2024-11-14T16:52:45-06:00 2023-12-31 135565207 KPMG LLP 3975 FREEDOM CIR DR 100 SANTA CLARA CA 95054 990 2023-01-01 941461843 JOHN MUIR HEALTH JOHN 9259393000 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 TIMOTHY MAURICE CFO 9259393000 2024-11-11 1 0 CAREY MCKEE P01281067 4083675764 2024-11-11 2023 2024-10-15 13:58:12Z MICHAEL THOMAS 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 2756499576 0 X WWW.JOHNMUIRHEALTH.COM X 1958 CA JOHN MUIR HEALTH IS DEDICATED TO IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE WITH QUALITY AND COMPASSION. JOHN MUIR HEALTH OFFERS THE COMMUNITY A NETWORK OF PRIMARY CARE AND SPECIALTY PHYSICIANS, TWO MEDICAL CENTERS, INCLUDING THE COUNTY'S ONLY TRAUMA CENTER AND A BEHAVIORAL HEALTH CENTER. THE HEALTH SYSTEM ALSO OFFERS A FULL-RANGE OF MEDICAL SERVICES, INCLUDING PRIMARY CARE, OUTPATIENT, AND IMAGING SERVICES, AND IS WIDELY RECOGNIZED AS A LEADER IN MANY SPECIALTIES - NEUROSCIENCES, ORTHOPEDIC, CANCER, CARDIOVASCULAR, TRAUMA, EMERGENCY, PEDIATRICS AND HIGH-RISK OBSTETRICS CARE. 16 15 5881 368 0 0 28050686 15883892 1666599909 1695796092 45815211 57337271 13128997 7146188 1753594803 1776163443 113269585 147775868 0 0 916625796 941232239 0 0 0 776301208 768900848 1806196589 1857908955 -52601786 -81745512 3323424314 3380744220 1236241704 1273349784 2087182610 2107394436 X THE MISSION OF JOHN MUIR IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH QUALITY AND COMPASSION. 0 0 699877442 0 756157472 HOSPITAL SERVICES - GENERAL MEDICINE AND SURGERYTHE CORE OF JOHN MUIR HEALTH'S SERVICE TO THE COMMUNITY IS IN ITS GENERAL MEDICINE AND SURGERY PROGRAM, WHICH PROVIDES COMPREHENSIVE CARE FROM EMERGENCY TO HIGH LEVEL CRITICAL CARE TO DISCHARGE SUPPORT AND HOME HEALTH PATIENTS WITH A VARIETY OF CONDITIONS. JOHN MUIR MEDICAL CENTER, WALNUT CREEK SERVES AS THE ONLY COUNTY-DESIGNATED TRAUMA CENTER FOR THE AREA, WORKING CLOSELY WITH LOCAL EMERGENCY SERVICES LEADERS. THE JOHN MUIR HEALTH TRAUMA CENTER RECEIVED THE AMERICAN COLLEGE OF SURGEON'S COMMITTEE ON TRAUMA UNCONDITIONAL RE-VERIFICATION AS A LEVEL II TRAUMA CENTER. NATIONAL AND STATE RECOGNITIONS RECEIVED IN 2023 INCLUDE: (1) RECOGNITION OF JOHN MUIR HEALTH, WALNUT CREEK MEDICAL CENTER BY U.S. NEWS & WORLD REPORT FOR THE 17TH YEAR IN A ROW AS ONE OF "AMERICA'S BEST HOSPITALS". DIABETES & ENDOCRINOLOGY, OBSTETRICS & GYNECOLOGY, AND PULMONOLOGY & LUNG SURGERY SERVICES AT THE WALNUT CREEK MEDICAL CENTER WERE RECOGNIZED AS AMONG THE TOP 50 IN THE UNITED STATES (LESS THAN 4% OF HOSPITALS HAD A NATIONALLY RANKED SPECIALTY), (2) RECOGNITION BY U.S. NEWS & WORLD REPORT OF EIGHT SPECIALTIES COMBINED AND 30 ADULT PROCEDURES AND CONDITIONS COMBINED AS HIGH PERFORMING AT JOHN MUIR HEALTH'S WALNUT CREEK AND CONCORD MEDICAL CENTERS, (3) U.S. NEWS AND WORLD REPORT ALSO RANKED THE WALNUT CREEK MEDICAL CENTER #2 AND CONCORD MEDICAL CENTER #3 OUT OF NEARLY 50 HOSPITALS IN THE SAN FRANCISCO METRO AREA BASED ON PATIENT SURVIVAL, PATIENT SAFETY, AND CARE-RELATED FACTORS SUCH AS NURSING AND PATIENT SERVICES, AND REPUTATION. THE TWO HOSPITALS WERE ALSO RANKED #9 AND #18 IN CALIFORNIA OUT OF MORE THAN 400 ACUTE CARE HOSPITALS, (4) JOHN MUIR HEALTH'S CONCORD AND WALNUT CREEK MEDICAL CENTERS ALSO EARNED THE DESIGNATION OF BEST REGIONAL HOSPITALS BY U.S. NEWS & WORLD REPORT - TWO OF JUST 484 HOSPITALS (11% OF THE HOSPITALS EVALUATED) TO ACHIEVE THIS DESIGNATION NATIONWIDE, (5) THE WALNUT CREEK MEDICAL CENTER WAS NAMED ONE OF THE NATION'S BEST HOSPITALS FOR MATERNITY CARE BY U.S. NEWS & WORLD REPORT AND BY NEWSWEEK, (6) THE WALNUT CREEK MEDICAL CENTER RECEIVED A CLINICAL EXCELLENCE AWARD FOR JOINT REPLACEMENT FROM HEALTHGRADES, (7) THE CONCORD MEDICAL CENTER WAS RECOGNIZED BY HEALTHGRADES AS ONE OF AMERICA'S TOP 50 HOSPITALS FOR CARDIAC SURGERY FOR THE FIFTH STRAIGHT YEAR, (8) COMBINED, THE TWO MEDICAL CENTERS HAD SIX FIVE-STAR RATINGS FROM HEALTHGRADES FOR SERVICES, PROCEDURES AND TREATMENTS, (9) NEWSWEEK RANKED THE WALNUT CREEK AND CONCORD MEDICAL CENTERS AS TWO OF THE BEST IN THE U.S. (#157 AND #177) AND (10) BOTH MEDICAL CENTERS ARE MAGNET RECOGNIZED FOR NURSING EXCELLENCE AND QUALITY PATIENT OUTCOMES, WITH THE WALNUT CREEK MEDICAL CENTER RE-DESIGNATED IN 2023.OUR PROGRAM EMPHASIS IN 2023 CONTINUED TO BE ON SERVING UNINSURED, UNDERSERVED, AND VULNERABLE POPULATIONS IN OUR SERVICE AREA THROUGH COMMUNITY PARTNERSHIPS, SUCH AS THE DENTAL COLLABORATIVE OF CONTRA COSTA COUNTY, MOBILE HEALTH CLINIC, AND SUPPORT FOR NONPROFIT ORGANIZATIONS PROVIDING ACCESS TO HEALTH CARE, MENTAL HEALTH SERVICES, FOOD, HOUSING, AND VIOLENCE PREVENTION. 229986603 253887394 CARDIOVASCULAR IS THE SECOND LARGEST HOSPITAL-BASED SERVICE OF JOHN MUIR HEALTH. CARDIOVASCULAR ACHIEVEMENTS IN 2023 INCLUDE: - CONCORD MEDICAL CENTER RECEIVED THE HEALTHGRADES CARDIAC SURGERY EXCELLENCE AWARD FOR SUPERIOR CLINICAL OUTCOMES IN HEART BYPASS SURGERY AND HEART VALVE SURGERY. CONCORD MEDICAL CENTER ALSO RECEIVED THE CORONARY INTERVENTION EXCELLENCE AWARD FOR SUPERIOR CLINICAL OUTCOMES IN CORONARY INTERVENTION PROCEDURES. - JOHN MUIR HEALTH'S CARDIAC SURGERY PROGRAM WAS RECOGNIZED BY THE SOCIETY OF THORACIC SURGEONS AS "BETTER THAN EXPECTED" FOR CORONARY BYPASS GRAFT SURGERY. APPROXIMATELY 12-15% OF HOSPITALS RECEIVE THIS "3-STAR" RATING FROM STS, WHICH DENOTES THE HIGHEST CATEGORY OF QUALITY. - CONCORD MEDICAL CENTER WAS RATED AS HIGH PERFORMING BY U.S. NEWS & WORLD REPORT IN 2023 IN AORTIC VALVE SURGERY, HEART ATTACK, HEART BYPASS SURGERY, HEART FAILURE AND TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR). WALNUT CREEK MEDICAL CENTER HAS AGAIN BEEN RATED AS HIGH PERFORMING BY U.S. NEWS & WORLD REPORT IN 2023 IN HEART ATTACK AND HEART FAILURE. - BOTH CONCORD AND WALNUT CREEK RECEIVED THE AMERICAN HEART ASSOCIATION'S GET WITH THE GUIDELINES- GOLD PLUS HEART FAILURE QUALITY ACHIEVEMENT AWARD FOR THEIR COMMITMENT TO MANAGING HEART FAILURE IN PATIENTS. GOLD PLUS IS THE HIGHEST ACHIEVEMENT LEVEL. - JOHN MUIR CONCORD RECEIVED THE MISSION: LIFELINE STEMI RECEIVING CENTER GOLD PLUS ACHIEVEMENT AWARD AND JOHN MUIR WALNUT CREEK WAS THE RECIPIENT OF THE MISSION: LIFELINE STEMI RECEIVING CENTER GOLD ACHIEVEMENT AWARD. THESE AWARDS RECOGNIZE HOSPITALS FOR IMPLEMENTING SPECIFIC QUALITY IMPROVEMENT MEASURES TO TREAT PATIENTS WHO SUFFER SEVERE HEART ATTACKS. - CONCORD MEDICAL CENTER IS RECOGNIZED AS A BLUE DISTINCTION CENTER FOR CARDIAC CARE. BLUE DISTINCTION CENTERS ARE RECOGNIZED FOR DISTINGUISHED CLINICAL CARE AND PROCESSES BY THE BLUE CROSS AND BLUE SHIELD ASSOCIATION. FACILITIES EARN THESE DESIGNATIONS BASED ON RIGOROUS, EVIDENCE-BASED, OBJECTIVE CRITERIA AND INPUT FROM EXPERT PHYSICIANS AND MEDICAL ORGANIZATIONS. - WALNUT CREEK MEDICAL CENTER IS THE RECIPIENT OF ECHOCARDIOGRAPHY ACCREDITATION BY THE INTERSOCIETAL ACCREDITATION COMMISSION (IAC) FOR ADULT TRANSTHORACIC AND ADULT STRESS ECHOCARDIOGRAPHY AND CONCORD MEDICAL CENTER IS THE RECIPIENT OF ECHOCARDIOGRAPHY ACCREDITATION BY THE IAC FOR ADULT TRANSTHORACIC ECHOCARDIOGRAPHY. - JOHN MUIR HEALTH'S CARDIAC REHABILITATION PROGRAM IS CERTIFIED BY THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION (AACVPR). AACVPR PROGRAM CERTIFICATION IS THE ONLY PEER-REVIEW ACCREDITATION PROCESS DESIGNED TO REVIEW INDIVIDUAL PROGRAMS FOR ADHERENCE TO STANDARDS DEVELOPED AND PUBLISHED BY THE AACVPR AND OTHER PROFESSIONAL SOCIETIES. - BOTH CONCORD AND WALNUT CREEK MEDICAL CENTERS ARE DESIGNATED BY CONTRA COSTA COUNTY DEPARTMENT OF EMERGENCY MEDICAL SERVICES AS STEMI RECEIVING CENTERS FOR HIGH-RISK HEART ATTACK PATIENTS. 148883356 217102199 WOMENS AND CHILDREN'S SERVICES IS THE THIRD LARGEST PROGRAM WITHIN JOHN MUIR HEALTH. THE PEDIATRIC INTENSIVE CARE UNIT AT THE WALNUT CREEK MEDICAL CENTER IS CERTIFIED BY THE CALIFORNIA CHILDREN'S SERVICES. ACCOMPLISHMENTS IN 2023 INCLUDE:- THE NICU IS WORKING ON THE CPQCC NEOBRAIN COLLABORATIVE, THE FIRST COLLABORATIVE THAT DIRECTLY INVOLVES PARENTS, WITH FAMILY FOCUS INVOLVEMENT BEGINNING AT NICU ADMISSION. THE PRIMARY AIM IS TO INCREASE POSITIVE TOUCH FOR ALL ELIGIBLE INFANTS WITHIN 72 HOURS OF ADMISSION. SECONDARY SIMS INCLUDE INCREASING THE PERCENTAGE OF ELIGIBLE INFANTS WHO RECEIVE SKIN TO SKIN CARE WITHIN THE FIRST WEEK OF LIFE, DECREASE THE TIME FROM BIRTH TO FIRST SKIN TO SKIN ENCOUNTER, DECREASE NOXIOUS STIMULI AND TO INCREASE FAMILY SELF-PERCEIVED COMPETENCE IN CARE AT THE TIME OF DISCHARGE.THE DEPARTMENT OF HEALTH CARE SERVICES (DHCS) HAS REVIEWED ALL OF JOHN MUIR HEALTH'S SUBMISSION, INCLUDING PLANS OF CORRECTIONS AND DETERMINED JMH ADEQUATELY ADDRESSED ALL DEFICIENCIES. EFFECTIVE AUGUST 18, 2023, DHCS HAS APPROVED JMH'S APPLICATION TO CONTINUE AS A CALIFORNIA CHILDREN'S SERVICES (CCS) PEDIATRIC INTENSIVE CARE UNIT. 404883172 147775868 468649027 OTHER SERVICES OFFERED AT JOHN MUIR HEALTH (JMH) ARE:REHABILITATION SERVICES BOTH INPATIENT AND OUTPATIENT COMBINED, CONTINUE TO SEE UPWARD TREND IN PATIENT VISIT VOLUMES, ALL THE WHILE MAINTAINING HIGH QUALITY REHABILITATION CARE. JMH'S OUTPATIENT THERAPY DIVISION SAW OVER 96,000 VISITS IN SERVING THE AMBULATORY COMMUNITY IN EAST COUNTY. JMH PLACED PARTICULAR EMPHASIS THIS PAST YEAR IN SERVING THE PEDIATRIC AND YOUTH SPORTS MEDICINE PATIENT POPULATION. INPATIENT REHABILITATION IMPLEMENTED PROGRAMS OF EARLY MOBILITY AND THERAPY EFFICIENCY PROGRAMS TO HELP IMPROVE PATIENT HOSPITAL THROUGHPUT AT BOTH CAMPUSES. JMH'S INPATIENT REHABILITATION UNIT (IRF) ADMITTED 518 PATIENTS IN 2023 (23% INCREASE FROM 2022), WITH STROKE REPRESENTING THE HIGHEST ADMITTING DIAGNOSIS AT 42.1%; FOLLOWED BY SPINAL CORD INJURY AT 17.4%, BRAIN INJURY AT 9.8%. THE AVERAGE LENGTH OF STAY IN 2023 WAS 13.8 DAYS. 2023 DISCHARGE DISPOSITION TO COMMUNITY WAS 85.5%. JMH CONTINUED TO EXCEED REGIONAL AND NATIONAL OUTCOMES FOR MEDICARE QUALITY INDICATOR MEASURES AS PUBLISHED ON THE MEDICARE CARE COMPARE WEBSITE FOR PERIOD 7/1/22-6/30/23 IN AREAS OF SKIN INTEGRITY-PRESSURE ULCER/INJURY, AND FOR FALLS. NEUROPSYCHOLOGY SERVICES ADDED A NEW CLINICIAN IN 2023 TO BETTER SERVE THE ACUTE REHABILITATION UNIT AND COVER MORE OUTPATIENT REFERRAL VOLUMES.ONCOLOGY AND SPECIALTY SERVICESBELOW IS THE SUMMARY OF SOME OF ONCOLOGY AND SPECIALTY SERVICES ACCOMPLISHMENTS IN 2023:- JMH'S GENETIC COUNSELING PROGRAM HAS HAD AN INCREASE IN PATIENT VOLUME AND TO HELP WITH TURNAROUND TIME OF BEING SEEN, AN ADDITIONAL GENETIC COUNSELOR WAS HIRED.- THE BREAST PROGRAM OBTAINED A GRANT THAT WILL PAY FOR MRI SERVICE FOR THE UNDERSERVED. PATIENTS THAT GO THROUGH EVERY WOMEN COUNTS PROGRAM WILL BE ABLE TO RECEIVE MRI SERVICES UNTIL DECEMBER 2024.- JMH HAS BEEN AWARDED A FULL THREE-YEAR REACCREDITATION STATUS BY THE NATIONAL ACCREDITATION FOR BREAST CENTERS.- JMH CONTINUES TO PROVIDE ANNUAL PROSTATE SCREENING EVENTS AND IN 2023 SCREENED 33 PATIENTS.DIGESTIVE HEALTH SERVICES 2023 ACCOMPLISHMENTS:THE ENDOSCOPY DEPARTMENT AT THE WALNUT CREEK HAS UPGRADED TO THE NEWEST TECHNOLOGIES TO TEST AND EVALUATES ESOPHAGEAL MOTILITY DISORDERS AND GASTROESOPHAGEAL REFLUX. THESE INCLUDE NEWEST SOFTWARE FOR HIGH RESOLUTION MANOMETRY (HRM) AND ENDOFLIP (ENDOLUMINAL FUNCTIONAL LUMEN IMAGING PROBE) SYSTEM. HRM MEASURES PRESSURES IN THE ESOPHAGUS DURING SWALLOWING TO DIAGNOSE ESOPHAGEAL MOTILITY DISORDERS. ENDOFLIP IS USED ALONGSIDE UPPER ENDOSCOPY IN THE EVALUATION OF PATIENTS BEFORE OR DURING PATIENTS UNDERGOING PERORAL ENDOSCOPIC MYOTOMY (POEM) PROCEDURES PERFORMED BY INTERVENTIONAL GASTROENTEROLOGIST AS AN ENDOSCOPIC ALTERNATIVE TO THE SURGICAL HELLER MYOTOMY. 404883172 147775868 468649027 1483630573 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 699 0 1 5881 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 16 15 0 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X JEFF SMITH 9259393000 1400 TREAT BLVD WALNUT CREEK CA 94597 JAY HARRIS CHAIRMAN 5.00 10.00 X X 0 0 0 ROGER BAILEY VICE CHAIRMAN 5.00 10.00 X X 18750 0 0 JOHN SAYRES SECRETARY & TREASURER 5.00 10.00 X X 18750 0 0 KATHLEEN ODNE DIRECTOR 5.00 10.00 X 18750 0 0 LAURA MARKSTEIN DIRECTOR 5.00 10.00 X 18750 0 0 JACK THOMPSON DIRECTOR 5.00 10.00 X 0 0 0 ANNE GRODIN DIRECTOR 5.00 10.00 X 18750 0 0 PETER WILSON DIRECTOR 5.00 10.00 X 18750 0 0 FATIMA ANGELES DIRECTOR 5.00 10.00 X 18750 0 0 VIVIAN WING MD DIRECTOR 5.00 10.00 X 18750 0 0 CHINNAVUTH DE MONTEIRO MD DIRECTOR 5.00 10.00 X 18750 0 0 RAVI HUNDAL MD DIRECTOR 5.00 10.00 X 18750 0 0 CAROLYN LACEY MD DIRECTOR 5.00 10.00 X 18750 0 0 MARK MUSCO MD DIRECTOR 5.00 10.00 X 18750 0 0 JOHANNES JOE PETERS MD DIRECTOR 5.00 10.00 X 18750 0 0 MICHAEL S THOMAS PRESIDENT/CEO 60.00 15.00 X X 1725770 0 866087 CHRISTIAN PASS SVP/CFO (THRU 2/10/23) 60.00 15.00 X 375567 0 11980 MELINDA ESTEP SVP/CFO (AS OF 8/14/23) 60.00 15.00 X 321729 0 66458 MAX REYNOLDS SVP/GENERAL COUNSEL 60.00 0.00 X 735844 0 712155 JANE WILLEMSEN CHIEF OPERATING OFFICER 60.00 12.00 X 1481379 0 536107 LISA FOUST SVP HUMAN RESOURCES 60.00 0.00 X 1230818 0 290652 GEORGE SAUTER SVP/CHIEF STRATEGY OFFICER 60.00 0.00 X 703265 0 694567 MICHELLE LOPES RN SVP HOSPITAL OPERATIONS 60.00 0.00 X 626631 0 681986 RUSSELL RODRIGUEZ SVP/CHIEF MEDICAL OFFICER 60.00 0.00 X 883579 0 272331 PAUL DEERINGER SVP/CSO (AS OF 5/7/23) 60.00 0.00 X 652214 0 246714 CALVIN KNIGHT FORMER PRESIDENT/CEO 0.00 0.00 X 1272988 0 0 10253534 0 4379037 3105 1 1 0 OPTUMINSIGHT PO BOX 84019 CHICAGO IL 606894002 PROFESSIONAL SERV 171681129 CROSS COUNTRY STAFFING LA LOCKBOX FILE 50941 LOS ANGELES CA 900740971 TEMP STAFFING 36142610 CEP ANSTHESIA 2100 POWELL STREET EMERYVILLE CA 946081803 MEDICAL 15890347 BAY AREA SURGICAL SPECIALIST PO BOX 97297 LAS VEGAS NV 891937297 MEDICAL 8094237 LUCILLE SALTER PACKARD CHILDRENS HOSP 725 WELCH ROAD MC 5553 PALO ALTO CA 94304 MEDICAL 6416802 164 15533892 350000 15883892 PATIENT REVENUE SERVIC 621400 1658911261 1658911261 PREMIUM REVENUE 621400 31831004 31831004 RELATED PROGRAM RENTS 621110 3954058 3954058 OTHER OPERATING REVENU 621400 1099769 1099769 1695796092 33076900 33076900 7972707 943987 7028720 7028720 7028720 1003463547 188970 979384678 7468 24078869 181502 24260371 24260371 PROPERTY TAX REFUNDS 531390 96689 96689 VENDING INCOME 722515 20779 20779 117468 1776163443 1695796092 0 64483459 147775868 147775868 8349814 7097342 1252472 735659957 643674766 91985191 37997175 31193996 6803179 114108873 96119488 17989385 45116420 42088859 3027561 152575085 152575085 9180535 501920 8678615 1126076 1126076 113404 113404 7499720 7499720 172285792 172285792 17645887 15127956 2517931 22773261 664191 22109070 49945309 40955202 8990107 1185797 831301 354496 28742410 23664387 5078023 85677818 61172693 24505125 13214991 33442 13181549 MEDICAL SUPPLIES 151047574 151047574 PHARMACEUTICALS 31648647 31648647 LICENSES & TAXES 5924871 5924871 ASSESSMENT 2528801 0 2528801 15784870 11708874 4075996 1857908955 1483630573 374278382 0 13402 13397 29467530 139398980 0 0 241429079 248196002 0 0 0 0 0 0 11293135 11293151 31725253 30208506 2257472504 1184755350 998351780 1072717154 1067213079 911138534 567874282 591810182 138588369 140124280 0 0 237468405 235844034 3323424314 3380744220 329564071 351695728 0 0 2625393 2149316 579409976 576073054 0 0 0 0 0 0 0 0 324642264 343431686 1236241704 1273349784 X 2086507602 2106602840 675008 791596 2087182610 2107394436 3323424314 3380744220 X -81745512 114619829 -12662491 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 113404 113404 0 PART II-B, LINE 1: OTHER ACTIVITIES JOHN MUIR HEALTH CONTRIBUTED TO CALIFORNIA COMMITTEE ON ISSUES (CHCI) SPONSORED BY CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEM (CAHHS) IN 2023 TO SUPPORT LOBBYING EFFORTS. 54256551 54256551 631486762 275137450 356349312 502485095 280761812 221723283 759620703 628856088 130764615 309623393 309623393 1072717154 PRIVATE EQUITY 261617909 F HEDGE FUNDS 241264990 F COMMINGLED FUNDS 88927283 F 591810182 OTHER RECEIVABLES 117830741 RIGHT OF USE ASSETS, NET 69132849 INTANGIBLE ASSETS AND OTHER 35110007 HELD PURSUANT BOND INDENTURE 11668348 REAL ESTATE FOR FUTURE USE 2102089 235844034 LEASE LIABILITY 78774599 OTHER PAYABLES 66382690 POST RETIREMENT BENEFIT OBLIGATION 58180254 RETIREMENT LIABILITY 45503576 WORKERS COMPENSATION 25883000 RISKPOOL LIABILITY 21123538 ASSET RETIREMENT OBLIGATION 17659992 OTHER LIABILITIES 12879562 PROFESSIONAL LIABILITY 12068687 INTEREST PAYABLE 4975788 343431686 1737119880 114619829 943987 115563816 1621556064 7499720 147107659 154607379 1776163443 1716908054 943987 943987 1715964067 7499720 134445168 141944888 1857908955 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL REVENUE REPORTED NET ON FORM 990 943,987. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUE REPORTED GROSS ON FORM 990, NET ON FINANCIAL STATEMENTS GRANTS TO RELATED PARTIES 134,445,168. UNAMORTIZED LOSS ON PENSION NOT REPORTED ON FORM 990 12,662,491. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL REVENUE REPORTED NET ON FORM 990 943,987. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES REPORTED NET OF REVENUE ON FINANCIAL STATEMENTS, GROSS ON FORM 990 GRANTS TO RELATED PARTIES 134,445,168. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 140400490 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS 56160776 0 0 0 0 0 0 196561266 0 196561266 1 0 0 1 1 0 1 1 X 1 X 400.000000000000 1 X 1 1 1 0 1 1 9277723 9277723 0.00500 308266429 161998679 146267750 0.07870 317544152 161998679 155545473 0.08370 3440736 270666 3170070 0.00170 5829690 5829690 0.00310 1846595 1846595 0.00100 982014 821388 160626 0.00010 4956867 285046 4671821 0.00250 17055902 1377100 15678802 0.00840 334600054 163375779 171224275 0.09210 7305 7305 0.00000 4196 4196 0.00000 10838 10838 0.00000 210032 210032 0.00010 1213523 47514 1166009 0.00060 1445894 47514 1398380 0.00070 1 19608750 440451575 623500577 -183049002 X 1 1 1 ASPEN SURGERY CENTER OPERATES A MULTISPECIALTY SURGERY CENTER 0.28680 0.01000 0.46390 2 HACIENDA SURGERY CENTER OPERATES A MULTISPECIALTY SURGERY CENTER 0.12500 0.00000 0.47600 2 1 JOHN MUIR MEDICAL CENTER WALNUT CREEK 1601 YGNACIO VALLEY RD WALNUT CREEK CA 94598 WWW.JOHNMUIRHEALTH.COM 140000265 X X X A 2 JOHN MUIR MEDICAL CENTER CONCORD 2540 EAST ST CONCORD CA 94520 WWW.JOHNMUIRHEALTH.COM 140000128 X X X A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 400.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: JOHN MUIR MEDICAL CENTER WALNUT CREEK, - FACILITY 2: JOHN MUIR MEDICAL CENTER CONCORD FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5: COMMUNITY INPUT PROCESSDESCRIPTION OF WHO WAS CONSULTED: COMMUNITY INPUT WAS PROVIDED BY A BROAD RANGE OF COMMUNITY MEMBERS VIA KEY INFORMANT INTERVIEWS AND FOCUS GROUPS. INDIVIDUALS WITH THE KNOWLEDGE, INFORMATION, AND EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE CONSULTED. THESE INDIVIDUALS INCLUDED REPRESENTATIVES FROM PUBLIC HEALTH AND OTHER PUBLIC AGENCIES, COMMUNITY ORGANIZATIONS, AND LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND RACIAL/ETHNIC POPULATIONS. KEY INFORMANT INTERVIEW METHODOLOGY: APPLIED SURVEY RESEARCH (ASR) CONDUCTED 32 KEY INFORMANT INTERVIEWS WITH REPRESENTATIVES FROM ORGANIZATIONS SERVING CONTRA COSTA COUNTY AND 43 KEY INFORMANT INTERVIEWS WITH INDIVIDUALS FROM ORGANIZATIONS SERVING ALAMEDA COUNTY. THOSE ORGANIZATIONS REPRESENT DIVERSE SECTORS. THE KEY INFORMANTS WERE IDENTIFIED COLLABORATIVELY BY KAISER PERMANENTE, THE PUBLIC HEALTH AGENCIES AND MEMBERS OF THE ALAMEDA AND CONTRA COSTA COUNTIES HOSPITAL CHNA GROUP. ALL INTERVIEWS WERE CONDUCTED IN ENGLISH AND FOLLOWED A STANDARD SET OF INTERVIEW QUESTIONS. CONFIDENTIALITY WAS ASSURED AT THE BEGINNING OF EACH INTERVIEW AND INTERVIEWERS TOOK DETAILED NOTES DURING THE CONVERSATION. INTERVIEW TOPICS: INTERVIEW QUESTIONS WERE DEVELOPED BY ASR AND ADDRESSED THE FOLLOWING TOPICS: - PRIORITY PLACED ON 2019 HEALTH NEEDS - OTHER PRIORITY HEALTH NEEDS - IMPACT OF COVID-19 ON PRIORITY HEALTH NEEDS - CHALLENGES TO ADDRESSING PRIORITY HEALTH NEEDS - SOURCES OF INFORMATION ON HEALTH NEEDS - STRATEGIES TO ADDRESS PRIORITY HEALTH NEEDS - HEALTH INEQUITIES AND DISPARITIES - STRATEGIES TO ADDRESS INEQUITIES/DISPARITIES - EXISTING COMMUNITY RESOURCES TO ADDRESS PRIORITY HEALTH NEEDSDATA ANALYSIS: ASR DELIVERED TO AD LUCEM CONSULTING A SPREADSHEET CONTAINING INDIVIDUAL INTERVIEWEE RESPONSES AND KEY THEMES. THE THEMES WERE FURTHER ORGANIZED BY AD LUCEM CONSULTING INTO THE HEALTH NEEDS DEFINED BY THE KAISER PERMANENTE COMMUNITY HEALTH DATA PLATFORM, THEN THE NUMBER OF MENTIONS FOR ALL THEMES RELATED TO A PARTICULAR HEALTH NEED WERE TALLIED TO DEVELOP AN INTERVIEW DATA SCORE. HEALTH NEEDS WERE ASSIGNED POINTS BASED ON THE FREQUENCY OF MENTIONS OF THE HEALTH NEED BY KEY INFORMANTS. POINTS FOR EACH HEALTH NEED WERE TALLIED ACROSS INTERVIEWEES TO DEVELOP INTERVIEW SCORES FOR HEALTH NEED PRIORITY, RACIAL/ETHNIC DISPARITIES, GEOGRAPHIC OR OTHER DISPARITIES AND IMPACT OF THE COVID-19 PANDEMIC ON THE HEALTH NEED.FOCUS GROUP METHODOLOGY: NINE COMMUNITY RESIDENT FOCUS GROUPS WERE CONDUCTED IN GEOGRAPHIC AREAS WITHIN EASTERN, CENTRAL, AND WESTERN CONTRA COSTA COUNTY. SEVEN GROUPS WERE CONDUCTED IN ENGLISH, AND TWO WERE CONDUCTED IN SPANISH. PARTICIPANTS WERE BLACK/AFRICAN AMERICAN AND LATINX COMMUNITY MEMBERS, AND ADULTS OVER THE AGE OF 65 FROM UNDERSERVED, LOW-INCOME, AND DIVERSE RACIAL/ETHNIC COMMUNITIES. TEN COMMUNITY RESIDENT FOCUS GROUPS WERE CONDUCTED IN GEOGRAPHIC AREAS WITHIN NORTHERN AND CENTRAL ALAMEDA COUNTY AND THE TRI-VALLEY AREA. THREE GROUPS WERE CONDUCTED IN ENGLISH, FOUR WERE CONDUCTED IN SPANISH, ONE IN VIETNAMESE, ONE IN CANTONESE, AND ONE IN A COMBINATION OF ENGLISH AND SPANISH. PARTICIPANTS WERE FROM UNDERSERVED, LOW-INCOME, SENIOR, UNHOUSED, LGBTQIA+, AND DIVERSE RACIAL/ETHNIC COMMUNITIES (VIETNAMESE, CANTONESE, BLACK/AFRICAN AMERICAN, INDIGENOUS, AND LATINX). FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDED IN CHNAALL JOHN MUIR HEALTH HOSPITAL FACILITIES (JOHN MUIR MEDICAL CENTER, WALNUT CREEK; JOHN MUIR MEDICAL CENTER, CONCORD; AND JOHN MUIR BEHAVIORAL HEALTH) COLLABORATED WITH SUTTER HEALTH, ST. ROSE HOSPITAL, STANFORD HEALTH CARE VALLEYCARE, UCSF BENIOFF CHILDREN'S HOSPITALS, KAISER PERMANENTE, ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT AND CONTRA COSTA HEALTH SERVICES ON THE COMMUNITY HEALTH NEEDS ASSESSMENT. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B: OTHER NON-HOSPITAL ORGANIZATIONS INCLUDED IN CHNAJOHN MUIR HEALTH CONTRACTED WITH AD LUCEM CONSULTING, A PUBLIC HEALTH CONSULTING FIRM, TO CONDUCT THE CHNA. AD LUCEM CONSULTING SPECIALIZES IN INITIATIVE DESIGN, STRATEGIC PLANNING, GRANTS MANAGEMENT, AND PROGRAM EVALUATION, TAILORING METHODS AND STRATEGIES TO EACH PROJECT AND ADAPTING TO CLIENT NEEDS AND PRIORITIES, POSITIONING CLIENTS FOR SUCCESS. AD LUCEM CONSULTING WORKS IN CLOSE COLLABORATION WITH CLIENTS, SYNTHESIZING COMPLEX INFORMATION INTO EASY-TO-UNDERSTAND, USABLE FORMATS, BRINGING A HANDS-ON, DOWN TO EARTH APPROACH TO EACH PROJECT. AD LUCEM CONSULTING SUPPORTS CLIENTS THROUGH A VARIETY OF SERVICES THAT CAN BE APPLIED TO A RANGE OF ISSUES. AD LUCEM CONSULTING HAS DEVELOPED NUMEROUS CHNA REPORTS AND IMPLEMENTATION STRATEGIES FOR HOSPITALS INCLUDING SYNTHESIS OF SECONDARY AND PRIMARY DATA, NEEDS PRIORITIZATION, AND IDENTIFICATION OF ASSETS AND IMPLEMENTATION STRATEGIES.ASR, WWW.APPLIEDSURVEYRESEARCH.ORG, CONDUCTED KEY INFORMANT INTERVIEWS FOR CHNAS COVERING ALAMEDA AND CONTRA COSTA COUNTIES. SECONDARY DATA CHARTS/TABLES AND INTERVIEW DATA WERE GENEROUSLY SHARED WITH MEMBERS OF THE ALAMEDA AND CONTRA COSTA COUNTIES HOSPITAL CHNA GROUP AND ARE INCLUDED IN THIS CHNA REPORT. ASR ALSO CONVENED COMMUNITY STAKEHOLDERS AND HOSPITAL REPRESENTATIVES TO REVIEW SERVICE AREA DATA AND PARTICIPATE IN A HEALTH NEED RANKING PROCESS. ASR IS A SOCIAL RESEARCH ORGANIZATION DEDICATED TO HELPING PEOPLE BUILD BETTER COMMUNITIES THROUGH MEASURING AND IMPROVING ORGANIZATIONAL IMPACT AND SERVICES AND QUALITY OF LIFE. ASR HAS A STRONG HISTORY OF WORKING WITH VULNERABLE POPULATIONS AND EXTENSIVE EXPERIENCE WORKING WITH PUBLIC AND PRIVATE AGENCIES, FEDERAL AND LOCAL GOVERNMENT, HEALTH AND HUMAN SERVICE ORGANIZATIONS, CITIES AND COUNTY OFFICES, SCHOOL DISTRICTS, INSTITUTIONS OF HIGHER LEARNING AND CHARITABLE FOUNDATIONS. PART V, SECTION B, LINE 7A CHNA REPORT MADE WIDELY AVAILABLE TO PUBLICTHE CHNA REPORT WAS MADE WIDELY AVAILABLE AT THE FOLLOWING URL:WWW.JOHNMUIRHEALTH.COM/ABOUT-JOHN-MUIR-HEALTH/COMMUNITY-COMMITMENT.HTML PART V, SECTION B, LINE 10A WEBSITE FOR ADOPTED IMPLEMENTATION STRATEGYTHE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING URL:WWW.JOHNMUIRHEALTH.COM/ABOUT-JOHN-MUIR-HEALTH/COMMUNITY-COMMITMENT.HTML PART V, SECTION B, LINE 11 SIGNIFICANT NEEDS ADDRESSED IN CHNATHE HEALTH SYSTEM IDENTIFIED NINE COMMUNITY HEALTH NEEDS:1. BEHAVIORAL HEALTH2. HOUSING AND HOMELESSNESS3. ECONOMIC SECURITY4. STRUCTURAL RACISM5. HEALTHCARE ACCESS AND DELIVERY6. COMMUNITY AND FAMILY SAFETY7. FOOD SECURITY8. EDUCATION9. TRANSPORTATIONTHE 2022 CHNA FOR JOHN MUIR HEALTH PLACED PARTICULAR EMPHASIS ON THE HEALTH ISSUES AND CONTRIBUTING FACTORS THAT IMPACT POPULATIONS WITH DISPROPORTIONATELY POOR HEALTH OUTCOMES. PRIORITY COMMUNITY PROFILES WERE DEVELOPED TO PRESENT LOCAL DATA AS A COMPLEMENT TO THE JOHN MUIR HEALTH SERVICE AREA DATA REPORTED ELSEWHERE IN THE CHNA. THE PROFILES INCLUDE DEMOGRAPHICS, DATA ON ROOT CAUSES OF HEALTH, AND ADDITIONAL STATISTICS.A. IDENTIFYING COMMUNITY HEALTH NEEDS I. DEFINITION OF "HEALTH NEED" FOR THE PURPOSES OF THE CHNA, HEALTH NEEDS ARE DEFINED AS INCLUDING THE ELEMENTS ESSENTIAL TO IMPROVING OR MAINTAINING HEALTH STATUS IN THE COMMUNITY AT LARGE AND IN PARTICULAR PARTS OF THE COMMUNITY, SUCH AS PARTICULAR GEOGRAPHIES OR POPULATIONS EXPERIENCING HEALTH INEQUITIES. ESSENTIAL ELEMENTS MAY INCLUDE ADDRESSING FINANCIAL AND OTHER BARRIERS TO CARE AS WELL AS PREVENTING ILLNESS, ENSURING ADEQUATE NUTRITION, OR ADDRESSING SOCIAL, BEHAVIORAL, AND ENVIRONMENTAL FACTORS THAT INFLUENCE HEALTH IN THE COMMUNITY. HEALTH NEEDS WERE IDENTIFIED BY THE COMPREHENSIVE IDENTIFICATION, INTERPRETATION, AND ANALYSIS OF A ROBUST SET OF PRIMARY AND SECONDARY DATA.II. CRITERIA AND ANALYTICAL METHODS USED TO IDENTIFY THE COMMUNITY HEALTH NEEDS THE FOLLOWING CRITERIA WERE EMPLOYED TO PRIORITIZE THE LIST OF HEALTH NEEDS FOR THE JOHN MUIR HEALTH SERVICE AREA: - SEVERITY: HOW SEVERE THE HEALTH NEEDS IS (POTENTIAL TO CAUSE DEATH OR DISABILITY) - MAGNITUDE OF SCALE: THE NUMBER OF PEOPLE AFFECTED BY THE HEALTH NEED - CLEAR DISPARITIES OR INEQUITIES: DIFFERENCES IN HEALTH OUTCOMES BY SUBGROUPS (BASED ON GEOGRAPHY, LANGUAGES, ETHNICITY, CULTURE, CITIZENSHIPS STATUS, SEXUAL ORIENTATION, AGE, GENDER, OR OTHERS) - COMMUNITY PRIORITY: THE COMMUNITY PRIORITIZES THE ISSUE OVER OTHER ISSUES - MULTIPLE EFFECT: A SUCCESSFUL SOLUTION TO THE HEALTH NEED HAS THE POTENTIAL TO SOLVE MULTIPLE PROBLEMSB. CRITERIA AND PROCESS USED FOR PRIORITIZATION OF HEALTH NEEDSI. PRIORITIZATION CRITERIATHE FOLLOWING CRITERIA WERE EMPLOYED TO PRIORITIZE THE LIST OF HEALTH NEEDS FOR THE JOHN MUIR HEALTH SERVICE AREA:-SEVERITY: HOW SEVERE THE HEALTH NEED IS (POTENTIAL TO CAUSE DEATH OR DISABILITY)-MAGNITUDE OR SCALE: THE NUMBER OF PEOPLE AFFECTED BY THE HEALTH NEED-CLEAR DISPARITIES OR INEQUITIES: DIFFERENCES IN HEALTH OUTCOMES BY SUBGROUPS (BASED ON GEOGRAPHY, LANGUAGES, ETHNICITY, CULTURE, CITIZENSHIP STATUS, ECONOMIC STATUS, SEXUAL ORIENTATION, AGE, GENDER, OR OTHERS)-COMMUNITY PRIORITY: THE COMMUNITY PRIORITIZES THE ISSUE OVER OTHER ISSUES-MULTIPLIER EFFECT: A SUCCESSFUL SOLUTION TO THE HEALTH NEED HAS THE POTENTIAL TO SOLVE MULTIPLE PROBLEMSII. PRIORITIZATION PROCESSA PROCESS WAS CONDUCTED TO RANK THE HEALTH NEEDS AND IDENTIFY THE TOP FOUR PRIORITY HEALTH NEEDS DURING VIRTUAL MEETINGS. IN PARTNERSHIP WITH KAISER PERMANENTE, ASR CONTACTED COMMUNITY LEADERS INCLUDING COUNTY HEALTH, PARTNER HOSPITALS, AND COMMUNITY ORGANIZATION LEADERS TO ATTEND COUNTY-LEVEL GROUP MEETINGS TO RANK TOP HEALTH NEEDS FOR SERVICE AREAS WITHIN CONTRA COSTA AND ALAMEDA COUNTIES. THE MEETING FOR CONTRA COSTA COUNTY WAS ATTENDED BY 12 PARTICIPANTS SERVING DIVERSE LOW-INCOME POPULATIONS EXPERIENCING HEALTH INEQUITIES, INCLUDING: HOSPITAL REPRESENTATIVES, CONTRA COSTA COUNTY HEALTH SERVICES, THE COMMUNITY CLINIC CONSORTIUM OF CONTRA COSTA AND SOLANO COUNTIES, THE CONTRA COSTA COUNTY OFFICE OF EDUCATION AND THE CALIFORNIA ENDOWMENT (A HEALTH FUNDER). THE MEETING FOR ALAMEDA COUNTY WAS ATTENDED BY 14 PARTICIPANTS SERVING DIVERSE LOW-INCOME POPULATIONS EXPERIENCING HEALTH INEQUITIES, INCLUDING: HOSPITAL REPRESENTATIVES, ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT, COMMUNITY HEALTH CENTER NETWORK, ALAMEDA COUNTY OFFICE OF EDUCATION AND THE CALIFORNIA ENDOWMENT (A HEALTH FUNDER). ASR PRESENTED QUALITATIVE AND QUANTITATIVE FINDINGS FOR THE TOP SCORING EIGHT HEALTH NEEDS IDENTIFIED THROUGH THE SCORING PROCESS DESCRIBED ABOVE. ONE REPRESENTATIVE FROM EACH ORGANIZATION AFFILIATED WITH EACH SERVICE AREA RANKED THE HEALTH NEEDS ON A SCALE OF 0-4, WITH 0 BEING NOT A PRIORITY" TO 4 BEING A "VERY HIGH PRIORITY". VOTE VALUES (0-4) FROM EACH VOTING ATTENDEE WERE AVERAGED. CONTINUED... C. PRIORITIZED DESCRIPTION OF HEALTH NEEDS THE RESULTS OF THE PRIORITIZATION AND BRIEF DESCRIPTIONS OF THE TOP PRIORITY HEALTH NEEDS ACROSS JOHN MUIR HEALTH'S CONTRA COSTA AND ALAMEDA COUNTY SERVICE AREAS ARE PROVIDED BELOW. BEHAVIORAL HEALTH: BEHAVIORAL HEALTH WHICH INCLUDES MENTAL HEALTH, EMOTIONAL AND PSYCHOLOGICAL WELL-BEING, ALONG WITH THE ABILITY TO COPE WITH NORMAL, DAILY LIFE AFFECTS A PERSON'S PHYSICAL WELL-BEING, ABILITY TO WORK AND PERFORM WELL IN SCHOOL AND TO PARTICIPATE FULLY IN FAMILY AND COMMUNITY ACTIVITIES. BEHAVIORAL HEALTH ALSO COVERS SUBSTANCE ABUSE, WHICH IMPACTS MANY ASPECTS OF HEALTH. BEHAVIORAL HEALTH AND THE MAINTENANCE OF GOOD PHYSICAL HEALTH ARE CLOSELY RELATED; COMMON MENTAL HEALTH DISORDERS SUCH AS DEPRESSION AND ANXIETY CAN AFFECT ONE'S ABILITY FOR SELF-CARE WHILE CHRONIC DISEASES CAN LEAD TO NEGATIVE IMPACTS ON MENTAL HEALTH. AMONG CONTRA COSTA COUNTY KEY INFORMANTS AND FOCUS GROUP PARTICIPANTS IDENTIFYING BEHAVIORAL HEALTH AS A PRIORITY, MOST REPORTED THAT BEHAVIORAL HEALTH WAS OFTEN LINKED TO OTHER HEALTH NEEDS SUCH AS TRAUMA, COMMUNITY SAFETY (OVER-POLICING AND OVER-INCARCERATION IN COMMUNITIES OF COLOR), SUBSTANCE USE, ECONOMIC SECURITY CHALLENGES, AND HOMELESSNESS. MENTAL HEALTH PROVIDERS ARE LESS AVAILABLE IN CONTRA COSTA COUNTY WHEN COMPARED TO THE CA AVERAGE (339 VERSUS 352 PER 100,000 POPULATION). HOUSING AND HOMELESSNESS: THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT DEFINES HOUSING AS AFFORDABLE WHEN IT COSTS NO MORE THAN 30% OF A HOUSEHOLD'S INCOME. THE EXPENDITURE OF GREATER SUMS CAN RESULT IN THE HOUSEHOLD BEING UNABLE TO AFFORD OTHER NECESSITIES SUCH AS FOOD, CLOTHING, TRANSPORTATION, AND MEDICAL CARE. THE PHYSICAL CONDITION OF A HOME, ITS NEIGHBORHOOD, AND THE COST OF RENT OR MORTGAGE ARE STRONGLY ASSOCIATED WITH THE HEALTH, WELLBEING, EDUCATIONAL ACHIEVEMENT, AND ECONOMIC SUCCESS OF THOSE WHO LIVE INSIDE. HOMELESSNESS IS CORRELATED WITH POOR HEALTH: POOR HEALTH CAN LEAD TO HOMELESSNESS AND HOMELESSNESS IS ASSOCIATED WITH GREATER RATES OF PREVENTABLE DISEASES, LONGER HOSPITAL STAYS, AND GREATER RISK OF PREMATURE DEATH. CONTRA COSTA COUNTY KEY INFORMANTS AND FOCUS GROUP PARTICIPANTS WHO IDENTIFIED HOUSING AND HOMELESSNESS AS A PRIORITY HEALTH NEED DISCUSSED HOW HOUSING CHALLENGES INFLUENCE OTHER HEALTH NEEDS BY INCREASING ECONOMIC AND FOOD INSECURITY, AND UNHEALTHY BEHAVIORS THAT EXACERBATE CHRONIC DISEASE AND DISABILITY. ECONOMIC SECURITY: FACTORS CONTRIBUTING TO ECONOMIC SECURITY CHALLENGES IDENTIFIED IN CONTRA COSTA COUNTY KEY INFORMANT INTERVIEWS AND FOCUS GROUPS INCLUDED: INSUFFICIENT VOCATIONAL TRAINING, LIMITED LIVING WAGE JOBS, AND LACK OF CLEAR COMMUNICATION ON AVAILABILITY OF/REGISTRATION FOR EXISTING INCOME/EMPLOYMENT SUPPORTS. THEY REPORTED THAT THESE ECONOMIC SECURITY CHALLENGES EXACERBATE A VARIETY OF ISSUES FOR CONTRA COSTA COUNTY RESIDENTS, SUCH AS HOUSING, ACCESS TO HEALTHCARE, UNHEALTHY BEHAVIORS THAT PROMOTE CHRONIC DISEASE AND DISABILITY, FOOD INSECURITY, MENTAL HEALTH ISSUES AND SUBSTANCE USE. STRUCTURAL RACISM: STRUCTURAL RACISM REFERS TO SOCIAL, ECONOMIC AND POLITICAL SYSTEMS AND INSTITUTIONS THAT PERPETUATE RACIAL INEQUITIES THROUGH POLICIES, PRACTICES AND NORMS. STRUCTURAL RACISM IS EMBEDDED IN MANY HEALTH NEEDS. CENTURIES OF STRUCTURAL RACISM HAVE FUELED ENDURING HEALTH INEQUITIES. THE LEGACIES OF RACIAL DISCRIMINATION AND ENVIRONMENTAL INJUSTICE ARE REFLECTED IN STARK DIFFERENCES IN HEALTH OUTCOMES AND LIFE EXPECTANCY FOR INDIVIDUALS WHO ARE BLACK/AFRICAN AMERICAN, LATINO/LATINX, INDIGENOUS, AND PEOPLE OF COLOR. STRUCTURAL RACISM WAS A MAJOR NEED IDENTIFIED BY KEY INFORMANTS AND FOCUS GROUP PARTICIPANTS IN CONTRA COSTA AND ALAMEDA COUNTIES. IN CONTRA COSTA COUNTY, SEVERAL KEY INFORMANTS AND FOCUS GROUP PARTICIPANTS DESCRIBED HOW STRUCTURAL RACISM RESULTS IN LIMITED HEALTHCARE ACCESS AND DELIVERY, WORSE QUALITY OF SERVICES RECEIVED, DECREASED SENSE OF COMMUNITY AND FAMILY SAFETY, AND HIGHER RATES OF TRAUMA AND MENTAL HEALTH DISORDERS FOR PEOPLE OF COLOR COMPARED TO WHITE RESIDENTS. HEALTHCARE ACCESS AND DELIVERY: ACCESS TO COMPREHENSIVE, QUALITY HEALTHCARE HAS A PROFOUND EFFECT ON HEALTH AND QUALITY OF LIFE. COMPONENTS OF ACCESS TO AND DELIVERY OF CARE INCLUDE: INSURANCE COVERAGE, ADEQUATE NUMBERS OF PRIMARY AND SPECIALTY CARE PROVIDERS, HEALTHCARE TIMELINESS, QUALITY AND TRANSPARENCY, MULTI-LINGUISTIC CAPACITY, AND CULTURAL COMPETENCE/CULTURAL HUMILITY. LIMITED ACCESS TO HEALTHCARE AND COMPROMISED HEALTHCARE DELIVERY NEGATIVELY AFFECT HEALTH OUTCOMES AND QUALITY OF LIFE. COMMUNITY AND FAMILY SAFETY: SAFE COMMUNITIES PROMOTE COMMUNITY COHESION, ECONOMIC DEVELOPMENT, AND OPPORTUNITIES TO BE ACTIVE WHILE REDUCING UNTIMELY DEATHS AND SERIOUS INJURIES. CRIME, VIOLENCE, AND INTENTIONAL INJURY ARE RELATED TO POORER PHYSICAL AND MENTAL HEALTH OUTCOMES. CHILDREN AND ADOLESCENTS EXPOSED TO VIOLENCE ARE AT RISK FOR POORER LONG-TERM BEHAVIORAL AND MENTAL HEALTH OUTCOMES. TWO KEY MEASURES OF COMMUNITY SAFETY, VIOLENT CRIME AND INJURY DEATHS, WERE SUBSTANTIALLY HIGHER IN ALAMEDA COUNTY THAN THE CA AVERAGE. KEY INFORMANTS IN CONTRA COSTA AND ALAMEDA COUNTIES IDENTIFIED SYSTEMIC RACISM AS NEGATIVELY IMPACTING COMMUNITY SAFETY.FOOD SECURITY: FOOD INSECURITY IS THE LACK OF CONSISTENT ACCESS TO ENOUGH FOOD FOR AN ACTIVE, HEALTHY LIFE. FOOD INSECURITY ENCOMPASSES: ANXIETY ABOUT FOOD INSUFFICIENCY, HOUSEHOLD FOOD SHORTAGES, REDUCED QUALITY, VARIETY, OR DESIRABILITY OF FOOD, DIMINISHED NUTRIENT INTAKE, AND DISRUPTED EATING PATTERNS. SEVERAL CONTRA COSTA COUNTY FOCUS GROUP PARTICIPANTS STATED THAT ACCESSING FRESH PRODUCE AND HEALTHY FOOD OPTIONS IS DIFFICULT THROUGHOUT THE COUNTY, REPORTING THAT STORES STOCKING HEALTHY FOODS ARE NOT IN WALKING DISTANCE FOR MOST RESIDENTS AND REQUIRE A CAR OR PUBLIC TRANSPORTATION TO ACCESS. CONTINUED... EDUCATION: THE LINK BETWEEN EDUCATION AND HEALTH IS WELL-KNOWN. THOSE WITH HIGHER LEVELS OF EDUCATION ARE MORE LIKELY TO BE HEALTHIER AND LIVE LONGER. PRE-SCHOOL EDUCATION IS POSITIVELY ASSOCIATED WITH READINESS FOR AND SUCCESS IN SCHOOL, AS WELL AS LONG-TERM ECONOMIC BENEFITS FOR INDIVIDUALS AND SOCIETY, INCLUDING GREATER EDUCATIONAL ATTAINMENT, HIGHER INCOME, AND LOWER ENGAGEMENT IN DELINQUENCY AND CRIME. INDIVIDUALS WITH AT LEAST A HIGH SCHOOL DIPLOMA DO BETTER ON A NUMBER OF MEASURES THAN HIGH SCHOOL DROPOUTS: INCOME, HEALTH OUTCOMES, LIFE SATISFACTION, AND SELF-ESTEEM. WEALTH AMONG FAMILIES IN WHICH THE HEAD OF HOUSEHOLD HAS A HIGH SCHOOL DIPLOMA IS 10 TIMES HIGHER THAN THAT OF FAMILIES IN WHICH THE HEAD OF HOUSEHOLD DROPPED OUT OF HIGH SCHOOL. TRANSPORTATION: WITHOUT RELIABLE AND SAFE TRANSPORTATION, INDIVIDUALS STRUGGLE TO MEET BASIC NEEDS SUCH AS EARNING AN INCOME, ACCESSING HEALTHCARE, AND SECURING FOOD. TRANSPORTATION INFRASTRUCTURE FAVORS INDIVIDUAL CAR USE, WHICH IS ASSOCIATED WITH A NUMBER OF ADVERSE CONSEQUENCES, INCLUDING MOTOR VEHICLE INJURIES AND DEATHS, THE EXPENSES OF OWNING A VEHICLE, AND GREENHOUSE GAS EMISSIONS WHICH ARE A RISK FACTOR FOR HEART DISEASE, STROKE, ASTHMA, AND CANCER. FOR HOUSEHOLDS WITHOUT ACCESS TO A CAR, INCLUDING MANY LOW-INCOME INDIVIDUALS AND PEOPLE OF COLOR, WALKING, BIKING AND USING PUBLIC TRANSPORTATION PROVIDE CRITICAL LINKS TO JOBS AND ESSENTIAL SERVICES AND PROMOTE EXERCISE AND SOCIAL COHESION. CONTRA COSTA COUNTY KEY INFORMANTS AND FOCUS GROUP PARTICIPANTS IDENTIFYING TRANSPORTATION AS A HEALTH NEED DESCRIBED HOW INADEQUATE TRANSPORTATION PRESENTS BARRIERS TO ACCESSING HEALTHCARE AND A NUMBER OF HEALTH RELATED ACTIVITIES OF DAILY LIVING, INCLUDING: ACCESS TO GROCERY STORES SELLING HEALTHY FOOD, ABILITY TO GET CHILDREN TO/FROM SCHOOL, ACCESS TO COMMUNITY EVENTS, AND ABILITY TO COMMUTE TO A LIVING WAGE JOB. HEALTH NEEDS JOHN MUIR HEALTH WILL ADDRESS ACROSS ITS SERVICE AREA DURING 2023-2025 ARE:1. STRUCTURAL RACISM (AN OVERARCHING NEED THAT CUTS ACROSS ALL OTHER HEALTH NEEDS) 2. HEALTHCARE ACCESS AND DELIVERY 3. BEHAVIORAL HEALTH 4. HOUSING AND HOMELESSNESSD. JOHN MUIR HEALTH IMPLEMENTATION STRATEGIESJOHN MUIR HEALTH HAS IDENTIFIED EXPECTED IMPACTS, STRATEGIES, FOCUS AREAS, AND PARTNERS FOR EACH PRIORITY HEALTH NEED, AS DESCRIBED BELOW. STRATEGY IMPLEMENTATION WILL DRAW ON JOHN MUIR HEALTH'S ORGANIZATIONAL RESOURCES (GRANTMAKING, INTERNAL PROGRAMS, JOHN MUIR HEALTH STAFF, AND OTHER ASSETS) IN COMBINATION WITH AN ARRAY OF PARTNERSHIPS AND COLLABORATIONS WITH COMMUNITY ORGANIZATIONS, STAKEHOLDERS, AND LEADERS THROUGHOUT ITS SERVICE AREA. JOHN MUIR HEALTH HAS SELECTED THE FOLLOWING NEEDS TO ADDRESS, WITH STRUCTURAL RACISM AS THE DRIVER THAT ADDRESSES ALL FOCUS AREAS. WITHIN EACH FOCUS AREA, JOHN MUIR HEALTH PLANS TO IMPLEMENT PROGRAMMING THAT ALIGNS WITH SPECIFIC PROGRAMMATIC CATEGORIES, PROMOTING HEALTH VIA MULTIFACETED APPROACHES: - WORKFORCE DEVELOPMENT - PROMOTION AND PREVENTION - DIRECT SERVICES AND TREATMENT - RESILIENCY AND SUPPORT SERVICESPRIORITY HEALTH NEED: STRUCTURAL RACISMSTRUCTURAL RACISM IS A SELECTED PRIORITY NEED THAT WILL BE INFUSED INTO STRATEGIES IMPLEMENTED TO ADDRESS ALL SELECTED HEALTH NEEDS. STRATEGIES AIMED AT ELIMINATING STRUCTURAL RACISM FOCUS ON SUPPORTING SYSTEMS CHANGE AMONG JOHN MUIR HEALTH GRANTEES AND PARTNERS (COMMUNITY-BASED NONPROFIT ORGANIZATIONS SERVING THE JOHN MUIR HEALTH SERVICE AREA) BY FINANCIALLY SUPPORTING INTERVENTIONS THAT GUIDE ADOPTION OF ANTI-RACISM POLICIES, PRACTICES, SERVICES AND RESOURCES.STRUCTURAL RACISM GOALS:LONG-TERM GOAL: ELIMINATE STRUCTURAL RACISM IN ITS ENTIRETY FOR ALL COMMUNITIES. INTERMEDIATE GOALS: - INCREASE FINANCIAL SUPPORT TO ALL JOHN MUIR HEALTH COMMUNITY BENEFIT PARTNER NONPROFIT ORGANIZATIONS TO SUPPORT ADOPTION OF NEW POLICIES, PRACTICES AND SERVICES THAT ADDRESS STRUCTURAL RACISM. - INCREASE COMMUNITY-BASED NONPROFIT ORGANIZATION ACCESS TO TOOLS THAT ADDRESS STRUCTURAL RACISM.TO PROMOTE ANTI-RACISM SYSTEMS CHANGE AT THE ORGANIZATIONAL LEVEL, JOHN MUIR HEALTH WILL AWARD ALL GRANTEES ADDITIONAL FUNDING TO BE RESTRICTED TOWARDS ADDRESSING STRUCTURAL RACISM AND WILL ENGAGE EVALUATION METHODOLOGIES TO MEASURE IMPACT ACROSS THE SERVICE AREA. JOHN MUIR HEALTH WILL GUIDE AND SUPPORT SYSTEMS CHANGE BY EXTERNALIZING INTERNAL RESOURCES AND EXPERTISE FROM THE OFFICE OF BELONGING AND EQUITY, PROVIDING GRANTEE AND PARTNER ORGANIZATIONS WITH A MENU OF ISSUES/STRATEGIES TO ADDRESS/IMPLEMENT, INCLUDING: - REPRESENTATION IN BOARD OF DIRECTORS AND LEADERSHIP COMPOSITION - HIRING AND WORKFORCE DEVELOPMENT PRACTICES - DIVERSITY, EQUITY, AND INCLUSION TRAININGS OR WORKSHOPS - EMPLOYEE ENGAGEMENT OPPORTUNITIES (I.E., EMPLOYEE RESOURCE GROUPS, CULTURAL CELEBRATIONS)PRIORITY HEALTH NEED: HEALTHCARE ACCESS AND DELIVERY LONG-TERM GOAL: THE ENTIRE COMMUNITY HAS ACCESS TO APPROPRIATE CULTURALLY AND LINGUISTICALLY-ALIGNED HEALTHCARE AND HEALTHCARE SUPPORT SERVICES THAT ARE DELIVERED WITH QUALITY AND COMPASSION. INTERMEDIATE GOALS: - INCREASE ACCESS TO A DIVERSE, LINGUISTICALLY AND CULTURALLY-ALIGNED HEALTHCARE WORKFORCE. - INCREASE ACCESS TO SUBSIDIZED CARE AND FINANCIAL ASSISTANCE FOR LOW-INCOME AND UNINSURED INDIVIDUALS. - INCREASE ACCESS TO COMPREHENSIVE PRIMARY CARE, SPECIALTY CARE SERVICES, SUPPORT SERVICES, AND PREVENTION PROGRAMMING FOR LOW-INCOME, VULNERABLE, AND UNINSURED INDIVIDUALS.EXPECTED IMPACT: - INCREASED OPPORTUNITIES FOR HEALTHCARE SECTOR CAREERS FOR POPULATIONS UNDERREPRESENTED IN THE HEALTHCARE WORKFORCE. - INCREASED ACCESS TO AND USE OF COMPREHENSIVE PRIMARY CARE AND SPECIALTY CARE FOR LOW-INCOME AND UNINSURED POPULATIONS. STRATEGY TO ACHIEVE THIS INCLUDES: - IMPROVED QUALITY OF CARE FOR CLIENTS OF SAFETY NET ORGANIZATIONS. - INCREASED ACCESS TO COMMUNITY-BASED HEALTH SCREENINGS AND HEALTHCARE SUPPORT SERVICESSTRATEGY TO ACHIEVE THESE GOALS INCLUDES:- PROVIDING WORKFORCE DEVELOPMENT PROGRAMMING TO HIGH SCHOOL, JUNIOR COLLEGE, AND MEDICAL SCHOOL STUDENTS UNDERREPRESENTED IN HEALTHCARE CAREERS TO INCLUDE YOUNG HEALERS AND CLIMB MENTORSHIP PROGRAMS.- PROVIDE SUPPORT TO THE VULNERABLE POPULATIONS CURRICULUM OF THE JOHN MUIR HEALTH FAMILY MEDICINE RESIDENCY TO ENGAGE MEDICAL RESIDENTS IN COMMUNITY-BASED SERVICES IN PARTNERSHIP WITH LOCAL NONPROFIT ORGANIZATIONS. - PROVIDE CHRONIC DISEASE PREVENTION EDUCATION, SCREENING, AND CLINICAL SERVICES TO VULNERABLE ADULTS THROUGH THE DIABETES EMPOWERMENT EDUCATION PROGRAM, JOHN MUIR HEALTH MOBILE HEALTH CLINIC, AND HAPPY FEET PROGRAM. - PROVIDE SCREENING PROGRAMS THROUGH EVERY WOMAN COUNTS AND THE LUNG CANCER SCREENING PROGRAM FOR LOW-INCOME ADULTS WHO ARE UNABLE TO ACCESS CARE DUE TO LACK OF INSURANCE COVERAGE.- PROVIDE FINANCIAL ASSISTANCE, VIA THE JOHN MUIR HEALTH CHARITY CARE POLICY, TO SUPPORT LOW-INCOME PATIENTS BY SUBSIDIZING ALL OR A PORTION OF THEIR JOHN MUIR HEALTH MEDICAL EXPENSES. - PARTICIPATE IN THE GOVERNMENT-SPONSORED MEDI-CAL PROGRAM TO PROVIDE COMPREHENSIVE INPATIENT CARE TO MEDI-CAL ENROLLEES THAT GENERATE UNPAID COSTS AT JOHN MUIR MEDICAL CENTER-WALNUT CREEK, JOHN MUIR MEDICAL CENTER-CONCORD, JOHN MUIR PHYSICIAN NETWORK, AND BEHAVIORAL HEALTH CENTER. - PROVIDE COMPREHENSIVE PRIMARY CARE SERVICES, VIA THE JOHN MUIR HEALTH MOBILE HEALTH CLINIC, FOR VULNERABLE AND UNSHELTERED INDIVIDUALS WHO ARE UNABLE TO ACCESS CARE DUE TO INADEQUATE INSURANCE COVERAGE, ACCESSIBILITY OF SERVICES, OR TIMELINESS OF APPOINTMENTS. - PROVIDE SPECIALTY CARE SERVICES THROUGH THE LA CLINICA/JOHN MUIR HEALTH SPECIALTY CARE PROGRAM AND OTHER SPECIALTY CARE PROGRAMS FOR ADULTS WHO ARE UNABLE TO ACCESS CARE DUE TO LACK OF INSURANCE COVERAGE.- LEAD THE DENTAL COLLABORATIVE OF CONTRA COSTA COUNTY AND PROVIDE DENTAL SERVICES AND DENTAL EDUCATION, VIA RONALD MCDONALD/JOHN MUIR HEALTH MOBILE DENTAL CLINIC, FOR CHILDREN IN SCHOOLS THAT SERVE LOW-INCOME FAMILIES. - PROVIDE HEALTHCARE SUPPORT SERVICES FOR CHILDREN IN SCHOOLS THAT SERVE LOW-INCOME FAMILIES THROUGH PROGRAMS SUCH AS THE JOHN MUIR HEALTH COMMUNITY SCHOOL NURSE PROGRAM. - PROVIDE ACCESS TO HEALTHCARE SUPPORT SERVICES FOR VULNERABLE OLDER ADULTS THAT PROMOTE INDEPENDENT LIVING AND WELLNESS THROUGH FALL PREVENTION SAFETY TRAININGS, HOME ASSESSMENTS AND MODIFICATIONS, HEALTH EDUCATION, AND ACCESS TO ASSISTIVE TECHNOLOGIES. CONTINUED... PRIORITY HEALTH NEED: BEHAVIORAL HEALTH LONG-TERM GOAL: THE ENTIRE COMMUNITY HAS ACCESS TO BEHAVIORAL AND MENTAL HEALTH PROGRAMMING, SUPPORT AND DIRECT SERVICES TO PROMOTE WHOLE HEALTH AND EMOTIONAL WELLNESS. INTERMEDIATE GOALS: - INCREASE ACCESS TO ALTERNATIVE MENTAL HEALTH WORKFORCE TO INCLUDE COMMUNITY HEALTH WORKERS AND PROMOTORES TRAINING PROGRAMS. - INCREASE ACCESS TO BEHAVIORAL AND MENTAL HEALTH SERVICES THAT PROVIDE PREVENTION, DIRECT SERVICE AND SUPPORT FOR VULNERABLE INDIVIDUALS AND FAMILIES. - INCREASE VIOLENCE PREVENTION AND RESILIENCY PROGRAMMING FOR VULNERABLE COMMUNITIES.EXPECTED IMPACT - INCREASED ACCESS TO AND USE OF BEHAVIORAL AND MENTAL HEALTH SERVICES. - INCREASED ACCESS TO CULTURALLY AND LINGUISTICALLY-ALIGNED BEHAVIORAL AND MENTAL HEALTH SERVICES. - IMPROVED YOUTH RESILIENCE. - INCREASED ACCESS TO SUPPORTIVE COMMUNITY-BASED SERVICES THAT PREVENT AND MITIGATE THE IMPACTS OF VIOLENCE AND TRAUMA.STRATEGY TO ACHIEVE THESE GOALS:- SUPPORT COMMUNITY HEALTH WORKER AND PROMOTORES PROGRAMS THAT OFFER TRAINING TO COMMUNITY MEMBERS TO PREVENT AND/OR REDUCE LEVELS OF STRESS, ANXIETY AND DEPRESSION IN VULNERABLE COMMUNITIES. - LEAD THE RESTORATIVE JUSTICE INITIATIVE ACROSS CONTRA COSTA COUNTY SCHOOLS TO PROMOTE VIOLENCE PREVENTION AND PROVIDE TRAININGS TO SCHOOL STAFF AND ADMINISTRATION ON HOW TO RESOLVE HARM AND REDUCE CONFLICT AMONG THE SCHOOL COMMUNITY. - SUPPORT PROGRAMMING THAT FOCUSES ON SOCIAL CONNECTION AMONG OLDER ADULTS TO REDUCE ISOLATION AND PROMOTE WELL-BEING. - PROVIDE DIRECT MENTAL HEALTH THERAPY SERVICES TO YOUTH, ADULTS AND FAMILIES WHO ARE UNABLE TO ACCESS CARE DUE TO INADEQUATE INSURANCE COVERAGE, ACCESSIBILITY OF SERVICES, OR TIMELINESS OF APPOINTMENTS. PROGRAMS INCLUDE: JOHN MUIR HEALTH BEYOND VIOLENCE, JOHN MUIR HEALTH MOBILE HEALTH CLINIC, CANCER SUPPORT SERVICES, AND SCHOOL-BASED SERVICES. - LEAD THE BEYOND VIOLENCE PROGRAM AND ALL PARTNERS COLLABORATIVE TO PROVIDE HOSPITAL-BASED VIOLENCE INTERVENTION SERVICES TO INDIVIDUALS IMPACTED BY INTENTIONAL VIOLENCE AND PROMOTE RESILIENCY BY PROVIDING ROBUST COMMUNITY-BASED SUPPORT SERVICES TO INDIVIDUALS AND THEIR FAMILIES VIA PARTNERSHIPS WITH LOCAL NONPROFIT ORGANIZATIONS. - PROVIDE PEER-DELIVERED SERVICES, SUPPORT GROUPS AND CONNECTION TO RESOURCES FOR VULNERABLE ADULTS DIAGNOSED WITH MENTAL ILLNESS.PRIORITY HEALTH NEED: HOUSING AND HOMELESSNESS LONG-TERM GOAL: THE ENTIRE COMMUNITY HAS ACCESS TO SAFE, HEALTHY, AND AFFORDABLE HOUSING. INTERMEDIATE GOALS: - INCREASE SUPPORT OF THE HOUSING NAVIGATORS WORKFORCE AND EMPLOYMENT OPPORTUNITIES TO COMMUNITIES PRONE TO HOMELESSNESS. - INCREASE ACCESS TO HOMELESSNESS PREVENTION RESOURCES TO LOW-INCOME AND VULNERABLE COMMUNITIES. - INCREASE ACCESS TO HOUSING RESOURCES AND SUPPORT SERVICES TO PROVIDE UNSHELTERED INDIVIDUALS AND FAMILIES WITH ACCESS TO TRANSITIONAL SUPPORTIVE HOUSING, RESPITE CARE AND RECUPERATIVE HOUSING, PERMANENT SUPPORTIVE HOUSING, AND ULTIMATELY INDEPENDENT PERMANENT AFFORDABLE HOUSING. - INCREASE FOOD SECURITY AND DECREASE THE FOOD COST BURDEN FOR LOW-INCOME FAMILIES TO FREE UP FUNDS TO COVER HOUSING COSTS.EXPECTED IMPACT: - INCREASED NUMBER OF COMMUNITY MEMBERS WITH STABLE HOUSING. - INCREASED ACCESS TO HOUSING SERVICES FOR COMMUNITY MEMBERS WHO ARE UNHOUSED AND AT RISK OF BECOMING UNHOUSED. - INCREASED COMMUNITY OUTREACH AND AWARENESS OF HOUSING RESOURCES. - INCREASED CONSISTENT ACCESS TO HEALTHY FOOD FOR LOW- INCOME AND UNHOUSED INDIVIDUALS.STRATEGIES TO ACHIEVE THESE GOALS INCLUDES:- PROVIDE SUPPORT TO HOUSING NAVIGATOR WORKFORCE PROGRAMS. - PROVIDE SUPPORT TO EMPLOYMENT PROGRAMS THAT DIRECTLY IMPACT COMMUNITIES PRONE TO HOMELESSNESS. - PROVIDE HOMELESSNESS PREVENTION SERVICES AND EMERGENCY FUNDING TO HOUSING INSECURE INDIVIDUALS AND FAMILIES TO ENSURE THAT COMMUNITY MEMBERS MAINTAIN STABLE HOUSING. - PROVIDE CONNECTION TO RESPITE CARE AND RECUPERATIVE HOUSING FOR HOMELESS PATIENTS DISCHARGED FROM LOCAL HOSPITALS, INCLUDING JOHN MUIR HEALTH. - PROVIDE CONNECTION TO TRANSITIONAL SUPPORTIVE HOUSING FOR INDIVIDUALS AND FAMILIES WHO ARE IN RECOVERY FROM ALCOHOL AND OTHER SUBSTANCES. - PROVIDE CONNECTION TO PERMANENT SUPPORTIVE AND AFFORDABLE HOUSING FOR HOMELESS INDIVIDUALS AND FAMILIES. - PROVIDE SUPPORT SERVICES TO UNHOUSED INDIVIDUALS AND FAMILIES TO INCLUDE: FOOD, SHOWER AND LAUNDRY FACILITIES, CLOTHING, EMPLOYMENT ASSISTANCE AND CONNECTION TO ADDITIONAL SUPPORT SERVICES. - SUPPORT COMMUNITY OUTREACH AND AWARENESS-BUILDING OF HOUSING RESOURCES AVAILABLE TO THE COMMUNITY. - SUPPORT FOOD ACCESS PROGRAMMING TO PROVIDE NUTRITIOUS FOODS, INCLUDING FRESH PRODUCE, FOR UNHOUSED AND LOW-INCOME INDIVIDUALS, FAMILIES, AND COMMUNITIES.JOHN MUIR HEALTH DEVELOPS COLLABORATIVE PARTNERSHIPS WITH LOCAL ORGANIZATIONS TO BE RESPONSIVE TO THE NEEDS OF THE MOST VULNERABLE AND UNDERSERVED POPULATIONS. THE FOLLOWING HIGHLIGHTS A FEW OF THE 2023-YEAR END RESULTS IN COLLABORATION WITH LOCAL ORGANIZATION BY EACH OF THE FOUR COMMUNITY HEALTH NEEDS THAT JOHN MUIR HEALTH IS ADDRESSING.COMMUNITY HEALTH NEEDS: STRUCTURAL RACISMHEALTH OUTCOMES ARE DIRECTLY IMPACTED BY RACISM AND SOCIETAL INEQUITIES. AS PART OF JMH'S COMMUNITY BENEFIT FUNDING STRATEGY, JMH IS INVESTING IN EACH OF ITS 33 COMMUNITY PARTNER ORGANIZATIONS EXPLICITLY TO ADOPT INTERVENTIONS THAT PROMOTE EQUITY WITHIN THEIR INDIVIDUAL ORGANIZATIONS, BOARDS, STAFF, AND THE COMMUNITY SERVED. EACH ORGANIZATION RECEIVES AN ADDITIONAL $5,000 PER YEAR, FOR THREE YEARS, TO SUPPORT FUNDAMENTAL AND LASTING CHANGES.COMMUNITY HEALTH NEED: HEALTHCARE ACCESS AND DELIVERY. THE FOLLOWING ARE SELECT HIGH IMPACT PROGRAM OUTCOMES IN 2023:- MOBILE HEALTH CLINIC: PROVIDE COMPREHENSIVE NO-COST PRIMARY CARE FOR VULNERABLE ADULTS WHO ARE UNABLE TO ACCESS CARE DUE TO INADEQUATE INSURANCE COVERAGE, AVAILABILITY OF SERVICES, TIMELINESS OF APPOINTMENTS OR ACCESSIBILITY. IN 2023, THE MOBILE CLINIC SERVED 629 PEOPLE FOR 912 ENCOUNTERS DURING SATURDAY VOLUNTEER PHYSICIAN CLINICS AND WEDNESDAY/THURSDAY RESIDENCY CLINIC. IT PROVIDED 765 ORAL HEALTH SERVICES TO 466 CHILDREN. 1,418 CHILDREN IN SCHOOLS THAT SERVE LOW-INCOME FAMILIES RECEIVED DENTAL ASSESSMENTS THROUGH THE COUNTY ORAL HEALTH COLLABORATIVE. OF THOSE CHILDREN WHO RECEIVED DENTAL ASSESSMENTS, 1,394 CHILDREN RECEIVED FLUORIDE TREATMENTS.- LA CLINICA SPECIALTY CARE PROGRAM: PROVIDE SPECIALTY CARE SERVICES THROUGH THE LA CLINICA SPECIALTY CARE PROGRAM FOR VULNERABLE ADULTS WHO ARE UNABLE TO ACCESS CARE DUE TO LACK OF COVERAGE. IN 2023, PROVIDERS WERE RECRUITED TO MEET THE NEEDS OF REFERRED PATIENTS, WHICH INCLUDED GYNECOLOGICAL ONCOLOGIST, GYNECOLOGIST, MEDICAL ONCOLOGIST, DIAGNOSTIC IMAGING, GASTROENTEROLOGIST, SURGEON, CANCER GENETICIST, AND UROLOGIST. IN TOTAL, 238 PATIENTS WERE REFERRED FROM LA CLINICA AND AMONG THEM, 226 WERE ACCEPTED INTO THE SPECIALTY CARE PROGRAM (ACCEPTANCE RATE OF 95%). IN ADDITION, 563 PROCEDURES AND INTERVENTIONS WERE PROVIDED THROUGHOUT THE YEAR. MOST INTERVENTIONS WERE CONSULTATIONS/FOLLOW-UP WITH SPECIALIST AND IMAGING.- OPERATION ACCESS: PROVIDE SPECIALTY CARE SERVICES THROUGH OPERATION ACCESS FOR VULNERABLE ADULTS WHO ARE UNABLE TO ACCESS DUE TO LACK OF COVERAGE. IN 2023, A TOTAL OF 138 SURGICAL PROCEDURES WERE PROVIDED IN A JOHN MUIR HEALTH OPERATING ROOM. THERE WERE 33 ACTIVE VOLUNTEER PHYSICIANS FROM JOHN MUIR HEALTH WHO PROVIDED AT LEAST ONE SURGICAL SERVICE.- EVERY WOMEN COUNTS PROGRAM: PROVIDE FREE BREAST CANCER SCREENING FOR LOW-INCOME WOMEN WHO ARE UNABLE TO ACCESS CARE DUE TO LACK OF COVERAGE. IN 2023, THERE WERE 36 BREAST CANCER SCREENING CLINICS. THE PROGRAM PROVIDED 27 BREAST BIOPSIES AND 100% RECEIVED BIOPSY RESULTS WITHIN TWO WEEKS. FOUR WOMEN WERE DIAGNOSED WITH BREAST CANCER AND 100% WERE PROVIDED WITH APPROPRIATE FOLLOW-UP TO MONITOR THEIR DIAGNOSIS.- MEALS ON WHEELS DIABLO REGION FALL PREVENTION PROGRAM (FPP): PROVIDE ACCESS TO HEALTH CARE SUPPORT AND CARE COORDINATION SERVICES FOR VULNERABLE ADULTS AND SENIORS THAT ADDRESS POOR HEALTH OUTCOMES, QUALITY AND SATISFACTION WHILE IMPROVING EFFICIENCY THROUGH SAFETY TRAININGS, HOME ASSESSMENTS AND MODIFICATIONS, AND EDUCATION. IN 2023, 234 INDIVIDUALS SERVED RESIDED IN COMMUNITY BENEFIT DESIGNATED AREAS. FPP RECEIVED 516 REFERRALS AND CONDUCTED 330 HOME SAFETY ASSESSMENTS AND COMPLETED HOME MODIFICATIONS IN 100% OF THE HOMES THAT WERE ASSESSED. CONTINUED... COMMUNITY HEALTH NEED: BEHAVIORAL HEALTH. THE FOLLOWING ARE SELECT HIGH-IMPACT PROGRAM OUTCOMES IN 2023:- IN 2023, THERE WAS A TOTAL CLIENT LOAD OF 60 INDIVIDUALS WHO CONSENTED TO RECEIVE BEYOND VIOLENCE SERVICES AT THE FOLLOWING PARTNER NONPROFIT ORGANIZATIONS: RYSE CENTER IN RICHMOND, ONE DAY AT A TIME IN BRENTWOOD, CENTER FOR HUMAN DEVELOPMENT IN CONCORD AND FAMILY JUSTICE CENTER IN ANTIOCH AND RICHMOND. - A TOTAL OF 182 INDIVIDUALS WERE PROVIDED MENTAL HEALTH COUNSELING SERVICES THROUGH THE FRED FINCH YOUTH AND FAMILY SERVICES.- IN 2023, 57 NEW MEMBERS JOINED MENTAL HEALTH CONNECTION, A PROGRAM THAT SUPPORTS AND/OR PROVIDES BEHAVIORAL HEALTH INTERVENTION SERVICES TO VULNERABLE ADULTS WITH SEVERE MENTAL HEALTH ILLNESS THROUGH EDUCATION AND VOCATIONAL REHABILITATION SUPPORT SERVICES.- A TOTAL OF 214 SENIORS WERE FOR 1,626 ENCOUNTERS IN 2023 THROUGH THE MONUMENT CRISIS CENTER, A PROGRAM THAT AIMS TO REDUCE SOCIAL ISOLATION AND PROMOTE MENTAL HEALTH AMONG OLDER ADULTS.COMMUNITY HEALTH NEED: HOUSING AND HOMELESSNESS. THE FOLLOWING ARE SELECT HIGH-IMPACT PROGRAM OUTCOMES IN 2023:- IN 2023, ALAMEDA COUNTY COMMUNITY FOOD BANK (ACCFB) PROVIDED CAPACITY BUILDING GRANTS TO FOUR PARTNER AGENCIES SERVING NORTH ALAMEDA COUNTY COMMUNITIES, WITH FOCUS ON AGENCIES THAT ARE HELPING FAMILIES TO STAY HOUSED. GRANTS WERE PROVIDED FOR KITCHEN INFRASTRUCTURE, STAFFING AND MISCELLANEOUS FOOD DISTRIBUTION SUPPLIES. ACCFB DISTRIBUTED 11,921,991 POUNDS OF NUTRITIOUS FOOD IN NORTHERN ALAMEDA COUNTY COMMUNITIES, 53% OF WHICH WAS FRESH FOOD.- GOODNESS VILLAGE, A PROGRAM THAT SUPPORT PERMANENT AFFORDABLE HOUSING AND SUPPORTIVE SERVICES FOR HOMELESS AND AT-RISK FAMILIES AND INDIVIDUALS, SERVED A TOTAL OF 31 INDIVIDUALS WITH ALL 28 HOMES CURRENTLY OCCUPIED. THERE WAS A TOTAL OF THREE NEW NEIGHBORS ADDED TO GOODNESS VILLAGE IN 2023. 28 NEIGHBORS WERE PROVIDED MENTAL HEALTH SUPPORT, 27 NEIGHBORS PARTICIPATED IN A VOCATIONAL PROGRAM AND FIVE SECURED A JOB.- THOUGH PARTNERSHIP WITH HOPE SOLUTIONS, 440 HOUSEHOLDS WERE NEWLY HOUSED, RESULTING IN 652 UNIQUE INDIVIDUALS AND 333 HOUSEHOLDS WHOSE EVICTION WAS PREVENTED.- PROVIDED EMERGENCY FUNDS FOR BACK RENT, UTILITIES AND OTHER RENTAL ASSISTANCE FOR 25 HOUSEHOLDS THROUGH PARTNERSHIP WITH SHELTER, INC.E. JOHN MUIR HEALTH WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS:1. ECONOMIC SECURITY2. COMMUNITY AND FAMILY SAFETY3. FOOD SECURITY4. EDUCATION5. TRANSPORTATIONJMH RECOGNIZES THE IMPORTANCE OF EACH OF THE PRIORITIZED COMMUNITY HEALTH NEEDS. HOWEVER, JMH'S EXPERIENCE IS THAT OUR INVESTMENTS COULD HAVE THE MOST IMPACT ON COMMUNITY HEALTH BY FOCUSING RESOURCES ON THE SELECTED COMMUNITY HEALTH NEEDS. THEREFORE, THE COMMUNITY BENEFIT OVERSIGHT COMMITTEE DECIDED TO ADDRESS THE COMMUNITY HEALTH NEEDS THAT ARE ALIGNED WITH OUR MISSION, LEVERAGE JMH'S EXPERTISE, AND HAVE FEASIBLE INTERVENTIONS AND PARTNERS FOR SCALABLE IMPACT.THE SELECTED HEALTH NEEDS DO NOT REPRESENT EVERYTHING JOHN MUIR HEALTH DOES TO IMPROVE COMMUNITY HEALTH. FOR THOSE NEEDS NOT SELECTED, GENERALLY, JOHN MUIR DOES NOT HAVE THE EXPERTISE OR CAPACITY TO ADDRESS THE NEED; HOWEVER, THERE ARE AREAS OF OVERLAP WITH CURRENT COMMUNITY BENEFIT STRATEGIES. FOR EXAMPLE, WHILE FOOD SECURITY WAS NOT EXPLICITLY SELECTED AS A PRIORITIZED NEED, JOHN MUIR HEALTH CONTINUES TO SUPPORT AND DONATE TO LOCAL FOOD BANKS. IN ADDITION, WHILE TRANSPORTATION WAS NOT CHOSEN, JOHN MUIR HEALTH WILL SUPPORT TRANSPORTATION INITIATIVES THAT DECREASE ISOLATION AMONG VULNERABLE SENIORS AND INCREASE ACCESS TO HEALTH AND SUPPORT SERVICES AMONG VULNERABLE INDIVIDUALS.JOHN MUIR HEALTH REMAINS DEDICATED TO BEING A LEADER IN BUILDING A HEALTHIER COMMUNITY. BY LISTENING, ENGAGING AND COLLABORATING WITH SERVICE AREA COMMUNITIES, JOHN MUIR HEALTH IS COMMITTED TO CREATING A NETWORK OF HEALTH AND WELLNESS SERVICES AND SUPPORT. THIS 2023-2025 COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS ADOPTED BY JOHN MUIR HEALTH'S BOARD OF DIRECTORS ON DECEMBER 14, 2022. PART V, SECTION B, LINE 13B INCOME LEVEL OTHER THAN FPGOTHER CRITERIA USED IS BASED ON THE PATIENT'S ELIGIBILITY FOR LOW-INCOME PROGRAMS THAT HAVE THE SAME OR MORE STRICT (LOWER) INCOME CRITERIA AS THE JOHN MUIR HEALTH CHARITY CARE PROGRAM. THIS INCLUDES PATIENTS WHO ARE QUALIFIED WITH SIX MONTHS OF THE DATE OF SERVICE FOR THE CALIFORNIA MEDICAID (MEDI-CAL) PROGRAM, OR FOR THE COUNTRY'S MEDICALLY INDIGENT PROGRAM. ADDITIONALLY, THE ORGANIZATION USES ESTIMATED FEDERAL POVERTY GUIDELINES DEVELOPED BY A CONTRACTED THIRD PARTY. THE THIRD PARTY DEVELOPED AN ALGORITHM BASED ON ESTIMATED HOUSEHOLD INCOME, WHICH IS THEN TRANSLATED INTO FPG FOR THE HOUSEHOLD. PART V, SECTION B, LINE 16A THE FAP IS WIDELY AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.JOHNMUIRHEALTH.COM/PATIENTS-AND-VISITORS/PAYMENT-AND-INSURANCE/PATIENT-FINANCIAL-ASSISTANCE-PROGRAM.HTML PART V, SECTION B, LINE 16B THE FAP APPLICATION FORM IS WIDELY AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.JOHNMUIRHEALTH.COM/PATIENTS-AND-VISITORS/PAYMENT-AND-INSURANCE/PATIENT-FINANCIAL-ASSISTANCE-PROGRAM.HTML PART V, SECTION B, LINE 16C A PLAIN LANGUAGE SUMMARY OF THE FAP IS WIDELY AVAILABLE AT THE FOLLOWING URL: HTTPS://WWW.JOHNMUIRHEALTH.COM/PATIENTS-AND-VISITORS/PAYMENT-AND-INSURANCE/PATIENT-FINANCIAL-ASSISTANCE-PROGRAM/PATIENT-FINANCIAL-ASSISTANCE.HTML PART I, LINE 3C: ELIGIBILITY CRITERIA USED FOR DETERMINING FREE OR DISCOUNTED CARETHE MAJORITY OF CHARITY CARE IS GIVEN BASED EITHER IN THE FEDERAL POVERTY GUIDELINES ("FPG") AS CALCULATED FROM DOCUMENTATION AND STATEMENTS MADE ON THE INTERNAL JOHN MUIR HEALTH CHARITY CARE APPLICATION, OR ON THE FPG AS ESTIMATED BY A CONTRACTED THIRD PARTY. THE THIRD PARTY HAD DEVELOPED AN ALGORITHM BASED ON ESTIMATED HOUSEHOLD INCOME, WHICH IS THEN TRANSLATED INTO FPG FOR THE HOUSEHOLD. JOHN MUIR HEALTH HAS NO INPUT INTO THE CRITERIA USED FOR THE ALGORITHM, WHICH IS THE SAME CALCULATION USED BY THE CONTRACTED THIRD PARTY FOR ALL OF THEIR CLIENTS NATIONWIDE.OTHER CRITERIA USED IS BASED ON THE PATIENT'S ELIGIBILITY FOR LOW-INCOME PROGRAMS THAT HAVE THE SAME OR MORE STRICT (LOWER) INCOME CRITERIA AS THE JOHN MUIR HEALTH CHARITY CARE PROGRAM. THIS INCLUDES PATIENTS WHO ARE QUALIFIED WITHIN SIX MONTHS OF THE DATE OF SERVICE FOR THE CALIFORNIAMEDICAID (MEDI-CAL) PROGRAM, OR FOR THE COUNTY'S MEDICALLY INDIGENT PROGRAM.IN ADDITION TO FORMAL QUALIFICATION IN A RECOGNIZED PROGRAM SERVING THE LOW-INCOME AND INDIGENT POPULATION, CHARITY CARE IS ALSO EXTENDED TO PATIENTS SEEN IN OUR EMERGENCY DEPARTMENTS AND WHO HAVE BEEN DOCUMENTED IN THE MEDICAL RECORDS AS BEING HOMELESS, OR HAVE A LACK OF HOUSING. CHARITY CARE IS ALSO APPLIED TO OUTSTANDING BALANCE FOR EMERGENCY SERVICES RENDERED TO DOCUMENTED MINOR AND ELDERLY VICTIMS OF ABUSE, BASED ON COMPASSION AS JOHN MUIR HEALTH HAS NO KNOWLEDGE OF THE CURRENT HOME ENVIRONMENT OF THESE PATIENTS. WE ALSO HAVE A PARTNERSHIP WITH A COMMUNITY PROGRAM, OPERATION ACCESS, WHICH SERVES THE LOW-INCOME INDIVIDUALS IN OUR COUNTY, TO PROVIDE FREE CARE ON A REFERRED, CASE-BY-CASE BASIS. OPERATION ACCESS HAS ALREADY PERFORMED THE SCREENING OF THEIR REFERRED PATIENTS FOR INCOME ELIGIBILITY.JMH CONTINUED A PARTNERSHIP WITH LA CLINICA DE LA RAZA TO PROVIDE SPECIALTY CARE FOR UNINSURED AND LOW INCOME PATIENTS. LA CLINICA DE LA RAZA HAS ALREADY PERFORMED SCREENING OF THEIR REFERRED PATIENTS FOR INCOME ELIGIBILITY.PART 1, LINE 4MEDICALLY INDIGENT CAREWE PROVIDE HEALTH CARE TO THE MOST VULNERABLE INDIVIDUALS OF OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY THROUGH OUR MEDICAL CENTERS IN WALNUT CREEK AND CONCORD. THIS INCLUDES THE CRITICAL EMERGENCY AND TRAUMA SERVICES AT OUR MEDICAL CAMPUSES.JOHN MUIR HEALTH HAS A NUMBER OF PROGRAMS TO HELP OUR PATIENTS WITH THEIR MEDICAL BILLS FOR SERVICES THEY RECEIVE AT ONE OF OUR MEDICAL CENTERS. THESE PROGRAMS INCLUDE A PATIENT ASSISTANCE PROGRAM TO ABSORB PART, OR ALL, OF THE BILL BASED ON INCOME AND OTHER PROGRAM GUIDELINES, ASSISTANCE ENROLLING IN A NUMBER OF INSURANCE PROGRAMS, AND EXTENDED PAYMENT PLANS. JOHN MUIR HEALTH MAY ALSO ASSIGN ACCOUNTS TO PRESUMPTIVE CHARITY, WITHOUT A PATIENT ASSISTANCE APPLICATION SUBMITTED BY THE PATIENT, BASED ON PREDETERMINED CRITERIA COLLECTED FROM APPROVED SOURCES. THIS CRITERIA INCLUDES:THE PATIENT HAVING DOCUMENTED IN HIS/HER MEDICAL RECORD AS BEING HOMELESS OR VERIFICATION RECEIVED THROUGH THE MEDICAL CENTER OR A FAMILY MEMBER THAT THE PATIENT IS CURRENTLY INCARCERATED.ORTHE PATIENT QUALIFIES FOR A GOVERNMENT PROGRAM WITH ELIGIBILITY REQUIREMENTS THAT REASONABLY MEET THE QUALIFICATIONS FOR THE JOHN MUIR HEALTH CHARITY CARE PROGRAM WITHIN SIX (6) MONTHS OF THE DATE THE PATIENT RECEIVED SERVICES AT THE MEDICAL CENTER.ORAFTER NORMAL COLLECTION EFFORTS HAVE NOT PRODUCED ANY PAYMENT, AND JOHN MUIR HEALTH HAS IDENTIFIED WITH REASONABLE EFFORT AND ASSURANCE THAT THE PATIENT'S ESTIMATED INCOME IS AT 400 PERCENT OR LESS OF THE FPL (FEDERAL POVERTY LEVEL). PART I, LINE 6A: COMMUNITY BENEFIT REPORTALL JOHN MUIR HEALTH ENTITIES (WALNUT CREEK CAMPUS, CONCORD CAMPUS AND BEHAVIORAL HEALTH) REPORT COMMUNITY BENEFIT INFORMATION AS PART OF THE JOHN MUIR HEALTH ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: FINANCIAL ASSISTANCE POLICYJOHN MUIR HEALTH HAS ADOPTED THE GUIDELINES DEVELOPED BY THE CATHOLIC HEALTHCARE ASSOCIATION AND VHA INC. FOR REPORTING THE ECONOMIC VALUE OF ITS COMMUNITY BENEFITS CONTRIBUTIONS. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIESJOHN MUIR HEALTH'S COMMUNITY BUILDING PROGRAMS AND ACTIVITIES ADDRESS SOCIOECONOMIC BARRIERS TO OPTIMAL PHYSICAL AND MENTAL HEALTH SUCH AS JOBS, EDUCATION, POVERTY, LANGUAGE, CULTURE, RACE, ETHNICITY, TRANSPORTATION, ETC. MANY OF OUR COMMUNITY BUILDING ACTIVITIES ALSO MEET THE DEFINITION OF COMMUNITY BENEFIT. IN 2023, WE PROVIDED SUPPORT TO ORGANIZATIONS WHOSE MISSION IS TO ADDRESS UNDERLYING CAUSES OF HEALTH PROBLEMS THROUGH EVENT SPONSORSHIP. LASTLY, JOHN MUIR HEALTH WORKS WITH A WIDE RANGE OF ORGANIZATIONS TO SUPPORT GREATER EXPOSURE OF YOUTH TO HEALTH CAREERS THROUGH A SPEAKER'S BUREAU, HEALTH CAREER FAIRS, WORKSHOPS, PRESENTATIONS AND HANDS ON LEARNING OPPORTUNITIES IN THE FOLLOWING AREAS:1. REGISTERED NURSING2. MEDICAL ASSISTANTS3. MEDICAL IMAGING TECHNOLOGY4. SONOGRAPHERS5. CLINICAL LAB SCIENTIST6. PHARMACIST AND PHARMACY TECHS7. THERAPIST/PHYSICAL, OCCUPATIONAL AND SPEECH8. ENGINEERING AND BIO ENGINEERING9. NUTRITION SERVICES/DIETITIANS AND CHEFS10. INFORMATION TECHNOLOGY11. HEALTHCARE ADMINISTRATION12. FAMILY MEDICINE PHYSICIANS13. EMERGENCY SERVICES/ER TECHS, PHYSICIANS AND NURSINGSPARTNERS:1. EAST COUNTY BUSINESS EDUCATION ALLIANCE2. CONTRA COSTA ECONOMIC PARTNERSHIP (CCEP) TO HELP REACH UNDERSERVED POPULATION.3. JEWISH VOCATION SERVICES (JVS) - DISPLACED WORKER TRAINING TO GET BACK IN THE WORKFORCE4. CALIFORNIA HOSPITAL ASSOCIATION WORKFORCE COMMITTEE5. BAY AREA COUNCIL6. EAST BAY HEALTH WORKFORCE PARTNERSHIPSTUDENTS:1. 17 HIGH SCHOOLS AND HEALTH ACADEMIES2. 14 UNIVERSITIES3. 9 STATE COLLEGES4. 8 JUNIOR COLLEGES5. 7 PRIVATE COLLEGES PART III, LINE 2: BAD DEBT EXPENSEBAD DEBT IS DETERMINED USING THE COST-TO-CHARGE METHODOLOGY. THE ORGANIZATION DOES NOT INCLUDE BAD DEBT IN COMMUNITY BENEFIT. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTETHE ORGANIZATION DOES NOT ISSUE SEPARATE, INDEPENDENT AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS INCLUDED IN THE JOHN MUIR HEALTH AND SUBSIDIARIES CONSOLIDATED, INDEPENDENT AUDITED FINANCIAL STATEMENTS THAT DO NOT INCLUDE A DESCRIPTION OF BAD DEBT EXPENSE. PART III, LINE 8: SHORTFALL TREATED AS COMMUNITY BENEFITTHE ORGANIZATION DOES NOT TREAT MEDICARE SHORTFALL AS COMMUNITY BENEFIT. JMH USES ITS COST ACCOUNTING SYSTEM TO CALCULATE THE MEDICARE SHORTFALL. PART III, LINE 9B: COLLECTION PRACTICESOTHER THAN SENDING STATEMENTS AND NOTIFICATIONS TO THE PATIENT, JOHN MUIR HEALTH DOES NOT CONDUCT PATIENT-OWED COLLECTION INTERNALLY. THESE TYPES OF FUNCTIONS ARE OUTSOURCED TO AN OUTSIDE AGENCY. THE COLLECTION POLICY IS IN THE FORM OF, AND INCORPORATED INTO, THE CONTRACT AGREEMENT WITH THE OUTSIDE AGENCY AS A FULL ADDENDUM TO THE CONTRACT, WITH A SEPARATESIGNATURE LINE FOR JOHN MUIR HEALTH AND THE AGENCY AS PART OF THE ADDENDUM. IN ADDITION TO THE CUSTOMIZED JOHN MUIR HEALTH COLLECTION GUIDELINES, THE ADDENDUM ALSO CONTAINS THE COLLECTION CRITERIA AND REQUIREMENTS FOUND IN CALIFORNIA LAW UNDER ASSEMBLY BILL 774. PART VI, LINE 2: NEEDS ASSESSMENTTHE 2022 HEALTH NEEDS ASSESSMENT INCLUDES A COMPREHENSIVE NEEDS ASSESSMENT OF THE COMMUNITY SERVED, WHICH HAS BEEN USED TO DEVELOP OUR ANNUAL AND TRIENNIAL COMMUNITY BENEFIT PLANS. FOR MORE INFORMATION, THECHNA REPORT AND IMPLEMENTATION STRATEGY (A.K.A. COMMUNITY HEALTH IMPROVEMENT PLAN) CAN BE FOUND HERE:HTTPS://WWW.JOHNMUIRHEALTH.COM/ABOUT-JOHN-MUIR-HEALTH/COMMUNITY-COMMITMENT.HTMLIN ADDITION TO THE CHNA, JMH IS CONTINUALLY ASSESSING THE NEEDS OF THE COMMUNITY IN A VARIETY OF WAYS. JOHN MUIR HEALTH DEVELOPS COLLABORATIVE PARTNERSHIPS WITH LOCAL ORGANIZATIONS IN ORDER TO BE RESPONSIVE TO THE NEEDS OF THE MOST VULNERABLE AND UNDERSERVED POPULATIONS IN OUR COMMUNITY. JOHN MUIR HEALTH KEPT ABREAST OF CURRENT HEALTH ISSUES OF IMPORTANCE TO THE COMMUNITY BY ACTIVE PARTICIPATION AND COMMUNICATION WITH A VARIETY OF COMMUNITY GROUPS INCLUDING BUT NOT LIMITED TO DENTAL COLLABORATIVE OF CONTRA COSTA, ACCESS TO CARE STAKEHOLDERS, EAST COUNTY ACCESS ACTION TEAM, HEALTHY AND ACTIVE BEFORE FIVE, FAMILIES COALITION FOR ACTIVITY AND NUTRITION, MOBILE HEALTH CLINIC ASSOCIATION NORTHERN CALIFORNIA ROUNDTABLE, AND THE EAST COUNTY HEALTH AND WEALTH INITIATIVE.THESE SOURCES OF INFORMATION PROVIDE CURRENT INFORMATION REGARDING COMMUNITY HEALTH STATUS AND ALSO HELP IDENTIFY EMERGING NEEDS IN THE SERVICE AREA POPULATION. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEJOHN MUIR HEALTH HAS SIGNAGE POSTED IN PATIENT ACCESS AREA/LOBBIES INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR THEIR HEALTH CARE BILLS AND ELIGIBILITY. SERVICES TO AID THE PATIENT IN QUALIFYING FOR AN APPROPRIATE ASSISTANCE PROGRAM IS POSTED IN THE EMERGENCY DEPARTMENT.ALL PATIENTS RECEIVE A "PATIENT ASSISTANCE" BROCHURE, WHICH IDENTIFIES VARIOUS FINANCIAL ASSISTANCE PROGRAMS AVAILABLE TO THE PATIENT, INCLUDING THE JOHN MUIR HEALTH CHARITY CARE PROGRAM AS WELL AS PROGRAMS THROUGH GOVERNMENT AGENCIES (STATE, COUNTY, ETC). THE BROCHURE ALSO LISTS CONTACT INFORMATION FOR THESE PROGRAMS. PATIENTS IN THE EMERGENCY DEPARTMENT TALK TO A TRAINED FINANCIAL COUNSELOR, AND IF APPROPRIATE, ARE ALSO ASKED TO SIGN A FORM ACKNOWLEDGING RECEIPT OF THE PATIENT ASSISTANCE MATERIALS OR DECLINING TO ACCEPT THE MATERIAL. TRAINED FINANCIAL COUNSELORS ARE ALSO AVAILABLE FOR PATIENTS WHO ARE NOT PRESENT FOR SERVICES THROUGH THE EMERGENCY DEPARTMENT. THE APPLICATION FORM AND A COPY OF THE POLICY FOR THE JOHN MUIR HEALTH CHARITY CARE PROGRAM IS ALSO AVAILABLE IN THE EMERGENCY DEPARTMENT AS WELL AS THE MAJOR PATIENT ACCESS AREAS AND THE BUSINESS OFFICE.NOTIFICATIONS THAT PROGRAMS, INCLUDING CHARITY CARE, ARE AVAILABLE ARE ALSO PRINTED ON PATIENT BILLING STATEMENTS, ACCOMPANIED BY THE ABILITY FOR A PATIENT TO REQUEST THE VARIOUS PROGRAM MATERIALS BE SENT TO HIS/HER HOME. CONTACT INFORMATION IS ALSO LISTED IN THE PATIENT STATEMENT. INFORMATION IN THE HEALTH SYSTEM'S CHARITY CARE PROGRAM IS POSTED ON THE JOHN MUIR HEALTH INTERNET WEBSITE AS WELL.PATIENTS ADMITTED TO THE HOSPITAL, AND WHO HAVE NO THIRD PARTY INSURANCE LISTED ARE INTERVIEWED BY TRAINED FINANCIAL COUNSELORS DURING THEIR HOSPITAL STAY TO INFORM THEM OF THE VARIOUS PROGRAMS WHICH ARE AVAILABLE, AND DETERMINE IF THE PATIENT WOULD LIKE ASSISTANCE TO OBTAIN ELIGIBILITY FOR THE STATE MEDICAID (MEDI-CAL) PROGRAM, STATE DISABILITY, CHARITY CARE OR OTHER AVAILABLE PROGRAM IN THE COUNTY. THIS ELIGIBILITY ASSISTANCE, WHICH INCLUDES HELP IN FILLING OUT THE APPLICATION, GATHERING REQUIRED DOCUMENTS, AND TRANSPORTATION TO ELIGIBILITY APPOINTMENTS, IF NECESSARY, IS OFFERED AT NO CHARGE TO THE PATIENT. IN ADDITION, PATIENT ACCOUNTING REPRESENTATIVES MAY ALSO CONTACT PATIENTS AFTER DISCHARGE TO ASK ABOUT PAYMENT ARRANGEMENTS AND TO INFORM THEM OF THE CHARITY CARE PROGRAM IF THE PATIENT NEEDS ASSISTANCE IN PAYING FOR THEIR MEDICAL BILLS. PART VI, LINE 4: COMMUNITY INFORMATIONJOHN MUIR HEALTH'S PRIMARY AND SECONDARY SERVICE AREA EXTENDS FROM SOUTHERN SOLANO COUNTY INTO EASTERN CONTRA COSTA COUNTY AND SOUTH TO SAN RAMON IN CONTRA COSTA COUNTY. JOHN MUIR HEALTH'S TRAUMA CENTER SERVES ALL OF CONTRA COSTA COUNTY, SOLANO COUNTY, AND MARIN COUNTY. IT IS ALSO THE BACKUP TRAUMA CENTER FOR ALAMEDA COUNTY. JOHN MUIR HEALTH ALSO SERVES EASTERN ALAMEDA COUNTY IN JOINT VENTURE WITH SAN RAMON REGIONAL MEDICAL CENTER AND SERVES NORTHERN ALAMEDA COUNTY IN JOINT VENTURE WITH UNIVERSITY OF CALIFORNIA, SAN FRANCISCO. JOHN MUIR HEALTH'S COMMUNITY BENEFIT PROGRAMS PRIMARILY FOCUS ON THE NEEDS OF VULNERABLE POPULATIONS IN CONTRA COSTA COUNTY, THE TRI-VALLEY, AND NORTHERN ALAMEDA COUNTY. VULNERABLE POPULATIONS ARE DEFINED AS EXPERIENCING EVIDENCED-BASED DISPARITIES IN HEALTH OUTCOMES, SIGNIFICANT BARRIERS TO CARE AND ECONOMIC INEQUITIES.THE JOHN MUIR HEALTH SERVICE AREA HAS THE FOLLOWING DEMOGRAPHIC PROFILE AS OF THE 2022 CHNA STUDY:CONTRA COSTA COUNTYTOTAL POPULATION:% AGE 65+: 16%% UNDER AGE 19: 25%RACE:WHITE: 52%AFRICAN AMERICAN: 9%ASIAN: 18%OTHER: 14%MULTIRACIAL: 6%AMERICAN INDIAN/ALASKAN NATIVE: <1%NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER: <1%ETHNICITY:HISPANIC: 26%NON-HISPANIC: 74%SOCIOECONOMIC DATA:LIVING IN POVERTY (<100% FEDERAL POVERTY LEVEL): 9%CHILDREN IN POVERTY: 12%SENIOR (>65) IN POVERTY: 6%UNEMPLOYMENT: 6%UNINSURED POPULATION: 6%ADULTS WITH NO HIGH SCHOOL DIPLOMA: 12% PART VI, LINE 5: COMMUNITY HEALTH PROMOTIONJOHN MUIR HEALTH IS A NOT-FOR-PROFIT, COMMUNITY BASED ORGANIZATION THAT IS GOVERNED BY THOSE WHO LIVE IN THE COMMUNITY WE SERVE. COMMUNITY RESIDENTS ARE ACTIVELY INVOLVED IN OUR VARIOUS BOARDS AND BOARD COMMUNITIES. THE BOARD OF JOHN MUIR HEALTH CONSISTS PRIMARILY OF MEMBERS OF THE COMMUNITY. FURTHER, OUR HOSPITAL MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PRACTITIONERS. OUR FOCUS REMAINS FIRMLY ON IMPROVING THE HEALTH OF THE PEOPLE OF CONTRA COSTA COUNTY AND SURROUNDING COMMUNITIES. AS A NOT-FOR-PROFIT ORGANIZATION, THERE ARE NO SHAREHOLDERS WHO BENEFIT FROM OUR FINANCIAL SURPLUSES. INSTEAD, WE REINVEST ANY SURPLUSES INTO THE COMMUNITY WITH NEW PROGRAM IMPLEMENTATION, ADVANCED TECHNOLOGY, COMMUNITY SERVICES AND BUILDING PROJECTS. JMH ALSO CONTRIBUTES SIGNIFICANTLY TO THE ECONOMIC VITALITY OF CONTRA COSTA COUNTY BY EMPLOYING OVER 6,600 INDIVIDUALS IN 2023.JOHN MUIR MEDICAL CENTER, WALNUT CREEK ALSO SERVES AS CONTRA COSTA COUNTY'S ONLY TRAUMA CENTER, WHICH REPRESENTS AN ENORMOUS FINANCIAL AND SERVICE COMMITMENT TO THE ENTIRE REGION. OUR TWO HOSPITALS' EMERGENCY DEPARTMENTS SERVE ALL RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NOT-FOR-PROFIT, JMH HAS AN OBLIGATION TO MAKE A CHARITABLE CONTRIBUTION TO THE COMMUNITY, BUT OUR COMMITMENT TO KEEPING THE COMMUNITIES WE SERVE GOES FAR DEEPER THAN THAT. JMH'S MISSION TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH QUALITY AND COMPASSION ACCURATELY REFLECTS OUR COMMUNITY HEALTH EFFORTS AS A CORPORATE LEADERAND COMMUNITY PARTNER. SOME OF THE PROGRAMS INCLUDE TREATING PATIENTS REFERRED BY LOCAL COMMUNITY CLINICS FOR SPECIALTY CARE SERVICES, PROVIDING MOBILE HEALTH CLINIC SERVICES IN UNDERSERVED COMMUNITIES, PROVIDING BREAST AND LUNG CANCER SCREENING FOR UNINSURED COMMUNITY MEMBERS AND SUPPORTING DEPRESSION PREVENTION ACTIVITIES FOR LOW-INCOME INDIVIDUALS. JMH SERVED OVER 103,218 RESIDENTS THROUGH COMMUNITY BENEFIT ACTIVITIES IN 2023.JMH'S COMMITMENT TO THE LOCAL COMMUNITY IS EXPRESSED IN THE MANY INITIATIVES WE DELIVER. JMH PROVIDES CHARITY CARE FOR MANY INDIVIDUALS AND FAMILIES WITH NO INSURANCE AND LIMITED MEANS. IN 2023, WE PROVIDED $9.3 MILLION IN CHARITY CARE COST. JMH ALSO ABSORBED $146.3 MILLION, THE COST OF PROVIDING CARE TO INDIVIDUALS THAT EXCEEDS THE PAYMENT WE RECEIVED FROM MEDI-CAL.JOHN MUIR HEALTH ALSO PROVIDES BROAD FINANCIAL AND TECHNICAL SUPPORT TO PROMOTE COMMUNITY WELLNESS. THE ORGANIZATION CONTRIBUTES $1 MILLION A YEAR TO THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND EACH YEAR, WHOSE GOAL IS TO FOSTER SYSTEMIC CHANGE THAT IMPROVES THE HEALTH OF PEOPLE IN CENTRAL AND EAST CONTRA COSTA COUNTY WHO ARE MOST LIKELY TO EXPERIENCE HEALTH CARE DISPARITIES.LASTLY, JOHN MUIR HEALTH CONTRIBUTES MANY NON-QUANTIFIABLE BENEFITS AT EACH OF OUR FACILITIES.NON-QUANTIFIABLE BENEFITS: THE HEALTH SYSTEM CONTINUALLY PROVIDES LEADERSHIP IN THE COMMUNITY, ASSISTS WITH LOCAL CAPACITY BUILDING, AND PARTICIPATES IN COMMUNITY-WIDE HEALTH PLANNING. IN ADDITION, JOHN MUIR HEALTH IS COMMITTED TO UPHOLDING THE HIGHEST ENVIRONMENTAL STANDARDS AND HAS INVESTED IN MULTIPLE EFFORTS FOR SUSTAINABILITY. THE FOLLOWING ARE EXAMPLES OF NON-QUANTIFIABLE BENEFITS PROVIDED IN 2023: - JOHN MUIR HEALTH NURSES ARE DEEPLY INVOLVED IN THEIR COMMUNITY THROUGH VOLUNTEERING. JOHN MUIR HEALTH ENCOURAGES NURSING VOLUNTEERISM THROUGH MAGNET RECOGNITION STATUS WHERE NURSES BUILD PARTNERSHIPS WITH THE COMMUNITY. FOR EXAMPLE, OUR NURSES PARTICIPATE AS VOLUNTEERS ON OUR MOBILE HEALTH CLINIC, AND VOLUNTEERED DURING THE HABITAT FOR HUMANITY WOMEN'S LEADERSHIP BUILD. - JOHN MUIR HEALTH LEADERSHIP ACTIVELY PARTICIPATE ON COMMUNITY BOARDS, SOME OF WHICH INCLUDE CALIFORNIA HOSPITAL ASSOCIATION, FAMILY JUSTICE CENTER OF CONTRA COSTA, MONUMENT IMPACT, HOPE SOLUTIONS AND CONTRA COSTA COUNTY WORK FORCE DEVELOPMENT. - JOHN MUIR HEALTH LEADERSHIP ACTIVELY PARTICIPATE ON GOVERNMENT AND CITY ADVISORY COUNCILS AND TASK FORCES, SOME OF WHICH INCLUDE CITY OF CONCORD, CITY OF WALNUT CREEK, AND THE WALNUT CREEK HOUSING TASK FORCE. - JOHN MUIR HEALTH'S COMMITMENT TO ENVIRONMENTAL SUSTAINABILITY IS EVIDENT THROUGH MANY INITIATIVES, SOME OF WHICH INCLUDE: - NURSING, EVS, MATERIALS PARTNERSHIP WITH A MEDICAL SUPPLY DONATION PROGRAM THAT BENEFITS THIRD WORLD COUNTRIES - WATERING OF OUTDOOR LANDSCAPING TWO DAYS PER WEEK - FACILITIES EQUIPPED WITH LOW-FLOW TOILETS, SHOWERS, SINKS - 51 CAR CHARGING STATIONS - ELIMINATED ALL STYROFOAM PRODUCTS - PEN AND PENCIL RECYCLING - LED LIGHTING FIXTURES IN PATIENT AND EMPLOYEE PARKING LOTS - ENERGY EFFICIENT CHILLERS AND BOILERS WHICH PROVIDE COOLING AND HEATING TO THE HOSPITAL BUILDINGS - ENERGY EFFICIENT AIR HANDLERS ON HOSPITAL BUILDINGS - HIGH EFFICIENCY WINDOWS - USE OF SOLAR PANELS ON ADMINISTRATIVE BUILDINGS, NEW MEDICAL OFFICE BUILDINGS AND WALNUT CREEK MEDICAL CENTER PARKING GARAGE - INVESTIGATING AND IMPLEMENTING RETRO-COMMISSIONING EFFORTS AT JMH SITES THAT WOULD REDUCE OVERALL ENERGY CONSUMPTION AND RUN BUILDING EQUIPMENT MORE EFFICIENTLY PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMJOHN MUIR BEHAVIORAL HEALTH1400 TREAT BOULEVARD, WALNUT CREEK, CA 94597 JOHN MUIR HEALTH OFFERS COMPLETE INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH PROGRAMS AND SERVICES THROUGH JOHN MUIR HEALTH BEHAVIORAL HEALTH CENTER, THE HEALTH SYSTEM'S FULLY ACCREDITED, 73 BED PSYCHIATRIC HOSPITAL LOCATED IN CONCORD. THE JOHN MUIR HEALTH BEHAVIORAL HEALTH CENTER OFFERS PSYCHIATRIC TREATMENT FOR ADULTS, CHILDREN AND ADOLESCENT WHO ARE EXPERIENCING EMOTIONAL OR BEHAVIORAL PROBLEMS. FOR THOSE WHO ARE DEPENDENT ON ALCOHOL OR DRUGS, THE BEHAVIORAL HEALTH CENTER OFFERS A FULL ARRAY OF CHEMICAL DEPENDENCY TREATMENT PROGRAMS. THE JOHN MUIR HEALTH BEHAVIORAL HEALTH CENTER IS FULLY ACCREDITED BY THE JOINT COMMISSION. JOHN MUIR HEALTH IS THE SOLE CORPORATE MEMBER OF JOHN MUIR BEHAVIORAL HEALTH.JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND5003 COMMERCIAL CIRCLE, SUITE 275, CONCORD, CA 94520 THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUNDS IS ONE ARM OF GRANT-MAKING AT JOHN MUIR HEALTH SYSTEM. THE FUND'S GOAL IS TO FOSTER SYSTEMIC CHANGE THAT IMPROVES THE HEALTH OF PEOPLE IN CENTRAL AND EASTERN CONTRA COSTA COUNTY WHO ARE UN- OR UNDER-INSURED, HAVE LIMITED ACCESS TO HEALTH CARE, ARE MORE AT-RISK FOR POOR HEALTH, AND ARE MOST LIKELY TO EXPERIENCE HEALTH CARE DISPARITIES. TO ACCOMPLISH THIS GOAL, THE FUND DEVELOPED A FUNDING PROCESS THAT NURTURES LONG TERM PARTNERSHIP WITH AND AMONG THE COMMUNITY BASED ORGANIZATIONS. THIS LEADS TO VISIONARY HEALTH INITIATIVE THAT BUILD AND SUSTAIN THE CAPACITY TO DELIVER ON THE PROMISE OF GOOD HEALTH AND AFFORDABLE HEALTH CARE FOR ALL. FROM 1997, THE YEAR THE COMMUNITY HEALTH FUND WAS FORMED, THROUGH 2023, THE FUND HAS GRANTED OVER $33 MILLION JOHN MUIR HEALTH COMMUNITY BENEFIT DOLLARS INTO LOCAL COMMUNITY-BASED HEALTH PROJECTS. MORE DETAILED INFORMATION ABOUT THE FUNDS, ITS GOVERNANCE, GRANT PROGRAM AND COMMUNITY BENEFIT REPORTS CAN BE FOUND ON ITS WEBSITE: HTTPS://WWW.JOHNMUIRHEALTH.COM/ABOUT-JOHN-MUIR-HEALTH/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-FUND.HTMLJOHN MUIR PHYSICIAN NETWORK1400 TREAT BOULEVARD, WALNUT CREEK, CA 94597 THE JOHN MUIR PHYSICIAN NETWORK IS A NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATION, WHOSE SOLE CORPORATE MEMBER IS JOHN MUIR HEALTH. SINCE ITS INCEPTION IN 1996, IT HAS BECOME ONE OF THE LARGEST PROVIDERS OF PHYSICIAN AND ALLIED HEALTH SERVICES IN NORTHERN CALIFORNIA, WITH OVER 1,000 PRIMARY CARE AND SPECIALTY PHYSICIANS WHO DELIVER COORDINATED PATIENT CARE. PHYSICIANS ASSOCIATED WITH THE PHYSICIAN NETWORK BELONG TO EITHER JOHN MUIR MEDICAL GROUP (JMMG), JOHN MUIR SPECIALTY GROUP (JMSMG), JOHN MUIR CARDIOVASCULAR GROUP (JMCVMG) OR JOHN MUIR HEALTH CANCER MEDICAL GROUP (JMHCMG). THE PHYSICIAN NETWORK OWNS AND OPERATES PRIMARY CARE CENTERS STAFFED BY JMMG PHYSICIANS IN NUMEROUS LOCATIONS FROM BRENTWOOD TO PLEASANTON. JMMG ALSO PROVIDES HOSPITALIST (IN-PATIENT MEDICAL SERVICES) AT JOHN MUIR HEALTH'S HOSPITALS. THE PHYSICIAN NETWORK ALSO OWNS SPECIALTY CLINICS STAFFED BY JMSMG, JMCVMG, AND JMHCMG. THE PHYSICIAN NETWORK IS ACTIVE IN COMMUNITY SERVICE, HEALTH EDUCATION AND CLINICAL RESEARCH. THE PHYSICIAN NETWORK CURRENTLY HOLDS CONTRACTS WITH SEVEN MAJOR HEALTH PLANS FOR MORE THAN 50,000 COMMERCIAL AND SENIOR HMO MEMBERS. THE PHYSICIAN NETWORK MANAGES HEALTH PLAN CONTRACTING FOR JOHN MUIR HEALTH AND ITS HOSPITALS AND ENGAGES PHYSICIAN RECRUITMENT TO MEET COMMUNITY NEEDS. THE PHYSICIAN NETWORK ALSO OPERATES THE JMH MEDICARE ACCOUNTABLE CARE ORGANIZATION (ACO) WHICH PROVIDES THE COORDINATION OF CARE FOR ITS MEDICARE ACO MEMBERS.JOHN MUIR HEALTH FOUNDATION1400 TREAT BOULEVARD, WALNUT CREEK, CA 94597THE JOHN MUIR HEALTH FOUNDATION RAISES FUNDS TO OFFSET THE COST OF CAPITAL AND OPERATING EXPENSES FOR THE JOHN MUIR HEALTH PROGRAMS, INCLUDING VARIOUS EDUCATIONAL PROGRAMS, OPERATIONS, BUILDINGS AND EQUIPMENT. IN THIS WAY, THE FOUNDATION HELPS TO MITIGATE THE COST OF CARE PROVIDED AND ASSISTS JOHN MUIR HEALTH IN MAINTAINING STATE-OF-THE-ART FACILITIES, EQUIPMENT AND PROGRAMS FOR THE COMMUNITY. JOHN MUIR HEALTH IS THE SOLE CORPORATE MEMBER OF THE JOHN MUIR HEALTH FOUNDATION. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 JOHN MUIR PHYSICIAN NETWORK 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 680360801 501(C)(3) 119859846 0 N/A N/A GENERAL SUPPORT JOHN MUIR BEHAVIORAL HEALTH 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 680249685 501(C)(3) 14421914 0 N/A N/A GENERAL SUPPORT JOHN MUIR HEALTH FOUNDATION 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 942650855 501(C)(3) 7036304 1080000 RETAIL VALUE N95 MASKS GENERAL SUPPORT JOHN MUIRMT DIABLO COMMUNITY HEALTH FUND 5003 COMMERCIAL CIRCLE SUITE 275 CONCORD CA 94597 911788973 501(C)(3) 1408194 0 N/A N/A COMMUNITY SUPPORT FRED FINCH YOUTH CENTER 3800 COOLIDGE AVENUE OAKLAND CA 94602 940474080 501(C)(3) 573220 0 N/A N/A COMMUNITY SUPPORT CONTRA COSTA FAMILY JUSTICE CENTER 256 24TH STREET RICHMOND CA 94804 474082871 501(C)(3) 490000 0 N/A N/A COMMUNITY SUPPORT OPERATION ACCESS 1119 MARKET STREET SUITE 400 SAN FRANCISCO CA 94103 943180356 501(C)(3) 250000 0 N/A N/A COMMUNITY SUPPORT RYSE CENTER 205 41ST STREET RICHMOND CA 94805 260692904 501(C)(3) 165000 0 N/A N/A COMMUNITY SUPPORT ULTIMATE SPORTS ASSOCIATION 2675 MITCHELL DRIVE WALNUT CREEK CA 94598 474361038 501(C)(3) 164946 0 N/A N/A ULTIMATE FIELDHOUSE SPONSORSHIP MENTAL HEALTH CONNECTION PO BOX 5809 CONCORD CA 94524 208873338 501(C)(3) 150000 0 N/A N/A COMMUNITY SUPPORT JUNIOR ACHIEVEMENT OF NORTHERN CALIFORNIA 3003 OAK ROAD NO 130 WALNUT CREEK CA 94597 941322179 501(C)(3) 142000 0 N/A N/A COMMUNITY SUPPORT INSPIRING COMMUNITIES 1511 SYCAMORE AVE M134 HERCULES CA 94547 471136159 501(C)(3) 140000 0 N/A N/A COMMUNITY SUPPORT MONUMENT IMPACT 1760 CLAYTON ROAD CONCORD CA 94520 943370919 501(C)(3) 140000 0 N/A N/A 20TH ANNIVERSARY GALA MEALS ON WHEELS 1300 CIVIC DRIVE WALNUT CREEK CA 94596 680044205 501(C)(3) 135000 0 N/A N/A COMMUNITY SUPPORT HOPE SOLUTIONS 535 MAIN ST SE 209 MARTINEZ CA 94553 911797391 501(C)(3) 111000 0 N/A N/A COMMUNITY SUPPORT CENTER FOR HUMAN DEVELOPMENT 901 SUNVALLEY BLVD CONCORD CA 94520 942520840 501(C)(3) 104977 0 N/A N/A COMMUNITY SUPPORT ONE DAY AT A TIME 354 PINE ST STE 700 SAN FRANCISCO CA 94104 943255070 501(C)(3) 91500 0 N/A N/A COMMUNITY SUPPORT SHELTER INC P O BOX 5368 CONCORD CA 94524 680117241 501(C)(3) 80000 0 N/A N/A COMMUNITY SUPPORT & SPONSORSHIP WOMEN'S CANCER RESEARCH 2908 ELLSWORTH ST BERKELEY CA 94705 943131204 501(C)(3) 72500 0 N/A N/A COMMUNITY SUPPORT GOODNESS VILLAGE 1660 FREISMAN ROAD LIVERMORE CA 94551 852812754 501(C)(3) 72400 0 N/A N/A SPONSORSHIP MONUMENT CRISIS CENTER 1900 MARKET ST CONCORD CA 94520 412111171 501(C)(3) 65750 0 N/A N/A COMMUNITY SUPPORT TRINITY CENTER WALNUT CREEK 1924 TRINITY AVENUE WALNUT CREEK CA 94596 371706813 501(C)(3) 60000 0 N/A N/A COMMUNITY SUPPORT PLANTING JUSTICE 319 105TH AVENUE OAKLAND CA 94603 270334905 501(C)(3) 60000 0 N/A N/A COMMUNITY SUPPORT ALAMO ROTARY FOUNDATION PO BOX 303 ALAMO CA 94507 770600752 501(C)(3) 55000 0 N/A N/A COMMUNITY SUPPORT VILLAGE COMMUNITY RESOURCE CENTER 633 VILLAGE DR BRENTWOOD CA 94513 412045701 501(C)(3) 55000 0 N/A N/A COMMUNITY SUPPORT WHITE PONY EXPRESS 3380 VINCENT ROAD 107 PLEASANT HILL CA 94523 465220565 501(C)(3) 55000 0 N/A N/A COMMUNITY SUPPORT NAMI CONTRA COSTA 2151 SALVIO ST STE V CONCORD CA 94520 680209474 501(C)(3) 50000 0 N/A N/A COMMUNITY SUPPORT & SPONSORSHIP PHILIP DORN RESPITE CENTER 2400 BISSO LANE SUITE D2 CONCORD CA 94520 946000509 CONTRACOSTACNTY 50000 0 N/A N/A COMMUNITY SUPPORT FOOD BANK OF CONTRA COSTA & SOLANO 4010 NELSON AVENUE CONCORD CA 94520 942418054 501(C)(3) 50000 0 N/A N/A COMMUNITY SUPPORT ALAMEDA COUNTY COMMUNITY FOOD BANK PO BOX 2599 OAKLAND CA 94614 942960297 501(C)(3) 50000 0 N/A N/A COMMUNITY SUPPORT ORDER OF MALTA 2121 HARRISON STREET NO 110 OAKLAND CA 94612 205969389 501(C)(3) 45000 0 N/A N/A COMMUNITY SUPPORT SUPPORT 4 RECOVERY INC PO BOX 31114 WALNUT CREEK CA 94598 611538303 501(C)(3) 45000 0 N/A N/A COMMUNITY SUPPORT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 45000 0 N/A N/A SPONSORSHIP HEALTHY AND ACTIVE BEFORE 5 1035 DETROIT AVE CONCORD CA 94518 942383037 501(C)(3) 40000 0 N/A N/A COMMUNITY SUPPORT ST VINCENT DE PAUL OF CONTRA COSTA COUNTY 2210 GLADSTONE DRIVE PITTSBURG CA 94565 941448577 501(C)(3) 33000 0 N/A N/A SPONSORSHIP INDEPENDENT LIVING RESOURCES 1850 GATEWAY BLVD STE 170 CONCORD CA 94520 680048218 501(C)(3) 30000 0 N/A N/A COMMUNITY SUPPORT THREE VALLEYS COMMUNITY FOUNDATION 5960 INGLEWOOD DR SUITE 201 PLEASANTON CA 94588 871782380 501(C)(3) 30000 0 N/A N/A COMMUNITY SUPPORT KEROSENE LAMP FOUNDATION 174 CRESVIEW DRIVE ORINDA CA 94563 010857784 501(C)(3) 22500 0 N/A N/A BACK PACK DRIVE HOSPICE OF THE EAST BAY 3470 BUSKIRK AVE PLEASANT HILL CA 94523 942515405 501(C)(3) 10000 0 N/A N/A SPONSORSHIP LA CLINICA DE LA RAZA PO BOX 22210 OAKLAND CA 94623 941744108 501(C)(3) 10000 0 N/A N/A SPONSORSHIP VITUITY CARES FOUNDATION 2100 POWELL STREET SUITE 400 EMERYVILLE CA 94608 851805937 501(C)(3) 10000 0 N/A N/A COMMUNITY SUPPORT AMERICAN CANCER SOCIETY 3380 CHASTAIN MEADOWS PKWY NW SUITE 200 KENNESAW GA 30144 131788491 501(C)(3) 10000 0 N/A N/A SPONSORSHIP HABITAT FOR HUMANITY 2619 BROADWAY OAKLAND CA 94612 943053687 501(C)(3) 10000 0 N/A N/A SPONSORSHIP HEALTH CAREER CONNECTION 300 FRANK H OGAWA PLAZA NO 243 OAKLAND CA 94612 251904312 501(C)(3) 7900 0 N/A N/A INTERNSHIP SPONSORSHIP ALS ASSOCIATION PO BOX 7082 WOODLAND HILLS CA 91365 954163338 501(C)(3) 7500 0 N/A N/A EAST BAY WALK TO DEFEAT ALS SPONSORSHIP HAVE A BALL FOUNDATION 662 ROCK ISLAND CIRCLE DANVILLE CA 94526 202420378 501(C)(3) 7500 0 N/A N/A SPONSORSHIP LIFELONG MEDICAL CARE PO BOX 11247 BERKELEY CA 94712 942502308 501(C)(3) 6717 0 N/A N/A SPONSORSHIP RAINBOW COMMUNITY CENTER 2380 SALVIO STREET SUITE 301 CONCORD CA 94520 680375857 501(C)(3) 6500 0 N/A N/A SPONSORSHIP CHOICE IN AGING 490 GOLF CLUB RD PLEASANT HILL CA 94523 942822559 501(C)(3) 6000 0 N/A N/A SPONSORSHIP 49 PART I, LINE 2: GRANT MONITORING PROCESS JOHN MUIR HEALTH FINANCIAL MANAGEMENT MONITORS THE USE OF RESTRICTED FUNDS TO MEET THE INTENDED PURPOSES. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 MICHAEL S THOMAS PRESIDENT/CEO 1330906 0 369194 0 25670 0 841902 0 24185 0 2591857 0 369194 0 JANE WILLEMSEN CHIEF OPERATING OFFICER 1060000 0 381870 0 39509 0 510071 0 26036 0 2017486 0 381870 0 LISA FOUST SVP HUMAN RESOURCES 581928 0 629191 0 19699 0 255389 0 35263 0 1521470 0 153289 0 MAX REYNOLDS SVP/GENERAL COUNSEL 573497 0 151273 0 11074 0 692099 0 20056 0 1447999 0 151273 0 GEORGE SAUTER SVP/CHIEF STRATEGY OFFICER 535073 0 144595 0 23597 0 677504 0 17063 0 1397832 0 144595 0 MICHELLE LOPES RN SVP HOSPITAL OPERATIONS 485932 0 121578 0 19121 0 664423 0 17563 0 1308617 0 121578 0 CALVIN KNIGHT FORMER PRESIDENT/CEO 0 0 498840 0 774148 0 0 0 0 0 1272988 0 1272988 0 RUSSELL RODRIGUEZ SVP/CHIEF MEDICAL OFFICER 694177 0 182148 0 7254 0 238522 0 33809 0 1155910 0 182148 0 PAUL DEERINGER SVP/CSO (AS OF 5/7/23) 506604 0 132471 0 13139 0 222754 0 23960 0 898928 0 132471 0 MELINDA ESTEP SVP/CFO (AS OF 8/14/23) 252692 0 0 0 69037 0 61737 0 4721 0 388187 0 0 0 CHRISTIAN PASS SVP/CFO (THRU 2/10/23) 112375 0 253174 0 10018 0 6623 0 5357 0 387547 0 253174 0 PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES JOHN MUIR HEALTH PAYS UP TO 50% OF HEALTH CLUB DUES FOR EXECUTIVE DIRECTORS OF OPERATIONS, VICE PRESIDENTS AND ABOVE. THESE BENEFITS ARE TREATED AS TAXABLE INCOME TO THESE INDIVIDUALS. PART-I LINE-4B NON-QUALIFIED RETIREMENT PLANS RETIREMENT RESTORATION PLAN EMPLOYEES ELIGIBLE FOR THE RETIREMENT RESTORATION PLAN ARE EITHER SENIOR VICE PRESIDENT OR VICE PRESIDENT LEVEL EMPLOYEES. EMPLOYER CONTRIBUTIONS ARE MADE TO THE PLAN ON BEHALF OF ELIGIBLE EMPLOYEES. THE ANNUAL INCREASE IN ACTUARIAL VALUE OF THE PLAN BENEFIT IS REPORTED IN PART II, COLUMN C. VESTING FOR THE RESTORATION PLAN IS AT THE EARLIEST OF THE FOLLOWING: REACHING AGE 65 WITH AT LEAST THREE YEARS OF SERVICE, BECOMING TOTALLY AND PERMANENTLY DISABLED, INVOLUNTARY TERMINATION FOR ANY REASON OTHER THAN CAUSE, CHANGE OF CONTROL OF JOHN MUIR HEALTH, OR DEATH. RESTORATION PLAN BENEFITS ARE PAYABLE AND TAXABLE UPON VESTING. NO PLAN BENEFIT PAYMENTS WERE MADE DURING THE YEAR. THE FOLLOWING EXECUTIVES PARTICIPATED IN THE PLAN AND EARNED THE FOLLOWING BENEFIT DURING THE YEAR: MAX REYNOLDS $54,411 GEORGE SAUTER $64,618 LISA FOUST $84,001 RUSSELL RODRIGUEZ $47,003 MICHELLE LOPES $98,596 PAUL DEERINGER $42,229 SUPPLEMENTAL EXECUTIVE PLAN EMPLOYEES ELIGIBLE FOR THE SUPPLEMENTAL EXECUTIVE PLAN ARE EITHER CEO, CFO, COO OR EVP OF JOHN MUIR HEALTH, CEO OR CAO OF JOHN MUIR PHYSICIAN NETWORK OR FORMER EMPLOYEES THAT PREVIOUSLY HELD ONE OF THOSE POSITIONS, AND CURRENT EMPLOYEES THAT PREVIOUSLY HELD ONE OF THOSE POSITIONS. EMPLOYER CONTRIBUTIONS ARE MADE TO THE PLAN ON BEHALF OF ELIGIBLE EMPLOYEES. THE ANNUAL INCREASE IN ACTUARIAL VALUE OF THE PLAN BENEFIT IS REPORTED IN PART II, COLUMN C. VESTING FOR THE SUPPLEMENTAL EXECUTIVE PLAN IS AT THE EARLIEST OF THE FOLLOWING: REACHING AGE 65 WITH AT LEAST THREE YEARS OF SERVICE, BECOMING DISABLED, INVOLUNTARY TERMINATION FOR ANY REASON OTHER THAN CAUSE, TERMINATION UPON CHANGE OF CONTROL OF JOHN MUIR HEALTH, OR DEATH. BENEFITS ARE PAYABLE AND TAXABLE UPON VESTING. THE FOLLOWING EXECUTIVES PARTICIPATED IN THE PLAN AND EARNED THE FOLLOWING BENEFIT DURING THE TAX YEAR: CHRISTIAN PASS $6,623 JANE WILLEMSEN $50,532 MICHAEL THOMAS $155,821 A CA STATEWIDE COMMUNITY DEVELOPMENT AUTHORITY 680164610 NONEAVAIL 2012-05-23 89800000 SEE PART IV 0 0 0 B CA STATEWIDE COMMUNITY DEVELOPMENT AUTHORITY 680164610 13080SMW1 2016-06-09 353140040 SEE PART IV 0 0 0 C CA STATEWIDE COMMUNITY DEVELOPMENT AUTHORITY 680164610 13080STN4 2018-05-15 92473440 REFUNDING OF 2017 BONDS 0 0 0 D CA STATEWIDE COMMUNITY DEVELOPMENT AUTHORITY 680164610 NONEAVAIL 2019-08-12 51532082 REFUNDING OF 2012B BONDS 0 0 0 A 85111250 89800000 502197 127803 89170000 2012 1 0 1 1 B 355940169 3133280 40926412 300002560 11668348 1 0 0 1 C 92476440 1419493 91053947 2018 1 0 1 1 D 51532082 482082 51050000 2019 0 1 1 1 A 0 0 1 0 0 0.00010 0.00010 0.00020 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 1 0 0 1 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 PART I, LINE A, COLUMN (F) DESCRIPTION OF BOND PURPOSE THE BONDS WERE ISSUED FOR THE PURPOSE OF REFUND AND PAYMENT IN FULL OF THE OUTSTANDING PRINCIPAL AMOUNT AND INTEREST DUE ON THE 1997 CERTIFICATES OF PARTICIPATION AND THE SERIES 2008B BONDS ISSUED 10/29/1997 AND 5/2/2008 RESPECTIVELY. PART I, LINE B, COLUMN (F) DESCRIPTION OF BOND PURPOSE THE BONDS WERE ISSUED FOR THE PURPOSES OF REFUNDING BONDS ISSUED 6/14/2006 AND 5/2/2008 AND FINANCING CAPITAL EXPENDITURES. PART II, LINE 3, COLUMN B TOTAL PROCEEDS FROM ISSUE THE $353,140,040 OF BOND PROCEEDS INCLUDE $2,063,199 OF TOTAL EARNINGS SINCE 2016 ON THE UNSPENT PROCEEDS. PART III, LINE 3B MANAGEMENT, SERVICES CONTRACTS OR RESEARCH AGREEMENTS JOHN MUIR HEALTH ENGAGES BOND COUNSEL IN CONNECTION WITH PUBLIC DEBT OFFERINGS OR REFINANCING, DURING WHICH BOND COUNSEL REVIEWS MANAGEMENT OR SERVICE CONTRACTS RELATED TO FINANCED PROPERTY. PART III, LINE 9 & PART V WRITTEN DISCLOSURES WHILE THE ORGANIZATION DID NOT HAVE BOARD APPROVED WRITTEN POLICIES AND PROCEDURES IN PLACE AS OF THE YEAR END, THE ORGANIZATION DID MONITOR COMPLIANCE WITH THE POST-ISSUANCE REQUIREMENTS IMPOSED ON THE BONDS. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT COMPANY JOHN MUIR HEALTH HAS ENGAGED OPTUM TO MANAGE NON CLINICAL FUNCTIONS, INCLUDING INFORMATION TECHNOLOGY, REVENUE CYCLE MANAGEMENT, ANALYTICS, PURCHASING AND CLAIMS PROCESSING. OPTUM BRINGS AN EXTENSIVE SET OF CAPABILITIES, INCLUDING OPERATIONAL TECHNOLOGIES, ANALYTIC SOLUTIONS AND TOOLS, AND ADMINISTRATIVE SERVICE EXPERTISE TO HELP JOHN MUIR HEALTH FURTHER ADVANCE ITS CLINICAL AND OPERATIONAL PERFORMANCE. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS SUBJECT TO APPROVAL THE BYLAWS OF JOHN MUIR HEALTH PROVIDE THAT JOHN MUIR HEALTH MAY NOT, WITHOUT THE PRIOR WRITTEN CONSENT OF THE MT. DIABLO HEALTHCARE DISTRICT, A POLITICAL SUBDIVISION OF THE STATE OF CALIFORNIA, AND THE JOHN MUIR ASSOCIATION, A CALIFORNIA NONPROFIT CORPORATION: (I) SELL, TRANSFER, OR OTHERWISE DISPOSE OF ALL OR SUBSTANTIALLY ALL THE ASSETS OF JOHN MUIR HEALTH; (II) ISSUE MEMBERSHIP IN JOHN MUIR HEALTH TO ANY PERSON OR ENTITY; (III) MERGER; WITH ANY OTHER PERSON OR ENTITY, UNLESS JOHN MUIR HEALTH IS THE SURVIVING CORPORATION IN THE MERGE: OR (IV) AMEND SECTION 5.6 OF THE BYLAWS OF JOHN MUIR HEALTH (WHICH OBLIGES JOHN MUIR HEALTH TO AMONG OTHER THINGS, PROVIDE AT LEAST ONE MILLION DOLLARS ($1,000,000) ANNUALLY TO FUND CERTAIN COMMUNITY BENEFIT PROJECTS SPONSORED BY THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND AND REASONABLE FUNDING FOR ADMINISTRATION, UP TO A MAXIMUM OF $200,000 PER YEAR. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990 BY THE GOVERNING BODY THE COMPLETED FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS SUFFICIENTLY IN ADVANCE OF THE FILING DEADLINE TO ENABLE A DETAILED AND CONSCIENTIOUS REVIEW BY ALL MEMBERS. AN OVERVIEW OF THE FORM 990, WITH SUFFICIENT DETAIL, IS PRESENTED TO THE BOARD WITH THE COMPLETED FORM 990. ALL QUESTIONS AND CONCERNS OF THE BOARD OF DIRECTORS WILL BE ADDRESSED BY THE CHIEF FINANCIAL OFFICER AND HIS DESIGNEE AND INCORPORATED INTO THE FORM 990 AS APPROPRIATE. AFTER ALL OF THE INPUT FROM THE BOARD OF DIRECTORS HAS BEEN APPROPRIATELY ADDRESSED, A COMPLETE COPY OF THE FORM 990 IS DISTRIBUTED TO THE FULL BOARD BEFORE JOHN MUIR HEALTH WILL FILE THE FINAL FORM 990 AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST MONITORING ANNUALLY, THE JOHN MUIR HEALTH BOARD CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO BOARD MEMBERS, ALONG WITH A CONFLICT OF INTEREST DISCLOSURE FORM REQUIRED TO BE COMPLETED AND SIGNED. DISCLOSED CONFLICTS ARE COMPILED IN A DOCUMENT AND REVIEWED BY THE BOARD CHAIR, PRESIDENT/CEO, AND GENERAL COUNSEL. TOGETHER, THESE INDIVIDUALS MONITOR ANY POTENTIAL CONFLICTS AND THE GENERAL COUNSEL ATTENDS BOARD MEETINGS TO ENSURE COMPLIANCE WITH THE POLICY. TRANSACTIONS INVOLVING A POTENTIAL CONFLICT ARE REVIEWED AND APPROVED IN ADVANCE BY THE GENERAL COUNSEL OR DESIGNEE, GOVERNANCE COMMITTEE AS INDICATED BY THE POLICY, AND FOR CERTAIN TRANSACTIONS WITH THE CURRENT BOARD MEMBERS, THE BOARD. THE POLICY ALSO REQUIRES BOARD MEMBERS TO DISCLOSE CONFLICTS DURING THE YEAR AND RECUSE THEMSELVES FROM VOTING ON ANY MATTERS RELATED TO A CONFLICT. AS QUESTIONS ABOUT POTENTIAL CONFLICTS ARISE DURING THE YEAR, THE GENERAL COUNSEL REVIEWS THEM WITH THE AFFECTED BOARD MEMBER, THE PRESIDENT/CEO AND THE BOARD CHAIR. TO ENSURE THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH CHARITABLE PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS, PERIODIC REVIEWS SHALL BE CONDUCTED, INCLUDING PERIODIC REVIEWS OF ITS TRANSACTIONS OR ARRANGEMENTS WITH ITS OFFICERS AND BOARD MEMBERS, AND ANY OTHER INDIVIDUAL OR ENTITIES THAT MAY HAVE A SUBSTANTIAL INFLUENCE OVER THE BUSINESS AND AFFAIRS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, OTHER OFFICERS AND KEY EMPLOYEES ARE ESTABLISHED ANNUALLY BY THE COMPENSATION COMMITTEE OF JOHN MUIR HEALTH. THE COMPENSATION COMMITTEE IS A STANDING COMMITTEE OF THE BOARD OF DIRECTORS COMPRISED OF NO LESS THAN 5 VOTING DIRECTORS, NONE OF WHICH HAS A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION TRANSACTIONS UNDER CONSIDERATION. THE COMPENSATION COMMITTEE UTILIZES AN OUTSIDE EXPERT COMPENSATION CONSULTANT. THE OUTSIDE CONSULTANT PROVIDES MARKET DATA OF SIMILARLY SITUATED ORGANIZATIONS FOR EACH INDIVIDUAL BASED UPON THEIR LEVEL OF RESPONSIBILITES. THAT DATA IS USED BY THE COMPENSATION COMMITTEE TO ESTABLISH THE ANNUAL COMPENSATION PACKAGE FOR EACH INDIVIDUAL. IT IS THE PHILOSOPHY OF THE ORGANIZATION TO ESTABLISH A COMPENSATION PACKAGE FOR EACH INDIVIDUAL THAT REFLECTS THE MEDIAN OF THE MARKET AS ESTABLISHED BY THE OUTSIDE CONSULTANT. THE COMMITTEE'S DELIBERATIONS AND DECISIONS REGARDING THESE COMPENSATION ARRANGEMENTS ARE DOCUMENTED IN THE COMMITTEE MINUTES THAT ARE REVIEWED AT ITS NEXT MEETING. THE DOCUMENTED MINUTES INCLUDE: (1) TERMS OF THE COMPENSATION ARRANGEMENT, INCLUDING DATE IT WAS APPROVED; (2) A DESCRIPTION OF THE COMPARABLE DATA RELIED UPON BY THE COMMITTEE AND HOW IT WAS OBTAINED; (3) A LIST OF THE MEMBERS PRESENT DURING THE DELIBERATIONS AND HOW THE MEMBERS VOTED; AND (4) ANY ACTIONS TAKEN WITH RESPECT TO CONSIDERATION OF ANY MEMBER OF THE COMMITTEE WHO HAD A POTENTIAL CONFLICT OF INTEREST WITH RESPECT TO THE TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE TO THE PUBLIC AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE FROM THE JOHN MUIR HEALTH LEGAL DEPARTMENT UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN UNAMORTIZED LOSS ON PENSION PLAN -12,662,491. JOHN MUIR HEALTH FOUNDATION 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 942650855 FUNDRAISING CA 501(C)(3) 7 JM HEALTH 1 JOHN MUIR PHYSICIAN NETWORK 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 680360801 HEALTHCARE CA 501(C)(3) 12A, III JM HEALTH 1 JOHN MUIR BEHAVIORAL HEALTH 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 680249685 HEALTHCARE CA 501(C)(3) 3 JM HEALTH 1 JOHN MUIRMT DIABLO COMMUNITY HEALTH 5003 COMMERCIAL CIRCLE SUITE 275 CONCORD CA 94520 911788973 GRANTMAKING CA 501(C)(3) 12C, III-FI JM HEALTH 1 JOHN MUIR MAGNETIC IMAGING 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 680202020 DIAG IMAGING CA JM HEALTH RELATED 2947910 4628588 0 1 0.90000 BAY AREA SURGICAL VENTURES 30 S WACKER DRIVE CHICAGO IL 60606 203052802 MED SERVICES CA JM HEALTH RELATED 1337108 2377792 0 0 0.53500 WALNUT CREEK CANCER CENTER 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 941461843 MED SERVICES CA JM HEALTH RELATED 5282007 18326415 0 0 0.60000 JOHN MUIRMT DIABLO PARENT COMPANY 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 900060434 INACTIVE CA JM HEALTH C 1.00000 1 1 1 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 0 JOHN MUIR PHYSICIAN NETWORK A 3954058 RENTS RECEIVED JOHN MUIR PHYSICIAN NETWORK B 119859846 EXPENSE PAID JOHN MUIR BEHAVIORAL HEALTH B 14421914 EXPENSE PAID JOHN MUIR HEALTH FOUNDATION B 8105762 SHARED SERVICES JOHN MUIR MT DIABLO COMM HEALTH FDN B 1408194 AGREEMENT TERMS JOHN MUIR HEALTH FOUNDATION C 6332359 SHARED SERVICES JOHN MUIR BEHAVIORAL HEALTH C 9187903 SHARED SERVICES JOHN MUIR MT DIABLO COMM HEALTH FDN C 13631 SHARED SERVICES JOHN MUIR BEHAVIORAL HEALTH J 1090260 SHARED SERVICES JOHN MUIR HEALTH FOUNDATION J 202171 AGREEMENT TERMS BAY AREA SURGICAL VENTURES J 1433111 AGREEMENT TERMS JOHN MUIR PHYSICIAN NETWORK J 2235289 AGREEMENT TERMS BAY AREA SURGICAL VENTURES L 170457 AGREEMENT TERMS JOHN MUIR MAGNETIC IMAGING J 488504 AGREEMENT TERMS JOHN MUIR MAGNETIC IMAGING L 1629618 AGREEMENT TERMS JOHN MUIR PHYSICIAN NETWORK M 4281682 AGREEMENT TERMS JOHN MUIR MAGNETIC IMAGING M 185461 AGREEMENT TERMS WALNUT CREEK CANCER PROGRAM P 21727327 AGREEMENT TERMS WALNUT CREEK CANCER PROGRAM Q 10528110 AGREEMENT TERMS JOHN MUIR PHYSICIAN NETWORK Q 444084 AGREEMENT TERMS