2011-08-15T13:27:17-05:00 2010-09-30 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2009-10-01 050259100 THE WESTERLY HOSPITAL WEST 4015966000 25 WELLS STREET WESTERLY RI 028912934 JEANNE LACHANCE 4015966000 2011-08-15 1 ELIZABETH SOLECKI 8605614000 2009 2016-02-24 21:20:13Z CHARLES KINNEY 25 WELLS STREET WESTERLY RI 028912934 94373193 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. 17 15 906 310 5064 0 598900 1212000 88184391 90848994 472785 893619 869761 1332824 90125837 94287437 0 0 47966491 51358840 0 0 41678665 41362146 89645156 92720986 480681 1566451 80704506 80297074 50546582 55944823 30157924 24352251 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 73056724 90848994 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 09/30/2010 THE HOSPITAL ADMITTED 4,543 PATIENTS AND HAD 24,900 VISITS TO THE EMERGENCY ROOM.THERE WERE 534,225 AMBULATORY/OUTPATIENT VISITS, 486,651 LABORATORY PROCEDURES, 42,001 PATHOLOGY PROCEDURES, 204 DIAGNOSTIC CARDIAC CATHETERIZATIONS, 61,715 PHYSICAL THERAPY PROCEDURES, 15,437 OR AND AMBULATORY VISITS FOR TOTAL DAYS OF PATIENT CARE OF 17,667, THE AVERAGE DAILY CENSUS WAS 46.4.THE RADIOLOGY DEPARTMENT PERFORMED THE FOLLOWING:35,778 DIAGNOSTIC PROCEDURES 1,768 NUCLEAR MEDICINE PROCEDURES13,485 CT SCANS 9,561 ULTRASOUND PROCEDURES 2,805 MAGNETIC RESONANCE IMAGING (MRI) 73056724 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 85 0 1 906 1 1 1 0 0 0 0 0 0 0 0 17 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JEANNE LACHANCE CFO 4013483711 25 WELLS STREET WESTERLY RI 028912934 FRED A ALLARDYCE 1.00 X X 0 0 0 DAVID R BAILEY 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 R RIVERA MD 1.00 X 0 0 0 CHRISTOPHER LEHRACH MD 40.00 X X 304532 0 48852 CHARLES KINNEY 40.00 X X 284615 0 40334 BARBARA J PERINO 1.00 X 0 0 0 JEANE M LACHANCE 40.00 X 193730 0 35842 MAUREEN L CARBONI 1.00 X 0 0 0 MARGARET AUSTIN 40.00 X 161770 0 28284 WILLIAM CONLIN 40.00 X 235963 0 39312 FRED JACCARINO 40.00 X 215988 0 38996 ALEXANDRA THRAN 36.00 X 191965 0 29957 KEVIN TORRES 40.00 X 236551 0 40303 NANCY BARISANO 40.00 X 140717 0 13172 1965831 0 315052 20 0 1 0 CARDINAL HEALTH PHARMACY MANAGEMENT 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY SERVICES 2323980 ARAMARK HEALTHCARE 40 ACCORD PARK DRIVE NORWELL MA 02601 BIOMED SERVICES 1053386 GASTROENTEROLOGY ASSOCIATES 45 WELLS STREET SUITE 102 WESTERLY RI 02891 MEDICAL SERVICE 600000 RHODE ISLAND BLOOD CENTER PO BOX 9399 PROVIDENCE RI 02940 LAB SERVICES 491255 QUEST DIAGNOSTICS 12436 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LAB SERVICES 376783 25 1212000 1212000 PATIENT SERVICE REV. 900099 90460251 90460251 FREE BED INCOME 900099 301296 301296 LIFELINE 900099 87447 87447 90848994 436914 436914 553468 85756 467712 467712 5064 462648 456705 456705 456705 456705 SETTLEMENT INCOME 900099 325000 325000 CAFETERIA SALES 900099 199383 199383 OTHER INCOME 900099 175582 175582 165147 165147 865112 94287437 90848994 5064 2221379 1292320 982163 310157 38056995 28923316 9133679 3002476 2281882 720594 6252165 4751646 1500519 2754884 2093712 661172 1339659 1018141 321518 147445 112058 35387 439295 333864 105431 154947 117760 37187 103472 78639 24833 2097306 1593953 503353 16106 12241 3865 1278015 971292 306723 4578666 3479786 1098880 1312088 1241235 70853 SUPPLIES 8300401 6308304 1992097 PURCHASED SERVICES 7632680 5800837 1831843 BAD DEBTS 5962284 5962284 LICENSING FEE 3807403 3807403 DRUGS 3017001 2292921 724080 1175378 893287 282091 92720986 73056724 19664262 0 2561630 2274270 7459592 7336470 101307 16356 1469759 1611752 1093687 1568252 112015583 75514568 38296354 36501015 20582181 21855856 7290244 7556551 1849752 1576552 80704506 80297074 10230795 9660439 118545 1469601 9315000 8610000 5378935 5163197 25503307 31041586 50546582 55944823 X 14734401 8468193 3461402 3583415 11962121 12300643 30157924 24352251 80704506 80297074 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2827 2827 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: DRAFTING LEGISLATION, GUIDANCE ON LEGISLATION, MEETING WTIH LEGISLATORS REGARDING LEGISLATION. 19347393 1278354 20625747 20261776 -4771 909612 19347393 0.59970 0.23000 0.17030 0 1 1 43905405 29598540 14306865 63694907 42939502 20755405 4415271 2976526 1438745 36501015 FUNDS HELD IN TRUST 7556551 F 7556551 3RD PARTY PAYOR SETTLEMENTS 872367 ACCRUED MINIMUM PENSION LIABILITY 20456320 LINE OF CREDIT 4566767 CAPITAL LEASE OBLIGATIONS 3733262 ASSET RETIREMENT OBLIGATION 1412870 31041586 94287437 92720986 1566451 733525 -8105649 -7372124 -5805673 87001189 733525 -8105640 -7372115 94373304 -85867 -85867 94287437 92806853 85867 85867 92720986 0 92720986 Part V, Line 4: Description of Intended Use of Endowment Funds: THE ENDOWMENT FUNDS ARE USED TO SUPPORT THE MISSION OF THE WESTERLY HOSPITAL. Part XI, Line 8 - Other Adjustments: CAPITAL TRANSACTIONS WITH AFFILIATES: -4915327. CHANGES IN ACCRUED MINIMUM PENSION LIABILITY: -3190322. Part XII, Line 2d - Other Adjustments: CHANGE IN MINIMUM PENSION LIABILITY: -3190322. CAPITAL TRANSACTIONS WITH AFFILIATES: -4915318. Part XII, Line 4b - Other Adjustments: RENTAL EXPENSES: -85867. Part XIII, Line 2d - Other Adjustments: RENTAL EXPENSES: 85867. 1 1 1 X 1 X 1 1 1 0 0 1338219 544681 793538 0.00860 8495803 8221982 273821 0.00300 9834022 8766663 1067359 0.01160 14795 720 14075 0.00020 100460 8000 92460 0.00100 29131 29131 0.00030 144386 8720 135666 0.00150 9978408 8775383 1203025 0.01310 2 43690 43690 0.00050 1 3398 3398 0.00000 3 47088 47088 0.00050 1 2222739 22295968 21953902 342066 X 1 0 THE WESTERLY HOSPITAL

25 WELLS STREET WESTERLY RI 02891

X X X Part III, Line 8: COSTING METHODOLOGY - (TOTAL ALLOWABLE MEDICAL COST PLUS BAD DEBT COSTS) TIMES RATIO OF MEDICAL REVENUE TO TOTAL PATIENT REVENUE. Part V: Part VI, Line 2: The hospital community benefits team looked at a variety of information to determine where to focus efforts to improve the health of the community: hospital admissions diagnoses; a primary care provider survey; community health education evaluation and survey; participation in the Westerly Infant and Child Health Partnership; and Department of Health and Human Services community health status indicators for Washington County, RI. These examinations helped to guide community education topics, sponsorships of community organizations and other health-related organizations, new program development (e.g., Tobacco Cessation program and StrongWomen), ongoing clinical education offerings, and community outreach activities. Part VI, Line 5: Coalition Building: Westerly Infant and Child Partnership (Teen Pregnancy)The Westerly Hospital is committed to community engagement around health issues affecting the community members it serves. In FY 2009-2010, for example, the hospital participated