2023-04-06T14:15:06-05:00 2022-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th Floor Manchester NH 03101 990 2021-07-01 510137745 Ammonoosuc Community Health Services Inc AMMO 6034442464 25 Mt Eustis Road Littleton NH 03561 Edward Shanshala CEO 6034442464 2023-03-23 1 Edward Shanshala 999009999 Melissa Magoon CPA P01712842 6036697337 2023-03-23 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Edward Shanshala 25 Mt Eustis Road Littleton NH 03561 12363788 0 X N/A X 1975 NH It is the mission of Ammonoosuc Community Health Services to provide a stable network of comprehensive Primary Health Care Services to individuals and families throughout the communities we serve. In support of this mission, ACHS provides evidence based, outcome specific, systematic care that is patient centered, focused on prevention, and accessible and affordable to all. 12 12 149 15 0 0 5215754 5035911 7583992 7299171 7565 6740 21966 21966 12829277 12363788 0 0 0 0 7852093 7777585 0 0 13929 3222080 3458367 11074173 11235952 1755104 1127836 9798084 10056023 2726032 1864362 7072052 8191661 X It is the mission of Ammonoosuc Community Health Services to provide a stable network of comprehensive Primary Health Care Services to individuals and families throughout the communities we serve. In support of this mission, ACHS provides evidence based, outcome specific, systematic care that is patient centered, focused on prevention, and accessible and affordable to all. 0 1 8859678 7299171 Primary Care - To provide medical and educational services to the local community.Clinical Pharmacy Services - To provide assistance to ACHS patients to better understand and manage their medications. 8859678 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 27 0 1 149 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NH X Tammy Talotta 6034442464 25 Mt Eustis Road Littleton NH 03561 Ivy Spencer President 1.00 X X 0 0 0 Barbara Szeidler Vice-President 1.00 X X 0 0 0 Jeffrey Jones Treasurer 1.00 X X 0 0 0 Bob Tortorice Secretary 1.00 X X 0 0 0 Evelyn Hagen Board Member 1.00 X 0 0 0 David McClure Board Member 1.00 X 0 0 0 Gary Merchant Board Member 1.00 X 0 0 0 Frank Pinter Board Member 1.00 X 0 0 0 John Rapoport Board Member 1.00 X 0 0 0 Kathy Ryan Board Member 1.00 X 0 0 0 James Shuchman Board Member 1.00 X 0 0 0 Carlene Whitcomb Board Member 1.00 X 0 0 0 Lynn Davis Past Board Member 1.00 X 0 0 0 Betsy Harman Past Board Member 1.00 X 0 0 0 Doug Harman Past Board Member 1.00 X 0 0 0 Edward Shanshala CEO 40.00 X 253678 0 606 Tammy Talotta CFO 40.00 X 135085 0 11834 Melissa Buddensee Physician 40.00 X 258780 0 7736 David Ferris Physician 40.00 X 190363 0 7919 David Nelson DO Physician 40.00 X 217888 0 1872 Caitlin O'Donnell Physician 39.00 X 179477 0 2750 Patricia Pratt MD Physician 30.00 X 169974 0 6704 1405245 0 39421 17 0 1 0 Secured Network Services 775 Industrial Park Road Littleton NH 03561 IT Services & Hardware 359578 0 4953868 82043 5035911 Patient Revenue 621110 7247638 7247638 Other Revenue 621110 51533 51533 7299171 6740 6740 21966 0 21966 21966 21966 12363788 7299171 0 28706 401202 50857 350345 6305759 5088110 1217649 65751 50472 15279 486947 383218 103729 517926 397570 120356 31556 31556 42106 42106 1105174 1038378 66796 46565 46565 164948 126618 38330 320609 246106 74503 391752 300716 91036 15859 12174 3685 35654 27369 8285 53948 41412 12536 264341 202913 61428 55478 42586 12892 Program Supplies 635587 635587 Other Expenses 163611 125589 38022 Telephone 117250 90003 27247 Fundraising Expenses 13929 13929 11235952 8859678 2362345 13929 X 185116 248348 3725669 4119062 94643 307120 699017 433110 139426 126189 8075522 3426743 4771748 4648779 182465 173415 9798084 10056023 630263 837243 153571 49572 1522507 977547 419691 0 2726032 1864362 X 6934791 8063246 137261 128415 7072052 8191661 9798084 10056023 X 1127836 -8227 X 0 1 X 1 1 1 X 2811681 2927688 3286786 5215754 5035911 19277820 9463590 8463901 8269437 7583992 7299171 41080091 12275271 11391589 11556223 12799746 12335082 60357911 10000 10000 0 10000 10000 60347911 3002 3246 25517 29531 28706 90002 3002 3246 25517 29531 28706 90002 6673 348 7021 12284946 11395183 11581740 12829277 12363788 60454934 0.99820 0.99870 0.00150 0.00110 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11100 11100 5984590 2171600 3812990 703186 140533 562653 1235273 1114610 120663 141373 141373 4648779 X 12355561 -8227 -8227 12363788 0 12363788 11235952 0 11235952 0 11235952 Part X, Line 2: The Organization is a public charity under Section 501(c)(3) of the Internal Revenue Code. As a public charity, the Organization is exempt from state and federal income taxes on income earned in accordance with its tax exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Organization's tax positions and concluded that the Organization has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. Part XI, Line 2d - Other Adjustments: Change in Beneficial Interest in Funds Held By Others -8,227. X X X 0 0 0 0 0 0 0 1 0 Melissa Buddensee Physician 253716 0 4947 0 117 0 0 0 7736 0 266516 0 0 0 Edward Shanshala CEO 248259 0 4860 0 559 0 0 0 606 0 254284 0 0 0 David Nelson DO Physician 213293 0 4400 0 195 