Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 3 | THE UNITED STATES BANKRUPTCY COURT APPROVED BH1'S CONFIRMATION PLAN ON DECEMBER 11, 2013. THE PBGC ASSUMED THE ROLE OF TRUSTEE FOR THE BAPTIST HOSPITAL SYSTEM, INC. RETIREMENT PLAN ON DECEMBER 11, 2013. THE CONFIRMATION PLAN WAS EFFECTIVE ON DECEMBER 27, 2013 AT WHICH TIME BH1 CEASED NORMAL OPERATIONS AND A LIQUIDATION AGENT APPROVED BY THE BANKRUPTCY COURT ASSUMED RESPONSIBILITY FOR OPERATIONS TO WIND DOWN THE CORPORATION. THE VAST MAJORITY OF BH1'S ASSETS WERE TRANSFERRED TO THE PBGC AS OF DECEMBER 31, 2013. |
| FORM 990, PART VI, SECTION A, LINE 8A | SEE 8B DETAIL BELOW |
| FORM 990, PART VI, SECTION A, LINE 8B | IN 2012, BH1 REDUCED ITS BOARD OF DIRECTORS SIZE TO THREE MEMBERS. AT THAT TIME, THE BOARD ELIMINATED ALL COMMITTEES AND BEGAN ADDRESSING ALL MATTERS AT THE BOARD OF DIRECTORS MEETINGS. THIS PRACTICE CONTINUED THROUGHOUT 2013 UNTIL THE COURT APPOINTED LIQUIDATION AGENT ASSUMED HIS DUTIES IN DECEMBER 2013. THROUGHOUT 2014, THE LIQUIDATION AGENT REPORTED TO AND WAS UNDER THE SUPERVISION OF THE BANKRUPTCY COURT. |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED BY THE PRESIDENT PRIOR TO ITS FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | BH1 REQUIRES ANNUAL DISCLOSURE FROM ITS DIRECTORS, OFFICERS AND KEY EMPLOYEES OF ANY POTENTIAL CONFLICTS OF INTEREST. BH1 HAS A WRITTEN CONFLICT OF INTEREST POLICY WHICH STATES THAT EACH BH1 DIRECTOR, OFFICER, AND KEY EMPLOYEE UNDERSTANDS THAT DECISIONS ABOUT BH1 OPERATIONS AND THE USE OR DISPOSITION OF BH1'S ASSETS SHOULD BE MADE TO FURTHER THE GOALS AND MISSION OF BH1 AND NOT FOR PRIVATE PROFIT OR OTHER PERSONAL BENEFIT TO THE INDIVIDUALS AFFILIATED WITH BH1 WHO TAKE PART IN THOSE DECISIONS. SUCH INDIVIDUALS ANNUALLY SIGN A STATEMENT THAT DISCLOSES ANY CURRENT OR POTENTIAL CONFLICTS OF INTEREST WITH ANY PROPOSED OR ONGOING BH1 TRANSACTION OR ARRANGEMENT. THE CONFLICT OF INTEREST POLICY ALSO IMPOSES A DUTY UPON SUCH INDIVIDUALS TO IMMEDIATELY DISCLOSE A POTENTIAL CONFLICT OF INTEREST SHOULD ONE ARISE PRIOR TO THE ANNUAL STATEMENT BEING SIGNED. THE CONFLICT OF INTEREST POLICY ALSO PROVIDES THAT THE BOARD OF DIRECTORS SHALL REVIEW SUCH ANNUAL DISCLOSURE STATEMENTS AND ANY SUCH REPORTS MADE DURING THE YEAR AND MAKE FURTHER INVESTIGATION AS IT DEEMS DESIRABLE. AFTER DISCLOSURE OF A POTENTIAL CONFLICT OF INTEREST AND ALL MATERIAL FACTS, THE QUESTION OF WHETHER A CONFLICT EXISTS SHALL BE DISCUSSED AND VOTED UPON BY THE DISINTERESTED DIRECTORS AND THE DISINTERESTED DIRECTORS SHALL DECIDE IF SUCH CONFLICT OF INTEREST EXISTS. IF A MAJORITY OF THE BOARD OF DIRECTORS IS INTERESTED PERSONS WITH RESPECT TO A PARTICULAR MATTER, THEN THE DISINTERESTED DIRECTORS OF BH1 SHALL APPOINT A SPECIAL CONFLICT OF INTEREST COMMITTEE OF NON-INTERESTED PERSONS TO REVIEW SUCH MATTER. THE CONFLICT OF INTEREST COMMITTEE SHALL REPORT DIRECTLY TO THE DISINTERESTED DIRECTORS. IF THE DISINTERESTED DIRECTORS OR CONFLICT OF INTEREST COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE DISINTERESTED DIRECTORS OR CONFLICT OF INTEREST COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE WHETHER (1) THE TRANSACTION OR ARRANGEMENT IS IN BH1'S BEST INTEREST AND FOR ITS OWN BENEFIT, (2) THE TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF BH1, AND (3) BH1 IS UNABLE TO OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IF THE DISINTERESTED DIRECTORS OR CONFLICT OF INTEREST COMMITTEE DECIDES THAT ANY OF THE CRITERIA SET FORTH IN ITEMS 1, 2 AND 3 HAVE NOT BEEN SATISFIED, BH1 WILL NOT ENTER INTO THE TRANSACTION OR ARRANGEMENT. IN DETERMINING WHETHER A TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO BH1, THE DISINTERESTED DIRECTORS OR CONFLICT OF INTEREST COMMITTEE SHALL OBTAIN AND REVIEW (WHERE APPROPRIATE, TAKING INTO ACCOUNT THE MATERIALITY OF THE TRANSACTION OR ARRANGEMENT) ONE OR MORE (I) APPRAISALS OF THE FAIR MARKET VALUE OF THE TRANSACTION OR ARRANGEMENT, (II) OFFERS FROM COMPARABLE COMPETING ENTITIES, (III) STUDIES OF COMPENSATION ARRANGEMENTS, OR (IV) REPORTS OR STUDIES FROM INDEPENDENT PARTIES WHO HAVE A DEMONSTRATED EXPERTISE IN VALUING OR ANALYZING THE FAIRNESS OF SUCH A TRANSACTION OR ARRANGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE LIQUIDATION AGENT AND HIS FEE WERE APPROVED BY THE BANKRUPTCY COURT. HE REPORTS TO AND IS UNDER THE SUPERVISION OF THE BANKRUPTCY COURT. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION'S FORM 990 IS IN THE ORGANIZATION'S STORAGE FACILITY, STORAGE PLACE OF COOL SPRINGS, 1006 FLAGPOLE COURT, BRENTWOOD ,TN 37207. THIS DOCUMENT IS AVAILABLE UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATIONAL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE FILED IN BINDERS AT THE ORGANIZATION'S STORAGE FACILITY, STORAGE PLACE OF COOL SPRINGS, 1006 FLAGPOLE COURT, BRENTWOOD ,TN 37207. THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 91,661. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,661. |
| FORM 990, PART XI, LINE 9: | CHANGE IN NET PENSION LIABILITY TO PENSION BENEFIT GUARANTY CORPORATION -321,850. |
| FORM 990, PART I, LINE 1: | REQUEST FOR DETERMINATION OF UNPAID LIABILITY (IN RE BH1, BANKRUPTCY CASE NO. 12-11744): BH1 (THE "DEBTOR") FILED A PETITION FOR RELIEF UNDER CHAPTER 11 OF TITLE 11 OF THE UNITED STATES CODE ON DECEMBER 28, 2012 IN THE BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF TENNESSEE. THE DEBTOR RETAINED POSSESSION OF ITS ESTATE, AND NO TRUSTEE WAS APPOINTED. BY ORDER ENTERED DECEMBER 11, 2013, THE COURT CONFIRMED THE DEBTOR'S CHAPTER 11 PLAN OF LIQUIDATION (THE "CONFIRMED PLAN"), WHICH PROVIDED FOR THE LIQUIDATION AND DISTRIBUTION OF ALL OF DEBTOR'S ASSETS. I AM THE DEBTOR'S LIQUIDATION AGENT, AS DEFINED IN THE CONFIRMED PLAN. ENCLOSED HEREWITH, PLEASE FIND THE FINAL TAX RETURN OF BH1 AND PAYMENT OF THE TAX LIABILITY SHOWN IN THE RETURN, IF ANY. PURSUANT TO 11 U.S.C. 505(B)(2), I REQUEST A DETERMINATION OF ANY UNPAID LIABILITY OF BH1, INC. FOR ANY TAX INCURRED DURING THE ADMINISTRATION OF ITS BANKRUPTCY CASE. PLEASE TAKE NOTE THAT, SHOULD YOU DECIDE TO EXAMINE THIS RETURN, YOU HAVE 60 DAYS FROM THE DATE OF THIS REQUEST TO NOTIFY ME THAT THIS RETURN HAS BEEN SELECTED FOR EXAMINATION. YOU MUST COMPLETE SUCH EXAMINATION AND INFORM ME OF ANY TAX YOU DETERMINE TO BE OWED WITHIN 180 DAYS OF THE DATE OF THIS REQUEST. SEE 11 U.S.C. 505(B)(2)(A). IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT ME AT RANDY.STARKWEATHER@BH1.ORG OR (615) 414-7251 OR GLENN ROSE, THE DEBTOR'S LEGAL COUNSEL, AT HARWELL HOWARD HYNE GABBERT & MANNER, P.C., (615) 256-0500 AND GBR@H3GM.COM. |
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