in a community wide coalition -- the Westerly Infant and Child Health Partnership to examine three issues that affect women and children (and by extension the entire community) in Westerly, RI. The issues looked at were food insufficiency, delayed prenatal care, and teen pregnancy. The Partnership comprised area health services, the public schools, social service agencies, clergy, parents, mental health agencies, and concerned citizens. The Partnership conducted a community assessment (key informant interviews, focus groups, and surveys) around the three issues. The data revealed rates of teen pregnancy in Westerly higher than state averages, record numbers of families seeking help from local food pantries, but decreasing rates of delayed prenatal care. As a leader in the community, the Westerly Hospital hosted the release of the Partnership report to the community, inviting physicians, parents, clergy, legislators and school officials to the hospital to hear the Partnership's findings and to help increase awareness of the issues facing the community. Hospital staff continues to be involved in ongoing discussions related to teen pregnancy reduction because children of teen parents are more at risk for poor health, learning/behavioral problems in school, living in poverty, and becoming teen parents themselves, all of which have social and economic consequences for communities with high teen pregnancy rates. The hospital recognizes that it has a role to play in raising awareness of teen pregnancy and in supporting educational efforts for parents around adolescent sexuality and communication. Although the original Partnership has disbanded, the hospital will continue to partner with other community stakeholders, including the public schools, to address the teen pregnancy issue. X X X X X 0 0 0 0 0 0 0 0 0 CHRISTOPHER LEHRACH MD 304532 0 0 0 0 0 30963 0 17889 0 353384 0 0 0 CHARLES KINNEY 284615 0 0 0 0 0 26686 0 13648 0 324949 0 0 0 JEANE M LACHANCE 193730 0 0 0 0 0 18455 0 17387 0 229572 0 0 0 MARGARET AUSTIN 161770 0 0 0 0 0 15101 0 13183 0 190054 0 0 0 WILLIAM CONLIN 235963 0 0 0 0 0 21791 0 17521 0 275275 0 0 0 FRED JACCARINO 215988 0 0 0 0 0 21487 0 17509 0 254984 0 0 0 ALEXANDRA THRAN 191965 0 0 0 0 0 12797 0 17160 0 221922 0 0 0 KEVIN TORRES 236551 0 0 0 0 0 22744 0 17559 0 276854 0 0 0 NANCY BARISANO 140717 0 0 0 0 0 12082 0 1090 0 153889 0 0 0 Form 990, Part VI, Section B, line 11 THE FORM 990 WAS REVIEWED BY THE PRESIDENT AND TREASURER OF THE ORGANIZATION, AND A COPY OF THE FORM 990 WAS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD FOR REVIEW 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. 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 COMMUNITY HEALTH OF WESTERLY 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 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 THE WESTERLY HOSPITAL AUXILIARY INC 25 WELLS STREET WESTERLY RI 028912934 222507181 SUPPORT THE WESTERLY HOSPITAL RI 501(C)(3) N/A 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 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 0 0 0 0 0 0 0 COMMUNITY HEALTH OF WESTERLY B 1241707 THE WESTERLY HOSPITAL FOUNDATION C 1212000 ATLANTIC MEDICAL GROUP INC B 3673612 ATLANTIC MEDICAL GROUP INC D 350000 NORTH STONINGTON HEALTH CENTER INC D 365080 COMMUNITY HEALTH OF WESTERLY D 154509 THE WESTERLY HOSPITAL FOUNDATION D 401683