efile Public Visual Render
ObjectId: 201943159349303739 - Submission: 2019-11-11
TIN: 35-1970706
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
HUNTINGTON MEMORIAL HOSPITAL INC
Employer identification number
35-1970706
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)
PARKVIEW HEALTH SYSTEM INC
10501 CORPORATE DRIVE
FORT WAYNE
,
IN
46845
35-1972384
HEALTH CARE
IN
501(C)(3)
LINE 12C, III-FI
N/A
No
(2)
PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC
2001 STULTS ROAD
HUNTINGTON
,
IN
46750
32-0012095
FUND MGMT
IN
501(C)(3)
LINE 12A, I
HUNTINGTON MEMORIAL HOSPITAL INC
Yes
(3)
PARKVIEW OCCUPATIONAL HEALTH CENTERS INC
10501 CORPORATE DRIVE
FORT WAYNE
,
IN
46845
35-2064353
OCCUP HEALTH
IN
501(C)(3)
LINE 3
PARKVIEW HEALTH SYSTEM INC
No
(4)
PARKVIEW HOSPITAL INC
11109 PARKVIEW PLAZA DRIVE
FORT WAYNE
,
IN
46845
35-0868085
HOSPITAL CARE
IN
501(C)(3)
LINE 3
PARKVIEW HEALTH SYSTEM INC
No
(5)
COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC
207 N TOWNLINE ROAD
LAGRANGE
,
IN
46761
20-2401676
HOSPITAL CARE
IN
501(C)(3)
LINE 3
PARKVIEW HEALTH SYSTEM INC
No
(6)
WHITLEY MEMORIAL HOSPITAL INC
1260 E STATE ROAD 205
COLUMBIA CITY
,
IN
46725
35-1967665
HOSPITAL CARE
IN
501(C)(3)
LINE 3
PARKVIEW HEALTH SYSTEM INC
No
(7)
COMMUNITY HOSPITAL OF NOBLE COUNTY INC
401 SAWYER ROAD
KENDALLVILLE
,
IN
46755
35-2087092
HOSPITAL CARE
IN
501(C)(3)
LINE 3
PARKVIEW HEALTH SYSTEM INC
No
(8)
PARKVIEW WABASH HOSPITAL INC
10 JOHN KISSINGER DRIVE
WABASH
,
IN
46992
47-1753440
HOSPITAL CARE
IN
501(C)(3)
LINE 3
PARKVIEW HEALTH SYSTEM INC
No
(9)
PARK CENTER INC
909 EAST STATE BLVD
FORT WAYNE
,
IN
46805
35-1135451
COMPREHENSIVE MENTAL HEALTH CENTER
IN
501(C)(3)
LINE 10
PARKVIEW HEALTH SYSTEM INC
No
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
(1)
ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC
10501 CORPORATE DRIVE
FORT WAYNE
,
IN
46845
26-0143823
ORTHO HOSPITAL
IN
N/A
N/A
No
No
(2)
FOUNDATION SURGERY AFFILIATE OF FORT WAYNE LLC
8004 CARNEGIE BLVD
FORT WAYNE
,
IN
46804
20-1394120
SURGICAL SERVICES
IN
N/A
N/A
No
No
(3)
MANAGED CARE SERVICES LLC
10501 CORPORATE DRIVE
FORT WAYNE
,
IN
46845
35-1996535
HEALTH PLAN ADMIN
IN
N/A
N/A
No
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)
MIDWEST COMMUNITY HEALTH ASSOCIATES INC
442 W HIGH STREET
BRYAN
,
OH
43506
34-1045870
PHYSICIANS
OH
N/A
C
No
(2)
WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC
202 W BERRY ST SUITE 800
FORT WAYNE
,
IN
46802
35-2058340
CONDO MANAGEMENT
IN
N/A
C
No
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
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
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
No
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)
PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC
B
80,000
PART VII SUPPLEMENTAL INFORMATION
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, PART V, LINE 2, COLUMN (C):
THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED.
Schedule R (Form 990) 2018
Additional Data
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