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ObjectId: 202322149349301352 - Submission: 2023-08-02
TIN: 01-0496221
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
Name of the organization
Mid Coast Geriatric Services Corporation
Employer identification number
01-0496221
Part I
Identification of Disregarded Entities.
Complete if the organization answered "Yes" on 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" on 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)
MaineHealth Services
110 Free Street
Portland
,
ME
04101
01-0431680
Healthcare
ME
501(c)(3)
Line 12c, III-FI
N/A
Yes
(2)
MaineHealth
22 Bramhall Street
Portland
,
ME
04102
01-0238552
Hospital
ME
501(c)(3)
Line 3
MaineHealth Services
Yes
(3)
St Joseph's Rehabilitation & Residence
1133 Washington Avenue
Portland
,
ME
04103
01-0339489
Nursing home
ME
501(c)(3)
Line 10
MaineHealth
Yes
(4)
Maine Medical Center Realty Corp
22 Bramhall Street
Portland
,
ME
04102
01-0434215
Property management
ME
501(c)(3)
Line 12a, I
MaineHealth
Yes
(5)
LincolnHealth Cove's Edge
35 Miles Street
Damariscotta
,
ME
04543
01-0382340
Healthcare
ME
501(c)(3)
Line 3
MaineHealth
Yes
(6)
LincolnHealth Medical Partners Inc
35 Miles Street
Damariscotta
,
ME
04543
26-3878235
Physicians practices
ME
501(c)(3)
Line 7
MaineHealth
Yes
(7)
Healthy Community Coalition Inc
105 Mt Blue Circle
Farmington
,
ME
04938
22-3305743
Community services
ME
501(c)(3)
Line 7
MaineHealth
Yes
(8)
Western Maine Multi-Medical Specialists
181 Main Street
Norway
,
ME
04268
01-0489824
Physician practices
ME
501(c)(3)
Line 10
MaineHealth
Yes
(9)
Western Maine Nursing Home Inc
181 Main Street
Norway
,
ME
04268
22-2842655
Nursing home
ME
501(c)(3)
Line 10
MaineHealth
Yes
(10)
Quarry Hill
4 White Street
Rockland
,
ME
04841
01-0213976
Long term care
ME
501(c)(3)
Line 7
MaineHealth
Yes
(11)
Community Health and Nursing Services
60 Baribeau Drive
Brunswick
,
ME
04011
01-0211546
Home health
ME
501(c)(3)
Line 10
MaineHealth
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Page 2
Schedule R (Form 990) 2021
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on 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
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust.
Complete if the organization answered "Yes" on 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)
Maine Medical Partners
22 Bramhall Street
Portland
,
ME
04102
01-0442142
Healthcare
ME
N/A
C
No
(2)
Waldo County Healthcare Mgmt Co
PO Box 287
Belfast
,
ME
04915
01-0485133
Management services
ME
N/A
C
No
(3)
PBH Management Company
PO Box 287
Belfast
,
ME
04915
01-0537278
Management services
ME
N/A
C
No
(4)
Midcoast Health Management Corp
123 Medical Center Drive
Brunswick
,
ME
04011
01-0429598
Management services
ME
N/A
C
No
(5)
Mid Coast Medical Group
123 Medical Center Drive
Brunswick
,
ME
04011
01-0484592
Management services
ME
N/A
C
No
(6)
Thornton Oaks Development Corp
123 Medical Center Drive
Brunswick
,
ME
04011
01-0448411
Management services
ME
N/A
C
No
Schedule R (Form 990) 2021
Page 3
Schedule R (Form 990) 2021
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on 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
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
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 related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
Schedule R (Form 990) 2021
Page 4
Schedule R (Form 990) 2021
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on 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 sections 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) 2021
Page 5
Schedule R (Form 990) 2021
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference
Explanation
Schedule R (Form 990) 2021
Additional Data
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