efile Public Visual Render
ObjectId: 201423179349300037 - Submission: 2014-11-13
TIN: 62-1403517
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.
See separate instructions.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
13
Open to Public Inspection
Name of the organization
METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Employer identification number
62-1403517
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
(1)
METHODIST HEALTHCARE DIALYSIS CENTER LLC
1211 UNION AVE SUITE 700
MEMPHIS
,
TN
38104
20-5678661
HEALTHCARE
TN
N/A
(2)
LE BONHEUR URGENT CARE LLC
6400 SHELBY VIEW DR SUITE 101
MEMPHIS
,
TN
38134
26-3041652
HEALTHCARE
TN
N/A
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)
METHODIST LE BONHEUR HEALTHCARE
1211 UNION AVENUE SUITE 700
MEMPHIS
,
TN
38104
58-1454711
SUPPORTING ORGANIZATION
TN
501(C)(3)
LINE 11B, II
N/A
No
(2)
METHODIST HEALTHCARE - MEMPHIS HOSPITALS
1265 UNION AVENUE
MEMPHIS
,
TN
38104
62-0479367
HOSPITALS
TN
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
(3)
METHODIST HEALTHCARE - FAYETTE HOSPITAL
214 LAKEVIEW DRIVE
SOMERVILLE
,
TN
38068
62-0862334
HOSPITAL
TN
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
(4)
METHODIST EXTENDED CARE HOSPITAL INC
225 SOUTH CLAYBROOK
MEMPHIS
,
TN
38104
62-1518342
HOSPITAL
TN
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
(5)
METHODIST HEALTHCARE PRIMARY CARE ASSOCIATES
1211 UNION AVENUE SUITE 657
MEMPHIS
,
TN
38104
58-2078931
OUTPATIENT HEALTHCARE
TN
501(C)(3)
LINE 9
METHODIST LE BONHEUR HEALTHCARE
No
(6)
ALLIANCE HEALTH SERVICES INC
6400 SHELBY VIEW SUITE 101
MEMPHIS
,
TN
38134
62-0841121
HEALTHCARE
TN
501(C)(3)
LINE 9
METHODIST LE BONHEUR HEALTHCARE
No
(7)
METHODIST HEALTHCARE FOUNDATION
1211 UNION AVENUE SUITE 450
MEMPHIS
,
TN
38104
23-7320638
FOUNDATION
TN
501(C)(3)
LINE 11A, I
METHODIST LE BONHEUR HEALTHCARE
No
(8)
LE BONHEUR CHILDREN'S HOSPITAL FOUNDATION
850 POPLAR AVENUE BLDG 2
MEMPHIS
,
TN
38105
62-1872938
FOUNDATION
TN
501(C)(3)
LINE 11A, I
METHODIST LE BONHEUR HEALTHCARE
No
(9)
LE BONHEUR COMMUNITY HEALTH AND WELL-BEING
50 PEABODY PLACE
MEMPHIS
,
TN
38103
62-1251288
FOUNDATION
TN
501(C)(3)
LINE 7
LE BONHEUR CHILDREN'S FOUNDATION
No
(10)
METHODIST HEALTHCARE-JONESBORO HOSPITAL
1211 UNION AVENUE SUITE 657
MEMPHIS
,
TN
38104
71-0499625
INACTIVE HOSPITAL
TN
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
(11)
METHODIST HEALTHCARE-DYERSBURG HOSPITAL
1211 UNION AVENUE SUITE 657
MEMPHIS
,
TN
38104
62-1155084
INACTIVE HOSPITAL
TN
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
(12)
METHODIST HEALTHCARE CENTRAL MS MEDICAL ASSOCIATES
1211 UNION AVENUE SUITE 657
MEMPHIS
,
TN
38104
64-0884720
INACTIVE HOSPITAL
TN
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
(13)
METHODIST HEALTHCARE-JACKSON HOSPITAL
1211 UNION AVENUE SUITE 657
MEMPHIS
,
TN
38104
64-0794199
INACTIVE HOSPITAL
TN
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
(14)
METHODIST HEALTHCARE-MIDDLE MISSISSIPPI HOSPITAL
1211 UNION AVENUE SUITE 657
MEMPHIS
,
TN
38104
64-0698911
INACTIVE HOSPITAL
TN
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
(15)
METHODIST HEALTHCARE-OLIVE BRANCH HOSPITAL
1211 UNION AVENUE SUITE 700
MEMPHIS
,
TN
38104
64-0889822
HOSPITAL
MS
501(C)(3)
LINE 3
METHODIST LE BONHEUR HEALTHCARE
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Page 2
Schedule R (Form 990) 2013
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)
DESOTO DIAGNOSTIC IMAGING LLC
9085 SANDIDGE CTR CV
OLIVE BRANCH
,
MS
38654
62-1802576
RADIOLOGY
MS
METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
RELATED
-208,961
3,642,713
No
No
60.000 %
(2)
NORTH SURGERY CENTER LP
3960 NEW COVINGTON PIKE
MEMPHIS
,
TN
38128
62-1685756
SURGERY CENTER
TN
N/A
(3)
METHODIST SURGERY CENTER-GERMANTOWN LP
1363 S GERMANTOWN ROAD
GERMANTOWN
,
TN
38138
62-1659904
SURGERY CENTER
TN
N/A
(4)
HAMILTON EYE INSTITUTE SURGERY CENTER LP
930 MADISON AVE 3RD FLOOR
MEMPHIS
,
TN
38103
20-2873438
SURGERY CENTER
TN
N/A
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)
AMBULATORY OPERATIONS INC
1211 UNION AVENUE SUITE 600
MEMPHIS
,
TN
38104
62-1157166
MEDICAL SERVICES
TN
METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
C
10,120,591
9,919,789
100.000 %
No
(2)
SOLUS MANAGEMENT SERVICES INC
6400 SHELBY VIEW SUITE 101
MEMPHIS
,
TN
38134
62-1361349
HEALTH SERVICES MANAGEMENT
TN
AMBULATORY OPERATIONS INC
C
1,755,084
3,791,004
100.000 %
No
(3)
MEMPHIS PROFESSIONAL BUILDING INC
1211 UNION AVENUE SUITE 600
MEMPHIS
,
TN
38104
62-1847544
INVESTMENTS
TN
AMBULATORY OPERATIONS INC
C
465,340
6,341,652
100.000 %
No
Schedule R (Form 990) 2013
Page 3
Schedule R (Form 990) 2013
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
.
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1a
No
b
Gift, grant, or capital contribution to related organization(s)
.
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1b
No
c
Gift, grant, or capital contribution from related organization(s)
.
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1c
No
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
Yes
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
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
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1l
No
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
No
o
Sharing of paid employees with related organization(s)
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1o
No
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
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 related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
DESOTO DIAGNOSTIC IMAGING LLC
S
157,800
CASH
Schedule R (Form 990) 2013
Page 4
Schedule R (Form 990) 2013
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) 2013
Page 5
Schedule R (Form 990) 2013
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
PART I, COLUMNS (D) AND (E):
THE ORGANIZATION DOES NOT TRACK ASSETS AND REVENUES DISCRETELY UNDER THE DISREGARDED ENTITIES LISTED ON SCHEDULE R, PART I. THE DISREGARDED ENTITIES ARE CREATED TO PROVIDE A UNIQUE BILLING IDENTIFICATION FOR CERTAIN TYPES OF TRANSACTIONS. THERE ARE NO SEPARATE ASSETS AND REVENUES FOR THE DISREGARDED ENTITIES LISTED.
PART IV, COLUMNS (F) AND (G):
AMBULATORY OPERATIONS, INC., SOLUS MANAGEMENT SERVICES, INC., AND MEMPHIS PROFESSIONAL BUILDING, INC. TOGETHER FILE A CONSOLIDATED TAX RETURN. AMBULATORY OPERATIONS, INC. IS THE PARENT CORPORATION OF THE GROUP. THE AMOUNTS SHOWN IN PART IV FOR COLUMNS (F) AND (G) ARE SHOWN PRE-CONSOLIDATION.
Schedule R (Form 990) 2013
Additional Data
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