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ObjectId: 201541409349300234 - Submission: 2015-05-20
TIN: 95-3545901
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.
See separate instructions.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
13
Open to Public Inspection
Name of the organization
Rady Children's Hospital and Health Center
Employer identification number
95-3545901
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)
Rady Children's Hospital - San Diego
3020 Childrens Way 5001
San Diego
,
CA
92123
95-1691313
hospital
CA
501(c)(3)
3
RCHHC
Yes
(2)
Rady Children's Hospital Research Center
3020 Childrens Way 5001
San Diego
,
CA
92123
95-3814185
Research
CA
501(c)(3)
11a
rchhc
Yes
(3)
Rady Children's Health Services San Dieg
3020 Childrens Way 5001
San Diego
,
CA
92123
33-0278018
Support RCHHC
CA
501(c)(3)
11a
RCHHC
Yes
(4)
Rady Children's Hospital Foundation San
3020 Childrens Way 5001
San Diego
,
CA
92123
33-0170626
Fundraising
CA
501(c)(3)
7
RCHHC
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Page 2
Schedule R (Form 990) 2013
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)
Children's Hospital Integrated Risk Prot
99-9999999
Captive Insur
BD
RCHHC
C Corp
0
385,833
100.000 %
Yes
(2)
Rady Children's Physician Management Ser
3860 Calle Fortunada Suite 200
San Diego
,
CA
921234282
33-0670694
Management Se
CA
RCHHC
C Corp.
39,150,328
10,440,917
100.000 %
Yes
(3)
Children's Hospital Insurance Limited
Canons Court 22 Victoria Street
Hamilton
HM12
BD
99-9999999
Captive Insur
BD
CHIRP
C corp
1,116,231
17,487,444
100.000 %
Yes
(4)
CRUT(6)
3020 CHILDRENS WAY MC 5133
SAN DIEGO
,
CA
921234282
crut
CA
RCHHC
Yes
Schedule R (Form 990) 2013
Page 3
Schedule R (Form 990) 2013
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
.
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1a
No
b
Gift, grant, or capital contribution to related organization(s)
.
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1b
No
c
Gift, grant, or capital contribution from related organization(s)
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1c
Yes
d
Loans or loan guarantees to or for related organization(s)
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1d
No
e
Loans or loan guarantees by related organization(s)
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1e
No
f
Dividends from related organization(s)
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1f
No
g
Sale of assets to related organization(s)
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1g
No
h
Purchase of assets from related organization(s)
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1h
No
i
Exchange of assets with related organization(s)
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1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
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1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
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1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
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1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
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1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
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1n
Yes
o
Sharing of paid employees with related organization(s)
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1o
Yes
p
Reimbursement paid to related organization(s) for expenses
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1p
Yes
q
Reimbursement paid by related organization(s) for expenses
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1q
Yes
r
Other transfer of cash or property to related organization(s)
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1r
No
s
Other transfer of cash or property from related organization(s)
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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)
children's hospital insurance limited
M
1,601,500
see part vii
(2)
children's hospital integrated risk prot
p
252,359
see part vii
(3)
rady children's hospital - san diego
p
173,146
see part vii
(4)
rady children's hospital foundation
o
274,896
see part vii
(5)
rady children's hospital foundation
q
622,356
see part vii
(6)
rady children's hospital - san diego
q
87,694
see part vii
(7)
rady children's hospital foundation
c
1,250,104
see part vii
Schedule R (Form 990) 2013
Page 4
Schedule R (Form 990) 2013
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) 2013
Page 5
Schedule R (Form 990) 2013
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
schedule r part v line 2
The amounts on Schedule R Part V Line 2 were determined as follows: (c) the grant to RCHHC was determined based on the original donor's requirements and as approved by respective donors (m) Premiums transfered were based on fair market value. (o) and (p) transactions - these amounts were reimbursements for employee salaries and benefits for the services the employees provided to RCHHC and cost reimbursements for other expenses. (q) - these are transfers of cash and donor related investments. The donor related investments were transferred at fair market value.
Schedule R (Form 990) 2013
Additional Data
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