efile Public Visual Render
ObjectId: 202341359349302724 - Submission: 2023-05-15
TIN: 38-2642724
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
MUNSON HEALTHCARE FOUNDATIONS
Employer identification number
38-2642724
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)
MUNSON DIALYSIS CENTER
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
38-3097861
DIALYSIS
MI
C3
3
MUNSON HC
MUNSON HEALTHCARE
Yes
(2)
MUNSON HEALTHCARE
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
38-2640544
PARENT
MI
C3
12B
N/A
No
(3)
MUNSON HOME CARE
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
38-2191390
HOME HEALT
MI
C3
10
MUN HOME H
MUNSON HOME HEALTH
Yes
(4)
MUNSON HOME SERVICES
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
38-2543463
HOME HEALT
MI
C3
10
MUN HOME H
MUNSON HOME HEALTH
Yes
(5)
MUNSON MEDICAL CENTER
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
38-1362830
HOSPITAL
MI
C3
3
MUNSON HC
MUNSON HEALTHCARE
Yes
(6)
NORTH FLIGHT INC
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
38-2657917
MED TRANSP
MI
C3
12B
MUNSON HC
MUNSON HEALTHCARE
Yes
(7)
PAUL OLIVER MEMORIAL HOSPITAL
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
38-1415623
HEALTHCARE
MI
C3
3
MUNSON HC
MUNSON HEALTHCARE
Yes
(8)
MUNSON MEDICAL GROUP
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
27-3600575
PHYSICIAN
MI
C3
10
MUNSON MED
MUNSON MEDICAL CENTER
Yes
(9)
MUNSON HEALTHCARE CADILLAC
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
47-1156297
HOSPITAL
MI
C3
3
MUNSON HC
MUNSON HEALTHCARE
Yes
(10)
MUNSON HEALTHCARE GRAYLING
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
47-1161992
HOSPITAL
MI
C3
3
MUNSON HC
MUNSON HEALTHCARE
Yes
(11)
MUNSON HEALTHCARE CHARLEVOIX HOSPIT
1105 SIXTH ST
TRAVERSE CITY
,
MI
49684
38-1459366
HOSPITAL
MI
C3
3
MUNSON HC
Yes
(12)
MUNSON HEALTHCARE MANISTEE HOSPITAL
1465 E PARKDALE AVE
MANISTEE
,
MI
496609709
38-0350304
HOSPITAL
MI
C3
3
MUNSON HC
Yes
(13)
MUNSON HEALTHCARE OTSEGO MEMORIAL H
825 N CENTER AVE
GAYLORD
,
MI
497351592
38-1303843
HOSPITAL
MI
C3
3
MUNSON HC
MUNSON HEALTHCARE
Yes
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)
NORTHERN MICHIGAN SUPPLY ALLIANCE
2651 AERO PARK DR
TRAVERSE CITY
,
MI
49686
38-3453378
PURCHASING
MI
N/A
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)
MUNSON SUPPORT SERVICES
PO BOX 1188
TRAVERSE CITY
,
MI
496851188
38-2872821
LAUNDRY
MI
N/A
Yes
(2)
MUNSON SERVICES INC
PO BOX 1188
TRAVERSE CITY
,
MI
496851188
38-3144382
PHARMACY
MI
N/A
Yes
(3)
MEDICAL OFFICE BUILDING CONDOMINIUM
ASSOCIATION
PO BOX 1188
TRAVERSE CITY
,
MI
496851188
38-3567278
REAL ESTAT
MI
N/A
Yes
(4)
SIXTH STREET DRUGS INC
PO BOX 1188
TRAVERSE CITY
,
MI
496851188
38-2298290
PHARMACY
MI
N/A
Yes
(5)
MEDICAL OFFICE CONDOMINIUM
ASSOCIATION
PO BOX 1188
TRAVERSE CITY
,
MI
496851188
20-1902620
REAL ESTAT
MI
N/A
Yes
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
Yes
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
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
No
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
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
(1)
MUNSON HEALTHCARE
P
220,086
ACTUAL AMOUNT PAID
(2)
MUNSON HEALTHCARE
O
84,846
ACTUAL AMOUNT PAID
(3)
MUNSON HEALTHCARE CADILLAC
B
1,251,060
ACTUAL AMOUNT PAID
(4)
MUNSON HEALTHCARE CADILLAC
L
137,528
ACTUAL AMOUNT PAID
(5)
MUNSON HEALTHCARE CHARLEVOIX HOSPIT
B
98,254
ACTUAL AMOUNT PAID
(6)
MUNSON HEALTHCARE CHARLEVOIX HOSPIT
L
79,309
ACTUAL AMOUNT PAID
(7)
MUNSON HEALTHCARE GRAYLING
B
81,229
ACTUAL AMOUNT PAID
(8)
MUNSON HEALTHCARE GRAYLING
L
117,923
ACTUAL AMOUNT PAID
(9)
MUNSON HEALTHCARE MANISTEE HOSPITAL
B
67,787
ACTUAL AMOUNT PAID
(10)
MUNSON HEALTHCARE MANISTEE HOSPITAL
L
87,325
ACTUAL AMOUNT PAID
(11)
MUNSON HEALTHCARE OTSEGO MEMORIAL H
B
147,888
ACTUAL AMOUNT PAID
(12)
MUNSON HEALTHCARE OTSEGO MEMORIAL H
L
146,734
ACTUAL AMOUNT PAID
(13)
MUNSON HOME CARE
B
508,531
ACTUAL AMOUNT PAID
(14)
MUNSON MEDICAL CENTER
B
5,066,249
ACTUAL AMOUNT PAID
(15)
MUNSON MEDICAL CENTER
L
900,475
ACTUAL AMOUNT PAID
(16)
MUNSON MEDICAL CENTER
P
80,066
ACTUAL AMOUNT PAID
(17)
MUNSON MEDICAL CENTER
O
824,637
ACTUAL AMOUNT PAID
(18)
PAUL OLIVER MEMORIAL HOSPITAL
B
757,381
ACTUAL AMOUNT PAID
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
MUNSON HEALTHCARE FOUNDATIONS USED THE ACCRUAL METHOD OF ACCOUNTING TO VALUE THE TRANSACTIONS WITH RELATED ENTITIES. ALL INTERCOMPANY TRANSACTIONS WITH RELATED ENTITIES WERE REVIEWED, SUMMARIZED, AND RECONCILED TO DETERMINE THE DISCLOSURE AMOUNTS.
Schedule R (Form 990) 2021
Additional Data
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