LAMPREY HEALTH CARE INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
LAMPREY HEALTH CARE INC (EIN 23-7305106)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-04-14
IRS object ID
201101049349300520
Schema version
2009v1.7
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

FieldValueIRS element (for citing)
Timestamp2011-04-14T14:56:46-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BRAD BORBIDGE PABusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1197 LOUDON ROAD STE 350AddressLine1
CityCONCORDCity
StateNHState
ZIP Code03301ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237305106EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LAMPREY HEALTH CARE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLAMPNameControl
Phone6036592494Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1207 SOUTH MAIN STREETAddressLine1
CityNEWMARKETCity
StateNHState
ZIP Code03857ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameAnn PetersName
TitleChief Executive OfficerTitle
Phone6032927214Phone
Date Signed2011-04-15DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameDimitrios Panacopoulos CPAName
Phone6032240849Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonANN PETERSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1207 SOUTH MAIN STREETAddressLine1
CityNEWMARKETCity
StateNHState
ZIP Code03857ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13325251GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.lampreyhealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionThe mission of Lamprey Health Care is to provide high quality primary medical care and health related services with an emphasis on prevention and lifestyle management to all individuals regardless of ability to pay.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees175TotalNbrEmployees
Total Nbr Volunteers18TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4931132ContributionsGrantsPriorYear
Contributions Grants Current Year5632850ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7217100ProgramServiceRevenuePriorYear
Program Service Revenue CY7688374ProgramServiceRevenueCY
Investment Income Prior Year16007InvestmentIncomePriorYear
Investment Income Current Year4027InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year12164239TotalRevenuePriorYear
Total Revenue Current Year13325251TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8621690SalariesEtcPriorYear
Salaries Etc Current Year9255215SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year8300TotalFundrsngExpCurrentYear
Other Expense Prior Year3294733OtherExpensePriorYear
Other Expenses Current Year3338974OtherExpensesCurrentYear
Total Expenses Prior Year11916423TotalExpensesPriorYear
Total Expenses Current Year12594189TotalExpensesCurrentYear
Revenues Less Expenses Prior Year247816RevenuesLessExpensesPriorYear
Revenues Less Expenses CY731062RevenuesLessExpensesCY
Total Assets BOY9219449TotalAssetsBOY
Total Assets EOY8893350TotalAssetsEOY
Total Liabilities BOY5699199TotalLiabilitiesBOY
Total Liabilities EOY4642038TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3520250NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4251312NetAssetsOrFundBalancesEOY
Mission DescriptionThe mission of Lamprey Health Care is to provide high quality primary medical care and health related services with an emphasis on prevention and lifestyle management to all individuals regardless of ability to pay.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
Expense11165857Expense
Revenue7688374Revenue
DescriptionTO PROVIDE MEDICAL, DENTAL, HEALTH, TRANSPORTATION AND REFERRAL RELATED SERVICES TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF ABILITY TO PAY.Description
Total Program Service Expense11165857TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109652NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees175NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNHStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSANDRA PARDUSNamePerson
Telephone Number6032927215TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1207 SOUTH MAIN STREETAddressLine1
CityNEWMARKETCity
StateNHState
ZIP Code03857ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per WeekAverageHoursPerWeekOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Thomas Chris Drew
bOARD OF DIRECTORSX000
Betty CREPEAU
BOARD presidentX000
Carol LaCross
BOARD TreasurerX000
AUDREY ASHTON-SAVAGE
BOARD SECRETARYX000
STEPHEN DENSBERGER
BOARD VICE PRESIDENTX000
GEORGE D DONOVAN JR
BOARD OF DIRECTORSX000
MICHAEL MERENDA
BOARD OF DIRECTORSX000
JEAN RAGONESE
BOARD OF DIRECTORSX000
COLETTE D TILTON
BOARD OF DIRECTORSX000
CYNTHIA GIGUERE-UNREIN
BOARD OF DIRECTORSX000
Janis Reams
bOARD OF DIRECTORSX000
Jazmin Miranda-Smith
bOARD OF DIRECTORSX000
paul m decarolis
bOARD OF DIRECTORSX000
Ann PEters
Chief Executive Officer14040802102240.00X
Sandra Pardus
Chief Financial Officer10177401596235.00X
PAUL FRIEDRICHS
Family Physician18804303502150.00X
rastilav osadsky
Family Physician18633302732450.00X
SIRONA PRUNA
OBGYN26522802584350.00X
Vasuki Nagaraj
Family Physician16750801571150.00X
Ajay Sharma
family Physician1667890945750.00X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1216083TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation150340TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
community health access network
207 s main streetnewmarketNH03857technology services220754
Partners for womans health
3 alumni drive suite 302exeterNH03833physician services131100
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Federated Campaigns89174FederatedCampaigns
Government Grants4533676GovernmentGrants
All Other Contributions1010000AllOtherContributions
Total Contributions5632850TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPrimary Health CareDescription
Business Code621110BusinessCode
Total Revenue Column7688374TotalRevenueColumn
Related Or Exempt Function Income7688374RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue7688374TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4027TotalRevenueColumn
Exclusion$4,027ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13325251TotalRevenueColumn
Related Or Exempt Function Income7688374RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$4,027ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total279166Total
Management And General279166ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7395304Total
Program Services6799019ProgramServices
Management And General596285ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1067118Total
Program Services949782ProgramServices
Management And General117336ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total513627Total
Program Services457150ProgramServices
Management And General56477ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total29520Total
Management And General29520ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total40625Total
Management And General40625ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total444963Total
Program Services396036ProgramServices
Management And General48927ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total42639Total
Program Services37951ProgramServices
Management And General4688ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total79599Total
Program Services70847ProgramServices
Management And General8752ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total317080Total
Program Services282215ProgramServices
Management And General34865ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total805900Total
Program Services717286ProgramServices
Management And General88614ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total72086Total
Program Services64160ProgramServices
Management And General7926ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total243913Total
Program Services217093ProgramServices
Management And General26820ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total35614Total
Program Services31698ProgramServices
Management And General3916ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total180130Total
Program Services160324ProgramServices
Management And General19806ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total119726Total
Program Services106561ProgramServices
Management And General13165ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Program supplies319041319041
bad debts207455207455
printing & publications12459511089513700
other expenses11759210466212930
Telephone974978677710720

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total60999Total
Program Services46905ProgramServices
Management And General5794ManagementAndGeneral
Fundraising8300Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12594189Total
Program Services11165857ProgramServices
Management And General1420032ManagementAndGeneral
Fundraising8300Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1157669BOY
EOY1264631EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY4075732BOY
EOY3367355EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY531346BOY
EOY546283EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY164897BOY
EOY121230EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis4545395LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2723033LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1518482BOY
EOY1822362EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1771323BOY
EOY1771489EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9219449BOY
EOY8893350EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY963894BOY
EOY1042693EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY3864564BOY
EOY2868163EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY670491BOY
EOY630932EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY200250BOY
EOY100250EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5699199BOY
EOY4642038EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3097445BOY
EOY3839736EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY422805BOY
EOY411576EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3520250BOY
EOY4251312EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9219449BOY
EOY8893350EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5343415CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4699057CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4813074CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4931132CurrentTaxYearMinus1Year
Current Tax Year5632850CurrentTaxYear
Total25419528Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5138056CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5711511CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6780413CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7217100CurrentTaxYearMinus1Year
Current Tax Year7688374CurrentTaxYear
Total32535454Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10481471CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10410568CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11593487CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12148232CurrentTaxYearMinus1Year
Current Tax Year13321224CurrentTaxYear
Total57954982Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year10000CurrentTaxYear
Total10000Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year10000CurrentTaxYear
Total10000Total
FieldValueIRS element (for citing)
