2017-11-03T10:14:20-05:00 2016-12-31 990 2016-01-01 222504349 ST MARY'S HEALTH SYSTEM STMA 2077778546 CAMPUS AVENUE PO BOX 7291 LEWISTON ME 042437291 PETER HOLDEN PRESIDENT 2077778546 2017-11-03 155.212.6.161 2017-11-03 11:14:03 US P E1A65C102B06E5C9ADAF8DC78101520DB9B2CC9D EC86DA79E5A1A808996D735F7529F51DEE19078A 2016 2021-01-29 14:40:06Z PETER HOLDEN CAMPUS AVENUE LEWISTON ME 04243 14927540 0 X WWW.STMARYSMAINE.COM X 1983 ME AS AN ENTITY, ST. MARY'S HEALTH SYSTEM PROVIDES ADMINISTRATIVE OVERSIGHT, MANAGEMENT RESOURCES AND SUPPORTIVE SERVICES TO ADVANCE COMPREHENSIVE PREVENTATIVE AND HEALING SERVICES FOR THE PATIENTS, EMPLOYEES AND THE LOCAL BUSINESS COMMUNITY OF ITS AFFILIATED ORGANIZATIONS. 17 14 0 0 0 0 173620 124959 12029018 13833189 62655 -25709 -8614 341479 12256679 14273918 1904962 1904054 0 0 1711515 1923339 0 0 598257 10372831 14153303 13989308 17980696 -1732629 -3706778 15584464 18914190 29869437 35458280 -14284973 -16544090 X AS AN ENTITY, ST. MARY'S HEALTH SYSTEM PROVIDES ADMINISTRATIVE OVERSIGHT, MANAGEMENT RESOURCES AND SUPPORTIVE SERVICES TO ADVANCE COMPREHENSIVE PREVENTATIVE AND HEALING SERVICES FOR THE PATIENTS, EMPLOYEES AND THE LOCAL BUSINESS COMMUNITY OF ITS AFFILIATED ORGANIZATIONS. THE PREVENTION & WELLNESS/TAKE CHARGE COMMUNITY HEALTH RISK SCREENING PROGRAM WAS DEVELOPED TO PROVIDE A COST EFFECTIVE WAY FOR INDIVIDUALS, PARTICULARLY UNDERSERVED POPULATIONS, TO LEARN MORE ABOUT THEIR HEALTH. THIS PROGRAM SERVED 745 INDIVIDUALS WITH ABOUT 42% BEING FEMALE AND 58% MALE. THE MAJORITY OF THOSE FOLKS WERE OF WORKING AGE WITH A LARGE PERCENTAGE FALLING INTO EITHER MODERATE OR HIGH RISK FOR HEART-RELATED ILLNESS. 0 0 13519989 11876750 INSURANCE MANAGEMENT: ST. MARY'S HEALTH SYSTEM MANAGES THE SELF-INSURANCE GROUP HEALTH INSURANCE AND MANAGES THE WORKERS COMPENSATION ACTIVITY FOR ITSELF AND ITS SUBSIDIARIES 1288067 1273817 OCCUPATIONAL/EMPLOYEE HEALTH: A PROGRAM TO PROVIDE SCREENING AND INJURY MANAGEMENT FOR ITS EMPLOYEES AND THE BUSINESS COMMUNITY. 205384 4057 PREVENTION & WELLNESS: A PROGRAM FOR INDIVIDUALS IN THE COMMUNITY TO BETTER UNDERSTAND THEIR HEALTH NEEDS AND TO PROVIDE EDUCATIONAL TOOLS FOR THE INDIVIDULE TO USE. 1560696 1904054 678565 1560696 1904054 678565 16574136 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 39 0 0 0 0 0 0 0 0 0 X 17 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X X X MICHAEL HENDRIX 2077778546 96 CAMPUS AVENUE LEWISTON ME 042437291 ANNE SCHUETTINGER DIRECTOR 2.00 X 0 0 0 CAROLYN KASABIAN TERM 62016 SECRETARY/TREASURER 2.00 38.00 X X 0 262122 12429 CAROLYN LEPAGE DIRECTOR 2.00 X 0 0 0 RALPH HARDER DIRECTOR 2.00 X 0 0 0 CHRISTOPHER CHEKOURAS PRESIDENT/CEO 2.00 38.00 X X 0 388288 24842 CRAIG GUNDERSON CHAIR 2.00 X X 0 0 0 DONALD FOURNIER DIRECTOR 2.00 X 0 0 0 JAMES PLACE MD DIRECTOR 2.00 X 0 0 0 JOHN CHAPMAN DIRECTOR 2.00 X 0 0 0 JOHN ISAACSON DIRECTOR 2.00 X 0 0 0 LENA HARTLEY DIRECTOR 2.00 X 0 0 0 JUDITH ANDRUCKI ESQ DIRECTOR 2.00 X 0 0 0 MARK ANTHOINE VICE CHAIR 2.00 X X 0 0 0 MARTIN EISENSTEIN ESQ DIRECTOR THRU 10/2016 2.00 X 0 0 0 MICHAEL KELLEY MD DIRECTOR 2.00 38.00 X 0 489312 23290 RICK VAIL DIRECTOR THRU 6/2016 2.00 X 0 0 0 JACK KEITH MD DIRECTOR 2.00 X 0 0 0 KATHY MCMANUS DIRECTOR 2.00 X 0 0 0 MICHAEL HENDRIX SECRETARY/TREASURER 2.00 38.00 X 0 204803 30903 JONATHAN TORRES MD PHYSICIAN 40.00 X 251286 0 25636 251286 1344525 117100 3 0 1 0 SYNERNET WORKERS COMPENSATION FUND PO BOX 7291 CAMPUS AVE LEWISTON ME 04240 WORKERS' COMP PREMIUMS 1650799 COVENANT HEALTH INC 100 AMES POND DRIVE SUITE 102 TEWKSBURY MA 01876 PURCHASED SERVICES 140509 2 124959 124959 OTHER OPERATING REVENUE 621110 13833189 13833189 13833189 28339 28339 746127 471171 274956 274956 274956 99744 153792 -54048 -54048 -54048 95182 28659 66523 66523 14273918 13833189 0 315770 1904054 1904054 1545282 1201440 42204 301638 8479 6592 232 1655 262161 203827 7160 51174 107417 83515 2934 20968 25944 24734 1210 10851 10851 1045 213 832 111166 94078 17088 19410 15862 3548 137265 137265 257480 1087 256393 143288 310496 -167208 PROGRAM CLAIMS 11701535 11701535 PURCHASED SERVICES 653006 131465 499827 21714 MISCELLANEOUS 590774 589028 1746 SUPPLIES 135091 131934 252 2905 366448 174276 17183 174989 17980696 16574136 808303 598257 2917647 5993125 53201 670994 212016 378992 120000 117900 68605 83385 10898854 3955600 7640009 6943254 968991 815588 3603995 3910952 15584464 18914190 6664939 6157549 687459 437370 40939 113186 1164764 974585 21311336 27775590 29869437 35458280 X -15749363 -17815538 1097605 904663 366785 366785 -14284973 -16544090 15584464 18914190 X -3706778 10137 1437524 X 0 1 X 1 0 X X 1 COVENANT HEALTH 222484505 10 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1464391 98771 27323 319037 1271448 1708382 153142 25190 422323 1464391 1673240 278523 26634 270015 1708382 1312428 224230 27646 108936 1455368 1429103 139643 32273 288591 1312428 0.28850 0.71150 0 0 994068 994068 7758919 2748810 5010109 6462 5654 808 788863 692454 96409 1350542 508682 841860 6943254 OTHER A/R 577137 OTHER 3333815 3910952 ACCRUED EMPLOYEE BENEFITS 982 SECURITY DEPOSIT 9452 DUE TO AFFILIATES 27765156 27775590 X 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 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 POSITIONS TAKEN ON ITS FILED TAX RETURNS. THE SYSTEM HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31,2016. UNDER INTERNAL REVENUE SERVICE REGULATIONS, THE