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LAMPREY HEALTH CARE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
LAMPREY HEALTH CARE INC (EIN 23-7305106)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-04-30
IRS object ID
201301209349300610
Schema version
2011v1.5
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)
Timestamp2013-04-30T10:10:54-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN020400296EIN

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 Date2011-10-01TaxPeriodBeginDate

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 Signed2013-04-30DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDIMITRIOS PANACOPOULOS CPAName
PTINP01603705PTIN
Phone6032240849Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

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 Receipts12236293GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
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 Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees180TotalNbrEmployees
Total Nbr Volunteers20TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year8099328ContributionsGrantsPriorYear
Contributions Grants Current Year4516339ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7766542ProgramServiceRevenuePriorYear
Program Service Revenue CY7718361ProgramServiceRevenueCY
Investment Income Prior Year3093InvestmentIncomePriorYear
Investment Income Current Year1593InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year15868963TotalRevenuePriorYear
Total Revenue Current Year12236293TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9625810SalariesEtcPriorYear
Salaries Etc Current Year8893431SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year8081TotalFundrsngExpCurrentYear
Other Expense Prior Year3427809OtherExpensePriorYear
Other Expenses Current Year3381889OtherExpensesCurrentYear
Total Expenses Prior Year13053619TotalExpensesPriorYear
Total Expenses Current Year12275320TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2815344RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-39027RevenuesLessExpensesCY
Total Assets BOY12599759TotalAssetsBOY
Total Assets EOY12290267TotalAssetsEOY
Total Liabilities BOY5533103TotalLiabilitiesBOY
Total Liabilities EOY5322316TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7066656NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6967951NetAssetsOrFundBalancesEOY
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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10834454Expense
Revenue7718361Revenue
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 Expense10834454TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
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
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109648NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees180NumberOfEmployees
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
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
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 Pardus CFONamePerson
Telephone Number6032927215TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1207 South Main StreetAddressLine1
CityNewmarketCity
StateNHState
ZIP Code03857ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Elizabeth Crepeau
President0.00X000
Carol LaCross
Secretary0.00X000
Audrey Ashton-Savage
Treasurer0.00X000
George D Donovan Jr
Board of Directors0.00X000
Raymond Goodman III
Board of Directors0.00X000
Michael Merenda
Board of Directors0.00X000
Jean Ragonese
Board of Directors0.00X000
Colette D Tilton
Board of Directors0.00X000
Thomas Chris Drew
Board of Directors0.00X000
Cynthia Giguere-Unrein
Board of Directors0.00X000
Jazmin Miranda-Smith
Board of Directors0.00X000
Janis Reams
Board of Directors0.00X000
Ann Peters
CEO40.00154944023884X
Sandra Pardus
CFO35.00103622011939X
Sirona Pruna
OBGYN40.00284551030541X
Paul Friedrichs
Physician40.00195631040233X
Vasuki Nagaraj
Physician40.00185027027461X
Ajay Sharma
Physician40.00193194022468X
Christopher Heatherton
Physician40.0014836007423X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1265329TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation163949TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
North Branch Construction
76 Old Turnpike RdConcordNH03301Construction Services570280
Community Health Access Network
207 S Main StreetNewmarketNH03857Technology Services301407
Partners for Womans Health
3 Alumni Drive Suite 302ExeterNH03833Physician Services136800
Dennis Mires PA
697 Union StreetManchesterNH03104Architect Services105000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Government Grants3575104GovernmentGrants
All Other Contributions941235AllOtherContributions
Total Contributions4516339TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPrimary Health CareDescription
Business Code621110BusinessCode
Total Revenue Column7718361TotalRevenueColumn
Related Or Exempt Function Income7718361RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue7718361TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1593TotalRevenueColumn
Exclusion$1,593ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12236293TotalRevenueColumn
Related Or Exempt Function Income7718361RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,593ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total294389Total
Management And General294389ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7089406Total
Program Services6501451ProgramServices
Management And General587955ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total921798Total
Program Services815603ProgramServices
Management And General106195ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total587838Total
Program Services520116ProgramServices
Management And General67722ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total20180Total
Management And General20180ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total42200Total
Management And General42200ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total457134Total
Program Services404470ProgramServices
Management And General52664ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total14985Total
Program Services13259ProgramServices
Management And General1726ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total75102Total
Program Services66450ProgramServices
Management And General8652ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total314075Total
Program Services277892ProgramServices
Management And General36183ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total802800Total
Program Services710314ProgramServices
Management And General92486ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total51911Total
Program Services45931ProgramServices
Management And General5980ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total207431Total
Program Services183534ProgramServices
Management And General23897ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total61861Total
Program Services54734ProgramServices
Management And General7127ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total285237Total
Program Services252376ProgramServices
Management And General32861ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total126213Total
Program Services111673ProgramServices
Management And General14540ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debts324237324237
Program Supplies260353260353
Printing & Publications1102589755612702
Telephone983818704711334

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total129531Total
Program Services107458ProgramServices
Management And General13992ManagementAndGeneral
Fundraising8081Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12275320Total
Program Services10834454ProgramServices
Management And General1432785ManagementAndGeneral
Fundraising8081Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1201265BOY
EOY1168284EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY3050302BOY
EOY2624177EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY739004BOY
EOY770908EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY126306BOY
EOY109491EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9295400LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3180075LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6114347BOY
EOY6115325EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1368535BOY
EOY1502082EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12599759BOY
EOY12290267EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1405162BOY
EOY1169510EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY2450789BOY
EOY2457045EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1603902BOY
EOY1622511EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY73250BOY
EOY73250EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5533103BOY
EOY5322316EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6670703BOY
EOY6472850EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY395953BOY
EOY495101EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7066656BOY
EOY6967951EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12599759BOY
EOY12290267EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-39027ReconcilationRevenueExpenses
Reconcilation Other Changes-59678ReconcilationOtherChanges
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 Years4813074CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4931132CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5632850CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8099328CurrentTaxYearMinus1Year
Current Tax Year4516339CurrentTaxYear
Total27992723Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6780413CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7217100CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7688374CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7766542CurrentTaxYearMinus1Year
Current Tax Year7718361CurrentTaxYear
Total37170790Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11593487CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12148232CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13321224CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15865870CurrentTaxYearMinus1Year
Current Tax Year12234700CurrentTaxYear
Total65163513Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years10000CurrentTaxYearMinus2Years
Total10000Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years10000CurrentTaxYearMinus2Years
Total10000Total
FieldValueIRS element (for citing)
Public Support Total50965153513PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years35837CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16007CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4027CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3093CurrentTaxYearMinus1Year
Current Tax Year1593CurrentTaxYear
Total60557Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years35837CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16007CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4027CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3093CurrentTaxYearMinus1Year
Current Tax Year1593CurrentTaxYear
Total60557Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11629324CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12164239CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13325251CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15868963CurrentTaxYearMinus1Year
Current Tax Year12236293CurrentTaxYear
Total65224070Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99890PublicSupportPercentage509
Prior Year Support Percentage0.99840PriorYearSupportPercentage
Investment Income Percentage0.00090InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00140PriorYrInvestIncomePercentage
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 Basis858193OtherCostOrOtherBasis
Book Value858193BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6578434OtherCostOrOtherBasis
Depreciation1720899Depreciation
Book Value4857535BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1858773OtherCostOrOtherBasis
Depreciation1459176Depreciation
Book Value399597BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6115325TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionAssets Limited as to UseDescription
Book Value1502082BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets1502082TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDue to Third PartiesDescription
Amount$73,250Amount
FieldValueIRS element (for citing)
Total Of Amounts73250TotalOfAmounts
Total Revenue12236293TotalRevenue
Total Expenses12275320TotalExpenses
Excess Or Deficit For Year-39027ExcessOrDeficitForYear
Other-$59,678OtherAmount
Total Adjustments-59678TotalAdjustments
Excess Or Deficit Per FS-98705ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt12176615TotRevenueEtcAuditedFinclStmt
Other Revenues-59678OtherRevenues
Revenue Not Rptd F990-59678RevenueNotRptdF990
Revenue Subtotal12236293RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99012236293TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt12275320TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal12275320ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99012275320TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
Part XI, Line 8 - Other Adjustments:Change in Fair Value of Financial Instrument -59,678.
Part IV, line 11f - Lamprey Health Care is a public charity under Section 501(c)(3) of the Internal Revenue Code. As public charities, the entities are 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 each entity's tax position and concluded that there is no unrelated business income or uncertain tax positions that require adjustment to the consolidated financial statements.

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
1549440000000238840178828000
Sirona Pruna
24923803531300000305410315092000
Paul Friedrichs
17152902410200000402330235864000
Vasuki Nagaraj
14523103979600000274610212488000
Ajay Sharma
14467104852300000224680215662000
Christopher Heatherton
143725046350000074230155783000

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, quality of care provided, and call coverage responsibilities.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Ann Peters
Lamprey Health Care's CEO is a member of the board of directors of CHAN286938Transactions include dues paid to Community Health Access Network(CHAN) in the amount of $18,150. Lamprey also contracted with CHAN for IT and other consulting services in the amount of $268,788.0
Ann Peters
Lamprey Health Care's CEO is a member of the board of directors of CHAN356037Transactions include employees leased to CHAN in the amount of $316,873 and facilities(including utilities) in the amount of $39,164.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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 5:Change in Fair Value of Financial Instrument -59,678. Total to Form 990, Part XI, Line 5: -59,678.Changes in Net Assets or Fund Balances:

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 StreetAddressLine1
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
Controlled Org1ControlledOrg
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
Method Of Amt DeterminationFMVMethodOfAmtDetermination