Berkeley City Council
November 19, 2024

43 to urgent care referrals, the Tang Center also
refers students to Alta Bates Campus for some
outpatient diagnostic procedures, maternity care,
and specialty care.

We reviewed SHIP billing data to estimate the
student utilization of Alta Bates Campus and
Sutter health care facilities more generally. As
noted, this is not the universe of all student health
care issues and students on other insurance
or without insurance are likely also accessing
the hospital. In addition, our review of studies
from the Journal of American College Health
suggested that across US universities, there were
approximately 100 ED visits per 1,000 enrolled
students (McKillip et al, 1990).

With approximately 40,000 students in 2017,
we estimated that UC Berkeley generates as
many as 4,000 student ED visits to Alta Bates
Campus per academic year. (We note here, but
did not analyze, that the East Bay has a number
of students at other institutions that will likely be
similarly impacted by the closure of Alta Bates
Campus. For example, there are an estimated
7,000 students at Berkeley City College, and
7,900 at Contra Costa College, but many of these
are commuter students and we were unable to
obtain data on these students’ health insurance
status or residence).

Student mental health is a critical issue on the
UC Berkeley campus. Severe episodes of stress,
depression, thoughts of suicide and other mental
health issues are prevalent in both undergraduate
and graduate settings. Receiving timely treatment
for these mental health issues is critical to the
health of students and the general UC Berkeley
population.

Our analyses of SHIP claimant data by diagnosis
code from August 2016 through May 2017
revealed that of the 8,111 SHIP diagnoses, 15%
were for some type of mental health-related
diagnosis, including, but not limited to: suicide
attempts, thoughts of suicide, psychosis, bipolar
disorder, depression, schizophrenia, eating
disorders and substance abuse. While a majority
of these were likely treated at the Tang Center,
we do note that 7% of the Alta Bates Campus ED
diagnoses in 2016 were for mental disorders/
episodes. Figure 25 compares SHIP utilization for
mental health related issues and those presenting
at the Alta Bates Campus ED.

While we cannot determine the exact number of
students visiting Alta Bates Campus for mental
health care, our conversations with Tang and Alta
Bates staff suggest that a high percentage of the
mental health and suicide/self-harm visits to Alta
Bates Campus are from UC Berkeley students.

Similarly, a significant proportion of UC Berkeley
Figure 25. Student vs Alta Bates mental
health care utilization
Suicide/self harm Mental disorders/episodes
Alta Bates ED
SHIP utilization
0 20
40 60
80 100
120
0 500
1000
1500
2000
2500
3000
3500
Number of Diagnoses
Source: SHIP , 2017 & OSHPD, 2016

44 students that utilize mental health services seem
to have received a referral after being seen at Alta
Bates Campus, sometimes through the ED for
issues such as anxiety and depression. The fact
that Sutter’s Herrick campus will not be affected
by a potential closure is significant and will likely
off-set any potential care that is now provided at
Alta Bates.

However, since Herrick does not have an ED,
a limited number of students that require
emergency psychiatric services will be impacted
by the closure. Runyan et al (2017) noted that
when young people are unfamiliar with where
to access care and support, this can adversely
impact suicide-related episodes. In addition, the
ED can provide important discharge counseling
protocols for patients with potential suicide risks
(Runyan, et al. 2017).

For accessing emergency care, travel by
ambulance or private vehicle from the Tang
Center to Summit or another ED besides Alta
Bates will likely increase time to receive care.

In addition, a number of students with chronic
disease rely on Alta Bates Campus for routine
specialty care for diagnosis and follow up. In the
event of a closure, these students may have to
travel farther, requiring more time to access care
and money to get there, and potentially resulting
in delays. The perception of this distance by
students could also change the way they access
care.

These impacts will be further compounded
by students’ time constraints, inexperience in
navigating the healthcare system, and financial
limitations. We predict that adding these barriers
will further complicate health care access for
students and may delay student utilization of care.

As depicted in Map 10, the 94704 (southside) and
Map 10. Population
density in ZIP Codes
surrounding UC Berkeley,
Alta Bates Campus, and
Summit Campus
25-30k
20-24.9k
15-19.9k
10-14.9k
5-9.9k
< 5k
People per square mile
(thousands)
UC Berkeley
Alta Bates Campus
Summit Campus
UC
AB
S
0 1.5mi
N

45 94709 (northside) ZIP Codes surrounding the
UC Berkeley campus and Alta Bates Campus
are the most densely populated in the RHIA
defined Hospital Service Area (HSA), with
25,297 and 20,165 persons per square mile
respectively. This greatly exceeds the density
of most other ZIP Codes in the HSA, with the
next highest being 17,766 persons per square
mile in Downtown Oakland (94612) and an
overall average of 5,989 persons per square
mile in the HSA (ACS 2012-2016).

Thus the student population may be most
adversely impacted during a campus or
regional emergency, in which a large volume
of students and residents in areas surrounding
the UC Berkeley campus require access to
timely care. We discuss the impacts of a
disaster scenario on emergency services in
more detail on page 56.

We interviewed students and met with
student organizations already concerned with
the potential impacts of the closure of Alta
Bates Campus. We heard from students that
had direct experience at Alta Bates Campus
and received treatment for appendicitis,
hand lacerations, allergic reactions and
other injuries. A common theme among the
students was that Alta Bates Campus and its
ED was close-by, familiar and served them
when the Tang Center was closed.

In general, students we heard from were not
familiar with other hospitals in the region
and would need more information on what
alternatives were available if Alta Bates
Campus were to close. We also heard from
both UCB health professionals and students
that they viewed Alta Bates as an ‘extension’ of
the UC Berkeley health care network. The likely
short-term impacts to student health on Alta
Bates closing are difficult to estimate, but may
include a disruption of familiar care options
and longer travel times to a 24hr ED.

Student 1:
“It was around 9pm so we could
not go to Tang first. I knew a
friend of
mine had gone to Alta
Bates previously for a night time
emergency, since it was the closest
emergency care available, so that is
why we chose it.”
Student 2:
“I don’t know of another urgent care
facility nearby that I trust, and had
the situation been worse, it may have
been too far to go.”
Student 3:
“[Alta Bates closing] would be
extremely detrimental as students
would no longer have a location
that was close for emergencies.

Particularly for more emergent
situations, [when] there is a need to
go see a doctor immediately. If not
then it could cause more harm than
good to go somewhere farther away.

UC BERKELEY

STUDENT VIEWS
ON AL

TA BATES

CLOSING

46 Whenever an urban hospital closes there are
concerns over travel times for ambulances to
reach the next closest ED and potential adverse
health outcomes from delayed access to care.

Liu et al. (2014) reviewed California emergency
department closures between 1999 and 2010
and found that patients who lived near a closed
emergency department and were later admitted
had a 5% higher chance of dying in the hospital
than those who did not live near a closure. They
concluded that ED closures do have significant
effects on patient outcomes.

Crandall et al. (2016) studied outcomes in EDs
for serious trauma after the closing of a large
medical center in Los Angeles. They did not
find any significant impact on trauma-related
health outcomes, but did find that one hospital
ED surrounding the closure had a tripling of
uninsured patients visiting their ED in a ten year
period. Lee et al. (2015), found that in NY State,
urban hospital ED use increased in areas where
hospitals have closed and that ED visits have risen
by 23% in the United States over the last decade.

Shen and Hsia (2016) studied changes in acute
myocardial infarction (AMI) among Medicare
patients whose communities experienced
increased driving time to an ED due to the
closing of an ED in their community. They found
that patients whose driving time related to
local ED closure increased by ≥ 30 minutes
had a statistically significant increase in 90-day
mortality by 6.58 percentage points (CI 2.49,

10.68) and 1-year mortality by 6.52 percentage
points. Patients whose driving time increased
by 10 – <30 minutes also had a significant
but less pronounced increase in 90-day and
1-year mortality, by 1.60 percentage points
(CI 0.53, 2.67) and 2.05 percentage points (CI

0.96, 3.14), respectively. Patients whose driving
time increased by less than 10 minutes did not
experience worse mortality rates after an ED
closed in their community.

IMPACT ON EMERGENCY

SERVICES
Longer wait times
Longer travel times
Longer on call times for EMS
Decreased capacity for surge
event
Emergency
Department
access
Excess burden on already vulnerable people
Increased health inequities
Increased morbidity
Increased mortality
Delayed critical care
In 2017, the Alta Bates Campus ED received 6,424 visits over the recommended number by the American College of Emergency Physicians (ACEP). Modeled travel times to Summit hospital surpass 40 minutes for the evening rush hour period for 10 ZIP Codes north of Alta Bates. For the Summit Campus, the average City of Berkeley EMS time on task is about 10-12 minutes longer than for transports to Alta Bates Campus. The additional travel time to Summit can result in about 2 hours of time an ambulance is away from service compared to ED transports to Alta Bates.

47 Hsia et al. (2012) used California data from 1999-
2009, and found that patients with an increase
in distance to the ne
arest ED (0.8 miles average
distance increase) did not have significantly
higher mortality in general or for specific
conditions, including those with acute myocardial
infarction, stroke, asthma or chronic obstructive
pulmonary disease, and sepsis. However, Nichol
et al. (2007) found that increased journey distance
to the hospital appeared to be associated
with an increased risk of mortality. Berlin et
al. (2016) studied acute myocardial infarction
(AMI) mortality in Switzerland and found a 19%
increase and a 10 % increase for men and women
respectively, all over 65 years, for those with
the longest driving time to a university hospital
compared to the same population group with the
shortest driving times to the same hospital.

Alta Bates ED Utilization
Alta Bates Campus had a total of 50,414 ED visits
in 2017, a 21% increase since 2010. The campus
treated an average of 126 patients per day in
2016 and 138 patients per day in 2017. Alta Bates
Campus currently has 22 emergency treatment
stations in their ED.
4 The American College of
Emergency Physicians (ACEP) recommends a
standard of 2,000 visits annually per emergency
treatment station. In 2016, Alta Bates Campus
had approximately 1,836 visits per emergency
treatment station, but this rate increased to 2,292
visits per emergency treatment station in 2017.
3 This increase resulted in 6,414 ED visits over the
ACEP standard in 2017.

Our analyses of OSHPD data and review of the
literature suggests that ED visits are increasing
nationwide and in the Bay Area. Further, there
may already be an inadequate supply of ED
treatment stations to keep up with this increasing
demand. The closing of Alta Bates Campus will
remove at least 22 ED treatment stations and, as
noted above, require a doubling of ED capacity
at Summit to accommodate the patients from the
Berkeley facility.

Analyses of Travel Times to Alta Bates vs Summit
Campus Emergency Departments
Sutter has indicated that it plans to relocate all
in-patient and emergency department services to
the Summit campus in Oakland by 2030, though
little details have been provided to date about the
extent and time line of the proposed expansion.

A concern is whether the move to Summit will
increase the travel time to the ED for some
people in the region.

Using Google Maps GPS navigation software,
the RHIA modeled travel times via private vehicle
to Alta Bates and Summit campuses during
the morning and evening peak traffic periods
(8:30am and 5:30pm). We compared these
periods to travel time at 12am as the non-traffic
period. We estimated travel times for all ZIP
Codes in the RHIA defined Alta Bates Hospital
Service Area. The analysis routed travel to Summit
and Alta Bates campuses from the center point
of each ZIP Code in the HSA, and recorded an
estimated range in minutes to each destination.

Figure 22 provides detailed findings of travel
times from all of the ZIP Codes north of Alta Bates
Campus, using the high end of each travel time
range. Findings revealed that travel times to both
Alta Bates and Summit Campuses from ZIP Codes
in north Alameda County and West Contra Costa
County are longest at the 5:30pm peak traffic
time. For the PM rush hour, all ZIP Codes in West
Contra Costa County (in Richmond, San Pablo, El
Sobrante, and El Cerrito) as well as Albany and
Berkeley, have increased travel times to Summit
Campus when compared to Alta Bates Campus.

These findings also overlap with ZIP Codes
identified in the vulnerable communities section,
indicating that there is a potential negative impact
of increased travel times on already vulnerable
populations that are served by Alta Bates.

48 Overall travel times at 5:30pm are longest from
ZIP Codes in West Contra Costa County, four of
which have a total travel time between 50-60
minutes to the Summit Campus. An additional
six ZIP Codes near the West Contra Costa and
Alameda County border fall within a 40 – 50
minute range of travel time to the Summit campus.

Timely transport to care is critical for a range of
health emergencies, but can mean the difference
between life and death for ST-segment elevation
myocardial infarction (STEMI) patients (i.e., a heart
attack in which an artery is blocked). Mathews
et al. found that up to 40% of STEMI patients
use private vehicle or non-EMS transportation to
reach the hospital. While ambulance transport
time is also critical, ambulances have life-saving
equipment to treat a time-critical patient.

Map 11 depicts travel times via private vehicle
to the Summit Campus during peak evening
traffic within 10 minute increments, and projected
annual emergency department visits related
to heart disease. We calculated the number of
estimated heart disease patients for each ZIP
code by multiplying the population by the actual
percent of ED visits for heart disease (from 2011).

Richmond, San Pablo and El Sobrante have both
the longest travel times to Summit and the largest
estimated heart disease related ED visits. 13 ZIP
Codes have estimated travel times greater than 30
minutes to Summit Campus, which is currently the
closest STEMI receiving center in the region.

No Traffic (12am) Traffic (8:30am) T raffic (5:30pm) Estimated annual Heart Disease related ED visits
City
ZIP Code Time
to AB
Time
to S
Diff
(S - AB)
Time
to AB
Time
to S
Diff
(S - AB)
Time
to AB
Time
to S
*
Diff
(S - AB)
Population x % heart disease ED
visit per ZIP Code (2011)
Berkeley
94702 10 12 2 18 22 4 20 40 20 321
94703 5 10 5 10 16 6 12 22 10 177
94704 6 12 6 9 22 13 12 26 14 645
94705 6 14 8 8 20 12 9 24 15 248
94706 16 10 -6 35 26 -9 28 45 17 367
94707 16 16 0 30 35 5 30 50 20 215
94708 20 22 2 22 28 6 22 35 13 280
94709 12 16 4 18 30 12 18 35 17 195
94710 10 8 -2 20 16 -4 24 40 16 86
94720 9 20 11
10 26 16 12 30 18 32
El C
errito 94530 20 14 -6 45 35 -10 40 45 5 185
Richmond
94801 26 22 -4 55 45 -10 45 50 5 165
94804 18 12 -6 45 35 -10 35 45 10 1,023
94805 18 12 -6 50 40 -10 35 45 10 249
El Sobr
ante 94803 26 22 -4 40 40 0 35 55 20 459
San Pablo 94806 26 22 -4 60 50 -10 45 50 5 1,275
Figure 26. Travel times to Alta Bates & Summit Campuses from ZIP Codes in the HSA

49 Map 12 depicts travel times to Summit Campus
and Alta Bates Campus via private vehicle at
5:30pm for thr
ee ZIP Codes in the RHIA defined
HSA. Each of these ZIP Codes experience shorter
travel times to Alta Bates Campus than Summit
Campus during peak evening traffic time, and one
relies on heavily congested freeways including
580 and 80.

Given that 15% of
households in the HSA report
having no vehicle (ACS 2012-2016), the analysis
also tested travels times via public transportation
(bus and BART). We did not find significant
differences in travel time to Alta Bates Campus
vs. Summit Campus for ZIP Codes north of Alta
Bates in the HSA for public transit. Travel times via
public transit averaged approximately 1 hour from
West Contra Costa County to both Alta Bates and
Summit campuses.

Projected annual Heart Disease related ED visits Alta Bates Campus Summit CampusSAB 20 - 29 minutes
30 - 39 minutes
40 - 49 minutes
50 - 59 minutes
#
Map 11. Estimated Number of Heart Disease ED visits & Private Vehicle Travel Time for Peak Period to Summit Campus for select ZIP Codes
Travel Time to Summit Campus
during Peak PM Period
0 1.5mi
N

50 Impacts on Ambulance Travel Time
Though this RHIA does not include an analysis
of projected ambulance travel times, we assume
that emergency vehicles are likely to travel faster
than private vehicles in both traffic and non-traffic
conditions.

When an ED closes it can cause ambulances
to travel to further, and may also result in ED
crowding. Overcrowding can cause increased
ambulance time on task – the total EMS time
from receiving a 9-1-1 call to arriving on scene,
then arriving at the hospital, and returning to
service. That window represents time that the
ambulance and associated staff cannot respond
to new incoming calls, and cannot be at the Fire
Department garage maintaining the vehicles or
completing trainings and other tasks.

The Alameda County Emergency Medical
Service (EMS) system responds to about 160,000
20 - 29 minutes
9 - 19 minutes
30 - 39 minutes
40 - 49 minutes
50 - 59 minutes
Alta Bates Campus Hospital Service Area (HSA) Alta Bates Campus Summit CampusSAB Map 12. Travel times to Alta Bates vs. Summit Campus at PM Peak Period from select ZIP Codes in the Alta Bates HSA 0 1.5mi
N

51 emergency calls annually. Under normal protocol
a fire department unit and Paramedics Plus
ambulance respond to emergency medical
calls, however the Berkeley Fire Department
EMS division owns and operates four of its own
ambulances and therefore generally provides the
emergency transport services in the Berkeley area.

In 2014, the Berkeley Fire Department transported
5,049 patients to Alta Bates Campus, while
Paramedics Plus transported less than 500 from
the Berkeley area to the same campus.

Given this large volume of Berkeley EMS
transports to Alta Bates Campus and findings
from the general travel time analysis (Figures 22
& 23) which indicate that 5 ZIP Codes in Berkeley
have increased travel times by vehicle to Summit
Campus compared to Alta Bates Campus during
no traffic hours, we focus the ambulance travel
time analysis on the experiences of the Berkeley
Fire Department, referencing data and insight
provided by the Fire Captain for the City of
Berkeley.

The Berkeley Fire Department transports about
7,000 patients annually to local hospitals, of which
there are 14 receiving facilities throughout the
county. Receiving centers are determined by
matching the closest hospital with the equipment
that the patient needs. For instance, if someone
standing on the corner of Telegraph and Ashby
has a major heart attack and is being transported
by ambulance, they may be transported to Summit
rather than Alta Bates Campus, since Summit is
the closest ST- elevation myocardial infarction
(STEMI) receiving center and can adequately
address the needs of a major heart attack patient.

The vast majority of all-cause City of Berkeley
EMS transports are taken to Alta Bates Campus,
followed by Kaiser Permanente in Richmond, and
the Summit Campus in Oakland (4,576, 1,093, and
578 transports in 2016, respectively).

We assume that most of these transports were not
for major heart attacks, since Alta Bates Campus
is not a STEMI receiving center. Despite this,
closing the Alta Bates Campus ED may result in
extra time spent transporting patients to care and
decreased regional EMS capacity for ambulance
transports, which is particularly concerning
for patients with conditions for which quicker
transport time is related to measurable differences
in health outcomes.

If Alta Bates Campus closes, the Berkeley Fire
Department expects that most of the emergency
transports would instead be taken to the Summit
Campus in Oakland. For the Summit Campus,
the average City of Berkeley EMS time on task
averages about 10-12 minutes longer than
transports to Alta Bates Campus. According to the
data from Berkeley EMS, there are an average of

12.5 emergency trips made to Alta Bates Campus
daily. If Alta Bates Campus were to close, the extra
time needed to transport these patients to the
Summit campus instead would add up to about
two hours extra of time on task in total per day.

Without additional resources, response times to
incoming emergency calls for all causes would
likely increase due to the additional time on task
required to transport patients to Summit and
to get back to Berkeley, where they can receive
another call. Assuming there are no additional
ambulances in rotation to offset additional time
on task for transport to Summit, patients with
intermediary or high risk of mortality, including
those requiring time-sensitive interventions – such
as coronary revascularization in acute myocardial
infarction, fibrinolytic therapy for acute ischemic
stroke, early goal directed therapy in sepsis, and
trauma center care for injuries may not receive
the timely response associated with a survival
benefit, and subsequently mortality rates for life
threatening conditions may increase. While Alta
Bates is not a critical stroke or STEMI receiving
center, stroke and major heart attack patients in
Berkeley will still be disproportionately impacted
by the proposed closure due to the added time
on task and decreased capacity of Berkeley EMS

52 to respond to all 9-1-1 calls. This impact may
be worsened by an increase in diversion hours
at Summit Campus after the proposed closure
of Alta Bates Campus, which we discuss in the
following section.

We find similar impacts on ambulance transports
in West Contra Costa County, where the closest
ED is at Kaiser-Richmond hospital, with the next
closest being Alta Bates Campus, followed by
Summit Campus. According to Patricia Frost,
Director of Emergency Medical Services for
Contra Costa County, prior to the DMC closure
the Kaiser Richmond ED received about 31% of
all ambulance transports, but after the closing
this increased to 52%. From January 1 to March
31, 2016, 11% of the 4,692 EMS ambulance
destinations in West Contra Costa County, 516
in total, went to Alta Bates Campus. From 2014
to 2016, the Alta Bates Campus experienced a
123% increase in transports from Contra Costa
County EMS, going from 2.5 trips to Alta Bates
per day to nearly 5.7 trips to Alta Bates per day.

If Alta Bates Campus closes, we would expect
these patients to go to Alta Bates Summit in
Oakland, which is further away from West Contra
Costa County than the Alta Bates Campus.

The additional distance is likely to increase
emergency service travel times and time-on-task,
which would keep ambulances out of rotation
longer and increase emergency response wait
times for others in Contra Costa County. In
addition to increased distance to Alta Bates
Summit, there could be time on task added if Alta
Bates Summit is on diversion status or is not on
diversion status, but is overwhelmed with a high
volume of patients. Closing Alta Bates Campus
will likely increase time on task for Contra Costa
EMS, forcing the county to either contract out
for additional ambulances or try to absorb the
additional time on task, which could put lives at
risk.

The 2014 Contra County Health Services report
analyzing the potential impacts from the closing
of the ED at Doctors Medical Center in San Pablo,
noted the following impacts which are worth
repeating here as they likely apply to the closing
of Alta Bates’ ED:

1. American Medical Response ambulance crews
will experience longer time-on-task for all
911 phone call
Event identification
EMS system response time
Ambulance “time on task”
Dispatch “Chute” T
ravel Treatment
Transport
Call transferred to medical call taker
Call location pre-alerted to dispatcher
First responders & ambulance crew notified
Ambulance en route
Ambulance arrives on scene
Cr
ew departs scene
Crew arrives at medical facility
Crew is
available
for call
Figure 27. Emergency response time line
Source: National Association of State EMS Officials, 2011

53 transports going to more distant hospitals as a
result of the DMC closure.

2. In addition to possible delays in fire and
ambulance response resulting from increased
time on task,
the West County community has
raised a concern that there may be an increase
in the number emergency calls. Increased 9-1-1
usage may result when patients choose to access
9-1-1 rather than private transport due to the
longer driving distance and lack of familiarity with
routes to other facilities.

3. 9-1-1 ambulance traffic from the region would
overwhelm Kaiser-Richmond’s ED or require
tr
ansporting patients to other EDs that would be
further away, impacting ambulance availability
within the county.

4. Kaiser-Richmond will experience 80 – 100 new ED
patients per day on top of the 78 it already sees
daily. That is an increase of at least 102 percent.

While there are 12 other EDs in the region,
Kaiser-Richmond will be disproportionately
impacted. The reason for this is that patients
typically choose the next closest ED for their
ED needs, barring significant new healthcare
resources in the community or an extensive
public education campaign.

Ambulance Diversion
Crowded EDs can also result in ambulance
diversion, which is when ambulances are
redirected to bring patients to a different ED than
they would under normal conditions for timely
treatment. Beyond indicating overcrowding,
diversion is harmful in itself, as it increases time to definitive care and can be associated with poor
outcomes for patients with certain conditions,
particularly stroke and acute myocardial infarction.

According to OSHPD, Alta Bates Campus had
182 hours of ambulance diversion in 2014 but
only 57 hours of ambulance diversion in 2016.

Sun et al. (2006) assessed the effects of nearby
hospital closures on ED ambulance diversion
in Los Angeles County from 1998 to 2004. They
documented ambulance diversion hours due to
ED saturation and found that hospital closures
increased ambulance monthly diversion hours by
an average of 56 hours for the first 4 months at the
nearest EDs.

In 2016, both Alta Bates and Summit campuses
practiced ambulance diversion for about 60
hours during the year.
3 However in 2017, Alta
Bates’ diversion hours decreased to 13, and
Summit decreased to 29. Comparatively, Highland
Hospital in Oakland had 161 hours of ambulance
diversion in 2017.
4 Since Summit is already
practicing diversion, there is a high likelihood that
additional diversion hours would be added to the
Summit ED after a closure of Alta Bates Campus.

Regional Emergency Department impacts
The San Francisco Bay Area is home to more than
80 acute care hospitals, serving a region of more
than 7 million people, situated within 9 counties
and 110 cities (ACS 2012-2016).
11 In Alameda and
Contra Costa Counties, there is a large hospital
network in place to serve the counties’ more than

2.7 million residents. However, the hospitals within
this network are not evenly distributed throughout
the region, and this may impact where patients go
for care if Alta Bates Campus is to close.

As we discuss throughout the report, the regional
hospital network was recently impacted by the
closure of Doctor’s Medical Center (DMC) in 2015.

