2016-05-13T08:19:10-05:00 2015-06-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2014-07-01 020315693 Catholic Medical Center CATH 6036683545 100 McGregor Street Manchester NH 031023770 Edward L Dudley III Exec VP & CFO 6036683545 2016-05-03 1 Nicholas E Porto P01310283 2078792100 2016-05-03 2014 2016-08-17 19:52:53Z Joseph Pepe MD 100 McGregor Street Manchester NH 031023770 404048404 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. 19 14 2496 301 388498 321783 4476967 3794563 331528573 347248774 6854321 3235927 -37406 120860 342822455 354400124 51168 28623 0 0 134125100 144404381 0 0 377122 176420928 181230826 310597196 325663830 32225259 28736294 304702834 310479366 179056091 203570167 125646743 106909199 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 285431691 28623 341200654 Medical & Surgical services provided to 10,558 inpatients and 373,596 outpatients. 5207320 6224750 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. 290639011 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 1 0 0 0 1 1 1 1 0 0 1 198 0 1 2496 1 1 1 0 0 0 0 0 0 0 0 0 X 19 14 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 X Adele Boufford Baker Director 1.00 3.00 X 0 0 0 William Clutterbuck MD Director 1.00 43.00 X 0 366159 36766 Eleanor Wm Dahar Esq Director 1.00 2.00 X 0 0 0 Raef Fahmy DPM Director (end 6/15) 40.00 3.00 X 279072 0 22088 Powen Hsu MD Director 1.00 3.00 X 0 0 0 Susan Huard PhD Director 1.00 2.00 X 0 0 0 Neil Levesque Director 1.00 3.00 X 0 0 0 Patrick A Mahon MD President Medical Staff 1.00 42.00 X 0 543609 37017 Diane Murphy Quinlan Esq Director 1.00 3.00 X 0 0 0 Msgr John P Quinn Director (end 1/15) 1.00 3.00 X 0 0 0 Keith A Stahl MD Director 1.00 42.00 X 0 293061 37967 Fr Patrick Sullivan OSB RN Director 1.00 3.00 X 0 0 0 Joseph Graham Director (end 1/15) 1.00 2.00 X 0 0 0 Harry E Dumay PhD Director (eff 1/15) 1.00 2.00 X 0 0 0 Louis I Fink MD Director (eff 1/15) 1.00 42.00 X 0 613180 22276 Matthew Kfoury Director (eff 1/15) 1.00 2.00 X 0 0 0 Paul S Moore Esq Director (eff 1/15) 1.00 2.00 X 0 0 0 Rick Botnick Chair 1.00 3.00 X X 0 0 0 Maria C Mongan Vice Chair 1.00 3.00 X X 0 0 0 John G Cronin Esq Secretary 1.00 3.00 X X 0 0 0 Daryl J Cady CPA Treasurer (end 8/14) 1.00 3.00 X X 0 0 0 Richard E Ashooh Treasurer (eff 9/14) 1.00 2.00 X X 0 0 0 Joseph Pepe MD President & CEO 40.00 5.00 X X 685057 0 138934 Edward Dudley III Exec. VP & CFO 40.00 4.00 X 442277 0 115762 Alexander Walker General Counsel 40.00 X 450330 0 114652 Robert Duhaime Chief Nursing Officer 40.00 X 291503 0 41333 Carolanne O'Sullivan VP of Physician Practices 40.00 X 289354 0 21347 Brian Tew Chief Information Officer 40.00 X 214586 0 34972 Merryll Rosenfield VP of Human Resources 40.00 X 234260 0 36135 Lucille Mulla VP Operations 40.00 X 206141 0 18740 Alyson Pitman Giles Former Officer 0.00 X 652861 0 5250 Raymond Bonito Former Officer 0.00 X 426414 0 4448 4171855 1816009 687687 131 1 1 0 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 Physician Services 15992215 Granite State Emergency Physicians 380 Lafayette Road Hampton NH 03842 Physician Services 974869 Integrity Healthcare Locums PO Box 823424 Philadelphia PA 191823424 Healthcare Staffing Services 863132 CHG Companies Inc 6440 South Millrock Drive Suite 17 Salt Lake City UT 84121 Healthcare Staffing Services 732069 Aramark Management Service 25863 Network Place Chicago IL 606731248 Facilities Management 676666 36 15000 260106 17500 2409596 1092361 28505 3794563 Patient Service Rev. 621400 338747838 338747838 Miscellaneous Rev. 621400 3327558 3327558 Disproportionate Share Funding 621400 2452816 2452816 Cafeteria Income 722210 1553806 1553806 Lab Client Revenue 621500 764766 764766 401990 401990 347248774 2103127 388498 1714629 50516372 49383572 1132800 1132800 1132800 27604 260106 83374 -55770 -55770 357964 181334 176630 176630 354400124 347425404 388498 2791659 28623 28623 3337145 2771559 565586 110831110 91889345 18751681 190084 5880514 4877034 995247 8233 16256342 13501182 2755160 8099270 6714838 1370284 14148 711210 711210 156745 156745 92448 76780 15668 202169 202169 8355163 6939112 1416051 1038443 862445 175998 9086166 7427569 1515730 142867 3806229 3161141 645088 8150633 6753496 1378173 18964 136147 113073 23074 136743 113048 23070 625 2639291 2191978 447313 11031483 9161843 1869640 1877741 1559497 318244 Medical Supplies 62305168 62305168 Physician Fees 26633971 26633971 Bad Debt Expense 22167345 22167345 Medicaid Enhancement Ta 14962857 14962857 7740874 6427107 1311566 2201 325663830 290639011 34647697 377122 49502444 36274084 32038873 32042736 29270115 38585556 72648 0 2010411 2124292 4071472 4387258 227993815 147040706 72977392 80953109 53105283 53701692 52830144 53092783 810003 731733 8014049 8586123 304702834 310479366 38939829 45246675 511373 242059 65085000 62495000 4536314 6435913 69983575 89150520 179056091 203570167 X 116956183 98262558 528802 330158 8161758 8316483 125646743 106909199 304702834 310479366 X 28736294 -1533482 -45940356 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 32448 0 0 1 60000 92448 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: $22,802 AHA: $9,646 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. 8690560 94278 155862 294059 8646641 7473844 500599 880858 164741 8690560 7047069 72536 590318 236079 7473844 7263764 51208 -187002 80901 7047069 6624284 81408 618215 60143 7263764 0.00000 0.96180 0.03820 0 0 1024690 1024690 80218722 36475545 43743177 6211495 3948289 2263206 129857110 102710519 27146591 10681798 3906353 6775445 80953109 Investment in Granite Healthcare HC 1620998 F Private Investment Funds 51471785 F 53092783 Accrued Pension & Other Liabilities 87774564 Due to Affiliates 1375956 89150520 X 324108974 -1533482 19550 432627 -1081305 325190279 202169 29007676 29209845 354400124 325745919 19550 264708 284258 325461661 202169 202169 325663830 Part V, Line 4: Proceeds from the Organization's endowment funds are used in operations. Part X, Line 2: The Medical Center and CMC Associates 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 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. With few exceptions, the Medical Center is no longer subject to income tax examination by the U.S. federal or state tax authorities for years before 2012. Part XI, Line 2d - Other Adjustments: Change in Interest in Perpetual Trust 167,919. Event Expenses 83,374. Gift Shop COGS 181,334. Part XI, Line 4b - Other Adjustments: Pension-Related Charges Other than Net Periodic Cost 28,985,617. Assets Released for Operations 22,059. Part XII, Line 2d - Other Adjustments: Event Expenses 83,374. Gift Shop COGS 181,334. Central America and the Caribbean 0 0 Investments 8716326 0 0 0 0 0 0 8716326 0 8716326 1 0 1 1 0 0 Schedule F, Part IV, Lines 3 & 4: The Medical Center has an ownership interest in several foreign corporations 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 198029 184370 13659 99 36906 2105 2265 17618 Beer & Wine Tasting 54335 48055 6280 500 9651 1995 1 35346 27681 7665 195 11547 243 250 287710 260106 27604 294 48953 11999 2265 19863 83374 -55770 1 1 1 X 1 X 1 1 1 0 1 1 5885176 5885176 0.01940 42641984 15401644 27240340 0.08980 48527160 15401644 33125516 0.10920 1667953 147927 1520026 0.00500 756372 10500 745872 0.00250 10670502 4743777 5926725 0.01950 99113 2520 96593 0.00030 459177 459177 0.00150 13653117 4904724 8748393 0.02880 62180277 20306368 41873909 0.13800 6477 6477 0.00000 777 777 0.00000 134424 33512 100912 0.00030 3109 3109 0.00000 78017 78017 0.00030 222804 33512 189292 0.00060 1 6877530 0 99809623 137014578 -37204955 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 200.000000000000 200.000000000000 X X X X 1 1 X 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 1 X 0 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 Westside Neighborhood Health Center (WSNHC). 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. The majority of WSNHC patients are refugees; they often arrive with very poor oral health. As patients of WSNHC, they are provided with oral health services. 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's 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 facility that list the financial programs available. Catholic Medical Center Part V, Section B, Line 22d: All patients are charged the same regardless of ability to pay. Part V, Line 7a & 7b: Hospital's Website URL:https://www.catholicmedicalcenter.org/uploads/2013%20CHNA%20FINAL%207-10-13.pdf 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/uploads/CMC_CHIP_Final.pdf 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/uploads/Financial%20Assistance%20FINAL%2010-26.pdf Financial Assistance Plain Languange Summary URL: https://www.catholicmedicalcenter.org/patients-and-visitors/financial-assistance/ Part V, Section B, Line 16 Financial Assistance Policy Website Availability Catholic Medical Center Part V, Section B, line 16a website: see Part V, Section C Catholic Medical Center Part V, Section B, line 16b website: see Part V, Section C Catholic Medical Center Part V, Section B, line 16c website: see Part V, Section C 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 $ 22,167,345. 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.The Medical Center sponsored the following partnerships and services to promote the health of the communities it serves:School Partnerships:Partnership with Manchester School SystemPartnership with VNA, education for classroom teachersPartnership with VNA, education for pre-school classroomsEmergency Services:Planning hours for emergency preparednessBioterrorism preparedness safety management Part III, Line 2: Costing methodology ratio of cost to charge is used to arrive at cost. 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 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 qualify for financial assistance. CMC will not refer an account to collections where the patient has submitted a completed financial assistance application. Before engaging in extraordinary collection efforts to obtain payment, 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. 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. The previous Community Needs Assessment was titled, "Believe in a Healthy Community 2009". Since hospitals are required to assess the needs of their community every three years, the Elliot and CMC have undertaken this Needs Assessment for 2013. The two hospitals chose to use the 2009 Assessment as a basis for this current assessment. Doing so allowed them to look more specifically at medically related health needs since that is their primary purview. Hence this report is more targeted and focused in scope. 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: Flyers are posted throughout the Hospital and physician practices highlighting Catholic Medical Center's uncompensated care program. Inpatients with no insurance are referred to our social service department for an evaluation to determine eligibility for federal, state and CMC's uncompensated program. The department works with them to facilitate the application process. Outpatients are referred to the uncompensated care office for such an evaluation and facilitation of the process if appropriate. Part VI, Line 4: Catholic Medical Center's primary service area consists of the following towns and cities: Auburn, Bedford, Candia, Deerfield, Goffstown, Hooksett, Londonderry, Manchester, and New Boston. Our secondary service area is made up of Allenstown, Amherst, Bow, Chester, Derry, Dunbarton, 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: Manchester Sustainable Access Project (MSAP), an initiative to improve healthcare access for the poor in our community; Manchester Oral Health Project, an initiative to improve the oral health of children; Catholic Medical Center School partnerships with elementary, middle, and high schools for health prevention education; partnering with the Organization for Refugee and Immigrant Success; providing a Fruit and Vegetable Assistance Program, an initiative to provide fresh produce weekly to our underserved patients; 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.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 Home Health and Hospice Care 7 Executive Park Drive Merrimack NH 03054 237331452 501(c)(3) 10954 Book Value iStat Analyzer - handheld blood analyzer Medical equipment for organization. 1 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 0 1 0 0 0 0 0 1 0 William Clutterbuck MD Director 0 366159 0 0 0 0 0 15600 0 21166 0 402925 0 0 Raef Fahmy DPM Director (end 6/15) 272494 0 0 0 6578 0 15600 0 6488 0 301160 0 0 0 Patrick A Mahon MD President Medical Staff 0 431489 0 59620 0 52500 0 15600 0 21417 0 580626 0 0 Keith A Stahl MD Director 0 212061 0 0 0 81000 0 17762 0 20205 0 331028 0 0 Louis I Fink MD Director (eff 1/15) 0 446787 0 115493 0 50900 0 18200 0 4076 0 635456 0 0 Joseph Pepe MD President & CEO 524858 0 109905 0 50294 0 107536 0 31398 0 823991 0 0 0 Edward Dudley III Exec. VP & CFO 334432 0 62888 0 44957 0 66525 0 49237 0 558039 0 0 0 Alexander Walker General Counsel 329010 0 59273 0 62047 0 60752 0 53900 0 564982 0 0 0 Robert Duhaime Chief Nursing Officer 254286 0 31896 0 5321 0 18685 0 22648 0 332836 0 0 0 Carolanne O'Sullivan VP of Physician Practices 226706 0 40381 0 22267 0 15595 0 5752 0 310701 0 0 0 Brian Tew Chief Information Officer 167886 0 26862 0 19838 0 12077 0 22895 0 249558 0 0 0 Merryll Rosenfield VP of Human Resources 209558 0 19760 0 4942 0 12452 0 23683 0 270395 0 0 0 Lucille Mulla VP Operations 186046 0 15979 0 4116 0 13843 0 4897 0 224881 0 0 0 Alyson Pitman Giles Former Officer 0 0 0 0 652861 0 0 0 5250 0 658111 0 645685 0 Raymond Bonito Former Officer 0 0 0 0 426414 0 0 0 4448 0 430862 0 426414 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, 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: $86,736 Edward Dudley, III: $50,925 Alexander Walker: $45,152 Part I, Line 7 A portion of compensation is at-risk and variable, and payment depends on the quality of job performance. Schedule A, Part II: Alyson Pitman Giles and Raymond Bonito provided no services as employees or officers to the Hospital during the fiscal year. Additionally, neither earned any amount of compensation in the current year for past services rendered. However, in accordance with IRS instructions, each has been listed as a "Former" officer on Form 990, Part VII, Section A as each received over $100,000 in W-2 compensation. The W-2 compensation they received consisted predominantly of payments of amounts previously earned as deferred compensation that accrued to them during their tenure with the Hospital and as previously reported on Schedule J, Part II, Column C of prior Form 990s. This deferred compensation represented remuneration for many years of distinguished service to the Hospital but does not reflect compensation for services rendered to the Hospital during the current fiscal year. A New Hampshire Health And Education Facilities Authority 020279866 64461TCV4 2006-05-24 33380829 Construction & Defeasance Escrow 0 0 0 B New Hampshire Health And Education Facilities Authority 020279866 644614x79 2012-12-19 38249382 See Part VI 0 0 0 A 405000 33380829 3148898 517960 20559500 2009 0 1 1 1 B 2185000 38249382 2926706 573155 3035221 2013 1 0 1 1 A 0 0 0 0 0 0 1 B 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 A 1 B 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 X 7 14420 Retail Value X Printed Materials 1 7500 Retail Value X Various Tickets 14 3803 Retail Value X Gift Basket 1 2500 Retail Value X Golf Items 3 282 Retail Value 0 1 0 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 VII, Section A: Alyson Pitman Giles and Raymond Bonito provided no services as employees or officers to the Hospital during the fiscal year. Additionally, neither earned any amount of compensation in the current year for past services rendered. However, in accordance with IRS instructions, each has been listed as a "Former" officer on Form 990, Part VII, Section A as each received over $100,000 in W-2 compensation. The W-2 compensation they received consisted predominantly of payments of amounts previously earned as deferred compensation that accrued to them during their tenure with the Hospital and as previously reported on Schedule J, Part II, Column C of prior Form 990s. This deferred compensation represented remuneration for many years of distinguished service to the Hospital but does not reflect compensation for services rendered to the Hospital during the current fiscal year. Form 990, Part XI, line 9: Net Transfer (to) from Affiliates -17,100,599. Pension Related Changes Other than Net Periodic Cost -28,985,617. Assets Released for Operations -22,059. Change in Interest in Perpetual Trust 167,919. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Form 990, Part X, Column A: The beginning of year balance sheet has been partially restated in order to more closely conform to the IRS guidelines for the Hospital's breakdown of investments. Part X, Column A, Line 2, 11, and 12 were updated as follows: Line 2 was updated from $0 to $32,038,873. Line 11 was updated from $137,974,300 to $53,105,283. Line 12 was updated from $0 to $52,830,144. Cash and investment assets as reported on Form 990, Part X, Column A, Lines 1, 2, 11, and 12 in total remain unchanged from prior year Form 990, Part X, Column B. CMC Ancillary Health Services LLC 100 McGregor Street Manchester NH 03102 464389318 Ancillary Health Services NH -20770 129518 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 Catholic Medical Center 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 21335 2329220 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