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ObjectId: 201632189349300343 - Submission: 2016-08-05
TIN: 91-2155626
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
UMASS MEMORIAL HEALTH CARE INC & AFFILIATES
Employer identification number
91-2155626
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)
UMASS MEMORIAL FOUNDATION INC
333 SOUTH STREET
SHREWSBURY
,
MA
01545
04-3108190
FUNDRAISING SUPPORT
MA
501(C)(3)
11C
N/A
No
(2)
HEALTH ALLIANCE REALTY CORPORATION
60 HOSPITAL ROAD
LEOMINSTER
,
MA
01473
04-2560754
REAL ESTATE MANAGEMENT
MA
501(C)(2)
N/A
N/A
No
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)
UMASS MEMORIAL INVESTMENT PARTNERSHIP LLP
ONE BIOTECH PARK 355 PLANTATION ST
WORCESTER
,
MA
01605
04-3530755
INVESTMENT MANAGEMENT
MA
N/A
EXCLUDED 514
23,004,489
453,170,744
No
2,186
Yes
100.000 %
(2)
UMASS MEMORIAL MRI OF MARLBOROUGH LLC
157 UNION STREET
MARLBOROUGH
,
MA
01752
20-2293995
MAGNETIC RESONANCE IMAGING
MA
MARLBOROUGH HOSPITAL
RELATED
565,497
412,728
No
No
56.000 %
(3)
UMASS MEMORIAL HEALTH ALLIANCE MRI CENTER LLC
60 HOSPITAL ROAD
LEOMINSTER
,
MA
01453
04-3561571
MAGNETIC RESONANCE IMAGING
MA
N/A
RELATED
993,573
1,289,638
No
No
60.000 %
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)
COMMONWEALTH PROFESSIONAL ASSURANCE CO LTD
PO BOX 1051 GT
GRAND CAYMAN
CJ
98-0226143
INSURANCE
CJ
N/A
C
-14,339,873
167,731,722
100.000 %
No
(2)
MEMORIAL OFFICE CONDOMINIUM TRUST
306 BELMONT STREET
WORCESTER
,
MA
01604
04-6616900
CONDOMINIUM ASSOCIATION
MA
UMASS MEMORIAL MEDICAL CENTER INC
T
271,634
53.690 %
No
(3)
BIO-LAB INC
215 WEST STREET
MILFORD
,
MA
01757
04-2708828
CLINICAL LABORATORY
MA
UMASS MEMORIAL HEALTH VENTURES INC
S
-45,915
2,212,007
100.000 %
No
(4)
116 BELMONT ST INC CO APPLETON CORP
57 SUFFOLK STREET
HOLYOKE
,
MA
01040
04-2717865
CONDOMINIUM ASSOCIATION
MA
UMASS MEMORIAL REALTY INC
C
215
144,305
63.040 %
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
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
Yes
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
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
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
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)
COMMONWEALTH PROFESSIONAL ASSURANCE COMPANY LTD
L
25,903,450
FAIR VALUE
(2)
UMASS MEMORIAL MEDICAL CENTER INC
B
328,847
FAIR VALUE
(3)
UMASS MEMORIAL REALTY INC
P
256,898
FAIR VALUE
(4)
MARLBOROUGH HOSPITAL
P
4,131,200
FAIR VALUE
(5)
THE CLINTON HOSPITAL ASSOCIATION
P
2,743,141
FAIR VALUE
(6)
CENTRAL NEW ENGLAND HEALTH ALLIANCE INC
P
4,016,667
FAIR VALUE
(7)
UMASS MEMORIAL MEDICAL CENTER INC
P
135,617,159
FAIR VALUE
(8)
UMASS MEMORIAL MEDICAL GROUP INC
P
34,291,782
FAIR VALUE
(9)
COMMUNITY HEALTHLINK INC
P
485,800
FAIR VALUE
(10)
UMASS MEMORIAL MEDICAL GROUP INC
B
705,787
FAIR VALUE
(11)
UMASS MEMORIAL REALTY INC
J
3,152,642
FAIR VALUE
(12)
THE CLINTON HOSPITAL ASSOCIATION
B
312,500
FAIR VALUE
(13)
COMMONWEALTH PROFESSIONAL ASSURANCE COMPANY LTD
P
33,585,804
FAIR VALUE
(14)
UMASS MEMORIAL MEDICAL CENTER INC
S
483,561
FAIR VALUE
(15)
UMASS MEMORIAL MEDICAL CENTER INC
Q
27,935
FAIR VALUE
(16)
UMASS MEMORIAL MEDICAL GROUP INC
L
5,383,644
FAIR VALUE
(17)
CENTRAL NEW ENGLAND HEALTH ALLIANCE INC
Q
8,026
FAIR VALUE
(18)
UMASS MEMORIAL ACCOUNTABLE CARE ORGANIZATION INC
L
353,923
FAIR VALUE
(19)
MARLBOROUGH HOSPITAL
B
9,312
FAIR VALUE
(20)
CENTRAL NEW ENGLAND HEALTH ALLIANCE INC
B
112,589
FAIR VALUE
(21)
COMMUNITY HEALTHLINK INC
R
5,895
FAIR VALUE
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
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