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ObjectId: 202413179349303446 - Submission: 2024-11-12
TIN: 23-7288765
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
23
Open to Public Inspection
Name of the organization
MILLS-PENINSULA HOSPITAL FOUNDATION
Employer identification number
23-7288765
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)
CALIFORNIA PACIFIC MEDICAL CTR FOUND
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-2728423
FUNDRAISING
CA
501(C)(3)
7
SUTTER BH
Yes
(2)
EAST BAY PERINATAL CENTER
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
51-0172285
HEALTHCARE
CA
501(C)(3)
3
SUTTER BH
Yes
(3)
SUTTER BAY MEDICAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-1156581
HEALTHCARE
CA
501(C)(3)
3
SUTTER HLTH
Yes
(4)
SUTTER AUBURN FAITH HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-2594966
FUNDRAISING
CA
501(C)(3)
7
SUTTER VH
Yes
(5)
SUTTER COAST HOSPITAL
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-2988520
HOSPITAL
CA
501(C)(3)
3
SUTTER HLTH
Yes
(6)
SUTTER DAVIS HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
68-0217870
FUNDRAISING
CA
501(C)(3)
7
SUTTER VH
Yes
(7)
SUTTER HEALTH
2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-2788907
SUPPORTING OR
CA
501(C)(3)
12c-III-FI
N/A
No
(8)
SUTTER HEALTH PACIFIC
91-2301 FT WEAVER RD
EWA BEACH
,
HI
96706
99-0298651
HOSPITAL
CA
501(C)(3)
3
SUTTER HLTH
Yes
(9)
SUTTER VALLEY HOSPITALS
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-1156621
HOSPITAL
CA
501(C)(3)
3
SUTTER HLTH
Yes
(10)
SUTTER INSURANCE SERVICES CORPORATION
745 FORT STREET SUITE 800
HONOLULU
,
HI
96813
99-0289310
INSURANCE SER
HI
501(C)(3)
12C-III-FI
SUTTER HLTH
Yes
(11)
SUTTER MEDICAL CENTER FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-2788906
FUNDRAISING
CA
501(C)(3)
7
SUTTER VH
Yes
(12)
SUTTER VALLEY MEDICAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
68-0273974
HEALTH CARE
CA
501(C)(3)
3
SUTTER HLTH
Yes
(13)
SUTTER ROSEVILLE MEDICAL CTR FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
68-0040113
FUNDRAISING
CA
501(C)(3)
7
SUTTER VH
Yes
(14)
SUTTER VISITING NURSE ASSOC AND HOSPICE
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-6068843
HEALTH CARE
CA
501(C)(3)
10
SUTTER HLTH
Yes
(15)
SUTTER BAY HOSPITALS
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-0562680
HOSPITAL
CA
501(C)(3)
3
SUTTER HLTH
Yes
(16)
TRACY HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
68-0318845
FUNDRAISING
CA
501(C)(3)
12a-I
SUTTER VH
Yes
(17)
MEMORIAL HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
94-2290244
FUNDRAISING
CA
501(C)(3)
12a-I
Sutter VH
Yes
(18)
SUTTER HEALTH PLAN
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
46-1183948
HEALTH PLAN
CA
501(c)(4)
N/A
SUTTER HLTH
Yes
(19)
Sansum Clinic
c/o SH Tax 2200 River Plaza Dr
Sacramento
,
CA
95833
95-6419205
Healthcare
CA
501(c)(3)
3
Sutter Hlth
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2023
Page 2
Schedule R (Form 990) 2023
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)
Surg Ctr of ABSMC
3875 TELEGRAPH
OAKLAND
,
CA
94609
47-0946086
PATIENT CARE
CA
N/A
(2)
CA PACIFIC ADV IMAG
PO BOX 6102
NOVATO
,
CA
94948
56-2311840
PATIENT CARE
CA
N/A
(3)
SF Endoscopy Center
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
91-2160588
PATIENT CARE
CA
N/A
(4)
SUT FAIRFIELD SURG
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
30-0233892
PATIENT CARE
CA
N/A
(5)
SUT AMADOR SURG CT
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
46-1398093
PATIENT CARE
CA
N/A
(6)
ROSEVILLE ENDOSCOPY
C/O SH TAX 2200 RIVER PLAZA DRIVE
SACRAMENTO
,
CA
95833
87-0710513
PATIENT CARE
CA
N/A
(7)
MEMORIAL MED BLDG
1800 COFFEE Rd 76
MODESTO
,
CA
95355
77-0234236
OFFICE RENTAL
CA
N/A
(8)
MAGNETIC IMAGING AF
2125 OAK GROVE RD
WALNUT CREEK
,
CA
94598
