2014-08-07T15:29:08-05:00 2013-12-31 020400296 BRAD BORBIDGE PA 197 LOUDON ROAD STE 350 CONCORD NH 03301 990 2013-01-01 200999212 Indian Stream Health Center Inc INDI 6032378336 141 Corliss Lane Colebrook NH 03756 Shirley Powell Cheif Executive Officer 6032378336 2014-08-07 1 DIMITRIOS PANACOPOULOS CPA P01603705 6032240849 2013 2015-11-30 17:44:51Z Shirley Powell 141 Corliss Lane Colebrook NH 03756 4368004 0 X N/A X 2005 NH 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. 10 9 43 13 0 0 1454425 1333298 2775359 3034706 0 0 0 0 4229784 4368004 0 0 0 0 1825367 2124198 0 0 0 1581865 1717904 3407232 3842102 822552 525902 2876624 3307252 1212717 1118635 1663907 2188617 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. 1 0 3165961 3034706 Provided primary health care to the residents of the Colebrook, NH region. 3165961 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 12 0 1 43 1 0 0 0 0 0 0 0 0 X 10 9 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 Bridget Freudenberger Board Member 0.00 X 0 0 0 Linda Lomasney Secretary 0.00 X 0 0 0 Julie Riffon Board Member 0.00 X 0 0 0 Steve Ellis Board Member 0.00 X 0 0 0 Bill Freedman Treasurer 0.00 X 0 0 0 Melissa Shaw Vice President 0.00 X 0 0 0 Charlie White Board Member 0.00 X 0 0 0 Dallas Chase Board Member 0.00 X 0 0 0 Gail Fisher President 0.00 X 0 0 0 Errin Meenan Board Member 0.00 X 0 0 0 Shirley Powell CEO 40.00 X 111425 0 2021 Jonathan Brown Finance Director 40.00 X 53484 0 4978 Peter Moran MD 40.00 X 156572 0 13181 321481 0 20180 2 0 1 0 Dartmouth Hitchcock One Medical Center Drive Hanover NH 03756 Contracted Services 247539 1 1233298 100000 1333298 Federally Qualified He 621110 3034706 3034706 3034706 4368004 3034706 0 0 X 341661 341661 1367368 1289377 77991 24365 18459 5906 254642 192917 61725 136162 103156 33006 8092 8092 40000 40000 538150 538150 11809 11809 12428 9415 3013 25967 19673 6294 69699 52804 16895 11501 8713 2788 7935 7935 42931 32525 10406 64105 48566 15539 15720 11909 3811 Program Supplies 748813 748813 Other Expenses 66448 50341 16107 Telephone 21091 15979 5112 Printing and Publicatio 19766 14975 4791 13449 10189 3260 3842102 3165961 676141 0 594500 425098 480893 667976 154584 341567 78035 157211 26216 1973732 275888 1333786 1697844 155650 70516 2876624 3307252 140942 125388 371269 567919 700506 425328 1212717 1118635 X 1513978 2188617 149929 0 1663907 2188617 2876624 3307252 X 525902 -1192 X 0 1 X 1 1 1 X 1123940 1597042 1290772 1454425 1333298 6799477 2061977 2059844 1716227 2775359 3034706 11648113 3185917 3656886 3006999 4229784 4368004 18447590 29500 29500 0 29500 29500 18418090 3185917 3656886 3006999 4229784 4368004 18447590 0.99840 0.99820 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 30000 30000 1943732 275888 1667844 1697844 4368004 0 4368004 0 4368004 3842102 0 3842102 0 3842102 Part IV, Line 11f 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. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Peter Moran MD 156572 0 0 0 0 0 0 0 13181 0 169753 0 0 0 Part I, Line 1b 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. Charles White Board Member 50000 Community benefit grant from UCVH to Indian Stream Health Center 0 Bruce Powell Spouse to CEO 12746 Financial Consultant reporting to the Finance Director and Board Treasurer 0 Form 990, Part III, line 2 Indian Stream began in-house pharmacy services. 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 from 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 Other Contracted Services: Program service expenses 538,150. Management and general expenses 0. Fundraising expenses 0. Total expenses 538,150. Form 990, Part XI, line 9: Pledges uncollectible -1,192.