2014-08-15T13:00:57-05:00 2013-09-30 042684828 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2012-10-01 222537423 TRUSTEES OF NOBLE HOSPITAL INC TRUS 4135682811 115 WEST SILVER STREET PO BOX 1634 WESTFIELD MA 010861634 RONALD BRYANT 4135682811 2014-08-13 1 ALAN GAROFALO P00744592 6177427788 2012 2015-11-30 17:44:51Z NOBLE HOSPITAL RONALD BRYANT 115 WEST SILVER STREET PO BOX 1634 WESTFIELD MA 010861634 55737971 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. 21 19 638 111 45182 0 2121228 2694143 51984243 52429279 84896 -20936 532431 56427 54722798 55158913 0 0 0 0 29375728 29570464 0 0 0 23580668 24723685 52956396 54294149 1766402 864764 24316129 25592324 37289103 27546300 -12972974 -1953976 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 44034776 52429279 PROVIDED ACUTE CARE INPATIENT, OUTPATIENT, AND OTHER HEALTH CARE SERVICES FOR WESTFIELD AND THE SURROUNDING COMMUNITIES. 44034776 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 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 1 125 0 1 638 1 1 1 0 0 0 0 1 1 0 0 0 0 0 X 21 19 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 0 0 0 MA X X RONALD BRYANT 4135682811 115 WEST SILVER STREET PO BOX 1634 WESTFIELD MA 01086 ROBERT BACON 1.00 X 0 0 0 MARK MORIN 1.00 X 0 0 0 ROBERT LAPALME 1.00 X 0 0 0 KEVIN QUEENIN 1.00 X 0 0 0 DONALD BIEKER 1.00 X 0 0 0 BARBARA BRAEM-JENSEN UNTIL 112013 1.00 X 0 0 0 ROGER BUTLER JR 1.00 X 0 0 0 SCOTT COOPER MD 1.00 X 0 0 0 HARRIET DEVERRY 1.00 X 0 0 0 JOHN GREANEY 1.00 X 0 0 0 WILLIAM HARMON 1.00 X 0 0 0 CAROL KAUFFMAN 1.00 X 0 0 0 JOSEPH P KEENAN MD 1.00 X 0 0 0 MICHAEL MCCABE 1.00 X 0 0 0 DAVID PETERSON MD 1.00 X 0 0 0 DONALD PION 1.00 X 0 0 0 LANCE REYNOLDS MD 1.00 X 0 0 0 DEBORAH STRYCHARZ 1.00 X 0 0 0 RONALD BRYANT 40.00 X X 357127 0 30033 STANLEY STRZEMPKO MD 30.00 X X 352512 0 1098 ROBIN JENSEN STARTED 1012012 1.00 X 0 0 0 JOHN SHAVER 40.00 X 186604 0 4613 DIANE BRUNELLE 40.00 X 162157 0 15640 TIMOTHY O'NEIL 40.00 X 125241 0 21189 HUI-WEN CHIA 42.00 X 123356 0 4877 STEVEN P CUMMINGS 40.00 X 112890 0 14230 DAVID ROSINSKI 40.00 X 110851 0 5939 EUNICE ACQUAH 40.00 X 109175 0 18340 1639913 0 115959 18 0 1 1 REHABCARE GROUP EAST INC 12567 W CEDAR DRIVE LAKEWOOD CO 80228 PHYSICIAL REHABILITATION 2179279 RAYMOND R HOULE CONSTRUCTION 5 MILLER STREET LUDLOW MA 01056 CONSTRUCTION 1345033 MORRISON MANAGEMENT SPECIALISTS INC 5801 PEACHTREE DUNWOODY ROAD NE ATLANTA GA 30368 FOOD AND NUTRITION SERVICES 1236037 CROTHALL HEALTHCARE INC 955 CHESTERBROOK BLVD 300 WAYNE PA 19087 LAUNDRY & OTHER SUPPLIES 787540 NEW ENGLAND PATHOLOGY 271 CAREW STREET SPRINGFIELD MA 01104 HEALTHCARE/PATHOLOGY 344788 23 239123 1324805 1130215 2694143 HOSPITAL REVENUE 622000 52282792 52282792 RENTAL INCOME FROM AFFILIATE 531390 146487 146487 52429279 57846 57846 435621 514403 -78782 -78782 -78782 64655 239123 64655 0 VENDOR REBATES AND COMMISSIONS 900099 56427 11245 45182 56427 55158913 52361742 45182 57846 X 931894 931894 23427202 20038348 3388854 1172989 961851 211138 2294391 1881401 412990 1743988 1430070 313918 225541 1475 224066 125465 125465 86476 86476 11346416 9026675 2319741 276681 1601 275080 1129747 710678 419069 1705157 1196331 508826 46523 15693 30830 29909 11702 18207 50378 24489 25889 2286617 1851781 434836 256290 256290 MEDICAL SUPPLIES 6922676 6850796 71880 DUES 116950 10596 106354 MISCELLANEOUS 76475 21289 55186 CONTINGENCY 40000 40000 2384 2384 54294149 44034776 10259373 0 50144 245906 1694388 1008781 5494477 4683647 789907 902133 