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PACKARD CHILDRENS HEALTH ALLIANCE: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
PACKARD CHILDRENS HEALTH ALLIANCE (EIN 32-0359189)
Tax period
2018-09-01 to 2019-08-31
Filed
2020-07-15
IRS object ID
202011979349303226
Schema version
2018v3.3
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2020-07-15T11:07:26-05:00ReturnTs
Tax Period End2019-08-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PricewaterhouseCoopers LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1101 SEAPORT BLVD SUITE 500AddressLine1Txt
CityBOSTONCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02210ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-09-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN320359189EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PACKARD CHILDREN'S HEALTH ALLIANCEBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% CAMERON D'ALPE FINANCE DEPTInCareOfNm
Business Name ControlPACKBusinessNameControlTxt
Phone6504978000PhoneNum

US Address USAddress

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

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDANA HAERINGPersonNm
Person TitleCFOPersonTitleTxt
Phone6507212222PhoneNum
Signature2020-07-08SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonGWEN SPENCERPreparerPersonNm
PTINP00641463PTIN
Phone6175305000PhoneNum
Preparation2020-07-08PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address155.201.42.76IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id04363820201975000061FederalOriginalSubmissionId
Federal Original Submission Id2020-07-15FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id0EBABC6EBE59E07D7A0B0201016F629EF3516635AtSubmissionCreationDeviceId
At Submission Filing Device IdD9F86E75EFDAFE7C85A38040228A3F35A3BFA220AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCAMERON D'ALPEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1725 WELCH ROAD MC 5551AddressLine1Txt
CityPALO ALTOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94304ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$108,444,792GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.STANFORDCHILDRENS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionSEE SCHEDULE OActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee391TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$98,604,230PYProgramServiceRevenueAmt
CY Program Service Revenue$108,444,792CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$98,604,230PYTotalRevenueAmt
CY Total Revenue$108,444,792CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$27,551,117PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$32,053,884CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$78,966,722PYOtherExpensesAmt
CY Other Expenses$90,778,836CYOtherExpensesAmt
PY Total Expenses$106,517,839PYTotalExpensesAmt
CY Total Expenses$122,832,720CYTotalExpensesAmt
PY Revenues Less Expenses-$7,913,609PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$14,387,928CYRevenuesLessExpensesAmt
Total Assets BOY$29,253,236TotalAssetsBOYAmt
Total Assets EOY$27,033,337TotalAssetsEOYAmt
Total Liabilities BOY$21,576,315TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,750,444TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,676,921NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,282,893NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE OMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$108,123,072ExpenseAmt
Revenue$108,444,792RevenueAmt
DescSEE SCHEDULE ODesc
Total Program Service Expenses$108,123,072TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document63IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee391EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCAMERON D'ALPE FINANCE DEPTPersonNm
Phone6507235636PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
John Walker
DIRECTOR/CHAIR1.03.0Yes (X)Yes (X)$0$0$0
William Kennedy MD
DIRECTOR1.050.0Yes (X)$0$476,766$43,213
Dennis P Lund MD
DIRECTOR, VICE CHAIR1.052.0Yes (X)Yes (X)$0$1,242,885$61,256
Andrew Smith
MEDICAL DIRECTOR50.00.0Yes (X)Yes (X)$394,435$0$19,216
Cameron D'Alpe
CEO17.033.0Yes (X)Yes (X)$0$464,073$95,412
Malinda Mitchell
DIRECTOR1.00.0Yes (X)$0$0$0
MARCIA COHEN
DIRECTOR1.01.0Yes (X)$0$648,145$53,670
Dana Haering
VP & CFO3.047.0Yes (X)$0$701,413$117,163
Malavika Narayan
DIR OF PHYSICIAN NETWORK FIN.50.00.0$0$234,623$37,005Yes (X)
Rick Vance
COO50.00.0$339,278$0$13,144Yes (X)
Michael Lipman
PROVIDER RECRUIT. AND DEV. DIR50.00.0$236,727$0$9,993Yes (X)
Dorothy Naidu
DIRECTOR, CLINICAL QUALITY50.00.0$181,467$0$8,557Yes (X)
Susan Ault
PRACTICE ADMINISTRATOR50.00.0$162,928$0$6,445Yes (X)
Gaguik Khachatourian
OPERATIONS EXEC (AS OF 4/18)50.00.0$187,727$0$5,599Yes (X)
TIKA MARTIN
DIRECTOR, HUMAN RESOURCES50.00.0$242,076$0$18,080Yes (X)
Kim Roberts
CHIEF STRAt. off. (until 6/18)17.033.0$0$721,968$71,880Yes (X)
Kenneth Cox
PROFESSOR MED CTR LINE50.00.0$0$181,691$2,170Yes (X)
Edward Kopetsky
VP & CIO1.050.0$0$665,747$80,914Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,744,638TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,337,311TotReportableCompRltdOrgAmt
Total Other Compensation$643,717TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K29IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PACKARD MEDICAL GROUP INC
725 WELCH ROAD MC 5551PALO ALTOCA94304PHYSICIAN SERVICES$43,449,478
G AND G ORGANIZATION LTD DBA PFS GR
2600 NORTH LOOP WEST STE 150HOUSTONTX77092SERVICE$1,956,008
CAREMARK LLC
PO BOX 848001DALLASTX75284SERVICE$898,374
Adecco Employment Services
DEPARTMENT LA 21403PASADENACA911851403EMPLOYMENT SERVICE$677,840
THE CORE GROUP
890 N MCCARTHY BLVD SUITE 100MILPITASCA95035PURCHASE SERVICES$233,845
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K36CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICES900099$96,966,640$96,966,640
PROGRAM SUPPORT900099$11,048,236$11,048,236
OTHER INCOME - RISK POOL900099$429,916$429,916
FieldValueIRS element (for citing)
Total Program Service Revenue$108,444,792TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

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

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

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

Royalties Revenue RoyaltiesRevenueGrp

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

Rental Income Or Loss RentalIncomeOrLossGrp

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

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

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

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

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

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

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

Net Income From Gaming NetIncomeFromGamingGrp

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

Net Income Or Loss NetIncomeOrLossGrp

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

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$108,444,792TotalRevenueColumnAmt
Related Or Exempt Func Income$108,444,792RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,010,255TotalAmt
Program Services$743,906ProgramServicesAmt
Management And General$266,349ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$17,577,744TotalAmt
Program Services$14,291,248ProgramServicesAmt
Management And General$3,286,496ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$736,323TotalAmt
Program Services$344,374ProgramServicesAmt
Management And General$391,949ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$11,113,001TotalAmt
Program Services$9,152,323ProgramServicesAmt
Management And General$1,960,678ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,616,561TotalAmt
Program Services$1,363,399ProgramServicesAmt
Management And General$253,162ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$333,052TotalAmt
Program Services$238,634ProgramServicesAmt
Management And General$94,418ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$284,381TotalAmt
Management And General$284,381ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$45,176TotalAmt
Management And General$45,176ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$61,250,633TotalAmt
Program Services$57,816,090ProgramServicesAmt
Management And General$3,434,543ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$109,907TotalAmt
Program Services$49,194ProgramServicesAmt
Management And General$60,713ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$13,183,874TotalAmt
Program Services$12,124,153ProgramServicesAmt
Management And General$1,059,721ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,742,106TotalAmt
Program Services$3,742,106ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$5,974,593TotalAmt
Program Services$5,887,480ProgramServicesAmt
Management And General$87,113ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$59,910TotalAmt
Program Services$24,353ProgramServicesAmt
Management And General$35,557ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,069,656TotalAmt
Program Services$1,816,030ProgramServicesAmt
Management And General$3,253,626ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$311,898TotalAmt
Management And General$311,898ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
UNCOLLECTIBLES$1,096,688$1,096,688$0$0
DUES & SUBSCRIPTIONS$349,511$227,598$121,913$0
UTILITIES$114,223$110,174$4,049$0
LICENSES & TAXES$63,022$20,110$42,912$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total-$1,209,794TotalAmt
Program Services-$924,788ProgramServicesAmt
Management And General-$285,006ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$122,832,720TotalAmt
Program Services$108,123,072ProgramServicesAmt
Management And General$14,709,648ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

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

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY-$713,981BOYAmt
EOY$101,918EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

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

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$9,094,558BOYAmt
EOY$9,740,723EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

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

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

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

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

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

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$770,946BOYAmt
EOY$689,779EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$19,559,060LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$14,421,612LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$6,664,599BOYAmt
EOY$5,137,448EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

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

Investments Other Securities InvestmentsOtherSecuritiesGrp

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

Investments Program Related InvestmentsProgramRelatedGrp

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

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$11,474,686BOYAmt
EOY$8,962,302EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,962,428BOYAmt
EOY$2,401,167EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$29,253,236BOYAmt
EOY$27,033,337EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,086,839BOYAmt
EOY$4,895,876EOYAmt

Grants Payable GrantsPayableGrp

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

Deferred Revenue DeferredRevenueGrp

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

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

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

Escrow Account Liability EscrowAccountLiabilityGrp

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

Loans From Officers Directors LoansFromOfficersDirectorsGrp

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

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

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

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

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

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,489,476BOYAmt
EOY$13,854,568EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$21,576,315BOYAmt
EOY$18,750,444EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,676,921BOYAmt
EOY$8,282,893EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

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

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

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

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,676,921BOYAmt
EOY$8,282,893EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$29,253,236BOYAmt
EOY$27,033,337EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$14,387,928ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$14,993,900OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

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

Schedule D IRS990ScheduleD

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

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,721,766OtherCostOrOtherBasisAmt
Depreciation$4,307,837DepreciationAmt
Book Value$1,413,929BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,620,718OtherCostOrOtherBasisAmt
Depreciation$10,113,775DepreciationAmt
Book Value$1,506,943BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,216,576OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$2,216,576BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$5,137,448TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
OTHER ASSETS$2,340,598
SECURITY DEPOSITS$60,569
FieldValueIRS element (for citing)
Total Book Value Other Assets$2,401,167TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO RELATED PARTIES, NETDesc
Amt$13,854,568Amt
FieldValueIRS element (for citing)
Total Liability$13,854,568TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

