2021-11-09T15:02:32-06:00 2021-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th Floor Manchester NH 03101 990 2020-07-01 510137745 Ammonoosuc Community Health Services Inc AMMO 6034442464 25 Mt Eustis Road Littleton NH 03561 Edward Shanshala CEO 6034442464 2021-11-08 1 Edward Shanshala 999009999 Melissa Magoon CPA P01712842 6036697337 2021-11-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Edward Shanshala 25 Mt Eustis Road Littleton NH 03561 12829277 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 13 165 15 0 0 3286786 5215754 8269437 7583992 3551 7565 21966 21966 11581740 12829277 0 0 0 0 8091291 7852093 0 0 9404 3063703 3222080 11154994 11074173 426746 1755104 9909677 9798084 4621989 2726032 5287688 7072052 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 8642232 7583992 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. 8642232 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 33 0 1 165 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 Melissa Buddensee Physician 40.00 X 258150 0 5114 Edward Shanshala CEO 40.00 X 249118 0 3150 David Nelson DO Physician 40.00 X 217896 0 2429 David Ferris Physician 40.00 X 192032 0 4352 Particia Pratt MD Physician 40.00 X 185357 0 9757 Robin Hallquist Physician 40.00 X 177776 0 12307 Tammy Talotta CFO 40.00 X 117734 0 8157 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 Lynn Davis 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 Doug Harman 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 Eric Becker Past Board Member 1.00 X 0 0 0 Lauren Rodier Past Board Member 1.00 X 0 0 0 1398063 0 45266 15 0 1 0 Secured Network Services 775 Industrial Park Road Littleton NH 03561 IT Services & Hardware 242295 1 5092545 123209 5215754 Patient Revenue 621110 7560681 7560681 Other Revenue 621110 23311 23311 7583992 7565 7565 21966 0 21966 21966 21966 12829277 7583992 0 29531 378160 50454 327706 6428168 5140315 1287853 502163 391566 110597 543602 415211 128391 11662 11662 43527 43527 849647 773311 76336 52129 52129 154593 118081 36512 218335 166768 51567 382516 289316 93200 13407 10240 3167 26853 20511 6342 64237 48586 15651 276575 211252 65323 55116 42098 13018 Program Supplies 691401 691401 Other Expenses 242950 174034 68916 Telephone 129728 99088 30640 Fundraising Expenses 9404 9404 11074173 8642232 2422537 9404 X 862171 185116 2661075 3725669 100044 94643 981344 699017 152 124264 139426 7934149 3162401 4993226 4771748 10000 177401 182465 9909677 9798084 840161 630263 57481 153571 1637905 1522507 2086442 419691 4621989 2726032 X 5179039 6934791 108649 137261 5287688 7072052 9909677 9798084 X 1755104 29260 X 0 1 X 1 1 1 X 2594871 2811681 2927688 3286786 5215754 16836780 9583101 9463590 8463901 8269437 7583992 43364021 12177972 12275271 11391589 11556223 12799746 60200801 0 0 0 60200801 2725 3002 3246 25517 29531 64021 2725 3002 3246 25517 29531 64021 9051 6673 348 16072 12189748 12284946 11395183 11581740 12829277 60280894 0.99870 0.99890 0.00110 0.00060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11100 11100 5984590 1998749 3985841 703186 100505 602681 1235273 1063147 172126 4771748 CARES Act Funding 419691 419691 X 12858537 29260 29260 12829277 0 12829277 11074173 0 11074173 0 11074173 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 29,260. X X X 0 0 0 0 0 0 0 0 0 Melissa Buddensee Physician 258028 0 0 0 122 0 0 0 5114 0 263264 0 0 0 Edward Shanshala CEO 248537 0 0 0 581 0 0 0 3150 0 252268 0 0 0 David Nelson DO Physician 217693 0 0 0 203 0 0 0 2429 0 220325 0 0 0 David Ferris Physician 191829 0 0 0 203 0 0 0 4352 0 196384 0 0 0 Particia Pratt MD Physician 183905 0 0 0 1452 0 0 0 9757 0 195114 0 0 0 Robin Hallquist Physician 176930 0 0 0 846 0 0 0 12307 0 190083 0 0 0 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 29,260.