GRANITEONE HEALTH: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GRANITEONE HEALTH (EIN 81-4663563)
- Tax period
- 2016-11-21 to 2017-09-30
- Filed
- 2018-08-09
- IRS object ID
- 201822219349300022
- Schema version
- 2016v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-08-09T10:28:39-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Newman & Noyes | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 507 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04112 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-11-21 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 814663563 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GraniteOne Health | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GRAN | BusinessNameControlTxt |
| Phone | 6036683545 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 McGregor Street | AddressLine1Txt |
| City | Manchester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03102 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Edward L Dudley III | PersonNm |
| Person Title | Chief Financial Officer | PersonTitleTxt |
| Phone | 6036683545 | PhoneNum |
| Signature | 2018-07-30 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Nicholas E Porto | PreparerPersonNm |
| PTIN | P01310283 | PTIN |
| Phone | 2078792100 | PhoneNum |
| Preparation | 2018-07-30 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Initial Return | Yes (X) | InitialReturnInd |
| Principal Officer | Joseph Pepe MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 McGregor Street | AddressLine1Txt |
| City | Manchester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $476,320 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.graniteonehealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2016 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To provide accessible, patient-centered, high quality care to our communities through exceptional collaboration and integration across the continuum of health. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $476,320 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| CY Total Revenue | $476,320 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| CY Other Expenses | $501,571 | CYOtherExpensesAmt |
| CY Total Expenses | $501,571 | CYTotalExpensesAmt |
| CY Revenues Less Expenses | -$25,251 | CYRevenuesLessExpensesAmt |
| Total Assets EOY | $476,320 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $501,571 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances EOY | -$25,251 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Our mission is to provide accessible, patient-centered, high quality care to our communities through exceptional collaboration and integration across the continuum of health. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $368,377 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $476,320 | RevenueAmt |
| Desc | 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 is 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 new integrated system; approve budgets and enumerated decisions of each supported hospital's board; coordinate the new integrated healthcare system by overseeing the centralization of agreed upon administrative, management, financial, technology, specialization, and compliance functions. | Desc |
| Total Program Service Expenses | $368,377 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Edward L Dudley III | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6036683545 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 McGregor Street | AddressLine1Txt |
| City | Manchester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03102 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Andy Crews | |||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Leslie NH MacLeod | |||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Cynthia K McGuire FACHE | |||||||
| Trustee/MCH CEO | 1.00 | 55.00 | Yes (X) | $0 | $291,471 | $45,298 | |
| Maria C Mongan | |||||||
| Trustee | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| Marcia Ober | |||||||
| Trustee | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| Jeremy S Roberge CPA | |||||||
| Trustee/HH CEO | 1.00 | 40.00 | Yes (X) | $0 | $263,544 | $8,596 | |
| Keith A Stahl MD | |||||||
| Trustee | 1.00 | 42.00 | Yes (X) | $0 | $321,447 | $24,616 | |
| Alexander J Walker Esq | |||||||
| Trustee/CMC CEO Designee | 1.00 | 43.00 | Yes (X) | $0 | $516,960 | $72,904 | |
| Rick Botnick | |||||||
| Chairperson | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Joseph Graham | |||||||
| Vice Chairperson | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Marie McKay CPA | |||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Matthew Albuquerque | |||||||
| Secretary | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Joseph Pepe MD | |||||||
| CEO/CMC CEO | 1.00 | 47.00 | Yes (X) | $0 | $800,886 | $59,304 | Yes (X) |
| Edward L Dudley III | |||||||
| CFO | 1.00 | 43.00 | $0 | $504,732 | $64,362 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,699,040 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $275,080 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Catholic Medical Center | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 McGregor Street | AddressLine1Txt |
| City | Manchester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Staffing | ServicesDesc |
| Compensation | $342,878 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Management Fees | Desc |
| Business | 561000 | BusinessCd |
| Total Revenue Column | $476,320 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $476,320 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $476,320 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $476,320 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $476,320 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,664 | TotalAmt |
| Management And General | $5,664 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,250 | TotalAmt |
| Management And General | $25,250 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,658 | TotalAmt |
| Program Services | $342,878 | ProgramServicesAmt |
| Management And General | $93,780 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,499 | TotalAmt |
| Program Services | $25,499 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,500 | TotalAmt |
| Management And General | $8,500 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $501,571 | TotalAmt |
| Program Services | $368,377 | ProgramServicesAmt |
| Management And General | $133,194 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $476,320 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $476,320 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $501,571 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $501,571 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | -$25,251 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | -$25,251 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $476,320 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$25,251 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 3 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (3 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| Catholic Medical Center | ||||
| 020315693 | 3 | Yes (1) | $0 | $285,792 |
| Huggins Hospital | ||||
| 020223332 | 3 | Yes (1) | $0 | $95,264 |
| Monadnock Community Hospital | ||||
| 020222157 | 3 | Yes (1) | $0 | $95,264 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 3 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $476,320 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| 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. |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $476,320 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $476,320 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $476,320 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $501,571 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $501,571 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $501,571 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The parent companies, hospitals and affiliates comprising the System, with the exception of Enterprises, DMA, CAHS, BASC 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, CAHS (dissolved in September 2017), BASC 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 nine-month period ended September 30, 2017. There are no significant deferred tax assets or liabilities at September 30, 2017. 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Cynthia K McGuire FACHE | ||||||||||||||
| Trustee/MCH CEO | $0 | $252,681 | $0 | $37,500 | $0 | $1,290 | $0 | $21,721 | $0 | $23,577 | $0 | $336,769 | $0 | $0 |
| Jeremy S Roberge CPA | ||||||||||||||
| Trustee/HH CEO | $0 | $229,615 | $0 | $33,750 | $0 | $179 | $0 | $7,901 | $0 | $695 | $0 | $272,140 | $0 | $0 |
| Keith A Stahl MD | ||||||||||||||
| Trustee | $0 | $320,787 | $0 | $0 | $0 | $660 | $0 | $21,200 | $0 | $3,416 | $0 | $346,063 | $0 | $0 |
| Alexander J Walker Esq | ||||||||||||||
| Trustee/CMC CEO Designee | $0 | $349,826 | $0 | $104,707 | $0 | $62,427 | $0 | $15,900 | $0 | $57,004 | $0 | $589,864 | $0 | $0 |
| Joseph Pepe MD | ||||||||||||||
| CEO/CMC CEO | $0 | $565,413 | $0 | $184,246 | $0 | $51,227 | $0 | $21,200 | $0 | $38,104 | $0 | $860,190 | $0 | $0 |
| Edward L Dudley III | ||||||||||||||
| CFO | $0 | $358,414 | $0 | $102,383 | $0 | $43,935 | $0 | $15,900 | $0 | $48,462 | $0 | $569,094 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 following represents contributions for many years of service: Joseph Pepe: $244,989 Edward Dudley, III: $121,316 Alexander Walker: $110,346 The amounts above were paid during the fiscal year ending June 30, 2017. As IRS instructions require that Form 990, Part VII and Schedule J, Part II report compensation and benefits for the calendar year ending within the fiscal year, these amounts will be reflected on the organization's 2017 tax return filing. Cynthia McGuire, President & CEO of Monadnock Community Hospital, a related organization, 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 will be reported to her as part of her W-2 wages. On June 21, 2016, $17,500 was deposited into Ms. McGuire's 457(f) plan account which is reported on Schedule J, Part II, Column C for this current fiscal year Form 990 filing. Additionally, on May 2, 2017, $17,500 was deposited into Ms. McGuire's 457(f) plan account which will be reported on Schedule J, Part II, Column C for the fiscal year ending September 30, 2018. The 2017 Form 990 will also be the first tax year to report any payments that were made to her 457(f) account in a prior period that have vested and thus will be reported in Schedule J, Part II, Column B(iii). |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 Services. |
| 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 | Organization Staffing: Program service expenses 342,878. Management and general expenses 0. Fundraising expenses 0. Total expenses 342,878. Consulting Fees: Program service expenses 0. Management and general expenses 93,780. Fundraising expenses 0. Total expenses 93,780. |
| Form 990, Part XII, Line 2c: | The 2016 Form 990 for the short period ending September 30, 2017, was the organization's initial tax year. The organization's financial statements underwent a review by an independent accounting firm and was included in the combined financial statements of CMC Healthcare System, Inc. and GraniteOne Health and Affiliates. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (1) | |
| CMC Healthcare System | |||||||||||
| 100 McGregor Street | Manchester | NH | 03102 | 010568516 | Management | NH | 501(c)(3) | Line 12b, II | 0 | N/A | |
| 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 | 0 | N/A | |
| Huggins Hospital | |||||||||||
| 240 South Main Street | Wolfeboro | NH | 03894 | 020223332 | Hospital | NH | 501(c)(3) | Line 3 | GraniteOne Health | Yes (1) | |
| Monadnock Community Hospital | |||||||||||
| 452 Old Street Road | Peterborough | NH | 03458 | 020222157 | Hospital | NH | 501(c)(3) | Line 3 | GraniteOne Health | Yes (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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| Bedford Ambulatory Surgical Center | |||||||
| 11 Washington Place | Bedford | NH | 03110 | 020519727 | Surgical Center | NH | N/A |
| McGregor Street MOB LLC | |||||||
| 100 McGregor Street | Manchester | NH | 03110 | 134347316 | Medical Office Building | NH | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Catholic Medical Center | ||
| O | $342,878 | Actual per Books |
| Catholic Medical Center | ||
| L | $285,792 | Actual per Books |
| Huggins Hospital | ||
| L | $95,264 | Actual per Books |
| Monadnock Community Hospital | ||
| L | $95,264 | Actual per Books |