Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 11,919,851 | 21,929,441 | 24,579,371 | 22,104,411 | 11,185,485 | 91,718,559 |
| 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 | 72,275,292 | 67,140,688 | 74,732,948 | 81,018,248 | 97,459,676 | 392,626,852 |
| 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 | 84,195,143 | 89,070,129 | 99,312,319 | 103,122,659 | 108,645,161 | 484,345,411 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 69,230 | 69,230 | ||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 69,230 | 69,230 | ||||
| 8 | Public support. (Subtract line 7c from line 6.) | 484,276,181 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 84,195,143 | 89,070,129 | 99,312,319 | 103,122,659 | 108,645,161 | 484,345,411 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 170,211 | 216,563 | 174,021 | 43,693 | 53,571 | 658,059 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 170,211 | 216,563 | 174,021 | 43,693 | 53,571 | 658,059 |
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | 268,598 | 88,281 | 356,879 | |||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 187,350 | 187,350 | ||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 84,552,704 | 89,286,692 | 99,486,340 | 103,434,950 | 108,787,013 | 485,547,699 |
| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12, Explanation of Other Income: | Forgiveness of Debt - 2019 Amount: $ 187,350. |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| Part I, Line 1, Description of Organization Mission: | Penobscot Community Health Center (PCHC) is a non-profit organization incorporated in 1997 that is governed by a Board of community volunteers and is the largest Federally Qualified Health Center in Maine. PCHC is driven by its mission statement "to provide comprehensive, integrated primary health care services for all to improve the health and wellbeing of our patients and the Maine Communities we serve," regardless of the ability to pay and demonstrates its dedication to quality care through Accreditation Association for Ambulatory Health Care as well as NCQA certification as a Primary Care Medical Home. As part of its Patient Centered Medical Home model, PCHC is proud to provide high quality family medical care to over 57,650 people in the greater Bangor Region, Waldo County and Jackman area. PCHC's four largest medical practices in Bangor, Brewer, and Old Town, Maine are open six days a week, Pediatrics open 5 days, and offer an integrated care model with medical care. Four of our practices provide pharmacy and one provides physical therapy under one roof. Also available are same day sick care, convenient early morning and evening hours, providers or nurses available by telephone call 24-hours a day, and six-day Walk-in Care at three locations. In addition to family medicine, PCHC offers a full range of services including pediatrics, dental care, pharmacy, care management, laboratory and x-ray services, physical therapy, speech therapy, audiology, infusion services, homeless health care and emergency shelter and transitional housing, as well as GYN, podiatry, chiropractic, and other specialty services. To learn more about PCHC's many services, providers, and locations, please visit www.PCHC.com. Our mission is to provide comprehensive, integrated primary health care services for all to improve the health and wellbeing of our patients and Maine Communities we serve. We commit not only to building the infrastructure for patient centeredness, but also to embracing the evolution of our personal roles, responsibilities, and attitudes as we shift to a collaborative, team-based model of care, partnered with the patient. We work to integrate community-based resources, family, and health care services in order to promote wellness, manage disease, advocate for helpful public policy, and celebrate successes. We strive to understand the full picture of our patients' lives and all of the factors which impact their wellbeing, to consider those strengths and challenges as we provide care, to understand who they are in their family, workplace, and community, and to ask about and listen for what matters most to them. We also commit, on a daily basis, to understand the role of our co-workers, to support each other in those roles, to properly value the contribution that every person makes to our success in fulfilling our mission, to communicate richly, to work together to solve problems and address challenges, and to interact with humor and good nature. We believe that health care is an inherent human right. We share an intellectual and emotional commitment to the care of our patients, which motivates us, sustains us and creates a generosity psychiatry, mental health counseling, geriatrics care and nursing home of spirit as we work together to fulfill our mission. We understand that quality occurs both in medical decision making and in human interaction, and that there is value both in that which we can measure, and in that which relies on our best nature and commitment to serve. We work for continuous improvement, in systems, in the effectiveness and efficiency of our care, in the experience of our patients and in the satisfaction of our team. We seek to challenge ourselves and each other, to innovate and to evaluate our work with humility as we undertake this bold endeavor. We embrace a collaborative spirit as we strive to fulfill our mission, and as we work with partners in our communities and across the state to transform health care. |
| Form 990, Part III, Line 1 - Organization's Mission | Penobscot Community Health Center (PCHC) is a non-profit organization incorporated in 1997 that is governed by a Board of community volunteers and is the largest Federally Qualified Health Center in Maine. PCHC is driven by its mission statement "to provide comprehensive, integrated primary health care services for all to improve the health and wellbeing of our patients and the Maine Communities we serve," regardless of the ability to pay and demonstrates its dedication to quality care through Accreditation Association for Ambulatory Health Care as well as NCQA certification as a Primary Care Medical Home. As part of its Patient Centered Medical Home model, PCHC is proud to provide high quality family medical care to over 57,650 people in the greater Bangor Region, Waldo County and Jackman area. PCHC's four largest medical practices in Bangor, Brewer, and Old Town, Maine are open five and six days a week and offer an integrated care model with medical care. Four of our practices provide pharmacy and one provides physical therapy under one roof. Also available are same day sick care, convenient early morning and evening hours, providers or nurses available by telephone call 24-hours a day, and six-day Walk-in Care at three locations. In addition to family medicine, PCHC offers a full range of services including pediatrics, dental care, pharmacy, care management, laboratory and x-ray services, physical therapy, speech therapy, audiology, infusion services, homeless health care and emergency shelter and transitional housing, as well as GYN, podiatry, chiropractic, and other specialty services. To learn more about PCHC's many services, providers, and locations, please visit www.PCHC.com. Our mission is to provide comprehensive, integrated primary health care services for all to improve the health and wellbeing of our patients and Maine Communities we serve. We commit not only to building the infrastructure for patient centeredness, but also to embracing the evolution of our personal roles, responsibilities, and attitudes as we shift to a collaborative, team-based model of care, partnered with the patient. We work to integrate community-based resources, family, and health care services in order to promote wellness, manage disease, advocate for helpful public policy, and celebrate successes. We strive to understand the full picture of our patients' lives and all of the factors which impact their wellbeing, to consider those strengths and challenges as we provide care, to understand who they are in their family, workplace and community, and to ask about and listen for what matters most to them. We also commit, on a daily basis, to understand the role of our co-workers, to support each other in those roles, to properly value the contribution that every person makes to our success in fulfilling our mission, to communicate richly, to work together to solve problems and address challenges, and to interact with humor and good nature. We believe that health care is an inherent human right. We share an intellectual and emotional commitment to the care of our patients, which motivates us, sustains us and creates a generosity psychiatry, mental health counseling, geriatrics care and nursing home of spirit as we work together to fulfill our mission. We understand that quality occurs both in medical decision making and in human interaction, and that there is value both in that which we can measure, and in that which relies on our best nature and commitment to serve. We work for continuous improvement, in systems, in the effectiveness and efficiency of our care, in the experience of our patients and in the satisfaction of our team. We seek to challenge ourselves and each other, to innovate and to evaluate our work with humility as we undertake this bold endeavor. We embrace a collaborative spirit as we strive to fulfill our mission, and as we work with partners in our communities and across the state to transform health care. |
| Form 990, Part VI, Section B, line 11b | The Treasurer of the Board initially reviews the 990 return. The Treasurer then reviews the 990 return with the Finance Committee and discusses any issues raised with the Board of Directors. The Chief Financial Officer sends a final draft of the 990 to each Board Member asking them to review and approve at the board meeting or via e-mail. |
| Form 990, Part VI, Section B, line 12c | The Compliance Officer does regular board updates and policy reviews, and a conflict of interest statement is completed annually. |
| Form 990, Part VI, Section B, line 15 | 1. The Compensation Committee: The Executive Committee of the PCHC Board of Directors shall serve as the Compensation Committee. Pursuant to the PCHC's Bylaws, the Executive Committee (and, therefore, the Compensation Committee) shall consist of the following Board members: the Chair, Vice-Chair, Chair of Finance Committee, Chair of Quality Management Committee, and Chair of the Governance/Corporate Compliance Committee. With respect to all compensation levels other than the compensation for the President & CEO, the President & CEO shall serve as ex officio member(s) of the Compensation Committee and shall make recommendations to the committee on appropriate and reasonable compensation levels for the Executives. 2. The Board Chair shall be responsible for leading the review of the compensation package of the President & CEO. The President & CEO shall not participate in the compensation review of his or her own salary. However, the President & CEO may negotiate with respect to compensation level, provided the final review and decision on compensation is made independently by the Compensation Committee. 3. The President/CEO will be responsible for initiating and leading the Compensation Committee in the review of compensation packages for all Executives other than the President & CEO (as defined in the policy). 4. Compensation levels of other key executives shall be approved by the Compensation Committee as the Board's designee. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy and financial statements are maintained in the administrative office and are available to the public during standard business hours. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment: | Section 1.263(a)-3(n) Election: Penobscot Community Health Center 103 Maine Avenue, PO Box 1358 Bangor, ME 04401 EIN: 01-0514750 Section 1.263(a)-3(n) Election: Penobscot Community Health Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
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