SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
CHARLEVOIX NURSING HOME CORPORATION
 
Employer identification number

38-3038683
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










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) BAY MEDICAL FOUNDATION

1900 COLUMBUS AVE

BAY CITY,MI48708
38-2156534 		FOUNDATION MI 501(C)(3) LINE 11A, I BAY REGIONAL MEDICAL CENTER
 
Yes
 
(2) BAY REGIONAL MEDICAL CENTER

1900 COLUMBUS AVE

BAY CITY,MI48708
38-1976271 		HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(3) BAY REGIONAL MEDICAL CENTER AUXILIARY

1908 COLUMBUS AVENUE

BAY CITY,MI48708
38-6081235 		SUPPORTING ORGANIZATION MI 501(C)(3) LINE 11A, I BAY REGIONAL MEDICAL CENTER
 
Yes
 
(4) BAY SPECIAL CARE HOSPITAL

1900 COLUMBUS AVE

BAY CITY,MI48708
38-3161753 		HOSPITAL MI 501(C)(3) LINE 3 BAY REGIONAL MEDICAL CENTER
 
Yes
 
(5) CENTRAL MICHIGAN COMMUNITY HOSPITAL

1221 SOUTH DRIVE

MT PLEASANT,MI48858
38-1420304 		HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(6) CENTRAL MICHIGAN COMMUNITY HOSPITAL RADIATION ONCOLOGY

1000 HARRINGTON

MT PLEASANT,MI48858
30-0312172 		HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(7) GREAT LAKES CANCER INSTITUTE

401 S BALLENGER HWY

FLINT,MI48532
38-3584572 		CANCER CARE CENTER MI 501(C)(3) LINE 7 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(8) INGHAM REGIONAL HEALTHCARE FOUNDATION

401 S GREENLAWN AVE

LANSING,MI48910
38-2463637 		FOUNDATION MI 501(C)(3) LINE 7 INGHAM REGIONAL MEDICAL CENTER
 
Yes
 
(9) INGHAM REGIONAL MEDICAL CENTER

401 S GREENLAWN AVE

LANSING,MI48910
38-1434090 		HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(10) LAPEER REGIONAL MEDICAL CENTER

1375 N MAIN ST

LAPEER,MI48446
38-2689033 		HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(11) LAPEER REGIONAL MEDICAL CENTER FOUNDATION

1375 N MAIN ST

LAPEER,MI48446
38-2689603 		FOUNDATION MI 501(C)(3) LINE 11A, I LAPEER REGIONAL MEDICAL CENTER
 
Yes
 
(12) MCLAREN HEALTH CARE CORPORATION

401 S BALLENGER HWY

FLINT,MI48532
38-2397643 		SUPPORTING ORG MI 501(C)(3) LINE 11A, I N/A
 
No
(13) MCLAREN HEALTH PLAN

G-3245 BEECHER ROAD

FLINT,MI48532
38-3383640 		HEALTH CARE SERVICES MI 501(C)(4)   MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(14) MCLAREN REGIONAL MEDICAL CENTER

401 S BALLENGER HWY

FLINT,MI48532
38-2383119 		HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(15) MOUNT CLEMENS REGIONAL HEALTHCARE FOUNDATION

PO BOX 326

MOUNT CLEMENS,MI48046
38-2578873 		FOUNDATION MI 501(C)(3) LINE 9 MOUNT CLEMENS REGIONAL MEDICAL CENTER
 
Yes
 
(16) MOUNT CLEMENS REGIONAL MEDICAL CENTER

1000 HARRINGTON

MOUNT CLEMENS,MI48043
38-1218516 		HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(17) POH REGIONAL MEDICAL CENTER

50 NORTH PERRY STREET

PONTIAC,MI48342
38-1428164 		HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(18) POH RILEY FOUNDATION

50 NORTH PERRY STREET

PONTIAC,MI48342
20-0442217 		FOUNDATION MI 501(C)(3) LINE 11C, III-FI POH REGIONAL MEDICAL CENTER
 
Yes
 
(19) VISITING NURSE SERVICE OF MICHIGAN

401 S BALLENGER HWY

FLINT,MI48532
38-3491714 		HEALTH CARE SERVICES MI 501(C)(3) LINE 9 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(20) WOMENS HOSPITAL ASSOCIATION OF FLINT MICHIGAN

401 S BALLENGER HIGHWAY

FLINT,MI48532
38-1358053 		SUPPORTING ORGANIZATION MI 501(C)(3) LINE 11A, I MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(21) REGIONAL EMERGENCY MEDICAL SERVICE INC

25400 W 8 MILE ROAD

SOUTHFIELD,MI48034
38-3255499 		AMBULANCE SERVICE MI 501(C)(3) LINE 9 MCLAREN MEDICAL MANAGEMENT INC
 
Yes
 
(22) NORTH OAKLAND NORTH MACOMB IMAGING INC

355 BARCLAY CIR STE A

ROCHESTER HILLS,MI48307
38-2807040 		MRI IMAGING MI 501(C)(3) LINE 3 N/A
Yes
 
(23) PRIMARY CARE

1900 COLUMBUS AVE

BAY CITY,MI48708
20-2443604 		HEALTH CARE SERVICES MI 501(C)(3) LINE 9 BAY REGIONAL MEDICAL CENTER
 
Yes
 
(24) MCLAREN HEALTH CARE VILLAGE FOUNDATION

401 S BALLENGER HIGHWAY

FLINT,MI48532
26-2693350 		SUPPORTING ORG MI 501(C)(3) LINE 11A, I MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(25) NORTHERN MICHIGAN MEDICAL MANAGEMENT

416 CONNABLE AVENUE

PETOSKEY,MI49770
20-8458840 		PHYSICIAN PRACTICE MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(26) THE CARDIAC INSTITUTE DBA MICHIGAN HEART & VASCULAR SPECIALISTS

416 CONNABLE AVENUE

PETOSKEY,MI49770
26-2774689 		PHYSICIAN PRACTICE MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(27) PETOSKEY COMMUNITY FREE CLINIC

416 CONNABLE AVENUE

PETOSKEY,MI49770
20-3675817 		HEALTH SERVICES MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(28) NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM

416 CONNABLE AVENUE

PETOSKEY,MI49770
38-2445613 		HEALTH SERVICES MI 501(C)(3) LINE 11A, I MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(29) NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM FOUNDATION

360 CONNABLE AVENUE

PETOSKEY,MI49770
38-2445611 		FUNDRAISING MI 501(C)(3) LINE 11A, I MCLAREN NORTHERN MICHIGAN
 
Yes
 
(30) VITALCARE INC

761 LAFAYETTE AVENUE

CHEBOYGAN,MI49721
38-2527255 		HOSPICE CARE/HOME HEALTH SERVICES MI 501(C)(3) LINE 9 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(31) NORTHERN MICHIGAN HEMATOLOGY AND ONCOLOGY

416 CONNABLE AVENUE

PETOSKEY,MI49770
32-0020293 		PHYSICIAN PRACTICE MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN
 
Yes
 
(32) MCLAREN NORTHERN MICHIGAN

416 CONNABLE AVENUE

PETOSKEY,MI49770
38-2146751 		ACUTE CARE HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION
 
Yes
 
(33) MCLAREN MEDICAL MANAGEMENT INC

401 S BALLENGER HWY

FLINT,MI48532
38-2988086 		MANAGEMENT COMPANY MI 501(C)(3) LINE 11A, I MCLAREN HEALTH CARE CORPORATION
 
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 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) MCLAREN - NORTHERN EQUITIES CANCER CENTER PROJECT LLC

39000 COUNTRY CLUB DRIVE
FARMINGTON HILLS,MI48331
26-3112935 		RENTAL REAL ESTATE MI N/A
                  
(2) MOUNT CLEMENS REGIONAL HEALTH BUILDING HEALTH PARTNERS

1000 HARRINGTON ST
MOUNT CLEMENS,MI48043
26-2524717 		BUILDING MANAGEMENT MI N/A
                  










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) HEALTH ADVANTAGE INC

G3245 BEECHER ROAD
FLINT,MI48532
91-2141720 		HEALTH CARE SERVICES MI N/A
 C         No
(2) CLARKSTON PROPERTY ASSOCIATES

50 NORTH PERRY STREET
PONTIAC,MI48342
43-2006072 		REAL ESTATE MI N/A
 C         No
(3) HOSPITAL HEALTH CARE INC

50 NORTH PERRY STREET
PONTIAC,MI48342
38-2643070 		HEALTH CARE MI N/A
 C         No
(4) PHYSICIAN ORGANIZED HEALTHCARE SYSTEM

50 NORTH PERRY STREET
PONTIAC,MI48342
38-3136458 		MANAGED CARE MI N/A
 C         No
(5) MCLAREN HEALTH PLAN INSURANCE COMPANY

G-3245 BEECHER ROAD SUITE 200
FLINT,MI48532
27-1780283 		INSURANCE MI N/A
 C         No
(6) VITALCARE HOME MEDICAL EQUIPMENT INC

761 LAFAYETTE AVENUE
CHEBOYGAN,MI49721
38-2662954 		SALE AND RENTAL OF DURABLE MEDICAL EQUIPMENT MI N/A
 C         No
(7) RAPIN & RAPIN INC DBA PRESCRIPTION SERVICES PHARMACY

416 CONNABLE AVENUE
PETOSKEY,MI49770
38-3465261 		RETAIL PHARMACY MI N/A
 C         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 . . . . . . . . . . . . . . . . . . . . . . .
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
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
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 other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM

 P 925,494 COST
(2) MCLAREN NORTHERN MICHIGAN

 P 2,587,354 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 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) 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: