2015-07-15T16:48:55-05:00 2014-08-31 PricewaterhouseCoopers LLP 125 High Street Boston MA 02110 990 2013-09-01 320359189 Packard Children's Health Alliance % KIM ROBERTS FINANCE DEPT PACK 4159831135 725 WELCH ROAD MC 5551 Suite PALO ALTO CA 94304 DANA HAERING CFO 4159831135 2015-07-15 true GWEN SPENCER P00641463 4159831135 2013 2016-02-25 16:41:14Z KIM ROBERTS 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 55158638 false X WWW.PCHA.ORG X 2011 CA SEE SCHEDULE O 7 2 238 0 0 0 0 34158708 55151112 0 7526 0 0 34158708 55158638 0 0 0 0 8067950 13629258 0 0 0 35562883 50054529 43630833 63683787 -9472125 -8525149 24908647 30162362 11872126 13650990 13036521 16511372 X SEE SCHEDULE O false false 54503922 55151112 SEE SCHEDULE O 54503922 true false false false false false false false false false true false false false true false false true false false false false false false false false false false false true false false false false false false false true false false false false false true true false false false true 70 0 true 238 true false false false false false false false false false false X 7 2 false false true false true true true true true false false true true true true true false false false false CA X KIM ROBERTS FINANCE DEPT 6507212222 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 X MARCIA COHEN Director/Treasurer 1.0 51.0 X 0 445061 59721 KENNETH L COX MD SECRETARY 2.0 52.0 X X 0 502463 28764 WILLIAM KENNEDY MD DIRECTOR/CHAIRMAN 1.0 50.0 X 0 356674 35810 KIM ROBERTS CEO 25.0 25.0 X X 0 436814 112408 JACOB CHACKO Director 1.0 0.0 X BERNADINE CHUCK FONG DIRECTOR 1.0 0.0 X ANDREW SMITH MED DIRECTOR (AS OF 1/21/14) 30.0 20.0 X X 81563 2699 TIMOTHY W CARMACK CFO until 1/3/2014 2.0 50.0 X 0 785027 52970 Dana Haering INT CFO/CNTRLR(AS OF 11/19/13) 2.0 50.0 X 0 276451 26162 MARGARET JOHNSON SR DIR FINANCE 12.0 38.0 X 0 241291 35428 RICK VANCE COO 50.0 0.0 X 176645 11076 CARLOTTA GABARD Practice Administrator 50.0 0.0 X 209294 24952 TIKA MARTIN HR Director 50.0 0.0 X 198064 12164 AUBYN REDMOND Practice Operations Manager 50.0 0.0 X 120382 15121 ELIZABETH CHASE Clinical Advice Nurse 50.0 0.0 X 120443 1573 JOAN TAYLOR Clinical Advice Nurse 50.0 0.0 X 104162 19286 1010553 3043781 438134 6 false true false PACKARD MEDICAL GROUP INC 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 PHYSICIAN SERVICES 26301514 PER-SE TECHNOLOGIES 1145 SANCTUARY PKWY STE 200 ALPHARETTA CA 30004 FIN & MGMT SOFTWARE 2807589 THE CAMDEN GROUP 100 N SEPULVEDA BLVD SUITE 600 EL SEGUNDO CA 90245 CONSULTING/VALUATION 505114 STANFORD UNIVERSITY 300 PASTEUR DRIVE STANFORD CA 94305 LEGAL & OTHER SERV. 394239 ECLINICALWORKS LLC 7011 Koll Center Pkwy PLEASANTON CA 94566 Fin & Mgmt Software 405833 14 0 PATIENT SERVICES 900099 46000186 46000186 GOVERNMENT FUND 900099 646000 646000 OTHER INCOME - RISK POOL 900099 181222 181222 PROGRAM SUPPORT 900099 8323704 8323704 55151112 7526 7526 0 0 0 0 0 0 0 0 0 0 55158638 55151112 7526 X 0 0 0 0 273765 123194 150571 0 9631028 8319188 1311840 166510 140351 26159 2678174 2477565 200609 879781 774569 105212 1509775 1176119 333656 378701 378701 12500 12500 0 0 0 32549716 28034290 4515426 43800 26103 17697 6761953 6466341 295612 1671169 958459 712710 0 3406009 3406009 62560 36302 26258 0 0 0 0 1670414 1041944 628470 312246 300 311946 UNCOLLECTIBLES 1030586 1030586 RECRUITMENT 139334 30324 109010 LICENSES & TAXES 63377 63377 DUES & SUBSCRIPTIONS 106742 83735 23007 335647 315166 20481 63683787 54503922 9179865 0 0 0 3618755 -203998 0 0 7189306 13149619 0 0 0 0 0 0 0 0 353844 558453 7674715 2262393 3039798 5412322 0 0 0 0 0 0 10647486 11005286 59458 240680 24908647 30162362 3818202 5068433 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8053924 8582557 11872126 13650990 X 13036521 16511372 0 0 0 0 13036521 16511372 24908647 30162362 X -8525149 12000000 X false true X true false X SCHEDULE A, PART I PACKARD CHILDREN'S HEALTH ALLIANCE ("PCHA") 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. 834777 156892 677885 2045631 2000931 44700 4794307 104570 4689737 5412322 0 DUE TO RELATED PARTIES, NET 8582557 8582557 SCHEDULE D, PART X, LINE 2 THE ORGANIZATION'S FINANCIAL STATEMENTS DID NOT REPORT A LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN48. false true false false false false false false false TIMOTHY W CARMACK CFO until 1/3/2014 0 464978 0 115811 0 204238 0 39837 0 13133 0 837997 0 112670 MARCIA COHEN Director/Treasurer 0 397231 0 47584 0 246 0 25500 0 34221 0 504782 0 0 KENNETH L COX MD SECRETARY 0 272940 0 228923 0 600 0 25500 0 3264 0 531227 0 0 MARGARET JOHNSON SR DIR FINANCE 0 206021 0 25724 0 9546 0 13247 0 22181 0 276719 0 0 WILLIAM KENNEDY MD DIRECTOR/CHAIRMAN 0 273314 0 67240 0 16120 0 25500 0 10310 0 392484 0 0 KIM ROBERTS CEO 0 334136 0 66176 0 36502 0 76603 0 35805 0 549222 0 28419 RICK VANCE COO 158799 10000 7846 0 11076 187721 0 Dana Haering INT CFO/CNTRLR(AS OF 11/19/13) 0 242637 0 33814 0 0 0 17500 0 8662 0 302613 0 0 CARLOTTA GABARD Practice Administrator 190879 18415 0 24952 234246 0 TIKA MARTIN HR Director 182410 15654 0 0 12164 210228 0 PROCEDURES FOR DETERMINING COMPENSATION SCHEDULE J, PART I, LINE 3 PCHA RELIED ON LPCH, A RELATED ORGANIZATION, TO DETERMINE OFFICER COMPENSATION. LPCH'S PROCESS FOR DETERMINING COMPENSATION REQUIRES COMPENSATION TO BE REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE OF THE BOARD, WHICH IS COMPRISED 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. 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 STANFORD HEALTH CARE ("SHC"), A RELATED ORGANIZATION. AT THE LAST DATE 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 amount became vested and wAS paid to the following individual in calendar year 2013: TIMOTHY W CARMACK $169,238 KIM ROBERTS $29,757 FOR CERTAIN INDIVIDUALS LISTED ON SCHEDULE J, PART II, AMOUNTS CREDITED UNDER THE PLAN ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (C). CERTAIN OFFICERS AND OTHERS AS ENUMERATED IN SCHEDULE J, PART II PARTICIPATE IN A DEFERRED COMPENSATION PLAN SPONSORED BY LPCH. ANNUALLY, AMOUNTS ARE CREDITED TO THE PLAN BASED ON PERFORMANCE AND CERTAIN OTHER FACTORS. PLAN BALANCES ARE SUBJECT TO FORFEITURE AND/OR PAYMENT ONLY IF CERTAIN CONDITIONS ARE MET. PACKARD MEDICAL GROUP SEE PART V 26301514 PHYSICIAN SERVICES & EXPENSES false SCHEDULE L, PART IV, COLUMN B KENNETH COX, A DIRECTOR AND OFFICER OF PCHA, IS A DIRECTOR OF PACKARD MEDICAL GROUP. 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 andprovide 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 2013 and August 2014 (FY 2014), PCHA continued its dramatic growth by adding the following practices and services to its network: Pulmonology - Walnut Creek Neurology - Emeryville General Pediatrics - Brentwood General Pediatrics - Monterey General Pediatrics - San Jose In addition, we opened our busiest multispeciality location in walnut creek. TO DRAMATICALLY IMPROVE OUR ACCESS TO PATIENT MEDICAL INFORMATION, WE UPGRADED ALL OF OUR SITES TO ONE COMMON CORE ELECTRONIC MEDICAL RECORD WHICH IS INTEROPERABLE WITH THE OTHER FOUR LARGE HEALTHCARE SYSTEMS IN OUR REGION. THIS ALLOWS DEMOGRAPHIC, INSURANCE AND CLINICAL INFORMATION TO BE TRANSFERRED TO VARIOUS CLINICAL PROVIDERS SUPPORTING PATIENTS WHEREVER THEY NEED MEDICAL CARE. The three largest services PCHA operated in fiscal year 2014 were: General Pediatrics - Bayside General Pediatrics - Peninsula Pediatrics Cardiology - Pediatric cardiology medical group 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 CARDIOLOGY MEDICAL GROUP: The Pediatric Cardiology Medical Group provides the full continuum of services to children and young adults with all types of congenital heart disease. Founded 30 years ago, the medical group provides therapeutic, interventional, surgical and follow up services to patients from all over the East Bay and Northern California. Patients visits provided in fiscal year 2014 for each of the largest services are: Bayside 92,207 Peninsula Pediatrics: 33,433 PEDIATRIC CARDIOLOGY MEDICAL GROUP: 8,376 During FY 2014, PCHA provided 173,770 office visits. Network growth for fiscal year 2015 is projected to be 20 additional physicians and to include the ent speciality. FORM 990, PART VI, LINE 4 IN 2014, THE BYLAWS OF PCHA WERE AMENDED TO INCLUDE THE FOLLOWING SIGNIFICANT CHANGES: - ESTABLISHED THREE EX-OFFICIO VOTING DIRECTORS AND UPDATED THE TERMS FOR THE DIRECTORS - Split Quality and Credentialing Committee of the Board into two committees, the Quality Advisory Committee and Credentialing Committee, and updated the membership and terms for the members of the Quality Advisory Committee - CLARIFIED ROLES, UPDATED TERMS AND PROCESS FOR ELECTION AND REMOVAL FOR OFFICERS OF PCHA MEMBERS FORM 990, PART VI, LINE 6 STANFORD UNIVERSITY AND LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD ARE THE MEMBERS OF PCHA. FORM 990, PART VI, LINE 7A STANFORD UNIVERSITY AND LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD, AS THE MEMBERS OF PCHA, APPOINT THE PCHA BOARD OF DIRECTORS. TWO OF THE DIRECTORS MUST BE PERSONS WHO RESIDE IN THE COMMUNITIES SERVED BY PCHA AND WHO ARE NOT COMPENSATED BY PCHA, THE MEMBERS, OR ANY MEDICAL GROUP AFFILIATED WITH PCHA. FORM 990, PART VI, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY ONE OR MORE MEMBERS: - ENTERING INTO PROFESSIONAL SERVICE AGREEMENTS WITH NEW MEDICAL GROUPS - ACQUISITION, MERGER, OR CONSOLIDATION OF ANY OTHER ENTITY PROCEDURES FOR REVIEWING FORM 990 FROM GOVERNING BODY FORM 990, PART VI, LINE 11 WORKING WITH PRICEWATERHOUSECOOPERS, THE FORM 990 IS PREPARED FOR MANAGEMENT'S REVIEW. A DRAFT OF THE FORM 990 IS MAILED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW, ALONG WITH AN EXECUTIVE SUMMARY OF RECENT CHANGES AND NEW REQUIREMENTS. THE DRAFT FORM 990 IS REVIEWED AT THE AUDIT AND COMPLIANCE COMMITTEE MEETING. A FINAL FORM 990 IS THEN DISTRIBUTED TO THE FULL BOARD BEFORE FILING WITH THE IRS. PRICEWATERHOUSECOOPERS SIGNS THE FINAL RETURN AS PAID PREPARER. PROCEDURES FOR MONITORING AND ENFORCING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 12C OFFICERS, DIRECTORS AND EMPLOYEES ARE REQUIRED TO COMPLETE AN INITIAL CONFLICT-OF-INTEREST DISCLOSURE STATEMENT ("DISCLOSURE STATEMENT") AT THE TIME OF APPOINTMENT AT PCHA. ADDITIONALLY, AN UPDATED DISCLOSURE STATEMENT IS REQUIRED THEREAFTER ON AN ANNUAL BASIS. A DISCLOSURE THAT APPEARS TO BE A CONFLICT WILL BE RESOLVED BY A MUTUAL AGREEABLE PLAN WITH THE PCHA CHIEF EXECUTIVE OFFICER THAT OUTLINES THE STEPS THE OFFICER, DIRECTOR OR EMPLOYEE MUST TAKE TO RECTIFY THE CONFLICT. 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. FORM 990, PART IX, LINE 11G TEMPORARY LABOR $433,291 Other Purchased services $6,804,289 Other Professional services $5,130 OTHER MEDICAL SERVICES $25,307,006 Total $32,549,716 RECONCILIATION FORM 990, PART XI, LINE 9 EQUITY TRANSFERS TO PCHA FROM LPCH $12,000,000 STANFORD HEALTHCARE 300 PASTEUR DRIVE MC 5555 STANFORD CA 94305 946174066 HEALTHCARE CA 501(C)(3) 3 STANFORD true LUCILE SALTER PACKARD CHILDRENS HOSPITAL 725 WELCH ROAD MC 5553 PALO ALTO CA 94304 770003859 HEALTHCARE CA 501(C)(3) 3 STANFORD true THE FREIDENRICH SUPPORT FOUNDATION 3145 PORTER DRIVE PALO ALTO CA 94304 300519583 SUPPORT CA 501(C)(3) 11, TYPE I STANFORD true SHR HOLDINGS INC 3145 PORTER DRIVE PALO ALTO CA 94304 943187167 REAL ESTATE CA 501(C)(25) N/A STANFORD true SU EMP BEN TRUST POST RETEMPYNT BEN 3145 PORTER DRIVE PALO ALTO CA 94304 943246199 BENEFITS CA 501(C)(9) N/A STANFORD true UNIVERSITY HEALTHCARE ALLIANCE 855 OAK GROVE AVE SUITE 100 MENLO PARK CA 94205 943192446 HEALTHCARE CA 501(C)(3) 3 SHC true THE DUDLEY E CHAMBERS FOUNDATION JP MORGAN CHASE PO BOX 3038 MILWAUKEE WI 53201 386841793 SUPPORT NY 501(C)(3) 11,TYPE III STANFORD true STANFORD UNIVERSITY BOOK STORE BLDG 60 MAIN QUAD NO 105 STANFORD CA 94305 940894150 SUPPORT CA 501(C)(3) 11, TYPE I STANFORD true STANFORD SCHOOLS CORPORATION 475 POPE STREET MENLO PARK CA 94025 202699147 EDUCATIONAL CA 501(C)(3) 2 STANFORD true UNIVERSITY HEALTHCARE ADVANTAGE 3220 BLUME DR STE 260 RICHMOND CA 948065741 464071746 SUPPORT CA 501(C)(3) 11, TYPE 1 SHC true STANFORD HABITAT CONSERVATION BOARD 3160 PORTER DR STE 200 PALO ALTO CA 94304 461882243 CONSERVATION CA 501(C)(3) 7 STANFORD true STANFORD FACULTY CLUB PO BOX 7229 STANFORD CA 94309 941187089 FAC INTERACT. 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SCHEDULE R, PART IV, LINE 3 CHARITABLE REMAINDER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. SCHEDULE R, PART IV, LINE 4 OTHER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. SCHEDULE R, PART IV, LINE 5 POOLED INVESTMENT FUNDS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.