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PACKARD CHILDRENS HEALTH ALLIANCE: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
PACKARD CHILDRENS HEALTH ALLIANCE (EIN 32-0359189)
Tax period
2021-09-01 to 2022-08-31
Filed
2023-07-13
IRS object ID
202301949349301710
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-07-13T15:15:27-05:00ReturnTs
Tax Period End2022-08-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PwC US Tax LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1101 SEAPORT BLVD SUITE 500AddressLine1Txt
CityBOSTONCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02210ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-09-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN320359189EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PACKARD CHILDREN'S HEALTH ALLIANCEBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% DANA HAERINGInCareOfNm
Business Name ControlPACKBusinessNameControlTxt
Phone6504978000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1725 WELCH ROAD MC 5551AddressLine1Txt
CityPALO ALTOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94304ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDANA HAERINGPersonNm
Person TitleCFOPersonTitleTxt
Phone6507212222PhoneNum
Signature2023-07-12SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDANAPersonFirstNm
Person LastHAERINGPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonGWEN SPENCERPreparerPersonNm
PTINP00641463PTIN
Phone6175305000PhoneNum
Preparation2023-07-11PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerChantal Volel-TorresPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1725 WELCH ROAD MC 5551AddressLine1Txt
CityPALO ALTOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94304ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$124,685,692GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.STANFORDCHILDRENS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionSEE SCHEDULE OActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent3VotingMembersIndependentCnt
Total Employee493TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$4,748,302PYContributionsGrantsAmt
CY Contributions Grants$1,657,287CYContributionsGrantsAmt
PY Program Service Revenue$114,646,265PYProgramServiceRevenueAmt
CY Program Service Revenue$123,028,405CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$119,394,567PYTotalRevenueAmt
CY Total Revenue$124,685,692CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$37,452,897PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$42,398,734CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$95,773,396PYOtherExpensesAmt
CY Other Expenses$96,253,469CYOtherExpensesAmt
PY Total Expenses$133,226,293PYTotalExpensesAmt
CY Total Expenses$138,652,203CYTotalExpensesAmt
PY Revenues Less Expenses-$13,831,726PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$13,966,511CYRevenuesLessExpensesAmt
Total Assets BOY$36,765,810TotalAssetsBOYAmt
Total Assets EOY$35,559,782TotalAssetsEOYAmt
Total Liabilities BOY$28,299,452TotalLiabilitiesBOYAmt
Total Liabilities EOY$27,059,935TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$8,466,358NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,499,847NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE OMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$125,384,768ExpenseAmt
Revenue$123,028,405RevenueAmt
DescSEE SCHEDULE ODesc
Total Program Service Expenses$125,384,768TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document73IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee493EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member3IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDANA HAERINGPersonNm
Phone6507235636PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1725 WELCH ROAD MC 5551AddressLine1Txt
CityPALO ALTOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94304ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Dennis P Lund MD
CHAIR UNTIL 12/31/21, DIRECTOR1.050.0Yes (X)Yes (X)$0$1,007,023$64,374
Dana Haering
EVP & CFO3.047.0Yes (X)$0$982,191$67,634
Marcia Cohen
Director UNTIL 12/15/211.049.0Yes (X)$0$730,910$63,935
PATRICK IDEMOTO
INTERIM CEO UNTIL 11/15/2125.025.0Yes (X)Yes (X)$0$650,887$95,517
TIM CORNELL MD
DIRECTOR1.049.0Yes (X)$0$543,033$80,385
ANDREW SMITH
MED DIR, VICE CHAIR AS OF 1/2250.00.0Yes (X)Yes (X)$529,569$0$76,509
RICK VANCE
COO50.00.0$433,489$0$38,814Yes (X)
TZIELAN LEE MD
SECRETARY AS OF 1/22, DIRECTOR1.049.0Yes (X)Yes (X)$0$348,151$84,743
TIKA MARTIN
DIRECTOR, HUMAN RESOURCES50.00.0$276,250$0$101,710Yes (X)
TAMMY OJEDA-LEAO
DIRECTOR GENERAL PEDIATRICS50.00.0$208,657$0$79,679Yes (X)
MICHAEL LIPMAN
DIRECTOR, PROVIDER RECRUIT.50.00.0$255,974$0$19,024Yes (X)
MALAVIKA NARAYAN
DIR PHYS NET FIN TO 8/27/2150.00.0$0$181,294$62,231Yes (X)
DOROTHY NAIDU
DIRECTOR, CLINICAL QUALITY50.00.0$207,113$0$33,225Yes (X)
TIFFANY AUBREY
DIR. OF PRACTICE OPERATIONS50.00.0$200,095$0$25,353Yes (X)
SAMAR S SHAKOOR
DIR - PHYSICIAN RELATIONS50.00.0$182,346$22,424$14,183Yes (X)
SUSAN AULT
PRACTICE MANAGER III50.00.0$179,104$0$30,374Yes (X)
EMILY KRUGER
DIR., PHYSICIAN NETWORK FIN.50.00.0$173,494$28,074$6,917Yes (X)
Cameron D'alpe
FORMER CEO17.033.0$0$120,295$30,558Yes (X)
Chantal Volel-Torres
CEO & DIRECTOR AS OF 11/15/2117.033.0Yes (X)Yes (X)$0$94,173$5,898
MALINDA MITCHELL
CHAIR AS OF 1/22, DIRECTOR1.00.0Yes (X)Yes (X)$0$0$0
LISA ERBURU MD
DIRECTOR1.00.0Yes (X)$0$0$0
JOHN WALKER
DIRECTOR1.00.0Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,646,091TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$4,708,455TotReportableCompRltdOrgAmt
Total Other Compensation$981,063TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K36IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PACKARD MEDICAL GROUP INC
725 WELCH ROAD MC 5551PALO ALTOCA94304PHYSICIAN SERVICES$59,599,439
G AND G ORGANIZATION LTD DBA PFS GR
2600 NORTH LOOP WEST SUITE 150HOUSTONTX77092PFS SERVICE$2,643,949
LIGHTHOUSE MANAGEMENT GROUP INC
333 WEST SAN CARLOS STREET SUITE 6SAN JOSECA951102731LABOR SERVICE$593,805
EMCOR GOVERNMENT SERVICES INC
6363 WALKER LANE SUITE 600ALEXANDRIAVA223103264FACILITIES SERVICE$579,991
SCRIBE AMERICA LLC
PO BOX 417756BOSTONMA02241LABOR SERVICE$446,097
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K16CntrctRcvdGreaterThan100KCnt
Government Grants$1,637,287GovernmentGrantsAmt
All Other Contributions$20,000AllOtherContributionsAmt
Total Contributions$1,657,287TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICES900099$106,725,645$106,725,645
MEDICARE/MEDICAID900099$7,986,700$7,986,700
PROGRAM SUPPORT900099$8,316,060$8,316,060
FieldValueIRS element (for citing)
Total Program Service Revenue$123,028,405TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$124,685,692TotalRevenueColumnAmt
Related Or Exempt Func Income$123,028,405RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,414,584TotalAmt
Program Services$1,053,030ProgramServicesAmt
Management And General$361,554ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$182,346TotalAmt
Program Services$82,056ProgramServicesAmt
Management And General$100,290ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$20,667,081TotalAmt
Program Services$17,370,613ProgramServicesAmt
Management And General$3,296,468ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,377,823TotalAmt
Program Services$468,736ProgramServicesAmt
Management And General$909,087ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$16,881,442TotalAmt
Program Services$14,647,781ProgramServicesAmt
Management And General$2,233,661ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,875,458TotalAmt
Program Services$1,621,101ProgramServicesAmt
Management And General$254,357ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$407,577TotalAmt
Program Services$179,995ProgramServicesAmt
Management And General$227,582ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$297,881TotalAmt
Management And General$297,881ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$48,395TotalAmt
Management And General$48,395ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$66,999,086TotalAmt
Program Services$62,901,643ProgramServicesAmt
Management And General$4,097,443ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$168,787TotalAmt
Program Services$64,890ProgramServicesAmt
Management And General$103,897ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$16,201,990TotalAmt
Program Services$16,041,944ProgramServicesAmt
Management And General$160,046ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,053,815TotalAmt
Program Services$4,053,815ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$6,412,000TotalAmt
Program Services$6,412,000ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$48,687TotalAmt
Program Services$35,530ProgramServicesAmt
Management And General$13,157ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,188,671TotalAmt
Program Services$1,802,985ProgramServicesAmt
Management And General$385,686ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$388,382TotalAmt
Program Services$28,480ProgramServicesAmt
Management And General$359,902ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
UNCOLLECTIBLES$671,887$671,887
LICENSES & TAXES$289,961$44,904$245,057
UTILITIES$148,488$148,488
DUES & SUBSCRIPTIONS$121,625$36,761$84,864

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total-$2,193,763TotalAmt
Program Services-$2,281,871ProgramServicesAmt
Management And General$88,108ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$138,652,203TotalAmt
Program Services$125,384,768ProgramServicesAmt
Management And General$13,267,435ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$61,620BOYAmt
EOY$415,894EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$10,610,515BOYAmt
EOY$11,724,825EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$741,014BOYAmt
EOY$895,931EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$21,504,290LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$18,539,181LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$3,271,650BOYAmt
EOY$2,965,109EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$6,784,991BOYAmt
EOY$5,742,785EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$15,296,020BOYAmt
EOY$13,815,238EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$36,765,810BOYAmt
EOY$35,559,782EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$6,919,918BOYAmt
EOY$6,070,354EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$21,379,534BOYAmt
EOY$20,989,581EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$28,299,452BOYAmt
EOY$27,059,935EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$8,466,358BOYAmt
EOY$8,494,847EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$5,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,466,358BOYAmt
EOY$8,499,847EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$36,765,810BOYAmt
EOY$35,559,782EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$13,966,511ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$14,000,000OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART IFormAndLineReferenceDesc
ExplanationPACKARD CHILDREN'S HEALTH ALLIANCE WAS RECOGNIZED AS A HEALTHCARE ORGANIZATION DESCRIBED IN SECTION 170(B)(1)(A)(III) OF THE INTERNAL REVENUE CODE. PCHA DOES NOT OPERATE A FACILITY THAT IS OR IS REQUIRED TO BE LICENSED AS A HOSPITAL. THEREFORE, PCHA IS NOT REQUIRED TO FILE FORM 990, SCHEDULE H.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp
BuildingsBuildingsGrp

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,243,084OtherCostOrOtherBasisAmt
Depreciation$5,595,118DepreciationAmt
Book Value$647,966BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,792,064OtherCostOrOtherBasisAmt
Depreciation$12,879,832DepreciationAmt
Book Value$1,912,232BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$469,142OtherCostOrOtherBasisAmt
Depreciation$64,231DepreciationAmt
Book Value$404,911BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$2,965,109TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
OTHER ASSETS$3,083,384
RIGHT OF USE LEASE ASSETS$10,669,710
SECURITY DEPOSITS$62,144
FieldValueIRS element (for citing)
Total Book Value Other Assets$13,815,238TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE TO RELATED PARTIES, NET$10,011,772
RIGHT OF USE LEASE LIABILITIES$10,977,809
FieldValueIRS element (for citing)
Total Liability$20,989,581TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PART X, LINE 2FormAndLineReferenceDesc
ExplanationFIN 48 PCHA IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF STANFORD UNIVERSITY, WHICH INCLUDE THE FOLLOWING NOTE: IN ACCORDANCE WITH THE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, MANAGEMENT REGULARLY EVALUATES ITS TAX POSITIONS AND DOES NOT BELIEVE PCHA HAS ANY UNCERTAIN TAX POSITIONS THAT REQUIRE DISCLOSURE OR ADJUSTMENT TO THE FINANCIAL STATEMENTS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ANDREW SMITH
MED DIR, VICE CHAIR AS OF 1/22$405,898$0$107,724$0$15,947$0$18,525$0$57,984$0$606,078$0$0$0
Cameron D'alpe
FORMER CEO$0$116,592$0$750$0$2,953$0$25,706$0$4,852$0$150,853$0$0
Dana Haering
EVP & CFO$0$659,502$0$223,948$0$98,741$0$49,765$0$17,869$0$1,049,825$0$0
Dennis P Lund MD
CHAIR UNTIL 12/31/21, DIRECTOR$0$415,526$0$513,385$0$78,112$0$29,000$0$35,374$0$1,071,397$0$0
DOROTHY NAIDU
DIRECTOR, CLINICAL QUALITY$192,782$0$14,161$0$170$0$12,900$0$20,325$0$240,338$0$0$0
EMILY KRUGER
DIR., PHYSICIAN NETWORK FIN.$163,489$28,074$9,736$0$269$0$0$2,816$0$4,101$173,494$34,991$0$0
MALAVIKA NARAYAN
DIR PHYS NET FIN TO 8/27/21$0$172,704$0$750$0$7,840$0$52,964$0$9,267$0$243,525$0$0
Marcia Cohen
Director UNTIL 12/15/21$0$613,703$0$117,207$0$0$0$29,000$0$34,935$0$794,845$0$0
MICHAEL LIPMAN
DIRECTOR, PROVIDER RECRUIT.$239,391$0$16,421$0$162$0$17,675$0$1,349$0$274,998$0$0$0
PATRICK IDEMOTO
INTERIM CEO UNTIL 11/15/21$0$463,967$0$156,987$0$29,933$0$91,978$0$3,539$0$746,404$0$865
RICK VANCE
COO$357,300$0$60,442$0$15,747$0$18,525$0$20,289$0$472,303$0$0$0
SAMAR S SHAKOOR
DIR - PHYSICIAN RELATIONS$171,743$22,424$10,433$0$170$0$11,537$1,616$0$1,030$193,883$25,070$0$0
SUSAN AULT
PRACTICE MANAGER III$171,054$0$7,975$0$75$0$9,719$0$20,655$0$209,478$0$0$0
TAMMY OJEDA-LEAO
DIRECTOR GENERAL PEDIATRICS$189,083$0$18,553$0$1,021$0$11,101$0$68,578$0$288,336$0$0$0
TIFFANY AUBREY
DIR. OF PRACTICE OPERATIONS$183,451$0$16,424$0$220$0$5,028$0$20,325$0$225,448$0$0$0
TIKA MARTIN
DIRECTOR, HUMAN RESOURCES$250,556$0$20,707$0$4,987$0$16,908$0$84,802$0$377,960$0$0$0
TIM CORNELL MD
DIRECTOR$0$324,083$0$178,339$0$40,611$0$19,910$0$60,475$0$623,418$0$0
TZIELAN LEE MD
SECRETARY AS OF 1/22, DIRECTOR$0$269,009$0$78,942$0$200$0$23,733$0$61,010$0$432,894$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 3PROCEDURES FOR DETERMINING COMPENSATION PCHA RELIED ON LPCH, A RELATED ORGANIZATION, TO DETERMINE OFFICER COMPENSATION. LPCH'S PROCESS FOR DETERMINING COMPENSATION REQUIRES COMPENSATION TO BE REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE OF THE BOARD, WHICH IS COMPRISED ON INDEPENDENT PERSONS. THE COMMITTEE ENGAGES AN INDEPENDENT CONSULTANT, WHO PROVIDES THE COMMITTEE WITH COMPARABLE MARKET DATA FROM THE FORMS 990 OF COMPARABLE ORGANIZATIONS SUPPLEMENTED BY PUBLISHED COMPENSATION AND BENEFITS SURVEYS TO BE CONSIDERED IN EVALUATING TOTAL COMPENSATION PACKAGES FOR EACH INDIVIDUAL EXECUTIVE. THE COMMITTEE CONDUCTS A REVIEW OF THIS COMPARABILITY DATA AND DOCUMENTED ITS DELIBERATIONS AND DISCUSSION IN MINUTES THAT ARE RETAINED WITH THE OTHER GOVERNANCE MATERIALS OF LPCH. THE VALUE OF EACH PAY ELEMENT AND THE TOTAL PACKAGE ARE REVIEWED ANNUALLY PRIOR TO ANNUAL INCREASE PAY ACTIONS BEING APPROVED BY THE COMPENSATION COMMITTEE. SPECIFIC FACTS AND CIRCUMSTANCES OF EACH ROLE, INCUMBENT, THEIR PERFORMANCE, SKILLS, AND RESPONSIBILITIES ARE REVIEWED AND ASSESSED INDIVIDUALLY. THE COMMITTEE RECEIVES RECOMMENDATIONS FROM THE CEO AS TO PAY ACTIONS FOR EACH INCUMBENT. THESE RECOMMENDATIONS ARE DISCUSSED AND THE RESULTS OF THE DELIBERATIONS ARE DOCUMENTED AS TO THE FINAL PAY ACTION APPROVED ALONG WITH THE RATIONALE FOR THE DECISION. THIS PROCESS OCCURS ANNUALLY AND IN CONJUNCTION WITH ANY PROGRAMMATIC CHANGE THAT COULD POTENTIALLY IMPACT THE PAY OR BENEFITS OF EXECUTIVES.
SCHEDULE J, PART I, LINE 4BSUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CERTAIN OFFICERS OF PCHA ARE PROVIDED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO SUPPLEMENT THEIR RETIREMENT BENEFITS BY LPCH, A RELATED ORGANIZATION. FOR EACH CALENDAR YEAR, A HYPOTHETICAL ACCOUNT IS ESTABLISHED FOR EACH PARTICIPANT AND CREDITED WITH AN AMOUNT EQUAL TO A PERCENTAGE OF BASE SALARY (DEPENDING ON THE INDIVIDUAL'S POSITION) AS OF THE LAST DAY OF EACH QUARTER. THE COMPENSATION COMMITTEE MAY DETERMINE THAT CREDITS SHALL BE MADE IN ADDITION TO THOSE ABOVE IN ITS SOLE DISCRETION. A PARTICIPANT BECOMES VESTED IN EACH CALENDAR YEAR ACCOUNT ON THE FIRST BUSINESS DAY OF JANUARY FOLLOWING THE SECOND CALENDAR YEAR IN WHICH THE ACCOUNT WAS ESTABLISHED (OR, IF LATER, THE DATE ON WHICH THE PARTICIPANT COMPLETES TWO FULL YEARS OF PARTICIPATION). THE PARTICIPANT BECOMES FULLY VESTED IN HIS OR HER ACCOUNTS UNDER THE SERP UPON THE EARLIEST OF (A) DISCHARGE FROM EMPLOYMENT WITHOUT CAUSE; (B) ENTITLEMENT TO LONG-TERM DISABILITY INCOME BENEFITS; (C) ATTAINMENT OF AGE OF 60 WHILE EMPLOYED OR IF LATER, THE PARTICIPANT'S COMPLETION OF TWO FULL YEARS OF PARTICIPATION; (D) COMPLETION OF SEVEN YEARS AS AN ELIGIBLE EMPLOYEE; OR (E) THE DATE OF DEATH, PRIOR TO PAYMENT OR FORFEITURE, WITH BENEFITS PAYABLE TO THE BENEFICIARY. THE FOLLOWING AMOUNTS BECAME VESTED AND WERE PAID TO THE FOLLOWING INDIVIDUALS IN CALENDAR YEAR 2021: DANA HAERING $ 80,144 PATRICK IDEMOTO $ 912 FOR CERTAIN INDIVIDUALS LISTED ON SCHEDULE J, PART II, AMOUNTS CREDITED UNDER THE PLAN ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (C).
SCHEDULE J, PART I, LINE 7CERTAIN OFFICERS AND OTHERS AS ENUMERATED IN SCHEDULE J, PART II PARTICIPATE IN THE SERP, WHICH WAS DESCRIBED ABOVE UNDER SCHEDULE J, PART I, LINE 4B. ANNUALLY, AMOUNTS ARE CREDITED TO THE PLAN BASED ON PERFORMANCE AND CERTAIN OTHER FACTORS. PLAN BALANCES ARE SUBJECT TO FORFEITURE AND/OR PAYMENT ONLY IF CERTAIN CONDITIONS ARE MET.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 1 & PART IIIORGANIZATION'S PRIMARY EXEMPT PURPOSE AT PCHA, THE FOCUS IS ON PATIENT CARE AND COMMUNITY OUTREACH TO ENSURE PATIENT ACCESS TO PCHA'S SERVICES. PCHA PHYSICIANS, NON-MD CLINICIANS, AND STAFF ASSUME THE ROLE OF EDUCATORS TO IMPROVE THE PHYSICAL AND BEHAVIORAL WELL-BEING OF CHILDREN IN THE COMMUNITIES IT SERVES. THE OVERALL STRATEGY TO ACCOMPLISH THE OBJECTIVE IS TWOFOLD: BECOME A RELIED UPON RESOURCE FOR CAREGIVERS/PARENTS AND PROVIDE PREVENTATIVE CARE FOR CHILDREN. EDUCATION IS THE KEY FOR BOTH STRATEGIES. WHILE MULTIPLE COMMUNITY SERVICES WILL BE OFFERED AT THE MEDICAL SITES, A SIGNIFICANT PART OF THE OUTREACH EFFORTS WILL BE SPENT SERVING THE PCHA COMMUNITY.
FORM 990, PART III, LINE 4APROGRAM SERVICE DESCRIPTION DURING THE PERIOD OF SEPTEMBER 2021 THROUGH AUGUST 2022 (FY 2022), PCHA PRIMARILY FOCUSED ON OPERATIONS AND EXISTING PROVIDER VISIT GROWTH. IN ADDITION, WE CONTINUE TO INCREASE OUR AVAILABILITY AT MANY OF OUR SITES BY INCREASING THE NUMBER OF PROVIDERS. THIS YEAR WE CONTINUED TO IMPROVE SERVICES OFFERED VIA OUR PATIENT PORTAL INCLUDING DIRECTLY SCHEDULING APPOINTMENTS, REQUESTING PRESCRIPTIONS, VIEWING BILLING STATEMENTS AND COMMUNICATING WITH MEDICAL PROVIDERS. THE THREE LARGEST SERVICES PCHA OPERATED IN FISCAL YEAR 2022 WERE: GENERAL PEDIATRICS - BAYSIDE GENERAL PEDIATRICS - PENINSULA PEDIATRICS GENERAL PEDIATRICS - PEDIATRIC ASSOCIATES BAYSIDE BAYSIDE PEDIATRICS WAS ESTABLISHED IN OAKLAND IN 1979 AND HAS GROWN THROUGHOUT THE EAST BAY INTO A NETWORK OF 9 PEDIATRIC OFFICES, WITH A DEDICATED TEAM WHO HAVE OUTSTANDING CREDENTIALS AND EXPERIENCE. WE PROVIDE PERSONALIZED, HIGH-QUALITY, AND PATIENT-CENTERED CARE. OUR PEDIATRICIANS SPECIALIZE IN THE CARE OF NEWBORNS, CHILDREN AND ADOLESCENTS AT ALL 9 OF OUR OFFICES. IN ADDITION, WE HAVE A PEDIATRICIAN WITH PULMONOLOGY EXPERIENCE WHO BRINGS EXPERTISE IN ASTHMA CARE TO OUR PATIENTS. WE ALSO PROVIDE TRAVEL MEDICINE SERVICES. WE ARE COMMITTED TO PROVIDING EXCELLENT CARE TO ALL CHILDREN AND THEIR FAMILIES. PENINSULA PEDIATRICS AT PENINSULA PEDIATRIC MEDICAL GROUP, OUR FAMILY OF EXPERIENCED AND CARING PEDIATRICIANS HAS BEEN SERVING CHILDREN IN THE BAY AREA FOR GENERATIONS. WE SPECIALIZE IN CARING FOR NEWBORNS THROUGH ADOLESCENTS IN THEIR LATE TEENS. WE WORK WITH PARENTS TO HELP CHILDREN REACH THEIR HIGHEST POTENTIAL BY GIVING THEM THE TOOLS THEY NEED TO LIVE A HEALTHY LIFE. WE STRIVE TO BE UNDERSTANDING AND AVAILABLE TO THE FAMILIES WE ARE PRIVILEGED TO SERVE, AND OFFER OUR SERVICES IN BURLINGAME, SAN MATEO AND MENLO PARK. PEDIATRIC ASSOCIATES MEDICAL GROUP THE PEDIATRIC ASSOCIATES MEDICAL GROUP HAS 8 PHYSICIANS IN TWO SAN JOSE LOCATIONS, SAMARITAN, AND CAMDEN. THE GROUP HAS BEEN PROVIDING THE FULL CONTINUUM OF GENERAL PEDIATRIC SERVICES TO CHILDREN AND YOUNG ADULTS FOR OVER 30 YEARS. PATIENT VISITS PROVIDED IN THE FISCAL YEAR 2022 FOR EACH OF THE LARGEST SERVICES ARE: BAYSIDE: 75,176 PENINSULA PEDIATRICS: 43,950 PEDIATRIC ASSOCIATES: 22,054 DURING FISCAL YEAR 2022 PCHA PROVIDED 302,330 OFFICE VISITS. In August 2022, Foster City Pediatric Medical Group joined PCHA and became the newest practice. The practice began in 1988, and the practice plans to continue providing the same excellent care it has offered for the last 30 years, as well as the additional benefits of being part of a world-class health care system.
FORM 990, PART VI, LINE 2FAMILY/BUSINESS RELATIONSHIP DANA HAERING AND PATRICK IDEMOTO ARE OFFICERS OF LUCILE SALTER PACKARD CHILDREN'S HOSPITAL. DENNIS LUND IS AN OFFICER AND DIRECTOR OF LUCILE SALTER PACKARD CHILDREN'S HOSPITAL. DANA HAERING, PATRICK IDEMOTO, AND CAMERON D'ALPE ARE EMPLOYEES OF LUCILE SALTER PACKARD CHILDREN'S HOSPITAL.
FORM 990, PART VI, LINE 6MEMBERS STANFORD UNIVERSITY AND LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD ARE THE MEMBERS OF PCHA.
FORM 990, PART VI, LINE 7ASTANFORD UNIVERSITY AND LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD, AS THE MEMBERS OF PCHA, APPOINT THE PCHA BOARD OF DIRECTORS. TWO OF THE DIRECTORS MUST BE PERSONS WHO RESIDE IN THE COMMUNITIES SERVED BY PCHA AND WHO ARE NOT COMPENSATED BY PCHA, THE MEMBERS, OR ANY MEDICAL GROUP AFFILIATED WITH PCHA.
FORM 990, PART VI, LINE 7BTHE FOLLOWING ACTIONS MUST BE APPROVED BY ONE OR MORE MEMBERS: - ENTERING INTO PROFESSIONAL SERVICE AGREEMENTS WITH NEW MEDICAL GROUPS - ACQUISITION, MERGER, OR CONSOLIDATION OF ANY OTHER ENTITY.
FORM 990, PART VI, LINE 11PROCEDURES FOR REVIEWING FORM 990 FROM GOVERNING BODY WORKING WITH PRICEWATERHOUSECOOPERS, THE FORM 990 IS PREPARED FOR MANAGEMENT'S REVIEW. A DRAFT OF THE FORM 990 IS MAILED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW, ALONG WITH AN EXECUTIVE SUMMARY OF RECENT CHANGES AND NEW REQUIREMENTS. THE DRAFT FORM 990 IS REVIEWED AT THE AUDIT AND COMPLIANCE COMMITTEE MEETING. A FINAL FORM 990 IS THEN DISTRIBUTED TO THE FULL BOARD BEFORE FILING WITH THE IRS. PRICEWATERHOUSECOOPERS SIGNS THE FINAL RETURN AS PAID PREPARER.
FORM 990, PART VI, LINE 12CPROCEDURES FOR MONITORING AND ENFORCING COMPLIANCE WITH CONFLICT-OF-INTEREST POLICY OFFICERS, DIRECTORS AND EMPLOYEES ARE REQUIRED TO COMPLETE AN INITIAL CONFLICT-OF-INTEREST DISCLOSURE STATEMENT ("DISCLOSURE STATEMENT") AT THE TIME OF APPOINTMENT AT PCHA. ADDITIONALLY, AN UPDATED DISCLOSURE STATEMENT IS REQUIRED THEREAFTER ON AN ANNUAL BASIS. A DISCLOSURE THAT APPEARS TO BE A CONFLICT WILL BE RESOLVED BY A MUTUAL AGREEABLE PLAN WITH THE PCHA CHIEF EXECUTIVE OFFICER THAT OUTLINES THE STEPS THE OFFICER, DIRECTOR OR EMPLOYEE MUST TAKE TO RECTIFY THE CONFLICT.
FORM 990, PART VI, LINE 15PROCEDURES FOR DETERMINING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER, PCHA RELIED ON LPCH, A RELATED ORGANIZATION, TO DETERMINE OFFICER COMPENSATION. LPCH'S PROCESS FOR DETERMINING COMPENSATION REQUIRES COMPENSATION TO BE REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE OF THE BOARD, WHICH IS COMPRISED OF INDEPENDENT PERSONS. THE COMMITTEE ENGAGES AN INDEPENDENT CONSULTANT, WHO PROVIDES THE COMMITTEE WITH COMPARABLE MARKET DATA FROM THE FORMS 990 OF COMPARABLE ORGANIZATIONS SUPPLEMENTED BY PUBLISHED COMPENSATION AND BENEFITS SURVEYS TO BE CONSIDERED IN EVALUATING TOTAL COMPENSATION PACKAGES FOR EACH INDIVIDUAL EXECUTIVE. THE COMMITTEE CONDUCTS A REVIEW OF THIS COMPARABILITY DATA AND DOCUMENTED ITS DELIBERATIONS AND DISCUSSION IN MINUTES THAT ARE RETAINED WITH THE OTHER GOVERNANCE MATERIALS OF LPCH. THE VALUE OF EACH PAY ELEMENT AND THE TOTAL PACKAGE ARE REVIEWED ANNUALLY PRIOR TO ANNAUL INCREASE PAY ACTIONS BEING APPROVED BY THE COMPENSATION COMMITTEE. SPECIFIC FACTS AND CIRCUMSTANCES OF EACH ROLE, INCUMBENT, THEIR PERFORMANCE, SKILLS, AND RESPONSIBILITIES ARE REVIEWED AND ASSESSED INDIVIDUALLY. THE COMMITTEE RECEIVES RECOMMENDATIONS FROM THE CEO AS TO PAY ACTIONS FOR EACH INCUMBENT. THESE RECOMMENDATIONS ARE DISCUSSED AND THE RESULTS OF THE DELIBERATIONS ARE DOCUMENTED AS TO THE FINAL PAY ACTION APPROVED ALONG WITH THE RATIONALE FOR THE DECISION. THIS PROCESS OCCURS ANNUALLY AND IN CONJUNCTION WITH ANY PROGRAMMATIC CHANGE THAT COULD POTENTIALLY IMPACT THE PAY OR BENEFITS OF EXECUTIVES. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES WHO ARE EMPLOYEES OF PCHA IS DETERMINED BY A PROCESS THAT INCLUDES A REVIEW OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DECISION. COMPENSATION DECISIONS WITH RESPECT TO OFFICERS AND KEY EMPLOYEES WHOSE COMPENSATION EXCEEDS A SPECIFIED THRESHOLD ARE MADE BY THE PCHA COMPENSATION COMMITTEE.
FORM 990, PART VI, LINE 19THE STATEMENTS OF OPERATIONS AND BALANCE SHEET ARE INCLUDED IN THE ANNUAL REPORT POSTED ON THE ORGANIZATION'S PUBLIC WEBSITE. COPIES OF THE FINANCIAL STATEMENTS ARE GENERALLY NOT AVAILABLE FOR PUBLIC INSPECTION BUT REQUESTS WILL BE EVALUATED ON A CASE-BY-CASE BASIS. COPIES OF THE GOVERNING DOCUMENTS ARE GENERALLY NOT AVAILABLE FOR PUBLIC INSPECTION BUT REQUESTS WILL BE EVALUATED ON A CASE-BY-CASE BASIS. THE CONFLICT OF INTEREST POLICY IS NOT CURRENTLY AVAILABLE FOR PUBLIC INSPECTION.
FORM 990, PART XI, LINE 9RECONCILIATION EQUITY TRANSFERS TO PCHA FROM LPCH IN FY22 $14,000,000
FORM 990 PART IX LINE 11GDESCRIPTION:TEMP LABOR - MEDICAL PHYSICIAN TOTAL FEES:1773455
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER PROFESSIONAL SERVICE TOTAL FEES:57325
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:5822476
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER MEDICAL SERVICES TOTAL FEES:59345830

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCdForeign PostalForeignAddress/ForeignPostalCd
THE BRD OF TRUST LELAND STANF JR UNIV
485 BROADWAY MAILCODE 8838REDWOOD CITYCA94063941156365EDUCATIONCA501(C)(3)2NAfalse
FUNDACION STANFORD UNIVERSITY EN CHILE
EDUCATION501(C)(3)STANFORDYes (true)AV CONDELL 189 PROVIDENCIASANTIAGOCICI
STANFORD HEALTH CARE TRI-VALLEY
1111 E STANLEY BLVDLIVERMORECA94550941429628HOSPITALCA501(C)(3)3SHCYes (true)
JAEDAN BUPIN STANFORD CENTER IN THE REPU
RESEARCH501(C)(3)N/AStanfordYes (true)KR
LUCILE PACKARD FOUNDATION FOR CHILDREN'S
400 HAMILTON AVENUE SUITE 340PALO ALTOCA94301770440090HEALTHCARECA501(C)(3)7LPCHYes (true)
LUCILE SALTER PACKARD CHILDRENS HOSPITAL
725 WELCH ROAD MC 5553PALO ALTOCA94304770003859HEALTHCARECA501(C)(3)3STANFORDYes (true)
SHR HOLDINGS INC
485 BROADWAY MAILCODE 8838REDWOOD CITYCA94063943187167REAL ESTATECA501(C)(25)N/ASTANFORDYes (true)
STANFORD FACULTY CLUB
PO BOX 7229STANFORDCA94309941187089FAC INTERACT.CA501(C)(7)N/ASTANFORDYes (true)
STANFORD FEDERAL CREDIT UNION
1860 EMBARCADERO RDPALO ALTOCA94303941492212CREDIT UNIONCA501(C)(1)N/ASTANFORDYes (true)
STANFORD HABITAT CONSERVATION BOARD
415 BROADWAYREDWOOD CITYCA94063461882243CONSERVATIONCA501(C)(3)7STANFORDYes (true)
STANFORD HEALTH CARE
300 PASTEUR DRIVE MC 5555STANFORDCA94305946174066HEALTHCARECA501(C)(3)3STANFORDYes (true)
STANFORD PROGRAMME (CAPE TOWN) NPC
EDUCATION501(C)(3)N/ASTANFORDYes (true)WAVERLY BUSINESS PARK BLDG 11CAPE TOWNSFSF
STANFORD UNIVERSITY BOOKSTORE
BLDG 60 MAIN QUAD NO 105STANFORDCA94305940894150SUPPORTCA501(C)(3)12A, ISTANFORDYes (true)
SU EMP BEN TRUST POST RETEMPYNT BEN
485 BROADWAY MAILCODE 8838REDWOOD CITYCA94063943246199BENEFITSCA501(C)(9)N/ASTANFORDYes (true)
THE DUDLEY E CHAMBERS FOUNDATION
JP MORGAN CHASE PO BOX 3038MILWAUKEEWI53201386841793SUPPORTNY501(C)(3)12D, III-OSTANFORDYes (true)
THE FREIDENRICH SUPPORT FOUNDATION
485 BROADWAY MAILCODE 8838REDWOOD CITYCA94063300519583SUPPORTCA501(C)(3)12A, ISTANFORDYes (true)
THE HONG KONGSU CHARITABLE TRUST
986078093SUPPORT501(C)(3)N/ASTANFORDYes (true)1401 CAROLINE CENTER 28 PING ROADCAUSEWAYHKHK
THE STANFORD TRUST
SUPPORT501(C)(3)N/ASTANFORDYes (true)65 HIGH STREETOXFORDUKUKOX1 46L
UNIVERSITY HEALTHCARE ALLIANCE
7999 GATEWAY BLVD STE 300NEWARKCA94560943192446HEALTHCARECA501(C)(3)3SHCYes (true)
VALLEYCARE MEDICAL FOUNDATION INC
1111 E STANLEY BLVDLIVERMORECA94550262593526SR. FACILITYCA501(C)(3)PFSHC-TVYes (true)
VALLEYCARE SENIOR HOUSING
1111 E STANLEY BLVDLIVERMORECA94550943382224SR. FACILITYCA501(C)(3)12A, ISHC-TVYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (45 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCdProvince Or StateForeignAddress/ProvinceOrStateNm
ADOM PARTNERS LP
1350 6TH AVE 2910NEW YORKNY10019813083288INVESTMENTSDENA
ALBUS SELECT FUND LP
750 MENLO AVE 380MENLO PARKCA94025812064357INVESTMENTSDENA
ARCOLA VENTURE LLC
7121 FAIRWAY DRIVE 410PALM BEACH GARDENSFL33418371689632REAL ESTATEDENA
CANARY SC FUND LP
65 E 55TH ST 35TH FLOORNEW YORKNY10022475662144INVESTMENTSDENA
CANARY SC MASTER FUND LP
981267847INVESTMENTSNA89 NEXUS WAY CAMANA BAYGRAND CAYMANCJKY1-9009CJ
CARLSBAD CO-INVEST LP
40 BEECHWOOD RDSUMMITNJ07901471702425INVESTMENTSDENA
CERASUS FUND II CAYMAN LP
INVESTMENTSNA190 ELGIN AVENUE GEORGE TOWNGRAND CAYMANCJKY1-9008CJ
CHP GTS BLOCKER HOLDINGS A LP
888 BOYLSTON STREET 1410BOSTONMA02199830881152INVESTMENTSDENA
CYPRESS MARINA HEIGHTS LLC
635 KNIGHT WAYSTANFORDCA94305954887979INVESTMENTSCANA
DGD INVESTMENT LP
INVESTMENTSNA190 ELGIN AVENUE GEORGE TOWNGRAND CAYMANCJKY1-9008CJ
EAGLE ROCK LI HOLDINGS II LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803271694413INVESTMENTSDENA
EDEN RADIATION THERAPY SERVICES LLC
300 PASTEUR DRIVESTANFORDCA94304HEALTHCARECANA
ER-S JV LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803834068077INVESTMENTSDENA
ER-S JV II LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803INVESTMENTSDENA
ER-S INVESTOR LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803834068357INVESTMENTSDENA
ER-S INVESTOR II LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803INVESTMENTSDENA
ER PROPERTIES FUND LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803834260396INVESTMENTSDENA
ER PROPERTIES FUND II LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803INVESTMENTSDENA
EZP OPPORTUNITY LP
160 BOVET RD STE 300SAN MATEOCA94402814562962INVESTMENTSDENA
FORTRESS IW COINVESTMENT (FUND B) LP
1345 AVE OF THE AMERICAS 46FLNEW YORKNY10105980509639INVESTMENTSNACJ
FOUR CROSSINGS INSTITUTIONAL PARTNERS V
ONE MARITIME PLAZA 2100SAN FRANCISCOCA94111814323705INVESTMENTSDENA
FOXLANE LP
550 E WATER ST 888CHARLOTTESVILLEVA22902813314647INVESTMENTSDENA
HHBG-II INVESTMENT LP
INVESTMENTSNA89 NEXUS WAY CAMANA BAY PO BOX 31GRAND CAYMANCJKY1-1205CJ
KEB INVESTORS II LP
INVESTMENTSNAWASHINGTON MALL STE 304 7 REID STHAMILTONBDHM 11BDBD
KF VERMILLION FUND LP
65 EAST 55TH STREET 35TH FLOORNEW YORKNY10022INVESTMENTSDENA
LSF V DHB HOLDINGS LP
2711 N HASKELL AVE 1700DALLASTX75204272858604INVESTMENTSDENA
OLIFANT FUND LTD
980404442INVESTMENTSNASUITE 5B201 2ND FL ONE NEXUS WAYGRAND CAYMANCJKY1-1108CJ
ONCOLOGY SOLUTIONS VENTURE LLC
300 PASTEUR DRIVESTANFORDCA94304863250041HEALTHCARECANA
OUTLAWS CASINO LTD
415 BROADWAYREDWOOD CITYCA94063841457498HOLDING COMPANYCONA
PALO ALTO LP
981126622INVESTMENTSNA13 CASTLE STREETST HELIER JERSEYJEJEJE
SANDOVAL LP
4640 ADMIRALTY WAY 5TH FLMARINA DEL REYCA90292371873346INVESTMENTSCANA
SANDPIPER FUND LP
2000 MCKINNEY AVE STE 2125DALLASTX75201260341626INVESTMENTTXNA
SAROFIM MULTIFAMILY PARTNERS LP
2525 MCKINNON STREET STE 530DALLASTX75201201929002RE DEVELOPMENTTXNA
SCP REAL ASSETS FUND (A) LP
2498 SAND HILL RDMENLO PARKCA94025203949682INVESTMENTSDENA
SEQUOIA MFM OPERATING COMPANY LLC
770 WELCH ROAD LPCHPALO ALTOCA94304475060529MFM PROGRAMCANA
SP SMC PARTNERS LLC
PO BOX 5377NEW YORKNY10185473103791INVESTMENTSDENA
STANFORD EMANUEL RADIATION ONCOLOGY CENT
825 DELBON AVTURLOCKCA95382208885091RADIOLOGYCANA
STANFORD PET-CT LLC
300 PASTEUR DRSTANFORDCA94305611423414MED. DIAGNOSTCANA
STANFORD-STARTX FUND LLC
485 BROADWAYREDWOOD CITYCA94063464297719INVESTMENTSDENA
SUMIT HOLDING INTERNATIONAL LLC
1400 PAGE MILL RDPALO ALTOCA94304263934706HOLDING COMPANYDENA
SV4 EQUITY LLC
1209 ORANGE STREETWILMINGTONDE19802INVESTMENTSDENA
TESSERA IONIC LP
PO BOX 194170SAN FRANCISCOCA941194170830896257INVESTMENTSDENA
VEDA INVESTORS FUND LP
ONE FAWCETT PLGREENWICHCT06830811810345INVESTMENTSDENA
VERMILION PEAK MASTER FUND
981327671INVESTMENTSNAPO BOX 309 UGLAND HOUSEGRAND CAYMANCJKY1-1104CJ
WREP III A LP
6710 E CAMELBACK RD 100SCOTTSDALEAZ85251474780701INVESTMENTSDENA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (28 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCdShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
BREP VII ALBERTA FDR (OFFSHORE) TE7 LP
345 PARK AVENUENEW YORKNY10154981066351INVESTMENTSCANAC CORP
BREP VII ALBERTA FDR (OFFSHORE) TE7-NQ
345 PARK AVENUENEW YORKNY10154981066355INVESTMENTSCANAC CORP
CANARY SC FUND LTD
921268195INVESTMENTSNAC CORP89 NEXUS WAY CAYMANA BAYGRAND CAYMANCJKY1-9009CJ
CLAT (14)
CHARITABLE TRCANATRUST
CLUT (2)
CHARITABLE TRCANATRUST
CRT (559)
CHARITABLE TRCANATRUST
EAST SAIL
INVESTMENTSNAC CORPC/O INTL FS INC IFS COURTTWENTYEIGHT CYBERCITY EBENEMPMP
ER-S REIT LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803834068725INVESTMENTSDENAC CORP
ER-S REIT II LLC
1670 OLD COUNTRY RD 227PLAINVIEWNY11803882004082INVESTMENTSDENAC CORP
GAVEA INVESTMENT FUND II-C LP
980537952INVESTMENTSNAC CORPPO BOX 309 UGLAND HOUSEGRAND CAYMANCJKY1-1104CJ
HHBG SF LIMITED
INVESTMENTSNAC CORP89 NEXUS WAY CAYMANA BAYGRAND CAYMANCJKY1-1205CJ
KAIZEN FUND
INVESTMENTSNAC CORPPO BOX 448GRAND CAYMANCJKY1-1106CJ
LS ALBERTA III LP
INVESTMENTSNAC CORPC/O LASALLE INV MGMT ONE CURZON STLONDONUKW1J 5HDUK
OTHER (4)
CHARITABLE TRCANATRUST
PIF (2)
CHARITABLE TRCANATRUST
PEPPERTREE CAPITAL CAYMAN ISLAND FUND LP
57 E WASHINGTON STREETCHAGRIN FALLSOH44022981235268INVESTMENTSNAC CORPCJ
PROFESSIONAL EXCHANGE ASSURANCE COMPANY
201 MERCHANT STREET SUITE 2400HONOLULUHI96813900897686INSURANCEHINAC CORP$1,000,197$8,944,2150.88700Yes (true)
SBFF LTD
INVESTMENTSNAC CORPSUITE 5B201 2ND FL ONE NEXUS WAYGRAND CAYMANCJKY1-1108CJ
SOLKATT LIMITED
INVESTMENTSNAC CORP190 ELGIN AVENUE GEORGE TOWNGRAND CAYMANCJKY1-9008CJ
STANFORD (BEIJING) CNSLTNG CO LTD (WFOE)
EDUCATIONNAC CORP5275TH FLBLDG CACADEMY SOUTH RDBEIJINGCHCH
STANFORD IN JAPAN GODO KAISHA
EDUCATIONNAC CORPDOSHISHA UNIVERSITY MEITOKUKAN-NAIKYOTOSHIJAJA
STANFORD INDIA PVT LTD
EDUCATIONNAC CORP333 3RD FLOOR DEVIKA TOWER 6 NEHDELHIININ
STANFORD MEDICINE INTL (HONG KONG) CO LT
PATIENT SRVCNAC CORP833 CHEUNG SHA WAN ROADKOWLOONHKHK
STANFORD UNIV MED NETWORK RISK AUTHORITY
1400 PAGE MILL RD MSC 5713PALO ALTOCA94304461132002RISK MGMT CONCANAC CORP
THE RUBRUM FUND
INVESTMENTSNAC CORP7 CLIFFORD STREETLONDONUKW1S 2FTUK
TVC MATSU FUND
INVESTMENTSNAC CORP89 NEXUS WAY CAYMANA BAYGRAND CAYMANCJKY1-9009CJ
VERMILION PEAK FUND
981333885INVESTMENTSNAC CORPPO BOX 309 UGLAND HOUSEGRAND CAYMANCJKY1-1104CJ
WOODBOURNE CANADA PARTNERS II - CAYMAN
980705321INVESTMENTSNAC CORP190 ELGIN AVEGRAND CAYMANCJKY1-9005CJ
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE R, PART IV, LINE 1POOLED INVESTMENT FUNDS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.
SCHEDULE R, PART IV, LINE 5CHARITABLE LEAD ANNUITY TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.
SCHEDULE R, PART IV, LINE 6CHARITABLE REMAINDER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.
SCHEDULE R, PART IV, LINE 7OTHER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.