BAYSTATE HEALTH INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
BAYSTATE HEALTH INC (EIN 04-2105941)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-08
IRS object ID
201412209349300926
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-08-08T13:55:08-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1Two Jericho PlazaAddressLine1
CityJerichoCity
StateNYState
ZIP Code11753ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN042105941EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Baystate Health IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBAYSNameControl
Phone4137940000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1759 Chestnut StreetAddressLine1
CitySpringfieldCity
StateMAState
ZIP Code01199ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDennis W ChalkeName
TitleCFO & Treasurer, Baystate HealthTitle
Phone4137940000Phone
Date Signed2014-08-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameChristine KaweckiName
PTINP00743140PTIN
Phone5169187000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDennis W ChalkeNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1759 Chestnut StreetAddressLine1
CitySpringfieldCity
StateMAState
ZIP Code01199ZIPCode
FieldValueIRS element (for citing)
Gross Receipts59811526GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.baystatehealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1983YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionThe mission of the organization is to improve the health of people in our communities every day, with quality and compassion.ActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers19TotalNbrVolunteers
Total Gross UBI1231239TotalGrossUBI
Net Unrelated Business Txbl Income833280NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6531372ContributionsGrantsPriorYear
Contributions Grants Current Year6536957ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3051209ProgramServiceRevenuePriorYear
Program Service Revenue CY4639754ProgramServiceRevenueCY
Investment Income Prior Year1307796InvestmentIncomePriorYear
Investment Income Current Year1485330InvestmentIncomeCurrentYear
Other Revenue Prior Year1069297OtherRevenuePriorYear
Other Revenue Current Year917939OtherRevenueCurrentYear
Total Revenue Prior Year11959674TotalRevenuePriorYear
Total Revenue Current Year13579980TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year315000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY315000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year931913SalariesEtcPriorYear
Salaries Etc Current Year1176825SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year13600444OtherExpensePriorYear
Other Expenses Current Year14078904OtherExpensesCurrentYear
Total Expenses Prior Year14847357TotalExpensesPriorYear
Total Expenses Current Year15570729TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-2887683RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1990749RevenuesLessExpensesCY
Total Assets BOY149312000TotalAssetsBOY
Total Assets EOY107070000TotalAssetsEOY
Total Liabilities BOY5547000TotalLiabilitiesBOY
Total Liabilities EOY22027822TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY143765000NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY85042178NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe mission of the organization is to improve the health of the people in our communities every day, with quality and compassion.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense13488842Expense
Grants315000Grants
Revenue4639754Revenue
DescriptionBaystate Health, Inc. (Baystate Health or BH) based in Springfield, Massachusetts is the parent corporation of an integrated health care delivery system with the mission "to improve the health of the people in our community every day, with quality and compassion." BH provides funding for strategic initiatives, as necessary, funding for research & education initiatives and support of community health, development, and outreach activities, mostly funded by BH board-designated funds. Partners for a Healthier Community is the primary recipient of BH support.Baystate Health currently includes the following:Baystate Medical Center (BMC) located in Springfield, Massachusetts, is the largest of the three hospitals in the Baystate Health system. BMC, the leading health facility in western Massachusetts is the only tertiary care referral medical center and level I trauma center in the region. It is also home to western New England's only neonatal and pediatric intensive care units. BMC is a 653 bed, tax exempt, not-for-profit, academic teaching hospital that serves as the western campus of Tufts University School of Medicine.Baystate Franklin Medical Center (BFMC) located in Greenfield, Massachusetts, is a 90-bed, tax exempt, not-for-profit, acute care community hospital. BFMC serves the northern tier of northwestern Massachusetts and southern Vermont.Baystate Mary Lane Hospital Corporation (BMLH) located in Ware, Massachusetts, is a 31-bed, tax exempt, not-for-profit, acute care community hospital. BMLH provides services to more than sixteen central Massachusetts communities.Baystate Medical Practices(BMP)is a multi-specialty academic group practice established as a tax exempt, not-for-profit foundation to support the educational and research programs of Baystate Health as well as numerous community primary care and outreach services.Baystate Visiting Nurse Association & Hospice (BVNAH) is a tax exempt, not-for-profit organization that provides comprehensive home health care committed to providing the highest quality care to patients and families, primarily