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 331003630 ELLIOT PROFESSIONAL SERVICES NETWORK INC ELLI 6036638914 1070 HOLT AVENUE UNIT 1 SUITE 2100 MANCHESTER NH 03109 RICHARD ELWELL 6036638914 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 55186971 0 X N/A X 2004 NH TO PROMOTE THE CHARITABLE, MEDICAL AND SCIENTIFIC, AND EDUCATIONAL PURPOSES OF THE ELLIOT HEALTH SYSTEM AND ITS AFFILIATED ORGANIZATIONS THROUGH THE EMPLOYMENT OF PHYSICIANS AND OTHER PROFESSIONAL PERSONNEL TO PROVIDE MEDICAL CARE TO THOSE IN NEED. 14 7 229 0 0 0 31753 10629 46119115 55170917 3100 5366 0 0 46153968 55186912 0 0 0 0 53756604 58367780 0 0 0 13000760 14094637 66757364 72462417 -20603396 -17275505 4007307 7438393 4521249 5653489 -513942 1784904 X THE ELLIOT PROFESSIONAL SERVICES IS A GROUP OF HIGHLY SPECIALIZED PHYSICIANS AND CARE PROVIDERS, WHICH ARE DEDICATED TO THE PROMOTION OF HIGHEST QUALITY, COMPASSIONATE AND ACCESSIBLE HEALTH CARE. WE REALIZE THE IMPORTANCE OF EACH PATIENT AND EACH PHYSICIAN IN THE PATIENT/PHYSICIAN RELATIONSHIP. WE ARE GUIDED BY THE DESIRE TO WORK WITHIN THE LARGER ELLIOT HEALTH SYSTEM TO CREATE A HEALTHY COMMUNITY. 0 0 70420528 55170917 TO PROVIDE QUALIFIED PROFESSIONAL PERSONNEL AND MAKE THE SERVICES OF SUCH HEALTH CARE PROFESSIONALS AVAILABLE TO SUCH PERSONS, INCLUDING INDIGENT PERSONS, REQUIRING MEDICAL CARE 70420528 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 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 0 1 15 0 1 229 1 0 0 0 0 0 0 0 0 0 0 X 14 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X MARC CULLEROT 6036638977 1070 HOLT AVENUE UNIT 1 SUITE 2100 MANCHESTER NH 03109 JOHN WEEKS 1.00 3.00 X X 0 0 0 JOHN HESSION 1.00 1.00 X 0 0 0 BARBARA RAND 1.00 1.00 X 0 0 0 DOUGLAS DEAN 1.00 43.00 X X 0 1996284 152995 EMILY BRYANT ARNP 1.00 1.00 X 0 0 0 PETER CHEUNG MD 1.00 1.00 X 0 0 0 RICHARD MARCUCCI MD 40.00 1.00 X 365251 0 23528 RICHARD PHELPS 1.00 43.00 X X 0 578667 87507 WILLIAM BAXTER MD 1.00 41.00 X 0 365580 15894 GUS EMMICK MD 1.00 42.00 X 0 285153 23587 JAMES FITZGERALD MD 1.00 42.00 X 0 212598 22991 LEA GOTTRESDEN DO 1.00 40.00 X 0 144147 16101 ROCHELLE LINDER DMD 1.00 1.00 X 0 0 0 ANN REMUS 1.00 4.00 X 0 0 0 RICHARD A ELWELL 1.00 43.00 X 0 485527 120861 CARL M FIER 40.00 0.00 X 827035 0 22669 LAWRENCE HOEPP 40.00 2.00 X 893217 0 20864 MICHAEL R KACZANOWSKI 40.00 0.00 X 969189 0 23770 BRIAN F GILCHRIST 40.00 0.00 X 789329 0 15027 AYDAMIR ALRAKAWI 40.00 0.00 X 1052086 0 24088 4896107 4067956 569882 133 0 1 0 MASS GENERAL PHYSICIAN ORG 55 FRUIT ST BULLFINCH 208 BOSTON MA 02114 HEALTH SERVICES 483329 FAITH MINARD ARNP 445 CYPRESS ST MANCHESTER NH 03103 PHYSICIAN - PROFESSIONAL SERVICES 189969 MEDICUS EMERGENCY ROOM SERVICE 7 INDUSTRIAL WAY UNIT 5 SALEM NH 03079 CONTRACTED LABOR 187842 MEDICAL DOCTOR ASSOC PO BOX 277185 ATLANTA GA 30384 LOCUM TENENS 179147 DARTMOUTH HITCHCOCK CLINIC 100 HITCHCOCK WAY MANCHESTER NH 03104 PHYSICIAN SERVICES 150255 9 10629 10629 PATIENT REVENUES 621110 55170917 55170917 55170917 5425 5425 59 -59 -59 -59 55186912 55170917 0 5366 365251 365251 51989445 51989445 1181184 1181184 2536628 2536628 2295272 2295272 3151 3151 647 647 10626 10626 52606 52606 1471189 1471189 5032 5032 230112 230112 18366 18366 PROVISION FOR BAD DEBT 7138869 7138869 BUSINESS SERVICE FEES 1986511 1986511 SUPPLIES 1424300 1424300 PHYSICIAN'S EXPENSE 453656 453656 1299572 1254820 44752 72462417 70420528 2041889 0 329661 1374510 3153612 5758582 0 1004441 845677 187750 158764 336284 146537 4007307 7438393 4290198 5244181 231051 409308 4521249 5653489 X -513942 1784904 -513942 1784904 4007307 7438393 X -17275505 19574351 X 0 1 X 1 0 X 8550 31753 10629 50932 22503344 27480530 35321866 46119115 55170917 186595772 22503344 27480530 35330416 46150868 55181546 186646704 0 0 0 186646704 2111 6624 9874 3100 5366 27075 2111 6624 9874 3100 5366 27075 22505455 27487154 35340290 46153968 55186912 186673779 0.99990 0.99980 0.00010 0.00020 X 1004441 845677 158764 158764 DUE TO AFFILIATES 362239 DUE TO THIRD PARTY PAYORS 47069 409308 X 55186912 0 55186912 0 55186912 72462417 0 72462417 0 72462417 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ELLIOT PROFESSIONAL SERVICES NETWORK, INC. IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ELLIOT HOSPITAL. INCLUDED IN THOSE CONSOLIDATED AUDITED FINANCIAL STATEMENTS WAS THE FOLLOWING, "MANAGEMENT EVALUATED THE HOSPITAL'S TAX POSITIONS AND CONCLUDED THE HOSPITAL 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 X, ELLIOT PROFESSIONAL SERVICES NETWORK, INC. IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ELLIOT HOSPITAL. INCLUDED IN THOSE CONSOLIDATED AUDITED FINANCIAL STATEMENTS WAS THE FOLLOWING, "MANAGEMENT EVALUATED THE HOSPITAL'S TAX POSITIONS AND CONCLUDED THE HOSPITAL 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." 1 X X X X X X 0 1 0 0 0 0 0 1 0 DOUGLAS DEAN 0 545926 0 217625 0 1232733 0 140856 0 12139 0 2149279 0 1003896 RICHARD MARCUCCI MD 313987 0 12306 0 38958 0 7500 0 16028 0 388779 0 0 0 RICHARD PHELPS 0 428404 0 105001 0 45262 0 71750 0 15757 0 666174 0 0 WILLIAM BAXTER MD 0 306110 0 25470 0 34000 0 0 0 15894 0 381474 0 0 GUS EMMICK MD 0 163993 0 104160 0 17000 0 8030 0 15557 0 308740 0 0 JAMES FITZGERALD MD 0 160528 0 35070 0 17000 0 7456 0 15535 0 235589 0 0 LEA GOTTRESDEN DO 0 121647 0 0 0 22500 0 9954 0 6147 0 160248 0 0 RICHARD A ELWELL 0 346099 0 91351 0 48077 0 109258 0 11603 0 606388 0 0 CARL M FIER 827035 0 0 0 0 0 7500 0 15169 0 849704 0 0 0 LAWRENCE HOEPP 853717 0 0 0 39500 0 7500 0 13364 0 914081 0 0 0 MICHAEL R KACZANOWSKI 428461 0 523728 0 17000 0 7500 0 16270 0 992959 0 0 0 BRIAN F GILCHRIST 766829 0 0 0 22500 0 7500 0 7527 0 804356 0 0 0 AYDAMIR ALRAKAWI 553500 0 464586 0 34000 0 7500 0 16588 0 1076174 0 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 A, LINE 6 ELLIOT HOSPITAL IS THE SOLE MEMBER OF THE REPORTING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ELLIOT HOSPITAL IS THE SOLE MEMBER OF THE REPORTING ORGANIZATION, AND HAS BOARD MEMBERS WHO ARE ALSO BOARD MEMBERS OF THE REPORTING ORGANIZATION. 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: TRANSFER FROM AFFILIATES 19,005,000. PENSION ADJUSTMENT 569,351. 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 JOHN & MARY ELLIOT CHARITABLE FOUNDATION 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 020512229 FUNDRAISING 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 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 ELLIOT HOSPITAL P 10490073 CASH ELLIOT HOSPITAL Q 5019419 CASH ELLIOT HOSPITAL J 216527 CASH