2024-11-12T11:06:00-06:00 2023-12-31 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th Floor Manchester NH 03101 990 2023-01-01 881355865 PCHC Belfast QALICB Inc PCHC 2079929200 103 Maine Avenue Bangor ME 04401 Christopher Linder Treasurer 2079929200 2024-11-09 1 1 Melissa Magoon CPA P01712842 6036697337 2024-11-09 2023 2024-10-15 13:58:12Z X Christopher Linder 103 Maine Avenue Bangor ME 04401 176768 0 X N/A X 2022 ME The purpose of PCHC Belfast QALICB, Inc. is to support the activities of Penobscot Community Health Center. 5 5 0 5 0 0 176768 0 0 0 176768 0 0 0 0 0 0 0 176768 8602511 8425743 176768 The purpose of PCHC Belfast QALICB, Inc. is to support the activities of Penobscot Community Health Center. 0 0 The purpose of PCHC Belfast QALICB, Inc. is to support the activities of Penobscot Community Health Center. 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 ME X Christine McLaughlin 2079929200 103 Maine Avenue Bangor ME 04401 X Brian King Chair 1.00 0.00 X X 0 0 0 Elisha Hardy Vice Chair 1.00 0.00 X X 0 0 0 Dorothy Havey Secretary 1.00 0.00 X X 0 0 0 Christopher Linder Treasurer 1.00 1.00 X X 0 0 0 Shelly Okere Director 1.00 1.00 X 0 0 0 0 0 0 0 0 0 0 0 176768 176768 176768 176768 0 0 0 0 0 0 0 X 4152811 4449700 0 4449700 0 8602511 8425743 0 8425743 X 176768 0 176768 0 8602511 176768 0 X 0 1 X 1 1 1 X X 1 Penobscot Community Health Center 010514750 10 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 Section E, line 2b Without PCHC Belfast QALICB, Inc. participation, PCHC would not be able to participate in the NMTC financing of the Project and would finance the debt incurred by the construction through means that are less beneficial to the PCHC Section E, line 2a Penobscot Community Health Center, 103 Main Avenue, Bangor, ME 04401, EIN: 01-0514750 PCHC Belfast QALICB, Inc. will participate in a NMTC transaction to allow the Penobscot Community Health Center to finance the construction and development of a behavioral health care center. Section D, Line 3 Shelly Okere is a Director of the PCHC Belfast QALICB, Inc (the Organization) and is the Vice Chair of PCHC (the Sponsor). Christopher Linder is the Treasurer of the Organization and is the Finance Chair of the Sponsor. The Organization was formed at the direction of the Sponsor as a supporting organization for the Sponsor in order to facilitate financing for the Project. Thus, communications, both formal and informal, between the Organization and the Sponsor occur daily and are ongoing. These communications include discussions on the Organization investment policies, the making and timing of grants and directing the use of income and assets. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4449700 4449700 4449700 X Property and Equipment 0 176768 FMV 0 0 0 0 Form 990, Part VI, Section B, line 11b The 990 will be shared by the Treasurer, outlining the filing, to all board members and ask for an email vote to file the Form 990. Form 990, Part VI, Section B, line 12c Annually the Board of Directors are required to complete the Conflict of Interest form disclosing any affiliations with any actual or potential Company grantee or borrower or any other organization with which the Company may have a financial relations and the affiliation of persons with whom you have a close relationship (a family member or close companion) with any actual or potential Company grantee or borrower or any other organization with which the Company may have a financial relationship. Form 990, Part VI, Section C, line 19 PCHC Belfast QALICB makes it governing documents, conflict of interest policy and financial statement available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment: Section 1.263(a)-3(n) Election: PCHC Belfast QALICB, Inc 103 Maine Avenue Bangor, ME 04401 EIN: 88-1355865 Section 1.263(a)-3(n) Election: PCHC Belfast QALICB, Inc is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Penobscot Community Health Center 103 Maine Avenue PO Box 1358 Bangor ME 04401 010514750 Healthcare ME 501(c)(3) Line 10 N/A 0 Community Care Partnership ME LLC PO Box 1358 Bangor ME 04402 463666823 ACO ME N/A 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0