2011-08-10T15:25:59-05:00 2010-09-30 Ernst & Young LLP 200 Clarendon Street Boston MA 02116 990 2009-10-01 222747685 Baystate Administrative Services Inc BAYS 4137947872 759 Chestnut Street Springfield MA 011990001 Dennis W Chalke 4137945740 2011-08-10 1 Ernst Young LLP 6172662000 2009 2016-02-24 21:20:13Z Dennis W Chalke 759 Chestnut Street Springfield MA 011990001 87376581 0 X www.baystatehealth.org X 1986 MA To improve the health of the people in our communities every day with quality and compassion 8 0 530 0 641025 0 0 87276658 87269990 101233 68603 48258 37988 87426149 87376581 0 0 53260957 53682358 0 0 32272154 34517990 85533111 88200348 1893038 -823767 34789274 34060151 51881353 47691073 -17092079 -13630922 The purpose of the organization 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 31877706 41262688 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. 45681208 45472868 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. 77558914 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 1 259 0 1 530 1 1 1 0 0 0 0 0 0 0 0 0 8 0 1 0 1 0 1 1 0 1 1 0 0 1 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 10.00 X X 1803826 0 104518 Keith C McLean-Shinaman 10.00 X X 753809 0 152022 Loring S Flint Jr MD 10.00 X X 879897 0 92113 Evan Benjamin MD FACP 10.00 X 0 411471 51425 Dennis W Chalke 10.00 X 336282 0 59584 Hal B Jenson MD MBA 10.00 X 444075 0 54428 Donna J Ross 10.00 X 414049 0 66595 Paula C Squires 10.00 X 374946 0 120287 Kristin R Delaney 10.00 X 87909 0 27679 Mark B Gorrell 60.00 X 375179 0 54938 Patricia Hannon 60.00 X 573116 0 96086 Gordon Josephson MD 60.00 X 449997 0 97227 Charles D Gijanto 60.00 X 317509 0 94044 Joan Sullivan 60.00 X 305137 0 52379 Neil Kudler MD 60.00 X 274504 0 49677 Michael J Daly 0.00 X 1074605 0 0 8464840 411471 1173002 100 1 1 1 Cerner Corporation 2800 Rockcreek Pkwy Kansas City MO 641172521 Computer Services 2465752 Siemens Medical Solutions Dept at 40565 Atlanta GA 311920065 Equipment Maintenance 1831074 Prudential Insurance Company PO Box 101241 Atlanta GA 303921241 Life Insurance 1360734 Towers Watson PO Box 8500 Suite 6110 Philadelphia PA 191786110 Legal/Consulting Services 1188093 Fidelity Security Life Ins PO Box 632530 Cincinnati OH 452632530 Visioncare Insurance 1097959 78 Affiliate Support 561000 86628965 86628965 641025 641025 87269990 68603 68603 Mini Med School 561000 17867 17867 Miscellaneous 561000 15621 15621 Health Services Tufts 561000 4500 4500 37988 87376581 86666953 641025 68603 6202136 6202136 36859142 36024204 834938 3146532 3020577 125955 4542414 4087558 454856 2932134 2493730 438404 1153942 1027437 126505 229651 229651 23000 23000 2900311 2639010 261301 1413578 1258655 154923 2097602 1984281 113321 20203527 20083706 119821 1231443 1110977 120466 463715 335417 128298 1012722 571645 441077 130439 116139 14300 151376 129941 21435 Miscellaneous 2847502 2294615 552887 Recruitment 468687 253115 215572 Temporary Help 161415 98827 62588 Dues & Memberships 29080 29080 88200348 77558914 10641434 0 577871 534454 21711501 17515378 288708 391046 279452 241702 4957466 6396576 4903069 4533190 478992 369879 6495284 8611116 34789274 34060151 22316919 20995978 29564434 26695095 51881353 47691073 X -17092079 -13360922 -17092079 -13630922 34789274 34060151 X 0 1 1 X 0 X X X 0 0 0 Baystate Health Inc 042105941 11(a) 1 1 1 0 Baystate Medical Center Inc 042790311 7 0 1 1 0 Baystate Franklin Medical Ctr 042103575 7 0 1 1 0 Baystate Mary Lane Hospital Corp 042103584 7 0 1 1 0 Visiting Nurse Association & Hospice of WNE Inc 042105803 7 0 1 1 0 5 0 Schedule A, Part IV, Supplemental Information: Schedule A, part I, line h(vii) BAS provides management, administrative, and professional services to support the organizations listed on line h(i). 0 1 0 0 0 0 1 168997 0 0 168997 0 4903069 4533190 369879 369879 Due from affiliated companies 8611116 8611116 Due to affiliated companies 13781263 Total accrued pension cost 2133025 Total minimum pension liability 10780807 26695095 No FIN48 footnote was included in the consolidated audited financial statements of Baystate Health, Inc. and Subsidiaries for the year ended September 30, 2010. 0 0 0 0 X Central America and the Caribbean 34500 Medications and medical supplies for Haitian disaster relief FMV 1 X X X X 1 1 X X X 0 1 1 0 0 0 0 0 0 Mark R Tolosky 668117 0 446775 0 688934 0 67614 0 36904 0 1908344 0 127326 0 Keith C McLean-Shinaman 367882 0 181104 0 204823 0 116742 0 35280 0 905831 0 50922 0 Loring S Flint Jr MD 448201 0 203326 0 228370 0 65764 0 26349 0 972010 0 52636 0 Evan Benjamin MD FACP 0 278921 0 94465 0 38085 0 35158 0 16267 0 462896 0 13818 Dennis W Chalke 229098 0 67920 0 39264 0 36667 0 22917 0 395866 0 8859 0 Hal B Jenson MD MBA 351949 0 84113 0 8013 0 28299 0 26129 0 498503 0 0 0 Donna J Ross 240935 0 96750 0 76364 0 45152 0 21443 0 480644 0 14049 0 Paula C Squires 262432 0 101475 0 11039 0 96280 0 24007 0 495233 0 0 0 Mark B Gorrell 260930 0 88523 0 25726 0 35170 0 19768 0 430117 0 12616 0 Patricia Hannon 257851 0 166320 0 148945 0 74811 0 21275 0 669202 0 28169 0 Gordon Josephson MD 323523 0 80087 0 46387 0 71275 0 25952 0 547224 0 21704 0 Charles D Gijanto 243235 0 64312 0 9962 0 73856 0 20188 0 411553 0 0 0 Joan Sullivan 225130 0 60950 0 19057 0 35768 0 16611 0 357516 0 4864 0 Neil Kudler MD 232345 0 26583 0 15576 0 28972 0 20705 0 324181 0 3315 0 Michael J Daly 0 0 0 0 1074605 0 0 0 0 0 1074605 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. 3. Club Dues - Several officers and/or key employees were provided with payment for dinner club dues for which the personal use did not exceed $300 for 2009, for any individual. The three 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, Lines 4b-c: Evan Benjamin, MD - Supplemental Retirement of $25,836 is included in column E. This amount consists of $12,018 earned in 2009 as well as $13,818 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Dennis W. Chalke - Supplemental Retirement of $15,618 is included in column E. This amount consists of $6,759 earned in 2009 as well as $8,859 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Loring S. Flint, MD - Supplemental Retirement of $191,414 is included in column E. This amount consists of $138,778 earned in 2009 as well as $52,636 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Mark B. Gorrell - Supplemental Retirement of $23,432 is included in column E. This amount consists of $10,816 earned in 2009 as well as $12,616 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Patricia Hannon - Supplemental Retirement of $116,149 is included in column E. This amount consists of $87,979 earned in 2009 as well as $28,169 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Hal B. Jenson, MD - Supplemental Retirement of $11,399 is included in column E. This amount was earned in 2009. Gordon Josephson, MD - Supplemental Retirement of $41,309 is included in column E. This amount consists of $19,604 earned in 2009 as well as $21,704 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Neil Kudler, MD - Supplemental Retirement of $5,130 is included in column E. This amount consists of $1,815 earned in 2009 as well as $3,315 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Keith C. McLean Shinaman - Supplemental Retirement of $192,048 is included in column E. This amount consists of $141,126 earned in 2009 as well as $50,922 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Donna Ross- Supplemental Retirement of $48,748 is included in column E. This amount consists of $34,699 earned in 2009 as well as $14,049 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Paula Squires - Supplemental Retirement of $79,380 is included in column E. This amount was earned in 2009. Joan Sullivan - Supplemental Retirement of $7,928 is included in column E. This amount consists of $3,064 earned in 2009 as well as $4,864 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. Mark R. Tolosky - Supplemental Retirement of $547,851 is included in column E. This amount consists of $420,526 earned in 2009 as well as $127,326 that was earned in 2008 and previously reported last year, and now included again in accordance with new reporting requirements. 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 2009 compensation of $85,283 was based on the difference between the fair market value at the date of exercise and the exercise price. The supplemental retirement plan offered to Mr. Daly 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 2009 compensation of $1,074,605 was based on the difference between the fair market value at the date of exercise and the exercise price. Supplemental Information Part III Part 1, Line 3 Baystate Health, Inc., a related organization and 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 official. American Excess Insurance Exchange Board Overlap 8439 Schedule O - 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 234354 Schedule O - The filing organization received payments from BHP for management and administrative services. BHP is an affiliate corporation of the filing organization. 0 Health New England (HNE) Common Board Members or Officers 331207 Schedule O - The filing organization received payments from HNE of $261,207 for reimbursement of benefits related expenses and $70,000 for management and administrative support. HNE is an affiliate corporation of the filing organization. 0 Ingraham Corporation (IC) Common Board Members or Officers 336671 Schedule O - The filing organization received payments from IC for management, administrative and information systems services. IC 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 Baystate 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, Loring S. Flint, MD, Hal B. Jenson, MD, Keith C. McLean-Shinaman, Donna J.Ross and Mark R. Tolosky are also officers or trustees of Baystate Health, Inc. & its affiliated entities. Form 990, Part VI, Section A, line 4 The filing organization amended its corporate bylaws to change the composition of the Board of Directors by (1) removing the ex-officio appointment of the Senior Vice President - Healthcare Operations/Baystate Health, Inc. and the Senior Vice President of Academic Affairs/BH, (2) adding the ex-officio appointments of the Senior Vice President - Healthcare Quality/BH and the Executive Vice President and Chief Operating Officer of BH, and (3) revising the titles of three other ex-officio positions serving on the Board. The filing organization approved and adopted the Baystate Health, Inc. Conflict of Interest Policy, Joint Venture Policy, Record Retention Policy and Whistleblower Policy as policies of the filing organization. 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 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. Form 990, Part VII, Section A, Line 1a, Column (B) Average hours per week: All individuals with compensation who have 10 average hours per week listed in Part VII, worked between 40 - 60 hours among all related entities. Form 990, Part VII, Section A, Line 5 Certain officers or trustees of the filing organization are paid by an entity (Baystate Medical Practices, Inc. 04-2888373) 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 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. Baystate Affiliated Practice Organization Inc 759 Chestnut Street Springfield MA 01199 043124541 Clinical Services MA 501 (c ) (3) 9 Baystate Health Inc Baystate Franklin Medical Center 164 High Street Greenfield MA 01301 042103575 Hospital MA 501 (c ) (3) 3 Baystate Health Inc Baystate Health Foundation Inc 759 Chestnut Street Springfield MA 01199 043549011 Fundraising MA 501 (c ) (3) 7 Baystate Health Inc 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 Baystate Health Inc 759 Chestnut Street Springfield MA 01199 042105941 Healthcare System Parent MA 501 (c ) (3) 7 Baystate Health Inc Baystate Mary Lane Hospital Corporation 85 South Street Ware MA 01082 042103584 Hospital MA 501 (c ) (3) 3 Baystate Health Inc Baystate Medical Center Inc 759 Chestnut Street Springfield MA 01199 042790311 Acute Care Teaching Hospital MA 501 (c ) (3) 3 Baystate Health Inc 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 Baystate Vascular Services Inc 759 Chestnut Street Springfield MA 01199 260193173 Clinical Services MA 501 (c ) (3) 9 Baystate Health Inc BH Insurance Company Ltd North Church Street Georgetown CJ 980421413 Offshore captive Insurance CJ Baystate Health Inc 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 Health New England Inc Monarch Place Suite 1500 Springfield MA 011441500 042864973 HMO/Insurance MA Baystate Health Inc C HNE Advisory Services Monarch Place Suite 1500 Springfield MA 011441500 043012347 Administrative Svs MA Health New England Inc C Health New England Insurance Monarch Place Suite 1500 Springfield MA 011441500 043183019 Ancilliary Insurance MA Health New England Inc C Health New England of Connecticut Monarch Place Suite 1500 Springfield MA 011441500 061398662 Dormant MA Health New England Inc C Ingraham Corporation 759 Chestnut Street Springfield MA 01199 043016257 Health care and other business activities MA Baystate Health Inc C Baystate Health System Ambulance Inc 759 Chestnut Street Springfield MA 01199 043018550 Ambulance Svs MA Ingraham Corporation C 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 Baystate Medical Center J 1100117 Baystate Medical Center K 67920323 Baystate Medical Center L 63515 Baystate Franklin Medical Center K 7553564 Baystate Mary Lane Hospital K 1530833 Baystate Visiting Nurse & Hospice K 1815838 Baystate Health Inc K 1869782 Baystate Affiliated Practice K 1017885 Baystate MedicalEducational Research Foundation K 4170579 Baystate MedicalEducational Research Foundation L 107102 Baystate Health Foundation B 90 Baystate Health Foundation L 1153942 Baystate Health Foundation P 20 Baystate Vascular Services K 56943 Ingraham Corporation K 336671 Baystate Health Insurance Co O 14208476 Baystate Health Insurance Co P 16912432 Health New England Inc K 70000 Health New England Inc P 261207 BHS Health & Welfare Benefit Trust O 76671922