COMMUNITY CLINICAL SERVICES INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY CLINICAL SERVICES INC (EIN 01-0409788)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-04
- IRS object ID
- 202213089349302721
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-04T15:11:01-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Newman & Noyes | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 650 Elm Street Suite 302 | AddressLine1Txt |
| City | Manchester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010409788 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Clinical Services Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 2075133897 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Campus Avenue PO Box 7291 | AddressLine1Txt |
| City | Lewiston | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 042407291 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Coleen Elias | PersonNm |
| Person Title | CEO & CFO | PersonTitleTxt |
| Phone | 2075133897 | PhoneNum |
| Signature | 2022-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Coleen | PersonFirstNm |
| Person Last | Elias | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Connor Smart | PreparerPersonNm |
| PTIN | P02285543 | PTIN |
| Phone | 6036262200 | PhoneNum |
| Preparation | 2022-11-02 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Coleen Elias | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Campus Avenue PO Box 7291 | AddressLine1Txt |
| City | Lewiston | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 042407291 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,302,823 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.communityclinicalservices.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | Federally qualified health center providing quality primary and specialty care. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 143 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $484,613 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,380,483 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,722,281 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,921,440 | CYProgramServiceRevenueAmt |
| PY Investment Income | $984 | PYInvestmentIncomeAmt |
| CY Investment Income | $900 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $12,207,878 | PYTotalRevenueAmt |
| CY Total Revenue | $15,302,823 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,782,805 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,648,221 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,966,232 | PYOtherExpensesAmt |
| CY Other Expenses | $5,915,254 | CYOtherExpensesAmt |
| PY Total Expenses | $13,749,037 | PYTotalExpensesAmt |
| CY Total Expenses | $14,563,475 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,541,159 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $739,348 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,101,044 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,925,013 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,917,048 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,002,726 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,183,996 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,922,287 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Community Clinical Services, Inc. is committed to improving the health and well-being of all patients who seek our services by providing the highest quality, most respectful, and most compassionate care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,976,072 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $3,746,408 | RevenueAmt |
| Desc | Family Practice: Medical care for infants, children, and adults. The Organization received 18,822 medical visits in 2021 for family practices. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,061,080 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $3,566,541 | RevenueAmt |
| Desc | Behavioral Medicine: Psychiatric care for children and adults. The Organization received 27,160 pyschiatry visits in 2021 for behavioral medicine. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,730,121 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,500,816 | RevenueAmt |
| Desc | Outpatient Counseling: Counseling services for children and adults. The Organization received 17,601 visits in 2021 for outpatient counseling. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,871,721 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $3,107,675 | RevenueAmt |
| Desc | Other program services offered by Community Clinical Services Inc. include dental care and dental services (of which there were 4,693 visits in 2021), care management, 340B pharmacy programs, and electronic handbook and meaningful-use incentive programs. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,871,721 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $3,107,675 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $13,638,994 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 143 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | ME | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Coleen Elias CEOCFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2075133897 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 57 Birch Street | AddressLine1Txt |
| City | Lewiston | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04240 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Paige Hagerstrom | ||||||||
| Director | 0.30 | 40.00 | Yes (X) | $0 | $212,638 | $31,411 | ||
| Jeffrey Hundman | ||||||||
| Director, SMHS VP Finance (end 11/21) | 0.10 | 40.30 | Yes (X) | $0 | $272,695 | $31,319 | ||
| Elizabeth Keene | ||||||||
| Director | 0.30 | 40.00 | Yes (X) | $0 | $161,432 | $21,538 | ||
| Elmuatz Abdelrahim | ||||||||
| Director (end 6/2021) | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Hawo Abdille | ||||||||
| Director | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Frances Rodgers | ||||||||
| Director | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Abdulkerim Said | ||||||||
| Director | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Lynn Ward | ||||||||
| Chair | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Melissa Dunn | ||||||||
| Vice Chair (end 6/2021) | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Laura Gormley | ||||||||
| Treasurer | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Nathan Miller | ||||||||
| Secretary | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Coleen Elias | ||||||||
| CEO & CFO | 40.00 | 0.00 | $135,841 | $0 | $23,169 | Yes (X) | ||
| Syed Fahd MD | ||||||||
| Physician | 40.00 | 0.00 | $285,998 | $0 | $36,089 | Yes (X) | ||
| Megan Brewer MD | ||||||||
| Physician | 40.00 | 0.00 | $289,554 | $0 | $10,563 | Yes (X) | ||
| Carolyn McNamara NP | ||||||||
| Nurse Practitioner | 40.00 | 0.00 | $139,542 | $0 | $33,446 | Yes (X) | ||
| Stephanie Mellen FNP | ||||||||
| Family Nurse Practitioner | 40.00 | 0.00 | $122,248 | $0 | $37,228 | Yes (X) | ||
| Jonathan Libby FNP | ||||||||
| Family Nurse Practitioner | 40.00 | 0.00 | $143,171 | $0 | $15,787 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,116,354 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $646,765 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $240,550 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| St Mary's Regional Med Ctr | |||||
| 93 Campus Avenue PO Box 7291 | Lewiston | ME | 04243 | Inter-Company Purchased Services | $3,550,796 |
| Covenant Health Inc | |||||
| 100 Ames Pond Drive Suite 102 | Tewksbury | MA | 01876 | Management services | $520,555 |
| LanguageLine Solutions | |||||
| PO Box 202564 | Dallas | TX | 75320 | Interpretation and translation | $105,589 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,354,933 | GovernmentGrantsAmt |
| All Other Contributions | $25,550 | AllOtherContributionsAmt |
| Total Contributions | $2,380,483 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient services | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $12,921,440 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,921,440 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,921,440 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $750 | TotalRevenueColumnAmt |
| Exclusion | $750 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $150 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $150 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $150 | TotalRevenueColumnAmt |
| Exclusion | $150 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,302,823 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,921,440 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $900 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,010 | TotalAmt |
| Management And General | $159,010 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,743,790 | TotalAmt |
| Program Services | $6,712,456 | ProgramServicesAmt |
| Management And General | $31,334 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,715 | TotalAmt |
| Program Services | $113,894 | ProgramServicesAmt |
| Management And General | $821 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,151,605 | TotalAmt |
| Program Services | $1,137,271 | ProgramServicesAmt |
| Management And General | $14,334 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $479,101 | TotalAmt |
| Program Services | $464,862 | ProgramServicesAmt |
| Management And General | $14,239 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,589 | TotalAmt |
| Management And General | $105,589 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,500 | TotalAmt |
| Management And General | $22,500 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,185,913 | TotalAmt |
| Program Services | $3,725,463 | ProgramServicesAmt |
| Management And General | $460,450 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $216,218 | TotalAmt |
| Program Services | $206,445 | ProgramServicesAmt |
| Management And General | $9,773 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,107 | TotalAmt |
| Program Services | $31,611 | ProgramServicesAmt |
| Management And General | $1,496 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $372,509 | TotalAmt |
| Program Services | $355,672 | ProgramServicesAmt |
| Management And General | $16,837 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,414 | TotalAmt |
| Program Services | $6,124 | ProgramServicesAmt |
| Management And General | $290 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,291 | TotalAmt |
| Program Services | $53,747 | ProgramServicesAmt |
| Management And General | $2,544 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,081 | TotalAmt |
| Management And General | $17,081 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,595 | TotalAmt |
| Program Services | $54,268 | ProgramServicesAmt |
| Management And General | $66,327 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Provision for bad debts | $580,762 | $580,762 | |
| Drugs/medical supplies | $156,944 | $156,944 | |
| Minor equipment/repairs | $41,072 | $39,216 | $1,856 |
| Food and dining | $259 | $259 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,563,475 | TotalAmt |
| Program Services | $13,638,994 | ProgramServicesAmt |
| Management And General | $924,481 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,449,123 | BOYAmt |
| EOY | $1,945,894 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $248,605 | BOYAmt |
| EOY | $43,130 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,210 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $784,598 | BOYAmt |
| EOY | $735,707 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,505 | BOYAmt |
| EOY | $18,508 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,891 | BOYAmt |
| EOY | $10,163 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $225,028 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $152,129 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,979 | BOYAmt |
| EOY | $72,899 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,427 | BOYAmt |
| EOY | $44,272 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,443,706 | BOYAmt |
| EOY | $54,440 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,101,044 | BOYAmt |
| EOY | $2,925,013 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $740,621 | BOYAmt |
| EOY | $739,744 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $397,956 | BOYAmt |
| EOY | $129,185 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,671,337 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,134 | BOYAmt |
| EOY | $133,797 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,917,048 | BOYAmt |
| EOY | $1,002,726 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $933,873 | BOYAmt |
| EOY | $1,877,614 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,123 | BOYAmt |
| EOY | $44,673 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,183,996 | BOYAmt |
| EOY | $1,922,287 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,101,044 | BOYAmt |
| EOY | $2,925,013 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $739,348 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,057 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,230,641 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,492,744 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,637,184 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $484,613 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,380,483 | CurrentTaxYearAmt |
| Total | $7,225,665 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,683,695 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,770,132 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,002,774 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,722,281 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $12,921,440 | CurrentTaxYearAmt |
| Total | $60,100,322 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,914,336 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,262,876 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,639,958 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,206,894 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,301,923 | CurrentTaxYearAmt |
| Total | $67,325,987 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $991,902 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,284,320 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,502,827 | CurrentTaxYearMinus2YearsAmt |
| Total | $3,779,049 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $991,902 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,284,320 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,502,827 | CurrentTaxYearMinus2YearsAmt |
| Total | $3,779,049 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $63,546,938 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,451 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,131 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,214 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $984 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $750 | CurrentTaxYearAmt |
| Total | $10,530 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,451 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,131 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,214 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $984 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $750 | CurrentTaxYearAmt |
| Total | $10,530 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,920,787 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,264,007 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,641,172 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,207,878 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,302,673 | CurrentTaxYearAmt |
| Total | $67,336,517 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.94370 | PublicSupportCY509Pct |
| Public Support PY509 | 0.91590 | PublicSupportPY509Pct |
| Investment Income CY | 0.00020 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00030 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $8,000 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $8,000 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Community Clinical Services partners with the Maine Primary Care Association, a like-minded health care association which supports public policies and initiatives that focus on improving health outcomes and the experience of health care, while also aiming to reduce the overall cost of receiving that care. To maintain this partnership, the Organization pays membership dues back to the Association. A portion of the dues paid to the Association have been designated as available for lobbying expenditures. In 2021, the Organization paid the Association total dues of $10,000. The Organization estimates that approximately 80%, or $8,000, of the dues paid in 2021 may have been available for lobbying purposes. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $79,179 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$79,179 | InvestmentEarningsOrLossesAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $181,760 | BeginningYearBalanceAmt |
| Contributions | $34,780 | ContributionsAmt |
| Other Expenditures | $137,361 | OtherExpendituresAmt |
| End Year Balance | $79,179 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $151,409 | BeginningYearBalanceAmt |
| Contributions | $37,341 | ContributionsAmt |
| Other Expenditures | $6,990 | OtherExpendituresAmt |
| End Year Balance | $181,760 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $54,858 | OtherCostOrOtherBasisAmt |
| Depreciation | $25,541 | DepreciationAmt |
| Book Value | $29,317 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $170,170 | OtherCostOrOtherBasisAmt |
| Depreciation | $126,588 | DepreciationAmt |
| Book Value | $43,582 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $72,899 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to affiliates | Desc |
| Amt | $133,797 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $133,797 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | In its 2019 tax year, the Organization determined that its restricted investment holdings, which were previously designated as endowment funds on Schedule D, Part V, did not meet the terms and definitions of endowment funds as provided in IRS Guidance and the Form 990 instructions. Accordingly, the Organization's 2019 ending balance for endowment funds was corrected to an appropriate zero-value. This continues to be the case in 2020; the figures reported on Schedule D, Part V have been maintained only to reflect the carryforward of the Organization's historic filings. Temporarily restricted funds continue to be reported separately on Form 990, Part X, Line 28. Restricted net assets, as were previously reported as endowment funds, are largely composed of restricted grants used to provide housing solutions to elderly, ill, or disenfranchised persons. |
| Part X, Line 2: | Covenant and its member organizations are considered not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code, except as noted below. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The System has evaluated the position taken on its filed tax returns. The System has concluded no uncertain income tax positions exist at December 31, 2021. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Syed Fahd MD | ||||||||||||||
| Physician | $285,608 | $0 | $0 | $0 | $390 | $0 | $4,108 | $0 | $31,981 | $0 | $322,087 | $0 | $0 | $0 |
| Jeffrey Hundman | ||||||||||||||
| Director, SMHS VP Finance (end 11/21 | $0 | $228,197 | $0 | $3,948 | $0 | $40,550 | $0 | $3,002 | $0 | $28,317 | $0 | $304,014 | $0 | $0 |
| Megan Brewer MD | ||||||||||||||
| Physician | $289,286 | $0 | $0 | $0 | $268 | $0 | $5,445 | $0 | $5,118 | $0 | $300,117 | $0 | $0 | $0 |
| Paige Hagerstrom | ||||||||||||||
| Director | $0 | $205,728 | $0 | $6,641 | $0 | $269 | $0 | $5,912 | $0 | $25,499 | $0 | $244,049 | $0 | $0 |
| Elizabeth Keene | ||||||||||||||
| Director | $0 | $154,834 | $0 | $5,767 | $0 | $831 | $0 | $3,921 | $0 | $17,617 | $0 | $182,970 | $0 | $0 |
| Carolyn McNamara NP | ||||||||||||||
| Nurse Practitioner | $137,417 | $0 | $2,000 | $0 | $125 | $0 | $0 | $0 | $33,446 | $0 | $172,988 | $0 | $0 | $0 |
| Stephanie Mellen FNP | ||||||||||||||
| Family Nurse Practitioner | $121,985 | $0 | $0 | $0 | $263 | $0 | $3,918 | $0 | $33,310 | $0 | $159,476 | $0 | $0 | $0 |
| Coleen Elias | ||||||||||||||
| CEO & CFO | $128,055 | $0 | $7,651 | $0 | $135 | $0 | $2,668 | $0 | $20,501 | $0 | $159,010 | $0 | $0 | $0 |
| Jonathan Libby FNP | ||||||||||||||
| Family Nurse Practitioner | $141,848 | $0 | $0 | $0 | $1,323 | $0 | $4,329 | $0 | $11,458 | $0 | $158,958 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. |
| Part I, Line 4a | During the 2021 tax year, Jeffrey Hundman served as the Treasurer and VP of Finance for St. Mary's Regional Medical Center of Lewiston, Maine, and other affiliated organizations within the Covenant Health System operating in the greater Lewiston-Auburn region and community. Jeffrey Hundman was paid directly by Covenant Health Inc., the parent of the System, for his services. In September, 2021, Jeffrey Hundman ended his term of service and employment with the System. As part of his separation from Covenant Health, Jeffrey Hundman received severance compensation in the amount of $39,045 in the 2021 tax year, which was included in his 2021 Form W-2 wages. In accordance with IRS Instructions, Jeffrey Hundman's severance compensation is reported on this Schedule J, Part II, within his column B(iii), Other Compensation total. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | St. Mary's Health System is the sole corporate member of the Organization. |
| Form 990, Part VI, Section A, line 7a | As the sole corporate member of the Organization, St. Mary's Health System retains the ability to appoint 37% of the total number of Directors, and to remove those same Directors with or without cause. |
| Form 990, Part VI, Section A, line 7b | As the sole corporate member of the Organization, St. Mary's Health System has the following powers and rights over the Organization as outlined in the Organization's bylaws: 1. To assure that all actions of the Corporation are consistent with its purpose and the philosophy and ethical and religious principles of the Roman Catholic Church. 2. However, the Corporate Member may not infringe on any aspect of provision of services or programs necessary to remain compliant with federal and/or state laws, regulations, or related policies. 3. All plans of merger, consolidation, reorganization, dissolution, or the sale, lease, assignment, or transfer of substantially all of the assets of the Corporation must be approved by at least 3/4 of the total Board members, including a minimum of two Directors appointed by the Corporate Member. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is provided to the governing body for their review and approval prior to filing. |
| Form 990, Part VI, Section B, line 12c | This process is the responsibility of the Compliance Officer. A conflict of interest disclosure form is submitted to all leadership, board members, board committee members, employed physicians, medical directors and certain employees in key positions annually to be completed. Reminders are sent to all persons of interest to ensure that all conflict of interest disclosure forms are completed and collected. |
| Form 990, Part VI, Section B, line 15 | Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. |
| Form 990, Part VI, Section C, line 19 | The Organization's Form 990, governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The Organization's Form 990 is also made available on the website of its parent organization, Covenant Health, at the following web address: https://www.covenanthealth.net/financial-information/financial-information |
| Form 990, Part IX, line 11g | Purchased medical and physician services: Program service expenses 2,537,792. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,537,792. Administrative and other fees: Program service expenses 1,187,671. Management and general expenses 460,450. Fundraising expenses 0. Total expenses 1,648,121. |
| Form 990, Part XII, Line 2c: | The audit process has not changed from the previous year. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (36 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Alternative Health Services | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 010422885 | Home health and hospice | ME | 501(c)(3) | Line 10 | St Joseph Healthcare Foundation | 0 | |
| CHS of Waltham Inc dba Maristhill Nursing & Rehab Center | |||||||||||
| 66 Newton Street | Waltham | MA | 02453 | 043333609 | Nursing home and restorative facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| CHS of Worcester Inc dba St Mary Care Center | |||||||||||
| 39 Queen Street | Worchester | MA | 01610 | 043419625 | Nursing home and restorative facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Covenant Health Foundation Inc | |||||||||||
| 100 Ames Pond Drive | Tewksbury | MA | 01876 | 800199674 | Charitable foundation | MA | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| Covenant Health Investment Trust | |||||||||||
| 420 Bedford Street | Lexington | MA | 02420 | 046835128 | Investment trust | MA | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| Covenant Health Inc | |||||||||||
| 100 Ames Pond Drive | Tewksbury | MA | 01876 | 222484505 | Health care management and resource organization | MA | 501(c)(3) | Line 10 | 0 | N/A | |
| Fanny Allen Corporation Inc | |||||||||||
| 790 College Parkway | Colchester | VT | 05446 | 222495808 | Charitable foundation | VT | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| Fanny Allen Holdings Inc | |||||||||||
| 790 College Parkway | Colchester | VT | 05446 | 030181052 | Real estate holding company | VT | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| Helping Hands of St Marguerite Inc | |||||||||||
| 799 Concord Avenue | Cambridge | MA | 02138 | 800199674 | Private home-care health services | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| M & J Company | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 222480150 | Lease holding company | ME | 501(c)(2) | St Joseph Healthcare Foundation | 0 | ||
| Mary Immaculate Guild Inc | |||||||||||
| 172 Lawrence Street | Lawrence | MA | 01841 | 463073987 | Supporting grants and donations | MA | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| MI Adult Day Health Care Center Inc | |||||||||||
| 189 Maple Street | Lawrence | MA | 01841 | 042921888 | Adult day care services | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| MI Management Inc | |||||||||||
| 172 Lawrence Street | Lawrence | MA | 01841 | 042857794 | Assisted living services | MA | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| MI Nursing Restorative Center Inc | |||||||||||
| 172 Lawrence Street | Lawrence | MA | 01841 | 042104851 | Nursing home and restorative facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| MI Residential Community Inc | |||||||||||
| 189 Maple Street | Lawrence | MA | 01841 | 042647207 | HUD low income housing | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| MI Transportation Inc | |||||||||||
| 189 Maple Street | Lawrence | MA | 01841 | 042921889 | Elderly transportation services | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Mount St Rita Health Centre | |||||||||||
| 15 Sumner Brown Road | Cumberland | RI | 02864 | 050342330 | Nursing home | RI | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Neighborhood Housing Initiative | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 010539730 | Affordable housing services | ME | 501(c)(3) | Line 10 | St Mary's Health System | 0 | |
| Penacook Place Inc | |||||||||||
| 150 Water Street | Haverhill | MA | 01830 | 237090088 | Nursing home | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Souhegan Nursing Association | |||||||||||
| 24 North River Road | Milford | NH | 03055 | 020222795 | Home health and hospice | NH | 501(c)(3) | Line 10 | St Joseph Hospital of Nashua NH Inc | 0 | |
| St Joseph Ambulatory Care Inc | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 222480373 | Physician practice | ME | 501(c)(3) | Line 10 | St Joseph Healthcare Foundation | 0 | |
| St Andre Health Care | |||||||||||
| 407 Pool Street | Biddeford | ME | 04005 | 010342399 | Nursing home and restorative facility | ME | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| St Joseph Healthcare Foundation | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 222480149 | Healthcare foundation | ME | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| St Joseph Hospital | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 010212435 | Hospital and health care facility | ME | 501(c)(3) | Line 3 | St Joseph Healthcare Foundation | 0 | |
| St Joseph Manor Health Care | |||||||||||
| 215 Thatcher Street | Brockton | MA | 02302 | 042565937 | Nursing home and restorative facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| St Joseph's Hospital of Nashua NH Inc | |||||||||||
| 172 Kinsley Street | Nashua | NH | 03061 | 020222215 | Hospital and health care facility | NH | 501(c)(3) | Line 3 | Covenant Health Inc | 0 | |
| St Mary's D'Youville Pavilion | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 010211558 | Nursing home and restorative facility | ME | 501(c)(3) | Line 10 | St Mary's Health System | 0 | |
| St Mary's Health System | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 222504349 | Hospital and health care facility | ME | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| St Mary's Regional Medical Center | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 010211551 | Hospital and health care facility | ME | 501(c)(3) | Line 3 | St Mary's Health System | 0 | |
| St Mary's Residences | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 222504356 | Low income housing | ME | 501(c)(3) | Line 10 | St Mary's Health System | 0 | |
| St Mary's Villa Nursing Home Inc | |||||||||||
| 675 St Marys Villa Road | Moscow | PA | 18444 | 232057177 | Nursing home and restorative facility | PA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| The Surgicenter at St Joseph Hospital Inc | |||||||||||
| 172 Kinsley Street | Nashua | NH | 03061 | 020222215 | Healthcare and surgery center | NH | 501(c)(3) | Line 10 | St Joseph Hospital of Nashua NH Inc | 0 | |
| Youville Hospital and Rehabilitation Center Inc | |||||||||||
| 1575 Cambridge Street | Cambridge | MA | 02138 | 043239563 | Hospital and health care facility | MA | 501(c)(3) | Line 10 | Youville Lifecare Inc | 0 | |
| Youville House Inc | |||||||||||
| 1573 Cambridge Street | Cambridge | MA | 02138 | 043239593 | Assisted living services | MA | 501(c)(3) | Line 10 | Youville Lifecare Inc | 0 | |
| Youville Lifecare Inc | |||||||||||
| 1575 Cambridge Street | Cambridge | MA | 02138 | 042103582 | Hospital and health care facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Youville Place | |||||||||||
| 10 Pelham Road | Lexington | MA | 02421 | 043297834 | Assisted living services | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Campus Holding | ||||||||||||||
| PO Box 7291 | Lewiston | ME | 04240 | 010406049 | Holding company | ME | N/A | C | 0 | |||||
| Covenant Health Insurance LTD | ||||||||||||||
| 043360127 | Self-insurance company | N/A | C | 0 | PO Box 69 | Grand Cayman | CJ | KY1-1102 | CJ | |||||
| GNM Corporation | ||||||||||||||
| 172 Kinsley Street | Nashua | NH | 03060 | 020400550 | Real estate holding company | NH | N/A | C | 0 | |||||
| SJ Physicians Services | ||||||||||||||
| 172 Kinsley Street | Nashua | NH | 03060 | 020522234 | Physician practice | NH | N/A | C | 0 | |||||
| St Joseph Corporate Services Inc | ||||||||||||||
| 172 Kinsley Street | Nashua | NH | 03060 | 020405197 | Holding company | NH | N/A | C | 0 | |||||
| Strauss Incorporated | ||||||||||||||
| 360 Broadway | Bangor | ME | 04402 | 010391369 | Repairs and transcriptions | ME | N/A | C | 0 | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |