2014-05-13T07:26:08-05:00 2013-06-30 010494526 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2012-07-01 020398138 Alliance Resources Inc ALLI 6036683545 100 McGregor Street Manchester NH 031023770 Edward L Dudley III 6036683545 2014-05-09 Nicholas E Porto P01310283 2078792100 2012 2015-11-30 17:44:51Z Joseph Pepe MD 100 McGregor Street Manchester NH 031023770 572974 0 0928 X www.catholicmedicalcenter.org X 1990 NH Property management and support services 19 14 0 14 0 0 0 0 539759 553720 -315585 54 55750 19200 279924 572974 0 0 0 0 0 0 0 0 0 725905 700804 725905 700804 -445981 -127830 2514526 2328020 165017 106341 2349509 2221679 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 700804 553720 Property Management and Support Services 700804 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 5 0 1 0 0 0 0 0 0 0 0 0 0 0 X 19 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 1.00 4.00 X 0 0 0 Gary Bouchard PhD 1.00 3.00 X 0 0 0 William Clutterbuck MD 1.00 43.00 X 0 336211 33424 John G Cronin Esq 1.00 3.00 X 0 0 0 Eleanor Wm Dahar Esq 1.00 3.00 X 0 0 0 Raef Fahmy DPM 1.00 43.00 X 0 147346 4431 Connor J Haugh MD FACC 1.00 43.00 X 0 631859 40161 Powen Hsu MD 1.00 3.00 X 0 0 0 Susan Huard PhD 1.00 3.00 X 0 0 0 Maria C Mongan 1.00 4.00 X 0 0 0 Diane Murphy Quinlan Esq 1.00 3.00 X 0 0 0 Msgr John P Quinn 1.00 4.00 X 0 0 0 Keith A Stahl MD 1.00 43.00 X 0 261526 37300 Fr Patrick Sullivan OSB RN 1.00 4.00 X 0 0 0 Guy D Chapdelaine 1.00 3.00 X 0 0 0 Joseph Graham 1.00 5.00 X X 0 0 0 Rick Botnick 1.00 3.00 X X 0 0 0 Suzanne K Mellon PhD RN 1.00 3.00 X X 0 0 0 Margaret-Ann Moran Esq 1.00 5.00 X X 0 0 0 Daryl J Cady CPA 1.00 4.00 X X 0 0 0 Joseph Pepe MD 1.00 45.00 X X 0 495191 92176 Edward Dudley III 1.00 43.00 X 0 423816 103350 Allen Ericson 1.00 43.00 X 0 325490 64430 Alyson Pitman Giles 0.00 X 0 2917789 23652 Raymond Bonito 0.00 X 0 131906 1822 0 5671134 400746 0 1 1 0 0 Rental Income 532000 553720 553720 553720 54 54 19200 0 19200 19200 19200 572974 553720 0 19254 2677 2677 493647 493647 125277 125277 Capital Project Expense 66331 66331 Bad Debt Expense 5170 5170 7702 7702 700804 700804 0 0 221588 195133 30524 51629 25571 20117 4118161 2057020 2236843 2061141 2514526 2328020 165017 106341 165017 106341 X 2349509 2221679 2349509 2221679 2514526 2328020 -127830 0 X X 0 1 X 1 0 X X X 0 0 0 CMC 020315693 3 1 1 0 1 0 633839 633839 3348479 1927703 1420776 109672 109672 0 26171 19645 6526 2061141 X 567804 0 567804 5170 5170 572974 695634 0 695634 5170 5170 700804 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Medical Center, PPA, Resources, AAS, Hillcrest, AHS, DMA and St. Peter's Home, Inc. 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. Part XI, Line 4b - Other Adjustments: Bad Debt Expense 5,170. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 5,170. 1 1 0 0 0 0 0 0 0 William Clutterbuck MD 0 336211 0 0 0 0 0 15000 0 18424 0 369635 0 0 Raef Fahmy DPM 0 147346 0 0 0 0 0 4420 0 11 0 151777 0 0 Connor J Haugh MD FACC 0 507021 0 124838 0 0 0 20000 0 20161 0 672020 0 0 Keith A Stahl MD 0 205126 0 56400 0 0 0 16959 0 20341 0 298826 0 0 Joseph Pepe MD 0 427363 0 67828 0 0 0 63982 0 28194 0 587367 0 0 Edward Dudley III 0 341812 0 82004 0 0 0 58650 0 44700 0 527166 0 0 Allen Ericson 0 266779 0 58711 0 0 0 43846 0 20584 0 389920 0 0 Alyson Pitman Giles 0 802717 0 82095 0 2032977 0 17500 0 6152 0 2941441 0 1339641 Raymond Bonito 0 103906 0 28000 0 0 0 1822 0 0 0 133728 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 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: $279,802 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. Alyson Pitman Giles: $270,207 Joseph Pepe: $43,982 Edward Dudley, III: $43,650 Allen Ericson: $27,269 Supplemental Information Part III Schedule J, Part II, Column F: Box 5 of Alyson Pitman Giles's W-2 reflects payouts of deferred compensation that was accrued in prior years dating back to 2001. The amount in Column F may not be reflective of all compensation that was reported on previous 990s due to changes in reporting requirements with the redesigned form. 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 the Organization, and is sent to an independent tax accounting firm (Baker, Newman, Noyes) for a thorough and exhaustive review. Upon completion of independent firm review, Form 990 is sent back 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 XII, Line 2c: The audit process has not changed from the prior year. 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 CMC Healthcare System Related 0 0 Doctors' Medical Association 100 McGregor Street Manchester NH 03102 020340690 Medical Office Building NH CMC Healthcare System C 0 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH CMC Healthcare System C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0