2022-08-15T07:33:18-05:00 2021-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2020-10-01 611508839 Alliance Health Services ALLI 6036683545 100 McGregor Street Manchester NH 03102 Edward L Dudley III Executive VP & CFO 6036683545 2022-07-28 1 Edward Dudley III 999009999 Connor Smart P02285543 2078792100 2022-07-28 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Alexander Walker Jr Esq 100 McGregor Street Manchester NH 03102 17372223 0 0928 X www.catholicmedicalcenter.org X 2007 NH To promote health care programs from the greater Manchester, New Hampshire community. 9 4 0 0 0 0 478188 0 16976395 17372223 0 0 0 0 17454583 17372223 0 0 0 0 0 0 0 0 0 23341698 23336005 23341698 23336005 -5887115 -5963782 2870082 2953026 2052878 2139604 817204 813422 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 0 0 19560822 0 17372223 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 19560822 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NH X Edward L Dudley III 6036683545 100 McGregor Street Manchester NH 03102 William B Clutterbuck MD Secretary/Treasurer 0.00 40.00 X X 0 350825 30843 Patricia Furey MD Director 0.10 41.60 X 0 516481 48213 Michael Gilbert MD Director 0.10 40.80 X 0 200543 7924 Joseph Pepe MD President & CEO/VC (end 6/2021) 0.10 43.20 X X 0 838893 441652 Jason Cole Esq Director 0.10 40.00 X 0 204626 45178 Alexander Walker Jr Esq President & CEO/Vice Chair 0.10 41.60 X 0 519813 236608 Craig Beck Director 0.10 0.00 X 0 0 0 Stephen LeBlanc Director 0.10 0.00 X 0 0 0 Maria Padin MD Director 0.10 40.00 X 0 0 0 John G Cronin Esq Chair 0.10 2.20 X X 0 0 0 Edward Dudley III Exec. VP & CFO 0.00 41.30 X 0 491606 229130 0 3122787 1039548 0 0 1 0 Dartmouth Hitchcock Clinic 1 Medical Center Drive Lebanon NH 03756 Medical Services 21176752 1 Patient service revenue 621400 16751707 16751707 Rental income 532000 620516 620516 17372223 17372223 17372223 0 0 X 3775183 3775183 15938349 15938349 43657 43657 1682101 1682101 822 822 2716 2716 29565 29565 108141 108141 Medical/pharmaceutical 938390 938390 Provision for bad debts 726839 726839 Equipment rental 62932 62932 Forms and supplies 27310 27310 23336005 19560822 3775183 0 272941 283542 2536026 2556918 15022 88532 522025 505497 46093 16528 0 7506 2870082 2953026 1645791 1852822 336402 286782 70685 0 2052878 2139604 X 817204 813422 817204 813422 2870082 2953026 X -5963782 5960000 X X 0 1 X 1 0 X 478188 478188 3771445 16724797 16862758 16976395 17372223 71707618 3771445 16724797 16862758 17454583 17372223 72185806 0 0 0 72185806 3771445 16724797 16862758 17454583 17372223 72185806 1.00000 1.00000 0.00000 X Schedule A, Page 3, Part III, Public Support Short Year Disc The organization changed accounting periods in a previous tax year, which resulted in a short-year Form 990 for the period July 1, 2017-September 30, 2017. This prior, short-year filing period is reflected in the 2016 column of Schedule A, Part III. 522025 505497 16528 16528 X 16645384 0 16645384 726839 726839 17372223 22609166 0 22609166 726839 726839 23336005 Part X, Line 2: The Organization is part of the Catholic Medical Center Healthcare System. The System and all related entities, with the exception of Enterprises and DMA, are not-for-profit corporations as described in Section 501(c)(3) of the Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to the consolidated financial statements. Part XI, Line 4b - Other Adjustments: Provision for bad debts net against revenues 726,839. Part XII, Line 4b - Other Adjustments: Provision for bad debts net against revenues 726,839. 1 1 0 0 0 0 0 0 0 Joseph Pepe MD President & CEO/VC (end 6/2021) 0 788582 0 0 0 50311 0 402330 0 39322 0 1280545 0 0 Alexander Walker Jr Esq President & CEO/Vice Chair 0 458699 0 0 0 61114 0 165437 0 71171 0 756421 0 0 Edward Dudley III Exec. VP & CFO 0 448437 0 0 0 43169 0 171760 0 57370 0 720736 0 0 Patricia Furey MD Director 0 486825 0 21676 0 7980 0 11400 0 36813 0 564694 0 0 William B Clutterbuck MD Secretary/Treasurer 0 350825 0 0 0 0 0 11400 0 19443 0 381668 0 0 Jason Cole Esq Director 0 199198 0 0 0 5428 0 6262 0 38916 0 249804 0 0 Michael Gilbert MD Director 0 200543 0 0 0 0 0 0 0 7924 0 208467 0 0 Part I, Line 3 The Organization's President & CEO's compensation was established by a related organization, Catholic Medical Center. That organization used a compensation committee, independent compensation consultant, Form 990 of other organizations, a compensation survey/study, and approval by their board of directors/compensation committee to determine the President & CEO's compensation and benefits. Part I, Lines 4a-b Schedule J, Page 1, Line 4a, serverance payments: Dr. Joseph Pepe, who served as the Organization's President and CEO, retired in June, 2021. As part of his retirement, Dr. Pepe is entitled to severance compensation as per his employment agreement. Dr. Pepe did not receive any severance payments until after his formal retirement in June, 2021. Therefore, reportable severance-compensation paid to him will be reflected on his 2021 Form W-2, and will be disclosed as required and applicable in full detail on the Hospital's Form 990 for the year ending September 30, 2022, as Schedule J, Part II, Column B(iii) Other Income. Schedule J, Page 1, Line 4b, supplemental non-qualified retirement plans: The following individuals take part in a section 457(f) forfeitable nonqualified deferred compensation plan. The amounts listed represent calendar year 2020 contributions for many years of service: Joseph Pepe: $388,080 Alexander Walker: $154,037 Edward Dudley, III: $160,956 Form 990, Part VI, Section A, line 6 The sole member of Alliance Health Services is CMC Healthcare System. Form 990, Part VI, Section A, line 7a The directors are appointed by the sole member. Form 990, Part VI, Section A, line 7b The sole member has reserved powers over Alliance Health Services but does not approve each separate action taken by the board. Form 990, Part VI, Section B, line 11b Form 990 is prepared by an independent tax accounting firm (Baker Newman Noyes). Upon completion, a draft of the Form 990 is sent to the Organization, where the CFO, Controller, and Director of Accounting perform a final in-house review prior to submission to the Board of Directors for final approval. Upon approval from the Board, the Form 990 is filed with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c Officers and directors are required to complete a conflict of interest questionnaire annually. Form 990, Part VI, Section B, line 15 A related organization, Catholic Medical Center, utilizes a compensation committee of the board of directors to set compensation levels and determine bonus potential for its senior leadership team. The committee is assisted by an independent consultant who surveys like-sized and performing institutions to benchmark relevant salary scales for each position. The consultant's findings are presented to the compensation committee who considers that external data with actual performance against a list of pre-established goals per senior leaders to set prospective compensation levels and bonus values. Bonus amounts are determined by how well an executive achieves a pre-defined set of goals. These goals, in general, are tied to the achievement of a specific task or project. Some goals are attached to achieve overall financial performance and mission performance, not solely revenue generation. Form 990, Part VI, Section C, line 19 The governing documents, the conflict of interest policy, and the financial statements are available upon request. Form 990, Part IX, line 11g Physician fees: Program service expenses 15,938,349. Management and general expenses 0. Fundraising expenses 0. Total expenses 15,938,349. Form 990, Part XI, line 9: Transfers from affiliates 5,960,000. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Alliance Ambulatory Services 100 McGregor Street Manchester NH 03102 020519436 Ambulatory Surgical Center NH 501(c)(3) Line 10 CMC Healthcare System 0 Alliance Resources 100 McGregor Street Manchester NH 03102 020398138 Real Estate NH 501(c)(3) Line 12b, II CMC Healthcare System 0 Catholic Medical Center 100 McGregor Street Manchester NH 03102 020315693 Hospital NH 501(c)(3) Line 3 CMC Healthcare System and GraniteOne Health 0 CMC Healthcare System 100 McGregor Street Manchester NH 03102 010568516 Parent NH 501(c)(3) Line 12b, II N/A 0 CMC Physician Practice Associates 100 McGregor Street Manchester NH 03102 020460245 Practices NH 501(c)(3) Line 10 CMC Healthcare System 0 GraniteOne Health 100 McGregor Street Manchester NH 03102 814663563 Supporting Organization NH 501(c)(3) Line 12a, I N/A 0 Huggins Hospital 240 South Main Street Wolfeboro NH 03894 020223332 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 Monadnock Community Hospital 452 Old Street Road Peterborough NH 03458 020222157 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 St Peter's Home 100 McGregor Street Manchester NH 03102 020222228 Day Care Services NH 501(c)(3) Line 10 CMC Healthcare System 0 Alliance Urgent Care Services LLC 100 McGregor Street Manchester NH 03102 831238167 Health Care Services NH N/A 0 0 Bedford Ambulatory Surgical Center LLC 11 Washington Place Bedford NH 03110 020519727 Surgical Center NH N/A 0 0 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH N/A C 0 Doctors' Medical Association 100 McGregor Street Manchester NH 03102 020340690 Medical Office Building NH N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1