ST MARYS HEALTH SYSTEM: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- ST MARYS HEALTH SYSTEM (EIN 22-2504349)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-07-14
- IRS object ID
- 201601969349301025
- Schema version
- 2015v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule K
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-07-14T12:53:04-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 LLC | 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 | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222504349 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STMA | BusinessNameControlTxt |
| Phone | 2077778546 | 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 | 042437291 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTOPHER CHEKOURAS | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 2077778546 | PhoneNum |
| Signature | 2016-07-07 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | E DREW CHENEY | PreparerPersonNm |
| PTIN | P00182972 | PTIN |
| Phone | 8002447444 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHRISTOPHER CHEKOURAS | 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 | 042437291 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,088,062 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STMARYSMAINE.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 39 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $300,053 | PYContributionsGrantsAmt |
| CY Contributions Grants | $173,620 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,466,682 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,029,018 | CYProgramServiceRevenueAmt |
| PY Investment Income | $40,451 | PYInvestmentIncomeAmt |
| CY Investment Income | $62,655 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$19,049 | PYOtherRevenueAmt |
| CY Other Revenue | -$8,614 | CYOtherRevenueAmt |
| PY Total Revenue | $15,788,137 | PYTotalRevenueAmt |
| CY Total Revenue | $12,256,679 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,697,958 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,904,962 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,724,353 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,711,515 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $448,325 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,037,799 | PYOtherExpensesAmt |
| CY Other Expenses | $10,372,831 | CYOtherExpensesAmt |
| PY Total Expenses | $17,460,110 | PYTotalExpensesAmt |
| CY Total Expenses | $13,989,308 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,671,973 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,732,629 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,848,817 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,584,464 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $33,265,028 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $29,869,437 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$13,416,211 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$14,284,973 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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 A HEART-RELATED ILLNESS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,523,104 | ExpenseAmt |
| Revenue | $10,464,561 | RevenueAmt |
| Desc | INSURANCE MANAGEMENT: ST MARYS HEALTH SYSTEM MANAGES THE SELF-INSURANCE GROUP HEALTH INSURANCE AND MANAGES THE WORKERS COMPENSATION ACTIVITY FOR ITSELF AND ITS SUBSIDIARIES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,384,390 | ExpenseAmt |
| Revenue | $1,273,817 | RevenueAmt |
| Desc | OCCUPATIONAL/EMPLOYEE HEALTH: A PROGRAM DESIGNED TO PROVIDE SCREENING AND INJURY MANAGEMENT FOR ITS EMPLOYEES AND BUSINESS COMMUNITY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $203,741 | ExpenseAmt |
| Revenue | $88,474 | RevenueAmt |
| Desc | PREVENTION & WELLNESS: A PROGRAM FOR INDIVIDUALS IN THE COMMUNITY TO BETTER UNDERSTAND THEIR HEALTH NEEDS AND TO PROVIDE EDUCATIONAL TOOLS FOR THE INDIVIDUALS TO USE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (2 entries)
| ExpenseExpenseAmt | GrantGrantAmt | DescDesc | RevenueRevenueAmt |
|---|---|---|---|
| $1,904,962 | $1,904,962 | COMMUNITY SUPPORT GRANT TO COMMUNITY CLINICAL SERVICES | |
| $60 | OTHER PROGRAMS | $202,166 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,905,022 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $1,904,962 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $202,166 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $13,016,257 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 174 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 39 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | ME | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| 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 | CAROLYN M KASABIAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2077778546 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 96 CAMPUS AVENUE | AddressLine1Txt |
| City | LEWISTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 042437291 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| ANNE SCHUETTINGER | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CAROLYN KASABIAN | |||||||||
| SECRETARY/TREASURER | 2.00 | Yes (X) | $0 | $274,848 | $23,417 | 38.00 | Yes (X) | ||
| CAROLYN LEPAGE | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CHRISTOPHER BOWE | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $403,941 | $25,292 | 38.00 | |||
| CHRISTOPHER CHEKOURAS | |||||||||
| PRESIDENT/CEO | 2.00 | Yes (X) | $0 | $84,207 | $1,373 | 38.00 | Yes (X) | ||
| CRAIG GUNDERSON | |||||||||
| CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| DONALD FOURNIER | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JAMES PLACE MD | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN CHAPMAN | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN ISAACSON | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOYCE GIBSON TERM 22015 | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JUDITH ANDRUCKI ESQ | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| LEO MYLES TERM 102015 | |||||||||
| PRESIDENT/CEO | 2.00 | Yes (X) | $0 | $365,796 | $22,464 | 38.00 | Yes (X) | ||
| MARK ANTHOINE | |||||||||
| VICE CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| MARTIN EISENSTEIN ESQ | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MICHAEL KELLEY MD | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $486,963 | $21,147 | 38.00 | |||
| RICK VAIL | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| VACANT | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| SUSAN KEILER | |||||||||
| COO | 1.00 | $0 | $276,777 | $21,316 | 39.00 | Yes (X) | |||
| JONATHAN TORRES | |||||||||
| PHYSICIAN | 40.00 | $250,159 | $0 | $23,414 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $250,159 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,892,532 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $138,423 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ANTHEM | |||||
| 3350 PEACHTREE ROAD NE | ATLANTA | GA | 30326 | ADMINISTRATION FEES | $420,805 |
| ST MARY'S REGIONAL MEDICAL CENTER | |||||
| CAMPUS AVENUE PO BOX 0291 | LEWISTON | ME | 042430291 | PURCHASED SERVICES | $313,032 |
| COVENANT HEALTH | |||||
| 100 AMES POND DRIVE SUITE 102 | TEWKSBURY | MA | 01876 | PURCHASED SERVICES | $248,302 |
| TRESTLE TREE INC | |||||
| 3715 BUSINESS DRIVE SUITE 202 | FAYETTEVILLE | AR | 72703 | CONSULTING FEES | $215,417 |
| BGA FINANCIAL | |||||
| PO BOX 130 | AUBURN | ME | 042120130 | CONSULTING FEES | $132,667 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $173,620 | AllOtherContributionsAmt |
| Noncash Contributions | $73,437 | NoncashContributionsAmt |
| Total Contributions | $173,620 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER OPERATING REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $12,029,018 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,029,018 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,029,018 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,834 | TotalRevenueColumnAmt |
| Exclusion | $29,834 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $722,064 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $808,722 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$86,658 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$86,658 | TotalRevenueColumnAmt |
| Exclusion | -$86,658 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $32,821 | 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 | $32,821 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,821 | TotalRevenueColumnAmt |
| Exclusion | $32,821 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $100,705 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $22,661 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $78,044 | TotalRevenueColumnAmt |
| Exclusion | $78,044 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,256,679 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,029,018 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $54,041 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,904,962 | TotalAmt |
| Program Services | $1,904,962 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,428,271 | TotalAmt |
| Program Services | $1,240,328 | ProgramServicesAmt |
| Management And General | $16,486 | ManagementAndGeneralAmt |
| Fundraising | $171,457 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,808 | TotalAmt |
| Program Services | $7,649 | ProgramServicesAmt |
| Management And General | $102 | ManagementAndGeneralAmt |
| Fundraising | $1,057 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,308 | TotalAmt |
| Program Services | $154,845 | ProgramServicesAmt |
| Management And General | $2,058 | ManagementAndGeneralAmt |
| Fundraising | $21,405 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,128 | TotalAmt |
| Program Services | $83,478 | ProgramServicesAmt |
| Management And General | $1,110 | ManagementAndGeneralAmt |
| Fundraising | $11,540 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,985 | TotalAmt |
| Program Services | $62,702 | ProgramServicesAmt |
| Management And General | $2,283 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,475 | TotalAmt |
| Management And General | $6,475 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,345 | TotalAmt |
| Program Services | $966 | ProgramServicesAmt |
| Fundraising | $1,379 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,808 | TotalAmt |
| Program Services | $93,732 | ProgramServicesAmt |
| Fundraising | $17,076 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,065 | TotalAmt |
| Program Services | $17,932 | ProgramServicesAmt |
| Fundraising | $7,133 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,128 | TotalAmt |
| Management And General | $147,128 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,423 | TotalAmt |
| Program Services | $2,450 | ProgramServicesAmt |
| Management And General | $5,973 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $442,851 | TotalAmt |
| Program Services | $319,459 | ProgramServicesAmt |
| Management And General | $123,392 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|---|
| PROGRAM CLAIMS | $7,730,857 | $7,730,857 | ||
| MISCELLANEOUS | $679,382 | $675,719 | $3,663 | |
| CONSULTING | $415,397 | $348,591 | $59,719 | $7,087 |
| PURCHASED SERVICES | $361,715 | $134,600 | $24,087 | $203,028 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $377,400 | TotalAmt |
| Program Services | $237,987 | ProgramServicesAmt |
| Management And General | $9,604 | ManagementAndGeneralAmt |
| Fundraising | $129,809 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,989,308 | TotalAmt |
| Program Services | $13,016,257 | ProgramServicesAmt |
| Management And General | $524,726 | ManagementAndGeneralAmt |
| Fundraising | $448,325 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,661,017 | BOYAmt |
| EOY | $2,917,647 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,150 | BOYAmt |
| EOY | $53,201 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $297,302 | BOYAmt |
| EOY | $212,016 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $712,489 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,000 | BOYAmt |
| EOY | $120,000 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,302 | BOYAmt |
| EOY | $68,605 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,165,775 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,525,766 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,039,130 | BOYAmt |
| EOY | $7,640,009 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $968,645 | BOYAmt |
| EOY | $968,991 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,931,782 | BOYAmt |
| EOY | $3,603,995 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,848,817 | BOYAmt |
| EOY | $15,584,464 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,054,258 | BOYAmt |
| EOY | $6,664,939 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $900,905 | BOYAmt |
| EOY | $687,459 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,277 | BOYAmt |
| EOY | $40,939 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,077,047 | BOYAmt |
| EOY | $1,164,764 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,177,541 | BOYAmt |
| EOY | $21,311,336 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,265,028 | BOYAmt |
| EOY | $29,869,437 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$15,124,592 | BOYAmt |
| EOY | -$15,749,363 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,341,596 | BOYAmt |
