efile Public Visual Render
ObjectId: 202341399349301009 - Submission: 2023-05-19
TIN: 41-1668347
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
BROWNS VALLEY HEALTH CENTER
Employer identification number
41-1668347
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)
AITKIN HEALTH SERVICES
301 MINNESOTA AVENUE
AITKIN
,
MN
56431
20-3367397
CAREGIVER
MN
501C3
10
SFHS
No
(2)
CHISHOLM HEALTH CENTER
321 NE 8TH STREET
CHISHOLM
,
MN
55719
41-1879639
CAREGIVER
MN
501C3
10
SFHS
No
(3)
DULUTH HEALTH SERVICES
3111 CHRUCH PLACE
DULUTH
,
MN
55811
41-1843283
CAREGIVER
MN
501C3
10
SFHS
No
(4)
FARMINGTON HEALTH SERVICES
3410 23RD STREET W
FARMINGTON
,
MN
55024
20-0100365
CAREGIVER
MN
501C3
10
SFHS
No
(5)
FRANCISCAN HEALTH CENTER
3910 MINNESOTA AVENUE
DULUTH
,
MN
55802
41-1799268
CAREGIVER
MN
501C3
10
SFHS
No
(6)
GUARDIAN ANGELS HEALTH & REHAB CENT
1500 3RD AVENUE E
HIBBING
,
MN
55746
41-1810369
CAREGIVER
MN
501C3
10
SFHS
No
(7)
KOOCHICHING HEALTH SERVICES
901 MAIN STREET
LITTLEFORK
,
MN
56635
81-0901949
CAREGIVER
MN
501C3
10
SFHS
No
(8)
LITTLE FALLS HEALTH SERVICES
1200 NE 1ST AVE
LITTLE FALLS
,
MN
56345
46-3626109
CAREGIVER
MN
501C3
10
SFHS
No
(9)
MORRIS HEALTH SERVICES
1001 SCOTT AVENUE
MORRIS
,
MN
56267
23-7625632
CAREGIVER
MN
501C3
10
SFHS
No
(10)
PENNINGTON HEALTH SERVICES
2001 EASTWOOD DR
THIEF RIVER FALLS
,
MN
56701
20-5617275
CAREGIVER
MN
501C3
10
SFHS
No
(11)
PRAIRIE COMMUNITY SERVICES
801 NEVADA AVENUE
MORRIS
,
MN
56267
41-1598442
CAREGIVER
MN
501C3
10
SFHS
No
(12)
RENVILLE HEALTH SERVICES
205 SE ELM AVENUE
RENVILLE
,
MN
56284
20-2581924
CAREGIVER
MN
501C3
10
SFHS
No
(13)
ST FRANCIS HEALTH SERVICES (SFHS)
801 NEVADA AVENUE
MORRIS
,
MN
56267
41-1484416
MGMT COMP
MN
501C3
12B
N/A
No
(14)
ZUMBROTA HEALTH SERVICES
433 MILL STREET
ZUMBROTA
,
MN
55992
51-0487275
CAREGIVER
MN
501C3
10
SFHS
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
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
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
Yes
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)
ST FRANCIS HEALTH SERVICES OF MORR
M
135,486
AMOUNT PAID OR ACCRUED
(2)
ST FRANCIS HEALTH SERVICES OF MORR
R
23,950
AMOUNT PAID OR ACCRUED
(3)
ST FRANCIS HEALTH SERVICES OF MORR
K
6,714
AMOUNT PAID OR ACCRUED
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
ST. FRANCIS HEALTH SERVICES OF MORRIS, INC HAS GUARANTEED EXISTING LOANS OF 743,492 AS SHOWN IN FORM 990, PART X, LINE 20. THERE WERE NO NEW LOAN GUARANTEES DURING THE FISCAL YEAR. BROWNS VALLEY HEALTH SERVICES ALSO HAS AN EXISTING LOAN PAYABLE TO ST. FRANCIS HEALTH SERVICES OF MORRIS, INC OF 175,171 AS SHOWN IN FORM 990, PART X, LINE 24. THE ORGANIZATION ALSO PAID INTEREST OF 9,485 TO ST. FRANCIS HEALTH SERVICES OF MORRIS, INC.
Schedule R (Form 990) 2021
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