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ObjectId: 202422279349303072 - Submission: 2024-08-14
TIN: 22-2563241
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
22
Open to Public Inspection
Name of the organization
SOUTHWESTERN VERMONT MEDICAL CENTER
Employer identification number
22-2563241
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)
SOUTHWESTERN VERMONT HEALTH CARE CORP
100 HOSPITAL DRIVE
BENNINGTON
,
VT
05201
03-0179435
MANAGEMENT
VT
501(C)(3)
LINE 3
N/A
No
(2)
MOUNT ANTHONY HOUSING CORPORATION
100 HOSPITAL DRIVE
BENNINGTON
,
VT
05201
03-0279740
NURSING HOMES
VT
501(C)(3)
LINE 10
SVHC
No
(3)
SOUTHWESTERN VT HEALTHCARE FOUNDATION
100 HOSPITAL DRIVE
BENNINGTON
,
VT
05201
45-3362785
FUNDRAISING
VT
501(C)(3)
LINE 12A, I
SVHC
No
(4)
TWIN RIVERS MEDICAL PC
16 DANFORTH STREET
HOOSICK FALLS
,
NY
12090
47-3028931
HEALTHCARE
NY
501(C)(3)
LINE 10
SVMC
Yes
(5)
NORTHERN BERKSHIRE MEDICAL PC
375 MAIN STREET
WILLIAMSTOWN
,
MA
01267
81-4023607
HEALTHCARE
MA
501(C)(3)
LINE 10
SVMC
Yes
(6)
HOOSICK FALLS HEALTH CENTER INC
21 DANFORTH STREET
HOOSICK FALLS
,
NY
12090
14-1370000
NURSING HOME
NY
501(C)(3)
LINE 3
SVHC
No
(7)
HOOSICK FALLS HEALTH CENTER FOUNDATION
21 DANFORTH STREET
HOOSICK FALLS
,
NY
12090
22-3186959
FUNDRAISING
NY
501(C)(3)
LINE 7
HFHC
No
(8)
SVHC REALTY INC
100 HOSPITAL DRIVE
BENNINGTON
,
VT
05201
86-1399877
REAL ESTATE MANAGEMENT
VT
501(C)(3)
LINE 12A, I
SVHC
No
(9)
DARTMOUTH-HITCHCOCK HEALTH
1 MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
26-4812335
PARENT ORGANIZATION
NH
501(C)(3)
LINE 7
N/A
No
(10)
VISITING NURSE ASSOCIATION AND HOSPICE OF VERMONT AND NEW HAMPSHIRE INC
88 PROSPECT STREET
WHITE RIVER JUNCTION
,
VT
05001
03-6006494
HOSPICE
VT
501(C)(3)
LINE 10
D-HH
No
(11)
CHESHIRE MEDICAL CENTER
580 COURT STREET
KEENE
,
NH
03431
02-0354549
HOSPITAL
NH
501(C)(3)
LINE 3
D-HH
No
(12)
MARY HITCHCOCK MEMORIAL HOSPITAL
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
02-0222140
HOSPITAL
NH
501(C)(3)
LINE 3
D-HH
No
(13)
DARTMOUTH-HITCHCOCK CLINIC
ONE MEDICAL CENTER DRIVE
LEBANON
,
NH
03756
22-2519596
PHYSICIAN SERVICES
NH
501(C)(3)
LINE 10
D-HH
No
(14)
WINDSOR HOSPITAL CORPORATION
289 COUNTY ROAD
WINDSOR
,
VT
05089
03-0183721
HOSPITAL
VT
501(C)(3)
LINE 3
D-HH
No
(15)
ALICE PECK DAY MEMORIAL HOSPITAL
10 ALICE PECK DAY DRIVE
LEBANON
,
NH
03766
02-0222791
HOSPITAL
NH
501(C)(3)
LINE 3
D-HH
No
(16)
THE NEW LONDON HOSPITAL ASSOCIATION
273 COUNTY ROAD
NEW LONDON
,
NH
03257
02-0222171
HOSPITAL
NH
501(C)(3)
LINE 3
D-HH
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2022
Page 2
Schedule R (Form 990) 2022
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)
SOUTHWESTERN VT HEALTHCARE ENTERPRISES
100 HOSPITAL DRIVE
BENNINGTON
,
VT
05201
03-0314501
HEALTH CARE
VT
N/A
C
No
Schedule R (Form 990) 2022
Page 3
Schedule R (Form 990) 2022
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
Yes
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
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
Yes
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)
NORTHERN BERKSHIRE MEDICAL PC
Q
375,000
FMV
(2)
NORTHERN BERKSHIRE MEDICAL PC
N
306,714
FMV
(3)
NORTHERN BERKSHIRE MEDICAL PC
R
609,026
FMV
(4)
TWIN RIVERS MEDICAL PC
Q
335,000
FMV
(5)
TWIN RIVERS MEDICAL PC
N
1,157,837
FMV
(6)
TWIN RIVERS MEDICAL PC
R
1,681,691
FMV
(7)
TWIN RIVERS MEDICAL PC
N
71,000
FMV
(8)
TWIN RIVERS MEDICAL PC
N
50,509
FMV
Schedule R (Form 990) 2022
Page 4
Schedule R (Form 990) 2022
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) 2022
Page 5
Schedule R (Form 990) 2022
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference
Explanation
SCHEDULE R PART II- IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS:
THE REPORTING ORGANIZATION IS A MEMBER OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM (ALSO KNOWN AS "DARTMOUTH HEALTH"). ADDITIONAL INFORMATION REGARDING RELATED ORGANIZATIONS CAN BE FOUND ON THE FORM 990, SCHEDULE R FOR DARTMOUTH-HITCHCOCK HEALTH.
Schedule R (Form 990) 2022
Additional Data
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