2014-08-08T14:34:23-05:00 2013-09-30 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2012-10-01 222747685 Baystate Administrative Services Inc BAYS 4137940000 759 Chestnut Street Springfield MA 011990001 Dennis W Chalke 4137945740 2014-08-08 1 Christine Kawecki P00743140 5169187000 2012 2015-11-30 17:44:51Z Dennis W Chalke 759 Chestnut Street Springfield MA 011990001 95004372 0 X www.baystatehealth.org X 1986 MA To improve the health of the people in our communities every day with quality and compassion 7 0 559 0 596025 0 0 0 92270721 94135222 323571 473111 30320 396039 92624612 95004372 0 0 0 0 56011441 56812708 0 0 0 36195823 38508642 92207264 95321350 417348 -316978 42285246 40141818 61867093 52643724 -19581847 -12501906 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 26605760 40870332 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. 50779986 53042080 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. 77385746 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 1 226 0 1 559 1 1 1 0 0 0 0 0 0 0 0 0 0 X 7 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 R Tolosky 1.00 49.00 X X 1555044 0 59300 Dennis W Chalke 1.00 49.00 X X 723685 0 52277 Donna J Ross 10.00 40.00 X X 465764 0 54302 Evan Benjamin MD FACP 10.00 40.00 X 543637 0 55276 Gregory A Harb 10.00 40.00 X 799614 0 161885 Mark A Keroack MD 1.00 49.00 X 814375 0 135233 Paula C Squires 10.00 40.00 X 469331 0 36978 Gordon Josephson MD 1.00 49.00 X 440372 0 56941 Kristin R Delaney 1.00 49.00 X 98119 0 19540 Joel L Vengco 40.00 10.00 X 338454 0 22706 Charles D Gijanto 1.00 49.00 X 440593 0 104270 Kevin Hinchey MD 40.00 10.00 X 393233 0 66443 Neil Kudler MD 40.00 10.00 X 312639 0 50058 Peter A Lyons 40.00 10.00 X 277501 0 51818 Lawrence G Emerson 40.00 10.00 X 272162 0 65759 Keith C McLean-Shinaman 0.00 X 298986 0 10208 8243509 0 1002994 129 1 1 0 Cerner Corporation 2800 Rockcreek Pkwy Kansas City MO 641172521 Computer Services 3270949 Siemens Medical Solutions USA PO Box 120001 Dallas TX 753120733 Medical Equipment 1920208 Cornerstone Relocation Group 106 Allen Road Basking Ridge NJ 07920 Recruitment/Relocation 1721593 Philips Medical Systems PO Box 100355 Atlanta GA 303840355 Medical Equipment 1481724 Bulkley Richardson & Gelinas 1500 Main St Suite 2700 Springfield MA 011155507 Legal Services 1322329 88 Affiliate Support 561000 94135222 93539197 596025 94135222 409597 409597 63514 0 63514 63514 63514 Electronic Medical Records 541511 338574 338574 Diversity Conference 611430 25180 25180 Mini Med School 611600 12595 12595 19690 19690 396039 95004372 93935236 596025 473111 7212026 5763130 1448896 39637255 31631615 8005640 3091914 2470958 620956 3734132 3032582 701550 3137381 2507250 630131 1329683 1329683 3688301 1685038 2003263 1611571 1435837 175734 2361422 2224675 136747 21101931 20442451 659480 1211667 1000263 211404 536460 369710 166750 1017367 583793 433574 139191 114903 24288 199301 161933 37368 Recruitment 1550405 1382695 167710 Temporary Help 325065 280624 44441 Dues & Memberships 16649 16649 0 3419629 2281640 1137989 95321350 77385746 17935604 0 5794 985106 24346309 16120551 1127197 889973 157945 117048 6905739 9149853 5344345 4872990 411474 471355 9330788 12407932 42285246 40141818 24802687 24534799 37064406 28108925 61867093 52643724 X -19581847 -12501906 -19581847 -12501906 42285246 40141818 X -316978 -545555 7942474 X 0 1 X 0 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 74806543 Baystate Franklin Medical Ctr 042103575 3 0 1 1 7749838 Baystate Mary Lane Hospital Corp 042103584 3 0 1 1 1212049 Visiting Nurse Association & Hospice of WNE Inc 042105803 9 0 1 1 1788223 Baystate Medical Practices Inc 042888373 9 0 1 1 4958375 Baystate Health Foundation Inc 043549011 7 0 1 1 45000 7 92429810 0 1 0 0 0 0 1 350341 0 0 350341 0 Part IV, Supplemental Information: The amount recorded on Part II-B, line 1j represents BAS salaries and operating expenses as reported on Massachusetts Public Records Division Lobbyist Disclosures for activities related to healthcare policy, bills and appropriations-related activities. 