Westfield Medical Corporation: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- Westfield Medical Corporation (EIN 04-3127730)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-08-09
- IRS object ID
- 201822219349301012
- Schema version
- 2016v3.0
- 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) |
|---|---|---|
| Return | 2018-08-09T13:11:28-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Two Jericho Plaza | AddressLine1Txt |
| City | Jericho | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 11753 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 043127730 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Westfield Medical Corporation | BusinessNameLine1Txt |
| Business Name Line2 | dba Noble Medical Group | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WEST | BusinessNameControlTxt |
| Phone | 4135682811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 115 West Silver Street | AddressLine1Txt |
| City | Westfield | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01085 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dennis W Chalke | PersonNm |
| Person Title | SVP Finance, CFO & Treasurer | PersonTitleTxt |
| Phone | 4135682811 | PhoneNum |
| Signature | 2018-08-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Christine Kawecki | PreparerPersonNm |
| PTIN | P00743140 | PTIN |
| Phone | 5169187000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Noble Medical Group | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Dennis W Chalke | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 115 West Silver Street | AddressLine1Txt |
| City | Westfield | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01085 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,817,877 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | http://baystatenoblehospital.org/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | The mission of the organization is to improve the health of the people in our communities every day, with quality and compassion. | ActivityOrMissionDesc |
| Voting Members Governing Body | 25 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 17 | VotingMembersIndependentCnt |
| Total Employee | 140 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,823,661 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,817,877 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $10,823,661 | PYTotalRevenueAmt |
| CY Total Revenue | $10,817,877 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,759,506 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,058,157 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,870,940 | PYOtherExpensesAmt |
| CY Other Expenses | $10,532,253 | CYOtherExpensesAmt |
| PY Total Expenses | $16,630,446 | PYTotalExpensesAmt |
| CY Total Expenses | $16,590,410 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$5,806,785 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$5,772,533 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,663,993 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,122,338 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,318,689 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,032,053 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,345,304 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,909,715 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The mission of the organization is to improve the health of the people in our communities every day, with quality and compassion. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $16,590,410 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $10,817,877 | RevenueAmt |
| Desc | Westfield Medical Corporation (WMC) provides physician services and medical education to people in the community within its geographic location. WMC's policy is to provide care to any patient in need of medical care, regardless of the patient's ability to pay for such care. Dependent upon the patient's financial capability to pay, WMC may provide such care free of charge or at amounts below its normal charges. Because WMC does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue.In addition to the charity care provided to patients, WMC's physicians participate in many and varied ongoing community outreach initiatives in the areas of education, safety and health. | Desc |
| Total Program Service Expenses | $16,590,410 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 140 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 25 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 17 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | John Shaver-Baystate Noble Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4135682811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 115 West Silver St | AddressLine1Txt |
| City | Westfield | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01085 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (39 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Anne M Paradis | |||||||||
| Chair (as of 1/1/17) | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| John F Maybury | |||||||||
| Vice Chair (as of 1/1/17) | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Adrian J Levsky | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Aleksandr Pugach MD | |||||||||
| Trustee | 1.00 | 48.00 | Yes (X) | $223,229 | $0 | $6,814 | |||
| Andrew Artenstein MD | |||||||||
| Trustee | 1.00 | 45.00 | Yes (X) | $281,998 | $486,856 | $62,074 | |||
| Claudia R Coplein DO | |||||||||
| Trustee (as of 1/1/17) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Colleen W Holmes | |||||||||
| Trustee (as of 1/1/17) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| David C Southworth | |||||||||
| Trustee (through 12/31/16) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Edward J Noonan | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Grace Makari-Judson MD | |||||||||
| Trustee/ Hematologist | 1.00 | 40.00 | Yes (X) | $347,988 | $0 | $78,646 | |||
| Gregory L Braden MD | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Harriet A DeVerry | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Hector Toledo | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| James P Sadowsky | |||||||||
| Trustee | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| James R Phaneuf | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| John A Egelhofer MD | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| John H Davis | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Kathleen B Scoble | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Kevin P Moriarty MD | |||||||||
| Trustee/ Chief Ped Surgery | 1.00 | 40.00 | Yes (X) | $0 | $699,348 | $45,950 | |||
| Mark A Keroack MD | |||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $2,182,220 | $38,487 | |||
| Paul R Murphy | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert J Bacon | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert L Pura PhD | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Steven M Mitus | |||||||||
| Trustee (through 12/31/16) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Timothy F Farrell | |||||||||
| Trustee (as of 1/1/17) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Victor Woolridge | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| William R Webber | |||||||||
| Trustee (as of 1/1/17) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Dennis Chalke | |||||||||
| Treasurer | 1.00 | 50.00 | Yes (X) | $0 | $935,201 | $89,071 | |||
| Kristin R Delaney | |||||||||
| Clerk | 1.00 | 39.00 | Yes (X) | $0 | $137,437 | $37,010 | |||
| Madeline Torres | |||||||||
| Assistant Clerk | 1.00 | 40.00 | Yes (X) | $0 | $56,586 | $13,801 | |||
| Ronald Bryant | |||||||||
| President, WMC | 5.00 | 45.00 | Yes (X) | $0 | $545,819 | $44,592 | |||
| Michele Urban | |||||||||
| VP Patient Care Services/CNO | 20.00 | 30.00 | $0 | $176,048 | $4,778 | Yes (X) | |||
| Beverly Fein | |||||||||
| VP Human Resources | 20.00 | 30.00 | $0 | $191,050 | $4,848 | Yes (X) | |||
| John Shaver | |||||||||
| Chief Financial Officer | 20.00 | 30.00 | $0 | $260,196 | $10,814 | Yes (X) | |||
| Mehdi Pajouh MD | |||||||||
| Physician | 50.00 | 0.00 | $366,754 | $0 | $22,389 | Yes (X) | |||
| Denzl Reid MD | |||||||||
| Physician | 50.00 | 0.00 | $294,652 | $0 | $17,462 | Yes (X) | |||
| Arthur King Jr MD | |||||||||
| Physician | 50.00 | 0.00 | $272,639 | $0 | $8,367 | Yes (X) | |||
| Heidi Kolek MD | |||||||||
| Physician | 50.00 | 0.00 | $260,519 | $0 | $17,004 | Yes (X) | |||
| Rulour Torio MD | |||||||||
| Physician | 50.00 | 0.00 | $221,781 | $0 | $5,978 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,269,560 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,670,761 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $508,085 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Westfield Emergency Physicians PC | |||||
| 9 Willow Brook Lane | Westfield | MA | 01085 | Medical Services | $1,065,281 |
| GBS Convergent Solutions LLC | |||||
| PO Box 2340 | North Canton | OH | 447200340 | Physician Billing | $849,334 |
| National Physician Services | |||||
| 25 Laurel Road | Rocky Hill | CT | 06067 | Physician Services | $282,911 |
| Allscripts Healthcare LLC | |||||
| 24630 Network Place | Chicago | IL | 606731246 | Electronic Health Records | $137,686 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient Medical Care | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $10,817,877 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,817,877 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,817,877 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,817,877 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,817,877 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,955,384 | TotalAmt |
| Program Services | $4,955,384 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,928 | TotalAmt |
| Program Services | $188,928 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $669,437 | TotalAmt |
| Program Services | $669,437 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244,408 | TotalAmt |
| Program Services | $244,408 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,321,301 | TotalAmt |
| Program Services | $1,321,301 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,611 | TotalAmt |
| Program Services | $190,611 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,496 | TotalAmt |
| Program Services | $24,496 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,059,733 | TotalAmt |
| Program Services | $1,059,733 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,926 | TotalAmt |
| Program Services | $6,926 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,344 | TotalAmt |
| Program Services | $21,344 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,769 | TotalAmt |
| Program Services | $16,769 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,271,685 | TotalAmt |
| Program Services | $5,271,685 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244,454 | TotalAmt |
| Program Services | $244,454 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $347,173 | TotalAmt |
| Program Services | $347,173 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Purchased Services | $1,363,337 | $1,363,337 |
| Medical Supplies | $644,777 | $644,777 |
| Dues & Subscriptions | $11,923 | $11,923 |
| Recruitment Expense | $7,724 | $7,724 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,590,410 | TotalAmt |
| Program Services | $16,590,410 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,312 | BOYAmt |
| EOY | $563,195 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $807,388 | BOYAmt |
| EOY | $875,198 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,773 | BOYAmt |
| EOY | $96,440 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,305,724 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $872,145 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,577,520 | BOYAmt |
| EOY | $1,433,579 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,000 | BOYAmt |
| EOY | $3,153,926 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,663,993 | BOYAmt |
| EOY | $6,122,338 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $865,430 | BOYAmt |
| EOY | $1,436,551 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $376,300 | BOYAmt |
| EOY | $332,287 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,959 | BOYAmt |
| EOY | $7,263,215 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,318,689 | BOYAmt |
| EOY | $9,032,053 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,345,304 | BOYAmt |
| EOY | -$2,909,715 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,345,304 | BOYAmt |
| EOY | -$2,909,715 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,663,993 | BOYAmt |
| EOY | $6,122,338 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$5,772,533 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,517,514 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baystate Noble Hospital Corporation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222537423 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $1,518,222 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $1,518,222 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $643,947 | OtherCostOrOtherBasisAmt |
| Depreciation | $238,461 | DepreciationAmt |
| Book Value | $405,486 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $518,067 | OtherCostOrOtherBasisAmt |
| Depreciation | $37,557 | DepreciationAmt |
| Book Value | $480,510 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,143,710 | OtherCostOrOtherBasisAmt |
| Depreciation | $596,127 | DepreciationAmt |
| Book Value | $547,583 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,433,579 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Medical Malpractice Insurance Recoverable | $20,000 |
| Due from Affiliates | $3,133,926 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,153,926 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Medical Malpractice Claims | $76,959 |
| Due to Affiliates | $7,186,256 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,263,215 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Aleksandr Pugach MD | ||||||||||||||
| Trustee | $200,434 | $0 | $0 | $0 | $22,795 | $0 | $6,651 | $0 | $163 | $0 | $230,043 | $0 | $0 | $0 |
| Andrew Artenstein MD | ||||||||||||||
| Trustee | $279,099 | $247,240 | $0 | $173,565 | $2,899 | $66,051 | $0 | $36,897 | $13,697 | $11,480 | $295,695 | $535,233 | $0 | $0 |
| Grace Makari-Judson MD | ||||||||||||||
| Trustee/ Hematologist | $275,652 | $0 | $50,668 | $0 | $21,668 | $0 | $60,173 | $0 | $18,473 | $0 | $426,634 | $0 | $0 | $0 |
| Kevin P Moriarty MD | ||||||||||||||
| Trustee/ Chief Ped Surgery | $0 | $537,664 | $0 | $124,279 | $0 | $37,405 | $0 | $26,500 | $0 | $19,450 | $0 | $745,298 | $0 | $0 |
| Mark A Keroack MD | ||||||||||||||
| Trustee | $0 | $876,848 | $0 | $401,474 | $0 | $903,898 | $0 | $19,875 | $0 | $18,612 | $0 | $2,220,707 | $0 | $562,123 |
| Dennis Chalke | ||||||||||||||
| Treasurer | $0 | $489,983 | $0 | $162,064 | $0 | $283,154 | $0 | $63,576 | $0 | $25,495 | $0 | $1,024,272 | $0 | $0 |
| Kristin R Delaney | ||||||||||||||
| Clerk | $0 | $122,188 | $0 | $14,668 | $0 | $581 | $0 | $18,742 | $0 | $18,268 | $0 | $174,447 | $0 | $0 |
| Ronald Bryant | ||||||||||||||
| President, WMC | $0 | $422,431 | $0 | $97,708 | $0 | $25,680 | $0 | $19,875 | $0 | $24,717 | $0 | $590,411 | $0 | $0 |
| Michele Urban | ||||||||||||||
| VP Patient Care Services/CNO | $0 | $153,968 | $0 | $20,682 | $0 | $1,398 | $0 | $0 | $0 | $4,778 | $0 | $180,826 | $0 | $0 |
| Beverly Fein | ||||||||||||||
| VP Human Resources | $0 | $167,576 | $0 | $22,671 | $0 | $803 | $0 | $0 | $0 | $4,848 | $0 | $195,898 | $0 | $0 |
| John Shaver | ||||||||||||||
| Chief Financial Officer | $0 | $228,216 | $0 | $29,844 | $0 | $2,136 | $0 | $4,825 | $0 | $5,989 | $0 | $271,010 | $0 | $0 |
| Mehdi Pajouh MD | ||||||||||||||
| Physician | $360,822 | $0 | $0 | $0 | $5,932 | $0 | $5,300 | $0 | $17,089 | $0 | $389,143 | $0 | $0 | $0 |
| Denzl Reid MD | ||||||||||||||
| Physician | $258,221 | $0 | $0 | $0 | $36,431 | $0 | $5,300 | $0 | $12,162 | $0 | $312,114 | $0 | $0 | $0 |
| Arthur King Jr MD | ||||||||||||||
| Physician | $264,090 | $0 | $0 | $0 | $8,549 | $0 | $3,740 | $0 | $4,627 | $0 | $281,006 | $0 | $0 | $0 |
| Heidi Kolek MD | ||||||||||||||
| Physician | $256,478 | $0 | $0 | $0 | $4,041 | $0 | $5,236 | $0 | $11,768 | $0 | $277,523 | $0 | $0 | $0 |
| Rulour Torio MD | ||||||||||||||
| Physician | $220,674 | $0 | $0 | $0 | $1,107 | $0 | $4,414 | $0 | $1,564 | $0 | $227,759 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) reviews and approves the compensation philosophy that is used to administer the specific pay decisions for the President of the filing organization. The compensation committee consists entirely of individuals serving on the board of the filing organization. The compensation of the President of the filing organization is determined by the member of the President's Cabinet (the Health System's senior leadership) responsible for that filing organization, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data and based on the Executive Compensation Philosophy Statement established by the compensation committee. |
| Part I, Line 4b | Ronald Bryant - Supplemental Retirement of $12,000 is included in column E. This amount was earned and paid in 2016. Dennis W. Chalke - Supplemental Retirement of $257,706 is included in column E. This amount was earned and paid in 2016. Mark A. Keroack, MD - Total Supplemental Retirement of $881,458 is included in column E. This amount consists of $264,321 earned and paid in 2016 and $562,123 that was previously reported as deferred compensation in prior years Forms 990, and that is currently reported as taxable income. This also includes $55,014 of investment earnings on prior year contributions. The amount is listed in Column F in accordance with reporting requirements. Grace Makari-Judson, MD- Supplemental Retirement of $16,599 is included in column E. This amount was earned in 2016. Kevin P. Moriarty, MD - Supplemental Retirement of $33,542 is included in column E. This amount was earned and paid in 2016. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Two or more of the persons listed in this Form 990 Part VII have a business relationship with each other by virtue of sitting on one or more Boards of Directors or by serving in an employment relationship with one or more entities in the Baystate Group of affiliated entities and in the community. The following trustees, officers, or key employees have a business relationship: (1) Grace P. Makari-Judson, MD, James P. Sadowsky and John H. Davis (2) Paul R. Murphy and Robert L. Pura, PhD, (3) John F. Maybury and Mark A. Keroack, MD, (4) Claudia R. Coplein, DO and Victor Woolridge (5) John F. Maybury and Anne M. Paradis. |
| Form 990, Part VI, Section A, line 3 | Westfield Medical Corporation is affiliated with Baystate Administrative Services, Inc. (BAS) which is a 501(c) (3) organization. Information Technology, Human Resources, Finance, Treasury, Accounting and other management and support functions are delegated to BAS. |
| Form 990, Part VI, Section A, line 6 | The filing organization has one member, who is a physician serving ex officio. |
| Form 990, Part VI, Section A, line 7a | The Board of Directors of the filing organization consists of the same individuals serving as members of the Board of Trustees of Baystate Noble Corporation ("BNH"), plus the organizations sole member, who is a physician serving ex officio. The Board of Trustees of BNH consists of the same individuals serving as the the Board of Trustees of Baystate Health, Inc ("BH"), the parent corporation of the health system to which the filing organization belongs, with the addition of the president of the medical staff of BNH. The Board of Trustees of BH are elected annually by the Board of Trustees of BH at their annual meeting. Form 990, Part VI, Section A, line 8b: The Trustees of Westfield Medical Corporation meet during certain scheduled Baystate Health, Inc. (BH) board meetings. The BH Board of Trustees and its committees, including the Audit and Compliance Committee, contemporaneously document meetings and actions relative to Westfield Medical Corporation as well as the annual acceptance of the audited financial statements. |
| Form 990, Part VI, Section B, line 11b | Prior to the filing of this return appropriate parts of this Form 990 were reviewed by representatives from the Tax, Finance, and Human Resources Departments of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) and by outside legal counsel. The entire return was reviewed by a tax expert from an outside accounting firm. The entire return was also reviewed prior to filing by the Audit and Compliance Committee of Baystate Health, Inc., which also includes some of the officers and trustees of the filing organization. This committee also reviews the audited financial statements for the health system. The Form 990 was provided to all members of the Board of Trustees prior to filing. |
| Form 990, Part VI, Section B, line 12c | Westfield Medical Corporation is an affiliate of Baystate Health, Inc. Baystate Health, Inc. and its affiliated entities have a comprehensive conflict of interest policy applicable to all of the affiliated entities. All directors, trustees, officers, key employees, and highest compensated employees of BH and its affiliates are asked to complete an annual "conflict of interest" form. We utilize an electronic database to receive and manage all conflict of interest submissions. This information is reviewed by the Chief Compliance Officer, Chief Executive Officer, Chair of the Board of Trustees, Chief General Counsel and the Chair of the Audit & Compliance Committee. A summary of the conflict of interest disclosures is provided to the Baystate Health Board of Trustees and the Tax Department. Potential conflict of interest transactions are reviewed as appropriate under the policy, which provides for recusal from discussion and deliberation by any party with a potential conflict of interest. |
| Form 990, Part VI, Section B, line 15 | The compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) reviews and approves the compensation philosophy that is used to administer the specific pay decisions for the President and employees of the filing organization. The compensation committee consists entirely of individuals serving on the board of Baystate Health. The compensation of the President of the filing organization is determined by the member of the President's Cabinet (the Health System's senior leadership) responsible for that filing organization, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data and based on the Executive Compensation Philosophy Statement established by the compensation committee. The compensation of other officers and key employees of the filing organization is determined by the President of the filing organization in accordance with the Executive Compensation Philosophy Statement, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data or the Baystate Health Board approved budget and wage program for each fiscal year. |
| Form 990, Part VI, Section C, line 19 | The organization makes its conflict of interest policy and financial statements available to the public at www.baystatehealth.org. Articles of organization and bylaws are generally available at the Commonwealth of Massachusetts website. |
| Form 990, Part VII, Section A, Line 5 | Certain officers or trustees of the filing organization are paid by an entity, Baystate Medical Practices, Inc. (BMP) EIN 04-2888373, which is part of the health care system to which the filing organization belongs but does not meet the technical requirements as a "Related Organization" per Schedule R. Compensation from BMP to the officers and trustees of the filing organization therefore, is reported as paid from an unrelated organization in Line 5 and according to the instructions reported as though paid by the filing organization. |
| Form 990, Part XI, line 9: | Forgiveness of payable due to a related organization 1,517,514. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Baystate Administrative Services Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 222747685 | Administrative services | MA | 501 (c ) (3) | 12c, III | Baystate Health Inc | 0 |
| Baystate Health Foundation Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 043549011 | Fundraising | MA | 501 (c ) (3) | 7 | Baystate Health Inc | 0 |
| Baystate Health Systems Inc Health & Welfare Benefits Plan | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 222531644 | Voluntary Employees' Benefit Association | MA | 501 (c ) (9) | Baystate Health Inc | 0 | |
| Baystate Health Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 042105941 | Healthcare system parent | MA | 501 (c ) (3) | 7 | Baystate Health Inc | 0 |
| Baystate Medical Center Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 042790311 | Acute care teaching hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Baystate Total Home Care Inc | ||||||||||
| 280 Chestnut Street | Springfield | MA | 01199 | 203260764 | Real estate and other | MA | 501 (c ) (3) | 12b, II | Baystate Medical Center | 0 |
| Visiting Nurse Assn and Hospice of Western New England Inc | ||||||||||
| 50 Maple Street | Springfield | MA | 01199 | 042105803 | Home health and hospice care | MA | 501 (c ) (3) | 10 | Baystate Health Inc | 0 |
| Baystate Wing Hospital Corporation | ||||||||||
| 40 Wright Street | Palmer | MA | 01069 | 222519813 | Hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Health New England Inc | ||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 042864973 | HMO/Insurance | MA | 501 (c ) (4) | Baystate Health Inc | 0 | |
| HNE of Connecticut Inc | ||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 455190134 | HMO/Insurance | CT | 501 (c ) (4) | Health New England Inc | 0 | |
| Baystate Franklin Medical Center | ||||||||||
| 164 High Street | Greenfield | MA | 01301 | 042103575 | Hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Baystate Noble Hospital Corporation | ||||||||||
| 115 West Silver St PO Box 1634 | Westfield | MA | 010861634 | 222537423 | Hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Noble Visiting Nurse Services Inc | ||||||||||
| 77 Mill Street | Westfield | MA | 01085 | 222757446 | Home health and hospice care | MA | 501 (c ) (3) | 10 | Visiting Nurse Assn and Hospice of Western New England | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HNE Advisory Services | |||||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 043012347 | Administrative services | MA | Health New England Inc | C | 0 | ||||
| HNE Insurance Services Corporation | |||||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 043183019 | Ancilliary insurance | MA | Health New England Inc | C | 0 | ||||
| Ingraham Corporation | |||||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 043016257 | Health care and other business activities | MA | Baystate Health Inc | C | 0 | ||||
| Baystate Health Insurance Company Ltd | |||||||||||||
| 980421413 | Offshore captive insurance | Baystate Health Inc | 0 | North Church Street | Georgetown | CJ | CJ | ||||||
| HNE Holding Corporation | |||||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 464620480 | Holding shares in subsidiary corporation | MA | Health New England Inc | C | 0 | ||||
| HNE Insurance Company Inc | |||||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 454462433 | Health services for Mass Medicare Supplement | MA | Health New England Inc | C | 0 | ||||
| Noble Health Services - Fidelity | |||||||||||||
| 115 W Silver Street PO Box 870 | Westfield | MA | 011441500 | 222909354 | Financial support for hospital | MA | Baystate Noble Hospital Corporation | T | 0 | ||||
| Noble Health Services - Vanguard | |||||||||||||
| 115 W Silver Street PO Box 870 | Westfield | MA | 011441500 | 912156429 | Financial support for hospital | MA | Baystate Noble Hospital Corporation | T | 0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |