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 | |||||
| (A)
BEACON MEDICAL GROUP INC |
351536132 | 10 | Yes | 53,476,849 | 0 | |
| (B)
ELKHART GENERAL HOSPITAL INC |
350877574 | 3 | Yes | 83,293,569 | 0 | |
| (C)
MEMORIAL HOSPITAL OF SOUTH BEND INC |
350868132 | 3 | Yes | 157,206,581 | 0 | |
| (D)
BEACON HEALTH FOUNDATION |
351536129 | 7 | No | 1,070,084 | 17,628 | |
| (E)
COMMUNITY HOSPITAL OF BREMEN |
350835006 | 3 | No | 4,240,670 | 30,000 | |
| (F)
THREE RIVERS HEALTH SYSTEM |
451257972 | 3 | Yes | 0 | 0 | |
|
Total 6
|
299,287,753 | 47,628 | ||||
Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART IV, SECTION A, LINE 1 | BEACON HEALTH SYSTEM'S ("BHS") ARTICLES OF INCORPORATION STATE THAT IT IS ORGANIZED TO CONTROL AS A SOLE MEMBER OF AN INTEGRATED REGIONAL HEALTH CARE SYSTEM COMPRISED OF ONE OR MORE SUBSIDIARY ORGANIZATIONS, INCLUDING ELKHART GENERAL HOSPITAL, INC. ("EGH"), MEMORIAL HEALTH SYSTEM, INC. (NOW BEACON MEDICAL GROUP ("BMG")), THREE RIVERS HEALTH SYSTEM ("TRH"), AND ALL OTHER RESPECTIVE AFFILIATES, WHICH INCLUDES MEMORIAL HOSPITAL OF SOUTH BEND ("MHSB"). EGH, BMG, AND MHSB ARE SPECIFICALLY DESIGNATED BY NAME. BHS ALSO SUPPORTS BEACON HEALTH FOUNDATION ("BHF") AND COMMUNITY HOSPITAL OF BREMEN ("CHB"). AS BOTH OF THESE ENTITIES ARE PART OF THE SAME INTEGRATED HEALTH SYSTEM WITH BHS AS THE SOLE MEMBER OF ALL SUBSIDIARIES, THEY HAVE A CONTINUOUS AND HISTORIC RELATIONSHIP. SCHEDULE A, PART IV, SECTION A, LINE 5A BEACON HEALTH SYSTEM, INC. ADDED THREE RIVERS HOSPITAL (TRH), EIN # 45-1257972 AS A SUPPORTED ORGANIZATION IN 2021. THIS WAS ACCOMPLISHED THROUGH BHS'S ACQUISITION OF TRH AND BY TRH'S 2021 AMENDMENT OF THE ARTICLES OF INCORPORATION TO INCLUDE BHS AS ITS SOLE MEMBER. AS BHS AND TRH HAVE A PARENT/SUBSIDIARY RELATIONSHIP WITHIN THE SAME INTEGRATED HEALTH SYSTEM, THEY HAVE A HISTORIC AND CONTINUOUS RELATIONSHIP. SCHEDULE A, PART IV, SECTION A, QUESTION 6 BEACON HEALTH SYSTEM (BHS) PROVIDED A SMALL NUMBER OF GRANTS TO SELECT COMMUNITY ORGANIZATIONS WHICH FURTHER THE CHARITABLE PURPOSES OF ITS SUPPORTED ORGANIZATIONS. AS BHS IS THE PARENT OF AN INTEGRATED HEALTH SYSTEM, ITS SUPPORTED ORGANIZATIONS ARE AWARE AND APPROVE OF THESE GRANTS. THE HEALTH SYSTEM IS CONTINUING TO RE-ALIGN ITS GRANTMAKING ACTIVITY IN 2021 TO DIRECT ALL GRANTS THROUGH ITS AFFILIATED FOUNDATION AND HOSPITAL ORGANIZATIONS. SCHEDULE A, PART IV, SECTION D, QUESTION 2 & 3 BEACON HEALTH SYSTEM (PARENT) MAINTAINS A CLOSE AND CONTINUING RELATIONSHIP WITH ALL OF ITS SUPPORTED ORGANIZATIONS, AS THEY COMPRISE ONE INTEGRATED HEALTH SYSTEM. THEIR GOVERNANCE IS CLOSELY RELATED. THE PARENT SHARES COMMON OFFICERS WITH ITS SUPPORTED ORGANIZATIONS, THE CHAIR OF EACH OF THE SUPPORTED ORGANIZATIONS ARE INVITED GUESTS AT THE PARENT BOARD MEETINGS, AND THE BOARD COMMITTEES ARE ALL POPULATED WITH BOARD MEMBERS FROM BOTH THE PARENT AND SUPPORTED ORGANIZATIONS. IN ADDITION, THE INVESTMENT COMMITTEE OF THE PARENT BOARD INCLUDES COMMITTEE MEMBERS FROM BOTH THE PARENT AND THE SUPPORTED ORGANIZATIONS. AS A RESULT OF THIS OVERLAP, THE SUPPORTED ORGANIZATIONS HAVE A SIGNIFICANT VOICE IN THE PARENT'S INVESTMENT POLICIES AND IN DIRECTING THE USE OF THE PARENT'S INCOME AND ASSETS AT ALL TIMES DURING THE TAX YEAR. SCHEDULE A, PART IV, SECTION E, QUESTION 3A The BHS BOARD WORKS WITH THE GOVERNANCE COMMITTEE AND EXECUTIVE COMMITTEE TO APPOINT OFFICERS AND DIRECTORS. SCHEDULE A, PART IV, SECTION E, QUESTION 3B THE BHS BOARD AND COMMITTEES OVERSEE THE POLICIES, PROGRAMS AND ACTIVITIES OF THE SUPPORTED ORGANIZATIONS, SEE SCH. O DISCLOSURE FOR ADDITIONAL DETAILS. |
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Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| CORE FORM | FORM 990 PART VI SECTION A, LINE 2 Amish Shah and Jessi Hsieh have a business relationship. Form 990, Part VI Section A, Line 4 1. The bylaws for BHS changed from 2020 to 2021. The following changes are as follows: - The selection of Board members is completed by a recommendation from the Nominating and Governance Committee to the Executive Committee, which in consultation with the CEO, will submit a nomination to the Board for approval. - The Board or such committee, as their discretion, may hold meetings by internet applications if and when conditions present that indicate it is the best course of action. - Annually, the CEO shall meet with the Executive Committee to discuss a Succession Plan for the Board, including Officers, which will be discussed at following board meetings and Executive session. It will then be forwarded to the Nominating and Governance Committee for recommendations. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION INCORPORATES NUMEROUS PARTIES IN THE PRODUCTION AND REVIEW OF THE FORM 990 AND ASSOCIATED SCHEDULES. SENIOR ACCOUNTING STAFF AND MANAGEMENT COMPLETE THE FORM 990 AND SCHEDULES. SOME FORMS AND SCHEDULES ARE REVIEWED BY THE CONTROLLER. SUBSEQUENT TO THOSE STEPS, THE ORGANIZATION ENGAGED ERNST & YOUNG TO REVIEW THE COMPLETED FORM 990 AND APPROPRIATE SCHEDULES. PRIOR TO FILING THE RETURN, THE CFO, THE COMPENSATION COMMITTEE OF THE ORGANIZATION AND THE CEO CONDUCT A GENERAL OVERVIEW OF THE FORM 990, INCLUDING APPLICABLE COMPENSATION SCHEDULES. IN ADDITION, EACH BOARD MEMBER RECEIVES NOTIFICATION OF THE IRS FORM 990 PLACEMENT ON THE ORGANIZATION'S BOARD PORTALS WHICH ALLOWS FOR BOARD MEMBER REVIEW PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THERE ARE THREE SEPARATE FORMS THAT ARE SENT OUT THROUGH THE INTERNAL AUDIT DEPARTMENT TO KEY EMPLOYEES OR BOARD MEMBERS REGARDING CONFLICT OF INTEREST. THEY ARE AS FOLLOWS: 1. THE FIRST IS A CONFLICT OF INTEREST STATEMENT THAT IS SENT TO SENIOR LEVEL ADMINISTRATION, MANAGEMENT, AND SELECT STAFF SUCH AS PURCHASING DEPARTMENT EMPLOYEES. THE PURPOSE OF THE STATEMENT IS TO REQUIRE THESE EMPLOYEES TO DISCLOSE ANY POTENTIAL CONFLICT OF INTERESTS THEY MAY HAVE. THE STATEMENTS ARE SENT IN JANUARY OF EACH YEAR FOR THE PREVIOUS YEAR ACTIVITIES WE PURSUE THE REPLIES TO GET A 100% RESPONSE RATE. IN THE CURRENT YEAR WE SENT OUT 364 STATEMENTS AND ARE WORKING TO ACHIEVE A 100% RESPONSE RATE. EACH RESPONSE IS REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT AND THE RESULTS ARE REPORTED TO THE CEO OF BEACON HEALTH SYSTEM, THE AUDIT COMMITTEE CHAIRMAN, AS WELL AS THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. 2. THE SECOND STATEMENT IS THE BOARD DUALITY OF INTEREST STATEMENT THAT IS SENT TO CURRENT BOARD MEMBERS, FORMER BOARD MEMBERS FROM THE LAST FIVE YEARS, AND OTHER KEY EMPLOYEES. THE DUALITY OF INTEREST STATEMENT IS SENT USING A WEB BASED SURVEY TOOL PROVIDED BY ERNST & YOUNG. THE REPLIES ARE REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT. THE RESULTS OF THE SURVEYS ARE SUMMARIZED USING THE WEB BASED TOOL, AND ARE REVIEWED BY ERNST & YOUNG IN COMPLETING THE 990. The RESULTS ARE REPORTED TO THE CEO OF BEACON HEALTH SYSTEM, THE AUDIT COMMITTEE CHAIRMAN, AND THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. 3. THE THIRD STATEMENT IS ENTITLED "CODE OF ETHICS FOR SENIOR FINANCIAL OFFICERS". THE STATEMENT REQUIRES AN ACKNOWLEDGEMENT FORM TO BE SIGNED BY BEACON HEALTH SYSTEM'S KEY FINANCIAL EMPLOYEES THAT BEACON'S FINANCIAL INFORMATION IS TO THE BEST OF THEIR KNOWLEDGE TRUE AND ACCURATE. THIS STATEMENT WAS SENT OUT ON JANUARY 25, 2022 AND THE SIGNED ACKNOWLEDGEMENTS ARE KEPT BY THE DIRECTOR OF INTERNAL AUDIT. IN 2021, 23 DESIGNATED EMPLOYEES WERE REQUESTED TO SIGN THE FORM AND WE HAD A 100% COMPLIANCE RATE. ANY POTENTIAL CONFLICTS OF INTERESTS ARE REVIEWED BY INDEPENDENT PARTIES BOTH INTERNAL AND EXTERNAL TO THE ORGANIZATION, AND IF NECESSARY, CORRECTIVE ACTION WOULD BE TAKEN TO RESOLVE A TRUE CONFLICT. THE INDIVIDUAL WITH THE POTENTIAL CONFLICT OF INTEREST WOULD BE EXCLUDED FROM ALL REVIEW PROCEEDINGS. FORM 990, PART VI, SECTION B, LINE 15A & 15B BEACON HEALTH SYSTEM, INC. HAS AN EXTENSIVE EXAMINATION THAT IS CONDUCTED FOR VICE PRESIDENT AND HIGHER. VICE PRESIDENT AND HIGHER COMPENSATION IS DETERMINED AFTER AN EXTENSIVE EXAMINATION IS CONDUCTED USING COMPARABLE MARKET DATA AND THEN REVIEWED BY AN INDEPENDENT CONSULTANT HIRED BY,AND REPORTING TO, THE BOARD OF DIRECTORS. HUMAN RESOURCES CONDUCTS THE ANALYSIS AND MAKES RECOMMENDATIONS TO THE CEO WHO THEN MAKES THE RECOMMENDATIONS FOR ALL OTHER EXECUTIVES/OFFICERS TO THE BOARD FOR APPROVAL. THE INDEPENDENT CONSULTING GROUP SEPARATELY MAKES THE RECOMMENDATIONS REGARDING THE CEO'S COMPENSATION TO THE BOARD FOR APPROVAL. RECOMMENDATIONS ARE PRESENTED TO THE COMPENSATION COMMITTEE OF THE BEACON HEALTH SYSTEM, INC. BOARD FOR DELIBERATION AND FINAL DECISION. DELIBERATION AND FINAL DECISION ARE PERFORMED BY THE INDEPENDENT MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE DISTRIBUTED QUARTERLY TO THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE AS PART OF THE CONTINUING DISCLOSURES FOR THE BEACON HEALTH SYSTEM, INC. BONDS. FORM 990, PART XI, LINE 9 WRITE OFF INTER COMPANY MEMORIAL HOSPITAL OF SB $111,970,086 WRITE OFF INTER COMPANY ELKHART GENERAL HOSPITAL $31,142,361 WRITE OFF INTER COMPANY BEACON MEDICAL GROUP $-121,397,375 WRITE OFF INTER COMPANY BEACON HEALTH FOUNDATION $-136,395 JOINT VENTURE TAX DIFFERENCES $-183,737 ROUNDING VARIANCE $24 TOTAL $21,394,964 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONSULTING TOTAL FEES:535789 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:EQUIPMENT RENTAL & MAINTENANCE TOTAL FEES:23330541 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:REDIOLOGY FEES TOTAL FEES:62462 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB READING FEES TOTAL FEES:320904 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT LABOR TOTAL FEES:63280 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:9526896 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION FEES TOTAL FEES:6555162 |
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