2019-05-10T14:40:08-05:00 2018-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2017-07-01 951643373 Community Hospital of San Bernardino % MARY JOHNSON ACCT DEPT COMM 7088876333 185 BERRY STREET SUITE 300 SAN FRANCISCO CA 94107 JUNE COLLISON PRESIDENT 9098061100 2019-05-09 true VALERIE J BALL P00178114 4159635100 162.135.0.56 94661320191305000002 2019-05-10 P AA03D6E076BF5615D6336EA7081A107B0F4C4C13 2B5788CE322FF00EB493AD5B21DC7D604E87DE51 2017 2019-02-21 02:37:17Z JUNE COLLISON PRESIDENT 1805 MEDICAL CENTER DRIVE SAN BERNARDINO CA 92411 274553499 false X http://www.dignityhealth.org/san-bernardino/ X 1938 CA COMMUNITY HOSPITAL OF SAN BERNARDINO IS COMMITTED TO FURTHERING THE HEALING MINISTRY OF JESUS, AND TO PROVIDING AFFORDABLE HEALTH CARE TO THE COMMUNITY WE SERVE. 13 7 1606 128 0 36669 816060 1014862 220691262 272923158 102057 -30007 605899 645486 222215278 274553499 1919025 3404344 0 0 140793029 146774048 0 0 0 109051790 126293939 251763844 276472331 -29548566 -1918832 134350321 146396396 231462033 245426940 -97111712 -99030544 X COMMUNITY HOSPITAL OF SAN BERNARDINO IS A NON-PROFIT, FULL-SERVICE, ACUTE CARE FACILITY IN BUSINESS TO PROVIDE ACUTE INPATIENT CARE, LONG-TERM CARE AND A WIDE RANGE OF ANCILLARY AND THERAPEUTIC CARE TO THE COMMUNITY WE SERVE. OUR VISION IS TO CREATE AND PROVIDE HEALTH CARE SOLUTIONS, AND MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY. false false 244275099 3404344 272923158 COMMUNITY HOSPITAL OF SAN BERNARDINO'S MISSION IS TO CONTRIBUTE TO THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST EFFECTIVE MANNER. THE HOSPITAL IS LICENSED FOR 431 BEDS AND CURRENTLY HAS 382 BEDS AVAILABLE. THE HOSPITAL HAD 89,647 TOTAL PATIENT DAYS, 11,655 ADMISSIONS, AND 70,796 EMERGENCY ROOM VISITS. INPATIENT SERVICES: ACUTE PATIENT CARE; MATERNAL CHILD CARE; MENTAL HEALTH CARE; NEUROLOGICAL CARE; AND A VARIETY OF OUTPATIENT CARE. 244275099 true true false true false false false false false false true false false false true true false true false false true true false false false false true true true true true true true false false false false false false false false false false false false false false true true true false false true 121 0 true 1606 true false false false false false false false false false false X 13 7 true false false false true true true true true false false false true true true true true false false true true CA X MARY JOHNSON ACCT DEPT 6022944117 3033 NORTH 3RD AVENUE PHOENIX AZ 85013 X Mary Connick Director 1.0 40.0 X 0 1208039 125221 Hendrik DeJager MD Ex-officio Dir (THRU 12/2017) 1.0 7.0 X 19784 0 0 Richard Gonzalez Esq Director 1.0 0.0 X 0 0 0 Gary Greensweig DO Director 1.0 40.0 X 0 831190 133161 Reg Javier Director 1.0 0.0 X 0 0 0 Vicki R Lee Director 1.0 0.0 X 0 0 0 Joe M Mawad MD Director 4.5 10.0 X 24432 0 0 Johnny Negusse MD Ex-officio Director 1.0 0.0 X 0 0 0 Gabriel Ramirez Director 1.0 0.0 X 0 0 0 Julie Sprengel Director 1.0 40.0 X 0 1040459 103396 Bruce Swartz Director 1.0 40.0 X 0 990104 120795 Rachelle Wenger Director 1.0 40.0 X 0 176333 36982 Claudia M Davis PhD Vice Chair 1.0 0.0 X X 0 0 0 Tony Myrell Chair 1.0 0.0 X X 0 0 0 June Collison Hospital President 40.0 0.0 X 0 712151 86473 David J Evans VP/CFO 40.0 0.0 X 303551 0 58782 Rosilyn Nolan CNE 40.0 0.0 X 248069 0 42653 Victoria Selby VP of Ancillary & Support Serv 40.0 0.0 X 275105 0 48326 Marc Marchetti Service Area Executive Directo 40.0 0.0 X 255548 0 55560 Marie R Orpilla CNIII 40.0 0.0 X 227692 0 49154 Lynda Castro Controller 40.0 0.0 X 221836 0 49318 Arlene P Landero CNII 40.0 0.0 X 215836 0 47595 Patricia Womack Director of Pharmacy 40.0 0.0 X 289637 0 32106 Darryl VandenBosch Former Officer 0.0 40.0 X 0 690379 29144 Jack Ivie Former Officer 0.0 40.0 X 0 780199 37023 2081490 6428854 1055689 347 true true false Horizon Media Inc Lockbox 10409 Horizon Media NEWARK NJ 071930409 marketing 7763310 Premier Community Anesthesia 1580 Mohave Drive COLTON CA 92324 Medical Services 1580004 Inpatient Specialists of California PO Box 742936 LOS ANGELES CA 900742936 medical services 1526417 American Vitalcare LLC PO Box 502096 ST LOUIS MO 631502096 medical services 1520915 Aligned Telehealth Inc 26135 Mureau Road 101 CALABASAS CA 91302 medical services 1307412 54 1007862 7000 14576 1014862 PATIENT REV NET OF CHARITY CARE AND BAD DEBT 900099 101880497 101880497 MEDICARE/MEDICAID PAYMENTS 900099 170183886 170183886 MEANINGFUL USE INCENTIVES (EHR) 900099 -98905 -98905 MEDICAL OFFICE BUILDING 900099 932899 932899 EDUCATION 900099 24781 24781 272923158 -30007 -30007 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA 900099 523651 523651 COMMISSIONS 900099 83467 83467 MEDICAL RECORDS/ABSTRACT SALES 900099 15923 15923 22445 22445 645486 274553499 272923158 615479 X 3350771 3350771 26323 26323 27250 27250 0 1036600 957972 78628 0 0 110296282 102472742 7823540 0 9000198 8367156 633042 0 18473898 18403596 70302 0 7967070 7396026 571044 0 0 432278 0 432278 0 63896 0 63896 0 88144 0 88144 0 0 0 40377437 28900989 11476448 0 1532685 26068 1506617 0 3910631 3337424 573207 0 8419013 522543 7896470 0 0 2146359 1888796 257563 0 167199 70721 96478 0 0 109386 50894 58492 0 10495660 10495660 0 0 0 9968461 9968461 0 0 2012868 2012868 0 0 MEDI-CAL PROVIDER FEE 28684391 28684391 0 0 MEDICAL SUPPLIES 15363417 15362025 1392 0 FOOD SUPPLIES 1343790 1316414 27376 0 LICENSES AND TAXES 575382 352973 222409 0 602942 283036 319906 276472331 244275099 32197232 0 6635 6635 4814931 108932 34046 738688 21389045 20191363 0 0 0 0 223879 111147 2930116 2971908 63965793 83063912 145407222 106226661 40906938 39180561 55688 0 0 0 0 0 0 0 23250 23250 134350321 146396396 35029459 46014830 0 0 0 1250000 2000000 2000000 0 0 0 0 381050 227307 0 0 194051524 195934803 231462033 245426940 X -97111712 -99030544 0 0 0 0 -97111712 -99030544 134350321 146396396 -1918832 X false true X true false X false false false false false false false false true 88144 88144 false SCHEDULE C, PART II-B, LINE 1I LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA $13,679 AMERICAN HOSPITAL ASSOCIATION $ 2,350 PEACH INC $69,930 CATHOLIC HEALTH ASSOCIATION $ 1,855 340B HEALTH (FORMERLY SAFETY NET HOSPITALS) $ 197 INLAND ACTION INC $ 114 AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES $ 1 ONCOLOGY NURSING SOCIETY $ 18 ______ TOTAL $88,144 ====== 799341 799341 94150650 72829874 21320776 44193050 33081562 11111488 6264181 315225 5948956 39180561 0 DUE TO RELATED PARTIES 190092500 PENSION PAYABLE 4751565 OTHER NON-CURRENT LIABILITY 1090738 195934803 X PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE DIGNITY HEALTH REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. true Central America and the Caribbean 0 0 Program Services COMMUNITY SUPPORT 27250 0 0 0 0 27250 27250 Central America and the Caribbean community support 27250 med equipment FMV 1 false false false false false false SCHEDULE F, PART I, LINE 2 AND 3 GRANTS ARE AWARDED TO INTERNATIONAL ORGANIZATIONS WHOSE MISSION IS ALIGNED WITH COMMUNITY HOSPITAL OF SAN BERNARDINO'S MISSION. SUCH AWARDS ARE APPROVED BY A DESIGNATED COMMITTEE OR THE EXECUTIVE LEADERSHIP TEAM OF THE ORGANIZATION. EXPENDITURES REPORTED ARE FOR MEDICAL EQUIPMENT AND AN AUTOMOBILE. THESE EXPENDITURES WERE BASED ON THE ACCRUAL METHOD OF ACCOUNTING AS REPORTED ON THE ORGANIZATION'S FINANCIAL STATEMENTS. true true X true X true X 500. true true true false true true 333 2518744 2518744 0.00910 69337 215154472 2220160594 69670 217673216 2220160594 2518744 0.00910 12 9182 986019 986019 0.00360 9 975 3239720 3239720 0.01170 21 10157 4225739 4225739 0.01530 21 79827 221898955 2220160594 6744483 0.02440 358 196581 196581 0.00070 358 196581 196581 0.00070 true 1047515 0 14864157 15417288 -553131 X true true 1 1 Community Hospital of San Bernardino 1805 Medical Center Drive San Bernadino CA 92411 www.dignityhealth.org/san-bernardino/ 240000198 X X X Community Hospital of San Bernardino 1 false false true X X X X X X X X X 16 true true false true X SEE SECTION C X true 16 true SEE SECTION C false true X 200. 500. X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT INTO THE TAX YEAR 2017 CHNA WAS DESIGNED TO VALIDATE SECONDARY DATA FINDINGS, IDENTIFY ADDITIONAL COMMUNITY ISSUES, SOLICIT INFORMATION ON DISPARITIES AMONG SUBPOPULATIONS, ASCERTAIN COMMUNITY ASSETS TO ADDRESS NEEDS AND DISCOVER GAPS IN RESOURCES. INFORMATION WAS OBTAINED THROUGH FOCUS GROUPS AND INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS, PUBLIC HEALTH, SERVICE PROVIDERS, MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS IN THE COMMUNITY, AND INDIVIDUALS OR ORGANIZATIONS SERVING OR REPRESENTING THE INTERESTS OF SUCH POPULATIONS. TWENTY-ONE TARGETED INTERVIEWS WERE USED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE COMMUNITY. PARTICIPANTS WERE SELECTED TO COVER A WIDE RANGE OF SECTORS REPRESENTING DIFFERENT AGE GROUPS AND RACIAL/ETHNIC POPULATIONS. FOUR FOCUS GROUPS WERE CONDUCTED THAT ENGAGED 68 PERSONS. TWO OF THE FOCUS GROUPS WERE CONDUCTED IN ENGLISH, ONE IN SPANISH WITH A SPANISH-SPEAKING FACILITATOR, AND ONE IN ENGLISH AND SPANISH. THE FOCUS GROUP MEETINGS WERE HOSTED BY TRUSTED COMMUNITY ORGANIZATIONS. SCHEDULE H, PART V, SECTION B, LINE 6A ST. BERNARDINE MEDICAL CENTER SCHEDULE H, PART V, SECTION B, LINE 7A HTTPS://WWW.DIGNITYHEALTH.ORG/SOCAL/LOCATIONS/SAN-BERNARDINO/ABOUT-US/SERV ING-THE-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-PLAN SCHEDULE H, PART V, SECTION B, LINE 10A DIGNITY HEALTH HOSPITAL FACILITY IMPLEMENTATION STRATEGY DOCUMENTS CAN BE ACCESSED AT HTTPS://WWW.DIGNITYHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH/COMMUNITY-HEALTH-P ROGRAMS-AND-REPORTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS. IMPLEMENTATION STRATEGIES ARE ALSO ON EACH HOSPITAL FACILITY'S WEB SITE, AT THE SAME LOCATIONS AS THEIR CHNA REPORTS LISTED IN PART V, SECTION B, LINE 7A ABOVE. SCHEDULE H, PART V, SECTION B, LINE 11 THE HOSPITAL WILL ADDRESS THE FOLLOWING IDENTIFIED SIGNIFICANT HEALTH NEEDS: ACCESS TO HEALTH CARE/PREVENTIVE PRACTICES; BIRTH INDICATORS; CHRONIC DISEASES/OVERWEIGHT AND OBESITY; HOMELESSNESS; AND YOUTH DEVELOPMENT FOR AT-RISK YOUTH, INCLUDING SAFETY AND VIOLENCE PREVENTION. THE HOSPITAL IS ADDRESSING THESE NEEDS IN NUMEROUS WAYS DESCRIBED IN DETAIL IN ITS IMPLEMENTATION STRATEGY, WHICH IS WIDELY AVAILABLE TO THE PUBLIC ONLINE. ACCESS TO HEALTH CARE/PREVENTIVE PRACTICES: PATIENT FINANCIAL ASSISTANCE, DIGNITY HEALTH COMMUNITY GRANTS PROGRAM, FREE COMMUNITY HEALTH EDUCATION, COMMUNITY HEALTH NAVIGATOR, FREE FLU SHOTS. BIRTH INDICATORS: SWEET SUCCESS PROGRAM FOR GESTATIONAL DIABETIC WOMEN, COMMUNITY HEALTH EDUCATION LACTATION SUPPORT, HEALTHY PREGNANCIES, AND PRE/POST-NATAL CARE AT THE HEALTH EDUCATION CENTER, STATUS AS A BABY-FRIENDLY ACUTE CARE HOSPITAL. CHRONIC DISEASES/OVERWEIGHT AND OBESITY: CHRONIC DISEASE SELF-MANAGEMENT PROGRAM, COMMUNITY GRANTS PROGRAM, SWEET SUCCESS, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS AT THE HEALTH EDUCATION CENTER. HOMELESSNESS: COMMUNITY GRANTS PROGRAM, COMMUNITY HEALTH NAVIGATOR TO CONNECT HOMELESS PATIENTS WITH SUPPORTIVE SOCIAL SERVICES, INCLUDING HOUSING SUPPORT. YOUTH DEVELOPMENT: STEPPING STONES HEALTH CARE CAREER EXPOSURE AND MENTORING, DONATED SPACE TO THE CATHOLIC CHARITIES FOCUS 92411 COMMUNITY HOMEWORK CENTER. TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, THE HOSPITAL WILL NOT DIRECTLY ADDRESS THE FOLLOWING IDENTIFIED NEEDS: MENTAL HEALTH; SEXUALLY TRANSMITTED INFECTIONS; AND SUBSTANCE ABUSE. THE HOSPITAL CANNOT ADDRESS ALL THE HEALTH NEEDS PRESENT IN THE COMMUNITY. THEREFORE, IT WILL CONCENTRATE ON THOSE HEALTH NEEDS THAT CAN MOST EFFECTIVELY BE ADDRESSED GIVEN THE ORGANIZATION'S AREAS OF FOCUS AND EXPERTISE. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, AND 16C HTTPS://WWW.DIGNITYHEALTH.ORG/SOCAL/LOCATIONS/SAN-BERNARDINO/PATIENTS-AND- VISITORS/FOR-PATIENTS/BILLING-PAYMENT-FINANCIAL-SERVICES/FINANCIAL-ASSISTA NCE SCHEDULE H, PART V, SECTION B, LINE 16J ADDITIONAL MEASURES TAKEN TO PUBLICIZE DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY INCLUDE THE PROVISION OF BROCHURES EXPLAINING AVAILABLE GOVERNMENT SPONSORED PROGRAMS AND THE FINANCIAL ASSISTANCE POLICY, A COPY OF THE FINANCIAL ASSISTANCE APPLICATION, A TELEPHONE NUMBER FOR PATIENTS TO REQUEST FURTHER INFORMATION ABOUT THE PROGRAM, AVAILABLITY OF INFORMATION IN LANGUAGES OTHER THAN ENGLISH, CONTACT INFORMATION FOR FINANCIAL COUNSELORS OR OTHER REPRESENTATIVES WHO CAN PROVIDE INFORMATION. THE FACILITY'S WEB SITE ALSO CONTAINS THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY OF THE POLICY, APPLICATION, BILLING AND COLLECTION POLICY, A DESCRIPTION OF THE AMOUNT GENERALLY BILLED AND A LISTING OF PROVIDERS AT EACH FACILITY THAT ARE COVERED AND NOT COVERED BY THE FINANICAL ASSISTANCE POLICY. CONTACT INFORMATION CAN ALSO BE FOUND ON THE FACILITY'S WEB PAGE. THE POLICYS PLAIN LANGUAGE SUMMARY IS INCLUDED IN THE HOSPITALS ANNUAL COMMUNITY BENEFIT REPORT WHICH IS WIDELY AVAILABLE TO THE PUBLIC ONLINE, AND IS SHARED WITH THE HOSPITALS COMMUNITY HEALTH/COMMUNITY BENEFIT COMMITTEE WHICH INCLUDES COMMUNITY REPRESENTATIVES. 1 Community Convalescent Center 1676 Medical Center Drive San Bernardino CA 92411 SKILLED NURSING Schedule H, Part I, Line 7 FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, CHSB USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO THE PATIENT LEVEL. THE COST ACCOUNTING SYSTEM ALGORITHM ALLOCATES TOTAL OPERATING EXPENSES TO THE PROCEDURE CHARGE CODE LEVEL BASED UPON AN RVU FOR PROCEDURES THAT HAVE BEEN STUDIED AND ASSIGNED AN RVU, OR BASED UPON A CCR FOR UNSTUDIED PROCEDURES THAT DO NOT HAVE AN RVU ASSIGNED. WHEN A CCR IS USED, THE SYSTEM CALCULATES THAT CCR ON A DEPARTMENTAL SPECIFIC BASIS AT THE HOSPITAL WHERE THE SERVICES WERE PROVIDED. THE CALCULATION IS SIMILAR TO THE WORKSHEET 2 OF SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES, EXCEPT IT IS CALCULATED ON A DEPARTMENTAL SPECIFIC BASIS, NOT IN THE AGGREGATE. THE ALLOCATED PROCEDURE CHARGE CODE LEVEL COSTS ARE THEN ROLLED UP TO THE PATIENT LEVEL BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH THOSE SERVICES PROVIDED TO EACH SPECIFIC PATIENT. THIS IS DONE FOR ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF CHARITY CARE IS CALCULATED BY APPLYING THE CCR DERIVED FROM THE COST ACCOUNTING SYSTEM ON A PER FACILITY BASIS, TO THE CHARGES INCURRED ON PATIENTS THAT QUALIFY FOR CHARITY CARE AT THE RESPECTIVE FACILITY. THE ACTUAL COST IS REPORTED FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH AND CASH AND IN-KIND DONATIONS. Schedule H, Part I, Line 7b, column (f) BEGINNING IN 2009, THE STATE OF CALIFORNIA ESTABLISHED PROVIDER FEE PROGRAMS. THESE PROGRAMS ARE FUNDED BY QUALITY ASSURANCE FEES PAID BY PARTICIPATING HOSPITALS AND MATCHING FEDERAL FUNDS. COMMUNITY HOSPITAL OF SAN BERNARDINO RECOGNIZED QUALITY ASSURANCE FEES DURING THE YEAR OF $28.64 MILLION WHICH ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO UNREIMBURSED MEDICAID (PART I, LINE 7B, COLUMN C), AND RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $95.46 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). THIS NET INCREASE IN THE COST OF THE MEDICAID PROGRAM IS DRIVING THE INCREASE IN THE OVERALL COST OF COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES WHEN COMPARED TO PRIOR YEARS. SCHEDULE H, PART I, LINE 7I INCLUDED IN CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT IS $2.34 MILLION IN GRANTS TO A FUND ESTABLISHED BY THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT") FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA, CONSISTENT WITH CHFT'S MISSION OF SUPPORTING HEALTH CARE, ASSESS TO HEALTH CARE, RESEARCH AND EDUCATION. Schedule H, Part II - Community Building Activities COMMUNITY HOSPITAL OF SAN BERNARDINO (CHSB) IS DEDICATED TO COMMUNITY BUILDING IN THE SURROUNDING NEIGHBORHOODS. CHSB STAFF HAS BEEN INTEGRAL IN A MULTI- YEAR PROCESS TO DEVELOP A COUNTYWIDE COMMUNITY VITAL SIGNS TRANSFORMATIONAL PLAN, BEGINNING WITH MULTIPLE COMMUNITY MEETINGS TO DEFINE KEY ISSUES TO DEVELOPING A MULTI-AGENCY PLAN TO LEAD CHANGE THROUGH EDUCATION, ECONOMY, ACCESS TO HEALTH & WELLNESS AND SAFETY. LASTLY, THE FOLLOWING AGENCIES ARE INVOLVED IN OUR COMMUNITY PROGRAMS: BLAIR PARK NEIGHBORHOOD ASSOCIATION, CALFRESH, CALIFORNIA STATE UNIVERSITY SAN BERNARDINO, CATHOLIC CHARITIES, COMMUNITY ACTION PARTNERSHIP UTILITIES ASSISTANCE (CAPSB), DEPARTMENT OF PUBLIC HEALTH, FAMILY RESOURCE CENTER, FONTANA COMMUNITY ASSISTANCE PROGRAM (CAP), HOME OF NEIGHBORLY SERVICE, HOUSING AUTHORITY, LATINO HEALTH COLLABORATIVE, MARY'S TABLE, MEXICAN CONSULATE, PREGNANCY RESOURCE CENTER, SAN BERNARDINO ADULT SCHOOL, SAN BERNARDINO COUNTY SEXUAL ASSAULT SERVICES, SAN BERNARDINO HIGH SCHOOL, VERONICA'S HOME OF MERCY AND VICTOR COMMUNITY SUPPORT SERVICES. SCHEDULE H, PART III, LINE 2 THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE ABOVE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. AS NOTED IN PART I, LINE 3, CHSB PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS THAT FALL INTO THREE CATEGORIES; UNDER 200%, 201%-350% OR 351%-500% OF THE FEDERAL POVERTY LEVEL. DIGNITY HEALTH ALSO PROVIDES PATIENTS OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL DIGNITY HEALTH FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT OF 30%. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 3 CHSB MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. CHSB FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. DIGNITY HEALTH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT NO SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE WERE REPORTED AS BAD DEBT. AS SUCH, CHSB DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. Schedule H, Part III, Line 4 THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2018, RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCES FOR CHARITY AND DOUBTFUL ACCOUNTS: PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNT FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED. CHSB MANAGES ITS COLLECTION RISK BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES. RESERVES FOR CHARITY AND UNCOLLECTIBLE AMOUNTS HAVE BEEN ESTABLISHED AND ARE NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE IN THE CONSOLIDATED BALANCE SHEET. Schedule H, Part III, Line 8 CHSB PREPARES MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR THE INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. Schedule H, Part III, Line 9b AT TIME OF PATIENT BILLING, CHSB PROVIDES TO ALL PATIENTS INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED. INFORMATION PROVIDED INCLUDES PATIENT FINANCIAL ASSISTANCE INFORMATION, UNINSURED PATIENT DISCOUNT INFORMATION, INFORMATION REGARDING ELIGIBILITY ASSISTANCE FOR GOVERNMENT-SPONSORED HEALTHCARE AND PAYMENT ASSISTANCE. CHSB ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. CHSB'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHOM THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF CHSB OR THE BILLING COMPANY RETAINED BY CHSB IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER CHSB'S PATIENT FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, CHSB WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. LEGAL ACTION WILL NOT BE PURSUED TO COLLECT DEBTS FROM PATIENTS WHO HAVE QUALIFIED FOR CHARITY OR ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DEBT. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY CHSB. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNTS TO A COLLECTION AGENCY, CHSB REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. Schedule H, Part VI, Line 2 - Needs Assessment CALIFORNIA'S COMMUNITY BENEFIT LAW (SB 697) CREATED A PROCESS FOR CHSB TO DETERMINE ITS COMMUNITYS HEALTH NEEDS AND TO PLAN TO HELP ADDRESS THEM. THESE CALIFORNIA REQUIREMENTS ARE FULFILLED IN CONJUNCTION WITH THE NEEDS ASSESSMENT MANDATED BY THE AFFORDABLE CARE ACT AND REPORTED ON ABOVE. THE CHNA CONTINUES TO BE A FOCAL POINT AND AN ESSENTIAL TOOL IN DEVELOPING THE STRATEGIC DIRECTION OF CHSB. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for ASSISTANCE COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: INFORMATION ABOUT DIGNITY HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS THE HOSPITAL MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES THE HOSPITAL SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT ALL UNINSURED PATIENTS RECEIVE AN UNINSURED DISCOUNT OF 30%, AND THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION OR WITH PROMPT PAYMENT. FINANCIAL ASSISTANCE INFORMATION, GOVERNMENT PROGRAM RESOURCE INFORMATION, TOOLS TO ASSIST PATIENTS IN FINDING HEALTH COVERAGE, ANSWERS TO FREQUENTLY ASKED BILLING QUESTIONS, AND OTHER SUCH INFORMATION CAN ALSO BE FOUND ON DIGNITY HEALTH'S WEBSITE AT WWW.DIGNITYHEALTH.ORG. AT THE POINT OF REGISTRATION, BROCHURES ARE MADE AVAILABLE TO ALL PATIENTS EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. COPIES OF THE FINANCIAL ASSISTANCE APPLICATION ARE MADE AVAILABLE TO ALL UNINSURED PATIENTS IN ADDITION TO THE BROCHURE UPON ADMISSION TO THE FACILITY. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO UNINSURED PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED, A STATEMENT INFORMING PATIENTS WITHOUT INSURANCE COVERAGE THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED FINANCIAL ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR FINANCIAL ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF DIGNITY HEALTH INCLUDES LANGUAGE REQUIRING ALL INITIAL STATEMENTS TO UNINSURED PATIENTS INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. ALSO, ANY MEMBER OF CHSB FACILITY STAFF OR MEDICAL STAFF MAY MAKE REFERRALS OF PATIENTS FOR FINANCIAL ASSISTANCE. THE PATIENT OR A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE. Schedule H, Part VI, Line 4 - Community Information COMMUNITY HOSPITAL OF SAN BERNARDINO SERVES A BROAD AND DIVERSE POPULATION RESIDING IN MULTIPLE ZIP CODES, AS IT SERVES AS A REGIONAL REFERRAL FOR HEART PROCEDURES. WHILE A FEW OF THE ZIP CODE COMMUNITIES ENJOY A HIGHER STANDARD OF LIVING, THE MAJORITY OF THE COMMUNITIES SERVED ARE HIGH NEED. SEVENTY-FIVE PERCENT (75%) OF DISCHARGES COME FROM SEVENTEEN (17) ZIP CODES CONCENTRATED IN THE FOLLOWING CITIES: BLOOMINGTON, COLTON, FONTANA, HESPERIA, HIGHLAND, RIALTO, SAN BERNARDINO, AND VICTORVILLE. TOTAL POPULATION: 887,392 RACE/ETHNICITY: WHITE - NON-HISPANIC 16.2%; BLACK/AFRICAN AMERICAN - NON-HISPANIC 9.6%; HISPANIC OR LATINO 67.3%; ASIAN/PACIFIC ISLANDER 4.6%; ALL OTHERS 2.3% MEDIAN INCOME: $55,073 UNEMPLOYMENT: 7.3% NO HIGH SCHOOL DIPLOMA: 28.8% MEDICAID: 36.7% UNINSURED: 10.2% OTHER AREA HOSPITALS: 5 MANY OF THE NEIGHBORHOODS SERVED HAVE BEEN FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA (MUA). PORTIONS OF THE FOLLOWING ZIP CODES SERVED BY THE HOSPITAL FALL IN A MUA: 92401, 92404, 92405, 92335 AND 92336. Schedule H, Part VI, Line 5 - Promotion of Community Health A MAJORITY OF THE CHSB'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS NOR CONTRACTORS OF THE HOSPITAL. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. CHSB RECOGNIZES THE IMPORTANCE OF COMMUNITY HEALTH AND PROMOTES COMMUNITY HEALTH BEYOND THE WALLS OF THE HOSPITAL THROUGH A VARIETY OF METHODS: COMMUNITY EDUCATION CLASSES ON A VARIETY OF TOPICS ARE OFFERED FREE OF CHARGE THROUGHOUT THE YEAR TO COMMUNITY MEMBERS; REFERRALS TO APPROPRIATE SOCIAL AGENCIES ARE MADE TO THOSE SEEKING ASSISTANCE; FREE FLU SHOTS; COLLABORATION WITH A VARIETY OF NON-PROFIT AGENCIES SHARING A MISSION OF HEALTH, ENVIRONMENT AND SOCIAL WELFARE INCLUDING FINBANCIAL ASSISTANCE TO SOME OF THESE AGENCIES THROUGH THE DIGNITY HEALTH COMMUNITY GRANTS PRORAM; ACTIVE MEMBERSHIP ON ST. BERNARDINE MEDICAL CENTER'S COMMUNITY BENEFIT INITIATIVE COMMITTEE (CBIC) WHERE INPUT FROM KEY COMMUNITY STAKEHOLDERS IS CRITICAL IN REVIEWING THE NEEDS OF THE COMMUNITY AND ASSIST IN ESTABLISHING HEALTH PRIORITIES AND GOALS. CHSB REINVESTS ALL ITS OPERATING AND INVESTMENT INCOME IN HOSPITAL IMPROVEMENTS, TECHNOLOGY ENHANCEMENTS, COMMUNITY HEALTH PROGRAMS, AND EMPLOYEE BENEFITS. THIS ACTIVE REINVESTMENT MAKES IT POSSIBLE FOR US TO DELIVER ON OUR MISSION, INCLUDING ENSURING THAT EVERYONE HAS ACCESS TO HEALTH CARE. Schedule H, Part VI, Line 6 - Affiliated Health Care System CHSB IS AFFILIATED WITH DIGNITY HEALTH. AFFILIATES OF DIGNITY HEALTH ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN BAKERSFIELD, SAN BERNARDINO, SAN FRANCISCO, SAN ANDREAS, AND GRASS VALLEY/NEVADA CITY, CALIFORNIA. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. THE SUMMARY OF TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE FOR DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS FOR THE YEAR ENDED JUNE 30, 2018, IS AS FOLLOWS: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 85,916 108,592,000 0.8% Unpaid Costs of Medicaid/Medi-Cal 1,739,745 555,935,000 4.1% Other Means-tested Programs 13,398 13,971,000 0.1% Community Services: Community Health Services 317,655 23,099,000 0.2% Health Professions Education 14 209,000 0.0% Subsidized Health Services 26,310 3,432,000 0.0% Donations 100,355 39,204,000 0.3% Community Building Activities 2,657 4,468,000 0.0% Community Benefit Operations 1,446 9,166,000 0.1% Total Community Services for the poor 448,437 79,578,000 0.6% Total Benefits for the Poor 2,287,496 758,076,000 5.6% Benefits for the Broader Community: Community Services: Community Health Services 235,185 12,634,000 0.1% Health Professions Education 18,906 98,392,000 0.7% Subsidized Health Services 418 631,000 0.0% Research 284 10,954,000 0.1% Donations 32,055 3,204,000 0.1% Community Building Activities 13,295 3,702,000 0.0% Community Benefit Operations 4,836 1,028,000 0.0% Total Benefits for the Broader Community 304,979 130,545,000 0.9% Total Community Benefits 2,592,475 888,621,000 6.5% Unpaid Costs of Medicare 1,412,924 1,213,419,000 8.9% Total Community Benefits including Unpaid Cost of Medicare 4,005,399 2,102,040,000 15.4% true Dignity Health 1980 Orange Tree Lane Redlands CA 92374 941196203 501(c)(3) 567583 N/A N/A COMMUNITY HEALTH Community Hospital Foundation of San Bernardino 1805 Medical Center Drive San Bernadino CA 92411 953051931 501(c)(3) 215710 N/A N/A Foundation Support Dignity Health Foundation-inland Empire 2101 N Waterman Avenue San Bernardino CA 92404 237440086 501(C)(3) 23560 N/A N/A Foundation Support California Health Foundation Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 2343927 N/A N/A Community Health Central Neighborhood Health Foundation 714 W Olympic Boulevard Suite 801 Los Angeles CA 90011 752986675 501(c)(3) 187500 n/a n/a Community Health 5 0 Cash Assistance - Patient Assistance 30 26323 0 N/A N/A Part I, Line 2 THE HOSPITAL USES A SOFTWARE PACKAGE TO DOCUMENT GRANT FUNDING, TO MONITOR AND REPORT PROGRAM OUTCOMES AND TO FORMULATE CRITERIA FOR GRANT SELECTIONS. true true false false false false false false false Mary Connick Director 0 427189 0 463139 0 317711 0 78836 0 46385 0 1333260 0 307671 Gary Greensweig DO Director 0 463507 0 353497 0 14186 0 73860 0 59301 0 964351 0 0 Julie Sprengel Director 0 625735 0 402025 0 12699 0 89463 0 13933 0 1143855 0 0 Bruce Swartz Director 0 467663 0 495135 0 27306 0 84476 0 36319 0 1110899 0 0 Rachelle Wenger Director 0 141624 0 33701 0 1008 0 19209 0 17773 0 213315 0 0 June Collison Hospital President 0 381829 0 312587 0 17735 0 63259 0 23214 0 798624 0 0 David J Evans VP/CFO 224432 0 67131 0 11988 0 31335 0 27447 0 362333 0 0 0 Rosilyn Nolan CNE 192369 0 42481 0 13219 0 22610 0 20043 0 290722 0 0 0 Victoria Selby VP of Ancillary & Support Serv 210722 0 62525 0 1858 0 21630 0 26696 0 323431 0 0 0 Marc Marchetti Service Area Executive Directo 202902 0 48769 0 3877 0 27775 0 27785 0 311108 0 0 0 Marie R Orpilla CNIII 221317 0 1710 0 4665 0 21579 0 27575 0 276846 0 0 0 Lynda Castro Controller 166509 0 36899 0 18428 0 22580 0 26738 0 271154 0 0 0 Arlene P Landero CNII 211404 0 1548 0 2884 0 20435 0 27160 0 263431 0 0 0 Patricia Womack Director of Pharmacy 223935 0 64094 0 1608 0 28317 0 3789 0 321743 0 0 0 Darryl VandenBosch Former Officer 0 54987 0 0 0 635392 0 12527 0 16617 0 719523 0 0 Jack Ivie Former Officer 0 187924 0 0 0 592275 0 23228 0 13795 0 817222 0 146470 Schedule J, Part I, Line 3 ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S PRESIDENT'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION. Schedule J, PART I, LINE 4a CERTAIN LISTED PERSONS PARTICIPATE IN A SEVERANCE PLAN ESTABLISHED BY ITS SUPPORTED ORGANIZATION. THE PLAN PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 1 MONTH TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. PAYMENTS MADE UNDER THIS PLAN OCCURED DURING 2017 FOR TWO FORMER OFFICERS; D. VANDENBOSCH; $589,168, AND J. IVIE; $355,632. Schedule J, PART I, LINE 4b CERTAIN OFFICERS AND KEY EMPLOYEES PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1, 2008. PAYMENTS PURSUANT TO THE PLAN ARRANGEMENTS WERE MADE TO ONE FORMER OFFICER, WHO WAS A DIGNITY HEALTH EMPLOYEE, J. IVIE; $146,470. CERTAIN LISTED PERSONS ARE ELIGIBLE TO PARTICIPATE IN NON-QUALIFIED 457(F) PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES HIRED PRIOR TO JUNE 30, 2006. THE BENEFIT IS INTENDED TO BRIDGE THE DIFFERENCE, IF ANY, BETWEEN THE BENEFIT PROVIDED UNDER THE DIGNITY HEALTH EXCESS BENEFIT PLAN HAD BENEFIT SERVICE NOT BEEN FROZEN AT JANUARY 1, 2008, AND THE BENEFITS PROVIDED FROM ALL OTHER QUALIFIED AND NON-QUALIFIED PLANS. BENEFITS VEST UNDER THIS 457(F) PLAN AT THE LATER OF THE DATE THE PARTICIPANT ATTAINS AGE 62 OR IS CREDITED WITH 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES, PRIMARILY THOSE WHO ARE NOT ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN OR THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN DESCRIBED ABOVE. THIS BENEFIT PROVIDES AN ANNUAL ACCRUAL OF 10% OF TOTAL COMPENSATION AND IS PAYABLE ANNUALLY ON JULY 1 ONCE VESTED, WHICH IS AGE 62 WITH 5 YEARS OF SERVICE; THE PLAN ALSO ALLOWS FOR SPECIAL AWARDS. PAYMENTS PURSUANT TO THE PLAN ARRANGEMENTS WERE MADE TO ONE BOARD MEMBER, WHO IS A DIGNITY HEALTH EMPLOYEE, M. CONNICK; $307,671. COMPENSATION AMOUNTS FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR ACCRUED (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)). PART II - SUPPLEMENTAL DISCLOSURES THE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE DIGNITY HEALTH TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES DIGNITY HEALTH SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND DIGNITY HEALTH'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2017. A California Health Facilities Financing Authority 521598225 13033FTN0 2004-05-19 150000000 BOND A: CUSIP 13033FTN0 - SEE PART false false true A 0 0 2000000 0 0 0 0 0 0 2000000 0 0 2005 false false true true A false true true true true true 0.02900 0.00000 0.02900 false false 0.00000 false true A false false false true true false 0 false 0 true true A true BOND A: CUSIP 13033FTN0 PART I, COLUMN (C) THE CHFFA 2004 SERIES J BONDS WERE EXCHANGED IN NOVEMBER 2009 FOR THE CHFFA 2009 SERIES H BONDS IN AN EXCHANGE PURSUANT TO NOTICE 2008-41 THAT WAS NOT TREATED AS A NEW ISSUANCE FOR PURPOSES OF SECTIONS 103 AND 141-150 OF THE INTERNAL REVENUE CODE. PART I, COLUMN (E) THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND PART II, LINE 3 IS PRIMARILY A RESULT THAT THE COMPOSITE BOND ISSUE WAS A POOLED FINANCING ISSUE. THE FULL ISSUE PRICE OF WHICH IS SHOWN IN PART I, COLUMN (E). IN COMPARISON, THE AMOUNT OF PROCEEDS SHOWN IN PART II, LINE 3 REFLECTS ONLY THE PORTION OF THE BOND ISSUE BORROWED BY COMMUNITY HOSPITAL OF SAN BERNARDINO AND CURRENTLY OUTSTANDING. A SMALL PART OF THE DIFFERENCE BETWEEN THE ISSUE PRICE AND PROCEEDS IS DUE TO INVESTMENT EARNINGS. PART I, COLUMN (F) FINANCE ACQUISITION OF MEDICAL EQUIPMENT AND CONSTRUCTION AND RENOVATION OF HOSPITAL FACILITIES. PART II, LINE 3 IN MAY 2013, ALL OF THE LOANS ORIGINATED WITH PROCEEDS OF THE BONDS MATURED AND WERE REPAID TO THE ISSUER. OF SUCH REPAYMENTS, COMMUNITY HOSPITAL OF SAN BERNARDINO BORROWED THE SUM OF $2,000,000 TO FINANCE THE CONSTRUCTION/RENOVATION OF FACILITIES AND THE ACQUISITION OF MEDICAL EQUIPMENT AT VARIOUS HOSPITALS. ALTHOUGH THE FACILITIES ORIGINALLY FINANCED WITH PROCEEDS OF THE BONDS WERE SUBSTANTIALLY COMPLETED IN THE YEAR INDICATED, REPAYMENTS OF THE LOANS ORIGINATED WITH PROCEEDS OF THE BONDS WERE AND/OR WILL BE RECYCLED INTO NEWLY ORIGINATED LOANS CONTINGENT ON DEMAND BY PARTICULAR BORROWERS AT THE TIME OF A LOAN REPAYMENT. COMPLETION DATES OF PROJECTS FINANCED OR TO BE FINANCED WITH SUCH RECYCLED AMOUNTS ARE NOT INDICATED. PART IV, LINE 2C THE MOST RECENT REBATE COMPUTATION DATE WAS 6/30/2016. FORM 990, PART I, LINE 7a PART I, LINE 7a INCLUDES SECTION 512(A)(7) QUALIFIED TRANSPORTATION FRINGE BENEFIT AMOUNTS THAT ARE NOT REVENUE AND THEREFORE NOT REPORTED ON FORM 990. FORM 990, PART VI, SECTION A, LINE 2 B. SWARTZ, G. GREENSWEIG - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A DIGNITY HEALTH, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY HEALTH BOARD APPROVES NEW BOARD MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBER INCLUDE: ADOPTION OF MISSION & PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; DISSOLUTION OF THE CORPORATION, ACQUIRE ANOTHER CORPORATION, OR CREATE A SUBSIDIARY; MERGING OR CONSOLIDATING WITH ANOTHER CORPORATION; PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE; INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS; RATIFICATION OF BOARD MEMBER APPOINTMENTS & DISMISSALS; SELECTION OR REMOVAL OF INDEPENDENT AUDITORS; TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CFO WORKED CLOSELY WITH THE PARENT ORGANIZATION AND AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. THE BOARD OF DIRECTORS HAS DELEGATED THE REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE. MANAGEMENT PRESENTED THE DRAFT OF THE FORM 990 TO THE FINANCE COMMITTEE. THE DRAFT WAS COMPLETE EXCEPT IT EXCLUDED COMPENSATION INFORMATION FOR DIRECTORS WHO ARE ALSO KEY EXECUTIVES OF DIGNITY HEALTH, THE FILING ORGANIZATION'S SOLE MEMBER. COMPENSATION BY DIGNITY HEALTH TO THOSE DIRECTORS HAS BEEN REVIEWED BY THE COMPENSATION AND BENEFITS COMMITTEE OF THE DIGNITY HEALTH BOARD OF DIRECTORS. SUBSEQUENT TO ITS REVIEW, THE FINANCE AND INVESTMENT COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS REVIEW AND PROVIDED A DRAFT TO THE BOARD OF DIRECTORS, AGAIN EXCLUDING COMPENSATION FOR CERTAIN DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. UNDER SUCH POLICIES, THE EVP/GENERAL COUNSEL IS DESIGNATED AS THE ORGANIZATION'S FILING OFFICER AND RESPONSIBLE FOR COLLECTING, REVIEWING AND VALIDATING ANNUAL DISCLOSURES OF ALL COVERED PERSONS INCLUDING THE MEMBERS OF DIGNITY HEALTH'S GOVERNING BODIES INCLUDING ITS BOARD OF DIRECTORS AND BOARD COMMITTEES, AS WELL AS DIGNITY HEALTH'S OFFICERS AND EXECUTIVE LEADERS, KEY EMPLOYEES, MANAGEMENT PERSONNEL AT THE VICE PRESIDENT LEVEL AND ABOVE, AND ANY OTHER PERSONNEL DESIGNATED BY THE FILING OFFICER ("COVERED PERSONS"). ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS ARISING FROM THE BUSINESS, OWNERSHIP, FINANCIAL AND PERSONAL INTERESTS HELD BY SUCH COVERED PERSONS OR THEIR FAMILY MEMBERS. COVERED PERSONS ARE REQUIRED TO DISCLOSE TO THEIR SUPERVISORS AND TO RELEVANT DECISION MAKERS ANY INTEREST THAT MAY PRESENT A CONFLICT OF INTEREST, OR THE APPEARANCE OF A CONFLICT OF INTEREST. SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON (E.G. UPON HIRING OR UPON PROMOTION), AND ANNUALLY THEREAFTER. AS PART OF THE ANNUAL DISCLOSURE SURVEY CONDUCTED PURSUANT TO THE COI POLICIES, EACH COVERED PERSON IS REQUIRED TO CERTIFY THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE COI POLICY OR COI POLICIES APPLICABLE TO HIS/HER POSITION; (2) HAS READ THE COI POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE COI POLICIES, INCLUDING COMPLETING THE CONFLICTS OF INTEREST DISCLOSURE SURVEY AS REQUIRED BY THE COI POLICIES. USING THE INFORMATION FROM THE ANNUAL DISCLOSURE SURVEY, THE FILING OFFICER PREPARES ANNUAL REPORTS OF REPORTED CONFLICTS OF INTEREST AND DISTRIBUTES THOSE REPORTS TO THE GOVERNING BODY CHAIRS, INCLUDING THE CHAIR OF THE BOARD OF DIRECTORS AND THE CHAIR OF DIGNITY HEALTH BOARD COMMITTEES, AS WELL AS TO KEY LEADERS OF THE ORGANIZATION TO ENABLE THE RESPONSIBLE INDIVIDUALS TO MONITOR AND MANAGE DISCLOSED CONFLICTS OF INTEREST AND ASSURE DECISIONS ARE MADE IN THE ORGANIZATION'S BEST INTERESTS. THE PROCEDURES FOR ADDRESSING A CONFLICT OF INTEREST RELATED TO A PROPOSED TRANSACTION IN THE CASE OF GOVERNING BODIES INCLUDE, BUT ARE NOT LIMITED TO: (1) THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST IS FULLY DISCLOSED TO THE APPLICABLE GOVERNING BODY AND ANY OTHER RELEVANT DECISION-MAKERS; (2) THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL LEAVE THE MEETING; (3) THE INTERESTED PERSON MAY BE EXCLUDED FROM THE DISCUSSION AND MUST BE EXCUSED FROM THE MEETING PRIOR TO AND DURING THE APPROVAL OF SUCH TRANSACTION; (4) IF WARRANTED, ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, AND COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) THE TRANSACTION OR ACTION IS APPROVED BY A MAJORITY OF DISINTERESTED MEMBERS OF THE GOVERNING BODIES, CONSISTENT WITH ANY REQUIREMENTS OF BYLAWS AND COI POLICIES; AND (6) ANY CONFLICTING ISSUES ARISING DURING THE COURSE OF A GOVERNING BODY MEETING WHICH CANNOT BE RESOLVED MAY BE REFERRED TO AN INDEPENDENT COMMITTEE OF THE APPLICABLE GOVERNING BODY. THERE ARE SIMILAR CONFLICTS OF INTEREST PROVISIONS UNDER DIGNITY HEALTH'S STANDARDS OF CONDUCT, WHICH ARE APPLICABLE TO ALL EMPLOYEES AND WHICH ARE ADMINISTERED BY THE VP/CORPORATE COMPLIANCE OFFICER WHO HAS REPORTING RESPONSIBILITY TO THE PRESIDENT/CEO AS WELL AS TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION EMPLOYS PERSONNEL; HOWEVER, THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IS SET BY A RELATED ORGANIZATION, DIGNITY HEALTH. FOR 2017, DIGNITY HEALTH'S HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EXECUTIVES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES OUTSIDE LEGAL COUNSEL AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF DIRECTORS. THE DOCUMENTATION OF THE DELIBERATIONS INCLUDES (A) THE TERMS OF THE TRANSACTION APPROVED AND THE DATE APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED TRANSACTION AND THOSE WHO VOTED ON IT; AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. FORM 990, PART VI, SECTION B, LINE 15B FOR 2017 COMPENSATION, THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF KEY EMPLOYEES. THE COMPENSATION FOR THESE INDIVIDUALS WAS BASED ON THE QUALIFICATION AND EXPERIENCE OF THE CANDIDATES. COMPENSATION IS ALSO REVIEWED ANNUALLY AS PART OF THE MERIT INCREASE PROCESS. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE ON THE HOSPITAL WEBSITE AND UPON REQUEST. FORM 990, PART VII, SECTION A DR J MAWAD AND DR H DEJAGER RECEIVED COMPENSATION FOR PHYSICIAN SERVICES PROVIDED TO THE FILING ORGANIZATION. M CONNICK, G GREENSWEIG, J SPRENGEL, B SWARTZ, R WENGER, J COLLISON, D VANDENBOSCH AND J IVIE RECEIVED COMPENSATION FOR SERVICES PROVIDED TO A RELATED ORGANIZATION, DIGNITY HEALTH. FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL FEES TOTAL FEES:11707714 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:10616865 FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS AND MAINTENANCE TOTAL FEES:5075813 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:1403436 FORM 990 PART IX LINE 11G DESCRIPTION:STORAGE TOTAL FEES:3285399 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:785883 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:1445476 FORM 990 PART IX LINE 11G DESCRIPTION:REVENUE CYCLE SERVICES TOTAL FEES:6056851 Community Hospital Foundation 1805 Medical Center Drive San Bernardino CA 92411 953051931 Fund Raising CA 501(c)(3) 12; Type I CHSB true DIGNITY HEALTH 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false false true true false false false false false false false false false true false false false false false false COMMUNITY HOSPITAL SAN BERNARDINO FOUNDATION C 260183 CASH COMMUNITY HOSPITAL SAN BERNARDINO FOUNDATION C 14576 NONCASH COMMUNITY HOSPITAL SAN BERNARDINO FOUNDATION B 215710 SEE PART VII Schedule R, Part V, line 2 COMMUNITY HOSPITAL OF SAN BERNARDINO (CHSB) IS SUPPORTED BY ONE FOUNDATION. AS A SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES FOR THE BENEFIT OF, TO RAISE FUNDS FOR, OR TO CARRY OUT THE PURPOSES OF CHSB. AS A RESULT, PAYMENTS ARE MADE DIRECTLY TO CHSB FROM THE FOUNDATION OR DIRECTLY TO THE FOUNDATION FROM CHSB. AMOUNT REPORTED UNDER TRANSACTION TYPE "B" REPRESENT FUNDS EXPENDED BY CHSB ON BEHALF OF THE FOUNDATION FOR OPERATIONAL EXPENSES. AMOUNT REPORTED AS TRANSACTION TYPE "C" REPRESENT FUNDS, BOTH CASH AND IN-KIND, RECEIVED FROM THE FOUNDATION AS GRANTS TO CHSB.