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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
MaineGeneral Health
Employer identification number
04-3369649
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
a
b
c
d
e
f
Enter the number of supported organizations
.............................
4
g
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 listed in your governing document?
(v) Amount of monetary support (see instructions)
(vi) Amount of other support (see instructions)
Yes
No
(A)
MaineGeneral Medical Center
043369653
Yes
0
0
(B)
MaineGeneral Community Care
010524384
Yes
0
0
(C)
MaineGeneral Rehabilitation & Long Term Care
222789192
Yes
0
0
(D)
MaineGeneral Retirement Community
010627194
Yes
0
0
Total 4
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) 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.
Section B. Total Support
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.
12
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
14
15
15
16a
b
17a
b
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) 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
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) 2010
(b) 2011
(c) 2012
(d) 2013
(e) 2014
(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 VI.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
Section C. Computation of Public Support Percentage
15
15
16
16
Section D. Computation of Investment Income Percentage
17
17
18
18
19a
b
20
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B.
If you checked 11b of Part I, complete Sections A and C.
If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents? If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose, describe the
designation. If historic and continuing relationship, explain.
1
Yes
2
Did the organization have any supported organization that does not have an IRS determination of status under section
509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was
described in section 509(a)(1) or (2).
2
No
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)?
If "Yes," answer (b) and (c)
below.
3a
No
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the
public support tests under section 509(a)(2)?
If "Yes," describe in Part VI when and how the organization made the
determination.
3b
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes?
If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
4a
Was any supported organization not organized in the United States ("foreign supported organization")?
If “Yes” and if you
checked 11a or 11b in Part I, answer (b) and (c) below.
4a
No
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported
organization?
If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or
supervised by or in connection with its supported organizations....
4b
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections
501(c)(3) and 509(a)(1) or (2)?
If “Yes,” explain in Part VI what controls the organization used to ensure that all support to
the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
5a
Did the organization add, substitute, or remove any supported organizations during the tax year?
If “Yes,” answer (b) and
(c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported
organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the
organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by
amendment to the organizing document).
5a
No
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the
organization's organizing document?
5b
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other
than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its
supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing
organization’s supported organizations?
If “Yes,” provide detail in Part VI.
6
No
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in
IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a
substantial contributor?
If “Yes,” complete Part I of Schedule L (Form 990) .
7
No
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7?
If “Yes,” complete Part II of Schedule L (Form 990).
8
No
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as
defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))?
If “Yes,” provide detail in Part VI.
9a
No
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting
organization had an interest?
If “Yes,” provide detail in Part VI.
9b
No
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets
in which the supporting organization also had an interest?
If “Yes,” provide detail in Part VI.
9c
No
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain
Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)?
If “Yes,” answer b below.
10a
No
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine
whether the organization had excess business holdings).
10b
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the
governing body of a supported organization?
11a
No
b
A family member of a person described in (a) above?
11b
No
c
A 35% controlled entity of a person described in (a) or (b) above?
If “Yes” to a, b, or c, provide detail in Part VI.
11c
No
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or
elect at least a majority of the organization’s directors or trustees at all times during the tax year?
If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or
trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such
powers during the tax year.
1
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that
operated, supervised, or controlled the supporting organization?
If “Yes,” explain in Part VI how providing such benefit
carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting
organization.
2
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of
each of the organization’s supported organization(s)?
If “No,” describe in Part VI how control or management of the
supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
Yes
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s
tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the
Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing
documents in effect on the date of notification, to the extent not previously provided?
1
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s)
or (ii) serving on the governing body of a supported organization?
If "No," explain in Part VI how the organization
maintained a close and continuous working relationship with the supported organization(s).
2
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the
organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax
year?
If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported
organization(s) to which the organization was responsive?
If "Yes," then in Part VI identify those supported
organizations and explain how these activities directly furthered their exempt purposes, how the organization was
responsive to those supported organizations, and how the organization determined that these activities constituted
substantially all of its activities.
2a
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the
organization’s supported organization(s) would have been engaged in?
If "Yes," explain in Part VI the reasons for the
organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s
involvement.
2b
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of
the supported organizations?
Provide details in Part VI.
3a
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its
supported organizations?
If "Yes," describe in Part VI the role played by the organization in this regard.
3b
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov.
20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
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)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
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
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
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
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)
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8
Breakdown of line 7:
a
From 2010.......X
b
From 2011.......X
c
From 2012.......X
d
From 2013.......
e
From 2014.......
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Return Reference
Explanation
Schedule A (Form 990 or 990-EZ) 2014
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 990-EZ 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
2014
Open to Public Inspection
Name of the organization
MaineGeneral Health
Employer identification number
04-3369649
Return Reference
Explanation
Form 990, Part VI, Section B, line 11
All Forms 990 and related attachments were reviewed by appropriate members of senior management, the Finance Committee, and the Board of Directors before the filings were sent to the Internal Revenue Service. Final drafts of Forms 990 were available thirty days prior to the filing deadline in order to be formally reviewed by the Chief Financial Officer, the Compliance Officer, the entire senior management team, the Finance Committee, and the Board of Directors. Forms 990 and related attachments were provided to and reviewed by the Finance Committee in April 2016 and by the Board of Directors in May 2016.
Form 990, Part VI, Section B, line 12c
MaineGeneral Health's Conflict of Interest Policy requires disclosure of any actual or potential conflict of interest to the Board Chair. Interested persons are prohibited from participating in the governing body's deliberations and decisions regarding any transactions when they have a conflict of interest. If the Board or Committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, the Board or Committee shall investigate and then determine by a majority vote whether a conflict of interest exists and whether the violation is grounds for removal from the Board or Committee. There are formal records of these proceedings. In addition, each director, officer, and member of the Board is required to annually complete and sign a Conflict of Interest Disclosure Statement. Employees must disclose in writing to their supervisors any conflicts of interest prior to engaging in transactions or taking positions with MaineGeneral Health. In addition, these disclosures must be approved by the supervisor's manager or, as applicable, the Board Chair, in conjunction with the Human Resources Compliance Officer. If management has reasonable cause to believe that an employee has intentionally failed to disclose a conflict of interest, appropriate disciplinary or corrective action up to and including termination shall be taken. In addition, upon hire or promotion to a management position, all management employees shall complete a Conflict of Interest Disclosure Statement, which will be submitted to the Ethics and Compliance Department for review and reporting to the Chief Compliance Officer, who will record and report each validated conflict of interest to the Board.
Form 990, Part VI, Section B, line 15
The Board of Directors is responsible for determining the compensation package for the Chief Executive Officer. An independent compensation consultant advises the Board using comparability data, expert compensation studies and other means. Paid executives who hold voting privileges may not vote or participate in discussions regarding their compensation; however, they may answer questions that will help the Board in its deliberations. For other officer and key employee positions, salary structures are developed and maintained based on national compensation data for healthcare organizations. The Chief Executive Officer's compensation was last reviewed in December 2012.
Form 990, Part VI, Section C, line 19
MaineGeneral Health makes its governing documents, conflict of interest policy and financial statements, whether or not audited, available to the general public by providing copies immediately upon request. The latest two fiscal years of audited financial statements are available on the company's website at www.mainegeneral.org. In addition, the Controller distributes financial statements and budgets on a quarterly and annual basis to designated third parties.
Form 990, Part XI, line 9:
Other Pension Related Charges -640605.
Form 990 Part XII, Line 2c.
MaineGeneral Health did not change its oversight process or selection process during the current tax year.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.