| EOY | $1,097,605 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $366,785 | BOYAmt |
| EOY | $366,785 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$13,416,211 | BOYAmt |
| EOY | -$14,284,973 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,848,817 | BOYAmt |
| EOY | $15,584,464 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,732,629 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$54,569 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $918,436 | OtherChangesInNetAssetsAmt |
| 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COVENANT HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222484505 | EIN |
| Organization Type | 9 | OrganizationTypeCd |
| Governing Document Listed | 0 | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, SECTION A, LINE 1 | FormAndLineReferenceDesc |
| Explanation | THE SUPPORTING ORGANIZATION OPERATES EXCLUSIVELY FOR THE BENEFIT, AND TO CARRY OUT SOME OR ALL OF THE PURPOSES, OF THE CORPORATE MEMBER [COVENANT HEALTH] AND IN THE DISCRETION OF THE CORPORATE MEMBER AND BOARD OF DIRECTORS, TO SUPPORT OTHER NON-FOR-PROFIT RELIGIOUS, EDUCATIONAL AND CHARITABLE ORGANIZATIONS. THE SUPPORTING ORGANIZATION PROVIDES A SELF-INSURANCE HEALTH PLAN TO ITS SUPPORTED ORGANIZATIONS AND APPROVES THEIR OPERATING BUDGETS. IT ALSO PROVIDES SELF-INSURANCE WORKERS COMPENSATION COVERAGE TO ITS SUPPORTED ORGANIZATIONS FOR CLAIMS PRIOR TO 2013. COVENANT HEALTH OPERATES TO SUPPORT THE ORGANIZATIONS IN THE ST. MARY'S HEALTH SYSTEM. | ExplanationTxt |
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 D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,708,382 | BeginningYearBalanceAmt |
| Contributions | $153,142 | ContributionsAmt |
| Investment Earnings Or Losses | $25,190 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $422,323 | OtherExpendituresAmt |
| End Year Balance | $1,464,391 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,673,240 | BeginningYearBalanceAmt |
| Contributions | $278,523 | ContributionsAmt |
| Investment Earnings Or Losses | $26,634 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $270,015 | OtherExpendituresAmt |
| End Year Balance | $1,708,382 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,312,428 | BeginningYearBalanceAmt |
| Contributions | $224,230 | ContributionsAmt |
| Investment Earnings Or Losses | $27,646 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | -$108,936 | OtherExpendituresAmt |
| End Year Balance | $1,673,240 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,429,103 | BeginningYearBalanceAmt |
| Contributions | $139,643 | ContributionsAmt |
| Investment Earnings Or Losses | $32,273 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $288,591 | OtherExpendituresAmt |
| End Year Balance | $1,312,428 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,418,410 | BeginningYearBalanceAmt |
| Contributions | $221,297 | ContributionsAmt |
| Investment Earnings Or Losses | $9,893 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,220,497 | OtherExpendituresAmt |
| End Year Balance | $1,429,103 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.25000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.75000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $994,068 | OtherCostOrOtherBasisAmt |
| Book Value | $994,068 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,719,608 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,414,361 | DepreciationAmt |
| Book Value | $5,305,247 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,462 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,331 | DepreciationAmt |
| Book Value | $1,131 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $788,863 | OtherCostOrOtherBasisAmt |
| Depreciation | $663,836 | DepreciationAmt |
| Book Value | $125,027 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,656,774 | OtherCostOrOtherBasisAmt |
| Depreciation | $442,238 | DepreciationAmt |
| Book Value | $1,214,536 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,640,009 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LONG TERM INVESTMENTS | Desc |
| Book Value | $968,991 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $968,991 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER AR | $533,761 |
| LIMITED USE ASSETS | $3,070,234 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,603,995 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED EMPLOYEE BENEFITS | $2,046 |
| SECURITY DEPOSIT | $7,957 |
| DUE TO AFFILIATES | $21,301,333 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $21,311,336 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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, 2015. UNDER INTERNAL REVENUE SERVICE REGULATIONS, THE SYSTEM'S TAX YEARS FROM 2012 THROUGH 2015 ARE OPEN AND SUBJECT TO EXAMINATION. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | CHEF SOIREE | Event1Nm |
| Gross Receipts Event1 | $38,905 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $38,905 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $7,669 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF TOURNAMENT | Event2Nm |
| Gross Receipts Event2 | $61,800 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $61,800 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $14,992 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $100,705 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $100,705 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $22,661 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $22,661 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $78,044 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY CLINICAL SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CAMPUS AVE PO BOX 7291 | AddressLine1Txt |
| City | LEWISTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 042407291 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 010409788 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $1,904,962 | CashGrantAmt |
| Purpose Of Grant | COMMUNITY SUPPORT GRANT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ST. MARY'S HEALTH SYSTEM REVIEWS THE ORGANIZATION'S 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 ORGANIZATION'S BOARD OF DIRECTORS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CAROLYN KASABIAN | ||||||||||||||
| SECRETARY/TREASURER | $0 | $274,848 | $0 | $0 | $0 | $0 | $0 | $2,624 | $0 | $20,793 | $0 | $298,265 | $0 | $0 |
| CHRISTOPHER BOWE | ||||||||||||||
| DIRECTOR | $0 | $403,941 | $0 | $0 | $0 | $0 | $0 | $2,609 | $0 | $22,683 | $0 | $429,233 | $0 | $0 |
| LEO MYLES TERM 102015 | ||||||||||||||
| PRESIDENT/CEO | $0 | $365,796 | $0 | $0 | $0 | $0 | $0 | $2,614 | $0 | $19,850 | $0 | $388,260 | $0 | $0 |
| MICHAEL KELLEY MD | ||||||||||||||
| DIRECTOR | $0 | $369,612 | $0 | $117,351 | $0 | $0 | $0 | $2,637 | $0 | $18,510 | $0 | $508,110 | $0 | $0 |
| SUSAN KEILER | ||||||||||||||
| COO | $0 | $276,777 | $0 | $0 | $0 | $0 | $0 | $2,634 | $0 | $18,682 | $0 | $298,093 | $0 | $0 |
| JONATHAN TORRES | ||||||||||||||
| PHYSICIAN | $250,159 | $0 | $0 | $0 | $0 | $0 | $2,424 | $0 | $20,990 | $0 | $273,573 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 FORM W-2 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 AT THE BEGINNING OF THE YEAR. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VARIABLE RATE REVENUE BONDS - SERIES 2009 FINANCE AUTHORITY OF MAINE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 010392006 | BondIssuerEIN |
| CUSIP | NONEAVAIL | CUSIPNum |
| Bond Issued | 2009-01-06 | BondIssuedDt |
| Issue Price | $5,300,000 | IssuePriceAmt |
| Purpose | CONSTRUCTION | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $5,300,000 | TotalProceedsAmt |
| Capital Expenditures | $5,300,000 | CapitalExpendituresAmt |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | Yes (1) | Form8038TFiledInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | Yes (1) | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TD BANK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 7.500000000000 | TermOfHedgePct |
| Superintegrated Hedge | 0 | SuperintegratedHedgeInd |
| Hedge Terminated | 0 | HedgeTerminatedInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K. PART IV, LINE 7 AND PART V: | FormAndLineReferenceDesc |
| Explanation | THE BOND IS CAREFULLY AND CONSISTENTLY MONITORED FOR POTENTIAL VIOLATIONS OF FEDERAL TAX REQUIREMENTS, 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 METHODOLOGY FOR ENSURING POST-ISSUANCE COMPLIANCE WITH IRS REQUIREMENTS PERTAINING TO TAX-EXEMPT DEBT AND CONTAIN SPECIFIC LANGUAGE REGARDING ORGANIZATIONAL RESPONSIBILITY, RECORD RETENTION, PRIVATE BUSINESS USE, ARBITRAGE REBATE, AND REMEDIAL ACTION. ALTHOUGH 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 IN PLACE THAT SUBSTANTIATE THESE REQUIREMENTS. | ExplanationTxt |
Schedule M IRS990ScheduleM
Clothing And Household Goods ClothingAndHouseholdGoodsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Noncash Contributions Rpt F990 | $1,600 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | DONOR INFORMATION | MethodOfDeterminingRevenuesTxt |
