ALLIANCE HEALTH SERVICES: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ALLIANCE HEALTH SERVICES (EIN 61-1508839)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-13
IRS object ID
201441339349300014
Schema version
2012v2.1
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

FieldValueIRS element (for citing)
Timestamp2014-05-13T07:26:08-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN010494526EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BAKER NEWMAN & NOYESBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 507AddressLine1
CityPORTLANDCity
StateMEState
ZIP Code04112ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN611508839EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Alliance Health ServicesBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlALLINameControl
Phone6036683545Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 McGregor StreetAddressLine1
CityManchesterCity
StateNHState
ZIP Code03102ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEdward L Dudley IIIName
TitleExec VP & CFOTitle
Phone6036683545Phone
Date Signed2014-05-09DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameNicholas E PortoName
PTINP01310283PTIN
Phone2078792100Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJoseph Pepe MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1100 McGregor StreetAddressLine1
CityManchesterCity
StateNHState
ZIP Code03102ZIPCode
FieldValueIRS element (for citing)
Gross Receipts15262417GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.catholicmedicalcenter.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2007YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionTo promote health care programs from the greater Manchester, New Hampshire community.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers5TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10766383ProgramServiceRevenuePriorYear
Program Service Revenue CY15262417ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year10766383TotalRevenuePriorYear
Total Revenue Current Year15262417TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year14966238OtherExpensePriorYear
Other Expenses Current Year19126505OtherExpensesCurrentYear
Total Expenses Prior Year14966238TotalExpensesPriorYear
Total Expenses Current Year19126505TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-4199855RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-3864088RevenuesLessExpensesCY
Total Assets BOY2511356TotalAssetsBOY
Total Assets EOY2900233TotalAssetsEOY
Total Liabilities BOY1238881TotalLiabilitiesBOY
Total Liabilities EOY1641846TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1272475NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1258387NetAssetsOrFundBalancesEOY
Mission DescriptionTo promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense16287737Expense
Revenue15262417Revenue
DescriptionTo promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community.Description
Total Program Service Expense16287737TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Edward L Dudley IIIBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6036683545TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 McGregor StAddressLine1
CityManchesterCity
StateNHState
ZIP Code03102ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerFormerFormer
Raef Fahmy DPM
Director1.0043.00X01473464431
Stephen Leblanc
Director1.00X000
Maria C Mongan
Director1.004.00X000
Steven Paris MD
Director1.00X000
Joseph Graham
Chair1.005.00X000X
Suzanne Mellon PhD RN
Vice Chair1.003.00X000X
Edward Dudley III
Treasurer/Secretary1.0043.00X0423816103350X
Joseph Pepe MD
President & CEO1.0045.00X049519192176X
Allen Ericson
COO1.0043.00032549064430X
Raymond Bonito
Former Officer0.0001319061822X
Alyson Pitman Giles
Former Officer0.000291778923652X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs4441538TotalReportableCompFrmRltdOrgs
Total Other Compensation289861TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Dartmouth Hitchcock ClinicBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1One Medical Center DrAddressLine1
CityLebanonCity
StateNHState
ZIP Code03756ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesProfessional ServicesDescriptionOfServices
Compensation17117987Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Rev.6214001464199314641993
Rental Income532000620424620424
FieldValueIRS element (for citing)
Total Program Service Revenue15262417TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column15262417TotalRevenueColumn
Related Or Exempt Function Income15262417RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2838768Total
Management And General2838768ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total12904162Total
Program Services12904162ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total39701Total
Program Services39701ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1826266Total
Program Services1826266ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total7983Total
Program Services7983ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total80090Total
Program Services80090ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
Bad Debts628783628783
Medical & Pharmaceutica515572515572
Transcription139308139308
Equipment Rental6477464774

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total81098Total
Program Services81098ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19126505Total
Program Services16287737ProgramServices
Management And General2838768ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY173816BOY
EOY348749EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1803693BOY
EOY2112124EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY76190BOY
EOY80588EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis662737LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec303965LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY432532BOY
EOY358772EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY25125BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2511356BOY
EOY2900233EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1238881BOY
EOY1606373EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY35473EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1238881BOY
EOY1641846EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1272475BOY
EOY1258387EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1272475BOY
EOY1258387EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2511356BOY
EOY2900233EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-3864088ReconcilationRevenueExpenses
Reconcilation Other Changes3850000ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1CMCBusinessNameLine1
FieldValueIRS element (for citing)
EIN020315693EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Organized In US1OrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis662737OtherCostOrOtherBasis
Depreciation303965Depreciation
Book Value358772BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings358772TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO AFFILIATESDescription
Amount$35,473Amount
FieldValueIRS element (for citing)
Total Of Amounts35473TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt14633634TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal14633634RevenueSubtotal
Other Revenues Not Included628783OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt628783RevenueNotRptdOnFinStmt
Total Revenue Per Form99015262417TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt18497721TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal18497721ExpensesSubtotal
Other Expenses Not Included628783OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt628783ExpensesNotRptdOnFinStmt
Total Expenses Per Form99019126504TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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 628,783.
Part XII, Line 4b - Other Adjustments:Bad Debt Expense 628,783.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Raef Fahmy DPM
Director0147346000004420011015177700
Edward Dudley III
Treasurer/Secretary034181208200400058650044700052716600
Joseph Pepe MD
President & CEO042736306782800063982028194058736700
Allen Ericson
COO026677905871100043846020584038992000
Raymond Bonito
Former Officer0103906028000000182200013372800
Alyson Pitman Giles
Former Officer080271708209502032977017500061520294144101339641

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 3The 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-bPart 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
Part IIISchedule 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.Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6The sole member of Alliance Health Services is Catholic Medical Center
Form 990, Part VI, Section A, line 7aThe directors are appointed by the sole member.
Form 990, Part VI, Section A, line 7bThe sole member has reserved powers over Alliance Health Services but does not approve each separate action taken by the board.
Form 990, Part VI, Section B, line 11Form 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 12cOfficers and directors are required to complete a conflict of interest questionnaire annually.
Form 990, Part VI, Section B, line 15A 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 19The governing documents, the conflict of interest policy, and the financial statements are available upon request.
Form 990, Part IX, line 11gPhysician Fees: Program service expenses 12,904,162. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,904,162.Other Fees
Form 990, Part XI, line 9:Transfer From Affiliates 3,850,000.Changes in Net Assets or Fund Balances:
Form 990, Part XII, Line 2c:The audit process has not changed from the prior year.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Catholic Medical Center
100 Mcgregor StreetManchesterNH03102020315693HospitalNH501(c)(3)Line 3CMC Healthcare System0
CMC Healthcare System
100 Mcgregor StreetManchesterNH03102010568516ParentNH501(c)(3)Line 11b, II0N/A
CMC Associates
100 Mcgregor StreetManchesterNH03102020344786Gift ShopNH501(c)(3)Line 11b, IICatholic Medical Center0
CMC Physician Practice Associates
100 Mcgregor StreetManchesterNH03102020460245PracticesNH501(c)(3)Line 11b, IICMC Healthcare System0
St Peter's Home
100 Mcgregor StreetManchesterNH03102020222228HomeNH501(c)(3)Line 9CMC Healthcare System0
Alliance Ambulatory Services
100 Mcgregor StreetManchesterNH03102020519436Ambulatory Surgical CenterNH501(c)(3)Line 11b, IICMC Healthcare System0
Alliance Resources
100 Mcgregor StreetManchesterNH03102020398138Real EstateNH501(c)(3)Line 11b, IICMC Healthcare System0

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1McGregor Steet MOBBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 McGregor StreetAddressLine1
CityManchesterCity
StateNHState
ZIP Code03102ZIPCode
FieldValueIRS element (for citing)
EIN134347316EIN
Primary ActivityMedical Office BuildingPrimaryActivity
Legal Domicile StateNHLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CMC Health SystemBusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeRelatedPredominantIncomeType
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityControlled OrgControlledOrg
Alliance Enterprises
100 McGregor StreetManchesterNH03102020386795Real EstateNHCMC Health SystemC0
Doctors' Medical Association
100 McGregor StreetManchesterNH03102020340690Medical Office BuildingNHCMC Health SystemC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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