Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) |
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| 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) |
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| 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): |
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| 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 |
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| 9 Distributable amount for 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a | Program Accomplishments: Baptist Health Richmond is a fully accredited, non-profit 501 (c) (3) hospital in Richmond, Kentucky. Licensed for 105 beds, Baptist Health Richmond is a rural, acute care facility. Established in 1892, the hospital has served Madison and surrounding counties with primary and secondary services for more than a century. Its core programs include inpatient, outpatient, diagnostic and community services. Its doctors provide care in 20 specialty areas, and have five board-certified hospitalists. Baptist Health Richmond offers cardiac rehabilitation, occupational, physical and respiratory therapy and women's health and childbirth services. Staffed with board-certified emergency physicians and nurses, the Emergency Department treats more than 31,000 patients a year and trains for disaster preparedness annually with the federal government's Chemical Stockpile Emergency Preparedness Program (CSEPP). The hospital offers outpatient surgery and infusion services on campus. The diagnostic services include a clinical laboratory, CT, MRI and radiologic imaging, nuclear medicine, cardiac catheterization, angioplasty, and sleep disorders. The original hospital mission-to care for all members of our community regardless of their race, creed or ability to pay-still guides the hospital today. Seventy-five thousand patients sought care at Baptist Health Richmond last year; many of them were among the area's rural poor. More than one third of its patients are from low-income households or underserved populations, and 97% of them live in Appalachia. BHR has charity care policies and procedures in place to determine a patient's ability to pay for services. BHR operates an emergency department that is open 24 hours a day, every day. Patients are treated without regard to their payment ability. BHR provided inpatient services to the citizens of Madison and surrounding counties, with 2,912 inpatients admitted and 7,330 surgical services performed during the twelve months ended August 31, 2018. BHR also provided obstetric services, a total of 471 deliveries were performed. The hospital is an active community partner, working with local government, businesses and civic organizations, education systems, and social service agencies to strengthen the community and provide opportunities for those less fortunate. |
| Part V, Line 1a | Form 1096 is filed by Baptist Healthcare System, Inc., FEIN 61-0444707. |
| Form 990, Part VI, Section A, 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, Section A, line 7a | Power to Elect or Appoint Members: Board of Directors are appointed by resolution of the organization's sole member, Baptist Healthcare System, Inc. (BHS). |
| Form 990, Part VI, Section A, line 7b | Decisions reserved to members or stockholders: The sole member, BHS, has the following reserved powers, acting through its Board of Directors, that include: 1. Approve the mission, vision, and values of the corporation and amendments there to. 2. Approve amendments to the articles of incorporation and the bylaws. 3. Approve the strategic plan of the corporation. 4. Approve the transfer or disposition of all or substantially all of the corporation's 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. 5. Approve the capital expenditure and operating budgets of the corporation, and any unbudgeted expenditures over $500,000. 6. Selection of the corporation's auditor. 7. 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. 8. 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. 9. 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 corporation's board. 10. 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 corporation's board. 11. 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. 12. 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, Section B, line 11b | Process Used To Review The Form 990: The internally prepared Form 990 is reviewed and approved by tax consultants. Copies are provided to each voting member of the Board of Directors prior to filing for their review. |
| Form 990, Part VI, Section B, line 12c | Monitoring and Enforcement of Compliance with Conflict of Interest Policy: Annually, the Secretary of Baptist Health System, Inc., (BHS), sends out a conflict of interest questionnaire to each of the directors and officers serving on the Board of Baptist Health Richmond, (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 BHR 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, Section B, line 15 | Process For Determining Compensation: The President of Baptist Health Richmond, Inc. is not an employee of Baptist Health Richmond, Inc. but is an employee of Baptist Healthcare System, Inc., a tax-exempt 501(c)(3) organization which is the sole member of Baptist Health Richmond, Inc. The President is compensated by Baptist Healthcare System, Inc. Annually in September, the Baptist Healthcare System, Inc. Compensation Committee reviews the compensation, including base compensation and incentive compensation for the President. The Baptist Healthcare System, Inc. Compensation Committee is comprised of independent Board Members. The Committee retains a Compensation Consultant to advise the Committee and who provides data as to comparable compensation for similarly qualified persons in functionally comparable positions at similarly situated healthcare organizations. The Committee reviews this information in approving annual base and incentive compensation and other items of reportable compensation described on Schedule J of the IRS Form 990. The decisions of the Committee regarding compensation are contemporaneously documented in the minutes of the Committee. Annually, the Committee Chairperson and the Compensation Consultant provide a report on executive compensation to the full Board of Directors of Baptist Healthcare System, Inc. Officers of Baptist Health Richmond, Inc. are not employees of Baptist Health Richmond, Inc. nor are they compensated by Baptist Health Richmond, Inc. The Baptist Health Richmond, Inc. officers are employees of Baptist Healthcare System, Inc. and are compensated by Baptist Healthcare System, Inc. The compensation of these officers is either reviewed and approved by the Compensation Committee of the Baptist Healthcare System, Inc. Board or are reviewed and approved by the Baptist Healthcare System, Inc. and/or the Baptist Health Richmond, Inc. President and/or CEO. The organization makes every effort to ensure that the compensation of all employees is reasonable and appropriate for the value of the services received by the organization. |
| Form 990, Part VI, Section C, 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: | Physician Entity Funding -9,813,209. IS Depreciation 2,407,295. Intercompany Transfers 18,361,462. Other Adjustments 1,373,381. |
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