2020-08-13T10:42:37-05:00 2019-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2018-10-01 814663563 GraniteOne Health GRAN 6036683545 100 McGregor Street Manchester NH 03102 Edward L Dudley III Chief Financial Officer 6036683545 2020-08-10 1 Nicholas E Porto P01310283 2078792100 2020-08-10 208.105.168.164 2020-08-10 10:15:23 ED P BC8AE4E166BFDF24A7972DDCC457CE4FCF4C8ABA DA1D1F22D002DE74304CAE64996AD19EA354FE22 2018 2020-11-06 18:47:13Z Joseph Pepe MD 100 McGregor Street Manchester NH 03102 3423954 0 X www.graniteonehealth.org X 2016 NH To provide accessible, patient-centered, high quality care to our communities through exceptional collaboration and integration across the continuum of health. 13 8 0 8 0 0 0 0 462927 3423954 0 0 0 0 462927 3423954 0 0 0 0 0 0 0 0 0 450926 3433315 450926 3433315 12001 -9361 312930 2951154 326180 2973765 -13250 -22611 X Our mission is to provide accessible, patient-centered, high quality care to our communities through exceptional collaboration and integration across the continuum of health. 0 0 2288249 0 3423954 GraniteOne Health operates exclusively to benefit three publicly supported 501(c)(3) New Hampshire hospitals: Catholic Medical Center in Manchester, Huggins Hospital in Wolfeboro, and Monadnock Community Hospital in Peterborough. Its principal purposes in support of these hospitals are to: - Promote cost savings, efficiencies, and quality improvements in the provision of healthcare services to the communities in which the hospitals operate. - Preserve the charitable missions of the supported hospitals and protect their ability to perform their missions by creating a regional healthcare network that will allow the hospitals collectively to address challenges in a way that is not possible for each hospital to address independently. - Integrate the management, administrative, and clinical functions of the supported hospitals in a way that will align their missions, clinical services, and economic interests. This integrated healthcare system will allow for greater coordination of care, implementation of best practices, elimination of inefficiencies, and collaborative regional planning, all of which will improve the quality and reduce the cost of care for the communities served. - Enhance the charitable missions of each of the supported hospitals by: (1) developing a clinical integration program to evaluate and modify provider practices; (2) creating a high degree of interdependence and cooperation to control costs; (3) ensuring quality of care and greater patient access to care; and (4) broadening the nature of the charitable services provided collectively to the communities served by Catholic Medical Center, Huggins Hospital, and Monadnock Community Hospital.To accomplish these goals, GraniteOne Health's role is to: oversee long-term strategic planning for the integrated system; approve budgets and enumerated decisions of each supported hospital's board; and coordinate the new integrated healthcare system by overseeing the centralization of agreed upon administrative, management, financial, technology, specialization, and compliance functions. 2288249 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 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 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 8 0 0 0 0 0 0 0 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 Andy Crews Trustee 0.50 0.00 X 0 0 0 Leslie NH MacLeod Trustee 0.60 1.00 X 0 0 0 Cynthia K McGuire FACHE Trustee/MCH CEO 0.60 55.00 X 0 286202 46892 Maria C Mongan Trustee 0.60 1.50 X 0 0 0 Marcia Ober Trustee 0.60 1.00 X 0 0 0 Jeremy S Roberge CPA Trustee/HH CEO 0.60 40.00 X 0 283680 10522 Keith A Stahl MD Trustee 0.00 40.10 X 0 338570 24200 Alexander J Walker Esq Trustee/CMC CEO Designee 0.60 43.10 X 0 605080 212505 Rick Botnick Chair 0.60 1.30 X X 0 0 0 Joseph Graham Vice Chair 0.60 0.00 X X 0 0 0 Marie McKay CPA Treasurer 0.50 0.00 X X 0 0 0 Matthew Albuquerque Secretary 0.60 0.00 X X 0 0 0 Joseph Pepe MD CEO/CMC CEO 0.60 47.50 X X 0 966705 400783 Edward L Dudley III CFO 0.60 43.30 X 0 555530 203991 0 3035767 898893 0 0 1 0 Dartmouth Hitchcock Clinic 1 Medical Center Drive Lebanon NH 03756 Affiliation Costs 2849924 Catholic Medical Center 100 McGregor Street Manchester NH 03102 Staffing 507103 2 Management fees 561000 3423954 3423954 3423954 3423954 3423954 0 0 X 1103899 1103899 27400 27400 2253203 2253203 17370 17370 4268 4268 13408 13408 3917 3917 9850 9850 3433315 2288249 1145066 0 175529 0 137401 2951154 312930 2951154 326180 2959777 0 13988 326180 2973765 X 0 0 0 0 -13250 -22611 -13250 -22611 312930 2951154 -9361 0 X X 1 X 0 1 0 X X X 3 Catholic Medical Center 020315693 3 1 0 2054372 Huggins Hospital 020223332 3 1 0 684791 Monadnock Community Hospital 020222157 3 1 0 684791 3 0 3423954 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Schedule A, Part I, Line 12g, Column vi: The amount of non-monetary support listed Schedule A, Part I, Line 12g, Column vi is an allocation of total membership fees received by GraniteOne Health from its respective supported organizations. These amounts effectively represent amounts expended or services rendered by GraniteOne Health to or for the benefit of the supported organizations in carrying out GraniteOne Health's exempt mission on behalf of its supported organizations. Schedule A, Part IV, Section B, Line 1: The power to appoint and/or remove Trustees is allocated among the three supported organizations as follows: the CEO or CEO designee of each supported hospital serves as a Trustee of the filing organization. Additionally, seven Board members are to be appointed by Catholic Medical Center and one member each by Huggins Hospital and Monadnock Community Hospital. 0 Cash overdraft 13988 13988 X 3423954 0 3423954 0 3423954 3433315 0 3433315 0 3433315 Part X, Line 2: The parent companies, hospitals and affiliates comprising the System, with the exception of Enterprises, DMA and MOB, are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (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 combined financial statements. Enterprises, DMA and MOB are for-profit organizations and, in accordance with federal and state tax laws, file income tax returns, as applicable. No significant income taxes were incurred or paid for the year ended September 30, 2019 and 2018. There are no significant deferred tax assets or liabilities at September 30, 2019 and 2018. These entities have concluded there are no significant uncertain tax positions requiring disclosure and there is no material liability for unrecognized tax benefits. It is the policy of these entities to recognize interest related to unrecognized tax benefits in interest expense and penalties in income tax expense. 0 1 0 0 0 0 0 0 0 Cynthia K McGuire FACHE Trustee/MCH CEO 0 264671 0 0 0 21531 0 23000 0 23892 0 333094 0 17500 Jeremy S Roberge CPA Trustee/HH CEO 0 270000 0 13500 0 180 0 8100 0 2422 0 294202 0 0 Keith A Stahl MD Trustee 0 338570 0 0 0 0 0 21500 0 2700 0 362770 0 0 Alexander J Walker Esq Trustee/CMC CEO Designee 0 421127 0 132968 0 50985 0 156267 0 56238 0 817585 0 0 Joseph Pepe MD CEO/CMC CEO 0 713027 0 213513 0 40165 0 372862 0 27921 0 1367488 0 0 Edward L Dudley III CFO 0 413216 0 109381 0 32933 0 162547 0 41444 0 759521 0 0 Part I, Line 3 The CEO of GraniteOne Health is compensated by a related organization, Catholic Medical Center. That organization used a compensation committee, independent compensation consultant, Form 990 of other organizations, a compensation study/survey, and approval by the board of directors/compensation committee to determine the CEO's compensation and benefits. Part I, Line 4b The following individuals take part in a section 457(f) forfeitable nonqualified deferred compensation plan through Catholic Medical Center, their employer, which is a related organization. The amounts listed represent calendar year 2018 contributions for many years of service: Joseph Pepe: $351,362 Edward Dudley, III: $146,047 Alexander Walker: $139,767 Cynthia McGuire, President & CEO, participates in a 457(f) plan with Monadnock Community Hospital. After a three year vesting period, amounts previously contributed to her by Monadnock Community Hospital are reported as part of her W-2 wages. In calendar year 2018, a total of $17,500 was deposited into Ms. McGuire's 457(f) plan account, which is included in the amount reported on Schedule J, Part II, Column C for this current fiscal year Form 990 filing. Additionally, $21,531 of compensation is reported in Column B(iii), which represents the vested 2015 contribution of $19,551 and earnings of $1,979. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an independent accounting firm (Baker Newman Noyes). Upon completion, a draft of the Form 990 is reviewed by the Organization's staff leadership prior to submission to the Board of Trustees 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 All organization officers and directors are required to disclose any potential conflicts of interest upon joining the organization and annually thereafter. The Board Chair becomes familiar with the listed potential conflicts submitted by all officers and directors to guide his or her conduct if a conflict arises. Officers and directors are also required to disclose any matter that comes before the Board or a committee that may give rise to a conflict of interest, whether or not it has been previously disclosed. To determine if a conflict exists, the interested person will leave the room and the remaining Board or committee members will determine if a conflict exists according to the guidelines outlined in the conflict of interest policy. In addition to disclosing all potential conflicts of interest, officers and directors must annually submit a statement that they have received, read, and understood the conflict of interest policy and agree to be bound by its terms. Form 990, Part VI, Section B, line 15 The organization does not directly compensate any officers or key employees. All officers are compensated by related organizations, which do include reviews, approval by independent persons, comparability data, and contemporaneous substantiation as part of their compensation determination processes. Form 990, Part VI, Section C, line 19 GraniteOne Health makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part VI, Section B, Lines 13 and 14: GraniteOne Health does not directly employ any staff members. However, all employees who provide services to GraniteOne Health are compensated by one of the hospitals supported by the filing organization and are covered by the written whistleblower and document retention/destruction policies of their respective employer. Form 990, Part IX, line 11g Consulting fees: Program service expenses 1,746,100. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,746,100. Organization staffing: Program service expenses 507,103. Management and general expenses 0. Fundraising expenses 0. Total expenses 507,103. Form 990, Part XII, Line 2c: The review 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 Health Services 100 McGregor Street Manchester NH 03102 611508839 Practices 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 GraniteOne Health 1 CMC Healthcare System 100 McGregor Street Manchester NH 03102 010568516 Management 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 Hospital and Community Aid Association Inc PO Box 1377 Wolfeboro NH 03894 026008048 Supporting Organization NH 501(c)(3) Line 12b, II N/A 0 Huggins Hospital 240 South Main Street Wolfeboro NH 03894 020223332 Hospital NH 501(c)(3) Line 3 GraniteOne Health 1 Monadnock Community Hospital 452 Old Street Road Peterborough NH 03458 020222157 Hospital NH 501(c)(3) Line 3 GraniteOne Health 1 Monadnock Health Services 452 Old Street Road Peterborough NH 03102 020420789 Inactive NH 501(c)(3) Line 12a, I Monadnock Community Hospital 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 Bedford Ambulatory Surgical Center 11 Washington Place Bedford NH 03110 020519727 Surgical Center NH N/A Alliance Urgent Services 100 McGregor Street Manchester NH 03110 831238167 Health Care Services NH N/A 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 Huggins Senior Housing PO Box 912 Wolfeboro NH 03894 020490445 Elderly Housing NH N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 Catholic Medical Center O 507103 Actual per Books Catholic Medical Center L 2054373 Actual per Books Huggins Hospital L 684791 Actual per Books Monadnock Community Hospital L 684791 Actual per Books