TY 2018 Form 990 Schedule O

efile Public Visual Render ObjectId: 202011209349300206 - Submission: 2020-04-29 TIN: 02-0458174

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

Amoskeag Health

Employer identification number

02-0458174

Return Reference	Explanation
Form 990, Part VI, Section A, line 4	The organization changed its name to Amoskeag Health. Additionally, the board approved to change the mission statement to "The mission of Amoskeag Health is to improve the health and well-being of our patients and the communities we serve by providing exceptional care and services that are accessible to all."
Form 990, Part VI, Section B, line 11b	Initial review is conducted by the CEO and CFO, and then the (revised, if necessary) document would be distributed to the finance committee for review, and then distributed to the full board.
Form 990, Part VI, Section B, line 12c	The conflict of interest policy covers both Board and staff members. Board members annually complete a survey disclosing any potential related party transactions. If a vote comes before the board, directors who may have a perceived conflict are to abstain from voting. For staff, they are not to be a participant in any decision-making process regarding employing a relative or contracting/purchasing goods from a relative, or leveraging their position to persuade others to engage in potential conflicts. Staff are expected to inform of any potential conflicts as well.
Form 990, Part VI, Section B, line 15a	Executive Director compensation is reviewed and approved by the Executive Committee of board of directors.
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.
Form 990, Part IX, line 11g	Subcontractors: Program service expenses 229,878. Management and general expenses 0. Fundraising expenses 0. Total expenses 229,878. Providers: Program service expenses 607,099. Management and general expenses 0. Fundraising expenses 0. Total expenses 607,099. Interpretation: Program service expenses 171,815. Management and general expenses 0. Fundraising expenses 0. Total expenses 171,815. Transportation: Program service expenses 24,842. Management and general expenses 0. Fundraising expenses 0. Total expenses 24,842. Contracted 340B Pharmacy: Program service expenses 336,857. Management and general expenses 0. Fundraising expenses 0. Total expenses 336,857. Contracted Information Systems: Program service expenses 92,491. Management and general expenses 0. Fundraising expenses 0. Total expenses 92,491. Other Contracted Services: Program service expenses 486,108. Management and general expenses 52,986. Fundraising expenses 21,502. Total expenses 560,596.
Form 990, Part X, Line 10: Land, Buildings, and Equipment:	Section 1.263(a)-3(n) Election: Amoskeah Health 145 Hollis Street, 2nd Floor Manchester, NH 03101 EIN: 02-0458174 Section 1.263(a)-3(n) Election: Amoskeag Health is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).
Form 990, Schedule A, Part I:	The organization is exempt under 170(b)(1)(a)(iii), as a hospital. The organization operates a federally qualified health center. The Health Center is not registered with the state of New Hampshire as a hospital. Accordingly no schedule H is attached.

Return Reference

Explanation

Form 990, Part VI, Section A, line 4

The organization changed its name to Amoskeag Health. Additionally, the board approved to change the mission statement to "The mission of Amoskeag Health is to improve the health and well-being of our patients and the communities we serve by providing exceptional care and services that are accessible to all."

Form 990, Part VI, Section B, line 11b

Initial review is conducted by the CEO and CFO, and then the (revised, if necessary) document would be distributed to the finance committee for review, and then distributed to the full board.

Form 990, Part VI, Section B, line 12c

The conflict of interest policy covers both Board and staff members. Board members annually complete a survey disclosing any potential related party transactions. If a vote comes before the board, directors who may have a perceived conflict are to abstain from voting. For staff, they are not to be a participant in any decision-making process regarding employing a relative or contracting/purchasing goods from a relative, or leveraging their position to persuade others to engage in potential conflicts. Staff are expected to inform of any potential conflicts as well.

Form 990, Part VI, Section B, line 15a

Executive Director compensation is reviewed and approved by the Executive Committee of board of directors.

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.

Form 990, Part IX, line 11g

Subcontractors: Program service expenses 229,878. Management and general expenses 0. Fundraising expenses 0. Total expenses 229,878. Providers: Program service expenses 607,099. Management and general expenses 0. Fundraising expenses 0. Total expenses 607,099. Interpretation: Program service expenses 171,815. Management and general expenses 0. Fundraising expenses 0. Total expenses 171,815. Transportation: Program service expenses 24,842. Management and general expenses 0. Fundraising expenses 0. Total expenses 24,842. Contracted 340B Pharmacy: Program service expenses 336,857. Management and general expenses 0. Fundraising expenses 0. Total expenses 336,857. Contracted Information Systems: Program service expenses 92,491. Management and general expenses 0. Fundraising expenses 0. Total expenses 92,491. Other Contracted Services: Program service expenses 486,108. Management and general expenses 52,986. Fundraising expenses 21,502. Total expenses 560,596.

Form 990, Part X, Line 10: Land, Buildings, and Equipment:

Section 1.263(a)-3(n) Election: Amoskeah Health 145 Hollis Street, 2nd Floor Manchester, NH 03101 EIN: 02-0458174 Section 1.263(a)-3(n) Election: Amoskeag Health is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).

Form 990, Schedule A, Part I:

The organization is exempt under 170(b)(1)(a)(iii), as a hospital. The organization operates a federally qualified health center. The Health Center is not registered with the state of New Hampshire as a hospital. Accordingly no schedule H is attached.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

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