2012-05-14T12:12:18-05:00 2011-06-30 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2010-07-01 020315693 CATHOLIC MEDICAL CENTER CATH 6036683545 C/O FINANCE DEPT 100 MCGREGOR STREET MANCHESTER NH 031023770 EDWARD DUDLEY 6036683545 2012-05-03 E DREW CHENEY 2078792100 2010 2016-02-24 21:20:13Z ALYSON PITMAN GILES C/O FINANCE DEPT 100 MCGREGOR STREET MANCHESTER NH 031023770 324124670 0 0928 X WWW.CATHOLICMEDICALCENTER.ORG X 1974 NH THE MISSION OF CATHOLIC MEDICAL CENTER IS TO PROVIDE HEALTH, HEALING, AND HOPE TO ALL. 22 17 2342 405 0 0 390994 390704 270543220 294570757 2373630 3970821 4427012 16731668 277734856 315663950 0 0 0 0 121452462 136572632 0 0 226056 144731758 164166429 266184220 300739061 11550636 14924889 232863478 258264871 179364600 157683086 53498878 100581785 X THE MISSION OF CATHOLIC MEDICAL CENTER IS TO PROVIDE HEALTH, HOPE AND HEALING TO ALL. WE OFFER INNOVATIVE, QUALITY HEALTHCARE IN A COMPASSIONATE ENVIRONMENT BUILT ON TRUST AND RESPECT. CMC IS A CATHOLIC ACUTE CARE HOSPITAL WHOSE PURPOSE IS TO EXTEND CHRIST'S HEALING MINISTRY TO ALL WHO SEEK ITS SERVICES. (CONTINUATION FROM PAGE 2) 0 0 193709126 309328186 MEDICAL & SURGICAL SERVICES PROVIDED TO 10,764 INPATIENTS AND 275,425 OUTPATIENTS. 67932030 1974239 VARIOUS OTHER SERVICES. PLEASE SEE SCHEDULE H.CATHOLIC MEDICAL CENTER (CMC), AS AN AGENCY OF THE ROMAN CATHOLIC CHURCH, SHALL PROVIDE HEALTH CARE IN A MANNER CONSISTENT WITH THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES AS INTERPRETED BY THE ROMAN CATHOLIC BISHOP OF MANCHESTER. CMC SHALL EMPLOY THE HIGHEST QUALITY HEALTH CARE PROFESSIONALS AND THE MOST APPROPRIATE TECHNOLOGY TO DELIVER AN ARRAY OF SERVICES EITHER DIRECTLY OR THROUGH STRATEGIC ALLIANCES WITH COMPATIBLE HEALTH CARE PROVIDERS. CMC SHALL TREAT WITH DIGNITY AND WITH OTHER COMPASSION THE BODY, MIND AND SPIRIT OF ALL WHO SEEK OR PROVIDE CARE AND COMFORT. DETAIL FOR THIS IS PROVIDED IN SCHEDULE H. 261641156 1 1 0 1 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 204 0 1 2342 1 0 0 0 0 0 0 0 0 0 0 X 22 17 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NH X EDWARD DUDLEY 6036683545 100 MCGREGOR STREET MANCHESTER NH 031023770 X ALYSON PITMAN GILES 60.00 X X 749399 0 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 40.00 X 56612 0 0 BISHOP FRANCIS J CHRISTIAN 1.00 X 0 0 0 BENJAMIN WESTBROOK 1.00 X 0 0 0 KATHLEEN ZAFFINO MD 1.00 X 0 0 0 RAYMOND BONITO 50.00 X 407078 0 133639 ALLEN ERICSON 50.00 X 342167 0 49551 JOSEPH PEPE 40.00 X 319480 0 12434 ROBERT DUHAIME 40.00 X 236803 0 26369 BRIAN TEW 40.00 X 215464 0 25928 MARGO COMPAGNA 40.00 X 220298 0 23508 LISA ROUX COGGINS 40.00 X 195617 0 14740 KEVIN KILDAY 0.00 X 344398 0 44045 3087316 1215782 775058 68 1 1 0 DARTMOUTH-HITCHCOCK CLINIC 100 HITCHCOCK WAY MANCHESTER NH 03104 MEDICAL SERVICES 1690116 GRIFFIN YORK AND KRAUSE 121 RIVER FRONT DR MANCHESTER NH 03102 MARKETING SERVICES 1475204 HARVEY CONSTRUCTION CORP TEN HARVEY ROAD BEDFORD NH 03110 CONSTRUCTION SERVICES 885258 ARAMARK MANAGEMENT