SYSTEM'S TAX YEARS FROM 2013 THROUGH 2016 ARE OPEN AND SUBJECT TO EXAMINATION. CHEF SOIREE 30550 30550 8775 GOLF TOURNAMENT 64632 64632 19884 95182 95182 28659 28659 66523 1 COMMUNITY CLINICAL SERVICES CAMPUS AVEPO BOX 7291 LEWISTON ME 042407291 010409788 501 (C)(3) 1904054 COMMUNITY SUPPORT GRANT PART I, LINE 2: ST. MARY'S HEALTH SYSTEM REVIEWS THE ORGANIZATIONS MONTHLY FINANCIAL STATEMENTS, MEETS WITH THE CFO ON A MONTHLY BASIS, AND IS INVOLVED IN PREPARING THE ANNUAL BUDGET. IN ADDITION, ST. MARY'S HEALTH SYSTEM HAS MEMBERS THAT SERVE ON THE ORGANIZATIONS BOARD OF DIRECTORS. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 CAROLYN KASABIAN TERM 62016 SECRETARY/TREASURER 0 238482 0 0 0 23640 0 2627 0 9802 0 274551 0 0 CHRISTOPHER CHEKOURAS PRESIDENT/CEO 0 364288 0 0 0 24000 0 0 0 24842 0 413130 0 0 MICHAEL KELLEY MD DIRECTOR 0 404652 0 72550 0 12110 0 2610 0 20680 0 512602 0 0 MICHAEL HENDRIX SECRETARY/TREASURER 0 204803 0 0 0 0 0 2129 0 28774 0 235706 0 0 JONATHAN TORRES MD PHYSICIAN 218970 0 10800 0 21516 0 2152 0 23484 0 276922 0 0 0 PART I, LINE 1A THE PRESIDENT/CEO OR THE CFO MAY AUTHORIZE PAYMENT OF SPOUSAL TRAVEL EXPENSES. THE PAYMENT OF SUCH AMOUNTS ARE TREATED AS TAXABLE COMPENSATION AND REPORTED ON W2 OR 1099 AS REQUIRED. PART I, LINE 7 IN CONJUNCTION WITH ITS SOLE MEMBER, COVENANT HEALTH, THE ORGANIZATION MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY COVENANT HEALTH'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS THAT ARE SET AS THE BEGINNING OF THE YEAR. A FINANCE AUTHORITY OF MAINE VAR RATE REV BONDS - SERIES 2009 010392006 NONEAVAIL 2009-01-06 5300000 CONSTRUCTION 0 0 0 A 5300000 5300000 0 0 1 1 A 0 0 0 0 0 0 0 A 1 1 1 TD BANK 7.500000000000 0 0 0 0 0 A 0 SCHEDULE K, PART IV, LINE 7 AND PART V: THE BOND IS CAREFULLY AND CONSISTENTLY MONITORED FOR POTENTIAL VIOLATIONS OF FEDERAL TAX REQUIREMENS, BUT THE PROCEDURES WERE NOT WRITTEN AS OF THE END OF THE YEAR COVERED BY THIS TAX RETURN. HOWEVER, THE ORGANIZATION IS CONSIDERING ADOPTING FORMAL POLICIES THAT SET FORTH THE ORGANIZATION'S METHODLOGY FOR ENSURING POST-ISSUANCE COMPLIANCE WITH IRS REQUIREMENTS PRETAINING TO TAX-EXEMPT DEBT AND CONTAIN SPECIFIC LANGUAGE REGARDING ORGANIZATIONAL RESPONSIBILITY, RECORD RETENSION, PRIVATE BUSINESS USE, ARBITRAGE REBATE, AND REMEDIAL ACTION. ALTHROUGH FORMAL POLICIES ARE NOT IN PLACE IN REGARDS TO THE REMEDIATION OF OUR BONDS, THE MONITORING REQUIREMENTS OF SECTION 148, AND PROCEDURES TO ENSURE THAT VIOLATIONS ARE TIMELY IDENTIFIED AND CORRECTED, THE ORGANIZATION HAS COMPLIANCE CHECKS INPLACE THAT SUBSTANTIATE THESE REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER MAY APPOINT OR REMOVE ONE OR