VISION CARE PLAN 401k Plan overview

VISION CARE PLAN Benefits

401k Sponsoring company profile

Company Name:	BAYSTATE HEALTH, INC.
Employer identification number (EIN):	042105941
NAIC Classification:	622000
NAIC Description:	Hospitals

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
520	2015-01-01	DONNA BREWER CEBS CMS RPA DIRECTOR
520	2015-01-01	DONNA BREWER CEBS CMS RPA DIRECTOR
520	2014-01-01	CHRISTINE LESSARD CCP SPHR SHRM-SCP
520	2013-01-01	MARY DUNN		MARY DUNN	2014-07-10
520	2012-01-01	MARY DUNN		MARY DUNN	2013-07-22
520	2011-01-01	MARY DUNN
520	2009-01-01	MARY DUNN		MARY DUNN	2010-10-12

Plan Statistics for VISION CARE PLAN

Measure	Date	Value
2015: VISION CARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	5,053
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	5,394
Total of all active and inactive participants	2015-01-01	5,394
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
2014: VISION CARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4,853
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	5,053
Total of all active and inactive participants	2014-01-01	5,053
2013: VISION CARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4,839
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	4,853
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	4,853
2012: VISION CARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4,543
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	4,839
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	4,839
2011: VISION CARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	4,647
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4,543
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	4,543
2009: VISION CARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4,449
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4,520
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	4,520

Form 5500 Responses for VISION CARE PLAN

Insurance Providers Used on plan

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• VISION CARE SERVICE CASH BALANCE PLAN [EIN = 710749979]
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