2012-07-20T13:28:41-05:00 2011-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2011-01-01 222495808 FANNY ALLEN CORPORATION FANN 9786546363 100 AMES POND DRIVE SUITE 102 TEWKSBURY MA 01876 TREASURER 9786546363 2012-07-09 1 MICHAEL A BARBARITA CPA P00801253 6036228881 2011 2016-02-24 21:20:13Z JOHN AHLE 100 AMES POND DRIVE SUITE 102 TEWSBURY MA 01876 590156 0 X N/A X 1983 VT TO 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. 8 7 0 0 0 0 0 0 351833 388827 48875 199462 0 1867 400708 590156 159250 182028 0 0 0 0 0 0 0 284769 297198 444019 479226 -43311 110930 7303657 7166661 272589 262601 7031068 6904060 TO 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. 0 0 265266 182028 IN 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. 265266 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 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 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 3.00 X X 0 0 0 LAURA WARREN 1.00 X X 0 0 0 MICHAEL NEW 1.00 X 0 0 0 CHRISTINE WERNEKE 1.00 X 0 0 0 NADINE SCIBEK 1.00 X 0 0 0 DAVID JILLSON 1.00 X 0 0 0 HEIDI ST PETER 1.00 X 0 0 0 ELLEN KANE 20.00 X X 0 63795 28151 JOHN AHLE 1.00 X 0 357922 165006 0 421717 193157 0 0 1 0 0 RENTAL INCOME 531120 388827 388827 388827 105933 105933 93529 93529 93529 93529 OTHER 900099 1867 1867 1867 590156 0 0 590156 182028 182028 935 935 8960 8960 4592 4592 4497 4497 2852 2852 17796 17796 2215 2215 DUES 205000 205000 ADMINISTRATIVE FESS 48810 48810 REPAIRS AND SUPPLIES 1526 1526 BANK CHARGES 15 15 479226 265266 213960 0 87084 32106 37228 75377 538792 364208 192380 174584 4778201 4813795 6875 6875 2201889 2063924 7303657 7166661 64000 272589 198601 272589 262601 X 5099532 4972524 1931536 1931536 7031068 6904060 7303657 7166661 X 110930 -237938 X 0 1 0 X 0 X X 0 0 0 FLETCHER ALLEN HEALTH CARE INC 030219305 3 1 1 1 0 1 0 1931536 -66213 1865323 1901991 29545 1931536 2017668 -115687 1901991 1968399 49269 2017668 1.00000 1 0 538792 364208 174584 174584 PROVIDENTIA PRIMA TRUST 4813795 F 4813795 REST FUND, CVS, SPLIT INTEREST ACCOUNT 1865323 DEFERRED COMPENSATION 198601 2063924 DEFERRED COMPENSATION 198601 198601 590156 479226 110930 -165566 -72372 -237938 -127008 424590 -165566 -165566 590156 0 590156 479226 0 479226 0 479226 PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFER AMONG AFFILIATES -72,370. ROUNDING -2. TOTAL TO SCHEDULE D, PART XI, LINE 8: -72,372. 1 BOYS & GIRLS CLUBS OF BURLINGTON 62 OAK STREET BURLINGTON VT 05401 030179307 3 10000 YOUTH CENTER CAMP EXCLAMATION POINT INC PO BOX 91 RICHMONT VT 05477 030329568 3 5000 DAY CAMP FOR LOW INCOME CHILDERN CHITTENDEN HOUSING CORP PO BOX 1157 CABOT VT 05647 030340615 3 7500 YOUTH ENRICHMENT PROGRAM COMMITTEE ON TEMPORARY SHELTER PO BOX 1616 BURLINGTON VT 05401 030285606 3 10000 HOMELESS PREVENTION FUND COMMUNITY HEALTH CENTER - BURLINGTON VT 617 RIVERSIDE STE 200 BURLINGTON VT 05401 237182584 3 10000 HEALTH CENTER FAITH IN ACTION 2 COMMON WAY PO BOX 157 CABOT VT 05647 208406050 3 9100 PROVIDE BASIC NEEDS TO SENIORS AND THE DISABLED DISMAS HOUSE 96 BUELL STREET BURLINGTON VT 05401 030369442 3 5000 HOUSING FOR FORMER PRISONERS HOMESHARE VERMONT 412 FARRELL ST STE 300 BURLINGTON VT 05403 134287957 3 5000 PROVIDE MATCHING HOME SHARING & CAREGIVING FOR LOW COST HOUSING ASSITANCE HUNGER FREE VERMONT 180 FLYNN AVENUE BURLINGTON VT 05401 030336357 3 7000 CHILDERN NUTRITION OUTREACH PROGRAM JOHN GRAHAM EMERGENY 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 6500 EMERGENCY ASSITANCE DIRECT AID KIDSAFE COLLABORATIVE 308 PINE STREET BURLINGTON VT 05401 030303867 3 5000 EMERGENCY NEEDS FOR PREGNANT AND POST PARTUM WOMEN KING STREET YOUTH CENTER PO BOX 1615 BURLINGTON VT 05402 237236312 3 10000 DAY CAMP FOR LOW INCOME CHILDERN LEROYER EMPLYEE ASSISTANCE C/O FLECTHER ALLEN HEALTH CARE BURLINGTON VT 05404 030219309 3 5000 EMERGENCY ASSISTANCE TO FLETCHER ALLEN EMPLOYEES AND THEIR FAMILIES LUND FAMILY CENTER 76 GLEN ROAD BURLINGTON VT 05406 030179434 3 10000 COMPREHENSIVE ADOPTION PROGRAM RESOURCE 266 PINE STREET BURLINGTON VT 05401 030326293 3 5000 PROVIDE JOB SKILLS FOR DISABLED CHILDERN SAMARITIAN HOUSE 20 KIGMAN ST SUITE 1 ST ALBANS VT 05478 030330331 3 10000 SHELTER AND TRANSITIONAL HOUSING FOR THE HOMELESS SARA HOLBROOK COMMUNITY CENTER 66 NORTH AVE BURLINGTON VT 05401 030179595 3 10000 EDUCATION FOR LOW INCOME CHILDERN SPRINGFIELD FAMILY CENTER 365 SUMMER STREET SPRINGFIELD VT 05156 030265213 3 5000 FAMILY CENTER VISITING NURSE ASSOCIATION 1110 PRIM ROAD COLCHESTER VT 05446 030179603 3 7000 ADULT DAY TRANSPORTION VERMONT DISASTER RELIEF FUND 412 FARRELL ST STE 200 BURLINGTON VT 05403 300192082 3 10000 DISASTER RELIEF WINOOSKI COALITION FOR A SAFE AND PEACEFUL COMMUNITY 32 MALLETS BAY AVENUE WINOOSKI VT 05404 036000782 3 5200 POVERTY EDUCATION AND AWARENESS PROGRAMS 22 22 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: INTERVIEW GRANTEE ORGANIZATIONS SEEKING DONATIONS AND MONITOR THEIR ACTIVITIES. 0 1 0 0 0 0 1 0 0 JOHN AHLE 0 334045 0 0 0 23877 0 132988 0 32018 0 522928 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 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 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 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. COMPENSATION BY RELATED ORGANIZATION 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 FOUNDATION 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 1 0 1 0 0 1 0 COVENANT HEALTH SYSTEMS INC L 205000 ACCRUAL FANNY ALLEN HOLDINGS Q 72371 ACCRUAL COVENANT HEALTH SYSTEMS INC N 45973 ACCRUAL