2021-07-15T11:03:31-05:00 2020-08-31 PricewaterhouseCoopers LLP 101 SEAPORT BLVD SUITE 500 BOSTON MA 02210 990 2019-09-01 320359189 PACKARD CHILDREN'S HEALTH ALLIANCE % CAMERON D'ALPE FINANCE DEPT PACK 6504978000 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 DANA HAERING CFO 6507212222 2021-07-13 true GWEN SPENCER P00641463 6175305000 2021-07-12 2019 2022-09-23 18:48:47Z CAMERON D'ALPE 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 105542760 false X WWW.STANFORDCHILDRENS.ORG X 2011 CA SEE SCHEDULE O 9 3 413 0 0 0 0 0 108444792 105542760 0 0 0 0 108444792 105542760 0 0 0 0 32053884 32716506 0 0 0 90778836 92816440 122832720 125532946 -14387928 -19990186 27033337 36301332 18750444 28008946 8282893 8292386 X SEE SCHEDULE O false false 113143035 105542760 SEE SCHEDULE O 113143035 true false false false false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true true false false false true 79 0 true 413 true false false false false false false false false false false false false X 9 3 true false true false true true true true true false false true true true true true false false false false CA X CAMERON D'ALPE FINANCE DEPT 6507235636 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 Dennis P Lund MD DIRECTOR, CHAIR (AS OF 3/20) 1.0 50.0 X X 0 1268021 64740 Dana Haering VP & CFO 3.0 47.0 X 0 1046944 115913 Edward Kopetsky VP & CIO 0.0 50.0 X 0 863253 91174 Cameron D'Alpe DIRECTOR/CEO 17.0 33.0 X X 0 693963 98984 Marcia Cohen DIRECTOR 1.0 51.0 X 0 693774 59868 William Kennedy MD DIRECTOR (UNTIL 7/20) 1.0 50.0 X 0 629307 45086 Kim Roberts CHIEF STRAT. OFF. (UNTIL 6/18) 0.0 50.0 X 0 462007 47604 Tim Cornell MD DIRECTOR (AS OF 6/20) 1.0 50.0 X 0 399062 96445 Andrew Smith MD MEDICAL DIRECTOR, SECRETARY 50.0 0.0 X X 421888 0 21374 Rick Vance COO 50.0 0.0 X 359228 0 14880 Tzielan Lee MD DIRECTOR (AS OF 6/20) 1.0 50.0 X 0 310209 29770 Malavika Narayan DIR OF PHYSICIAN NETWORK FIN. 50.0 0.0 X 0 288636 36193 Tika Martin DIRECTOR, HUMAN RESOURCES 50.0 0.0 X 272370 0 21237 Michael Lipman DIRECTOR, PROVIDER RECRUIT. 50.0 0.0 X 247168 0 5832 Dorothy Naidu DIRECTOR, CLINICAL QUALITY 50.0 0.0 X 197658 0 9267 Tiffany Aubrey DIR. OF PRACTICE OPERATIONS 50.0 0.0 X 204818 0 1284 Emily Kruger SR PHYS NETWORK FINANCE MGR 50.0 0.0 X 0 155115 45647 Tammy Ojeda-Leao DIRECTOR GENERAL PEDIATRICS 50.0 0.0 X 169475 0 14041 John Walker DIRECTOR, CHAIR (UNTIL 3/20) 1.0 3.0 X X 0 0 0 Lisa Erburu MD DIRECTOR (AS OF 6/20) 1.0 0.0 X 0 0 0 Malinda Mitchell DIRECTOR,VICE CHAIR AS OF 5/20 1.0 0.0 X X 0 0 0 1872605 6810291 819339 32 true true false PACKARD MEDICAL GROUP INC 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 PHYSICIAN SERVICES 54915147 G AND G ORGANIZATION LTD DBA PFS GR 2600 NORTH LOOP WEST STE 150 HOUSTON TX 77092 PYMT COLLECTION SVCS 2159897 CAREMARK LLC PO BOX 848001 DALLAS TX 75284 PHARMACY SERVICES 810092 LIGHTHOUSE MANAGEMENT GROUP INC 11040 BOLLINGER CANYON RD STE E-88 SAN RAMON CA 94582 EMPLOYMENT SERVICE 700632 ADECCO EMPLOYMENT SERVICES DEPARTMENT LA 21403 PASADENA CA 911851403 EMPLOYMENT SERVICE 621364 19 0 PATIENT SERVICES 900099 93791805 93791805 PROGRAM SUPPORT 900099 10889569 10889569 OTHER INCOME - RISK POOL 900099 861386 861386 105542760 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 105542760 105542760 0 0 0 0 1149316 843973 305343 0 18022506 15100283 2922223 1109160 389305 719855 10772492 9510066 1262426 1663032 1459132 203900 129168 43059 86109 197668 197668 45863 45863 0 0 0 63664843 59756979 3907864 115779 71373 44406 14825874 13664548 1161326 3555576 3555576 0 6373996 6373996 53268 30773 22495 0 0 0 0 2973775 1965096 1008679 266426 -740 267166 DUES & SUBSCRIPTIONS 289194 220032 69162 LICENSES & TAXES 189995 32271 157724 UTILITIES 159514 159514 RECRUITMENT 31775 26700 5075 -56274 -58901 2627 125532946 113143035 12389911 0 0 0 101918 -486922 0 0 9740723 9107987 0 0 0 0 0 0 0 0 689779 780839 20372483 16308284 5137448 4064199 0 0 0 0 0 0 8962302 7875199 2401167 14960030 27033337 36301332 4895876 5462180 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13854568 22546766 18750444 28008946 X 8282893 8292386 0 0 8282893 8292386 27033337 36301332 X -19990186 19999679 X false true X true false X SCHEDULE A, PART I 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. 5940455 4913198 1027257 13933930 11395086 2538844 498098 498098 4064199 OTHER ASSETS 3106058 RIGHT OF USE LEASE ASSETS 11792763 SECURITY DEPOSITS 61209 14960030 0 DUE TO RELATED PARTIES, NET 10517495 RIGHT OF USE LEASE LIABILITIES 12029271 22546766 X SCHEDULE D, PART X, LINE 2 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. false true false false false false false true false Cameron D'Alpe DIRECTOR/CEO 0 375136 0 180215 0 138612 0 84358 0 14626 0 792947 0 31635 Dennis P Lund MD DIRECTOR, CHAIR (AS OF 3/20) 0 398004 0 789377 0 80640 0 22417 0 42323 0 1332761 0 0 Andrew Smith MD MEDICAL DIRECTOR, SECRETARY 357594 0 64294 0 0 0 10600 0 10774 0 443262 0 0 0 Marcia Cohen DIRECTOR 0 582742 0 110572 0 460 0 28000 0 31868 0 753642 0 0 Tim Cornell MD DIRECTOR (AS OF 6/20) 0 301994 0 94950 0 2118 0 5368 0 91077 0 495507 0 0 Tzielan Lee MD DIRECTOR (AS OF 6/20) 0 218754 0 55855 0 35600 0 22622 0 7148 0 339979 0 0 Dana Haering VP & CFO 0 608951 0 336164 0 101829 0 100291 0 15622 0 1162857 0 58000 Rick Vance COO 314588 0 44640 0 0 0 10600 0 4280 0 374108 0 0 0 Emily Kruger SR PHYS NETWORK FINANCE MGR 0 155115 0 0 0 0 0 14769 0 30878 0 200762 0 0 Malavika Narayan DIR OF PHYSICIAN NETWORK FIN. 0 237100 0 0 0 51536 0 23765 0 12428 0 324829 0 0 Tiffany Aubrey DIR. OF PRACTICE OPERATIONS 182062 0 22756 0 0 0 0 0 1284 0 206102 0 0 0 Tammy Ojeda-Leao DIRECTOR GENERAL PEDIATRICS 158701 0 10774 0 0 0 5319 0 8722 0 183516 0 0 0 Dorothy Naidu DIRECTOR, CLINICAL QUALITY 181473 0 16185 0 0 0 7959 0 1308 0 206925 0 0 0 Tika Martin DIRECTOR, HUMAN RESOURCES 253497 0 18873 0 0 0 6724 0 14513 0 293607 0 0 0 Michael Lipman DIRECTOR, PROVIDER RECRUIT. 227376 0 19792 0 0 0 4550 0 1282 0 253000 0 0 0 Kim Roberts CHIEF STRAT. OFF. (UNTIL 6/18) 0 390135 0 50000 0 21872 0 46500 0 1104 0 509611 0 0 Edward Kopetsky VP & CIO 0 544079 0 253663 0 65511 0 54463 0 36711 0 954427 0 0 William Kennedy MD DIRECTOR (UNTIL 7/20) 0 389787 0 230411 0 9109 0 27896 0 17190 0 674393 0 0 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. AT THE LAST DAY OF EACH QUARTER, EACH PARTICIPANT'S ACCOUNT IS CREDITED WITH AN AMOUNT EQUAL TO A PERCENTAGE OF BASE SALARY (DEPENDING ON THE INDIVIDUAL'S POSITION). THE COMPENSATION COMMITTEE MAY DETERMINE THAT CREDITS SHALL BE MADE IN ADDITION TO THOSE ABOVE IN ITS SOLE DISCRETION. A PARTICIPANT BECOMES VESTED IN THE ACCOUNT AS FOLLOWS: (A) THE FIRST BUSINESS DAY OF JANUARY FOLLOWING THE YEAR IN WHICH THE ACCOUNT WAS ESTABLISHED AND THE PARTICIPANT COMPLETES TWO FULL YEARS OF PARTICIPATION; (B)DISCHARGE FROM EMPLOYMENT; (C) ENTITLEMENT TO LONG-TERM DISABILITY; OR (D) THE PARTICIPANT ATTAINS THE AGE OF 60 WHILE EMPLOYED. THE FOLLOWING AMOUNTS BECAME VESTED AND WERE PAID TO THE FOLLOWING INDIVIDUALS IN CALENDAR YEAR 2019: DANA HAERING $ 61,723 CAMERON D'ALPE $ 33,634 EDWARD KOPETSKY $ 65,511 KIM ROBERTS $ 15,676 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 A DEFERRED COMPENSATION PLAN SPONSORED BY LPCH. 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. 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 2019 THROUGH AUGUST 2020 (FY 2020), PCHA PRIMARILY FOCUSED ON OPERATIONS AND EXISTING PROVIDER VISIT GROWTH, AND ACQUIRED JUST ONE NEW PRACTICE IN JULY 2019, TOWN & COUNTRY. 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 2020 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 10 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 10 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 2019 FOR EACH OF THE LARGEST SERVICES ARE: BAYSIDE: $64,326 PENINSULA PEDIATRICS: $35,627 PEDIATRIC ASSOCIATES: $21,744 DURING FISCAL YEAR 2020 PCHA PROVIDED 251,054 OFFICE VISITS. FAMILY/BUSINESS RELATIONSHIP FORM 990, PART VI, LINE 2 ANDREW SMITH, MARCIA COHEN, WILLIAM KENNEDY, LISA ERBURU, TIM CORNELL, TZIELAN LEE, AND DENNIS LUND ARE EMPLOYEES OF STANFORD SCHOOL OF MEDICINE. 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 FY20 $19,999,679 FORM 990, PART VI, LINE 4 IN MARCH 2020, PCHA AMENDED ITS BYLAWS TO INCREASE THE NUMBER OF DIRECTORS FROM SEVEN TO NINE AND CREATED A NEW LPCH DESIGNATED DIRECTOR WHO IS A PHYSICIAN EMPLOYED BY PACKARD MEDICAL GROUP WHICH IS A PCHA AFFILIATED MEDICAL GROUP. FORM 990 PART IX LINE 11G DESCRIPTION:OTHER MEDICAL SERVICES TOTAL FEES:54642255 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:6956474 FORM 990 PART IX LINE 11G DESCRIPTION:TEMP LABOR - MEDICAL PHYSICIAN TOTAL FEES:1974891 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PROFESSIONAL SERVICES TOTAL FEES:91223 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 HOSPITAL COMMITTEE FOR THE L-P AREAS 1111 E STANLEY BLVD LIVERMORE CA 94550 941429628 HOSPITAL CA 501(C)(3) 3 SHC true LUCILE PACKARD FOUNDATION FOR CHILDREN'S 400 HAMILTON AVENUE SUITE 340 PALO ALTO CA 94301 770440090 HEALTHCARE CA 501(C)(3) 7 LPCH true LUCILE SALTER PACKARD CHILDRENS HOSPITAL 725 WELCH ROAD MC 5553 PALO ALTO CA 94304 770003859 HEALTHCARE CA 501(C)(3) 3 STANFORD true SHR HOLDINGS INC 485 BROADWAY MAILCODE 8838 REDWOOD CITY CA 94063 943187167 REAL ESTATE CA 501(C)(25) N/A STANFORD true STANFORD FACULTY CLUB PO BOX 7229 STANFORD CA 94309 941187089 FAC INTERACT. CA 501(C)(7) N/A STANFORD true STANFORD FEDERAL CREDIT UNION 1860 EMBARCADERO RD PALO ALTO CA 94303 941492212 CREDIT UNION CA 501(C)(1) N/A STANFORD true STANFORD HABITAT CONSERVATION BOARD 415 BROADWAY REDWOOD CITY CA 94063 461882243 CONSERVATION CA 501(C)(3) 7 STANFORD true STANFORD HEALTH CARE 300 PASTEUR DRIVE MC 5555 STANFORD CA 94305 946174066 HEALTHCARE CA 501(C)(3) 3 STANFORD true STANFORD HEALTH CARE ADVANTAGE 1221 BROADWAY 3RD FLOOR OAKLAND CA 94612 464071746 HEALTHCARE CA 501(c)(3) 12A, I SHC true STANFORD PROGRAMME (CAPE TOWN) NPC WAVERLY BUSINESS PARK BLDG 11 CAPE TOWN SF EDUCATION SF 501(C)(3) N/A STANFORD true STANFORD UNIVERSITY BOOKSTORE BLDG 60 MAIN QUAD NO 105 STANFORD CA 94305 940894150 SUPPORT CA 501(C)(3) 12A, I STANFORD 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 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 true THE FREIDENRICH SUPPORT FOUNDATION 485 BROADWAY MAILCODE 8838 REDWOOD CITY CA 94063 300519583 SUPPORT CA 501(C)(3) 12A, I STANFORD true THE HONG KONGSU CHARITABLE TRUST 1401 CAROLINE CENTER 28 PING ROAD CAUSEWAY HK 986078093 SUPPORT HK 501(C)(3) N/A STANFORD true THE STANFORD TRUST 65 HIGH STREET OXFORD UK OX1 46L SUPPORT UK 501(C)(3) N/A STANFORD true UNIVERSITY HEALTHCARE ALLIANCE 7999 GATEWAY BLVD STE 300 NEWARK CA 94560 943192446 HEALTHCARE CA 501(C)(3) 3 SHC true VALLEYCARE MEDICAL FOUNDATION INC 1111 E STANLEY BLVD LIVERMORE CA 94550 262593526 SUPPRT SHC-VC CA 501(C)(3) 10 HOSP CMTE LP true VALLEYCARE SENIOR HOUSING 1111 E STANLEY BLVD LIVERMORE CA 94550 943382224 SR. FACILITY CA 501(C)(3) 12A, I HOSP CMTE LP true 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 89 NEXUS WAY CAMANA BAY GRAND CAYMAN CJ KY1-9009 981267847 INVESTMENTS CJ NA CARLSBAD CO-INVEST LP 40 BEECHWOOD RD SUMMIT NJ 07901 471702425 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 CJ NA 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 CJ NA 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 89 NEXUS WAY CAMANA BAY PO BOX 31 GRAND CAYMAN CJ INVESTMENTS CJ NA KEB INVESTORS II LP WASHINGTON MALL STE 304 7 REID ST HAMILTON BD HM 11 INVESTMENTS BD NA LSF V DHB HOLDINGS LP 2711 N HASKELL AVE 1700 DALLAS TX 75204 272858604 INVESTMENTS DE NA OLIFANT FUND LTD 635 KNIGHT WAY STANFORD CA 94305 980404442 INVESTMENTS CJ NA OUTLAWS CASINO LTD 415 BROADWAY REDWOOD CITY CA 94063 841457498 HOLDING COMPANY CO NA PALO ALTO LP 13 CASTLE STREET ST HELIER JE 981126622 INVESTMENTS JE NA SANDOVAL LP 635 KNIGHT WAY STANFORD CA 94305 371873346 INVESTMENTS DE NA SANDPIPER FUND LP 2000 MCKINNEY AVE STE 2125 DALLAS TX 75201 260341626 INVESTMENT TX NA SAROFIM MULTIFAMILY PARTNERS LP 8115 PRESTON RD 400 DALLAS TX 75225 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. DIAGNOST 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 WINTER ROCK ALTERNATIVE CREDIT MASTER L PO BOX 10008 WILLOW HOUSE CRICKET GRAND CAYMAN CJ KY1-1001 941141686 INVESTMENTS CJ NA WREP III A LP (FKA WOLFF REAL ESTATE 6710 E CAMELBACK RD 100 SCOTTSDALE AZ 85251 474780701 INVESTMENTS DE NA BREP VII AlBERTA FDR (OFFSHORE) TE7 LP 635 KNIGHT WAY STANFORD CA 94305 981066351 INVESTMENTS CA NA C CORP BREP VII AlBERTA FDR (OFFSHORE) TE7-NQ 635 KNIGHT WAY STANFORD CA 94305 981066355 INVESTMENTS CA NA C CORP CANARY SC FUND LTD 89 NEXUS WAY CAYMANA BAY GRAND CAYMAN CJ KY1-9009 981268195 INVESTMENTS CJ NA C CORP CLAT (15) CHARITABLE TR CA NA TRUST CLUT (2) CHARITABLE TR CA NA TRUST CRT (555) CHARITABLE TR CA NA TRUST EAST SAIL C/O INTL FS INC IFS COURT TWENTYEIGHT CYBERCITY EBENE MP INVESTMENTS MP NA C CORP GAVEA INVESTMENT FUND II-C LP PO BOX 896GT HARBOUR CENTRE GEORGE TOWN CJ 980537952 INVESTMENTS CJ NA C CORP HHBG SF Limited 635 KNIGHT WAY STANFORD CA 94305 REAL ESTATE CJ NA C CORP JAEDAN BUPIN STANFORD CENTER IN THE REPU EDUCATION KS NA C CORP KAIZEN FUND 2ND FL MIDTOWN PLAZA PO BOX 448 GRAND CAYMAN CJ KY1-1106 INVESTMENTS CJ NA C CORP LS ALBERTA III LP 1650 TYSON BLVD MCLEAN VA 22102 980493425 INVESTMENTS CA NA C CORP OTHER (5) CHARITABLE TR CA NA TRUST PIF (2) CHARITABLE TR CA NA TRUST PEPPERTREE CAPITAL CAYMAN ISLAND FUND LP 86W ST CHAGRIN FALLS OH 44022 981235268 INVESTMENTS CJ NA C CORP PROFESSIONAL EXCHANGE ASSURANCE COMPANY 201 MERCHANT ST HONOLULU HI 96813 900897686 INSURANCE HI NA C CORP 855375 5918041 0.37830 true SBFF LTD PO BOX 1344 GEORGE TOWN CJ KY1-1108 INVESTMENTS CJ NA C CORP STANFORD (BEIJING) CNSLTNG CO LTD (WFOE) 5275TH FLBLDG CACADEMY SOUTH RD BEIJING CH EDUCATION CH NA C CORP STANFORD IN JAPAN GODO KAISHA DOSHISHA UNIVERSITY MEITOKUKAN-NAI KYOTOSHI JA EDUCATION JA NA C CORP STANFORD INDIA PVT LTD 333 3RD FLOOR DEVIKA TOWER 6 NEH DELHI IN EDUCATION IN NA C CORP STANFORD INTL MEDICAL SERVICES RAK FZE PO BOX 56500 AE PATIENT SRVC AE NA C CORP STANFORD MEDICINE INTL (HONG KONG) CO LT 833 CHEUNG SHA WAN ROAD KOWLOON HK PATIENT SRVC HK NA C CORP STANFORD SGGS EUROPE INC UGLAND HOUSE S CHURCH ST PO BOX 3 GEORGE TOWN CJ 131684331 INVESTMENTS CJ NA C CORP STANFORD UNIV MED NETWORK RISK AUTHORITY 1400 PAGE MILL RD PALO ALTO CA 94304 461132002 RISK MGMT CON CA NA C CORP THE RUBRUM FUND PO BOX 309 UGLAND HOUSE GRAND CAYMAN CJ INVESTMENTS CJ NA C CORP TVC MATSU FUND 635 KNIGHT WAY STANFORD CA 94305 INVESTMENTS CJ NA C CORP VERMILION PEAK FUND 635 KNIGHT WAY STANFORD CA 94305 981333885 INVESTMENTS CJ NA C CORP WINTER ROCK ALTERNATIVE CREDIT I LP PO BOX 10008 WILLOW HOUSE CRICKET GRAND CAYMAN CJ KY1-1001 981140761 INVESTMENTS CJ NA C CORP WOODBOURNE CANADA PARTNERS II - CAYMAN 190 ELGIN AVE GRAND CAYMAN CJ KY1-9005 980705321 INVESTMENTS CJ NA C CORP false false true false false false false false false false false false false false true false false false true 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. SCHEDULE R, PART IV, LINE 1 POOLED INVESTMENT FUNDS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.