2017-05-18T14:33:23-05:00 2016-12-31 010242373 MACPAGE LLC 30 LONG CREEK DRIVE SOUTH PORTLAND ME 04106 990 2016-01-01 205150062 HEALTHINFONET HEAL 2075419250 125 PRESUMPSCOT STREET BOX 8 PORTLAND ME 04103 DEVORE CULVER CEO 2075419250 2017-05-18 1 PETER MONTANO P01200943 2077745701 2017-05-02 66.186.191.122 2017-05-18 14:59:59 ED P D78927040672B75B2FA6451201D41A17A798FC5E 5A5A6FB4774B284172384D6262CFAA0891E67F87 2016 2021-01-29 14:40:06Z 125 PRESUMPSCOT STREET BOX 8 PORTLAND ME 04103 4930812 0 X WWW.HINFONET.ORG X 2008 ME TO OVERSEE THE IMPLEMENTATION AND OPERATION OF A STATEWIDE HEALTH INFORMATION TECHNOLOGY NETWORK. 19 19 25 0 0 0 0 8579 6198691 4919196 2202 3037 0 0 6200893 4930812 0 0 0 0 2781367 2772474 0 0 0 2474111 2635880 5255478 5408354 945415 -477542 4061740 3658188 684548 758538 3377192 2899650 TO OVERSEE THE IMPLEMENTATION AND OPERATION OF A STATEWIDE HEALTH INFORMATION TECHNOLOGY NETWORK. 0 0 4596317 4919196 CONTINUED TO MOVE TOWARD FULL IMPLEMENTATION OF THE PROJECT AS SCHEDULED. 4596317 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 10 0 1 25 1 0 0 0 0 0 0 0 0 X 19 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KIM BUSTAMANTE 2075419250 125 PRESUMPSCOT STREET BOX 8 PORTLAND ME 04103 RICHARD WHITE CHAIR 1.00 X X 0 0 0 KYLE JOHNSON DIRECTOR 1.00 X 0 0 0 KEVIN LEWIS DIRECTOR 1.00 X 0 0 0 MARY MAYHEW DIRECTOR 1.00 X 0 0 0 PETER MILLS TREASURER 1.00 X X 0 0 0 KAREN BELL VICE CHAIRPERSON 1.00 X X 0 0 0 STEPHEN SEARS DIRECTOR 1.00 X 0 0 0 KEN MCCALL DIRECTOR 1.00 X 0 0 0 MICHELLE PROBERT DIRECTOR 1.00 X 0 0 0 PAUL STEIN DIRECTOR 1.00 X 0 0 0 CAROL TIMBERLAKE DIRECTOR 1.00 X 0 0 0 ANN SULLIVAN SECRETARY 1.00 X X 0 0 0 LYNN DUBY DIRECTOR 1.00 X 0 0 0 DONALD KRAUSE DIRECTOR 1.00 X 0 0 0 SHERYL PEAVEY DIRECTOR 1.00 X 0 0 0 MARIE VIENNEAU DIRECTOR 1.00 X 0 0 0 ED KANE DIRECTOR 1.00 X 0 0 0 EDWARD TRAINER DIRECTOR 1.00 X 0 0 0 DERVILLA MCCANN DIRECTOR 1.00 X 0 0 0 DEVORE CULVER CEO 40.00 X 281681 0 29548 PETER PIKE CFO 4.00 X 8580 0 0 SHAUN ALFREDS COO 40.00 X 243415 0 31579 PHILIP PROFENNO DIRECTOR OF INFORMATION SE 40.00 X 133871 0 9465 KIM BUSTAMANTE DIRECTOR OF FINANCE AND AD 40.00 X 119947 0 24709 CHRIS CLOSSON SENIOR ANALYST 40.00 X 105424 0 8192 892918 0 103493 5 0 1 0 SYSTEMS ENGINEERING 120 EXCHANGE STREET PORTLAND ME 04101 SERVICES 489867 ORION PO BOX 2927 BUFFALO NY 142402927 SOFTWARE AND SUPPORT 434895 HBI 530 LYTTON AVENUE SECOND FLOOR PALO ALTO CA 94301 SOFTWARE AND SUPPORT 250558 IBM PO BOX 643600 PITTSBURG PA 152643600 SOFTWARE AND SUPPORT 156123 SURESCRIPTS 2800 CRYSTAL DRIVE ARLINGTON VA 22202 SERVICES 142009 5 8579 8579 PARTICIPATION REVENUE 2721866 2721866 CONTRACTED SERVICES 2146807 2146807 GRANT REVENUE 32220 32220 COMMISSION 18303 18303 4919196 3037 3037 4930812 4919196 0 3037 594805 294637 300168 1699937 1515741 184196 104577 93490 11087 216693 180415 36278 156462 124660 31802 17625 14087 3538 137537 117182 20355 21908 18665 3243 26348 1333 25015 291388 158566 132822 48472 32170 16302 VENDORS 1182316 1182316 