efile Public Visual Render
ObjectId: 202311329349306016 - Submission: 2023-05-12
TIN: 87-1006981
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
Piedmont Macon Hospital Inc
Employer identification number
87-1006981
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)
COLISEUM MEDICAL CENTER LLC
350 Hospital Drive
MACON
,
GA
31217
62-1736983
HEALTHCARE
GA
0
0
PMaH INC
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)
PIEDMONT HEALTHCARE INC
1800 HOWELL MILL RD STE 850
ATLANTA
,
GA
30318
58-1503902
HC MANAGEMENT
GA
501(c)(3)
12C, III-FI
NA
No
(2)
PIEDMONT HOSPITAL Inc
1968 PEACHTREE ROAD NW
ATLANTA
,
GA
30309
58-0566213
HOSPITAL
GA
501(c)(3)
3
PHC
No
(3)
FAYETTE COMMUNITY HOSPITAL INC
1255 HIGHWAY 54 WEST
FAYETTEVILLE
,
GA
30214
58-2232328
HOSPITAL
GA
501(c)(3)
3
PHC
No
(4)
PIEDMONT MOUNTAINSIDE HOSPITAL INC
1266 HIGHWAY 515 SOUTH
JASPER
,
GA
30143
35-2228583
HOSPITAL
GA
501(c)(3)
3
PHC
No
(5)
PIEDMONT NEWNAN HOSPITAL INC
745 POPLAR ROAD
NEWNAN
,
GA
30265
20-5077249
HOSPITAL
GA
501(c)(3)
3
PHC
No
(6)
PIEDMONT HEALTHCARE FOUNDATION INC
2001 PEACHTREE RD NE STE 400
ATLANTA
,
GA
30309
58-1272768
FUNDRAISING
GA
501(c)(3)
12B, II
PHC
No
(7)
PIEDMONT HENRY HOSPITAL INC
1133 EAGLES LANDING PKWY
STOCKBRIDGE
,
GA
30281
58-2200195
HOSPITAL
GA
501(c)(3)
3
PHC
No
(8)
PIEDMONT NEWTON HOSPITAL INC
5126 HOSPITAL DRIVE NE
COVINGTON
,
GA
30014
58-2155150
HOSPITAL
GA
501(C)(3)
3
PHC
No
(9)
PIEDMONT ATHENS REGIONAL FOUNDATION INC
1199 PRINCE AVENUE
ATHENS
,
GA
30606
58-1978389
FUNDRAISING
GA
501(c)(3)
12B, II
PARMC
No
(10)
PIEDMONT ATHENS REGIONAL HEALTH RESOURCE
1199 PRINCE AVENUE
athens
,
GA
30606
58-1930580
DEVELOPMENT
GA
501(c)(3)
12B, II
PARMC
No
(11)
PIEDMONT ATHENS REGIONAL MEDICAL CENTER
1199 PRINCE AVENUE
ATHENS
,
GA
30606
58-2179986
HOSPITAL
GA
501(c)(3)
3
PHC
No
(12)
ATHENS REGIONAL PHYSICIAN SERVICES INC
1199 PRINCE AVENUE
ATHENS
,
GA
30606
58-2332921
HEALTHCARE
GA
501(c)(3)
12B, II
PARMC
No
(13)
ATHENS REGIONAL SPECIALTY SERVICES INC
1199 PRINCE AVENUE
Athens
,
GA
30606
27-1975001
HEALTHCARE
GA
501(c)(3)
3
PARMC
No
(14)
REGIONAL FIRSTCARE INC
1199 PRINCE AVENUE
Athens
,
GA
30606
58-2362733
URGENT CARE
GA
501(c)(3)
12B, II
PARMC
No
(15)
THE MEDICAL CENTER INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1685139
HOSPITAL
GA
501(C)(3)
3
CRHS
No
(16)
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1719994
MANAGEMENT
GA
501(C)(3)
12B, II
PHC
No
(17)
COLUMBUS REGIONAL MEDICAL FOUNDATIONINC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1501642
FUNDRAISING
GA
501(C)(3)
7
CRHS
No
(18)
HUGHSTON HOSPITAL INC
707 CENTER STREET
COLUMBUS
,
GA
31901
33-1216751
HOSPITAL
GA
501(C)(3)
3
CRHS
No
(19)
PIEDMONT ROCKDALE HOSPITAL INC
1412 MILSTEAD AVE
CONYERS
,
GA
30012
30-0999841
HOSPITAL
GA
501(C)(3)
3
PHC
No
(20)
PIEDMONT WALTON HOSPITAL INC
2151 WEST SPRING ST
MONROE
,
GA
30655
82-4194264
HOSPITAL
GA
501(C)(3)
3
PHC
No
(21)
PIEDMONT HEART INSTITUTE INC
95 COLLIER ROAD NW STE 2045
ATLANTA
,
GA
30309
26-3553500
HEALTHCARE
GA
501(C)(3)
10
PHC
No
(22)
COLUMBUS AMBULATORY HEALTHCARE SERVICES
707 CENTER STREET
COLUMBUS
,
GA
31901
58-1719867
AMBULATORY
GA
501(C)(3)
3
CRHS
No
(23)
COLUMBUS REGIONAL SENIOR LIVING INC
707 CENTER STREET
COLUMBUS
,
GA
31901
58-2628502
HEALTHCARE
GA
501(C)(3)
12C, III-FI
PHC
No
(24)
PIEDMONT CARTERSVILLE HOSPITAL INC
960 JOE FRANK HARRIS PKWY SE
CARTERSVILLE
,
GA
30120
87-0963633
HOSPITAL
GA
501(C)(3)
3
PHC
No
(25)
PIEDMONT EASTSIDE HOSPITAL INC
1700 MEDICAL WAY
snellville
,
GA
30078
87-0982886
HOSPITAL
GA
501(C)(3)
3
PHC
No
(26)
PIEDMONT MACON NORTH HOSPITAL INC
400 CHARTER BLVD
MACON
,
GA
31210
87-1031034
HOSPITAL
GA
501(C)(3)
3
PHC
No
(27)
UNIVERSITY HEALTH SERVICES INC
1350 WALTON WAY
AUGUSTA
,
GA
30901
58-1581103
HOSPITAL
GA
501(C)(3)
3
PHC
No
(28)
UNIVERSITY MCDUFFIE COUNTY REG MED CTR
1350 WALTON WAY
AUGUSTA
,
GA
30901
45-4166209
HOSPITAL
GA
501(C)(3)
3
PHC
No
(29)
UNIVERSITY HEALTH CARE FOUNDATION INC
2260 WRIGHTSBORO ROAD
AUGUSTA
,
GA
30904
58-1343550
FUNDRAISING
GA
501(C)(3)
7
UHS
No
(30)
UNIVERSITY EXTENDED CARE INC
1350 WALTON WAY
AUGUSTA
,
GA
30901
58-1581105
HEALTHCARE
GA
501(C)(3)
3
UHS
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)
GA SURG CTR PCHTREE
2061 PEACHTREE RD STE 100
ATLANTA
,
GA
30309
58-2394271
SURGERY
GA
NA
NONE
0
0
No
0
No
(2)
ORTHOATLANTA SURGERY CENTER FAYETTEVILLE
900 CIRCLE 75 PKWY SE STE 1700
ATLANTA
,
GA
30339
20-2961633
SURGERY
GA
NA
NONE
0
0
No
0
No
(3)
ATHENS ASC HOLDINGS LLC
2142 W BROAD ST BLDG 100 STE 100
ATHENS
,
GA
30606
45-4014891
SURGERY
GA
NA
NONE
0
0
No
0
No
(4)
COLUMBUS DIAGNOSTIC IMAGING CTR
116 INTRACOASTAL POINTE DR 300
JUPITER
,
FL
33477
26-2291768
IMAGING
GA
NA
NONE
0
0
No
0
No
(5)
THE SURGERY CTR LLC
100 FIRST COURT
COLUMBUS
,
GA
31909
58-2520623
SURGERY
GA
NA
NONE
0
0
No
0
No
(6)
PIEDMONT ENCOMPASS REHAB HOSPITALS LLC
9001 LIBERTY PKWY
BIRMINGHAM
,
AL
35242
85-3544795
HEALTHCARE
DE
NA
NONE
0
0
No
0
No
(7)
COLISEUM SAME DAY SURGERY CTR LP
340 HOSPITAL DR
MACON
,
GA
31217
62-1805346
SURGERY
GA
NA
NONE
0
0
No
0
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)
Piedmont Medical Care Corporation
2727 Paces Ferry Road suite 1-1100
Atlanta
,
GA
30339
58-2092768
Healthcare
GA
NA
C CORP
0
0
No
(2)
THE PIEDMONT CLINIC INC
2727 Paces Ferry Road suite 1-1100
Atlanta
,
GA
30339
58-2005358
Healthcare
GA
NA
C CORP
0
0
No
(3)
PIEDMONT HEART INSTITUTE PHYSICIANS INC
95 COLLIER ROAD NW STE 2045
ATLANTA
,
GA
30309
26-0593850
Healthcare
GA
NA
C CORP
0
0
No
(4)
COLUMBUS HEALTHCARE RESOURCES
PO BOX 790
COLUMBUS
,
GA
31902
58-1717754
Healthcare
GA
NA
C CORP
0
0
No
(5)
Columbus Health Services Inc
PO BOX 790
COLUMBUS
,
GA
31902
58-1640939
Healthcare
GA
NA
C CORP
0
0
No
(6)
Amster McRae Insurance Company
PO BOX 1159
GRAND CAYMAN
KY1-1102
CJ
98-0427603
RELATED INSUR
CJ
NA
C CORP
0
0
No
(7)
UNIVERSITY HEALTH RESOURCES INC
PO BOX 790
COLUMBUS
,
GA
31901
58-1601372
HEALTHCARE
GA
NA
C-CORP
0
0
No
(8)
UNIVERSITY HOSPITAL AIKEN INC
1350 WALTON WAY
AUGUSTA
,
GA
30901
47-2713774
HOSPITAL
SC
NA
C-CORP
0
0
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
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
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
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
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, LINE 1: DISREGARDED ENTITIES
THE LIMITED LIABILITY COMPANY LISTED IN SCHEDULE R, PART I, OPERATES AS A DEPARTMENT OF PIEDMONT MACON HOSPITAL AND IS INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LIMITED LIABILITY COMPANY AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.
Schedule R (Form 990) 2021
Additional Data
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