2014-08-08T13:55:08-05:00 2013-09-30 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2012-10-01 042888373 Baystate Medical Practices Inc BAYS 4137940000 759 Chestnut Street Springfield MA 01199 Dennis W Chalke 4137943290 2014-08-08 1 Christine Kawecki P00743140 5169187000 2012 2015-11-30 17:44:51Z Dennis W Chalke 759 Chestnut Street Springfield MA 01199 219747101 0 X baystatehealth.org X 1985 MA To improve the health of the people in our communities every day, with quality and compassion. Baystate Medical Practice's vision states it will be the multi-specialty group practice of choice, known for exceptional service, quality, value, and academic leadership. 18 0 1541 1 948944 -278654 0 0 220624064 219743167 3428 3934 0 0 220627492 219747101 0 0 0 0 194094105 197473601 0 0 0 42203051 43375752 236297156 240849353 -15669664 -21102252 28870300 34504128 85819073 69241657 -56948773 -34737529 X To deliver excellent patient care, provide innovative medical education and pursue meaningful research. 0 0 223234425 218794223 Baystate Medical Practices, Inc. provides physician services, medical education and research programs to people in the community within its geographic location. BMP's policy is to provide care to any patient in need of medical care, regardless of the patient's ability to pay for such care. Dependent upon the patient's financial capability to pay, BMP may provide such care free of charge or at amounts below its normal charges. Because BMP does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. In addition to the charity care provided to patients, BMP's physicians participate in many and varied ongoing community outreach initiatives in the areas of education, employment, safety and health. For example, the BMP physicians in the Department of Pediatrics, in collaboration with the Springfield School Department, staff six school-based clinics that enhance school health education programs, provide professional development courses for teachers and administrators and establish a school-to-work program.BMP has also taken a leadership role in strengthening the health of disadvantaged citizens in surrounding communities including specific focus on AIDS and HIV and by providing physician staffing for three community-based health centers through Baystate Medical Center.Part VI, Section A, Line 1b:Baystate Medical Practices, Inc. (BMP) is part of an integrated delivery system including not for profit community hospitals, which have community boards. BMP is a physician organization, which supports Baystate Health and its affiliates and is comprised primarily of BMP employees. This board structure has not changed significantly since the organization applied for exempt status. 223234425 1 0 0 0 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 0 0 0 0 1 131 0 1 1541 1 1 1 0 0 0 0 0 0 0 0 0 X 18 0 1 1 0 0 1 1 1 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 X Gordon Josephson MD 48.00 2.00 X X 440372 0 56941 Mark A Keroack MD 48.00 2.00 X X 814375 0 135233 Benjamin Liptzin MD 40.00 10.00 X X 493358 0 34985 Dennis W Chalke 1.00 49.00 X X 723685 0 52277 Mohammed S Ahmed MD 30.00 20.00 X X 390539 0 43006 Elizabeth Boyle MD 49.00 1.00 X 219916 0 47021 Jeffrey Cossin MD 49.00 1.00 X 224929 0 66273 Wayne Duke MD 49.00 1.00 X 375275 0 52754 Gregory A Harb 10.00 40.00 X 799614 0 161885 Oz Harmanli MD 49.00 1.00 X 358031 0 43264 Thomas Higgins MD 49.00 1.00 X 530345 0 60269 Kevin Hinchey MD 49.00 1.00 X 393233 0 66443 Mark K Hirko MD 49.00 1.00 X 731627 0 76016 M Dale Janes 1.00 0.00 X 0 0 0 Laura M Koenigs MD 49.00 1.00 X 151401 0 65908 Christie L Miller MD 49.00 1.00 X 220547 0 36456 Michael Picchioni MD 49.00 1.00 X 210672 0 42342 Sara Rourke MD 49.00 1.00 X 197461 0 29390 Joseph Schmidt MD 49.00 1.00 X 344734 0 50672 Scott Siege MD 49.00 1.00 X 175096 0 25798 Roy Sittig MD 49.00 1.00 X 317525 0 49926 Mark R Tolosky 1.00 49.00 X 1555044 0 59300 Kelly Tyler MD 49.00 1.00 X 325142 0 20017 Richard Wait MD 49.00 1.00 X 818173 0 105169 Jackson William MD 49.00 1.00 X 101080 0 12527 Kristin R Delaney 1.00 49.00 X 98119 0 19540 Andrew Artenstein MD 50.00 X 157093 0 9202 Aaron Kugelmass MD 50.00 X 937278 0 77552 Gerda Maissel MD 30.00 20.00 X 343151 0 51730 Sherry Taylor MD 50.00 X 829064 0 31860 Dennis Oh MD 50.00 X 759250 0 31764 David Refermat MD 50.00 X 594640 0 40623 Clemens Schirmer MD 50.00 X 556585 0 31886 Thomas Kaye MD 50.00 X 553136 0 70790 15740490 0 1758819 499 0 1 1 Baystate Administrative Services Inc 759 Chestnut Street Springfield MA 01199 Management services 4958375 Baystate Medical Center Inc 759 Chestnut Street Springfield MA 01199 Patient schedule svcs & rent 4708230 PatientKeeper 880 Winter Street Suite 300 Waltham MA 02451 Billing service 583666 Baystate Franklin Medical Center 164 High Street Springfield MA 01301 Rent 570628 Radiology & Imaging Inc 1350 Main Street Springfield MA 011031628 Physician services 548800 31 Physician Practice Fees 621110 137201712 137201712 Hospital reimb programs 621110 55274020 55274020 MD performance incentives 621110 7436833 7436833 EHR incentive Medicare/Medicaid 621110 5324775 5324775 3rd party contract reimb 621110 2987090 2987090 11518737 10569793 948944 219743167 3934 3934 219747101 218794223 948944 3934 9638922 9638922 160015552 156409685 3605867 10547624 10305613 242011 8725116 8528892 196224 8546387 8363446 182941 5358371 5358371 332610 332610 51115 51115 4681176 3909402 771774 94987 90238 4749 2546639 2328589 218050 74049 52585 21464 5044023 4791822 252201 325145 325145 365213 346952 18261 6934 6934 821996 780896 41100 14598368 8741112 5857256 Purchased Svcs Clerical 3239454 3239454 Medical Supplies 2749981 2749981 Prof'l Exp Acct 1821218 1821218 Dues & Memberships 428419 428419 836054 810473 25581 240849353 223234425 17614928 0 5131873 3126924 15717977 13482939 192708 97444 589104 1531906 23037219 15452617 2555316 7584602 4683322 8680313 28870300 34504128 29690550 31104905 461756 290625 55666767 37846127 85819073 69241657 X -56948773 -34737529 -56948773 -34737529 28870300 34504128 X -21102252 43313496 X X 0 1 X 1 0 X 135989036 140855978 206929699 219827643 218759374 922361730 135989036 140855978 206929699 219827643 218759374 922361730 0 0 0 922361730 46568 8640 3831 3428 3934 66401 46568 8640 3831 3428 3934 66401 309068 297439 379972 796421 983793 2766693 136344672 141162057 207313502 220627492 219747101 925194824 0.99690 0.99720 0.00010 0.00020 X 1103927 440582 663345 5196126 1149344 4046782 16357457 13862691 2494766 379709 379709 7584602 Due from Affiliated Companies 2900604 Accounts Receivable, Other (net of MD loans) 5779709 8680313 Due to Affiliated Companies 12613883 Insurance IBNR Loss Reserves 8768420 Accrued Pension Cost 15647819 Line of credit, affiliate 816005 37846127 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Schedule D, Part X, Line 2: Baystate Medical Practices, Inc. does not have a FIN 48 footnote included in its audited financial statements. X 1 1 0 1 0 0 0 0 0 0 0 Gordon Josephson MD 334491 0 72386 0 33495 0 40575 0 16366 0 497313 0 0 0 Mark A Keroack MD 446725 0 170955 0 196695 0 119597 0 15636 0 949608 0 0 0 Benjamin Liptzin MD 358166 0 81200 0 53992 0 17537 0 17448 0 528343 0 0 0 Dennis W Chalke 365785 0 155550 0 202350 0 28000 0 24277 0 775962 0 0 0 Mohammed S Ahmed MD 309105 0 59299 0 22135 0 24420 0 18586 0 433545 0 0 0 Elizabeth Boyle MD 188726 0 29544 0 1646 0 23760 0 23261 0 266937 0 0 0 Jeffrey Cossin MD 186852 0 27126 0 10951 0 44895 0 21378 0 291202 0 0 0 Wayne Duke MD 291023 0 67154 0 17098 0 31640 0 21114 0 428029 0 0 0 Gregory A Harb 444085 0 236430 0 119099 0 139147 0 22738 0 961499 0 0 0 Oz Harmanli MD 269585 0 74331 0 14115 0 26769 0 16495 0 401295 0 0 0 Thomas Higgins MD 383023 0 89600 0 57722 0 41410 0 18859 0 590614 0 0 0 Kevin Hinchey MD 311222 0 63375 0 18636 0 41376 0 25067 0 459676 0 0 0 Mark K Hirko MD 540942 0 187450 0 3235 0 59411 0 16605 0 807643 0 0 0 Laura M Koenigs MD 145728 0 4228 0 1445 0 38981 0 26927 0 217309 0 0 0 Christie L Miller MD 147115 0 70618 0 2814 0 24132 0 12324 0 257003 0 0 0 Michael Picchioni MD 196775 0 13245 0 652 0 26250 0 16092 0 253014 0 0 0 Sara Rourke MD 163039 0 34068 0 354 0 8235 0 21155 0 226851 0 0 0 Joseph Schmidt MD 281360 0 56023 0 7351 0 32163 0 18509 0 395406 0 0 0 Scott Siege MD 166502 0 8000 0 594 0 8930 0 16868 0 200894 0 0 0 Roy Sittig MD 281600 0 27690 0 8235 0 26399 0 23527 0 367451 0 0 0 Mark R Tolosky 697835 0 441536 0 415673 0 28089 0 31211 0 1614344 0 0 0 Kelly Tyler MD 277445 0 39990 0 7707 0 12500 0 7517 0 345159 0 3486 0 Richard Wait MD 588045 0 151500 0 78628 0 68867 0 36302 0 923342 0 0 0 Andrew Artenstein MD 149006 0 7500 0 587 0 0 0 9202 0 166295 0 0 0 Aaron Kugelmass MD 535706 0 398271 0 3301 0 47193 0 30359 0 1014830 0 0 0 Gerda Maissel MD 276504 0 45261 0 21386 0 35636 0 16094 0 394881 0 0 0 Sherry Taylor MD 653768 0 2860 0 172436 0 20000 0 11860 0 860924 0 120256 0 Dennis Oh MD 597503 0 141000 0 20747 0 12500 0 19264 0 791014 0 0 0 David Refermat MD 592478 0 0 0 2162 0 19047 0 21576 0 635263 0 0 0 Clemens Schirmer MD 449570 0 106000 0 1015 0 19982 0 11904 0 588471 0 0 0 Thomas Kaye MD 495042 0 50000 0 8094 0 43261 0 27529 0 623926 0 0 0 Part I, Line 1a Club Dues One member of the Board of Directors was provided with payment for dinner club dues for which the personal use did not exceed $40 for 2012. This item was 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 Baystate Health, Inc., the parent organization of the health care system to which the filing organization belongs, 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, which includes the filing organization's top management officials. Part I, Line 4b Mohammed Shafeeq Ahmed, MD - Supplemental Retirement of $10,429 is included in column E. This amount was earned in 2012. Dennis W. Chalke - Supplemental Retirement of $127,250 is included in column E. This amount was earned in 2012. Wayne Duke, MD - Supplemental Retirement of $15,177 is included in column E. This amount was earned in 2012. Gregory A. Harb - Supplemental Retirement of $16,819 is included in column E. This amount was earned in 2012. Oz Harmanli, MD - Supplemental Retirement of $12,282 is included in column E. This amount was earned in 2012. Thomas Higgins, MD - Supplemental Retirement of $31,158 is included in column E. This amount was earned in 2012. Kevin Hinchey, MD Supplemental Retirement of $4,922 is included in column E. This amount was earned in 2012. Mark K. Hirko, MD - Supplemental Retirement of $43,161 is included in column E. This amount was earned in 2012. Gordon Josephson, MD - Supplemental Retirement of $23,894 is included in column E. This amount was earned in 2012. Thomas Kaye, MD- Supplemental Retirement of $23,261 is included in column E. This amount was earned in 2012. Mark A. Keroack, MD- Supplemental Retirement of $3,994 is included in column E. This amount was earned in 2012. Aaron Kugelmass, MD- Supplemental Retirement of $30,943 is included in column E. This amount was earned in 2012. Benjamin Liptzin, MD - Supplemental Retirement of $29,220 is included in column E. This amount was earned in 2012. Gerda Maissel, MD Supplemental Retirement of $8,687 is included in column E. This amount was earned in 2012. Dennis Oh, MD - Supplemental Retirement of $19,083 is included in column E. This amount was earned in 2012. Neil Rathlev, MD Supplemental Retirement of $18,277 is included in column E. This amount was earned in 2012. David Refermat, MD Supplemental Retirement of $6,547 is included in column E. This amount was earned in 2012. Joseph Schmidt, MD - Supplemental Retirement of $5,057 is included in column E. This amount was earned in 2012. Clemens Schirmer, MD- Supplemental Retirement of $9,982 is included in column E. This amount was earned in 2012. Roy Sittig, MD - Supplemental Retirement of $7,668 is included in column E. This amount was earned in 2012. Sherry Taylor, MD Supplemental Retirement of $165,831 is included in column E. This amount consists of $38,072 earned in 2012 as well as $127,760 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. Mark R. Tolosky - Supplemental Retirement of $351,665 is included in column E. This amount was earned in 2012. Kelly Tyler, MD Supplemental Retirement of $7,085 is included in column E. This amount consists of $3,339 earned in 2012 as well as $3,746 non-vested amounts that were earned in the previous 4 years. Richard B. Wait, MD - Supplemental Retirement of $69293 is included in column E. This amount was earned in 2012. Supplemental Information Part III Schedule J, Part II Mr. Harb received $61,733 relating to relocation payments in 2012. Dr. Hirko received $100,000 relating to relocation and retention payments in 2012. Dr. Keroack received $101,687 relating to relocation and retention payments in 2012. Dr. Kugelmass received $300,000 relating to relocation and retention payments in 2012. American Excess Insurance Exchange (AEIX) Board Overlap 1384929 See Part V - Mark Tolosky, President of the filing organization is also Chairman of the Board of Directors of AEIX. The filing organization purchases general & professional liability insurance from AEIX. 0 Baycare Health Partners Inc (BHP) Common Board Members or Officers 5654998 See Part V - The filing organization received payments from BHP of $5,006,449 for patient care services for which BMP is the intermediary between the filing organization and third party payers. $112,730 for medical services and $535,810 for Healthcare Initiatives. BHP is an affiliate corporation of the filing organization. 0 Baycare Health Partners Inc (BHP) Common Board Members or Officers 103800 See Part V - The filing organization made payments to BHP for physician membership dues. BHP is an affiliate corporation of the filing organization. 0 Baystate Health Insurance Company Ltd (BHIC) Common Board Members or Officers 4636000 See Part V - The filing organization received payments from BHIC of $4,636,000 representing Retrospective pass-thru premiums. BHIC is an affiliate corporation of the filing organization. 0 Health New England Inc (HNE) Common Board Members or Officers 18189688 See Part V - The filing organization received $16,378,688 related to medical claims, $450,000 for medical consulting services and $1,361,000 in Surplus Sharing payments from HNE. HNE is an affiliate corporation of the filing organization. 0 Ingraham Corporation (IC) Common Board Members or Officers 530600 See Part V - The filing organization made payments to IC for rental of medical office space. IC is an affiliate corporation of the filing organization. 0 Form 990, Part VI, Section A, line 2 Dennis W. Chalke, Kristin R. Delaney, Gregory Harb, Gordon Josephson, MD, Mark A. Keroack, MD, MPH, Benjaman Liptzin, MD, Mohammed S. Ahmed, MD, Sara Rourke, MD, Scott Siege, MD and Mark R. Tolosky are also officers or trustees of Baystate Health, Inc. & its affiliated entities Form 990, Part VI, Section A, line 3 Baystate Medical Practices, Inc. is affiliated with Baystate Administrative Services, Inc.(BAS)which is a 501 (c)(3) organization that provides management support for the BH subsidiaries, including human resources, marketing, strategic planning, information services and financial services. Form 990, Part VI, Section A, line 6 The members of the filing organization are physicians, all of whom who have medical staff appointments at a Baystate Health, Inc. (BH) hospital affiliate, provide at least 1,000 hours of professional service annually on behalf of the filing organization, and are parties to a membership agreement with the filing organization approved by the Board of Directors. Form 990, Part VI, Section A, line 7a The Board of Directors consists of 21 Directors, seven of whom are either appointed by BH or serve ex officio based on positions they hold with BH, and 14 of whom are at large directors elected by the members of the filing organization. Form 990, Part VI, Section A, line 7b The bylaws of the filing organization provide that the following matters approved by the Board of Directors are also subject to the approval of BH: (1) the filing organization's annual budget, (2) the form and content of agreements with members and other employees of the filing organization for their compensation and benefits, (3) policies regarding personal time, sick time, leaves of absence, hours of work, and number of working days, (4) the establishment of reserves to meet any unusual expense, loss, or anticipated year-end expense or a discretionary fund to support the filing organization's educational and research programs, (5) any pledge of the filing organization's credit, the borrowing of any money, or the execution of any promissory note by the filing organization, (6) amendments to the bylaws of the filing organization, with the exception of certain technical amendments. Form 990, Part VI, Section B, line 11 Prior to the filing of this return appropriate parts of this Form 990 were reviewed by representatives from the Tax, Finance, and Human Resources Departments of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs), some of whom are officers or trustees of the filing organization and by outside legal counsel. The entire return was reviewed by a tax expert from an outside accounting firm. 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 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 key 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. (the parent organization of the health care system to which the filing organization belongs) and all such deliberations and decisions are documented contemporaneously. Form 990, Part VI, Section C, line 19 Form 990, Part VI, Section C, Line 19 The organization makes its conflict of interest policy and financial statements available to the public at www.baystatehealth.org. Articles of organization and bylaws are generally available at the Commonwealth of Massachusetts website. Form 990, Part VII, Section A, Line 5 Certain officers or trustees of the filing organization are paid by an entity,Baystate Administrative Services, Inc. (BAS) EIN 22-2747685, who is part of the health care system to which the filing organization belongs but one that does not meet the technical requirements as a "Related Organization" per Schedule R. Compensation from BAS 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Current year acquisitions to other entities 4,987,115. Transfer to/from affiliate, net 18,836,623. Minimum pension liability adjustment 19,489,755. rounding 3. Audit oversight and compilation of financial statements 990 Part XII, line 2c The process has not changed from the prior year.