AMMONOOSUC COMMUNITY HEALTH SERVICES INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- AMMONOOSUC COMMUNITY HEALTH SERVICES INC (EIN 51-0137745)
- Tax period
- 2018-07-01 to 2019-06-30
- Filed
- 2019-12-03
- IRS object ID
- 201903379349300975
- Schema version
- 2018v3.1
- 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 | 2019-12-03T13:08:31-06:00 | ReturnTs |
| Tax Period End | 2019-06-30 | 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 | 1000 Elm Street 4th Floor | AddressLine1Txt |
| City | Manchester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 510137745 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ammonoosuc Community Health | BusinessNameLine1Txt |
| Business Name Line2 | Services Inc | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AMMO | BusinessNameControlTxt |
| Phone | 6034442464 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Mt Eustis Road | AddressLine1Txt |
| City | Littleton | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03561 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Edward Shanshala | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6034442464 | PhoneNum |
| Signature | 2019-12-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Melissa Magoon CPA | PreparerPersonNm |
| PTIN | P01712842 | PTIN |
| Phone | 6036697337 | PhoneNum |
| Preparation | 2019-12-03 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 69.49.157.66 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-12-03 | IPDt |
| IP Tm | 11:23:09 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | BCE379EC6B2F882893C3F02DE0A5A3D951B1B2ED | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BFB386403C9EAE7FF660C386334FC3E1098CE7FC | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-03-31 21:24:44Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Edward Shanshala | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Mt Eustis Road | AddressLine1Txt |
| City | Littleton | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03561 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,396,335 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1975 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 109 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,811,681 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,927,688 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,463,590 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,463,901 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,002 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,246 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,673 | PYOtherRevenueAmt |
| CY Other Revenue | $348 | CYOtherRevenueAmt |
| PY Total Revenue | $12,284,946 | PYTotalRevenueAmt |
| CY Total Revenue | $11,395,183 | 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 | $8,041,541 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,364,903 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $5,702 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,847,067 | PYOtherExpensesAmt |
| CY Other Expenses | $2,944,384 | CYOtherExpensesAmt |
| PY Total Expenses | $11,888,608 | PYTotalExpensesAmt |
| CY Total Expenses | $11,309,287 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $396,338 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $85,896 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,246,148 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,284,303 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,472,256 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,422,581 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,773,892 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,861,722 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,033,259 | ExpenseAmt |
| Revenue | $8,463,901 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $9,033,259 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | 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 | 16 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 109 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | 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 | Ken Riebel | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6034442464 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Mt Eustis Road | AddressLine1Txt |
| City | Littleton | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03561 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Barbara Szeidler | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Betsy Harman | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Bob Tortorice | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Doug Harman | |||||||
| President | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Eric Becker | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Evelyn Hagen | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Frank Pinter | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Gary Merchant | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Ivy Pearson | |||||||
| Vice President | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Jeffrey Jones | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| John Rapoport | |||||||
| Treasurer | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Lynn Davis | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Mark Secord | |||||||
| Past Vice President | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Ned Densmore | |||||||
| Past Secretary | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Ron Spaulding | |||||||
| Past Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Sandra Laleme | |||||||
| Secretary | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Edward Shanshala | |||||||
| CEO | 40.00 | $190,551 | $0 | $6,074 | Yes (X) | ||
| Kenneth Riebel | |||||||
| CFO | 40.00 | $135,799 | $0 | $3,538 | Yes (X) | ||
| David Ferris | |||||||
| Physician | 40.00 | $186,246 | $0 | $3,000 | Yes (X) | ||
| David Nelson DO | |||||||
| Physician | 40.00 | $215,662 | $0 | $2,755 | Yes (X) | ||
| Robin Hallquist | |||||||
| Physician | 40.00 | $175,147 | $0 | $11,399 | Yes (X) | ||
| Melissa Buddensee | |||||||
| Physician | 40.00 | $248,604 | $0 | $2,885 | Yes (X) | ||
| Particia Pratt MD | |||||||
| Physician | 40.00 | $205,327 | $0 | $10,494 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,357,336 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $40,145 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,751,795 | GovernmentGrantsAmt |
| All Other Contributions | $175,893 | AllOtherContributionsAmt |
| Total Contributions | $2,927,688 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Revenue | 621110 | $8,374,895 | $8,374,895 |
| Other Revenue | 621110 | $89,006 | $89,006 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,463,901 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,246 | TotalRevenueColumnAmt |
| Exclusion | $3,246 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $1,500 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $1,152 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $348 | TotalRevenueColumnAmt |
| Exclusion | $348 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,395,183 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,463,901 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,594 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $335,962 | TotalAmt |
| Program Services | $49,157 | ProgramServicesAmt |
| Management And General | $286,805 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,810,650 | TotalAmt |
| Program Services | $5,558,923 | ProgramServicesAmt |
| Management And General | $1,251,727 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $647,331 | TotalAmt |
| Program Services | $508,543 | ProgramServicesAmt |
| Management And General | $138,788 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $570,960 | TotalAmt |
| Program Services | $448,546 | ProgramServicesAmt |
| Management And General | $122,414 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,967 | TotalAmt |
| Program Services | $16,472 | ProgramServicesAmt |
| Management And General | $4,495 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,800 | TotalAmt |
| Program Services | $38,337 | ProgramServicesAmt |
| Management And General | $10,463 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $591,717 | TotalAmt |
| Program Services | $488,688 | ProgramServicesAmt |
| Management And General | $103,029 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,575 | TotalAmt |
| Program Services | $50,730 | ProgramServicesAmt |
| Management And General | $13,845 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,442 | TotalAmt |
| Program Services | $49,054 | ProgramServicesAmt |
| Management And General | $13,388 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200,211 | TotalAmt |
| Program Services | $157,286 | ProgramServicesAmt |
| Management And General | $42,925 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $389,300 | TotalAmt |
| Program Services | $305,834 | ProgramServicesAmt |
| Management And General | $83,466 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,811 | TotalAmt |
| Program Services | $35,204 | ProgramServicesAmt |
| Management And General | $9,607 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,175 | TotalAmt |
| Program Services | $40,203 | ProgramServicesAmt |
| Management And General | $10,972 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,203 | TotalAmt |
| Program Services | $48,081 | ProgramServicesAmt |
| Management And General | $13,122 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $266,820 | TotalAmt |
| Program Services | $209,614 | ProgramServicesAmt |
| Management And General | $57,206 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,493 | TotalAmt |
| Program Services | $55,379 | ProgramServicesAmt |
| Management And General | $15,114 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Program Supplies | $632,584 | $632,584 | |
| Other Expenses | $203,231 | $159,658 | $43,573 |
| Printing & Publications | $74,824 | $58,782 | $16,042 |
| Telephone | $73,344 | $57,619 | $15,725 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,887 | TotalAmt |
| Program Services | $64,565 | ProgramServicesAmt |
| Management And General | $17,620 | ManagementAndGeneralAmt |
| Fundraising | $5,702 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,309,287 | TotalAmt |
| Program Services | $9,033,259 | ProgramServicesAmt |
| Management And General | $2,270,326 | ManagementAndGeneralAmt |
| Fundraising | $5,702 | 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 | $1,160,446 | BOYAmt |
| EOY | $346,841 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $620,464 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $159,074 | BOYAmt |
| EOY | $45,911 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $941,880 | BOYAmt |
| EOY | $1,070,365 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $967 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,362 | BOYAmt |
| EOY | $125,070 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,528,843 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,619,103 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,719,087 | BOYAmt |
| EOY | $4,909,740 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $10,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,299 | BOYAmt |
| EOY | $154,945 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,246,148 | BOYAmt |
| EOY | $7,284,303 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $783,677 | BOYAmt |
| EOY | $859,487 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,149 | BOYAmt |
| EOY | $6,200 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,658,430 | BOYAmt |
| EOY | $1,556,894 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,472,256 | BOYAmt |
| EOY | $2,422,581 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,695,880 | BOYAmt |
| EOY | $4,751,777 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,711 | BOYAmt |
| EOY | $47,644 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,301 | BOYAmt |
| EOY | $62,301 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,773,892 | BOYAmt |
| EOY | $4,861,722 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,246,148 | BOYAmt |
| EOY | $7,284,303 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $85,896 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,934 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| 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 | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $2,460,713 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,492,877 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,594,871 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,811,681 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,927,688 | CurrentTaxYearAmt |
| Total | $13,287,830 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,600,777 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,706,444 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,583,101 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,463,590 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,463,901 | CurrentTaxYearAmt |
| Total | $44,817,813 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $18,861 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,629 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,140 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,951 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,500 | CurrentTaxYearAmt |
| Total | $73,081 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,080,351 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,218,950 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,194,112 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,292,222 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,393,089 | CurrentTaxYearAmt |
| Total | $58,178,724 | 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 | $58,178,724 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $271 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,017 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,725 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,002 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,246 | CurrentTaxYearAmt |
| Total | $12,261 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $271 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,017 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,725 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,002 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,246 | CurrentTaxYearAmt |
| Total | $12,261 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,080,622 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,221,967 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,196,837 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,295,224 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,396,335 | CurrentTaxYearAmt |
| Total | $58,190,985 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99980 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99820 | PublicSupportPY509Pct |
| Investment Income CY | 0.00020 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00020 | 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,100 | OtherCostOrOtherBasisAmt |
| Book Value | $11,100 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,924,524 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,653,174 | DepreciationAmt |
| Book Value | $4,271,350 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $107,094 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,503 | DepreciationAmt |
| Book Value | $70,591 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,168,822 | OtherCostOrOtherBasisAmt |
| Depreciation | $929,426 | DepreciationAmt |
| Book Value | $239,396 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $317,303 | OtherCostOrOtherBasisAmt |
| Book Value | $317,303 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,909,740 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $11,397,117 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,934 | OtherRevenueAmt |
| Revenue Not Reported | $1,934 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,395,183 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,395,183 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,309,287 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $11,309,287 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,309,287 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 1,934. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Edward Shanshala | ||||||||||||||
| CEO | $187,296 | $0 | $2,739 | $0 | $516 | $0 | $0 | $0 | $6,074 | $0 | $196,625 | $0 | $0 | $0 |
| David Ferris | ||||||||||||||
| Physician | $183,407 | $0 | $2,659 | $0 | $180 | $0 | $0 | $0 | $3,000 | $0 | $189,246 | $0 | $0 | $0 |
| David Nelson DO | ||||||||||||||
| Physician | $199,264 | $0 | $16,218 | $0 | $180 | $0 | $0 | $0 | $2,755 | $0 | $218,417 | $0 | $0 | $0 |
| Robin Hallquist | ||||||||||||||
| Physician | $173,638 | $0 | $1,204 | $0 | $305 | $0 | $0 | $0 | $11,399 | $0 | $186,546 | $0 | $0 | $0 |
| Melissa Buddensee | ||||||||||||||
| Physician | $228,257 | $0 | $20,239 | $0 | $108 | $0 | $0 | $0 | $2,885 | $0 | $251,489 | $0 | $0 | $0 |
| Particia Pratt MD | ||||||||||||||
| Physician | $198,190 | $0 | $6,345 | $0 | $792 | $0 | $0 | $0 | $10,494 | $0 | $215,821 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 7 | FormAndLineReferenceDesc |
| Explanation | Physicians received bonus compensation calculated by quality measures, patient satisfaction, citizenship and work RVUs. Edward Shanshala's bonus was authorized by the board and was calculated as follows: 50% of the amount based on full time equivalents (FTE), with each FTE receiving the same amount, and 50% based on a percentage of total wages paid during the fiscal year for all eligible employees. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 1,934. |
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