2012-08-15T16:22:07-05:00 2011-09-30 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2010-10-01 050259100 THE WESTERLY HOSPITAL WEST 4015966000 25 WELLS STREET WESTERLY RI 028912934 W MARK RUSSO 4015966000 2012-08-15 1 ELIZABETH SOLECKI 8605614000 2010 2016-02-24 21:20:13Z CHARLES KINNEY 25 WELLS STREET WESTERLY RI 028912934 96842128 0 X WWW.WESTERLYHOSPITAL.ORG X 1921 RI THE WESTERLY HOSPITAL PROVIDES INPATIENT AND OUTPATIENT MEDICAL CARE TO ADULTS, CHILDREN, AND NEWBORNS IN THE WESTERLY, RHODE ISLAND COMMUNITY AND IN SURROUNDING TOWNS. 16 12 922 265 9865 0 1212000 2406556 90848994 91484564 893619 1574658 1332824 1300436 94287437 96766214 0 0 0 0 51358840 52154387 0 0 0 41362146 45491498 92720986 97645885 1566451 -879671 80297074 76275007 55944823 67564057 24352251 8710950 X THE WESTERLY HOSPITAL PROVIDES INPATIENT AND OUTPATIENT MEDICAL CARE TO ADULTS, CHILDREN AND NEWBORNS IN THE WESTERLY, RHODE ISLAND COMMUNITY AND IN SURROUNDING TOWNS. 0 0 77110204 91484564 THE WESTERLY HOSPITAL IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL PROVIDING MEDICAL CARE TO ADULTS, CHILDREN, AND NEWBORNS IN THE WESTERLY, RHODE ISLAND COMMUNITY AND SURROUNDING TOWNS. DURING THE FISCAL YEAR ENDED 09/30/2011 THE HOSPITAL ADMITTED 4,301 PATIENTS AND HAD 23,510 VISITS TO THE EMERGENCY ROOM.THERE WERE 546,123 AMBULATORY/OUTPATIENT VISITS, 514,057 LABORATORY PROCEDURES, 40,951 PATHOLOGY PROCEDURES, 599 DIAGNOSTIC CARDIAC CATHETERIZATIONS, 68,911 PHYSICAL THERAPY PROCEDURES, 21,101 OR AND AMBULATORY VISITS FOR TOTAL DAYS OF PATIENT CARE OF 16,716, THE AVERAGE DAILY CENSUS WAS 45.8.THE RADIOLOGY DEPARTMENT PERFORMED THE FOLLOWING:27,483 DIAGNOSTIC PROCEDURES 1,281 NUCLEAR MEDICINE PROCEDURES10,777 CT SCANS 9,146 ULTRASOUND PROCEDURES 2,704 MAGNETIC RESONANCE IMAGING (MRI) 77110204 1 1 0 1 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 67 0 1 922 1 1 1 0 0 0 0 0 0 0 0 0 X 16 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X THE ORGANIZATION 4013483711 25 WELLS STREET WESTERLY RI 028912934 FRED A ALLARDYCE 1.00 X X 0 0 0 GEORGE BOURGANOS MD 1.00 X 0 0 0 JOHN P CASEY 1.00 X 0 0 0 DAVID D'ERAMO PHD 1.00 X 0 0 0 JOHN T GORBY 1.00 X 0 0 0 MARTHA MCQ HOSP 1.00 X X 0 0 0 ALLEN W LEADBETTER MD 1.00 X X 0 0 0 LEONARD C EDWARDS 1.00 X 0 0 0 WILLIAM G MCKENDREE 1.00 X X 0 0 0 DAVID V DEVAULT 1.00 X 0 0 0 MARY JO ORSINGER 1.00 X 0 0 0 MAUREEN N FITZGERALD 1.00 X 0 0 0 RICHARD C HOLLIDAY 1.00 X 0 0 0 DAVID J NELSON 1.00 X 0 0 0 CHRISTOPHER LEHRACH MD 40.00 X X 404077 0 32418 CHARLES KINNEY 40.00 X X 328076 0 46603 BARBARA J PERINO 1.00 X 0 0 0 JENNIFER SCHWINDT 1.00 X 0 0 0 JEANNE M LACHANCE 40.00 X 227683 0 42211 MAUREEN L CARBONI 1.00 X 0 0 0 MARGARET AUSTIN 40.00 X 185143 0 33242 WILLIAM CONLIN 40.00 X 263140 0 21285 FRED JACCARINO 40.00 X 255178 0 21285 WHITNEY FISHER 40.00 X 150010 0 16181 KEVIN TORRES 40.00 X 290495 0 21285 NANCY BARISANO 40.00 X 145488 0 638 2249290 0 235148 17 0 1 0 CARDINAL HEALTH PHARMACY MANAGEMENT 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY SERVICES 2047326 