2013-05-06T13:15:10-05:00 2012-06-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2011-07-01 020404562 Crotched Mountain Community Care Inc CROT 6035473311 1 Verney Drive Greenfield NH 03047 Thomas A Zubricki 6035473311 2013-05-06 1 Rachel Williamson CPA P00186614 6036697337 2013-05-06 2011 2016-02-25 16:41:14Z Donald L Shumway 1 Verney Drive Greenfield NH 03047 2714707 0 X www.cmf.org X 1986 NH Crotched Mountain Community Care provides care management and care coordination services to seniors and adults with disabilities so that they can continue to live in their own homes. 6 3 43 0 0 0 21684 19939 2871230 2694768 0 0 0 0 2892914 2714707 0 0 0 0 1894811 1771021 0 0 0 912476 1017058 2807287 2788079 85627 -73372 930076 850663 168520 155817 761556 694846 X The mission of Crotched Mountain Community Care, Inc. is to provide quality support, advocacy, and community connections to residents of New Hampshire, including caregivers, their family members, and individuals who are seeking to achieve and maintain a safe and healthy lifestyle at home in their community. 0 0 2076834 2281405 Crotched Mountain began our Community Care program in 1986. CMCC provides quality support, advocacy, and community connections to residents of New Hampshire, including caregivers, their family members, and individuals who are seeking to achieve and maintain a safe and healthy lifestyle at home in their community. Our care management services include: in-home assessment; development of a plan of care; referrals to home care agencies to provide the care needed to continue living independently and safely in your home; ongoing monitoring of the care plan; ongoing advocacy and care coordination with the home care agencies providing care, the client's physician and any other community resources needed to meet client needs; arrangement for transportation to medical appointments as needed; a liaison to the family who may live at a distance to keep them updated and informed as to their relative's well being; assistance with applications and benefit management when necessary including state assistance programs; ongoing support, advocacy, and community connections; a sliding fee scale based on income. 363988 413363 Crotched Mountain is the fiscal agent for the ServiceLink Resource Center of Rockingham County, NH. ServiceLink Resource Centers are New Hampshire's resource for information and much more. ServiceLink Resource Centers are dedicated to helping older adults, adults with disabilities or chronic illness, and their families solve problems with a personal touch. There are no fees for eligibility for these services. ServiceLink was established in 2000 as a statewide network of locally administered programs serving every community in New Hampshire. There are 10 programs throughout the state and over 50 satellite sites. ServiceLink Centers have developed local partnerships with community organizations, businesses, and individuals to address the needs of residents and identify the concerns for older adults, adults with disabilities and/or chronic illness, and family caregivers. ServiceLink Resource Center of Rockingham County serves all residents of Rockingham County as well as anyone in need of information regarding this area. 2440822 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 7 0 1 43 1 0 0 0 0 0 0 0 0 0 0 X 6 3 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 NH X Thomas Zubricki 6035473311 1 Verney Drive Greenfield NH 03047 Deanna S Howard 0.50 X X 0 0 0 Cynthia Yuknewicz 0.50 X X 0 0 0 Benjamin F Gayman 0.50 X X 0 0 0 David H Barnes 0.50 X 0 0 0 James W Varnum 0.50 X 0 0 0 Donald L Shumway 0.50 X X 0 253512 0 Michael Redmond 0.50 X 0 159920 18238 Margaret Lins 0.50 X 86048 0 7429 Joseph Fermano 0.50 X 0 220312 0 Deborah DeCicco 0.50 X 0 0 0 86048 633744 25667 0 0 1 0 Personal Touch 5 Dartmouth Drive Suite 302 Londonderry NH 03053 Nursing Services 205940 1 18263 1676 19939 Care Management Fees 624310 2674528 2674528 Other Income 624310 20240 20240 2694768 2714707 2694768 0 0 93478 81835 11643 1317538 1153437 164101 257638 225549 32089 102367 89617 12750 213825 187193 26632 363913 318587 45326 4340 3799 541 69142 60530 8612 1848 1618 230 143023 125209 17814 64288 56281 8007 161 141 20 4320 3782 538 Bad Debts 129114 113033 16081 Miscellaneous Expense 22647 19828 2819 Supplies 413 362 51 Auto Expense 24 21 3 2788079 2440822 347257 0 28464 128133 362822 325620 7574 7574 294086 278932 12434 15154 518782 374182 930076 850663 168520 155817 168520 155817 X 623762 550388 80813 89913 56981 54545 761556 694846 930076 850663 X -73372 6662 X X 0 1 1 X 0 X 300264 103354 103965 21684 19939 549206 2680503 2777894 2835316 2871230 2694768 13859711 2980767 2881248 2939281 2892914 2714707 14408917 0 0 0 14408917 174 174 174 174 2980941 2881248 2939281 2892914 2714707 14409091 1.00000 1.