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ObjectId: 202001849349302000 - Submission: 2020-07-02
TIN: 52-2173382
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
MERCY HEALTH SERVICES INC
Employer identification number
52-2173382
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)
MARYLAND SPECIALTY SERVICES LLC
301 ST PAUL PLACE
BALTIMORE
,
MD
21202
27-1111353
SPECIALTY CARE
MD
0
0
MHS
(2)
LUTHERVILLE HEMATOLOGY & ONCOLOGY LLC
1734 YORK ROAD
LUTHERVILLE
,
MD
21093
27-4697590
SPECIALTY CARE
MD
30,179,830
925,621
MHS
(3)
NORTH CALVERT ANESTHESIOLOGY SERVICESLLC
301 ST PAUL PLACE
BALTIMORE
,
MD
21202
61-1758896
SPECIALTY CARE
MD
13,838,551
1,268,510
MHS
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)
MERCY MEDICAL CENTER INC
301 ST PAUL PLACE
BALTIMORE
,
MD
21202
52-0591658
HOSPITAL
MD
501(C)(3)
LINE 3
MHS
Yes
(2)
SAINT PAUL PLACE SPECIALISTS INC
301 ST PAUL PLACE
BALTIMORE
,
MD
21202
52-1495113
SPECIALTY CARE
MD
501(C)(3)
LINE 3
MHS
Yes
(3)
MERCY HEALTH FOUNDATION INC
301 ST PAUL PLACE
BALTIMORE
,
MD
21202
52-2173656
FOUNDATION
MD
501(C)(3)
LINE 7
MHS
Yes
(4)
STELLA MARIS INC
2300 DULANEY VALLEY ROAD
TIMONIUM
,
MD
21093
52-1419602
NURSING FACILITY
MD
501(C)(3)
LINE 10
MHS
Yes
(5)
MARYLAND FAMILY CARE INC
301 ST PAUL PLACE
BALTIMORE
,
MD
21202
52-2046586
MEDICAL SERVICE
MD
501(C)(3)
LINE 3
MHS
Yes
(6)
MERCY TRANSITIONAL CARE SERVICES INC
301 ST PAUL PLACE
BALTIMORE
,
MD
21202
52-1968440
SKILLED NURSE SERVICE
MD
501(C)(3)
LINE 10
N/A
Yes
(7)
CARDINAL SHEHAN CENTER
2300 DULANEY VALLEY ROAD
TIMONIUM
,
MD
21093
52-1180710
SENIOR HOUSE
MD
501(C)(3)
LINE 10
N/A
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)
VASCULAR SPECIALTY SERVICES INC
341 N CALVERT STREET SUITE 200
BALTIMORE
,
MD
21202
52-1995474
MEDICAL PRACTICE
MD
MHS
C
3,761,093
218,214
100.000 %
Yes
(2)
GREENLEAF INSURANCE CO LTD
PO BOX 1363 KY1-1108
GRAND CAYMAN
CJ
98-0206045
INSURANCE
CJ
MMC
C
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
No
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
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
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
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
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)
MARYLAND FAMILY CARE
S
4,723,919
FMV
(2)
MARYLAND FAMILY CARE
J
219,189
FMV
(3)
MERCY MEDICAL CENTER
Q
925,070
FMV
(4)
MERCY MEDICAL CENTER
R
333,328
FMV
(5)
MERCY MEDICAL CENTER
S
50,085,841
FMV
(6)
MERCY MEDICAL CENTER
L
1,416,752
FMV
(7)
MERCY MEDICAL CENTER
O
19,667,293
FMV
(8)
SAINT PAUL PLACE SPECIALISTS INC
S
30,227,165
FMV
(9)
STELLA MARIS
S
213,882
FMV
(10)
MERCY HEALTH FOUNDATION INC
R
538,170
FMV
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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