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ObjectId: 201420459349301447 - Submission: 2014-02-14
TIN: 58-1719994
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
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
Employer identification number
58-1719994
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)
REGIONAL ORTHOPEDICS LLC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-2578658
PHYSICIANS
GA
0
0
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
(2)
REGIONAL PHYSICIANS GROUP LLC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-2578657
PHYSICIANS
GA
0
0
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
(3)
STADIUM DIAGNOSTIC CENTER LLC
707 CENTER STREET
COLUMBUS
,
GA
31901
02-0574744
PHYSICIANS
GA
0
0
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
(4)
STADIUM ACUTE CARE CENTER LLC
707 CENTER STREET
COLUMBUS
,
GA
31901
02-0574738
ACUTE CARE CENTER
GA
0
0
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
(5)
REGIONAL ONCOLOGY LLC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-2578648
ONCOLOGY BILLING
GA
0
0
THE MEDICAL CENTER INC
(6)
REGIONAL ANESTHESIA ASSOCIATES LLC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-2634874
ANESTHESIA BILLING
GA
0
0
THE MEDICAL CENTER INC
(7)
COLUMBUS RADIATION ONCOLOGY TREATMENT CENTER LLC
707 CENTER STREET
COLUMBUS
,
GA
31901
27-3019214
ONCOLOGY
GA
539,510
5,590,999
COLUMBUS AMBULATORY HEALTHCARE SERVICES INC
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)
THE MEDICAL CENTER INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1685139
ACUTE CARE HOSPITAL
GA
501(C)(3)
LINE 3
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
No
(2)
COLUMBUS AMBULATORY HEALTHCARE SERVICES INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1719867
AMBULATORY CARE
GA
501(C)(3)
LINE 3
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
No
(3)
COLUMBUS REGIONAL MEDICAL FOUNDATION INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1501642
FUNDRAISING
GA
501(C)(3)
LINE 7
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
No
(4)
DOCTOR'S HOSPITAL INC
707 CENTER STREET
COLUMBUS
,
GA
31901
26-1739383
ACUTE CARE HOSPITAL
GA
501(C)(3)
LINE 3
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
No
(5)
HUGHSTON HOSPITAL INC
707 CENTER STREET
COLUMBUS
,
GA
31901
33-1216751
ORTHOPEDIC HOSPITAL
GA
501(C)(3)
LINE 3
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
No
(6)
COLUMBUS REGIONAL AUXILIARY (FKA MEDICAL CENTER AUXILIARY)
707 CENTER STREET
COLUMBUS
,
GA
31901
58-0917974
HOSITAL AUXILIARY
GA
501(C)(3)
LINE 11C, III-FI
THE MEDICAL CENTER INC
No
(7)
CRHS LONG TERM AND HOME CARE INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1719867
NURSING HOME
GA
501(C)(3)
LINE 3
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
No
(8)
DOCTOR'S HOSPITAL AUXILIARY
616 19TH STREET
COLUMBUS
,
GA
31901
58-1295777
HOSITAL AUXILIARY
GA
501(C)(3)
LINE 11C, III-FI
DOCTOR'S HOSPITAL INC
No
(9)
COLUMBUS REGIONAL SENIOR LIVING INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-2628502
ASSISTED LIVING
GA
501(C)(3)
LINE 11C, III-FI
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
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
(1)
EVERGREEN MEDICAL GROUP LLC
PO BOX 790
COLUMBUS
,
GA
31902
58-2244760
MEDICAL SERVICES
GA
COLUMBUS HEALTHCARE RESOURCES INC
No
No
(2)
COLUMBUS DIAGNOSTIC IMAGING CTR LLC
116 INTRACOASTAL POINTE DR 300
JUPITER
,
FL
33477
26-2291768
DIAGNOSTIC IMAGING
FL
COLUMBUS HEALTHCARE RESOURCES INC
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)
COLUMBUS HEALTH SERVICES INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1640939
PHARMACIES
GA
COLUMBUS AMBULATORY HEALTHCARE SERVICES INC
C
2,891,709
3,317,279
100.000 %
Yes
(2)
COLUMBUS HEALTHCARE RESOURCES INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1717754
PROPERY MANAGEMENT
GA
N/A
C
7,121,326
43,257,279
100.000 %
Yes
(3)
WOMEN'S MEDICAL SERVICES
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1695456
MANAGEMENT
GA
N/A
C
237,586
-447,132
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
No
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
Yes
q
Reimbursement paid by related organization(s) for expenses
.
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1q
No
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
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)
THE MEDICAL CENTER INC
B
2,156,813
(2)
THE MEDICAL CENTER AUXILIARY
B
107,926
(3)
COLUMBUS REGIONAL MEDICAL FOUNDATION INC
B
240,000
(4)
THE MEDICAL CENTER INC
L
22,317,686
(5)
COLUMBUS HEALTH SERVICES INC
L
213,284
(6)
COLUMBUS HEALTHCARE RESOURCES INC
L
331,625
(7)
COLUMBUS REGIONAL MEDICAL FOUNDATION INC
L
48,669
(8)
DOCTOR'S HOSPITAL INC
L
3,761,975
(9)
HUGHSTON HOSPITAL INC
L
3,141,373
(10)
THE MEDICAL CENTER INC
C
107,926
(11)
COLUMBUS REGIONAL MEDICAL FOUNDATION INC
C
2,156,813
(12)
COLUMBUS REGIONAL AUXILIARY
C
156,200
(13)
COLUMBUS REGIONAL MEDICAL FOUNDATION INC
B
156,200
(14)
COLUMBUS REGIONAL SENIOR LIVING INC
L
158,400
(15)
THE MEDICAL CENTER INC
B
33,990
(16)
COLUMBUS REGIONAL AUXILIARY
C
33,990
(17)
COLUMBUS REGIONAL MEDICAL FOUNDATION INC
B
400
(18)
COLUMBUS AMBULATORY HEALTHCARE SERVICES INC
C
400
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: