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ObjectId: 202221059349300702 - Submission: 2022-04-14
TIN: 38-1366927
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
21
Open to Public Inspection
Name of the organization
Holland Home
Employer identification number
38-1366927
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)
Christian Living Services
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
26-1126816
Admin Services
MI
501(c)(3)
12b
N/A
No
(2)
Faith Hospice
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
38-3062893
Hospice Care
MI
501(c)(3)
12b
Christian Living Services
No
(3)
Reliance Community Care Partners
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
38-2295909
Community Services
ME
501(c)(3)
10
Christian Living Services
No
(4)
Helpers of Holland Home
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
27-1062997
In-Home services
MI
501(c)(3)
12b
Christian Living Services
No
(5)
Atrio Home Health
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
38-2660300
Home Health Care
MI
501(c)(3)
12b
Christian Living Services
No
(6)
Trillium Institute
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
47-1295260
Education Services
MI
501(c)(3)
12b
Christian Living Services
No
(7)
Rehab Dimensions
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
38-3337881
Rehabilitation Services
MI
501(c)(3)
12b
Christian Living Services
No
(8)
Atrio Home Health Lakeshore
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
81-4839696
Home Health Care
MI
501(c)(3)
12b
Atrio Home Care
No
(9)
Atrio Home Care
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
81-3166606
In-Home Services
MI
501(c)(3)
10
CLS
No
(10)
Holland Home Foundation
2100 Raybrook St SE Suite 300
Grand Rapids
,
MI
49546
38-2663466
Mission Fundraising
MI
501(c)(3)
7
Holland Home
Yes
(11)
Care Resources
4150 Kalamazoo Ave SE
Grand Rapids
,
MI
49508
30-0166828
PACE Services
MI
501(c)(3)
12b
N/A
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Page 2
Schedule R (Form 990) 2021
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)
EHCO Group LLC
2100 Raybrook St SE
Grand Rapids
,
MI
49534
health management
MI
N/A
Related
No
No
20 %
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) 2021
Page 3
Schedule R (Form 990) 2021
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
Yes
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
Yes
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
Yes
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
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
(1)
Holland Home Foundation
c
650,000
cash transfer/gift.
(2)
Atrio Home Care
m
306
Purchased Services.
(3)
Care Resources
r
211
Payroll donations.
(4)
Faith Hospice
r
62,010
Transfer of donations.
(5)
Holland Home Foundation
r
24,081
Donation transfers
(6)
Reliance Community Care Partners
p
17,588
Reimbursement for expenses.
(7)
Faith Hospice
l
1,089,172
Board & Care rates - set fee based on services.
(8)
Faith Hospice
j
95,331
Rent
(9)
Faith Hospice
l
2,197,560
Management services
(10)
Faith Hospice
q
1,847,016
Reimbursement for expenses.
(11)
Holland Home Foundation
s
2,000
Contribution transfer
(12)
Holland Home Foundation
q
576
Expense reimbursement
(13)
Atrio Home Care
q
212,869
Reimbursement for expenses
(14)
Atrio Home Care
l
74,969
Management fees.
(15)
Atrio Home Health
q
455,765
Reimbursement for expenses
(16)
Atrio Home Health
l
314,203
Management fee
(17)
Atrio Home Health
j
58,858
Rent
(18)
Atrio Home Health Lakeshore
q
162,635
Reimbursement for expenses
(19)
Atrio Home Health Lakeshore
l
153,424
Management fee
(20)
Care Resources
q
7,746,964
Reimbursement for expenses.
(21)
Care Resources
l
263,778
Management fee
(22)
Reliance Community Care Partners
q
595,751
Reimbursement for expenses.
(23)
Reliance Community Care Partners
l
1,154,976
Management fee
(24)
Reliance Community Care Partners
k
226,416
Rent
(25)
EHCO Group LLC
q
3,269,235
Reimbursement for expenses.
(26)
EHCO Group LLC
l
179,840
Management fee
(27)
Trillium Institute
q
537,815
Reimbursement for expenses.
(28)
Trillium Institute
l
45,000
Management fee
(29)
Reliance Community Care Partners
r
75,000
Interest on note payable.
(30)
EHCO Group LLC
s
40,000
Payment of loan
Schedule R (Form 990) 2021
Page 4
Schedule R (Form 990) 2021
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) 2021
Page 5
Schedule R (Form 990) 2021
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference
Explanation
Schedule R, Part I
EHCO Group, LLC (dba Tandem 365) is not an exempt organization. Holland Home, a wholly-owned subsidiary of Christian Living Services, maintains a 20% membership interest. The organization is a collaborative partnership between five organizations focused on managing health care costs of a specific pool of individuals, based upon contracting with health insurers and health care providers. Raybrook Partners was dissolved in 2018 and previously held ownership of the 2100 Raybrook corporate office of Holland Home. The property was transferred to Holland Home in 2018 and the partnership subsequently dissolved
Schedule R (Form 990) 2021
Additional Data
Software ID:
21013178
Software Version:
v1.00