NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY INC (EIN 02-0300637)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-15
- IRS object ID
- 202302279349303490
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-15T15:34:33-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2211 Congress St | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020300637 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | North Country Home Health & Hospice | BusinessNameLine1Txt |
| Business Name Line2 | Agency Inc | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 6034445317 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 536 Cottage Street | AddressLine1Txt |
| City | Littleton | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03561 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Matthew Streeter | PersonNm |
| Person Title | System CFO | PersonTitleTxt |
| Phone | 6034445317 | PhoneNum |
| Signature | 2023-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Matthew | PersonFirstNm |
| Person Last | Streeter | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Joseph R Byrne | PreparerPersonNm |
| PTIN | P01289281 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2023-08-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Tiffany Haynes | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 536 Cottage Street | AddressLine1Txt |
| City | Littleton | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03561 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,335,443 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.northcountryhomehealth-hospice.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1971 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To provide quality home health and hospice care, utilizing a holistic approach, while working in collaboration with all community resources, to meet the comprehensive needs of the clients and their families, in a cost effective manner. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 96 | TotalEmployeeCnt |
| Total Volunteers | 31 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $760,620 | PYContributionsGrantsAmt |
| CY Contributions Grants | $743,488 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,299,303 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,551,973 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,114 | PYInvestmentIncomeAmt |
| CY Investment Income | $13,666 | CYInvestmentIncomeAmt |
| PY Other Revenue | $33,891 | PYOtherRevenueAmt |
| CY Other Revenue | $26,316 | CYOtherRevenueAmt |
| PY Total Revenue | $9,102,928 | PYTotalRevenueAmt |
| CY Total Revenue | $10,335,443 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,700,811 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,863,699 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,160,918 | PYOtherExpensesAmt |
| CY Other Expenses | $2,914,942 | CYOtherExpensesAmt |
| PY Total Expenses | $8,861,729 | PYTotalExpensesAmt |
| CY Total Expenses | $8,778,641 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $241,199 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,556,802 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,198,676 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,015,233 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,452,979 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,972,579 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,745,697 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,042,654 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide quality home health and hospice care, utilizing a holistic approach, while working in collaboration with all community resources, to meet the comprehensive needs of the clients and their families, in a cost effective manner. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,777,155 | ExpenseAmt |
| Revenue | $9,578,289 | RevenueAmt |
| Desc | Home care: provides home health, hospice, and health promotion services to residents of upper Grafton and Coos Counties of New Hampshire. | Desc |
| Total Program Service Expenses | $6,777,155 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 96 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Matthew Streeter | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6033265610 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8 Clover Lane | AddressLine1Txt |
| City | Whitefield | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03598 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Chrissy Smith | ||||||||
| Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Roxie Severance | ||||||||
| Vice Chair | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Patrick Kelly | ||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mell Brooks | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Darrell Bodnar | ||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $254,388 | $32,958 | ||
| JJ Bujeaud | ||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Greg Eastman | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kimberly Force | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Ann Hebert | ||||||||
| Trustee | 1.00 | 39.00 | Yes (X) | $0 | $4,253 | $128 | ||
| Holly McCormack | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Brian O'Hearn | ||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $229,636 | $48,726 | ||
| Chad Sterns | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| John Starr | ||||||||
| Past Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Tiffany Haynes | ||||||||
| President/CEO | 40.00 | 0.00 | Yes (X) | $141,833 | $0 | $28,381 | ||
| Thomas Mee | ||||||||
| System CEO | 1.00 | 45.00 | Yes (X) | $0 | $677,301 | $39,588 | ||
| Matthew Streeter | ||||||||
| System CFO | 1.00 | 45.00 | Yes (X) | $0 | $167,302 | $26,546 | ||
| Michael J Counter | ||||||||
| Past President/CEO | 40.00 | 0.00 | Yes (X) | $167,637 | $0 | $5,877 | ||
| Kevin Botelho | ||||||||
| APRN | 40.00 | 0.00 | $132,542 | $0 | $25,741 | Yes (X) | ||
| Jessica C Foster-Hebert | ||||||||
| Director of Clinical Services | 39.00 | 1.00 | $108,222 | $0 | $15,925 | Yes (X) | ||
| Ashley A Horwy | ||||||||
| Hospital Coordinator | 40.00 | 0.00 | $106,833 | $0 | $3,404 | Yes (X) | ||
| Amy L Remick | ||||||||
| Physical Therapy Manager | 40.00 | 0.00 | $104,959 | $0 | $14,941 | Yes (X) | ||
| Alyssa Lennon | ||||||||
| Director of Hospice | 40.00 | 0.00 | $103,067 | $0 | $23,931 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $865,093 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,332,880 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $266,146 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Berry Dunn McNeil & Parker | |||||
| 1000 Elm St 4th Floor | Manchester | NH | 03101 | Audit, Billing & Coding | $405,150 |
| MAS Medical Staffing | |||||
| 156 Harvey Road | Londonderry | NH | 03053 | Clinical Staff | $301,829 |
| McBee Associates | |||||
| PO Box 823519 | Philadelphia | PA | 19182 | Accounts Receivable Mgmt | $176,365 |
| North Country Healthcare Inc | |||||
| 8 Clover Lane | Whitefield | NH | 03598 | Management Services | $170,282 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $630,912 | GovernmentGrantsAmt |
| All Other Contributions | $112,576 | AllOtherContributionsAmt |
| Total Contributions | $743,488 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Home Health Care | Desc |
| Business | 621610 | BusinessCd |
| Total Revenue Column | $9,551,973 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,551,973 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,551,973 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,666 | TotalRevenueColumnAmt |
| Exclusion | $13,666 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $26,316 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $26,316 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,316 | TotalRevenueColumnAmt |
| Exclusion | $26,316 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,335,443 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,551,973 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $39,982 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,728 | TotalAmt |
| Management And General | $343,728 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,241,240 | TotalAmt |
| Program Services | $3,813,120 | ProgramServicesAmt |
| Management And General | $428,120 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,436 | TotalAmt |
| Program Services | $67,348 | ProgramServicesAmt |
| Management And General | $7,088 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $889,769 | TotalAmt |
| Program Services | $769,284 | ProgramServicesAmt |
| Management And General | $120,485 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $314,526 | TotalAmt |
| Program Services | $263,547 | ProgramServicesAmt |
| Management And General | $50,979 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,391 | TotalAmt |
| Management And General | $47,391 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,000 | TotalAmt |
| Management And General | $6,000 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,000 | TotalAmt |
| Management And General | $30,000 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6 | TotalAmt |
| Management And General | $6 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $726,597 | TotalAmt |
| Program Services | $296,345 | ProgramServicesAmt |
| Management And General | $430,252 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,060 | TotalAmt |
| Program Services | $46,974 | ProgramServicesAmt |
| Management And General | $9,086 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,597 | TotalAmt |
| Program Services | $104,402 | ProgramServicesAmt |
| Management And General | $20,195 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $209,130 | TotalAmt |
| Program Services | $175,234 | ProgramServicesAmt |
| Management And General | $33,896 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,230 | TotalAmt |
| Program Services | $37,899 | ProgramServicesAmt |
| Management And General | $7,331 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $277,541 | TotalAmt |
| Program Services | $271,818 | ProgramServicesAmt |
| Management And General | $5,723 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,683 | TotalAmt |
| Program Services | $16,493 | ProgramServicesAmt |
| Management And General | $3,190 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,728 | TotalAmt |
| Program Services | $20,720 | ProgramServicesAmt |
| Management And General | $4,008 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,013 | TotalAmt |
| Program Services | $90,504 | ProgramServicesAmt |
| Management And General | $17,509 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,476 | TotalAmt |
| Program Services | $48,160 | ProgramServicesAmt |
| Management And General | $9,316 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Patient Care Supplies | $588,762 | $588,762 | |
| Loss on Disposals | $443,101 | $90,826 | $352,275 |
| Other Expenses | $75,719 | $75,719 | |
| Intercompany Allocation | $74,908 | $74,908 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,778,641 | TotalAmt |
| Program Services | $6,777,155 | ProgramServicesAmt |
| Management And General | $2,001,486 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $725,330 | BOYAmt |
| EOY | $2,745,264 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $401,574 | BOYAmt |
| EOY | $405,061 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,311,291 | BOYAmt |
| EOY | $1,685,349 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,359 | BOYAmt |
| EOY | $35,329 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,064,165 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,222,557 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,362,395 | BOYAmt |
| EOY | $841,608 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $291,915 | BOYAmt |
| EOY | $238,288 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,812 | BOYAmt |
| EOY | $64,334 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,198,676 | BOYAmt |
| EOY | $6,015,233 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,254,104 | BOYAmt |
| EOY | $871,390 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,840 | BOYAmt |
| EOY | $5,840 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $759,569 | BOYAmt |
| EOY | $645,174 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $433,466 | BOYAmt |
| EOY | $450,175 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,452,979 | BOYAmt |
| EOY | $1,972,579 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,405,810 | BOYAmt |
| EOY | $3,752,120 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $339,887 | BOYAmt |
| EOY | $290,534 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,745,697 | BOYAmt |
