2017-05-11T14:09:42-05:00 2016-06-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2015-07-01 611508839 Alliance Health Services ALLI 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 16334379 0 0928 X www.catholicmedicalcenter.org X 2007 NH To promote health care programs from the greater Manchester, New Hampshire community. 8 4 0 0 0 0 0 0 15442315 16334379 0 0 0 0 15442315 16334379 0 0 0 0 0 0 0 0 0 20108767 20878730 20108767 20878730 -4666452 -4544351 3614578 3781557 3341700 2113030 272878 1668527 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 0 0 17857017 16334379 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 17857017 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 X 8 4 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Edward L Dudley III 6036683545 100 McGregor St Manchester NH 03102 Stephen J Leblanc Director 1.00 0.00 X 0 0 0 Steven A Paris MD Director 1.00 0.00 X 0 0 0 Maria C Mongan Director 1.00 4.00 X 0 0 0 Robert A Catania MD Director 1.00 42.00 X 0 544513 45319 Matthew Kfoury Chair (eff 6/16) 1.00 3.00 X X 0 0 0 Richard E Ashooh Chair (end 6/16) 1.00 3.00 X X 0 0 0 William B Clutterbuck MD Treasurer/Secretary 1.00 43.00 X X 0 366772 44214 Joseph Pepe MD President & CEO/Vice Chair 1.00 44.00 X X 0 725390 281003 Edward Dudley III Exec VP & CFO/ Director 1.00 43.00 X X 0 478103 184819 0 2114778 555355 0 0 1 0 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 Physician Services 20894892 1 Patient Service Rev. 621400 15658019 15658019 Rental Income 532000 535264 535264 Miscellaneous Revenue 621400 141096 141096 16334379 16334379 16334379 0 0 X 3021713 3021713 14783079 14783079 57045 57045 1573404 1573404 3348 3348 46337 46337 Medical & Pharmaceutica 686013 686013 Bad Debts 508325 508325 Transcription 118883 118883 Equipment Rental 64774 64774 15809 15809 20878730 17857017 3021713 0 1013248 858412 2252330 2555753 94081 158810 662737 454155 254919 208582 3614578 3781557 3292888 1691530 371738 48812 49762 3341700 2113030 X 272878 1668527 272878 1668527 3614578 3781557 X -4544351 5940000 X X 0 1 X 1 0 X 10766383 15262417 14953001 15442315 16334379 72758495 10766383 15262417 14953001 15442315 16334379 72758495 0 0 0 72758495 10766383 15262417 14953001 15442315 16334379 72758495 1.00000 1.00000 0.00000 X 662737 454155 208582 208582 Due to Affiliates 49762 49762 X 16334379 0 16334379 0 16334379 20878730 0 20878730 0 20878730 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. 0 1 0 0 0 0 0 0 0 Robert A Catania MD Director 0 511320 0 33193 0 0 0 21150 0 24169 0 589832 0 0 William B Clutterbuck MD Treasurer/Secretary 0 366772 0 0 0 0 0 21150 0 23064 0 410986 0 0 Joseph Pepe MD President & CEO/Vice Chair 0 537600 0 134680 0 53110 0 250934 0 30069 0 1006393 0 0 Edward Dudley III Exec VP & CFO/ Director 0 346789 0 84000 0 47314 0 130118 0 54701 0 662922 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 Form 990, Part VI, Section A, line 4 The Organization's bylaws were updated to change the sole corporate member from Catholic Medical Center to CMC Healthcare System. 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 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 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 14,783,079. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,783,079. Form 990, Part XI, line 9: Transfer From Affiliates 5,940,000. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. 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 CMC Physician Practice Associates 100 Mcgregor Street Manchester NH 03102 020460245 Practices NH 501(c)(3) Line 9 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 Alliance Resources 100 Mcgregor Street Manchester NH 03102 020398138 Real Estate NH 501(c)(3) Line 11b, II CMC Healthcare System 0 McGregor Steet MOB 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 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