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

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
William Kennedy MD
DIRECTOR$0$375,387$0$87,810$0$13,569$0$27,165$0$16,048$0$519,979$0$0
Dennis P Lund MD
DIRECTOR, VICE CHAIR$0$394,948$0$820,769$0$27,168$0$19,967$0$41,289$0$1,304,141$0$0
Andrew Smith
MEDICAL DIRECTOR$346,184$0$48,251$0$0$0$10,600$0$8,616$0$413,651$0$0$0
Dana Haering
VP & CFO$0$553,586$0$30,000$0$117,827$0$102,566$0$14,597$0$818,576$0$54,671
Cameron D'Alpe
CEO$0$360,355$0$30,000$0$73,718$0$76,798$0$18,614$0$559,485$0$24,669
Michael Lipman
PROVIDER RECRUIT. AND DEV. DIR$220,868$0$15,859$0$0$0$9,429$0$564$0$246,720$0$0$0
Dorothy Naidu
DIRECTOR, CLINICAL QUALITY$175,352$0$6,115$0$0$0$7,309$0$1,248$0$190,024$0$0$0
Susan Ault
PRACTICE ADMINISTRATOR$156,791$0$6,137$0$0$0$4,933$0$1,512$0$169,373$0$0$0
Gaguik Khachatourian
OPERATIONS EXEC (AS OF 4/18)$187,727$0$0$0$0$0$4,791$0$808$0$193,326$0$0$0
Malavika Narayan
DIR OF PHYSICIAN NETWORK FIN.$0$219,623$0$15,000$0$0$0$24,525$0$12,480$0$271,628$0$0
Rick Vance
COO$304,659$0$34,619$0$0$0$10,600$0$2,544$0$352,422$0$0$0
Kim Roberts
CHIEF STRAt. off. (until 6/18)$0$564,739$0$80,000$0$77,229$0$56,419$0$15,461$0$793,848$0$0
Kenneth Cox
PROFESSOR MED CTR LINE$0$12,782$0$166,396$0$2,513$0$1,280$0$890$0$183,861$0$0
Edward Kopetsky
VP & CIO$0$525,566$0$77,000$0$63,181$0$45,643$0$35,271$0$746,661$0$0
TIKA MARTIN
DIRECTOR, HUMAN RESOURCES$227,789$0$14,287$0$0$0$6,324$0$11,756$0$260,156$0$0$0
MARCIA COHEN
DIRECTOR$0$544,807$0$102,858$0$480$0$27,500$0$26,170$0$701,815$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PROCEDURES FOR DETERMINING COMPENSATIONSCHEDULE 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 PLANSCHEDULE 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 2018: DANA HAERING $ 55,413 KIM ROBERTS $ 55,485 EDWARD KOPETSKY $ 63,181 CAMERON D'ALPE $ 25,007 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 7CERTAIN 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.
SCHEDULE J, PART II, DESCRIPTION FOR COLUMN B (III)OTHER REPORTABLE COMPENSATION IN SCHEDULE J, COLUMN B-III INCLUDES SERP CASH DISTRIBUTION, ACCRUED VACATION PAY OUT, AND GROUP TERM LIFE. IN ADDITION, PCHA HAS PROVIDED VARIOUS ITEMS OF LISTED PROPERTY (I.E. COMPUTERS AND PERIPHERALS) TO THE ABOVE LISTED EMPLOYEES PRINCIPALLY FOR THEIR BUSINESS USE.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
ORGANIZATION'S PRIMARY EXEMPT PURPOSEFORM 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 DESCRIPTIONFORM 990, PART III, LINE 4A DURING THE PERIOD OF SEPTEMBER 2018 THROUGH AUGUST 2019 (FY 2019), 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 2019 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 11 PEDIATRIC AND FAMILY PRACTICE OFFICES, WITH A DEDICATED TEAM OF PEDIATRICIANS AND FAMILY PRACTITIONERS 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 SEVEN 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: $80,212 PENINSULA PEDIATRICS: $38,266 PEDIATRIC ASSOCIATES: $27,000 DURING FISCAL YEAR 2019 PCHA PROVIDED 281,728 OFFICE VISITS.
FAMILY/BUSINESS RELATIONSHIPFORM 990, PART VI, LINE 2 ANDREW SMITH, MARCIA COHEN, WILLIAM KENNEDY, AND DENNIS LUND ARE EMPLOYEES OF STANFORD SCHOOL OF MEDICINE.
MEMBERSFORM 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 7ASTANFORD UNIVERSITY AND LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD, AS THE MEMBERS OF PCHA, APPOINT THE PCHA BOARD OF DIRECTORS. TWO OF THE DIRECTORS MUST BE PERSONS WHO RESIDE IN THE COMMUNITIES SERVED BY PCHA AND WHO ARE NOT COMPENSATED BY PCHA, THE MEMBERS, OR ANY MEDICAL GROUP AFFILIATED WITH PCHA.
FORM 990, PART VI, LINE 7BTHE FOLLOWING ACTIONS MUST BE APPROVED BY ONE OR MORE MEMBERS: - ENTERING INTO PROFESSIONAL SERVICE AGREEMENTS WITH NEW MEDICAL GROUPS - ACQUISITION, MERGER, OR CONSOLIDATION OF ANY OTHER ENTITY
PROCEDURES FOR REVIEWING FORM 990 FROM GOVERNING BODYFORM 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 COMPLIANCEWITH 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 COMPENSATIONFORM 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 19THE STATEMENTS OF OPERATIONS AND BALANCE SHEET ARE INCLUDED IN THE ANNUAL REPORT POSTED ON THE ORGANIZATION'S PUBLIC WEBSITE. COPIES OF THE FINANCIAL STATEMENTS ARE GENERALLY NOT AVAILABLE FOR PUBLIC INSPECTION BUT REQUESTS WILL BE EVALUATED ON A CASE-BY-CASE BASIS. COPIES OF THE GOVERNING DOCUMENTS ARE GENERALLY NOT AVAILABLE FOR PUBLIC INSPECTION BUT REQUESTS WILL BE EVALUATED ON A CASE-BY-CASE BASIS. THE CONFLICT OF INTEREST POLICY IS NOT CURRENTLY AVAILABLE FOR PUBLIC INSPECTION.
RECONCILIATIONFORM 990, PART XI, LINE 9 EQUITY TRANSFERS TO PCHA FROM LPCH IN FY19 $ 14,993,900
FORM 990 PART IX LINE 11GDESCRIPTION:TEMP LABOR - MEDICAL PHYSICIAN TOTAL FEES:1754269
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER PROFESSIONAL SERVICE TOTAL FEES:91310
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:5804487
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER MEDICAL SERVICES TOTAL FEES:53600567

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (20 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCdForeign PostalForeignAddress/ForeignPostalCd
THE BRD OF TRUST LELAND STANF JR UNIV
485 BROADWAY MAIL CODE 8838REDWOOD CITYCA94063941156365EDUCATIONCA501(C)(3)2NAfalse
HOSPITAL COMMITTEE FOR THE L-P AREAS
1111 E STANLEY BLVDLIVERMORECA94550941429628HOSPITALCA501(C)(3)3SHCYes (true)
LUCILE PACKARD FOUNDATION FOR CHILDREN'S
400 HAMILTON AVENUE SUITE 340PALO ALTOCA94301770440090HEALTHCARECA501(C)(3)7LPCHYes (true)
LUCILE SALTER PACKARD CHILDRENS HOSPITAL
725 WELCH ROAD MC 5553PALO ALTOCA94304770003859HEALTHCARECA501(C)(3)3STANFORDYes (true)
SHR HOLDINGS INC
485 BROADWAY MAILCODE 8838REDWOOD CITYCA94063943187167REAL ESTATECA501(C)(25)N/ASTANFORDYes (true)
STANFORD FACULTY CLUB
PO BOX 7229STANFORDCA94309941187089FAC INTERACT.CA501(C)(7)N/ASTANFORDYes (true)
STANFORD FEDERAL CREDIT UNION
1860 EMBARCADERO RDPALO ALTOCA94303941492212CREDIT UNIONCA501(C)(1)N/ASTANFORDYes (true)
STANFORD HABITAT CONSERVATION BOARD
415 BROADWAYREDWOOD CITYCA94063461882243CONSERVATIONCA501(C)(3)7STANFORDYes (true)
STANFORD HEALTH CARE
300 PASTEUR DRIVE MC 5555STANFORDCA94305946174066HEALTHCARECA501(C)(3)3STANFORDYes (true)
STANFORD HEALTH CARE ADVANTAGE
1221 BROADWAY 3RD FLOOROAKLANDCA94612464071746HEALTHCARECA501(c)(3)12A, ISHCYes (true)
STANFORD PROGRAMME (CAPE TOWN) NPC
EDUCATION501(C)(3)N/ASTANFORDYes (true)WAVERLY BUSINESS PARK BLDG 11CAPE TOWNSFSF
STANFORD UNIVERSITY BOOKSTORE
BLDG 60 MAIN QUAD NO 105STANFORDCA94305940894150SUPPORTCA501(C)(3)12A, ISTANFORDYes (true)
SU EMP BEN TRUST POST RETEMPYNT BEN
485 BROADWAY MAILCODE 8838REDWOOD CITYCA94063943246199BENEFITSCA501(C)(9)N/ASTANFORDYes (true)
THE DUDLEY E CHAMBERS FOUNDATION
JP MORGAN CHASE PO BOX 3038MILWAUKEEWI53201386841793SUPPORTNY501(C)(3)12D, III-OSTANFORDYes (true)
THE FREIDENRICH SUPPORT FOUNDATION
485 BROADWAY MAILCODE 8838REDWOOD CITYCA94063300519583SUPPORTCA501(C)(3)12A, ISTANFORDYes (true)
THE HONG KONGSU CHARITABLE TRUST
986078093SUPPORT501(C)(3)N/ASTANFORDYes (true)1401 CAROLINE CENTER 28 PING ROADCAUSEWAYHKHK
THE STANFORD TRUST
SUPPORT501(C)(3)N/ASTANFORDYes (true)65 HIGH STREETOXFORDUKUKOX1 46L
UNIVERSITY HEALTHCARE ALLIANCE
7999 GATEWAY BLVD STE 300NEWARKCA94560943192446HEALTHCARECA501(C)(3)3SHCYes (true)
VALLEYCARE MEDICAL FOUNDATION INC
5655 W LAS POSITAS BLVD 220PLEASANTONCA94588262593526SUPPRT SHC-VCCA501(C)(3)10HOSP CMTE LPYes (true)
VALLEYCARE SENIOR HOUSING
1111 E STANLEY BLVDLIVERMORECA94550943382224SR. FACILITYCA501(C)(3)12A, IHOSP CMTE LPYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (40 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
ADOM PARTNERS LP
590 MADISON AVENUE 27TH FLOORNEW YORKNY10022813083288INVESTMENTSDENA
ALBUS SELECT FUND LP
750 MENLO AVENUEMENLO PARKCA94025812064357INVESTMENTSDENA
ARCOLA VENTURE LLC
635 KNIGHT WAYSTANFORDCA94305371689632RE DEVELOPMENTDENA
CANARY SC FUND LP
399 PARK AVENUENEW YORKNY10022475662144INVESTMENTSDENA
CANARY SC MASTER FUND LP
981267847INVESTMENTSNA89 NEXUS WAY CAMANA BAYGRAND CAYMANCAKY1-9009CJ
CARLSBAD CO-INVEST LP
51 JOHN F KENNEDY PARKWAY SUITE 2SHORT HILLSNJ07078471702425INVESTMENTSDENA
CEE EQUITY HOLDINGS LP
INVESTMENTSNAJTC HOUSE 28 ESPLANADEST HELIER JERSEYJEJE4 2QPJE
CLAIRVUE CAPITAL PARTNERS II-TE 1 LP
TWO EMBARCADERO CENTER SUITE 480SAN FRANCISCOCA94111800909516INVESTMENTSDENA
CLAIRVUE CAPITAL PARTNERS II-TE 2 LP
TWO EMBARCADERO CENTER SUITE 480SAN FRANCISCOCA94111800909556INVESTMENTSDENA
CYPRESS MARINA HEIGHTS LLC
635 KNIGHT WAYSTANFORDCA94305954887979INVESTMENTSCANA
DGD INVESTMENT LP
635 KNIGHT WAYSTANFORDCA943057297INVESTMENTSNACJ
ER-S JV LLC
635 KNIGHT WAYSTANFORDCA943057297INVESTMENTSDENA
ER-S REIT LLC
635 KNIGHT WAYSTANFORDCA943057297INVESTMENTSDENA
ER-S INVESTOR LLC
635 KNIGHT WAYSTANFORDCA943057297INVESTMENTSDENA
EZP OPPORTUNITY LP
635 KNIGHT WAYSTANFORDCA943057297814562962INVESTMENTSDENA
FORTRESS IW COINVESTMENT (FUND B) LP
1345 AVE OF THE AMERICAS 45TH FLNEW YORKNY10105980509639INVESTMENTSNACJ
FOUR CROSSINGS INSTITUTIONAL PARTNERS V
ONE MARITIME PLAZA SUITE 200SAN FRANCISCOCA94111814323705INVESTMENTSDENA
FOXLANE LP
410 E WATER STREET SUITE 888CHARLOTTESVILLEVA22902813314647INVESTMENTSDENA
HHBG-II INVESTMENT LP
INVESTMENTSNA89 NEXUS WAY CAMANA BAY PO BOX 31GRAND CAYMANCAKY1-9009CJ
KEB INVESTORS II LP
INVESTMENTSNAWASHINGTON MALL STE 304 7 REID STHAMILTONBDHM 11BD
LSF V DHB HOLDINGS LP
2711 N HASKELL AVE STE 1700DALLASTX75204272858604INVESTMENTSDENA
OLIFANT FUND LTD
635 KNIGHT WAYSTANFORDCA94305INVESTMENTSNACJ
OUTLAWS CASINO LTD
415 BROADWAYREDWOOD CITYCA94063841457498HOLDING COMPANYCONA
PALO ALTO LP
981126622INVESTMENTSNA13 CASTLE STREETST HELIER JERSEYJEJE
SANDOVAL LP
635 KNIGHT WAYSTANFORDCA943057297371873346INVESTMENTSDENA
SANDPIPER FUND LP
2000 MCKINNEY AVE STE 2125DALLASTX75201260341626INVESTMENTSTXNA
SAROFIM MULTIFAMILY PARTNERS LP
8115 PRESTON RD ST400DALLASTX75225201929002RE DEVELOPMENTTXNA
SCP REAL ASSETS FUND (A) LP
2498 SAND HILL RDMENLO PARKCA94025203949682INVESTMENTSDENA
SEQUOIA MFM OPERATING COMPANY LLC
770 WELCH ROAD LPCH- ADMIN MC5551PALO ALTOCA94304475060529MFM PROGRAMCANA
SIC SNOWCREEK VIII LLC
635 KNIGHT WAYSTANFORDCA94305275431605RE DEVELOPMENTCANA
SP SMC PARTNERS LLC
PO BOX 5377NEW YORKNY10185473103791INVESTMENTSDENA
STANFORD EMANUEL RADIATION ONCOLOGY CENT
825 DELBON AVTURLOCKCA95382208885091RADIOLOGYCANA
STANFORD PET-CT LLC
300 PASTEUR DR MC 5555STANFORDCA94305611423414MED. DIAGNOSTCANA
STANFORD-STARTX FUND LLC
485 BROADWAY MAILCODE 8838REDWOOD CITYCA94063464297719INVESTMENTSDENA
SUMIT HOLDING INTERNATIONAL LLC
1400 PAGE MILL ROAD MC5713PALO ALTOCA94304263934706HOLDING COMPANYDENA
TESSERA IONIC LP
635 KNIGHT WAYSTANFORDCA943057297INVESTMENTSDENA
VEDA INVESTORS FUND LP
ONE FAWCETT PLGREENWICHCT06830811810345INVESTMETNSDENA
VERMILION PEAK MASTER FUND
635 KNIGHT WAYSTANFORDCA943057297INVESTMENTSDENA
WINTER ROCK ALTERNATIVE CREDIT MASTER L
941141686INVESTMENTSNAPO BOX 10008 WILLOW HOUSE CRICKETGRAND CAYMANCJKY1-1001CJ
WREP III A LP
6710 E CAMELBACK ROAD SUITE 100SCOTTSDALEAZ85251474780701INVESTMENTSDENA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (30 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCdShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
BREP VII ALBERTA FDR (OFFSHORE) TE7 LP
635 KNIGHT WAYSTANFORDCA94305981066351INVESTMENTSCANAC CORP
BREP VII ALBERTA FDR (OFFSHORE) TE7-NQ
635 KNIGHT WAYSTANFORDCA94305981066355INVESTMENTSCANAC CORP
CANARY SC FUND LTD
981268195INVESTMENTSNAC CORP89 NEXUS WAY CAYMANA BAYGRAND CAYMANCJKY1-9009CJ
CLAT (16)
CHARITABLE TRCANATRUST
CLUT (2)
CHARITABLE TRCANATRUST
CRT (554)
CHARITABLE TRCANATRUST
EAST SAIL
INVESTMENTSNAC CORPC/O INTL FS INC IFS COURTTWENTYEIGHT CYBERCITY EBENEMPMP
GAVEA INVESTMENT FUND II-C LP
980537952INVESTMENTSNAC CORPPO BOX 896GT HARBOUR CENTREGEORGE TOWNCJCJ
HHBG SF LIMITED
635 KNIGHT WAYSTANFORDCA94305REAL ESTATENAC CORPCJ
KAIZEN FUND
INVESTMENTSNAC CORP2ND FL MIDTOWN PLAZA PO BOX 448GRAND CAYMANCJKY1-1106CJ
LS ALBERTA III LP
C/O JE ROBERT COS 1650 TYSON BLVDMCLEANVA22102980493425INVESTMENTSCANAC CORP
OTHER (5)
CHARITABLE TRCANATRUST
PIF (2)
CHARITABLE TRCANATRUST
PEPPERTREE CAPITAL CAYMAN ISLAND FUND LP
86 West StreetChagrin FallsOH44022981235268INVESTMENTSNAC CORPCJ
PROFESSIONAL EXCHANGE ASSURANCE COMPANY
201 MERCHANT STREET SUITE 2400HONOLULUHI96813900897686INSURANCEHINAC CORP$5,123,788$967,5290.33730Yes (true)
SBFF LTD
INVESTMENTSNAC CORPPO BOX 1344GEORGE TOWNCJKY1-1108CJ
SEA SMOKE FUND LLC
INVESTMENTSDENAC CORP190 ELGIN AVENUEGEORGE TOWNCJKY 9005
SEA SMOKE FUND LTD
635 KNIGHT WAYSTANFORDCA943057297INVESTMENTSNAC CORPCJ
STANFORD (BEIJING) CNSLTNG CO LTD (WFOE)
EDUCATIONNAC CORP5275TH FLBLDG CACADEMY SOUTH RDBEIJINGCHCH
STANFORD IN JAPAN GODO KAISHA
EDUCATIONNAC CORPDOSHISHA UNIVERSITY MEITOKUKAN-NAIKYOTOSHIJAJA
STANFORD INDIA PVT LTD
EDUCATIONNAC CORP333 3RD FLOOR DEVIKA TOWER 6 NEHDELHIININ
STANFORD INTL MEDICAL SERVICES RAK FZE
PATIENT SRVCNAC CORPPO BOX 56500AEAE
STANFORD MEDICINE INTL (HONG KONG) CO LT
PATIENT SRVCNAC CORP833 CHEUNG SHA WAN ROADKOWLOONHKHK
STANFORD SGGS EUROPE INC
131684331INVESTMENTSNAC CORPUGLAND HOUSE S CHURCH ST PO BOX 3GEORGE TOWNCJCJ
STANFORD UNIV MED NETWORK RISK AUTHORITY
1400 PAGE MILL RD MSC 5713PALO ALTOCA94304461132002RISK MGMT CONCANAC CORP
STRUCTURED SERVICING HOLDINGS (OFFSHORE)
INVESTMENTSNAC CORP87 MARY STREETGEORGE TOWNCJKY1-9002CJ
THE RUBRUM FUND
INVESTMENTSNAC CORPPO BOX 309 UGLAND HOUSEGRAND CAYMANCJCJ
VERMILION PEAK FUND
635 KNIGHT WAYSTANFORDCA943057297981333885INVESTMENTSNAC CORPCJ
WINTER ROCK ALTERNATIVE CREDIT I LP
981140761INVESTMENTSNAC CORPPO BOX 10008 WILLOW HOUSE CRICKETGRAND CAYMANCJKY1-1001CJ
WOODBOURNE CANADA PARTNERS II - CAYMAN
980705321INVESTMENTSNAC CORP190 ELGIN AVENUEGRAND CAYMANCJKY1-9005CJ
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail (4 entries)

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