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ObjectId: 202040349349200779 - Submission: 2020-02-03
TIN: 01-0513301
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SCHEDULE N
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution, or Significant Disposition of Assets
Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
Attach certified copies of any articles of dissolution, resolutions, or plans.
Attach to Form 990 or 990-EZ.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
18
Open to Public
Inspection
Name of the organization
Cancer Community Center
Employer identification number
01-0513301
Part I
Liquidation, Termination, or Dissolution.
Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.
1
(a)
Description of asset(s)
distributed or transaction
expenses paid
(b)
Date of
distribution
(c)
Fair market value of
asset(s) distributed or
amount of transaction
expenses
(d)
Method of
determining FMV for
asset(s) distributed or
transaction expenses
(e)
EIN of recipient
(f)
Name and address of recipient
(g)
IRC section
of recipient(s) (if
tax-exempt) or type
of entity
Cash equivalents after final collections; immaterial general-use assets and equipment.
03-31-2019
104,919
Cash equivalent value; net book value
82-1547129
Dempsey Centers for Quality Cancer Care Inc
29 Lowell Street Floor 5
Lewiston
,
ME
04240
501(c)(3)
Publicly traded securities and investments, which were transferred in full at the time of the merger.
03-31-2019
1,889,106
Active marketplace fair market value
82-1547129
Dempsey Centers for Quality Cancer Care Inc
29 Lowell Street Floor 5
Lewiston
,
ME
04240
501(c)(3)
Book value of outstanding payables and debts, settled at the time of the merger.
03-31-2019
43,094
Net book value.
82-1547129
Dempsey Centers for Quality Cancer Care Inc
29 Lowell Street Floor 5
Lewiston
,
ME
04240
501(c)(3)
Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization?
.........................
2a
Yes
b
Become an employee of, or independent contractor for, a successor or transferee organization?
.....................
2b
c
Become a direct or indirect owner of a successor or transferee organization?
.....................
2c
No
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution?
........
2d
Yes
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
Cat. No. 50087Z
Schedule N (Form 990 or 990-EZ) (2018)
Page 2
Schedule N (Form 990 or 990-EZ) (2018)
Page
2
Part I
Liquidation, Termination, or Dissolution
(continued)
Note.
If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.
Yes
No
3
Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III
.............
3
Yes
4a
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate?
......
4a
Yes
b
If "Yes," did the organization provide such notice?
.....................
4b
Yes
5
Did the organization discharge or pay all of its liabilities in accordance with state laws?
.....................
5
Yes
6a
Did the organization have any tax-exempt bonds outstanding during the year?
.....................
6a
No
b
If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?
6b
c
If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.
Part II
Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets.
Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.
1
(a)
Description of asset(s)
distributed or transaction
expenses paid
(b)
Date of
distribution
(c)
Fair market value of
asset(s) distributed or
amount of transaction
expenses
(d)
Method of
determining FMV for
asset(s) distributed or
transaction expenses
(e)
EIN of recipient
(f)
Name and address of recipient
(g)
IRC section
of recipient(s) (if
tax-exempt) or type
of entity
Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization?
.........................
2a
Yes
b
Become an employee of, or independent contractor for, a successor or transferee organization?
.....................
2b
c
Become a direct or indirect owner of a successor or transferee organization?
.....................
2c
No
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution?
........
2d
Yes
e
If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
Cat. No. 50087Z
Schedule N (Form 990 or 990-EZ) (2018)
Page 3
Schedule N (Form 990 or 990-EZ) (2018)
Page
3
Part III
Supplemental Information.
Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.
Return Reference
Explanation
Part I, Line 2e:
Person(s) Involved: Schedule N, Part I, Line 2a: William Williams, President; Margaret Coughlin Page, Vice President; Timothy Griffin, Treasurer; Karen Bradbury, MemberSchedule N, Part I, Line 2d: Nicole Avery, Executive Director
Part I, Line 2e:
Explanation of Involvement: Schedule N, Part I, Line 2a Explanation:In June of 2018, the Cancer Community Center filed official Articles of Merger with the State of Maine to consolidate and merge its operations and assets into the Dempsey Centers for Quality Cancer Care, Inc. As a result of the merger, a number of individuals who served on the Board of Directors for the Cancer Community Center became board members of the Dempsey Centers for Quality Cancer Care. These individuals, and their respective positions both before and after the merger, are detailed below.William WilliamsCancer Community Center Position: PresidentDempsey Center Position: PresidentMargaret Coughlin PageCancer Community Center Position: Vice PresidentDempsey Center Position: Board MemberTimothy GriffinCancer Community Center Position: TreasurerDempsey Center Position: Vice PresidentKaren BradburyCancer Community Center Position: Board MemberDempsey Center Position: Officer, Chair of GovernanceSchedule N, Part I, Line 2d Explanation:Prior to the merger, Nicole Avery served the Cancer Community Center as its Executive Director. Once the merger was finalized, Nicole Avery left her position as Executive Director within the broader organization and received a severance payment in the amount of $50,500 on June 27, 2018. The $50,500 severance payment was included in Nicole Avery's 2018 Form W-2. Ms. Avery did not receive any additional compensation after the merger and receipt of her severance payment.
Schedule N (Form 990 or 990-EZ) (2018)
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