2017-11-15T09:24:00-06:00 2016-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2016-01-01 941498697 CALIFORNIA HEALTH FOUNDATION AND TRUST CALI 9165527629 1215 K Street No 800 Sacramento CA 95814 Jennifer Newman SVP & CFO 9165527629 2017-11-09 1 Tracy S Paglia P00366884 2099556100 2017-11-09 12.129.7.100 2017-11-09 17:19:42 PS P 76D4B3FCF07BDA3995A0020FFED00C66F7CB08D7 EE4C3990ADBFF1D7AB96F98A4D28E8D7BD183798 2016 2017-02-10 21:41:12Z C Duane Dauner 1215 K Street No 800 Sacramento CA 95814 24306934 0 X N/A X 1956 CA SUPPORT ACCESS, RESEARCH, AND EDUCATION IN THE HEALTHCARE FIELD 14 13 0 0 0 0 36381386 23919217 0 0 166317 164568 0 223149 36547703 24306934 54720503 49066927 0 0 76437 49866 0 0 0 2667427 3161283 57464367 52278076 -20916664 -27971142 122506549 61146638 14978146 18700760 107528403 42445878 X SUPPORT ACCESS, RESEARCH, AND EDUCATION IN THE FIELD OF HEALTHCARE DELIVERY, FINANCING, AND PATIENT CARE. 0 0 51471545 48977459 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. 300098 89468 CRITICAL ACCESS HOSPITALS GRANT PROGRAM:TO RETAIN EXPERT SERVICES AND PROVIDE TECHNICAL SUPPORT TO CRITICAL ACCESS HOSPITALS UNDER THE MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM. 76862 30 AND 21 MONTH 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. 363657 OTHER PROGRAM SERVICES IN SUPPORT OF MISSION 363657 52212162 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 0 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 James R Holmes Chair 1.00 2.00 X X 0 0 0 Ann Madden Rice Chair-Elect 1.00 2.00 X X 0 0 0 Gregory A Adams Past Chair 1.00 2.00 X X 0 0 0 Richard Afable Secretary/ Treasurer 1.00 2.00 X X 0 0 0 C Duane Dauner President 1.00 39.00 X X 0 1390487 46197 Elaine Batchlor Trustee 1.00 1.00 X 0 0 0 Lawrence E Lewis Trustee 1.00 1.00 X 0 0 0 Gary J Passama Trustee 1.00 1.00 X 0 0 0 Jon Van Boening Trustee 1.00 1.00 X 0 0 0 Richard E Yochum Trustee 1.00 1.00 X 0 0 0 Vicki Veal Trustee 1.00 2.00 X 0 0 0 Linda Van Fulpen Trustee 1.00 1.00 X 0 0 0 Janice Ide Trustee 1.00 X 0 0 0 James Sauer Trustee 1.00 X 0 0 0 Jennifer M Newman Senior VP/CFO 2.80 37.20 X 0 315376 63221 0 1705863 109418 0 0 1 0 Western Healthcare Alliance PO Box 2907 Grand Junction CO 815022907 Professional Service 239435 CA Assn of Hospitals and Health Systems 1215 K Street Suite 800 Sacramento CA 95814 Professional Service 233429 HealthTech Management Services Inc 5110 Maryland Way Ste 200 Brentwood TN 37027 Professional Service 128880 RURAL HEALTH SOLUTIONS 1535 Shannon Drive Woodbury MN 55125 Professional Service 121936 4 181500 300098 23437619 23919217 164568 164568 CRQAR revenue 900099 115075 115075 group purchasing 900099 89288 89288 18786 18786 223149 24306934 0 0 387717 49066927 49066927 49866 49866 2497725 2497725 26590 26590 29203 29203 37701 37701 7845 7845 10121 10121 Hospital Admin Fee 73223 73223 478875 478875 52278076 52212162 65914 0 15000000 0 98450293 51153235 8268642 9174099 34994 65618 7620 7507 745000 746179 122506549 61146638 118267 117056 14859879 18583704 14978146 18700760 X 942254 1220585 106361149 41000293 225000 225000 107528403 42445878 122506549 61146638 X -27971142 -37111383 X 0 1 X 1 1 1 X 205015018 46319120 150031462 36381386 23919217 461666203 205015018 46319120 150031462 36381386 23919217 461666203 177177182 284489021 10910 243797 82572 166317 164568 668164 223149 223149 462557516 0.61500 0.96240 X Schedule A, Part II, Line 10, Explanation of Other Income: Other Income - 2016 Amount: $ 18,786. CRQAR Revenue - 2016 Amount: $ 115,075. Group Purchasing - 2016 Amount: $ 89,288. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 243904 5447 249351 256362 4542 17000 243904 252350 4012 256362 263351 5999 17000 252350 257317 6034 263351 0.00000 0.90230 0.09770 0 0 0 X 61418317 37111383 37111383 24306934 0 24306934 52278076 0 52278076 0 52278076 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 were no uncertain tax positions as of December 31, 2016. Part XI, Line 2d - Other Adjustments: Net Assets returned to grantor 37,111,383. 1 Eisenhower Medical Center Operating Account 39000 Bob Hope Dr Rancho Mirage CA 922703221 956130458 501(c)(3) 18704167 To develop the "Health System" by expanding programs and accrss to health care servces . Also health education, promotion and wellness. John Muir Health 1400 Treat Blvd Walnut Creek CA 94597 941461843 501(c)(3) 2568823 To fund various community benefits expendiutes made by John Muir Health to support the health of the communities they serve Methodist Hospital of Southern CA 300 W Huntington Dr Arcadia CA 91007 951643336 501(c)(3) 7589461 To provide health care to under/unisured population and also provide community benefit education , preventative screenings and immunization Torrance Memorial Medical Center 3330 Lomita Blvd Torrance CA 905055073 951644042 501(c)(3) 7733293 To help support on going charity care effors and communtiy health education efforts. HMNMH Concentration Account 23845 McBean Parkway Parkway CA 91355 952821104 501(c)(3) 10817575 Utilized to fund Medical losses from 1/1/14-12/31/16 CFHS Holdings Inc 555 East Hardy Way Inglewood CA 903014073 201645949 N/A 1564138 Provides uncompensated patient care, patient safety capital needs and emergency services capital needs Catalina Island Medical Center PO Box 1563 Avalon CA 90704 330222508 501(c)(3) 10000 Rural Healthcare Enrishment Funding to improve population health Kern Valley Hospital Foundation KVHF PO Box 1628 Lake Isabella CA 93240 956142366 501(c)(3) 10000 Kern Valley Hospital - Erskine Fire Relief fund Mayers Memorial Hospital District 43563 State Highway 299 East Fall River Mills CA 96028 941634940 501(c)(3) 8000 Rural Healthcare Enrichment Funding to support of employee attendance at Annual Western Region FLEX Conference and Rural Healthcare Symposium Mercy Medical Center Mt Shasta 914 Pine Street Mt Shasta CA 96067 941196203 501(c)(3) 10000 Rural Healthcare Enrichment Funding to improve HCAHPS Scores Seneca Healthcare District PO Box 737 Chester CA 96020 941322200 501(c)(3) 10000 Rural Healthcare Enrichment Funding to support Rural SYmposium attendance and improve HCAHPS scores Northern Inyo Hospital 150 Pioneer Lane Bishop CA 93514 956005449 501(c)(3) 10000 Rural Healthcare Enrichment Funding to support Financial Needs Assessment Plumas District Hospital 1065 Bucks Lake Road Quincy CA 95971 946036992 501(c)(3) 10000 Rural Healthcare Enrichment Funding to support Operation Education Sutter Lakeside Hospital 5196 Hill Road East Suite 300 Lakeport CA 95453 940562680 501(c)(3) 10000 Rural Healthcare Enrichment Funding to support Population Health Management Tool Implementation 13 1 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 C Duane Dauner President 0 959347 0 378257 0 52883 0 18550 0 27647 0 1436684 0 0 Jennifer M Newman Senior VP/CFO 0 264134 0 50000 0 1242 0 36550 0 26671 0 378597 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 and approved 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 -37,111,383. California Hospital Association 1215 K Street Suite 800 sacramento CA 95814 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 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