Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Baystate Wing Hospital Corporation
 
Employer identification number

22-2519813
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
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.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014
Page 2

Schedule J (Form 990) 2014
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Charles E Cavagnaro III MDPresident & Director (i)
(ii)
233,473
.................
122,347
0
.................
57,708
935,329
.................
4,371
340,358
.................
0
14,789
.................
2,478
1,523,949
.................
186,904
935,329
.................
0
2Dennis ChalkeDirector (i)
(ii)
0
.................
432,876
0
.................
264,360
0
.................
231,815
0
.................
55,591
0
.................
24,054
0
.................
1,008,696
0
.................
0
3Mark Keroack MDDirector (i)
(ii)
0
.................
658,452
0
.................
301,313
0
.................
20,465
0
.................
185,350
0
.................
18,006
0
.................
1,183,586
0
.................
0
4David L Maguire MDDirector (i)
(ii)
240,001
.................
0
9,202
.................
0
762
.................
0
9,968
.................
0
512
.................
0
260,445
.................
0
0
.................
0
5Linda J Schoonover MDDirector (i)
(ii)
115,532
.................
0
59,919
.................
0
258
.................
0
7,437
.................
0
31,173
.................
0
214,319
.................
0
0
.................
0
6Keary T AlliconCFO & Treasurer (i)
(ii)
105,284
.................
48,388
0
.................
17,269
39,152
.................
115
32,795
.................
0
15,411
.................
5,206
192,642
.................
70,978
0
.................
0
7Janice KucewiczRegional VP/Quality,Process Improvem (i)
(ii)
177,973
.................
0
13,956
.................
0
258
.................
0
7,838
.................
0
10,081
.................
0
210,106
.................
0
0
.................
0
8Brian Laliberte MDPhysician (i)
(ii)
386,400
.................
0
0
.................
0
138
.................
0
10,400
.................
0
27,538
.................
0
424,476
.................
0
0
.................
0
9Zachary Zichittella MDPhysician (i)
(ii)
378,070
.................
0
11,000
.................
0
54
.................
0
10,400
.................
0
22,178
.................
0
421,702
.................
0
0
.................
0
10David Wexler MDPhysician (i)
(ii)
341,796
.................
0
0
.................
0
138
.................
0
10,400
.................
0
23,540
.................
0
375,874
.................
0
0
.................
0
11Thomas Johnson MDPhysician (i)
(ii)
218,481
.................
0
98,165
.................
0
60
.................
0
10,400
.................
0
25,508
.................
0
352,614
.................
0
0
.................
0
12Rene Umanzor MDPhysician (i)
(ii)
190,740
.................
0
129,938
.................
0
60
.................
0
10,400
.................
0
21,962
.................
0
353,100
.................
0
0
.................
0
Schedule J (Form 990) 2014
Page 3

Schedule J (Form 990) 2014
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
Part I, Line 3 During January 1st through August 31st of calendar year 2014, the process to determine and approve the compensation for Dr. Charles Cavagnaro, CEO of Baystate Wing Hospital, was controlled by UMass Memorial, the former parent of Baystate Wing Hospital. At UMass Memorial, all compensation matters for CEO's throughout the system were governed and overseen by the Board of Trustees of the Parent. The Board approved a compensation philosophy that governed all such decisions. The philosophy included the objectives of the program, components of CEO compensation, the relevant market, positioning in the market, factors considered in setting CEO compensation and the importance of tying such compensation to performance. The Board established a Compensation Committee, made up of desinterested trustess, who were given the authority to establish compensation for all CEO's, within the parameters of the philosophy, and with full and complete reporting to the full Board. The Compensation Committee performed its work pursuant to its charter and a compensation policy that established the process the Committee would follow in reviewing and approving CEO compensation each year. The Committee ensured that its process met the rebuttable presumption of reasonableness established by the IRS. In order to assist the Committee in its responsibilities, the Compensation Committee hired independent, outside compensation consultants to advise the Committee and the Board on the reasonableness of overall executive compensation program, including compensation of the CEO's. These consultants reported directly to the Committee and not to management. The Committee worked with these consultants, and with Umass Legal Counsel, to ensure that all compensation paid, as well as the process followed to determine such compensation, was reasonable, met all regulatory requirements and was competitive with the relevant market. Beginning September 1, 2014 as Baystate Wing Hospital, the compensation committee of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) has been appointed through board resolution as the compensation committee of the filing organization. The compensation committee reviews and approves the compensation philosophy that is used to administer the specific pay decisions for the President of the filing organization. The compensation committee consists entirely of individuals serving on the board of the filing organization. The compensation of the President of the filing organization is determined by the member of the President's Cabinet (the Health System's senior leadership) responsible for that filing organization, in consultation with Human Resources, based on information provided by independent third party consultants for reasonableness including appropriate comparability data and based on the Executive Compensation Philosophy Statement established by the compensation committee.
Part I, Line 4b Line 4b: Charles E. Cavagnaro III, MD - Supplemental Retirement of $236,081 is included in column E. This amount was paid in 2014. Dennis W. Chalke - Supplemental Retirement of $146,489 is included in column E. This amount was earned and paid in 2014. Mark A. Keroack, MD Supplemental Retirement of $164,550 is included in column E. This amount was earned in 2014. Line 5: Certain officers or trustees of the filing organization are paid by an entity, Baystate Administrative Services, Inc. (BAS) EIN 22-2747685, 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 BAS to the officers and trustees of the filing organization therefore, is reported as paid from an unrelated organization in Line 5 and according to the instructions reported as though paid by the filing organization.
Schedule J (Form 990) 2014

Additional Data


Software ID:  
Software Version: