2020-08-13T10:42:27-05:00 2019-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2018-10-01 611508839 Alliance Health Services ALLI 6036683545 100 McGregor Street Manchester NH 03102 Edward L Dudley III Executive VP & CFO 6036683545 2020-08-10 1 Nicholas E Porto P01310283 2078792100 2020-08-10 208.105.168.164 2020-08-10 10:10:46 ED P BC8AE4E166BFDF24A7972DDCC457CE4FCF4C8ABA DA1D1F22D002DE74304CAE64996AD19EA354FE22 2018 2020-09-22 18:59:49Z Joseph Pepe MD 100 McGregor Street Manchester NH 03102 16862758 0 0928 X www.catholicmedicalcenter.org X 2007 NH To promote health care programs from the greater Manchester, New Hampshire community. 7 3 0 6 0 0 0 0 16724797 16862758 0 0 0 0 16724797 16862758 0 0 0 0 0 0 0 0 0 21027213 22148542 21027213 22148542 -4302416 -5285784 2669460 2914545 2054357 1935226 615103 979319 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 0 0 18795741 0 16862758 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 18795741 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 0 0 0 0 0 0 0 0 0 0 0 0 X 7 3 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 Craig Beck Director 0.20 0.00 X 0 0 0 Robert A Catania MD Director 0.20 41.50 X 0 580271 40921 Jason Cole Esq Director 0.20 40.50 X 0 239858 34345 Steven A Paris MD Director (end 12/18) 0.10 0.00 X 0 0 0 Stephen LeBlanc Director 0.00 0.00 X 0 0 0 John G Cronin Esq Chair 0.20 4.40 X X 0 0 0 Maria C Mongan Chair (end 12/18) 0.00 2.10 X X 0 0 0 William B Clutterbuck MD Secretary/Treasurer 0.00 40.00 X X 0 365502 40921 Joseph Pepe MD President & CEO/Vice Chair 0.20 47.90 X X 0 966705 400783 Edward Dudley III Exec. VP & CFO 0.20 43.70 X 0 555530 203991 0 2707866 720961 0 0 1 0 Dartmouth Hitchcock Clinic 1 Medical Center Drive Lebanon NH 03756 Medical Services 17573951 1 Patient service revenue 621400 16273475 16273475 Rental income 532000 589283 589283 16862758 16862758 16862758 0 0 X 3352801 3352801 15352959 15352959 46768 46768 1655184 1655184 4701 4701 2417 2417 34602 34602 103485 103485 Medical/pharmaceutical 839024 839024 Provision for bad debts 672481 672481 Equipment rental 65004 65004 Forms and supplies 19116 19116 22148542 18795741 3352801 0 166645 222020 2309881 2509272 81804 84131 662737 586209 111130 76528 0 22594 2669460 2914545 1660520 1557916 390851 372466 2986 4844 2054357 1935226 X 615103 979319 615103 979319 2669460 2914545 X -5285784 5650000 X X 0 1 X 1 0 X 16334379 16679690 3771445 16724797 16862758 70373069 16334379 16679690 3771445 16724797 16862758 70373069 0 0 0 70373069 16334379 16679690 3771445 16724797 16862758 70373069 1.00000 1.00000 0.00000 X Part III, Short Year Explanation: 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. 662737 586209 76528 76528 Due to affiliates 4844 4844 X 16862758 0 16862758 0 16862758 22148542 0 22148542 0 22148542 Part X, Line 2: The System and all related entities, with the exception of Enterprises and DMA, are not-for-profit corporations as described in Sections 501(c)(3) of the Code and are exempt from federal income taxes on related income pursuant to Sections 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. Enterprises and DMA are for-profit organizations and, in accordance with federal and state tax laws, file income tax returns, as applicable. There was no provision for income taxes for the years ended September 30, 2019 and 2018. There are no significant deferred tax assets or liabilities. 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 Robert A Catania MD Director 0 535153 0 45118 0 0 0 18850 0 22071 0 621192 0 0 Jason Cole Esq Director 0 198653 0 41205 0 0 0 9176 0 25169 0 274203 0 0 William B Clutterbuck MD Secretary/Treasurer 0 365502 0 0 0 0 0 18850 0 22071 0 406423 0 0 Joseph Pepe MD President & CEO/Vice Chair 0 713027 0 213513 0 40165 0 372862 0 27921 0 1367488 0 0 Edward Dudley III Exec. VP & CFO 0 413216 0 109381 0 32933 0 162547 0 41444 0 759521 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, Line 4b The following individuals take part in a section 457(f) forfeitable nonqualified deferred compensation plan. The amounts listed represent calendar year 2018 contributions for many years of service: Joseph Pepe: $351,362 Edward Dudley, III: $146,047 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 15,352,959. Management and general expenses 0. Fundraising expenses 0. Total expenses 15,352,959. Form 990, Part XI, line 9: Transfers from affiliates 5,650,000. 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 Bedford Ambulatory Surgical Center LLC 11 Washington Place Bedford NH 03110 020519727 Surgical Center 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 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1