SERVICE PO BOX 33170 NEWARK NJ 07188 STAFFING SERVICES 704913 DEVINE MILLIMET AND BRANCH PO BOX 719 MANCHESTER NH 03105 LEGAL SERVICES 682206 32 390704 390704 PATIENT SERVICE REV. 900099 294570757 294570757 294570757 1983762 1983762 315596 315596 315596 315596 10433779 14000 8430774 29946 2003005 -15946 1987059 1987059 EMPLOYEE SALES 722210 1322683 1322683 15093389 15093389 16416072 315663950 311302425 0 3970821 2686306 2257988 428318 99784429 83777354 15891743 115332 11539702 9698431 1839697 1574 15250840 12819169 2431671 7311355 6138947 1164498 7910 1224694 1029423 195271 275000 231153 43847 7568 6361 1207 5168659 4344542 824117 1778162 1460979 277133 40050 2221196 1863787 353542 3867 3455659 2904671 550988 7223129 6071437 1151692 196481 165153 31328 162906 136931 25975 2798611 2352386 446225 10791994 9071264 1720730 2334167 1961996 372171 MEDICAL SUPPLIES 55374682 46545464 8829218 BAD DEBT EXPENSE 23309455 23309455 PHYSICIAN FEES 20887455 20887455 MEDICAID ENHANCEMENT TA 12521429 12521429 EQUIPMENT MAINTENANCE 7966735 6696479 1270256 6468447 5388902 1022222 57323 300739061 261641156 38871849 226056 35440334 46716254 4743419 4748890 27689982 32302845 417534 319476 1224129 1228166 2313505 3402177 198455958 120769175 81772991 77686783 78265782 90967858 995802 892422 232863478 258264871 26716213 31720126 842714 744653 70742817 70561568 248508 81062856 54408231 179364600 157683086 X 46874594 93318020 357814 381533 6266470 6882232 53498878 100581785 232863478 258264871 X 14924889 32158018 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 39857 39857 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: CATHOLIC MEDICAL CENTER IS A MEMBER OF THE NH HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS AVAILABLE FOR LOBBYING EXPENDITURES ON BEHALF OF CMC AND THE OTHER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES. CMC DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. DEVINE, MILLIMET AND BRANCH, PA PROVIDED LOBBYING SERVICES WHICH INCLUDED PROVIDING INFORMATION REGARDING PUBLIC POLICY PENDING BEFORE THE LEGISLATURE. DEVINE, MILLIMET AND BRANCH, PA PARTICIPATED IN THE ADMINISTRATIVE RULE-MAKING PROCESS WITH RESPECT TO RULES CONCERNING THE CERTIFICATE OF NEEDS BOARD. THEY ALSO PROVIDED GENERAL COMMUNICATION WITH ELECTED OFFICIALS. 6624284 81408 618215 60143 7263764 6155849 468435 6624284 7356078 31900 -1232129 6155849 0.00000 0.94750 0.05250 0 0 1024690 1024690 75260904 27135505 48125399 4345589 2934299 1411290 116117624 89533417 26584207 1707151 1165954 541197 77686783 ACCRUED PENSION & OTHER LIABILITIES 53434346 DUE TO AFFILIATES 973885 54408231 315663950 300739061 14924889 10001115 22156903 32158018 47082907 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PROCEEDS FROM THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED IN OPERATIONS. PART XI, LINE 8 - OTHER ADJUSTMENTS: NET TRANSFER (TO) FROM AFFILIATES -7,530,577. PENSION RELATED CHANGES OTHER THAN NET PERIODIC COST 29,331,769. CHANGE IN INTEREST IN PERPETUAL TRUST 408,370. ASSETS RELEASED FROM RESTRICTION USED FOR OPERATIONS -40,163. ADOPTION OF NEW ACCOUNTING PRINCIPLE - GOODWILL IMPAIRMENT -12,496. 1 1 1 X 0 1 1 0 1 1 14347 8731675 8731675 0.02900 21475 13811586 13811586 0.04590 63966 25961497 25961497 0.08630 99788 48504758 48504758 0.16120 336574 4130687 216156 3914531 0.01300 2793 669676 669676 0.00220 24361 13887396 1749083 12138313 0.04040 379 106370 9000 97370 0.00030 633143 633143 0.00210 364107 19427272 1974239 17453033 0.05800 463895 67932030 1974239 65957791 0.21920 2366 696721 109136 587585 0.00200 2366 696721 109136 587585 0.00200 1 8041762 81680942 107417951 -25737009 X 1 1 1 1 CATHOLIC MEDICAL CENTER

100 MCGREGOR STREET MANCHESTER NH 03102

X X X CATHOLIC MEDICAL CENTER 1 1 1 200.000000000000 1 200.000000000000 1 X X X X X 1 1 X X 1 X X X 1 X X 1 X 0 1 PART II: COMMUNITY SUPPORT: SCHOOL PARTNERSHIPS -PARTNERSHIP WITH MANCHESTER SCHOOL SYSTEM -PARTNERSHIP WITH VNA, EDUCATION FOR CLASSROOM TEACHERS -PARTNERHIP WITH VNA, EDUCATION FOR PRESCHOOL CLASSROOMSEMERGENCY SERVICES: PLANNING HOURS FOR EMERGENCY PREPAREDNESS -BIOTERRORISM PREPAREDNESS SAFETY MANAGEMENT PART III, LINE 4: THERE IS NO FOOTNOTE IN THE FINANCIAL STATEMENT DESCRIBING BAD DEBT EXPENSE.COSTING METHODOLOGY - RATIO OF COST TO CHARGE TO ARRIVE AT COST. PART III, LINE 8: THE AMOUNT IN LINE 7 IS REPORTED ON OUR COMMUNITY BENEFIT REPORT TO THE STATE OF NEW HAMPSHIRE. PART III, LINE 9B: ALL PATIENTS ARE TREATED THE SAME ACCORDING TO OUR COLLECTION PROCEDURES. CATHOLIC MEDICAL CENTER PART V, SECTION B, LINE 13G: SIGNS ARE POSTED THROUGHOUT THE FACILITY WHICH DETAIL THE FINANCIAL PROGRAMS AVAILABLE. CATHOLIC MEDICAL CENTER PART V, SECTION B, LINE 17E: SIGNS ARE POSTED THROUGHOUT THE FACILITY THAT LIST THE FINANCIAL PROGRAMS. PHRASES APPEAR ON OUR STATEMENTS AND PATIENTS ARE NOTIFIED DURING PHONE CONVERSATIONS. CATHOLIC MEDICAL CENTER PART V, SECTION B, LINE 19D: ALL PATIENTS ARE CHARGED THE SAME REGARDLESS OF ABILITY TO PAY. CATHOLIC MEDICAL CENTER PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE SAME REGARDLESS OF ABILITY TO PAY. PART VI, LINE 2: IN COLLABORATION WITH THE CITY OF MANCHESTER AND OTHER HEALTH CARE AND SOCIAL SERVICE AGENCIES, CMC PARTICIPATES IN A COMMUNITY NEEDS ASSESSMENT EVERY FIVE YEARS AS REQUIRED BY THE NH ATTORNEY GENERAL'S OFFICE DIVISION OF CHARITABLE TRUSTS. THE MOST RECENT COMMUNITY NEEDS ASSESSMENT, BELIEVE IN A HEALTHY COMMUNITY 2009. ADDITIONAL INFORMATION IS OBTAINED ON AN ONGOING BASIS TO ASSIST THE ORIGINATION IN EVALUATING PROGRESS TOWARDS MEETING OUR GOALS AND THE IDENTIFICATION OF NEWS AREAS OF NEED. THIS INFORMATION IS COLLECTED THROUGH COMMUNITY SURVEYS, FOCUS GROUPS AND DISCUSSIONS WITH COMMUNITY LEADERS, PROGRAM EVALUATIONS AND COMMUNICATION WITH THOSE IN THE COMMUNITY WHO INTERACT WITH OUR VULNERABLE POPULATIONS. PART VI, LINE 3: FLYERS ARE POSTED THROUGHOUT THE HOSPITAL AND PRACTICES HIGHLIGHTING CATHOLIC MEDICAL CENTER'S UNCOMPENSATED CARE PROGRAM. INPATIENTS WITH NO INSURANCE ARE REFERRED TO OUR SOCIAL SERVICE DEPARTMENT FOR AN EVALUATION TO DETERMINE ELIGIBILITY FOR FEDERAL, STATE AND CMC'S UNCOMPENSATED PROGRAM. THE DEPARTMENT WORKS WITH THEM TO FACILITATE THE APPLICATION PROCESS. OUTPATIENTS ARE REFERRED TO THE UNCOMPENSATED CARE OFFICE FOR SUCH AN EVALUATION AND FACILITATION OF THE PROCESS IF APPROPRIATE. PART VI, LINE 4: CATHOLIC MEDICAL CENTER'S PRIMARY SERVICE AREA CONSISTS OF THE FOLLOWING TOWNS AND CITIES: AUBURN, BEDFORD, CANDIA, DEERFIELD, GOFFSTOWN, HOOKSETT, LONDONDERRY, MANCHESTER AND NEW BOSTON. OUR SECONDARY SERVICE AREA IS MADE UP OF ALLENSTOWN, AMHERST, BOW, CHESTER, DERRY, DUNBARTON, MERRIMACK, RAYMOND AND WEARE. PART VI, LINE 6: COMMUNITY SUPPORT: CMC IS INVOLVED IN A NUMBER OF COMMUNITY INITIATIVES TO IMPROVE THE HEALTH OUTCOMES OF OUR COMMUNITY; MANCHESTER SUSTAINABLE ACCESS PROJECT (MSAP), AN INITIATIVE TO IMPROVE HEALTH CARE ACCESS FOR THE POOR IN OUR COMMUNITY MADE UP OF ALL THE MAJOR HEALTH CARE PROVIDER'S SENIOR LEADERSHIP TEAMS; MANCHESTER ORAL HEALTH PROJECT TO IMPROVE THE ORAL HEALTH OF CHILDREN; CMC SCHOOL PARTNERSHIPS WITH AN ELEMENTARY, MIDDLE AND HIGH SCHOOL FOR HEALTH PREVENTION EDUCATION, STATE OF NH IN THE PROMOTION OF HEALTHY BEHAVIORS TO IMPROVE EDUCATIONAL OUTCOMES (LAEP), EMERGENCY AND BIOTERRORISM PREPAREDNESS SAFETY MANAGEMENT TO NAME A FEW OF OUR COMMUNITY INITIATIVES. PART VI, LINE 7: CMC IS A LICENSED 330 BED FULL SERVICE ACUTE CARE HOSPITAL LOCATED IN MANCHESTER NH, THE STATE'S LARGEST CITY. CMC IS KNOWN FOR ITS ADVANCED CARDIAC AND GENERAL CARE SURGICAL CAPABILITIES AND ITS COMPREHENSIVE PROGRAMS FOR HIGH ACUITY PATIENTS. SERVING THE COMMUNITY FOR MORE THAN 100 YEARS, CMC IS DEDICATED TO PROVIDING HEALTH, HEALING AND HOPE TO ALL. CMC OFFERS FULL MEDICAL AND SURGICAL CARE WITH MORE THAN 25 SUBSPECIALTIES, COMPREHENSIVE ORTHOPEDIC CARE, INPATIENT AND OUTPATIENT REHABILITATION SERVICES, A 24 HOUR EMERGENCY DEPARTMENT, OUTPATIENT PSYCHIATRIC SERVICES, DIAGNOSTIC IMAGING AND COMMUNITY HEALTH SERVICES. CMC PROVIDES INPATIENT AND OUTPATIENT SERVICES AT ITS MCGREGOR STREET FACILITY TO ALMOST 110,000 PATIENTS PER YEAR, MAKING IT ONE OF THE STATE'S LARGEST MEDICAL CENTERS.CMC IS THE HOME OF THE NATIONALLY RECOGNIZED NEW ENGLAND HEART INSTITUTE (NEHI). NEHI COMPRISES CARDIOLOGISTS WHO ARE BOARD CERTIFIED IN INTERVENTIONAL CARDIOLOGY, ELECTROPHYSIOLOGY, AND NON-INVASIVE CARDIOLOGY. THESE SPECIALISTS ARE JOINED BY BOARD CERTIFIED CARDIOVASCULAR SURGEONS AND THE ONLY BOARD CERTIFIED LIPIDOLOGIST CARDIOLOGIST IN NH. CMC HAS BEEN NAMED ONE OF THE 100 BEST HOSPITALS IN THE NATION FOR CARDIAC CARE BY HEALTHGRADES. WE ARE ALSO PROUD TO BE THE RECIPIENT OF A NUMBER OF OTHER RECOGNITIONS FOR OUR CARDIAC SERVICES.- RANKED AMONG THE TOP 10 IN THE NATION FOR CARDIOLOGY SERVICE AND OVERALL CARDIAC CARE - HOLD A FIVE STAR RATING FOR CARDIAC SERVICES, FOR TREATMENT OF HEART ATTACK AND FOR INTERVENTIONAL PROCEDURES - RATED NUMBER 1 IN NH FOR CARDIAC SERVICES AND INTERVENTIONAL PROCEDURES CMC CONTINUES TO LEAD THE WAY IN ADVANCED MEDICAL TECHNOLOGY. IT IS ONE OF THE FEW HOSPITALS IN NEW ENGLAND USING THE DAVINCI SURGICAL ROBOTICS SYSTEMS TO PERFORM LIFE SAVING SURGERY WITH FEWER COMPLICATIONS. WE WERE THE FIRST HOSPITAL TO UTILIZE A 64SLICE CT SCANNER TO PROVIDE FASTER, LESS INVASIVE DIAGNOSIS OF CARDIAC DISEASE. CMC IS EQUIPPED WITH AN ACHIEVA QUASAR3.0 T MRI ALLOWING FOR HIGHER RESOLUTION IMAGES IN LESS TIME. THE ORTHOPEDIC SURGEONS HAVE ACCESS TO NEW O-ARM IMAGING SYSTEM, A HIGHER DEFINITION CT SCANNER THAT PROVIDES REAL TIME THREE DIMENSIONAL IMAGES DURING SURGERY. CMC ALSO OFFERS DIGITAL MAMMOGRAPHY TO BETTER SERVE AND CARE FOR OUR POPULATION. ALMOST 400 PHYSICIANS HAVE SOME LEVEL OF PRIVILEGES AT CMC. CMC MAINTAINS A RIGOROUS APPLICATION AND CREDENTIALING PROCESS FOR ITS STAFF TO ENSURE THAT PATIENTS RECEIVE THE HIGHEST QUALITY OF CARE POSSIBLE. CMC HAS A JOINT VENTURE WITH A FREE STANDING AMBULATORY SURGICAL CENTER. CMC HAS A DEEPLY ROOTED HISTORY OF PROVIDING CARE TO THOSE MOST IN NEED THROUGH THE COMMUNITY HEALTH SERVICES DEPARTMENT. CMC REACHES BEYOND THE WALLS OF THE HOSPITAL AND INTO THE COMMUNITY ASSISTING INDIVIDUALS WITH HEALTH INFORMATION AND ACCESS TO CARE. COMMUNITY HEALTH SERVICES PROVIDES A WIDE VARIETY OF EDUCATION, CLINICAL SERVICES AND RESOURCES FOR THOSE IN OUR PRIMARY AND SECONDARY MARKETS. IT IS THE HOME OF THE WEST SIDE NEIGHBORHOOD HEALTH CENTER, THE POISSON DENTAL FACILITY, THE HEALTH CARE FOR THE HOMELESS PROGRAM AND THE PARISH NURSE PROGRAM. WE PROVIDE MEDICATION ASSISTANCE, BREAST AND CERVICAL CANCER SCREENINGS, HEALTH SCREENINGS, AND FERTILITY EDUCATION. REPORTS FILED WITH STATES PART VI, LINE 7 NH X X X X X 1 1 0 0 0 0 0 1 0 ALYSON PITMAN GILES 611927 0 137472 0 0 0 274487 0 96529 0 1120415 0 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 346879 0 60199 0 0 0 91903 0 41736 0 540717 0 0 0 ALLEN ERICSON 306319 0 35848 0 0 0 16045 0 33506 0 391718 0 0 0 JOSEPH PEPE 297429 0 22051 0 0 0 10849 0 1585 0 331914 0 0 0 ROBERT DUHAIME 223804 0 12999 0 0 0 8563 0 17806 0 263172 0 0 0 BRIAN TEW 198792 0 16672 0 0 0 8015 0 17913 0 241392 0 0 0 MARGO COMPAGNA 207331 0 12967 0 0 0 7932 0 15576 0 243806 0 0 0 LISA ROUX COGGINS 182513 0 13104 0 0 0 7283 0 7457 0 210357 0 0 0 KEVIN KILDAY 344398 0 0 0 0 0 12707 0 31338 0 388443 0 0 0 PART I, LINES 4A-B PART I, LINES 4A-B: 4A: THE FOLLOWING INDIVIDUAL RECEIVED COMPENSATION UNDER A SEVERANCE AGREEMENT. KEVIN KILDAY $137,977 4B: THE FOLLOWING INDIVIDUALS TAKE PART IN A SECTION 457(F) FORFEITABLE NONQUALIFIED DEFERRED COMPENSATION PLAN. THESE REPRESENT CONTRIBUTIONS FOR MANY YEARS OF SERVICE. ALYSON PITMAN GILES: $257,348 RAY 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. NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 64461TCV4 2006-05-10 32910000 CONSTRUCTION & DEFEASANCE ESCROW 0 0 0 NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 NONEAVAIL 2010-04-20 7000000 REFINANCE 2009 NOTE 0 0 0 32910000 3111888 9891082 480821 20559500 1226860 2009 0 1 1 1 7000000 7000000 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 1 0 0 1 MBIA 5.900000000000 1 1 0 1 0 0 0 0 0 0 0 SARAH PITMAN FAMILY MEMBER OF ALYSON PITMAN GILES 54635 EMPLOYMENT 0 SETH PITMAN FAMILY MEMBER OF ALYSON PITMAN GILES 12750 EMPLOYMENT 0 JOYCE DUVAL FAMILY MEMBER OF JEROME DUVAL 32795 EMPLOYMENT 0 GRANITE STATE EMERGENCY PHYSICIANS KATHLEEN ZAFFINO IS A MINORITY OWNER 527293 ENTITY IS AN INDEPENDENT CONTRACTOR OF EMERGENCY ROOM PHYSICIANS 0 CARDIOTHORACIC SURGICAL ASSOCIATES ENTITY MORE THAN 35% OWNED BY BENJAMIN WESTBROOK 232855 ENTITY IS AN INDEPENDENT CONTRACTOR THAT PROVIDES A MEDICAL DIRECTOR OF CARDIOVASCULAR SURGERY. 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF CMC IS CMC HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS OF CMC ARE APPOINTED BY THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS RESERVED POWERS OVER CMC BUT DOES NOT APPROVE EACH SEPARATE ACTION TAKEN BY THE CMC BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PRESENTED TO THE BOARD BEFORE FINALIZED. 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 CMC 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 PERFOMANCE AND MISSION PERFORMANCE, NOT SOLELY REVENUE GENERATION. FORM 990, PART VI, SECTION C, LINE 19 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 CONNOR HAUGH: 40 HRS WILLIAM CLUTTERBUCK: 40 HRS KEITH A. STAHL, MD: 40 HRS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 10,001,115. NET TRANSFER (TO) FROM AFFILIATES -7,530,577. PENSION RELATED CHANGES OTHER THAN NET PERIODIC COST 29,331,769. CHANGE IN INTEREST IN PERPETUAL TRUST 408,370. ASSETS RELEASED FROM RESTRICTION USED FOR OPERATIONS -40,163. ADOPTION OF NEW ACCOUNTING PRINCIPLE - GOODWILL IMPAIRMENT -12,496. TOTAL TO FORM 990, PART XI, LINE 5: 32,158,018. ALLIANCE RESOURCES 100 MCGREGOR ST MANCHESTER NH 03102 020398138 REAL ESTATE NH 501(C)(3) LINE 11B, II CMC SYSTEMS 0 ALLIANCE HEALTH SERVICES 100 MCGREGOR ST MANCHESTER NH 03102 611508839 PRACTICES NH 501(C)(3) LINE 11B, II CMC SYSTEMS 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 SUPPORT NH 501(C)(3) LINE 11B, II CMC 1 CMC PHYSICIAN PRACTICE ASSOCIATES 100 MCGREGOR ST MANCHESTER NH 03102 020460245 PRACTICES NH 501(C)(3) LINE 11B, II CMC SYSTEMS 0 NEHI FOUNDATION 100 MCGREGOR ST MANCHESTER NH 03102 223041916 SUPPORT NH 501(C)(3) LINE 7 CMC 1 ST PETER'S HOME 100 MCGREGOR ST MANCHESTER NH 03102 020222228 HOME NH 501(C)(3) LINE 9 CMC SYSTEMS 0 ALLIANCE AMBULATORY SERVICES 100 MCGREGOR ST MANCHESTER NH 03102 020519436 PRACTICES NH 501(C)(3) LINE 11B, II CMC SYSTEMS 0 MCGREGOR ST MOB 100 MCGREGOR ST MANCHESTER NH 03102 134347316 MEDICAL OFFICE BLDG NH CMC SYSTEM 0 0 0.00000 ALLIANCE ENTERPRISES 100 MCGREGOR ST MANCHESTER NH 03102 020386795 REAL ESTATE NH CMC SYSTEM C DOCTORS MEDICAL ASSOCIATION 100 MCGREGOR ST MANCHESTER NH 03102 020340690 MEDICAL OFFICE BUILDING NH CMC SYSTEM C 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 1 NEW ENGLAND HEART INSTITUTE FOUNDATION R 267846 CASH TRANSFERRED