2013-05-07T12:16:27-05:00 2012-06-30 010494526 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2011-07-01 611508839 Alliance Health Services ALLI 6036683545 100 McGregor St Manchester NH 03102 Edward L Dudley III 6036683545 2013-05-02 Nicholas E Porto P01310283 2078792100 2011 2016-03-07 17:11:31Z Joseph Pepe MD 100 McGregor St Manchester NH 03102 10766383 0 0928 X www.catholicmedicalcenter.org X 2007 NH To promote health care programs from the greater Manchester, New Hampshire community. 7 5 0 11 0 0 0 0 10794064 10766383 0 0 0 0 10794064 10766383 0 0 0 0 0 0 0 0 0 14723718 14966238 14723718 14966238 -3929654 -4199855 4520797 2511356 4448467 1238881 72330 1272475 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 0 0 12934040 10766383 To promote health care programs for a broad cross-section of the greater Manchester, New Hampshire community. 12934040 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 0 1 4 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 0 0 0 NH X Edward L Dudley III 6036683545 100 McGregor St Manchester NH 03102 X Stephen Camann 1.00 X 0 0 0 Thomas J Colacchio MD 1.00 X 0 0 0 Jerome Duval 1.00 X 0 0 0 Jeff Eisenberg 1.00 X 0 0 0 Raef Fahmy DPM 1.00 X 0 116392 2432 Stephen Leblanc 1.00 X 0 0 0 Steven Paris MD 1.00 X 0 0 0 Ronald Rioux 1.00 X 0 0 0 Joseph Graham 1.00 X X 0 0 0 Suzanne Mellon PhD RN 1.00 X X 0 0 0 Guy D Chapdelaine 1.00 X X 0 0 0 Joseph Pepe MD 1.00 X X 0 346001 19545 Alyson Pitman Giles 1.00 X X 0 798551 348357 Raymond Bonito 1.00 X X 0 428228 137121 Edward Dudley III 1.00 X 0 358208 82328 Allen Ericson 1.00 X 0 408870 43671 Kevin Kilday 0.00 X 0 124809 0 0 2581059 633454 0 1 1 0 Dartmouth Hitchcock Clinic One Medical Center Dr Lebanon NH 03756 Professional Services 13147735 1 Patient Service Rev. 621400 10461627 10461627 Rental Income 532000 304756 304756 10766383 10766383 10766383 0 0 2032198 2032198 10366333 10366333 905880 905880 641947 641947 7013 7013 71480 71480 Bad Debts 449429 449429 Medical & Pharmaceutica 362644 362644 Transcription 64221 64221 Equipment Rental 20954 20954 44139 44139 14966238 12934040 2032198 0 2790606 173816 1441726 1803693 48976 76190 656407 223875 239489 432532 0 25125 4520797 2511356 4429333 1238881 19134 0 4448467 1238881 X 72330 1272475 72330 1272475 4520797 2511356 X -4199855 5400000 X X 0 1 1 X 0 X X X 0 0 0 CMC 020315693 3 1 1 1 0 1 0 656407 223875 432532 432532 Description of Uncertain Tax Positions Under FIN 48: Part X: 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. X X X X X 1 1 0 0 0 0 0 0 0 Joseph Pepe MD 0 315300 0 30701 0 0 0 11206 0 8339 0 365546 0 0 Alyson Pitman Giles 0 654209 0 144342 0 0 0 288191 0 60166 0 1146908 0 0 Raymond Bonito 0 365021 0 63207 0 0 0 96265 0 40856 0 565349 0 0 Edward Dudley III 0 328206 0 30002 0 0 0 40013 0 42315 0 440536 0 0 Allen Ericson 0 349070 0 59800 0 0 0 16067 0 27604 0 452541 0 0 Kevin Kilday 0 124809 0 0 0 0 0 0 0 0 0 124809 0 0 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). 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: $40,013 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 C, line 19 The governing documents, the conflict of interest policy, and the financial statements are available 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 Allen Ericson: 50 hrs Edward Dudley, III: 50 hrs Raef Fahmy, DPM: 40 hrs Alyson Pitman Giles: 60 hrs Raymond Bonito: 50 hrs Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Transfer From Affiliates 5,400,000. Total to Form 990, Part XI, Line 5: 5,400,000. 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 CMC 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 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 1 0 0 0 0 0 0 0 0 1