2019-10-31T07:57:11-05:00 2018-12-31 221478099 COHNREZNICK LLP 350 CHURCH STREET 12TH FLOOR HARTFORD CT 06103 990 2018-01-01 200999212 INDIAN STREAM HEALTH CENTER INDI 6032378336 141 CORLISS LANE COLEBROOK NH 03756 KEVIN J KELLEY CEO 6032378336 2019-10-28 1 PAUL BALLASY P00852868 9592007000 2019-10-27 209.59.242.22 2019-10-28 09:21:41 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 238159564A7F207AC3E2D33505B4833284B8AC6F 2018 2019-02-21 02:37:17Z KEVIN J KELLEY 141 CORLISS LANE COLEBROOK NH 03756 6156647 0 X WWW.INDIANSTREAM.ORG X 2005 NH TO PROVIDE EXCELLENT PREVENTIVE, ACUTE, AND WELLNESS-FOCUSED HEALTH CARE TO RESIDENTS WITHIN THE ORGANIZATION'S SERVICE AREA REGARDLESS OF PATIENT'S ABILITY TO PAY. WE WILL FOCUS OUR RESOURCES TO MAXIMIZE THE QUALITY OF LIFE OF AREA RESIDENTS IN A COST-EFFECTIVE AND EFFICIENT MANNER. 10 10 81 0 126175 0 2266573 2030828 4386429 4038995 75 0 71870 86824 6724947 6156647 0 0 0 0 4861137 4135384 0 0 0 3182589 2303513 8043726 6438897 -1318779 -282250 2976804 2773867 863202 942515 2113602 1831352 X TO PROVIDE EXCELLENT PREVENTIVE, ACUTE, AND WELLNESS-FOCUSED HEALTH CARE TO RESIDENTS WITHIN THE ORGANIZATION'S SERVICE AREA REGARDLESS OF PATIENT'S ABILITY TO PAY. WE WILL FOCUS OUR RESOURCES TO MAXIMIZE THE QUALITY OF LIFE OF AREA RESIDENTS IN A COST-EFFECTIVE AND EFFICIENT MANNER. 0 0 4398345 3998664 PROVIDE PRIMARY HEALTH CARE TO THE RESIDENTS OF THE COLEBROOK, NH REGION. 4398345 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 81 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X PHILIP KNEER 6032378336 141 CORLISS LANE COLEBROOK NH 03756 CASSIE HURLBERT BOARD MEMBER 1.00 X 0 0 0 DALLAS CHASE BOARD MEMBER 1.00 X 0 0 0 DAVID THATCHER TREASURER 3.00 X X 0 0 0 GAIL FISHER PAST PRESIDENT 4.00 X X 0 0 0 GREG CULLEY BOARD MEMBER 1.00 X 0 0 0 JENNIFER NOYES PRESIDENT 4.00 X X 0 0 0 LINDA LOMASNEY OUTGOING BOARD MEMBER 1.00 X 0 0 0 LINDSAY RANCOURT OUTGOING BOARD MEMBER 1.00 X 0 0 0 LORI MORANN BOARD MEMBER 1.00 X 0 0 0 MIKE BRUTNICK SECRETARY 3.00 X X 0 0 0 SCOTT COOPER OUTGOING BOARD MEMBER 1.00 X 0 0 0 STEVE ELLIS VICE PRESIDENT 3.00 X X 0 0 0 SUZANNE PHINNEY BOARD MEMBER 1.00 X 0 0 0 GRAHAM RAE CFO THRU 3/18 40.00 X 33431 0 1254 KEVIN J KELLEY CEO 40.00 X 93945 0 3928 PHILIP G KNEER JR FINANCE DIRECTOR 40.00 X 77391 0 20815 ELIZABETH SWEENEY DO 40.00 X 132141 0 23897 MARGARET R FITZGERALD MEDICAL DIRECTOR 40.00 X 126300 0 4046 MARY JUDD PA 40.00 X 105894 0 17568 PAULA TROIE PHARMACIST 40.00 X 119951 0 24438 PETER MORAN MD 40.00 X 207699 0 21088 896752 0 117034 5 0 1 0 SHEEHAN PHINNEY BASS & GREEN PO BOX 3701 MANCHESTER NH 06105 LEGAL SERVICES 220740 BARTON ASSOCIATES PO BOX 417844 BOSTON MA 02241 LOCUM MD SERVICES 109990 2 2028678 2150 56806 2030828 PHARMACY REVENUE 621110 1249398 1123223 126175 MEDICARE 621110 1072426 1072426 MEDICAID 621110 685293 685293 THIRD PARTY PAYORS 621110 567827 567827 NURSING SERVICES 621110 347790 347790 116261 116261 4038995 980 0 980 980 980 INCENTIVE PAYMENTS 900099 57681 57681 MISCELLANEOUS REVENUE 900099 28163 28163 85844 6156647 3998664 126175 980 230764 161816 68948 3070663 2153208 917455 62756 44006 18750 528626 370683 157943 242575 170098 72477 105810 105810 60431 60431 564627 243010 321617 209979 132269 77710 201045 142659 58386 12007 6690 5317 11948 11948 147544 104695 42849 54628 38763 15865 PHARMACY COSTS 587300 587300 BAD DEBTS 127717 127717 220477 115431 105046 6438897 4398345 2040552 0 100482 179287 70639 1024 13119 386931 362034 98978 88538 83471 68496 2837465 775072 2235279 2062393 2976804 2773867 583177 665743 5420 42716 274605 234056 863202 942515 X 2113602 1831352 2113602 1831352 2976804 2773867 -282250 0 X X 0 1 X 1 1 1 X 1548429 1704540 2108170 2266573 2030828 9658540 3035362 3917246 4408316 4386429 3912820 19660173 4583791 5621786 6516486 6653002 5943648 29318713 0 0 0 29318713 26502 1706 980 29188 26502 1706 980 29188 126175 126175 47527 71870 85844 205241 4583791 5621786 6590515 6726578 6156647 29679317 0.98780 0.99470 0.00100 0.00100 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: INCENTIVE PAYMENTS - 2016 AMOUNT: $ 47,527. 2017 AMOUNT: $ 37,180. 2018 AMOUNT: $ 57,681. MISCELLANEOUS REVENUE - 2017 AMOUNT: $ 34,690. 2018 AMOUNT: $ 28,163. 60000 60000 2398908 577344 1821564 378557 197728 180829 2062393 X 6028930 -127717 -127717 6156647 0 6156647 6311180 0 6311180 127717 127717 6438897 PART X, LINE 2: THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2018 AND 2017. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2015 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. THE CENTER RECOGNIZES INTEREST AND PENALTIES ASSOCIATED WITH TAX MATTERS, AS OPERATING EXPENSES AND INCLUDES ACCRUED INTEREST AND PENALTIES WITH ACCRUED EXPENSES IN THE STATEMENTS OF FINANCIAL POSITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS -127,717. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 127,717. X X X X 0 0 0 0 0 0 0 1 0 ELIZABETH SWEENEY DO 122042 0 10000 0 99 0 3978 0 19919 0 156038 0 0 0 PETER MORAN MD 206465 0 0 0 1234 0 6082 0 15006 0 228787 0 0 0 PART I, LINE 7 CERTAIN HIGHLY COMPENSATED EMPLOYEES RECEIVED BOARD APPROVED BONUSES WHICH ARE REPORTED IN THEIR 2018 W2. X 1 56806 FMV 0 0 0 PART I, COLUMN (B): THE AMOUNT IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C INDIAN STREAM HEALTH CENTER INC REQUIRES THEIR BOARD MEMBERS TO ANNUALLY SIGN A FORM STATING WHAT OTHER ORGANIZATIONS THEY ARE INVOLVED IN. THE BOARD MEMBERS ARE NOT ALLOWED TO VOTE ON ISSUES IF THEY PERTAIN TO ANOTHER ORGANIZATION THE BOARD MEMBER IS INVOLVED WITH. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS OF INDIAN STREAM HEALTH CENTER, INC CHECKED SALARY INFORMATION FROM OTHER FQHCS AND REVIEWED THE FORM 990S OF THE OTHER NON-PROFITS TO OBTAIN COMPARBILITY INFORMATION FOR THE OFFICERS' SALARIES.- THE ORGANIZATION ALSO PARTICIPATED IN NACHCS SALARY SURVEY. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART XII, LINE 2C THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.