2012-05-14T12:12:18-05:00 2011-06-30 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2010-07-01 020398138 ALLIANCE RESOURCES INC ALLI 6036683545 100 MCGREGOR ST MANCHESTER NH 03102 EDWARD L DUDLEY III 6036683545 2012-05-02 E DREW CHENEY 2078792100 2010 2016-02-24 21:20:13Z EDWARD L DUDLEY III 100 MCGREGOR ST MANCHESTER NH 03102 1068515 0 0928 X WWW.CATHOLICMEDICALCENTER.ORG X 1990 NH PROPERTY MANAGEMENT AND SUPPORT SERVICES 22 17 0 21 0 0 0 0 601767 569879 30 467698 0 0 601797 1037577 0 0 0 0 0 0 0 0 0 773342 756729 773342 756729 -171545 280848 2537620 2910531 87978 115041 2449642 2795490 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 756729 569879 PROPERTY MANAGEMENT AND SUPPORT SERVICES 756729 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 22 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NH X EDWARD DUDLEY III 6036683545 100 MCGREGOR ST MANCHESTER NH 03102 X ALYSON PITMAN GILES 1.00 X X 0 749399 371016 CONNOR J HAUGH 1.00 X 0 611034 16790 WILLIAM CLUTTERBUCK 1.00 X 0 353421 29595 GUY D CHAPDELAINE 1.00 X X 0 0 0 STEPHEN CAMANN 1.00 X X 0 0 0 JOSEPH GRAHAM 1.00 X X 0 0 0 MSGR JOHN P QUINN 1.00 X X 0 0 0 ADELE BOUFFORD BAKER 1.00 X 0 0 0 GARY BOUCHARD PHD 1.00 X 0 0 0 SUZANNA D MAJEWSKI 1.00 X 0 0 0 PAUL S BOYNTON 1.00 X 0 0 0 SUZANNE K MELLON PHD RN 1.00 X 0 0 0 DARYL J CADY 1.00 X 0 0 0 MARGARET-ANN MORAN ESQ 1.00 X 0 0 0 ANNE M O'CONNOR MD 1.00 X 0 0 0 ELEANOR WM DAHAR ESQ 1.00 X 0 0 0 RONALD J RIOUX 1.00 X 0 0 0 JEROME DUVAL 1.00 X 0 0 0 KEITH A STAHL MD 1.00 X 0 251327 27443 JEFF EISENBERG 1.00 X 0 0 0 REV GAYLE WHITTEMORE 1.00 X 0 0 0 RAEF FAHMY DPM 1.00 X 0 56612 0 BISHOP FRANCIS J CHRISTIAN 1.00 X 0 0 0 BEJAMIN WESTBROOK MD 1.00 X 0 0 0 KATHLEEN ZAFFION MD 1.00 X 0 0 0 RAYMOND BONITO 1.00 X 0 407078 133639 ALLEN ERICSON 1.00 X 0 342167 49551 KEVIN KILDAY 0.00 X 0 344398 44045 0 3115436 672079 0 1 1 0 0 RENT INCOME FROM AFFIL 532000 569879 569879 569879 109 109 498527 30938 467589 467589 467589 1037577 569879 0 467698 523476 523476 180900 180900 52353 52353 756729 756729 0 0 0 51380 50077 98223 56136 17034 21942 4580590 1798214 2370983 2782376 2537620 2910531 87978 115041 87978 115041 X 2449642 2795490 2449642 2795490 2537620 2910531 X 280848 65000 X 0 1 1 X 0 X X X 0 0 0 CMC 020315693 3 1 1 1 0 1 0 633839 633839 3810908 1671874 2139034 109672 109672 0 26171 16668 9503 2782376 1037577 756729 280848 65000 65000 345848 PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFER FROM AFFILIATE 65,000. X X X X X 1 1 0 0 0 0 0 1 0 ALYSON PITMAN GILES 0 611927 0 137472 0 0 0 274487 0 96529 0 1120415 0 0 CONNOR J HAUGH 0 491157 0 119877 0 0 0 14723 0 2067 0 627824 0 0 WILLIAM CLUTTERBUCK 0 353421 0 0 0 0 0 10979 0 18616 0 383016 0 0 KEITH A STAHL MD 0 219994 0 31333 0 0 0 8299 0 19144 0 278770 0 0 RAYMOND BONITO 0 346879 0 60199 0 0 0 91903 0 41736 0 540717 0 0 ALLEN ERICSON 0 306319 0 35848 0 0 0 16045 0 33506 0 391718 0 0 KEVIN KILDAY 0 344398 0 0 0 0 0 12707 0 31338 0 388443 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 $137,977 4B: THE FOLLOWING INDIVIDUALS TAKE PART IN A SECTION 457(F) FORFEITABLE NONQUALIFIED DEFERRED COMPENSATION PLAN. THIS REPRESENTS CONTRIBUTIONS FOR MANY YEARS OF SERVICE. ALYSON PITMAN GILES: $257,348 RAYMOND BONITO: $80,065 ALLEN ERICSON: $5,019 KEVIN KILDAY: $9,356 PART I, LINE 7 A PORTION OF COMPENSATION IS AT-RISK AND VARIABLE, AND PAYMENT DEPENDS ON THE QUALITY OF JOB PERFORMANCE. 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 THE FORM 990 IS PRESENTED TO THE BOARD BEFORE IT IS FINALIZED. 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 C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, LINE 1B: AVERAGE HOURS PER WEEK FOR A RELATED ORGANIZATION ALYSON GILES: 60 HRS WILLIAM CLUTTERBUCK, MD: 40 HRS CONNOR HAUGH, MD: 40 HRS KEITH STAHL, MD: 40 HRS RAYMOND BONITO: 50 HRS ALLEN ERICSON: 50 HRS RAEF FAHMY, DPM: 40 HRS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: TRANSFER FROM AFFILIATE 65,000. TOTAL TO FORM 990, PART XI, LINE 5: 65,000. ALLIANCE HEALTH SERVICES 100 MCGREGOR ST MANCHESTER NH 03102 611508839 PRACTICES NH 501(C)(3) LINE 11B, II CMC SYSTEM 0 CATHOLIC MEDICAL CENTER 100 MCGREGOR ST MANCHESTER NH 03102 020315693 HOSPITAL NH 501(C)(3) LINE 3 CMC SYSTEM 0 CMC HEALTHCARE SYSTEM 100 MCGREGOR ST MANCHESTER NH 03102 010568516 PARENT NH 501(C)(3) LINE 11B, II N/A 0 CMC ASSOCIATES 100 MCGREGOR ST MANCHESTER NH 03102 020344786 GIFT SHOP NH 501(C)(3) LINE 11B, II CMC 0 CMC PHYSICIAN PRACTICE ASSOCIATES 100 MCGREGOR ST MANCHESTER NH 03102 020460245 PRACTICES NH 501(C)(3) LINE 11B, II CMC SYSTEM 0 NEHI FOUNDATION 100 MCGREGOR ST MANCHESTER NH 03102 223041916 SUPPORT NH 501(C)(3) LINE 7 CMC 0 ST PETERS HOME 100 MCGREGOR ST MANCHESTER NH 03102 020222228 HOME NH 501(C)(3) LINE 9 CMC SYSTEM 0 ALLIANCE AMBULATORY SERVICES 100 MCGREGOR ST MANCHESTER NH 03102 020519436 AMBULATORY SURGICAL CENTER NH 501(C)(3) LINE 11B, II CMC SYSTEM 0 MCGREGOR STEET MOB 100 MCGREGOR ST MANCHESTER NH 03102 134347316 MEDICAL OFFICE BUILDING NH CMC SYSTEM 0 0 0.00000 DOCTORS MEDICAL ASSOCIATION 100 MCGREGOR ST MANCHESTER NH 03102 020340690 MEDICAL OFFICE BUILDING NH CMC SYSTEM C ALLIANCE ENTERPRISES 100 MCGREGOR ST MANCHESTER NH 03102 020386795 REAL ESTATE NH CMC SYSTEM C 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1