2012-08-15T10:25:20-07:00 2011-09-30 990 2010-10-01 222537423 TRUSTEES OF NOBLE HOSPITAL INC TRUS 4135682811 115 West Silver Street P O Box 1634 Westfield MA 010861634 Ronald Bryant 4135682811 2012-08-15 2010 2016-02-24 21:20:13Z Noble Hospital Ronald Bryant 115 West Silver Street Westfield MA 01086 53253297 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 17 745 97 95290 0 550084 357128 51984624 52364980 4899 20846 763286 417365 53302893 53160319 0 0 0 0 29412205 30103684 0 0 0 25829683 24533109 55241888 54636793 -1938995 -1476474 20176161 21125508 29278384 34519717 -9102223 -13394209 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 45941340 0 52364980 Provided acute care inpatient, outpatient and other health care services for Westfield and the surrounding communities. 0 0 0 45941340 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 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 1 131 0 1 745 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 20 17 1 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X X Ronald Bryant 4135682811 115 West Silver Street P O Box 1634 Westfield MA 010861634 Robert Bacon 1 X 0 0 0 Mark Morin 1 X 0 0 0 Robert LaPalme 1 X 0 0 0 Mary O'Connell 1 X 0 0 0 Patti Andras 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 Kevin Queenin 1 X 0 0 0 Robert Paul 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 14615 245332 29078 Lance Reynolds MD 1 X 0 0 0 Robert P Perry 40 X X 135756 0 15150 Ronald Bryant 40 X X 14104 0 0 Stanley Strzempko MD 18 X X 142200 0 0 Robert Blondin 40 X 230112 0 20081 John Shaver 40 X 128578 0 3179 Sharon Cygan 51 X 148532 0 12998 Diane Brunelle 40 X 142654 0 14905 Hui-Wen Chia 43 X 133030 0 3419 Timothy O'Neil 40 X 129516 0 3588 Brenda Theriaque 48 X 120235 0 23130 George Koller 0 X 398813 0 9086 1738145 245332 134614 24 1 1 1 RehabCare Group Inc P O Box 502096 St Louis MO 631502096 physical rehabilitation management 1780716 Alliance Healthcare Services Inc 1900 S State College Blvd Suite 600 Anaheim CA 92806 diagnostic imaging 844393 Milford Anesthesia Associates PC 831 Boston Post Road Milford CT 06460 clinical anesthesiology services 440090 Umass Memorial Medical Center P O Box 417433 Boston MA 022417433 laboratory testing and analysis 425094 Morrison Management Specialists Inc P O Box 102289 Atlanta GA 30368 food and nutrition services 382369 18 0 0 143640 0 77545 135943 0 357128 hospital revenue 622000 52270207 52174917 95290 0 rental income from affiliate 531390 94773 94773 0 0 0 0 0 0 52364980 5137 0 0 5137 0 0 0 0 0 0 0 0 0 0 0 65282 0 49573 0 15709 15709 15709 0 0 43405 143640 43405 0 0 0 endowment principal and interest transfers 900099 141861 141861 0 0 vendor rebates and commissions 900099 37182 37182 0 0 238322 238322 0 0 417365 53160319 52702764 95290 5137 0 0 0 0 0 0 0 0 756638 0 756638 0 0 0 0 0 23790210 21078057 2712153 0 1086307 937640 148667 0 2697611 2342777 354834 1772918 1524710 248208 0 468587 0 468587 0 163794 1437 162357 0 211935 0 211935 0 58000 0 58000 0 0 0 0 0 0 0 8356948 6614762 1742186 0 245131 7584 237547 0 7545767 7263331 282436 0 0 0 0 0 0 0 0 0 1754359 1198879 555480 0 38350 17524 20826 0 0 0 0 0 22958 13374 9584 0 97129 82253 14876 0 0 0 0 0 2416225 2013405 402820 0 242160 204053 38107 0 Provision for uncollectible accounts 2601295 2601295 0 0 Dues 137958 10642 127316 0 Equipment rentals 65982 26344 39638 0 106531 3273 103258 54636793 45941340 8695453 0 -43947 395912 689800 201782 0 0 4762938 5223182 0 0 0 0 0 0 707782 773597 164095 182477 50732715 39717464 11875724 11015251 0 3300561 0 0 0 0 2019769 32746 20176161 21125508 9650364 11231002 0 0 147005 98620 0 0 0 0 0 0 6865659 6746758 0 0 12615356 16443337 29278384 34519717 X -11293611 -16911821 1713033 2637064 478355 880548 -9102223 -13394209 20176161 21125508 X -1476474 -2815512 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 58000 1 16925 0 74925 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 The organization contracted directly with consultants to assist in pursuing its government affairs objectives. These consultants were 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. 0 3300943 0 0 0 0 3300943 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.27 0.73 0 0 0 927517 927517 0 23524550 17629311 5895239 0 436469 357778 78691 0 25634895 21730375 3904520 0 209284 0 209284 11015251 0 Accrued pension liability 16146182 Asset retirement obligation 297155 16443337 53160319 54636793 -1476474 0 0 0 0 -219798 -219798 -1696272 52940521 0 0 0 0 0 52940521 0 219798 219798 53160319 54636793 0 0 0 0 0 54636793 0 0 0 54636793 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 $219,798 is included in revenue in Form 990 but not in the audited financial statements. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b $219,798 is grants and contributions included in temporarily restricted net assets in the audited financial statements. Noble Ball 187045 143640 43405 0 0 0 24121 3385 15899 0 0 187045 143640 43405 0 0 0 24121 3385 15899 43405 0 0 1 1 784399 322646 461753 0.0087 6344284 5504968 839316 0.0161 1109801 895853 213948 0.0041 0 0 8238484 6723467 1515017 0.0289 110005 10065 99940 0.0019 2190 2190 0 0 112195 10065 102130 0.0019 0 0 8350679 6733532 1617147 0.0308 0 955716 0 18772246 20754195 -1981949 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 1 1 Noble Hospital Sports & Rehabilitation Center

74 Main Street Westfield MA 01085

Physical rehabilitation outpatient clinic SchH_P01_S00_L06a Schedule H, Part I, Line 6a The organization filed its final Community Benefit report covering the tax year October 1 2010 through September 30 2011 on May 16, 2012 with the Attorney General's office of the Commonwealth of Massachusetts. It is available to the public through the Attorney General's website. 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, 2011. 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 will be finalized by August 31, 2012. The MUA application is in process and will be 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 42,133, of which 93.6% is white, 1.6% is black, 4.9% is Latino and 1.6% is Asian/Pacific Islander. The per capita income is $25,436. Westfield's educational attainment profile is slightly better than the state's, except for a lower rate of post-college education. Twelve percent of Westfield residents live below the Federal Povery Level and 23% live below 200% of the FPL. 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 $2,135,000 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. X 1 1 X X X 1 0 0 0 0 0 0 0 0 Robert P Perry 135756 0 0 0 0 0 0 0 15150 0 150906 0 0 0 Ronald Bryant 14104 0 0 0 0 0 0 0 0 0 14104 0 0 0 George Koller 0 0 0 0 398813 0 0 0 9086 0 407899 0 0 0 Denzil Reid MD 14615 245332 0 0 0 0 0 2814 0 27433 14615 275579 0 0 Robert Blondin 204220 0 0 0 25892 0 4113 0 16699 0 250924 0 0 0 Sharon Cygan 148532 0 0 0 0 0 12998 0 474 0 162004 0 0 0 Diane Brunelle 142654 0 0 0 0 0 2790 0 12808 0 158252 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a The organization reimbursed the Interim President & Chief Executive Officer and the President & Chief Executive Officer for temporary lodging expenses incurred, in accordance with their respective contracts. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The organization entered into a severance agreement in September 2009 with George Koller, the Former President & Chief Executive Officer of the organization. The agreement provided for one year of salary to be paid weekly through September 2010 ($5,231 gross weekly) and continuance on the organization's group medical plan through September 2010 at a net cost of approximately $800 monthly. In addition, Mr. Koller received $158,000 as a one-time severance payment on March 12, 2010 and $36,119 as a one-time severance payment on April 8, 2010, all less applicable payroll taxes. The organization entered into a severance agreement in November 2010 with the Former Vice President, Finance. This agreement provided for six months of salary, at his then current rate, to be paid weekly through May 2011 ($3,407 gross weekly) and continuance on the organization's group medical plan through May 2011 at a net cost of approximately $1,289 monthly. 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_S0A_L03 Form 990, Part VI, Section A, Line 3 The organization contracted both with an executive management company and directly with outside consultants for the services of president and executive vice president. Collectively, those services began on September 23, 2009 and ended on June 30, 2011. F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 Effective September 30, 2011, two previously-related companies, Noble Health Systems Inc and Silvermill Realty Corporation, merged with and into the organization, with the organization being the surviving corporation. As a result of and in accordance with the mergers, the organization filed Restated Articles of Organization with the Commonwealth of Massachusetts and produced Amended and Restated By-Laws. 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 of Trustees prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c All trustees, officers and senior management employees are required to disclose annually any interests that could give rise to conflicts. Administration periodically reviews the submitted conflict of interest statements to ensure full compliance with the policy. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization makes it's governing documents, conflict of interest policy and audited financial statements available to the public upon request. These documents can be reviewed in a conference room adjacent to 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_P11_S00_L05 Form 990, Part XI, Line 5 The change in net assets includes a transfer of $1,995,710 of assets from merged affiliates, $169,815 of transfers from an affiliate to finance equipment additions, ($1,539,402) of forgiveness of an affiliated company's receivables, ($3,272,593) of pension-related changes other than net periodic benefit cost, ($139,817) of change in beneficial interest in net assets held by affiliate and ($29,225) of net assets released from temporary restrictions for operations. Noble Health Systems Inc 115 West Silver Street P O Box 1634 Westfield MA 010861634 042131755 Marketing and development support MA 501(c)(3) 11b N/A 1 Silvermill Realty Corporation 115 West Silver Street P O Box 1634 Westfield MA 010861634 222552923 Real estate holding company MA 501(c)(3) 11b N/A 1 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 1 0 0 0 0 0 1 0 0 0 1 0 0 1 0 1 Westfield Medical Corporation a-iv 94773 Westfield Medical Corporation b 1518177 Noble Health Systems Inc c 141861 Noble Health Systems Inc c 170815 Noble Health Systems Inc r 3309089 Silvermill Realty Corporation r 537377 An application for an additional three-month extension was approved by the IRS on June 11, 2012. The filing due date is August 15, 2012.