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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
SPRING HARBOR COMMUNITY SERVICES
Employer identification number
01-0524835
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
474,801
870,739
746,255
614,981
358,938
3,065,714
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......
10,643,400
12,550,141
12,064,423
8,105,467
3,706,412
47,069,843
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.
11,118,201
13,420,880
12,810,678
8,720,448
4,065,350
50,135,557
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.)
50,135,557
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
11,118,201
13,420,880
12,810,678
8,720,448
4,065,350
50,135,557
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
108
2
110
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
108
2
110
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.)..
11,118,309
13,420,880
12,810,678
8,720,448
4,065,352
50,135,667
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
100.000 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
100.000 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
SPRING HARBOR COMMUNITY SERVICES
Employer identification number
01-0524835
Return Reference
Explanation
FORM 990, PAGE 2, PART III, LINE 3
IN PRIOR YEAR SHCS CONDUCTED THE MENTAL HEALTH INTEGRATION SERVICES PROGRAM. THIS PROGRAM WAS TRANSFERRED TO MAINE MENTAL HEALTH PARTNERS, THE PARENT COMPANY. ON APRIL 1, 2014, MAINE MENTAL HEALTH PARTNERS (MMHP) AND ITS MEMBERS, INCLUDING SPRING HARBOR COMMUNITY SERVICES (SHCS), MERGED INTO A SINGLE, UNIFIED ORGANIZATION UNDER THE TAX IDENTIFICATION NUMBER OF SPRING HARBOR HOSPITAL, 01-0524834. THE NEW, MERGED ORGANIZATION WAS RENAMED MAINE BEHAVIORAL HEALTHCARE (MBH). THE PROGRAMS OF SHCS CONTINUE TO OPERATE AND BE CONDUCTED IN THE SAME MANNER UNDER MBH. SEE SCHEDULE N FOR MORE DETAILS.
FORM 990, PAGE 6, PART VI, LINE 4
ON APRIL 1, 2014, MAINE MENTAL HEALTH PARTNERS (MMHP) AND ITS MEMBERS, INCLUDING SPRING HARBOR COMMUNITY SERVICES (SHCS), MERGED INTO A SINGLE, UNIFIED ORGANIZATION UNDER THE TAX IDENTIFICATION NUMBER OF SPRING HARBOR HOSPITAL, 01-0524834. THE NEW, MERGED ORGANIZATION WAS RENAMED MAINE BEHAVIORAL HEALTHCARE (MBH). SEE SCHEDULE N FOR MORE DETAILS.
FORM 990, PAGE 6, PART VI, LINE 6
MAINE MENTAL HEALTH PARTNERS (MMHP) - EIN 26-3426990 IS THE SOLE MEMBER OF SPRING HARBOR COMMUNITY SERVICES. MAINEHEALTH (EIN - 01-0431680), AS SOLE MEMBER OF MMHP HAS THE RIGHT TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY OF MMHP AND ITS SUBSIDIARIES.
FORM 990, PAGE 6, PART VI, LINE 7A
THE SOLE MEMBER, MAINE MENTAL HEALTH PARTNERS MAY ELECT THE BOARD OF DIRECTORS FROM A SLATE OF NOMINEES SUBMITTED BY THE CORPORATION. THE OFFICERS ARE ELECTED BY THE BOARD OF TRUSTEES, EXCEPT THAT THE CFO IS APPOINTED BY THE BOARD OF TRUSTEES BASED UPON A RECOMMENDATION OF THE CEO.
FORM 990, PAGE 6, PART VI, LINE 7B
DECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS STRATEGIES, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION, AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL BY MAINE MENTAL HEALTH PARTNERS & MAINEHEALTH.
FORM 990, PAGE 6, PART VI, LINE 11B
THE FORM 990 WAS MADE AVAILABLE TO THE BOARD OF THE NEWLY FORMED ORGANIZATION, MAINE BEHAVIORAL HEALTHCARE. (DETAILS AT BEGINNING OF SCHEDULE O). A DETAILED REVIEW OF THE FORM 990 IS PERFORMED BY THE CONTROLLER & CFO, PRIOR TO THE CFO SIGNING AND FILING THE RETURN.
FORM 990, PAGE 6, PART VI, LINE 12C
THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS INCORPORATED AS PART OF THE BY-LAWS OF THE CORPORATION. ALL OFFICERS AND TRUSTEES ARE REQUIRED TO COMPLETE AN ANNUAL QUESTIONNAIRE. THE CHAIRPERSON REVIEWS ALL CONFLICT OF INTEREST FORMS ANNUALLY. ANY REPORTED CONFLICTS ARE IMMEDIATELY REVIEWED BY THE COMPLIANCE OFFICER AND THESE ARE ADDRESSED IMMEDIATELY.
FORM 990, PAGE 6, PART VI, LINE 15A
SPRING HARBOR COMMUNITY SERVICES BOARD OF DIRECTORS ARE RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. FOR THOSE KEY ADMINISTRATIVE EMPLOYEES THAT ARE SHARED WITH MMHP, COMPENSATION IS EVALUATED BY THE MMHP GOVERNANCE COMMITTEE AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTING FIRM, AND INDUSTRY SURVEY.
FORM 990, PAGE 6, PART VI, LINE 15B
SPRING HARBOR COMMUNITY SERVICES BOARD OF DIRECTORS ARE RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION, SUBJECT TO APPROVAL BY THE MEMBER. COMPENSATION OF THE CEO IS EVALUATED BY THE COMPENSATION COMMITTEE APPOINTED BY THE MEMBER, AND THE ORGANIZATION'S BOARD OF DIRECTORS MUST APPROVE OF THE COMPENSATION. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTING FIRM, AND INDUSTRY SURVEY.
FORM 990, PAGE 6, PART VI, LINE 19
DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART X
ON APRIL 1, 2014, ALL OF THE ASSETS, LIABILITIES AND NET ASSETS WERE TRANSFERRED TO THE NEW, MERGED ORGANIZATION, MAINE BEHAVIORAL HEALTHCARE. SEE SCHEDULE N FOR MORE DETAILS.
FORM 990, PART XI, LINE 9
NET ASSET TRANSFER TO MAINE BEHAVIORAL HEALTHCARE -255,333
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.