SUBCONTRACTS 764834 764834 CONTRACTUAL SERVICES 63043 37826 25217 SUPPLIES 28656 14594 14062 53753 45801 7952 5408354 4596317 812037 0 2750225 2321547 493581 361006 217354 299025 1265293 806895 398955 458398 201625 218212 4061740 3658188 206279 334055 478269 424483 684548 758538 X 3377192 2899650 3377192 2899650 4061740 3658188 -477542 0 X 0 1 X 1 0 X 41764 8579 50343 5318880 6425303 6666193 6198691 4919196 29528263 5318880 6425303 6707957 6198691 4927775 29578606 0 2360270 1530923 919779 4810972 2360270 1530923 919779 4810972 24767634 851 396 935 2202 3037 7421 851 396 935 2202 3037 7421 5319731 6425699 6708892 6200893 4930812 29586027 0.83710 0.72740 0.00030 0.00020 X 1265293 806895 458398 458398 4930812 0 4930812 0 4930812 5408354 0 5408354 0 5408354 PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING X 1 0 X X X 0 0 0 0 0 0 0 1 0 DEVORE CULVER CEO 265301 0 0 0 16380 0 0 0 29548 0 311229 0 0 0 SHAUN ALFREDS COO 243415 0 0 0 0 0 0 0 31579 0 274994 0 0 0 PART I, LINE 1A CEO RECEIVES A HOUSING ALLOWANCE OF $16,380 ANNUALLY; IT IS INCLUDED IN HIS W-2 WAGES BUT IS NOT PART OF HIS BASE SALARY. PART I, LINE 3 THE EXECUTIVE COMMITTEE PERFORMS INDEPENDENT THIRD-PARTY COMPENSATION REVIEWS EVERY THREE YEARS FOR THE OFFICERS. THE EXECUTIVE COMMITTEE DETERMINES AMOUNT OF COMPENSATION AND ANNUAL BONUS FOR THE CEO. THE CEO HAS THE AUTHORITY TO DETERMINE AMOUNT OF COMPENSATION AND ANNUAL BONUS AMOUNTS FOR OTHER OFFICERS BASED UPON GUIDELINES DETERMINED BY THE EXECUTIVE COMMITTEE. BONUSES ARE BASED ON ORGANIZATIONAL AND EMPLOYEE PERFORMANCE. PART I, LINE 7 EMPLOYEES INCLUDING THE CEO ARE ELIGIBLE TO RECEIVE MERIT BONUSES FROM THE ORGANIZATION AT THEIR ANNUAL REVIEWS. THIS IS INCLUDED ON THE W-2S. KYLE JOHNSON CHIEF INFORMATION OFFICER AT EASTERN MAINE HEALTHCARE BOD MEMBER 808164 SCHEDULE O - HIN REVENUE 0 PAUL STEIN COO AT MAINEGENERAL MEDICAL CENTER BOD MEMBER 157500 SCHEDULE O - HIN REVENUE 0 ANDY CROWDER SENIOR VP AND CIO MAINEHEALTH BOD MEMBER 570500 SCHEDULE O - HIN REVENUE 0 ARTHUR BLANK CEO MDI HOSPITAL BOD OFFICER 43198 SCHEDULE O - HIN REVENUE 0 DONALD KRAUSE MD ST JOSEPH HEALTHCARE BOD MEMBER 182529 SCHEDULE O - HIN REVENUE 0 MARIE VIENNEAU CEO MAYO REGIONAL HOSPITAL BOD MEMBER 42000 SCHEDULE O - HIN REVENUE 0 DERVILLA MCCANN CHIEF OF POPULATION HEALTH CENTRAL MAINE HEALTH CARE BOD MEMBER 183750 SCHEDULE O - HIN REVENUE 0 MARY MAYHEW SHERYL PEAVEY DHHS MAINE CDC BOD MEMBER 335050 SCHEDULE O - HIN REVENUE 0 FORM 990, PART VI, SECTION B, LINE 11B LINE 11A EXPLANATION - THE IRS 990 REPORT IS AN INFORMATIONAL TAX FILING FOR ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX. THESE REPORTS ARE DUE TO THE IRS BY MAY FOLLOWING THE CLOSED FISCAL YEAR. THE INDEPENDENT AUDIT FIRM REQUIRES VARIOUS INTERNAL DOCUMENTS TO COMPLETE THE 990 REPORT INCLUDING INCOME, EXPENSES, GRANT AWARDS, PAYROLL, EQUIPMENT INVENTORY, ETC. THE 990 TAX RETURN IS SUBMITTED TO THE DIRECTOR OF ADMINISTRATION & FINANCE TO REVIEW PRIOR TO SIGNING BY THE CEO. THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE 990 PRIOR TO FILING WITH THE IRS. COPIES OF EACH YEAR'S 990 REPORTS ARE MAINTAINED IN ACTIVE FINANCE OFFICE FILES WITH ORIGINALS MAILED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY AND DISCLOSE ANY CONFLICT OF INTEREST ISSUES AT MEETINGS WHEN APPLICABLE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE PERFORMS INDEPENDENT THIRD-PARTY COMPENSATION REVIEWS EVERY THREE YEARS FOR THE OFFICERS. THE EXECUTIVE COMMITTEE DETERMINES AMOUNT OF COMPENSATION AND ANNUAL BONUS FOR THE CEO. THE CEO HAS THE AUTHORITY TO DETERMINE AMOUNT OF COMPENSATION AND ANNUAL BONUS AMOUNTS FOR OTHER OFFICERS BASED UPON GUIDELINES DETERMINED BY THE EXECUTIVE COMMITTEE. BONUSES ARE BASED ON ORGANIZATIONAL AND EMPLOYEE PERFORMANCE. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND POLICIES ARE PROVIDED UPON REQUEST. SCHEDULE L, SUPPLEMENTAL INFORMATION HEALTHINFONET RECEIVES REVENUE FROM SEVERAL ENTITIES WHICH HAVE REPRESENTATIVES SERVING ON THE BOARD OF DIRECTORS. IN ADDITION, HEALTHINFONET MAKES PAYMENTS TO SEVERAL OF THESE ENTITIES WHICH PARTICIPATE IN A PROGRAM FUNDED BY A FEDERAL GRANT. PART IV (1) KYLE JOHNSON, MD, CHIEF INFORMATION OFFICER OF EASTERN MAINE HEALTHCARE SYSTEMS. EASTERN MAINE HEALTHCARE SYSTEM MADE GRANTS AND PAYMENTS TO HEALTHINFONET TOTALING REVENUE OF $808,164 AND $4,167 IN DEFERRED REVENUE. PART IV (2) PAUL STEIN, CHIEF OPERATING OFFICER, MAINEGENERAL MEDICAL CENTER (MEMBER MAINEGENERAL HEALTH). MAINEGENERAL HEALTH PROVIDED HEALTHINFONET WITH REVENUE TOTALING $157,500 IN 2016. PART IV (3) ANDY CROWDER, SENIOR VP AND CIO, MAINEHEALTH. MAINEHEALTH AND MAINE MEDICAL CENTER PROVIDED REVENUE TOTALING $570,500 AND $24,896 IN DEFERRED REVENUE TO HEALTHINFONET IN 2016. PART IV (4) ARTHUR J. BLANK, PRESIDENT & CEO, MT. DESERT ISLAND HOSPITAL. MT. DESERT ISLAND HOSPITAL PROVIDED HEALTHINFONET WITH REVENUE TOTALING $43,198 IN 2016. HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $40,475 DUE FROM MDI HOSPITAL AT DEC. 31, 2016. PART IV (5) MARY MAYHEW, COMMISSIONER, DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE MAINE CDC MADE GRANTS TO HEALTHINFONET TOTALING $335,050 IN 2016; HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $98,810 DUE FROM THE MAINE CDC AT DEC. 31, 2016. PART IV (6) DONALD KRAUSE, MD, ST. JOSEPH'S HEALTHCARE. ST. JOSEPH'S HEALTHCARE PROVIDED HEALTHINFONET WITH REVENUE TOTALING $182,529 IN 2016 AND $31,500 IN DEFERRED REVENUE; HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $3,336 DUE FROM ST. JOSEPH'S HEALTHCARE AT DEC. 31, 2016. PART IV (7) MARIE VIENNEAU, CEO, MAYO REGIONAL HOSPITAL. MAYO REGIONAL HOSPITAL PROVIDED HEALTHINFONET WITH REVENUE TOTALING $42,000 IN 2016; HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $3,500 DUE FROM MAYO REGIONAL HOSPITAL AT DEC. 31, 2016. PART IV (8) DERVILLA MCCANN, CHIEF OF POPULATION HEALTH, CENTRAL MAINE HEALTH CARE. CENTRAL MAINE HEALTH CARE PROVIDED HEALTHINFONET WITH REVENUE TOTALING $183,750 AND $24,688 IN DEFERRED REVENUE IN 2016.