2012-04-20T14:22:32-05:00 2011-09-30 BRAD BORBIDGE PA 197 LOUDON ROAD STE 350 CONCORD NH 03301 990 2010-10-01 237305106 LAMPREY HEALTH CARE INC LAMP 6036592494 207 SOUTH MAIN STREET NEWMARKET NH 03857 ANN PETERS 6032927214 2012-04-15 1 DIMITRIOS PANACOPOULOS CPA 6032240849 2012-03-29 2010 2016-02-24 21:20:13Z ANN PETERS 207 SOUTH MAIN STREET NEWMARKET NH 03857 15868963 0 X WWW.LAMPREYHEALTH.ORG X 1971 NH THE 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. 13 13 187 20 0 0 5632850 8099328 7688374 7766542 4027 3093 0 0 13325251 15868963 0 0 0 0 9255215 9625810 0 0 13117 3338974 3427809 12594189 13053619 731062 2815344 8893350 12599759 4642038 5533103 4251312 7066656 THE 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. 0 0 11530933 7766542 TO PROVIDE MEDICAL, DENTAL, HEALTH, TRANSPORTATION AND REFERRAL RELATED SERVICES TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF ABILITY TO PAY. 11530933 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 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 1 1 0 0 1 55 0 1 187 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NH X X SANDRA PARDUS 6032927215 207 SOUTH MAIN STREET NEWMARKET NH 03857 THOMAS CHRIS DREW X 0 0 0 ELIZABETH CREPEAU X 0 0 0 CAROL LACROSS X 0 0 0 AUDREY ASHTON-SAVAGE X 0 0 0 STEPHEN DENSBERGER X 0 0 0 GEORGE D DONOVAN JR X 0 0 0 MICHAEL MERENDA X 0 0 0 JEAN RAGONESE X 0 0 0 COLETTE D TILTON X 0 0 0 CYNTHIA GIGUERE-UNREIN X 0 0 0 JANIS REAMS X 0 0 0 JAZMIN MIRANDA-SMITH X 0 0 0 PAUL M DECAROLIS X 0 0 0 ANN PETERS 40.00 X 143204 0 22665 SANDRA PARDUS 35.00 X 96410 0 11095 PAUL FRIEDRICHS 40.00 X 187835 0 38861 SIRONA PRUNA 40.00 X 279590 0 28018 VASUKI NAGARAJ 40.00 X 185717 0 21675 AJAY SHARMA 40.00 X 183089 0 21145 EDWARD SCULLY 32.00 X 132418 0 30070 1208263 0 173529 10 0 1 0 NORTH BRANCH CONSTRUCTION 76 OLD TURNPIKE RD CONCORD NH 03301 CONSTRUCTION SERVICES 2134152 COMMUNITY HEALTH ACCESS NETWORK 207 S MAIN STREET NEWMARKET NH 03857 TECHNOLOGY SERVICES 216210 PARTNERS FOR WOMANS HEALTH 3 ALUMNI DRIVE SUITE 302 EXETER NH 03833 PHYSICIAN SERVICES 136800 DENNIS MIRES PA 697 UNION STREET MANCHESTER NH 03104 ARCHITECT SERVICES 118410 4 6642722 1456606 8099328 PRIMARY HEALTH CARE 621110 7766542 7766542 7766542 3093 3093 15868963 7766542 0 3093 273374 273374 7752037 7093088 658949 961067 853007 108060 639332 567447 71885 47454 47454 45873 45873 335363 297656 37707 27321 24249 3072 61742 54800 6942 302064 268101 33963 827129 734128 93001 58716 52114 6602 285670 253550 32120 69100 61331 7769 182043 161574 20469 125232 111151 14081 PROGRAM SUPPLIES 329458 329458 BAD DEBTS 288422 288422 OTHER EXPENSES 162136 143906 18230 PRINTING & PUBLICATIONS 112343 99711 12632 TELEPHONE 95741 84976 10765 72002 52264 6621 13117 13053619 11530933 1509569 13117 1264631 1201265 3367355 3050302 546283 739004 121230 126306 9019423 2905076 1822362 6114347 1771489 1368535 8893350 12599759 1042693 1405162 2868163 2450789 630932 1603902 100250 73250 4642038 5533103 X 3839736 6670703 411576 395953 4251312 7066656 8893350 12599759 2815344 0 X X 0 1 1 X 1 1 X 4699057 4813074 4931132 5632850 8099328 28175441 5711511 6780413 7217100 7688374 7766542 35163940 10410568 11593487 12148232 13321224 15865870 63339381 10000 10000 0 10000 10000 63329381 31132 35837 16007 4027 3093 90096 31132 35837 16007 4027 3093 90096 10441700 11629324 12164239 13325251 15868963 63429477 0.99840 0.99810 0.00140 0.00170 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 827246 827246 6461486 1473216 4988270 1730691 1431860 298831 6114347 ASSETS LIMITED AS TO USE 1368535 1368535 DUE TO THIRD PARTIES 73250 73250 15868963 13053619 2815344 0 2815344 15868963 0 15868963 0 15868963 13053619 0 13053619 0 13053619 FORM 990. 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. X X X X X X 0 0 0 0 0 0 0 1 0 ANN PETERS 143204 0 0 0 0 0 0 0 22665 0 165869 0 0 0 PAUL FRIEDRICHS 166834 0 21001 0 0 0 0 0 38861 0 226696 0 0 0 SIRONA PRUNA 223772 0 55818 0 0 0 0 0 28018 0 307608 0 0 0 VASUKI NAGARAJ 143549 0 42168 0 0 0 0 0 21675 0 207392 0 0 0 AJAY SHARMA 140243 0 42846 0 0 0 0 0 21145 0 204234 0 0 0 EDWARD SCULLY 120022 0 12396 0 0 0 0 0 30070 0 162488 0 0 0 PART I, LINE 7 PHYSICIANS ARE PROVIDED INCENTIVE PAYMENTS BASED ON NUMBER OF PATIENTS SEEN, COMPLEXITY OF PATIENT ACUITY, TIMELY DOCUMENTATION, PATIENT SATISIFACTION, AND QUALITY OF CARE PROVIDED. ANN PETERS LAMPREY HEALTH CARE'S CEO IS A MEMBER OF THE BOARD OF DIRECTORS OF CHAN 280932 TRANSACTIONS 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 $222,315. LAMPREY ALSO PASSED THROUGH $40,467 OF THE CIP GRANT TO CHAN TO UPGRADE CHAN'S IT INFRASTRUCTURE. 0 ANN PETERS LAMPREY HEALTH CARE'S CEO IS A MEMBER OF THE BOARD OF DIRECTORS OF CHAN 371939 TRANSACTIONS INCLUDE EMPLOYEES LEASED TO CHAN IN THE AMOUNT OF $320,153 AND FACILITIES(INCLUDING UTILITIES) IN THE AMOUNT OF $51,786. 0 ANN PETERS LAMPREY HEALTH CARE'S CEO IS A MEMBER OF THE BOARD OF DIRECTORS OF BI-STATE 123517 LAMPREY HEALTH CARE IS A MEMBER OF BI-STATE AND RECEIVED GRANT PASS THROUGH FUNDS IN THE AMOUNT OF $123,517. 0 FORM 990, PART VI, SECTION A, LINE 7B THE 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 11 THE 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 12C ANNUALLY, 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 15 THE 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 19 UPON REQUEST FORM 990. PART XII, LINE 2C. NO CHANGES FROM PRIOR YEAR. FRIENDS OF LAMPREY HEALTH CARE INC 207 SOUTH MAIN ST NEWMARKET NH 03857 020348630 SUPPORT LHC NH 501(C)(3) 509(A)(3) TYPE III N/A 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 FRIENDS OF LAMPREY HEALTH CARE INC J 227916 FMV