2022-11-08T08:06:17-06:00 2022-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th Floor Manchester NH 03101 990 2021-07-01 020350051 Coos County Family Health Services Inc COOS 6037522040 133 Pleasant Street Berlin NH 03570 Patti Stolte Board President 6037527719 2022-11-07 1 Patti Stolte 999009999 Melissa Magoon CPA P01712842 6036697337 2022-11-07 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Ken Gordon 133 Pleasant Street Berlin NH 03570 16994570 0 X www.coosfamilyhealth.org X 1980 NH Federally Qualified Health Center 14 14 168 32 0 0 6896883 5777622 10409953 11054801 25524 24322 7343 11580 17339703 16868325 0 0 0 0 10400559 11642837 0 0 3553 4528803 4337458 14929362 15980295 2410341 888030 17181637 19734526 6202008 7934886 10979629 11799640 Coos County Family Health Services, Inc. is a community-based organization providing innovative, personalized, comprehensive health care and social services of the highest quality to everyone, regardless of economic status. 0 0 14110981 11054801 Provision of primary care services to the community. 14110981 1 1 0 0 0 0 0 0 0 1 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 1 0 0 0 1 35 0 1 168 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X X Ken Gordon 6037522040 133 Pleasant Street Berlin NH 03570 Alana Scannell Past Board Member 1.00 X 0 0 0 Aline Boucher Past Treasurer 1.00 X X 0 0 0 Claudette Morneau Board Member 1.00 X 0 0 0 Cynthia Desmond Treasurer 1.00 X X 0 0 0 David Morin Board Member 1.00 X 0 0 0 Gregg Marrer Board Member 1.00 X 0 0 0 H Guyford Stever Jr Immediate Past President 1.00 X 0 0 0 Holly Carter Board Member 1.00 X 0 0 0 Kassie Eafrati Vice President 1.00 X X 0 0 0 Marge McClellan Board Member 1.00 X 0 0 0 Melanie Maynor Esq Past Board Member 1.00 X 0 0 0 Patti Stolte President 1.00 X X 0 0 0 Pauline Tibbetts Secretary 1.00 X X 0 0 0 Rebecca Witmon Board Member 1.00 X 0 0 0 Robert Pelchat Board Member 1.00 X 0 0 0 Roland Olivier Past Board Member 1.00 X 0 0 0 Kenneth E Gordon CEO 40.00 X 176253 0 18450 Philip G Kneer CFO 40.00 X 104665 0 39586 Ahmad Rashid Physician 40.00 X 189049 0 23032 Brian M Beals Physician 37.50 X 239901 0 44013 Brianne MC Teaboldt Physician 40.00 X 242085 0 47552 Elaine Chappell Physician 24.00 X 173643 0 9933 Michael Creppy Physician 40.00 X 247264 0 33994 1372860 0 216560 16 0 1 0 Nicole Lang Office Cleaning 25 Ray Street Gorham NH 03581 Office Cleaning 110430 Virence Health Technologies 925 4th Avenue Seattle WA 98104 EMR Vendor 102354 Weatherby Healthcare 6451 North Federal Highway Suite 7 Fort Lauderdale FL 33308 Locum Provider 100016 3 575 4536883 1240164 9101 5777622 Patient Service Revenue 621110 11158744 11158744 Other revenue 900099 128607 128607 AVH Reiumbursements 900099 15118 15118 Bad Debts 900099 -247668 -247668 11054801 24769 24769 11580 0 11580 11580 11580 125798 126245 -447 -447 -447 16868325 11054801 0 35902 338955 48677 290278 8863462 7957269 906193 525491 465601 59890 1183379 1075829 107550 731550 640106 91444 71874 71874 80064 80064 3194 3194 439638 439638 38317 33527 4790 430541 376724 53817 418889 366528 52361 545116 476976 68140 28089 24578 3511 79408 69482 9926 91 80 11 246692 215855 30837 86215 75438 10777 340B Program Expenses 1084206 1084206 Program Supplies 612734 612734 Other Expenses 168837 147733 21104 Fundraising Expense 3553 3553 15980295 14110981 1865761 3553 X 1300 1300 8245563 7819516 4700261 7172498 1047495 1198946 130599 160862 6329464 4065266 2140410 2264198 781005 925418 135004 191788 17181637 19734526 1417438 1364104 4784570 6570782 6202008 7934886 X 10888194 11729666 91435 69974 10979629 11799640 17181637 19734526 X 888030 -64103 -3916 X 0 1 X 1 1 1 X 3437218 3646015 4334883 6896883 5777622 24092621 10118769 11454780 10829740 10409953 11054801 53868043 13555987 15100795 15164623 17306836 16832423 77960664 0 0 0 77960664 11398 33008 42822 33736 36349 157313 11398 33008 42822 33736 36349 157313 13567385 15133803 15207445 17340572 16868772 78117977 0.99800 0.99820 0.00200 0.00180 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 35200 -3916 31284 29897 5303 35200 27878 2019 29897 28188 1075 -1385 27878 25440 920 1828 28188 1.00000 0 0 153257 153257 3493228 1963705 1529523 2682979 2101561 581418 2264198 X 16797112 -64103 -3916 -68019 16865131 3194 3194 16868325 15977101 0 15977101 3194 3194 15980295 Part V, Line 4: Income earned is used for operations. 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 Fair Market Value in Beneficial Interest -3,916. X X X X 0 0 0 0 0 0 0 1 0 Brianne MC Teaboldt Physician 235569 0 6000 0 516 0 10273 0 37279 0 289637 0 0 0 Brian M Beals Physician 238136 0 0 0 1765 0 8123 0 35890 0 283914 0 0 0 Michael Creppy Physician 246851 0 0 0 413 0 10417 0 23577 0 281258 0 0 0 Ahmad Rashid Physician 188744 0 0 0 305 0 7982 0 15050 0 212081 0 0 0 Kenneth E Gordon CEO 174024 0 0 0 2229 0 7384 0 11066 0 194703 0 0 0 Elaine Chappell Physician 173245 0 0 0 398 0 7686 0 2247 0 183576 0 0 0 Part I, Line 7 Physicians are provided incentive payments based on number of patients seen, complexity of patient acuity, timely documentation, patient satisfication, and quality of care provided. Form 990, Part VI, Section B, line 11b The CFO compares the Form 990 to the audited financial statements and prior year 990. A copy is given to the Finance Committee to review and then a copy is given to the board of directors to review and approve. Form 990, Part VI, Section B, line 12c Annually, the board re-affirms their compliance with the conflict of interest policy with a written compliance document. Form 990, Part VI, Section B, line 15 HR currently participates in a salary survey with a national health center organization and utilizes the results to assist with setting market rates of pay for the CEO, COO, and CFO. The CEO sets the COO and CFO salaries based upon these results. The board of directors approves and sets the salary of the CEO. Form 990, Part VI, Section C, line 19 Documents are posted to the Organization's website and are available upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Coos County Family Health Services, Inc. 133 Pleasant Street Berlin, NH 03570 EIN: 02-0350051 Coos County Family 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 Fair Value of Beneficial Interest in Funds Held by Others -3,916. Great Northwoods Community Foundation 59 Page Hill Road Berlin NH 03570 020452547 Health Care Services NH 501(c)(3) Line 12b, II N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0