ARAMARK HEALTHCARE 40 ACCORD PARK DRIVE NORWELL MA 02601 BIOMED SERVICES 1408666 CARPEDIA 75 NAVY STREET OAKVILLE ONTARIO CA CONSULTING SERVICE 1181400 NURSEFINDERS PO BOX 910738 DALLAS TX 753910738 NURSING SERVICE 771066 QUEST DIAGNOSTICS 12436 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LAB SERVICES 651225 23 1715000 691556 2406556 PATIENT SERVICE REV. 900099 87590990 87590990 FREE BED INCOME 900099 3796659 3796659 LIFELINE 900099 96915 96915 91484564 1378865 1378865 494204 75914 418290 418290 9865 408425 195793 195793 195793 195793 SETTLEMENT INCOME 900099 325000 325000 OTHER INCOME 900099 314784 314784 CAFETERIA SALES 900099 211345 211345 31017 31017 882146 96766214 91484564 9865 2865229 969601 736898 232703 37126680 28216276 8910404 3469191 2636585 832606 7887147 5994231 1892916 2701768 2053344 648424 1227712 933061 294651 210673 160111 50562 398572 302915 95657 64601 49097 15504 89108 67722 21386 2103896 1598961 504935 5081 3862 1219 1383295 1051303 331992 4685286 3560817 1124469 1365030 1291318 73712 SUPPLIES 11104442 8439376 2665066 PURCHASED SERVICES 8275855 6289650 1986205 BAD DEBTS 6782130 6782130 LICENSING FEE 4240522 4240522 DRUGS 2511756 1908935 602821 1043539 793090 250449 97645885 77110204 20535681 0 2274270 3083667 7336470 8914587 16356 1611752 1556917 1568252 1550853 116567219 80205711 36501015 36361508 21855856 15827019 7556551 3874529 1576552 5105927 80297074 76275007 9660439 16957031 1469601 1344327 8610000 7860000 5163197 4734858 31041586 36667841 55944823 67564057 X 8468193 -2318909 3583415 2343893 12300643 8685966 24352251 8710950 80297074 76275007 X -879671 -14761630 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2847 0 0 0 2847 0 20625747 816000 6900000 14541747 19347393 1278354 20625747 20261776 -4771 909612 19347393 0.51270 0.33090 0.15640 0 1 1 43905405 30724319 13181086 70184560 47794426 22390134 2477254 1686966 790288 36361508 FUNDS HELD IN TRUST 3874529 F 3874529 DEFERRED FINANCING COSTS 186410 OTHER LONG TERM ASSETS 4817365 DUE TO RELATED PARTY 102152 5105927 3RD PARTY PAYOR SETTLEMENTS 724933 ACCRUED MINIMUM PENSION LIABILITY 26310958 LINE OF CREDIT 4966766 CAPITAL LEASE OBLIGATIONS 3039506 ASSET RETIREMENT OBLIGATION 1425678 OTHER LIABILITIES 200000 36667841 96766214 97645885 -879671 -3560001 -11201629 -14761630 -15641301 82080497 -3560001 -11201630 -14761631 96842128 -75914 -75914 96766214 97721799 75914 75914 97645885 0 97645885 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED TO SUPPORT THE MISSION OF THE WESTERLY HOSPITAL. PART XI, LINE 8 - OTHER ADJUSTMENTS: CAPITAL TRANSACTIONS WITH AFFILIATES -4,957,194. CHANGES IN ACCRUED MINIMUM PENSION LIABILITY -6,244,436. ROUNDING 1. PART XII, LINE 2D - OTHER ADJUSTMENTS: CAPITAL TRANSACTIONS WITH AFFILIATES -4,957,194. CHANGES TO ACCRUED PENSION LIABILITY -6,244,436. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -75,914. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 75,914. 1 1 1 X 1 X 1 1 1 0 0 1157269 408117 749152 0.00770 9319533 8335972 983561 0.01010 10476802 8744089 1732713 0.01780 17961 6144 11817 0.00010 127430 8000 119430 0.00120 24083 24083 0.00020 169474 14144 155330 0.00150 10646276 8758233 1888043 0.01930 1 2844713 20993096 22433200 -1440104 X 1 0 1 1 THE WESTERLY HOSPITAL

