2024-03-04T08:39:34-06:00 2023-06-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2022-07-01 454960453 Portland Community Health Center PORT 2078742141 180 Park Avenue Portland ME 04102 Ann Tucker CEO 2078742141 2024-03-01 1 Ann Tucker 999009999 1 Melissa Magoon CPA P01712842 2077752387 2024-03-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Greater Portland Health Ann Tucker 180 Park Avenue Portland ME 04102 20724699 0 X www.greaterportlandhealth.org X 2013 ME To provide high quality, patient-centered healthcare that is accessible, affordable, and culturally sensitive. 12 12 226 26 0 0 8993051 8488796 7991233 12139686 9441 96217 0 0 16993725 20724699 0 0 0 0 10368633 13575889 0 0 0 4574239 6711599 14942872 20287488 2050853 437211 9568336 14333037 2828518 7156008 6739818 7177029 To provide high quality, patient-centered healthcare that is accessible, affordable, and culturally sensitive. 0 0 11819549 8072891 The Organization is a community health center providing comprehensive primary care services to the greater Portland community across the full lifecycle (pediatric, adolescent, adult and geriatric care). The organization provides an array of enabling services with the support of community health workers, peer support specialists, and financial assistance counselors. The financial assistance counselors connect patients to insurances and an affordable sliding fee scale. The referrals team connects patients to specialty care that is offered in the community. Transportation and interpreting services are offered for patients that need these options. 3234824 2209423 The Organization provided comprehensive mental health and substance use counseling services in a fully integrated manner on-site at its Portland and South Portland, Maine locations. The organization has a psychiatric nurse practitioner team to support patient's mental health. The organization also has Licensed clinical social workers and Licensed clinical professional counselors on each health care team help patients make needed changes through health coaching and providing behavioral strategies that improve health and reduce harm. Some of these include stress management techniques, smoking cessation and motivational interviewing. Support groups and educational sessions are offered as needed. 2719385 1857371 The Organization provides comprehensive oral health services including preventative treatment, exams, follow up and oral health education for adults and children at its Portland sites and at the Portland, Westbrook and South Portland public school's locations. 17773758 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 22 0 1 226 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X Robert Zager 2078742141 180 Park Avenue Portland ME 04102 Paul Santomenna President 3.00 X X 0 0 0 Martha Borrero Vice President 1.00 X X 0 0 0 Rebecca Bass Secretary 1.00 X X 0 0 0 Richard White Treasurer 1.00 X X 0 0 0 Bibiche Bekoka Director 0.50 X 0 0 0 Christine Caulfield Director 0.50 X 0 0 0 Christopher Dana Director 0.50 X 0 0 0 Jean Paul Mugiraneza Director 0.50 X 0 0 0 John Skeen Director 0.50 X 0 0 0 Eileen Skillings Director 0.50 X 0 0 0 Joelle Rutembesa Director 0.50 X 0 0 0 Grete Zemans Director /Past Board President 3.00 X 0 0 0 Amy Kustra-Barksdale Past Board Secretary 0.50 X 0 0 0 Joyce Racine Past Director 0.50 X 0 0 0 Benjamin White Past Director 0.50 X 0 0 0 Ann Tucker Chief Executive Officer 40.00 X 222365 0 30604 Robert E Zager Chief Financial Officer 40.00 X 138252 0 27738 Renee M Fay-LeBlanc Chief Medical Officer 40.00 X 282053 0 30004 Gita A Rao Physician - Pediatric Clinical Director 40.00 X 187357 0 7054 Kevin G Sullivan Physician - Clinical Director 38.00 X 180860 0 19550 John P Fitzsimons Dental Director 40.00 X 178586 0 20202 Diana Lapp Physician - Clinical Director 32.00 X 171030 0 18840 Gladys Estrada Physician - Clinical Director 28.00 X 145254 0 3586 1505757 0 157578 20 0 1 0 Gorham Savings Bank 10 Wentworth Drive Gorham ME 04038 Financial Mgmt Services 667633 Logically PO Box 1700 Portland ME 04104 IT Support Services 609740 American Funds Retirement Planning PO Box 659530 San Antonio TX 785659530 Retirement Mgmt Services 573306 Preble Street Resource Center 55 Portland St Portland ME 04101 Case Management 461573 Language Line Services 1 Lower Ragsdale Drive Building 2 Monterey CA 93940 Interpretation & Translation Services 372873 11 29267 7968144 491385 8488796 Patient Service Revenue 621110 10474637 10474637 Recuperative services 621110 1617943 1617943 Investment in CCPM LLC 621110 47106 47106 12139686 96217 96217 20724699 12139686 0 96217 731016 731016 10681459 9764968 916491 129788 117625 12163 1153792 1065386 88406 879834 758681 121153 76620 76620 79095 79095 1743068 1667813 75255 19649 16943 2706 310490 267736 42754 590441 509137 81304 877400 756582 120818 25127 21667 3460 79064 68177 10887 150888 130111 20777 107397 92608 14789 340B Program Supplies 1037930 1037930 Other Expenses 813149 701178 111971 Program Supplies 771759 771759 Equipment Rental/Repair 29522 25457 4065 20287488 17773758 2513730 0 X 703499 462946 4010069 4313410 971293 1499700 580803 541756 177023 226340 4890451 1203842 2829442 3686609 268176 315282 3258963 28031 28031 9568336 14333037 1118640 2083844 109878 133012 1600000 1641113 0 3298039 2828518 7156008 X 6538273 6951763 201545 225266 6739818 7177029 9568336 14333037 437211 0 X 0 1 X 1 1 1 X Schedule A, Part I, Line 3: The Organization's tax exemption is based upon the classification as a hospital or cooperative hospital service organization described in Section 170(b)(1)(A)(iii). Since the Organization is not licensed in the State of Maine as a hospital, but rather as an FQHC, Schedule H is not required. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 737171 737171 1733937 46270 1687667 566027 286339 279688 1547385 871233 676152 305931 305931 3686609 Operating Lease Liability 3298039 3298039 X 20890849 166150 166150 20724699 0 20724699 20453638 166150 166150 20287488 0 20287488 Part X, Line 2: The Organization is a public charity under Section 501(c)(3) of the Internal Revenue Code. As a public charity, the Organization is exempt from state and federal income taxes on income earned in accordance with its tax-exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Organization's tax positions and concluded that the Organization has no uncertain tax positions that require adjustment to the financial statements. Part XI, Line 2d - Other Adjustments: In-Kind Rent Contribution 166,150. Part XII, Line 2d - Other Adjustments: In-Kind Rent Contribution 166,150. X X X X 0 0 0 0 0 0 0 1 0 Renee M Fay-LeBlanc Chief Medical Officer 263846 0 18207 0 0 0 2882 0 27122 0 312057 0 0 0 Ann Tucker Chief Executive Officer 196496 0 25869 0 0 0 2298 0 28306 0 252969 0 0 0 Kevin G Sullivan Physician - Clinical Director 174419 0 6441 0 0 0 1876 0 17674 0 200410 0 0 0 John P Fitzsimons Dental Director 172143 0 6443 0 0 0 1828 0 18374 0 198788 0 0 0 Gita A Rao Physician - Pediatric Clinical Direc 180627 0 6730 0 0 0 1904 0 5150 0 194411 0 0 0 Diana Lapp Physician - Clinical Director 164582 0 6448 0 0 0 1745 0 17095 0 189870 0 0 0 Robert E Zager Chief Financial Officer 123977 0 14275 0 0 0 1441 0 26297 0 165990 0 0 0 Part I, Line 7 Bonuses amounts are approved and paid at the discretion of the CEO and/or Board. Form 990, Part VI, Section B, line 11b The Form 990 was provided to the Board of Directors for discussion, review, and approval before filing. Form 990, Part VI, Section B, line 12c The Corporation will inform employees, officers, board members, and agents of its conflict of interest standards of conduct. Employees, officers, board members and agents shall receive the conflict of interest Standards of Conduct and a conflict of interest form to disclose actual and potential conflicts of interest in writing upon hire, election and/or entering into a vendor agreement and annually or if a real or apparent conflict arises. They will submit in writing (or electronic) the acknowledgements and disclosure form ("Disclosure Form"). Each employee, officer, board member, or agent or individual with Board-delegated powers shall annually sign a statement which affirms that such person: . Has received a copy of the conflict-of-interest policy, . Has read and understands the policy, . Has agreed to comply with the policy, and Understands that the Corporation is a section 501(c)(3) organization and that to maintain its federal tax-exempt status it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. Discloses facts and circumstances that could constitute a financial or other conflict-of-interest. Should an appearance of impropriety or actual conflict of interest exist, appropriate actions must be taken, which will vary depending on the particular facts. The employee, officer, board member, or agent must work cooperatively with the board, officer, manager, CFO and/or CEO depending on their position to achieve a resolution of the conflict issues in the best interests of the Corporation, as requested by Greater Portland Health. If the conflict involves a financial activity on behalf of the Corporation, written documentation of the conflict disclosure and the steps taken to address the conflict must be completed promptly and submitted to the Compliance Officer. " Form 990, Part VI, Section B, line 15 Compensation process for top official senior management, officers, and key employee salaries are based on National Association of Community Health Centers salary survey information that is provided and reviewed annually by the finance committee and Board of Directors. Compensation in the range is based on requisite experience. Form 990, Part VI, Section C, line 19 Governing documents disclosure explanation, printed copies of governing documents, and the conflict of interest policy are available at the Organization's headquarters. Financial statements are not available to the public; however, pertinent annual financial results are available upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment: Section 1.263(a)-3(n) Election: Portland Community Health Center 180 Park Avenue Portland, ME 04102 EIN: 45-4960453 Section 1.263(a)-3(n) Election: Portland Community Health Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).