2020-08-13T13:20:58-05:00 2019-09-30 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2018-10-01 043127730 Westfield Medical Corporation WEST 4135682811 115 West Silver Street Westfield MA 01085 Raymond McCarthy Interim SVP, CFO and Treasurer 4135682811 2020-08-13 1 Jeanne Fahrenbach P01365953 5169187000 208.99.255.62 2020-08-13 13:06:56 ED P CE2E37D982145188185ED530D22A0BCB5FB961D3 BD88743F010F9F35FF8FC0562FA147AF9CEA6F78 2018 2020-11-06 18:47:13Z X Noble Medical Group Raymond McCarthy 759 Chestnut Street Springfield MA 01199 6932681 0 X WWW.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. X 21 16 130 20 0 0 0 0 12488085 6895681 0 -362763 0 0 12488085 6532918 0 0 0 0 4630325 2457274 0 0 0 13273786 9037808 17904111 11495082 -5416026 -4962164 2363610 0 10689351 0 -8325741 0 X The mission of the organization is to improve the health of the people in our communities every day, with quality and compassion. 0 1 11495082 6532918 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. 11495082 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 0 1 0 0 0 1 14 0 1 130 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 16 1 1 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 0 MA X John C Shaver - Baystate Noble Hospital 4135682811 115 West Silver Street Westfield MA 01085 X John F Maybury Chair (As of 1/1/19) 1.00 2.00 X X 0 0 0 Robert J Bacon Vice Chair (as of 1/1/19) 1.00 2.00 X X 0 0 0 Adrian J Levsky Trustee 1.00 1.00 X 0 0 0 Aleksandr Pugach MD Trustee (thru 12/31/18)/Internist 5.00 45.00 X 224520 0 11269 Andrew Artenstein MD Trustee/President BMP CPE CAO 4.00 46.00 X 0 1062673 41371 Anne M Paradis Trustee/ Chair (Through 12/31/18) 1.00 2.00 X X 0 0 0 Claudia R Coplein DO Trustee 1.00 1.00 X 0 0 0 Colleen W Holmes Trustee 1.00 1.00 X 0 0 0 Edward J Noonan Trustee 1.00 1.00 X 0 0 0 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 Irene Rodriguez Martin Trustee 1.00 1.00 X 0 0 0 James R Phaneuf Trustee 1.00 1.00 X 0 0 0 John A Egelhofer MD Trustee (through 12/31/18) 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 49.00 X 702493 0 31882 Maria P Goncalves Trustee 1.00 49.00 X 0 0 0 Mark A Keroack MD Trustee/ President & CEO, BH 1.00 49.00 X 0 2027506 40042 Melissa D Cragg Trustee (as of 1/1/19) 1.00 1.00 X 0 0 0 Paul R Murphy Trustee 1.00 1.00 X 0 0 0 Robert L Pura PhD Trustee (through 4/9/19) 1.00 1.00 X 0 0 0 Stanley Strzempko MD Trustee (as of 1/1/19) 1.00 1.00 X 0 7500 0 Timothy F Farrell Trustee (through 4/9/19) 1.00 1.00 X 0 0 0 William R Webber Trustee 1.00 1.00 X 0 0 0 Ronald P Bryant President 5.00 45.00 X 0 591144 48176 Dennis Chalke Treasurer 1.00 49.00 X 0 947658 90444 Kristin R Delaney Clerk 1.00 49.00 X 0 145051 37639 Nancy Remillard Assistant Clerk (as of 11/13/18) 1.00 39.00 X 0 51003 8248 John Shaver Chief Financial Officer 5.00 45.00 X 0 257804 15001 David A Higgins Advanced Practitioner 57 50.00 0.00 X 156992 0 3099 1084005 5090339 327171 1 0 1 1 GBS Convergent Solutions LLC PO Box 2340 North Canton OH 447200340 Physician Billing 600580 Westfield Emergency Physicians PC 9 Willow Brook Lane Westfield MA 01085 Medical Services 466336 National Physician Services 25 Laurel Road Rocky Hill CT 06067 IT Services 279374 Shiftwise 200 SW Market Street Suite 700 Portland OR 97201 Temporary Help Services 176741 4 Patient Medical Care 621110 6895681 6895681 6895681 37000 399763 -362763 -362763 -362763 6532918 6532918 0 0 1984434 1984434 27885 27885 299217 299217 145738 145738 279 279 396849 396849 120744 120744 111964 111964 822017 822017 1552 1552 2358 2358 10961 10961 5940315 5940315 149133 149133 30770 30770 Purchased Services 1115348 1115348 Medical Supplies 330373 330373 Dues & Subscriptions 5145 5145 11495082 11495082 0 0 124986 0 0 0 916003 0 0 0 0 0 15211 0 0 1287410 0 0 0 0 0 20000 0 2363610 0 849756 292415 9547180 0 10689351 0 X -8325741 0 -8325741 0 2363610 0 X -4962164 13287905 X 0 1 X 1 0 X X 1 Baystate Noble Hospital Corporation 222537423 3 1 94247 0 1 94247 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 Aleksandr Pugach MD Trustee (thru 12/31/18)/Internist 209668 0 2664 0 12188 0 10762 0 507 0 235789 0 0 0 Andrew Artenstein MD Trustee/President BMP CPE CAO 0 607372 0 216448 0 238853 0 17875 0 23496 0 1104044 0 63064 Kevin P Moriarty MD Trustee/ Chief Ped Surgery 565382 0 106924 0 30187 0 23375 