2018-11-12T09:35:50-06:00 2018-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th Floor Manchester NH 03101 990 2017-07-01 510137745 Ammonoosuc Community Health Services Inc AMMO 6034442464 25 Mt Eustis Road Littleton NH 03561 Edward Shanshala CEO 6034442464 2018-11-05 1 Dimitrios Panacopoulos CPA P01603705 6036697337 2018-11-05 69.49.157.66 2018-11-05 10:14:47 ES P 393F6F577DCA6683369501490DDC019E9BE95353 C86B3C3384E7B30FA9F9EB149CE7FBCC333204C6 2017 2019-02-21 02:37:17Z Edward Shanshala 25 Mt Eustis Road Littleton NH 03561 12295224 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. 11 11 142 11 0 0 2594871 2811681 9583101 9463590 2725 3002 9051 6673 12189748 12284946 0 0 0 0 8197756 8041541 0 0 6208 4082951 3847067 12280707 11888608 -90959 396338 6716817 7246148 2345577 2472256 4371240 4773892 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 1 9638029 9463590 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. 9638029 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 0 1 142 1 0 0 0 0 0 0 0 0 0 0 X 11 11 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1 1 0 0 NH X Ken Riebel 6034442464 25 Mt Eustis Road Littleton NH 03561 Ned Densmore Secretary 1.00 X X 0 0 0 Mark Secord Vice President 1.00 X X 0 0 0 John Rapoport Treasurer 1.00 X X 0 0 0 C Ronald Spaulding DDS Board Member 1.00 X 0 0 0 Doug Harman President 1.00 X X 0 0 0 Betsy Harman Board Member 1.00 X 0 0 0 Gary Merchant Board Member 1.00 X 0 0 0 Eric Becker Board Member 1.00 X 0 0 0 Sandy Laleme Board Member 1.00 X 0 0 0 Ivy Pearson Board Member 1.00 X 0 0 0 Bob Tortorice Board Member 1.00 X 0 0 0 Edward Shanshala CEO 40.00 X 183310 0 7262 Kenneth Riebel CFO 40.00 X 130642 0 4745 Particia Pratt MD Physician 40.00 X 212689 0 3696 David Nelson DO Physician 40.00 X 197342 0 4163 Imelyn Lahey MD Physician 40.00 X 196720 0 4647 Melissa Buddensee Physician 40.00 X 222203 0 8046 David Ferris Physician 40.00 X 179530 0 3546 1322436 0 36105 17 0 1 0 0 2610420 201261 2811681 Patient Revenue 621110 9399994 9399994 Other Revenue 621110 63596 63596 9463590 3002 3002 16951 10278 6673 6673 12284946 9463590 0 9675 325959 47644 278315 6535787 5368934 1166853 631816 499451 132365 547979 433177 114802 20349 20349 38999 38999 405249 292042 113207 72634 72634 68188 53903 14285 201270 201270 341785 270181 71604 29035 22952 6083 55013 55013 59710 47201 12509 260117 205622 54495 71583 56586 14997 Program Supplies 1845280 1845280 Other Expenses 169691 134141 35550 Printing & Publications 70892 56040 14852 Equipment Rental/Repair 52032 41131 10901 85240 62474 16558 6208 11888608 9638029 2244371 6208 X 810305 1160446 73874 159074 907377 941880 143954 0 129103 108362 7071371 2352284 4510366 4719087 10000 141838 147299 6716817 7246148 934723 783677 0 30149 1410854 1658430 2345577 2472256 X 4299034 4695880 9905 15711 62301 62301 4371240 4773892 6716817 7246148 X 396338 6314 X 0 1 X 1 1 1 X 1965585 2460713 2492877 2594871 2811681 12325727 6227742 7600777 9706444 9583101 9463590 42581654 8193327 10061490 12199321 12177972 12275271 54907381 0 0 0 54907381 91 271 3017 2725 3002 9106 91 271 3017 2725 3002 9106 18351 18861 19629 16140 16951 89932 8211769 10080622 12221967 12196837 12295224 55006419 0.99820 0.99800 0.00020 0.00010 X 6001414 1510724 4490690 1069957 841560 228397 4719087 X 12291260 6314 6314 12284946 0 12284946 11888608 0 11888608 0 11888608 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. Amble 16951 16951 10278 16951 16951 10278 10278 6673 X X X 0 0 0 0 0 0 0 1 0 Edward Shanshala CEO 183034 0 0 0 276 0 0 0 7262 0 190572 0 0 0 Particia Pratt MD Physician 201554 0 10343 0 792 0 0 0 3696 0 216385 0 0 0 David Nelson DO Physician 186995 0 10227 0 120 0 0 0 4163 0 201505 0 0 0 Imelyn Lahey MD Physician 191612 0 5000 0 108 0 0 0 4647 0 201367 0 0 0 Melissa Buddensee Physician 212354 0 9741 0 108 0 0 0 8046 0 230249 0 0 0 David Ferris Physician 179350 0 0 0 180 0 0 0 3546 0 183076 0 0 0 Part I, Line 7 Physicians received bonus compensation calculated by quality measures, patient satisfaction, citizenship and work RVUs. 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.