efile Public Visual Render
ObjectId: 201813189349303596 - Submission: 2018-11-14
TIN: 22-3524939
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
VIRTUA HEALTH INC
Employer identification number
22-3524939
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)
VIRTUA PHYSICIAN PARTNERS LLC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
30-0872711
CLINICALLY INTEGRATED NETWORK
NJ
0
0
VIRTUA HEALTH 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)
VIRTUA - WEST JERSEY HEALTH SYSTEM INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
21-0634532
ACUTE CARE HOSPITAL
NJ
501(C)(3)
3
VIRTUA HEALTH INC
Yes
(2)
VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
21-0634562
ACUTE CARE HOSPITAL
NJ
501(C)(3)
3
VIRTUA HEALTH INC
Yes
(3)
VIRTUA SURGICAL GROUP PA
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
22-2580215
SURGICAL PHYSICIAN PRACTICE
NJ
501(C)(3)
9
N/A
No
(4)
VIRTUA HEALTH AND REHABILITATION CENTER AT BERLIN INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
22-3554707
REHABILITATION CENTER AND NURSING HOME
NJ
501(C)(3)
3
VIRTUA HEALTH INC
Yes
(5)
VIRTUA HEALTH AND REHABILITATION CENTER AT MT HOLLY INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
22-2394675
REHABILITATION CENTER AND NURSING HOME
NJ
501(C)(3)
9
VIRTUA HEALTH INC
Yes
(6)
VIRTUA HOME CARE - COMMUNITY NURSING SERVICES INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
21-0679591
HOME CARE
NJ
501(C)(3)
9
VIRTUA HEALTH INC
Yes
(7)
SUMMIT HEALTH - VIRTUA INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
52-1814579
HEALTH AND WELLNESS SERVICES
NJ
501(C)(3)
3
VIRTUA MEDICAL GROUP PA
No
(8)
WEST JERSEY RENEW INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
22-3580917
LOW INCOME HOUSING
NJ
501(C)(3)
9
VIRTUA HEALTH INC
Yes
(9)
MEMORIAL HOSPITAL OF BURLINGTON COUNTY FOUNDATION INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
22-2337170
FUND RAISING FOUNDATION
NJ
501(C)(3)
7
VIRTUA HEALTH INC
Yes
(10)
WEST JERSEY HEALTH & HOSPITAL FOUNDATION
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
23-7414388
FUND RAISING FOUNDATION
NJ
501(C)(3)
7
VIRTUA HEALTH INC
Yes
(11)
VIRTUA HEALTH FOUNDATION INC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
04-3722352
FUND RAISING FOUNDATION
NJ
501(C)(3)
7
VIRTUA HEALTH INC
Yes
(12)
VIRTUA MEDICAL GROUPPA
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
27-1348772
PHYSICIAN SERVICES
NJ
501(C)(3)
9
N/A
No
(13)
WEST JERSEY HEALTH SYSTEM WORKERS COMP TRUST
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
22-3142739
WORKER COMP TRUST
NJ
501(C)(3)
11A
VIRTUA HEALTH INC
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)
VIRTUA RADIATION ONCOLOGY ASSOCIATES LLC
101 CARNIE BOULEVARD
VOORHEES
,
NJ
08043
04-3849932
RADIOLOGY SERVICES
NJ
N/A
(2)
SOUTH JERSEY MUSCULOSKELETAL INSTITUTE LLC
556 EGG HARBOR ROAD
SEWELL
,
NJ
08080
20-4481032
SURGICAL CENTER
NJ
N/A
(3)
SUMMIT SURGICAL CENTER LLC
110 CARNIE BOULEVARD
VOORHEES
,
NJ
08043
73-1730859
SURGICAL CENTER
NJ
N/A
(4)
AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP LLC
20 W STOW ROAD SUITE 8
MARLTON
,
NJ
08053
20-8643005
SURGICAL CENTER
NJ
N/A
(5)
VANTAGE SURGICAL CENTER LLC
180 ROUTE 70
MEDFORD
,
NJ
08055
45-0516750
SURGICAL CENTER
NJ
N/A
(6)
MEMORIAL AMBULATORY SURGERY CENTER LLC
160 MADISON AVENUE
MT HOLLY
,
NJ
08060
20-4941260
SURGICAL CENTER
NJ
N/A
(7)
ROCKLAND SURGICAL PROJECTLLC - RAMAPO VALLEY SURGICAL CENTER
500 NORTH FRANKLIN TURNPIKE
RAMSEY
,
NJ
07446
20-0580403
SURGICAL CENTER
NJ
N/A
(8)
SHORE AMBULATORY SURGERY CENTER LLC
405 BETHEL ROAD
SOMERS POINT
,
NJ
08244
22-3778333
SURGICAL CENTER
NJ
N/A
(9)
RADIATION THERAPY RENTALS WASHINGTON TOWNSHIP LLC
20 W STOW ROAD SUITE 8
MARLTON
,
NJ
08053
27-1526973
MEDICAL RENTAL
NJ
N/A
(10)
CENTER FOR AMBULATORY AND MINIMALLY INVASIVE SURGERYLLC
234 INDUSTRIAL WAY WEST BLDG B
EATONTOWN
,
NJ
07724
27-0907140
SURGICAL CENTER
NJ
N/A
(11)
FREEHOLD ENDOSCOPY ASSOCIATES LLC
222 SCHANCK ROAD SUITE 100
FREEHOLD
,
NJ
07728
84-1634126
SURGICAL CENTER
NJ
N/A
(12)
VIRTUA ADULT IMAGING SERVICES AT VOORHEES LLC
303 LIPPINCOTT DR 4/FLR
MARLTON
,
NJ
08053
46-4055781
IMAGING SERVICES
NJ
N/A
(13)
GASTRO-SURGI CENTER OF NJ
1132 SPRUCE DRIVE
MOUNTAINSIDE
,
NJ
07092
22-3472632
SURGICAL CENTER
NJ
N/A
(14)
VOORHEES ENDOSCOPY HOLDING CO LLC
1A BRUTON HILLS BLVD
NASHVILLE
,
TN
37215
47-4669710
MEDICAL
TN
N/A
(15)
VIRTUA-SCA HOLDINGS LLC
569 BROOKWOOD VILLAGE SUITE 901
BIRMINGHAM
,
AL
35209
47-3247166
MEDICAL
NJ
N/A
(16)
VIRTUA-USP PRINCETON LLC
15305 DALLAS PKWY STE 1600 LB28
ADDISON
,
TX
75001
81-3270494
MEDICAL
NJ
N/A
(17)
BURLINGTON CTY ENDO CTR LLC CO PHYSICIANS ENDOSCOPY LLC
140 MOUNT HOLLY BYPASS UNIT 5
LUMBERTON
,
NJ
08048
20-8205206
HEALTH CARE
NJ
N/A
(18)
FRESENIUS MEDICAL CARE LLC
920 WINTER STREET
WALTHAM
,
MA
02451
47-2128074
DIALYSIS
NJ
N/A
(19)
VIRTUA PENN RADIATION ONCOLOGY PARTNERS LLC
200 BOWMAN DR STE D190
VOORHEES
,
NJ
08043
82-1947444
RADIOLOGY SERVICES
NJ
N/A
(20)
ACENTUS PRACTICE MANAGEMENT LLC
1040 N KINGS HIGHWAY STE 701
CHERRY HILL
,
NJ
08034
81-4861192
COLLECTIONS SERVICE
NJ
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)
VIRTUA ASSURANCE
76 SAINT PAUL ST SUITE 500
BURLINGTON
,
VT
05401
20-3025606
CAPTIVE INSURANCE COMPANY
VT
N/A
C
1,789,190
29,695,513
100.000 %
No
(2)
VRI INC
401 N RTE 73 50 LAKE CENTER DRIVE S
MARLTON
,
NJ
08053
20-0247120
HEALTH AND WELLNESS
NJ
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
Yes
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
Yes
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
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)
VIRTUA HEALTH FOUNDATION INC - GRANTS
C
1,160,851
FAIR MARKET VALUE
(2)
VIRTUA HEALTH FOUNDATION INC - MISC
P
1,550,986
FAIR MARKET VALUE
(3)
VIRTUA HEALTH FOUNDATION INC - PR MICP
Q
645,882
FAIR MARKET VALUE
(4)
VIRTUA HEALTH FOUNDATION INC - LEASE EQUIPMENT
J
43,337
FAIR MARKET VALUE
(5)
VIRTUA HEALTH FOUNDATION INC
B
45,592
FAIR MARKET VALUE
(6)
VIRTUA - WEST JERSEY HEALTH SYSTEM INC
Q
415,350,348
FAIR MARKET VALUE
(7)
VIRTUA - WEST JERSEY HEALTH SYSTEM INC
P
278,336,171
FAIR MARKET VALUE
(8)
VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY INC
Q
107,960,535
FAIR MARKET VALUE
(9)
VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY INC
P
9,732,294
FAIR MARKET VALUE
(10)
VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY INC
I
103,493
FAIR MARKET VALUE
(11)
COMMUNITY NURSING SERVICES
P
872,418
FAIR MARKET VALUE
(12)
COMMUNITY NURSING SERVICES
Q
729,582
FAIR MARKET VALUE
(13)
COMMUNITY NURSING SERVICES
I
37,667
FAIR MARKET VALUE
(14)
VIRTUA MEDICAL GROUP
P
3,690,280
FAIR MARKET VALUE
(15)
VIRTUA MEDICAL GROUP
Q
28,252,786
FAIR MARKET VALUE
(16)
VIRTUA MEDICAL GROUP
I
24,593,451
FAIR MARKET VALUE
(17)
VIRTUA HEALTH AND REHABILITATION CENTER AT BERLIN
Q
2,977,688
FAIR MARKET VALUE
(18)
VIRTUA HEALTH AND REHABILITATION CENTER AT BERLIN
P
2,831,669
FAIR MARKET VALUE
(19)
VIRTUA HEALTH AND REHABILITATION CENTER AT BERLIN
I
146,569
FAIR MARKET VALUE
(20)
VIRTUA HEALTH AND REHABILITATION CENTER AT MOUNT HOLLY INC
Q
2,983,024
FAIR MARKET VALUE
(21)
VIRTUA HEALTH AND REHABILITATION CENTER AT MOUNT HOLLY INC
P
1,267,877
FAIR MARKET VALUE
(22)
VIRTUA HEALTH AND REHABILITATION CENTER AT MOUNT HOLLY INC
I
1,717,289
FAIR MARKET VALUE
(23)
WEST JERSEY HEALTH SYSTEM WORKERS COMP TRUST
P
1,100,000
FAIR MARKET 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 (Form 990) 2017
Additional Data
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