2024-11-13T09:34:15-06:00 2023-12-31 010494526 Baker Newman & Noyes 650 Elm Street Suite 302 Manchester NH 03101 990 2023-01-01 010409788 Community Clinical Services Inc COMM 2075133897 Campus Avenue PO Box 7291 Lewiston ME 042407291 Coleen Elias CEO 2075133897 2024-11-05 1 0 Connor Smart P02285543 6036262200 2024-11-05 2023 2024-10-15 13:58:12Z Coleen Elias Campus Avenue PO Box 7291 Lewiston ME 042407291 15458049 0 X www.communityclinicalservices.com X 1984 ME Federally qualified health center providing quality primary and specialty care. 9 8 128 9 0 0 2742160 2104033 12841516 13351740 3049 -838 0 0 15586725 15454935 0 0 0 0 9096658 10003794 0 0 0 5967279 5159724 15063937 15163518 522788 291417 3831038 4166949 1410436 1578799 2420602 2588150 X Community Clinical Services is committed to improve the health and well-being of our community through patient-centered care, advocacy, and community engagement. 0 0 6189055 0 3871167 Family Practice: Medical care for infants, children, and adults. The Organization received 16,703 medical visits in 2023 for family practices. 4205815 0 3685311 Behavioral Medicine: Psychiatric care for children and adults. The Organization received 28,076 pyschiatry visits in 2023 for behavioral medicine. 1791782 0 2584097 Outpatient Counseling: Counseling services for children and adults. The Organization received 11,317 visits in 2023 for outpatient counseling. 1938428 0 3211165 Other program services offered by Community Clinical Services Inc. include dental care and dental services (of which there were 3,836 visits in 2023), care management, 340B pharmacy programs, and electronic handbook and meaningful-use incentive programs. 1938428 0 3211165 14125080 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 8 0 1 128 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 ME X X Coleen Elias CEO 2075133897 57 Birch Street Lewiston ME 04240 Paige Hagerstrom Director 0.30 40.00 X 0 205387 33181 Elizabeth Keene Director (end 12/2023) 0.30 40.00 X 0 138504 29910 Abdi Abdalla Director 0.30 0.00 X 0 0 0 Amanda Karomba Director 0.30 0.00 X 0 0 0 Nathan Miller Director (end 1/2023) 0.30 0.00 X 0 0 0 Abdulerim Said Director 0.30 0.00 X 0 0 0 Lynn Ward Chair 0.50 0.00 X X 0 0 0 Hawo Abille Vice Chair 0.30 0.00 X X 0 0 0 Laura Gormley Treasurer 0.50 0.00 X X 0 0 0 Frances Rodgers Secretary (end 3/2023) 0.30 0.00 X X 0 0 0 Andrew Lunn Secretary 0.30 0.00 X X 0 0 0 Coleen Elias CEO 40.00 0.00 X 146379 0 24431 John Melehov CFO, CCS (part year) 40.00 0.00 X 96585 0 2993 Joseph Marino CFO & Treasurer, SMHS Lewiston 0.00 40.30 X 0 221387 2328 Megan Brewer MD CMO 40.00 0.00 X 253709 0 7598 Donna Martinez Director CCS Behavioral Health 40.00 0.00 X 119197 0 26941 Syed Fahd MD Physician 40.00 0.00 X 289847 0 22736 Jonathan Libby NP Nurse Practitioner 40.00 0.00 X 131605 0 14931 Tyler Gagnon MD Physician 40.00 0.00 X 158933 0 11855 Daniel Strauss NP Nurse Practitioner 40.00 0.00 X 123221 0 39110 1319476 565278 216014 11 0 1 0 St Mary's Regional Med Ctr 93 Campus Avenue PO Box 7291 Lewiston ME 04243 Inter-Company Purchased Services 2545021 1 2006033 98000 2104033 Patient services 621110 13351740 13351740 13351740 1438 1438 838 3114 -2276 -2276 -2276 15454935 13351740 0 -838 X 531695 518585 13110 7541096 7357847 183249 147342 142963 4379 1209138 1173202 35936 574523 557448 17075 2272 2272 63975 63975 3715672 3306948 408724 266076 182196 83880 34421 23570 10851 324273 222046 102227 20088 13755 6333 6924 4741 2183 10952 10952 160539 72243 88296 Provision for bad debts 302179 302179 Drugs/medical supplies 236133 236133 Minor equipment/repairs 15848 10852 4996 Food and dining 372 372 15163518 14125080 1038438 0 1496306 3076423 545431 170336 807734 655167 18508 18508 7945 900 234326 177247 59307 57079 41539 44557 854268 143979 3831038 4166949 748275 584227 5027 176799 657134 817773 1410436 1578799 X 1875171 2587824 545431 326 2420602 2588150 3831038 4166949 X 291417 236 -124105 X X 0 1 X 1 1 1 X 1637184 484613 2380483 2742160 2104033 9348473 13002774 11722281 12921440 12841516 13351740 63839751 14639958 12206894 15301923 15583676 15455773 73188224 1502827 1502827 0 1502827 1502827 71685397 1214 984 750 825 1438 5211 1214 984 750 825 1438 5211 14641172 12207878 15302673 15584501 15457211 73193435 0.97940 0.96010 0.00010 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 8000 0 0 0 8000 0 Part II-B, Line 1: Part II-B, Line 1f: Community Clinical Servics, Inc. ("CCS") partners with various like-minded professional associations which support public policies and initiatives that focus on improving health outcomes and the experience of health care, while also aiming to reduce the overall cost of receiving that care. One such membership-association is the Maine Primary Care Association. To maintain this partnership, CCS pays membership dues back to the Association. A portion of the dues paid to the Association have been designated as available for lobbying expenditures (in 2023, the portion eligible for lobbying purposes has been deemed to be up to 80% of total dues paid). Any lobbying expenditures paid by the Association is incurred to help track and discuss legislation affecting health care policy on behalf of its members. The specific dues paid by CCS to association in 2023, as well as the portion of those dues that were estimated to be available for lobbying expenditures, are detailed below: Maine Primary Care Association - Total 2023 dues: $10,000 - Portion of dues available for lobbying: $8,000 79179 -79179 0.00000 0.00000 0.00000 54858 32892 21966 170170 144355 25815 9298 9298 57079 Due to affiliates 817773 817773 X Part V, Line 4: In its 2019 tax year, the Organization determined that its restricted investment holdings, which were previously designated as endowment funds on Schedule D, Part V, did not meet the terms and definitions of endowment funds as provided in IRS Guidance and the Form 990 instructions. Accordingly, the Organization's 2019 ending balance for endowment funds was corrected to an appropriate zero-value. This continues to be the case in 2020; the figures reported on Schedule D, Part V have been maintained only to reflect the carryforward of the Organization's historic filings. Temporarily restricted funds continue to be reported separately on Form 990, Part X, Line 28. Restricted net assets, as were previously reported as endowment funds, are largely composed of restricted grants used to provide housing solutions to elderly, ill, or disenfranchised persons. Part X, Line 2: Covenant and its member organizations are considered not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code, except as noted below. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The System has evaluated the position taken on its filed tax returns. The System has concluded no uncertain income tax positions exist at December 31, 2023. X X X X 1 0 0 0 0 0 0 0 0 Syed Fahd MD Physician 289414 0 0 0 433 0 5193 0 17543 0 312583 0 0 0 Megan Brewer MD CMO 253381 0 0 0 328 0 5073 0 2525 0 261307 0 0 0 Paige Hagerstrom Director 0 205062 0 0 0 325 0 6396 0 26785 0 238568 0 0 Joseph Marino CFO & Treasurer, SMHS Lewiston 0 220007 0 0 0 1380 0 1500 0 828 0 223715 0 0 Coleen Elias CEO 146204 0 0 0 175 0 2884 0 21547 0 170810 0 0 0 Tyler Gagnon MD Physician 141466 0 0 0 17467 0 2137 0 9718 0 170788 0 0 0 Elizabeth Keene Director (end 12/2023) 0 137181 0 0 0 1323 0 4143 0 25767 0 168414 0 0 Daniel Strauss NP Nurse Practitioner 123063 0 0 0 158 0 3976 0 35134 0 162331 0 0 0 Part I, Line 3 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Form 990, Part VI, Section A, line 6 St. Mary's Health System is the sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a The Organization's Board of Directors consists of Class A and Class B Directors. As the sole corporate member of the Organization, St. Mary's Health System shall appoint Class B Directors of the Board. Class A directors are appointed by a majority vote of all board members, including the Class B directors that are directly appointed by St. Mary's Health System. Additionally, as the sole Corporate Member, St. Mary's Health System also holds the following powers over the Organization's governing body: 1. Any Director appointed by the Corporate Member may be removed at any time from such position at any time by the Corporate Member with or without cause. 2. A vacancy due to death, resignation, removal, or otherwise of any Director appointed by the Corporate Member shall be filled by the Corporate Member until the position which was vacated has been permanently filled in accordance with the procedures for election and appointment of new Directors as outlined in the Organization's bylaws. Form 990, Part VI, Section A, line 7b As the sole corporate member of the Organization, St. Mary's Health System has the following powers and rights over the Organization as outlined in the Organization's bylaws: 1. The Corporate Member shall act in a stewardship capacity to assure that all actions of the Corporation are consistent with the purpose of the Corporation and the philosophy and ethical and religious principles of the Roman Catholic Church. 2. The Corporate Member shall interpret the Ethical and Religious Directives for Catholic Health Care Services applicable to the Corporation and with respect to the services and programs offered directly by the Corporation. Should the Corporate Member determine that services or programs of the Corporation are inconsistent with the Directives, it shall specify to the Corporation the way in which it determines such inconsistency, and the Corporate Member and the Corporation shall work together to ensure that the method of delivery of such services or programs are conducted in a manner that is consistent with the Directives. Notwithstanding the foregoing, the Corporate Member may not infringe on any aspect of the Corporation's provision of services or programs necessary to remain compliant with Federal and/or State laws, regulations or related policies, including Section 330 of the Public Health Service Act and Community Health Center Program Expectations as amended from time to time. 3. The Corporate Member shall act in accordance with its own bylaws by executing and delivering to the Secretary of the corporation a written instrument signed by an authorized officer of the Corporate Member setting forth the action taken and the date of action taken by the Corporate Member, which may be a Secretary's Certificate of the action taken by the Corporate Member. The action of the Corporate Member shall be deemed to have been taken on the dates such written instruments are so delivered, unless the instruments provide otherwise 4. Special Meetings of the Corporate Member shall be held whenever called by: (1) the Corporate Member; or (2) when requested by the Chairperson at the request of a majority of the Directors of the Corporation. 5. The presence of the duly designated representative of the Corporate Member, in person or by proxy, shall constitute a quorum for the transaction of business at all Meetings of the Corporate Member. 6. The Corporate Member may designate a new fiscal year for the Organization. Form 990, Part VI, Section B, line 11b The Form 990 is provided to the governing body for their review and approval prior to filing. Form 990, Part VI, Section B, line 12c This process is the responsibility of the Compliance Officer. A conflict of interest disclosure form is submitted to all leadership, board members, board committee members, employed physicians, medical directors and certain employees in key positions annually to be completed. Reminders are sent to all persons of interest to ensure that all conflict of interest disclosure forms are completed and collected. Form 990, Part VI, Section B, line 15 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Form 990, Part VI, Section C, line 19 The Organization's Form 990, governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The Organization's Form 990 is also made available on the website of its parent organization, Covenant Health, at the following web address: https://www.covenanthealth.net/financials Form 990, Part IX, line 11g Purchased medical and physician services: Program service expenses 1,842,290. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,842,290. Administrative and other fees: Program service expenses 1,464,658. Management and general expenses 408,724. Fundraising expenses 0. Total expenses 1,873,382. Form 990, Part XI, line 9: Valuation adjustment in restricted net assets -124,105. Form 990, Part XII, Line 2c: The audit process has not changed from the previous year. Alternative Health Services 360 Broadway Bangor ME 04402 010422885 Home health and hospice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 Bangor Nursing and Rehabilitation Center 103 Texas Avenue Bangor ME 04401 010538534 Long-term care nursing facility ME 501(c)(3) Line 10 Covenant Health Inc 0 CHS of Waltham Inc dba Maristhill Nursing & Rehab Center 66 Newton Street Waltham MA 02453 043333609 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 CHS of Worcester Inc dba St Mary Care Center 39 Queen Street Worchester MA 01610 043419625 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Covenant Health Foundation Inc 40 Shattuck Road Suite 317 Andover MA 01810 800199674 Charitable foundation MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Investment Trust 40 Shattuck Road Suite 317 Andover MA 01810 046835128 Investment trust MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Inc 40 Shattuck Road Suite 317 Andover MA 01810 222484505 Health care management and resource organization MA 501(c)(3) Line 10 N/A 0 Fanny Allen Corporation Inc 40 Shattuck Road Suite 317 Andover MA 01810 222495808 Charitable foundation VT 501(c)(3) Line 12a, I Covenant Health Inc 0 Fanny Allen Holdings Inc 40 Shattuck Road Suite 317 Andover MA 01810 030181052 Real estate holding company VT 501(c)(3) Line 12a, I Covenant Health Inc 0 Helping Hands of St Marguerite Inc 799 Concord Avenue Cambridge MA 02138 800199674 Private home-care health services MA 501(c)(3) Line 10 Covenant Health Inc 0 M & J Company 360 Broadway Bangor ME 04402 222480150 Lease holding company ME 501(c)(2) St Joseph Healthcare Foundation 0 Mary Immaculate Guild Inc 172 Lawrence Street Lawrence MA 01841 463073987 Supporting grants and donations MA 501(c)(3) Line 12a, I Covenant Health Inc 0 MI Adult Day Health Care Center Inc 189 Maple Street Lawrence MA 01841 042921888 Adult day care services MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Management Inc 172 Lawrence Street Lawrence MA 01841 042857794 Assisted living services MA 501(c)(3) Line 12a, I Covenant Health Inc 0 MI Nursing Restorative Center Inc 172 Lawrence Street Lawrence MA 01841 042104851 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Residential Community Inc 189 Maple Street Lawrence MA 01841 042647207 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Transportation Inc 189 Maple Street Lawrence MA 01841 042921889 Elderly transportation services MA 501(c)(3) Line 10 Covenant Health Inc 0 Mount St Rita Health Centre 15 Sumner Brown Road Cumberland RI 02864 050342330 Nursing home RI 501(c)(3) Line 10 Covenant Health Inc 0 Neighborhood Housing Initiative PO Box 7291 Lewiston ME 04243 010539730 Affordable housing services ME 501(c)(3) Line 10 St Mary's Health System 0 Penacook Place Inc 150 Water Street Haverhill MA 01830 237090088 Nursing home MA 501(c)(3) Line 10 Covenant Health Inc 0 Souhegan Nursing Association 24 North River Road Milford NH 03055 020222795 Home health and hospice NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 St Joseph Ambulatory Care Inc 360 Broadway Bangor ME 04402 222480373 Physician practice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 St Andre Health Care 407 Pool Street Biddeford ME 04005 010342399 Nursing home and restorative facility ME 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Healthcare Foundation 360 Broadway Bangor ME 04402 222480149 Healthcare foundation ME 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Hospital 360 Broadway Bangor ME 04402 010212435 Hospital and health care facility ME 501(c)(3) Line 3 St Joseph Healthcare Foundation 0 St Joseph Manor Health Care 215 Thatcher Street Brockton MA 02302 042565937 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph's Hospital of Nashua NH Inc 172 Kinsley Street Nashua NH 03061 020222215 Hospital and health care facility NH 501(c)(3) Line 3 Covenant Health Inc 0 St Mary's D'Youville Pavilion PO Box 7291 Lewiston ME 04243 010211558 Nursing home and restorative facility ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's Health System PO Box 7291 Lewiston ME 04243 222504349 Hospital and health care facility ME 501(c)(3) Line 12a, I Covenant Health Inc 0 St Mary's Regional Medical Center PO Box 7291 Lewiston ME 04243 010211551 Hospital and health care facility ME 501(c)(3) Line 3 St Mary's Health System 0 St Mary's Residences PO Box 7291 Lewiston ME 04243 222504356 Low income housing ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's Villa Nursing Home Inc 675 St Marys Villa Road Moscow PA 18444 232057177 Nursing home and restorative facility PA 501(c)(3) Line 10 Covenant Health Inc 0 The Surgicenter at St Joseph Hospital Inc 172 Kinsley Street Nashua NH 03061 020222215 Healthcare and surgery center NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 Youville Hospital and Rehabilitation Center Inc 1575 Cambridge Street Cambridge MA 02138 043239563 Hospital and health care facility MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville House Inc 1573 Cambridge Street Cambridge MA 02138 043239593 Assisted living services MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville Lifecare Inc 1575 Cambridge Street Cambridge MA 02138 042103582 Hospital and health care facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Youville Place 10 Pelham Road Lexington MA 02421 043297834 Assisted living services MA 501(c)(3) Line 10 Covenant Health Inc 0 Campus Holding PO Box 7291 Lewiston ME 04240 010406049 Holding company ME N/A C 0 Covenant Health Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ N/A C 0 GNM Corporation 172 Kinsley Street Nashua NH 03060 020400550 Real estate holding company NH N/A C 0 SJ Physicians Services 172 Kinsley Street Nashua NH 03060 020522234 Physician practice NH N/A C 0 St Joseph Corporate Services Inc 172 Kinsley Street Nashua NH 03060 020405197 Holding company NH N/A C 0 Strauss Incorporated 360 Broadway Bangor ME 04402 010391369 Repairs and transcriptions ME N/A C 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0