The closure of DMC resulted in a regional gap
in ED care, making Kaiser Richmond (which has
limited capacity for non-Kaiser patients) the only
ED besides Alta Bates Campus along the corridor
from San Pablo to Berkeley. This RHIA has found
that Kaiser-Richmond experienced an increase
in ED utilization since DMC closed, going from
40,065 ED visits in 2013 to 64,680 in 2017.
4,7
According the 2016 Contra Costa EMS System
Performance Report there was an approximate

54 12% increase in EMS responses from 2014-2016 in
the county, with an average of 271 EMS responses
per day (in 2016). Since 2014, there has not only
been a large increase in total ambulance usage,
but, as a result of the DMC closure and distance
to the next closest hospitals, there has also been
a large increase in ambulances originating from
Richmond, San Pablo and nearby areas that
travel high traffic roads and freeways to Kaiser-
Richmond, Alta Bates Campus, Contra Costa
Regional Medical Center in Martinez and John
Muir Medical Center in Walnut Creek.

Within Alameda and Contra Costa County,
only 6 hospital other than Alta Bates Campus
(Summit Campus, Kaiser Richmond, Kaiser
Oakland, Highland Hospital, Alameda Hospital
and Children’s Hospital Oakland) receive a
significant (25% or more) number of patients
from the RHIA defined Alta Bates Hospital Service
Area (HSA), and in 2016 Alta Bates Campus was
overwhelmingly the most utilized non-Kaiser
hospital by residents of Berkeley, Albany, El
Cerrito, Richmond and San Pablo.

Given the increasing reliance on Alta Bates
Campus ED by patients from West Contra Costa
County and the high utilization by Berkeley
residents, it is unclear where people in the HSA
will seek emergency care, both independently
and by ambulance transport.

To assess the capacity of regional hospitals to
absorb additional ED patients, we used the
American College of Emergency Physicians
(ACEP) standard of 2,000 ED visits annually per ED
treatment station. Figure 24 shows the additional
number of ED visits (using 2017 data) that could
be absorbed by regional hospitals per year should
Alta Bates Campus ED close, before exceeding
the ACEP standard. If Alta Bates Campus were to
close and all of the 50,414 ED patients in 2017
utilized the remaining open EDs, particularly
Highland Hospital and Kaiser-Oakland, there
would be capacity in the region even without
an expansion of Summit Campus in Oakland. In
2017, Highland could have absorbed 48,003 visits
before exceeding the ACEP standard, and Kaiser-
Oakland could have absorbed 32,313 visits before
exceeding the ACEP standard. However, whether
or not the 50,414 patients that went to the Alta
Bates Campus ED in 2017 will utilize Kaiser and/
or Highland in the event of an Alta Bates Campus
closure is unclear, given the disproportionate
utilization of the campus (in 2017 Alta Bates
Campus ED surpassed the ACEP standard by over
6,000 visits).

Figure 28. Additional ED visits/year
hospitals can absorb before exceeding
American College of Emergency
Physicians (ACEP) standard, 2017.
0 10000
20000
30000
40000
50000
Summit Oakland Kaiser Oakland Highland Hospital Alameda Hospital K Number of visits

55 Highland Hospital receives the majority of its
patients from central and east Oakland, and in
2016 the hospital received 62% of its ED patients
from 10 ZIP Codes. 8 of the 10 ZIP Codes fall
within the Alta Bates Campus HSA, however just
14% of Alta Bates Campus ED patients came from
those same 8 ZIP Codes.
6 Since there is currently
relatively low utilization of Highland by the
population primarily served by Alta Bates Campus,
it is not likely that Highland will become the
primary receiving center for Alta Bates Campus
ED patients. It is more likely that the majority
of Alta Bates Campus’ current patients would
choose to utilize Summit, which is already near
capacity and would need to double its capacity to
accommodate all of the patients that utilize Alta
Bates Campus ED annually.

Figure 25 shows the relationship between the
number of ED stations, total ED visits and the
ACEP standard for the Alta Bates and Summit
campuses. To calculate the emergency
department capacity, based on the ACEP
standard, the number of emergency department
stations is multiplied by 2,000, which is the ACEP
standard for yearly visits per emergency treatment
station. In 2017, Alta Bates Campus had an ACEP
defined capacity of 44,000 (22 ETS*2,000) and
was over capacity by 6,424 visits. Meanwhile, Alta
Bates Summit had an ACEP defined capacity of
50,000 (25 ETS*2,000) and was under capacity
by 2,883 visits. Summit Campus would need
to expand their emergency treatment stations
by at least 24 to accommodate the increase in
patients from Alta Bates Campus. Sutter Health
has stated on their Vision 2030 website that they
would increase the Alta Bates Summit Campus
emergency department capacity to accommodate
90,000 visits per year. However, this would
be insufficient to accommodate all Alta Bates
Campus emergency department patients, should
the campus close.
# ED
Stations
(2017)
A CEP standard
(yearly visits per station)
ACEP Defined
Capacity
2017 Total ED
Visits
Visits that e xceed capactiy
(+ e xceeds, - under capacity)
Alta Bates campus 22 2000 44000 50414 +6414
Summit campus 25 2000 50000 47117 -2883
Total 47 94000 97531 +3531
Figure 29. Alta Bates & Summit ED utilization & American College of Emergency Physicians’ recommended capacity ACEP standard of
2,000 ED visits
annually per
treatment station

56 In this section, we estimate the potential impact
of the closing of Alta Bates on emergency
department capacity during two disasters, an
earthquake and large fire. We base these analyses
on the HayWired Reports Volume I & II which detail
likely impacts from an earthquake on the Hayward
fault line, and data from the aftermath of a 2012
fire at the Chevron refinery in Richmond, CA.

The entire Alta Bates HSA runs along the Hayward
fault line, and the Working Group on California
Earthquake Probabilities calculates that there is a
33-percent likelihood of a large (6.7 magnitude
or greater) earthquake occurring along this fault
line in the next few decades (USGS, 2018). In
order to fully examine the potential impacts of a
major earthquake along the Hayward fault line,
the USGS, along with a number of stakeholders,
created the HayWired scenario and resulting
reports.

The HayWired scenario is one of many plausible
scenarios for the region’s next major earthquake. It
investigates the likely impacts of a 7.0 magnitude
earthquake along the Hayward fault, with an
epicenter under the city of Oakland. In this
scenario, the 7.0 magnitude earthquake strikes on
April 18, 2018 at 4:18pm, just around the start of
the week-day rush hour (USGS, 2018).

According to FEMA data, there are an estimated
837 people mortally injured, 461 life-threatening
injuries, 3,007 injuries requiring a high degree
of medical care, and 12,263 injuries that require
medical attention and cannot be treated at home
after the initial quake. In total, there are 16,568
casualties from the earthquake, 837 fatalities and
15,731 people that require medical attention. The
HayWired scenario rounds FEMA’s estimates to
800 fatalities and 16,000 injured and needing
medical attention. FEMA estimates that 84% of
displaced households will come from Alameda
County (68%) and Contra Costa County (16%)
(USGS, 2018). Using these same percentages, we
estimate that those injured and needing medical
attention would total to 13,440 in Alameda
County and Contra Costa Counties, with 10,880
needing medical attention in Alameda County
and 2,560 in Contra Costa County.

Access and time to treatment will be critical for
many of the injured, and considering that the
majority of the impact will be felt in Alameda
County and Contra Costa County, there will
be increased pressure on the existing hospital
network and emergency services to respond to
and treat the surge of patients in the ED. If all of
the injuries that occur in Alameda County seek
treatment at hospitals in Alameda County in an
even manner (all hospitals are evenly impacted
by the event), there would be an estimated
837 additional patients seeking treatment at
each emergency department as a result of the
quake. For instance, in the event of the HayWired
Haywired Earthquake Scenario:
84% of households are displaced in
Alameda and Contra Costa Counties
14,000 estimated injuries requiring
medical attention from Alameda and
Contra Costa Counties
$57 billion in total direct economic
loss

DISASTER EVENT IMPACTS

57 Map 13. Earthquake along the Hay-
war
d Fault & Hospital Locations
Source: HayWired
Report Volume I
scenario, Kaiser San Leandro, which addresses
the highest # of ED cases/day in Alameda County,
would need to serve an estimated 1,028 patients.

This is a 438% increase from their daily average
number of visits. If Alta Bates Campus were to
close, the number of surge patients requiring ED
treatment in Alameda County would increase by
an additional 64 visits for each hospital in the
county.

In Contra Costa County, we estimate 2,560 injuries
needing medical attention. We estimate that
roughly 280 people from Contra Costa County
would access emergency treatment at Alta Bates
Campus. Since the Kaiser Richmond emergency
department is the primary receiving center for
West Contra Costa County residents, we would
expect at least half of the remaining 2,280 to
go to Kaiser Richmond. The Kaiser Richmond
Emergency Department could be overwhelmed
with an estimated 1,316 people needing
treatment the day of the earthquake. If Alta Bates
were to close, we estimate that Kaiser Richmond
would experience an additional 282 ED patients
immediately following the earthquake.

In the 1994 Northridge earthquake, a magnitude

6.7 earthquake in Los Angeles, there were over
0 1.5 3mi
N

58 9,000 people injured and 57 fatalities. Research
conducted around the Northridge Earthquake
showed that injuries increased significantly with
age. 60-79 year olds were 10.9 times more likely
to be injured, and people 80 and older were

34.6 times more likely than 0-19 year olds to
sustain earthquake related injuries (Peek-Asa,
1998). The Northridge Earthquake highlighted
that those most impacted by injuries are likely
to be the aging/elderly (60+), and aging/elderly
populations already experience issues of mobility,
from issues related to driving restrictions, physical
limitations or other cognitive/familiarity issues that
inhibit their ability to access far away or unfamiliar
hospitals.

Approximately 13% of the population in the Alta
Bates Campus HSA are over the age of 65, with
an additional 12% between 55-64. Compared
to other cities in the HSA, Berkeley has a high
concentration of elderly, as people over 65 make
up between 20-30% of the population in three of
its ZIP Codes (94705, 94707 and 94708). The ZIP
Codes with the highest total number of elderly
(65+) in the HSA are located in Richmond (94806),
Alameda (94501) and Oakland (95611), each with
over 6,500 residents over 65. These six zip codes
would be particularly vulnerable to the impacts of
an earthquake without Alta Bates Campus.

Though our earthquake analysis does not account
for potential post-earthquake barriers to local
hospitals, it is critical to note that the Summit
Campus is bounded by freeways, including 580,
980 and 880. Under the Haywired scenario there
is a high possibility that local freeways will be
compromised and hospitals, including Summit,
may not be accessible by all that need care.

Concentrating ED care in fewer locations in the
East Bay may compromise access to emergency
medical treatment after an earthquake.

Potential Impact from Chevron Refinery Fire
On August 6, 2012, a major fire erupted at the
Chevron Refinery in Richmond, CA. A Level 3
community warning and shelter in place order
were immediately issued. There were no injuries
or fatalities at the scene, but the emergency
departments at Kaiser-Richmond and Doctors
Medical Center began to receive patients that
complained of respiratory problems. Emergency
departments were overwhelmed and placed on
diversion status. American Medical Response
(AMR), a subcontractor for emergency services,
requested mutual aid resources, and an
ambulance staging area with one ambulance
from San Ramon Valley Fire and two Paramedics
Plus Units from Alameda County was established
at San Pablo Town Hall. Tents were set up at both
Kaiser and DMC, establishing separate areas for
patients to be seen. Within the first two hours after
the fire, 200 patients sought emergency treatment
at DMC. On the peak day four days after the fire,
regional EDs (mostly in Contra Costa County), saw
2,876 visits related to the fire, and an approximate
4,500 visited the ED over the next 3 days. In
total, the fire sent over 15,000 patients to the
emergency department for 18 days following the
event (CCHS, 2012).

Figure 26 shows the regional emergency
department surge pattern for ED visits related to
Chevron Fire Example:

Estimated 15,000 related emergency
department visits over 2 ½ weeks
2,876 visits to emergency
departments on peak day (4 days after
fire occurred)
200 ED visits
within the first 2 hours after the fire

59 the Chevron fire in the two
weeks following the incident.

At the time of the fire, both
DMC and Kaiser-Richmond
EDs were in full operation.

Before its closure, DMC had
25 emergency treatment
stations, and Kaiser Richmond
had 15 emergency treatment
stations. Even with two hospitals receiving the
surge of patients, both emergency departments
were quickly overwhelmed and both hospitals did
not return to normal operations until August 23rd
(CCHS, 2012).

As highlighted in the Alta Bates Campus
Utilization and Hospital Service Area sections
above, Alta Bates Campus has seen an increase
in patients from West Contra Costa County since
the closure of DMC in 2015. If this scenario were
to happen without the ED of Alta Bates Campus,
we estimate that between 1000- 1,200 people
would seek treatment at regional EDs in the first
three days of the event. Kaiser Richmond would
be most impacted, but it is unclear where patients
from Contra Costa County and northern Alameda
would seek treatment without Alta Bates Campus.

We estimate that Summit and Highland Hospital,
as well as urgent care facilities in Contra Costa
County would need to absorb the increased ED
patient load.

Without Alta Bates Campus, the emergency
response plan to provide residents from Contra
Costa County with timely care in the case of
a major fire would need to be addressed. As
noted above, a fire or earthquake disaster may
overwhelm ED capacity and services at hospitals
throughout the region, and these impacts may be
critical if the Alta Bates Campus closes.

Figure 30. Emergency Department patient surge volume after Chevron refinery fire, Richmond, CA, 2012 “The magnitude of the earthquake that’s going to happen here is so significant that we really do need to have every critical facility in the best possible earthquake shape possible.” - Nancy Skinner (NY Times Article)

60 Hospitals such as Alta Bates Campus are major
generators of economic activity. As a result,
closure of a hospital can not only impact those
employed there but the local and regional
economy. In 2016, Alta Bates Campus reported
earning almost $1.9 billion in revenue for
providing care to patients, with billing including
Medicare (35% of total revenue), Medi-Cal (26%),
and private insurance providers (38%).
2 Though
Alta Bates Campus earned almost $1.9 billion in
revenue, with spending, adjustments and other
deductions, their net income was approximately
$19 million in 2016.

Much Alta Bates Campus’ revenue is subsequently
spent on hospital clinical and nonclinical
operations. In 2016, Alta Bates Campus reported
spending a total of $604 million on operations. Of
this, $284 million was spent on direct expenses,
which includes purchases of supplies and
equipment, leases and rents, and purchased
services such as parking and security.
2 Of the $604 million spent on operations, the
other $320 million was spent on employee
compensation. Aside from high-skilled and high-
paying staff such as physicians, surgeons, and
nurses, Alta Bates Campus is also a major source
of low-skilled jobs. According to SEIU-UHW, the
hospital directly employed 280 people in low-
skilled, lower-paid jobs in 2015 (Rauber, 2014).

These positions include clerks, patient aides, food
service and custodial staff, nursing assistants,
and technical support staff. With average hourly
wages between $20 and $24 per hour, these
lower paid positions nonetheless offer generally
higher wages when compared with similar jobs in
different settings.

In line with their announced plan to systematically
shut down service lines and transfer them to
Summit campus, Alta Bates Campus has already
reported significant decreases in spending for
certain service lines. Cardiac Services saw a 68%
reduction, with spending going from almost $4.4
million in 2012 to less than $1.4 million in 2016.

Radiology Services - for both diagnostic and
therapeutic purposes - had a decrease of 57% or
over $19 million over the same time period.

Adolescents service lines showed no spending by
2016.
1,2

ECONOMIC IMPACTS
Alta Bates generated over $1.9 billion in patient revenue and spent $604 million on operations and employee compensation in 2016. According to their filing with the State of CA, Alta Bates has reduced their overall spending by over $81 million since 2012. The closing of Alta Bates will adversely impact the local economy but the extent of the impact will depend on the nature of replacement services, hiring and contracting at the Summit campus.

Excess burden on already vulnerable people
Increased economic inequality
Increased costs for local governments
Decreased regional spending
Lost wages
Lost jobs
Lost contracting
Regional
economy

61 According to their financial disclosures, Alta Bates has even started to reduce spending in their
bir
thing center. Between 2012 to 2016, Labor
and Delivery Services saw an almost 23%, or $7
million reduction in spending, while spending on
Neonatal Intensive Care fell almost 35% over this
same time period.
1 Impact Magnitude
L
ow wage
workers
165 workers already laid off since 2012
Community
benefits
Potential reduction of $91 million in charity
care
Local
economic
activity
Potential loss of $1.5B annually in local
economic activity
Alta Bates as an Economic Base Multiplier
Alta Bates Campus, like all hospitals, has a large
impact on the regional economy. Hospitals draw
in billions of dollars in revenue from medical
reimbursements. These reimbursements come
overwhelmingly from outside the region:

Medicare brings in federal dollars; Medi-Cal
brings in a combinations of federal and state
dollars; and private insurance brings in money
from corporations based across the country.

With this continuous source of revenue,
hospitals like Alta Bates Campus typically spend
overwhelmingly within the metropolitan area
or its surrounding region. In fact, economists
estimate that an average urban hospital spends
at least 80% of its patient revenue within the
metropolitan area (Erickson et at., 1986).

The nature of hospital operations necessitates
that Alta Bates Campus contracts with local
companies for everything from medical supplies
and equipment to food for its patients, staff,
and visitors. They must also contract with
local companies for purchased services such
as laundry, parking, and security. Alta Bates
Campus also contributes to the regional economy
by employing hundreds of staff. If not through
direct employment, Alta Bates supports dozens of
jobs through its purchasing of services.

As a nonprofit hospital, Alta Bates Campus
is required by law to reinvest any surplus
revenue back into the community in the form
of community benefit programs. According
to its Community Benefit Plan, Alta Bates
spent over $97 million in 2016 for community
benefit programs, activities, and initiatives.

The vast majority of this community benefit--
over $91 million--comes in the form of charity
care, providing free medical services for those
without coverage and unable to afford the cost
of their care (Sutter Health, 2016). The rest is
spent funding various public health programs
such as asthma and diabetes resource centers,
neighborhood revitalization programs, and youth
outreach and career development services.

As a result, Alta Bates Campus acts as what
economists call an economic base multiplier.

That is, the hospital generates significantly higher
$1.9 billion in patient revenue
generated in 2016
23% reduction in spending on Labor &
Delivery Services from 2012-16
35% reduction in spending on Neonatal
Intensive Care from 2012-16
165 lower wage workers
already laid off by Alta Bates since 2012

62 downstream economic output in proportion to
its revenue. A number of studies highlighted
this economic base multiplier effect on urban
hospitals in Pittsburgh, PA, Syracuse, NY, and
Minneapolis, MN. These studies found that the
multiplier ranged from 2.63 to 2.69, meaning
that every dollar that a hospital earns in patient
revenue generates between $2.63 and $2.69
in economic activity for the surrounding region
(Moore, 1974 & Doeksen et al., 1997).

We used the economic-multiplier idea and
conservative assumptions to estimate the
hospital’s likely contributions to the local
economy. Given that in 2016 Alta Bates Campus
spent $604 million, we estimate that the hospital
is likely responsible for generating approximately
$1.5 billion in economic activity for the Bay Area.

The economic impacts from the closing of Alta
Bates Campus will likely also include loss of low
wage jobs. These workers may lose income and
experience other hardships. Skilled workers, such
as physicians and nurses will either be relocated
to Summit, find work elsewhere, loose their
jobs, or leave the region to find work elsewhere.

If skilled nurses leave, the region’s health care
facilities may experience an increase in the
nursing shortage.

There is little doubt that Alta Bates Campus
provides economic benefits to the local and
regional economy. The exact adverse impacts
from the closing are difficult to estimate, but our
review of OSHPD data suggests that close to $1.5
billion in local economic activity could be lost.

Majority of hospital patient revenue sources are from outside of the region (i.e. Medicare, Medi-Cal, and Private Insurance)
Total Patient
Revenue 2015:
$1.89 billion
Direct Spending on
Supplies and Operations
Regional spending on:
purchased services, supplies,
direct costs
(e.g. utilities, rent)
Employees spend money
locally for living expenses &
recreation
By law, nonprofit hospitals
must spend surplus on local
community benefit
Employee
Compensation
Surplus R
evenues
(“Profits”)
Figure 31. How hospitals contribute to regional Economies

63 APPENDICES
A. Acknowledgments, Reviewers &
Interviewees
Alta Bates Regional Task Force, Members
Andy Katz, Alta Bates Regional Task Force
Member
Anna Harte MD, Medical Director, UC Berkeley
University Health Services
Mary Kay Lacey, Bateman Neighborhood
Association
Bahar Navab, Associate Director, University
Health Services
Carolyn Bowden, Community Organizer,
California Nurses Association
Claudia Covello, Assistant Vice Chancellor,
University of California, Berkeley Student
Affairs & Executive Director, University Health
Services

Community Health Commission, City of
Berkeley
Cynthia Frankel, EMS Coordinator, Alameda
County Emergency Medical Services
Daniel Caraco, Alta Bates Regional Task Force
David McPartland, EMS Captain, Berkeley Fire
Department
Declan Walsh, Research Analyst, SEIU-UHW
West
Dominic Chan, California Nurses Association
Gabriel Quinto, Mayor, City of El Cerrito
Jacquelyn McCormick, Senior Advisor to the
Mayor, City of Berkeley
Jesse Arreguin, Mayor, City of Berkeley
Patrick Richards, Associate Director, Business
and Finance at University of California,
Berkeley
Rochelle Pardue-Okimoto, Mayor Pro Tem, El
Cerrito
Scott Donahue, Council member, City of
Emeryville
Calculation
Description
C
alculation Notes
AB HSA AB CHNA zip codes +
non-CHNA zip codes
sending highest
numbers of patients
to AB = approximately
75% of AB patients
See Table 1
below for more
information
Surge Event
Injuries Alameda
County Estimate
(16,000 Haywired
estimated
injured)*(estimate
of 68% of displaced
households coming
from Alameda
County)= 10,880
estimated injuries in
Alameda County
Assumes that
the percentage
of displaced
households is
equivalent to the
percentage of
injuries occurring
in Alameda County
Economic Loss
Estimate
$2.5 (economic base
multiplier)*($1.9
billion in patient
revenue in 2016)=
$4,750,000,000
Economic base
multiplier = $2.5
per every dollar in
patient revenue
B. HSA Calculation & Discharges by ZIP Code

64 Zip Code 2016 # Patient Discharges
fr
om Alta Bates Campus
94613 10
94720 276
94612 866
94619 875
94618 972
94610 992
94602 1,106
94709 1,130
94708 1,186
94603 1,194
94606 1,215
94707 1,230
94710 1,295
94607 1,297
94621 1,579
94611 1,629
94605 1,751
94609 1,855
94705 1,992
94601 2,241
94704 2,394
94608 2,754
94702 2,922
94703 3,035
Total CHNA patient discharges 35796
94805 822
94803 1,145
94501 1,431
94801 1,557
94706 1,737
94530 2,156
94804 2,764
94806 3,134
Total non-CHNA zip code patient
discharges (approximately 75% of
all ABC patient discharges)
14746

65 Hospital County 2016 ED Visits/Beds (AMA benchmark
is 2000 visits/Emergency Treatment
Station (ETS)
2017 ED Visits/Beds (AMA benchmark is
2000 visits/Emergency Treatment Station
(ETS)
Alta Bates Berkeley Alameda County 1836 visits/ETS (25 ETS) 2292 visits/ETS (22 ETS) Alta Bates Summit Alameda County 1481 visits/ETS (32 ETS) 1885 visits/ETS (25 ETS) Highland Hospital Alameda County 1211 visits/ETS (57 ETS) 1158 visits/ETS (57ETS) Kaiser Oakland Alameda County 1289 visits/ETS (48 ETS) 1327 visits/ETS (48 ETS) Kaiser Fremont Alameda County 2347 visits/ETS (16 ETS) 2452 visits/ETS (16 ETS) Kaiser San Leandro Alameda County 1645 visits/ETS (40 ETS) 1739 visits/ETS (40 ETS) Alameda Hospital Alameda County 1404 visits/ETS (12 ETS) 1369 visits/ETS (12 ETS) St. Rose Hospital Alameda County 2037 visits/ETS (17 ETS) 2134 visits/ETS (17 ETS) CHORI Alameda County 1289 visits/ETS (37 ETS) 1261 visits/ETS (37 ETS) San Leandro Hospital Alameda County 2739 visits/ETS (12 ETS) 2,851 visits/ETS (12 ETS) Washington Hospital
Fremont
Alameda County 2236 visits/ETS (23 ETS) 2168 visits/ETS (23 ETS) Eden Medical Center Alameda County 2097 visits/ETS (22 ETS) 1943 visits/ETS (22 ETS) Stanford ValleyCare Alameda County 1768 visits/ETS (18 ETS) 1886 visits/ETS (18 ETS) Contra Costa Regional
Medical Center (CCRMC)
Contra Costa County 2122 visits/ETS (20 ETS) 1499 visits/ETS (26 ETS) Kaiser Richmond Contra Costa County 2256 visits/ETS (28 ETS) 2310 visits/ETS (28 ETS) Kaiser Antioch Contra Costa County 1588 visits/ETS (36 ETS) 1699 visits/ETS (36 ETS) Kaiser Walnut Creek Contra Costa County 1183 visits/ETS (52 ETS) 1224 visits/ETS (52 ETS) John Muir Concord Contra Costa County 1876 visits/ETS (32 ETS) 1858 visits/ETS (32 ETS) John Muir Walnut Creek Contra Costa County 1206 visits/ETS (44 ETS) 1262 visits/ETS (44 ETS) Sutter Delta Antioch Contra Costa County 1906 visits/ETS (32 ETS) 1835 visits/ETS (32 ETS) San Ramon Regional
Medical Center
Contra Costa County 1526 visits/ETS (12 ETS) 1578 visits/ETS (12 ETS) C. Acute Care Hospitals in Alameda County and Contra Costa County with Basic or Comprehensive EDs

66 RHIA
Reference #
Report or Data
Set Source
Data Set Description URL Data Used in HIA Data Location 1 Annual Financial
Disclosures
Report 2012
Hospitals and long-term care (LTC)
facilities report detailed annual
facility-level data on services capacity,
inpatient/outpatient utilization,
patients, revenues and expenses by
type and payer, balance sheet and
income statement.
https://siera.
oshpd.ca.gov/
FinancialDisclosure.
aspx
Total Patient Revenue Page 12
Clinical Operations Page 17
Nonclinical Operations Page 18
2 Annual Financial
Disclosures
Report 2016
See above https://siera.
oshpd.ca.gov/
FinancialDisclosure.
aspx
Total Patient Revenue Page 12
Clinical Operations Page 17
Nonclinical Operations Page 18
3 Hospital Annual
Utilization Data
2016 (including

ALIRTS)
Contains basic licensing information
including bed classifications; patient
demographics including occupancy
rates, the number of discharges and
patient days by bed classification, and
the number of live births; as well as
information on the type of services
pr
ovided.
https://www.
oshpd.ca.gov/HID/
Hospital-Utilization.
html#Pivot
Overview of capacity
and services offered
Pivot Table
4 Hospital Annual
Utilization Data
2017 (including

ALIRTS)
See above https://www. oshpd.ca.gov/HID/
Hospital-Utilization.
html#Pivot
Overview of capacity
and services offered
Pivot Table
5 Patient Origin
and Market
Share Reports
2012-2013
ZIP Code of residence for all ED visits
and hospitalizations
https://www.oshpd.
ca.gov/HID/POMS-
Report.html#Pivot
Pivot Table

REFERENCES
OSHPD Data Sets

67 6 Patient Origin
and Market
Share Reports
2016 - 2017
See above https://www.oshpd.
ca.gov/HID/POMS-
Report.html#Pivot
Pivot Table
7 Facility Summary
Reports 2013
Patient level data are reported
through the Medical Information
Reporting for California (MIRCal)
system. These reports display a
numerical and percentage breakdown
of patient level data. These Summary
Reports combine report periods into
an annual view of a facility's Hospital
Inpatient (IP), Emergency Department
(ED), or Ambulatory Surgery (AS)
patient level data.
https://www.oshpd.
ca.gov/HID/Facility-
Summary-Reports.
html
Patient Payer Mix
Emergency Department
Ambulatory Services
Inpatient services
Downloadable
Report
8 Facility Summary
Reports 2016
See above https://www.oshpd.
ca.gov/HID/Facility-
Summary-Reports.
html
Patient Payer Mix
Emergency Department
Ambulatory Services
Inpatient services
Downloadable
Report
9 Seismic
Compliance
Unit: Seismic
Performance
Ratings
Description of the seismic
performance (SPC) rating criteria
https://www.
oshpd.ca.gov/
FDD/seismic_
compliance/
SB1953/
SeisPerfRatings.
html
Definitions of SPC +
MPC ratings
Web page
10 C
alifornia
Hospital and
Skilled Nursing
Facility Data
2018
This page presents information
for California hospitals and skilled
nursing facilities such as site plans
(also called "keyplans"), building
numbers, SPC/NPC ratings and
various links associated with the
facility. Links to the OSHPD Report
Center for open, closed, and old
projects are included.
https://www.oshpd.
ca.gov/FDD/Forms/
Keyplans/index.
html
Building Site Plans
+ SPC Ratings of
Buildings
Open Projects
Web page
11 General Facility
Listing 2017
All California hospital facilities in
2017
https://www.oshpd.
ca.gov/HID/Facility-
Listing.html
Acute care hospitals in
region

68 Ahmedani, B. K., Simon, G. E., Stewart, C., Beck,
A., Waitzfelder, B. E., Rossom, R., ... & Operskalski,
B. H. (2014). Health care contacts in the year
before suicide death. Journal of general internal
medicine, 29(6), 870-877.

Alameda County Data Sharing Initiative. (2014).

Paramedics Plus Response Time. https://data.
acgov.org/Public- Safety/Paramedic-Plus-
Response-Time/9yek-274s/about. Accessed
November 2017.

Associates in Process Improvement. Alameda
County Emergency Medical Services Quality
Improvement Program Plan 2017. http://www.
acphd.org/media/476290/2016%20alameda%20
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74 Alta Bates Summit
Medical Center

RAPID HEALTH IMPACT

ASSESSMENT

1 City of Berkeley
Briefing on Berkeley Hospital Financing Options
Memorandum of Findings

Briefing on Berkeley Hospital Financing Options
Memorandum of Findings

Updated 11.4.2024

2 City of Berkeley
Briefing on Berkeley Hospital Financing Options
Memorandum of Findings

Executive Summary
The City of Berkeley is exploring options to finance the construction of a new 100-200 bed hospital to replace the Alta Bates Medical Center following Sutter Health’s announcement that it will cease inpatient hospital operations in 2030 due to the cost of seismic retrofit. The cost to develop a new facility has been estimated to be up to $2 billion. The City of Berkeley is not interested in operating the hospital.

This initial assessment considered strategic and financial options related to paying for and structuring this new hospital, yielding the following conclusions:

1. The hospital’s revenues are not projected to support all of the debt service cost of financing the acquisition and construction of the hospital. Municipal tax supported debt — specifically, a general obligation (GO) bond secured by ad valorem property taxes— offers the lowest cost of capital to finance the construction of a new facility with current rates between 3-5%.1,2

2. The City of Berkeley should seek to mitigate municipal tax supported debt and local tax burden by spreading the property tax base to reflect the expected service area, lowering overall project costs, identifying additional capital and/or future revenue
sources to subsidize and service the debt, and over
the long term, take advantage of opportunities to
refinance a portion of the municipal tax supported
debt with revenue supported debt once the hospital
has fully ramped up operations. Executing all of
these mitigation tactics could result in a tax burden
of a tenth of what would be experienced if the City
were to issue a GO bond for the full $2 billion.

3. The City of Berkeley should prioritize exploring the establishment of a new healthcare district or joint
powers agreement (JPA) to offer the debt and spread the tax responsibility across a geography that reflects where expected patients reside. This is the most impactful lever to lower the local tax burden. For example, by expanding the tax base to three times the City’s total property value, the tax increase would drop from $429 to $143 per $100,000 in assessed property value if $2 billion in GO bond debt financing were required. As confirmed by the City’s bond counsel, a JPA offers a faster and more flexible alternative to a healthcare district, and a JPA may issue a GO bond directly in support of the hospital project.

4. For a hospital opening by 2030 to be possible, planning and feasibility activities should begin in earnest immediately. In a best case scenario, it will take between five to six years to complete all the necessary steps.

1 Assumes entire hospital project will be eligible for tax exempt municipal financing 2 It would be possible to support the tax supported debt with another special tax (most likely a non -ad valorem based property tax), but the required v oter approval would be the same and this memorandum assumes the use of GO bonds.

Debt/Tax Minimization Levers and Impact (llustrative)
Annual Property Tax Impact per $100k
in Taxable Assessed Value
Base Case
City led GO Bond of $2 billion
(4% rate, 30 yr. term) $429
Tax Impact Lever 1
Spread Property Tax Base (3x base) $143
Tax Impact Lever 2
Reduce Sticker Price/Debt to $1B $71
Tax Impact Lever 3
Abate using Lease Revenue
(Assumes $20M/yr lease) $47
Tax Impact Lever 4
Refinance in Future to 3.5% $42

3 City of Berkeley
Briefing on Berkeley Hospital Financing Options
Memorandum of Findings

Contents
Executive Summary ....................................................................................................................................... 2 Introduction .................................................................................................................................................. 4 Project Assumptions ................................................................................................................................. 4 Approach ................................................................................................................................................... 5 Summary Findings ......................................................................................................................................... 6 1: What type of financing is best suited to fund the hospital construction? ............................................ 6 2: What is the estimated tax impact and how can it be minimized? ........................................................ 7 3: How can the estimated tax impact be shared across the hospital’s expected service area? ............... 8 4: What are next steps and under what timeframe? ................................................................................ 9 Roadmap (Illustrative): Path to Open by 2030 (Best Case Scenario) ...................................................... 12 Detailed Assessment ................................................................................................................................... 13 Section A: Approaches for Funding Hospital Construction ..................................................................... 13 Section B: Mechanisms to Minimize Debt Financing .............................................................................. 16 Section C: Structural Options for Distributing Tax Impact across Potential Service Area ....................... 19 Establishing or Joining an Existing Healthcare District ........................................................................ 22 Establishing Joint Powers Authority .................................................................................................... 22 Bay Area Healthcare District Context .................................................................................................. 23 Section D: Next Steps and Timing ........................................................................................................... 24 Appendices .................................................................................................................................................. 27 Appendix A: Moody’s Special District GO Bond Rating Criteria .............................................................. 28 Appendix B: California Health and Safety Codes: Division 23 – Hospital Districts .................................. 29 Appendix C: Summary of Nearby Municipalities in Service Area Geography and Current District Participation Status ................................................................................................................................. 31 Appendix D: Case Profile ......................................................................................................................... 32

4 City of Berkeley
Briefing on Berkeley Hospital Financing Options
Memorandum of Findings

Introduction
This memorandum describes initial findings following a strategic and financial assessment of a range of available options to establish and fund the development of a new acute care inpatient hospital facility in the City of Berkeley.

In 2016, Sutter Health announced plans to close Alta Bates Summit Medical Center (Alta Bates), a 339- bed acute inpatient facility located in Berkeley, CA, by 2030, citing the costs of seismic retrofit.3 Closure of the facility without some replacement is expected to result in significantly reduced access to acute care and emergency services for residents of Berkeley and the surrounding communities. To mitigate the potential loss, the City of Berkeley is exploring options to retain access to acute inpatient services.

Project Assumptions
This assessment focuses on scenarios related to financing the construction of a new hospital to replace the Alta Bates facility. The inpatient facility being contemplated would have up to 200 inpatient beds and provide a service mix similar to that of Alta Bates for both inpatient and outpatient services. The capital required is estimated to be up to $2 billion. Additionally, assuming Sutter’s exit from inpatient operations, the City of Berkeley will need to find an experienced partner to operate the new or retrofitted hospital once complete, and potentially to take facility ownership in the future.

Assumptions:
• The new inpatient hospital will be between 100-200 beds in size. • The project timeline should seek to eliminate, if at all possible, time duration between closing of Alta Bates and the opening of the new hospital.
• Partnerships will be pursued across the hospital catchment area to support the financial commitments of building the hospital.
• The project will be funded primarily through debt financing. Other sources will be pursued to subsidize and are anticipated to represent minority contribution (e.g., philanthropy, appropriation, grant).
• Although the hospital's revenues are not projected to support all of the debt service cost of financing the acquisition and construction of the hospital, the financing approach selected should consider all opportunities to minimize taxpayer burden. • The City of Berkeley will seek an experienced California based operator to manage and oversee all aspects of hospital operations. The City of Berkeley is not interested in operating the hospital. • The new facility will maintain a service mix that at a minimum includes emergency services, obstetrics and gynecology, medical-surgical, psychiatric and intensive care, consistent with the specialty mix currently offered at Alta Bates.
• The new facility will either be newly constructed (scenario 1) or developed through the retrofit of an existing facility (scenario 2). This memorandum focuses on scenario 1. Scenario 2 may be funded through similar mechanisms, but was not evaluated thoroughly due to a lack of capital estimate.

3 Berkeley’s Only Hospital, Alta Bates, to Close by 2030, San Francisco Chronicle July 2, 2016

5 City of Berkeley
Briefing on Berkeley Hospital Financing Options
Memorandum of Findings

*Note: $1.853M per bed was estimated in 2019 for seismic retrofits at 95% cost percentile before accounting for additional facility improvements, capital equipment, and if not previously an inpatient facility, costs to retrofit building to meet regulatory planning requirements.4

Approach
Manatt performed a series of analyses leveraging publicly available information to develop a detailed understanding of the options and related considerations available to the City of Berkeley. This included reviews of California municipal finance, healthcare district and joint powers authority regulations; current and historical financing arrangements for new healthcare facilities across California; healthcare district and joint powers authority context in the Bay Area, and ratings and financial information for the City of Berkeley.

Additionally, Manatt conducted interviews with leaders in the public finance and healthcare divisions of four investment banks.

4 Source: Updating the costs of compliance for California’s Hospital Seismic Saf ety Standards, RAND Corporation report for California Hospital Association, 2019

6 City of Berkeley
Briefing on Berkeley Hospital Financing Options
Memorandum of Findings

Summary Findings
This memo considers four critical questions that the City of Berkeley faces prior to moving forward with the hospital project:
1: What type of financing is best suited to fund the hospital construction? A tax-exempt revenue bond secured by the hospital’s revenues generally has a higher interest rate than a GO bond and would be untenable without public tax support. The annual debt service requirements for a $2 billion revenue bond offering, even at GO level interest rates, would command a majority share of the hospital’s net patient service revenues (NPSR) on an annual basis.5 This means that the hospital could not be financed on a revenue-only basis; therefore, whether a hospital district is involved or not, voter approval for tax-secured financing will be needed.

See Section A in the memo below for additional details regarding this question.

Municipal tax supported debt — specifically, a tax-exempt general obligation (GO) bond secured by ad valorem property taxes — offers the lowest cost of capital to finance the construction of a new facility and a resilient revenue source for debt service. A bond secured through a special tax, such as a non-ad valorem parcel tax, offers more flexibility in its uses (e.g., for operating support). However, it would have less flexibility for annual adjustment or abatement, and if a parcel tax, the revenue would be limited by the number of taxable parcels in the given geography. 6

5 Definitive Healthcare Hospital View as Sourced from Medicare Cost Report as of June 2024 6 While GO bonds can only finance the acquisition and improvement of real property, a special tax (most likely a non-ad valorem based property tax, often referred to as a “parcel tax”) could finance these and ongoing operations. Because the required voter approval would be the same for G O bonds and parcel taxes and the City has not expressed an interest in establishing an ongoing tax to support operations of the hospital, this memorandum assumes the use of GO b onds for the limited purposes of financing acquisition and construction of the hospital.

Amount % of NPSR
Average NPSR for a 100-250 bed hospital (US) $228,000,000 Annual Debt Service: $2 billion GO
4% fixed interest rate, 30 year term $114,580,000 50%
Annual Debt Service: $1 billion GO
4% fixed interest rate, 30 year term $57,290,000 25%

7 City of Berkeley
Briefing on Berkeley Hospital Financing Options
Memorandum of Findings

The market for tax exempt GO municipal debt is favorable, with interest rates in the 3-5% range for credit worthy issuers, like the City of Berkeley.7 The interest cost of any such GO bonds would primarily reflect the property tax base on which the ad valorem taxes are levied. However, issuers with lower credit ratings or without history, such as a newly formed healthcare district, may receive a higher rate.

2: What is the estimated tax impact and how can it be minimized? The City should mitigate debt and local tax burden by seeking to distribute tax responsibility across the expected service area, accessing other sources of capital, lowering overall project costs, and over the long term, take advantage of opportunities to refinance a portion of the tax supported debt with revenue supported debt once the hospital has fully ramped up operations. • Shape taxed geography to reflect expected service area: By establishing a new healthcare district or joint powers authority, Berkeley can distribute the construction costs across the municipalities expected to use the hospital, as demonstrated in the following table.

• Reduce the sticker price: The current construction estimate of $2B is on the high end for a 100- 200 bed hospital.8 The City should evaluate the potential to construct for less and/or the potential for its hospital operator to make in-kind contributions that would lower associated capital requirements.
• Secure non-debt-based capital to subsidize project costs: Including other non-debt based capital contributions to partially fund the project will lower the amount of debt financing required, lower interest payments to service the debt, and heighten investor interest. Similar to a mortgage, investors will view a funding approach that includes a “down payment” from other sources as lower risk. This also aligns with the City’s interest in mitigating local tax burden. Other non-debt based capital contributions to fund the project may include grants, philanthropy, and direct contribution by issuer and/or operator. It is not likely that any such capital sources would be sufficient to eliminate the need for tax supported debt. • Identify non-tax based revenue sources to abate the property tax burden, such as through a leasing agreement with the operator: Under a scenario where property taxes (ad valorem GO taxes and/or parcel taxes) secure the debt, those taxes may be reduced on an annual basis in the

7 City of Berkeley currently maintains a AA rating with Moody’s and an Aa1 with S&P. Bloomberg Market Data (as of July 29, 2024) 8 Source: Updating the costs of compliance for California’s Hospital Seismic Safety Standards, RAND Corporation report for Cali fornia Hospital Association, 2019 Tax Impact Comparison: City led vs Regionally led Offering Scenario 1 Scenario 2 Scenario 3
HCD/JPA led GO
Bond(s) of $1 billion
HCD/JPA led GO
Bond(s) of $1.5 billion
HCD/JPA led GO
Bond(s) of $2 billion
Annual Debt Service $57,290,000 $85,935,000 $114,580,000 City of Berkeley Only:

Assumes $26.712 billion in estimated
taxable property value (source FY2023
Annual Report) $214 $322 $429
HCD or JPA w/3x Tax Base:

Assumes HCD/JPA has property tax base
3x that of City of Berkeley ~$80.137
billion $71 $107 $143
Annual Property Tax Impact per $100k in Taxable Assessed Value

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future as facility or lease revenues are used to offset the tax burden. Further assessment is required to ensure applicability of the lease revenue model. • Structure the GO bond to allow for refinancing with revenue bonds, in whole or in part, in the future: GO bonds typically are structured to include a redemption date 10 years following issuance at which point they may be refinanced to achieve savings, but shorter lock out periods are possible. The California Health Facilities Financing Authority (CHFFA) offers revenue-based bond refinancing for facilities with an operating history tied to the State’s GO bond rating, which may be better than what is received if the refunding revenue bonds are issued by a new healthcare district or a JPA.

The below table describes the impact these initiatives could have in combination:

See Section B in the memo below for additional details regarding this question.

3: How can the estimated tax impact be shared across the hospital’s expected service area?
Berkeley property owners would face a heavy tax burden if debt were not distributed across other municipalities expected to be in the hospital’s service area. The City should first explore establishing a new healthcare district or joint powers authority to offer the debt. • A healthcare district (HCD) or joint powers authority (JPA) would enable tax support to be spread across a larger base that reflects the new hospital’s expected service area. The closure of the existing Alta Bates facility will impact access for patients beyond just those within Berkeley city limits, including Emeryville, Albany and other communities across north Alameda and Contra Costa Counties. An offering structure that is inclusive of other affected stakeholders should be pursued.
• Healthcare facility financing linked to a healthcare district is generally viewed favorably by investors due to its dedicated purpose, public engagement, and ability to levy taxes across a broader geography than the City alone. However, existing districts have encountered significant Debt/Tax Minimization Levers and Impact (llustrative)
Annual Property Tax Impact per $100k
in Taxable Assessed Value
Base Case
City led GO Bond of $2 billion
(4% rate, 30 yr. term) $429
Tax Impact Lever 1
Spread Property Tax Base (3x base) $143
Tax Impact Lever 2
Reduce Sticker Price/Debt to $1B $71
Tax Impact Lever 3
Abate using Lease Revenue
(Assumes $20M/yr lease) $47
Tax Impact Lever 4
Refinance in Future to 3.5% $42

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financial issues, and without special legislation at the State level, establishing a new district can significantly extend the development timeline because they require voter approval. • A JPA offers a faster and more flexible alternative to a healthcare district, including liability protection. Also, as confirmed by the City’s bond counsel, a JPA may issue a GO bond directly in support of the hospital project. The benefit of a JPA is that it would allow multiple cities to jointly seek voter approval and issue general obligation bonds. The JPA offers no benefit if the City is the only public agency financing the hospital.

4: What are next steps and under what timeframe?
For a hospital opening by 2030 to be possible, planning and feasibility activities should begin in earnest immediately since under a best case scenario it will take approximately five years to complete all the necessary steps.
• Perform Feasibility Study and Facility Planning (1-2+ years): The immediate next step is to conduct a feasibility study and begin detailed facility planning. This step is highly involved and is the primary organizing step in the process including assessment of the local healthcare market and community health needs, defining the clinical service need and inpatient bed mix, initial facility schematic design, preferred structure and partners, and hospital operating partner assessment and selection. Many of these activities can occur concurrently, and in total could take two years to complete.
o Stakeholder Engagement and Preparing for Public Announcement: The financing and development of a new hospital will involve the engagement of multiple stakeholders, including but not limited to the intended operator of the new hospital, Sutter Health, professional services firms, and the intended municipal and/or county partners and their respective local communities. To ensure a successful outcome, a stakeholder engagement and communications plan will need to be developed early in the process.

Engagement considerations for key partners are described below.

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• Gain Necessary Approvals (4-18 months): Issuing a GO bond will require majority voter approval and local legislative approval. The exact steps for this process will ultimately be determined by the structure selected to issue the debt and oversee the hospital assets and related operations.

For example, establishing a healthcare district will require the engagement of all municipalities and territories to be included within the healthcare district as well as the agencies overseeing them, and local voter approval via a single vote. A JPA-issued GO bond will also require a public vote that is inclusive of all geographies supporting the hospital financing through the JPA, though a vote to form the JPA will not be required. Public resistance to either of these options could result in a timeline at the higher end of the range as it could extend the process prior to holding the vote. Local and legislative engagement, advocacy, and related planning activities in this step may begin during the feasibility and planning phase.
• Issue Debt (4-9 months): Debt issuance could take anywhere from 4-9 months once approvals are received and a feasibility study has been submitted. This step involves engaging a municipal advisor and investment bank(s) to underwrite the debt. This can occur in parallel during the planning and approval phase. Issuance activities cannot begin until the feasibility study, planning, and approvals are completed.
• Complete Permitting and Construction (3-5+ years): Facility development can take anywhere from 3-5+ years once funding has been secured. This step includes securing any necessary land, entitlements, and permits which can occur concurrently with the bond design and issuance step.

This is the longest step timewise. Selecting a developer with a demonstrated ability to complete new hospital projects on time and on budget is critical.

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• Open Hospital: New facility opens for operations under management of selected operator. Lease payments begin. Each year, the district can assess the extent to which lease payments can reduce the need for the ad valorem tax levy.

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Roadmap (Illustrative): Path to Open by 2030 (Best Case Scenario)

See Section D in the memo below for additional details regarding next steps and timeframe.

Calendar Year
Step Key Activities H1 H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2 Define and Narrow Range of Financing Options Available to Construct New Hospital Assess Structures to Fund and Oversee Hospital Assets and Operations Estimate Taxpayer Impact and Identify Ways to Mitigate
Engage Possible Operating Partner(s)
Inititiate Feasibility Study
Define Market and Clinical Service Needs
Define Operating Model and Select Operating Partner
Determine Oversight and Financing Structure and Engage Public Financing Partners to Execute (JPA or HCD) Prepare Capital Funding Requirements and Financing Approach Finalize Feasibility Assessment and Move to Approvals and Issuance Finalize Facility Location and Plan (Design, Phasing)
Prepare for Public Announcement of Project and Related Funding Need and Tax to Support Engage Legislative Advocacy Process for Healthcare District Formation* Execute Agency Review Process for Healthcare District Formation (if pursued) Initiate Local Processes for Debt Issuance
Develop Community (Voter) Engagement Plan and Execute
Organize Voter Inititiative(s)
Hold Public Vote to Approve (bond issuance, district formation as needed) Engage Municipal Finance Advisor
Engage Underwriter(s) for Bond (Competitive Bid)
Plan and Structure Bond
Authorize Bond (Public and Agency Approvals)
Market and Issue Bond
Close Bond (Funding Received)
Apply for and Receive Necessary Permits
Break Ground
Construct Hospital and Complete Licensing
Step 5: Open Hospital Hospital Welcomes First Patient
*If seeking legislative action to rapidly establish
2030
Step 0: Assess Financing Options
and Estimate Tax Impact
Step 1: Perform Feasibility Study
and Planning
Step 2: Gain Necessary Public
Approvals
Step 3: Issue Debt
2028 2029
Step 4: Complete Permitting and
Construction
2024 2025 2026 2027

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Detailed Assessment

As the City of Berkeley contemplates the major investment to fund a new hospital – potentially totaling up to $2B, it faces decisions related to how to fund as well as which entity (or entities) should offer any required debt. The following sections consider:

A. Approaches for funding hospital construction
B. Mechanisms to minimize debt financing
C. Structural options for distributing tax impact across potential service area D. Next steps and timing
Section A: Approaches for Funding Hospital Construction New hospitals are typically paid for through a combination of funding (capital that does not need to be repaid) and financing (debt). Based on project assumptions and available grant opportunities, direct funding opportunities are limited. Therefore, with an estimated capital need of up to $2B, debt financing is required for Berkeley’s hospital construction.

As a local government with taxing authority, the City of Berkeley has the ability to incur tax exempt debt directly via a tax or revenue backed municipal bond offering. Under either arrangement, the City can also utilize regional measures such as establishing a new, or joining an existing, health care district, entering into a JPA, or a combination of the two, through which debt can be issued (further explored in Section C).

General obligation (GO) bonds are serviced from ad valorem property taxes while revenue bonds can be secured by project or other revenue sources. Each option has unique elements to consider, as outlined in Table A below.

The hospital’s revenues are not projected to support all of the debt service cost of financing the acquisition and construction of the hospital because debt service on a revenue bond to finance all of the acquisition and construction costs could be as high as 50% of the hospital’s revenue.

Therefore, public tax support would be needed to cover a significant portion of the debt service. As the financing will be for the limited purpose of acquiring land for and constructing the new hospital, a GO bond secured by ad valorem property taxes offers the City the lowest cost of capital to finance the construction of a new facility. The market for tax-exempt GO municipal debt is favorable, with interest rates in the 3-5% range for issuers with the tax base to support. Taxable debt —whether revenue bonds or GO bonds -- would bear a higher interest rate than tax-exempt debt.

