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ObjectId: 201412279349301016 - Submission: 2014-08-15
TIN: 57-0314381
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
Conway Hospital Inc
Employer identification number
57-0314381
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)
CONWAY LONG-TERM CARE SERVICES INC
300 SINGLETON RIDGE RD
CONWAY
,
SC
29526
57-0875232
HEALTHCARE
SC
501(c)(3)
3
CONWAY HOSP
Yes
(2)
CONWAY HOSPITAL COMMUNITY SERVICES
300 SINGLETON RIDGE RD
CONWAY
,
SC
29526
57-1119337
HEALTHCARE
SC
501(c)(3)
3
CONWAY HOSP
Yes
(3)
CONWAY HOSPITAL EMERGENCY PROF SERVICES
300 SINGLETON RIDGE RD
CONWAY
,
SC
29526
20-8817905
EMERGENCY
SC
501(c)(3)
11 A-I
CONWAY HOSP
Yes
(4)
CONWAY HOSPITAL ANESTHESIA PROF SERVICES
300 SINGLETON RIDGE RD
CONWAY
,
SC
29526
20-8817302
ANESTHESIA
SC
501(c)(3)
11 A-I
CONWAY HOSP
Yes
(5)
CONWAY HOSPITAL FOUNDATION
300 SINGLETON RIDGE RD
CONWAY
,
SC
29526
57-0870199
FUNDRAISING
SC
501(c)(3)
11C-III-FI
CONWAY HOSP
No
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
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)
MEDICAL PROPERTIES INC
300 SINGLETON RIDGE RD
CONWAY
,
SC
29526
57-0751357
RENTALS
SC
CONWAY HOSPITAL
C Corp
1,412,789
6,730,352
100.000 %
Yes
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
No
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
No
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
No
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
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
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1l
Yes
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
Yes
o
Sharing of paid employees with related organization(s)
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1o
Yes
p
Reimbursement paid to related organization(s) for expenses
.
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.
1p
No
q
Reimbursement paid by related organization(s) for expenses
.
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1q
Yes
r
Other transfer of cash or property to related organization(s)
.
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1r
No
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)
CONWAY LONG-TERM CARE SERVICES INC
B
4,813,959
CASH (FMV)
(2)
CONWAY HOSPITAL COMMUNITY SERVICES INC
B
11,670,751
CASH (FMV)
(3)
CONWAY HOSPITAL EMERGENCY PROF SERVICES
B
27,667
CASH (FMV)
(4)
CONWAY HOSPITAL ANESTHESIA PROF SERVICES
B
4,039,537
CASH (FMV)
(5)
MEDICAL PROPERTIES INC
B
98,953
CASH (FMV)
(6)
CONWAY HOSPITAL ANESTHESIA PROF SERVICES
Q
3,295,862
COST
(7)
CONWAY HOSPITAL ANESTHESIA PROF SERVICES
S
1,875,128
COST
(8)
CONWAY LONG-TERM CARE SERVICES INC
S
4,751,639
COST
(9)
CONWAY HOSPITAL COMMUNITY SERVICES INC
S
7,144,007
COST
(10)
MEDICAL PROPERTIES INC
S
820,755
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: