2019-12-03T13:08:31-06:00 2019-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th Floor Manchester NH 03101 990 2018-07-01 510137745 Ammonoosuc Community Health Services Inc AMMO 6034442464 25 Mt Eustis Road Littleton NH 03561 Edward Shanshala CEO 6034442464 2019-12-03 1 Melissa Magoon CPA P01712842 6036697337 2019-12-03 69.49.157.66 2019-12-03 11:23:09 ES P BCE379EC6B2F882893C3F02DE0A5A3D951B1B2ED BFB386403C9EAE7FF660C386334FC3E1098CE7FC 2018 2020-03-31 21:24:44Z Edward Shanshala 25 Mt Eustis Road Littleton NH 03561 11396335 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 13 109 13 0 0 2811681 2927688 9463590 8463901 3002 3246 6673 348 12284946 11395183 0 0 0 0 8041541 8364903 0 0 5702 3847067 2944384 11888608 11309287 396338 85896 7246148 7284303 2472256 2422581 4773892 4861722 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 9033259 8463901 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. 9033259 1 1 0 0 0 0 0 0 0 0 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 0 0 0 0 1 16 0 1 109 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 Ken Riebel 6034442464 25 Mt Eustis Road Littleton NH 03561 Barbara Szeidler Board Member 1.00 X 0 0 0 Betsy Harman Board Member 1.00 X 0 0 0 Bob Tortorice Board Member 1.00 X 0 0 0 Doug Harman President 1.00 X X 0 0 0 Eric Becker Board Member 1.00 X 0 0 0 Evelyn Hagen Board Member 1.00 X 0 0 0 Frank Pinter Board Member 1.00 X 0 0 0 Gary Merchant Board Member 1.00 X 0 0 0 Ivy Pearson Vice President 1.00 X X 0 0 0 Jeffrey Jones Board Member 1.00 X 0 0 0 John Rapoport Treasurer 1.00 X X 0 0 0 Lynn Davis Board Member 1.00 X 0 0 0 Mark Secord Past Vice President 1.00 X 0 0 0 Ned Densmore Past Secretary 1.00 X 0 0 0 Ron Spaulding Past Board Member 1.00 X 0 0 0 Sandra Laleme Secretary 1.00 X X 0 0 0 Edward Shanshala CEO 40.00 X 190551 0 6074 Kenneth Riebel CFO 40.00 X 135799 0 3538 David Ferris Physician 40.00 X 186246 0 3000 David Nelson DO Physician 40.00 X 215662 0 2755 Robin Hallquist Physician 40.00 X 175147 0 11399 Melissa Buddensee Physician 40.00 X 248604 0 2885 Particia Pratt MD Physician 40.00 X 205327 0 10494 1357336 0 40145 14 0 1 0 0 2751795 175893 2927688 Patient Revenue 621110 8374895 8374895 Other Revenue 621110 89006 89006 8463901 3246 3246 1500 1152 348 348 11395183 8463901 0 3594 335962 49157 286805 6810650 5558923 1251727 647331 508543 138788 570960 448546 122414 20967 16472 4495 48800 38337 10463 591717 488688 103029 64575 50730 13845 62442 49054 13388 200211 157286 42925 389300 305834 83466 44811 35204 9607 51175 40203 10972 61203 48081 13122 266820 209614 57206 70493 55379 15114 Program Supplies 632584 632584 Other Expenses 203231 159658 43573 Printing & Publications 74824 58782 16042 Telephone 73344 57619 15725 87887 64565 17620 5702 11309287 9033259 2270326 5702 X 1160446 346841 620464 159074 45911 941880 1070365 967 108362 125070 7528843 2619103 4719087 4909740 10000 10000 147299 154945 7246148 7284303 783677 859487 30149 6200 1658430 1556894 2472256 2422581 X 4695880 4751777 15711 47644 62301 62301 4773892 4861722 7246148 7284303 X 85896 1934 X 0 1 X 1 1 1 X 2460713 2492877 2594871 2811681 2927688 13287830 7600777 9706444 9583101 9463590 8463901 44817813 18861 19629 16140 16951 1500 73081 10080351 12218950 12194112 12292222 11393089 58178724 0 0 0 58178724 271 3017 2725 3002 3246 12261 271 3017 2725 3002 3246 12261 10080622 12221967 12196837 12295224 11396335 58190985 0.99980 0.99820 0.00020 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11100 11100 5924524 1653174 4271350 107094 36503 70591 1168822 929426 239396 317303 317303 4909740 X 11397117 1934 1934 11395183 0 11395183 11309287 0 11309287 0 11309287 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. X X X 0 0 0 0 0 0 0 1 0 Edward Shanshala CEO 187296 0 2739 0 516 0 0 0 6074 0 196625 0 0 0 David Ferris Physician 183407 0 2659 0 180 0 0 0 3000 0 189246 0 0 0 David Nelson DO Physician 199264 0 16218 0 180 0 0 0 2755 0 218417 0 0 0 Robin Hallquist Physician 173638 0 1204 0 305 0 0 0 11399 0 186546 0 0 0 Melissa Buddensee Physician 228257 0 20239 0 108 0 0 0 2885 0 251489 0 0 0 Particia Pratt MD Physician 198190 0 6345 0 792 0 0 0 10494 0 215821 0 0 0 Part I, Line 7 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. 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.