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Table A: Bond Funding Options
Funding Option General Obligation (GO) Bonds Revenue Bonds Summary Description In California, municipal bond issued by local agencies and secured by ad valorem property
taxes
Municipal bond secured by revenue from a
specific project that the bond is funding
Financing Type Debt Debt
Available to • City
• County
• Healthcare district
• JPA9
• City
• County
• Healthcare district
• JPA
Source of Repayment Voter approved ad valorem property taxes Revenues from hospital operations and/or Revenues from special taxes (e.g., parcel, gas,
cigarettes, sales, etc.)
Voter Approval Required Yes, 2/3 voter approval No, unless revenue bond is being secured by a “special tax” requiring 2/3 voter approval.

Obligated Party Issuer Issuer
Current Market Interest
Rate
3-5% 4- 12%* depending on project risk and issuer
credit rating (subject to 12% cap for public
issuers)
Interest Rate Cap 12% 12%
Typical Term 30 years 20-30 years
Option to be Tax
Exempt10
Yes Yes
Advantages • Generally viewed as lower risk as backed by unlimited ad valorem taxing authority of
issuer rather than revenue from a discrete
project, allowing for a lower interest rate
• Can abate the ad valorem tax over time with
hospital or lease revenues
• Lower cost to issue

• No voter approval required unless debt
service reliant on new special tax
• Revenues from hospital operations can
mitigate local tax burden to service debt,
however certain “special taxes” (e.g., sales,
tobacco) once established are difficult to
abate
• Typically faster to issue if no voter approval
required (however, this factor is less
relevant in this scenario as revenue-only
financing is not a viable option)
Disadvantages • Voter approval required
• Limited use – can only be used to acquire
and improve real property

• Cost of capital higher than GO bonds due to
market view of being riskier as tied to
project revenues
• Higher fees to issue compared to GO bonds
• Typically fund up to 80% of project costs
requiring capital contribution from other
sources akin to a “down payment”
• Voter approval required if levying new
“special tax” such as a non-ad valorem
parcel tax
Examples of Use in
Recent Projects
Pajero Valley Health Care District
Watsonville Community Hospital renovation
106 bed hospital
Amount: $116M ($24 per $100k assessed
property tax increase to fund);
Passed 4/2/2024 by a vote of 68.5% to 31.5%
LA County
MLK Jr. Community Hospital renovation
131 bed hospital
Amount: $260M in Tax Exempt Lease Revenue
Bonds; 5% interest (AA Rated)
Issued 2021

9 As confirmed by the City’s bond counsel.
10 Interest on bonds not subject to Federal or State of California income tax.

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Other funding sources may be available to support the capital need, including direct State support, either through appropriation or grant, contribution(s) from the intended operator, and philanthropy.

Gaining contribution from one or several of these sources is viewed favorably, improving bond ratings, overall investor interest, and most importantly, lowering the debt financing requirement and any related tax impact. With the current California State budget shortfall, the likelihood for significant State contribution is low;11 however, targeted capital grant opportunities for behavioral health services are available and are further described in the next section. However, it is not expected that these other funding sources could eliminate the need for tax supported debt.

Alternative financing techniques that do not involve the City of Berkeley or a regionally created structure taking on debt exist, including public private partnerships (P3). Under a P3 arrangement, a private developer finances and constructs the hospital for the public partner and passes along the debt service to the public partner via a long term lease. The public partner, in this case the City, health care district, or JPA, avoids debt exposure, the need for voter approval, and passes the project risk (e.g., potential for cost overruns) to the private developer. The primary disadvantage is the cost of capital to the private developer will almost always be higher and they will want an additional return which will be passed to the public partner in the form of high lease payments. The public partner will also have limited, if any, ownership equity in the hospital. Due to the limited examples of recent California inpatient hospital projects having been advanced with this approach, a P3 arrangement was excluded from further evaluation.

Will the debt offering require tax support?
Hospitals in the United States with 100-250 beds receive an average of $228 million in NPSR a year.12 As shown in the table below, this is not enough to independently support the debt service requirements for a $2 billion bond offering, eliminating the possibility of a revenue bond secured by hospital revenues to independently fund the hospital. Tax or other revenue support will be required and, therefore, the project is not viable without voter approval for taxes that finance the hospital.

Exhibit: Patient Revenue to Debt Service Ratio Comparison

A GO bond will provide the lowest cost of capital and require ad valorem tax support via a new levy on taxable property in the City or the service area, depending on the structure. While a GO bond may only be used to finance land acquisition and facility construction, once the debt is approved by voters, the ad valorem tax support provides a resilient tax revenue stream in the event of catastrophic loss to property

11 LAO FY24-25 California Fiscal Budget Outlook
12 Definitive Healthcare Hospital View as Sourced from Medicare Cost Report as of June 2024 Annual Debt Service Obligation Under GO and Revenue Bond Offering Scenarios Amount % of NPSR
Average NPSR for a 100-250 bed hospital (US) $228,000,000 Annual Debt Service: $2 billion GO
4% fixed interest rate, 30 year term $114,580,000 50%
Annual Debt Service: $1 billion GO
4% fixed interest rate, 30 year term $57,290,000 25%
Annual Debt Service: $2 billion Revenue Bond
6% fixed interest rate, 30 year term $143,892,000 63%
Annual Debt Service: $1 billion Revenue Bond
6% fixed interest rate, 30 year term $71,946,000 32%

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values within the taxable geography. With a hospital cost of $2 billion, this GO bond debt service would result in $429 in additional property tax burden per $100k in assessed property value if applied only to the City of Berkeley.13 Assuming an average assessed property value of $1,000,000,14 property owners’ bills would increase by $4,290 per year on average.

A bond secured through a special tax, such as a non-ad valorem parcel tax, offers more flexibility in its uses (e.g., for operating support). However, it would have less flexibility for annual adjustment or abatement, and if a parcel tax, the revenue would be limited by the number of taxable parcels in the given geography. As the City has not expressed interest in securing financing to support ongoing operations, a GO bond is the preferred option for the limited use of acquiring the land for and constructing the hospital.

Section B: Mechanisms to Minimize Debt Financing
With a guiding principle for the project to minimize taxpayer burden, the City should seek to minimize the level of debt financing required to execute the project and has several levers to do so both before construction and following it. The following table illustrates the combined impact of these levers, which are then further described below.

Tax Impact Lever 1 - Expand Taxable Geography: Financing through the establishment of a new healthcare district or a JPA can allow for an expanded geography over which to assess the tax securing the bond. This can lower the tax burden on individual property owners significantly, as illustrated in the table below.

Exhibit: Impact of Debt Minimization and Property Tax Base Expansion on Tax Impact

13 Based on 2023 estimated taxable property value for City of Berkeley - FY2023 Annual Comprehensive Financial Report Schedule V 14 Median sale price for a home in Berkeley was $1.24 million as of Dec 2023; City of Berkeley Office of Economic Development Debt/Tax Minimization Levers and Impact (llustrative)
Annual Property Tax Impact per
$100k in Taxable Assessed Value
Base Case
City led GO Bond of $2 billion
(4% rate, 30 yr. term) $429
Tax Impact Lever 1
Spread Property Tax Base (3x
base) $143
Tax Impact Lever 2
Reduce Sticker Price/Debt to $1B $71
Tax Impact Lever 3
Abate using Lease Revenue
(Assumes $20M/yr lease) $47
Tax Impact Lever 4
Refinance in Future to 3.5% $42

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Tax Impact Lever 2 – Reduce Sticker Price / Debt Requirement: Before it seeks financing, the City can aim to reduce its total financing requirement by lowering the price to construct and identifying additional sources of capital:

• Lowering the price to construct - Constructing a hospital in California is more expensive than doing so in other parts of the United States, and in a metropolitan area, such as Berkeley, even more so.15 However, the current estimate of $1.5-2 billion for a 100-200 bed hospital is particularly high and on a cost per bed basis, it would be one of the more expensive to be built.16,17 Prior to securing any non-debt based capital contributions, the City of Berkeley should work with its hospital planning collaborators to thoroughly assess and identify opportunities for cost savings to lower the total construction bill. A meaningful reduction has potential to lower the debt and associated tax burden significantly.

• Securing non-debt based capital contributions - Of particular attraction to revenue bond investors is having the selected operator contribute capital, directly or in kind. This helps assure investors that the relationship will be durable, since the operator will be less likely to exit in a financial downturn. In instances where the operator is not willing to put up capital funding directly, a philanthropy agreement, whereby the operator agrees to raise a certain amount of capital from philanthropic sources to support the project, or the provision of capital equipment and/or infrastructure, such as an electronic health records license, can be effective to reduce the up-front debt load.

15 The High Cost of Building California Hospitals, Scripps Health, April 2023 16 Source: Updating the costs of compliance for California’s Hospital Seismic Safety Standards, RAND Corporation report for Cali fornia Hospital Association, 2019 17 Assumes cumulative inflation of 36% for new hospital construction since 2019 report; Federal Reserve of S t. Louis Economic Data accessed August 2024 Average 95th Percentile
Price per Bed $4.4 $9.8
Estimated Cost: 100 Beds $440 $980
Estimated Cost 200 Beds $880 $1,960
Source: Updating the costs of compliance for California’s Hospital Seismic Safety Standards, RAND Corporation report for California Hospital Association, 2019 Assumes cumulative inflation of 36% for new hospital construction since 2019 report; Federal Reserve of St. Louis Economic Data accessed August 2024 Price to Construct a New Seismically Compliant Hospital in California on a Per Bed Basis (in millions)

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Another option is to generate grant funding through the State for discrete aspects of the facility.

One such option currently available is through the bond program recently approved under the California Behavioral Health Services Act. Through this program, the state’s Department of Health Care Services is administering $6.4 billion in grant funding through a competitive bidding process for the development of behavioral health inpatient treatment beds and residential settings, $1.5 billion of which being awarded to solely to counties, cities and tribal entities.

Considering Berkeley’s community health needs and the desire to maintain the service mix of Alta Bates which includes inpatient behavioral health beds, these grants present a compelling opportunity to reduce the overall debt financing required.18

After construction and following the first few years of hospital operations, the City may apply several levers to further mitigate the long-term cost of capital and/or tax burden. However, it is unlikely that any such non-debt based capital contributions could eliminate the need for tax supported debt.

Tax Impact Lever 3 – Identify non-tax based revenue sources to abate the property tax burden: With general obligation bonds, the taxing entity can assess each year the extent of ad valorem property taxes needed. Specifically, the taxing entity can use lease revenue from the operator to fund the debt service, reducing the taxes needed considerably. This would be achieved through a long-term lease agreement with fixed and predictable lease payments and term assurances. An abatement may be instituted annually or for a predetermined period across multiple years. Certain conditions may apply, and the opportunity should be thoroughly analyzed with bond counsel prior to execution. The impact of a lease revenue subsidy towards debt service is demonstrated in the exhibit below.

Exhibit: Potential Impact of Hospital Lease Revenues in Reducing Local Tax Burden

Tax Impact Lever 4 – Refinance to a lower interest rate in the future: An additional lever to reduce tax impact is through refinancing a portion of the initial GO bonds with revenue bonds in the future. GO bonds typically are structured to include a redemption date ten years following issuance, though shorter lock-out periods are possible, at which point they may be refinanced with revenue bonds. The CHFFA bond financing program offers access to low interest rate tax exempt financing tied to the State of California’s credit rating, and it supports debt issuance at a lower than market fee structure.19 This program is available for refinancing existing debt; however, refinancing would be available only to revenue bonds. The eligibility requirements for participation are narrow; only public and non-profit health facilities that have been operating for at least three years and have either the revenue or collateral to cover the debt service are eligible. The CHFFA has supported bond offerings of the scale

18 California Behavioral Health Transformation Behavioral Health Bond Program 19 California Health Facilities Financing Authority Bond Financing Program

Annual Debt Service
Scenario Annual Lease Revenue w/Lease Revenue w/o Lease Revenue w/Lease Revenue w/o Lease Revenue w/Lease Revenue w/o Lease Revenue Scenario 1 : City led $20,000,000 $140 $214 $247 $322 $354 $429 Scenario 2 : Healthcare District
or JPA led: 2x property tax base $20,000,000 $70 $107 $123 $161 $177 $214 Scenario 3 : Healthcare District
or JPA led: 3x property tax base $20,000,000 $47 $71 $82 $107 $118 $143 Scenario 4 : Healthcare District
or JPA led: 4x property tax base $20,000,000 $35 $54 $62 $80 $89 $107 $85,935,000 $114,580,000
Bond Scenario C
Annual Property Tax Impact per $100k in Asseesed Property Value GO Bond of $1.5 billion GO Bond of $2 billion
Term = 30 Years
Interest Rate = 4% Bond Scenario A
GO Bond of $1 billion
Bond Scenario B
$57,290,000

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being contemplated with a recent example being the Cedars Sinai Marina Del Ray Hospital which received $1.03 billion in debt financing in 2021. The City should further assess this option with its bond counsel.20

Section C: Structural Options for Distributing Tax Impact across Potential Service Area Financing through the establishment of a new healthcare district or a JPA can allow for an expanded geography over which to assess the tax securing the bond. As demonstrated, this option offers the greatest potential for reducing the tax impact across the hospital service area.

Healthcare facility financing linked to a healthcare district is generally viewed favorably by investors due to its dedicated purpose, public engagement, and ability to levy taxes across a broader geography.

However, existing districts have encountered significant financial issues, and without special legislation at the State level, establishing a new district can significantly extend the development timeline because they require voter approval. As confirmed by the City’s bond counsel, a JPA offers a faster and more flexible alternative to a healthcare district, including liability protection, and has the ability to issue GO bonds in support of a JPA project. The benefit of a JPA is that it would allow multiple cities to jointly seek voter approval and issue general obligation bonds; the JPA offers no benefit if the City is the only public agency financing the hospital. The following table describes each structural option and the tradeoffs between the two.

Table B: Structural Options

20 In possible future circumstances where CHFFA is not a vailable or does not offer more favorable rates, it may still, however, be politically necessary to utilize this lever regardless of whether the refunding revenue bonds will bear a lower interest rate than the refunded GO bonds.

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Structural
Options
Healthcare District Joint Powers Authority21
Summary
Description
• Independent public entities established under California law22 to address the unique healthcare needs of specific geographic regions • Responsible for planning, funding and delivering healthcare services for their defined district23
• May own and operate hospitals and other healthcare facilities, directly or indirectly;24,25 Some districts no longer operate any facilities and support healthcare services through grantmaking and other activities • Independent entities established by two or more governmental entities to fulfill a common objective, effectively a public joint venture • Support pooling of public resources by public entities • Coordinate efforts and support efficiencies across governmental agencies/entities to save taxpayers money
• If authorized by their legislative or other governing bodies, two or more public agencies by agreement may jointly exercise any power common to the contracting parties, including, but not limited to, levying a fee, assessment, or tax26
• Non-governmental entities may participate in JPAs (such as through agreement with non-profit hospital to provide services) Financing • Patient service revenue
• Taxes and assessments:27 Special taxes or assessments on real and personal property within the district, subject to voter approval (taxes and assessments made up 6% of non-debt healthcare district revenue in 2021)28
• Debt financing: Districts may issue general obligation bonds (with 2/3 voter approval to raise property taxes to repay the bonds) and revenue bonds (do not require separate voter approval, paid using revenues from the district)
• Other sources: Including revenue from capital assets, state and federal funds and grants
• Patient service revenue
• Taxes and assessments: Can charge fees, make assessments and levy taxes via taxing authority of member(s)
• Debt financing: Flexibilities provided to JPAs in bond issuance include:
o Revenue bonds can be issued without voter approval
o A JPA may issue GO bonds leveraging the powers of its members so long as 2/3 voter approval is received across all participating member jurisdictions29
• Other sources: Including revenue from capital assets, state and federal funds and grants
Governance • Board of Directors comprised of five registered voters in the district, with four-year terms
• Initial Board is appointed by county Board of Supervisors, with subsequent vacancies filled by election30
• Sessions of the Board of Directors must be open to the public, with limited exceptions31
• Formed via agreement between member entities (must be filed within 30 days with Secretary of State and State Controller)
• JPA formation and revenue-only bond issuance are not subject to voter approval
• Board of Directors: Must be identified (flexibility in design as positions could be ex officio or appointed by city councils) and in most cases include a treasurer and auditor

21 Nevada County, CA Grand Jury Report: Joint Powers Authority: What You Need to Know, 2021 22 Cal. Health & Safety Code § 32001
23 “About Healthcare Districts”, Association of California Healthcare Districts 24 Cal. Health & Safety Code § 32121
25 Cal. Health & Safety Code § 32129
26 Cal. Govt code § 6502
27 Cal. Health & Safety Code § 32200-32205, 32221-32223, 32240-32243 28 California State Controller’s Office, Special District Data, 2021 29 4 As confirmed by the City’s bond counsel
30 Cal. Government Code § 1780
31 Cal. Health & Safety Code § 32106

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• Governance model determined during formation of JPA, with horizontal structure allowing a group of distinct and separate member entities to form JPA and provide oversight for activities
• Sessions of the Board of Directors must be open to the public, with limited exceptions
Advantages • Clear purpose: Healthcare districts, unlike Cities or counties, are focused on the delivery of health services to the community and can tailor those based on community need. Although, in this case, the City is interested in financing the hospital, not on delivering health services to the community • Transparency and accountability: Districts are publicly governed with an elected Board and financial reporting requirements allowing tax base to clearly see how district revenues are being spent on public healthcare services. Open meetings allow for public involvement and influence • Spread tax base: District limits can extend beyond city limits limiting per capita tax impact
• Liability Protection: As a legally separate public entity, individual JPA members are typically not liable for JPA debts. This protection does not extend to liabilities independently held by the JPA members. • Flexibility: Broad latitude in JPA design and purpose so long as the situation can benefit from having collaboration between public agencies • Ease of Formation: Voter approval is not required to establish or issue revenue-only bonds; however, 2/3 voter approval is still required to issue debt secured by a new tax (e.g., a GO bond or special tax revenue bond).
• Agility/Nimbleness: JPAs can move quickly and can incorporate as private organizations with member appointed governing bodies, allowing for delegated decision making without requirement for public review.
• Transparency and Accountability: Board meetings are open to the public with limited exceptions and financial reporting requirements allow tax base to clearly see how district revenues are being spent (it is expected the revenues would primarily or exclusively pay for debt service). Open meetings allow for public involvement.

Disadvantages • Cost of Capital: While having taxing authority and the ability to issue GO bonds, a new healthcare district without credit history or rating will likely receive a higher interest rate than GO bonds issued by municipalities with strong credit history.
• Time to Establish: Healthcare district formation is multi-step requiring the engagement of all governments and territories with land within district boundaries, extensive planning and agency review, and a public vote.
• Inefficient/Duplication of Service: Healthcare districts often extend across multiple jurisdictions and provide similar services to those already provided by or to the City or County if another healthcare district overlaps their borders
• Regional Planning: Can lead to discoordination of efforts as independent board not connected to other local governing bodies and their related health efforts

• Bond Process: Due to the complexities of the laws and rules around GO bonds and JPAs, there may be additional procedural and legal steps required before the JPA could issue a GO bond.
•

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Establishing or Joining an Existing Healthcare District If pursued, healthcare districts can be formed through public process or legislative action.

The process for healthcare district formation is defined in the California Health and Safety Code32 and subject to review by the California Local Agency Formation Commission (LAFCO). The process includes:

1. Define health care district geography and purpose (§ 32001): District geography may include any territory, incorporated and/or unincorporated, in one or any more counties, and does not need to be contiguous. Municipalities within district boundaries must be fully included and may not be divided. Petitions for district establishment must demonstrate need, feasibility, and public support.

2. Public and Agency Review (§ 32002): Prior to petition going to hearing and public vote, it will be subject to agency and public review. Stakeholders with formal review duties include each health planning agency with territory in the district, and the Office of Statewide Health Planning and Development. A public review and comment period of 54 days is also required where comments for or against can be submitted. If comments against district formation are submitted, they must be published and distributed along with election date notifications at least 10 days prior to the election date.

3. Public Vote and Approval (§ 32003): Following review, the petition may be presented at any meeting of the supervising authority of the county with the greatest portion of the land proposed for the district resides. The petition must have signatures from at least 12% of the registered votes within the proposed district boundaries. A vote may then be scheduled and held. If the majority of votes cast are in favor of the district, it may form immediately.

There is also precedent for legislative action to rapidly establish a new healthcare district in urgent circumstance. For example, Pajaro Valley Health Care was established with the 2022 passage of Senate Bill 418 to acquire and ensure the ongoing operation of Watsonville Community Hospital following bankruptcy (see appendix for case profile). Recent precedent for fast tracking district formation in urgent circumstance seems to be driven by the goal to avoid healthcare deserts, which would not likely apply to the East Bay market.33 However, if the City were to explore the potential for this, the next opportunity for review and action will be in 2025’s legislative session.

Additional detail for this process can be found in Appendix B.

Establishing Joint Powers Authority
JPAs can be established relatively rapidly through written contractual agreement between two or more public agencies. This includes public health systems. A joint powers authority does not require voter approval but is subject to public review like other public agencies. While able to bypass the voter approval required for health care district formation, the JPA will still need to include a public member

32 California Health and Safety Code Division 23 Sec 32000 -32003 33 Pajaro Valley Health Care District was established by legislative action under SB 418 in February 2022 to purchase and mainta in operations of Watsonville Hospital following Chapter 11 bankruptcy.

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with taxing authority in addition to the City to allow for tax support from a broader geographic base and require 2/3 voter approval across the participating jurisdictions to issue a GO bond.

Bay Area Healthcare District Context
The Bay Area is home to multiple healthcare districts with two adjacent to Berkeley, Alameda Health Care District and the West Contra Costa Health Care District, which is currently being overseen by the Contra Costa County Board of Supervisors following District bankruptcy in 2016. Other Bay area healthcare districts include El Camino Health, Marin Healthcare District, Peninsula Healthcare District, and Sequoia Healthcare District.

Each healthcare district has unique features informed by the scope of services and population base to whom those services are provided. The below table describes the features and key differences between three of the most proximate healthcare districts to Berkeley.

Healthcare District City of Alameda Healthcare
District
West Contra Costa Healthcare
District
Marin Healthcare District
Overview District is the steward for
Alameda Hospital and its
associated facilities, which are
operated by Alameda Health
System (AHS), formerly
Alameda County Medical
Center and currently a public
hospital authority, under a JPA
formed in 2012 between the
District and AHS.

District is responsible for
collection of parcel tax to
support hospital and facilities
in the City of Alameda
Currently dormant following
2016 bankruptcy (exited in
2021). District was formed to
build Doctors Medical Center
(formerly Brookside) and
oversaw health planning for
West Contra Costa County.

Following District bankruptcy,
Governor passed Senate Bill
522 in 2018 placing the Contra
Costa County Board of
Supervisors as governing body
for District.

Owns and is steward for
Marin General Hospital, an
independent non-profit
hospital, the only acute care
facility in Marin County.

District ensures countywide
access to care and that
hospital facility is in
compliance with seismic
standards.

Population Served City of Alameda West Contra Costa County Marin County, excluding Novato
District Facilities • Alameda Hospital
• South Shore
Rehabilitation
• Park Ridge Rehabilitation
• Kate Creedon Wound
Center
• Doctors Medical Center
(closed 2015)
Marin General Hospital dba
MarinHealth Medical Center
Tax Levied through
District
Yes, annual parcel tax of $298
on every parcel and possessory
interest within district
boundaries ($5.9M received
annually) to support operating
and capital funding needs of
Alameda Hospital and related
facilities
Yes, parcel tax levied in 2004 to
support struggling Doctors
Medical Center Facility and a
second parcel tax in 2011 to
further subsidize facility losses.

Collectively, parcel taxes
brought in $11.3 million in
FY23.34 Parcel taxes support
~$3M in annual debt service on
Doctors Medical Center related
bonds set to mature in 2042
Yes, property tax of $22.3 per
$100k in assessed property
value approved by Marin
Health Care District voters in
2013 to fund $394M GO bond
to finance rebuild of Marin
General Hospital

34 West Contra Costa Healthcare District FY23 Audited Financials

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with remainder funding other
liabilities and district services.

Existing Financing
Arrangements and
Purpose
Certificate of Participation
secured by statutory lien on
parcel taxes to fund capital
improvements necessary to
meet seismic standards
(Amount TBD)
None; Doctors Medical Center
(sole acute care facility) closed
2015
General Obligation Bond of
$394M to fund rebuild of
Marin General Hospital
facilities (30-year term)
Finance Issues to
Note
• JPA Compliance: Alameda
Hospital has experienced
ongoing financial distress
despite parcel tax revenue
subsidy due to
mismanagement of facility
by AHS. Resulted in
$200M in debt owed to
Alameda County.35
• Financial Shortfall: High
governmental payer mix
coupled with service mix
has resulted in ongoing
operating deficit
Current tax is financing
repayment of existing debt and
some local health services that
remain.
• No financial issues of note
• $394 million for bonds
outstanding to finance Oak
Pavilion Hospital Building.

Receives $16 million in
property tax revenue to
service annual debt
requirement

Section D: Next Steps and Timing
The City of Berkeley faces many upcoming steps and decisions as it considers options for financing a new hospital. Each structural and financing option carries implication for the time required to execute. Given that a guiding principle is to eliminate the time between the new facility opening and the closure of Alta Bates, and that the assumed closure is to occur in 2030, expediency is a leading consideration. The following represent the major steps in the process and the estimated timeframe to complete.

