2015-11-02T13:01:47-06:00 2014-12-31 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2014-01-01 200999212 Indian Stream Health Center Inc INDI 6032378336 141 Corliss Lane Colebrook NH 03756 Shirley Powell MBA 6032378336 2015-10-22 1 Dimitrios Panacopoulos P01603705 6036697337 2015-10-22 2014 2016-04-25 22:37:26Z Jonathan W Brown 141 Corliss Lane Colebrook NH 03756 4583791 0 X N/A 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 54 13 0 0 1333298 1548429 3034706 3035362 0 0 0 0 4368004 4583791 0 0 0 0 2124198 2810137 0 0 0 1717904 1808393 3842102 4618530 525902 -34739 3307252 3091823 1118635 937945 2188617 2153878 X To provide excellent preventive, acute, and wellness-focused health care to residents within the organziation'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 3831330 3035362 Provided primary health care to the residents of the Colebrook, NH region. 3831330 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 0 0 0 0 0 0 0 0 0 1 12 0 1 54 1 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 Shirley Powell Chief Executive Officer 6032378336 141 Corliss Lane Colebrook NH 03756 Linda Lomasney Secretary 1.00 X X 0 0 0 Julie Riffon Board Member 1.00 X 0 0 0 Steve Ellis Board Member 1.00 X 0 0 0 Bill Freedman Board Member 1.00 X 0 0 0 Melissa Shaw Vice President 1.00 X X 0 0 0 Dallas Chase Board Member 1.00 X 0 0 0 Gail Fisher President 1.00 X X 0 0 0 Ben Young Board Member 1.00 X 0 0 0 Chad Fournier Board Member 1.00 X 0 0 0 Rick Tillotson Treasurer 1.00 X X 0 0 0 Shirley Powell CEO 40.00 X 116901 0 3945 Jonathan Brown Finance Director 40.00 X 69510 0 68 Peter Moran MD 40.00 X 165875 0 10490 Elizabeth Sweeney MD 40.00 X 105233 0 43 April Allin Pharmacist 40.00 X 109099 0 5549 566618 0 20095 4 0 1 0 Dartmouth Hitchcock One Medical Center Drive Hanover NH 03756 Contracted Services 226911 1 1498429 50000 1548429 Patient Service Rev. 621110 2997035 2997035 Other Revenue 621110 121151 121151 Provision for Bad Debt 621110 -82824 -82824 3035362 4583791 3035362 0 0 X 190424 190424 2024706 1751729 272977 38710 30666 8044 379408 300567 78841 176889 140131 36758 1433 1433 35900 35900 488036 471570 16466 19147 19147 13591 10767 2824 41801 33115 8686 78661 62315 16346 12184 9652 2532 4327 4327 19053 15094 3959 78026 61812 16214 24881 19711 5170 Program Supplies 668198 668198 Printing & Publications 150688 119375 31313 Other Expenses 133506 105763 27743 Telephone 20625 16339 4286 18336 14526 3810 4618530 3831330 787200 0 425098 352633 667976 359172 341567 301811 78035 107260 26216 29967 2204250 333582 1697844 1870668 70516 70312 3307252 3091823 125388 251602 567919 295095 425328 391248 1118635 937945 X 2188617 2153878 2188617 2153878 3307252 3091823 -34739 0 X 0 1 X 1 1 1 X 1597042 1290772 1454425 1333298 1548429 7223966 2059844 1716227 2775359 3034706 3035362 12621498 3656886 3006999 4229784 4368004 4583791 19845464 29500 29500 0 29500 29500 19815964 3656886 3006999 4229784 4368004 4583791 19845464 0.99850 0.99840 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 30000 30000 2038880 244312 1794568 135370 89270 46100 1870668 X 4583791 0 4583791 0 4583791 4618530 0 4618530 0 4618530 Part X, Line 2: 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. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Peter Moran MD 165875 0 0 0 0 0 0 0 10490 0 176365 0 0 0 Part I, Line 1a Indian Stream Health Center, Inc. rents an apartment that Shirley Powell, the CEO, is allowed to use when she is in town on business. The value of this benefit is included in her taxable compensation on her form W-2. Form 990, Part VI, Section B, line 11 Indian Stream Health Center Inc.'s Finance Committee reviews the Form 990. Form 990, Part VI, Section B, line 12c Indian Stream Health Center Inc. Requires their board members to 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 FQHC's and reviewed the form 990's of the other non-profits to obtain comparability information for the officers' salaries. Form 990, Part VI, Section C, line 19 Indian Stream Health Center, Inc. Makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Contracted Physicians: Program service expenses 306,299. Management and general expenses 0. Fundraising expenses 0. Total expenses 306,299. Contracted Billing: Program service expenses 102,498. Management and general expenses 0. Fundraising expenses 0. Total expenses 102,498. Other Contracted Services: Program service expenses 62,773. Management and general expenses 16,466. Fundraising expenses 0. Total expenses 79,239.