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ObjectId: 201803199349320025 - Submission: 2018-11-15
TIN: 36-2235165
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.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
17
Open to Public Inspection
Name of the organization
Presence Chicago Hospitals Network
Employer identification number
36-2235165
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)
PRESENCE HEALTH NETWORK
200 SOUTH WACKER DRIVE
CHICAGO
,
IL
60606
36-1649520
PARENT CORP
IL
501(c)(3)
3
NA
No
(2)
MEDICARE VALUE PARTNERS
100 NORTH RIVER ROAD
DES PLAINES
,
IL
60016
36-3495969
HEALTH CARE
IL
501(c)(3)
10
PHPS
Yes
(3)
MOUNT LORETTO NURSING HOME INC
302 SWART HILL ROAD
AMSTERDAM
,
NY
12010
14-1363014
HEALTH CARE
NY
501(c)(3)
3
RM NEW YORK
Yes
(4)
PRESENCE HEALTH PARTNERS SERVICES
2380 E DEMPSTER AVE STE 236
DES PLAINES
,
IL
60016
36-2644178
HEALTH CARE
IL
501(c)(3)
Type II
PHN
No
(5)
PRESENCE CARE HOME
18927 HICKORY CREEK DR 300
MOKENA
,
IL
60448
46-0483587
HEALTH CARE
IL
501(c)(3)
10
PLC
Yes
(6)
PRESENCE CARE TRANSFORMATION CORPORATION
1000 REMINGTON BLVD STE 100
BOLINGBROOK
,
IL
60440
36-3366652
MGMT SUPPORT
IL
501(c)(3)
Type III-FI
PHN
No
(7)
PRESENCE HOME CARE
18927 HICKORY CREEK DR 300
MOKENA
,
IL
60448
46-0483581
HEALTH CARE
IL
501(c)(3)
10
PLC
Yes
(8)
PRESENCE CENTRAL AND SUBURBAN HOSP
1000 REMINGTON BLVD STE 100
BOLINGBROOK
,
IL
60440
36-4195126
HEALTH CARE
IL
501(c)(3)
3
PCTC
Yes
(9)
LAVERNA TERRACE HOUSING CORPORATION
18927 HICKORY CREEK DR 300
MOKENA
,
IL
60448
36-3438977
SENIOR LIVING
IL
501(c)(3)
10
PLC
Yes
(10)
PRESENCE LIFE CONNECTIONS
18927 HICKORY CREEK DR 300
MOKENA
,
IL
60448
37-1127787
HEALTH CARE
IL
501(c)(3)
10
PCTC
Yes
(11)
PRESENCE BEHAVIORAL HEALTH
1820 SOUTH 25TH AVENUE
BROADVIEW
,
IL
60155
36-2709982
HEALTH CARE
IL
501(c)(3)
3
PCTC
Yes
(12)
PRESENCE AMBULATORY SERVICES
100 NORTH RIVER ROAD
DES PLAINES
,
IL
60016
36-4286236
HEALTH CARE
IL
501(c)(3)
10
PCTC
Yes
(13)
PRESENCE HEALTH FOUNDATION BOARD OF TRUSTEES
200 SOUTH WACKER DRIVE
CHICAGO
,
IL
60606
36-3330929
FUNDRAISING
IL
501(c)(3)
7
PHN
No
(14)
RESURRECTION NURSING HOME INC
90 NORTH MAIN STREET
CASTLETON
,
NY
12033
14-1348691
HEALTH CARE
NY
501(c)(3)
3
RM NEW YORK
Yes
(15)
PRESENCE SENIOR SERVICES - CHICAGOLAND
100 NORTH RIVER ROAD
DES PLAINES
,
IL
60016
23-7061646
HEALTH CARE
IL
501(c)(3)
10
PCTC
Yes
(16)
PRESENCE HEALTHCARE SERVICES
100 NORTH RIVER ROAD
DES PLAINES
,
IL
60016
36-3330928
HEALTH CARE
IL
501(c)(3)
10
PCTC
Yes
(17)
ARTHUR MERKLE - CLARA KNIPPRATH NURSING
1190 E 2900 N ROAD
CLIFTON
,
IL
60927
36-2841358
HEALTH CARE
IL
501(c)(3)
10
PLC
Yes
(18)
RAINBOW HOSPICE AND PALLATIVE CARE
1550 BISHOP COURT
MOUNT PROSPECT
,
IL
60056
36-3296367
HEALTH CARE
IL
501(c)(3)
10
PLC
Yes
(19)
RESURRECTION UNIVERSITY
1431 N CLAREMONT
CHICAGO
,
IL
60622
36-2182170
EDUCATION
IL
501(c)(3)
2
PHN
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)
BEL HARLEM SURG CTR
3101 NORTH HARLEM
CHICAGO
,
IL
60634
41-2237162
MEDICAL SERVICE
IL
NA
N/A
(2)
RH SLEEP CTR - NW
665 WEST NORTH AVE 500
LOMBARD
,
IL
60148
26-1519627
MEDICAL SERVICE
IL
NA
N/A
(3)
RH SLEEP CTR - EVAN
665 WEST NORTH AVE 500
LOMBARD
,
IL
60148
26-1519556
MEDICAL SERVICE
IL
NA
N/A
(4)
RH SLEEP CTR - LP
665 WEST NORTH AVE 500
LOMBARD
,
IL
60148
26-1519667
MEDICAL SERVICE
IL
NA
N/A
(5)
ALVERNO CLINIC LAB
2434 INTERSTATE PLAZA DRIVE
HAMMOND
,
IN
46324
20-3240648
MEDICAL SERVICE
IN
NA
N/A
(6)
PROF CLINIC LAB LLC
113 E 4TH ST
MICHIGAN CITY
,
IN
46360
30-0711211
MEDICAL SERVICE
IN
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)
L GILBRAITH INSURANCE SPC LTD
68 W BAY ROAD PO BOX 1109
GRAND CAYMAN
CJ
INSURANCE
CJ
PHN
C Corporation
No
(2)
PROVENA HEALTH ASSURANCE SPC
23 LIME TREE BAY AVE PO BOX 1051
GRAND CAYMAN
CJ
98-0420054
INSURANCE
CJ
PCTC
C Corporation
Yes
(3)
PRESENCE PROPERTIES INC
100 NORTH RIVER ROAD
DES PLAINES
,
IL
60016
36-3520630
MEDICAL
IL
PV
C Corporation
Yes
(4)
PRESENCE SERVICE CORPORATION
2380 E DEMPSTER ROAD
DES PLAINES
,
IL
60016
36-4314354
MEDICAL
IL
PCTC
C Corporation
Yes
(5)
PRESENCE VENTURES INC
100 NORTH RIVER ROAD
DES PLAINES
,
IL
60016
37-1168085
MEDICAL
IL
PCTC
C Corporation
Yes
(6)
RESURRECTION MEDICAL CENTER AUXILIARY
7435 WEST TALCOTT AVENUE
CHICAGO
,
IL
60631
36-6109825
FUNDRAISING
IL
PCHN
C Corporation
Yes
(7)
RESURRECTION MINISTRIES OF NEW YORK
90 NORTH MAIN STREET
CASTLETON
,
NY
12033
14-1720818
PARENT CORP
NY
PCHN
C Corporation
Yes
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
No
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
No
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
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
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
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
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)
PRESENCE HEALTH FOUNDATION BOARD OF TRUSTEES
C
3,691,810
CASH
(2)
PRESENCE CARE TRANSFORMATION CORPORATION
C
90,700
BOOK VALUE
(3)
PRESENCE CARE TRANSFORMATION CORPORATION
M
125,814,381
COST ALLOCATION
(4)
PRESENCE CARE TRANSFORMATION CORPORATION
P
986,492,175
COST
(5)
PRESENCE CARE TRANSFORMATION CORPORATION
S
239,083
BOOK VALUE
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, Part V REIMBURSEMENTS FOR SHARED SERVICES
PRESENCE CARE TRANSFORMATION CORPORATION (FEIN 36-3366652) PAYS ALL OF THE COMPENSATION AND ACCOUNTS PAYABLE FOR ALL ENTITIES UNDER THE PRESENCE HEALTH SYSTEM AS THE DESIGNATED PAYMENT AGENT FOR SUCH ENTITIES, CASH IS DEPOSITED INTO AN ACCOUNT BY PRESENCE HEALTH ENTITIES AND SWEPT ON A MONTHLY BASIS TO REIMBURSE PRESENCE CARE TRANSFORMATION CORPORATION FOR THESE EXPENSES AT COST. THE AMOUNTS REPORTED ON PART V OF SCHEDULE R REFLECT THE TOTAL CASH TRANSFERS TO/FROM PRESENCE CARE TRANSFORMATION.
Schedule R (Form 990) 2017
Additional Data
Software ID:
17005876
Software Version:
2017v2.2