2019-01-25T08:08:59-06:00 2018-06-30 390758449 WIPFLI LLP 1 MARKET SQUARE AUGUSTA ME 043304637 990 2017-07-01 010284446 REDINGTON-FAIRVIEW GENERAL HOSPITAL REDI 2074745121 PO BOX 468 SKOWHEGAN ME 049760468 ELMER DOUCETTE CFO 2074745121 2019-01-24 1 BOB DUBE CPA P01231018 2076224766 2019-01-24 50.241.82.165 2019-01-24 10:14:33 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F60847090D07EA8A664346B67C021E159FD4183C 2017 2019-02-21 02:37:17Z RICHARD D WILLETT PO BOX 468 SKOWHEGAN ME 049760468 106492964 0 X WWW.RFGH.NET X 1969 ME REDINGTON-FAIRVIEW GENERAL HOSPITAL'S MISSION IS TO DEVELOP, PROVIDE, AND FACILITATE QUALITY, SAFE, COMPREHENSIVE, COST-EFFECTIVE HEALTH SERVICES FOR THE PEOPLE WE SERVE. WE AFFIRM A COMMITMENT TO MAINTAIN OUR UNIQUE COMMUNITY HOSPITAL IDENTITY, OFFERING PERSONALIZED SERVICES. 9 6 819 39 0 0 2075413 1770818 94217267 99753624 615332 1449627 2280238 3518895 99188250 106492964 0 0 0 0 56266430 58698274 0 0 0 41497132 45454642 97763562 104152916 1424688 2340048 112241474 115195180 47297547 44474418 64943927 70720762 X SEE SCHEDULE O 0 0 52583695 70564328 RFGH PROVIDES 24 HOUR SEVEN DAY A WEEK EMERGENCY SERVICES. THESE SERVICES INCLUDE AN EMERGENCY DEPARTMENT STAFFED WITH PHYSICIANS 24 HOURS A DAY AS WELL AS AN AMBULANCE SERVICE WHICH OPERATES 24 HOURS A DAY. DURING FISCAL 2018, RFGH HAD 24,798 EMERGENCY DEPARTMENT VISITS AND 3,814 AMBULANCE RUNS. IN ADDITION TO EMERGENCY SERVICES, THE HOSPITAL PROVIDES A FULL RANGE OF SERVICES, RADIOLOGY, C.T., ULTRASOUND, NUCLEAR MEDICINE, BLOOD BANK, PATHOLOGY, CARDIOLOGY AND LABORATORY SERVICES. IN TOTAL, THESE SERVICES TREATED APPROXIMATELY 40,470 PATIENTS. 23054578 11231911 RFGH OPERATES A NUMBER OF PHYSICIAN OFFICES IN ORDER TO BETTER SERVE THE RESIDENTS OF SOMERSET COUNTY. DURING FISCAL 2018, THESE PHYSICIAN SPECIALTIES INCLUDED INTERNAL MEDICINE, ENDOCRINOLOGY, GENERAL SURGERY, ORTHOPEDICS, PEDIATRICS, FAMILY MEDICINE, OBSTETRICS, GASTROENTEROLOGY, NEUROLOGY, AND UROLOGY. DURING FISCAL 2018, THESE PHYSICIAN SPECIALTIES SERVED 16,255 PATIENTS WHO TOTALLED 67,492 VISITS AT THESE OFFICES. 14584636 17957385 RFGH IS LICENSED AS A CRITICAL ACCESS HOSPITAL OPERATING 25 BEDS. RFGH EMPLOYS HOSPITALISTS WHO ARE PHYSICIANS DEDICATED TO THE TREATMENT OF INPATIENTS. INPATIENT SERVICES INCLUDE MEDICAL AND SURGICAL, SPECIAL CARE, OBSTETRICS AND PEDIATRICS. DURING FISCAL 2018, RFGH PROVIDED INPATIENT SERVICES TO 1,430 PATIENTS WHO STAYED 4,649 PATIENT DAYS. MEDICARE AND MEDICAID PATIENTS REPRESENTED 80% OF RFGH'S INPATIENTS. 1227861 1037954 REDINGTON-FAIRVIEW GENERAL HOSPITAL OPERATES SOMERSET PUBLIC HEALTH, A PROGRAM WHOSE PURPOSE IS TO PROTECT AND IMPROVE THE QUALITY OF LIFE AND HEALTH OF ALL GREATER SOMERSET COUNTY RESIDENTS. 1227861 1037954 91450770 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 64 0 1 819 1 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X RICHARD D WILLETT 2078582315 46 FAIRVIEW AVE SKOWHEGAN ME 049760468 CHRISTOPHER PERKINS PRESIDENT 2.00 X X 0 0 0 L JOSEPH CLARK VICE PRESIDENT 2.00 X X 0 0 0 JEFFREY LLOYD TREASURER 2.00 X X 0 0 0 JEFFREY MCGOWN DIRECTOR 2.00 X 0 0 0 MICHAEL CURRAN MD DIRECTOR 50.00 X 507247 0 4050 WILLIAM LANEY DIRECTOR 2.00 X 0 0 0 MICHAEL LAMBKE MD DIRECTOR 50.00 X 194165 0 0 JOHN WITHERSPOON DIRECTOR 2.00 X 0 0 0 GINA GOMEZ MD DIRECTOR 50.00 X 274125 0 3916 RICHARD D WILLETT CEO/SECRETARY 50.00 X 409055 0 9978 DANA C KEMPTON ASSOCIATE DIRECTOR 50.00 X 281868 0 6465 ELMER DOUCETTE CFO 50.00 X 224443 0 454 TIRUNELLAI R SHANKAR MD SURGEON 50.00 X 528307 0 2596 AMIR BAIG MD ANESTHESIOLOGIST 50.00 X 338331 0 2700 JOHN COMIS MD ER PHYSICIAN 50.00 X 403717 0 3375 TRACEY REILLY MD ER PHYSICIAN 50.00 X 325551 0 0 WINOAH HENRY MD GASTROENTEROLOGIST 50.00 X 493418 0 1862 3980227 0 35396 74 0 1 0 COMPHEALTH 7259 S BINGHAM JCT BLVD MIDVALE UT 84047 CLINICAL STAFFING 838882 QUEST DIAGNOSTIC INC 5763 COLLECTION CENTER DR CHICAGO IL 60693 LAB TESTING 574423 DAHL-CHASE DIAGNOSTIC SERVICES 417 STATE STREET BANGOR ME 04401 LAB TESTING 539873 VISTA STAFFING SOLUTIONS 275 EAST 200 SOUTH SALT LAKE CITY UT 84111 CLINICAL STAFFING 479841 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 CLINICAL STAFFING 356411 17 651557 1119261 1770818 NET PATIENT REVENUE 622110 99753624 99753624 99753624 1449627 1449627 OTHER MISCELLANEOUS 622110 3211401 3211401 CAFETERIA 622110 307494 307494 3518895 106492964 102965025 0 1757121 1915766 983503 932263 40936660 36859200 4077460 2029713 1729315 300398 10991498 9364756 1626742 2824637 2406591 418046 46195 10372 35823 199998 199998 10905 10905 468401 12477 455924 4888644 4758851 129793 131345 131345 5408539 4819715 588824 3756735 1735262 2021473 2046665 1843603 203062 79233 75776 3457 236760 221650 15110 1064686 919889 144797 3968480 3173369 795111 963661 761568 202093 BAD DEBT EXPENSE 11687358 11687358 PHARMACEUTICALS 5338030 5338030 EQUIPMENT & MAINTENANCE 2344841 2022052 322789 HOSPITAL PROVIDER TAX 1735722 1735722 1078444 991711 86733 104152916 91450770 12702146 0 2917790 4238181 3452850 3847908 13130090 13483447 444350 0 1505843 1602417 193250 245661 87595503 60199924 30098999 27395579 59937178 63709074 561124 672913 112241474 115195180 8413207 8774943 26812304 24762257 12072036 10937218 47297547 44474418 X 63799035 69792310 1144892 928452 64943927 70720762 112241474 115195180 X 2340048 4008128 -571341 X 0 1 X 1 0 X 10905 10905 10905 10905 104142011 104142011 104152916 104152916 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 9590 11190 10006 10905 41691 250000 250000 250000 250000 1000000 1500000 396680 396680 50552167 28848980 21703187 36646656 31350944 5295712 27395579 LIABILITY FOR PENSION BENEFITS 3719858 ESTIMATED THIRD PARTY SETTLEMENTS 7217360 10937218 98813734 4008128 4008128 94805606 11687358 11687358 106492964 92465558 0 92465558 11687358 11687358 104152916 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 11,687,358. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 11,687,358. 1 1 1 X 1 X 1 1 0 0 1531034 1531034 0.01470 1531034 1531034 0.01470 1306577 1306577 0.01250 23054578 11231911 11822667 0.11350 24361155 11231911 13129244 0.12600 25892189 11231911 14660278 0.14070 1 5403735 36012384 38413089 -2400705 X 1 1 1 1 REDINGTON-FAIRVIEW GENERAL HOSPITAL 46 FAIRVIEW AVENUE PO BOX 468 SKOWHEGAN ME 04976 WWW.RFGH.NET 38095 X REDINGTON-FAIRVIEW GENERAL HOSPITAL 1 0 0 1 X X X X X X 16 1 1 1 1 X HTTPS://WWW.RFGH.NET/PORTALS/0/PDFS/COMMUNITY%20HEALTH%20NEEDS X SEE COMPLETE URL IN PART VI X 1 16 0 1 0 1 X 150.000000000000 225.000000000000 1 1 X X X 1 X WWW.RFGH.NET/PORTALS/0/PDFS/SLIDING%20FEE X X X X X 0 0 X X X X 1 0 0 REDINGTON-FAIRVIEW GENERAL HOSPITAL PART V, SECTION B, LINE 5: HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED:IN 2016, RFGH COLLABORATED WITH THE MAINE SHARED HEALTH NEEDS ASSESSMENT & PLANNING PROCESS PROJECT - A COLLABORATION OF MULTIPLE HEALTHCARE SYSTEMS ACROSS MAINE AND THE MAINE CDC. A QUALITATIVE SURVEY WAS COMPLETED IN KENNEBEC AND SOMERSET COUNTY BY COMMUNITY LEADERSHIP AND HEALTH EXPERTS, LOCAL GOVERNMENT, OTHER GOVERNMENTAL AGENCIES, YOUTH SERVING ORGANIZATIONS, FAITH BASED ORGANIZATION, AND OTHER INTERESTED INDIVIDUALS. KEY HEALTH ISSUES IDENTIFIED FROM THE QUALITATIVE SURVEY: OBESITY (CHILDHOOD AND ADULT), ELDER HEALTH, DEPRESSION, CARDIOVASCULAR AND RESPIRATORY DISEASES, DIABETES, DRUG AND ALCOHOL ABUSE, NUTRITION AND PHYSICAL ACTIVITY, TOBACCO USE, ORAL HEALTH AND MENTAL HEALTH. KEY HEALTH FACTORS IDENTIFIED WERE POVERTY, EMPLOYMENT, FOOD INSECURITY, HOUSING, ADVERSE CHILDHOOD EXPERIENCES, SOCIAL SUPPORT AND INTERACTIONS, ACCESS TO BEHAVIORAL CARE / MENTAL HEALTH CARE, HEALTH CARE INSURANCE, HEALTH LITERACY, ACCESS TO ORAL CARE, TRANSPORTATION, ACCESS TO HEALTHY FOODS. REDINGTON-FAIRVIEW GENERAL HOSPITAL PART V, SECTION B, LINE 6A: OTHER HOSPITALS AND OTHER ORGANIZATIONS INCLUDED IN CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENT:RFGH HAS COLLABORATED WITH THE MAINE SHARED HEALTH NEEDS ASSESSMENT & PLANNING PROCESS (SHNAPP) PROJECT - A COLLABORATIVE OF CENTRAL MAINE HEALTHCARE, EASTERN MAINE HEALTHCARE SYSTEMS, MAINEGENERAL HEALTH, MAINEHEALTH, AND THE MAINE CENTER FOR DISEASE CONTROL AND PREVENTION. THE SHNAPP WORKS TO IMPROVE THE HEALTH STATUS OF MAINE RESIDENTS AND TRACK RESULTS. RFGH HAS HAD ACTIVE REPRESENTATION ON THE COMMUNITY ENGAGEMENT TEAM OF THE PROJECT AND HAS ACTIVELY PARTICIPATED IN IDENTIFYING FORUM FOCUSES AND DEVELOPING FEEDBACK OPPORTUNITIES FROM THE FORUMS. REDINGTON-FAIRVIEW GENERAL HOSPITAL PART V, SECTION B, LINE 11: HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS......:ACCORDING TO THE 2017 COMMUNITY HEALTH IMPROVEMENT PLAN, HEALTH PRIORITIES INCLUDE DIABETES, TOBACCO USE, SUPPORT FOR OLDER ADULTS, MENTAL HEALTH TREATMENT, AND ORAL HEALTH. GOAL STATEMENTS, ACTIVITIES, ACTIONS TAKEN, PROGRAMS AND RESOURCES COMMITTED, COLLABORATION WITH OTHER ORGANIZATIONS, AND EVALUATION OF THE IMPACT OF THE ACTIONS TAKEN BY RFGH ARE SUMMARIZED IN THE IMPROVEMENT PLAN. PART V, SECTION B, LINE 22D: HOW HOSPITAL DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED FAP-ELIGIBLE INDIVIDUALS:ALL ACCOUNT GUARANTORS WHO EXPRESS AN INABILITY TO PAY FOR SERVICES ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE USING AN APPLICATION AND GUIDELINES ESTABLISHED BY THE HOSPITAL. UNDER THESE GUIDELINES, ELIGIBLE APPLICANTS MAY QUALIFY FOR 100% CHARITY CARE OR DISCOUNTED CHARGES RANGING FROM 25% TO 100%. PART I, LINE 7: PART I, LINE 7A: METHODOLOGY USED TO ESTIMATE FINANCIAL ASSISTANCE AT COST:CHARITY CARE WRITE-OFFS ARE RECORDED AT GROSS CHARGES. IN ORDER TO COMPUTE THE COST OF THESE SERVICES, THE HOSPITAL ADJUSTED BOTH GROSS CHARGES AND EXPENSES BY EXCLUDING THE GROSS CHARGES AND EXPENSES ASSOCIATED WITH SUBSIDIZED HEALTH SERVICES REPORTED IN SCHEDULE H PART I LINE 7G AND CALCULATED A RATIO OF COST-TO-CHARGES. THE RESULTING RATIO OF 46.24% WAS APPLIED TO THE GROSS CHARGES PERTAINING TO CHARITY CARE WRITE-OFFS.PART I, LINE 7E:METHODOLOGY USED TO ESTIMATE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS:THESE COMMUNITY BENEFIT EXPENSES REPRESENT THE ACTUAL EXPENDITURES OF OPERATING THE SOMERSET PUBLIC HEALTH COLLABORATIVE WHICH SERVES MOST OF MAINE'S SOMERSET COUNTY. PART I, LINE 7G: METHODOLOGY USED TO ESTIMATE SUBSIDIZED HEALTH SERVICES:THESE COMMUNITY BENEFIT EXPENSES REPRESENT THE DIRECT AND INDIRECT COSTS OF OPERATING PHYSICIAN PRACTICES WHICH OPERATE WITH REVENUES THAT ARE INSUFFICIENT TO COVER THE OVERALL COSTS. INDIRECT COSTS ARE CALCULATED USING AN ALLOCATION METHOD SIMILAR TO MEDICARE COST REPORT METHODS OF ALLOCATING OVERHEAD COSTS. PART III, LINE 2: BAD DEBT WRITE-OFFS ARE RECORDED AT GROSS CHARGES. IN ORDER TO COMPUTE THE COST OF THESE SERVICES, THE HOSPITAL ADJUSTED BOTH GROSS CHARGES AND EXPENSES BY EXCLUDING THE GROSS CHARGES AND EXPENSES ASSOCIATED WITH SUBSIDIZED HEALTH SERVICES REPORTED IN SCHEDULE H PART I LINE 7G AND CALCULATED A RATIO OF COST-TO-CHARGES. THE RESULTING RATIO OF 46.24% WAS APPLIED TO THE GROSS CHARGES PERTAINING TO BAD DEBT WRITE-OFFS. PART III, LINE 4: FOOTNOTE DESCRIBING BAD DEBTS:NOTE 2 - CONCENTRATION OF CREDIT RISKIN FULFILLING ITS CHARITABLE MISSION, THE HOSPITAL GRANTS CREDIT WITHOUT COLLATERAL TO THEIR PATIENTS, MANY OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. AT JUNE 30, 2018 AND 2017, NET ACCOUNTS RECEIVABLE RELATING TO PATIENTS WITHOUT INSURANCE WAS 39.2% AND 35.5%, RESPECTIVELY.ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT THAT MANAGEMENT EXPECTS TO COLLECT. MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO THE CONSOLIDATED STATEMENT OF OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE ALLOWANCE ACCOUNT AND A CREDIT TO ACCOUNTS RECEIVABLE.IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE HOSPITAL DEDUCTED ITS PROVISION FOR UNCOLLECTABLE ACCOUNTS OF $11,687,358 AND $9,089,395 FOR THE YEARS ENDED JUNE 30, 2018 AND 2017, RESPECTIVELY, FROM REVENUE.ACCOUNTS RECEIVABLE AT JUNE 30, 2018 AND 2017 ARE COMPRISED OF THE FOLLOWING:_______________________________________2018__________________2017 PATIENT ACCOUNTS___________________$25,732,197______________$23,671,434ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS(7,520,893)____________(5,457,291)ALLOWANCE FOR CONTRACTUAL ALLOWANCES(4,727,857)____________(5,084,053)ACCOUNT RECEIVABLE - NET__________$ 13,483,447_____________$13,130,090 PART III, LINE 8: MEDICARE SHORTFALL METHOD OF CALCULATING:MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B. INPATIENT MEDICARE COSTS ARE CALCULATED BASED UPON A COMBINATION OF ALLOWABLE COST PER DAY MULTIPLIED BY MEDICARE DAYS FOR ROUTINE SERVICES PLUS A COST-TO-CHARGE RATIO MULTIPLIED BY MEDICARE CHARGES BY ANCILLARY DEPARTMENT. OUTPATIENT COST IS CALCULATED BASED ON A COST-TO-CHARGE RATIO MULTIPLIED BY MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: COLLECTION PRACTICES:THE HOSPITAL'S COLLECTION POLICY CONTAINS THE GUIDELINES FOR FINANCIAL ASSISTANCE, AND CONTAINS PROVISIONS FOR HOSPITAL STAFF TO EXTEND TO QUALIFIED PATIENTS WHO WOULD LIKELY MEET SLIDING SCALE FEE CRITERIA THE OPPORTUNITY TO APPLY FOR DISCOUNTED CARE. HOSPITAL RESOURCES ARE MADE AVAILABLE TO PATIENTS REQUIRING ASSISTANCE IN COMPLETING APPLICATIONS. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY ARE PROVIDED DISCOUNTS RANGING FROM 25% TO 100% OF CHARGES. ONCE QUALIFIED PATIENTS MAY BE EXTENDED REDUCED FEE FOR HEALTH CARE SERVICES RECEIVED IN THE FUTURE. ALL PATIENTS ARE ASKED TO REAPPLY ANNUALLY TO THE SLIDING FEE PROGRAM. OUTSIDE COLLECTION AGENCIES CONTRACTED WITH THE HOSPITAL MUST SPECIFY THEIR STANDARDS AND SCOPE OF PRACTICES, ALL OF WHICH MUST BE IN COMPLIANCE WITH THE COLLECTION POLICY. PART VI, LINE 2: NEEDS ASSESSMENT: DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED:REDINGTON-FAIRVIEW GENERAL HOSPITAL OPERATES SOMERSET PUBLIC HEALTH (SPH), A PROGRAM WHOSE PURPOSE IS TO PROTECT AND IMPROVE THE QUALITY OF LIFE AND HEALTH OF ALL GREATER SOMERSET COUNTY RESIDENTS. SPH PROVIDES PLANNING AND EVALUATION OF BOTH LONG AND SHORT RANGE STRATEGIES FOR ESSENTIAL PUBLIC HEALTH SERVICES. SPH INVOLVES CITIZENS IN DEVELOPING AND CARRYING OUT CHRONIC DISEASE PREVENTION THROUGH VARIOUS INITIATIVES. SPH MOBILIZES BOTH PUBLIC AND PRIVATE RESOURCES IN SUPPORT OF THESE INITIATIVES AND COORDINATES EFFORTS THROUGHOUT THE COMMUNITY. BY WORKING WITH CITIZENS, SPH SERVES AS ADVOCATES ON MATTERS OF POLICIES THAT AFFECT HEALTH STATUS, WHILE PROMOTING INSTITUTIONAL IMPROVEMENT AND DESIRABLE CHANGES IN SOCIAL POLICY AND ENVIRONMENTAL CHANGE. SPH IMPLEMENTS PROGRAMS FINANCED THROUGH GRANTS, OR DELEGATES IMPLEMENTATION TO OTHER AGENCIES. SPH ALSO IDENTIFIES AND PURSUES OTHER AVAILABLE FUNDS DEEMED IMPORTANT FOR THE HEALTH OF CITIZENS. IN ITS WORK TO IMPROVE AND PROTECT PUBLIC HEALTH AND REDUCE CHRONIC DISEASE, SPH FOCUSES ITS EFFORTS AND FUNDING ON SUBSTANCE ABUSE AND TOBACCO PREVENTION, PHYSICAL ACTIVITY AND NUTRITION PROMOTION, AND WORKSITE WELLNESS.AS PART OF THE WORK OF THE SHNAPP, A QUALITATIVE STATEWIDE STAKEHOLDER SURVEY WAS CONDUCTED IN JUNE 2015. AS A MEANS OF GATHERING ADDITIONAL INPUT FROM THE DIRECT COMMUNITY THAT RFGH SERVES, A SIMPLE QUALITATIVE SURVEY WAS DEVELOPED BY RFGH AND TAKEN TO A TOTAL OF 18 COMMUNITY EVENTS / PRESENTATIONS. THE SURVEY PURPOSE OR INTENT WAS TO PROVIDE A CONSISTENT AND STRUCTURED METHOD FOR ASKING QUESTIONS OF COMMUNITY MEMBERS. IT WAS AN OPPORTUNITY FOR MEMBERS OF THE COMMUNITY TO PROVIDE FEEDBACK AND OPINIONS WITHOUT THE POTENTIAL INFLUENCE THAT CAN OCCUR WHEN AN INDIVIDUAL VERBALLY ASKS A QUESTION. THE SURVEY FOCUSED ON WHICH HEALTH ISSUES IMPACT THEIR OVERALL HEALTH. THE SURVEYS FOCUSED ON FAMILY HEALTH, INFECTIOUS DISEASES, CHRONIC DISEASES, HEALTHY BEHAVIORS AND OTHER HEALTH ISSUES. THIS SURVEY WAS WELL RECEIVED BY COMMUNITY MEMBERS AND WAS EASILY COMPLETED. BETWEEN AUGUST OF 2015 AND JUNE OF 2016, 850 RESPONDENTS COMPLETED THE LIVE SURVEY. COMMUNITY MEMBERS WERE INVITED TO COMPLETE THE SURVEY AT THE BEGINNING OF A COMMUNITY EVENT, SUPPORT GROUP, PRESENTATION, OR OTHER EVENT. THE OPPORTUNITIES FOR THESE SURVEYS INCLUDED SEVERAL WORKSITES, NURSING HOMES, TRIATHLON EVENT, DIABETES EVENT, MULTIPLE SUPPORT GROUPS, WEIGHT MANAGEMENT GROUPS/CLASSES, A NUTRITION CLASS, LOCAL FAIR THAT FOCUSED ON FAMILY AND VIOLENCE PREVENTION, FARMER'S MARKET, LOCAL FOOD CUPBOARD, AND AN EVENT FOCUSING ON CANCER SURVIVAL. THIS METHOD OF GATHERING COMMUNITY INPUT ON HOW HEALTH ISSUES IMPACT THEM WAS VALUABLE IN REACHING MANY DIFFERENT POPULATIONS - MEDICALLY UNDERSERVED, POVERTY OR LOW INCOME, HARD TO REACH GROUPS SUCH AS THOSE WHO RELY ON OTHERS FOR TRANSPORTATION (FOR EXAMPLE; SUPPORT GROUP INDIVIDUALS OR THE NURSING HOME ENVIRONMENT). AS AN ADDITIONAL MEANS OF GATHERING INPUT FROM THE COMMUNITY THAT RFGH SERVES, A FOCUSED FOLLOW-UP OCCURRED WHEREBY 40 PARTICIPANTS WERE ASKED TO SHARE THEIR OPINIONS ABOUT THE TOPIC AT HAND AND TO OFFER SUGGESTIONS FOR ACTION. THEY WERE ASKED ABOUT THEIR PERCEPTION ABOUT THE FOLLOWING FOUR HEALTH ISSUES: DRUG ABUSE/ADDICTION, SMOKING, OBESITY AND TRANSPORTATION. WHEN ASKED "WHAT NEEDS TO BE CHANGED?" PARTICIPANTS PROVIDED THEIR PERCEPTION OF HEALTH AND SOCIAL/ENVIRONMENTAL HEALTH OUTCOMES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:REDINGTON-FAIRVIEW GENERAL HOSPITAL PROVIDES THE FOLLOWING INFORMATION IN THE FIRST BILL THAT EACH PATIENT RECEIVES:REDINGTON-FAIRVIEW GENERAL HOSPITAL46 FAIRVIEW AVENUEPO BOX 468SKOWHEGAN, ME 04976207-474-5121CATEGORY A & B SLIDING FEE SCALEREDINGTON-FAIRVIEW GENERAL HOSPITAL (RFGH) FOLLOWS MAINE STATE LAW AND PROVIDES FREE HOSPITAL SERVICE TO THOSE INDIVIDUALS WHO CANNOT AFFORD TO PAY UNDER CATEGORY A FREE CARE. RFGH HAS A SLIDING FEE SCALE (CATEGORY B) AND OTHER PROGRAMS AVAILABLE WHICH MAY PROVIDE HOSPITAL SERVICES AT A REDUCED AMOUNT TO THOSE INDIVIDUALS WHO CANNOT AFFORD TO PAY. IF YOU BELIEVE YOU QUALIFY FOR ASSISTANCE, YOU MAY COMPLETE AN APPLICATION AT THE PATIENT ACCOUNTS OFFICE, LOCATED AT 22 JONES STREET-THE WHITE BUILDING IN THE BACK PARKING LOT OF THE HOSPITAL. THE PATIENT ACCOUNTS OFFICE IS OPEN FROM 7:30AM TO 3:00 PM MONDAY THROUGH FRIDAY. IF YOU WOULD LIKE TO SPEAK TO A REPRESENTATIVE REGARDING THE APPLICATION PROCESS AND/OR WOULD LIKE TO MAKE AN APPOINTMENT TO COMPLETE THE APPLICATION PROCESS, PLEASE CALL 858 - 8367 TO COMPLETE THE APPLICATION PROCESS YOU (OR YOUR DESIGNEE) WILL NEED TO PRESENT AND PROVIDE PROOF OF INCOME TO DETERMINE YOUR ELIGIBILITY FOR ASSISTANCE, INCLUDING THE FOLLOWING:- YOUR MOST RECENT FEDERAL INCOME TAX RETURN, IF YOU DO NOT FILE TAXES YOU WILL HAVE TO SIGN A DOCUMENT STATING YOU DO NOT FILE INCOME TAXES. - YOUR LAST THREE MONTHS WAGE STUBS OR A COPY OF YOUR WAGE STUB WITH YEAR TO DATE FOR A PERIOD OF AT LEAST THREE MONTHS. - COPY OF LAST THREE MONTHS CHECKING AND SAVINGS ACCOUNT STATEMENTS. IF APPLYING UNDER CATEGORY B AND SELF-EMPLOYED 3 MONTHS OF BUSINESS CHECKING STATEMENTS WILL ALSO BE REQUIRED. - LIST OF ALL INCOME INCLUDING ALIMONY, CHILD SUPPORT, STOCKS, BONDS, ANNUITIES, AND RENTAL INCOME. - PROOF OF INSURANCE OF ANY KIND, INCLUDING HEALTH SAVINGS ACCOUNTS/CO-OP PROGRAMS TO HELP PAY FOR YOUR CARE. YOU WILL NEED TO SHOW THAT YOUR HSA HAS BEEN FULLY UTILIZED PRIOR TO APPROVAL. - YOU WILL ALSO BE REQUIRED TO APPLY TO THE STATE OF MAINE FOR COVERAGE. IF YOU ARE NOT ELIGIBLE YOU WILL BE ISSUED A DENIAL AND MUST PROVIDE A COPY OF THE ENTIRE PACKET, INCLUDING A LIST OF ASSETS. {NOTE: THIS DENIAL LETTER IS ONLY GOOD FOR SIX MONTHS.}TO BE ELIGIBLE FOR FREE CARE (CATEGORY A) OR THE RFGH SLIDING FEE (CATEGORY B), YOUR FAMILY INCOME MUST BE BELOW THE FOLLOWING LEVELS. THE HOSPITAL WILL CONSIDER THE HIGHEST INCOME LEVEL AVAILABLE BASED ON THE NUMBER OF DEPENDENTS THAT YOU HAVE (SEE THE TABLES BELOW). IF YOU DO NOT QUALIFY FOR FREE CARE (CATEGORY A), YOU ARE ALLOWED TO ASK FOR A FAIR HEARING. THE STATE DEPARTMENT OF HUMAN SERVICES WILL TELL YOU HOW TO APPLY FOR A FAIR HEARING. IN ADDITION, RFGH WILL PROVIDE YOU WITH A FINAL DETERMINATION OF YOUR ELIGIBILITY FOR ASSISTANCE WITHIN FIVE (5) WORKING DAYS OF YOUR REQUEST. IF YOU DO NOT QUALIFY FOR A FULL 100% RFGH DISCOUNT (CATEGORY B), A MONTHLY PAYMENT PLAN WILL BE CALCULATED BY THE PATIENT ACCOUNTS REPRESENTATIVE. DURING THE DETERMINATION OF YOUR PAYMENT PLAN YOU WILL ALSO NEED TO HAVE INFORMATION ABOUT YOUR HOUSEHOLD EXPENSES AVAILABLE. YOU WILL NEED TO SIGN A PAYMENT AGREEMENT CONTRACT AND FAITHFULLY COMPLETE YOUR PAYMENT PORTION IN ORDER TO RECEIVE THE NEGOTIATED DISCOUNT. **SERVICES THAT ARE NOT MEDICALLY NECESSARY ARE NOT ELIGIBLE FOR FREE OR DISCOUNTED CARE AND YOU WILL BE REQUIRED TO PAY FOR THEM BEFORE SERVICES ARE RENDERED.**CATEGORY AFREE CARE @ 100%FAMILY SIZE ANNUAL INCOME1_______18,2102_______24,6903_______31,1704_______37,6505_______44,1306_______50,6107_______57,0908_______63,570FOR EACH ADDITIONAL PERSON, ADD $6,480 ANNUALLY.CATEGORY B RFGH SLIDING FEE SCALEDISCOUNT 100% 75% 50% 25% INCOME INCOME INCOME INCOME FAMILY SIZE TO TO TO TO1_____________29,136________33,456_______37,776_______42,0962_____________35,184________39,504_______43,824_______48,1443_____________41,232________45,552_______49,872_______54,1924_____________47,280________51,600_______55,920_______60,2405_____________53,328________57,648_______61,968_______66,2886_____________59,376________63,696_______68,016_______72,3367_____________65,424________69,744_______74,064_______78,3848_____________71,472________75,792_______80,112_______84,432FOR EACH ADDITIONAL PERSON, ADD $6,048 ANNUALLY.IF YOU PROVIDE FALSE OR INACCURATE INFORMATION IN YOUR APPLICATION ANY AND ALL FINANCIAL ASSISTANCE PROVIDED WILL BE REVOKED AND BALANCES WILL BE THE PATIENT RESPONSIBILITY. PART VI, LINE 4: COMMUNITY INFORMATION:REDINGTON-FAIRVIEW GENERAL HOSPITAL IS AN INDEPENDENT 25-BED CRITICAL ACCESS HOSPITAL LOCATED IN SKOWHEGAN, MAINE. THE HOSPITAL PROVIDES HEALTH CARE TO MORE THAN 51,000 RESIDENTS LIVING IN SOMERSET COUNTY, MAINE. ITS PRIMARY SERVICE AREA EXTENDS FROM SKOWHEGAN TO THE CANADIAN BORDER. A STATE OF THE ART MEDICAL OFFICE BUILDING ADJACENT TO THE HOSPITAL PROVIDES EASY ACCESS TO PRIMARY AND SPECIALTY CARE. A MEDICAL STAFF OF MORE THAN 40 PHYSICIANS SKILLED IN A VARIETY OF FIELDS, AND APPROXIMATELY 750 FULL AND PART-TIME PROFESSIONAL AND TECHNICAL EMPLOYEES ENSURE THE DELIVERY OF PROGRESSIVE HEALTH AND MEDICAL SERVICES. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:THE HOSPITAL IS LOCATED IN A MEDICALLY UNDERSERVED AREA. CONSEQUENTLY, THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF. IN ADDITION TO THE PROGRAMS OUTLINED IN OTHER AREAS OF THE FORM 990, THE HOSPITAL OPERATES A FITNESS FACILITY WHICH OPERATES AT A LOSS. THE FITNESS FACILITY OPERATES MANY PROGRAMS WHICH PROMOTES WELLNESS. OTHER WELLNESS PROGRAMS ARE ALSO PROVIDED THROUGH THE INDOOR POOL THAT THE HOSPITAL OPERATES AT A LOSS. THE POOL PROMOTES WELLNESS AMONG INDIVIDUALS WHO WOULD NOT BE ABLE TO OTHERWISE EXERCISE (DISABLED INDIVIDUALS WITH CHRONIC PAIN, MS AND OTHER DEBILITATING DISEASES). THE HOSPITAL ALSO OPERATES SOMERSET PUBLIC HEALTH, A PROGRAM WHOSE PURPOSE IS TO PROTECT AND IMPROVE THE QUALITY OF LIFE AND HEALTH OF ALL GREATER SOMERSET COUNTY RESIDENTS. X X X X 0 0 0 1 0 0 0 0 0 MICHAEL CURRAN MD DIRECTOR 345231 0 148714 0 13302 0 4050 0 0 0 511297 0 0 0 MICHAEL LAMBKE MD DIRECTOR 175755 0 5540 0 12870 0 0 0 0 0 194165 0 0 0 GINA GOMEZ MD DIRECTOR 259983 0 0 0 14142 0 3916 0 0 0 278041 0 0 0 RICHARD D WILLETT CEO/SECRETARY 395763 0 0 0 13292 0 9978 0 0 0 419033 0 0 0 DANA C KEMPTON ASSOCIATE DIRECTOR 268590 0 0 0 13278 0 6465 0 0 0 288333 0 0 0 ELMER DOUCETTE CFO 211409 0 0 0 13034 0 454 0 0 0 224897 0 0 0 TIRUNELLAI R SHANKAR MD SURGEON 268420 0 246585 0 13302 0 2596 0 0 0 530903 0 0 0 AMIR BAIG MD ANESTHESIOLOGIST 323992 0 0 0 14339 0 2700 0 0 0 341031 0 0 0 JOHN COMIS MD ER PHYSICIAN 389378 0 0 0 14339 0 3375 0 0 0 407092 0 0 0 TRACEY REILLY MD ER PHYSICIAN 311212 0 0 0 14339 0 0 0 0 0 325551 0 0 0 WINOAH HENRY MD GASTROENTEROLOGIST 399811 0 79268 0 14339 0 1862 0 0 0 495280 0 0 0 PART I, LINE 5 PHYSICIANS EMPLOYED BY THE HOSPITAL PARTICIPATE IN AN INCENTIVE BASED COMPENSATION PROGRAM. THE PROGRAM IS BASED UPON A REVENUE TARGET WHICH WILL PRODUCE A TARGET COMPENSATION LEVEL, WHICH IS BASED ON BOTH LOCAL AND NATIONAL BENCHMARK INFORMATION. IN ORDER TO ALIGN THE PHYSICIAN WITH THE CHARITABLE MISSION OF THE HOSPITAL, THE PROGRAM IS BASED ON THE HOSPITAL'S ACTUAL CHARGES, SO THAT THE PHYSICIAN WILL HAVE AN INCENTIVE TO TAKE ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SUM OF ALL CHARGES FOR SERVICES PERFORMED BY THE PHYSICIAN IS TABULATED ON A QUARTERLY BASIS. THAT TABULATION IS THEN DIVIDED BY THE REVENUE TARGET, WHICH IS MULTIPLIED TIMES THE TARGET COMPENSATION LEVEL. IF A PHYSICIAN'S ACTUAL COMPENSATION IS LESS THAN THE CALCULATED SALARY, THE PHYSICIAN WILL RECIEVE A BONUS PAYMENT THAT RECOGNIZES THE PHYSICIAN'S CONTIRBUTION TO THE HOSPITAL'S ACHIEVEMENT OF IT'S CHARITABLE MISSION TO PROVIDE HEALTH SERVICES FOR THE BENEFIT OF THE COMMUNITY. A MAINE HEALTH & HIGHER EDUCATION FACILITY AUTHORITY 010314384 560427JA5 2010-06-24 108030000 BOND REFUNDING 1 0 1 B MAINE HEALTH & HIGHER EDUCATION FACILITY AUTHORITY 010314384 2016-01-20 7500000 ED EXPANSION AND INPATIENT RENOV 0 0 0 C MAINE HEALTH & HIGHER EDUCATION FACILITY AUTHORITY 010314384 56042RQL9 2017-12-28 48573817 BOND REFUNDING 1 0 1 A 2632756 4202585 390171 4439445 47690 0 1 1 1 B 1000000 7500000 7500000 0 0 1 1 C 285000 18815225 1316450 19456877 191946 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 FORM 990, PART III, LINE 1: REDINGTON-FAIRVIEW GENERAL HOSPITAL'S MISSION IS TO DEVELOP, PROVIDE, AND FACILITATE QUALITY, SAFE, COMPREHENSIVE, COST-EFFECTIVE HEALTH SERVICES FOR THE PEOPLE WE SERVE. WE AFFIRM A COMMITMENT TO MAINTAIN OUR UNIQUE COMMUNITY HOSPITAL IDENTITY, OFFERING PERSONALIZED SERVICES. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990, THE HOSPITAL'S CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER REVIEWED THE FILING IN DETAIL WITH THE HOSPITAL BOARD. THE BOARD FOUND THE REPORT TO BE COMPREHENSIVE AND COMPLETE AND SUPPORTED ITS FILING AS REVIEWED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE CONFLICT OF INTERESTS DISCLOSURE IS REVIEWED WITH THE MEMBERS OF THE BOARD AND DIRECTORS, WHO THEN SIGN THE DISCLOSURE FORM 990, PART VI, SECTION B, LINE 15A SEE SCHEDULE J FORM 990, PART VI, SECTION C, LINE 19 REDINGTON-FAIRVIEW GENERAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS AND FINANIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: (DECREASE) INCREASE IN TEMPORARILY RESTRICTED ASSETS -216,440. EFFECT OF ASC 715 -354,901. SOMERSET FITNESS CENTER INC 6 COMMERCE DRIVE SKOWHEGAN ME 04976 010524417 FITNESS CENTER ME 316780 79819 REDINGTON FAIRVIEW GENERAL HOSPITAL REDINGTON MEMORIAL HOSPITAL ASSN PO BOX 468 SKOWHEGAN ME 04976 010211154 SOLE SUPPORTING ORGANIZATION OF RFGH ME 501 C (3) 11 (D) N/A 0 FAIRVIEW HOSPITAL INC PO BOX 468 SKOWHEGAN ME 04976 010222130 SOLE SUPPORTING ORGANIZATION OF RFGH ME 501 C (3) 11 (D) N/A 0 SOMERSET SPORTS & FITNESS CENTER 6 COMMERCE DRIVE SKOWHEGAN ME 04976 010524417 FITNESS CENTER ME RFGH 1.00000 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 REDINGTON MEMORIAL HOSPITAL ASSOCIATION C 494870 CASH FAIRVIEW HOSPITAL INC C 47314 CASH REDINGTON MEMORIAL HOSPITAL ASSOCIATION K 233150 CASH