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)
BENEFIS HOSPITALS INC |
810232122 | 3 | Yes | 0 | 69,398,988 | |
| (B)
BENEFIS HOSPITALS INC |
810232122 | 3 | Yes | 0 | 19,647,547 | |
| (C)
BENEFIS MEDICAL GROUP INC |
263538192 | 3 | Yes | 0 | 3,856,829 | |
| (D)
BENEFIS COMMUNITY CARE INC |
810431871 | 10 | Yes | 0 | 2,408,019 | |
| (E)
BENEFIS COMMUNITY CARE INC |
810431871 | 10 | Yes | 0 | 1,526,780 | |
| (F)
BENEFIS COMMUNITY HOSPITALS INC |
473448483 | 3 | Yes | 0 | 1,168,856 | |
| (G)
BENEFIS COMMUNITY HOSPITALS INC |
473448483 | 3 | Yes | 0 | 488,685 | |
|
Total 7
|
0 | 98,495,704 | ||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 2022 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-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART I, LINE 12G: | BENEFIS HOSPITALS, INC. MANAGEMENT FEE INCOME: $69,398,988 BENEFIS HOSPITALS, INC. HEALTH PLAN BENEFITS INCOME: $19,647,547 BENEFIS MEDICAL GROUP, INC. HEALTH PLAN BENEFITS INCOME $3,856,829 BENEFIS COMMUNITY CARE, INC. MANAGEMENT FEE INCOME: $2,408,019 BENEFIS COMMUNITY CARE, INC. HEALTH PLAN BENEFITS INCOME: $1,526,780 BENEFIS COMMUNITY HOSPITALS, INC. MANAGEMENT FEE INCOME: $1,168,856 BENEFIS COMMUNITY HOSPITALS, INC. HEALTH PLAN BENEFITS INCOME: $488,685 |
| PART IV, SECTION A, LINE 9C: | BENEFIS HEALTH SYSTEM, INC. AND TRUSTS, IRAS, AND A FAMILY MEMBER OF DIRECTORS ARE INVESTED IN A JOINT VENTURE ORGANIZED AS A PARTNERSHIP. SEE SCHEDULE L FOR MORE INFORMATION ON INTERESTS OVER 10%. |
| PART IV, SECTION E, LINE 3A: | BENEFIS HEALTH SYSTEM, INC. (BHS) SERVES AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH NEEDS OF PERSONS THROUGHOUT NORTH CENTRAL MONTANA. BHS HOLDS VARIOUS RESERVED POWERS IN RELATION TO EACH OF THE SUPPORTED ORGANIZATIONS, INCLUDING THE AUTHORITY TO ELECT ITS BOARD OF DIRECTORS. |
| PART IV, SECTION E, LINE 3B: | BHS PROVIDES CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES TO ITS SUPPORTED ORGANIZATIONS. BHS PROVIDES THESE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT OPERATING ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING: - MANAGEMENT OF HUMAN RESOURCES INCLUDING POLICIES, PRACTICES, AND BENEFITS - MANAGEMENT, PLANNING, BUDGETING AND REPORTING OF FINANCIAL OPERATIONS - MANAGEMENT OF BILLING AND COLLECTIONS POLICIES AND FUNCTIONS - MANAGEMENT OF INFORMATION TECHNOLOGY SERVICES - OVERSIGHT OF QUALITY STANDARDS, COMPLIANCE AND RISK MANAGEMENT - MANAGEMENT OF REGIONAL, COMMUNITY AND GOVERNMENT RELATIONS AND MARKETING - MANAGEMENT OF GRANTS DEVELOPMENT THE BOARD OF DIRECTORS OF BHS ALSO GENERALLY OVERSEES THE GOVERNANCE FUNCTIONS CARRIED ON BY THE BOARDS OF THE SUPPORTED ORGANIZATIONS. |
| PART IV, SECTION A, LINE 5A: | (I) BENEFIS COMMUNITY HOSPITAL, EIN 47-3448483 (II) BENEFIS COMMUNITY HOSPITAL IS A TAX-EXEMPT HOSPITAL ORGANIZATION WITHIN THE INTEGRATED SYSTEM THAT BENEFIS HEALTH SYSTEM IS A PARENT OF. (III) THE BOARD OF DIRECTORS OF BENEFIS HEALTH SYSTEM HAS THE AUTHORITY TO ADD, REMOVE OR SUBSTITUTE SUPPORTED ORGANIZATION TO ITS ARTICLES OF INCORPORATION. (IV) BENEFIS COMMUNITY HOSPITAL WAS ADDED AS A SUPPORTED ORGANIZATION TO THE ARTICLE OF INCORPORATION OF BENEFIS HEALTH SYSTEM. |
| 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 2 | CERTAIN OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. SUCH BUSINESS RELATIONSHIPS ARE UNDERTAKEN IN THE ORDINARY COURSE OF BUSINESS. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE ARTICLES OF INCORPORATION WERE AMENDED TO LIST BENEFIS COMMUNITY HOSPITALS AS A SUPPORTED ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 INCLUDING SCHEDULE B WAS MADE AVAILABLE TO ALL MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS AND WAS PRESENTED TO THE BHS BOARD BY THE ACCOUNTING FIRM. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND VOTING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE SENIOR EXECUTIVE TEAM WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES AND MANAGERS WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILAR SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. |
| FORM 990, PART VI, SECTION C, LINE 19 | BENEFIS HEALTH SYSTEM, INC. PROVIDES COPIES OF AUDITED FINANCIAL STATEMENTS AND FORM 990 TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. |
| FORM 990, PART XI, LINE 9: | GAIN/LOSS ON INTEREST RATE SWAP AGREEMENT 2,441,437. BOOK/TAX DIFFERENCE IN SUBSIDIARY AND JV INCOME 33,726. |
| FORM 990, BOX B - AMENDED RETURN STATEMENT | IN 2022, THE FILING ORGANIZATION REPORTED AN ESTIMATE OF UNRELATED DEBT FINANCED INCOME. UDFI WAS NOT AVAILABLE BEFORE THE FILING DATE AND THE ORGANIZATION FILED WITH AN ESTIMATE USING MOST CURRENT INVESTMENT INFORMATION. AS A RESULT, UNRELATED BUSINESS INCOME WAS UNDERSTATED. THE AMENDED RETURN CORRECTS UDFI FOR INVESTMENT ACTIVITES (SEQUENCE 3). THE FOLLOWING SECTIONS WERE UPDATED ON THE AMENDED 990 RETURN: - PART I, LINE 7A AND 7B HAVE BEEN UPDATED TO REFLECT CORRECT UNRELATED BUSINESS REVENUE AND UNRELATED TAXABLE INCOME. - PART VIII, LINE 11C, COLUMN C AND D HAVE BEEN UPDATED TO REFLECT THE CORRECT ALLOCATED INCOME FOR EACH COLUMN DUE TO CHANGE IN UBI. |
| Software ID: | |
| Software Version: |