2014-07-14T14:06:01-05:00 2013-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2013-01-01 222495808 FANNY ALLEN CORPORATION FANN 9786546363 100 AMES POND DRIVE SUITE 102 TEWKSBURY MA 01876 JOHN AHLE TREASURER 9786546363 2014-06-25 1 WILLIAM G STEELE JR CPA P00233103 6036228881 2013 2015-11-30 17:44:51Z JOHN AHLE 100 AMES POND DRIVE SUITE 102 TEWSBURY MA 01876 179429 0 X N/A X 1983 VT THE FANNY ALLEN CORPORATION PROVIDES SUPPORT AND GRANTS TO OTHER NOT FOR PROFIT ORGANIZATIONS IN VERMONT THAT SERVE THE POOR AND DISENFRANCHISED. 8 7 0 0 0 0 0 0 399325 0 155690 179429 0 0 555015 179429 205441 207300 0 0 0 0 0 0 0 357916 113405 563357 320705 -8342 -141276 7655460 8157323 139339 73647 7516121 8083676 THE FANNY ALLEN CORPORATION PROVIDES SUPPORT AND GRANTS TO OTHER NOT FOR PROFIT ORGANIZATIONS IN VERMONT THAT SERVE THE POOR AND DISENFRANCHISED. 0 0 267407 207300 THE FANNY ALLEN CORPORATION PROVIDES SUPPORT AND GRANTS TO OTHER NOT FOR PROFIT ORGANIZATIONS IN VERMONT THAT SERVE THE POOR AND DISENFRANCHISED. 267407 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 X X JOHN AHLE 9786546363 100 AMES POND DRIVE SUITE 102 TEWKSBURY MA 01862 MICHAEL TOMKOWICZ DIRECTOR/CHAIR 3.00 3.00 X X 0 0 0 LAURA WARREN DIRECTOR/SECRETARY 1.00 1.00 X X 0 0 0 MICHAEL NEW DIRECTOR 1.00 1.00 X 0 0 0 CHRISTINE WERNEKE DIRECTOR 1.00 1.00 X 0 0 0 NADINE SCIBEK DIRECTOR 1.00 1.00 X 0 0 0 DAVID JILLSON DIRECTOR 1.00 1.00 X 0 0 0 HEIDI ST PETER DIRECTOR 1.00 1.00 X 0 0 0 ELLEN KANE DIRECTOR/ PRESIDENT 15.00 25.00 X X 0 68013 27504 JOHN AHLE TREASURER/ CHS 1.00 39.00 X 0 382416 101750 0 450429 129254 0 0 1 0 0 92823 92823 86606 0 86606 86606 86606 179429 0 0 179429 207300 207300 717 717 5100 5100 818 818 879 879 4966 4966 2273 2273 ADMINISTRATIVE FESS 51171 51171 DUES 47481 47481 320705 267407 53298 0 245853 192102 10999 0 156787 5164633 5823276 6875 2070313 2141945 7655460 8157323 139339 73647 139339 73647 X 5572105 6139660 1362279 1362279 581737 581737 7516121 8083676 7655460 8157323 X -141276 707711 1120 X 0 1 X 0 0 X X 0 0 0 FLETCHER ALLEN HEALTH CARE INC 030219305 3 1 1 1 0 1 0 1930974 137324 2068298 1865323 1283586 65651 1283586 1930974 1931536 -66213 1865323 1901991 29545 1931536 2017668 -115687 1901991 0.28130 0.71870 1 0 0 PROVIDENTIA PRIMA TRUST 5823276 F 5823276 RESTRICTED FUNDS, CVS, SPLIT INTEREST ACCOUNT 2068298 DEFERRED COMPENSATION 73647 2141945 DEFERRED COMPENSATION 73647 73647 X PART X, LINE 2: INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS IS THE FOLLOWING "TAX EXEMPT ORGANIZATIONS COULD BE REQUIRED TO RECORD AN OBLIGATION FOR INCOME TAXES AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS INCLUDING UNRELATED BUSINESS INCOME OR TAX STATUS. THE SYSTEM HAS EVALUATED THE POSITIONS TAKEN ON ITS FILED TAX RETURNS, AND HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31, 2013." 1 CAMP EXCLAMATION POINT INC PO BOX 91 RICHMONT VT 05477 030329568 3 6000 DAY CAMP FOR LOW INCOME CHILDERN COMMITTEE ON TEMPORARY SHELTER PO BOX 1616 BURLINGTON VT 05401 030285606 3 10000 HOMELESS PREVENTION FUND AND DAY SHELTER FAITH IN ACTION NORTHERN COMMUNITIES PTRSHP INC 2 COMMON WAY PO BOX 157 CABOT VT 05647 208406050 3 10000 PROVIDE BASIC NEEDS TO SENIORS AND THE DISABLED BURLINGTON DISMAS HOUSE 96 BUELL STREET BURLINGTON VT 05401 030369442 3 7000 HOUSING FOR FORMER PRISONERS JOHN GRAHAM EMERGENCY CENTER 69 MAIN STREET VERGENNES VT 05401 030275219 3 10000 HOMELESS SHELTER PROGRAMS JOINT URBAN MINISTRY PROJECT 38 SOUTH WINOOSKI AVENUE BURLINGTON VT 05401 202055113 3 5000 EMERGENCY ASSITANCE DIRECT AID SAMARITIAN HOUSE 20 KIGMAN ST SUITE 1 ST ALBANS VT 05478 030330331 3 10000 SHELTER AND TRANSITIONAL HOUSING FOR THE HOMELESS CHAMPLAIN SENIOR CENTER 241 NO WINOOSKI AVENUE BURLINGTON VT 05401 237056383 3 5800 SENIOR LUNCH PROGRAM VERMONT CATHOLIC CHARITIES INC 55 JOY DRIVE BURLINGTON VT 05403 030181216 3 10000 EMERGENCY ASSITANCE FOR ECOMOMICALLY DISADVANTAGED ASSOCIATION OF AFRICANS LIVING IN VT INC 20 ALLEN STREET BURLINGTON VT 05401 030371003 3 7500 FOOD PROGRAM FOR NEW AMERICANS BURLINGTON EMERGENCY SHELTER 89 NORTH STREET BURLINGTON VT 05401 030287599 3 5000 EMERGENCY SHELTER FOR THE HOMELESS CAMP AGAPE VERMONT PO BOX 8283 ESSEX VT 05451 263990854 3 7500 SUMMER CAPE FOR UNDER PRIVILEDGE YOUTH CHAMPLAIN HOUSING TRUST 88 KING STREET BURLINGTON VT 05401 222536446 3 25000 HARBOR PLACE SHELTER CHAAMPLAIN VALLEY OFFICE OF ECONOMIC OPPORTUNITY PO BOX 1603 BURLINGTON VT 05402 030216837 3 5000 SUPPORT LOW INCOME SEEKING EMPLOYMENT CHARTER HOUSE COALITION 27 NORTH PLEASANT ST MIDDLEBURY VT 05753 562531802 3 6000 FOOD FOR THE HOMELESS WINOOSKI COMMUNITY SERVICE DEPARTMENT 27 WEST ALLEN WINOOSKI VT 05404 360000782 3 10000 SUMMER YOUTH ENRICHMENT PROGRAM CHAMPLAIN VALLEY AGENCY ON AGING 76 PERAL ST STE 201 ESSEX JUNCTION VT 05452 222474636 3 10000 MEALS ON WHEELS SPECTRUM YOUTH AND FAMILY SERVICES 31 ELMWOOD BURLINGTON VT 05401 030253232 3 7500 HOMELESS YOUTH FOOD PROGRAM UPPER VALLEY HAVEN INC 713 HARTFORD WHITE RIVER JUNCTION VT 05001 030277908 3 10000 HOMELESS SUPPORT SERVICES VERMONT FOODBANK 33 PARKER ROAD BARRE VT 05641 223021942 3 10000 COMMUNITY KITCHEN WOMEN HELPING BATTERED WOMEN INC PO BOX 1535 BURLINGTON VT 05402 030283657 3 15000 TEMPORARY SHELTER FOR BATTERED WOMEN 21 PART I, LINE 2: INTERVIEW GRANTEE ORGANIZATIONS SEEKING DONATIONS AND MONITOR THEIR ACTIVITIES. 0 1 0 0 0 0 1 0 0 JOHN AHLE TREASURER/ CHS 0 339914 0 0 0 42502 0 70050 0 31700 0 484166 0 0 PART I, LINE 4B THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM FOR CERTAIN EXECUTIVES UNDER WHICH THE ORGANIZATION MAKES A CONTRIBUTION FOR THE BENEFIT OF THE EXECUTIVE THAT IS INTENDED TO PROVIDE A SPECIFIED LEVEL OF RETIREMENT BENEFITS AT RETIREMENT AGE COMMENSURATE WITH RETIREMENT BENEFITS PROVIDED TO EXECUTIVES IN COMPARABLE POSITIONS BY SIMILARLY SITUATED ORGANIZATIONS. AMOUNTS CONTRIBUTED ARE HELD FOR THE BENEFIT OF THE EXECUTIVE UNTIL HE OR SHE REACHES AGE 60, AT WHICH TIME THEY ARE RELEASED TO THE EXECUTIVE. THE FULL AMOUNT IS TAXABLE TO THE EXECUTIVE WHEN SO PAID, AND IS INCLUDED IN THE EXECUTIVE'S REPORTED COMPENSATION. PART I, LINE 6 THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THAT ORGANIZATION'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS THAT ARE SET AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. THE ORGANIZATION PAID INCENTIVE COMPENSATION AWARDS TO JOHN AHLE IN 2013 BASED ON PERFORMANCE DURING 2012. DURING 2013, THE ORGANIZATION DID NOT PAY ANY ACCRUED INCENTIVE COMPENSATION TO THE OFFICERS. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH SYSTEMS, INC. IS THE SOLE MEMBER OF FANNY ALLEN CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH SYSTEMS, INC. IS THE SOLE MEMBER OF FANNY ALLEN CORPORATION AND AS SUCH HAS CERTAIN RESERVED RIGHTS. FORM 990, PART VI, SECTION A, LINE 7B COVENANT HEALTH SYSTEMS, INC. IS THE SOLE MEMBER OF FANNY ALLEN CORPORATION AND AS SUCH HAS CERTAIN RESERVED RIGHTS TO APPROVE CERTAIN DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED IN DETAIL BY THE GOVERNING BODY PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS AN OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 FOR THE RELATED PARTY, COVENANT HEALTH SYSTEMS, INC. - EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH SYSTEMS BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. THE SPECIFIC OBJECTIVES OF THIS ANALYSIS ARE TO: - ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM. - DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS. - ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 ALL POLICIES AND FORM 990'S ARE MAINTAINED WITH THE BOOKS AND RECORDS AND ARE AVAILABLE TO THE PUBLIC FOR INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER AMONG AFFILIATES 1,120. FORM 990 PART VII & SCHEDULE J THE REPORTABLE AND OTHER COMPENSATION PAID BY A RELATED ORGANIZATION TO JOHN AHLE WAS PAID BY COVENANT HEALTH SYSTEM, INC. FANNY ALLEN HOLDINGS 101 COLLEGE PARKWAY COLCHESTER VT 05446 030181052 REAL ESTATE HOLDING VT 501(C) 3 509(A) 2 CHS 0 COVENANT HEALTH SYSTEMS INC 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(C) 3 501(A) 2 CHS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 FANNY ALLEN HOLDINGS S 1120 ACCRUAL COVENANT HEALTH SYSTEMS INC O 51171 ACCRUAL COVENANT HEALTH SYSTEMS INC R 98551 ACCRUAL