Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 41,764 | 41,764 | ||||
| 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...... | 5,291,080 | 6,076,313 | 5,318,880 | 6,425,303 | 6,666,193 | 29,777,769 |
| 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. | 5,291,080 | 6,076,313 | 5,318,880 | 6,425,303 | 6,707,957 | 29,819,533 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 4,648,808 | 3,562,106 | 2,360,270 | 1,530,923 | 919,779 | 13,021,886 |
| c | Add lines 7a and 7b.. | 4,648,808 | 3,562,106 | 2,360,270 | 1,530,923 | 919,779 | 13,021,886 |
| 8 | Public support (Subtract line 7c from line 6.) | 16,797,647 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 5,291,080 | 6,076,313 | 5,318,880 | 6,425,303 | 6,707,957 | 29,819,533 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,667 | 983 | 851 | 396 | 935 | 4,832 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,667 | 983 | 851 | 396 | 935 | 4,832 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 5,292,747 | 6,077,296 | 5,319,731 | 6,425,699 | 6,708,892 | 29,824,365 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | 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 CEO AND/OR COO CONDUCTS AN ANNUAL REVIEW OF KEY EMPLOYEES. SALARIES FOR OFFICERS ARE DETERMINED BY THE BOARD OF DIRECTORS. AN INDEPENDENT COMPENSATION CONTRACTOR HAS BEEN USED TO DETERMINE APPROPRIATE SALARY RANGES. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS CONDUCTS AN ANNUAL PERFORMANCE EVALUATION OF THE CEO AND DETERMINES COMPENSATION, WHICH IS APPROVED BY THE FULL BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND POLICIES ARE PROVIDED UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | ROUNDING -2. |
| 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) AND (7) RICHARD FREEMAN, MD, SENIOR VP & CHIEF TRANSFORMATION OFFICER OF EASTERN MAINE HEALTHCARE SYSTEMS. EASTERN MAINE HEALTHCARE SYSTEM MADE GRANTS AND PAYMENTS TO HEALTHINFONET TOTALING REVENUE OF $725,909. HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $907 DUE FROM THE EASTERN MAINE HEALTHCARE SYSTEMS AT DEC. 31, 2014. HEALTHINFONET MADE PAYMENTS TOTALING $50,869 TO EASTERN MAINE HEALTHCARE SYSTEMS IN 2014. PART IV (2) NONA BOYINK, MD, PRESIDENT, HEALTHREACH NETWORK AND MAINEGENERAL REHAB & NURSING CARE (MEMBER MAINEGENERAL HEALTH). MAINEGENERAL HEALTH PROVIDED HEALTHINFONET WITH REVENUE TOTALING $150,000 IN 2014. PART IV (3)AND (6) WILLIAM CARON, PRESIDENT, MAINEHEALTH. MAINEHEALTH AND MAINE MEDICAL CENTER PROVIDED REVENUE TOTALING $510,000 AND $25,000 DEFERRED REVENUE TO HEALTHINFONET IN 2014. HEALTHINFONET MADE PAYMENTS TOTALING $2,366 TO MAINEHEALTH AND MAINE MEDICAL CENTER IN 2014. PART IV (4) AND (12) ARTHUR J. BLANK, PRESIDENT & CEO, MT. DESERT ISLAND HOSPITAL. MT. DESERT ISLAND HOSPITAL PROVIDED HEALTHINFONET WITH REVENUE TOTALING $28,500 IN 2014. HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $28,167 DUE FROM MDI HOSPITAL AT DEC. 31, 2014. HEALTHINFONET MADE PAYMENTS TOTALING $20,111 TO MT. DESERT ISLAND HOSPITAL IN 2014. PART IV (5) STEPHEN D. SEARS, MD, STATE EPIDEMIOLOGIST, MAINE CDC, MARY MAYHEW, COMMISSIONER, DEPARTMENT OF HEALTH AND HUMAN SERVICES, JAY YOE, DIRECTOR, MAINECARE, DHHS. THE MAINE CDC MADE GRANTS TO HEALTHINFONET TOTALING $407,839 IN 2014; HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $104,205 DUE FROM THE MAINE CDC AT DEC. 31, 2014. PART IV (8) DONALD KRAUSE, MD, ST. JOSEPH'S HEALTHCARE. ST. JOSEPH'S HEALTHCARE PROVIDED HEALTHINFONET WITH REVENUE TOTALING $132,386 IN 2014 AND $30,000 DEFERRED REVENUE; HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $6,669 DUE FROM ST. JOSEPH'S HEALTHCARE AT DEC. 31, 2014. PART IV (9) AND (13) RALPH JOHNSON, CHIEF INFORMATION OFFICER, FRANKLIN MEMORIAL HOSPITAL. FRANKLIN MEMORIAL HOSPITAL PROVIDED HEALTHINFONET WITH REVENUE TOTALING $27,917 IN 2014 AND $18,750 DEFERRED REVENUE. HEALTHINFONET MADE PAYMENTS TOTALING $21,294 TO FRANKLIN MEMORIAL HOSPITAL IN 2014. PART IV (10) DAWN GALLAGHER, DIRECTOR, OFFICE OF STATE COORDINATOR, MAINECARE. THE OFFICE OF THE STATE COORDINATOR FOR MAINECARE MADE GRANTS TOTALING $2,849,842 IN REVENUE TO HEALTHINFORNET IN 2014 AND $44,817 DEFERRED REVENUE. HEALTHINFONET HAD ACCOUNTS RECEIVABLE TOTALING $91,356 DUE FROM MAINECARE AT DEC. 31, 2014. PART IV (11) LYNN DUBY, CEO, CRISIS AND COUNSELING. HEALTHINFONET MADE PAYMENTS TOTALING $35,000 TO CRISIS AND COUNSELING IN 2014. |
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