PACKARD CHILDRENS HEALTH ALLIANCE: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PACKARD CHILDRENS HEALTH ALLIANCE (EIN 32-0359189)
- Tax period
- 2020-09-01 to 2021-08-31
- Filed
- 2022-07-13
- IRS object ID
- 202201949349301200
- Schema version
- 2020v4.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-07-13T09:00:55-05:00 | ReturnTs |
| Tax Period End | 2021-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PricewaterhouseCoopers LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 SEAPORT BLVD SUITE 500 | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320359189 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACKARD CHILDREN'S HEALTH ALLIANCE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % PATRICK IDEMOTO | InCareOfNm |
| Business Name Control | PACK | BusinessNameControlTxt |
| Phone | 6504978000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 WELCH ROAD MC 5551 | AddressLine1Txt |
| City | PALO ALTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94304 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANA HAERING | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6507212222 | PhoneNum |
| Signature | 2022-07-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DANA | PersonFirstNm |
| Person Last | HAERING | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | GWEN SPENCER | PreparerPersonNm |
| PTIN | P00641463 | PTIN |
| Phone | 6175305000 | PhoneNum |
| Preparation | 2022-06-20 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PATRICK IDEMOTO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 WELCH ROAD MC 5551 | AddressLine1Txt |
| City | PALO ALTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94304 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $119,394,567 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STANFORDCHILDRENS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 388 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,748,302 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $105,542,760 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $114,646,265 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $105,542,760 | PYTotalRevenueAmt |
| CY Total Revenue | $119,394,567 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $32,716,506 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $37,452,897 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $92,816,440 | PYOtherExpensesAmt |
| CY Other Expenses | $95,773,396 | CYOtherExpensesAmt |
| PY Total Expenses | $125,532,946 | PYTotalExpensesAmt |
| CY Total Expenses | $133,226,293 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$19,990,186 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$13,831,726 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $36,301,332 | TotalAssetsBOYAmt |
| Total Assets EOY | $36,765,810 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,008,946 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $28,299,452 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,292,386 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,466,358 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $121,082,661 | ExpenseAmt |
| Revenue | $114,646,265 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $121,082,661 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 81 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 388 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATRICK IDEMOTO | PersonNm |
| Phone | 6507235636 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 WELCH ROAD MC 5551 | AddressLine1Txt |
| City | PALO ALTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94304 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Dana Haering | ||||||||||
| EVP & CFO | 3.0 | 47.0 | Yes (X) | $0 | $1,096,753 | $69,322 | ||||
| Dennis P Lund MD | ||||||||||
| DIRECTOR/CHAIR | 1.0 | 50.0 | Yes (X) | $0 | $974,477 | $66,335 | Yes (X) | |||
| TIM CORNELL MD | ||||||||||
| DIRECTOR | 1.0 | 50.0 | $0 | $763,923 | $107,475 | Yes (X) | ||||
| Edward Kopetsky | ||||||||||
| SVP & CIO | 0.0 | 50.0 | $0 | $776,164 | $83,458 | Yes (X) | ||||
| MARCIA COHEN | ||||||||||
