2017-05-11T14:04:44-05:00 2016-06-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2015-07-01 020460245 Catholic Medical Center Physicians Practice Associates CATH 6036683545 100 McGregor Street Manchester NH 03102 Edward L Dudley III Exec. VP & CFO 6036683545 2017-04-25 1 Nicholas E Porto P01310283 2078792100 2017-04-25 2015 2021-01-29 14:40:06Z Joseph Pepe MD 100 McGregor Street Manchester NH 03102 20963741 0 0928 X www.catholicmedicalcenter.org X 2002 NH The heart of Catholic Medical Center is to provide health, healing and hope in a manner that offers innovative high quality services, compassion, and respect for the human dignity of every individual who seeks or needs our care as part of Christ's healing ministry through the Catholic Church. 9 4 158 0 0 0 0 0 19732200 20963741 0 0 0 0 19732200 20963741 0 0 0 0 33744024 40607442 0 0 0 1707777 1844496 35451801 42451938 -15719601 -21488197 1724731 1914427 12219871 20290060 -10495140 -18375633 X The heart of Catholic Medical Center is to provide health, healing and hope in a manner that offers innovative high quality services, compassion, and respect for the human dignity of every individual who seeks or needs our care as part of Christ's healing ministry through the Catholic Church. 0 0 33495038 20963741 To provide physician and hospital care, both inpatient and outpatient, to persons in the service area of Catholic Medical Center. Physicians participate in Medicare and Medicaid programs. 33495038 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 9 0 1 158 1 0 0 0 0 0 0 0 0 0 0 X 9 4 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NH X Edward L Dudley III 6036683545 100 McGregor Street Manchester NH 03102 William B Clutterbuck MD Director & Phy (end 12/15) 40.00 4.00 X 366772 0 44214 Powen Hsu MD Director & Physician 1.00 3.00 X 0 0 0 Fr Patrick Sullivan OSB RN Director 1.00 3.00 X 0 0 0 Adele Boufford Baker Director 1.00 3.00 X 0 0 0 Carolyn Claussen MD Director 40.00 3.00 X 99551 0 7518 Harry E Dumay PhD Director 1.00 3.00 X 0 0 0 Louis I Fink MD Chair & Cardiologist 40.00 3.00 X X 610287 0 28002 Keith A Stahl MD Secretary & Treasurer 40.00 3.00 X X 322835 0 23254 Joseph Pepe MD President & CEO, Vice Chai 1.00 44.00 X X 0 725390 281003 Edward Dudley III Director/Exec. VP & CFO 1.00 43.00 X X 0 478103 184819 Benjamin Westbrook MD Cardiologist 40.00 0.00 X 1051816 0 41635 Yvon Baribeau MD Cardiologist 40.00 0.00 X 1051428 0 33447 David Goldberg MD Cardiologist 40.00 0.00 X 667170 0 40545 Jamie Kim MD Cardiologist 40.00 0.00 X 630024 0 42085 Jeffrey Bleakley MD Cardiologist 40.00 0.00 X 618589 0 42085 5418472 1203493 768607 90 0 1 0 CHG Companies Inc 6440 Millrock Drive 175 Salt Lake City UT 84121 Labor 141972 1 Patient Service Revenue 621110 20499996 20499996 Miscellaneous Revenue 621110 463745 463745 20963741 20963741 20963741 0 0 1502433 1185436 316997 34499593 27220552 7279041 1721016 1357900 363116 1715401 1353470 361931 1168999 922353 246646 171972 135688 36284 92087 72658 19429 331452 261519 69933 52485 41411 11074 370696 292483 78213 825804 651568 174236 42451938 33495038 8956900 0 331293 319629 33800 33800 0 0 1393438 1594798 1724731 1914427 2230474 3321583 9989397 16968477 12219871 20290060 X -10495140 -18375633 -10495140 -18375633 1724731 1914427 X -21488197 13607704 X X 0 1 X 1 0 X 13458010 14320969 17486214 19732200 20963741 85961134 13458010 14320969 17486214 19732200 20963741 85961134 0 0 0 85961134 13458010 14320969 17486214 19732200 20963741 85961134 1.00000 1.00000 0.00000 X 33800 33800 0 0 Due from Affiliates 1594798 1594798 Accrued Pension & Other Liabilities 16968477 16968477 X 14133945 0 14133945 6829796 6829796 20963741 42451938 0 42451938 0 42451938 Part X, Line 2: The System and all related entities, with the exception of Enterprises, DMA and CAHS, 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 consolidated financial statements. Enterprises, DMA and CAHS 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 each of the years ended June 30, 2016 and 2015. 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. Part XI, Line 4b - Other Adjustments: Net Change in Pension Liability 6,829,796. 0 1 0 0 0 0 0 1 0 William B Clutterbuck MD Director & Phy (end 12/15) 366772 0 0 0 0 0 21150 0 23064 0 410986 0 0 0 Louis I Fink MD Chair & Cardiologist 446263 0 123024 0 41000 0 23800 0 4202 0 638289 0 0 0 Keith A Stahl MD Secretary & Treasurer 296920 0 0 0 25915 0 21200 0 2054 0 346089 0 0 0 Joseph Pepe MD President & CEO, Vice Chai 0 537600 0 134680 0 53110 0 250934 0 30069 0 1006393 0 0 Edward Dudley III Director/Exec. VP & CFO 0 346789 0 84000 0 47314 0 130118 0 54701 0 662922 0 0 Benjamin Westbrook MD Cardiologist 787482 0 244334 0 20000 0 15900 0 25735 0 1093451 0 0 0 Yvon Baribeau MD Cardiologist 787094 0 244334 0 20000 0 15900 0 17547 0 1084875 0 0 0 David Goldberg MD Cardiologist 442308 0 107362 0 117500 0 18550 0 21995 0 707715 0 0 0 Jamie Kim MD Cardiologist 439912 0 125112 0 65000 0 18550 0 23535 0 672109 0 0 0 Jeffrey Bleakley MD Cardiologist 447931 0 103658 0 67000 0 18550 0 23535 0 660674 0 0 0 Part I, Line 3 The Organization's President and CEO's compensation was established by a related organization, Catholic Medical Center. That organization used a compensation committee, independent compensation consultant, the Form 990 of other organizations, a compensation study/survey, and approval by their board of directors/compensation committee to determine the President and 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 following represents contributions for many years of service: Joseph Pepe: $229,734 Edward Dudley, III: $114,218 Part I, Line 7 A portion of compensation is at-risk and vairable, and payment depends on the quality of job performance. Form 990, Part VI, Section A, line 6 The sole member of CMC Physician Practice Associates is CMC Healthcare System. Form 990, Part VI, Section A, line 7a The directors of CMC Physician Practice Associates are appointed by the sole member. Form 990, Part VI, Section A, line 7b The sole member has reserved powers over CMC Physician Practice Associates but does not approve each separate action taken by the CMC Physician Practice Associates board. Form 990, Part VI, Section B, line 11 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 Board, 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 Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, line 9: Transfer from Affiliates 20,437,500. Net Change in Pension Liability -6,829,796. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Form 990, Part X, Lines 17 and 25, Column A: The beginning of year balance sheet has been partially restated in order to more closely conform to the IRS guidelines for the breakdown of accounts payable and accrued expenses. Part X, Column A, Line 17 and 25 were updated as follows: Line 17 was updated from $12,219,871 to $2,230,474. Line 25 was updated from $0 to $9,989,397. Liabilities in total as reported on Form 990, Part X, Column A, Line 26 remain unchanged from prior year Form 990, Part X, Column B. Alliance Health Services 100 McGregor Street Manchester NH 03102 611508839 Practices NH 501(c)(3) Line 9 CMC Healthcare System 0 Catholic Medical Center 100 McGregor Street Manchester NH 03102 020315693 Hospital NH 501(c)(3) Line 3 CMC Healthcare System 0 CMC Healthcare System 100 McGregor Street Manchester NH 03102 010568516 Parent NH 501(c)(3) Line 11b, II N/A 0 Alliance Resources Inc 100 McGregor Street Manchester NH 03102 020398138 Real Estate NH 501(c)(3) Line 11b, II CMC Healthcare System 0 St Peter's Home 100 McGregor Street Manchester NH 03102 020222228 Home NH 501(c)(3) Line 9 CMC Healthcare System 0 Alliance Ambulatory Services 100 McGregor Street Manchester NH 03102 020519436 Ambulatory Surgical Center NH 501(c)(3) Line 9 CMC Healthcare System 0 McGregor Steet MOB LLC 100 McGregor Street Manchester NH 03102 134347316 Medical Office Building NH N/A Bedford Ambulatory Surgical Center LLC 11 Washington Place Bedford NH 03110 020519727 Surgical Center NH N/A Doctors' Medical Association 100 McGregor Street Manchester NH 03102 020340690 Medical Office Building NH N/A C 0 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1