Food Inventory FoodInventoryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 93 | ContributionCnt |
| Noncash Contributions Rpt F990 | $63,846 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | DONOR INFORMATION | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | MISCELLANEOUS | Desc |
| Contribution | 25 | ContributionCnt |
| Noncash Contributions Rpt F990 | $7,991 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | DONOR INFORMATION | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE FOLLOWING PROVISOS WERE ADDED TO THE BY-LAWS: THE CHIEF EXECUTIVE OFFICER OF ST. MARY'S REGIONAL MEDICAL CENTER SHALL SERVE ON THE BOARD, WITHOUT VOTE, SO LONG AS THIS INDIVIDUAL IS NOT ALSO THE CURRENT CHIEF EXECUTIVE OFFICER OF ST. MARY'S HEALTH SYSTEM. AT LEAST THREE (3) ADDITIONAL DIRECTORS SHALL BE CLINICIANS WHO ARE MEMBERS OF, OR WHO MEET ELIGIBILITY CRITERIA FOR MEMBERSHIP ON THE MEDICAL STAFF OR ALLIED HEALTH PROFESSIONAL STAFF OF ST. MARY'S REGIONAL MEDICAL CENTER (A "CLINICIAN") WHO ARE APPOINTED BY THE CORPORATE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS A SOLE CORPORATE MEMBER, COVENANT HEALTH, INC. |
| 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 11 | FORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED AT THE JUNE MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THIS PROCESS IS THE RESPONSIBILITY OF 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 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 MERCER HUMAN RESOURCES CONSULTING 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 918,436. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY CLINICAL SERVICES | ||||||||||
| CAMPUS AVE PO BOX 7291 | LEWISTON | ME | 04240 | 010409788 | PHYSICIAN PRACTICE | ME | 501(C)(3) | 9 | ST MARY'S HEALTH SYSTEM | Yes (1) |
| ST MARY'S D'YOUVILLE PAVILION | ||||||||||
| 102 CAMPUS AVE | LEWISTON | ME | 04240 | 010211558 | NURSING HOME | ME | 501(C)(3) | 9 | ST MARY'S HEALTH SYSTEM | Yes (1) |
| ST MARY'S REGIONAL MEDICAL CENTER | ||||||||||
| CAMPUS AVE PO BOX 0291 | LEWISTON | ME | 04240 | 010211551 | HOSPITAL | ME | 501(C)(3) | 11 | ST MARY'S HEALTH SYSTEM | Yes (1) |
| ST MARY'S RESIDENCES | ||||||||||
| CAMPUS AVE PO BOX 7291 | LEWISTON | ME | 04240 | 222504356 | LOW INCOME HOUSING | ME | 501(C)(3) | 9 | ST MARY'S HEALTH SYSTEM | Yes (1) |
| COVENANT HEALTH | ||||||||||
| 100 AMES POND ROAD | TEWKSBURY | MA | 01876 | 222484505 | HEALTHCARE MANAGEMENT AND RESOUCE ORGANIZATION | MA | 501(C)(3) | 9 | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMPUS HOLDING | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 97 CAMPUS AVE | AddressLine1Txt |
| City | LEWISTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010406049 | EIN |
| Primary Activities | HOLDING COMPANY | PrimaryActivitiesTxt |
| Legal Domicile State | ME | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | 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 | Yes (1) | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (14 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ST MARY'S REGIONAL MEDICAL CENTER | ||
| L | $50,188 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S REGIONAL MEDICAL CENTER | ||
| A | $503,520 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S REGIONAL MEDICAL CENTER | ||
| H | $106,391 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S REGIONAL MEDICAL CENTER | ||
| O | $29,892 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S REGIONAL MEDICAL CENTER | ||
| P | $4,368,057 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S REGIONAL MEDICAL CENTER | ||
| S | $1,904,962 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S D'YOUVILLE PAVILION | ||
| L | $593,952 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S D'YOUVILLE PAVILION | ||
| M | $6,026 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S D'YOUVILLE PAVILION | ||
| O | $12,701 | REIMBURSEMENT OF ACTUAL EXPENSE |
| COMMUNITY CLINICAL SERVICES | ||
| L | $145,671 | REIMBURSEMENT OF ACTUAL EXPENSE |
| COMMUNITY CLINICAL SERVICES | ||
| J | $30,000 | REIMBURSEMENT OF ACTUAL EXPENSE |
| COMMUNITY CLINICAL SERVICES | ||
| R | $2,469,165 | REIMBURSEMENT OF ACTUAL EXPENSE |
| COMMUNITY CLINICAL SERVICES | ||
| O | $108,672 | REIMBURSEMENT OF ACTUAL EXPENSE |
| ST MARY'S RESIDENCES | ||
| Q | $22,347 | REIMBURSEMENT OF ACTUAL EXPENSE |
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