2014-11-14T14:06:51-07:00 2013-12-31 990 2013-01-01 951644629 SANTA BARBARA COTTAGE HOSPITAL SANT 8056827111 PO BOX 689 SANTA BARBARA CA 931020689 Joan Bricher Sr. Vice President & CFO 8058798752 2014-11-14 2013 2015-11-30 17:44:51Z Ronald C Werft Same as C above Santa Barbara CA 93102 736016051 0 X WWW.COTTAGEHEALTHSYSTEM.ORG X 1888 CA It is the mission of Santa Barbara Cottage Hospital to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 17 13 3204 740 13137189 -5425841 2086846 1260200 542778800 604534117 11999419 25607167 12934133 7012761 569799198 638414245 1916555 2013654 0 0 252276896 253686564 0 0 0 299542302 314209081 553735753 569909299 16063445 68504946 1160226356 1279611452 485260002 444815584 674966354 834795868 It is the mission of Santa Barbara Cottage Hospital (SBCH) to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 0 0 485436163 2013654 611546878 Santa Barbara Cottage Hospital is a 408-bed acute-care hospital located in the City of Santa Barbara. In 2013, the Hospital had 83,338 patient days, served 127,893 outpatients, including emergency services to 44,397 patients. The Hospital provides a wide array of inpatient and outpatient services, including but not limited to the areas of cardiology, orthopedics, neurology, trauma, labor & delivery, psychiatric, neonatal intensive care, pediatric intensive care, pediatrics, laboratory, imaging, therapy, diabetes, oncology, emergency and rehabilitation services. Cottage Health System, which includes Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital, provides critical funding for community health, charity care, and external grants, while also realizing shortfalls in Medicare, Medi-Cal, and indigent care. Activities in these areas included screenings and health fairs; classes, clinics, lectures, and seminars; community services; community collaborations; and coalitions/committees. In 2013, Cottage Health System spent over $146 million on these programs. Cottage Health System has also been diligent in ensuring that all patients have adequate access to care. All patients who do not present insurance are automatically screened for eligibility in government health programs and are assisted in applying for charity if the patient does not qualify for any other assistance. 0 0 0 485436163 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 511 0 1 3204 1 1 1 0 0 0 0 0 0 0 0 0 X 17 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Karen Jones Grandidier 8055697294 400 West Pueblo SANTA BARBARA CA 93105 Judith Hopkinson Director 1 3 X 0 0 0 Gregory Faulkner Director 1 3 X 0 0 0 Elliot Prager MD Director 1 3 X 0 0 0 Lori Gaskin PhD Director 1 3 X 0 0 0 Dorothy Largay PhD Director 1 3 X 0 0 0 Edward Bentley MD Director 1 3 X 0 0 0 John Romo Committee Chair 1.25 3.75 X 0 0 0 Jon Clark Committee Chair 1.25 3.75 X 0 0 0 Thomas Watson MD Committee Chair 1.25 3.75 X 13065 0 0 Charles A Jackson Committee Chair (partial year) 1.25 3.75 X 0 0 0 Gretchen Milligan Committee Chair 1.25 3.75 X 0 0 0 Fred Lukas Committee Chair 1.25 3.75 X 0 0 0 Margaret Baker Committee Chair 1.25 3.75 X 0 0 0 Alex Koper MD Secretary 1.25 3.75 X X 33852 8400 0 Marshall Turner Jr Vice Chair 1.25 3.75 X X 0 0 0 Robert Nakasone Vice Chair 1.25 3.75 X X 0 0 0 P Steven Ainsley Vice Chair 1.25 3.75 X X 0 0 0 Robert Nourse Board Chair 5 15 X X 0 0 0 Ronald C Werft CEO 15 45 X 0 1102878 718319 Steven A Fellows COO 22.5 27.5 X 0 632925 198617 Joan F Bricher CFO 12.5 37.5 X 0 564018 211993 Julie J Artoux Assistant Secretary 12.5 37.5 X 0 121989 27354 Melinda Staveley VP CRH 40 0 X 270955 0 39502 David Nichols VP Business Devel-Lab 40 0 X 565122 0 0 Jeffrey M Gauvin Director Surgical Education 40 0 X 472141 0 22302 Sally I Dickson Director PDL Sales & Marketing 40 0 X 351898 0 22566 Andrew S Gersoff Director Medical Education 40 0 X 268925 0 25216 Stephen S Kaminski Director Trama Svcs & SICU 40 0 X 398905 0 25216 Sharon Lutz VP Quality Sup Svcs 0 40 X 0 244122 44365 Afshin Fatholahi VP Support Services 0 40 X 0 279554 45649 Herbert J Geary VP Pt Care Svcs, CNO 0 40 X 0 339964 49885 Lisa M Moore VP Clinical Services 0 40 X 0 337648 49845 Alberto J Kywi VP ISD & CIO 0 40 X 0 407671 52123 2374863 4039169 1532952 544 1 1 0 Armstrong Associates 1825 State St STE 202 Santa Barbara CA 93101 General Contracting 5822273 Comforce PO BOX 31001-0893 PASADENA CA 911100893 CONTRACT LABOR 4214712 Mayo Medical Laboratories PO Box 9146 Minneapolisa MN 55480 LABORATORY SERVICES 1963116 Anesthesia Medical Group SB Inc 514 Pueblo Street 2nd Floor Santa Barbara CA 93105 Professional Fees 1681404 Sansum Clinic PO Box 62106 Santa Barbara CA 93160 Professional Fees 1519191 123 0 0 0 30967 366668 862565 0 1260200 NET PATIENT SERVICE REVENUE 900099 530249103 530249103 0 0 LABORATORY SERVICES 900099 31076321 17939132 13137189 0 CA HOSPITAL FEE PROGRAM 900099 41775455 41775455 0 0 EHR MEDICARE & MEDI-CAL INCENTIVE 900099 706874 706874 0 0 MEDICAL OFFICE BLDG RENTAL 900099 670194 670194 0 0 56170 56170 0 0 604534117 12066558 0 0 12066558 0 0 0 0 0 0 0 0 0 0 111142415 0 97601806 0 13540609 0 13540609 0 0 13540609 0 LAB MANAGEMENT 900099 1602905 1602905 0 0 CAFETERIA/GIFT SHOP/DELI/VILLA RIVIERA 900099 1688812 1688812 0 0 REBATES 900099 642699 642699 0 0 3078345 3078345 0 0 7012761 638414245 598409689 13137189 25607167 2013654 2013654 0 0 0 0 0 0 357374 0 357374 0 94767 94767 0 0 165264692 139966442 25298250 0 23092088 19474758 3617330 0 51500657 43331107 8169550 0 13376986 11163670 2213316 0 1211977 1211977 0 1621778 0 1621778 0 166177 0 166177 0 57433 0 57433 0 0 0 2404063 0 2404063 0 41810742 31769802 10040940 0 170300 61033 109267 0 11098000 8747092 2350908 0 1093103 936067 157036 0 0 0 0 0 9460564 7589737 1870827 0 561901 129905 431996 0 0 0 0 0 151983 34731 117252 0 15363175 12960375 2402800 0 0 0 0 0 41453289 35765496 5687793 0 3662628 3123666 538962 0 MEDICAL SUPPLIES 91057802 91056963 839 0 SYSTEM MANAGEMENT ALLOCATION 49378355 40359054 9019301 0 HOSPITAL FEE PROGRAM 28185679 28185679 0 0 EQUIPMENT MAINTENANCE 9411362 8288727 1122635 0 5888770 383438 5505332 0 569909299 485436163 84473136 0 19975346 17485856 57392976 48766182 0 0 89723230 91034576 250000 250000 0 0 0 0 13187406 12429030 8663402 7155608 869241636 243549363 653274811 625692273 181392001 292811567 89390151 134456441 0 7740172 7208633 39236861 42321286 1160226356 1279611452 57201792 68637165 0 0 3015 2457019 323718127 317089095 0 0 0 0 0 0 0 0 104337068 56632305 485260002 444815584 X 661162205 818412260 8209893 10789352 5594256 5594256 674966354 834795868 1160226356 1279611452 X 68504946 47115905 0 0 0 44208663 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 57433 57433 0 Schedule C, Part II-B, Line 1 Lobbying activities are calculated as a percentage of dues paid to various organizations. 12541861 0 2798120 0 299316 56782 14983883 11636302 0 1323701 0 358958 59184 12541861 12120151 0 -100999 0 338496 44354 11636302 11387435 0 1031032 0 269432 28884 12120151 10754765 0 687451 0 25782 28999 11387435 0 0.373 0.627 0 1 1 1645545 12434725 14080270 1061461 646965531 150533711 497493281 0 9052017 1456579 7595438 0 151180357 89660966 61519391 0 46902000 1898107 45003893 625692273 134456441 F 134456441 993048 SELF INSURANCE LIABILITY 31894032 RETIREMENT PLAN - SERP 7353 INTEREST RATE SWAP 21178250 PHYSICIAN GUARANTEES 3779596 MINIMUM PENSION LIABILITY -1219974 56632305 X Schedule D, Part V, Line 4 Endowment funds support specific programs of SBCH. Schedule D, Part X, Line 2 The System completed an analysis of its tax positions, in accordance with FASB ASC 740, Income Taxes, and determined that there are no uncertain tax positions taken. The System has recognized no interest or penalties related to uncertain tax positions. The System is subject to routine audits by the taxing jurisdictions, however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2009. 1 1 X 1 X 3.5 1 X 5.42 1 1 0 1 1 12015663 0 12015663 0.0211 113632676 87514489 26118187 0.0458 4705750 1217739 3488011 0.0061 0 0 130354089 88732228 41621861 0.0730 9174749 600000 8574749 0.015 9397681 4756378 4641303 0.0082 3343781 308526 3035255 0.0053 107688 22850 84838 0.0002 844123 0 844123 0.0015 0 0 22868022 5687754 17180268 0.0302 0 0 153222111 94419982 58802129 0.1032 1 8254890 0 103766996 131960994 -28193998 X 1 1 1 1 Santa Barbara Cottage Hospital 400 West Pueblo Santa Barbara CA 93105 www.cottagehealthsystem.org 050000140 X X X X X Santa Barbara Cottage Hospital and Cottage Rehab Hospital (operating under one license.) Santa Barbara Cottage Hospital 1 1 X X X X X X X X X 13 1 1 1 X http://santabarbaragoleta.healthforecast.net/ X X X X X X 0 0 1 1 350 1 542 1 X X X X 1 1 X X 1 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-Santa Barbara Cottage Hospital As part of this Community Health Needs Assessment, five focus groups were held on October 9-10, 2013. The focus group participants included 52 local key informants: representatives from public health; physicians; other health professionals; social service providers; employers; and other community leaders. A list of recommended participants for the focus groups was provided by Cottage Health System. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Focus group candidates were first contacted by letter to request their participation. Follow-up phone calls were then made to ascertain whether or not they would be able to attend. Confirmation calls were placed the day before the groups were scheduled to insure a reasonable turnout. Through this process, input was gathered from a representatives of local government officials, public health, as well as several individuals whose organizations work with low-income, minority (including Latino/Mixteco, Native American, Asian, and African American), or other medically underserved populations (specifically, persons who are young adults, elderly, veterans, disabled, lesbian/gay/bisexual/transgender [LGBT], homeless, mentally ill, undocumented, uninsured/underinsured, or receive Medi-Cal/Medicare). Final participation included representatives of the following organizations the Santa Barbara County Education Office, Santa Barbara Unified School District, Santa Barbara Neighborhood Clinics, Planned Parenthood of Santa Barbara, Ventura, & San Luis Obispo Counties, American Indian Health & Services, Mental Wellness Center, Santa Barbara Rescue Mission, Council on Alcoholism & Drug Abuse, County of Santa Barbara Department of Social Services, Foodbank of Santa Barbara County, Pacific Pride, Domestic Violence Solutions, Sarah House, Arthritis Foundation, Pacific Region, Central Coast Office, Hospice of Santa Barbara, Alliance for Living & Dying Well, CenCal Health, Community Action Commission, Central Coast Commission for Senior Citizens-Area Agency on Aging, Visiting Nurse & Hospice Care, DASH (Doctors Assisting Seniors at Home), Carpinteria Children's Project at Main, United Way of Santa Barbara County, American Red Cross, Santa Barbara County Chapter Alzheimer's Association, California Central Chapter, Alpha Resource Center of Santa Barbara, American Heart Association, Central Coast Division , PathPoint, Friendship Center , Independent Living Resource Center, Isla Vista Youth Projects, County of Santa Barbara Public Health Department, Santa Barbara Neighborhood Clinics, Sansum Clinic, Cottage Health System, Santa Barbara Street Medicine - Doctors Without Walls, Santa Barbara City College and the Orfalea Foundation. Schedule H, Part V, Section B, Line 4-Santa Barbara Cottage Hospital CHNA was completed in conjunction with Goleta Valley Cottage Hospital. Schedule H, Part V, Section B, Line 5-Santa Barbara Cottage Hospital The hospital sent out a press release regarding the availability of the CHNA and has presented and reported information contained in the CHNA to community groups. Schedule H, Part V, Section B, Line 7-Santa Barbara Cottage Hospital As a member of Cottage Health System (CHS), the needs identified in the Hospitals CHNA will be incorporated into the Community Benefit Program of CHS. The implementation strategy of the CHS Community Benefit Program plans to address all the needs identified in the Hospital CHNA through various hospital programs, health fairs and grant programs. Santa Barbara Cottage Hospital supports the following identified health needs through its hospital programs and health fairs: Access to Care, Immunization/Infectious Diseases, Infant Health/Family Planning, Substance Abuse, Nutrition, Physical Activity/Weight, Dementias, Diabetes, and Mental Health/Mental Disorders. The hospital does not support Oral Health through direct programs but does provide grants to support this focus area. Schedule H, Part V, Section B, Line 14-Santa Barbara Cottage Hospital A summary of the policy is posted in admitting offices. The full policy is reported to and available from the OSHPD website (www.oshpd.ca.gov). The policy can also be obtained upon request from a Patient Financial Counselor, whose contact information is provided on all billing statements along with a message regarding financial assistance. Patients that do not present any third party insurance information receive a brochure and eligibility counseling from the Patient Business Office. Schedule H, Part V, Section B, Line 20-Santa Barbara Cottage Hospital The maximum that could be charged is based on % of charges that is lower than commercial rates. 8 Pacific Diagnostic Laboratories 454 South Patterson Goleta CA 93117 Outpatient Lab Services Advanced Imaging Center 2410 Fletcher Street Santa Barbara CA 93105 Outpatient radiology center Cottage Residential Center 312 West Montecito Street Santa Barbara CA 93101 Substance abuse rehabilitation center SB Cope 2325 De La Vina Street Santa Barbara CA 93105 Substance abuse and detox treatment Outpatient Rehabilitation 1035 Peach Street Suite 203 San Luis Obisop CA 93401 Outpatient clinic Children's Outpatient Specialty Clinics (2) 2329 Oak Park Lane Santa Barbara CA 93105 Outpatient pediatric clinic for hemotology, oncology and gastrointestinal Pediatric Endocrinology Clinic 427 West Pueblo Santa Barbara CA 93105 Outpatient pediatric endocrineology clinic Schedule H, Part I, Line 6a Cottage Health System prepares a Community Benefit Report on behalf of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital. It is filed with the State of California, in compliance with California Senate Bill 697. The Community Benefit Report is available to the public upon request. Schedule H, Part I, Line 7 The costing methodology includes inpatient, outpatient, and emergency department and is broken down by payer categories. Both direct and overhead costs have been allocated, by services rendered. Each Payers net revenue is offset by the total cost and the results by Payer are calculated. In addition to a hospital wide cost to charge ratio, we have calculated cost to charge ratios for each Payer, based on the cost of the type of services rendered to their specific patients. Therefore, the community benefit amounts attributable to Medicaid and other government programs are calculated based on their specific cost to charge ratio. Schedule H, Part I, Line 7g Palliative Care services are provided at no cost to the patient. In addition, Santa Barbara Cottage Hospital provides pediatric outpatient clinics, cognitive health services, and lactation services to the community, all at a substantial financial loss to the hospital. Schedule H, Part III, Section A, Line 2 Patient service revenue, net of contractual allowances and discounts, is reduced by the provision for bad debts, and accounts receivable is reduced by an allowance for uncollectible accounts. The System establishes an allowance for uncollectible accounts based on many factors, including payer mix, age of receivables, historical cash collection experience, and other relevant information. A significant portion of the Systems uninsured patients will be unable or unwilling to pay for services provided and a significant portion of the Systems insured patients will be unable or unwilling to pay for co-payments and deductibles. Thus, the System records a significant provision for bad debts related to these insured and uninsured patients in the period the services are provided. The System writes down the expected reimbursement after reasonable collection efforts have been exhausted. Schedule H, Part III, Section A, Line 4 Bad debt is not included in the Community Benefit report. FOOTNOTE: Patient service revenue, net of contractual allowances and discounts, is reduced by the provision for bad debts, and accounts receivable is reduced by an allowance for uncollectible accounts. The System establishes an allowance for uncollectible accounts based on many factors, including payer mix, age of receivables, historical cash collection experience, and other relevant information. A significant portion of the Systems uninsured patients will be unable or unwilling to pay for services provided and a significant portion of the Systems insured patients will be unable or unwilling to pay for co-payments and deductibles. Thus, the System records a significant provision for bad debts related to these insured and uninsured patients in the period the services are provided. The System writes down the expected reimbursement after reasonable collection efforts have been exhausted. Schedule H, Part III, Section B, Line 8 The shortfall from total costs for Medicare patients is a significant loss to the hospital. The Hospital is providing care to patients whose insurance (Medicare) does not cover the entire cost of their care. This provides significant aid to the elderly in the community. Some of these elderly people would qualify under FAP guidelines for charity care under any other Payer program. The dollars reported are taken from the 2013 Medicare Cost Report and are derived following their guidelines of allowable and non-allowable costs. Schedule H, Part III, Section C, Line 9b All patients receive 6 statements over 135 days, which include a statement about how to inquire about financial assistance. Patients who are known to qualify for charity care or are in the process of applying for charity care are not sent to collection until a final charity care determination is made. If they qualify, their account is written down to zero. Schedule H, Part VI, Line 2 Cottage Health System, through its hospitals Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital, assesses the needs of the community through the Community Health Needs Assessment. For each hospital, an outside consultant was engaged to review the relevant health and population statistics, conduct a telephone survey of identified community members and hold focus groups with community leaders who represented a broad group of community members. Along with the CHNA conducted by the Hospital, CHS also utilizes the health assessment prepared by the County of Santa Barbara to assess the health of the community. Needs identified in the CHNA include: Access to Care, Immunization & Infectious Diseases, Infant Health & Family Planning, Oral Health, Substance Abuse, Nutrition, Physical Activity & Weight, Dementias, Diabetes, and Mental Health & Mental Disorders. Hospitals are using the information to further support the robust community benefit program that was already in place. The Hospitals provide critical funding for community health, charity care, and external grants, while also realizing shortfalls in Medicare, Medi-Cal, and indigent care. Activities in these areas included screenings and health fairs; classes, clinics, lectures, and seminars; community services; community collaborations; and coalitions/committees. In 2013, Cottage Health System spent over $146 million on these programs. Schedule H, Part VI, Line 3 Cottage Health System has a multifaceted Financial Assistance Program to ensure that patients who do not have insurance are screened for eligibility in a government sponsored healthcare plan and receive information about charity care programs. Every patient who does not present the hospital with proof of insurance or existing government support will be given a handout (in English or Spanish) upon registration that is compliant with California Assembly Bill 774 (AB774). The handout contains information about the Hospital charity care programs. This includes where to obtain applications, income guidelines, other qualification information and contact information for Customer Service and the Admitting department. The Hospital posts information about the charity care program in all registration areas required by AB774. Signs in English and Spanish are located in all areas where patients are registered for inpatient and outpatient services. Signs are also located in the patient billing office and cashier office. Patients will also be contacted by an admitting representative or eligibility counselor to assist the patient in determining eligibility for government sponsored insurance programs and assist with the application process at no cost to the patient. Patient Financial Counselors who answer customer service calls are instructed to offer charity care applications to all patients who indicate they have financial need. Schedule H, Part VI, Line 4 Santa Barbara County consists of 2,750 square miles of land and inland water area. Approximately rectangular in shape, Santa Barbara County is bordered on the north by San Luis Obispo County, on the east by Ventura County, and on the south and west by 107 miles of Pacific coastline. Much of the county is mountainous. The Santa Ynez, San Rafael and Sierra Madre mountains extend in a predominately east west direction. Within the county, there are numerous fertile agricultural areas, including the Santa Maria, Cuyama, Lompoc, and Santa Ynez Valleys, and the southeast coastal plain. These areas, which include most of the developed land, also accommodate the majority of the population. Los Padres National Forest, in the eastern part of the county, covers approximately 44 percent of the total county area. Vandenberg Air Force Base is in the Lompoc region, while UCSB is on the South Coast. North County refers to the area west and north of Gaviota and includes the Lompoc, Santa Maria, Santa Ynez and Cuyama valleys. South Coast refers to the Goleta, Santa Barbara, and Carpinteria coastal plain. Santa Barbara Countys 423,895 population is divided into six sub regions: Carpinteria Valley (4.2%); Santa Barbara/Goleta Region (43.5%); Santa Ynez Valley (5.3%); Lompoc Valley (14%), Santa Maria Valley (31%); Guadalupe Valley (1.7%); and the Cuyama Valley (.3%). Of the total population, 50% are females. The median age is 33.6 years. The population age breakdown is: 29% percent is 0 to 17 years old; 58 % are 20 to 54 years old and 13% are 65 and older. For people reporting one race, 88.6% are White; 2.4% are Black or African American; 1.7% are American Indian or Alaska Native; 4.5% are Asian; less than 0.3% are Native Hawaiian or Other Pacific Islander, and 2.5% reported 2 or more races. 40.4% are persons of Hispanic or Latino origin. Of the County's population, 21% are foreign-born, 32.8% of persons over the age of five reported speaking a language other than English at home, and 12.7% of county residents live below the poverty level. The residents of the County are served by 5 hospitals throughout the county. Schedule H, Part VI, Line 5 The Board of Directors is made up of prominent community members who volunteer their time to ensure that the Santa Barbara Community has access to high quality, affordable healthcare. The Board of Directors is actively involved in the Hospitals strategic decisions and takes its commitment to the Community very seriously. The Board approves of an annual financial budget and ten year financial plan to guarantee the Hospital will continue to offer hospital services to the Community for years to come. The Board also approves of annual top goals that are consistent with the mission, vision and values of the Hospital. The financial forethought of the Board of Directors resulted in surplus funds that are being used to rebuild the facility. Santa Barbara Cottage Hospital is building a new hospital in order to comply with the unfunded mandate of the State of California Senate Bill 1953 (SB1953), which requires all hospitals to retrofit or rebuild in order to withstand a major earthquake. The Hospital used this opportunity to live the core value of excellence by ensuring that the new facility will meet the current and future healthcare needs of the Community. This is the largest project in the history of the Hospital. As the new facility is built the Hospital continues to evaluate bed allocations in order to ensure that Subacute services continue to be available, determining dedicated pediatric bed needs, and allocating beds by patient care unit based upon projected health needs. Santa Barbara Cottage Hospital works cooperatively with the open medical staff to improve healthcare in the community. The Hospital is exploring how to better align with physicians in order to provide the highest quality of care. Schedule H, Part VI, Line 6 Cottage Health System is the parent organization of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital and Goleta Valley Professional Buildings, Inc. These organizations have a common Board of Directors. Cottage Health System Hospitals are the sole hospital providers in the Community and strategic plans are created with all the Hospitals and their Communities in mind. Santa Barbara Cottage Hospital Foundation provides grants to various organizations to promote healthy living and support nurse-training programs in the Community. Santa Barbara Cottage Hospital is the largest hospital in the system and provides the widest array of services. As such, Santa Barbara Cottage Hospital experiences the largest amount of charity care and Medicaid shortfall from cost. The hospital also provides the majority of community benefit programs, which are reported in the Cottage Health System Community Benefit Report. Schedule H, Part VI, Line 7 Cottage Health System files an annual community benefit report in the State of California on behalf of Santa Barbara Cottage Hospital. 1 Santa Barbara City College 721 Cliff Drive Santa Barbara CA 93109 953234551 government 483000 Support of Nursing Department at Santa Barbara City College California State University Channel Islands Foundation One University Drive Camarillo CA 93012 770433230 501(c)3 292000 Support of the BSN program in Santa Barbara Santa Barbara Neighborhood Clinics 1900 State Street Suite G Santa Barbara CA 93101 770496382 501(c)3 265942 To support Santa Barbara Neighborhood Clinics, in order for the clinics to provide access to primary care services to low-income residents in Santa Barbara. Santa Barbara County Education Office 4400 Cathedral Oaks Road Santa Barbara CA 93160 956000940 government 175000 Support of (1) Welcome Every Baby program which supports new parents with education and child development guidance, and (2) Health Linkages program which focuses on child development and health. Casa Esperanza PO Box 24116 Santa Barbara CA 93121 770502754 501(c)3 124081 Casa Esperanza assists homeless individuals and families achieve self-sufficiency by helping as many as possible access the services they need to transition to stable employment and housing. University of California Regents UCSB Santa Barbara CA 93106 954377221 government 100897 Support of research programs American Indian Health Services 4141 State Street Santa Barbara CA 93110 770398793 501(c)3 95000 Support of the American Indian Oral Health Program to ensure access to dental needs. Visiting Nurse and HOSPICE Care Foundation 222 East Canon Perdido Street Santa Barbara CA 93101 951641969 501(c)3 95000 Supports the Alliance for Living and Dying Well Sansum Clinic 470 South Patterson Ave Santa Barbara CA 93111 956419205 501(c)3 75898 Support of the Patient Navigator Program at the Cancer Center of Santa Barbara. Carpinteria Unified School District 5201 Eighth Street Carpenteria CA 93013 956101195 government 75000 Support of Children's Early Health and Wellness Program: health screenings, health fair and preschool activity program. Jodi House Inc 625 Chapala Street Santa Barbara CA 93101 953836137 501(c)3 30000 Funding for the Brain Injury Support Center Sarah House PO Box 20031 Santa Barbara CA 93120 770224415 501(c)3 30000 Offset the end of life care provided to low income patients that transfer from the Hospital Palliative Care facility Family Service Agency 315A Meigs Road Suite 355 Santa Barbara CA 93109 951644031 501(c)3 25000 Support of the Senior Services Program Willbridge of Santa Barbara 1215 East Montecito Street Santa Barbara CA 93130 571194195 501(c)3 22842 Support for the transitional housing beds for homeless patients who are not appropriate for discharge to the streets or shelters and who need supervised convalescense Community Action Commission 5638 Hollister Ave Goleta CA 93117 952491790 501(c)3 20000 Support of the Healthy Senior Lunch program Doctors Without Walls PO Box 3751 Santa Barbara CA 93103 331210731 501(c)3 20000 Support of health needs for the poor and homeless of Santa Barbara Food Bank of Santa Barbara County 1525 State Street Suite 100 Santa Barbara CA 93101 770169294 501(c)3 20000 Support of the Children's Health Initiative which provides healthy food and food literacy education Friendship Adult Day Services 89 Eucalyptus Lane Santa Barbara CA 93108 953398938 501(c)3 20000 Support H.E.A.R.T (Help Elders At Risk Today) Program People Helping People PO Box 1478 Solvang CA 93464 770338060 501(c)3 20000 Support of the Adult Dental Fund Hospitality House 924 Anacapa Street Suite 1-T Santa Barbara CA 93101 770434600 501(c)3 10000 Funding helps provide low cost housing to families of severely ill or injured hospital and extended treatment patients who cannot provide their own lodging. Thresholds of Recovery 1038 Pittsfield Lane Ventura CA 93001 770335136 501(c)3 8570 Grant funding provides help to individuals who have been intoxicated in the public. The program offers an alternative to incarceration. Program follow-up includes referral for treatment of alcoholism as an effort in recovery. 21 1 Schedule I, Part I, Line 2 Grant funds are monitored through the Community Health Coordinating Committee of CHS. Grantees are required to submit a report in June of each year that is reviewed by the committee prior to entire amount of funds being disbursed X X X X 0 1 0 0 0 0 0 0 0 Ronald C Werft CEO 0 810869 0 279660 0 12349 0 700565 0 17754 0 1821197 0 0 Steven A Fellows COO 0 480586 0 141176 0 11163 0 180863 0 17754 0 831542 0 0 Joan F Bricher CFO 0 449279 0 107214 0 7524 0 194115 0 17878 0 776010 0 0 Melinda Staveley VP CRH 211965 0 30892 0 28097 0 26876 0 12626 0 310456 0 14492 0 David Nichols VP Business Devel-Lab 131162 0 433960 0 0 0 0 0 0 0 565122 0 0 0 Jeffrey M Gauvin Director Surgical Education 470738 0 160 0 1242 0 12250 0 10052 0 494442 0 0 0 Sally I Dickson Director PDL Sales & Marketing 184097 0 166521 0 1279 0 12250 0 10316 0 374463 0 0 0 Andrew S Gersoff Director Medical Education 246351 0 160 0 22414 0 12250 0 12966 0 294141 0 0 0 Stephen S Kaminski Director Trama Svcs & SICU 397916 0 160 0 828 0 12250 0 12966 0 424120 0 0 0 Sharon Lutz VP Quality Sup Svcs 0 208127 0 33067 0 2928 0 26611 0 17754 0 288487 0 0 Afshin Fatholahi VP Support Services 0 227055 0 42963 0 9536 0 27917 0 17732 0 325203 0 0 Herbert J Geary VP Pt Care Svcs, CNO 0 288443 0 38833 0 12688 0 32153 0 17732 0 389849 0 0 Lisa M Moore VP Clinical Services 0 288679 0 45427 0 3542 0 32169 0 17676 0 387493 0 0 Alberto J Kywi VP ISD & CIO 0 307389 0 46876 0 53407 0 33460 0 18663 0 459795 0 20343 Schedule J, Part I, Line 3 On an annual basis the Executive Compensation Committee (ECC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the ECC are independent members of the Board of Directors. The ECC engages an independent consultant to prepare comparative compensation reports for each position. The executives individual performance will also be considered when determining compensation. The ECC recommends compensation for the executives to the full Board for approval. This process takes place annually for all executives. Additional details found in the narrative for Schedule O, Part VI, Line 15. Schedule J, Part I, Line 4 The amounts reported in the current years deferred compensation includes recognition of past service. The amounts are subject to a substantial risk of forfeiture. Any amounts paid under this plan in the future will be reported again as reportable compensation in the year paid. The System provides certain executives a supplemental retirement program. The program is defined as deferred compensation under the IRC Section 457(f). The annual contribution is 6.95% of base years salary with the contributions vesting five years from crediting date, or at age 62, or immediately in the event of death, disability, or involuntary termination without cause. The unvested account balances are assets of the System and are included in other assets and the accrued expense is included in pension liability and other in the accompanying consolidated balance sheets. Melinda Stavely received a payout from the 457(f) plan in the amount of $14,492. A California Health Facilities Financing Authority 521643828 13033FQT0 2003-11-20 120987862 Refund 1985 issuance and hospital replacement project 0 0 0 B California Statewide Communities Development Authority 680164610 130795Y76 2010-10-20 300168359 Refund 2008 issue 0 0 0 A 0 0 120987862 0 0 0 1366915 300700 0 99220247 20100000 0 2012 1 0 1 1 B 0 0 300168359 0 0 0 2937359 0 0 0 297231000 0 2012 1 0 1 1 A 0 1 0 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 Schedule K, Part IV, Line 2c-11/20/2003 120,987,862 California Health Facilities 9/30/09 Schedule K, Part IV, Line 2c-10/20/2010 300,168,359 California Statewide January 2011 Herb Geary Former Employee Home purchase X 250000 250000 0 1 1 250000 Jo Ellen Watson Wife of Board member 94767 Employee 0 Santa Barbara Cardiovascular Medical Group Thomas Watson MD is a partner 162340 Medical professional fees 0 Schedule L, Part II Herb Geary is still employed by a related tax-exempt entity and serves as a key employee to that entity. Form 990, Part VI, Section A, Line 6 Cottage Health System is the sole corporate member of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital and Goleta Valley Professional Buildings, Inc. Form 990, Part VI, Section A, Line 7a Cottage Health System is the sole corporate member of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, and Goleta Valley Professional Buildings, Inc and can appoint Directors to the Board. Form 990, Part VI, Section A, Line 7b The Board of Directors for Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, and Goleta Valley Professional Buildings, Inc must obtain prior approval from the Board of Directors of Cottage Health System, in order to: a) amend or restate the Articles of Incorporation or Bylaws; b) implement the annual budget and long-term capital and operational budget; c) sell, lease, mortgage, pledge, merge, consolidate or make any other disposition of any material part of the property and assets of this corporation; or d) voluntarily dissolve the corporation. Form 990, Part VI, Section B, Line 11b Form 990 is prepared under the direction of the Vice President of Finance and CFO. Form 990 is reviewed by VP Finance, CFO and independent tax consultants prior to submitting to the Audit and Compliance Committee. All members of the Board receive a copy of the organization's form 990 for review prior to filing. Form 990, Part VI, Section B, Line 12c The purpose of the Conflict of Interest policy is to protect the interest of the Hospital when it contemplates entering into a transaction or arrangement that could benefit the private interest of a Director or Officer of Cottage Health System, Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, Santa Barbara Cottage Hospital Foundation and Goleta Valley Professional Buildings, Inc., collectively known as Cottage Health System. The Cottage Health System Directors have a duty to: 1.) discharge their duties to benefit the Cottage Health System and not the Directors personally 2.) disclose situations with the potential for conflict of interest with the vision and mission of Cottage Health System 3.) refrain from discussing confidential Cottage Health System business with others. Each Board member will annually complete the Cottage Health System Directors Annual Conflict Disclosure Form. The Disclosure information will be reviewed annually by the Board Chair and the results reported to the full Board. Each Director or Officer will disclose to the Board Chair items to be discussed at a Board meeting. If there are any material financial or personal interests a Board member/family member may have in a Board decision, the Director or Officer will disclose this to the Committee Chair for items to be discussed at Board Committees, before the Board reviews the transaction and takes action. In general, an Officer who had disclosed a potential conflict should be excused from the decision making portion of the discussion and is prohibited from voting on a matter involving a potential conflict of interest. If the Board has reasonable cause to believe that a Director or Officer failed to disclose a material financial interest or other potential material conflict of interest, the Board Chair shall inform the member of the basis for the belief and afford the member an opportunity to explain the alleged failure to disclose. After hearing the Director or Officer's response and conducting any further necessary investigation, the Board determines if the Director or Officer failed to disclose a material financial or other potential material conflict of interest. The Board Chair shall take appropriate corrective action. Committee Chairs who address conflict of interest situations with a Board Committee member are responsible for reporting such situations to the Board Chair. Key employees are treated as other employees of Cottage Health System and sign an annual conflict of interest form. These forms are reviewed by Compliance and any issues are brought to the Chief Compliance Officer. Form 990, Part VI, Section B, Line 15 On an annual basis the Executive Compensation Committee (ECC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the ECC are independent members of the Board of Directors. The ECC engages an independent consultant to prepare comparative compensation reports for each position. The executive's individual performance will also be considered when determining compensation. The ECC recommends compensation for the executives to the full Board for approval. This process takes place annually for all employed officers and key employees. Form 990, Part VI, Section C, Line 19 Tax filings can be obtained upon request from the CFO. Audited Financial Statements are attached to the Form 990 in accordance with IRS instructions. The organizations bylaws and conflict of interest policies are not available to the public. Form 990, Part XI, Line 9 Change in pension liability $50,830,912; Change in fair value of interest rate swaps $11,981,816; Net assets transferred to affiliate ($18,604,065) Pacific Diagnostic Laboratories LLC PO Box 689 Santa Barbara CA 93102 205038438 Outpatient laboratory services CA 44073023 23856629 SANTA BARBARA COTTAGE HOSPITAL Cottage Health System PO Box 689 Santa Barbara CA 931020689 770431902 Parent organization for 3 hospitals and medical professional building CA 501 (C) (3) 11b-II N/A 0 Goleta Valley Cottage Hospital PO Box 689 Santa Barbara CA 931020689 952413596 Hospital CA 501 (C) (3) 3 Cottage Health System 1 Santa Ynez Valley Cottage Hospital Inc PO Box 689 Santa Barbara CA 931020689 952224265 Hospital CA 501 (C) (3) 3 Cottage Health System 1 Santa Barbara Cottage Hospital Foundation PO Box 689 Santa Barbara CA 931020689 953802238 Foundation to support Santa Barbara Cottage Hospital CA 501 (C) (3) 7 Santa Barbara Cottage Hospital 0 Goleta Valley Professional Blds PO Box 689 Santa Barbara CA 931020689 770004202 Medical Prof Bldg CA 501 (C) (3) 11b-II Cottage Health System 1 Rio Bravo Energia I Investments Holdings LP 89 Nexus Way Camana Bay Grand Cayman KY CJ 1-9007 999999999 Investment CA SB Cottage Hosp Fndtn 0 0 0 0 Villa Riviera Real Estate Company PO Box 689 Santa Barbara CA 93102 272996284 Workforce housing developer CA SBCHF C 0 0 1 0 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 Cottage Health System m 49379665 accrual Cottage Health System o 352636 accrual Cottage Health System p 2495862 accraul Cottage Health System q 11283477 accrual Cottage Health System r 10546745 accrual Goleta Valley Cottage Hospital a-i 760970 accrual Goleta Valley Cottage Hospital l 4023545 accrual Goleta Valley Cottage Hospital o 1306294 accrual Goleta Valley Cottage Hospital p 442004 accrual Goleta Valley Cottage Hospital q 32353907 accrual Goleta Valley Cottage Hospital r 768242 accrual Santa Ynez Valley Cottage Hospital Inc l 774852 accrual Santa Ynez Valley Cottage Hospital Inc o 365129 accrual Santa Ynez Valley Cottage Hospital Inc p 165050 accrual Santa Ynez Valley Cottage Hospital Inc q 3580320 accrual Santa Ynez Valley Cottage Hospital Inc r 74545 accrual Goleta Valley Professional Blds a-i 35302 accrual Goleta Valley Professional Blds q 803339 accrual Goleta Valley Professional Blds r 486289 accrual Santa Barbara Cottage Hospital Foundation q 201499 accrual Santa Barbara Cottage Hospital Foundation r 431819 accrual