25 WELLS STREET WESTERLY RI 02891

X X X THE WESTERLY HOSPITAL 1 PART III, LINE 8: COSTING METHODOLOGY - (TOTAL ALLOWABLE MEDICAL COST PLUS BAD DEBT COSTS) TIMES RATIO OF MEDICAL REVENUE TO TOTAL PATIENT REVENUE. PART VI, LINE 2: THE HOSPITAL DID NOT PERFORM A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT IN FY 2011, BUT PLANS ARE UNDERWAY AND RESOURCES ALLOCATED FOR A FY 2013 COMMUNITY HEALTH NEEDS ASSESSMENT. CURRENTLY, THE HOSPITAL USES A VARIETY OF INFORMATION GATHERING UPON WHICH TO ASSESS COMMUNITY NEED AS WELL AS PAST INFORMATION SUPPLIED THROUGH A VARIETY OF COMMUNITY RESOURCES. THE FOLLOWING DATA WERE USED TO DETERMINE COMMUNITY NEED IN FY 2011: HOSPITAL PATIENT DISCHARGE DATA WERE USED TO LOOK AT RECURRING DIAGNOSES AND REASONS FOR ADMISSIONS; DEPARTMENT OF HEALTH AND HUMAN SERVICES COMMUNITY HEALTH STATUS INDICATORS FOR WASHINGTON COUNTY, RI, WERE EXAMINED TO DETERMINE AREAS IN NEED OF IMPROVEMENT; HEALTHY PEOPLE 2020 WAS USED AS A RESOURCE TO ALIGN ONGOING COMMUNITY EDUCATION AND COMMUNITY BENEFIT PROGRAMS WITH NATIONAL HEALTH GOALS; AND ALL COMMUNITY HEALTH EDUCATION PROGRAM PARTICIPANTS WERE SURVEYED TO DETERMINE PRESENTATION TOPICS DESIRED BY THE COMMUNITY TO DETERMINE HEALTH EDUCATION PROGRAM TOPICS. IN FY 2011, AN ONLINE SURVEY WAS ALSO AVAILABLE ON HOSPITAL WEBSITE TO SOLICIT INFORMATION REGARDING HEALTH PROMOTION TOPICS TO INCLUDE IN THE HOSPITALS FREE HEALTHY FOR LIFE COMMUNITY EDUCATION PROGRAM. PART VI, LINE 6: THE HOSPITAL CONTINUES TO PARTICIPATE IN LOCAL GROUPS CONCERNED WITH THE HEALTH AND WELFARE OF THE COMMUNITY IT SERVES AS RESOURCES AND STAFF TIME AFFORDS. WITH LIMITED RESOURCES, THE HOSPITAL CHOSE TO PARTICIPATE IN THE NEW WESTERLY PARENT ACADEMY (WPA) THAT FORMED IN FY 2011 WITH INITIAL MEETING IN THE SUMMER OF 2011. THIS NEW ACADEMY BOASTS BROAD REPRESENTATION WITHIN THE COMMUNITY FROM BANKING TO SCHOOLS TO LOCAL BUSINESSES AND HEALTH AGENCIES. THE ACADEMY IS COMMUNITY-DRIVEN INITIATIVE DESIGNED TO PROVIDE EDUCATIONAL RESOURCES, COURSE WORK AND OTHER OPPORTUNITIES TO BUILD THE SKILLS, KNOWLEDGE AND KNOW-HOW OF PARENTS AND FAMILIES TO BECOME FULL PARTNERS IN THEIR CHILDS EDUCATION. THE HOSPITAL IS A PARTNER IN THIS NEW COMMUNITY INITIATIVE PROVIDING HEALTH EDUCATION OPPORTUNITIES FOR PARENTS IN THE COMMUNITY. COURSES WILL BEGIN AT THE HOSPITAL IN FALL 2012. HOSPITAL COURSES WILL PROMOTE HEALTH-RELATED GOALS DETERMINED TO BE OF NEED AND INTEREST BY THE WPA. ALTHOUGH THE WESTERLY INFANT AND CHILD HEALTH PARTNERSHIP IS NO LONGER MEETING, THE HOSPITAL CONTINUES TO SUPPORT EFFORTS TO REDUCE TEEN PREGNANCY RATES IN WASHINGTON COUNTY BY ISSUING LETTERS OF SUPPORT FOR SOUTH COUNTY COMMUNITY ACTION WHICH IS SEEKING A GRANT TO INITIATE NEW PROGRAMS. THE HOSPITAL HAS VOWED TO SUPPORT AS IT CAN WITH LIMITED RESOURCES ANY PROGRAMS FOR TEENS AND FOR PARENTS TO HELP REDUCE THE TEEN PREGNANCY RATES IN THE COUNTY AND WILL CONTINUE TO PARTNER WITH ANY OTHER COMMUNITY STAKEHOLDERS INVOLVED WITH THIS INITIATIVE INCLUDING PUBLIC SCHOOLS AND LOCAL HEALTH AGENCIES. X X X X X 0 0 0 0 0 0 0 0 0 CHRISTOPHER LEHRACH MD 404077 0 0 0 0 0 10798 0 21620 0 436495 0 0 0 CHARLES KINNEY 328076 0 0 0 0 0 29506 0 17097 0 374679 0 0 0 JEANNE M LACHANCE 227683 0 0 0 0 0 20296 0 21915 0 269894 0 0 0 MARGARET AUSTIN 185143 0 0 0 0 0 16547 0 16695 0 218385 0 0 0 WILLIAM CONLIN 263140 0 0 0 0 0 0 0 21285 0 284425 0 0 0 FRED JACCARINO 255178 0 0 0 0 0 0 0 21285 0 276463 0 0 0 WHITNEY FISHER 150010 0 0 0 0 0 0 0 16181 0 166191 0 0 0 KEVIN TORRES 290495 0 0 0 0 0 0 0 21285 0 311780 0 0 0 WASHINGTON TRUST BOARD MEMBERS B. PERINO AND D. DEVAULT ARE OFFICERS AT WASHINGTON TRUST 460251 THE ORGANIZATION HAS A LOAN OUTSTANDING TO WASHINGTON TRUST. INTEREST INCURRED ON THE LOAN DURING THE FISCAL YEAR WAS $460,251. 0 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION IS CURRENTLY IN RECEIVERSHIP, AND THEREFORE, THERE IS NO BOARD OF DIRECTORS. THE 990 WAS REVIEWED BY THE INTERIM CFO BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT ANNUALLY. THEY ARE REQUIRED TO DISCLOSE ANY RELATIONSHIP THEY, THEIR BUSINESSES, OR THEIR FAMILY MEMBERS MAY HAVE WITH THE HOSPITAL. IF A DISCUSSION OR VOTE OCCURS ON A TRANSACTION WITH A POTENTIAL CONFLICT, THE BOARD MEMBER EXCUSES THEMSELVES FROM THE DISCUSSION AND VOTE. FORM 990, PART VI, SECTION B, LINE 15 SUBCOMMITTEE OF THE GOVERNING BOARD MEETS TO DETERMINE ALL COMPENSATION ARRANGEMENTS OF THE TOP EXECUTIVE, OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -3,560,001. CAPITAL TRANSACTIONS WITH AFFILIATES -4,957,194. CHANGES IN ACCRUED MINIMUM PENSION LIABILITY -6,244,436. ROUNDING 1. TOTAL TO FORM 990, PART XI, LINE 5: -14,761,630. FORM 990, PART VII, SECTION A - COMPENSATION OF OFFICERS: MAUREEN L. CARBONI IS COMPENSATED AS AN EMPLOYEE OF THE WESTERLY HOSPITAL. SHE RECEIVES NO COMPENSATION FOR HER POSITION AS SECRETARY OF THE BOARD. THE WESTERLY HOSPITAL FOUNDATION INC 25 WELLS STREET WESTERLY RI 028912934 050508064 SUPPORT THE WESTERLY HOSPITAL RI 501(C)(3) 509(A)(3) - TYPE I N/A 1 WESTERLY HOSPITAL HEALTHCARE INC 25 WELLS STREET WESTERLY RI 028912934 222490227 SUPPORT THE WESTERLY HOSPITAL AND AFFILIATES RI 501(C)(3) 509(A)(3) - TYPE II N/A 0 ATLANTIC MEDICAL GROUP INC 25 WELLS STREET WESTERLY RI 028912934 320250865 SUPPORT THE WESTERLY HOSPITAL RI 501(C)(3) 509(A)(3) - TYPE II N/A 0 THE WESTERLY HOSPITAL AUXILIARY INC 25 WELLS STREET WESTERLY RI 028912934 222507181 SUPPORT THE WESTERLY HOSPITAL RI 501(C)(3) N/A 0 NORTH STONINGTON HEALTH CENTER INC 183 PROVIDENCE NEW LONDON TPKE NORTH STONINGTON CT 06359 271833030 OPERATE A HEALTH CENTER CT 501(C)(3) N/A 0 MASTUXET REALTY 25 WELLS STREET WESTERLY RI 02891 222501886 INACTIVE RI N/A C 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 THE WESTERLY HOSPITAL FOUNDATION C 1715000 AMOUNT TRANSFERRED THE WESTERLY HOSPITAL FOUNDATION D 679902 AMOUNT LOANED