Board Form 990 | Baptist Foundation

In order to file the Form 990 that non-profits are required to file, the IRS requires all board members to complete a questionnaire every year. Please fill out the below questionnaire. Should you have any questions, please reach out to Rebecca Tidwell, Martie McEnerney, or Tommy McKinnon.

Baptist Health Care Foundation
Form 990 Questionnaire

During the year, did any person who is a current or former officer, director, trustee or key employee:

1.) Have a direct business relationship with the organization? YesNo

2.) Have an indirect business relationship through ownership of 35% or more in another entity? YesNo

3.) Have a family member with a direct or indirect business relationship with the organization? YesNo

4.) Serve as an officer, director, trustee, key employee, partner, or member of an entity or shareholder of a professional corporation doing business YesNo

5.) Does the Board allow employees discounts that are not available to all employees? YesNo

6.) Does the Board grant discounts to Board Members or their dependents? YesNo

7.) Does the Board employ any members of a Board member's family? YesNo

8. Does any Board member own 10% or more of the outstanding stock of any bank with which the Board does business? YesNo

9.) Do any 2 or more Board members collectively own 15% or more of the outstanding stock of any such bank? YesNo

10.) Does the Board purchase insurance whereby a Board member receives a commisson? YesNo

11.) Do hospital employees perform private work for Board members while on hospital time? YesNo

12.) Do Board members or employees use hospital equipment to perform private work? YesNo

13.) Do Board members or employees use hospital tax exempt status to make purchase for personal use? YesNo

14.) Did the Board pay bonuses during the fiscal year? YesNo

15.) Has a Board member ever obtained a loan from the Board? YesNo

16.) Does the Board provide any private physicians with:

17.) Does the Board purchase items from a company owned by a Board Member by a Board member? YesNo

18.) Has the Board written off any accounts receivable pertaining to a Board member or his family? YesNo

If answer Yes to any question above please explain relationship with the organization, amount of transaction (if any), and description of transaction such as employment or independent contractor arrangement, rental of property, or sale of assets.

Relationship Explanation(s)

The information furnished in this questionnaire and its attachments is correct to the best of our knowledge and belief.

Board Title

Name

Baptist Health Care Foundation Form 990 Questionnaire

If answer Yes to any question above please explain relationship with the organization, amount of transaction (if any), and description of transaction such as employment or independent contractor arrangement, rental of property, or sale of assets.

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Baptist Health Care Foundation
Form 990 Questionnaire