Alameda Health System (the Health System) represents the business-type activities presented as part of the government-wide financials. The government-wide financial statement activity consists of two major funds, Alameda Health and Hayward Sisters Hospital dba St. Rose Hospital (St. Rose), and the discretely presented Alameda Health System Foundation (AHS Foundation). The Alameda Health major fund is comprised of Alameda Hospital, Fairmont Hospital, Wilma Chan Highland Hospital, John George Psychiatric Hospital, and community ambulatory care clinics (collectively AHS) and Alameda Health Medical Group (AHMG) component units. The St. Rose major fund is comprised of St. Rose Hospital (SRH), St. Rose Medical Building Inc. (St. Rose MOB), and St. Rose Foundation (St. Rose Foundation) component units. The government-wide financial statements are reflected in the County of Alameda (County) annual comprehensive financial report as a discretely presented component unit. Information for the individual companies is discussed below. The Health System is a Public Hospital Authority created originally under the name of Alameda County Medical Center (Medical Center) on July 1, 1998, pursuant to California Health and Safety Code Section 101850 with a fiscal year ending June 30th. The governance, management, administration, and control of health care facilities were transferred from the County to the Medical Center in 1998. The Medical Center started doing business as the Health System on January 1, 2013. The Health System is governed by a nine-member Board of Trustees (Trustees), eight members of which are appointed by a majority vote of the Board of Supervisors of the County. Trustees are appointed for three-year terms and can be reappointed for up to three consecutive complete terms. The remaining position on the Board of Trustees is filled by a representative of the Medical Staff of the Health System, which is also appointed by the Board of Supervisors. Under the terms of the transfer arrangement (Master Contract) between the County and the Health System, certain operating assets, liabilities, and the net (deficit) position of health care operations were transferred from the County to the Health System. The Health System leases land, hospital facilities, and other equipment from the County for one dollar annually. Leased facilities include Fairmont Hospital, Wilma Chan Highland Hospital, John George Psychiatric Hospital, and community ambulatory care clinics. The County has the authority to terminate any or all of the transfer agreements with or without cause. The Health System through Alameda Health provides a continuum of acute and long-term care to residents of the County. In addition to offering general acute care, skilled nursing, and rehabilitative care, the Health System provides an adult day health center and a trauma center. Alameda Health is currently licensed for 272 acute, 69 acute psychiatric, and 325 sub-acute skilled nursing and acute rehabilitation beds. AHMG is a blended component unit of Alameda Health and is included in these financial statements as a condensed combined unit with AHS. AHMG was established as a governmentally financed public benefit corporation under the California Corporations Code with a fiscal year ending June 30. AHMG is a wholly controlled subsidiary of the AHS. AHMG’s mission is to serve the public purposes of Section 1400.2 of California’s Welfare and Institutions Code. The Articles of Incorporation and Bylaws of AHMG provide that AHS is the sole Corporate Member of AHMG, which includes substantial reserved power over AHMG, including the power to appoint or remove AHMG Board members and approve any changes to AHMG’s Bylaws. Separate financial statements of AHMG can be obtained from AHMG, 55 Harrison Street, Suite 600, Oakland, California 94607. SRH is the sole corporate member of St. Rose MOB and St. Rose Foundation, collectively are included as a condensed combined unit of the Health System and is included in these financial statements. SRH operates as an independent, nonprofit, community hospital with 177 beds providing access to care in Alameda County. SRH is organized as an exempt entity under Section 501(c)(3) of the Internal Revenue Code with fiscal year ending on September 30. On October 31, 2024, a Membership Issuance Agreement was signed to establish the AHS as the sole statutory member of SRH with an effective date of November 1, 2024. AHS is not responsible for expenses, losses or liabilities of St. Rose and has no rights to profits or assets of St. Rose. Separate financial statements of St. Rose can be obtained from St. Rose Hospital, 27200 Calaroga Avenue, Hayward, California 94545. AHS Foundation is a discretely presented component unit of the Health System and is included in these financial statements. The AHS Foundation’s mission is to raise funds and generate community support for the Health System. The Articles of Incorporation and Bylaws of the AHS Foundation provide that the Health System approve the AHS Foundation’s Board members and that upon dissolution, the AHS Foundation’s remaining assets will be distributed to the Health System. The AHS Foundation is organized as an exempt entity under Section 501(c)(3) of the Internal Revenue Code with a fiscal year ending June 30. Stand-alone audited financial statements of the AHS Foundation can be obtained from the AHS Foundation, 55 Harrison Street, Suite 600, Oakland, California 94607.
The schedule of expenditures of federal awards (the Schedule) includes the federal grant activity of the Health System. All federal awards received directly from federal agencies as well as federal awards passed through other entities are included in this Schedule except for assistance related to Medical Assistance (Medi-Cal) and Medicare Hospital Insurance (Medicare) described in Note 4. The Schedule is presented using the accrual basis of accounting, which is described in Note 2 to the Health System’s basic financial statements. Expenditures reported include any property or equipment acquisitions incurred under the federal program. Under the accrual basis of accounting, expenditures are recognized when incurred, regardless of timing of cash flows. Such expenditures are recognized following the cost principles contained in the Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), wherein certain types of expenditures are not allowable or are limited as to reimbursement. The Health System incurred eligible expenditures in fiscal years 2020 through 2023 and the expenditures were approved by the Federal Emergency Management Agency (FEMA) in fiscal year 2025. The total amount of expenditures incurred in the prior year was $5,830,181.
The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures can be reconciled with the amounts reported in the Health System’s basic financial statements.
Direct Medi-Cal and Medicare expenditures are excluded from the Schedule. These expenses represent fees for services and are not included in the Schedule or in determining major programs. The Health System provides Medi-Cal and Medicare services through its facilities. The Health System participates in the California Medi-Cal Administrative Activities (MAA) program, which offers reimbursement under the federal program, Grants to States for Medicaid (FALN 93.778), for a portion of the costs related to specific, approved activities that are necessary for the proper and efficient administration of the Medi-Cal program, and these expenditures are included in the Schedule.
The Health System did not provide federal awards to subrecipients during the year ended June 30, 2025.
The Health System has not elected to use the de minimis indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract.
The Health System has the following programs presented in the Schedule under FALN 16.575. Program Description: 1) Rape Crisis Program, Contract Number - RC23 38 1146, and Federal Expenditures of $65,668; 2) Rape Crisis Program, Contract Number - RC24 04 9601, and Federal Expenditures of 24,880; 3) Sexual Assault Response Team Program, Contract Number - XS23 05 1146, and Federal Expenditures of $33,149; 4) Specialized Emergency Housing Program, Contract Number - KE23 02 1146, and Federal Expenditures of $50,533; 5) Specialized Emergency Housing Program, Contract Number - KE24 04 9601, and Federal Expenditures of $25,778, and 7) Total Federal Expenditures of $200,008.