2013-04-26T14:26:24-05:00 2012-06-30 203968236 JAMES A GEORGE PC 20 PARK PLAZA SUITE 833 BOSTON MA 02116 990 2011-07-01 510137745 AMMONOOSUC COMMUNITY HEALTH SERVICES INC AMMO 6034442464 25 MT EUSTIS ROAD LITTLETON NH 03561 EDWARD SHANSHALA 6034442464 2013-02-14 1 P00659906 6174820272 2011 2016-03-07 17:11:31Z AMMONOOSUC COMMUNITY HEALTH SERVICES EDWARD SHANSHALA 25 MT EUSTIS ROAD LITTLETON NH 03561 6340619 0 X N/A X 1975 NH TO PROVIDE PREVENTITIVE HEALTH PROGRAMS AND PRIMARY CARE PROGRAMS TO RESIDENT OF LITTLETON, NH AND SURROUNDING COMMUNITIES. 14 14 97 0 0 0 5155698 1871460 3863614 4443124 1273 634 39136 25401 9059721 6340619 0 0 0 0 4906878 4808549 0 0 7964 1507145 1493639 6414023 6302188 2645698 38431 5175533 5061195 1607199 1456829 3568334 3604366 X TO PROVIDE MEDICAL AND EDUCATIONAL SERVICES TO THE LOCAL COMMUNITY. 0 0 5532033 152819 4443124 PRIMARY CARE - TO PROVIDE MEDICAL AND EDUCATIONAL SERVICES TO THE LOCAL COMMUNITY. 299023 104058 FAMILY PLANNING - TO PROVIDE COUNCELING IN FAMILY PLANNING TO THE LOCAL COMMUNITY. 154900 15000 FAMILY SUPPORT - TO PROVIDE COUNSELING IN FAMILY SUPPORT TO THE LOCAL COMMUNITY. 17593 0 ORAL HEALTH 23564 28224 CANCER SCREENING AND STD/HIV 41157 28224 6027113 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 0 1 12 0 97 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1 1 0 0 NH X X KEN RIEBEL 6034442464 25 MT EUSTIS ROAD LITTLETON NH 03561 CHARLES THIBODEAU 1.00 X 0 0 0 GARY BOYLE 1.00 X 0 0 0 BOB TORTORICE 1.00 X 0 0 0 KAREN CROWE 1.00 X 0 0 0 BRUCE BROWN 1.00 X 0 0 0 RAY LOBDELL 1.00 X 0 0 0 INGA JOHNSON 1.00 X 0 0 0 LAURA SJOLANDER 1.00 X 0 0 0 ALAN SMITH 1.00 X 0 0 0 LYNN DAVIS 1.00 X 0 0 0 RONALD SPAULDING 1.00 X 0 0 0 BETH HARWOOD 1.00 X 0 0 0 SALLY SHERRARD 1.00 X 0 0 0 NED DENSMORE 1.00 X 0 0 0 SHAWN TESTER 40.00 X 72476 0 0 KENNETH RIEBEL 40.00 X 85749 0 0 EDWARD SHNANSHALA 40.00 X 113320 0 0 JILL BLUMBERG MD 40.00 X 118843 0 0 PHILIP LAWSON MD 40.00 X 134833 0 0 DAVID NELSON 40.00 X 162360 0 0 CAITLIN O'DONNELL 40.00 X 130516 0 0 CHARLES WOLCOTT MD 40.00 X 153719 0 0 AARON D SOLNIT 40.00 X 106904 0 0 1078720 0 0 7 0 1 0 BREADLOAF CONSTRUCTION 1293 ROUTE 7 SOUTH MIDDLEBURY VT 05753 CONSTRUCTION 265568 1 1779755 91705 1871460 PATIENT REVENUE 621110 4443124 4443124 4443124 634 634 PROFESSIONAL FEES 621110 12918 12918 OTHER INCOME 621110 12483 12483 25401 6340619 4468525 0 634 278714 278714 3600804 3600804 595712 595712 333319 333319 6781 6781 16795 16795 33267 33267 424349 286604 137745 46859 46859 380801 380801 43904 43904 51960 51960 183864 183864 53830 53830 CONTRACT LABOR 71645 71645 BAD DEBT 52111 52111 DUES & MEMBERSHIPS 36305 36305 LAB EXPENSE 29985 29985 61183 53219 7964 6302188 6027113 267111 7964 31605 120217 248352 30608 456622 499936 44948 52479 60025 5357542 1240675 4195589 4116867 190886 188594 5175533 5061195 945146 534087 11231 662053 911511 1607199 1456829 X 3506033 3542065 62301 62301 3568334 3604366 5175533 5061195 X 38431 -2399 X 0 1 1 X 1 1 X 2205627 2184941 2676183 5155698 1871460 14093909 3745052 3908684 4004408 3867794 4456042 19981980 5950679 6093625 6680591 9023492 6327502 34075889 0 0 0 34075889 3982 1856 1526 1273 634 9271 3982 1856 1526 1273 634 9271 56082 57063 4182 23377 12483 153187 6010743 6152544 6686299 9048142 6340619 34238347 0.99530 0.99440 0.00030 0.00040 X 4451093 607132 3843961 887349 614443 272906 19100 19100 0 4116867 6340619 6302188 38431 -2399 -2399 36032 6338221 -2398 -2398 6340619 0 6340619 6302188 0 6302188 0 6302188 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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. X X X 0 0 0 0 0 0 0 0 0 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,399.