EXETER HEALTH RESOURCES INC SELF-INSURANCE TRUST: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
EXETER HEALTH RESOURCES INC SELF-INSURANCE TRUST (EIN 20-0753662)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-05-15
IRS object ID
201221369349300322
Schema version
2010v3.4
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)
Timestamp2012-05-15T07:35:37-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN200753662EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1EXETER HEALTH RESOURCES INC SELF-INSURANCE TRUSTBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlEXETNameControl
Phone6035806695Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line15 ALUMNI DRIVEAddressLine1
CityEXETERCity
StateNHState
ZIP Code03833ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameOFFICERName
TitleTREASURERTitle
Phone6035806695Phone
Date Signed2012-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL A BARBARITA CPAName
Phone6036228881Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKEVIN CALLAHANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line15 ALUMNI DRIVEAddressLine1
CityEXETERCity
StateNHState
ZIP Code03833ZIPCode
FieldValueIRS element (for citing)
Gross Receipts158161GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation2003YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionA SELF-INSURANCE TRUST HOLDING FUNDS TO COVER LOSSES OF SUPPORTED ORGANIZATIONSActivityOrMissionDescription
Nbr Voting Members Governing Body0NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
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 Year657552ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year138962InvestmentIncomePriorYear
Investment Income Current Year158161InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year796514TotalRevenuePriorYear
Total Revenue Current Year158161TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3000SalariesEtcPriorYear
Salaries Etc Current Year3000SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year833096OtherExpensePriorYear
Other Expenses Current Year449936OtherExpensesCurrentYear
Total Expenses Prior Year836096TotalExpensesPriorYear
Total Expenses Current Year452936TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-39582RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-294775RevenuesLessExpensesCY
Total Assets BOY7370465TotalAssetsBOY
Total Assets EOY7078691TotalAssetsEOY
Total Liabilities BOY6260522TotalLiabilitiesBOY
Total Liabilities EOY6263523TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1109943NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY815168NetAssetsOrFundBalancesEOY
Mission DescriptionNONEMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense452936Expense
Revenue0Revenue
DescriptionPROVISION OF FUNDING FOR PROFESSIONAL, GENERAL, AND OTHER LIABILITY LOSSES FOR ORGANIZATIONS CONTROLLED, DIRECTLY OR INDIRECTLY, BY EXETER HEALTH RESOURCES, INC.Description
Total Program Service Expense452936TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
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 Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
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
Compliance With Backup Witholding1ComplianceWithBackupWitholding
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 Members0NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KEVIN O'LEARYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6035806695TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15 ALUMNI DRIVEAddressLine1
CityEXEXTERCity
StateNHState
ZIP Code03833ZIPCode

Form990 Part VII Section A Form990PartVIISectionA

FieldValueIRS element (for citing)
Name PersonBANK OF AMERICANamePerson
TitleTRUSTEETitle
Average Hours Per Week1.00AverageHoursPerWeek
Institutional TrusteeXInstitutionalTrustee
Reportable Comp From Organization3000ReportableCompFromOrganization
Reportable Comp From Related Orgs0ReportableCompFromRelatedOrgs
Other Compensation0OtherCompensation
FieldValueIRS element (for citing)
Total Reportable Comp From Org3000TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SHEEHAN PHINNEY BASS & GREENBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11000 ELM ST PO BOX 3701AddressLine1
CityMANCHESTERCity
StateNHState
ZIP Code03105ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesLEGAL SERVICESDescriptionOfServices
Compensation105286Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column158161TotalRevenueColumn
Exclusion$158,161ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column158161TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$158,161ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3000Total
Program Services3000ProgramServices

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
ADMIN EXP/CLAIMS PAID437074437074
REALIZED LOSSES1286212862

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total452936Total
Program Services452936ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY7370465BOY
EOY7078691EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7370465BOY
EOY7078691EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1370755BOY
EOY140846EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4889767BOY
EOY6122677EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6260522BOY
EOY6263523EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1109943BOY
EOY815168EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1109943BOY
EOY815168EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7370465BOY
EOY7078691EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-294775ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

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

Supported Org Information SupportedOrgInformation (4 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
EXETER HOSPITAL INC
2226740143111$0
EXETER HEALTHCARE INC
02036096611111$0
ROCKINGHAM VISITING NURSE ASSOC & HOSPICE
0202749059111$0
CORE PHYSICIANS LLC
8708079149111$0
FieldValueIRS element (for citing)
Total Number Of Supported Orgs4TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionOTHER INVESTMENTSDescription
Book Value7078691BookValue
Method Of ValuationCMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities7078691TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionACCRUED CLAIMSDescription
Amount$6,122,677Amount
FieldValueIRS element (for citing)
Total Of Amounts6122677TotalOfAmounts

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 7AEXETER HEALTH RESOURCES, INC. IS THE GRANTOR OF THE TRUST. THE GRANTOR, BY RESOLUTION OF ITS BOARD OF DIRECTORS MAY REMOVE THE TRUSTEE AT ANY TIME AND APPOINT A SUCCESSOR
FORM 990, PART VI, SECTION A, LINE 7BAS GRANTOR,EXETER HEALTH RESOURCES, INC. SETS THE FUNDING POLICY AND METHODS OF THE TRUST. THE TRUSTEE INVESTS IN SUCH PROPERTY AND FOR SUCH DURATION AS THE TRUSTEE DETERMINES TO BE CONSISTENT WITH THE POLICIES SET FORTH BY THE GRANTOR.
FORM 990, PART VI, SECTION B, LINE 11THE 990 IS PREPARED BY AN OUTSIDE TAX ACCOUNTANT WITH INFORMATION PROVIDED BY THE ORGANIZATION. THE 990 IS REVIEWED BY THE ORGANIZATION'S TREASURER BEFORE IT IS FILED WITH THE IRS.
THESE DOCUMENTS ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
EXETER HEALTH RESOURCES INC
5 ALUMNI DRIVEEXETERNH03833020222126MANAGEMENT AND SUPPORTING ORGANIZATION; HOLDING COMPANYNH501C3110
EXETER HOSPITAL INC
5 ALUMNI DRIVEEXETERNH03833222674014HOSPITALNH501C330EXETER HEALTH RESOURCES INC
CORE PHYSICIANS LLC
5 ALUMNI DRIVEEXETERNH03833870807914PHYSICIAN PRACTICESNH501C390EXETER HEALTH RESOURCES INC
ROCKINGHAM VISITING NURSE ASSOCIATION
5 ALUMNI DRIVEEXETERNH03833020274905HOME CARE, HOSPICENH501C390EXETER HEALTH RESOURCES INC
MATRIX HEALTH INC
5 ALUMNI DRIVEEXETERNH03833020473737MANAGE RESOURCESNH501C3110EXETER HEALTH RESOURCES INC
EXETER HEALTHCARE INC
5 ALUMNI DRIVEEXETERNH03833020360966SUBACUTE NURSING FACILITYNH501C390EXETER HEALTH RESOURCES INC
EXETER MED REAL INC
5 ALUMNI DRIVEEXETERNH03833020418718REAL ESTATE HOLDINGNH501C250EXETER HEALTH RESOURCES INC

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
CONVERGENT HEALTH SYSTEMS INC
5 ALUMNI DRIVEEXETERNH03833020469711WELLNESS CENTERSNHEXETER HEALTH RESOURCES INCC
VX HEALTH SERVICES INC
5 ALUMNI DRIVEEXETERNH03833020469712FITNESS CENTERNHCONVERGENT HEALTH SYSTEMS INCC
EXETER MEDICAL SERVICES INC
5 ALUMNI DRIVEEXETERNH03833020419850INACTIVE PHYSICIAN PRACTICENHCONVERGENT HEALTH SYSTEMS INCC
CORE HEALTH SERVICES OF MA
5 ALUMNI DRIVEEXETERNH03833201598042INACTIVE PHYSICIAN PRACTICEMAEXETER HEALTH RESOURCES INCC
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 Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
EXETER HOSPITAL INC
R1120240CASH
EXETER HEALTHCARE INC
R33440CASH
EXETER MED REAL INC
R6688CASH
ROCKINGHAM VISITING NURSE ASSOCIATION AND HOSPICE
R33440CASH
CORE PHYSICIANS LLC
R468160CASH
EXETER HEALTH RESOURCES INC
R5016CASH

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