149683 170685 55818647 43120419 10883578 12698228 3763452 4171944 1490500 1711000 24316129 25592324 11996146 13343345 133558 60883 6900647 7791297 18258752 6350775 37289103 27546300 X -16910969 -6358506 3057447 3523982 880548 880548 -12972974 -1953976 24316129 25592324 X 864764 10154234 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 70000 1 16476 0 86476 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION CONTRACTED DIRECTLY WITH A CONSULTANT TO ASSIST IN PURSUING ITS GOVERMENT AFFAIRS OBJECTIVES. THIS CONSULTANT WAS 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. 3740947 794284 365317 4169914 3300943 598094 158090 3740947 3300943 3300943 0.00000 0.21000 0.79000 0 0 822598 822598 24685204 19095169 5590035 459563 373210 86353 27154294 23652040 3502254 2696988 2696988 12698228 MALPRACTICE INSURANCE RECOVERY RECEIVABLES 1711000 1711000 ACCRUED PENSION LIABILITY 4200000 MEDICAL MALPRACTICE CLAIMS LIABILITY 1853620 ASSET RETIREMENT OBLIGATION 297155 6350775 54477194 0 54477194 681719 681719 55158913 54294149 0 54294149 0 54294149 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER CHANGES IN NET ASSETS 681,719. NOBLE BALL 280570 215915 64655 4245 31385 8000 21025 5K 23208 23208 303778 239123 64655 4245 31385 8000 21025 64655 0 1 1 1 X 1 X 1 0 1 1 729053 340001 389052 0.00720 7536903 5920280 1616623 0.02980 1541627 1058221 483406 0.00890 9807583 7318502 2489081 0.04590 9807583 7318502 2489081 0.04590 1 1195998 0 22688231 20733001 1955230 X 1 1 1 1 NOBLE HOSPITAL

115 WEST SILVER STREET WESTFIELD MA 01086

X X X PSYCHIATRIC AND PHYSICAL REHABILITATION SERVICES NOBLE HOSPITAL INC 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X 1 0 0 0 0 0 0 0 1 0 1 0 1 1 NOBLE HOSPITAL SPORTS & REHAB CENTER

74 MAIN STREET WESTFIELD MA 01086

PHYSICAL REHABILITATION OUTPATIENT CLINIC PART III, LINE 4: THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS INCLUDE ADOPTED ASU 2011-7 FOR HEALTH CARE ENTITIES: PRESENTATION AND DISCLOSURE OF NET REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. UNDER THE NEW GUIDANCE, BAD DEBTS RELATING TO PATIENT SERVICES REVENUE WILL BE SEPERATELY DISCLOSED IN THE STATEMENT OF OPERATIONS AND REPORTED AS A COMPONENT OF NET PATIENT SERVICE REVENUE. BAD DEBTS ASSOCIATED WITH ACTIVITIES OTHER THAN PATIENT SERVICE REVENUE WILL CONTINUE TO BE REPORTED AS AN OPERATING EXPENSE.ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE, ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED, AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.COSTING METHODOLOGY - 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. PART III, LINE 8: THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE ORGANIZATION'S MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2013 FOR INPATIENT, PSYCHIATRIC, AND OUTPATIENT SERVICES. IN ADDITION, FEE BASED SERVICES INCLUDING LABORATORY FEES ARE DETERMINED THROUGH PS&R CHARGES TIMES OUTPATIENT COST TO CHARGE RATIO. THE ORGANIZATION BELIEVES THAT MEDICARE UNDERPAYMENTS SHOULD BE TREATED AS A COMMUNITY BENEFIT SINCE THESE SERVICES ARE 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. PART III, 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. NOBLE HOSPITAL, INC. PART V, SECTION B, LINE 3: CONTACT WAS MADE WITH PROVIDERS AND COMMUNITY MEMBERS IN MUNICIPAL, PUBLIC, AND PRIVATE PROGRAMS AND ORGANIZATIONS, SCHOOLS, RESETTLEMENT PROGRAMS, HOUSING AGENCIES, COMMUNITY-BASED SOCIAL PROGRAMS AND SERVICES, AND ETHNIC ORGANIZATIONS. INFORMANTS MADE RECOMMENDATIONS FOR OTHER CONTACTS, LEADING TO A BROAD NETWORK OF CONNECTIONS IN VARIOUS ORGANIZATIONS THROUGHOUT THE CITY OF WESTFIELD. INTERVIEWS WERE CONDUCTED IN PERSON OR BY PHONE USING A NUMBER OF OPEN ENDED QUESTIONS WHICH WERE TAILORED TO THE EXPERTISE AND EXPERIENCE OF EACH INFORMANT. NOBLE HOSPITAL, INC. PART V, SECTION B, LINE 4: HOLYOKE HEALTH CENTER NOBLE HOSPITAL, INC. PART V, SECTION B, LINE 22: THE ORGANIZATION HAS TO INITIALLY BILL ALL PATIENTS THE SAME AMOUNT OF GROSS CHARGES REGARDLESS OF THEIR INSURANCE PLAN OR LACK THEREOF. LINE 7 THE HOSPITAL RESPONDS TO PRIORITY HEALTH NEEDS IN MANY WAYS, AND IN TIMES THAT ARE CRITICAL FOR PATIENTS IN CRISIS. IN ADDITION TO CHARITY CARE, INDIGENT CARE, A SIGNFICANT NUMBER OF PROGRAMS AND SERVICES OFFERED ADDRESS THE PRIORITY NEEDS IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT DATED JULY 2012. OUR HOSPITAL DOES NOT HAVE THE AVAILABLE RESOURCES TO DEVELOP INITIATIVES TO MEET EVERY PRIORITY HEALTH NEED IDENTIFIED, WHICH MAKES COLLABORATION WITH COMMUNITY NEEDS CRITICAL. 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. 1 X X X 0 0 0 0 0 0 0 0 0 RONALD BRYANT 312427 0 44700 0 0 0 3033 0 27000 0 387160 0 0 0 STANLEY STRZEMPKO MD 330672 0 21840 0 0 0 0 0 1098 0 353610 0 0 0 JOHN SHAVER 177704 0 8900 0 0 0 3616 0 997 0 191217 0 0 0 DIANE BRUNELLE 154658 0 7499 0 0 0 2894 0 12746 0 177797 0 0 0 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. FORM 990, PART VI, SECTION B, LINE 11 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 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL TRUSTEES UPON APPOINTMENT TO THE BOARD AND ANNUALLY THEREAFTER, ARE REQUIRED TO DISCLOSE ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS IN A SIGNED TRUSTEE'S DECLARATION. THE DECLARATION FORMS ARE REVIEWED AND SIGNED BY THE BOARD'S CHAIRMAN AND VICE CHAIRMAN, THEN FORWARDED TO THE PRESIDENT & CEO OF THE ORGANIZATION FOR FURTHER REVIEW. AS MATTERS COME BEFORE THE BOARD AND IN THE EVENT OF ANY CONFLICT, THE CHAIRMAN (OR VICE CHAIRMAN) WILL REQUIRE THAT THE TRUSTEE(S) INVOLVED BE REMOVED FROM ANY FURTHER DISCUSSION AND VOTING ON THAT MATTER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THESE DOCUMENTS CAN BE REVIEWED BY CONTACTING 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. OTHER FEES FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,723,140. MANAGEMENT AND GENERAL EXPENSES 801,972. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,525,112. CONTRACTS: PROGRAM SERVICE EXPENSES 1,893,825. MANAGEMENT AND GENERAL EXPENSES 703,134. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,596,959. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 1,409,710. MANAGEMENT AND GENERAL EXPENSES 814,635. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,224,345. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TEMPORARY RESTRICTED ACTIVITY -162,050. FORGIVENESS OF INTER-COMPANY -2,592,837. ADJUSTMENT FOR PENSION 4,359,651. GAIN ON PENSION SETTLEMENT 8,355,383. NET ASSETS RELEASED FOR EQUIP 194,087. WESTFIELD MEDICAL CORPORATION 115 WEST SILVER STREET WESTFIELD MA 010853628 043127730 PHYSICIAN MEDICAL SERVICES MA 501(C)(3) LINE 11A, I N/A 1 NOBLE VISITING NURSE & HOSPICE SERVICES INC 77 MILL STREET WESTFIELD MA 010853628 222757446 HOME HEALTH CARE AND HOSPICE MA 501(C)(3) LINE 9 N/A 1 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 WESTFIELD MEDICAL CORPORATION A 146487 WESTFIELD MEDICAL CORPORATION B 2592837 NOBLE VISITING NURSE & HOSPICE SERVICES INC Q 47998