2021-03-10T11:06:23-06:00 2020-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th Floor Manchester NH 03101 990 2019-07-01 510137745 Ammonoosuc Community Health Services Inc AMMO 6034442464 25 Mt Eustis Road Littleton NH 03561 Edward Shanshala CEO 6034442464 2021-01-19 1 Melissa Magoon CPA P01712842 6036697337 2021-01-19 2019 2022-09-23 18:48:47Z Edward Shanshala 25 Mt Eustis Road Littleton NH 03561 11581740 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. 13 13 143 15 0 0 2927688 3286786 8463901 8269437 3246 3551 348 21966 11395183 11581740 0 0 0 0 8364903 8091291 0 0 4506 2944384 3063703 11309287 11154994 85896 426746 7284303 9909677 2422581 4621989 4861722 5287688 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 0 8895591 8269437 Primary Care - To provide medical and educational services to the local community.Oral Health Program - To provide dental and oral health services to the local community.Clinical Pharmacy Services - To provide assistance to ACHS patients to better understand and manage their medications. 8895591 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 14 0 1 143 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 1 0 0 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 Pearson 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 Eric Becker Board Member 1.00 X 0 0 0 Lynn Davis Board Member 1.00 X 0 0 0 Kathy Ryan Board Member 1.00 X 0 0 0 Evelyn Hagen Board Member 1.00 X 0 0 0 Betsy Harman 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 Lauren Rodier Board Member 1.00 X 0 0 0 Doug Harman Board Member 1.00 X 0 0 0 Sandra Laleme Past Board Member 1.00 X 0 0 0 John Rapoport Past Board Member 1.00 X 0 0 0 Edward Shanshala CEO 40.00 X 210300 0 6430 Tammy Talotta CFO 40.00 X 72017 0 7200 Kenneth Riebel Past CFO 40.00 X 133826 0 3576 Melissa Buddensee Physician 40.00 X 253707 0 5215 David Ferris Physician 40.00 X 183761 0 3000 David Nelson DO Physician 40.00 X 208694 0 2743 Robin Hallquist Physician 40.00 X 180148 0 12871 Particia Pratt MD Physician 40.00 X 201443 0 11544 1443896 0 52579 19 0 1 0 Marc Tsagaris 304 B Island Pond Road Derry NH 03038 Construction 535129 1 3203236 83550 3286786 Patient Revenue 621110 8215048 8215048 Other Revenue 621110 54389 54389 8269437 3551 3551 21966 0 21966 21966 21966 11581740 8269437 0 25517 433350 54183 379167 6472388 5300950 1171438 634471 504833 129638 551082 428301 122781 8440 8440 41400 41400 770359 770359 49218 49218 52328 40669 11659 282531 219583 62948 371680 288857 82823 36287 28202 8085 35519 27605 7914 65037 50544 14493 266724 207289 59435 68783 53458 15325 Program Supplies 603557 603557 Telephone 79158 61522 17636 Printing & Publications 74768 58729 16039 Equipment Rental/Repair 55436 43085 12351 202478 153865 44107 4506 11154994 8895591 2254897 4506 X 346841 862171 620464 2661075 45911 100044 1070365 981344 967 152 125070 124264 7879052 2885826 4909740 4993226 10000 10000 154945 177401 7284303 9909677 859487 840161 6200 57481 1556894 1637905 0 2086442 2422581 4621989 X 4751777 5179039 109945 108649 4861722 5287688 7284303 9909677 X 426746 -780 X 0 1 X 1 1 1 X 2492877 2594871 2811681 2927688 3286786 14113903 9706444 9583101 9463590 8463901 8269437 45486473 12199321 12177972 12275271 11391589 11556223 59600376 0 0 0 59600376 3017 2725 3002 3246 25517 37507 3017 2725 3002 3246 25517 37507 14524 9051 6673 348 30596 12216862 12189748 12284946 11395183 11581740 59668479 0.99890 0.99980 0.00060 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11100 11100 5984590 1825852 4158738 703186 60477 642709 1180176 999497 180679 4993226 CARES Act Funding 2086442 2086442 X 11580960 0 11580960 780 780 11581740 11154994 0 11154994 0 11154994 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 4b - Other Adjustments: Change in Beneficial Interest in Funds Held By Others 780. X X X 0 0 0 0 0 0 0 1 0 Edward Shanshala CEO 209766 0 0 0 534 0 0 0 6430 0 216730 0 0 0 Melissa Buddensee Physician 236112 0 17483 0 112 0 0 0 5215 0 258922 0 0 0 David Ferris Physician 183575 0 0 0 186 0 0 0 3000 0 186761 0 0 0 David Nelson DO Physician 208511 0 0 0 183 0 0 0 2743 0 211437 0 0 0 Robin Hallquist Physician 179328 0 0 0 820 0 0 0 12871 0 193019 0 0 0 Particia Pratt MD Physician 198162 0 2461 0 820 0 0 0 11544 0 212987 0 0 0 Part I, Line 7 Physicians received bonus compensation calculated by quality measures, patient satisfaction, citizenship and work RVUs. Form 990, Part VI, Section A, line 2 Doug and Betsy Harman have a family relationship. 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 -780.