TY 2013 Form 990 Schedule L

efile Public Visual Render ObjectId: 201521969349301917 - Submission: 2015-07-15 TIN: 77-0003859

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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, line 38a or 40b.
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Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.
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Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

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 assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2013

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Schedule L (Form 990 or 990-EZ) 2013

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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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ELIZABETH DAWES	SEE PART V	73,474	COMP FOR EMPLOYMENT		No
(2) KATHLEEN COX	SEE PART V	188,268	COMP FOR EMPLOYMENT		No
(3) ANGELA KOPETSKY	SEE PART V	128,521	COMP FOR EMPLOYMENT		No
(4) LUKE AURELIO	SEE PART V	91,786	COMP FOR EMPLOYMENT		No
(5) SUMIT INSURANCE COMPANY	SEE PART V	3,761,408	INSURANCE		No
(6) McKesson	SEE PART V	116,412	SUPPLIES		No
(7) Hewlett Packard	SEE PART V	714,466	IT SUPPORT		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
FORM 990, SCHEDULE L, PART IV COLUMN (B)	ELIZABETH DAWES: EMPLOYEE IS A FAMILY MEMBER OF AN OFFICER. 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. SUMIT INSURANCE COMPANY: AN OFFICER AND A DIRECTOR OF LPCH ARE VOTING MEMBERS OF THE SUMIT INSURANCE COMPANY BOARD OF DIRECTORS. THE OFFICERS DID NOT PARTICIPATE IN ANY WAY IN DECISION MAKING OR DISCUSSION OF THE RELATIONSHIP BETWEEN LPCH AND SUMIT INSURANCE COMPANY. McKesson: A Director of LPCH is also a Director of McKesson. The director did not participate in any way in decision making or discussion of the relationship between LPCH and McKesson. Hewlett Packard : A Director of LPCH is also a Director of Hewlett Packard. The director did not participate in any way in decision making or discussion of the relationship between LPCH and Hewlett Packard.

Return Reference

Explanation

FORM 990, SCHEDULE L, PART IV COLUMN (B)

ELIZABETH DAWES: EMPLOYEE IS A FAMILY MEMBER OF AN OFFICER. 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. SUMIT INSURANCE COMPANY: AN OFFICER AND A DIRECTOR OF LPCH ARE VOTING MEMBERS OF THE SUMIT INSURANCE COMPANY BOARD OF DIRECTORS. THE OFFICERS DID NOT PARTICIPATE IN ANY WAY IN DECISION MAKING OR DISCUSSION OF THE RELATIONSHIP BETWEEN LPCH AND SUMIT INSURANCE COMPANY. McKesson: A Director of LPCH is also a Director of McKesson. The director did not participate in any way in decision making or discussion of the relationship between LPCH and McKesson. Hewlett Packard : A Director of LPCH is also a Director of Hewlett Packard. The director did not participate in any way in decision making or discussion of the relationship between LPCH and Hewlett Packard.

Schedule L (Form 990 or 990-EZ) 2013

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