efile Public Visual Render
ObjectId: 201811979349300246 - Submission: 2018-07-16
TIN: 94-6174066
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.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
16
Open to Public Inspection
Name of the organization
STANFORD HEALTH CARE
Employer identification number
94-6174066
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)
CARE COUNSEL LLC
899 NORTHGATE DRIVE STE 530
SAN RAFAEL
,
CA
94903
68-0396696
MEDICAL
CA
2,019,856
556,204
SHC
(2)
STANFORD BLOOD CENTER LLC
3373 HILLVIEW AVENUE
PALO ALTO
,
CA
94304
81-0816100
BLOOD CENTER
CA
71,704,202
20,280,362
SHC
(3)
AUGMNTED INTELLIGENCE MED SYS PSYCHIATRY
PO BOX 60954
PALO ALTO
,
CA
94306
37-1865230
RESEARCH
DE
0
0
SHC
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)
EAST PALO ALTO ACADEMY
475 POPE STREET
MENLO PARK
,
CA
94025
20-2699147
EDUCATIONAL
CA
501(C)(3)
2
STANFORD
Yes
(2)
HOSPITAL COMMITTEE FOR THE L-P AREAS
1111 E STANLEY BLVD
LIVERMORE
,
CA
94550
94-1429628
HOSPITAL
CA
501(C)(3)
3
SHC
Yes
(3)
LUCILE PACKARD FOUNDATION FOR CHILDREN'S
400 HAMILTON AVENUE SUITE 340
PALO ALTO
,
CA
94301
77-0440090
HEALTHCARE
CA
501(C)(3)
7
LPCH
Yes
(4)
LUCILE SALTER PACKARD CHILDRENS HOSPITAL
725 WELCH ROAD MC 5553
PALO ALTO
,
CA
94304
77-0003859
HEALTHCARE
CA
501(C)(3)
3
STANFORD
Yes
(5)
PACKARD CHILDREN'S HEALTH ALLIANCE
725 WELCH ROAD MC5551
PALO ALTO
,
CA
94304
32-0359189
HEALTHCARE
CA
501(C)(3)
3
LPCH
Yes
(6)
SHR HOLDINGS INC
3145 PORTER DRIVE
PALO ALTO
,
CA
94304
94-3187167
REAL ESTATE
CA
501(C)(25)
N/A
STANFORD
Yes
(7)
STANFORD FACULTY CLUB
PO BOX 7229
STANFORD
,
CA
94309
94-1187089
FAC INTERACT.
CA
501(C)(7)
N/A
STANFORD
Yes
(8)
STANFORD FEDERAL CREDIT UNION
1860 EMBARCADERO RD
PALO ALTO
,
CA
94303
94-1492212
CREDIT UNION
CA
501(C)(1)
N/A
STANFORD
Yes
(9)
STANFORD HABITAT CONSERVATION BOARD
3160 PORTER DR STE 200
PALO ALTO
,
CA
94304
46-1882243
CONSERVATION
CA
501(C)(3)
7
STANFORD
Yes
(10)
STANFORD HEALTH CARE ADVANTAGE
1221 BROADWAY 3RD FLOOR
OAKLAND
,
CA
94612
46-4071746
HEALTHCARE
CA
501(c)(3)
12A, I
SHC
Yes
(11)
STANFORD PROGRAMME (CAPE TOWN) NPC
WAVERLY BUSINESS PARK BUILDING 11
CAPE TOWN
SF
EDUCATION
SF
501(C)(3)
N/A
STANFORD
Yes
(12)
STANFORD UNIVERSITY BOOKSTORE
BLDG 60 MAIN QUAD NO 105
STANFORD
,
CA
94305
94-0894150
SUPPORT
CA
501(C)(3)
12A, I
STANFORD
Yes
(13)
SU EMP BEN TRUST POST RETEMPYNT BEN
3145 PORTER DRIVE
PALO ALTO
,
CA
94304
94-3246199
BENEFITS
CA
501(C)(9)
N/A
STANFORD
Yes
(14)
THE BRD OF TRUST LELAND STANF JR UNIV
3145 PORTER DRIVE
PALO ALTO
,
CA
94304
94-1156365
EDUCATION
CA
501(C)(3)
2
NA
No
(15)
THE DUDLEY E CHAMBERS FOUNDATION
JP MORGAN CHASE PO BOX 3038
MILWAUKEE
,
WI
53201
38-6841793
SUPPORT
NY
501(C)(3)
12D, III-O
STANFORD
Yes
(16)
THE FREIDENRICH SUPPORT FOUNDATION
3145 PORTER DRIVE
PALO ALTO
,
CA
94304
30-0519583
SUPPORT
CA
501(C)(3)
12A, I
STANFORD
Yes
(17)
THE HONG KONGSU CHARITABLE TRUST
1401 CAROLINE CENTER
PING ROAD
,
CAUSEWAY
HK
98-6078093
SUPPORT
HK
501(C)(3)
N/A
STANFORD
Yes
(18)
THE STANFORD TRUST
65 HIGH STREET
OXFORD
OX1 46L
UK
SUPPORT
UK
501(C)(3)
N/A
STANFORD
Yes
(19)
UNIVERSITY HEALTHCARE ALLIANCE
7999 GATEWAY BLVD STE 300
NEWARK
,
CA
94560
94-3192446
HEALTHCARE
CA
501(C)(3)
3
SHC
Yes
(20)
VALLEYCARE MEDICAL FOUNDATION INC
5655 W LAS POSITAS BLVD 220
PLEASANTON
,
CA
94588
26-2593526
SUPPRT SHC-VC
CA
501(C)(3)
10
HOSP CMTE LP
Yes
(21)
VALLEYCARE SENIOR HOUSING
1111 E STANLEY BLVD
LIVERMORE
,
CA
94550
94-3382224
SR. FACILITY
CA
501(C)(3)
12C, III-FI
HOSP CMTE LP
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
(1)
ADOM PARTNERS LP
500 MADISON AVENUE
NEW YORK
,
NY
10022
81-3083288
INVESTMENTS
DE
NA
(2)
ALBUS SELECT FUND LP
750 MENLO AVENUE
MENLO PARK
,
CA
94025
81-2064357
INVESTMENTS
DE
NA
(3)
ARCOLA RESIDENTIAL VENTURE LLC
635 KNIGHT WAY
STANFORD
,
CA
943057297
90-0818278
INVESTMENTS
DE
NA
(4)
ARCOLA VENTURE LLC
635 KNIGHT WAY
STANFORD
,
CA
943057297
37-1689632
RE DEVELOPMENT
DE
NA
(5)
CANARY SC FUND LP
399 PARK AVENUE
NEW YORK
,
NY
10022
47-5662144
INVESTMENTS
DE
NA
(6)
CANARY SC MASTER FUND LP
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
CJ
NA
(7)
CARLSBAD CO-INVEST LP
51 JOHN F KENNEDY PARKWAY SUITE 2
SHORT HILLS
,
NJ
07078
47-1702425
INVESTMENTS
DE
NA
(8)
CEE EQUITY HOLDINGS LP
ELIZABETH HOUSE 9 CASTLE ST
ST HELIER
,
JERSEY
JE4 2QP
JE
INVESTMENTS
JE
NA
(9)
CLAIRVUE CAPITAL PARTNERS II-TE 1 LP
150 CALIFORNIA STREET STE 850
SAN FRANCISCO
,
CA
94111
80-0909516
INVESTMENTS
DE
NA
(10)
CLAIRVUE CAPITAL PARTNERS II-TE 2 LP
150 CALIFORNIA STREET STE 850
SAN FRANCISCO
,
CA
94111
80-0909556
INVESTMENTS
DE
NA
(11)
ENERGY CAPITAL PARTNERS III (SENDERO CO-
51 JOHN F KENNEDY PARKWAY SUITE 2
SHORT HILLS
,
NJ
07078
47-1702425
INVESTMENTS
DE
NA
(12)
EUCALIPTO FUND LTD
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
CJ
NA
(13)
EZP OPPORTUNITY LP
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
DE
NA
(14)
FORTRESS IW COINVESTMENT (FUND B) LP
1345 AVE OF THE AMERICAS 45TH FL
NEW YORK
,
NY
10105
98-0509639
INVESTMENTS
CJ
NA
(15)
FOUR CROSSINGS INSTITUTIONAL PARTNERS V
635 KNIGHT WAY
STANFORD
,
CA
943057297
94-3106323
INVESTMENTS
DE
NA
(16)
FOXLANE LP
635 KNIGHT WAY
STANFORD
,
CA
943057297
81-3314647
INVESTMENTS
DE
NA
(17)
HHBG-II INVESTMENT LP
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
DE
NA
(18)
KEB INVESTORS II LP
WASHINGTON MALL STE 304 7 REID ST
HAMILTON
,
HM 11
BD
94-1156365
INVESTMENTS
BD
NA
(19)
LSF V DHB HOLDINGS LP
2711 N HASKELL AVE STE 1700
DALLAS
,
TX
75204
27-2858604
INVESTMENTS
DE
NA
(20)
OUTLAWS CASINO LTD
3160 PORTER DR
PALO ALTO
,
CA
94304
84-1457498
HOLDING COMPANY
CO
NA
(21)
PALO ALTO LP
13 CASTLE STREET
ST HELIER JERSEY
JE
98-1126622
INVESTMENTS
JE
NA
(22)
PROJECT EDISON PARTNERS FUND LP
55 E 52ND ST
NEW YORK
,
NY
10055
47-3184706
INVESTMENTS
DE
NA
(23)
RMS FOREST GROWTH II LP
30 INVERNESS CENTER PARKWAY STE 36
BIRMINGHAM
,
AL
35242
20-0841908
INVESTMENTS
CA
NA
(24)
SANDPIPER FUND LP
2000 MCKINNEY AVE STE 2125
DALLAS
,
TX
75201
26-0341626
INVESTMENT
TX
NA
(25)
SAROFIM MULTIFAMILY PARTNERS LP
8115 PRESTON RD ST400
DALLAS
,
TX
75225
20-1929002
RE DEVELOPMENT
TX
NA
(26)
SCP REAL ASSETS FUND (A) LP
2498 SAND HILL RD
MENLO PARK
,
CA
94025
20-3949682
INVESTMENTS
DE
NA
(27)
SEQUOIA MFM OPERATING COMPANY LLC
770 WELCH ROAD LPCH- ADMIN MC5551
PALO ALTO
,
CA
94304
47-5060529
MFM PROGRAM
CA
NA
(28)
SIC SNOWCREEK VIII LLC
635 KNIGHT WAY
STANFORD
,
CA
94305
27-5431605
RE DEVELOPMENT
CA
NA
(29)
SP SMC PARTNERS LLC
2711 CENTERVILLE RD STE 400
WILMINGTON
,
DE
19808
47-3103791
INVESTMENTS
DE
NA
(30)
STANFORD EMANUEL RAD ONCOLOGY CENTER
825 DELBON AV
TURLOCK
,
CA
95382
20-8885091
RADIOLOGY
CA
SHC
RELATED
2,140,851
7,231,278
No
0
No
60.000 %
(31)
STANFORD PET-CT LLC
300 PASTEUR DR MC 5555
STANFORD
,
CA
94305
61-1423414
MED. DIAGNOST
CA
SHC
RELATED
7,072,181
13,432,060
No
0
Yes
50.000 %
(32)
STANFORD-STARTX FUND LLC
3145 PORTER DR
PALO ALTO
,
CA
94304
46-4297719
INVESTMENTS
DE
NA
EXCLUDED
-316,313
45,711,334
No
0
No
33.333 %
(33)
SUMIT HOLDING INTERNATIONAL LLC
1400 PAGE MILL ROAD MC5713
PALO ALTO
,
CA
94304
26-3934706
HOLDING COMPANY
DE
SHC
RELATED
-1,815,270
63,182,662
No
0
No
82.000 %
(34)
VEDA INVESTORS FUND LP
ONE FAWCETT PL
GREENWICH
,
CT
06830
81-1810345
INVESTMETNS
DE
NA
(35)
VERMILION PEAK MASTER FUND
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
DE
NA
(36)
WOLFF REAL ESTATE PARTNERS III A LP
635 KNIGHT WAY
STANFORD
,
CA
943057297
47-4780701
INVESTMENTS
DE
NA
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)
ALPINE CHALET INC
PO BOX 9988
SOUTH LAKE TAHOE
,
CA
96158
94-1556099
SKI LODGE
CA
NA
C CORP
(2)
BIENVILLE ARGENTINA OPPS OFFSHORE FUND
405 LEXINGTON AVE 34TH FLOOR
NEW YORK
,
NY
10174
INVESTMENTS
CJ
NA
C CORP
(3)
BISHOP ROCK OPPORTUNITY OFFSHORE FUND
635 KNIGHT WAY
STANFORD
,
CA
94305
INVESTMENTS
CJ
NA
C CORP
(4)
CANARY SC FUND LTD
399 PARK AVE
NEW YORK
,
NY
10022
INVESTMENTS
CJ
NA
C CORP
(5)
CLAT (16)
CHARITABLE TR
CA
NA
TRUST
(6)
CRT (548)
CHARITABLE TR
CA
NA
TRUST
(7)
EAST SAIL
C/O INTL FS INC IFS COURT
TWENTYEIGHT CYBERCITY EBENE
MP
INVESTMENTS
MP
NA
C CORP
(8)
GAVEA INVESTMENT FUND II-C LP
PO BOX 896GT HARBOUR CENTRE
GEORGE TOWN
,
CAYMAN ISLANDS
CJ
98-0537952
INVESTMENTS
CJ
NA
C CORP
(9)
KAIZEN FUND
1 NORTH BRIDGE RD 6-8
SINGAPORE
,
SINGAPORE
179094
SN
INVESTMENTS
CJ
NA
C CORP
(10)
LS ALBERTA III LP
C/O JE ROBERT COS 1650 TYSON BLVD
MCLEAN
,
VA
22102
98-0493425
INVESTMENTS
CA
NA
C CORP
(11)
MIDPOINT TECHNOLOGY PARK OWNERS ASSOC
3145 PORTER DRIVE
PALO ALTO
,
CA
94304
94-3287254
REAL ESTATE
CA
NA
C CORP
(12)
OTHER (7)
CHARITABLE TR
CA
NA
TRUST
(13)
PIF (2)
CHARITABLE TR
CA
NA
TRUST
(14)
PROFESSIONAL EXCHANGE ASSURANCE COMPANY
201 MERCHANT STREET SUITE 2400
HONOLULU
,
HI
96813
90-0897686
INSURANCE
HI
NA
C CORP
(15)
SBFF LTD
PO BOX 1344
GEORGE TOWN
CJ
INVESTMENTS
CJ
NA
C CORP
(16)
SEA SMOKE FUND LLC
190 ELGIN AVENUE
GEORGE TOWN
,
GRAND CAYMAN
KY 9005
CJ
INVESTMENTS
DE
NA
C CORP
(17)
SEA SMOKE FUND LTD
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
CA
NA
C CORP
(18)
STANFORD (BEIJING) CNSLTNG CO LTD (WFOE)
5275TH FLBLDG CACADEMY SOUTH RD
HAIDAN DISTRICT
,
BEIJING
CH
EDUCATION
CH
NA
C CORP
(19)
STANFORD IN JAPAN GODO KAISHA
DOSHISHA UNIVERSITY MEITOKUKAN-NAI
KAMIGYOKU
,
KYOTO-SHI
JA
EDUCATION
JA
NA
C CORP
(20)
STANFORD INDIA PVT LTD
333 3RD FLOOR DEVIKA TOWER 6 NEH
SOUTH DELHI
,
DELHI
IN
EDUCATION
IN
NA
C CORP
(21)
STANFORD INTL MEDICAL SERVICES RAK FZE
PO BOX 56500
AE
PATIENT SRVC
AE
SHC
C CORP
0
0
100.000 %
Yes
(22)
STANFORD MEDICINE INTL (HONG KONG) CO LT
833 CHEUNG SHA WAN ROAD
KOWLOON
,
HONG KONG
HK
PATIENT SRVC
HK
SHC
C CORP
0
0
100.000 %
Yes
(23)
STANFORD SGGS EUROPE INC
UGLAND HOUSE S CHURCH ST
PO BOX GT GEORGE TOWN
CJ
13-1684331
INVESTMENTS
CJ
NA
C CORP
(24)
STANFORD UNIV MED NETWORK RISK AUTHORITY
1400 PAGE MILL RD MSC 5713
PALO ALTO
,
CA
94304
46-1132002
RISK MGMT CON
CA
NA
C CORP
(25)
STRUCTURED SERVICING HOLDINGS (OFFSHORE)
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
CJ
NA
C CORP
(26)
THE RUBRUM FUND
PO BOX 309 UGLAND HOUSE
GRAND CAYMAN
,
CAYMAN ISLANDS
CJ
INVESTMENTS
CJ
NA
C CORP
(27)
VERMILION PEAK FUND
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
CJ
NA
C CORP
(28)
WINTER ROCK ALTERNATIVE CREDIT I LP
PO BOX 10008 WILLOW HOUSE
GRAND CAYMAN
,
CAYMAN ISLANDS
KY1-1001
CJ
98-1140761
INVESTMENTS
CJ
NA
C CORP
(29)
WINTER ROCK ALTERNATIVE CREDIT MASTER LP
635 KNIGHT WAY
STANFORD
,
CA
943057297
INVESTMENTS
CJ
NA
C CORP
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
Yes
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
Yes
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
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
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
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)
SUMIT HOLDING INTERNATIONAL LLC
R
9,860,345
BOOK
(2)
SEROC
Q
725,011
COST
(3)
LPCH
L
83,656,915
FMV
(4)
LPCH
M
789,689
FMV
(5)
LPCH
N
4,591,853
FMV
(6)
LPCH
O
31,359,933
FMV
(7)
LPCH
Q
13,071,482
COST
(8)
UNIVERSITY HEALTHCARE ALLIANCE
B
73,617,010
BOOK
(9)
UNIVERSITY HEALTHCARE ALLIANCE
L
6,319,414
COST
(10)
UNIVERSITY HEALTHCARE ALLIANCE
P
41,478,834
COST
(11)
UNIVERSITY HEALTHCARE ALLIANCE
Q
9,900,956
COST
(12)
HOSPITAL COMMITTEE FOR THE L-P AREAS
A
2,183,607
COST
(13)
HOSPITAL COMMITTEE FOR THE L-P AREAS
P
8,942,586
COST
(14)
HOSPITAL COMMITTEE FOR THE L-P AREAS
Q
8,774,481
COST
(15)
HOSPITAL COMMITTEE FOR THE L-P AREAS
R
10,544,079
COST
(16)
HOSPITAL COMMITTEE FOR THE L-P AREAS
S
1,946,000
COST
(17)
STANFORD HEALTH CARE ADVANTAGE
B
9,000,000
BOOK
(18)
STANFORD HEALTH CARE ADVANTAGE
L
4,952,641
COST
(19)
STANFORD HEALTH CARE ADVANTAGE
O
379,364
COST
(20)
STANFORD HEALTH CARE ADVANTAGE
Q
3,629,029
COST
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, PART IV, LINE 5
CHARITABLE LEAD ANNUITY TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.
SCHEDULE R, PART IV, LINE 6
CHARITABLE REMAINDER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.
SCHEDULE R, PART IV, LINE 5
OTHER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.
SCHEDULE R, PART IV, LINE 6
POOLED INCOME FUNDS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.
Schedule R (Form 990) 2016
Additional Data
Software ID:
Software Version: