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ObjectId: 202021359349301692 - Submission: 2020-05-14
TIN: 35-1938136
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
CVPA HOLDING CORPORATION
Employer identification number
35-1938136
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)
COMMUNITY FOUNDATION OF NW INDIANA INC
10010 DONALD S POWERS DR 201
MUNSTER
,
IN
46321
31-1128781
SUPPORT ORG
IN
501(c)(3)
12(C)
NA
No
(2)
MUNSTER MEDICAL RESEARCH FNDN INC
901 MACARTHUR BOULEVARD
MUNSTER
,
IN
46321
35-1107009
HOSPITAL
IN
501(c)(3)
3
CFNI
Yes
(3)
ST CATHERINE HOSPITAL INC
4321 FIR STREET
EAST CHICAGO
,
IN
46312
35-1738708
HOSPITAL
IN
501(c)(3)
3
CFNI
Yes
(4)
ST MARY MEDICAL CENTER INC
1500 S LAKE PARK AVENUE
HOBART
,
IN
46342
35-2007327
HOSPITAL
IN
501(c)(3)
3
CFNI
Yes
(5)
COMMUNITY CANCER RESEARCH FNDN INC
901 MACARTHUR BOULEVARD
MUNSTER
,
IN
46321
35-2146374
CANCER FUNDR
IN
501(c)(3)
7
MMRF
Yes
(6)
COMMUNITY VILLAGE INC
10000 COLUMBIA AVENUE
MUNSTER
,
IN
46321
35-1956395
RETIRMT HOME
IN
501(c)(3)
10
CFNI
Yes
(7)
THEATRE AT THE CENTER INC
1040 RIDGE ROAD
MUNSTER
,
IN
46321
35-1939427
PLAYS & ARTS
IN
501(c)(3)
10
CFNI
Yes
(8)
COMMUNITY CARE NETWORK INC
901 MACARTHUR BOULEVARD
MUNSTER
,
IN
46321
45-4158203
PHYS SERVICES
IN
501(C)(3)
10
MMRF SCH SMM
Yes
(9)
COMMUNITY STROKE & REHAB CTR INC
905 RIDGE ROAD
MUNSTER
,
IN
46321
82-0854709
REHAB
IN
501(C)(3)
3
CFNI
Yes
(10)
COMMUNITY HEALTHCARE PTNRS ACO INC
905 RIDGE ROAD
MUNSTER
,
IN
46321
82-1583355
ACO
IN
501(C)(3)
10
CFNI
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)
COMMUNITY RESOURCES INC
905 RIDGE ROAD
MUNSTER
,
IN
46321
35-1727711
MGMT SERVICES
IN
CFNI
C CORP
Yes
(2)
COMMUNITY MEDICAL & PROFESSIONAL CENTER
800 MACARTHUR BOULEVARD
MUNSTER
,
IN
46321
23-7437942
CONDO ASSOC
IN
CFNI
C CORP
Yes
(3)
COMMUNITY HEALTHCARE PARTNERS LLC
905 RIDGE ROAD
MUNSTER
,
IN
46321
47-2012011
CLINICAL INTG
IN
CFNI
C CORP
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
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
No
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
No
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
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
No
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)
THEATRE AT THE CENTER INC
A
59,200
FMV
(2)
THEATRE AT THE CENTER INC
O
250,462
FMV
(3)
THEATRE AT THE CENTER INC
P
924,062
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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