TY 2012 Form 990 Schedule O

efile Public Visual Render ObjectId: 201421299349302587 - Submission: 2014-05-09 TIN: 01-0518516

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 to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

LifeFlight of Maine

Employer identification number

01-0518516

Identifier	Return Reference	Explanation
	Form 990, Part VI, Section A, line 3	LifeFlight of Maine (LOM) has entered into an administrative and management services contract with Affiliated Healthcare Management (AHM) under which AHM provides LOM with executive management, financial support, and marketing and fundraising support services. Thomas Judge, Executive Director of both LOM and LifeFlight Foundation (LFF), received $171,477 during the 2012 tax year as compensation and benefits from AHM for the services he provided to both LOM and LFF. LOM reimbursed AHM for Mr. Judge's services provided to both entities: LOM in the amount of $114,318 and LFF in the amount of $57,159.
	Form 990, Part VI, Section A, line 6	The Organization is owned 50% by Central Maine Healthcare Corporation (CMHC) and 50% by Eastern Maine Healthcare Systems (EMHS).
	Form 990, Part VI, Section A, line 7a	LifeFlight of Maine's membership is held 50% by Eastern Maine Healthcare Systems and 50% by Central Maine Healthcare Corporation. Each of the two members are represented by three voting representatives from their respective organizations for the governing body.
	Form 990, Part VI, Section A, line 8b	The Organization does not have any committees with authority to act on behalf of the governing body.
	Form 990, Part VI, Section B, line 11	Prior to filing Form 990, a copy is provided to the Steering Committee to review.
	Form 990, Part VI, Section B, line 12c	In 2012 LifeFlight of Maine implemented a policy which indicates that the Steering Committee members need to annually disclose any conflicts of interest.
	Form 990, Part VI, Section C, line 19	The Organization makes its governing documents and financial statements available upon request.
Other Fees	Form 990, Part IX, line 11g	Pilots and Mechanics: Program service expenses 1,306,871. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,306,871. Air transportation: Program service expenses 1,268,268. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,268,268. Medical services: Program service expenses 997,884. Management and general expenses 0. Fundraising expenses 0. Total expenses 997,884. Billing and IS services: Program service expenses 92,669. Management and general expenses 11,191. Fundraising expenses 0. Total expenses 103,860. Professional Fees: Program service expenses 0. Management and general expenses 0. Fundraising expenses 296,177. Total expenses 296,177.
Changes in Net Assets or Fund Balances:	Form 990, Part XI, line 9:	Change in Net Assets of Financially Interrelated Organization -82,326. Change in Fair Value of Interest Rate Swaps 54,364.
Employee policies	Form 990, Part VI, Section B, Lines 13 and 15:	The Organization does not have employees.

Identifier

Return Reference

Explanation

Form 990, Part VI, Section A, line 3

LifeFlight of Maine (LOM) has entered into an administrative and management services contract with Affiliated Healthcare Management (AHM) under which AHM provides LOM with executive management, financial support, and marketing and fundraising support services. Thomas Judge, Executive Director of both LOM and LifeFlight Foundation (LFF), received $171,477 during the 2012 tax year as compensation and benefits from AHM for the services he provided to both LOM and LFF. LOM reimbursed AHM for Mr. Judge's services provided to both entities: LOM in the amount of $114,318 and LFF in the amount of $57,159.

Form 990, Part VI, Section A, line 6

The Organization is owned 50% by Central Maine Healthcare Corporation (CMHC) and 50% by Eastern Maine Healthcare Systems (EMHS).

Form 990, Part VI, Section A, line 7a

LifeFlight of Maine's membership is held 50% by Eastern Maine Healthcare Systems and 50% by Central Maine Healthcare Corporation. Each of the two members are represented by three voting representatives from their respective organizations for the governing body.

Form 990, Part VI, Section A, line 8b

The Organization does not have any committees with authority to act on behalf of the governing body.

Form 990, Part VI, Section B, line 11

Prior to filing Form 990, a copy is provided to the Steering Committee to review.

Form 990, Part VI, Section B, line 12c

In 2012 LifeFlight of Maine implemented a policy which indicates that the Steering Committee members need to annually disclose any conflicts of interest.

Form 990, Part VI, Section C, line 19

The Organization makes its governing documents and financial statements available upon request.

Other Fees

Form 990, Part IX, line 11g

Pilots and Mechanics: Program service expenses 1,306,871. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,306,871. Air transportation: Program service expenses 1,268,268. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,268,268. Medical services: Program service expenses 997,884. Management and general expenses 0. Fundraising expenses 0. Total expenses 997,884. Billing and IS services: Program service expenses 92,669. Management and general expenses 11,191. Fundraising expenses 0. Total expenses 103,860. Professional Fees: Program service expenses 0. Management and general expenses 0. Fundraising expenses 296,177. Total expenses 296,177.

Changes in Net Assets or Fund Balances:

Form 990, Part XI, line 9:

Change in Net Assets of Financially Interrelated Organization -82,326. Change in Fair Value of Interest Rate Swaps 54,364.

Employee policies

Form 990, Part VI, Section B, Lines 13 and 15:

The Organization does not have employees.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

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