FANNY ALLEN CORPORATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FANNY ALLEN CORPORATION (EIN 22-2495808)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-07-20
IRS object ID
201202029349300120
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-07-20T13:28:41-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN020383073EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WILLIAM STEELE & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line140 STARK STREETAddressLine1
CityMANCHESTERCity
StateNHState
ZIP Code03101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN222495808EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FANNY ALLEN CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFANNNameControl
Phone9786546363Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVE SUITE 102AddressLine1
CityTEWKSBURYCity
StateMAState
ZIP Code01876ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTREASURERName
TitleTREASURERTitle
Phone9786546363Phone
Date Signed2012-07-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL A BARBARITA CPAName
PTINP00801253PTIN
Phone6036228881Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN AHLENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVE SUITE 102AddressLine1
CityTEWSBURYCity
StateMAState
ZIP Code01876ZIPCode
FieldValueIRS element (for citing)
Gross Receipts590156GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1983YearFormation
State Legal DomicileVTStateLegalDomicile
Activity Or Mission DescriptionTO CONTINUE THE MISSION OF THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH BY SUPPORTING NONPROFIT ORGANIZATIONS THAT REFLECT THE COMPASSION OF CHRIST IN THEIR SERVICE TO THE SICK, POOR, MOST NEEDY AND SPIRITUALLY BROKEN.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year351833ProgramServiceRevenuePriorYear
Program Service Revenue CY388827ProgramServiceRevenueCY
Investment Income Prior Year48875InvestmentIncomePriorYear
Investment Income Current Year199462InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year1867OtherRevenueCurrentYear
Total Revenue Prior Year400708TotalRevenuePriorYear
Total Revenue Current Year590156TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year159250GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY182028GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year284769OtherExpensePriorYear
Other Expenses Current Year297198OtherExpensesCurrentYear
Total Expenses Prior Year444019TotalExpensesPriorYear
Total Expenses Current Year479226TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-43311RevenuesLessExpensesPriorYear
Revenues Less Expenses CY110930RevenuesLessExpensesCY
Total Assets BOY7303657TotalAssetsBOY
Total Assets EOY7166661TotalAssetsEOY
Total Liabilities BOY272589TotalLiabilitiesBOY
Total Liabilities EOY262601TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7031068NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6904060NetAssetsOrFundBalancesEOY
Mission DescriptionTO CONTINUE THE MISSION OF THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH BY SUPPORTING NONPROFIT ORGANIZATIONS THAT REFLECT THE COMPASSION OF CHRIST IN THEIR SERVICE TO THE SICK, POOR, MOST NEEDY AND SPIRITUALLY BROKEN.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense265266Expense
Grants182028Grants
DescriptionIN CONJUCTION WITH FANNY ALLEN HOLDINGS WE CONTINUE THE MISSION OF THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH BY SUPPORTING NONPROFIT ORGANIZATIONS THAT REFLECT THE COMPASSION OF CHRIST IN THEIR SERVICE TO THE SICK, POOR, MOST NEEDY AND SPIRITUALLY BROKEN.Description
Total Program Service Expense265266TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JOHN AHLEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9786546363TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVE SUITE 102AddressLine1
CityTEWKSBURYCity
StateMAState
ZIP Code01862ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
MICHAEL TOMKOWICZ
DIRECTOR/CHAIR3.00XX000
LAURA WARREN
DIRECTOR/SECRETARY1.00XX000
MICHAEL NEW
DIRECTOR1.00X000
CHRISTINE WERNEKE
DIRECTOR1.00X000
NADINE SCIBEK
DIRECTOR1.00X000
DAVID JILLSON
DIRECTOR1.00X000
HEIDI ST PETER
DIRECTOR1.00X000
ELLEN KANE
DIRECTOR/ PRESIDENT20.00XX06379528151
JOHN AHLE
TREASURER/ CHS1.00X0357922165006
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs421717TotalReportableCompFrmRltdOrgs
Total Other Compensation193157TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRENTAL INCOMEDescription
Business Code531120BusinessCode
Total Revenue Column388827TotalRevenueColumn
Exclusion$388,827ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue388827TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column105933TotalRevenueColumn
Exclusion$105,933ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities93529Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities93529Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column93529TotalRevenueColumn
Exclusion$93,529ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHERDescription
Business Code900099BusinessCode
Total Revenue Column1867TotalRevenueColumn
Exclusion$1,867ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1867TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column590156TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$590,156ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total182028Total
Program Services182028ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total935Total
Program Services935ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total8960Total
Management And General8960ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total4592Total
Program Services4592ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4497Total
Program Services4497ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total2852Total
Program Services2852ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total17796Total
Program Services17796ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total2215Total
Program Services2215ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
DUES205000205000
ADMINISTRATIVE FESS4881048810
REPAIRS AND SUPPLIES15261526
BANK CHARGES1515

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total479226Total
Program Services265266ProgramServices
Management And General213960ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY87084BOY
EOY32106EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY37228BOY
EOY75377EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis538792LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec364208LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY192380BOY
EOY174584EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4778201BOY
EOY4813795EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY6875BOY
EOY6875EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2201889BOY
EOY2063924EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7303657BOY
EOY7166661EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
EOY64000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY272589BOY
EOY198601EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY272589BOY
EOY262601EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY5099532BOY
EOY4972524EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1931536BOY
EOY1931536EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7031068BOY
EOY6904060EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7303657BOY
EOY7166661EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses110930ReconcilationRevenueExpenses
Reconcilation Other Changes-237938ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1FLETCHER ALLEN HEALTH CARE INCBusinessNameLine1
FieldValueIRS element (for citing)
EIN030219305EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1931536BeginningOfYearBalance
Investment Earnings Or Losses-66213InvestmentEarningsOrLosses
End Of Year Balance1865323EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1901991BeginningOfYearBalance
Investment Earnings Or Losses29545InvestmentEarningsOrLosses
End Of Year Balance1931536EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2017668BeginningOfYearBalance
Investment Earnings Or Losses-115687InvestmentEarningsOrLosses
End Of Year Balance1901991EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1968399BeginningOfYearBalance
Investment Earnings Or Losses49269InvestmentEarningsOrLosses
End Of Year Balance2017668EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis538792OtherCostOrOtherBasis
Depreciation364208Depreciation
Book Value174584BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings174584TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionPROVIDENTIA PRIMA TRUSTDescription
Book Value4813795BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities4813795TotalOfBookValueSecurities

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
REST FUND, CVS, SPLIT INTEREST ACCOUNT1865323
DEFERRED COMPENSATION198601
FieldValueIRS element (for citing)
Total Book Value Other Assets2063924TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDEFERRED COMPENSATIONDescription
Amount$198,601Amount
FieldValueIRS element (for citing)
Total Of Amounts198601TotalOfAmounts
Total Revenue590156TotalRevenue
Total Expenses479226TotalExpenses
Excess Or Deficit For Year110930ExcessOrDeficitForYear
Net Unrealized GL On Investments-165566NetUnrealizedGLOnInvestments
Other-$72,372OtherAmount
Total Adjustments-237938TotalAdjustments
Excess Or Deficit Per FS-127008ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt424590TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-165566NetUnrealizedGainsInvestments
Revenue Not Rptd F990-165566RevenueNotRptdF990
Revenue Subtotal590156RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990590156TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt479226TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal479226ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990479226TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPART XI, LINE 8 - OTHER ADJUSTMENTS:Identifier
ExplanationTRANSFER AMONG AFFILIATES -72,370. ROUNDING -2. TOTAL TO SCHEDULE D, PART XI, LINE 8: -72,372.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (22 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
BOYS & GIRLS CLUBS OF BURLINGTON
62 OAK STREETBURLINGTONVT05401030179307310000YOUTH CENTER