MORE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD OF DIRECTORS ARE SUBJECT TO APPROVAL BY THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED. FORM 990, PART VI, SECTION B, LINE 12C THIS PROCESS IS THE RESPONSIBILITY OF THE ORGANIZATIONAL INTEGRITY OFFICER. A FORM IS USUALLY SUBMITTED TO ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, AND CERTAIN EMPLOYEES IN KEY POSITIONS ANNUALLY TO BE COMPLETED. REMINDERS ARE USUALLY SENT TO MAKE CERTAIN ALL CONFLICT OF INTEREST FORMS ARE RETURNED. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH'S BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COMPENSATION COMMITTEE HAS ENGAGED A HUMAN RESOURCES CONSULTING FIRM TO CONDUCT THIS ANALYSIS. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE CURRENT 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 PROVIDES FORM 1023 TO THE PUBLIC WHEN REQUESTED AND FORM 990 IS AVAILABLE ON OUR WEBSITE. THE ORGANIZATION DOES NOT CURRENTLY PROVIDE ACCESS TO GOVERNING DOCUMENTS CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS. FORM 990, PART XI, LINE 9: NET TRANSFERS 1,437,524. COMMUNITY CLINICAL SERVICES CAMPUS AVE PO BOX 7291 LEWISTON ME 04240 010409788 PHYSICIAN PRACTICES ME 501(C)(3) LINE 10 ST MARY'S HEALTH SYSTEM 1 ST MARY'S REGIONAL MEDICAL CENTER CAMPUS AVE PO BOX 7291 LEWISTON ME 04240 010211551 HOSPITAL ME 501(C)(3) LINE 11 ST MARY'S HEALTH SYSTEM 1 ST MARY'S RESIDENCES CAMPUS AVE PO BOX 7291 LEWISTON ME 04240 222504356 LOW INCOME HOUSING ME 501(C)(3) LINE 10 ST MARY'S HEALTH SYSTEM 1 COVENANT HEALTH SYSTEMS 100 AMES POND ROAD TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(C)(3) LINE 10 0 CAMPUS HOLDING 97 CAMPUS AVE LEWISTON ME 04240 010406049 HOLDING COMAPNY ME ST MARY'S HEALTH SYSTEM C 1.00000 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 1 1 ST MARY'S REGIONAL MEDICAL CENTER L 502309 REIMBURSEMENT OF ACTUAL EXPENSE ST MARY'S REGIONAL MEDICAL CENTER K 13960 REIMBURSEMENT OF ACTUAL EXPENSE ST MARY'S REGIONAL MEDICAL CENTER J 512508 REIMBURSEMENT OF ACTUAL EXPENSE ST MARY'S REGIONAL MEDICAL CENTER P 23149 REIMBURSEMENT OF ACTUAL EXPENSE ST MARY'S REGIONAL MEDICAL CENTER S 1903004 REIMBURSEMENT OF ACTUAL EXPENSE COMMUNITY CLINICAL SERVICES P 58086 REIMBURSEMENT OF ACTUAL EXPENSE COMMUNITY CLINICAL SERVICES Q 737 REIMBURSEMENT OF ACTUAL EXPENSE COMMUNITY CLINICAL SERVICES L 218270 REIMBURSEMENT OF ACTUAL EXPENSE COMMUNITY CLINICAL SERVICES J 30000 REIMBURSEMENT OF ACTUAL EXPENSE COMMUNITY CLINICAL SERVICES R 1901954 REIMBURSEMENT OF ACTUAL EXPENSE ST MARY'S RESIDENCES Q 22296 REIMBURSEMENT OF ACTUAL EXPENSE ST MARY'S RESIDENCES J 12298 REIMBURSEMENT OF ACTUAL EXPENSE ST MARY'S RESIDENCES L 14064 REIMBURSEMENT OF ACTUAL EXPENSE