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ObjectId: 201411909349300106 - Submission: 2014-07-09
TIN: 61-0444707
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
Attach to Form 990.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public Inspection
Name of the organization
Baptist Healthcare System Inc
Employer identification number
61-0444707
Part I
Identification of Disregarded Entities
(Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
(1)
Purchase Health Quality Collaborative
2501 Kentucky Avenue
Paducah
,
KY
42001
45-4290974
Phys Ntwrk
KY
596,887
0
BHSI
Part II
Identification of Related Tax-Exempt Organizations
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Baptist Health Madisonville Inc
900 Hospital Dr
Madisonville
,
KY
42431
61-0654587
Hospital
KY
501(c)(3)
3
BHSI
Yes
(2)
Baptist Health Richmond Inc
PO Box 1600
Richmond
,
KY
40476
61-0461940
Hospital
KY
501(c)(3)
3
BHSI
Yes
(3)
Baptist Health Foundation Richmond Inc
PO Box 1600
Richmond
,
KY
40476
31-1506378
Fundraising
KY
501(c)(3)
11a
BHR
Yes
(4)
Pattie A Clay Hospital Auxiliary
PO Box 1600
Richmond
,
KY
40476
51-0172717
Support
KY
501(c)(3)
11a
BHR
Yes
(5)
Baptist Physicians Southeast Inc
2701 Eastpoint Parkway
Louisville
,
KY
40223
26-0766344
Phys SRVCS
KY
501(c)(3)
Line 3
BHSI
Yes
(6)
Western Baptist Medical Ventures Inc
2701 Eastpoint Parkway
Louisville
,
KY
40223
61-1194899
Phys SRVCS
KY
501(c)(3)
Line 3
BHSI
Yes
(7)
Baptist Healthcare Foundation Inc
2701 Eastpoint Parkway
Louisville
,
KY
40223
31-1122867
Fundraising
KY
501(c)(3)
Line 11a
BHSI
Yes
(8)
Baptist Hlth Fnd of Grt Louisville Inc
4000 Kresge Way
Louisville
,
KY
40207
20-0292291
Fundraising
KY
501(c)(3)
Line 11a
BHSI
Yes
(9)
Baptist Health Foundation Lexington Inc
1740 Nicholasville Rd
Lexington
,
KY
40503
61-1480774
Fundraising
KY
501(c)(3)
Line 11a
BHSI
Yes
(10)
Lexington Cardiac Research Fnd Inc
1740 Nicholasville Rd
Lexington
,
KY
40503
20-4242792
Med research
KY
501(c)(3)
Line 11a
BHSI
Yes
(11)
Baptist Health Foundation Paducah Inc
2501 Kentucky Ave
Paducah
,
KY
42003
26-4057759
Fundraising
KY
501(c)(3)
Line 11a
BHSI
Yes
(12)
Mercy Reg Emergency Med Sys LLC
126 Lone Oak Rd
Paducah
,
KY
42001
61-1310466
Amb SRVCS
KY
501(c)(3)
Line 11a
BHSI
Yes
(13)
Baptist Healthcare Affiliates Inc
2701 Eastpoint Parkway
Louisville
,
KY
40223
61-1226399
HOSPITAL
KY
501(C)(3)
LINE 3
BHSI
Yes
(14)
Baptist Community Health Services Inc
2701 Eastpoint Parkway
LOUISVILLE
,
KY
40223
61-1141242
MEDICAL SVCS
KY
501(C)(3)L
LINE 11A
BHSI
Yes
(15)
Baptist Medical Associates Inc
2701 Eastpoint Parkway
LOUISVILLE
,
KY
40223
20-5497203
PHYSCN SVCS
KY
501(C)(3)
LINE 3
BHSI
Yes
(16)
Baptist Physicians Lexington Inc
2701 Eastpoint Parkway
LOUISVILLE
,
KY
40223
20-5494939
PHYSCN SVCS
KY
501(C)(3)
LINE 3
BHSI
Yes
(17)
Medical Center Ambulance Services Inc
629 Lafoon Street
MADISONVILLE
,
KY
42431
61-0946210
AMBLNC SVCS
KY
501(C)(3)
LINE 9
N/A
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Page 2
Schedule R (Form 990) 2012
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code VUBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
Muhlenberg Medical Center
200 Clinic Dr
Madisonville
,
KY
42431
20-0108053
Rental
KY
BMMSI
UNRELATED
No
No
19.350 %
(2)
Baptist Physicians' Surgery Center LLC
1720 Nicholasville Rd 101
Lexington
,
KY
40503
04-3665929
AMBULATORY SRGRY
KY
BCHS
RELATED
No
No
(3)
Baptist Eastpoint Surgery Center LLC
2400 Eastpoint Parkway
Louisville
,
KY
40223
26-0834852
AMBULATORY SRGRY
KY
BCHS
RELATED
No
No
(4)
Medical Associates of Middletown LLC
4000 Kresge Way
Louisville
,
KY
40207
20-0399400
MDCL OFFICE BLDG
KY
BHSI
RELATED
No
No
(5)
PETCT Management LLC
7807 Shelbyville Rd Ste 201
Louisville
,
KY
40222
20-0154982
MGMT AND EQPMNT
KY
BHSI
RELATED
No
No
(6)
St Matthews Surgery Center LLC
4130 Dutchmans Lane Ste 200
Louisville
,
KY
40207
45-3714318
AMBULATORY SRGRY
KY
BCHS
RELATED
No
No
(7)
Baptist EastMilestone LLC
750 Cypress Station Dr
LOUISVILLE
,
KY
40207
61-1355065
FITNESS CENTER
KY
BAPT VNTRS INC
EXCLUDED
No
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Mutual Credit Services Inc
PO Box 149
Madisonville
,
KY
42431
61-0660705
Collection agency
KY
BHSI
C Corp
No
(2)
Baptist Medical Management Services Inc
900 Hospital Drive
Madisonville
,
KY
42431
37-1519513
HC MSO
KY
BHSI
C Corp
No
(3)
Bluegrass Family Health Inc
651 Perimeter Park Ste 300
Lexington
,
KY
40517
61-1241101
Insurance
KY
BHSI
C CORP
No
(4)
Baptist Ventures Inc
2701 Eastpoint Parkway
LOUISVILLE
,
KY
40223
61-1217018
MANAGEMENT
KY
BHSI
C CORP
100.000 %
No
(5)
Baptist Health Network Inc
4000 Kresge Way
LOUISVILLEK
,
KY
40207
27-2939694
ACO
BHSI
C CORP
100.000 %
No
(6)
Regional Surgical Alliance LLC
900 Hospital Drive
MADISONVILLE
,
KY
42431
HEALTHCARE SVCS
KY
BHSI
C CORP
100.000 %
No
Schedule R (Form 990) 2012
Page 3
Schedule R (Form 990) 2012
Page
3
Part V
Transactions With Related Organizations
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest
(ii)
annuities
(iii)
royalties or
(iv)
rent from a controlled entity
.
.
.
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1a
Yes
b
Gift, grant, or capital contribution to related organization(s)
.
.
.
.
.
.
.
.
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1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
.
.
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1c
Yes
d
Loans or loan guarantees to or for related organization(s)
.
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1d
Yes
e
Loans or loan guarantees by related organization(s)
.
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1e
No
f
Dividends from related organization(s)
.
.
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1f
g
Sale of assets to related organization(s)
.
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1g
No
h
Purchase of assets from related organization(s)
.
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1h
No
i
Exchange of assets with related organization(s)
.
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1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.
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1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
.
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1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.
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1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.
.
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1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
.
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1n
No
o
Sharing of paid employees with related organization(s)
.
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.
1o
No
p
Reimbursement paid to related organization(s) for expenses
.
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.
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
.
.
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.
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1q
Yes
r
Other transfer of cash or property to related organization(s)
.
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1r
Yes
s
Other transfer of cash or property from related organization(s)
.
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1s
Yes
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
Baptist Ventures Inc
a
52,911
Cost
(2)
Baptist Health Foundation of Greater Louisvil
b
506,760
Cost
(3)
Baptist Health Foundation Paducah
c
149,235
cost
(4)
Baptist Health Foundation of Greater Louisvil
c
2,692,648
cost
(5)
Baptist Ventures Inc
d
97,388
cost
(6)
Baptist Community Health Services Inc
j
2,631,276
cost
(7)
Baptist Physicians Lexington Inc
j
1,163,674
cost
(8)
Baptist Medical Associates Inc
j
2,043,933
cost
(9)
PETCT Management LLC
p
1,061,896
cost
(10)
Baptist Medical Associates Inc
p
7,862,663
cost
(11)
Baptist Healthcare Affiliates Inc
k
137,467
cost
(12)
Baptist Community Health Services Inc
q
2,720,577
cost
(13)
Baptist Physicians Lexington Inc
q
3,997,744
cost
(14)
Western Baptist Medical Ventures Inc
q
182,906
cost
(15)
Baptist Healthcare Affiliates Inc
q
6,691,225
cost
(16)
Baptist Health Network
r
1,015,880
cost
(17)
Baptist Community Health Services Inc
r
15,264,133
cost
(18)
Western Baptist Medical Ventures Inc
r
15,459,558
cost
(19)
Baptist Medical Associates Inc
r
17,683,267
cost
(20)
Baptist Physicians Lexington Inc
r
29,918,242
cost
(21)
Baptist Physicians Southeast Inc
r
10,887,580
cost
(22)
Baptist Healthcare Affiliates Inc
s
1,958,829
cost
(23)
Baptist Community Health Services Inc
s
1,250,000
cost
(24)
Baptist Health Foundation of Greater Louisvil
s
50,378
cost
(25)
Baptist Ventures Inc
s
78,828
cost
(26)
PETCT Management LLC
s
331,680
cost
(27)
Baptist Health Foundation Paducah
b
79,428
cost
(28)
Baptist Physicians Lexington Inc
q
296,561
cost
(29)
Baptist Health Richmond Inc
q
567,872
cost
(30)
Baptist Healthcare Affiliates Inc
r
1,167,013
cost
(31)
Baptist Health Foundation Lexington
r
703,289
cost
(32)
Purchase Health Quality Collaborative
r
1,096,887
cost
(33)
Baptist Health Madisonville
r
250,090
cost
(34)
Baptist Health Richmond Inc
r
24,715,829
cost
(35)
Lexington Cardiac Research Foundation
s
133,297
cost
Schedule R (Form 990) 2012
Page 4
Schedule R (Form 990) 2012
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
(Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code VUBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2012
Page 5
Schedule R (Form 990) 2012
Page
5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier
Return Reference
Explanation
Additional Data
Software ID:
Software Version: