TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) James P Sadowsky........................................................................ Chair 1/1/2015-9/30/15	1.00 .......................2.00	X	X	0	0	0
(2) Anne M Paradis........................................................................ Vice Chair 1/1/2015-9/30/15	1.00 .......................1.00	X	X	0	0	0
(3) Robert J Bacon........................................................................ Trustee 7/1/15-9/30/15	1.00 .......................1.00	X		0	0	0
(4) Gregory L Braden MD........................................................................ Trustee	1.00 .......................1.00	X		0	0	0
(5) John H Davis........................................................................ Trustee	1.00 .......................1.00	X		0	0	0
(6) Harriet A DeVerry........................................................................ Trustee 7/1/15-9/30/15	1.00 .......................1.00	X		0	0	0
(7) John A Egelhofer MD........................................................................ Trustee	1.00 .......................1.00	X		0	0	0
(8) Mark A Keroack MD........................................................................ Trustee	1.00 .......................49.00	X		0	980,230	203,356
(9) John E Kole........................................................................ Trustee 10/1/14-12/31/14	1.00 .......................1.00	X		0	0	0
(10) Grace P Makari-Judson MD........................................................................ Trustee/ Hematologist, MD	1.00 .......................49.00	X		369,844	0	85,491
(11) John F Maybury........................................................................ Trustee	1.00 .......................1.00	X		0	0	0
(12) Steven M Mitus........................................................................ Trustee	1.00 .......................1.00	X		0	0	0
(13) Kevin P Moriarty MD........................................................................ Trustee 1/1-9/30/15/Chief Ped Surgery	1.00 .......................49.00	X		594,308	0	43,650
(14) Paul R Murphy........................................................................ Trustee 1/1/15-9/30/15	1.00 .......................1.00	X		0	0	0
(15) Edward J Noonan........................................................................ Trustee	1.00 .......................1.00	X		0	0	0
(16) John M O'Brien III........................................................................ Trustee	1.00 .......................1.00	X		0	0	0
(17) James R Phaneuf........................................................................ Trustee	1.00 .......................1.00	X		0	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Robert L Pura PhD........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(19) Timothy S Rice........................................................................ Trustee 10/1/14-12/31/14	1.00 .......................1.00	X					0	0	0
(20) Scott Siege MD........................................................................ Trustee/Med Dir Mary Lane Peds	1.00 .......................49.00	X					244,308	0	30,486
(21) Kathleen B Scoble........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(22) David C Southworth........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(23) Richard B Steele Jr........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(24) Katherine McG Sullivan........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(25) Howard G Trietsch MD........................................................................ Trustee 10/1/14-12/31/14	1.00 .......................1.00	X					0	0	0
(26) Hector Toledo........................................................................ Trustee 1/1/15-9/30/15	1.00 .......................1.00	X					0	0	0
(27) Victor Woolridge........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(28) Charles E Cavagnaro III MD........................................................................ President	20.00 .......................30.00		X				930,507	422,722	357,625
(29) Dennis W Chalke........................................................................ Treasurer	1.00 .......................49.00		X				0	929,051	79,645
(30) Kristin R Delaney........................................................................ Clerk	1.00 .......................49.00		X				0	107,000	29,470
(31) Madeline Torres........................................................................ Assistant Clerk	1.00 .......................49.00		X				0	28,799	7,703
(32) Mohammed S Ahmed MD........................................................................ CMO - Eastern Region	30.00 .......................20.00			X			436,028	0	142,994
(33) Lisa A Beaudry........................................................................ Director of Nursing	50.00 .......................0.00				X		153,584	0	30,629
(34) Charles Gilbert........................................................................ Mgr Inpatient Pharmacy BMLH	50.00 .......................0.00				X		137,914	0	31,505
(35) Jill Stolgitis........................................................................ CNRP - RN III	50.00 .......................0.00				X		117,248	0	18,267
(36) Tina L Paulson........................................................................ Nurse Manager	50.00 .......................0.00				X		112,973	0	18,586
(37) Suanne E Despres........................................................................ CNRP - RN IV	50.00 .......................0.00				X		110,307	0	28,069
(38) Mark R Tolosky........................................................................ President Emeritus, BH	20.00 .......................5.00					X	0	1,089,033	234,000
(39) Charles D Gijanto........................................................................ Former President, BFMC	0.00 .......................0.00					X	0	334,861	24,098

(A) Name and business address	(B) Description of services	(C) Compensation
Baystate Medical Practices Inc 759 Chestnut Street Springfield,MA01199	Physician Services	2,872,417
Baystate Medical Center Inc 759 Chestnut Street Springfield,MA01199	Laboratory, & Adm Services	2,836,665
Baystate Administrative Serv Inc 759 Chestnut Street Springfield,MA01199	Management Services	1,537,320
Sound Physicians of Mass Inc 1123 Pacific Ave Tacoma,WA98402	Physician Services	124,180

2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 4

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	283,418	283,418
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	11,736,838	11,234,028	502,810
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	568,448	545,710	22,738
9	Other employee benefits .......	1,221,410	1,172,554	48,856
10	Payroll taxes ...........	908,199	871,871	36,328
11	Fees for services (non-employees):
a	Management ......	2,242,962	1,068,721	1,174,241
b	Legal .........	18,651		18,651
c	Accounting ...........	14,657		14,657
d	Lobbying ...........	12,301		12,301
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	6,120,352	6,078,008	42,344
12	Advertising and promotion ....
13	Office expenses .......	2,191,295	2,108,126	83,169
14	Information technology ......	103,180		103,180
15	Royalties ..
16	Occupancy ...........	727,271	700,935	26,336
17	Travel ............	62,905	60,092	2,813
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	1,403,262	1,398,340	4,922
23	Insurance ..............	70,729	70,729
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
b
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	27,685,878	25,592,532	2,093,346	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............		1
2	Savings and temporary cash investments .........	4,757,627	2	3,560,127
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	2,801,726	4	2,708,822
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	739,393	8	790,152
9	Prepaid expenses and deferred charges ..........	150,482	9	208,844
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	38,212,952
b	Less: accumulated depreciation .....	10b	29,006,699	8,921,235	10c	9,206,253
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	8,563,202	15	7,637,997
16	Total assets. Add lines 1 through 15 (must equal line 34)......	25,933,665	16	24,112,195
	17	Accounts payable and accrued expenses .........	3,383,261	17	3,219,614
18	Grants payable .................		18
19	Deferred revenue ................	142,674	19	276,105
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	3,716,021	25	3,853,053
26	Total liabilities. Add lines 17 through 25.........	7,241,956	26	7,348,772
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	10,910,633	27	9,611,293
28	Temporarily restricted net assets ...........	574,186	28	605,691
29	Permanently restricted net assets ...........	7,206,890	29	6,546,439
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	18,691,709	33	16,763,423
34	Total liabilities and net assets/fund balances ........	25,933,665	34	24,112,195

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

Baystate Mary Lane Hospital Corporation

Employer identification number

04-2103584

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Baystate Mary Lane Hospital Corporation

Employer identification number

04-2103584

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2014

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

12,301

Total. Add lines 1c through 1i ...............................

12,301

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	Baystate Mary Lane Hospital pays membership dues to the Massachusetts Hospital Association (MHA) and the American Hospital Association (AHA). These organizations have advised us that portion of these dues are used for lobbying purposes for various healthcare matters at the state level. The portion of dues listed as lobbying expense for the year ending September 30, 2015 is $12,301.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Baystate Mary Lane Hospital Corporation

Employer identification number

04-2103584

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	15,921		15,921
b	Buildings ................	21,688,131	15,679,615	6,008,516
c	Leasehold improvements ............	886,440	886,440	0
d	Equipment ................	14,758,717	11,965,864	2,792,853
e	Other .................	863,743	474,780	388,963
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				9,206,253

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Other A/R				37,860
(2) Estimated Final Settlements				181,676
(3) Due From Affiliated Companies				82,782
(4) Beneficial interest in net assets of BHF-Long term investments				775,616
(5) Beneficial interest in BHF PR Trust- Assets whose use is limited				6,376,514
(6) Beneficial interest in BHF Endow B/D- Assets whose use is limited				183,549



Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				7,637,997

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
Estimated Final Settlements Payable		1,359,923
Malpractice Reserve		51,000
Pension Liability		2,442,130






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		3,853,053
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Part V, Line 4:	Certain endowments are held at Baystate Health Foundation (BHF), an affiliate, and are reported as temporarily restricted and permanently restricted but Part V has not been completed as it is already addressed on BHF's Form 990 (EIN 04-3549011).

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Baystate Mary Lane Hospital Corporation

Employer identification number

04-2103584

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	598,526	111,968	486,558	1.760 %
b	Medicaid (from Worksheet 3, column a) ....	4,618,384	3,638,973	979,411	3.540 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	784,335	648,114	136,221	0.490 %
d	Total Financial Assistance and Means-Tested Government Programs .	6,001,245	4,399,055	1,602,190	5.790 %
Other Benefits		175,016	0	175,016	0.630 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	175,016	0	175,016	0.630 %
f	Health professions education (from Worksheet 5) ..	0	0
g	Subsidized health services (from Worksheet 6) ..	0	0
h	Research (from Worksheet 7)	0	0
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	0	0
j	Total. Other Benefits ..	175,016		175,016	0.630 %
k	Total. Add lines 7d and 7j .	6,176,261	4,399,055	1,777,206	6.420 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	1,149	1,149	0 %
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	1,149	1,149

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

407,696

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

6,631,874

Enter Medicare allowable costs of care relating to payments on line 5.....

7,610,510

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-978,636

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Baystate Mary Lane Hospital Corp 85 South Street Ware,MA01082 2148	X	X	X

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Baystate Mary Lane Hosptial Corporation
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V

Other website (list url): See Part V

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): See Part V

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	Baystate Mary Lane Hosptial Corporation
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url): https://www.baystatehealth.org/patients/billing-and-insurance

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	Baystate Mary Lane Hosptial Corporation
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Baystate Mary Lane Hosptial Corporation	Part V, Section B, Line 3j: The CHNA report also described collaborating organizations. BMLH collaborated with each of the hospital facilities that are members of the Coalition of Western Massachusetts Hospitals for its CHNA. BMLH also collaborated with organizations that participated in a "Design Team" established by the Coalition. Representatives from the Collaborative for Community Health, Inc., the Franklin Regional Council of Governments, the Massachusetts Department of Public Health, and the Springfield Department of Health and Human Services participated on this Team. Many individuals provided input for this assessment. Lists of interviewees are included in the report.
Baystate Mary Lane Hosptial Corporation	Part V, Section B, Line 5: Community input was gathered through interviews, a community survey, and community listening sessions. Interviews were conducted with public health experts, representatives of health, social services, or other departments or agencies, community leaders, health care providers, and persons representing the broad interests of the community. The interviews were structured to help identify the most pressing health status and access issues in the community. BMLH also sought input from the public regarding the health of the community through an online and paper-based survey. A website link to the survey (in both English and Spanish) was made available from January through February 2013. Paper copies of the survey were distributed at various local organizations and clinics in multiple languages. Efforts were made to reach those without internet access as well as vulnerable populations such as racial and ethnic minorities, low-income groups, individuals with low literacy levels, and non-English speakers. The survey was publicized via flyers, social media, human services organizations, boards of health, newspapers, email listservs, and other methods. A listening session was held during which community members reviewed and discussed preliminary findings from this assessment. Discussion at the listening session was helpful in that it validated assessment findings and contributed to the prioritization process. The survey consisted of 48 questions about a range of health status and access issues and respondent demographic characteristics. 621 residents from the Baystate Mary Lane community participated in the survey. Seventy-six percent of respondents were female and 52 percent were between the ages of 45 and 64. Ninety-three percent were White and 2 percent identified as Hispanic (or Latino). The majority of respondents reported being in good or very good overall health (74 percent), married (61 percent), employed full time (64 percent), privately insured (73 percent), and having an undergraduate degree or higher (50 percent). The majority (97 percent) of respondents speak English in the home. Two percent of respondents reported that they spoke multiple languages at home. Survey responses were received from residents of 21 of the Baystate Mary Lane community's 23 ZIP codes.Key informant interviews were conducted face-to-face and by telephone by Mark Rukavina, Principal at Community Health Advisors, LLC. The interviews were designed to gain perspective into health needs in the community served by Baystate. A total of 31 local key informants, including external and internal stakeholders (those affiliated or employed by Baystate Mary Lane Hospital) were interviewed during December 2012 through February 2013. In addition, 10 staff members from the Massachusetts Department of Public Health regional office in Northampton also were interviewed as a part of this assessment. These interviews were conducted using a structured questionnaire. Informants were asked to discuss community health issues and encouraged to look broadly at the social determinants of health. Interviewees were asked about issues related to health care access, changes in community population, prevalence of chronic health conditions, and health disparities. The frequency with which community health issues was mentioned and the interviewees' perceptions of the significance of each concern were assessed.The 41 interviewees were comprised of public health experts; individuals from health or other departments and agencies; leaders or representatives of medically underserved, low-income, and minority populations; and other community members. In addition, 15 community members participated in the CHNA listening sessions.
Baystate Mary Lane Hosptial Corporation	Part V, Section B, Line 6a: Baystate Mary Lane Hospital is a member of the Coalition of Western MA Hospitals. The Coalition is a partnership between ten (10) non-profit hospitals/health plan in western Massachusetts; Baystate Medical Center, Baystate Franklin Medical Center, Baystate Mary Lane Hospital, Baystate Noble Hospital, Baystate Wing Hospital, Cooley Dickinson Hospital, Holyoke Medical Center, Mercy Medical Center (a member of Sisters of Providence Health System), Shriners Hospitals for Children - Springfield, and Health New England, a local health insurer whose service areas covers four counties of western Massachusetts. The Coalition was formed in 2012 to bring hospitals within western Massachusetts together to share resources and work in partnership to identify and address the health needs of their communities through regional community health assessments. Baystate Noble Hospital and Health New England were not a part of the Coalition during the inital formation in 2012. Following feedback from key community stakeholders during the community health needs assessment process, the Coalition has taken its uniqure collaboration to the next level by identifying a shared health priority that it will address in partnership across the region. The shared health priority the Coalition selected was behavioral health.
Baystate Mary Lane Hosptial Corporation	Part V, Section B, Line 7d: Baystate Mary Lane Hospital made its CHNA report widely available to the public via an email distribution, with links to the hospital's website, to all key informant interviewees, listening session participants, and an internal communication to hospital employees.
Baystate Mary Lane Hosptial Corporation	Part V, Section B, Line 11: In partnership with Coalition of Western MA Hospitals, Baystate Mary Lane Hospital conducted its most recent community health needs assessment (CHNA) in 2013 of the geographic areas served by the hospital pursuant to the requirements of the MA Attorney General's Community Benefit Guidelines and Section 501(r) of the Internal Revenue Code ("Section 501(r)"). The CHNA findings were made available on the hospital's website in September 2013. Per the Internal Revenue Service (IRS) and the Massachusetts Office of the Attorney General, each non-profit hospital must conduct a formal community health needs assessment (CHNA) every three-years in partnership with community organizations and individuals across the hospital's service area. The aim is to identify community assets as well as the critical gaps/needs in public health resources and the weak connections between medical care and community care. This "gaps analysis" assists Baystate Health's Board of Trustees and senior managers in developing community benefit policy, which targets our charitable resources in focused areas. These areas frame existing community benefit programs, assist in transforming community service activities to comply with the IRS and MA Attorney General's criteria, and set priorities in the design of new programs. The CHNA is the basis for developing accountable community benefits programs. In an ideal situation, an effective and large scale community benefits program will demonstrate measurable community impacts on the health status and quality of life for residents - effectively closing gaps when current data is compared to initial CHNA baseline indicators. At a more practical program level, the CHNA guides a "theory of change" linking health needs to community benefits efforts to desired program and community outcomes. BMLH's CHNA began by identifying the communities served by the hospital. Findings are based on various quantitative analyses regarding health-related needs in those areas, a review of health assessments conducted by other organizations in recent years, information obtained from interviews, and findings from a community survey. Preliminary assessment findings were discussed with community stakeholders during a series of "listening sessions and feedback from participants helped validate findings. Finally, the Coalition applied a ranking methodology to help prioritize the community health needs identified by the assessment including multiple data sources and stakeholder views which are important when assessing the level of consensus that exists regarding priority community health needs. If alternative data sources including interviews support similar conclusions, then confidence is increased regarding the most problematic health needs in a community. Further information about the analytic methods and prioritization process and criteria can be found in the CHNA report. The list that follows describes the health needs identified throughout the assessment as priorities in the community served by Baystate Mary Lane Hospital. These needs are presented in alphabetical order, by category. The prioritized list identifies the thirteen (13) most problematic community health needs found by this assessment. Needs were determined by synthesizing findings from multiple data sources.Access to Care Lack of Affordable and Accessible Medical Care Need for Care CoordinationHealth Behaviors High Rates of Alcohol, Tobacco (Hampden and Worcester counties), and Drug Use High Rates of Unsafe Sex (Hampden County), Teen Pregnancy, and Chlamydia (Hampden County) Maternal and Child Health Prevalent Infant Health Risk Factors (e.g., smoking during pregnancy, births to women age 40-54) Pediatric Disability (Hampden County) Mental Health Lack of Access to Mental Health Services and Poor Mental Health Status Morbidity and Mortality High Rates of Diet and Exercise-Related Diseases and Mortality (e.g., obesity, diabetes, heart disease) High Rates of Asthma (Hampden County) Disease Morbidity and Mortality (e.g. cancer, chronic liver disease, circulatory system diseases) Physical Environment Poorly Built Environment and Environmental Quality (e.g., air quality, presence of food deserts) Social and Economic Factors Basic Needs Insecurity: Financial Hardship, Housing, and Food Access Low Educational Achievement Physical and Social IsolationNo community hospital facility can address all of the health needs present in its community. BMLH is committed to adhering to its mission and remaining financially healthy so that it can continue to enhance its clinical excellence and to provide quality community benefit programs. The hospital's Implementation Strategy does not address the following priority community health needs identified in the 2013 CHNA due to no new funding or resources, other hospitals or community organizations within service area are already addressing the need or the need falls outside of the hospital's mission or capacity. These health priorities include high rates of unsafe sex, teen pregnancy, and chlamydia; prevalent infant health risk factors; pediatric disability; high rates of asthma; poor built environment and environmental quality; low educational achievement; and physical and social isolation.
Baystate Mary Lane Hosptial Corporation	Part V, Section B, Line 13b: All patients with account balances (other than balances resulting from co- payments or deductibles on insured services) are eligible to receive a prompt pay discount of 20% of the balance for claims paid in full at time of service or within 60 days of the date of the initial bill. Patients must request the discount. The discount cannot be combined with the Hospital Supplemental Financial Assistance Program. The hospital offer a co-payment discount program for patients receiving services in the emergency departments of the hospitals. This discount program is available to all hospital emergency department patients with co-payment obligations under private or government health insurance (unless prohibited by law or a BH Hospital's contract with a private insurer or government authority). These patients may reduce the otherwise applicable emergency department service co-payment by 10% if the patient elects to pay the co-payment at the conclusion of the patient's emergency department visit.
Baystate Mary Lane Hosptial Corporation	Part V, Section B, Line 15e: The hospital provide patients with information about the availability of State Programs, Health Safety Net, or the Hospital Supplemental Financial Assistance Program which may cover all or some of their unpaid hospital bill as well as about hospital discount programs. For those patients who request such assistance, the hospital assists patients by screening them for eligibility in available State Program and assisting them in applying for such programs. When applicable, the hospital may also assist patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. The hospital has contracted with the Executive Office of Health and Human Services and the Commonwealth Health Insurance Connector Authority to serve as a Certified Application Counselor Organization. As a Certified Application Counselor (CAC), appropriate staff will inform a patient of the functions and responsibility of a CAC, seek that the patient sign a Certified Application Counselor Designation Form, and assist the patient in finding applicable financial assistance
Form 990, Part V, Line 7	7a:https://www.baystatehealth.org/~/media/files/community%20programs/2013%20baystate%20mary%20lane%20hospital%20chna.pdf7b: http://www.cbsys.ago.state.ma.us/cbpublic/public/hccbindex.aspx
Form 990, Part V, Line 10	10a: http://www.baystatehealth.org/StaticFiles/Baystate/About%20Us/Community%20Programs/Community%20Health%20Planning/Community%20Benefits%20Program/BMLH-Implementation-Strategy.pdf
Part V, Section B, Line 16	Financial Assistance Policy Website Availability
Baystate Mary Lane Hosptial Corporation Part V, Section B, line 16a website:	https://www.baystatehealth.org/patients/billing-and-insurance

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	BMLH Lab & Radiology Patient Srvc Center 95 Sargent Street Belchertown,MA01007	Outpatient Facility
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 6a:	Baystate Mary Lane Hospital files an annual community benefit report electronically with the Massachusetts Attorney General's office via their website at http://www.cbsys.ago.state.ma.us/cbpublic/public/hccbindex.aspx. Baystate Mary Lane Hospital's annual community benefit report is available to the public via the Massachusetts Attorney General's website (see above) and via Baystate Health's website http://www.baystatehealth.org/Baystate/Main+Nav/About+Us/Community+Programs/Community+Health+Planning/Community+Benefits+Program. Our community benefit report provides the Attorney General's Office and the general public important information about how Baystate Mary Lane Hospital partners with our communities to identify and address unmet health needs of disadvantaged and vulnerable populations in support of our charitable mission.
Part I, Line 7:	Line 7a (Charity Care) - community benefit expense was calculated by applying the ratio of patient care cost to charges, calculated on Worksheet 2, against total charity care gross patient charges from the audited financial statements. Line 7b (Unreimbursed Medicaid) - community benefit expense was derived using the organization's cost accounting system, which takes into account all hospital inpatients, outpatients and emergency room patients for whom services were provided and covered under Medicaid and Medicaid managed care plans.Line 7c (Other Means-Tested Programs) - community benefit expense was derived using the organization's cost accounting system, which takes into account all hospital inpatients, outpatients and emergency room patients for whom services were provided and covered under other means-tested government programs.Line 7e Community Health Improvement Services calculations are derived from direct and indirect costs associated with community benefit activities that are aligned with the hospital's 2013 community health needs assessment. These activities are carried out to improve community health and wellness and extend beyond patient care, beyond the walls of the hospital. Community Benefit Operations calculations are derived from costs associated with assigned staff and community health needs and/or assets assessment, as well as other costs associated with community benefit strategy and operations.
Part I, Ln 7 Col(f):	In fiscal year 2013, the organization adopted the provisions of Accounting Standards Update 2011-07, Health Care Entities (Topic 954), Presentation and disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities on October 1, 2012. The update changed how the provision for bad debts is reported on the audited financial statements. In prior years it was included with total operating expenses, and subtracted from total expenses reported in Part IX, Line 25, column (A) for the purpose of calculating the percentages in Part I, Line 7, column (f). In 2015, the provision for bad debts was reported as a deduction to net patient service revenue. The 2015 provision for bad debts totaled $966,849 and is not included in total expenses reported in Part IX, Line 25, column (A) for the purpose of calculating the percentages in Part 1, Line 7, column (f).
Part II, Community Building Activities:	Specific to Part II Baystate Mary Lane Hospital paid $1,149 to Quaboag Hills Chamber of Commerce. BMLH participates in the Chamber as we are one of the largest local employers in our service area. The Chamber and its membership coordinate activities toward a common purpose of sustainability and economic growth for the region.The following description is not quantified specifically in Part II of Schedule H. Baystate Mary Lane Hospital (BMLH) is committed to creating healthier communities and understands that many state and federally mandated community benefit programs and services are not sufficient to address ethnic, racial and economic health disparities. BMLH extends the traditional definition of "health" to include economic opportunity, affordable housing, quality education, safe neighborhoods, food security, arts/culture, and racism and homophobia free communities all elements that are needed for individuals, families and communities to thrive. In keeping with our commitment to improve health, Baystate Mary Lane Hospital provides many valuable services, resources and programs beyond the walls of the hospital and into the communities and homes of the people we serve; including community sponsorships and involvement of hospital employees with not-for-profit boards that align with our mission.
Part III, Line 4:	The cost of bad debts reported in Part III, line 2 was calculated by applying a ratio of cost to charges (based on the organization's cost accounting system including all hospital inpatients and outpatients) against total patient bad debt net of recoveries as reported in the audited financial statements. For 2015, there was no bad debt attributable to patients who may qualify for financial assistance under the hospital's charity care program (reported in Part III line 3). As noted above, the organization adopted Accounting Standards Update 2011-07 effective October 1, 2012, which changed the way entities report and disclose certain financial information including the provision for bad debts. See footnote #2 (Significant Accounting Policies) on page 13 of the audited financial statements under the caption "Allowance for Uncollectible Accounts" for a description of the organization's reporting of its provision for bad debts.If a patient is determined eligible for financial assistance, the appropriate adjustment is made to the patient account based on their income level. Once the necessary approvals are obtained, it then flows to the general ledger. Patients applying for a prompt payment discount will have this allowance entered after agreed upon payment is received.
Part III, Line 8:	Line 6 - included all Medicare allowable costs as calculated in Worksheets D-1 Part II (inpatient) and D Part V (outpatient) of the hospital's 2015 Medicare cost report, based on Medicare costing principles. We believe the shortfall reported on line 20 should be treated as community benefit expense for tax reporting purposes because providing care for the elderly is a key component of our commitment to the community. The unreimbursed expenses should be treated similarly to unreimbursed Medicaid since the majority of the local elderly population is not affluent.
Part III, Line 9b:	For patients who are known to qualify for Charity Care or Financial Assistance: The patient may have requested assistance up front at time of service with a Financial Counselor or the Patient could have asked for assistance after receiving their bill by contacting our Patient Billing Services Representatives. The Financial Counselor will assist the patient in applying for the appropriate type of assistance based on their income and circumstances. Once approved for a State Medicaid or other program, all billing and collection activity will stop (except for required co-payments or deductibles).For all other patients, our statements contain information regarding how to apply for financial assistance. Notices concerning availability for assistance are also posted at patient care sites.
Part VI, Line 2:	The Baystate Mary Lane Hospital's Community Benefits Advisory Council (to become Baystate Eastern Region Community Benefits Advisory Council in 2016) and Baystate Health's Board of Trustees are actively involved in overseeing community benefits programs and expenditures. In July 2010, the Baystate Health Board of Trustees assigned oversight of community benefits to the Board's Governance Committee. Through its regular board meetings, internal hospital meetings and leadership activities, Baystate Health is actively involved in shaping community benefits provided throughout the system. For FY 2015 the system's Vice President for Public Health and Community Relations, under the direction of the Sr. Vice President for Strategy & External Relations, supervised the Manager for Public Health and Community Relations. Additionally, the Manager worked collaboratively with the Public Affairs & Community Relations Manager for the Baystate Eastern Region to oversee the hospitals' community benefits planning, community health needs assessment, annual program data collection, and state and federal reporting of community benefits. The Baystate Health Board Governance Committee meets minimally two times per year and is charged with advocating for community benefits at the Board level and throughout the health system; aligning the five (5) hospital-specific community benefits implementation strategies into the health system's strategic plan; periodic review of community health needs assessment data; approval of a community benefits mission statement and health priorities; review impact of community benefits programs in promoting health of the community; and ensure community benefits programs are in compliance with guidelines established by the MA Attorney General and IRS. Annually, the Office of Public Health and Community Relations provides updates to the Baystate Health Board of Trustees. In 2015, the Baystate Mary Lane Hospital Community Benefits Advisory Council (CBAC) continued to meet monthly and in 2016 will grow its membership to include representatives from the Baystate Wing Hospital service areas. Through the community health initiatives funding and community health needs assessment, the hospital engaged more internal and community stakeholders who took a liking to the hospitals community benefits planning efforts. The CBAC continues to bring a community lens and filter for the hospital's health priorities. The CBAC provides a community perspective on how to increase wellness and resilience opportunities for optimal health for an entire population; guidance in matching Baystate Mary Lane's resources to community resources, thus making the most of what is possible with the goal to improve health status and quality of life; and policy advocacy to assure and restore health equity by targeting resources for residents. Participants on the CBAC represent the constituencies and communities served by the Baystate Mary Lane Hospital. CBAC members are responsible for reviewing community needs assessment data and use this analysis as a foundation for providing the hospital with input on its community benefits planning process.
Part VI, Line 3:	Baystate Mary Lane Hospital (BMLH) is committed to ensuring that patients in its community have access to quality health care services with fairness and respect without regard to the patients' ability to pay. BMLH recognizes that the cost of necessary health care services can impose a significant financial burden on patients who are uninsured or underinsured and acts affirmatively to lessen that burden by offering patients in need the opportunity to apply for free or reduced cost services. BMLH not only offers free and reduced cost care to the financially needy as required by law, but has also voluntarily established discount and financial assistance programs that provide additional free and reduced cost care to more patients residing within the communities served by BMLH. Baystate Mary Lane Hospital recognizes that the billing and collection process can be bewildering and burdensome for patients and has implemented procedures to make the process understandable for patients; to inform patients about discount and financial assistance options; and to ensure that patients are not subject to aggressive collection activities. Consistent with its patient commitment BMLH is required to maintain a credit and collection policy that reflects its patient billing and collection procedures and complies with applicable state and federal laws and regulations.Baystate Mary Lane Hospital has Financial Counselors available to help patients apply for available financial assistance programs that may cover unpaid hospital bills, including a variety of federal and state programs as well as financial assistance through Baystate Mary Lane Hospital. BMLH Financial Counselors have been trained and certified by the state as Certified Account Counselors to assist patients in applying for available state and federal programs. BMLH is committed to ensuring that patients or prospective patients in the community are aware of financial assistance programs. For uninsured or underinsured patients, BMLH will assist in applying for available financial assistance programs. To assist patients the hospital provides all patients with a general notice of the availability of programs in both the initial bill sent to patients as well as in general notices posted throughout the hospital.The goal of these notices is to assist patients in applying for coverage within a financial assistance program. When applicable, BMLH also assists patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. BMLH provides, upon request, specific information about the eligibility process to be a Low Income Patient under either the Massachusetts Health Safety Net Program or additional assistance for patients who are low income through BMLH's own internal financial assistance program. BMLH also notifies patients about available payment plans based on their family size and income.Signs are posted around the hospital to notify patients of the availability of financial assistance programs. Signs are clearly visible in the hospital's service area: they are 8-1/2 x 11 inches and the Header print font is 32 pts. Notice of availability of financial assistance programs are posted in the following locations; inpatient, clinic, emergency department admissions and/or registration areas, central admission/registration area, patient financial counselor areas and business office areas that are open to patients. Our Credit and Collection Policy is posted on the baystatehealth.org website. The goal of posting the Credit and Collection Policy is to ensure that patients or prospective patients in our community are aware of our financial assistance programs Baystate Mary Lane Hospital's Credit and Collection Policy was developed in partnership with Health Care For All, a Massachusetts non-profit organization dedicated to making adequate and affordable health care accessible to everyone, regardless of income, social or economic status.
Part VI, Line 4:	Baystate Mary Lane Hospital, located in Ware, Massachusetts, is a 25-bed acute care community hospital. We are dedicated to the health and well-being of our patients, their families and our community and have been a valued community neighbor for a century and are committed to bringing our patients the best of both worlds the clinical excellence, state-of-the-art technology and convenience of a community hospital. The community served by the hospital is defined based on the geographic origins of the hospital's discharges and is comprised of 23 ZIP codes in 17 towns: Belchertown, Barre, Brimfield, Brookfield, East Brookfield, Granby, Hardwick, Ludlow, Monson, New Braintree, North Brookfield, Palmer, Spencer, Wales, Ware, Warren, and West Brookfield. The overall community encompasses parts of Hampden, Hampshire, and Worcester counties and includes a total population of 118,831. In 2012, the community served by the hospital was comprised of 95.2% White residents, 1.2% African American residents, 3.1 % Latino residents and 0.9% Asian residents. Non-White populations are expected to grow faster than White populations in the community. The Asian, American Indian, Black, and Other are expected to have the fastest growth. The growing diversity of the community is important to recognize, given the presence of health disparities. For FY 2015 BMLH's ethnic mix of inpatient & outpatient patients included 93.88% White; 2.56% Hispanic; 1.03% Black; 0.58% Asian; 0.11% Native American; 1.84% Other. BMLH's payer mix of patients included 70.33% Medicare; 10.67% Medicaid; 16.65% Managed Care; 0.53% Non-Managed Care; 1.81% Other. In FY 2015 BMLH had 937 inpatient discharges and 13,103 emergency service visits. Payer mix for ED visits included 30.24% Medicaid; 2.14% Free Care; 5.20% Healthnet; 0.70% Commonwealth Care; 61.71% Other.The BMLH service area is a rural, central region that covers over 400 square miles and has a population of 118,831. The 23 ZIP codes in 17 towns that make up the hospital's service area is a rural and suburban mix with a population density of about 200 people per square mile. The population centers of the target service area consist of Palmer in eastern Hampden County, and Belchertown and Ware in eastern Hampshire County. In the past, these population centers were the "mill towns" of the region, supported by textiles and light manufacturing and surrounded by small farming communities. In the last thirty years the manufacturing base of the region has dissipated. Over the last two decades, Massachusetts has experienced a technology-based economic boom that completely bypassed the western and more rural communities of the state. Nationwide and in Massachusetts, poverty rates are higher in rural areas than in metropolitan areas. Rural adults have less formal schooling, and a greater share derive their livelihood from low-skill, low-wage jobs. The lower population density in the BMLH rural community makes it much more difficult to have all support services -- public transportation, education and job training, child care, emergency services, and health and mental health care -- available and easily accessible. The rural central area of Massachusetts has a higher percentage of low-income working people who are self-employed, work for small businesses, do seasonal work, or fail to apply for assistance programs for which they are eligible. The BMLH service area does not have Medically Underserved Area or Population (MUA/P) or have Health Professional Shortage Area (HPSA) designation from the Health Resources and Services Administration (HRSA).
Part VI, Line 5:	Baystate Mary Lane Hospital has a responsibility to respond to health care needs unsupported by government programs. In exchange for this responsibility, BMLH qualifies for tax-exempt status under 501(c)(3). However, providing hospital care alone is not enough to qualify for tax-exempt status. Hospitals also must operate in the public interest and provide programs that benefit the community. Baystate Mary Lane Hospital is fully committed to its role in the community and serves with pride and compassion for people in need.The charitable mission of BMLH, a member hospital of Baystate Health (BH), is to improve the health of the people in our communities every day, with quality and compassion. Baystate Mary Lane Hospital's Community Benefits Mission is to reduce health disparities, promote community wellness and improve access to care for vulnerable populations. BMLH is committed to meeting the identified health and wellness needs of constituencies and communities served through the combined efforts of Baystate Health's member organizations, affiliated providers, and community partners.Baystate Mary Lane Hospital meets all of the factors required of medical facilities in order to maintain tax exemption, as first described in Revenue Ruling 69-545. In support of patient care and the medical needs of the communities served by BMLH, medical staff membership and privileges are extended to all qualified physicians and practitioners in western Massachusetts who meet the requirements for credentialing and clinical privileges, whether employed by a related Baystate entity or community-based. Baystate Mary Lane Hospital's emergency department is open to all in need of care and services; no one requiring emergency care is denied treatment. In addition, surplus funds from operations are generally applied, as permitted, to the following: improvements in patient care, expansion and renovation of existing facilities, purchase and replacement of equipment, debt service, expenses associated with training of physicians and other health care professionals, professional development of medical and other clinical staff, and the support of scientific, translational, and clinical research.Baystate Health's volunteer Board of Trustees, the governing body of the organization and its affiliates, is comprised of the President and Chief Executive Officer of Baystate Health and up to twenty-two (22) other elected Trustees who are representative of the broad range of interests which exist in the communities served by Baystate Health and its affiliates. The Governance Committee oversees the nomination of Trustees and submits recommendations to the Board of Trustees for membership on the various Board committees. In considering nominations or recommendations for trustees, directors, committee members or officers the Governance Committee select nominees who are representative of the various and diverse constituencies served by Baystate Health and its affiliates. In particular the Committee nominates persons who are representative of the community consumer interests of the various neighborhoods and localities which are served by Baystate Health and its affiliates in the carrying out of and pursuant to the charitable mission of the Baystate Health and its affiliates.The Patient and Family Advisory Council (PFAC) at Baystate Mary Lane Hospital is a nine (9) member group comprised of hospital personnel, retired physicians, community members, human services professionals, and business members from the hospital's primary service area. The group was formed in 2009, and meets monthly throughout the calendar year. The council continues to have the opportunity to learn about, provide feedback and advise the hospital on hospital policies, programs and services. The council provides hospital leadership with an enhanced understanding of how to improve quality, program development, service excellence, communications, patient safety, facility design, patient and family education, marketing efforts, patient and family satisfaction, Infection Control, and customer loyalty. Specific advice on varied matters such as the continued work around hospital signage, parking lot improvements, and the re-design of a number of hospital departments, has proven helpful. Please refer to the section above in line 2 for additional examples of Baystate Mary Lane Hospital' responsiveness to the community and opportunities for community involvement; including the Board of Trustees' Governance Committee, Community Benefits Advisory Council, and Community Health Needs Assessment. For additional information, please see Line 6 below.
Part VI, Line 6:	Baystate Health, Inc. is the parent entity of a multi-institutional integrated delivery system composed of five hospitals and other 501(c)(3) organizations. The five hospitals are Baystate Medical Center, Baystate Franklin Medical Center, Baystate Mary Lane Hospital, Baystate Noble Hospital and Baystate Wing Hospital and the other 501(c)(3) organizations include Baystate Medical Practices, Visiting Nurse Association and Hospice of Western New England, Inc., and Baystate Health Foundation. In September 2014 Baystate Wing Hospital became part of the Baystate Health system. Additionally in July 2015, Baystate Noble Hospital became part of the Baystate Health System. In addition to its nearly 12,500 employees, Baystate Health has 1,504 medical staff, 2,428 nurses and 2,274 new residents and fellows, medical students, nursing students, and allied health students who gained comprehensive medical education during the year. In addition, 541 volunteers donated 48,205 hours to Baystate Medical Center; 320 volunteers and auxilary members donated over 30,000 hours to Baystate Franklin Medical Center; 32 volunteers donated 3,600 hours to Baystate Mary Lane Hospital; 75 volunteers donated 6,000 hours to Baystate Wing Hospital.Baystate Medical Center (BMC), the flagship 710-bed hospital (including Baystate Children's Hospital) based in Springfield, Massachusetts is Western New England's only tertiary care referral medical center, Level 1 trauma center and neonatal and pediatric intensive care units. BMC serves as a regional resource for specialty medical care and research, while providing comprehensive primary medical services to the community. BMC's community benefit efforts included providing assessment, treatment and crisis support to child abuse victims and their non-offending caretakers affected by child abuse and domestic violence in western Massachusetts, offering enrichment and career development programs for disadvantaged Springfield students, ensuring cohesive health care for school-aged children and the broader community, prevention of accidental childhood injuries and death through public awareness, safety education and distribution of safety devices, coordination of health education focus groups, community health forums and fairs, supporting transgender individuals, their allies and anyone from the broader community who identifies as LGBT through a peer lead and psychosocial support group, providing TB diagnosis and treatment to patients throughout western Massachusetts, and providing financial counseling services to inpatient and outpatient individuals who have concerns about how to pay for care. Baystate Franklin Medical Center (BFMC), a 90-bed facility located in Greenfield, Massachusetts (40 miles north of Springfield near the Vermont border) provides high quality inpatient and outpatient services to residents of rural Franklin county and the North Quabbin region. Inpatient services include behavioral health, intensive care, medical-surgical care, and obstetrics/midwifery. Outpatient services include cardiology, emergency medicine, gastroenterology, general surgery, neurology, oncology, ophthalmology, orthopedics, pediatrics, physical medicine & rehabilitation, pulmonology & sleep medicine, sports medicine, vascular surgery, wound care & hyperbaric medicine. BFMC's community benefit efforts included the ongoing support group through the Franklin County Postpartum Partnership - a partnership initiated by BFMC nurses; expanded senior outreach program to focus on persons most at-risk for hospital readmission due to issues with medication management; and continued the regionally recognized Blood & Guts program for youth, including an annual hospital-based event for high school students and three school-based events for elementary school students and their families. In addition, BFMC HealthBeat TV, a monthly 30-minute cable access talk show produced, directed and hosted by Baystate Franklin employees, engages the hospital's physicians, employees, patients and community leaders in discussions of interest to residents of Franklin County. Topics range from heart health, emergency response to senior outreach. The program runs more than 60 times a month on stations throughout the county.Baystate Wing Hospital (BWH), a 74-bed facility located in Palmer, Massachusetts (18 miles east of Springfield) provides a broad range of emergency, medical, surgical and psychiatric services. Our five medical centers in Belchertown, Ludlow, Monson, Palmer and Wilbraham offer extensive outpatient services to meet the needs of our communities. BWH also includes the Griswold Behavioral Health Center, providing comprehensive behavioral health and addiction recovery services and the Wing VNA and Hospice. We are fully accredited by the Joint Commission and are a designated Primary Stroke Service by the Massachusetts Department of Public Health. BWH's community benefit efforts include community outreach and education, support for Belchertown/Palmer Public Health Nurse, financial counseling, and support groups.Baystate Noble Hospital (BNH) is a 97-bed acute care community hospital providing a broad range of services to the Greater Westfield community. BNH is able to offer direct access to world-class technology, diagnostics, and specialists as a proud member of Baystate Health. Together, we passionately work to ensure that our patients have access to exceptional health care, close to home. An ideal combination of "high tech and "high touch," a staff of highly trained and compassionate nurses and medical support personnel complements an outstanding medical staff. Services include intensive care, diagnostic imaging, emergency services, cardiopulmonary services and rehab, cancer services, lab and behavioral health.
Form 990, Part VI, Line 6	Baystate Medical Practices (BMP) is a tax-exempt, not-for-profit corporation organized to support and assist Baystate Health and its affiliate hospitals, including BMC, BFMC, BMLH, BWH and BNH each of which is a Massachusetts not-for-profit corporation, in achieving the fulfillment of their clinical, teaching, research, and other missions related to health care. 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 and consistent with BH and BMP policy, BMP may provide such care free of charge or at amounts below its normal charges. In FY 2015 BMP provided $2,373,564 in charity care. 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. 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.Visiting Nurse Association and Hospice of Western New England, Inc. (BVNAH) based in Springfield, Massachusetts is a tax-exempt, not-for-profit corporation organized to support and assist Baystate Health and its affiliate hospitals, including BMC and BMLH, each of which is a Massachusetts not-for-profit corporation, in achieving the fulfillment of their clinical, teaching, research, and other missions related to health care. BVNAH is a comprehensive home health care agency committed to providing the highest quality care to patients and families, primarily in the home setting. BVNAH has the expertise to meet individual needs by bringing experienced nurses, rehabilitation therapists, social workers and home care aides to patients' homes. The Home Care Program of Baystate's Visiting Nurse Association and Hospice serves over 6,950 home health and hospice patients annually of which approximately 995 are on service daily. Home Care services are aimed at allowing patients to recuperate and achieve independence with their own care in the comfort of their homes. The Hospice and Palliative Care Program of Baystate's Visiting Nurse Association and Hospice provides end of life care for patients in the community, assisted living facilities and skilled nursing facilities. Hospice has an interdisciplinary approach using nursing, social work, chaplains, hospice aides and volunteers to provide patients and their families with comfort and symptom management. The Hospice and Palliative Care program coordinates care for an average daily census of about 170 patients of all ages. In FY 2015 there were approximately 110,000 home health, hospice and palliative visits rendered by Baystate Visiting Nurse Association & Hospice nurses. Baystate Health Foundation raised $3.5 million in fiscal year 2015 for the Baystate Franklin Surgery Center Expansion and an additional $4.0 million through system wide annual fundraising efforts. Along with the Campaign for Baystate Franklin Surgery Center, the Foundation actively engaged in annual fund, major gift, and event fundraising to ensure ongoing annual support for education, research, programs and capital needs throughout the health system that impact patient care throughout western Massachusetts.In addition to the brief descriptions of the affiliated entities above, this further information speaks to activities of Baystate Health and its affiliates regarding promotion of community health.In FY 2015 Baystate Health's Interpreter and Translation Services provided over 196,684 sessions in 70 languages to help deliver a positive patient care experience. In addition, nearly 4,693 pages of documents, signs and clinical research were translated for providers. Interpreter sessions included in person, telephonic and video interpreting for American Sign Language. Baystate Health has more than 60 staff interpreters throughout our health system for American Sign Language, Arabic, Mandarin, Nepali, Polish, Portuguese, Romanian, Russian, Somali, Spanish, Ukrainian and Vietnamese. Baystate Health also contracts with local agencies to provide in-person interpreter services as needed for patients who come to Baystate Medical Center for pre-scheduled appointments or for emergencies for languages not covered by staff interpreters, such as Swahili. The heath system contracts with a telephonic interpreting company by which any staff member can pick up any house phone, dial an internal extension and be nearly immediately connected to a national telephonic interpreting agency that provides trained and competent interpreters for over 200 languages. BH also subscribes to software called Care Notes by Micromedex that provides information on illnesses for patients or their family members in 15 languages and the documents are written at a 5th grade reading level. Similarly, BH purchased software called Exit Writer from Krames that was integrated into the patient's electronic medical record. Information in five languages about illnesses and aftercare instructions can be provided to patients and their family members and be documented in the patient's electronic medical record as patient education automatically. Baystate Health also added 20 video interpreting units to better assist our Deaf patients and their family members, and also assist patients that speak any of the other 15 languages that are now available at our five (5) hospitals. Baystate Medical Center is recognized as a leading academic medical center. As the Western Campus of Tufts University School of Medicine since 1974, BMC offers clinical training and undergraduate and graduate medical student education across all specialties. In addition to BMC, medical residents and fellows rotate through Baystate Franklin Medical Center and Baystate Mary Lane Hospital.Baystate Health is a nationally accredited provider of continuing education for health care professionals, including physicians, nurses, pharmacists, mental health counselors and psychologists. We also arrange credit for other health care professionals. Baystate provides both live and web based courses. Our educational activities are designed for Baystate staff and non Baystate health care professionals throughout Western New England. Our mission is to provide high-quality, evidence based continuing education to maintain and enhance the knowledge, expertise, and performance of health care professionals, to improve the health of the people in our communities every day, with quality and compassion. In 2015, Baystate Health provided a total of 440 hours of continuing education instruction. Total attendance for credit bearing activities was 3,292. Our educational activities are a service to the community.
Form 990, Part VI, Line 6	Baystate Medical Center's Midwifery Education Program is offered in collaboration with the Midwifery Institute of Philadelphia University. Through our affiliation with the Massachusetts College of Pharmacy and Health Science, we offer a one-year pharmacy residency. Baystate Health's educational partnerships allow us to offer allied health programs such as emergency medical technician (EMT), pharmacy technician and surgical technologist. For nursing we offer clinical practicums for baccalaureate, masters, or doctoral-level nursing students in affiliation with the University of Massachusetts, University of Connecticut, Yale University, and other schools of nursing. Baystate Medical Center's high quality nursing care earned re-designation as a Magnet Hospital for Nursing Excellence by the American Nurses Credentialing Center (ANCC) - one of 170 in the nation and only five in Massachusetts. As an academic teaching hospital and the Western Campus of Tufts University School of Medicine, Baystate Medical Center is a center for research. Strong partnerships with other research organizations allow BMC to further its institutional commitment to improve the health of the community through research and education. Collaborations enable Baystate Health to better support the innovative research of our investigators and to improve the lives of the people in the communities we serve. Baystate Medical Center is an active participant in the research communities of Massachusetts and a member institution of the state and regional organizations that also promote the goals of biomedical research. Its faculty and research staff are engaged in basic, clinical and biomedical research across a broad spectrum of medical and surgical specialties, with nationally-recognized research programs in quality of care. Baystate Medical Center serves as a regional resource for specialty medical care while providing comprehensive primary medical services to its community.Baystate Medical Center is also a research partner with University of Massachusetts through the Pioneer Valley Life Sciences Institute. Formed in 2003, PVLSI is a research institution which applies its translational research efforts in the areas of cancer, diabetes, obesity, and wound healing. Its scientists and technicians are committed to improving human health and reducing suffering from disease through creative strategies for early detection and preventive interventions. Other Baystate Health affiliations include Council of Teaching Hospitals and Health Systems (COTH) of the Association of American Medical Colleges (AAMC), Alliance of Independent Academic Medical Centers (AIAMC), and Group on Regional Medical Campuses (GRMC) of the Association of American Medical Colleges (AAMC), Joint Commission and Medical Library Association (MLA)Baystate Health and its affiliates are committed to creating healthier communities and continue to partner with members of the community to ensure we are meeting the diverse needs of the community. Baystate Health extends the traditional definition of "health" to include economic opportunity, affordable housing, quality education, safe neighborhoods, food security, arts/culture and racism and homophobia free communities -- all elements that enable families and communities to thrive. In keeping with this commitment to improve health Baystate Health and its affiliates provide a range of community benefits including support groups, financial counseling and assistance and other health and wellness programs. As an integrated delivery system BH provides further benefits to the hospital's community by coordinating within and among its various entities.Baystate Health and its affiliates are committed to providing the communities they serve throughout western Massachusetts with the resources necessary to stay informed and healthy by providing both basic and extensive educational opportunities such as parent education classes, including our new program "Baystate's New Beginnings". Also offered are breastfeeding classes, a "Just for Dads" class, Prenatal/Postnatal Yoga and infant/toddler safety classes. We also offer Babysitter's Academy, which provides a full day class for teens. Some classes are free while others are offered at a reasonable fee. No one is turned away due to inability to pay. Baystate Health offers many free parenting support groups including breastfeeding gatherings, new parents groups, toddler groups, parents of multiples groups, and a MotherWoman support group. Most of these groups meet weekly. In addition, Baystate Health has libraries and resource centers at Baystate Medical Center and Baystate Franklin Medical Center staffed by professionals who help patients, families and the general public access reliable health information.The Mini-Medical School program is an eight-part health education series offered at Baystate Medical Center featuring a different aspect of medicine each week. Designed for an adult audience, each course is taught by an energetic faculty member who will explain the science of medicine without resorting to complex terms. Mini-Medical School gives Baystate Health the opportunity to open our doors to the public and share our knowledge of medicine in a comfortable and friendly environment. Many of the students participate due to a general interest and later find that many of the things they learned over the semester are relevant to their own lives. The goal of this program is to help members of the public make more informed decisions about all aspects of their health care while receiving insight on what it's like to be a medical student. Tuition is $95 per person, $80 for Senior Class and Spirit of Women members. Baystate Health offers 50+ free programs to seniors and women. Baystate Health Senior Class is a loyalty program dedicated to health and wellness for men and women ages 55 and over. The 23,000 Senior Class members receive a quarterly newsletter with valuable health information, benefits and invitations to special events designed with their interests in mind. Baystate Spirit of Women Loyalty Program offers its 15,000 members 50+ monthly seminars with direct access to physicians, nurses and other medical professionals and the latest women's health information. The program is designed to increase knowledge of women's health issues so they are well prepared to make the best decisions regarding their health.Named in honor of our past President and CEO, the Mark R. Tolosky Baystate Neighbors Program provides forgivable loans to Baystate Health employees purchasing their first homes in the communities surrounding our hosptials. Qualified employees are granted a forgivable loans up to $7,500 that may be used towards a down payment or closing costs. In FY 2015, Baystate Health granted $165,000 to 22 employees and their families. Since 1999, Baystate Health has invested nearly $1 million in the futures of more than 167 employees and their families.
Form 990, Part VI, Line 6	Since its inception in 1994, Rays of Hope has been helping women and men in the fight against breast cancer by walking alongside them on their cancer journey. Through the Baystate Health Breast Network, Rays of Hope cares for the whole person from diagnosis and beyond by supporting research at the Rays of Hope Center for Breast Cancer Research, providing funding for state-of-the-art equipment, breast health programs and outreach and education throughout Baystate Health as well as providing grants for complementary therapies and cancer programs to our community partners throughout western Massachusetts. Now in its 23rd year, Rays of Hope has raised over $13 million- all of which has been awarded locally throughout western Massachusetts.The United Way develops and supports programs that directly improve the lives of people in our communities, a mission proudly shared by Baystate Health. Baystate Health is a strong supporter of the United Way, and a major contributor to the organization with three workforce campaigns and thousands of employee donors and volunteers. Baystate Health's contributions help the United Way serve our families, friends, colleagues and others who seek help in different ways and at different times in their lives. Three community campaigns are held annually: Springfield workplace to support the United Way of Pioneer Valley, Greenfield workplace to support the United Way of Franklin County and Ware workplace to support the United Way of Hampshire County. Employees can direct their donations to one or all of the United Way's action areas: Education, Income and Health or designate to a qualified agency with a minimum contribution. Baystate Health employees once again donated generously to the United Way of the Pioneer Valley in 2015, raising a total of $351,542. Baystate Franklin Medical Center employees raised about $35,000 for the United Way of Franklin County. Baystate Mary Lane Hospital employees raised $9,413 for the United Way of Hampshire Country.See also additional information regarding Baystate Health, Inc. and its affiliates promotion of community health above in Line 5.
Form 990, Part VI, Line 7	List of States receiving community benefit report: MA.

