PACKARD CHILDRENS HEALTH ALLIANCE: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- PACKARD CHILDRENS HEALTH ALLIANCE (EIN 32-0359189)
- Tax period
- 2015-09-01 to 2016-08-31
- Filed
- 2017-07-17
- IRS object ID
- 201701989349301835
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-07-17T16:21:56-05:00 | ReturnTs |
| Tax Period End | 2016-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PricewaterhouseCoopers LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 SEAPORT BOULEVARD | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320359189 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACKARD CHILDREN'S HEALTH ALLIANCE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % KIM ROBERTS FINANCE DEPT | InCareOfNm |
| Business Name Control | PACK | BusinessNameControlTxt |
| Phone | 6504978000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 WELCH ROAD MC 5551 | AddressLine1Txt |
| City | PALO ALTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94304 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREG HOGUE | PersonNm |
| Person Title | CONTROLLER | PersonTitleTxt |
| Phone | 6507212222 | PhoneNum |
| Signature | 2017-07-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | GWEN SPENCER | PreparerPersonNm |
| PTIN | P00641463 | PTIN |
| Phone | 6175305000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KIM ROBERTS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 WELCH ROAD MC 5551 | AddressLine1Txt |
| City | PALO ALTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94304 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $81,855,201 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PCHA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 341 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $71,682,237 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $81,855,201 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $71,682,237 | PYTotalRevenueAmt |
| CY Total Revenue | $81,855,201 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,991,883 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $23,102,959 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $64,114,095 | PYOtherExpensesAmt |
| CY Other Expenses | $68,168,725 | CYOtherExpensesAmt |
| PY Total Expenses | $83,105,978 | PYTotalExpensesAmt |
| CY Total Expenses | $91,271,684 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$11,423,741 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$9,416,483 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $27,470,485 | TotalAssetsBOYAmt |
| Total Assets EOY | $30,517,724 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,605,453 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $22,917,480 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,865,032 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,600,244 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $83,571,354 | ExpenseAmt |
| Revenue | $81,855,201 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $83,571,354 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 75 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 341 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KIM ROBERTS FINANCE DEPT | PersonNm |
| Phone | 6507212222 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 WELCH ROAD MC 5551 | AddressLine1Txt |
| City | PALO ALTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94304 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| MARCIA COHEN | |||||||||
| DIRECTOR/CHAIR | 1.0 | 50.0 | Yes (X) | Yes (X) | $0 | $546,604 | $75,066 | ||
| WILLIAM KENNEDY MD | |||||||||
| DIRECTOR | 1.0 | 50.0 | Yes (X) | $0 | $421,908 | $39,034 | |||
| KIM ROBERTS | |||||||||
| CEO | 25.0 | 25.0 | Yes (X) | Yes (X) | $0 | $669,258 | $133,667 | ||
| JACOB CHACKO | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| JOHN WALKER | |||||||||
| DIRECTOR/VICE CHAIR | 1.0 | 3.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DENNIS P LUND MD | |||||||||
| DIRECTOR | 1.0 | 50.0 | Yes (X) | $0 | $793,402 | $51,138 | |||
| ANDREW SMITH | |||||||||
| MEDICAL DIRECTOR | 50.0 | 0.0 | Yes (X) | Yes (X) | $359,843 | $0 | $33,018 | ||
| DANA HAERING | |||||||||
| CFO | 2.0 | 50.0 | Yes (X) | $0 | $532,041 | $80,411 | |||
| MALAVIKA NARAYAN | |||||||||
| SR DIR FINANCE | 50.0 | 0.0 | $0 | $185,012 | $28,415 | Yes (X) | |||
| RICK VANCE | |||||||||
| COO | 50.0 | 0.0 | $297,442 | $0 | $28,714 | Yes (X) | |||
| EDWARD KOPETSKY | |||||||||
| VP & CIO | 1.0 | 50.0 | $0 | $853,966 | $67,389 | Yes (X) | |||
| MARGARET JOHNSON | |||||||||
| SR DIR FINANCE (UNTIL 8/16/15) | 12.0 | 38.0 | $0 | $204,723 | $40,603 | Yes (X) | |||
| CARLOTTA GABARD | |||||||||
| PRACTICE ADMINISTRATOR | 50.0 | 0.0 | $224,274 | $0 | $25,968 | Yes (X) | |||
| TIKA MARTIN | |||||||||
| DIRECTOR, HUMAN RESOURCES | 50.0 | 0.0 | $222,758 | $0 | $25,875 | Yes (X) | |||
| MICHAEL LIPMAN | |||||||||
| PROVIDER RECRUIT. AND DEV. DIR | 50.0 | 0.0 | $212,848 | $0 | $25,329 | Yes (X) | |||
| DOROTHY NAIDU | |||||||||
| DIRECTOR, CLINICAL QUALITY | 50.0 | 0.0 | $169,130 | $0 | $17,893 | Yes (X) | |||
| AUBYN REDMOND | |||||||||
| DIRECTOR, PRACTICE OPERATIONS | 50.0 | 0.0 | $159,424 | $0 | $9,084 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,645,719 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,206,914 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $681,604 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PACKARD MEDICAL GROUP INC | |||||
| 725 WELCH ROAD MC 5551 | PALO ALTO | CA | 94304 | PHYSICIAN SERVICES | $39,268,596 |
| ADP INC | |||||
| PO Box 31001-1874 | PASADENA | CA | 91110 | Payroll & Benefits | $3,230,002 |
| G AND G ORGANIZATION LTD DBA PFS GR | |||||
| 2600 NORTH LOOP WEST STE 150 | HOUSTON | TX | 77092 | PAYROLL SERVICES | $1,309,209 |
| ADECCO EMPLOYMENT SERVICES | |||||
| Department LA 21403 | PASADENA | CA | 91185 | Payroll & Benefits | $1,264,410 |
| DOME CONSTRUCTION | |||||
| 393 E GRAND AVE | S SAN FRANCISCO | CA | 94080 | CONSTRUCTION | $872,610 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 44 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 900099 | $71,689,557 | $71,689,557 |
| PROGRAM SUPPORT | 900099 | $10,243,190 | $10,243,190 |
| OTHER INCOME - RISK POOL | 900099 | -$77,546 | -$77,546 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $81,855,201 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $81,855,201 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $81,855,201 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $689,753 | TotalAmt |
| Program Services | $516,733 | ProgramServicesAmt |
| Management And General | $173,020 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,252,429 | TotalAmt |
| Program Services | $12,594,152 | ProgramServicesAmt |
| Management And General | $1,658,277 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $682,381 | TotalAmt |
| Program Services | $628,868 | ProgramServicesAmt |
| Management And General | $53,513 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,141,202 | TotalAmt |
| Program Services | $5,174,861 | ProgramServicesAmt |
| Management And General | $966,341 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,337,194 | TotalAmt |
| Program Services | $1,204,960 | ProgramServicesAmt |
| Management And General | $132,234 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,225,076 | TotalAmt |
| Program Services | $627,522 | ProgramServicesAmt |
| Management And General | $597,554 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,115 | TotalAmt |
| Management And General | $39,115 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,877,904 | TotalAmt |
| Program Services | $45,478,859 | ProgramServicesAmt |
| Management And General | $3,399,045 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,751 | TotalAmt |
| Program Services | $8,712 | ProgramServicesAmt |
| Management And General | $38,039 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,843,159 | TotalAmt |
| Program Services | $10,317,518 | ProgramServicesAmt |
| Management And General | $525,641 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $875 | TotalAmt |
| Program Services | $875 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,024,852 | TotalAmt |
| Program Services | $5,020,682 | ProgramServicesAmt |
| Management And General | $4,170 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,932 | TotalAmt |
| Program Services | $76,340 | ProgramServicesAmt |
| Management And General | $12,592 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,829,692 | TotalAmt |
| Program Services | $1,201,534 | ProgramServicesAmt |
| Management And General | $628,158 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $396,414 | TotalAmt |
| Management And General | $396,414 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| UNCOLLECTIBLES | $1,188,890 | $1,188,890 | |
| RECRUITMENT | $45,471 | $35,826 | $9,645 |
| LICENSES & TAXES | $55,418 | $55,333 | $85 |
| DUES & SUBSCRIPTIONS | $165,805 | $107,180 | $58,625 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$1,659,629 | TotalAmt |
| Program Services | -$667,491 | ProgramServicesAmt |
| Management And General | -$992,138 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,271,684 | TotalAmt |
| Program Services | $83,571,354 | ProgramServicesAmt |
| Management And General | $7,700,330 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $823,805 | BOYAmt |
| EOY | $571,439 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,306,776 | BOYAmt |
| EOY | $7,047,466 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $399,940 | BOYAmt |
| EOY | $535,710 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $15,926,180 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,814,827 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,142,061 | BOYAmt |
| EOY | $10,111,353 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,064,286 | BOYAmt |
| EOY | $11,336,186 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $733,617 | BOYAmt |
| EOY | $915,570 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,470,485 | BOYAmt |
| EOY | $30,517,724 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,639,828 | BOYAmt |
| EOY | $6,087,013 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,965,625 | BOYAmt |
| EOY | $16,830,467 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,605,453 | BOYAmt |
| EOY | $22,917,480 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,865,032 | BOYAmt |
| EOY | $7,600,244 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,865,032 | BOYAmt |
| EOY | $7,600,244 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,470,485 | BOYAmt |
| EOY | $30,517,724 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$9,416,483 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $9,151,695 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART I | FormAndLineReferenceDesc |
| Explanation | PACKARD CHILDREN'S HEALTH ALLIANCE WAS RECOGNIZED AS A HEALTHCARE ORGANIZATION DESCRIBED IN SECTION 170(B)(1)(A)(III) OF THE INTERNAL REVENUE CODE. PCHA DOES NOT OPERATE A FACILITY THAT IS OR IS REQUIRED TO BE LICENSED AS A HOSPITAL. THEREFORE, PCHA IS NOT REQUIRED TO FILE FORM 990, SCHEDULE H. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $431,877 | OtherCostOrOtherBasisAmt |
| Book Value | $431,877 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,463,519 | OtherCostOrOtherBasisAmt |
| Depreciation | $499,872 | DepreciationAmt |
| Book Value | $2,963,647 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,199,959 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,180,761 | DepreciationAmt |
| Book Value | $3,019,198 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,830,825 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,134,194 | DepreciationAmt |
| Book Value | $3,696,631 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,111,353 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED PARTIES, NET | Desc |
| Amt | $16,830,467 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $16,830,467 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARCIA COHEN | ||||||||||||||
| DIRECTOR/CHAIR | $0 | $457,688 | $0 | $88,916 | $0 | $0 | $26,500 | $0 | $48,566 | $0 | $621,670 | $0 | $0 | |
| WILLIAM KENNEDY MD | ||||||||||||||
| DIRECTOR | $0 | $301,037 | $0 | $108,798 | $0 | $0 | $26,500 | $0 | $12,534 | $0 | $460,942 | $0 | $0 | $12,073 |
| KIM ROBERTS | ||||||||||||||
| CEO | $0 | $496,757 | $0 | $106,501 | $0 | $0 | $94,813 | $0 | $38,854 | $0 | $802,925 | $0 | $36,085 | $66,000 |
| DENNIS P LUND MD | ||||||||||||||
| DIRECTOR | $0 | $288,544 | $0 | $480,310 | $0 | $0 | $0 | $0 | $51,138 | $0 | $844,540 | $0 | $0 | $24,548 |
| ANDREW SMITH | ||||||||||||||
| MEDICAL DIRECTOR | $311,970 | $0 | $37,517 | $0 | $10,356 | $24,000 | $0 | $9,018 | $0 | $392,861 | $0 | $0 | $0 | $0 |
| DANA HAERING | ||||||||||||||
| CFO | $0 | $405,162 | $0 | $117,573 | $0 | $0 | $68,671 | $0 | $11,740 | $0 | $612,452 | $0 | $0 | $9,306 |
| CARLOTTA GABARD | ||||||||||||||
| PRACTICE ADMINISTRATOR | $213,022 | $0 | $11,252 | $0 | $0 | $24,000 | $0 | $1,968 | $0 | $250,242 | $0 | $0 | $0 | $0 |
| TIKA MARTIN | ||||||||||||||
| DIRECTOR, HUMAN RESOURCES | $205,441 | $0 | $17,317 | $0 | $0 | $18,000 | $0 | $7,875 | $0 | $248,633 | $0 | $0 | $0 | $0 |
| MICHAEL LIPMAN | ||||||||||||||
| PROVIDER RECRUIT. AND DEV. DIR | $197,057 | $0 | $15,791 | $0 | $0 | $24,000 | $0 | $1,329 | $0 | $238,177 | $0 | $0 | $0 | $0 |
| DOROTHY NAIDU | ||||||||||||||
| DIRECTOR, CLINICAL QUALITY | $156,286 | $0 | $12,844 | $0 | $0 | $11,317 | $0 | $6,576 | $0 | $187,023 | $0 | $0 | $0 | $0 |
| AUBYN REDMOND | ||||||||||||||
| DIRECTOR, PRACTICE OPERATIONS | $146,167 | $0 | $13,257 | $0 | $0 | $4,903 | $0 | $4,181 | $0 | $168,508 | $0 | $0 | $0 | $0 |
| MALAVIKA NARAYAN | ||||||||||||||
| SR DIR FINANCE | $0 | $172,647 | $0 | $12,365 | $0 | $0 | $17,778 | $0 | $10,637 | $0 | $213,427 | $0 | $0 | |
| RICK VANCE | ||||||||||||||
| COO | $260,248 | $0 | $25,194 | $0 | $12,000 | $18,000 | $0 | $10,714 | $0 | $326,156 | $0 | $0 | $0 | $0 |
| EDWARD KOPETSKY | ||||||||||||||
| VP & CIO | $0 | $461,170 | $0 | $205,675 | $0 | $0 | $36,550 | $0 | $30,839 | $0 | $921,355 | $0 | $115,355 | $187,121 |
| MARGARET JOHNSON | ||||||||||||||
| SR DIR FINANCE (UNTIL 8/16/15) | $174,775 | $0 | $29,948 | $0 | $0 | $11,037 | $0 | $29,566 | $0 | $245,326 | $0 | $0 | $0 | |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PROCEDURES FOR DETERMINING COMPENSATION | SCHEDULE J, PART I, LINE 3 PCHA RELIED ON LPCH, A RELATED ORGANIZATION, TO DETERMINE OFFICER COMPENSATION. LPCH'S PROCESS FOR DETERMINING COMPENSATION REQUIRES COMPENSATION TO BE REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE OF THE BOARD, WHICH IS COMPRISED ON INDEPENDENT PERSONS. THE COMMITTEE ENGAGES AN INDEPENDENT CONSULTANT, WHO PROVIDES THE COMMITTEE WITH COMPARABLE MARKET DATA FROM THE FORMS 990 OF COMPARABLE ORGANIZATIONS SUPPLEMENTED BY PUBLISHED COMPENSATION AND BENEFITS SURVEYS TO BE CONSIDERED IN EVALUATING TOTAL COMPENSATION PACKAGES FOR EACH INDIVIDUAL EXECUTIVE. THE COMMITTEE CONDUCTS A REVIEW OF THIS COMPARABILITY DATA AND DOCUMENTED ITS DELIBERATIONS AND DISCUSSION IN MINUTES THAT ARE RETAINED WITH THE OTHER GOVERNANCE MATERIALS OF LPCH. THE VALUE OF EACH PAY ELEMENT AND THE TOTAL PACKAGE ARE REVIEWED EACH SEPTEMBER PRIOR TO ANY PAY ACTIONS BEING APPROVED BY THE COMPENSATION COMMITTEE. SPECIFIC FACTS AND CIRCUMSTANCES OF EACH ROLE, INCUMBENT, THEIR PERFORMANCE, SKILLS, AND RESPONSIBILITIES ARE REVIEWED AND ASSESSED INDIVIDUALLY. THE COMMITTEE RECEIVES RECOMMENDATIONS FROM THE CEO AS TO PAY ACTIONS FOR EACH INCUMBENT. THESE RECOMMENDATIONS ARE DISCUSSED AND THE RESULTS OF THE DELIBERATIONS ARE DOCUMENTED AS TO THE FINAL PAY ACTION APPROVED ALONG WITH THE RATIONALE FOR THE DECISION. THIS PROCESS OCCURS ANNUALLY AND IN CONJUNCTION WITH ANY PROGRAMMATIC CHANGE THAT COULD POTENTIALLY IMPACT THE PAY OR BENEFITS OF EXECUTIVES. |
| SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | SCHEDULE J, PART I, LINE 4B CERTAIN OFFICERS OF PCHA ARE PROVIDED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO SUPPLEMENT THEIR RETIREMENT BENEFITS BY LPCH, A RELATED ORGANIZATION. 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 2015: DANA HAERING 7,289 KIM ROBERTS 36,561 EDWARD KOPETSKY 172,019 FOR CERTAIN INDIVIDUALS LISTED ON SCHEDULE J, PART II, AMOUNTS CREDITED UNDER PLAN ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (C). CERTAIN OFFICERS AND OTHER 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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ORGANIZATION'S PRIMARY EXEMPT PURPOSE. | FORM 990, PART I, LINE 1 & PART III, LINE 1 AT PCHA, THE FOCUS IS ON PATIENT CARE AND COMMUNITY OUTREACH TO ENSURE PATIENT ACCESS TO PCHA'S SERVICES. PCHA PHYSICIANS, NON MD CLINICIANS, AND STAFF ASSUME THE ROLE OF EDUCATORS TO IMPROVE THE PHYSICAL AND BEHAVIORAL WELL-BEING OF CHILDREN IN THE COMMUNITIES IT SERVES. THE OVERALL STRATEGY TO ACCOMPLISH THE OBJECTIVE IS TWOFOLD: BECOME A RELIED UPON RESOURCE FOR CAREGIVERS/PARENTS AND PROVIDE PREVENTATIVE CARE FOR CHILDREN. EDUCATION IS THE KEY FOR BOTH STRATEGIES. WHILE MULTIPLE COMMUNITY SERVICES WILL BE OFFERED AT THE MEDICAL SITES, A SIGNIFICANT PART OF THE OUTREACH EFFORTS WILL BE SPENT SERVING THE PCHA COMMUNITY. |
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE DESCRIPTION DURING THE PERIOD OF SEPTEMBER 2015 THROUGH AUGUST 2016 (FY 2016), PCHA CONTINUED ITS DRAMATIC GROWTH BY ADDING THE FOLLOWING PRACTICES AND SERVICES TO ITS NETWORK: JUVVADI PEDIATRICS - MOUNTAIN VIEW ALTOS OAKS MEDICAL GROUP - MOUNTAIN VIEW WOMEN'S CARE MEDICAL GROUP - REDWOOD CITY IN ADDITION, WE CONTINUE TO INCREASE OUR AVAILABILITY AT MANY OF OUR SITES BY INCREASING THE NUMBER OF PROVIDERS. THIS YEAR WE CONTINUE 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 2016 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 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, AND OUR FAMILY PRACTITIONERS PROVIDE ADULT CARE AT TWO OF OUR OFFICES (BERKELEY AND ALAMEDA). 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 AND SAN MATEO. 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 2016 FOR EACH OF THE LARGEST SERVICES ARE: BAYSIDE: 93,371 PENINSULA PEDIATRICS: 38,408 PEDIATRIC ASSOCIATES: 24,215 DURING FISCAL YEAR 2016 PCHA PROVIDED 258,990 OFFICE VISITS. NETWORK GROWTH FOR FISCAL YEAR 2017 IS PROJECTED TO BE 5 ADDITIONAL PHYSICIAN PRACTICES. |
| 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 | 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. |
| DOCUMENT RETENTION POLICY. | FORM 990, PART VI, LINE 14 PCHA IS IN THE PROCESS OF DEVELOPING ITS OWN DOCUMENT RETENTION POLICY FOR ADOPTION BY THE BOARD OF DIRECTORS. |
| 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 $9,151,695 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:TEMP LABOR - MEDICAL PHYSICIAN TOTAL FEES:1598838 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PROFESSIONAL SERVICE TOTAL FEES:19686 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:6962615 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER MEDICAL SERVICES TOTAL FEES:40296765 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (20 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Foreign PostalForeignAddress/ForeignPostalCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THE BRD OF TRUST LELAND STANF JR UNIV | ||||||||||||||||
| 3145 PORTER DRIVE | PALO ALTO | CA | 94304 | 941156365 | EDUCATION | CA | 501(C)(3) | 2 | NA | false | ||||||
| STANFORD HEALTH CARE | ||||||||||||||||
| 300 PASTEUR DRIVE MC 5555 | STANFORD | CA | 94305 | 946174066 | HEALTHCARE | CA | 501(C)(3) | 3 | STANFORD | Yes (true) | ||||||
| LUCILE SALTER PACKARD CHILDRENS HOSPITAL | ||||||||||||||||
| 725 WELCH ROAD MC 5553 | PALO ALTO | CA | 94304 | 770003859 | HEALTHCARE | CA | 501(C)(3) | 3 | STANFORD | Yes (true) | ||||||
| HOSPITAL COMMITTEE FOR THE L-P AREAS | ||||||||||||||||
| 1111 E STANLEY BLVD | LIVERMORE | CA | 94550 | 941429628 | HOSPITAL | CA | 501(C)(3) | 3 | SHC | Yes (true) | ||||||
| VALLEYCARE MEDICAL FOUNDATION INC | ||||||||||||||||
| 5655 W LAS POSITAS BLVD 220 | PLEASANTON | CA | 94588 | 262593526 | SUPPRT SHC-VC | CA | 501(C)(3) | 9 | HOSP CMTE LP | Yes (true) | ||||||
| VALLEYCARE SENIOR HOUSING | ||||||||||||||||
| 1111 E STANLEY BLVD | LIVERMORE | CA | 94550 | 943382224 | SR. FACILITY | CA | 501(C)(3) | 11C, III-FI | HOSP CMTE LP | Yes (true) | ||||||
| THE FREIDENRICH SUPPORT FOUNDATION | ||||||||||||||||
| 3145 PORTER DRIVE | PALO ALTO | CA | 94304 | 300519583 | SUPPORT | CA | 501(C)(3) | 11A, I | STANFORD | Yes (true) | ||||||
| SHR HOLDINGS INC | ||||||||||||||||
| 3145 PORTER DRIVE | PALO ALTO | CA | 94304 | 943187167 | REAL ESTATE | CA | 501(C)(25) | N/A | STANFORD | Yes (true) | ||||||
| SU EMP BEN TRUST POST RETEMPYNT BEN | ||||||||||||||||
| 3145 PORTER DRIVE | PALO ALTO | CA | 94304 | 943246199 | BENEFITS | CA | 501(C)(9) | N/A | STANFORD | Yes (true) | ||||||
| UNIVERSITY HEALTHCARE ALLIANCE | ||||||||||||||||
| 7999 GATEWAY BLVD STE 300 | NEWARK | CA | 94560 | 943192446 | HEALTHCARE | CA | 501(C)(3) | 3 | SHC | Yes (true) | ||||||
| THE DUDLEY E CHAMBERS FOUNDATION | ||||||||||||||||
| JP MORGAN CHASE PO BOX 3038 | MILWAUKEE | WI | 53201 | 386841793 | SUPPORT | NY | 501(C)(3) | 11D, III-O | STANFORD | Yes (true) | ||||||
| STANFORD UNIVERSITY BOOKSTORE | ||||||||||||||||
| BLDG 60 MAIN QUAD NO 105 | STANFORD | CA | 94305 | 940894150 | SUPPORT | CA | 501(C)(3) | 11A, I | STANFORD | Yes (true) | ||||||
| STANFORD HABITAT CONSERVATION BOARD | ||||||||||||||||
| 3160 PORTER DR STE 200 | PALO ALTO | CA | 94304 | 461882243 | CONSERVATION | CA | 501(C)(3) | 7 | STANFORD | Yes (true) | ||||||
| STANFORD FACULTY CLUB | ||||||||||||||||
| PO BOX 7229 | STANFORD | CA | 94309 | 941187089 | FAC INTERACT. | CA | 501(C)(7) | N/A | STANFORD | Yes (true) | ||||||
| THE HONG KONGSU CHARITABLE TRUST | ||||||||||||||||
| 986078093 | SUPPORT | 501(C)(3) | STANFORD | Yes (true) | 1401 CAROLINE CENTER | 28 PING ROAD | CAUSEWAY | HK | HK | |||||||
| THE STANFORD TRUST | ||||||||||||||||
| SUPPORT | 501(C)(3) | STANFORD | Yes (true) | 65 HIGH STREET | OXFORD | UK | UK | OX1 46L | ||||||||
| STANFORD PROGRAMME (CAPE TOWN) NPC | ||||||||||||||||
| EDUCATION | 501(C)(3) | STANFORD | Yes (true) | WAVERLY BUSINESS PARK BUILDING 11 | CAPE TOWN | SF | SF | |||||||||
| STANFORD FEDERAL CREDIT UNION | ||||||||||||||||
| 1860 EMBARCADERO RD | PALO ALTO | CA | 94303 | 941492212 | CREDIT UNION | CA | 501(C)(1) | N/A | STANFORD | Yes (true) | ||||||
| STANFORD HEALTH CARE ADVANTAGE | ||||||||||||||||
| 1221 BROADWAY 3RD FLOOR | OAKLAND | CA | 94612 | 464071746 | HEALTHCARE | CA | 501(c)(3) | 11A, I | SHC | Yes (true) | ||||||
| STANFORD SCHOOLS CORPORATION | ||||||||||||||||
| 475 POPE STREET | MENLO PARK | CA | 94025 | 202699147 | EDUCATIONAL | CA | 501(C)(3) | 2 | STANFORD | Yes (true) | ||||||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (30 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | EINEIN | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ADOM PARTNERS LP | |||||||||||||
| 500 MADISON AVENUE | NEW YORK | NY | 10022 | INVESTMENTS | DE | NA | |||||||
| ALBUS SELECT FUND LP | |||||||||||||
| 750 MENLO AVENUE | MENLO PARK | CA | 94025 | INVESTMENTS | DE | NA | |||||||
| ARCOLA RESIDENTIAL VENTURE LLC | |||||||||||||
| 635 KNIGHT WAY | STANFORD | CA | 943057297 | REAL ESTATE | DE | NA | 900818278 | ||||||
| ARCOLA VENTURE LLC | |||||||||||||
| 635 KNIGHT WAY | STANFORD | CA | 943057297 | RE DEVELOPMENT | DE | NA | 371689632 | ||||||
| ATWATER 12 LP | |||||||||||||
| 2100 ROSS AVE STE 1600 | DALLAS | TX | 75201 | INVESTMENTS | DE | NA | 752944481 | ||||||
| AVALANCHE ROYALTY PARTNERS LLC | |||||||||||||
| 410 17TH ST STE 1150 | DENVER | CO | 80202 | INVESTMENTS | DE | NA | 841539807 | ||||||
| CEE EQUITY HOLDINGS LP | |||||||||||||
| INVESTMENTS | NA | ELIZABETH HOUSE 9 CASTLE ST | ST. HELIER, | JERSEY | JE | JE4 2QP | JE | ||||||
| CLAIRVUE CAPITAL PARTNERS II-TE 1 LP | |||||||||||||
| 150 CALIFORNIA STREET STE 850 | SAN FRANCISCO | CA | 94111 | INVESTMENTS | DE | NA | 800909516 | ||||||
| CLAIRVUE CAPITAL PARTNERS II-TE 2 LP | |||||||||||||
| 150 CALIFORNIA STREET STE 850 | SAN FRANCISCO | CA | 94111 | INVESTMENTS | DE | NA | 800909556 | ||||||
| CANARY SC FUND LP | |||||||||||||
| 399 PARK AVENUE | NEW YORK | NY | 10022 | INVESTMENTS | DE | NA | |||||||
| ENERGY CAPITAL PARTNERS III (SENDERO CO- | |||||||||||||
| 51 JOHN F KENNEDY PARKWAY SUITE 2 | SHORT HILLS | NJ | 07078 | INVESTMENTS | DE | NA | 471702425 | ||||||
| FORTRESS IW COINVESTMENT (FUND B) LP | |||||||||||||
| 1345 AVE OF THE AMERICAS 45TH FL | NEW YORK | NY | 10105 | INVESTMENTS | NA | 980509639 | CJ | ||||||
| KEB INVESTORS II LP | |||||||||||||
| INVESTMENTS | NA | WASHINGTON MALL STE 304 7 REID ST | HAMILTON, | HM 11 | BD | BD | |||||||
| LSF V DHB HOLDINGS LP | |||||||||||||
| 2711 N HASKELL AVE STE 1700 | DALLAS | TX | 75204 | INVESTMENTS | DE | NA | 272858604 | ||||||
| OUTLAWS CASINO LTD | |||||||||||||
| 3160 PORTER DR | PALO ALTO | CA | 94304 | HOLDING COMPANY | CO | NA | 841457498 | ||||||
| PALO ALTO LP | |||||||||||||
| INVESTMENTS | NA | 981126622 | 13 CASTLE STREET | ST. HELIER, JERSEY | JE | JE | |||||||
| PROJECT EDISON PARTNERS FUND LP | |||||||||||||
| 55 E 52ND ST | NEW YORK | NY | 10055 | INVESTMENTS | DE | NA | 473184706 | ||||||
| RESERVOIR RESOURCE PTRS TE LP | |||||||||||||
| 767 FIFTH AVE 16TH FLOOR | NEW YORK | NY | 10153 | INVESTMENTS | DE | NA | 462286221 | ||||||
| RMS FOREST GROWTH II LP | |||||||||||||
| 30 INVERNESS CENTER PARKWAY STE 36 | BIRMINGHAM | AL | 35242 | INVESTMENTS | CA | NA | 200841908 | ||||||
| SANDPIPER FUND LP | |||||||||||||
| 2000 MCKINNEY AVE STE 2125 | DALLAS | TX | 75201 | INVESTMENT | TX | NA | 260341626 | ||||||
| SAROFIM MULTIFAMILY PARTNERS LP | |||||||||||||
| 8115 PRESTON RD ST400 | DALLAS | TX | 75225 | RE DEVELOPMENT | TX | NA | 201929002 | ||||||
| SCP REAL ASSETS FUND (A) LP | |||||||||||||
| 2498 SAND HILL RD | MENLO PARK | CA | 94025 | INVESTMENTS | DE | NA | 203949682 | ||||||
| SEQUOIA MFM OPERATING COMPANY LLC | |||||||||||||
| 770 WELCH ROAD LPCH- ADMIN MC5551 | PALO ALTO | CA | 94304 | MFM PROGRAM | CA | NA | 475060529 | ||||||
| SIC SNOWCREEK VIII LLC | |||||||||||||
| 635 KNIGHT WAY | STANFORD | CA | 94305 | RE DEVELOPMENT | CA | NA | 275431605 | ||||||
| SP SMC PARTNERS LLC | |||||||||||||
| 2711 CENTERVILLE RD STE 400 | WILMINGTON | DE | 19808 | INVESTMENTS | DE | NA | 473103791 | ||||||
| STANFORD EMANUEL RAD ONCOLOGY CENTER | |||||||||||||
| 825 DELBON AV | TURLOCK | CA | 95382 | RADIOLOGY | CA | NA | 208885091 | ||||||
| STANFORD PET-CT LLC | |||||||||||||
| 300 PASTEUR DR MC 5555 | STANFORD | CA | 94305 | MED. DIAGNOST | CA | NA | 611423414 | ||||||
| STANFORD-STARTX FUND LLC | |||||||||||||
| 3145 PORTER DR | PALO ALTO | CA | 94304 | INVESTMENTS | DE | NA | 464297719 | ||||||
| SUMIT HOLDING INTERNATIONAL LLC | |||||||||||||
| 1400 PAGE MILL ROAD MC5713 | PALO ALTO | CA | 94304 | HOLDING COMPANY | DE | NA | 263934706 | ||||||
| VEDA INVESTORS FUND LP | |||||||||||||
| ONE FAWCETT PL | GREENWICH | CT | 06830 | INVESTMENTS | DE | NA | |||||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (28 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Province Or StateForeignAddress/ProvinceOrStateNm | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Legal Domicile StateLegalDomicileStateCd | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Foreign PostalForeignAddress/ForeignPostalCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STANFORD SGGS EUROPE INC | ||||||||||||||||||
| UGLAND HOUSE S CHURCH ST | PO BOX 309GT, GEORGE TOWN | CJ | 131684331 | INVESTMENTS | CJ | NA | C CORP | |||||||||||
| 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 | CAYMAN ISLANDS | ||||||||||
| LS ALBERTA III LP | ||||||||||||||||||
| 980493425 | INVESTMENTS | CA | NA | C CORP | C/O JE ROBERT COS 1650 TYSON BLVD | MCLEAN | VA | 22102 | ||||||||||
| CLAT (16) | ||||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | |||||||||||||||
| CRT (555) | ||||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | |||||||||||||||
| OTHER (7) | ||||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | |||||||||||||||
| PIF (2) | ||||||||||||||||||
| CHARITABLE TR | NA | TRUST | CA | |||||||||||||||
| ALPINE CHALET INC | ||||||||||||||||||
| 941556099 | SKI LODGE | NA | C CORP | PO BOX 9988 | SOUTH LAKE TAHOE | CA | 96158 | CA | ||||||||||
| STANFORD (BEIJING) CNSLTNG CO LTD (WFOE) | ||||||||||||||||||
| 5275TH FLBLDG CACADEMY SOUTH RD | HAIDAN DISTRICT | CH | EDUCATION | CH | NA | C CORP | BEIJING | |||||||||||
| STANFORD UNIV MED NETWORK RISK AUTHORITY | ||||||||||||||||||
| 461132002 | RISK MGMT CON | NA | C CORP | 1400 PAGE MILL RD MSC 5713 | PALO ALTO | CA | 94304 | CA | ||||||||||
| PROFESSIONAL EXCHANGE ASSURANCE COMPANY | ||||||||||||||||||
| 900897686 | INSURANCE | NA | C CORP | 201 MERCHANT STREET SUITE 2400 | HONOLULU | HI | 96813 | HI | -$77,546 | $856,446 | 0.29400 | Yes (true) | ||||||
| ARCOLA RES DEVELOPMENT CORP | ||||||||||||||||||
| 800804754 | INVESTMENTS | NA | C CORP | C/O SMC 635 KNIGHT WAY | STANFORD | CA | 943057297 | DE | ||||||||||
| BREP VII ALBERTA FEEDER(OFFSHORE)TE7 LP | ||||||||||||||||||
| 981066351 | INVESTMENTS | CA | NA | C CORP | C/O THE BLACKSTONE GROUP 345 PARK | NEW YORK | NY | 10154 | ||||||||||
| BREP VII ALBERTA FEEDER(OFFSHORE)TE7NQLP | ||||||||||||||||||
| 981066355 | INVESTMENTS | CA | NA | C CORP | C/O THE BLACKSTONE GROUP 345 PARK | NEW YORK | NY | 10154 | ||||||||||
| WEST FACE ALTERNATIVE CREDIT CAYMAN LP | ||||||||||||||||||
| PO BOX 10008 WILLOW HOUSE | GRAND CAYMAN | CJ | 981140761 | INVESTMENTS | CJ | NA | C CORP | CAYMAN ISLANDS | KY1-1001 | |||||||||
| MIDPOINT TECHNOLOGY PARK OWNERS ASSOC | ||||||||||||||||||
| 943287254 | REAL ESTATE | NA | C CORP | 3145 PORTER DRIVE | PALO ALTO | CA | 94304 | CA | ||||||||||
| BIENVILLE ARGENTINA OPPS OFFSHORE FUND | ||||||||||||||||||
| INVESTMENTS | CJ | NA | C CORP | 405 LEXINGTON AVE 34TH FLOOR | NEW YORK | NY | 10174 | |||||||||||
| KAIZEN FUND | ||||||||||||||||||
| 1 NORTH BRIDGE RD 6-8 | SINGAPORE | SN | INVESTMENTS | CJ | NA | C CORP | SINGAPORE | 179094 | ||||||||||
| AFFINITY MEDICAL SOLUTIONS INC | ||||||||||||||||||
| 203134011 | HEALTHCARE | NA | C CORP | 1221 BROADWAY 3RD FLOOR | OAKLAND | CA | 94612 | DE | ||||||||||
| BISHOP ROCK OPPORTUNITY OFFSHORE FUND | ||||||||||||||||||
| INVESTMENTS | CJ | NA | C CORP | C/O SMC 635 KNIGHT WAY | STANFORD | CA | 94305 | |||||||||||
| SBFF LTD | ||||||||||||||||||
| PO BOX 1344 | GEORGE TOWN | CJ | INVESTMENTS | CJ | NA | C CORP | ||||||||||||
| CANARY SC FUND LTD | ||||||||||||||||||
| INVESTMENTS | CJ | NA | C CORP | 399 PARK AVE | NEW YORK | NY | 10022 | |||||||||||
| THE RUBRUM FUND | ||||||||||||||||||
| PO BOX 309 UGLAND HOUSE | GRAND CAYMAN | CJ | INVESTMENTS | CJ | NA | C CORP | CAYMAN ISLANDS | |||||||||||
| SEA SMOKE FUND LLC | ||||||||||||||||||
| 190 ELGIN AVENUE | GEORGE TOWN | CJ | INVESTMENTS | CJ | NA | C CORP | GRAND CAYMAN | KY 9005 | ||||||||||
| STANFORD MEDICINE INTL (HONG KONG) CO LT | ||||||||||||||||||
| 833 CHEUNG SHA WAN ROAD | KOWLOON | HK | PATIENT SRVC | HK | NA | C CORP | HONG KONG | |||||||||||
| STANFORD INTL MEDICAL SERVICES RAK FZE | ||||||||||||||||||
| PO BOX 56500 | AE | PATIENT SRVC | AE | NA | C CORP | |||||||||||||
| STANFORD IN JAPAN GODO KAISHA | ||||||||||||||||||
| DOSHISHA UNIVERSITY MEITOKUKAN-NAI | KAMIGYO-KU | JA | EDUCATION | JA | NA | C CORP | KYOTO-SHI | |||||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE R, PART IV, LINE 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. |