2016-01-12T14:16:14-06:00 2015-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2014-07-01 020350051 Coos County Family Health Services Inc COOS 6037522040 133 Pleasant Street Berlin NH 03570 Robert Pelchat Board President 6037527719 2016-01-12 1 Dimitrios Panacopoulos P01603705 6036697337 2016-01-06 2014 2016-04-25 22:37:26Z Ken Gordon 133 Pleasant Street Berlin NH 03570 11097296 0 X www.coosfamilyhealth.org X 1980 NH Coos County Family Health Services, Inc. is a community-based organization providing innovative, personalized, comprehensive health care and social services of the highest quality to everyone, regrdless of economic status. 13 13 141 20 0 0 3305345 2846003 7773326 8248232 4707 3061 0 0 11083378 11097296 0 0 0 0 7210447 7507353 0 0 2489 2756036 2871285 9966483 10378638 1116895 718658 4915079 5445033 1759673 1570727 3155406 3874306 Coos County Family Health Services, Inc. is a community-based organization providing innovative, personalized, comprehensive health care and social services of the highest quality to everyone, regardless of economic status. 0 0 9033817 8248232 Provision of primary care services to the community. 9033817 1 1 0 0 0 0 0 0 0 1 1 0 0 1 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 35 0 1 141 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X X X Ken Gordon 6037522040 133 Pleasant Street Berlin NH 03570 Robert Pelchat President 1.00 X X 0 0 0 Joan Merrill Vice President 1.00 X X 0 0 0 Aline Boucher Treasurer 1.00 X X 0 0 0 Jeffrey Smith Secretary 1.00 X X 0 0 0 Marge McClellan Board Member 1.00 X 0 0 0 H Guyford Stever Jr Board Member 1.00 X 0 0 0 Andrea Gagne Board Member 1.00 X 0 0 0 Charles Greenhalgh Board Member 1.00 X 0 0 0 Roland Olivier Board Member 1.00 X 0 0 0 Christie Nelson Board Member 1.00 X 0 0 0 David Morin Board Member 1.00 X 0 0 0 Robert Thompson Board Member 1.00 X 0 0 0 Linda Sjostrom Board Member 1.00 X 0 0 0 Adele Woods CEO 40.00 X 146127 0 8975 Melissa Frenette CFO 40.00 X 96084 0 23512 Brian Beals Physician 38.00 X 236316 0 36610 Thomas Temme Physician 30.00 X 130459 0 34062 Elaine Chappell Physician 32.00 X 154998 0 7928 Josee Bourbeau MD Physician 30.00 X 148426 0 34408 Mitchell Sullivan MD Physician 40.00 X 144298 0 24349 1056708 0 169844 10 0 1 0 Ray's Electric 33 Jericho Rd Berlin NH 03570 Building Renovation 311490 Androscoggin Valley Hospital 59 Page Hill Rd Berlin NH 03570 Rent/Physicians/OB 147624 Corporate Data & Voice Solutions 59 Stiles Rd 201 Salem NH 03079 Computer Equipment 125094 3 4484 2159115 682404 2846003 Patient Service Revenue 621110 8094909 8094909 Other Operating Revenue 621110 153323 153323 8248232 3061 3061 11097296 8248232 0 3061 274698 38776 235922 5475200 4927680 547520 159361 138373 20988 1140701 990471 150230 457393 397154 60239 20537 20537 45130 45130 333892 333892 35057 35057 93591 81265 12326 154477 154477 302613 262759 39854 28568 24806 3762 82202 82202 27282 23689 3593 229013 198852 30161 51503 44720 6783 Program Supplies 1100254 1100254 Other Expenses 154311 133988 20323 Printing & Publications 86291 74926 11365 Telephone 52536 45617 6919 74028 62118 9421 2489 10378638 9033817 1342332 2489 X 371527 836038 143394 298215 978555 1064656 91036 71972 5098723 2638479 2619138 2460244 711429 713908 4915079 5445033 957960 854875 26724 774989 715852 1759673 1570727 X 2392640 3750548 740809 99461 21957 24297 3155406 3874306 4915079 5445033 X 718658 242 X 0 1 X 1 1 1 X 3560033 2785222 2761749 3305345 2846003 15258352 5699859 5687797 6014105 7773326 8248232 33423319 9259892 8473019 8775854 11078671 11094235 48681671 0 0 0 48681671 1882 3881 3664 4707 3061 17195 1882 3881 3664 4707 3061 17195 9261774 8476900 8779518 11083378 11097296 48698866 0.99960 0.99970 0.00040 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 23930 125 1066 824 24297 22026 1267 1699 1062 23930 19107 2113 806 22026 17623 1657 -173 19107 15874 2003 -254 17623 1.00000 0 0 153257 153257 3205175 1160071 2045104 1740291 1478408 261883 2460244 Due from Third Party Payers 45000 Assets Limited as to Use 648693 Beneficial Interest in Perpetual Trust Held by Others 20215 713908 X 11097538 242 242 11097296 0 11097296 10378638 0 10378638 0 10378638 Part V, Line 4: Income earned is used for operations. 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 Fair value of Beneficial Interest 242. Part V, line 1: Prior year amounts have been restated in order to agree to financial statements. X X X X 0 0 0 0 0 0 0 1 0 Adele Woods CEO 146127 0 0 0 0 0 0 0 8975 0 155102 0 0 0 Brian Beals Physician 146706 0 78334 0 11276 0 0 0 36610 0 272926 0 0 0 Thomas Temme Physician 116332 0 10000 0 4127 0 0 0 34062 0 164521 0 0 0 Elaine Chappell Physician 154998 0 0 0 0 0 0 0 7928 0 162926 0 0 0 Josee Bourbeau MD Physician 91367 0 54168 0 2891 0 0 0 34408 0 182834 0 0 0 Mitchell Sullivan MD Physician 109870 0 31026 0 3402 0 0 0 24349 0 168647 0 0 0 Part I, Line 7 Physicians are provided incentive payments based on number of patients seen, complexity of patient acuity, timely documentation, patient satisfication, and quality of care provided. Form 990, Part VI, Section B, line 11 The CFO compares the Form 990 to the audited financial statements and prior year 990. A copy is given to the Finance Committee to review and then a copy is given to the board of directors to review and approve. Form 990, Part VI, Section B, line 12c Annually, the board re-affirms their compliance with the conflict of interest policy with a written compliance document. Form 990, Part VI, Section B, line 15 The compensation process for the CEO, COO and CFO includes an independent compensation consultant completing a compensation survey or study. The compensation amount is then approved by the board of directors. Form 990, Part VI, Section C, line 19 Documents are posted to the Organization's website and are available upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Coos County Family Health Services, Inc. 133 Pleasant Street, Berlin, NH 03570 EIN 02-0350051 Coos County Family 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 fair value of beneficial interest in perpetual trust 242.