47-3696091
PATIENT CARE
CA
N/A
(9)
ASC OPTRS-SNTA ROSA
C/O SH TX 2200 RIVER PLAZA
SACRAMENTO
,
CA
95833
26-3386169
CARE MANAGEMENT
CA
N/A
(10)
Divisadero Holdings
C/O SH Tax 2200 River Plaza Dr
Sacramento
,
CA
95833
32-0621050
CARE MANAGEMENT
CA
N/A
(11)
PENINSULA ENDOSCOPY
c/o SH Tax 2200 River Plaza Dr
Sacramento
,
CA
95833
27-1905059
PATIENT CARE
CA
N/A
(12)
S Placer Surg Ctr
8 Medical Plaza
Roseville
,
CA
95661
42-1540694
Patient Care
CA
N/A
(13)
Sac Surg Ctr Assoc
1800 Tribute Rd
Sacramento
,
CA
95815
68-0516588
Patient Care
CA
N/A
(14)
Fort Sut Surg Ctr
2801 K ST
SACRAMENTO
,
CA
95816
68-0116391
Patient Care
CA
N/A
(15)
Sutter Alhambra Surg
1201 Alhambra
SACRAMENTO
,
CA
95816
63-1221949
Patient Care
CA
N/A
(16)
Auburn Surg Ctr
148 Maple St
Auburn
,
CA
95603
36-4123623
Patient Care
CA
N/A
(17)
ASC Operators LLC
2200 RIVER PLAZA DRIVE
SACRAMENTO
,
CA
95833
20-8970704
CARE MANAGEMENT
CA
N/A
(18)
DE SHAW ALP PLUS
1166 AVE AMERICAS
New York
,
NY
10036
83-2024364
Investment
DE
N/A
(19)
ICG CR OPP FUND 1A
11111 SANTA MONICA BLVD SUITE 2100
LOS ANGELES
,
CA
90025
82-5045573
Investment
DE
N/A
(20)
ICG CR OPP FUND 2A
11111 SANTA MONICA BLVD SUITE 2100
LOS ANGELES
,
CA
90025
85-2303976
Investment
DE
N/A
(21)
MAKENA RE II
2755 Sand Hill
Menlo Park
,
CA
94025
98-1298071
Investment
CJ
N/A
(22)
DE SHAW ALL CTRY
1166 AVE AMERICAS
New York
,
NY
10036
83-2024364
Investment
DE
N/A
(23)
DE SHAW ALP PLUS
1166 AVE AMERICAS
New York
,
NY
10036
88-2890454
Investment
DE
N/A
(24)
ICG SPEC OPP FND I
11111 SANTA MONICA BLVD SUITE 2100
LOS ANGELES
,
CA
90025
86-3196460
Investment
DE
N/A
(25)
Makena Strat Opp SH
2755 SAND HILL RD
MENLO PK
,
CA
94025
84-4965838
Investment
CA
N/A
(26)
ASC OPTRS - SLO LLC
2200 RIVER PL DR
Sacramento
,
CA
95833
27-2673776
CARE MANAGEMENT
CA
N/A
(27)
TAP CMDITYBLDR FUND
257 PARK AVENUE SOUTH SUITE 7
New York
,
NY
10010
27-4871720
Investment
NY
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)
CHARITABLE REMAINDER TRUSTS-9
C/O SH TAX 2200 RIVER PLAZA DR
SACRAMENTO
,
CA
95833
CRT
CA
MPHF
(2)
NORTHWOOD EUROPE TE FEEDER LP
1819 WAZEE STREET 2ND FLOOR
DENVER
,
CO
80202
98-1272216
HOLDING COMPANY
CJ
N/A
C CORP
Yes
(3)
SUTTER HEALTH DEFERRED COMP PLANs' trust
2200 RIVER PLAZA DRIVE
SACRAMENTO
,
CA
95833
27-6851989
RABBI TRUST
CA
N/A
TRUST
Yes
(4)
Health Ventures Inc
3012 SUMMIT ST 3RD FLR
Oakland
,
CA
94609
94-2918780
Health Serv.
CA
N/A
C Corp
Yes
(5)
Wilsop Segregated Portfolio 1
PO box 10008
Willow House Cricket Sq
,
grand cayman
KY1-10001
CJ
INVESTMENT
CJ
N/A
c corp
Yes
(6)
Wilsop Segregated Portfolio 2
PO box 10008
Willow House Cricket Sq
,
grand cayman
KY1-10001
CJ
INVESTMENT
CJ
N/A
c corp
Yes
(7)
AQR REAL RETURN OFFSHORE FUND LP
89 NEXUS WAY CAMANA BAY
GRAND CAYMAN
KY1-9009
CJ
98-0700570
Investment
CJ
N/A
C Corp
Yes
(8)
BRIGADE LEVERAGED CAPITAL STRUCTURE OFFS
ONE NEXUS WAY CAMANA BAY
GRAND CAYMAN
KY1-9005
CJ
98-1020330
Investment
CJ
N/A
C Corp
Yes
(9)
AQR MULTI-STRATEGY FUND XXIII LP
ONE GREENWICH PLAZA STE 130
Greenwich
,
CT
06830
98-1716386
Investment
CJ
N/A
C Corp
Yes
Schedule R (Form 990) 2023
Page 3
Schedule R (Form 990) 2023
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
No
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
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
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
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)
Sutter Bay Hospitals
Q
1,593,512
FMV
(2)
Sutter Bay Hospitals
B
2,442,064
FMV
(3)
Sutter Bay Hospitals
L
2,833,533
FMV
Schedule R (Form 990) 2023
Page 4
Schedule R (Form 990) 2023
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) 2023
Page 5
Schedule R (Form 990) 2023
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) 2023
Additional Data
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