2017-03-23T15:23:00-05:00 2016-06-30 010242373 MACPAGE LLC 30 LONG CREEK DRIVE SOUTH PORTLAND ME 04106 990 2015-07-01 010284446 REDINGTON-FAIRVIEW GENERAL HOSPITAL REDI 2074745121 PO BOX 468 SKOWHEGAN ME 049760468 ELMER DOUCETTE CFO 2074745121 2017-03-23 1 GEORGE RAFUSE P00340697 2077745701 2017-03-23 2015 2021-01-29 14:40:06Z RICHARD D WILLETT PO BOX 468 SKOWHEGAN ME 049760468 97503169 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 6 778 35 0 0 3001533 2945550 82127247 91012411 3344706 1528795 290758 2016413 88764244 97503169 0 0 0 0 48008281 53539373 0 0 0 39488423 41357033 87496704 94896406 1267540 2606763 104303179 110127274 46659467 51604635 57643712 58522639 X SEE SCHEDULE O 0 0 45573491 62112961 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 2016, RFGH HAD 24,857 EMERGENCY DEPARTMENT VISITS AND 3,602 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 40,056 PATIENTS. 20390754 10099702 RFGH OPERATES A NUMBER OF PHYSICIAN OFFICES IN ORDER TO BETTER SERVE THE RESIDENTS OF SOMERSET COUNTY. DURING FISCAL 2016, THESE PHYSICIAN SPECIALTIES INCLUDED INTERNAL MEDICINE, ENDOCRINOLOGY, GENERAL SURGERY, ORTHOPEDICS, PEDIATRICS, FAMILY MEDICINE, OBSTETRICS, GASTROENTEROLOGY, NEUROLOGY, AND UROLOGY. DURING FISCAL 2016, THESE PHYSICIAN SPECIALTIES SERVED 15,769 PATIENTS WHO TOTALLED 64,807 VISITS AT THESE OFFICES. 13454284 18799749 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 2016, RFGH PROVIDED INPATIENT SERVICES TO 1,597 PATIENTS WHO STAYED 5,339 PATIENT DAYS. MEDICARE AND MEDICAID PATIENTS REPRESENTED 76% OF RFGH'S INPATIENTS. 2067145 1877107 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. 2067145 1877107 81485674 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 76 0 1 778 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 467177 0 3975 WILLIAM LANEY DIRECTOR 2.00 X 0 0 0 MICHAEL LAMBKE MD DIRECTOR 50.00 X 229156 0 0 JOHN WITHERSPOON DIRECTOR 2.00 X 0 0 0 GINA GOMEZ MD DIRECTOR 50.00 X 266978 0 3133 RICHARD D WILLETT CEO/SECRETARY 50.00 X 365891 0 9409 DANA C KEMPTON ASSOCIATE DIRECTOR 50.00 X 266973 0 6296 ELMER DOUCETTE CFO 50.00 X 207492 0 0 TIRUNELLAI R SHANKAR MD SURGEON 50.00 X 385219 0 1298 AMIR BAIG MD ANESTHESIOLOGIST 50.00 X 327323 0 3975 JOHN COMIS MD ER PHYSICIAN 50.00 X 511725 0 3270 KEVIN MCGUIRE MD ER PHYSICIAN 50.00 X 311340 0 0 WINOAH HENRY MD GASTROENTEROLOGIST 50.00 X 430582 0 0 3769856 0 31356 62 0 1 0 MONITOR BUILDERS INC 225 FRIEND STREET BOSTON MA 02114 CONSTRUCTION & MGT 3266444 VISTA STAFFING SOLUTIONS 275 EAST 200 SOUTH SALT LAKE CITY UT 84111 CLINICAL STAFFING 830842 QUEST DIAGNOSTIC INC 5763 COLLECTION CENTER DR CHICAGO IL 60693 LAB TESTING 526031 DAHL-CHASE DIAGNOSTIC SERVICES 417 STATE STREET BANGOR ME 04401 LAB TESTING 508906 SECURITAS SECURITY SERVICES PO BOX 403412 ATLANTA GA 30384 SECURITY SERVICES 340573 20 1638381 1307169 2945550 NET PATIENT REVENUE 622110 91012411 91012411 91012411 1528795 1528795 OTHER MISCELLANEOUS 622110 1719525 1719525 CAFETERIA 622110 296888 296888 2016413 97503169 92731936 0 1825683 1826480 970419 856061 37734917 33573540 4161377 2217322 1873637 343685 9163695 7743322 1420373 2596959 2194430 402529 129674 33601 96073 97641 26000 71641 11190 11190 377123 14737 362386 4057832 3910312 147520 132116 132116 8151557 7458879 692678 3471085 1264940 2206145 1901639 1714467 187172 98306 93452 4854 244138 206395 37743 1028052 722721 305331 3822002 2686868 1135134 872190 714049 158141 BAD DEBT EXPENSE 9526662 9526662 PHARMACEUTICALS 2303813 2303813 EQUIPMENT & MAINTENANCE 2268028 1779488 488540 MEDICAID PROVIDER TAX 1574204 1574204 1289781 1099738 190043 94896406 81485674 13410732 0 4169519 2053230 6265751 4753214 11813892 14235574 494653 468655 1545444 1504264 167866 196590 82907231 52118591 26800024 30788640 52365408 55516167 680622 610940 104303179 110127274 8622520 8587846 21536247 28186775 16500700 14830014 46659467 51604635 X 56566045 57659711 1077667 862928 57643712 58522639 104303179 110127274 X 2606763 -2494979 767143 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11190 11190 11190 11190 94885216 94885216 94896406 94896406 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 9617 10270 9590 11190 40667 250000 250000 250000 250000 1000000 1500000 375711 375711 47849365 24229618 23619747 34682155 27888973 6793182 30788640 LIABILITY FOR PENSION BENEFITS 6410653 ESTIMATED THIRD PARTY SETTLEMENTS 8419361 14830014 85481528 -2494979 -2494979 87976507 9526662 9526662 97503169 85369744 0 85369744 9526662 9526662 94896406 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 9,526,662. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 9,526,662. 1 1 1 X 1 X 1 1 0 0 1639208 1639208 0.01730 1639208 1639208 0.01730 2142354 2142354 0.02260 20390754 10099702 10291052 0.10840 22533108 10099702 12433406 0.13100 24172316 10099702 14072614 0.14830 1 4641164 30100603 30550548 -449945 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 14 1 1 1 1 X HTTPS://WWW.RFGH.NET/PORTALS/0/PDFS/COMMUNITY%20HEALTH%20NEEDS X SEE COMPLETE URL IN PART VI X 1 15 1 HTTPS://WWW.RFGH.NET/PORTALS/0/WORKPLAN%20UPDATE%20COMMUNITY%20%20ASSESSMEN 1 0 1 X 150.000000000000 225.000000000000 1 1 X X X 1 X X X X 0 0 X X X X 1 X 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:THE ORIGINAL SOURCE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IS THE SOMERSET COUNTY HEALTH COLLABORATIVE WHICH IS COMPOSED OF MANY COMMUNITY ORGANIZATIONS SUCH AS THE POLICE DEPARTMENT, SMALL BUSINESSES, RELIGIOUS GROUPS, BEHAVIORAL HEALTH GROUPS, SCHOOL SYSTEMS, AND OTHER RESOURCE GROUPS. AT THE REGIONAL LEVEL, SOMERSET PUBLIC HEALTH HAS TWO REPRESENTATIVES THAT PARTICIPATE ON THE CENTRAL DISTRICT GROUP WHERE COLLABORATION WITH OTHER HEALTH SYSTEMS OCCURS. REDINGTON-FAIRVIEW GENERAL HOSPITAL PART V, SECTION B, LINE 6A: OTHER HOSPITALS AND OTHER ORGANIZATIONS INCLUDED IN CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENT:THE 2014 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH EASTERN MAINE HEALTHCARE SYSTEMS. RFGH HAS ALSO 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......:SEE ATTACHED RFGH 2016 COMMUNITY HEALTH ANNUAL NEEDS ASSESSMENT REPORT & COMMUNITY HEALTH WORK-PLAN. REDINGTON-FAIRVIEW GENERAL HOSPITAL 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 48.70% 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 