2014-05-14T14:55:51-05:00 2013-06-30 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2012-07-01 020512229 MARY AND JOHN ELLIOT CHARITABLE FOUNDATION MARY 6036638977 1070 HOLT AVENUE UNIT 1 SUITE 2100 MANCHESTER NH 03109 RICHARD ELWELL 6036638977 2014-05-09 1 WILLIAM G STEELE JR CPA P00233103 6036228881 2014-05-09 2012 2015-11-30 17:44:51Z RICHARD ELWELL 1070 HOLT AVENUE UNIT 1 SUITE 2100 MANCHESTER NH 03109 2728226 0 X N/A X 2001 NH THE FOUNDATION'S MISSION IS TO SUPPORT THE IMMEDIATE AND ONGOING RESOURCE NEEDS OF THE ELLIOT HOSPITAL. 11 10 0 0 0 0 1739361 1728985 0 0 208767 328424 421559 587978 2369687 2645387 1696012 1241795 0 0 0 0 0 0 0 348561 424501 2044573 1666296 325114 979091 6584489 7552850 661947 576011 5922542 6976839 THE FOUNDATION'S MISSION IS TO SUPPORT THE IMMEDIATE AND ONGOING RESOURCE NEEDS OF THE ELLLIOT HOSPITAL. 0 0 1666296 1241795 380287 SUPPORT OF THE FUNDRAISING ACTIVITIES OF THE ELLIOT HOSPITAL AND ITS RELATED TAX EXEMPT ORGANIZATIONS 1666296 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 0 1 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X MARC CULLEROT 6036635809 1070 HOLT AVENUE UNIT 1 SUITE 2100 MANCHESTER NH 03101 JAMES J TENN ESQUIRE 1.00 0.00 X X 0 0 0 ANN G REMUS 1.00 4.00 X X 0 0 0 DOUGLAS F DEAN 1.00 43.00 X X 0 1996284 152995 SELMA NACCACH-HOFF 1.00 2.00 X X 0 0 0 RICHARD I WINNEG 1.00 2.00 X 0 0 0 SID BAINES 1.00 0.00 X 0 0 0 RENEE WALSH 1.00 0.00 X 0 0 0 DAVID BELLMAN 1.00 0.00 X 0 0 0 CATHY CHAMPAGNE 1.00 0.00 X 0 0 0 CHARLES GOODWIN 1.00 0.00 X 0 0 0 CHARLES F ROLECEK 1.00 0.00 X 0 0 0 RICHARD A ELWELL 1.00 43.00 X 0 485527 120861 RICHARD PHELPS 1.00 43.00 X 0 578667 87507 0 3060478 361363 0 0 1 0 0 1728985 1728985 148561 148561 179863 0 179863 179863 179863 290530 82839 207691 207691 MANAGEMENT FEE INCOME 561000 380287 380287 380287 2645387 380287 0 536115 1241795 1241795 1029 1029 9632 9632 1546 1546 470 470 PURCHASED SERVICES 232137 232137 EVENT COSTS 83045 83045 TRUST FUND FEES 38274 38274 CONSULTING FEES 27274 27274 31094 31094 1666296 1666296 0 0 773856 859156 148416 85402 16000 0 9991 8355 2105 1636 5632528 6577807 11584 28849 6584489 7552850 21947 9811 6200 640000 560000 661947 576011 X 4854937 5347311 1067605 1629528 5922542 6976839 6584489 7552850 X 979091 153380 -78174 X 0 1 X 1 0 X 1013593 1184977 918380 1844041 2227206 7188197 1013593 1184977 918380 1844041 2227206 7188197 7188197 204092 188299 135741 139957 148561 816650 8004847 1629444 0.89800 0.89700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1067605 558367 3556 1629528 775945 282540 9120 1067605 2337619 190477 18083 1770234 775945 1582058 670870 84691 2337619 1097517 413069 71472 1582058 1.00000 0 0 9991 8355 1636 1636 SECURITIES AND OTHER INVESTMENTS 6577807 F 6577807 X 1598228 153380 153380 1444848 1200539 1200539 2645387 465757 0 465757 1200539 1200539 1666296 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: PART X, INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS WAS THE FOLLOWING, "MANAGEMENT HAS 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." PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSE RECLASS 1,200,539. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSE RECLASS 1,200,539. RECLASSIFICATION OF EXPENSES ELLIOT GOLF CLASSIC 116194 116194 3955 10058 1045 ELLIOT HOSPTL GALA 161823 161823 31634 33531 1 12513 12513 1896 720 290530 290530 3955 43588 35296 82839 207691 1 THE CAREGIVERS INC 020395429 501(C)(3) 10000 TO SUPPORT A MARKETING INITIATIVE TO RECRUIT NEW VOLUNTEERS GRANITE STATE INDEPENDENT LIVING 020350170 501(C)(3) 10000 TO PROVIDE SUPPORT TO THE NURSING FACILITY TRANSITION PROGRAM SUPPORTING LOW INCOME ELDERLY EASTER SEALS OF NEW HAMPSHIRE 020272825 501(C)(3) 25000 TO PROVIDE SUPPORT FOR INITIAL ORAL HEALTH EVALUATIONS AND TREATMENT FOR UNINSURED ELDERLY THE MOORE CENTER 020261136 501(C)(3) 15000 TO EXPAND SHARED HOUSING FOR THE ELDERLY ELLIOT HOSPITAL 020232673 501(C)(3) 25000 TO DEVELOP AN AMBULATORY CARE COORDINATION TRAINING PROGRAM FOR THE ELDERLY 5 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE 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. 0 1 0 0 0 0 0 1 0 DOUGLAS F DEAN 0 545926 0 217625 0 1232733 0 140856 0 12139 0 2149279 0 1003896 RICHARD A ELWELL 0 346099 0 91351 0 48077 0 109258 0 11603 0 606388 0 0 RICHARD PHELPS 0 428404 0 105001 0 45262 0 71750 0 15757 0 666174 0 0 PART I, LINE 4B DOUGLAS DEAN - $108,075; RICK PHELPS - $64,250; RICHARD ELWELL - $73,882; WILLIAM BAXTER - $34,640 PART I, LINE 7 THE ORGANIZATION HAS ADOPTED AN INCENTIVE PAY PROGRAM THAT PROVIDES DESIGNATED MANAGEMENT EMPLOYEES AN OPPORTUNITY TO EARN A DESIGNATED PERCENTAGE OF SALARY BASED ON THE ACHIEVEMENT BY THE ORGANIZATION OF A NUMBER OF CRITICAL SUCCESS FACTORS. THE CRITICAL SUCCESS FACTORS ARE ESTABLISHED ANNUALLY BY THE INDEPENDENT EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES WITH ASSISTANCE FROM AN INDEPENDENT NATIONAL COMPENSATION CONSULTING COMPANY. THE MAXIMUM POTENTIAL INCENTIVE PAYMENTS UNDER THE PLAN ARE CONSIDERED BY THE COMPENSATION CONSULTANT IN ENSURING THAT MANAGEMENT COMPENSATION IS REASONABLE. SUPPLEMENTAL INFORMATION PART III THE SALARIES OF DOUGLAS DEAN, RICK PHELPS, AND RICHARD ELWELL REPRESENT SERVICES PROVIDED TO ALL RELATED ENTITIES. SUPPLEMENTAL INFORMATION PART III PART II LINE 1 - DURING THE YEAR MR DEAN WITHDREW FUNDS FROM HIS DEFERRED COMPENSATION PLAN ($1,003,896) AS SUCH THIS AMOUNT IS REPORTED IN COLUMN B(III) AND IN PRIOR YEARS CONTRIBUTIONS TO HIS DEFERRED COMPENSATION PLAN WHICH SUPPORT THE CURRENT DISTRIBUTION WERE REPORTED IN COLUMN C. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED 990 IS PRESENTED TO THE BOARD PRIOR TO FILING. SPECIFIC KEY SECTIONS OF THE 990 ARE SINGLED OUT FOR ADDITIONAL DISCUSSION AND INPUT FROM BOARD MEMBERS. 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 VP'S. AGAIN NATIONAL AND LOCAL BENCHMARKS FOR SALARIES ARE CONSULTED TO DETERMINE SALARY LEVELS FOR THESE VP'S. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFERS TO AFFILIATES -78,174. ELLIOT HEALTH SYSTEM PROFESSIONAL & GENERAL LIABILITY INSURANCE TRUST 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 016217452 INSURANCE TRUST NH 501(C)3 LINE 11, TYPE 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 STE 2100 MANCHESTER NH 03109 020509589 PHYSICIAN SERVICES NH 501(C)3 LINE 3 ELLIOT HEALTH SYSTEM 0 ELLIOT HEALTH SYSTEM 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 020509911 MANAGEMENT NH 501(C)3 LINE 11, TYPE II 0 VNA OF MANCHESTER & SOUTHERN NH & SUBS 33 SOUTH COMMERCIAL STREET SUITE 40 MANCHESTER NH 03101 020395296 VNA HOLDING COMPANY NH 501(C)3 LINE 7 ELLIOT HOSPITAL 0 ELLIOT PROFESSIONAL SERVICES NETWORK 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 331003630 PHYSICIAN SERVICES NH 501(C)3 LINE 7 ELLIOT HEALTH SYSTEM 0 VNA HOME HEALTH & HOSPICE SERVICES INC 33 SOUTH COMMERCIAL STREET SUITE 40 MANCHESTER NH 03101 020222241 HOME CARE & HOSPICE SERVICES NH 501(C)3 LINE 11, TYPE II VNA OF MANCHESTER & SOUTHERN NH INC 0 VNA COMMUNITY SERVICES INC 33 SOUTH COMMERCIAL STREET SUITE 40 MANCHESTER NH 03101 020396549 NURSING SERVICES NH 501(C)3 LINE 11, TYPE II VNA OF MANCHESTER & SOUTHERN NH INC 0 VNA PERSONAL SERVICES INC 33 SOUTH COMMERCIAL STREET SUITE 40 MANCHESTER NH 03101 020395295 PRIVATE HEALTH & HOMEMAKER SERVICES NH 501(C)3 LINE 11, TYPE II VNA OF MANCHESTER & SOUTHERN NH INC 0 ELLIOT COMMON TRUST FUND LLC 1 ELLIOT WAY MANCHESTER NH 03103 203653624 INVESTMENTS NH N/A 289911 6610630 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0