518342 461496 56846 3454057 3039548 414509 1371946 1371946 0 471355 Due from affiliated companies 12407932 12407932 Due to affiliated companies 18982359 Total accrued pension cost 2096479 Total minimum pension liability 7030087 28108925 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, 2013. X X X 1 1 1 1 0 0 0 0 0 0 0 Mark R Tolosky 697835 0 441536 0 415673 0 28089 0 31211 0 1614344 0 0 0 Dennis W Chalke 365785 0 155550 0 202350 0 28000 0 24277 0 775962 0 0 0 Donna J Ross 270000 0 109161 0 86603 0 49814 0 4488 0 520066 0 0 0 Evan Benjamin MD FACP 326944 0 112718 0 103975 0 35452 0 19824 0 598913 0 0 0 Gregory A Harb 444085 0 236430 0 119099 0 139147 0 22738 0 961499 0 0 0 Mark A Keroack MD 446725 0 170955 0 196695 0 119597 0 15636 0 949608 0 0 0 Paula C Squires 274686 0 98362 0 96283 0 16250 0 20728 0 506309 0 0 0 Gordon Josephson MD 334491 0 72386 0 33495 0 40575 0 16366 0 497313 0 0 0 Joel L Vengco 180302 0 128000 0 30152 0 13000 0 9706 0 361160 0 0 0 Charles D Gijanto 314191 0 82496 0 43906 0 80649 0 23621 0 544863 0 0 0 Kevin Hinchey MD 311222 0 63375 0 18636 0 41376 0 25067 0 459676 0 0 0 Neil Kudler MD 213393 0 82282 0 16964 0 34302 0 15756 0 362697 0 0 0 Peter A Lyons 207428 0 51040 0 19033 0 28167 0 23651 0 329319 0 0 0 Lawrence G Emerson 209389 0 49195 0 13578 0 54000 0 11759 0 337921 0 0 0 Keith C McLean-Shinaman 0 0 0 0 298986 0 0 0 10208 0 309194 0 0 0 Part I, Line 1a 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 Baystate Health, Inc., a related organization and the parent organization of the health care system to which the filing system 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. 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, 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: Evan Benjamin, MD - Supplemental Retirement of $92,471 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. Lawrence Emerson - Supplemental Retirement of $1,832 is included in column E. This amount was earned in 2012. Charles Gijanto - Supplemental Retirement of $15,378 is included in column E. This amount consists of $6,341 that was earned in 2012 as well as $9,037 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. Gregory A. Harb - Supplemental Retirement of $16,819 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. Gordon Josephson, MD - Supplemental Retirement of $23,894 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. Neil Kudler, MD Supplemental Retirement of $6,032 is included in column E. This amount was earned in 2012. Peter A. Lyons - Supplemental Retirement of $4,944 is included in column E. This amount was earned in 2012. Donna Ross- Supplemental Retirement of $74,306 is included in column E. This amount was earned in 2012. Paula Squires - Supplemental Retirement of $68,053 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. Part II Gregory A. Harb received $61,733 relating to relocation payments in 2012. Mark A. Keroack, MD received $101,687 relating to relocation payments in 2012. Supplemental Information Part III Baycare Health Partners Inc (BHP) Common Board Members or Officers 234354 See Part V - The filing organization received payments of $234,354 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 114098 See Part V - The filing organization received payments of $14,098 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 17844575 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 12858232 See Part V - The filing organization made payments of $52,000 representing payments for Retrospective pass-thru premiums and $12,806,232 in 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 Dennis W. Chalke, Kristin R. Delaney, Gregory Harb, Gordon Josephson, MD, Mark A. Keroack, MD, Donna J.Ross and Mark R. Tolosky are also officers or trustees of Baystate Health, Inc. & its affiliated entities. 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 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 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Pension Adjustment 7,943,472. rounding -998. 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 Health 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 Health New England Inc Monarch Place Suite 1500 Springfield MA 011441500 042864973 HMO/Insurance MA Baystate Health Inc C 0 HNE Advisory Services Monarch Place Suite 1500 Springfield MA 011441500 043012347 Administrative Svs MA Health New England Inc C 0 Health New England Insurance Monarch Place Suite 1500 Springfield MA 011441500 043183019 Ancilliary Insurance MA Health New England Inc C 0 Health New England of Connecticut Monarch Place Suite 1500 Springfield MA 011441500 061398662 Dormant MA Health New England Inc C 0 Ingraham Corporation 759 Chestnut Street Springfield MA 01199 043016257 Health care and other business activities MA Baystate Health Inc C 0 Baystate Health 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 Baystate Medical Center K accrual Baystate Medical Center L accrual Baystate Medical Center M accrual Baystate Franklin Medical Center L accrual Baystate Mary Lane Hospital L accrual Baystate Visiting Nurse & Hospice L accrual Baystate Health Inc L accrual Ingraham Corporation L accrual Baystate Health Insurance Co P cash Baystate Health Insurance Co Q cash Health New England Inc L accrual Health New England Inc Q cash BHS Health & Welfare Benefit Trust P cash