TY 2017 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) Anne M Paradis...................................................................... Chair	1.00 ................. 2.00	X	X	0	0
(2) John F Maybury...................................................................... Vice Chair	1.00 ................. 1.00	X	X	0	0
(3) Adrian J Levsky...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(4) Claudia R Coplein DO...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(5) Colleen W Holmes...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(6) Edward J Noonan...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(7) Grace Makari-Judson MD...................................................................... Trustee/Hematologist (thru 12/31/17)	1.00 ................. 40.00	X		340,368	77,945
(8) Gregory L Braden MD...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(9) Harriet A DeVerry...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(10) Hector Toledo...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(11) Irene Rodriguez Martin...................................................................... Trustee (as of 1/1/18)	1.00 ................. 1.00	X		0	0
(12) James P Sadowsky...................................................................... Trustee (through 12/31/17)	1.00 ................. 2.00	X		0	0
(13) James R Phaneuf...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(14) John A Egelhofer MD...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(15) John H Davis...................................................................... Trustee (through 12/31/17)	1.00 ................. 1.00	X		0	0
(16) Kathleen B Scoble...................................................................... Trustee	1.00 ................. 1.00	X		0	0
(17) Kevin P Moriarty MD...................................................................... Trustee/Chief Ped Surg	1.00 ................. 40.00	X		686,449	38,262

(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) Maria P Goncalves........................................................................ Trustee (as of 1/1/18)	1.00 .......................1.00	X					0	0	0
(19) Mark A Keroack MD........................................................................ Trustee	1.00 .......................49.00	X					0	1,888,794	32,862
(20) Michael P Albert MD........................................................................ Trustee	49.00 .......................1.00	X					331,391	0	59,976
(21) Paul R Murphy........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(22) Robert J Bacon........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(23) Robert L Pura PhD........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(24) Timothy F Farrell........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(25) Victor Woolridge........................................................................ Trustee (through 12/31/17)	1.00 .......................1.00	X					0	0	0
(26) William R Webber........................................................................ Trustee	1.00 .......................1.00	X					0	0	0
(27) Nancy Shendell-Falik........................................................................ President	27.00 .......................23.00		X				0	840,145	211,038
(28) Dennis Chalke........................................................................ Treasurer	26.00 .......................24.00		X				0	994,659	87,008
(29) Kristin R Delaney........................................................................ Clerk	1.00 .......................39.00		X				0	143,978	37,512
(30) Madeline Torres........................................................................ Assistant Clerk	1.00 .......................40.00		X				0	57,772	15,600
(31) Christine Klucznik........................................................................ VP/ CNO	50.00 .......................0.00			X			0	361,915	26,959
(32) Tejas Gandhi........................................................................ VP/ COO	50.00 .......................1.00			X			0	514,558	40,018
(33) Peter Friedmann MD........................................................................ Assoc Dean Chief Res Officer	50.00 .......................0.00				X		405,233	0	48,388
(34) Douglas Salvador MD........................................................................ SVP/ Chief Quality Officer	50.00 .......................0.00				X		148,716	247,381	36,199
(35) Peter Lindenauer MD........................................................................ Asst Dean Population Health	50.00 .......................0.00				X		370,790	0	49,671
(36) Vishal Tiwari MD........................................................................ Assoc Med Dir Hosp Care Mgmt	50.00 .......................0.00				X		331,951	0	34,482
(37) Amy Gottleib MD........................................................................ Assoc Dean Chief Fac Devel	50.00 .......................0.00				X		328,938	0	20,404
(38) Deborah A Provost........................................................................ Former Chief Regulatory Officer	25.00 .......................25.00					X	283,939	0	74,164

(A) Name and business address	(B) Description of services	(C) Compensation
Baystate Administrative Services Inc 759 Chestnut Street Springfield,MA01199	Management Svcs.	93,046,965
Baystate Medical Practices Inc 759 Chestnut Street Springfield,MA01199	Medical, Educ, Clin	67,830,729
Shields Specialty Pharmacy of Springfiel 1200 Hancock St 300 Quincy,MA02169	Management Svcs.	7,226,477
Shiftwise 1800 SW 1st Ave Suite 510 Portland,MA97201	Contract Svcs.	5,285,839
Mayo Clinic Laboratories PO Box 9146 Minneapolis,MN55480	Contract Svcs.	4,840,443
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 176

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Baystate Medical Center Inc

Employer identification number

04-2790311

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 12, 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 (Form 990 or 990-EZ).)

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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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 (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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 section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

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

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 9a) 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 9a) 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 section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b 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

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) 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) 2019

Page 6

Part V

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

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). 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

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) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

Baystate Medical Center Inc

Employer identification number

04-2790311

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization Baystate Medical Center Inc

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization Baystate Medical Center Inc		Employer identification number 04-2790311

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization Baystate Medical Center Inc			Employer identification number 04-2790311
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on 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 Medical Center Inc

Employer identification number

04-2790311

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(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

290,777

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

290,777

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-i	Baystate Medical Center, Inc. pays membership dues to the Massachusetts Hospital Association (MHA), the American Hospital Association (AHA) and the National Association of Urban Hospitals. These organizations have advised us that portions of these dues are used for lobbying purposes for various healthcare matters at the state level. The portion of dues listed as lobbying expenses for the year ending September 30, 2018 is $290,777.

Return Reference

Explanation

Part II-B, Line 1-i

Baystate Medical Center, Inc. pays membership dues to the Massachusetts Hospital Association (MHA), the American Hospital Association (AHA) and the National Association of Urban Hospitals. These organizations have advised us that portions of these dues are used for lobbying purposes for various healthcare matters at the state level. The portion of dues listed as lobbying expenses for the year ending September 30, 2018 is $290,777.

Schedule C (Form 990 or 990EZ) 2019

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," on 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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Baystate Medical Center Inc

Employer identification number

04-2790311

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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" on 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 7/25/06, 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 FASB 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 on 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 FASB ASC 958 relating to these items:

Revenue included on 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) 2019

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(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

Term endowment SchDMd Bullet

The percentages on 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" on 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" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	12,535,382		12,535,382
b	Buildings ....	757,077,149	319,539,597	437,537,552
c	Leasehold improvements	5,849,806	2,457,101	3,392,705
d	Equipment ....	662,151,675	567,677,229	94,474,446
e	Other .....	54,751,239	37,085,483	17,665,756
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				565,605,841

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on 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........	1,683,664	C
(3) Other (A) Securities other	96,536,519	C
(B) Securities real estate	1,479,798	C
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	99,699,981

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	44,383,791
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) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on 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' on 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
Schedule D, Part V	Certain endowments are held at Baystate Health Foundation, Inc. (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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Baystate Medical Center Inc

Employer identification number

04-2790311

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) . . .	13,687,136	4,010,450	9,676,686	0.810 %
b	Medicaid (from Worksheet 3, column a) . . . . .	236,497,050	207,702,155	28,794,895	2.400 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	2,878,882	2,568,616	310,266	0.030 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	253,063,068	214,281,221	38,781,847	3.240 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	2,300,323	0	2,300,323	0.190 %
f	Health professions education (from Worksheet 5) . . .	59,522,591	18,686,207	40,836,384	3.410 %
g	Subsidized health services (from Worksheet 6) . . . .	19,130,085	13,067,610	6,062,475	0.510 %
h	Research (from Worksheet 7) .	18,848,513	12,970,955	5,877,558	0.490 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	492,314	0	492,314	0.040 %
j	Total. Other Benefits . .	100,293,826	44,724,772	55,569,054	4.640 %
k	Total. Add lines 7d and 7j .	353,356,894	259,005,993	94,350,901	7.880 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

6,248,752

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. ......

798,637

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).....

311,706,578

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

289,016,353

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

22,690,225

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) 2019

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?1Name, 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 Medical Center Inc 759 Chestnut Street Springfield,MA01199 2339	X	X	X	X	X	X

Schedule H (Form 990) 2019

Page 4

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 Medical Center Inc
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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

6 a

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. ............................

Yes

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 narratives

Other website (list url): See Part V narratives

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 16

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

Yes

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

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

12b

If "Yes" on 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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Baystate Medical Center Inc
Name of hospital facility or letter of facility reporting group

Yes

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 150.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

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)

Was widely publicized 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-financial-assistance

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

https://www.baystatehealth.org/patients/billing-and-financial-assistance

A plain language summary of the FAP was widely available on a website (list url):
https://www.baystatehealth.org/patients/billing-and-financial-assistance

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Baystate Medical Center Inc
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

Did the hospital facility or other authorized 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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	Baystate Medical Center Inc
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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 Medical Center, Inc.	Part V, Section B, Line 5: A wide range of stakeholders took part in the 2016 Coalition CHNA process, including local and regional public health and health departments, other local municipal agencies, diverse community-based organizations, advocacy organizations, healthcare providers, and community residents. These stakeholders provided input through focus groups, key informant interviews and participation in the CHNA Steering Committee. Additionally, community listening sessions were conducted to vet findings with community members.The following organizations/community stakeholders were interviewed: Public Health Experts: Caulton-Harris, Helen, Commissioner of Public Health, City of Springfield; Dennis, Soloe, Western Region Director, Massachusetts Department of Public Health (MDPH); Garcia, Luz Eneida, Care Coordinator, MDPH Division for Perinatal, Early Childhood and Special Needs, Care Coordination Unit; Hyry-Dermith, Dalila, Supervisor, MDPH Division for Perinatal, Early Childhood and Special Needs, Care Coordination Unit; Merriam, Carolyn, Public Health Nurse, Town of Ware; Metcalf, Judy, Director, Quabbin Health District; O'Leary, Meredith, Director, Northampton Health Department; Steinbock, Lisa, Public Health Nurse, City of Chicopee; Walker, Phoebe, Director of Community Services, Franklin Regional Council of Governments (FRCOG); and White, Lisa, Public Health Nurse, Franklin Regional Council of Governments (FRCOG). Community Leaders or Health or Other Agencies Interviewed: Adzigirey, Liliya, Translator/ Interpreter, Baystate Noble Hospital; Azeez, Robert, Medicaid Behavioral Health Manager, Health New England; Balder, Dr. Andrew, Director, Mason Square Neighborhood Health Center and Health Care for the Homeless; Beck-Brewer, Joni, Vice President, Patient Services, Square One; Benjamin, Dr. Evan, Chief Quality Officer and Sr. VP of Quality and Population Health, Baystate Health; Blanchet, M.D., Jacques, Director of the Emergency Department, Baystate Noble Hospital; Boos, Dr. Stephen, Medical Director, Baystate Family Advocacy; Bouthillette, Marianne, Director of Child and Family Services, Parent Child Development Center, Community Action of the Franklin, Hampshire and North Quabbin Regions; Bradley, Leah, Director of Behavioral Health, Baystate Wing Hospital Griswold Center; Cardaropoli, Antonia, School Adjustment Counselor, Ware Junior/Senior High School; Cox, Jennifer, Director of Behavioral Health, Baystate Franklin Medical Center; Crowley, Kelley, Administrative Director of Behavioral Health, Baystate Noble Hospital; Cummings, Sara, Director of Community Services and Asset Development, Community Action of the Franklin, Hampshire and North Quabbin Regions; Davis, Kim, Nurse Manager, Baystate Mary Lane Hospital; Di Leo, Marlene, Superintendent, Ware Public Schools; Durkin, Dr. Louis, Director of Emergency Medicine, Mercy Medical Center; Gerard, Mary Beth, WIC Director, Community Action of the Franklin, Hampshire and North Quabbin Regions; Hettler, Dr. Joeli, Chief, Pediatric Emergency Medicine, Baystate Health; Higgins, Clare, Executive Director, Community Action of the Franklin, Hampshire and North Quabbin Regions; Jean-Guillaume, M.D., Rock, Chair of Emergency Medicine, Baystate Wing Hospital; Jock, Jacqueline, School Adjustment Counselor, Ware Middle School; Johnson, Yolanda, Executive Officer for Student Services, Springfield Public Schools; LaBounty, Kerry, Medicaid Program Manager, Health New England; Manser, Katherine, WIC Senior Nutritionist, Community Action of the Franklin, Hampshire, and North Quabbin Regions; Martoccia, Roseann, Executive Director, LifePath; Ostiguy, Karen, Nurse Manager, Baystate Wing Hospital; Paulson, Tina, Nurse Manager, Baystate Mary Lane Hospital; Plourde, Annette, RN, Nurse, Monson Medical Center; Rathlev, Dr. Niels, Chair, Emergency Medicine, Baystate Health; Reilly, Elizabeth, Hardwick Youth Center and Food Pantry; Roose, Dr. Robert, Chief Medical Officer, Addiction Services for the Sisters of Providence Health System; Member of the Governor's Task Force on Opioid Abuse; Russo-Appel, Dr. Maria, Chief Medical Officer, Providence Behavioral Health Hospital (PBHH); Shaver, John, Chief Financial Officer, Baystate Noble Hospital; Shendell-Falik, Nancy, President, Baystate Medical Center and Sr. VP, Hospital Operations, Baystate Health; Silva, David, Medicaid Community Leader, Health New England; Spain, M.D., Jackie, Medicaid Program Medical Director, Health New England; Talati, M.D., Rakesh, Chair of Emergency Medicine, Baystate Franklin Medical; Taylor, Charles, Reverend, United Church of Ware; Velazquez, M.D., Louis, Baystate Wing Griswold Center. The following individuals served on the CHNA Steering Committee, which met monthly over the course of a year with the Coalition and CHNA Consultant Team: Allard, Andrea, President/CEO, YMCA of Westfield; Amador, Ruth, President, National Association of Hispanic Nurses -Western MA Chapter; Ayres, Jim, President and CEO, United Way of Hampshire County; Barber, Tania, President/CEO, Caring Health Center; Blanchette, Mary Ellen, Nurse Leader, Palmer Public Schools; Caisse, Ed, C3/Safe Neighborhood Initiative - South Holyoke, Hampden County Sheriff's Department; Christopolis, Dave, Executive Director, Hilltown CDC; Garozzo, Salvatore, Executive Director, United Cerebral Palsy Assoc. of Berkshire County, Inc.; Graves, Marie, Program Director, Springfield Dept. Health & Human Services; Rudder, Shannon Executive Director, MotherWoman; Lee, Jennifer, Systems Advocate for Change, Stavros Center for Independent Living; Lewandowski, Sue, Representative for Worcester County, Assumption College; Lopez, Luz, Director, MetroCare of Springfield; McCafferty, Gerry, Director of Housing, City of Springfield, Office of Housing; Prullage, Beth, Clinical Social Worker, Providence Behavioral Health; Reeves, Halley, Community Health Planning And Engagement Specialist, MA Dept. of Public Health; Silverman, Risa, Coordinator, Office for Public Health Practice & Outreach, UMASS Amherst School of Public Health and Health Sciences; Simmons, Tony, Community Liaison, Hampden County District Attorney's Office; Simonds, Jane, Sr. Program Manager, Behavioral Health Network - Outpatient Services; Walker, Phoebe, BFMC CBAC Co-chair, Franklin Regional Council of Governments (FRCOG); Wilson, Gloria, Member Western MA Black Nurses Association; Wood, Ben, Healthy Community Design Coordinator, MA Dept. of Public Health.
Baystate Medical Center, Inc.	Part V, Section B, Line 6a: In 2016, in partnership with the Coalition of Western MA Hospitals/Insurer, the hospital facility conducted a community health needs assessments ("CHNA") of the geographic area served by the hospital facility. The Coalition of Western Massachusetts Hospitals/Insurer ("Coalition"), a partnership between nine (9) not-for-profit hospitals and an insurer in Western Massachusetts that includes: Baystate Medical Center, Baystate Franklin Medical Center, Baystate Noble Hospital, Baystate Wing Hospital (including Baystate Mary Lane Outpatient Center), Holyoke Medical Center, Cooley Dickinson Hospital, Mercy Medical Center (a member of Trinity Health-New England), Shriners Hospitals for Children-Springfield , and Health New England, a local health insurer whose service area covers the four counties of Western Massachusetts.
Baystate Medical Center, Inc.	Part V, Section B, Line 6b: The Coalition of Western MA Hospitals and Insurer engaged the Public Health Institute of Western MA (PHIWM), based in Springfield, MA, as the lead consultant to conduct the CHNA's. PHIWM was supported by two other consultant teams; Community Health Solutions, based in Northampton, MA and Pioneer Valley Planning Commision (PVPC), based in Springfield, MA. The Coalition includes Health New England, a local health insurer whose service area covers the four counties of Western Massachusetts.
Baystate Medical Center, Inc.	Part V, Section B, Line 7d: The hospital facility made its CHNA report widely available to the public via an email distribution, with links to the hospital's website, to community partners and organizations. The regional findings from the CHNA reports were shared publicly at the Western MA Health Equity Summit in November 2016 (over 300 attendees). In addition, the CHNA reports have informed the development and implementation of county wide community health improvement plans. Hospital and CHNA consultant staff have been invited to various venues and audiences to present on the CHNA process and key findings.
Baystate Medical Center, Inc.	Part V, Section B, Line 11: The hospital facility anticipates health needs and available resources may change, therefore, a flexible approach was adopted in the development of its implementation strategy. For example, certain community health needs may become more pronounced and require changes to the initiatives identified by the hospital in the Strategy. Other community organizations may address certain needs, indicating that the hospital's strategies should be refocused on alternative community health needs or assume a different focus on the needs identified in the 2016 CHNA.Hospital resource inputs that will help address priority health needs include, Community Benefits Investments, Community Relations Investments, Better Together Grant Program, hospital-based community benefits activities, external grants received by hospital, and other hospital-based program/services.The hospital facility views a community benefits implementation strategy as a "LIVING" document. Due to the evolving climate in health care, the hospital's financial health year to year remains unknown; therefore hospital resources and inputs may increase, decrease, or need to be modified. The hospital's implementation strategy work plan provides an opportunity for the hospital to be strategic and focused, yet flexible in its community health planning and improvement efforts. The hospital facility, in partnership with its Community Benefits Advisory Council updates the work plan with annual outputs and outcomes for each input and activity.No health care system or hospital facility can address all the health needs present in its community. The hospital facility is committed to adhering to its mission and remaining financially healthy so that it can continue to enhance its clinical excellence and patient experience, as well as continue community health planning and improvement efforts. The hospital facility's implementation strategy does not explicitly address all the priority community health needs identified in the 2016 CHNA due to; 1. the hospital's limited resources (time, talent and financial), 2. other hospitals or community organizations within service area are addressing the need; 3. the need falls outside of the hospitals' mission or limited resource capacity. However, many, if not all of the CHNA priority health needs will be addressed INDIRECTLY by the hospital and/or community partners through existing community health planning and improvement efforts.Needs being addressed by the hospital include, basic needs (such as housing), care coordination, community safety, cultural humility, health equity, institutional racism, insurance challenges, limited availability of providers, maternal/infant/child health, mental health and substance use disorders, physical activity and healthy diet, and transportation. Needs not directly being addressed by the hospital include, chronic health conditions, environmental concerns, food deserts/insecurity, health literacy, and sexual health.
Baystate Medical Center, Inc.	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. Baystate Medical Center offers a co-payment discount program for the patients receiving services in the emergency department of the hospital. 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 Baystate Medical Center'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 Medical Center, Inc.	Part V, Section B, Line 15e: Baystate Medical Center (BMC) provides 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 BMC bills as well as about BMC discount programs. For those patients who request such assistance, the hospital assists patients by screening them for eligibility in available State Programs and assisting them in applying for such programs. When applicable, BMC 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. BMC has contracted with the Executive Office of Health and Human Services and the Commonwealth Health Insurance Connector Authority to serve as a Certified Application Couselor 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.
Baystate Medical Center, Inc.	Part V, Section B, Line 16j: Paper copies of our financial assistance policy (FAP) and the FAP application, and a FAP plain language summary as well as the Billing and Collections Policy are available upon request, in English, Spanish, and Russian, and free of charge in the hospital and by mail, as well as the hospital facilities website https://www.baystatehealth.org/patients/billing-and-financial-assistance. A plain language summary of the FAP is offered to all patientes at all registration sites including our full service health centers in the community - Baystate Brightwood Health Center and Baystate Mason Square Neighborhood Health Center. In addition, copies of the full FAP, FAP application and Billing and Collections Policy are also available at all Registrations sites.Copies of our community health needs assessment are available for viewing and download on our website at https://www.baystatehealth.org/about-us/community-programs/community-benefits/community-health-needs-assessment. Hard copies of our CHNA are available upon request free of charge. We have also shared our CHNA with all the community members who were involved with CHNA as well as each hospitals Community Benefits Advisory Council (CBAC). The hospital is committed to ongoing efforts to widely publicize our FAP and CHNA to the community, specifically, to low-income populations. Additional efforts will include promotion via our hospitals various social media platforms and providing printed materials to key social service agencies and educating their staff that work with low income populations in the hospitals service area.
Baystate Medical Center, Inc.	Part V, Section B, Line 20e: We rely on Medicaid for presumptive eligibility determinations. We would perform these actions if needed but did not have any patient during the tax year where an ECA was initiated.
Form 990, Schedule H, Part V, Line 7	7a: https://www.baystatehealth.org/about-us/community-programs/community-benefits/community-health-needs-assessment7b: http://www.cbsys.ago.state.ma.us/cbpublic/public/annual_reports_start.aspx
Form 990, Schedule H, Part V, Line 10	10a: https://www.baystatehealth.org/about-us/community-programs/community-benefits/community-health-needs-assessment

Schedule H (Form 990) 2019

Page 9

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?20
Name and address		Type of Facility (describe)
1	1 - Baystate Ambulatory Care Ctr 3300 Main Street Springfield,MA01107	Outpatient Physician Offices
2	2 - Baystate Ambulatory Care Ctr 140 High Street Springfield,MA01105	Outpatient Facility
3	3 - Baystate Breast and Wellness Center 100 Wason Avenue Suite 300 Springfield,MA01107	Outpatient Facility
4	4 - Baystate Brightwood Health Center 380 Plainfield Street Springfield,MA01107	Outpatient Clinic
5	5 - Baystate Child Hospitalziation Prog 150 Lower Westfield Road Suite 3 Holyoke,MA01040	Outpatient Facility
6	6 - Baystate Children's Specialty Center 50 Wason Avenue 1st Floor Springfield,MA01107	Outpatient Facility
7	7 - Baystate Heart & Vascular ProgImaging 10 Main Street Basement Level Florence,MA01060	Outpatient Facility
8	8 - Baystate Imaging & Transplant Services 100 Wason Avenue Ground Floor Suite 21 Springfield,MA01107	Outpatient Facility
9	9 - Baystate Mason Sq Neighborhood Hlth Ctr 11 Wilbraham Road Springfield,MA01199	Outpatient Clinic
10	10 - Baystate Orthopedic Surgery Cntr 50 Wason Avenue 2nd Floor Springfield,MA01107	Outpatient Surgery Center
11	11 - Baystate Reference Laboratories 361 Whitney Avenue Holyoke,MA01040	Outpatient Laboratory Services
12	12 - Baystate Regional Cancer Program Davis Blding 85 South St 4th Fl Ware,MA01082	Outpatient Cancer Center
13	13 - Baystate Rehabilitation Care 294 North Main Street East Longmeadow,MA01028	Rehabilitation Clinic
14	14 - Baystate Rehabilitation Care 200 Silver St Ste 101 Agawam,MA01001	Rehabilitation Clinic
15	15 - Baystate Rehab Care Adult OP Svs 360 Birnie Avenue Springfield,MA01107	Rehabilitation Clinic
16	16 - Baystate Rehabilitation Care Rymd Ctr 470 Granby Rd Ste 4 South Hadley,MA01075	Rehabilitation Clinic
17	17 - Baystate Specialty Pharmacy 3300 Main Street Springfield,MA01107	Outpatient Facility
18	18 - Baystate Vascular Services 3500 Main Street 2nd Floor Springfield,MA01107	Outpatient Facility
19	19 - BMC Pain Management Center 3400 Main Street 2nd Flr Springfield,MA01107	Outpatient Facility
20	20 - D'Amour Center for Cancer Care 3350 Main Street Springfield,MA01199	Outpatient Cancer Center

Schedule H (Form 990) 2019

Page 10

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:	The hospital facility files an annual community benefit report electronically with the Massachusetts Office of the Attorney General's via their website at http://www.mass.gov/nonprofit-hospital-and-hmo-community-benefits. The hospital facility's annual community benefit report is also published on the Baystate Health website at https://www.baystatehealth.org/about-us/community-programs/community-benefits/community-health-needs-assessment. The hospital's community benefits report provides the Office of the Attorney General and the general public important information about how the hospital partners with the community to identify and address health needs.
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 & Benefit Operations) - Community Health Improvement Services calculations are derived from direct and indirect costs associated with community benefit activities that are aligned with the hopital'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. Line 7f (Health Professional Education) - community benefit expense was derived using the organization's cost accounting system.Line 7g (Subsidized Programs) - community benefit expense was derived using the organization's cost accounting system. The expense relates to specific outpatient programs. There are no costs attributable to physician clinics reported as subsidized health services in Part I, line 7g.Line 7h (Research) - community benefit expense was derived using the organization's cost accounting system. In addition to the research costs reported on line 7h, there was $790,700 of expenses related to Industry-sponsored grants that we believe should be treated as community benefit expense because they were incurred to promote the health and well-being of the local population and are a key component of our commitment to the community.
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). Beginning in 2013, the provision for bad debts was reported as a deduction to net patient service revenue. The 2018 provision for bad debts totaled $18,625,048 and is not included in total expenses reported in Part IX, Line 25, column (A) of Form 990 for the purposes of calculating the percentages in Part 1, Line 7, column (f) of this Schedule H.
Part II, Community Building Activities:	The following description is not quantified specifically in Part II of Schedule H. The hospital facility is committed to creating healthier communities and understands that many state and federal mandated community benefit programs and services are not sufficent to address ethnic, racial and economic health disparities and inequities. The hospital embraces the traditional definition of "health" to include economic opportunity, affordable housing, quality education, safe neighborhoods, food security, social and racial justice, and the arts/culture - all elements that are needed for individuals, families and communities to thrive. The hospital provides many valuable services, resources, programs and financial support - beyond the walls of the hospital and into the communities and homes of the people we serve; including grants and sponsorship of local community-based organizations and the involvement of Baystate leadership with various community boards that align with our mission. Baystate Medical Center provided $215,023 as Payment in Lieu of Taxes (PILOT) to the City of Springfield for our facilities at 3400 Main Street & 11 Wilbraham Road. Baystate Medical Center provided $39,465 as a Payment in Lieu of Taxes (PILOT) to the City of Chicopee for our employee parking lot located at Center Street, Chicopee. The hospital facility is a dues paying member of the Economic Development Council of Western Massachusetts (EDC) and the Springfield Regional Chamber of Commerce. The hospital participates in the EDC and local Chamber as we are the largest employer in our region. The Chamber and its membership coordinate activities toward a common purpose of sustainability and economic growth for the region.
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. The portion of bad debt that reasonably could be attributable to patients who may qualify for financial assistance under the hospital's charity care program (reported in Part III line 3) was calculated by applying the percentage of bad debts by zip code (for which the average household income for each zip code is less than 200% of the federal poverty level) to the total cost of bad debt reported in Part III line 2. Since this portion of bad debt is attributable to patients residing in an area where the average income is less than 200% of the Federal poverty level, it is highly likely these patients would have qualified for the organization's charity care program had they applied. For this reason, we believe the amount, totalling $798,637, should be treated as community benefit expense in Part I. 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 12 and 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 inpatient psych), D Part V (outpatient) and E Part A (organ acquisition) of the hospital's 2018 Medicare cost report, net of Medicare costs reported in Part 1, line 7g, and based on Medicare costing principles. There is no shortfall reported on line 7.
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 Board Governance Committee convenes semi-annually and is charged with advocating for community benefits at the Board level and throughout the health system and broader community; aligning the system's four (4) hospital-specific community benefits implementation strategies into the health system's strategic plan; review of CHNA data; approval of a community benefits mission statement and health priorities; review impacts of community benefits activities and investments; and ensure Baystate's community benefits are in compliance with guidelines established by the MA Attorney General and IRS. Annually, the Office of Government and Community Relations provides updates to the Baystate Board of Trustees, Baystate President's Cabinet, and other Baystate leadership teams, as requested. The hospital Community Benefits Advisory Council (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 hospital 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 hospital CBAC represent constituencies and communities served by the 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 Medical Center (BMC) 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. The hospital 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. The hospital 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 the hospital.The 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 the hospital is required to maintain a financial assistance policy and a billing and collection policy that reflects its financial assistance options and patient billing and collection procedures and complies with applicable state and federal laws and regulations.The hospital has financial counselors available to help patients apply for financial assistance programs that may cover unpaid hospital bills, including a variety of federal and state programs as well as financial assistance through the hospital. Hospital financial counselors have all been trained and certified by the state as Certified Account Counselors to assist patients in applying for available state and federal programs. The hospital is committed to ensuring that patients or prospective patients in the community are aware of financial assistance programs. For uninsured or underinsured patients, the hospital will assist in applying for available financial assistance programs. The hospital notifies patients of the availability of assistance in both the initial bill sent to patients as well as in general notices posted throughout the hospital.When applicable, the hospital also assists patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. The hospital 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 BMC's own internal financial assistance program. The hospital also notifies patients about available payment plans based on their family size and income. Our Financial Assistance Policy and Billing and Collection Policy are posted on the baystatehealth.org website at https://www.baystatehealth.org/-/media/files/patients-and-visitors/billing-and-financial-assistance/baystate-health-hospitals-billing-collections-policy-91516.pdf?la=en. The goal of posting the Financial Assistance Policy and the Billing and Collection Policy is to ensure that patients or prospective patients in our community are aware of our financial assistance programs. Signs about the availability of financial assistance programs at the hospital are translated into Spanish, and Russian as Spanish and Russian are primarily spoken by more than 1000 residents or 1% of the residents in the hospital's service area. Signs are large enough to be clearly visible. Hospital signs are 8.5 x 11 inches and the header print font is 24 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.
Part VI, Line 4:	Baystate Medical Center is a 724-bed academic medical center (including Baystate Children's Hospital) based in Springfield, Massachusetts and is Western New England's only tertiary care referral medical center, Level 1 trauma center, and neonatal and pediatric intensive care units. Baystate Medical Center serves as a regional resource for specialty medical care and research, while providing comprehensive primary medical services to the community. The service area for Baystate Medical Center includes all 23 communities within Hampden County, including the third largest city in Massachusetts -- Springfield (population over 150,000). Three adjacent cities (Holyoke, Chicopee and West Springfield) create a densely-populated urban core that includes over half of the population of the service area (around 270,000 people). Smaller, suburban communities exist to the east and west of this central core area. Many of these communities have populations under 20,000 people. Urban areas, as defined by the U.S. Census Bureau consist of census tracts and/or blocks meeting the minimum population density requirement (2,500-49,999 for urban clusters and over 50,000 for urbanized areas) or are adjacent and meet additional criteria. The service area has more racial and ethnic diversity than many other parts of Western Massachusetts. County-wide, 22% of the population identifies as Hispanic or Latino, 9% Black or African American, and 2% as Asian (ACS, 2010-2014). However, this diversity is not equally spread throughout the region and tends to be concentrated in the urban core. The Pioneer Valley Transit Authority, the second largest public transit system in the state, serves 11 communities in the service area and connects suburban areas to the core cities and services. Paratransit service is also available for people with disabilities within 3/4 mile of a fixed route to facilitate access to medical care. Economically, the Baystate Medical Center service area is home to many of the largest employers in the region as well as numerous colleges and universities, and provides a strong economic engine for the broader region. The largest industries and employers include health care, service and wholesale trade and manufacturing. At the same time, the county struggles with higher rates of unemployment and poverty, lower household incomes and lower rates of educational attainment as compared to the state. The median household income in the service area is about $50,000 ($17,000 less than the state) (ACS 2010-2014). The poverty rate is more than 5% higher than that statewide, and the child poverty rate is an alarming 27%, more than 10% higher than the state rate (ACS, 2010-2014). Despite being at the core of the Knowledge Corridor region, only 26% of the population age 25 and over has a bachelor's degree. Hampden County's unemployment rate of 6.8% is higher than the state average of 4.9%. The unemployment rate is based on the number of people who are either working or actively seeking work. The median age for the service area is similar to that of Massachusetts, though the population over 45 years old is growing as a percentage of the total population.
Part VI, Line 5:	The hospital facility has a responsibility to respond to health care needs unsupported by government programs. In exchange for this responsibility, the hospital 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. The hospital is fully committed to its role in the community and serves with pride and compassion for people in need.The charitable mission of the hospital facility, a member hospital of Baystate Health (BH), is to improve the health of the people in our communities every day, with quality and compassion. The hospital's Community Benefits Mission is to reduce health disparities, promote community wellness and improve access to care for vulnerable populations. The hospital 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.The hospital facility 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 the hospital, 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. The 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, 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 in the carrying out of and pursuant to the charitable mission of the Baystate Health and its affiliates.The hospital's Patient and Family Advisory Council facilitate patients and families to share information and advise the hospital regarding policies and programs. Information from 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, patient and family satisfaction, and loyalty.Please refer to the section above in line 2 for additional examples of the hospital's 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 four hospitals and other 501(c)(3) organizations. The four hospitals are Baystate Medical Center, Inc., Baystate Franklin Medical Center, Baystate Noble Hospital Corporation, and Baystate Wing Hospital Corporation (and Baystate Mary Lane Outpatient Center); the other 501(c)(3) organizations include Baystate Medical Practices, Inc., Visiting Nurse Association and Hospice of Western New England, Inc., Noble Visiting Nurse Services, Inc., Baystate Administrative Services, Inc., Baystate Total Home Care, Inc., Westfield Medical Corporation and Baystate Health Foundation, Inc. In addition to its 12,000 employees, Baystate Health has medical staff, nurses, residents and fellows, medical students, nursing students, and allied health students who gain comprehensive medical education during the year. A recognized leader in educational innovation, Baystate Medical Center has been training doctors since 1914. Now the regional campus of the University of Massachusetts Medical School, we offer: 10 ACGME-accredited residencies; 20+ fellowships; 50 4th-year electives for medical students; and Population-based Urban and Rural Community Health (PURCH)-a curriculum track of the University of Massachusetts Medical School. We are a nationally accredited provider of continuing education for the entire team of health care professionals. Continuing education is provided through regional conferences, grand rounds, and internet courses. We offer clinical practicums for baccalaureate, masters, or doctoral-level nursing students at affiliated schools of nursing. We offer four pharmacy residencies-two PGY1 programs and two PGY2 programs-through our affiliations with the Massachusetts College of Pharmacy and Health Science, and Western New England University College of Pharmacy and Health Science. We also offer Advanced Practitioners education including: Midwifery Education Program, Physician Assistant Residency in Emergency Medicine, and Clinical rotations for Advanced Practice students. Volunteers enhance the work of our employees and interactions with our patients and families. In 2018, more than 900 volunteers donated over 100,000 hours showing their belief in the care we provide to our community.Baystate Medical Center (BMC) is a 724-bed, 57-bassinet, academic medical center in Springfield, Massachusetts. As a major referral care center and the only Level 1 trauma center and pediatric trauma center for western Massachusetts, BMC has one of New England's busiest emergency rooms. In addition, the medical center offers the Baystate Children's Hospital, Baystate Heart & Vascular Program and the Baystate Regional Cancer Program, among other advanced specialty medical, behavioral health, diagnostic, and surgical services.Baystate Children's Hospital, part of Baystate Medical Center, is the only accredited full-service children's hospital and pediatric-specific emergency department in western Massachusetts. It provides primary and advanced medical care to babies, children, adolescents, and their families.Baystate Franklin Medical Center, located in Greenfield, Massachusetts, is an 89-bed acute care hospital that boasts a state-of-the-art surgical center. The hospital provides comprehensive inpatient and outpatient services including 24-hour emergency, heart & vascular, cancer care, behavioral medicine, and family-centered obstetrical care.Baystate Noble Hospital, a 97-bed community hospital located in Westfield, Massachusetts, offers a variety of inpatient and outpatient services for over 80,000 residents in the Westfield, Massachusetts area including surgery, pulmonary rehabilitation and acute inpatient rehabilitation, cardiac, behavioral health, and emergency care. Baystate Noble Hospital's network also includes Noble Medical Group Primary Care physicians and specialists, Visiting Nurse Association and Hospice of Western New England, Noble Visiting Nurse Services, Inc., and Noble Sports & Rehabilitation Center.Baystate Wing Hospital, a 74-bed community hospital located in Palmer, Massachusetts, offers 24-hour emergency care and a broad range of inpatient and outpatient medical and surgical services, including comprehensive outpatient behavioral health and addiction recovery services. Satellite facility Baystate Mary Lane Outpatient Center offers 24-hour emergency services, and outpatient medical, surgical, ancillary, and cancer care.Baystate Medical Practices (BMP) is a multi-specialty group of over 950 physicians and advanced practice clinicians in primary care, specialty, and surgical disciplines with more than 100 practices across 85 locations. BMP offers patient-centered care, including: family practice, internal medicine and pediatric providers, community health centers, urgent care clinics, suburban and rural practices. Many sites are designated Patient Centered Medical Homes, signifying our emphasis on communication with patients, collaboration among providers, and continuity of care. 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 2018 BMP provided $1,475,687 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 and Noble Visiting Nurse Services, Inc. provide the highest quality care and supplies to patients and families, primarily in their homes. They are a comprehensive in-home health care, hospice, and palliative care agency with a staff of over 450 managing more than 90,000 visits annually. Our home health team works together to ensure a safe and swift recovery from illness, accident, or surgery in the comfort of home. Visiting Nurse Association and Hospice of Western New England, and Noble Visiting Nurse Services, Inc. offers medical expertise through our extensive network of caregivers to support patients facing a serious or life limiting illness. Each patient and family is cared for by our certified and experienced nurses, therapists, social workers, hospice aides, spiritual and bereavement counselors, and volunteers. This care team works together, with both the patient and family, to bring understanding, comfort, dignity and a sense of peace, as each patient journey towards the final stage of life.Baystate Reference Laboratories, part of Baystate Health, is the region's largest reference laboratory and is staffed by 24 board-certified pathologists and over 500 technologists and support personnel.In addition to the brief descriptions of some of the affiliated entities above, this further information speaks to activities of Baystate Health and its affiliates regarding promotion of community health.In 2018, over 170,700 language interpreter sessions helped patients and families better understand their care. Staff interpreted about 59 languages in person, over the phone, and via video, and translated 3,264 pages of patient-related information. In partnership with the University of Massachusetts Medical School, Baystate Health is now the regional campus for an innovative new curriculum track called PURCH (Population-based Urban and Rural Community Health). The PURCH track focuses on addressing the social determinants of health for our patients. Forty-eight students are currently enrolled in PURCH; twenty-nine are Massachusetts residents. The PURCH track is designed to prepare students to care for Baystate's diverse patient populations by providing classroom and clinical experiences in a variety of clinical settings, led by faculty who have expertise in population health and clinical effectiveness research. The goals of the program are to increase access to students in Massachusetts seeking an affordable medical education; to respond to the health care needs of the Commonwealth by increasing the number of Massachusetts physicians trained in urban and rural primary care; and to apply proven academic research methods to improve population health, reduce health disparities, and make health care better integrated, more efficient, and more effective.
Form 990, Schedule H, Part VI, Line 6 continued	The Nurse Residency Program expanded to all Baystate Health hospitals. Baystate's Nurse Residency Program is a one-year program for newly graduated registered nurses, offering hands-on clinical experience, in-depth learning through monthly seminars, participation in evidence-based projects, and ongoing professional development. Baystate Health is committed to continuing education programs in 30 different professional areas through partnerships with Elms College, Springfield College, Western New England University, STCC, Greenfield Community College, Holyoke Community College, Westfield State University, and many others. Our post graduate programs expanded to 10 medical residencies and 20 fellowships, including new fellowship training programs in hospital medicine and gastroenterology. Baystate Springfield Educational Partnership (BSEP) ran courses for 307 students, primarily residents of Springfield. During the summer, BSEP provided theme-based workshops for 66 students, coordinated 13 summer internships at Baystate Medical Center and placed 16 students in work experiences as part of the Workforce Innovation and Opportunity Act program and the YouthWorks program, both sponsored by the Regional Employment Board of Hampden County and awarded 18 BSEP alumni with a total of $25,000 in scholarships for undergraduate and graduate education. 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 "Baystate's New Beginnings". Also offered are breastfeeding classes, prenatal/postnatal classes, and infant/toddler safety classes. 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 a health science library staffed by professionals who help patients, families and the general public access reliable health information.Baystate Medical Center provided a safe way to dispose of unwanted medications and sharps. Community members now have a resource for safely and confidentially throwing away household sharps (needles and other sharp or glass medical tools), thanks to collection receptacles now installed in the Daly lobby at Baystate Medical Center. These secure kiosks are available to the community 24 hours a day, seven days a week. With the help of Baystate Franklin Medical Center's EMPOWER (Engaging Mothers for Positive Outcomes With Early Referrals) program, a team of nurses and doctors at Baystate Medical Center implemented an innovative program called "rooming-in" where babies at risk for neonatal abstinence syndrome (a condition where babies need treatment for symptoms of withdrawal after birth) stay in a private hospital room with their mothers after birth. The program allows mothers to care for their babies while receiving specialized nursing support. Results of the program show that babies are requiring less to no medication to treat withdrawal symptoms and their hospital lengths of stay are shorter. This was a wonderful example of collaboration between the two hospitals, utilizing Baystate Franklin's expertise and working together to address the Opioid crisis in our communities. Baystate Health certified Specialty Pharmacy liaisons continue to help patients save dollars in out-of-pocket medication expenses. Liaisons are located in multiple outpatient practices including the Children's Specialty Center, the D'Amour Center for Cancer Care, and Baystate Franklin Medical Center to help ensure patients have access to critically needed and often expensive medications. 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 Every Woman members. Mini Medical School Alumni is now over 2,000 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 21,300 Senior Class members receive a quarterly newsletter with valuable health information, benefits and invitations to special events designed with their interests in mind. Baystate Every Woman Loyalty Program offers its 15,730 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.Baystate Home Buying Program helped employees purchase their first homes. In 2018, 20 employees were awarded forgivable loans to purchase their first home through the Mark R. Tolosky Baystate Neighbors Program. This Baystate Health benefit provides forgivable loans to employees purchasing their first homes in the communities surrounding Baystate Health hospitals. To-date, the program has provided more than $1.8 million in forgivable home loans.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 25th year, Rays of Hope has raised over $14.8 million to date. All funds raised remain local in 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 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, Westfield, and Palmer 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.See also additional information regarding Baystate Health, Inc. and its affiliate's promotion of community health above in Line 5.
Form 990, Schedule H, Part VI, Line 7	List of States Receiving Community Benefit Report: MA

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Baystate Medical Center Inc

Employer identification number
04-2790311

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Cancer Connection Inc 41 Locust Street Northampton,MA01060	04-3493483	501(c)(3)	36,392	Support groups, complementary therapies, workshops and classes for women living with breast cancer and their families and caregivers.
(2) Baystate Health Inc 759 Chestnut Street Springfield,MA01199	04-2105941	501(C)(3)	15,663,000	Strategic initiatives
(3) Pioneer Valley Riverfront Club 121 West Street Springfield,MA01104	26-0251831	501(c)(3)	20,729	Breast cancer survivors dragon boat team.
(4) YMCA of Greater Springfield 275 Chestnut Street Springfield,MA01104	04-1859893	501(c)(3)	34,545	Breast cancer survivors excercise program.
(5) CHD Cancer House of Hope Inc 1999 Westfield Street West Springfield,MA01089	04-2503926	501(C)(3)	17,859	Funding expenses of the most well-attended CHH programming utilized by women with breast cancer.
(6)				Breast cancer survivors dragon boat team

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) Art therapy workshops for breast cancer survivors	1	11,800
(2) Yoga and water dance for breast cancer survivors	1	8,130
(3) Water fitness classes for women with breast cancer	1	10,428
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Part I, Line 2:

Explanation: The Rays of Hope grants that are awarded are reviewed and approved by the Rays of Hope Community Advisory Board. Recipients are required to submit a Community Program Grant Application. As part of the application process the recipient is required to provide their SSN or EIN. Once the grant is awarded by the Advisory Board quarterly reports are submitted by the recipient to monitor the grant. A final report of the grant program and budget summary is due upon completion of the program.

Part III

For items in Part III the number of recipients are not easily quantified. Items are purchased in bulk and distributed as needed.

Schedule I (Form 990) 2019

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Baystate Medical Center Inc

Employer identification number

04-2790311

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 on 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 on 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 on 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 on 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 on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

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

Were any amounts reported on 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" on 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) 2019

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 on 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 on 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)
1Grace Makari-Judson MD Trustee/Hematologist (thru 12/31/17)	(i) (ii)	291,317 ------------- 0	44,081 ------------- 0	4,970 ------------- 0	56,259 ------------- 0	21,686 ------------- 0	418,313 ------------- 0	0 ------------- 0
2Kevin P Moriarty MD Trustee/Chief Ped Surg	(i) (ii)	543,203 ------------- 0	100,207 ------------- 0	43,039 ------------- 0	22,950 ------------- 0	15,312 ------------- 0	724,711 ------------- 0	0 ------------- 0
3Mark A Keroack MD Trustee	(i) (ii)	0 ------------- 1,001,554	0 ------------- 525,000	0 ------------- 362,240	0 ------------- 17,550	0 ------------- 15,312	0 ------------- 1,921,656	0 ------------- 0
4Michael P Albert MD Trustee	(i) (ii)	288,237 ------------- 0	39,432 ------------- 0	3,722 ------------- 0	37,250 ------------- 0	22,726 ------------- 0	391,367 ------------- 0	0 ------------- 0
5Nancy Shendell-Falik President	(i) (ii)	0 ------------- 554,723	0 ------------- 262,899	0 ------------- 22,523	0 ------------- 185,570	0 ------------- 25,468	0 ------------- 1,051,183	0 ------------- 0
6Dennis Chalke Treasurer	(i) (ii)	0 ------------- 518,753	0 ------------- 189,630	0 ------------- 286,276	0 ------------- 58,410	0 ------------- 28,598	0 ------------- 1,081,667	0 ------------- 0
7Kristin R Delaney Clerk	(i) (ii)	0 ------------- 128,397	0 ------------- 14,975	0 ------------- 606	0 ------------- 13,738	0 ------------- 23,774	0 ------------- 181,490	0 ------------- 0
8Christine Klucznik VP/ CNO	(i) (ii)	0 ------------- 295,998	0 ------------- 61,656	0 ------------- 4,261	0 ------------- 22,167	0 ------------- 4,792	0 ------------- 388,874	0 ------------- 0
9Tejas Gandhi VP/ COO	(i) (ii)	0 ------------- 406,015	0 ------------- 107,625	0 ------------- 918	0 ------------- 17,550	0 ------------- 22,468	0 ------------- 554,576	0 ------------- 0
10Peter Friedmann MD Assoc Dean Chief Res Officer	(i) (ii)	332,576 ------------- 0	70,686 ------------- 0	1,971 ------------- 0	25,238 ------------- 0	23,150 ------------- 0	453,621 ------------- 0	0 ------------- 0
11Douglas Salvador MD SVP/ Chief Quality Officer	(i) (ii)	148,216 ------------- 162,047	0 ------------- 81,839	500 ------------- 3,495	0 ------------- 17,550	9,279 ------------- 9,370	157,995 ------------- 274,301	0 ------------- 0
12Peter Lindenauer MD Asst Dean Population Health	(i) (ii)	294,510 ------------- 0	45,183 ------------- 0	31,097 ------------- 0	29,448 ------------- 0	20,223 ------------- 0	420,461 ------------- 0	0 ------------- 0
13Vishal Tiwari MD Assoc Med Dir Hosp Care Mgmt	(i) (ii)	302,294 ------------- 0	19,393 ------------- 0	10,264 ------------- 0	13,500 ------------- 0	20,982 ------------- 0	366,433 ------------- 0	0 ------------- 0
14Amy Gottleib MD Assoc Dean Chief Fac Devel	(i) (ii)	270,890 ------------- 0	56,700 ------------- 0	1,348 ------------- 0	17,550 ------------- 0	2,854 ------------- 0	349,342 ------------- 0	0 ------------- 0
15Deborah A Provost Former Chief Regulatory Officer	(i) (ii)	227,879 ------------- 0	33,719 ------------- 0	22,341 ------------- 0	60,873 ------------- 0	13,291 ------------- 0	358,103 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

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. This committee consists entirely of individuals serving on the board of Baystate Health, Inc. The individuals responsible for deliberating the compensation arrangement for the President and CEO would be those individuals who do not have a conflict of interest with respect to the compensation arrangement and would be considered independent for compensation deliberation purposes. The compensation of the President and CEO is established based on information provided by independent third party consultants for reasonableness and appropriate comparability data. The compensation is then established, reviewed and approved by the duly authorized compensation committee of Baystate Health, Inc. and all such deliberations and decisions are documented contemporaneously.

Part I, Line 4b

Michael Albert, MD - Supplemental Retirement of $5,761 is included in column B. This amount was earned and paid in 2017. Dennis W. Chalke - Supplemental Retirement of $186,459 is included in column B. This amount was earned and paid in 2017. Peter Friedmann, MD - Supplemental Retirement of $7,688 is included in column B. This amount was earned and paid in 2017. Mark A. Keroack, MD - Total Supplemental Retirement of $334,356 is included in column B. This amount was earned in 2017. Christine E. Klucznik, MD - Total Supplemental Retirement of $4,617 is included in column B. This amount was earned in 2017. Peter Lindenauer, MD - Supplemental Retirement of $6,845 is included in column E. This amount was earned and paid in 2017. Grace Makari-Judson, MD- Supplemental Retirement of $9,031 is included in column B. This amount was earned in 2017. Kevin P. Moriarty, MD - Supplemental Retirement of $39,037 is included in column B. This amount was earned and paid in 2017. Douglas Salvador, MD - Supplemental Retirement of $6,312 is included in column B. This amount was earned and paid in 2017. Nancy Shendell-Falik- Supplemental Retirement of $168,020 is included in column C. This amount was earned in 2017.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Baystate Medical Center Inc

Employer identification number
04-2790311

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MA Health & Educ Facil Authority - Ser G	04-2456011	57586CNHA	10-27-2005	71,740,000	MA HEFA Series G - See Part VI		X		X		X
B	MA Health & Educ Facil Authority - Ser H	04-2456011		01-18-2007	10,000,000	MA HEFA Series H - See Part VI		X		X		X
C	MA Health & Educ Facil Authority - Ser M2	04-2456011		06-30-2008	10,157,671	MA HEFA Series M2 - See Part VI		X		X	X
D	MA Health & Educ Facil Authority - Ser IJK	04-2456011	57586EKC4	06-25-2009	198,611,250	MA HEFA Series IJK - See Part VI		X		X		X
	MA Development Finance Agency - Ser L	04-3431814		11-02-2011	25,000,000	MA DFA Series L - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814		11-02-2011	20,000,000	MA DFA Cap Lease - See Part VI		X		X		X
	MA Development Finance Agency - Ser M	04-3431814		08-09-2012	40,137,000	MA DFA Series M - See Part VI		X		X		X
	MA Development Finance Agency - Ser N	04-3431814	57583UN79	11-06-2014	60,742,119	MA DFA Series N - See Part VI		X		X		X
	MA Development Finance Agency - Ser O	04-3431814	000000000	05-12-2016	20,000,000	MDFA Series O-see Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	09-22-2016	14,062,890	MDFA CoGen Lease - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	12-29-2016	3,000,000	MDFA LA #1 Lease - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	11-15-2017	2,937,110	MDFA LA #2 Lease - See Part VI		X		X		X
	MA Development Finance Agency - Ser P-1	04-3431814	000000000	12-21-2017	40,595,000	MA DFA Series P-1 - See Part VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	38,840,000		7,777,778		5,727,122		329,090
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	71,740,000		10,000,000		10,157,671		199,122,425
4 Gross proceeds in reserve funds .............					43,671
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............	39,871,232
7 Issuance costs from proceeds ...............	735,004		72,250		229,661		1,845,403
8 Credit enhancement from proceeds .............							93,479
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	6,990,000		9,927,750		3,000,772		132,183,543
11 Other spent proceeds .............	64,014,996				10,114,000		65,000,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2005		2006		1999		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X			X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.020 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0.010 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0.030 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X	X			X		X
c No rebate due? .........	X			X	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	Citibank
c Term of hedge .........	2070.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: MA Health & Educ. Facil. Authority - Ser. G Date the Rebate Computation was Performed: 09/27/2006 Issuer Name: MA Health & Educ. Facil. Authority - Ser. M2 Date the Rebate Computation was Performed: 06/18/2013 Issuer Name: MA Health & Educ. Facil. Authority - Ser. IJK Date the Rebate Computation was Performed: 08/24/2012
Bond Issues Supplemental Information	A - MHEFA Series G Bonds Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) to advance refund $61,930,000 principal amount of the Authority's Revenue Bonds, Baystate Medical Center (the Institution) Issue, Series E (the "Series E Bonds"), which were issued July 11, 1996 to finance or refinance the following property owned by the Institution: (a) construction of a new 104,500 gross square foot Ambulatory Care Center at 3300 Main Street, Springfield, Massachusetts; (b) construction of a new 100,000 gross square foot building to house the Ambulatory Surgery Center, Medical Library and education/conference space on the Institution's North campus located at 759 Chestnut Street, Springfield, Massachusetts; (c) renovation of various existing spaces within the Institution's North campus; and (d) acquisition of equipment for the new facilities; (ii) to finance routine capital construction, renovations, and equipping of various facilities of the Institution; and (iii) to pay certain costs of issuance of the Series G Bonds. B- MHEFA Series H Bonds Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) the construction, improvement, equipping, and other related capital expenditures of a parking garage walkway, and other related work at an existing building at 280 Chestnut Street owned and used by the Institution, and (ii) the acquisition and installation of capital equipment and renovations to existing facilities of the Institution and other routine capital expenditures in connection with the Institution's hospital operations. C- MHEFA Series M-2, Pool 2 Part I - Per the Loan Document the purpose of the bond is to refinance Baystate Medical Center's MHEFA Pool J-2 Loan, which was issued February 2, 1999 to finance the acquisition and equipping of the property located at 280 Chestnut Street, Springfield, Massachusetts (the "Property"), and the renovation of the Property and existing facilities of the Institution and the acquisition of capital equipment for the Institution's existing facilities. The MHEFA indebtedness listed is a pool loan; therefore the issue price, Parts I, II, III, and IV (Lines 5-7) are being answered with respect to the Baystate Medical Center loan alone rather than with respect to proceeds loaned to other conduit borrowers. The actual date of issue of the MHEFA Series M2 Bonds was 5/30/2002, and the CUSIP number shown on Form 8038 was 57585KA57. While that issue was not a refunding issue, the purpose of the loan taken by BMC was to refund prior debt, as reflected in our response to Part II, Line 14. Accordingly, Part III has not been completed, as the original project was financed with bonds issued prior to 2003. D- MHEFA Series I, J-1, J-2, K-1, K-2 Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) to pay a portion of the costs associated with the acquisition of land, site development, construction or alteration of buildings or the acquisition or installation of furnishings and equipment, refinancing of, or any combination of the foregoing, in connection with the construction, improvement, equipping, and other related capital expenditures of a seven-story, approximately 599,100 gross square foot primarily inpatient building located at 759 Chestnut Street, Springfield, Massachusetts, including demolition and site work, which building will be constructed by Baystate Total Home Care (BTHC) and leased to Baystate Medical Center by BTHC; (ii) for the acquisition and installation of capital equipment and renovations to existing facilities of the Medical Center and other routine capital expenditures included or to be included in the Medical Center's capital budget over the next three years for use in connection with the Medical Center's hospital operations; (iii) for the refinancing of a portion of an outstanding commercial loan in the amount of $65,000,000 made by Bank of America, N.A. on October 20, 2008 to the Medical Center in connection with the defeasance of the Authority's Revenue Bonds, Baystate Medical Center Issue, Series D, issued September 16, 1993; (iv) for the financing of costs associated with the issuance of bonds and; (v) financing of routine capital construction, renovations, and equipping of various facilities of Baystate Medical Center. E - MDFA Revenue Bonds, Series L Part I - Per the Official Statement, the purpose of the bond proceeds is for the construction, improvement, and other capital expenditures relating to the build-out of an equipping of certain interior space within a seven-story approximately 599,100 gross square foot primarily inpatient building owned by Baystate Total Home Care, Inc. and leased to the Institution located at 759 Chestnut Street, Springfield, Massachusetts, such build-out to consist of space to be used for the Emergency Department of the Institution and ancillary support areas and the financing costs associated with the issuance of the bonds. F - MDFA Tax Exempt Capital Lease Part I - Per the Master Lease and Sublease Agreement, the purpose of the Tax Exempt Capital Lease is for the Acquisition of Equipment. "Equipment" means the fixed and moveable personal property to be used in connection with the Sub-Lessee's health care operations identified in a Schedule executed by or pursuant to the Agency of the Lessee and the Sub-Lessee, accepted by the Lessor and acknowledged by the Escrow Agent in writing and identified as part of this Master Lease (including certain items originally financed through internal advances of the Sub-Lessee in anticipation of obtaining permanent financing through the Lessee), together with all replacement parts, additions, repairs, accessions, and accessories incorporated therein and/or affixed to such personal property and replacements and substitutions therefor and proceeds and products thereof. G - MDFA Revenue Bonds Series M - Part I - The purpose of the bond proceeds is: (i) to advance refund $39,907,339 principal amount of Massachusetts Health and Education Facilities Authority's Revenue Bonds, Baystate Medical Center (the Institution) Issue, Series F (the "Series F Bonds"), issued June 12, 2002 the proceeds of which financed the Construction of a new Cancer Center with a partial third floor medical record and support area; acquisition of a surgery center facility, certain renovations and equipment acquisitions; and (ii) finance costs of issuance relating to the Bond. H - MDFA Revenue Bonds Series N - Part I - The purpose of the bond proceeds is: (i) capital expenditures, including capitalized interest, in connection with the following projects (the "Project"); a) the build-out of and equipping of certain interior space within a seven-story, approximately 599,100 gross square foot primarily inpatient building owned by BTHC and leased to Baystate Medical Center located at 759 Chestnut Street, Springfield, Massachusetts, such build-out to include inpatient rooms, operating rooms, and inpatient pharmacy, and b) the acquisition of medical equipment, information technology equipment, and other equipment and assets to be owned or leased and used by the Medical Center at the Medical Center's health care facilities located at 759 Chestnut Street, Springfield, Massachusetts, 3300,3350,3400 and 3601 Main Street, Springfield, Massachusetts and 50, 80, and 100 Wason Avenue, Springfield, Massachusetts, and (ii) costs of issuance relating to the Bonds.
I - MDFA Revenue Bonds Series O	Part I - The purpose of the bond proceeds is to indirectly finance the following: (a) the construction, improvement, equipping, and other related capital expenditures of a seven-story, approximately 599,100 gross square foot primarily inpatient building located at 759 Chestnut Street, Springfield, Massachusetts, including demolition and site work, which building was constructed by BTHC and leased to the Medical Center by BTHC; and (b) the acquisition and installation of capital equipment and renovations to existing facilities of the Medical Center and other routine capital expenditures included or to be included in the Medical Center's capital budget over a three-year period for use in connection with the Medical Center's hospital operations at the following facilities of the Medical Center: Springfield Building (including all wings and attached buildings), located at 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Cardiac Services, Medical Services, Lab, and Inpatient Beds); Wesson Women and Infants Building, 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Birthing Services, Neonatal Services, and Inpatient Beds); Daly Building (formerly the Centennial Building), 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Emergency Room, Radiology, MRI, Ultrasound, Ambulatory and Inpatient Pharmacies, Lab, Operating Rooms, Inpatient Beds, ElectroPhysio Labs, ICU, and PICU); Daly Parking Garage, 759 Chestnut Street, Springfield, Massachusetts (a patient and visitor parking garage); D'Amour's Center for Cancer Care, 3350 Main Street, Springfield, Massachusetts (primarily used for Clinical Cancer Services); Chestnut Building, 759 Chestnut Street, Springfield, Massachusetts (primarily used for Ambulatory Surgery, Library, and Simulation Center); and Whitney Avenue Building (specifically capital expenditures related to information technology), 361 Whitney Avenue, Holyoke, Massachusetts (used for general health system purposes). J - MDFA CoGen Lease A Part I - The purpose of the lease is to finance the construction of an approximately 5,000 square foot co-generational, combined heat and power plant providing electricity, chilled water and steam to the facilities of the Institution. K - MDFA LA #1 Lease B Part I - The purpose of the lease is to finance the acquisition and installation of a linear accelerator. L - MDFA LA #2 Lease Part I The purpose of the lease is to finance the acquisition and installation of a linear accelerator. M - MDFA Series P-1 Part I - The Bond is being issued for the purpose of providing funds to refund on an advance basis a portion of the $63,380,000 aggregate stated principal amount outstanding as of the date hereof of the Revenue Bonds, Baystate Medical Center Issue, Series I (the "Refunded Bonds"), the proceeds of which were used to pay a portion of the construction costs of a new hospital building located at 759 Chestnut Street, Springfield, Massachusetts. Part I and Part II, Differences between the issue price (Part I) and total proceeds (Part II, Line 3) are due to investment earnings. Part III, Lines 4 and 5, Column D (Series IJK): As the refunded bonds were issued prior to January 1, 2003, this question is being answered solely with respect to the new money portion of the bonds. Part III, Column G (Series M): As these bonds refunded debt issued prior to January 1, 2003, the organization is availing itself of the Part III reporting exemption available for such bonds. Part IV, Line 2c, Column C (Series M-2): The Issuing Authority engages an outside consultant to prepare rebate computations. As of the most recent computation period, May 29, 2017 no rebate was owed. The cumulative rebate amount is zero as of the outside consultant's most recent report. Part IV, Line 6, Column A (Series G): This question is being answered without regard to yield-restricted advance funding escrow financed with proceeds of the bonds.

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Baystate Medical Center Inc

Employer identification number
04-2790311

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MA Health & Educ Facil Authority - Ser G	04-2456011	57586CNHA	10-27-2005	71,740,000	MA HEFA Series G - See Part VI		X		X		X
B	MA Health & Educ Facil Authority - Ser H	04-2456011		01-18-2007	10,000,000	MA HEFA Series H - See Part VI		X		X		X
C	MA Health & Educ Facil Authority - Ser M2	04-2456011		06-30-2008	10,157,671	MA HEFA Series M2 - See Part VI		X		X	X
D	MA Health & Educ Facil Authority - Ser IJK	04-2456011	57586EKC4	06-25-2009	198,611,250	MA HEFA Series IJK - See Part VI		X		X		X
	MA Development Finance Agency - Ser L	04-3431814		11-02-2011	25,000,000	MA DFA Series L - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814		11-02-2011	20,000,000	MA DFA Cap Lease - See Part VI		X		X		X
	MA Development Finance Agency - Ser M	04-3431814		08-09-2012	40,137,000	MA DFA Series M - See Part VI		X		X		X
	MA Development Finance Agency - Ser N	04-3431814	57583UN79	11-06-2014	60,742,119	MA DFA Series N - See Part VI		X		X		X
	MA Development Finance Agency - Ser O	04-3431814	000000000	05-12-2016	20,000,000	MDFA Series O-see Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	09-22-2016	14,062,890	MDFA CoGen Lease - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	12-29-2016	3,000,000	MDFA LA #1 Lease - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	11-15-2017	2,937,110	MDFA LA #2 Lease - See Part VI		X		X		X
	MA Development Finance Agency - Ser P-1	04-3431814	000000000	12-21-2017	40,595,000	MA DFA Series P-1 - See Part VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	38,840,000		7,777,778		5,727,122		329,090
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	71,740,000		10,000,000		10,157,671		199,122,425
4 Gross proceeds in reserve funds .............					43,671
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............	39,871,232
7 Issuance costs from proceeds ...............	735,004		72,250		229,661		1,845,403
8 Credit enhancement from proceeds .............							93,479
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	6,990,000		9,927,750		3,000,772		132,183,543
11 Other spent proceeds .............	64,014,996				10,114,000		65,000,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2005		2006		1999		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X			X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.020 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0.010 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0.030 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X	X			X		X
c No rebate due? .........	X			X	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	Citibank
c Term of hedge .........	2070.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: MA Health & Educ. Facil. Authority - Ser. G Date the Rebate Computation was Performed: 09/27/2006 Issuer Name: MA Health & Educ. Facil. Authority - Ser. M2 Date the Rebate Computation was Performed: 06/18/2013 Issuer Name: MA Health & Educ. Facil. Authority - Ser. IJK Date the Rebate Computation was Performed: 08/24/2012
Bond Issues Supplemental Information	A - MHEFA Series G Bonds Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) to advance refund $61,930,000 principal amount of the Authority's Revenue Bonds, Baystate Medical Center (the Institution) Issue, Series E (the "Series E Bonds"), which were issued July 11, 1996 to finance or refinance the following property owned by the Institution: (a) construction of a new 104,500 gross square foot Ambulatory Care Center at 3300 Main Street, Springfield, Massachusetts; (b) construction of a new 100,000 gross square foot building to house the Ambulatory Surgery Center, Medical Library and education/conference space on the Institution's North campus located at 759 Chestnut Street, Springfield, Massachusetts; (c) renovation of various existing spaces within the Institution's North campus; and (d) acquisition of equipment for the new facilities; (ii) to finance routine capital construction, renovations, and equipping of various facilities of the Institution; and (iii) to pay certain costs of issuance of the Series G Bonds. B- MHEFA Series H Bonds Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) the construction, improvement, equipping, and other related capital expenditures of a parking garage walkway, and other related work at an existing building at 280 Chestnut Street owned and used by the Institution, and (ii) the acquisition and installation of capital equipment and renovations to existing facilities of the Institution and other routine capital expenditures in connection with the Institution's hospital operations. C- MHEFA Series M-2, Pool 2 Part I - Per the Loan Document the purpose of the bond is to refinance Baystate Medical Center's MHEFA Pool J-2 Loan, which was issued February 2, 1999 to finance the acquisition and equipping of the property located at 280 Chestnut Street, Springfield, Massachusetts (the "Property"), and the renovation of the Property and existing facilities of the Institution and the acquisition of capital equipment for the Institution's existing facilities. The MHEFA indebtedness listed is a pool loan; therefore the issue price, Parts I, II, III, and IV (Lines 5-7) are being answered with respect to the Baystate Medical Center loan alone rather than with respect to proceeds loaned to other conduit borrowers. The actual date of issue of the MHEFA Series M2 Bonds was 5/30/2002, and the CUSIP number shown on Form 8038 was 57585KA57. While that issue was not a refunding issue, the purpose of the loan taken by BMC was to refund prior debt, as reflected in our response to Part II, Line 14. Accordingly, Part III has not been completed, as the original project was financed with bonds issued prior to 2003. D- MHEFA Series I, J-1, J-2, K-1, K-2 Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) to pay a portion of the costs associated with the acquisition of land, site development, construction or alteration of buildings or the acquisition or installation of furnishings and equipment, refinancing of, or any combination of the foregoing, in connection with the construction, improvement, equipping, and other related capital expenditures of a seven-story, approximately 599,100 gross square foot primarily inpatient building located at 759 Chestnut Street, Springfield, Massachusetts, including demolition and site work, which building will be constructed by Baystate Total Home Care (BTHC) and leased to Baystate Medical Center by BTHC; (ii) for the acquisition and installation of capital equipment and renovations to existing facilities of the Medical Center and other routine capital expenditures included or to be included in the Medical Center's capital budget over the next three years for use in connection with the Medical Center's hospital operations; (iii) for the refinancing of a portion of an outstanding commercial loan in the amount of $65,000,000 made by Bank of America, N.A. on October 20, 2008 to the Medical Center in connection with the defeasance of the Authority's Revenue Bonds, Baystate Medical Center Issue, Series D, issued September 16, 1993; (iv) for the financing of costs associated with the issuance of bonds and; (v) financing of routine capital construction, renovations, and equipping of various facilities of Baystate Medical Center. E - MDFA Revenue Bonds, Series L Part I - Per the Official Statement, the purpose of the bond proceeds is for the construction, improvement, and other capital expenditures relating to the build-out of an equipping of certain interior space within a seven-story approximately 599,100 gross square foot primarily inpatient building owned by Baystate Total Home Care, Inc. and leased to the Institution located at 759 Chestnut Street, Springfield, Massachusetts, such build-out to consist of space to be used for the Emergency Department of the Institution and ancillary support areas and the financing costs associated with the issuance of the bonds. F - MDFA Tax Exempt Capital Lease Part I - Per the Master Lease and Sublease Agreement, the purpose of the Tax Exempt Capital Lease is for the Acquisition of Equipment. "Equipment" means the fixed and moveable personal property to be used in connection with the Sub-Lessee's health care operations identified in a Schedule executed by or pursuant to the Agency of the Lessee and the Sub-Lessee, accepted by the Lessor and acknowledged by the Escrow Agent in writing and identified as part of this Master Lease (including certain items originally financed through internal advances of the Sub-Lessee in anticipation of obtaining permanent financing through the Lessee), together with all replacement parts, additions, repairs, accessions, and accessories incorporated therein and/or affixed to such personal property and replacements and substitutions therefor and proceeds and products thereof. G - MDFA Revenue Bonds Series M - Part I - The purpose of the bond proceeds is: (i) to advance refund $39,907,339 principal amount of Massachusetts Health and Education Facilities Authority's Revenue Bonds, Baystate Medical Center (the Institution) Issue, Series F (the "Series F Bonds"), issued June 12, 2002 the proceeds of which financed the Construction of a new Cancer Center with a partial third floor medical record and support area; acquisition of a surgery center facility, certain renovations and equipment acquisitions; and (ii) finance costs of issuance relating to the Bond. H - MDFA Revenue Bonds Series N - Part I - The purpose of the bond proceeds is: (i) capital expenditures, including capitalized interest, in connection with the following projects (the "Project"); a) the build-out of and equipping of certain interior space within a seven-story, approximately 599,100 gross square foot primarily inpatient building owned by BTHC and leased to Baystate Medical Center located at 759 Chestnut Street, Springfield, Massachusetts, such build-out to include inpatient rooms, operating rooms, and inpatient pharmacy, and b) the acquisition of medical equipment, information technology equipment, and other equipment and assets to be owned or leased and used by the Medical Center at the Medical Center's health care facilities located at 759 Chestnut Street, Springfield, Massachusetts, 3300,3350,3400 and 3601 Main Street, Springfield, Massachusetts and 50, 80, and 100 Wason Avenue, Springfield, Massachusetts, and (ii) costs of issuance relating to the Bonds.
I - MDFA Revenue Bonds Series O	Part I - The purpose of the bond proceeds is to indirectly finance the following: (a) the construction, improvement, equipping, and other related capital expenditures of a seven-story, approximately 599,100 gross square foot primarily inpatient building located at 759 Chestnut Street, Springfield, Massachusetts, including demolition and site work, which building was constructed by BTHC and leased to the Medical Center by BTHC; and (b) the acquisition and installation of capital equipment and renovations to existing facilities of the Medical Center and other routine capital expenditures included or to be included in the Medical Center's capital budget over a three-year period for use in connection with the Medical Center's hospital operations at the following facilities of the Medical Center: Springfield Building (including all wings and attached buildings), located at 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Cardiac Services, Medical Services, Lab, and Inpatient Beds); Wesson Women and Infants Building, 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Birthing Services, Neonatal Services, and Inpatient Beds); Daly Building (formerly the Centennial Building), 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Emergency Room, Radiology, MRI, Ultrasound, Ambulatory and Inpatient Pharmacies, Lab, Operating Rooms, Inpatient Beds, ElectroPhysio Labs, ICU, and PICU); Daly Parking Garage, 759 Chestnut Street, Springfield, Massachusetts (a patient and visitor parking garage); D'Amour's Center for Cancer Care, 3350 Main Street, Springfield, Massachusetts (primarily used for Clinical Cancer Services); Chestnut Building, 759 Chestnut Street, Springfield, Massachusetts (primarily used for Ambulatory Surgery, Library, and Simulation Center); and Whitney Avenue Building (specifically capital expenditures related to information technology), 361 Whitney Avenue, Holyoke, Massachusetts (used for general health system purposes). J - MDFA CoGen Lease A Part I - The purpose of the lease is to finance the construction of an approximately 5,000 square foot co-generational, combined heat and power plant providing electricity, chilled water and steam to the facilities of the Institution. K - MDFA LA #1 Lease B Part I - The purpose of the lease is to finance the acquisition and installation of a linear accelerator. L - MDFA LA #2 Lease Part I The purpose of the lease is to finance the acquisition and installation of a linear accelerator. M - MDFA Series P-1 Part I - The Bond is being issued for the purpose of providing funds to refund on an advance basis a portion of the $63,380,000 aggregate stated principal amount outstanding as of the date hereof of the Revenue Bonds, Baystate Medical Center Issue, Series I (the "Refunded Bonds"), the proceeds of which were used to pay a portion of the construction costs of a new hospital building located at 759 Chestnut Street, Springfield, Massachusetts. Part I and Part II, Differences between the issue price (Part I) and total proceeds (Part II, Line 3) are due to investment earnings. Part III, Lines 4 and 5, Column D (Series IJK): As the refunded bonds were issued prior to January 1, 2003, this question is being answered solely with respect to the new money portion of the bonds. Part III, Column G (Series M): As these bonds refunded debt issued prior to January 1, 2003, the organization is availing itself of the Part III reporting exemption available for such bonds. Part IV, Line 2c, Column C (Series M-2): The Issuing Authority engages an outside consultant to prepare rebate computations. As of the most recent computation period, May 29, 2017 no rebate was owed. The cumulative rebate amount is zero as of the outside consultant's most recent report. Part IV, Line 6, Column A (Series G): This question is being answered without regard to yield-restricted advance funding escrow financed with proceeds of the bonds.

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Baystate Medical Center Inc

Employer identification number
04-2790311

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MA Health & Educ Facil Authority - Ser G	04-2456011	57586CNHA	10-27-2005	71,740,000	MA HEFA Series G - See Part VI		X		X		X
B	MA Health & Educ Facil Authority - Ser H	04-2456011		01-18-2007	10,000,000	MA HEFA Series H - See Part VI		X		X		X
C	MA Health & Educ Facil Authority - Ser M2	04-2456011		06-30-2008	10,157,671	MA HEFA Series M2 - See Part VI		X		X	X
D	MA Health & Educ Facil Authority - Ser IJK	04-2456011	57586EKC4	06-25-2009	198,611,250	MA HEFA Series IJK - See Part VI		X		X		X
	MA Development Finance Agency - Ser L	04-3431814		11-02-2011	25,000,000	MA DFA Series L - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814		11-02-2011	20,000,000	MA DFA Cap Lease - See Part VI		X		X		X
	MA Development Finance Agency - Ser M	04-3431814		08-09-2012	40,137,000	MA DFA Series M - See Part VI		X		X		X
	MA Development Finance Agency - Ser N	04-3431814	57583UN79	11-06-2014	60,742,119	MA DFA Series N - See Part VI		X		X		X
	MA Development Finance Agency - Ser O	04-3431814	000000000	05-12-2016	20,000,000	MDFA Series O-see Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	09-22-2016	14,062,890	MDFA CoGen Lease - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	12-29-2016	3,000,000	MDFA LA #1 Lease - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	11-15-2017	2,937,110	MDFA LA #2 Lease - See Part VI		X		X		X
	MA Development Finance Agency - Ser P-1	04-3431814	000000000	12-21-2017	40,595,000	MA DFA Series P-1 - See Part VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	38,840,000		7,777,778		5,727,122		329,090
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	71,740,000		10,000,000		10,157,671		199,122,425
4 Gross proceeds in reserve funds .............					43,671
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............	39,871,232
7 Issuance costs from proceeds ...............	735,004		72,250		229,661		1,845,403
8 Credit enhancement from proceeds .............							93,479
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	6,990,000		9,927,750		3,000,772		132,183,543
11 Other spent proceeds .............	64,014,996				10,114,000		65,000,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2005		2006		1999		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X			X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.020 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0.010 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0.030 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X	X			X		X
c No rebate due? .........	X			X	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	Citibank
c Term of hedge .........	2070.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: MA Health & Educ. Facil. Authority - Ser. G Date the Rebate Computation was Performed: 09/27/2006 Issuer Name: MA Health & Educ. Facil. Authority - Ser. M2 Date the Rebate Computation was Performed: 06/18/2013 Issuer Name: MA Health & Educ. Facil. Authority - Ser. IJK Date the Rebate Computation was Performed: 08/24/2012
Bond Issues Supplemental Information	A - MHEFA Series G Bonds Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) to advance refund $61,930,000 principal amount of the Authority's Revenue Bonds, Baystate Medical Center (the Institution) Issue, Series E (the "Series E Bonds"), which were issued July 11, 1996 to finance or refinance the following property owned by the Institution: (a) construction of a new 104,500 gross square foot Ambulatory Care Center at 3300 Main Street, Springfield, Massachusetts; (b) construction of a new 100,000 gross square foot building to house the Ambulatory Surgery Center, Medical Library and education/conference space on the Institution's North campus located at 759 Chestnut Street, Springfield, Massachusetts; (c) renovation of various existing spaces within the Institution's North campus; and (d) acquisition of equipment for the new facilities; (ii) to finance routine capital construction, renovations, and equipping of various facilities of the Institution; and (iii) to pay certain costs of issuance of the Series G Bonds. B- MHEFA Series H Bonds Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) the construction, improvement, equipping, and other related capital expenditures of a parking garage walkway, and other related work at an existing building at 280 Chestnut Street owned and used by the Institution, and (ii) the acquisition and installation of capital equipment and renovations to existing facilities of the Institution and other routine capital expenditures in connection with the Institution's hospital operations. C- MHEFA Series M-2, Pool 2 Part I - Per the Loan Document the purpose of the bond is to refinance Baystate Medical Center's MHEFA Pool J-2 Loan, which was issued February 2, 1999 to finance the acquisition and equipping of the property located at 280 Chestnut Street, Springfield, Massachusetts (the "Property"), and the renovation of the Property and existing facilities of the Institution and the acquisition of capital equipment for the Institution's existing facilities. The MHEFA indebtedness listed is a pool loan; therefore the issue price, Parts I, II, III, and IV (Lines 5-7) are being answered with respect to the Baystate Medical Center loan alone rather than with respect to proceeds loaned to other conduit borrowers. The actual date of issue of the MHEFA Series M2 Bonds was 5/30/2002, and the CUSIP number shown on Form 8038 was 57585KA57. While that issue was not a refunding issue, the purpose of the loan taken by BMC was to refund prior debt, as reflected in our response to Part II, Line 14. Accordingly, Part III has not been completed, as the original project was financed with bonds issued prior to 2003. D- MHEFA Series I, J-1, J-2, K-1, K-2 Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) to pay a portion of the costs associated with the acquisition of land, site development, construction or alteration of buildings or the acquisition or installation of furnishings and equipment, refinancing of, or any combination of the foregoing, in connection with the construction, improvement, equipping, and other related capital expenditures of a seven-story, approximately 599,100 gross square foot primarily inpatient building located at 759 Chestnut Street, Springfield, Massachusetts, including demolition and site work, which building will be constructed by Baystate Total Home Care (BTHC) and leased to Baystate Medical Center by BTHC; (ii) for the acquisition and installation of capital equipment and renovations to existing facilities of the Medical Center and other routine capital expenditures included or to be included in the Medical Center's capital budget over the next three years for use in connection with the Medical Center's hospital operations; (iii) for the refinancing of a portion of an outstanding commercial loan in the amount of $65,000,000 made by Bank of America, N.A. on October 20, 2008 to the Medical Center in connection with the defeasance of the Authority's Revenue Bonds, Baystate Medical Center Issue, Series D, issued September 16, 1993; (iv) for the financing of costs associated with the issuance of bonds and; (v) financing of routine capital construction, renovations, and equipping of various facilities of Baystate Medical Center. E - MDFA Revenue Bonds, Series L Part I - Per the Official Statement, the purpose of the bond proceeds is for the construction, improvement, and other capital expenditures relating to the build-out of an equipping of certain interior space within a seven-story approximately 599,100 gross square foot primarily inpatient building owned by Baystate Total Home Care, Inc. and leased to the Institution located at 759 Chestnut Street, Springfield, Massachusetts, such build-out to consist of space to be used for the Emergency Department of the Institution and ancillary support areas and the financing costs associated with the issuance of the bonds. F - MDFA Tax Exempt Capital Lease Part I - Per the Master Lease and Sublease Agreement, the purpose of the Tax Exempt Capital Lease is for the Acquisition of Equipment. "Equipment" means the fixed and moveable personal property to be used in connection with the Sub-Lessee's health care operations identified in a Schedule executed by or pursuant to the Agency of the Lessee and the Sub-Lessee, accepted by the Lessor and acknowledged by the Escrow Agent in writing and identified as part of this Master Lease (including certain items originally financed through internal advances of the Sub-Lessee in anticipation of obtaining permanent financing through the Lessee), together with all replacement parts, additions, repairs, accessions, and accessories incorporated therein and/or affixed to such personal property and replacements and substitutions therefor and proceeds and products thereof. G - MDFA Revenue Bonds Series M - Part I - The purpose of the bond proceeds is: (i) to advance refund $39,907,339 principal amount of Massachusetts Health and Education Facilities Authority's Revenue Bonds, Baystate Medical Center (the Institution) Issue, Series F (the "Series F Bonds"), issued June 12, 2002 the proceeds of which financed the Construction of a new Cancer Center with a partial third floor medical record and support area; acquisition of a surgery center facility, certain renovations and equipment acquisitions; and (ii) finance costs of issuance relating to the Bond. H - MDFA Revenue Bonds Series N - Part I - The purpose of the bond proceeds is: (i) capital expenditures, including capitalized interest, in connection with the following projects (the "Project"); a) the build-out of and equipping of certain interior space within a seven-story, approximately 599,100 gross square foot primarily inpatient building owned by BTHC and leased to Baystate Medical Center located at 759 Chestnut Street, Springfield, Massachusetts, such build-out to include inpatient rooms, operating rooms, and inpatient pharmacy, and b) the acquisition of medical equipment, information technology equipment, and other equipment and assets to be owned or leased and used by the Medical Center at the Medical Center's health care facilities located at 759 Chestnut Street, Springfield, Massachusetts, 3300,3350,3400 and 3601 Main Street, Springfield, Massachusetts and 50, 80, and 100 Wason Avenue, Springfield, Massachusetts, and (ii) costs of issuance relating to the Bonds.
I - MDFA Revenue Bonds Series O	Part I - The purpose of the bond proceeds is to indirectly finance the following: (a) the construction, improvement, equipping, and other related capital expenditures of a seven-story, approximately 599,100 gross square foot primarily inpatient building located at 759 Chestnut Street, Springfield, Massachusetts, including demolition and site work, which building was constructed by BTHC and leased to the Medical Center by BTHC; and (b) the acquisition and installation of capital equipment and renovations to existing facilities of the Medical Center and other routine capital expenditures included or to be included in the Medical Center's capital budget over a three-year period for use in connection with the Medical Center's hospital operations at the following facilities of the Medical Center: Springfield Building (including all wings and attached buildings), located at 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Cardiac Services, Medical Services, Lab, and Inpatient Beds); Wesson Women and Infants Building, 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Birthing Services, Neonatal Services, and Inpatient Beds); Daly Building (formerly the Centennial Building), 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Emergency Room, Radiology, MRI, Ultrasound, Ambulatory and Inpatient Pharmacies, Lab, Operating Rooms, Inpatient Beds, ElectroPhysio Labs, ICU, and PICU); Daly Parking Garage, 759 Chestnut Street, Springfield, Massachusetts (a patient and visitor parking garage); D'Amour's Center for Cancer Care, 3350 Main Street, Springfield, Massachusetts (primarily used for Clinical Cancer Services); Chestnut Building, 759 Chestnut Street, Springfield, Massachusetts (primarily used for Ambulatory Surgery, Library, and Simulation Center); and Whitney Avenue Building (specifically capital expenditures related to information technology), 361 Whitney Avenue, Holyoke, Massachusetts (used for general health system purposes). J - MDFA CoGen Lease A Part I - The purpose of the lease is to finance the construction of an approximately 5,000 square foot co-generational, combined heat and power plant providing electricity, chilled water and steam to the facilities of the Institution. K - MDFA LA #1 Lease B Part I - The purpose of the lease is to finance the acquisition and installation of a linear accelerator. L - MDFA LA #2 Lease Part I The purpose of the lease is to finance the acquisition and installation of a linear accelerator. M - MDFA Series P-1 Part I - The Bond is being issued for the purpose of providing funds to refund on an advance basis a portion of the $63,380,000 aggregate stated principal amount outstanding as of the date hereof of the Revenue Bonds, Baystate Medical Center Issue, Series I (the "Refunded Bonds"), the proceeds of which were used to pay a portion of the construction costs of a new hospital building located at 759 Chestnut Street, Springfield, Massachusetts. Part I and Part II, Differences between the issue price (Part I) and total proceeds (Part II, Line 3) are due to investment earnings. Part III, Lines 4 and 5, Column D (Series IJK): As the refunded bonds were issued prior to January 1, 2003, this question is being answered solely with respect to the new money portion of the bonds. Part III, Column G (Series M): As these bonds refunded debt issued prior to January 1, 2003, the organization is availing itself of the Part III reporting exemption available for such bonds. Part IV, Line 2c, Column C (Series M-2): The Issuing Authority engages an outside consultant to prepare rebate computations. As of the most recent computation period, May 29, 2017 no rebate was owed. The cumulative rebate amount is zero as of the outside consultant's most recent report. Part IV, Line 6, Column A (Series G): This question is being answered without regard to yield-restricted advance funding escrow financed with proceeds of the bonds.

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Baystate Medical Center Inc

Employer identification number
04-2790311

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MA Health & Educ Facil Authority - Ser G	04-2456011	57586CNHA	10-27-2005	71,740,000	MA HEFA Series G - See Part VI		X		X		X
B	MA Health & Educ Facil Authority - Ser H	04-2456011		01-18-2007	10,000,000	MA HEFA Series H - See Part VI		X		X		X
C	MA Health & Educ Facil Authority - Ser M2	04-2456011		06-30-2008	10,157,671	MA HEFA Series M2 - See Part VI		X		X	X
D	MA Health & Educ Facil Authority - Ser IJK	04-2456011	57586EKC4	06-25-2009	198,611,250	MA HEFA Series IJK - See Part VI		X		X		X
	MA Development Finance Agency - Ser L	04-3431814		11-02-2011	25,000,000	MA DFA Series L - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814		11-02-2011	20,000,000	MA DFA Cap Lease - See Part VI		X		X		X
	MA Development Finance Agency - Ser M	04-3431814		08-09-2012	40,137,000	MA DFA Series M - See Part VI		X		X		X
	MA Development Finance Agency - Ser N	04-3431814	57583UN79	11-06-2014	60,742,119	MA DFA Series N - See Part VI		X		X		X
	MA Development Finance Agency - Ser O	04-3431814	000000000	05-12-2016	20,000,000	MDFA Series O-see Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	09-22-2016	14,062,890	MDFA CoGen Lease - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	12-29-2016	3,000,000	MDFA LA #1 Lease - See Part VI		X		X		X
	MA Development Finance Agency - Cap Lease	04-3431814	000000000	11-15-2017	2,937,110	MDFA LA #2 Lease - See Part VI		X		X		X
	MA Development Finance Agency - Ser P-1	04-3431814	000000000	12-21-2017	40,595,000	MA DFA Series P-1 - See Part VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	38,840,000		7,777,778		5,727,122		329,090
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	71,740,000		10,000,000		10,157,671		199,122,425
4 Gross proceeds in reserve funds .............					43,671
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............	39,871,232
7 Issuance costs from proceeds ...............	735,004		72,250		229,661		1,845,403
8 Credit enhancement from proceeds .............							93,479
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	6,990,000		9,927,750		3,000,772		132,183,543
11 Other spent proceeds .............	64,014,996				10,114,000		65,000,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2005		2006		1999		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X			X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.020 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0.010 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0.030 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X	X			X		X
c No rebate due? .........	X			X	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	Citibank
c Term of hedge .........	2070.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: MA Health & Educ. Facil. Authority - Ser. G Date the Rebate Computation was Performed: 09/27/2006 Issuer Name: MA Health & Educ. Facil. Authority - Ser. M2 Date the Rebate Computation was Performed: 06/18/2013 Issuer Name: MA Health & Educ. Facil. Authority - Ser. IJK Date the Rebate Computation was Performed: 08/24/2012
Bond Issues Supplemental Information	A - MHEFA Series G Bonds Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) to advance refund $61,930,000 principal amount of the Authority's Revenue Bonds, Baystate Medical Center (the Institution) Issue, Series E (the "Series E Bonds"), which were issued July 11, 1996 to finance or refinance the following property owned by the Institution: (a) construction of a new 104,500 gross square foot Ambulatory Care Center at 3300 Main Street, Springfield, Massachusetts; (b) construction of a new 100,000 gross square foot building to house the Ambulatory Surgery Center, Medical Library and education/conference space on the Institution's North campus located at 759 Chestnut Street, Springfield, Massachusetts; (c) renovation of various existing spaces within the Institution's North campus; and (d) acquisition of equipment for the new facilities; (ii) to finance routine capital construction, renovations, and equipping of various facilities of the Institution; and (iii) to pay certain costs of issuance of the Series G Bonds. B- MHEFA Series H Bonds Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) the construction, improvement, equipping, and other related capital expenditures of a parking garage walkway, and other related work at an existing building at 280 Chestnut Street owned and used by the Institution, and (ii) the acquisition and installation of capital equipment and renovations to existing facilities of the Institution and other routine capital expenditures in connection with the Institution's hospital operations. C- MHEFA Series M-2, Pool 2 Part I - Per the Loan Document the purpose of the bond is to refinance Baystate Medical Center's MHEFA Pool J-2 Loan, which was issued February 2, 1999 to finance the acquisition and equipping of the property located at 280 Chestnut Street, Springfield, Massachusetts (the "Property"), and the renovation of the Property and existing facilities of the Institution and the acquisition of capital equipment for the Institution's existing facilities. The MHEFA indebtedness listed is a pool loan; therefore the issue price, Parts I, II, III, and IV (Lines 5-7) are being answered with respect to the Baystate Medical Center loan alone rather than with respect to proceeds loaned to other conduit borrowers. The actual date of issue of the MHEFA Series M2 Bonds was 5/30/2002, and the CUSIP number shown on Form 8038 was 57585KA57. While that issue was not a refunding issue, the purpose of the loan taken by BMC was to refund prior debt, as reflected in our response to Part II, Line 14. Accordingly, Part III has not been completed, as the original project was financed with bonds issued prior to 2003. D- MHEFA Series I, J-1, J-2, K-1, K-2 Part I - Per the Official Statement, the purpose of the bond proceeds is: (i) to pay a portion of the costs associated with the acquisition of land, site development, construction or alteration of buildings or the acquisition or installation of furnishings and equipment, refinancing of, or any combination of the foregoing, in connection with the construction, improvement, equipping, and other related capital expenditures of a seven-story, approximately 599,100 gross square foot primarily inpatient building located at 759 Chestnut Street, Springfield, Massachusetts, including demolition and site work, which building will be constructed by Baystate Total Home Care (BTHC) and leased to Baystate Medical Center by BTHC; (ii) for the acquisition and installation of capital equipment and renovations to existing facilities of the Medical Center and other routine capital expenditures included or to be included in the Medical Center's capital budget over the next three years for use in connection with the Medical Center's hospital operations; (iii) for the refinancing of a portion of an outstanding commercial loan in the amount of $65,000,000 made by Bank of America, N.A. on October 20, 2008 to the Medical Center in connection with the defeasance of the Authority's Revenue Bonds, Baystate Medical Center Issue, Series D, issued September 16, 1993; (iv) for the financing of costs associated with the issuance of bonds and; (v) financing of routine capital construction, renovations, and equipping of various facilities of Baystate Medical Center. E - MDFA Revenue Bonds, Series L Part I - Per the Official Statement, the purpose of the bond proceeds is for the construction, improvement, and other capital expenditures relating to the build-out of an equipping of certain interior space within a seven-story approximately 599,100 gross square foot primarily inpatient building owned by Baystate Total Home Care, Inc. and leased to the Institution located at 759 Chestnut Street, Springfield, Massachusetts, such build-out to consist of space to be used for the Emergency Department of the Institution and ancillary support areas and the financing costs associated with the issuance of the bonds. F - MDFA Tax Exempt Capital Lease Part I - Per the Master Lease and Sublease Agreement, the purpose of the Tax Exempt Capital Lease is for the Acquisition of Equipment. "Equipment" means the fixed and moveable personal property to be used in connection with the Sub-Lessee's health care operations identified in a Schedule executed by or pursuant to the Agency of the Lessee and the Sub-Lessee, accepted by the Lessor and acknowledged by the Escrow Agent in writing and identified as part of this Master Lease (including certain items originally financed through internal advances of the Sub-Lessee in anticipation of obtaining permanent financing through the Lessee), together with all replacement parts, additions, repairs, accessions, and accessories incorporated therein and/or affixed to such personal property and replacements and substitutions therefor and proceeds and products thereof. G - MDFA Revenue Bonds Series M - Part I - The purpose of the bond proceeds is: (i) to advance refund $39,907,339 principal amount of Massachusetts Health and Education Facilities Authority's Revenue Bonds, Baystate Medical Center (the Institution) Issue, Series F (the "Series F Bonds"), issued June 12, 2002 the proceeds of which financed the Construction of a new Cancer Center with a partial third floor medical record and support area; acquisition of a surgery center facility, certain renovations and equipment acquisitions; and (ii) finance costs of issuance relating to the Bond. H - MDFA Revenue Bonds Series N - Part I - The purpose of the bond proceeds is: (i) capital expenditures, including capitalized interest, in connection with the following projects (the "Project"); a) the build-out of and equipping of certain interior space within a seven-story, approximately 599,100 gross square foot primarily inpatient building owned by BTHC and leased to Baystate Medical Center located at 759 Chestnut Street, Springfield, Massachusetts, such build-out to include inpatient rooms, operating rooms, and inpatient pharmacy, and b) the acquisition of medical equipment, information technology equipment, and other equipment and assets to be owned or leased and used by the Medical Center at the Medical Center's health care facilities located at 759 Chestnut Street, Springfield, Massachusetts, 3300,3350,3400 and 3601 Main Street, Springfield, Massachusetts and 50, 80, and 100 Wason Avenue, Springfield, Massachusetts, and (ii) costs of issuance relating to the Bonds.
I - MDFA Revenue Bonds Series O	Part I - The purpose of the bond proceeds is to indirectly finance the following: (a) the construction, improvement, equipping, and other related capital expenditures of a seven-story, approximately 599,100 gross square foot primarily inpatient building located at 759 Chestnut Street, Springfield, Massachusetts, including demolition and site work, which building was constructed by BTHC and leased to the Medical Center by BTHC; and (b) the acquisition and installation of capital equipment and renovations to existing facilities of the Medical Center and other routine capital expenditures included or to be included in the Medical Center's capital budget over a three-year period for use in connection with the Medical Center's hospital operations at the following facilities of the Medical Center: Springfield Building (including all wings and attached buildings), located at 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Cardiac Services, Medical Services, Lab, and Inpatient Beds); Wesson Women and Infants Building, 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Birthing Services, Neonatal Services, and Inpatient Beds); Daly Building (formerly the Centennial Building), 759 Chestnut Street, Springfield, Massachusetts (the principal uses of which include Emergency Room, Radiology, MRI, Ultrasound, Ambulatory and Inpatient Pharmacies, Lab, Operating Rooms, Inpatient Beds, ElectroPhysio Labs, ICU, and PICU); Daly Parking Garage, 759 Chestnut Street, Springfield, Massachusetts (a patient and visitor parking garage); D'Amour's Center for Cancer Care, 3350 Main Street, Springfield, Massachusetts (primarily used for Clinical Cancer Services); Chestnut Building, 759 Chestnut Street, Springfield, Massachusetts (primarily used for Ambulatory Surgery, Library, and Simulation Center); and Whitney Avenue Building (specifically capital expenditures related to information technology), 361 Whitney Avenue, Holyoke, Massachusetts (used for general health system purposes). J - MDFA CoGen Lease A Part I - The purpose of the lease is to finance the construction of an approximately 5,000 square foot co-generational, combined heat and power plant providing electricity, chilled water and steam to the facilities of the Institution. K - MDFA LA #1 Lease B Part I - The purpose of the lease is to finance the acquisition and installation of a linear accelerator. L - MDFA LA #2 Lease Part I The purpose of the lease is to finance the acquisition and installation of a linear accelerator. M - MDFA Series P-1 Part I - The Bond is being issued for the purpose of providing funds to refund on an advance basis a portion of the $63,380,000 aggregate stated principal amount outstanding as of the date hereof of the Revenue Bonds, Baystate Medical Center Issue, Series I (the "Refunded Bonds"), the proceeds of which were used to pay a portion of the construction costs of a new hospital building located at 759 Chestnut Street, Springfield, Massachusetts. Part I and Part II, Differences between the issue price (Part I) and total proceeds (Part II, Line 3) are due to investment earnings. Part III, Lines 4 and 5, Column D (Series IJK): As the refunded bonds were issued prior to January 1, 2003, this question is being answered solely with respect to the new money portion of the bonds. Part III, Column G (Series M): As these bonds refunded debt issued prior to January 1, 2003, the organization is availing itself of the Part III reporting exemption available for such bonds. Part IV, Line 2c, Column C (Series M-2): The Issuing Authority engages an outside consultant to prepare rebate computations. As of the most recent computation period, May 29, 2017 no rebate was owed. The cumulative rebate amount is zero as of the outside consultant's most recent report. Part IV, Line 6, Column A (Series G): This question is being answered without regard to yield-restricted advance funding escrow financed with proceeds of the bonds.

Schedule K (Form 990) 2019

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	22
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 2019 (Part V, line 2a) ......	5	8,440
6	Total number of volunteers (estimate if necessary) .............	6	424
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	7,136,969
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-2,102,303

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,891,390	9,603,517
9	Program service revenue (Part VIII, line 2g) .........	1,143,646,536	1,199,523,762
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	28,302,911	34,890,459
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	65,068,460	73,946,813
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,242,909,297	1,317,964,551
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	11,389,487	15,807,203
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)	508,446,278	526,939,128
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)....	627,810,676	654,659,686
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,147,646,441	1,197,406,017
19	Revenue less expenses. Subtract line 18 from line 12.......	95,262,856	120,558,534
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,339,784,677	1,362,808,541
21	Total liabilities (Part X, line 26).............	575,061,607	535,124,648
22	Net assets or fund balances. Subtract line 21 from line 20.....	764,723,070	827,683,893

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 549,702,202 including grants of $ 15,807,203 ) (Revenue $ 621,020,153 )
	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 FY18, Baystate Medical Center, Inc. provided 210,747 patient days of inpatient services, with 42,416 discharges.

4b	(Code: ) (Expenses $ 423,441,750 including grants of $ ) (Revenue $ 403,610,182 )
	Outpatient healthcare services - Providing outpatient clinical services to the surrounding region. Services are available to individuals regardless of their ability to pay. During FY18, Baystate Medical Center, Inc. had 465,067 outpatient visits.

4c	(Code: ) (Expenses $ 38,575,305 including grants of $ ) (Revenue $ 41,152,130 )
	Emergency department services - Providing emergency department services to the surrounding region. Services are available to individuals regardless of their ability to pay. During FY18, Baystate Medical Center, Inc. had 117,299 emergency department visits.

	(Code: ) (Expenses $ 104,876,712 including grants of $ ) (Revenue $ 194,475,875 )
	Other program services - Providing ambulatory pharmacy and infusion and respiratory services to the surronding region. Services are available to individuals regardless of their ability to pay.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 104,876,712 including grants of $ ) (Revenue $ 194,475,875 )
4e	Total program service expenses1,116,595,969

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,227,775	5,049,202	890,488

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	4,711,574
e	Government grants (contributions)		1e	3,437,364

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,454,579

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		9,603,517

		Business Code
2a	Inpatient Revenue	900099	646,498,766	646,498,766
b	Outpatient Revenue	621400	530,817,847	523,700,923	7,116,924
c	Sponsored Programs	900099	9,432,681	9,432,681
d	MCD Waiver Safety Net	900099	6,802,125	6,802,125
e	Next Gen ACO	900099	3,353,633	3,353,633
f	All other program service revenue.		2,618,710	2,618,710
g	Total. Add lines 2a–2f .....		1,199,523,762

3 Investment income (including dividends, interest, and othersimilar amounts) ......			4,599,553			4,599,553
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		489,470	6a
b	Less: rental expenses		508,509	6b
c	Rental income or (loss)		-19,039	6c
d	Net rental income or (loss).......			-19,039			-19,039
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	10,666,498	33,100,448	7a
b	Less: cost or other basis and sales expenses	7,498,806	5,977,234	7b
c	Gain or (loss)	3,167,692	27,123,214	7c
d	Net gain or (loss).........			30,290,906			30,290,906
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Pharmacy Service		900099	38,300,851	38,300,851
b	Intercompany Charges		900099	22,417,399	22,417,399
c	Cafeteria Income		900099	6,093,256			6,093,256
d	All other revenue ....			7,154,346	7,133,252	20,045	1,049
e	Total. Add lines 11a–11d ......			73,965,852
12	Total revenue. See instructions.....			1,317,964,551	1,260,258,340	7,136,969	40,965,725

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	15,776,845	15,776,845
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	30,358	30,358
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 ...........	391,367	391,367
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	117,712	117,712
7	Other salaries and wages........	435,661,212	400,396,229	35,264,983
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	14,808,202	13,607,412	1,200,790
9	Other employee benefits .......	43,350,491	39,843,188	3,507,303
10	Payroll taxes ...........	32,610,144	29,973,180	2,636,964
11	Fees for services (non-employees):
a	Management ......	45,357,694	42,327,118	3,030,576
b	Legal .........	904,139		904,139
c	Accounting ...........	514,342		514,342
d	Lobbying ...........	290,777		290,777
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)	152,479,705	142,099,396	10,380,309
12	Advertising and promotion ....	345,607	345,607
13	Office expenses .......	285,980,942	283,514,114	2,466,828
14	Information technology ......	65,399,474	64,775,854	623,620
15	Royalties ..
16	Occupancy ...........	23,173,649	12,502,515	10,671,134
17	Travel ............	1,330,927	1,135,522	195,405
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,299,716	1,145,297	154,419
20	Interest ...........	10,388,286	10,388,286
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	58,772,756	50,948,794	7,823,962
23	Insurance ...	8,421,672	7,277,175	1,144,497
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	1,197,406,017	1,116,595,969	80,810,048	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).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			65,429,707	2	79,823,279
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			206,066,491	4	207,602,809
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			26,575,257	8	26,610,122
9	Prepaid expenses and deferred charges ......			21,399,490	9	23,322,726
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,492,365,251
b	Less: accumulated depreciation	10b	926,759,410	579,243,424	10c	565,605,841
11	Investments—publicly traded securities .			295,536,405	11	340,292,738
12	Investments—other securities. See Part IV, line 11 .....			126,593,862	12	99,699,981
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			1,551,527	14	1,551,527
15	Other assets. See Part IV, line 11 ...........			17,388,514	15	18,299,518
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,339,784,677	16	1,362,808,541

17	Accounts payable and accrued expenses .....	99,424,407	17	100,050,588
18	Grants payable ...		18
19	Deferred revenue .........	654,309	19	2,878,331
20	Tax-exempt bond liabilities .........	375,586,248	20	370,978,538
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	19,300,107	23	16,833,400
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	80,096,536	25	44,383,791
26	Total liabilities. Add lines 17 through 25..	575,061,607	26	535,124,648

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	764,723,070	32	827,683,893
33	Total liabilities and net assets/fund balances ........	1,339,784,677	33	1,362,808,541

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Hector Toledo	Family member of Hector Toledo	18,251	See Part V - Family member of Hector Toledo employed by the filing organization.		No
(2) James R Phaneuf CIC	Family member of James R. Phaneuf, CIC	52,814	See Part V - Family member of James R. Phaneuf CIC is employed by the filing organization.		No

Return Reference	Explanation
Form 990, Part VI, Section A, line 1	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	Two or more of the persons listed in this Form 990 Part VII have a business relationship with each other by virtue of sitting on one or more Boards of Directors or by serving in an employment relationship with one or more entities in the Baystate Group of affiliated entities and in the community. The following trustees, officers, or key employees have a business relationship: (1) Grace P. Makari-Judson, MD, James P. Sadowsky and John H. Davis, (2) Paul R. Murphy and Robert L. Pura, PhD, (3) John F. Maybury and Mark A. Keroack, MD, (4) Hector F. Toledo and Timothy F. Farrell, (5) Claudia R. Coplein, DO and Victor Woolridge, (6) Colleen W. Holmes and James P. Sadowsky, (7) John F. Maybury and Anne M. Paradis.
Form 990, Part VI, Section A, line 3	Baystate Medical Center, Inc. is affiliated with Baystate Administrative Services, Inc. (BAS) which is a 501(c) (3) organization. Information Technology, Human Resources, Finance, Treasury, Accounting and other management and support functions are delegated to BAS.
Form 990, Part VI, Section A, line 6	The 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 A, line 8b: The Trustees of Baystate Medical Center, Inc. meet during certain scheduled Baystate Health, Inc. (BH) board meetings. The BH Board of Trustees and its committees, including the Audit and Compliance Committee, contemporaneously document meetings and actions relative to Baystate Medical Center, Inc. as well as the annual acceptance of the audited financial statements.
Form 990, Part VI, Section B, line 11b	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) 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. This committee also reviews the audited financial statements for the health system. 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 Medical Center, Inc. is an affiliate of Baystate Health, Inc. (BH). BH and its affiliated entities have a comprehensive conflict of interest policy applicable to all of the affiliated entities. 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 Chief Compliance Officer, Chief Executive Officer, Chair of the Board of Trustees, Chief General Counsel and the Chair of the Audit & Compliance Committee. A summary of the conflict of interest disclosures is provided to the Baystate Health Board of Trustees and the Tax Department. Potential conflict of interest transactions are reviewed as appropriate under the policy, which provides for recusal from discussion and deliberation by any party with a potential conflict of interest.
Form 990, Part VI, Section B, line 15	The compensation of the President and CEO is reviewed and determined annually by the compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs), which has been appointed through board resolution as the compensation committee of the filing organization. This committee consists entirely of individuals serving on the board of the filing organization. The individuals responsible for deliberating the compensation arrangement for the President and CEO would be those individuals who do not have a conflict of interest with respect to the compensation arrangement and would be considered independent for compensation deliberation purposes. The compensation of the President and CEO is established based on information provided by independent third party consultants for reasonableness and appropriate comparability data. The compensation is then established, reviewed and approved by the duly authorized compensation committee of Baystate Health, Inc. The compensation of other officers and key employees is administered under the Executive Compensation Philosophy Statement, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data or the Baystate Health Board approved budget and wage program for each fiscal year. Line 15a has been answered No because the President and CEO is paid by Baystate Administrative Services, Inc., an affiliate and related organization of the filing organization. Form 990, Part VI, Section B, Line 16b Baystate Health, Inc. has a joint venture policy that covers affiliated tax exempt entities including Baystate Medical Center, Inc.
Form 990, Part VI, Section C, line 19	The organization makes its conflict of interest policy and financial statements available to the public at www.baystatehealth.org. Articles of organization and bylaws are generally available at the Commonwealth of Massachusetts website.
Form 990, Part VII, Section A, Line 5	Certain officers or trustees of the filing organization are paid by an entity, Baystate 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 IX, line 11g	BMP Support: Program service expenses 67,830,729. Management and general expenses 0. Fundraising expenses 0. Total expenses 67,830,729. Fees, Physicians: Program service expenses 8,478,232. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,478,232. Fees, Laboratory & Clinical: Program service expenses 12,319,016. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,319,016. Purchased Service: Program service expenses 12,212,913. Management and general expenses 4,361,283. Fundraising expenses 0. Total expenses 16,574,196. Supplementary Service: Program service expenses 6,987,874. Management and general expenses 1,894,575. Fundraising expenses 0. Total expenses 8,882,449. Temporary Help: Program service expenses 10,236,375. Management and general expenses 243,693. Fundraising expenses 0. Total expenses 10,480,068. Consulting: Program service expenses 4,364,775. Management and general expenses 2,349,115. Fundraising expenses 0. Total expenses 6,713,890. Contracted Service: Program service expenses 9,466,588. Management and general expenses 689,462. Fundraising expenses 0. Total expenses 10,156,050. Outside Services: Program service expenses 6,140,242. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,140,242. Subcontractor: Program service expenses 1,306,361. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,306,361. Billing Service: Program service expenses 1,218,980. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,218,980. Transcription Service: Program service expenses 1,138,669. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,138,669. Garage Administrative: Program service expenses 398,642. Management and general expenses 842,181. Fundraising expenses 0. Total expenses 1,240,823.
Form 990, Part XI, line 9:	Transfer from affiliate for land, buildings and equipment 2,631,116. Transfer of funds to affiliated companies -62,665,429. Minimum pension liability adjustment 15,347,813. Funds utilized for property and equipment 3,430,205. Net assets released from restrictions from affiliates -111,055.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(f) Direct controlling entity
(1) Pioneer Valley Information Exchange LLC 101 Wason Avenue Suite 200 Springfield,MA01107 04-2790311	Operation of a health information exchange and related activities	MA	Baystate Medical Center Inc

(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)	12c, III	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 Total Home Care Inc 280 Chestnut Street Springfield,MA01104 20-3260764	Real Estate and Other	MA	501 (c ) (3)	12b, II	Baystate Medical Center Inc	Yes
(7)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)	10	Baystate Health Inc		No
(8)Health New England Inc Monarch Place Suite 1500 Springfield,MA011441590 04-2864973	HMO/Insurance	MA	501 (c ) (4)		Baystate Health Inc		No
(9)Baystate Wing Hospital Corporation 40 Wright Street Palmer,MA01069 22-2519813	Hospital	MA	501 (c ) (3)	3	Baystate Health Inc		No
(10)HNE of Connecticut Inc Monarch Place Suite 1500 Springfield,MA011441590 46-5190134	HMO/Insurance	CT	501 (c ) (4)		Health New England Inc		No
(11)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
(12)Westfield Medical Corporation 115 West Silver Street PO Box 1634 Westfield,MA010861634 04-3127730	Healthcare	MA	501 (c ) (3)	12a, I	Baystate Noble Hospital Corporation		No
(13)Noble Visiting Nurse Services Inc 77 Mill Street Westfield,MA01085 22-2757446	Homehealth and Hospice care	MA	501 (c ) (3)	10	Visiting Nurse Assn and Hospice of Western New England Inc		No

(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

(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