in the home setting. BVNAH meets individual needs by bringing experienced nurses, rehabilitation therapists, social workers, and home care aides to patients' homes. Health New England, Inc. (HNE) is a health maintenance organization that converted from a taxable for profit corporation to a non-profit corporation as of January 1, 2013. It is located in Springfield, Massachusetts. HNE's service area in Massachusetts includes Franklin, Berkshire, Hampden and Hampshire counties and part of Worcester county. HNE also serves Hartford, Litchfield and Tolland counties in Connecticut.Ingraham Corporation (IC) is a for-profit, taxable corporation that currently serves as a holding company for Baystate Health Ambulance, Inc.Baystate Health Ambulance, Inc. (BHA) is a for-profit, taxable corporation that delivers the latest in mobile critical care providing 24-hour service throughout western New England.Baystate Administrative Services, Inc. (BAS) is a tax exempt, not-for-profit corporation that provides management support for the BH subsidiaries, including human resources, marketing, strategic planning, information services and financial services.Baystate Health Foundation, Inc. (BHF) is a tax exempt, charitable organization established for the purpose of fund-raising for healthcare related activities, in support, and for the benefit, of BH and those subsidiaries of BH that are tax exempt, not-for-profit corporations, and to hold endowment, charitable donations, and other funds for their benefit.Baystate Health Insurance Company, Ltd. (BHIC) is a captive insurance company organized and licensed in the Cayman Islands, British West Indies. BHIC provides professional liability and other insurance coverage to BH and its corporate affiliates and their employees. In 2004, BHIC began offering malpractice insurance to members of BH's medical staff who meet criteria for participation.Description
Total Program Service Expense13488842TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities1ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109672NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Name Of Foreign CountryUKNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledFLStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonPeter Lyons Baystate Health IncNamePerson
Telephone Number4137940000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1759 Chestnut StreetAddressLine1
CitySpringfieldCity
StateMAState
ZIP Code011990001ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationFormerFormer
Mark R Tolosky
President, CEO & Trustee40.0010.00XX0155504459300
Victor Woolridge
Chair2.001.00XX000
James P Sadowsky
Vice Chair2.001.00XX000
Gregory L Braden MD
Trustee 1/1 - 9/30/131.001.00X000
Ruth H Constantine
Trustee 1/1 - 9/30/131.001.00X000
Charles L D'Amour
Trustee 10/1 - 12/31/121.001.00X000
John H Davis
Trustee1.001.00X000
John A Egelhofer MD
Trustee1.001.00X000
John E Kole
Trustee1.001.00X000
Grace P Makari-Judson MD
Trustee/ Hematologist M. D1.001.00X329977071041
John F Maybury
Trustee1.001.00X000
Steven M Mitus
Trustee1.001.00X000
John M O'Brien III
Trustee1.001.00X000
Anne M Paradis
Trustee1.001.00X000
Robert L Pura PhD
Trustee 1/1 - 9/30/131.001.00X000
Katherine E Putnam
Trustee1.001.00X000
Timothy S Rice
Trustee1.001.00X000
David C Southworth
Trustee1.001.00X000
Barbara W Stechenberg MD
Trustee/ Infectious Disease1.001.00X144720032595
Katherine McG Sullivan
Trustee1.001.00X000
Howard G Trietsch MD
Trustee1.001.00X000
Richard B Steele Jr
Trustee1.001.00X000
Dennis W Chalke
Treasurer40.0010.00X072368552277
Kristin R Delaney
Clerk40.0010.00X09811919540
Patricia A Sheldon
Assistant Clerk40.0010.00X06479015809
Keith C McLean-Shinaman
Former Treasurer0.00029898610208X
FieldValueIRS element (for citing)
Total Reportable Comp From Org474697TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2740624TotalReportableCompFrmRltdOrgs
Total Other Compensation260770TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Baystate Administrative Services Inc
759 Chestnut StreetSpringfieldMA011990001Management Services1861570
Thayer Street Associates
8 Coates AveSouth DeerfieldMA01373Consulting Services432577
JKA LLC
3917 Kathleen WayDavenportIA52807Consulting Services372570
University of MASS
651 North Pleasant StreetAmherstMA01003Nursing Initiatives180733
Market Mentors LLC
1680 C Riverdale StWest SpringfieldMA01089Marketing Services144861
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
Related Organizations6270000RelatedOrganizations
All Other Contributions266957AllOtherContributions
Total Contributions6536957TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Premier Purchasing Partners, L.P.52599026867272686727
Ins and Prship UBI525990927685927685
Miscellaneous524298590334295334295000
Intercompany Rent531120268340268340
HNE Surplus Sharing524298166668166668
FieldValueIRS element (for citing)
Total Program Service Revenue4639754TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column987657TotalRevenueColumn
Unrelated Business Revenue8554UnrelatedBusinessRevenue
Exclusion$979,103ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities46729219Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities46231546Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities497673Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column497673TotalRevenueColumn
Exclusion$497,673ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionBHF/BH TRR & BINA INCDescription
Business Code525990BusinessCode
Total Revenue Column917939TotalRevenueColumn
Exclusion$917,939ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue917939TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13579980TotalRevenueColumn
Related Or Exempt Function Income3417069RelatedOrExemptFunctionIncome
Unrelated Business Revenue1231239UnrelatedBusinessRevenue
Exclusion$2,394,715ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total315000Total
Program Services315000ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1176825Total
Program Services1176825ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total310312Total
Management And General310312ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total-13410Total
Management And General-13410ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total90000Total
Program Services90000ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total108402Total
Management And General108402ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1283813Total
Program Services1245971ProgramServices
Management And General37842ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total188673Total
Program Services188673ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total38299Total
Management And General38299ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total10750Total
Management And General10750ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total59785Total
Program Services59785ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total50579Total
Program Services50579ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total43821Total
Program Services43821ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total1804288Total
Program Services1132937ProgramServices
Management And General671351ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2782Total
Program Services2782ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total61877Total
Management And General61877ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
RESEARCH INITIATIVES33994803399480
BAD DEBT30000003000000
STRATEGIC INITIATIVES17415241741524
BAS ADMIN CHARGES761558569690191868

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1136371Total
Program Services471775ProgramServices
Management And General664596ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15570729Total
Program Services13488842ProgramServices
Management And General2081887ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY20614492BOY
EOY22282199EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY77210BOY
EOY4590454EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY9616BOY
EOY11570EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis348439LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec253430LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY81796BOY
EOY95009EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY30013125BOY
EOY31245045EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY7853133BOY
EOY7639504EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY90662628BOY
EOY41206219EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY149312000BOY
EOY107070000EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2028000BOY
EOY1615988EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3519000BOY
EOY20411834EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5547000BOY
EOY22027822EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY123346000BOY
EOY64239858EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY20419000BOY
EOY20802320EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY143765000BOY
EOY85042178EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY149312000BOY
EOY107070000EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1990749ReconcilationRevenueExpenses
Reconciliation Unrealized Invest678812ReconciliationUnrealizedInvest
Reconcilation Other Changes-57410885ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6497105CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2268253CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2440269CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6531372CurrentTaxYearMinus1Year
Current Tax Year6536957CurrentTaxYear
Total24273956Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6497105CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2268253CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2440269CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6531372CurrentTaxYearMinus1Year
Current Tax Year6536957CurrentTaxYear
Total24273956Total
FieldValueIRS element (for citing)
Public Support Total17024273956PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1380550CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1166916CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1022969CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year887897CurrentTaxYearMinus1Year
Current Tax Year987657CurrentTaxYear
Total5445989Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years299456CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years62091CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year167675CurrentTaxYearMinus1Year
Current Tax Year833280CurrentTaxYear
Total1362502Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1308984CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1018209CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years955876CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1069297CurrentTaxYearMinus1Year
Current Tax Year917939CurrentTaxYear
Total5270305Total
FieldValueIRS element (for citing)
Total Support36352752TotalSupport
Gross Receipts From Admissions Etc17146368GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.66770PublicSupportPertcentage170
Public Support Pertcent Prior Year0.61990PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
General ExplanationSchedule A, Part IV, Supplemental Information: Schedule A, Part II, Line 10 Descriptions Interest Income - Baycare Loan Interest Income - Loomis Loan Interest Income - Commercial Paper Operations from Total Rate of Return Total Rate of Return AdjustmentGeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$90,000DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB90000TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart IV, Supplemental Information:Identifier
ExplanationBH paid 90,000 to Rauschenbach Associates as reported on Massachusetts Public Records Division Lobbyist Disclosures for lobbying activities related to healthcare policy, bills and appropriations-related activities.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance18718148BeginningOfYearBalance
Contributions170271Contributions
Investment Earnings Or Losses869696InvestmentEarningsOrLosses
End Of Year Balance19758115EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance17468653BeginningOfYearBalance
Contributions79814Contributions
Investment Earnings Or Losses1169681InvestmentEarningsOrLosses
End Of Year Balance18718148EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance18056698BeginningOfYearBalance
Contributions70532Contributions
Investment Earnings Or Losses-658577InvestmentEarningsOrLosses
End Of Year Balance17468653EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance17584865BeginningOfYearBalance
Contributions60772Contributions
Investment Earnings Or Losses411061InvestmentEarningsOrLosses
End Of Year Balance18056698EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance19047559BeginningOfYearBalance
Contributions80997Contributions
Investment Earnings Or Losses-1543691InvestmentEarningsOrLosses
End Of Year Balance17584865EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis59124OtherCostOrOtherBasis
Book Value59124BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis233233OtherCostOrOtherBasis
Depreciation223463Depreciation
Book Value9770BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis18589OtherCostOrOtherBasis
Depreciation8468Depreciation
Book Value10121BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis21295OtherCostOrOtherBasis
Depreciation21295Depreciation
Book Value0BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis16198OtherCostOrOtherBasis
Depreciation204Depreciation
Book Value15994BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings95009TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionInvestments - Other SecuritiesDescription
Book Value7639504BookValue
Method Of ValuationCMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities7639504TotalOfBookValueSecurities

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
Due from Affiliated Companies4521950
Equity Investment in For-Profit Subsidiary (Ingraham Corporation)1195882
Line of Credit -- Affiliate1810440
Interest in Net Assets in BHF22605495
Rounding-1
Deferred Expenses11072453
FieldValueIRS element (for citing)
Total Book Value Other Assets41206219TotalBookValueOtherAssets
Federal Income Tax Liability-132561FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Due to Affiliated Companies$9,365,914
Due to Board-Designated Funds$1,028,486
Insurance Reserves$10,150,000
rounding-$5
FieldValueIRS element (for citing)
Total Of Amounts20411834TotalOfAmounts

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

ExplanationExplanation
Part V, line 4: Endowment assets are to provide funding to support programs that further Baystate Health's mission.
Part X, Line 2: Baystate Health, Inc. did not have a FIN 48 footnote included in the audited financial statements.

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable (2 entries)

RegionRegionType Of Activities ConductedTypeOfActivitiesConductedTotal ExpendituresTotalExpenditures
CaribbeanInsurance12693198
EuropeInvestments12000000
FieldValueIRS element (for citing)
Subtotal Number Of Offices0SubtotalNumberOfOffices
Subtotal Number Of Employees0SubtotalNumberOfEmployees
Cont Number Of Offices0ContNumberOfOffices
Cont Number Of Employees0ContNumberOfEmployees
Total Number Of Offices0TotalNumberOfOffices
Total Number Of Employees0TotalNumberOfEmployees
Subtotal Amount Spent24693198SubtotalAmountSpent
Cont Amount Spent0ContAmountSpent
Total Amount Spent24693198TotalAmountSpent
Transfer To Foreign Corp1TransferToForeignCorp
Interest In Foreign Trust0InterestInForeignTrust
Own Foreign Corp1OwnForeignCorp
Passive Foreign Invest Co0PassiveForeignInvestCo
Foreign Partnership1ForeignPartnership
Boycott Countries0BoycottCountries

Form990 Schedule F Part V Form990ScheduleFPartV

FieldValueIRS element (for citing)
IdentifieritemizationIdentifier
Return ReferencePart 1, line 3ReturnReference
Explanationtotal expenditures of $12,693,198 in the Caribbean are comprised of insurance related cash transfers of $12,573,198 and Baystate Health's book value of $120,000 BHIC investment contributions of $12,000,000 were made to an investment partnership fund domiciled in Edinburgh, UKExplanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Partners for a Healthier Community Inc
PO Box 15769SpringfieldMA01115043342182501(c)(3)250000To assist Partner's for a Healthier Community to narrow the gap in health disparities for some of Springfield's most vulnerable citizens, and to be a source of support for building civic leaders, creating strategies for change, and promoting policy actions to create healthier communities.
Baystate Health Foundation Inc
759 Chestnut StreetSpringfieldMA01199043549011501(c)(3)65000To provide support for the Health Science Library and Medical Staff Pledge.
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPart II, lines 1Identifier
ExplanationBaystate Health, Inc. has a close relationship with its grantees, which includes Baystate Health Foundation (BHF). Through this close relationship, management is able to ensure the granted money is used for the intended purposes. For BHF, funds are accounted for and monitored in individual temporarily restricted purpose funds in accordance with the restrictions. Fund administrators of the related entity are assigned responsibility to assure that the fund purpose is met before releasing from restrictions.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Mark R Tolosky
President, CEO & Trustee0697835044153604156730280890312110161434400
Grace P Makari-Judson MD
Trustee/ Hematologist M. D2765050302320232400440620269790401018000
Barbara W Stechenberg MD
Trustee/ Infectious Disease132412012299090221320104630177315000
Dennis W Chalke
Treasurer036578501555500202350028000024277077596200
Keith C McLean-Shinaman
Former Treasurer0000029898600010208030919400

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 3Baystate Health, Inc uses an independent compensation committee, an independent compensation consultant, and appropriate comparability data and approval by the compensation committee to establish the compensation of its key officers, directors, and employees.
Part I, Lines 4a-bPart I, Lines 4a-b: Line 4a: Keith McLean-Shinaman terminated employment effective 9/30/2011. The compensation numbers include various one time termination payments. Line 4b: Dennis W. Chalke - Supplemental Retirement of $127,250 is included in column E. This amount was earned in 2012. Grace Makari-Judson, MD- Supplemental Retirement of $8,900 is included in column E. This amount was earned in 2012. Mark R. Tolosky - Supplemental Retirement of $351,665 is included in column E. This amount was earned in 2012.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (9 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Baycare Health Partners Inc (BHP)
Common Board Members or Officers9625See Part V - The filing organization received payments from BHP for reimbursement of expenses. BHP is a Physician Hospital Organization and an affiliate corporation of the filing organization.0
Baycare Health Partners Inc (BHP)
Common Board Members or Officers533330See Part V - The filing organization made payments to BHP for physician membership dues of $183,330 and Patient Centered Medical Home Pilot of $200,000. The filing organization made payments of $150,000 to BHP for consultant fees. BHP is a Physician Hospital Organization and an affiliate corporation of the filing organization.0
Baystate Health Insurance Company Ltd (BHIC)
Common Board Members or Officers3788603See Part V - The filing organization made payments of $3,747,603 for Indemnity pass-thru premiums and $41,000 for Retrospective pass-thru premiums to BHIC. BHIC is an affiliate organization of the filing organization.0
Baystate OBGYN Group (BOG)
Partnership - Owned more than 5% by Dr. Howard Trietsch, Board Member420532See Part V - The filing organization received pass through payments from BOG for community physician insurance premiums due Baystate Health Insurance Company, Ltd.0
Health New England Inc
Common Board Members or Officers166668See Part V - The filing organization received $166,668 in Surplus Sharing payments from HNE. HNE is an affiliate corporation of the filing organization.0
Ingraham Corporation (IC)
Common Board Members or Officers144549See Part V - The filing organization received principal and interest payments from IC related to the line of credit. IC is an affiliate corporation of the filing organization.0
Mass Mutual Financial Group (MMFG)
Board Overlap515401See Part V - Victor Woolridge, Board Member of the filing organization is also the Vice President of Cornerstone Real Estate Advisors, LLC, a subsidiary of MMFG. The filing organization purchases investment management & administrative services from MMFG and its subsidiaries.0
Pioneer Valley Accountable Care LLC (PVAC)
Common Board Members or Officers3021000See Part V - The filing organization made payments to PVAC for an increase in loan principal of $3,000,000 to assist with a Medicare Shared Savings program in the Pioneer Valley. The filing organization received payments of $21,000 from PVAC for interest in connection with the original loan principal. PVAC is an Accountable Care Organization and is a subsidary partnership of Baycare Health Partners, a Physician Hospital Organization and an affiliate corporation of the filing organization.0
Western New England Renal & Transplant (WNERTA)
Board Overlap348486See Part V - Gregory L. Braden, MD, Board Member of the filing organization is also a Member of the Board of Directors of WNERTA. The filing organization received payments from WNERTA for community physicians insurance premiums due to Baystate Health Insurance Company, Ltd. of $344,986 and memberships of $3,500.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VIGoverning Body and Management Part VI, Line 1b Four members of the Board of Trustees of the filing organization are not considered independent as a result of their service on the board of an affiliate of the filing organization.
Form 990, Part VI, Section A, line 2Gregory L. Braden, MD, Dennis W. Chalke, Ruth H. Constantine, Charles L. D'Amour, John H. Davis, Kristin R. Delaney, John A. Egelhofer, MD, John E. Kole, Grace P. Makari-Judson, MD, John E. Maybury, Steven M. Mitus, John M. O'Brien, III, Ann M. Paradis, Robert L. Pura, PhD, Katherine E. Putnam, Timothy S. Rice, James P. Sadowsky, Patricia A. Sheldon, David C. Southworth, Barbara W. Stechenberg, MD, Richard B.Steele, Jr., Katherine M. Sullivan, Mark R. Tolosky, Howard G. Trietsch, MD and Victor Woolridge are 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) Katherine E. Putnam and David Southworth (2) Richard B. Steele, Jr. and Katherine McG. Sullivan (3) Steven M. Mitus, Robert L. Pura, PhD and Richard B. Steele, Jr.; (4) Charles D'Amour, John F. Maybury and Mark R. Tolosky (5) John M. O'Brien, III and Victor Woolridge. Form 990, Part VI, Section A, Line 1a 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 3Form 990, Part VI, Section A, Line 3 Baystate Health, Inc. is affiliated with Baystate Administrative Services, Inc. (BAS) which is a 501(c)(3) organization. Management and support functions for the BH subsidiaries, including human resources, marketing, strategic planning, information services and financial services, are delegated to BAS.
Form 990, Part VI, Section A, line 4The filing organization amended the section of its bylaws describing its Audit and Compliance Committee to clarify the language regarding the Committee's authority with respect to Health New England, Inc. ("HNE"), an affiliate of the filing organization. This amendment was in connection with HNE's conversion from a for profit corporation to a non-profit corporation under state law, which resulted in the filing organization becoming the sole corporate member of HNE, where it had previously been the majority shareholder.
Form 990, Part VI, Section B, line 11Prior 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., 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 of the filing organization.
Form 990, Part VI, Section B, line 12cBaystate 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, 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 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 15The compensation of the President and CEO and of other key officers and 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 19The 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.
Part VII, Section A, Line 5Certain 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.persons from unrelated organizations
Form 990, Part XI, line 9:Transfers to Affiliated Companies, Net 14,885,687. Property, Plant & Equipment Transfers -10,803,553. Health New England Investment Elimination -61,783,798. Equity Gain / (Loss) in Baycare -77,213. Equity Gain / (Loss) in Ingraham 922,970. Change in Interest of Net Assets of BHF 383,182. Premier Purchasing Partners, L.P. - Unrelated Business Gain/Loss -70,465. Premier Purchasing Partners, L.P. - Interest -10,638. Fidelity Real Estate Growth Fund III LP 110,445. Harbourvest Partners VI - Buyout Partnership Fund, L.P. 945. Harbourvest Partners VI - Partnership Fund, L.P. 1,080. Mesirow Financial Capital Partners IX, L.P. 972. Mesirow Financial Private Equity Partnership Fund III, L.P. 4,827. Metropolitan Real Estate Partners, III-A, L.P. 5,825. Metropolitan Real Estate Partners IV-B, L.P. 49,792. Metropolitan Real Estate Partners V, L.P. 7,613. Pantheon USA III Fund, L.P. -887. Park Street Capital Private Equity Fund IX, LP -209. Tower Square Capital Partners III, L.P. 1,734. Truebridge-Kauffman Endowment Fund II, L.P. -9. Wilshire Asia Private Markets Fund VII, L.P. -1,701. Wilshire European Private Markets Fund VII, L.P. 1,699. Wilshire U.S. Private Markets Fund VII, L.P. -121. BHIC UBTI -1,039,225. Rounding 163.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Baystate Administrative Services Inc
759 Chestnut StreetSpringfieldMA01199222747685Administrative servicesMA501 (c ) (3)11c, IIIcBaystate Health Inc0
Baystate Franklin Medical Center
164 High StreetGreenfieldMA01301042103575HospitalMA501 (c ) (3)3Baystate Health Inc0
Baystate Health Foundation Inc
759 Chestnut StreetSpringfieldMA01199043549011FundraisingMA501 (c ) (3)7Baystate Health Inc0
Baystate Health Systems Inc Health & Welfare Benefits Plan
759 Chestnut StreetSpringfieldMA01199222531644Voluntary Employees' Benefit AssociationMA501 (c ) (9)Baystate Health Inc0
Baystate Mary Lane Hospital Corporation
85 South StreetWareMA01082042103584HospitalMA501 (c ) (3)3Baystate Health Inc0
Baystate Medical Center Inc
759 Chestnut StreetSpringfieldMA01199042790311Acute Care Teaching HospitalMA501 (c ) (3)3Baystate Health Inc0
Baystate Total Home Care Inc
50 Maple StreetSpringfieldMA01199203260764Real Estate and OtherMA501 (c ) (3)11b, IIBaystate Health Inc0
Visiting Nurse Assn and Hospice of Western New England Inc
50 Maple StreetSpringfieldMA01199042105803Homehealth and Hospice careMA501 (c ) (3)9Baystate Health Inc0

Form990 Schedule R Part IV Form990ScheduleRPartIV (18 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityPercentage OwnershipPercentageOwnershipControlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNAAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
Health New England Inc
Monarch Place Suite 1500SpringfieldMA011441500042864973HMO/InsuranceMABaystate Health IncC1.000000
HNE Advisory Services
Monarch Place Suite 1500SpringfieldMA011441500043012347Administrative SvsMAHealth New England IncC1.000000
Health New England Insurance
Monarch Place Suite 1500SpringfieldMA011441500043183019Ancilliary InsuranceMAHealth New England IncC1.000000
Health New England of Connecticut
Monarch Place Suite 1500SpringfieldMA011441500061398662DormantMAHealth New England IncC1.000000
Ingraham Corporation
759 Chestnut StreetSpringfieldMA01199043016257Health care and other business activitiesMABaystate Health IncC1.000000
Baystate Health System Ambulance Inc
759 Chestnut StreetSpringfieldMA01199043018550Ambulance SvsMAIngraham CorporationC1.000000
Frances Lutolf BO Wesson Hosp
Bank of America 100 Federal StBostonMA02110046019056TrustMAT1.000000N/A
Daniel Wesson TUW W Maternity
Bank of America 100 Federal StBostonMA02110046019096TrustMAT1.000000N/A
Daniel Wesson TUW W Memorial
Bank of America 100 Federal StBostonMA02110046019097TrustMAT1.000000N/A
Louise G Pease BO Baystate Med
Bank of America 100 Federal StBostonMA02110046019113TrustMAT1.000000N/A
Gertrude Hibbard TUW W Mem
Bank of America 100 Federal StBostonMA02110046019230TrustMAT1.000000N/A
Herbert Thresher UW W Hosp
Bank of America 100 Federal StBostonMA02110046088132TrustMAT1.000000N/A
Tr UW H Dexter FB Wesson M
Bank of America 100 Federal StBostonMA02110046018707TrustMAT1.000000N/A
Tr UW H Dexter FB Wesson W
Bank of America 100 Federal StBostonMA02110046018708TrustMAT1.000000N/A
L & F Tifft BO BSHS Tr UA
Bank of America 100 Federal StBostonMA02110046046282TrustMAT1.000000N/A
TW D B Wesson FB W M H
Bank of America 100 Federal StBostonMA02110046018682TrustMAT1.000000N/A
TW D B Wesson FB WWH
Bank of America 100 Federal StBostonMA02110046018681TrustMAT1.000000N/A
Baystate Health Insurance Company Ltd
980421413Offshore Captive InsuranceBaystate Health Inc0North Church StreetGeorgetownCayman IslandsCJCJ
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (15 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Visiting Nurse Assn and Hospice of Western New England Inc
P72064
Visiting Nurse Assn and Hospice of Western New England Inc
B683000
Baystate Health Foundation Inc
M386000
Baystate Health Foundation Inc
B65000
Baystate Health Foundation Inc
S1160710
Baystate Administrative Services Inc
M1869782
Baystate Medical Center Inc
L6270000
Baystate Medical Center Inc
M3851231
Baystate Medical Center Inc
K268340
Baystate Medical Center Inc
C35154000
Baystate Medical Center Inc
R3318191
Baystate Franklin Medical Center Inc
R598708
Ingraham Corporation
D144549
L & F Tifft BO BSHS Tr UA
A170271
BH Insurance Company Ltd
P3788603

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