2015-01-26T14:19:28-06:00 2014-06-30 020400296 Brad Borbidge PA 197 Loudon Road Concord NH 03301 990 2013-07-01 020350051 Coos County Family Health Services Inc COOS 6037522040 133 Pleasant Street Berlin NH 03570 Robert Pelchat Board President 6037527719 2015-01-26 1 Dimitrios Panacopoulos CPA P01603705 6032240849 2013 2016-02-25 16:41:14Z Adele Woods 133 Pleasant Street Berlin NH 03570 11083378 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. 12 12 135 20 0 0 2761749 3305345 6014105 7773326 3664 4707 0 0 8779518 11083378 0 0 0 0 6688068 7210447 0 0 2046 1978429 2756036 8666497 9966483 113021 1116895 3865467 4915079 1826956 1759673 2038511 3155406 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 8728330 7773326 Provision of primary care services to the community. 8728330 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 1 0 0 0 0 0 0 0 0 0 1 35 0 1 135 1 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X X X Adele Woods 6037522040 133 Pleasant Street Berlin NH 03570 Robert Pelchat President 0.00 X 0 0 0 Joan Merrill Vice President 0.00 X 0 0 0 Aline Boucher Treasurer 0.00 X 0 0 0 Marge McClellan Board of Directors 0.00 X 0 0 0 Asa Brosnan Board of Directors 0.00 X 0 0 0 Linda Sjostrom Board of Directors 0.00 X 0 0 0 H Guyford Stever Jr Board of Directors 0.00 X 0 0 0 Andrea Gagne Board of Directors 0.00 X 0 0 0 Jeffrey Smith Secretary 0.00 X 0 0 0 Charles Greenhalgh Board of Directors 0.00 X 0 0 0 Roland Olivier Board of Directors 0.00 X 0 0 0 Christie Nelson Board of Directors 0.00 X 0 0 0 Adele Woods CEO 40.00 X 141579 0 8534 Melissa Frenette CFO 40.00 X 91647 0 16202 Patricia Couture COO 40.00 X 102060 0 6027 Mitchell Sullivan MD Medical Director 40.00 X 178669 0 34551 Brian Beals Physician 37.50 X 202185 0 35324 Thomas Temme Physician 30.00 X 126938 0 33220 Josee Bourbeau MD Physician 30.00 X 165677 0 34481 Sandra Benckendorf Physician 30.00 X 122922 0 23827 William Gessner Physician 30.00 X 129665 0 15024 1261342 0 207190 8 0 1 0 Androscoggin Valley Hospital 59 Page Hill Rd Berlin NH 03570 Rent/Physicians/OB 290004 1 500 2619904 684941 3305345 Office of Physicians 621110 7773326 7773326 7773326 4707 4707 11083378 7773326 0 4707 579269 348027 231242 5011020 4509918 501102 160026 139479 20547 1018134 887406 130728 441998 385245 56753 7970 7970 40801 40801 385113 385113 42787 42787 116770 101777 14993 143780 143780 302170 263371 38799 28412 24764 3648 69446 69446 33618 29301 4317 235073 204890 30183 54257 47290 6967 Program Supplies 1014793 1014793 Other Expenses 91682 79910 11772 Printing and Publicatio 67772 59070 8702 Telephone 56574 49310 7264 65018 54886 8086 2046 9966483 8728330 1236107 2046 310353 371527 242150 143394 435123 978555 102267 91036 5082653 2463515 2100494 2619138 675080 711429 3865467 4915079 763723 957960 60282 26724 981894 774989 21057 0 1826956 1759673 X 1153541 2392640 864280 740809 20690 21957 2038511 3155406 3865467 4915079 1116895 0 X 0 1 X 1 1 1 X 3420596 3560033 2785222 2761749 3305345 15832945 5664361 5699859 5687797 6014105 7773326 30839448 9084957 9259892 8473019 8775854 11078671 46672393 0 0 0 46672393 1273 1882 3881 3664 4707 15407 1273 1882 3881 3664 4707 15407 9086230 9261774 8476900 8779518 11083378 46687800 0.99970 0.99970 0.00030 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 22026 1267 1699 24992 19107 2113 806 22026 17623 1657 -173 19107 15874 2003 -254 17623 12919 2917 38 15874 1.00000 0 0 153257 153257 3176922 1042192 2134730 1752474 1421323 331151 2619138 Due From Third Party Payers 40105 Assets Limited as to Use 651351 Beneficial Interest in Perpetual Trust Held By Others 19973 711429 11083378 0 11083378 0 11083378 9966483 0 9966483 0 9966483 Part V, Line 4: Income earned is used for operations. Part IV, Line 11F 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. X X X X 0 0 0 0 0 0 0 1 0 Adele Woods CEO 141579 0 0 0 0 0 0 0 8534 0 150113 0 0 0 Mitchell Sullivan MD Medical Director 148927 0 29742 0 0 0 0 0 34551 0 213220 0 0 0 Brian Beals Physician 158934 0 43251 0 0 0 0 0 35324 0 237509 0 0 0 Thomas Temme Physician 116938 0 10000 0 0 0 0 0 33220 0 160158 0 0 0 Josee Bourbeau MD Physician 119996 0 45681 0 0 0 0 0 34481 0 200158 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. Adele Woods CEO 151668 The Organization is a participant of the North Country Accountable Care Organization (NCACO). The NCACO was created to undertake programs and activities of ACO participants for the purpose of participating in the Medicare Shared Savings Program for services to Medicare Beneficiaries. Adele Woods is also the Vice President of the board of directors for the NCACO. The transaction amount reported represents startup monies and shared savings passed through to the Organization from the NCACO through June 30, 2014. 0 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.