SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2016
Open to Public Inspection
Name of the organization
COOK CHILDREN'S HEALTH CARE SYSTEM
 
Employer identification number

75-2705881
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)COOK CHILDREN'S HEALTH PLAN
801 SEVENTH AVE

FORT WORTH,TX76104
76-0585240
INSURANCE TX 501(C)(3) 10 CCHCS
 
Yes
 
(2)COOK CHILDREN'S PHYSICIAN NETWORK
801 SEVENTH AVE

FORT WORTH,TX76104
75-2485366
PHYSICIAN SVC TX 501(C)(3) 3 CCHCS
 
Yes
 
(3)WI COOK FOUNDATION
801 SEVENTH AVE

FORT WORTH,TX76104
75-2051649
FUNDRAISING TX 501(C)(3) 7 NA
 
 
No
(4)COOK CHILDREN'S MEDICAL CENTER
801 SEVENTH AVE

FORT WORTH,TX76104
75-2051646
HOSPITAL TX 501(C)(3) 3 CCHCS
 
Yes
 
(5)COOK CHILDREN'S HOME HEALTH
801 SEVENTH AVE

FORT WORTH,TX76104
75-2896983
HEALTHCARE TX 501(C)(3) 10 CCHCS
 
Yes
 
(6)ROSEDALE OFFICE BUILDING INC
801 SEVENTH AVE

FORT WORTH,TX76104
46-0866421
TITLE HOLDING TX 501(C)(2) N/A CCHF
 
Yes
 


For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2016
Page 2
Schedule R (Form 990) 2016
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) COOK CHILDREN'S HEALTH SERVICES INC

801 7TH AVENUE
FORT WORTH,TX76104
45-4024843
HEALTHCARE TX CCHCS
 
C CORPORATION 847,319 3,517,814 100.000 % Yes  












Schedule R (Form 990) 2016
Page 3
Schedule R (Form 990) 2016
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
 
No
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
Yes
 
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
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) COOK CHILDREN'S MEDICAL CENTER

A 561,171 FMV
(2) COOK CHILDREN'S MEDICAL CENTER

B 1,214,591 FMV
(3) COOK CHILDREN'S MEDICAL CENTER

O 72,103 FMV
(4) COOK CHILDREN'S MEDICAL CENTER

Q 195,687,577 FMV
(5) COOK CHILDREN'S PHYSICIAN NETWORK

A 1,996,340 FMV
(6) COOK CHILDREN'S PHYSICIAN NETWORK

B 544,794 FMV
(7) COOK CHILDREN'S PHYSICIAN NETWORK

O 10,154,339 FMV
(8) COOK CHILDREN'S PHYSICIAN NETWORK

P 449,248 FMV
(9) COOK CHILDREN'S PHYSICIAN NETWORK

Q 19,532,461 FMV
(10) COOK CHILDREN'S HOME HEALTH

A 880,405 FMV
(11) COOK CHILDREN'S HOME HEALTH

Q 4,704,669 FMV
(12) COOK CHILDREN'S HEALTH PLAN

A 771,302 FMV
(13) COOK CHILDREN'S HEALTH PLAN

O 243,821 FMV
(14) COOK CHILDREN'S HEALTH PLAN

Q 9,530,323 FMV
(15) COOK CHILDREN'S HEALTH SERVICES

Q 220,132 FMV
(16) ROSEDALE OFFICE BUILDING

K 1,275,574 FMV
(17) ROSEDALE OFFICE BUILDING

O 80,668 FMV
(18) ROSEDALE OFFICE BUILDING

P 1,565,418 FMV
Schedule R (Form 990) 2016
Page 4
Schedule R (Form 990) 2016
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) 2016
Page 5
Schedule R (Form 990) 2016
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) 2016

Additional Data


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