2022-07-13T13:17:38-05:00 2021-08-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2020-09-01 770440090 LUCILE PACKARD FOUNDATION FOR CHILDREN'S HEALTH LUCI 6504978365 400 HAMILTON AVENUE NO 340 PALO ALTO CA 94301 KATHRYN COULBOURN CFO 6504978365 2022-07-08 1 KATHRYN COULBOURN XXX-XX-XXXX KATHRYN J OKIMOTO P00746598 4254544919 2022-07-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CYNTHIA BRANDT 400 HAMILTON AVENUE NO 340 PALO ALTO CA 94301 201306630 0 X WWW.LPFCH.ORG X 1996 CA THE LUCILE PACKARD FOUNDATION FOR CHILDREN'S HEALTH WORKS IN ALIGNMENT WITH LUCILE PACKARD CHILDREN'S HOSPITAL STANFORD AND THE CHILD HEALTH PROGRAMS OF STANFORD UNIVERSITY. OUR MISSION IS TO ELEVATE THE PRIORITY OF CHILDREN'S HEALTH AND INCREASE THE QUALITY AND ACCESSIBILITY OF CHILDREN'S HEALTH CARE THROUGH LEADERSHIP AND DIRECT INVESTMENT. 27 25 102 264 0 0 85001090 151133651 20106980 22342066 334781 2194830 -2968 0 105439883 175670547 112291658 138462928 0 0 16287042 16803792 21784 595770 18801546 7314073 8295180 135914557 164157670 -30474674 11512877 325810216 374660556 42536941 40980864 283273275 333679692 X THE LUCILE PACKARD FOUNDATION FOR CHILDREN'S HEALTH WORKS IN ALIGNMENT WITH LUCILE PACKARD CHILDREN'S HOSPITAL STANFORD AND THE CHILD HEALTH PROGRAMS OF STANFORD UNIVERSITY.OUR MISSION IS TO ELEVATE THE PRIORITY OF CHILDREN'S HEALTH AND INCREASE THE QUALITY AND ACCESSIBILITY OF CHILDREN'S HEALTH CARE THROUGH LEADERSHIP AND DIRECT INVESTMENT. 0 1 135060835 135060835 22342066 DEVELOPMENT: THE FOUNDATION RAISES MONEY TO SUPPORT THE LUCILE PACKARD CHILDREN'S HOSPITAL AND THE PEDIATRIC AND OBSTETRIC PROGRAMS AT THE STANFORD SCHOOL OF MEDICINE. ONE HUNDRED PERCENT OF FUNDS RAISED ARE TRANSFERRED TO THE HOSPITAL AND SCHOOL OF MEDICINE ON A MONTHLY BASIS. THE FOUNDATION COMPLETED ITS LAST CAMPAIGN AT THE END OF 2012, RAISING A TOTAL OF $548M AGAINST A CAMPAIGN GOAL OF $500M. THE FOUNDATION HAS ENTERED A NEW CAMPAIGN AND IS CURRENTLY DEVELOPING THE CASE STATEMENT AND SOLICITING LEAD GIFTS. 5954250 3402093 FOUNDATION PROGRAMS: THROUGH ITS PROGRAMS AND PARTNERSHIPS WORK, THE FOUNDATION SEEKS TO BUILD AWARENESS ABOUT ISSUES AFFECTING CHILDREN'S HEALTH BY INVESTING IN PROGRAMS TO ENHANCE THE SYSTEM OF CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND THEIR FAMILIES AND THROUGH THE PROVISION OF DATA ON THE HEALTH AND WELL BEING OF CHILDREN IN CALIFORNIA. DURING THE FISCAL YEAR ENDED AUGUST 31, 2021, THE FOUNDATION INVESTED APPROXIMATELY $5.9 MILLION IN THIS AREA. 141015085 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 1 71 0 102 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 27 25 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 AL AR CA FL GA HI IL KS KY MD MA MI MN MS NH NJ NM NY NC OR PA RI SC TN UT VA WV WI X KATHRYN COULBOURN 6504978365 400 HAMILTON AVENUE SUITE 340 PALO ALTO CA 94301 PAUL KING DIRECTOR 0.30 50.00 X 0 1650405 251012 BRIAN PERRONNE SVP FOR DEVELOPMENT ADMIN, COO 40.00 0.00 X 904670 0 50907 CYNTHIA BRANDT PRESIDENT & CEO 40.00 0.00 X X 772269 0 126716 KATHRYN COULBOURN CFO 40.00 0.00 X 539505 0 52782 SARAH COLLINS VP PRINCIPAL GIFTS 40.00 0.00 X 342595 0 30614 JAMES DEASY ASSOCIATE VP & DEPUTY OPS 40.00 0.00 X 281447 0 52925 RACHEL GLEBOV ASSOCIATE VP MAJOR GIFTS 40.00 0.00 X 274221 0 41950 CINDI TROST ASSOCIATE VP CAMPAIGNS 40.00 0.00 X 257149 0 35178 JEAN GORMAN DIRECTOR OF GIFT PLANNING 40.00 0.00 X 244683 0 35601 EILEEN WALSH FORMER KEY EMPLOYEE 15.00 0.00 X 268317 0 4141 ELIZABETH DUNLEVIE CHAIR 0.30 3.00 X X 0 0 0 MINDY ROGERS VICE CHAIR 0.30 3.00 X X 0 0 0 DAN BOMZE DIRECTOR 0.30 0.00 X 0 0 0 KIRK BOSTROM DIRECTOR 0.30 0.00 X 0 0 0 C BRYAN CAMERON DIRECTOR 0.30 0.00 X 0 0 0 JEFF CHAMBERS DIRECTOR 0.30 12.00 X 0 0 0 LISA COLE DIRECTOR 0.30 0.00 X 0 0 0 KATE DACHS DIRECTOR 0.30 0.00 X 0 0 0 SUSAN FORD DORSEY DIRECTOR 0.30 0.00 X 0 0 0 JANE DUNLEVIE DIRECTOR 0.30 0.00 X 0 0 0 PAUL FISHER MD DIRECTOR 0.30 0.00 X 0 0 0 CHRIS GALLO DIRECTOR 0.30 0.00 X 0 0 0 PAUL KWAN DIRECTOR 0.30 0.00 X 0 0 0 MARY B LEONARD MD DIRECTOR 0.30 3.00 X 0 0 0 JOHN LILLIE DIRECTOR 0.30 0.00 X 0 0 0 LLOYD MINOR MD DIRECTOR 0.30 3.00 X 0 0 0 PETER MUNZIG DIRECTOR 0.30 0.00 X 0 0 0 KATHERINE ORR DIRECTOR 0.30 0.00 X 0 0 0 SUSAN P ORR DIRECTOR 0.30 0.00 X 0 0 0 MICHELLE SANDBERG MD DIRECTOR 0.30 0.00 X 0 0 0 DAVID K STEVENSON MD DIRECTOR 0.30 0.00 X 0 0 0 GEORGE TIDMARSH MD PHD DIRECTOR 0.30 0.00 X 0 0 0 HILARY VALENTINE DIRECTOR 0.30 0.00 X 0 0 0 CHARLOTTE WAXMAN DIRECTOR 0.30 0.00 X 0 0 0 ELIZABETH WEIL DIRECTOR 0.30 0.00 X 0 0 0 CHRIS SCHAEPE DIRECTOR 0.30 0.00 X 0 0 0 NANCY LARSSON DIRECTOR 0.30 0.00 X 0 0 0 ESTHER LEVY DIRECTOR 0.30 0.00 X 0 0 0 BILL C SONNEBORN DIRECTOR 0.30 0.00 X 0 0 0 3884856 1650405 681826 46 1 1 0 COMMUNITY COUNSELLING SERVICE 527 MADISON AVENUE 5TH FLOOR NEW YORK NY 10022 CONSULTING/RECRUITMENT 620000 POPULATION REFERENCE BUREAU 1875 CONNECTICUT AVE NW STE 520 WASHINGTON DC 200095728 CONSULTING/DATA COLLECTION 262240 SCHULTZ & WILLIAMS INC ONE PENN CTR 1617 JFK BLVD STE 1 PHILADELPHIA PA 19103 CONSULTING/PRINTING 252372 MATTHEW I REAMY PO BOX 46216 DENVER CO 80202 CONSULTING/RECRUITMENT 207022 DAVINCI DIRECT INC 3 VILLAGE GREEN N 311 PMBB6 PLYMOUTH MA 02360 CONSULTING/PRODUCTION/PRINTING 195909 14 3997 98000 151031654 10786494 151133651 DEVELOPMENT FEES REIMB 900099 22342066 22342066 22342066 286450 286450 27544463 25636083 1908380 1908380 1908380 175670547 22342066 0 2194830 138398262 138398262 64666 64666 1960283 118383 384092 1457808 100341 73191 8145 19005 11717887 979633 1039354 9698900 949959 50775 105857 793327 1250835 113680 223182 913973 824487 77131 80478 666878 180757 180757 595770 595770 346232 346232 3393623 726865 1364256 1302502 221550 36549 185001 523779 11222 73093 439464 600087 94670 163923 341494 1741465 154081 161173 1426211 16887 348 2034 14505 62586 2102 20421 40063 280375 20405 70200 189770 101258 1715 54956 44587 PRINTING 425036 670 699 423667 PUBLICATIONS 115306 6044 1135 108127 TAXES & LICENSES 90913 73804 16069 1040 UBI TAXES 40000 0 40000 0 155326 10889 4983 139454 164157670 141015085 4341039 18801546 304704 277142 62863115 30692067 109333333 152686866 1927446 1088965 2318 17818 607752 585868 2143832 1702972 508893 440860 23760284 28257598 110647652 146140568 15854719 14472804 325810216 374660556 3060157 3486024 1143364 2140323 8938032 10019759 29395388 25334758 42536941 40980864 X 118465472 151776707 164807803 181902985 283273275 333679692 325810216 374660556 X 11512877 37925087 968453 X 0 1 X 1 0 X 152037713 74363774 140831261 85001090 151133651 603367489 152037713 74363774 140831261 85001090 151133651 603367489 121991378 481376111 533741 590922 592472 497152 286450 2500737 605868226 100598193 0.79450 0.73300 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 118883388 39885897 2233924 2985942 387344 153162075 116637637 9154414 1681052 7099088 -1871477 118883388 118241165 489705 2094558 2814728 -2816053 116637637 113411531 8999933 3590488 2810823 -2231012 118241165 112452618 11767062 1220808 8701992 885349 113411531 1.00000 0.00000 0.00000 0 0 379667 313972 65875 1340051 1006196 333675 424114 382804 41310 440860 HEDGE FUNDS 26232213 F INTERNATIONAL EQUITY TRUSTS 53973093 F REAL ASSET FUNDS 14735751 F VENTURE CAPITAL/PRIVATE EQUITY 43085961 F DEBT SECURITIES 5812562 F FIXED INCOME 2300988 F 146140568 FUNDS TO BE TRANSFERRED TO LPCH AND SOM 2445079 FUNDS TO BE TRANSFERRED TO OTHERS 621685 PAYMENTS FOR TRUST BENEFICIARY 7596875 LEASE LIABILITY - REAL ESTATE 14671119 25334758 X 214173965 37925087 622221 38547308 175626657 43890 43890 175670547 163767548 0 163767548 346232 43890 390122 164157670 PART V, LINE 4: THE FOUNDATION USES ITS ENDOWMENT TO FUND ACTIVITIES TO SUPPORT ITS PROGRAMMATIC OBJECTIVES IN CHILDREN'S HEALTH AND RELATED ADMINISTRATIVE COSTS. PROGRAMMATIC OBJECTIVES INCLUDE BUILDING AWARENESS AT THE COMMUNITY AND STATE LEVEL ABOUT ISSUES AFFECTING CHILDREN'S HEALTH AND ENHANCING THE SYSTEM OF CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND THEIR FAMILIES. PART X, LINE 2: THE FOUNDATION FOLLOWS THE PROVISION OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES, WHICH PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX PROVISION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN AND PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. MANAGEMENT BELIEVES THAT NO SUCH UNCERTAIN TAX POSITIONS EXIST REQUIRING ACCRUAL OR DISCLOSURE AS OF AUGUST 31, 2021 OR 2020. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSES -346,232. CHANGE IN VALUE OF INVESTMENTS HELD IN TRUST 968,453. PART XI, LINE 4B - OTHER ADJUSTMENTS: DONATED GIFTS IN KIND 43,890. PART XII, LINE 4B - OTHER ADJUSTMENTS: DONATED GIFTS IN KIND 43,890. 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 31127361 NORTH AMERICA 0 0 GRANTS TO RECIPIENTS LOCATED IN THE REGION 64666 NORTH AMERICA 0 0 FUNDRAISING 7745 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 MANAGEMENT & GENERAL 2222 NORTH AMERICA 0 0 FUNDRAISING REVENUES RECEIVED FROM DONORS IN THE REGION SOUTH AMERICA 0 0 FUNDRAISING REVENUES RECEIVED FROM DONORS IN THE REGION EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 FUNDRAISING REVENUES RECEIVED FROM DONORS IN THE REGION MIDDLE EAST AND NORTH AFRICA 0 0 FUNDRAISING REVENUES RECEIVED FROM DONORS IN THE REGION 0 0 0 0 0 0 31201994 0 31201994 NORTH AMERICA ADDRESSING CLINICAL CHALLENGES IN THE CARE OF CHILDREN WITH MEDICAL COMPLEXITY 64666 ACH 1 0 1 0 0 0 1 1 PART I, LINE 2: GRANTS ARE AWARDED TO ORGANIZATIONS BASED ON THEIR ABILITY TO SUPPORT THE FOUNDATION'S CHARITABLE PROGRAM OBJECTIVES, SPECIFICALLY IN RESPECT OF THE FOUNDATION'S WORK TO ENHANCE THE SYSTEM OF CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND THEIR FAMILIES. APPLICANT ORGANIZATIONS SUBMIT PROPOSALS BASED ON MUTUALLY AGREED UPON OBJECTIVES, MILESTONES AND DELIVERABLES. FOUNDATION PROGRAM STAFF ANALYZE THE APPLICANT'S EXPERTISE, PROJECT GOALS, AND COSTS BEFORE AWARDING A GRANT. GRANTS OVER $50,000 AND UP TO $250,000 MAY BE APPROVED BY THE CEO UPON REVIEW AND FORMAL RECOMMENDATION OF A MAJORITY OF THE MEMBERS OF THE PROGRAMS AND PARTNERSHIPS COMMITTEE. GRANTS OVER $250,000 MUST BE APPROVED BY THE BOARD. PART I, LINE 3: THE ACCRUAL BASIS WAS USED TO ACCOUNT FOR EXPENDITURES. PART III ACCOUNTING METHOD: SCHEDULE F, PART I THE FOUNDATION'S DISCLOSURE IN PART 1, LINE 3(1) REFLECTS THE DOMICILE OF CERTAIN INVESTMENT ENTITIES WHICH SERVE MERELY AS THE VEHICLE FOR SUBSEQUENT INVESTING OF FUNDS AND IS NOT REPRESENTATIVE OF THE UNDERLYING GEOGRAPHICAL STRATEGY OF THOSE INVESTMENTS. THE FOUNDATION'S INVESTMENTS ARE FULLY DIVERSIFIED ACROSS ASSET CLASSES, STRATEGIES AND GEOGRAPHICAL REGIONS. IT ADHERES TO AN APPROVED STATEMENT OF INVESTMENT OBJECTIVES AND POLICIES AND HAS IN PLACE A STRATEGIC ASSET ALLOCATION POLICY WHICH ALLOWS IT TO ACHIEVE ITS SHORT TERM FINANCIAL AND LONG TERM INVESTMENT OBJECTIVES. X X X X X X 1 COMMUNITY COUNSELLING SERVICE CO LLC 527 MADISON AVENUE 5TH FLOOR NEW YORK NY 10022 GUIDANCE AND CONSULTING ON STRATEGIC FUNDRAISING PLAN 0 0 286000 -286000 GRENZEBACH GLIER & ASSOCIATES 200 S MICHIGAN AVENUE SUITE 2100 CHICAGO IL 60604 WRITING GIFT PROPOSALS AND DONOR IMPACT REPORTS. 0 0 102250 -102250 HELEN ELIZABETH BROWN 489 MT AUBURN STREET SUITE 4 WATERTOWN MA 02472 PROSPECT RESEARCH 0 0 99520 -99520 RUTH RICHERSON CONSULTING 720 EVELYN AVENUE ALBANY CA 94706 FUNDRAISING CONSULTING & IMPLEMENTING FUNDRAISING STRATEGIES 0 0 69000 -69000 DAVINCI DIRECT 3 VILLAGE GREEN N 311 PMBB6 PLYMOUTH MA 02360 CREATIVE DIRECTION IN PLANNING DIRECT MAIL PROGRAM 0 0 39000 -39000 595770 -595770 AL AK AR CA CO CT FL GA HI IL KS KY LA ME MD MA MI MN MS MO NV NH NJ NM NY NC ND OH OK OR PA RI SC TN UT VA WA WV WI 1 NATIONAL ALLIANCE TO ADVANCE ADOLESCENT HEALTH (NAAAH) 1615 M ST NW SUITE 290 WASHINGTON DC DC 20036 204145524 501C(3) 50000 PEDIATRIC TO ADULT HEALTH CARE TRANSITION QUALITY MEASUREMENT UNIVERSITY OF COLORADO DENVER 13001 E 17TH PLACE AURORA CO 80045 840404231 501C(3) 122195 BEST PRACTICES FOR ENGAGING PATIENT, YOUTH AND FAMILY LEADERS AS RESEARCH PARTNERS NATIONAL HEALTH LAW PROGRAM 3701 WILSHIRE BLVD SUITE 750 LOS ANGELES CA 90010 953080947 501C(3) 50000 COVID-19 POLICY ISSUANCE AND CLARITY IN THE CALIFORNIA CHILDRENS SERVICES PROGRAM FAMILY VOICES OF CALIFORNIA 1663 MISSION STREET 7TH FLOOR SAN FRANCISCO CA 94103 942819062 501C(3) 49898 PARENT LEADERSHIP COORDINATION AND EXPANSION COVID-19 SUPPLEMENT POPULATION REFERENCE BUREAU 1875 CONNECTICUT AVE NW STE 520 WASHINGTON DC DC 20009 530214030 501C(3) 1700000 KIDSDATA THE CHILDREN'S PARTNERSHIP 811 WILSHIRE BLVD SUITE 1000 LOS ANGELES CA 90017 464106389 501C(3) 100000 PROMOTING TELEHEALTH TO ADDRESS BARRIERS TO CARE FOR CHILDREN OF COLOR WITH SPECIAL HEALTH CARE NEEDS IN CALIFORNIA COLUMBIA UNIVERSITY MEDICAL CENTER 630 WEST 168TH STREET BOX 49 NEW YORK NY 10032 135598093 501C(3) 155636 PEDIATRIC ICU CONTINUITY STRATEGIES CONFERENCE AND GUIDELINES FORMULATION THE REGENTS OF THE UNIVERSITY OF CALIFORNIA SAN FRANCISCO 3333 CALIFORNIA STREET SAN FRANCISCO CA 94118 946036493 501C(3) 249400 THE AFFIRM 2021 STUDY (ASSESSING FAMILY FRIENDLY CARE IN REALIZING SELF-MANAGEMENT): DEVELOPMENT AND PHASE I PILOT OF A SELF-MANAGEMENT SUPPORT SURVEY FOR FAMILIES OF CHILDREN WITH SPECIAL HEALTH CARE TIDES CENTER 1012 TORNEY AVENUE SAN FRANCISCO CA 94129 943213100 501C(3) 150000 CALIFORNIA HEALTH REPORT SOLUTIONS JOURNALISM ON CSHCN FAMILY VOICES OF CALIFORNIA 1663 MISSION STREET 7TH FLOOR SAN FRANCISCO CA 94103 942819062 501C(3) 418192 PROJECT LEADERSHIP PHASE VI: ENGAGING DIVERSE FAMILIES FOR HEALTH SYSTEMS IMPROVEMENT THE NATIONAL ALLIANCE TO ADVANCE ADOLESCENT HEALTH 1615 M ST NW SUITE 290 WASHINGTON DC DC 20036 204145524 501C(3) 25000 SUPPLEMENTAL: PAYING FOR THE TRANSITION FROM PEDIATRIC JACOBS HEART CHILDREN'S CANCER SUPPORT SERVICES 680 WEST BEACH STREET WATSONVILLE CA 95076 680143822 501C(3) 50000 DEVELOPMENT OF A TRANSITION TASK FORCE FOR PEDIATRICPAL JOHNS HOPKINS UNIVERSITY 1101 E 33RD ST BALTIMORE MD 21218 520595110 501C(3) 49981 HOME HEALTH CARE SERVICES FOR CHILDREN AND YOUTH IN FOSTER CARE LUCILE PACKARD CHILDREN'S HOSPITAL & STANFORD SCHOOL OF MEDICINE 725 WELCH ROAD PALO ALTO CA 94304 941156365 501C(3) 99294 CHILDREN'S HEALTH INITIATIVE LUCILE PACKARD CHILDREN'S HOSPITAL & STANFORD SCHOOL OF MEDICINE 725 WELCH ROAD PALO ALTO CA 94304 941156365 501C(3) 135060835 CHILDREN'S HEALTH LUCILE PACKARD CHILDREN'S HOSPITAL & STANFORD SCHOOL OF MEDICINE 725 WELCH ROAD PALO ALTO CA 94304 770003859 501C(3) 67831 CHILDREN'S HEALTH 14 0 PART I, LINE 2: GRANTS ARE AWARDED TO ORGANIZATIONS BASED ON THEIR ABILITY TO SUPPORT THE FOUNDATION'S CHARITABLE PROGRAM OBJECTIVES, SPECIFICALLY IN RESPECT OF THE FOUNDATION'S WORK TO ENHANCE THE SYSTEM OF CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND THEIR FAMILIES. APPLICANT ORGANIZATIONS SUBMIT PROPOSALS BASED ON MUTUALLY AGREED UPON OBJECTIVES, MILESTONES AND DELIVERABLES. FOUNDATION PROGRAM STAFF ANALYZE THE APPLICANT'S EXPERTISE, PROJECT GOALS, AND COSTS BEFORE AWARDING A GRANT. GRANTS OVER $50,000 AND UP TO $250,000 MAY BE APPROVED BY THE CEO UPON REVIEW AND FORMAL RECOMMENDATION OF A MAJORITY OF THE MEMBERS OF THE PROGRAMS AND PARTNERSHIPS COMMITTEE. GRANTS OVER $250,000 MUST BE APPROVED BY THE BOARD. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 PAUL KING DIRECTOR 0 1092420 0 512835 0 45150 0 231117 0 19895 0 1901417 0 0 BRIAN PERRONNE SVP FOR DEVELOPMENT ADMIN, COO 386931 0 135558 0 382181 0 28500 0 22407 0 955577 0 273330 0 CYNTHIA BRANDT PRESIDENT & CEO 556299 0 139125 0 76845 0 117388 0 9328 0 898985 0 0 0 KATHRYN COULBOURN CFO 345266 0 53026 0 141213 0 28500 0 24282 0 592287 0 91237 0 SARAH COLLINS VP PRINCIPAL GIFTS 281738 0 60317 0 540 0 28500 0 2114 0 373209 0 0 0 JAMES DEASY ASSOCIATE VP & DEPUTY OPS 240897 0 30414 0 10136 0 28500 0 24425 0 334372 0 0 0 RACHEL GLEBOV ASSOCIATE VP MAJOR GIFTS 253114 0 20568 0 539 0 27938 0 14012 0 316171 0 0 0 CINDI TROST ASSOCIATE VP CAMPAIGNS 237159 0 19189 0 801 0 26683 0 8495 0 292327 0 0 0 JEAN GORMAN DIRECTOR OF GIFT PLANNING 220873 0 17864 0 5946 0 24265 0 11336 0 280284 0 0 0 EILEEN WALSH FORMER KEY EMPLOYEE 77899 0 0 0 190418 0 2484 0 1657 0 272458 0 0 0 PART I, LINE 1A CYTHIA BRANDT RECEIVES A HOUSING ALLOWANCE THAT IS TREATED AS TAXABLE COMPENSATION. PART I, LINE 4B THE FOUNDATION OFFERS A 457(F) PLAN FOR SELECT MEMBERS OF EXECUTIVE MANAGEMENT. DURING THE CALENDAR YEAR 2020, THE CEO, CFO, AND COO WERE ELIGIBLE TO RECEIVE CONTRIBUTIONS FROM THE PLAN. THE TOTAL AMOUNT CONTRIBUTED TO THE PLAN, BUT NOT PAID OUT, FOR CYNTHIA BRANDT (CEO) WAS $88,888. THE TOTAL AMOUNT DISTRIBUTED FROM THE PLAN TO THE FOLLOWING EMPLOYEES WAS $518,094: BRIAN PERRONNE (SVP FOR DEVELOPMENT ADMIN & COO) RECEIVED $378,122 AND KATHRYN COULBOURN (CFO) RECEIVED $139,972. PART I, LINE 7 THE CEO, CFO, AND COO RECEIVE AN INCENTIVE COMPENSATION PAYMENT EQUAL TO A PERCENTAGE OF TOTAL BASE COMPENSATION. THE PERCENTAGE IS DETERMINED BASED ON THE ACHIEVEMENT OF SPECIFIC GOALS BUT IS LIMITED TO ENSURE THAT TOTAL COMPENSATION REMAINS WITHIN THE FOUNDATION'S POLICY RANGE OF THE 75TH TO 90TH PERCENTILE OF COMPENSATION AS PER SPECIFIC COMPENSATION SURVEYS. THE PERCENTAGE MAY VARY YEAR TO YEAR AS A RESULT OF THIS PROCESS. INCENTIVE COMPENSATION FOR THE CEO IS DETERMINED AND APPROVED BY THE COMPENSATION COMMITTEE. THE INCENTIVE COMPENSATION FOR THE CFO AND COO IS PROPOSED BY THE CEO AND APPROVED BY THE COMPENSATION COMMITTEE. X 1 0 APPRAISAL X 84 10742604 AVERAGE MARKET VALUE X SUPPLIES 220 43890 RETAIL VALUE 1 0 1 1 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS WAS DETERMINED BASED ON THE NUMBER OF ITEMS (SUPPLIES) OR CONTRIBUTIONS RECEIVED (PUBLICLY TRADED STOCK). PART I, LINE 32B: THE FOUNDATION ENGAGES A BROKER TO RECEIVE AND LIQUIDATE GIFTS OF MARKETABLE SECURITIES. FORM 990, PART I, LINE 6: VOLUNTEERS INCLUDE THE FOUNDATION'S BOARD OF DIRECTORS AS WELL AS VOLUNTEERS WHO SUPPORT VARIOUS FOUNDATION FUNDRAISING EVENTS. FORM 990, PART III, LINE 3 THE FOUNDATION SUBSTANTIALLY COMPLETED PHILANTHROPIC FUNDING OF THE CHILDREN'S HEALTH INITIATIVE IN FY2021. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE BOARD BETWEEN BOARD MEETINGS WITH THE EXCEPTION OF CERTAIN SPECIFIC POWERS, AS SPECIFIED IN THE BYLAWS. THE EXECUTIVE COMMITTEE IS COMPOSED OF THE CHAIR OF THE BOARD, THE VICE CHAIR OF THE BOARD, THE PRESIDENT/CEO OF THE FOUNDATION, THE CHAIRS OF ALL OTHER STANDING COMMITTEES, THE DEAN OF THE STANFORD UNIVERSITY SCHOOL OF MEDICINE, AND THE PRESIDENT OF THE CHILDREN'S HOSPITAL AT STANFORD. ALL MEMBERS OF THE EXECUTIVE COMMITTEE ARE MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2 JEFF CHAMBERS, ELIZABETH DUNLEVIE, PAUL KING, MARY LEONARD, LLOYD MINOR, SUSAN ORR, MINDY ROGERS, AND CYNTHIA BRANDT HAVE A BUSINESS RELATIONSHIP. KATHERINE ORR AND SUSAN ORR HAVE A FAMILY RELATIONSHIP. ELIZABETH DUNLEVIE AND JANE DUNLEVIE HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE LUCILE PACKARD CHILDREN'S HOSPITAL AT STANFORD IS THE SOLE MEMBER OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE FOUNDATION, THE LUCILE PACKARD CHILDREN'S HOSPITAL AT STANFORD, HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE FOUNDATION, THE LUCILE PACKARD CHILDREN'S HOSPITAL AT STANFORD, HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS OF THE FOUNDATION. REVISIONS TO THE FOUNDATION'S BYLAWS MUST BE APPROVED BY THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT MAKES THE REDACTED FORM 990 AVAILABLE TO THE FULL BOARD AND ANY NON-DIRECTOR MEMBERS OF THE AUDIT COMMITTEE PRIOR TO THE AUDIT COMMITTEE MEETING AT WHICH THE FORM WILL BE REVIEWED. THE BOARD AND AUDIT COMMITTEE ARE ASKED TO PROVIDE FEEDBACK AND/OR QUESTIONS FOR DISCUSSION AT THE AUDIT COMMITTEE MEETING. UPON REVIEW OF THE FORM 990 AND AFTER ALL FEEDBACK AND QUESTIONS HAVE BEEN ADDRESSED, THE AUDIT COMMITTEE WILL VOTE WHETHER TO APPROVE A RECOMMENDATION TO THE FULL BOARD TO APPROVE THE FORM 990. THE PUBLIC DISCLOSURE COPY OF THE FORM 990 IS THEN PRESENTED TO THE FULL BOARD FOR FINAL APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, OFFICERS, AND KEY EMPLOYEES ("KEY PERSONS") ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS AND TO DISCLOSE ALL REAL AND POTENTIAL CONFLICTS OF INTEREST. KEY PERSONS ARE REQUIRED TO CONFIRM THAT THEY HAVE REVIEWED THE POLICY BY SIGNING THAT THEY HAVE DONE SO, EVEN IF NO CONFLICTS ARE DISCLOSED. IN ADDITION, KEY PERSONS ARE REQUIRED TO DISCLOSE REAL OR APPARENT CONFLICTS AT THE TIME WHEN SUCH CONFLICTS ARISE DURING DISCUSSIONS OF THE BOARD, BOARD COMMITTEES, OR STAFF. KEY PERSONS WITH CONFLICTS ARE REQUIRED TO RECUSE THEMSELVES FROM RELATED DISCUSSIONS AND DECISIONS. THE FOUNDATION'S CEO IS RESPONSIBLE FOR ENSURING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION HAS A COMPENSATION COMMITTEE COMPRISED ENTIRELY OF INDEPENDENT DIRECTORS, NONE OF WHOM HAVE A CONFLICT OF INTEREST WITH THE CEO, CFO OR ANY OF THE KEY EMPLOYEES. THE COMPENSATION COMMITTEE ESTABLISHES THE COMPENSATION PHILOSOPHY FOR THE ORGANIZATION AND MEETS ANNUALLY TO SET THE SALARY FOR THE CEO AND CFO AND REVIEW AND DISCUSS SALARIES FOR KEY EMPLOYEES. THE COMMITTEE HAS ENGAGED A THIRD PARTY INDEPENDENT COMPENSATION CONSULTANT TO ATTEND ITS ANNUAL MEETING THE LAST OF WHICH WAS HELD ON SEPTEMBER 29, 2021. IN DETERMINING COMPENSATION LEVELS, THE COMMITTEE USES TWO INDEPENDENT THIRD PARTY SALARY SURVEYS, ONE PUBLISHED BY WOODMARK AND ONE PUBLISHED BY LASNIK BROIDA. KEY DELIBERATIONS OF THE COMPENSATION COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING. THE LAST COMPENSATION REVIEW WAS DONE ON SEPTEMBER 29, 2021 FORM 990, PART VI, SECTION C, LINE 19 WHILE FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND AUDITED FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INVESTMENTS HELD IN TRUST 968,453. LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD 725 WELCH ROAD PALO ALTO CA 94304 770003859 HEALTHCARE/HOSPITAL CA 501(C)(3) LINE 3 N/A 0 CHARITABLE REMAINDER TRUST (12) INVESTMENT CA N/A T 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1