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ObjectId: 201943149349300219 - Submission: 2019-11-10
TIN: 45-3864076
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 instructions and the latest information.
OMB No. 1545-0047
20
18
Open to Public Inspection
Name of the organization
Beacon Health System Inc
Employer identification number
45-3864076
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)
Community Occupational Medicine
22818 Old US 20
Elkhart
,
IN
46516
35-2073758
Medical Cent
IN
7,091,542
3,300,665
BHS
(2)
CHA ACO LLC
53842 Generations Dr
South Bend
,
IN
46635
46-2860087
ACO
IN
52,850
175,778
BHS
(3)
Beacon Health LLC
615 N MICHIGAN ST
SOUTH BEND
,
IN
46601
32-0541809
MEDICAL SRVCS
IN
1,911,673
1,773,412
BHS
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)
MEMORIAL HOSPITAL OF SOUTH BEND INC
615 N MICHIGAN ST
SOUTH BEND
,
IN
46601
35-0868132
HOSPITAL
IN
501(C)(3)
3
BHS
Yes
(2)
BEACON HEALTH FOUNDATION INC
615 N MICHIGAN ST
SOUTH BEND
,
IN
46601
35-1536129
FINANCIAL SUP
IN
501(C)(3)
7
BHS
Yes
(3)
ELKHART GENERAL HOSPITAL INC
600 EAST BLVD
ELKHART
,
IN
46514
35-0877574
HOSPITAL
IN
501(C)(3)
3
BHS
Yes
(4)
BEACON MEDICAL GROUP INC
615 N MICHIGAN ST
SOUTH BEND
,
IN
46601
35-1536132
PHY PRACTICES
IN
501(C)(3)
10
BHS
Yes
(5)
MEMORIAL ENDOWMENT FUND FOR MEMORIAL HOS
PO BOX 1602
SOUTH BEND
,
IN
46634
35-6068581
ENDOWMENT
IN
501(C)(3)
12D III-O
MHSB
Yes
(6)
COMMUNITY HOSPITAL OF BREMEN INC
1020 HIGH ROAD
BREMEN
,
IN
46506
35-0835006
HOSPITAL
IN
501(C)(3)
3
BHS
Yes
(7)
COMMUNITY HOSPITAL OF BREMEN FOUNDATION
1020 HIGH ROAD
BREMEN
,
IN
46506
35-0835006
FINANCIAL SUP
IN
501(c)(3)
12B,II
BHS
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Page 2
Schedule R (Form 990) 2018
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
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)
BEACON HEALTH VENTURES INC
615 N MICHIGAN ST
SOUTH BEND
,
IN
46601
35-1901068
HOME MEDICAL
IN
BHS
C
14,221,274
11,096,927
100.000 %
Yes
(2)
BEACON HEALTH VENTURES MICHIGAN INC
615 N MICHGIAN ST
SOUTH BEND
,
IN
46601
20-8259773
HOME MEDICAL
MI
BHS
C
176,126
3,887,494
100.000 %
Yes
Schedule R (Form 990) 2018
Page 3
Schedule R (Form 990) 2018
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
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
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
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
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)
Beacon Medical Group
a
2,516,022
Actual Charges
(2)
Beacon Medical Group
k
138,152
Actutal Charges
(3)
Beacon Medical Group
p
24,355,752
Actual Charges
(4)
Beacon Medical Group
q
48,252,533
Actual Charges
(5)
Beacon Medical Group
r
62,339,127
Cash
(6)
Beacon Medical Group
l
11,473,732
Transfer Price
(7)
Beacon Medical Group
i
125,352
Actual Charges
(8)
Memorial Hospital of South Bend
p
40,182,624
Actual Charges
(9)
Memorial Hospital of South Bend
q
78,726,693
Actual Charges
(10)
Memorial Hospital of South Bend
s
175,200,000
Cash
(11)
Memorial Hospital of South Bend
l
35,013,650
Transfer Price
(12)
Beacon Health Foundation
q
1,419,869
Actual Charges
(13)
Beacon Health Foundation
s
1,129,000
Cash
(14)
Beacon Health Foundation
l
152,889
Transfer Price
(15)
Beacon Health Foundation
c
340,726
Actual Charges
(16)
Community Hospital of Bremen
q
3,133,163
Actual Charges
(17)
Community Hospital of Bremen
r
1,253,880
Cash
(18)
Beacon Health Ventures
k
80,836
Actual Charges
(19)
Beacon Health Ventures
p
674,637
Actual Charges
(20)
Beacon Health Ventures
q
6,844,079
Actual Charges
(21)
Beacon Health Ventures
s
4,004,596
Cash
(22)
Beacon Health Ventures
l
1,239,276
Transfer Price
(23)
Beacon Health Ventures
i
114,763
Actual Charges
(24)
Elkhart General Hospital
p
3,717,497
Actual Charges
(25)
Community Hospital of Bremen
l
667,663
Transfer Price
(26)
Elkhart General Hospital
q
71,977,524
Actual Charges
(27)
Elkhart General Hospital
s
114,500,000
Cash
(28)
BEACON MEDICAL GROUP
b
99,560,577
Actual Charges
(29)
MEMORIAL HOSPITAL OF SOUTH BEND
C
101,602,864
Actual Charges
(30)
ELKHART GENERAL HOSPITAL
C
23,215,999
Cash
(31)
COMMUNITY HOSPITAL OF BREMEN
B
1,131,792
Actual Charges
(32)
Elkhart General Hospital
l
23,031,125
Transfer Price
(33)
BEACON HEALTH FOUNDATION
A
23,410
Actual Charges
Schedule R (Form 990) 2018
Page 4
Schedule R (Form 990) 2018
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) 2018
Page 5
Schedule R (Form 990) 2018
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) 2018
Additional Data
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