48.70% 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, 2016 AND 2015, NET ACCOUNTS RECEIVABLE RELATING TO PATIENTS WITHOUT INSURANCE WAS 23.7% AND 23.2%, 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 $9,526,662 AND $8,321,678 FOR THE YEARS ENDED JUNE 30, 2016 AND 2015, RESPECTIVELY, FROM REVENUE.ACCOUNTS RECEIVABLE AT JUNE 30, 2016 AND 2015 ARE COMPRISED OF THE FOLLOWING:_______________________________________2016__________________2015 PATIENT ACCOUNTS___________________$25,666,340______________$20,891,479ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS(6,021,180)____________(4,228,298)ALLOWANCE FOR CONTRACTUAL ALLOWANCES(5,409,586)____________(4,849,288)ACCOUNT RECEIVABLE - NET__________$ 14,235,574_____________$11,813,893 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. QUALITATIVE DATA (DATA THAT CAN BE ARRANGED INTO CATEGORIES WHICH ARE NOT NUMERICAL, ALSO REFERRED TO AS CATEGORICAL DATA) WAS COLLECTED FROM 1,639 INDIVIDUALS REPRESENTING MORE THAN 80 ORGANIZATIONS AND BUSINESSES ACROSS THE STATE OF MAINE. OUT OF THE 1,639, 102 STAKEHOLDERS WERE FROM SOMERSET COUNTY, REPRESENTING COMMUNITY LEADERSHIP AND HEALTH EXPERTS. THE SURVEY ASKED THE RESPONDENTS MANY QUESTIONS. IN SEPTEMBER 2015, SOMERSET PUBLIC HEALTH INVITED THE COMMUNITY TO A FORUM TO HAVE CONVERSATION ABOUT WHAT IS CAUSING SOMERSET COUNTY TO HAVE THE LOWEST RANKING IN MAINE, "MOVING UP THE RANKS". THE DIRECTOR OF THE HEALTH INDEX INITIATIVE (MMC) PRESENTED COUNTY HEALTH RANKING INFORMATION (DATA) AND 80+ PARTICIPANTS WORKED ON ACTION PLANNING FOR CHANGING OUR HEALTH STATUS. AT THE TIME THE CURRENT DATA AND INFORMATION WAS BASED ON THE 2015 COUNTY HEALTH RANKINGS BY THE ROBERT WOOD JOHNSON FOUNDATION. THE 89 INDIVIDUALS ATTENDING WERE FROM THE UNITED WAY, MEDICAL CARE DEVELOPMENT, LOCAL AND STATE PUBLIC HEALTH, KENNEBEC BEHAVIORAL HEALTH, LOCAL ELEMENTARY EDUCATORS, MULTIPLE MUNICIPALITIES (MADISON, STARKS, ST. ALBANS, AND SKOWHEGAN), SPECTRUM GENERATIONS, MAINE CDC, MAINE PARENT FEDERATION, SENIORS, HOSPITALS, A LOCAL NURSING HOME; LOCAL BUSINESS; HOSPICE; AND OTHERS. ACTION PLANNING FOCUSED ON PRIORITIZING ISSUES IN THE DATA, ACTION STEPS TO TAKE IMMEDIATELY TO ADDRESS IDENTIFIED ISSUES IN A COLLABORATIVE WAY, IDENTIFYING OTHERS WHO NEED TO BE BROUGHT TO THE CONVERSATION, IDENTIFYING HOW TO ENGAGE COMMUNITY STAKEHOLDERS TO THE CONVERSATION, AND THE NEXT ACTION STEPS. IN DECEMBER OF 2015 COMMUNITY MEMBERS WERE INVITED TO ADDITIONAL FORUMS ACROSS SOMERSET COUNTY AS ANOTHER METHOD OF GATHERING INFORMATION FROM THE COMMUNITY AT LARGE. THE GOAL WAS THAT PEOPLE WITH DIVERSE BACKGROUNDS WOULD HAVE THE OPPORTUNITY TO SHARE THEIR PERSPECTIVE ABOUT THE ISSUES AT HAND. THREE SUCH FORUMS WERE HELD TO MAXIMIZE RESOURCES IN THE TWO COUNTIES OF KENNEBEC AND SOMERSET. A SUMMARY OF THE KEY HEALTH ISSUES IDENTIFIED AND DISCUSSED DURING THESE FORUMS INCLUDED OBESITY, TOBACCO, MENTAL HEALTH, AND DRUG AND ALCOHOL ABUSE.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 SIGNED STATEMENT FROM YOUR EMPLOYER VERIFYING YOUR GROSS EARNINGS FOR THE LAST THREE MONTHS.- A LIST OF ALL INCOME FROM STOCKS, BONDS, INTEREST INCOME ON SAVINGS ACCOUNTS, ANNUITIES, AND RENTAL INCOME.YOU WILL ALSO BE ASKED TO OBTAIN A DENIAL LETTER FROM THE STATE OF MAINE IF YOU ARE NOT ELIGIBLE FOR MAINECARE ASSISTANCE. (NOTE: THIS DENIAL LETTER IS ONLY GOOD FOR THIRTY (30) DAYS.)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_______17,6552_______23,8953_______30,1354_______36,3755_______42,6156_______48,8557_______55,0958_______61,335FOR EACH ADDITIONAL PERSON, ADD $6,240 ANNUALLY.CATEGORY B RFGH SLIDING FEE SCALEDISCOUNT 100% 75% 50% 25% INCOME INCOME INCOME INCOME FAMILY SIZE TO TO TO TO1_____________28,248________32,014_______35,781_______39,5472_____________34,072________37,838_______41,605_______45,3713_____________39,896________43,662_______47,429_______51,1954_____________45,720________49,486_______53,253_______57,0195_____________51,544________55,310_______59,077_______62,8436_____________57,368________61,134_______64,901_______68,6677_____________63,192________66,958_______70,725_______74,4918_____________69,016________72,782_______76,549_______80,315 FOR EACH ADDITIONAL PERSON, ADD $5,824 ANNUALLY 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 650 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 349112 0 105015 0 13050 0 3975 0 0 0 471152 0 0 0 MICHAEL LAMBKE MD DIRECTOR 175998 0 41547 0 11611 0 0 0 0 0 229156 0 0 0 GINA GOMEZ MD DIRECTOR 253581 0 0 0 13397 0 3133 0 0 0 270111 0 0 0 RICHARD D WILLETT CEO/SECRETARY 351797 0 0 0 14094 0 9409 0 0 0 375300 0 0 0 DANA C KEMPTON ASSOCIATE DIRECTOR 252385 0 0 0 14588 0 6296 0 0 0 273269 0 0 0 ELMER DOUCETTE CFO 194823 0 0 0 12669 0 0 0 0 0 207492 0 0 0 TIRUNELLAI R SHANKAR MD SURGEON 247167 0 126082 0 11970 0 1298 0 0 0 386517 0 0 0 AMIR BAIG MD ANESTHESIOLOGIST 316488 0 0 0 10835 0 3975 0 0 0 331298 0 0 0 JOHN COMIS MD ER PHYSICIAN 498393 0 0 0 13332 0 3270 0 0 0 514995 0 0 0 KEVIN MCGUIRE MD ER PHYSICIAN 299513 0 0 0 11827 0 0 0 0 0 311340 0 0 0 WINOAH HENRY MD GASTROENTEROLOGIST 362770 0 54480 0 13332 0 0 0 0 0 430582 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 560425V80 2007-11-01 72040461 REPLACE TWO BOILERS & PURCHASE BACK-UP GENERATOR 0 0 1 B MAINE HEALTH & HIGHER EDUCATION FACILITY AUTHORITY 010314384 560427JA5 2010-06-24 108030000 BOND REFINANCING 1 0 1 C MAINE HEALTH & HIGHER EDUCATION FACILITY AUTHORITY 010314384 2016-01-20 7500000 ED EXPANSION AND INPATIENT RENOV 0 0 0 A 5885611 23882032 1513579 304303 23577729 0 0 1 1 B 2087756 4202585 390171 4439445 47690 0 1 1 1 C 7500000 7500000 0 0 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 0 0 1 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 0 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 11 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 FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST FORM 990, PART XI, LINE 9: (DECREASE) INCREASE IN TEMPORARILY RESTRICTED ASSETS -214,739. EFFECT OF ASC 715 981,882. SOMERSET FITNESS CENTER INC PO BOX 3158 SKOWHEGAN ME 04976 010524417 FITNESS ACTIVITIES FOR MEMBERS ME 309107 83331 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 857331 CASH FAIRVIEW HOSPITAL INC C 30173 CASH REDINGTON MEMORIAL HOSPITAL ASSOCIATION K 201802 CASH