Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 09-01-2011 and ending 08-31-2012
BCheck if applicable:
CName of organization
Lucile Salter Packard Children's
Hospital at Stanford
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
725 Welch Road MC 5553
 
Room/suite
City or town, state or country, and ZIP + 4
Palo Alto, CA94304
D Employer identification number

77-0003859
E Telephone number

G Gross receipts $ 1,142,392,548
F Name and address of principal officer:
TIMOTHY W CARMACK
725 WELCH ROAD
PALO ALTO,CA94304
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.lpch.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1983
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 28
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 21
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 0
6 Total number of volunteers (estimate if necessary) .... 6 878
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 18,703,148 156,503,385
9 Program service revenue (Part VIII, line 2g) ......... 881,139,616 942,244,172
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 20,657,203 23,384,218
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 21,709,246 20,260,773
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 942,209,213 1,142,392,548
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 4,159,592 849,246
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 355,667,312 378,946,961
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet8,135,509    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 471,641,540 536,666,452
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 831,468,444 916,462,659
19 Revenue less expenses. Subtract line 18 from line 12....... 110,740,769 225,929,889
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,584,356,175 2,028,550,838
21 Total liabilities (Part X, line 26)............. 341,739,015 561,684,779
22 Net assets or fund balances. Subtract line 21 from line 20..... 1,242,617,160 1,466,866,059
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 266,960,000 including grants of $ 0 ) (Revenue $ 276,130,000 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $ 192,900,000 including grants of $ 0 ) (Revenue $ 237,020,000 )
SEE SCHEDULE 0
4c (Code:   ) (Expenses $ 111,816,000 including grants of $ 0 ) (Revenue $ 114,721,000 )
SEE SCHEDULE O
4d Other program services (Describe in Schedule O.)
(Expenses $ 254,551,449 including grants of $ 849,246 ) (Revenue $ 314,373,172 )
4e Total program service expensesMediumBullet$ 826,227,449
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
Yes
 
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
366
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
28
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
21
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
FINANCE DEPARTMENT
725 WELCH ROAD
PALO ALTO,CA94304
(650) 721-2222
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) JOHN LILLIE
CHAIR (UNTIL 12/2011)
 4.0 X                
(2) ELIZABETH DUNLEVIE
DIRECTOR
 2.0 X                
(3) MARISSA PETERSON
DIRECTOR (UNTIL 12/2011)
 2.0 X                
(4) DENISE O'LEARY
DIRECTOR (UNTIL 12/2011)
 2.0 X                
(5) KENNETH L COX MD
DIRECTOR
 2.0 X           0 460,927 27,944
(6) CHRISTOPHER G DAWES
PRESIDENT/CEO
 50.0 X   X         1,427,666 351,195
(7) MARIANN BYERWALTER
DIRECTOR
 2.0 X                
(8) PHILIP A PIZZO MD
DIRECTOR
 2.0 X             637,592 532,745
(9) DAVID ALEXANDER MD
DIRECTOR
 2.0 X                
(10) THOMAS KRUMMEL MD
DIRECTOR
 2.0 X             1,006,079 51,244
(11) CHRISTY SANDBORG MD
DIRECTOR
 2.0 X             355,041 41,740
(12) BERNADINE C FONG
DIRECTOR
 2.0 X                
(13) DANA G MEAD JR
DIRECTOR
 2.0 X                
(14) MARY ANN CARMACK MD
DIRECTOR
 2.0 X                
(15) MARY B CRANSTON
CHAIR (AS OF 1/2012)
 2.0 X                
(16) HARRY R HAGEY
DIRECTOR
 2.0 X                
(17) HUGH O'BRODOVICH MD
DIRECTOR
 2.0 X             623,039 38,974
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) SUSAN ORR
VICE CHAIR
 2.0 X                
(19) ANNE BASS
DIRECTOR
 2.0 X                
(20) JEFFREY CHAMBERS
DIRECTOR
 2.0 X                
(21) JONATHAN COSLET
DIRECTOR
 2.0 X                
(22) WILLIAM CROWN
DIRECTOR
 2.0 X                
(23) SUSAN FORD DORSEY
DIRECTOR
 2.0 X                
(24) ANN LIVERMORE
DIRECTOR
 2.0 X                
(25) JOHN WALKER
DIRECTOR
 2.0 X                
(26) DAVID GRUBB
DIRECTOR
 2.0 X                
(27) AMIR DAN RUBIN
DIRECTOR
 2.0 X           0 2,816,310 284,852
(28) J TAYLOR CRANDALL
DIRECTOR (AS OF 6/2012)
 2.0 X                
(29) JANE SHAW
DIRECTOR (AS OF 6/2012)
 2.0 X                
(30) VAUGHN WILLIAMS
DIRECTOR (AS OF 4/2012)
 2.0 X                
(31) JAMES WOODY MD
DIRECTOR (AS OF 1/2012)
 2.0 X                
(32) SUSAN S FLANAGAN
COO
 50.0     X       0 770,830 26,659
(33) TIMOTHY W CARMACK
VP & CFO
 50.0     X       0 648,680 86,785
(34) PAMELA A MOLANO
VP PHYSICIAN & AMB SVS
 50.0       X       479,323 61,883
(35) PAMELA J WELLS
CHIEF NURSING OFFICER
 50.0       X     0 445,206 32,402
(36) OWEN R AURELIO
VP CLINICAL SERVICES
 50.0       X     0 394,474 45,031
(37) MARK TORTORICH
VP PLANNING, DESIGN, CONSTRUC
 25.0       X     0 438,556 71,940
(38) EDWARD KOPETSKY
VP & CIO
 50.0       X       661,173 100,870
(39) KIM ROBERTS
VP PHY NW DEV & MGMT
 25.0       X     0 356,311 65,175
(40) BRADFORD P TOUSSAINT
VP MGMT SYST STRATEGY & PLAN
 50.0         X   0 365,619 45,062
(41) JAMES MCCAUGHEY
SR VP BUS DEV & STRAT PLNG
 50.0         X     458,658 83,590
(42) GREGORY J SOUZA
VP HR
 50.0         X   0 422,305 38,644
(43) VICKI LINK
DIR-QUAL. MGMT
 50.0         X     354,581 22,064
(44) BRET KELSEY
CHIEF REVENUE OFFICER
 50.0         X   0 347,510 35,423
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 13,469,880 2,044,222
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1,261
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
STANFORD HOSPITAL AND CLINICS
300 PASTEUR DR
STANFORD,CA94305 		MED LAB/PURCH SVCS 83,904,028
DPR CONSTRUCTION INC
1450 VETERANS BLVD
REDWOOD CITY,CA94063 		CONSTRUCTION 23,271,199
STANFORD UNIVERSITY
450 SERRA MALL
STANFORD,CA94303 		PURCHASED SERVICES 22,603,571
CARDINAL HEALTH
7000 CARDINAL PLACE
DUBLIN,OH43017 		HEALTH CARE MANU/PCP 17,250,045
OWENS MINOR
18250 STANFORD ROAD
TRACY,CA95377 		MED PROD SUPPLIER 14,526,216
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet314
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 98,000,000
f All other contributions, gifts, grants, and
similar amounts not included above1f 		58,503,385
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 156,503,385
Program Service Revenue Business Code
2a PATIENT SERVICE 900,099 724,515,109 724,515,109    
b GOVERNMENT FUND 900,099 8,211,978 8,211,978    
c MEDICARE/MEDICAID 900,099 137,754,667 137,754,667    
d PROVIDER FEE 900,099 67,993,972 67,993,972    
e JOINT VENTURES 900,099 3,768,446 3,768,446    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 942,244,172
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 23,074,821     23,074,821
4 Income from investment of tax-exempt bond proceeds..MediumBullet 309,397     309,397
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA 900,099 1,407,868     1,407,868
b INVESTMENT INCOME FROM RELATED PROGRAM 900,099 1,581,007     1,581,007
c PARKING 900,099 383,391     383,391
d All other revenue .... 16,888,507     16,888,507
e Total. Add lines 11a–11d ......MediumBullet 20,260,773
12 Total revenue. See Instructions....MediumBullet 1,142,392,548 942,244,172   43,644,991
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 849,246 849,246
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 5,226,384 2,037,330 2,924,150 264,904
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 503,892 503,892    
7 Other salaries and wages 251,015,735 238,882,320 12,133,415  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 22,901,023 21,721,250 1,179,773  
9 Other employee benefits ....... 79,411,763 74,566,348 4,845,415  
10 Payroll taxes ........... 19,888,164 18,874,784 1,013,380  
11 Fees for services (non-employees):        
a Management ...... 13,692,850 7,615,092 6,077,758  
b Legal ......... 3,456,005   3,456,005  
c Accounting ........... 415,334   415,334  
d Lobbying ........... 51,282 51,282    
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 193,831 193,831    
g Other .......... 278,939,982 262,971,624 15,968,358  
12 Advertising and promotion .... 661,241 660,041 1,200  
13 Office expenses ....... 84,687,693 83,443,655 1,244,038  
14 Information technology ...... 24,088,393 13,930,012 10,158,381  
15 Royalties .. 0      
16 Occupancy ........... 18,714,821 9,769,354 8,945,467  
17 Travel ............ 777,476 605,499 171,977  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 6,590,001 6,360,251 229,750  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 37,378,529 30,430,464 6,948,065  
23 Insurance .............. 8,123,553 4,984,644 3,138,909  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a PROVIDER FEES 32,941,391 32,941,391    
b UNCOLLECTIBLES 9,149,062 9,149,062    
c UTILITIES 3,735,108 3,160,442 574,666  
d DUES AND SUBSCRIPTIONS 1,175,859 457,980 717,879  
e
f All other expenses 11,894,041 2,067,655 1,955,781 7,870,605
25 Total functional expenses. Add lines 1 through 24f 916,462,659 826,227,449 82,099,701 8,135,509
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 1,895 1 1,895
2 Savings and temporary cash investments ....... 90,312,193 2 85,383,505
3 Pledges and grants receivable, net ......... 29,731,724 3 147,321,453
4 Accounts receivable, net ......... 141,290,553 4 203,274,071
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 5,173,077 8 5,164,376
9 Prepaid expenses and deferred charges ............ 9,130,825 9 4,840,561
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 798,163,801
b Less: accumulated depreciation. ..... 10b 277,351,832 459,725,276 10c 520,811,969
11 Investments—publicly traded securities .......... 65,262,244 11 66,906,974
12 Investments—other securities. See Part IV, line 11 ...... 753,932,978 12 961,493,848
13 Investments—program-related. See Part IV, line 11 .. 13,356,362 13 15,412,023
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 16,439,048 15 17,940,163
16 Total assets. Add lines 1 through 15 (must equal line 34)... 1,584,356,175 16 2,028,550,838
Liabilities 17 Accounts payable and accrued expenses . 105,186,948 17 134,616,984
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 150,525,267 20 363,765,611
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 86,026,800 25 63,302,184
26 Total liabilities. Add lines 17 through 25..... 341,739,015 26 561,684,779
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 902,008,503 27 982,133,648
28 Temporarily restricted net assets ..... 141,750,674 28 284,973,150
29 Permanently restricted net assets ..... 198,857,983 29 199,759,261
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 1,242,617,160 33 1,466,866,059
34 Total liabilities and net assets/fund balances ..... 1,584,356,175 34 2,028,550,838
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
1,142,392,548
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
916,462,659
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
225,929,889
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
1,242,617,160
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-1,680,990
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
1,466,866,059
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Lucile Salter Packard Children's
Hospital at Stanford 		Employer identification number

77-0003859
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Lucile Salter Packard Children's
Hospital at Stanford 		Employer identification number

77-0003859
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Lucile Salter Packard Children's
Hospital at Stanford 		Employer identification number

77-0003859
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
Yes
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
146,143
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
110,374
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
256,517
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
ORGANIZATIONS EXEMPT UNDER SECTION 501(C)(3) FORM 990, SCHEDULE C, PART II B LESS THAN 1% OF THE TOTAL VOLUNTEER HOURS DONATED TO LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD ("LPCH") WERE USED TO ATTEMPT TO INFLUENCE LEGISLATIVE MATTERS. STAFF INTERACTS ON A REGULAR BASIS WITH ELECTED OFFICIALS AND THEIR STAFF ON ALL LEVELS OF GOVERNMENT. MOST IS RELATIONSHIP BUILDING AND MAINTAINING AS WELL AS WORKING ON COLLABORATIVE PROGRAMS AND PROJECTS TO ENHANCE THE OVERALL HEALTH OF THE COMMUNITY. IN FY12, ROUGHLY 22% OF THE CHIEF GOVERNMENT RELATIONS OFFICER'S TIME AND ROUGHLY 30% OF THE SENIOR POLICY MANAGER'S TIME WAS SPENT ON LOBBYING ON SPECIFIC LEGISLATIVE ISSUES - VALUE APPROXIMATELY $116,000 (INCLUDES DOLLARS ALLOCATED FOR BENEFITS). IN ADDITION, IN FY12, THE HOSPITAL HAD A LOBBYIST IN WASHINGTON D.C. DAVID WETMORE CARPI AND CLAY ONE MASSACHUSETTS AVE, NW SUITE 330 WASHINGTON, D.C. 20001 GOVERNMENT RELATIONS STAFF SEND LETTERS TO LEGISLATORS ON SPECIFIC PIECES OF LEGISLATION. IN ADDITION, MAILINGS OF PUBLICATIONS PRODUCED BY BOTH THE HOSPITAL AND THE LUCILE PACKARD FOUNDATION FOR CHILDREN'S HEALTH ARE SENT WITH A COVER LETTER SIGNED BY THE DIRECTOR OF GOVERNMENT RELATIONS FOUR TIMES A YEAR. LPCH BELONGS TO CERTAIN TRADE ASSOCIATIONS IN WHICH A PORTION OF DUES PAID TO THESE ORGANIZATIONS IS SPENT ON EFFORTS TO INFLUENCE LEGISLATIVE MATTERS IN THE HEALTH CARE INDUSTRY. DURING FY12, LPCH PAID DUES OF APPROXIMATELY $256,517 TO THESE TRADE ASSOCIATIONS AND THE APPROXIMATE AMOUNT OF THE DUES SPENT ON LOBBYING PURPOSES WAS $110,374.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 270,361,140 270,472,140 313,335,140 392,255,140
b Contributions ........ 822,000 34,000 581,000 18,740,000
c Net investment earnings, gains, and losses ... 8,136,000 41,601,000 33,016,000 -76,431,000
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		12,925,000 41,746,000 76,460,000 21,229,000
f Administrative expenses ....        
g End of year balance ...... 266,394,140 270,361,140 270,472,140 313,335,140
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet75.000 %
c
Temporarily restricted endowment SchDMd Bullet25.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................   325,450,235 114,702,150 210,748,085
c Leasehold improvements ............   13,834,251 4,270,446 9,563,805
d Equipment ................   197,671,668 146,245,688 51,425,980
e Other .................   261,207,647 12,133,548 249,074,099
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 520,811,969
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) MANAGED POOL 		762,777,263 F

(B) LIMITED ASSETS HELD BY TRUSTEE 		198,716,585 F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 961,493,848
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
DUE TO GOVERNMENT AGENCIES 1,701,101
DUE TO RELATED PARTIES, NET 25,766,430
SELF-INSURANCE RESERVE 35,834,653






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 63,302,184
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
SCHEDULE D, PART III, LINE 4   LPCH DOES NOT RECOGNIZE CONTRIBUTIONS OF WORKS OF ART ON LPCH'S FINANCIALS SINCE 1) THEY ARE HELD FOR PUBLIC EXHIBITION RATHER THAN FINANCIAL GAIN; 2) THEY ARE PROTECTED, KEPT UNENCUMBERED, CARED FOR, AND PRESERVED; 3) ARE SUBJECT TO AN ORGANIZATIONAL POLICY THAT REQUIRES THE PROCEEDS FROM SALES OF COLLECTION ITEMS TO BE USED TO ACQUIRE OTHER ITEMS FOR COLLECTION. SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS LPCH'S ENDOWMENT CONSISTS OF VARIOUS INDIVIDUAL FUNDS. THE USES OF THE FUNDS ARE RESTRICTED TO DONORS' STIPULATIONS. THESE FUNDS ARE USED TO SUPPORT THE MISSION OF LPCH. SCHEDULE D, PART X FIN 48 LIABILITY THE ORGANIZATION'S FINANCIAL STATEMENTS DID NOT REPORT A LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

 

No
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		  397 646,384 0 646,384 0.070 %
b Medicaid (from Worksheet 3, column a) .....   21,097 341,462,533 146,247,286 195,215,247 21.550 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .   2,790 935,690 109,010 826,680 0.090 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		  24,284 343,044,607 146,356,296 196,688,311 21.710 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		10 6,002 1,644,872 18,863 1,626,009 0.180 %
f Health professions education
(from Worksheet 5) .. 		5 432 15,578,490 0 15,578,490 1.720 %
g Subsidized health services
(from Worksheet 6) .. 		2 1,271 200,326 4,500 195,826 0.020 %
h Research (from Worksheet 7)   0 0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) .... 7 8,911 2,818,679 0 2,818,679 0.310 %
jTotal Other Benefits ... 24 16,616 20,242,367 23,363 20,219,004 2.230 %
kTotal. Add lines 7d and 7j. .. 24 40,900 363,286,974 146,379,659 216,907,315 23.940 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development 1   58,727 0 58,727 0.010 %
3 Community support 1 3,000 236,311   236,311 0.030 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 1   12,465 0 12,465 0 %
7 Community health improvement advocacy 2   159,426 0 159,426 0.020 %
8 Workforce development            
9 Other            
10 Total 5 3,000 466,929 0 466,929 0.060 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
2,570,886
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
2,853,544
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
6,759,520
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-3,905,976
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 LUCILE SALTER PACKARD CHILDREN'S HSPTL
725 WELCH ROAD
PALO ALTO,CA94304 		X X X X          
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
LUCILE SALTER PACKARD CHILDREN'S HSPTL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, LINE 3C   NOT APPLICABLE. PART I, LINE 6A NOT APPLICABLE. PART I, LINE 7G NOT APPLICABLE. PART I, LINE 7, COLUMN (F) THE AMOUNT OF BAD DEBT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN LINE 7, COLUMN (F) WAS $9,149,062. PART I, LINE 7 SOME OF THE AMOUNTS IN LINE 7 WERE CALCULATED BASED ON A COST ACCOUNTING SYSTEM. THESE ITEMS INCLUDE CHARITY CARE AT COST, UNREIMBURSED MEDICAID COST, AND UNREIMBURSED COSTS RELATED TO OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS, BUT EXCLUDES RESEARCH AND SOME GRANT RELATED COSTS. OTHER BENEFIT COSTS ARE DIRECT, SEPARATELY IDENTIFIABLE COSTS INCURRED BY THE ORGANIZATION. PART II COMMUNITY BUILDING ACTIVITIES INCLUDE PROGRAMS THAT ADDRESS UNDERLYING CAUSES OF HEALTH PROBLEMS IN ORDER TO IMPROVE HEALTH STATUS AND QUALITY OF LIFE FOR THE COMMUNITY. THEY FOCUS ON THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ENVIRONMENTAL ISSUES. FOR PACKARD CHILDREN'S, OUR COMMUNITY BUILDING ACTIVITIES INCLUDE ADVOCACY EFFORTS FOR EXPECTANT MOTHERS AND CHILDREN'S HEALTH ISSUES, SUPPORT FOR COMMUNITY-BASED SERVICE CLUBS AND YOUTH SERVING ORGANIZATIONS, AND SUPPORT FOR COMMUNITY EMERGENCY MANAGEMENT PROGRAMS. PART III, LINE 4 THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A SPECIFIC FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. IN THE CONTEXT OF DESCRIBING THE PROCESS FOR ESTIMATING THE ULTIMATE COLLECTIBILTY OF PATIENT RECEIVABLES, THE FOOTNOTES DO NOTE THAT "REVISIONS IN THE RESERVE FOR DOUBTFUL ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO THE PROVISION FOR DOUBTFUL ACCOUNTS," OR BAD DEBT EXPENSE. SO INCLUDED IN THE ORGANIZATION'S BAD DEBT EXPENSE ARE REVISIONS TO OUR RESERVES FOR DOUBTFUL ACCOUNTS, AND WRITE-OFFS TO BAD DEBT FOR SUCH THINGS AS THE PATIENT LIABILITY. BAD DEBT WRITE-OFFS RESULT FROM UNSETTLED ACCOUNTS WHERE THE INABILITY TO PAY HAS NOT BEEN DETERMINED. BAD DEBT WRITE-OFFS DO NOT APPLY TO ACCOUNTS THAT QUALIFY FOR CHARITY (IF AN ACCOUNT WAS INITIALLY DEEMED BAD DEBT BUT SUBSEQUENT INFORMATION QUALIFIED IT FOR CHARITY, THE BAD DEBT WRITE-OFF IS REVERSED AND REPLACED WITH CHARITY WRITE-OFFS). THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 2 IS BASED ON A COST ACCOUNTING SYSTEM. WE HAVE APPLIED THE SAME SYSTEMWIDE COST TO CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM TO OUR BAD DEBT BASED ON CHARGES AS WAS APPLIED TO OUR CHARITY CARE BASED ON CHARGES. THE COST TO CHARGE RATIO FROM OUR COST ACCOUNTING SYSTEM DOES ADDRESS ALL PATIENT SEGMENTS AND EXCLUDES RESEARCH AND SOME GRANT RELATED COSTS. PART III, LINE 8 THE MEDICARE SHORTFALL OF ($3,905,976) REPORTED IN PART III, LINE 7 WAS CALCULATED BASED ON A COST ACCOUNTING SYSTEM. THIS AMOUNT SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE THE RATES PAID BY MEDICARE DO NOT ACCURATELY REFLECT THE COST OF CARE PROVIDED BY THE HOSPITAL. ACCORDINGLY, THE HOSPITAL MUST SUBSIDIZE THE COST OF CARE PROVIDED TO MEDICARE BENEFICIARIES WITH OTHER REVENUES. PART III, LINE 9B IF A PATIENT IS ATTEMPTING TO QUALIFY FOR ELIGIBILITY UNDER LPCH'S CHARITY CARE OR DISCOUNT PAYMENT POLICY AND IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH LPCH BY NEGOTIATING A REASONABLE PAYMENT PLAN OR BY MAKING REGULAR PARTIAL PAYMENTS OF A REASONABLE AMOUNT, LPCH SHALL NOT SEND THE UNPAID BILL TO ANY COLLECTION AGENCY OR OTHER ASSIGNEE, UNLESS THAT ENTITY AGREES TO COMPLY WITH THE PROVISIONS OF ARTICLE 3 OF THE HEALTH AND SAFETY CODE. LPCH OR OTHER ASSIGNEE WHICH IS AN AFFILIATE OR SUBSIDIARY OF LPCH SHALL NOT, IN DEALING WITH PATIENTS ELIGIBLE UNDER LPCH'S CHARITY CARE OR DISCOUNT PAYMENT POLICIES, USE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS. PART VI, LINE 2 Lucile Packard Children's Hospital at Stanford participates in collaborative processes in San Mateo and Santa Clara counties that assess community health needs. As required by California Senate Bill 697, these formal assessments take place every three years. Both processes engage other not-for-profit hospitals, public health departments, appropriate community-based organizations, United Way etc. In both counties, data is derived from the Behavioral Risk Factor Surveillance Survey, the California Healthy Kids Survey, California Health Information Survey, and more focused assessments conducted by the Lucile Packard Foundation for Children's Health and other organizations working in the child health arena. In addition, ongoing involvement of hospital community benefit leaders with a number of community efforts such as Kids in Common's Children's Agenda, First Five, Project Safety Net, etc. provides continual updates on needs and concerns in the two-county area in which we concentrate community benefit programming. Santa Clara County conducted the Behavioral Risk Factor Surveillance Survey in fall 2009 and published results in July 2010. A process to complete a community assessment by spring 2013 is currently underway. San Mateo County performed a scan of the most recent secondary data in late fall 2010 and is fielding a telephone survey in spring 2012. In both counties, there will be a formal process to solicit community input into identifying priorities. PART VI, LINE 3 A. PUBLIC NOTICE CONCERNING THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY IS GIVEN BY THE FOLLOWING MEANS: 1. NOTICES ARE POSTED IN VISIBLE LOCATIONS WHERE THERE ARE HIGH VOLUMES OF INPATIENT AND/OR OUTPATIENT ADMITTING/REGISTRATIONS, BILLING OFFICES, ADMITTING OFFICES AND HOSPITAL OUTPATIENT SERVICE SETTINGS. 2. POSTED NOTICES EXPLAIN THAT LPCH HAS A VARIETY OF OPTIONS AVAILABLE INCLUDING FINANCIAL ASSISTANCE AND DISCOUNTS TO PATIENTS WHO ARE UNINSURED OR UNDERINSURED. 3. NOTICES INCLUDE A CONTACT TELEPHONE NUMBER A PATIENT CAN CALL TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND TO APPLY FOR FINANCIAL ASSISTANCE. B. THE LPCH WEBSITE INCLUDES AN EXPLANATION OF THE FINANCIAL ASSISTANCE/CHARITY CARE POLICY, THE UNINSURED PATIENT DISCOUNT POLICY, THE AVAILABILITY OF SUCH ASSISTANCE AND DISCOUNTS, AND A CONTACT TELEPHONE NUMBER. C. LPCH BILLING STATEMENTS INFORM THE PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE BY CONTACTING THE LPCH CUSTOMER SERVICE CENTER. PART VI, LINE 4 While LPCH is a regional hospital serving children, adolescents, and pregnant women from the greater San Francisco Bay Area, northern California, California and the western United States, community benefit programming is focused on Santa Clara and San Mateo counties. These two counties are primarily urban-suburban, with some small rural communities along the San Mateo coast. There are 20 incorporated cities in San Mateo County and 15 in Santa Clara County, ranging from populations of 1 million to small enclaves of under 10,000. San Mateo County has 739,311 people (2011 census), 256,423 households, and 175,697 families with 30.8% having children under age 18. 22.1% of the total population is under age 18. Median household income is $87,633 with per capita income at $45,346. About 7% of the population is below the FPL, with 8.9% of those under age 18 living under the FPL. Ethnic breakdown for the 157,167 children in San Mateo County: 35.1% Hispanic/Latino; 32% Caucasian/white; 22.7% Asian/Pacific Islander; 6.1% multi-ethnic; 2.1% African-American, and .2% Native American. Santa Clara County has 1,837,504 (2011 CENSUS) people, 599,652 households, and 426,824 families, with 34.8% of the households having children under 18. 23.9% of the population is under age 18. Median household income is $89,064, with per capita income at $40,698. About 9.2% of the population is below the FPL, with 10.4% of those under age 18 living in poverty. Ethnic breakdown for the 429,152 children living in Santa Clara County: 36.7% Hispanic/Latino; 24.3% Caucasian/white; 31% Asian/Pacific Islander; 5.5% Multi-ethnic; 2% African-American; .2% Native-American. San Mateo and Santa Clara counties are two of the most affluent counties in the nation. But, there are huge income disparities between the very wealthy whose numbers and magnitude of net worth skew data like average household income, and the very poor. In addition, the federal poverty guideline is not a good measure of one's ability to be self-sufficient in these two counties, where housing, health care and other typical costs are very high. Using only the federal poverty guideline, the latest data shows that the percentage of children 0-18 years old living in poverty was 8.9 percent in San Mateo County and 10.4 percent in Santa Clara County. A better standard is the Self-Sufficiency Standard for California, which defines the income required by California families to pay for the basic costs of housing, food, child care, health care, transportation, taxes, and miscellaneous costs on a county-by county basis. For a family of one adult, one pre-school child and one school-aged child in San Mateo County, the required income is $78,945. In Santa Clara County, it is $77,973.
Both are much above the federal poverty level so that clearly, many   more families with young children than the federal poverty level statistics show are having a hard time making ends meet. PART VI, LINE 5 The three priority focus areas for LPCH's community benefit work are improving access to care, with focus on a medical home model; preventive education programs with special attention to prevention of pediatric obesity; and improving the social and emotional health of youth. The hospital invested more than $4.95 million (not including its substantial commitment to government insured patients) in FY2012 in programs addressing these focus areas. These programs are fully described in the FY2012 Community Benefit Report and FY2013 Community Investment Plan filed FEBRUARY 20, 2013 with the State of California Office of Statewide Health Planning and Development. This is a brief listing of hospital-sponsored programs and support for programs managed by other community organizations that support each focus area: Focus Area 1: Improving access to primary health services focusing on building capacity into existing community resources and the medical home concept: - Community Health Network for the Underserved in San Mateo County: support for pediatric and OB capacity in San Mateo County clinics. - Support for Ravenswood Family Health Center, an East Palo Alto FQHC, for pediatric services, integrated mental health, and dental services. - Mobile Adolescent Health Services serving homeless and uninsured teens. - Support for children's health insurance programs in both counties. - Support for enhanced school nurse capacity in San Jose Unified School District. - Care A Van for Kids providing transportation to medical services for families that lack reliable transportation. Focus Area Two: Preventive and educational programs that provide awareness and education about pediatric health issues and help create community environments that promote improved health status for children, adolescents, and expectant women, with special attention to prevention of pediatric obesity. - Funding for the Silicon Valley Youth Health Literacy Collaborative providing a K-12 health education curriculum for local schools. - Funding for nutrition education in School Health Clinics of Santa Clara County. - Leadership in community collaborative efforts addressing obesity prevention. - Coordination of the SafeKids Coalition of San Mateo and Santa Clara counties. - Provision of child passenger seat fitting and parent education at a permanent site at the hospital and a mobile program going to community sites. - Perinatal, parenting, and community health education programming. Focus Area Three: Improving the Social and Emotional Health of Youth. - Leadership in Project Safety Net and the Health Care Alliance for Response to Adolescent Depression in Palo Alto. In addition to providing direct services or funding others to provide community programs, LPCH, as an academic medical center invests significantly in training the health-care professionals of the future. In FY2012, 167 pediatric residents and fellows and 190 nursing students received their training and clinical experience at LPCH at a cost of $15,578,490. PART VI, LINE 6 NOT APPLICABLE. PART VI, LINE 7 CA
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number
77-0003859
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) SCHOOL HEALTH CLINIC OF SANTA CLARA5671 SANTA TERESA BLVD
SAN JOSE,CA95123 		77-0031679 501(c)(3) 100,000       DIETICIAN SUPPORT
(2) SAN JOSE UNIFIED SCHOOL DISTRICT855 LENZEN AVE
SAN JOSE,CA95126 		77-6002606 170C 265,000       SCHOOL NURSE PROJECT
(3) EATING DISORDER RESOURCE CENTER2105 S BASCOM AVE
CAMPBELL,CA95008 		68-0616393 501(c)(3) 7,500       EATING DISORDER PROGRAM
(4) RAVENSWOOD FAMILY HEALTH CENTER1798A BAY RD
EAST PALO ALTO,CA94303 		94-3372130 501(c)(3) 300,000       CHILD HEALTH SVCS.
(5) HEALTH TEACHER INC5500 MARYLAND WAY
SUITE 200
BRENTWOOD,TN37027 		20-3456491   75,213       ONLINE HEALTH EDUCATION
(6) SANTA CLARA FAMILY HEALTH FOUNDATION210 HACIENDA AVENUE
CAMPBELL,CA95008 		77-0545774 501(C)(3) 50,000       HEALTHY KIDS PREMIUMS
(7) SAN MATEO COUNTY CHILDREN'S HEALTH INITIATIVE701 GATEWAY BLVD
SAN FRANCISCO,CA94080 		94-6000532 501(C)(3) 50,000       HEALTHY KIDS PREMIUMS
(8) EDUCATION FOUNDATION CENTERPO BOX 396
MENLO PARK,CA94026 		26-0166433 501(C)(3) 10,000       SCHOOL LUNCH PROGRAM








2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
7
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
1
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE US SCHEDULE I, PART I, LINE 2 LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD (LPCH) DOES NOT SPONSOR AN OPEN GRANT PROCESS THAT SOLICITS COMMUNITY ORGANIZATIONS TO APPLY FOR GRANTS, PARTICIPATE IN A GRANT SELECTION PROCESS, AND THEN BE "AWARDED" A GRANT. RATHER, THE HOSPITAL IDENTIFIES PRIORITY FOCUS AREAS FOR HOSPITAL FUNDING, IDENTIFIES COMMUNITY ORGANIZATIONS THAT ARE ALREADY WORKING IN THAT FOCUS AREA, AND IDENTIFIES PROJECTS THAT ARE ALREADY ADDRESSING AN ISSUE AND THEN COMMITS TO FUNDING IT. OR, THE HOSPITAL MAY DESIGN, TOGETHER WITH A COMMUNITY ORGANIZATION, A PROJECT THAT ADDRESSES AN IDENTIFIED NEED AND THEN COMMITS FUNDS TO THAT PROJECT. ANY ORGANIZATION RECEIVING LPCH COMMUNITY INVESTMENT FUNDING MUST BE A 501(C)(3) ORGANIZATION OR GOVERNMENT ORGANIZATION LOCATED IN SANTA CLARA OR SAN MATEO COUNTIES THAT SHARES THE HOSPITAL'S COMMUNITY BENEFIT MISSION OF IMPROVING THE HEALTH STATUS OF LOCAL CHILDREN, ADOLESCENTS, OR PREGNANT WOMEN. IN COLLABORATION WITH THE ORGANIZATION'S LEADERSHIP, METRICS FOR EACH GRANT ARE DETERMINED ANNUALLY BEFORE FUNDING IS PROVIDED. A PROGRESS REPORT IS REQUIRED AT SIX MONTHS, A SITE VISIT IS CONDUCTED IF APPROPRIATE, AND A FINAL ANNUAL REPORT ABOUT PROGRESS TOWARD METRICS IS REQUIRED AT THE END OF THE FUNDING CYCLE. IN ADDITION, A MEMORANDUM OF UNDERSTANDING ACCOMPANIES EACH FUNDING THAT CLEARLY SPELLS OUT THE USAGE FOR THE FUNDS. LPCH ALSO PROVIDES SMALLER FINANCIAL SUPPORT (LESS THAN $10,000) TO NOT-FOR-PROFIT ORGANIZATIONS SERVING CHILDREN, ADOLESCENTS, AND PREGNANT WOMEN TO SUPPORT THEIR PROGRAM OR TO PRESENT SYMPOSIA, SEMINARS, OR CONFERENCES. TYPICAL EXAMPLES ARE THE HOSPITAL'S SPONSORSHIP OF KIDS IN COMMON'S CHILDREN'S AGENDA 2015 CONFERENCE AND THE HOSPITAL'S SUPPORT FOR THE EATING DISORDERS RESOURCE CENTER, WHICH IS A VALUED PARTNER FOR THE HOSPITAL IN SERVING YOUNG PEOPLE WHO SUFFER FROM EATING DISORDERS AND THEIR FAMILIES. LPCH ALSO PROVIDES FUNDS IN THE $200 TO $12,000 RANGE TO SPONSOR THE FUND-RAISING DINNERS, WALKS, AND OTHER EVENTS FOR ORGANIZATIONS SUCH AS THE MARCH OF DIMES, NATIONAL BRAIN TUMOR SOCIETY, PATHWAYS HOSPICE FOUNDATION, RONALD MCDONALD HOUSE, ETC.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) KENNETH L COX MD (i)
(ii)		 0
252,962 		0
17,380 		0
190,585 		0
24,500 		0
3,444 		0
488,871 		0
0
(2) CHRISTOPHER G DAWES (i)
(ii)		  
805,172 		 
421,398 		 
201,096 		0
326,950 		0
24,245 		0
1,778,861 		0
0
(3) PHILIP A PIZZO MD (i)
(ii)		  
620,862 		 
0 		 
16,730 		0
507,937 		0
24,808 		0
1,170,337 		0
0
(4) THOMAS KRUMMEL MD (i)
(ii)		  
518,370 		 
487,709 		 
0 		0
24,500 		0
26,744 		0
1,057,323 		0
0
(5) SUSAN S FLANAGAN (i)
(ii)		 0
501,632 		0
167,924 		0
101,274 		0
0 		0
26,659 		0
797,489 		0
0
(6) CHRISTY SANDBORG MD (i)
(ii)		  
202,283 		 
24,869 		 
127,889 		0
23,408 		0
18,332 		0
396,781 		0
0
(7) TIMOTHY W CARMACK (i)
(ii)		 0
437,091 		0
151,711 		0
59,878 		0
78,904 		0
7,881 		0
735,465 		0
55,528
(8) HUGH O'BRODOVICH MD (i)
(ii)		  
409,628 		 
0 		 
213,411 		0
17,983 		0
20,991 		0
662,013 		0
0
(9) PAMELA A MOLANO (i)
(ii)		  
325,494 		 
107,531 		 
46,298 		0
49,475 		0
12,408 		0
541,206 		0
27,583
(10) PAMELA J WELLS (i)
(ii)		 0
269,101 		0
62,603 		0
113,502 		0
23,328 		0
9,074 		0
477,608 		0
33,023
(11) OWEN R AURELIO (i)
(ii)		 0
254,854 		0
68,649 		0
70,971 		0
22,050 		0
22,981 		0
439,505 		0
42,503
(12) MARK TORTORICH (i)
(ii)		 0
285,838 		0
77,798 		0
74,920 		0
57,452 		0
14,488 		0
510,496 		0
34,532
(13) BRADFORD P TOUSSAINT (i)
(ii)		 0
262,712 		0
67,175 		0
35,732 		0
22,050 		0
23,012 		0
410,681 		0
0
(14) JAMES MCCAUGHEY (i)
(ii)		  
309,788 		 
103,186 		 
45,684 		0
62,565 		0
21,025 		0
542,248 		0
38,909
(15) GREGORY J SOUZA (i)
(ii)		 0
296,833 		0
80,218 		0
45,254 		0
22,050 		0
16,594 		0
460,949 		0
0
(16) EDWARD KOPETSKY (i)
(ii)		  
416,264 		 
116,169 		 
128,740 		0
76,362 		0
24,508 		0
762,043 		0
44,468
(17) AMIR DAN RUBIN (i)
(ii)		 0
1,478,121 		0
1,287,800 		0
50,389 		0
256,827 		0
28,025 		0
3,101,162 		0
0
(18) KIM ROBERTS (i)
(ii)		 0
278,305 		0
75,046 		0
2,960 		0
42,123 		0
23,052 		0
421,486 		0
0
(19) VICKI LINK (i)
(ii)		  
128,212 		 
31,315 		 
195,054 		0
16,260 		0
5,804 		0
376,645 		0
0
(20) BRET KELSEY (i)
(ii)		 0
232,397 		0
64,530 		0
50,583 		0
27,100 		0
8,323 		0
382,933 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
HOUSING SCHEDULE J, PART I, LINE 1 EDWARD KOPETSKY, BRET KELSEY, AND MARK TORTORICH RECEIVED HOUSING AS A TAXABLE BENEFIT AND THE AMOUNT HAS BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B(III). SEVERANCE PAYMENT SCHEDULE J, PART I, LINE 4A VICKI LINK RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $175,445. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD ("LPCH") AND SHC PROVIDE ALL SENIOR EXECUTIVES WITH A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO SUPPLEMENT THEIR RETIREMENT BENEFITS. 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 amounts became vested and were paid to the following individuals in calendar year 2011: CHRISTOPHER G DAWES $139,347 SUSAN S FLANAGAN $61,665 TIMOTHY W CARMACK $56,985 EDWARD KOPETSKY $47,528 PAMELA A MOLANO $27,751 PAMELA J WELLS $99,727 OWEN R AURELIO $63,287 GREGORY J SOUZA $36,251 JAMES MCCAUGHEY $39,511 BRADFORD P TOUSSAINT $21,414 MARK TORTORICH $36,909 FOR CERTAIN INDIVIDUALS LISTED ON SCHEDULE J, PART II, AMOUNTS CREDITED UNDER THE PLAN ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (C). THE INDIVIDUALS LISTED BELOW PARTICIPATE 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. KENNETH L COX MD PHILIP A PIZZO MD THOMAS KRUMMEL MD CHRISTOPHER DAWES, PRESIDENT OF LUCILE PACKARD CHILDREN'S HOSPITAL AT STANFORD HAS A NONQUALIFIED DEFERRED COMPENSATION ARRANGEMENT. UNDER THE AGREEMENT, MR. DAWES RECEIVES AN ANNUAL CREDIT TO HIS ACCOUNT THROUGH 2016 PROVIDED HE REMAINS EMPLOYED IN HIS CURRENT POSITION. AMOUNTS CREDITED UNDER THE PLAN WILL BE PAYABLE UPON THE EARLIER OF: (1) TERMINATION WITHOUT CAUSE; (2) DISABILITY; (3) DEATH; OR (4) AUGUST 31, 2016 PROVIDED MR. DAWES REMAINS EMPLOYED AT THAT DATE. THE INITIAL CREDIT TO MR. DAWES PLAN OF $300,000 IS INCLUDED IN SCHEDULE J, PART II, COLUMN (C). 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 B(III) OTHER REPORTABLE COMPENSATION in schedule J-1, Column B-III INCLUDES HOUSING ASSISTANCE, SEVERANCE PAYMENTS, SERP CASH DISTRIBUTION, ACCRUED VACATION PAY OUT, AND GROUP TERM LIFE. IN ADDITION, LPCH HAS PROVIDED VARIOUS ITEMS OF "LISTED PROPERTY" (E.G. COMPUTERS AND PERIPHERALS) TO THE ABOVE LISTED EMPLOYEES PRINCIPALLY FOR THEIR BUSINESS USE. 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 LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD ("LPCH") LEASES ITS EMPLOYEES FROM STANFORD HOSPITAL AND CLINICS ("SHC") AND REIMBURSES SHC FOR THE COST OF THE EMPLOYEES. LPCH'S REIMBURSEMENT OF SALARIES, BENEFITS AND PAYROLL TAXES TOTALED $378,946,962 AND IS INCLUDED IN PART IX, LINES 5-10. THE TOTAL NUMBER OF EMPLOYEES LEASED FROM SHC FOR THE FISCAL YEAR 2012 WAS 3,017.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number
77-0003859
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LWQ6 03-21-2012 93,450,000 REFUND 2008 ISSUE   X   X   X
B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LWR4 03-21-2012 270,684,581 FINANCE HEALTH FAC & REDEMPTION OF   X   X   X
C CALIFORNIA HEALTH FACILITES FINANCING AUTHORITY
  		52-1643828 13033FPB0 07-09-2003 118,112,900 TO FINANCE HEALTH FACILITIES X     X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 60,000,000  
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 55,000,000  
3 Total proceeds of issue . . . . . . . . . . . . . 93,450,000 270,684,581 132,946,826  
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . 0 183,154 4,198,843  
6 Proceeds in refunding escrows . . . . . . . . . . . 0 58,857,496 0  
7 Issuance costs from proceeds . . . . . . . . . . . 547,136 2,931,081 1,656,550  
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0  
9 Working capital expenditures from proceeds . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . 0 10,754,357 127,091,433  
11 Other spent proceeds . . . . . . . . . . . 92,902,864 0 0  
12 Other unspent proceeds . . . . . . . . . . . 0 197,958,493 0  
13 Year of substantial completion . . . . . . . . . . . 2009 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X     X   X    
15 Were the bonds issued as part of an advance refunding issue? . . . .   X X     X    
16 Has the final allocation of proceeds been made? . . . . . . X     X X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X    
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X   X      
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X   X    
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000%   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0.00000%   %   %
7 Does the bond issue meet the private security or payment test? . . . X   X   X      
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X    
2 Is the bond issue a variable rate issue?   X X   X      
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .                
b Name of provider . . . . . . 0
  		0
  		0
  		 
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X X      
6 Did the bond issue qualify for an exception to rebate? . X     X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X     X   X    
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SEE SCHEDULE O 0  
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) ELIZABETH DAWES SEE PART V 77,936 COMP FOR EMPLOYMENT   No
(2) KATHLEEN COX SEE PART V 210,648 COMP FOR EMPLOYMENT   No
(3) ANGELA KOPETSKY SEE PART V 131,611 COMP FOR EMPLOYMENT   No
(4) LUKE AURELIO SEE PART V 83,697 COMP FOR EMPLOYMENT   No
(5) MEDTRONIC SEE PART V 1,018,654 PAYMENT FOR PRODUCTS   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
RELATIONSHIP BETWEEN PERSON AND ORGANIZATION FORM 990, SCHEDULE L, PART IV COLUMN (B) ELIZABETH DAWES: EMPLOYEE IS A FAMILY MEMBER OF A DIRECTOR. KATHLEEN COX: EMPLOYEE IS A FAMILY MEMBER OF A DIRECTOR. ANGELA KOPETSKY: EMPLOYEE IS A FAMILY MEMBER OF A KEY EMPLOYEE. LUKE AURELIO: EMPLOYEE IS A FAMILY MEMBER OF A KEY EMPLOYEE. MEDTRONIC: A DIRECTOR OF LPCH IS ALSO A DIRECTOR OF MEDTRONIC. THE DIRECTOR DID NOT PARTICIPATE IN ANY WAY IN DECISION MAKING OR DISCUSSION OF THE RELATIONSHIP BETWEEN LPCH AND MEDTRONIC.
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Identifier Return Reference Explanation
ORGANIZATION'S PRIMARY EXEMPT PURPOSE FORM 990, PART I, LINE 1 THE SPECIFIC AND PRIMARY EXEMPT PURPOSES OF LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD ("LPCH") ARE TO SUPPORT, BENEFIT AND FURTHER THE CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES OF THE BOARD OF TRUSTEES OF THE LELAND STANFORD JUNIOR UNIVERSITY (THE "UNIVERSITY"), INCLUDING ITS SCHOOL OF MEDICINE, AND STANFORD HOSPITAL AND CLINICS ("SHC") BY OPERATING AND MANAGING A CONSOLIDATED MEDICAL FACILITY THAT OFFERS COMPREHENSIVE MEDICAL CARE SERVICES FOR CHILDREN AND ADOLESCENTS AND OBSTETRICAL SERVICES FOR PREGNANT WOMEN AND FURTHERS TEACHING AND RESEARCH IN THE MEDICAL SCIENCES AND OTHER FIELDS RELATING TO THE HEALTH AND WELL-BEING OF INFANTS, CHILDREN, ADOLESCENTS AND PREGNANT WOMEN, IN COOPERATION WITH AND IN SUPPORT OF THE UNIVERSITY'S SCHOOL OF MEDICINE AND STANFORD HOSPITAL AND CLINICS. FORM 990, PART III, LINE 4a PROGRAM SERVICE DESCRIPTION JOHNSON CENTER OF EXCELLENCE THE JOHNSON CENTER IS A CENTER OF EXCELLENCE THAT ENCOMPASSES MATERNITY CARE AND HIGH RISK OBSTETRICS AS WELL AS HEALTHY NEWBORN AND NEONATAL INTENSIVE CARE BUILT UPON A SUCCESSFUL ACADEMIC-COMMUNITY HOSPITAL PARTNERSHIP. IN 2012, WE CONTINUED TO SERVE THE ACADEMIC MISSION OF THE STANFORD SCHOOL OF MEDICINE FACULTY AND THE COMMUNITY THROUGH OUR COMPREHENSIVE MATERNITY PROGRAM AND NEONATAL PROGRAMS. WITH A STRONG SUPPORT FROM LOCAL PROVIDERS, OBSTETRICIANS IN PRIVATE PRACTICE CONTINUED TO CHOOSE LPCH TO DELIVER THEIR PATIENTS. THE JOHNSON CENTER ALSO MANAGES SIX CLINICAL OUTREACH SERVICES IN MATERNAL-FETAL MEDICINE, PROVIDING EARLY DIAGNOSIS AND CONSULTATIVE SERVICES FOR HIGH RISK MATERNITY CARE THROUGHOUT THE REGION: PALO ALTO, REDWOOD CITY, MOUNTAIN VIEW, FREMONT, SALINAS AND SANTA CRUZ. IN 2012, THE JOHNSON CENTER CONTINUED ITS INVESTMENT IN BEHAVIORAL-DEVELOPMENTAL PEDIATRICS. THIS HAS EXPANDED A CLINICAL SERVICE OF IMPORTANCE TO CHILDREN BY ENHANCING CAPABILITIES FOR LONG-TERM FOLLOW-UP FOR PATIENTS GRADUATING FROM THE NEONATAL INTENSIVE CARE UNIT. WITH A FOCUS OF ENHANCING OUR PATIENT EXPERIENCE, WE HAVE DEVELOPED TWO NEW PROGRAMS IN FY 2012. THE HOME SWEET HOME PROGRAM ALLOWS WOMEN WITH UNCOMPLICATED DELIVERIES TO GO HOME A DAY EARLY AND THEN HAVE A HOME VISIT WITH AN EXPERIENCED MOTHER-BABY RN. FOR HIGH RISK PREGNANT WOMEN, WE HAVE DEVELOPED AN ANTEPARTUM HOUSING PROGRAM. THE PROGRAM PROVIDES HOUSING FOR WOMEN FROM BOTH OUR FETAL CENTER AND HIGH RISK ANTEPARTUM UNIT. THE JOHNSON CENTER CONTINUES TO LEAD IN THE DEVELOPMENT AND EVALUATION OF SIMULATION TRAINING, BOTH IN THE LABORATORY, AND ON-SITE. SIMULATION TRAINING PROVIDES STAFF AND THE COMMUNITY AN OPPORTUNITY TO LEARN IN A SUPPORTED ENVIRONMENT. THE JOHNSON CENTER SERVICES ARE LOCAL AND REGIONAL IN NATURE. THE REGION HAS EXPERIENCED A DECLINE IN BIRTHS IN RECENT YEARS. CONSISTENT WITH THIS MARKET TREND, OBSTETRIC DISCHARGES FROM LPCH'S JOHNSON CENTER DROPPED TO 4,467 IN FISCAL YEAR 2012 - COMPARED TO THE PRIOR YEAR DISCHARGES OF 4,637. THE AVERAGE LENGTH OF STAY FOR OBSTETRIC PATIENTS REMAINED STABLE AT 3.2 DAYS COMPARED TO 3.1 DAYS IN THE PRIOR YEAR. OBSTETRIC PATIENTS FROM THE PRIMARY SERVICE AREA COUNTIES OF SAN MATEO AND SANTA CLARA ACCOUNTED FOR 89% OF DISCHARGES IN FY 2012. TEN PERCENT OF PATIENTS CAME FROM THE EIGHT BAY AREA COUNTIES AND 1% FROM THE REMAINING CALIFORNIA COUNTIES. THE JOHNSON CENTER NEONATAL INTENSIVE CARE UNIT SERVED A TOTAL OF 1,330 INPATIENTS IN FISCAL YEAR 2012 COMPARED TO 1,427 IN THE PRIOR YEAR. OF THOSE PROVIDED IN FY 2012, 60% WERE FROM THE PRIMARY SERVICE AREA, WITH 36% COMING FROM THE EIGHT-COUNTY BAY AREA AND 5% FROM OUTSIDE THE BAY AREA. BOTH THE LENGTH OF STAY AND CASE MIX INDEX FOR NEONATAL PATIENTS INCREASED IN FISCAL YEAR 2012, INDICATING AN INCREASE IN THE ACUITY OF THE PATIENTS RECEIVING CARE AT PACKARD CHILDREN'S. THE SERVICE HAD AN AVERAGE LENGTH OF STAY OF 14.5 DAYS COMPARED TO 13.1 DAYS IN THE PRIOR YEAR, AND A CASE MIX INDEX OF 2.91 COMPARED TO 2.71 IN 2011. FORM 990, PART III, LINE 4b PROGRAM SERVICE DESCRIPTION CHILDREN'S HEART CENTER THE HEART CENTER'S VISION IS TO BRING TOGETHER PROFESSIONAL AND FACILITY RESOURCES UNDER ONE CENTER OF EXCELLENCE THAT SERVES BOTH OUR LOCAL PATIENTS AND THE GREATER COMMUNITY. WITH A MULTIDISCIPLINARY TEAM SPECIALLY TRAINED TO DIAGNOSE AND TREAT INFANTS, CHILDREN, AND YOUNG ADULTS WITH CONGENITAL AND ACQUIRED HEART DISEASES, THE CENTER CARES FOR CHILDREN REQUIRING SPECIALIZED CARDIOTHORACIC SERVICES ON A NATIONAL AND INTERNATIONAL BASIS, DRAWING PATIENTS FROM ALL OVER CALIFORNIA, AT LEAST 34 DIFFERENT STATES, AND SEVERAL DIFFERENT COUNTRIES. THE PROGRAM GOALS FOR THE YEAR WERE AIMED AT CONTINUING THE INTEGRATION AND EXPANSION OF THE CLINICAL, ADMINISTRATIVE, AND ACADEMIC ACTIVITIES TO BETTER SERVE OUR PEDIATRIC POPULATION -- CARDIOLOGY, CARDIAC SURGERY, CARDIAC INTENSIVE CARE, CARDIAC ANESTHESIA, AND CARDIAC IMAGING. ADDITIONALLY, WE CONTINUE TO FOCUS ON EARLY IDENTIFICATION OF CARDIAC ANOMALIES THROUGH OUR FETAL ECHOCARDIOGRAPHY PROGRAM, IN CONJUNCTION WITH THE CENTER FOR FETAL AND MATERNAL HEALTH. IN 2012, OUR VENTRICULAR ASSIST DEVICE PROGRAM CONTINUED TO GROW TO CARE FOR THE SICKEST OF CHILDREN WITH ADVANCED HEART FAILURE, AND WE IMPLANTED 40 ASSIST DEVICES OVER THE PAST THREE YEARS. IN ADDITION, WE HAVE ADDED THE SYNCARDIA TOTAL ARTIFICIAL HEART TO OUR ARMAMENTARIUM OF CARE FOR IMPLANTABLE DEVICES IN APPROPRIATE CASES. IN FISCAL YEAR 2012, THE HEART CENTER FOCUSED ON IMPROVING THE CAPABILITIES OF THE 20-BED CARDIOVASCULAR INTENSIVE CARE UNIT. THE CENTER ALSO CONTINUED TO EXPAND THE SERVICES OFFERED, BOTH IN LOCATION AND SPECIALTY. ONE EXAMPLE IS THE DEVELOPMENT AND EXPANSION OF THE ADULT CONGENITAL HEART PROGRAM IN CONJUNCTION WITH STANFORD HOSPITAL & CLINICS, A PARTNERSHIP TO CARE FOR PATIENTS WITH CONGENITAL HEART DEFECTS AS THEY REACH ADULTHOOD. WE ALSO EXPANDED OUR OUTREACH CAPABILITIES BY ESTABLISHING OFFSITE OFFICES IN SAN FRANCISCO, PASO ROBLES, CRESCENT CITY, AND CHICO. THE NUMBER OF INPATIENTS SERVED BY THE HEART CENTER INCREASED FROM 772 IN FISCAL YEAR 2011 TO 863 IN FISCAL YEAR 2012. OF THESE, THERE WERE 487 CARDIAC SURGERIES AND 15 HEART TRANSPLANTS. THE INPATIENT PROGRAM HAD A CASE MIX INDEX OF 5.32, INDICATING THE HIGHLY COMPLEX POPULATION THAT WE SERVE. TWENTY-FOUR PERCENT OF PATIENTS CAME FROM OUR PRIMARY SERVICE AREA OF SAN MATEO AND SANTA CLARA COUNTIES, 26% CAME FROM THE EIGHT-COUNTY BAY AREA, 27% CAME FROM OTHER AREAS WITHIN CALIFORNIA, AND 29% CAME FROM OTHER STATES. FORM 990, PART III, LINE 4c PROGRAM SERVICE DESCRIPTION CANCER CENTER OF EXCELLENCE THE BASS CENTER IS A CENTER OF EXCELLENCE THAT OFFERS COMPREHENSIVE CARE AND INNOVATIVE THERAPIES FOR CHILDREN WITH CANCER AND BLOOD DISEASES. THIS STATE-OF-THE-ART FACILITY INTEGRATES INPATIENT AND OUTPATIENT CARE AND HAS A 27-BED INPATIENT UNIT (15 HEMATOLOGY/ONCOLOGY BEDS AND 12 STEM CELL TRANSPLANT BEDS) ALONG WITH A CONTIGUOUS 8-BED DAY HOSPITAL, INFUSION ROOM, LAB, AND CLINIC. THE CENTER ALSO HAS EIGHT BEDS ALLOCATED TO THE PROGRAM TO SUPPORT CHEMOTHERAPY INPATIENT INFUSIONS AT THE LPCH-LICENSED INPATIENT UNIT AT EL CAMINO HOSPITAL OF MOUNTAIN VIEW OF CALIFORNIA. THE CENTER IS STAFFED BY INDIVIDUALS TRAINED IN THE SPECIALIZED NEEDS OF PEDIATRIC CANCER PATIENTS AND INCLUDES APPROPRIATE ISOLATION ROOMS. THE PROGRAM DIAGNOSES AND TREATS APPROXIMATELY OVER 160 NEW CANCER PATIENTS PER YEAR. IN 2012, THE CENTER DEVELOPED A FIVE-YEAR VISION AND STRATEGIC PLAN. THE BASS CENTER GOAL IS TO HAVE A COMPREHENSIVE PLAN THAT WILL SERVE MORE PATIENTS, DEVELOP A MORE ROBUST RESEARCH PLATFORM, AND EXPAND ITS GEOGRAPHIC REACH TO PROVIDE MORE CHILDREN WITH ACCESS TO THE SPECIALIZED SERVICES OFFERED BY THE CENTER. INPATIENT DISCHARGES FOR HEMATOLOGY/ONCOLOGY AND STEM CELL TRANSPLANT IN FISCAL YEAR 2012 TOTALED 1,115 WITH A CASE MIX INDEX OF 1.72 AND AN AVERAGE LENGTH OF STAY OF 8.3 DAYS. THE BASS CENTER IS A STRONG REGIONAL PROGRAM WITH 45% OF PATIENTS COMING FROM THE PRIMARY SERVICE AREA OF SAN MATEO AND SANTA CLARA COUNTIES, 40% FROM THE EIGHT SURROUNDING BAY AREA COUNTIES, 14% FROM OTHER CALIFORNIA COUNTIES, AND 1% FROM OUTSIDE THE STATE OF CALIFORNIA.
FORM 990, PART III, LINE 4d   PROGRAM SERVICE DESCRIPTION OTHER PROGRAMS IN ADDITION TO THE THREE PROGRAMS DESCRIBED ABOVE, LUCILE PACKARD CHILDREN'S HOSPITAL PROVIDES CLINICAL SERVICES THROUGH THREE ADDITIONAL CENTERS OF EXCELLENCE: CENTER FOR CHILDREN'S BRAIN AND BEHAVIOR THIS CENTER SPECIALIZES IN TREATING DISORDERS OF BRAIN DEVELOPMENT AND FUNCTION, WHICH MAY MANIFEST THEMSELVES IN BEHAVIORAL, EMOTIONAL, LEARNING, LANGUAGE, DEVELOPMENT, SENSATION, OR MOVEMENT ABNORMALITIES. THE CENTER COMBINES THE EXPERTISE OF SPECIALISTS IN A BROAD RANGE OF DISEASES, INCLUDING EPILEPSY, AUTISM AND DEVELOPMENTAL DISORDERS, MOVEMENT DISORDERS, CEREBROVASCULAR DISORDERS, DEPRESSION, BIPOLAR AND ANXIETY DISORDERS, TRAUMATIC BRAIN INJURY, NEUROGENETIC DISORDERS, BRAIN TUMORS, AND CONGENITAL CENTRAL NERVOUS SYSTEM DEFECTS. THE HOSPITAL'S CENTER FOR BRAIN TUMORS IS ONE OF THE LEADING PROGRAMS IN THE COUNTRY. THE EATING DISORDER PROGRAM LINKS AN INPATIENT PROGRAM WITH AN EVIDENCE-BASED OUTPATIENT PROGRAM THAT COORDINATES MEDICAL AND PSYCHIATRIC TREATMENT. A NUMBER OF PHYSICIAN RECRUITMENTS WERE COMPLETED IN FISCAL YEAR 2012, WHICH WILL ALLOW THE CENTER TO EXPAND SERVICES FOR CHILDREN WITH COMPLEX NEUROLOGICAL DISEASES SUCH AS NEUROMUSCULAR DISEASE, MOVEMENT DISORDERS, STROKE AND EPILEPSY. IN ALL OF THE CENTER'S PROGRAMS, PSYCHIATRISTS, PSYCHOLOGISTS, NEUROSURGEONS, AND NEUROLOGISTS WORK CLOSELY WITH BASIC RESEARCHERS TO DISCOVER THE INNER WORKINGS OF THE BRAIN AND HOW IT IMPACTS BEHAVIOR SO THAT CHILDREN COPING WITH COMPLEX CONDITIONS MAY LEAD MORE FULL AND PRODUCTIVE LIVES. CENTER FOR CYSTIC FIBROSIS AND PULMONARY DISEASES THIS CENTER INTEGRATES AN INTERDISCIPLINARY TEAM OF CLINICIANS AND RESEARCHERS FROM LPCH AND THE STANFORD SCHOOL OF MEDICINE. THEIR COMBINED EFFORTS HAVE PRODUCED A PROGRAM THAT FOCUSES ON LEADING EDGE CARE OF CHILDREN WITH A PLETHORA OF RESPIRATORY AND PULMONARY CONDITIONS, FROM THE COMMON AND SIMPLE TO THE COMPLEX AND RARE. THE CENTER IS ONE OF THE LARGEST CARE PROVIDERS FOR CHILDREN WITH CONDITIONS SUCH AS CYSTIC FIBROSIS, ASTHMA, CHRONIC LUNG DISEASE OF INFANCY RESULTING FROM PREMATURE BIRTH AND IMMATURE LUNGS, ACUTE OR CHRONIC RESPIRATORY INFECTIONS, MULTI-SYSTEM DISORDERS THAT AFFECT BREATHING AND LUNGS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR DISEASES SUCH AS SPINAL MUSCULAR ATROPHY (SMA) AND OTHER MUSCULAR DYSTROPHIES, AS WELL AS OTHER GENETIC AND METABOLIC DISORDERS THAT IMPACT SWALLOWING AND BREATHING. IN ADDITION, THE CENTER IS HOME TO A DEDICATED PEDIATRIC SLEEP PROGRAM AND OPERATES ONE OF THE FEW ACTIVE LUNG TRANSPLANT PROGRAMS IN THE UNITED STATES DEDICATED EXCLUSIVELY TO CHILDREN. CENTER FOR TRANSPLANT AND TISSUE ENGINEERING THIS CENTER PERFORMS PEDIATRIC KIDNEY, LIVER, AND INTESTINAL TRANSPLANTS AND SPECIALIZES IN DIALYSIS AND TRANSPLANTATION OF INFANTS, CHILDREN, AND HIGHLY COMPLEX CASES. THE TRANSPLANT PROGRAM RANKS AMONG THE TOP PROGRAMS IN THE NATION IN THE NUMBER OF PEDIATRIC KIDNEY AND LIVER TRANSPLANTS PERFORMED, AND CONTINUES TO DELIVER OUTCOMES AMONG THE BEST IN THE COUNTRY. THE TRANSPLANT TEAM HAS PIONEERED NEW APPROACHES TO IMMUNOSUPPRESSION AND CONTINUES TO DEVELOP AND IMPLEMENT INNOVATIVE TREATMENT STRATEGIES TO REDUCE POST-TREATMENT COMPLICATIONS AND IMPROVE OUTCOMES. ADDITIONALLY, RESEARCH AND EDUCATION ARE PRIMARY COMPONENTS OF THE HOSPITAL'S MISSION AND INTEGRAL TO THE HOSPITAL'S CLINICAL OPERATIONS. THE HOSPITAL IS COMMITTED TO SUPPORTING AND FUNDING QUALITY GRADUATE MEDICAL EDUCATION PROGRAMS AND EXCELLENCE IN RESIDENCY TRAINING AND RESEARCH. LUCILE PACKARD CHILDREN'S HOSPITAL CURRENTLY SPONSORS 23 RESIDENCY/FELLOWSHIP PROGRAMS APPROVED BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATIONS WITH OVER 167 ENROLLED RESIDENTS AND FELLOWS (STATED IN FULL TIME EQUIVALENTS). RESIDENCY PROGRAMS IN PHARMACY, SOCIAL WORK, HOSPITAL CHAPLAINCY, AND NURSING ARE ALSO PROVIDED. LUCILE PACKARD CHILDREN'S PARTNERS WITH STANFORD SCHOOL OF MEDICINE TO CONDUCT RESEARCH IN ALL SIX CENTERS OF EXCELLENCE DESCRIBED ABOVE. LUCILE PACKARD CHILDREN'S HOSPITAL IS ALSO COMMITTED TO ADVOCACY AND COMMUNITY OUTREACH TO IMPROVE THE HEALTH STATUS OF CHILDREN AND PREGNANT WOMEN BY DEVELOPING AND SUPPORTING INNOVATIVE PROGRAMS (PRIMARILY WITHIN ITS PRIMARY SERVICE AREAS OF SAN MATEO AND SANTA CLARA COUNTIES AND BEYOND) TO ENHANCE ITS OWN AND THE COMMUNITY'S CAPACITY TO CARE FOR CHILDREN AND PREGNANT WOMEN. THESE PROGRAMS INCLUDE: - MOBILE ADOLESCENCE HEALTH SERVICES - CARE A VAN FOR KIDS - PARTNERSHIP WITH RAVENSWOOD FAMILY HEALTH CENTER - SUPPORT FOR PEDIATRIC WEIGHT CONTROL PROGRAM - SUPPORT OF CHILDREN'S HEALTH INSURANCE INITIATIVES - SUPPORT OF PUTTING HEALTHCARE BACK IN SCHOOLS INITIATIVE - SUPPORT FOR PEDIATRIC RESIDENT ADVOCACY PROGRAM - VARIOUS COMMUNITY HEALTH EDUCATION PROGRAMS - PRACTICAL SUPPORT TO PATIENT AND FAMILIES (MEALS, TRANSPORTATION, INFANT CAR SEATS, BABY CARE EQUIPMENT, AND OTHER EXPENSES). EQUIPMENT AND SUPPLY DONATIONS TO A NUMBER OF OVERSEAS MISSIONS. IN THE COUNTIES THAT COMPRISE THE HOSPITAL'S PRIMARY SERVICE AREA, NEARLY ALL CHILDREN ARE ELIGIBLE FOR HEALTH INSURANCE COVERAGE THROUGH EITHER GOVERNMENT-SPONSORED OR LOCAL INITIATIVE INSURANCE PROGRAMS. HOWEVER, NEARLY ALL OF THESE PROGRAMS REIMBURSE THE HOSPITAL AT AMOUNTS FAR LESS THAN THE COST OF SERVICES PROVIDED. ADDITIONALLY, PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE HOSPITAL'S CHARITY CARE POLICY RECEIVE SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES.
EXECUTIVE COMMITTEE FORM 990, PART VI, LINE 1A IF A MATTER NORMALLY REQUIRING ACTION BY THE BOARD OF DIRECTORS ARISES BETWEEN MEETINGS OF THE BOARD AND IS A MATTER WHICH, IN THE OPINION OF ANY FOUR (4) OUT OF SIX (6) OF THE CHAIR OF THE BOARD, THE VICE CHAIR, THE DEAN OF THE STANFORD UNIVERSITY SCHOOL OF MEDICINE, THE PRESIDENT OF THE CORPORATION, THE CHAIR OF THE FINANCE COMMITTEE AND THE CHAIR OF THE AUDIT COMMITTEE, REQUIRES ACTION BY THE BOARD BEFORE THE NEXT REGULAR OR SPECIAL MEETING OF THE BOARD, THEN ANY FOUR (4) OR MORE OUT OF THOSE SIX (6) DIRECTORS ACTING AS A COMMITTEE OF THE BOARD OF DIRECTORS, ARE AUTHORIZED JOINTLY TO TAKE WHATEVER ACTION IS NECESSARY TO RESOLVE THE MATTER, AND SUCH ACTION WILL CONSTITUTE AUTHORIZED ACTION OF THE BOARD TO THE SAME EXTENT AS IF IT HAS BEEN ADOPTED AT A MEETING OF THE BOARD; PROVIDED, HOWEVER, THAT AT LEAST ONE (1) OF THE FOUR (4) DIRECTORS ACTING AS A COMMITTEE OF THE BOARD PURSUANT TO THIS SECTION SHALL BE AN "OUTSIDE DIRECTOR," AS DEFINED IN BYLAWS AND PROVIDED, FURTHER, THAT THE DIRECTORS ACTING AS A COMMITTEE OF THE BOARD SHALL NOT IN ANY CASE BE AUTHORIZED BY THIS SECTION TO EXERCISE THOSE POWERS WHICH BY LAW, THE ARTICLES OF INCORPORATION, THESE BYLAWS OR SPECIFIC ACTION BY THE MEMBER, SET FORTH IN A RESOLUTION OF THE MEMBER, MAY BE EXERCISED ONLY BY THE MEMBER OR MAY NOT BE DELEGATED TO A COMMITTEE OF THE BOARD. FAMILY/BUSINESS RELATIONSHIPS FORM 990, PART VI, LINE 2 KENNETH COX, THOMAS KRUMMEL, HUGH O'BRODOVICH, PHILIP PIZZO AND CHRISTY SANDBORG ARE EMPLOYEES OF STANFORD UNIVERSITY. PHILIP PIZZO IS THE DEAN OF THE STANFORD SCHOOL OF MEDICINE, AND MARIANN BYERWALTER IS A TRUSTEE OF STANFORD UNIVERSITY. DAVID ALEXANDER IS THE CEO AND A DIRECTOR OF LUCILE PACKARD FOUNDATION FOR CHILDREN'S HEALTH (LPFCH). CHRISTOPHER DAWES AND SUSAN ORR ARE DIRECTORS OF LPFCH. MEMBERS FORM 990, PART VI, LINE 6 STANFORD UNIVERSITY IS THE SOLE MEMBER OF LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD. FORM 990, PART VI, LINE 7A STANFORD UNIVERSITY, AS THE SOLE MEMBER OF LPCH, APPOINTS THE LPCH BOARD OF DIRECTORS. 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 FINANCE 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") WITHIN 30 DAYS OF BEGINNING SERVICE AT LUCILE PACKARD CHILDREN'S HOSPITAL (LPCH). ADDITIONALLY, AN UPDATED DISCLOSURE STATEMENT IS REQUIRED THEREAFTER ON AN ANNUAL BASIS. FURTHER, OFFICERS, DIRECTORS AND EMPLOYEES ARE REQUIRED TO UPDATE THEIR DISCLOSURE STATEMENT WITHIN TEN (10) BUSINESS DAYS OF A MATERIAL CHANGE IN THEIR SITUATIONS THAT MAY CREATE AN ACTUAL OR PERCEIVED CONFLICT-OF-INTEREST. A DISCLOSURE THAT APPEARS TO BE A CONFLICT WILL BE RESOLVED BY A MUTUAL AGREEABLE PLAN WITH THE VICE PRESIDENT OF HUMAN RESOURCES THAT OUTLINES THE STEPS THE OFFICER, DIRECTOR OR EMPLOYEE MUST TAKE TO RECTIFY THE CONFLICT. IN MATTERS THAT ARE UNCLEAR OR QUESTIONABLE, THE OFFICE OF CHIEF COMPLIANCE OFFICER WILL BE CONSULTED FOR A RULING. IF FURTHER INQUIRY IS NECESSARY THE OFFICE OF THE GENERAL COUNSEL WILL BE CONSULTED FOR A RULING. FORM 990, PART VI, LINE 14 LPCH currently has a document retention and destruction policy for its medical records that has been approved by its governing body. All other document retention and destruction policies have been approved by management. PROCEDURES FOR DETERMINING COMPENSATION FORM 990, PART VI, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION FOR LPCH'S CEO AND OTHER TOP MANAGEMENT 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. HOURS AT RELATED ORGANIZATIONS FORM 990, PART VII KENNETH COX: 50 HOURS AT STANFORD UNIVERSITY AND 1 HOUR AT UNIVERSITY HEALTHCARE ALLIANCE THOMAS KRUMMEL: 50 HOURS AT STANFORD UNIVERSITY HUGH O'BRODOVICH: 50 HOURS AT STANFORD UNIVERSITY PHILIP PIZZO: 50 HOURS AT STANFORD UNIVERSITY AND 2 HOURS AT STANFORD HOSPITAL AND CLINICS CHRISTY SANDBORG: 50 HOURS AT STANFORD UNIVERSITY MARIANN BYERWALTER: 2 HOURS AT STANFORD UNIVERSITY AND 2 HOURS AT STANFORD HOSPITAL AND CLINICS MARK TORTORICH: 25 HOURS AT STANFORD HOSPITAL AND CLINICS CHRISTOPHER G DAWES: 2 HOURS AT STANFORD HOSPITAL AND CLINICS DENISE O'LEARY: 2 HOURS AT STANFORD HOSPITAL AND CLINICS JOHN LILLIE: 2 HOURS AT STANFORD HOSPITAL AND CLINICS COMPENSATION OF LEASED EMPLOYEES FORM 990, PART IX, LINES 5-10 LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD ("LPCH") LEASES ITS EMPLOYEES FROM STANFORD HOSPITAL AND CLINICS ("SHC") AND REIMBURSES SHC FOR THE COST OF THE EMPLOYEES. LPCH'S REIMBURSEMENT OF SALARIES, BENEFITS AND PAYROLL TAXES TOTALED $378,946,962 AND IS INCLUDED IN PART IX, LINES 5-10. THE TOTAL NUMBER OF EMPLOYEES LEASED FROM SHC FOR THE FISCAL YEAR 2012 WAS 3,017. RECONCILIATION FORM 990, PART XI, LINE 5 CHANGE IN VALUE OF BENEFICIAL INTEREST IN REMAINDER TRUSTS (10,616) ADJUSTMENT FOR MINIMUM PENSION AND POST RETIREMENT LIABILITY 964,000 TRANSFER TO STANFORD UNIVERSITY AND OTHER (7,825,908) TRANSFER OF NET INVESTMENT LOSS ON CERTAIN ENDOWMENTS 60,853 UNREALIZED GAIN ON UNIVERSITY MANAGED POOLED FUND 5,130,681 ______________ (1,680,990) SCHEDULE K, PART II, LINE 3 DIFFERENCE IN COLUMN (A) REPRESENTS INVESTMENT EARNINGS. SCHEDULE K, PART III, LINES 4 & 5 LPCH HAS CONDUCTED AN EXTENSIVE ANALYSIS OF ALL ACTIVITIES CONDUCTED WITHIN ITS BOND-FINANCED FACILITIES AND HAS DETERMINED THAT, EXCEPT FOR A DE MINIMUS AMOUNT OF INCIDENTAL USE, THERE IS NO PRIVATE BUSINESS USE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Lucile Salter Packard Children's
Hospital at Stanford
Employer identification number

77-0003859
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) STANFORD HOSPITAL AND CLINICS

300 PASTEUR DRIVE MC 5555

STANFORD,CA94304
94-6174066 		HEALTHCARE CA 501(C)(3) 3 STANFORD
 
Yes
 
(2) LELAND STANFORD JUNIOR UNIVERSITY

3145 PORTER DR

PALO ALTO,CA94304
94-1156365 		ACADEMIA CA 501(C)(3) 2 NA
 
 
No
(3) THE FREIDENRICH SUPPORT FOUNDATION

3145 PORTER DRIVE

PALO ALTO,CA94304
30-0519583 		EDUCATIONAL CA 501(C)(3) 11, TYPE 1 STANFORD
 
Yes
 
(4) SHR HOLDINGS INC

3145 PORTER DRIVE

PALO ALTO,CA94304
94-3187167 		REAL ESTATE CA 501(C)(25) N/A STANFORD
 
Yes
 
(5) STANFORD UNIV TRUST POST RETEMPYNT BEN

3145 PORTER DRIVE

PALO ALTO,CA94304
94-3246199 		BENEFITS CA 501(C)(9) N/A STANFORD
 
Yes
 
(6) UNIVERSITY HEALTHCARE ALLIANCE

855 OAK GROVE AVE SUITE 100

MENLO PARK,CA94205
94-3192446 		HEALTHCARE CA 501(C)(3) 3 SHC
 
Yes
 
(7) STANFORD UNIVERSITY BOOK STORE

BLDG 60 MAIN QUAD NO 105

STANFORD,CA94305
94-0894150 		SUPPORT CA 501(C)(3) 11, TYPE I STANFORD
 
Yes
 
(8) STANFORD SCHOOLS CORPORATION

475 POPE STREET

MENLO PARK,CA94025
20-2699147 		EDUCATIONAL CA 501(C)(3) 2 STANFORD
 
Yes
 
(9) PACKARD CHILDREN'S HEALTH ALLIANCE

725 WELCH ROAD MC5551

PALO ALTO,CA94304
32-0359189 		HEALTHCARE CA 501(C)(3) 3 LPCH
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) ARCOLA LP

C/O ARCOLOA GP LLC 1 EMBARCADERO C
SAN FRANCISCO,CA94111
20-4222260 		REAL ESTATE D DE na
  		n/a                
(2) ATWATER 12 LP

2001 ROSS AVENUE SUITE 1600
DALLAS,TX75201
75-2944481 		REAL ESTATE I DE na
  		n/a                
(3) AVENUE ASIA CAPITAL PARTNERS LP

399 Park Avenue 6th Floor
NEW YORK,NY10022
01-0553224 		FOREIGN INV. DE na
  		n/a                
(4) JER R E QUALIFIED PARTNERS EUROPE LP

C/O JE ROBERT COS 1650 TYSON BL
STE MCLEAN,VA22102
54-2029560 		REAL ESTATE I DE na
  		n/a                
(5) KEB INVESTORS II LP

 
 
FOREIGN INV. BD na
  		n/a                
(6) LINCOLN COMMERCE PARK II LTD

PO BOX 1920
DALLAS,TX75221
20-4681486 		REAL ESTATE D DE na
  		n/a                
(7) PALO ALTO LP

 
 
FOREIGN INV. BD na
  		n/a                
(8) PARMENTER REALTY FUND II LP

1111 BRICKELL AVENUE SUITE 2910
MIAMI,FL33131
20-0973616 		REAL ESTATE I DE na
  		n/a                
(9) REGENT OFFICE CENTER LP

c/o Bentall Kennedy US LP 1215 4
SEATTLE,WA98161
91-2116424 		REAL ESTATE I TX na
  		n/a                
(10) SANDPIPER FUND LP

2100 MCKINNEY AVENUE SUITE 1770
DALLAS,TX75201
26-0341626 		INV. IN SECUR TX na
  		n/a                
(11) SAROFIM MULTIFAMILY PARTNERS LP

8115 PRESTON ROAD SUITE 400
DALLAS,TX75225
20-1929002 		Real Estate D DE na
  		n/a                
(12) SKY HARBOR ASSOCIATES LP

PO BOX 1920
DALLAS,TX75221
20-5803431 		COMM. PROP. I DE na
  		n/a                
(13) SNOWCREEK VI PARTNERS LLC

C/O SMC 2770 SAND HILL RD
MENLO PARK,CA94025
86-1089966 		REAL ESTATE D CA na
  		n/a                
(14) STERLING STAMOS REAL ASSETS FUND (A) LP

250 PARK AVENUE 29TH FLOOR
NEW YORK,NY10022
20-3949682 		REAL ESTATE I DE na
  		n/a                
(15) DEK PORTFOLIO LLC

C/O SPAULDING SLYE INV 1 PO S
BOSTON,MA02109
04-3446765 		REAL ESTATE I DE na
  		n/a                
(16) BROWN BARK I LP

PO BOX 1068
STAFFORD,TX774971068
72-1604614 		NOTES REC. IN DE na
  		n/a                
(17) BROWN BARK II LP

PO BOX 1068
STAFFORD,TX774971068
20-8727391 		NOTES REC. IN DE na
  		n/a                
(18) BROWN BARK III LP

PO BOX 1068
STAFFORD,TX774971068
26-1780743 		NOTES REC. IN DE na
  		n/a                
(19) FORTRESS IW COINVESTMENT (FUND B) LP

1345 AVE OF THE AMERICAS 23RD FL
NEW YORK,NY10105
98-0509639 		TRAVEL INV   na
  		n/a                
(20) JER REAL ESTATE PARTNERS EUROPE II LP

 
 
REAL ESTATE I   na
  		n/a                
(21) STANFORD PET-CT LLC

300 PASTEUR DRIVE M/C 5555
STANFORD,CA94305
61-1423414 		MED. DIAGNOSI CA na
  		n/a                
(22) CYPRESS MARINA HEIGHTS LP

2716 COEAN PARK BLVD SUITE 3025
SANTA MONICA,CA90405
95-4887979 		REAL ESTATE I CA na
  		n/a                
(23) CEE EQUITY HOLDINGS LP

 
 
INVESTMENTS   na
  		n/a                
(24) LSF V DHB HOLDINGS LP

2711 North Haskell Avenue Suite 17
DALLAS,TX75204
27-2858604 		INVESTMENTS I DE na
  		n/a                
(25) SIC SNOWCREEK VIII LLC

635 KNIGHT WAY
STANFORD,CA94305
27-5431605 		REAL ESTATE D CA na
  		n/a                
(26) SHI LLC

1400 PAGE MILL ROAD MC5713
PALO ALTO,CA94304
26-3934706 		HOLDING COMPANY DE SHC
  		RELATED       No 0   No 18.000 %
(27) STANFORD EMANUEL RAD ONCOLOGY

880 TUOLUMNE
TURLOCK,CA95382
 RADIOLOGY CA NA
  		                 
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) MARINER VOYAGER INTERNATIONAL LTD
C/O STUARTS CORP SVCS PO BOX 2510
GEORGE TOWN    
CJ
INVESTMENTS CJ na
  		C CORP      
(2) STANFORD SGGS EUROPE INC
UGLAND HOUSE S CHURCH ST
PO BOX 309GT, GEORGE TOWN    
CJ
13-1684331 		INVESTMENTS CJ na
  		C CORP      
(3) BLACK RIVER EMEA INVESTORS FUND LTD
UGLAND HOUSE S CHURCH ST
GEORGE TOWN    
CJ
98-0428006 		INVESTMENTS CJ na
  		C CORP      
(4) EAST SAIL
C/O INTL FS INC IFS COURT
TWENTYEIGHT, CYBERCITY, EBENE    
MP
INVESTMENTS MP na
  		C CORP      
(5) GAVEA INVESTMENT FUND II-C LP
PO BOX 896GT HARBOUR CENTRE
GEORGE TOWN    
CJ
98-0537952 		INVESTMENTS CJ na
  		C CORP      
(6) JER ALBERTA LP
C/O JE ROBERT COS 1650 TYSON BLVD
MCLEAN,VA22102
98-0423557 		INVESTMENTS CA na
  		C CORP      
(7) JER ALBERTA III LP
C/O JE ROBERT COS 1650 TYSON BLVD
MCLEAN,VA22102
98-0493425 		INVESTMENTS CA na
  		C CORP      
(8) MARBLETON PROPERTY FUND (ALBERTA) LP
C/O JE ROBERT COMPANIES 1650 TYSON
MCLEAN,VA22102
98-0531893 		Real Estate I CA na
  		C CORP      
(9) CLAT (16)
 
 
CHARITABLE TR CA na
  		TRUST      
(10) CRT (501)
 
 
CHARITABLE TR CA na
  		TRUST      
(11) OTHER (11)
 
 
CHARITABLE TR CA na
  		TRUST      
(12) PIF (89)
 
 
CHARITABLE TR CA na
  		TRUST      
(13) MIDPOINT TECHNOLOGY PARK
3145 PORTER DR
PALO ALTO,CA94304
94-3287254 		REAL ESTATE CA na
  		C CORP      
(14) NORTHWEST CAMPUS MIDPOINT
3145 PORTER DR
PALO ALTO,CA94304
20-1627958 		REAL ESTATE CA na
  		C CORP      
(15) STANFORD PROGRAMME (CAPE TOWN)
WAVERLY BUSINESS PARK BUILDING 11
CAPE TOWN    
SF
EDUCATION SF na
  		C CORP      
(16) THE HONG KONGSU CHARITABLE TRUST
1401 CAROLINE CENTER
28 PING ROAD,CAUSEWAY  
HK
EDUCATION HK na
  		TRUST      
(17) THE STANFORD TRUST (UK)
65 HIGH STREET
OXFORD, OX1 46L    
UK
EDUCATION UK na
  		TRUST      
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) STANFORD HOSPITAL AND CLINICS (SHC)

 K,L 64,214,627 FMV
(2) STANFORD HOSPITAL AND CLINICS (SHC)

 N 19,689,401 FMV
(3) STANFORD HOSPITAL AND CLINICS (SHC)

 O,P 341,163,046 FMV
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
SCHEDULE R, PART IV, LINE 2   CHARITABLE LEAD ANNUITY TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. SCHEDULE R, PART IV, LINE 3 CHARITABLE REMAINDER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. SCHEDULE R, PART IV, LINE 4 OTHER TRUSTS ARE PRINCIPALLY DOMICILIED IN CALIFORNIA. SCHEDULE R, PART IV, LINE 5 POOLED INVESTMENT FUNDS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. SCHEDULE R, PART V THE PURCHASED SERVICES PAYMENT WITH STANFORD HOSPITAL AND CLINICS IS CALCULATED BASED ON THE RATIO OF DIRECT COST TO CHARGES PLUS NEGOTIATED OVERHEAD. THE SHARED SERVICES WITH STANFORD HOSPITAL AND CLINICS IS A NEGOTIATED FIXED DOLLAR ANNUAL RATE. FOR OTHER SERVICES, PAYMENT IS BASED ON EITHER NEGOTIATED RATE OR CONTRACT AGREEMENT.
Additional Data


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