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)
BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER |
470379834 | 3 | Yes | 257,606 | 0 | |
| (B)
BLUE RIVERS AREA AGENCY ON AGING |
470555810 | 7 | No | 20,000 | 0 | |
| (C)
GOOD SAMARITAN SOCIETY |
450228055 | 9 | No | 5,400 | 0 | |
|
Total 3
|
283,006 | 0 | ||||
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 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) 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)
![]() |
(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) |
||||
| 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 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. |
||||
| 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) |
||||
| 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. |
||||
|
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. |
||||
|
7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
||||
| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part IV, Section A, Line 1 Supported Orgs Listed By Name | THE TAXPAYER'S SUPPORTED ORGANIZATIONS ARE DESIGNATED BY CLASS OR PURPOSE IN THE TAXPAYER'S RESTATED ARTICLES OF INCORPORATION. THEY ARE ORGANIZATIONS WHOSE PRIMARY PURPOSE OR FUNCTION ARE TO PROVIDE HEALTHCARE RELATED SERVICES OR TO SUPPORT AND PROMOTE THE PROVISION OF HEALTHCARE RELATED SERVICES AND HEALTHCARE ACCESS AND QUALITY AS OUTLINED IN THE TAXPAYER'S ARTICLES OF INCORPORATION. PURSUANT TO THE TAXPAYER'S ARTICLES OF INCORPORATION THE ORGANIZATIONS DESCRIBED IN SECTIONS 509(A)(1) AND 509(A)(2) OF THE CODE THAT THE TAXPAYER SUPPORTS INCLUDE THE FOLLOWING TWO GROUPS: - ONE GROUP CONSISTS ONLY OF BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER, WHICH IS THE ORGANIZATION THAT OPERATE, SUPERVISE, OR CONTROL THE TAXPAYER FOR PURPOSES OF SECTION 509(A)(3)(B)(I) OF THE CODE. - THE OTHER GROUP CONSISTS OF ALL PUBLIC CHARITIES THAT ARE CLOSELY RELATED IN PURPOSE OR FUNCTION TO THE HOSPITAL IN TERMS OF THE DELIVERY AND THE SUPPORT AND PROMOTION OF HEALTHCARE. THIS GROUP INCLUDES ESSENTIALLY ALL PUBLIC CHARITIES WITH A HEALTHCARE FOCUS THAT OPERATE IN THE AREA WHICH WAS SERVED BY BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER, I.E., IN OR NEAR BEATRICE, NEBRASKA (THE SERVICE AREA). |
| Schedule A, Part IV, Section A, Line 5a Added, Substituted, or Removed Sup. Org. | THE SECOND GROUP IS DEFINED BROADLY IN THE TAXPAYER'S RESTATED ARTICLES OF INCORPORATION THAT ITS PRACTICAL EFFECT IS TO INCLUDE ALL PUBLIC CHARITIES WITH A HEALTHCARE FOCUS THAT OPERATE IN THE SERVICE AREA. THE NATURE OF THE TAXPAYER'S ACTIVITIES IS SUCH THAT IT MAY VARY THE AMOUNT OF SUPPORT IT PROVIDES TO A PARTICULAR SUPPORTED ORGANIZATION IN THIS SECOND GROUP FROM YEAR TO YEAR. FOR EXAMPLE, IN SOME YEARS A SUPPORTED ORGANIZATION MAY RECEIVE A GRANT THAT IS INTENDED TO PROVIDE SUPPORT FOR MORE THAN A YEAR. THUS, THE ORGANIZATION MAY NOT RECEIVE ANOTHER GRANT FROM THE TAXPAYER FOR ONE OR MORE YEARS FOLLOWING THE YEAR THAT THE MULTI-YEAR GRANT WAS MADE. HOWEVER, IT DOES NOT MEAN THAT THE ORGANIZATION HAS BEEN REMOVED OR SUBSTITUTED AS A SUPPORTED ORGANIZATION BY THE TAXPAYER. IN THE EVENT A SUPPORTED ORGANIZATION IS ADDED, SUBSTITUTED, OR REMOVED BY THE TAXPAYER, THERE MAY BE A NUMBER OF REASONS WHY THIS OCCURS. THE REASONS INCLUDE A SHIFT IN THE HEALTHCARE NEEDS OF INDIVIDUALS LIVING IN THE AREA SERVED BY THE TAXPAYER, THE SUPPORTED ORGANIZATION NO LONGER PROVIDES SUCH SERVICES OR GOES OUT OF EXISTENCE, ANOTHER SUPPORTED ORGANIZATION IS MORE EFFECTIVE IN PROVIDING SUCH SERVICES, OR FOR OTHER SIMILAR REASONS, WITH SOME OF THE REASONS OUT OF THE CONTROL OF THE TAXPAYER. |
| Schedule A, Part IV, Section B, Line 2 Benefit Of Supp. Org. Other Than The One Operating The Org. | AS DISCUSSED IN PART IV, SECTION A, ITEM 1, THE TAXPAYER SUPPORTS TWO GROUPS OF SECTION 509(A)(1) AND 509(A)(2) ORGANIZATIONS DESCRIBED AS FOLLOWS: - ONE GROUP IS the Beatrice Community Hospital and Health Center THAT OPERATE, SUPERVISE, OR CONTROL THE TAXPAYER FOR PURPOSES OF SECTION 509(A)(3)(B)(I) OF THE CODE (I.E., THE CONTROLLING entity). - THE OTHER GROUP CONSISTS OF PUBLIC CHARITIES THAT ARE CLOSELY RELATED IN PURPOSE OR FUNCTION TO THE Beatrice Community Hospital and Health Center IN TERMS OF THE DELIVERY AND THE SUPPORT AND PROMOTION OF HEALTHCARE AND HEALTHCARE ACCESS AND QUALITY AS OUTLINED IN THE TAXPAYER'S ARTICLES OF INCORPORATION. THIS GROUP INCLUDES ESSENTIALLY PUBLIC CHARITIES WITH A HEALTHCARE FOCUS THAT OPERATE IN THE SERVICE AREA. THE TAXPAYER MAKES GRANTS TO THE SUPPORTED ORGANIZATIONS DESCRIBED IN THE SECOND GROUP THAT ARE TO BE USED TO HELP SUCH SUPPORTED ORGANIZATIONS ACCOMPLISH THEIR CHARITABLE PURPOSES. THE ACTIVITIES OF THE SUPPORTED ORGANIZATIONS IN THIS GROUP ARE CLOSELY RELATED IN PURPOSE OR FUNCTION TO Beatrice Community Hospital and Health Center. |
| Software ID: | 23017437 |
| Software Version: | 2023v6.0 |
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | DON HARMON, PATTY KAUFMAN, MITCHELL DEINES, STEVE SANDMAN, AND DEANNE CASPERS-MOON - Business relationship |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | THE BCH FOUNDATION SUBMITS NOMINEES FOR ELECTION TO THE FOUNDATION BOARD FOR APPROVAL TO THE BEATRICE COMMUNITY HOSPITAL'S BOARD OF DIRECTORS. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | THE BOARD OF DIRECTORS OF BEATRICE COMMUNITY HOSPITAL FOUNDATION, INC. IS REQUIRED TO OBTAIN THE APPROVAL OF BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER, WITH REGARD TO THE FOLLOWING: - SELECTION AND EMPLOYMENT OF THE EXECUTIVE DIRECTOR - CHANGES TO THE GENERAL MISSION STATEMENTS OF BEATRICE COMMUNITY HOSPITAL FOUNDATION, INC., AS TO THE DEVELOPMENT OF NEW SERVICES OR ACTIVITIES OR THE ACQUISITION OF DISPOSITION OF CAPITAL ASSETS - ENTERING INTO ANY COOPERATIVE ARRANGEMENTS OF JOINT VENTURES WITH ANY OTHER PARTY - AMENDMENTS TO THE BYLAWS - APPROVAL OF THE ANNUAL BUDGET |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTANT SELECTED BY THE BOARD OF DIRECTORS. UPON COMPLETION OF THE PREPARATION, A DRAFT FORM 990 IS PROVIDED TO THE BCH FOUNDATION SENIOR EXECUTIVE AND THE BCH CFO FOR REVIEW. ONCE REVIEWED THE FORM 990 IS PRESENTED TO THE BCH FOUNDATION FINANCE/EXECUTIVE COMMITTEE FOR REVIEW, AND FINALLY PRESENTED TO THE FULL BCH FOUNDATION BOARD OF DIRECTORS FOR APPROVAL. ONLY AFTER THE BOARD'S FINAL APPROVAL IS THE FORM 990 SIGNED AND FILED WITH THE IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | BEATRICE COMMUNITY HOSPITAL FOUNDATION BOARD MEMBERS ARE REQUIRED TO ANNUALLY REVIEW THE CONFLICT OF INTEREST POLICY AND SUBMIT A SIGNED FORM STATING ANY POTENTIAL CONFLICTS OF INTEREST. THE FORMS ARE REVIEWED AND INITIALED BY THE BCH FOUNDATION SENIOR EXECUTIVE AND KEPT ON FILE WITH BCH ADMINISTRATIVE ASSISTANT. IF A CONFLICT SHOULD ARISE, THE AFFECTED BOARD MEMBER WILL BE EXCUSED FROM THE DISCUSSION AND/OR VOTE. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | Compensation of the organization's top management official was conducted by the CEO of the supporting agency through support from the Human Resources Department and their ability to run comparable data for similar positions. This process was last undertaken in 2024. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST THROUGH THE BHC FOUNDATION SENIOR EXECUTIVE. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | CHANGE IN BENEFICIAL INTEREST IN TRUST - 6505; |
| FORM 990, PART VI, LINE 15A & 15B - PROCESS TO ESTABLISH COMPENSATION | THE BEATRICE COMMUNITY HOSPITAL FOUNDATION HAS THREE STAFF MEMBERS: A SENIOR EXECUTIVE, AN ADMINISTRATIVE AND ANNUAL GIVING COORDINATOR AND A SPECIAL EVENTS AND DEVELOPMENT COORDINATOR. ALL ARE EMPLOYEES OF BEATRICE COMMUNITY HOSPITAL, INC (BCH). COMPENSATION IS SET BY THE HUMAN RESOURCE DEPARTMENT OF BCH. ANNUALLY, THE ADMINISTRATIVE AND ANNUAL GIVING COORDINATOR AND THE SPECIAL EVENTS AND DEVELOPMENT COORDINATOR RECEIVE A PERFORMANCE REVIEW BY THE SENIOR EXECUTIVE. ANNUALLY, THE SENIOR EXECUTIVE RECEIVES A PEFORMANCE REVIEW BY CEO OF BCH, WITH INPUT FROM THE BCH FOUNDATION BOARD OF DIRECTORS. THE SENIOR EXECUTIVE COMPENSATION IS APPROVED BY A VOTE OF THE BCH FOUNDATION BOARD OF DIRECTORS UPON HIRE. |
| FORM 990, PART XI, LINE 2C | THE BOARD OF DIRECTORS SELECTS THE INDEPENDENT ACCOUNTANT AND HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. UPON COMPLETION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, LINE 14 | BEATRICE COMMUNITY HOSPITAL FOUNDATION, INC. FOLLOWS THE HOSPITAL'S POLICY. |
| Software ID: | 23017437 |
| Software Version: | 2023v6.0 |