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): |
|||||
| 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 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 I, LINE 1 | AND COMPASSIONATE CARE. OUR VISION STATEMENT IS: TO BE THE TRUSTED CHOICE FOR EXEMPLARY, COMPASSIONATE, PATIENT-AND-FAMILY-CENTERED HEALTHCARE FOR BEATRICE AND THE COMMUNITIES WE SERVE. |
| FORM 990, PART III, LINE 4A | HOSPITAL INPATIENT AND OUTPATIENT CARE: SERVICES INCLUDE ANCILLARY AND ACUTE CARE ALONG WITH SERVING AS A CLINICAL EDUCATION SITE FOR STUDENTS FOR AREAS INVOLVING THE PHYSICAL THERAPY DEPARTMENT, THE EMERGENCY DEPARTMENT, THE SPEECH PATHOLOGY DEPARTMENT, THE OCCUPATIONAL THERAPY DEPARTMENT AND THE NURSING DEPARTMENT. PHYSICIAN CLINICS: SERVICES INCLUDE ACUTE CARE SERVICES AS WELL AS PROVIDING SPORTS PHYSICALS FOR LOCAL HIGH SCHOOL ATHLETES AND FOR PARTICIPANTS IN THE SPECIAL OLYMPICS. HOSPICE/LONG-TERM CARE: SERVICES INCLUDE CARE-TAKING FOR THE ELDERLY ALONG WITH PROVIDING A GRIEF RECOVERY PROGRAM FOR THOSE PEOPLE WHO HAVE LOST A LOVED ONE TO DEATH. HOME HEALTH IS AVAILABLE FOR PEOPLE OF ALL AGES, ASSISTING THEM IN THE RECOVERY AND REHABILITATION FROM ALL TYPES OF ILLNESS, INJURIES AND OTHER HEALTH PROBLEMS. SKILLED INTERMITTENT HOME CARE THAT IS PHYSICIAN ORDERED IS PROVIDED BY REGISTERED NURSES, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS AND NURSE AIDES. AREAS SERVED INCLUDE: GAGE, JEFFERSON, PAWNEE AND SALINE COUNTIES. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE NOMINEES FOR THE BOARD OF DIRECTORS ARE APPROVED BY HEALTH SYSTEM OF BEATRICE, INC. AND THEN FORWARDED TO THE BOARD OF DIRECTORS FOR VOTE. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE HEALTH SYSTEM OF BEATRICE, INC., A TAX EXEMPT CORPORATION, HAS THE FOLLOWING POWER AND AUTORITY: - TO APPROVE ALL DIRECTORS AND ADVISORY MEMBERS - TO APPROVE OF ANY INDEBTEDNESS OR ENCUMBRANCE OF THE CORPROATION AND ANY EXPENDITURE, INDEBTEDNESS OR ENCUMBRANCE WHICH REQUIRES PLEDGING OF THE CORPORATIONS ASSETS - TO APPROVE THE ANNUAL BUDGET - TO APPROVE THE MISSION STATEMENT - TO APPROVAL ANY COOPERATIVE ARRANGEMENTS OR JOINT VENTURES WITH ANY OTHER PARTY - TO APRROVAL ANY AMENDMENTS TO THE ARTICLES OR BYLAWS |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. IT IS THEN REVIEWED BY THE ORGANIZATIONS OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THEY HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FORM 990 IS THEN PROVIDED TO THE BEATRICE COMMUNITY HOSPITAL'S FINANCE COMMITTEE FOR REVIEW PRIOR TO FILING. ONCE THE FINANCE COMMITTEE RECOMMENDS SUBMISSION OF THE FORM 990 TO THE IRS, EACH BOARD MEMBER IS GIVEN ACCESS TO THE FORM 990 VIA THE BOARD PORTAL PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS HANDED OUT ANNUALLY FOR BOARD MEMBERS AND OFFICERS TO IDENTIFY ANY BOARDS, BUSINESSES, ETC. THAT MAY POTENTIALLY GIVE RISE TO CONFLICT. IF A CONFLICT SHOULD ARISE, THE AFFECTED BOARD MEMBER OR OFFICER WILL BE EXCUSED FROM THE DISCUSSION AND/OR VOTE. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | LISTED BELOW IS INFORMATION FROM OUR POLICY ON WAGE AND SALARY ADMINISTRATION. THIS POLICY APPLIES TO ALL EMPLOYEES EXCEPT EXECUTIVE LEVEL STAFF AND THOSE WITH WRITTEN CONTRACTS (PHYSICIANS, ALLIED HEALTH STAFF,ETC.). AN OUTSIDE CONSULTING FIRM MAKES COMPENSATION RECOMMENDATIONS TO THE BOARD OF DIRECTORS BASED UPON MARKET DATA FOR THE POSITION. A. STRUCTURE OF THE WAGE AND SALARY PLAN 1. PAY GRADES AND WAGE SCALES/RANGES ARE ESTABLISHED TO REWARD EMPLOYEES FOR DIFFERENT LEVELS OF SKILLS, RESPONSIBILITY AND KNOWLEDGE. JOB POSITIONS ARE ASSIGNED A PAY GRADE BASED UPON MARKET CONDITIONS, SKILLS, RESPONSIBILITY, EDUCATION EXPERIENCE, PHYSICAL DEMANDS AND WORKING CONDITIONS REQUIRED OF THE POSITION. EACH PAY GRADE HAS A RANGE OF PAY FROM MINIMUM TO MAXIMUM, ESTABLISHED TO REWARD EMPLOYEES FOR EXPERIENCE AND PERFORMANCE. B. ADJUSTMENTS TO THE WAGE AND SALARY PLAN 1. THE WAGE PLAN IS REVIEWED AT LEAST ANNUALLY TO ENSURE COMPETITIVE SALARIES FOR ALL POSITIONS. LABOR MARKET SURVEYS ARE COMPLETED AND UTILIZED ON A REGULAR BASIS. BASED UPON MARKET INFORMATION AND/OR A REVIEW OF JOB DESCRIPTIONS, ADJUSTMENTS MAY BE MADE TO THE WAGE AND SALARY PLAN THAT INCLUDE ADJUSTMENTS TO THE OVERALL WAGE AND SALARY STRUCTURE OR REPOSITIONING OF A SPECIFIC JOB POSITION(S) TO A DIFFERENT PAY GRADE. FOR THE CEO POSITION THAT IS HELD BY THOMAS SOMMERS, THE BOARD CHAIR WORKS WITH A CONSULTING COMPANY, IH STRATEGIES, TO DETERMINE THE APPROPRIATE COMPENSATION. THIS INFORMATION IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | CHANGE IN INTEREST IN BEATRICE COMM. HOSPITAL FOUNDATION $ 35,554 LOSS ON REFUNDING OF DEBT $(4,073,446) NET TRANSFERS FROM RELATED ORGANIZATIONS $ 43,119 ------------ TOTAL $(3,994,773) |
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| Software Version: |