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 294086 278932 15154 15154 Interest in Net Assets of Crotched Mountain Foundation 144458 Due from Affiliates 229724 374182 2714707 2788079 -73372 6662 6662 -66710 2721369 6662 6662 2714707 0 2714707 2788079 0 2788079 0 2788079 Part XI, Line 8 - Other Adjustments: Change in Interest in Net Assets of CMF 6,662. Part XII, Line 2d - Other Adjustments: Change in Interest in Net Assets of CMF 6,662. X X X X X 0 0 0 0 0 0 0 0 0 Donald L Shumway 0 253512 0 0 0 0 0 0 0 0 0 253512 0 0 Michael Redmond 0 159920 0 0 0 0 0 0 0 18238 0 178158 0 0 Joseph Fermano 0 220312 0 0 0 0 0 0 0 0 0 220312 0 0 Benjamin F Gayman Secretary Benjamin F. Gayman is a 5% owner of Devine, Millimet & Branch, PA, a firm that provided legal services to the parent organization, Crotched Mountain Foundation. No legal fees were paid by this entity. 0 David H Barnes Director David H. Barnes is a 5% owner of Devine, Millimet & Branch, PA, a firm that provided legal services to the parent organization, Crotched Mountain Foundation. No legal fees were paid by this entity. 0 Form 990, Part VI, Section A, line 2 Benjamin Gayman and David Barnes are both Shareholders and Directors of Devine, Millimet & Branch. Form 990, Part VI, Section B, line 11 Form 990 is reviewed by the Organization's Board of Directors before it is filed. Form 990, Part VI, Section B, line 12c An Annual Disclosure statement is requested by the Secretary of the Board of Directors. The Secretary follows up with all the Board members to ensure the form is submitted. Conflicts of interest, if any, are published in the local papers. The public is able to comment on disclosures that they are aware of but that may not have not been included in the publication. Form 990, Part VI, Section B, line 15 The Organization's CEO and other officers are compensated by the parent organization, Crotched Mountain Foundation. There is no compensation review conducted by the filing organization; however, Crotched Mountain Foundation's Board of Directors approve the CEO's compensation annually. They request information from compensation consultants and review other market data. For other officers, and key employees, the human resource director reviews market data in order to set salary ranges. The HR director and the CEO determine compensation. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Change in Interest in Net Assets of CMF 6,662. Total to Form 990, Part XI, Line 5: 6,662. Oversight of Audit Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Crotched Mountain Rehabilitation Center 1 Verney Drive Greenfield NH 03047 222541478 Rehabilitative Care Facility NH 501(c)(3) Line 2 Crotched Mountain Foundation 0 CMRS Inc 1 Verney Drive Greenfield NH 03047 222849875 Care Management Facility NH 501(c)(3) Line 9 Crotched Mountain Foundation 0 CMRS II Inc 1 Verney Drive Greenfield NH 03047 222540660 Residential and Day Support NH 501(c)(3) Line 9 Crotched Mountain Foundation 0 CMRS IV Inc 1 Verney Drive Greenfield NH 03047 223292356 Residential and Day Support NH 501(c)(3) Line 9 Crotched Mountain Foundation 0 CMRS Whitefield Inc 1 Verney Drive Greenfield NH 03047 222540983 Residential and Day Support NH 501(c)(3) Line 9 Crotched Mountain Foundation 0 Crotched Mountain of New York I East Greenbush Inc 1 Verney Drive Greenfield NH 03047 141785202 Residential and Day Support NH 501(c)(3) Line 9 Crotched Mountain Foundation 0 NH Assistive Technology Center 67 Communications Drive Laconia NH 03246 020488042 Home Healthcare Services Delivery NH 501(c)(3) Line 7 Crotched Mountain Foundation 0 Sunnyfield Farm Inc 1 Verney Drive Greenfield NH 03047 201700093 Vocational and Social Support NH 501(c)(3) Line 11a, I Crotched Mountain Foundation 0 Crotched Mountain Foundation 1 Verney Drive Greenfield NH 03047 020222168 Rehabilitative and Residential Support NH 501(c)(3) Line 7 N/A 0 C-MAT Inc 1 Verney Drive Greenfield NH 03047 550838643 Medical Equipment Wholesaler NH Crotched Mountain Foundation C 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0