2024-08-14T07:35:00-05:00 2023-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2022-10-01 020519436 Alliance Ambulatory Services ALLI 6036683545 100 McGregor Street Manchester NH 03102 Pamela J Martel Vice President & CFO 6036683545 2024-08-01 1 0 Connor Smart P02285543 2078792100 2024-08-01 2022 2024-08-08 14:25:15Z Alexander Walker Jr Esq 100 McGregor Street Manchester NH 03102 2783159 0 0928 X www.catholicmedicalcenter.org X 2000 NH To promote and generate healthcare programs for a broad cross-section of the greater Manchester, New Hampshire community. 15 12 0 14 0 0 0 0 1600198 2782391 472 768 0 0 1600670 2783159 0 0 0 0 0 0 0 0 0 0 0 0 0 1600670 2783159 6443278 6974437 0 0 6443278 6974437 To create and promote healthcare programs in the Manchester, New Hampshire community. 0 0 0 0 2782391 Revenue from partnership interest in Bedford Ambulatory Surgical Center, LLC and Alliance Urgent Care Services, LLC. 1 0 0 0 0 0 0 0 0 0 0 0 1 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 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 NH X Pamela J Martel VP & CFO 6036683545 100 McGregor Street Manchester NH 03102 Alexander Walker Jr Esq President & CEO 0.20 43.70 X X 0 705005 397339 Louis I Fink MD Director (end 7/2023) 0.10 41.80 X 0 688177 19799 Patricia Furey Medical Staff President 0.20 41.60 X 0 505822 52436 Robert Capodilupo MD Interim Trustee/Exec Med Dir NEHI 0.10 40.70 X 0 686462 45682 Carolyn Claussen MD Director (end 12/2022) 0.00 41.10 X 0 252296 11658 Matthew Albuquerque Director 0.20 2.40 X 0 0 0 Re Msg Anthony Frontiero Director (end 4/2023) 0.10 0.60 X 0 0 0 William Furlong Director 0.20 0.90 X 0 0 0 Robert Gossett Director 0.20 2.40 X 0 0 0 Roger Jean Director 0.20 1.30 X 0 0 0 Dereck McDonald Director/Bishop's Delegate 2.00 2.40 X 0 0 0 Kristy Merrill Director 0.20 1.10 X 0 0 0 John J Munoz MD Director 0.20 1.30 X 0 0 0 Grace Tung Director 0.10 1.90 X 0 0 0 Timothy Riley Chair 0.20 2.60 X 0 0 0 John G Cronin Esq Chair (end 6/2023) 0.00 1.30 X X 0 0 0 Marie McKay CPA Treasurer 0.20 2.00 X X 0 0 0 Pamela Diamantis Vice Chair 0.20 2.60 X X 0 0 0 Matthew Kfoury Secretary 0.20 2.50 X X 0 0 0 Edward Dudley III Executive VP & CFO (end 2/2023) 0.00 40.10 X 0 548250 278328 Pamela Martel Executive VP & CFO 0.00 40.40 X 0 179495 18897 Joseph Pepe MD Former President & CEO (end 6/2021) 0.00 0.50 X 0 733333 1338 0 4298840 825477 0 1 1 0 0 Interest in Ambulatory 621990 2782391 2782391 2782391 768 768 2783159 2782391 0 768 0 0 0 0 318643 339725 134167 255556 5990468 6379156 6443278 6974437 0 0 X 6443278 6974437 6443278 6974437 6443278 6974437 X 2783159 -2252000 X X 0 1 X 1 0 X 2450518 1139618 4156106 1600198 2782391 12128831 2450518 1139618 4156106 1600198 2782391 12128831 0 0 0 12128831 14106 1252 389 472 768 16987 14106 1252 389 472 768 16987 2464624 1140870 4156495 1600670 2783159 12145818 0.99860 0.99840 0.00140 0.00160 X 0 Investment in affiliates 6379156 F 6379156 X 2783159 0 2783159 0 2783159 0 0 0 0 0 Part X, Line 2: The Organization is part of the CMC Healthcare System. The System and all related entities, with the exception of Enterprises, are not-for-profit corporations as described in Section 501(c)(3) of the Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to the consolidated financial statements. 1 1 0 0 0 0 0 0 0 Alexander Walker Jr Esq President & CEO 0 627831 0 0 0 77174 0 292846 0 104493 0 1102344 0 0 Edward Dudley III Executive VP & CFO (end 2/2023) 0 494403 0 338 0 53509 0 222434 0 55894 0 826578 0 0 Joseph Pepe MD Former President & CEO (end 6/2021) 0 0 0 0 0 733333 0 0 0 1338 0 734671 0 0 Robert Capodilupo MD Interim Trustee/Exec Med Dir NEHI 0 550015 0 136447 0 0 0 15250 0 30432 0 732144 0 0 Louis I Fink MD Director (end 7/2023) 0 543154 0 145023 0 0 0 15250 0 4549 0 707976 0 0 Patricia Furey Medical Staff President 0 466939 0 38883 0 0 0 12200 0 40236 0 558258 0 0 Carolyn Claussen MD Director (end 12/2022) 0 232669 0 19627 0 0 0 11648 0 10 0 263954 0 0 Pamela Martel Executive VP & CFO 0 178567 0 0 0 928 0 7491 0 11406 0 198392 0 0 Part I, Line 3 The Organization's President & CEO's compensation was established by a related organization, Catholic Medical Center. That organization used a compensation committee, independent compensation consultant, Form 990 of other organizations, a compensation survey/study, and approval by their board of directors/compensation committee to determine the President & CEO's compensation and benefits. Part I, Lines 4a-b Schedule J, Page 1, Line 4a, severance payments: Dr. Joseph Pepe, who previously served as the Organization's President and CEO, retired in June, 2021. As part of his retirement, Dr. Pepe became entitled to severance compensation, as per his employment agreement, from the Catholic Medical Center (a related organization). Dr. Pepe received severance compensation of $733,333 during calendar year 2022, after his formal retirement in June, 2021. This severance was included in his 2022 Form W-2 wages, and is also included in the amount of compensation reported on this Schedule J, Part II, Column B(iii). Schedule J, Page 1, Line 4b, supplemental non-qualified retirement plans: The following individuals take part in a section 457(f) forfeitable nonqualified deferred compensation plan. The amounts listed represent calendar year 2022 contributions for many years of service, and are included in the total deferred compensation reported on this Schedule J, Part II, Column C. - Edward Dudley, III: $211,145 - Alexander Walker, Jr., Esq.: $280,646 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 11b Form 990 is prepared by an independent tax accounting firm (Baker Newman Noyes). Upon completion, a draft of the Form 990 is sent to the Organization, where the Executive Director of Finance and Assistant Controller perform a final in-house review prior to submission to the Board of Directors for final review. Once provided and reviewed by the Board, the 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 policy annually. Form 990, Part VI, Section B, line 15 A related organization, Catholic Medical Center, 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 performance and mission performance, not solely revenue generation. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, line 9: Net transfers to affiliates -2,252,000. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Alliance Health Services 100 McGregor Street Manchester NH 03102 611508839 Practices NH 501(c)(3) Line 10 CMC Healthcare System 0 Catholic Medical Center 100 McGregor Street Manchester NH 03102 020315693 Hospital NH 501(c)(3) Line 3 CMC Healthcare System and GraniteOne Health 0 CMC Healthcare System 100 McGregor Street Manchester NH 03102 010568516 Parent NH 501(c)(3) Line 12b, II N/A 0 CMC Physician Practice Associates 100 McGregor Street Manchester NH 03102 020460245 Practices NH 501(c)(3) Line 10 CMC Healthcare System 0 St Peter's Home 100 McGregor Street Manchester NH 03102 020222228 Day Care Services NH 501(c)(3) Line 10 CMC Healthcare System 0 Alliance Resources 100 McGregor Street Manchester NH 03102 020398138 Real Estate NH 501(c)(3) Line 12b, II CMC Healthcare System 0 GraniteOne Health 100 McGregor Street Manchester NH 03102 814663563 Supporting Organization NH 501(c)(3) Line 12a, I N/A 0 Monadnock Community Hospital 452 Old Street Road Peterborough NH 03458 020222157 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 Huggins Hospital 240 South Main Street Wolfeboro NH 03894 020223332 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 Bedford Ambulatory Surgical Center LLC 11 Washington Place Bedford NH 03110 020519727 Surgical Center NH N/A Related 1901920 4019350 0 1 0.42590 Alliance Urgent Care Services LLC 100 McGregor Street Manchester NH 03102 831238167 Health Care Services NH N/A Related 0 1 0.50000 Doctors' Medical Association 100 McGregor Street Manchester NH 03102 020340690 Medical Office Building NH N/A C 0 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1