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ObjectId: 201513209349314146 - Submission: 2015-11-16
TIN: 35-1330472
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.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
Employer identification number
35-1330472
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)
ATHENS OUTPATIENT SERVICES LLC
1710 LAFAYETTE ROAD
CRAWFORDSVILLE
,
IN
47933
20-3686603
MEDICAL SRVCS
IN
28,248,199
0
FRANCISCAN
(2)
FRANCISCAN ALLIANCE ACCOUNTABLE CARE ORG
1515 DRAGOON TRAIL
MISHAWAKA
,
IN
46544
45-2884517
ACCOUNT. CARE
IN
6,799,998
2,655,198
FRANCISCAN
(3)
ST FRANCIS INSURANCE SERVICES LLC
1600 ALBANY STREET
BEECH GROVE
,
IN
46107
20-0048077
INSURANCE
IN
11,636
0
FRANCISCAN
(4)
SPECIALTY PHYSICIANS OF ILLINOIS LLC
333 DIXIE HIGHWAY
CHICAGO HEIGHTS
,
IL
60411
05-0540914
PHYSICIAN
IL
15,076,662
4,915,000
FRANCISCAN
(5)
FAITH HOPE AND LOVE CANCER CENTER LLC
1250 SOUTH CREASY LN STE A
LAFAYETTE
,
IN
47905
68-0612977
MEDICAL SRVCS
IN
21,365,387
1,226,199
FRANCISCAN
(6)
FRANCISCAN HAMMOND CLINIC LLC
7905 CALUMET AVENUE
MUNSTER
,
IN
46321
27-4958737
MEDICAL SRVCS
IN
0
0
FRANCISCAN
(7)
FRANCISCAN PRACTICE MANAGEMENT LLC
5224 S EAST STREET SUITE 3
INDIANAPOLIS
,
IN
46227
27-2919869
HEALTHCARE
IN
0
0
FRANCISCAN
(8)
ST FRANCIS MEDICAL GROUP LLC
5330 E STOP 11 RD
INDIANAPOLIS
,
IN
46237
26-3877295
MEDICAL SRVCS
IN
109,445,184
28,092,144
FRANCISCAN
(9)
HEALTHPARTNERS MEDICAL GROUP LLC
1225 E COLLSPRING AVENUE
MICHIGAN CITY
,
IN
46320
20-0474054
HEALTHCARE
IN
0
0
FRANCISCAN
(10)
FRANCISCAN AHN ACO LLC
1515 DRAGOON TRAIL
MISHAWAKA
,
IN
46544
45-4171713
ACCOUNT. CARE
IN
5,485,744
2,449,868
FRAN ACO LLC
(11)
FRANCISCAN UNION HOSPITAL ACO LLC
1515 DRAGOON TRAIL
MISHAWAKA
,
IN
46544
46-0889127
ACCOUNT. CARE
IN
1,314,254
205,330
FRAN ACO LLC
(12)
FRANCISCAN PHYSICIANS REAL PROPERTY LLC
701 SUPERIOR STREET
MUNSTER
,
IN
46321
26-0787231
REAL PROPERTY
IN
0
0
FRANCISCAN
(13)
FRANCISCAN CENTRAL INDIANA ACO LLC
1515 DRAGOON TRAIL
MISHAWAKA
,
IN
46544
32-0410552
ACCOUNT. CARE
IN
0
0
FRAN ACO LLC
(14)
FRANCISCAN COLLABORATIVE ACO LLC
1515 DRAGOON TRAIL
MISHAWAKA
,
IN
46544
30-0785171
ACCOUNT. CARE
IN
0
0
FRAN ACO LLC
(15)
FRANCISCAN HEALTHCARE MUNSTER
701 SUPERIOR STREET
MUNSTER
,
IN
46321
20-8411919
HEALTHCARE
IN
0
0
FRANCISCAN
(16)
SIGMA MEDICAL GROUP LLC
2400 SOUTH ST
LAFAYETTE
,
IN
47904
20-1716029
HEALTHCARE
IN
0
0
FRANCISCAN
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)
ALVERNO CLINICAL LABS INC
2434 INTERSTATE PLAZA DRIVE
HAMMOND
,
IN
46324
35-2060754
LAB SERVICES
IN
501(C)(3)
11 - Type 1
FRANCISCAN
Yes
(2)
HILLS INSURANCE COMPANY INC
1515 DRAGOON TRAIL
MISHAWAKA
,
IN
46544
03-0372512
CAPTIVE INS
VT
501(C)(3)
11 - Type 1
FRANCISCAN
Yes
(3)
SISTERS OF ST FRANCIS OF PERPETUAL ADOR
PO BOX 766
MISHAWAKA
,
IN
46546
35-1328145
RELIGIOUS
IN
501(C)(3)
1
NA
No
(4)
ST ALEXIS HOSPITAL ASSOCIATION
PO BOX 1290
MISHAWAKA
,
IN
46546
34-0714485
SUPPORT ALEXA
OH
501(C)(3)
3
FRANCISCAN
Yes
(5)
FRANCISCAN ALLIANCE FOUNDATION INC
1600 ALBANY STREET - FINANCE 9010
BEECH GROVE
,
IN
46107
35-1955283
FUNDRAISING
IN
501(C)(3)
7
FRANCISCAN
Yes
(6)
ST JAMES COMMUNITY FOUNDATION
1423 CHICAGO ROAD
CHICAGO HEIGHTS
,
IL
60411
20-4249251
FUNDRAISING
IL
501(C)(3)
7
FRANCISCAN
Yes
(7)
VNS AT ST FRANCIS INC
4701 N KEYSTONE AVE S418
INDIANAPOLIS
,
IN
46205
35-0868199
HOME HEALTH
IN
501(C)(3)
9
FRANCISCAN
Yes
(8)
AT YOUR SERVICE HOME CARE INC
4701 N KEYSTONE AVE S418
INDIANAPOLIS
,
IN
46205
35-2107306
HEALTHCARE
IN
501(C)(3)
9
FRANCISCAN
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Page 2
Schedule R (Form 990) 2014
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)
FRANCISCAN SURGERY CENTER LLC
421 N EMERSON AVE
BEECH GROVE
,
IN
46143
35-2128334
MEDICAL SERVICES
IN
FRANCISCAN
RELATED
6,392,698
9,710,751
No
0
No
50.320 %
(2)
LAFAYETTE HEART PROGRAM HOLDINGS LLC
1501 HARTFORD STREET
LAFAYETTE
,
IN
47904
38-3750811
MEDICAL SERVICES
IN
FRANCISCAN
RELATED
1,424,655
14,397,410
No
0
No
51.000 %
(3)
ST ANTHONY HEALTH NETWORK LLC
PO BOX 310
MISHAWAKA
,
IN
46546
35-1985170
CLAIMS PROCESSING
IN
FRANCISCAN
RELATED
85,638
338,818
No
0
Yes
88.070 %
(4)
ST FRANCIS MOORESVILLE SURGERY CTR LLC
1215 HADLEY ROAD SUITE 100
MOORESVILLE
,
IN
46158
20-2256900
MEDICAL SERVICES
IN
FRANCISCAN
RELATED
609,712
256,465
No
0
No
70.420 %
(5)
ST FRANCIS RADIATION THERAPY CENTERS LLC
421 N EMERSON AVE
GREENWOOD
,
IN
46143
77-0663631
MEDICAL SERVICES
IN
FRANCISCAN
RELATED
4,824,838
7,252,013
No
0
No
88.950 %
(6)
MAJOR HOSPITAL CARDIAC DIAGNOSTICS LLC
150 West Washington Street
Shelbyville
,
IN
46176
20-8715441
MEDICAL SERVICES
IN
FRANCISCAN
RELATED
388,571
379,309
No
0
No
53.600 %
(7)
ST FRANCIS IMAGING CTR (GREENWOOD) LLC
421 N EMERSON AVE
GREENWOOD
,
IN
46143
20-4607426
IMAGING SERVICES
IN
FRANCISCAN
RELATED
507,210
776,254
No
0
No
60.000 %
(8)
TONN AND BLANK CONST LLC
1623 GREENWOOD AVE
MICHIGAN CITY
,
IN
46360
CONSTRUCTION
IN
FRANCISCAN
RELATED
3,137,715
15,243,134
No
335,905
No
32.293 %
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)
FRANCISCAN HOLDING CORPORATION
1515 DRAGOON TRAIL
MISHAWAKA
,
IN
46544
36-3593505
HOLDING CO.
IN
FRANCISCAN
C CORP
6,616,495
50,942,669
100.000 %
Yes
(2)
FRANCISCAN ACO INC
700 E SOUTHPORT RD
INDIANAPOLIS
,
IN
46107
35-1904455
INSURANCE
IN
FRANCISCAN
C CORP
0
17,490,880
100.000 %
Yes
(3)
ST JAMES PHO INC
30 E 11TH ST SUITE 402
CHICAGO HEIGHTS
,
IL
60411
36-3945083
MANAGED CARE
IL
FRANCISCAN
C CORP
18,933,269
1,553,451
50.000 %
No
Schedule R (Form 990) 2014
Page 3
Schedule R (Form 990) 2014
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
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
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
Yes
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
Yes
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
No
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 related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
FRANCISCAN SURGERY CENTER LLC
B
7,348,236
FMV
(2)
FRANCISCAN ALLIANCE FOUNDATION INC
B
8,241,058
FMV
(3)
TONN AND BLANK CONSTRUCTION LLC
C
875,496
FMV
(4)
ST FRANCIS RADIATION THERAPY CENTERS LLC
C
4,851,333
FMV
(5)
ST FRANCIS IMAGING CENTER (GREENWOOD) LLC
C
495,600
FMV
(6)
FRANCISCAN SURGERY CENTER LLC
C
7,787,490
FMV
(7)
MAJOR HOSPITAL CARDIAC DIAGNOSTICS LLC
C
300,000
FMV
(8)
ST FRANCIS MOORESVILLE SURGERY CENTER LLC
C
635,000
FMV
Schedule R (Form 990) 2014
Page 4
Schedule R (Form 990) 2014
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) 2014
Page 5
Schedule R (Form 990) 2014
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2014
Additional Data
Software ID:
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