2016-08-11T15:14:59-05:00 2015-09-30 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2014-10-01 222747685 Baystate Administrative Services Inc BAYS 4137940000 759 Chestnut Street Springfield MA 011990001 Dennis W Chalke SVP Finance, CFO & Treasurer 4137945740 2016-08-11 1 Christine Kawecki P00743140 5169187000 2014 2016-09-27 15:27:22Z Dennis W Chalke 759 Chestnut Street Springfield MA 011990001 116606728 0 X www.baystatehealth.org X 1986 MA To improve the health of the people in our communities every day with quality and compassion 7 0 554 0 318729 0 0 0 102423858 108282009 -46065 -69787 676429 7300903 103054222 115513125 0 0 0 0 58116098 62776581 0 0 0 46231275 45840436 104347373 108617017 -1293151 6896108 29643625 21026408 46583394 42186486 -16939769 -21160078 The organization's purpose is to promote the health, charitable and educational purposes of Baystate Health, Inc. whose mission is to improve the health of the people in our communities every day, with quality and compassion. 0 0 27418387 52881451 BAS provides management and administrative support to Baystate Health and its affiliates. These services are an integral part of the healthcare delivery system and include strategic planning, human resources, risk management (insurance) programs, marketing, financial services and benefit plans administration for all health system employees. 61240824 62382732 BAS provides information technology support to Baystate Health and its affiliates. These services are an integral part of the healthcare delivery system and include all software applications, telecommunications, clinical engineering, and computerized equipment at the hospitals. 88659211 1 0 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 0 0 0 0 0 0 0 1 0 0 0 1 297 0 1 554 1 1 1 0 0 0 0 0 0 0 0 0 X 7 0 1 0 1 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MA X Peter Lyons Baystate Health Inc 4137940000 759 Chestnut Street Springfield MA 01199 Mark A Keroack MD President/Director 1.00 49.00 X X 980230 0 203356 Dennis W Chalke Treasurer/Director 1.00 49.00 X X 929051 0 79645 Evan Benjamin MD FACP Director/SVP Quality Patient Population 10.00 40.00 X 786152 0 69644 Jennifer Endicott Director / SVP Strategy & External Relations 10.00 40.00 X 397567 0 63834 John Schrieber MD DOH Director / President, BMP 10.00 40.00 X 670948 0 125355 Nancy Shendell-Falik Director 1/1-9/30/15 / COO/ CNO BMC 10.00 40.00 X 540682 0 138721 Paula C Squires Director/ SVP Chief HR Officer 10.00 40.00 X 635359 0 44133 Kristin R Delaney Clerk 1.00 49.00 X 107000 0 29470 Madeline Torres Assistant Clerk 1/1-9/30/15 1.00 49.00 X 28799 0 7703 Joel L Vengco VP Information Services 50.00 0.00 X 473343 0 38580 Kevin Hinchey MD Chief Academic Officer 50.00 0.00 X 495191 0 78223 Neil Kudler MD Chief Med Information Officer 50.00 0.00 X 380987 0 56272 Steven F Bradley President, BFMC 50.00 0.00 X 340162 0 101972 Charles D Gijanto Former President, BFMC 1.00 19.00 X 334861 0 24098 Douglas D Muehlberg COO Baystate Medical Practices 50.00 0.00 X 327622 0 123356 Mark R Tolosky President Emeritus 1.00 24.00 X 1089033 0 234000 8516987 0 1418362 142 1 1 0 Siemens Medical Solutions USA PO Box 120001 Dallas TX 753120733 Medical Equipment 1979672 Philips Medical Systems PO Box 100355 Atlanta GA 303840355 Medical Equipment 1620916 Olympus America PO Box 200194 Pittsburg PA 152510194 Medical Equipment 1375397 3M Health Information Systems PO Box 844127 Dallas TX 752844127 Computer Services 1015489 Lighthouse Computer Svcs Inc PO Box 842086 Boston MA 022842086 Computer Services 988266 98 Affiliate Support 561000 108282009 107963280 318729 108282009 53041 53041 4275 966500 14970 1078633 -10695 -112133 -122828 -122828 Pension Curtailment 525100 6660874 6660874 Electronic Medical Records 541511 381924 381924 Flex Spending Forfeitures 561000 120000 120000 138105 138105 7300903 115513125 115264183 318729 -69787 7672604 5958544 1714060 45070570 35039412 10031158 2593600 2014375 579225 4080051 3143630 936421 3359756 2609351 750405 667557 667557 5652952 3485837 2167115 1746054 1512814 233240 3394819 3139080 255739 28250580 26812592 1437988 1114167 902259 211908 699959 498245 201714 1412305 1111418 300887 141503 117967 23536 320485 254735 65750 Recruitment 612482 422304 190178 Accrual - unrecorded AP 225000 225000 Food Services 204860 170786 34074 Physician Peer Educatio 121301 101125 20176 1276412 1139737 136675 108617017 88659211 19957806 0 124263 111031 4911723 3258523 874565 338842 38484 46839 11073055 10103037 5638502 5173758 420378 464744 12201157 6703392 29643625 21026408 25540701 27725165 21042693 14461321 46583394 42186486 X -16939769 -21160078 -16939769 -21160078 29643625 21026408 X 6896108 821 -11117238 X 0 0 1 0 X X 9 Baystate Health Inc 042105941 7 1 2235657 0 Baystate Medical Center Inc 042790311 3 0 85437324 0 Baystate Franklin Medical Ctr 042103575 3 0 7546138 0 Baystate Mary Lane Hospital Corp 042103584 3 0 1522892 0 Baystate Wing Hospital 222519813 3 0 731418 0 Visiting Nurse Association & Hospice of WNE Inc 042105803 9 0 1847426 0 Baystate Medical Practices Inc 042888373 9 0 5129256 0 Baystate Health Foundation Inc 043549011 7 0 99184 0 Baystate Noble Hospital 222537423 3 0 145038 0 9 104694333 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 X 1 1 Part IV, Section A, Line 5a: (i)Baystate Noble Hospital, EIN 22-2537423 was added as a supported organization. (ii) Effective July 1, 2015, Baystate Health acquired The Trustees of Noble Hospital, Inc. and subsidiaries (Noble). Noble was renamed Baystate Noble Hospital after the acquisition. (iii)Such action was deemed authorized by Page 2A of Baystate Administrative Services' Articles of Organization, in accordance with the purpose for which the corporation was formed: "To promote the health, charitable and educational purpose of Baystate Health Systems, Inc. by managing, operating and providing management counsel and advice in connection with the provision of medical or health care and services ancillary thereto". Part IV, Section A, Question 1 The organization is in the process of filing amendments to its Articles of Organization to update the name of Baystate Health, Inc. (which was changed in 2005) and to include the names of all the supported entities, which are all affiliates of the parent, Baystate Health, Inc. 0 1 0 0 0 0 0 0 1 166419 166419 0 Part II-B, line j The amount recorded on Part II-B, line j represents BAS salaries and operating expenses as reported on Massachusetts Public Records Division Lobbyist Disclosures for activities related to healthcare policy, bills and appropriations. 525715 473599 52116 3620963 3328213 292750 1491824 1371946 119878 464744 Due from affiliated companies 6703392 6703392 Due to affiliated companies 462584 Total accrued pension cost 2692597 Total minimum pension liability 11306140 14461321 X X X 1 1 0 1 0 0 0 0 0 0 0 Mark A Keroack MD President/Director 658452 0 301313 0 20465 0 185350 0 18006 0 1183586 0 0 0 Dennis W Chalke Treasurer/Director 432876 0 264360 0 231815 0 55591 0 24054 0 1008696 0 0 0 Evan Benjamin MD FACP Director/SVP Quality Patient Populat 415370 0 224100 0 146682 0 44225 0 25419 0 855796 0 0 0 Jennifer Endicott Director / SVP Strategy & External R 253762 0 105300 0 38505 0 53819 0 10015 0 461401 0 0 0 John Schrieber MD DOH Director / President, BMP 437597 0 153167 0 80184 0 106094 0 19261 0 796303 0 0 0 Nancy Shendell-Falik Director 1/1-9/30/15 / COO/ CNO BMC 393609 0 131480 0 15593 0 120137 0 18584 0 679403 0 0 0 Paula C Squires Director/ SVP Chief HR Officer 288410 0 134658 0 212291 0 20800 0 23333 0 679492 0 0 0 Joel L Vengco VP Information Services 339880 0 128824 0 4639 0 22598 0 15982 0 511923 0 0 0 Kevin Hinchey MD Chief Academic Officer 340437 0 108787 0 45967 0 50597 0 27626 0 573414 0 0 0 Neil Kudler MD Chief Med Information Officer 282971 0 71964 0 26052 0 37615 0 18657 0 437259 0 0 0 Steven F Bradley President, BFMC 273226 0 61784 0 5152 0 81020 0 20952 0 442134 0 0 0 Charles D Gijanto Former President, BFMC 187869 0 65597 0 81395 0 15597 0 8501 0 358959 0 0 0 Douglas D Muehlberg COO Baystate Medical Practices 255301 0 53468 0 18853 0 106046 0 17310 0 450978 0 0 0 Mark R Tolosky President Emeritus 571202 0 306472 0 211359 0 202614 0 31386 0 1323033 0 0 0 Part I, Line 1a Explanation: 1. Companion Travel - Several Trustees, Officers, and/or key employees were provided with compensation for spouses to attend a company board event. 2. Tax Gross up / Discretionary Spending Account - Several employees were provided with reimbursement for financial, tax and estate planning requiring a tax gross up. The two items above were treated as taxable compensation as appropriate in accordance with Baystate's written policies which require compliance with the IRS's accountable plan rules. Part I, Line 3 The compensation of the President and CEO 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 President and CEO 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 and CEO 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. The Baystate Administrative Services, Inc. Board of Directors is composed of management of Baystate Health, Inc and its affiliates. Therefore it is more appropriate that the establishment and review of the compensation of the organization's top management officials be performed at the Baystate Health level, which has a more independent board. Part I, Line 4b Evan Benjamin, MD - Supplemental Retirement of $130,220 is included in column E. This amount was earned and paid in 2014. Steven F. Bradley - Supplemental Retirement of $376 is included in column E. This amount was earned and paid in 2014. Dennis W. Chalke - Supplemental Retirement of $146,489 is included in column E. This amount was earned and paid in 2014. Jennifer Endicott - Supplemental Retirement of $40,819 is included in column E. This amount was earned in 2014. Charles Gijanto - Supplemental Retirement of $16,384 is included in column E. This amount was earned and paid in 2014. Kevin Hinchey, MD - Supplemental Retirement of $28,132 is included in column E. This amount was earned and paid in 2014. Mark A. Keroack, MD - Supplemental Retirement of $164,550 is included in column E. This amount was earned in 2014. Neil Kudler, MD - Supplemental Retirement of $12,515 is included in column E. This amount was earned and paid in 2014. Douglas D. Muehlberg - Supplemental Retirement of $4,603 is included in column E. This amount was earned and paid in 2014. John Schreiber, MD - Supplemental Retirement of $89,194 is included in column E. This amount was earned in 2014. Nancy Shendell-Falik- Supplemental Retirement of $103,237 is included in column E. This amount was earned in 2014. Paula Squires - Supplemental Retirement of $73,716 is included in column E. This amount was earned and paid in 2014. Mark R. Tolosky - Supplemental Retirement of $150,900 is included in column E. This amount was earned and paid in 2014. Joel L. Vengco - Supplemental Retirement of $9,598 is included in column E. This amount was earned in 2014. Form 990, Part VI, Section A, line 1 Baystate Administrative Services Inc. (BAS) is part of an integrated delivery system including not for profit community hospitals, which have community boards. BAS is a management services supporting organization, which supports Bayste Health and its affiliates and is comprised of BAS employees. This board structure has not changed significantly since the organization applied for exempt status. Form 990, Part VI, Section A, line 2 Evan Benjamin, MD, FACP, Dennis W. Chalke, Kristin R. Delaney, Jennifer Endicott, Mark A. Keroack, MD, John Schreiber, MD, Paula C. Squires and Mark R. Tolosky are also officers or trustees of Baystate Health, Inc. & its affiliated entities. The following trustees, officers, or key employees serve on a common board of a non-affiliated entity: None that we know of. Form 990, Part VI, Section A, line 4 The organization amended its bylaws to change the office associated with one of the ex officio positions on its Board of Directors. 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 All of the members of the Board of Directors of the filing organization are individuals serving ex officio based on positions they hold with BH. 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 sole member of the filing organization and 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. In addition, this return was provided to and reviewed by the Audit and Compliance Committee of Baystate Health, Inc. This committee also reviews the audited financial statements for the health system. This return was also provided prior to filing to the Baystate Health, Inc. Board of Trustees. 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 15a The compensation of the President and CEO 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 President and CEO 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 President and CEO 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 is administered under the Executive Compensation Philosophy Statetment or the Baystate Health Board approved budget and wage program for each fiscal year. Form 990, Part VI, Section C, line 19 Public Inspection of Organizational Policies 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 XI, line 9: Reduction in Workforce -363,880. Adjustment for Minimum Pension Liability -10,781,919. Transfer for PP&E 29,550. rounding -989. 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 50 Maple Street Springfield MA 01199 203260764 Real Estate and Other MA 501 (c ) (3) 11b, II Baystate Medical Center Inc 0 Visiting Nurse Assn and Hospice of Western New England Inc 50 Maple Street Springfield MA 01199 042105803 Home Health Care and Hospice MA 501 (c ) (3) 9 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 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) 11a, I Baystate Noble Hospital Corporation 0 Noble Visiting Nurse and Hospice Services Inc 115 West Silver Street PO Box 1634 Westfield MA 010861634 112757446 Home Health Care and Hospice MA 501 (c ) (3) 9 Baystate Noble Hospital Corporation 0 Health New England Inc Monarch Place Suite 1500 Springfield MA 01199 042864973 HMO/Insurance MA 501 (c ) (4) Health New England Inc 0 HNE of Connecticut Inc Monarch Place Suite 1500 Springfield MA 01199 455190134 HMO/Insurance CT 501 (c ) (4) Health New England Inc 0 HNE Insurance Company Inc Monarch Place Suite 1500 Springfield MA 011441500 454462433 Health Services for Massachusetts Medicare Supplement Members MA Health New England 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 Services Corporation Monarch Place Suite 1500 Springfield MA 011441500 043183019 Ancilliary Insurance MA Health New England Inc C 0 HNE Advisory Services Inc Monarch Place Suite 1500 Springfield MA 011441500 043012347 Administrative Services 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 Systen Ambulance Inc 759 Chestnut Street Springfield MA 01199 043018550 Ambulance Services MA Ingraham Corporation C 0 Baystate Health Insurance Company Ltd North Church Street Georgetown Cayman Islands CJ 980421413 Offshore Captive Insurance CJ Baystate Health Inc 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1