ST JOSEPH AMBULATORY CARE INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ST JOSEPH AMBULATORY CARE INC (EIN 22-2480373)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-08-14
- IRS object ID
- 201322269349302702
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-14T13:32:48-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010494526 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 507 | AddressLine1 |
| City | PORTLAND | City |
| State | ME | State |
| ZIP Code | 04112 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222480373 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Joseph Ambulatory Care Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STJO | NameControl |
| Phone | 2072621000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 360 Broadway PO Box 403 | AddressLine1 |
| City | Bangor | City |
| State | ME | State |
| ZIP Code | 044020403 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kevin Sedgwick | Name |
| Title | CFO | Title |
| Phone | 2072621000 | Phone |
| Date Signed | 2013-08-12 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Nicholas E Porto | Name |
| PTIN | P01310283 | PTIN |
| Phone | 2078792100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Mary Prybylo | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 360 Broadway PO Box 403 | AddressLine1 |
| City | Bangor | City |
| State | ME | State |
| ZIP Code | 044020403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 9653070 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | ME | StateLegalDomicile |
| Activity Or Mission Description | Various physician practices | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 208 | TotalNbrEmployees |
| Total Nbr Volunteers | 5 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8743931 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9622119 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 668 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8831 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 90091 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 8834690 | TotalRevenuePriorYear |
| Total Revenue Current Year | 9630950 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11141533 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12080933 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3919691 | OtherExpensePriorYear |
| Other Expenses Current Year | 3868464 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15061224 | TotalExpensesPriorYear |
| Total Expenses Current Year | 15949397 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -6226534 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -6318447 | RevenuesLessExpensesCY |
| Total Assets BOY | 1030387 | TotalAssetsBOY |
| Total Assets EOY | 1850982 | TotalAssetsEOY |
| Total Liabilities BOY | 838990 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1300137 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 191397 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 550845 | NetAssetsOrFundBalancesEOY |
| Mission Description | Various physician practices | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 14790387 | Expense |
| Revenue | 9622119 | Revenue |
| Description | St. Joseph's Ambulatory Care, Inc. provides ambulatory care, clinics and clinical advisory services in the vicinity of Bangor, Maine. | Description |
| Total Program Service Expense | 14790387 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 1 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 24 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 208 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kevin Sedgwick | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2079071200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 360 Broadway PO Box 403 | AddressLine1 |
| City | Bangor | City |
| State | ME | State |
| ZIP Code | 044020403 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| David Gauvin | ||||||||
| Trustee | 0.10 | 0.10 | X | 0 | 0 | 0 | ||
| Gregory Jamisen | ||||||||
| Trustee | 0.10 | 0.10 | X | 0 | 0 | 0 | ||
| Deborah Marsters | ||||||||
| Trustee | 0.10 | 0.10 | X | 0 | 0 | 0 | ||
| Adrien Roy Jr | ||||||||
| Trustee | 0.10 | 0.10 | X | 0 | 0 | 0 | ||
| Elizabeth Weiss MD | ||||||||
| Trustee | 1.50 | 0.10 | X | 8640 | 0 | 0 | ||
| William Lucy | ||||||||
| Chairman | 0.10 | 0.10 | X | 0 | 0 | 0 | X | |
| Mary Prybylo | ||||||||
| President/CEO | 0.10 | 40.00 | X | 0 | 320700 | 11146 | X | |
| Kevin Sedgwick | ||||||||
| Treasurer/CFO | 0.10 | 40.00 | X | 0 | 179992 | 10791 | X | |
| Wayne Woodward part year | ||||||||
| Treasurer/EVP/CFO | 0.10 | 40.00 | X | 0 | 275402 | 10063 | X | |
| Angel Fernandez MD | ||||||||
| Physician | 40.00 | 402420 | 0 | 4194 | X | |||
| Mark Lena MD | ||||||||
| Physician | 40.00 | 393502 | 0 | 7145 | X | |||
| Erika Madrigal MD | ||||||||
| Physician | 40.00 | 393728 | 0 | 8457 | X | |||
| Ganesha Santhyadka MD | ||||||||
| Physician | 40.00 | 501827 | 0 | 12405 | X | |||
| Hatem Shoukeir MD | ||||||||
| Physician | 40.00 | 387224 | 0 | 16145 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2087341 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 776094 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 80346 | TotalOtherCompensation |
| Number Individuals GT100 K | 26 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Vista Staffing Solutions | |||||
| 675 East 2100 South | Salt Lake City | UT | 84106 | Physician services | 427374 |
| Integra Health | |||||
| PO Box 1124 | Holden | ME | 04429 | Physician services | 260740 |
| Penobscot Respiratory | |||||
| 417 State Street | Bangor | ME | 04401 | Physician services | 243900 |
| Penobscot Surgical Care | |||||
| 700 Mount Hope Avenue | Bangor | ME | 04401 | Physician services | 184673 |
| Synernet Inc | |||||
| 222 St John Street | Portland | ME | 04102 | Transcription services | 109757 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient services | 621990 | 8326202 | 8326202 |
| Non-patient services | 621990 | 1257870 | 1257870 |
| Affiliated income | 621990 | 38047 | 38047 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9622119 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7890 | TotalRevenueColumn |
| Exclusion | $7,890 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 23061 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 20868 | Securities |
| Other | 1252 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2193 | Securities |
| Other | -1252 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 941 | TotalRevenueColumn |
| Exclusion | $941 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9630950 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9622119 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $8,831 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8640 | Total |
| Program Services | 8640 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10007621 | Total |
| Program Services | 9326515 | ProgramServices |
| Management And General | 681106 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74144 | Total |
| Program Services | 69102 | ProgramServices |
| Management And General | 5042 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1379809 | Total |
| Program Services | 1285982 | ProgramServices |
| Management And General | 93827 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 610719 | Total |
| Program Services | 569190 | ProgramServices |
| Management And General | 41529 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 323932 | Total |
| Program Services | 301905 | ProgramServices |
| Management And General | 22027 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96000 | Total |
| Management And General | 96000 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1323415 | Total |
| Program Services | 1233423 | ProgramServices |
| Management And General | 89992 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14869 | Total |
| Program Services | 13858 | ProgramServices |
| Management And General | 1011 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 450056 | Total |
| Program Services | 419452 | ProgramServices |
| Management And General | 30604 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 588291 | Total |
| Program Services | 548287 | ProgramServices |
| Management And General | 40004 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37584 | Total |
| Program Services | 35028 | ProgramServices |
| Management And General | 2556 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 113349 | Total |
| Program Services | 105641 | ProgramServices |
| Management And General | 7708 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9109 | Total |
| Program Services | 8490 | ProgramServices |
| Management And General | 619 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 288247 | Total |
| Program Services | 268646 | ProgramServices |
| Management And General | 19601 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 216005 | Total |
| Program Services | 201317 | ProgramServices |
| Management And General | 14688 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Provision for bad debt | 220955 | 220955 | |
| Maintenance and repairs | 157097 | 146414 | 10683 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29555 | Total |
| Program Services | 27542 | ProgramServices |
| Management And General | 2013 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15949397 | Total |
| Program Services | 14790387 | ProgramServices |
| Management And General | 1159010 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 689 | BOY |
| EOY | 111241 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36232 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 411188 | BOY |
| EOY | 557436 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 111014 | BOY |
| EOY | 92263 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 919841 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 421270 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 450882 | BOY |
| EOY | 498571 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20382 | BOY |
| EOY | 452582 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 138889 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1030387 | BOY |
| EOY | 1850982 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 838990 | BOY |
| EOY | 694032 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 606105 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 838990 | BOY |
| EOY | 1300137 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 191397 | BOY |
| EOY | 550845 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 191397 | BOY |
| EOY | 550845 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1030387 | BOY |
| EOY | 1850982 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -6318447 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 3768 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 6674127 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Joseph Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010212435 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 0 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $0 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 54097 | OtherCostOrOtherBasis |
| Depreciation | 38737 | Depreciation |
| Book Value | 15360 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 865744 | OtherCostOrOtherBasis |
| Depreciation | 382533 | Depreciation |
| Book Value | 483211 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 498571 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 9634718 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 3768 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 3768 | RevenueNotRptdF990 |
| Revenue Subtotal | 9630950 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 9630950 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 15949397 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 15949397 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 15949397 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X, Line 2: | ReturnReference |
| 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. St. Joseph Hospital Corporate Services, Inc., a wholly-owned subsidiary of Nashua, is a for-profit organization, which is subject to federal and state income taxes. CHSIL, a wholly-owned subsidiary, is subject to taxation in the Cayman Islands. No income taxes are levied in the Cayman Islands, and CHSIL has been granted an exemption for any taxes that might be introduced. Accordingly, no provision for income taxes has been made in the accompanying financial statements. 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. 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, 2012. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mary Prybylo | ||||||||||||||
| President/CEO | 0 | 300450 | 0 | 0 | 0 | 20250 | 0 | 0 | 0 | 11146 | 0 | 331846 | 0 | 0 |
| Kevin Sedgwick | ||||||||||||||
| Treasurer/CFO | 0 | 157492 | 0 | 0 | 0 | 22500 | 0 | 0 | 0 | 10791 | 0 | 190783 | 0 | 0 |
| Wayne Woodward part year | ||||||||||||||
| Treasurer/EVP/CFO | 0 | 235902 | 0 | 0 | 0 | 39500 | 0 | 0 | 0 | 10063 | 0 | 285465 | 0 | 0 |
| Angel Fernandez MD | ||||||||||||||
| Physician | 370762 | 0 | 0 | 0 | 31658 | 0 | 0 | 0 | 4194 | 0 | 406614 | 0 | 0 | 0 |
| Mark Lena MD | ||||||||||||||
| Physician | 371071 | 0 | 0 | 0 | 22431 | 0 | 0 | 0 | 7145 | 0 | 400647 | 0 | 0 | 0 |
| Erika Madrigal MD | ||||||||||||||
| Physician | 360552 | 0 | 0 | 0 | 33176 | 0 | 0 | 0 | 8457 | 0 | 402185 | 0 | 0 | 0 |
| Ganesha Santhyadka MD | ||||||||||||||
| Physician | 317366 | 0 | 150461 | 0 | 34000 | 0 | 0 | 0 | 12405 | 0 | 514232 | 0 | 0 | 0 |
| Hatem Shoukeir MD | ||||||||||||||
| Physician | 370224 | 0 | 0 | 0 | 17000 | 0 | 0 | 0 | 16145 | 0 | 403369 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 3 | The CEO/Executive Director of St. Joseph Ambulatory Care, Inc. is an employee of St. Joseph Hospital, a related organization, and Ambulatory Care, Inc. does not maintain any procedures to establish their compensation. However, the Hospital uses a compensation committee, compensation survey/study, and approval by their board and compensation committee. |
| Part I, Line 4a | Wayne Woodford received a severance payment of $12,598. |
| Part I, Line 7 | Ganesha Santhyadka received incentive bonuses in 2012. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | St. Joseph Healthcare Foundation, a Maine nonprofit corporation, shall be the sole member of St. Joseph Ambulatory Care, Inc. | |
| Form 990, Part VI, Section A, line 7a | The Member of St. Joseph Ambulatory Care, Inc. shall elect the trustees of the Organization and may remove them with or without cause. | |
| Form 990, Part VI, Section A, line 7b | St. Joseph Healthcare Foundation, the Member of St. Joseph Ambulatory Care, Inc. (the Organization), shall have the following powers and rights, as outlined in its articles of incorporation and bylaws: (a) To approve any change in the written statements of philosophy and mission of the Organization or any subsidiary of the Organization, and to monitor compliance with same; (b) To amend and to repeal the articles of incorporation and the bylaws of the Organization, and to approve the adoption, amendment or repeal of the governing instruments of any subsidiary of the Organization; (c) To elect the Trustees of the Organization and to remove them with or without cause; (d) To appoint and remove the President of the Organization, including a President secured by management contract; (e) To ratify the Board of Trustees' election of