2015-08-11T12:44:30-05:00 2014-09-30 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2013-10-01 222747685 Baystate Administrative Services Inc BAYS 4137940000 759 Chestnut Street Springfield MA 011990001 Dennis W Chalke SVP Finance, CFO & Treasurer 4137945740 2015-08-10 1 Christine Kawecki P00743140 5169187000 2013 2016-02-25 16:41:14Z Dennis W Chalke 759 Chestnut Street Springfield MA 011990001 104765694 0 X www.baystatehealth.org X 1986 MA To improve the health of the people in our communities every day with quality and compassion 6 0 555 0 569135 0 0 0 94135222 102423858 473111 -46065 396039 676429 95004372 103054222 0 0 0 0 56812708 58116098 0 0 0 38508642 46231275 95321350 104347373 -316978 -1293151 40141818 29643625 52643724 46583394 -12501906 -16939769 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 28755954 44372503 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. 56688233 58158649 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. 85444187 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 1 0 0 0 0 0 1 0 0 0 1 279 0 1 555 1 1 1 0 0 0 0 0 0 0 X 6 0 1 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MA X Peter Lyons Baystate Health Inc 4137940000 759 Chestnut Street Springfield MA 01199 Mark A Keroack MD PresDir 7/1-9/30/14; Exec VP/COO-BH in 2013 1.00 49.00 X X 776897 0 179311 Mark R Tolosky Pres/Director 10/1/13- 7/01/14 1.00 49.00 X X 1639060 0 87835 Dennis W Chalke Treasurer/Director 1.00 49.00 X X 769165 0 75032 Evan Benjamin MD FACP Director/ SVP Hlth Care Quality 10.00 40.00 X 656389 0 63030 Jennifer Endicott Director 2/24/14 - 9/30/14 SVP Strategy 10.00 40.00 X 0 0 0 Gordon Josephson MD Director 10/1/13 - 2/03/14 COO, BMP 10.00 40.00 X 529869 0 62659 John Schrieber MD DOH 2314 Director 2/03- 9/30/14 President, BMP 10.00 40.00 X 5036 0 0 Paula C Squires Director/SVP Human Resources 10.00 40.00 X 480554 0 41677 Kristin R Delaney Assistant Clerk 1.00 49.00 X 103365 0 28954 Joel L Vengco VP Information Services 50.00 0.00 X 450814 0 35270 Charles Gijanto President Regional Markets 1.00 49.00 X 889781 0 35923 Kevin Hinchey MD Chief Academic Officer 5.00 45.00 X 490558 0 66584 Donna Ross SVP Strategy & Busi Dev 15.00 35.00 X 424142 0 53053 Neil Kudler MD Chief Med Information Officer 15.00 35.00 X 376441 0 54300 Peter A Lyons VP Finance Support Svcs 8.00 42.00 X 286734 0 71786 7878805 0 855414 129 0 1 0 Cerner Corporation 2800 Rockcreek Pkwy Kansas City MO 641172521 Computer Services 5943547 Microsoft Licensing GP 6100 Neil Road Reno NV 895111132 Computer Software 2763365 Siemens Medical Solutions USA PO Box 120001 Dallas TX 753120733 Medical Equipment 1837926 Philips Medical Systems PO Box 100355 Atlanta GA 303840355 Medical Equipment 1703126 Bulkley Richardson & Gelinas 1500 Main St Suite 2700 Springfield MA 011155507 Legal Services 1327076 99 Affiliate Support 561000 102423858 101854723 569135 102423858 58438 58438 11969 1595000 0 1711472 11969 -116472 -104503 -104503 Electronic Medical Records 541511 352191 352191 Flex Spending Forfeitures 561000 120000 120000 Diversity Conference 611430 37522 37522 166716 166716 676429 103054222 102531152 569135 -46065 5984917 4692773 1292144 42197600 33032770 9164830 2937042 2302829 634213 3723394 2979484 743910 3273145 2566388 706757 1005876 1005876 5014095 3353220 1660875 1781128 1539238 241890 2593466 2381013 212453 26314339 25358040 956299 1054842 876501 178341 587034 383647 203387 1016448 780474 235974 159265 132394 26871 245463 197644 47819 Recruitment 1076648 730075 346573 Dues & Memberships 14215 14215 5368456 4123482 1244974 104347373 85444187 18903186 0 985106 124263 16120551 4911723 889973 874565 117048 38484 9149853 11073055 5452633 5032255 471355 420378 12407932 12201157 40141818 29643625 24534799 25540701 28108925 21042693 52643724 46583394 X -12501906 -16939769 -12501906 -16939769 40141818 29643625 X -1293151 36977 -3181689 X 0 1 X 1 0 X X X 0 0 0 Baystate Health Inc 042105941 7 1 1 1 1869782 Baystate Medical Center Inc 042790311 3 0 1 1 79584024 Baystate Franklin Medical Ctr 042103575 3 0 1 1 7249838 Baystate Mary Lane Hospital Corp 042103584 3 0 1 1 1472048 Baystate Wing Hospital 222519813 3 0 1 1 101400 Visiting Nurse Association & Hospice of WNE Inc 042105803 9 0 1 1 1788223 Baystate Medical Practices Inc 042888373 9 0 1 1 4961078 Baystate Health Foundation Inc 043549011 7 0 1 1 45000 8 97071393 0 1 0 0 0 0 0 0 1 210265 210265 0 Part II-B, line i,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 467547 58168 3551309 3192762 358547 1375609 1371946 3663 420378 Due from affiliated companies 12201157 12201157 Due to affiliated companies 10113287 Total accrued pension cost 2098483 Total minimum pension liability 8830923 21042693 Part X, line 2 No FIN48 footnote was included in the consolidated audited financial statements of Baystate health, Inc. and Subsidiaries for the year ended September 30, 2014. X X X 1 1 0 1 0 0 0 0 0 0 0 Mark A Keroack MD PresDir 7/1-9/30/14; Exec VP/COO-BH in 2013 537949 0 223630 0 15318 0 165853 0 13458 0 956208 0 0 0 Mark R Tolosky Pres/Director 10/1/13- 7/01/14 728085 0 456876 0 454099 0 57333 0 30502 0 1726895 0 0 0 Dennis W Chalke Treasurer/Director 393944 0 159840 0 215381 0 53098 0 21934 0 844197 0 0 0 Evan Benjamin MD FACP Director/ SVP Hlth Care Quality 390694 0 138302 0 127393 0 42213 0 20817 0 719419 0 0 0 Gordon Josephson MD Director 10/1/13 - 2/03/14 COO, BMP 340675 0 152412 0 36782 0 45150 0 17509 0 592528 0 0 0 Paula C Squires Director/SVP Human Resources 282484 0 98252 0 99818 0 20400 0 21277 0 522231 0 0 0 Joel L Vengco VP Information Services 326954 0 110914 0 12946 0 15897 0 19373 0 486084 0 0 0 Charles Gijanto President Regional Markets 327104 0 130328 0 432349 0 20400 0 15523 0 925704 0 293474 0 Kevin Hinchey MD Chief Academic Officer 335131 0 119204 0 36223 0 43345 0 23239 0 557142 0 0 0 Donna Ross SVP Strategy & Busi Dev 210000 0 127148 0 86994 0 49321 0 3732 0 477195 0 0 0 Neil Kudler MD Chief Med Information Officer 272108 0 77700 0 26633 0 35923 0 18377 0 430741 0 0 0 Peter A Lyons VP Finance Support Svcs 217773 0 48983 0 19978 0 57333 0 14453 0 358520 0 0 0 Part I, Line 1a 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. and these individuals would be considered independent for compensation deliberation purposes as related to the filing organization. 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 independent 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 $110,597 is included in column E. This amount was earned in 2013. Dennis W. Chalke - Supplemental Retirement of $135,242 is included in column E. This amount was earned in 2013. Charles Gijanto - Supplemental Retirement of $403,145 is included in column E. This amount was earned in 2013 and $293,474 non-vested amounts that were earned in the previous 4 years and previously reported each year as deferred compensation, and now included again in accordance with reporting requirements. Kevin Hinchey, MD Supplemental Retirement of $17,905 is included in column E. This amount was earned in 2013. Gordon Josephson, MD - Supplemental Retirement of $26,718 is included in column E. This amount was earned in 2013. Mark A. Keroack, MD - Supplemental Retirement of $145,453 is included in column E. This amount was earned in 2013. Neil Kudler, MD Supplemental Retirement of $12,520 is included in column E. This amount was earned in 2013. Peter A. Lyons - Supplemental Retirement of $5,621 is included in column E. This amount was earned in 2013. Donna J. Ross Supplemental Retirement of $64,060 is included in column E. This amount was earned in 2013. Paula Squires - Supplemental Retirement of $70,361 is included in column E. This amount was earned in 2013. Mark R. Tolosky - Supplemental Retirement of $387,879 is included in column E. This amount was earned in 2013. Joel L. Vengco - Supplemental Retirement of $3,147 is included in column E. This amount was non-vested amount earned in 2013. n Baycare Health Partners Inc (BHP) Common Board Members or Officers 232464 See Part V - The filing organization received payments of $232,464 for management and administrative services from BHP. BHP is an affiliate corporation of the filing organization. 0 Health New England (HNE) Common Board Members or Officers 106890 See Part V - The filing organization received payments of $6,890 for reimbursement of benefits related expenses and $100,000 for management and administrative support from HNE. NHE is an affiliate corporation of the filing organization. 0 Ingraham Corporation (IC) Common Board Members or Officers 336672 See Part V - The filing organization received payments from IC for management, administrative and information systems services. IC is an affiliate corporation of the filing organization. 0 Baystate Health Insurance Company Ltd (BHIC) Common Board Members or Officers 18702384 See Part V - The filing organization received payments from BHIC for Claim Insurance reimbursements and Indemnity Pass-Through payments. BHIC is an affiliate corporation of the filing organization. 0 Baystate Health Insurance Company Ltd (BHIC) Common Board Members or Officers 16405008 See Part V - The filing organization made payments for Insurance premiums to BHIC. BHIC is an affiliate corporation of the filing organization. 0 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, Gordon Josephson, 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 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 15 The compensation of the President and CEO and of other officers and key employees 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. and these individuals would be considered independent for compensation deliberation purposes as related to the filing organization. The compensation of the President and CEO and of other officers and key employees 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 independent compensation committee of Baystate Health, Inc. 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: Pension Adjustment -3,231,706. Transfer for PP&E 50,016. rounding 1. 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 Homehealth and Hospice care 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 Health New England Inc Monarch Place Suite 1500 Springfield MA 01199 042864973 HMO/Insurance MA 501 (c ) (4) Baystate Health 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 Holding Corporation Monarch Place Suite 1500 Springfield MA 011441500 464620480 Dormant 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 Svs MA Health New England Inc C 0 HNE Insurance Company Inc Monarch Place Suite 1500 Springfield MA 011441500 454462433 Health Insurance Services for MA Medicare Supplement MA Health New England Inc C 0 Health New England of Connecticut Monarch Place Suite 1500 Springfield MA 011441500 061398662 Dormant CT 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 System Ambulance Inc 759 Chestnut Street Springfield MA 01199 043018550 Ambulance Svs 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