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ObjectId: 202301299349302095 - Submission: 2023-05-09
TIN: 43-2007492
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
HOME & COMMUNITY SERVICES INC
Employer identification number
43-2007492
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)
H&CS SERVICES LLC
PO BOX 1803
MACON
,
GA
31202
45-5012031
HEALTHCARE
GA
48,541
NA
(2)
MGAS HOLDINGS LLC
PO BOX 1803
MACON
,
GA
31202
45-3639743
HEALTHCARE
GA
206,725
4,276,596
NA
(3)
JACKSON COUNTY HC HOLDINGS LLC
PO BOX 1037
MACON
,
GA
31202
46-4302674
HEALTHCARE
GA
4,741,256
NA
(4)
COMMUNITY AMBULANCE COMPANY LLC
PO BOX 1803
MACON
,
GA
31202
45-5012031
AMBULANCE
GA
12,532,092
3,229,617
NA
(5)
RESTORATION HEALTHCARE COMMERCELLC
70 MEDICAL CENTER DRIVE
COMMERCE
,
GA
30529
27-1914362
HOSPITAL
GA
10,956,292
1,851,159
NA
(6)
RHC REAL ESTATE LLC
PO BOX 1037
MACON
,
GA
31202
27-2146759
REALESTATE
GA
876,554
5,595,328
NA
(7)
COMMERCE PHYSICIAN GROUP LLC
PO BOX 1037
MACON
,
GA
31202
36-4737947
HEALTHCARE
GA
NA
(8)
SOURCE CARE MANAGEMENT LLC
PO BOX 1803
MACON
,
GA
31202
58-2651175
CASE MGMT
GA
15,423,720
940,903
NA
(9)
AMICITA HOME HEALTH
213 THIRD STREET
MACON
,
GA
31201
27-1563270
HOME HEALT
GA
2,627,669
1,521,823
NA
(10)
AFFINIS HOSPICE
213 THIRD STREET
MACON
,
GA
31201
27-1452535
HOSPICE
GA
24,600,470
3,989,154
NA
(11)
STONEBROOKE SUITES LLC
1005 BOULDER DRIVE
GRAY
,
GA
31032
54-2101866
HEALTHCARE
GA
460,059
44,470
NA
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)
CLINICAL SERVICES INC
1005 BOULDER DRIVE
GRAY
,
GA
31032
57-1157115
CLINICAL &
GA
501C
10
CHSI
No
(2)
COMMUNITY HEALTH FOUNDATION INC
110 STONE BROOKE DRIE
GRAY
,
GA
31032
57-1157153
FINANCIAL
GA
501C
10
CHSI
No
(3)
COMMUNITY HEALTH SYSTEMS INC
PO BOX 1037
MACON
,
GA
31202
74-3083593
SUPPORT SE
GA
501C
12A
NA
No
(4)
COMMUNITY REHABILITATION SERVICES
110 STONE BROOKE DRIVE
GRAY
,
GA
31032
20-3253779
REHABILITA
GA
501C
10
CHSI
No
(5)
HEALTH SCHOLARSHIPS INC
1005 BOULDER DRIVE
GRAY
,
GA
31032
58-1805305
OPERATION
GA
501C
10
CHSI
No
(6)
HEALTH SYSTEMS REAL ESTATE INC
110 STONE BROOKE DRIVE
GRAY
,
GA
31032
43-2007488
RE
GA
501C
10
CHSI
No
(7)
HEALTH SYSTEMS FACILITIES INC
1005 BOULDER DRIVE
GRAY
,
GA
31032
74-3083594
OPERATION
GA
501C
10
CHSI
No
(8)
COMMUNITY ANCILLARY SERVICES INC
110 STONE BROOKE DRIVE
GRAY
,
GA
31032
43-2007496
PHAR
GA
501C
10
CHSI
No
(9)
PIEDMONT REGIONAL HEALTH INC
1005 BOULDER DRIVE
GRAY
,
GA
31032
43-2007498
OPERATION
GA
501C
10
CHSI
No
(10)
STEWARD HEALTH SERVICES INC
110 STONE BROOKE DRIVE
GRAY
,
GA
31032
43-2007486
HOSPICE
GA
501C
10
CHSI
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
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)
COMMUNITY HEALTH VENTURES INC
4875 RIVERSIDE DRIVE SUITE 105
MACON
,
GA
31210
20-1392241
RISK MGMT.
GA
CHSI
C CORP
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
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
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)
COMMUNITY HEATH SYSTEMS INC
M
2,761,204
(2)
CLINICAL SERVICES INC
M
1,011,384
(3)
COMMUNITY ANCILLARY SERVICES INC
M
996,317
(4)
COMMUNITY REHABILITATION SERVICES
M
1,498,487
(5)
HEATLH SCHOLARSHIPS INC
K
7,716,000
(6)
HEALTH SYSTEMS FACILITIES INC
K
1,992,000
(7)
PIEDMONT REGIONAL HEALTH INC
K
566,000
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 (Form 990) 2021
Additional Data
Software ID:
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