2013-10-10T15:27:22-05:00 2013-06-30 020400296 Brad Borbidge PA 197 Loudon Road Concord NH 03301 990 2012-07-01 020350051 Coos County Family Health Services Inc COOS 6037522040 133 Pleasant Street Berlin NH 03570 Robert Pelchat 6037527719 2013-10-10 1 Dimitrios Panacopoulos CPA P01603705 6032240849 2012 2016-02-25 16:41:14Z Adele Woods 133 Pleasant Street Berlin NH 03570 8779518 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 13 135 20 0 0 2785222 2761749 5687797 6014105 3881 3664 0 0 8476900 8779518 0 0 0 0 6443676 6688068 0 0 1382 2124783 1978429 8568459 8666497 -91559 113021 4503072 3865467 2577856 1826956 1925216 2038511 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 7531530 6014105 Provision of primary care services to the community. 7531530 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 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 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 Adele Woods 6037522040 133 Pleasant Street Berlin NH 03570 Robert Pelchat 0.00 X 0 0 0 Joan Merrill 0.00 X 0 0 0 Betty Gosselin 0.00 X 0 0 0 Aline Boucher 0.00 X 0 0 0 Marge McClellan 0.00 X 0 0 0 Asa Brosnan 0.00 X 0 0 0 Linda Sjostrom 0.00 X 0 0 0 Michael Poulin 0.00 X 0 0 0 H Guyford Stever Jr 0.00 X 0 0 0 Kenneth Cargill 0.00 X 0 0 0 Andrea Gagne 0.00 X 0 0 0 Jeffrey Smith 0.00 X 0 0 0 Richelle Greer 0.00 X 0 0 0 Adele Woods 40.00 X 132070 0 7854 Melissa Frenette 40.00 X 88136 0 6491 Patricia Couture 40.00 X 98447 0 5940 Mitchell Sullivan MD 40.00 X 173479 0 32501 Brian Beals 37.50 X 187017 0 33357 Debra Perry 25.00 X 100266 0 29775 Thomas Temme 30.00 X 126938 0 31377 Josee Bourbeau MD 34.00 X 164489 0 33299 1070842 0 180594 5 0 1 0 Androscoggin Valley Hospital 59 Page Hill Rd Berlin NH 03570 Rent/Physicians/OB 290004 1 2000 2100436 659313 2761749 Office of Physicians 621110 6014105 6014105 6014105 3664 3664 8779518 6014105 0 3664 544918 334910 210008 4707316 4236584 470732 145048 126424 18624 874830 762502 112328 415956 362547 53409 14911 14911 48327 48327 319475 319475 12640 12640 89955 78405 11550 138575 138575 288148 251150 36998 24631 21468 3163 63108 63108 42629 37155 5474 227921 198656 29265 44136 38469 5667 Program Supplies 371470 371470 Other Expenses 81673 71186 10487 Telephone 69817 60852 8965 Printing and Publicatio 68716 59893 8823 72297 61809 9106 1382 8666497 7531530 1133585 1382 905538 310353 247547 242150 376734 435123 62585 102267 4328936 2228442 2236926 2100494 673742 675080 4503072 3865467 716759 763723 793834 60282 1067263 981894 0 21057 2577856 1826956 X 871052 1153541 1035587 864280 18577 20690 1925216 2038511 4503072 3865467 113021 274 0 X 0 1 X 1 1 1 X 3089355 3420596 3560033 2785222 2761749 15616955 5860487 5664361 5699859 5687797 6014105 28926609 8949842 9084957 9259892 8473019 8775854 44543564 0 0 0 44543564 1477 1273 1882 3881 3664 12177 1477 1273 1882 3881 3664 12177 8951319 9086230 9261774 8476900 8779518 44555741 0.99970 0.99980 0.00030 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19107 2113 806 22026 17623 1657 -173 19107 15874 2003 -254 17623 12919 2917 38 15874 11446 1173 300 12919 0.94000 0.06000 0 0 153257 153257 2603290 938327 1664963 1572389 1290115 282274 2100494 Due From Third Party Payers 31737 Assets Limited as to Use 625069 Beneficial Interest in Perpetual Trust Held By Others 18274 675080 Due To Third Party Payers 21057 21057 8779518 0 8779518 0 8779518 8666497 0 8666497 0 8666497 Description of Intended Use of Endowment Funds: 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 Mitchell Sullivan MD 144987 0 28492 0 0 0 0 0 32501 0 205980 0 0 0 Brian Beals 148800 0 38217 0 0 0 0 0 33357 0 220374 0 0 0 Thomas Temme 116938 0 10000 0 0 0 0 0 31377 0 158315 0 0 0 Josee Bourbeau MD 121304 0 43185 0 0 0 0 0 33299 0 197788 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 189585 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, 2013. 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.