COMMUNITY HEALTH ACCESS NETWORK: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH ACCESS NETWORK (EIN 04-3349104)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-04-30
- IRS object ID
- 201311209349300021
- Schema version
- 2011v1.5
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-04-30T10:10:54-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020400296 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRAD BORBIDGE PA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 197 LOUDON ROAD STE 350 | AddressLine1 |
| City | CONCORD | City |
| State | NH | State |
| ZIP Code | 03301 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 043349104 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Health Access Network | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 6036592494 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 207 South Main Street | AddressLine1 |
| City | Newmarket | City |
| State | NH | State |
| ZIP Code | 03857 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kirsten Platte | Name |
| Title | Executive Director | Title |
| Phone | 6036592494 | Phone |
| Date Signed | 2013-04-30 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DIMITRIOS PANACOPOULOS CPA | Name |
| PTIN | P01603705 | PTIN |
| Phone | 6032240849 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Kirsten Platte | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 207 South Main Street | AddressLine1 |
| City | Newmarket | City |
| State | NH | State |
| ZIP Code | 03857 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1750186 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.chan-nh.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | To enable our member agencies to develop the program and resources necessary to assure access to efficient, effective quality health care for all clients in our communities particularly the uninsured, Medicaid, and medically underserved populations. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 6 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 877869 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 981316 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 702774 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 768870 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1580643 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1750186 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 240126 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 275350 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1347478 | OtherExpensePriorYear |
| Other Expenses Current Year | 1316238 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1587604 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1591588 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -6961 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 158598 | RevenuesLessExpensesCY |
| Total Assets BOY | 1904187 | TotalAssetsBOY |
| Total Assets EOY | 1846406 | TotalAssetsEOY |
| Total Liabilities BOY | 1118140 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 901761 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 786047 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 944645 | NetAssetsOrFundBalancesEOY |
| Mission Description | To enable our member agencies to develop the program and resources necessary to assure access to efficient, effective quality health care for all clients in our communities particularly the uninsured, Medicaid, and medically underserved populations. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1404045 | Expense |
| Revenue | 768870 | Revenue |
| Description | To provide services and conduct activities that improve the health status of communities served. | Description |
| Total Program Service Expense | 1404045 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 9 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 6 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kirsten Platte | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6032927205 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 207 South Main Street | AddressLine1 |
| City | Newmarket | City |
| State | NH | State |
| ZIP Code | 03857 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (8 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| Helen Taft | ||||||
| President/Chair | 0.00 | X | 0 | 0 | 0 | |
| Edward George | ||||||
| Secretary | 0.00 | X | 0 | 0 | 0 | |
| Richard Silverberg | ||||||
| Treasurer | 0.00 | X | 0 | 0 | 0 | |
| Janet Atkins | ||||||
| Board Member | 0.00 | X | 0 | 0 | 0 | |
| Ann Peters | ||||||
| Board Member | 0.00 | X | 0 | 0 | 0 | |
| Dustin Hawk | ||||||
| Board Member | 0.00 | X | 0 | 0 | 0 | |
| Peter Kelleher | ||||||
| Board Member | 0.00 | X | 0 | 0 | 0 | |
| Kirsten Platte | ||||||
| Executive Director | 40.00 | 72264 | 0 | 7539 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 72264 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 7539 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Lamprey Health Care | |||||
| 207 South Main Street | Newmarket | NH | 03857 | Contracted Staff | 302657 |
| Southern New Hampshire AHEC | |||||
| 207 South Main Street | Newmarket | NH | 03857 | Chronic Disease Management | 137201 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Membership Dues | 121815 | MembershipDues |
| Government Grants | 859501 | GovernmentGrants |
| Total Contributions | 981316 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Service Revenue | Description |
| Business Code | 518210 | BusinessCode |
| Total Revenue Column | 768870 | TotalRevenueColumn |
| Related Or Exempt Function Income | 768870 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 768870 | TotalProgramServiceRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1750186 | TotalRevenueColumn |
| Related Or Exempt Function Income | 768870 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79803 | Total |
| Management And General | 79803 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158382 | Total |
| Program Services | 127460 | ProgramServices |
| Management And General | 30922 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18713 | Total |
| Program Services | 10341 | ProgramServices |
| Management And General | 8372 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18452 | Total |
| Program Services | 10197 | ProgramServices |
| Management And General | 8255 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5620 | Total |
| Management And General | 5620 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13000 | Total |
| Management And General | 13000 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 588840 | Total |
| Program Services | 588840 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 857 | Total |
| Program Services | 474 | ProgramServices |
| Management And General | 383 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 291834 | Total |
| Program Services | 291834 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42816 | Total |
| Program Services | 23661 | ProgramServices |
| Management And General | 19155 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10895 | Total |
| Program Services | 6021 | ProgramServices |
| Management And General | 4874 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8766 | Total |
| Program Services | 4844 | ProgramServices |
| Management And General | 3922 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 322611 | Total |
| Program Services | 322611 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12163 | Total |
| Program Services | 6722 | ProgramServices |
| Management And General | 5441 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Telephone | 13164 | 7275 | 5889 |
| Dues | 3250 | 1796 | 1454 |
| Program Supplies | 1409 | 1409 | |
| Other Expenses | 716 | 396 | 320 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 297 | Total |
| Program Services | 164 | ProgramServices |
| Management And General | 133 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1591588 | Total |
| Program Services | 1404045 | ProgramServices |
| Management And General | 187543 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54839 | BOY |
| EOY | 76211 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1060345 | BOY |
| EOY | 803522 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58505 | BOY |
| EOY | 9243 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 119438 | BOY |
| EOY | 154442 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2482886 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1679898 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 611060 | BOY |
| EOY | 802988 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1904187 | BOY |
| EOY | 1846406 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61251 | BOY |
| EOY | 335178 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1056889 | BOY |
| EOY | 566583 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1118140 | BOY |
| EOY | 901761 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 786047 | BOY |
| EOY | 944645 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 786047 | BOY |
| EOY | 944645 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1904187 | BOY |
| EOY | 1846406 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 158598 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 251818 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 455304 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 926625 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 877869 | CurrentTaxYearMinus1Year |
| Current Tax Year | 981315 | CurrentTaxYear |
| Total | 3492931 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 251818 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 455304 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 926625 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 877869 | CurrentTaxYearMinus1Year |
| Current Tax Year | 981315 | CurrentTaxYear |
| Total | 3492931 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 3492931 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 510 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 34 | CurrentTaxYearMinus3Years |
| Total | 544 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 3493475 | TotalSupport |
| Gross Receipts From Admissions Etc | 3332499 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.99980 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.99930 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2482886 | OtherCostOrOtherBasis |
| Depreciation | 1679898 | Depreciation |
| Book Value | 802988 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 802988 | TotalOfBookValueLandBuildings |
| Total Revenue | 1750186 | TotalRevenue |
| Total Expenses | 1591588 | TotalExpenses |
| Excess Or Deficit For Year | 158598 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 158598 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 1750186 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 1750186 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1750186 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1591588 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1591588 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1591588 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | 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 position and concluded that the Organization has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (7 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Janet Atkins | |||
| Board Member | 153342 | Janet Atkins is the CEO of Goodwin Community Health, a member of Community Health Access Network. Transactions reported here include the following: Dues $18,150, Shared IT Systems $135,025, and other income $168. | 0 |
| Helen Taft | |||
| Board President | 72150 | Helen Taft is the Executive Director of Families First of Greater Seacoast, a member of Community Health Access Network. Transactions reported here include the following: Dues $18,150, Shared IT Systems $50,466, Licenses purchased $1,890 and Other income $1,644. | 0 |
| Richard Silverberg | |||
| Board Treasurer | 43132 | Richard Silverberg is the Executive Director of Health First Family Care Center, Inc. (HFFCC), a member of Community Health Access Network. Transactions reported here include the following: Dues $18,150, Shared IT Systems $10,616, Consulting $1,541, Licenses purchased $12,240 and Other income $585. | 0 |
| Ann Peters | |||
| Board Member | 286938 | Ann Peters is the CEO of Lamprey Health Care, Inc. (LHC), a member of Community Health Access Network. Transactions here include the following revenue transactions: Dues received: $18,150, Shared IT Sytems: $244,767, Other Income: $23,556 and Consulting $466. | 0 |
| Ann Peters | |||
| Board Member | 356018 | Ann Peters is the CEO of Lamprey Health Care, Inc. (LHC), a member of Community Health Access Network. Transactions here include the following expense transactions: Employees leased from LHC: $302,657, and facilities leased from LHC (including utilities): $53,361. | 0 |
| Edward George | |||
| Board Secretary | 127142 | Edward George is the President/CEO of Manchester Community Health Center, a member of Community Health Access Netowrk. Transactions reported here include the following: Dues $18,150, Shared IT Systems $104,137, Other income $2,140 and Licenses purchased $2,715. | 0 |
| Dustin Hawk | |||
| Board Member | 141841 | W. Greg Henson is the Executive Director at Shackleford County Community Resource Center. transactions reported here include the following: Dues $18,150, Shared IT Systems $79,697, Other income $6,678 and Licenses purchased $37,316. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 4 | Articles of Agreement: Article 2, paragraph 7 - changes distribution of any remaining assets in event of termination, dissolution or winding-up of the Corporation from founding members of the Corporation which are members at time of such distribution to members of the Corporation which are members at time of such distribution. Bylaws Article IV, Section 1 deletes any reference to the founding members of the Corporation. Verbiage inserted to note that not only do full members provide comprehensive primary health care to the community regardless of payment source, but that this be the principle purpose of full members of the Corporation. Article V Section 2 notes appointed representative from full members to have decision making authority on behalf of appointing organization. Article V Section 3 gives consumer representative the right to vote and the right to appoint a member of the Board of Directors by deleting verbiage noting consumer representative shall not have voting rights nor the right to appoint a member to the Board of Directors. Article V Section 8 changes regular meetings of the Board of Directors from at least four to at least eight times each year. Also adds verbiage noting with 3 unexcused absences each year director may be removed by 75% of Board of Directors vote, with replacement to be appointed within 30 days. |
| Form 990, Part VI, Section B, line 11 | The 990 is reviewed by the Executive Director and the Board treasurer. |
| Form 990, Part VI, Section B, line 12c | Board members sign the policy upon becoming a member and periodically review the policy. |
| Form 990, Part VI, Section B, line 15 | The Board of Directors review and approve the compensation of the Executive Director. |
| Form 990, Part VI, Section C, line 19 | They are made available upon request. |
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