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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Lexington Cardiac Research Foundation Inc
Employer identification number
20-4242792
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)
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 monetary support
Yes
No
Yes
No
Yes
No
(A)
BAPTIST HEALTH LEXINGTON
610444707
03
Yes
10,000
Total
10,000
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Lexington Cardiac Research Foundation Inc
Employer identification number
20-4242792
Return Reference
Explanation
FORM 990, PART V, LINE 2B
THE EMPLOYMENT TAX RETURNS FOR THE THREE EMPLOYEES REPORTED IN LINE 2A WERE REPORTED UNDER A COMMON PAYMASTER. THE EMPLOYMENT TAXES WERE PAID BY BAPTIST HEALTHCARE SYSTEM, INC. (EIN: 61-0444707).
FORM 990, PART VI, SECTION A, LINE 6
BAPTIST HEALTHCARE SYSTEM, INC. (EIN: 61-0444707) IS THE SOLE MEMBER OF LEXINGTON CARDIAC RESEARCH FOUNDATION, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE SOLE MEMBER APPOINTS ALL DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B
THE CONSENT & APPROVAL OF THE SOLE MEMBER SHALL BE REQUIRED FOR ALL MAJOR CORPORATE ACTIONS, AND 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 ORGANIZATION; (C) LIQUIDATE, REORGANIZE OR RECAPITALIZE THE CORPORATION; (D) CREATE OR INCUR ANY UNBUDGETED INDEBTEDNESS WHICH EXCEEDS $100,000; (E) MAKE ANY UNBUDGETED CAPITAL EXPENDITURE WHICH EXCEEDS $100,000; (F) AUTHORIZE THE EXECUTION OF ANY CONTRACT, AGREEMENT OR SIMILAR INSTRUMENT BY WHICH THE CORPORATION MAY BE OBLIGATED TO PAY MORE THAN $100,000 IN ANY YEAR; (G) OTHER THAN ACQUIRING MARKETABLE SECURITIES HELD FOR INVESTMENT PURPOSES, ACQUIRE THE STOCK OF ANY CORPORATION OR INVEST IN OR ACQUIRE AN 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, OTHER THAN MARKETABLE SECURITIES DISPOSED OF IN THE ORDINARY COURSE OF THE CORPORATION'S ACTIVITIES; I) ADOPT THE CORPORATION'S ANNUAL OPERATING BUDGET & CAPITAL EXPENDITURES BUDGET; J) ACCEPT ANY GIFT THAT REQUIRES THE CORPORATION OR THE MEMBER TO MATCH FUNDS, CARRY OUT SUBSTANTIAL NEW ACTIVITIES IN CONNECTION WITH THE GIFT, OR THAT IS MADE SUBJECT TO RESTRICTIONS THAT ARE NOT CLEARLY CONSISTENT WITH THE CORPORATION'S CHARITABLE PURPOSE OR WITH THE MEMBER'S MISSION; K) ACCEPT ANY GIFT OF REAL PROPERTY; L) ACCEPT ANY GIFT THAT REQUIRES THE CORPORATION TO ASSUME INDEBTEDNESS; M) MAKE ANY GIFT OR CONTRIBUTION TO ANY ORGANIZATION OTHER THAN THE MEMBER UNLESS SUCH GIFT OR CONTRIBUTION IS APPROVED BY THE MEMBER OR IS CONSISTENT WITH GUIDELINES ESTABLISHED BY THE MEMBER; N) ADOPT INVESTMENT GUIDELINES OR SELECT A FUND MANAGER.
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 SYSTEM, INC. SENDS OUT A CONFLICT OF INTEREST QUESTIONNAIRE TO EACH OF THE DIRECTORS SERVING ON THE BOARD OF LEXINGTON CARDIAC RESEARCH FOUNDATION (LCRF). 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 LCRF AND/OR 2) ACT IN THE BEST INTERESTS OF LCRF IN A MANNER CONSISTENT WITH THE TAX-EXEMPT PURPOSES OF LCRF. 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, SECTION B, LINE 15
OFFICERS OF LEXINGTON CARDIAC RESEARCH FOUNDATION, INC. (LCRF) ARE NOT EMPLOYEES OF LCRF BUT ARE EMPLOYEES OF BAPTIST HEALTHCARE SYSTEM, INC. OR BAPTIST PHYSICIANS LEXINGTON, INC., TAX-EXEMPT 501(C)(3) ORGANIZATIONS. BAPTIST HEALTHCARE SYSTEM, INC. IS THE SOLE MEMBER OF LCRF.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST.
FORM 990, PART VII
OFFICERS FOR LEXINGTON CARDIAC RESEARCH FOUNDATION PROVIDE SERVICES TO BAPTIST HEALTHCARE SYSTEM, INC. AND ITS SUBSIDIARIES. HOURS WORKED ARE NOT TRACKED ON AN ENTITY BY ENTITY BASIS. THEREFORE, ALL OFFICERS AND DIRECTORS HOURS 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.
FORM 990, PART IX, LINE 7-10
THE SALARIES REPORTED ARE FROM A COMMON PAYMASTER. THE BENEFITS REPORTED ARE A PERCENTAGE OF GROSS SALARIES REPORTED ON LINE 7. THE BENEFITS REPORTED ON LINE 10 INCLUDE PENSION EXPENSE AND AND OTHER BENEFITS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.