2021-08-13T08:51:50-05:00 2020-09-30 010523282 Berry Dunn McNeil & Parker LLC PO BOX 1100 Portland ME 041041100 990 2019-10-01 010546327 Sebasticook Family Doctors SEBA 2073684213 118 Moosehead Trail No 5 Newport ME 04953 Robin Winslow CEO 2073684213 2021-08-11 1 Melissa Magoon CPA P01712842 2077752387 2021-08-11 2019 2022-09-23 18:48:47Z Hometown Health Center Robin Winslow 118 Moosehead Trail No 5 Newport ME 04953 6114318 0 X www.hometownhealthcenter.org X 2001 ME Providing quality healthcare to the uninsured and under insured regardless of their ability to pay. 10 10 87 10 0 0 2173215 2064229 3685399 4048715 0 1374 17 0 5858631 6114318 5734 5556 0 0 3290573 3682695 0 0 1574 2035208 1844611 5331515 5532862 527116 581456 2416901 3701891 323758 1027292 2093143 2674599 X The mission of Sebasticook Family Doctors (SFD) is to ensure that primary care, dental, and mental health services are available to those that live in and around communities in which SFD serves (Newport and Dexter) SFD is a Federally Qualified Health Center (FQHC) and provides health care services to those that would otherwise be unable to afford them. 0 0 2722845 3578256 Sebasticook Family Doctors, a Federally Qualified Health Center (FQHC), is a nonprofit organization located in Newport, Maine which operates a network of physician practices in the towns of Dexter and Newport. These practices provide, or assure access to primary care, specialty care, mental health and dental health care services to residents of communities in Penobscot, Piscataquis, Somerset, and Waldo Counties. 97135 5556 470459 SFD participates in the federal 340B Drug Discount Program. Under the program, prescription drugs are purchased at reduced rates and a discount prescription drug program is available to all patients, regardless of income levels. SFD contracts with a community pharmacy to dispense these drugs to qualified patients in Newport, Dexter, and Dover-Foxcroft. 2819980 1 1 0 0 0 0 0 0 0 1 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 28 0 1 87 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Robin Winslow 2073684213 118 Moosehead Trail Suite 5 Newport ME 04953 Jim Lemieux Board President 1.00 X X 0 0 0 Dawn Gordon Board Vice President 1.00 X X 0 0 0 Michael Wiers Board Treasurer 1.00 X X 0 0 0 Jim Burns Board Secretary 1.00 X X 0 0 0 John Parola Board Member 1.00 X 0 0 0 Deborah Wisdom Board Member 1.00 X 0 0 0 Debra Capilli Board Member 1.00 X 0 0 0 Dawn Huntt Board Member 1.00 X 0 0 0 Marjorie Downing Board Member 1.00 X 0 0 0 Jody Fernald Board Member 1.00 X 0 0 0 Robin Winslow Chief Executive Officer 40.00 X 151991 0 41202 Joshua Snowman Chief Financial Officer 40.00 X 96943 0 19646 Michael Macdonald Medical Director 40.00 X 227900 0 22166 Lindsay Norton Assistant Medical Director 40.00 X 144624 0 1521 Cynthia Levick Past Nurse Practioner 40.00 X 113607 0 14548 Victoria Donaldson Past Chief Operating Officer 40.00 X 102766 0 14115 837831 0 113198 5 0 1 0 OSIS PO Box 772852 Chicago IL 606772852 EMR Maintenance and Consulting 290654 Roundtable Technology PO Box 2313 Lewiston ME 042412313 IT Consultants and On-Site Support 185528 2 2053728 10501 2064229 Patient Fees 621110 3188747 3188747 Drug Program Revenue 621110 470459 470459 Other Revenue 621110 355495 355495 Bad Debt Recoveries 621110 34014 34014 4048715 1374 1374 6114318 4048715 0 1374 5556 5556 667177 667177 2432712 1828062 604650 35063 15008 20055 320571 147430 173141 227172 133757 93415 41672 41672 18834 18834 130057 83100 46957 143216 7681 135535 43924 43924 626032 284867 341165 286835 14582 272253 118251 32677 85574 17992 17992 86144 26488 59656 58620 58620 Program Supplies 120908 120908 Drug Program 97135 97135 Dues & Subscriptions 53417 22729 30688 Miscellaneous 1574 1574 5532862 2819980 2711308 1574 X 867769 1006365 537092 275330 858554 502134 495921 10036 28429 74360 157086 1728356 1195725 414411 532631 98219 189955 9447 13331 26599 21123 2416901 3701891 251328 365775 72430 46517 0 615000 323758 1027292 X 2086277 2665188 6866 9411 2093143 2674599 2416901 3701891 581456 0 X 0 1 X 1 1 1 X 2057858 1929603 1983852 2173215 2064229 10208757 4717781 3735033 3463582 3685416 4048715 19650527 6775639 5664636 5447434 5858631 6112944 29859284 0 0 0 29859284 1374 1374 1374 1374 6775639 5664636 5447434 5858631 6114318 29860658 1.00000 1.00000 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6866 8101 5556 9411 7712 5560 5734 672 6866 9893 6768 8949 7712 9633 7586 7326 9893 9633 5408 5408 9633 0.00000 0.00000 1.00000 0 0 297239 207124 90115 1431117 988601 442516 532631 Interest in Community Care Partnership of Maine LLC 189955 F 189955 CARES Act Funding 615000 615000 X 6080304 0 6080304 34014 34014 6114318 5498848 0 5498848 34014 34014 5532862 Part V, Line 4: The Organization's endowment funds consist entirely of the Hands of Giving Fund. The Hands of Giving Fund provides financial assistance to patients and staff members in need, and to the communities served by SFD. The Fund is fully funded by voluntary, direct deposits from SFD employees and other donations. 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 unrelated business income or uncertain tax positions that require adjustment to the financial statements. Part XI, Line 4b - Other Adjustments: Bad Debt Recoveries 34,014. Part XII, Line 4b - Other Adjustments: Bad Debt Recoveries 34,014. 1 Hands of Giving Funds 11 5556 0 Part I, Line 2: A patient or staff member of SFD who needs assistance shall fill out a form (the "outreach form") containing the following information (I) the name of the person in need (unless the request is made anonymously), (II) patient date of birth, (III) the amount of financial assistance requested, and (IV) the reason the financial assistance is needed. The Organization's campaign committee shall be responsible for (I) establishing the policies that govern the campaign, and (II) deciding which of the requests for assistance will be fulfilled. The outreach department will take the request and research resources for the patient. If the request can be fulfilled without Hands of Giving monies, the outreach department will handle this and will report this out at the quarterly campaign committee meeting. If the request cannot be fulfilled the outreach department will resent the request to the Hands of Giving committee. SFD also looks at needs in the community and donates to these programs, individuals, or families. Again, the same process is followed and the outreach department looks at resources and then the request goes through the committee to be voted upon. X X X 0 0 0 0 0 0 0 1 0 Robin Winslow Chief Executive Officer 145991 0 6000 0 0 0 6080 0 35122 0 193193 0 0 0 Michael Macdonald Medical Director 227900 0 0 0 0 0 0 0 22166 0 250066 0 0 0 Part I, Line 7 Bonuses are determined based upon measurable goals and are encounter-based. Bonuses are discretionary in nature. Form 990, Part VI, Section B, line 11b A draft of the Form 990 is reviewed by the Organization's finance committee before being submitted for final approval by the full board. Once approved, the Form is filed with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c At the regular meetings of the board of directors, members are reminded about the importance of adhering to the conflict of interest policy, and, at that time, members are asked if any conflict of interest(s) exist. Any employee who is uncertain whether their conduct violates the conflict of interest policy is instructed to consult with the Organization's CEO. Any employee who has reason to believe that the conflict of interest has been violated by another employee is required to report such belief to their immediate supervisor who shall then report the matter to the CEO. Form 990, Part VI, Section B, line 15 The executive committee evaluates the compensation package of the Organization's CEO. Their evaluation is taken to the full board for final approval and a two- year contract is then signed. The committee reviews the CEO's compensation annually. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment: Section 1.263(a)-3(n) Election: Sebasticook Family Doctors 118 Moosehead Trail No 5 Newport, ME 04953 EIN: 01-0546327 Sebasticook Family Doctors is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).