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)
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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)
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(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) |
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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 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. |
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| 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) |
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| 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. |
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|
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. |
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|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 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 |
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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 VI, SECTION A, LINE 6 | THE CORPORATION IS A NONPROFIT CORPORATION AND HAS MEMBERS CONSISTING OF INDIVIDUAL MEMBERS OF THE COMMUNITY. THE CORPORATION HAS NO SHAREHOLDERS AND DOES NOT PAY DIVIDENDS OR OTHERWISE DISTRIBUTE PROFITS OR EXCESS REVENUES. THE MEMBERS, AS A GROUP, ELECT THE GOVERNING BODY AND HAVE THE POWER TO REMOVE MEMBERS OF THE GOVERNING BODY. THE MEMBERS CAN AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. THE MEMBER CANNOT RECEIVE ANY SHARE OF THE ORGANIZATIONS PROFITS OR ASSETS AT ANY TIME. A MEMBER CAN RECEIVE A DISTRIBUTION OF THE ORGANIZATIONS ASSETS UPON DISSOLUTION, IF IT IS AN ORGANIZATION OR ORGANIZATIONS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, RELIGIOUS, OR SCIENTIFIC PURPOSES AS SHALL AT THE TIME QUALIFY AS AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION IS A NONPROFIT CORPORATION AND HAS ONE CLASS OF MEMBERS CONSISTING OF INDIVIDUAL MEMBERS OF THE COMMUNITY. THE MEMBERS, AS A GROUP, HAVE THE POWER TO ELECT THE MEMBERS OF THE GOVERNING BODY AND HAVE THE POWER TO REMOVE MEMBERS OF THE GOVERNING BODY AND HAVE THE POWER TO REMOVE MEMBERS OF THE GOVERNING BODY, PERIODICALLY OR AS VACANCIES ARISE. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ORGANIZATION HAS ONE CLASS OF MEMBERS WHO VOTE FOR MEMBERSHIP DECISIONS. MEMBER APPROVAL IS REQUIRED FOR (I) REMOVAL OF MEMBERS,(II) ELECTION AND REMOVAL OF A TRUSTEE, (III) CHANGES TO THE PHILOSOPHY AND MISSION OF THE ORGANIZATION, (IV) CHANGES IN THE ELIGIBILITY AND QUALIFICATION OF TRUSTEES, (V) AMENDMENT OF THE ARTICLES OF INCORPORATION, (VI) A SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION, (VII) MERGER WITH ANOTHER ENTITY, AND (VIII) DISSOLUTION OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS REVIEWED BY THE VICE PRESIDENT OF FINANCE AND THE CFO. |
| FORM 990, PART VI, SECTION B, LINE 12C | DIRECTORS AND ABOVE ANNUALLY COMPLETE A QUESTIONNAIRE. THE CHIEF HUMAN RESOURCES OFFICER INVESTIGATES ANY POTENTIAL CONFLICTS AND TAKES APPROPRIATE ACTION DEPENDING ON THE NATURE OF THE CONFLICT. THE BOARD MEMBERS ARE REQUIRED TO ANNUALLY SUBMIT A WRITTEN STATEMENT AND ANSWER A QUESTIONNAIRE. A SUBCOMMITTEE OF THE BOARD REVIEWS ANY CONFLICTS AND REPORTS THOSE TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE DETERMINES THE APPROPRIATE ACTION DEPENDING ON THE NATURE OF THE CONFLICT. IF AN ISSUE WERE TO ARISE IN WHICH A POTENTIAL CONFLICT EXISTED, THE PERSON WITH THE POTENTIAL CONFLICT WOULD BE EXCUSED AND WOULD NOT VOTE ON THE TOPIC AT HAND. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | THE EXECUTIVE COMMITTEE OF THE BOARD APPOINTS DIRECTORS TO THE ADMINISTRATIVE COMPENSATION COMMITTEE. THE ADMINISTRATIVE COMPENSATION COMMITTEE APPROVES THE INITIAL SALARY AND ANY SUBSEQUENT SALARY ADJUSTMENTS FOR THE PRESIDENT/CEO FOR BAPTIST HEALTH. THE CHRO PRESENTS THE COMPENSATION PHILOSOPHY, AN OVERVIEW OF MARKET DATA RESULTS, AND A SUMMARY OF BENEFITS TO THE ADMINISTRATIVE COMPENSATION COMMITTEE OF THE BOARD. AN INDEPENDENT REVIEW OF THE EXECUTIVES SALARY RANGES WILL BE PERFORMED AT A MINIMUM OF EVERY TWO YEARS UNLESS EXTENUATING CIRCUMSTANCES ARISE. THE DIRECTOR AND ABOVE, EXECUTIVE DIRECTORS OR KEY EMPLOYEES WILL HAVE AN ANNUAL REVIEW OF SALARY RANGES AT A MINIMUM OF EVERY TWO YEARS FOR USE IN DETERMINING THE APPROPRIATE SALARY RANGE AND PAY FOR THE LEADERSHIP TEAM. |
| FORM 990, PART VI, SECTION C, LINE 19 | COPIES OF THE ORGANIZATION'S POLICIES AND GOVERNING DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9 | CHANGE IN DEFINED BENEFIT PLANS GAINS & LOSSES $12,775,684 TRANSFER TO AFFILIATE ($9,785,292) CHANGE IN FMV OF SWAP $2,550,350 SPRINGHILL K-1 ADJUSTMENT $157,690 CHANGE IN SERP $285,000 ------------- OTHER CHANGES IN NET ASSETS $5,983,432 |
| AMENDED RETURN CHANGES | AFTER THE 2021 RETURNS WERE FILED, IT WAS DISCOVERED THE INSURANCE PREMIUMS PREVIOUSLY TREATED AS UNRELATED BUSINESS INCOME ON THE ORIGINALLY FILED RETURNS WERE IN FACT REIMBURSEMENTS FOR EXPENSES PAID TO A THIRD PARTY ADMINISTRATOR. NO UNRELATED BUSINESS INCOME RESULTED FROM THE TRANSACTIONS. THE RETURN IS BEING AMENDED TO REMOVE THE INCOME AND DIRECTLY RELATED EXPENSES. ORIGINAL AMENDED ---------- --------- PAGE 1, PART I, LINE 7A 3,029,212 2,610,046 PAGE 1, PART I, LINE 7B 1,712,601 1,421,126 PAGE 9, PART VIII, LINE 11B COL C 419,166 NONE PAGE 9, PART VIII, LINE 11B COL D 9,503,481 9,922,647 PAGE 9, PART VIII, LINE 12 COL C 3,029,212 2,610,046 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:XXX-XX-XXXX |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:57458276 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT LABOR TOTAL FEES:XXX-XX-XXXX |
| Software ID: | |
| Software Version: |