2018-08-09T13:11:27-05:00 2017-09-30 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2016-10-01 222757446 Noble Visiting Nurse Services Inc NOBL 4135627049 77 Mill Street Suite 201 No 201 Westfield MA 01085 Dennis W Chalke SVP Finance, CFO & Treasurer 4135682811 2018-08-09 1 Christine Kawecki P00743140 5169187000 2016 2022-09-23 18:48:47Z Dennis W Chalke 77 Mill Street Suite 201 No 201 Westfield MA 01085 6664222 0 X See Schedule O X 1986 MA The mission of the organization is to provide comprehensive home care services, including skilled nursing, medical social services, with the provision of necessary supplies, to individuals and families in their places of residence for the purpose of promoting, maintaining or restoring health, minimizing the effects of illness and disability, and maximizing the level of independence. 24 17 113 22 0 0 61728 11909 9536290 6652080 428 233 3580 0 9602026 6664222 0 0 0 0 7370363 6024082 0 0 0 2385025 1477367 9755388 7501449 -153362 -837227 2631920 2046085 3394917 1793309 -762997 252776 X The mission of the organization is to provide comprehensive home care services, including skilled nursing, medical social services, with the provision of necessary supplies, to individuals and families in their places of residence for the purpose of promoting, maintaining or restoring health, minimizing the effects of illness and disability, and maximizing the level of independence. 0 0 6605340 6652080 To provide comprehensive home care services, including skilled nursing, therapy, medical social worker, and home health aide services to individuals and families in their places of residence. 6605340 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 0 0 0 1 0 0 0 1 6 0 1 113 1 0 0 0 0 0 0 0 0 0 0 X 24 17 1 1 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X Martin Degen - Noble Visiting Nurse Services Inc 4135627049 77 Mill Street Suite 201 Westfield MA 01085 X Anne M Paradis Chair (as of 1/1/17) 1.00 2.00 X X 0 0 0 John F Maybury Vice Chair (as of 1/1/17) 1.00 1.00 X X 0 0 0 Adrian J Levsky Trustee 1.00 1.00 X 0 0 0 Aleksandr Pugach MD Trustee 1.00 48.00 X 98525 124703 6814 Claudia R Coplein DO Trustee (as of 1/1/17) 1.00 1.00 X 0 0 0 Colleen W Holmes Trustee (as of 1/1/17) 1.00 1.00 X 0 0 0 David C Southworth Trustee (through 12/31/16) 1.00 1.00 X 0 0 0 Edward J Noonan Trustee 1.00 1.00 X 0 0 0 Grace Makari-Judson MD Trustee/Hematologist 1.00 40.00 X 347988 0 78646 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 James P Sadowsky Trustee 1.00 2.00 X 0 0 0 James R Phaneuf Trustee 1.00 1.00 X 0 0 0 John A Egelhofer MD Trustee 1.00 1.00 X 0 0 0 John H Davis Trustee 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 40.00 X 699348 0 45950 Mark A Keroack MD Trustee 1.00 40.00 X 0 2182220 38487 Paul R Murphy Trustee 1.00 1.00 X 0 0 0 Robert J Bacon Trustee 1.00 1.00 X 0 0 0 Robert L Pura PhD Trustee 1.00 1.00 X 0 0 0 Steven M Mitus Trustee (through 12/31/16) 1.00 1.00 X 0 0 0 Timothy F Farrell Trustee (as of 1/1/17) 1.00 1.00 X 0 0 0 Victor Woolridge Trustee 1.00 1.00 X 0 0 0 William R Webber Trustee (as of 1/1/17) 1.00 1.00 X 0 0 0 Dennis Chalke Treasurer 1.00 50.00 X 0 935201 89071 Kristin R Delaney Clerk 1.00 39.00 X 0 137437 37010 Madeline Torres Assistant Clerk 1.00 40.00 X 0 56586 13801 Ronald Bryant Interim President 5.00 45.00 X 0 545819 44592 Frank Fortune Physical Therapist 50.00 0.00 X 131370 0 18000 Jennifer Crain Clinical Manager 50.00 0.00 X 104159 0 20457 David Mol President & CEO 0.00 0.00 X 173642 0 5413 1555032 3981966 398241 3 1 1 1 Baystate Visiting Nurse Association of N 50 Maple Street Springfield MA 01102 Administrative Services 366751 Baystate Administrative Services 759 Chestnut Street Springfield MA 01199 Administrative Services 300166 Leidos Cyber Inc 28074 Network Place Chicago IL 606731280 Computer Services 111463 3 11909 11909 Home Care & Hospice Se 621610 6652080 6652080 6652080 233 233 6664222 6652080 0 233 179055 179055 4856845 4419243 437602 37937 34361 3576 495491 452188 43303 454754 415191 39563 315326 315326 90328 90328 3 3 31811 29043 2768 275589 251613 23976 105245 96089 9156 289387 289387 3224 2944 280 3557 3248 309 69815 63741 6074 Telephone 129698 118414 11284 Program Supplies 124384 124384 Bad Debt Expenses 25000 25000 0 Postage Shipping 12166 11108 1058 1834 1834 7501449 6605340 896109 0 82647 351430 2397987 1613184 667405 585934 151286 81471 2631920 2046085 900729 971682 377874 368817 1435233 0 681081 452810 3394917 1793309 X -762997 252776 -762997 252776 2631920 2046085 X -837227 1853000 X 0 1 X 1 0 X 109127 103055 103565 61728 11909 389384 6501879 8662981 9148564 9536290 6652080 40501794 6611006 8766036 9252129 9598018 6663989 40891178 0 0 0 40891178 325 49 84 428 233 1119 325 49 84 428 233 1119 6611331 8766085 9252213 9598446 6664222 40892297 1.00000 1.00000 0.00000 X 76357 39031 37326 591048 546903 44145 81471 Due to Affiliates 354458 Due to Third Party 98352 452810 1 1 0 0 0 0 0 0 0 Aleksandr Pugach MD Trustee 95961 104472 0 0 2564 20231 5936 715 131 32 104592 125450 0 0 Grace Makari-Judson MD Trustee/Hematologist 275652 0 50668 0 21668 0 60173 0 18473 0 426634 0 0 0 Kevin P Moriarty MD Trustee/Chief Ped Surgery 537664 0 124279 0 37405 0 26500 0 19450 0 745298 0 0 0 Mark A Keroack MD Trustee 0 876848 0 401474 0 903898 0 19875 0 18612 0 2220707 0 562123 Dennis Chalke Treasurer 0 489983 0 162064 0 283154 0 63576 0 25495 0 1024272 0 0 Kristin R Delaney Clerk 0 122188 0 14668 0 581 0 18742 0 18268 0 174447 0 0 Ronald Bryant Interim President 0 422431 0 97708 0 25680 0 19875 0 24717 0 590411 0 0 David Mol President & CEO 24616 0 0 0 149026 0 3168 0 2245 0 179055 0 0 0 Part I, Line 3 The compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) reviews and approves the compensation philosophy that is used to administer the specific pay decisions for the President of the filing organization. The compensation committee consists entirely of individuals serving on the board of the filing organization. The compensation of the President of the filing organization is determined by the member of the President's Cabinet (the Health System's senior leadership) responsible for that filing organization, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data and based on the Executive Compensation Philosophy Statement established by the compensation committee. Part I, Lines 4a-b David Mol received $149,026 in 2016 Ronald Bryant - Supplemental Retirement of $12,000 is included in column E. This amount was earned and paid in 2016. Dennis W. Chalke - Supplemental Retirement of $257,706 is included in column E. This amount was earned and paid in 2016. Mark A. Keroack, MD - Total Supplemental Retirement of $881,458 is included in column E. This amount consists of $264,321 earned and paid in 2016 and $562,123 that was previously reported as deferred compensation in prior years Forms 990, and that is currently reported as taxable income. This also includes $55,014 of investment earnings on prior year contributions. The amount is listed in Column F in accordance with reporting requirements. Grace Makari-Judson, MD- Supplemental Retirement of $16,599 is included in column E. This amount was earned in 2016. Kevin P. Moriarty, MD - Supplemental Retirement of $33,542 is included in column E. This amount was earned and paid in 2016. Form 990, Part VI, Section A, line 1 The filing organization has a standing executive committee, which is entitled to act between meetings of the Board, on all matters as to which the Board is entitled to act and permitted by law to delegate to a committee. The members of the executive committee are the same individuals serving on the executive committee of Baystate Health, Inc. 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) Grace P. Makari-Judson, MD, James P. Sadowsky and John H. Davis (2) Paul R. Murphy and Robert L. Pura, PhD, (3) John F. Maybury and Mark A. Keroack, MD, (4) Claudia R. Coplein, DO and Victor Woolridge (5) John F. Maybury and Anne M. Paradis. Form 990, Part VI, Section A, line 3 Noble Visiting Nurse Services, Inc. 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 The filing organization amended its Articles of Organization to change its name to Noble Visiting Nurse Services, Inc. and amended its bylaws to change the sole member of the organization from Baystate Noble Hospital Corporation to Visiting Nurse Association and Hospice of Western New England, Inc. Form 990, Part VI, Section A, line 6 The filing organization has one member, Visiting Nurse Association and Hospice of Western New England, Inc. Form 990, Part VI, Section A, line 7a The board of Trustees of the filing organization consists of the same individuals serving as members of the Board of Trustees of BNH, the organizations sole member. The Board of Trustees of BNH are the same individuals serving as 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 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 Noble Visiting Nurse Services, Inc. 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 Noble Visiting Nurse Services, Inc. as well as the annual acceptance of the audited financial statements. Form 990, Part VI, Section B, line 11b Prior to the filing of this return appropriate parts of this Form 990 were reviewed by representatives from the Tax, Finance, and Human Resources Departments of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) and by outside legal counsel. The entire return was reviewed by a tax expert from an outside accounting firm. The entire return was also reviewed prior to filing by the Audit and Compliance Committee of Baystate Health, Inc., which also includes some of the officers and trustees of the filing organization. This committee also reviews the audited financial statements for the health system. The Form 990 was provided to all members of the Board of Trustees prior to filing. Form 990, Part VI, Section B, line 12c Noble Visiting Nurse Services, Inc. is an affiliate of Baystate Health, Inc. Baystate Health, Inc. 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 15 The compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) reviews and approves the compensation philosophy that is used to administer the specific pay decisions for the President and employees of the filing organization. The compensation committee consists entirely of individuals serving on the board of Baystate Health. The compensation of the President of the filing organization is determined by the member of the President's Cabinet (the Health System's senior leadership) responsible for that filing organization, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data and based on the Executive Compensation Philosophy Statement established by the compensation committee. The compensation of other officers and 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. 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: Transfer from Affiliates 1,853,000. Form 990, Line J Website: www.baystatehealth.org/services/home-health/home-health-services Baystate Administrative Services Inc 759 Chestnut Street Springfield MA 01199 222747685 Administrative services MA 501 (c ) (3) 12c,III 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 Health Foundation Inc 759 Chestnut Street Springfield MA 01199 043549011 Fundraising MA 501 (c ) (3) 7 Baystate Health Inc 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 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 Noble Hospital Corporation 115 West Silver St PO Box 1634 Westfield MA 010861634 222537423 Hospital MA 501 (c ) (3) 3 Baystate Health Inc 0 Baystate Total Home Care Inc 280 Chestnut Street Springfield MA 01199 203260764 Real Estate and Other MA 501 (c ) (3) 12b, II Baystate Medical Center 0 Baystate Wing Hospital Corporation 40 Wright Street Palmer MA 01069 222519813 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 455190134 HMO/Insurance CT 501 (c ) (4) Health New England Inc 0 Visiting Nurse Assn and Hospice of Western New England Inc 50 Maple Street Springfield MA 01199 042105803 Home health and Hospice care MA 501 (c ) (3) 10 Baystate Health Inc 0 Westfield Medical Corporation 115 West Silver St PO Box 1634 Westfield MA 010861634 043127730 Physician Services MA 501 (c ) (3) 12a,1 Baystate Noble Hospital Corporation 0 Baystate Health Insurance Company Ltd North Church Street Georgetown CJ 980421413 Offshore captive Insurance CJ Baystate Health Inc 0 HNE Advisory Services Inc Monarch Place Suite 1500 Springfield MA 011441500 043012347 Administrative Services MA Health New England Inc C 0 HNE Holding Corporation Monarch Place Suite 1500 Springfield MA 011441500 464620480 Holding shares in subsidiary corporation MA Health New England Inc C 0 HNE Insurance Company Inc Monarch Place Suite 1500 Springfield MA 011441500 454462433 Health services For Mass Medicare Supplement MA Health New England Inc C 0 HNE Insurance Services Corporation Monarch Place Suite 1500 Springfield MA 011441500 043183019 Ancilliary Insurance MA Health New England Inc C 0 Ingraham Corporation 759 Chestnut Street Springfield MA 01199 043016257 Health care and other business activities MA Baystate Health Inc C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0