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ObjectId: 202003189349307295 - Submission: 2020-11-13
TIN: 90-0779996
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
19
Open to Public Inspection
Name of the organization
CHILDREN'S HEALTHCARE OF ATLANTA GROUP RETURN
Employer identification number
90-0779996
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)
CHILDREN'S SEDATION SERVICES LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
81-0582607
PHYS SERVICES
GA
1,301,928
0
EGLESTON PED
(2)
CHILDREN'S ANESTHESIA SERVICES LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
20-0044124
PHYS SERVICES
GA
17,273,909
0
EGLESTON PED
(3)
CHOA CENTER FOR PAIN RELIEF LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
32-0185406
PHYS SERVICES
GA
0
0
EGLESTON PED
(4)
PED NEUROSURGERY ASSOC AT CHILDREN'S LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
26-0833842
PHYS SERVICES
GA
5,564,215
0
EGLESTON PED
(5)
CHOA - MULTISPECIALTY LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
61-1665353
PHYS SERVICES
GA
49,736,104
0
EGLESTON PED
(6)
CHOA - HOSPITAL BASED LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
80-0863895
PHYS SERVICES
GA
104,397,824
0
EGLESTON PED
(7)
SPECIALTY PROVIDERS AT CHILDREN'S LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
61-1753346
PHYS SERVICES
GA
0
0
EGLESTON PED
(8)
MED-SURGICAL PROVIDERS AT CHILDREN'S LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
30-0853755
PHYS SERVICES
GA
0
EGLESTON PED
(9)
CARDIOTHORACIC PROVDRS AT CHILDREN'S LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
32-0456470
PHYS SERVICES
GA
5,918,302
0
EGLESTON PED
(10)
PRIMARY CARE AT CHILDREN'S LLC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
61-1752679
PHYS SERVICES
GA
1,975,042
0
EGLESTON PED
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)
CHILDREN'S HEALTHCARE OF ATLANTA INC
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
58-2367819
HLTHCRE MGMT
GA
501(c)(3)
12B
NA
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Page 2
Schedule R (Form 990) 2019
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)
MERIDIAN MARK LLC 01-0723254
1575 NE EXPY
ATL
,
GA
30329
SURGERY CENTER
GA
SCOTTISH RITE
RELATED
10,549,057
14,588,805
No
No
51.000 %
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)
EMORY-EGLESTON CHILDREN'S HEART CENTER
2835 BRANDYWINE RD SUITE 300
ATLANTA
,
GA
30329
58-1871713
CARDIAC SERVICES
GA
CHOA
C CORP
0
0
100.000 %
Yes
(2)
THE CHILDREN'S CARE NETWORK
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
47-1373158
PHYSICIAN SRVS
GA
CHOA
C CORP
-1,687,628
6,783,734
100.000 %
Yes
(3)
CHARITABLE REMAINDER TRUST - SUNTRUST
303 PEACHTREE ST
ATLANTA
,
GA
30303
SPLIT INT. TRUST
GA
NA
TRUST
26,934
1,012,363
100.000 %
No
(4)
LAURIE DAVIS WEBSTER TRUST
303 PEACHTREE ST
ATLANTA
,
GA
30303
58-6026013
CHARITABLE TRUST
GA
CHOA
TRUST
2,498
103,240
100.000 %
Yes
(5)
WE CHAPLIN TRUST
303 PEACHTREE ST
ATLANTA
,
GA
30303
58-6026010
CHARITABLE TRUST
GA
CHOA
TRUST
320
13,187
100.000 %
Yes
(6)
THOMAS EGLESTON TRUST
303 PEACHTREE ST
ATLANTA
,
GA
30303
58-6026009
CHARITABLE TRUST
GA
CHOA
TRUST
407,539
23,967,659
100.000 %
Yes
(7)
CHARITABLE REMAINDER TRUST - WELLS FARGO
3375 NORTHEAST EXPRESSWAY
ATLANTA
,
GA
30341
SPLIT INT. TRUST
NC
NA
TRUST
Yes
(8)
NEAL ALLEN CHARITABLE REMAINDER UNITRUST
303 PEACHTREE ST
ATLANTA
,
GA
30303
CHARITABLE TRUST
GA
N/A
23,062
899,844
100.000 %
Yes
(9)
TYCHO HOWLE CHARITABLE REMAINDER UNITRUS
303 PEACHTREE ST
ATLANTA
,
GA
30303
CHARITABLE TRUST
GA
N/A
10,671
41,923
100.000 %
Yes
Schedule R (Form 990) 2019
Page 3
Schedule R (Form 990) 2019
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
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
Yes
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
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
No
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
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)
THOMAS EGLESTON TRUST
C
407,539
CASH TRANSFER
Schedule R (Form 990) 2019
Page 4
Schedule R (Form 990) 2019
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) 2019
Page 5
Schedule R (Form 990) 2019
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) 2019
Additional Data
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