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Baystate Mary Lane Hospital Corporation

Employer identification number

04-2103584

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Mark A Keroack MDTrustee	(i) (ii)	0 ............................... 658,452	0 ............................... 301,313	0 ............................... 20,465	0 ............................... 185,350	0 ............................... 18,006	0 ............................... 1,183,586	0 ............................... 0
2Grace P Makari-Judson MDTrustee/ Hematologist, MD	(i) (ii)	300,766 ............................... 0	36,984 ............................... 0	32,094 ............................... 0	53,652 ............................... 0	31,839 ............................... 0	455,335 ............................... 0	0 ............................... 0
3Kevin P Moriarty MDTrustee 1/1-9/30/15/Chief Ped Surger	(i) (ii)	467,406 ............................... 0	92,796 ............................... 0	34,106 ............................... 0	27,300 ............................... 0	16,350 ............................... 0	637,958 ............................... 0	0 ............................... 0
4Scott Siege MDTrustee/Med Dir Mary Lane Peds	(i) (ii)	207,150 ............................... 0	36,458 ............................... 0	700 ............................... 0	16,148 ............................... 0	14,338 ............................... 0	274,794 ............................... 0	0 ............................... 0
5Charles E Cavagnaro III MDPresident	(i) (ii)	0 ............................... 355,821	0 ............................... 57,708	930,507 ............................... 9,193	0 ............................... 340,358	0 ............................... 17,267	930,507 ............................... 780,347	930,418 ............................... 4,821
6Dennis W ChalkeTreasurer	(i) (ii)	0 ............................... 432,876	0 ............................... 264,360	0 ............................... 231,815	0 ............................... 55,591	0 ............................... 24,054	0 ............................... 1,008,696	0 ............................... 0
7Mohammed S Ahmed MDCMO - Eastern Region	(i) (ii)	338,170 ............................... 0	69,601 ............................... 0	28,257 ............................... 0	129,515 ............................... 0	13,479 ............................... 0	579,022 ............................... 0	0 ............................... 0
8Lisa A BeaudryDirector of Nursing	(i) (ii)	131,105 ............................... 0	15,323 ............................... 0	7,156 ............................... 0	24,786 ............................... 0	5,843 ............................... 0	184,213 ............................... 0	0 ............................... 0
9Charles GilbertMgr Inpatient Pharmacy BMLH	(i) (ii)	135,713 ............................... 0	0 ............................... 0	2,201 ............................... 0	18,062 ............................... 0	13,443 ............................... 0	169,419 ............................... 0	0 ............................... 0
10Mark R ToloskyPresident Emeritus, BH	(i) (ii)	0 ............................... 571,202	0 ............................... 306,472	0 ............................... 211,359	0 ............................... 202,614	0 ............................... 31,386	0 ............................... 1,323,033	0 ............................... 0
11Charles D GijantoFormer President, BFMC	(i) (ii)	0 ............................... 187,869	0 ............................... 65,597	0 ............................... 81,395	0 ............................... 15,597	0 ............................... 8,501	0 ............................... 358,959	0 ............................... 0

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference

Explanation

Part I, Line 3

The compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) has been appointed through board resolution as the compensation committee of the filing organization. The compensation committee reviews and approves the compensation philosophy that is used to administer the specific pay decisions for the President of the filing organization. The compensation committee consists entirely of individuals serving on the board of the filing organization. The compensation of the President of the filing organization is determined by the member of the President's Cabinet (the Health System's senior leadership) responsible for that filing organization, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data and based on the Executive Compensation Philosophy Statement established by the compensation committee.

Part I, Line 4b

Mohammed Shafeeq Ahmed, MD - Supplemental Retirement of $15,843 is included in column E. This amount was earned and paid in 2014. Charles Cavagnaro III, MD - Supplemental Retirement of $236,081 is included in column E. This amount was paid in 2014. Dennis W. Chalke - Supplemental Retirement of $146,489 is included in column E. This amount was earned and paid in 2014. Charles Gijanto - Supplemental Retirement of $16,384 is included in column E. This amount was earned and paid in 2014. Mark A. Keroack, MD - Supplemental Retirement of $164,550 is included in column E. This amount was earned in 2014. Grace Makari-Judson, MD- Supplemental Retirement of $15,889 is included in column E. This amount was earned and paid in 2014. Kevin P. Moriarty, MD - Supplemental Retirement of $31,163 is included in column E. This amount was earned and paid in 2014. Mark R. Tolosky - Supplemental Retirement of $150,900 is included in column E. This amount was earned and paid in 2014.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

Baystate Mary Lane Hospital Corporation

Employer identification number

04-2103584

Return Reference	Explanation
Form 990, Part VI, Section A, line 1	a. The filing organization has a standing executive committee, which is entitled to act between meetings of the Board, on all matters as to which the Board is entitled to act and permitted by law to delegate to a committee. The members of the executive committee are the same individuals serving on the executive committee of Baystate Health, Inc.
Form 990, Part VI, Section A, line 2	M. Shafeeq Ahmed, MD, Robert J. Bacon, Gregory L. Braden, MD, Charles E. Cavagnaro III, MD, Dennis W. Chalke, John H. Davis, Kristin R. Delaney, Harriet A Deverry, John A. Egelhofer, MD, Charles Gijanto, Mark A. Keroack, MD, John E. Kole, Grace P. Makari-Judson, MD, John F. Maybury, Steven M. Mitus, Kevin P Moriarty, MD, Paul R. Murphy, Edward Noonan, John M. O'Brien, III, Anne M. Paradis, James Phaneuf, CIC, Robert L. Pura, PhD, Timothy S. Rice, James P. Sadowsky, Kathleen B. Scoble, Scott Siege, MD, David C. Southworth, Richard B. Steele, Jr., Katherine McG.Sullivan, Hector Toledo, Mark R. Tolosky, Madeline Torres, Howard G. Trietsch, MD and Victor Woolridge are officers or trustees of its affiliated entities. The following trustees, officers, or key employees serve on a common board of a non-affiliated entity: (1) John H. Davis and James P. Sadowsky (2) Richard B. Steele, Jr., Katherine McG Sullivan, James P. Sadowsky and John H. Davis (3) Steven M. Mitus, Robert L. Pura, PhD and John H. Davis (4) John F. Maybury, David C. Southworth, Mark A. Keroack MD and John H. Davis (5) John E. Kole and Richard B. Steele, Jr. (6) Steven M. Mitus and David C. Southworth (7) Charles E. Cavagnaro, III,MD and James R. Phaneuf (8) John F. Maybury and Anne M. Paradis (9) John M. O'Brien, III and Victor Woolridge
Form 990, Part VI, Section A, line 3	Baystate Mary Lane Hospital 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 filing organization has one member, Baystate Health, Inc. (BH).
Form 990, Part VI, Section A, line 7a	The Board of Trustees of the filing organization are the same individuals serving as members of the Board of Trustees of BH with the addition of the president of the medical staff of the filing organization. The Board of Trustees of BH are elected annually by the Board of Trustees of BH at their annual meeting.
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. The entire return was also reviewed prior to filing by the Audit and Compliance Committee of Baystate Health, Inc., which also includes some of the officers and trustees of the filing organization. The Form 990 was provided to all members of the Board of Trustees prior to filing.
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 Legal Counsel, 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 committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) has been appointed through board resolution as the compensation committee of the filing organization. The compensation committee reviews and approves the Executive Compensation Philosophy Statement that is used to administer the specific pay decisions for the President and employees of the filing organization. The compensation committee consists entirely of individuals serving on the board of the filing organization. The compensation of the President of the filing organization is determined by the member of the President's Cabinet (the Health System's senior leadership) responsible for that filing organization, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data and based on the Executive Compensation Philosophy Statement established by the compensation committee. The salaries of other employees of the filing organization are determined by the President of the filing organization in accordance with the Executive Compensation Philosophy Statement or the Baystate Health Board approved budget and wage program for each fiscal year.
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, Column (B)	Individuals with such reported compensation who have 10 or less 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. (BMP) EIN 04-2888373, which is part of the health care system to which the filing organization belongs but 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.
Form 990, Part XI, line 9:	Transfer of funds for land,bldg. & equip. from affiliated companies 3,901. Minimum Pension Liability Adjustment -2,478,732. Change in value of beneficial interest in net assets of BHF-Temp Restricted 31,505. Change in value of beneficial interest in net assets of BHF-Perm Restricted -660,451. Transfers from Affiliate 883,000. Rounding Adjustment 3.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Baystate Mary Lane Hospital Corporation

Employer identification number

04-2103584

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Baystate Administrative Services Inc 759 Chestnut Street Springfield,MA01199 22-2747685	Administrative services	MA	501 (c ) (3)	11c, IIIc	Baystate Health Inc		No
(2) Baystate Franklin Medical Center 164 High Street Greenfield,MA01301 04-2103575	Hospital	MA	501 (c ) (3)	3	Baystate Health Inc		No
(3) Baystate Health Foundation Inc 759 Chestnut Street Springfield,MA01199 04-3549011	Fundraising	MA	501 (c ) (3)	7	Baystate Health Inc		No
(4) Baystate Health Systems Inc Health & Welfare Benefits Plan 759 Chestnut Street Springfield,MA01199 22-2531644	Voluntary Employees' Benefit Association	MA	501 (c ) (9)		Baystate Health Inc		No
(5) Baystate Health Inc 759 Chestnut Street Springfield,MA01199 04-2105941	Healthcare System Parent	MA	501 (c ) (3)	7	Baystate Health Inc		No
(6) Baystate Medical Center Inc 759 Chestnut Street Springfield,MA01199 04-2790311	Acute Care Teaching Hospital	MA	501 (c ) (3)	3	Baystate Health Inc		No
(7) Baystate Total Home Care Inc 280 Chestnut Street Springfield,MA01104 20-3260764	Real Estate and Other	MA	501 (c ) (3)	11b, II	Baystate Medical Center		No
(8) Visiting Nurse Assn and Hospice of Western New England Inc 50 Maple Street Springfield,MA01199 04-2105803	Homehealth and Hospice care	MA	501 (c ) (3)	9	Baystate Health Inc		No
(9) Health New England Inc Monarch Place Suite 1500 Springfield,MA011441500 04-2864973	HMO/Insurance	MA	501 (c ) (4)		Baystate Health Inc		No
(10) Baystate Wing Hospital Corporation 40 Wright Street Palmer,MA01069 22-2519813	Hospital	MA	501 (c ) (3)	3	Baystate Health Inc		No
(11) HNE of Connecticut INC Monarch Place Suite 1500 Springfield,MA011441500 45-5190134	HMO/Insurance	CT	501 (c ) (4)		Health New England Inc		No
(12) Baystate Noble Hospital Corporation 115 West Silver Street PO Box 1634 Westfield,MA010861634 22-2537423	Hospital	MA	501 (c ) (3)	3	Baystate Health Inc		No
(13) Westfield Medical Corporation 115 West Silver Street PO Box 1634 Westfield,MA010861634 04-3127730	Physician Services	MA	501 (c ) (3)	11a, I	Baystate Noble Hospital Corporation		No
(14) Noble Visiting Nurse and Hospice Services Inc 77 Mill Street Westfield,MA01085 22-2757446	Homehealth and Hospice care	MA	501 (c ) (3)	9	Baystate Noble Hospital Corporation		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) HNE Advisory Services Inc Monarch Place Suite 1500 Springfield,MA011441500 04-3012347	Administrative Services	MA	Health New England Inc	C					No
(2) HNE Insurance Services Corporation Monarch Place Suite 1500 Springfield,MA011441500 04-3183019	Ancilliary Insurance	MA	Health New England Inc	C					No
(3) Ingraham Corporation 759 Chestnut Street Springfield,MA01199 04-3016257	Health care and other business activities	MA	Baystate Health Inc	C					No
(4) Baystate Health System Ambulance Inc 759 Chestnut Street Springfield,MA01199 04-3018550	Ambulance Svs	MA	Ingraham Corporation	C					No
(5) TTEE UW L Gilbert fbo Lane Hospital 100 Federal Street Boston,MA02110 04-6024320	Trust	MA	N/A	T			100.000 %		No
(6) BH Insurance Company Ltd North Church Street Georgetown CJ 98-0421413	Offshore captive insurance	CJ	Baystate Health Inc						No
(7) HNE Insurance Company Inc Monarch Place Suite 1500 Springfield,MA011441500 45-4462433	Health Services for Massachusetts Medicare Supplement Members	MA	Health New England Inc	C			100.000 %		No
(8) HNE Holding Corporation Monarch Place Suite 1500 Springfield,MA011441500 46-4620480	Holding shares in subsidiary corporations	MA	Health New England Inc	C					No

Schedule R (Form 990) 2014

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2014

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: The mission of the organization is to improve the health of the people in our communities every day, with quality and compassion.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	24
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	17
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	273
6	Total number of volunteers (estimate if necessary) .............	6	39
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	254,233	97,912
9	Program service revenue (Part VIII, line 2g) .........	24,310,290	25,033,188
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	471,896	406,098
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	845,691	2,477,249
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	25,882,110	28,014,447
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	14,374,354	14,718,313
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	12,986,702	12,967,565
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	27,361,056	27,685,878
19	Revenue less expenses. Subtract line 18 from line 12.......	-1,478,946	328,569
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	25,933,665	24,112,195
21	Total liabilities (Part X, line 26).............	7,241,956	7,348,772
22	Net assets or fund balances. Subtract line 21 from line 20.....	18,691,709	16,763,423

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 7,671,659 including grants of $ ) (Revenue $ 6,996,944 )
	Inpatient healthcare services - Providing inpatient community-based medicine and tertiary care to the surrounding region. Services are available to individuals regardless of their ability to pay. During FY15, Baystate Mary Lane Hospital Corporation provided 2,602 patient days of inpatient services, with 954 discharges.

4b	(Code: ) (Expenses $ 10,501,390 including grants of $ ) (Revenue $ 10,186,495 )
	Outpatient healthcare services - Providing outpatient clinical services to the surrounding region. Services are available to individuals regardless of their ability to pay. During FY15, Baystate Mary Lane Hospital Corporation had 49,751 outpatient visits.

4c	(Code: ) (Expenses $ 6,655,212 including grants of $ ) (Revenue $ 6,547,863 )
	Emergency department services - Providing emergency department services to the surrounding region. Services are available to individuals regardless of their ability to pay. During FY15, Baystate Mary Lane Hospital Corporation had 14,589 emergency department visits.

	(Code: ) (Expenses $ 764,271 including grants of $ ) (Revenue $ 3,573,283 )


4d	Other program services (Describe in Schedule O.)
	(Expenses $ 764,271 including grants of $ ) (Revenue $ 3,573,283 )
4e	Total program service expenses25,592,532

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,207,021	3,891,696	1,365,574

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		97,912

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			97,912
			Business Code
2a	Patient Service Revenue		900099	24,451,495	24,451,495
b	Rental Income from related org		532000	496,753	496,753
c	CMS ELEC MED REC FDG		900099	84,940	84,940
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			25,033,188
3	Investment income (including dividends, interest, and other similar amounts).......			422,121			422,121
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	244,153
b	Less: rental expenses	274,367
c	Rental income or (loss)	-30,214
d	Net rental income or (loss).......			-30,214			-30,214
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	9,944,201
b	Less: cost or other basis and sales expenses	9,960,224
c	Gain or (loss)	-16,023
d	Net gain or (loss)..........			-16,023			-16,023
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	Pension Curtailment		525100	1,531,315	1,531,315
b	Intercompany Charges		900099	280,977	280,977
c	Insurance Property Reimbursement		900099	238,413	238,413
d	All other revenue ....			456,758	220,692		236,066
e	Total. Add lines 11a–11d ......			2,507,463
12	Total revenue. See Instructions......			28,014,447	27,304,585	0	611,950


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............				1
2	Savings and temporary cash investments .........			4,757,627	2	3,560,127
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			2,801,726	4	2,708,822
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			739,393	8	790,152
9	Prepaid expenses and deferred charges ..........			150,482	9	208,844
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	38,212,952
b	Less: accumulated depreciation .....	10b	29,006,699	8,921,235	10c	9,206,253
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			8,563,202	15	7,637,997
16	Total assets. Add lines 1 through 15 (must equal line 34)......			25,933,665	16	24,112,195
17	Accounts payable and accrued expenses .........			3,383,261	17	3,219,614
18	Grants payable .................				18
19	Deferred revenue ................			142,674	19	276,105
20	Tax-exempt bond liabilities .............				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			3,716,021	25	3,853,053
26	Total liabilities. Add lines 17 through 25.........			7,241,956	26	7,348,772
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			10,910,633	27	9,611,293
28	Temporarily restricted net assets ...........			574,186	28	605,691
29	Permanently restricted net assets ...........			7,206,890	29	6,546,439
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			18,691,709	33	16,763,423
34	Total liabilities and net assets/fund balances ........			25,933,665	34	24,112,195