Civic Intelligence

Baystate Health Systems Inc Health & Welfare Benefits Plan

EIN 22-2531644 • 501(c)9 • Springfield, MA

Profile

The organization is a Voluntary Employees' Benefit Association (VEBA)

759 Chestnut StreetSpringfield, MA 01199

n/A

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2017

Liabilities / Revenue

21st percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

501(c)9 • $50M-$100M nonprofits • Source year 2017

Net Margin

33rd percentile

-0.4%

Higher net margin than 33% of similar nonprofits.

501(c)9 • $50M-$100M nonprofits • Source year 2017

Top Officer Pay

99th percentile

$1,921,656

Higher top officer pay than 99% of similar nonprofits.

Top officer pay equals 2.6% of source-year revenue.

501(c)9 • $50M-$100M nonprofits • Source year 2017

Asset Growth

5th percentile

-100%

Faster asset growth than 5% of similar nonprofits.

501(c)9 • $50M-$100M nonprofits • Annualized from 2016 to 2017

Revenue Growth

9th percentile

-15%

Faster revenue growth than 9% of similar nonprofits.

501(c)9 • $50M-$100M nonprofits • Annualized from 2016 to 2017

Assets

Down

$0

Down $10,496,640 (-100%) from 2016

Liabilities

Down

$0

Down $91,334 (-100%) from 2016

Net Assets

Down

$0

Down $10,405,306 (-100%) from 2016

Revenue

Down

$74,234,211

Down $13,240,583 (-15%) from 2016

Expenses

Down

$74,505,072

Down $13,584,307 (-15%) from 2016

Net Income

Up

-$270,861

Up $343,724 (+56%) from 2016

Trend Graphs

Balance Sheet Trend

Grouped bars show assets, liabilities, and net assets across loaded filings.

$15M$10M$5.0M$0Assets 2010: $10,489,721Liabilities 2010: $123,530Net Assets 2010: $10,366,1912010Assets 2011: $10,630,716Liabilities 2011: $199,443Net Assets 2011: $10,431,2732011Assets 2012: $11,741,442Liabilities 2012: $161,429Net Assets 2012: $11,580,0132012Assets 2013: $10,793,862Liabilities 2013: $209,485Net Assets 2013: $10,584,3772013Assets 2014: $11,267,984Liabilities 2014: $118,379Net Assets 2014: $11,149,6052014Assets 2015: $11,149,408Liabilities 2015: $129,517Net Assets 2015: $11,019,8912015Assets 2016: $10,496,640Liabilities 2016: $91,334Net Assets 2016: $10,405,3062016Assets 2017: $0Liabilities 2017: $0Net Assets 2017: $02017

Highlighted filing

2017

Assets$0
Liabilities$0
Net Assets$0

Operations Trend

Revenue, expenses, and net income by year, with the latest filing highlighted.

$100M$50M$0-$50MExpenses 2010: $72,081,3882010Revenue 2011: $77,632,297Expenses 2011: $77,567,215Net Income 2011: $65,0822011Expenses 2012: $69,186,7062012Revenue 2013: $73,048,161Expenses 2013: $74,043,797Net Income 2013: -$995,6362013Revenue 2014: $74,242,782Expenses 2014: $73,677,554Net Income 2014: $565,2282014Revenue 2015: $77,976,003Expenses 2015: $78,105,717Net Income 2015: -$129,7142015Revenue 2016: $87,474,794Expenses 2016: $88,089,379Net Income 2016: -$614,5852016Revenue 2017: $74,234,211Expenses 2017: $74,505,072Net Income 2017: -$270,8612017

Highlighted filing

2017

Revenue$74,234,211
Expenses$74,505,072
Net Income-$270,861

Filings

Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2017 to Dec 31, 2017
Signed
Nov 14, 2018
Return Version
2017v2.3
Gross Receipts
$74,234,211
Mission and Program Overview

Mission

The organization is a Voluntary Employees' Benefit Association (VEBA)

Administration of a Health Benefits Plan - Voluntary Employees' Benefits Association (VEBA)

Balance Sheet Detail
LineBeginningEndChange
Assets
Rtn Earn Endowment Incm Other Fnds$10,405,306$0▼ $10,405,306
Savings and Temporary Cash Investments$5,835,899$0▼ $5,835,899
Accounts Receivable$4,331,523$0▼ $4,331,523
Prepaid Expenses and Deferred Charges$329,218$0▼ $329,218
Cash and Non-Interest-Bearing Accounts-$0-
Other Notes and Loans Receivable, Net-$0-
Pledges and Grants Receivable-$0-
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities-$0-
Investments Program Related-$0-
Investments in Publicly Traded Securities-$0-
Land, Buildings, and Equipment, Net-$0-
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Intangible Assets-$0-
Inventories for Sale or Use-$0-
Total Assets$10,496,640$0▼ $10,496,640
Other Assets Total-$0-
Liabilities
Accounts Payable and Accrued Expenses$91,334$0▼ $91,334
Total Liabilities$91,334$0▼ $91,334
Net Assets / Fund Balance
Total Net Assets Fund Balance$10,405,306$0▼ $10,405,306
Total Liabilities and Net Assets / Fund Balance$10,496,640$0▼ $10,496,640
Compensation and Service Providers

Board Members and Trustees

NameTitle
Mark A Keroack MD TrusteePresident & CEO,BH
Paula CSquiresTrustee/SVP Human Resource
Dennis WChalkeTrustee/Treasurer & CFO,BH

Highest Paid Contractors

ContractorServicesLocationCompensation
Health New EnglandClaims payments/admin fees1 Monarch Place, Springfield, MA 01144, Cj$64,883,343
Delta DentalClaims payments/admin fees465 Medford Street, Boston, MA 02129-1454$7,193,594
Baystate Health Insurance Company LTDReinsurance300 Jericho Quadrangle, Jericho, NY 11753$481,667
Weight Watchers North America IncEmployee Benefit Program4565 Paysphere Circle, Chicago, IL 60674$300,000
Mercer Health & Benefits LLCConsulting-$189,698
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$74,234,211
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$-270,861

Audited Revenue Reconciliation

Revenue per Audited Statements
$74,234,211
Revenue Not Reported on Financial Statements
$0
Revenue Not Reported on Form 990
$0
Total Revenue per Audited Statements
$74,234,211
Total Revenue per Form 990
$74,234,211
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$6,317,605
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Benefits to Members---$68,187,467
Fees for Services Management---$6,317,605
Total Functional Expenses$0$0$0$74,505,072

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$74,505,072
Total Expenses per Audited Statements$74,505,072
Total Expenses per Form 990$74,505,072
Expenses Not Reported on Financial Statements$0
Expenses Not Reported on Form 990$0
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Audit committee
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
Yes
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
No
Audited financial statements prepared
No
Key decisions subject to board approval
No
Management duties delegated
Yes

Governance Explanations

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 4

On 12/31/2017, the Baystate Health & Welfare Benefits Trust was dissolved. 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 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 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 filing organization belongs. The compensation of the Trustees, who are all Officers of Baystate Health, Inc., is reviewed and determined annually by the compensation committee of Baystate Health, Inc. This committee consists entirely of individuals serving on the Board of Baystate Health, Inc. The individuals responsible for deliberating the compensation arrangement for these individuals 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 these individuals 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. Lines 15a and 15b have been answered No because the individuals are paid by Baystate Administrative Services, Inc. an affiliate and related organization of the filing organization.

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.

Filing and Contact Details

Filer

Filer Name
Baystate Health Systems Inc Health &
EIN
22-2531644
Phone
4137940000
Address
759 Chestnut Street, Springfield, MA 01199

Signing Officer

Name
Dennis W Chalke
Title
Trustee/Treasurer & CFO, BH
Phone
4137940000
Signed
2018-11-14
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Dennis W Chalke
Formed
1983
Legal Domicile
Ma
Voting Board Members
3
Independent Board Members
0
Employees
0
Volunteers
0

Preparer

Firm
Deloitte Tax LLP
Address
Two Jericho Plaza, Jericho, NY 11753
Preparer
Christine Kawecki
Phone
5169187000
Supplemental Narrative

Additional Explanations

Form 990, Part XI, line 9:

Net Assets Transferred to Baystate Administrative Services, Inc. -10,134,445.

Financial Statement Notes

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, 2017, 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 2013.

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This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0Plan 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, 2017, 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 2013.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0Part X, Line 2:
IRS990ScheduleD/TotalBookValueLandBuildingsAmt00
IRS990ScheduleD/TotalExpensesPerForm990Amt074505072
IRS990ScheduleD/TotalRevenuePerForm990Amt074234211
IRS990ScheduleD/TotalRevEtcAuditedFinclStmtAmt074234211
IRS990ScheduleD/TotExpnsEtcAuditedFinclStmtAmt074505072
IRS990ScheduleJ/EquityBasedCompArrngmInd00
IRS990/ScheduleJRequiredInd01
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt0525000
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt1189630
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt2123737
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt01001554
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt1518753
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt2266174
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt017550
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt158410
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt25350
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt015312
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt128598
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt210659
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt0362240
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt1286276
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt2105382
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0Mark A Keroack MD Trustee
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1Dennis WChalke
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm2Paula CSquires
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0President & CEO,BH
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1Trustee/Treasurer & CFO,BH
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2Trustee/SVP Human Resource
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt01921656
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt11081667
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt2511302
IRS990ScheduleJ/SeverancePaymentInd00
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0Dennis W. Chalke - Supplemental Retirement of $186,459 is included in column B. This amount was earned and paid in 2017. Mark A. Keroack, MD - Supplemental Retirement of $334,356 is included in column B. This amount was earned and paid in 2017. Paula Squires - Supplemental Retirement of $ 73,670 is included in column B. This amount was earned and paid in 2017.
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0Part I, Line 4b
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd01
IRS990ScheduleN/AssetsDistributedInd01
IRS990ScheduleN/AttorneyGeneralNotifiedInd00
IRS990ScheduleN/BondsOutstandingInd00
IRS990ScheduleN/DirectorOfSuccessorInd01
IRS990ScheduleN/EmployeeOfSuccessorInd01
IRS990ScheduleN/LiabilitiesPaidInd01
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/AssetsDistriOrExpnssPaidDesc0Employer Contribution Receivables
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/AssetsDistriOrExpnssPaidDesc1Pharmacy Rebate Receivable
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/BusinessName/BusinessNameLine1Txt0Baystate Administrative Services Inc
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/BusinessName/BusinessNameLine1Txt1Baystate Administrative Services Inc
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/DistributionDt02017-12-31
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/DistributionDt12017-12-31
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/EIN0222747685
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/EIN1222747685
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/FairMarketValueOfAssetAmt08591823
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/FairMarketValueOfAssetAmt11600000
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/IRCSectionTxt0501(c)(3)
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/IRCSectionTxt1501(c)(3)
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/MethodOfFMVDeterminationTxt0Assets were transferred at book value
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/AddressLine1Txt0759 Chestnut Street
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/AddressLine1Txt1759 Chestnut Street
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/CityNm0Springfield
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/CityNm1Springfield
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/StateAbbreviationCd0MA
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/StateAbbreviationCd1MA
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/ZIPCd0011990001
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/ZIPCd1011990001
IRS990ScheduleN/OwnerOfSuccessorInd00
IRS990ScheduleN/ReceiveCompensationInd00
IRS990ScheduleN/RequiredToNotifyAGInd00
IRS990ScheduleN/SupplementalInformationDetail/ExplanationTxt0Person(s) Involved: Mark A. Keroack, MD Trustee/President, Dennis W. Chalke Trustee/Treasurer and Paula Squires, Trustee of Baystate Health Systems, Inc. Health & Welfare Benefits Plan currently hold the same positions for the transferee organization, Baystate Administrative Services, Inc.
IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc0Part I, Line 2e:
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0Two 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1Baystate 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2On 12/31/2017, the Baystate Health & Welfare Benefits Trust was dissolved. 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3Prior 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4Baystate 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5The Trustees are employees of an affiliate of Baystate Health, Inc., the parent organization of the health care system to which the filing organization belongs. The compensation of the Trustees, who are all Officers of Baystate Health, Inc., is reviewed and determined annually by the compensation committee of Baystate Health, Inc. This committee consists entirely of individuals serving on the Board of Baystate Health, Inc. The individuals responsible for deliberating the compensation arrangement for these individuals 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 these individuals 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. Lines 15a and 15b have been answered No because the individuals are paid by Baystate Administrative Services, Inc. an affiliate and related organization of the filing organization.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6Baystate 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7Net Assets Transferred to Baystate Administrative Services, Inc. -10,134,445.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Form 990, Part VI, Section A, line 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Form 990, Part VI, Section A, line 3
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Form 990, Part VI, Section A, line 4
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3Form 990, Part VI, Section B, line 11b
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4Form 990, Part VI, Section B, line 12
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5Form 990, Part VI, Section B, line 15
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6Form 990, Part VI, Section C, line 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7Form 990, Part XI, line 9:
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd10
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd20
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd30
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd40
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd50
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt0Health New England Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt1Health New England Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt2Baystate Health Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt3Health New England Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt4Health New England Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt5Baystate Health Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN0043012347
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN1043183019
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN2043016257
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN3464620480
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN4454462433
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN5980421413
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt0C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt1C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt2C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt3C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt4C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt5C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/AddressLine1Txt0North Church St
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/CityNm0Georgetown
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/CountryCd0CJ
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileForeignCountryCd0CJ
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd0MA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd1MA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd2MA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd3MA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd4MA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt0Administrative Services
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt1Ancilliary Insurance
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt2Health care and other business activities
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt3Holding shares in subsidiary corporations
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt4Health Ins svcs for Mass Medicare supplement members
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt5Offshore captive insurance
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt0HNE Advisory Services Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt1HNE Insurance Services Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt2Ingraham Corporation
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt3HNE Holding Corporation
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt4HNE Insurance Company Inc
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt5Baystate Health Insurance Company LTD
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt0Monarch Place Suite 1500
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt1Monarch Place Suite 1500
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt2759 Chestnut Street
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt3Monarch Place Suite 1500
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt4Monarch Place Suite 1500
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm0Springfield
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm1Springfield
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm2Springfield
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm3Springfield
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm4Springfield
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd0MA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd1MA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd2MA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd3MA

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