2011-05-12T05:04:06-05:00 2010-06-30 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2009-07-01 020315693 CATHOLIC MEDICAL CENTER CATH 6036683545 C/O FINANCE DEPT 100 MCGREGOR ST MANCHESTER NH 031023770 EDWARD DUDLEY 6036683545 2011-05-03 2078792100 2009 2016-02-24 21:20:13Z ALYSON PITMAN GILES C/O FINANCE DEPT 100 MCGREGOR ST MANCHESTER NH 031023770 277969109 0 0928 X www.catholicmedicalcenter.org X 1974 NH THE MISSION OF CATHOLIC MEDICAL CENTER IS TO PROVIDE HEALTH, HEALING, AND HOPE TO ALL. 20 17 2213 385 0 0 299885 390994 241989561 270543220 2193026 2373630 3434393 4427012 247916865 277734856 0 0 112151970 121452462 0 191199 122591763 144731758 234743733 266184220 13173132 11550636 222601847 232863478 159556268 179364600 63045579 53498878 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 206849860 273761281 MEDICAL & SURGICAL SERVICES PROVIDED TO 9,436 INPATIENTS AND 300,023 OUTPATIENTS. 17634075 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. 224483935 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 202 0 1 2213 1 0 0 0 0 0 0 0 0 0 20 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 ALYSON PITMAN GILES 60.00 X X 719721 0 358237 GUY D CHAPDELAINE 1.00 X X 0 0 0 BENJAMIN WESTBROOK MD 1.00 X 0 0 0 ADELE BOUFFORD BAKER 1.00 X 0 0 0 CONNOR HAUGH MD 1.00 X 0 550274 27462 GARY BOUCHARD PHD 1.00 X 0 0 0 BISHOP FRANCIS J CHRISTIAN 1.00 X 0 0 0 ELEANOR WM DAHAR ESQ 1.00 X 0 0 0 JOSEPH GRAHAM 1.00 X 0 0 0 JEROME DUVAL 1.00 X 0 0 0 KATHLEEN ZAFFINO MD 1.00 X 0 0 0 MARGARET-ANN MORAN ESQ 1.00 X 0 0 0 PAUL BOYNTON 1.00 X 0 0 0 RAEF FAHMY DPM 1.00 X 0 0 0 REV GAYLE WHITTEMORE 1.00 X 0 0 0 SUZANNA D MAJEWSKI 1.00 X 0 0 0 WILLIAM CLUTTERBUCK MD 1.00 X 0 227748 17401 RONALD J RIOUX 1.00 X X 0 0 0 STEVEN CAMANN 1.00 X X 0 0 0 MSGR JOHN P QUINN 1.00 X X 0 0 0 RAYMOND J BONITO 50.00 X 635495 0 132089 KEVIN KILDAY 50.00 X 324382 0 37525 ALLEN ERICSON 50.00 X 268412 0 41249 DAVID RBULMER 40.00 X 180329 0 19640 ROBERT DUHAIME 40.00 X 204078 0 26745 TINA LEGERE 40.00 X 194772 0 16645 MARGO COMPAGNA 40.00 X 195438 0 22084 LISA rOUX 40.00 X 179277 0 16080 2901904 778022 715157 57 0 1 0 DARTMOUTH-HITCHCOCK CLINIC 100 HITCHCOCK WAY MANCHESTER NH 03104 MEDICAL SERVICES 1957084 DEVINE MILLIMET & BRANCH PA PO BOX 719 MANCHESTER NH 03105 LEGAL SERVICES 1003548 ARAMARK MANAGEMENT SERVICE PO BOX 33170 NEWARK NJ 07188 STAFFING SERVICES 739311 QUEST DIAGNOSTICS PO BOX 64363 BALTIMORE MD 21264 MEDICAL SERVICES 577845 GRANITE STATE EMERGENCY PHYSICIANS 100 MCGREGOR ST MANCHESTER NH 03102 MEDICAL SERVICES 519965 21 390994 390994 PATIENT SERVICE REV. 900099 270543220 270543220 270543220 1224842 1224842 310178 310178 310178 310178 1378841 4200 234253 1144588 4200 1148788 1148788 MISCELLANEOUS 900099 2907883 2907883 EMPLOYEE SALES 722210 1208951 1208951 4116834 277734856 273761281 0 3582581 2531484 2068222 463262 91560685 74736409 16740224 84052 8356445 6826185 1528999 1261 12385580 10119019 2266561 6618268 5402681 1210148 5439 2878202 2351491 526711 319710 261203 58507 7250 5923 1327 6466990 5283531 1183459 2095915 1655641 370847 69427 2777075 2264516 507229 5330 3668895 2997487 671408 6509189 5318007 1191182 180450 147428 33022 174435 142513 31922 2960086 2418390 541696 10542949 8613590 1929359 1682193 1374352 307841 MEDICAL SUPPLIES 53065380 43354415 9710965 PHYSICIAN FEES 21101868 21101868 BAD DEBT EXPENSE 18065552 18065552 EQUIPMENT MAINTENANCE 7380780 6030097 1350683 DIETARY EXPENSES 1321237 1079169 241723 345 3533602 2866246 642011 25345 266184220 224483935 41509086 191199 37231837 35440334 4735741 4743419 25069791 27689982 870922 417534 1251715 1224129 1598441 2313505 192176502 110403511 79602628 81772991 71350881 78265782 889891 995802 222601847 232863478 25473550 26716213 930102 842714 71963515 70742817 61189101 81062856 159556268 179364600 X 56889730 46874594 320238 357814 5835611 6266470 63045579 53498878 222601847 232863478 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 50386 50386 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 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. 6155849 468435 6624284 7356078 31900 -1232129 6155849 0.00000 0.95000 0.05000 0 0 1024690 1024690 73959121 24711627 49247494 4227573 2603742 1623831 110072650 81930130 28142520 2892468 1158012 1734456 81772991 ACCRUED PENSION & OTHER LIABILITIES 79796270 DUE TO AFFILIATES 1266586 81062856 277734856 266184220 11550636 3880842 -24978179 -21097337 -9546701 281615698 3880842 3880842 277734856 0 277734856 266184220 0 266184220 0 266184220 Part V, Line 4: Description of Intended Use of Endowment Funds: PROCEEDS FROM THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED IN OPERATIONS. Part XI, Line 8 - Other Adjustments: NET TRANSFER (TO) FROM AFFILIATES: -7,751,373 PENSION RELATED CHANGES OTHER THAN NET PERIODIC COST: -17,483,749 CHANGE IN INTEREST IN PERPETUAL TRUST: 344,084 ASSETS RELEASED FROM RESTRICTION USED FOR OPERATIONS: -87,141 1 1 1 X 0 1 1 0 1 1 10587 8120695 8120695 0.03050 19712 10749326 10749326 0.04040 58107 22472930 22472930 0.08440 88406 41342951 41342951 0.15530 329677 3813285 3813285 0.01430 1595 126879 126879 0.00050 23566 13067116 13067116 0.04910 369 87143 87143 0.00030 539652 539652 0.00200 355207 17634075 17634075 0.06620 443613 58977026 58977026 0.22150 6704 534603 534603 0.00200 6704 534603 534603 0.00200 1 6400625 75622676 97952546 -22329870 X 1 1 CATHOLIC MEDICAL CENTER

100 MCGREGOR STREET MANCHESTER NH 03102

X X X Part VI, Line 2: In collaboration with the City of Manchester in association with social services agencies and health care providers CMC completes a community needs assessment every 5 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-Greater Manchester Community Needs Assessment 2009" was completed as a community collaborative of the health care and social service agencies in our community. Additional information is obtained on an ongoing basis to assist the organization in evaluating progress towards meeting our goals and the identification of new needs. This information is collected through community surveys, focus groups and discussions with community leaders, program evaluations and communication with the agencies interacting with our vulnerable populations. As the quantitative data is updated it is made available to the community for review. CMC, in collaboration with the community, is in the process of developing a Community Improvement Plan based upon the 2009 Believe In A Healthy Community Study, that will guide us and the community in addressing our needs in a more organized manner. Part VI, Line 3: Flyers are posted throughout the hospital highlighting Catholic Medical Center's Uncompensated Care Program. If the patient is an inpatient and has no insurance, that patient is referred by the social worker to our Internal Health Resource Counselor to determine if the patient qualifies for a federal and/or state program. If no eligibility for either program is evident, a free care application is given to the patient. The application has all the instructions for the patient and supplies him or her with a work sheet that would include the required verifications and other information. The patient has 15 days to return the application for review. The patient is informed of either acceptance or denial into the program within 30 days of receipt.If the patient is an outpatient and admittedly needs financial assistance, a card is given to the patient and he/she is asked to contact the Patient Financial Services Department. Part VI, Line 4: Catholic Medical Center defines its primary service area as the towns and cities of Auburn, Bedford, Candia, Deerfield, Goffstown, Hooksett, Londonderry, Manchester and New Boston. In addition, Catholic Medical Center includes the towns of Allenstown, Amherst, Bow, Chester, Derry, Dunbarton, Merrimack, Raymond and Weare in its secondary service area. Part VI, Line 5: 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 VI, Line 6: CMC is a licensed 330-bed full-service acute care hospital located in Manchester, the state's largest city. CMC is known for its advanced cardiac and general 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-surgical care with more than 25 subspecialties, comprehensive orthopedic care, inpatient and outpatient rehabilitation services, a 24-hour emergency department, outpatient psychiatric services, and diagnostic imaging.Catholic Medical Center provides in and outpatient services at its Mcgregor Street facility to almost 110,000 patients per year, making it one of New Hampshire's largest medical centers.CMC continues to lead the way in advanced medical technology. It's one of the few hospitals in New England using the Da Vinci Surgical Robotics Systems to perform life-saving surgery with fewer complications. In 2009, CMC acquired a second robot to meet the increasing demand for minimally invasive surgeries. It was the first hospital in southern NH to utilize the 64-slice CT Scanner to provide faster, less invasive, diagnoses of cardiac disease. CMC is equipped with an Achieva Quasar 3.0T MRI from Philips Medical Systems, allowing for higher resolution images in less time. The orthopedic surgeons now have access to the new O-Arm Imaging System, A high definition CT Scan that provides real-time three-dimensional images during spine surgery. CMC is also one of the few hospitals to offer state-of-the-art digital mammography.Almost 400 physicians have some level of privileges at CMC. CMC maintains a rigorous application and credentialing process or its medical staff to ensure that patients receive the highest quality of care possible.CMC has a joint venture with the freestanding Bedford Ambulatory Surgical Center.Catholic Medical Center 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 in our primary and secondary market neighborhoods. It is the home of the West Side Neighborhood Health Center, Poisson Dental Facility, Mobile Community Healthcare for the homeless program and Parish Nurse program. We provide Medication Assistance; the Breast and Cervical Cancer Screening Program, Let No Women be Overlooked; health screenings; Fertility Education and 24/7 Nurse triage and information and referrals through its 24 hour call center, ASK-A-Nurse.Catholic Medical Center is also home to the nationally recognized New England Heart Institute. The New England Heart Institute 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 New Hampshire. X X X X X 0 1 0 1 1 1 1 1 0 ALYSON PITMAN GILES 582248 0 137473 0 0 0 254893 0 103344 0 1077958 0 0 0 CONNOR HAUGH MD 0 426305 0 123969 0 0 0 9800 0 17662 0 577736 0 0 WILLIAM CLUTTERBUCK MD 0 227748 0 0 0 0 0 0 0 17401 0 245149 0 0 RAYMOND J BONITO 323315 0 312180 0 0 0 86053 0 46036 0 767584 0 0 0 KEVIN KILDAY 279832 0 44550 0 0 0 5814 0 31711 0 361907 0 0 0 ALLEN ERICSON 234953 0 33459 0 0 0 9260 0 31989 0 309661 0 0 0 DAVID RBULMER 180329 0 0 0 0 0 3637 0 16003 0 199969 0 0 0 ROBERT DUHAIME 200078 0 4000 0 0 0 3725 0 23020 0 230823 0 0 0 TINA LEGERE 190272 0 4500 0 0 0 3480 0 13165 0 211417 0 0 0 MARGO COMPAGNA 190438 0 5000 0 0 0 3541 0 18543 0 217522 0 0 0 LISA rOUX 174277 0 5000 0 0 0 3454 0 12626 0 195357 0 0 0 Part I, Line 4a THE FOLLOWING INDIViDUALS TAKE PART IN A SECTION 457(F) FORFEITABLE NONQUALIFIED DEFERRED COMPENSATION PLAN. THESE REPRESENT CONTRIBUTIONS IN ARREARS FOR MANY YEARS OF SERVICE. ALYSON PITMAN GILES: $245,093 RAY BONITO: $76,253 Part I, Line 5 BONUSES MAY BE BASED in part ON REVENUE. Part I, Line 6 BONUSES MAY BE BASED in part ON NET EARNINGS. Part I, Line 7 A PORTION OF COMPENSATION IS AT-RISK AND VARIABLE, AND PAYMENT DEPENDS ON THE QUALITY OF JOB PERFORMANCE. Supplemental Information Part III $251,980 OF MR. BONITO'S CURRENT COMPENSATION REPRESENTS THE PAYMENT OF A NON-RECURRING RETENTION BONUS AND IS ATTRIBUTABLE TO TEN YEARS OF SERVICE. NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 64461TCV4 2006-05-10 32910000 CONSTRUCTION & DEFEASANCE ESCROW 0 0 NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 noneavail 2009-04-20 7000000 REFINANCE 2008 NOTE 0 0 32910000 3157753 9891082 1226860 480821 20559500 2009 0 1 1 1 7000000 7000000 1 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 1 0 0 1 MBIA 5.900000000000 1 1 0 1 0 0 0 0 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, SECTION A DIRECTORS EMPLOYED BY A RELATED ORGANIZATION CONNOR J. HAUGH, MD - 40 HOURS/WEEK WILLIAM B. CLUTTERBUCK, MD - 40 HOURS/WEEK ALLIANCE RESOURCES 100 MCGREGOR ST MANCHESTER NH 03102 020398138 REAL ESTATE NH 501(C)(3) 11 TYPE II N/A ALLIANCE HEALTH SERVICES 100 MCGREGOR ST MANCHESTER NH 03102 611508839 PRACTICES NH 501(C)(3) 11 TYPE II N/A CMC HEALTHCARE SYSTEM 100 MCGREGOR ST MANCHESTER NH 03102 010568516 PARENT NH 501(C)(3) 11 TYPE II N/A CMC ASSOCIATES 100 MCGREGOR ST MANCHESTER NH 03102 020344786 SUPPORT NH 501(C)(3) 11 TYPE II N/A CMC PHYSICIAN PRACTICE ASSOCIATES 100 MCGREGOR ST MANCHESTER NH 03102 020460245 PRACTICES NH 501(C)(3) 11 TYPE II N/A NEHI FOUNDATION 100 MCGREGOR ST MANCHESTER NH 03102 223041916 SUPPORT NH 501(C)(3) 7 N/A ST PETER'S HOME 100 MCGREGOR ST MANCHESTER NH 03102 020222228 HOME NH 501(C)(3) 9 N/A ALLIANCE AMBULATORY SERVICES 100 MCGREGOR ST MANCHESTER NH 03102 020519436 PRACTICES NH 501(C)(3) 11 TYPE II N/A MCGREGOR ST MOB 100 MCGREGOR ST MANCHESTER NH 03102 134347316 MEDICAL OFFICE BLDG NH N/A ALLIANCE ENTERPRISES 100 MCGREGOR ST MANCHESTER NH 03102 020386795 REAL ESTATE NH N/A C 0 1 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 1 NO TRANSACTIONS MET THE FILING THRESHOLD