Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Baystate Medical Center Inc
 
Employer identification number

04-2790311
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Page 2

Schedule L (Form 990 or 990-EZ) 2013
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(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?
Yes No
(1) American Excess Insurance Exchange (AEIX)
  		Board Overlap 1,100,655 See Part V - Mark Tolosky, President of the filing organization is also a Member of the Board of Directors of AEIX. The filing organization purchases general & professional liability insurance from AEIX.   No
(2) Baycare Health Partners Inc (BHP)
  		Common Board Members or Officers 1,076,174 See Part V - The filing organization received payments for patient care services for which BHP is the intermediary between the filing organization and third party payer from BHP. BHP is an affiliate corporation of the filing organization.   No
(3) Baycare Health Partners Inc (BHP)
  		Common Board Members or Officers 1,555,161 See Part V - The filing organization made payments to BHP for annual support fees. BHP is an affiliate corporation of the filing organization.   No
(4) Baystate Health System Ambulance Inc (BHSA)
  		Common Board Members or Officers 107,565 See Part V - The filing organization received payments from BHSA for an employee assistance program. BHSA is an affiliate corporation of the filing organization.   No
(5) Baystate Health System Ambulance Inc (BHSA)
  		Common Board Members or Officers 337,628 See Part V - The filing organization made payments to BHSA of $235,634 for patient transport services and $101,994 for patient care services. BHSA is an affiliate corporation of the filing organization.   No
(6) Baystate MRI & Imaging Center LLC
  		Common Board Members or Officers 75,881 See Part V - The filng organization received payments from BMRI for other services. BMRI is an affiliate corporation of the filing organization.   No
(7) Baystate MRI & Imaging Center LLC
  		Common Board Members or Officers 34,956 See Part V - The filng organization made payments to BMRI for patient services. BMRI is an affiliate corporation of the filing organization.   No
(8) Baystate Radiology & Imaging LLC(BRI)
  		Common Board Members or Officers 2,015,558 See Part V - The filing organization received payments from BRI of $437,500 for partnership distributions, $178,150 for Outside Technologists, and $1,399,908 for Contracted Services. BRI is an affiliate corporation of the filing organization.   No
(9) Baystate Radiology & Imaging LLC (BRI)
  		Common Board Members or Officers 3,156 See Part V - The filing organization made payments to BRI of $3,156 for Rent. BRI is an affiliate corporation of the filing organization.   No
(10) Health New England Inc (HNE)
  		Common Board Members or Officers 117,308,166 See Part V - The filing organization received payments of $114,883,524 related to medical claims, $3,589 for support of community and quality programs and $2,421,053 in Surplus Sharing payments from HNE. HNE is an affiliate corporation of the filing organization.   No
(11) Ingraham Corporation (IC)
  		Common Board Members or Officers 97,784 See Part V - The filing organization received payments from IC for rent. IC is an affiliate corporation of the filing organization.   No
(12) Ingraham Corporation (IC)
  		Common Board Members or Officers 54,144 See Part V - The filing organization made payments to IC for lease payments. IC is an affiliate corporation of the filing organization.   No
(13) Western New England Renal & Transplant Associates PC(WNERTA)
  		Board Overlap 301,103 See Part V - Gregory L. Braden, MD,and Jeffrey G. Mulhern, MD are Board Members of the filing organization and Members of the Board of Directors of WNERTA. The filing organization made payments to WNERTA of $71,501 for Contracted Physician Services, $185,642 for Physician Stipends, and $43,960 for patient refunds.   No
(14) Western New England Renal & Transplant Associates PC(WNERTA)
  		Board Overlap 886 See Part V - Gregory L. Braden, MD, and Jeffrey G. Mulhern, MD are Board Members of the filing organization and Members of the Board of Directors of WNERTA. The filing organization received payments to WNERTA of $886 for Supplemental Services.   No
(15) John M O'Brien III Family member of John M. O'Brien 46,798 See Part V - Family member of John M. O'Brien employed by the filing organization.   No
(16) Timothy S Rice Family member of Timothy S. Rice 138,517 See Part V - Family member of Timothy S. Rice is employed by the filing organization.   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2013


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