Existing law provides for the licensure and regulation of health facilities, including general acute care hospitals, by the State Department of Public Health.

This bill would require covered hospitals and medical entities, as defined, to annually submit to the Office of Statewide Health Planning and Development an executive compensation report for every executive whose annual compensation exceeds a specified threshold. The bill would also require each covered hospital or medical entity with 100 or more employees to annually report compensation information by employee classification and by gender, ethnicity, race, sexual orientation, and gender identity, as self-reported by its employees. The bill would require specified information to be included in these reports, and would require that certain reports be attested to under penalty of perjury. Because a violation thereof would be a crime, the bill would impose a state-mandated local program. The bill would authorize the office to impose a reasonable fee to cover the costs of implementation and administration of these provisions. The bill would require the office to post these reports on its Internet Web site.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of health facilities, including general acute care hospitals, by the State Department of Public Health.

This bill would require covered hospitals and medical entities, as defined, to annually submit to the Office of Statewide Health Planning and Development an executive compensation report for every executive whose annual compensation exceeds a specified threshold. The bill would also require each covered hospital or medical entity with 100 or more employees to annually report compensation information by employee classification and by gender, ethnicity, race, sexual orientation, and gender identity, as self-reported by its employees. The bill would require specified information to be included in these reports, and would require that certain reports be attested to under penalty of perjury. Because a violation thereof would be a crime, the bill would impose a state-mandated local program. The bill would authorize the office to impose a reasonable fee to cover the costs of implementation and administration of these provisions. The bill would require the office to post these reports on its Internet Web site.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of health facilities, including general acute care hospitals, by the State Department of Public Health.

This bill would require covered hospitals and medical entities, as defined, to annually submit to the Office of Statewide Health Planning and Development an executive compensation report for every executive whose annual compensation exceeds a specified threshold. The bill would also require each covered hospital or medical entity with 100 or more employees to annually report compensation information by employee classification and by gender, ethnicity, race, sexual orientation, and gender identity, as self-reported by its employees. The bill would require specified information to be included in the report, and include a requirement these reports, and would require that certain reports be attested to under penalty of perjury. Because a violation thereof would be a crime, the bill would impose a state-mandated local program. The bill would authorize the office to impose a reasonable fee to cover the costs of implementation and administration of these provisions. The bill would require the office to post these reports on its Internet Web site.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law provides for the licensure and regulation of health facilities, including general acute care hospitals, by the State Department of Public Health.

This bill would require covered hospitals and medical entities, as defined, to annually submit to the Office of Statewide Health Planning and Development an executive compensation report for every executive whose annual compensation exceeds a specified threshold. The bill would require specified information to be included in the report, and include a requirement that certain reports be attested to under penalty of perjury. Because a violation thereof would be a crime, the bill would impose a state-mandated local program. The bill would authorize the office to impose a reasonable fee to cover the costs of implementation and administration of these provisions. The bill would require the office to post these reports on its Internet Web site.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

ASSEMBLY THIRD READING

ATR Bill Id:AB 2467

Author:(Gomez)

As Amended Ver:May 31, 2016

Majority vote

SUMMARY: Establishes the Hospital Executive Compensation Transparency Act of 2016 which requires covered hospitals or medical entities, as defined, to submit an annual hospital executive compensation report to the Office of Statewide Health Planning and Development (OSHPD) which provides specified information regarding executives earning over $300,000 per year; and, for covered hospitals or medical entities with 100 or more employees, requires the report to also include information regarding the pay bands of various employee classifications, as well as voluntarily self-reported information regarding employees' gender, ethnicity, race, sexual orientation, and gender identity, by job categories. Specifically, this bill:

1. Requires, on and after October 1, 2017, each covered hospital or medical entity to submit an annual hospital executive compensation report (annual report) to OSHPD for every hospital executive whose total annual compensation met or exceeded the executive compensation reporting threshold (EXCRT).
2. Requires the annual report to include all of the following information for the prior fiscal year:
   1. The names, positions, or titles of each hospital executive and the aggregate total annual compensation for each hospital executive at or exceeding the EXCRT, with a description of each entity that has contributed to the total annual compensation of each hospital executive, in any form, and the amount of such compensation;
   2. A detailed breakdown of all wage and nonwage compensation;
   3. Identification of any benefit or remuneration excluded from the definition of total annual compensation; and,
   4. A detailed breakdown of board compensation, which shall include all of the following:
      1. The name of the publicly traded company, privately held company, or nonprofit organization that provided the board compensation; and,
      2. The number of hours the hospital executive spent on matters related to their duties as a director of the publicly traded company, privately held company, or nonprofit organization for which the board compensation was received.
3. Requires, consistent with the federal annual equal employment opportunity and compensation report on employees' ethnicity, race, and sex by job category and compensation, on or after October 1, 2017, and annually thereafter each covered hospital or medical entity with 100 or more employees to submit to the Department of Public Health all of the following information for the prior fiscal year:
   1. The number of employees earning annual total compensation in 12 pay bands, as proposed by the federal Equal Employment Opportunity Commission (EEOC) in the Federal Register, Volume 81 Number 20, on February 1, 2016, on pages 5113 to 5121, inclusive, for each of the eight employee classifications defined in OSHPD's hospital annual financial data and by self-reported gender, ethnicity, and race, and voluntarily self-reported sexual orientation and gender identity; and,
   2. The total number of hours worked by the employees included in each pay band.
4. Requires OSHPD, on and after January 1, 2018, to post the annual hospital executive compensation report for each covered hospital or medical entity on OSHPD's Internet Web site. Requires the report to be submitted on the form or in the format required by OSHPD.
5. Requires the board of directors (BOD) of any nonprofit or for-profit corporation that owns, operates, or controls, in whole or in part, a covered hospital or medical entity to approve the annual report before it is submitted to OSHPD, and requires each director to act in good faith and with reasonable care and inquiry in approving the annual report and in ensuring the corporation complies with the requirements of this bill.
6. Requires the annual report for each covered hospital or medical entity governed, owned, or controlled by a BOD, to state that it was approved by the BOD, the date it was approved, and contain an attestation under penalty of perjury by an authorized representative of the covered hospital or medical entity BOD, as specified.
7. Specifies that any scheme or artifice that has the purpose of avoiding the reporting requirements of this bill is a violation of this bill.
8. Specifies that payments, compensation, or remuneration by a separate entity that is purported not to be for work performed or services provided at or for a covered hospital or medical entity, but that is disproportionate to its purported purpose so as to evade the annual hospital executive compensation reporting requirements is a violation of this bill.
9. Requires OSHPD to establish and assess reasonable fees, to be submitted with each annual report to cover only the reasonable costs of implementing and ensuring compliance with this bill.
10. Defines board compensation as the total annual compensation provided to each hospital executive by any publicly traded company, privately held company, or nonprofit organization on whose BOD hospital executive sits and from which the hospital executive received total annual compensation of more than $1,000.
11. Defines covered hospital or medical entity as any of the following:
    1. A private nonprofit general acute care hospital;
    2. An acute psychiatric hospital;
    3. Any private for-profit general acute care hospital;
    4. A hospital group, or any person, corporation, partnership, limited liability company, trust, or other entity that owns, operates or controls, in whole or in part, any such group;
    5. A hospital-affiliated medical foundation that is directly or indirectly, including through one or more intermediaries, controlled or owned by, or controlled or owned by the same person or entity as, a hospital, hospital group, hospital-affiliated physicians group, or nonprofit corporation that owned, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated physicians group. Specifies that a medical foundation will be deemed a hospital-affiliated medical foundation if either or both of the following are true:
       1. The medical foundation is a disregarded entity of, or would be required to be designated as a related organization on the Internal Revenue Service (IRS) form 900 (or its accompanying schedules or the successor of such forms or schedule) of, a hospital, hospital group, hospital-affiliated physicians group, or a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated physicians group; and/or;
       2. A majority of the medical foundation's assets are owned by a hospital, hospital group, or hospital-affiliated physicians group or by a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated physicians group or of a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated physicians group;
    6. A hospital-affiliated physicians group, is any physicians group or medical group that is directly or indirectly, including through one or more intermediaries, controlled or owned by, or controlled or owned by the same person or entity as, a hospital, hospital group, hospital-affiliated medical foundation, or a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated medical foundation. A physicians group shall be deemed a hospital-affiliated physicians group if either or both of the following are true:
       1. The physicians group is a disregarded entity of, or would be required to be designated as a related organization on IRS form 990 (or its accompanying schedules or the successor of such forms or schedules) of, a hospital, hospital group, or hospital-affiliated medical foundation or a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated medical foundation; and/or,
       2. A majority of the physicians group's assets are owned by a hospital, hospital group, or hospital-affiliated medical foundation or a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated medical foundation.
    7. A health care district.
12. Exempts the following from the definition of a covered hospital or medical entity:
    1. Hospitals operated or licensed by the United States Department of Veterans Affairs or public hospitals, with the exception of hospitals owned or operated by a health care district; and,
    2. Designated public hospitals, as defined.
13. Specifies that EXCRT means the total annual compensation from any source for work performed or services provided at or for the covered hospital or medical entity that is greater than three hundred thousand dollars ($300,000) in a year.
14. Specifies that hospital executive means all persons whose primary duties are executive, managerial, or administrative at or for the covered hospital or medical entity, even if that person also performs or performed other duties.
15. Specifies that hospital executive includes, but is not limited to, chief executive officers (CEOs), chief executive managers, chief executives, executive officers, executive directors, chief financial officers (CFOs), presidents, executive presidents, vice presidents, executive vice presidents, and other comparable positions.
16. Specifies that the definition of hospital executive applies irrespective of whether the person exercising executive, managerial, or administrative authority is or was an employee of a covered hospital or medical entity or a nonprofit corporation that owns, operates, or controls, in whole or in part, a covered hospital or medical entity. The definition shall also apply to any person who exercises or exercised such authority even if the arrangements for such authority or for compensation or both are pursuant to a contract or subcontract.
17. Specifies that the definition of hospital executive includes any person who held the duties described in these provisions during the period covered by the annual report, even if the person is postemployment or post-service.
18. Specifies that the definition of a hospital executive does not apply to medical or health care professionals whose primary duties are or were the provision of medical services, research, direct patient care, or other non-managerial, nonexecutive, and non-administrative services.
19. Specifies that total annual compensation means all remuneration paid, earned, or accrued in the course of a fiscal year for work performed or services provided, including the cash value of all remuneration (including benefits) in any medium other than cash, and including, but not limited to, all of the following:
    1. Wages; salary; paid time off; bonuses; incentive payments; lump-sum cash payments; the fair market value of below-market-rate loans or loan forgiveness; housing payments; payments for transportation, travel, meals, or other expenses in excess of actual documented expenses incurred in the performance of duties; payments or reimbursement for entertainment or social club memberships; the cash value of housing, automobiles, parking, or similar benefits; scholarships or fellowships; the cash value of dependent care or adoption assistance or personal legal or financial services; the cash value of stock options or awards; payments or contributions for insurance, except as exempted in 20) below, to a Section 125 cafeteria plan or equivalent arrangement, to a health savings account, or for severance or its equivalent; and deferred compensation earned or accrued, even if not yet vested nor paid;
    2. The total value in the aggregate of the compensation or payments authorized or paid under a severance or similar post-service or post-employment arrangement, to include the fair market value of all cash remuneration as well as the fair market value of all remuneration (including benefits) paid in any medium other than cash;
    3. Payments, compensation, or remuneration for work performed or services provided at or for a covered hospital or medical entity even if made by a separate person or entity, including, but not limited to, any of the following:
       1. A for-profit or unincorporated entity;
       2. A corporation, partnership, or limited liability company;
       3. A trust or other entity that is controlled by the same person or persons who govern a covered hospital or medical entity;
       4. A supporting or supported organization within the meaning of the Internal Revenue Code Sections 509(a)(3) and 509(f)(3); or,
       5. A disregarded entity of, or related organization as set forth within, the IRS form 990 of a covered hospital or medical entity or a nonprofit corporation that owns, operates, or controls, in whole or in part, a covered hospital or medical entity.
    4. Payment of compensation or remuneration by any person, corporation, partnership, limited liability company, trust, or other entity that a covered hospital or medical entity, or a nonprofit corporation that owns, operates, or controls, in whole or in part, a covered hospital or medical entity, participates in, belongs to, is a member of, or pays into shall be presumed compensation for work performed or services provided at or for the covered hospital or medical entity.
20. Specifies that total annual compensation does not include the cost of health insurance or disability insurance or payments or contributions to a health reimbursement account.

FISCAL EFFECT: According to the Assembly Appropriations Committee, staff and information technology costs to OSHPD of $390,000 in year one, $240,000 in year two, and ongoing costs of $110,000 to implement this bill (fee-supported by fee revenue authorized pursuant to this bill). One-time activities include development of regulations, preparation of system requirements and design documents, information technology system testing, Ongoing activities include reviewing reports, researching which unlicensed entities must report, contacting report entities with missing or delinquent reports and addressing questions from the public and policy makers.

COMMENTS: According to the author, currently there is little transparency over whether for-profit or non-profit hospitals use taxpayer dollars to provide high-quality, affordable medical care, or if funds are being diverted to exorbitant executive compensation packages. The author states that this bill ensures more accountability and transparency in an otherwise opaque environment.

Rising healthcare costs. The United States (U.S.) Census Bureau has published new estimates of health spending based on their Quarterly Services Survey, published on March 10, 2016. Analysis of the survey data shows that health spending was 7.3% higher in the first quarter of 2015 than in the first quarter of last year. Hospital spending increased 9.2%. A Kaiser Family Foundation analysis of the data concludes that greater use of health services, as well as more people covered by the Patient Protection and Affordable Care Act appear to be responsible for most of the increase, noting that people are beginning to use more physician and outpatient services again as the economy improves and that the number of days people spent in hospitals also rose.

Executive compensation. According to the proponents of this bill, little is known about what factors drive health care costs, however they point to the fact that hospital executive compensation has spiked in recent years. According to the healthcare industry publication "Payers & Providers," 66 executives at the state's three largest hospital systems (Sutter Health, Dignity Health, and Kaiser Permanente) earned more than $1 million each in 2013, up from 52 executives just two years before.

Publicly available information.

1. Non-profit entities. The IRS 990, officially, the "Return of Organization Exempt from Income Tax" is an IRS form that provides the public with financial information about a non-profit organization. It is often the only source of such information. Non-profit hospitals are required to file the form 990 in order to maintain their non-profit/tax-exempt status. However, only the top 20 wage earners over $150,000 have to be identified on the forms, and due to differing corporate structures of hospitals and hospital systems, the data is not easily comparable. For example, Kaiser is one corporate entity with two branches, North and South. Their 990 covers their hospitals and health plan, however their medical group (the doctors) are a for profit entity, so their salaries are not included on the 990. Conversely, Dignity Health (Dignity) files a single 990 for the entire system. The top 20 wage earners on Dignity's form are system-wide employees, so their 990 excludes many CEOs.

According a June 30, 2015 article published in the Chronicle of Philanthropy, the IRS is working on a technology that should allow it to release electronic version of the form 990 by early this year, which would make it much easier for the public to search for information about non-profit finances and operations.

1. For-profit entities. Publicly traded companies report significant amounts of financial data to shareholders and the government in their annual U.S. Securities and Exchange Commission (SEC) filings. Several documents that companies are required to file include information about the company's executive compensation policies and practices including; the company's annual proxy statement; the company's annual report; and, registration statements filed by the company to register securities for sale to the public. The information is available on the SEC's searchable database, EDGAR.
2. Private for-profit entities. Privately owned for-profit hospitals are not required to report on their executive's salaries. Of the 105 for-profit hospitals in the state, approximately 50 are not publicly traded, and do not report salary information.

Federal annual equal employment opportunity and compensation report (EEO-1 Report). The EEO-1 Report is a compliance survey mandated by federal statute and regulations. The survey requires company employment data to be categorized by race/ethnicity, gender and job category. On January 29, 2016, the EEOC announced proposed changes to its EEO-1 report, which requires employers to submit employee W-2 earnings and hours worked. Under the proposal, all employers with at least 100 employees (not just federal contractors) would be required to comply. In addition, the proposed changes will require the submission of payroll data broken down by race/ethnicity, in addition to gender. The data would be made available to the EEOC and the Office of Federal Contract Compliance Programs for enforcement purposes. The proposed rule was published on February 1, 2016 and interested parties have 60 days to submit comments.

The EEOC proposing to change the reporting requirements to include the data on employees' earnings and hours worked, beginning in 2017. The EEOC's proposed pay bands (which are included in the reporting provisions of this bill) are as follows:

1. $19, 239 and under;
2. $19,240 - $24, 439;
3. $24,440 - $30,679;
4. $30,680 - $38,999;
5. $39,000 – $49,919;
6. $49,920 - $62,919;
7. $62,920 - $80,079;
8. $80,080 - $101,919
9. $128,960 - $163,799;
10. $163,800 - $207,999; and,
11. $208,000 and over.

The EEOC is prohibited from making public the employment data derived from any of its compliance surveys. The EEOC uses EEO-1 data to support civil rights enforcement and to analyze employment patterns, such as the representation of female and minority workers within companies, industries or regions. The EEOC is not proposing to require an employer to begin collecting additional data on actual hours worked for salaried workers, to the extent that the employer does not currently maintain such information.

Self-reported employee information. According to the Human Rights Campaign (HRC) unlike other diversity categories, such as race and gender, employers are not required to collect statistics on the number of lesbian, gay, bisexual, and transgender (LGBT) people they employ. Employers have sought to determine the number of their employees who identify as LGBT while balancing privacy concerns. Some employers use LGBT employee group membership numbers to generate estimates, but this method is limited by the scope of such voluntary groups over a highly dispersed workforce. More recently, employers have gathered statistics through anonymous employee engagement or satisfaction surveys, which can include upward of 100 questions, and through confidential and secure employee records. In both cases, whether an employee discloses their gender identity or sexual orientation is optional and voluntary and any reporting or direct access to the data is designed to ensure confidentiality of the employee. In the HRC Corporate Equality Index 2015 survey of 781 employers, 46% allow employees to voluntarily disclose their sexual orientation and gender identity on anonymous surveys or confidential Human Resource records, compared with 141 of the 519 employers (27%) in the 2008 survey and just 17% in the 2006 survey.

The California State Council of the Service Employees International Union (SEIU California) supports this bill, stating, while California public hospitals (city, county, or University of California) are already required to provide complete salary information for all employees through the Controller, which publicly reports these data, significant gaps and inconsistencies exist for our understanding of not-for-profit and for-profit hospitals.

Hospitals which are publicly-traded must disclose executive compensation for their CEO, CFO, and the next three top paid employees company-wide to the SEC, which seldom capture their California executives if the firm is national. SEIU California continues, with nonprofits, the public makes a significant investment in the form of over a billion a year in tax exemptions in California, but nonprofit hospitals must only disclose their top five highest compensated employees, beyond their officers and directors, which often obfuscates individual hospital CEO compensation, particularly at large multi-facility nonprofit hospital chains. In each of these examples there has already been established a compelling policy reason to understand how top executives are being paid – for the sake of understanding public investments, and informing private investor decision-making – but the reporting requirements in each case are different in scope and detail and ultimately become of little use in very large nonprofit chains or national companies, especially for national systems not based in California. SEIU California notes that, at issue for non-profit operated hospitals is the need to better understand whether the state's investment through tax breaks and others subsidies leads hospitals to provide more charity care and community benefits, or whether it simply serves as a mechanism to provide hospital executives with more excessive pay. SEIU California points to a 2015 study published in Health Affairs that found that California's nonprofit hospitals spent the same amount on uncompensated care as for-profit hospitals, which suggests greater accountability is warranted. SEIU California concludes this bill will align hospital executive compensation reporting for all non-profit and for-profit hospitals, including investor owned hospitals, and consolidate that reporting within OSHPD, which already collects and reports a myriad of different hospital financial data.

The California Labor Federations states that increasing transparency of CEO compensation at hospitals is a first step in examining all cost drivers in health care, starting at the top of the hospital chain, and given that the largest California hospitals are non-profits, taxpayers should have access to the compensation and other data about hospitals that they support with tax breaks.

The California Hospital Association (CHA) opposes this bill and states that hospitals and health systems are not opposed to transparency; many hospitals currently report much of the information sought and it is available to the public, however this bill only increases hospital costs and discloses private compensation information without any justification. CHA also notes that the bill raises significant privacy concerns for a broad array of employees, extending to exempt employees, not just executives, thus nurse managers or information technology personnel whose total compensation meets for exceeds $250,000 annually would be reported. CHA notes that in many organizations, particularly in urban areas, this reporting threshold would reach deep into the organization. The Hospital Corporation of America states it is concerned about the unintended consequences of public reporting of salaries, noting that it could actually drive up labor costs where employees and applicants use the salary information as benchmarks for the myriad of hard to fill positions in health care.

The California Chamber of Commerce (the Chamber) states that this bill inappropriately assumes that hospital executive compensation is a major driver of overall health care spending. The Chamber notes that hospital executives play a critical role in ensuring that millions of Californians receive quality health care services, even as cost pressures and increasing demand for hospital services are making it harder and harder for many hospitals to keep their doors open.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003260

Date of Hearing: May 4, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 2467

Author:(Gomez) – As Amended Ver:April 21, 2016

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill requires hospitals and medical groups to report information about employee compensation. Specifically, this bill:

1. Requires, on and after October 1, 2017, covered hospitals or medical entities, as defined, to submit an annual hospital executive compensation report to the Office of Statewide Health Planning and Development (OSHPD) for every hospital executive whose total annual compensation meets or exceeds $250,000 per year.
2. Requires reporting the number of employees earning annual total compensation in 12 pay bands, as well as demographic data including self-reported gender, ethnicity, and race, and voluntarily self-reported sexual orientation and gender identity.
3. Requires OSHPD to establish and assess reasonable fees, to be submitted with each annual report, to cover only the reasonable costs of implementation and ensuring compliance.

FISCAL EFFECT:

Staff and information technology costs to OSHPD of $390,000 in year 1, $240,000 in year 2, and ongoing costs of $110,000 to implement this bill (fee-supported by fee revenue authorized pursuant to this bill).

One-time activities include development of regulations, preparation of system requirements and design documents, information technology system testing,  Ongoing activities include reviewing reports, researching which unlicensed entities must report, contacting report entities with missing or delinquent reports and addressing questions from the public and policy makers.

COMMENTS:

1. Purpose. This bill is intended to assess how hospital executive compensation is contributing to overall rising health care costs and to provide data related to pay equity in California hospitals.
2. Background. The level and growth of corporate executive compensation across the United States has been a topic of significant media attention and public dialogue in recent years. Hospitals and hospital systems are complex for-profit, non-profit, and public organizations that provide executive compensation packages to attract and retain executives. Not-for-profit hospitals must report certain compensation information on federal Internal Revenue Service form 990, but this is reported at the hospital system level, not the individual hospital level. For-profit publicly traded hospitals must report salaries for the five most highly compensated employees, while private for-profit hospitals have no existing requirement. This bill would enhance existing compensation-related reporting requirements and expand reporting to more entities.

This bill also requires submission of pay data similar to that required by recently proposed federal regulations. Gender inequity in pay, as well as underrepresentation of females in senior management, have been noted in the health care sector. This bill would add demographic information to allow analysis of pay data by demographic variables.

1. Support. The sponsor of this bill, Service Employees International Union (SEIU), asserts hospital executive compensation has spiked to excessive levels in recent years, and that requiring public reporting will assist the public and health care stakeholders to understand these compensation practices, and how they may relate to the level of charity care or community benefits provided, as well as their impact on prices and utilization. Furthermore, they cite a lack of data on pay equity among the workforce at California hospitals, and believe increased transparency will increase understanding of such inequity. Labor organizations including the California Labor Federation and the United Nurses Association of California/Union of Healthcare Professionals, as well as LGBT advocacy groups, also support this bill.
2. Opposition. The California Hospital Association opposes this bill, citing a lack of connection between executive compensation and charity care, requirements that are both duplicative and onerous, significant privacy and safety concerns, concern about the reliability of self-reported data, concern the bill could actually drive up compensation by providing a basis for executives or boards to increase wages, and prematurity, given federal rules on pay equity reporting are forthcoming. The California Chamber of Commerce and numerous individual hospitals and health systems also oppose this bill.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 19, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2467

Author:(Gomez) – As Amended Ver:April 5, 2016

SUBJECT: Health facilities: executive compensation.

SUMMARY: Establishes the Hospital Executive Compensation Transparency Act of 2016 which requires covered hospitals or medical entities, as defined, to submit an annual hospital executive compensation report to the Office of Statewide Health Planning and Development (OSHPD) which provides specified information regarding executives earning over $250,000 per year; and, for covered hospitals or medical entities with 100 or more employees, requires the report to also include information regarding the pay bands of various employee classifications, as well as voluntarily self-reported information regarding employees' gender, ethnicity, race, sexual orientation, and gender identity, by job categories. Specifically, this bill:

1. Requires, on and after October 1, 2017, each covered hospital or medical entity to submit an annual hospital executive compensation report (annual report) to OSHPD for every hospital executive whose total annual compensation met or exceeded the executive compensation reporting threshold (EXCRT).
2. Requires the annual report to include all of the following information for the prior fiscal year:
   1. The names, positions, or titles of each hospital executive and the aggregate total annual compensation for each hospital executive at or exceeding the EXCRT, with a description of each entity that has contributed to the total annual compensation of each hospital executive, in any form, and the amount of such compensation;
   2. A detailed breakdown of all wage and nonwage compensation;
   3. Identification of any benefit or remuneration excluded from the definition of total annual compensation; and,
   4. A detailed breakdown of board compensation, which shall include all of the following:
      1. The name of the publicly traded company, privately held company, or nonprofit organization that provided the board compensation; and,
      2. The number of hours the hospital executive spent on matters related to their duties as a director of the publicly traded company, privately held company, or nonprofit organization for which the board compensation was received.
3. Requires, consistent with the federal annual equal employment opportunity and compensation report on employees' ethnicity, race, and sex by job category and compensation, on or after October 1, 2017, and annually thereafter each covered hospital or medical entity with 100 or more employees to submit to OSHPD all of the following information for the prior fiscal year:
   1. The number of employees earning annual total compensation in 12 pay bands, as proposed by the federal Equal Employment Opportunity Commission (EEOC) in the Federal Register, Volume 81 Number 20, on February 1, 2016, on pages 5113 to 5121, inclusive, for each of the eight employee classifications defined in OSHPD’s hospital annual financial data and by self-reported gender, ethnicity, and race, and voluntarily self-reported sexual orientation and gender identity; and,
   2. The total number of hours worked by the employees included in each pay band.
4. Requires OSHPD, on and after January 1, 2018, to post the annual hospital executive compensation report for each covered hospital or medical entity on OSHPD's Internet Website. Requires the report to be submitted on the form or in the format required by OSHPD.
5. Requires the board of directors (BOD) of any nonprofit or for-profit corporation that owns, operates, or controls, in whole or in part, a covered hospital or medical entity to approve the annual report before it is submitted to OSHPD, and requires each director to act in good faith and with reasonable care and inquiry in approving the annual report and in ensuring the corporation complies with the requirements of this bill.
6. Requires the annual report for each covered hospital or medical entity governed, owned, or controlled by a BOD, to state that it was approved by the BOD, the date it was approved, and contain an attestation under penalty of perjury by an authorized representative of the covered hospital or medical entity BOD, as specified.
7. Specifies that any scheme or artifice that has the purpose of avoiding the reporting requirements of this bill is a violation of this bill.
8. Specifies that payments, compensation, or remuneration by a separate entity that is purported not to be for work performed or services provided at or for a covered hospital or medical entity, but that is disproportionate to its purported purpose so as to evade the annual hospital executive compensation reporting requirements is a violation of this bill.
9. Requires OSHPD to establish and assess reasonable fees, to be submitted with each annual report to cover only the reasonable costs of implementing and ensuring compliance with this bill.
10. Defines board compensation as the total annual compensation provided to each hospital executive by any publicly traded company, privately held company, or nonprofit organization on whose BOD hospital executive sits and from which the hospital executive received total annual compensation of more than one thousand dollars ($1,000).
11. Defines covered hospital or medical entity as any of the following:
    1. A private nonprofit general acute care hospital;
    2. An acute psychiatric hospital;
    3. Any private for-profit general acute care hospital;
    4. A hospital group, or any person, corporation, partnership, limited liability company, trust, or other entity that owns, operates or controls, in whole or in part, any such group;
    5. A hospital-affiliated medical foundation that is directly or indirectly, including through one or more intermediaries, controlled or owned by, or controlled or owned by the same person or entity as, a hospital, hospital group, hospital-affiliated physicians group, or nonprofit corporation that owned, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated physicians group. Specifies that a medical foundation will be deemed a hospital-affiliated medical foundation if either or both of the following are true:
       1. The medical foundation is a disregarded entity of, or would be required to be designated as a related organization on the Internal Revenue Service (IRS) form 900 (or its accompanying schedules or the successor of such forms or schedule) of, a hospital, hospital group, hospital-affiliated physicians group, or a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated physicians group; and/or;
       2. A majority of the medical foundation's assets are owned by a hospital, hospital group, or hospital-affiliated physicians group or by a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated physicians group or of a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated physicians group;
    6. A hospital-affiliated physicians group, is any physicians group or medical group that is directly or indirectly, including through one or more intermediaries, controlled or owned by, or controlled or owned by the same person or entity as, a hospital, hospital group, hospital-affiliated medical foundation, or a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated medical foundation. A physicians group shall be deemed a hospital-affiliated physicians group if either or both of the following are true:
       1. The physicians group is a disregarded entity of, or would be required to be designated as a related organization on IRS form 990 (or its accompanying schedules or the successor of such forms or schedules) of, a hospital, hospital group, or hospital-affiliated medical foundation or a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated medical foundation; and/or,
       2. A majority of the physicians group’s assets are owned by a hospital, hospital group, or hospital-affiliated medical foundation or a nonprofit corporation that owns, operates, or controls, in whole or in part, a hospital, hospital group, or hospital-affiliated medical foundation.
    7. A health care district.
12. Exempts the following from the definition of a covered hospital or medical entity:
    1. Hospitals operated or licensed by the United States Department of Veterans Affairs or public hospitals, with the exception of hospitals owned or operated by a health care district; and,
    2. Designated public hospitals, as defined.
13. Specifies that EXCRT means the total annual compensation from any source for work performed or services provided at or for the covered hospital or medical entity that is greater than two hundred fifty thousand dollars ($250,000) in a year.
14. Specifies that hospital executive means all persons whose primary duties are executive, managerial, or administrative at or for the covered hospital or medical entity, even if that person also performs or performed other duties.
15. Specifies that hospital executive includes, but is not limited to, chief executive officers, chief executive managers, chief executives, executive officers, executive directors, chief financial officers, presidents, executive presidents, vice presidents, executive vice presidents, and other comparable positions.
16. Specifies that the definition of hospital executive applies irrespective of whether the person exercising executive, managerial, or administrative authority is or was an employee of a covered hospital or medical entity or a nonprofit corporation that owns, operates, or controls, in whole or in part, a covered hospital or medical entity. The definition shall also apply to any person who exercises or exercised such authority even if the arrangements for such authority or for compensation or both are pursuant to a contract or subcontract.
17. Specifies that the definition of hospital executive includes any person who held the duties described in these provisions during the period covered by the annual report, even if the person is postemployment or post-service.
18. Specifies that the definition of a hospital executive does not apply to medical or health care professionals whose primary duties are or were the provision of medical services, research, direct patient care, or other non-managerial, nonexecutive, and non-administrative services.
19. Specifies that total annual compensation means all remuneration paid, earned, or accrued in the course of a fiscal year for work performed or services provided, including the cash value of all remuneration (including benefits) in any medium other than cash, and including, but not limited to, all of the following:
    1. Wages; salary; paid time off; bonuses; incentive payments; lump-sum cash payments; the fair market value of below-market-rate loans or loan forgiveness; housing payments; payments for transportation, travel, meals, or other expenses in excess of actual documented expenses incurred in the performance of duties; payments or reimbursement for entertainment or social club memberships; the cash value of housing, automobiles, parking, or similar benefits; scholarships or fellowships; the cash value of dependent care or adoption assistance or personal legal or financial services; the cash value of stock options or awards; payments or contributions for insurance, except as exempted in 20) below, to a Section 125 cafeteria plan or equivalent arrangement, to a health savings account, or for severance or its equivalent; and deferred compensation earned or accrued, even if not yet vested nor paid;
    2. The total value in the aggregate of the compensation or payments authorized or paid under a severance or similar post-service or post-employment arrangement, to include the fair market value of all cash remuneration as well as the fair market value of all remuneration (including benefits) paid in any medium other than cash;
    3. Payments, compensation, or remuneration for work performed or services provided at or for a covered hospital or medical entity even if made by a separate person or entity, including, but not limited to, any of the following:
       1. A for-profit or unincorporated entity;
       2. A corporation, partnership, or limited liability company;
       3. A trust or other entity that is controlled by the same person or persons who govern a covered hospital or medical entity;
       4. A supporting or supported organization within the meaning of Sections 509(a)(3) and 509(f)(3) of the Internal Revenue Code; or,
       5. A disregarded entity of, or related organization as set forth within, the IRS form 990 of a covered hospital or medical entity or a nonprofit corporation that owns, operates, or controls, in whole or in part, a covered hospital or medical entity.
    4. Payment of compensation or remuneration by any person, corporation, partnership, limited liability company, trust, or other entity that a covered hospital or medical entity, or a nonprofit corporation that owns, operates, or controls, in whole or in part, a covered hospital or medical entity, participates in, belongs to, is a member of, or pays into shall be presumed compensation for work performed or services provided at or for the covered hospital or medical entity.
20. Specifies that total annual compensation does not include the cost of health insurance or disability insurance or payments or contributions to a health reimbursement account.

EXISTING FEDERAL LAW:

1. Requires non-profit organizations with gross receipts of $200,000 or more or total assets of $500,000 or more to file financial information, including regarding salaries, with the IRS. The IRS form 990, officially, the "Return of Organization Exempt from Income Tax" is an IRS form that provides the public with financial information about a nonprofit organization. It is often the only source of such information. It is also used by government agencies to prevent organizations from abusing their tax-exempt status. Certain nonprofits have more comprehensive reporting requirements, such as hospitals and other health care organizations.
2. Requires publicly traded companies to file reports with the Securities and Exchange Commission (SEC). The SEC is one of the regulatory watchdogs of the U.S. government, created in the 1930s to protect investors, maintain fair and efficient markets, and facilitate capital formation. This is accomplished by collecting and disseminating documents that disclose financial and other company information so the public can make sound investment decisions. To fulfill this responsibility, the SEC has the authority to require publicly-traded companies to file disclosure documents, which are then made available to the investing public via the Electronic Data Gathering, Analysis, and Retrieval system (EDGAR), the SEC’s online database of public company filings. All companies (including foreign entities) that publicly sell securities in the U.S. must be registered with the SEC and comply with its filing requirements.
   
   EDGAR performs automated collection, validation, indexing, acceptance, and forwarding of submissions by companies and others who are required by law to file forms with the SEC. Its primary purpose is to increase the efficiency and fairness of the securities market for the benefit of investors, corporations, and the economy by accelerating the receipt, acceptance, dissemination, and analysis of time-sensitive corporate information filed with the SEC.

EXISTING STATE LAW:

1. Requires local agency financial transaction reports to include information about the annual compensation of the local agency's elected officials, officers, and employees, requires local agencies to post this information on their Internet Websites, and requires the State Controller to compile, publish, and make this information publicly available on the Controller's Website.
2. Establishes OSHPD, and designates OSHPD as the single state agency to collect specified health facility or clinic data for use by all state agencies.
   
3. Requires private non-profit hospitals to complete a community needs assessment and adopt a community benefits plan, and to annually submit the community benefit plan to OSHPD, along with a report of the economic value of community benefits provided in furtherance of the plan.
   

FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, currently there is little transparency over whether for-profit or non-profit hospitals use taxpayer dollars to provide high-quality, affordable medical care, or if funds are being diverted to exorbitant executive compensation packages. The author states that this bill ensures more accountability and transparency in an otherwise opaque environment.
2. BACKGROUND.
   1. Rising healthcare costs. The U.S. Census Bureau has published new estimates of health spending based on their Quarterly Services Survey, published on March 10, 2016. Analysis of the survey data shows that health spending was 7.3% higher in the first quarter of 2015 than in the first quarter of last year. Hospital spending increased 9.2%. A Kaiser Family Foundation analysis of the data concludes that greater use of health services, as well as more people covered by the Patient Protection and Affordable Care Act appear to be responsible for most of the increase, noting that people are beginning to use more physician and outpatient services again as the economy improves and that the number of days people spent in hospitals also rose.
      
   2. Executive compensation. According to the proponents of this bill, little is known about what factors drive health care costs, however they point to the fact that hospital executive compensation has spiked in recent years. According to the healthcare industry publication "Payers & Providers," 66 executives at the state’s three largest hospital systems (Sutter Health, Dignity Health, and Kaiser Permanente) earned more than $1 million each in 2013, up from 52 executives just two years before.
   3. Publicly available information.
      1. Non-profit entities. The IRS 990, officially, the "Return of Organization Exempt from Income Tax" is an IRS form that provides the public with financial information about a non-profit organization. It is often the only source of such information. Non-profit hospitals are required to file the form 990 in order to maintain their non-profit/tax-exempt status. However, only the top 20 wage earners over $150,000 have to be identified on the forms, and due to differing corporate structures of hospitals and hospital systems, the data is not easily comparable. For example, Kaiser is one corporate entity with two branches, North and South. Their 990 covers their hospitals and health plan, however their medical group (the doctors) are a for profit entity, so their salaries are not included on the 990. Conversely, Dignity Health (Dignity) files a single 990 for the entire system. The top 20 wage earners on Dignity's form are system-wide employees, so their 990 excludes many CEO's.
         
         According a June 30, 2015 article published in the Chronicle of Philanthropy, the IRS is working on a technology that should allow it to release electronic version of the form 990 by early this year, which would make it much easier for the public to search for information about non-profit finances and operations.
      2. For-profit entities. Publicly traded companies report significant amounts of financial data to shareholders and the government in their annual U.S. SEC filings. Several documents that companies are required to file include information about the company's executive compensation policies and practices including; the company's annual proxy statement; the company's annual report; and, registration statements filed by the company to register securities for sale to the public. The information is available on the SEC's searchable database, EDGAR.
      3. Private for-profit entities. Privately owned for-profit hospitals are not required to report on their executive's salaries. Of the 105 for-profit hospitals in the state, approximately 50 are not publicly traded, and do not report salary information.
   4. Federal annual equal employment opportunity and compensation report (EEO-1 Report). The EEO-1 Report is a compliance survey mandated by federal statute and regulations. The survey requires company employment data to be categorized by race/ethnicity, gender and job category. On January 29, 2016, the EEOC announced proposed changes to its EEO-1 report, which requires employers to submit employee W-2 earnings and hours worked. Under the proposal, all employers with at least 100 employees (not just federal contractors) would be required to comply. In addition, the proposed changes will require the submission of payroll data broken down by race/ethnicity, in addition to gender. The data would be made available to the EEOC and the Office of Federal Contract Compliance Programs for enforcement purposes. The proposed rule was published on February 1, 2016 and interested parties have 60 days to submit comments.
      
      The EEOC proposing to change the reporting requirements to include the data on employees' earnings and hours worked, beginning in 2017. The EEOC's proposed pay bands (which are included in the reporting provisions of this bill) are as follows:
      
      1. $19, 239 and under:
      2. $19,240 - $24, 439;
      3. $24,440 - $30,679;
      4. $30,680 - $38,999;
      5. $39,000 – $49,919;
      6. $49,920 - $62,919;
      7. $62,920 - $80,079;
      8. $80,080 - $101,919
      9. $128,960 - $163,799;
      10. $163,800 - $207,999; and,
      11. $208,000 and over.
          

The EEOC is prohibited from making public the employment data derived from any of its compliance surveys. The EEOC uses EEO-1 data to support civil rights enforcement and to analyze employment patterns, such as the representation of female and minority workers within companies, industries or regions. The EEOC is not proposing to require an employer to begin collecting additional data on actual hours worked for salaried workers, to the extent that the employer does not currently maintain such information.

• 1. Self-reported employee information. According to the Human Rights Campaign (HRC) unlike other diversity categories, such as race and gender, employers are not required to collect statistics on the number of lesbian, gay, bisexual, and transgender (LGBT) people they employ. Employers have sought to determine the number of their employees who identify as LGBT while balancing privacy concerns. Some employers use LGBT employee group membership numbers to generate estimates, but this method is limited by the scope of such voluntary groups over a highly dispersed workforce. More recently, employers have gathered statistics through anonymous employee engagement or satisfaction surveys, which can include upward of 100 questions, and through confidential and secure employee records. In both cases, whether an employee discloses their gender identity or sexual orientation is optional and voluntary and any reporting or direct access to the data is designed to ensure confidentiality of the employee. In the HRC Corporate Equality Index 2015 survey of 781 employers, 46% allow employees to voluntarily disclose their sexual orientation and gender identity on anonymous surveys or confidential Human Resource records, compared with 141 of the 519 employers (27%) in the 2008 survey and just 17% in the 2006 survey.
     

1. SUPPORT. The California State Council of the Service Employees International Union (SEIU California) supports this bill, stating, while California public hospitals (city, county, or University of California) are already required to provide complete salary information for all employees through the Controller, which publicly reports these data, significant gaps and inconsistencies exist for our understanding of not-for-profit and for-profit hospitals.

Hospitals which are publicly-traded must disclose executive compensation for their Chief Executive Officer, Chief Financial Officer, and the next three top paid employees company-wide to the SEC, which seldom capture their California executives if the firm is national. SEIU California continues, with nonprofits, the public makes a significant investment in the form of over a billion a year in tax exemptions in California, but nonprofit hospitals must only disclose their top five highest compensated employees, beyond their officers and directors, which often obfuscates individual hospital CEO compensation, particularly at large multi-facility nonprofit hospital chains. In each of these examples there has already been established a compelling policy reason to understand how top executives are being paid – for the sake of understanding public investments, and informing private investor decision-making – but the reporting requirements in each case are different in scope and detail and ultimately become of little use in very large nonprofit chains or national companies, especially for national systems not based in California. SEIU California notes that, at issue for non-profit operated hospitals is the need to better understand whether the state’s investment through tax breaks and others subsidies leads hospitals to provide more charity care and community benefits, or whether it simply serves as a mechanism to provide hospital executives with more excessive pay. SEIU California points to a 2015 study published in Health Affairs that found that California’s nonprofit hospitals spent the same amount on uncompensated care as for-profit hospitals, which suggests greater accountability is warranted. SEIU California concludes this bill will align hospital executive compensation reporting for all non-profit and for-profit hospitals, including investor owned hospitals, and consolidate that reporting within OSHPD, which already collects and reports a myriad of different hospital financial data.

The California Labor Federations states that increasing transparency of CEO compensation at hospitals is a first step in examining all cost drivers in health care, starting at the top of the hospital chain, and given that the largest California hospitals are non-profits, taxpayers should have access to the compensation and other data about hospitals that they support with tax breaks.

1. OPPOSITION. The California Hospital Association (CHA) opposes this bill and states that hospitals and health systems are not opposed to transparency; many hospitals currently report much of the information sought and it is available to the public, however this bill only increases hospital costs and discloses private compensation information without any justification. CHA also notes that the bill raises significant privacy concerns for a broad array of employees, extending to exempt employees, not just executives, thus nurse managers or information technology personnel whose total compensation meets for exceeds $250,000 annually would be reported. CHA notes that in many organizations, particularly in urban areas, this reporting threshold would reach deep into the organization.
   
   The Hospital Corporation of America states it is concerned about the unintended consequences of public reporting of salaries, noting that it could actually drive up labor costs where employees and applicants use the salary information as benchmarks for the myriad of hard to fill positions in health care.
   
   The California Chamber of Commerce (the Chamber) states that this bill inappropriately assumes that hospital executive compensation is a major driver of overall health care spending. The Chamber notes that hospital executives play a critical role in ensuring that millions of Californians receive quality health care services, even as cost pressures and increasing demand for hospital services are making it harder and harder for many hospitals to keep their doors open.
2. RELATED LEGISLATION. AB 1890 (Dodd) provides that an employer with 100 or more employees in the state and a contract with the state of 30 days or more shall submit a description of its nondiscrimination program to the Department of Fair Employment and Housing, and shall be required to submit periodic reports (no more than annually) of its compliance with that program. AB 1890 is currently pending in the Assembly Appropriations Committee.
3. PREVIOUS LEGISLATION.
   1. AB 2040 (Cristina Garcia), Chapter 894, Statutes of 2014, requires local agency financial transaction reports to include information about the annual compensation of the local agency's elected officials, officers, and employees, requires local agencies to post this information on their Internet Websites, and requires the Controller to compile, publish, and make this information publicly available on the Controller's Website.
   2. SB 346 (Wieckowski) of 2015 would have repealed the existing hospital community benefit law, and established a new hospital community law to require private non-profit hospitals to complete a community needs assessment, followed by a community benefits plan, and required 90% of a private non-profit hospital’s community benefit moneys to be allocated to charity care and projects that improve community health for underserved and vulnerable populations. SB 346 died in the Senate Health Committee.
   3. AB 2180 (Alejo), Chapter 322, Statutes of 2012, requires a written employment agreement between a health care district and a hospital administrator to include all material terms and conditions agreed to between the district and the hospital administrator regarding compensation and other benefits, as specified, that differ from those available to other full-time employees.
4. TECHNICAL AMENDMENTS. The definition of a covered hospital or medical entity incorrectly cross references the wrong section of current law. The bill should be amended to correct the drafting error, and to clarify the definition of a hospital-affiliated physicians group.
5. POLICY COMMENTS.
   1. As currently drafted, this bill incorporates requirements that are based on a federal EEOC policy that has yet to be adopted. The Committee may wish to consider whether it is premature to predicate California law on a pending federal proposal.
   2. As currently drafted this bill requires the annual report to include voluntarily self-reported employee data on sexual orientation and gender identity. Should the bill move forward, the author may wish to consider adding language to clarify that the data is private, and any reporting of the data will not directly identify the employee by name.
      

REGISTERED SUPPORT / OPPOSITION:

Support

SEIU California (sponsor)

California Labor Federation

California Lesbian, Gay, Bisexual and Transgender Health and Human Services Network

Equality California
Health Access, California
United Nurses Associations of California/Union of Health Care Professionals

Opposition

Adventist Health and Loma Linda University Health

Adventist Medical Center-Hanford

Adventist Medical Center-Reedley

Adventist Medical Center-Selma

Alliance of Catholic Health Care

Antelope Valley Hospital

Association of California Healthcare Districts

Banner Lassen Medical Center

Barstow Community Hospital

California Chamber of Commerce

California Hospital Association

Citrus Valley Health Partners

Coalinga Regional Medical Center

Community Hospital Long Beach

Community Medical Centers

Corona Regional Medical Center

Cottage Health

Delano Regional Medical Center

Desert Valley Hospital

Eisenhower Medical Center

Enloe Medical Center

Fairchild Medical Center

Feather River Hospital

Good Samaritan Hospital

Healdsburg District Hospital

HealthSouth Bakersfield Rehabilitation Hospital

Hemet Valley Medical Center

Hospitals Corporation of America

John Muir Health

Kaiser Permanente

Lodi Memorial Hospital

Long Beach Memorial

Mad River Community Hospital

Madera Community Hospital

Marin General Hospital

MemorialCare Health System

MemorialCare Medical Foundation

Menifee Valley Medical Center

Mercy Hospitals

Methodist Hospital of Southern California

Miller Children's and Women's Hospital Long Beach

Monterey Park Hospital

NorthBay Healthcare

Orange Coast Memorial

Palo Verde Hospital

Plumas District Hospital

Pomona Valley Hospital Medical Center

Prime Healthcare

Private Essential Access Community Hospitals

Providence Health & Services

Providence Holy Cross medical Center in Mission Hills

Providence Little Company of Mary Medical Center San Pedro

Providence Little Company of Mary Medical Center Torrance

Providence Saint John's Health Center

Providence Saint Joseph Medical Center in Burbank

Providence Tarzana Medical Center

Queen of the Valley Medical Center

Redlands Community Hospital

Ridgecrest Regional Hospital

Riverside Community Hospital

St. Jude Medical Center in Fullerton

San Bernardino Mountains Community Hospital

Santa Rosa Memorial Hospital and Petaluma Valley Hospital

Southwest Healthcare System – Inland Valley and Rancho Springs Medical Centers

Stanford Health Care

Tahoe Forest Health System

Tenet Healthcare

Ukiah Valley Medical Center

United Hospital Association

Valley Children's Healthcare

Vibra Hospital of Sacramento

Watsonville Community Hospital

White Memorial Medical Center

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097