COMMUNITY HOSPITAL OF SAN BERNARDINO: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HOSPITAL OF SAN BERNARDINO (EIN 95-1643373)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-05-10
IRS object ID
201611319349302836
Schema version
2014v6.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-05-10T15:01:08-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line155 SECOND STREET SUITE 1400AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94105ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN951643373EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Community Hospital of San BernardinoBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% SHANTRA WAYNE ACCT DEPTInCareOfNm
Business Name ControlCOMMBusinessNameControlTxt
Phone7088876333PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1185 BERRY STREET SUITE 300AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94107ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVE EVANSPersonNm
Person TitleCFOPersonTitleTxt
Phone9088876333PhoneNum
Signature2016-05-10SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonVALERIE J BALLPreparerPersonNm
PTINP00178114PTIN
Phone4159635100PhoneNum
Preparation2016-05-10PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJUNE COLLISON PRESIDENTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11805 MEDICAL CENTER DRIVEAddressLine1Txt
CitySAN BERNARDINOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP92411ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$278,147,305GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CHSB.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1938FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionCommunity Hospital of San Bernardino is committed to furthering the healing ministry of Jesus, and to providing affordable health care to the community we serve.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee1578TotalEmployeeCnt
Total Volunteers150TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$1,295,962PYContributionsGrantsAmt
CY Contributions Grants$89,221CYContributionsGrantsAmt
PY Program Service Revenue$181,985,902PYProgramServiceRevenueAmt
CY Program Service Revenue$277,215,886CYProgramServiceRevenueAmt
PY Investment Income$474,370PYInvestmentIncomeAmt
CY Investment Income$105,439CYInvestmentIncomeAmt
PY Other Revenue$1,705,389PYOtherRevenueAmt
CY Other Revenue$736,759CYOtherRevenueAmt
PY Total Revenue$185,461,623PYTotalRevenueAmt
CY Total Revenue$278,147,305CYTotalRevenueAmt
PY Grants And Similar Paid$2,180,494PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$3,389,285CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$124,714,445PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$133,751,323CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$76,253,011PYOtherExpensesAmt
CY Other Expenses$114,088,522CYOtherExpensesAmt
PY Total Expenses$203,147,950PYTotalExpensesAmt
CY Total Expenses$251,229,130CYTotalExpensesAmt
PY Revenues Less Expenses-$17,686,327PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$26,918,175CYRevenuesLessExpensesAmt
Total Assets BOY$65,831,563TotalAssetsBOYAmt
Total Assets EOY$124,237,036TotalAssetsEOYAmt
Total Liabilities BOY$149,097,605TotalLiabilitiesBOYAmt
Total Liabilities EOY$180,584,903TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$83,266,042NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$56,347,867NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionCOMMUNITY 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$216,880,687ExpenseAmt
Grant$3,389,285GrantAmt
Revenue$277,215,886RevenueAmt
DescCOMMUNITY 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 455 BEDS AND CURRENTLY HAS 403 BEDS AVAILABLE. THE HOSPITAL HAD 91,463 TOTAL PATIENT DAYS, 14,244 ADMISSIONS, AND 63,283 EMERGENCY ROOM VISITS. INPATIENT SERVICES: ACUTE PATIENT CARE; MATERNAL CHILD CARE; MENTAL HEALTH CARE; NEUROLOGICAL CARE; AND A VARIETY OF OUTPATIENT CARE.Desc
Total Program Service Expenses$216,880,687TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsYes (true)InvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document167IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1578EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSHANTRA WAYNE ACCT DEPTPersonNm
Phone6022171894PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13033 NORTH 3RD AVENUEAddressLine1Txt
CityPHOENIXCityNm
State AbbreviationAZStateAbbreviationCd
ZIP85013ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Steven Barron
Director1.040.0Yes (X)$0$1,387,187$127,377
Alvaro Bolivar MD
Ex-officio Director40.00.0Yes (X)$169,100$0$0
Claudia M Davis PhD
Director1.00.0Yes (X)$0$0$0
Bruce Ermann MD
Director (thru 1/31/15)1.040.0Yes (X)$0$491,357$37,020
Richard Gonzalez Esq
Director1.00.0Yes (X)$0$0$0
Gary Greensweig DO
Director1.040.0Yes (X)$0$522,717$70,152
Albert Karnig PhD
Director1.00.0Yes (X)$0$0$0
Vicki R Lee
Director1.00.0Yes (X)$0$0$0
Deisell Martinez PhD
Director1.00.0Yes (X)$0$0$0
Joe M Mawad MD
Director4.50.0Yes (X)$93,048$0$0
Vellore Muraligopal MD
Director (thru 1/31/15)1.00.0Yes (X)$0$0$0
Tony Myrell
Director1.00.0Yes (X)$0$0$0
Nitin Nanda MD
Director (thru 3/30/15)1.00.0Yes (X)$0$0$0
Frank Schnetz
Director1.00.0Yes (X)$0$0$0
Bruce Swartz
Director1.040.0Yes (X)$0$844,605$93,187
Rachelle Wenger
Director1.040.0Yes (X)$0$173,616$38,296
Susan Whitten
Director (thru 1/5/15)1.040.0Yes (X)$0$629,959$91,548
Peggy Merryman
Secretary (thru 6/30/15)1.00.0Yes (X)$0$0$0Yes (X)
Marvin Reiter CPA
Chairman (thru 6/30/15)1.00.0Yes (X)$0$0$0Yes (X)
June Collison
Hospital President40.00.0$0$587,545$91,717Yes (X)
David J Evans
VP/CFO40.00.0$244,827$0$45,752Yes (X)
Darryl VandenBosch
VP/CFO (thru 2/5/15)20.020.0$0$427,830$61,986Yes (X)
Kimiko Ford
VP of Ancillary Services40.00.0$249,722$0$50,191Yes (X)
Victoria Selby
VP, Behavioral Health & Neuro40.00.0$242,771$0$37,715Yes (X)
Charlie J Chavez
Dir, Clinical Informatics & St40.00.0$199,618$0$25,306Yes (X)
Marc Marchetti
VP Business Development40.00.0$244,261$0$46,140Yes (X)
Rosilyn Nolan
Dir of Educ & Diab Wellness40.00.0$209,445$0$40,585Yes (X)
Darlena A Stevens
Dir Quality Management40.00.0$199,006$0$35,260Yes (X)
Patricia Womack
Director of Pharmacy40.00.0$214,257$0$25,051Yes (X)
Jack Ivie
FORMER OFFICER0.040.0$544,622$0$67,494Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,610,677TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,064,816TotReportableCompRltdOrgAmt
Total Other Compensation$984,777TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K275IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PREMIER COMMUNITY ANESTHESIA
1580 MOHAVE DRIVECOLTONCA92324Medical Services$1,550,604
AMERICAN VITALCARE LLC
680 S FOURTH STREETLOUISVILLEKY40202Medical Services$1,343,866
METROPOLITAN FAMILY MEDICAL GROUP
742 W HIGHLAND AVESAN BERNARDINOCA92405MEDICAL SERVICES$354,050
INPATIENT CONSULTANTS OF CALIFORNIA
PO BOX 844929LOS ANGELESCA900844929Medical Services$789,457
CA EMERGENCY PHYSICIAN MEDICAL GROU
2100 POWELL ST 900EMERYVILLECA94608Medical Services$392,658
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K25CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd
Related Organizations$72,588RelatedOrganizationsAmt
Government Grants$16,620GovernmentGrantsAmt
All Other Contributions$13AllOtherContributionsAmt
Noncash Contributions$40,000NoncashContributionsAmt
Total Contributions$89,221TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REV NET OF CHARITY CARE AND BAD DEBT900099$62,411,860$62,411,860
MEDICARE/MEDICAID PAYMENTS900099$213,516,377$213,516,377
MEANINGFUL USE INCENTIVES (EHR)900099$640,672$640,672
MEDICAL OFFICE BUILDING900099$636,496$636,496
EDUCATION900099$10,481$10,481
FieldValueIRS element (for citing)
Total Program Service Revenue$277,215,886TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$47,939TotalRevenueColumnAmt
Exclusion$47,939ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$57,500OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$57,500OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$57,500TotalRevenueColumnAmt
Exclusion$57,500ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
CAFETERIA900099$410,376$0$410,376
GIFT SHOPS900099$183,486$0$183,486
EMS FUNDS RECEIVED900099$97,125$0$97,125

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$45,772TotalRevenueColumnAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$45,772ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$736,759OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$278,147,305TotalRevenueColumnAmt
Related Or Exempt Func Income$277,215,886RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$842,198ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$3,389,285TotalAmt
Program Services$3,389,285ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,706,604TotalAmt
Program Services$1,601,349ProgramServicesAmt
Management And General$105,255ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$505,810TotalAmt
Program Services$505,810ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$101,832,544TotalAmt
Program Services$95,417,421ProgramServicesAmt
Management And General$6,415,123ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$4,920,157TotalAmt
Program Services$4,624,948ProgramServicesAmt
Management And General$295,209ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$17,434,954TotalAmt
Program Services$14,638,147ProgramServicesAmt
Management And General$2,796,807ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$7,351,254TotalAmt
Program Services$6,836,666ProgramServicesAmt
Management And General$514,588ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$468,497TotalAmt
Program Services$400ProgramServicesAmt
Management And General$468,097ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$68,887TotalAmt
Program Services$0ProgramServicesAmt
Management And General$68,887ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$135,191TotalAmt
Program Services$9,903ProgramServicesAmt
Management And General$125,288ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$29,311,294TotalAmt
Program Services$19,758,987ProgramServicesAmt
Management And General$9,552,307ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,094,562TotalAmt
Program Services$37,913ProgramServicesAmt
Management And General$1,056,649ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,872,658TotalAmt
Program Services$4,290,009ProgramServicesAmt
Management And General$582,649ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$12,239,188TotalAmt
Program Services$1,506,437ProgramServicesAmt
Management And General$10,732,751ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,494,650TotalAmt
Program Services$2,195,017ProgramServicesAmt
Management And General$299,633ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$204,638TotalAmt
Program Services$102,398ProgramServicesAmt
Management And General$102,240ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$169,831TotalAmt
Program Services$61,387ProgramServicesAmt
Management And General$108,444ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$7,109,793TotalAmt
Program Services$7,109,793ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,181,005TotalAmt
Program Services$2,703,854ProgramServicesAmt
Management And General$477,151ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,610,298TotalAmt
Program Services$1,610,298ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDI-CAL PROVIDER FEE$34,666,486$34,666,486$0$0
MEDICAL SUPPLIES$13,947,870$13,944,857$3,013$0
FOOD SUPPLIES$668,415$612,464$55,951$0
LICENSES AND TAXES$525,354$383,191$142,163$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,319,905TotalAmt
Program Services$873,667ProgramServicesAmt
Management And General$446,238ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$251,229,130TotalAmt
Program Services$216,880,687ProgramServicesAmt
Management And General$34,348,443ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$7,328BOYAmt
EOY$7,328EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$253,240BOYAmt
EOY$628,002EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$15,013EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$21,750,798BOYAmt
EOY$21,717,513EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,821,893BOYAmt
EOY$1,072,683EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$2,475,495BOYAmt
EOY$2,864,935EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$13,108,955BOYAmt
EOY$62,464,123EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$123,910,857LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$88,529,591LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$26,340,796BOYAmt
EOY$35,381,266EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$39,808BOYAmt
EOY$52,923EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$33,250BOYAmt
EOY$33,250EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$65,831,563BOYAmt
EOY$124,237,036EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$16,198,384BOYAmt
EOY$30,279,340EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,000,000BOYAmt
EOY$2,000,000EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$672,704EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$130,899,221BOYAmt
EOY$147,632,859EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$149,097,605BOYAmt
EOY$180,584,903EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$83,266,042BOYAmt
EOY-$56,347,867EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$83,266,042BOYAmt
EOY-$56,347,867EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$65,831,563BOYAmt
EOY$124,237,036EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$26,918,175ReconcilationRevenueExpnssAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$135,191OtherActivitiesAmt
Total Lobbying Expenditures$135,191TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1iFormAndLineReferenceDesc
ExplanationLOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA $7,439 AMERICAN HOSPITAL ASSOCIATION $1,111 CALIFORNIA HOSPITAL ASSOCIATION $58,643 PEACH INC $66,600 CATHOLIC HEALTH ASSOCIATION $1,138 340B HEALTH (FORMERLY SAFETY NET HOSPITALS) $96 ASHP $164 __________ Total $ 135,191 ==========ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$799,341OtherCostOrOtherBasisAmt
Book Value$799,341BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$76,228,675OtherCostOrOtherBasisAmt
Depreciation$65,383,066DepreciationAmt
Book Value$10,845,609BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$31,599,421OtherCostOrOtherBasisAmt
Depreciation$22,885,095DepreciationAmt
Book Value$8,714,326BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,283,420OtherCostOrOtherBasisAmt
Depreciation$261,430DepreciationAmt
Book Value$15,021,990BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$35,381,266TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DUE TO RELATED PARTIES$143,645,396
PENSION PAYABLE$3,071,658
OTHER NON-CURRENT LIABILITY$915,805
FieldValueIRS element (for citing)
Total Liability$147,632,859TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTEFormAndLineReferenceDesc
ExplanationDIGNITY HEALTH REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other500.DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served516PersonsServedCnt
Total Community Benefit Expns$3,043,707TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,043,707NetCommunityBenefitExpnsAmt
Total Expense0.01210TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served63759PersonsServedCnt
Total Community Benefit Expns$189,151,942TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$220,350,962DirectOffsettingRevenueAmt
Net Community Benefit Expns-$31,199,020NetCommunityBenefitExpnsAmt
Total Expense0.12430TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Persons Served36PersonsServedCnt
Total Community Benefit Expns$316,894TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$152,477DirectOffsettingRevenueAmt
Net Community Benefit Expns$164,417NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served64311PersonsServedCnt
Total Community Benefit Expns$192,512,543TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$220,503,439DirectOffsettingRevenueAmt
Net Community Benefit Expns-$27,990,896NetCommunityBenefitExpnsAmt
Total Expense0.11150TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs14ActivitiesOrProgramsCnt
Persons Served12344PersonsServedCnt
Total Community Benefit Expns$681,986TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$67,672DirectOffsettingRevenueAmt
Net Community Benefit Expns$614,314NetCommunityBenefitExpnsAmt
Total Expense0.00240TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$51,824TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$51,824NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs8ActivitiesOrProgramsCnt
Persons Served1845PersonsServedCnt
Total Community Benefit Expns$3,093,715TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,093,715NetCommunityBenefitExpnsAmt
Total Expense0.01230TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs23ActivitiesOrProgramsCnt
Persons Served14189PersonsServedCnt
Total Community Benefit Expns$3,827,525TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$67,672DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,759,853NetCommunityBenefitExpnsAmt
Total Expense0.01490TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs23ActivitiesOrProgramsCnt
Persons Served78500PersonsServedCnt
Total Community Benefit Expns$196,340,068TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$220,571,111DirectOffsettingRevenueAmt
Net Community Benefit Expns-$24,231,043NetCommunityBenefitExpnsAmt
Total Expense0.09660TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served797PersonsServedCnt
Total Community Benefit Expns$69,147TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$69,147NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served797PersonsServedCnt
Total Community Benefit Expns$69,147TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$69,147NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$992,393BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$17,577,717ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$16,697,002CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$880,715MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Community Hospital of San BernardinoBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11805 Medical Center DriveAddressLine1Txt
CitySan BernadinoCityNm
State AbbreviationCAStateAbbreviationCd
ZIP92411ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.dignityhealth.org/san-bernardino/WebsiteAddressTxt
State License240000198StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Community Hospital of San BernardinoBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE SECTION CStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care500.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE SECTION CFAPAppAvailableOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE H, PART V, SECTION BFormAndLineReferenceDesc
ExplanationLINE 5 IN FY2014, COMMUNITY HOSPITAL OF SAN BERNARDINO (CHSB), IN COLLABORATION WITH ST. BERNARDINE MEDICAL CENTER, CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT. BIEL CONSULTING, INC. WAS ENGAGED TO CONDUCT THE ASSESSMENT. TWENTY COMMUNITY STAKEHOLDERS, IDENTIFIED BY THE COMMUNITY BENEFIT INITIATIVE COMMITTEE, WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT. INTERVIEW PARTICIPANTS INCLUDED LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THOSE CONSULTED INCLUDE HEALTH CARE CONSUMERS AND REPRESENTATIVES OF NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, ACADEMIC EXPERTS, LOCAL GOVERNMENT OFFICIALS (INCLUDNG THE LOCAL HEALTH DEPARTMENT), LOCAL SCHOOL DISTRICTS, HEALTH CARE PROVIDERS AND COMMUNITY HEALTH CENTERS. ADDITIONALLY, SIX FOCUS GROUPS WERE CONDUCTED TO OBTAIN INPUT FROM THOSE WHO ARE DIRECT RECIPIENTS OF SERVICES IN THE COMMUNITY AND INCLUDED MEMBERS OF MEDICALLY UNDERSERVED POPULATIONS. LINE 6A ST. BERNARDINE MEDICAL CENTER LINE 7A http://www.dignityhealth.org/san-bernardino/who-we-are/serving-the-communi ty/community-health-needs-assessment-and-plan/health-needs-report LINE 10A HTTP://WWW.DIGNITYHEALTH.ORG/SAN-BERNARDINO/WHO-WE-ARE/SERVING-THE-COMMUNI TY LINE 11 THE IDENTIFIED SIGNIFICANT HEALTH NEEDS INCLUDED: CHRONIC DISEASES (ASTHMA, CANCER, HEART DISEASE, DIABETES); ACCESS TO CARE; MENTAL HEALTH; OVERWEIGHT/OBESITY; PREVENTIVE HEALTH CARE; COMMUNITY GROWTH AND ENRICHMENT (SAFETY, HOMELESSNESS, EDUCATION, ECONOMIC DEVELOPMENT); ALCOHOL/DRUGS/TOBACCO; AND DENTAL HEALTH. THESE WERE SUMMARIZED INTO: ACCESS TO CARE; CHRONIC HEALTH CONDITIONS; AND YOUTH DEVELOPMENT. ACCESS TO CARE: EMERGENCY DEPARTMENT NAVIGATOR; FINANCIAL ASSISTANCE; ENROLLMENT ASSISTANCE INTO NO COST OR LOW COST COVERAGE; COMMUNITY EDUCATION; FLU SHOT CLINICS; BEHAVIORAL HEALTH ASSESSMENTS; COMMUNITY GRANTS PROGRAM. CHRONIC HEALTH CONDITIONS: COMMUNITY HEALTH EDUCATION. STANFORD UNIVERSITY CHRONIC DISEASE SELF-MANAGEMENT OFFERED IN ENGLISH AND SPANISH, WITH A FOCUS ON DIABETES AND HEART DISEASE; SWEET SUCCESS PROGRAM IS OFFERED TO EXPECTANT MOTHERS WITH DIABETES; HEART CARE CENTER; SUPPORT GROUPS; COMMUNITY GRANTS. YOUTH DEVELOPMENT: FOCUS 92411 HOMEWORK CENTER WITH CATHOLIC CHARITIES; FAMILY FOCUS CENTER PROVIDES THE OPPORTUNITY TO EDUCATE THE COMMUNITY'S AT-RISK YOUTH IN THE AREAS OF HEALTH, DRUG AND GANG AVOIDANCE, AND EDUCATION PROMOTION TO IMPROVE HIGH SCHOOL GRADUATION RATES. PROGRAMS INCLUDE AFTER SCHOOL ACTIVITIES, A SUMMER CAMP AND COLLABORATION WITH VARIOUS LOCAL AGENCIES. TEEN CHOICES, A PROGRAM AIMED TO PROVIDE EXPERT INFORMATION AND ADVICE FOR PREGNANT AND PARENTING TEENS WHO WANT TO MAKE THE BEST DECISIONS FOR THEIR BABIES AND THEMSELVES. STEPPING STONES PROVIDES COMMUNITY YOUTH WITH HOSPITAL-BASED INTERNSHIP, MENTORING AND CAREER DEVELOPMENT OPPORTUNITIES TO INCREASE EXPOSURE TO AND EMPLOYMENT IN THE HEALTH CARE FIELD. SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT ADDRESSED IN THE IMPLEMENTATION STRATEGY ARE COMMUNITY GROWTH AND ENRICHMENT (SAFETY, HOMELESSNESS, EDUCATION, AND ECONOMIC DEVELOPMENT) SPECIFIC TO ADULT POPULATIONS. WE ARE STRONGLY COMMITTED TO BREAKING THE CYCLE OF PHENOMENA (I.E. EDUCATION, POVERTY, AND EMPLOYMENT) THAT IMPACT THE SOCIAL DETERMINANTS OF HEALTH. THEREFORE OUR EFFORTS AT COMMUNITY GROWTH AND ENRICHMENT ARE TARGETED TO YOUTH. WHILE RECOGNIZING THAT THERE ARE OTHER VALID CONCERNS THAT IMPACT THE HEALTH OF THE COMMUNITY, THE COMMITTEE IDENTIFIED THE HOSPITAL HAS LIMITED RESOURCES. THEREFORE, THE COMMITTEE ELECTED TO FOCUS ON THIS ISSUE SPECIFIC TO AT-RISK YOUTH POPULATIONS. THERE ARE EXISTING PROGRAMS IN PLACE THAT HAVE THE COMPETENCIES AND CAPACITY TO ADDRESS THE OTHER ISSUES. LINE 16B http://www.dignityhealth.org/san-bernardino/patients-and-visitors/patients /billing-payment-and-financial-services/payment-assistance-programs LINE 16I ADDITIONAL MEASURES TAKEN TO PUBLICIZE DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY INCLUDE THE PROVISION OF BROCHURES EXPLAINING AVAILABLE GOVERNMENT SPONSORED PROGRAMS, A COPY OF THE CHARITY CARE 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, AND THE FACILITY'S WEBPAGE ADDRESS WHERE ADDITIONAL INFORMATION AND APPLICATIONS CAN BE ACCESSED. LINE 22D PATIENTS WHO ARE APPLYING FOR DISCOUNTS UNDER THE DISCOUNT PROVISION POLICY WHOSE HOUSEHOLD INCOME IS AT OR BELOW 350% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT THE HIGHEST AVERAGE PAYMENT RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES FROM MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT SPONSORED HEALTH PROGRAM OR HEALTH BENEFIT IN WHICH THE HOSPITAL PARTICIPATES. PATIENTS WHOSE INCOME IS ABOVE 350% BUT NOT MORE THAN 500% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT 135% OF THE HIGHEST AVERAGE PAYMENT RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES TO PATIENTS COVERED BY MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT-SPONSORED HEALTH PROGRAM OF HEALTH BENEFITS IN WHICH THE HOSPITAL PARTICIPATES.ExplanationTxt
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Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part I, Line 7FOR 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 (e) & (f)LIne 7b, column (e) THE MEDICAID SURPLUS IS DUE TO THE INCREASED NET PROVIDER FEE IN FY2015 RESULTING IN AN OVERALL NEGATIVE PERCENT OF TOTAL EXPENSE. 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 $34.7 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 $103.2 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). THIS NET REDUCTION IN THE COST OF THE MEDICAID PROGRAM IS DRIVING THE DECREASE IN THE OVERALL COST OF COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES WHEN COMPARED TO PRIOR YEARS. THE CALIFORNIA HOSPITAL ASSOCIATION CREATED A PRIVATE PROGRAM, THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT"), ESTABLISHED FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA. DURING THE YEAR, COMMUNITY HOSPITAL OF SAN BERNARDINO RECORDED A PLEDGE TO A GRANT FUND ESTABLISHED BY CHFT IN THE AMOUNT $2.5 MILLION. THE GRANT IS REPORTED UNDER OTHER BENEFITS (PART I, LINE 7I, COLUMN C), AS CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. COLUMN C), AS CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS.
Schedule H, Part II - Community Building ActivitiesCommunity Hospital of San Bernardino (CHSB) is dedicated to community building in the surrounding neighborhoods. CHSB actively partners with Healthy San Bernardino, a multi-agency collaboration devoted to advocating for community health improvement, especially in the areas of access to healthy food; safe streets and public spaces, schools, parks and open spaces; appropriate healthcare, wellness and prevention, including behavioral health; and personal awareness, motivation and responsibility with a community-wide sense of hope and purpose. As a member of the Hospital Association of Southern California (HASC) Community Benefit Stakeholders Committee, CHSB joined other local hospitals in establishing the goal of "displacing heart disease as the leading cause of death in San Bernardino County." CHSB staff has been integral in a three 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: American Lung Association, Blair Park Neighborhood Association, CalFresh, California State University San Bernardino, Catholic Charities, Community Action Partnership Utilities Assistance (CAPSB), Childhelp USA, Department of Public Health, Family Resource Center, Fontana Community Assistance Program (CAP), Home of Neighborly Service, Housing Authority, Inland Empire Baby Friendly, Inland Empire Breastfeeding Coalition, 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 2THE 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. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT. 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. CHSB 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 RECEIVE AN AUTOMATIC UNINSURED DISCOUNT OF 25% FOR PATIENTS SEEN. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT.
SCHEDULE H, PART III, LINE 3CHSB 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 A 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 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 4THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2015, 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 8CHSB 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 9bAT 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 COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO 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 EACH HOSPITAL PATIENT FINANCIAL ASSISTANCE DEPARTMENT. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, CHSB REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.
Schedule H, Part VI, Line 2 - Needs AssessmentTHE PASSING OF CALIFORNIA'S COMMUNITY BENEFIT LAW (SB 697) CREATED A PROCESS AND MAJOR TOOL FOR CHSB TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW THE HOSPITAL WILL GIVE BACK TO THE COMMUNITY IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES TO ADDRESS UNMET COMMUNITY HEALTH NEEDS. IN THE SPRING OF 2014 A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CARRIED OUT IN PARTNERSHIP WITH ST. BERNARDINE MEDICAL CENTER. IT INCORPORATES COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE CHSB SERVICE AREA. ADDITIONALLY, SIX FOCUS GROUPS WERE CONDUCTED WITH RESIDENTS OF COMMUNITIES IN THE CHSB PRIMARY SERVICE AREA. FOUR OF THE GROUPS WERE CONDUCTED IN ENGLISH AND TWO IN SPANISH. THROUGH THE PARTICIPATION IN THIS NEEDS ASSESSMENT AND BENEFITS PLANNING PROCESS CHSB REMAINS COMMITTED TO PARTICIPATING IN COMMUNITY PROCESSES THAT UPDATE AND REFRESH THE ONGOING QUEST TO UNDERSTAND AND TO RESPOND TO THE COMMUNITY'S PRIORITIES FOR HEALTH AND QUALITY OF LIFE IMPROVEMENTS. THE CHNA CONTINUES TO BE A FOCAL POINT AND AN ESSENTIAL TOOL IN DEVELOPING THE STRATEGIC DIRECTION OF CHSB, ALONG WITH PARTICIPATORY AND SOLUTION FOCUSED PROCESSES WHICH HAVE TAKEN INVENTORY OF COMMUNITY ASSETS AND RESOURCES IN OUR COMMUNITY BY THE LATINO HEALTH COLLABORATIVE, THE AFRICAN AMERICAN HEALTH INSTITUTE, AND THE LOMA LINDA SCHOOL OF PUBLIC HEALTH.
Schedule H, Part VI, Line 3 - Patient Education of Eligibility forAssistance 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 25% FOR SERVICES PROVIDED AND THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION. 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, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. UNINSURED PATIENTS RECEIVE COPIES OF THE FINANCIAL ASSISTANCE AND MEDICAID APPLICATIONS 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 InformationCommunity Hospital of San Bernardino serves a diverse population residing in multiple zip codes. Eighty percent (80%) of discharges come from fifteen (15) zip codes concentrated in the following cities: Bloomington, Colton, Fontana, Highland, Rialto and San Bernardino. The Inland Empire continues to suffer the effects of the Great Recession of 2008. Within the service area, unemployment had risen as high as 16.2% in 2010. Currently, 7.5% to 48.5% of the population lives at or below 100% of the Federal Poverty Level. In San Bernardino 92401, 88.5% of individuals live at or below the 200% poverty level, followed by 92411 (72.5%) and 92410 (71.0%). Confirming the difficult economics of the region, in July 2012 the City of San Bernardino filed for Chapter 9 bankruptcy protection. Most recently, Los Angeles Times reporter Joe Mozingo painted a dismal picture of San Bernardino in a June 14, 2015 article entitled, "San Bernardino: Broken City". Still, many citizens, businesses and non-profit agencies remain committed to the city and work creatively and collaboratively together to improve the lives of our residents. And improvements have been made. In 2010, San Bernardino County was ranked 45th (out of 56) for Health Outcomes by County Health Rankings & Roadmaps. In 2015, the county rose to 37th place. The following reflects demographics for the primary service area: -Population: 722,874 -Diversity: Hispanic (68.0%), Caucasian (14.9%), African American (10.2%), Asian & Pacific Islander (4.7%), American Indian/Alaska Native (0.3%), Other Race/Multiracial (1.9%) -Median Household Income: $48,173 -Uninsured: 11.7% -Unemployment: 10.0% -No High School Diploma: 31.7% -MediCal Population: 38.0% In addition to Community Hospital of San Bernardino and St. Bernardine Medical Center, other hospitals serving the area include: Arrowhead Regional Medical Center, Kaiser Permanente-Fontana, Loma Linda University Medical Center, Redlands Community Hospital and San Antonio Community Hospital. The Community Need Index (CNI) is a tool developed by Dignity Health to measure community need in a specific geography through analyzing the degree to which a community has the following health care access barriers: 1) Income Barriers, 2) Educational Barriers, 3) Cultural Barriers, 4) Insurance Barriers and 5) Housing Barriers. Communities with scores of "5" are more than twice as likely to need inpatient care for preventable conditions as communities with a score of "1". The median CNI score of the hospital's service area is 4.8 with five (5) of the zip code communities scoring a "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 HealthA 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; 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 SystemCHSB 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, 2015, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 155,869 144,043,000 1.2% Unpaid Costs of Medicaid/Medi-Cal 1,529,842 582,988,000 4.9% Other Means-tested Programs 269,823 9,201,000 0.1% Community Services: Community Health Services 376,686 41,756,000 0.3% Health Professions Education 79 3,000 0.0% Subsidized Health Services 96,294 24,872,000 0.2% Donations 123,504 36,533,000 0.3% Community Building Activities 7,795 1,818,000 0.0% Community Benefit Operations 143 7,124,000 0.1% Total Community Services for the poor 604,501 112,106,000 0.9% Total Benefits for the Poor 2,560,035 848,338,000 7.1% Benefits for the Broader Community: Community Services: Community Health Services 278,419 12,046,000 0.1% Health Professions Education 27,306 67,915,000 0.6% Subsidized Health Services 3,641 1,441,000 0.0% Research 14,806 10,910,000 0.1% Donations 31,341 8,662,000 0.1% Community Building Activities 7,583 3,822,000 0.0% Community Benefit Operations 31 1,333,000 0.0% Total Benefits for the Broader Community 363,127 106,129,000 0.9% Total Community Benefits 2,923,162 954,467,000 8.0% Unpaid Costs of Medicare 1,042,065 756,109,000 6.3% Total Community Benefits including Cost of Medicare 3,965,227 1,710,576,000 14.3%

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDescPurpose Of GrantPurposeOfGrantTxt
California Health Foundation and Trust
1215 K Street Ste 800SacramentoCA95814941498697501(c)(3)$2,481,068$0N/AN/AService for the poor
Dignity Health
1980 Orange Tree LaneRedlandsCA92374941196203501(c)(3)$464,976$0N/AN/ACOMMUNITY HEALTH
Community Hospital Foundation of San Bernardino
1805 Medical Center DriveSan BernadinoCA92411953051931501(c)(3)$436,761$0N/AN/AFoundation Support
FieldValueIRS element (for citing)
Total501c3 Org3Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2FormAndLineReferenceDesc
ExplanationTHE HOSPITAL USES A SOFTWARE PACKAGE TO DOCUMENT GRANT FUNDING, TO MONITOR AND REPORT PROGRAM OUTCOMES AND TO FORMULATE CRITERIA FOR GRANT SELECTIONS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Steven Barron
Director$0$459,721$0$482,876$0$444,590$0$68,448$0$58,929$0$1,514,564$0$401,861
Alvaro Bolivar MD
Ex-officio Director$169,100$0$0$0$0$0$0$0$0$0$169,100$0$0$0
Bruce Ermann MD
Director (thru 1/31/15)$0$167,584$0$0$323,773$0$12,017$0$25,003$0$528,377$0$0
Gary Greensweig DO
Director$0$400,785$0$119,160$0$2,772$0$43,987$0$26,165$0$592,869$0$0
Bruce Swartz
Director$0$434,587$0$389,540$0$20,478$0$64,918$0$28,269$0$937,792$0$0
Rachelle Wenger
Director$0$131,409$0$41,586$0$621$0$17,316$0$20,980$0$211,912$0$0
Susan Whitten
Director (thru 1/5/15)$0$263,801$0$236,909$0$129,249$0$43,592$0$47,956$0$721,507$0$109,510
June Collison
Hospital President$0$314,881$0$256,920$0$15,744$0$48,153$0$43,564$0$679,262$0$0
David J Evans
VP/CFO$197,372$0$37,057$0$10,398$0$23,787$0$21,965$0$290,579$0$0$0
Darryl VandenBosch
VP/CFO (thru 2/5/15)$0$312,298$0$100,852$0$14,680$0$36,827$0$25,159$0$489,816$0$0
Kimiko Ford
VP of Ancillary Services$190,154$0$57,814$0$1,754$0$25,633$0$24,558$0$299,913$0$0$0
Victoria Selby
VP, Behavioral Health & Neuro$193,888$0$47,981$0$902$0$16,716$0$20,999$0$280,486$0$0$0
Charlie J Chavez
Dir, Clinical Informatics & St$162,220$0$30,263$0$7,135$0$17,405$0$7,901$0$224,924$0$0$0
Marc Marchetti
VP Business Development$197,784$0$37,792$0$8,685$0$23,803$0$22,337$0$290,401$0$0$0
Rosilyn Nolan
Dir of Educ & Diab Wellness$166,871$0$31,775$0$10,799$0$17,250$0$23,335$0$250,030$0$0$0
Darlena A Stevens
Dir Quality Management$166,135$0$31,073$0$1,798$0$19,635$0$15,625$0$234,266$0$0$0
Patricia Womack
Director of Pharmacy$173,326$0$32,445$0$8,486$0$20,860$0$4,191$0$239,308$0$0$0
Jack Ivie
FORMER OFFICER$324,985$0$187,756$0$31,881$0$43,528$0$23,966$0$612,116$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3ALTHOUGH 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 4aCERTAIN 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 WERE MADE UNDER THIS PLAN DURING 2014; B ERMANN, MD, $262,949.
Schedule J, PART I, LINE 4bCERTAIN LISTED PERSONS ARE ELIGIBLE TO 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. THERE WERE NO PAYMENTS RELATED TO THIS PLAN IN 2014. CERTAIN LISTED PERSONS ARE ELIGIBLE TO PARTICIPATE IN ONE OF TWO 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 FOR TWO BOARD MEMBERS, WHO ARE DIGNITY HEALTH EMPLOYEES, INCLUDE S BARRON, 401,861 AND S WHITTEN, 109,510. 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 DISCLOSURESTHE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE THE 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.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN521598225BondIssuerEIN
CUSIP13033FTN0CUSIPNum
Bond Issued2004-05-19BondIssuedDt
Issue Price$150,000,000IssuePriceAmt
PurposeBOND A: CUSIP 13033FTN0 - SEE PARTPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingYes (true)PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$0RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$2,000,000TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$0IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$2,000,000CapitalExpendituresAmt
Other Spent Proceeds$0OtherSpentProceedsAmt
Unspent$0UnspentAmt
Substantial Completion2005SubstantialCompletionYr
Current RefundingfalseCurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsYes (true)AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropYes (true)MgmtContractBondFincdPropInd
Engage Bond Counsel ContractsYes (true)EngageBondCounselContractsInd
Any Research AgreementsYes (true)AnyResearchAgreementsInd
Engage Bond Counsel ResearchYes (true)EngageBondCounselResearchInd
Private Bus Use By Others0.01600PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.01600TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Change In Use Bond Financed Prop0.00000ChangeInUseBondFinancedPropPct
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DueYes (true)NoRebateDueInd
Variable Rate IssueYes (true)VariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds InvestedYes (true)GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceBOND A: CUSIP 13033FTN0FormAndLineReferenceDesc
ExplanationPART 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 CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFOMED ON 6/30/2015.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonNEONATOLOGY MEDICAL GROUP INCPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionSEE PART VRelationshipDescriptionTxt
Transaction$424,250TransactionAmt
TransactionMEDICAL SERVICESTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART IV, COLUMN (B)FormAndLineReferenceDesc
ExplanationGREATER THAN 35% ownership, BOD, V Muraligopal, MD.ExplanationTxt

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArtGrp
Art Historical TreasuresArtHistoricalTreasuresGrp
Art Fractional InterestArtFractionalInterestGrp
Books And PublicationsBooksAndPublicationsGrp
Clothing And Household GoodsClothingAndHouseholdGoodsGrp
Cars And Other VehiclesCarsAndOtherVehiclesGrp
Boats And PlanesBoatsAndPlanesGrp
Intellectual PropertyIntellectualPropertyGrp
Securities Publicly TradedSecuritiesPubliclyTradedGrp
Securities Closely Held StockSecuritiesCloselyHeldStockGrp
Secur Prtnrshp Trust IntrstsSecurPrtnrshpTrustIntrstsGrp
Securities MiscellaneousSecuritiesMiscellaneousGrp
Qualified Contrib Hist StructQualifiedContribHistStructGrp
Qualified Contrib OtherQualifiedContribOtherGrp
Real Estate ResidentialRealEstateResidentialGrp
Real Estate CommercialRealEstateCommercialGrp
Real Estate OtherRealEstateOtherGrp
CollectiblesCollectiblesGrp
Food InventoryFoodInventoryGrp
Drugs And Medical SuppliesDrugsAndMedicalSuppliesGrp
TaxidermyTaxidermyGrp
Historical ArtifactsHistoricalArtifactsGrp
Scientific SpecimensScientificSpecimensGrp
Archaeological ArtifactsArchaeologicalArtifactsGrp

Other Non Cash Contri Table OtherNonCashContriTableGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
DescTOY - ANIMATRONIC DINOSAURDesc
Contribution1ContributionCnt
Noncash Contributions Rpt F990$40,000NoncashContributionsRptF990Amt
Method Of Determining RevenuesCOMPARABLE SALEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Form8283 Received1Form8283ReceivedCnt
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsYes (true)ReviewProcessUnusualNCGiftsInd
Third Parties UsedfalseThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE M, PART I, COLUMN (B)FormAndLineReferenceDesc
ExplanationTOY - ANIMATRONIC DINOSAUR: THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI through PART XIIFORM 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, SENIOR DIRECTOR OF FINANCE, AND CONTROLLER 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 responsible for collecting, reviewing and validating annual disclosures of all covered persons (i.e., Board and Board Committee members, officers and executive leadership, key employees, management personnel at the vice president level and above, and any other personnel at his or her discretion). All covered persons are required to disclose real or potential conflicts arising from the business, financial and personal interests held by such covered persons or their family members. Covered persons are required to disclose to their superiors and to relevant decision makers any interest that may present a conflict, 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, and annually thereafter. Each covered person is required to certify at least annually that he/she: (1) has received a copy of the policy applicable to his/her position; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest disclosure statement as required by the policy. The President/CEO and EVP/General Counsel prepare annual reports of reported conflicts of interest, which are provided to the Board of Directors, Committee Chairs, and key leaders of the organization to enable 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 include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the Board of Directors; (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 is excluded from the discussion and 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 persons, consistent with any requirements of bylaws or policies; and (6) any conflicting issues arising during the course of a board meeting which cannot be resolved may be referred to an independent committee of the Board of Directors. There are similar conflicts of interest provisions under the 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 2014, 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 employees. 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 2014 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 DRS A BOLIVAR AND J MAWAD RECEIVED COMPENSATION FOR PHYSICIAN SERVICES PROVIDED TO THE FILING ORGANIZATION. J IVIE RECEIVED COMPENSATION FOR SERVICES PROVIDED TO A RELATED ORGANIZATION, DIGNITY HEALTH. FORM 990, PART XII, LINE 3B THE ORGANIZATION'S FEDERAL AWARDS WERE INCLUDED IN DIGNITY HEALTH'S CONSOLIDATED OMB CIRCULAR A-133 AUDITED SCHEDULE OF FEDERAL EXPENDITURES.
FORM 990 PART IX LINE 11GDESCRIPTION:MEDICAL FEES TOTAL FEES:8481435
FORM 990 PART IX LINE 11GDESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:12540800
FORM 990 PART IX LINE 11GDESCRIPTION:REPAIRS & MAINTENANCE CONTRACT TOTAL FEES:3712493
FORM 990 PART IX LINE 11GDESCRIPTION:LAUNDRY & LINEN TOTAL FEES:1032888
FORM 990 PART IX LINE 11GDESCRIPTION:PROFESSIONAL/CONSULTING FEES TOTAL FEES:650270
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:2893408

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
Community Hospital Foundation
1805 Medical Center DriveSan BernardinoCA92411953051931Fund RaisingCA501(c)(3)11; Type ICHSBYes (true)
DIGNITY HEALTH
185 Berry StreetSan FranciscoCA94107941196203HospitalCA501(c)(3)3NAfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
COMMUNITY HOSPITAL SAN BERNARDINO FOUNDATION
B$436,761SEE PART VII
COMMUNITY HOSPITAL SAN BERNARDINO FOUNDATION
c$72,588cash/non-cash

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule R, Part V, line 2FormAndLineReferenceDesc
ExplanationCOMMUNITY 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.ExplanationTxt

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