ALLIANCE AMBULATORY SERVICES: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ALLIANCE AMBULATORY SERVICES (EIN 02-0519436)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-07
IRS object ID
201301279349301210
Schema version
2011v1.5
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)
Timestamp2013-05-07T12:16:27-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

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 Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN020519436EIN

Name Name

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

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameEdward L Dudley IIIName
TitleSenior VP & CFOTitle
Phone6036683545Phone
Date Signed2013-05-02DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameNicholas E PortoName
PTINP01310283PTIN
Phone2078792100Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

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 StAddressLine1
CityManchesterCity
StateNHState
ZIP Code03102ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2878403GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.catholicmedicalcenter.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2000YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionTo promote and generate healthcare programs for a broad cross-section of the greater Manchester, New Hampshire communityActivityOrMissionDescription
Nbr Voting Members Governing Body19NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers26TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3130375ProgramServiceRevenuePriorYear
Program Service Revenue CY2878179ProgramServiceRevenueCY
Investment Income Prior Year262InvestmentIncomePriorYear
Investment Income Current Year224InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year3130637TotalRevenuePriorYear
Total Revenue Current Year2878403TotalRevenueCurrentYear
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 Year317432OtherExpensePriorYear
Other Expenses Current Year64OtherExpensesCurrentYear
Total Expenses Prior Year317432TotalExpensesPriorYear
Total Expenses Current Year64TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2813205RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2878339RevenuesLessExpensesCY
Total Assets BOY6535802TotalAssetsBOY
Total Assets EOY6484141TotalAssetsEOY
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6535802NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6484141NetAssetsOrFundBalancesEOY
Mission DescriptionTo create and promote healthcare programs in the Manchester New Hampshire, community.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense64Expense
Revenue2878179Revenue
DescriptionRevenue from partnership interest in Bedford Ambulatory Surgical Center, LLCDescription
Total Program Service Expense64TotalProgramServiceExpense
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 Equip0ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
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
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership1ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
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 Members19NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
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 Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
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
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerFormerFormer
Adele Boufford Baker
Director1.00X000
Gary Bouchard PhD
Director1.00X000
Paul S Boynton
Director (Part Year)1.00X000
Daryl J Cady
Director1.00X000
Stephen Camann
Director (Part Year)1.00X000
Guy D Chapdelaine
Director1.00X000
William Clutterbuck MD
Director1.00X034250633294
Eleanor Wm Dahar Esq
Director1.00X000
Jeff Eisenberg
Director (Part Year)1.00X000
Raef Fahmy DPM
Director1.00X01163922432
Connor J Haugh MD FACC
Director1.00X063060234137
Susan Huard
Director1.00X000
Suzanna D Majewski
Director1.00X000
Anne M O'Connor MD
Director1.00X000
Msgr John P Quinn
Director1.00X000
Ronald J Rioux
Director (Part Year)1.00X000
Keith A Stahl MD
Director1.00X028704112440
Rev Gayle Whittemore
Director (Part Year)1.00X000
Joseph Graham
Chair1.00X000X
Suzanne K Mellon PhD RN
Vice Chair1.00X000X
Jerome Duval
Treasurer1.00X000X
Margaret-Ann Moran Esq
Secretary1.00X000X
Joseph Pepe MD
President & CEO1.00X034600119545X
Alyson Pitman Giles
President & CEO (Part Year)1.00X0798551348357X
Edward Dudley III
Senior VP & CFO1.00035820882328X
Allen Ericson
COO1.00040887043671X
Raymond Bonito
Exec. VP (Part Year)1.000428228137121X
Kevin Kilday
Former Officer0.0001248090X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3841208TotalReportableCompFrmRltdOrgs
Total Other Compensation713325TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionInterest in AmbulatoryDescription
Business Code621990BusinessCode
Total Revenue Column2878179TotalRevenueColumn
Related Or Exempt Function Income2878179RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue2878179TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column224TotalRevenueColumn
Exclusion$224ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2878403TotalRevenueColumn
Related Or Exempt Function Income2878179RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$224ExclusionAmount

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total64Total
Program Services64ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total64Total
Program Services64ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY211065BOY
EOY161225EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY6324737BOY
EOY6322916EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6535802BOY
EOY6484141EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6535802BOY
EOY6484141EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6535802BOY
EOY6484141EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6535802BOY
EOY6484141EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2878339ReconcilationRevenueExpenses
Reconcilation Other Changes-2930000ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionInvestment in Bedford Ambulatory Surgical CareDescription
Book Value6322916BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities6322916TotalOfBookValueSecurities

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDescription of Uncertain Tax Positions Under FIN 48:Identifier
Return ReferencePart X:ReturnReference
ExplanationThe 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
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 (9 entries)

Base 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
William Clutterbuck MD
03425060000014700018594037580000
Connor J Haugh MD FACC
0503116012748600014962019175066473900
Keith A Stahl MD
0279968070730001007102369029948100
Joseph Pepe MD
03153000307010001120608339036554600
Alyson Pitman Giles
065420901443420002881910601660114690800
Edward Dudley III
032820603000200040013042315044053600
Allen Ericson
034907005980000016067027604045254100
Raymond Bonito
036502106320700096265040856056534900
Kevin Kilday
012480900000000012480900

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Lines 4a-bReturnReference
ExplanationPart I, Lines 4a-b: 4A: The following individual received base compensation under a severance agreement from a related organization (Catholic Medical Center). Kevin Kilday $124,809 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 Raymond Bonito: $84,065 Allen Ericson: $4,186 Edward Dudley: $40,013Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6The sole member of Alliance Ambulatory services is CMC Healthcare System.
Form 990, Part VI, Section A, line 7aThe directors of Alliance Ambulatory Services are appointed by the sole member.
Form 990, Part VI, Section A, line 7bThe 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 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 are required to complete a conflict of interest policy annually.
Form 990, Part VI, Section C, line 19The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.
Form 990, Part VII:Several individuals reported on Form 990, Part VII split their time with related organizations. The following are the average hours per week those respective members spent during the year at related organizations: Joseph Pepe: 50 hrs William Clutterbuck, MD: 40 hrs Connor Haugh, MD: 40 hrs Keith Stahl, MD: 40 hrs Allen Ericson: 50 hrs Edward Dudley, III: 50 hrs Raef Fahmy, DPM: 40 hrs Alyson Pitman Giles: 60 hrs Raymond Bonito: 50 hrs
Form 990, Part XI, line 5:Net Transfer to Affiliates -2,930,000. Total to Form 990, Part XI, Line 5: -2,930,000.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
Alliance Health Services
100 McGregor StreetManchesterNH03102611508839PracticesNH501(c)(3)Line 11b, IICMC Healthcare System0
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, IICMC0
CMC Physician Practice Associates
100 McGregor StreetManchesterNH03102020460245PracticesNH501(c)(3)Line 11b, IICMC Healthcare System0
St Peters Home
100 McGregor StreetManchesterNH03102020222228HomeNH501(c)(3)Line 9CMC 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 Healthcare 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 EntityTypeOfEntity
Doctors' Medical Association
100 McGregor StreetManchesterNH03102020340690Medical Office BuildingNHCMC Healthcare SystemC
Alliance Enterprises
100 McGregor StreetManchesterNH03102020386795Real EstateNHCMC Healthcare SystemC
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
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
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 Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Form990 Schedule R Part VI Form990ScheduleRPartVI

Name Of Business NameOfBusiness

FieldValueIRS element (for citing)
Business Name Line1Bedford Ambulatory Surgical Center LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111 Washington PlaceAddressLine1
CityBedfordCity
StateNHState
ZIP Code03110ZIPCode
FieldValueIRS element (for citing)
EIN020519727EIN
Primary ActivityOutpatient surgeryPrimaryActivity
Legal Domicile StateNHLegalDomicileState
Predominate IncomeRelatedPredominateIncomeDesc
All Partners C3 S0AllPartnersC3S
Share Of Total Income2849692ShareOfTotalIncome
Share Of EOY Assets3726826ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
Code V$0CodeVAmount
General Or Managing Partner1GeneralOrManagingPartner
Percentage Ownership0.50000PercentageOwnership

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