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ObjectId: 202103099349304035 - Submission: 2021-11-05
TIN: 59-0724462
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
20
Open to Public Inspection
Name of the organization
Winter Haven Hospital Inc
Employer identification number
59-0724462
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)
BAYCARE HEALTH SYSTEM
2985 DREW ST
CLEARWATER
,
FL
337593012
59-2796965
HEALTH SRVCS
FL
501(c)(3)
Type I
NA
No
(2)
BAYCARE BEHAVIORAL HEALTH INC
7809 MASSACHUSETTS AVE
NEW PORT RICHEY
,
FL
346533028
59-1371752
HEALTH SRVCS
FL
501(c)(3)
7
BAYCARE
No
(3)
BC EMERGENCY ASSISTANCE PROGRAM INC
2985 DREW ST
CLEARWATER
,
FL
337593012
59-2697770
EMERG ASSIST
FL
501(c)(3)
10
BAYCARE
No
(4)
BAYCARE HOME CARE INC
8452 118TH AVE NORTH
LARGO
,
FL
337735007
59-3582520
HOME HLTH SRV
FL
501(c)(3)
10
BAYCARE
No
(5)
BEHAVIORAL HEALTH MANAGEMENT SRVCS INC
900 CARILLON PKWY SUITE 406
ST PETERSBURG
,
FL
337161121
59-3279573
HEALTH SRVCS
FL
501(c)(3)
10
BC BEH HEALTH
No
(6)
WINTER HAVEN HOSPITAL AUXILIARY INC
200 AVE F NORTHEAST
WINTER HAVEN
,
FL
338814131
23-7190109
VOLUNTEER SRV
FL
501(c)(3)
10
NA
No
(7)
WINTER HAVEN HOSPITAL FOUNDATION INC
200 AVE F NORTHEAST
WINTER HAVEN
,
FL
338814131
03-0406130
FUNDRAISING
FL
501(c)(3)
7
Mid-Florida Medical Services Inc
No
(8)
BAYCARE MEDICAL GROUP INC
300 S PARK PLACE BLVD
CLEARWATER
,
FL
337594931
59-3140335
PHYSICIANS
FL
501(c)(3)
10
BAYCARE
No
(9)
BARTOW REGIONAL MEDICAL CENTER INC
2200 OSPREY BLVD
BARTOW
,
FL
338303308
47-5387418
HOSPITAL
FL
501(c)(3)
3
BAYCARE
No
(10)
BAYCARE SELECT HEALTH PLANS INC
2985 DREW STREET
CLEARWATER
,
FL
337593012
81-0795815
MCR ADVANTAGE
FL
501(c)(4)
BAYCARE
No
(11)
BAYCARE PASCO INC
2985 DREW ST
CLEARWATER
,
FL
337593012
83-2099849
POTENTIAL HOSPITAL
FL
501(c)(3)
3
BAYCARE
No
(12)
Mid-Florida Medical Services Inc
200 Avenue F NE
Winter Haven
,
FL
33881
59-2486580
Support Organization
FL
501(c)(3)
Type III-FI
NA
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2020
Page 2
Schedule R (Form 990) 2020
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)
BC PURCHASING PARTNERS LLC
8731 FLORIDA MINING BLVD
TAMPA
,
FL
336341259
64-0950837
GROUP PURCHASING
FL
BAYCARE
Related
1,117,140
941,120
No
59,747
No
11.42 %
(2)
BC SURGERY CENTER LLC
8452 118TH A N
LARGO
,
FL
337745007
46-0591430
SURGERY CENTER
FL
NA
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)
BCHS INSURANCE INC
CAPTIVE INSURANCE
FL
NA
C Corporation
No
(2)
MEDSPECIALISTS INC
2985 DREW ST
CLEARWATER
,
FL
337593012
68-0587533
PAYROLL SRVCS
FL
NA
C Corporation
No
Schedule R (Form 990) 2020
Page 3
Schedule R (Form 990) 2020
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
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
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
Yes
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
Yes
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
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
Schedule R (Form 990) 2020
Page 4
Schedule R (Form 990) 2020
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) 2020
Page 5
Schedule R (Form 990) 2020
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) 2020
Additional Data
Software ID:
20011424
Software Version:
2020v4.0