2013-05-07T12:16:27-05:00 2012-06-30 010494526 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2011-07-01 020315693 Catholic Medical Center CATH 6036683545 C/O Finance Dept 100 McGregor Street Manchester NH 031023770 Edward L Dudley III 6036683545 2013-05-02 Nicholas E Porto P01310283 2078792100 2011 2016-02-25 16:41:14Z Joseph Pepe MD C/O Finance Dept 100 McGregor Street Manchester NH 031023770 330672703 0 0928 X www.catholicmedicalcenter.org X 1974 NH The mission of Catholic Medical Center is to provide health, healing, and hope to all. 19 14 2342 359 0 0 390704 3781596 294570757 318036565 3970821 2463731 16731668 -54409 315663950 324227483 0 0 0 0 136572632 131177658 0 0 245107 164166429 169864335 300739061 301041993 14924889 23185490 258264870 279702554 157683085 219082011 100581785 60620543 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 see its services. (Continuation from Page 2) 0 0 252494188 310406321 Medical & Surgical services provided to 9,702 inpatients and 371,422 outpatients. 6206679 7630244 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. With dignity and compassion, CMC shall treat the body, mind, and spirit of all who seek or provide care and comfort. Additional details provided in Schedule H. 258700867 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 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 1 193 0 1 2342 1 0 0 0 0 0 1 1 0 0 0 0 X 19 14 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 C/O Finance Dept 100 McGregor Manchester NH 031023770 X Adele Boufford Baker 1.00 X 0 0 0 Gary Bouchard PhD 1.00 X 0 0 0 Paul S Boynton 1.00 X 0 0 0 Daryl J Cady CPA 1.00 X 0 0 0 Stephen Camann 1.00 X 0 0 0 Guy D Chapdelaine 1.00 X 0 0 0 William Clutterbuck MD 1.00 X 0 342506 33294 Eleanor Wm Dahar Esq 1.00 X 0 0 0 Jeff Eisenberg 1.00 X 0 0 0 Raef Fahmy DPM 40.00 X 116392 0 2432 Connor J Haugh MD FACC 1.00 X 0 630602 34137 Susan Huard PhD 1.00 X 0 0 0 Suzanna D Majewski 1.00 X 0 0 0 Anne M O'Connor MD 1.00 X 0 0 0 Msgr John P Quinn 1.00 X 0 0 0 Ronald J Rioux 1.00 X 0 0 0 Keith A Stahl MD 1.00 X 0 287041 12440 Rev Gayle Whittemore 1.00 X 0 0 0 Joseph Graham 1.00 X X 0 0 0 Suzanne K Mellon PhD RN 1.00 X X 0 0 0 Jerome Duval 1.00 X X 0 0 0 Margaret-Ann Moran Esq 1.00 X X 0 0 0 Joseph Pepe MD 40.00 X X 346001 0 19545 Alyson Pitman Giles 40.00 X X 798551 0 348357 Edward Dudley III 40.00 X 358208 0 82328 Allen Ericson 1.00 X 408870 0 43671 Raymond Bonito 50.00 X 428228 0 137121 Lisa Roux Coggins 40.00 X 201443 0 12151 Margo Compagna 40.00 X 198315 0 15273 Robert Duhaime 40.00 X 249440 0 30213 Carolanne O'Sullivan 40.00 X 208036 0 12799 Brian Tew 40.00 X 248654 0 29727 Kevin Kilday 0.00 X 124809 0 0 3686947 1260149 813488 84 1 1 0 Dartmouth Hitchcock Clinic One Medical Center Dr Lebanon NH 03756 Professional Services 22983220 Granite State Emergency Physicians 380 Lafayette Rd Hampton NH 03842 Professional Services 690457 Aramark Management Services 24863 Network Place Chicago IL 60673 Professional Services 657719 Benefit Strategies LLC 97 Elm Street Manchester NH 03101 Professional Services 593840 Quest Diagnostics 195 McGregor Street Manchester NH 03102 Diagnostic Testing Services 569336 26 15000 179680 116500 2451817 1018599 3781596 Patient Service Rev. 621400 310406321 310406321 Miscellaneous Rev. 621400 5826702 5826702 Cafeteria Income 722210 1414336 1414336 Rental Income 532000 389206 389206 318036565 1359146 1359146 7465626 16150 6201597 175594 1264029 -159444 1104585 1104585 13620 179680 68029 -54409 -54409 324227483 318036565 0 2409322 3207761 2645216 562545 98437584 81063024 17239277 135283 5413605 4460426 948577 4602 16747821 13810755 2937066 7370887 6070349 1290951 9587 582362 480233 102129 232742 191926 40816 13984 11532 2452 255623 255623 5717522 4714840 1002682 1180337 932210 198249 49878 2166253 1782988 379179 4086 3404407 2807376 597031 7632237 6293771 1338466 163068 134471 28597 44195 36445 7750 2765357 2280396 484961 10554860 8703854 1851006 2136251 1761617 374634 Medical Supplies 56020757 46196395 9824362 Bad Debt Expense 25990192 25990192 Physician Fees 20727286 20727286 Medicaid Enhancement Ta 15240270 15240270 15036632 12365295 2629666 41671 301041993 258700867 42096019 245107 45078847 62005310 8095887 7040423 32302845 30745571 319476 218859 1228166 1248598 3402177 3469354 206725239 130791109 77686783 75934130 89258267 81698372 892422 17341937 258264870 279702554 31720126 35661222 744653 684482 70561567 67513065 248508 3672855 54408231 111550387 157683085 219082011 X 93318020 53573474 381533 353996 6882232 6693073 100581785 60620543 258264870 279702554 X 23185490 -63146732 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 30748 0 0 1 13984 44732 0 Explanation of Lobbying Activities: Part II-B, Line 1: 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, & Branch, PA provided lobbying services which included providing information regarding public policy pending before the legislature. Devine, Millimet, & 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. 7263764 51208 -187002 80901 7047069 6624284 81408 618215 60143 7263764 6155849 468435 6624284 7356078 31900 -1232129 6155849 0.00000 0.94980 0.05020 0 0 1024690 1024690 75380884 29586536 45794348 4394778 3205135 1189643 118149210 96429820 21719390 7775677 1569618 6206059 75934130 Due From Affiliates 443573 Insurance Recoveries 16038200 Other Assets 25278 Unamortized Debt Issuance Costs 834886 17341937 Accrued Pension & Other Liabilities 111550387 111550387 Description of Intended Use of Endowment Funds: Part V, Line 4: Proceeds from the Organization's endowment funds are used in operations. Description of Uncertain Tax Positions Under FIN 48: Part X: The Medical Center, NEHIF and CMC Associates 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. Gala 193300 179680 13620 50 2500 48620 11312 5547 193300 179680 13620 50 2500 48620 11312 5547 68029 -54409 1 1 1 X 1 X 1 1 0 1 1 11647 8928362 8928362 0.03250 18665 27991053 27991053 0.10180 64144 29104504 29104504 0.10580 94456 66023919 66023919 0.24010 229425 2442986 68231 2374755 0.00860 2274 671345 671345 0.00240 21393 17989388 1495133 16494255 0.06000 361 102276 3000 99276 0.00040 616101 616101 0.00220 253453 21822096 1566364 20255732 0.07360 347909 87846015 1566364 86279651 0.31370 8014 404707 127978 276729 0.00100 8014 404707 127978 276729 0.00100 1 9052394 0 86117591 114991948 -28874357 X 1 1 1 1 Catholic Medical Center

100 McGregor Street Manchester NH 03102

X X X Catholic Medical Center 1 0 09 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 I, L7 Col(f): Bad debt expense of $25,990,192 has been removed from the denominator of the calculation in Schedule H, Part I, Line 7, column f. Part II: The Medical Center sponsored the following partnerships and services to promote the health of the communities it serves:School Partnerships:Partnership with Manchester School SystemPartnership with VNA, education for classroom teachersPartnership with VNA, education for pre-school classroomsEmergency Services:Planning hours for emergency preparednessBioterrorism preparedness safety management Part III, Line 4: There is no footnote in the audited financial statements describing bad debt expense. Costing methodology ratio of cost to charge to arrive at cost. Part III, Line 8: The entire Medicare shortfall is reported in our Community Benefit Report to the State of New Hampshire. It is reported under the "Financial Assistance Cost". 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 through the facility that list the financial programs available. Catholic Medical Center Part V, Section B, Line 17e: Signs are posted through the facility that list the financial programs available. Phrases appear on statements we send to patients and patients are notified during telephone 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, Catholic Medical Center participates in a community needs assessment every five years as required by the New Hampshire Attorney General's Office Division of Charitable Trusts. The most recent Community Needs Assessment was titled, "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 new 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 physician 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 5: Catholic Medical Center is involved in numerous community initiatives to improve the health outcomes of our community: Manchester Sustainable Access Project (MSAP), an initiative to improve healthcare access for the poor in our community is made up of all the major healthcare providers' senior leadership teams; Manchester Oral Health Project, an initiative to improve the oral health of children; Catholic Medical Center School partnerships with an elementary, middle, and high schools for health prevention education; State of NH in the promotion of healthy behaviors to improve educational outcomes (LAEP); Emergency bioterrorism prpearedness safety management, to name a few of our community initiatives. Part VI, Line 6: Catholic Medical Center is a licensed 330 bed, full-service, acute care hospital located in Manchester, New Hampshire, the State's largest city. CMC is known for its advanced cardiac, 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 has been named one of the 100 best hospitals in the nation for cardiac care by Healthgrades. CMC is also proud to be the recipient of a number of other recognitions for cardiac services:- Ranked among the top 10 in the nation for cardiology service and overall cardiac care - Holds a five-star rating for cardiac services, for treatment of heart attack and for interventional procedures - Rated number 1 in New Hampshire for cardiac services and interventional procedures Catholic Medical Center 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. CMC was 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 systems, 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 500 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 William Clutterbuck MD 0 342506 0 0 0 0 0 14700 0 18594 0 375800 0 0 Connor J Haugh MD FACC 0 503116 0 127486 0 0 0 14962 0 19175 0 664739 0 0 Keith A Stahl MD 0 279968 0 7073 0 0 0 10071 0 2369 0 299481 0 0 Joseph Pepe MD 315300 0 30701 0 0 0 11206 0 8339 0 365546 0 0 0 Alyson Pitman Giles 654209 0 144342 0 0 0 288191 0 60166 0 1146908 0 0 0 Edward Dudley III 328206 0 30002 0 0 0 40013 0 42315 0 440536 0 0 0 Allen Ericson 349070 0 59800 0 0 0 16067 0 27604 0 452541 0 0 0 Raymond Bonito 365021 0 63207 0 0 0 96265 0 40856 0 565349 0 0 0 Lisa Roux Coggins 184098 0 17345 0 0 0 7334 0 4817 0 213594 0 0 0 Margo Compagna 198315 0 0 0 0 0 6498 0 8775 0 213588 0 0 0 Robert Duhaime 232720 0 16720 0 0 0 8834 0 21379 0 279653 0 0 0 Carolanne O'Sullivan 191027 0 17009 0 0 0 7600 0 5199 0 220835 0 0 0 Brian Tew 216754 0 31900 0 0 0 8735 0 20992 0 278381 0 0 0 Kevin Kilday 124809 0 0 0 0 0 0 0 0 0 124809 0 0 0 Part I, Lines 4a-b Part I, Lines 4a-b: 4A: The following individual received base compensation under a severance agreement from the Organization: Kevin Kilday $124,809 4B: The following individuals take part in a section 457(f) forfeitable nonqualified deferred compensation plan. 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 Part I, Line 7 A portion of compensation is at-risk and vairable, 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 2012-04-20 6000000 Refinance 2011 Note 0 0 0 32910000 3170077 10216000 517960 20559500 2009 0 1 1 1 6000000 6000000 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 1 1 0 0 1 MBIA 5.900000000000 1 1 0 1 0 0 0 0 0 Sarah Pitman Family Member of Alyson Pitman Giles 59674 Employment 0 Joyce Duval Family Member of Jerome Duval 31453 Employment 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 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 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 performance and mission performance, not solely revenue generation. Form 990, Part VI, Section C, line 19 CMC makes its governing documents, conflict of interest policy, and financial statements available to the public 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: 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 losses on investments: -6,035,245. Net Transfer (to) from Affiliates -11,658,129. Pension Related Changes Other than Net Periodic Cost -45,281,196. Assets Released for Operations -67,076. Change in Interest in Perpetual Trust -105,086. Total to Form 990, Part XI, Line 5: -63,146,732. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Alliance Resources 100 McGregor Street Manchester NH 03102 020398138 Real Estate NH 501(C)(3) Line 11b, II CMC Healthcare System 0 Alliance Health Services 100 McGregor Street Manchester NH 03102 611508839 Practices NH 501(C)(3) Line 11b, II 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 Catholic Medical Center 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 McGregor Street Mob 100 McGregor Street Manchester NH 03102 134347316 Medical Office Building NH CMC Health System Unrelated 0 0 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH CMC Health System C Doctors' Medical Association Inc 100 Mcgregor Street Manchester NH 03102 020340690 Condo Association NH CMC Health System C 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 1 Catholic Medical Center Associates C 116500 Cash Transferred