2018-11-15T12:26:45-06:00 2017-12-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2017-01-01 941498697 CALIFORNIA HEALTH FOUNDATION AND TRUST CALI 9165527629 1215 K STREET NO 800 SACRAMENTO CA 95814 JENNIFER NEWMAN SVP & CFO 9165527629 2018-11-09 1 TRACY S PAGLIA P00366884 2099556100 2018-11-09 12.129.7.100 2018-11-09 16:25:38 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 590998BD83A1AFC8298AB8E54118062D6841B7FE 2017 2019-02-21 02:37:17Z CARMELA COYLE 1215 K STREET NO 800 SACRAMENTO CA 95814 76335048 0 X N/A X 1956 CA SUPPORT ACCESS, RESEARCH, AND EDUCATION IN THE HEALTHCARE FIELD 14 13 0 0 0 0 23919217 76061234 0 0 164568 97145 223149 176669 24306934 76335048 49066927 38854988 0 0 49866 65721 0 0 0 3161283 1341021 52278076 40261730 -27971142 36073318 61146638 114208248 18700760 38774866 42445878 75433382 X SUPPORT ACCESS, RESEARCH, AND EDUCATION IN THE FIELD OF HEALTHCARE DELIVERY, FINANCING, AND PATIENT CARE. 0 0 38362833 38362833 2017-2019 HOSPITAL GRANT PROGRAM:STATEWIDE EFFORT TO ASSIST HOSPITALS AND HOSPITAL HEALTH SYSTEMS IN CALIFORNIA TO CONTINUE TO PROVIDE ACCESS TO CARE FOR UNINSURED AND UNDERINSURED PEOPLE, PRESERVE PHYSICAL ACCESS TO CARE, AND PROVIDE COMMUNITY SERVICES SUCH AS MENTAL HEALTH ACCESS, WELLNESS, AND PREVENTION PROGRAMS. THE PROGRAM RECOVERS 3 BILLION OF THE 7 BILLION SHORT FALL ANNUALLY IN MEDI-CAL PAYMENTS. 876220 2014-2016 HOSPITAL GRANT PROGRAM:STATEWIDE EFFORT TO ASSIST HOSPITALS AND HOSPITAL HEALTH SYSTEMS IN CALIFORNIA TO CONTINUE TO PROVIDE ACCESS TO CARE FOR UNINSURED AND UNDERINSURED PEOPLE, PRESERVE PHYSICAL ACCESS TO CARE, AND PROVIDE COMMUNITY SERVICES SUCH AS MENTAL HEALTH ACCESS, WELLNESS, AND PREVENTION PROGRAMS. THE PROGRAM RECOVERS 3 BILLION OF THE 7 BILLION SHORT FALL ANNUALLY IN MEDI-CAL PAYMENTS. 505843 275055 CRITICAL ACCESS HOSPITALS GRANT PROGRAM:TO RETAIN EXPERT SERVICES AND PROVIDE TECHNICAL SUPPORT TO CRITICAL ACCESS HOSPITALS UNDER THE MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM. 438843 17000 OTHER PROGRAM SERVICES IN SUPPORT OF MISSION 438843 17000 40183739 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 5 0 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X JENNIFER NEWMAN CFO 9165527629 1215 K STREET SUITE 800 SACRAMENTO CA 95814 ANN MADDEN RICE CHAIR 1.00 2.00 X X 0 0 0 RICHARD F AFABLE MD CHAIR-ELECT 1.00 2.00 X X 0 0 0 JAMES R HOLMES PAST CHAIR 1.00 2.00 X X 0 0 0 CALVIN CAL KNIGHT SECRETARY/ TREASURER 1.00 2.00 X X 0 0 0 CARMELA COYLE PRESIDENT 1.00 39.00 X X 0 772182 259 C DUANE DAUNER PRESIDENT (THRU 10/17) 1.00 39.00 X X 0 1646273 51742 ELAINE BATCHLOR MD TRUSTEE 1.00 1.00 X 0 0 0 LINDA BRADLEY TRUSTEE 1.00 1.00 X 0 0 0 JANICE IDE TRUSTEE 1.00 1.00 X 0 0 0 LAWRENCE E LEWIS TRUSTEE 1.00 1.00 X 0 0 0 SUZANNE RICHARDS RN TRUSTEE 1.00 1.00 X 0 0 0 JON VAN BOENING TRUSTEE 1.00 1.00 X 0 0 0 JAMES E SAUER JR TRUSTEE 1.00 1.00 X 0 0 0 VICKI J VEAL TRUSTEE 1.00 2.00 X 0 0 0 AVI ZARAYA TRUSTEE 1.00 1.00 X 0 0 0 GREGORY A ADAMS PRIOR PAST CHAIR (THRU ) 1.00 2.00 X 0 0 0 GARY J PASSAMA TRUSTEE (THRU ) 1.00 1.00 X 0 0 0 RICHARD E YOCHUM TRUSTEE (THRU ) 1.00 1.00 X 0 0 0 JENNIFER M NEWMAN SENIOR VP/ CFO 2.80 37.20 X 0 331555 63346 0 2750010 115347 0 0 1 0 WESTERN HEALTHCARE ALLIANCE PO BOX 2907 GRAND JUNCTION CO 815022907 PROFESSIONAL SERVICE 184425 CA ASSN OF HOSPITALS AND HEALTH SYSTEMS 1215 K STREET SUITE 800 SACRAMENTO CA 95814 PROFESSIONAL SERVICE 172378 2 211750 20000 507464 75322020 76061234 97145 97145 GROUP PURCHASING 900099 85361 85361 CRQAR REVENUE 900099 29160 29160 62148 62148 176669 76335048 0 0 273814 38837988 38837988 17000 17000 65721 65721 876220 876220 37122 37122 388158 365934 22224 8028 8028 16861 16861 4015 4015 10617 10617 40261730 40183739 77991 0 51153235 66355669 9174099 47368881 65618 230623 7507 9333 746179 243742 61146638 114208248 117056 412033 18583704 38362833 18700760 38774866 X 1220585 1420901 41000293 73787481 225000 225000 42445878 75433382 61146638 114208248 X 36073318 -2136 -3083678 X 0 1 X 1 1 1 X 46319120 150031462 36381386 23919217 76061234 332712419 46319120 150031462 36381386 23919217 76061234 332712419 139519054 193193365 243797 82572 166317 164568 97145 754399 223149 176669 399818 333866636 0.57870 0.61500 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2016 AMOUNT: $ 18,786. 2017 AMOUNT: $ 62,148. CRQAR REVENUE - 2016 AMOUNT: $ 115,075. 2017 AMOUNT: $ 29,160. GROUP PURCHASING - 2016 AMOUNT: $ 89,288. 2017 AMOUNT: $ 85,361. 249351 5126 17000 237477 243904 5447 249351 256362 4542 17000 243904 252350 4012 256362 263351 5999 17000 252350 0.00000 0.94750 0.05250 0 0 0 X 79416590 -2136 3083678 3081542 76335048 0 76335048 40261730 0 40261730 0 40261730 PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED FOR THE WALKER/SULLIVAN ENDOWMENT WHICH FUNDS GRANTS TO STUDY HEALTHCARE OPERATIONS. PART X, LINE 2: CHFT IS A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION AND IS EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND CALIFORNIA REVENUE AND TAX CODE SECTION 23701D. ACCORDINGLY, THE FINANCIAL STATEMENTS DO NOT REFLECT ANY PROVISION FOR INCOME TAXES. IN THE EVENT CHFT HAD A TAX PROVISION THAT WAS UNCERTAIN OF BEING SUSTAINED, CHFT WOULD APPLY THE MINIMUM PROBABILITY THRESHOLD TO DETERMINE WHETHER A FINANCIAL STATEMENT LIABILITY OR BENEFIT SHOULD BE RECOGNIZED. THERE WASNO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RETURNED TO GRANTOR 3,083,678. 1 BEAR VALLEY COMMUNITY HEALTHCARE DISTRICT PO BOX 1649 BIG BEAR LAKE CA 923151649 330294751 N/A 11475 TO HELP SUPPORT AND DEVELOP A SUSTAINABLE AND EFFECTIVE SMOKING CESSATION PROGRAM REGARDLESS OF HEALTH INSURANCE STATUS CATALINA ISLAND MEDICAL CENTER PO BOX 1563 AVALON CA 90704 330222508 501(C)(3) 15000 TO PROVIDE OPERATIONAL IMPROVEMENTS IN BILLING TO IMPROVE REVENUE AND INCREASE PATIENT SATISFACTION EISENHOWER MEDICAL CENTER OPERATING ACCOUNT 39000 BOB HOPE DR RANCHO MIRAGE CA 922703221 956130458 501(C)(3) 16430571 TO DEVELOP THE "HEALTH SYSTEM" BY EXPANDING PROGRAMS AND ACCESS TO HEALTHCARE SERVICES HEALDSBURG DISTRICT HOSPITAL 1375 UNIVERSITY AVE HEALDSBURG CA 95448 364483322 N/A 15000 IMPROVE PRIORITIZED INPATIENT CLINICAL QUALITY INCLUDING IMMUNIZATIONS AND BREAST CANCER SCREENINGS KERN VALLEY HEALTHCARE DISTRICT PO BOX 1628 LAKE ISABELLA CA 93240 956142366 501(C)(3) 11331 TO HELP IMPROVE PATIENT SATISFACTION IN COMMUNICATION WITH NURSES, COMMUNICATION ABOUT MEDICINES, AND RESPONSIVENESS OF STAFF MAMMOTH HOSPITAL PO BOX 660 MAMMOTH LAKES CA 93546 202601653 501(C)(5) 10969 TO HELP IMPROVE PATIENT UNDERSTANDING OF SELF CARE INSTRUCTIONS, MEDICAL INFORMATION, AND HEALTH LITERACY METHODIST HOSPITAL OF SOCAL 300 W HUNTINGTON DR ARCADIA CA 91007 951643336 501(C)(3) 3453880 TO PROVIDE HEALTH CARE TO UNDER/UNDERINSURED POPULATION AND ALSO PROVIDE COMMUNITY BENEFIT OLYMPIA MEDICAL CENTER 5900 W OLYMPIC BLVD LOS ANGELES CA 90036 300559239 N/A 4384677 TO SERVE THE SURROUNDING COMMUNITY, INCLUDING THOSE IN MOST NEED OF CARE SUCH AS INDIGENT PATIENTS, MEDI-CAL PATIENTS, THE UNINSURED AND THE UNDER-INSURED. SAN BERNARDINO MOUNTAINS COMM HOSP PO BOX 70 LAKE ARROWHEAD CA 92352 262201665 501(C)(3) 16475 TO HELP BRING MEDI-CAL BILLING IN HOUSE TO CREATE SAVINGS BY HIRING TWO FULL TIME EMPLOYEES SANTA YNEZ VALLEY COTTAGE HOSPITAL 2050 VIBORG LANE SOLVANG CA 934632295 952224265 501(C)(3) 11250 TO HELP OBTAIN STROKE READY CERTIFICATION SO PATIENTS DO NOT NEED TO BE DIVERTED IN THE FIELD BY EMS CEDARS-SINAI 8700 BEBERLY BOULEVARD SUITE 2622 LOS ANGELES CA 900481804 951644600 501(C)(3) 6206956 TO PROVIDE CARE TO THE INDIGENT AND COMMUNITY BENEFITS TO THE REGION CHINESE HOSPITAL 845 JACKSON STREET SAN FRANCISCO CA 941334899 940382780 501(C)(3) 851721 TO CONTINUE TO PROVIDE CULTURALLY AND LINGUISTICALLY QUALITY CARE AND ACCESS TO THE MONOLINGUAL, LOW INCOME CHINESE POPULATION IN SAN FRANCISCO CITY AND COUNTY AND TO CONTINUE/EXPAND THE UNIQUE COMMUNITY BENEFITS WE HAVE BEEN OFFERING TO THE CHINESE COMMUNITY. COMMUNITY HOSPITAL OF MONTEREY PENINSULA (MONTAGE HEALTH) 23625 HOLMAN HIGHWAY PO BOX HH MONTEREY CA 93942 940760193 501(C)(3) 4727733 TO IMPROVE THE OVERALL HEALTH OF PENINSULA RESIDENTS, IMPROVE ACCESS TO HEALTH SERVICES, AND ADDRESS UNMET HEALTH NEEDS. HENRY MAYO NEWHALL 23845 MCBEAN PARKWAY VALENCIA CA 913552083 953849903 501(C)(3) 2307295 UTILIZED TO FUND MEDICAL LOSSES FROM 1/1/17-12/31/19 10 4 WALKER SULLIVAN FELLOWSHIP AWARD- ROGER SEAVER 1 17000 SCHEDULE I, PART 1, LINE 1 HOSPITAL FEE GRANTEES ARE REQUIRED TO SUBMIT GRANT APPLICATION FORMS TO DESCRIBE THE PURPOSE OF THE GRANT, AND ALSO WRITE UP A NARRATIVE OF HOW GRANT FUNDS WILL BE USED. TO ENABLE THE FOUNDATION TO EVALUATE THE EFFECTIVNESS OF THIS GRANT, THE GRANTEE SHALL SUBMIT TO THE FOUNDATION A WRITTEN REPORT ONE YEAR AFTER THE LAST DISBURSEMENT FROM CHFT TI GRANTEE OCCURS, CHFT SENDS THE REPORT FORM TO GRANTEE AT THE ONE YEAR ANNIVERSARY. THE GRANTEE REPORT WILL CONTAIN THE FOLLOWING: 1) PROGRESS MADE ON ACCOMPLISHING GRANT OBJECTIVES, AND 2) HOW GRANT FUNDS WERE EXPENDED. SCHEDULE I, PART 1, LINE 2: GRANTEES ARE REQUIRED TO SIGN RECIPIENT AGREEMENTS WHICH DETERMINE THE ALLOWABLE USE OF GRANT FUNDS AND REPORTING REQUIREMENTS. 0 1 0 0 0 0 0 0 0 CARMELA COYLE PRESIDENT 0 419309 0 350000 0 2873 0 0 0 259 0 772441 0 0 C DUANE DAUNER PRESIDENT (THRU 10/17) 0 1121473 0 469489 0 55311 0 18900 0 32842 0 1698015 0 0 JENNIFER M NEWMAN SENIOR VP/ CFO 0 273396 0 56917 0 1242 0 36900 0 26446 0 394901 0 0 PART I, LINE 3 CHFT RELIES ON CAHHS, A RELATED ORGANIZATION, TO ESTABLISH COMPENSATION FOR THE PRESIDENT USING ONE OR MORE OF THE METHODS DESCRIBED ON SCHEDULE J, PART I LINE 3. THE COMPENSATION REPORTED FOR THE OFFICERS OF CHFT IS PAID BY CAHHS AND IS FOR SERVICES PROVIDED TO CAHHS AND CALIFORNIA HOSPITAL ASSOCIATION. PART I, LINE 4B THE ORGANIZATION MAINTAINS A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. THIS PLAN IS INTENDED TO QUALIFY AS AN UNFUNDED PLAN OF DEFERRED COMPENSATION THAT IS MAINTAINED BY AN EMPLOYER PRIMARILY FOR THE PURPOSE OF PROVIDING DEFERRED COMPENSATION FOR THE SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES AS THOSE TERMS ARE DEFINED UNDER THE PROVISIONS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED (ERISA). FUNDING FOR THIS PLAN IS THROUGH ANNUAL EMPLOYER CONTRIBUTIONS AND IS LIMITED TO THE ANNUAL AMOUNT SET FORTH BY THE US TREASURY DEPARTMENT. JENNIFER NEWMAN PARTICIPATED IN THE PLAN AND RECEIVED A BENEFIT OF $18,000 FOR THE YEAR. FORM 990, PART VI, SECTION B, LINE 11B EACH MEMBER OF THE CALIFORNIA HEALTH FOUNDATION AND TRUST BOARD OF DIRECTORS WAS SENT A COPY OF THE DRAFT 990 BEFORE IT WAS FILED. IN ADDITION, THE AUDIT COMMITTE REVIEWED THE FORM BEFORE IT WAS FINALIZED OR FILED. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL DISCLOSURE MUST BE SIGNED BY OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES AND REPORTED TO THE AUDIT COMMITTEE IF A CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 SEE SCHEDULE J, PART III FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: NET ASSETS RETURNED TO GRANTOR -3,083,678. CALIFORNIA HOSPITAL ASSOCIATION 1215 K STREET SUITE 800 SACRAMENTO CA 95814 680343712 REPRESENT HOSPITAL INTEREST BEFORE LEGISLATORS AND REGULATORS CA 501(C)(6) 0 CALIFORNIA ASSOCIATION OF HOSPITALS HEALTH 1215 K STREET SUITE 800 SACRAMENTO CA 95814 941205908 REPRESENT HOSPITAL INTEREST BEFORE LEGISLATORS AND REGULATORS CA 501(C)(6) CHA 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0