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 (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 | |||||
| (A)
BETHESDA HOSPITAL INC |
592447554 | 3 | Yes | 0 | 13,037,835 | |
| Total 1 | 0 | 13,037,835 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part IV, Section D, Line 3 Supp. Org. Have Significant Voice In Investment Policies | A MAJORITY OF THE OFFICERS AND DIRECTORS OF BETHESDA HEALTH, INC. SERVE AS OFFICERS AND DIRECTORS OF ITS SUPPORTED ORGANIZATION AND THEREFORE THE SUPPORTED ORGANIZATION HAS A SIGNIFICANT VOICE IN BETHESDA HEALTH, INC.'S INVESTMENT POLICIES AND USE OF THE ORGANIZATION'S INCOME OR ASSETS. |
| Schedule A, Part IV, Section E, Line 3a Power To Appoint/Elect Majority of Officer/Director/Trustee | BETHESDA HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF THE SUPPORTED ORGANIZATION, AND, AS SUCH, HAS THE RIGHT TO ELECT, OR APPROVE CANDIDATES PROPOSED TO BE ELECTED TO, THE RESPECTIVE GOVERNING BOARD OF THE SUPPORTED ORGANIZATION. |
| Schedule A, Part IV, Section E, Line 3b Substantial Direction Over Policies/Programs/Activities | BETHESDA HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF THE SUPPORTED ORGANIZATION, AND, AS SUCH, HOLDS CERTAIN RESERVED POWERS OVER THAT ENTITY, including THE RIGHT TO ADOPT A PLAN OF DISSOLUTION; AUTHORIZE THE SUPPORTED ORGANIZATION TO ENGAGE IN, OR ENTER INTO, ANY TRANSACTION PROVIDING FOR THE SALE, MORTGAGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE SUPPORTED ORGANIZATION; ADOPT A PLAN OF REORGANIZATION OR THE MERGER OR CONSOLIDATION OF THE SUPPORTED ORGANIZATION WITH ANOTHER ENTITY; ADOPT ANY ANNUAL OR LONG-TERM CAPITAL AND OPERATIONAL BUDGETS AND APPROVE CERTAIN FUNDAMENTAL CORPORATE CHANGES. AS SUCH, BETHESDA HEALTH, INC. EXERCISES A SUBSTANTIAL DEGREE OF DIRECTION OVER THE POLICIES, PROGRAMS, AND ACTIVITIES OF THE SUPPORTED ORGANIZATION. |
| Software ID: | 15000238 |
| Software Version: | 2015v3.0 |
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 VI, Line 1a Delegate broad authority to a committee | 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. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | ROGER L. KIRK, JOANNE AQUILINA, AND ROBERT BROADWAY - Business relationship |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | 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. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The organization's conflict of interest policy covers any trustee, director, 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. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | 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 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, 2016. The process and decisions are documented in the board minutes. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | 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 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 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, 2016. 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. |
| Form 990, Part VI, Line 19 Required documents available to the public | 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. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | Badge Replacement Fee - Total Revenue: 112, Related or Exempt Function Revenue: 112, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Transfer from Affiliates - 4143319; Change in investment in subsidiary - -19638; |
| Software ID: | 15000238 |
| Software Version: | 2015v3.0 |