2023-11-01T13:55:39-05:00 2022-12-31 135565207 KPMG LLP MISSION TOWERS I 3975 FREEDOM CIRCLE DR SANTA CLARA CA 95054 990 2022-01-01 911788973 JOHN MUIRMT DIABLO COMMUNITY HEALTH FUND JOHN 9259413100 5003 COMMERCIAL CIRCLE 275 CONCORD CA 94520 GAIL CRISTANCHO CHAIR 9259413100 2023-10-27 1 GAIL CRISTANCHO XXX-XX-XXXX 0 CAREY MCKEE P01281067 4083675764 2023-10-30 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z LILLIAN ROSELIN 5003 COMMERCIAL CIRCLE 275 CONCORD CA 94520 1470344 0 X WWW.JOHNMUIRHEALTH.COM/CHF X 1998 CA THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND ("CHF") IS A TAX EXEMPT 501(C)(3) SUPPORTING ORGANIZATION TO JOHN MUIR HEALTH ("JMH") FOCUSING ON POPULATIONS WHO ARE UNINSURED OR UNDER-INSURED AND MOST LIKELY TO EXPERIENCE DISPARITIES IN HEALTH CARE. 10 10 2 10 0 0 1334193 1470344 0 0 0 0 0 0 1334193 1470344 1030216 1006110 0 0 317663 346988 0 0 0 27501 117246 1375380 1470344 -41187 0 102411 336661 0 234250 102411 102411 X THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND SUPPORTS HEALTH INITIATIVES THAT ADDRESS CURRENT AND EMERGING HEALTH CARE NEEDS. TO DO SO, WE DISTRIBUTE GRANTS TO AND PARTNER WITH THE LEADERS OF THESE INITIATIVES: COMMUNITY-BASED, NONPROFIT (CONTINUED ON SCHEDULE O) 0 0 1395877 1006110 0 THE JOHN MUIR COMMUNITY HEALTH FUND IS THE COMMUNITY BENEFIT GRANTMAKING ARM OF JOHN MUIR HEALTH. OUR GRANTS FOSTER SYSTEMATIC CHANGES IN HOW HEALTH CARE SERVICES ARE PROVIDED TO IMPROVE THE HEALTH OF PEOPLE IN CENTRAL AND EAST CONTRA COSTA COUNTY. OUR GRANTS FOCUS ON POPULATIONS WHO ARE UN- OR UNDER-INSURED, HAVE LIMITED ACCESS TO HEALTH CARE, ARE MOST AT-RISK FOR POOR HEALTH, AND ARE MOST LIKELY TO EXPERIENCE HEALTH CARE DISPARITIES. OUR FUNDING PROCESS NURTURES LONG-TERM PARTNERSHIPS WITH AND AMONG COMMUNITY-BASED HEALTH CARE ORGANIZATIONS, LEADING TO VISIONARY HEALTH INITIATIVES THAT BUILD AND SUSTAIN THE CAPACITY TO DELIVER ON THE PROMISE OF GOOD HEALTH AND AFFORDABLE HEALTH CARE FOR ALL. 1395877 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 2 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 0 0 CA X X LILLIAN ROSELIN 9259413100 5003 COMMERCIAL CIRCLE STE 275 CONCORD CA 94520 ARTHUR SHINGLETON VICE CHAIR 5.00 0.00 X X 0 0 0 ERNESTO AVILA TREASURER 5.00 0.00 X X 0 0 0 GAIL CRISTANCHO CHAIR 5.00 0.00 X X 0 0 0 TASHA JOHNSON SECRETARY 5.00 0.00 X X 0 0 0 AN VU PHD DIRECTOR 5.00 0.00 X 0 0 0 CAROLYN FONG RN NP PHD DIRECTOR 5.00 0.00 X 0 0 0 MATTHEW RINN DIRECTOR 5.00 0.00 X 0 0 0 NIKO ANAGNOSTOPOULOS DIRECTOR 5.00 0.00 X 0 0 0 RAYMOND BARBOUR DIRECTOR 5.00 0.00 X 0 0 0 RUJA MANGHANI MD DIRECTOR 5.00 0.00 X 0 0 0 LILLIAN ROSELIN EXECUTIVE DIRECTOR 40.00 0.00 X 161340 0 43924 161340 0 43924 1 0 1 0 0 1470344 1470344 1470344 0 0 0 1006110 1006110 161340 145206 16134 102774 92497 10277 19072 17165 1907 44175 39757 4418 19627 17664 1963 1057 1057 92802 54250 38552 3347 3347 5959 5959 WRITING & COMMUNICATION 9322 9322 TRAINING 3042 3042 DUES & SUBSCRIPTIONS 1016 0 1016 OTHER EXPENSES 501 501 200 200 1470344 1395877 74467 0 5360 237846 0 0 97051 98815 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102411 336661 0 234250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 234250 X 0 0 102411 102411 102411 102411 102411 336661 0 0 X 0 1 X 1 0 X X 1 JOHN MUIR HEALTH 941461843 3 1 0 1470344 1 0 1470344 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 X 1 1 PART-I LINE-12G SCH A, PART I, LINE 12G, COLUMN VI JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND (CHF) DIRECTLY PERFORMS ONE OF JOHN MUIR HEALTH'S MOST IMPORTANT COMMUNITY BENEFIT FUNCTIONS WHICH IS TO CREATE SUSTAINABLE HEALTH INITIATIVES THAT EXPAND AND ENHANCE HEALTH CARE SERVICES FOR UNINSURED AND UNDERSERVED POPULATIONS. BUT FOR THE INVOLVEMENT OF CHF, THESE ACTIVITIES WOULD NORMALLY BE ENGAGED IN BY JOHN MUIR HEALTH. CHF PROVIDES DIRECT SERVICES TO JOHN MUIR HEALTH TOTALING $1,395,877. IN ADDITION, CHF AWARDS AND MONITORS COMMUNITY GRANTS THAT DELIVER CRITICAL HEALTH CARE SERVICES, SUPPORTING THE JOHN MUIR HEALTH MISSION. SEE SCHEDULE O FOR ADDITIONAL DETAIL REGARDING THESE PROGRAMS. PART-IV, SECTION A LINE 6 SUPPORT PROVIDED TO OTHER THAN SUPPORTED ORGANIZATIONS GRANTS PROVIDED TO OTHER ORGANIZATIONS MUST ALIGN WITH JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND AND JOHN MUIR HEALTH'S MISSIONS. FUNDS ARE USED CONSISTENT WITH THE 501(C)(3) PURPOSES AS DESCRIBED IN SECTION 170(C)(2)(B). PART-IV LINE-SECTION D LINE 2 ORGANIZATION'S OFFICERS, DIRECTORS OR TRUSTEES THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND BYLAWS SPECIFY THAT ITS BOARD OF DIRECTORS CONSISTS OF TEN (10) MEMBERS, WITH FIVE (5) APPPOINTED BY JOHN MUIR ASSOCIATION, THREE (3) APPOINTED BY THE CONCORD/PLEASANT HILL HEALTH CARE DISTRICT, AND TWO (2) APPOINTED BY THE CITY OF PLEASANT HILL. PART-IV, LINE-SECTION D, LINE 2 LEADERSHIP TEAMS CHF AND JMH LEADERSHIP TEAMS COMMUNICATE ON A REGULAR BASIS. THE CHF EXECUTIVE DIRECTOR SUBMITS THE CHF BOARD APPROVED ANNUAL BUDGET TO JMH'S CFO FOR JMH BOARD APPROVAL. TO KEEP JOHN MUIR HEALTH LEADERS APPRISED OF THE CHF'S GRANTMAKING ACTIVITIES, THE CHF EXECUTIVE DIRECTOR MEETS QUARTERLY WITH JOHN MUIR HEALTH'S COMMUNITY IMPROVEMENT DIRECTOR AND GOVERNANCE & COMMUNITY AFFAIRS MANAGER . JOHN MUIR SENIOR LEADERSHIP IS NOTIFIED VIA EMAIL AS GRANTS ARE APPROVED THROUGHOUT THE YEAR. ACCURATE REPORTING OF THE CHF'S CONTRIBUTIONS ARE HIGHLIGHTED IN JMH'S ANNUAL COMMUNITY BENEFIT REPORT. CHF STAFF WORKS WITH JMH FINANCE TO COMPLETE AND FILE THE CHF'S ANNUAL TAX RETURN. PART-IV LINE-SECTION E LINE 2A SUPPORTED ORGANIZATIONS THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND CARRIES OUT A UNIQUE COMMUNITY BENEFIT FUNCTION FOR JOHN MUIR HEALTH: DISTRIBUTING GRANTS TO NONPROFIT ORGANIZATIONS WORKING TO IMPROVE THE HEALTH AND WELL-BEING OF MEDICALLY UNINSURED, UNDERINSURED, UNDERSERVED, AND VULNERABLE POPULATIONS MOST AT-RISK FOR POOR HEALTH IN CENTRAL AND EAST CONTRA COSTA COUNTY. OUR GOVERNING BOARD'S MISSION IS TO CREATE LASTING HEALTH AND HEALTH CARE IMPROVEMENTS FOR THESE INDIVIDUALS AND COMMUNITIES. OUR MOST VALUABLE CONTRIBUTION HAS BEEN FOSTERING THE START-UP AND EXPANSION OF PROGRAMS AND SERVICES THAT ACHIEVE THIS MISSION. THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND SUPPORTS HEALTH INITIATIVES THAT SUSTAINABLY ADDRESS CURRENT AND EMERGING HEALTH CARE NEEDS. TO DO SO, THE CHF DISTRIBUTES GRANTS TO AND PARTNERS WITH COMMUNITY-BASED, NONPROFIT ORGANIZATIONS THAT PROVIDE HIGH QUALITY, AFFORDABLE PRIMARY, SPECIALTY, DENTAL, AND BEHAVIORAL HEALTH CARE OR ANCILLARY WELLNESS AND SUPPORT SERVICES THAT CONTRIBUTE TO GOOD HEALTH. PART-IV LINE-SECTION E LINE 2B SUPPORTED ORGANIZATION ACTIVITIES JOHN MUIR HEALTH MAKES ITS COMMUNITY BENEFIT CONTRIBUTIONS THROUGH THREE AVENUES: THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND, COMMUNITY HEALTH IMPROVEMENT, AND ITS PATIENT FINANCIAL ASSISTANCE PROGRAM. THIS APPROACH EXTENDS JOHN MUIR HEALTH'S REACH BY SUPPORTING COMMUNITY-BASED ORGANIZATIONS AND FIRMLY CONNECTS OUR HOSPITAL AND CLINICAL EXPERTISE TO COMMUNITY PROGRAMS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 X 1470344 0 1470344 0 1470344 1470344 0 1470344 0 1470344 PART X, LINE 2: UNCERTAIN TAX POSITIONS THE HEALTH SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED USING THE LARGEST AMOUNT THAT EXCEEDS A 50% PROBABILITY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN ESTIMATE OCCURS. 1 OPPORTUNITY JUNCTION 3102 DELTA FAIR BLVD ANTIOCH CA 94509 680459131 501 (C)(3) 140000 0 N/A N/A HCP IMPLEMENTATION LA CLINICA DE LA RAZA PO BOX 22210 OAKLAND CA 94623 941744108 501 (C)(3) 176610 0 N/A N/A VET HLTH NAV/MENTAL HLTH STIGMA INIT LOAVES AND FISHES OF CONTRA COSTA 835 FERRY STREET MARTINEZ CA 94553 680018077 501 (C)(3) 153025 0 N/A N/A MEAL DELIVERY IMPLEMENTATION BAY AREA COMMUNITY RESOURCES 171 CARLOS DRIVE SAN RAFAEL CA 94903 942346815 501 (C)(3) 21975 0 N/A N/A MEAL DELIVERY IMPLEMENTATION MINDFUL LIFE PROJECT 1001 CANAL BLVD SUITE A RICHMOND CA 94804 475066819 501 (C)(3) 71500 0 N/A N/A COCO EXPANSION/EQUITY RETREAT STIPEND VILLAGE KEEPERS INC 2024 VILLA DRIVE APT 106 BAY POINT CA 94565 800362057 501 (C)(3) 150000 0 N/A N/A PLAN & IMPLEM AFR AMER FAM WELLNESS CNTR JOHN MUIR LAND TRUST PO BOX 31 MARTINEZ CA 94553 680194652 501 (C)(3) 50000 0 N/A N/A FAMILY HARVEST FARM IMPLEM HIJAS DEL CAMPO 18 OAK STREET PO BOX 1780 BRENTWOOD CA 94513 863224204 501 (C)(3) 169000 0 N/A N/A PLAN & IMPLEM MIGRANT/SEASONAL FARMWRKR RAINBOW COMMUNITY CENTER 2380 SALVIO STREET SUITE 301 CONCORD CA 94520 680375857 501 (C)(3) 40000 0 N/A N/A STRATEGIC PLANNING CONTRA COSTA CRISIS CENTER 307 LENNON LANE WALNUT CREEK CA 94598 941747227 501 (C)(3) 15000 0 N/A N/A PLANNING PEOPLE WHO CARE 2231 RAILROAD AVENUE PITTSBURG CA 94565 161634099 501 (C)(3) 6250 0 N/A N/A ROUNDTABLE/EQUITY RETREAT STIPENDS 11 0 PART I, LINE 2: THE COMMUNITY HEALTH FUND (CHF) HAS ESTABLISHED PROCEDURES FOR MONITORING THE PERFORMANCE OF FUNDED ORGANIZATIONS. THIS INCLUDES REQUIRING WRITTEN REPORTS DESCRIBING PROGRAM ACHIEVEMENTS AS WELL AS BUDGET REPORTS ON THE USE OF GRANT FUNDS. IN ADDITION, STAFF AND BOARD MEMBERS FROM CHF MEET FACE TO FACE WITH STAFF AND BOARD MEMBERS FROM FUNDED ORGANIZATIONS AT LEAST TWICE A YEAR. THESE MEETINGS FACILITATE THE DISCUSSION OF PROGRESS ACHIEVED IN ACCOMPLISHING GOALS AND IMPLEMENTING PLANS FOR SUSTAINING THE FUNDED PROGRAMS. THERE IS A GRANT FILE FOR EACH GRANT RECIPIENT WHICH CONTAINS A PROPOSAL, FINANCIAL STATEMENTS, 501(C)(3) DOCUMENTATION, GRANT AWARD LETTER, MID & YEAR END NARRATIVE PROGRAM REPORTS, BUDGET COMPARISON REPORTS AND OTHER MATERIALS THAT DOCUMENT THE CHARITABLE USE OF CHF FUNDS. X X X 0 0 0 0 0 0 0 0 0 LILLIAN ROSELIN EXECUTIVE DIRECTOR 149455 0 7387 0 4498 0 28346 0 15578 0 205264 0 7387 0 FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: ORGANIZATIONS THAT PROVIDE EITHER HIGH QUALITY, AFFORDABLE PRIMARY, SPECIALITY, DENTAL AND BEHAVIORAL HEALTH CARE OR INNOVATIVE WELLNESS AND SUPPORT PROGRAMS THAT CONTRIBUTE TO GOOD HEALTH. FORM 990, PART V, LINE 2A: COMMON PAYMASTER THE FORM 1096 AND RELATED FORM 1099'S, FORM W-3 AND RELATED FORM W-2'S ARE ISSUED BY JOHN MUIR HEALTH UNDER EIN 94-1461843. JOHN MUIR HEALTH IS THE SOLE CORPORATE MEMBER AND SUPPORTED ORGANIZATION OF JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS JOHN MUIR HEALTH IS THE SOLE CORPORATE MEMBER OF JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT OR APPOINT MEMBERS OF GOVERNING BODIES THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND BYLAWS SPECIFY THAT ITS BOARD OF DIRECTORS CONSISTS OF TEN (10) MEMBERS, WITH FIVE (5) APPOINTED BY JOHN MUIR ASSOCIATION, THREE (3) APPOINTED BY THE CONCORD/PLEASANT HILL HEALTH CARE DISTRICT, AND TWO (2) APPOINTED BY THE CITY OF PLEASANT HILL. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS SUBJECT TO APPROVAL BY THE MEMBER THE MEMBER SHALL HAVE THE RIGHT TO APPROVE ANY MERGER AND ITS PRINCIPAL TERMS AND ANY AMENDMENT OF THOSE TERMS, AND APPROVE ANY ELECTION TO DISSOLVE THE CORPORATION. IN ADDITION, THE MEMBER SHALL APPROVE ANY AMENDMENTS TO THE ARTICLES OR THESE BYLAWS OF JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND. 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 AND INCORPORATED INTO THE FORM 990 AS APPROPRIATE. AFTER ALL OF THE INPUT FROM THE BOARD OF DIRECTORS HAS BEEN APPROPRIATELY ADDRESSED, SENIOR MANAGEMENT OF THE JOHN MUIR/MT. DIABLO COMMUNITY HEALTH FUND WILL FILE THE FINAL FORM 990 AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTERERST POLICY THE BOARD HAS APPROVED CONFLICT OF INTEREST POLICIES AND PROCEDURES. BOARD MEMBERS FILE ANNUAL STATEMENTS WHICH REQUIRE THEM TO IDENTIFY ANY CONFLICTS. THE BOARD REGULARLY ENFORCES THE POLICIES. FORM 990, PART VI, SECTION B, LINE 15A EXECUTIVE COMPENSATION THE BOARD HAS ESTABLISHED POLICIES AND PROCEDURES FOR EVALUATING THE EXECUTIVE DIRECTOR, SETTING THE COMPENSATION AND ASSESSING COMPARABLE SALARIES LOCALLY. THE COMPENSATION COMMITTEE'S EXECUTIVE DIRECTOR EVALUATION REPORT IS REVIEWED BY THE BOARD AND DELIBERATIONS ARE DOCUMENTED AND FINAL DECISION REGARDING COMPENSATION ARE RECORDED IN MINUTES OF A BOARD MEETING. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. JOHN MUIR HEALTH FOUNDATION 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 942650855 FUNDRAISING CA 7 501(C)(3) JM HEALTH 1 JOHN MUIR BEHAVIORAL HEALTH 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 680249685 HEALTHCARE CA 3 501(C)(3) JM HEALTH 1 JOHN MUIR PHYSICIAN NETWORK 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 680360801 CLINIC SRVS CA 12A, III-FI 501(C)(3) JM HEALTH 1 JOHN MUIR HEALTH 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 941461843 HEALTHCARE CA 3 501(C)(3) N/A 0 JOHN MUIR MAGNETIC IMAGING 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 680202020 DIAG IMAGING CA N/A 0 0 BAY AREA SURGICAL VENTURES 30 S WACKER DRIVE SUITE 2302 CHICAGO IL 60606 203052802 MED SERVICES CA N/A 0 0 WALNUT CREEK CANCER CENTER 1400 TREAT BOULEVARD WALNUT CREEK CA 94597 941461843 CA N/A 0 0 JOHN MUIRMT DIABLO PARENT COMPANY 1400 TREAT BLVD WALNUT CREEK CA 94597 900060434 INACTIVE CA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 JOHN MUIR HEALTH C 1470344 CASH RECEIVED