4A (Expenses $ 368901416 including grants of $ 202000) (Revenue $ 415208923)
SEE SCHEDULE O.

PART V, SECTION B
TWO FACILITIES OPERATE UNDER SHC TRI-VALLEY'S LICENSE WITH THE FOLLOWING ADDRESSES. 1111 E STANLEY BLVD LIVERMORE, CA 94550 5555 W LAS POSITAS BLVD PLEASANTON, CA 94588

PART V, SECTION B, LINE 5
"THE HOSPITAL COMMISSIONED AN INDEPENDENT LOCAL RESEARCH FIRM, ACTIONABLE INSIGHTS, LLC (""AI""), TO ASSIST WITH THE VARIOUS ASSESSMENTS FOR THE 2021-2022 CHNA CYCLE. STANFORD HEALTH CARE TRI-VALLEY (SHC TRI-VALLEY) AND 12 OTHER HOSPITALS IN ALAMEDA AND CONTRA COSTA COUNTIES (SUBSEQUENTLY REFERRED TO AS ""THE HOSPITALS"") COLLABORATED FOR THE PURPOSE OF IDENTIFYING CRITICAL HEALTH NEEDS OF THE COMMUNITY. WORKING TOGETHER, THE HOSPITALS CONDUCTED AN EXTENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE 2022 CHNA BUILT UPON EARLIER ASSESSMENTS CONDUCTED BY THE HOSPITALS. AI COMPLETED THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. TO DO SO, AI ASSISTED SHC TRI-VALLEY WITH CHNA PLANNING, COLLECTED SECONDARY DATA, SYNTHESIZED SECONDARY DATA AND KEY PRIMARY DATA INSIGHTS, FACILITATED THE PROCESSES OF IDENTIFYING COMMUNITY ASSETS AND HEALTH NEEDS, ASSISTED WITH DETERMINING THE PRIORITIZATION OF COMMUNITY HEALTH NEEDS, AND DOCUMENTED THE PROCESSES AND FINDINGS IN THIS REPORT. ADDITIONALLY, FOR THE 2021-2022 CHNA CYCLE, SHC TRI-VALLEY EMPLOYED AD LUCEM TO CONDUCT AND ANALYZE KEY INFORMANT INTERVIEWS AND ANALYZED FOCUS GROUP DATA, PROVIDING KEY THEMES AND QUOTES, AND TO DESCRIBE THE PROCESSES AND METHODS IT USED IN THOSE EFFORTS. UTILIZING THE SERVICES OF BOTH AI AND AD LUCEM, PRIMARY AND SECONDARY RESEARCH, WAS COLLECTED AND SYNTHESIZED FOR A FINAL HEALTH NEEDS LIST, ASSISTED WITH THE HOSPITALS' PRIORITIZATION OF COMMUNITY HEALTH NEEDS AND DOCUMENTED THE PROCESS AND FINDINGS IN A REPORT. DURING THE 2022 CHNA PROCESS, THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED, INCLUDING FROM THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH THROUGH INTERVIEWS OF PUBLIC AND COMMUNITY HEALTH LEADERS, ADVOCATES AND EXPERTS. INPUT WAS ALSO GATHERED FROM RESIDENT AND PROFESSIONAL FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WHICH REPRESENTED THE FOLLOWING POPULATIONS MEDICALLY UNDERSERVED, LOW-INCOME INDIVIDUALS AND MINORITY POPULATIONS. FINDINGS REGARDING COMMUNITY HEALTH CONCERNS THAT HAD BEEN IDENTIFIED FROM AN ANALYSIS OF SECONDARY DATA WERE DISCUSSED WITH GROUPS OF PEOPLE FROM UNDERSERVED, MINORITY AND LOW-INCOME POPULATIONS. CONSULTING FIRMS APPLIED SURVEY RESEARCH (ASR) AND AD LUCEM CONSULTING CONDUCTED A TOTAL OF 10 KEY INFORMANT INTERVIEWS RELEVANT TO THE TRI-VALLEY AREA. INTERVIEWEES INCLUDED ORGANIZATIONS SERVING BOTH ALAMEDA AND CONTRA COSTA COUNTIES AS WELL AS ORGANIZATIONS FOCUSED ON THE TRI-VALLEY. INTERVIEWEES REPRESENTED DIVERSE SECTORS INCLUDING: PUBLIC HEALTH, HEALTH CARE, MENTAL HEALTH CARE, FOOD ASSISTANCE, HOMELESS AND SOCIAL SERVICES, AND EDUCATION. THE KEY INFORMANTS WERE IDENTIFIED BY MEMBERS OF THE ALAMEDA CONTRA COSTA HOSPITAL COUNCIL CHNA COLLABORATIVE AND STANFORD HEALTH CARE TRI-VALLEY STAFF. ALL INTERVIEWS WERE CONDUCTED BY TELEPHONE IN ENGLISH AND FOLLOWED A STANDARD SET OF INTERVIEW QUESTIONS AND THE INTERVIEWERS TOOK DETAILED NOTES DURING THE CALL. AT THE BEGINNING OF THE INTERVIEW, CONFIDENTIALITY WAS ASSURED. FIVE COMMUNITY RESIDENT FOCUS GROUPS WERE CONDUCTED; TWO IN ALAMEDA COUNTY AND THREE IN CENTRAL CONTRA COSTA COUNTY. THREE GROUPS WERE CONDUCTED IN ENGLISH, TWO WERE CONDUCTED IN SPANISH. PARTICIPANTS WERE FROM UNDERSERVED, LOW-INCOME COMMUNITIES. THE LIST BELOW CONTAINS THE DETAILS OF LEADERS, REPRESENTATIVES, AND MEMBERS WHO WERE CONSULTED FOR THEIR EXPERTISE IN THE COMMUNITY. LEADERS WERE IDENTIFIED BASED ON THEIR PROFESSIONAL EXPERTISE AND KNOWLEDGE OF TARGET GROUPS INCLUDING LOW-INCOME POPULATIONS, MINORITIES, AND THE MEDICALLY UNDERSERVED. ID#: 1 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: LEADERSHIP, OPEN HEART KITCHEN TOPIC: HOMELESSNESS, FOOD INSECURITY #OF PEOPLE: 1 TARGET GROUP(S) REPRESENTED: LOW-INCOME, OLDER ADULTS, YOUTH ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 7/22/2021 ID#: 2 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: LEADER, ALAMEDA COUNTY COMMUNITY FOOD BANK TOPIC: FOOD INSECURITY #OF PEOPLE: 1 TARGET GROUP(S) REPRESENTED: LOW-INCOME ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 7/27/2021 ID#: 3 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: LEADERSHIP & DIRECTOR LEVEL, TRI-VALLEY HAVEN TOPIC: FOOD INSECURITY #OF PEOPLE: 2 TARGET GROUP(S) REPRESENTED: LOW-INCOME ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 8/4/2021 ID#: 4 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: PROGRAM MANAGER, ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT TOPIC: PUBLIC HEALTH #OF PEOPLE: 1 TARGET GROUP(S) REPRESENTED: LOW-INCOME, MEDICALLY UNDERSERVED, MINORITY ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 8/9/2021 ID#: 5 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: LEADERSHIP & NURSE, LIVERMORE VALLEY JOINT UNIFIED SCHOOL DISTRICT TOPIC: EDUCATION #OF PEOPLE: 2 TARGET GROUP(S) REPRESENTED: MEDICALLY UNDERSERVED, YOUTH ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 8/27/2021 ID#: 6 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: CO-FOUNDER, Z-CARES FOUNDATION TOPIC: YOUTH MENTAL HEALTH #OF PEOPLE: 1 TARGET GROUP(S) REPRESENTED: YOUTH ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 9/21/2021 ID#: 7 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: CEO & CHIEF DEVELOPMENT OFFICER, AXIS COMMUNITY HEALTH TOPIC: ACCESS TO CARE #OF PEOPLE: 2 TARGET GROUP(S) REPRESENTED: MEDICALLY UNDERSERVED ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 9/21/2021 ID#: 8 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: DIRECTOR OF STUDENT SERVICES, DUBLIN UNIFIED SCHOOL DISTRICT TOPIC: EDUCATION #OF PEOPLE: 1 TARGET GROUP(S) REPRESENTED: YOUTH ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 10/19/2021 ID#: 9 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: ASSISTANT SUPERINTENDENT, PLEASANTON UNIFIED SCHOOL DISTRICT TOPIC: EDUCATION #OF PEOPLE: 1 TARGET GROUP(S) REPRESENTED: YOUTH ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 10/20/2021 ID#: 10 DATA COLLECTION METHOD: INTERVIEW TITLE, AGENCY: EPIDEMIOLOGIST/BIOSTATISTICIAN & PUBLIC HEALTH ACCREDITATION COORDINATOR, CONTRA COSTA HEALTH SERVICES TOPIC: PUBLIC HEALTH #OF PEOPLE: 2 TARGET GROUP(S) REPRESENTED: LOW-INCOME, MEDICALLY UNDERSERVED ROLE IN TARGET GROUP: LEADER DATE INPUT WAS GATHERED: 11/5/2021 COMMUNITY RESIDENTS (FOCUS GROUPS) ID#: 11 DATA COLLECTION METHOD: FOCUS GROUP TITLE, AGENCY: HOST: CONTRA COSTA HEALTH SERVICES TOPIC: SPANISH-SPEAKING LATINX RESIDENTS #OF PEOPLE: 10 TARGET GROUP(S) REPRESENTED: MINORITY ROLE IN TARGET GROUP: MEMBER DATE INPUT WAS GATHERED: 9/23/2021 ID#: 12 DATA COLLECTION METHOD:FOCUS GROUP TITLE, AGENCY: HOST: LA FAMILIA TOPIC: SPANISH- SPEAKING LATINX OLDER ADULTS #OF PEOPLE: 9 TARGET GROUP(S) REPRESENTED: LOW-INCOME, MINORITY, OLDER ADULTS ROLE IN TARGET GROUP: MEMBER DATE INPUT WAS GATHERED: 9/24/2021 ID#: 13 DATA COLLECTION METHOD: FOCUS GROUP TITLE, AGENCY: HOST: CONTRA COSTA HEALTH SERVICES TOPIC: OLDER ADULTS #OF PEOPLE: 9 TARGET GROUP(S) REPRESENTED: MINORITY ROLE IN TARGET GROUP: MEMBER DATE INPUT WAS GATHERED: 9/28/2021 ID#: 14 DATA COLLECTION METHOD: FOCUS GROUP TITLE, AGENCY: HOST: CONTRA COSTA HEALTH SERVICES TOPIC: BLACK RESIDENTS #OF PEOPLE: 2 TARGET GROUP(S) REPRESENTED: MINORITY ROLE IN TARGET GROUP: MEMBER DATE INPUT WAS GATHERED: 9/29/2021 ID#: 15 DATA COLLECTION METHOD: FOCUS GROUP TITLE, AGENCY: HOST: GOODNESS VILLAGE TOPIC: FORMERLY HOMELESSNESS RESIDENTS #OF PEOPLE: 9 TARGET GROUP(S) REPRESENTED: LOW-INCOME ROLE IN TARGET GROUP: MEMBER DATE INPUT WAS GATHERED: 10/6/2021"

PART V, SECTION B, LINE 6A
STANFORD HEALTH CARE TRI-VALLEY COLLABORATED WITH THE FOLLOWING HEALTH SYSTEMS AND ORGANIZATIONS TO PREPARE THE 2022 CHNA: - ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT - APPLIED SURVEY RESEARCH - CONTRA COSTA HEALTH SERVICES - JOHN MUIR HEALTH - KAISER PERMANENTE - DIABLO AREA (ANTIOCH AND WALNUT CREEK KAISER FOUNDATION HOSPITALS) - KAISER PERMANENTE - EAST BAY AREA (OAKLAND AND RICHMOND KAISER FOUNDATION HOSPITALS) - KAISER PERMANENTE - GREATER SOUTHERN ALAMEDA AREA (FREMONT AND SAN LEANDRO KAISER FOUNDATION HOSPITALS) - ST. ROSE HOSPITAL - SUTTER HEALTH BAY AREA (ALTA BATES SUMMIT MEDICAL CENTER AND HERRICK CAMPUS, DELTA MEDICAL CENTER, AND EDEN MEDICAL CENTER) - UCSF BENIOFF CHILDREN'S HOSPITAL

PART V, SECTION B, LINES 7A/10A
URL AT WHICH THE CHNA AND IMPLEMENTATION STRATEGY ARE AVAILABLE: HTTPS://STANFORDHEALTHCARE.ORG/TRI-VALLEY/ABOUT-US/COMMUNITY-BENEFITS.HTML

PART V, SECTION B, LINE 11
SHC TRI-VALLEY'S COMMUNITY BENEFIT ADVISORY GROUP (CBAG) MET ON MARCH 2, 2022 TO REVIEW THE HEALTH NEEDS IDENTIFIED DURING THE ASSESSMENT AND TO PARTICIPATE IN THE PRIORITIZATION PROCESS. (THE CBAG MEMBERS WHO PARTICIPATED ARE LISTED IN THE PROCESS AND METHODS SECTION OF THIS REPORT.) THE CBAG USED THESE CRITERIA TO PRIORITIZE THE LIST OF HEALTH NEEDS: - COMMUNITY PRIORITY. THE COMMUNITY PRIORITIZES THE ISSUE OVER OTHER ABOUT WHICH IT HAS EXPRESSED CONCERN DURING THE CHNA PRIMARY DATA COLLECTION PROCESS. - CLEAR DISPARITIES OR INEQUITIES. THIS REFERS TO DIFFERENCES IN HEALTH OUTCOMES BY SUBGROUPS. SUBGROUPS MAY BE BASED ON GEOGRAPHY, LANGUAGE, ETHNICITY, CULTURE, CITIZENSHIP STATUS, ECONOMIC STATUS, SEXUAL ORIENTATION, AGE, GENDER, OR OTHERS. - LACKING SUFFICIENT COMMUNITY ASSETS AND/OR RESOURCES. THE IRS REQUIRES THAT HOSPITALS TAKE INTO CONSIDERATION WHETHER EXISTING ASSETS/ RESOURCES ARE AVAILABLE TO ADDRESS THE ISSUE. - MULTIPLIER EFFECT. A SUCCESSFUL SOLUTION TO THE HEALTH NEED HAS TO SOLVE MULTIPLE PROBLEMS. FOR EXAMPLE, IF RATES OF OBESITY GO DOWN, DIABETES RATES COULD ALSO GO DOWN. PRIORITIZED 2022 HEALTH NEEDS BASED ON THOSE CRITERIA, THE CBAG MEMBERS REACHED CONSENSUS IN RANKING NINE COMMUNITY HEALTH NEEDS. THESE NEEDS ARE LISTED BELOW IN OUR HOSPITAL'S PRIORITY ORDER, FROM HIGHEST TO LOWEST. SUMMARIZED DESCRIPTIONS OF EACH NEED, INCLUDING STATISTICAL DATA AND COMMUNITY FEEDBACK, APPEAR IN THE COMMUNITY HEALTH NEEDS OF THIS REPORT. 1. HOUSING AND HOMELESSNESS 2. BEHAVIORAL HEALTH 3. ECONOMIC STABILITY 4. HEALTHY EATING/ACTIVE LIVING, DIABETES AND OBESITY 5. HEALTH CARE ACCESS AND DELIVERY 6. COMMUNITY SAFETY 7. HEART DISEASE AND STROKE 8. CANCER 9. CLIMATE AND NATURAL ENVIRONMENT

PART V, SECTION B, LINE 16A-C
URL AT WHICH THE FAP, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY IS AVAILABLE: HTTPS://WWW.STANFORDHEALTHCARE.ORG/TRI-VALLEY/PATIENTS-AND-VISITORS/ BILLING.HTML

PART V, SECTION B, LINE 20A
SHC TRI-VALLEY WILL PURSUE PAYMENT FOR DEBTS OWED FOR HEALTH CARE SERVICES PROVIDED BY SHC TRI-VALLEY. ALL PATIENT ACCOUNT BALANCES THAT MEET SHC TRI-VALLEY CRITERIA FOR ASSIGNMENT TO BAD DEBT ACCORDING TO THE DEBT COLLECTION POLICY ARE ELIGIBLE FOR PLACEMENT WITH A COLLECTION AGENCY. HOWEVER, SHC TRI-VALLEY DOES NOT CURRENTLY ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIVITY (ECA). PER SHC TRI-VALLEY POLICY, ECA IS DEFINED TO INCLUDE PLACING LIENS ON INDIVIDUAL PROPERTY, FORECLOSING CAUSING ON REAL PROPERTY, COMMENCING A CIVIL ACTION AGAINST AN ARREST, GARNISHING WAGES, REPORTING ADVERSE INFORMATION TO A CREDIT AGENCY, DEFERRING OR DENYING MEDICALLY NECESSARY CARE, REQUIRING PAYMENT BEFORE PROVIDING MEDICALLY NECESSARY CARE BECAUSE OF OUTSTANDING BILLS, AND SALE OF DEBT TO A THIRD PARTY.

PART I, LINE 6A:
UNDER STATE LAW SB 697, THE STATE OF CALIFORNIA REQUIRES ALL NON-PROFIT HOSPITALS IN CALIFORNIA TO COMPLETE AND SUBMIT AN ANNUAL COMMUNITY BENEFIT REPORT. ALTHOUGH HOSPITALS BRING NUMEROUS BENEFITS TO THEIR LOCAL ECONOMIES, THESE REPORTS ARE INTENDED TO DOCUMENT THE WAYS IN WHICH EACH HOSPITAL GOES ABOVE AND BEYOND THE CORE FUNCTIONS OF A HOSPITAL TO SUPPORT THE HEALTH NEEDS OF ITS COMMUNITY.

PART I, LINE 7:
RATIO OF PATIENT CARE COST TO CHARGES WAS USED TO CALCULATE THE AMOUNTS INCLUDED IN THE TABLE AT SCHEDULE H, PART I, LINES 7A AND 7B. AMOUNTS INCLUDED IN OTHER LINES WERE BASED ON SHC TRI-VALLEY'S COST ACCOUNTING INFORMATION, INCLUDING AVERAGE HOURLY WAGES FOR STAFF TIME DEVOTED TO SPECIFIC PROGRAMS, AVERAGE COST OF SPACE USED BY COMMUNITY HEALTH PROGRAMS, INDIRECT COST FACTORS, AND RELATED INFORMATION.

PART II, LINE 8:
THE FOLLOWING PROGRAMS ADDRESS COMMUNITY WIDE WORKFORCE ISSUES. THESE PROGRAMS STRENGTHEN THE COMMUNITIES' CAPACITY TO PROMOTE THE HEALTH AND WELL-BEING OF ITS RESIDENCES BY OFFERING THE EXPERTISE AND RESOURCES OF SHC TRI-VALLEY. SPECIALIZED HEALTH CARE WORKFORCE TRAINING SHC TRI-VALLEY PROVIDED CLINICAL EXPERIENCE AND PRECEPTORS FOR GRADUATE NURSING STUDENTS. STUDENTS RECEIVED EXPOSURE TO AND EXPERIENCE IN THE POSITIONS OF NURSE PRACTITIONER, NURSING ADMINISTRATION, AND CLINICAL NURSE SPECIALIST. SHC TRI-VALLEY REGISTERED NURSES IN MULTIPLE NURSING UNITS, INCLUDING MEDICAL/SURGICAL AND INTENSIVE CARE UNITS, PROVIDED DIRECT SUPERVISION IN A CLINICAL ENVIRONMENT TO STUDENT NURSES CONNECTED WITH CHABOT COLLEGE, OHLONE COLLEGE, CAPELLA UNIVERSITY, CSU EAST BAY, WALTON AND SMU. APPROXIMATELY 96 STUDENTS PARTICIPATED DURING THE REPORTING PERIOD. SHC TRI-VALLEY PROVIDED SURGICAL TECHNOLOGY (ST) TRAINING FOR STUDENTS IN THE OPERATING ROOM, SUPERVISED BY A SURGICAL TECHNOLOGIST AND REGISTERED NURSES. 1 STUDENT PARTICIPATED DURING THE REPORTING PERIOD. SHC TRI-VALLEY PROVIDED EDUCATION FOR 9 STUDENTS FROM LAS POSITAS COLLEGE AND CALIFORNIA STATE UNIVERSITY SACRAMENTO WHO WERE TRAINING TO BECOME PARAMEDICS. THROUGHOUT THE YEAR, SHC TRI-VALLEY HOSTED COLLEGE STUDENT INTERNS IN PHYSICAL AND OCCUPATIONAL THERAPY IN VARYING AFFILIATION PERIODS. STUDENTS RECEIVED ON-THE-JOB INSTRUCTION AND HANDS-ON TREATMENT SKILLS IN THE INPATIENT AND/OR OUTPATIENT SETTING IN ORDER TO MEET THE REQUIREMENTS FOR THEIR DEGREES AND LICENSURE. DURING FY22, SHC TRI-VALLEY HOSTED FOUR (4) STUDENTS FROM CRISTO REY DE LA SALLE - A RIGOROUS AND PERSONALIZED COLLEGE PREPARATORY CURRICULUM INTEGRATED WITH A CORPORATE WORK STUDY EXPERIENCE PREPARES HIGH SCHOOL STUDENTS OF LIMITED ECONOMIC MEANS TO SUCCEED IN COLLEGE AND IN LIFE. STUDENTS COMPLETED A REMOTE HIGH SCHOOL WORK STUDY PROGRAM WHERE THEY IMPROVED THEIR PRESENTATION SKILLS AND LEARNED HOW TO PROPERLY SOURCE THEIR FINDINGS.

PART III, LINE 2:
PROVISION FOR DOUBTFUL ACCOUNTS OR BAD DEBT EXPENSE ON THE INCOME STATEMENT FOR FISCAL YEAR 2022 WAS $25,021,021, WHICH IS AT CHARGES. BAD DEBT IS BASED ON REMAINING ACCOUNT BALANCE AFTER ANY DISCOUNTS OR PAYMENTS HAVE BEEN APPLIED. SHC TRI-VALLEY DOES NOT RECLASSIFY ANY BAD DEBT TO CHARITY UNLESS THE PATIENT QUALIFIES UNDER THE CHARITY CARE POLICY. A COST TO CHARGE RATIO WAS USED TO DETERMINE COST.

PART III, LINE 3:
SHC TRI-VALLEY DOES NOT CALCULATE THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.

PART III, LINE 4:
THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL EXPERIENCE AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.

PART III, LINE 8:
THE MEDICARE SHORTFALL OF $70,410,308 REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT. SHC TRI-VALLEY BELIEVES THIS MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE: 1. ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER MEANS-BASED GOVERNMENT PROGRAMS, 2. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS, 3. THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION ON REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUAL, AND 4. THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE OR OTHER COMMUNITY BENEFIT NEEDS.

PART III, LINE 9B:
IT IS THE POLICY OF SHC TRI-VALLEY TO FOLLOW THE STANDARDS AND PRACTICES FOR COLLECTION OF PATIENT DEBT IN ACCORDANCE WITH THE REQUIREMENTS OF CALIFORNIA ASSEMBLY BILL 774. SHC TRI-VALLEY HAS A VARIETY OF OPTIONS FOR PATIENTS FACING FINANCIAL HARDSHIP, INCLUDING UNINSURED DISCOUNTING, NO INTEREST PAYMENT ARRANGEMENTS, AND A CHARITY CARE PROGRAM. PATIENTS WHO APPLY FOR CHARITY CARE AND QUALIFY MAY RECEIVE UP TO 100% FINANCIAL ASSISTANCE. SHC TRI-VALLEY WILL SUSPEND ANY AND ALL COLLECTION ACTIONS IF A COMPLETED FINANCIAL ASSISTANCE APPLICATION, INCLUDING ALL REQUISITE SUPPORTING DOCUMENTATION, IS RECEIVED. SHC TRI-VALLEY DOES NOT ALLOW THEIR COLLECTION AGENCIES TO REPORT DEBT TO CREDIT BUREAUS, GARNISH WAGES, OR FILE LIENS ON PRIMARY RESIDENCES.

PART VI, LINE 2:
IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, SHC TRI-VALLEY ASSESSES COMMUNITY HEALTH NEEDS BY ANALYZING UTILIZATION AND OTHER ADMINISTRATIVE DATA AND BY RECEIVING REGULAR INPUT FROM ITS INDEPENDENT BOARD OF DIRECTORS AND ITS MEDICAL STAFF REGARDING HEALTH ISSUES IN THE COMMUNITY.

PART VI, LINE 7:
LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: CA

PART VI, LINE 3:
SHC TRI-VALLEY INTERVIEWS EACH PATIENT/GUARANTOR AND DETERMINE THE CAPABILITY TO MEET HIS/HER FINANCIAL OBLIGATIONS FOR MEDICAL CARE SERVICES PROVIDED BY SHC TRI-VALLEY. THOSE WHO DETERMINED TO BE UNABLE TO MEET THE FINANCIAL OBLIGATION ARE SCREENED FOR POSSIBLE ELIGIBILITY UNDER STATE OR FEDERAL HEALTHCARE PROGRAMS. INDIVIDUALS INELIGIBLE FOR THESE PROGRAMS ARE INTERVIEWED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, AS DEFINED IN THE FINANCIAL ASSISTANCE/CHARITY CARE POLICY. SHC TRI-VALLEY ALSO PROVIDES DEDICATED RESOURCES TO PATIENTS THAT APPLY FOR CHARITY CARE AND PROACTIVELY CONDUCTS OUTREACH TO PATIENTS TO INFORM THEM OF THE PROGRAM'S AVAILABILITY AND THEIR POTENTIAL ELIGIBILITY FOR ASSISTANCE. BROCHURES AND SIGNAGE ARE CONSPICUOUSLY DISPLAYED AT ALL CARE DELIVERY LOCATIONS WITH INSTRUCTION ON WHERE TO LOCATE ADDITIONAL INFORMATION ON ELIGIBILITY FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE APPLICATIONS, AND INSTRUCTIONS ON HOW TO APPLY ARE ALSO AVAILABLE ON THE SHC TRI-VALLEY WEBSITE, VIA MAIL, MYHEALTH (SHC TRI-VALLEY'S ONLINE PATIENT BILLING PLATFORM), ON THE BACK OF ALL PATIENT STATEMENTS, AND IN ALL SHC TRI-VALLEY CARE DELIVERY LOCATIONS.

PART VI, LINE 4:
SHC TRI-VALLEY'S PRIMARY SERVICE AREA IS THE TRI-VALLEY. THE TRI-VALLEY ENCOMPASSES THE SUBURBAN CITIES OF LIVERMORE, PLEASANTON, DUBLIN, AND SAN RAMON IN THE THREE VALLEYS FROM WHICH IT TAKES ITS NAME: AMADOR VALLEY, LIVERMORE VALLEY, AND SAN RAMON VALLEY. DUBLIN, LIVERMORE, AND PLEASANTON ARE IN ALAMEDA COUNTY, AND DANVILLE AND SAN RAMON ARE IN CONTRA COSTA COUNTY. SHC TRI-VALLEY OPERATES FACILITIES IN DUBLIN, LIVERMORE, AND PLEASANTON. THE TRI-VALLEY ACCOUNTS FOR THE MAJORITY OF SHC TRI-VALLEY'S INPATIENT DISCHARGES. THE U.S. CENSUS ESTIMATES A POPULATION OF ABOUT 379,000 IN THE TRI-VALLEY. THE AREA IS HIGHLY DIVERSE: THE TWO LARGEST ETHNIC SUBPOPULATIONS ARE WHITE AND ASIAN (51 % AND 28%, RESPECTIVELY). THE NON-WHITE POPULATION ACCOUNTS FOR 49% OF THE POPULATION IN THE TRI-VALLEY AREA.

PART VI, LINE 5:
SHC TRI-VALLEY HAS PROVIDED HIGH-QUALITY, NOT-FOR-PROFIT HEALTH CARE TO THE TRI-VALLEY AND SURROUNDING COMMUNITIES SINCE 1961. THROUGH HIGHLY SKILLED PHYSICIANS, NURSES AND STAFF AND STATE-OF-THE ART TECHNOLOGY, SHC TRI-VALLEY OFFERS A WIDE RANGE OF HEALTH CARE SERVICES AT ITS LIVERMORE, PLEASANTON AND DUBLIN MEDICAL FACILITIES. SHC TRI-VALLEY IS NOT PUBLICLY OWNED OR OPERATED, NOR IS IT SUPPORTED BY TAXES. SHC TRI-VALLEY REINVESTS ANY PROFITS IT MAKES INTO NEW SERVICES, EQUIPMENT AND FACILITIES. SHC TRI-VALLEY HAS AN 11-MEMBER BOARD OF DIRECTORS. EVERY THREE YEARS, NON-PROFIT HOSPITALS IN CALIFORNIA MUST CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY THE GREATEST HEALTH NEEDS AFFECTING THEIR RESPECTIVE COMMUNITIES. THE COMMUNITY BENEFITS REPORT CAN BE FOUND ON OUR WEBSITE AT: ABOUT US: COMMUNITY BENEFITS : STANFORD HEALTH CARE HTTPS://WWW.STANFORDHEALTHCARE.ORG/TRI-VALLEY/ABOUT-US/COMMUNITY- BENEFITS.HTML THE FOLLOWING PROGRAMS AND SERVICES FURTHER THE ORGANIZATION'S EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY: PLEASANTON CAMPUS: SHC TRI-VALLEY CAMPUS IN PLEASANTON, WHICH OPENED IN DECEMBER 1991, IS AN ACUTE CARE COMMUNITY HOSPITAL WITH APPROXIMATELY 114,000 SQUARE FEET OF SPACE THAT PROVIDES A COMPREHENSIVE RANGE OF MEDICAL AND SURGICAL INPATIENT AND OUTPATIENT ACUTE SERVICES, INCLUDING AN OUTPATIENT SURGICAL CENTER, A DIAGNOSTIC IMAGING CENTER INCLUDING COMPUTERIZED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING AND A WOMEN'S CENTER (MAMMOGRAPHY), CARDIAC CARE, EMERGENCY ROOM, INTENSIVE CARE, OBSTETRICS, PEDIATRICS AND OPERATING AND RECOVERY ROOMS. THE CURRENT LICENSED BED CAPACITY IS 167 ACUTE CARE BEDS (1 BED IS CURRENTLY IN SUSPENSION), INCLUDING 116 MEDICAL/SURGICAL ACUTE CARE, 15 PERINATAL, 22 CRITICAL CARE, 4 PEDIATRIC, AND 10 INTENSIVE CARE NURSERY BEDS. LIVERMORE CAMPUS: SHC TRI-VALLEY'S CAMPUS, IN LIVERMORE IS AN ACUTE CARE COMMUNITY HOSPITAL WITH APPROXIMATELY 125,000 SQUARE FEET OF SPACE. THE CURRENT LICENSED BED CAPACITY IS 75 BEDS IN TOTAL - 35 GENERAL ACUTE CARE, 14 ACUTE PSYCHIATRIC, AND 26 SKILLED NURSING (ALL 75 BEDS ARE CURRENTLY IN SUSPENSION). ADDITIONAL SERVICES AT VALLEY MEMORIAL HOSPITAL INCLUDE URGENT CARE, LABORATORY, DIAGNOSTIC IMAGING (ULTRASOUND, MAMMOGRAPHY, BONE DENSITOMETRY) AND RADIOLOGY.

PART VI, LINE 6:
IN MAY 2015, THE COMPANY (NOW SHC TRI-VALLEY) BECAME AN AFFILIATE OF STANFORD HEALTH CARE (SHC). SHC TRI-VALLEY PARTNERS WITH SHC TO SERVE THE EAST BAY'S TRI-VALLEY REGION IN THE CITIES OF LIVERMORE, DUBLIN, PLEASANTON AND SAN RAMON. SHC TRI-VALLEY ALLOWS SHC TO EXPAND ITS PRESENCE IN THE CRITICAL TRI-VALLEY AREA BY PARTNERING WITH A HIGH QUALITY, HIGH VALUE COMMUNITY HOSPITAL. SHC TRI-VALLEY WILL PARTICIPATE IN ALL THREE OF SHC'S MISSIONS BY PROVIDING SHC'S LEADING EDGE CLINICAL CARE IN THE SHC TRI-VALLEY COMMUNITY, TRAINING FUTURE MEDICAL LEADERS THROUGH RESIDENCY ROTATIONS AND OTHER ACADEMIC PURSUITS, AND PROVIDING THE TRI-VALLEY AREA INCREASED ACCESS TO CLINICAL TRIALS FOR LIFE-SAVING TREATMENTS. IN ADDITION, SHC'S GROWING EXPERTISE IN POPULATION AND PRECISION HEALTH WILL BE LEVERAGED TO SERVE THIS COMMUNITY.