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Object ID: 202243199349322254 - Rendered 2024-05-06
TIN: 36-2167060
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
NorthShore University HealthSystem
Employer identification number
36-2167060
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)
NorthShore Physician Partners LLC
1301 Central Street
Evanston
,
IL
60201
87-4293274
Healthcare
IL
0
0
NorthShore University HealthSystem
(2)
NorthShore Physician Associates LLC
1301 Central Street
Evanston
,
IL
60201
88-1019298
Healthcare
IL
0
0
NorthShore Physician Partners LLC
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)
NorthShore University HealthSystem Faculty Practice Associates
1301 Central Street
Evanston
,
IL
60201
36-3738206
Healthcare
IL
501(c)(3)
Type I
NorthShore University HealthSystem
Yes
(2)
Radiation Medicine Institute
1301 Central Street
Evanston
,
IL
60201
36-3815543
Healthcare
IL
501(c)(3)
Type I
NorthShore University HealthSystem
Yes
(3)
Healthcare Foundation of Highland Park
610 Central Avenue
Highland Park
,
IL
60035
36-3196647
Fundraising
IL
501(c)(3)
Type II
NA
No
(4)
Swedish Covenant Health
5145 N California Avenue
Chicago
,
IL
60625
36-2179813
Hospital
IL
501(c)(3)
3
NorthShore University HealthSystem
Yes
(5)
Swedish Covenant Hospital Foundation
5145 N California Avenue
Chicago
,
IL
60625
20-5055155
Support of Swedish Covenant Hospital
IL
501(c)(3)
7
Swedish Covenant Health
Yes
(6)
Northwest Community Healthcare
3040 Salt Creek Lane
Arlington Heights
,
IL
60005
36-3125209
Support of Northwest Community Hospital
IL
501(c)(3)
Type II
NorthShore University HealthSystem
Yes
(7)
Northwest Community Hospital
3040 Salt Creek Lane
Arlington Heights
,
IL
60005
36-2340313
Hospital
IL
501(c)(3)
3
Northwest Community Healthcare
Yes
(8)
Northwest Community Hospital Foundation
3040 Salt Creek Lane
Arlington Heights
,
IL
60005
36-3125193
Fundraising
IL
501(c)(3)
7
Northwest Community Healthcare
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)
Ravine Way Surgery Center LLC
2401 Ravine Way
Glenview
,
IL
60025
20-1245279
Healthcare
IL
NorthShore University HealthSystem
Related
733,862
1,051,362
No
Yes
27 %
(2)
NPC Cyberknife LLC
3040 Salt Creek Lane
Arlington Heights
,
IL
60005
20-4462828
Equipment Leasing
IL
Northwest Community Healthcare
N/A
(3)
NWC Day Surgery Center II LLC
3040 Salt Creek Lane
Arlington Heights
,
IL
60005
30-0798249
Outpatient Care
IL
Northwest Community Healthcare
N/A
(4)
Northwest Endo Center LLC
3040 Salt Creek Lane
Arlington Heights
,
IL
60005
81-2338623
Surgical Care
IL
NWC Health Services Inc
N/A
(5)
EnVision Medical Imaging LLC
8930 Waukegan Road
Suite 130
Morton Grove
,
IL
60053
82-2067179
Imaging Services
IL
NWC Health Services Inc
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)
NorthShore Physician Associates Inc
1301 Central Street
Evanston
,
IL
60201
36-3648026
Healthcare
IL
NorthShore University HealthSystem Faculty Practice Associates
C Corporation
Yes
(2)
NorthShore Physician Associates Value Based Care LLC
1301 Central Street
Evanston
,
IL
60201
82-2268872
Healthcare
IL
NorthShore Physician Associates Inc
C Corporation
Yes
(3)
NorthShore University HealthSystem Insurance International
98-0419452
Insurance
CJ
NorthShore University HealthSystem
C Corporation
1,464,137
20,925,739
100 %
Yes
(4)
Swedish Covenant Management Services Inc
5145 N California Avenue
cHICAGO
,
IL
60625
36-4073303
Physician Practice Management
IL
Swedish Covenant Health
C Corporation
Yes
(5)
Swedish Covenant Physician Partners Ltd
5145 N California Avenue
Chicago
,
IL
60625
36-3120220
Physician Practice Management
IL
Swedish Covenant Health
C Corporation
Yes
(6)
Central Insurance Company Ltd
PO Box 10233
Grand Cayman
KY11002
CJ
98-1109518
Insurance
CJ
Northwest Community Healthcare
C Corporation
Yes
(7)
Northwest Community Health Services Inc
800 West Central Road
Arlington Heights
,
IL
60005
36-3312906
Healthcare
IL
Northwest Community Healthcare
C Corporation
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
Yes
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
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
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)
NorthShore University HealthSystem Faculty Practice Associates
A
6,495,747
FMV
(2)
NorthShore University HealthSystem Faculty Practice Associates
B
30,106,789
FMV
(3)
NorthShore University HealthSystem Faculty Practice Associates
C
846,479
FMV
(4)
Healthcare Foundation of Highland Park
C
300,000
FMV
(5)
NorthShore University HealthSystem Faculty Practice Associates
P
14,116,692
FMV
(6)
NorthShore University HealthSystem Faculty Practice Associates
Q
5,071,961
FMV
(7)
NorthShore Physician Associates Inc
Q
154,504
FMV
(8)
Radiation Medicine Institute
Q
29,866
FMV
(9)
NorthShore University HealthSystem Faculty Practice Associates
R
145,699,625
FMV
(10)
Radiation Medicine Institute
R
1,248,690
FMV
(11)
Swedish Covenant Health
R
42,059,172
FMV
(12)
NorthShore Physician Associates Inc
R
31,572,227
FMV
(13)
Northwest Community Healthcare
R
18,332,799
FMV
(14)
Radiation Medicine Institute
S
1,218,823
FMV
(15)
NorthShore Physician Associates Inc
S
31,335,313
FMV
(16)
Ravine Way Surgery Center LLC
S
162,000
FMV
(17)
NorthShore University HealthSystem Faculty Practice Associates
S
150,419,272
FMV
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:
21014044
Software Version:
2021v4.2