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
2020
Open to Public Inspection
Name of the organization
HEALTH SERVICES MANAGEMENT INC
 
Employer identification number

62-1808817
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) AYERS HEALTH & REHABILITATION CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
62-1832456
NURSING CENTER FL 11,942,250 8,982,281 N/A
(2) BEAR CREEK NURSING CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
62-1832453
NURSING CENTER FL 12,346,034 7,070,518 N/A
(3) BROOKSVILLE HEALTH CARE CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
62-1832455
NURSING CENTER FL 15,354,523 6,935,479 N/A
(4) CYPRESS COVE CARE CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
62-1832454
NURSING CENTER FL 12,324,828 3,547,329 N/A
(5) HEATHER HILL NURSING CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
62-1832434
NURSING CENTER FL 10,056,692 2,363,522 N/A
(6) ROYAL OAK NURSING CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
62-1832435
NURSING CENTER FL 11,840,340 5,179,146 N/A
(7) HEALTH SERVICES MGMT OF FLORIDA LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
20-5198485
ADMINISTRATIVE OPERATIONS FOR FL NURSING CENTERS FL 170,724 -73,511 N/A
(8) HSMTXSTALLONES-TOMBALL LLC
13415 MEDICAL COMPLEX DRIVE
TOMBALL,TX77375
52-2331985
NURSING CENTER TX 2,192,270 -9,236 N/A
(9) HSMTXJANISCH-HOUSTON LLC
617 JANISCH
HOUSTON,TX77018
52-2331995
NURSING CENTER TX 4,838,645 -718,768 N/A
(10) HSMTXRICHMOND LLC
705 JACKSON
RICHMOND,TX77469
52-2332014
NURSING CENTER TX 3,979,039 -1,265,745 N/A
(11) HSMTXCONROE LLC
2019 NORTH FRAIZER
CONROE,TX77301
52-2332002
NURSING CENTER TX 7,166,100 1,659,163 N/A
(12) HSMTXFRIENDSWOOD LLC
213 HERITAGE
FRIENDSWOOD,TX77546
52-2331987
NURSING CENTER TX 6,225 -1,242,478 N/A
(13) HSMTXHUNTSVILLE LLC
2628 MILAM
HUNTSVILLE,TX77340
52-2332015
NURSING CENTER TX 5,148,168 700,942 N/A
(14) HSMTXCLEVELAND LLC
903 EAST HOUSTON
CLEVELAND,TX77340
52-2332016
NURSING CENTER TX 8,864,446 4,373,873 N/A
(15) HSMTXBEAUMONT LLC
795 LINDBERGH
BEAUMONT,TX77707
52-2331997
NURSING CENTER TX 326,744 1,892,390 N/A
(16) HSMTXLINDBERGH-BEAUMONT LLC
4150 COLLEGE STREET
BEAUMONT,TX77707
52-2331994
NURSING CENTER TX 5,419,222 3,072,514 N/A
(17) HSMTXLAWRENCE-TOMBALL LLC
615 LAWRENCE
TOMBALL,TX77375
52-2332020
NURSING CENTER TX 7,411,683 507,495 N/A
(18) HSMTXSUGAR LAND LLC
333 MATLAGE WAY
SUGAR LAND,TX77478
52-2332006
NURSING CENTER TX 10,252,887 4,358,149 N/A
(19) HSMTXLIBERTY LLC
1206 NORTH TRAVIS
LIBERTY,TX77575
52-2332017
NURSING CENTER TX 7,904,346 1,945,323 N/A
(20) HEALTH SERVICES MGMT OF TEXAS LLC
13415 MEDICAL COMPLEX DRIVE
TOMBALL,TX77375
41-2061529
ADMINISTRATIVE OPERATIONS FOR TX NURSING CENTERS TX 7,628 10,153,015 N/A
(21) CASTLETON HEALTH CARE CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
52-2274993
NURSING CENTER IN 232,637 -2,149,728 N/A
(22) HSM FINANCIAL SERVICES LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
26-1146659
FINANCIAL SERVICES FOR ALL CONSOLIDATING ENTITIES TN 198,833 20,047,534 N/A
(23) RICHMOND REALTY LLC
705 JACKSON STREET
RICHMOND,TX77469
80-0295974
HOLDS REAL ESTATE FOR NURSING CENTER TX 162 -921,508 N/A
(24) SUGAR LAND REALTY LLC
333 MATLAGE WAY
SUGAR LAND,TX77478
26-3663166
HOLDS REAL ESTATE FOR NURSING FACILITY TX -5,247 -2,843,455 N/A
(25) FRIENDSWOOD REALTY LLC
213 HERITAGE
FRIENDSWOOD,TX77546
37-0560353
HOLDS REAL ESTATE FOR NURSING FACILITY TX 200,800 2,519,546 N/A
(26) HSMINHEALTH SERVICES MANAGEMENT OF INDIANA LLC
7056 W GULF TO LAKE HIGHWAY
CRYSTAL RIVER,FL34429
45-3820667
NO ACTIVITY IN 0 0 N/A
(27) LINDBERGH-BEAUMONT REALTY LLC
795 LINDBERGH
BEAUMONT,TX77707
26-3662748
HOLDS REAL ESTATE FOR NURSING FACILITY TX 144 -620,149 N/A
(28) CLEVELAND REALTY LLC
903 EAST HOUSTON
CLEVELAND,TX77340
45-0645556
HOLDS REAL ESTATE FOR NURSING FACILITY TX -26,315 -1,821,518 N/A
(29) JANISCH-HOUSTON REALTY LLC
617 JANISCH
HOUSTON,TX77018
45-0646051
HOLDS REAL ESTATE FOR NURSING FACILITY TX -2,253 411,287 N/A
(30) HUNTSVILLE REALTY LLC
2628 MILAM
HUNTSVILLE,TX77340
45-0646221
HOLDS REAL ESTATE FOR NURSING FACILITY TX -14,189 -833,976 N/A
(31) LIBERTY REALTY LLC
1206 NORTH TRAVIS
LIBERTY,TX77575
80-0295944
HOLDS REAL ESTATE FOR NURSING FACILITY TX -2,385 -1,009,414 N/A
(32) LAWRENCE-TOMBALL REALTY LLC
615 LAWRENCE
TOMBALL,TX77375
27-1768886
HOLDS REAL ESTATE FOR NURSING FACILITY TX 158 -1,178,453 N/A
(33) CONROE REALTY LLC
2019 NORTH FRAIZER
CONROE,TX77301
80-0295954
HOLDS REAL ESTATE FOR NURSING FACILITY TX 148 -1,452,594 N/A
(34) HSMTXMASTER TENANT LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
45-4639375
REAL ESTATE PASS THROUGH ENTITY TX 0 -3,154 N/A
(35) HSM TRANSPORTATION LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
46-3773826
HOLD TRANSPORTATION ASSETS TN 0 -331,476 N/A
(36) BROWNSBURG HEALTH CARE CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
52-2326251
NURSING CENTER IN 1,865,907 3,696,300 N/A
(37) PLAINFIELD HEALTH CENTER LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
52-2326247
NURSING CENTER IN 4,022,273 6,402,268 N/A
(38) HSM REALTY LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
REAL ESTATE ENTITY TN 0 -375,510 N/A
(39) HSMTNTHE LODGE OPERATING COMPANY LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
45-2683488
ASSISTED LIVING CENTER TN 4,643,370 1,895,013 N/A
(40) HSMTNTHE LODGE AT NATCHEZ TRACE
206 FORTRESS BLVD
MURFREESBORO,TN37128
45-2683380
HOLDS REAL ESTATE FOR NURSING FACILITY TN 0 2,706,504 N/A
(41) HSM PHARMACY SERVICES LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
47-1658071
PHARMACY JOINT VENTURE TN 452,351 2,073,781 N/A
(42) HEALTH SERVICES MANAGEMENT OF TENNESSEE LLC
206 FORTRESS BLVD
MURFREESBORO,TN37128
47-3946821
PAYROLL LEASING COMPANY TN 0 -4,578,960 N/A
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












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












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












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
 
 
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
 
e Loans or loan guarantees by related organization(s) ............................
1e
 
 
f Dividends from related organization(s) ............................
1f
 
 
g Sale of assets to related organization(s) ............................
1g
 
 
h Purchase of assets from related organization(s) ............................
1h
 
 
i Exchange of assets with related organization(s) ............................
1i
 
 
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
 
o Sharing of paid employees with related organization(s) ............................
1o
 
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
 
s Other transfer of cash or property from related organization(s) ............................
1s
 
 
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


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