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ObjectId: 201841249349301564 - Submission: 2018-05-04
TIN: 36-3297853
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
16
Open to Public Inspection
Name of the organization
Sanford Health Foundation
Employer identification number
36-3297853
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)
Sanford
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
27-1218956
Supporting Organization
ND
501(c)(3)
12-II
No
(2)
Edith Sanford Breast Cancer Foundation
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
45-0404126
Foundation
ND
501(c)(3)
12-II
Sanford Health
Yes
(3)
F-M Ambulance Service Inc
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
45-0344371
EMT
ND
501(c)(4)
Sanford North
Yes
(4)
Sanford Health Foundation North
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
45-0398104
Foundation
ND
501(c)(3)
7
Sanford North
Yes
(5)
Sanford Health Foundation Hillsboro
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
36-3542187
Foundation
ND
501(c)(3)
7
Sanford Hillsboro
Yes
(6)
Sanford Health Foundation of Northern Minnesota
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
41-1389317
Foundation
MN
501(c)(3)
12-II
Sanford Health of Northern Minnesota
Yes
(7)
Sanford Health Foundation West
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
45-0397196
Foundation
ND
501(c)(3)
7
Sanford Bismarck
Yes
(8)
Medcenter One Inc Auxiliary
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
23-7293043
Supporting Organization
ND
501(c)(3)
12-II
Sanford Bismarck
Yes
(9)
Sanford Heart of America Health Plan
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
45-0346132
Insurance
ND
501(c)(4)
Sanford Health Plan
Yes
(10)
Sanford Health Foundation Thief River Falls
PO Box 5039 Rte 5218
Sioux Falls
,
SD
571175039
41-1761135
Foundation
MN
501(c)(3)
7
Sanford Medical Center Thief River Falls
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2016
Page 2
Schedule R (Form 990) 2016
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)
National Student Housing-South Dakota LLC
100 S Phillips Ave
Sioux Falls
,
SD
57104
20-2129839
Investment
SD
N/A
(2)
RAC Rentals LLC
100 S Phillips Ave
Sioux Falls
,
SD
57104
26-1961077
Investment
SD
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)
Sanford Home Medical Equipment Inc
2710 W 12th Street
Sioux Falls
,
SD
57105
46-0388597
Healthcare Equipment
SD
N/A
C
Yes
(2)
Sanford Health Plan
300 Cherapa Place
Sioux Falls
,
SD
57103
91-1842494
Insurance
SD
N/A
C
Yes
(3)
Sanford Health Plan of MN
300 Cherapa Place
Sioux Falls
,
SD
57103
46-0445852
Insurance
MN
N/A
C
Yes
(4)
Sanford Frontiers
1305 W 18th Street PO Box 5039
Sioux Falls
,
SD
571175039
45-5436599
Weight Loss/Fitness
SD
N/A
C
Yes
(5)
SOB Inc
2701 S Minnesota Avenue Suite 2
Sioux Falls
,
SD
57105
46-0442628
Air Transportation
SD
Sanford Health Foundation
C
629,086
1,036,071
100.000 %
Yes
(6)
Sanford Affiliated Services Inc
300 N 7th Street
Bismarck
,
ND
58501
45-0403146
Investment Activity
ND
N/A
C
Yes
(7)
Sanford World Clinics - Ghana
Sarbah Road Tantri Lorry Station
Cape Coast
GH
Healthcare
GH
N/A
C
Yes
(8)
Shanghai Sanford Healthcare Management Consulting Co Ltd
188 Yesheng Road Room A-862 Guoma
Shanghai
CH
Healthcare
CH
N/A
C
Yes
(9)
Sanford International - Munich GmbH
Nymphenburger Strasse 3
Munich
GM
Healthcare
GM
N/A
C
Yes
(10)
Split Interest Trust (10)
Trust
SD
N/A
T
Yes
Schedule R (Form 990) 2016
Page 3
Schedule R (Form 990) 2016
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
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
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
No
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)
Sanford USD Medical Center
B
41,623,300
Cash Method
(2)
Sanford Health
S
8,653,618
Cost Basis
Schedule R (Form 990) 2016
Page 4
Schedule R (Form 990) 2016
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) 2016
Page 5
Schedule R (Form 990) 2016
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) 2016
Additional Data
Software ID:
Software Version: