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
2012
Open to Public Inspection
Name of the organization
Baptist Health Richmond Inc
Employer identification number
61-0461940
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 supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012
Additional Data
Software ID:
Software Version:
-
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
2012
Open to Public Inspection
Name of the organization
Baptist Health Richmond Inc
Employer identification number
61-0461940
Identifier
Return Reference
Explanation
FORM 990, PART III, LINE 4A
PROGRAM ACCOMPLISHMENTS
BAPTIST HEALTH RICHMOND, INC. ("BHR") REALIZES THAT NOT ALL PATIENTS HAVE FINANCIAL RESOURCES TO PAY THEIR BILL. IN LIGHT OF THIS, BHR HAS CHARITY CARE POLICIES AND PROCEDURES IN PLACE TO DETERMINE A PATIENTS ABILITY TO PAY FOR SERVICES. FOLLOWING THE CHARITY CARE POLICY, BHR PROVIDED $6,961,634 OF UN-REIMBURSED CHARITY CARE CHARGES FOR THE TWELVE MONTHS ENDED AUGUST 31, 2013. UN-REIMBURSED CHARITY CARE CHARGES REPRESENT 3.8% OF NET PATIENT SERVICE REVENUE FOR THE YEAR. BHR OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN 24 HOURS A DAY, EVERY DAY. PATIENTS ARE TREATED WITHOUT REGARD TO THEIR PAYMENT ABILITY. BHR EXPERIENCED 30,155 EMERGENCY DEPARTMENT VISITS FOR THE TWELVE MONTHS ENDED AUGUST 31, 2013. BHR PROVIDED INPATIENT SERVICES TO THE CITIZENS OF MADISON AND SURROUNDING COUNTIES. A TOTAL OF 3,179 INPATIENTS WERE ADMITTED DURING THE TWELVE MONTHS ENDED AUGUST 31, 2013 RESULTING IN 12,000 INPATIENT DAYS. BHR PROVIDED OBSTETRIC SERVICES TO THE CITIZENS OF MADISON AND SURROUNDING COUNTIES. A TOTAL OF 768 DELIVERIES WERE PERFORMED DURING TWELVE MONTHS ENDED AUGUST 31, 2013. BHR PROVIDED SURGICAL SERVICES TO 6,333 PATIENTS DURING TWELVE MONTHS ENDED AUGUST 31, 2013. IN ADDITION TO THE LARGEST PROGRAM SERVICES, BHR ALSO PROVIDES OR SUPPORTS THE FOLLOWING COMMUNITY PROGRAMS AT FREE OR SUBSTANTIALLY REDUCED COST TO THE COMMUNITY: COMMUNITY HEALTH FAIR: PROVIDE FREE BLOOD PRESSURE, HEIGHT AND WEIGHT, PULMONARY FUNCTION, BODY FAT ANALYSIS, OSTEOPOROSIS SCREENING, PSA, BLOOD TYPING, BLOOD GLUCOSE, ANEMIA SCREENING, POSTURE, GLAUCOMA, COUNSELING, EDUCATIONAL MATERIALS. (APPROXIMATELY 200 PARTICIPANTS) TAKE YOUR HEALTH TO HEART PROGRAM AND SPONSORSHIP OF THE HOT WOMEN AND HEALTH SERIES WHERE WE BRING IN REGIONAL OR NATIONAL SPEAKERS TO DISCUSS THE WARNING SIGNS OF DECLINING HEART HEALTH. (APPROXIMATELY 200 PARTICIPANTS ANNUALLY) GREAT EXPECTATIONS IS AN ANNUAL MATERNITY FAIR DESIGNED TO PROVIDE EDUCATION AND RESOURCES FOR THOSE EXPECTING A CHILD. THE EVENT PROVIDES EDUCATION ON SHAKEN BABY SYNDROME, INFANT CPR, MOTHER/BABY NUTRITION, AND BREASTFEEDING IN ADDITION TO PRIZES ANSurNEEDED ITEMS FOR ATTENDEES. (APPROXIMATELY 250 ATTENDEES) FREE PROSTATE CANCER SCREENING AND PSAS: FREE PSA BLOOD WORK AND DIGITAL RECTAL EXAM BY A UROLOGIST. (APPROXIMATELY 55 PARTICIPANTS) COMMUNITY BASED EDUCATIONAL PROGRAMS: HIP/KNEE SCREENING WITH ORTHOPEDIC SURGEON, CHILDBIRTH CLASSES, BREAST FEEDING CLASSES, SAFE DRIVING CLASSES, SMOKING CESSATION CLASSES, NUTRITION, DIABETES EDUCATION, AND STRESS MANAGEMENT. SUPPORT OF CITY AND COUNTY PROJECTS: PROVIDED PLANT OPERATIONS SUPPORT FOR VARIOUS CITY AND COUNTY FUNCTIONS; SERVED ON ECONOMIC DEVELOPMENT COMMITTEES AND ENROLLED A MEMBER OF MANAGEMENT TEAM IN LEADERSHIP mADISON COUNTY. PARTICIPATION IN OTHER HEALTH FAIRS: PROVIDE STAFFING AND EDUCATIONAL MATERIALS FOR VARIOUS HEALTH FAIRS IN THE COMMUNITY. (MORE THAN 2,500 COMMUNITY MEMBERS SERVED) PROVIDE SPEAKERS ON HEALTH CAREERS AND TOURS OF THE HOSPITAL: THIS COMMUNITY SERVICE BENEFITS APPROXIMATELY 500 STUDENTS. STARLIGHT MILE AND 5K WALK/RUN: PROVIDE FUNDING FOR ONE MILE AND 5K WALK/RUN FOR CHILDREN AND ADULTS TO PROMOTE HEALTHY LIFESTYLES. (APPROXIMATELY 500 PARTICIPANTS) LEADERSHIP MADISON COUNTY: PROVIDE CLASSES FOR PARTICIPANTS, FOODS, SPACE, ETC. (APPROXIMATELY 40 LEADERS SERVED) FORM 990, PART VI, LINE 6 MEMBERS OR STOCKHOLDERS THE ORGANIZATION'S SOLE MEMBER IS BAPTIST HEALTHCARE SYSTEM, INC. ("BHS"), A NON-PROFIT, TAX EXEMPT CORPORATION ORGANIZED UNDER AND PURSUANT TO THE PROVISIONS OF THE LAW OF THE COMMONWEALTH OF KENTUCKY.
Form 990, Part VI, Line 7a
Power to elect or appoint members
BOARD OF DIRECTORS ARE APPOINTED BY RESOLUTION OF THE ORGANIZATIONS SOLE MEMBER, bhs.
Form 990, Part VI, Line 7b
Decisions reserved to members or stockholders
THE SOLE MEMBER, BHS, HAS THE FOLLOWING RESERVED POWERS ACTING THROUGH ITS BOARD INCLUDING: (I) APPROVE THE MISSION, VISION, AND VALUES OF THE CORPORATION AND AMENDMENTS THERE TO. (II) APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION AND THE BYLAWS. (III) APPROVE THE STRATEGIC PLAN OF THE CORPORATION. (IV) APPROVE THE TRANSFER OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATIONS ASSETS OR INVESTMENT OR INTEREST IN ANY BUSINESS ENTERPRISE; ANY MERGER, COMBINATION, OR REORGANIZATION OF THE CORPORATION; ANY LIQUIDATION, REORGANIZATION, OR RECAPITALIZATION OF THE CORPORATION; OR ANY AGREEMENT TO DO THE FOREGOING. (V) APPROVE THE CAPITAL EXPENDITURE AND OPERATING BUDGETS OF THE CORPORATION, AND ANY UNBUDGETED EXPENDITURES OVER $500,000. (VI) SELECTION OF THE CORPORATIONS AUDITOR. (VII) APPROVE THE INCURRENCE OF DEBT OF THE CORPORATION ABOVE $500,000 OR OTHER AMOUNT ESTABLISHED BY BHS AND THE MAKING OF ANY CAPITAL EXPENDITURE ABOVE $500,000 OR OTHER AMOUNT ESTABLISHED BY BHS. (VIII) APPROVE THE APPOINTMENT, REMOVAL, AND EVALUATION OF THE PRESIDENT OR CHIEF EXECUTIVE OFFICER OF THE CORPORATION ACTING THROUGH THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF BHS. (IX) APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION. APPOINTMENT AND REMOVAL SHALL NOT REQUIRE A RECOMMENDATION OF THE CORPORATIONS BOARD. (X) APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR OF THE BOARD OF THE CORPORATION. APPOINTMENT AND REMOVAL SHALL NOT REQUIRE A RECOMMENDATION OF THE CORPORATIONS BOARD. (XI) AUTHORIZE EXECUTION OF ANY CONTRACT, AGREEMENT, OR SIMILAR INSTRUMENT BY WHICH THE CORPORATION MAY BE OBLIGATED TO PAY MORE THAN AN AMOUNT ESTABLISHED BY BHS. (XII) ACQUIRE ANY STOCK OF ANY CORPORATION OR ANY EQUITY IN ANOTHER CORPORATE FORM, OR INVEST IN OR ACQUIRE ANY INTEREST IN ANY BUSINESS ENTERPRISE. FORM 990, PART VI, LINE 11B PROCESS USED TO REVIEW THE FORM 990 THE INTERNALLY PREPARED FORM 990 IS REVIEWED AND APPROVED BY TAX CONSULTANTS. COPIES ARE GIVEN TO EACH VOTING MEMBER OF THE BOARD PRIOR TO FILING FOR THEIR REVIEW.
Form 990, Part VI, Line 12c
Monitoring and enforcement of compliance with conflict of interest policy
ANNUALLY, THE SECRETARY OF BHS SENDS OUT A CONFLICT OF INTEREST QUESTIONNAIRE TO EACH OF THE DIRECTORS AND OFFICERS SERVING ON THE BOARD OF BHr. AFTER COMPLETION, THEY ARE RETURNED TO THE SECRETARY AND REVIEWED BY THE BOARD OR THE GOVERNANCE EFFECTIVENESS COMMITTEE FOR ANY POTENTIAL CONFLICTS. A CONFLICT OF INTEREST IS ANY CIRCUMSTANCE, RELATIONSHIP (FINANCIAL OR OTHERWISE), ACTIVITY OR DECISION (MADE IN THE COURSE OF GOVERNANCE, MANAGEMENT OR PROFESSIONAL RESPONSIBILITIES OR OTHERWISE) THAT ADVERSELY INFLUENCES OR APPEARS TO ADVERSELY INFLUENCE THE ABILITY OF A COVERED PERSON TO: 1) MAKE OBJECTIVE DECISIONS ON BEHALF OF BHA AND/OR 2) ACT IN THE BEST INTERESTS OF BHr IN A MANNER CONSISTENT WITH THE TAX-EXEMPT PURPOSES OF BHr. THE BOARD OR COMMITTEE WILL DETERMINE BY A MAJORITY VOTE OF DISINTERESTED DIRECTORS WHETHER THE DISCLOSED FINANCIAL OR SPECIAL INTEREST MAY RESULT IN A CONFLICT OF INTEREST.
Form 990, Part VI, Line 15
Process for determining compensation
ORGANIZATION'S DIRECTOR OF HUMAN RESOURCES (HR) COMPLETES AN ANNUAL SALARY SURVEY. DATA IS COMPILED FROM TWO SOURCES: THE KENTUCKY SOCIETY OF HEALTHCARE HUMAN RESOURCES ADMINISTRATORS (KSHHRA) AND THE KENTUCKY HOSPITAL ASSOCIATION (KHA). BOTH OF THESE RESOURCES USE A THIRD PARTY TO RETRIEVE AND ANALYZE DATA. KHA USES COMPDATA AND KSHHRA USES HR ADVANTAGE. THE DIRECTOR OF HR TAKES EVERY POSITION WITHIN THE ORGANIZATION AND MATCHES A POSITION FROM EACH GROUP. THE DIRECTOR THEN COMPARES WHAT THE CURRENT COMPENSATION RATES ARE WITH THE SURVEY RESULTS AND ANALYZES EACH POSITION TO DETERMINE WHERE THE ORGANIZATION IS COMPARED TO THE MARKET. A LIST IS COMPILED FOR POSITIONS IN WHICH THE ORGANIZATION IS COMPENSATING LOWER THAN THE MARKET WITH RECOMMENDATIONS TO INCREASE THE COMPENSATION FOR THOSE POSITIONS. THE LIST AND RECOMMENDATIONS ARE GIVEN TO THE ADMINISTRATIVE TEAM. AFTER REVIEWING THE DATA PRESENTED AND THE RECOMMENDATIONS, THE ADMINISTRATIVE TEAM WILL OFFER ITS SUGGESTIONS AND MAKE A FINAL RECOMMENDATION TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS MAKES THE FINAL DECISION ON CHANGES TO THE ANNUAL COMPENSATION PACKAGE. THE ANNUAL COMPENSATION ADJUSTMENT FOR THE CEO IS ALWAYS PUT IN WRITING AS APPROVED BY THE BOARD AND FILED IN THE HR DEPARTMENT. FOR NEW EMPLOYEES, A RANGE IS SET FOR ALL POSITIONS WITH THE EXCEPTION OF DEPARTMENT DIRECTORS AND THOSE IN HIGHER POSITIONS. THE SALARIES FOR DEPARTMENT DIRECTORS AND ABOVE ARE DETERMINED BY THE VICE-PRESIDENT OVER THAT PARTICULAR AREA WITH INPUT FROM THE HR DIRECTOR BASED ON INFORMATION FROM THE SURVEYS MENTIONED ABOVE. THE DETERMINED COMPENSATION RATE IS COMMUNICATED TO THE NEW EMPLOYEE VIA AN OFFER LETTER AND DOCUMENTED ON THE REQUEST TO HIRE IN HIS/HER PERSONNEL FILE.
Form 990, Part VI, Line 19
Process for making documents available to the public
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9
OTHER CHANGES IN NET ASSETS OR FUND BALANCES
CHANGE IN MINIMUM PENSION LIABILITY $3,700,980 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS $2,266,481 BAPTIST HEALTHCARE SYSTEM, INC. ASSET ACQUISITION ($8,623,114) FAIR MARKET VALUE ADJUSTMENT 9-1-12 CHANGE IN TEMPORAILY RESTRICTED NET ASSETS ($275,134) -------------- TOTAL ($2,930,787)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.