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ObjectId: 202212279349302816 - Submission: 2022-08-15
TIN: 59-3528774
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
Health First Inc
Employer identification number
59-3528774
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)
Cape Canaveral Hospital Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
59-2477479
Hospital
FL
501(c)(3)
Line 3
Health First Shared Services Inc
Yes
(2)
Health First Foundation Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
84-3851693
Fundraising
FL
501(c)(3)
Line 7
Health First Shared Services Inc
Yes
(3)
Health First Shared Services Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
59-3336894
Shared Services
FL
501(c)(3)
Line 10
Health First Inc
Yes
(4)
Holmes Regional Medical Center Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
59-0624371
Hospital
FL
501(c)(3)
Line 3
Health First Shared Services Inc
Yes
(5)
Hospice of Health First Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
59-1911574
Healthcare
FL
501(c)(3)
Line 10
Health First Shared Services Inc
Yes
(6)
Viera Hospital Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
26-4019868
Hospital
FL
501(c)(3)
Line 3
Health First Shared Services Inc
Yes
(7)
Health First Administrative Plans Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
82-1851221
Healthcare
FL
501(c)(4)
Health First Shared Services Inc
Yes
(8)
Health First Commercial Plans Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
82-1866443
Healthcare
FL
501(c)(4)
Health First Shared Services Inc
Yes
(9)
Health First Health Plans Inc
3300 Fiske Blvd
Rockledge
,
FL
329554305
47-2736029
Healthcare
FL
501(c)(4)
Health First Shared Services Inc
Yes
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)
Doctors GI Partnership Ltd
3300 Fiske Blvd
Rockledge
,
FL
32955
59-3758988
Healthcare
FL
N/A
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)
Cape Health Properties Inc
3300 Fiske Blvd
Rockledge
,
FL
32955
59-3086711
Real Estate
FL
N/A
C
Yes
(2)
Health First Holding Corp
3300 Fiske Blvd
Rockledge
,
FL
32955
59-3509709
Holding Corp.
FL
N/A
C
Yes
(3)
Health First Insurance Inc
3300 Fiske Blvd
Rockledge
,
FL
32955
45-3131932
Health Care
FL
N/A
C
Yes
(4)
Health First Medical Management Inc
3300 Fiske Blvd
Rockledge
,
FL
32955
59-3348252
Health Care
FL
N/A
C
Yes
(5)
Health First Physician Specialties
3300 Fiske Blvd
Rockledge
,
FL
32955
26-3094596
Health Care
FL
N/A
C
Yes
(6)
Health First Physicians Inc
3300 Fiske Blvd
Rockledge
,
FL
32955
59-3346397
Health Care
FL
N/A
C
Yes
(7)
Holmes Regional Enterprises Inc
3300 Fiske Blvd
Rockledge
,
FL
32955
59-2109953
Real Estate
FL
N/A
C
Yes
(8)
Physicians GI Partnership Inc
3300 Fiske Blvd
Rockledge
,
FL
32955
59-3756961
Health Care
FL
N/A
C
Yes
(9)
Space Coast Indemnity
PO Box 1051
Grand Cayman
KY1-1102
CJ
98-1612801
Self-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
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
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
Yes
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)
Health First Foundation Inc
R
6,437,272
See part VII
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
Form 990, Schedule R, Part V, Disclosures:
All transactions reported in this section are based upon corporate books and records which are kept according to Generally Accepted Accounting Principles. Net Assets were transferred to HF Foundation, Inc. Please see schedule N for further details.
Schedule R (Form 990) 2020
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