SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Hospice of Jackson
 
Employer identification number

38-2336367
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)WA Foote Memorial Hospital dba Henry Ford Allegiance Health
205 N East Avenue

Jackson,MI49201
38-2027689
Exempt Hospital MI 501(c)(3) Line 3 Henry Ford Allegiance Health Group
 
Yes
 
(2)Henry Ford Allegiance Health Group
205 N East Avenue

Jackson,MI49201
38-2756428
Exempt Health System MI 501(c)(3) Line 12b, II Henry Ford Health System
 
 
No
(3)Henry Ford Allegiance Health Foundation
205 N East Avenue

Jackson,MI49201
38-3607833
Supports Allegiance Health MI 501(c)(3) Line 12b, II Henry Ford Allegiance Health Group
 
Yes
 
(4)Carelink Of Jackson
110 North Elm Avenue

Jackson,MI49202
38-1218485
Long Term Acute Care Hospital MI 501(c)(3) Line 3 Henry Ford Allegiance Health Group
 
Yes
 
(5)Henry Ford Health System
One Ford Place

Detroit,MI48202
38-1357020
Healthcare Service Provider MI 501(c)(3) Line 3 N/A
 
No
(6)Henry Ford Wyandotte Hospital
2333 Biddle Ave

Wyandotte,MI48192
38-2791823
Healthcare Service Provider MI 501(c)(3) Line 3 Henry Ford Health System
 
Yes
 
(7)Henry Ford Health System Foundation
One Ford Place

Detroit,MI48202
23-7383042
Supporting Organization MI 501(c)(3) Line 12a, I Henry Ford Health System
 
Yes
 
(8)Health Alliance Plan
2850 W Grand Blvd

Detroit,MI48202
38-2242827
Health Maintenance Organization MI 501(c)(4) N/A Henry Ford Health System
 
Yes
 
(9)HFII Corporation
One Ford Place

Detroit,MI48202
90-0840304
Scientific Research MI 501(c)(3) Line 7 Henry Ford Health System
 
Yes
 
(10)Henry Ford Health System Government Affairs Services
One Ford Place

Detroit,MI48202
46-4064067
Advocacy Services for HFHS MI 501(c)(4) N/A Henry Ford Health System
 
Yes
 
(11)Healthlink
205 N East Avenue

Jackson,MI49201
38-2756425
Home Health Care MI 501(c)(3) Line 12a, I Henry Ford Allegiance Health Group
 
Yes
 
(12)Henry Ford Macomb Hospital Corporation
One Ford Place

Detroit,MI48202
38-2947657
Healthcare Service Provider DE 501(c)(3) Line 3 Henry Ford Health System
 
Yes
 
(13)The Clarence S Livingood Lectureship And Education Fund
3031 West Grand Boulevard No 800

Detroit,MI48202
38-2682321
Supporting Organization MI 501(c)(3) Line 12b, II Henry Ford Health System
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Page 2
Schedule R (Form 990) 2019
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) Foote Health Center Associates

1100 E Michigan Avenue
Jackson,MI49201
38-3017711
Lessor of Medical Condominiums MI WA Foote Memorial Hospital
 
Related       No     No  
(2) Northwest Detroit Dialysis

30100 Telegraph
Bingham Farms,MI48025
38-3232668
Operate Dialysis Clinic MI Henry Ford Health System
 
Related       No     No  
(3) Macomb Regional Dialysis Centers

16151 Nineteen Mile Rd
Clinton Township,MI48038
26-0423581
Operate Dialysis Clinic MI Henry Ford Health System
 
Related       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) Henry Ford Allegiance Pharmacy

205 N East Avenue
Jackson,MI49201
38-3370242
Pharmacy MI Henry Ford Allegiance Health Group
 
C       Yes  
(2) Sha Realty Inc

One Ford Place
Detroit,MI48202
38-1378121
Real Estate Holding MI Henry Ford Health System Foundation
 
C       Yes  
(3) Fairlane Health Services

30100 Telegraph
Bingham Farms,MI48025
38-2565235
Healthcare Management MI Henry Ford Health System
 
C       Yes  
(4) Alliance Health and Life Insurance

2850 W Grand Blvd
Detroit,MI48202
38-3291563
Health Insurance Provider MI Health Alliance Plan
 
C       Yes  
(5) HAP Preferred Inc

2850 W Grand Blvd
Detroit,MI48202
38-2513504
Provider Network Leasing MI Health Alliance Plan
 
C       Yes  
(6) Onika Insurance Ltd

First Carribean House
Grand Cayman    
CJ
Captive Insurance CJ Henry Ford Health System
 
C       Yes  
(7) Henry Ford Physician Network

one Ford Place
Detroit,MI48202
32-0306774
Physician Network MI Henry Ford Health System
 
C       Yes  
(8) Adminstration Systems Research Corporation

2850 W Grand Blvd
Detroit,MI48202
38-2651185
Thrid Party Insurance Admin. MI Health Alliance Plan
 
C       Yes  
(9) HAP Empowered Health Plan Inc

2850 W Grand Blvd
Detroit,MI48202
38-3123777
Health Insurance Provider MI Health Alliance Plan
 
C       Yes  
(10) Henry Ford Elijah McCoy Condominium Association

1150 Elijah McCoy Dr
Detroit,MI48202
85-2144748
Condominium Association MI Henry Ford Health System
 
C       Yes  
Schedule R (Form 990) 2019
Page 3
Schedule R (Form 990) 2019
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
 
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
 
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
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) Henry Ford Allegiance Health

K 86,630 Cost
(2) Henry Ford Allegiance Health

M 867,338 Cost
(3) Henry Ford Allegiance Health

P 2,003,800 Cost
(4) Jackson Community Ambulance

M 13,766 Cost
(5) Alliance Health & Life Insurance Co

M 52,038 cost

Schedule R (Form 990) 2019
Page 4
Schedule R (Form 990) 2019
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) 2019
Page 5
Schedule R (Form 990) 2019
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) 2019

Additional Data


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