AMMONOOSUC COMMUNITY HEALTH SERVICES INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- AMMONOOSUC COMMUNITY HEALTH SERVICES INC (EIN 51-0137745)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2013-12-20
- IRS object ID
- 201333549349300408
- Schema version
- 2012v2.1
- 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 | 2013-12-20T08:52:17-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | 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 | 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 | 2012-07-01 | 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 | 2013-12-20 | 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 | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| 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 | 7179217 | 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 | It is the mission of Ammonoosuc Community Health Services to provide a stable network of comprehensive Primary Health Care Services to individuals and families throughout the communities we serve. In support of this mission, ACHS provides evidence based, outcome specific, systematic care that is patient centered, focused on prevention, and accessible and affordable to all. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 94 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1871460 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1792569 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 4443124 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5356854 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 634 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8056 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 25401 | OtherRevenuePriorYear |
| Other Revenue Current Year | 16019 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6340619 | TotalRevenuePriorYear |
| Total Revenue Current Year | 7173498 | 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 | 4808549 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5176111 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1946 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1493639 | OtherExpensePriorYear |
| Other Expenses Current Year | 2017876 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6302188 | TotalExpensesPriorYear |
| Total Expenses Current Year | 7193987 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 38431 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -20489 | RevenuesLessExpensesCY |
| Total Assets BOY | 5061195 | TotalAssetsBOY |
| Total Assets EOY | 4985513 | TotalAssetsEOY |
| Total Liabilities BOY | 1456829 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1401636 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3604366 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3583877 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | It is the mission of Ammonoosuc Community Health Services to provide a stable network of comprehensive Primary Health Care Services to individuals and families throughout the communities we serve. In support of this mission, ACHS provides evidence based, outcome specific, systematic care that is patient centered, focused on prevention, and accessible and affordable to all. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 5714591 | Expense |
| Revenue | 5356854 | Revenue |
| Description | Primary Care - To provide medical and educational services to the local community.Family Planning - To provide counceling in family planning to the local community.Family Support - To provide counseling in family support to the local community. | Description |
| Total Program Service Expense | 5714591 | 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 | 1 | 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 | 1 | 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 | 1 | 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 |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 94 | 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 | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| 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 | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | 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 (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Charles Thibodeau | ||||||||
| President | 1.00 | X | 0 | 0 | 0 | |||
| Alan Smith | ||||||||
| Vice-President | 1.00 | X | 0 | 0 | 0 | |||
| Lynn Davis | ||||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | |||
| Inga Johnson | ||||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | |||
| Gary Boyle | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Bruce Brown | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Ned Densmore | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Beth Harwood | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Ray Lobdell | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Sally Sherrard | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Laura Sjolander | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Ronald Spaulding | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Robert Tortorice | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Edward Shanshala | ||||||||
| CEO | 40.00 | 125845 | 0 | 2418 | X | |||
| Kenneth Riebel | ||||||||
| CFO | 40.00 | 84135 | 0 | 7908 | X | |||
| Shawn Tester | ||||||||
| COO | 40.00 | 80931 | 0 | 2360 | X | |||
| David Nelson DO | ||||||||
| Medical Director | 40.00 | 159547 | 0 | 10545 | X | |||
| Aaron Solnit MD | ||||||||
| Physician | 22.00 | 119705 | 0 | 702 | X | |||
| Sarah Young-Xu MD | ||||||||
| Physician | 27.00 | 125558 | 0 | 1188 | X | |||
| Caitlin O'Donnell MD | ||||||||
| Physician | 30.00 | 135160 | 0 | 0 | X | |||
| Philip Lawson MD | ||||||||
| Physician | 24.00 | 139026 | 0 | 850 | X | |||
| Charles Wolcott MD | ||||||||
| Physician | 36.00 | 151703 | 0 | 926 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1121610 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 26897 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Government Grants | 1711549 | GovernmentGrants |
| All Other Contributions | 81020 | AllOtherContributions |
| Total Contributions | 1792569 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Revenue | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 5356854 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5356854 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5356854 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 540 | TotalRevenueColumn |
| Exclusion | $540 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7516 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7516 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7516 | TotalRevenueColumn |
| Exclusion | $7,516 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 21738 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 5719 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16019 | TotalRevenueColumn |
| Exclusion | $16,019 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7173498 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5356854 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $24,075 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 473689 | Total |
| Program Services | 277120 | ProgramServices |
| Management And General | 196569 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3768663 | Total |
| Program Services | 3011305 | ProgramServices |
| Management And General | 757358 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 596229 | Total |
| Program Services | 462853 | ProgramServices |
| Management And General | 133376 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 337530 | Total |
| Program Services | 262025 | ProgramServices |
| Management And General | 75505 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19974 | Total |
| Management And General | 19974 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18165 | Total |
| Management And General | 18165 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 140079 | Total |
| Program Services | 140079 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36828 | Total |
| Management And General | 36828 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48823 | Total |
| Program Services | 37901 | ProgramServices |
| Management And General | 10922 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 172145 | Total |
| Program Services | 172145 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256788 | Total |
| Program Services | 199345 | ProgramServices |
| Management And General | 57443 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13979 | Total |
| Program Services | 10852 | ProgramServices |
| Management And General | 3127 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33945 | Total |
| Management And General | 33945 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40547 | Total |
| Program Services | 31477 | ProgramServices |
| Management And General | 9070 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 214393 | Total |
| Program Services | 166433 | ProgramServices |
| Management And General | 47960 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57392 | Total |
| Program Services | 44553 | ProgramServices |
| Management And General | 12839 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Program Supplies | 675125 | 675125 | |
| Telephone | 104816 | 81369 | 23447 |
| Other Expenses | 66666 | 51753 | 14913 |
| Printing and Publicatio | 53865 | 41815 | 12050 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64346 | Total |
| Program Services | 48441 | ProgramServices |
| Management And General | 13959 | ManagementAndGeneral |
| Fundraising | 1946 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7193987 | Total |
| Program Services | 5714591 | ProgramServices |
| Management And General | 1477450 | ManagementAndGeneral |
| Fundraising | 1946 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 120217 | BOY |
| EOY | 171483 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30608 | BOY |
| EOY | 27179 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 499936 | BOY |
| EOY | 581149 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44948 | BOY |
| EOY | 78270 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60025 | BOY |
| EOY | 46318 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 5378126 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1431160 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4116867 | BOY |
| EOY | 3946966 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 188594 | BOY |
| EOY | 134148 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5061195 | BOY |
| EOY | 4985513 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 534087 | BOY |
| EOY | 612995 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11231 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 911511 | BOY |
| EOY | 749819 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 38822 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1456829 | BOY |
| EOY | 1401636 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3542065 | BOY |
| EOY | 3521576 | 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 | 3604366 | BOY |
| EOY | 3583877 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5061195 | BOY |
| EOY | 4985513 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -20489 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| 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 | 2184941 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2676183 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 5155698 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1871460 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1792569 | CurrentTaxYear |
| Total | 13680851 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3908684 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4004408 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3867794 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4456042 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5356854 | CurrentTaxYear |
| Total | 21593782 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 6093625 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6680591 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9023492 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6327502 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7149423 | CurrentTaxYear |
| Total | 35274633 | 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 | 35274633 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1856 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1526 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1273 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 634 | CurrentTaxYearMinus1Year |
| Current Tax Year | 540 | CurrentTaxYear |
| Total | 5829 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1856 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1526 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1273 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 634 | CurrentTaxYearMinus1Year |
| Current Tax Year | 540 | CurrentTaxYear |
| Total | 5829 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 6095481 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6682117 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9024765 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6328136 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7149963 | CurrentTaxYear |
| Total | 35280462 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99980 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99530 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00020 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00030 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
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
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 62301 | BeginningOfYearBalance |
| End Of Year Balance | 62301 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4457632 | OtherCostOrOtherBasis |
| Depreciation | 732095 | Depreciation |
| Book Value | 3725537 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 920494 | OtherCostOrOtherBasis |
| Depreciation | 699065 | Depreciation |
| Book Value | 221429 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3946966 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Advance From Third Party Payors | Description |
| Amount | $38,822 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 38822 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 7173498 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 7173498 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 7173498 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 7193987 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 7193987 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 7193987 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| 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 Organizations tax positions and concluded that the Organization has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. Management believes the Agency is no longer subject to income tax examinations for years prior to 2010. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Amble | NameOfEvent1 |
| Gross Receipts Event1 | 21738 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 21738 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 5719 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 21738 | GrossReceiptsTotal |
| Gross Revenue Total Events | 21738 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 5719 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 5719 | DirectExpenseSummaryEvents |
| Net Income Summary | 16019 | NetIncomeSummary |
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 | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| TitleTitle | 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 DO | ||||||||||||||
| Medical Director | 147729 | 0 | 11818 | 0 | 0 | 0 | 0 | 0 | 10545 | 0 | 170092 | 0 | 0 | 0 |
| Charles Wolcott MD | ||||||||||||||
| Physician | 145176 | 0 | 6527 | 0 | 0 | 0 | 0 | 0 | 926 | 0 | 152629 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 7 | ReturnReference |
| Explanation | Physicians received bonus compensation calculated by quality measures, patient satisfaction, citizenship and work RVUs. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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 determings top mangagement 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 filing are available at the request of the Organization, or through guidstar.org. |
| Form 990, Part VI, Section C, line 19 | Upon request. |