Everwell Inc

Members of the Organization

“Form 990, Part VI Initial Filing of IRS Form 990 & Tax Exempt Status The organization filed Form 1023 with the IRS on 12/15/2014 to request tax-exempt status as an IRC Section 501(c)(3) Type I supporting organization. The organization is awaiting approval from the IRS. Form 990, Part VI, Line 6 & 7a The organization is made of member organizations supported by Everwell. There is a single class of members who shall have such rights as stated within the articles of agreement and bylaws. The members consist of Dartmouth Hitchcock-Health and Elliot Health System, both 501(c)(3) organizations. No other persons or entities are entitled to membership. Each member organization elects representatives to the board of Everwell. Members have the reserved powers to appoint trustees, appoint/discharge the CEO of the corporation, appoint administrator of joint services, approved Everwell's requests for any contributions from member organizations, and to fullfill obligations under state or federal licensing of the members or affiliates with respect to joint services. IRS Form 990 Review Process Form 990, Part VI Line 11B The IRS form 990 is prepared internally and reviewed by an external third part consultant and the Board Treasurer. Conflict of Interest Policy Form 990 Part VI Section B Line 12C The Everwell Board of Trustees is in the process of formally approving a policy concerning a voluntary self-disclosure of any potential conflict of interest. The Dartmouth-Hitchcock Compliance and Audit Services Department conducts an annual survey of all officers and trustees and performs other procedures as considered necessary to report on compliance with the Dartmouth-Hitchcock Medical Center conflict of interest policy. Per the policy, any conflicts or otherwise perceived conflicts are required to be addressed by the Board of Trusteees on an ongoing basis. In the event a conflict arises, the individual shall be removed from participating in any decision making regarding the identified conflict and/or its corresponding transactions. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Board Policies Form 990, Part VI, Section B, Lines 12, 13, and 14 The board is in the process of reviewing and approving a formal whistleblower and record retention policy. Form 990 Part VI Section B, Line 15a and 15b, and Form 990 Part VII Section A, Line 1 The compensation paid by related organizations was for services provided to those related organizations and not the filing organization. Although the individuals worked the time listed as part of their board of trustee duties, they were not compensated with respect to those hours. The time/hours at the related organization varies by individual and organization, and would be the hours necessary to total to their respective full hours per week. Availability of Documents Form 990 Part VI Section C Line 19 The Organization makes its audited financial statements, governing documents, and policies available upon request in hardcopy form. Reconciliation of Net Assets Form 990, Part XI, Line 9 Other changes in initial assets: ($1,823,520) A-133 Audit Form 990 Part XII, Line 3a DURING FISCAL YEAR 2014, MARY HITCHCOCK MEMORIAL HOSPITAL EXPENDED FUNDS FROM FEDERAL AWARDS IN EXCESS OF THE MINIMUM THRESHHOLD SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133, THEREFORE REQUIRING AN AUDIT. DUE TO THE ISSUANCE OF THE COMBINED FINANCIAL STATEMENTS, THE SINGLE AUDIT WAS PERFORME”