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TIN: 61-1740292
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.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
16
Open to Public Inspection
Name of the organization
Spectrum Health System Group Return
Employer identification number
61-1740292
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)
PHMB PROPERTIES LLC
1231 EAST BELTLINE NE
GRAND RAPIDS
,
MI
49525
38-2715520
PROP. MGMT
MI
3,356,461
24,094,079
PRIORITY HEALTH
(2)
SPECTRUM HEALTH INNOVATIONS LLC
100 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
27-2868213
IP DEVELOP
MI
58
270,176
SPECTRUM HEALTH SYSTEM
(3)
PRIORITY ADVANTAGE LLC
1231 EAST BELTLINE NE
GRAND RAPIDS
,
MI
49525
82-2211831
INSURANCE CONSULTING
MI
0
0
PRIORITY HEALTH MANAGED BENEFITS INC
(4)
SPECTRUM HEALTH VENTURES LLC
100 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
81-5424150
INVESTMENT IN HEALTHCARE INNOVATION
MI
0
1,157,501
SPECTRUM HEALTH SYSTEM
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)
PRIORITY HEALTH
1231 EAST BELTLINE NE
GRAND RAPIDS
,
MI
49525
38-2715520
HMO
MI
501(c)(4)
SPECTRUM HEALTH SYSTEM
Yes
(2)
TRINITY HEALTH PLANS
1231 EAST BELTLINE NE
GRAND RAPIDS
,
MI
49525
38-2663747
HMO MGMT
MI
501(c)(4)
PRIORITY HEALTH
Yes
(3)
PRIORITY HEALTH CHOICE INC
1231 EAST BELTLINE NE
GRAND RAPIDS
,
MI
49525
32-0016523
HMO (MEDICAID)
MI
501(c)(3)
10
PRIORITY HEALTH
Yes
(4)
KENT COMMUNITY HEALTH FOUNDATION
750 FULLER AVE NE
GRAND RAPIDS
,
MI
49503
38-3607110
PHILANTHROPY
MI
501(c)(3)
Type III-O
SPECTRUM HEALTH KENT COMMUNITY CAMPUS
Yes
(5)
SPECTRUM HEALTH - MSU ALLIANCE CORPORATION
100 MICHIGAN ST NE MC 498
GRAND RAPIDS
,
MI
49503
76-0845329
RESEARCH
MI
501(c)(3)
Type I
SPECTRUM HEALTH HOSPITALS
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2016
Schedule R (Form 990) 2016
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)
HELEN DEVOS WOMEN'S AND CHILDREN'S HEALTH PAVILION ASSOCIATION
330 BARCLAY NE
GRAND RAPIDS
,
MI
49503
38-3264184
MGMT
MI
SPECTRUM HEALTH HOSPITALS
C Corporation
491,980
528,036
86.96 %
Yes
(2)
THE FRED AND LENA MEIJER HEART CENTER CONDOMINIUM ASSOCIATION
100 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
83-0464302
MGMT
MI
SPECTRUM HEALTH HOSPITALS
C Corporation
2,132,209
1,908,104
98.81 %
Yes
(3)
CAMPUS TOWN CENTRE CONDO ASSC
4868 LAKE MICHIGAN DRIVE
ALLENDALE
,
MI
49401
38-2910067
MGMT
MI
SPECTRUM HEALTH HOSPITALS
C Corporation
29,509
0
90 %
Yes
(4)
PRIORITY HEALTH INSURANCE COMPANY
1231 EAST BELTLINE NE
GRAND RAPIDS
,
MI
49525
20-1529553
INSURANCE
MI
NA
C Corporation
No
(5)
PRIORITY HEALTH MANAGED BENEFITS
1231 EAST BELTLINE NE
GRAND RAPIDS
,
MI
49525
38-3085182
THIRD PARTY ADMINISTRATOR
MI
NA
C Corporation
No
(6)
WEST MICHIGAN HEART
1840 WEALTHY STREET SE
GRAND RAPIDS
,
MI
49506
38-2125186
PHYSICIANS
MI
NA
C Corporation
No
(7)
SPECTRUM HEALTH PHYSICIAN ALLIANCE
100 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
37-1655728
PHYSICIANS
MI
NA
C Corporation
No
(8)
35 MICHIGAN STREET CONDOMINIUM ASSOCIATION
35 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
27-2193084
MGMT
MI
SPECTRUM HEALTH HOSPITALS
C Corporation
741,896
177,188
100 %
Yes
(9)
LEMMEN-HOLTON CANCER PAVILION CONDOMINIUM ASSOCIATION
145 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
16-1734150
MGMT
MI
SPECTRUM HEALTH HOSPITALS
C Corporation
2,392,971
1,288,612
84.36 %
Yes
(10)
MUSCULOSKELETAL CENTER CONDOMINIUM ASSOCIATION
230 MICHIGAN NE
GRAND RAPIDS
,
MI
49503
38-3180086
MGMT
MI
SPECTRUM HEALTH HOSPITALS
C Corporation
181,465
187,114
89.54 %
Yes
(11)
25 MICHIGAN STREET CONDOMINUIM ASSOCIATION
100 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
16-1734157
MGMT
MI
SPECTRUM HEALTH HOSPITALS
C Corporation
647,649
452,352
82.51 %
Yes
(12)
THE MICHIGAN STREET PARKING CONDOMINUIM ASSOCIATION
100 MICHIGAN ST NE
GRAND RAPIDS
,
MI
49503
16-1734145
MGMT
MI
SPECTRUM HEALTH HOSPITALS
C Corporation
654,005
603,942
69.13 %
Yes
(13)
PENNOCK VENTURES INC
1009 WEST GREEN STREET
HASTINGS
,
MI
49058
38-2712819
HEALTH CARE
MI
Pennock Hospital
C Corporation
1,059,925
1,063,782
100 %
Yes
(14)
PENNOCK PHARMACY INC
1009 WEST GREEN STREET
HASTINGS
,
MI
49058
38-2750680
HEALTH CARE
MI
Pennock Hospital
C Corporation
2,170,226
0
100 %
Yes
(15)
MEMORIAL MEDICAL CENTER MEDICAL OFFICE BUILDING CONDOMINIUM ASSOCIATION
5 N ATKINSON DRIVE
LUDINGTON
,
MI
49431
81-3322057
MGMT
MI
MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
C Corporation
0
0
100 %
Yes
(16)
MEMORIAL MEDICAL CENTER MOB II CONDOMINIUM ASSOCIATION
7 N ATKINSON DRIVE
LUDINGTON
,
MI
49431
81-3094794
MGMT
MI
MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
C Corporation
0
6,445
81.5 %
Yes
Schedule R (Form 990) 2016
Schedule R (Form 990) 2016
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
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
Yes
i
Exchange of assets with related organization(s)
............................
1i
No
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
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
No
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
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)
Priority Health
L
585,212,428
CASH, GAAP, OR FMV
(2)
Priority Health
M
191,278,125
CASH, GAAP, OR FMV
(3)
Spectrum Health- Kent Community Campus
L
6,041,160
CASH, GAAP, OR FMV
(4)
Spectrum Health Worth Services
L
2,755,068
CASH, GAAP, OR FMV
(5)
Spectrum Health Continuing Care Campus
L
2,716,596
CASH, GAAP, OR FMV
(6)
Spectrum Health Kelsey
L
2,191,487
CASH, GAAP, OR FMV
(7)
Visiting Nurse Services of Western Michigan
L
1,877,760
CASH, GAAP, OR FMV
(8)
Lemmen-Holton Cancer Pavilion Condominium Association
Q
2,890,067
CASH, GAAP, OR FMV
(9)
The Fred and Lena Meijer Heart Center Condominium
Q
2,166,240
CASH, GAAP, OR FMV
(10)
Michigan Street Parking Condominium Association
Q
917,295
CASH, GAAP, OR FMV
(11)
25 Michigan Condominium Association
Q
745,175
CASH, GAAP, OR FMV
(12)
35 Michigan Condominium Association
Q
725,122
CASH, GAAP, OR FMV
(13)
Helen DeVos Women and Children's Health Pavilion Association
Q
560,579
CASH, GAAP, OR FMV
(14)
Musculoskeletal Center Condominium Association
Q
180,339
CASH, GAAP, OR FMV
Schedule R (Form 990) 2016
Schedule R (Form 990) 2016
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) 2016
Schedule R (Form 990) 2016
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R, Part IV IDENTIFICATION OF RELATED ORGANIZATIONS
35 MICHIGAN STREET CONDOMINIUM ASSOCIATION AND LEMMEN-HOLTON CANCER PAVILION CONDOMINIUM ASSOCIATION ARE INCLUDED ON SCHEDULE R, PART IV AS THE VOTING POWER IS CONTROLLING UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF UNDER SECTION 318 OF THE INTERNAL REVENUE CODE. SCHEDULE R, PART IV, COLUMNS (F) SHARE OF TOTAL INCOME AND (G) SHARE OF END-OF-YEAR ASSETS ARE REPORTED BASED ON OWNERSHIP RATHER THAN VOTING POWER. SCHEDULE R, PART IV, COLUMN (H) IS REPORTED BASED ON THE GREATER OF OWNERSHIP OR VOTING POWER.
Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ORGANIZATIONS
THE AMOUNTS LIST IN PART V, LINE 2, TRANSACTION TYPE L & M FOR PRIORITY HEALTH REPRESENT THE AGGREGATE AMOUNT OF TRANSACTIONS AMONG ALL ORGANIZATIONS INCLUDED IN THE GROUP RETURN.
Schedule R (Form 990) 2016
Additional Data
Software ID:
16000421
Software Version:
2016v3.0