efile Public Visual Render
ObjectId: 202312239349302171 - Submission: 2023-08-11
TIN: 58-2296052
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
Prisma Health-Midlands
Employer identification number
58-2296052
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)
PRISMA HEALTH MIDLANDS NETWORK
1301 TAYLOR STREET
STE 9A
COLUMBIA
,
SC
29210
27-3029587
ACO
SC
16,910,458
80,251
PRISMA HEALTH-MIDLANDS
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)
PRISMA HEALTH
300 E MCBEE AVE 302
GREENVILLE
,
SC
29601
82-2595551
HEALTHCARE
SC
501(c)(3)
Type III-FI
NA
No
(2)
PRISMA HEALTH-UPSTATE
300 E MCBEE AVE 302
GREENVILLE
,
SC
29601
81-1723202
HOSPITAL
SC
501(c)(3)
3
PRISMA HEALTH
No
(3)
PRISMA HEALTH TUOMEY
129 NORTH WASHINGTON STREET
SUMTER
,
SC
29150
47-4914917
HOSPITAL
SC
501(c)(3)
3
PRISMA HEALTH - MIDLANDS
Yes
(4)
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
300 E MCBEE AVE 302
GREENVILLE
,
SC
29601
57-1004971
PHYSICIAN PRACTICES
SC
501(c)(3)
10
PRISMA HEALTH-UPSTATE
No
(5)
GREENVILLE HEALTH CORPORATION
300 E MCBEE AVE 302
GREENVILLE
,
SC
29601
57-0835816
HEALTHCARE
SC
501(c)(3)
10
PRISMA HEALTH-UPSTATE
No
(6)
PRISMA HEALTH MIDLANDS FOUNDATION
1600 MARION STREET
COLUMBIA
,
SC
29202
57-0725699
SUPPORTS HOSPITAL
SC
501(c)(3)
Type III-FI
NA
No
(7)
PALMETTO RICHLAND MEMORIAL AUXILIARY
5 RICHLAND MEDICAL PARK DRIVE
COLUMBIA
,
SC
29203
57-0645678
SUPPORTS HOSPITAL
SC
501(c)(3)
Type II
NA
No
(8)
PRISMA HEALTH MEDICAL GROUP-MIDLANDS
15 MEDICAL PARK STE 300
COLUMBIA
,
SC
29203
47-1345819
PHYSICIAN PRACTICES
SC
501(c)(3)
10
PRISMA HEALTH - MIDLANDS
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)
RADIATION ONCOLOGY
7 RICHLAND MEDICAL PARK ROAD
COLUMBIA
,
SC
29203
36-4542465
HEALTHCARE
SC
NA
Related
1,150,261
1,714,386
No
No
51 %
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)
HEALTHSOURCE INC
PO BOX 2266
COLUMBIA
,
SC
29202
57-0938686
HEALTHCARE
SC
PRISMA HEALTH-MIDLANDS
C Corporation
1,528,499
2,937,811
100 %
Yes
(2)
HOSPITAL SERVICES INC
2751 THE BOULEVARD
COLUMBIA INDUSTRIAL PARK
COLUMBIA
,
SC
29209
HEALTHCARE
SC
PRISMA HEALTH-MIDLANDS
C Corporation
0
81,436
71.85 %
Yes
(3)
PHCA INC
300 E MCBEE AVENUE SUITE 302
GREENVILLE
,
SC
29601
88-3421661
HEALTHCARE
SC
NA
C Corporation
No
(4)
PHVPHIC INC
300 E MCBEE AVENUE SUITE 302
GREENVILLE
,
SC
29601
88-3279433
HEALTHCARE
SC
NA
C Corporation
No
(5)
PROMISE HEALTH INSURANCE COMPANY SC INC
300 E MCBEE AVENUE SUITE 302
GREENVILLE
,
SC
29601
88-2888859
INSURANCE
SC
NA
C Corporation
No
(6)
PROMISE FIRST INC
300 E MCBEE AVENUE SUITE 302
GREENVILLE
,
SC
29601
88-4158136
INSURANCE
SC
NA
C Corporation
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
Yes
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
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
Yes
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
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
(1)
PRISMA HEALTH MIDLANDS FOUNDATION
C
1,552,785
BOOK BASIS
(2)
Prisma Health University Medical Group Prisma Health Prisma Health-Midlands
Prisma Health Tuomey
I
1,577,822
BOOK BASIS
(3)
Prisma Health University Medical Group Greenville Health Corporation Prisma
Health Prisma Health-Upstate Prisma Health Medical Group-Midlands
J
2,322,576
BOOK BASIS
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 V, Line 1q
ENTRIES ARE MADE TO TRANSFER EXPENSES BETWEEN RELATED ENTITIES TO THE APPROPRIATE ENTITY; HOWEVER, NO EXCHANGE OF CASH OCCURS.
Schedule R (Form 990) 2021
Additional Data
Software ID:
21014044
Software Version:
2021v4.2