Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
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| Yes | No | Yes | No | Yes | No | ||||
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| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| Form 990, Part VI, Section A, line 2 | The Board of Directors is made up of executives from related organizations. The following individuals have a business relationship in that they serve on the Board of Directors of the organization and are officers and/or directors of a related organization: Tommy Smith, Janet Norton, Carl Herde. | |
| Form 990, Part VI, Section A, line 6 | Baptist Healthcare System, Inc. (EIN: 61-0444707) is the sole member of the Corporation. | |
| Form 990, Part VI, Section A, line 7a | Baptist Healthcare System, Inc., the sole member, appoints all directors. | |
| Form 990, Part VI, Section A, line 7b | The consent and approval of the Member shall be required for (i) any and all actions for which the Member by resolution, policy or practice requires other hospitals within the Member's system of hospitals to obtain consent or approval from the Baptist Healthcare System Board of Directors, and (ii) all other major corporate actions, including, but not limited to, any act the result of which would be to: (a) amend, repeal or alter the articles of incorporation or bylaws; (b) merge or consolidate or agree to merge or consolidate the Corporation with or into any other corporation; (c) liquidate, reorganize or recapitalize the Corporation; (d) create or incur any indebtedness which shall exceed limits established by the Member; (e) make any capital expenditure requiring the payment of more than an amount established by the Member; (f) authorize the execution of any contract, agreement or similar instrument by which the Corporation may be obligated to pay more than an amount established by the Member; (g) acquire any stock of any corporation or invest in or acquire any interest in any business enterprise; (h) sell or agree to sell or otherwise dispose of all or a substantial part of the assets of the Corporation or any investment or interest in any business enterprise; (i) approve the Corporation's annual operating budget and capital expenditures budget. | |
| Form 990, Part VI, Section B, line 11 | A copy of the 990 is provided to the board of directors prior to the filing of the return. Any questions or comments are addressed by explanation or a change to the form. | |
| Form 990, Part VI, Section B, line 12c | Annually, the secretary of Baptist Healthcare Affiliates, Inc. (BHA) sends out a conflict of interest questionnaire to each of the directors serving on the board of BHA. After completion, they are returned to the secretary and reviewed by her and the Board or a Board committee for any potential conflicts. | |
| Form 990, Part VI, Section B, line 15 | The President and CEO of Baptist Healthcare Affiliates, Inc. is not an employee of Baptist Healthcare Affiliates, Inc. but is an employee of Baptist Healthcare System, Inc., a tax-exempt 501(c)(3) organization which is the sole member of Baptist Healthcare Affiliates, Inc. The President and CEO is compensated by Baptist Healthcare System, Inc. Annually, the Baptist Healthcare System, Inc. Compensation Committee reviews the compensation, including base compensation and incentive compensation for the CEO. The Baptist Healthcare System, Inc. Compensation Committee is comprised of independent Board Members. The Committee retains a Compensation Consultant to advise the Committee and who provides data as to comparable compensation for similarly qualified persons in functionally comparable positions at similarly situated healthcare organizations. The Committee reviews this information in approving annual base and incentive compensation and other items of reportable compensation described on Schedule J of the IRS Form 990. The decisions of the Committee regarding compensation are contemporaneously documented in the minutes of the Committee. Annually, the Committee Chairperson and the Compensation Consultant provide a report on executive compensation to the full Board of Directors of Baptist Healthcare System, Inc. Officers of Baptist Healthcare Affiliates, Inc. are not employees of Baptist Healthcare Affiliates, Inc. nor are they compensated by Baptist Healthcare Affiliates, Inc. The Baptist Healthcare Affiliates, Inc. Officers are employees of Baptist Healthcare System, Inc. and are compensated by Baptist Healthcare System, Inc. The compensation of these Officers is either reviewed and approved by the Compensation Committee of the Baptist Healthcare System, Inc. Board or are reviewed and approved by the Baptist Healthcare System, Inc. President and CEO. | |
| Form 990, Part VI, Section C, line 19 | The articles of incorporation are available to the public via the Secretary of State's website. | |
| Explanation of Hours for Officers: | Form 990, Part VII, Section A: | Officers for Baptist Healthcare Afilliates, Inc. provide services to Baptist Healthcare System, Inc. and its subsidiaries. Hours worked are not tracked on an entity by entity basis. Therefore, hours for officers (where noted with a "Sch O" reference) reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week for all entities. |
| Changes in Net Assets or Fund Balances: | Form 990, Part XI, line 5: | Funding for Strategic & Capital Needs -35,899. Total to Form 990, Part XI, Line 5: -35,899. |
| Explanation of Attached Audited Financial Statements: | Form 990, Part IV, Line 20b: | The activity of Baptist Healthcare Affiliates, Inc. and other member of Baptist Healthcare System, Inc. are reported in the consolidated financial statements of Baptist Healthcare System, Inc. No individual audit of Baptist Healthcare Affiliates, Inc. is completed. Therefore, the attached audited financial statements are of Baptist Healthcare System, Inc. (which include the activity of Baptist Healthcare Affiliates, Inc.). |
| Community Benefit Report: | Form 990, Part III: | Baptist Healthcare Affiliates (BHA), d/b/a Baptist Hospital Northeast is a 100% owned and controlled subsidiary of Baptist Healthcare System, Inc. Since its inception in 1924, Baptist Healthcare System, Inc. and its affiliated organizations (Baptist) are dedicated to providing accessible, quality healthcare to all patients regardless of their ability to pay. VISION The vision of BHA is to be the healthcare leader in Kentucky. Having earned a reputation of providing high quality patient care and utilizing the latest in medical technology, patients seek out the BHA facility for their care. BHA Statistics: Licensed Beds 120 Beds Employees 533 Employees Admitting Physicians 56 Doctors Inpatient Care 3,412 Admissions/17,491 Days Obstetric (Deliveries) 538 Babies Emergency Visits 14,621 Registrations Outpatient Visits 46,235 Hospital Visits MISSION As indicated by its mission statement, BHA strives to continue its "Christian heritage of service and to enhance the health of the people and the communities we serve." BHA is organized and operated exclusively for the benefit of the community and the hospital is considered a valuable community asset. The BHA Board of Directors is comprised of local representatives who, along with the hospital's management and employees, understand that they are responsible to the community for providing high quality health care services. Over the years, BHA has gained a reputation for providing compassionate, high quality, cost efficient, patient friendly care. RESPONSIVE TO COMMUNITY NEED Operating healthcare facilities in today's environment requires a delicate balance between producing a sufficient margin to allow for adequate staffing and investment in new technologies, while also providing enough resources to absorb the cost of care for those patients who do not have the ability to pay for the services. In 2011, despite a loss from hospital operations, BHA invested nearly $2.3 million into the communities in new technology, construction, renovation and systems improvement. Because of the need to generate a modest margin while caring for all patients, BHA strives to fulfill its community responsibility of collecting appropriate reimbursement from all patients who have the necessary resources while providing a generous, yet accountable charity care policy to assist those patients who do not have the means to pay for the services rendered. (See "Charity Care Policy" on the next page for further discussion). From a broad perspective, BHA consistently provides a high level of quality care to every patient and enhances the health of the people it serves through health promotions, health screenings, medical research, and training of health professionals. Other community benefits include: - Maintaining necessary, but unprofitable services that meet community needs - Helping to recruit physicians to underserved areas - Helping patients coordinate services with other healthcare providers - Providing resources for support groups - Promoting and providing preventive care services - Monitoring clinical outcomes in order to ensure quality care - Committing resources to improving safety and processes of care - Providing services conveniently accessible by patients In addition, BHA employees volunteer hundreds of hours in community services and leadership. BHA's support for community activities underscores its commitment to improving the lives of those served. Because BHA and its employees contribute so much of their time, talents and resources to serve others, communities served by BHA are better places to live and work. Quantification of many of the community benefits is detailed further below. However, what the Statement of Program Service Accomplishments doesn't measure is the economic benefit derived by the community from BHA being one of the major employers in the area. The economic impact of the wages paid to BHA employees is significant considering the dollars they spend on food, housing, services, and other products. CHARITY CARE POLICY To further the mission of enhancing the health of the people and communities it serves, BHA provides medically necessary inpatient and outpatient care to patients regardless of race, religion, sex, national origin, disability, age or their ability to pay. Recognizing that not all patients have the ability to pay, BHA has a charity care policy to evaluate a patient's ability to pay for services received. BHA relies solely on the physician order to determine whether treatment is medically necessary and whether the patient is treated on an inpatient or outpatient basis. Neither the patient's financial condition nor their ability to pay for services has any bearing upon whether, or how, the patient is treated in a BHA facility. Patients are transferred only when BHA does not provide the specialized service that is required, or by specific request of the patient. BHA has notices posted throughout the hospital that clearly communicate its charity care policy. BHA employees are instructed in the application of the charity care policy and are trained to recognize situations that indicate the financial resources of a patient may be inadequate. These employees freely and willingly volunteer information regarding the charity care policy to any patient who may express a concern regarding the ability to pay for services. The policy provides that: 1. Patients with resources of less than 200% of the Poverty Guideline for family size of one will receive full charity. 2. Patients with resources of 200% but less than 400% of the Poverty Guideline for a family size of one will qualify for partial charity. The ratio of resources up to 400% of the Poverty Guideline determines the percentage of the bill that will be the responsibility of the applicant. However, the patient's liability is capped at 10% of the patient's resources. 3. Patients with resources of 400% to 1200% of the Poverty Guideline for a family size of one will qualify for partial charity if the patient's liability exceeds 20% of their resources. In these situations, the patient will be responsible for an amount not to exceed 20% of the resources. 4. If eligible for a charity discount, a patient will receive the discount regardless of whether they pay the balance on the bill. If necessary, payment arrangements may be made on the balance of the patient's bill in accordance with hospital procedures. If charity care eligibility cannot be determined, good stewardship requires that the hospital initially begin the collection process. However, immediately upon determining that the guarantor is eligible for charity care, collection efforts on the balance eligible for charity will cease and the appropriate balance will be designated as charity. |
| TAX-EXEMPT STATUS REQUIREMENTS The Internal Revenue Service Revenue Ruling 69-545 provides that a hospital can demonstrate it has met the community benefit standard by having a full-time emergency room open to the public regardless of ability to pay for services received. BHA operates an Emergency Department that is open 24 hours a day, 365 days a year and treated 14,621 emergency patients during fiscal year 2011. BHA and its emergency department posts policies stating that patients will be treated regardless of their ability to pay. Depending on the severity of a patient's condition, as a service to the patient BHA may verify insurance prior to rendering services in the emergency department. Under no circumstances is emergency care delayed by discussions regarding insurance coverage or ability to pay for services. In addition, BHA does not convey or intimate in any way to any emergency medical transportation service an unwillingness to treat any particular patient in need of medical attention. ACCOUNTABILITY TO THE BROADER COMMUNITY As previously noted, the BHA Board of Directors embraces its responsibility to represent the broader community in guiding BHA in its provision of healthcare services. The Board meets periodically to provide oversight as to how best to continue to serve each community. Regularly scheduled meetings of the Baptist Healthcare Affiliates, Inc. Board occur quarterly. The following is a summary of BHA community service for the year ended August 31, 2011, in terms of services to the poor and indigent and the benefits provided to the communities it serves. Quantifiable Community Benefit: BHA is fully committed to its responsibility as a charitable organization and commits extensive resources to fulfill that obligation to the community. To the extent possible, BHA has quantified the benefits provided to the communities it serves: Description Amount Benefits for the Poor and Indigent: Unreimbursed Cost of Charity Care = $2,051,000 Unreimbursed Cost of Medicaid = $1,448,000 Total Benefits for the Poor & Indigent = $3,499,000 Benefits for the Broader Community: Net Loss on Subsidized Health Services = $1,857,000 Community Health Improvement Services = $195,000 Financial & In-Kind Contributions = $66,000 Total Benefits for the Broader Community = $2,118,000 Total Quantifiable Community Benefit = $5,617,000 Glossary of Community Benefit Terms: - Benefits for the Poor and Indigent: Describes services provided to persons who cannot afford healthcare because of inadequate resources and/or who are uninsured or underinsured. This includes those patients that qualify for Charity, Medicaid, Kentucky's Children Health Insurance Program (KCHIP), Kentucky Hospital Care Program (KHCP) and other citizens whose income is inadequate (based on each patient's individual circumstances). 1. Unreimbursed cost of charity care describes the services provided to persons who cannot afford to pay. It also includes the Health Care Provider Tax (Kentucky Revised Statutes 142.303) that is assessed on all hospital patient revenues received for the purpose of funding state Medicaid, KHCP and KCHIP programs. The amounts reflect the net cost after reducing the costs for contributions and other revenues received by BHA as direct assistance for the provision of care. 2. Unreimbursed cost of Medicaid reflects costs of treating Medicaid beneficiaries not reimbursed by government programs. - Benefits for the Broader Community: Describes services provided to other needy populations that may not qualify as indigent but that need special services and support. The benefits include the cost of health promotion and education, health clinics and screenings, and medical research that benefits the community. 1. Net loss on subsidized health services reflects the loss from services that may be discontinued if the decision was based on a profit motive only. 2. Community health improvement services includes costs incurred by BHA in providing support and coordination of health education and awareness events as well as the cost of employees paid time to attend, staff, and coordinate these activities. 3. BHA makes cash and in-kind donations on behalf of the poor and needy to community agencies and to special funds used for charitable purposes. |
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