ALLIANCE AMBULATORY SERVICES: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- ALLIANCE AMBULATORY SERVICES (EIN 02-0519436)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-13
- IRS object ID
- 201501339349300505
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-13T06:03:23-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 507 | AddressLine1 |
| City | PORTLAND | City |
| State | ME | State |
| ZIP Code | 04112 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020519436 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alliance Ambulatory Services | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ALLI | BusinessNameControlTxt |
| Phone | 6036683545 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 McGregor Street | AddressLine1 |
| City | Manchester | City |
| State | NH | State |
| ZIP Code | 03102 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Edward L Dudley III | PersonNm |
| Person Title | Exec VP & CFO | PersonTitleTxt |
| Phone | 6036683545 | PhoneNum |
| Signature | 2015-05-06 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Nicholas E Porto | PreparerPersonNm |
| PTIN | P01310283 | PTIN |
| Phone | 2078792100 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Joseph Pepe MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 McGregor Street | AddressLine1 |
| City | Manchester | City |
| State | NH | State |
| ZIP Code | 03102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,580,528 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.catholicmedicalcenter.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To promote and generate healthcare programs for a broad cross-section of the greater Manchester, New Hampshire community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,266,573 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,580,501 | CYProgramServiceRevenueAmt |
| PY Investment Income | $83 | PYInvestmentIncomeAmt |
| CY Investment Income | $27 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $2,266,656 | PYTotalRevenueAmt |
| CY Total Revenue | $2,580,528 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $0 | PYOtherExpensesAmt |
| CY Other Expenses | $0 | CYOtherExpensesAmt |
| PY Total Expenses | $0 | PYTotalExpensesAmt |
| CY Total Expenses | $0 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,266,656 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,580,528 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,176,712 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,272,240 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $915 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $915 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,175,797 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,271,325 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To create and promote healthcare programs in the Manchester, New Hampshire community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Revenue | $2,580,501 | RevenueAmt |
| Desc | Revenue from partnership interest in Bedford Ambulatory Surgical Center, LLC | Desc |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Edward L Dudley III | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6036683545 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 McGregor Street | AddressLine1 |
| City | Manchester | City |
| State | NH | State |
| ZIP Code | 03102 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| Adele Boufford Baker | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Gary Bouchard PhD | ||||||||
| Director (Part Year) | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Guy D Chapdelaine | ||||||||
| Director (Part Year) | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| William B Clutterbuck MD | ||||||||
| Director | 1.00 | 43.00 | Yes (X) | $0 | $352,749 | $36,460 | ||
| Eleanor Wm Dahar Esq | ||||||||
| Director | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Raef Fahmy DPM | ||||||||
| Director | 1.00 | 42.00 | Yes (X) | $0 | $255,376 | $16,062 | ||
| Joseph Graham | ||||||||
| Director | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| Connor J Haugh MD FACC | ||||||||
| Director | 1.00 | 42.00 | Yes (X) | $0 | $602,513 | $38,011 | ||
| Powen Hsu MD | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Susan D Huard PhD | ||||||||
| Director | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Neil Levesque | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Patrick A Mahon MD | ||||||||
| Director | 1.00 | 42.00 | Yes (X) | $0 | $438,625 | $36,674 | ||
| Diane Murphy Quinlan Esq | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Msgr John P Quinn | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Keith A Stahl MD | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $295,743 | $37,938 | ||
| Fr Patrick Sullivan OSB RN | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Richard E Ashooh | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Rick Botnick | ||||||||
| Chair | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Maria C Mongan | ||||||||
| Vice Chair | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Suzanne Mellon PhD RN | ||||||||
| Vice Chair (Part Year) | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Daryl J Cady CPA | ||||||||
| Treasurer | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| John G Cronin Esq | ||||||||
| Secretary | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Margaret-Ann Moran Esq | ||||||||
| Secretary (Part Year) | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Joseph Pepe MD | ||||||||
| President & CEO | 1.00 | 44.00 | Yes (X) | $0 | $615,990 | $114,075 | Yes (X) | |
| Edward Dudley III | ||||||||
| Exec. VP & CFO | 1.00 | 43.00 | $0 | $432,406 | $92,784 | Yes (X) | ||
| Alyson Pitman Giles | ||||||||
| Former Officer | 0.00 | $0 | $333,381 | $5,250 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,326,783 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $377,254 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Interest in Ambulatory | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $2,580,501 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,580,501 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,580,501 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27 | TotalRevenueColumnAmt |
| Exclusion | $27 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,580,528 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,580,501 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $27 | ExclusionAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $282,222 | BOYAmt |
| EOY | $477,249 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,894,490 | BOYAmt |
| EOY | $5,794,991 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,176,712 | BOYAmt |
| EOY | $6,272,240 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $915 | BOYAmt |
| EOY | $915 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $915 | BOYAmt |
| EOY | $915 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,175,797 | BOYAmt |
| EOY | $6,271,325 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,175,797 | BOYAmt |
| EOY | $6,271,325 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,176,712 | BOYAmt |
| EOY | $6,272,240 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,580,528 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2,485,000 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Certification | Yes (X) | CertificationInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Catholic Medical Ctr | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020315693 | EIN |
| Organization Type | 3 | OrganizationTypeDesc |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $2,485,000 | SupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $2,485,000 | SupportSumAmt |
Form990 Schedule A Part IV Form990ScheduleAPartIVGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part I, Line 11h: | FormAndLineReferenceDesc |
| Explanation | Alliance Ambulatory Services supports its affiliated tax-exempt organization by helping to create and promote healthcare programs in the Manchester, New Hampshire community. The monetary value of this support cannot be accurately estimated. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Investment in Bedford Ambulatory Surgical Care | Desc |
| Book Value | $5,794,991 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $5,794,991 | TotalBookValueProgramRltdAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,580,528 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,580,528 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,580,528 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $0 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $0 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $0 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The System and all related entities, with the exception of Enterprises, 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. With few exceptions, the System is no longer subject to income tax examination by the U.S. federal or state tax authorities for years before 2011. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| William B Clutterbuck MD | ||||||||||||||
| Director | $0 | $351,042 | $0 | $1,707 | $0 | $0 | $0 | $15,300 | $0 | $21,160 | $0 | $389,209 | $0 | $0 |
| Raef Fahmy DPM | ||||||||||||||
| Director | $0 | $250,016 | $0 | $0 | $0 | $5,360 | $0 | $14,712 | $0 | $1,350 | $0 | $271,438 | $0 | $0 |
| Connor J Haugh MD FACC | ||||||||||||||
| Director | $0 | $443,242 | $0 | $121,771 | $0 | $37,500 | $0 | $17,850 | $0 | $20,161 | $0 | $640,524 | $0 | $0 |
| Patrick A Mahon MD | ||||||||||||||
| Director | $0 | $374,137 | $0 | $24,488 | $0 | $40,000 | $0 | $15,300 | $0 | $21,374 | $0 | $475,299 | $0 | $0 |
| Keith A Stahl MD | ||||||||||||||
| Director | $0 | $213,243 | $0 | $82,500 | $0 | $0 | $0 | $17,597 | $0 | $20,341 | $0 | $333,681 | $0 | $0 |
| Joseph Pepe MD | ||||||||||||||
| President & CEO | $0 | $450,939 | $0 | $115,704 | $0 | $49,347 | $0 | $94,306 | $0 | $19,769 | $0 | $730,065 | $0 | $0 |
| Edward Dudley III | ||||||||||||||
| Exec. VP & CFO | $0 | $307,182 | $0 | $61,805 | $0 | $63,419 | $0 | $61,613 | $0 | $31,171 | $0 | $525,190 | $0 | $0 |
| Alyson Pitman Giles | ||||||||||||||
| Former Officer | $0 | $0 | $0 | $0 | $0 | $333,381 | $0 | $0 | $0 | $5,250 | $0 | $338,631 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, Lines 4a-b | 4A: The following individual received base compensation under a severance agreement from a related organization (Catholic Medical Center). Alyson Pitman Giles: $326,435 4B: The following individuals take part in a section 457(f) forfeitable nonqualified deferred compensation plan through Catholic Medical Center (a related organization). The following represents contributions for many years of service. Joseph Pepe: $76,456 Edward Dudley, III: $46,313 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The sole member of Alliance Ambulatory services is CMC Healthcare System. |
| Form 990, Part VI, Section A, line 7a | The directors of Alliance Ambulatory Services are appointed by the sole member. |
| Form 990, Part VI, Section A, line 7b | The sole member has reserved powers over Alliance Ambulatory Services but does not approve each separate action taken by the Alliance Ambulatory Services 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 are required to complete a conflict of interest policy 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: | Net Transfer to Affiliates -2,485,000. |
| Form 990, Part XII, Line 2c: | The audit process has not changed from the prior year. |
| Form 990, Part VI, Line 16b: | The Organization currently does not have a written joint venture policy to evaluate its participation in joint ventures. However, the Organization does actively and consistently monitor its involvement with its joint ventures to safeguard and ensure the Organization's exempt status is not jeopardized with respect to such arrangements. The Catholic Medical Center System is currently examining all of its policies and is in the process of developing a written joint venture policy in the near future. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMC Ancillary Health Services LLC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 McGregor Street | AddressLine1 |
| City | Manchester | City |
| State | NH | State |
| ZIP Code | 03102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 464389318 | EIN |
| Primary Activities | Ancillary Health Services | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Catholic Medical Center | BusinessNameLine1 |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Alliance Health Services | |||||||||||
| 100 McGregor Street | Manchester | NH | 03102 | 611508839 | Practices | NH | 501(c)(3) | Line 11b, II | 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 | 0 | N/A | |
| CMC Associates | |||||||||||
| 100 McGregor Street | Manchester | NH | 03102 | 020344786 | Gift Shop | NH | 501(c)(3) | Line 11b, II | Catholic Medical Center | 0 | |
| CMC Physician Practice Associates | |||||||||||
| 100 McGregor Street | Manchester | NH | 03102 | 020460245 | Practices | NH | 501(c)(3) | Line 11b, II | CMC Healthcare System | 0 | |
| St Peters Home | |||||||||||
| 100 McGregor Street | Manchester | NH | 03102 | 020222228 | Home | 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Related | $2,619,137 | $2,584,949 | 0 | Yes (1) | 0.50000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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