Public Support Total50957944982PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10458CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years31132CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years35837CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16007CurrentTaxYearMinus1Year
Current Tax Year4027CurrentTaxYear
Total97461Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10458CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years31132CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years35837CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16007CurrentTaxYearMinus1Year
Current Tax Year4027CurrentTaxYear
Total97461Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10491929CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10441700CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11629324CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12164239CurrentTaxYearMinus1Year
Current Tax Year13325251CurrentTaxYear
Total58052443Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99810PublicSupportPercentage509
Prior Year Support Percentage0.99820PriorYearSupportPercentage
Investment Income Percentage0.00170InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00180PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis34749OtherCostOrOtherBasis
Book Value34749BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2799419OtherCostOrOtherBasis
Depreciation1321255Depreciation
Book Value1478164BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1711227OtherCostOrOtherBasis
Depreciation1401778Depreciation
Book Value309449BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1822362TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionASSETS LIMITED AS TO USEDescription
Book Value1771489BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets1771489TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO THIRD PARTIESDescription
Amount$100,250Amount
FieldValueIRS element (for citing)
Total Of Amounts100250TotalOfAmounts
Total Revenue13325251TotalRevenue
Total Expenses12594189TotalExpenses
Excess Or Deficit For Year731062ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS731062ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt13325251TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal13325251RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99013325251TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt12594189TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal12594189ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99012594189TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Ann PEters
1404080000000210220161430000
PAUL FRIEDRICHS
1880430000000350210223064000
rastilav osadsky
1863330000000273240213657000
SIRONA PRUNA
2652280000000258430291071000
Vasuki Nagaraj
1675080000000157110183219000
Ajay Sharma
166789000000094570176246000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 7ReturnReference
ExplanationPhysicians are provided incentive payments based on number of patients seen, complexity of patient acuity, timely documentation, patient satisifaction, and quality of care provided.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Community Health Access Network
Lamprey Health Care's CEO is a member of the board of directors760694Transactions include payment for occupancy and contracted staffing provided by Lamprey Health Care to CHAN and equipment, services, and membership dues provided by CHAN.0
Bi-State Primary Care Association
Lamprey Health Care's CEO is a member of the board of directors137124Transactions included here are membership dues paid to Bi-State as well as a Federal Grant pass through from Bi-State to Lamprey Health Care primarily for the care of the underserved population.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part III, line 2New Program ServicesThe organization opened a primary care site in the behavioral health office.
Form 990, Part VI, Section A, line 7bThe US Department of Health and Human Services Health Resources and Services Administration and the NH Division of Charitable Trusts must approve the decision to dissolve the organization.
Form 990, Part VI, Section B, line 11The 990 will be reviewed by the CEO and CFO. The Finance Committee will review and approve the 990 on behalf of the full Board prior to filing.
Form 990, Part VI, Section B, line 12cAnnually, the board of directors sign a conflict of interest form, on which they disclose any conflicts of interest. Board members will abstain from any votes related to a conflict.
Form 990, Part VI, Section B, line 15The Board hires a firm to do a CEO analysis periodically. In between, the National Association of Community Health Centers (NACHC) Benefits and Compensation survey results are used. The NACHC study is also used for other key employees, as well as other local studies (including the Medical Group Management Association (MGMA) salary survey), as they are available.
Form 990, Part VI, Section C, line 19upon request
Form 990. Part XI, line 2cNo change from prior year.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Friends of Lamprey Health Care IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1207 South main stAddressLine1
CitynewmarketCity
StateNHState
ZIP Code03857ZIPCode
FieldValueIRS element (for citing)
EIN020348630EIN
Primary Activitiessupport lhcPrimaryActivities
Legal Domicile StateNHLegalDomicileState
Exempt Code Section501(c)(3)ExemptCodeSection
Public Charity Status509(a)(3) type iiiPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1friends of lamprey health care incBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeJTransactionType
Amount Involved227916AmountInvolved

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