efile Public Visual Render
ObjectId: 201813139349302451 - Submission: 2018-11-09
TIN: 54-0648699
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
HALIFAX REGIONAL HOSPITAL INC
Employer identification number
54-0648699
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)
HALIFAX REGIONAL PROFESSIONAL SERVICES LLC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
20-8386107
PHYSN SUBSIDY
VA
0
100,506
HALIFAX REGIONAL HOSPITAL INC
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)
HALIFAX REGIONAL HEALTH SYSTEM INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1801466
HEALTH CARE
VA
501(C)(3)
LINE 7
N/A
No
(2)
SENTARA HEALTHCARE
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
52-1271901
HEALTH CARE
VA
501(C)(3)
LINE 7
N/A
No
(3)
CLARKSVILLE SENIOR CARE LLC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1957066
SENIOR CARE
VA
501(C)(3)
LINE 12A, I
HALIFAX REGIONAL HOSPITAL
Yes
(4)
HALIFAX REGIONAL DEV FOUNDATION INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1801459
HLTH/WELFARE
VA
501(C)(3)
LINE 7
HALIFAX REGIONAL HOSPITAL
Yes
(5)
HALIFAX REGIONAL LONG TERM CARE INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-6074529
SENIOR CARE
VA
501(C)(3)
LINE 12A, I
HALIFAX REGIONAL HOSPITAL
Yes
(6)
SENTARA HALIFAX REGIONAL PROPERTIES INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1801463
HLTH/WELFARE
VA
501(C)(3)
LINE 12A, I
HALIFAX REGIONAL HOSPITAL
Yes
(7)
SENTARA PRINCESS ANNE HOSPITAL
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
27-3208969
HEALTH CARE
VA
501(C)(3)
LINE 3
SENTARA HOSPITALS
Yes
(8)
SENTARA HOSPITALS
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1547408
HEALTH CARE
VA
501(C)(3)
LINE 3
SENTARA HEALTHCARE
Yes
(9)
SENTARA MEDICAL GROUP
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1217184
HEALTH CARE
VA
501(C)(3)
LINE 10
SENTARA HEALTHCARE
Yes
(10)
SENTARA ENTERPRISES
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1917649
HEALTH CARE
VA
501(C)(3)
LINE 10
SENTARA HEALTHCARE
Yes
(11)
SENTARA LIFE CARE CORP
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1217183
HEALTH CARE
VA
501(C)(3)
LINE 10
SENTARA HEALTHCARE
Yes
(12)
MPB INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1346393
TITLE HOLDING COMPANY
VA
501(C)(2)
SENTARA ENTERPRISES
Yes
(13)
OPTIMA HEALTH PLAN
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1283337
HMO
VA
501(C)(3)
LINE 12A, I
SENTARA HEALTHCARE
Yes
(14)
POTOMAC HOSPITAL CORP OF PRINCE WILLIAM
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-0853898
HEALTH CARE
VA
501(C)(3)
LINE 3
SENTARA HEALTHCARE
Yes
(15)
SENTARA RMH MEDICAL CENTER
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-0506331
HEALTH CARE
VA
501(C)(3)
LINE 3
SENTARA BLUE RIDGE LLC
Yes
(16)
VALLEY WELLNESS CENTER
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
52-1309257
PREVENTATIVE HEALTH/REHAB
VA
501(C)(3)
LINE 10
SENTARA RMH MEDICAL CENTER
Yes
(17)
MJH FOUNDATION
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1401357
INVEST/MGT SVCS FOR MARTHA JEFFERSON HOSPITAL
VA
501(C)(3)
LINE 12A, I
MARTHA JEFFERSON HOSPITAL
Yes
(18)
MARTHA JEFFERSON HOSPITAL FOUNDATION
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
30-0041113
FUNDRAISING
VA
501(C)(3)
LINE 12A, I
MARTHA JEFFERSON HOSPITAL
Yes
(19)
MARTHA JEFFERSON HOSPITAL
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-0261840
HEALTH CARE
VA
501(C)(3)
LINE 3
SENTARA BLUE RIDGE LLC
Yes
(20)
OPTIMA FAMILY CARE OF NC INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
82-3610648
MEDICAID HMO
NC
501(C)(3)
LINE 10
OPTIMA HEALTH OF NORTH CAROLINA LLC
Yes
(21)
OPTIMA HEALTH OF NORTH CAROLINA LLC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
82-3623430
SUPPORTING ORG
NC
501(C)(3)
LINE 12A, I
SENTARA HEALTHCARE
Yes
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)
MANAGEMENT SERVICES LLC
814 GREENBRIER CIRCLE
CHESAPEAKE
,
VA
23320
54-1365012
HLTH MGT SV
VA
N/A
(2)
OBICI REAL ESTATE HOLDINGS LLC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
26-1749881
RE RENTAL
VA
N/A
(3)
PRINCESS ANNE AMB SURG MGT LLC
1975 GLENN MITCHELL STE 300
VA BEACH
,
VA
23456
20-4920880
HEALTH CARE
VA
N/A
(4)
VA BEACH AMBULATORY SURGERY CENTER
1700 WILL O WISP DRIVE
VA BEACH
,
VA
23454
54-1448218
HEALTH CARE
VA
N/A
(5)
CANCER CENTERS OF VA LLC
5900 LAKE WRIGHT DRIVE
NORFOLK
,
VA
23502
20-1338518
HEALTH CARE
VA
N/A
(6)
HAMPTON ROADS LITHOTRIPSY LLC
225 CLEARFIELD AVE
VIRGINIA BEACH
,
VA
23462
20-0942600
HEALTH CARE
VA
N/A
(7)
RADIOLOGY SERVICES OF HAMPTON ROADS LC
814 GREENBRIER CIRCLE STE L
CHESAPEAKE
,
VA
23320
54-1774472
HEALTH CARE
VA
N/A
(8)
SENTARA OBICI AMBULATORY SURGERY LLC
2750 GODWIN BLVD
SUFFOLK
,
VA
23434
26-0144898
HEALTH CARE
VA
N/A
(9)
ST LUKES PROPERTIES LLC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
27-2774684
MOB RENTAL
VA
N/A
(10)
POTOMAC INOVA HEALTHCARE ALLIANCE LLC
8110 GATEHOUSE RD STE 400W
FALLS CHURCH
,
VA
22042
54-1802733
HEALTHCARE
VA
N/A
(11)
ORTHOPAEDIC HOSPITAL MANAGEMENT LLC
3000 COLISEUM DRIVE
HAMPTON
,
VA
23666
27-4185117
MGT SVCS
VA
N/A
(12)
CAREPLEX ORTHOPAEDIC ASC LLC
3000 COLISEUM DRIVE
HAMPTON
,
VA
23666
27-1867311
HEALTH CARE
VA
N/A
(13)
PHYSICAL THERAPY ACACLLC
501 ALBEMARLE SQUARE
CHARLOTTESVILLE
,
VA
22901
26-0080717
HEALTH CARE
VA
N/A
(14)
MNS SUPPLY CHAIN NETWORK LLC
11525 N COMMUNITY HOUSE RD STE 450
CHARLOTTE
,
NC
28277
45-4235238
GPO
DE
N/A
(15)
LAKE RIDGE AMBULATORY SURGERY CENTER LLC
12825 MINNIEVILLE RD STE 204
WOODBRIDGE
,
VA
22192
45-5347932
HEALTH CARE
VA
N/A
(16)
ALETA HEALTH LLC
2300 OPITZ BLVD
WOODBRIDGE
,
VA
22191
46-5661314
MSO
DE
N/A
(17)
OPACC I LLC
18000 W SARAH LANE SUITE 250
BROOKFIELD
,
WI
53045
39-2021431
RE RENTAL
WI
N/A
(18)
MEDSTREAMING LLC
9840 WILLOWS ROAD NE SUITE 200
REDMOND
,
WA
98052
45-1573625
SOFTWARE DEV
WA
N/A
(19)
HIGHLAND CORE FIXED INCOME FUND
C/O GTC 12 GILL ST SUITE 2600
WOBURN
,
MA
01801
47-4618533
POOLED INV FD
DE
N/A
(20)
HIGHLAND EQUITY FUND
C/O GTC 12 GILL ST SUITE 2600
WOBURN
,
MA
01801
47-4606269
POOLED INV FD
DE
N/A
(21)
HIGHLAND PUBLIC INFLATION HEDGES FD
C/O GTC 12 GILL ST SUITE 2600
WOBURN
,
MA
01801
47-4601867
POOLED INV FD
DE
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)
SENTARA HOLDINGS INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1555638
HOLDING COMPANY
VA
N/A
C
Yes
(2)
SENTARA HEALTH PLANS INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
52-2368125
TPA
VA
N/A
C
Yes
(3)
OPTIMA HEALTH GROUP
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1473382
HMO
VA
N/A
C
Yes
(4)
OPTIMA HEALTH INSURANCE COMPANY
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1642752
HEALTH INSURANCE
VA
N/A
C
Yes
(5)
OPTIMA BEHAVIORAL HEALTH SERVICES
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
62-1382666
MENTAL HEALTH SVCS
VA
N/A
C
Yes
(6)
SENTARA VENTURES INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1688615
HOLDING COMPANY
VA
N/A
C
Yes
(7)
SENTARA OBICI PROFESSIONAL CENTER
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1445865
RE RENTAL
VA
N/A
C
Yes
(8)
SENTARA STRATEGIC SOLUTIONS INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1020941
HEALTH CARE
VA
N/A
C
Yes
(9)
SENTARA HEALTH PLANS OF OHIO INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
47-1509408
TPA
OH
N/A
C
Yes
(10)
SENTARA HEALTH INSURANCE CO OF NC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
47-1888140
HEALTH INSURANCE
NC
N/A
C
Yes
(11)
SENTARA HEALTH PLANS OF NC INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
46-5510421
TPA
NC
N/A
C
Yes
(12)
MANAGED CARE SERVICES INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
81-5421060
ALT HEALTH DELIVERY
VA
N/A
C
Yes
(13)
SENTARA SOUTHSIDE HEALTH SERVICES INC
2204 WILBORN AVENUE
SOUTH BOSTON
,
VA
24592
54-1417772
HEALTH SERVICES
VA
HALIFAX REGIONAL HOSPITAL INC
C
1,671,802
3,482,210
100.000 %
Yes
(14)
DOMINION HEALTH MEDICAL ASSOCIATES LTD
2204 WILBORN AVENUE
SOUTH BOSTON
,
VA
24592
54-1060357
PHYS PRACTICE
VA
HALIFAX REGIONAL PROFESSIONAL SERVICES LLC
C
28,444,161
12,309,275
100.000 %
Yes
(15)
SMG INNOVATIONS INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
20-3730331
HEALTH CARE
VA
N/A
C
Yes
(16)
POTOMAC VENTURES CORP
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1441420
PHARMACY
VA
N/A
C
Yes
(17)
ROCKINGHAM HEALTH SERVICES INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
54-1721387
CONTRACTING SVCS
VA
N/A
C
Yes
(18)
MARTHA JEFFERSON MEDICAL ENTERPRISES INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
22911
54-1841528
MEDICAL BILLING SVCS
VA
N/A
C
Yes
(19)
BAY PRIMEX INSURANCE COMPANY LTD
PO BOX 1051
GRAND CAYMAN
KY1-1102
CJ
98-0704114
INSURANCE
CJ
N/A
C
Yes
(20)
ALBEMARLE PHYSICIAN SERVICES-SENTARA INC
6015 POPLAR HALL DRIVE
NORFOLK
,
VA
23502
26-4592192
PHYS PRACTICE
NC
N/A
C
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
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
Yes
i
Exchange of assets with related organization(s)
............................
1i
Yes
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
Yes
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
Yes
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)
SENTARA HALIFAX REGIONAL PROPERTIES INC
H
114,098
CORP BOOKS/REC
(2)
SENTARA HALIFAX REGIONAL PROPERTIES INC
I
628,088
CORP BOOKS/REC
(3)
SENTARA HALIFAX REGIONAL PROPERTIES INC
K
81,953
CORP BOOKS/REC
(4)
SENTARA HALIFAX REGIONAL PROPERTIES INC
L
131,516
CORP BOOKS/REC
(5)
SENTARA HALIFAX REGIONAL PROPERTIES INC
B
759,586
CORP BOOKS/REC
(6)
SENTARA HALIFAX REGIONAL PROPERTIES INC
R
163,372
CORP BOOKS/REC
(7)
HALIFAX REGIONAL LONG TERM CARE INC
C
18,623,433
CORP BOOKS/REC
(8)
HALIFAX REGIONAL LONG TERM CARE INC
Q
454,385
CORP BOOKS/REC
(9)
HALIFAX REGIONAL LONG TERM CARE INC
S
18,955,935
CORP BOOKS/REC
(10)
HALIFAX REGIONAL LONG TERM CARE INC
H
65,432
CORP BOOKS/REC
(11)
HALIFAX REGIONAL LONG TERM CARE INC
L
177,239
CORP BOOKS/REC
(12)
CLARKSVILLE SENIOR CARE LLC
C
15,256,216
CORP BOOKS/REC
(13)
CLARKSVILLE SENIOR CARE LLC
P
121,844
CORP BOOKS/REC
(14)
CLARKSVILLE SENIOR CARE LLC
Q
281,911
CORP BOOKS/REC
(15)
CLARKSVILLE SENIOR CARE LLC
S
15,415,150
CORP BOOKS/REC
(16)
DOMINION HEALTH MEDICAL ASSOCIATES LTD
Q
102,989
CORP BOOKS/REC
(17)
OPTIMA HEALTH PLAN
L
2,729,832
CORP BOOKS/REC
(18)
SENTARA HEALTH PLAN
L
2,267,224
CORP BOOKS/REC
(19)
SENTARA HOSPITALS
R
8,357,591
CORP BOOKS/REC
(20)
SENTARA HOSPITALS
B
3,690,636
CORP BOOKS/REC
(21)
SENTARA HOSPITALS
N
2,648,674
CORP BOOKS/REC
(22)
SENTARA HOSPITALS
L
101,775
CORP BOOKS/REC
(23)
SENTARA HOSPITALS
M
5,781,051
CORP BOOKS/REC
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
Software ID:
Software Version: