health Network C 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 1 0