2012-08-10T10:33:07-05:00 2011-09-30 Ernst & Young LLP 200 Clarendon Street Boston MA 02116 990 2010-10-01 042888373 Baystate Medical Practices Inc BAYS 4137940000 759 Chestnut Street Springfield MA 01199 Dennis W Chalke 4137943290 2012-08-10 1 Jeanne M Schuster 6172662000 2010 2016-02-24 21:20:13Z Dennis W Chalke 759 Chestnut Street Springfield MA 01199 207313502 0 X N/A 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. 20 1 1494 1 379972 -166430 0 0 141153417 207309671 1540 3831 7100 0 141162057 207313502 0 0 0 0 120070480 183877453 0 0 0 24609428 37273564 144679908 221151017 -3517851 -13837515 25611499 27863501 63122719 78100074 -37511220 -50236573 X To deliver excellent patient care, provide innovative medical education and pursue meaningful research. 0 0 208308510 206929699 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. 208308510 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 1 0 1 0 0 0 0 0 0 0 0 0 0 1 166 0 1 1494 1 1 1 0 0 0 0 0 0 0 0 0 X 20 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 Loring S Flint MD 10.00 X X 1511683 0 77581 Gordon W Josephson MD 10.00 X X 431735 0 94658 Mark A Keroack MD MPH 10.00 X X 0 0 0 Benjamin Liptzin MD 1.00 X X 478869 0 114595 Dennis W Chalke 1.00 X X 564783 0 51532 Mohammed Shafeeq Ahmed MD 1.00 X 443029 0 52099 Jeffrey Cossin MD 1.00 X 220538 0 82621 Wayne Duke MD 1.00 X 330128 0 56329 Daniel Grow MD 1.00 X 467572 0 53838 Gregory A Harb 1.00 X 0 0 0 Thomas Higgins MD 1.00 X 331268 0 17625 Mark K Hirko MD 1.00 X 565310 0 57159 M Dale Janes 1.00 X 0 0 0 Hal B Jenson MD 1.00 X 497497 0 46780 Laura Koenigs MD 1.00 X 129005 0 51572 Harvey Lederman MD 1.00 X 134559 0 49545 David L Longworth MD 1.00 X 523345 0 59071 Christie L Miller MD 1.00 X 214299 0 45710 Michael Picchioni MD 1.00 X 192008 0 40825 Joseph Schmidt MD 1.00 X 258160 0 53355 Joseph Shin MD 1.00 X 475718 0 33503 Scott Siege MD 1.00 X 150850 0 22898 Roy Sittig MD 1.00 X 252911 0 44487 Mark R Tolosky 1.00 X 1638402 0 112208 Kristin R Delaney 1.00 X 92401 0 29700 Richard B Wait MD 50.00 X 812133 0 85718 Dennis Oh MD 50.00 X 671460 0 50692 Sherry Taylor MD 50.00 X 662257 0 55514 Aaron Kugelmass MD 50.00 X 601967 0 70248 Mark Bean MD 50.00 X 578163 0 62138 Marc J Schweiger MD 50.00 X 501754 0 95413 13731804 0 1667414 415 0 1 0 Baystate Administrative Services Inc 759 Chestnut Street Springfield MA 01199 Management services 4068157 Baystate Medical Center Inc 759 Chestnut Street Springfield MA 01199 Patient schedule svcs & rent 3900926 Radiology & Imaging Inc 1350 Main St 10th Floor Springfield MA 011031628 Physician contract services 579188 Ingraham Corporation 759 Chestnut Street Springfield MA 01199 Rent 530394 Catuogno Court Reporting & Sten-Tel Tran One Monarch Place Ste 600 Springfield MA 01144 Transcription services 342005 21 Physician Practice Fee 621110 206929699 206929699 BRL Gainshare 900099 354639 354639 BMC Support 900099 25333 25333 207309671 3831 3831 207313502 206929699 379972 3831 6307185 6307185 151183190 146132827 5050363 8717645 8416482 301163 9659217 9334043 325174 8010216 7751660 258556 5138114 5138114 290989 290989 75196 75196 3520513 3259674 260839 187435 178063 9372 2222879 2058218 164661 78132 56740 21392 4554272 4326558 227714 279942 279942 305966 290668 15298 6892 6892 1001389 951320 50069 6711102 6592164 118938 Bad Debts 4501371 4501371 Purchased Svcs Clerical 2748762 2748762 Medical Supplies 2264598 2264598 Prof'l Exp Acct 1824272 1824272 Minor Equipment 367787 364543 3244 1193953 669420 524533 221151017 208308510 12842507 0 5140408 2818666 14099095 15028300 251666 267375 350106 1144501 18876558 15295777 3632498 3580781 2137726 5023878 25611499 27863501 20651837 25451203 109374 387525 42361508 52261346 63122719 78100074 X -37511220 -50236573 -37511220 -50236573 25611499 27863501 X -13837515 1112162 X 0 1 1 X 0 X 120783166 127231314 135989036 140855978 206929699 731789193 120783166 127231314 135989036 140855978 206929699 731789193 0 0 0 731789193 134321 93647 46568 8640 3831 287007 134321 93647 46568 8640 3831 287007 464754 382925 309068 297439 379972 1834158 121382241 127707886 136344672 141162057 207313502 733910358 0.99710 0.99660 0.00040 0.00060 X 1103927 405258 698669 1086609 1076116 10493 16686022 13814403 2871619 3580781 Due from Affiliated Companies 692537 Accounts Receivable, Other (net of MD loans) 4331341 5023878 Due to Affiliated Companies 11133252 Insurance IBNR Loss Reserves 6397108 Accrued Pension Cost 33728009 Line of credit, affiliate 1002977 52261346 Schedule D, Part X, Line 2: Baystate Medical Practices, Inc. does not have a FIN 48 footnote included in its audited financial statements. 0 1 1 0 0 0 0 0 0 Loring S Flint MD 917432 0 360152 0 234099 0 48361 0 29220 0 1589264 0 0 0 Gordon W Josephson MD 327583 0 75030 0 29122 0 77000 0 17658 0 526393 0 0 0 Benjamin Liptzin MD 346076 0 74600 0 58193 0 85957 0 28638 0 593464 0 0 0 Dennis W Chalke 315800 0 113223 0 135760 0 23333 0 28199 0 616315 0 0 0 Mohammed Shafeeq Ahmed MD 338151 0 79280 0 25598 0 22484 0 29615 0 495128 0 0 0 Jeffrey Cossin MD 183601 0 27056 0 9881 0 57000 0 25621 0 303159 0 0 0 Wayne Duke MD 250974 0 69019 0 10135 0 26843 0 29486 0 386457 0 0 0 Daniel Grow MD 369607 0 56175 0 41790 0 32995 0 20843 0 521410 0 0 0 Thomas Higgins MD 274258 0 33600 0 23410 0 0 0 17625 0 348893 0 0 0 Mark K Hirko MD 475702 0 72375 0 17233 0 31225 0 25934 0 622469 0 0 0 Hal B Jenson MD 350775 0 76279 0 70443 0 15925 0 30855 0 544277 0 36156 0 Laura Koenigs MD 122210 0 5629 0 1166 0 26993 0 24579 0 180577 0 0 0 Harvey Lederman MD 92092 0 42410 0 57 0 34847 0 14698 0 184104 0 0 0 David L Longworth MD 403396 0 82285 0 37664 0 29916 0 29155 0 582416 0 0 0 Christie L Miller MD 206612 0 0 0 7687 0 20007 0 25703 0 260009 0 0 0 Michael Picchioni MD 187328 0 4097 0 583 0 20609 0 20216 0 232833 0 0 0 Joseph Schmidt MD 228325 0 23955 0 5880 0 27332 0 26023 0 311515 0 0 0 Joseph Shin MD 384184 0 89627 0 1907 0 21915 0 11588 0 509221 0 0 0 Scott Siege MD 140545 0 10000 0 305 0 7765 0 15133 0 173748 0 0 0 Roy Sittig MD 236319 0 15301 0 1291 0 21917 0 22570 0 297398 0 0 0 Mark R Tolosky 680614 0 380604 0 577184 0 73034 0 39174 0 1750610 0 0 0 Richard B Wait MD 580265 0 149472 0 82396 0 48820 0 36898 0 897851 0 0 0 Dennis Oh MD 510986 0 137500 0 22974 0 33878 0 16814 0 722152 0 0 0 Sherry Taylor MD 655807 0 0 0 6450 0 43575 0 11939 0 717771 0 0 0 Aaron Kugelmass MD 494696 0 104329 0 2942 0 41725 0 28523 0 672215 0 0 0 Mark Bean MD 507073 0 61921 0 9169 0 35800 0 26338 0 640301 0 0 0 Marc J Schweiger MD 428237 0 22562 0 50955 0 70039 0 25374 0 597167 0 0 0 Part I, Lines 4b-c Mohammed Shafeeq Ahmed, MD - Supplemental Retirement of $23,789 is included in column E. This amount was earned in 2010. Dennis W. Chalke - Supplemental Retirement of $109,384 is included in column E. This amount was earned in 2010. Wayne Duke, MD - Supplemental Retirement of $7,677 is included in column E. This amount was earned in 2010. Loring S. Flint, MD - Supplemental Retirement of $142,221 is included in column E. This amount was earned in 2010. Daniel Grow, MD - Supplemental Retirement of $25,530 is included in column E. This amount was earned in 2010. Thomas Higgins, MD - Supplemental Retirement of $9,508 is included in column E. This amount was earned in 2010. Mark K. Hirko, MD - Supplemental Retirement of $15,300 is included in column E. This amount was earned in 2010. Hal B. Jenson, MD - Supplemental Retirement of $64,083 is included in column E. This amount was earned in 2010. Gordon Josephson, MD - Supplemental Retirement of $24,243 is included in column E. This amount was earned in 2010. Aaron Kugelmass, MD- Supplemental Retirement of $25,800 is included in column E. This amount was earned in 2010. Benjamin Liptzin, MD - Supplemental Retirement of $33,502 is included in column E. This amount was earned in 2010. David L. Longworth, MD- Supplemental Retirement of $33,629 is included in column E. This amount was earned in 2010. Keith C. McLean Shinaman - Supplemental Retirement of $60,038 is included in column E. This amount was earned in 2010. Dennis Oh, MD - Supplemental Retirement of $21,628 is included in column E. This amount was earned in 2010. Joseph Schmidt, MD - Supplemental Retirement of $1,456 is included in column E. This amount was earned in 2010. Marc J. Schweiger, MD - Supplemental Retirement of $43,732 is included in column E. This amount was earned in 2010. Joseph Shin, MD- Supplemental Retirement of $9,664 is included in column E. This amount was earned in 2010. Roy Sittig, MD - Supplemental Retirement of $789 is included in column E. This amount was earned in 2010. Sherry Taylor, MD Supplemental Retirement of $27,649 is included in column E. . This amount was earned in 2010. Mark R. Tolosky - Supplemental Retirement of $418,714 is included in column E. This amount was earned in 2010. Richard B. Wait, MD - Supplemental Retirement of $73,780 is included in column E. This amount was earned in 2010. 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 2010 compensation of $102,413 was based on the difference between the fair market value at the date of exercise and the exercise price. Supplemental Information Part III Schedule J, Part 1, 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 II Dr. Flint terminated employment effective 12/30/2010. The compensation numbers include various one time termination payments. American Excess Insurance Exchange Board Overlap 1541099 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 2272041 See Part V - The filing organization received payments from BHP of $ 2,130,950 for patient care services for which BHP is the intermediary between the filing organization and third party payers and $141,901 for medical services. BHP is an affiliate corporation of the filing organization. 0 Baycare Health Partners Inc (BHP) Common Board Members or Officers 97800 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 63932 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 19810887 See Part V - The filing organization received payments from HNE of $19,774,709 related to medical claims, $32,082 for medical consulting services and $4,096 for patient related reimbursements. HNE is an affiliate corporation of the filing organization. 0 Ingraham Corporation (IC) Common Board Members or Officers 530394 See Part V - The filing organization made payments to IC for rent 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, 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 support functions are delegated to BAS. Form 990, Part VI, Section A, line 6 The Board of Directors consists of 20 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 7a 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 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 acquisition from BHF 8,657. Minimum pension liability adj -10,111,281. Transfers from/to affiliates, net 11,214,786. Total to Form 990, Part XI, Line 5: 1,112,162.