2014-07-15T15:51:50-05:00 2013-08-31 PricewaterhouseCoopers LLP 125 High Street Boston MA 02110 990 2012-09-01 320359189 Packard Children's Health Alliance % KIM ROBERTS FINANCE DEPT PACK 4159831135 725 WELCH ROAD MC 5551 Suite PALO ALTO CA 94304 DANA HAERING 6507212222 2014-07-11 true 6175305000 2012 2015-11-30 17:44:51Z KIM ROBERTS 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 34158708 false X WWW.PCHA.ORG X 2011 CA SEE SCHEDULE O 5 2 201 0 0 0 0 938997 34158708 5 0 13 0 939015 34158708 0 0 0 0 622785 8067950 0 0 0 2892642 35562883 3515427 43630833 -2576412 -9472125 617014 24908647 2406215 11872126 -1789201 13036521 X SEE SCHEDULE O false false 33162506 34158708 SEE SCHEDULE O 33162506 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 0 0 true 201 true false false false false false false false false false false X 5 2 false false false false true true true true true false false true false false false false false false CA X KIM ROBERTS FINANCE DEPT 6507212222 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 X MARCIA COHEN 1.0 1.0 X 0 432980 91692 KENNETH L COX MD 2.0 52.0 X X 0 478565 28637 WILLIAM KENNEDY MD 1.0 50.0 X 0 372332 31107 JACOB CHACKO 1.0 0.0 X 0 0 0 BERNADINE CHUCK FONG 1.0 0.0 X 0 0 0 TIMOTHY W CARMACK 2.0 50.0 X 0 606698 90746 KIM ROBERTS 25.0 25.0 X 0 358487 87491 RICK VANCE 50.0 0.0 X 0 0 0 MARGARET JOHNSON 50.0 0.0 X 0 208450 44384 0 2457512 374057 0 false true false PACKARD MEDICAL GROUP INC 725 WELCH ROAD MC 5551 PALO ALTO CA 94304 PHYSICIAN SERVICES 14738347 PER-SE TECHNOLOGIES 1145 SANCTUARY PKWY STE 200 ALPHARETTA CA 30004 FIN & MGMT SOFTWARE 449687 THE CAMDEN GROUP 100 N SEPULVEDA BLVD SUITE 600 EL SEGUNDO CA 90245 CONSULTING/VALUATION 254790 HEALTHCARE INVESTMENT VISIONS 1901 HARRISON ST OAKLAND CA 94612 PROFESSIONAL SERVICE 160200 STANFORD UNIVERSITY 300 PASTEUR DRIVE STANFORD CA 94305 LEGAL & OTHER SERV. 139760 10 0 PATIENT SERVICES 900099 29553879 29553879 PROGRAM SUPPORT 900099 4604829 4604829 34158708 0 0 0 0 0 0 0 0 0 0 0 34158708 34158708 X 0 0 0 0 92696 41713 50983 0 6137171 5413886 723285 10926 2156 8770 1281661 391527 890134 545496 482369 63127 1551836 218375 1333461 1355903 1355903 21195 21195 0 0 0 19807778 15559031 4248747 17436 14593 2843 5616335 5466558 149777 1715860 993190 722670 0 2108192 2108192 25798 14414 11384 0 0 0 0 589663 358377 231286 521657 58606 463051 UNCOLLECTIBLES 1633069 1633069 RECRUITMENT 167213 167213 LICENSES & TAXES 97045 95928 1117 DUES & SUBSCRIPTIONS 70506 59739 10767 263397 250783 12614 43630833 33162506 10468327 0 0 0 255659 3618755 0 0 165848 7189306 0 0 0 0 0 0 0 0 88541 353844 3631777 591979 85966 3039798 0 0 0 0 0 0 21000 10647486 0 59458 617014 24908647 638994 3818202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1767221 8053924 2406215 11872126 X -1789201 13036521 0 0 0 0 -1789201 13036521 617014 24908647 X -9472125 24297847 X false true X true false X PCHA HAS APPLIED TO THE IRS FOR RECOGNITION 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. 279502 64765 214737 1013472 527214 486258 2338803 2338803 3039798 0 DUE TO RELATED PARTIES, NET 8053924 8053924 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 0 450248 0 59930 0 96520 0 80229 0 10517 0 697444 0 0 MARCIA COHEN 0 376445 0 56048 0 487 0 25000 0 66692 0 524672 0 0 KENNETH L COX MD 0 261143 0 216322 0 1100 0 25000 0 3637 0 507202 0 0 MARGARET JOHNSON 0 182485 0 17460 0 8505 0 21504 0 22880 0 252834 0 0 WILLIAM KENNEDY MD 0 265113 0 88726 0 18493 0 21298 0 9809 0 403439 0 0 KIM ROBERTS 0 318413 0 34538 0 5536 0 56600 0 30891 0 445978 0 0 PROCEDURES FOR DETERMINING COMPENSATION SCHEDULE J, PART I, LINE 3 PCHA RELIED ON LPCH, A RELATED ORGANIZATION, TO DETERMINE OFFICER COMPENSATION. LPCH'S PROCESS FOR DETERMINING COMPENSATION REQUIRES COMPENSATION TO BE REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE OF THE BOARD, WHICH IS COMPRISED 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 PACKARD CHILDREN'S HEALTH ALLIANCE ARE PROVIDED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO SUPPLEMENT THEIR RETIREMENT BENEFITS BY STANFORD HOSPITAL AND CLINICS, 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 2012: TIMOTHY W CARMACK $55,125 KIM ROBERTS $2,098 FOR CERTAIN INDIVIDUALS LISTED ON SCHEDULE J, PART II, AMOUNTS CREDITED UNDER THE PLAN ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (C). KENNETH L COX, M.D. PARTICIPATES IN A DEFERRED COMPENSATION PLAN AT STANFORD UNIVERSITY, A RELATED ORGANIZATION. ANNUALLY, AMOUNTS ARE CREDITED TO THE PLAN BASED ON PERFORMANCE AND CERTAIN OTHER FACTORS. THESE AMOUNTS APPEAR IN SCHEDULE J, PART II, COLUMN (C). PLAN BALANCES ARE SUBJECT TO FORFEITURE AND/OR PAYMENT ONLY IF CERTAIN CONDITIONS ARE MET. SCHEDULE J, PART I, LINE 7 OFFICERS AND OTHERS AS ENUMERATED IN SCHEDULE J, PART II PARTICIPATE IN A DEFERRED COMPENSATION PLAN SPONSORED BY SHC. 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(II) OFFICERS AND OTHERS WITH AMOUNTS IN THIS COLUMN RECEIVE BONUSES, AWARDS AND INCENTIVE COMPENSATION. SCHEDULE J, PART II, DESCRIPTION FOR COLUMN C & D THESE EMPLOYEES ACCRUE FUTURE BENEFITS THAT ARE AVAILABLE TO ALL STANFORD EMPLOYEES, SUCH AS EMPLOYER'S CONTRIBUTION TO QUALIFIED RETIRMENT PLAN. COMPENSATION OF LEASED EMPLOYEES SCHEDULE J, PART II LISA HOLBROOK DEVOTED FULL TIME AND EFFORT TO PCHA FOR THE PERIOD 10/7/11 THROUGH 3/31/12. LISA HOLBROOK WAS PAID BY SHC, A RELATED ENTITY, AND THIS AMOUNT WAS REIMBURSED BY LPCH, A RELATED ENTITY. THIS AMOUNT IS REFLECTED AS A PAYABLE TO LPCH IN FORM 990, PART X. PACKARD MEDICAL GROUP SEE PART V 14738347 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 Packard Children's Health Alliance (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; 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 outside the practice setting serving the PCHA community. FORM 990, PART III, LINE 4A PROGRAM SERVICE DESCRIPTION During the period of September 2012 and August 2013 (FY 2013), PCHA grew rapidly adding the following practices to its network: -Orthopedics (Sept 12) - Pediatric orthopedics, 4 medical providers, 4 locations -Peninsula Pediatrics (Nov 12) - General pediatrics, 11 medical providers, 2 locations -LPSR (Mid Nov 12) - General pediatrics, 7 medical providers, 3 locations -Bayside (Jan 13) - General pediatrics, 34 medical providers, 10 locations -GI (Jan 13) - General gastroenterology, 6 medical providers, 3 locations -PCMG (Jan 13) - Pediatric cardiology, 10 physicians, 10 locations -PCA (Mar 13) - Pediatric cardiology, 3 physicians, 3 locations -DVCN (Mar 13) - Pediatric neurology, 2 medical providers, 1 location The three largest services PCHA operated in fiscal year 2013 were all primary care pediatrics: Bayside, Peninsula Pediatrics and LPSR as determined by expense. General pediatrics is focused on healing sick child illness as well as a large focus on preventative medicine consisting largely of immunizations. Bayside Medical Group 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. Livermore Pleasanton San Ramon Pediatrics Group Livermore Pleasanton San Ramon Pediatrics Group was established in 1974, and has grown to serve our expanding community. We are proud to build rewarding and lasting relationships with the children and families we serve, and honored that second and even third generation patients continue to choose us. With a compassionate focus on your child's individual needs, we offer comprehensive and routine medical services for children from birth through college age. 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. Patients visits provided in fiscal year 2013 for each of the largest services are: Peninsula Pediatrics 29,483 LPSR 15,438 Bayside 71,371 During FY 2013, PCHA generated 141,154 office visits. Network growth for the next two fiscal years is projected to be 20 physicians per year. 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. POLICIES FORM 990, PART VI, LINES 12, 13, & 14 PCHA CURRENTLY DOES NOT HAVE A WRITTEN CONFLICT OF INTEREST POLICY, A WRITTEN WHISTLEBLOWER POLICY, OR A WRITTEN DOCUMENT RETENTION POLICY; HOWEVER, OFFICERS, DIRECTORS AND EMPLOYEES OF PCHA WHO ARE OFFICERS, DIRECTORS OR EMPLOYEES OF LPCH ARE SUBJECT TO LPCH'S POLICIES. PCHA IS IN THE PROCESS OF DEVELOPING ITS OWN POLICIES FOR ADOPTION BY THE BOARD OF DIRECTORS. PROCEDURES FOR DETERMINING COMPENSATION FORM 990, PART VI, LINE 15 FOR THE CHIEF EXECUTIVE DIRECTOR 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. 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 Contracted Physician Services $12,444,483 Other Purchased services $6,674,382 Temporary Labor $563,744 Other Professional services $125,169 Total $19,807,778 RECONCILIATION FORM 990, PART XI, LINE 9 EQUITY TRANSFERS TO PCHA FROM LPCH $24,297,847 STANFORD HOSPITAL AND CLINICS 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 LELAND STANFORD JUNIOR UNIVERSITY 3145 PORTER DRIVE PALO ALTO CA 94304 941156365 ACADEMIA CA 501(C)(3) 2 NA false 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.