Baystate Health Systems Inc Health &: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- Baystate Health Systems Inc Health & (EIN 22-2531644)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-08
- IRS object ID
- 201623139349301367
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-08T11:09:51-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Two Jericho Plaza | AddressLine1Txt |
| City | Jericho | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 11753 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222531644 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baystate Health Systems Inc Health & | BusinessNameLine1Txt |
| Business Name Line2 | Welfare Benefits Plan | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BAYS | BusinessNameControlTxt |
| Phone | 4137940000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 759 Chestnut Street | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01199 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dennis W Chalke | PersonNm |
| Person Title | Trustee/Treasurer & CFO, BH | PersonTitleTxt |
| Phone | 4137940000 | PhoneNum |
| Signature | 2016-11-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Deloitte Tax LLP | PreparerPersonNm |
| PTIN | P00743140 | PTIN |
| Phone | 5169187000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Dennis W Chalke | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 759 Chestnut Street | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01199 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $77,976,003 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Trust | Yes (X) | TypeOfOrganizationTrustInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | Administration of a Health Benefits Plan - Voluntary Employees' Benefits Association (VEBA) | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $74,242,782 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $77,976,003 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $74,242,782 | PYTotalRevenueAmt |
| CY Total Revenue | $77,976,003 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $66,572,202 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $71,191,150 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,105,352 | PYOtherExpensesAmt |
| CY Other Expenses | $6,914,567 | CYOtherExpensesAmt |
| PY Total Expenses | $73,677,554 | PYTotalExpensesAmt |
| CY Total Expenses | $78,105,717 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $565,228 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$129,714 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,267,984 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,149,408 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $118,379 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $129,517 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,149,605 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,019,891 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The organization is a Voluntary Employees' Benefit Association (VEBA) | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Desc | The Voluntary Employees' Benefit Association Plan (VEBA) provides certain medical, dental, and pharmacy benefits to eligible employees and their dependents. The Plan also provides health benefits to participants during periods of unemployment, consistent with the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986. | Desc |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Peter Lyons | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4137940000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 759 Chestnut Street | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01199 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (3 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| Mark A Keroack MD | ||||||
| Trustee/ President & CEO BH | 1.00 | 49.00 | Yes (X) | $0 | $1,258,998 | $213,008 |
| Dennis W Chalke | ||||||
| Trustee/ Treasurer & CFO BH | 1.00 | 49.00 | Yes (X) | $0 | $1,085,400 | $89,529 |
| Paula C Squires | ||||||
| Trustee/SVP Human Resource | 1.00 | 49.00 | Yes (X) | $0 | $615,137 | $42,813 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,959,535 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $345,350 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Health New England | |||||
| 1 Monarch Place | Springfield | MA | 01144 | Claims payments/admin fees | $70,406,478 |
| Delta Dental | |||||
| 465 Medford Street | Boston | MA | 021291454 | Claims payments/admin fees | $7,133,466 |
| Weight Watchers North America Inc | |||||
| 300 Jericho Quadrangle | Jerico | NY | 11753 | Employee Benefit Program | $312,007 |
| Baystate Administrative Services | |||||
| 759 Chestnut Street | Springfield | MA | 01199 | Claims payments/fee reimbursement | $158,582 |
| Mercer Health & Benefits LLC | |||||
| 4565 Paysphere Circle | Chicago | IL | 60674 | Consulting | $150,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Employer Contributions to Plan As | 525100 | $54,264,549 | $54,264,549 |
| Participant Contributions to Plan | 525100 | $23,711,454 | $23,711,454 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $77,976,003 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,976,003 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $77,976,003 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,191,150 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,914,567 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,105,717 | TotalAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,205,196 | BOYAmt |
| EOY | $6,687,964 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,452,590 | BOYAmt |
| EOY | $4,132,226 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $610,198 | BOYAmt |
| EOY | $329,218 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,267,984 | BOYAmt |
| EOY | $11,149,408 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,379 | BOYAmt |
| EOY | $129,517 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,379 | BOYAmt |
| EOY | $129,517 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,149,605 | BOYAmt |
| EOY | $11,019,891 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,149,605 | BOYAmt |
| EOY | $11,019,891 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,267,984 | BOYAmt |
| EOY | $11,149,408 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$129,714 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $77,976,003 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $77,976,003 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $77,976,003 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $78,105,717 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $78,105,717 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $78,105,717 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | Plan management is required to evaluate tax positions taken by the plan and recognize a tax liability (or asset) if the plan has taken an uncertain position that more-likely-than-not would not be sustained upon examination by the Internal Revenue Service. The plan administrator has analyzed the tax positions taken by the Plan and has concluded that as of December 31, 2015, there are no uncertain tax positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The Plan is subject to routine audits by taxing jurisdiction; however, there currently no audits for any tax periods in progress. The Plan administrator believes the Plan is no longer subject to income tax examinations for years prior to 2012. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mark A Keroack MD | ||||||||||||||
| Trustee/ President & CEO BH | $0 | $760,075 | $0 | $310,077 | $0 | $188,846 | $0 | $192,620 | $0 | $20,388 | $0 | $1,472,006 | $0 | $90,766 |
| Dennis W Chalke | ||||||||||||||
| Trustee/ Treasurer & CFO BH | $0 | $466,083 | $0 | $357,889 | $0 | $261,428 | $0 | $64,000 | $0 | $25,529 | $0 | $1,174,929 | $0 | $0 |
| Paula C Squires | ||||||||||||||
| Trustee/SVP Human Resource | $0 | $302,675 | $0 | $149,836 | $0 | $162,626 | $0 | $21,200 | $0 | $21,613 | $0 | $657,950 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4b | FormAndLineReferenceDesc |
| Explanation | Dennis W. Chalke - Supplemental Retirement of $171,159 is included in column B. This amount was earned in 2015. Mark A. Keroack, MD - Supplemental Retirement of $328,080 is included in column B and C. This amount was earned in 2015. Paula Squires - Supplemental Retirement of $75,107 is included in column B. This amount was earned in 2015. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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/trustees or by serving in employment relationship one or more entities within the Baystate network of affiliated organizations. |
| Form 990, Part VI, Section A, line 3 | Baystate Health Systems, Inc. Health & Welfare Benefits Plan is affiliated with Baystate Administrative Serviecs, Inc. (BAS) which is a 501 (c)(3) organization. Various management and support functions are delegated to BAS. Form 990, Part VI, Section A, line 8a and 8b: The Trustees of the Baystate Health Systems, Inc Health & Welfare Benefits Plan meet during certain scheduled Baystate health,Inc board meetings. The Baystate Health, Inc Board of Trustees and its committees, including the Audit and Compliance committee contemporaneously document meetings and actions relative to the Trust, including annual acceptance of the audited statements. |
| Form 990, Part VI, Section B, line 11 | Prior to the filing of this return appropriate parts of this Form 990 were reviewed by representatives from the Tax, Finance, and Human Resources Departments of Baystate Health, Inc. (the parent organization of the health care system to which the filing organization belongs) and by legal counsel. The entire return was reviewed by a tax expert from an outside accounting firm. Before filing with the IRS, a copy of the complete 990 declaration is provided to all board members. |
| Form 990, Part VI, Section B, line 12 | Baystate Health Systems, Inc. Health & Welfare Benefits Plan is an affiliate of Baystate Health, Inc. Baystate Health, Inc. and its affiliated entities have a comprehensive conflict of interest policy applicable to all of the affiliated entities. All directors, trustees, key employees and highest compensated employees are asked to complete an annual "conflict of interest" form. We utilize an electronic database to receive and manage all conflict of interest submissions. This information is reviewed by the BH Chief Compliance Officer, the BH Chief Executive Officer, the Chair of the BH Board of Trustees, and the Chair of the Audit & Compliance Committee of BH. A summary of the conflict of interest disclosures is provided to the Baystate Health Board of Trustees and the Tax Department and reviewed by outside counsel. Potential conflict of interest transactions are reviewed as appropriate under the policy, which provides for recusal from discussion and deliberation by any party with a potential conflict of interest. |
| Form 990, Part VI, Section B, line 15 | The Trustees are employees of an affiliate of Baystate Health, Inc., the parent organization of the health care system to which the VEBA belongs. The compensation of the President and CEO and of other key officers and employees is established based on information provided by independent third party consultants for reasonableness and appropriate comparability data. The compensation is then established, reviewed and approved by the independent compensation committee of Baystate Health, Inc (the parent organization of the health system to which the filing organization belongs) and all such deliberations and decisions are documented contemporaneously. |
| Form 990, Part VI, Section C, line 19 | Baystate Health, Inc., the parent organization of the health care system to which the VEBA belongs, makes its conflict of interest policy and financial statements available to the public at www.baystatehealth.org. The VEBA financial statements are available upon request. Articles of organization and bylaws are generally available at the Commonwealth of Massachusetts website. Form 990, Part XII, Line 2c: Baystate Health Systems, Inc. Health & Benefits Plan is affiliated with Baystate Administrative Services, Inc. (BAS), a 501(c)(3)organization which performs various management and support functions, including the compilation, review and audit oversight of its financial statements. No change was made in the process from the prior year. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Baystate Health Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 042105941 | Healthcare System Parent | MA | 501 (c ) (3) | 7 | Baystate Health Inc | 0 |
| Baystate Medical Center Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 042790311 | Acute Care Teaching Hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Baystate Franklin Medical Center | ||||||||||
| 164 High Street | Greenfield | MA | 01301 | 042103575 | Hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Baystate Mary Lane Hospital Corporation | ||||||||||
| 85 South Street | Ware | MA | 01082 | 042103584 | Hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Baystate Wing Hospital Corporation | ||||||||||
| 40 Wright Street | Palmer | MA | 01069 | 222519813 | Hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Baystate Medical Practices Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 042888373 | Charitable, Educational and Research Activities | MA | 501 (c ) (3) | 9 | Baystate Health Inc | 0 |
| Visiting Nurse Assn and Hospice of Western New England Inc | ||||||||||
| 50 Maple Street | Springfield | MA | 01199 | 042105803 | Homehealth and Hospice care | MA | 501 (c ) (3) | 9 | Baystate Health Inc | 0 |
| Baystate Total Home Care Inc | ||||||||||
| 50 Maple Street | Springfield | MA | 01199 | 203260764 | Real Estate and Other | MA | 501 (c ) (3) | 11b, II | Baystate Health Inc | 0 |
| Baystate Administrative Services Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 222747685 | Administrative services | MA | 501 (c ) (3) | 11c, IIIc | Baystate Health Inc | 0 |
| Baystate Health Foundation Inc | ||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 043549011 | Fundraising | MA | 501 (c ) (3) | 7 | Baystate Health Inc | 0 |
| Baystate Noble Hospital Corporation | ||||||||||
| 115 West Silver Street | Westfield | MA | 010861634 | 222537423 | Hospital | MA | 501 (c ) (3) | 3 | Baystate Health Inc | 0 |
| Westfield Medical Corporation | ||||||||||
| 115 West Silver Street | Westfield | MA | 010861634 | 043127730 | Healthcare | MA | 501 (c ) (3) | 9 | Baystate Health Inc | 0 |
| Noble Visiting Nurse and Hospice Services Inc | ||||||||||
| 115 West Silver Street | Westfield | MA | 010861634 | 112757446 | Homehealth and Hospice care | MA | 501 (c ) (3) | 9 | Baystate Health Inc | 0 |
| Health New England Inc | ||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 042864973 | HMO/Insurance | MA | 501 (c ) (4) | Baystate Health Inc | 0 | |
| HNE of Connecticut Inc | ||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 455190134 | HMO/Insurance | CT | 501 (c ) (4) | Health New England | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HNE Advisory Services Inc | |||||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 043012347 | Administrative Services | MA | Health New England Inc | C | 0 | ||||
| HNE Insurance Services Corporation | |||||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 043183019 | Ancilliary Insurance | MA | Health New England Inc | C | 0 | ||||
| Ingraham Corporation | |||||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 043016257 | Health care and other business activities | MA | Baystate Health Inc | C | 0 | ||||
| HNE Holding Corporation | |||||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 464620480 | Holding shares in subsidiary corporations | MA | Health New England Inc | C | 0 | ||||
| HNE Insurance Company Inc | |||||||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 454462433 | Health Ins svcs for Mass Medicare supplement members | MA | Health New England Inc | C | 0 | ||||
| Baystate Health insurance Company LTD | |||||||||||||
| 980421413 | Offshore captive insurance | Baystate Health Inc | 0 | North Church St | Georgetown | CJ | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |