efile Public Visual Render
ObjectId: 202133009349302053 - Submission: 2021-10-27
TIN: 84-1103606
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
SCL HEALTH - FRONT RANGE INC
Employer identification number
84-1103606
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)
GOOD SAMARITAN MEDICAL CENTER LLC
200 EXEMPLA CIRCLE
LAFAYETTE
,
CO
80026
43-1982139
HOSPITAL SERVICES
CO
322,362,057
282,401,460
SCL HEALTH - FRONT RANGE INC
(2)
SCL HEALTH MEDICAL GROUP - DENVER LLC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
46-3778226
PHYSICIAN SERVICES
CO
146,193,361
43,531,523
SCL HEALTH - FRONT RANGE INC
(3)
SCL PHYSICIANS - RMPC LLC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
35-2563201
PHYSICIAN SERVICES
CO
0
0
SCL HEALTH MEDICAL GROUP - DENVER LLC
(4)
SCL HEALTH MEDICAL GROUP - GRAND JUNCTION LLC
2635 NORTH 7TH STREET
GRAND JUNCTION
,
CO
81502
46-3778277
PHYSICIAN SERVICES
CO
76,569,122
9,560,355
SCL HEALTH - FRONT RANGE INC
(5)
SCL HEALTH - FRONT RANGE NETWORK LLC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
85-1517471
CLINICALLY INTEGRATED NETWORK
CO
0
0
SCL HEALTH - FRONT RANGE INC
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)
SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
23-7379161
MANAGEMENT OF RELATED TAX EXEMPT HOSPITALS AND HEALTHCARE SERVICES
KS
501(C)(3)
LINE 12C, III-FI
N/A
No
(2)
SCL HEALTH FOUNDATION
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
82-3290526
SUPPORT RELATED TAX EXEMPT ORGANIZATIONS
CO
501(C)(3)
LINE 7
SCLHS
No
(3)
SCL HEALTH RESEARCH INSTITUTE INC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
85-2014794
MEDICAL RESEARCH
CO
501(C)(3)
LINE 4
SCLHS
No
(4)
INTEGRITY HEALTH
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
47-4520350
SUPPORTING ORGANIZATION
CO
501(C)(3)
LINE 12C, III-FI
SCLHS
No
(5)
BRIGHTON COMMUNITY HOSPITAL ASSOCIATION
1600 PRAIRIE CENTER PARKWAY
BRIGHTON
,
CO
80601
84-0482695
HOSPITAL SERVICES
CO
501(C)(3)
LINE 3
INTEGRITY HEALTH
No
(6)
PLATTE VALLEY MEDICAL CENTER FOUNDATION
1600 PRAIRIE CENTER PARKWAY
BRIGHTON
,
CO
80601
74-2255936
SUPPORTING ORGANIZATION
CO
501(C)(3)
LINE 12A, I
BRIGHTON COMMUNITY HOSPITAL ASSOCIATION
No
(7)
MOUNT ST VINCENT HOME INC
4159 LOWELL BOULEVARD
DENVER
,
CO
80211
84-0405260
RESIDENT CARE
CO
501(C)(3)
LINE 10
SCLHS
No
(8)
NJH-SJH INC
500 ELDORADO BLVD SUITE 4300
DENVER
,
CO
80211
47-1194849
MANAGEMENT OF RELATED TAX EXEMPT HOSPITALS AND HEALTHCARE SERVICES
CO
501(C)(3)
LINE 12A, I
SCLHS
No
(9)
SAINT JOSEPH HOSPITAL INC
1375 EAST 19TH AVENUE
DENVER
,
CO
80218
84-0417134
HOSPITAL SERVICES
CO
501(C)(3)
LINE 3
SCLHS
No
(10)
SAINT JOSEPH HOSPITAL FOUNDATION
1375 EAST 19TH AVENUE
DENVER
,
CO
80218
84-0735096
SUPPORT RELATED TAX EXEMPT ORGANIZATIONS
CO
501(C)(3)
LINE 7
SAINT JOSEPH HOSPITAL INC
No
(11)
GOOD SAMARITAN MEDICAL CENTER FOUNDATION
200 EXEMPLA CIRCLE
LAFAYETTE
,
CO
80026
84-1649162
SUPPORT RELATED TAX EXEMPT ORGANIZATIONS
CO
501(C)(3)
LINE 7
SCL HEALTH-FRONT RANGE INC
Yes
(12)
LUTHERAN MEDICAL CENTER FOUNDATION
8300 WEST 38TH AVENUE
WHEAT RIDGE
,
CO
80033
20-8846152
SUPPORT RELATED TAX EXEMPT ORGANIZATIONS
CO
501(C)(3)
LINE 7
SCL HEALTH-FRONT RANGE INC
Yes
(13)
ST MARYS HOSPITAL & MEDICAL CENTER INC
2635 NORTH 7TH STREET
GRAND JUNCTION
,
CO
81501
84-0425720
HOSPITAL SERVICES
CO
501(C)(3)
LINE 3
SCLHS
No
(14)
ST MARYS HOSPITAL FOUNDATION
2635 NORTH 7TH STREET
GRAND JUNCTION
,
CO
81501
23-7001007
SUPPORTING ORGANIZATION
CO
501(C)(3)
LINE 12A, I
ST MARYS HOSPITAL & MEDICAL CENTER INC
No
(15)
CARITAS CLINICS INC
818 NORTH 7TH STREET
LEAVENWORTH
,
KS
66048
48-1009910
CLINIC SERVICES
KS
501(C)(3)
LINE 3
SCLHS
No
(16)
MARIAN CLINIC INC
3164 SE 6TH AVENUE
TOPEKA
,
KS
66607
48-1046905
CLINIC SERVICES
KS
501(C)(3)
LINE 3
SCLHS
No
(17)
ST FRANCIS HEALTH CENTER INC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
48-0547719
HOSPITAL SERVICES
KS
501(C)(3)
LINE 3
SCLHS
No
(18)
HOLY ROSARY HEALTHCARE
2600 WILSON STREET
MILES CITY
,
MT
59301
81-0231792
HOSPITAL SERVICES
MT
501(C)(3)
LINE 3
SCLHS
No
(19)
HOLY ROSARY HEALTHCARE FOUNDATION INC
2600 WILSON STREET
MILES CITY
,
MT
59301
20-2270238
SUPPORTING ORGANIZATION
MT
501(C)(3)
LINE 12A, I
HOLY ROSARY HEALTHCARE
No
(20)
ST JAMES HEALTHCARE
400 SOUTH CLARK STREET
BUTTE
,
MT
59701
81-0231785
HOSPITAL SERVICES
MT
501(C)(3)
LINE 3
SCLHS
No
(21)
ST JAMES HEALTHCARE FOUNDATION INC
400 SOUTH CLARK STREET
BUTTE
,
MT
59701
65-1202190
SUPPORTING ORGANIZATION
MT
501(C)(3)
LINE 12A, I
ST JAMES HEALTHCARE
No
(22)
SCL HEALTH - MONTANA
1233 NORTH 30TH STREET
BILLINGS
,
MT
59101
81-0232124
HOSPITAL SERVICES
MT
501(C)(3)
LINE 3
SCLHS
No
(23)
ST VINCENT HEALTHCARE FOUNDATION INC
1106 NORTH 30TH STREET
BILLINGS
,
MT
59101
81-0468034
SUPPORT RELATED TAX EXEMPT ORGANIZATIONS
MT
501(C)(3)
LINE 7
SCL HEALTH - MONTANA
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)
LUTHERAN CAMPUS ASC LLC
569 BROOKWOOD VILLAGE SUITE 901
BIRMINGHAM
,
AL
35209
02-0749532
OP SURGERY
CO
N/A
No
No
(2)
SCLH-GI ENDOSCOPY HOLDINGS LLC
382 S ARTHUR AVENUE
LOUISVILLE
,
CO
80027
81-2979243
OP ENDOSCOPY
CO
N/A
No
No
(3)
SCLTDI JV LLC
4200 SIX FORKS ROAD SUITE 1000
RALEIGH
,
NC
27609
47-2294770
RADIOLOGY
DE
N/A
No
No
(4)
ATHLETIC MEDICINE & PERFORMANCE LLC
1144 NORTH 28TH STREET
BILLINGS
,
MT
59101
27-2270640
PHYSICAL THERAPY
MT
N/A
No
No
(5)
GRAND VALLEY SURGICAL CENTER LLC
710 WELLINGTON
GRAND JUNCTION
,
CO
81501
84-1505075
OP SURGERY
CO
N/A
No
No
(6)
HEALTHCARE MANAGEMENT LLC
PO BOX 1929
GRAND JUNCTION
,
CO
81502
84-1238904
MANAGEMENT SERVICES
CO
N/A
No
No
(7)
PAVILION IMAGING LLC
750 WELLINGTON
GRAND JUNCTION
,
CO
81501
03-0516198
RADIOLOGY
CO
N/A
No
No
(8)
SAN JUAN CANCER CENTER LLC
600 SOUTH 5TH STREET
MONTROSE
,
CO
81401
20-2856331
OP CANCER
CO
N/A
No
No
(9)
CAREFLIGHT OF THE ROCKIES LLC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
47-3525381
MEDICAL AIR TRANSPORT
CO
N/A
No
No
(10)
MED-MAP LLC
PO BOX 1295
BILLINGS
,
MT
59103
81-0491356
RENTAL REAL ESTATE
MT
N/A
No
No
(11)
YELLOWSTONE SURGERY CENTER LLC
1144 NORTH 28TH STREET
BILLINGS
,
MT
59101
72-1519467
OP SURGERY
MT
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)
CARITAS INC AND SUBSIDIARIES
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
48-0941069
HEALTHCARE
KS
N/A
C
No
(2)
ST FRANCIS ACCOUNTABLE HEALTH NETWORK INC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
46-2874128
HEALTHCARE
KS
N/A
C
No
(3)
WEST END ASSOCIATION INC
500 ELDORADO BLVD SUITE 4300
BROOMFIELD
,
CO
80021
85-4261243
REAL ESTATE MANAGEMENT
MT
N/A
C
No
(4)
LEAVEN INSURANCE COMPANY LTD
23 LIME TREE BAY AVENUE WEST BAY R
GRAND CAYMAN
KY1-1102
CJ
98-0370522
INSURANCE
CJ
N/A
C
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
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
Yes
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
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
No
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
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)
GOOD SAMARITAN MEDICAL CENTER FOUNDATION
B
668,209
CASH
(2)
GOOD SAMARITAN MEDICAL CENTER FOUNDATION
C
335,348
CASH
(3)
LUTHERAN MEDICAL CENTER FOUNDATION
B
652,549
CASH
(4)
LUTHERAN MEDICAL CENTER FOUNDATION
C
1,760,237
CASH
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:
Software Version: