2017-11-13T12:49:36-06:00 2017-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2016-07-01 510137745 Ammonoosuc Community Health Services Inc AMMO 6034442464 25 Mt Eustis Road Littleton NH 03561 Edward Shanshala CEO 6034442464 2017-11-10 1 Dimitrios Panacopoulos CPA P01603705 6036697337 2017-11-10 69.49.157.66 2017-11-10 15:33:24 ES P A008E2FD9533E1BBB31C63A12AF0D0E643CE99E5 2F6A6628984E28F532C67895704E4F1F38634DDA 2016 2017-02-10 21:41:12Z Edward Shanshala 25 Mt Eustis Road Littleton NH 03561 12196837 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. 12 12 142 12 0 0 2492877 2594871 9706444 9583101 3017 2725 14524 9051 12216862 12189748 0 0 0 0 7475142 8197756 0 0 312 4305511 4082951 11780653 12280707 436209 -90959 6788237 6716817 2336464 2345577 4451773 4371240 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. 1 0 10067336 9583101 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. 10067336 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 12 12 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 Beth Harwood Co-Vice President 1.00 X X 0 0 0 Alan Smith Board Member 1.00 X 0 0 0 Ned Densmore Secretary 1.00 X X 0 0 0 Mark Secord Co-Vice President 1.00 X X 0 0 0 John Rapoport Treasurer 1.00 X X 0 0 0 Ronald Spaulding 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 Rick Chrisofferson 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 Natch Greyes Board Member 1.00 X 0 0 0 Edward Shanshala CEO 40.00 X 196519 0 3639 Kenneth Riebel CFO 40.00 X 128996 0 6841 Particia Pratt MD Physician 40.00 X 220116 0 1613 David Nelson DO Medical Director 40.00 X 196514 0 1826 Imelyn Lahey MD Physician 40.00 X 202607 0 5376 Damian Anthony-Canuto Pharmacist 40.00 X 147995 0 3448 Melissa Buddensee Physician 40.00 X 196073 0 17573 1288820 0 40316 17 0 1 0 0 2507431 87440 11100 2594871 Patient Revenue 621110 9583101 9583101 9583101 2725 2725 16140 7089 9051 9051 12189748 9583101 0 11776 335995 50040 285955 6702772 5527930 1174842 596726 473502 123224 562263 446156 116107 22701 22701 35398 35398 377087 261984 115103 41344 41344 59491 47206 12285 201263 201263 312280 247794 64486 23615 18739 4876 75187 75187 50984 40456 10528 258704 205282 53422 67462 53531 13931 Program Supplies 2248795 2248795 Other Expenses 102466 81307 21159 Printing & Publications 77442 61450 15992 Equipment Rental/Repair 52086 41330 10756 76646 60571 15763 312 12280707 10067336 2213059 312 X 660596 810305 39793 73874 896913 907377 236704 143954 131877 129103 6602532 2092166 4698815 4510366 123539 141838 6788237 6716817 831198 934723 15000 0 1490266 1410854 2336464 2345577 X 4389472 4299034 9905 62301 62301 4451773 4371240 6788237 6716817 X -90959 10426 X 0 1 X 1 1 1 X 1792569 1965585 2460713 2492877 2594871 11306615 5356854 6227742 7600777 9706444 9583101 38474918 7149423 8193327 10061490 12199321 12177972 49781533 0 0 0 49781533 540 91 271 3017 2725 6644 540 91 271 3017 2725 6644 21738 18351 18861 19629 16140 94719 7171701 8211769 10080622 12221967 12196837 49882896 0.99800 0.99990 0.00010 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5575314 1338415 4236899 1027218 753751 273467 4510366 X 12200174 10426 10426 12189748 0 12189748 12280707 0 12280707 0 12280707 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 10,426. Amble 16140 16140 7089 16140 16140 7089 7089 9051 X X X 0 0 0 0 0 0 0 1 0 Edward Shanshala CEO 169345 0 0 0 27174 0 0 0 3639 0 200158 0 0 0 Particia Pratt MD Physician 200927 0 18854 0 335 0 0 0 1613 0 221729 0 0 0 David Nelson DO Medical Director 186771 0 9617 0 126 0 0 0 1826 0 198340 0 0 0 Imelyn Lahey MD Physician 188592 0 8969 0 5046 0 0 0 5376 0 207983 0 0 0 Damian Anthony-Canuto Pharmacist 147954 0 0 0 41 0 0 0 3448 0 151443 0 0 0 Melissa Buddensee Physician 184360 0 6672 0 5041 0 0 0 17573 0 213646 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 2 Vision Program 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 10,426.