2017-05-11T10:49:00-05:00 2016-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2016-01-01 010376890 Pines Health Services PINE 2074982356 PO Box 40 Caribou ME 04736 James M Davis Chief Executive Officer 2074982356 2017-04-25 1 Joseph R Byrne CPA P01289281 2077752387 2017-04-25 69.49.157.66 2017-04-25 11:07:38 ED P 3C04E448DABE24E92640F190E4B6AF6321E92A4E 110E64D7D7C632CB204D3607306484447A51AD6C 2016 2021-01-29 14:40:06Z James M Davis PO Box 40 Caribou ME 04736 23126158 0 X www.pineshealth.org X 1981 ME Group of health centers serving northern Maine. Six of the centers have FQHC designation. 12 12 187 12 0 0 3642207 4476990 18820614 18641539 -21350 1619 0 0 22441471 23120148 42717 30664 0 0 14691519 15443107 0 0 0 6750614 7682218 21484850 23155989 956621 -35841 7346696 7149180 1357872 1196197 5988824 5952983 X Multi-specialty outpatient healthcare organization, promoting the development of quality health care, health care services and the development and operation of related activities necessary to encourage quality health care in Aroostook County. 0 0 6202437 5516679 Family Practice Services provide general care to families. The services are performed by physicians, physician assistants, and family nurse practitioners. The services have been provided since the date of inception. 1281581 643853 Internal Medicine Services provide internal medicine to patients with more severe medical complications. The services are performed by physicians. The services have been provided since the date of inception. 2437935 2072108 Obstetrical and gynecological services are provided to female patients. These services are performed by physicians & Certified Nurse Midwives. The services have been provided since the date of inception. 11312942 30664 10408899 Various other medical services provided to patients. 11312942 30664 10408899 21234895 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 66 0 1 187 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Anthony Lahey 2074982356 PO Box 40 Caribou ME 04736 Betty Hatch Director 1.00 X 360 0 0 Chris Bell Director 1.00 X 300 0 0 Dana Rattray Vice Chair 1.00 X X 360 0 0 John Pelletier Past Director 1.00 X 210 0 0 Kevin Barnes Director 1.00 X 330 0 0 Kris Doody Director 1.00 X 0 0 0 Norm Collins Chair 1.00 X X 330 0 0 Peter Doebener Secretary/Treasurer 1.00 X X 360 0 0 Steve Rogeski Director 1.00 X 0 0 0 Tanya Sleeper Director 1.00 X 0 0 0 Tim Poitras Director 1.00 X 120 0 0 Kristie Moir Director 1.00 X 120 0 0 Jennifer Flynn Director 1.00 X 240 0 0 James Davis Chief Executive Officer 40.00 X 130525 0 15204 Lisa Caron Chief Operating Officer 40.00 X 103763 0 14485 Jean-Pierre Michaud Orthopedic Surgeon 40.00 X 699645 0 16340 Allan Espinosa Hematologist/Oncologist 40.00 X 422570 0 18448 Carl Flynn Family Physician 40.00 X 437323 0 18506 Nadia Rajack Hematologist/Oncologist 40.00 X 406243 0 18589 Natania Piper Urology Physician 40.00 X 380036 0 21098 2582835 0 122670 38 0 1 0 Weatherby Locums PO Box 972633 Dallas TX 75397 Locum Services 1031624 CompHealth PO Box 972651 Dallas TX 75397 Locum Services 525371 Dr Julio Arebalo 275 NE 18th Street Apt 205 Miami FL 33132 Provider Coverage 460130 Locum Tenens PO Box 405547 Atlanta GA 30384 Locum Services 369070 Dr Philip Din 5118 Duguid Road Manlius NY 13104 Provider Coverage 244236 8 2476990 2000000 4476990 Patient Service Rev. 621110 19702784 19702784 Income Guarantee 621110 4724188 4724188 Meaningful Use Revenue 621110 250750 250750 Bad Debt Expense 621110 -775806 -775806 Contractual/Char. Adj. 621110 -5260377 -5260377 18641539 7629 7629 6010 -6010 -6010 -6010 23120148 18641539 0 1619 X 30664 30664 266707 266707 13215519 12873506 342013 72986 72570 416 1133431 1080606 52825 754464 711254 43210 3800712 3549839 250873 64241 64241 529474 313202 216272 182284 182284 844456 818959 25497 185917 73374 112543 406666 205626 201040 388358 334059 54299 Medical Supplies 981611 981611 CME 115608 115608 Relocation 108874 108874 Physical Plant Expenses 74017 74017 23155989 21234895 1921094 0 X 424516 111542 1698197 1855826 2097657 2103184 1428443 1329578 43487 40548 70957 77539 4053155 2864570 1332218 1188585 9606 27092 225003 225003 16612 190283 7346696 7149180 1308169 1159660 49703 36537 1357872 1196197 X 3988824 3952983 2000000 2000000 5988824 5952983 7346696 7149180 -35841 0 X 0 1 X 1 1 1 X 3786234 3842833 3527579 3642207 4476990 19275843 3786234 3842833 3527579 3642207 4476990 19275843 19275843 363 268 329 2892 7629 11481 19287324 85928476 0.99940 0.99980 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 40025 40025 1520326 1080827 439499 2403558 1783743 619815 89246 89246 1188585 23120148 0 23120148 0 23120148 23155989 0 23155989 0 23155989 1 City of Caribou 25 High Street Caribou ME 04736 016000101 Caribou, Maine 10000 Sponsorship of 2017 Caribou Marathon 1 0 Part I, Line 2: The Organization provides grants and other assistance payments only to other 501(c)(3) organizations or governmental entities. Therefore, additional monitoring is not deemed necessary. X X 0 0 0 0 0 0 0 0 0 Jean-Pierre Michaud Orthopedic Surgeon 699645 0 0 0 0 0 2650 0 13690 0 715985 0 0 0 Allan Espinosa Hematologist/Oncologist 422570 0 0 0 0 0 0 0 18448 0 441018 0 0 0 Carl Flynn Family Physician 437323 0 0 0 0 0 2650 0 15856 0 455829 0 0 0 Nadia Rajack Hematologist/Oncologist 406243 0 0 0 0 0 2650 0 15939 0 424832 0 0 0 Natania Piper Urology Physician 380036 0 0 0 0 0 2650 0 18448 0 401134 0 0 0 Cary Medical Center An entity of which Kris Doody, current director, is an officer 225522 Lease of Property 0 Cary Medical Center An entity of which Kris Doody, current director, is an officer 550387 Pines Health Services receives housekeeping services and management and staffing services by Cary Medical Center, of which Kris Doody is Chief Executive Officer. 0 Cary Medical Center An entity of which Kris Doody, current director, is an officer 35000 Pines Health Services provides management and staffing services to Cary Medical Center, of which Kris Doody is the Chief Executive Officer. 0 Cary Medical Center An entity of which Kris Doody, current director, is an officer 2000000 Pines Health Services received charitable contributions in the form of a community benefit grant from Cary Medical Center, of which Kris Doody is Chief Executive Officer. 0 Cary Medical Center An entity of which Kris Doody, current director, is an officer 4724188 Pines Health Services received an income guarantee as part of a contractual relationship for the recruitment and retention of providers pertaining to the non-FQHC side of operations from Cary Medical Center. 0 Form 990, Part VI, Section B, line 11b Pines Health Services has its Form 990 reviewed by the board prior to filing. The 990 is given to the CEO for review and forwarded to the Board of Directors to be discussed at a regularly scheduled Board of Directors meeting. If a meeting cannot be held prior to the submission deadline, the Organization forwards the 990 electronically to the Board of Directors for review and comment. Form 990, Part VI, Section B, line 12c Annually, the Board of Directors sign forms indicating there are no conflicts of interest. If a conflict is brought to the board's attention, appropriate action will take place depending on the situation. This includes not allowing the member to vote on issues where there is a conflict, or other actions deemed necessary and appropriate by the board. Form 990, Part VI, Section B, line 15 For executives, the Board Executive Committee will review local market conditions and other factors. The salary is set below the MGMA national median range for practices of comparable size group by number of physicians, revenues and number of employees. For key employees (physicians, mid level providers), salary is set based on the MGMA annual Physician Compensation & Productivity Survey. 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 IX, line 11g Billing Services: Program service expenses 479,713. Management and general expenses 0. Fundraising expenses 0. Total expenses 479,713. Support Services: Program service expenses 438,487. Management and general expenses 0. Fundraising expenses 0. Total expenses 438,487. Professional Fees: Program service expenses 2,631,639. Management and general expenses 250,873. Fundraising expenses 0. Total expenses 2,882,512. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Pines Health Services PO Box 40 Caribou, ME 04736 EIN: 01-0376890 Pines Health Services is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).