AMMONOOSUC COMMUNITY HEALTH SERVICES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: AMMONOOSUC COMMUNITY HEALTH SERVICES INC (EIN 51-0137745)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-04-26
IRS object ID: 201321169349300627
Schema version: 2011v1.2
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
Form 990
Schedule A
Schedule D
Schedule J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-04-26T14:26:24-05:00	Timestamp
Tax Period End Date	2012-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	203968236	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	JAMES A GEORGE PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	20 PARK PLAZA SUITE 833	AddressLine1
City	BOSTON	City
State	MA	State
ZIP Code	02116	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	510137745	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	AMMONOOSUC COMMUNITY HEALTH SERVICES INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	AMMO	NameControl
Phone	6034442464	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	25 MT EUSTIS ROAD	AddressLine1
City	LITTLETON	City
State	NH	State
ZIP Code	03561	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	EDWARD SHANSHALA	Name
Title	CEO	Title
Phone	6034442464	Phone
Date Signed	2013-02-14	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
PTIN	P00659906	PTIN
Phone	6174820272	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-03-07 17:11:31Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	AMMONOOSUC COMMUNITY HEALTH SERVICES	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	EDWARD SHANSHALA	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	25 MT EUSTIS ROAD	AddressLine1
City	LITTLETON	City
State	NH	State
ZIP Code	03561	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	6340619	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1975	YearFormation
State Legal Domicile	NH	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE PREVENTITIVE HEALTH PROGRAMS AND PRIMARY CARE PROGRAMS TO RESIDENT OF LITTLETON, NH AND SURROUNDING COMMUNITIES.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	14	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	14	NbrIndependentVotingMembers
Total Nbr Employees	97	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	5155698	ContributionsGrantsPriorYear
Contributions Grants Current Year	1871460	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	3863614	ProgramServiceRevenuePriorYear
Program Service Revenue CY	4443124	ProgramServiceRevenueCY
Investment Income Prior Year	1273	InvestmentIncomePriorYear
Investment Income Current Year	634	InvestmentIncomeCurrentYear
Other Revenue Prior Year	39136	OtherRevenuePriorYear
Other Revenue Current Year	25401	OtherRevenueCurrentYear
Total Revenue Prior Year	9059721	TotalRevenuePriorYear
Total Revenue Current Year	6340619	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	4906878	SalariesEtcPriorYear
Salaries Etc Current Year	4808549	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	7964	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1507145	OtherExpensePriorYear
Other Expenses Current Year	1493639	OtherExpensesCurrentYear
Total Expenses Prior Year	6414023	TotalExpensesPriorYear
Total Expenses Current Year	6302188	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	2645698	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	38431	RevenuesLessExpensesCY
Total Assets BOY	5175533	TotalAssetsBOY
Total Assets EOY	5061195	TotalAssetsEOY
Total Liabilities BOY	1607199	TotalLiabilitiesBOY
Total Liabilities EOY	1456829	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	3568334	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	3604366	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO PROVIDE MEDICAL AND EDUCATIONAL SERVICES TO THE LOCAL COMMUNITY.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	5532033	Expense
Grants	152819	Grants
Revenue	4443124	Revenue
Description	PRIMARY CARE - TO PROVIDE MEDICAL AND EDUCATIONAL SERVICES TO THE LOCAL COMMUNITY.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	299023	Expense
Grants	104058	Grants
Description	FAMILY PLANNING - TO PROVIDE COUNCELING IN FAMILY PLANNING TO THE LOCAL COMMUNITY.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	154900	Expense
Grants	15000	Grants
Description	FAMILY SUPPORT - TO PROVIDE COUNSELING IN FAMILY SUPPORT TO THE LOCAL COMMUNITY.	Description

Activity Other ActivityOther (2 entries)

ExpenseExpense	GrantsGrants	DescriptionDescription
17593	0	ORAL HEALTH
23564	28224	CANCER SCREENING AND STD/HIV

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	41157	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	28224	TotalOfOtherProgramServiceGrnt
Total Program Service Expense	6027113	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	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	1	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	0	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	12	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	97	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
Form8899 Filed	0	Form8899Filed
Form1098 C Filed	0	Form1098CFiled
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	14	NbrVotingGoverningBodyMembers
Number Independent Voting Members	14	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	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	0	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	0	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	NH	StatesWhereCopyOfReturnIsFiled
Other Website	X	OtherWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	KEN RIEBEL	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	6034442464	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	25 MT EUSTIS ROAD	AddressLine1
City	LITTLETON	City
State	NH	State
ZIP Code	03561	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
CHARLES THIBODEAU
PRESIDENT	1.00	X	0	0	0
GARY BOYLE
VICE-PRESIDENT	1.00	X	0	0	0
BOB TORTORICE
TREASURER	1.00	X	0	0	0
KAREN CROWE
SECRETARY	1.00	X	0	0	0
BRUCE BROWN
DIRECTOR	1.00	X	0	0	0
RAY LOBDELL
DIRECTOR	1.00	X	0	0	0
INGA JOHNSON
DIRECTOR	1.00	X	0	0	0
LAURA SJOLANDER
DIRECTOR	1.00	X	0	0	0
ALAN SMITH
DIRECTOR	1.00	X	0	0	0
LYNN DAVIS
DIRECTOR	1.00	X	0	0	0
RONALD SPAULDING
DIRECTOR	1.00	X	0	0	0
BETH HARWOOD
DIRECTOR	1.00	X	0	0	0
SALLY SHERRARD
DIRECTOR	1.00	X	0	0	0
NED DENSMORE
DIRECTOR	1.00	X	0	0	0
SHAWN TESTER
COO	40.00		72476	0	0	X
KENNETH RIEBEL
CFO	40.00		85749	0	0	X
EDWARD SHNANSHALA
CEO	40.00		113320	0	0	X
JILL BLUMBERG MD
PHYSICIAN	40.00		118843	0	0		X
PHILIP LAWSON MD
PHYSICIAN	40.00		134833	0	0		X
DAVID NELSON
MEDICAL DIRECTOR	40.00		162360	0	0		X
CAITLIN O'DONNELL
PHYSICIAN	40.00		130516	0	0		X
CHARLES WOLCOTT MD
PHYSICIAN	40.00		153719	0	0		X
AARON D SOLNIT
PHYSICIAN	40.00		106904	0	0		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1078720	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	0	TotalOtherCompensation
Number Individuals GT100 K	7	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	BREADLOAF CONSTRUCTION	BusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1293 ROUTE 7 SOUTH	AddressLine1
City	MIDDLEBURY	City
State	VT	State
ZIP Code	05753	ZIPCode

Field	Value	IRS element (for citing)
Description Of Services	CONSTRUCTION	DescriptionOfServices
Compensation	265568	Compensation

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	1	NumberOfContractorsGT100K
Government Grants	1779755	GovernmentGrants
All Other Contributions	91705	AllOtherContributions
Total Contributions	1871460	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PATIENT REVENUE	Description
Business Code	621110	BusinessCode
Total Revenue Column	4443124	TotalRevenueColumn
Related Or Exempt Function Income	4443124	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	4443124	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	634	TotalRevenueColumn
Exclusion	$634	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PROFESSIONAL FEES	621110	12918	12918
OTHER INCOME	621110	12483	12483

Field	Value	IRS element (for citing)
Total Other Revenue	25401	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	6340619	TotalRevenueColumn
Related Or Exempt Function Income	4468525	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$634	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	278714	Total
Program Services	278714	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	3600804	Total
Program Services	3600804	ProgramServices

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	595712	Total
Program Services	595712	ProgramServices

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	333319	Total
Program Services	333319	ProgramServices

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	6781	Total
Management And General	6781	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	16795	Total
Management And General	16795	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	33267	Total
Program Services	33267	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	424349	Total
Program Services	286604	ProgramServices
Management And General	137745	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	46859	Total
Program Services	46859	ProgramServices

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	380801	Total
Program Services	380801	ProgramServices

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	43904	Total
Program Services	43904	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	51960	Total
Management And General	51960	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	183864	Total
Program Services	183864	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	53830	Total
Management And General	53830	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
CONTRACT LABOR	71645	71645
BAD DEBT	52111	52111
DUES & MEMBERSHIPS	36305	36305
LAB EXPENSE	29985	29985

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	61183	Total
Program Services	53219	ProgramServices
Fundraising	7964	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	6302188	Total
Program Services	6027113	ProgramServices
Management And General	267111	ManagementAndGeneral
Fundraising	7964	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	31605	BOY
EOY	120217	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	248352	BOY
EOY	30608	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	456622	BOY
EOY	499936	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
EOY	44948	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	52479	BOY
EOY	60025	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	5357542	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	1240675	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	4195589	BOY
EOY	4116867	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	190886	BOY
EOY	188594	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	5175533	BOY
EOY	5061195	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	945146	BOY
EOY	534087	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
EOY	11231	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	662053	BOY
EOY	911511	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	1607199	BOY
EOY	1456829	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	3506033	BOY
EOY	3542065	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	62301	BOY
EOY	62301	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	3568334	BOY
EOY	3604366	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	5175533	BOY
EOY	5061195	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	38431	ReconcilationRevenueExpenses
Reconcilation Other Changes	-2399	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 Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2205627	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2184941	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2676183	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	5155698	CurrentTaxYearMinus1Year
Current Tax Year	1871460	CurrentTaxYear
Total	14093909	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3745052	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3908684	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4004408	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	3867794	CurrentTaxYearMinus1Year
Current Tax Year	4456042	CurrentTaxYear
Total	19981980	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	5950679	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	6093625	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	6680591	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	9023492	CurrentTaxYearMinus1Year
Current Tax Year	6327502	CurrentTaxYear
Total	34075889	Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Amts From Subst Contributors AmtsFromSubstContributors

Field	Value	IRS element (for citing)
Total	0	Total

Support From DQ Ps Etc SupportFromDQPsEtc

Field	Value	IRS element (for citing)
Total	0	Total

Field	Value	IRS element (for citing)
Public Support Total509	34075889	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3982	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1856	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1526	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1273	CurrentTaxYearMinus1Year
Current Tax Year	634	CurrentTaxYear
Total	9271	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3982	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1856	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1526	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1273	CurrentTaxYearMinus1Year
Current Tax Year	634	CurrentTaxYear
Total	9271	Total

Other Income509 OtherIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	56082	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	57063	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4182	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	23377	CurrentTaxYearMinus1Year
Current Tax Year	12483	CurrentTaxYear
Total	153187	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	6010743	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	6152544	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	6686299	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	9048142	CurrentTaxYearMinus1Year
Current Tax Year	6340619	CurrentTaxYear
Total	34238347	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.99530	PublicSupportPercentage509
Prior Year Support Percentage	0.99440	PriorYearSupportPercentage
Investment Income Percentage	0.00030	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.00040	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	4451093	InvestmentCostOrOtherBasis
Depreciation	607132	Depreciation
Book Value	3843961	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	887349	InvestmentCostOrOtherBasis
Depreciation	614443	Depreciation
Book Value	272906	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	19100	InvestmentCostOrOtherBasis
Depreciation	19100	Depreciation
Book Value	0	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	4116867	TotalOfBookValueLandBuildings
Total Revenue	6340619	TotalRevenue
Total Expenses	6302188	TotalExpenses
Excess Or Deficit For Year	38431	ExcessOrDeficitForYear
Net Unrealized GL On Investments	-2399	NetUnrealizedGLOnInvestments
Total Adjustments	-2399	TotalAdjustments
Excess Or Deficit Per FS	36032	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	6338221	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	-2398	NetUnrealizedGainsInvestments
Revenue Not Rptd F990	-2398	RevenueNotRptdF990
Revenue Subtotal	6340619	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	6340619	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	6302188	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	6302188	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	6302188	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	Identifier
Return Reference	PART X:	ReturnReference
Explanation	DURING 2010, THE ORGANIZATION WAS REQUIRED TO ADOPT CERTAIN PROVISIONS OF FASB ASC 740, INCOME TAXES WHICH PROVIDE A NEW FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. WITH THESE CHANGES, THE ORGANIZATION MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE ORGANIZATION DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2012. AS OF JUNE 30, 2012, THE ORGANIZATION DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THEREFORE, THE CERTAIN PROVISIONS OF FASB ASC 740, WHICH WERE ADOPTED DURING 2010, HAD NO IMPACT ON THE ORGANIZATIONS FINANCIAL STATEMENTS. THE ORGANIZATION FILES IRS FORM 990 ANNUALLY WITH THE FEDERAL GOVERNMENT AND IS STILL OPEN TO EXAMINATION BY TAXING AUTHORITIES FOR THE PAST THREE (3) YEARS.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID NELSON
162360	0	0	0	0	0	0	0	0	0	162360	0	0	0
CHARLES WOLCOTT MD
153719	0	0	0	0	0	0	0	0	0	153719	0	0	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11	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	THE ORGANIZATION DETERMINES TOP MANAGEMENT COMPENSATION BY USING SALARY SURVEYS FROM NACHC AND OTHER GEOGRAPHICAL DATA FROM THE HEALTHCARE INDUSTRY.
FORM 990, PART VI, SECTION C, LINE 18	THE ORGANIZATION'S TAX FILINGS ARE AVAIALABLE AT THE REQUEST OF THE ORGANIZATION, OR THROUGH GUIDESTAR.ORG.
FORM 990, PART VI, SECTION C, LINE 19	ANY OF THESE DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION AT THE ORGANIZATION'S REQUEST.
FORM 990, PART XI, LINE 5:	NET UNREALIZED LOSSES ON INVESTMENTS: -2,399.	CHANGES IN NET ASSETS OR FUND BALANCES: