AMMONOOSUC COMMUNITY HEALTH SERVICES INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: AMMONOOSUC COMMUNITY HEALTH SERVICES INC (EIN 51-0137745)
Tax period: 2017-07-01 to 2018-06-30
Filed: 2018-11-12
IRS object ID: 201843169349300149
Schema version: 2017v2.3
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule G
Schedule J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-11-12T09:35:50-06:00	ReturnTs
Tax Period End	2018-06-30	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	2017-07-01	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	2018-11-05	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Dimitrios Panacopoulos CPA	PreparerPersonNm
PTIN	P01603705	PTIN
Phone	6036697337	PhoneNum
Preparation	2018-11-05	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	2018-11-05	IPDt
IP Tm	10:14:47	IPTm
IP Timezone	ES	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	393F6F577DCA6683369501490DDC019E9BE95353	AtSubmissionCreationDeviceId
At Submission Filing Device Id	C86B3C3384E7B30FA9F9EB149CE7FBCC333204C6	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	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	$12,295,224	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	11	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	142	TotalEmployeeCnt
Total Volunteers	11	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$2,594,871	PYContributionsGrantsAmt
CY Contributions Grants	$2,811,681	CYContributionsGrantsAmt
PY Program Service Revenue	$9,583,101	PYProgramServiceRevenueAmt
CY Program Service Revenue	$9,463,590	CYProgramServiceRevenueAmt
PY Investment Income	$2,725	PYInvestmentIncomeAmt
CY Investment Income	$3,002	CYInvestmentIncomeAmt
PY Other Revenue	$9,051	PYOtherRevenueAmt
CY Other Revenue	$6,673	CYOtherRevenueAmt
PY Total Revenue	$12,189,748	PYTotalRevenueAmt
CY Total Revenue	$12,284,946	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	$8,197,756	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$8,041,541	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$6,208	CYTotalFundraisingExpenseAmt
PY Other Expenses	$4,082,951	PYOtherExpensesAmt
CY Other Expenses	$3,847,067	CYOtherExpensesAmt
PY Total Expenses	$12,280,707	PYTotalExpensesAmt
CY Total Expenses	$11,888,608	CYTotalExpensesAmt
PY Revenues Less Expenses	-$90,959	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$396,338	CYRevenuesLessExpensesAmt
Total Assets BOY	$6,716,817	TotalAssetsBOYAmt
Total Assets EOY	$7,246,148	TotalAssetsEOYAmt
Total Liabilities BOY	$2,345,577	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$2,472,256	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$4,371,240	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$4,773,892	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	Yes (1)	SignificantChangeInd
Expense	$9,638,029	ExpenseAmt
Revenue	$9,463,590	RevenueAmt
Desc	Primary Care - To provide medical and educational services to the local community.Family Planning - To provide counseling in family planning to the local community.Family Support - To provide counseling in family support to the local community.Oral Health Program - To provide dental and oral health services to the local community.	Desc
Total Program Service Expenses	$9,638,029	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	Yes (1)	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	8	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	142	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
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	11	GoverningBodyVotingMembersCnt
Independent Voting Member	11	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	0	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	0	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 (18 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
Ned Densmore
Secretary	1.00	Yes (X)	Yes (X)	$0	$0	$0
Mark Secord
Vice President	1.00	Yes (X)	Yes (X)	$0	$0	$0
John Rapoport
Treasurer	1.00	Yes (X)	Yes (X)	$0	$0	$0
C Ronald Spaulding DDS
Board Member	1.00	Yes (X)		$0	$0	$0
Doug Harman
President	1.00	Yes (X)	Yes (X)	$0	$0	$0
Betsy Harman
Board Member	1.00	Yes (X)		$0	$0	$0
Gary Merchant
Board Member	1.00	Yes (X)		$0	$0	$0
Eric Becker
Board Member	1.00	Yes (X)		$0	$0	$0
Sandy Laleme
Board Member	1.00	Yes (X)		$0	$0	$0
Ivy Pearson
Board Member	1.00	Yes (X)		$0	$0	$0
Bob Tortorice
Board Member	1.00	Yes (X)		$0	$0	$0
Edward Shanshala
CEO	40.00		Yes (X)	$183,310	$0	$7,262
Kenneth Riebel
CFO	40.00		Yes (X)	$130,642	$0	$4,745
Particia Pratt MD
Physician	40.00			$212,689	$0	$3,696	Yes (X)
David Nelson DO
Physician	40.00			$197,342	$0	$4,163	Yes (X)
Imelyn Lahey MD
Physician	40.00			$196,720	$0	$4,647	Yes (X)
Melissa Buddensee
Physician	40.00			$222,203	$0	$8,046	Yes (X)
David Ferris
Physician	40.00			$179,530	$0	$3,546	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,322,436	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$36,105	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	17	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	$2,610,420	GovernmentGrantsAmt
All Other Contributions	$201,261	AllOtherContributionsAmt
Total Contributions	$2,811,681	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient Revenue	621110	$9,399,994	$9,399,994
Other Revenue	621110	$63,596	$63,596

Field	Value	IRS element (for citing)
Total Program Service Revenue	$9,463,590	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,002	TotalRevenueColumnAmt
Exclusion	$3,002	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$16,951	FundraisingGrossIncomeAmt
Fundraising Direct Expenses	$10,278	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$6,673	TotalRevenueColumnAmt
Exclusion	$6,673	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$12,284,946	TotalRevenueColumnAmt
Related Or Exempt Func Income	$9,463,590	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$9,675	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$325,959	TotalAmt
Program Services	$47,644	ProgramServicesAmt
Management And General	$278,315	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$6,535,787	TotalAmt
Program Services	$5,368,934	ProgramServicesAmt
Management And General	$1,166,853	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$631,816	TotalAmt
Program Services	$499,451	ProgramServicesAmt
Management And General	$132,365	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$547,979	TotalAmt
Program Services	$433,177	ProgramServicesAmt
Management And General	$114,802	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$20,349	TotalAmt
Management And General	$20,349	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$38,999	TotalAmt
Management And General	$38,999	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$405,249	TotalAmt
Program Services	$292,042	ProgramServicesAmt
Management And General	$113,207	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$72,634	TotalAmt
Management And General	$72,634	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$68,188	TotalAmt
Program Services	$53,903	ProgramServicesAmt
Management And General	$14,285	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$201,270	TotalAmt
Program Services	$201,270	ProgramServicesAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$341,785	TotalAmt
Program Services	$270,181	ProgramServicesAmt
Management And General	$71,604	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$29,035	TotalAmt
Program Services	$22,952	ProgramServicesAmt
Management And General	$6,083	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$55,013	TotalAmt
Management And General	$55,013	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$59,710	TotalAmt
Program Services	$47,201	ProgramServicesAmt
Management And General	$12,509	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$260,117	TotalAmt
Program Services	$205,622	ProgramServicesAmt
Management And General	$54,495	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$71,583	TotalAmt
Program Services	$56,586	ProgramServicesAmt
Management And General	$14,997	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Program Supplies	$1,845,280	$1,845,280
Other Expenses	$169,691	$134,141	$35,550
Printing & Publications	$70,892	$56,040	$14,852
Equipment Rental/Repair	$52,032	$41,131	$10,901

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$85,240	TotalAmt
Program Services	$62,474	ProgramServicesAmt
Management And General	$16,558	ManagementAndGeneralAmt
Fundraising	$6,208	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$11,888,608	TotalAmt
Program Services	$9,638,029	ProgramServicesAmt
Management And General	$2,244,371	ManagementAndGeneralAmt
Fundraising	$6,208	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	$810,305	BOYAmt
EOY	$1,160,446	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$73,874	BOYAmt
EOY	$159,074	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$907,377	BOYAmt
EOY	$941,880	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$143,954	BOYAmt
EOY	$0	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$129,103	BOYAmt
EOY	$108,362	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$7,071,371	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$2,352,284	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$4,510,366	BOYAmt
EOY	$4,719,087	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
EOY	$10,000	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$141,838	BOYAmt
EOY	$147,299	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$6,716,817	BOYAmt
EOY	$7,246,148	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$934,723	BOYAmt
EOY	$783,677	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$30,149	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$1,410,854	BOYAmt
EOY	$1,658,430	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$2,345,577	BOYAmt
EOY	$2,472,256	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$4,299,034	BOYAmt
EOY	$4,695,880	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$9,905	BOYAmt
EOY	$15,711	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	$4,371,240	BOYAmt
EOY	$4,773,892	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$6,716,817	BOYAmt
EOY	$7,246,148	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$396,338	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$6,314	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	$1,965,585	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$2,460,713	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$2,492,877	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,594,871	CurrentTaxYearMinus1YearAmt
Current Tax Year	$2,811,681	CurrentTaxYearAmt
Total	$12,325,727	TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$6,227,742	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$7,600,777	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$9,706,444	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$9,583,101	CurrentTaxYearMinus1YearAmt
Current Tax Year	$9,463,590	CurrentTaxYearAmt
Total	$42,581,654	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$8,193,327	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$10,061,490	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$12,199,321	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$12,177,972	CurrentTaxYearMinus1YearAmt
Current Tax Year	$12,275,271	CurrentTaxYearAmt
Total	$54,907,381	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	$54,907,381	PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$91	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$271	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$3,017	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,725	CurrentTaxYearMinus1YearAmt
Current Tax Year	$3,002	CurrentTaxYearAmt
Total	$9,106	TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$91	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$271	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$3,017	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,725	CurrentTaxYearMinus1YearAmt
Current Tax Year	$3,002	CurrentTaxYearAmt
Total	$9,106	TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$18,351	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$18,861	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$19,629	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$16,140	CurrentTaxYearMinus1YearAmt
Current Tax Year	$16,951	CurrentTaxYearAmt
Total	$89,932	TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$8,211,769	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$10,080,622	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$12,221,967	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$12,196,837	CurrentTaxYearMinus1YearAmt
Current Tax Year	$12,295,224	CurrentTaxYearAmt
Total	$55,006,419	TotalAmt

Field	Value	IRS element (for citing)
Public Support CY509	0.99820	PublicSupportCY509Pct
Public Support PY509	0.99800	PublicSupportPY509Pct
Investment Income CY	0.00020	InvestmentIncomeCYPct
Investment Income PY	0.00010	InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509	Yes (X)	ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,001,414	OtherCostOrOtherBasisAmt
Depreciation	$1,510,724	DepreciationAmt
Book Value	$4,490,690	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,069,957	OtherCostOrOtherBasisAmt
Depreciation	$841,560	DepreciationAmt
Book Value	$228,397	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$4,719,087	TotalBookValueLandBuildingsAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$12,291,260	TotalRevEtcAuditedFinclStmtAmt
Other Revenue	$6,314	OtherRevenueAmt
Revenue Not Reported	$6,314	RevenueNotReportedAmt
Revenue Subtotal	$12,284,946	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$12,284,946	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$11,888,608	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$11,888,608	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$11,888,608	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 perpetual trust 6,314.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	Amble	Event1Nm
Gross Receipts Event1	$16,951	GrossReceiptsEvent1Amt
Gross Revenue Event1	$16,951	GrossRevenueEvent1Amt
Other Direct Expenses Event1	$10,278	OtherDirectExpensesEvent1Amt
Gross Receipts Total	$16,951	GrossReceiptsTotalAmt
Gross Revenue Total Events	$16,951	GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events	$10,278	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$10,278	DirectExpenseSummaryEventsAmt
Net Income Summary	$6,673	NetIncomeSummaryAmt

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	$183,034	$0	$0	$0	$276	$0	$0	$0	$7,262	$0	$190,572	$0	$0	$0
Particia Pratt MD
Physician	$201,554	$0	$10,343	$0	$792	$0	$0	$0	$3,696	$0	$216,385	$0	$0	$0
David Nelson DO
Physician	$186,995	$0	$10,227	$0	$120	$0	$0	$0	$4,163	$0	$201,505	$0	$0	$0
Imelyn Lahey MD
Physician	$191,612	$0	$5,000	$0	$108	$0	$0	$0	$4,647	$0	$201,367	$0	$0	$0
Melissa Buddensee
Physician	$212,354	$0	$9,741	$0	$108	$0	$0	$0	$8,046	$0	$230,249	$0	$0	$0
David Ferris
Physician	$179,350	$0	$0	$0	$180	$0	$0	$0	$3,546	$0	$183,076	$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.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part III, line 3	Closed in-house pharmacy.
Form 990, Part VI, Section A, line 2	Doug and Betsy Harman have a family relationship.
Form 990, Part VI, Section B, line 11b	A copy of the 990 was provided to and approved by the board of directors prior to filing.
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 perpetual trust 6,314.