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TIN: 72-1014324
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
19
Open to Public Inspection
Name of the organization
OUR LADY OF THE LAKE FOUNDATION
Employer identification number
72-1014324
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)
ST BERNARD HEALTH FUND
4200 ESSEN LANE
BATON ROUGE
,
LA
70809
20-4685614
HEALTHCARE
LA
501(C)(3)
12 TYPE 1
FMOL
No
(2)
HEALTH CARE CENTERS IN SCHOOLS
4200 ESSEN LANE
BATON ROUGE
,
LA
70809
72-1443935
HEALTHCARE
LA
501(C)(3)
10
OLOL
No
(3)
ST DOMINIC HEALTH SERVICES INC
969 LAKELAND DRIVE
JACKSON
,
MS
39216
64-0714999
HOLDING CO
MS
501(C)(3)
12 TYPE 3FI
FMOL
No
(4)
COMMUNITY HEALTH SERVICES - ST DOMINIC
969 LAKELAND DRIVE
JACKSON
,
MS
39216
64-0884870
HEALTH PROGRA
MS
501(C)(3)
10
SDHS
No
(5)
ST DOMINIC - JACKSON MEMORIAL HOSPITAL
969 LAKELAND DRIVE
JACKSON
,
MS
39216
64-0303091
HOSPITAL
MS
501(C)(3)
3
SDHS
No
(6)
ST DOMINIC - HEALTH SERVICES FOUNDATION
969 LAKELAND DRIVE
JACKSON
,
MS
39216
43-1992975
FUNDRAISING
MS
501(C)(3)
7
SDHS
No
(7)
ST CATHERINE'S VILLAGE INC
969 LAKELAND AND DRIVE
JACKSON
,
MS
39216
64-0714997
RET HOME
MS
501(C)(3)
10
SDHS
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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)
LOURDES IMAGING DEVELOPMENT LLC
4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE
,
LA
70508
20-8326287
REAL ESTATE
LA
LOURDES
N/A
(2)
PARK PLACE SURGERY CENTER LLC
4811 AMBASSADOR CAFFERY PKWY
LAFAYETTE
,
LA
70508
72-1404092
HEALTHCARE
LA
LOURDES
N/A
(3)
BRPT LAKE REHABILITATION CENTERS LLC
175 S ENGLISH STATION RD STE 218
LOUISVILLE
,
KY
40245
72-1506100
HEALTHCARE
LA
OLOL
N/A
(4)
CONVENIENT CARE LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
72-1439481
HEALTHCARE
LA
OLOL
N/A
(5)
SURGICAL SPECIALTY CENTER OF BATON ROUGE
8080 BLUEBONNET BLVD
BATON ROUGE
,
LA
70810
26-3120962
HEALTHCARE
LA
OLOL
N/A
(6)
ST ELIZABETH-MARY BIRD PERKINS CANCER
4950 ESSEN LANE
BATON ROUGE
,
LA
70809
26-0628752
HEALTHCARE
LA
OLOL
N/A
(7)
NORTHEAST LA CANCER INSTITUTE LLC
411 CALYPSO STREET
MONROE
,
LA
71201
72-1329499
HEALTHCARE
LA
SFMC
N/A
(8)
LHCG-XIII LLC dba Lourdes Home Health
901 S HUGH WALLIS ROAD
LAFAYETTE
,
LA
70508
20-8068308
HEALTHCARE
LA
LOURDES
N/A
(9)
LOURDES AFTER HOURS LLC
7777 HENNESSY BLVD SUITE 1004-202
BATON ROUGE
,
LA
70809
20-1367299
HEALTHCARE
LA
LOURDES
N/A
(10)
LAKE URGENT CARE ASCENSION LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
35-2463092
HEALTHCARE
LA
OLOL
N/A
(11)
OLOLUSP SURGERY CENTER LLC
15305 DALLAS PKWY STE 1600 LB 28
ADDISON
,
TX
75001
35-2457810
HEALTHCARE
TX
OLOL
N/A
(12)
ST FRANCIS URGENT CARE LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
47-4013731
HEALTHCARE
LA
SFMC
N/A
(13)
GAMMA KNIFE OF LOUISIANA LLC
4950 ESSEN LANE
BATON ROUGE
,
LA
70809
81-1827194
HEALTHCARE
LA
OLOL
N/A
(14)
LHCG LXVII LLC
901 S HUGH WALLIS ROAD
LAFAYETTE
,
LA
70508
47-4283509
HEALTHCARE
LA
LOURDES
N/A
(15)
PREMIER HEALTH HOLDINGS LLC
10319 JEFFERSON HIGHWAY
BATON ROUGE
,
LA
70809
47-2665226
HEALTHCARE
LA
OLOL
N/A
(16)
PINNACLE CARE HOLDINGS LLC
5627 S SHERWOOD FOREST BLVD
BATON ROUGE
,
LA
70816
82-1637627
HEALTHCARE
LA
OLOL
N/A
(17)
LAFAYETTE SURGERY CENTER LIMITED PARTNER
C/O C T CORPORATION SYSTEM 3867 PL
BATON ROUGE
,
LA
70816
72-0423635
HEALTHCARE
LA
LOURDES
N/A
(18)
HIGHLAND MEDICAL ARTS LLC
PO BOX 55769
JACKSON
,
MS
39296
74-3073171
MED BUILDING
MS
SDHS
N/A
(19)
D1 SPORTS TRAINING OF MISSISSIPPI LLC
7715 SOUTH SPRINGS DRIVE
FRANKLIN
,
TN
37067
27-5277568
ATHLETIC CENTER
MS
SDMHS
N/A
(20)
MEA PRIMARY CARE PLUS LLC
308 corporate drive
Ridgeland
,
MS
39157
HEALTHCARE
MS
FIC
N/A
(21)
FREMAUX OFFICE MM LLC
3500 NORTH CAUSEWAY BOULEVARD STE
METAIRIE
,
LA
70002
HEALTHCARE
LA
FMOLHS
N/A
(22)
FREMAUX MOB LLC
3500 NORTH CAUSEWAY BOULEVARD STE
METAIRIE
,
LA
70002
MED BLDG
LA
FMOLHS
N/A
(23)
HEART HOSPITAL OF ACADIANA LLC
1105 KALISTE SALOOM ROAD
LAFAYETTE
,
LA
70508
30-0442368
HEALTHCARE
LA
LOURDES
N/A
(24)
SHP Managing Member LLC
7015 HIGHWAY 190 E SERVICE ROAD ST
COVINGTON
,
LA
70433
83-2168844
HEALTHCARE
LA
OLOL
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)
HOSPITAL ASSISTANCE SERVICES
4200 ESSEN LANE
BATON ROUGE
,
LA
70809
72-1073486
HEALTHCARE
LA
LOURDES
C CORP
(2)
LOUISE INSURANCE COMPANY
PO BOX 1051
KY1-1102
CJ
INSURANCE
CJ
FMOL
C CORP
(3)
FRANCISICAN HEALTH & WELLNESS SERVICES I
4200 ESSEN LANE
BATON ROUGE
,
LA
70809
45-5492379
HEALTHCARE
LA
FMOL
C CORP
(4)
FMOL HEALTH SYSTEM HOLDINGS INC
4200 ESSEN LANE
BATON ROUGE
,
LA
70809
45-4405024
INVESTMENT
LA
FMOL
C CORP
(5)
ST DOMINIC MADISON HEALTH SERVICES INC
969 LAKELAND DRIVE
JACKSON
,
MS
39216
20-2870254
HEALTHCARE
MS
SDHS
C CORP
(6)
FIRST INTERMED CORPORATION
308 CORPORATE DRIVE
RIDGELAND
,
MS
39157
64-0824796
MEDICAL SERVICES
MS
SDHS
C CORP
(7)
ST DOMINIC INTEGRATED SERVICES INC
969 LAKELAND DRIVE
JACKSON
,
MS
39216
27-1493623
INVESTMENTS
MS
SDJMH
C CORP
(8)
LAFAYETTE SURGICARE INC
C/O C T CORPORATION SYSTEM 3867 PL
BATON ROUGE
,
LA
70816
94-3419282
HEALTHCARE
LA
LOURDES
C CORP
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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
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
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
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
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
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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) 2019
Schedule R (Form 990) 2019
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) 2019
Additional Data
Software ID:
Software Version: