2017-08-07T13:17:41-05:00 2016-09-30 861065772 Deloitte & Touche Two Jericho Plaza Jericho NY 11753 990 2015-10-01 042105803 Visiting Nurse Association & Hospice of Western New England Inc VISI 4137940000 50 Maple St PO Box 9058 Springfield MA 011029058 Dennis W Chalke SVP Finance, CFO & Treasurer 4137940000 2017-08-04 1 Christine Kawecki P00743140 5169187000 2015 2021-01-29 14:40:06Z Dennis W Chalke 759 Chestnut Street Springfield MA 01107 32829275 0 X www.baystatehealth.org X 1914 MA The mission of the organization is to improve the health of the people in our communities every day,with quality and compassion. 22 15 254 98 0 0 157859 181932 19545984 19988696 20244 68105 1484531 130542 21208618 20369275 0 0 0 0 16111262 15269591 0 0 0 6003051 6388867 22114313 21658458 -905695 -1289183 8228379 8039244 9618445 10079892 -1390066 -2040648 The mission of Baystate Visiting Nurse Association and Hospice is to improve the health of the people in our communities every day, with quality and compassion. 0 0 12444253 14242884 Home Care: The Home Care Program of Baystate Visiting Nurse Association and Hospice serves about 6000 patients annually. The services, aimed at allowing patients to recuperate while remaining in the comfort of their homes, include skilled nursing, rehabilitation therapy, medical social work and personal care. The organization assists patients with self-management of chronic disease such as heart failure through technology and teaching by incorporating telemonitoring into the plan of care. Currently, BVNAH provides remote telemonitoring to approximately 125 patients 4276485 5913243 Hospice: The Hospice and Palliative Care Program of Baystate Visiting Nurse Association and Hospice provides end of life care for patients in the community, assisted living facilities and skilled nursing facilities. The program coordinates care for an average daily census of about 150 to 170 patients of all ages. Hospice has an interdisciplinary approach using nursing, social work, chaplains and hospice aides. A unique feature of hospice is its strong team of volunteers which number nearly a 100 and who provide such services as errands, respite and companionship as well as legal counsel from volunteer attorneys. 16720738 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 39 0 1 254 1 0 0 0 0 0 0 0 0 0 0 X 22 15 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X Peter Lyons Baystate Health Inc 4137940000 759 Chestnut Street Springfield MA 01199 X Adrian J Levsky Trustee (as of 1/1/16) 1.00 1.00 X 0 0 0 Anne M Paradis Vice Chair 1.00 2.00 X 0 0 0 David C Southworth Trustee 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 395012 0 91314 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 Chair 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 F Maybury Trustee 1.00 1.00 X 0 0 0 John H Davis Trustee 1.00 1.00 X 0 0 0 John M O'Brien III Trustee (Through 12/31/15) 1.00 1.00 X 0 0 0 Katherine McG Sullivan Trustee (Through 12/31/15) 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 634583 0 46896 Mark A Keroack MD Trustee 1.00 40.00 X 0 1258998 213008 Paul R Murphy Trustee 1.00 1.00 X 0 0 0 Richard B Steele Jr Trustee (Through 12/31/15) 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 1.00 1.00 X 0 0 0 Victor Woolridge Trustee 1.00 1.00 X 0 0 0 Dennis Chalke Treasurer 1.00 50.00 X 0 1085400 89529 Kristin R Delaney Clerk 1.00 39.00 X 0 109755 31677 Madeline Torres Assistant Clerk 1.00 40.00 X 0 53103 16597 Maura McQueeney President 50.00 0.00 X 220406 0 22457 Anna M Michaud Hospice RN 50.00 0.00 X 117315 0 26779 Heather L Rising Medical Surgical RN 50.00 0.00 X 111700 0 9539 Jody A Dion Dir Hospice & Palliative Care 50.00 0.00 X 115117 0 10554 Linda L Twyeffort Hospice RN IV 50.00 0.00 X 124446 0 24140 Sally B Kaufmann Dir Post Acute Integration VNA 50.00 0.00 X 106181 0 13081 1824760 2507256 595571 8 0 1 1 Baystate Administrative Services 759 Chestnut St Springfield MA 01079 Administrative Services 2069800 TCG Services LLC PO Box 17844 Clearwater FL 337620844 Consulting Services 697204 Verizon Wireless PO Box 15108 Albany NY 122125108 Telephone Services 163434 Medtronic Care MGMT EB 113 PO Box 1691 Minneapolis MN 55480 Consulting Services 147437 Fazzi Associates Inc 11 Village Hill Rd Northampton MA 01060 Consulting Services 140732 11 181932 181932 Net Patient Services 621610 19601388 19601388 Rents from Affiliates 900099 163768 163768 223540 223540 19988696 47909 36889 11020 12480196 12460000 20196 20196 20196 Management Assessment 900099 103611 103611 Operations Transfers 900099 32165 32165 HNE Surplus Sharing 900099 6442 6442 -11676 -11676 130542 20369275 20156127 0 31216 89885 89885 12079285 10588841 1490444 552810 510374 42436 1621610 1576091 45519 926001 855444 70557 2644216 513246 2130970 177 177 162301 151580 10721 2548 2548 1116390 710608 405782 32528 16853 15675 1012489 952682 59807 296305 45261 251044 95267 95267 414960 395597 19363 20830 13355 7475 249380 2000 247380 78971 65212 13759 Ambulance Services 91818 91818 Temp Help 67763 62930 4833 Recruitment 61277 58425 2852 Utilities 15353 15353 26294 17988 8306 21658458 16720738 4937720 0 508848 364355 3848258 3799807 47211 97117 8716872 7119409 1826444 1597463 1997618 2180502 8228379 8039244 2822697 3280981 520695 502021 6275053 6296890 9618445 10079892 X -3018529 -3750088 141957 136832 1486506 1572608 -1390066 -2040648 8228379 8039244 X -1289183 7776 630825 X 0 1 X 1 0 X 80808 87379 185271 157859 181932 693249 22295900 22610177 23392913 19813360 20156127 108268477 22376708 22697556 23578184 19971219 20338059 108961726 0 0 0 108961726 5088 5368 8526 20244 31216 70442 5088 5368 8526 20244 31216 70442 22381796 22702924 23586710 19991463 20369275 109032168 0.99940 0.99960 0.00060 0.00040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2548 2548 0 Part II-B, Line 1: Line 1(i), Other activities: Lobbying expenditures are incurred through membership dues paid to home health care industry trade associations. Lobbying Expenses: Home Care Alliance of MA: Dues: $12,421 Lobbying amount: 14.10% = $1,751 Hospice Palliative Care of MA: Dues: $5,304 Lobbying amount: 9.5% = $504 NHPCO Dues: $6,084 Lobbying amount: 4.82% = $293 Total lobbying amount = $2,548 126516 126516 2975508 1793973 1181535 929225 825884 103341 4685623 4499552 186071 1597463 Due From Affiliated Entities 127954 Beneficial Interest in Baystate Health Foundation 2052548 2180502 Due to Affiliated Entities 2527243 Estimated Settlements Due to Third Parties 708819 Malpractice Reserve 63000 Pension Liability 2997828 6296890 Schedule D Part V Additional Information: Part V: Certain endowments are held at Baystate Health Foundation (BHF), an affiliate, and are reported as temporarily restricted and permanently restricted but Part V has not been completed as it is already addressed on BHF's Form 990 (EIN 04-3549011). X X 0 1 0 0 0 0 0 0 0 Grace Makari-Judson MD Trustee/Hematologist 299974 0 64558 0 30480 0 56254 0 35060 0 486326 0 0 0 Kevin P Moriarty MD Trustee/ Chief Ped Surgery 502996 0 96018 0 35569 0 27825 0 19071 0 681479 0 0 0 Mark A Keroack MD Trustee 0 760075 0 310077 0 188846 0 192620 0 20388 0 1472006 0 90766 Dennis Chalke Treasurer 0 466083 0 357889 0 261428 0 64000 0 25529 0 1174929 0 0 Maura McQueeney President 193034 0 23663 0 3709 0 16634 0 5823 0 242863 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) has been appointed through board resolution as the compensation committee of the filing organization. The compensation committee 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, Line 4b 4b Dennis W. Chalke - Supplemental Retirement of $171,159 is included in column E. This amount was earned and paid in 2015. Mark A. Keroack, MD - Supplemental Retirement of $328,081 is included in column E. This amount consists of $237,315 earned and paid in 2015 and $90,766 that was previously reported as deferred compensation in prior years Forms 990, and that is currently reported as taxable income. The amount is listed in Column F in accordance with reporting requirements. Grace Makari-Judson, MD- Supplemental Retirement of $14,673 is included in column E. This amount was earned in 2015. Kevin P. Moriarty, MD - Supplemental Retirement of $32,279 is included in column E. This amount was earned and paid in 2015. Paul R Murphy Family member of Paul R. Murphy 85755 See Part V - Family member of Paul R. Murphy is employed by the filing organization. 0 Form 990, Part VI, Section A, line 1 a. 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. Form 990, Part VI, Section A, line 2 Robert J. Bacon, Gregory L. Braden, MD Dennis W. Chalke, John H. Davis, Kristin R. Delaney, Harriet A Deverry, John A. Egelhofer, MD, Mark A. Keroack, MD, Adrian J. Levsky, Grace P. Makari-Judson, MD, John F. Maybury, Maura McQueeney, Steven M. Mitus, Kevin P. Moriarty, MD, Paul R. Murphy, Edward Noonan, John M. O'Brien, III, Anne M. Paradis, James Phaneuf, CIC, Robert L. Pura, PhD, James P. Sadowsky, Kathleen B. Scoble, David C. Southworth, Richard B. Steele, Jr., Katherine McG. Sullivan, Hector Toledo, Madeline Torres, and Victor Woolridgeare also officers or trustees of its affiliated entities. The following trustees, officers, or key employees serve on a common board of a non-affiliated entity: (1) Richard B. Steele, Jr., James P Sadowsky, John H Davis; (2) Robert L. Pura, PhD, Richard B Steele Jr; (3) John F. Maybury, Mark A Keroack MD; (4) John M. O'Brien, III, Victor Woolridge; (5) John F Maybury, Anne M Paradis. Form 990, Part VI, Section A, line 3 Visiting Nurse Association and Hospice of Western New England, 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 6 The filing organization has one member, Baystate Health, Inc. (BH) Form 990, Part VI, Section A, line 7a The Board of Trustees of the filing organization are the same individuals serving as members of the Board of Trustees of BH. 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 B, line 11 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), some of whom are officers or trustees of the filing organization 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. The Form 990 was provided to all members of the Board of Trustees prior to filing. Form 990, Part VI, Section B, line 12c Baystate Health, Inc. (BH) has a comprehensive conflict of interest policy which has been adopted by the filing organization. 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 BH Chief Compliance Officer, the BH Chief Executive Officer, the Chair of the BH Board of Trustees, and the Chair of the Audit & Compliance Committee of BH. A summary of the conflict of interest disclosures is provided to the Baystate Health Board of Trustees and the Tax Department and reviewed by outside counsel. 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) has been appointed through board resolution as the compensation committee of the filing organization. The compensation committee 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 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. The salaries of other employees of the filing organization are determined by the President of the filing organization in accordance with the Executive Compensation Philosophy Statement 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: Minimum Pension Liability Adjustment -993,862. Change in Value of Beneficial Interest in Net Assets-Temporarily Restricted -5,125. Change in Value of Beneficial Interest in Net Assets-Permanently Restricted 86,100. Transfer to Affiliates 1,472,000. Changes in Unrestricted Interest in Baystate Health Foundation 71,712. Baystate Administrative Services Inc 759 Chestnut Street Springfield MA 01199 222747685 Administrative services MA 501 (c ) (3) 11c, IIIc 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 Mary Lane Hospital Corporation 85 South Street Ware MA 01082 042103584 Hospital MA 501 (c ) (3) 3 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 Total Home Care Inc 280 Chestnut Street Springfield MA 01104 203260764 Real Estate and Other MA 501 (c ) (3) 11b, 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 Baystate Noble Hospital Corporation 115 West Silver Street PO Box 1634 Westfield MA 010861634 222537423 Hospital MA 501 (c ) (3) 3 Baystate Health Inc 0 Westfield Medical Corporation 115 West Silver Street PO Box 1634 Westfield MA 010861634 043127730 Physician Services MA 501 (c ) (3) Line 11a, I Baystate Noble Hospital Corp 0 Noble Visiting Nurse Services Inc 77 Mill Street Suite 201 Westfield MA 01085 222757446 Home Health Care and Hospice MA 501 (c ) (3) Line 9 Baystate Noble Hospital Corp 0 HNE Advisory Services Inc Monarch Place Suite 1500 Springfield MA 011441500 043012347 Administrative Svs 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 HNE Insursance Company Inc Monarch Place Suite 1500 Springfield MA 011441500 454462433 Health Services for Mass Medicare Supplement Members 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 Baystate Health Insurance Company Ltd North Church Street Georgetown CJ 980421413 Offshore captive Insurance CJ 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 0 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 1 0 1