2015-08-11T12:44:30-05:00 2014-09-30 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2013-10-01 042888373 Baystate Medical Practices Inc BAYS 4137940000 759 Chestnut Street Springfield MA 01199 Dennis W Chalke SVP Finance, CFO & Treasurer 4137943290 2015-08-11 1 Christine Kawecki P00743140 5169187000 2013 2016-02-25 16:41:14Z Dennis W Chalke 759 Chestnut Street Springfield MA 01199 236573335 0 X baystatehealth.org X 1985 MA The mission of the organization is 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. 20 0 1587 1 728665 -177138 0 0 219743167 236558945 3934 14390 0 0 219747101 236573335 0 0 0 0 197473601 216928371 0 0 0 43375752 46140594 240849353 263068965 -21102252 -26495630 34504128 41248222 69241657 87481931 -34737529 -46233709 X To deliver excellent patient care, provide innovative medical education and pursue meaningful research. 0 0 249566538 235830280 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. 249566538 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 1 136 0 1 1587 1 1 1 0 0 0 0 0 0 0 0 0 X 20 0 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 MA X Peter Lyons Baystate Health Inc 4137940000 759 Chestnut Street Springfield MA 01199 Gordon Josephson MD Chair/President 10/1/13 - 2/03/14 40.00 10.00 X X 529869 0 62659 John Schrieber MD Chair/President 2/03/14 - 9/30/14 40.00 10.00 X X 5036 0 0 Benjamin Liptzin MD Vice Chair/Director 40.00 10.00 X X 527947 0 53291 Dennis W Chalke Treasurer/Director 1.00 49.00 X X 769165 0 75032 Evan Benjamin MD Director 7/1/-9/30/14/ Sr VP Quality 1.00 49.00 X 656389 0 63030 Elizabeth Boyle MD Director/ Medical Dir-Health Ctr 49.00 1.00 X 234047 0 46812 Wayne Duke MD Director/ Vice Chair Pathology 49.00 1.00 X 369538 0 51804 Oz Harmanli MD Director / Chief Urology 49.00 1.00 X 356987 0 48619 Thomas Higgins MD Director/ Vice Chair Clinical Affairs 49.00 1.00 X 458665 0 90008 Kevin Hinchey MD Director/ Chief Academic Affairs 49.00 1.00 X 490558 0 66584 M Dale Janes Director 1.00 0.00 X 0 0 0 Mark A Keroack MD Director/ Exec VP/COO-BH 1.00 49.00 X 776897 0 179311 Aaron Kugelmass MD Director 10/2/13 -9/30/14 VP Chief Cardio 49.00 1.00 X 914683 0 35853 Sivakumar Natanasapathy MD Director 10/2/13-9/30/14 Med Dir Adult HMP 49.00 1.00 X 423613 0 44610 Michael Picchioni MD Director/ Internist 49.00 1.00 X 237937 0 46393 Sara Rourke MD Director/ Med Dir BFMC 49.00 1.00 X 233357 0 27009 Joseph Schmidt MD Director/ Vice Chair Emergency Med 49.00 1.00 X 341817 0 52656 Scott Siege MD Director/Med Dir BMLH Peds Prac 49.00 1.00 X 202608 0 31290 Mark R Tolosky Director 10/1/13-7/01/14 President & CEO BH 1.00 49.00 X 1639060 0 87835 Kelly Tyler MD Director/ General Surgeon 49.00 1.00 X 312156 0 21193 Richard Wait MD Director/ Chairman, Dept of Surgery 49.00 1.00 X 882995 0 100434 Jackson William MD Director / Chief Pedi HMP 49.00 1.00 X 207653 0 23042 Kristin R Delaney Clerk 1.00 49.00 X 103365 0 28954 Andrew Artenstein MD Chairman, Department of Medicine 50.00 0.00 X 406462 0 46592 Gerda Maissel MD CMO Northern Region 50.00 0.00 X 576659 0 42963 Douglas D Muehlberg COO Baystate Medical Practices 50.00 0.00 X 390905 0 58028 M Shafeeq Ahmed MD COO/CMO Eastern Region 30.00 20.00 X 283562 0 115751 Dennis Oh MD Neurosurgeon 50.00 X 774522 0 30102 David Refermat MD Chief Plastic Surgery 50.00 X 716412 0 31177 Sherry Taylor MD Chief Division Of Neurosurgery 50.00 X 708431 0 33044 Niels K Rathlev MD Chairman Emergency Services 50.00 X 595582 0 39860 Kevin P Moriarty MD Chief Pediatric Surgery 50.00 X 585835 0 44922 15712712 0 1678858 499 0 1 1 Baystate Administrative Services Inc 759 Chestnut Street Springfield MA 01199 Management services 4961168 Baystate Medical Center Inc 759 Chestnut Street Springfield MA 01199 MD scheduling service 3714692 Radiology & Imaging Inc 1350 Main St 10th Floor Springfield MA 011031628 MD services 554550 Croes Olivia Group Inc 2222 Prospect Street Suite 6 Belmont MA 02478 Consulting services 447659 Hayes Locums LLC 6700 North Andrews Ave Ste 6 Fort Lauderdale FL 33309 MD services 432037 26 Physician Practice Fees 621110 149339663 149339663 Hospital reimb programs 621110 61283804 61283804 BH Strategic Initiative funding 621110 5260759 5260759 MD performance incentives 621110 4639728 4639728 EHR incentive Medicare/Medicaid 621110 3652029 3652029 12382962 11654297 728665 236558945 14390 14390 236573335 235830280 728665 14390 9622649 9622649 176359563 172484762 3874801 11852762 11596626 256136 9622607 9410592 212015 9470790 9273473 197317 5361164 5361164 573689 573689 80393 80393 8178079 7016379 1161700 112849 107207 5642 2501620 2269232 232388 100640 44793 55847 6292375 5977756 314619 240355 240355 173341 165876 7465 6536 6536 1320564 1254536 66028 11210326 10684172 526154 Purchased Svcs Clerical 3695875 3695875 Medical Supplies 3065914 3065914 Prof'l Exp Acct 1889490 1889490 Dues & Memberships 562962 562962 774422 766851 7571 263068965 249566538 13502427 0 3126924 1986545 13482939 17521889 97444 0 1531906 1992715 26744264 16763625 7584602 9980639 8680313 9766434 34504128 41248222 31104905 34761893 290625 280208 37846127 52439830 69241657 87481931 X -34737529 -46233709 -34737529 -46233709 34504128 41248222 X -26495630 14999450 X X 0 1 X 1 0 X 140855978 206929699 219827643 218759374 235830282 1022202976 140855978 206929699 219827643 218759374 235830282 1022202976 0 0 0 1022202976 8640 3831 3428 3934 14390 34223 8640 3831 3428 3934 14390 34223 297439 379972 796421 983793 728665 3186290 141162057 207313502 220627492 219747101 236573337 1025423489 0.99690 0.99690 0.00000 0.00010 X 1103927 465983 637944 7543469 1567082 5976387 18074243 14730560 3343683 22625 22625 9980639 Due from Affiliated Companies 3096234 Accounts Receivable, Other 6670200 9766434 Due to Affiliated Companies 22602683 Insurance IBNR Loss Reserves 9044184 Accrued Pension Cost 20071187 Line of credit, affiliate 721776 52439830 0 1 0 0 0 0 0 0 0 Gordon Josephson MD Chair/President 10/1/13 - 2/03/14 340675 0 152412 0 36782 0 45150 0 17509 0 592528 0 0 0 Benjamin Liptzin MD Vice Chair/Director 366793 0 114369 0 46785 0 35800 0 17491 0 581238 0 0 0 Dennis W Chalke Treasurer/Director 393944 0 159840 0 215381 0 53098 0 21934 0 844197 0 0 0 Evan Benjamin MD Director 7/1/-9/30/14/ Sr VP Quality 390694 0 138302 0 127393 0 42213 0 20817 0 719419 0 0 0 Elizabeth Boyle MD Director/ Medical Dir-Health Ctr 197816 0 35220 0 1011 0 25797 0 21015 0 280859 0 0 0 Wayne Duke MD Director/ Vice Chair Pathology 312754 0 40512 0 16272 0 33167 0 18637 0 421342 0 0 0 Oz Harmanli MD Director / Chief Urology 277700 0 65434 0 13853 0 30626 0 17993 0 405606 0 0 0 Thomas Higgins MD Director/ Vice Chair Clinical Affair 342123 0 64937 0 51605 0 71760 0 18248 0 548673 0 0 0 Kevin Hinchey MD Director/ Chief Academic Affairs 335131 0 119204 0 36223 0 43345 0 23239 0 557142 0 0 0 Mark A Keroack MD Director/ Exec VP/COO-BH 537949 0 223630 0 15318 0 165853 0 13458 0 956208 0 0 0 Aaron Kugelmass MD Director 10/2/13 -9/30/14 VP Chief C 540375 0 222866 0 151442 0 16575 0 19278 0 950536 0 103513 0 Sivakumar Natanasapathy MD Director 10/2/13-9/30/14 Med Dir Adu 371209 0 38294 0 14110 0 26962 0 17648 0 468223 0 0 0 Michael Picchioni MD Director/ Internist 202998 0 34274 0 665 0 30261 0 16132 0 284330 0 0 0 Sara Rourke MD Director/ Med Dir BFMC 185557 0 46422 0 1378 0 11729 0 15280 0 260366 0 0 0 Joseph Schmidt MD Director/ Vice Chair Emergency Med 295036 0 32881 0 13900 0 33709 0 18947 0 394473 0 0 0 Scott Siege MD Director/Med Dir BMLH Peds Prac 175226 0 26802 0 580 0 13455 0 17835 0 233898 0 0 0 Mark R Tolosky Director 10/1/13-7/01/14 President & 728085 0 456876 0 454099 0 57333 0 30502 0 1726895 0 0 0 Kelly Tyler MD Director/ General Surgeon 304773 0 3432 0 3951 0 12750 0 8443 0 333349 0 0 0 Richard Wait MD Director/ Chairman, Dept of Surgery 602783 0 209100 0 71112 0 78413 0 22021 0 983429 0 0 0 Jackson William MD Director / Chief Pedi HMP 177641 0 29669 0 343 0 17457 0 5585 0 230695 0 0 0 Andrew Artenstein MD Chairman, Department of Medicine 320073 0 59142 0 27247 0 28145 0 18447 0 453054 0 0 0 Gerda Maissel MD CMO Northern Region 447169 0 129240 0 250 0 22913 0 20050 0 619622 0 0 0 Douglas D Muehlberg COO Baystate Medical Practices 281811 0 70659 0 38435 0 42403 0 15625 0 448933 0 0 0 M Shafeeq Ahmed MD COO/CMO Eastern Region 224916 0 41891 0 16755 0 98047 0 17704 0 399313 0 0 0 Dennis Oh MD Neurosurgeon 614730 0 133440 0 26352 0 12750 0 17352 0 804624 0 0 0 David Refermat MD Chief Plastic Surgery 517308 0 157267 0 41837 0 12750 0 18427 0 747589 0 23849 0 Sherry Taylor MD Chief Division Of Neurosurgery 669193 0 0 0 39238 0 20400 0 12644 0 741475 0 0 0 Niels K Rathlev MD Chairman Emergency Services 396424 0 98655 0 100503 0 20400 0 19460 0 635442 0 61669 0 Kevin P Moriarty MD Chief Pediatric Surgery 472845 0 80916 0 32074 0 26775 0 18147 0 630757 0 8021 0 Part I, Line 3 The compensation of President and CEO is reviewed and determined annually by the compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs). This committee consists entirely of individuals serving on the board of Baystate Health, Inc. and these individuals would be considered independent for compensation deliberation purposes as related to the filing organization. The compensation of the President and CEO 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. and all such deliberations and decisions are documented contemporaneously. Part I, Line 4b Mohammed Shafeeq Ahmed, MD - Supplemental Retirement of $15,187 is included in column E. This amount was earned in 2013. Andrew Artenstein, MD Supplemental Retirement of $22,913 is included in column E. This amount was earned in 2013. Evan B. Benjamin, MD - Supplemental Retirement of $110,597 is included in column E. This amount was earned in 2013. Dennis W. Chalke - Supplemental Retirement of $135,242 is included in column E. This amount was earned in 2013. Wayne Duke, MD - Supplemental Retirement of $14,289 is included in column E. This amount was earned in 2013. Oz Harmanli, MD - Supplemental Retirement of $12,020 is included in column E. This amount was earned in 2013. Thomas Higgins, MD - Supplemental Retirement of $33,423 is included in column E. This amount was earned in 2013. Kevin Hinchey, MD Supplemental Retirement of $17,905 is included in column E. This amount was earned in 2013. Gordon Josephson, MD - Supplemental Retirement of $26,718 is included in column E. This amount was earned in 2013. Mark A. Keroack, MD- Supplemental Retirement of $145,453 is included in column E. This amount was earned in 2013. Aaron Kugelmass, MD- Supplemental Retirement of $148,280 is included in column E. This amount consists of $44,767 earned in 2013 and $103,513 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. Benjamin Liptzin, MD - Supplemental Retirement of $32,135 is included in column E. This amount was earned in 2013. Gerda Maissel, MD Supplemental Retirement of $11,015 is included in column E. This amount was earned in 2013. Kevin Moriarty, MD- Supplemental Retirement of $29,460 is included in column E. This amount consists of $21,439 earned in 2013 and $8,021 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. Sivakumar Natanasapathy, MD - Supplemental Retirement of $13,280 is included in column E. This amount was earned in 2013. Dennis Oh, MD - Supplemental Retirement of $24,633 is included in column E. This amount was earned in 2013. Neils K. Rathlev, MD Supplemental Retirement of $88,291 is included in column E. This amount consists of $26,622 earned in 2013 and $61,669 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. David Refermat, MD Supplemental Retirement of $40,730 is included in column E. This amount consists of $16,881 earned in 2013 and $23,849 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. Joseph Schmidt, MD - Supplemental Retirement of $11,427 is included in column E. This amount was earned in 2013. Sherry Taylor, MD - Supplemental Retirement of $32,757 is included in column E. This amount was earned in 2013. Mark R. Tolosky - Supplemental Retirement of $387,879 is included in column E. This amount was earned in 2013. Kelly Tyler, MD Supplemental Retirement of $3,281 is included in column E. This amount was earned in 2013. Richard B. Wait, MD - Supplemental Retirement of $70,812 is included in column E. This amount was earned in 2013. American Excess Insurance Exchange (AEIX) Board Overlap 1876951 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 419425 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 Radiology & Imaging LLC Common Board Members or Officers 28385 See Part V - The filing organization made payments to BRI for patient and medical care services. BRI is an affiliate corporation of the filing organization. 0 Baystate Radiology & Imaging LLC Common Board Members or Officers 143822 See Part V - The filing organization received rent payments from BRI. BRI is an affiliate corporation of the filing organization. 0 Greater Springfield Independent Practice Association (GSIPA) Board Overlap 104988 See Part V - Benjamin Liptzin, MD, Vice Chair of the filing organization is also a Board Member of GSIPA. The filing organization makes dues/membership payments to GSIPA. 0 Health New England Inc (HNE) Common Board Members or Officers 18096053 See Part V - The filing organization received $17,075,543 related to medical claims, $450,000 for medical consulting services and $570,510 in Surplus Sharing payments from HNE. HNE is an affiliate corporation of the filing organization. 0 Ingraham Corporation (IC) Common Board Members or Officers 609485 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 Baycare Health Partners Inc (BHP) Common Board Members or Officers 5147234 See Part V - The filing organization received payments from BHP of 5,147,234 for patient care services which BMP is the intermediary between the filing organization and third party payers 0 Form 990, Part VI, Section A, line 2 M. Shafeeq Ahmed, Dennis W. Chalke, Kristin R. Delaney, Gordon Josephson, MD, Mark A. Keroack, MD, Benjamin Liptzin, MD, Gerda Maissel, MD, John Schreiber, MD, Scott Siege, MD, 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. Information Technology, Human Resources, Finance, Treasury, Accounting and other management and support 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 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 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 organizations 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 organizations educational and research programs, (5) any pledge of the filing organizations 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 15b The compensation of the President and of other officers and key employees is reviewed and determined annually by the compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs). This committee consists entirely of individuals serving on the board of Baystate Health, Inc. and these individuals would be considered independent for compensation deliberation purposes as related to the filing organization. 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. Line 15a has been answered No because the President and other officers are paid by Baystate Administrative Services, Inc., an affiliate organization of the filing organization. Key Employees are paid by the filing organization. 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. Form 990, Part XI, line 9: Current year acquisitions from other entities 2,785,121. Transfer to/from affiliate, net 20,143,500. Minimum pension liability adjustment -7,929,172. rounding 1. 990 Part XII, line 2c The process has not changed from the prior year.