2013-08-13T09:44:17-07:00 2012-09-30 990 2011-10-01 222537423 TRUSTEES OF NOBLE HOSPITAL INC TRUS 4135682811 115 West Silver Street P O Box 1634 Westfield MA 010861634 Ronald Bryant 4135682811 2013-08-13 2011 2016-02-25 16:41:14Z Noble Hospital Ronald Bryant 115 West Silver Street Westfield MA 010861634 57264769 0 X www.noblehospital.org X 1984 MA The mission of Noble Hospital is to deliver the highest quality health care through a broad range of services to the diverse people of Greater Westfield and surrounding areas. 20 18 685 98 0 0 357128 2121228 52364980 51984243 20846 84896 417365 532431 53160319 54722798 0 0 0 0 30103684 29375728 0 0 0 24533109 23580668 54636793 52956396 -1476474 1766402 21125508 24316129 34519717 37289103 -13394209 -12972974 The mission of Noble Hospital is to deliver the highest quality health care through a broad range of services to the diverse people of Greater Westfield and surrounding areas. 0 0 43743278 0 51984243 Provided acute care inpatient, outpatient and other health care services for Westfield and the surrounding communities. 0 0 0 43743278 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 125 0 1 685 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 X 20 18 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 0 0 0 MA X X Ronald Bryant 4135682811 115 West Silver Street P O Box 1634 Westfield MA 010861634 X Robert Bacon 1 X 0 0 0 Mark Morin 1 X 0 0 0 Robert LaPalme 1 X 0 0 0 Kevin Queenin 1 X 0 0 0 Donald Bieker 1 X 0 0 0 Barbara Braem-Jensen 1 X 0 0 0 Roger Butler Jr 1 X 0 0 0 Scott Cooper MD 1 X 0 0 0 Harriett Deverry 1 X 0 0 0 John Greaney 1 X 0 0 0 William Harmon 1 X 0 0 0 Carol Kaufman 1 X 0 0 0 Joseph P Keenan MD 1 X 0 0 0 Michael McCabe 1 X 0 0 0 Mary O'Connell 1 X 0 0 0 David Peterson MD 1 X 0 0 0 Donald Pion 1 X 0 0 0 Denzil Reid MD 1 X 10000 242952 29893 Lance Reynolds MD 1 X 0 0 0 Deborah Strycharz 1 X 0 0 0 Ronald Bryant 40 X X 246642 0 19365 Stanley Strzempko MD 30 X X 315000 0 0 John Shaver 40 X 136496 0 3297 Diane Brunelle 40 X 147645 0 15171 Timothy O'Neil 40 X 127053 0 3745 Hui-Wen Chia 42 X 126053 0 4577 Brenda Theriaque 45 X 116599 0 21519 Diane Stimpson 46 X 114879 0 25651 Robert P Perry 0 X 108334 0 7000 1448701 242952 130218 21 1 1 1 RehabCare Group Inc P O Box 502096 St Louis MO 631502096 physical rehabilitation management 1847748 Alliance Healthcare Services Inc 1900 S State College Blvd Suite 600 Anaheim CA 92806 diagnostic imaging 962840 Morrison Management Specialists Inc P O Box 102289 Atlanta GA 30368 food and nutrition services 812399 Umass Memorial Medical Center P O Box 417433 Boston MA 022417433 laboratory testing and analysis 434947 Leaders for Today LLC 50 Resnik Road Suite 103 Plymouth MA 02360 executive management and recruitment 303850 18 0 0 175797 0 1752246 193185 0 2121228 hospital revenue 622000 51877618 51877618 0 0 rental income from affiliate 531390 106625 106625 0 0 0 0 0 0 51984243 55126 0 0 55126 0 0 0 0 0 0 0 0 0 0 2286542 242660 2130173 369259 156369 -126599 29770 29770 0 0 42539 175797 42539 0 0 0 endowment principal and interest withdrawals 900099 235102 235102 0 0 vendor rebates and commissions 900099 28664 28664 0 0 268665 268665 0 0 532431 54722798 52546444 0 55126 0 0 0 0 0 0 0 0 886679 0 886679 0 0 0 0 0 23060797 20161313 2899484 0 1303671 1099298 204373 0 2411304 2041480 369824 0 1713277 1439153 274124 0 0 0 0 0 161282 2037 159245 0 117800 0 117800 0 71305 0 71305 0 0 0 0 0 0 0 10184340 7939994 2244346 0 225312 0 225312 0 1329435 886986 442449 0 0 0 0 0 0 0 0 0 1695285 1157824 537461 0 40783 12811 27972 0 0 0 0 0 33767 14020 19747 0 74538 61933 12605 0 0 0 0 0 2384963 1931425 453538 0 329553 290008 39545 0 Medical supplies 6683356 6683356 0 0 Dues 125838 15202 110636 0 123111 6438 116673 0 52956396 43743278 9213118 0 395912 50144 201782 1694388 0 0 5223182 5494477 0 0 0 0 0 0 773597 789907 182477 149683 52152251 41268673 11015251 10883578 3300561 3763452 0 0 0 0 0 0 32746 1490500 21125508 24316129 11231002 11996146 0 0 98620 133558 0 0 0 0 0 0 6746758 6900647 0 0 16443337 18258752 34519717 37289103 X -16911821 -16910969 2637064 3057447 880548 880548 -13394209 -12972974 21125508 24316129 X 1766402 -1345167 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 55000 1 16304 0 71304 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 The organization contracted directly with a consultant to assist in pursuing its government affairs objectives. This consultant was paid to perform lobbying and other public affairs work. Lobbying was conducted on various initiatives related to the delivery and financing of health care. In addition, the organization paid membership dues to the Massachusetts Hospital Association and to the American Hospital Association, both of whom have advised that portions of those dues were used for lobbying purposes. 3300943 0 598094 0 158090 0 3740947 0 3300943 0 0 0 0 3300943 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.24 0.76 0 0 0 822598 822598 0 24090176 18324161 5766015 0 442474 364979 77495 0 26502766 22579533 3923233 0 294237 0 294237 10883578 Malpractice insurance recovery receivables 1490500 1490500 0 Accrued pension liability 16349113 Medical malpractice claims liability 1601326 Asset retirement obligation 308313 18258752 54722798 52956396 1766402 0 0 0 0 -380255 -380255 1386147 54236816 0 0 0 0 0 54236816 0 485982 485982 54722798 52956396 0 0 0 0 0 52956396 0 0 0 52956396 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The organization's endowment funds are restricted primarily for the provision of health care services and the upkeep and maintenance of the physical plant. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 $380,255 is included in revenue in Form 990 but not in the audited financial statements. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b $105,727 is included in the audited financial statements in non-operating gains and losses, and $223,886 is grants and contributions and $156,369 is realized gains, both included in temporarily restricted net assets in the audited financial statements. Noble Ball 194628 152089 42539 0 0 2090 29991 3200 7258 5K 23708 23708 0 0 0 0 0 0 0 0 218336 175797 42539 0 0 2090 29991 3200 7258 42539 0 1 1 1 X 1 X 1 0 1 1 787532 136429 651103 0.0123 6602149 5138890 1463259 0.0276 1574914 816980 757934 0.0143 0 0 8964595 6092299 2872296 0.0542 60687 6658 54029 0.001 2640 0 2640 0.00 0 0 63327 6658 56669 0.0010 0 0 9027922 6098957 2928965 0.0552 0 1431726 0 24620721 22179495 2441226 X 1 1 1 1 Noble Hospital

115 West Silver Street Westfield MA 01086

X X X Psychiatric and physical rehabilitation services Noble Hospital 1 0 0 0 0 0 0 1 0 1 0 1 1 Noble Hospital Sports & Rehabilitation Center

74 Main Street Westfield MA 01086

Physical rehabilitation outpatient clinic SchH_P01_S00_L06a Schedule H, Part I, Line 6a The organization filed its Community Benefit report covering the tax year October 1, 2011 through September 30, 2012 on March 26, 2013, with a revised report filed on June 19, 2013. It is available to the public through the website of the Attorney General's office of the Commonwealth of Massachusetts. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Financial Assistance at cost, Unreimbursed Medicaid and Unreimbursed costs - other means-tested government programs were calculated by using a cost to charge ratio derived from Worksheet 2 - Ratio of Patient Care Cost to Charges. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Bad debt expense at cost was calculated using total bad debt from the financial statements multiplied by the Ratio of Patient Care Cost to Charges, which was derived using Worksheet 2 in the instructions for Schedule H. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The Medicare allowable costs were obtained from the organization's Medicare cost report for the year ended September 30, 2012. The organization believes that Medicare underpayments should be treated as a community benefit since these services and related costs promoted the health of the community and were rendered as part of the organization's policy of providing care to any patient in need of medical care, regardless of the patient's ability to pay for such care. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b The policy addresses both how the organization helps individuals who do not have health insurance find assistance when it is available and how these accounts are processed based on the insurance and type of claim involved. SchH_P05_S0B_L21 Schedule H, Part V, Section B, Line 21 The organization has to initially bill all patients the same amount of gross charges regardless of their insurance plan or lack thereof. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 A Community Needs Assessment has been completed and finalized. The MUA application is in process and has been submitted for review by HRSA and the Commonwealth of Massachusetts. All elements of the assessment per HRSA requirements have been completed by the staff and contractor with mid-year reports on file at Region 1. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The organization has established a charity program with the Greater Westfield Free Clinic. Currently we are working to include this program in the organization's credit and collection policy. We are currently working on enhancing this program to those patients who are in need of medical services and do not qualify for state funded programs but have no financial means to pay. These patients will be screened using the state eligibility tools and will be approved on a case by case basis. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Westfield is an urban area that is relatively densely populated. The city of Westfield is bordered by West Springfield on the east, Southwick on the south, Granville on the southwest, Russell and Montgomery on the west, Southampton on the north and Holyoke on the northeast. Westfield is 99 miles from Boston and 85 miles from Albany, NY. Westfield has the second largest land area in the Commonwealth of Massachusetts, covering 30,000 acres. Westfield has a population of 41,094, of which 92.8% is white, 1.6% is black, 7.5% is Latino and 1.3% is Asian/Pacific Islander. The per capita income is $26,605. Westfield's educational attainment profile is slightly better than the state's, except for a lower rate of post-college education. Nine percent of Westfield's residents live below the Federal Poverty Level. Over 43% of renters pay 35% or greater of their household income on rent. Westfield was a resettlement site for individuals from the former Soviet Union and over 2,400 have settled in the area. There is a growing Latino population as well as low income student population that study and work in the city. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 The organization provides services to all. The organization provided $2,123,000 in Free Care gross charges to the community during the year. Some of the organization's and related organization's providers served the Westfield Public Schools and worked at the Westfield Free Health Clinic. The organization has an active Patient and Family Advisory Council. The organization shared internal newsletter space with community events, fundraisers and information that was of interest to our employees. The organization allowed outside groups to use its facilities, including meeting and conference rooms, for free. Staff members participated in many different community events, school activities and health fairs in the greater Westfield area during the year. These staff members were able to give out educational materials, talk to visitors, perform blood pressure checks, blood glucose tests, skin analyses and other informational tests. Many of the brochures and pamphlets are available in English, Spanish and Russian, reaching out to more people in the community. Staff members also visited private homes, nursing homes and other facilities for "Noble Conversations" where questions about health care and offered services were answered. Whenever possible, the organization supported local non-profit groups with sponsorships, volunteer help at events and with other non-monetary donations. The organization also partnered with other for-profit and non-profit organizations in the area to enhance the awareness of good health maintenance and the services that are offered. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 The organization files its community benefits report with the Commonwealth of Massachusetts. X 1 1 X X X 0 0 0 0 0 0 0 0 0 Robert P Perry 108334 0 0 0 0 0 0 0 7000 0 115334 0 0 0 Ronald Bryant 246642 0 0 0 0 0 0 0 19847 0 266489 0 0 0 Stanley Strzempko MD 315000 0 0 0 0 0 0 0 527 0 315527 0 0 0 Denzil Reid MD 10000 242952 0 0 0 0 0 2860 0 28207 10000 274019 0 0 Diane Brunelle 147645 0 0 0 0 0 2770 0 13126 0 163541 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a The organization reimbursed the Former Interim President & Chief Executive Officer and the President & Chief Executive Officer for temporary lodging expenses incurred, in accordance with their respective contracts. F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 Certain Trustees on the Board of Trustees ("Board") of the organization had various business relationships with certain other Trustees on the Board in their respective business capacities within the greater Westfield community. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b A copy of this Form 990 was provided to the organization's Finance Committee for their review, discussion and comment prior to filing. It was also distributed to the full Board prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c All trustees, upon appointment to the Board and annually thereafter, are required to disclose any interests that could give rise to conflicts in a signed Trustee's Declaration. The Declaration forms are reviewed and signed by the Board's Chairman and Vice Chairman, then forwarded to the President & CEO of the organization for further review. As matters come before the Board and in the event of any conflict, the Chairman (or Vice Chairman) will require that the trustee(s) involved be removed from any further discussion and voting on that matter. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization makes its governing documents, conflict of interest policy and audited financial statements available to the public upon request. These documents can be reviewed by contacting the Administration offices at Noble Hospital during the regular business hours of 8:00 a.m. through 4:30 p.m. Monday through Friday, excluding recognized holidays. The Form 990 and audited financial statements are also available at various state agencies' offices and websites. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a Denzil Reid MD works an average of 40 hours per week as a physician for Westfield Medical Corporation, a related organization. F990_P11_S00_L05 Form 990, Part XI, Line 5 The change in net assets includes unrealized gains on investments of $353,262, ($2,167,565) of forgiveness of an affiliated company's receivables, $629,688 of pension-related changes other than net periodic benefit cost, ($13,913) of net assets released from temporary restrictions for operations and ($146,639) of net appreciation of investments utilized for operations. Westfield Medical Corporation 115 West Silver Street Westfield MA 010853628 043127730 Physician medical services MA 501(c)(3) 11a N/A 1 Noble Visiting Nurse & Hospice Services Inc 77 Mill Street Westfield MA 01085 222757446 Home health care and hospice MA 501(c)(3) 9 N/A 1 1 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 Westfield Medical Corporation a-iv 106625 Westfield Medical Corporation b 2167565 Noble Visiting Nurse & Hospice Services Inc p 57834 An application for an additional three-month extension was approved by the IRS on June 3, 2013. The filing due date is August 15, 2013.