2018-08-09T13:11:28-05:00 2017-09-30 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2016-10-01 043127730 Westfield Medical Corporation dba Noble Medical Group WEST 4135682811 115 West Silver Street Westfield MA 01085 Dennis W Chalke SVP Finance, CFO & Treasurer 4135682811 2018-08-09 1 Christine Kawecki P00743140 5169187000 2016 2022-09-23 18:48:47Z Noble Medical Group Dennis W Chalke 115 West Silver Street Westfield MA 01085 10817877 0 X http://baystatenoblehospital.org/ X 1991 MA The mission of the organization is to improve the health of the people in our communities every day, with quality and compassion. 25 17 140 22 0 0 0 0 10823661 10817877 0 0 0 0 10823661 10817877 0 0 0 0 10759506 6058157 0 0 0 5870940 10532253 16630446 16590410 -5806785 -5772533 2663993 6122338 1318689 9032053 1345304 -2909715 The mission of the organization is to improve the health of the people in our communities every day, with quality and compassion. 0 0 16590410 0 10817877 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. 16590410 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 140 1 0 0 0 0 0 0 0 0 0 0 X 25 17 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X John Shaver-Baystate Noble Hospital 4135682811 115 West Silver St Westfield MA 01085 X Anne M Paradis Chair (as of 1/1/17) 1.00 2.00 X X 0 0 0 John F Maybury Vice Chair (as of 1/1/17) 1.00 1.00 X X 0 0 0 Adrian J Levsky Trustee 1.00 1.00 X 0 0 0 Aleksandr Pugach MD Trustee 1.00 48.00 X 223229 0 6814 Andrew Artenstein MD Trustee 1.00 45.00 X 281998 486856 62074 Claudia R Coplein DO Trustee (as of 1/1/17) 1.00 1.00 X 0 0 0 Colleen W Holmes Trustee (as of 1/1/17) 1.00 1.00 X 0 0 0 David C Southworth Trustee (through 12/31/16) 1.00 1.00 X 0 0 0 Edward J Noonan Trustee 1.00 1.00 X 0 0 0 Grace Makari-Judson MD Trustee/ Hematologist 1.00 40.00 X 347988 0 78646 Gregory L Braden MD Trustee 1.00 1.00 X 0 0 0 Harriet A DeVerry Trustee 1.00 1.00 X 0 0 0 Hector Toledo Trustee 1.00 1.00 X 0 0 0 James P Sadowsky Trustee 1.00 2.00 X 0 0 0 James R Phaneuf Trustee 1.00 1.00 X 0 0 0 John A Egelhofer MD Trustee 1.00 1.00 X 0 0 0 John H Davis Trustee 1.00 1.00 X 0 0 0 Kathleen B Scoble Trustee 1.00 1.00 X 0 0 0 Kevin P Moriarty MD Trustee/ Chief Ped Surgery 1.00 40.00 X 0 699348 45950 Mark A Keroack MD Trustee 1.00 40.00 X 0 2182220 38487 Paul R Murphy Trustee 1.00 1.00 X 0 0 0 Robert J Bacon Trustee 1.00 1.00 X 0 0 0 Robert L Pura PhD Trustee 1.00 1.00 X 0 0 0 Steven M Mitus Trustee (through 12/31/16) 1.00 1.00 X 0 0 0 Timothy F Farrell Trustee (as of 1/1/17) 1.00 1.00 X 0 0 0 Victor Woolridge Trustee 1.00 1.00 X 0 0 0 William R Webber Trustee (as of 1/1/17) 1.00 1.00 X 0 0 0 Dennis Chalke Treasurer 1.00 50.00 X 0 935201 89071 Kristin R Delaney Clerk 1.00 39.00 X 0 137437 37010 Madeline Torres Assistant Clerk 1.00 40.00 X 0 56586 13801 Ronald Bryant President, WMC 5.00 45.00 X 0 545819 44592 Michele Urban VP Patient Care Services/CNO 20.00 30.00 X 0 176048 4778 Beverly Fein VP Human Resources 20.00 30.00 X 0 191050 4848 John Shaver Chief Financial Officer 20.00 30.00 X 0 260196 10814 Mehdi Pajouh MD Physician 50.00 0.00 X 366754 0 22389 Denzl Reid MD Physician 50.00 0.00 X 294652 0 17462 Arthur King Jr MD Physician 50.00 0.00 X 272639 0 8367 Heidi Kolek MD Physician 50.00 0.00 X 260519 0 17004 Rulour Torio MD Physician 50.00 0.00 X 221781 0 5978 2269560 5670761 508085 17 0 1 1 Westfield Emergency Physicians PC 9 Willow Brook Lane Westfield MA 01085 Medical Services 1065281 GBS Convergent Solutions LLC PO Box 2340 North Canton OH 447200340 Physician Billing 849334 National Physician Services 25 Laurel Road Rocky Hill CT 06067 Physician Services 282911 Allscripts Healthcare LLC 24630 Network Place Chicago IL 606731246 Electronic Health Records 137686 4 Patient Medical Care 621110 10817877 10817877 10817877 10817877 10817877 0 0 4955384 4955384 188928 188928 669437 669437 244408 244408 1321301 1321301 190611 190611 24496 24496 1059733 1059733 6926 6926 21344 21344 16769 16769 5271685 5271685 244454 244454 347173 347173 Purchased Services 1363337 1363337 Medical Supplies 644777 644777 Dues & Subscriptions 11923 11923 Recruitment Expense 7724 7724 16590410 16590410 0 0 207312 563195 807388 875198 51773 96440 2305724 872145 1577520 1433579 20000 3153926 2663993 6122338 865430 1436551 376300 332287 76959 7263215 1318689 9032053 X 1345304 -2909715 1345304 -2909715 2663993 6122338 X -5772533 1517514 X 0 1 X 1 0 X X 1 Baystate Noble Hospital Corporation 222537423 3 1 1518222 0 1 1518222 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 643947 238461 405486 518067 37557 480510 1143710 596127 547583 1433579 Medical Malpractice Insurance Recoverable 20000 Due from Affiliates 3133926 3153926 Medical Malpractice Claims 76959 Due to Affiliates 7186256 7263215 0 1 0 0 0 0 0 0 0 Aleksandr Pugach MD Trustee 200434 0 0 0 22795 0 6651 0 163 0 230043 0 0 0 Andrew Artenstein MD Trustee 279099 247240 0 173565 2899 66051 0 36897 13697 11480 295695 535233 0 0 Grace Makari-Judson MD Trustee/ Hematologist 275652 0 50668 0 21668 0 60173 0 18473 0 426634 0 0 0 Kevin P Moriarty MD Trustee/ Chief Ped Surgery 0 537664 0 124279 0 37405 0 26500 0 19450 0 745298 0 0 Mark A Keroack MD Trustee 0 876848 0 401474 0 903898 0 19875 0 18612 0 2220707 0 562123 Dennis Chalke Treasurer 0 489983 0 162064 0 283154 0 63576 0 25495 0 1024272 0 0 Kristin R Delaney Clerk 0 122188 0 14668 0 581 0 18742 0 18268 0 174447 0 0 Ronald Bryant President, WMC 0 422431 0 97708 0 25680 0 19875 0 24717 0 590411 0 0 Michele Urban VP Patient Care Services/CNO 0 153968 0 20682 0 1398 0 0 0 4778 0 180826 0 0 Beverly Fein VP Human Resources 0 167576 0 22671 0 803 0 0 0 4848 0 195898 0 0 John Shaver Chief Financial Officer 0 228216 0 29844 0 2136 0 4825 0 5989 0 271010 0 0 Mehdi Pajouh MD Physician 360822 0 0 0 5932 0 5300 0 17089 0 389143 0 0 0 Denzl Reid MD Physician 258221 0 0 0 36431 0 5300 0 12162 0 312114 0 0 0 Arthur King Jr MD Physician 264090 0 0 0 8549 0 3740 0 4627 0 281006 0 0 0 Heidi Kolek MD Physician 256478 0 0 0 4041 0 5236 0 11768 0 277523 0 0 0 Rulour Torio MD Physician 220674 0 0 0 1107 0 4414 0 1564 0 227759 0 0 0 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. 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. 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 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 North Church Street Georgetown CJ 980421413 Offshore captive insurance CJ Baystate Health Inc 0 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 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0