efile Public Visual Render
ObjectId: 201843139349300014 - Submission: 2018-11-09
TIN: 82-1406555
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
Highmark Health Group
Employer identification number
82-1406555
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)
AHN Surgery Center - Bethel Park LLC
1000 Higbee Drive
Bethel Park
,
PA
15102
47-3690355
Healthcare
PA
1,434,052
158,124
AHN
(2)
West Penn Allegheny Foundation LLC
4800 Friendship Avenue
Pittsburgh
,
PA
15224
20-1107650
Capital Acq.
PA
3,296,286
30,802,786
WPAHS
(3)
Peters Township ASC LLC
160 Gallery Drive
McMurray
,
PA
15317
27-3982341
Healthcare
PA
4,400,624
5,032,216
WPAHS
(4)
West Penn ASC LLC
4800 Friendship Avenue
Pittsburgh
,
PA
15224
27-2344847
Inactive
PA
0
0
WPAHS
(5)
JRMC Diagnostic Services LLC
565 Coal Valley Road
Pittsburgh
,
PA
15025
80-0069336
Healthcare
PA
1,188,435
315,128
JRMC
(6)
SV Shared Savings Program ACO LLC
232 West 25th Street
Erie
,
PA
16544
45-5550348
Inactive
PA
0
0
SVHC
(7)
SVEC LLC
232 West 25th Street
Erie
,
PA
16544
20-8572620
Inactive
PA
0
0
SVHC
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)
Canonsburg Hospital & Health Foundation
100 Medical Boulevard
Canonsburg
,
PA
15317
25-1818505
Inactive
PA
501(c)(3)
12a-TYPE I
NA
No
(2)
Clinical Pathology Institute Cooperative
1526 Peach Street
Erie
,
PA
16501
25-1528055
Healthcare
PA
501(c)(3)
3
SVHC
No
(3)
Community Blood Bank
232 West 25th Street
Erie
,
PA
16544
25-1181389
Healthcare
PA
501(c)(3)
12a-TYPE I
SVHC
No
(4)
Emergycare Inc
232 West 25th Street
Erie
,
PA
16544
25-1430922
Healthcare
PA
501(c)(3)
9
SVHC
No
(5)
Gateway Health Foundation
444 Liberty Avenue
Pittsburgh
,
PA
15222
81-1343916
Fundraising
PA
501(c)(3)
12a-TYPE I
Gateway LP
No
(6)
Greater Canonsburg Health System
100 Medical Boulevard
Canonsburg
,
PA
15317
25-1488089
Inactive
PA
501(c)(3)
12a-TYPE I
NA
No
(7)
Highmark Health
120 Fifth Avenue Suite 922
Pittsburgh
,
PA
15222
45-3674900
Healthcare
PA
501(c)(3)
12a-TYPE I
NA
No
(8)
Regional Cancer Center
232 West 25th Street
Erie
,
PA
16544
25-1385705
Healthcare
PA
501(c)(3)
3
SVHS
No
(9)
Regional Heart Network
232 West 25th Street
Erie
,
PA
16544
25-1856341
Healthcare
PA
501(c)(3)
3
SVHC
No
(10)
Regional Home Health and Hospice
232 West 25th Street
Erie
,
PA
16544
83-0371265
Healthcare
PA
501(c)(3)
9
SVHS
No
(11)
Suburban Health Foundation
100 South Jackson Ave
Pittsburgh
,
PA
15202
25-1472073
Fundraising
PA
501(c)(3)
12a-TYPE I
WPAHS INC
No
(12)
Vantage Health Group
232 West 25th Street
Erie
,
PA
16544
25-1498145
Healthcare
PA
501(c)(3)
3
SVHC
No
(13)
West Allegheny Hospital
100 Medical Boulevard
Pittsburgh
,
PA
15317
25-1054206
Inactive
PA
501(c)(3)
3
NA
No
(14)
Penn State Health
500 University Drive
Hershey
,
PA
17033
47-3769205
Healthcare
PA
501(c)(3)
12a-TYPE I
NA
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)
5148 Liberty Assoc
5989 Centre Avenue
Pittsburgh
,
PA
15206
25-1689871
Property Rental
PA
WPAHS Inc
EXCLUDED
372,595
927,518
No
No
50.000 %
(2)
AHN Emerus LLC
30 Isabella St
Pittsburgh
,
PA
15212
82-3655381
Medical Practice
PA
AHN
RELATED
0
0
No
No
51.000 %
(3)
AHN Home Infusion
312 West 25th Street
Erie
,
PA
16502
25-1736527
Medical Practice
PA
SVHS
RELATED
6,290,369
789,706
No
No
80.000 %
(4)
Celtic Hospice
30 Isabella St
Pittsburgh
,
PA
15212
20-5661063
Medical Practice
PA
WPAHS Inc
RELATED
0
0
No
No
80.000 %
(5)
JV Holdco LLC
30 Isabella St
Pittsburgh
,
PA
15212
47-2368587
Holding Company
PA
WPAHS Inc
RELATED
31,092,124
30,783,383
No
No
60.000 %
(6)
Mccandles Endoscopy
4800 Friendship Ave
Pittsburgh
,
PA
15224
26-1284448
Medical Practice
PA
WPAHS Inc
RELATED
1,341,130
503,720
No
No
50.000 %
(7)
N Shore Endoscopy
4800 Friendship Ave
Pittsburgh
,
PA
15224
25-1880238
Medical Practice
PA
WPAHS Inc
RELATED
1,221,997
423,534
No
No
50.000 %
(8)
Provider PPI LLC
120 Fifth Avenue Suite 922
Pittsburgh
,
PA
15222
32-0429947
Group Purchasing
PA
HMPG
RELATED
26,188,436
41,611,551
No
No
99.000 %
(9)
ST VINC PROF BLDG
312 West 25th Street
Erie
,
PA
16502
25-1578290
Property Mgmt
PA
SVHC
RELATED
429,996
334,121
No
No
97.000 %
(10)
Vantage HLDNG COMP
312 West 25th Street
Erie
,
PA
16502
03-0477182
Capital Mgmt
PA
CSI
RELATED
542,905
1,064,651
No
No
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)
Clinical Services Inc
232 West 25th Street
Erie
,
PA
16544
25-1403846
Holding Company
PA
SVHS
C Corp
5,002,292
14,046,879
100.000 %
Yes
(2)
Family Practice Medical Associates South
2414 Lytle Rd Ste 300
Bethel Park
,
PA
15102
25-1684735
Medical Practice
PA
JRMC
C Corp
8,251,700
2,538,692
100.000 %
Yes
(3)
Grandis Rubin Shanahan & Assoc
565 Coal Valley Rd
Jefferson Hills
,
PA
15025
45-3355906
Medical Practice
PA
JRMC
C Corp
5,615,703
1,471,282
100.000 %
Yes
(4)
Health System Services Corp & Subs
565 Coal Valley Rd
Jefferson Hills
,
PA
15025
25-1403745
Real Estate Opera
PA
JRMC
C Corp
3,094,817
21,722,342
100.000 %
Yes
(5)
HMPG Inc
120 Fifth Ave Suite 922
Pittsburgh
,
PA
15222
45-3444325
Holding Company
PA
AHN
C Corp
6,606,183
130,738,303
100.000 %
Yes
(6)
JRMC Physician Service Corp
565 Coal Valley Rd
Jefferson Hills
,
PA
15025
86-1159658
Medical Practice
PA
JRMC
C Corp
227,365
199,056
100.000 %
Yes
(7)
Lake Erie Medical Group PC
120 Fifth Ave Suite 922
Pittsburgh
,
PA
15222
45-3444157
Medical Practice
PA
AC
C Corp
1,663,439
303,506
100.000 %
Yes
(8)
Palladium Risk Retention Group
409 Broad St Ste 270
Sewickley
,
PA
15143
46-3476730
Insurance
VT
WPAHS Inc
C Corp
28,631,737
89,507,827
100.000 %
Yes
(9)
Physician Landing Zone PC
120 Fifth Ave Suite 922
Pittsburgh
,
PA
15222
45-3913973
Health Care
PA
AC
C Corp
10,185,783
926,881
100.000 %
Yes
(10)
Pittsburgh Pulmonary & Critical Care
1200 BROOKS LN STE 130
Clairton
,
PA
15025
46-3274101
Medical Practice
PA
JRMC
C Corp
4,033,364
1,109,782
100.000 %
Yes
(11)
Premier Medical Associates PC
120 Fifth Ave Suite 922
Pittsburgh
,
PA
15222
25-1742869
Medical Practice
PA
AC
C Corp
62,051,141
29,985,117
100.000 %
Yes
(12)
Premier Women's Health
120 Fifth Ave Suite 922
Pittsburgh
,
PA
15222
46-4682160
Medical Practice
PA
AC
C Corp
6,395,236
1,358,177
100.000 %
Yes
(13)
Primary Care Group 2 Inc
6011 Baptist Rd Ste 220
Pittsburgh
,
PA
15236
90-0451375
Medical Practice
PA
JRMC
C Corp
0
0
100.000 %
Yes
(14)
Primary Care Group 4 Inc
1907 Lebanon Church Rd
West Mifflin
,
PA
15122
80-0403090
Medical Practice
PA
JRMC
C Corp
631,316
64,611
100.000 %
Yes
(15)
Primary Care Group 5 Inc
624 Monongahela Ave
Glassport
,
PA
15045
80-0403100
Medical Practice
PA
JRMC
C Corp
551,882
84,558
100.000 %
Yes
(16)
Primary Care Group 6 Inc
PO Box 333
West Mifflin
,
PA
15122
90-0503600
Medical Practice
PA
JRMC
C Corp
431,489
68,379
100.000 %
Yes
(17)
Primary Care Group 8 Inc
803 Miller Ave
Clairton
,
PA
15025
01-0927360
Medical Practice
PA
JRMC
C Corp
164,735
330,920
100.000 %
Yes
(18)
Primary Care Group 10 Inc
3726 Brownsville Rd
Pittsburgh
,
PA
15227
38-3807173
Medical Practice
PA
JRMC
C Corp
385,138
122,869
100.000 %
Yes
(19)
Primary Care Group 12 Inc
17 Arentzen Blvd Ste 101
Charleroi
,
PA
15022
90-0614054
Medical Practice
PA
JRMC
C Corp
1,280,530
301,030
100.000 %
Yes
(20)
Specialty Group Practice 1 Inc
575 Coal Valley Rd Ste 365
Clairton
,
PA
15025
35-2367818
Medical Practice
PA
JRMC
C Corp
67,015
1,018,657
100.000 %
Yes
(21)
West Penn Corporate Medical ServicesInc
4800 Friendship Avenue
Pittsburgh
,
PA
15224
25-1437405
Inactive
PA
WPAHS Inc
C Corp
0
89,483
100.000 %
Yes
(22)
West Penn Neurosurgery PC
4800 Friendship Avenue
Pittsburgh
,
PA
15224
25-1630719
Inactive
PA
WPAHS Inc
C Corp
0
0
100.000 %
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
Yes
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
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
Yes
f
Dividends from related organization(s)
............................
1f
Yes
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
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
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
Yes
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)
Allegheny Clinic
P
389,665,764
FMV
(2)
Wexford Medical Mall LLC
P
3,210,024
FMV
(3)
Allegheny Health Network Home Infusion LLC
P
1,509,041
FMV
(4)
Allegheny Clinic Medical Oncology
P
1,033,673
FMV
(5)
Monroeville Ambulatory Surgery Center LLC
P
1,013,335
FMV
(6)
Peters Township Surgery Center LLC
P
519,715
FMV
(7)
Gold Mist Advisors LLC
P
259,340
FMV
(8)
Jefferson Regional Medical Center
P
254,419
FMV
(9)
AHN Surgery Center Bethel Park LLC
P
217,245
FMV
(10)
Saint Vincent Foundation for HHS
P
65,009
FMV
(11)
West Penn Hospital Foundation
P
54,878
FMV
(12)
PDL Distribution Services LLC
P
52,829
FMV
(13)
West Penn Allegheny Health System
Q
415,865,391
FMV
(14)
Wexford Medical Mall LLC
Q
6,247,979
FMV
(15)
Saint Vincent Health Center
Q
5,641,481
FMV
(16)
Allegheny Clinic
Q
3,902,889
FMV
(17)
Saint Vincent Medical Group
Q
1,043,213
FMV
(18)
Allegheny Singer Research Institute
Q
586,341
FMV
(19)
Alle-Kiski Medical Center
Q
402,666
FMV
(20)
Osiris Properties LLC
Q
379,995
FMV
(21)
HMPG Properties North LLC
Q
347,097
FMV
(22)
Physician Partners of Western PA LLC
Q
291,685
FMV
(23)
Summer Wind Management LLC
Q
168,535
FMV
(24)
Promedix LLC
Q
131,648
FMV
(25)
Provider PPI LLC
Q
66,489
FMV
(26)
Saint Vincent Professional Building Assn
Q
63,825
FMV
(27)
Westfield Memorial Hospital
Q
63,525
FMV
(28)
Regional Home Health and Hospice
Q
59,462
FMV
(29)
Saint Vincent CIC Disease LLC
Q
53,230
FMV
(30)
Saint Vincent Health Center
B
695,714
FMV
(31)
Westfield Memorial Hospital Foundation
B
50,000
FMV
(32)
St Vincent Foundation
C
838,400
FMV
(33)
Jefferson Regional Foundation
C
241,000
FMV
(34)
Highmark Foundation
C
140,000
FMV
(35)
Jefferson Auxiliary Hospital
C
89,000
FMV
(36)
Forbes Medical Staff
C
62,000
FMV
(37)
Highmark Inc
C
838,400
FMV
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, LINE 2
HIGHMARK HEALTH GROUP TRANSACTS BUSINESS WITH THE LISTED RELATED ORGANIZATIONS IN THE MANNER IDENTIFIED IN COLUMN 2(B). HIGHMARK HEALTH GROUP HAS CHOSEN TO REFLECT THESE TRANSACTIONS COMBINED FOR PURPOSES OF DISCLOSURE ON SCHEDULE R, PART V, LINE 2.
Schedule R (Form 990) 2017
Additional Data
Software ID:
Software Version: