TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) DAVID ENTWISTLE...................................................................... DIRECTOR	4.25 ................. 52.4	X				0	4,854,308	409,571
(2) QUINN MCKENNA...................................................................... DIRECTOR	3.0 ................. 51.2	X				0	2,552,399	226,537
(3) LINDA HOFF...................................................................... DIRECTOR	3.25 ................. 51.4	X				0	1,752,900	175,403
(4) RICHARD SHUMWAY...................................................................... PRESIDENT/CEO	49.6 ................. 20.4		X			922,060	0	275,433
(5) AARON SALYAPONGSE...................................................................... DIRECTOR	1.6 ................. 0.0	X				0	849,385	44,752
(6) RON DALMAN...................................................................... DIRECTOR	1.6 ................. 0.2	X				0	809,939	74,976
(7) DAVID SVEC MD...................................................................... CMO	1.6 ................. 48.4			X		0	542,128	67,865
(8) TOPHER SHARP...................................................................... DIRECTOR	1.6 ................. 0.2	X				0	505,550	74,865
(9) TRACEY LEWIS TAYLOR...................................................................... COO	50.0 ................. 0.0		X			521,343	0	35,769
(10) KYLE WICHELMANN...................................................................... CFO	50.0 ................. 0.4		X			500,640	0	35,501
(11) JENNIFER SAAVEDRA...................................................................... REGISTERED NURSE II	50.0 ................. 0.0				X	374,337	0	38,987
(12) MONICA DAVILA...................................................................... CNO	50.0 ................. 0.0			X		358,224	0	47,395
(13) MANOJ SASTRY...................................................................... VP SRVC & MKT DEVEL	50.0 ................. 0.0				X	357,524	0	42,666
(14) THERESA KULLMAN...................................................................... SR DIRECTOR COMPLIANCE & LEGAL	50.0 ................. 0.0				X	329,838	0	47,107
(15) JAMIE WELSH...................................................................... VP HR	50.0 ................. 0.0				X	349,225	0	23,298
(16) JUSTIN DIMAYA...................................................................... REGISTERED NURSE II	50.0 ................. 0.0				X	336,764	0	26,071
(17) JOHN YEE MD...................................................................... VP CLINICAL INITIATIVES	50.0 ................. 0.0			X		332,806	0	29,683

(A) Name and business address	(B) Description of services	(C) Compensation
SODEXO INC AFFILIATES, PO BOX 360170 PITTSBURGH,PA152516170	HOSPITALITY SERVICES	4,667,219
AYA HEALTHCARE INC, DEPT 3519 PO BOX 123519 DALLAS,TX753123519	PATIENT CARE SERVICE	4,656,753
HERRERO BUILDERS INCORPORATED, 2100 OAKDALE AVENUE SAN FRANCISCO,CA94124	CONSTRUCTION SERVICE	4,586,186
TOTAL RENAL CARE INC, PO BOX 781607 PHILADELPHIA,PA191781607	PATIENT CARE SERVICE	1,278,166
FLEXCARE LLC, PO BOX 203684 DALLAS,TX753203684	PATIENT CARE SERVICE	1,256,090
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 53

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

STANFORD HEALTH CARE TRI-VALLEY

Employer identification number

94-1429628

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

STANFORD HEALTH CARE TRI-VALLEY

Employer identification number

94-1429628

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization STANFORD HEALTH CARE TRI-VALLEY

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization STANFORD HEALTH CARE TRI-VALLEY		Employer identification number 94-1429628

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization STANFORD HEALTH CARE TRI-VALLEY			Employer identification number 94-1429628
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

STANFORD HEALTH CARE TRI-VALLEY

Employer identification number

94-1429628

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

64,496

Total. Add lines 1c through 1i ....................................................................................................

64,496

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1	LOBBYING ACTIVITIES: SHC TRI-VALLEY BELONGS TO THE CALIFORNIA HOSPITAL ASSOCIATION/HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIFORNIA IN WHICH A PORTION OF DUES PAID TO THESE ORGANIZATIONS IS SPENT ON EFFORTS TO INFLUENCE LEGISLATION MATTERS IN THE HEALTH CARE INDUSTRY. DURING FY22, SHC TRI-VALLEY PAID DUES OF APPROXIMATELY $128,657 TO THESE ORGANIZATIONS AND THE APPROXIMATE AMOUNT OF DUES SPENT ON LOBBYING PURPOSES WAS $64,496.

Return Reference

Explanation

PART II-B, LINE 1

LOBBYING ACTIVITIES: SHC TRI-VALLEY BELONGS TO THE CALIFORNIA HOSPITAL ASSOCIATION/HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIFORNIA IN WHICH A PORTION OF DUES PAID TO THESE ORGANIZATIONS IS SPENT ON EFFORTS TO INFLUENCE LEGISLATION MATTERS IN THE HEALTH CARE INDUSTRY. DURING FY22, SHC TRI-VALLEY PAID DUES OF APPROXIMATELY $128,657 TO THESE ORGANIZATIONS AND THE APPROXIMATE AMOUNT OF DUES SPENT ON LOBBYING PURPOSES WAS $64,496.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

STANFORD HEALTH CARE TRI-VALLEY

Employer identification number

94-1429628

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	51,124,005		51,124,005
b	Buildings ....	138,952,018	25,461,832	113,490,186
c	Leasehold improvements	10,573,971	7,334,213	3,239,758
d	Equipment ....	120,178,898	65,046,830	55,132,068
e	Other .....	29,522,540	3,634,511	25,888,029
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				248,874,046

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)INTERCOMPANY RECEIVABLE				3,342,580
(2)EQUITY INVESTMENT (PPA-II)				7,262,302
(3)EQUITY INVESTMENT (PPA-I)				1,645,258
(4)DEPOSITS				609,810
(5)HOSP QUAL ASSURANCE RECEIVABLE				3,548,249
(6)NON PATIENT RECEIVABLES				743,787
(7)RIGHT-OF-USE ASSETS				30,416,453
(8)GOVERNMENT RECEIVABLES				119,357
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				47,687,796

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	111,436,975
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2	FIN 48 SHC AND ITS SUBSIDIARIES HAVE NO UNCERTAIN TAX POSITIONS PERTAINING TO UNRELATED BUSINESS INCOME.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

STANFORD HEALTH CARE TRI-VALLEY

Employer identification number

94-1429628

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 400 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			2,033,496		2,033,496	0.500 %
b	Medicaid (from Worksheet 3, column a) . . . . .			30,451,078	18,918,051	11,533,027	2.840 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			39,462,373	12,958,321	26,504,052	6.520 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			71,946,947	31,876,372	40,070,575	9.860 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	25	3,566	5,615,312	119,244	5,496,068	1.350 %
f	Health professions education (from Worksheet 5) . . .	6	107	488,089		488,089	0.120 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	8	5,285	1,227,026	389,288	837,738	0.210 %
j	Total. Other Benefits . .	39	8,958	7,330,427	508,532	6,821,895	1.680 %
k	Total. Add lines 7d and 7j .	39	8,958	79,277,374	32,384,904	46,892,470	11.540 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	2	3,500	37,266	0	37,266	0.010 %
9	Other
10	Total	2	3,500	37,266	0	37,266	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

25,021,021

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

114,641,344

Enter Medicare allowable costs of care relating to payments on line 5.....

185,051,652

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-70,410,308

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	STANFORD HEALTH CARE TRI-VALLEY 1111 E STANLEY BLVD LIVERMORE,CA94550 stanfordhealthcare.org/tri-valley 140000114	X	X	X	MED FITNESS FACILITY URGENT CARE WOMEN'S CENTER

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	STANFORD HEALTH CARE TRI-VALLEY
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	STANFORD HEALTH CARE TRI-VALLEY
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 400.%
and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V

The FAP application form was widely available on a website (list url):

SEE PART V

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	STANFORD HEALTH CARE TRI-VALLEY
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	STANFORD HEALTH CARE TRI-VALLEY
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
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.

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
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 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.
PART VI, LINE 7:	LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: CA

Schedule H (Form 990) 2021

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
STANFORD HEALTH CARE TRI-VALLEY

Employer identification number
94-1429628

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) AXIS COMMUNITY HEALTH INC 5925 W LAS POSITAS BLVD SUITE 100 PLEASANTON,CA94588	94-2232394	501(C)(3)	140,000				GENERAL SUPPORT
(2) GOODNESS VILLAGE 1660 FREISMAN RD LIVERMORE,CA94551	85-2812754	501(C)(3)	52,000				GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2	PROCEDURES FOR MONITORING USE OF GRANT FUNDS PROGRAM RECIPIENT IS REQUIRED TO SUBMIT DATA ON PERSONS SERVED OR HOW THEY UTILIZED THE FUNDS. DETAIL IS PROVIDED IN OUR COMMUNITY BENEFIT REPORT. GOODNESS VILLAGE REPORTED THEY SPENT FUNDS SPECIFICALLY ON CASE MANAGEMENT SPECIALISTS, AND AXIS PROVIDED NUMBER OF PATIENTS SERVED FOR MENTAL HEALTH SERVICES.

Schedule I (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

STANFORD HEALTH CARE TRI-VALLEY

Employer identification number

94-1429628

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1AARON SALYAPONGSE DIRECTOR	(i) (ii)	0 ------------- 299,304	0 ------------- 550,081	0 ------------- 0	0 ------------- 7,879	0 ------------- 36,873	0 ------------- 894,137	0 ------------- 0
2DAVID ENTWISTLE DIRECTOR	(i) (ii)	0 ------------- 1,912,080	0 ------------- 1,974,161	0 ------------- 968,067	0 ------------- 357,971	0 ------------- 51,600	0 ------------- 5,263,879	0 ------------- 312,114
3DAVID SVEC MD CMO	(i) (ii)	0 ------------- 336,927	0 ------------- 204,481	0 ------------- 720	0 ------------- 22,662	0 ------------- 45,203	0 ------------- 609,993	0 ------------- 0
4JENNIFER SAAVEDRA REGISTERED NURSE II	(i) (ii)	167,435 ------------- 0	2,819 ------------- 0	204,083 ------------- 0	12,903 ------------- 0	26,084 ------------- 0	413,324 ------------- 0	0 ------------- 0
5JOHN YEE MD VP CLINICAL INITIATIVES	(i) (ii)	258,207 ------------- 0	67,095 ------------- 0	7,504 ------------- 0	7,746 ------------- 0	21,937 ------------- 0	362,489 ------------- 0	0 ------------- 0
6KYLE WICHELMANN CFO	(i) (ii)	385,123 ------------- 0	113,516 ------------- 0	2,001 ------------- 0	17,400 ------------- 0	18,101 ------------- 0	536,141 ------------- 0	0 ------------- 0
7LINDA HOFF DIRECTOR	(i) (ii)	0 ------------- 903,700	0 ------------- 680,710	0 ------------- 168,490	0 ------------- 138,697	0 ------------- 36,706	0 ------------- 1,928,303	0 ------------- 104,540
8MANOJ SASTRY VP SRVC & MKT DEVEL	(i) (ii)	285,227 ------------- 0	71,315 ------------- 0	982 ------------- 0	13,536 ------------- 0	29,130 ------------- 0	400,190 ------------- 0	0 ------------- 0
9MONICA DAVILA CNO	(i) (ii)	290,394 ------------- 0	66,830 ------------- 0	1,000 ------------- 0	16,733 ------------- 0	30,662 ------------- 0	405,619 ------------- 0	0 ------------- 0
10QUINN MCKENNA DIRECTOR	(i) (ii)	0 ------------- 1,205,808	0 ------------- 902,516	0 ------------- 444,075	0 ------------- 174,937	0 ------------- 51,600	0 ------------- 2,778,936	0 ------------- 136,394
11RICHARD SHUMWAY PRESIDENT/CEO	(i) (ii)	635,219 ------------- 0	247,206 ------------- 0	39,635 ------------- 0	244,518 ------------- 0	30,915 ------------- 0	1,197,493 ------------- 0	38,114 ------------- 0
12RON DALMAN DIRECTOR	(i) (ii)	0 ------------- 413,631	0 ------------- 396,308	0 ------------- 0	0 ------------- 29,000	0 ------------- 45,976	0 ------------- 884,915	0 ------------- 0
13RYAN DEGRAFF VP OPERATIONS (UNTIL 09/21)	(i) (ii)	187,302 ------------- 0	0 ------------- 0	7,942 ------------- 0	11,691 ------------- 0	21,650 ------------- 0	228,585 ------------- 0	0 ------------- 0
14TRACEY LEWIS TAYLOR COO	(i) (ii)	395,578 ------------- 0	124,460 ------------- 0	1,305 ------------- 0	17,400 ------------- 0	18,369 ------------- 0	557,112 ------------- 0	0 ------------- 0
15JUSTIN DIMAYA REGISTERED NURSE II	(i) (ii)	142,411 ------------- 0	3,454 ------------- 0	190,899 ------------- 0	7,551 ------------- 0	18,520 ------------- 0	362,835 ------------- 0	0 ------------- 0
16JAMIE WELSH VP HR	(i) (ii)	277,164 ------------- 0	67,866 ------------- 0	4,195 ------------- 0	11,456 ------------- 0	11,842 ------------- 0	372,523 ------------- 0	0 ------------- 0
17CHRISTOPHER SHARP MD DIRECTOR	(i) (ii)	0 ------------- 395,669	0 ------------- 109,161	0 ------------- 720	0 ------------- 28,962	0 ------------- 45,903	0 ------------- 580,415	0 ------------- 0
18THERESA KULLMAN SR DIRECTOR COMPLIANCE & LEGAL	(i) (ii)	269,647 ------------- 0	52,177 ------------- 0	8,014 ------------- 0	16,575 ------------- 0	30,532 ------------- 0	376,945 ------------- 0	0 ------------- 0
19JACQUELINE STEIN FORMER SECRETARY	(i) (ii)	126,162 ------------- 0	750 ------------- 0	218 ------------- 0	6,310 ------------- 0	939 ------------- 0	134,379 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 4B	STANFORD HEALTH CARE ("SHC"), A RELATED ORGANIZATION, PROVIDES ALL SENIOR EXECUTIVES WITH A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO SUPPLEMENT THEIR RETIREMENT BENEFITS. FOR EACH CALENDAR YEAR, A HYPOTHETICAL ACCOUNT IS ESTABLISHED FOR EACH PARTICIPANT AND CREDITED WITH AN AMOUNT EQUAL TO A PERCENTAGE OF BASE SALARY (DEPENDING ON THE INDIVIDUAL'S POSITION) AS OF THE LAST DAY OF EACH QUARTER. THE COMPENSATION COMMITTEE MAY DETERMINE THAT CREDITS SHALL BE MADE IN ADDITION TO THOSE ABOVE IN ITS SOLE DISCRETION. A PARTICIPANT BECOMES VESTED IN EACH CALENDAR YEAR ACCOUNT ON THE FIRST BUSINESS DAY OF JANUARY FOLLOWING THE SECOND CALENDAR YEAR IN WHICH THE ACCOUNT WAS ESTABLISHED (OR, IF LATER, THE DATE ON WHICH THE PARTICIPANT COMPLETES TWO FULL YEARS OF PARTICIPATION). THE PARTICIPANT BECOMES FULLY VESTED IN HIS OR HER ACCOUNTS UNDER THE SERP UPON THE EARLIEST OF (A) DISCHARGE FROM EMPLOYMENT WITHOUT CAUSE; (B) ENTITLEMENT TO LONG-TERM DISABILITY INCOME BENEFITS; (C) ATTAINMENT OF AGE OF 60 WHILE EMPLOYED OR IF LATER, THE PARTICIPANT'S COMPLETION OF TWO FULL YEARS OF PARTICIPATION; (D) COMPLETION OF SEVEN YEARS AS AN ELIGIBLE EMPLOYEE; OR (E) DEATH. THE FOLLOWING AMOUNTS BECAME VESTED AND WERE PAID TO THE FOLLOWING INDIVIDUALS IN CALENDAR YEAR 2021: DAVID ENTWISTLE $ 323,758 QUINN MCKENNA $ 141,483 LINDA HOFF $ 108,441 FOR CERTAIN INDIVIDUALS LISTED ON SCHEDULE J, PART II, AMOUNTS CREDITED UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). AMOUNTS CREDITED AND DISCLOSED ON THE FORM 990 IN PRIOR YEARS THAT VESTED AND WERE PAID IN CALENDAR 2021 ARE REPORTED IN COLUMN (F). SHC TRI-VALLEY'S PRESIDENT PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO SUPPLEMENT HIS RETIREMENT BENEFITS. UNDER THE PLAN, A HYPOTHETICAL ACCOUNT IS ESTABLISHED FOR THE PARTICIPANT AND CREDITED WITH AN AMOUNT EQUAL TO A PERCENTAGE OF BASE SALARY AS OF THE LAST DAY OF EACH QUARTER. THE COMPENSATION COMMITTEE MAY DETERMINE THAT CREDITS SHALL BE MADE IN ADDITION TO THOSE ABOVE IN ITS SOLE DISCRETION. THE PARTICIPANT BECOMES VESTED IN EACH CALENDAR YEAR ACCOUNT ON THE FIRST BUSINESS DAY OF JANUARY FOLLOWING THE SECOND CALENDAR YEAR IN WHICH THE ACCOUNT WAS ESTABLISHED (OR, IF LATER, THE DATE ON WHICH THE PARTICIPANT COMPLETES TWO FULL YEARS OF PARTICIPATION). THE PARTICIPANT BECOMES FULLY VESTED IN HIS OR HER ACCOUNTS UNDER THE SERP UPON THE EARLIEST OF (A) DISCHARGE FROM EMPLOYMENT WITHOUT CAUSE; (B) ENTITLEMENT TO LONG-TERM DISABILITY INCOME BENEFITS; (C) ATTAINMENT OF AGE OF 60 WHILE EMPLOYED OR IF LATER, THE PARTICIPANT'S COMPLETION OF TWO FULL YEARS OF PARTICIPATION; (D) COMPLETION OF SEVEN YEARS AS AN ELIGIBLE EMPLOYEE; OR (E) DEATH. THE FOLLOWING AMOUNT BECAME VESTED AND WAS PAID TO RICHARD SHUMWAY IN CALENDAR YEAR 2021: $38,114. AMOUNTS CREDITED UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C).
SCHEDULE J, PART I, LINE 7	EIGHT EXECUTIVES RECEIVED A BONUS THAT WAS APPROVED BY SENIOR MANAGEMENT.
SCHEDULE J, PART II, COLUMN B(III)	OTHER REPORTABLE COMPENSATION IN SCHEDULE J, PART II, COLUMN (III) INCLUDES ACCRUED VACATION PAY OUT, GROUP TERM LIFE, SERP DISTRIBUTION, AND ADDITIONAL SHIFT WORK PAY.
SCHEDULE J, PART II	DIRECTORS ARE NOT COMPENSATED IN THEIR CAPACITY AS DIRECTORS OF SHC TRI-VALLEY. HOWEVER, THE INDIVIDUALS LISTED WERE ALSO EMPLOYEES OF RELATED ORGANIZATIONS, POSITIONS FOR WHICH THEY RECEIVED COMPENSATION AS REPORTED IN PART II.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

STANFORD HEALTH CARE TRI-VALLEY

Employer identification number

94-1429628

Return Reference	Explanation
FORM 990, PAGE 1, BOX B - NAME CHANGE	ON JULY 26, 2022, STANFORD MARKETING LAUNCHED ORGANIZATIONAL REBRANDING EFFORTS. STANFORD MEDICINE IS THE COLLECTIVE BRAND TO UNIFY ALL ENTITIES: PEDIATRIC (LPCH), ACADEMIC (SOM) AND ADULT (SHC). AS PART OF THE REBRANDING INITIATIVE, THE COMPANY'S LEGAL NAME WAS CHANGED FROM THE HOSPITAL COMMITTEE FOR THE LIVERMORE-PLEASANTON AREAS TO STANFORD HEALTH CARE TRI-VALLEY ("SHC TRI-VALLEY") AND IS NO LONGER BEING REFERRED TO STANFORD HEALTH CARE - VALLEYCARE DBA. THE ADDITION OF THE STANFORD MEDICINE BRAND REFLECTS THE RELATIONSHIP TO THE OVERALL ENTERPRISE AND ACKNOWLEDGES THE CRITICAL ROLE SHC TRI-VALLEY PLAYS IN EXTENDING THE REACH INTO THE TRI-VALLEY COMMUNITIES AND BEYOND.
FORM 990, PART I, LINE 1	STANFORD HEALTH CARE - TRI-VALLEY'S MISSION STATEMENT: FOR THE BENEFIT OF OUR PATIENTS AND THE COMMUNITY WE SERVE, OUR MISSION IS TO CARE, TO EDUCATE, AND TO DISCOVER. VISION STATEMENT: HEALING HUMANITY THROUGH SCIENCE AND COMPASSION, ONE PATIENT AT A TIME.
FORM 990, PART III, LINE 4A	SHC TRI-VALLEY'S OPERATIONAL SERVICES INCLUDE INPATIENT MEDICAL, SURGICAL AND MATERNAL & CHILD HEALTH, EMERGENCY, DIAGNOSTIC AND THERAPEUTIC, AMBULATORY PROCEDURAL AND ADDITIONAL HEALTH CARE SERVICES. CARE IS PROVIDED TO ALL INCLUDING THOSE INSURED BY GOVERNMENT, COMMERCIAL OR OCCUPATIONAL HEALTH COVERAGES, SELF-PAY PATIENTS AND PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE CHARITY-CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. ANY PROFITS MADE FROM OPERATIONS ARE INVESTED INTO NEW FACILITIES, EQUIPMENT AND SERVICES OR COMMUNITY BENEFIT PROGRAMS. STANFORD HEALTH CARE TRI-VALLEY'S ANNUAL COMMUNITY BENEFIT INVESTMENT FOCUSES ON IMPROVING THE HEALTH OF THE COMMUNITY'S MOST VULNERABLE POPULATIONS, INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME, AND POPULATIONS AFFECTED BY HEALTH DISPARITIES. THIS INCLUDED HEALTH RESEARCH, HEALTH EDUCATION AND TRAINING, AND PROVIDING ESSENTIAL SERVICES FOR THOSE MOST IN NEED IN OUR COMMUNITIES. AS PART OF SHC TRI-VALLEY'S SUPPORT FOR ITS COMMUNITY PARTNERS AND OTHER COMMUNITY-BASED AGENCIES, SHC TRI-VALLEY CONDUCTED A VARIETY OF ACTIVITIES FOR COMMUNITY MEMBERS, RANGING FROM EDUCATION AND SUPPORT TO PERSONS WITH CHRONIC CONDITIONS, MEALS TO THE DISABLED AND SENIORS AND REDUCED-COST WELLNESS PROGRAMS FOR ECONOMICALLY DISADVANTAGED MEMBERS OF THE COMMUNITY. ACTIVITIES FOR VULNERABLE POPULATIONS DURING FY22, SHC TRI-VALLEY'S FUNDING ALLOWED THE SENIOR SUPPORT PROGRAM OF THE TRI-VALLEY (SSPTV) TO PROVIDE FREE, PREVENTIVE HEALTH SCREENINGS AND EXAMS TO LOW-INCOME SENIORS. THESE SCREENINGS GENERALLY INCLUDED BLOOD PRESSURE AND DIABETES CHECKS, COMPLETE FOOT CARE, EDUCATION ABOUT MEDICATION MANAGEMENT, ALCOHOL AND DRUG EDUCATION, AS WELL AS REFERRALS, WHEN APPROPRIATE. PERSONS SERVED: 22 IN FY22, SHC TRI-VALLEY PROVIDED OPEN HEART KITCHEN SPACE ON ITS LIVERMORE CAMPUS FREE OF CHARGE. THIS LOCAL NONPROFIT ORGANIZATION, WHICH SERVES FREE MEALS TO THE HUNGRY, STORED FOOD AND ASSEMBLED BOX LUNCHES IN THE SPACE ON CAMPUS. SHC TRI-VALLEY PROVIDED FUNDING TO SUPPORT ALAMEDA COUNTRY'S HEALING HEARTS EVENT FOR SUICIDE PREVENTION. THE EVENT IS FOCUSED ON RAISING AWARENESS OF THE TRAGEDY OF SUICIDE, REDUCING THE STIGMA ASSOCIATED WITH DEPRESSION AND MENTAL ILLNESS, EDUCATING THE COMMUNITY ABOUT AVAILABLE SERVICES, SUPPORTING LOCAL SUICIDE PREVENTION PROGRAMS, AND PROVIDING A SAFE PLACE TO HEAL FOR THOSE WHO HAVE LOST LOVED ONES TO SUICIDE. PERSONS SERVED: 150 FOR MEALS ON WHEELS, SHC TRI-VALLEY PREPARED MORE THAN 34,420 MEALS (MORE THAN 90 MEALS PER DAY, 5 DAYS PER WEEK) 800 PEOPLE ARE SERVED, FOR HOMEBOUND SENIORS IN THE FOLLOWING ALAMEDA COUNTY CITIES, PLEASANTON, LIVERMORE, DUBLIN AND SUNOL. THESE HOT MEAL PROGRAMS PROVIDE LOCAL SENIORS WITH THE NUTRITION CRITICAL TO THEIR HEALTH AND WELL-BEING. SHC TRI-VALLEY ALSO PROVIDED OFFICE SPACE TO SPECTRUM, THE NONPROFIT ORGANIZATION IN CHARGE OF ORGANIZING THE MEALS ON WHEELS PROGRAM IN THE TRI-VALLEY AREA. SHC TRI-VALLEY SUPPORTED CAPE'S PROVISION OF MEALS FOR PRESCHOOL-AGED CHILDREN BY PREPARING ALL THE MEALS. CAPE, INC.'S PRIMARY FOCUS IS PROVIDING THE HIGHEST QUALITY EARLY CHILDHOOD DEVELOPMENT SERVICES THAT MEET THE NEEDS OF LOW-INCOME CHILDREN AND THEIR FAMILIES INCLUDING HEALTH AND NUTRITION. SERVED OVER 150 PRESCHOOLERS. SHC TRI-VALLEY PROVIDED FUNDING TO SUPPORT OPERATION CRANBERRY SAUCE (OCS). OCS FOOD PACKAGES FEED A FAMILY OF FIVE FOR A THANKSGIVING MEAL. EACH LOW-INCOME FAMILY RECEIVED ONE BOX OF GROCERIES THAT INCLUDED STAPLES AND NONPERISHABLE ITEMS AND A FROZEN TURKEY. PERSONS SERVED: 1,500 PACKAGES FED APPROX. 9,000 FAMILY MEMBERS PROVIDED EXPERTS TO ASSIST UNINSURED, LOW-INCOME PATIENTS RESEARCH THEIR HEALTH CARE OPTIONS. SERVICES PROVIDED AT NO COST BY MEDDATA INVOLVE HELPING INDIVIDUALS RESEARCH ELIGIBILITY REQUIREMENTS, IDENTIFY APPROPRIATE HEALTH INSURANCE PROGRAMS, COMPLETE APPLICATIONS, COMPILE REQUIRED DOCUMENTATION, AND FOLLOW UP WITH COUNTY CASE MANAGERS. THIS SERVICE ASSISTS ELIGIBLE PATIENTS IN OBTAINING COVERAGE FOR MEDICAL NECESSITIES, SUCH AS HOSPITAL CARE, PRESCRIPTION DRUGS, AND HOME HEALTH CARE. TO SUPPORT POST HOSPITAL SUPPORT FOR PATIENTS THAT HAVE LIMITED OR NO ABILITY TO PAY FOR NECESSARY MEDICAL AND NON-MEDICAL SERVICES, SHC TRI-VALLEY PROVIDES FUNDING AND RESOURCES FOR SERVICES INCLUDING TRANSPORTATION, MEDICATIONS AND MEAL ASSISTANCE.
FORM 990, PART III, LINE 4A (CONT.)	PROVIDED FUNDS FOR A LICENSED MARRIAGE AND FAMILY THERAPIST (MFT) FOR AXIS COMMUNITY HEALTH. THIS THERAPIST INCREASED CAPACITY TO SERVE TRI-VALLEY RESIDENTS AT AXIS' CLINICAL SITE. THE ADDITIONAL COUNSELOR HAS HELPED TO ALLEVIATE THE DIRE NEED FOR MORE MENTAL HEALTH SERVICES IN THE COMMUNITY. IN ADDITION, WAIT TIMES FOR MENTAL HEALTH SERVICES APPOINTMENTS AT THE CLINIC HAVE BEEN REDUCED. A TOTAL OF 1,096 MENTAL HEALTH VISITS WERE PROVIDED TO UNINSURED. SHC TRI-VALLEY'S GRANT SUPPORTED SAFE LANDING, AN ALAMEDA COUNTY OUTREACH AND TREATMENT PROGRAM. THE DROP-IN CENTER IS LOCATED ON THE GROUNDS OF SANTA RITA JAIL FOR PEOPLE WITH MENTAL ILLNESS, CO-OCCURRING CONDITIONS, AND SUBSTANCE USE DISORDERS, ASSISTING THEM WITH IMMEDIATE NEEDS AS THEY ARE RELEASED FROM JAIL. THE DROP-IN CENTER PROVIDES A SAFE, COMFORTABLE, NON-THREATENING, TEMPORARY STOP-OVER AS NEXT OPTIONS ARE CONSIDERED, AND PROVIDES ASSISTANCE/CONNECTION WITH: LOCATING BOTH IMMEDIATE AND LONG-TERM HOUSING, MEDICATION, GRIEF COUNSELING AND CRISIS COUNSELING, REFERRALS TO FURTHER MENTAL HEALTH AND/OR SUBSTANCE USE SERVICES, CONNECTION TO TRANSPORTATION (BART, BUS, CAB), REFRESHMENTS AND CHANGE OF CLOTHES. TELEPHONE AND/OR INTERNET TO LINE UP TRANSPORTATION AND OTHER POST-RELEASE NECESSITIES. PERSONS SERVED: 3,367 PROVIDED GRANT FUNDING AT GOODNESS VILLAGE FOR A CASE MANAGEMENT SPECIALIST. GOODNESS VILLAGE IS A TINY HOME COMMUNITY THAT PROVIDES AFFORDABLE AND PERMANENT HOUSING OPTIONS IN A SUPPORTIVE COMMUNITY FOR PEOPLE TRANSITIONING OUT OF CHRONIC HOMELESSNESS. SHC TRI-VALLEY PROVIDED A WIDE VARIETY OF RESOURCES AND SERVICES TO THE BROADER COMMUNITY REGARDING CARDIAC INFORMATION AND EDUCATION, INCLUDING LECTURES. PERSONS SERVED: 123 SHC TRI-VALLEY PROVIDES FREE, NON-MEDICAL SUPPORT SERVICES TO CANCER PATIENTS, FAMILY MEMBERS, AND CAREGIVERS REGARDLESS OF WHERE PATIENTS RECEIVE TREATMENT. SERVICES PROVIDED INCLUDE SUPPORT GROUPS, HEALTH EDUCATION CLASSES, SEMINARS, AND SYMPOSIA, EXERCISE AND YOGA CLASSES, AND HEALING TOUCH SUPPORTIVE CARE. PERSONS SERVED: 968 SHC TRI-VALLEY PROVIDED HERS FOUNDATION OFFICE SPACE FREE OF CHARGE. HERS FOUNDATION HELPS SUPPORT WOMEN HEALING FROM BREAST CANCER BY PROVIDING POST-SURGICAL PRODUCTS AND SERVICES, REGARDLESS OF FINANCIAL STATUS. HERS STANDS FOR HOPE, EMPOWERMENT, RENEWAL, AND SUPPORT. SHC TRI-VALLEY PROVIDED FUNDS TO SUPPORT CULINARY ANGELS, A VOLUNTEER, DONATION-BASED ORGANIZATION THAT PROVIDES NUTRIENT-RICH MEALS AND NUTRITION EDUCATION TO PEOPLE GOING THROUGH A SERIOUS HEALTH CHALLENGE. MEALS ARE DELIVERED FREE-OF- CHARGE THROUGHOUT LIVERMORE, DUBLIN AND PLEASANTON. SHC TRI-VALLEY HELD MATERNAL AND CHILD EDUCATION CLASSES TO PREPARE PARENTS FOR CHILDBIRTH. THESE CLASSES WERE OFFERED TO THE COMMUNITY AT LARGE AND WERE FREE TO LOW-INCOME PARENTS. IN ADDITION, SHC TRI-VALLEY PROVIDED EDUCATION FOR NEW MOTHERS ON THE BENEFITS AND IMPORTANCE OF BREASTFEEDING THEIR INFANTS. THE NEW MOMS SUPPORT GROUP SUPPORTED NEW MOTHERS BY PROVIDING PROGRAMS WITH GUEST SPEAKERS WHO FOCUSED ON BREASTFEEDING AS A HEALTHY START TO LIFE. PERSONS SERVED: 785 IN FY22, THE SHC TRI-VALLEY HEALTH LIBRARY PROVIDED SCIENTIFICALLY BASED HEALTH INFORMATION TO ASSIST COMMUNITY MEMBERS IN MAKING MORE INFORMED DECISIONS ABOUT THEIR HEALTH AND HEALTH CARE. THE HEALTH LIBRARY IS OPEN TO THE COMMUNITY AND REACHES OUT TO THE LOCAL POPULATION, AS WELL AS TO ANYONE WHO USES THE INTERNET. THE LIBRARY HAS AN EXTENSIVE COLLECTION OF ONLINE HEALTH AND WELLNESS RESOURCES, INCLUDING MEDICAL WEBSITES AND FULL-TEXT ARTICLES. ALL INFORMATIONAL AND EDUCATIONAL MATERIALS ARE AVAILABLE IN ENGLISH AND SPANISH. SHC TRI-VALLEY PROVIDED FUNDING TO SMITH ELEMENTARY SCHOOL IN LIVERMORE TO FUND NEEDED EQUIPMENT FOR PHYSICAL EDUCATION. PROVIDED FIRST AID AT LOCAL COMMUNITY EVENTS SUCH AS THE LIVERMORE RODEO AND LITTLE LEAGUE WORLD SERIES. FOR THOSE WITH DIABETES, SHC TRI-VALLEY OFFERED A MONTHLY DIABETES SUPPORT GROUP WITH OCCASIONAL GUEST SPEAKERS. PERSONS SERVED: 85 SHC TRI-VALLEY OFFERED BI-WEEKLY SUPPORT GROUPS FOR BOTH BARIATRIC WEIGHT LOSS AND MEDICAL WEIGHT MANAGEMENT PATIENTS FROM THE BROADER COMMUNITY. PERSONS SERVED: 120 STANFORD HEALTH CARE TRI-VALLEY REMAINED COMMITTED TO SUPPORTING THE BROAD COMMUNITY NEEDS EMERGING FROM THE COVID-19 PANDEMIC. THROUGH PARTNERSHIP WITH FEDERAL, STATE, AND LOCAL GOVERNMENT AND PUBLIC HEALTH AGENCIES, OTHER HEALTH CARE PROVIDERS, AND LOCAL COMMUNITY-BASED ORGANIZATIONS, DURING FY22, THE COVID-19 RESPONSE INVESTMENT TOTALED OVER $4,702,310, INCLUDING: - SUPPORTED COMMUNITY HEALTH IMPROVEMENT ACTIVITIES FOR PATIENTS AND THE BROAD COMMUNITY, INCLUDING ADMINISTERING VACCINATIONS. - IMPROVED HEALTH EQUITY AND VACCINE ACCESS, INCLUDING PROVIDING BOOSTERS. - PROVIDED DEDICATED AND BARRIER-FREE SCHEDULING FOR VACCINE APPOINTMENTS TO HIGH-RISK AND VULNERABLE POPULATIONS THROUGH PARTNERSHIPS WITH LOCAL PUBLIC HEALTH DEPARTMENT AND COMMUNITY PARTNERS. WHILE VACCINATION IS A CORNERSTONE OF STANFORD HEALTH CARE TRI-VALLEY FY22 COVID-19 RESPONSE, BROAD COVID-19 SUPPORT INCLUDED: - EXPANDED ACCESS TO CARE AND COMMUNITY-BASED COVID-19 TESTING - PARTICIPATED IN COVID-19 CLINICAL TRIALS - PROVIDED IN-KIND COMMUNITY-LEVEL EMERGENCY MANAGEMENT EXPERTISE SPECIALIZED HEALTH CARE WORKFORCE TRAINING - SEE SCHEDULE H, PART VI SUPPLEMENTAL INFORMATION RELATED TO PART II, LINE 8.
FORM 990, PART VI, SECTION A, LINE 2	THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF STANFORD HEALTH CARE: DAVID ENTWISTLE LINDA HOFF QUINN MCKENNA THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF STANFORD UNIVERSITY: TOPHER SHARP MD RON DALMAN MD AARON SALYAPONGSE MD DAVID SVEC MD THE FOLLOWING INDIVIDUALS ARE BOARD MEMBERS AT STANFORD HEALTH CARE: DAVID ENTWISTLE KAYE FOSTER THE FOLLOWING INDIVIDUALS ARE VOTING BOARD MEMBERS AT SUMIT HOLDING INTERNATIONAL, LLC DAVID ENTWISTLE LINDA HOFF THE FOLLOWING INDIVIDUALS ARE VOTING BOARD MEMBERS AT SUMIT INSURANCE COMPANY, LTD.: DAVID ENTWISTLE LINDA HOFF THE FOLLOWING INDIVIDUALS ARE CLASS A SUBSCRIBER VOTING MEMBERS AT THE PROFESSIONAL EXCHANGE ASSURANCE COMPANY: (AS OF 9/1/2022) DAVID ENTWISTLE LINDA HOFF THE FOLLOWING INDIVIDUALS ARE MANAGERS AT STANFORD PET-CT LLC: DAVID ENTWISTLE QUINN MCKENNA THE FOLLOWING INDIVIDUALS ARE DIRECTORS AT LUCILE SALTER PACKARD CHILDREN'S HOSPITAL: DAVID ENTWISTLE
FORM 990, PART VI, SECTION A, LINE 6	STANFORD HEALTH CARE IS THE SOLE MEMBER OF SHC TRI-VALLEY.
FORM 990, PART VI, SECTION A, LINE 7A	STANFORD HEALTH CARE, AS THE SOLE MEMBER OF SHC TRI-VALLEY, APPOINTS ALL CLASS "B" DIRECTORS, AND APPROVES APPOINTMENT OF CLASS "A" DIRECTORS TO THE SHC TRI-VALLEY BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	THE FOLLOWING POWERS ARE RESERVED TO STANFORD HEALTH CARE, AS THE SOLE MEMBER OF SHC TRI-VALLEY: (A) APPOINTMENT AND REMOVAL OF ALL SENIOR LEADERSHIP AND ENGAGEMENT OF STANFORD UNIVERSITY TO PROVIDE LEGAL AND INTERNAL AUDIT SERVICES TO THE CORPORATION; (B) SELECTION OF THE AUDITORS OF THE CORPORATION; (C) AMENDMENT OF THESE BYLAWS, EXCEPT AS PROVIDED IN ARTICLE X; (D) APPROVAL OF THE INCURRENCE OF DEBT BY THE CORPORATION OTHER THAN DEBT PROVIDED FOR IN AN APPROVED CAPITAL BUDGET APPROVED BY THE MEMBER; (E) APPROVAL OF OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; AND (F) APPROVAL OF STRATEGIC PLANS THAT HAVE BEEN DEVELOPED BY MANAGEMENT AND SUBMITTED FOR APPROVAL TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11B	THE FINANCE DEPARTMENT REVIEWS THE FORM 990 FOR ACCURACY, WITH INPUT FROM COMMUNITY BENEFITS DEPARTMENT PRIMARILY FOR SCHEDULE H. PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE, A COMPLETE COPY OF THE FORM 990 IS SENT ELECTRONICALLY TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR THEIR REVIEW. THE CHIEF FINANCIAL OFFICER REVIEWS THE FORM 990 WITH THE AUDIT COMMITTEE AND INVITES QUESTIONS. FOLLOWING THIS REVIEW, A FULL COPY OF THE FINAL RETURN IS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS PRIOR TO FILING. ONCE THESE STEPS ARE COMPLETE, THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE AN INITIAL CONFLICT-OF-INTEREST DISCLOSURE STATEMENT ("DISCLOSURE STATEMENT") WITHIN 30 DAYS OF BEGINNING SERVICE AT SHC TRI-VALLEY. ADDITIONALLY, AN UPDATED DISCLOSURE STATEMENT IS REQUIRED THEREAFTER ON AN ANNUAL BASIS. FURTHERMORE, OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO UPDATE THEIR DISCLOSURE STATEMENT WITHIN TEN (10) BUSINESS DAYS OF A MATERIAL CHANGE IN THEIR SITUATIONS THAT MAY CREATE AN ACTUAL OR PERCEIVED CONFLICT-OF-INTEREST. A DISCLOSURE THAT APPEARS TO BE A CONFLICT WILL BE RESOLVED BY A MUTUAL AGREEABLE PLAN WITH THE VICE PRESIDENT OF HUMAN RESOURCES THAT OUTLINES THE STEPS THE OFFICER, DIRECTOR OR KEY EMPLOYEE MUST TAKE TO RECTIFY THE CONFLICT. IN MATTERS THAT ARE UNCLEAR OR QUESTIONABLE, THE OFFICE OF CHIEF COMPLIANCE OFFICER WILL BE CONSULTED FOR A RULING. IF FURTHER INQUIRY IS NECESSARY THE OFFICE OF THE GENERAL COUNSEL WILL DETERMINE THE APPROPRIATE COURSE OF ACTION.
FORM 990, PART VI, SECTION B, LINES 15A & 15B	SHC TRI-VALLEY UTILIZES THE SERVICES OF WILLIS TOWERS WATSON FOR COMPENSATION BENCHMARKING, ANALYSIS, AND REPORTING. THE BOARD OF DIRECTORS HAS A COMPENSATION & WORKFORCE SUB-COMMITTEE WHO REVIEWS THE RESULTS OF THE COMPENSATION REVIEW AND IS ASSURED THAT TOTAL COMPENSATION IS CONSISTENT WITH THE MARKET. THIS PROCESS WAS LAST PERFORMED IN NOVEMBER 2022.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING/ORGANIZING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:13451383
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER TEMP MEDICAL SVCS TOTAL FEES:34982104

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

STANFORD HEALTH CARE TRI-VALLEY

Employer identification number

94-1429628

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) TRI-VALLEY AMBULATORY SURGERY CENTERLLC 5555 W LAS POSITAS BLVD PLEASANTON,CA94588 84-3305341	HEALTHCARE	CA	0	0	TRI-VALLEY

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)THE BRD OF TRUST LELAND STANF JR UNIV 485 BROADWAY MAILCODE 8838 REDWOOD CITY,CA94063 94-1156365	EDUCATION	CA	501(C)(3)	2	NA		No
(2)FUNDACION STANFORD UNIVERSITY EN CHILE AV CONDELL 189 PROVIDENCIA SANTIAGO CI	EDUCATION	CI	501(C)(3)		STANFORD	Yes
(3)JAEDAN BUPIN STANFORD CENTER IN THE REPU	RESEARCH	KR	501(C)(3)	N/A	STANFORD	Yes
(4)LUCILE PACKARD FOUNDATION FOR CHILDREN'S 400 HAMILTON AVENUE SUITE 340 PALO ALTO,CA94301 77-0440090	HEALTHCARE	CA	501(C)(3)	7	LPCH	Yes
(5)LUCILE SALTER PACKARD CHILDRENS HOSPITAL 725 WELCH ROAD MC 5553 PALO ALTO,CA94304 77-0003859	HEALTHCARE	CA	501(C)(3)	3	STANFORD	Yes
(6)PACKARD CHILDREN'S HEALTH ALLIANCE 725 WELCH ROAD MC5551 PALO ALTO,CA94304 32-0359189	HEALTHCARE	CA	501(C)(3)	3	LPCH	Yes
(7)SHR HOLDINGS INC 485 BROADWAY MAILCODE 8838 REDWOOD CITY,CA94063 94-3187167	REAL ESTATE	CA	501(C)(25)	N/A	STANFORD	Yes
(8)STANFORD FACULTY CLUB PO BOX 7229 STANFORD,CA94309 94-1187089	FAC INTERACT.	CA	501(C)(7)	N/A	STANFORD	Yes
(9)STANFORD FEDERAL CREDIT UNION 1860 EMBARCADERO RD PALO ALTO,CA94303 94-1492212	CREDIT UNION	CA	501(C)(1)	N/A	STANFORD	Yes
(10)STANFORD HABITAT CONSERVATION BOARD 415 BROADWAY REDWOOD CITY,CA94063 46-1882243	CONSERVATION	CA	501(C)(3)	7	STANFORD	Yes
(11)STANFORD HEALTH CARE 300 PASTEUR DRIVE MC 5555 STANFORD,CA94305 94-6174066	HEALTHCARE	CA	501(C)(3)	3	STANFORD	Yes
(12)STANFORD PROGRAMME (CAPE TOWN) NPC WAVERLY BUSINESS PARK BLDG 11 CAPE TOWN SF	EDUCATION	SF	501(C)(3)	N/A	STANFORD	Yes
(13)STANFORD UNIVERSITY BOOKSTORE BLDG 60 MAIN QUAD NO 105 STANFORD,CA94305 94-0894150	SUPPORT	CA	501(C)(3)	12A, I	STANFORD	Yes
(14)SU EMP BEN TRUST POST RETEMPYNT BEN 485 BROADWAY MAILCODE 8838 REDWOOD CITY,CA94063 94-3246199	BENEFITS	CA	501(C)(9)	N/A	STANFORD	Yes
(15)THE DUDLEY E CHAMBERS FOUNDATION JP MORGAN CHASE PO BOX 3038 MILWAUKEE,WI53201 38-6841793	SUPPORT	NY	501(C)(3)	12D, III-O	STANFORD	Yes
(16)THE FREIDENRICH SUPPORT FOUNDATION 485 BROADWAY MAILCODE 8838 REDWOOD CITY,CA94063 30-0519583	SUPPORT	CA	501(C)(3)	12A, I	STANFORD	Yes
(17)THE HONG KONGSU CHARITABLE TRUST 1401 CAROLINE CENTER 28 PING ROAD CAUSEWAY HK 98-6078093	SUPPORT	HK	501(C)(3)	N/A	STANFORD	Yes
(18)THE STANFORD TRUST 65 HIGH STREET OXFORD OX1 46L UK	SUPPORT	UK	501(C)(3)	N/A	STANFORD	Yes
(19)UNIVERSITY HEALTHCARE ALLIANCE 7999 GATEWAY BLVD STE 300 NEWARK,CA94560 94-3192446	HEALTHCARE	CA	501(C)(3)	3	SHC	Yes
(20)VALLEYCARE MEDICAL FOUNDATION INC 1111 E STANLEY BLVD LIVERMORE,CA94550 26-2593526	SR. FACILITY	CA	501(C)(3)	PF	SHC-TV	Yes
(21)VALLEYCARE SENIOR HOUSING 1111 E STANLEY BLVD LIVERMORE,CA94550 94-3382224	SR. FACILITY	CA	501(C)(3)	12A, I	SHC-TV	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) ADOM PARTNERS LP 1350 6TH AVE 2910 NEW YORK,NY10019 81-3083288	INVESTMENTS	DE	NA
(2) ALBUS SELECT FUND LP 750 MENLO AVE 380 MENLO PARK,CA94025 81-2064357	INVESTMENTS	DE	NA
(3) ARCOLA VENTURE LLC 7121 FAIRWAY DRIVE 410 PALM BEACH GARDENS,FL33418 37-1689632	REAL ESTATE	DE	NA
(4) CANARY SC FUND LP 65 E 55TH ST 35TH FLOOR NEW YORK,NY10022 47-5662144	INVESTMENTS	DE	NA
(5) CANARY SC MASTER FUND LP 89 NEXUS WAY CAMANA BAY GRAND CAYMAN KY1-9009 CJ 98-1267847	INVESTMENTS	CJ	NA
(6) CARLSBAD CO-INVEST LP 40 BEECHWOOD RD SUMMIT,NJ07901 47-1702425	INVESTMENTS	DE	NA
(7) CERASUS FUND II CAYMAN LP 190 ELGIN AVENUE GEORGE TOWN GRAND CAYMAN KY1-9008 CJ	INVESTMENTS	CJ	NA
(8) CHP GTS BLOCKER HOLDINGS A LP 888 BOYLSTON STREET 1410 BOSTON,MA02199 83-0881152	INVESTMENTS	DE	NA
(9) CYPRESS MARINA HEIGHTS LLC 635 KNIGHT WAY STANFORD,CA94305 95-4887979	INVESTMENTS	CA	NA
(10) DGD INVESTMENT LP 190 ELGIN AVENUE GEORGE TOWN GRAND CAYMAN KY1-9008 CJ	INVESTMENTS	CJ	NA
(11) EAGLE ROCK LI HOLDINGS II LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803 27-1694413	INVESTMENTS	DE	NA
(12) EDEN RADIATION THERAPY SERVICES LLC 300 PASTEUR DRIVE STANFORD,CA94304	HEALTHCARE	CA	NA
(13) ER-S JV LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803 83-4068077	INVESTMENTS	DE	NA
(14) ER-S JV II LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803	INVESTMENTS	DE	NA
(15) ER-S INVESTOR LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803 83-4068357	INVESTMENTS	DE	NA
(16) ER-S INVESTOR II LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803	INVESTMENTS	DE	NA
(17) ER PROPERTIES FUND LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803 83-4260396	INVESTMENTS	DE	NA
(18) ER PROPERTIES FUND II LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803	INVESTMENTS	DE	NA
(19) EZP OPPORTUNITY LP 160 BOVET RD STE 300 SAN MATEO,CA94402 81-4562962	INVESTMENTS	DE	NA
(20) FORTRESS IW COINVESTMENT (FUND B) LP 1345 AVE OF THE AMERICAS 46FL NEW YORK,NY10105 98-0509639	INVESTMENTS	CJ	NA
(21) FOUR CROSSINGS INSTITUTIONAL PARTNERS V ONE MARITIME PLAZA 2100 SAN FRANCISCO,CA94111 81-4323705	INVESTMENTS	DE	NA
(22) FOXLANE LP 550 E WATER ST 888 CHARLOTTESVILLE,VA22902 81-3314647	INVESTMENTS	DE	NA
(23) HHBG-II INVESTMENT LP 89 NEXUS WAY CAMANA BAY PO BOX 31 GRAND CAYMAN KY1-1205 CJ	INVESTMENTS	CJ	NA
(24) KEB INVESTORS II LP WASHINGTON MALL STE 304 7 REID ST HAMILTON,BDHM 11 BD	INVESTMENTS	BD	NA
(25) KF VERMILLION FUND LP 65 EAST 55TH STREET 35TH FLOOR NEW YORK,NY10022	INVESTMENTS	DE	NA
(26) LSF V DHB HOLDINGS LP 2711 N HASKELL AVE 1700 DALLAS,TX75204 27-2858604	INVESTMENTS	DE	NA
(27) OLIFANT FUND LTD SUITE 5B201 2ND FL ONE NEXUS WAY GRAND CAYMAN KY1-1108 CJ 98-0404442	INVESTMENTS	CJ	NA
(28) ONCOLOGY SOLUTIONS VENTURE LLC 300 PASTEUR DRIVE STANFORD,CA94304 86-3250041	HEALTHCARE	CA	NA
(29) OUTLAWS CASINO LTD 415 BROADWAY REDWOOD CITY,CA94063 84-1457498	HOLDING COMPANY	CO	NA
(30) PALO ALTO LP 13 CASTLE STREET ST HELIER JERSEY,JE JE 98-1126622	INVESTMENTS	JE	NA
(31) SANDOVAL LP 4640 ADMIRALTY WAY 5TH FL MARINA DEL REY,CA90292 37-1873346	INVESTMENTS	CA	NA
(32) SANDPIPER FUND LP 2000 MCKINNEY AVE STE 2125 DALLAS,TX75201 26-0341626	INVESTMENT	TX	NA
(33) SAROFIM MULTIFAMILY PARTNERS LP 2525 MCKINNON STREET STE 530 DALLAS,TX75201 20-1929002	RE DEVELOPMENT	TX	NA
(34) SCP REAL ASSETS FUND (A) LP 2498 SAND HILL RD MENLO PARK,CA94025 20-3949682	INVESTMENTS	DE	NA
(35) SEQUOIA MFM OPERATING COMPANY LLC 770 WELCH ROAD LPCH PALO ALTO,CA94304 47-5060529	MFM PROGRAM	CA	NA
(36) SP SMC PARTNERS LLC PO BOX 5377 NEW YORK,NY10185 47-3103791	INVESTMENTS	DE	NA
(37) STANFORD EMANUEL RADIATION ONCOLOGY CENT 825 DELBON AV TURLOCK,CA95382 20-8885091	RADIOLOGY	CA	NA
(38) STANFORD PET-CT LLC 300 PASTEUR DR STANFORD,CA94305 61-1423414	MED. DIAGNOST	CA	NA
(39) STANFORD-STARTX FUND LLC 485 BROADWAY REDWOOD CITY,CA94063 46-4297719	INVESTMENTS	DE	NA
(40) SUMIT HOLDING INTERNATIONAL LLC 1400 PAGE MILL RD PALO ALTO,CA94304 26-3934706	HOLDING COMPANY	DE	NA
(41) SV4 EQUITY LLC 1209 ORANGE STREET WILMINGTON,DE19802	INVESTMENTS	DE	NA
(42) TESSERA IONIC LP PO BOX 194170 SAN FRANCISCO,CA941194170 83-0896257	INVESTMENTS	DE	NA
(43) VEDA INVESTORS FUND LP ONE FAWCETT PL GREENWICH,CT06830 81-1810345	INVESTMENTS	DE	NA
(44) VERMILION PEAK MASTER FUND PO BOX 309 UGLAND HOUSE GRAND CAYMAN KY1-1104 CJ 98-1327671	INVESTMENTS	CJ	NA
(45) WREP III A LP 6710 E CAMELBACK RD 100 SCOTTSDALE,AZ85251 47-4780701	INVESTMENTS	DE	NA

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) BREP VII ALBERTA FDR (OFFSHORE) TE7 LP 345 PARK AVENUE NEW YORK,NY10154 98-1066351	INVESTMENTS	CA	NA	C CORP
(2) BREP VII ALBERTA FDR (OFFSHORE) TE7-NQ 345 PARK AVENUE NEW YORK,NY10154 98-1066355	INVESTMENTS	CA	NA	C CORP
(3) CANARY SC FUND LTD 89 NEXUS WAY CAYMANA BAY GRAND CAYMAN KY1-9009 CJ 92-1268195	INVESTMENTS	CJ	NA	C CORP
(4) CLAT (14)	CHARITABLE TR	CA	NA	TRUST
(5) CLUT (2)	CHARITABLE TR	CA	NA	TRUST
(6) CRT (559)	CHARITABLE TR	CA	NA	TRUST
(7) EAST SAIL C/O INTL FS INC IFS COURT TWENTYEIGHT CYBERCITY EBENE MP	INVESTMENTS	MP	NA	C CORP
(8) ER-S REIT LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803 83-4068725	INVESTMENTS	DE	NA	C CORP
(9) ER-S REIT II LLC 1670 OLD COUNTRY RD 227 PLAINVIEW,NY11803 88-2004082	INVESTMENTS	DE	NA	C CORP
(10) GAVEA INVESTMENT FUND II-C LP PO BOX 309 UGLAND HOUSE GRAND CAYMAN KY1-1104 CJ 98-0537952	INVESTMENTS	CJ	NA	C CORP
(11) HHBG SF LIMITED 89 NEXUS WAY CAYMANA BAY GRAND CAYMAN KY1-1205 CJ	INVESTMENTS	CJ	NA	C CORP
(12) KAIZEN FUND PO BOX 448 GRAND CAYMAN KY1-1106 CJ	INVESTMENTS	CJ	NA	C CORP
(13) LS ALBERTA III LP C/O LASALLE INV MGMT ONE CURZON ST LONDON W1J 5HD UK	INVESTMENTS	UK	NA	C CORP
(14) OTHER (4)	CHARITABLE TR	CA	NA	TRUST
(15) PIF (2)	CHARITABLE TR	CA	NA	TRUST
(16) PEPPERTREE CAPITAL CAYMAN ISLAND FUND LP 57 E WASHINGTON STREET CHAGRIN FALLS,OH44022 98-1235268	INVESTMENTS	CJ	NA	C CORP
(17) PROFESSIONAL EXCHANGE ASSURANCE COMPANY 201 MERCHANT STREET SUITE 2400 HONOLULU,HI96813 90-0897686	INSURANCE	HI	NA	C CORP
(18) SBFF LTD SUITE 5B201 2ND FL ONE NEXUS WAY GRAND CAYMAN KY1-1108 CJ	INVESTMENTS	CJ	NA	C CORP
(19) SOLKATT LIMITED 190 ELGIN AVENUE GEORGE TOWN GRAND CAYMAN KY1-9008 CJ	INVESTMENTS	CJ	NA	C CORP
(20) STANFORD (BEIJING) CNSLTNG CO LTD (WFOE) 5275TH FLBLDG CACADEMY SOUTH RD BEIJING CH	EDUCATION	CH	NA	C CORP
(21) STANFORD IN JAPAN GODO KAISHA DOSHISHA UNIVERSITY MEITOKUKAN-NAI KYOTOSHI JA	EDUCATION	JA	NA	C CORP
(22) STANFORD INDIA PVT LTD 333 3RD FLOOR DEVIKA TOWER 6 NEH DELHI IN	EDUCATION	IN	NA	C CORP
(23) STANFORD MEDICINE INTL (HONG KONG) CO LT 833 CHEUNG SHA WAN ROAD KOWLOON HK	PATIENT SRVC	HK	NA	C CORP
(24) STANFORD UNIV MED NETWORK RISK AUTHORITY 1400 PAGE MILL RD MSC 5713 PALO ALTO,CA94304 46-1132002	RISK MGMT CON	CA	NA	C CORP
(25) THE RUBRUM FUND 7 CLIFFORD STREET LONDON W1S 2FT UK	INVESTMENTS	UK	NA	C CORP
(26) TVC MATSU FUND 89 NEXUS WAY CAYMANA BAY GRAND CAYMAN KY1-9009 CJ	INVESTMENTS	CJ	NA	C CORP
(27) VERMILION PEAK FUND PO BOX 309 UGLAND HOUSE GRAND CAYMAN KY1-1104 CJ 98-1333885	INVESTMENTS	CJ	NA	C CORP
(28) WOODBOURNE CANADA PARTNERS II - CAYMAN 190 ELGIN AVE GRAND CAYMAN KY1-9005 CJ 98-0705321	INVESTMENTS	CJ	NA	C CORP

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) UNIVERSITY HEALTHCARE ALLIANCE	P	2,767,648	COST
(2) UNIVERSITY HEALTHCARE ALLIANCE	Q	3,068,817	COST

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation
SCHEDULE R, PART III, COLUMNS (E), (F), (G), (H), (I), (J), AND (K)	RESPONSE IS "N/A" FOR ALL ORGANIZATIONS.
SCHEDULE R, PART IV	CHARITABLE LEAD ANNUITY TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. CHARITABLE LEAD UNITRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. CHARITABLE REMAINDER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. OTHER TRUSTS ARE PRINCIPALLY DOMICILED IN CALIFORNIA. POOLED INCOME FUNDS ARE PRINCIPALLY DOMICILED IN CALIFORNIA.
SCHEDULE R, PART IV, COLUMNS (F), (G), AND (H)	RESPONSE IS "N/A" FOR ALL ORGANIZATIONS.

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	1,584
6	Total number of volunteers (estimate if necessary) .............	6	70
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	373,078
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	181,028

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	12,293,109	5,313,093
9	Program service revenue (Part VIII, line 2g) .........	347,183,776	413,718,364
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	394,152	389,027
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	897,982	445,594
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	360,769,019	419,866,078
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	202,000
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	187,556,128	205,057,377
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 450,000
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	161,649,952	200,953,809
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	349,206,080	406,213,186
19	Revenue less expenses. Subtract line 18 from line 12.......	11,562,939	13,652,892
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	347,907,183	370,813,783
21	Total liabilities (Part X, line 26).............	156,295,953	165,549,661
22	Net assets or fund balances. Subtract line 21 from line 20.....	191,611,230	205,264,122

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 368,901,416 including grants of $ 202,000 ) (Revenue $ 415,208,923 )
	SEE SCHEDULE O.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses368,901,416

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) RYAN DEGRAFF........................................................................ VP OPERATIONS (UNTIL 09/21)	50.0 .......................0.0			X		195,244	0	33,341
(19) DIANE GRUNSKY........................................................................ SECRETARY	49.6 .......................0.4		X			125,257	0	18,573
(20) JACQUELINE STEIN........................................................................ FORMER SECRETARY	50.0 .......................0.0				X	127,130	0	7,249
(21) ALCINA WEGRZYNOWSKI........................................................................ DIRECTOR	1.6 .......................0.0	X				0	0	0
(22) JOHN SENSIBA........................................................................ CHAIR	1.6 .......................0.2	X				0	0	0
(23) RANDY POND........................................................................ DIRECTOR	1.6 .......................0.2	X				0	0	0
(24) REENA JADHAV........................................................................ DIRECTOR	1.6 .......................0.2	X				0	0	0
(25) KAYE FOSTER........................................................................ DIRECTOR	1.6 .......................2.2	X				0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	4,830,392	11,866,609	1,735,042

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	5,003,503

f	All other contributions, gifts, grants, and similar amounts not included above		1f	309,590

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		5,313,093

		Business Code
2a	PATIENT SERVICES	621990	413,718,364	413,345,286	373,078
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		413,718,364

3 Investment income (including dividends, interest, and othersimilar amounts) ......			389,027			389,027
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		2,419,162	6a
b	Less: rental expenses		3,464,127	6b
c	Rental income or (loss)	0	-1,044,965	6c
d	Net rental income or (loss).......			-1,044,965			-1,044,965
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	DIETARY SERVICES		900099	552,237	552,237
b	CLINICAL REVENUE		900099	312,932	312,932
c	REBATE ON AGREEMENTS		900099	312,623	312,623
d	All other revenue ....			312,767	312,767
e	Total. Add lines 11a–11d ......			1,490,559
12	Total revenue. See instructions.....			419,866,078	414,835,845	373,078	-655,938

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	202,000	202,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	3,431,269		3,431,269
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	143,374,648	134,280,131	8,805,158	289,359
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,792,100	5,265,914	526,186
9	Other employee benefits .......	42,052,221	39,366,280	2,525,300	160,641
10	Payroll taxes ...........	10,407,139	9,461,697	945,442
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	1,376,791	4,536	1,372,255
c	Accounting ...........	218,297		218,297
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	48,433,487	46,374,738	2,058,749
12	Advertising and promotion ....	0
13	Office expenses .......	2,128,498	1,089,346	1,039,152
14	Information technology ......	25,962,276	16,096,611	9,865,665
15	Royalties ..	0
16	Occupancy ...........	9,619,025	9,350,787	268,238
17	Travel ............	72,307	59,938	12,369
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	170,905	153,675	17,230
20	Interest ...........	1,876,487	1,876,487
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	11,998,169	11,900,064	98,105
23	Insurance ...	3,559,682	3,164,099	395,583
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	55,124,592	54,570,596	553,996
b	PURCHASED SERVICES	21,940,247	19,318,225	2,622,022
c	HOSPITAL QUALITY ASSUR FEE	15,430,122	15,430,122
d	LICENSE, TAX AND FEES	282,844	91,222	191,622
e	All other expenses	2,760,080	844,948	1,915,132
25	Total functional expenses. Add lines 1 through 24e	406,213,186	368,901,416	36,861,770	450,000
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			7,383	1	3,229
2	Savings and temporary cash investments .........			5,593,240	2	5,804,933
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			39,410,039	4	50,605,384
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			7,359,218	8	8,400,730
9	Prepaid expenses and deferred charges ......			11,066,578	9	9,155,973
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	350,351,432
b	Less: accumulated depreciation	10b	101,477,386	175,680,432	10c	248,874,046
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			385,272	14	281,692
15	Other assets. See Part IV, line 11 ...........			108,405,021	15	47,687,796
16	Total assets. Add lines 1 through 15 (must equal line 33)...			347,907,183	16	370,813,783

17	Accounts payable and accrued expenses .....	41,604,254	17	40,654,938
18	Grants payable ...	0	18	0
19	Deferred revenue .........	12,500,811	19	13,457,748
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	102,190,888	25	111,436,975
26	Total liabilities. Add lines 17 through 25..	156,295,953	26	165,549,661

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	185,699,101	27	201,136,759
28	Net assets with donor restrictions ...........	5,912,129	28	4,127,363
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	191,611,230	32	205,264,122
33	Total liabilities and net assets/fund balances ........	347,907,183	33	370,813,783