SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBulletGo to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
PRINCE WILLIAM HOSPITAL
 
Employer identification number

54-0696355
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) PRINCE WILLIAM-FAUQUIER CANCER CENTER LLC
2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
05-0570221
HEALTHCARE VA 10,396,513 30,722,598 PRINCE WILLIAM HOSPITAL
 










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)AUXILIARY OF FORSYTH MEMORIAL HOSPITAL
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-0862112
HEALTHCARE NC 501(C)(3) LINE 10 FORSYTH MEMORIAL HOSPITAL INC
 
 
No
(2)BRUNSWICK NOVANT MEDICAL CENTER FOUNDATION
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
27-4616751
HEALTHCARE NC 501(C)(3) LINE 7 BRUNSWICK COMMUNITY HOSPITAL LLC
 
 
No
(3)CAROLINA MEDICORP ENTERPRISES INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
58-1466368
HEALTHCARE NC 501(C)(3) LINE 12B, II NOVANT MEDICAL GROUP INC
 
 
No
(4)COMMUNITY GENERAL HEALTH PARTNERS INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-0636250
HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH TRIAD REGION LLC
 
 
No
(5)COMMUNITY GENERAL HOSPITAL FOUNDATION INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-1828629
HEALTHCARE NC 501(C)(3) LINE 7 COMMUNITY GENERAL HEALTH PARTNERS INC
 
 
No
(6)FORSYTH MEDICAL CENTER FOUNDATION
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-2120959
HEALTHCARE NC 501(C)(3) LINE 7 FORSYTH MEMORIAL HOSPITAL INC
 
 
No
(7)FORSYTH MEMORIAL HOSPITAL INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-0928089
HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH TRIAD REGION LLC
 
 
No
(8)FOUNDATION HEALTH SYSTEMS CORP
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-1373175
HEALTHCARE NC 501(C)(3) LINE 10 NOVANT HEALTH INC
 
 
No
(9)MEDICAL PARK HOSPITAL INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-1340424
HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH TRIAD REGION LLC
 
 
No
(10)NMG SERVICES INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-2098809
HEALTHCARE NC 501(C)(3) LINE 10 NOVANT HEALTH INC
 
 
No
(11)NOVANT HEALTH INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-1376950
HEALTHCARE NC 501(C)(3) LINE 12C, III-FI N/A
 
No
(12)NOVANT MEDICAL GROUP INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
58-1728803
HEALTHCARE NC 501(C)(3) LINE 3 NMG SERVICES INC
 
 
No
(13)PERSONAL CARE SERVICES
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
54-1291284
HEALTHCARE VA 501(C)(3) LINE 10 PRINCE WILLIAM HEALTH SYSTEM
 
 
No
(14)PRESBYTERIAN HOSPITAL FOUNDATION
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
58-1413074
HEALTHCARE NC 501(C)(3) LINE 7 NOVANT HEALTH SOUTHERN PIEDMONT REGION LLC
 
 
No
(15)PRESBYTERIAN MEDICAL CARE CORPORATION
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-1376368
HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH SOUTHERN PIEDMONT REGION LLC
 
 
No
(16)PRINCE WILLIAM HEALTH SYSTEM
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
54-1278944
HEALTHCARE VA 501(C)(3) LINE 12C, III-FI NOVANT HEALTH UVA HEALTH SYSTEM
 
 
No
(17)PWHS FOUNDATION
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
54-1307595
HEALTHCARE VA 501(C)(3) LINE 7 PRINCE WILLIAM HEALTH SYSTEM
 
 
No
(18)ROWAN HEALTH SERVICES CORPORATION
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-1424814
HEALTHCARE NC 501(C)(3) LINE 12C, III-FI NOVANT HEALTH INC
 
 
No
(19)ROWAN REGIONAL MEDICAL CENTER AUXILIARY
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
23-7022472
HEALTHCARE NC 501(C)(3) LINE 10 ROWAN REGIONAL MEDICAL CENTER INC
 
 
No
(20)ROWAN REGIONAL MEDICAL CENTER FOUNDATION INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-1424818
HEALTHCARE NC 501(C)(3) LINE 7 ROWAN REGIONAL MEDICAL CENTER INC
 
 
No
(21)ROWAN REGIONAL MEDICAL CENTER INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-0547479
HEALTHCARE NC 501(C)(3) LINE 3 ROWAN HEALTH SERVICES CORPORATION
 
 
No
(22)SELF INSURANCE FUND - NOVANT HEALTH INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
58-1867242
HEALTHCARE NC 501(C)(3) LINE 12C, III-FI NOVANT HEALTH INC
 
 
No
(23)THE PRESBYTERIAN HOSPITAL
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
56-0554230
HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH SOUTHERN PIEDMONT REGION LLC
 
 
No
(24)CULPEPER MEMORIAL HOSPITAL INC
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
54-0622371
HEALTHCARE VA 501(C)(3) LINE 3 NOVANT HEALTH UVA HEALTH SYSTEM
 
 
No
(25)NOVANT HEALTH UVA HEALTH SYSTEM
2085 FRONTIS PLAZA BLVD

WINSTON SALEM,NC27103
81-0868533
HEALTHCARE VA 501(C)(3) LINE 12A, I NOVANT HEALTH INC
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2017
Page 2
Schedule R (Form 990) 2017
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) HAYMARKET SURGERY CENTER LLC

2085 FRONTIS PLAZA BLVD
WINSTONSALEM,NC27103
46-2874962
HEALTHCARE VA PRINCE WILLIAM HOSPITAL
 
RELATED 265,422 2,449,920   No   Yes   51.010 %
(2) PRINCE WILLIAM AMBULATORY SURGERY CENTER LLC (PWASC)

2085 FRONTIS PLAZA BLVD
WINSTONSALEM,NC27103
77-0594498
HEALTHCARE VA PRINCE WILLIAM HOSPITAL
 
RELATED 796,625 2,365,988   No   Yes   51.000 %










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) ADEPT HEALTH INC FKA NOVANT HEALTH SHARED SERVICES INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
56-2226937
ADMIN SERVICES NC N/A
C         No
(2) CHOICEHEALTH INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
56-1896065
MANAGED CARE NC N/A
C         No
(3) COMMUNICARE INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
56-1952950
RENTAL REAL ESTATE NC N/A
C         No
(4) KERNERSVILLE MEDICAL CENTER PARK OWNERS' ASSOCIATION

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
47-1511401
RENTAL REAL ESTATE NC N/A
C         No
(5) MEDQUEST INC & SUBSIDIARIES

3480 PRESTON RIDGE RD STE 600
ALPHARETTA,GA30005
22-3860764
DIAGNOSTIC IMAGING DE N/A
C         No
(6) NOVANT HEALTH FOUNDATION INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
81-3895369
INACTIVE NC N/A
C         No
(7) NOVANT HEALTH TRINOVA INSURANCE PROTECTED CELL INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
81-2963143
INSURANCE NC N/A
C         No
(8) ROWAN MEDICAL ALLIANCE INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
56-1992669
INSURANCE NC N/A
C         No
(9) ROWAN MEDICAL FACILITIES INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
56-1424672
MEDICAL SUPPLIES NC N/A
C         No
(10) SALEM DIAGNOSTICS INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
56-1513621
HEALTH RELATED NC N/A
C         No
(11) SALEM HEALTH SERVICES INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
56-1342654
HEALTH RELATED NC N/A
C         No
(12) THE PARK AT MONROE PROPERTY OWNERS ASSOCIATION INC

2085 FRONTIS PLAZA BLVD
WINSTON SALEM,NC27103
46-3910256
RENTAL REAL ESTATE NC N/A
C         No
Schedule R (Form 990) 2017
Page 3
Schedule R (Form 990) 2017
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
 
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
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
 
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
 
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
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) PRINCE WILLIAM AMBULATORY SURGERY CENTER

S 1,083,504 CASH
(2) HAYMARKET SURGERY CENTER LLC

S 426,642 CASH




Schedule R (Form 990) 2017
Page 4
Schedule R (Form 990) 2017
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) 2017
Page 5
Schedule R (Form 990) 2017
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) 2017

Additional Data


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