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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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 2023 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-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | 23017437 |
| Software Version: | 2023v5.1 |
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a PROGRAM ACHIEVEMENTS: | THE FACILITY PROVIDES A FULL RANGE OF INTEGRATED PATIENT CARE SERVICES, INCLUDING ACUTE, PRIMARY AND SPECIALTY CARE IN BOTH THE INPATIENT AND OUTPATIENT SETTINGS. THE DELIVERY OF INPATIENT AND AMBULATORY CARE IS ALSO SUPPORTED BY THE SERVICES PROVIDED THROUGH SPECIALIZED CENTERS AND FACILITIES THROUGHOUT THE REGION. SOUTHEAST HOSPITAL HAS AN ORGANIZED ACTIVE, ASSOCIATE AND CONSULTING MEDICAL STAFF OF PHYSICIANS, DENTISTS, AND PODIATRISTS FROM MORE THAN 40 MEDICAL AND SURGICAL FIELDS. MISSION: TOGETHER WE WILL EVOLVE HEALTHCARE THROUGH INNOVATION, COMPASSION, AND PARTNERSHIPS. VISION: AS A LEADING PROVIDER OF HEALTH SERVICES, SOUTHEASTHEALTH IS DEDICATED TO CONTINUOUS IMPROVEMENT OF THE REGION'S HEALTH STATUS IN A COLLABORATIVE COST-EFFECTIVE MANNER. VALUES: TO ACCOMPLISH OUR MISSION AND VISION, WE UPHOLD THESE VALUES: -VISION FOR CHANGE OUR CHALLENGE IN PREPARING FOR TOMORROW'S HEALTH NEED IS TO KEEP CONTEMPORARY CARE AVAILABLE FOR THOSE WE SERVE. BY EVALUATING THE PRESENT, SETTING APPROPRIATE GOALS, BEING FLEXIBLE AND INNOVATIVE, WE PREPARE DAILY TO MEET AND SHAPE THE FUTURE OF HEALTH CARE IN OUR REGION. -ACCESS TO CARE WE BELIEVE THAT ALL PATIENTS IN OUR CARE ARE ENTITLED TO QUALITY HEATH SERVICES, INFORMATION AND CONFIDENTIALITY ABOUT THEIR CARE AND TREATMENT WITH DIGNITY AND COMPASSION IN ALL OF LIFE'S STAGES. -LEADERSHIP WITH RESPONSIBILITY DEDICATED TO MAINTAINING PUBLIC TRUST AND A HIGH LEVEL OF INTEGRITY, OUR HOSPITAL LEADERS STRIVE TO BALANCE PROGRESS WITH COSTS, REGULATIONS AND COMPETITION WHILE ALWAYS PRESERVING THE HUMAN TOUCH. AS A NOT-FOR-PROFIT HOSPITAL, WE ARE PLEDGED TO ENHANCING QUALITY OF LIFE THROUGH WISE USE OF HUMAN AND MATERIAL RESOURCES IN MEDICAL AND CIVIC ENDEAVORS. -UNITY OF PURPOSE A SPIRIT OF COOPERATION, MUTUAL RESPECT AND CONCERN IS PROMOTED BY OUR HOSPITAL FAMILY TO DELIVER EFFICIENT AND COORDINATED SERVICES. WE ALSO WORK TOGETHER TO PROVIDE PATIENTS AND FAMILIES WITH REASSURANCES, SUPPORT AND CARE THAT IS SENSITIVE TO ALL THEIR NEEDS. -EXCELLENCE IN PERFORMANCE AT SOUTHEAST HOSPITAL, WE HAVE MADE A COMMITMENT TO EXCELLENCE IN INDIVIDUAL PERFORMANCE, TECHNOLOGY AND FACILITIES. THIS TRADITION OF EXCELLENCE IS EXPRESSED BY HELPING PATIENTS ATTAIN THE HIGHEST QUALITY OF LIFE THEY ARE CAPABLE OF ACHIEVING AND BY PROVIDING REGIONAL LEADERSHIP FOR HEALTH CARE ISSUES AND DEVELOPMENTS. -SERVICE ABOVE SELF TO DEMONSTRATE PROFESSIONALISM, ETHICS AND DEVOTION TO DUTY IS OUR CHARGE; TO SERVE WITH ENTHUSIASM AND COMPASSION IS OUR SPIRIT. RECOGNIZING THAT TECHNOLOGY IS IN OUR HANDS AND PEOPLE ARE IN OUR HEARTS, WE TAKE PRIDE IN GIVING OUR PERSONAL BEST FOR THE BENEFIT OF OTHERS. |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | SOUTHEAST HEALTH UPDATED ITS BYLAWS DURING THE YEAR TO REFLECT THE AFFILIATION AGREEMENT BETWEEN MERCY HEALTH, SOUTHEASTHEALTH SYSTEM, INC., SOUTHEAST HOSPITAL, AND SOUTHEASTHEALTH REPRESENTATIVE, LLC. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SOLE MEMBER IS SOUTHEASTHEALTH SYSTEM, INC., A RELATED ORGANIZATION. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | THE BOARD OF DIRECTORS OF SOUTHEAST HOSPITAL IS ELECTED AT THE ANNUAL MEETING OF THE MEMBER IN ACCORDANCE WITH THE MEMBER'S BYLAWS, WITH THE DIRECTORS TO BE ELECTED FROM THE SLATE OF CANDIDATES PREPARED BY THE MEMBER'S GOVERNANCE AND NOMINATING COMMITTEE. AMONG THE POWERS RESERVED TO THE MEMBER IS THE POWER TO ELECT, EVALUATE, AND REMOVE THE DIRECTORS OF THE CORPORATION, PROVIDED THAT SUCH REMOVAL REQUIRES TWO-THIRDS OR GREATER ACTION BY THE SYSTEM BOARD. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | THE MEMBER RESERVES ALL POWER, SUBJECT TO THE AUTHORITY OF SOUTHEAST HEALTH SYSTEM, INC. (SYSTEM) TO TAKE THE ACTIONS BELOW WITH RESPECT TO SOUTHEAST HOSPITAL: (1) ESTABLISH AND INTERPRET PHILOSOPHY, EXPECTATIONS, AND CORE VALUES OF THE CORPORATION AND THE CORPORATION'S SUBSIDIARIES; (2) ESTABLISH ANNUAL PERFORMANCE OBJECTIVES AND COMPENSATION FOR THE PRESIDENT/CEO OF THE CORPORATION AND THE PRESIDENT/CEOS OF THE CORPORATION'S SUBSIDIARIES; (3) ESTABLISH THE DEBT LIMITS OF, AND DEBT GUIDELINES FOR, THE CORPORATION AND THE CORPORATION'S SUBSIDIARIES; (4) SELECT THE AUDITOR FOR THE CORPORATION AND THE CORPORATION'S SUBSIDIARIES; (5) ESTABLISH GUIDELINES FOR TRANSFERRING OR ENCUMBERING ASSETS OF THE CORPORATION AND THE CORPORATION'S SUBSIDIARIES FINANCED USING TAX-EXEMPT BONDS; AND (6) ESTABLISH GUIDELINES FOR PROJECTS AND TRANSACTIONS WHICH MAY BE APPROVED BY THE CORPORATION OR THE CORPORATION'S SUBSIDIARIES; THE MEMBER FURTHER RESERVES THE POWER TO TAKE THE ACTIONS AS DESCRIBED BELOW WITH RESPECT TO SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY, PROVIDED, HOWEVER, THAT THE BOARD SHALL HAVE THE RIGHT TO MAKE RECOMMENDATIONS REGARDING SUCH ACTIONS WHICH THE MEMBER MAY TAKE INTO CONSIDERATION, BUT THE BOARD SHALL NOT HAVE THE POWER TO TAKE ANY OF THE FOLLOWING ACTIONS UNLESS DIRECTED TO DO SO BY THE MEMBER, AND FURTHER SUBJECT TO THE MEMBER'S AUTHORITY GRANTED BY THE SYSTEM: (1) ESTABLISH, MODIFY, AND INTERPRET MISSION AND VISION STATEMENTS FOR THE CORPORATION AND THE CORPORATION'S SUBSIDIARIES; (2) APPROVE THE FORMATION OR ACQUISITION OF LEGAL ENTITIES BY THE CORPORATION OR THE CORPORATION'S SUBSIDIARIES; (3) APPROVE THE SALE, TRANSFER, DISPOSITION OF, OR SUBSTANTIAL CHANGE TO THE USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR THE CORPORATION'S SUBSIDIARIES; (4) APPROVE A DIVESTITURE, MERGER, DISSOLUTION, REORGANIZATION, CLOSING, OR CONSOLIDATION INVOLVING THE CORPORATION OR THE CORPORATION'S SUBSIDIARIES; (5) APPROVE A CHANGE TO THE CORPORATE MEMBERSHIP OR OWNERSHIP OF THE CORPORATION OR THE CORPORATION'S SUBSIDIARIES; (6) ADOPT AND AMEND THE ARTICLES OF INCORPORATION, BYLAWS, ARTICLES OF ORGANIZATION, AND/OR OPERATING AGREEMENTS, AS APPLICABLE, OF THE CORPORATION AND THE CORPORATION'S SUBSIDIARIES; (7) ESTABLISH CORE COMPETENCIES FOR THE DIRECTORS OR MANAGERS (AS APPLICABLE) (8) ELECT, EVALUATE, AND REMOVE THE DIRECTORS OR MANAGERS (AS APPLICABLE) OF THE CORPORATION'S SUBSIDIARIES; (9) TRANSFER ASSETS AND REALLOCATE DEBT OF THE CORPORATION AND THE CORPORATION'S SUBSIDIARIES; AND (10) ESTABLISH POLICIES AND PROCEDURES, INCLUDING POLICIES FOR PROVIDER CREDENTIALING, QUALITY, AND PATIENT SAFETY (AS APPLICABLE), FOR THE CORPORATION AND THE CORPORATION'S SUBSIDIARIES. AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT AND MANAGEMENT. THE FORM 990 IS REVIEWED BY THE ACCOUNTING DEPARTMENT, LEGAL COUNSEL, AND MANAGEMENT AND IS THEN PROVIDED TO THE BOARD OF DIRECTORS AT A MEETING BEFORE FILING.. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT AND MANAGEMENT. THE FORM 990 IS REVIEWED BY THE ACCOUNTING DEPARTMENT, LEGAL COUNSEL, AND MANAGEMENT AND IS THEN PROVIDED TO THE BOARD OF DIRECTORS AT A MEETING BEFORE FILING. |
| Form 990, Part VI, Line 12c Conflict of interest policy | ALL TRUSTEES AND KEY EMPLOYEES (ADMINISTRATIVE STAFF) ARE REQUIRED TO READ THE ORGANIZATIONAL ETHICS STATEMENT ANNUALLY AND COMPLETE A CERTIFICATION STATEMENT TO THAT EFFECT. DIRECTORS, OFFICERS, MANAGERS AND KEY EMPLOYEES MUST DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST TO THE BOARD OF DIRECTORS. THE REMAINING DIRECTORS WILL DISCUSS AND VOTE UPON WHETHER A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST IS DETERMINED TO EXIST, THE CHAIRMAN SHALL APPOINT A DISINTERESTED DIRECTOR TO INVESTIGATE ALTERNATIVE OPTIONS FOR THE TRANSACTION/ARRANGEMENT IN QUESTION. IF A MORE ADVANTAGEOUS OPTION IS NOT AVAILABLE, A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WILL DETERMINE IF IT IS IN THE BEST INTEREST OF THE ORGANIZATION TO CONTINUE WITH THE TRANSACTION/ARRANGEMENT. IF A CONFLICT OF INTEREST HAS FAILED TO BE DISCLOSED, THE INTERESTED PARTY WILL BE NOTIFIED AND APPROPRIATE DISCIPLINARY ACTION WILL BE TAKEN AS NEEDED. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | DATA FROM TWO ORGANIZATIONS (MO HOSPITAL ASSOCIATION AND ANOTHER INDEPENDENT AGENCY) ARE USED FOR COMPARISON. RECOMMENDATIONS ARE MADE FROM THAT INFORMATION TO THE BOARD OF TRUSTEES, WHO THEN DETERMINE THE COMPENSATION FOR THE CEO. THE BOARD COMPLETES THIS REVIEW ANNUALLY. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | THE CEO AND VICE PRESIDENTS DETERMINE COMPENSATION FOR APPLICABLE KEY EMPLOYEES AND OTHER OFFICERS. HUMAN RESOURCES COMPILES EXTERNAL DATA FOR COMPARABLE AMOUNTS TO CONFIRM RATES ARE ADEQUATE. |
| Form 990, Part VI, Line 19 Required documents available to the public | COPIES OF THE SOUTHEAST HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FEDERAL FORM 990 ARE AVAILABLE AT THE ADMINISTRATIVE OFFICE UPON REQUEST. |
| Form 990, Part VII, Section A BOARD MEMBER COMPENSATION: | NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR ROLES AS BOARD MEMBERS. KENNETH BATEMAN RECEIVED COMPENSATION FOR HIS ROLE AS CEO. JAMIE HARRISON RECEIVED COMPENSATION FOR HER ROLE AS A FAMILY PRACTITIONER. |
| Form 990, Part VIII, Line 2f Other Program Service Revenue | OTHER REVENUE - Total Revenue: 2494262, Related or Exempt Function Revenue: 2343130, Unrelated Business Revenue: 151132, 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 - 5872873; CHANGE IN INTEREST IN RELATED PARTY - 404005; |
| Software ID: | 23017437 |
| Software Version: | 2023v5.1 |