ALLIANCE AMBULATORY SERVICES: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- ALLIANCE AMBULATORY SERVICES (EIN 02-0519436)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-14
- IRS object ID
- 201211359349302646
- Schema version
- 2010v3.4
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-14T12:12:18-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 507 | AddressLine1 |
| City | PORTLAND | City |
| State | ME | State |
| ZIP Code | 04112 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020519436 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALLIANCE AMBULATORY SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ALLI | NameControl |
| Phone | 6036683545 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MCGREGOR ST | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03102 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | EDWARD L DUDLEY III | Name |
| Title | SENIOR VP & CFO | Title |
| Phone | 6036683545 | Phone |
| Date Signed | 2012-05-02 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | E DREW CHENEY | Name |
| Phone | 2078792100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | EDWARD L DUDLEY III | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MCGREGOR ST | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3130637 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CATHOLICMEDICALCENTER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2000 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | TO PROMOTE AND GENERATE HEALTHCARE PROGRAMS FOR A BROAD CROSS-SECTION OF THE GREATER MANCHESTER NEW HAMPSHIRE COMMUNITY | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 22 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 17 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 21 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2962194 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 3130375 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 262 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 227 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2962421 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3130637 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 317432 | OtherExpensePriorYear |
| Other Expenses Current Year | 317432 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 317432 | TotalExpensesPriorYear |
| Total Expenses Current Year | 317432 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2644989 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2813205 | RevenuesLessExpensesCY |
| Total Assets BOY | 6162597 | TotalAssetsBOY |
| Total Assets EOY | 6535802 | TotalAssetsEOY |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6162597 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6535802 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO CREATE AND PROMOTE HEALTHCARE PROGRAMS IN THE MANCHESTER NEW HAMPSHIRE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 317432 | Expense |
| Revenue | 3130375 | Revenue |
| Description | REVENUE FROM PARTNERSHIP INTEREST IN BEDFORD AMBULATORY SURGICAL CENTER, LLC | Description |
| Total Program Service Expense | 317432 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 1 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 22 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 17 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 1 | LocalChapters |
| Policies Reference Chapters | 1 | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EDWARD L DUDLEY III | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6036683545 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MCGREGOR ST | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (28 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | FormerFormer |
|---|---|---|---|---|---|---|---|
| ALYSON PITMAN GILES | |||||||
| PRESIDENT & CEO | 1.00 | X | X | 0 | 749399 | 371016 | |
| CONNOR J HAUGH | |||||||
| DIRECTOR | 1.00 | X | 0 | 611034 | 16790 | ||
| WILLIAM CLUTTERBUCK | |||||||
| DIRECTOR | 1.00 | X | 0 | 353421 | 29595 | ||
| GUY D CHAPDELAINE | |||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| STEPHEN CAMANN | |||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| JOSEPH GRAHAM | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| MSGR JOHN P QUINN | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| ADELE BOUFFORD BAKER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| GARY BOUCHARD PHD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| SUZANNA D MAJEWSKI | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| PAUL S BOYNTON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| SUZANNE K MELLON PHD RN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DARYL J CADY | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| MARGARET-ANN MORAN ESQ | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ANNE M O'CONNOR MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ELEANOR WM DAHAR ESQ | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RONALD J RIOUX | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JEROME DUVAL | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| KEITH A STAHL MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 251327 | 27443 | ||
| JEFF EISENBERG | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| REV GAYLE WHITTEMORE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RAEF FAHMY DPM | |||||||
| DIRECTOR | 1.00 | X | 0 | 56612 | 0 | ||
| BEJAMIN WESTBROOK MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| KATHLEEN ZAFFION MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| BISHOP FRANCIS J CHRISTIAN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RAYMOND BONITO | |||||||
| EXEC. VP | 1.00 | X | 0 | 407078 | 132829 | ||
| ALLEN ERICSON | |||||||
| COO | 1.00 | X | 0 | 342167 | 49551 | ||
| KEVIN KILDAY | |||||||
| CFO | 0.00 | 0 | 344398 | 44045 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3115436 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 671269 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INTEREST IN AMBULATORY | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 3130375 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3130375 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 3130375 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 262 | TotalRevenueColumn |
| Exclusion | $262 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3130637 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3130375 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $262 | ExclusionAmount |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 317432 | Total |
| Program Services | 317432 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 317432 | Total |
| Program Services | 317432 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113803 | BOY |
| EOY | 211065 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6048794 | BOY |
| EOY | 6324737 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6162597 | BOY |
| EOY | 6535802 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6162597 | BOY |
| EOY | 6535802 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6162597 | BOY |
| EOY | 6535802 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6162597 | BOY |
| EOY | 6535802 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2813205 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -2440000 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020315693 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $0 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INVESTMENT IN BEDFORD AMBULATORY SURGICAL CARE | Description |
| Book Value | 6324737 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 6324737 | TotalBookValueOtherAssets |
| Total Revenue | 3130637 | TotalRevenue |
| Total Expenses | 317432 | TotalExpenses |
| Excess Or Deficit For Year | 2813205 | ExcessOrDeficitForYear |
| Other | -$2,440,000 | OtherAmount |
| Total Adjustments | -2440000 | TotalAdjustments |
| Excess Or Deficit Per FS | 373205 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART XI, LINE 8 - OTHER ADJUSTMENTS: | Identifier |
| Explanation | TRANSFER TO AFFILIATES -2,440,000. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 91093 | 0 | 41736 | 0 | 539907 | 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 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF ALLIANCE AMBULATORY SERVICES IS CMC HEALTHCARE SYSTEM | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE DIRECTORS OF ALLIANCE AMBULATORY SERVICES ARE APPOINTED BY THE SOLE MEMBER. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE 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 11 | A FORM 990 IS PRESENTED TO THE BOARD BEFORE IT IS FINALIZED. | |
| OFFICERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST POLICY ANNUALLY. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| 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 | FROM 990, PART VII, LINE 1B: | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | TRANSFER TO AFFILIATES -2,440,000. TOTAL TO FORM 990, PART XI, LINE 5: -2,440,000. | FORM 990, PART XI, LINE 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
| 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 RESOURCES | |||||||||||
| 100 MCGREGOR ST | MANCHESTER | NH | 03102 | 020398138 | REAL ESTATE | NH | 501(C)(3) | LINE 11B, II | CMC SYSTEM | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGREGOR STEET MOB | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MCGREGOR ST | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 134347316 | EIN |
| Primary Activity | MEDICAL OFFICE BUILDING | PrimaryActivity |
| Legal Domicile State | NH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMC SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Percentage Ownership | 0.00000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Form990 Schedule R Part VI Form990ScheduleRPartVI
Name Of Business NameOfBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BEDFORD AMBULATORY SURGICAL CENTER LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 WASHINGTON PLACE | AddressLine1 |
| City | BEDFORD | City |
| State | NH | State |
| ZIP Code | 03110 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020519727 | EIN |
| Primary Activity | OUTPATIENT SURGERY | PrimaryActivity |
| Legal Domicile State | NH | LegalDomicileState |
| All Partners C3 S | 0 | AllPartnersC3S |
| Share Of EOY Assets | 3726826 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| Code V | $0 | CodeVAmount |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
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