2016-05-13T11:03:22-05:00 2015-06-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2014-07-01 020512229 Mary and John Elliot Charitable Foundation MARY 6036638977 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 Jeffrey Rooney CFO 6036638977 2016-05-12 1 Timothy R Hepburn P00182393 8002447444 2016-05-12 2014 2016-08-17 19:52:53Z James Woodward 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 2510442 0 X N/A X 2001 NH The Mary and John Elliot Foundation's mission is to support the immediate and ongoing resource needs of the Elliot Health System. 13 12 0 0 0 0 2904287 1718143 0 0 393394 340196 575967 379580 3873648 2437919 2612023 1174592 0 0 0 0 0 0 0 376046 477957 2988069 1652549 885579 785370 9109282 8082709 520927 410737 8588355 7671972 The Mary and John Elliot Foundation's mission is to support the immediate and ongoing resource needs of the Elliot Health System. 0 0 1560165 1174592 423211 Support of the fundraising activities of The Elliot Hospital of the City of Manchester and its related tax exempt organizations. 1560165 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 1 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 5 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 13 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Jeffrey Rooney 6036638977 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 Sid Baines Trustee 1.00 X 0 0 0 David Bellman Trustee 1.00 X 0 0 0 Cathy Champagne Trustee 1.00 X 0 0 0 Charles Goodwin Trustee 1.00 X 0 0 0 John A Hession CPA Trustee 1.00 2.00 X 0 0 0 Selma Naccach-Hoff Trustee (until Jan 2014) 1.00 X 0 0 0 Richard Rawlings Trustee 1.00 X 0 0 0 Renee Walsh Trustee 1.00 X 0 0 0 Richard Winneg Trustee 1.00 2.00 X 0 0 0 Ann G Remus Chair 1.00 2.00 X X 0 0 0 Charles F Rolocek Vice Chair 1.00 2.00 X X 0 0 0 James J Tenn Esq Secretary 1.00 X X 0 0 0 James Woodward CEO (beginning 8/1/14) 1.00 43.00 X X 0 283595 37558 Douglas F Dean President & CEO (until 8/1/14) 1.00 43.00 X X 0 934341 55063 Richard Phelps President & COO (until 6/20/14) 1.00 43.00 X 0 1250999 46389 Richard Elwell CFO 1.00 43.00 X 0 507499 133327 0 2976434 272337 0 0 1 0 0 237388 1480755 53760 1718143 135908 135908 204288 0 204288 204288 204288 27280 237388 72523 -45243 -45243 1612 0 1612 1612 Reimbursed Expenses 561000 423211 423211 423211 2437919 423211 0 296565 1174592 1174592 2520 2520 54162 54162 322486 286784 35702 87803 87803 8560 8560 844 844 994 994 588 588 1652549 1560165 92384 0 1081627 1073056 37143 40188 10496 9514 1570 982 6349280 7964482 609888 24460 9315 9109282 8082709 35927 4937 5000 5800 480000 400000 520927 410737 X 6509813 6736576 2078542 935396 8588355 7671972 9109282 8082709 X 785370 -161808 -1539945 X X 0 1 X 1 0 X 918380 1844041 2227206 3158445 1718143 9866215 918380 1844041 2227206 3158445 1718143 9866215 1690461 8175754 135741 139957 148561 153440 135908 713607 10579822 1905451 0.77280 0.92420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2078542 484442 -109697 1517891 935396 1629528 349989 99025 2078542 1067605 558367 3556 1629528 775945 282540 9120 1067605 2337619 190477 18083 1770234 775945 1.00000 0 0 10496 9514 982 982 Alternative Investments through Elliot Common Trust Fund 609888 C 609888 X 1139055 -161810 -161810 1300865 54162 1082892 1137054 2437919 2055440 1539945 1539945 515495 54162 1082892 1137054 1652549 Part V, Line 4: Endowment funds are used to further the missions of the Elliot Health System's not-for-profit entities. Part X, Line 2: The System and all related entities, with the exception of Elliot Health System Holdings, Inc. and Subsidiaries, are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to the consolidated financial statements. With few exceptions, the System is no longer subject to income tax examination by the U.S. Federal or state tax authorities for years before 2012. Elliot Health System Holdings, Inc. is a holding company and its subsidiaries are for-profit companies subject to federal and state taxation. Income taxes are recorded based upon the asset and liability method. Elliot Health System Holdings, Inc. believes that it has appropriate support for the income tax positions taken and to be taken on tax returns, and that their accruals for tax liabilities are adequate for all open tax years (2012 and thereafter) based on an assessment of many factors and including experience and interpretations of tax laws applied to the facts of each matter. Elliot Health System Holdings, Inc. has concluded there are no significant uncertain tax positions requiring disclosure and there is no material liability for unrecognized tax benefits. Elliot Health System Holdings, Inc.'s policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in income tax expense. Part XI, Line 4b - Other Adjustments: Reclassed Grant Expenses 