COOS COUNTY FAMILY HEALTH SERVICES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: COOS COUNTY FAMILY HEALTH SERVICES INC (EIN 02-0350051)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2012-09-28
IRS object ID: 201242729349300739
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 B
Schedule D
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-09-28T15:50:37-05:00	Timestamp
Tax Period End Date	2012-06-30	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 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	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	020350051	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COOS COUNTY FAMILY HEALTH SERVICES INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	COOS	NameControl
Phone	6037522040	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	133 PLEASANT STREET	AddressLine1
City	BERLIN	City
State	NH	State
ZIP Code	03570	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	ROBERT PELCHAT	Name
Title	BOARD PRESIDENT	Title
Phone	6037527719	Phone
Date Signed	2012-09-28	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	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	ADELE WOODS	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	133 PLEASANT STREET	AddressLine1
City	BERLIN	City
State	NH	State
ZIP Code	03570	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	8476900	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.COOSFAMILYHEALTH.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1980	YearFormation
State Legal Domicile	NH	StateLegalDomicile
Activity Or Mission Description	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.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	13	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	13	NbrIndependentVotingMembers
Total Nbr Employees	131	TotalNbrEmployees
Total Nbr Volunteers	20	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	3560033	ContributionsGrantsPriorYear
Contributions Grants Current Year	2785222	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	5699859	ProgramServiceRevenuePriorYear
Program Service Revenue CY	5687797	ProgramServiceRevenueCY
Investment Income Prior Year	1882	InvestmentIncomePriorYear
Investment Income Current Year	3881	InvestmentIncomeCurrentYear
Other Revenue Prior Year	0	OtherRevenuePriorYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	9261774	TotalRevenuePriorYear
Total Revenue Current Year	8476900	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	6521850	SalariesEtcPriorYear
Salaries Etc Current Year	6443676	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	369	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2226632	OtherExpensePriorYear
Other Expenses Current Year	2124783	OtherExpensesCurrentYear
Total Expenses Prior Year	8748482	TotalExpensesPriorYear
Total Expenses Current Year	8568459	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	513292	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-91559	RevenuesLessExpensesCY
Total Assets BOY	3675928	TotalAssetsBOY
Total Assets EOY	4503072	TotalAssetsEOY
Total Liabilities BOY	1659153	TotalLiabilitiesBOY
Total Liabilities EOY	2577856	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	2016775	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1925216	NetAssetsOrFundBalancesEOY
Mission Description	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.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	7462559	Expense
Revenue	5687797	Revenue
Description	PROVISION OF PRIMARY CARE SERVICES TO THE COMMUNITY.	Description
Total Program Service Expense	7462559	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	1	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	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	35	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	131	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	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	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
Own Website	X	OwnWebsite
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	ADELE WOODS	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	6037522040	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	133 PLEASANT STREET	AddressLine1
City	BERLIN	City
State	NH	State
ZIP Code	03570	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 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
ROBERT PELCHAT
PRESIDENT	0.00	X	0	0	0
JOAN MERRILL
VICE PRESIDENT	0.00	X	0	0	0
BETTY GOSSELIN
SECRETARY	0.00	X	0	0	0
ALINE BOUCHER
TREASURER	0.00	X	0	0	0
MARGE MCCLELLAN
BOARD OF DIRECTORS	0.00	X	0	0	0
ASA BROSNAN
BOARD OF DIRECTORS	0.00	X	0	0	0
LINDA SLOWIK
BOARD OF DIRECTORS	0.00	X	0	0	0
MICHAEL POULIN
BOARD OF DIRECTORS	0.00	X	0	0	0
H GUYFORD STEVER JR
BOARD OF DIRECTORS	0.00	X	0	0	0
KENNETH CARGILL
BOARD OF DIRECTORS	0.00	X	0	0	0
LINDA SJOSTROM
BOARD OF DIRECTORS	0.00	X	0	0	0
JEFFREY SMITH
BOARD OF DIRECTORS	0.00	X	0	0	0
DAVID SMITH
BOARD OF DIRECTORS	0.00	X	0	0	0
ADELE WOODS
CEO	40.00		131193	0	7751	X
MELISSA FRENETTE
CFO	40.00		88082	0	6808	X
PATRICIA COUTURE
COO	40.00		97457	0	5926	X
MITCHELL SULLIVAN MD
MEDICAL DIRECTOR	40.00		169424	0	30774		X
BRIAN BEALS
PHYSICIAN	37.50		178442	0	32594			X
KEERTHY KRISHNAMANI
PHYSICIAN	33.00		112445	0	21523			X
THOMAS TEMME
PHYSICIAN	33.00		129241	0	30715			X
JOSEE BOURBEAU MD
PHYSICIAN	34.00		169165	0	31732			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1075449	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	167823	TotalOtherCompensation
Number Individuals GT100 K	8	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	ANDROSCOGGIN VALLEY HOSPITAL	BusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	59 PAGE HILL RD	AddressLine1
City	BERLIN	City
State	NH	State
ZIP Code	03570	ZIPCode

Field	Value	IRS element (for citing)
Description Of Services	RENT/PHYSICIANS/OB	DescriptionOfServices
Compensation	334325	Compensation

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	1	NumberOfContractorsGT100K
Federated Campaigns	4491	FederatedCampaigns
Government Grants	2061170	GovernmentGrants
All Other Contributions	719561	AllOtherContributions
Total Contributions	2785222	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	HOME HEALTH CARE SRVCS	Description
Business Code	621610	BusinessCode
Total Revenue Column	5687797	TotalRevenueColumn
Related Or Exempt Function Income	5687797	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	5687797	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	3881	TotalRevenueColumn
Exclusion	$3,881	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	8476900	TotalRevenueColumn
Related Or Exempt Function Income	5687797	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$3,881	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	537415	Total
Program Services	327978	ProgramServices
Management And General	209437	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	4524404	Total
Program Services	4071964	ProgramServices
Management And General	452440	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	142531	Total
Program Services	124073	ProgramServices
Management And General	18458	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	838481	Total
Program Services	729898	ProgramServices
Management And General	108583	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	400845	Total
Program Services	348936	ProgramServices
Management And General	51909	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	7298	Total
Management And General	7298	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	29566	Total
Management And General	29566	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	286410	Total
Program Services	286410	ProgramServices

Advertising Advertising

Field	Value	IRS element (for citing)
Total	13843	Total
Management And General	13843	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	91900	Total
Program Services	79999	ProgramServices
Management And General	11901	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	139349	Total
Program Services	139349	ProgramServices

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	326827	Total
Program Services	284503	ProgramServices
Management And General	42324	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	25600	Total
Program Services	22285	ProgramServices
Management And General	3315	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	80029	Total
Management And General	80029	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	41447	Total
Program Services	36080	ProgramServices
Management And General	5367	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	237004	Total
Program Services	206312	ProgramServices
Management And General	30692	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	49470	Total
Program Services	43064	ProgramServices
Management And General	6406	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBT EXPENSE	286208	286208
PROGRAM SUPPLIES	247187	247187
PRINTING AND PUBLICATIO	71578	62309	9269
TELEPHONE	63933	55654	8279

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	127134	Total
Program Services	110350	ProgramServices
Management And General	16415	ManagementAndGeneral
Fundraising	369	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	8568459	Total
Program Services	7462559	ProgramServices
Management And General	1105531	ManagementAndGeneral
Fundraising	369	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	290233	BOY
EOY	905538	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	129460	BOY
EOY	247547	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	417670	BOY
EOY	376734	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	84769	BOY
EOY	62585	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	4237448	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	2000522	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2100167	BOY
EOY	2236926	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	653629	BOY
EOY	673742	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	3675928	BOY
EOY	4503072	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	784415	BOY
EOY	716759	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
EOY	793834	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	874738	BOY
EOY	1067263	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	1659153	BOY
EOY	2577856	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	813154	BOY
EOY	871052	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1186701	BOY
EOY	1035587	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	16920	BOY
EOY	18577	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2016775	BOY
EOY	1925216	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	3675928	BOY
EOY	4503072	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-91559	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 Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2988706	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3089355	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	3420596	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	3560033	CurrentTaxYearMinus1Year
Current Tax Year	2785222	CurrentTaxYear
Total	15843912	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	5955938	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	5860487	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	5664361	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	5699859	CurrentTaxYearMinus1Year
Current Tax Year	5687797	CurrentTaxYear
Total	28868442	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	8944644	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	8949842	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	9084957	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	9259892	CurrentTaxYearMinus1Year
Current Tax Year	8473019	CurrentTaxYear
Total	44712354	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	44712354	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1992	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1477	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1273	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1882	CurrentTaxYearMinus1Year
Current Tax Year	3881	CurrentTaxYear
Total	10505	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1992	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1477	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1273	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1882	CurrentTaxYearMinus1Year
Current Tax Year	3881	CurrentTaxYear
Total	10505	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	8946636	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	8951319	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	9086230	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	9261774	CurrentTaxYearMinus1Year
Current Tax Year	8476900	CurrentTaxYear
Total	44722859	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.99980	PublicSupportPercentage509
Prior Year Support Percentage	0.99980	PriorYearSupportPercentage
Investment Income Percentage	0.00020	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.00020	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	17623	BeginningOfYearBalance
Contributions	1657	Contributions
Investment Earnings Or Losses	-173	InvestmentEarningsOrLosses
End Of Year Balance	19107	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	15874	BeginningOfYearBalance
Contributions	2003	Contributions
Investment Earnings Or Losses	-254	InvestmentEarningsOrLosses
End Of Year Balance	17623	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	12919	BeginningOfYearBalance
Contributions	2917	Contributions
Investment Earnings Or Losses	38	InvestmentEarningsOrLosses
End Of Year Balance	15874	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	11446	BeginningOfYearBalance
Contributions	1173	Contributions
Investment Earnings Or Losses	300	InvestmentEarningsOrLosses
End Of Year Balance	12919	EndOfYearBalance

Field	Value	IRS element (for citing)
Permanent Endowment EOY Balance	0.97000	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.03000	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	0	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	153257	OtherCostOrOtherBasis
Book Value	153257	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2557494	OtherCostOrOtherBasis
Depreciation	837005	Depreciation
Book Value	1720489	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1526697	OtherCostOrOtherBasis
Depreciation	1163517	Depreciation
Book Value	363180	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	2236926	TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescription	Book ValueBookValue
DUE FROM THIRD PARTY PAYERS	41000
ASSETS LIMITED AS TO USE	632742

Field	Value	IRS element (for citing)
Total Book Value Other Assets	673742	TotalBookValueOtherAssets
Total Revenue	8476900	TotalRevenue
Total Expenses	8568459	TotalExpenses
Excess Or Deficit For Year	-91559	ExcessOrDeficitForYear
Excess Or Deficit Per FS	-91559	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	8476900	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	8476900	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	8476900	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	8568459	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	8568459	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	8568459	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
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.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Independent Consultant	X	IndependentConsultant
Form990 Of Other Organizations	X	Form990OfOtherOrganizations
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 (4 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
MITCHELL SULLIVAN MD
146691	0	22733	0	0	0	0	0	30774	0	200198	0	0	0
BRIAN BEALS
151768	0	26674	0	0	0	0	0	32594	0	211036	0	0	0
THOMAS TEMME
119241	0	10000	0	0	0	0	0	30715	0	159956	0	0	0
JOSEE BOURBEAU MD
133291	0	35874	0	0	0	0	0	31732	0	200897	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Return Reference	PART I, LINE 7	ReturnReference
Explanation	PHYSICIANS ARE PROVIDED INCENTIVE PAYMENTS BASED ON NUMBER OF PATIENTS SEEN, COMPLEXITY OF PATIENT ACUITY, TIMELY DOCUMENTATION, PATIENT SATISFICATION, AND QUALITY OF CARE PROVIDED.	Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	ADELE WOODS	BusinessNameLine1

Field	Value	IRS element (for citing)
Relationship	CEO	Relationship
Amount Of Transaction	113751	AmountOfTransaction
Description Of Transaction	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, 2012.	DescriptionOfTransaction
Sharing Of Revenues	0	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReference	ExplanationExplanation
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.