2014-05-13T07:26:08-05:00 2013-06-30 010494526 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2012-07-01 611508839 Alliance Health Services ALLI 6036683545 100 McGregor Street Manchester NH 03102 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 03102 15262417 0 0928 X www.catholicmedicalcenter.org X 2007 NH To promote health care programs from the greater Manchester, New Hampshire community. 7 5 0 5 0 0 0 0 10766383 15262417 0 0 0 0 10766383 15262417 0 0 0 0 0 0 0 0 0 14966238 19126505 14966238 19126505 -4199855 -3864088 2511356 2900233 1238881 1641846 1272475 1258387 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 0 0 16287737 15262417 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 16287737 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 3 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Edward L Dudley III 6036683545 100 McGregor St Manchester NH 03102 Raef Fahmy DPM 1.00 43.00 X 0 147346 4431 Stephen Leblanc 1.00 X 0 0 0 Maria C Mongan 1.00 4.00 X 0 0 0 Steven Paris MD 1.00 X 0 0 0 Joseph Graham 1.00 5.00 X X 0 0 0 Suzanne Mellon PhD RN 1.00 3.00 X X 0 0 0 Edward Dudley III 1.00 43.00 X X 0 423816 103350 Joseph Pepe MD 1.00 45.00 X X 0 495191 92176 Allen Ericson 1.00 43.00 X 0 325490 64430 Raymond Bonito 0.00 X 0 131906 1822 Alyson Pitman Giles 0.00 X 0 2917789 23652 0 4441538 289861 0 1 1 0 Dartmouth Hitchcock Clinic One Medical Center Dr Lebanon NH 03756 Professional Services 17117987 1 Patient Service Rev. 621400 14641993 14641993 Rental Income 532000 620424 620424 15262417 15262417 15262417 0 0 X 2838768 2838768 12904162 12904162 39701 39701 1826266 1826266 7983 7983 80090 80090 Bad Debts 628783 628783 Medical & Pharmaceutica 515572 515572 Transcription 139308 139308 Equipment Rental 64774 64774 81098 81098 19126505 16287737 2838768 0 173816 348749 1803693 2112124 76190 80588 662737 303965 432532 358772 25125 0 2511356 2900233 1238881 1606373 0 35473 1238881 1641846 X 1272475 1258387 1272475 1258387 2511356 2900233 X -3864088 3850000 X X 0 1 X 1 0 X X X 0 0 0 CMC 020315693 3 1 1 0 1 0 662737 303965 358772 358772 DUE TO AFFILIATES 35473 35473 X 14633634 0 14633634 628783 628783 15262417 18497721 0 18497721 628783 628783 19126504 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. 1 1 0 0 0 0 0 0 0 Raef Fahmy DPM 0 147346 0 0 0 0 0 4420 0 11 0 151777 0 0 Edward Dudley III 0 341812 0 82004 0 0 0 58650 0 44700 0 527166 0 0 Joseph Pepe MD 0 427363 0 67828 0 0 0 63982 0 28194 0 587367 0 0 Allen Ericson 0 266779 0 58711 0 0 0 43846 0 20584 0 389920 0 0 Raymond Bonito 0 103906 0 28000 0 0 0 1822 0 0 0 133728 0 0 Alyson Pitman Giles 0 802717 0 82095 0 2032977 0 17500 0 6152 0 2941441 0 1339641 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 Health Services is Catholic Medical Center 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 Health Services but does not approve each separate action taken by the 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 questionnaire 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 governing documents, the conflict of interest policy, and the financial statements are available upon request. Other Fees Form 990, Part IX, line 11g Physician Fees: Program service expenses 12,904,162. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,904,162. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer From Affiliates 3,850,000. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. 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 Alliance Resources 100 Mcgregor Street Manchester NH 03102 020398138 Real Estate NH 501(c)(3) Line 11b, II CMC Healthcare System 0 McGregor Steet MOB 100 McGregor Street Manchester NH 03102 134347316 Medical Office Building NH CMC Health System Related 0 0 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH CMC Health System C 0 Doctors' Medical Association 100 McGregor Street Manchester NH 03102 020340690 Medical Office Building NH CMC Health System C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1