2011-11-14T12:24:11-06:00 2011-06-30 LEONE MCDONNELL & ROBERTS PA 10 DUPREY ROAD NORTH CONWAY NH 03860 990 2010-07-01 020300994 NORTHERN HUMAN SERVICES INC NORT 6034473347 87 WASHINGTON STREET CONWAY NH 03818 DALE HEON 6034473347 2011-11-09 1 JOHN D CALLAHAN JR 6033566358 2011-11-09 2010 2016-02-24 21:20:13Z DALE HEON 87 WASHINGTON STREET CONWAY NH 03818 35128585 0 X WWW.NORTHERHS.ORG X 1971 NH ASSIST PEOPLE AFFECTED BY MENTAL ILLNESS, DEVELOPMENTAL DISABILITIES AND RELATED DISORDERS. 11 11 960 0 0 0 1812337 1594310 32508520 32729096 15559 7105 530934 798074 34867350 35128585 0 0 0 0 19626582 20293259 0 0 0 13390111 14485413 33016693 34778672 1850657 349913 8794903 9053555 2114289 1912308 6680614 7141247 TO ASSIST PEOPLE AFFECTED BY MENTAL ILLNESS, DEVELOPMENTAL DISABILITES AND RELATED DISORDERS TO LIVE MORE MEANINGFUL LIVES. 0 0 12421343 12840563 PROVIDED VARIOUS SERVICES TO MENTALLY ILL CLIENTS IN ALL OF NORTHERN NEW HAMPSHIRE, INCLUDING PSYCHIATRIC EMERGENCY SERVICES, OUTPATIENT THERAPY, PSYCHIATRIC EMERGENCY CARE, SUBSTANCE ABUSE TREATMENT AND OUTREACH. 19739427 20686607 PROVIDED SERVICES TO DEVELOPMENTALLY DISABLED CLIENTS IN ALL OF NORTHERN NEW HAMPSHIRE, INCLUDING COMPREHENSIVE DAY SERVICES, PERSONAL HYGIENE, COMMUNITY INTEGRATION, RESIDENTIAL SERVICES AND NURSING. 32160770 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 1 1 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 1 0 0 1 0 1 55 0 960 1 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 0 1 1 1 1 0 NH X DOMINIC IPPOLITO 6034473801 71 HOBBS STREET 3RD FLOOR CONWAY NH 03818 MARGARET MCCLELLAN 1.00 X X 0 0 0 STEPHEN MICHAUD 1.00 X 0 0 0 BOB FINK 1.00 X X 0 0 0 JAMES SALMON 1.00 X X 0 0 0 LISA DANAULT 1.00 X 0 0 0 MADELENE COSTELLO 1.00 X 0 0 0 GENE EHLERT 1.00 X 0 0 0 GEORGEIA CARON 1.00 X X 0 0 0 MARTI FAULKNER 1.00 X 0 0 0 KATHLEEN KELLEY 1.00 X 0 0 0 JENN PINEO 1.00 X 0 0 0 DENNIS MACKAY 40.00 X 162630 0 5590 ERIC JOHNSON 40.00 X 100655 0 5491 DALE HEON 40.00 X 80326 0 5444 PAUL LIDSTROM 35.00 X 189931 0 654 LESTER NICHOLSON 40.00 X 190282 0 650 ERINN FELLNER 40.00 X 165710 0 12860 MELISSA MYERS 40.00 X 156298 0 12882 ERIC VAN LEUVEN 40.00 X 215681 0 9464 1261513 0 53035 8 0 1 0 DONNA SAWYER 2665 E CONWAY RD CENTER CONWAY NH 03813 CLIENT CARE 232597 THERESA MAURA PO BOX 255 TAMWORTH NH 03886 CLIENT CARE 186799 PAUL KONKEL 386 N SKINNYRIDGE RD LITTLETON NH 03561 CLIENT CARE 170308 DAWN PATNEAU 2 NORTH COURT STREET WOODSVILLE NH 03785 CLIENT CARE 128776 SHARON DAVIS 24 MOODY POND ROAD CENTER OSSIPEE NH 03814 CLIENT CARE 106779 5 1108844 485466 1594310 CLIENT SERVICE FEES 624100 32252329 32252329 CLIENT PRODUCTION INCO 624100 476767 476767 32729096 7105 7105 OTHER REVENUE 624100 798074 798074 798074 35128585 33527170 0 7105 15871844 14516003 1355841 3143708 2869957 273751 1277707 1193131 84576 9259012 8824230 434782 1310434 1228614 81820 1056738 1042921 13817 195060 188503 6557 CONSUMABLE SUPPLIES 615631 562650 52981 CLIENT WAGES 432099 432099 COMMUNICATIONS 416311 303592 112719 EQUIPMENT EXPENSE 368110 213438 154672 ASSISTANCE TO INDIVIDUA 100616 97563 3053 731402 688069 43333 34778672 32160770 2617902 0 5266521 5883811 228264 141567 52998 2202625 2102106 252642 255852 3300572 3008964 433330 291608 269954 467180 8794903 9053555 1887913 1847862 77065 14757 149311 49689 2114289 1912308 X 6426114 6887911 2083 919 252417 252417 6680614 7141247 8794903 9053555 X 349913 110720 X 0 0 0 X 2488516 1948998 1706821 1812337 1594310 9550982 28056934 26669453 32039287 32508520 32729096 152003290 30545450 28618451 33746108 34320857 34323406 161554272 0 0 0 161554272 84169 44115 11899 15559 7105 162847 84169 44115 11899 15559 7105 162847 193113 142520 106216 441849 30822732 28805086 33864223 34336416 34330511 162158968 0.99630 0.99340 0.00100 0.00120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2716392 2546871 169521 584180 462093 122087 291608 DUE FROM AFFILIATES 467180 467180 GIFT ANNUITY PAYABLE 5566 CAPITAL LEASE 44123 49689 35128585 34778672 349913 110720 110720 460633 35156051 27466 27466 35128585 0 35128585 34778672 0 34778672 0 34778672 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN SPLIT INTEREST AGREEMENT 6,759. CHANGE IN CASH VALUE OF LIFE INSURANCE 20,707. TRANSFER OF NET ASSETS FROM RELATED ENTITY 83,254. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN SPLIT INTEREST AGREEMENT 6,759. CHANGE IN CASH VALUE OF LIFE INSURANCE 20,707. X X 0 0 0 0 0 0 0 0 0 DENNIS MACKAY 162630 0 0 0 0 0 0 0 5590 0 168220 0 0 0 PAUL LIDSTROM 189931 0 0 0 0 0 0 0 654 0 190585 0 0 0 LESTER NICHOLSON 190282 0 0 0 0 0 0 0 650 0 190932 0 0 0 ERINN FELLNER 165710 0 0 0 0 0 0 0 12860 0 178570 0 0 0 MELISSA MYERS 156298 0 0 0 0 0 0 0 12882 0 169180 0 0 0 ERIC VAN LEUVEN 215681 0 0 0 0 0 0 0 9464 0 225145 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY MANAGEMENT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 15 NORTHERN HUMAN SERVICES INC. HIRES AN INDEPENDENT CONSULTANT TO REVIEW COMPENSATION DECISIONS. FORM 990, PART VI, SECTION C, LINE 19 NORTHERN HUMAN SERVICES INC. 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 SPLIT INTEREST AGREEMENT 6,759. CHANGE IN CASH VALUE OF LIFE INSURANCE 20,707. TRANSFER OF NET ASSETS FROM RELATED ENTITY 83,254. TOTAL TO FORM 990, PART XI, LINE 5: 110,720. SHALLOW RIVER PROPERTIES INC 87 WASHINGTON STREET CONWAY NH 03818 020426312 OWN & MANAGE REAL PROPERTY FOR NORTHERN HUMAN SERVICES NH 501(C)2 N/A 0 NORTHERN NEW HAMPSHIRE MENTAL HEALTH HOUSING INC 87 WASHINGTON STREET CONWAY NH 03818 020347162 PROVIDE HOUSING AND LIFE SKILLS TRAINING TO MENTALLY ILL CLIENTS NH 501(C)3 170(B)(1)(A)(VI) N/A 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 SHALLOW RIVER PROPERTIES C SHALLOW RIVER PROPERTIES J