CAMP EXCLAMATION POINT INC
PO BOX 91RICHMONTVT0547703032956835000DAY CAMP FOR LOW INCOME CHILDERN
CHITTENDEN HOUSING CORP
PO BOX 1157CABOTVT0564703034061537500YOUTH ENRICHMENT PROGRAM
COMMITTEE ON TEMPORARY SHELTER
PO BOX 1616BURLINGTONVT05401030285606310000HOMELESS PREVENTION FUND
COMMUNITY HEALTH CENTER - BURLINGTON VT
617 RIVERSIDE STE 200BURLINGTONVT05401237182584310000HEALTH CENTER
FAITH IN ACTION
2 COMMON WAY PO BOX 157CABOTVT0564720840605039100PROVIDE BASIC NEEDS TO SENIORS AND THE DISABLED
DISMAS HOUSE
96 BUELL STREETBURLINGTONVT0540103036944235000HOUSING FOR FORMER PRISONERS
HOMESHARE VERMONT
412 FARRELL ST STE 300BURLINGTONVT0540313428795735000PROVIDE MATCHING HOME SHARING & CAREGIVING FOR LOW COST HOUSING ASSITANCE
HUNGER FREE VERMONT
180 FLYNN AVENUEBURLINGTONVT0540103033635737000CHILDERN NUTRITION OUTREACH PROGRAM
JOHN GRAHAM EMERGENY CENTER
69 MAIN STREETVERGENNESVT05401030275219310000HOMELESS SHELTER PROGRAMS
JOINT URBAN MINISTRY PROJECT
38 SOUTH WINOOSKI AVENUEBURLINGTONVT0540120205511336500EMERGENCY ASSITANCE DIRECT AID
KIDSAFE COLLABORATIVE
308 PINE STREETBURLINGTONVT0540103030386735000EMERGENCY NEEDS FOR PREGNANT AND POST PARTUM WOMEN
KING STREET YOUTH CENTER
PO BOX 1615BURLINGTONVT05402237236312310000DAY CAMP FOR LOW INCOME CHILDERN
LEROYER EMPLYEE ASSISTANCE
C/O FLECTHER ALLEN HEALTH CAREBURLINGTONVT0540403021930935000EMERGENCY ASSISTANCE TO FLETCHER ALLEN EMPLOYEES AND THEIR FAMILIES
LUND FAMILY CENTER
76 GLEN ROADBURLINGTONVT05406030179434310000COMPREHENSIVE ADOPTION PROGRAM
RESOURCE
266 PINE STREETBURLINGTONVT0540103032629335000PROVIDE JOB SKILLS FOR DISABLED CHILDERN
SAMARITIAN HOUSE
20 KIGMAN ST SUITE 1ST ALBANSVT05478030330331310000SHELTER AND TRANSITIONAL HOUSING FOR THE HOMELESS
SARA HOLBROOK COMMUNITY CENTER
66 NORTH AVEBURLINGTONVT05401030179595310000EDUCATION FOR LOW INCOME CHILDERN
SPRINGFIELD FAMILY CENTER
365 SUMMER STREETSPRINGFIELDVT0515603026521335000FAMILY CENTER
VISITING NURSE ASSOCIATION
1110 PRIM ROADCOLCHESTERVT0544603017960337000ADULT DAY TRANSPORTION
VERMONT DISASTER RELIEF FUND
412 FARRELL ST STE 200BURLINGTONVT05403300192082310000DISASTER RELIEF
WINOOSKI COALITION FOR A SAFE AND PEACEFUL COMMUNITY
32 MALLETS BAY AVENUEWINOOSKIVT0540403600078235200POVERTY EDUCATION AND AWARENESS PROGRAMS
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants22TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations22TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: INTERVIEW GRANTEE ORGANIZATIONS SEEKING DONATIONS AND MONITOR THEIR ACTIVITIES.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonJOHN AHLENamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs334045CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs23877OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs132988DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs32018NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs522928TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BTHE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM FOR CERTAIN EXECUTIVES UNDER WHICH THE ORGANIZATION MAKES A CONTRIBUTION TO A GRANTOR TRUST 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 TO THE GRANTOR TRUST 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 PAID INTO THE GRANTOR TRUST IS TAXABLE TO THE EXECUTIVE WHEN SO PAID, AND IS INCLUDED IN THE EXECUTIVE'S REPORTED COMPENSATION.
PART I, LINE 6THE 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 NO INCENTIVE COMPENSATION AWARDS TO JOHN AHLE IN 2011 BASED ON PERFORMANCE DURING 2010. DURING 2011, THE ORGANIZATION ACCRUED $118,464 OF INCENTIVE COMPENSATION FOR MR. AHLE.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6COVENANT HEALTH SYSTEMS, INC. IS THE SOLE MEMBER OF FANNY ALLEN CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7ACOVENANT 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 7BCOVENANT 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 11THE FORM 990 IS REVIEWED IN DETAIL BY THE GOVERNING BODY PRIOR TO BEING FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION HAS AN OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15FOR 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 19ALL 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 5:NET UNREALIZED LOSSES ON INVESTMENTS: -165,566. TRANSFER AMONG AFFILIATES -72,370. ROUNDING -2. TOTAL TO FORM 990, PART XI, LINE 5: -237,938.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990 PART VII & SCHEDULE JTHE REPORTABLE AND OTHER COMPENSATION PAID BY A RELATED ORGANIZATION TO JOHN AHLE WAS PAID BY COVENANT HEALTH SYSTEM, INC.COMPENSATION BY RELATED ORGANIZATION

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
FANNY ALLEN HOLDINGS
101 COLLEGE PARKWAYCOLCHESTERVT05446030181052FOUNDATIONVT501(C) 3509(A) 2CHS0
COVENANT HEALTH SYSTEMS INC
100 AMES POND DRIVETEWKSBURYMA01876222484505HEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATIONMA501(C) 3501(A) 2CHS0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
COVENANT HEALTH SYSTEMS INC
L205000ACCRUAL
FANNY ALLEN HOLDINGS
Q72371ACCRUAL
COVENANT HEALTH SYSTEMS INC
N45973ACCRUAL

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