2017-05-11T14:05:30-05:00 2016-06-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2015-07-01 020315693 Catholic Medical Center CATH 6036683545 100 McGregor Street Manchester NH 031023770 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 031023770 428947465 0 0928 X www.catholicmedicalcenter.org X 1974 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. 20 15 2643 273 7409 5722 3794563 3322280 347248774 395326782 3235927 484672 120860 1444922 354400124 400578656 28623 52410 0 0 144404381 157995914 0 0 439767 181230826 198961289 325663830 357009613 28736294 43569043 310479366 323864484 203570167 245633902 106909199 78230582 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 308574583 52410 387371499 Medical & Surgical services provided to 11,382 inpatients and 393,761 outpatients. 6475869 8129534 Various other services. Please see Schedule H.Catholic Medical Center (CMC), as an agency of the Roman Catholic Church, shall provide health care in a manner consistent with the ethical and religious directives for Catholic health care services as interpreted by the Roman Catholic Bishop of Manchester. CMC shall employ the highest quality health care professionals and the most appropriate technology to deliver an array of services either directly or through strategic alliances with compatible health care providers. With dignity and compassion, CMC shall treat the body, mind, and spirit of all who seek or provide care and comfort. Additional details provided in Schedule H. 315050452 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 1 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 226 0 1 2643 1 1 1 0 0 0 0 1 1 0 0 0 0 X 20 15 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 NH X Edward Dudley 6036683545 c/o Finance Dept 100 McGregor Manchester NH 031023770 Adele Boufford Baker Director (end 12/15) 1.00 3.00 X 0 0 0 William Clutterbuck MD Director (end 12/15) 1.00 43.00 X 0 366772 44214 Eleanor Wm Dahar Esq Director (end 12/15) 1.00 2.00 X 0 0 0 Powen Hsu MD Director 1.00 3.00 X 0 0 0 Susan Huard PhD Director 1.00 2.00 X 0 0 0 Patrick A Mahon MD Director (end 1/16) 1.00 42.00 X 0 545741 45100 Diane Murphy Quinlan Esq Director 1.00 3.00 X 0 0 0 Keith A Stahl MD Director 1.00 42.00 X 0 322835 23254 Fr Patrick Sullivan OSB RN Director 1.00 3.00 X 0 0 0 Harry E Dumay PhD Director 1.00 3.00 X 0 0 0 Louis I Fink MD Director 1.00 42.00 X 0 610287 28002 Matthew Kfoury Director 1.00 3.00 X 0 0 0 Paul S Moore Esq Director 1.00 2.00 X 0 0 0 Rick Botnick Director (ex officio) 1.00 3.00 X 0 0 0 Robert A Catania MD Director (eff 1/16) 1.00 42.00 X 0 544513 45319 Carolyn Claussen MD Director (eff 1/16) 1.00 42.00 X 0 99551 7518 Jeannette Davila Director (eff 1/16) 1.00 2.00 X 0 0 0 Pamela Diamantis Director (eff 1/16) 1.00 2.00 X 0 0 0 Thomas J Kleeman MD President Medical Staff (eff 1/16) 1.00 2.00 X 0 0 0 Maria C Mongan Chair 1.00 4.00 X X 0 0 0 John G Cronin Esq Vice Chair 1.00 3.00 X X 0 0 0 Neil Levesque Secretary 1.00 3.00 X X 0 0 0 Richard E Ashooh Treasurer (end 6/16) 1.00 3.00 X X 0 0 0 Donald St Germain Treasurer (eff 6/16) 1.00 2.00 X X 0 0 0 Joseph Pepe MD President & CEO 40.00 5.00 X X 725390 0 281003 Edward Dudley III Exec. VP & CFO 40.00 4.00 X 478103 0 184819 Alexander Walker Esq Exec. VP, Operations 40.00 0.00 X 494573 0 166478 William Goodman MD Chief Medical Officer 40.00 0.00 X 376662 0 20957 Carolanne O'Sullivan VP of Physician Practices 40.00 0.00 X 313905 0 24554 Robert Duhaime Chief Nursing Officer 40.00 0.00 X 289012 0 37956 Merryll Rosenfield VP of Human Resources 40.00 0.00 X 246431 0 33751 Lucille Mulla VP Operations/Emergency Services 40.00 0.00 X 233539 0 19985 Thomas Della Flora VP Chief Information Officer 40.00 0.00 X 217226 0 20827 Raef Fahmy MD Former Chief Medical Officer 0.00 0.00 X 305738 0 11344 3680579 2489699 995081 130 1 1 0 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 Medical Services 16980589 Integrity Healthcare Locums PO Box 823424 Philadelphia PA 191823424 Healthcare Staffing Services 1365497 Granite State Emergency Physicians 380 Lafayette Road Hampton NH 03842 Physician Services 978411 Aramark Management Service 25863 Network Place Chicago IL 606731248 Facilities Management 763084 Eisenberg Vital & Ryze LLC 155 Dow Street Manchester NH 03101 Marketing Services 754405 37 252613 17500 2612272 439895 16453 3322280 Patient Service Rev. 621400 375950006 375950006 Disproportionate Share Funding 621400 11421493 11421493 Miscellaneous Rev. 621400 4184696 4184696 Lab Client Revenue 621500 1746865 1746865 Cafeteria Income 722210 1612133 1612133 411589 411589 395326782 1330223 7409 1322814 27241476 28087027 -845551 -845551 -845551 47022 252613 102705 -55683 -55683 1672 690 982 982 352638 178387 174251 174251 Debt Settlement 900099 1325372 1325372 1325372 400578656 395501033 7409 1747934 52410 52410 2727984 2222869 505115 121377011 98720040 22432686 224285 6419839 5223265 1186911 9663 18765938 15291230 3474708 8705142 7079793 1608780 16569 958272 958272 154913 154913 91271 74371 16900 181660 181660 10530107 8580348 1949759 1482393 1207913 274480 11210088 9001943 2045560 162585 3854790 3141036 713754 8599139 6991097 1588625 19417 173269 141186 32083 196673 159894 36334 445 2208655 1799700 408955 12441142 10137535 2303607 1809932 1474804 335128 Medical Supplies 74237255 74237255 Physician Fees 27023736 27023736 Bad Debt Expense 20941899 20941899 Medicaid Enhancement Ta 15778153 15778153 7087942 5769975 1311164 6803 357009613 315050452 41519394 439767 36274084 39176245 32042736 32768957 38585556 47860095 711093 2124292 3199310 4387258 6314657 230186885 148473963 80953109 81712922 53701692 54150978 53092783 49015159 731733 8586123 8955068 310479366 323864484 45246675 45329172 242059 405913 62495000 62516312 6435913 4892038 89150520 132490467 203570167 245633902 X 98262558 69990495 330158 395655 8316483 7844432 106909199 78230582 310479366 323864484 X 43569043 -2370455 -69877205 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 31271 0 0 1 60000 91271 0 Part II-B, Line 1: Catholic Medical Center is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of CMC and the other organizations in furtherance of their exempt purposes. CMC does not directly perform any lobbying activities. Portion of dues paid that constitutes lobbying is as follows: NHHA: $21,749 AHA: $9,522 Devine, Millimet, & Branch, PA provided lobbying services which included providing information regarding public policy pending before the legislature. Devine, Millimet, & Branch, PA participated in the administrative rule-making process with respect to rules concerning the certificate of needs board. They also provided general communication with elected officials. CMC paid Devine, Milliment, & Branch $60,000 for these services. 8646641 182178 -470680 118052 8240087 8690560 94278 155862 294059 8646641 7473844 500599 880858 164741 8690560 7047069 72536 590318 236079 7473844 7263764 51208 -187002 80901 7047069 0.00000 0.95200 0.04800 0 0 1024690 1024690 81164512 37849613 43314899 6250276 4296470 1953806 131736980 101110253 30626727 10010427 5217627 4792800 81712922 Investment in Granite Healthcare HC 1096153 F Private Investment Funds 47919006 F 49015159 Accrued Pension & Other Liabilities 130914684 Due to Affiliates 1575783 132490467 X 353036037 -2370455 30178 281781 -2058496 355094533 181660 45302463 45484123 400578656 354780383 30178 281781 311959 354468424 181660 2359529 2541189 357009613 Part V, Line 4: Proceeds from the Organization's endowment funds are used in operations. Part X, Line 2: The Medical Center is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Medical Center's tax positions and concluded the Medical Center 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. Part XI, Line 2d - Other Adjustments: Event Expenses 103,394. Gift Shop COGS 178,387. Part XI, Line 4b - Other Adjustments: Pension-Related Charges Other than Net Periodic Cost 42,003,139. Assets Released for Operations 43,030. Change in FMV of Interest Rate Swap Agreement 462,570. Change in Interest in Perpetual Trust 434,195. Debt Settlement Income 2,359,529. Part XII, Line 2d - Other Adjustments: Event Expenses 103,394. Gift Shop COGS 178,387. Part XII, Line 4b - Other Adjustments: Debt Settlement Income 2,359,529. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments 7998000 0 0 0 0 0 0 7998000 0 7998000 0 0 1 1 0 0 Schedule F, Part IV, Lines 3 & 4: The Medical Center has an ownership interest in several foreign corporate holdings as well as being an indirect shareholder of several passive foreign investment companies (PFIC) by way of their ownership in various alternative investments. The Medical Center's interest in these foreign corporations did not surpass the filing threshold for Form 5471. Additionally, the Medical Center had no unrelated business income related to their PFIC interest and therefore is not required to file Form 8621. Gala 186600 167745 18855 0 79 37334 2273 14141 10267 Golf Tournament 73908 54831 19077 0 2067 13686 4651 1880 368 1 39127 30037 9090 0 0 500 12069 0 3390 299635 252613 47022 2146 51520 18993 16021 14025 102705 -55683 1 1 1 X 125.000000000000 1 X 1 1 0 1 1 3600559 3600559 0.01070 49042738 29141879 19900859 0.05920 52643297 29141879 23501418 0.06990 2302791 118579 2184212 0.00650 1264714 1264714 0.00380 9181910 4744982 4436928 0.01320 49843 700 49143 0.00010 554500 554500 0.00160 13353758 4864261 8489497 0.02520 65997055 34006140 31990915 0.09510 7435 7435 0.00000 76085 20242 55843 0.00020 71487 71487 0.00020 155007 20242 134765 0.00040 1 6202990 0 110450185 142693056 -32242871 X 1 1 1 1 Catholic Medical Center 100 McGregor Street Manchester NH 03102 00646 X X X Catholic Medical Center 1 0 0 1 X X X X X X X X X 13 1 1 0 1 X see Part V, Section C X see Part V, Section C X X 1 13 1 see Part V, Section C 0 0 1 X 125.000000000000 200.000000000000 X X X X 1 1 X X X 1 X see Part V, Section C X see Part V, Section C X see Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Catholic Medical Center Part V, Section B, Line 5: A variety of different secondary data sources were accessed. They included the Centers for Disease Control and Prevention (CDC), New Hampshire Department of Health and Human Services, NH HealthWRQS and the City of Manchester Department of Health.Also, during March, April, and May of 2013, the hospitals conducted seven focus groups which included clergy, first responders, pregnant women, school nurses, Bhutanese refugees as well as two seniors groups. Due to concerns on the part of many participants, anonymity was guaranteed andtherefore they were not listed by name.A group discussion was conducted on March 25, 2013 with members of the Manchester Sustainable Access Project which included Jennifer Driscoll, Vice President, Planning & Business Development, Elliot Hospital; Raef Fahmy, DPM, Chief Medical Officer, Catholic Medical Center; Peter Janelle,President, Mental Health Center of Greater Manchester; Paul Mertzic, Executive Director of Operations, Physician Practice Association, Primary Care & Community Health Services, Catholic Medical Center; Steven Paris, MD, Medical Director, Dartmouth-Hitchcock Manchester; Tim Soucy, Public Health Director, Manchester Health Department; Anna Thomas, Deputy Public Health Director, Manchester Health Department.Other key informants included Ted Gatsas, Mayor, City of Manchester, NH and Chris Pappas, Member of The Executive Council of the State of New Hampshire & Manchester small business owners. Catholic Medical Center Part V, Section B, Line 6a: Elliot Health System in Manchester, NH. Catholic Medical Center Part V, Section B, Line 7d: Our "Healthy Living News" flyers were distributed to our primary and secondary service areas (approximately 120,000 people). Flyers contained a summary report of the community benefit CMC provides. Catholic Medical Center Part V, Section B, Line 11: Catholic Medical Center has addressed the needs identified in the 2013 CHNA through the implementation of programs and services throughout the Manchester health service area (HSA). Mental illness and violence are often intrinsically intertwined. CMC has increased services within our Behavioral Health Department and developed the Opioid Use/Misuse Resource. This is an online tool available to all CMC staff to create consistency of care in the treatment and recovery of this public health epidemic. Catholic Medical Center has expanded access to behavioral health services to patients of the Pregnancy Care Center wishing to become patients of the West Side Neighborhood Health Clinic. Health Care for the Homeless (HCH) of CMC provides behavioral health services and substance abuse counseling to the homeless throughout the Manchester HSA. CMC has improved the mental health assessment tool in Primary Care, a key component in the early identification and treatment of mental illness. In collaboration with Governor Hassan's Senior Director of Substance Misuse and Behavioral Health and Boston University School of Medicine, CMC conducted the "State-of-the art Management of the Opiate-dependent Patient, Pain Treatment and the Heroin Epidemic". The targeted audience for this conference included prescribers, nurses, allied health professionals, pharmacists and social service agencies. The program addressed many facets of substance abuse within our community, hospitals and practices.Ambulatory Care, chronic disease, including asthma and aging issues have all been addressed through various means. Catholic Medical Center's Primary Care has implemented The Medical Home Model, a proactive approach to preventative medicine through the introduction of Care Coordinators to the Primary Care Practices. Clinical resource specialists work with the practices most high risk patients (Asthma, Diabetes, COPD, etc) to assure they understand their medications and follow-up care. The Medical Home Model encourages patients to become involved, comprehensive, educated in their personal care plan. CMC offers free health screenings, chronic disease and self-management classes. These programs provide the opportunity for early detection of chronic disease; referral based follow-up care and education on adopting healthy lifestyle behaviors, communicating with the healthcare team, problem solving and goal setting. To aid with aging issues, CMC's Parish Nurse Program provides nurse consultations, education, referrals and screenings at Parishes throughout the Greater Manchester Area.In order to address the barriers to access of health care services related to poverty (lack of insurance, cost, transportation and education on accessing care, lack of medical home) WSNHC at CMC provides comprehensive care to Manchester's underserved and refugee populations. Health Care for the Homeless provides comprehensive care to Manchester's homeless community. CMC's Certified Application Counselors (CAC) provide outreach and enrollment services to the communities' uninsured. CACs provide information on a full range of qualified health plan (QHP) options and assist individuals in applying for coverage through a QHP in the ACA's Marketplace Exchange. The Pregnancy Care Center provides prenatal care for women in need regardless of their ability to pay. In addition to The Medical Home Model, CMC has staffed the emergency department with a community health worker to improve primary care access for the homeless population, provide education on accessing care, and transportation support. CMC provides shuttle support to CMC ancillary services to those in need, at no cost. CMC assists patients through the Medication Assistance Program to obtain medications they would otherwise not be able to afford and has developed a prescription delivery program with Rite Aid Pharmacy to assist patients with filling their medications upon discharge.CMC's Poisson Dental Facility has expanded access to oral health services to patients of the Pregnancy Care Center and Manchester Community Health Center (MCHC). The Poisson Dental Facility provides access to exams and treatment planning for women from the Pregnancy Care Center and access to oral health care during the first post-partum year until their treatment plan has been completed. CMC's Poisson Dental facility provides oral health services to not-for-profit agencies in our community including, Mental Health Center of Greater Manchester, Moore Center Services, Manchester Health Department, and Health Care for the Homeless (HCH). The majority of HCH patients often arrive with very poor oral health. In an effort to meet the growing need for oral health services, CMC's Poisson Dental expanded services to include school-based dental care for children in need attending Manchester elementary and middle schools. This school-based program is made possible through collaboration with the City of Manchester Health Department and Easter Seals NH. Poisson Dental also provides onsite dentistry at Dartmouth Hitchcock Manchester by integrating these services within their pediatric practice. This allows for ease of access for the patients and direct communication amongst the providers of care.CMC's Fertility Education provides teens at local schools and parishes educational opportunities such as The Cradle Within, Ideal Dating, and Sexual Risk Behavior and Conflict Resolution. The goal is to equip adolescents with the tools to identify healthy relationships and the benefits of choosing sexual risk avoidance behaviors. The Pregnancy Care Center provides supportive prenatal care to all women, including teens, regardless of their ability to pay. Their mission is to improve pregnancy outcomes by serving those most in need and unable to access services in a traditional prenatal setting. The Pregnancy Care Center expanded services, adding Centering Group Prenatal Care; this program is a multifaceted model of group care that integrates the three major components of care: health assessment, education and support. Visits promote greater patient engagement, personal empowerment and community-building. Catholic Medical Center has a long history of providing services to the community and currently has programs in place to meet every identified need in the most recent CHNA. In addition to the programs we currently offer, we will expand many of our services in response to the needs of the community that have not been addressed. Catholic Medical Center Part V, Section B, Line 16i: Signs are posted throughout the hospital facility and physician practices that list the financial programs available and contact information for assistance. Catholic Medical Center Part V, Section B, Line 22d: The maximum amount that can be charged to a FAP-eligible individual for emergent or medically necessary care is determined by reducing the gross charges by the coverage discount amount received by individuals who are covered by health insurance. This discount rate is recalculated on an annual basis. Part V, Line 7a & 7b: Hospital's Website URL:https://www.catholicmedicalcenter.org/about-us/Community-Health-Needs-Assessment.aspx Other Websites URLs:http://elliothospital.org/website/downloads/QualitativeNeedsAssessment.pdfhttp://www.library.unh.edu/digital/object/mrg:0103 Part V, Line 10a: https://www.catholicmedicalcenter.org/about-us/Community-Health-Implementation-Plan.aspx Schedule H, Part V, Section B, Line 16a-16c: Financial Assistance Policy URL: https://www.catholicmedicalcenter.org/patients-and-visitors/financial-assistance/Financial Assistance Policy Application URL:https://www.catholicmedicalcenter.org/patients-and-visitors/financial-assistance/ Financial Assistance Plain Languange Summary URL: https://www.catholicmedicalcenter.org/patients-and-visitors/financial-assistance/ 2 1 - Bedford Ambulatory Surgical Center 11 Washington Place Bedford NH 03110 Ambulatory Surgical Center (50% JV) 2 - Catholic Medical Center-Business Office 195 McGregor Street Manchester NH 03102 Hospital Business Office Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 20,941,899. Part II, Community Building Activities: The Medical Center participates in a wide range of community building activities, committees, boards, and partnerships to promote the health of the communities it serves, including City Year, Granite United Way and New Hampshire Charities among others. The Medical Center sponsors emergency service efforts through planning hours for emergency preparedness and bioterrorism preparedness safety management. Part III, Line 2: Costing methodology ratio of cost to charge is used to arrive at cost of bad debt expense. Part III, Line 3: Patients deemed eligible for financial asssistance follow CMC's charity care policies. Therefore, no bad debt expense related to patients eligible under the Hospital's financial assistance policy is included as a community benefit. Part III, Line 4: See Footnote 2 on Page 9 of the attached audited financial statements. Part III, Line 8: The entire Medicare shortfall is reported in our Community Benefit Report to the State of New Hampshire. The Medicare shortfall represents costs incured by the Hospital for providing care to Medicare patients in the Hospital's service area that were not reimbursed by the federal government. The Hospital considers this amount to be a significant shortfall for providing healthcare-related services to these patients which ultimately benefits the community it serves. Part III, Line 9b: CMC is a charitable healthcare organization that treats patients for ermergent or medically necessary care regardless of their financial status. CMC's Collections Policy and Procedures addresses the procedures for patients who choose not to make payment or work with CMC to make payment arrangements for their bill. The policy contains specific language that applies to those patients who may qualify for financial assistance. CMC will hold collection activities where the patient has submitted a completed financial assistance application. CMC makes reasonable efforts to determine whether an individual is eligible for financial assistance under our Financial Assistance Policy (FAP). In order to determine whether a patient is eligible for financial assistance, CMC provides written notice that indicates the availability of financial assistance, provides a plain-language summary of the FAP, and attempts to notify the individual orally about the FAP and how the patient may get assistance with the application process. CMC also publishes the policy on our website, at patient registration locations, and provides notice to the community. Part VI, Line 2: In collaboration with the city of Manchester and other health care and social service agencies, Catholic Medical Center participates in a community needs assessment as required by the New Hampshire Attorney General's Office Division of Charitable Trusts.Since hospitals are required to assess the needs of their community every three years, CMC has completed a 2016 Needs Assessment and approved by the board and made widely available to the public shortly after the fiscal year covered by this Form 990, Schedule H. The previous Needs Assessment was completed in fiscal year 2013 by CMC and the Elliot Hospital of the City of Manchester. The focus of the 2013 Needs Assessment was on medically related health needs as that is their primary purview. Additional information is obtained on an ongoing basis to assist the Organization in evaluating progress towards meeting our goals and the identification of new areas of need. This information is collected through community surveys, focus groups and discussions with community leaders, program evaluations and communication with those in the community who interact with our vulnerable populations. Part VI, Line 3: Patients are notified of CMC's FAP via notices upon registration, discharge, postings to our website, in the hospital, and physician practices. Signage is posted throughout the Hospital and physician practices highlighting Catholic Medical Center's financial assistance. CMC also communicates the policy to the community via mailings and other postings in relevant local support organizations. CMC also contacts patients verbally to inform them of the programs available. Part VI, Line 4: Catholic Medical Center's primary service area consists of the following towns and cities: Allenstown, Auburn, Bedford, Candia, Deerfield, Dunbarton, Goffstown, Hooksett, Manchester, and New Boston. Our secondary service area is made up of Amherst, Bow, Chester, Derry, Londonderry, Merrimack, Raymond, and Weare. Part VI, Line 5: Catholic Medical Center is involved in numerous community initiatives to improve the health outcomes of our community, including, but not limited to the following: DSRIP 1115 Waiver, N4H a federally funded program with the state of New Hampshire to transform care by integrating primary and behavioral health care to improve health outcomes; a collaboration with The Manchester Health Department, Easter Seals, and Catholic Medical Center to provide school-based dental care to school-aged children in need. Services are provided at all Manchester elementary and middle schools along with one of the high schools; partnership with Dartmouth Hitchcock Clinic for the integration of dental care within a pediatric clinic setting, improving oral health and overall health and a partnership with Manchester Community Health Center to provide oral health exams hygiene and a referral to a dental home for children ages 1-5; 500 Cities initiative with CMC's Parish Nurse Program and Manchester Health Department to offer assessments and services to high risk populations located within neighborhoods; primary care, specialty care and care coordination the homeless population via the HRSA grant; Medication Assistance Program offering free or reduced cost medication through the pharmaceutical companies and other low cost resources; emergency bioterrorism preparedness safety management. Part VI, Line 6: Catholic Medical Center operates as part of CMC Healthcare System. Under the System, CMC offers a range of healthcare services to the community. The System includes CMC as a licensed, 330 bed full-service, acute care hospital, physician practices, general care surgical capabilities, and advanced care for cardiac needs. Catholic Medical Center offers full medical-surgical care with more than 25 subspecialties, comprehensive orthopedic care, inpatient and outpatient rehabilitation services, a 24 hour emergency department, outpatient behavioral health services, and diagnostic imaging. In addition, Catholic Medical Center has the Special Care Nursery which is a state-of-the-art neonatal facility designed to meet the distinct needs of our babies and their families. Catholic Medical Center is also home to the nationally recognized New England Heart and Vascular Institute (NEHVI), which provides a full-range of cardiac services, and is a pioneer in offering innovative surgical procedures. The Institute is also a national center for advanced clinical trials and cardiovascular rehabilitation and wellness education to help patients recover in a multi-step program of exercise, education, risk factor management and the development of healthy lifestyles. The System also participates in a joint venture, Bedford Ambulatory Surgical Center, through its wholly-owned entity, Alliance Ambulatory Services, and Tuft's Health Freedom Plan through the Granite Health Network.CMC has a deeply rooted history of providing care to those most in need through the Community Health Services department. CMC reaches beyond the walls of the hospital and into the community, assisting underserved individuals with health information and access to care. Community Health Services provides a wide variety of education, clinical services and resources for those in our primary and secondary markets. It is the home of the Pregnancy Care Center, West Side Neighborhood Health Center, the Poisson Dental Facility, the Health Care for the Homeless program, and the Parish Nurse program. We provide medication assistance, breast and cervical cancer screenings, health screenings, and fertility education. Part VI, Line 7, Reports Filed With States NH 1 Hooksett New Hampshire Fire Department 15 Legends Drive Hooksett NH 03106 26636 New Lifepak 15 Monitor/Defibrillator 1 0 Part I, Line 2: The Hospital only makes donations to 501(c)(3) public charities or governmental municipalities, additional monitoring is not deemed necessary. X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 William Clutterbuck MD Director (end 12/15) 0 366772 0 0 0 0 0 21150 0 23064 0 410986 0 0 Patrick A Mahon MD Director (end 1/16) 0 482415 0 29565 0 33761 0 21150 0 23950 0 590841 0 0 Keith A Stahl MD Director 0 296920 0 0 0 25915 0 21200 0 2054 0 346089 0 0 Louis I Fink MD Director 0 446263 0 123024 0 41000 0 23800 0 4202 0 638289 0 0 Robert A Catania MD Director (eff 1/16) 0 511320 0 33193 0 0 0 21150 0 24169 0 589832 0 0 Joseph Pepe MD President & CEO 537600 0 134680 0 53110 0 250934 0 30069 0 1006393 0 0 0 Edward Dudley III Exec. VP & CFO 346789 0 84000 0 47314 0 130118 0 54701 0 662922 0 0 0 Alexander Walker Esq Exec. VP, Operations 339896 0 89079 0 65598 0 118469 0 48009 0 661051 0 0 0 William Goodman MD Chief Medical Officer 365662 0 0 0 11000 0 0 0 20957 0 397619 0 0 0 Carolanne O'Sullivan VP of Physician Practices 231540 0 57502 0 24863 0 17604 0 6950 0 338459 0 0 0 Robert Duhaime Chief Nursing Officer 235767 0 47500 0 5745 0 18543 0 19413 0 326968 0 0 0 Merryll Rosenfield VP of Human Resources 206247 0 34801 0 5383 0 12923 0 20828 0 280182 0 0 0 Lucille Mulla VP Operations/Emergency Services 193870 0 35320 0 4349 0 14575 0 5410 0 253524 0 0 0 Thomas Della Flora VP Chief Information Officer 199165 0 18061 0 0 0 0 0 20827 0 238053 0 0 0 Raef Fahmy MD Former Chief Medical Officer 170078 0 0 0 135660 0 9796 0 1548 0 317082 0 0 0 Part I, Line 1a Catholic Medical Center provides certain fringe benefits that have gross-up calculations to cover taxes for a select few officers and/or highly compensated employees. In no case did this amount exceed $15,000 during the year for any one individual. Part I, Lines 4a-b 4a.) Dr. Raef Fahmy served as Chief Medical Officer of the Medical Center until June 2015. Dr. Fahmy's 2015 calendar year compensation included servance payments of $132,621 which are reported in Schedule J, Part II, Column B(iii). 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 Alexander Walker: $102,569 Part I, Line 7 A portion of compensation is at-risk and variable, and payment depends on the quality of job performance. A New Hampshire Health And Education Facilities Authority 020279866 64461TCV4 2006-05-24 33380829 Construction & Defeasance Escrow 1 0 0 B New Hampshire Health And Education Facilities Authority 020279866 644614x79 2012-12-19 38249382 See Part VI 0 0 0 C New Hampshire Health And Education Facilities Authority 020279866 2015-09-03 24070000 See Part VI 0 0 0 A 2910000 20655000 33380829 968431 517960 20559500 2009 0 1 1 1 B 5470000 38249382 2976618 573155 3035221 2013 1 0 1 1 C 24070000 21737024 257332 3828187 2016 1 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 1 0 0 1 MBIA 0.900000000000 1 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 Schedule K, Part I, Line B(f): Refinance of Series 2002A Bonds Refinance of Series 2002B Bank Placement Refinance of Series 2012 Capital Note Routine Capital Improvements Schedule K, Part I, Line C(f): Refinance of Series 2006 Bonds Routine Capital Improvements Schedule K, Part I: Bond issues, Line C, Column (e) - Issue price presented on Schedule K is different from Form 8038 as initial issue of $24,070,000 were issued in September 2016 to advance refund a portion of the 2006 bonds and fund equipment and construction needs via 2015A bonds. Remaining $8,650,000 of 2015B bonds were issued in July 2016 to currently refund remaining 2006 bonds. The 2015B bonds will be reported on the Hospital's 2016 Schedule K filing as they were issued after the close of the tax period covered by this return. Schedule K, Part IV, Line 5: The 2006 series bonds were invested in a guaranteed investment contract during the fiscal year that expired on June 1, 2016. Form 990, Part VI, Section A, line 6 The sole member of CMC is CMC Healthcare System. Form 990, Part VI, Section A, line 7a Directors of CMC are appointed by the sole member. Form 990, Part VI, Section A, line 7b The sole member has reserved powers over CMC but does not approve each separate action taken by the CMC 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 CMC 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 CMC makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, line 9: Net Transfer (to) from Affiliates -26,934,271. Pension Related Changes Other than Net Periodic Cost -42,003,139. Assets Released for Operations -43,030. Change in Interest in Perpetual Trust -434,195. Change in Fair Market Value of Interest Rate Swap -462,570. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Form 990: During the fiscal year covered by this return, Catholic Medical Center began engaging in negotiations to become affiliated with Huggins Hospital of Wolfeboro, New Hampshire and Monadnock Community Hospital of Peterborough, New Hampshire. The Bishop's approval was obtained on June 22, 2016 and the Affiliation Agreement was fully executed on June 29, 2016. Huggins and Monadnock each submitted the required Notice to the Charitable Trust Unit on July 7, 2016. Each hospital submitted a joint request for approval to the Antitrust Bureau on July 7, 2016. The Director of Charitable Trust Unit issued his report of approval on November 3, 2016. The New Hampshire antitrust bureau approved the affiliation on December 9, 2016. As this affiliation was formally effectuated after June 30, 2016 it will be disclosed in greater detail in Catholic Medical Center's Form 990 for the June 30, 2017 tax period. CMC Ancillary Health Services LLC 100 McGregor Street Manchester NH 03102 464389318 Ancillary Health Services NH 1826 246817 Catholic Medical Center Alliance Resources 100 McGregor Street Manchester NH 03102 020398138 Real Estate NH 501(c)(3) Line 11b, II CMC Healthcare System 0 Alliance Health Services 100 McGregor Street Manchester NH 03102 611508839 Practices NH 501(c)(3) Line 9 CMC Healthcare System 1 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 McGregor Street 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 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH Catholic Medical Center C 14052 2346226 1.00000 1 Doctors' Medical Association Inc 100 Mcgregor Street Manchester NH 03102 020340690 Medical Office Building NH N/A C 0 0 0 1 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 1