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ObjectId: 201601369349300335 - Submission: 2016-05-15
TIN: 63-0288861
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
Providence Hospital
Employer identification number
63-0288861
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
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)
ASCENSION HEALTH ALLIANCE
PO BOX 45998
ST LOUIS
,
MO
63145
45-3358926
NATIONAL HEALTH SYSTEM
MO
501(c)(3
Type I
NA
No
(2)
ASCENSION HEALTH
PO BOX 45998
ST LOUIS
,
MO
63145
31-1662309
NATIONAL HEALTH SYSTEM
MO
501(c)(3
Type I
ASCENSION HEALTH ALLIANCE
No
(3)
PROVIDENCE HEALTH SYSTEM
6801 AIRPORT BLVD
MOBILE
,
AL
36608
63-0934712
SUPPORT PROVIDENCE HOSPITAL
AL
501(c)(3
Type III-FI
ASCENSION HEALTH
No
(4)
SETON MEDICAL MANAGEMENT
6801 AIRPORT BLVD
MOBILE
,
AL
36608
63-0937704
SUPPORT PROVIDENCE HOSPITAL
AL
501(c)(3
Type II
PROVIDENCE HEALTH SYSTEM
Yes
(5)
PROVIDENCE HEALTHCARE SERVICES
6801 AIRPORT BLVD
MOBILE
,
AL
36608
63-0937705
SUPPORT PROVIDENCE HOSPITAL
AL
501(c)(3
Type III-FI
PROVIDENCE HEALTH SYSTEM
Yes
(6)
PROVIDENCE FOUNDATION
6801 AIRPORT BLVD
MOBILE
,
AL
36608
63-0915493
SUPPORT PROVIDENCE HOSPITAL
AL
501(c)(3
7
PROVIDENCE HEALTH SYSTEM
Yes
(7)
PROVIDENCE BUILDING CORPORATION
6801 AIRPORT BLVD
MOBILE
,
AL
36608
63-0914564
SUPPORT PROVIDENCE HOSPITAL
AL
501(c)(2
PROVIDENCE HEALTH SYSTEM
Yes
(8)
ALABAMA PROVIDENCE HEALTHCARE SERVICES
6801 AIRPORT BLVD
MOBILE
,
AL
36608
46-2847744
SUPPORT PROVIDENCE HOSPITAL
AL
501(c)(3
Type III-FI
PROVIDENCE HEALTH SYSTEM
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)
SOUTH COAST REAL ESTATE VENTURE LLC
5907 HIGHWAY 90
MOSS POINT
,
MS
39563
45-5599047
OWN REAL ESTATE FOR PHYSICIAN OFFICE BUILDING
MS
NA
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)
PROVIDENCE PARK
PO BOX 850429
MOBILE
,
AL
36685
63-0886846
REAL ESTATE
AL
NA
C Corporation
No
(2)
ANESTHESIA SOLUTIONS OF MOBILE INC
6701 AIRPORT BLVD SUITE D-430B
MOBILE
,
AL
36608
82-0547505
ANESTHESIA SERVICES
AL
NA
C Corporation
No
(3)
MISSISSIPPI PROVIDENCE HEALTHCARE SERVICES INC
6801 AIRPORT BLVD
MOBILE
,
AL
36608
46-1130426
HEALTHCARE SERVICES
MS
NA
C Corporation
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
Yes
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
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
Yes
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
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
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)
Providence Building Corporation
J
639,991
FMV
(2)
Providence Park Inc
A
1,841,919
FMV
(3)
Providence Park Inc
O
110,099
FMV
(4)
Providence Building Corporation
O
194,411
FMV
(5)
Ascension Health
P
19,496,270
FMV
(6)
Anesthesia Solutions of Mobile Inc
P
88,616,560
FMV
(7)
Providence Building Corporation
P
730,476
FMV
(8)
Providence Foundation
P
727,095
FMV
(9)
Alabama Providence Healthcare Services
P
11,777,413
FMV
(10)
Providence Park Inc
P
7,502,825
FMV
(11)
Providence Health System
P
118,742
FMV
(12)
South Coast Real Estate Venture
P
312,916
FMV
(13)
Mississippi Providence Healthcare Services Inc
P
2,323,778
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:
14000329
Software Version:
2014v1.0