Breathe California

What do they do? Breathe California of the Bay Area, Golden Gate, and Central Coast provides cessation education, asthma education and home assessments, and low-cost respiratory equipment. It also conducts tobacco and clean-air policy work, environmental education, senior services, and community outreach. This is the San Jose lungsrus.org operator, EIN 94-1156307, rather than Breathe Southern California, whose separate EIN is 95-1641451. More

Why this approach interests us

• Its equipment, prescription and home-visit pathways identify concrete delivery work rather than an unspecified awareness benefit.
• Current newsletters and a June 2025 original tax return support continued operation despite the old audit link.
• The policy/environmental portfolio may produce benefits beyond the narrow clinical subtotal, although the causal and financial bridge remains missing.

Our main reservations

• No current marginal gift-to-completed-service commitment or verified room for more funding has been found; low equipment inventory is not proof cash can solve the bottleneck.
• The latest filing reproduces pandemic-era activity prose, and an anomalous zero-filled FY2024 return conflicts with other years; current unique throughput and reliable three-year trend remain unresolved.
• Clinical utility and household effects depend on uncertain transfer, alternative care, age mix, sustained use, fees, travel, lost work, and double-counting; neither the scenario weights nor the new cash illustrations are empirical expected values.

What do you get for your dollar? Our conditional reference is $1.1M per DALY in the Bay Area, counting finite cessation, asthma and CPAP health alongside an explicit no-net-household-cash assumption. Signed tobacco savings, equipment-financing savings, care costs and lost work are assessed separately. Those sensitivities change the estimate; the reference is not a measured complete-portfolio expected value. More

What Breathe California does

Breathe California of the Bay Area, Golden Gate, and Central Coast provides cessation education, asthma education and home assessments, and low-cost respiratory equipment. It also conducts tobacco and clean-air policy work, environmental education, senior services, and community outreach. This is the San Jose lungsrus.org operator, EIN 94-1156307, rather than Breathe Southern California, whose separate EIN is 95-1641451.

Spending breakdown and financial appendix

Fresh originals are retained in the receipts file. The latest three available returns for EIN94-1156307 end June 2025, June 2024 and June 2023; no FY2022 filing appears in the current index. FY2025 original reports revenue $1,648,480, functional expense $1,373,246, direct event expense $6,344 and government grants $749,252. Whole work-cost boundary is therefore $1,379,590, preserving the previously chosen event-inclusive numerator. Program expense $1,242,890 plus administration $130,356 reconciles functional expense. Reported largest program categories are environmental $511,139, lung $407,539, tobacco $299,166 and community $25,046. These are allocations of existing expense, not marginal unrestricted gift decisions.

FY2025 Part VIII line2a reports $65,740 labeled CPAP Machines/Hoses/Masks, reconfirmed in the original efile during this correction. This is an observable aggregate payment/program-revenue anchor: the equipment program cannot be assumed free. It does not establish whether the ultimate payer was each patient, another household, an insurer, or an institutional purchaser; nor does it identify fee distributions, unique episodes, equipment-only versus supplies, or the marginal payment caused by an additional gift. It is not divided by the filing's reused historical453-equipment narrative or the model's hypothetical episodes. The selected cash0 reference means no-net-cash for comparison, not zero fee receipts.

Payment reconciliation: the $500 nominal CPAP internal-delivery cost is a judgment about work consumed, whereas a patient fee is funding transferred toward that work. The $65,740 receipts appear in revenue; they do not justify subtracting receipts from the event-inclusive expense boundary or adding fees on top of that boundary as new real resources. The $400 external allowance is separately intended for real complementary equipment/clinical inputs outside the internal cost; it must be reduced if those same inputs are already captured in the $500 or reported organization expenses. A future episode ledger should identify actual internal labor/processing, recognized donated inventory, supplies, clinical partner resources, patient/insurer payments, outside funding and the no-gift alternative before claiming full donor-unit cost or a social-resource ratio. The candidate's $116,689 gross partial resource envelope is conditional pending that reconciliation, and household fees/travel enter welfare only as incremental net losses relative to the household's no-gift option. The numerator is never silently reduced by hypothetical household savings.

FY2025 net assets reconcile: $1,483,421 beginning +$275,234 revenue-minus-expense +$95,338 unrealized gains +$140,576 prior-period adjustments =$1,994,569 ending. This reconciliation does not resolve the cause of the prior-period adjustment or FY2024 anomaly.

FY2024 original identifies the same EIN, July 1,2023–June 30,2024 period, and prints prior-year revenue $1,485,579 versus current0, prior expense $888,864 versus current0, and net assets beginning $1,483,421/end0. Original HTML column headers were inspected; final-return and amended-return boxes are unchecked. These are confirmed printed zeros in an anomalous filing, not confirmed zero actual annual expense or closure. Do not use them as a denominator or three-year average. FY2023 original reports revenue $1,333,909, expense $1,159,379, government grants $518,172 and net assets $579,364. Its figures disagree with FY2024 prior-year columns; restatement/entity-consolidation/reporting explanation is unresolved.

The website financial page still points to an audit for June 2021 and 2020. The linked original audit has an auditor opinion dated January 23,2024; a March 2026 upload path is not a new audited period. It reports FY2021 expense $1,150,261, in-kind services $197,371, in-kind goods $94,964 and 198 donated CPAP machines. Recognized in-kind expense must not be added twice; old machine counts are not current throughput. No newer original audit was found in this bounded public check, and the latest audit date remains unknown beyond that public document.

June 2026 newsletter listing, current donation recipient/address, and latest tax filing support ongoing operation. They do not independently verify completed2026 programs or current licenses, every location, or capacity. The affiliate directory lists lungsrus and breathesocal separately; Southern California financials are not substituted into this Bay Area denominator.

Monitoring and information sharing

Current newsletters and the latest original filing support continuing operation, but do not establish current unique throughput or capacity. The latest program prose repeats pandemic-era descriptions; historical counts cannot be relabeled as verified 2025 or2026 delivery. We need dated unique-person records, prescriptions, equipment delivery, follow-ups, sustained quits, age mix, alternatives and household payments before replacing selected assumptions.

Clinical evidence and transfer

Cessation: Lung Health Study randomized 5,887 middle-aged people with airway obstruction to a much more intensive intervention than the local six-session class. Its five-year sustained quit contrast was 21.7% versus 5.4%, and mortality was 8.83 versus 10.38 per 1,000 person-years. Those are trial-arm results, not smoker/former-smoker state hazards. Retain the modest three-percentage-point incremental six-month quit reference and finite ten-year smoker/former-smoker/death trajectories as judgments; later quitting, relapse, death, two-year recovery lag and three-percent discount remain explicit. The local Ash Kickers 60% endclass abstinence claim has no supplied comparator, independent sustained verification or missingness denominator, so it does not replace the causal contrast. No survivor wages, GDP, or lifetime earnings tail is added.

Asthma: Healthy Homes II gives 24.4 additional symptom-free days per year over nurse-only education; HomeBASE gives 2.02 days per fortnight in adults with uncontrolled asthma, using about 4.9 visits over a year. Local all-age services describe assessment, equipment and two to three follow-ups. The transfer of 0.5 is plausible as a cautious reference but unvalidated; age composition 0.6 children and adult-homevisit share 0.8 remain judgments. Retain one-year duration and the 0.1 utility gap as an expressly unvalidated symptom-day mapping, without adding caregiver QALYs or survival. Adult urgent-care differences were nonsignificant (P=.83), and child urgent-care differences were also nonsignificant; no automatic medical-spending saving is credited. A symptom-free day is not a full recovered workday, so wages are a separate signed user cash input.

CPAP: PREDICT primary economic evaluation reports one-year EQ-5D gain0.005 (CI−0.034 to0.044), versus SF-6D0.018. The instrument disagreement supports retaining the integrated small EQ-5D reference, explicit lower/upper/null sensitivities and transfer0.8, not selecting the larger instrument to improve ranking. SAVE found no prevented cardiovascular events in its established-CVD population; it does not justify a survival bonus. The trial integrated QALY already incorporates observed adherence, so an extra generic adherence haircut would duplicate it. Local prescription and calibration requirements make travel, clinical support and equipment access material. FY2025 reports aggregate CPAP Machines/Hoses/Masks program revenue $65,740; no verified per-household or marginal fee, current unique machine denominator, or local sustained-use rate is supplied.

Qualitative assessment

Concrete care and equipment pathways, current communications and original filings are reasons to investigate. The Bay operator is not Breathe Southern California. The strongest disconfirmation is financing replacement without additional health, especially with substantial participant fees, travel or treatment costs. Filing anomalies and reused activity descriptions reduce confidence without proving closure or ineffectiveness. No empirical complete-portfolio expected value or verified top-four endorsement is claimed.

What do you get for your dollar?

Our conditional reference is $1.1M per DALY in the Bay Area, counting finite cessation, asthma and CPAP health alongside an explicit no-net-household-cash assumption. Signed tobacco savings, equipment-financing savings, care costs and lost work are assessed separately. Those sensitivities change the estimate; the reference is not a measured complete-portfolio expected value.

At the $100,000 whole-gift reference: 0.41635 additional initial quits ($240,180/quit), 22.074 child symptom-free days ($4,530/day), 25.410 adult symptom-free days ($3,935/day), and 13.293 additional CPAP episodes ($7,523/episode). These are whole-gift-per-single-path outcome diagnostics, not additive valuations or current observed local units; each places all gift cost against one pathway and must not be described as the actual restricted delivery price. Conditional nominal offer cost priors remain $250 cessation, $1,200 asthma, $500 CPAP. These imply pathway-allocated costs $20,833/additional initial quit and $1,000/additional CPAP episode after additionality, but no organization accepts such a marginal purchase on this evidence.

Selected current conditional estimate

I select the retained clinical value after reconsideration, not merely because it is the legacy output. The native contrasts have surviving primary trial support, but none of the fresh records identifies a new local marginal care commitment or a uniquely better coefficient. The following retained values form one coherent, low-conversion conditional care-access case. They are judgments selected for the displayed estimate, not posterior means, empirical EV, current price quotations, or accepted restricted purchases. Wider alternatives remain material; retaining the number does not imply unusually strong precision.

Adjacent signed cash sensitivities at the same clinical priors: net tobacco+$1,500/year gives Bay cash-equivalent +.021274 and conditional total price $875K; net tobacco−$500/year gives−.007233 and $1.2M. CPAP fee/travel/treatment burden $250 per added episode gives−.026457 and $1.5M. A separate financing-replacement cohort equal to .25 of nominal episodes, net purchase saving $350, gives+.018409 Bay equivalent years and $898K. Asthma net lost-work/care change−$50 gives−.001198 and $1.1M. These are selected signed scenarios, not observed local cash amounts or weighted expected values. Cash credit below1 reduces only positive cash welfare; clinical health and negative cash remain intact.

Health and signed household resources

The candidate imports the shared signed income bridge: $50,000 reference income and $100,000 healthy-year comparison value, using logarithmic total household income changes and own delay/discount schedule. This is welfare equivalence, not measured clinical QALYs. The $50,000 baseline is a reference, not the measured income of patients. Each added care pathway has a one-year net household change: after-tax/benefit-adjusted earnings plus unreimbursed care savings less fees, travel and treatment resources paid by the household. Components are combined before taking the logarithm. Zero-valued inputs have householdStatus unknown, and negative remaining income is rejected.

CPAP purchase replacement is a separate financing cohort. Someone who would buy the same machine without the gift may save cash but has zero incremental clinical treatment from this purchase; someone gaining otherwise unavailable treatment may gain health but must not also receive the full avoided-purchase benefit. The candidate bounds the nominal financing-replacement share plus clinical additionality at1. The illustrative replacement share .25 and $350 net saving are judgments after $500 avoided purchase less $100 fees and $50 travel, not observed prices. The replacement cohort has no added QALY. Government reimbursements and household fees are transfers in a societal ledger: count household incidence once, do not add the payment again as a real resource consumed. Organization donor cost is not reduced by patient savings.

Tobacco savings have no measured local quantity or welfare netting, so their selected reference is0/unknown. The +$1,500 and−$500 annual cases use extra initial quits and finite common-survivor abstinence exposure, attenuated by background quitting, relapse and mortality; they exclude wages/consumption of extra survivors. Net annual tobacco input must already subtract replacement products and any foregone consumption value the evaluator elects to include. It is not the gross cigarette bill treated as free welfare. To avoid summing logarithms for the same household, joint nonzero cessation acquisition cash plus tobacco savings are rejected pending an integrated household distribution.

The corrected overlap mechanism is clinical unchanged, cash-positive welfare independence only. cashIndependentShare asks what share of a positive household welfare row can additionally be counted beyond clinical utility; it does not deduplicate recipients, alter treatment incidence, or discount negative consequences. All positive and negative clinical pathway effects remain as calculated, each explicit offer or independent harm is debited once, and each negative household row persists at full value. Positive cash is multiplied by this share before rows are summed, so a positive cessation cash row cannot erase a negative CPAP row before the credit adjustment. The tobacco stream follows the same signed rule. Health and cash are not automatic duplicates merely because the same person receives both; share 1 is the selected reference, and lower shares are sensitivity judgments without empirical identification.

Actual duplicate recipient records require a person/household cohort correction before computing either outcome; this parameter is not a substitute for that correction. The reference assumes distinct recipient households across pathways pending a verified crosswalk. The old ambiguous nonoverlapShare parameter is rejected to prevent silent reuse of its former health-discount meaning.

Partial resource envelope retains the original nominal-offer complementary inputs ($100 cessation, $300 asthma, $400 CPAP), regardless of health success. They are allowances, not audited invoices. Household cash welfare is not itself a societal resource saving. Fees/transfers must be reconciled against these costs before claiming a net social-resource ICER; the candidate deliberately reports a gross partial resource ratio. No automatic positive donor welfare, staff-wage benefit, or baseline earnings of surviving people is counted.

Revision record and model appendix

The previous conditional clinical Bay reference was $1.1M; the selected health-and-household no-net-cash reference remains unchanged after reconsideration. This does not mean household effects were measured as zero. Signed cash sensitivities can improve or worsen the price. The historical weighted $1.2M is a separate subjective mixture, not the selected center. Complete historical report, baseline, allocation variants, five prior worlds and nine source hashes are frozen unchanged. Current diagnostics are unweighted sensitivities, not confidence intervals. Cash independence affects only positive cash credit; health and all adverse cash persist. Actual organization-specific research intervals exclude integration, testing, deployment and waits.

Funding and previous grants

The full donor cash stays in the numerator, including common operations and unquantified work. The $100,000 scale is a comparison, not an identified available tranche. Government grants, annual expenses and equipment scarcity do not establish marginal capacity. An executable proposed budget, restrictions, distinct additional outcomes, patient fees and accessible alternatives would be needed to identify what additional money buys. Gross complementary resources remain separate from transfers and household cash.