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ObjectId: 202432289349304278 - Submission: 2024-08-15
TIN: 54-1190879
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
Carilion Services Inc
Employer identification number
54-1190879
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)
BLUE RIDGE INDEMNITY COMPANY LLC
76 ST PAUL STREET
SUITE 500
BURLINGTON
,
VT
05401
27-0927178
INSURANCE
VT
15,331,178
82,564,267
CARILION SERVICES INC
(2)
CARILION CLINIC PATIENT TRANSPORTATION LLC
PO BOX 12385
ROANOKE
,
VA
24025
54-1864693
TRANSPORTATION
VA
11,247,325
4,640,136
CARILION SERVICES INC
(3)
CARILION PROFESSIONAL SERVICES LLC
PO BOX 12385
ROANOKE
,
VA
24025
54-2030773
HEALTHCARE
VA
15,790,292
220,087
CARILION SERVICES 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)
CARILION CLINIC
PO BOX 12385
ROANOKE
,
VA
24025
54-1190771
SUPPORTING ORGANIZATION
VA
501(c)(3)
Type II
NA
No
(2)
CARILION CLINIC FOUNDATION
PO BOX 12385
ROANOKE
,
VA
24025
54-1190773
FUNDRAISING
VA
501(c)(3)
7
CARILION CLINIC
Yes
(3)
CARILION FRANKLIN MEMORIAL HOSPITAL
PO BOX 12385
ROANOKE
,
VA
24025
54-0480606
HEALTHCARE
VA
501(c)(3)
3
CARILION CLINIC
Yes
(4)
CARILION GILES COMMUNITY HOSPITAL
PO BOX 12385
ROANOKE
,
VA
24025
54-0549603
HEALTHCARE
VA
501(c)(3)
3
CARILION CLINIC
Yes
(5)
CARILION MEDICAL CENTER
PO BOX 12385
ROANOKE
,
VA
24025
54-0506332
HEALTHCARE
VA
501(c)(3)
3
CARILION CLINIC
Yes
(6)
CARILION NEW RIVER VALLEY MEDICAL CENTER
PO BOX 12385
ROANOKE
,
VA
24025
54-0553805
HEALTHCARE
VA
501(c)(3)
3
CARILION CLINIC
Yes
(7)
CARILION ROCKBRIDGE COMMUNITY HOSPITAL
PO BOX 12385
ROANOKE
,
VA
24025
54-0568001
HEALTHCARE
VA
501(c)(3)
3
CARILION CLINIC
Yes
(8)
CARILION TAZEWELL COMMUNITY HOSPITAL
PO BOX 12385
ROANOKE
,
VA
24025
54-6074580
HEALTHCARE
VA
501(c)(3)
3
CARILION CLINIC
Yes
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
(1)
FRANKLIN COUNTY VENTURES LLC
PO BOX 12385
ROANOKE
,
VA
24025
47-4365316
REAL ESTATE
VA
NA
N/A
(2)
CARILION CLINIC MEDICARE SHARED SAVINGS COMPANY LLC
PO BOX 12385
ROANOKE
,
VA
24025
45-5235473
MEDICARE ACO
VA
NA
N/A
(3)
ROANOKE AMBULATORY SURGERY CENTER LLC
1102 JEFFERSON ST SE
ROANOKE
,
VA
24016
01-0691564
SURGERY CENTER
VA
NA
N/A
(4)
SOUTHWEST VIRGINIA HEALTH PROPERTIES LLC
1102 Jefferson Street SE
Roanoke
,
VA
24016
01-0691570
REAL ESTATE
VA
NA
N/A
(5)
RAVEN ASSET-BASED OPPORTUNITY FUND IV LP
75 Spring St 6th FL
New York
,
NY
10012
82-4119491
Investments
DE
NA
N/A
(6)
STARWOOD VEP II CO-INVEST LLC
591 W Putnam Avenue
Greenwich
,
CT
06830
83-3262407
INVESTMENTS
DE
NA
N/A
(7)
TI PLATFORM CC SMA LP
255 Kansas Street Suite 300
San Francisco
,
CA
94103
84-2852539
INVESTMENTS
DE
NA
N/A
(8)
TI FBV GR LP
255 Kansas Street Suite 300
San Francisco
,
CA
94103
86-2597246
INVESTMENTS
DE
NA
N/A
(9)
TI Platform DCI SPV LP
800 Town and Country Suite 500
Houston
,
TX
77024
87-1897835
INVESTMENTS
DE
NA
N/A
(10)
Transpose Platform Zippedi SPV LP
4304 18th Street 14427
San Francisco
,
CA
941149991
87-3425361
Investments
DE
NA
N/A
(11)
Transpose Platform Gorgias SPV LP
800 Town and Country Suite 500
Houston
,
TX
77024
87-4563291
Investments
DE
NA
N/A
(12)
Transpose Platform Fintech Fund II LP
4304 18th Street 14427
San Francisco
,
CA
941149991
87-3126138
Investments
DE
NA
N/A
(13)
Opera Investment Two SCSP
Investments
LU
NA
N/A
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)
CHS INC
PO BOX 12385
ROANOKE
,
VA
24025
54-1725732
SERVICES
VA
CARILION SERVICES INC
C Corporation
77,840,976
826,651,085
100 %
Yes
(2)
CARILION BEHAVIORAL HEALTH INC
PO BOX 12385
ROANOKE
,
VA
24025
20-3136891
HEALTHCARE
VA
CHS INC
C Corporation
1,025,449
136,286
100 %
Yes
(3)
CARILION EMERGENCY SERVICES INC
PO BOX 12385
ROANOKE
,
VA
24025
54-2033006
HEALTHCARE
VA
CHS INC
C Corporation
14,191,814
4,344,397
100 %
Yes
(4)
SCA CREDIT SERVICES INC
PO BOX 12385
ROANOKE
,
VA
24025
54-1180398
COLLECTION AGENCY
VA
CHS INC
C Corporation
619,813
321,587
100 %
Yes
(5)
CARILION HEALTHCARE CORPORATION
PO BOX 12385
ROANOKE
,
VA
24025
54-1586601
HEALTHCARE
VA
CHS INC
C Corporation
156,101,154
57,742,412
100 %
Yes
(6)
MEDKEY INC
PO BOX 12385
ROANOKE
,
VA
24025
54-1645357
FINANCING SERVICES
VA
CHS INC
C Corporation
216,130
128,751
100 %
Yes
(7)
CARILION DTC SERVICES INC
PO BOX 12385
ROANOKE
,
VA
24025
87-2635239
HEALTHCARE
VA
CHS INC
C Corporation
55,480
19,598
100 %
Yes
(8)
SPROTT PRIVATE RESOURCE LENDING (C-CO-INVEST) LP
98-1378742
INVESTMENTS
CA
NA
C Corporation
Yes
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
Yes
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
Yes
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
Yes
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
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)
Carilion Medical Center
A
3,112
Cost
(2)
Carilion Medical Center
L
242,077,553
Cost
(3)
Carilion New River Valley Medical Center
L
46,653,500
Cost
(4)
Carilion Giles Community Hospital
L
13,022,223
Cost
(5)
Carilion Franklin Memorial Hospital
L
11,747,753
Cost
(6)
Carilion Rockbridge Community Hospital
L
11,802,435
Cost
(7)
Carilion Tazewell Community Hospital
L
4,200,750
Cost
(8)
CHS Inc
L
3,139,490
Cost
(9)
Carilion Emergency Services Inc
L
2,891,227
Cost
(10)
SCA Credit Services Inc
L
57,747
Cost
(11)
Carilion Healthcare Corporation
L
18,197,341
Cost
(12)
Carilion Medical Center
K
278,060
Cost
(13)
Carilion Medical Center
M
820,545
Cost
(14)
Carilion Rockbridge Community Hospital
K
53,038
Cost
(15)
Carilion Clinic Foundation
M
1,194,146
Cost
(16)
Carilion Behavioral Health Inc
M
69,966
Cost
(17)
CHS Inc
K
87,120
Cost
(18)
CHS Inc
M
77,974
Cost
(19)
Carilion Medical Center
S
76,524,394
Cash
(20)
Carilion New River Valley Medical Center
S
26,752,449
Cash
(21)
Carilion Rockbridge Community Hospital
S
3,595,616
Cash
(22)
Carilion Clinic
S
8,197,736
Cash
(23)
CHS Inc
R
66,800,000
Cash
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 (Form 990) 2022
Additional Data
Software ID:
22016089
Software Version:
2022v5.0