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ObjectId: 201402259349300305 - Submission: 2014-08-13
TIN: 01-0263628
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
Attach to Form 990.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public Inspection
Name of the organization
EASTERN MAINE HEALTHCARE SYSTEMS
SEBASTICOOK VALLEY HEALTH
Employer identification number
01-0263628
Part I
Identification of Disregarded Entities
(Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
Part II
Identification of Related Tax-Exempt Organizations
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Restoration Health LLC
43 Whiting Hill Road
Brewer
,
ME
04412
35-2449986
Provide Mental Health & Behavioral hlth
ME
503(c)(3)
9
AHI
Yes
(2)
Sebasticook Valley Work Health LLC
447 North Main Street
Pittsfield
,
ME
04967
45-3359446
Provide Patient Care
ME
501(c)(3)
3
SVH
Yes
(3)
Sebasticook Valley Family Practice Assoc
447 North Main Street
Pittsfield
,
ME
04967
01-0357854
Provide Patient Care
ME
501 (c)(3)
9
SVH
Yes
(4)
Meadow Wood LLC
43 Whiting Hill Road
Brewer
,
ME
04412
27-2935243
Provide Patient Care
ME
501 (c)(3)
9
AHI
Yes
(5)
Blue Hill Memorial Hospital BHMH
57 Water Street
Blue Hill
,
ME
046145231
01-0227195
Provide Healthcare Services
ME
501(c)(3)
3
EMHS
Yes
(6)
ME Institute for Human Genetics & Health
43 Whiting Hill Road
Brewer
,
ME
04412
55-0894346
Biomedical research & development
ME
501(c)(3)
9
EMHS
Yes
(7)
TAMC Title Corp
PO Box 151 140 Academy Street
Presque Isle
,
ME
047690151
01-0389226
Real Estate Holding Company
ME
501(c)(2)
TAMC
Yes
(8)
Eastern Maine HomeCare
PO BOX 688
Caribou
,
ME
04736
01-0328442
Provide Home health & hospice services
ME
501(c)(3)
9
EMHS
Yes
(9)
Horizons Health Services
PO Box 151 140 Academy Street
Presque Isle
,
ME
047690151
01-0504393
Provide Patient Care
ME
501(c)(3)
3
TAMC
Yes
(10)
TAMC Endowments
PO Box 151 140 Academy Street
Presque Isle
,
ME
047690151
01-0389222
Raise funds for exempt organizations
ME
501(c)(3)
11 Type I
TAMC
Yes
(11)
The Aroostook Medical Center TAMC
PO Box 151 140 Academy Street
Presque Isle
,
ME
047690151
01-0372148
Provide healthcare services
ME
501(c)(3)
3
EMHS
Yes
(12)
CADean Memorial Hospital
Pritham Avenue PO Box 1129
Greenville
,
ME
044411129
04-3341666
Provide Healthcare Services
ME
501(c)(3)
3
EMHS
Yes
(13)
Lakewood A Continuing Care Center
220 Kennedy Memorial Drive
Waterville
,
ME
04901
01-0421234
Provide Skilled and long-term nursing care
ME
501(c)(3)
3
Inland Hospital
Yes
(14)
Inland Hospital
200 Kennedy Memorial Drive
Waterville
,
ME
04901
01-0217211
Provide Healthcare Services
ME
501(c)(3)
3
EMHS
Yes
(15)
Norumbega Medical Specialists LTD
43 Whiting Hill Road Ste 400
Brewer
,
ME
04412
01-0465231
Provide Patient care and education
ME
501(c)(3)
9
EMMC
Yes
(16)
EMHS Foundation
43 Whiting Hill Road
Brewer
,
ME
04412
22-2514163
Raise and manage funds for exempt organizations
ME
501(c)(3)
11 Type II
EMHS
Yes
(17)
Acadia Healthcare Inc
43 Whiting Hill Road
Brewer
,
ME
04412
22-3183888
Provide Healthcare Services
ME
503(c)(3)
9
AHC
Yes
(18)
Eastern Maine Medical Center Auxiliary
43 Whiting Hill Road
Brewer
,
ME
04412
01-0377901
Fund raising for exempt Eastern Maine Medical Center
ME
501(c)(3)
9
EMMC
Yes
(19)
Acadia Hospital Corp AHC
43 Whiting Hill Road
Brewer
,
ME
04412
01-0459837
Provide heathcare services
ME
501(c)(3)
3
EMHS
Yes
(20)
Rosscare Nursing Homes Inc
43 Whiting Hill Road
Brewer
,
ME
04412
01-0430751
Operation of Nursing Homes
ME
501(c)(3)
9
Rosscare
Yes
(21)
Rosscare
43 Whiting Hill Road
Brewer
,
ME
04412
01-0391038
provide services to elderly
ME
501(c)(3)
PF
EMHS
Yes
(22)
Eastern Maine Healthcare Real Estate
43 Whiting Hill Road
Brewer
,
ME
04412
01-0391036
leases real estate
ME
501(c)(2)
EMHS
Yes
(23)
Eastern Maine Medical Center EMMC
PO BOX 404 489 State Street
Bangor
,
ME
044020404
01-0211501
Provide Healthcare Services
ME
501(c) (3)
3
EMHS
Yes
(24)
Eastern Maine Healthcare Systems EMHS
43 Whiting Hill Road
Brewer
,
ME
04412
01-0527066
Supporting organization for healthcare affiliates
ME
501 (c)(3)
11 TYPE 111 Func Int
N/A
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Page 2
Schedule R (Form 990) 2012
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
Beacon Health LLC
43 Whitting Hill Road
Brewer
,
ME
04412
45-2967056
Accountable care organization
ME
EMHS
No
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Alliance Health Documentation LLC
9 Central Street jSte 205
Bangor
,
ME
04401
46-2751855
Trnascription
ME
AHS
C
No
(2)
Miller Drug LLC
P O BOX 1179
Bangor
,
ME
044021779
27-2175482
Pharmacy
ME
AHS
C
No
(3)
Dirigo Pines Development Co LLC
9 Alumni Drive
Orono
,
ME
04473
01-0537924
Ret Cottage
ME
AHS
C
No
(4)
Dirigo Funding LLC
9 Alumni Drive
Orono
,
ME
04473
01-0599996
Providing Finance
ME
AHS
C
No
(5)
Dirigo Pines Inn LLC
9 Alumni Drive
Orono
,
ME
04473
02-0547749
Continuing Care
ME
ROSSCARE
C
No
(6)
Dirigo Pines REtirement Community LLC
9 Alumni Drive
Orono
,
ME
04473
01-0537924
Holding Co
ME
AHS
C
No
(7)
Maine Network for Health
PO BOX 2813
Bangor
,
ME
044022813
01-0496352
Support Service
ME
EHMS
C
No
(8)
Meridian Mobile Health LLC
931 Union Street PO Box 940
Bangor
,
ME
044020940
01-0512673
Ambulance
ME
AHS
C
No
(9)
DE Collections dba Affiliated Collection
PO BOX 2759
Bangor
,
ME
044022759
01-0366209
Collections
ME
AHS
C
No
(10)
Affiliated Pharmacy Services
917 Union Street Suite 7
Bangor
,
ME
04401
01-0587230
Pharmacy
ME
AHS
C
No
(11)
Affiliated Materiel Services
PO BOX 1300
Bangor
,
ME
044021300
01-0381189
purchasing
ME
AHS
C
No
(12)
Affiliated Laboratory Inc
POBOX 638
Bangor
,
ME
044020638
01-0381283
Clinical Lab
ME
AHS
C
No
(13)
Affiliated Healthcare Management
PO BOX 811
Bangor
,
ME
044020811
01-0349339
Healthcare Management
ME
AHS
C
No
(14)
Affiliated Healthcare Systems AHS
P O BOX 940
Bangor
,
ME
044020940
01-0385322
Holding Co.
ME
EMHS
C
No
Schedule R (Form 990) 2012
Page 3
Schedule R (Form 990) 2012
Page
3
Part V
Transactions With Related Organizations
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest
(ii)
annuities
(iii)
royalties or
(iv)
rent from a controlled entity
.
.
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1a
No
b
Gift, grant, or capital contribution to related organization(s)
.
.
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1b
No
c
Gift, grant, or capital contribution from related organization(s)
.
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1c
No
d
Loans or loan guarantees to or for related organization(s)
.
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1d
No
e
Loans or loan guarantees by related organization(s)
.
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1e
No
f
Dividends from related organization(s)
.
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1f
No
g
Sale of assets to related organization(s)
.
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1g
No
h
Purchase of assets from related organization(s)
.
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1h
No
i
Exchange of assets with related organization(s)
.
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1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.
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1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
.
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1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.
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1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.
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1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
.
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1n
No
o
Sharing of paid employees with related organization(s)
.
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1o
No
p
Reimbursement paid to related organization(s) for expenses
.
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.
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
.
.
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1q
No
r
Other transfer of cash or property to related organization(s)
.
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1r
Yes
s
Other transfer of cash or property from related organization(s)
.
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1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
Alliance Health Documentation LLC
m
63,282
FMV
(2)
Affiliated Materiel Services
p
543,176
FMV
(3)
Affiliated Laboratory Inc
m
245,952
FMV
(4)
Affiliated Healthcare Management
m
243,773
FMV
(5)
Sebasticook Valley Work Health LLC
r
218,157
FMV
(6)
Sebasticook Valley Work Health LLC
l
58,528
FMV
(7)
Inland Hospital
m
127,783
FMV
(8)
EMHS Foundation
m
149,400
FMV
(9)
Eastern Maine Medical Center EMMC
m
496,576
FMV
(10)
Eastern Maine Healthcare Systems EMHS
r
260,503
FMV
(11)
Eastern Maine Healthcare Systems EMHS
p
2,816,854
FMV
(12)
Eastern Maine Healthcare Systems EMHS
m
443,344
FMV
Schedule R (Form 990) 2012
Page 4
Schedule R (Form 990) 2012
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
(Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2012
Page 5
Schedule R (Form 990) 2012
Page
5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier
Return Reference
Explanation
Additional Data
Software ID:
12000229
Software Version:
2012v2.0