2022-03-03T13:09:21-06:00 2021-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2020-07-01 454960453 Portland Community Health Center PORT 2078742141 180 Park Avenue Portland ME 04102 Ann Tucker CEO 2078742141 2022-02-28 1 Ann Tucker 999009999 Melissa Magoon CPA P01712842 2077752387 2022-02-28 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Greater Portland Health Ann Tucker 180 Park Avenue Portland ME 04102 14240428 0 X www.greaterportlandhealth.org X 2013 ME To provide high quality, patient-centered healthcare that is accessible, affordable, and culturally sensitive. 15 15 177 16 0 0 6156192 7336780 5985758 6894851 7980 8797 0 0 12149930 14240428 0 0 0 0 8004217 9053525 0 0 0 3345066 4143576 11349283 13197101 800647 1043327 8014989 6097385 4527823 1408420 3487166 4688965 X To provide high quality, patient-centered healthcare that is accessible, affordable, and culturally sensitive. 1 0 7381308 4440284 The Organization is a community health center providing comprehensive primary care services to the greater Portland community across the full lifecycle (pediatric, adolescent, adult and geriatric care). The organization provides an array of enabling services: community health workers, peer support, and financial assistance counselors. The financial assistance counselors connect patients to insurances and an affordable sliding fee scale. The referrals team connects patients to specialty care that is offered in the community. Transportation and interpreting services are offered for patients that need these options. 2762260 1661659 The Organization provided comprehensive mental health and substance use counseling services in a fully integrated manner on-site at its Portland and South Portland, Maine locations. Licensed clinical social workers on each health care team help patients make needed changes through health coaching and providing behavioral strategies that improve health and reduce harm. Some of these include stress management techniques, smoking cessation and motivational interviewing. Support groups and educational sessions are offered as needed. 1318091 792907 The Organization provides comprehensive dental services including preventative treatment, exams, follow up and oral health education for adults and children at its Portland sites and at the Portland public schools locations. 11461659 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 21 0 1 177 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Robert Zager 2078742141 180 Park Avenue Portland ME 04102 Grete Zemans President 3.00 X X 0 0 0 M Isabella Borrero Vice President 1.00 X X 0 0 0 Richard White Treasurer 1.00 X X 0 0 0 Paul Santomenna Secretary 1.00 X X 0 0 0 Amy Kustra Barksdale Director 0.50 X 0 0 0 Rebecca Bass Director 0.50 X 0 0 0 Chris Dana Director 0.50 X 0 0 0 Gloria Herboldsheimer Director 0.50 X 0 0 0 Jean Paul Mugiraneza Director 0.50 X 0 0 0 Joyce Racine Director 0.50 X 0 0 0 Joelle Rutembesa Director 0.50 X 0 0 0 John Skeen Director 0.50 X 0 0 0 Eileen Skillings Director 0.50 X 0 0 0 Jeanne Uwimana Director 0.50 X 0 0 0 Benjamin White Director 0.50 X 0 0 0 Adria Moynihan Rusk Past Director 0.50 X 0 0 0 Ann Tucker Chief Executive Officer 40.00 X 200303 0 31369 Robert E Zager Chief Financial Officer 40.00 X 124265 0 19634 Renee M Fay-LeBlanc Chief Medical Officer 40.00 X 266008 0 29182 John P Fitzsimons Dental Director 40.00 X 176874 0 9285 Diana Lapp Physician, Clinical Director 34.00 X 161622 0 14617 Gita A Rao Physician, Pediatric Clinical Director 40.00 X 151798 0 3250 Magan R Waterman Physician 32.00 X 142166 0 24511 Gladys Estrada Physician, Clinical Director 28.00 X 138335 0 750 1361371 0 132598 16 0 1 0 0 37252 6606336 693192 7336780 Patient Service Revenue 621110 6856580 6856580 Income from CCPM LLC 621110 38271 38271 6894851 8797 8797 14240428 6894851 0 8797 670760 670760 7025766 6525864 499902 80750 71114 9636 668214 639300 28914 608035 520964 87071 32005 32005 103070 103070 609685 565941 43744 25640 21968 3672 220951 189310 31641 412700 353601 59099 587810 524199 63611 40922 35062 5860 3196 2738 458 104208 89285 14923 70050 60019 10031 Program Supplies 1437222 1437222 Other expenses 475261 407203 68058 Equipment Rental/Repair 20856 17869 2987 13197101 11461659 1735442 0 X 2261893 3892738 300366 62 3723975 450385 912070 821706 22925 105393 1507537 954912 552487 552625 208174 246445 3196 0 29903 28031 8014989 6097385 1052321 1378819 3475502 29601 4527823 1408420 X 3401424 4523051 85742 165914 3487166 4688965 8014989 6097385 X 1043327 158472 X 0 1 X 1 1 1 X Schedule A, Part I, Line 3: The Organization's tax exemption is based upon the classification as a hospital or cooperative hospital service organization described in Section 170(b)(1)(A)(iii). Since the Organization is not licensed in the State of Maine as a hospital, but rather as an FQHC, Schedule H is not required. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 461011 170977 290034 1046526 783935 262591 552625 X 14264428 24000 24000 14240428 0 14240428 13221101 24000 24000 13197101 0 13197101 Part X, Line 2: The Organization is a public charity under Section 501(c)(3) of the Internal Revenue Code. As a public charity, the Organization is exempt from state and federal income taxes on income earned in accordance with its tax-exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Organization's tax positions and concluded that the Organization has no uncertain tax positions that require adjustment to the financial statements. X X X X 0 0 0 0 0 0 0 1 0 Renee M Fay-LeBlanc Chief Medical Officer 234210 0 12298 0 19500 0 750 0 28432 0 295190 0 0 0 Ann Tucker Chief Executive Officer 158782 0 15521 0 26000 0 750 0 30619 0 231672 0 0 0 John P Fitzsimons Dental Director 152519 0 4855 0 19500 0 750 0 8535 0 186159 0 0 0 Diana Lapp Physician, Clinical Director 145201 0 2921 0 13500 0 750 0 13867 0 176239 0 0 0 Magan R Waterman Physician 119600 0 5046 0 17520 0 750 0 23761 0 166677 0 0 0 Gita A Rao Physician, Pediatric Clinical Direct 128479 0 3819 0 19500 0 750 0 2500 0 155048 0 0 0 Part I, Line 7 Bonuses amounts are approved and paid at the discretion of the board. Form 990, Part III, line 2 We opened a school-based health clinic at Westbrook High School and Sagamore Village, though those clinics provide similar services as existing clinics. Form 990, Part VI, Section B, line 11b The Form 990 was provided to the Board of Directors for discussion, review, and approval before filing. Form 990, Part VI, Section B, line 12c Board members and key employees are required to read and sign conflict of interest statements on an annual basis, or when there is a change in board member or key officer. Form 990, Part VI, Section B, line 15 Compensation process for top official senior management, officers, and key employee salaries are based on National Association of Community Health Centers salary survey information that is provided and reviewed annually by the finance committee and Board of Directors. Compensation in the range is based on requisite experience. Form 990, Part VI, Section C, line 19 Governing documents disclosure explanation, printed copies of governing documents, and the conflict of interest policy are available at the Organization's headquarters. Financial statements are not available to the public; however, pertinent annual financial results are available upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment: Section 1.263(a)-3(n) Election: Portland Community Health Center 180 Park Avenue Portland, ME 04102 EIN: 45-4960453 Section 1.263(a)-3(n) Election: Portland Community Health Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Restatement of Deferred Revenue - Donor Restricted Contributions 158,472.