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ObjectId: 202343199349322309 - Submission: 2023-11-15
TIN: 61-6145328
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
22
Open to Public Inspection
Name of the organization
Baptist Healthcare System Inc Workers
Compensation Trust
Employer identification number
61-6145328
Part I
Identification of Disregarded Entities.
Complete if the organization answered "Yes" on 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
Part II
Identification of Related Tax-Exempt Organizations.
Complete if the organization answered "Yes" on 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 Medical Group Inc
1901 Campus Place
Louisville
,
KY
40299
20-5497203
Physician Services
KY
501(c)(3)
Line 3
BHS
Yes
(2)
Mercy Regional Emergency Medical Systems
126 Lone Oak Road
Paducah
,
KY
42001
61-1310466
Ambulance Service
KY
501(c)(3)
Line 12a, I
BHS
Yes
(3)
Baptist Health Foundation Richmond Inc
1901 Campus Place
Louisville
,
KY
40299
31-1506378
Fundraising
KY
501(c)(3)
Line 12a, I
BHS
Yes
(4)
Baptist Health Foundation Corbin Inc
1901 Campus Place
Louisville
,
KY
40299
47-3033550
Fundraising
KY
501(c)(3)
Line 12a, I
BHS
Yes
(5)
Baptist Health Foundation Lexington Inc
1901 Campus Place
Louisville
,
KY
40299
61-1480774
Fundraising
KY
501(c)(3)
Line 12a, I
BHS
Yes
(6)
Baptist Health Foundation Paducah Inc
1901 Campus Place
Louisville
,
KY
40299
26-4057759
Fundraising
KY
501(c)(3)
Line 12a, I
BHS
Yes
(7)
Baptist Health Foundation Greater Louisville Inc
1901 Campus Place
Louisville
,
KY
40299
20-0292291
Fundraising
KY
501(c)(3)
Line 12a, I
BHS
Yes
(8)
Baptist Healthcare Foundation Inc
1901 Campus Place
Louisville
,
KY
40299
31-1122867
Fundraising
KY
501(c)(3)
Line 12a, I
BHS
Yes
(9)
Pattie A Clay Hospital Auxiliary
PO Box 1600
Richmond
,
KY
40476
51-0172717
Hospital Support
KY
501(c)(3)
Line 12a, I
BHS
No
(10)
Baptist Healthcare System Inc
1901 Campus Place
Louisville
,
KY
40299
61-0444707
Hospital
KY
501(c)(3)
Line 3
N/A
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2022
Page 2
Schedule R (Form 990) 2022
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on 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 V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
Baptist East Milestone Fitness Center
750 Cypress Station Road
Louisville
,
KY
40207
61-1355065
Fitness Center
KY
N/A
N/A
No
No
(2)
Baptist Physicians Surgery Center
1720 Nicholasville Road
Lexington
,
KY
40503
04-3665929
Ambulatory Surgery Center
KY
N/A
N/A
No
No
(3)
Medical Associates of Middletown
4000 Kresge Way
Louisville
,
KY
40207
20-0399400
Medical Office Building
KY
N/A
N/A
No
No
(4)
Cumberland Valley Surgical Center LLC
PO Box 1620
Corbin
,
KY
40701
61-1348280
Ambulatory Surgery Center
KY
N/A
N/A
No
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust.
Complete if the organization answered "Yes" on 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)
Baptist Health Assurance Group LTD
Cricket Square Hutchins Drive
Grand Cayman
CJ
98-1681017
Captive Insurance Company
CJ
N/A
T
Yes
Schedule R (Form 990) 2022
Page 3
Schedule R (Form 990) 2022
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on 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
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
No
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 related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
Baptist Healthcare System Inc
C
4,148,479
Book Value
(2)
Baptist Health Assurance Group LTD
R
952,475
Book Value
Schedule R (Form 990) 2022
Page 4
Schedule R (Form 990) 2022
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on 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 sections 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 V-UBI
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) 2022
Page 5
Schedule R (Form 990) 2022
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference
Explanation
Schedule R (Form 990) 2022
Additional Data
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