0 0 0 1872 0 219760 0 0 0 David Ferris Physician 186061 0 4107 0 195 0 0 0 7919 0 198282 0 0 0 Caitlin O'Donnell Physician 175355 0 3929 0 193 0 0 0 2750 0 182227 0 0 0 Patricia Pratt MD Physician 165736 0 3446 0 792 0 0 0 6704 0 176678 0 0 0 Part I, Line 7 The bonuses were a pay for performance payment and it was to all employees for the FY 2022 year amount was determined and approved by the board $162,500 in total. Form 990, Part III, line 3 The Organization suspended their Oral Health Program during FY22. Form 990, Part VI, Section A, line 2 Doug and Betsy Harman have a family relationship. Form 990, Part VI, Section A, line 4 During fiscal year ended 6/30/22 the Organization amended their bylaws, thus making the following changes to the Board Composition, Responsibilities, Responsible of Individual Directors, and the Executive Committee. Below are the changes made: 2.6 Responsibilities - 2.6.1 The Board maintains authority for oversight of the health center project and that no other individual, entity, or committee (including, and not limited to an executive committee authorized by the Board) may reserve approval authority or have veto power over the Board with regard to the required authorities and functions. 2.6.2 Hiring, annually evaluating, and dismissing the Chief Executive Officer of the Corporation who is an agent of, and accountable to, the governing Board. 2.6.4 Developing, adopting, periodically reviewing, and updating and appropriately documenting the Corporation's Financial Policies, including a system to assure accountability for corporate resources and long-range financial planning, fee schedules, charity policies such as sliding fee discount programs, billing, collections, and appropriate follow-up actions are taken, including a policy on waiving or reducing patient fees, and, if applicable, refusal to pay. 2.6.5 Developing, adopting, periodically reviewing, updating, and appropriately documenting the Corporation's Health Care Policies, including scope and availability of services, location and hours of operation, services, and quality of care audit. 2.6.6 Developing, adopting, periodically reviewing, updating, and appropriately documenting the Corporation's policies on quality improvement/ assurance program. 2.6.10 Approving the Strategic Plan Document at least once every three years, which, at a minimum, addresses financial management, capital expenditures need, and identifies health center priorities. 2.6.11 Overseeing the development of the overall plan for the health center project. 2.6.12 Assuring that the health center operates in compliance with applicable Federal, State, and Local laws and regulations. 2.6.13 Approving the annual budget as presented by the Finance Committee in consultation with the Chief Financial Officer and the Chief Executive Officer. 2.7 Responsibilities of Individual Directors - 2.7.5 Each Board Director has a fiduciary duty to the health center and that his or her actions must be in the best interest of the health center (, i.e., compliance with the duty of loyalty) Executive Committe - 4.2.3 Is the only committee that is authorized to act on behalf of the Board in regard to the required health center project authorities and functions, as described above, and the full Board must subsequently vote on all such Executive Committee actions. Form 990, Part VI, Section B, line 11b Upon receipt of the completed 990 from the audit firm, the CFO reviews the 990 for accuracy. If the CFO has any questions concerning any data on the 990, the auditor will be asked for clarification or correction. The 990 is provided to the Finance Committee members for review and then provided to all Board members prior to filing the 990. Form 990, Part VI, Section B, line 12c Covered individuals include all individuals working with ACHS whether associated through board membership, employment, contract, volunteer or other agreement. All conflicts of interest whether real or perceived, must be disclosed as soon as the individual becomes aware of the conflict to a supervisor, coordinator or director. The supervisor, coordinator or director will work with the compliance officer to put forth a plan to ensure the conflict of interest does not adversely impact ACHS patients or business interests. Workforce members in violation of the policy may be subject to disciplinary action up to and including termination or removal from the board. All workforce members are required to complete a conflict of interest disclosure statement upon hire and every year thereafter. Board members complete a conflict of interest form upon becoming a member and then annually as long as they remain a member. Form 990, Part VI, Section B, line 15a CEO compensation is reviewed and approved by the Executive Committee using comparability data. Form 990, Part VI, Section C, line 19 Ammonoosuc Community Health Services, Inc. makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Ammonoosuc Community Health Services, Inc. 25 Mt. Eustis Road Littleton, NH 03561 Ammonoosuc Community Health Services, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in beneficial interest in funds held by others -8,227.