1,082,892. Part XII, Line 2d - Other Adjustments: Transfers to Affiliates 1,539,945. Part XII, Line 4b - Other Adjustments: Reclassed Grant Expenses 1,082,892. Central America and the Caribbean 0 0 Investments through Elliot Common Trust Fund 447170 0 0 0 0 0 0 447170 0 447170 0 0 0 0 0 0 Schedule F, Part I, Line 3: The legal owner of Mary and John Elliot Charitable Foundation's foreign investments is a related organization, Elliot Common Trust Fund. Since a portion of the total foreign investments are allocated to the Foundation's assets on the financial statements, those allocated investments have been disclosed on Schedule F, Part I, Line 3 of the Foundation's Form 990, However, any required IRS Forms 926 nad other foreign reporting obligations are filed by the legal owner, Elliot Common Trust Fund. Schedule F, Part IV, Line 3: The Mary and John Elliot Charitable Foundation did not have an ownership interest in any foreign corporation that is greater than the 10% filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Schedule F, Part IV, Line 4: The Mary and John Elliot Charitable Foundation meets the exception for tax-exempt organizations with respect to filing Form 8621. Accordingly, Form 8621 is not required to be filed for the Hospital. Gala 145788 125913 19875 30118 1208 4200 22516 Golf Classic 118880 111475 7405 3938 9721 822 264668 237388 27280 3938 39839 1208 4200 23338 72523 -45243 1 The Caregivers Inc 19 Harvey Road Bedford NH 03110 020395429 501(c)(3) 6700 Add 50 additional clients and inaugurate a bi-annual food drive Child & Family Services of New Hampshire 464 Chestnut Street Box 448 Manchester NH 03105 020222164 501(c)(3) 25000 Care management and in-home support/ services for frail, impoverished senior citizens Easter Seals of New Hampshire 555 Auburn Street Manchester NH 03103 020272825 501(c)(3) 25000 Enhance quality of in-home care provided for low income seniors with Alzheimer's Disease The Elliot Hospital of the City of Manchester 1 Elliot Way Manchester NH 03103 020232673 501(c)(3) 953819 Support the programmatic and capital needs of the Hospital Elliot Professional Services Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 331003630 501(c)(3) 27641 $15,000-develop Memory and Mobility website for caregivers and others; $12,641-general support New Hampshire Association for the Blind McGreal Sight Center 25 Walker Street Concord NH 03301 020223606 501(c)(3) 10000 Vision rehabilitation services for blind and visually impaired elderly men and women St Joseph Community Services PO Box 910 Merrimack NH 03054 020335003 501(c)(3) 10000 Assist in the provision of 893 rides to 45 Manchester elderly residents VNA Home Health & Hospice Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020222241 501(c)(3) 43434 General Operating Support VNA of Manchester and Southern NH and Subs 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020395296 501(c)(3) 65000 General Operating Support 9 0 Part I, Line 2: The Foundation's Pearl Manor Advisory Committee meets to review requests for grants, meet leaders of organizations requesting grant funding, and requires updates on the use of funds in many instances, both written and presentation. 1 1 0 0 0 0 0 0 0 James Woodward CEO (beginning 8/1/14) 0 251894 0 25000 0 6701 0 32500 0 5058 0 321153 0 0 Douglas F Dean President & CEO (until 8/1/14) 0 460654 0 216000 0 257687 0 43667 0 11396 0 989404 0 251913 Richard Phelps President & COO (until 6/20/14) 0 389700 0 141185 0 720114 0 34500 0 11889 0 1297388 0 720114 Richard Elwell CFO 0 395794 0 104884 0 6821 0 121931 0 11396 0 640826 0 0 Part I, Line 3 The CEO's of Mary & John Elliot Charitable Foundation, Doug Dean until August 2014, and James Woodward beginning in August 2014, are compensated by a related organization, The Elliot Hospital of the City of Manchester. The Hospital uses a compensation committee, an independent compensation consultant, Forms 990 of other organizations, compensation studies, and approval by the Board or a compensation committee to establish the compensation for the CEO. Part I, Lines 4a-b Richard Phelps, who was employed by a related organization, The Elliot Hospital of the City of Manchester, received a severence payment of $150,382 in 2014. 2014 contributions to the related organization's 457(f) plan were: James Woodward-$32,500; Richard Elwell-$80,049; Richard Phelps-$34,500. Form 990, Part VII-A and Schedule J, Part II: Douglas Dean served as CEO of Elliot Hospital, a related organization, until August 2014 and was compensated by that organization. After his retirement, he continued to serve on the Board and work with the Hospital and related organizations as a non-officer employee. Of his reported compensation, $76,155 was compensation paid as a non-officer employee. Part II Lines 2 and 3 During the year Mr. Dean and Mr. Phelps withdrew funds from their deferred compensation plans ($251,913 and $720,114, respectively). These amounts are reported as taxable compensation in Part II, Column B(iii). It should be noted that amounts that were reported in prior years as deferred compensation in Part II, Column C. Accordingly, the prior year deferrals are also reflected in Part II, Column F. X 4 52552 Stock Market Value X Beverages for Special Event 1 1208 Fair Market Value 0 1 1 Part I, Line 32b: The Organization sells contributions of securities through the investment management group of its financial institution. All gifts of securities are sold as soon as administratively possible. Form 990, Part VI, Section A, line 6 Elliot Health System is the sole member of the reporting organization. Form 990, Part VI, Section A, line 7a Elliot Health System, the sole member of the reporting organization, has the right to ratify the election of all Board members of the Mary & John Elliot Charitable Foundation. The Foundation's Board of Trustees shall be comprised of not more than 50% and not less than 1/3 of present or former members of the Elliot Health System Board of Directors. Form 990, Part VI, Section A, line 7b The sole member, Elliot Health System, has the right to the following governance decisions: approval of Mary & John Elliot Charitable Foundation's annual budget; approval of Bylaws and Articles of Organization and amendments of same; approval of strategic plans. Form 990, Part VI, Section B, line 11 The completed Form 990 is provided to the full Board for questions, comments, and review prior to filing. Form 990, Part VI, Section B, line 12c officers, directors and key employees are required annually to sign a conflict of interest form which requires reporting any potential conflict of interest arrangements with the organization. Form 990, Part VI, Section B, line 15 The compensation committee of the board utilizes outside compensation consultants to evaluate the salaries for the CEO, CFO, and COO. The consultants utilize their internal data along with national and local benchmark data from the industry to develop salary levels. Recommendations of the consultant are reviewed by the compensation committee, who recommends compensation levels to the full Board for approval. An outside consulting firm is also used by the organization to review the compensation of the remainder of the Vice Presidents. Again, national and local benchmarks for salaries are consulted to determine salary levels for these positions. Form 990, Part VI, Section C, line 19 Each of these documents is filed with the New Hampshire Secretary of State and is available upon request. Form 990, Part XI, line 9: Transfers to Affiliates -1,539,945. Form 990, Part XII, Line 2c: The audit process did not change from the prior year. Elliot Health System 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509911 Management NH 501(c)(3) Line 11b, II 0 Elliot Health System Professional & GEneral LIT 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 016217452 Insurance Trust NH 501(c)(3) Line 11b, II Elliot Health System 0 Elliot Hospital 1 Elliot Way Manchester NH 03103 020232673 Physician Services NH 501(c)(3) Line 3 Elliot Health System 0 Elliot Physician Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 331003630 Physician Services NH 501(c)(3) Line 3 Elliot Hospital 0 Elliot Professional Services Network Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 331003630 Physician Services NH 501(c)(3) Line 9 Elliot Hospital 0 Everwell Inc 1 Medical Center Drive Lebanon NH 03756 352506275 Supporting Organization NH 501(c)(3) Line 11a, I N/A 0 VNA Community Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020396549 Nursing Services NH 501(c)(3) Line 9 Elliot Health System 0 VNA Home Health and Hospice Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020222241 Home Care and Hospice NH 501(c)(3) Line 9 Elliot Health System 0 VNA of Manchester & Southern NH & Subs 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020395296 VNA Holding Company NH 501(c)(3) Line 11b, II Elliot Health System 0 VNA Personal Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020395295 Private Health and Homemaker Services NH 501(c)(3) Line 9 Elliot Health System 0 Elliot Common Trust Fund LLC 1 Elliot Way Manchester NH 03103 203653624 Investments NH N/A Elliot Health System Holdings & Subsidiaries 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512224 Management NH N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Part II Everwell, Inc. was formed in 2014 as a 501c(3) organization. It is a joint venture between Elliot Health System and Dartmouth Hitchcock Health, with each entity having equal representation on the Board of Directors.