Baystate Health Systems Inc Health &: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- Baystate Health Systems Inc Health & (EIN 22-2531644)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-01
- IRS object ID
- 201223069349301562
- Schema version
- 2011v1.2
- 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) |
|---|---|---|
| Timestamp | 2012-11-01T13:36:25-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 346565596 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ernst & Young LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Clarendon Street | AddressLine1 |
| City | Boston | City |
| State | MA | State |
| ZIP Code | 02116 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222531644 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baystate Health Systems Inc Health & | BusinessNameLine1 |
| Business Name Line2 | Welfare Benefits Plan | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BAYS | NameControl |
| Phone | 4137940000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 759 Chestnut Street | AddressLine1 |
| City | Springfield | City |
| State | MA | State |
| ZIP Code | 01199 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Mark R Tolosky | Name |
| Title | Trustee | Title |
| Phone | 4137940000 | Phone |
| Date Signed | 2012-11-01 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| PTIN | P00743154 | PTIN |
| Phone | 6172662000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Mark R Tolosky | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 759 Chestnut Street | AddressLine1 |
| City | Springfield | City |
| State | MA | State |
| ZIP Code | 01199 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 77632297 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Trust | X | TypeOfOrganizationTrust |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | MA | StateLegalDomicile |
| Activity Or Mission Description | Administration of a Health Benefits Plan - A Voluntary Employees' Benefits Association (VEBA | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 1 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 72666241 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 77632297 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 906 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 72667147 | TotalRevenuePriorYear |
| Total Revenue Current Year | 77632297 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 65205297 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 70521234 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6876091 | OtherExpensePriorYear |
| Other Expenses Current Year | 7045981 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 72081388 | TotalExpensesPriorYear |
| Total Expenses Current Year | 77567215 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 585759 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 65082 | RevenuesLessExpensesCY |
| Total Assets BOY | 10489721 | TotalAssetsBOY |
| Total Assets EOY | 10630716 | TotalAssetsEOY |
| Total Liabilities BOY | 123530 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 199443 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10366191 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10431273 | NetAssetsOrFundBalancesEOY |
| Mission Description | The organization is a Voluntary Employees' Benefit Association (VEBA) | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Description | 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. | Description |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 1 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicy |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Peter Lyons | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4137940000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 759 Chestnut Street | AddressLine1 |
| City | Springfield | City |
| State | MA | State |
| ZIP Code | 01199 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Mark R Tolosky | NamePerson |
| Title | Trustee | Title |
| Average Hours Per Week | 1.00 | AverageHoursPerWeek |
| Individual Trustee Or Director | X | IndividualTrusteeOrDirector |
| Reportable Comp From Organization | 0 | ReportableCompFromOrganization |
| Reportable Comp From Related Orgs | 1536640 | ReportableCompFromRelatedOrgs |
| Other Compensation | 99365 | OtherCompensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1536640 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 99365 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Health New England | |||||
| 1 Monarch Place | Springfield | MA | 01144 | Claims payments/admin fees | 54273946 |
| Medmetrics Health Partners | |||||
| 100 Century Drive | Worcester | MA | 01606 | Claims payments/admin fees | 10811309 |
| Delta Dental | |||||
| 465 Medford Street | Boston | MA | 021291454 | Claims payments/admin fees | 6060507 |
| Health & Benefits Consultants | |||||
| 1331 Main Street | Springfield | MA | 01103 | Consulting fees | 194400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Employer Contributions | 525100 | 52163396 | 52163396 |
| Participant Contributi | 525100 | 25468901 | 25468901 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 77632297 | TotalProgramServiceRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 77632297 | TotalRevenueColumn |
| Related Or Exempt Function Income | 77632297 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70521234 | Total |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Administrative service | Description |
| Total | 7045981 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 77567215 | Total |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8117547 | BOY |
| EOY | 5280800 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2154682 | BOY |
| EOY | 5301367 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 217492 | BOY |
| EOY | 48549 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10489721 | BOY |
| EOY | 10630716 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123530 | BOY |
| EOY | 199443 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123530 | BOY |
| EOY | 199443 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10366191 | BOY |
| EOY | 10431273 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10366191 | BOY |
| EOY | 10431273 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10489721 | BOY |
| EOY | 10630716 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 65082 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Total Revenue | 77632297 | TotalRevenue |
| Total Expenses | 77567215 | TotalExpenses |
| Excess Or Deficit For Year | 65082 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 65082 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 77632297 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 77632297 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 77632297 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 77567215 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 77567215 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 77567215 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X: | ReturnReference |
| 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, 2011, 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 are 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 2008. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 1 | EquityBasedCompArrangement |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Mark R Tolosky | NamePerson |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 696553 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 315856 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 524231 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 58633 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 40732 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 1636005 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Lines 4b-c | Mark R. Tolosky - Supplemental Retirement of $332,054 is included in column E. This amount was earned in 2011. Schedule J, Part 1, Line 4c The supplemental retirement plan offered to Mr. Tolosky from 1997-2002 provided the right to purchase mutual fund shares at a specified price, with the rights expiring at the end of the 10 years. The 2011 compensation of $130,991 was based on the difference between the fair market value at the date of exercise and the exercise price. | |
| Part III | Schedule J, Part 1, Line 3 The Organization is a Voluntary Employees' Benefits Association (VEBA) and has no CEO/Executive Director. | Supplemental Information |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Health New England Inc | |||
| Board Overlap | 54273946 | Hlth claims pmnts | 0 |
| Baycare Health Partners Inc | |||
| Board Overlap | 90193 | Payroll deductions forwarded to the trust via Baystate Administrative Services as intermediary. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | Mark R. Tolosky's only business relationship arises from his role as Officer or Trustee of Baystate Health, Inc. & its affiliated entities. | |
| Form 990, Part VI, Section A, line 3 | Baystate Health Systems, Inc. Health & Welfare Benefits Plan is affiliated with Baystate Adminstrative 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 and 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 financial 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. | |
| 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. | |
| The Trustee is an employee 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 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 | The organization makes its conflict of interest policy and financial statements available to the public at www.baystatehealth.org. Articles of organization and bylaws are generally available at the Commonwealth of Massachusetts website. No change was made in the process from the prior year. | |
| 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. | Financial Statements and Reporting |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 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 Medical Center Auxiliary Inc | ||||||||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 046065279 | Supporting organization for Hospital | MA | 501 (c ) (3) | 7 | Baystate Health Inc | 0 | ||||
| BH Insurance Company Ltd | ||||||||||||||
| 980421413 | Offshore captive Insurance | Baystate Health Inc | 0 | North Church Street | Georgetown | CJ | CJ | |||||||
Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| Health New England Inc | ||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 042864973 | HMO/Insurance | MA | Baystate Health Inc | C |
| HNE Advisory Services | ||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 043012347 | Administrative Svs | MA | Health New England Inc | C |
| Health New England Insurance | ||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 043183019 | Ancilliary Insurance | MA | Health New England Inc | C |
| Health New England of Connecticut | ||||||||
| Monarch Place Suite 1500 | Springfield | MA | 011441500 | 061398662 | Dormant | MA | Health New England Inc | C |
| Ingraham Corporation | ||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 043016257 | Health care and other business activities | MA | Baystate Health Inc | C |
| Baystate Health System Ambulance Inc | ||||||||
| 759 Chestnut Street | Springfield | MA | 01199 | 043018550 | Ambulance Svs | MA | Ingraham Corporation | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Health New England Inc | ||
| O | 54273946 | cash basis |
| Baystate Administrative Services Inc | ||
| P | 67996267 | cash basis |
Comments