| DIRECTOR | 1.0 | 51.0 | $0 | $725,407 | $61,838 | Yes (X) | ||||
| Cameron D'alpe | ||||||||||
| CAO PHYS PRAC, CEO TO 2/21 | 17.0 | 33.0 | Yes (X) | $0 | $613,185 | $63,978 | Yes (X) | |||
| PATRICK IDEMOTO | ||||||||||
| INTERIM CEO AS OF 3/1/21 | 25.0 | 25.0 | Yes (X) | $0 | $590,514 | $70,763 | Yes (X) | |||
| ANDREW SMITH | ||||||||||
| MEDICAL DIRECTOR, SECRETARY | 50.0 | 0.0 | Yes (X) | $448,965 | $0 | $67,606 | Yes (X) | |||
| RICK VANCE | ||||||||||
| COO | 50.0 | 0.0 | $367,096 | $0 | $35,253 | Yes (X) | ||||
| TZIELAN LEE MD | ||||||||||
| DIRECTOR | 1.0 | 50.0 | $0 | $304,002 | $43,290 | Yes (X) | ||||
| TIKA MARTIN | ||||||||||
| DIRECTOR, HUMAN RESOURCES | 50.0 | 0.0 | $293,054 | $0 | $53,913 | Yes (X) | ||||
| MALAVIKA NARAYAN | ||||||||||
| DIR. OF PHYSCN NET. FIN. | 50.0 | 0.0 | $0 | $321,906 | $0 | Yes (X) | ||||
| MICHAEL LIPMAN | ||||||||||
| DIRECTOR, PROVIDER RECRUIT. | 50.0 | 0.0 | $260,415 | $0 | $15,542 | Yes (X) | ||||
| TAMMY OJEDA-LEAO | ||||||||||
| DIRECTOR GENERAL PEDIACTRICS | 50.0 | 0.0 | $186,119 | $0 | $76,873 | Yes (X) | ||||
| DOROTHY NAIDU | ||||||||||
| DIRECTOR, CLINICAL QUALITY | 50.0 | 0.0 | $211,221 | $0 | $30,861 | Yes (X) | ||||
| TIFFANY AUBREY | ||||||||||
| DIR. OF PRACTICE OPERATIONS | 50.0 | 0.0 | $199,975 | $0 | $22,631 | Yes (X) | ||||
| SAMAR S SHAKOOR | ||||||||||
| DIR - PHYSICIAN RELATIONS | 50.0 | 0.0 | $172,730 | $0 | $42,511 | Yes (X) | ||||
| SUSAN AULT | ||||||||||
| PRACTICE MANAGER III | 50.0 | 0.0 | $179,830 | $0 | $31,146 | Yes (X) | ||||
| EMILY KRUGER | ||||||||||
| DIR., PHYSICIAN NETWORK FIN. | 50.0 | 0.0 | $0 | $170,980 | $38,493 | Yes (X) | ||||
| MALINDA MITCHELL | ||||||||||
| DIRECTOR/ VICE CHAIR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| JOHN WALKER | ||||||||||
| DIRECTOR | 1.0 | 3.0 | $0 | $0 | $0 | Yes (X) | ||||
| LISA ERBURU MD | ||||||||||
| DIRECTOR | 1.0 | 50.0 | $0 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,319,405 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $6,337,311 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $981,288 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 40 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PACKARD MEDICAL GROUP INC | |||||
| 725 WELCH ROAD MC 5551 | PALO ALTO | CA | 94304 | PHYSICIAN SERVICES | $58,654,902 |
| SANOFI PASTEUR INC | |||||
| 12458 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | Medical supplies | $7,983,849 |
| G AND G ORGANIZATION LTD DBA PFS GR | |||||
| 2600 NORTH LOOP WEST STE 150 | HOUSTON | TX | 77092 | Service | $2,644,261 |
| MCKESSON MEDICAL-SURGICAL | |||||
| PO BOX 848001 | DALLAS | TX | 94582 | Medical supplies | $1,291,011 |
| CAREMARK LLC | |||||
| DEPARTMENT LA 21403 | PASADENA | CA | 911851403 | Service | $1,114,597 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 23 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,748,302 | GovernmentGrantsAmt |
| Total Contributions | $4,748,302 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 900099 | $96,140,792 | $96,140,792 |
| MEDICARE/MEDICAID | 900099 | $8,138,529 | $8,138,529 |
| PROGRAM SUPPORT | 900099 | $10,366,944 | $10,366,944 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $114,646,265 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $119,394,567 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $114,646,265 | RelatedOrExemptFuncIncomeAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,418,911 | TotalAmt |
| Program Services | $1,046,782 | ProgramServicesAmt |
| Management And General | $372,129 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,686,861 | TotalAmt |
| Program Services | $17,231,780 | ProgramServicesAmt |
| Management And General | $3,455,081 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $917,640 | TotalAmt |
| Program Services | $459,902 | ProgramServicesAmt |
| Management And General | $457,738 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,578,411 | TotalAmt |
| Program Services | $10,754,679 | ProgramServicesAmt |
| Management And General | $1,823,732 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,851,074 | TotalAmt |
| Program Services | $1,634,304 | ProgramServicesAmt |
| Management And General | $216,770 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,928 | TotalAmt |
| Program Services | $84,209 | ProgramServicesAmt |
| Management And General | $86,719 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $253,613 | TotalAmt |
| Management And General | $253,613 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,569 | TotalAmt |
| Management And General | $47,569 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,547,715 | TotalAmt |
| Program Services | $61,946,468 | ProgramServicesAmt |
| Management And General | $3,601,247 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,025 | TotalAmt |
| Program Services | $30,792 | ProgramServicesAmt |
| Management And General | $40,233 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,875,799 | TotalAmt |
| Program Services | $15,690,479 | ProgramServicesAmt |
| Management And General | $185,320 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,920,631 | TotalAmt |
| Program Services | $3,920,631 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,462,983 | TotalAmt |
| Program Services | $6,462,939 | ProgramServicesAmt |
| Management And General | $44 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,657 | TotalAmt |
| Program Services | $25,951 | ProgramServicesAmt |
| Management And General | $15,706 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,655,064 | TotalAmt |
| Program Services | $1,841,005 | ProgramServicesAmt |
| Management And General | $814,059 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $488,853 | TotalAmt |
| Program Services | $30,374 | ProgramServicesAmt |
| Management And General | $458,479 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| UNCOLLECTIBLES | $917,969 | $917,969 | |
| LICENSES & TAXES | $242,228 | $26,391 | $215,837 |
| DUES & SUBSCRIPTIONS | $231,905 | $176,033 | $55,872 |
| UTILITIES | $161,205 | $161,205 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$1,315,748 | TotalAmt |
| Program Services | -$1,359,232 | ProgramServicesAmt |
| Management And General | $43,484 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,226,293 | TotalAmt |
| Program Services | $121,082,661 | ProgramServicesAmt |
| Management And General | $12,143,632 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$486,922 | BOYAmt |
| EOY | $61,620 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,107,987 | BOYAmt |
| EOY | $10,610,515 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $780,839 | BOYAmt |
| EOY | $741,014 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,788,353 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,516,703 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,064,199 | BOYAmt |
| EOY | $3,271,650 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,875,199 | BOYAmt |
| EOY | $6,784,991 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,960,030 | BOYAmt |
| EOY | $15,296,020 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,301,332 | BOYAmt |
| EOY | $36,765,810 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,462,180 | BOYAmt |
| EOY | $6,919,918 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,546,766 | BOYAmt |
| EOY | $21,379,534 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,008,946 | BOYAmt |
| EOY | $28,299,452 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,292,386 | BOYAmt |
| EOY | $8,466,358 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,292,386 | BOYAmt |
| EOY | $8,466,358 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,301,332 | BOYAmt |
| EOY | $36,765,810 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$13,831,726 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $14,005,698 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART I | FormAndLineReferenceDesc |
| Explanation | PACKARD 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp | |
| Buildings | BuildingsGrp |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,904,286 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,233,565 | DepreciationAmt |
| Book Value | $670,721 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,179,082 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,283,138 | DepreciationAmt |
| Book Value | $1,895,944 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $704,985 | OtherCostOrOtherBasisAmt |
| Book Value | $704,985 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,271,650 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER ASSETS | $3,070,876 |
| RIGHT OF USE LEASE ASSETS | $12,163,000 |
| SECURITY DEPOSITS | $62,144 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $15,296,020 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTIES, NET | $8,914,387 |
| RIGHT OF USE LEASE LIABILITIES | $12,465,147 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $21,379,534 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 | FormAndLineReferenceDesc |
| Explanation | FIN 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TZIELAN LEE MD | ||||||||||||||
| DIRECTOR | $0 | $260,945 | $0 | $43,057 | $0 | $0 | $0 | $24,179 | $0 | $19,111 | $0 | $347,292 | $0 | $0 |
| TIM CORNELL MD | ||||||||||||||
| DIRECTOR | $0 | $315,740 | $0 | $141,155 | $0 | $307,028 | $0 | $16,872 | $0 | $90,603 | $0 | $871,398 | $0 | $0 |
| MARCIA COHEN | ||||||||||||||
| DIRECTOR | $0 | $607,941 | $0 | $117,206 | $0 | $260 | $0 | $28,500 | $0 | $33,338 | $0 | $787,245 | $0 | $0 |
| MALAVIKA NARAYAN | ||||||||||||||
| DIR. OF PHYSCN NET. FIN. | $0 | $282,271 | $0 | $39,635 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $321,906 | $0 | $0 |
| Dennis P Lund MD | ||||||||||||||
| DIRECTOR/CHAIR | $0 | $410,562 | $0 | $485,276 | $0 | $78,639 | $0 | $26,425 | $0 | $39,910 | $0 | $1,040,812 | $0 | $0 |
| Dana Haering | ||||||||||||||
| EVP & CFO | $0 | $680,989 | $0 | $157,750 | $0 | $258,014 | $0 | $52,450 | $0 | $16,872 | $0 | $1,166,075 | $0 | $137,520 |
| Cameron D'alpe | ||||||||||||||
| CAO PHYS PRAC, CEO TO 2/21 | $0 | $418,385 | $0 | $75,092 | $0 | $119,708 | $0 | $48,295 | $0 | $15,683 | $0 | $677,163 | $0 | $73,452 |
| EMILY KRUGER | ||||||||||||||
| DIR., PHYSICIAN NETWORK FIN. | $0 | $170,980 | $0 | $0 | $0 | $0 | $0 | $15,530 | $0 | $22,963 | $0 | $209,473 | $0 | $0 |
| RICK VANCE | ||||||||||||||
| COO | $338,061 | $0 | $29,035 | $0 | $0 | $0 | $16,800 | $0 | $18,453 | $0 | $402,349 | $0 | $0 | $0 |
| TIKA MARTIN | ||||||||||||||
| DIRECTOR, HUMAN RESOURCES | $273,426 | $0 | $19,628 | $0 | $0 | $0 | $16,784 | $0 | $37,129 | $0 | $346,967 | $0 | $0 | $0 |
| MICHAEL LIPMAN | ||||||||||||||
| DIRECTOR, PROVIDER RECRUIT. | $242,874 | $0 | $17,541 | $0 | $0 | $0 | $14,061 | $0 | $1,481 | $0 | $275,957 | $0 | $0 | $0 |
| DOROTHY NAIDU | ||||||||||||||
| DIRECTOR, CLINICAL QUALITY | $194,470 | $0 | $16,751 | $0 | $0 | $0 | $12,352 | $0 | $18,509 | $0 | $242,082 | $0 | $0 | $0 |
| ANDREW SMITH | ||||||||||||||
| MEDICAL DIRECTOR, SECRETARY | $384,998 | $0 | $63,967 | $0 | $0 | $0 | $16,800 | $0 | $50,806 | $0 | $516,571 | $0 | $0 | $0 |
| TIFFANY AUBREY | ||||||||||||||
| DIR. OF PRACTICE OPERATIONS | $187,267 | $0 | $12,708 | $0 | $0 | $0 | $4,122 | $0 | $18,509 | $0 | $222,606 | $0 | $0 | $0 |
| TAMMY OJEDA-LEAO | ||||||||||||||
| DIRECTOR GENERAL PEDIACTRICS | $174,059 | $0 | $12,060 | $0 | $0 | $0 | $9,661 | $0 | $67,212 | $0 | $262,992 | $0 | $0 | $0 |
| Edward Kopetsky | ||||||||||||||
| SVP & CIO | $0 | $565,139 | $0 | $108,132 | $0 | $102,893 | $0 | $55,589 | $0 | $27,869 | $0 | $859,622 | $0 | $0 |
| PATRICK IDEMOTO | ||||||||||||||
| INTERIM CEO AS OF 3/1/21 | $0 | $464,337 | $0 | $78,620 | $0 | $47,557 | $0 | $67,276 | $0 | $3,487 | $0 | $661,277 | $0 | $0 |
| SUSAN AULT | ||||||||||||||
| PRACTICE MANAGER III | $172,508 | $0 | $7,322 | $0 | $0 | $0 | $12,269 | $0 | $18,877 | $0 | $210,976 | $0 | $0 | $0 |
| SAMAR S SHAKOOR | ||||||||||||||
| DIR - PHYSICIAN RELATIONS | $161,620 | $0 | $11,110 | $0 | $0 | $0 | $10,311 | $0 | $32,200 | $0 | $215,241 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PROCEDURES FOR DETERMINING COMPENSATION | SCHEDULE J, PART I, LINE 3 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 EACH SEPTEMBER PRIOR TO ANY 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. |
| SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | SCHEDULE J, PART I, LINE 4B 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 2020: DANA HAERING $ 225,791 EDWARD KOPETSKY $ 69,871 CAMERON D'ALPE $ 117,920 FOR CERTAIN INDIVIDUALS LISTED ON SCHEDULE J, PART II, AMOUNTS CREDITED UNDER PLAN ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (C). |
| SCHEDULE J, PART I, LINE 7 | CERTAIN OFFICERS AND OTHERS AS ENUMERATED IN SCHEDULE J, PART II PARTICIPATE IN 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 (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ORGANIZATION'S PRIMARY EXEMPT PURPOSE | FORM 990, PART I, LINE 1 & PART III, LINE 1 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. |
| PROGRAM SERVICE DESCRIPTION | FORM 990, PART III, LINE 4A DURING THE PERIOD OF SEPTEMBER 2020 THROUGH AUGUST 2021 (FY 2021), 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 2021 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 2021 FOR EACH OF THE LARGEST SERVICES ARE: BAYSIDE: 62,553 PENINSULA PEDIATRICS: 36,012 PEDIATRIC ASSOCIATES: 19,605 DURING FISCAL YEAR 2021 PCHA PROVIDED 256,310 OFFICE VISITS. FAMILY/BUSINESS RELATIONSHIP FORM 990, PART VI, LINE 2 MARCIA COHEN, TIM CORNELL, TZIELAN LEE, AND DENNIS LUND ARE EMPLOYEES OF STANFORD SCHOOL OF MEDICINE. DANA HAERING IS AN OFFICER OF LUCILE SALTER PACKARD CHILDREN'S HOSPITAL. DENNIS LUND IS AN OFFICER AND DIRECTOR OF LUCILE SALTER PACKARD CHILDREN'S HOSPITAL. |
| MEMBERS | FORM 990, PART VI, LINE 6 STANFORD UNIVERSITY AND LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD ARE THE MEMBERS OF PCHA. |
| FORM 990, PART VI, LINE 7A | STANFORD 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 7B | THE 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. |
| PROCEDURES FOR REVIEWING FORM 990 FROM GOVERNING BODY | FORM 990, PART VI, LINE 11 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. |
| PROCEDURES FOR MONITORING AND ENFORCING COMPLIANCE | WITH CONFLICT-OF-INTEREST POLICY FORM 990, PART VI, LINE 12C 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. |
| PROCEDURES FOR DETERMINING COMPENSATION | FORM 990, PART VI, LINE 15 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 EACH SEPTEMBER PRIOR TO ANY 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 19 | THE 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. |
| RECONCILIATION | FORM 990, PART XI, LINE 9 EQUITY TRANSFERS TO PCHA FROM LPCH IN FY21 $14,005,698 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:TEMP LABOR - MEDICAL PHYSICIAN TOTAL FEES:1323652 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PROFESSIONAL SERVICE TOTAL FEES:71943 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:6385978 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER MEDICAL SERVICES TOTAL FEES:57766142 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (22 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Foreign PostalForeignAddress/ForeignPostalCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THE BRD OF TRUST LELAND STANF JR UNIV | ||||||||||||||||
| 485 BROADWAY MAILCODE 8838 | REDWOOD CITY | CA | 94063 | 941156365 | EDUCATION | CA | 501(C)(3) | 2 | NA | false | ||||||
| FUNDACION STANFORD UNIVERSITY EN CHILE | ||||||||||||||||
| AV CONDELL 189 PROVIDENCIA | SANTIAGO | CI | CI | N/A | ||||||||||||
| HOSPITAL COMMITTEE FOR THE L-P AREAS | ||||||||||||||||
| 1111 E STANLEY BLVD | LIVERMORE | CA | 94550 | 941429628 | HOSPITAL | CA | 501(C)(3) | 3 | SHC | Yes (true) | ||||||
| JAEDAN BUPIN STANFORD CENTER IN THE REPU | ||||||||||||||||
| RESEARCH | 501(C)(3) | N/A | Stanford | Yes (true) | KR | |||||||||||
| LUCILE PACKARD FOUNDATION FOR CHILDREN'S | ||||||||||||||||
| 400 HAMILTON AVENUE SUITE 340 | PALO ALTO | CA | 94301 | 770440090 | HEALTHCARE | CA | 501(C)(3) | 7 | LPCH | Yes (true) | ||||||
| LUCILE SALTER PACKARD CHILDRENS HOSPITAL | ||||||||||||||||
| 725 WELCH ROAD MC 5553 | PALO ALTO | CA | 94304 | 770003859 | HEALTHCARE | CA | 501(C)(3) | 3 | STANFORD | Yes (true) | ||||||
| SHR HOLDINGS INC | ||||||||||||||||
| 485 BROADWAY MAILCODE 8838 | REDWOOD CITY | CA | 94063 | 943187167 | REAL ESTATE | CA | 501(C)(25) | N/A | STANFORD | Yes (true) | ||||||
| STANFORD FACULTY CLUB | ||||||||||||||||
| PO BOX 7229 | STANFORD | CA | 94309 | 941187089 | FAC INTERACT. | CA | 501(C)(7) | N/A | STANFORD | Yes (true) | ||||||
| STANFORD FEDERAL CREDIT UNION | ||||||||||||||||
| 1860 EMBARCADERO RD | PALO ALTO | CA | 94303 | 941492212 | CREDIT UNION | CA | 501(C)(1) | N/A | STANFORD | Yes (true) | ||||||
| STANFORD HABITAT CONSERVATION BOARD | ||||||||||||||||
| 415 BROADWAY | REDWOOD CITY | CA | 94063 | 461882243 | CONSERVATION | CA | 501(C)(3) | 7 | STANFORD | Yes (true) | ||||||
| STANFORD HEALTH CARE | ||||||||||||||||
| 300 PASTEUR DRIVE MC 5555 | STANFORD | CA | 94305 | 946174066 | HEALTHCARE | CA | 501(C)(3) | 3 | STANFORD | Yes (true) | ||||||
| STANFORD HEALTH CARE ADVANTAGE | ||||||||||||||||
| 1221 BROADWAY 3RD FLOOR | OAKLAND | CA | 94612 | 464071746 | HEALTHCARE | CA | 501(c)(3) | 12A, I | SHC | Yes (true) | ||||||
| STANFORD PROGRAMME (CAPE TOWN) NPC | ||||||||||||||||
| EDUCATION | 501(C)(3) | N/A | STANFORD | Yes (true) | WAVERLY BUSINESS PARK BLDG 11 | CAPE TOWN | SF | SF | ||||||||
| STANFORD UNIVERSITY BOOKSTORE | ||||||||||||||||
| BLDG 60 MAIN QUAD NO 105 | STANFORD | CA | 94305 | 940894150 | SUPPORT | CA | 501(C)(3) | 12A, I | STANFORD | Yes (true) | ||||||
| SU EMP BEN TRUST POST RETEMPYNT BEN | ||||||||||||||||
| 485 BROADWAY MAILCODE 8838 | REDWOOD CITY | CA | 94063 | 943246199 | BENEFITS | CA | 501(C)(9) | N/A | STANFORD | Yes (true) | ||||||
| THE DUDLEY E CHAMBERS FOUNDATION | ||||||||||||||||
| JP MORGAN CHASE PO BOX 3038 | MILWAUKEE | WI | 53201 | 386841793 | SUPPORT | NY | 501(C)(3) | 12D, III-O | STANFORD | Yes (true) | ||||||
| THE FREIDENRICH SUPPORT FOUNDATION | ||||||||||||||||
| 485 BROADWAY MAILCODE 8838 | REDWOOD CITY | CA | 94063 | 300519583 | SUPPORT | CA | 501(C)(3) | 12A, I | STANFORD | Yes (true) | ||||||
| THE HONG KONGSU CHARITABLE TRUST | ||||||||||||||||
| 986078093 | SUPPORT | 501(C)(3) | N/A | STANFORD | Yes (true) | 1401 CAROLINE CENTER 28 PING ROAD | CAUSEWAY | HK | HK | |||||||
| THE STANFORD TRUST | ||||||||||||||||
| SUPPORT | 501(C)(3) | N/A | STANFORD | Yes (true) | 65 HIGH STREET | OXFORD | UK | UK | OX1 46L | |||||||
| UNIVERSITY HEALTHCARE ALLIANCE | ||||||||||||||||
| 7999 GATEWAY BLVD STE 300 | NEWARK | CA | 94560 | 943192446 | HEALTHCARE | CA | 501(C)(3) | 3 | SHC | Yes (true) | ||||||
| VALLEYCARE MEDICAL FOUNDATION INC | ||||||||||||||||
| 1111 E STANLEY BLVD | LIVERMORE | CA | 94550 | 262593526 | SUPPRT SHC-VC | CA | 501(C)(3) | PF | HOSP CMTE LP | Yes (true) | ||||||
| VALLEYCARE SENIOR HOUSING | ||||||||||||||||
| 1111 E STANLEY BLVD | LIVERMORE | CA | 94550 | 943382224 | SR. FACILITY | CA | 501(C)(3) | 12A, I | HOSP CMTE LP | Yes (true) | ||||||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (39 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ADOM PARTNERS LP | ||||||||||||
| 1350 6TH AVE 1610 | NEW YORK | NY | 10019 | 813083288 | INVESTMENTS | DE | NA | |||||
| ALBUS SELECT FUND LP | ||||||||||||
| 750 MENLO AVE 380 | MENLO PARK | CA | 94025 | 812064357 | INVESTMENTS | DE | NA | |||||
| ARCOLA VENTURE LLC | ||||||||||||
| 635 KNIGHT WAY | STANFORD | CA | 94305 | 371689632 | RE DEVELOPMENT | DE | NA | |||||
| CANARY SC FUND LP | ||||||||||||
| 399 PARK AVE | NEW YORK | NY | 10022 | 475662144 | INVESTMENTS | DE | NA | |||||
| CANARY SC MASTER FUND LP | ||||||||||||
| 981267847 | INVESTMENTS | NA | 89 NEXUS WAY CAMANA BAY | GRAND CAYMAN | CJ | KY1-9009 | CJ | |||||
| CARLSBAD CO-INVEST LP | ||||||||||||
| 40 BEECHWOOD RD | SUMMIT | NJ | 07901 | 471702425 | INVESTMENTS | DE | NA | |||||
| CHP GTS BLOCKER HOLDINGS A LP | ||||||||||||
| 888 BOYLSTON STREET | BOSTON | MA | 02199 | 830881152 | INVESTMENTS | DE | NA | |||||
| CYPRESS MARINA HEIGHTS LLC | ||||||||||||
| 635 KNIGHT WAY | STANFORD | CA | 94305 | 954887979 | INVESTMENTS | CA | NA | |||||
| DGD INVESTMENT LP | ||||||||||||
| 635 KNIGHT WAY | STANFORD | CA | 94305 | INVESTMENTS | NA | CJ | ||||||
| ER-S JV LLC | ||||||||||||
