2015-11-13T12:57:54-06:00 2014-12-31 861065772 Deloitte Tax LLP Two Jericho Plaza Jericho NY 11753 990 2014-01-01 222531644 Baystate Health Systems Inc Health & Welfare Benefits Plan BAYS 4137940000 759 Chestnut Street Springfield MA 01199 Dennis W Chalke Trustee/Treasurer,CFO,BH 4137940000 2015-11-13 1 P00743140 5169187000 2014 2016-03-07 17:11:31Z Dennis W Chalke 759 Chestnut Street Springfield MA 01199 74242782 0 X N/A X 1983 MA Administration of a Health Benefits Plan - Voluntary Employees' Benefits Association (VEBA) 3 0 0 0 0 0 0 0 73048161 74242782 0 0 0 0 73048161 74242782 0 0 67651561 66572202 0 0 0 0 0 6392236 7105352 74043797 73677554 -995636 565228 10793862 11267984 209485 118379 10584377 11149605 The organization is a Voluntary Employees' Benefit Association (VEBA) 0 0 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. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 X 3 0 1 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X Peter Lyons 4137940000 759 Chestnut Street Springfield MA 01199 Mark R Tolosky Through 7114 Trustee/ President & CEO,BH 1.00 49.00 X 0 1089033 234000 Mark A Keroack MD As of 9114 Trustee/ President & CEO,BH 1.00 49.00 X 0 980230 203356 Dennis W Chalke Trustee/ Treasurer & CFO,BH 1.00 49.00 X 0 929051 79645 Paula C Squires Trustee/SVP Human Resources 1.00 49.00 X 0 635359 44133 0 3633673 561134 0 0 1 0 Health New England 1 Monarch Place Springfield MA 01144 Claims payments/admin fees 64914898 Delta Dental 465 Medford Street Boston MA 021291454 Claims payments/admin fees 6244188 BlueCrossBlue Shield of Massachusetts 101 Huntington Avenue Suite 1300 Boston MA 02199 Claims payments 1421800 Baystate Administrative Services 759 Chestnut Street Springfield MA 01199 Claims payments/fee reimbursement 1151680 Weight Watchers North America Inc 300 Jericho Quadrangle 350 Jerico NY 11753 Employee Benefit Program 308307 6 Employer Contributions to Plan As 525100 52899381 52899381 Participant Contributions to Plan 525100 21343401 21343401 74242782 74242782 74242782 0 0 66572202 7105352 73677554 7555376 8205196 3238486 2452590 610198 10793862 11267984 209485 118379 209485 118379 X 0 0 0 0 10584377 11149605 10584377 11149605 10793862 11267984 565228 0 X 0 1 X 0 0 0 X 74242782 0 74242782 0 74242782 73677554 0 73677554 0 73677554 Part X, Line 2: 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, 2014, 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 2011. 0 1 0 Mark R Tolosky Through 7114 Trustee/ President & CEO,BH 0 571202 0 306472 0 211359 0 202614 0 31386 0 1323033 0 0 Mark A Keroack MD As of 9114 Trustee/ President & CEO,BH 0 658452 0 301313 0 20465 0 185350 0 18006 0 1183586 0 0 Dennis W Chalke Trustee/ Treasurer & CFO,BH 0 432876 0 264360 0 231815 0 55591 0 24054 0 1008696 0 0 Paula C Squires Trustee/SVP Human Resources 0 288410 0 134658 0 212291 0 20800 0 23333 0 679492 0 0 Part I, Line 4b Dennis W. Chalke - Supplemental Retirement of $146,489 is included in column B. This amount was earned in 2014. Mark A. Keroack, MD - Supplemental Retirement of $164,551 is included in column C. This amount was earned in 2014. Paula Squires - Supplemental Retirement of $73,716 is included in column B. This amount was earned in 2014. Mark R. Tolosky - Supplemental Retirement of $150,900 is included in column B. This amount was earned in 2014. Part I, Line 3 The Organization is a Voluntary Employees' Benefits Association (VEBA) and has no CEO/Executive Director. 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 Services, 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 manangement 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. 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 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 HNE Advisory Services Inc Monarch Place Suite 1500 Springfield MA 011441500 043012347 Administrative Svs 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 Health New England of Connecticut Monarch Place Suite 1500 Springfield MA 011441500 061398662 Dormant CT 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 Baystate Health System Ambulance Inc 759 Chestnut Street Springfield MA 01199 043018550 Ambulance Svs MA Ingraham Corporation C 0 Baystate Health Insurance Company Ltd North Church St Georgetown Cayman Islands CJ 980421413 Offshore captive insurance CJ Baystate Health Inc C 0 HNE Holding Corporation Monarch Place Suite 1500 Springfield MA 011441500 464620480 Dormant 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0