Step 1: Feasibility and Planning (12-24+ months): Prior to the debt offering, a detailed feasibility study will need to be conducted and presented for investor and public scrutiny. This phase also involves planning and stakeholder engagement to align partner and community interest. This extends to identification and engagement of the future operating partner. This step can take anywhere from 1-2+ years depending on the stakeholders and project scale, amongst other factors.

The feasibility study will evaluate the need for and long term financial sustainability of the proposed hospital project. This is an investor requirement necessary to set bond terms to the extent revenue bonds are utilized, but is politically necessary for GO bonds. The planning process includes partner and vendor selection for financing, constructing and operating the hospital. These activities can occur concurrently.

Elements assessed by investors will include, but are not limited to:
• Geography and Related Community Need: What is the geography of service? What is the socioeconomic, health, and coverage status of the population to be served? How competitive is

35 Alameda County Grand Jury Report 2014-15

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the local market and do gaps in care exist currently? Does local service demand/needs support the need for a facility of this size and with the proposed service mix? • Facility Payer Mix and Reimbursement: What are the projected financials for the hospital? What assumptions drive that projection and what are the sensitivities (e.g., volume, payer mix, contracted reimbursement rates, etc.)? For example, in a scenario where the facility has a high governmental payer mix, ongoing or additional tax support may be required to offset operating losses if the operator were to require it either through agreement or in the event of a crisis. • Performance of Existing Facility: What is the operating performance of the facility to be replaced? Financial performance of the current inpatient facility will be used to assess likelihood of future performance for the planned facility.
• Oversight and Funding Structure: Under what structure will the hospital be organized and how will it be funded? If a health care district and/or JPA is to be formed, the public partners necessary to enable will need to be engaged during this step to develop the plan for establishment, financing and funds flow. Healthcare districts receive independent credit ratings from the municipalities and territories that comprise them. The structure and “what is in” will have implication for credit terms.
• Operating Partner: Who is chosen to be the operator will be one of the most, if not the most, important factors investors will look at. Considerations will include:
o Experience - Investors want an experienced operator. For example, a new healthcare district with no prior operational experience running the hospital would be considered higher risk.
o Financial interest - Investors in revenue bonds want to see that a third-party operator has some “skin in the game” to give confidence in the durability of the relationship so in the event of financial downturn, the operator has incentive to improve performance rather than exiting the operating or lease agreement. Contribution can take many forms, including capital, philanthropy commitment and/or infrastructure. o Well-regarded brand presence in the market - Respected healthcare brands (e.g., UCs, Kaiser) are attractive to patients and are more likely to capture and maintain market share.
o History of strong financial performance - Particularly important if debt service tied to operating revenues or lease.
• Timing Between Closing of Old and Opening of New: Ideally, there should be no gap between the closing of the old and the opening of the new facility. Gaps in access, even short ones, can risk loss of local market share before the new facility opens. • Project Team: All vendors and professionals participating in project will be scrutinized (engineers, architects, etc.) There is a need to select a highly qualified team with demonstrated experience in developing projects of this scale on time and on budget.

Step 2a: Establish Healthcare District if pursued (4-9 months): If choosing to establish a new healthcare district, or join and expand the boundaries and scope of service for an existing one, California state law requires planning and submission of a petition for formation, review and comment by the CA Office of Statewide Health Planning and Development and by each health

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planning agency with territory within the proposed district (60 days), notification of election to LAFCO and response (10 days), posting of proposal for formation and public comment (54 days), distribution of notice for public vote prior to election (10 days minimum), and finally a public vote with at least 12% of registered voters within proposed district boundaries participating and recording majority approval.36
Step 2b: Establish Joint Powers Authority if pursued (4-6 months): If choosing to establish a JPA, a vote will not be required. Once authorized by their legislative or governing bodies, the public agencies may enter into an agreement. The agreements shall state the purpose of the agreement or the power to be exercised and provide for the method by which the purpose will be accomplished or the manner in which the power will be exercised. Once executed, the agreement must be filed with the Secretary of State within 30 days of the effective date with an additional copy to be sent to the Controller. Once successfully filed, the JPA may issue bonds and finance projects.37 Step 2c: Gain Voter Approval of Additional Debt and Associated Tax to Secure (4-9 months): If debt is to be secured by new tax revenues, ad valorem or special tax, voter approval will be required.

Organizing, publicizing, and holding the vote may take anywhere from 4-9 months. (If establishing a healthcare district, the vote can occur at same time as district formation vote.) Step 3: Issue Debt (4-9 months): Once approval to offer debt is received, the issuing entity will work with investment banks and advisors to develop offering(s) and then make them available to investors. Generally, this can take 4-9 months, though complex circumstances could result in longer timelines extending up to 12-18 months.

Step 4: Complete Permitting and Construction (3-5+ years): Once funded, project construction will begin. The construction timeline has several dependencies, such as permitting, land acquisition, and regulatory review, which may be initiated in parallel with the prior steps. As the most time-intensive step, choosing a developer in the planning and feasibility stage with demonstrated experience executing a hospital project of similar scale in the same or similar geography is essential.

36 California Healthcare District Law 32000-32003
37 California Government Code - Section 6500-6536 :: Article 1. Joint Powers Agreements

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Appendices

Appendix A: Special District GO Bond Rating Criteria (Moody’s) Appendix B: California Healthcare District Formation Regulations (32000-32003) Appendix C: Summary of Regional Municipalities and Current District Participation Status Appendix D: Case Profile – Pajero Valley Health Care District Formation via Legislation

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Appendix A: Moody’s Special District GO Bond Rating Criteria

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Appendix B: California Health and Safety Codes: Division 23 – Hospital Districts

Division 23, Chapter 1: Formation of District
Section Policy
§ 32001 A local hospital district may be organized, incorporated and managed, as provided in this division and may exercise the powers herein granted or necessarily implied. Such a district may include incorporated or unincorporated territory, or both, or territory in any one or more counties. The territory comprising this district need not be contiguous but the territory of a municipal corporation shall not be divided; provided, that land either in a municipal corporation or in unincorporated territory which the supervising authority finds will not be benefited shall not be included.
(Amended by Stats. 1965, Ch. 2043.)
§ 32002 The manner of formation of local hospital districts, and the conducting of all hospital district elections, unless otherwise provided in this division shall be as in the manner provided, respectively, by Chapter 1 (commencing with Section 58000) of Division 2 of Title 6 of the Government Code, and Part 3 (commencing with Section 10400) and Part 4 (commencing with Section 10500) of Division 10 of the Elections Code. Except as provided in this division, these provisions are hereby incorporated in this division by reference and shall have the same effect and force as if fully set forth herein. In addition to all other requirements regarding formation of hospital districts, no hearing upon the petition to form a hospital district shall be held until comments and recommendations of the Office of Statewide Health Planning and Development and each area health planning agency having territory within the proposed district, concerning the need for new or additional health facilities in the area to be served by the proposed district have been filed with the supervising authority. The Office of Statewide Health Planning and Development and the area health planning agency or agencies shall submit these comments and recommendations to the supervising authority within 60 days after receiving a request therefor from the proponents. Failure to submit these comments to the supervising body within 60 days shall be deemed to constitute a “no comment” response.
(Amended by Stats. 1994, Ch. 923, Sec. 145. Effective January 1, 1995.) § 32002.31 Within five days after the district formation election has been called, the legislative body which has called the election shall transmit, by registered mail, a written notification of the election call to the executive officer of the local agency formation commission of the county or principal county in which the territory or major portion of the territory of the proposed district is located.

Such written notice shall include the name and a description of the proposed district, and may be in the form of a certified copy of the resolution adopted by the legislative body calling the district formation election.

The executive officer, within five days after being notified that a district formation election has been called, shall submit to the commission, for its approval or modification, an impartial analysis of the proposed district formation.

The impartial analysis shall not exceed 500 words in length and shall include a specific description of the boundaries of the district proposed to be formed.

The local agency formation commission, within five days after the receipt of the executive officer’s analysis, shall approve or modify the analysis and submit it to the officials in charge of conducting the district formation election.
(Added by Stats. 1970, Ch. 736.)
§ 32002.32 The board of supervisors or any member or members of the board authorized by the board, or any individual voter or bona fide association of citizens entitled to vote on the district formation proposition, or any combination of such voters and associations of citizens, may file a written argument for or a written argument against the proposed district formation.

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Arguments shall not exceed 300 words in length and shall be filed with the officials in charge of conducting the election not less than 54 days prior to the date of the district formation election. (Added by Stats. 1970, Ch. 736.)
§ 32002.33 If more than one argument for or more than one argument against the proposed district formation is filed with the election officials within the time prescribed, such election officials shall select one of the arguments for printing and distribution to the voters.

In selecting the arguments, the election officials shall give preference and priority in the order named to the arguments of the following:
(a) The board of supervisors or any member or members of the board authorized by the board. (b) Individual voters or bona fide associations of citizens or a combination of such voters and associations.
(Added by Stats. 1970, Ch. 736.)
§ 32002.34 The elections officials in charge of conducting the election shall cause a ballot pamphlet concerning the district formation proposition to be voted on to be printed and mailed to each voter entitled to vote on the district formation question.

The ballot pamphlet shall contain the following, in the order prescribed:
(a) The complete text of the proposition.
(b) The impartial analysis of the proposition, prepared by the local agency formation commission. (c) The argument for the proposed district formation.
(d) The argument against the proposed district formation.

The elections officials shall mail a ballot pamphlet to each voter entitled to vote in the district formation election at least 10 days prior to the date of the election. The ballot pamphlet is “official matter” within the meaning of Section 13303 of the Elections Code. (Amended by Stats. 1994, Ch. 923, Sec. 146. Effective January 1, 1995.) § 32003 Whenever the formation of a local hospital district is desired, a petition may be presented at a regular meeting of the supervising authority of the county in which the land, or a greater portion of the land, in the proposed district is situated, said petition to be signed by the registered voters residing within the boundaries of the proposed district, equal in number to at least 12 percent of the voters registered within the boundaries of the proposed district 30 days prior to the date the petition is filed. The number of written protests required to terminate the proceedings shall be a majority of the registered voters residing in the proposed district.

If a majority of all the votes cast in the proposed district are in favor of organization, the supervising authority by resolution entered on its minutes shall declare the district duly organized under this act, shall give the name of the district as theretofore designated and shall describe the boundaries of such district. The county whose supervising authority declares the district organized shall be designated the “organizing county.”
(Amended by Stats. 1963, Ch. 1232.)

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Appendix C: Summary of Nearby Municipalities in Service Area Geography and Current District Participation Status
Municipality
/ Territory
Distance from
Alta Bates
Summit
Medical Center
(miles)
Currently
in/Contains
a Health
Care District
(Y/N)
Health
Care
District
Health Care District
Tax
Net Assessed
Value of
Taxable
Property (in
billions)38
Berkeley 0.0 No N/A No $26.712
Emeryville 2.3 No N/A No $7.190
Piedmont 3.6 No N/A No $4.70039
Oakland 3.7 No N/A No $79.755
Albany 4.2 No N/A No $3.409
Kensington 4.4 Yes West
Contra
Costa
$52 per parcel tax +
tiered parcel tax based
on property type*
Not Available
El Cerrito 6.1 Yes West
Contra
Costa
$52 per parcel tax +
tiered parcel tax based
on property type*
$5.478
Orinda 6.7 No N/A No $8.874
Richmond 8.8 Yes West
Contra
Costa
$52 per parcel tax +
tiered parcel tax based
on property type*
$13.649
Moraga 11 No N/A No $5.237
Lafayette 11.2 No* N/A No $10.524
San Pablo 11.7 Yes West
Contra
Costa
$52 per parcel tax +
tiered parcel tax based
on property type*
$2.622
Walnut Creek 14.3 No N/A No $22.555

Alameda
County
N/A Yes City of
Alameda
District specific $379.140
Contra Costa
County
N/A Yes Los
Medanos;
Concord/
Pleasant
Hill; West
Contra
Costa
District specific $256.266
*Tiered parcel tax approved in November 2011 (Measure J): $47/single family home; $94/small multi-unit residential; $282/small commercial or industrial property; $470/medium commercial or industrial property; $940/large commercial or industrial property.

Source: Contra Costa County Public Records

38 Net Assessed Value of Taxable Property sourced from FY23 Audited Comprehensive Annual Financial Reports respective municipali ties and county. 39 Piedmont does not report net assessed value in annual audited financials and relies on Alameda County for annual estimate. $4.7 billion value as of June 2020 from Report of the Piedmont Budget Advisory and Financial Planning Committee .

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Appendix D: Case Profile

Profile: Pajero Valley Health Care District Formation via Legislation

Office of the Mayor
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-[XXXX] ● TDD: (510) 981-6903 ● Fax: (510) 981-[XXXX] E-Mail: [e-mail address]

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Mayor Jesse Arreguín (Author)
Subject: Referral to City Manager: Equity for Black Berkeley (E4BB) Initiative

RECOMMENDATION
Adopt a resolution, recognizing the vision and goals of the Equity for Black Berkeley (E4BB, previously referred to as EBB), historicizing the work that has been completed to date, recognizing the current and past City staff and external stakeholders involved with E4BB, and maintaining E4BB as a priority of the City.

Refer to the City Manager the following actions to be taken:

1. Establish a representative for E4BB (the “E4BB Representative”) with the following responsibilities:
a. Represent the City’s interests when relating to matters of the E4BB initiative;
b. Liaise between City officials and external partners and parties associated with E4BB;
c. Draft policies that advance the work aligned with vision and goals of E4BB in connection with the Mayor’s Office and other legislators within the City and across jurisdictions and agencies, as needed;
d. Oversee and coordinate the implementation of work related to E4BB across the City and with external stakeholders, providing updates to the Mayor’s Office, as appropriate; and
e. Pursue internal and external resources and funding opportunities to advance the work of E4BB in the near- (1-2 years) and long-term (3+ years).

2. Determine the appropriate staffing and financial resources needed to monitor and communicate the implementation of the following existing and future projects and policies related to E4BB with the E4BB Representative:
a. Implementation of Ashby BART TOD;
b. Data collection and analysis of the impact of the Preference Policy; c. Implementation of Housing Element, with particular attention in identifying priorities sites for expanding the efficacy of the Preference Policy and

24

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

what unmet needs may be invested in through the establishment of a non- governmental organization outside of the City;
d. Improvements to establish cultural vibrancy and accessibility in South Berkeley, creating recommendations for what potential EIFD funds can be used towards;
e. Growth opportunities to expand the economic viability of small businesses and commerce in the South Berkeley area, including support to sustain and grow the success of the Berkeley Flea Market;
f. Facilitating the intersection of the African American Holistic Resource Center (AAHRC) with relevant work in South Berkeley, particularly the new Ashby TOD residents and EFID related projects;
g. Management of financing, expenditures, and balance sheets received by the City related to E4BB including but not limited to grants, City investments from the General Fund, and an EIFD fund;
h. Legal representation and support with negotiations, contracts, and MOUs with outside jurisdictions, external E4BB partners, and internal discussions of authority and governance; and
i. Provide 1) supervision of an unpaid staff person offered by the Partnership for the Bay’s Future (PBF) grant program (should the City of Berkeley become selected as a government host site) and 2) communication on the progress and connection of projects relating to E4BB including but not limited to the Ashby BART TOD, Black Arts and Cultural District, Small Sites, EIFD, Black Health Equity Zone, Berkeley Flea Market and AAHRC.

3. With assistance from the E4BB representative, create a template MOU to be drafted and circulated with outside groups engaged in E4BB, including, but not limited to:
a. Berkeley Flea Market;
b. Healthy Black Families;
c. San Francisco Foundation; and
d. External Consultants (Ndidi Love, Randolph Belle aka Creative Development Partners, communications experts, etc).

4. Work with the E4BB Representative to pursue additional external and internal investments to help with creating a non-governmental organization to manage a community investment fund beyond 2026 and transition the work of E4BB to be managed within this entity.

FINANCIAL IMPLICATIONS
None explicitly requested. The investment of staff will be given at the discretion of the City Manager. Additional resourcing of staff and financing can be requested by Council at a future date, at their discretion. Current investments made come from the Mayor’s staff and office budget and successfully awarded philanthropic grants.

CURRENT SITUATION AND ITS EFFECTS
Equity 4 Black Berkeley (E4BB, previously referred to as EBB) is an initiative started in Mayor Arreguín’s Office in partnership with community, philanthropic, and government

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

partners with the goal of addressing historical harm and injustices while committing to community wellness and generational wealth building into the future. This multi-year, multi-stage, cross-industry, cross-sectoral, multi-departmental collaboration between partners in South Berkeley, the East Bay, and the greater Bay Area region demonstrates a commitment to advancing racial equity, promoting progressive housing and social policies, and advancing the outcomes and opportunities of those formerly and currently displaced by historical redlining, BART development and property seizure, and gentrification.

In anticipation of the upcoming mayoral and council transition, it is necessary to 1) enshrine the vison, goals, and work of E4BB so that its prioritization can be maintained, 2) lay the groundwork for the initiative to permanently transition out of the Mayor’s Office (and eventually the City), and 3) outline the remaining work and potential resources needed to accomplish the goals and vision of E4BB.

BACKGROUND
In 2020, the City of Berkeley Mayor’s Office was selected as the government partner in connection to the first1 San Francisco Foundation’s Partnership for the Bay’s Future (PBF) cohort with the stated goals of building out a housing preference policy and Tenants Opportunity to Purchase Act (TOPA) with the East Bay Community Law Center (EBCLC), the selected community partner in this work. Additional community partners included Healthy Black Families (HBF) the Northern California Land Trust (NCLT), and Bay Area Community Land Trust (BACLT). During this two-year grant period, Equity 4 Black Berkeley was conceived as an initiative that could nest this opportunity along with ongoing and future community grassroots and grasstops efforts to advance housing, economic, and social opportunities for current and displaced Black residents.

In 2022, the Mayor’s Office was once again selected as the government partner for the second PBF grant2 to work on three stated goals with HBF, the selection community partner: 1) community-driven, equitable development recommendations at the North Berkeley and Ashby BART stations in conjunction with supportive policies such as Right to Return and Local Preference policy3 2) innovative financing to raise $500M for development at BART sites, and 3) building a replicable model for reparative work. This funding, allowed the Mayor’s Office to build upon its previous E4BB concept, working with HBF to collect data from community members on what priority policy activities they would like to pursue, synthesize data into categories that could promote policy creation.

The community identified housing as the leading priority. Within this priority category, affordable home ownership opportunities and affordable housing were identified as chief needs. Central to these priorities are the achievement of E4BB’s five values:
● The Right to Return for displaced residents and/or their descendants; ● The Right to Remain for residents at all income-levels and housing needs; ● The Right to Own properties of all types and at all pricing levels; and 1 The first PBF grant was referred to as the Challenge grant. 2 The second PBF grant was referred to as the Breakthrough grant. 3 The Affordable Housing Preference Policy was adopted by Council on July 11, 2023.

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

● The Right to Thrive, an affirmative commitment to valuing and elevating the active well being of Black residents.
● To secure members of the historically Black community as large an equity stake in the Adeline Corridor redevelopment project as possible.

In 2022, the Berkeley Mayor’s office paired this second PBF grant opportunity with additional investments from the Mayor’s Office budget and the SFF’s Power and Place grantmaking portfolio, increasing the capacity for the E4BB team4 to include expertise from an innovative real estate investment and development company,5 a communications expert,6 technical assistance,7 strategic planning,8 and project management along with additional research support.9 These supports gave capacity for the Mayor’s Office to:
 Build a reparative framework to be incorporated in negotiations with BART related to the Ashby BART Transit Oriented Development term sheet, developer selection process, and community benefit prioritization;  Create and deploy near-term, medium-term, and long-term visioning and strategic planning to revitalize, sustain, and grow the Berkeley Flea Market (BFM) through modernization efforts including new governance, board, and financing strategies, in addition to guidance to assist the BFM in its temporary and permanent relocation and economic growth strategy in connection with the Ashby BART TOD;
 Research to support policy development and targeted investments to expand opportunity for missing middle housing;10
 Research to investigate finance structures that can support E4BB’s Right to Stay and Right to Own pillars through the creation of investment funds, such as the Institutional Fund11, a Community Fund12, and an Enhanced Infrastructure Financing District (EIFD) fund13; and
 Draft governance documents to assist with the conceptualization of a community- led, non-governmental organization that can house E4BB activities, one or more 4 Mayor’s Office Staff and HBF.
5 Provided by Creative Development Partners (CDP), represented by Randolph Belle. 6 Provided by Planet DMA Inc., represented by Donna Marie Anderson (DMA). 7 Provided by Schuyler Karr, MPA student, now graduate from UC Berkeley Goldman School’s of Public Policy.
8 Provided by CDP and Ndidi Love.
9 Provided by a number of paid short-term consultants, such as Amy Gao and Gail McGuire, and Anthony Rodriguez, staff member in the Office of the Mayor of Berkeley. 10 Missing middle housing refers to the concept of needing to provide housing at all affordability levels, including middle-income housing opportunities that are typically under-supported through income-driven rental and homeowner assistance programs and policies and market-rate housing solutions. 11 The Institutional Fund has been conceived as $500M private fund to invest in affordable housing development.
12 The Community Fund is a community-driven, funded, and governed fund to invest in economic opportunities for new and emerging businesses.
13 The EIFD fund would be grown from transfer taxes in a specific and/or discontinuous area to be earmarked for infrastructure improvements (beautifying, placemaking, cultural expression, etc) for a geographic area.

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

of these funds, and organize for the development of community-led policy making.

For four years, the Mayor's Office has worked with community partners to actively seek out, engage, and center Black leadership, Black organizations, Black community members to include them in policy-making processes and decisions to collect data on and feedback from displaced residents and residents who are or might be impacted by or eligible for housing opportunities.14 This inclusive and participatory process, demonstrates an intentional experience is being pursued to advance policymaking through effective partnership cultivation and constituent engagement. Advancing E4BB’s work will require further ingenuity in how policies, programs, and collaborative efforts generate systemic change to identify, address, heal from, and overturn systemic inequities that disproportionately affect marginalized communities historically underinvested, deprived, and extracted from.

E4BB is presently poised to become a catalyst for change, improving the current housing ecosystem that creates and perpetuates an existing multi-generational wealth gap. In its next phase of work, E4BB aims to explore opportunities to increase Black homeownership in South Berkeley within a generation, build sustainable economic engines in the area, and move the fulcrum of power determining the future of residents’ lives to the center of community. Coordinated efforts with the Planning Department to support the revitalization of the BFM are in place and will continue through January 2025. The Mayor’s Office is a finalist for the third PBF grant15 which will focus on conceiving homeownership opportunities in partnership with HBF. Through coordinated efforts by CDP, the Northern California Grantmakers, San Francisco Foundation, and East Bay Community Foundation will host a funders forum in February 2025 to bring greater regional support to E4BB, with a goal of generating $4M over 5 years to assist with permanently transitioning E4BB out of the City of Berkeley. To help ensure the continued success and pursuit of E4BB’s vision from one administration to the next, Mayor Arreguín hired a dedicated team member to focus on managing the E4BB’s initiative across internal and external stakeholders.16 This person will serve as the E4BB Representative on behalf of the City.
14 HBF held 14 People’s Assembly’s in 2022 and 2023 to help garner input, collect quantitative and qualitative data, and generate community priorities for E4BB among Black residents. Using philanthropic funding ,the Mayor’s Office hosted a set of Strategy Sessions, led by Planet DMA, to create a Minimum Viable Product (MVP) in support of ideating around one meaningful, low-intensity action to be taken to advance the needs of the community in line with E4BB’s goals and vision. 15 The third PBF grant will be considered a grant from the Policy grantmaking portfolio. Decisions will be made in November/December 2024, with work commencing in February 2025. 16 The maintenance of this position is left at the discretion of future Mayoral administrations.

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
There are no identifiable environmental effects associated with adopting this recommendation, however there are opportunities to improving the social determinants of health through community investments in housing17 and social inclusion18.

CONTACT PERSON
Mayor Jesse Arreguín 510-981-7100
Anthony Rodriguez [email protected]
Gail McGuire [email protected]
Attachments:
1: Resolution
2: E4BB Narrative

3. E4BB Reparative Framework

4. Healthy Black Families’ Case Study
17 See “Optimizing Investment in Housing as a Social Determinant of Health” by Dr. Stuart M. Butler via the Journal of the American Medical Association (JAMA). https://jamanetwork.com/journals/jama-health- forum/fullarticle/2796572
18 See National Academies of Sciences, Engineering, and Medicine’s The Future of Nursing 2020-2030 journal, chapter 2: “Social Determinants of Health and Health Equity”. https://www.ncbi.nlm.nih.gov/books/NBK573923/

RESOLUTION NO. ##,###-N.S.

ENRISHING EQUITY 4 BLACK BERKELEY (E4BB) AS A PRIORITY OF THE MAYOR’S OFFICE AND CITY
WHEREAS, Equity 4 Black Berkeley (E4BB, previously referred to as EBB), is an initiative conceived out of Mayor Jesse Arreguín’s Office in partnership with Healthy Black Families (HBF) and other Black community members to address historical injustices and commit to community wellness and generational wealth building; and WHEREAS, since Mayor Arreguín’s election in 2016, equitable and affordable housing has been a core focus of his administration; and
WHEREAS, The City of Berkeley acknowledges the historical and current harm to cultural vibrancy, economic vitality, population growth, and generational wealth building among Black and other melanated residents through the systemic, intentional, and unintentional consequences from institutional redlining during the 1960’s and 1970’s, the planned and ongoing construction of BART stations and infrastructure leading to mass displacement via eminent domain and property purchasing, and modern forms of gentrification causing increases to cost-of-living that disrupt the life of those who remain; and WHEREAS, through E4BB, the City of Berkeley commits to and acts to become a place where former and current Black residents can live, work, engage with community, and personally, financially, and healthily thrive in an effort to address and repair aforementioned institutional harm, with particular attention given to those having resided in the South Berkeley Area; and
WHEREAS, E4BB maintains four main pillars or work including: A Right to Return for displaced residents or their descendants, A Right to Remain in Berkeley for residents at all income-levels and housing needs, A Right to Own properties of all types and at all pricing levels in connection to homeownership and building generational wealth, and A Right to Thrive, an affirmative commitment to valuing and elevating the active well-being of Black residents; and
WHEREAS, a three-pronged approach to the E4BB initiative was used in community stakeholders and partners, including 1) engaging community members, 2) enacting critical policy measures, and 3) ensuring measurable impact; and WHEREAS, the City of Berkeley has taken major actions in the form of policy referrals and adoptions that advance the goals and activities of E4BB including: the Affordable Housing Policy, the Housing Preference Policy, the Adeline Corridor Specific Plan, the Small Sites Program, the Enhanced Infrastructure Finance District (EIFD) referral, the establishment of a Black Arts and Culture District, and the Ashby BART Transit Oriented Development (TOD) term sheet adoption; and

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

WHEREAS, the Mayor’s Office has generated resources, guided partnerships, and advocated for the advancement of E4BB’s work across public, private, and non-profit partnerships, including a set of direct investments from the San Francisco Foundation’s Place and Power grantmaking, the selection to participate in the first two San Francisco Foundation’s Partnership for the Bay’s Future (PBF) grant program cohorts with Healthy Black Families, the investment of monies from the General Fund to revitalize, sustain, and grow the Berkeley Flea Market (BFM), and a pending budget referral to HBF in support of the creation of a Community Advisory Group to provide thought leadership around implementation of a Black Cultural Zone and Health Equity Zone; and WHEREAS, from 2020-2024 the City of Berkeley’s Eviction Defense Center served 939 unduplicated households. 36% of those households were Black/African American; and WHEREAS, $111 million of Measure O’s $135 million already has been allocated, providing 784 units of affordable housing that have either been completed, under construction, or in pre-development (including Berkeley Unified School District Workforce Housing and affordable housing at Ashby and North Berkeley BART); and WHEREAS, for four years, through E4BB, the Mayor's office and community partners (led by HBF) have actively sought out, engaged, and centered Black leadership, Black organizations, Black community members to include them in policy-making processes and decisions, collected data on and feedback from displaced residents and residents who are or might be impacted by or eligible for housing opportunities.

NOW, THEREFORE, BE IT RESOLVED that the City of Berkeley establishes a representative for E4BB (the “E4BB Representative”) with the following responsibilities:
a. Represent the City’s interests when relating to matters of the E4BB initiative;
b. Liaise between City Officials and external partners and parties associated with E4BB;
c. Draft policies that advance the work aligned with vision and goals of E4BB in connection with the Mayor’s Office and other legislators within the City and across jurisdictions and agencies, as needed; and
d. Oversee and coordinate the implementation of work related to E4BB across the City and with external stakeholders, providing updates to the Mayor’s Office, as appropriate; and
e. Pursue internal and external resources and funding opportunities to advance the work of E4BB in the near- (1-2 years) and long-term (3+ year).

BE IT FURTHER RESOLVED that the City Manager will determine the appropriate staffing and financial resources needed to monitor and communicate the implementation of the following existing and future projects and policies related to E4BB with the E4BB Representative:

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

a. Implementation of Ashby BART TOD;
b. Data collection and analysis of the impact of the Preference Policy; c. Implementation of Housing Element, with particular attention in identifying priorities sites for expanding the efficacy of the Preference Policy and what unmet needs may be invested in through the establishment of a non- governmental organization outside of the City;
d. Improvements to establish cultural vibrancy and accessibility in South Berkeley, creating recommendations for what potential EIFD funds can be used towards;
e. Growth opportunities to expand the economic viability of small businesses and commerce in the South Berkeley area, including support to sustain and grow the success of the Berkeley Flea Market;
f. Facilitating the intersection of the African American Holistic Resource Center (AAHRC) with relevant work in South Berkeley, particularly the new Ashby TOD residents and EFID related projects;
g. Management of financing, expenditures, and balance sheets received by the City related to E4BB including but not limited to grants, City investments from the General Fund, and an EIFD fund;
h. Legal representation and support with negotiations, contracts, and MOUs with outside jurisdictions, external E4BB partners, and internal discussions of authority and governance; and
i. Provide 1) supervision of an unpaid staff person offered by the Partnership for the Bay’s Future (PBF) grant program (should the City of Berkeley become selected as a government host site) and 2) communication on the progress and connection of projects relating to E4BB including but not limited to the Ashby BART TOD, Black Arts and Cultural District, Small Sites, EIFD, Black Health Equity Zone, Berkeley Flea Market and AAHRC.

BE IT FURTHER RESOLVED that, with assistance from the E4BB representative, the City Manager shall create a template Memorandum of Understanding (MOU) to be drafted and circulated with outside groups engaged in E4BB, including, but not limited to:
a. Berkeley Flea Market;
b. Healthy Black Families;
c. San Francisco Foundation; and

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

d. External Consultants (Ndidi Love, Randolph Belle aka Creative Development Partners, communications experts, etc); and BE IT FURTHER RESOLVED that the City Manager will work with the E4BB Representative to pursue additional external and internal investments to help with creating a non-governmental organization to manage a community investment fund beyond 2026 and transition the work of E4BB to be managed within this entity.

BE IT FURTHER RESOLVED that the City of Berkeley acknowledges that E4BB has been spearheaded by Mayor Jesse Arreguin and his office, with immeasurable contributions provided through the involvement of city leaders and public servants including Jacquelyn McCormick, Anthony Rodriguez, Gail McGuire, Anna Cash, Mike Urbeti, Lisa Warhuus, Alisa Shen, Jordan Klein, Babalwa Kwanele, Paul Buddenhagen, Councilmember Ben Bartlett, James Chang, Dyana Delfin Polk, Hank Levy, Amy Shrago, Demisha Burns, Secretary Tomiquia Moss, Michelle Starratt, and countless others.

BE IT FURTHER RESOLVED that the City of Berkeley acknowledges the following partners and community stakeholders involved in bringing E4BB to life, fostering its advancement, and supporting its current position for growth and expansion, including:

Randolph Belle of Creative Development Partners (CDP); Donna Michelle Anderson (DMA) of Planet DMA; Schuyler Karr; Wilhelmina Wilson, (Mama) Ayanna Davis, Erin Alexander, Suzette Chaumette, Derethia DuVal, Deborah Hailu, and Yusef Herbert of Healthy Black Families (HBF); Alan Dones of Strategic Urban Development Alliance (SUDA); Nikki Beasley of Richmond Neighborhood Housing Services; Willie Phillips of Resources for Community Development (RCD); Michael Trujillo of the East Bay Community Law Center (EBCLC); Ms. Ritchie of the Friends of Adeline and the Friends of Adeline Board; Aysha Pamukcu, Ella Zimbalist, Demitrius Burnett, and Rodney Nickens, and Judith Bell of the San Francisco Foundation (SFF); Matt Gustafson of the Bay Area Community Land Trust (BACLT); Phillip Palmer of Berkshire Hathaway Realty; Charles Wilson of BDO; Arthur Summerville; Moni Law; Ambrose Carroll of Green the Church; Michael McBride of The Way Christian Church; Aisha Brown of BART; Eli Moore of UC Berkeley’s Othering and Belonging Institute; Nathan Brostrom of the UC Office of the President; Dr. Jovan Scott Lewis, PhD; Christine “Chris” Schildt; Dan Lindheim; Aleks Vorobets; Rick Jacobus; Sameer Sood; Josh Prasad; Amy Gao; the Center for Food, Faith & Justice (CCFJ); Coro Northern California; numerous faith- based groups; and additional unnamed contributors.

BE IT FURTHER RESOLVED by the Council of the City of Berkeley that the City of Berkeley recognizes E4BB as a priority of the City to be maintained until the initiative is transitioned outside of the City and under the responsibility of an outside City entity.

BE IT FURTHER RESOLVED that E4BB is poised to become a catalyst for change, improving the current housing ecosystem that creates and perpetuates an existing

Equity 4 Black Berkeley (E4BB) Referral CONSENT CALENDAR November 19, 2024

multi-generational wealth gap, and in its next phase of work, E4BB aims to explore opportunities to increase Black homeownership in South Berkeley within a generation, build sustainable economic engines in the area, and move the fulcrum of power determining the future of residents’ lives to the center of community.

EQUITY 4

BLACK BERKELEY

NARRATIVE & NEXT STEPS
A U G U S T 2 0 2 4
For the City of Berkeley
Prepared by Planet DMA

TABLE OF CONTENTS
01 THE VISION
02 THE ECOSYSTEM
03 THE RESIDENT’S JOURNEY
04 HISTORICAL CONTEXT
05 KEY MILESTONES
06 MAYORAL FOCUS

AFFORDABLE HOUSING

HOUSING PREFERENCE POLICY

ADELINE CORRIDOR

SMALL SITES PROGRAM

OUTCOMES
07 TIMELINE
08 FRAMES OF REFERENCE
09 THE GOAL
10 THE URGENCY

RESIDENTS SNAPSHOT
11 THE ENTITY

SHORT-TERM ACTIVATIONS

NEAR-TERM ACTIVATIONS

LONG-TERM ACTIVATIONS

APPENDICES

TIMELINE
DATA

SOURCES

E4BB — Narrative & Next Steps
The current priority lens of this vision is housing.

Through E4BB, the City of Berkeley commits to and acts to become a place where former and current Black residents can live, work, engage with community, and personally, financially, and healthily thrive.

Per the directive of Black community leaders and members engaged with E4BB, the current priority lens of this vision is housing, particularly affordable housing, with the City emphasizing and ensuring:
● A Right to Return (for displaced residents or their descendants) ● A Right to Remain (for residents at all income-levels and housing needs) ● A Right to Own (properties of all types and at all pricing levels) ● A Right to Thrive (an affirmative commitment to valuing and elevating the active well-being of Black residents)
EQUITY 4 BLACK BERKELEY

01. THE VISION
Equity 4 Black Berkeley (E4BB), originally known as Equitable Black Berkeley (EBB), is a four-year initiative of the City of Berkeley Mayor’s Office, in partnership with Healthy Black Families (HBF) and other Black community members, to address historical injustices and commit to community wellness and generation wealth. This report sets forth a foundation and framework for transitioning E4BB into an independent, non-governmental entity.

Dozens of independent entities impact the lives and housing experiences of Berkeley’s Black residents. These entities vary by:
● Sector
○ Public
○ Private
○ Non-profit organizations
● Levels (public sector)
○ Local: neighborhood, city, county, tribal, regional
○ State
○ Federal
● Spheres of influence
○ Policy
○ Health care
○ Employment
○ Law enforcement
● Platforms of engagement
○ Online portals
○ In-person meetings
○ Video conferencing
○ Emails, letters, phone calls

02. THE ECOSYSTEM
E4BB — Narrative & Next Steps
2 There are 22 discrete web sites to seek affordable housing in Berkeley.

In order to find or retain housing, individual residents are charged with navigating dozens of entities, processes, and policies, learning as they go.

Their success and failure is relegated to the individuals themselves. ● Unassigned. No entity or individual currently is charged with ensuring Black residents (or any residents) reach the E4BB vision of returning to housing after displacement, remaining in current housing, owning a home, or thriving as individuals, families, and community members. It is no one’s affirmative responsibility to ensure Black residents experience equity – or to mitigate harm that’s been or being done to them. ● Under-resourced. Functionally specific entities serve many Black residents effectively but can be understaffed, underpaid, and under-resourced for the size and needs of their service population. ● De-centered. In a recent call regarding short-term plans and priorities for Black residents and housing, none of the City departments and elected leaders in attendance actively advocated for, or articulated a passionate, prioritized vision for, the well-being of Black residents.

Ultimately, the resident-facing entities, services, processes, and resources are deeply decentralized. Residents cannot quickly and effectively succeed in finding and leveraging their best-fit opportunities and resources, from finding housing and services, to protecting their housing rights, to creating and sharing generational wealth.

03. THE RESIDENT’S JOURNEY
E4BB — Narrative & Next Steps
3 It’s no one’s responsibility to ensure Black residents experience equity.

● 1933 to 1977: Berkeley is one of many cities nationwide institutionally redlined in the government-sponsored Home Owners’ Loan Corporation (HOLC) maps.
● 1960s and 1970s: The planned and ongoing construction of BART stations caused a loss of businesses, community and culture, and displaced many Black residents of Berkeley (either via eminent domain or, more commonly, property purchase).
● 1980s+: Gentrification, cost-of-living, and continued structural and institutionalism racism continue to reduce the number of Black residents and disrupt quality of life for those who remain.

04. HISTORICAL CONTEXT
E4BB — Narrative & Next Steps
4

1973 Berkeley adopts Inclusionary
Housing policy as part of Neighborhood
Preservation Ordinance.

05. KEY MILESTONES
E4BB — Narrative & Next Steps
5 1980 The Rent Stabilization and Good
Cause for Eviction Ordinance regulates
rent increases and evictions.
1987 Berkeley adopts Inclusionary
Ordinance (expands over time to include
Affordable Housing Mitigation Fees),
governing multi-unit rental and ownership
properties (5 or more)
2012 Governor Jerry Brown dissolves
California's multi-billion dollar
redevelopment agencies.
1977 The Housing Element of the
Berkeley Master Plan affirms the right
to decent, affordable, adequate,
pleasant housing options for Berkeley
residents
1990 City establishes the Housing Trust
Fund to support the creation and
preservation of affordable housing in
Berkeley.
2010 Community members and
organizations, especially in South
Berkeley, begin advocacy to establish
local preferences for Berkeley’s
affordable housing, including a right to
return and right to stay.
2016 Berkeley City Council’s first
discussion of a Housing Preference
policy to reduce displacement.

Participants in the E4BB initiative have contributed to research, development, and execution of all of these arenas.

Since Mayor Arreguín’s election in 2016, affordable and equitable housing has been a core focus of the administration – including establishing the E4BB initiative. The three-pronged approach has been to:
● Engage community members
● Enact critical policy
● Assure measurable impact
The four central arenas of action have been:
● Affordable Housing Policy. The administration has proposed, shepherded, and signed off on transformative legislation. ● Housing Preference Policy. A cross-sector effort delivered an implemented a preference framework for displaced residents, and the first housing development to apply the policy has opened. ● Adeline Corridor Specific Plan. Negotiations are ongoing for the housing, commerce, community, and cultural opportunities connected to the development surrounding the North Berkeley and Ashby BART Stations.
● Small Sites Program. The City has funded two pilots for shorter-term, lower-budget housing developments with community partners.

06. MAYORAL FOCUS
E4BB — Narrative & Next Steps
6

● The City reconstitutes and bolsters the 2008 Housing Retention Program and rental assistance grants through the Eviction Defense Center.
● The City prioritizes developing the Berkeley Way project. ● Measure P, a tax increase on the transfer of real property was on the ballot for Berkeley voters in Alameda County, California, on November 6, 2018. It was approved. ● Measure O provides $135 million of funding from bond revenue to pay for affordable housing projects. Berkeley voters passed Measure O in November 2018 with 77.5% approval. The original ballot question read:
● The city passes an affordable housing bond.

AFFORDABLE HOUSING
E4BB — Narrative & Next Steps
7 2017-2018
● 2020: Berkeley Housing Authority (BHA) incorporates Affordable Housing Berkeley to facilitate the creation of new affordable housing through both acquisition and new construction. (BHA administers $32 million annually in Section 8 Housing Choice Vouchers and Project-Based Vouchers, and has $15.5 million from sale proceeds that can be invested in affordable housing in Berkeley.)
● 2020: The Affordable Housing Mitigation Fee and methodology are updated. ● 2021: $60 million still uncommitted from City's affordable housing bond. ● 2022: Berkeley Opens Doors to Largest Affordable Housing Development and Homeless Services Center in City History - BRIDGE Housing.
● 2022: The city issues a request for proposals to conduct a fair housing analysis. ● BHA is selected as a participating Move To Work (MTW) agency in the landlord incentive cohort.
● City earns a Pro-housing designation from the State of CA ● The City funds Eviction Defense Center to provide housing retention grants to households that are at imminent risk of homelessness.
2020-23
2024

● 2019: The City Council makes a referral to create policies to develop a right to return for displaced residents, with a priority to support displaced Black residents. ● 2020: Berkeley receives two-year PBF Challenge Grant for fellow to develop preference policy.
● 2020: EBCLC and the PBF Fellow conduct historical and legal research on racial discrimination in the City of Berkeley’s housing policies and potential pathways for a race-specific housing preference

HOUSING PREFERENCE POLICY
E4BB — Narrative & Next Steps
8 2019-22
● 2023: The Preference Policy is unanimously adopted by the Berkeley City Council on July 11, 2023.
● 2023: The City receives HCD approval to apply the preferences to Maudelle Miller Shirek Community in December 2023.
● 2024: Maudelle Miller Shirek housing development in South Berkeley opened for applications, with the first implementation of the Housing Preference Policy. Almost 10,000 applications were submitted for 75 units.
● 2024: The Health, Housing, and Community Services Department receives a referral to look at city-wide historical data for preference policy-eligible residents, with anticipated assistance from E4BB partner Healthy Black Families.
● 2024: The Health, Housing, and Community Services Department builds the first database of displaced residents due to BART/transit development. 2023-24

● Memorandum of Understanding between BART and City, signed on March 3, 2020 ● Community Advisory Group and community meetings begin re the BART developments.
● HBF, EBCLC, and other community partners begin engaging with the broader community through a community leaders’ group, focus groups, surveys and town halls. (continues for next four years)
● In October, Street Level Advisors are contracted to do a study regarding the plan for new housing in the Adeline Corridor plan.
● The City dedicates $7 million in infrastructure bond funds to the creation of an African American Holistic Resource Center in South Berkeley.
● HBF and other community leaders develop a steering committee to secure additional funding for both the physical site and programming through a Black-led process.) ● The city adopts the Adeline Corridor Specific Plan, which recommended developing a local Housing Preference Policy for future affordable units at Ashby BART (December), which names a goal of striving for 100% affordable housing at the Ashby BART station development.

ADELINE CORRIDOR
E4BB — Narrative & Next Steps
9 2020
● 2021: Per Street Level Advisors' models and recommendation, City Council reserves $53m for Adeline Corridor plan housing founding ($26.5 for No Berkeley and Ashby each), with a recommendation of 35% affordable housing (and explanations for the tradeoffs required for 100% affordable, including no longer being eligible for an EIFD). ● 2021: Equitable Black Berkeley Project statement that it's policies will be embedded into the Ashby BART RFQ.
● 2021: Joint Vision & Priorities for Transit-Oriented Development for Ashby and North Berkeley BART Stations.
● 2022: Joint Vision and Priorities Document is approved by the City on June 2, 2022 and by BART on June 9, 2022.
● 2022: MOA re North Berkeley and Ashby Transit-Oriented Developments (June 30) ● 2024: Rick Jacobis Report and Century Urban report re EIFD ●
2021-2024

● On October 2, 2018, the City Council approves guidelines for the Small Sites Program, which was established to fund the acquisition and renovation of small multifamily properties.

SMALL SITES PROGRAM
E4BB — Narrative & Next Steps
10 2018
● Small Sites Program : $10M approved by City Council
● Planning Department piloting two projects with the Bay Area Community Land Trust and Northern California Community Land Trust, respectively. 2024

OUTCOMES
E4BB — Narrative & Next Steps
11 From 2020-24, Berkeley’s Eviction Defense Center served 939 unduplicated households. 36% of those households
were African-American.
$111 million of Measure O’s $135 million already has been allocated, providing 784 units of affordable housing that have either been completed, under construction, or in
pre-development (including Berkeley Unified School
District Workforce Housing and affordable housing at Ashby and North Berkeley BART).

07. E4BB TIMELINE
For four years, through E4BB, the Mayor's office and community partners (led by Healthy Black Families, or HBF) have actively sought out, engaged, and centered Black leadership, Black organizations, Black community members to include them in policy-making processes and decisions, collecting data on and feedback from displaced residents and residents who are or might be impacted by or eligible for housing opportunities:
● 2020 E4BB created a funding-focused proposal, and engaged funding consultants/advisors, to assess options to raise and administer a community development and housing fund and/or create an EIFD in connection with the Ashby BART transit development. E4BB Partner, Healthy Black Families, continued surveying and leading community forums for engagement regarding housing displacement and policy. ● 2020 E4BB engaged consultants to shepherd and engage around the Berkeley Flea Market and business district opportunity outlined in the Adeline Corridor Specific Plan.
● 2023 E4BB engaged a consultant to review, update, and socialize a current strategy, including community and civic leadership sessions, and to assist in developing a clear path forward for E4BB as a separate entity.
● 2024 The E4BB team and HBF worked with the administration to collect and review historical data; evaluate “missing middle housing” as a tool for housing justice; and re-engage the community and City in community-facing and cross-sector Strategy Sessions.
● 2024 E4BB will present a proposal to select funders to fund an independent entity to continue, expand, and institutionalize its work.

E4BB — Narrative & Next Steps
11

E4BB’s current priority focus is on housing – the Right to Return, Right to Remain, Right to Own, and Right to Thrive:
● for prior or current residents;
● at all income levels (with a priority on affordable housing); ● for renters and owners;
● inclusive of the community and cultural influences that drive and derive from housing (education, open spaces, transportation, employment, etc.) E4BB’s lens is through the surfacing and centering Black voices, needs, experiences, and outcomes in Berkeley, recognizing that:
● Black residents of Berkeley were specifically targeted for discrimination. in historical practices and continue to experience both legacy impact and present-day discrimination and obstruction.
● Black residents, similar to other community segments, have specific experiences that require specific activations to remedy and repair. ● Historically and statistically, general community uplift does not sufficiently elevate Black community members because there have been and continue to be specific perspectives and practices that actively oppress them and must be directly countered and overcome. “All Lives Matter” approaches cannot dismantle targeted anti-Black sentiments and actions. ● Uplift for Black residents ultimately is an uplift for all residents, because policies that protect and uplift Black residents inherently benefit others in similar situations.
● E4BB’s scope can’t be sustained over time via an elected administration or public entity. It requires a cross-sector, independent organization.

08. FRAMES OF REFERENCE
E4BB — Narrative & Next Steps
12

E4BB is not forming an entity to become the initiator,
executor, or leader of this work, but to structurally and visibly exist as a nexus to and for the Black community for the work its many partners already do. It will serve as both a champion of wellness and a beacon for
accountability for Berkeley’s African-American
community and all who serve it.

E4BB — Narrative & Next Steps
13 09. THE GOAL

E4BB’s outreach and opportunities for impact are being limited by:
● Confusion among multiple governmental and communities partners about the structure, focus, and benefits of E4BB.
○ In interviews with an E4BB consultant, several departmental staff members thought it was an organization rather than an initiative. ○ The Doorways regional housing portal was designed and implemented over the past 18 months without notice to or input from E4BB’s community partners.
● The end of the Mayor’s second and final term, which will end the shepherding of the E4BB initiative. Note: the administration has created a transition plan for the next administration to continue these efforts. ● The immediate timeline of decisions and funding for the Adeline Corridor Specific Plan, and particularly the Ashby BART transit development, which greatly impacts Black residents and is directly tied to historical displacement of the community.
● Imminent deadlines for critical grants that would advance E4BB’s mission priorities, particularly two Department of Transportation opportunities and a Partnership for the Bay’s Future grant. ● Ongoing community challenges regarding income, employment, affordable housing levels, waiting lists and displacement or exodus.

Black residents of Berkeley need near-term strategies and measurable outcomes to balance/supplement the multiple large-scale, long-term projects already underway to make sure more people don’t slip into crisis levels in the immediate months and years to come.

10. THE URGENCY
E4BB — Narrative & Next Steps
14

Berkeley’s African-American high school students are the least likely to complete UC/CSU required courses with a C or better (at 37% vs 88% of White NH - the most likely - 2016).

They comprise 4.1% of the UC Berkeley (vs 33.8% AAPI, the highest) and 15% of the Berkeley City College population.

RESIDENTS SNAPSHOT
E4BB — Narrative & Next Steps
15 POPULATION
“Based on student populations and poverty rates, Black or African American and American Indian or Alaska Native residents are most disproportionately affected by poverty in Berkeley.” INCOME

HOUSING
The population declined 5.6% from 2010 to 2019. 9,324 (7.7%) The Black population has the second lowest median income (above American Indian or Alaskan Native residents) and the second highest poverty rate* (2019). *The large population of Asian/API students in the City likely contributes to tier having the highest poverty rate.

25.4%
% of Population
Poverty rate
$39,441
Median Income
vs highest
White NH: $107,660
vs lowest
White NH: 12.1%
57%
% of unhoused
population
70%
% of HH <80% AMI
vs lowest
API: 11%
% of originated
mortgage apps
% of denied
mortgage apps
47%
Source: Berkeley 2023-2031 Housing Element Redlined 02-17-2023v2_1

23.9%
vs highest
White NH: 65.6% (2019)
vs lowest
AINA: 13.3% (2019)

7.7% of total pop (2019)

EDUCATION

E4BB will form a non-profit entity that serves as the nexus to and for Black residents of Berkeley across the many sectors, organizations, processes, resources, and events they must engage with to live and thrive.

The entity will launch with a series of Short-Term (1-6 months), Near-Term (6-12 months), and Longer-Term (a year or greater) activations.

11. THE ENTITY
E4BB — Narrative & Next Steps
16

SHORT-TERM
E4BB — Narrative & Next Steps
17 In its first six months, E4BB will:
● Create and minimally staff an entity to navigate the ecosystem and centralize information and stay connected and current on the issues and events that affect housing.
● Recap, reframe, and re-introduce E4BB to Black residents and leaders, Berkeley residents at large, City and other public sector divisions and officials (regional, state and federal), non-profit sector partners, and potential private sector partners and investors.
● Immediately prioritize grant writing technical and staffing support for upcoming grants.
● Collaborate with the Doorways Regional Housing Portal to engage Black community voices in the project and raise awareness.
● Prepare and socialize a community update on the Ashby BART negotiations, the three presented models for levels of affordable housing, and why the current plan is 35% and will not be 100%.
● Join and help lead, a small, cross-sector Working Group (formed by the Mayor’s office) for an EIFD at or non-contiguous to the BART-owned Ashby BART.
● Debrief with City Manager about communications and opportunities to grow, including sharing public data, creating points of contact, and sharing of even complex decisions with residents.
● Host a (standing) gathering of Berkeley’s Black community-facing service organization, to check in, find partners and fiscal sponsors, eliminate duplication, and support and promote each other’s upcoming efforts.

NEAR-TERM
E4BB — Narrative & Next Steps
18 In its first year, E4BB will additionally:
● Develop and adopt a strategic plan (at least a one-pager). ● Actively curate or independently collect valid baseline data on Black residents and housing, including:
○ The distribution, among Black residents, of those: seeking to rent vs buy; housing stable or at-risk; eligible for each level of affordable housing/BMR vs AMR offerings, etc.
○ The demographics of Black residents of Berkeley. and all residents of Berkeley, in terms of income, employment, current housing status, and desired housing status
○ A mapping of all existing housing in the City of Berkeley, including available vs not available units, level of affordability, rental vs owned, vacant not vacant, BMR vs AMR, tax-credit larger development vs small sites and CLT-level opportunities
○ Clear and detailed user journeys of Black Berkeley's: 1) median/most common resident who is navigating housing needs, 2) most at risk residents in that space; 3) most easily elevated residents in that space.
● Act as a main participant in the remaining Adeline Corridor negotiations, including Ashby BART development.
● Support the African-American Holistic Resource Center. ● Devise and execute 2-3 small pilots reflecting the values and requests from both strategy sessions for immediate/shorter-term impact on Black residents and housing (e.g., navigators, educational offerings, etc.).

LONGER-TERM
E4BB — Narrative & Next Steps
19 In its first two years and beyond, E4BB will additionally:
● Expand E4BB by recruiting, researching, and staffing it as an independent, third-party entity, with a mix of staff experience that includes but is not limited to: Black community advocacy, housing investment, housing development, and housing law and policy. ● Actively compete for or raise and disseminate initial smaller funds (e.g., of $10-15 million) for small sites - potentially in partnership with PBF. ● Actively expand the scale of operations to seek and receive 9-figure level of funding.
● Build out a replicable model for other communities to stop harm and create new ways of living for their own residents.

Incorporating an Equitable Black Berkeley (EBB) in the Ashby Station Development Developing the Ashby BART Station provides a chance to do something incredible. Not doing all that can be done, now, will only serve to repeat historic harms; there are no “do-overs” .

This project must begin to reverse and repair the inter-generational harm that was inflicted from the development of the station and redlining. The only way to do that, is to do something different in terms of who gets the opportunity to develop the site, the level of partnership between BART , the City of Berkeley, the impacted communities, the community at large, and how the project is financed.

EBB is not simply asking for developer contributions that will drive up costs for the selected developer and jeopardize the feasibility of the project, although the developer will certainly have a role to play. A countervailing narrative must be embraced as to the framing of what community benefits are, what they mean or their cost to a project, based on preconceptions, precedents, and business as usual.

We are talking about economic participation and enterprise with a community investment and reasonable return on that investment to achieve harm repair and community restoration. City of Berkeley’s goal, which should be a mutual goal, is lifting up a new model for all BART stations, as other regions will have their own unique needs that can be satisfied by innovation in the way we all work together . A solution that rises to the magnitude of the harm, the ongoing challenges, and the vision for the future must be foremost. That is not something that anybody has done before, given the unique opportunity and context that stands before us with this project.

Developer Selection Process - EBB participation

1. A three (3) member “Vision of Community Repair Team” composed of the City of Berkeley, BART and EBB will make a qualitative assessment of the submittals, not based on technical or programmatic proposal materials, but based on the Community Repair Narrative proposal materials, including EBB goals, value alignment and adherence to the reparations framework, to determine if the proposal teams meet the threshold and standards of EBB.

2. The Developer Selection Team, will include one (1) EBB representative-. The Developer Selection Team will select the finalists based on review of technical and programmatic submission materials.

3. The community/public will have two opportunities (weekend and evening) to hear finalist presentations and vote for their favorite. Community preference will have considerable weight in the scoring and selection process.

Reparative EBB Framework Consideration
● Recognition of harm and embracing the need for repair in the design and operational lifespan of the project
○ The respondents will be asked to demonstrate how their proposal addresses a reparative framework that redresses the BART’s historic negative impacts and lasting harms on the Black residents, businesses, and cultural institutions in the neighboring communities.

■ How the proposer defines harm, the impacted community and the need for harm repair
■ How the project achieves cessation of harm
■ How the project assures the non-repetition of harm based on historical practices by BART
■ How the project serves to restore the community through permanent and sustainable support for community serving organizations
■ How the project enables economic inclusion, participation and enterprise development by the community
■ How the project serves as a catalyst for neighborhood revitalization ■ How the project honors those who have been harmed
● Environmental and culturally appropriate infrastructure and site planning ● Ongoing community engagement for feedback and priority setting ○ Incorporating feedback from HBF People’s Assembly meetings ○ Conforming to the JVP goals
○ EBB engagement in City objective standards process, and EBB involvement in future City participation in shaping the design and construction of the project ● Promoting neighborhood support and synergy
○ How the design will incorporate adequate open space for community gathering to support the arts, neighborhood/community events and how the management/use of that space will be equitable.
○ Placemaking (culturally appropriate with historical reference) ● Wealth building and reinvestment
○ Opportunities for individuals/family wealth building
○ A mechanism that provides for the City of Berkeley on behalf of EBB to contribute investment capital and receive a reasonable return on investment. ○ Developer capital sources will be measured against existing City of Berkeley ESG principles with a priority to capital sources that have local impact. ● Promoting health, education and community support services (child care, etc) ○ Any non-residential space provided on all Ashby Station parcels will prioritize lessees such as community based organizations supporting the EBB framework and local artists, artisans and food entrepreneurs with a priority given to Ashby Flea Market vendors. ● Future Flexibility
○ Although the current opportunity allows for the development of 8-12 floors, the solicitation will encourage respondents to consider and analyze the feasibility of engineering buildings to allow for vertically phased future development to achieve additional future value, based on established principles, precedent projects, and future need, and contingent upon a separate planning process. Inclusion of enhanced engineering for vertically phased future development does not constitute or preclude a right of the respondent to develop future phases.

○ The City of Berkeley reserves the right to capture the additional value of unused air rights to EBB for future development should at any point in the future the project densifies. Any such densification revenue may benefit EBB.

EBB requested clarifications to the Term Sheet:
● Public Art and Open Space
○ The project will incorporate the public artwork by Mildred Howard that was recently commissioned by the City of Berkeley. If the artwork is installed prior to project implementation, the City of Berkeley will cover relocation and installation costs. ○ The selected developer will include on-site publicly accessible artwork valued at 1.75% of construction costs.
○ Respondents will receive additional points for identifying additional opportunities for local artisans and craftspeople to participate in professional opportunities i.e. FFE, architectural elements, landscaping/hardscaping, interior design, etc. to achieve higher levels of local small business utilization and workforce development targets. ○ The project will incorporate adequate open space for community gathering to support the arts, neighborhood/community events and a system provided to support those events.
● Commercial/Retail
○ The Ashby Project will include 25,000 square feet of ‘warm shell’ commercial component, for the purposes of use by EBB stakeholder organizations and Berkeley Flea Market graduates.
● A portion of net project profit from the Ashby mixed income or market rate development parcels shall be allocated to create a reparative community benefits fund for South Berkeley. Upon achievement of a Temporary Certificate of Occupancy (“TCO”), each mixed-income development parcel (excluding the 100% affordable parcels) shall be required to fund $50,000 per project, post TCO in years 1 through 3, and by the earlier of (i) the beginning of year 4 or (ii) parcel stabilization (i.e., 95% occupancy), each mixed income parcel at the Ashby TOD development shall be required to fund its pro rata share of $250,000 allocated by mixed income parcel net rentable square footage, with annual cost of living adjustments no less than 3.0% per annum. ● A community advisory committee composed of EBB and other community stakeholders will be created to direct the fund expenditures.
● Community Investment/Economic Participation
○ The City of Berkeley reserves the right on behalf of EBB to contribute investment capital and receive pari passu return on investment.
○ A community advisory committee composed of EBB stakeholders will be created to direct the EBB fund expenditures.
○ Developer capital sources will be measured against existing City of Berkeley ESG principles with a priority to capital sources that have local impact. ● Additional Justification for Harm Repair as the primary objective of the Project:
○ Traditional financing will generate returns that go back to those traditional sources, wherever they may be, so we need to look at additional and alternative sources of

financing that provide local returns that will positively impact the local community. ○ The competing and sometimes conflicting dynamics of project feasibility vs. high levels of community benefits can be solved for in this project. As we work together, we’ll show that there’s a business case for innovation in the way BART and the City of Berkeley do business, and all stakeholders need to understand what the community already knows in terms of why this harm repair initiative is so vital.

Healthy Black Families and the
Fight for a Thriving Black Berkeley
This is the story of the Berkeley Black community’s experience of decades of displacement and disinvestment, and how a small, grassroots community organization helped to advance the right to stay, right to return and right to thrive in South Berkeley.

M E S U S T R A T E G I E S
Mesu Strategies, LLC is a research and strategy firm
committed to realizing a more just and inclusive society.

Based in Oakland, California / Huchiun, the unceded land of the Lisjan Ohlone, Mesu Strategies works nationally to
advance healthy, resilient and equitable community
environments for low- income people and communities of
color. Mesu Strategies partners with leaders in communities and organizations to operationalize equity and catalyze transformational change through action research, policy advocacy and organizational development approaches
rooted in the principles of cultural humility.

H E A L T H Y B L A C K F A M I L I E S
Healthy Black Families, Inc. provides people with knowledge, skills and strategies to make social systems and policies more equitable for Black people and communities. Healthy Black Families’ vision is to organize individuals, families and the organizations that serve them into communities empowered with skills to advance social equity and justice, with a focus on Black individuals and families. Healthy Black Families is located in South Berkeley, California.

P H O T O

C R E D I T S
Cover: Dancers at Berkeley’s 2019 Juneteenth
Festival by Liliana Michelena at KQED

Gates from the Anthony Bruce Collection; Family
photo in front of California house from the
African American Museum & Library at Oakland
Photograph Collection, MS189_1234

Berkeleyside, 2018; Rainbow Sign flyer from the
private collection of Odette Pollar, 1972

1960s; Boys pose with Black Peoples Free Store
sign, Bob Fitch, 1960s, Ticky-tacky photo from
Darrell Owens, Twitter, 2020

Peterson, SF Chronicle

Ashby Flea Market photo source unknown

Katayama, KQED, 2017

by Pam Uzell via
Berkeleyside and video still from
the Daily Californian

Francisco Chronicle

Pages 3, 14, 24, 26, 28, 31:

Photos from the City of Berkeley
Pages 16, 18, 22, 25, 27, 29, 30: Community
photos provided by Healthy Black Families, Inc.

S P E C I A L T H A N K S
The report authors would like to recognize the interviewees for their time, experience and perspectives, the team at Healthy Black Families, Inc. for their heart, soul and
dedication to lifting up the voice of the Berkeley Black community to create equitable change, the San Francisco Foundation and the Coro Foundation for their ongoing
support of the housing advocacy efforts and this report.

Special thanks to Wilhelmenia Wilson for her steady, joyful leadership, <Mama= Ayanna Davis for her committed activism and enduring wisdom, and Dr. Vicki Alexander for her
pioneering public health work and advocacy.

This report is dedicated to the memory of Rahwa Neguse, without whom Healthy Black Families’ housing advocacy
efforts would not have been possible.

RECOMMENDED

CITATION
McLean, J. M. Daniel and T. Clark.

Healthy Black Families and the
Fight for a Thriving Black Berkeley.

Oakland, CA: Mesu Strategies, 2024.

Acknowledgements

Table of Contents
02 01
03 04
05 06
Development, Displacement and the Black
Community in Berkeley
Executive Summary
The Fight for Equity for Black Berkeley
Toward the Vision of a Thriving Black Berkeley
Afterword
References

equitable

requires everyone

Berkeley

community base

generate solutions

campaign

Black community

Berkeley

Development, Displacement and the Black Community in Berkeley Although Berkeley is widely considered to be one of the most progressive cities in the United States, like many other places in the nation, racism is baked into its design. In the early- and mid-20th century, exclusionary policies and practices kept Black families and other people of color from moving into the beautiful, park-like residences in the hills and near the university.

Non-white people had little choice but to live in South Berkeley, an area in the <flatlands= bound by Telegraph Avenue to the east, the San Francisco Bay to the west, Dwight Way to the north, and Oakland to the south. Over time, restrictive covenants, redlining and single family zoning led to calcified patterns of residential racial segregation.

Segregation brought many challenges, including chronic disinvestment and the concentration of poverty. In the face of these hardships, however, the Black residents of South Berkeley built a robust community with diverse social and cultural offerings. South Berkeley became not just a home for the Black community in Berkeley; it was a cultural center and attraction. At its peak in 1970, when the Black population comprised 25% of the city’s overall population, South Berkeley was home to nearly 75% of the city's Black residents, and a number of art centers, schools, and social clubs led by and dedicated to Black people.

The community faced a dire turning point, however, when city and regional planning decisions in the 1960s helped drive many Black families out of South Berkeley and the city altogether. Decisions to build the Ashby BART Station took many homes from South Berkeley residents by eminent domain in the 1970s. Decisions to limit housing development citywide led to constraints in the housing supply and affordability in the decades that Executive Summary
Executive Summary Page 03
Mural on Adeline Street by Youth Spirit Artworks
01

Despite many existing social and economic challenges, and the new obstacle of distance brought by displacement, the Berkeley Black community remained connected across geographies. Families continued to work with one another for mutual aid and support, and to remain politically active in Berkeley politics. When the timing was right, Black leaders in the Berkeley community sought the support of Healthy Black Families, Inc. (HBF) to help advance its fight against displacement and for the community’s survival and right to thrive.

HBF is a grassroots community-based organization located in South Berkeley founded by local public health leaders who have long fought for improved environments, systems and resources for the health of Black women and their families. HBF leads efforts to educate and organize communities to promote systems changes to support Black community health. HBF facilitates community connections across geographic and general boundaries, and fosters trust across diverse Black community members. They also work to educate Berkeley leaders and the Berkeley community at large on the priorities of the Black community, emphasizing the importance of addressing the social determinants of health: the environmental factors like housing and food access that shape community well-being.

In 2022, HBF, the City of Berkeley, East Bay Community Law Center, and other allies (see Figure 1, page 6) worked together with Berkeley’s Black community to stem displacement in Berkeley, and repair historical harms. The <Equity 4 Black Berkeley= campaign involved the coordination of allies, funders, and other community leaders to prioritize the voices of South Berkeley residents affected by historical planning decisions. Targeted organizing, communications and research activities in this campaign led to a number of gains, including a big policy win in 2023 called the Affordable Housing Preference Policy (AHPP).

The AHPP addresses plans for the development of new affordable housing units to alleviate patterns of displacement. It includes guidelines for who will receive preference in accessing new units when they become available. Recognizing the <right to stay and right to return= of all communities that have long called Berkeley home, the policy includes specific considerations that give priority in new affordable housing to people who were systematically displaced from Berkeley.

Though the AHPP does not solve all issues related to displacement over many decades in Berkeley, it presents an important step toward equitable change.

The Fight for Equity for Black Berkeley
followed. The Black population suffered a precipitous drop. Today, Berkeley’s overall population is only 6% Black, with the majority of Black residents residing in South Berkeley.

Communities and leaders of color can work at all times to create and harness power in numbers, to build power through continuous learning and information-sharing across generations and borders, to value and lift up the community connectors and caretakers, to adopt a stance of readiness in their work, and to leverage partnerships with allies Allies to communities of color -- including individuals, organizations or agencies -- can work to earn the trust of communities of color, offer needed skills and resources to center the community’s leadership, seek creative ways to foster and formalize community-driven change, and socialize community stories to build will for change Philanthropic funders do more than provide resources for communities -- they can lift up true community leadership, support innovation to build community power, convene coalitions and connect resources to support community-led policy development The public can ensure equitable changes are a priority by staying curious and getting informed about community issues and experiences, being persistent amplifiers of community-led solutions, and voting for inclusive leaders.

Executive Summary Page 05
Toward the Vision of a Thriving Black Berkeley ... and Beyond The challenges of displacement are not unique to Black communities in Berkeley. HBF’s story provides an example of how communities and their partners can work toward equitable changes in both challenging times and times of opportunity. Communities of color, professionals working for philanthropic or government organizations, and members of the broader public can all draw lessons from this example about advancing equitable housing changes. In particular:

Entity Description Role in Campaign
Bay Area Regional
Health Inequities
Initiative (BARHII)
A national engine for health
equity thought leadership
Supported capacity building of
Black community members
Berkeley Black
Community
Current and former residents of
South Berkeley belonging to the
Black Community
Provided qualitative information
about lived experience in South
Berkeley, community needs and
priorities for policy change
City of Berkeley
Health, Housing and
Community Services
Department
A public agency responsible for
addressing public health
prevention and emergencies as
well as the physical health, mental
health, and basic needs of those
most vulnerable in Berkeley
Collaborated with Berkeley
residents and leaders on the
development and advancement of
the Affordable Housing
Preference Policy (AHPP)
City of Berkeley
Elected Officials
The Mayor and City Council of
Berkeley are responsible for
leading local governement
Led the review, approval and
direction of local government
efforts to address public priorities
East Bay Community
Law Center
A regional legal organization
providing legal and social services
for communities of color
Supported capacity building of
Black community members
Ecology Center
A Berkeley community
organization focused on
improving the health and
environmental impacts of
Berkeley residents
Supported capacity building of
Black community members
Friends of Adeline A neighborhood organization in
South Berkeley
Served as an ally and advocate for
the Berkeley Black community
Healthy Black Families,
Inc.

A community organization
providing people with knowledge,
skills and strategies to make
social systems and policies more
equitable for Black people and
communities.

Working under the guidance of
local residents, facilitated the
coordination and organization of
the Berkeley Black community
with allies, funders, and local
leaders on the Equity 4 Black
Berkeley campaign
National Association
for the Advancement
of Colored People
(NAACP)
A national civil rights and
social group
Supported outreach to Black
community members, served as a
collaborator on advocacy
Partnership for the
Bay’s Future
A fund pooling private and
philanthropic contributions to
produce, preserve and protect
affordable housing in the Bay
Area
Provided financial resources to
support the Equity 4 Black
Berkeley campaign through two
grants (the Challenge Grant and
the Breakthrough Grant)
Figure 1. Key Collaborators involved on the Equity 4 Black Berkeley Campaign for the Affordable Housing Preference Policy Equity 4 Black Berkeley Campaign Participants

Black people first came to Berkeley in
significant numbers beginning in the 1910s,
with the Great Migration. At that time,
Berkeley was an up-and-coming city boasting
some of the nation9s newest intellectual,
spiritual and cultural attractions. It started
growing in earnest after the San Francisco
earthquake of 1906, when many people fled to
the East Bay. Previously, the area had been
rural farmland since European settlers seized
the territory from the Ohlone centuries before.

The 8fitting and beautiful homes9 Berkeley promised newcomers were not available to all.

Many of the properties had deeds with restrictive covenants – clauses prohibiting their sale or lease to 8undesirable9 occupants, which the developers considered to be <people of African, Mongolian or Asiatic descent.= Although racialized zoning was prohibited early on, discriminatory attitudes and practices in private sales would remain unregulated for decades. Developers commonly relied on exclusionary practices to control neighborhood composition in an effort to <protect= their financial investments. Under pressure from developers, Berkeley policymakers passed single-family zoning in 1916. Single-family zoning Black Americans have called South Berkeley home for over a century The first Black Americans arriving to Berkeley found limited choices for where to live Development, Displacement and the
Black Community in Berkeley
A Brief History of the Housing Landscape
The roots of the Black community in Berkeley, California run deep

1 2
3 4
6 5
7 8
02 Mansion built in 1910 in Berkeley’s Elmwood neighborhood, which was originally designed exclusively for white people Martin family on Juneteenth in California, 1920s
helped to implicitly codify and expedite racial
segregation by preventing new housing
development in neighborhoods where
restrictive covenants were common. Since
neighborhoods excluding Black people and
other people of color were predominantly
located in North Berkeley and the hills of East
Berkeley, Black people and other people of
color often had no choice but to take up
residence in the flatlands neighborhoods of
South and Southwest Berkeley.

Even after the college and town were established in the 1860s-1870s, most residential development in the region took place in neighboring San Francisco and Oakland. To accommodate and capitalize on a growing population, developers in Berkeley worked to turn large tracts of land into high-end 8private residence parks,9 which would prioritize design that harmonized with the environment9s natural beauty. By 1910, Berkeley was the fifth largest city in California, known for its natural beauty, the university, and a growing number of industries.

<I moved to South Berkeley in 1955, when I was 1 year old. I was lucky to inherit my home here.

Generational wealth is hard to come by. Back then, Martin Luther King, Jr. Way was the race cutoff line. Today, it feels like we still live in these relationships, with neighborhood lines.= – South Berkeley resident
The Berkeley Black community grew larger, more dense, and more robust

9 10
11 12
14 13
15 16
Flyer for a 1972 event at the Rainbow
Sign featuring renowned singer
Nina Simone,
Figure 2. Map of the Home Owners Loan Corporation (HOLC) designations of risk for mortgages in Berkeley in the 1930s-1960s -- South Berkeley is deemed <hazardous= due to <Predominance of Negroes and Orientals. Also mixed classes of wage earners and colored professional people.=
South Berkeley grew quickly between 1940 and 1970. For a variety of reasons, the neighborhoods also became more densely populated by Black people during this time. A second wave of Black migrants moved to the area for jobs during WWII. After the war, many white people moved out of more urban areas to the suburbs, where they could purchase American <dream homes= with federal home loans. However, these loans were not as accessible to communities of color in the South Berkeley neighborhoods, given redlining practices in the home mortgage industry (see Figure 2, redlining map).

Although Black people in Berkeley were effectively segregated to South Berkeley, they used their circumstances to their favor and worked to build supportive neighborhoods. South Berkeley became a thriving Black enclave, rich with Black-owned businesses and cultural institutions. Black doctors and dentists ran local clinics that understood and served the needs of their diverse Black patients. Social hubs like the Rainbow Sign and the Black House attracted influential thinkers and activists, including James Baldwin and Huey Newton, and served as a cultural meeting spot for community members, like the family of future Vice President Kamala Harris. For a brief time, the neighborhood was even home to a school specifically focused on teaching local teens about the Black experience. Generations of families would congregate at churches established at that time. From commerce to entertainment, worship and education, South Berkeley became a welcoming, safe home to the Black community.

17 The 1950s-1960s saw the rapid development of
multi-unit buildings aiming to capitalize on a
growing demand for housing in the <flatlands=
area of Berkeley -- predominantly South Berkeley
-- which were not zoned for single-family housing.

These poorly constructed buildings were
nicknamed <ticky-tackies,= and considered an
eyesore by many Berkeley residents. In response
to concerns about the blight and tenant
exploitation brought by the landlords of ticky-
tackies, local policymakers passed a ban on the
development of new multifamily housing in most
residential areas.

Development decisions stymied South Berkeley’s growth
Displacement presented an existential threat to the Berkeley Black community A 1960s-era <ticky tacky= in Berkeley

18 19
Together with the existing segregation perpetuated by mortgage redlining practices common during the 1930s-1960s, the new multifamily housing ban significantly limited the growth of the Berkeley housing supply. Home sale and rental prices climbed, forcing many low- and middle-income residents to relocate to make ends meet. Black households were particularly vulnerable to such shifts, given the widespread discrimination they already experienced in jobs, education, and many other areas of everyday life. 20 Family life, 1960s
Development, Displacement and the Berkeley Black Community

Black Population
1970 1980 1990 2000 2010 2020
0 5
10 15
20 25
Data from Bay Area Census
%
%
%
%
%
%
Development decisions in the decades to follow continued to disproportionately impact Black Berkeleyans. In the 1970s, anti-growth sentiments led to decisions to prioritize neighborhood preservation and cap property taxes. Although displacement affected both Black and white population groups at this time, <the white homeowner population increased throughout several Black neighborhoods.= In the 1980s, the Black population continued to drop as homelessness and gentrification grew amid a shortage of affordable housing, deindustrialization, and the elimination of federal welfare programs. Displacement continued in the 1990s but accelerated with subprime lending in 2007-2010, disproportionately affecting low-income communities of color. The rapid growth of the tech sector fueled a widening income gap which helped to drive up housing costs. By the early 2020s, the total Black population in Berkeley was estimated at under 10% of Berkeley’s overall population, representing over a 50% drop since 1970 (see Figure 3). Some analyses show that on some historically Black blocks in the neighborhood, the Black household count dropped by four times between 1970 and 2020.

Displacement led to a precipitous decline in Berkeley’s Black population 22 23 24 25
26 28
27

<<When BART and the forces of change and displacement came to town, they tore a hole in the heart of South Berkeley… But that act is what started everything in South Berkeley. That’s what launched an entire generation of activists.= – Berkeley Council Member
21 Around this time, in the 1960s, BART started the construction of the region’s new transit system. Development of the Ashby BART station required taking property from numerous Black households in South Berkeley by means of eminent domain. This exacerbated the housing shortage and disproportionately impacted the residents of the surrounding neighborhoods, who were predominantly members of the Black Berkeley community. For the first time in Berkeley’s history, the size of its Black population dropped, interrupting the growth and vibrancy of the community.
<Jumbo= tunnel digger for construction of Berkeley BART line Percent of Black residents in Berkeley
as a % of all residents in Berkeley
Figure 3. Percent of Black Residents in Berkeley 1970-2020

The harmful impacts of displacement on the Black community are difficult to quantify

29 30 31
33 32
Displacement sows isolation
across family networks and
social supports, and
negatively influences
economic mobility, mental
health, and voting agency.

Research shows that Black
communities in California
experiencing displacement
also have limited political
representation, which in
turn, perpetuates systemic
issues working against the
community’s interests.

Figure 4. The Social
Determinants of Health
Ashby Flea Market, 1970s
Development, Displacement and the Berkeley Black Community Displacement disrupted the lives and wellbeing of Black individuals, families, and communities in Berkeley. The full extent of the impacts can be difficult to quantify. However, the relationship between displacement and racial disparities is documented across a host of health outcomes, including chronic health diseases, preterm birth rates, and mortality (see Figure 4).

A growing national housing crisis spurred public pressure for change By the middle of the 2010s, the housing crisis reached fever pitch in Berkeley and other large cities across the state following the growth of the tech sector and an economic crash fueled by predatory lending. In California, people at multiple income levels were experiencing the strain of rising rents and housing costs. At this time, a growing body of research on housing patterns had begun to catch up to the experiences of low-income people and communities of color, demonstrating patterns of

Recent changes promise to turn the tide on displacement in Berkeley Healthy Black Families and the Fight for a Thriving Black Berkeley Berkeley leaders began to address the history of displacement Hearing the calls for change, in 2016, the Berkeley City Council pledged support to explore anti- displacement policies in local development plans. In the years to follow, the City would explore and adopt a range of new policies to address the housing crisis and stem displacement. In 2018, Berkeley voters passed Measure O, a $135M bond to fund housing for low-, very low-, below-median-, and middle-income individuals and working families over 36 years. That same year, the City identified strategic long-term goals to create more affordable housing, more support services for vulnerable populations, and champion social and racial equity. Work plans prioritized increasing affordable housing citywide as well as addressing 35 34
Homeless encampment in South Berkeley in 2017
displacement and gentrification
and validating the experiences of
limited housing affordability and
availability nationwide. With the
Black Lives Matter movement
bringing greater awareness of
racial inequities to the broader
public, public pressure for leaders
to increase affordable housing
became calls to stop the disparate
impacts of displacement during the
COVID pandemic.

Figure 5. Map of Adeline Corridor
Housing and displacement were issues the City of Berkeley addressed in the Specific Plan for the Adeline Corridor in South Berkeley

The 2023 Affordable Housing Preference Policy (AHPP) recognizes that those who have been unfairly pushed out of Berkeley for a variety of reasons, have a right to return to their home community. Similar to policies in New York, San Francisco, Seattle and Portland, Oregon, the Berkeley AHPP targets households that lost property due to eminent domain during the period of urban renewal or discriminatory home loan decisions. The policy outlines priorities, processes and timelines for identifying new tenants in various types of housing developments.

New Berkeley policies offer displaced community members an opportunity to return 39 <Black Berkeley was once a solid
community. At one point, we were at
least 48,000 people in the flatlands.

Our numbers now might be 8,000, if
that. People have known each other
all their lives, we have been raised
together. We got to know each other.

Even though we are spread apart
now, Black Berkeley still functions
like a small town.=
-- South Berkeley Resident
36 37 38
Preference Details
Displacement due to eminent
domain for BART construction
Descendant of someone whose home was taken via
eminent domain to develop Ashby or North Berkeley
BART station
Displaced by foreclosure 1 point: Applicants displaced due to foreclosure in Berkeley since 2005.

Families with children 1 point: household with at least one child aged 18 or under
Homeless/At Risk of Homelessness
1 point: At Imminent Risk of Homelessness in Berkeley/
with former address in Berkeley OR 1 point: Literally
Homeless in North Alameda County
Ties to redlined areas
1 point: Applicant has current/former address in
Berkeley’s redlined areas AND/OR 1 point: Applicant’s
parent/ grandparent has current/former address in
redlined areas.

Figure 6. Affordable Housing Preference Policy preference summary, 2022 Development, Displacement and the Berkeley Black Community displacement and economic development
in South Berkeley.

With significant input and leadership from
the Black community, the City adopted
targeted measures addressing
displacement in the South Berkeley
neighborhood in the Adeline Corridor
Specific Plan in 2020 (Figure 5).

In 2023, the Berkeley City Council
unanimously passed the Affordable
Housing Preference Policy, Berkeley’s first
policy directly addressing its history of
displacement and a huge victory for Black
Berkeley.

The AHPP will provide opportunity for people who were; pushed out of the city due to the development of the Ashby BART station in the 1960s and 1970s, those affected by the foreclosure crisis of 2007-2010 or eviction in recent years, as well as those who suffered from redlining decisions, to have the chance to return to their Berkeley community. This opportunity extends to include the descendants of Black families who were affected by these historic actions. Though many changes are needed to fully counter patterns of exclusion that have persisted in Berkeley for over a century, recent changes open the opportunity for the city to repair harms to Black community members.

Ashby BART Station entrance from South Berkeley parking lot Aerial view of the Ashby BART Station Figure 7. Parcel map of the Ashby BART station area prior to development of the transit station

An Overview of the Campaign for Equitable Change

Community advocacy was essential for making new policies equitable Community expertise helped to shape the Affordable Housing Preference Policy 40 The Fight for Equity for
Black Berkeley
03 The community meets at a People’s Assembly hosted by Healthy Black Families, Inc. to discuss affordable housing priorities Among the range of policies to reverse displacement trends in Berkeley, the Affordable Housing Preference Policy (AHPP) stands out for addressing the specific priorities and needs of communities that have been and are actively being displaced from Berkeley. Like other anti-displacement policies, the AHPP was made possible through the collaboration of a wide range of partners, including lawmakers, city workers, legal aid organizations and advocacy groups (see Figure 1, page 6 for further details). But unlike other policymaking processes, the development of the AHPP involved the direct participation and input of Berkeley’s Black community early and often in the policymaking process. Through this direct collaboration between the City and the community, the voices of this shrinking population could be heard along with other voices in Berkeley, instead of being drowned out by them.

The Berkeley Black community’s identity and cohesion transcended geographic boundaries 41 Mildred Howard with her mother Mable Howard in Berkeley in 1985
Mildred Howard in a 2017 interview explaining how rising rent prices pushed her out of Berkeley
Artist Mildred Howard’s sculpture <Delivered, Mabel’s Promissory Note= after its installation in South Berkeley

The Fight for Equity for Black Berkeley
For the Berkeley Black community to meaningfully engage in local advocacy on housing policy, the community had to overcome hardships caused in part by decades of displacement. This started with staying connected; community members made the effort to sustain the community fabric in the face of its existential threats. As displacement was happening, community members, many of whom have known each other for generations, kept in touch across city limits. Some who moved to other places came back regularly to Berkeley to visit family, shop, socialize, and go to church. Some remaining in the community continued to reach out and stay active with their far-flung connections. For both the people continuing to reside in South Berkeley as well as legacy families that were pushed out, South Berkeley was home. This broad community umbrella also included a transitional population of Black students at the university who found a home <for radicalism and movement thinking and organizing= in the neighborhood. Together, these dispersed and diverse community could speak with a common and collective voice.

<Where you live determines
what you eat, how you travel,
the quality of air, the economics
in the area, the schools, health
care, food security, and even
physical security. So when you
can’t afford your housing, you
experience multiple impacts –
not being able to eat, afford
bills, pay registration, buy
clothing. The list goes on and on
when the rents are too high.=
– Berkeley Council Member

Ongoing advocacy from the community, a growing movement for racial equity, and increased availability of data validating stories about the displacement happening to Black residents in South Berkeley helped bring awareness to City leaders to the disparate impacts of the crisis on the Black population in Berkeley. In the mid 2010s, City leaders mobilized to address a growing housing crisis, and began to focus more diligently on housing policy.

Housing was a key focus in their efforts to update plans for the Adeline Corridor, one of the main streets in South Berkeley, and a historic cultural area for the Berkeley Black community. Through their participation in public planning related to the Adeline Corridor Specific Plan, the Black community made the case for establishing preferences for new affordable housing units to help curb displacement. A few years later, the City explored the possibility of creating a new Affordable Housing Preference Policy. When they performed The Berkeley Black community steadily beat the drum on its priorities When the conditions were right to create change, the community was ready Healthy Black Families and the Fight for a Thriving Black Berkeley Berkeley council members outside of 1910 Elmwood mansion, remembering racially-exclusive housing policies that shaped Berkeley’s landscape Despite the challenges that came with being
dispersed across geographies, working across
generational divides, facing multiple social and
economic inequities, and at times even being divided
about the pathway to resolution, the Berkeley Black
community continually engaged in local politics.

Many community members attribute their
persistence to the community culture of activism
linked with the Black Panther Party, the Republic of
New Afrika Independence Movement, and the Free
Speech Movement in the 1960s. Their priority issues
have historically included disparities in access to
healthy environments, the wealth gap, food access,
education, housing affordability in Berkeley, and the
social determinants of health -- the systemic and
environmental factors that influence access to
healthful opportunities, resources and choices.
42 43
44 public outreach to gather
input on the process, the
Black community in Berkeley
insisted that the City work
directly and intentionally to
understand the impact on
the community and lift up
the community’s perspective.

When the City reached out to
the community in response,
the community pushed
forward leaders at Healthy
Black Families, Inc. as their
representatives.

Healthy Black Families, Inc. (HBF) is a community-based public health organization focused on improving conditions for the Black community in Berkeley. HBF’s vision is to organize individuals, families and the organizations that serve them, into communities empowered with skills to advance social equity and justice, with a focus on Black individuals and families.

HBF was founded in 2013 by local public health leader Dr. Vicki Alexander to organize and address local health disparities, successfully reducing local Black infant mortality inequities by half. Building on this legacy, HBF has worked for over a decade to champion health equity through programming to; connect and empower Black parents, build skills and kindergarten-readiness for Black children, educate about and improve physical activity and food environments and choices for Black families, promote health and wellness and physical activity, and amplify the voices of the Black community through storytelling, education, advocacy and policy development.

HBF provides people with knowledge, skills and strategies to make social systems and policies more equitable for Black people and communities.

Healthy Black Families, Inc. (HBF) is a grassroots community leader <We value working with our allies, but the work with allies has done nothing to stop the inequities, mortality and displacement affecting the Black community. HBF staff is directly from the Berkeley Black community and all have experienced what inequity means in our lives and are dedicated to not just interrupting but stopping the harm on every level possible.= – HBF Representative
Healthy Black Families, Inc. led the campaign for equity in Black Berkeley The Fight for Equity for Black Berkeley
Healthy Black Families staff members at a community event

<Healthy Black Families provides a kind of space where people feel like they do belong.

They’re one of the few organizations – if not the only organization – that can do that.

Although we are a small community, we are fragmented – people have different ways of seeing things, different interests, different ways of aligning. Political forces can leverage these differences to divide and conquer. To create change, we have to get out of our comfort bubbles and create new relationships to one another, and Healthy Black Families, Inc. makes that change possible.=
– Community Member
When HBF began its work with the City on the Affordable Housing Preference Policy , the City shared its plans to gather input from all Berkeley residents to inform priorities for the policy. HBF was familiar with the City’s public input process; HBF had participated in public meetings for the Adeline Corridor Specific Plan and had also provided input to the City and its partners on research related to tenant rights. Recognizing the unique needs and challenges of the Berkeley Black community, HBF made the case to shift away from the general city-wide survey process, which would feel more transactional than meaningful to the community, and also leave many of the community’s disconnected members out.

The City agreed with HBF’s recommendation to continue with the citywide survey but add on a more targeted and customized process for the community’s participation. Soon, new outreach plans were underway in the South Berkeley neighborhood. To support the work, the City of Berkeley and several nonprofit partners updated a grant for staff capacity from the San Francisco Foundation’s Partnership for the Bay’s Future to include HBF’s work. The philanthropic support for <Equity 4 Black Berkeley= helped to support a campaign for equity that would lead to greater community participation in the policymaking process and ultimately, the adoption of an Affordable Housing Preference Policy prioritizing the community’s concerns.

HBF encouraged meaningful shifts to the City’s policy development process HBF worked quickly to outreach to the community about the opportunity for change. The staff’s deep and longstanding relationships in Berkeley provided a strong foundation for outreach to more senior members of the community as well as those who were displaced long ago. The organization’s work with families and young women through their work on the STEP program, Kindergarten Readiness Program, and Thirsty for Change Campaign had broadened their network over the years, and provided a strong foundation to identify and outreach to young leaders. The organization’s leaders brought their experience in community organizing and social change efforts to the work, informing strategy and tactics for the campaign. Through this knowledge, and a strong baseline understanding of the community’s assets, strengths, challenges and opportunities for change, under the leadership of Executive Director Wilhelmenia Wilson and Deputy Executive Director Ayanna Davis, HBF brought together a community leaders group to address and explore how best to approach the opportunity at hand.

HBF prioritized inclusive and representative community participation The heart and soul of the campaign required building a strong community base

To build community awareness and participation, HBF hosted various events which served to unite a broad range of community members. Included in these events were the Community Leaders Groups, a podcast led by HBF (<The Housing Chronicles=) and most notably, the <Equity 4 Black Berkeley= People’s Assemblies. Complementary to their gatherings, they also provided trainings on Policy Advocacy and Organizing, and an HBF fellowship to build the confidence, knowledge, capacity, and strength of community members to engage in important discussions about housing, displacement and community conditions.

Understanding the need for unity and wide-reaching engagement, HBF’s strategy included inviting elders, developers and policymakers to speak at assemblies and motivating local youth to lead in online communication and outreach strategies. When disagreements would arise, HBF facilitated across the community’s differences through discussions, forums, and education. Over time, the participatory, human-centered work of this group would extend into the community and grow the size and power of the community coalition.

HBF provided supports to build community unity, power and capacity <Education is key to movement building. If you’re going to capture the hearts and minds of people, small group engagement is one of the best ways to do it.= - HBF representative
The Fight for Equity for Black Berkeley
Little Bobby Hutton and the 10th point from the Black Panthers’ Ten Point Program, as part of a 2012 Oakland Museum of California art installation in collaboration with Life is Living / Reflections of Healing

Community-led, community-based research helped to provide detailed and accurate information about conditions in South Berkeley and the priorities of the community. HBF’s surveys captured extensive qualitative information from the community about their experiences with displacement and feelings about returning. Healthy Black Families, Inc. employed multiple strategies to ensure the data they gathered truly reflected the needs and priorities of the community, including: reaching out to both community members living in Berkeley and those who were displaced, gathering information broadly using surveys, training community members to engage in outreach and survey administration, and discussing and collaboratively interpreting findings at public assemblies. To support engagement, HBF held meetings in places familiar and easily accessible to the community, providing food, childcare and safe practices (e.g., COVID safety) to attend to support participant needs.

HBF led the community through participatory research strategies

Campaign leaders invested time and care for the community to generate solutions Healthy Black Families and the Fight for a Thriving Black Berkeley HBF’s survey findings provided a strong basis for the community to reflect upon and understand conditions in Berkeley as identified by members of the Black community, and to discuss and vet ideas for solutions. The community welcomed this contrast to other public processes, which often asked for resident priorities without the opportunity for collective community self-reflection and discussion. Being in a university town, the community was also accustomed to and tired of extractive processes in which researchers would gather information from the community to draw conclusions and make recommendations without their participation, approval, or sometimes even their awareness. In this process, community members reviewed data collected across community to arrive at conclusions.

Throughout this process, HBF encouraged them to focus on <strategic unity,= and finding the things they could all agree on in order to strengthen the power of their recommendations.

HBF facilitated the community’s process to develop evidence-based recommendations Healthy Black Families hosts a People’s Assembly to discuss community priorities

Figure 8. A schematic summarizing Healthy Black Families’ efforts to advance a campaign to address the displacement of the

Black community from the South Berkeley neighborhood, including the efforts they input, the outcomes of those efforts, and the longer-term impacts towards the vision of Equity 4 Black Berkeley.INPUTS IMPACTSOUTCOMES

HBF applied clear messaging around the community’s shared priorities

<HBF's sharing of the Black experience with Berkeley elected created really powerful presentations which had elements of communication and narrative change, especially combined with the really clear frameworks that they put out around <right to stay, right to return, right to own= shows that narrative change that can happen from naming and clarity.=
– Community Partner
City of Berkeley public meeting
45 Healthy Black Families and the Fight for a Thriving Black Berkeley With input from the community on the central question of <What do we need to create a thriving Black Berkeley?=, HBF coalesced the recommendations together with research findings to deliver clear messages to local elected officials, city representatives, and funders about the community’s priorities for change. HBF worked with the City to generate presentations, flyers and other materials to educate others.

The community’s priorities of housing, health, community and finance centered on a widely discussed point in their meetings, one that drew from the wisdom of the Black communities they were connected to across the country and also international liberatory movements such as the Right to Stay Movement that started in Palestine in 1948: that affordable housing was not an effective response to an apartheid state, as affordable housing rested upon an assumption of <the ability of the people to afford.= From here, the language of the campaign shifted to invoke the more inspiring and inclusive vision of <a thriving Black Berkeley= and <equity for Black Berkeley,= from prior language that focused more narrowly on achieving an <equitable Black Berkeley.=

Equitable processes were integral to Equity 4 Black Berkeley campaign success HBF worked strategically to build and engage allies along the way With limited capacity and resources to organize the community and advance change, HBF welcomed strategic partnerships to support the community and advance their priorities. To support community capacity building, HBF leveraged relationships with other nonprofits and advocacy groups, such as the Ecology Center and the Bay Area Regional Health Inequities Initiative (BARHII). HBF also collaborated with a former councilmember who led resident Equity Summits, established community groups like Friends of Adeline, and Black-led organizations like the National Association for the Advancement of Colored People (NAACP) - Berkeley chapter and the Berkeley African American Holistic Resource Center to ensure broad outreach on their community survey and to get messages out. To expand its reach while also building stronger community leadership, HBF also developed the HBF Fellows Program and collaborated with Dr. Derethia Duval, a Black professor specializing in qualitative research on participatory research strategies. HBF also welcomed the collaboration of a fellow from the Partnership for the Bay’s Future, staff at the City, and allies at the East Bay Community Law Center to interpret community recommendations along with results from a citywide public survey administered by the City, along with other public data.

The Fight for Equity for Black Berkeley
Berkeley Black community discusses affordable housing priorities

The community recommendations were a critical component for developing policy. HBF worked with staff at the City of Berkeley and other community leaders to review these recommendations along with, citywide survey results, public demographic and housing data, and examples and models of preference policies in other places to develop meaningful, solutions-oriented recommendations. The Black community in Berkeley could get behind this work when they saw their input reflected in the draft policies. With a broad coalition of support and a strong basis of research supporting their work, HBF ultimately co-presented clear recommendations to leaders in Berkeley.

HBF influenced decision-makers with well-backed recommendations and broad support <We couldn’t have done this without HBF. They immediately came up with the logo and putting out info to the Black community. They had a QR code that people would use to download
questions. They created a whole communication list. That was initial. Then they did [People’s Assemblies], they’d discuss topics every month. That’s where some of the priorities came from...The question was not just health but what would it take to create a thriving Black Berkeley? They were able to glean and put data points together and come up with a great report to inform where the money will go over time.=
– Community Partner
46 Berkeley City Council discussion

Toward the Vision of a Thriving
Black Berkeley
A Summary of Lessons Learned
Achieving the vision for a thriving Black Berkeley requires everyone

The Affordable Housing Preference Policy represents an important start to addressing institutional racism and the systematic displacement of Berkeley community members, but more work is needed to achieve a sustainable, thriving community. Patterns of displacement have been the result of multiple decisions at different junctures over decades; creating new patterns of inclusion will require everyone’s readiness and willingness to design, seize and implement other opportunities for change in the future. That readiness will hinge upon: (1) the community’s continued organizing to monitor and enforce the implementation of AHPP and other policies, (2) the City’s continued work to effectively and meaningfully partner with the community in future public processes, and (3) the continued support of funders and allies to attend to the priorities of the Black people in Berkeley and to stop the systemic harm and economic extraction of resources from their community.

Achieving a thriving Black community in Berkeley requires continued collaboration among diverse stakeholders around a common vision. Favorable conditions to create and adopt the AHPP were born from the alignment of Berkeley residents around goals to curb displacement and address institutionalized racism in local exclusionary housing policies.

Strengthening the alignment around the community’s vision for a sustainable, thriving Black community in Berkeley will help to generate greater momentum to meaningfully address a long history of exclusion. This vision extends beyond the AHPP’s promise to help legacy families return to their Berkeley roots. It calls for greater opportunities for Black families to build generational wealth, stronger investments in community culture, and better supports for youth and workforce development.

The AHPP is a key early step in the overall journey
Collaboration on a common vision of a thriving Black Berkeley Future opportunities for change
This vision can be made possible through
policies and programs that support greater
homeownership among Black families, the
revitalization of historic cultural gathering
places like the Ashby Flea Market, and the
development of new ones like the African
American Holistic Resource Center. It
includes efforts to build alliances and
coalitions in support of their vision, outreach
to investors to infuse sizable resources into
equity for Black Berkeley, and research on
opportunities for policy development or
change.

Healthy Black Families and the Fight for a Thriving Black Berkeley 04 City of Berkeley planning workshop

Healthy Black Families’ efforts around housing advocacy in Berkeley have demonstrated that it is important for communities facing challenges to:

As Healthy Black Families, Inc. moves forward in its work with the City of Berkeley and other partners to build momentum toward a shared vision, it is important to look back at the lessons from the campaign to date. Communities, allies and funders involved so far have shared multiple lessons for others engaging in similar work, listed below.

Create power in numbers – To seize opportunities for change when they arise, communities benefit from building a strong base. Staying connected across geographies and generations is especially important in times of adversity, like when facing displacement.

Build power through learning – Knowledge is power. Communities can build power through both simple and organized acts of learning, including: ensuring the transmission of information across generations, leveraging the knowledge of different generations, engaging in community data gathering efforts, and co- creating data-informed recommendations.

Strengthen and unify the community through community connectors and caretakers – Communities are not monolithic, and conflict among diverse community members is often inevitable. To overcome these natural patterns, communities must find and value the people in the community who demonstrate the greatest care and compassion to help facilitate across disagreement, build trust, and strengthen community cohesion.

Lessons for communities
An equitable process was integral to the success of the equity campaign

A South Berkeley community resident, community organizer and leader at Healthy Black Families, Inc. listens to the words of another member of the community

Adopt a stance of readiness – A strong community base is ready to speak up and speak out, ready to identify solutions, and ready to ask questions and challenge norms both when the time is right and when it is inconvenient. Communities can prepare by staying politically engaged, monitoring social and political shifts, and staying on the lookout for opportunities to advocate for change.

Allies in public agencies and community organizations played an important role in the housing policy efforts to advance equity for Black Berkeley. Allies pursuing other, similar efforts should note that:

Lessons for allies
Work to earn trust – Collaboration <moves at the speed of trust,= particularly when working with communities that have chronically faced systems or leaders that do not trust or prioritize their input. Allies can build trust by proving themselves trustworthy; listening to understand the community’s perspective, leading with community priorities, offering supports, and following through on promises.

Healthy Black Families is a community-based and community-led organization located in South Berkeley Work in solidarity – Creating alliances with other leaders and groups is essential for advancing shared liberation. Healthy Black Families has operated under ideologies that understand that while policies and issues will shift, fundamental root causes and values will remain the same. Engaging a wide range of partners helps to build flexibility, muscle and endurance for long-term change processes.

Toward the Vision of a Thriving Black Berkeley
<This is a story that needs to be told. It needs to not just be in front of people who care about social justice, but also people who are agnostic, who don’t understand the privilege that we have had by being white and not discriminated against. In a progressive community like Berkeley, we might be able to find new funding for big efforts like this. There are all sorts of opportunities that could happen if the greater world were to understand the true impact of discrimination.= – Community Partner
Offer resource-intensive support to support the community’s leadership – Support and build upon the community’s expertise and leadership by providing research, planning, strategy, and technical supports that will help to validate their priorities and expedite their solutions. In the work on the AHPP, the City of Berkeley brought technical research skills to expand knowledge of policy models supporting community priorities, and the Partnership for the Bay’s Future brought resources to support analysis and communication activities under the community’s leadership.

Find creative ways to formalize community-driven change – Leadership involves forging new paths, and leadership can happen from any seat. Every actor in a change process, working with shared values toward a common vision, has the power to identify barriers and opportunities for change. In the fight for equity for Black Berkeley, leaders in varying seats of local government worked with and found different ways to advance change in favor of the AHPP.

Promote the community’s stories – By sharing the stories of the community’s obstacles, challenges and wins, allies can leverage their existing networks and reach to help broaden understanding of the community’s conditions, priorities, and solutions. In today’s digital landscape, allies can look to and promote the podcasts, blogs, and social media posts of their community partners.