0 8507 0 734375 0 0 0 Mark A Keroack MD Trustee/ President & CEO, BH 0 1092918 0 555500 0 379088 0 17875 0 22167 0 2067548 0 4050 Ronald P Bryant President 0 450110 0 113625 0 27409 0 17875 0 30301 0 639320 0 0 Dennis Chalke Treasurer 0 546049 0 196086 0 205523 0 59898 0 30546 0 1038102 0 4050 Kristin R Delaney Clerk 0 129310 0 15113 0 628 0 14190 0 23449 0 182690 0 0 John Shaver Chief Financial Officer 0 229273 0 25252 0 3279 0 4100 0 10901 0 272805 0 0 David A Higgins Advanced Practitioner 57 150525 0 6009 0 458 0 0 0 3099 0 160091 0 0 0 Part I, Line 3 The compensation of the President is reviewed and determined annually by the compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs). This committee consists entirely of individuals serving on the board of the filing organization. The individuals responsible for deliberating the compensation arrangement for the President would be those individuals who do not have a conflict of interest with respect to the compensation arrangement and would be considered independent for compensation deliberation purposes. The compensation of the President is established based on information provided by independent third party consultants for reasonableness and appropriate comparability data. The compensation is then established, reviewed and approved by the duly authorized compensation committee of Baystate Health, Inc. and all such deliberations and decisions are documented contemporaneously. Part I, Line 4b Andrew Artenstein, MD Total Supplemental Retirement of $223,186 is included in column B. This amount consists of $153,098 earned and paid in 2018 and $63,064 that was previously reported as deferred compensation in prior years Forms 990 and that is currently reported as taxable income. This also includes $7,024 of investment earnings on prior year contributions. The amount is listed in Column F in accordance with reporting requirements. Ronald P Bryant- Supplemental Retirement of $11,081 is included in column B. This amount was earned and paid in 2018. Dennis W. Chalke - Supplemental Retirement of $151,701 is included in column B. This amount was earned and paid in 2018. Mark A. Keroack, MD Supplemental Retirement of $351,037 is included in column B. This amount was earned in 2018. Kevin P. Moriarty, MD - Supplemental Retirement of $22,859 is included in column B. This amount was earned and paid in 2018. CASH BALANCE 2019-09-30 -38132 ACTUAL COST 222537423 Baystate Noble Hospital Corporation 115 West Silver Street Westfield MA 010861634 501(c)(3) NET ACCOUNTS RECEIVABLE 2019-09-30 253379 ACTUAL COST 222537423 Baystate Noble Hospital Corporation 115 West Silver Street Westfield MA 010861634 501(c)(3) 1 0 0 0 0 0 0 0 0 Part I, Line 2e: Explanation of Involvement: Westfield Medical Corporation (WMC) merged with and into Baystate Noble Hospital Corporation (BNH), its sole member, on October 1, 2019. Prior to the merger, the officers and trustees of WMC were the same individuals serving as the officers and trustees of BNH, and they have continued to serve in the same capacities following the merger. Form 990, Part III, line 3 Westfield Medical Corporation's last day of existence was September 30, 2019 and its first day as a consolidated entity with Baystate Noble Hospital Corporation was October 1, 2019. 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) Anne M. Paradis, Paul R. Murphy and Robert L. Pura, PhD, (2) John F. Maybury and Mark A. Keroack, MD, (3) Hector F. Toledo and Timothy F. Farrell. 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 4 On September 30, 2019, Westfield Medical Corporation merged with Baystate Noble Hospital Corporation. 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 filing the Form 990, appropriate sections were reviewed by the Tax, Finance, and Human Resources areas of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) and by outside legal counsel. The Form 990 was also reviewed by tax experts from an independent accounting firm and signed-off as a paid preparer. The process, key areas and any new changes were reviewed prior to filing with the Baystate Health Audit and Compliance Committee (ACC), which is composed of trustees of the filing organization. The ACC members had an opportunity to ask questions regarding the tax compliance process and the tax filings in general. The Form 990 was provided to all members of the Baystate Health Board of Trustees prior to filing. Form 990, Part VI, Section B, line 12c Westfield Medical Corporation is an affiliate of Baystate Health, Inc (BH). BH 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 15b The compensation of the President is reviewed and determined annually by the compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs). This committee consists entirely of individuals serving on the board of the filing organization. The individuals responsible for deliberating the compensation arrangement for the President would be those individuals who do not have a conflict of interest with respect to the compensation arrangement and would be considered independent for compensation deliberation purposes. The compensation of the President is established based on information provided by independent third party consultants for reasonableness and appropriate comparability data. The compensation is then established, reviewed and approved by the duly authorized compensation committee of Baystate Health, Inc. The compensation of the Senior Vice President, Finance, CFO and Treasurer is reviewed and determined annually by the compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs). This committee consists entirely of individuals serving on the board of Baystate Health, Inc. The individuals responsible for deliberating the compensation arrangement for the Senior Vice President, Finance, CFO and Treasurer and of other officers would be those individuals who do not have a conflict of interest with respect to the compensation arrangement and would be considered independent for compensation deliberation purposes. The compensation of the Senior Vice President, Finance, CFO and Treasurer is established based on information provided by independent third party consultants for reasonableness and appropriate comparability data. The compensation is then established, reviewed and approved by the duly authorized compensation committee of Baystate Health, Inc. 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. Line 15a has been answered No because the President is paid by Baystate Administrative Services, Inc., an affiliate and related organization of the filing organization. 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: Net Transfers From Affiliated Companies 13,287,905. 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 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 Franklin Medical Center 164 High Street Greenfield MA 01301 042103575 Hospital MA 501 (c ) (3) 3 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 Visiting Nurse Assn and Hospice of Western New England Inc 30 Capital Drive Suite A West Springfield MA 01089 042105803 Homehealth and Hospice Care MA 501 (c ) (3) 10 Baystate Health Inc 0 Baystate Total Home Care Inc 50 Maple Street Springfield MA 01199 203260764 Real Estate and Other MA 501 (c ) (3) 12b, II Baystate Medical Center Inc 0 Baystate Health Foundation Inc 759 Chestnut Street Springfield MA 01199 043549011 Fundraising MA 501 (c ) (3) 7 Baystate Health Inc 0 Baystate Noble Hospital Corporation 115 West Silver Street Westfield MA 010861634 222537423 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 465190134 HMO/Insurance CT 501 (c ) (4) Health New England 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 HNE Advisory Services Inc Monarch Place Suite 1500 Springfield MA 011441500 043012347 Administrative Services MA HNE Holding Corporation C 0 HNE Insurance Services Inc Monarch Place Suite 1500 Springfield MA 011441500 043183019 Ancilliary Insurance MA HNE Holding Corporation C 0 Ingraham Corporation 759 Chestnut Street Springfield MA 01199 043016257 Health care and other business activities MA Baystate Health Inc C 0 HNE Holding Corporation Monarch Place Suite 1500 Springfield MA 011441500 464620480 Holding shares in subsidiary corporations MA Health New England Inc C 0 HNE Insurance Company Inc Monarch Place Suite 1500 Springfield MA 011441500 454462433 Health Ins svcs for Mass Medicare supplement members MA HNE Holding Corporation C 0 Baystate Health Insurance Company LTD North Church St Georgetown CJ 980421413 Offshore captive insurance CJ Baystate Health Inc C 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1