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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 819,757 | 764,898 | 712,620 | 854,254 | 953,290 | 4,104,819 |
| 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...... | 17,184,747 | 15,497,392 | 16,791,595 | 18,747,811 | 22,795,424 | 91,016,969 |
| 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. | 18,004,504 | 16,262,290 | 17,504,215 | 19,602,065 | 23,748,714 | 95,121,788 |
| 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.) | 95,121,788 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 18,004,504 | 16,262,290 | 17,504,215 | 19,602,065 | 23,748,714 | 95,121,788 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 65,779 | 71,120 | 84,846 | 75,947 | 173,541 | 471,233 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 65,779 | 71,120 | 84,846 | 75,947 | 173,541 | 471,233 |
| 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.).. | 18,070,283 | 16,333,410 | 17,589,061 | 19,678,012 | 23,922,255 | 95,593,021 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| 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, PAGE 2, PART III, LINE 2 | ON MAY 1, 2016, MAINEHEALTH CARE AT HOME PURCHASED CERTAIN ASSETS OF MAINEHEALTH AFFILIATES WALDO COUNTY HOME HEALTHCARE SERVICES (EIN 22- 2864960), KNO-WAL-LIN HOME CARE AND HOSPICE, INC. (EIN 01-0340947), AND KNO-WAL-LIN HELP AT HOME, INC. (EIN 22-2968726) THE OPERATING RESULTS FOR THESE ENTITIES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS OF MAINEHEALTH CARE AT HOME SINCE THE DATE OF ACQUISITION. AS A RESULT, THE SIGNIFICANT PROGRAM SERVICES DURING THE YEAR NOW INCLUDE THOSE DESCRIBED ON LINE 4. |
| FORM 990, PAGE 2, PART III, LINE 4D | PCH GRANT: NEWBORNS AND MOTHERS GOT A HEALTHY START WITH HOME NURSING VISITS OFFERED AT NO CHARGE THROUGH A HEALTH PROMOTION GRANT FROM THE DIVISION OF FAMILY HEALTH OF THE STATE OF MAINE DEPARTMENT OF HUMAN SERVICES. SERVICES INCLUDED 857 ADMISSIONS AND 2,735 HOME VISITS. COMMUNITY HEALTH: OUR COMMUNITY HEALTH NURSES PROVIDE EDUCATION, FLU SHOTS, FOOT CARE AND BLOOD PRESSURE SCREENINGS THROUGHOUT SOUTHERN MAINE. REGISTERED DIETITIANS PROVIDE CONSULTATION AND EDUCATIONAL PROGRAMS RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION. COMMUNITY HEALTH NURSES ALSO PROVIDED FLU SHOTS AND OTHER ENCOUNTERS, WHICH INCLUDED FOOT CARE AND BLOOD PRESSURE CHECKS. PRIVATE DUTY: TO PROVIDE PERSONAL CARE SUPPORT TO ENHANCE INDEPENDENCE AND DIGNITY. |
| FORM 990, PART V | MAINE MEDICAL CENTER, ACTING ON BEHALF OF MAINEHEALTH (EIN 01-0431680), FILED 952 FORM 1099S FOR THE CALENDAR YEAR 2015 ON BEHALF OF THE FOLLOWING ORGANIZATIONS: MAINEHEALTH, MAINE MEDICAL CENTER, WALDO COUNTY HEALTHCARE, INC., WALDO COUNTY GENERAL HOSPITAL, COASTAL HEALTHCARE ALLIANCE, MMC REALTY, MAINE MEDICAL PARTNERS, NORDX, AND HOME HEALTH VISITING NURSES. |
| FORM 990, PAGE 6, PART VI, LINE 4 | EFFECTIVE APRIL 7, 2016, THE CORPORATE BYLAWS OF HOMEHEALTH - VISITING NURSES OF SOUTHERN MAINE, INC. WERE AMENDED TO INCLUDE THREE CHANGES: 1. NAME CHANGE TO "MAINEHEALTH CARE AT HOME" 2. EXPAND THE CORPORATE PURPOSES 3. REVISE THE DESCRIPTION OF THE BOARD TO INCLUDE ONE DIRECTOR NOMINATED BY COASTAL HEALTH CARE ALLIANCE. A COPY OF THE NEW DOCUMENTS HAVE BEEN INCLUDED IN THIS FILING. AS NOTED ON SCHEDULE O, PART III, LINE 2, MAINEHEALTH CARE AT HOME PURCHASED CERTAIN ASSETS OF MAINEHEALTH AFFILIATES WALDO COUNTY HOME HEALTHCARE SERVICES (EIN 22-2864960), KNO-WAL-LIN HOME CARE AND HOSPICE, INC. (01-0340947), AND KNO-WAL-LIN HELP AT HOME, INC. (EIN 22-2968726)ON MAY 1, 2016. |
| FORM 990, PAGE 6, PART VI, LINE 6 | MAINEHEALTH (EIN 01-0431680) IS THE ORGANIZATION'S SOLE MEMBER. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE MEMBER ELECTS THE BOARD MEMBERS ANNUALLY. OFFICERS OF THE CORPORATION ARE ELECTED OR APPOINTED BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 7B | THE MEMBER ELECTS THE BOARD OF DIRECTORS. THE MEMBER ALSO WOULD HAVE SOLE AUTHORITY TO APPROVE OF ANY SALE OR DISPOSITION OF CORPORATE ASSETS GREATER THAN 100,000, TO APPROVE OF ANY CORPORATE MERGER, ACQUISITION, DISSOLUTION OR LIQUIDATION, OR ANY OTHER ACTIONS REQUIRED OF MEMBERS BY LAW. THE BOARD OF DIRECTORS ARE RESPONSIBLE FOR THE GOVERNANCE AND MANAGEMENT OF THE CORPORATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A DETAILED REVIEW OF THE 990 WAS PERFORMED BY THE EXECUTIVE COMMITTEE AND PROVIDED TO THE BOARD OF DIRECTORS. THE CHIEF FINANCIAL OFFICER ALSO PERFORMS A DETAILED REVIEW OF THE ENTIRE FORM 990 BEFORE SIGNING AND PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ALL OFFICERS AND DIRECTORS ARE REQUIRED TO COMPLETE AN ANNUAL QUESTIONNAIRE. THE CEO 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 | THE PROCESS FOLLOWED FOR DETERMINING COMPENSATION OF THE CEO AND OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION IS A FORMAL PROCESS PERFORMED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. A RELATED ORGANIZATION USES AN OUTSIDE FIRM, SULLIVAN COTTER, TO PERFORM AN INDEPENDENT BENCHMARK ANALYSIS FOR THE CEO OF HOMEHEALTH-VISITING NURSES OF SOUTHERN MAINE, INC., ALONG WITH OTHER EXECUTIVES IN THE MAINEHEALTH SYSTEM. THE FIRM MEETS WITH THE EXECUTIVE COMMITTEE TO REVIEW EACH EXECUTIVE'S BENCHMARK REPORT. THE COMMITTEE THEN DELIBERATES ON MAINEHEALTH'S WRITTEN SALARY AND INCENTIVE PLAN PHILOSOPHY BEFORE MAKING A FINAL DECISION. ALL DECISIONS AND MEETINGS ARE CAPTURED IN MINUTES AND THERE ARE APPROPRIATE APPROVALS AT ALL LEVELS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE EXPLANATION ABOVE UNDER FORM 990, PART VI, LINE 15A - COMPENSATION FOR TOP OFFICIAL. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. |
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