| 1670 OLD COUNTRY RD 227 | PLAINVIEW | NY | 11803 | 834068077 | INVESTMENTS | DE | NA | |||||
| ER-S REIT LLC | ||||||||||||
| 1670 OLD COUNTRY RD 227 | PLAINVIEW | NY | 11803 | 834068725 | INVESTMENTS | DE | NA | |||||
| ER-S INVESTOR LLC | ||||||||||||
| 1670 OLD COUNTRY RD 227 | PLAINVIEW | NY | 11803 | 834068357 | INVESTMENTS | DE | NA | |||||
| ER PROPERTIES FUND LLC | ||||||||||||
| 1670 OLD COUNTRY RD 227 | PLAINVIEW | NY | 11803 | 834260396 | INVESTMENTS | DE | NA | |||||
| EZP OPPORTUNITY LP | ||||||||||||
| 160 BOVET RD STE 300 | SAN MATEO | CA | 94402 | 814562962 | INVESTMENTS | DE | NA | |||||
| FORTRESS IW COINVESTMENT (FUND B) LP | ||||||||||||
| 1345 AVE OF THE AMERICAS | NEW YORK | NY | 10105 | 980509639 | INVESTMENTS | NA | CJ | |||||
| FOUR CROSSINGS INSTITUTIONAL PARTNERS V | ||||||||||||
| ONE MARITIME PLAZA 200 | SAN FRANCISCO | CA | 94111 | 814323705 | INVESTMENTS | DE | NA | |||||
| FOXLANE LP | ||||||||||||
| 550 E WATER ST 888 | CHARLOTTESVILLE | VA | 22902 | 813314647 | INVESTMENTS | DE | NA | |||||
| HHBG-II INVESTMENT LP | ||||||||||||
| INVESTMENTS | NA | 89 NEXUS WAY CAMANA BAY PO BOX 31 | GRAND CAYMAN | CJ | CJ | |||||||
| KEB INVESTORS II LP | ||||||||||||
| INVESTMENTS | NA | WASHINGTON MALL STE 304 7 REID ST | HAMILTON | BD | HM 11 | BD | ||||||
| LSF V DHB HOLDINGS LP | ||||||||||||
| 2711 N HASKELL AVE 1700 | DALLAS | TX | 75204 | 272858604 | INVESTMENTS | DE | NA | |||||
| NGP CENTENNIAL FOLLOW-ON LLC | ||||||||||||
| 2850 N HARWOOD STREET 19TH FLOOR | DALLAS | TX | 75201 | 611758772 | INVESTMENTS | DE | NA | |||||
| OLIFANT FUND LTD | ||||||||||||
| 635 KNIGHT WAY | STANFORD | CA | 94305 | 980404442 | INVESTMENTS | NA | CJ | |||||
| ONCOLOGY SOLUTIONS VENTURE LLC | ||||||||||||
| 300 PASTEUR DRIVE | STANFORD | CA | 94304 | 863250041 | HEALTHCARE | CA | NA | |||||
| OUTLAWS CASINO LTD | ||||||||||||
| 415 BROADWAY | REDWOOD CITY | CA | 94063 | 841457498 | HOLDING COMPANY | CO | NA | |||||
| PALO ALTO LP | ||||||||||||
| 981126622 | INVESTMENTS | NA | 13 CASTLE STREET | ST HELIER | JE | JE | ||||||
| SANDOVAL LP | ||||||||||||
| 4640 ADMIRALTY WAY 5TH FL | MARINA DEL REY | CA | 90292 | 371873346 | INVESTMENTS | DE | NA | |||||
| SANDPIPER FUND LP | ||||||||||||
| 2000 MCKINNEY AVE STE 2125 | DALLAS | TX | 75201 | 260341626 | INVESTMENT | TX | NA | |||||
| SAROFIM MULTIFAMILY PARTNERS LP | ||||||||||||
| 2525 MCKINNON STREET STE 530 | DALLAS | TX | 75201 | 201929002 | RE DEVELOPMENT | TX | NA | |||||
| SCP REAL ASSETS FUND (A) LP | ||||||||||||
| 2498 SAND HILL RD | MENLO PARK | CA | 94025 | 203949682 | INVESTMENTS | DE | NA | |||||
| SEQUOIA MFM OPERATING COMPANY LLC | ||||||||||||
| 770 WELCH ROAD LPCH | PALO ALTO | CA | 94304 | 475060529 | MFM PROGRAM | CA | NA | |||||
| SP SMC PARTNERS LLC | ||||||||||||
| PO BOX 5377 | NEW YORK | NY | 10185 | 473103791 | INVESTMENTS | DE | NA | |||||
| STANFORD EMANUEL RADIATION ONCOLOGY CENT | ||||||||||||
| 825 DELBON AV | TURLOCK | CA | 95382 | 208885091 | RADIOLOGY | CA | NA | |||||
| STANFORD PET-CT LLC | ||||||||||||
| 300 PASTEUR DR | STANFORD | CA | 94305 | 611423414 | MED. DIAGNOSTIC | CA | NA | |||||
| STANFORD-STARTX FUND LLC | ||||||||||||
| 485 BROADWAY | REDWOOD CITY | CA | 94063 | 464297719 | INVESTMENTS | DE | NA | |||||
| SUMIT HOLDING INTERNATIONAL LLC | ||||||||||||
| 1400 PAGE MILL RD | PALO ALTO | CA | 94304 | 263934706 | HOLDING COMPANY | DE | NA | |||||
| TESSERA IONIC LP | ||||||||||||
| PO BOX 194170 | SAN FRANCISCO | CA | 94119 | 830896257 | INVESTMENTS | DE | NA | |||||
| VEDA INVESTORS FUND LP | ||||||||||||
| ONE FAWCETT PL | GREENWICH | CT | 06830 | 811810345 | INVESTMENTS | DE | NA | |||||
| VERMILION PEAK MASTER FUND | ||||||||||||
| 635 KNIGHT WAY | STANFORD | CA | 94305 | 981327671 | INVESTMENTS | DE | NA | |||||
| WREP III A LP (FKA WOLFF REAL ESTATE | ||||||||||||
| 6710 E CAMELBACK RD 100 | SCOTTSDALE | AZ | 85251 | 474780701 | INVESTMENTS | DE | NA | |||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (27 entries)
| EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Legal Domicile StateLegalDomicileStateCd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THE ADM MACULUS FUND III LP | |||||||||||||||||
| 980508924 | INVESTMENTS | CJ | NA | C CORP | |||||||||||||
| BREP VII AlBERTA FDR (OFFSHORE) TE7 LP | |||||||||||||||||
| 981066351 | INVESTMENTS | NA | C CORP | 345 PARK AVENUE | NEW YORK | NY | 10154 | CA | |||||||||
| BREP VII AlBERTA FDR (OFFSHORE) TE7-NQ | |||||||||||||||||
| 981066355 | INVESTMENTS | NA | C CORP | 345 PARK AVENUE | NEW YORK | NY | 10154 | CA | |||||||||
| CANARY SC FUND LTD | |||||||||||||||||
| 981268195 | INVESTMENTS | CJ | NA | C CORP | 89 NEXUS WAY CAYMANA BAY | GRAND CAYMAN | CJ | KY1-9009 | |||||||||
| CLAT (15) | |||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | ||||||||||||||
| CLUT (2) | |||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | ||||||||||||||
| CRT (556) | |||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | ||||||||||||||
| EAST SAIL | |||||||||||||||||
| INVESTMENTS | MP | NA | C CORP | C/O INTL FS INC IFS COURT | TWENTYEIGHT CYBERCITY EBENE | MP | |||||||||||
| GAVEA INVESTMENT FUND II-C LP | |||||||||||||||||
| 980537952 | INVESTMENTS | CA | NA | C CORP | 100 KING STREET WEST SUITE 6000 | TORONTO | CA | M5X 1E2 | |||||||||
| HHBG SF Limited | |||||||||||||||||
| REAL ESTATE | CJ | NA | C CORP | 89 NEXUS WAY CAYMANA BAY | GRAND CAYMAN | CJ | KY1-1205 | ||||||||||
| KAIZEN FUND | |||||||||||||||||
| INVESTMENTS | CJ | NA | C CORP | 2ND FL MIDTOWN PLAZA PO BOX 448 | GRAND CAYMAN | CJ | KY1-1106 | ||||||||||
| LS ALBERTA III LP | |||||||||||||||||
| 980493425 | INVESTMENTS | GB | NA | C CORP | C/O LASALLE INV MGMT ONE CURZON ST | LONDON | GB | W1J 5HD | |||||||||
| OTHER (5) | |||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | ||||||||||||||
| PIF (2) | |||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | ||||||||||||||
| PEPPERTREE CAPITAL CAYMAN ISLAND FUND LP | |||||||||||||||||
| 981235268 | INVESTMENTS | CJ | NA | C CORP | 57 E WASHINGTON STREET | CHAGRIN FALLS | OH | 44022 | |||||||||
| PROFESSIONAL EXCHANGE ASSURANCE COMPANY | |||||||||||||||||
| 900897686 | INSURANCE | NA | C CORP | 201 MERCHANT STREET SUITE 2400 | HONOLULU | HI | 96813 | HI | $693,115 | $7,894,069 | 0.41350 | Yes (true) | |||||
| SBFF LTD | |||||||||||||||||
| INVESTMENTS | CJ | NA | C CORP | SUITE 5B201 2ND FL ONE NEXUS WAY | GRAND CAYMAN | CJ | KY1-1108 | ||||||||||
| STANFORD (BEIJING) CNSLTNG CO LTD (WFOE) | |||||||||||||||||
| EDUCATION | CH | NA | C CORP | 5275TH FLBLDG CACADEMY SOUTH RD | BEIJING | CH | |||||||||||
| STANFORD IN JAPAN GODO KAISHA | |||||||||||||||||
| EDUCATION | JA | NA | C CORP | DOSHISHA UNIVERSITY MEITOKUKAN-NAI | KYOTOSHI | JA | |||||||||||
| STANFORD INDIA PVT LTD | |||||||||||||||||
| EDUCATION | IN | NA | C CORP | 333 3RD FLOOR DEVIKA TOWER 6 NEH | DELHI | IN | |||||||||||
| STANFORD MEDICINE INTL (HONG KONG) CO LT | |||||||||||||||||
| PATIENT SRVC | HK | NA | C CORP | 833 CHEUNG SHA WAN ROAD | KOWLOON | HK | |||||||||||
| STANFORD SGGS EUROPE INC | |||||||||||||||||
| 131684331 | INVESTMENTS | CJ | NA | C CORP | UGLAND HOUSE S CHURCH ST PO BOX 3 | GEORGE TOWN | CJ | ||||||||||
| STANFORD UNIV MED NETWORK RISK AUTHORITY | |||||||||||||||||
| 461132002 | RISK MGMT CON | NA | C CORP | 1400 PAGE MILL RD MSC 5713 | PALO ALTO | CA | 94304 | CA | |||||||||
| THE RUBRUM FUND | |||||||||||||||||
| INVESTMENTS | GB | NA | C CORP | 7 CLIFFORD STREET | LONDON | GB | W1S 2FT | ||||||||||
| TVC MATSU FUND | |||||||||||||||||
| INVESTMENTS | CJ | NA | C CORP | 89 NEXUS WAY CAYMANA BAY | GRAND CAYMAN | CJ | KY1-9009 | ||||||||||
| VERMILION PEAK FUND | |||||||||||||||||
| 981333885 | INVESTMENTS | CJ | NA | C CORP | PO BOX 309 UGLAND HOUSE | GRAND CAYMAN | CJ | KY1-1104 | |||||||||
| WOODBOURNE CANADA PARTNERS II - CAYMAN | |||||||||||||||||
| 980705321 | INVESTMENTS | CJ | NA | C CORP | 190 ELGIN AVENUE | GRAND CAYMAN | CJ | GRAND CAYMAN | |||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE R, PART IV, LINE 1 | POOLED INVESTMENT FUNDS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. |
| 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 7 | OTHER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. |