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TIN: 80-0225150
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
21
Open to Public Inspection
Name of the organization
INTERMOUNTAIN HEALTHCARE
FOUNDATION INC
Employer identification number
80-0225150
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)
INTERMOUNTAIN HEALTH CARE INC
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
87-0269232
HOLDING COMPANY
UT
501(C)(3)
LINE 12B, II
N/A
No
(2)
IHC HEALTH SERVICES INC
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
94-2854057
HEALTHCARE
UT
501(C)(3)
LINE 3
INTERMOUNTAIN HEALTH CARE INC
No
(3)
INTERMOUNTAIN COMMUNITY CARE FOUNDATION INC
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
94-2853320
COMMUNITY HEALTH
UT
501(C)(3)
LINE 12B, II
INTERMOUNTAIN HEALTH CARE INC
Yes
(4)
INTERMOUNTAIN HEALTH CARE RETIREE VEBA
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
74-2675605
RETIREMENT BENEFITS
UT
501(C)(9)
N/A
INTERMOUNTAIN HEALTH CARE INC
Yes
(5)
SELECTHEALTH INC
5381 GREEN STREET
MURRAY
,
UT
84123
87-0409820
DELIVERY OF HEALTH BENEFITS
UT
501(C)(4)
N/A
INTERMOUNTAIN HEALTH CARE INC
Yes
(6)
HEART & LUNG RESEARCH FOUNDATION
5121 S COTTONWOOD DRIVE
MURRAY
,
UT
84157
87-0617606
COMMUNITY HEALTH
UT
501(C)(3)
LINE 7
INTERMOUNTAIN HEALTHCARE FOUNDATION INC
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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)
MCKAY DEE SURGICAL CENTER LLC
3895 HARRISON BLVD
OGDEN
,
UT
84403
26-0286308
OUTPATIENT SURGERY
UT
N/A
N/A
No
No
(2)
HEART LUNG INSTITUTE LLC
5121 SOUTH COTTONWOOD DRIVE
MURRAY
,
UT
84157
RESEARCH AND DEVELOPMENT
UT
N/A
N/A
No
No
(3)
GRANDEUR PEAK INTERNATIONAL STALWARTS LP
136 S MAIN STREET STE 720
SALT LAKE CITY
,
UT
84101
47-5468723
INVESTMENTS
DE
N/A
N/A
No
No
(4)
INNOVATION FUND HOLDINGS COMPANY LLC
1000 W FULTON STREET
CHICAGO
,
IL
60607
47-1525723
INNOVATION
DE
N/A
N/A
No
No
(5)
HEALTHBOX SALT LAKE CITY I LLC
1000 W FULTON MARKET STE 213
CHICAGO
,
IL
60607
46-5338772
INNOVATION
DE
N/A
N/A
No
No
(6)
HOMESPIRE LLC
36 S STATE STREET STE 2200
SALT LAKE CITY
,
UT
84111
82-3121436
HOMECARE ASSISTANCE
UT
N/A
N/A
No
No
(7)
INTERMOUNTAIN VENTURES FUND LLC
36 S STATE STREET STE 2200
SALT LAKE CITY
,
UT
84111
84-4037085
INVESTMENTS
DE
N/A
N/A
No
No
(8)
PELION OPPORTUNITY FUND III LLC
2750 E COTTONWOOD PARKWAY STE 600
SALT LAKE CITY
,
UT
84121
84-2757193
INVESTMENTS
DE
N/A
N/A
No
No
(9)
AACP KOREA BUYOUT INVESTORS II LP
ONE EMBARCADERO 16TH FLOOR
SAN FRANCISCO
,
CA
94111
82-4971663
INVESTMENTS
CJ
N/A
N/A
No
No
(10)
AACP SPECIAL SITUATIONS II LP
ONE EMBARCADERO 16TH FLOOR
SAN FRANCISCO
,
CA
94111
83-2883726
INVESTMENTS
CJ
N/A
N/A
No
No
(11)
BVA SM GROUP LLC
901 PIER VIEW DRIVE SUITE 201
IDAHO FALLS
,
ID
83402
83-4516988
HOLDING COMPANY
ID
N/A
N/A
No
No
(12)
AACP KOREA BUYOUT INVESTORS IV LP
ONE EMBARCADERO 16TH FLOOR
SAN FRANCISCO
,
CA
94111
98-1549044
INVESTMENTS
CJ
N/A
N/A
No
No
(13)
LOGAN SURGERY CENTER LLC
1300 NORTH 500 EAST
LOGAN
,
UT
84341
86-1965725
OUTPATIENT SURGERY
UT
N/A
N/A
No
No
(14)
ST GEORGE SURGERY CENTER LLC
652 SOUTH MEDICAL CENTER DRIVE
ST GEORGE
,
UT
84790
85-3880188
OUTPATIENT SURGERY
UT
N/A
N/A
No
No
(15)
SALTZER ASC TEN MILE LLC
875 S VANGUARD WAY STE 120
MERIDIAN
,
ID
83642
84-5119941
OUTPATIENT SURGERY
UT
N/A
N/A
No
No
(16)
NORTHPOINTE SURGICAL CENTER LLC
2326 NORTH 400 EAST SUITE 100
TOOELE
,
UT
84074
46-1487986
OUTPATIENT SURGERY
UT
N/A
N/A
No
No
(17)
HW AE CO-INVESTMENT PARTNERS LP
2500 N MILITARY TRAIL 470
BOCA RATON
,
FL
33431
87-3405511
INVESTMENTS
DE
N/A
N/A
No
No
(18)
PERFORMANCE EQUITY GROWTH OPPORTUNITIES FUND LP
5 GREENWICH OFFICE PARK THIRD FLOOR
GREENWICH
,
CT
06831
85-3942801
INVESTMENTS
DE
N/A
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)
HEALTHCARE CAPTIVE INSURANCE COMPANY
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
20-1937561
INSURANCE
AZ
N/A
C
Yes
(2)
SELECTHEALTH BENEFIT ASSURANCE COMPANY INC
5381 GREEN STREET
MURRAY
,
UT
84123
87-0497579
DELIVERY OF HEALTH BENEFITS
UT
N/A
C
Yes
(3)
INTERMOUNTAIN SUPPLY SERVICES INC
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
47-4576955
HOLDING COMPANY
DE
N/A
C
Yes
(4)
INTALERE INC
TWO CITY PLACE DRIVE SUITE 400
ST LOUIS
,
MO
63141
43-1415071
GROUP PURCHASING
DE
N/A
C
Yes
(5)
NAVICAN GENOMICS INC
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
81-4153832
CANCER TREATMENT
DE
N/A
C
Yes
(6)
EMPIRIC HEALTH INC
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
38-4026200
HEALTH SERVICES TECHNOLOGY
DE
N/A
C
Yes
(7)
ALLUCEO INC
36 SOUTH STATE SUITE 2200
SALT LAKE CITY
,
UT
84111
82-4614934
MENTAL HEALTH INTEGRATION SERVICES
DE
N/A
C
Yes
(8)
INTERMOUNTAIN MEDICAL HOLDINGS NEVADA INC
770 EAST WARM SPRINGS ROAD
LAS VEGAS
,
NV
89110
20-0160881
HOLDING COMPANY
DE
N/A
C
Yes
(9)
HEALTHCARE PARTNERS MEDICAL GROUP (COATS) LTD
770 EAST WARM SPRINGS ROAD
LAS VEGAS
,
NV
89110
88-0213519
HEALTHCARE
NV
N/A
C
Yes
(10)
SALTZER MEDICAL GROUP INC
215 EAST HAWAII AVENUE
NAMPA
,
ID
83686
82-0299231
MEDICAL SERVICES
ID
N/A
C
Yes
(11)
CLASSIC MEDICAL INC
1031 SOUTH DOUGLAS STREET
SALT LAKE CITY
,
UT
84105
46-1141912
MEDICAL AIR TRANSPORTATION
UT
N/A
C
Yes
(12)
CLASSIC HELICOPTERS INC
1031 SOUTH DOUGLAS STREET
SALT LAKE CITY
,
UT
84105
46-1153642
AIR TRANSPORT SUPPORT
UT
N/A
C
Yes
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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
No
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
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
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
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)
IHC HEALTH SERVICES INC
B
39,158,296
COST
(2)
IHC HEALTH SERVICES INC
C
6,068,023
COST
(3)
IHC HEALTH SERVICES INC
P
1,021,139
COST
(4)
INTERMOUNTAIN COMMUNITY CARE FOUNDATION INC
Q
176,187
COST
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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) 2021
Schedule R (Form 990) 2021
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) 2021
Additional Data
Software ID:
Software Version: