2012-08-08T10:40:07-05:00 2011-12-31 010494526 BAKER NEWMAN & NOYES BOX 507 PORTLAND ME 04112 990 2011-01-01 020389434 Strafford Health Alliance STRA 6037427492 200 Route 108 3 Somersworth NH 038781106 Deborah Shipman 6037427492 2012-07-31 1 TIMOTHY R HEPBURN CPA P00182393 2078792100 2012-07-30 2011 2016-02-24 21:20:13Z Deborah Shipman 200 Route 108 3 Somersworth NH 038781106 9640716 0 X N/A X 1985 NH Physical therapy, mammography, & thoracic & vascular services 8 8 98 0 0 0 0 0 8507893 9371086 92180 29491 49507 19605 8649580 9420182 0 0 0 0 5833319 6728500 0 0 0 2902036 2958202 8735355 9686702 -85775 -266520 8386676 7718867 3955937 3454648 4430739 4264219 To provide the highest quality, most cost-effective healthcare services to the members of our community. 0 0 7841395 9419998 Provision of physical therapy, mammography, and thoracic & vascular services to residents of southeastern New Hampshire 7841395 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 0 0 0 0 1 17 0 1 98 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 0 1 0 NH X Vicki Parshley 6037427492 200 Route 108 3 Somersworth NH 038781106 DEBORAH SHIPMAN 5.00 X 0 0 0 NOREEN BIEHL 0.50 X 0 0 0 JANET DAVIS 0.50 X 0 0 0 ALVIN FELGAR 0.50 X 0 0 0 GREGORY WALKER 0.50 X 0 0 0 CAROL BAILEY 0.50 X 0 0 0 DONNA RINALDI 0.50 X 0 0 0 GREGORY SMITH 0.50 X 0 0 0 VICKI PARSHLEY 40.00 X 94105 0 12968 ROBERT HARRELL MD 40.00 X 486329 0 37306 DAVID QUINT 40.00 X 128713 0 27346 BETH BEAUDIN 40.00 X 124539 0 20549 ROBERT ORAM MD 40.00 X 305587 0 21121 SHAWN ROUSSIN PA 40.00 X 110562 0 1096 1249835 0 120386 5 0 1 0 CompHealth PO Box 972651 Dallas TX 75397 Locums for call coverage 171262 1 Net Patient Services 621400 9371086 9371086 9371086 184 184 211257 191652 19605 19605 19605 58189 28882 29307 29307 29307 9420182 9419998 0 184 107073 107073 5311552 4855303 456249 169506 154521 14985 786415 691784 94631 353954 309600 44354 10008 10008 48695 48695 18931 18931 450415 171262 279153 95965 4498 91467 331187 331187 333139 283168 49971 2079 2079 59516 59516 786597 668607 117990 204426 173762 30664 Equipment rental and ma 258138 258138 Bad debt expense 143696 143696 215410 65461 149949 9686702 7841395 1845307 0 1124424 1000772 249359 368871 897455 887355 15679 14433 203805 118026 11966766 6708029 5837554 5258737 58400 70673 8386676 7718867 516610 499927 95642 106123 3343685 2831602 0 16996 3955937 3454648 X 4430739 4264219 4430739 4264219 8386676 7718867 X -266520 100000 X X 0 1 1 X 0 X 7472808 7709015 7978127 8507893 9371086 41038929 7472808 7709015 7978127 8507893 9371086 41038929 0 0 0 41038929 205451 235491 231758 246871 211257 1130828 205451 235491 231758 246871 211257 1130828 7678259 7944506 8209885 8754764 9582343 42169757 0.97320 0.97100 0.02680 0.02900 X 563951 563951 6354887 3408185 2946702 1019084 836594 182490 3856890 2463250 1393640 171954 171954 5258737 Due to affiliate 16996 16996 9420182 9686702 -266520 100000 100000 -166520 9611834 191652 191652 9420182 0 9420182 9878354 191652 191652 9686702 0 9686702 Description of Uncertain Tax Positions Under FIN 48: Part X: The audited 2011 financial statements state the following regarding uncertain tax positions under FIN 48: The Alliance is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes pursuant to Section 501(a) of the Code. Management has determined that it has not taken, nor does it expect to take, any uncertain tax positions in any tax return. Tax years 2008 through 2011 are open for Internal Revenue Service or state examination. Part XI, Line 8 - Other Adjustments: Capital contributions 100,000. Rental income net of expenses of $191,652 is reported in Part I. Financial statements include rental expenses of $191,652 that are netted against income in Part I. 0 0 0 0 0 1 0 0 0 ROBERT HARRELL MD 486329 0 0 0 0 0 15704 0 21602 0 523635 0 0 0 DAVID QUINT 126213 0 2500 0 0 0 6603 0 20743 0 156059 0 0 0 ROBERT ORAM MD 305587 0 0 0 0 0 0 0 21121 0 326708 0 0 0 Part I, Line 6 Strafford Health Alliance utilizes an annual management bonus program. The respective program establishes, in advance, both qualitative and financial goals. Based on the performance of each division, the respective management personnel can earn a bonus up to but not exceeding 8% of total salary. Supplemental Information Part III The President of the Board of Directors of Strafford Health Alliance (Deborah Shipman) is an employee of Frisbie Memorial Hospital (FMH). The Vice President of the Board of Directors (Noreen Biehl) is an employee of Wentworth-Douglass Hospital (WDH). FMH and WDH are each 50 percent stockholders in Strafford Health Alliance. Compensation data for these board officers may be found in the respective IRS Forms 990 for FMH and WDH. Form 990, Part VI, Section A, line 6 Strafford Health Alliance has authorized 300 shares of no par value common stock, with 100 shares issued and outstanding, equally divided between Wentworth-Douglass Hospital and Frisbie Memorial Hospital. Form 990, Part VI, Section A, line 7a Each shareholder of Strafford Health Alliance elects three members to the Board of Directors. Form 990, Part VI, Section A, line 8b There are no committees empowered to act without a full Board of Directors vote. Form 990, Part VI, Section B, line 11 Each board member receives a complete copy of Form 990 and is requested to review it and vote to allow its timely filing with the IRS. Form 990, Part VI, Section B, line 12c Annually, each board member signs a statement disclosing any conflicts of interest. Form 990, Part VI, Section B, line 15b The board directors and officers do not receive any compensation from Strafford Health Alliance (SHA). Further, there are no SHA employees who meet the IRS definition of "key employee" for Form 990 reporting purposes. The President of SHA (Deborah Shipman) is an employee of Frisbie Memorial Hospital (FMH). The Vice President of SHA (Noreen Biehl) is an employee of Wentworth-Douglass Hospital (WDH). FMH and WDH are each 50 percent stockholders in SHA. Compensation of all employees is based on performance, salary ranges and market competitive data that is also within Board approved budgetary guidelines. Compensation raises are determined annually by the President for the Division Managers and by the Division Managers for all other employees. Form 990, Part VI, Section C, line 19 Strafford Health Alliance (SHA) files audited financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of any pecuniary benefit transactions that have occurred between SHA and a board member or officer. Notices of such transactions, if any, exceeding $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-A, II(D). Current copies of SHA'S Form 990 are on file with the Charitable Trust Unit. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Capital contributions 100,000. Total to Form 990, Part XI, Line 5: 100,000. RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL AUDIT FORM 990, PART XI, LINE 2C Strafford Health Alliance's Board of Directors reviews the financial statement audit annually and oversees the selection of the independent accounting firm. The audit process did not change from the prior year. TOP FINANCIAL OFFICIAL FORM 990, PART VII, SECTION A For Form 990 compensation reporting purposes, Vicki Parshely (Controller) has been deemed to be the "top financial official" who has the ultimate responsibility for managing the organization's finances. PURCHASED SERVICES FROM STOCKHOLDERS FORM 990, PART IV, LINE 28 Strafford Health Alliance (SHA) has directors who are also officers, directors and/or employees of its two stockholders, Wentworth-Douglass Hospital (WDH) and Frisbee Memorial Hospital (FMH). Both WDH and FMH are 501(c)(3) organizations. In 2011, SHA purchased from/reimbursed its stockholders for various administrative and management services. In addition, SHA also leased program and administrative office space from a tax-exempt affiliate of one of its stockholders. CHANGE IN ACTIVITIES FORM 990, PART III, LINE 4 In December 2011, a provider employed by the Alliance left the practice to become an employee of one of the stockholders. One of the two remaining providers, Dr. Harrell, has an employment contract with SHA that terminates June 30, 2012. SHA does not intend to extend the contract and has voted to discontinue the Alliance's thoracic and vascular practices as of June 30, 2012. The 2011 audited financial statements report the income and expenses for the discontinued thoracic and vascular operations separately from the rest of the operating income and expenses, as a net loss of $1,297,125. However, to conform with IRS Form 990 reporting requirements, income and expense amounts for the respective operating and discontinued activities have been combined and reported on the required lines in Parts VIII and IX.