the Chairperson of the Board of Trustees; (f) To approve all plans of merger, consolidation, reorganization or dissolution of the Organization or any subsidiary of the Organization, or the sale, lease, assignment or transfer of substantially all of the assets of the Organization or any subsidiary of the Organization, or the purchase or acquisition by the Organization or any subsidiary of the Organization of an interest in any corporation, partnership, joint venture or other entity, whether newly created or previously existing, which interest, in the case of a for profit entity, represents 25 percent or more of the voting power thereof or equity interest therein, or, in the case of a nonprofit entity, represents 25 percent or more of the voting power thereof or membership interest therein; (g) To approve all Board-approved long-range strategic plans of the Organization before their implementation; (h) To approve the acquisition, sale or encumbrance by the Organization or any subsidiary of the Organization of any real estate valued in excess of the amount set by the Member in writing from time to time; (i) To approve all Board approved capital budgets of the Organization and non-budgeted expenses which are in excess of the amount set by the Member in writing from time to time, and to approve the Organization's operating budget in accordance with policies set by the Member in writing from time to time; (j) To approve all debt of the Organization, not part of the approved budget, in excess of limits set by the Member in writing from time to time before such debt is incurred; (k) To appoint the auditors of the Organization and any subsidiary of the Organization; (l) To approve the sale, assignment or transfer by the Organization or any subsidiary of the Organization of any equity interest or membership interest in any subsidiary of the Organization; (m) To approve any reclassification or other change of any capital stock or other equity security of any subsidiary of the Organization, or any recapitalization of any subsidiary of the Organization; and (n) To approve the issuance of, or the creation of any obligation to issue, any equity security of any subsidiary of the Organization, or any increase or decrease in the total number of shares of authorized capital stock or other equity security of any subsidiary of the Organization. | |
| Form 990, Part VI, Section B, line 11 | There is a formal presentation of the 990 to the executive committee and then to the board. | |
| Form 990, Part VI, Section B, line 12c | Each board member is required to complete a form disclosing any conflict of interest. These conflicts are known; any member with a conflict of interest is asked to leave the meeting or abstain from voting or both. | |
| Form 990, Part VI, Section B, line 15 | St Joseph Ambulatory Care, Inc. does not compensate its officers or top management officials and thus does not administer a review/determination process for those positions. However, through compensation surveys/studies and employment contracts, compensation is determined for the Organization's CEO, officers, and top management officials by the compensation committee of St. Joseph's Hospital, a related organization, and approved by the Hospital's board. | |
| 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 each individual request. | |
| Form 990, Part XI, line 9: | Transfer from affiliate 6,674,127. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, line 2c: | The audit process has not changed from the prior year. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| St Joseph Healthcare Foundation | |||||||||||
| 360 Broadway | Bangor | ME | 044020403 | 222480149 | Diversified holistic health care services | ME | 501(c)(3) | Line 11a, I | Covenant Health Systems Inc | 0 | |
| St Joseph Hospital | |||||||||||
| 360 Broadway | Bangor | ME | 044020403 | 010212435 | Community hospital | ME | 501(c)(3) | Line 3 | St Joseph Healthcare Foundation | 0 | |
| M & J Company | |||||||||||
| 360 Broadway | Bangor | ME | 044020403 | 222480150 | Real estate holding company | ME | 501(c)(2) | St Joseph Healthcare Foundation | 0 | ||
| Alternative Health Services | |||||||||||
| 360 Broadway | Bangor | ME | 044020403 | 010422885 | Home health agency | ME | 501(c)(3) | Line 3 | St Joseph Healthcare Foundation | 0 | |
| Covenant Health Systems Inc | |||||||||||
| 100 Ames Pond Drive | Tewksbury | MA | 01876 | 222484505 | Sponsoring and operating a health care system | MA | 501(c)(3) | Line 9 | 0 | N/A | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Strauss Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 360 Broadway | AddressLine1 |
| City | Bangor | City |
| State | ME | State |
| ZIP Code | 044020403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010391369 | EIN |
| Primary Activity | Medical transcription | PrimaryActivity |
| Legal Domicile State | ME | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Joseph Healthcare Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| M & J Company | ||
| K | 514585 | Actual amount paid |
| M & J Company | ||
| S | 200000 | Actual amount paid |
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