Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MAINEHEALTH
Employer identification number
01-0431680
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
(A)
MAINE MEDICAL CENTER
010238552
3
Yes
Yes
Yes
156,900
(B)
HOME HEALTH-VISITING NURSES OF SOUTHERN MAINE
222571902
9
Yes
Yes
Yes
0
(C)
ST ANDREWS HOSPITAL
010153960
3
Yes
Yes
Yes
25,000
(D)
NORDX
010511356
9
Yes
Yes
Yes
0
(E)
STEPHENS MEMORIAL HOSPITAL ASSOCIATION
010219904
3
Yes
Yes
Yes
50,000
(F)
SPRING HARBOR HOSPITAL
010452483
3
Yes
Yes
Yes
0
(G)
GERIATRIC RESOURCE NETWORK
010542842
9
Yes
Yes
Yes
0
(H)
MILES MEMORIAL HOSPITAL
010211796
3
Yes
Yes
Yes
0
(I)
THE WEBBER HOSPITAL ASSOCIATION
010179500
3
Yes
Yes
Yes
150,000
(J)
WALDO COUNTY GENERAL HOSPITAL
010177170
3
Yes
Yes
Yes
40,000
(K)
PENOBSCOT BAY MEDICAL CENTER
010285286
3
Yes
Yes
Yes
50,000
(L)
HENRIETTA D GOODALL HOSPITAL INC
010078060
3
Yes
Yes
Yes
0
Total
471,900
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
PART I, LINE 11, COLUMN (VII): MAINEHEALTH ALSO PROVIDES VARIOUS MANAGEMENT SERVICES TO ITS SUPPORTED ORGANIZATIONS INCLUDING; PROGRAM DEVELOPMENT SERVICES, INFORMATION TECHNOLOGY SERVICES, LEGAL SERVICES AND AUDIT & COMPLIANCE SERVICES.
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MAINEHEALTH
Employer identification number
01-0431680
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
MAINEHEALTH WILL LEAD THE DEVELOPMENT OF THE PREMIER COMMUNITY CARE NETWORK THAT PROVIDES A BROAD RANGE OF INTEGRATED HEALTH CARE SERVICES IN MAINE AND NORTHERN NEW ENGLAND. THROUGH MAINEHEALTH'S AFFILIATED ORGANIZATIONS, THE NETWORK WILL ORGANIZE SERVICES ALONG THE FULL CONTINUUM OF CARE NECESSARY TO IMPROVE THE HEALTH STATUS OF THE POPULATIONS IT SERVES IN A COST EFFECTIVE MANNER.
THIRD ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4C
(CONTINUED FROM PAGE 2 OF 990, LINE 4C) QUALITY IMPROVEMENT, SEPSIS CARE, AMI, INFECTION PREVENTION, HOSPITAL MEDICINE AND PHARMACY AND THERAPEUTICS. WE HAVE PROGRAMS THAT FOCUS ON TRANSITIONS OF CARE SUCH AS EMERGENCY MEDICINE, REDUCING READMISSIONS, PRE-HOSPITAL CARE, HEART FAILURE, AND PALLIATIVE CARE. IN ADDITION THERE ARE PROGRAMS THAT CUT ACROSS THE CONTINUUM SUCH AS TELEHEALTH, ELDER CARE SERVICES, EDUCATION SERVICES, HIGH VALUE HEALTHCARE COLLABORATIVE, AND OTHER PROGRAMS MORE BROADLY FOCUSED ON IMPROVING QUALITY AND VALUE.
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
MAINEHEALTH'S OTHER PROGRAMS INCLUDE ACCESS TO CARE PROGRAMS (CAREPARTNERS AND MEDACCESS);COMMUNITY EDUCATION PROGRAMS (MAINEHEALTH LEARNING RESOURCE CENTERS, NORTHERN NEW ENGLAND POISON CENTER, CANCER RESOURCE CENTER, PARKINSON'S INFORMATION & REFERRAL CENTER AND SHARED DECISION MAKING RESOURCE CENTER) AND SUBSIDIZED HEALTH SERVICES.
CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PAGE 6, PART VI, LINE 6
THE ORGANIZATION HAS MEMBERS WHO SERVE ON A BOARD OF CORPORATORS.
ELECTION OF MEMBERS AND THEIR RIGHTS
FORM 990, PAGE 6, PART VI, LINE 7A
THE ORGANIZATION'S BOARD OF CORPORATORS HAS THE ABILITY TO ELECT TRUSTEES, EXCEPT FOR "TRANSITIONAL TRUSTEES", AT AN ANNUAL OR A SPECIAL MEETING.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS
FORM 990, PAGE 6, PART VI, LINE 7B
AS STATED IN THE ORGANIZATION'S BY LAWS, THE BOARD OF CORPORATORS SHALL ACT ON ANY MATTERS BROUGHT TO IT BY THE BOARD OF TRUSTEES.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE 990 WAS REVIEWED IN DETAIL BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. THE EXECUTIVE VICE PRESIDENT & TREASURER ALSO REVIEWED THE 990 IN DETAIL PRIOR TO SIGNING THE RETURN. THE FORM 990 WAS PROVIDED TO THE FULL BOARD OF TRUSTEES PRIOR TO FILING THE RETURN.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
CONFLICT OF INTEREST STATMENTS ARE OBTAINED ANNUALLY. THE ORGANIZATION REVIEWS THE RESPONSES TO THESE DOCUMENTS AND ADDRESSES ANY ISSUES IMMEDIATELY.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
MAINEHEALTH USES AN OUTSIDE FIRM TO PERFORM AN INDEPENDENT BENCHMARK ANALYSIS. THEY MEET WITH THE BOARD OF TRUSTEES EXECUTIVE COMPENSATION COMMITTEE TO REVIEW EACH EXECUTIVE BENCHMARK REPORT. THE COMMITTEE THEN DELIBERATES ON THE ORGANIZATION'S WRITTEN SALARY AND INCENTIVE PLAN PHILOSOPHY AND DOCUMENTS BEFORE MAKING A FINAL DECISION. ALL DECISIONS AND MEETINGS ARE CAPTURED IN MINUTES. THERE ARE APPROPRIATE SIGN OFFS AT ALL LEVELS.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
MAINEHEALTH USES AN OUTSIDE FIRM TO PERFORM AN INDEPENDENT BENCHMARK ANALYSIS. THEY MEET WITH THE BOARD OF TRUSTEES EXECUTIVE COMPENSATION COMMITTEE TO REVIEW EACH EXECUTIVE BENCHMARK REPORT. THE COMMITTEE THEN DELIBERATES ON THE ORGANIZATION'S WRITTEN SALARY AND INCENTIVE PLAN PHILOSOPHY AND DOCUMENTS BEFORE MAKING A FINAL DECISION. ALL DECISIONS AND MEETINGS ARE CAPTURED IN MINUTES. THERE ARE APPROPRIATE SIGN OFFS AT ALL LEVELS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST.
OTHER CHANGES IN NET ASSETS EXPLANATION
FORM 990, PART XI, LINE 9
EQUITY TRANSFER FROM AFFILIATE 1,937,731
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.