2013-08-13T09:28:37-05:00 2012-09-30 346565596 Ernst & Young LLP 200 Clarendon Street Boston MA 02116 990 2011-10-01 042888373 Baystate Medical Practices Inc BAYS 4137940000 759 Chestnut Street Springfield MA 01199 Dennis W Chalke 4137943290 2013-08-13 1 Jeanne M Schuster P00743154 6172662000 2011 2016-02-24 21:20:13Z Dennis W Chalke 759 Chestnut Street Springfield MA 01199 220627492 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 multispecialty group practice of choice, known for exceptional service, quality, value, and academic leadership. 22 1 1505 1 796421 -281170 0 0 207309671 220624064 3831 3428 0 0 207313502 220627492 0 0 0 0 183877453 194094105 0 0 0 37273564 42203051 221151017 236297156 -13837515 -15669664 27863501 28870300 78100074 85819073 -50236573 -56948773 X To deliver excellent patient care, provide innovative medical education and pursue meaningful research. 0 0 221990492 219827643 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. 221990492 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 0 1 143 0 1 1505 1 1 1 0 0 0 0 0 0 0 0 0 X 22 1 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 Mark A Keroack MD MPH 10.00 X X 301105 0 80102 Benjamin Liptzin MD 10.00 X X 468250 0 66728 Dennis W Chalke 10.00 X X 672631 0 92548 Mohammed S Ahmed MD 1.00 X 357424 0 71815 Jeffrey Cossin MD 1.00 X 241162 0 66725 Wayne Duke MD 1.00 X 370515 0 69586 Daniel Grow MD 1.00 X 499464 0 52046 Gregory A Harb 1.00 X 584765 0 133003 Oz Harmanli MD 1.00 X 354868 0 57878 Thomas Higgins MD 1.00 X 488124 0 70011 Kevin Hinchey MD 1.00 X 289928 0 94876 Mark K Hirko MD 1.00 X 915128 0 63434 M Dale Janes 1.00 X 0 0 0 Laura M Pinkston Koenigs MD 1.00 X 207718 0 41003 Christie L Miller MD 1.00 X 214048 0 44644 Michael Picchioni MD 1.00 X 147112 0 56586 Sara Rourke MD 1.00 X 194491 0 22988 Joseph Schmidt MD 1.00 X 280761 0 57804 Scott Siege MD 1.00 X 182446 0 25095 Roy Sittig MD 1.00 X 309971 0 50471 Mark R Tolosky 1.00 X 1536640 0 99365 Richard Wait MD 1.00 X 804253 0 106456 Kristin R Delaney 1.00 X 94511 0 47834 Gordon Josephson MD 50.00 X 437277 0 66333 Aaron Kugelmass MD 50.00 X 739018 0 69668 Gerda Maissel MD 50.00 X 332156 0 145433 Sherry Taylor MD 50.00 X 688917 0 59203 Dennis Oh MD 50.00 X 659960 0 53984 Thomas Kaye MD 50.00 X 534072 0 44311 Marc J Schweiger MD 50.00 X 497990 0 156241 Clemens Schirmer MD 50.00 X 493861 0 32070 13898566 0 2098241 466 0 1 1 Baystate Administrative Services Inc 759 Chestnut Street Springfield MA 01199 Management services 4774001 Baystate Medical Center Inc 759 Chestnut Street Springfield MA 01199 Patient schedule svcs & rent 4534325 Radiology & Imaging Inc 1350 Main St 10th Floor Springfield MA 011031628 Physician contract services 668417 Baystate Franklin Medical Center 164 High Street Greenfield MA 01301 Rent 536864 Ingraham Corporation 759 Chestnut Street Springfield MA 01199 Rent 517434 29 Physician Practice Fee 621110 219827643 219827643 BRL Gainshare 900099 333449 333449 W.Brookfield profit/lo 900099 262349 262349 Medical Director Contr 900099 176804 176804 BMC Support 900099 23819 23819 220624064 3428 3428 220627492 219827643 796421 3428 8249549 8249549 158040531 152974356 5066175 10174523 9838511 336012 9360039 9058614 301425 8269463 8015644 253819 5173997 5173997 197150 197150 68400 68400 3440024 3208954 231070 168189 159780 8409 2313925 2247499 66426 109466 57213 52253 4787036 4547684 239352 276601 276601 425127 403869 21258 16181 16181 887592 843212 44380 9369839 7580388 1789451 Bad Debts 5760992 5760992 Purchased Svcs Clerical 3217759 3217759 Medical Supplies 2674734 2674734 Prof'l Exp Acct 1825644 1825644 1490395 1049489 440906 236297156 221990492 14306664 0 2818666 5131873 15028300 15717977 267375 192708 1144501 589104 17216268 14660952 3580781 2555316 5023878 4683322 27863501 28870300 25451203 29690550 387525 461756 52261346 55666767 78100074 85819073 X -50236573 -56948773 -50236573 -56948773 27863501 28870300 X -15669664 8957464 X 0 1 1 X 0 X 127231314 135989036 140855978 206929699 219827643 830833670 127231314 135989036 140855978 206929699 219827643 830833670 0 0 0 830833670 93647 46568 8640 3831 3428 156114 93647 46568 8640 3831 3428 156114 382925 309068 297439 379972 796421 2165825 127707886 136344672 141162057 207313502 220627492 833155609 0.99720 0.99710 0.00020 0.00040 X 1103927 415181 688746 1576240 1075809 500431 14536101 13169962 1366139 2555316 Due from Affiliated Companies 882179 Accounts Receivable, Other (net of MD loans) 3801143 4683322 Due to Affiliated Companies 7910663 Insurance IBNR Loss Reserves 7362420 Accrued Pension Cost 39483884 Line of credit, affiliate 909800 55666767 Description of Uncertain Tax Positions Under FIN 48: Part X: 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 1 0 0 0 0 0 0 Mark A Keroack MD MPH 245679 0 33750 0 21676 0 64800 0 15302 0 381207 0 0 0 Benjamin Liptzin MD 351598 0 59704 0 56948 0 41094 0 25634 0 534978 0 0 0 Dennis W Chalke 363180 0 131625 0 177826 0 58000 0 34548 0 765179 0 0 0 Mohammed S Ahmed MD 299673 0 38395 0 19356 0 41613 0 30202 0 429239 0 0 0 Jeffrey Cossin MD 194329 0 35678 0 11155 0 45076 0 21649 0 307887 0 0 0 Wayne Duke MD 286644 0 72162 0 11709 0 38256 0 31330 0 440101 0 0 0 Daniel Grow MD 392676 0 66780 0 40008 0 31149 0 20897 0 551510 0 0 0 Gregory A Harb 337108 0 180000 0 67657 0 108675 0 24328 0 717768 0 0 0 Oz Harmanli MD 265482 0 82697 0 6689 0 31108 0 26770 0 412746 0 0 0 Thomas Higgins MD 390033 0 68000 0 30091 0 49288 0 20723 0 558135 0 0 0 Kevin Hinchey MD 261466 0 18878 0 9584 0 73348 0 21528 0 384804 0 0 0 Mark K Hirko MD 531080 0 380878 0 3170 0 36125 0 27309 0 978562 0 0 0 Laura M Pinkston Koenigs MD 201715 0 103 0 5900 0 21972 0 19031 0 248721 0 0 0 Christie L Miller MD 202978 0 10446 0 624 0 23731 0 20913 0 258692 0 0 0 Michael Picchioni MD 138042 0 7761 0 1309 0 30613 0 25973 0 203698 0 0 0 Sara Rourke MD 175493 0 17971 0 1027 0 7635 0 15353 0 217479 0 0 0 Joseph Schmidt MD 247373 0 29824 0 3564 0 30118 0 27686 0 338565 0 0 0 Scott Siege MD 162464 0 19628 0 354 0 9114 0 15981 0 207541 0 0 0 Roy Sittig MD 273297 0 33823 0 2851 0 26648 0 23823 0 360442 0 0 0 Mark R Tolosky 696553 0 315856 0 524231 0 58633 0 40732 0 1636005 0 0 0 Richard Wait MD 588259 0 135540 0 80454 0 67800 0 38656 0 910709 0 0 0 Gordon Josephson MD 332901 0 71071 0 33305 0 46725 0 19608 0 503610 0 0 0 Aaron Kugelmass MD 550451 0 185168 0 3399 0 39673 0 29995 0 808686 0 0 0 Gerda Maissel MD 277948 0 34094 0 20114 0 128453 0 16980 0 477589 0 0 0 Sherry Taylor MD 667467 0 15000 0 6450 0 46689 0 12514 0 748120 0 0 0 Dennis Oh MD 520854 0 117476 0 21630 0 32532 0 21452 0 713944 0 0 0 Thomas Kaye MD 488359 0 40759 0 4954 0 16786 0 27525 0 578383 0 0 0 Marc J Schweiger MD 437353 0 8246 0 52391 0 129735 0 26506 0 654231 0 0 0 Clemens Schirmer MD 448388 0 44555 0 918 0 19782 0 12288 0 525931 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 $250 for 2011. 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, Lines 4b-c Line 4b: Mohammed Shafeeq Ahmed, MD - Supplemental Retirement of $18,342 is included in column E. This amount was earned in 2011. Dennis W. Chalke - Supplemental Retirement of $145,066 is included in column E. This amount was earned in 2011. Wayne Duke, MD - Supplemental Retirement of $10,474 is included in column E. This amount was earned in 2011. Daniel Grow, MD - Supplemental Retirement of $22,492 is included in column E. This amount was earned in 2011. Gregory A. Harb - Supplemental Retirement of $96,425 is included in column E. This amount was earned in 2011. Oz Harmanli, MD - Supplemental Retirement of $5,616 is included in column E. This amount was earned in 2011. Thomas Higgins, MD - Supplemental Retirement of $9,796 is included in column E. This amount was earned in 2011. Mark K. Hirko, MD - Supplemental Retirement of $20,200 is included in column E. This amount was earned in 2011. Gordon Josephson, MD - Supplemental Retirement of $23,507 is included in column E. This amount was earned in 2011. Thomas Kaye, MD- Supplemental Retirement of $861 is included in column E. This amount was earned in 2011. Mark A. Keroack, MD- Supplemental Retirement of $48,875 is included in column E. This amount was earned in 2011. Aaron Kugelmass, MD- Supplemental Retirement of $23,748 is included in column E. This amount was earned in 2011. Benjamin Liptzin, MD - Supplemental Retirement of $31,829 is included in column E. This amount was earned in 2011. Dennis Oh, MD - Supplemental Retirement of $20,282 is included in column E. This amount was earned in 2011. Joseph Schmidt, MD - Supplemental Retirement of $1,830 is included in column E. This amount was earned in 2011. Marc J. Schweiger, MD - Supplemental Retirement of $39,314 is included in column E. This amount was earned in 2011. Clemens Schirmer, MD- Supplemental Retirement of $9,982 is included in column E. This amount was earned in 2011. Roy Sittig, MD - Supplemental Retirement of $1,514 is included in column E. This amount was earned in 2011. Sherry Taylor, MD Supplemental Retirement of $27,089 is included in column E. . This amount was earned in 2011. Mark R. Tolosky - Supplemental Retirement of $332,054 is included in column E. This amount was earned in 2011. Richard B. Wait, MD - Supplemental Retirement of $70,642 is included in column E. This amount was earned in 2011. Line 4c: The supplemental retirement plan offered to Mr. Tolosky from 1997-2002 provided the right to purchase mutual fund shares at a specified price, with the rights expiring at the end of the 10 years. The 2011 compensation of $130,991 was based on the difference between the fair market value at the date of exercise and the exercise price. Supplemental Information Part III Part II Gregory A. Harb was a Director for the entire fiscal year, however his employment start date was 3/31/2011, therefore his compensation figures do not reflect an entire year of compensation. Mark A. Keroack, MD was the President and Chairman of the Board for the entire fiscal year, however his employment start date was 6/13/2011, therefore his compensation figures do not reflect an entire year of compensation. American Excess Insurance Exchange Board Overlap 1634565 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 2480780 See Part V - The filing organization received payments from BHP of $ 2,362,429 for patient care services for which BHP is the intermediary between the filing organization and third party payers and $118,351 for medical services. BHP is an affiliate corporation of the filing organization. 0 Baycare Health Partners Inc (BHP) Common Board Members or Officers 72600 See Part V - The filing organization made payments to BHP for physician membership dues. BHP is an affiliate corporation of the filing organization. 0 Greater Springfield IPA GSIPA Board Overlap 137475 See Part V - Benjamin Liptzin, MD, Board Member of the filing organization is also a Board Member of GSIPA. The filing organization made payments to GSIPA for physician membership dues. 0 Health New England Inc (HNE) Common Board Members or Officers 18352825 See Part V - The filing organization received payments from HNE of $17,752,825 related to medical claims and $600,000 for medical consulting services. HNE is an affiliate corporation of the filing organization. 0 Ingraham Corporation (IC) Common Board Members or Officers 514434 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 1 Baystate Medical Practices, Inc. is affiliated with Baystate Administrative Services, Inc. (BAS) which is a 501(c) (3) organization. Various management and support functions are delegated to BAS. Form 990, Part VI, Section A, line 2 Dennis W. Chalke, Kristin R. Delaney, Loring S. Flint, MD, M. Dale Janes, Hal B. Jenson, MD, Benjaman Liptzin, 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. Various management and supoport functions are delegated to BAS. 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. Average hours per week: Form 990, Part VII, Section A, Line 1a, Column (B) All individuals with compensation who have 10 average hours per week listed in Part VII, worked between 40 - 60 hours among all related entities. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Current year acquisitions to other entities -721,981. Transfer to/from affiliate, net 17,839,996. Minimum pension liability adjustment -8,160,548. rounding -3. Total to Form 990, Part XI, Line 5: 8,957,464.