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
HEALTHY ACADIA
Employer identification number
27-0548057
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)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
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
Total
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.") ....
477,765
355,859
619,344
1,245,224
2,698,192
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
477,765
355,859
619,344
1,245,224
2,698,192
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.
2,698,192
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..
477,765
355,859
619,344
1,245,224
2,698,192
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
1,672
1,095
918
349
4,034
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).
2,702,226
12
Gross receipts from related activities, etc. (see instructions)
..................
12
1,862
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
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
HEALTHY ACADIA
Employer identification number
27-0548057
Identifier
Return Reference
Explanation
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
HANCOCK & WASHINGTON COUNTIES TO FORMULATE A TWO-YEAR DISTRICT PUBLIC HEALTH IMPROVEMENT PLAN.
SUBSTANCE ABUSE PREVENTION AND HEALTH PROMOTION THIS AREA OF PROGRAMMING, FUNDED BY PRIVATE FOUNDATION GRANTS AND MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES FUNDING, DEALS WITH A NUMBER OF INITIATIVES AROUND HEALTH PROMOTION, DISEASE PREVENTION (INCLUDING LEAD POISONING PREVENTION), AND ALCOHOL, TOBACCO, MARIJUANA, AND PRESCRIPTION DRUG ABUSE PREVENTION IN COMMUNITIES THROUGHOUT HANCOCK COUNTY, MAINE. PROGRAM ACTIVITIES INCLUDE DISSEMINATION OF EDUCATIONAL MATERIALS; HOSTING EDUCATIONAL CLASSES, TRAINING AND PROFESSIONAL DEVELOPMENT FOR HEALTH PROVIDERS, EDUCATORS AND STUDENTS, BUSINESS OWNERS AND EMPLOYEES; AND STRENGTHENING LINKAGES BETWEEN PRIMARY CARE PROVIDERS, HEALTH SYSTEMS, COMMUNITY BASED ORGANIZATIONS AND HEALTH RESOURCES. THESE ACTIVITIES ARE COORDINATED BY STAFF WITH TRAINING AND EDUCATION IN COMMUNITY HEALTH. SOME ACTIVITIES ARE CARRIED OUT WITH THE SUPPORT OF SUBCONTRACT PARTNERS, CONSULTANTS AND VOLUNTEERS WORKING TOGETHER IN COLLABORATIVE, COMMUNITY- BASED EFFORTS. DRUG FREE COMMUNITIES THE DRUG FREE COMMUNITIES (DFC) PROGRAM IS A FEDERAL GRANT FUNDED THROUGH THE OFFICE OF NATIONAL DRUG CONTROL POLICY AND SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION. THROUGH THE DFC PROGRAM, HEALTHY ACADIA IS WORKING WITH A COUNTYWIDE COALITION OF COMMUNITY MEMBERS AND LOCAL ORGANIZATIONS WHO ARE DEDICATED TO EMPOWERING YOUTH AND REDUCING UNDERAGE USE OF ALCOHOL, TOBACCO, AND OTHER DRUGS ACROSS HANCOCK COUNTY. HEALTHY ACADIA SUPPORTS SCHOOLS, ORGANIZATIONS AND PROGRAMS TO CARRY OUT COMMUNITY-LEVEL CHANGE THROUGH SEVERAL SUB-AWARDS TO COMMUNITY PARTNERS. THE DFC COALITION IS WORKING ON A VARIETY OF INITIATIVES TO PREVENT SUBSTANCE ABUSE AND TO HELP CHILDREN AND YOUTH THRIVE.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
UPON COMPLETION OF THE FORM 990 A DRAFT COPY IS SUBMITTED TO THE BOARD OF DIRECTORS (BOD) FOR REVIEW, AT THE SUBSEQUENT BOD MEETING THE 990 IS REVIEWED AND ANY QUESTIONS ARE ANSWERED AND THEN A VOTE TO AUTHORIZE FILING IS TAKEN AND DOCUMENTED.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
ALL NEW EMPLOYEES AND BOARD MEMBERS ARE GIVEN A COPY OF THE CONFLICT OF INTEREST POLICY AS PART OF THE ORIENTATION PACKAGE AND ASKED TO COMPLETE THE CONFLICT OF INTEREST DISCLOSURE CERTIFICATION AND RETURN IT TO THE BUSINESS MANAGER WHO KEEPS A FILE COPY. ANNUALLY THE CONFLICT OF INTEREST POLICY IS SCHEDULED FOR REVIEW AT BOTH A FULL STAFF MEETING AND A BOARD MEETING, A COPY OF THE POLICY IS PROVIDED AND A CONFLICT OF INTEREST DISCLOSURE CERTIFICATION IS REQUESTED FROM EACH PERSON AND IS FORWARDED TO THE BUSINESS MANAGER WHO MAINTAINS A FILE COPY WITH THE CONFLICT OF INTEREST POLICY. ALSO, CONSULTANTS ARE ASKED TO COMPLETE A DISCLOSURE CERTIFICATION IF IT IS DETERMINED ONE IS NECESSARY.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
MARKET SALARY INFORMATION IS OBTAINED FROM VARIOUS SOURCES (APHA, MPHA, COLUMBIA BOOKS AND ASSOCIATION TRENDS), ANALYZED IN CONJUNCTION WITH THE STATUS OF THE ORGANIZATIONS GROWTH AND THE INCUMBENTS PERFORMANCE, AND THEN A RECOMMENDATION IS PRESENTED TO THE BOARD FOR APPROVAL.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
RECOMMENDATIONS ARE EVALUATED, APPROVED AND ADMINISTERED BY THE EXECUTIVE DIRECTOR. THE BOARD APPROVES OF THE EXECUTIVE DIRECTORS DECISIONS REGARDING COMPENSATION CHANGES AS PART OF THE ANNUAL BUDGET APPROVAL PROCESS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED IN THE OFFICE AND ARE AVAILABLE TO THE PUBLIC DURING STANDARD BUSINESS HOURS.
OTHER FEES FOR SERVICES
FORM 990, PART IX, LINE 11G
CONSULTING/CONTRACT SERVICES 498,877 6,553 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.