Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
BETHESDA HEALTH INC
Employer identification number
59-2447553
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(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?
Yes
No
Yes
No
Yes
No
(1)
BETHESDA HOSPITAL INC
592447554
3
Yes
Yes
Yes
11,183,920
(2)
BETHESDA HEALTH CITY INC
650561263
9
Yes
Yes
Yes
416,476
(3)
WOMEN'S DIAGNOSTIC CENTER OF BETHESDA INC
592771779
9
Yes
Yes
Yes
569,057
(4)
BETHESDA MEDICAL ASSOCIATES INC
650561267
3
Yes
Yes
Yes
1,952,583
Total
14,122,036
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000230
Software Version:
v2011.1.0
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
BETHESDA HEALTH INC
Employer identification number
59-2447553
Identifier
Return Reference
Explanation
Delegate broad authority to a committee
Form 990, Part VI, Section A, Line 1a
THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIR, THE VICE CHAIR, THE SECRETARY, AND OTHER SUCH TRUSTEES AS APPOINTED BY THE CHAIR. THE PRESIDENT SHALL SERVE AS AN EX-OFFICIO NONVOTING MEMBER OF THE EXECUTIVE COMMITTEE. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION, EXCEPT AS SUCH AUTHORITY IS LIMITED BY STATUTE OR BY RESOLUTION CREATING OR OTHERWISE CONTROLLING THE EXECUTIVE COMMITTEE.
Significant changes to organizational documents
Form 990, Part VI, Section A, Line 4
THE ARTICLES OF INCORPORATION AND BYLAWS WERE AMENDED BECAUSE THE ORGANIZATION CHANGED IT'S NAME DURING THE YEAR.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
THE CHIEF FINANCIAL OFFICER OF THE ORGANIZATION REVIEWS THE FORM 990 AND ALL REQUIRED SUPPORTING SCHEDULES. THE FORM 990 IS THEN PROVIDED TO THE BOARD OF TRUSTEES OF THE ORGANIZATION FOR REVIEW PRIOR TO FILING WITH THE IRS.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ANY TRUSTEE, DIRECTOR, PRINCIPAL OFFICER OR MEMBER OF ANY COMMITTEE OF THE BOARD WITH BOARD-DELEGATED POWERS. THE INDIVIDUALS COVERED UNDER THE POLICY ARE REQUIRED TO DISCLOSE ANNUALLY ANY CONFLICTS OF INTEREST. THE CHAIRMAN OF THE BOARD AND THE INTERNAL AUDIT DIVISION OF BETHESDA HEALTH CONTINUOUSLY REVIEW AND MONITOR ALL CONFLICTS OF INTEREST NOTED BY THE INDIVIDUALS COVERED UNDER THE POLICY. ANY INDIVIDUAL WHO HAS A CONFLICT OF INTEREST IS PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISION IN THE TRANSACTION.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
THE BOARD OF TRUSTEES OF BETHESDA HEALTH, INC. ANNUALLY APPOINTS THE PRESIDENT/CEO TO A ONE-YEAR TERM AND ESTABLISHES AND APPROVES THE COMPENSATION OF THE PRESIDENT/CEO. THE BOARD OF TRUSTEES OF BETHESDA HEALTH PERIODICALLY ENGAGES AN INDEPENDENT OUTSIDE PROFESSIONAL COMPENSATION FIRM TO REVIEW COMPENSATION AND BENEFIT LEVELS OF THE PRESIDENT AND CHIEF FINANCIAL OFFICER OF THE BETHESDA HEALTH. THE CONSULTING FIRM WORKS INDEPENDENTLY OF MANAGEMENT AND REPORTS THE INFORMATION DIRECTLY TO THE TRUSTEES OF BETHESDA HEALTH FOR THE OFFICER'S POSITIONS. THE CONSULTING FIRM PROVIDES DETAILED COMPENSATION AND BENEFIT DATA FOR COMPARABLY SIZED HEALTHCARE ORGANIZATIONS ON A REGIONAL AND NATIONAL BASIS. BASED ON THE COMPENSATION PHILOSOPHY OF THE BOARD OF TRUSTEES OF THE BETHESDA HEALTH AS IT RELATES TO THE MARKET IN GENERAL AND ON SPECIFIC COMPENSATION LEVELS NOTED AS THE RESULT OF THE CONSULTING ENGAGEMENT, THE BOARD OF TRUSTEES OF BETHESDA HEALTH SETS THE COMPENSATION AND BENEFITS OF THE POSITIONS NOTED ABOVE. THE PROCESS WAS UNDERTAKEN IN THE YEAR ENDED SEPTEMBER 30, 2012. THE PROCESS AND DECISIONS ARE DOCUMENTED IN THE BOARD MINUTES.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
THE OTHER OFFICERS OF THE ORGANIZATION ARE SUBJECT TO BETHESDA HEALTH'S ANNUAL EMPLOYEE REVIEW PROCESS. THE VICE PRESIDENT OF HUMAN RESOURCES RECOMMENDS TO THE PRESIDENT/CEO OF THE BETHESDA HEALTH, INC. COMPENSATION AND BENEFIT LEVELS. THE VICE PRESIDENT OF HUMAN RESOURCES PERIODICALLY ENGAGES AN INDEPENDENT OUTSIDE PROFESSIONAL COMPENSATION FIRM TO REVIEW COMPENSATION AND BENEFIT LEVELS OF THIS AND OTHER MANAGEMENT LEVEL POSITIONS. THE CONSULTING FIRM WORKS INDEPENDENTLY OF MANAGEMENT AND PROVIDES DETAILED COMPENSATION AND BENEFIT DATA FOR COMPARABLY SIZED HEALTHCARE ORGANIZATIONS ON A REGIONAL AND NATIONAL BASIS. BASED ON THE COMPENSATION PHILOSOPHY OF THE BOARD OF TRUSTEES OF THE BETHESDA HEALTH AS IT RELATES TO THE MARKET IN GENERAL AND ON SPECIFIC COMPENSATION LEVELS NOTED AS THE RESULT OF THE CONSULTING ENGAGEMENT, THE PRESIDENT/CEO OF BETHESDA HEALTH SETS THE COMPENSATION AND BENEFITS FOR THE OTHER OFFICERS. THE PROCESS WAS UNDERTAKEN FOR THE YEAR ENDED SEPTEMBER 30, 2012. THE PROCESS AND DECISIONS ARE DOCUMENTED IN THE EMPLOYEE FILES. THE COMPENSATION OF THE CHIEF FINANCIAL OFFICER IS DETERMINED BY THE BOARD OF TRUSTEES OF BETHESDA HEALTH AS DESCRIBED IN THE NARRATIVE FOR FORM 990, PART VI, LINE 15A.
Governing documents, conflict of interest policy and financial statements available to the public
Form 990, Part VI, Section C, Line 19
THE GOVERNING DOCUMENTS OF THE ORGANIZATION, ITS CONFLICT OF INTEREST POLICY, ITS FINANCIAL STATEMENTS ARE AVAILABLE ON REQUEST. DEPENDING ON THE QUANTITY OF THE REQUEST A MINIMAL FEE MAY APPLY.
Average number of hours devoted per week to related organization
Form 990, Part VII, Section A, Column B
FRED B. DEVITT, JR, ESQ:BETHESDA HOSPITAL, INC.- 2.000;GEORGE T. ELMORE:BETHESDA HOSPITAL, INC.- 2.000;STORMET C. NOREM:BETHESDA HOSPITAL FOUNDATION, INC.- 2.0002.000, BETHESDA HOSPITAL, INC.- 2.000;THOMAS A. SMITH:BETHESDA HOSPITAL, INC.- 2.000;WILLIAM F. KOCH, JR.:BETHESDA HOSPITAL, INC.- 2.000;WILLIAM F. CASSADY:BETHESDA HOSPITAL, INC.- 2.000;N. M. WEEMS, M.D.:BETHESDA HOSPITAL, INC.- 2.000;FRED W. LOVE, M.D.:BETHESDA HOSPITAL FOUNDATION, INC.- 2.0002.000, BETHESDA HOSPITAL, INC.- 2.000;ROBERT B HILL:BETHESDA MEDICAL ASSOCIATES, INC.- 2.0002.000, BETHESDA HEALTH CITY, INC.- 2.0002.000, WOMEN'S DIAGNOSTIC CENTER OF BETHESDA, INC.- 2.0002.000, BETHESDA HOSPITAL, INC.- 2.0002.000, BETHESDA MEMORIAL SIT - WORKMAN'S COMP- 2.0002.000, BETHESDA MEMORIAL SIT - MALPRACTICE- 2.0002.000, BETHESDA PAYROLL SERVICES, INC.- 2.0002.000, BETHESDA HOSPITAL FOUNDATION, INC.- 2.000;ROGER L KIRK:BETHESDA MEDICAL ASSOCIATES, INC.- 2.0002.000, BETHESDA HEALTH CITY, INC.- 2.0002.000, WOMEN'S DIAGNOSTIC CENTER OF BETHESDA, INC.- 2.0002.000, BETHESDA HOSPITAL, INC.- 2.0002.000, BETHESDA MEMORIAL SIT - WORKMAN'S COMP- 2.0002.000, BETHESDA MEMORIAL SIT - MALPRACTICE- 2.0002.000, BETHESDA PAYROLL SERVICES, INC.- 2.0002.000, BETHESDA HOSPITAL FOUNDATION, INC.- 2.000;JOANNE AQUILINA:BETHESDA MEDICAL ASSOCIATES, INC.- 2.0002.000, BETHESDA HEALTH CITY, INC.- 2.0002.000, WOMEN'S DIAGNOSTIC CENTER OF BETHESDA, INC.- 2.0002.000, BETHESDA HOSPITAL, INC.- 2.0002.000, BETHESDA PAYROLL SERVICES, INC.- 2.000;ROBERT BROADWAY:BETHESDA MEDICAL ASSOCIATES, INC.- 2.0002.000, BETHESDA HEALTH CITY, INC.- 2.0002.000, WOMEN'S DIAGNOSTIC CENTER OF BETHESDA, INC.- 2.0002.000, BETHESDA HOSPITAL, INC.- 2.0002.000, BETHESDA PAYROLL SERVICES, INC.- 2.000;
Other changes in net assets or fund balances
Form 990, Part XI, Line 5
NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 6702469; TRANSFER TO/FROM AFFILIATES - 46913555; EQUITY IN BETHESDA HOLDING COMPANY - -87650; CHANGE IN VALUE OF INTEREST RATE SWAP - -1844081;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.