2019-11-12T11:59:01-06:00 2019-01-01 990 2018-10-01 010211503 Franklin Memorial Hospital FRAN 2077792500 111 Franklin Health Commons Farmington ME 04938 John Cox REGIONAL CFO 2077792500 2019-10-29 63.247.60.254 2019-11-12 12:54:44 ES P 05B59A79989D8D80B3E3D119B5D3766651DA35E3 05B59A79989D8D80B3E3D119B5D3766651DA35E3 2018 2020-03-31 21:24:44Z X Timothy Churchill 111 Franklin Health Commons Farmington ME 04938 20129084 0 X www.fchn.org X 1926 ME Community Hospital X 18 10 826 105 0 0 1047070 20268 80422412 20081813 4556 -2574 24177 10011 81498215 20109518 0 0 0 0 51904709 13385069 0 0 0 34502397 9141706 86407106 22526775 -4908891 -2417257 50598315 0 29742862 0 20855453 0 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 12222726 15351036 FMH ROUTINE INPATIENT AND ANCILLARY OUTPATIENT SERVICES FRANKLIN MEMORIAL HOSPITAL IS A NON-FOR-PROFIT COMMUNITY HOSPITAL WHICH PROVIDES HIGH-QUALITY, COST-EFFECTIVE, PATIENT-CENTERED INPATIENT AND OUTPATIENT 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 ROUTINE ADULT, PEDIATRIC AND INTENSIVE CARE INPATIENT SERVICES AS WELL AS A VARIETY OF OUTPATIENT SERVICES INCLUDING ONCOLOGY, HEMATOLOGY, CARDIOLOGY, OTOLARYNGOLOGY, ORTHOPEDICS, BEHAVIORAL SERVICES, OCCUPATIONAL HEALTH, PULMONOLOGY, PAIN MANAGEMENT, PEDIATRIC ENDOCRINOLOGY, PHYSICAL REHABILITATION, SPORTS MEDICINE. DURING THE THREE MONTHS ENDING DECEMBER 31, 2018 THERE WERE 461 INPATIENT DISCHARGES, 394 OUTPATIENT SURGERIES, 60,603 OUTPATIENT LAB TESTS AND 11,054 OUTPATIENT IMAGING PROCEDURES. 5070659 2920925 FRANKLIN HEALTH PHYSICIAN PRACTICES FRANKLIN MEMORIAL HOSPITAL IDENTIFIED ACCESS TO PRIMARY CARE AS A CENTRAL COMMUNITY NEED AND IS COMMITTED TO PROVIDING HIGH QUALITY PHYSICIAN SERVICES OF FAMILY PRACTICE, INTERNAL MEDICINE, PEDIATRICS AND WOMEN'S CARE. IN ADDITION, FRANKLIN MEMORIAL HOSPITAL OFFERS A VARIETY OF SPECIALTY CARE SERVICES INCLUDING DERMATOLOGY, SURGERY, ORTHOPEDICS, UROLOGY AND BEHAVIORAL HEALTH SERVICES. DURING THE THREE MONTHS ENDING DECEMBER 31, 2018 FRANKLIN MEMORIAL HOSPITAL PROVIDED 15,026 PRIMARY CARE VISITS AND 4,778 SPECIALTY CARE VISITS IN THE FRANKLIN HEALTH PHYSICIAN PRACTICES. 1565906 1807278 EMERGENCY ROOM FRANKLIN MEMORIAL HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WHICH OPERATES 24 HOURS A DAY SEVEN DAYS A WEEK. THE EMERGENCY DEPARTMENT SERVES AS THE PRIMARY CARE PHYSICIAN FOR A NUMBER OF LOW INCOME AND INDIGENT RESIDENTS OF THE WEST CENTRAL MAINE COMMUNITY. GIVEN FRANKLIN MEMORIAL HOSPITAL'S COMMITMENT TO ACCESS TO CARE REGARDLESS OF THE ABILITY TO PAY, THE EMERGENCY DEPARTMENT SERVES A VITAL ROLE IN THE COMMUNITY'S HEALTH CARE NETWORK. DURING THREE MONTHS ENDING DECEMBER 31, 2018 FRANKLIN MEMORIAL HOSPITAL HAD 3,471 EMERGENCY ROOM VISITS. 18859291 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 1 X 0 0 826 1 0 0 0 0 0 0 0 0 0 0 X 18 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X John Cox 2077792265 111 Franklin Health Commons Farmington ME 04938 Madelyn Besse Director 1.00 0.00 X 0 0 0 Connie Coggins Director 1.00 0.00 X 0 0 0 Darryl Wood Director 1.00 0.00 X 0 0 0 David Dixon MD Director 1.00 0.00 X 0 0 0 Jack Peck Director 1.00 0.00 X 0 0 0 Katherine Heer DMD Director 1.00 0.00 X 0 0 0 Michael Cormier Director 1.00 0.00 X 0 0 0 Michele McCormick MD Director 1.00 0.00 X 0 0 0 Peter Judkins Director 1.00 0.00 X 0 0 0 Ronald Aseltine Esq Director 1.00 0.00 X 0 0 0 Sheena Bunnell Director 1.00 0.00 X 0 0 0 Stephen Goss DO Medical Staff Pres. 50.00 0.00 X 225377 0 34368 William L Caron Jr MH CEO 1.00 50.00 X 0 1555829 120606 Clint Boothby Chairman 1.00 0.00 X X 0 0 0 Gilly Hitchcock Vice Chair 1.00 0.00 X X 0 0 0 John Bogar Treasurer 1.00 0.00 X X 0 0 0 Connie Adler MD Secretary 1.00 0.00 X X 33006 0 0 Timothy Churchill President/CEO 1.00 50.00 X X 0 425804 65387 John Cox Regional CFO 1.00 50.00 X 0 264618 46424 Christopher Renaud DO Anesthesiologist 50.00 0.00 X 372490 0 33225 Marni Mishler MD Surgeon 50.00 0.00 X 349430 0 33127 Joanie Peter MD Physician 50.00 0.00 X 412196 0 31862 James Lancaster MD Anesthesiologist 50.00 0.00 X 369118 0 30168 Heather Decarolis MD Anesthesiologist 50.00 0.00 X 350521 0 36225 2112138 2246251 431392 62 0 1 0 NorDx Inc 301A US Route One Scarborough ME 04074 Lab Services 2696990 Medical Ambassadors LLC 189 Sunrise Hill Ln Auburndale FL 33823 Phys. Staffing 1793469 Weatherby Locums Inc 6440 S Millrock Dr Suite 175 Salt Lake City UT 84121 Phys. Staffing 1437634 MaineGeneral Medical Center 10 Water St Suite 213 Waterville ME 04901 Phys. Staffing 892790 Comphealth PO Box 972651 Dallas TX 75397 Phys. Staffing 822199 23 6225 14043 20268 Patient Services 621990 19270655 19270655 Other 621990 620457 620457 Ambulance Subsidies 621910 150654 150654 Cafeteria 722514 40047 40047 20081813 27003 16992 10011 10011 10011 2574 -2574 -2574 -2574 20109518 20079239 0 10011 10967742 9820243 1147499 137934 123503 14431 1713005 1533782 179223 566388 507130 59258 2575 2575 51197 51197 2994 2994 1272543 942305 330238 223699 157193 66506 11389 11389 474048 471411 2637 27909 25926 1983 75463 67875 7588 192468 172331 20137 878111 786239 91872 192596 187877 4719 Affiliate services 2656655 1014059 1642596 Medical supplies 2494702 2494702 Hospital tax 412267 412267 Other 173090 142448 30642 22526775 18859291 3667484 0 2955 0 4381087 0 0 7623618 0 0 0 0 1608965 0 922072 0 0 24638263 0 0 0 0 0 11421355 0 50598315 0 6066717 0 106488 0 16298788 0 7270869 0 29742862 0 X 18176688 0 1510999 0 1167766 0 20855453 0 50598315 0 X -2417257 -18438196 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2994 2994 0 SCHEDULE C, PART II-B, LINE 1 DUES WERE PAID TO THE MAINE HOSPITAL ASSOCIATION FOR $9,793 AND THE AMERICAN HOSPITAL ASSOCIATION FOR $4,955. THE MAINE HOSPITAL ASSOCIATION USED 20.3% OF THEIR DUES REVENUE FOR LOBBYING ACTIVITIES, WHILE THE AMERICAN HOSPITAL ASSOCIATION USED 20.0%. 3246842 -114278 3132564 3210572 102538 66268 3246842 2826394 200531 350340 166693 3210572 2691932 112614 182291 160443 2826394 2799451 408226 -187776 327969 2691932 0.00000 0.00000 0.00000 0 0 0 Part V, Line 1g Effective January 1, 2019, Franklin Memorial Hospital merged into MaineHealth (EIN 01-0238552). Upon the merger, the endowment fund balance was transferred to MaineHealth. 1 1 1 X 175.000000000000 0 1 1 0 0 334892 334892 0.01490 3024961 2733760 291201 0.01290 3359853 2733760 626093 0.02780 284384 16700 267684 0.01190 19668 6225 13443 0.00060 2878430 1408710 1469720 0.06520 5319 5319 0.00020 3187801 1431635 1756166 0.07790 6547654 4165395 2382259 0.10570 0 846180 4067576 4093463 -25887 X 1 1 1 1 Franklin Memorial Hospital 111 Franklin Health Commons Farmington ME 04938 See Part V, Section C ME State License #38930 X X X Franklin Memorial Hospital 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X See Part V, Section C 1 16 1 See Part V, Section C 0 1 X 175.000000000000 X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section A: Franklin Memorial Hospital:Part V, Section B, Line 7a & 10a: THE CHNA AND IMPLEMENTATION STRATEGY ARE POSTED ON THE FOLLOWING WEBSITE: HTTPS://MAINEHEALTH.ORG/FRANKLIN-COMMUNITY-HEALTH-NETWORKFranklin Memorial Hospital:Part V, Section B, Line 16a, 16b, 16c: THE FINANCIAL ASSISTANCE POLICY (FREE CARE POLICY AND BILLING AND COLLECTION POLICY), FREE CARE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ON THE FOLLOWING WEBSITE: HTTPS://MAINEHEALTH.ORG/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/FREE-CARE. Franklin Memorial Hospital Part V, Section B, Line 5: IN 2015, A COLLABORATIVE CALLED THE MAINE SHARED HEALTH NEEDS ASSESSMENT PLANNING PROCESS (SHNAPP) WAS LAUNCHED TO CREATE A FRAMEWORK AND APPROACH FOR A SHARED CHNA THAT CAN: I) ADDRESS COMMUNITY BENEFIT REPORTING NEEDS OF HOSPITALS, II) SUPPORT STATE AND LOCAL PUBLIC HEALTH ACCREDITATION EFFORTS, AND III) PROVIDE VALUABLE POPULATION HEALTH ASSESSMENT DATA FOR VARIOUS ORGANIZATIONS CONCERNED WITH THE HEALTH OF MAINE'S COMMUNITIES AND CITIZENS. MAINE HEALTHCARE, NORTHERN LIGHT HEALTH, CENTRAL MAINE HEALTHCARE, MAINEGENERAL HEALTH AND THE MAINE CENTER FOR DISEASE CONTROL AND PREVENTION ARE CONTRIBUTING FINANCIAL SUPPORT TO THE STUDY AND REPORTS.AS OF FY16, THE THREE-YEAR CYCLE OF THE CHNA PROCESS HAS BECOME ALIGNED WITH MAINE HEALTHCARE MEMBER ORGANIZATIONS' STRATEGIC PLANNING PROCESSES (ALSO THREE-YEAR CYCLES). WE EXPECT THIS ALIGNMENT TO STRENGTHEN THE COORDINATION AND RESOURCE ALLOCATION FOR COMMUNITY HEALTH IMPROVEMENT EFFORTS ACROSS THE MAINE HEALTHCARE ORGANIZATIONS.IN 2019, THIS PROCESS, NOW NAMED THE MAINE SHARED COMMUNITY NEEDS ASSESSMENT, WILL PRODUCE COUNTY-LEVEL CHNA REPORTS AND HELP COORDINATE COMMUNITY ENGAGEMENT PROCESSES THAT WILL ULTIMATELY RESULT IN THE PRIORITIZATION OF HEALTH ISSUES BY HOSPITALS, STATE/LOCAL GOVERNMENTS AND OTHER PARTNERS. IN COLLABORATION WITH MAINE HEALTHCARE, EACH HOSPITAL WILL PRODUCE A DETAILED CHNA REPORT AND IMPLEMENTATION PLAN COVERING THE TIME PERIOD OF 2019-2021. THESE REPORTS WILL BE FORMALLY ADOPTED BY THE MAINEHEALTH BOARD FOR SUBMISSION WITH THE RESPECTIVE FY19 990 FILING.AT A LOCAL AND REGIONAL LEVEL, THE HEALTHY COMMUNITY COALITION OF FRANKLIN COMMUNITY HEALTH NETWORK, WILL CONVENE A DIVERSE PLANNING COMMITTEE TO REVIEW THE DATA COLLECTED FOR THE CHNA REPORT, PLAN COMMUNITY FORUM AND OTHER ENGAGEMENT ACTIVITIES, IDENTIFY PRIORITIES, AND DEVELOP IMPLEMENTATION STRATEGIES. Franklin Memorial Hospital Part V, Section B, Line 6a: THE CHNA WAS CONDUCTED THROUGH A PARTNERSHIP BETWEEN MAINE HEALTHCARE, CENTRAL MAINE HEALTHCARE, NORTHERN LIGHT HEALTH, MAINEGENERAL HEALTH AND THE MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES. Franklin Memorial Hospital Part V, Section B, Line 11: THE ORGANIZATION HAS CONTINUED TO WORK ON ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE FORMER CHNA AND IMPLEMENTATION PLAN. THE CURRENT CHNA IMPLEMENTATION PLAN IS CURRENTLY IN DRAFT FORM AND WILL BE COMPLETED BY JUNE 2019. ONCE COMPLETE IT WILL GO THROUGH LOCAL AND ORGANIZATION APPROVAL PROCESSES. FOR THE 2019-2021 PLAN, THE ORGANIZATION HAS IDENTIFIED PRIORITIES AND DEVELOPED STRATEGIES TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND PROVIDED REASONS IF IDENTIFIED NEEDS ARE NOT BEING ADDRESSED. Franklin Memorial Hospital Part V, Section B, Line 16j: FRANKLIN MEMORIAL HOSPITAL TAKES A NUMBER OF STEPS TO PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE TO PATIENTS.1.NOTICES OF THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN LOCATIONS WITHIN THE HOSPITAL AT WHICH MEMBERS OF THE PUBLIC GENERALLY TRANSACT BUSINESS WITH THE HOSPITAL OR PRESENT THEMSELVES TO RECEIVE OR REQUEST HOSPITAL SERVICES, INCLUDING ADMITTING AREAS, WAITING ROOMS, BUSINESS OFFICES AND OUTPATIENT RECEPTION AREAS.2.WITH RESPECT TO INPATIENT ADMISSIONS, INDIVIDUAL WRITTEN NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS PRESENTED TO EACH PATIENT UPON ADMISSION OR IN THE CASE OF EMERGENCY ADMISSION, BEFORE DISCHARGE. IN ADDITION, ALL INPATIENTS ARE VISITED BY A PATIENT FINANCIAL ADVOCATE TO DISCUSS AVAILABILITY OF FINANCIAL ASSISTANCE AND GOVERNMENT COVERAGE OPTIONS.3.AVAILABILITY OF FINANCIAL ASSISTANCE IS PUBLICIZED ON THE PATIENT INVOICES SUPPLYING PATIENTS WITH A CONTACT NUMBER TO OBTAIN FURTHER INFORMATION ABOUT AVAILABLE OPTIONS.4.FINANCIAL ASSISTANCE OPTIONS ARE OUTLINED ON THE HOSPITAL'S WEBSITE AND ARE READILY AVAILABLE TO THE PUBLIC.5.RACK CARDS AND FINANCIAL ASSISTANCE APPLICATIONS ARE LOCATED THROUGHOUT THE HOSPITAL AND THE PHYSICIAN PRACTICES.6.HOSPITAL BOOKLETS ARE AVAILABLE IN ALL PATIENT ROOMS WITH A SECTION REGARDING FINANCIAL ASSISTANCE.7.PATIENT FINANCIAL ADVOCATES WORK WITH ALL PATIENTS WITHOUT HEALTH INSURANCE COVERAGE TO NOTIFY THEM ABOUT AVAILABLE FINANCIAL ASSISTANCE RESOURCES AND ASSIST WITH MAINECARE APPLICATIONS FOR ELIGIBLE INDIVIDUALS. 16 1 - Franklin Health Livermore Falls Fam Prac 21 Main Street Livermore Falls ME 04254 Family Practice 2 - Franklin Health Farmington Fam Practice 111 Franklin Health Commons Farmington ME 04938 Family Practice 3 - Franklin Health Internal Medicine 111 Franklin Health Commons Farmington ME 04938 Internal Medicine Practice 4 - Franklin Health Pediatrics 111 Franklin Health Commons Farmington ME 04938 Pediatrician Practice 5 - Franklin Health Orthopaedics 111 Franklin Health Commons Farmington ME 04938 Orthopaedic Practice 6 - Franklin Health Surgery 111 Franklin Health Commons Farmington ME 04938 General Surgery Practice 7 - Outpatient Services at Livermore Falls 21 Main Street Livermore Falls ME 04254 Outpatient Clinic 8 - NorthStar 15 School Street Rangeley ME 04970 Ambulance Base 9 - NorthStar 138C Park Street Phillips ME 04966 Ambulance Base 10 - NorthStar 119 Federal Road Livermore ME 04254 Ambulance Base 11 - NorthStar 1001 Carriage Road Carrabasset Valley ME 04947 Ambulance Base 12 - NorthStar 111 Franklin Health Commons Farmington ME 04938 Ambulance Base 13 - Franklin Health Women's Care 111 Franklin Health Commons Farmington ME 04938 OB/GYN 14 - Franklin Health Behavioral Services 131 Franklin Health Commons Farmington ME 04938 Behavioral Health Practice 15 - Franklin Health Urology 126 Middle Street Farmington ME 04938 Urology Practice 16 - Franklin Health Primary Care Practice 131 Franklin Health Commons Farmington ME 04938 Primary Care Practice Part I, Line 7: THE COSTING METHODOLOGY FOR THE AMOUNTS REPORTED IN PART I, LINE 7 OF THE SCHEDULE H IS BASED ON A RATIO OF PATIENT CARE COST TO CHARGES. THIS COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES PROVIDED IN THE INSTRUCTIONS FOR SCHEDULE H. Part I, Line 7g THE ORGANIZATION HAS INCLUDED COSTS ASSOCIATED WITH PRIMARY CARE (FAMILY PRACTICES, PEDIATRICS, INTERNAL MEDICINE, AND WOMEN'S CARE) AND BEHAVIORAL SERVICES. Part III, Line 2: SEE PART III, LINE 4 - BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS Part III, Line 4: BAD DEBT EXPENSE REPRESENTS HEALTHCARE SERVICES THAT FRANKLIN MEMORIAL HOSPITAL HAS PROVIDED WITHOUT COMPENSATION. AS A TAX EXEMPT HOSPITAL, FRANKLIN MEMORIAL HOSPITAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. A PORTION OF FRANKLIN MEMORIAL HOSPITAL'S BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE THAT FOR A VARIETY OF REASONS, DO NOT COMPLETE THE FINANCIAL ASSISTANCE APPLICATION PROCESS. FRANKLIN MEMORIAL HOSPITAL CANNOT DETERMINE THE AMOUNT OF BAD DEBT EXPENSE THAT COULD BE REASONABLY ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FRANKLIN MEMORIAL HOSPITAL'S FREE CARE POLICY. 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.FRANKLIN MEMORIAL HOSPITAL BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL HAS A CLEAR MISSION COMMITMENT TO SERVING ELDERLY PATIENTS AND ADULTS WITH DISABILITIES THROUGH THE PROVISION OF SPECIFIC SUBSIDIZED PROGRAMS DEVELOPED TO HELP IMPROVE THE HEALTH STATUS OF THESE PATIENTS. IF THESE CRITICAL SUBSIDIZED PROGRAMS WERE NOT PROVIDED BY THE HOSPITAL, THEY WOULD BECOME THE OBLIGATION OF THE FEDERAL GOVERNMENT. Part III, Line 9b: COLLECTION AGENCIES WORK WITH PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND REFER PATIENTS WHO INQUIRE ABOUT FINANCIAL ASSISTANCE BACK TO FRANKLIN MEMORIAL HOSPITAL FOR FOLLOW UP WITH A PATIENT FINANCIAL ADVOCATE 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 COMMUNITY HEALTH NETWORK PARTICIPATES IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS EVERY THREE YEARS TO IDENTIFY THE PRIORITY HEALTH NEEDS OF THE COMMUNITY. THIS PROCESS UTILIZES A COMMITTEE COMBINED OF KEY PARTNERS FROM MULTIPLE ORGANIZATION INCLUDING FRANKLIN COMMUNITY HEALTH NETWORKS EMPLOYEES, LOCAL SOCIAL SERVICE AGENCIES AND INDEPENDENT PROVIDERS WHO SERVE FRANKLIN COUNTY. THROUGH COMMUNITY FORUMS, SURVEYS, FOCUS GROUPS AND KEY INFORMANT INTERVIEWS, INFORMATION IS COLLECTED AS PART OF THE MAINE SHARED COMMUNITY NEEDS ASSESSMENT PROCESS. A REPORT WITH THE COLLECTED DATA IS CREATED TO SHARE WITH THE COMMUNITY AND TO THE STATE. THE LAST CHNA PROCESS STARTED COLLECTING INFORMATION IN EARLY FALL OF 2018 AND ALL DATA WAS SUBMITTED PRIOR TO THE END OF DECEMBER 2018. THE FINAL REPORT FOR FRANKLIN COUNTY WILL BE RELEASED IN APRIL 2019. UTILIZING THE REPORTS AND OTHER DATA, IMPLEMENTATION PLANS ARE CREATED AND SUBMITTED TO THE FRANKLIN COMMUNITY HEALTH NETWORK BOARD FOR APPROVAL. THE IMPLEMENTATION PLANS CONTAIN STRATEGIES FOR IMPROVEMENT SPECIFIC TO THE TOP HEALTH PRIORITIES IDENTIFIED THROUGH THE CHNA PROCESS INCLUDING THE METRICS TO MEASURE PROGRESS, PARTNERS AND THE YEAR(S) IN WHICH THE STRATEGY WILL BE ADDRESSED. IMPLEMENTATION PLANS WILL BE FINALIZED BY FALL 2019 IN PREPARATION FOR THE 2019-2021 STRATEGIC PLANS. Part VI, Line 3: WHEN PATIENTS ARE REGISTERED THERE ARE BROCHURES AVAILABLE THAT DESCRIBE FRANKLIN MEMORIAL HOSPITAL'S CHARITY CARE PROGRAM. WHEN A PATIENT IS ADMITTED WITH NO INSURANCE, REGISTRATION SENDS A PATIENT FINANCIAL ADVOCATE 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 PATIENT FINANCIAL ADVOCATE WHEN A PATIENT IS IDENTIFIED AS NEEDING ASSISTANCE. Part VI, Line 4: FRANKLIN MEMORIAL HOSPITAL'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: PROMOTION OF COMMUNITY HEALTH:THE TAX-EXEMPT PURPOSE OF THE ORGANIZATION TO IMPROVE THE HEALTH OF THE COMMUNITY IS PROMOTED AND ENHANCED IN THE FOLLOWING WAYS:1.THE MAJORITY OF THE GOVERNING BODY IS COMPOSED OF PERSONS LIVING WITHIN THE HOSPITAL SERVICE AREA THAT ARE NEITHER EMPLOYED BY, NOR HAVE CONTRACTUAL RELATIONSHIPS WITH, THE HOSPITAL OR ITS AFFILIATES.2.MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.3.SOLICITATION OF COMMUNITY INPUT IN THE STRATEGIC PLANNING PROCESS.4.COMMON GOVERNANCE OF THE HOSPITAL AND PHYSICIAN SERVICES PROVIDED IN THE COUNTY TO PROMOTE COMMON HEALTH CARE AND IMPROVEMENT PLANNING AND CONTROL COSTS.5.SURPLUS FUNDS ARE REINVESTED IN CAPITAL EQUIPMENT AND IMPROVEMENTS TO ENSURE HIGH QUALITY CARE.6.EACH YEAR A PORTION OF RETAINED EARNINGS ARE DISTRIBUTED TO OUR PARENT, MAINE HEALTHCARE, FOR THE SPECIFIC PURPOSE OF HEALTH STATUS IMPROVEMENT PROGRAMS THROUGHOUT THE MAINE HEALTHCARE SERVICE AREA. COMMUNITY BUILDING:PHYSICAL IMPROVEMENTS AND HOUSING:1.DEVELOPMENT AND MAINTENANCE OF THE RAIL TRAIL WHICH IS ON FMH PROPERTY AND IS AVAILABLE TO THE PUBLIC TO ENCOURAGE HEALTH AND WELLNESS.ECONOMIC DEVELOPMENT:1.MEMBER OF GREATER FRANKLIN DEVELOPMENT CORPORATION - AN ORGANIZATION COMMITTED TO ECONOMIC DEVELOPMENT.COMMUNITY SUPPORT:1.PERFORM DISASTER DRILLS WITH THE COMMUNITY 1-2 TIMES A YEAR.2.COMMUNITY DENTAL (PROVIDE LOW COST RENTAL SPACE).COALITION BUILDING:1.HEALTHY COMMUNITY COALITION OF GREATER FRANKLIN COUNTY, FOUNDED IN 1989, IS ONE OF THE OLDEST HEALTH COALITIONS IN THE COUNTRY. ITS MISSION IS TO MEASURABLY IMPROVE THE WELL-BEING OF ALL PEOPLE IN GREATER FRANKLIN COUNTY AND NEIGHBORING TOWNS USING A COORDINATED PUBLIC HEALTH APPROACH OF EDUCATION, PROMOTION, AND OUTREACH. WITH ITS QUALIFIED STAFF OF PUBLIC HEALTH PROFESSIONALS, HEALTHY COMMUNITY COALITION OFFERS HEALTH SCREENINGS, HEALTH INFORMATION, AND PROGRAMS AND EVENTS TO SUPPORT HEALTHY LIFESTYLES THAT PREVENT DISEASE AND IMPROVE QUALITY OF LIFE. ITS COMMUNITY OUTREACH EFFORTS APPEAR IN EVERY TOWN AND CORNER OF THE REGION. IN THE PAST YEAR, MORE THAN 2,000 INDIVIDUALS BENEFITED FROM OUTREACH ACTIVITIES PROVIDED THROUGH THE MOBILE HEALTH UNIT WHERE HEALTH RISK APPRAISALS (HRAS) ARE ROUTINELY OFFERED. HRAS INCLUDE A BLOOD PRESSURE AND CHOLESTEROL CHECK AND INDIVIDUALIZED HEALTH EDUCATION. ADDITIONAL OUTREACH EVENTS WERE HELD THROUGHOUT THE REGION SUCH AS: BONE DENSITY SCREENINGS, FLU IMMUNIZATIONS, BODY COMPOSITION ANALYSIS, FREE CLINICAL BREAST EXAMS, EDUCATION ON TOBACCO, NUTRITION, PHYSICAL ACTIVITY AND SUBSTANCE ABUSE, AND EDUCATION ON THE PREVENTION OF BREAST, CERVICAL, COLON, LUNG, PROSTATE, AND SKIN CANCER.2.AHEC EDUCATION CENTER - ESTABLISHED IN 2004, THE FRANKLIN AHEC PROGRAM WAS DEVELOPED OUT OF GREAT INTEREST FROM EMPLOYEES AND COMMUNITY MEMBERS REQUESTING LOCAL OPPORTUNITIES TO PURSUE CAREERS IN THE HEALTH FIELD AND EDUCATIONAL PROGRAMS FOR RETENTION AND PROFESSIONAL GROWTH. THE FRANKLIN AHEC ALLOWS US TO MEET THE NEEDS OF THE RURAL POPULATION. IT ALSO BRINGS TO THE MAINE AHEC NETWORK THE RESOURCES OF A LARGE INNOVATIVE RURAL HEALTH SYSTEM THAT INCLUDES 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: FMH, ALONG WITH ALL OTHER MAINE HOSPITALS AND HUNDREDS OF PHYSICIAN PRACTICES IN MAINE NOW HAVE ACCESS TO A NEW, CONSOLIDATED ELECTRONIC HEALTH RECORD MADE POSSIBLE BY HEALTHINFONET THAT CONTAINS CRITICAL INFORMATION DRAWN FROM RECORDS THAT HAVE TRADITIONALLY BEEN SEPARATELY MAINTAINED IN PHYSICIAN PRACTICES, HOSPITALS AND OTHER SETTINGS. ARMED WITH MORE COMPLETE AND TIMELY INFORMATION ABOUT A PATIENT, CLINICIANS CAN PROVIDE BETTER QUALITY CARE AND IMPROVE THE COORDINATION OF CARE, PARTICULARLY FOR THOSE PATIENTS WHO SEE SEVERAL PROVIDERS AND RECEIVE CARE IN MORE THAN ONE COMMUNITY OR SETTING. Part VI, Line 6: MAINE HEALTHCARE IS A NOT-FOR-PROFIT FAMILY OF LEADING HIGH-QUALITY PROVIDERS AND OTHER HEALTHCARE ORGANIZATIONS WORKING TOGETHER SO THEIR COMMUNITIES ARE THE HEALTHIEST IN AMERICA. RANKED AMONG THE NATION'S TOP 100 INTEGRATED HEALTHCARE DELIVERY NETWORKS, MAINE HEALTHCARE IS GOVERNED BY A BOARD OF TRUSTEES CONSISTING OF COMMUNITY AND BUSINESS LEADERS FROM ITS SOUTHERN, CENTRAL AND WESTERN MAINE REGIONAL SERVICE AREAS. THE COLLABORATION OF MAINE HEALTHCARE MEMBERS MAKES IT POSSIBLE TO OFFER AN EXTENSIVE RANGE OF CLINICAL INTEGRATION AND COMMUNITY HEALTH PROGRAMS, MANY AIMED AT IMPROVING ACCESS TO PREVENTIVE AND PRIMARY CARE SERVICES. MAINE HEALTHCARE INCLUDES THE FOLLOWING MEMBER ORGANIZATIONS: LINCOLNHEALTH GROUP, MAINEHEALTH, MAINE BEHAVIORAL HEALTHCARE (SPRING HARBOR HOSPITAL), COASTAL HEALTHCARE ALLIANCE (PEN BAY MEDICAL CENTER AND WALDO COUNTY GENERAL HOSPITAL), SOUTHERN MAINE HEALTH CARE (SOUTHERN MAINE MEDICAL CENTER AND GOODALL CAMPUSES), WESTERN MAINE HEALTH CARE (STEPHENS MEMORIAL HOSPITAL), THE MEMORIAL HOSPITAL AT NORTH CONWAY, N.H., MAINEHEALTH CARE AT HOME, NORDX, SYNERNET AND MAINEHEALTH ACCOUNTABLE CARE ORGANIZATION. THE STRATEGIC AFFILIATES OF MAINE HEALTHCARE ARE MAINEGENERAL MEDICAL CENTER, MID COAST HOSPITAL AND ST. MARY'S REGIONAL MEDICAL CENTER. Part VI, Line 7, Reports Filed With States ME 0 0 0 0 0 0 0 0 0 Stephen Goss DO Medical Staff Pres. 219478 0 1727 0 4172 0 4673 0 29695 0 259745 0 0 0 William L Caron Jr MH CEO 0 1057674 0 307230 0 190925 0 81804 0 38802 0 1676435 0 0 Timothy Churchill President/CEO 0 349225 0 57000 0 19579 0 35023 0 30364 0 491191 0 0 John Cox Regional CFO 0 237275 0 24720 0 2623 0 19787 0 26637 0 311042 0 0 Christopher Renaud DO Anesthesiologist 359805 0 0 0 12685 0 5500 0 27725 0 405715 0 0 0 Marni Mishler MD Surgeon 327444 0 0 0 21986 0 5500 0 27627 0 382557 0 0 0 Joanie Peter MD Physician 382754 0 15000 0 14442 0 5500 0 26362 0 444058 0 0 0 James Lancaster MD Anesthesiologist 362862 0 0 0 6256 0 5500 0 24668 0 399286 0 0 0 Heather Decarolis MD Anesthesiologist 347004 0 0 0 3517 0 5500 0 30725 0 386746 0 0 0 Part I, Line 3 TOP MANAGEMENT OFFICIALS ARE COMPENSATED BY RELATED ORGANIZATIONS. THESE ORGANIZATIONS USED ONE OR MORE OF THE METHODS SHOWN AT PART 1, LINE 3 TO ESTABLISH THE COMPENSATION OF TOP MANAGEMENT. SEE DESCRIPTION OF PROCESS IN SCHEDULE O - FORM 990, PART VI, LINE 15A - COMPENSATION FOR TOP OFFICIAL Rebecca Wood Family Member 48534 Employment 0 Adam Dixon Family Member 13240 Employment 0 Stacy Hershfeld Family Member 50033 Employment 0 SCHEDULE L, PART V - ADDITIONAL INFORMATION REBECCA WOOD WAS EMPLOYED BY FRANKLIN MEMORIAL HOSPITAL AS CHIEF NURSING OFFICER. HER HUSBAND, DARRYL WOOD, IS A BOARD MEMBER. ADAM DIXON WAS EMPLOYED BY FRANKLIN MEMORIAL HOSPITAL AS A RADIOGRAPHER. HIS FATHER, DAVID DIXON IS A BOARD MEMBER. STACY HERSHFELD, DO WAS EMPLOYED BY FRANKLIN MEMORIAL HOSPITAL AS A PHYSICIAN. HER HUSBAND, STEPHEN GOSS, MD IS A BOARD MEMBER. Cash 2019-01-01 4044179 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Patient Accounts Receivable, net 2019-01-01 7294551 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Investments 2019-01-01 769285 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Other Current Assets 2019-01-01 401826 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Estimated Amounts Receivable Under Reimbursement 2019-01-01 2415396 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Inventories 2019-01-01 1604501 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Prepaids 2019-01-01 701426 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Due from Affiliates 2019-01-01 1405619 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Long Term Assets Whose Use Is Limited 2019-01-01 2504472 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 PP&E, net 2019-01-01 25457520 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Other Assets 2019-01-01 6749969 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Due to Affiliates 2019-01-01 -5847516 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Accounts Payable and Other Current Liabilities 2019-01-01 -2821700 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Accrued Expenses and Deferred Revenue 2019-01-01 -3967332 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Long Term Debt 2019-01-01 -16284500 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Other Long Term Liabilities 2019-01-01 -6360520 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Unrestricted Net Assets 2019-01-01 -15562703 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Temporarily Restricted Net Assets 2019-01-01 -1336708 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 Permanently Restricted Net Assets 2019-01-01 -1167765 010238552 MaineHealth 22 Bramhall Street Portland ME 04102 501c3 1 1 0 0 1 1 1 1 1 0 Part I, Line 2e: Person(s) Involved: Clint Boothby; Stephen Goss; William L Caron Jr; Connie Adler; TimothyChurchill; John Cox Part I, Line 2e: Explanation of Involvement: Clint Boothby, Chairman of FCHN, became a member of MaineHealth's (EIN01-0238552) board of trustees upon FCHN's merger with MaineHealth on1/1/2019.Stephen Goss, Connie Adler, Timothy Churchill, and John Cox becameemployees of MaineHealth upon the merger date.William L Caron Jr is an employee of MaineHealth. Part I, Line 6c: Effective January 1, 2019, all tax exempt bond liabilities were transferred to MaineHealth (EIN 01-0238552) as part of Franklin Memorial Hospital's merger with MaineHealth. Form 990, Part V, Line 1a MAINEHEALTH (EIN 01-0238552), ACTING ON BEHALF OF MAINE HEALTHCARE (EIN 01-0431680), FILED 1,645 FORM 1099S FOR THE CALENDAR YEAR 2018 ON BEHALF OF THE FOLLOWING ORGANIZATIONS: MAINE HEALTHCARE, MAINEHEALTH, SOUTHERN MAINE HEALTH CARE, COASTAL HEALTHCARE ALLIANCE, PEN BAY MEDICAL CENTER, WALDO COUNTY GENERAL HOSPITAL, FRANKLIN MEMORIAL HOSPITAL, LINCOLNHEALTH GROUP, MEMORIAL HOSPITAL, WESTERN MAINE HEALTHCARE, MAINE BEHAVIORAL HEALTHCARE, NORDX, MAINEHEALTH CARE AT HOME. Form 990, Part V, Line 2a FRANKLIN MEMORIAL HOSPITAL (EIN 01-0211503) FILED FORM W-3, REPORTING 826 EMPLOYEES FOR THE CALENDAR YEAR 2018 ON BEHALF OF THE FOLLOWING ORGANIZATIONS: FRANKLIN MEMORIAL HOSPITAL, EVERGREEN BEHAVIORAL SERVICES, AND HEALTHY COMMUNITY COALITION. Form 990, Part VI, Section A, line 6 MAINE HEALTHCARE (EIN 01-0431680) IS THE SOLE MEMBER OF FRANKLIN COMMUNITY HEALTH NETWORK (FCHN) (EIN: 22-3209406). FCHN IS THE SOLE MEMBER OF FRANKLIN MEMORIAL HOSPITAL (FMH). Form 990, Part VI, Section A, line 7a MAINE HEALTHCARE AND FRANKLIN COMMUNITY HEALTH NETWORK HAVE THE RESPONSIBILITY FOR THE ELECTION OF THE MEMBERS OF THE GOVERNING BODY. Form 990, Part VI, Section A, line 7b DECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS STRATEGIES, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL OF THE SOLE MEMBER. Form 990, Part VI, Section B, line 11b THE FORM 990 WAS REVIEWED BY THE REGIONAL CHIEF FINANCIAL OFFICER PRIOR TO SIGNING THE RETURN. THE FORM 990 WAS THEN MADE AVAILABLE TO THE FULL BOARD PRIOR TO FILING. 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 COMPENSATION FOR CEO THE PROCESS FOLLOWED FOR DETERMINING COMPENSATION OF THE CEO COMPENSATED BY THIS OR OTHER RELATED ORGANIZATION IS A FORMAL PROCESS PERFORMED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. A RELATED ORGANIZATION USES AN OUTSIDE FIRM, SULLIVAN COTTER, TO PERFORM AN INDEPENDENT BENCHMARK ANALYSIS FOR THE CEO OF FRANKLIN MEMORIAL HOSPITAL, ALONG WITH OTHER EXECUTIVES IN THE MAINE HEALTHCARE SYSTEM. THE FIRM MEETS WITH THE EXECUTIVE COMMITTEE TO REVIEW EACH EXECUTIVE'S BENCHMARK REPORT. THE COMMITTEE THEN DELIBERATES ON MAINE HEALTHCARE'S WRITTEN SALARY AND INCENTIVE PLAN PHILOSOPHY BEFORE MAKING A FINAL DECISION. ALL DECISIONS AND MEETINGS ARE CAPTURED IN MINUTES AND THERE ARE APPROPRIATE APPROVALS AT ALL LEVELS. COMPENSATION FOR OFFICERS THE MEMBER IS RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. COMPENSATION IS EVALUATED BY THE COMPENSATION COMMITTEE APPOINTED BY THE MEMBER, AND THE ORGANIZATION'S BOARD OF TRUSTEES MUST APPROVE OF THE COMPENSATION. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTING FIRM AND INDUSTRY SURVEY. Form 990, Part VI, Section C, line 19 DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. Form 990, Part XI, line 9: Transfer to MaineHealth (EIN 01-0238552) -18,067,176. Transfers from Affiliates, net -183,000. Change in interest in temporarily restricted net assets -188,020. Form 990, Part XI, Line 9 EFFECTIVE JANUARY 1, 2019, FRANKLIN MEMORIAL HOSPITAL MERGED WITH MAINEHEALTH (EIN 01-0238552) TO BEGIN OPERATING AS A UNIFIED SYSTEM UNDER THE LEGAL NAME OF MAINEHEALTH. ON JANUARY 1, 2019, ALL OF THE ASSETS, LIABILITIES, AND NET ASSETS OF FRANKLIN MEMORIAL HOSPITAL WERE TRANSFERRED TO MAINEHEALTH (EIN 01-0238552). SEE SCHEDULE N FOR MORE DETAILS. Evergreen Behavioral Services 131 Franklin Health Commons Farmington ME 04938 010492747 Mental health ME 501(c)(3) Line 10 Franklin Community Health Network 0 Franklin Community Health Network 111 Franklin Health Commons Farmington ME 04938 223209406 Healthcare ME 501(c)(3) Line 12b, II Maine Healthcare 0 Healthy Community Coalition Inc 105 Mt Blue Circle Farmington ME 04938 223305743 Community services ME 501(c)(3) Line 7 Franklin Community Health Network 0 Maine Healthcare 110 Free Street Portland ME 04101 010431680 Healthcare ME 501(c)(3) Line 12c, III-FI N/A 0 William A Howell Trust Fund PO Box 830269 Dallas TX 75283 016032170 Perpetual Trust ME N/A T 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 Part IV, columns (f), (g) & (h) The tax year of the listed trust did not end with or within the tax year of Franklin Memorial Hospital. Therefore, no amounts are entered in these columns.