| EOY | $4,042,654 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,198,676 | BOYAmt |
| EOY | $6,015,233 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,556,802 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$60,958 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$198,887 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $970,356 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $434,101 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,216,713 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $760,620 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $743,488 | CurrentTaxYearAmt |
| Total | $4,125,278 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,189,207 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,832,461 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,651,151 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,299,303 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,551,973 | CurrentTaxYearAmt |
| Total | $38,524,095 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,159,563 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,266,562 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,867,864 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,059,923 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,295,461 | CurrentTaxYearAmt |
| Total | $42,649,373 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $42,649,373 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,782 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,123 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,958 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $40,804 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $39,982 | CurrentTaxYearAmt |
| Total | $98,649 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,782 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,123 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,958 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $40,804 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $39,982 | CurrentTaxYearAmt |
| Total | $98,649 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $30,506 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $33,246 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,201 | CurrentTaxYearMinus1YearAmt |
| Total | $65,953 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,163,345 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,303,191 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,909,068 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,102,928 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,335,443 | CurrentTaxYearAmt |
| Total | $42,813,975 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99620 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99630 | PublicSupportPY509Pct |
| Investment Income CY | 0.00230 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00180 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $319,611 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$51,310 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $6 | AdministrativeExpensesAmt |
| End Year Balance | $268,295 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $265,950 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $56,620 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $2,959 | AdministrativeExpensesAmt |
| End Year Balance | $319,611 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $250,092 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $18,327 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $2,469 | AdministrativeExpensesAmt |
| End Year Balance | $265,950 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $245,018 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $7,476 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $2,402 | AdministrativeExpensesAmt |
| End Year Balance | $250,092 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $240,272 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $6,249 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,503 | AdministrativeExpensesAmt |
| End Year Balance | $245,018 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.15690 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.84310 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $168,203 | OtherCostOrOtherBasisAmt |
| Book Value | $168,203 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,136,921 | OtherCostOrOtherBasisAmt |
| Depreciation | $787,580 | DepreciationAmt |
| Book Value | $349,341 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $747,155 | OtherCostOrOtherBasisAmt |
| Depreciation | $434,977 | DepreciationAmt |
| Book Value | $312,178 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,886 | OtherCostOrOtherBasisAmt |
| Book Value | $11,886 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $841,608 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Related Parties | $43,336 |
| CARES Act Provider Relief Funds | $406,839 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $450,175 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,261,001 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$60,958 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$13,478 | OtherRevenueAmt |
| Revenue Not Reported | -$74,436 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,335,437 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $6 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $6 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,335,443 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,778,635 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $8,778,635 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $6 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $6 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $8,778,641 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | All income of the endowment assets earned is to be used for the general operations of the Agency. |
| Part X, Line 2: | The Agency is a public charity under Section 501(c)(3) of the Internal Revenue Code (IRC). As a public charity, the Agency 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 Agency's tax positions and concluded that the Agency has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. |
| Part XI, Line 2d - Other Adjustments: | Change in fair value of perpetual trust -13,478. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Thomas Mee | ||||||||||||||
| System CEO | $0 | $538,642 | $0 | $126,000 | $0 | $12,659 | $0 | $5,597 | $0 | $33,991 | $0 | $716,889 | $0 | $0 |
| Darrell Bodnar | ||||||||||||||
| Trustee | $0 | $194,186 | $0 | $52,020 | $0 | $8,182 | $0 | $7,736 | $0 | $25,222 | $0 | $287,346 | $0 | $0 |
| Brian O'Hearn | ||||||||||||||
| Trustee | $0 | $182,130 | $0 | $39,500 | $0 | $8,006 | $0 | $8,000 | $0 | $40,726 | $0 | $278,362 | $0 | $0 |
| Matthew Streeter | ||||||||||||||
| System CFO | $0 | $157,136 | $0 | $10,000 | $0 | $166 | $0 | $0 | $0 | $26,546 | $0 | $193,848 | $0 | $0 |
| Michael J Counter | ||||||||||||||
| Past President/CEO | $114,880 | $0 | $45,000 | $0 | $7,757 | $0 | $2,943 | $0 | $2,934 | $0 | $173,514 | $0 | $0 | $0 |
| Tiffany Haynes | ||||||||||||||
| President/CEO | $134,387 | $0 | $1,690 | $0 | $5,756 | $0 | $2,996 | $0 | $25,385 | $0 | $170,214 | $0 | $0 | $0 |
| Kevin Botelho | ||||||||||||||
| APRN | $125,307 | $0 | $4,500 | $0 | $2,735 | $0 | $3,875 | $0 | $21,866 | $0 | $158,283 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | North Country Healthcare, a related organization, uses the following methods to establish compensation for the top management official of the filing organization: - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Written employment contract - Compensation survey or study - Approval by the board or compensation committee |
| Part I, Line 4b | Thomas Mee, System CEO, participated in a 457(f) plan administered by North Country Healthcare, a related organization. |
| Part I, Line 7 | Michael Counter's amount of $45,000 was based on achievement of his performance goals and agency performance. It was approved by NCHHH Board of Directors. The bonuses for both Tiffany Haynes and Kevin Botelho were productivity bonuses. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | North Country Healthcare, Inc. is the sole member. |
| Form 990, Part VI, Section A, line 7a | Each member of the Corporation Board shall be nominated by action of an Affiliate Board, or by the Corporation Board, as the case may be, in accordance with the nomination powers indicated in the Corporation's Bylaws. |
| Form 990, Part VI, Section A, line 7b | The Corporation Bylaws include Major Matters which include specific duties and responsibilities which are shared by the Corporation Board and the Affiliate Boards. These Major Matters are further distinguished between Major Organizational Matters and Major Operational Matters. In both cases, the Bylaws contain the provisions for the approval of these matters including whether they are approved by a majority vote or super majority vote of all boards. In all cases, the Major Matters require approval by the Corporation Board and the Affiliate Boards. |
| Form 990, Part VI, Section B, line 11b | A copy of the Form 990 will be shared electronically with the entire NCH Board and Finance committee before filing, with adequate time for questions to be asked. |
| Form 990, Part VI, Section B, line 12c | Conflict of Interest Process: - Conflict of Interest Disclosure completed via BoardPaq (electronic means). - Results compiled into Conflict Matrix which is reviewed and approved by the Board. - Conflicts that meet the Pecuniary Benefit criteria are identified, shared with the Board and approved. - Disclosure notices are placed in local papers. - The NH Division of Charitable Trusts is notified of the Pecuniary Benefit and copies of the public notices are attached. |
| Form 990, Part VI, Section B, line 15 | The Compensation Committee is a subcommittee of the Finance Committee of the Corporation Board. This committee oversees the executive compensation policy and practices of the organization including the CEO, the Affiliate Presidents, and the CEO Cabinet which includes key executive positions for the organization. The Compensation Committee engages with an outside consultant to determine compensation benchmarks and best practices which guide the compensation processes for these executive positions. The comparison benchmark data and guidance are reviewed by the Committee and recommendations are made to the Corporation Board and Affiliate Boards. This is done on an annual basis. |
| Form 990, Part VI, Section C, line 19 | The Organization has implemented all policies and the governing documents and financial statements are available to the public upon request. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment: | Section 1.263(a)-3(n) Election: North Country Home Health & Hospice Agency, Inc. 536 Cottage Street Littleton, NH 03561 EIN: 02-0300637 North Country Home Health & Hospice Agency is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
| Form 990, Part XI, line 9: | Change in interest of beneficial trust -13,478. Intercompany equity transfer -185,409. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| North Country Healthcare Inc | |||||||||||
| 8 Clover Lane | Whitefield | NH | 03598 | 812225283 | Healthcare Management | NH | 501(c)(3) | Line 12a, I | N/A | 0 | |
| Androscoggin Valley Hospital | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 020280367 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | 0 | North Country Healthcare Inc | |
| Upper Connecticut Valley Hospital | |||||||||||
| Corliss Lane | Colebrook | NH | 03576 | 020276210 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | 0 | North Country Healthcare Inc | |
| Weeks Medical Center | |||||||||||
| 173 Middle Street | Lancaster | NH | 03584 | 020222242 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | 0 | North Country Healthcare Inc | |
| Androscoggin Valley Hospital Foundation | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 223035216 | Management and Financial Support | NH | 501(c)(3) | Line 12b, II | 0 | Androscoggin Valley Hospital Inc | |
| Northcare Inc | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 521596952 | Supporting Services | NH | 501(c)(3) | Line 12b, II | 0 | Androscoggin Valley Hospital Inc | |
| Great Northwoods Community Foundation | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 020452547 | Healthcare Services | NH | 501(c)(3) | Line 12b, II | 0 | Androscoggin Valley Hospital Inc | |
| Lancaster Patient Care Center | |||||||||||
| 173 Middle Street | Lancaster | NH | 03584 | 832130386 | Supporting Services | NH | 501(c)(3) | Line 12a, I | 0 | Weeks Medical Center | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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