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ObjectId: 201941359349304609 - Submission: 2019-05-15
TIN: 72-0408970
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
ST FRANCIS MEDICAL CENTER
Employer identification number
72-0408970
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)
ST FRANCIS MEDICAL GROUP
PO BOX 1901
MONROE
,
LA
71210
HEALTHCARE
LA
20,329,764
-4,418,680
SFMC
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)
ST BERNARD HEALTH FUND
4200 ESSEN LANE
BATON ROUGE
,
LA
70809
20-4685614
HEALTHCARE
LA
501(C)(3)
11 TYPE 1
FMOL
No
(2)
HEALTH CARE CENTERS IN SCHOOLS
5000 HENNESSY BLVD
BATON ROUGE
,
LA
70808
72-1443935
HEALTHCARE
LA
501(C)(3)
7
OLOL
Yes
(3)
ST FRANCIS AMBULATORY SERVICES
PO BOX 1901
MONROE
,
LA
71210
72-1206096
HEALTHCARE
LA
501(C)(3)
3
SFMC
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)
HEART HOSPITAL OF ACADIANA LLC
1105 KALISTE SALOOM ROAD
LAFAYETTE
,
LA
70508
30-0442368
HEALTHCARE
LA
LOURDES
N/A
(2)
PERKINS PLAZA IMAGING DEVELOPMENT LLC
5000 HENNESSY BLVD
BATON ROUGE
,
LA
70808
20-3894521
REAL ESTATE
LA
OLOL
N/A
(3)
P&S SURGERY CENTER LLC
312 GRAMMONT STREET
MONROE
,
LA
71201
72-1387870
HEALTHCARE
LA
SFMC
RELATED
-110,367
9,263,178
No
0
Yes
50.000 %
(4)
LOURDES IMAGING DEVELOPMENT LLC
4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE
,
LA
70508
20-8326287
REAL ESTATE
LA
LOURDES
N/A
(5)
PARK PLACE SURGERY CENTER LLC
4811 AMBASSADOR CAFFERY PKWY
LAFAYETTE
,
LA
70508
72-1404092
HEALTHCARE
LA
LOURDES
N/A
(6)
BRPT LAKE REHABILITATION CENTERS LLC
5222 BRITTANY DRIVE
BATON ROUGE
,
LA
70808
72-1506100
HEALTHCARE
LA
OLOL
N/A
(7)
CONVENIENT CARE LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
72-1439481
HEALTHCARE
LA
OLOL
N/A
(8)
SURGICAL SPECIALTY CENTER OF BATON ROUGE
8080 BLUEBONNET BLVD
BATON ROUGE
,
LA
70810
26-3160962
HEALTHCARE
LA
OLOL
N/A
(9)
ST ELIZABETH-MARY BIRD PERKINS CANCER C
4950 ESSEN LANE
BATON ROUGE
,
LA
70809
26-0628752
HEALTHCARE
LA
STEH
N/A
(10)
ST MARYS IMAGING CENTER II LLC
4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE
,
LA
70508
72-1329499
HEALTHCARE
LA
LOURDES IMAGING
N/A
(11)
NORTHEAST LA CANCER INSTITUTE LLC
411 CALYPSO STREET
MONROE
,
LA
71201
72-1329499
HEALTHCARE
LA
SFMC
RELATED
621,795
5,715,404
No
0
Yes
50.000 %
(12)
LHCG-XIII LLC
901 S HUGH WALLIS ROAD
LAFAYETTE
,
LA
70508
20-8068308
HEALTHCARE
LA
LOURDES
N/A
(13)
LOURDES AFTER HOURS LLC
7777 HENNESSY BLVD SUITE 1004-202
BATON ROUGE
,
LA
70809
20-1367299
HEALTHCARE
LA
LOURDES
N/A
(14)
LAKE URGENT CARE ASCENSION LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
35-2463092
HEALTHCARE
LA
STEH
N/A
(15)
LAKE URGENT CARE ASCENSION LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
35-2463092
HEALTHCARE
LA
OLOL
N/A
(16)
OLOLUSP SURGERY CENTER LLC
15305 DALLAS PKWY STE 1600 LB 28
ADDISON
,
TX
75001
35-2457810
HEALTHCARE
TX
OLOL
N/A
(17)
ST FRANCIS URGENT CARE LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
47-4013731
HEALTHCARE
LA
SFMC
RELATED
2,102,593
640,046
No
0
Yes
50.000 %
(18)
GAMMA KNIFE OF LOUISIANA LLC
4950 ESSEN LANE
BATON ROUGE
,
LA
70809
81-1827194
HEALTHCARE
LA
OLOL
N/A
(19)
LHCG LXVII LLC
901 S HUGH WALLIS ROAD
LAFAYETTE
,
LA
70508
72-0423635
HEALTHCARE
LA
LOURDES
N/A
(20)
PREMIER HEALTH HOLDINGS LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
47-2665226
HEALTHCARE
LA
OLOL
N/A
(21)
PINNACLE CARE HOLDINGS LLC
5627 S SHERWOOD FOREST BLVD
BATON ROUGE
,
LA
70816
72-0423651
HEALTHCARE
LA
LOURDES
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)
ST FRANCIS INSURANCE AGENCY
309 JACKSON STREET
MONROE
,
LA
71201
72-1435136
INSURANCE
LA
SFMC
C CORP
3,497
0
100.000 %
Yes
(2)
HOSPITAL ASSISTANCE SERVICES
PO BOX 4027-C
LAFAYETTE
,
LA
70502
72-1073486
HEALTHCARE
LA
LOURDES
C CORP
(3)
LOUISE INSURANCE COMPANY
PO BOX 1051
CAYMAN ISLANDS
KY1-1102
CJ
INSURANCE
CJ
FMOL
C CORP
(4)
MONROE HEALTH SERVICES
PO BOX 3187
MONROE
,
LA
71210
72-1057820
HEALTHCARE
LA
AMBULATORY
C CORP
(5)
NORTHEAST LA HEALTH NETWORK
309 JACKSON STREET
MONROE
,
LA
71201
72-1294587
HEALTHCARE
LA
AMBULATORY
C CORP
(6)
FRANCISICAN HEALTH & WELLNESS SERVICES I
4200 ESSEN LANE
BATON ROUGE
,
LA
70809
45-5492379
HEALTHCARE
LA
FMOL
C CORP
(7)
FMOL HEALTH SYSTEM HOLDINGS INC
4200 ESSEN LANE
BATON ROUGE
,
LA
70809
45-4405024
INVESTMENT
LA
FMOL
C CORP
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
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
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
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
No
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
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
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
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)
P&S SURGERY CENTER
a
901,105
FMV
(2)
P&S SURGERY CENTER
l
226,020
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 (Form 990) 2017
Additional Data
Software ID:
Software Version: