information, and then see what -- see what else can be done. >> and then, what about the building department in regards to the -- >> i think they have a representative. he should be doing his job. >> i'll drop jeremy. >> just a point of clarification, does that -- that just keeps the status quo, though. that doesn't help us -- >> it doesn't help you because they can't sell right at the moment. but i -- i don't think we need that much time, do we? all right. madam director. >> clerk: okay. >> wehere should i move this t? >> clerk: may 23rd or june 13th.

we're still pretty busy may 23rd, but... >> pretty congested, huh? >> yeah, an suppression of new

licenses and suppression of new tau ba tobacco licenses in her district. i think that the district supervisor prefers to step back and let the community speak for itself. >> i agree. >> thank you. >> this is an ongoing hardship for this family, and every month is a hard month. >> yeah, thank you. >> does the 23rd -- may 23rd work for both sides? health department and

appellant? >> clerk: we'll put you first. you guys deserve the first slot. >> if it works, we will have you first on the calendar. >> i'm sorry, sir. i am -- i have a family trip on -- starting on the 22nd. i'm returning on the 29th. could we do this on the 30th? >> no, there's no meeting on the 30th. it would have to go to june 6th. >> we have nine appeals on june 6th. possibly the 13th? >> how about may 6th? >> no meeting. there's no meeting next week. >> so it's either the 23rd or

the -- >> june 6th. >> clerk: or june 13th. >> the google should be short. >> i'll google that. >> the 6th or the 13th. >> okay. let's move onto juit to june 6 >> 6th? >> okay. >> do we have a motion. >> motion to allow the health department to conduct a density report analysis to june 6th. >> okay. we have a motion from president fung to continue this matter to june 6th to enable the department of public health to

gather further data on their density cap analysis. on that motion -- [ roll call. ] >> clerk: okay. that motion passes, and this meeting is adjourned. thank you. >> clerk: madam chair.

>> supervisor fewer: oh, thanks, so sorry. are we good? i do it every single time. gavel down. the meeting will come to order. this is the april 20, 2018 regular meeting of the san francisco local agency formation commission. i am sandra lee fewer, chair of the commission. i am joined by commissioner cynthia pollock on my right and commissioner hillary ronen on my left. also joining me is newly sworn in commissioner shanti singh. madam clerk, do you have any announcements? >> clerk: yes. please be sure to silence any cell phones or sound producing devices. >> supervisor fewer: thank

you. madam clerk. will you read item number two. [agenda item read]. >> supervisor fewer: are there any members of the public would wish to comment on item number two? seeing none, public comment is now closed. is there a motion to approve the minutes? great. moved by commissioner pollock and seconded by commissioner ronen. without objections, these minutes are approved. madam clerk, can you please call item number three. [agenda item read]. >> clerk: there's one seat and one applicant, the one applicant being cynthia pollock. >> supervisor fewer: do we have an update from an interim administrative officer? >> chair fewer, members of the commission, angela calvillo, the interim officer. >> miss calvillo, so sorry to

interrupt, because this does pertain to my application, i would just like to excuse myself from the room. >> supervisor fewer: oh, yes. >> as you know, commissioners, cynthia pollock remains in seat six as you know she may do so until another commissioner is appointed or she is reappointed. now commissioner shanti singh was appointed to the alternate seat to lafco. welcome, commissioner singh. the commissioner was able to participate in commissioner business, and with commissioner singh, we have the necessary quorum to consider item three. given that commissioner pollock has already recused herself and left the room, anthothose conc my remarks. >> supervisor fewer: thank you very much. let's open this up to public comment. are there any members of the

public who wish to comment on this item? seeing none, public comment is closed. >> i make a motion to excuse commissioner pollock. >> great. that was made by commissioner ronen, seconded by commissioner singh. we can take that without objection, is that correct? and colleagues, can we have a motion to approve cynthia pollock to join lafco in the public seat? >> supervisor ronen: so moved. >> commissioner singh: second. >> supervisor fewer: thank you. there was a motion by commissioner ronen, seconded by commissioner singh. thank you. madam clerk, can you please call item number four. [agenda item read]. >> i believe we have a staff

presentation. >> good morning, commissioners, michael himes director of the cleanpowersf program for the sfpuc. i do have a cleanpowersf update for you today, and we also actually have a presentation for you on our enrollment communications plan, so what i'm going to do is provide some fairly brief remarks and then i'm going to turn the podium over to our puc deputy director of communications for power, tyler gamble. so -- and i'm going to cover a few things today in my remarks. our enrollment activities, our service to customers today, and an update on regulatory activities. with respect to enrollment and service to customers, the program -- i think this is present consistent with what i reported last time. the program's serving 81,000

accounts today. that's about 22% of cleanpowersf's potential service. once citywide enrollment is completed, our opt out rate is 3.2%. it's been at that level now for sometime, so we've been able to retain 96.8% of the customers we've enrolled. our super green upgrade rate has increased a bit. we're at 4.2%, so a tenth of a% increase, and we've actually been conducting a small enrollment in april. you may recall from previous updates, we are conducting quarterly enrollment for customers that sign up fore the program, so we did that in april for customers that had signed up since january , and there were 230 such accounts that had signed up over those

few months. looking ahead, and i think we indicated this at the last meeting, but our next enrollment will be july of 2018, which is really right around the corner for us, which is very exciting. on a related point, i'm going to get a bit more into that, but on april 10th, our commission adopted new rates for the cleanpowersf program for the new fiscal year starting in july. these programs are expected to fund the financial reserves while delivering about a 2% -- about 2% savings as compared to comparable service from pg&e. to date, the program has been -- when we've set rates, we've tried to benchmark to a 2.5% discount, which is a really small discount, so we're really excited to be able to deliver something a little bit

more material in july, especially when we're gearing up to enroll customers. i do want to comment that today, the rates are about 5% lower, so customers are saving under the cleanpowersf program. the july enrollment will increase the program customer account from the 81,000 i mentioned a moment ago to just over 105,000, and we're mostly going to be adding commercial accounts in it the city. that's about 25,000 new commercial accounts, and about 1300 net energy metering accounts. and as a reminder, energy metering is the program for the customers that have solar on their roofs. the enrollment will increase our average demand served from about 65 megawatts to about 270

megawatts. it's essentially tripling the program size from an energy demand standpoint. we are also planning to enroll the balance of the city in april of 2019, so that's our general timeline. we will continue, though, to invite signups throughout the city, and we're also continue to conduct those quarterly enrollments to accommodate those customers that want to get in sooner. so as i've indicated, we're -- we're on track to complete enrollment by july of 2019, which was the goal that our commission set forth for the program. that'll bring total accounts served to 365,000, and our average program demand to just about 405 megawatts, from 235

to 405 come this time next year. it's a pretty steep ramp, but we're on track, so very exciting. on the regulatory front, i wanted to remark a bit on the pcia. so the city's been an active participant in the pcia proceeding at the california public utilities commission. the pcia stands for power charge indifference adjustment. most folks just refer to it as the pcia. the cpuc's considering forms to the charge, and this is the charge that pg&e levees on customers' bills. for several months, staff from the sfpuc and the city attorney's office have been working with our colleagues from other communities to prepare testimony that was submitted into the proceeding by the california community choice association, calcca. that testimony was filed on

april 2nd, and calcca presented a proposal featuring a number of strategies intended to reduce electricity costs for all rate payers in the investor in utilities while supporting the transition to what we're framing as a new vision for california's retail electricity market that of course prominently features cca's. the existing pcia methodology adopted by the cpuc, it calculates what is called the net unavoidable power procurement costs. you could also think of these as sort of the above market costs of the commitments that approxima pg&e's made to serve customers, and it calculates those costs that are attributable to the customers that leave utility supply service for a cca program or a third-party

provider in the direct access market. the calculation has been contentious for sometime now. parties on both sides of the issue debate perceived cost shifts in either direction, and we're hoping and anticipating that the california puc is going to correct and adopt the fair solution to this issue. i do want to point out that as the city -- this is not a new charge. it is -- forms of it were adopted more than a decade ago. the pcia in its current form was adopted around 2010, i think. and throughout the city as the voice of all of its citizens, including customers that elect to stay with pg&e has advocated for a solution that does not shift costs, and that has been our approach throughout. of course we want it done in a

manner that's fair, that does not un -- inappropriately burden cca's and cca programs. so sort of to that extent, calcca's proposals, of course have been influenced by the city and have been guided by the following principles: first, minimizing costs borne by call customers, second protecting customers from rate shock through stable and predictable rates. this is one of the problems we've had with cca it gets launched once a year and it can get set any rate. when we're endeavoring to set our rates for our service that accounts for those costs, that is he aa big chunk of our overall program costs that we need to manage around, so there are mechanisms that the california puc as a regulator

can put in place to regulate and stablize those changes over time. ensure transparency and the regulation to allocate costs responsibly. so make it easy to see that the numbers are correct, in other words. to accurately reflect the long-term and short-term value streams in the commitments that the utilities made for customers. generally speaking, the -- the proposals that we've seen from the utilities have overemphasized short-term evaluation, so it's something that we hope the puc will consider. encourage prudent utility resource procurement and portfolio management so that they actively manage those resources and go into the market if they need to to sell them at the highest rate possible. that reduces the fees that departing customers have to pay. on a voluntary basis, provide access to the resources in the utilities portfolio.

so to the extent a cca formation results in a utility like pg&e having excess supply that the utility makes those available to the community to purchase on a voluntary basis. and enable california to continue its progress towards achieving its environmental and climate goals. pretty important one there. so the cca is preparing a written briefing on the lafco for this topic, and i believe that was be sent to your attention very soon. we're almost done with that. so with that, i'll pause and take any questions you might have on at least what i discussed. >> supervisor fewer: so colleagues, any questions? >> supervisor ronen: just out of curiosity, have you done any research why customers are opting out, the ones that are doing so, given the savings

that are available to them. just curious. >> yeah. actually we have. whenever the customer opts out, we present them with sort of a questionnaire to identify from a select set of options the reason. and there are two -- two of those sort of stand out against the others. the first is a distrust in local government providing these services, and the second is a -- a dislike of the auto enrollment mechanism that is part of the cca statute and cca program. those, i would say, with the two -- two main issues. >> supervisor ronen: got it. >> yeah. >> supervisor ronen: that makes sense. the other question i had that given the mayor's announcement this week of being climate neutral by 2022, how much is

cca going to play a role in that or does that change role or strategies or plans? >> at this point, i don't think it changes our basic strategy, which is to deliver carbon free electricity to san francisco citywide no later than 2030, right? so our program is procuring power and planning long-term to develop a set of resources that will make our electric supply ghg-free. i think the related element is there are other components of the city's overall greenhouse gas footprint and climate footprint that cleanpowersf may contribute to solving, like transportation, for example, switching fuels from burning, combusting gasoline, combusting natural gas to using clean

electricity? and you know, that's happening a lot. there's work being done in the city. the department of the environment is working on initiatives to address that. the puc is, as well, but you know, electrifying transportation is going to be a one, and that's balancing the city's overall goals with respect to transit. but an electric vehicle that can plug into the grid and get ghg-free power from the city is going to be the solution. >> supervisor fewer: commissioner pollock? >> commissioner pollock: thank you so much for your presentation and thank you to the commission for appointing me for another four years, and i'm happy to serve on this body. i just wanted to thank you for the work that the puc is doing and you know, the climate action strategy that the city

presented to the public and has really geared our programs around that strategy echos all of our thoughts, which were that claenl power sf was the number one way that we could achieve the city's climate goals. so i want to make sure that we're always echoing that and supporting that, and hopefully, they move forward quickly, and i can't wait until april 2019. >> me either. >> supervisor fewer: okay. thank you very much. do you -- >> so i know i have another component. i did have a few slides. do we have time for that? >> supervisor fewer: sure. >> so if no other questions, it's my pleasure to introduce tyler gamble. he's been at the puc for six months? eight months.

i knew it's been around there. mr. gamble's been with the puc for eight months, came to us from the great city of new orleans. he's going to present some slides on our communications plan. >> hey, good morning, commissioners. how are you? i will run through our communications strategy that we have so you guys kind of know the tactics that we're taking over the next few weeks and months to enroll these customers and as we look forward to 2019, as well. so as mistake just talked abou we've got a great opportunity. this year, we're looking at enrolling 25,000 power customers in san francisco. our goal is to educate customers about the program. that's why we're taking a multifaceted approach here. the message cleanpowersf gives you the power to choose cleaner

energy options for your business at a competitive price. so the number of strategies we're looking at, we have our required mailings that give us an opportunity to put our messages on them. we're going to leverage local and regional media outlets, we're going to target high energy user customers of that 25,000, engage business organizations, and launch a paid digital media campaign, as well. and so for starters, talking about the enrollment notices, we've cleaned them up a little bit. they look a little bit more modern. we're focusing on imageery. the first notice goes out on may 7th. they're the first of four. as you know customers get two ahead of the enrollment and two after, and for the first time we're going to separate those enrollment notices, so we have some customers that have opted in early, so they'll be opted in in july.

we'll have separate notices for business customers and residential customers that can really highlight the benefits, based on the kind of customer you are. next leveraging media outlets, we're going to leverage our relationships with the media to tell that story. we'll focus a lot on the business media for this up coming july enrollment, and it's going to help customers signed up in july early, or they'll be enrolled in 2019. we've created a digital press kit that includes faq's for business customers, for residential customers. it's going to include social media posts, newsletter, copy that organization ones who maybe don't have time to meet with us in person can use that same material to educate their -- their membership who in turn will be those customers. of course we're going to use the mayor's communication

assets, the board of supervisors communication assets, and sfgov, and then sfpuc has digital copies of everything that goes out to our customers, as well. moving onto clean energy influencers, so throughout the year we partner with stakeholders who are part of this movement. we do a lot of phone banking recentlies with them to upgrade customers to super green. we're going to share that information, we're going to attend events, we're going to attend more of those sound banking nights, and we're going to attend more panels as well to have a little bit more discussion about why it's important to go super green, why it's important to have this type of energy in san francisco. it's also important to meet some of these customers face-to-face, so we're looking at a very diverse customer base. we have small mom and pop shops, but we have large customers that don't even manage their own energy bills,

they have a party that does that. so we did get some information from other cca's across the state, where third party customers prefer to have that face-to-face. so we are going to have meetings with face-to-face customers, and let them know what the perks are. and we're engaging business organizations, so we've worked really closely over the last few weeks with the mayor's office of economic and workforce development. we've got a number of organizations that we're going to hit. if nothing else they're going to get our information in the press kit, but ideally, we'd like to meet them at events that they have, at meetings that they have, and any way we can hit them to help spread this message. and we have a print and digital

media campaign as well. starting in may we're going to roll that out with targeting digital print. we also did a rehit of our website, so cleanpowersf.org, we -- we own the url for that, but it goes to the sf water website, but we wanted to have a website that was very clean, aligned with what our other notices looked like, and people would be able to look at that, get information, and we're going to have a bill claytonor, and people can type in their electricity use and find out what their bill would look like. and then, there'll be big button options, enroll right now, a lot of direction where they need to go. we're looking at local newspapers and just other simple places to hit the customers that we want to. we really ramped up our outreach this year.

we've hired more communications staff that's focused on power communications both on the cca side and on hetch hetchy power, as well. we're attending more events this year so far, we've hit 20 event. we're going to be participating in earth day, we're a sponsor of small power sf week. as i mentioned earlier, we partner with our advocates, so we've done two sierra club phone banking recentlies this year that resulted in multiple opt ups for the super green product, and we've increased our social media increase on twitter with regular posts and interaction with customers and other influencers and we're leveraging our local sfpuc audience. that was the update i wanted to give you. do you have any questions, thoughts, comments that we haven't thought about? >> yes. thank you for presenting this. it's really exciting to see things moving forward.

i know that over the last couple years that lafco has echoed concerns from advocates that cleanpowersf wasn't separating itself from -- from water in the ways of how it's presented to customers, and so it is exciting to see that a lot of the feedback is being incorporated into the communications plan. i know that it was for me a source of some frustration, and so it's exciting to see it moving forward. i really want to support the social media post that you're doing. i know that they're still maybe just trickling in a bit, but i'm excited to see the ramp-up, and if we could hear some -- some reports at a later time on how -- how you notice this reaching customers, what type of impact, the types of budgeting that you're doing

towards communications and how that is actually presenting -- sounds exciting out there. and how that's sort of fruitful a in getting more sign ups and opt ups to super green. >> yeah, happy to do that. we're certainly evaluating in real-time, and we'll do some evaluate after. i think the coaleolest part ab the new website, first, it's mobile friendly and secondly we're going to be able to do a lot of tracking on who's coming onto the website and how long they're spending, so we'll be able to present that to you in the next few months. >> supervisor fewer: any other comments or questions? just one question. are you doing this in multiple languages? >> yes. >> supervisor fewer: and are you interested in participating in my district's health fair which we're having hundreds and hundreds people come to the richmond district. >> yes.

absolutely. when is it fewer fufr ju. >> supervisor fewer: just wanted to invite you to the event. >> what's the date on that? >> supervisor fewer: it's may 4th or 5th. it's the 11th annual health festival that we're doing. you can reach nicholas brusky for more information. >> thank you. >> supervisor fewer: mr. himes, are you done or is there any other components of your presentation? >> no, i'm done. >> supervisor fewer: mr. himes, thank you very much. yes. let's open this up for public comment now. come on up. you have two minutes. >> thank you, chair fewer, and commissioners. i'm jed holtzman from 350 bay area. i just want to say to supervisor ronen's comments about the climate, definitely

moving to 100% renewable energy. it was 50% of the climate action goals and cleanpowersf is obviously going to be the vehicle that does that for us over time. we also support it being a hub of programs and services like energy efficiency electric vehicle programs and things to incentivize distributed energy, all of what will be moving beyond that goal other than just consuming 100% renewable energy from somewhere. we had made comments some years ago about the super green imageery and messaging and branding, and it seems like all of those are moving forward now and it's great. saw a bus ad from the sfpuc about how our tap water is powering the bus, and i feel like something about cleanpowersf should be in that location starting new in perpetuity, and i'll just use a

few of my last seconds to say that 350 bay area is a 501-3(c), and climate action organizations like ours have started all over the world, many of which work on local policies and actions to ke keep emissions in the ground. 350.org really just serves to turn people onto the climate movement and get them mobilized. so pretty sure that 350.org hasn't been contacted. it's been us, so i just wanted to point that out. >> supervisor fewer: okay. >> thank you all. >> hello, commissioners. eric brooks, san francisco green party, our city sf, and san francisco clean energy advocates, and californians for

energy choice. first of all, it's nice to see the new commissioner sitting in that seat, commissioner singh, that's great. so the only thing i would add to everything that's been said is just the state, what's going on at the state level. i had thought that you were going to agendaize aba 13, the grid privatization bill. that's going to move at the beginning of this month, so i don't believe this body will be able to take action on it in time, but the board of supervisors could do an adoption without committee reference, and i would highly recommend you do that. if that bill passes, and it's been rewritten to make it easier to pass, instead of california running its electricity grid, donald trump and warren buffet will run our electricity grids for profit and for coal interests, and so

if that happens, all bets are off for californians -- californians' ability to compete with pg&e because it'll have access to a subsidized energy choice that will allow them to compete with us more on price than they have. that brings up an issue that the board of supervisors needs to make action on. for the most part -- besides the bill that i just mentioned, for the most part, the state advocates have been able to stop most of pg&e's bills at the state level, so what pg&e has shifted to the california public utilities commission where they're starting to win incrementally and a death of a thousand ket strategy, we need the board of supervisors --

>> supervisor fewer: thank you, mr. brooks. anymore public comment? seeing none, public comment is now closed. there's no action for the commission to take on this matter, so madam clerk, can you please call item number five. [agenda item read]. >> supervisor fewer: thank you. i'd like to recognize our legal counsel, teresa strickler, who i believe has a presentation for us. >> good afternoon, chair fewer and commissioners. i am teresa stricker, the general counsel for lafco. staff had requested that we provide an overview of some options for the lafco to study hospital community benefits. and the first thing that staff requested is that i clarify what is meant by the term community benefits. that term can mean many different things depending on the context with which you're

using it, so i'm going to go over a few areas that local government frequently use the term community benefits and then focus us on what we're looking at here today. sometimes agencies and other cities will in negotiating a development agreement, will -- with a private developer, will agree -- have the developer agree to include certain projects that are often referred to as community benefits or public benefits, such as the development of a park or another public amenity. for example, california pacific medical center development agreement requires the development of a variety of different public amenities. so that is not what we're talking about today, so i just wanted to clarify that. additionally, the term community benefit is often used in the context of talking about a community benefit district. san francisco has a number of community benefit districts the districts can be created under state law by a city or a county

according to certain procedures and subject to the approval of the property heard within the district. if approved, there's a special assessment that goes on the property bill that can be used only for limited purposes for providing public improvements, maintenance and oth maintenance and activities that promote economic vitality in the district. when we're talking about looking at hospital community benefit oversights. that's not the context with which we're using community benefits, and certainly creating a community benefit district wouldn't really assist in looking at hospital community benefit. so what are we really talking about here, and that would be hospital community benefits as an area which again has nothing to do with the other two contexts. state law requires nonprofit hospitals in california to provide community benefits that

serve the public interest in exchange for their tax exempt status. to fulfill this obligation under state law, nonprofit hospitals are required to do a number of things. first they have to conduct a community benefits assessment every three years. second, they have to develop a community benefit plan in consultation with the local community, and third, they have to submit on an annual basis a copy of its plan -- its community benefit plan to the office of statewide community planning and development which is the statewide agency that's charged with overseeing this requirement. for purposes of this state law, the term community benefit means a hospital's activities that are intended to address community needs and priorities primarily through disease prevention and improvement of health status, and they can include but are not limited to, the following things, so this is just a list. it's not an exclusive list. it can be health care services

rendered to vulnerable populations. it can be the reimbursement of cost of services listed in the state code, including wellness and health promotion, prevention of services, health care medical research, and medical education. it can be financial or in-kind support of public health programs, it can be a donation of funds, property or other resources that contribute to a community priority. it can be health care costs containment programs, enhancement of access to health care or related services that contribute to a healthy community. services offered without regard to financial return because they meet a community need in the service area of a particular hospital or it can be food, shelter, clothing, transportation or other goods and services that help maintain the community's health. community benefit plans generally include a description of the activities that the particular hospital has

undertaken to address identified community needs within its mission and financial capacity, and the process by which the hospital developed the plan in consultation with the community. oshpd -- again, this is the agency -- the state agency that administers this program maintains an on-line database of the annual community benefit plans from each nonprofit hospital. in san francisco, we have ten nonprofit hospitals that are subject to the community benefit requirements. those are chinese hospital, jewish home san francisco, kaiser foundation san francisco, st. francis memorial hospital san francisco, st. mary's hospital, san francisco, and then, the five different california pacific medical center campuses that exist here in san francisco. so what are the options for the lafco to explore whether there's a way to look at

hospital communication benefit compliance? one idea that was proposed briefly at the last meeting was perhaps establishing a health care district. state law does permit the formation subject to a lafco approval of a hospital health care district for the following purposes: one, building or operating a health care facility in underserved areas, two operating ambulance services, or three operating health care programs such as those related to wellness, chemical dependency, health education, rehabilitation, etcetera. because oversight of hospitals compliance with state mandated community benefits does not fall within one of those purposes, forming a health care district doesn't really get at the issue that the lafco, as i understand it, is interested in looking at. so how does lafco go about

looking at this? well, as you know, you have the authority to conduct a special study. lafco may conduct a special study on the issue of hospitals compliance with state mandated community benefit obligations to make a recommendation about whether there's a need for additional or different local government services to provide for the needs of the community. if, based on a special study, lafco concluded that there are short comings in the nonprofit hospital's compliance with state imposed community benefit obligations, it's not clear without more facts what options would be available to lafco. identifies what those facts and thus what lafco's options are is an appropriate part of a lafco study. for example, if a hospital receives funding from the city and county of san francisco, lafco may be in a position to recommend that the city condition future receipt of city funds on the nonprofit

hospital's compliance with a state mandated community benefit obligation. to the extent that such contractual obligations already exist with the city, lafco may recommend that the city take steps to enforce those obligations. in the case of nonprofit hospitals that receive no city funding and of course these are private, nonprofit agencies, these are not government agencies, there may not be an opportunity to -- for san francisco itself to do something directly, but certainly, lafco could recommend to the city and county of san francisco to pursue some legislative options on the state level to ensure that the state is holding nonprofit hospitals accountable for their community benefit obligations. end of my presentation. >> supervisor fewer: any questions, colleagues? so i have a question. so it seems as though we are able to -- this hospital health care district, you -- that is

an option for us to develop one in san francisco? >> so we would have to -- we would have to go through and look at what the requirements are, and the purposes, but it wouldn't get at this issue. the issue that you -- that i'm understanding you wanting to look at is are the hospitals complying with the obligations that the state already imposes on those hospitals to provide for community benefits here in san francisco? that -- enforcing that or looking at compliance would not fall within the purposes of creating a hospital district or a health care district. >> supervisor fewer: because that might be something that might follow after we do a special study that may or may not show that hospitals are complying with their community benefits plan, could we curtail or direct then services to be directed to -- you mentioned, i think substance abuse, mental

health? >> what a hospital district would be formed for would be one of the purposes that is set forth in the statute, so one would be building or operating health care facilities in underserved areas, so there would have to be a determination consistent with how that state law is construed that there's an underserved area to fall within that purpose. another statutory purpose would be for operating ambulance services which i don't think is really the issue here. the third would be operating health care programs, which would include for example as i mentioned before, wellness programs, chemical dependency programs, health education and rehabilitation programs, so we would need to look at what is currently being provided and our -- is what lafco recommending is a development of a health care district in order to provide those services, which is a little bit

different than our health care -- our hospitals within san francisco complying with their identified plans under state law to provide for community benefits, which may go well beyond that. so certainly, we could look into a deeper dive to see whether when you're looking at this, there is an opportunity here to create a health care district, but it may be that whatever short comings there are really are about enforcing what the state is requiring, but perhaps there isn't sufficient oversight or sufficient enforcement, rather than creating a health care district. >> supervisor fewer: got it. and then, the private hospitals, because they're not under this nonprofit sort of status, that we -- in order to look at that benefit packet, that would have to be through development plans, is that correct? >> so when you're talking about for-profit or are you just talking about -- >> supervisor fewer: for-profit. >> for-profit, we probably

would be talking about development agreements, that this option we've provided of community benefit is really an animal of the nonprofit status that certain hospitals enjoy, so in exchange for getting the tax exemption status, they are obligationed oblt obligated to provide a certain level of community benefits. we do have a number of hospitals in san francisco san francisco, and they are all supposed to have community benefit plans and are supposed to be moving toward satisfying them. so looking at whether those exist, how are the hospitals doing, are they meeting the state law requirements is one area that lafco may, if it chooses, decide to pursue. >> supervisor fewer: oh, yes, commissioner pollock. >> commissioner pollock: thank you so much for this

presentation. i think it's helpful to understand how we might direct staff to move forward and better understand the issue altogether. i just wanted to ask a quick question about oshpd, and do they set of bar in terms of what's acceptable on the benefits that a nonprofit might provide to the community or does san francisco identify the needs of the community and ask oshpd to monitor them? how does that work? >> so we would need -- if directed by the lafco, we can take a deeper dive into exactly how these requirements and obligations work and how really the synergy is supposed to work with working with the community. there's a clear obligation under the statute to work with the community to identify the needs, but how exactly that works, we would need to take a deeper dive. i will after my part of the presentation, chelsea has a

presentation. she has actually contacted the agency, has a little bit more information. again we're still at the beginning of the process and want to get some direction from lafco before we go any deeper. >> commissioner pollock: great, thank you. >> but i think that's a great area of exploration if the lafco is so inclined to do that. >> supervisor fewer: supervisor ronen? >> supervisor ronen: yes. when i was a legislative aide for supervisor campos, this is something that i worked on. and there's not much we can do or even the type of body that we are at lafco -- i don't even know how to describe it, because of certain issues at the state. we did pass several resolutions supporting bills that encouraged more rigorous enforcement and further defining what this charitable benefit requires at a minimum? so i'm not sure that there's

much to do there. what could be interesting especially if we talk to some of our, you know, community and union partners, is a comparative study of the amount of money different nonprofit hospitals spend on meeting this requirement and the -- and the amount of tax benefit they receive from their nonprofit status and just do a comparison to, you know, put some media and other types of pressure on those hospital chains that are not doing their fair chair comparative to their peers? that would be, i think, a really interesting study. but we have -- i have done quite a bit of work on here, and unfortunately, at our level, there's just not much we can do with teeth. >> supervisor fewer: lack of local control is -- should we have chelsea come up and speak

right now? >> absolutely. >> supervisor fewer: okay. >> i will just point out that if there is money coming from the city to these hospitals -- and again, you know, we'd have to do a deeper dive, but again, certainly areas where there may be money, that there may be a contractual hook for the city, even though there isn't a regulatory hook. so it's not a question of local work, it's a question of fiscal control of local grant money, and i don't know if you have the opportunity to look at that. so that's an area -- and i don't know the answer to the question -- that may provide some hook, but yes, it's really at the state level, and it would be pressure at the state level. i'm going to -- if there are no further questions, i'm going to pass the mic off to chelsea. >> supervisor fewer: oh, i think commissioner pollock has a question. >> commissioner pollock: my apologies to just back in and

ask one question. is there additional -- i don't want to say local control, but is there something that would be different because lafco is a state body and not a city and county body? >> no. no. good try. >> supervisor fewer: yes. >> hello. chelsea boulard, legislative staff for supervisor fewer. so most kind of echoing miss stricker's comments and commissioner ronen's comments about what's possible at a local level, i did reach out to the state office of local and planning development. one of the things that's being handed to you is a copy of the 1994 legislation, sb 697 that was passed that essentially mandates, you know, that nonprofit hospitals provide community benefit thes.

and as you can see, like, on pages 23 and 4, there is not a lot of specificity on what hospitals are required. there are some broad categories but no, you know, specific dollar amounts and very little accountability or kind of teeth to -- to the legislation. when i spoke to staff at the office of statewide health planning and development, they kbi confirmed that they are essentially a clearinghouse for this information, so at their essence, they publish the community benefit plans that these hospitals are developing, but they don't necessarily even do an assessment or an analysis of these plans, you know, and so i think there are some limitations there to kind of the scope of their responsibilities with regard to -- to these community benefit plans. i did reach out to the department of public health, and they essentially as a

local, you know, department, have no jurisdiction over any of these plans. the one thing i did want to note is they do work with these nonprofit hospitals that are based in san francisco through the san francisco health improvement partnerships community health needs assessment, the chna, and the chna provides data enabling identification of priority issues that are impacting health and san francisco, and that needs assessment is the foundation for a lot of the citywide health planning processes, including the community health improvement plan, san francisco's health care services master plan, the san francisco department of public health population health division static plan, and then each of the nonprofit hospitals, community health needs assessments, and their own benefit plans. so essentially this kind of joint collective needs assessment that happens is what informs those nonprofit hospital community benefit

plans, but essentially, it is up to those hospitals to create the plans themselves right there, and there isn't kind of external oversight in that besides the statewide office of health planning and development. part of this initiative where it came from is i understand there was a 2014 initiative published. i've handed out copies of that report to you all. on page 20, there is a list of recommendations that they included. most of these as kind of have been noted are -- would be -- need to take place at the state level. there are recommendations with regards to hospitals themselves making changes and potentially, you know, putting pressure on those hospitals to make those changes, but there are a couple of things that could have local impact that might be worth exploring further, and i did

reach out to the green lighting institute, and we weren't able to coordinate for them to come to this meeting, but they would be happy to come if the commission decided to continue this item for further exploration, they would be happy to come and present on these recommendations at the next meeting in may, and we have a call scheduled for this week to explore also, have there been kind of updates to this report or their work around nonprofit community -- nonproperty hospital community developments. and the department of public health has also, you know, said that they would be willing to come and speak kind of more on the -- the health -- the needs assessment in particular. and the other option is the commission could also direct staff to reach out to nonprofit hospitals directly and ask them to come and present on community -- on their community benefit plans, which they may or may not decide to come, but it's another kind of