Instrumentl eFile Render
Object ID: 202231369349302953 - Rendered 2024-05-04
TIN: 41-1806657
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
20
Open to Public Inspection
Name of the organization
CENTRACARE CLINIC
Employer identification number
41-1806657
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 CLOUD HOSPITAL
1406 6TH AVENUE NORTH
SAINT CLOUD
,
MN
56303
41-0695596
ACUTE/LT CARE
MN
501(C)(3)
3
CENTRACARE HEALTH SYSTEM
No
(2)
CENTRACARE HEALTH SYSTEM
1406 6TH AVENUE NORTH
SAINT CLOUD
,
MN
56303
41-1813221
INTEGRATED HEALTH SYSTEM
MN
501(C)(3)
3
N/A
No
(3)
CENTRACARE HEALTH FOUNDATION
1406 6TH AVENUE NORTH
SAINT CLOUD
,
MN
56303
41-1855173
FUNDRAISING
MN
501(C)(3)
7
CENTRACARE HEALTH SYSTEM
No
(4)
CENTRACARE HEALTH - MELROSE
525 MAIN STREET WEST
MELROSE
,
MN
56352
41-1865315
ACUTE/LT CARE
MN
501(C)(3)
3
CENTRACARE HEALTH SYSTEM
Yes
(5)
CENTRACARE HEALTH - LONG PRAIRIE
50 CENTRACARE DRIVE
LONG PRAIRIE
,
MN
56347
41-1924645
ACUTE/LT CARE
MN
501(C)(3)
3
CENTRACARE HEALTH SYSTEM
Yes
(6)
CENTRACARE HEALTH - SAUK CENTRE
425 ELM STREET NORTH
SAUK CENTRE
,
MN
56378
45-2438973
ACUTE/LT CARE
MN
501(C)(3)
3
CENTRACARE HEALTH SYSTEM
Yes
(7)
CARRIS HEALTH FOUNDATION
301 BECKER AVENUE SW
WILLMAR
,
MN
56201
41-1611555
SUPPORT FOR CARRIS HEALTH
MN
501(C)(3)
7
CENTRACARE HEALTH FOUNDATION
No
(8)
CUSHMAN ALBERT RICE TRUST
1100 WEST ST GERMAIN STREET
SAINT CLOUD
,
MN
56303
41-6019335
SUPPORT FOR CARRIS HEALTH
MN
501(C)(3)
12A, I
CARRIS HEALTH
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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)
MONTICELLO CANCER CENTER
1001 HART BOULEVARD SUITE 50
MONTICELLO
,
MN
55362
26-1909519
RADIATION & ONCOLOGY SERVICES
MN
N/A
No
No
(2)
BENSON MEDICAL LLC
1228 ATLANTIC AVENUE
BENSON
,
MN
56215
20-3149203
HEALTHCARE
MN
N/A
No
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)
CENTRACARE HOLDINGS INC
1406 6TH AVENUE NORTH
SAINT CLOUD
,
MN
56303
47-2688595
HOLDING COMPANY/PHARMACY
MN
N/A
C
No
(2)
AFFILIATED COMMUNITY MEDICAL CENTERS PA
301 BECKER AVENUE SOUTHWEST
WILLMAR
,
MN
56201
41-0850702
HEALTHCARE SYSTEM
MN
N/A
C
No
(3)
AFFILIATED COMMUNITY HEALTH NETWORK INC
101 WILLMAR AVENUE SOUTHWEST
WILLMAR
,
MN
56201
41-1765606
HEALTH NETWORK
MN
N/A
C
No
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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
No
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
Yes
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
No
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
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)
CENTRACARE HEALTH SYSTEM
P
274,928,632
FMV
(2)
CENTRACARE HEALTH SYSTEM
N
5,267,200
FMV
(3)
CENTRACARE HEALTH FOUNDATION
C
396,785
FMV
(4)
CENTRACARE HEALTH SYSTEM
C
88,334,565
FMV
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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) 2020
Schedule R (Form 990) 2020
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) 2020
Additional Data
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