2024-07-15T16:49:57-05:00 2023-08-31 346565596 Ernst & Young US LLP 221 E 4th Street Suite 2900 Cincinnati OH 45202 990 2022-09-01 472893430 Baptist Health Deaconess Madisonville Foundation Inc BAPT 2703266133 900 Hospital Drive Madisonville KY 42431 Alisa Coleman President 2703266133 2024-07-15 1 Alisa Coleman 999009999 0 Julie L Sparks P01268401 5136121400 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X Alisa Coleman 900 Hospital Drive Madisonville KY 42431 718305 0 X www.baptisthealthdeaconess.com X 2014 KY See Schedule O. 20 19 1 15 0 0 1591549 681285 0 0 38015 37020 0 0 1629564 718305 230618 416477 0 0 237808 201929 0 0 68893 69502 81392 537928 699798 1091636 18507 3369018 3880461 210839 1129239 3158179 2751222 X To assist, advance, strengthen & support Baptist Health Deaconess Madisonville, Inc. hospital in its mission & ministry of continuing our Christian heritage of service by enhancing the health of the people & communities we serve. 0 0 508997 416477 See Schedule O 508997 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 KY X Richard F Carrico 5028965000 1901 Campus Place Louisville KY 40299 X Alisa Coleman Pres & Dir (Effective 1/19/23)) 1.00 0.00 X X 0 0 0 Beth Oldham Director 1.00 0.00 X 0 0 0 Cheri McNary Director (Effective 1/19/23) 1.00 0.00 X 0 0 0 Chuck Shockley Director 1.00 0.00 X 0 0 0 Daniel Mercer Director (Effective 1/19/23) 1.00 0.00 X 0 0 0 David Lamb Director 1.00 0.00 X 0 0 0 Devi Thorp Director 1.00 0.00 X 0 0 0 Gerard Colman Director (Through 4/28/23) 1.00 0.00 X 0 0 0 James M Fellows MD Director 1.00 0.00 X 0 0 0 Jason Vincent Vice Chair & Dir (Effective 1/19/23) 1.00 0.00 X X 0 0 0 Joe Collins Director (Through 12/31/22) 1.00 0.00 X 0 0 0 Kara Foster Director 1.00 0.00 X 0 0 0 Kenneth Allen Director (Through 12/31/22) 1.00 0.00 X 0 0 0 Lynn Lingafelter Director (Through 5/1/23) 1.00 0.00 X 0 0 0 Mary Badgett Ashby Director 1.00 0.00 X 0 0 0 Mary Chandler Director (Through 12/31/22) 1.00 0.00 X 0 0 0 Mary Susan Fishman Vice Chair & Dir (Through 12/31/22) 1.00 0.00 X X 0 0 0 Megan Chaney Director 1.00 0.00 X 0 0 0 Molly Deahl Director (Effective 7/20/23) 1.00 0.00 X 0 0 0 Nan Nance Director (Effective 1/19/23) 1.00 0.00 X 0 0 0 Patrick Falvey Director 1.00 0.00 X 0 0 0 Penelope Metcalfe Director 1.00 0.00 X 0 0 0 R Steven Cox Chair & Dir (Through 12/31/22) 1.00 0.00 X X 0 0 0 Rev Ken Hundley Director 1.00 0.00 X 0 0 0 Robert Ramey Pres & Dir (Through 12/16/22) 1.00 0.00 X X 0 592760 23525 Ron Sanders Director (Effective 4/20/23) 1.00 0.00 X 0 0 0 Sarah Fisher MD Director 1.00 40.00 X 0 594774 10489 Shawn McCoy Director (Through 5/1/23) 1.00 0.00 X 0 0 0 Terry Faulk Douglass Chair (Effective 1/19/23) & Dir 1.00 0.00 X X 0 0 0 Ashley Galvan Asst. Sec (Effective 8/9/23) 40.00 0.00 X 0 63545 910 Janet M Norton Secretary 1.00 0.00 X 0 0 0 Kaytlen Dame Asst. Sec (Through 8/8/23) 40.00 0.00 X 0 43160 9551 Richard F Carrico Treasurer (Effective 2/8/23) 1.00 0.00 X 0 0 0 Stephen R Oglesby Treasurer (Through 1/6/23) 1.00 0.00 X 0 0 0 Valarie Howard Asst. Treasurer 1.00 40.00 X 0 130234 5700 Kim Ashby Former Treasurer (Through 2/2018) 0.00 40.00 X 0 258205 10779 0 1682678 60954 0 1 1 0 0 289633 391652 681285 28044 28044 8976 0 8976 8976 8976 718305 0 0 37020 416477 416477 162841 61065 61065 40711 2819 1057 1057 705 24237 9089 9089 6059 12032 4512 4512 3008 10395 10395 23457 3519 14699 5239 8551 2505 4886 1160 9626 5259 4367 Stewardship & Cultivati 14025 2014 12011 Administrative Expense 11385 2793 8592 Purchased Services 2250 2250 Other Expenses 1703 707 996 699798 508997 121908 68893 1428852 1542962 444630 424241 220508 12460 1274403 1899773 1025 1025 -400 0 3369018 3880461 210839 1129239 210839 1129239 X 1655540 1327593 1502639 1423629 3158179 2751222 3369018 3880461 X 18507 98744 -524208 X 0 1 X 1 0 X X X 1 Baptist Health Deaconess Madisonville Inc 610654587 3 1 416477 0 1 416477 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Schedule A, Part IV, Section B, Line 1 The power to appoint and/or remove directors or trustees rests solely with Baptist Health Deaconess Madisonville, Inc., the sole member of Baptist Health Deaconess Madisonville Foundation, Inc. Schedule A, Part IV, Section B, Line 2 The Baptist Health Deaconess Madisonville Foundation supports Baptist Health Deaconess Madisonville, Inc., by assisting, advancing and strengthening the hospital. In doing this, the foundation is also carrying out the mission and purposes of Baptist Health Deaconess Madisonville, Inc. the sole member of Baptist Health Deaconess Madisonville Foundation, Inc. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 Due to Affiliate 1129239 1129239 X Part X, Line 2: From the Baptist Health Deaconess, LLC. consolidated financial statements that include this filing organization: Baptist Health Deaconess, LLC. evaluates its uncertain tax positions on an annual basis. A tax benefit from an uncertain position may be recognized when it is more likely than not that the position will be sustained upon examination, including the resolution of any related appeals or litigation processes, based on the technical merit of the position. Baptist Health Deaconess, LLC. has determined that it has no uncertain tax positions that are required to be recorded as of August 31, 2023. As Baptist Health Deaconess, LLC. started operations September 1, 2021, 2022 and 2023 are the only tax years that are open. 1 Baptist Health Deaconess Madisonville Inc 900 Hospital Drive Madisonville KY 42431 610654587 501(c)(3) 416477 0 Purchase of supplies and funding of patient care and assistance programs. 1 0 Part I, Line 2: Baptist Health Deaconess Madisonville Foundation provides only direct contributions and other general support; therefore, no monitoring of charitable contributions is performed. 0 0 0 0 0 0 1 0 0 Robert Ramey Pres & Dir (Through 12/16/22) 0 447984 0 133154 0 11622 0 12200 0 11325 0 616285 0 0 Sarah Fisher MD Director 0 396182 0 182220 0 16372 0 0 0 10489 0 605263 0 0 Kim Ashby Former Treasurer (Through 2/2018) 0 237525 0 15868 0 4812 0 9501 0 1278 0 268984 0 0 Part I, Line 3 Baptist Health Deaconess LLC, a related organization of Baptist Health Deaconess Madisonville Foundation, Inc., used the following to establish the compensation of the organization's President (through 12/16/2022): - Compensation committee, - Independent compensation consultant, - Form 990 of other organizations, - Written employment contract, - Compensation survey or study, and - Approval by the Board or Compensation committee Part I, Line 6 Compensation Contingent Upon Net Earnings: Incentive compensation payments made by a related organization are based upon the successful achievement of established inpatient satisfaction measures, outpatient satisfaction measures, compliance with publicly reported quality indicators, operating margin as well as other technical and personal functional goals of both the organization and related organizations. The incentive compensation programs are formulated to reward behavior that balances patient needs and the efficient delivery of patient care to ensure the best outcomes are achieved. Form 990, Part I, Line 1, Description of Organization Mission: To assist, advance, strengthen and support Baptist Health Deaconess Madisonville, Inc., its sole member, in its mission and ministry to continue our Christian heritage of service by enhancing the health of the people and communities we serve by fostering partnerships to further enhance the quality medical care provided by the hospital. Form 990, Part III, Line 4a, Description of Program Service: Baptist Health Deaconess Madisonville Foundation, Inc. is a non-profit, non-stock corporation which operates to encourage, solicit and receive donations, bequests, gifts and benefactions made to or for the benefit of Baptist Health Deaconess Madisonville, Inc., an entity that is described under section 501(c)(3) and is classified under Section 509(A)(1) as a public charity. Baptist Health Deaconess Madisonville Foundation is operated exclusively for the benefit of, to perform the functions of, and to carry out the purpose of Baptist Health Deaconess Madisonville, Inc. Through 8/31/2021, Baptist Health Deaconess Madisonville Foundation, Inc. was 100% owned and operated by Baptist Healthcare System, Inc. Effective 9/1/2021, Baptist Healthcare System, Inc. and Deaconess Health Kentucky, Inc. formed the joint venture Baptist Health Deaconess, LLC. which owns Baptist Health Deaconess Madisonville, Inc. hospital and Baptist Health Deaconess Medical Group, Inc. which operates physician practices and outpatient clinics. Through this joint venture, Baptist Healthcare System, Inc. and Deaconess Health Kentucky, Inc. bring capital and expertise that will provide enhanced health care services to the Madisonville community. The mission of the foundation to support the Madisonville hospital remains unchanged. Part V, Line 2B All employment taxes for the employees reported on Line 2A were reported under a common paymaster. The employment tax returns were filed and the taxes were paid by Baptist Health Deaconess Madisonville, Inc. (61-0654587). Form 990, Part VI, Section A, line 6 The organization's sole member is Baptist Health Deaconess Madisonville, Inc. (EIN: 61-0654587), a non-profit, tax-exempt 501(c)(3) entity organized under and pursuant to the provisions of the laws of the Commonwealth of Kentucky. Form 990, Part VI, Section A, line 7a Baptist Health Deaconess Madisonville, Inc., the sole member, has the authority to appoint the Board members for Baptist Health Deaconess Madisonville Foundation, Inc. Form 990, Part VI, Section A, line 7b The consent and approval of the sole member, Baptist Health Deaconess Madisonville, Inc., shall be required for all major corporate actions, and any act the result of which would be to: 1) amend, repeal or alter the Articles of Incorporation or Bylaws; 2) merge or consolidate or agree to merge or consolidate the corporation with or into any organization; 3) liquidate, reorganize or recapitalize the corporation; 4) create or incur any indebtedness which exceeds $50,000; 5) make any capital expenditure which exceeds $50,000; 6) authorize the execution of any contract, agreement or similar instrument by which the corporation may be obligated to pay more than $50,000 in any year; 7) other than acquiring marketable securities held for investment purposes, acquire the stock of any corporation or invest in or acquire an interest in any business enterprise; 8) sell or agree to sell or otherwise dispose of all or a substantial part of the assets of the corporation or any investment or interest in any business enterprise, other than marketable securities disposed of in the ordinary course of the corporation's activities; 9) adopt the corporation's annual operating budget and capital expenditures budget; 10) accept any gift that requires the corporation or the Member to match funds, carry out substantial new activities in connection with the gift, or that is made subject to restrictions that are not clearly consistent with the corporation's charitable purpose or with the Member's mission; 11) accept any gift of real property; 12) accept any gift that requires the corporation to assume indebtedness; 13) make any gift or contribution to any organization other than the Member -unless such gift or contribution is approved by the Member or is consistent with guidelines established by the Member; 14) adopt investment guidelines or select a fund manager. Form 990, Part VI, Section B, line 11b The internally prepared Form 990 is reviewed by an outside accounting firm. The governing body receives an electronic copy of the Form 990, including all required schedules, prior to filing with the IRS. Any questions are addressed by explanation or a change to the form. Form 990, Part VI, Section B, line 12c Annually the Secretary of Baptist Health Deaconess LLC. sends out a Conflict of Interest questionnaire to each of the officers and directors serving on the Board of Baptist Health Deaconess Madisonville Foundation. After completion, they are returned to the secretary and reviewed by the Board or the Governance Effectiveness Committee for any potential conflicts. A conflict of interest is any circumstance, relationship (financial or otherwise), activity or decision (made in the course of governance, management or professional responsibilities or otherwise) that adversely influences or appears to adversely influence the ability of a covered person to: 1) make objective decisions on behalf of Baptist Health Deaconess Madisonville Foundation and/or 2) act in the best interests of Baptist Health Deaconess Madisonville Foundation in a manner consistent with the tax-exempt purposes of Baptist Health Deaconess Madisonville Foundation. The Board or Committee will determine by a majority vote of disinterested directors whether the disclosed financial or special interest may result in a conflict of interest. Form 990, Part VI, Section B, line 15 Officers of Baptist Health Deaconess Madisonville Foundation, Inc. are not employees of Baptist Health Deaconess Madisonville Foundation, Inc. nor are they compensated by Baptist Health Deaconess Madisonville Foundation, Inc. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part VII Officers of Baptist Health Deaconess Madisonville Foundation, Inc. provided services to Baptist Health Deaconess Madisonville, Inc. during the fiscal year. Hours worked are not tracked on an entity by entity basis. Therefore, all officers and directors' hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees and Independent Contractors represent aggregate hours worked per week for all entities. Form 990, Part XI, line 9: Balance Sheet Transfer -2,086. Unrestricted Capital -496,659. Other Change -25,463. Baptist Health Deaconess Madisonville Inc 900 Hospital Drive Madisonville KY 42431 610654587 Hospital KY 501(c)(3) Line 3 BHD LLC 1 Baptist Health Deaconess Medical Group Inc 900 Hospital Drive Madisonville KY 42431 863269008 Physician Services KY 501(c)(3) Line 3 BHD LLC 1 Baptist Health Deaconess LLC 900 Hospital Drive Madisonville KY 42431 862361058 Management KY N/A N/A 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Baptist Health Deaconess Madisonville Inc C 289633 Cash Baptist Health Deaconess Madisonville Inc B 416477 Cash