2015-05-13T06:03:23-05:00 2014-06-30 010494526 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2013-07-01 020398138 Alliance Resources Inc ALLI 6036683545 100 McGregor Street Manchester NH 031023770 Edward L Dudley III Exec VP & CFO 6036683545 2015-05-06 Nicholas E Porto P01310283 2078792100 2015-05-06 2013 2016-02-25 16:41:14Z Joseph Pepe MD 100 McGregor Street Manchester NH 031023770 574489 0 0928 X www.catholicmedicalcenter.org X 1990 NH Property management and support services 20 14 0 14 0 0 0 0 553720 574475 54 -988773 19200 0 572974 -414298 0 0 0 0 0 0 0 0 0 700804 777277 700804 777277 -127830 -1191575 2328020 2599392 106341 150172 2221679 2449220 To facilitate healthcare programs as well as further quality and accessibility of healthcare services in the greater Manchester community and the state of New Hampshire. 0 0 777277 574475 Property Management and Support Services 777277 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 0 0 0 0 0 0 0 0 0 0 0 X 20 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Edward Dudley III 6036683545 100 McGregor Street Manchester NH 031023770 Adele Boufford Baker Director 1.00 3.00 X 0 0 0 Gary Bouchard PhD Director (Part Year) 1.00 2.00 X 0 0 0 Guy D Chapdelaine Director (Part Year) 1.00 3.00 X 0 0 0 William B Clutterbuck MD Director 1.00 43.00 X 0 352749 36460 Eleanor Wm Dahar Esq Director 1.00 2.00 X 0 0 0 Raef Fahmy DPM Director 1.00 42.00 X 0 255376 16062 Joseph Graham Director 1.00 4.00 X 0 0 0 Connor J Haugh MD FACC Director 1.00 42.00 X 0 602513 38011 Powen Hsu MD Director 1.00 3.00 X 0 0 0 Susan D 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 Director 1.00 42.00 X 0 438625 36674 Diane Murphy Quinlan Esq Director 1.00 3.00 X 0 0 0 Msgr John P Quinn Director 1.00 3.00 X 0 0 0 Keith A Stahl MD Director 1.00 3.00 X 0 295743 37938 Fr Patrick Sullivan OSB RN Director 1.00 3.00 X 0 0 0 Richard E Ashooh Director 1.00 3.00 X 0 0 0 Rick Botnick Chair 1.00 2.00 X X 0 0 0 Maria C Mongan Vice Chair 1.00 3.00 X X 0 0 0 Suzanne Mellon PhD RN Vice Chair (Part Year) 1.00 3.00 X X 0 0 0 Daryl J Cady CPA Treasurer 1.00 3.00 X X 0 0 0 John G Cronin Esq Secretary 1.00 2.00 X X 0 0 0 Margaret-Ann Moran Esq Secretary (Part Year) 1.00 4.00 X X 0 0 0 Joseph Pepe MD President & CEO 1.00 44.00 X X 0 615990 114075 Edward Dudley III Exec. VP & CFO 1.00 43.00 X 0 432406 92784 Alyson Pitman Giles Former Officer 0.00 X 0 333381 5250 0 3326783 377254 0 1 1 0 0 Rental Income 532000 574475 574475 574475 14 14 988787 -988787 -988787 -988787 -414298 574475 0 -988773 501814 501814 92196 92196 Capital Project Expense 175560 175560 7707 7707 777277 777277 0 0 195133 119518 51629 58437 20117 19912 3893825 1492300 2061141 2401525 2328020 2599392 106341 150172 106341 150172 X 2221679 2449220 2221679 2449220 2328020 2599392 X -1191575 1419116 X X 0 1 X 1 0 X X X 0 0 0 Catholic Medical Ctr 020315693 3 1 0 1 0 Schedule A, Part I, Line 11h: Alliance Resources supports its affiliated tax-exempt organization by providing property management and support services for the Hospital. The monetary value of this support cannot be accurately estimated. 633839 633839 3124143 1362047 1762096 109672 109672 0 26171 20581 5590 2401525 X -414298 0 -414298 0 -414298 777277 0 777277 0 777277 Part X, Line 2: 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. 1 1 0 0 0 0 0 0 0 William B Clutterbuck MD Director 0 351042 0 1707 0 0 0 15300 0 21160 0 389209 0 0 Raef Fahmy DPM Director 0 250016 0 0 0 5360 0 14712 0 1350 0 271438 0 0 Connor J Haugh MD FACC Director 0 443242 0 121771 0 37500 0 17850 0 20161 0 640524 0 0 Patrick A Mahon MD Director 0 374137 0 24488 0 40000 0 15300 0 21374 0 475299 0 0 Keith A Stahl MD Director 0 213243 0 82500 0 0 0 17597 0 20341 0 333681 0 0 Joseph Pepe MD President & CEO 0 450939 0 115704 0 49347 0 94306 0 19769 0 730065 0 0 Edward Dudley III Exec. VP & CFO 0 307182 0 61805 0 63419 0 61613 0 31171 0 525190 0 0 Alyson Pitman Giles Former Officer 0 0 0 0 0 333381 0 0 0 5250 0 338631 0 0 Part I, Line 3 The Organization's President and CEO's compensation was established by a related organization, Catholic Medical Center. That organization used a compensation committee, independent compensation consultant, the Form 990 of other organizations, a compensation study/survey, and approval by their board of directors/compensation committee to determine the President and CEO's compensation and benefits. Part I, 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: $75,456 Edward Dudley, III: $46,313 Form 990, Part VI, Section A, line 6 The sole member of Alliance Resources is CMC Healthcare System Form 990, Part VI, Section A, line 7a The directors are appointed by the sole member. Form 990, Part VI, Section A, line 7b The sole member has reserved powers over Alliance Resources but does not approve each separate action taken by the Alliance Resources 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 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 from Affiliate 1,419,116. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. CMC Ancillary Health Services LLC 100 McGregor Street Manchester NH 03102 464389318 Ancillary Health Services NH 0 0 Catholic Medical Center 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 N/A 0 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 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 11b, II 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 Doctors' Medical Association 100 McGregor Street Manchester NH 03102 020340690 Medical Office Building NH N/A C 0 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0