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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
JOHN MUIR HEALTH
 
Employer identification number
94-1461843
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A CA STATEWIDE COMMUNITY DEVELOPMENT AUTHORITY
  		68-0164610 NONEAVAIL 05-23-2012 89,800,000 SEE PART IV   X   X   X
B CA STATEWIDE COMMUNITY DEVELOPMENT AUTHORITY
  		68-0164610 13080SMW1 06-09-2016 353,140,040 SEE PART IV   X   X   X
C CA STATEWIDE COMMUNITY DEVELOPMENT AUTHORITY
  		68-0164610 13080STN4 05-15-2018 92,473,440 REFUNDING OF 2017 BONDS   X   X   X
D CA STATEWIDE COMMUNITY DEVELOPMENT AUTHORITY
  		68-0164610 NONEAVAIL 08-15-2019 51,532,082 REFUNDING OF 2012B BONDS   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 81,236,250      
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 89,800,000 354,957,913 92,473,440 51,532,082
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 502,197 3,133,280 1,419,493 482,082
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds ............. 127,803      
10 Capital expenditures from proceeds .............   17,965,830    
11 Other spent proceeds ............. 89,170,000 300,002,560 91,053,947 51,050,000
12 Other unspent proceeds .............   33,723,745    
13 Year of substantial completion ............. 2012 2018 2019
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		X   X   X     X
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X   X   X X  
16 Has the final allocation of proceeds been made? .......... X     X X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X   X
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X     X   X   X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?   X            
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0.010 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0.010 % 0 % 0 % 0 %
6 Total of lines 4 and 5 ............. 0.020 % 0 % 0 % 0 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X   X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		  X   X   X   X
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X X   X     X
b Exception to rebate? ........ X     X   X   X
c No rebate due? .........   X   X   X   X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X X   X     X
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?                
7 Has the organization established written procedures to monitor the requirements of section 148? ...   X   X   X   X
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?   X   X   X   X
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
PART I, LINE A, COLUMN (F) DESCRIPTION OF BOND PURPOSE THE BONDS WERE ISSUED FOR THE PURPOSE OF REFUND AND PAYMENT IN FULL OF THE OUTSTANDING PRINCIPAL AMOUNT AND INTEREST DUE ON THE 1997 CERTIFICATES OF PARTICIPATION AND THE SERIES 2008B BONDS ISSUED 10/29/1997 AND 5/2/2008 RESPECTIVELY.
PART I, LINE B, COLUMN (F) DESCRIPTION OF BOND PURPOSE THE BONDS WERE ISSUED FOR THE PURPOSES OF REFUNDING BONDS ISSUED 6/14/2006 AND 5/2/2008 AND FINANCING CAPITAL EXPENDITURES.
PART II, LINE 3, COLUMN B TOTAL PROCEEDS FROM ISSUE THE $353,140,040 OF BOND PROCEEDS INCLUDE $1,817,873 OF TOTAL EARNINGS SINCE 2016 ON THE UNSPENT PROCEEDS.
PART III, LINE 3B MANAGEMENT, SERVICES CONTRACTS OR RESEARCH AGREEMENTS JOHN MUIR HEALTH ENGAGES BOND COUNSEL IN CONNECTION WITH PUBLIC DEBT OFFERINGS OR REFINANCING, DURING WHICH BOND COUNSEL REVIEWS MANAGEMENT OR SERVICE CONTRACTS RELATED TO FINANCED PROPERTY.
PART III, LINE 9 & PART V WRITTEN DISCLOSURES WHILE THE ORGANIZATION DID NOT HAVE BOARD APPROVED WRITTEN POLICIES AND PROCEDURES IN PLACE AS OF THE YEAR END, THE ORGANIZATION DID MONITOR COMPLIANCE WITH THE POST-ISSUANCE REQUIREMENTS IMPOSED ON THE BONDS. THE ORGANIZATION HAS DRAFTED FORMAL WRITTEN POLICIES AND PROCEDURES THAT ARE PENDING BOARD REVIEW AND APPROVAL.
Schedule K (Form 990) 2021

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