COMMUNITY CLINICAL SERVICES INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY CLINICAL SERVICES INC (EIN 01-0409788)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-07
- IRS object ID
- 201713119349301101
- Schema version
- 2016v3.0
- 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) |
|---|---|---|
| Return | 2017-11-07T08:31:29-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010409788 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY CLINICAL SERVICESINC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 2077778546 | PhoneNum |
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 |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOAN CHURCHILL | PersonNm |
| Person Title | EXECUTIVE DIRECTOR/CFO | PersonTitleTxt |
| Phone | 2077778546 | PhoneNum |
| Signature | 2017-11-07 | SignatureDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 155.212.6.161 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-07 | IPDt |
| IP Tm | 09:31:16 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 7EA5F91826FDEC39AFBB39687538FEB01BFA2691 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | E1A65C102B06E5C9ADAF8DC78101520DB9B2CC9D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2018-03-14 21:41:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOAN CHURCHILL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 57 BIRCH ST SUITE 201 | AddressLine1Txt |
| City | LEWISTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 042407291 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,811,752 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.COMMUNITYCLINICALSERVICES.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | PRIMARY AND SPECIALTY HEALTHCARE TO ALL RESIDENTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 173 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,155,660 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,241,901 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,837,168 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,558,506 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,914 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,345 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $15,001,742 | PYTotalRevenueAmt |
| CY Total Revenue | $15,811,752 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,940,016 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,372,589 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,038,246 | PYOtherExpensesAmt |
| CY Other Expenses | $3,306,446 | CYOtherExpensesAmt |
| PY Total Expenses | $14,978,262 | PYTotalExpensesAmt |
| CY Total Expenses | $15,679,035 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $23,480 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $132,717 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,927,466 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,830,166 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,864,687 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,634,344 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,062,779 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,195,822 | NetAssetsOrFundBalancesEOYAmt |
| Mission | COMMUNITY CLINICAL SERVICES, INC. IS A NOT-FOR-PROFIT, FEDERALLY QUALIFIED HEALTH CENTER, WHICH PROVIDES PRIMARY AND SPECIALTY HEALTHCARE SERVICES TO RESIDENTS IN THE SURROUNDING COMMUNITY REGARDLESS OF THE ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,172,281 | ExpenseAmt |
| Revenue | $5,711,804 | RevenueAmt |
| Desc | BEHAVIORAL MEDICINE: PSYCHIATRIC CARE FOR CHILDREN AND ADULTS. 2016 VISITS - 39,599 | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,765,353 | ExpenseAmt |
| Revenue | $3,453,439 | RevenueAmt |
| Desc | FAMILY PRACTICE: MEDICAL CARE FOR INFANTS, CHILDREN, AND ADULTS. 2016 VISITS - 19,589 | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,282,456 | ExpenseAmt |
| Revenue | $1,988,042 | RevenueAmt |
| Desc | OUTPATIENT COUNSELING: COUNSELING SERVICES FOR CHILDREN AND ADULTS. 2016 VISITS - 16,681 | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,627,055 | ExpenseAmt |
| Revenue | $2,405,221 | RevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,627,055 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $2,405,221 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $14,847,145 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | 0 | 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 | Yes (1) | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 0 | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 173 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | 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 |
| 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 | MICHAEL HENDRIX | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2077778546 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 96 CAMPUS AVENUE PO BOX 7291 | AddressLine1Txt |
| City | LEWISTON | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 042407291 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ABDIFATAH AHMED | ||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA RANKINS TERMED 62016 | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| BRADELY EDWARDS | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| CAROLE MOREAU | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ELIZABETH KEENE | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $126,247 | $9,667 | 38.00 | ||
| ELMUATZ ABDELRAHIM | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| FOWSIA MUSSE | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| MELISSA DUNN | ||||||||
| CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| RENE DUMONT | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $209,279 | $28,515 | 38.00 | ||
| ROBERT GAGNON | ||||||||
| VICE CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SALLY BELISLE | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SUSAN KEILER TERM 32106 | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | 38.00 | |
| ZAMZAM MOHAMUD TERM 62016 | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| LAURA PETERSON | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| PAIGE HAGERSTROM | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $121,894 | $7,653 | 38.00 | ||
| CAROLYN KASABIAN | ||||||||
| TREASURER | 2.00 | $0 | $262,122 | $12,429 | Yes (X) | 38.00 | ||
| JOAN CHURCHILL | ||||||||
| CFO/CEO | 40.00 | $89,300 | $0 | $8,619 | Yes (X) | |||
| SYED FAHD | ||||||||
| PHYSICIAN | 40.00 | $356,695 | $0 | $23,403 | Yes (X) | |||
| KEVIN KAVOOKJIAN | ||||||||
| PHYSICIAN | 40.00 | $399,935 | $0 | $25,779 | Yes (X) | |||
| MICHAEL KELLEY | ||||||||
| PHYSICIAN | 40.00 | $489,312 | $0 | $23,290 | Yes (X) | |||
| THADDEUS SHATTUCK | ||||||||
| PHYSICIAN | 40.00 | $471,109 | $0 | $25,185 | Yes (X) | |||
| SCOTT TREWORGY | ||||||||
| PHYSICIAN | 40.00 | $419,967 | $0 | $22,199 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,226,318 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $719,542 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $186,739 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 34 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ST MARY'S REGIONAL MEDICAL CENTER | |||||
| PO BOX 7291 CAMPUS AVE | LEWISTON | ME | 042430291 | PURCHASED SERVICES | $1,267,896 |
| BARTON ASSOCIATES INC | |||||
| PO BOX 417844 | BOSTON | MA | 022417844 | PEDIATRIC LOCUM | $193,586 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,903,004 | RelatedOrganizationsAmt |
| Government Grants | $212,694 | GovernmentGrantsAmt |
| All Other Contributions | $126,203 | AllOtherContributionsAmt |
| Total Contributions | $2,241,901 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICES REVENUE | 621110 | $11,621,395 | $11,621,395 |
| OTHER PROGRAM SERVICES REVENUE | 621110 | $1,368,061 | $1,368,061 |
| MEDICAL DIRECTOR REVENUE | 621110 | $569,050 | $569,050 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,558,506 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,345 | TotalRevenueColumnAmt |
| Exclusion | $11,345 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,811,752 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,558,506 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,345 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,011,606 | TotalAmt |
| Program Services | $10,819,783 | ProgramServicesAmt |
| Management And General | $191,823 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,316 | TotalAmt |
| Program Services | $55,432 | ProgramServicesAmt |
| Management And General | $884 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $650,778 | TotalAmt |
| Program Services | $418,450 | ProgramServicesAmt |
| Management And General | $232,328 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $653,889 | TotalAmt |
| Program Services | $643,427 | ProgramServicesAmt |
| Management And General | $10,462 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,816 | TotalAmt |
| Management And General | $2,816 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,700 | TotalAmt |
| Management And General | $17,700 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,699 | TotalAmt |
| Program Services | $300,549 | ProgramServicesAmt |
| Management And General | $4,150 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,862 | TotalAmt |
| Program Services | $125,549 | ProgramServicesAmt |
| Management And General | $1,313 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,215 | TotalAmt |
| Program Services | $21,295 | ProgramServicesAmt |
| Management And General | $36,920 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,537 | TotalAmt |
| Program Services | $92,624 | ProgramServicesAmt |
| Management And General | $94,913 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $1,379,297 | $1,179,625 | $199,672 |
| OUTSIDE LABOR | $793,554 | $793,453 | $101 |
| MINOR EQUIPMENT | $105,048 | $105,048 | $0 |
| SUPPLIES | $97,865 | $67,646 | $30,219 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,853 | TotalAmt |
| Program Services | $224,264 | ProgramServicesAmt |
| Management And General | $8,589 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,679,035 | TotalAmt |
| Program Services | $14,847,145 | ProgramServicesAmt |
| Management And General | $831,890 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $810,895 | BOYAmt |
| EOY | $631,544 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,199,714 | BOYAmt |
| EOY | $1,239,692 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,610 | BOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,475 | BOYAmt |
| EOY | $29,988 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $746,861 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $516,149 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $280,101 | BOYAmt |
| EOY | $230,712 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $552,671 | BOYAmt |
| EOY | $698,230 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,927,466 | BOYAmt |
| EOY | $2,830,166 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,820,980 | BOYAmt |
| EOY | $1,588,938 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,707 | BOYAmt |
| EOY | $45,406 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,864,687 | BOYAmt |
| EOY | $1,634,344 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,035,951 | BOYAmt |
| EOY | $1,044,413 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,828 | BOYAmt |
| EOY | $151,409 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,062,779 | BOYAmt |
| EOY | $1,195,822 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,927,466 | BOYAmt |
| EOY | $2,830,166 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $132,717 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$248 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $574 | 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,143,641 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,324,833 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,894,589 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,155,660 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,241,901 | CurrentTaxYearAmt |
| Total | $12,760,624 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,996,437 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,366,097 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,881,443 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,837,168 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,558,506 | CurrentTaxYearAmt |
| Total | $55,639,651 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,140,078 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,690,930 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,776,032 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $14,992,828 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,800,407 | CurrentTaxYearAmt |
| Total | $68,400,275 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $68,400,275 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $44 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,082 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,968 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,914 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,345 | CurrentTaxYearAmt |
| Total | $26,353 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $44 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,082 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,968 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,914 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,345 | CurrentTaxYearAmt |
| Total | $26,353 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,140,122 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,692,012 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,781,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,001,742 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,811,752 | CurrentTaxYearAmt |
| Total | $68,426,628 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99960 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99980 | PublicSupportPY509Pct |
| Investment Income CY | 0.00040 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00020 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $125 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $125 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | COMMUNITY CLINCAL SERVICES IS A MEMBER OF THE MAINE PRIMARY CARE ASSOCIATION AND A PORTION OF THE DUES PAID IN THE AMOUNT OF $125.00 IS USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $26,828 | BeginningYearBalanceAmt |
| Contributions | $126,205 | ContributionsAmt |
| Other Expenditures | $1,624 | OtherExpendituresAmt |
| End Year Balance | $151,409 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $52,215 | BeginningYearBalanceAmt |
| Contributions | $19,735 | ContributionsAmt |
| Other Expenditures | $45,122 | OtherExpendituresAmt |
| End Year Balance | $26,828 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $56,576 | BeginningYearBalanceAmt |
| Contributions | $40,092 | ContributionsAmt |
| Other Expenditures | $44,452 | OtherExpendituresAmt |
| End Year Balance | $52,215 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,601 | BeginningYearBalanceAmt |
| Contributions | $55,000 | ContributionsAmt |
| Other Expenditures | $25 | OtherExpendituresAmt |
| End Year Balance | $56,576 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $14,101 | BeginningYearBalanceAmt |
| Contributions | $2,500 | ContributionsAmt |
| Other Expenditures | $15,000 | OtherExpendituresAmt |
| End Year Balance | $1,601 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $47,090 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,219 | DepreciationAmt |
| Book Value | $31,871 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,200 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,200 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $694,571 | OtherCostOrOtherBasisAmt |
| Depreciation | $495,730 | DepreciationAmt |
| Book Value | $198,841 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $230,712 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE TO RESTRICTED FUNDS | $151,409 |
| BOARD DESIGNATED FUNDS | $535,633 |
| DUE FROM SMHS | $2,472,187 |
| DUE TO SMRMC | -$2,308,232 |
| DUE TO RESIDENCES | -$152,767 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $698,230 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO THIRD PARTY PAYORS | Desc |
| Amt | $45,406 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $45,406 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,782,545 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $2,086 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$462 | OtherRevenueAmt |
| Revenue Not Reported | $1,624 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,780,921 | RevenueSubtotalAmt |
| Other Revenues Not Included | $2,030,831 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,030,831 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,811,752 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,679,035 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,679,035 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,679,035 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | CCS IS CONSIDERED A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. 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. CCS HAS EVALUATED THE POSITIONS TAKEN ON ITS FILED TAX RETURNS. CCS HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31, 2016. CCS'S TAX YEARS FROM 2013 THROUGH 2016 ARE OPEN AND SUBJECT TO EXAMINATION. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | TRANSFERS TO AFFILIATES -462. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTIONS-RESTRICTED 614. COMMUNITY SUPPORT GRANT 1,903,004. GRANT DONATION-RESTRICTED 125,589. NET ASSETS RELEASED FOR PPE 1,624. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RENE DUMONT | ||||||||||||||
| DIRECTOR | $0 | $185,279 | $0 | $0 | $0 | $24,000 | $0 | $2,117 | $0 | $26,398 | $0 | $237,794 | $0 | $0 |
| CAROLYN KASABIAN | ||||||||||||||
| TREASURER | $0 | $238,482 | $0 | $0 | $0 | $23,640 | $0 | $2,627 | $0 | $9,802 | $0 | $274,551 | $0 | $0 |
| SYED FAHD | ||||||||||||||
| PHYSICIAN | $181,995 | $0 | $156,700 | $0 | $18,000 | $0 | $2,507 | $0 | $20,896 | $0 | $380,098 | $0 | $0 | $0 |
| KEVIN KAVOOKJIAN | ||||||||||||||
| PHYSICIAN | $298,110 | $0 | $83,825 | $0 | $18,000 | $0 | $2,553 | $0 | $23,226 | $0 | $425,714 | $0 | $0 | $0 |
| MICHAEL KELLEY | ||||||||||||||
| PHYSICIAN | $404,652 | $0 | $72,550 | $0 | $12,110 | $0 | $2,610 | $0 | $20,680 | $0 | $512,602 | $0 | $0 | $0 |
| THADDEUS SHATTUCK | ||||||||||||||
| PHYSICIAN | $221,010 | $0 | $232,099 | $0 | $18,000 | $0 | $1,823 | $0 | $23,362 | $0 | $496,294 | $0 | $0 | $0 |
| SCOTT TREWORGY | ||||||||||||||
| PHYSICIAN | $300,786 | $0 | $95,181 | $0 | $24,000 | $0 | $2,620 | $0 | $19,579 | $0 | $442,166 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | IN CONJUNCTION WITH 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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ST. MARY'S HEALTH SYSTEM (SMHS) IS THE SOLE CORPORATE MEMBER WITH LIMITED RESERVE POWER. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION HAS MEMBERS THAT CAN ELECT OTHER MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | APPROVAL OF THE MEMBERS IS REQUIRED FOR THE DISOLUTION OR MERGER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED AT THE OCTOBER 2017 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 | AN EXTERNAL COMPENSATION FIRM DOES A COMPENSATION SURVEY FOR THE EXECUTIVE DIRECTOR POSITION AND THE COMPENSATION PACKAGE IS REVIEWED BY THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION PROVIDES FORM 1023 AND FORM 990 TO THE PUBLIC WHEN REQUESTED. THE ORGANIZATION DOES NOT CURRENTLY PROVIDE ACCESS TO GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS. |
| FORM 990, PART XI, LINE 9: | NET ASSETS RELEASED FROM RESTRICTION 1,624. INTERCOMPANY TRANSFERS -1,050. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| ST MARY'S HEALTH SYSTEMS | ||||||||||
| POBOX 7291 CAMPUS AVE | LEWISTON | ME | 042437291 | 222504349 | PARENT COMPANY | ME | 501(C)3 | 11A | COVENANT HEALTH INC | 0 |
| ST MARY'S REGIONAL MEDICAL CENTER | ||||||||||
| POBOX 7291 CAMPUS AVE | LEWISTON | ME | 042430291 | 010211551 | HOSPITAL | ME | 501(C)3 | 3 | ST MARY'S HEALTH SYSTEM | 0 |
| ST MARY'S RESIDENCES | ||||||||||
| POBOX 7291 CAMPUS AVE | LEWISTON | ME | 042437291 | 222504356 | LOW-INCOME HOUSING | ME | 501(C)3 | 9 | ST MARY'S HEALTH SYSTEM | 0 |
| COVENANT HEALTH INC | ||||||||||
| 100 AMES POND DRIVE | TEWKSBURY | MA | 01876 | 222484505 | HEALTHCARE MANAGEMENT AND RESOURCE ADMINISTRATION | 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 | PO BOX 7291 | 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 NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | 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 | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |