2022-11-04T15:11:01-05:00 2021-12-31 010494526 Baker Newman & Noyes 650 Elm Street Suite 302 Manchester NH 03101 990 2021-01-01 010409788 Community Clinical Services Inc COMM 2075133897 Campus Avenue PO Box 7291 Lewiston ME 042407291 Coleen Elias CEO & CFO 2075133897 2022-11-02 1 Coleen Elias 999009999 Connor Smart P02285543 6036262200 2022-11-02 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Coleen Elias Campus Avenue PO Box 7291 Lewiston ME 042407291 15302823 0 X www.communityclinicalservices.com X 1984 ME Federally qualified health center providing quality primary and specialty care. 8 6 143 8 0 0 484613 2380483 11722281 12921440 984 900 0 0 12207878 15302823 0 0 0 0 7782805 8648221 0 0 0 5966232 5915254 13749037 14563475 -1541159 739348 4101044 2925013 2917048 1002726 1183996 1922287 X 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. 0 0 5976072 0 3746408 Family Practice: Medical care for infants, children, and adults. The Organization received 18,822 medical visits in 2021 for family practices. 4061080 0 3566541 Behavioral Medicine: Psychiatric care for children and adults. The Organization received 27,160 pyschiatry visits in 2021 for behavioral medicine. 1730121 0 2500816 Outpatient Counseling: Counseling services for children and adults. The Organization received 17,601 visits in 2021 for outpatient counseling. 1871721 0 3107675 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. 1871721 0 3107675 13638994 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 0 0 0 1 6 0 1 143 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 ME X X Coleen Elias CEOCFO 2075133897 57 Birch Street Lewiston ME 04240 Paige Hagerstrom Director 0.30 40.00 X 0 212638 31411 Jeffrey Hundman Director, SMHS VP Finance (end 11/21) 0.10 40.30 X 0 272695 31319 Elizabeth Keene Director 0.30 40.00 X 0 161432 21538 Elmuatz Abdelrahim Director (end 6/2021) 0.30 0.00 X 0 0 0 Hawo Abdille Director 0.30 0.00 X 0 0 0 Frances Rodgers Director 0.30 0.00 X 0 0 0 Abdulkerim Said Director 0.30 0.00 X 0 0 0 Lynn Ward Chair 0.50 0.00 X X 0 0 0 Melissa Dunn Vice Chair (end 6/2021) 0.50 0.00 X X 0 0 0 Laura Gormley Treasurer 0.50 0.00 X X 0 0 0 Nathan Miller Secretary 0.30 0.00 X X 0 0 0 Coleen Elias CEO & CFO 40.00 0.00 X 135841 0 23169 Syed Fahd MD Physician 40.00 0.00 X 285998 0 36089 Megan Brewer MD Physician 40.00 0.00 X 289554 0 10563 Carolyn McNamara NP Nurse Practitioner 40.00 0.00 X 139542 0 33446 Stephanie Mellen FNP Family Nurse Practitioner 40.00 0.00 X 122248 0 37228 Jonathan Libby FNP Family Nurse Practitioner 40.00 0.00 X 143171 0 15787 1116354 646765 240550 11 0 1 0 St Mary's Regional Med Ctr 93 Campus Avenue PO Box 7291 Lewiston ME 04243 Inter-Company Purchased Services 3550796 Covenant Health Inc 100 Ames Pond Drive Suite 102 Tewksbury MA 01876 Management services 520555 LanguageLine Solutions PO Box 202564 Dallas TX 75320 Interpretation and translation 105589 3 2354933 25550 2380483 Patient services 621110 12921440 12921440 12921440 750 750 150 0 150 150 150 15302823 12921440 0 900 X 159010 159010 6743790 6712456 31334 114715 113894 821 1151605 1137271 14334 479101 464862 14239 105589 105589 22500 22500 4185913 3725463 460450 216218 206445 9773 33107 31611 1496 372509 355672 16837 6414 6124 290 56291 53747 2544 17081 17081 120595 54268 66327 Provision for bad debts 580762 580762 Drugs/medical supplies 156944 156944 Minor equipment/repairs 41072 39216 1856 Food and dining 259 259 14563475 13638994 924481 0 1449123 1945894 248605 43130 13210 0 784598 735707 18505 18508 8891 10163 225028 152129 89979 72899 44427 44272 1443706 54440 4101044 2925013 740621 739744 397956 129185 1671337 0 107134 133797 2917048 1002726 X 933873 1877614 250123 44673 1183996 1922287 4101044 2925013 739348 -1057 0 X X 0 1 X 1 1 1 X 1230641 1492744 1637184 484613 2380483 7225665 11683695 10770132 13002774 11722281 12921440 60100322 12914336 12262876 14639958 12206894 15301923 67325987 991902 1284320 1502827 3779049 0 991902 1284320 1502827 3779049 63546938 6451 1131 1214 984 750 10530 6451 1131 1214 984 750 10530 12920787 12264007 14641172 12207878 15302673 67336517 0.94370 0.91590 0.00020 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 8000 0 0 0 8000 0 Part II-B, Line 1: 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. 79179 -79179 181760 34780 137361 79179 151409 37341 6990 181760 0.00000 0.00000 0.00000 54858 25541 29317 170170 126588 43582 72899 Due to affiliates 133797 133797 X 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. X X X X 1 0 0 0 0 0 0 0 0 Syed Fahd MD Physician 285608 0 0 0 390 0 4108 0 31981 0 322087 0 0 0 Jeffrey Hundman Director, SMHS VP Finance (end 11/21 0 228197 0 3948 0 40550 0 3002 0 28317 0 304014 0 0 Megan Brewer MD Physician 289286 0 0 0 268 0 5445 0 5118 0 300117 0 0 0 Paige Hagerstrom Director 0 205728 0 6641 0 269 0 5912 0 25499 0 244049 0 0 Elizabeth Keene Director 0 154834 0 5767 0 831 0 3921 0 17617 0 182970 0 0 Carolyn McNamara NP Nurse Practitioner 137417 0 2000 0 125 0 0 0 33446 0 172988 0 0 0 Stephanie Mellen FNP Family Nurse Practitioner 121985 0 0 0 263 0 3918 0 33310 0 159476 0 0 0 Coleen Elias CEO & CFO 128055 0 7651 0 135 0 2668 0 20501 0 159010 0 0 0 Jonathan Libby FNP Family Nurse Practitioner 141848 0 0 0 1323 0 4329 0 11458 0 158958 0 0 0 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. 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. 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 N/A 0 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 Campus Holding PO Box 7291 Lewiston ME 04240 010406049 Holding company ME N/A C 0 Covenant Health Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ N/A C 0 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 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 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