COMMUNITY HOSPITAL OF SAN BERNARDINO: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: COMMUNITY HOSPITAL OF SAN BERNARDINO (EIN 95-1643373)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2014-05-05
IRS object ID: 201421259349300302
Schema version: 2012v2.1
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-05-05T07:02:36-05:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	135565207	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	KPMG LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	55 SECOND STREET SUITE 1400	AddressLine1
City	SAN FRANCISCO	City
State	CA	State
ZIP Code	94105	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	951643373	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL OF SAN BERNADINO	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	COMM	NameControl
Phone	9088876333	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1805 Medical Center Drive	AddressLine1
City	San Bernardino	City
State	CA	State
ZIP Code	92411	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	DARRYL VANDENBOSCH	Name
Title	CFO	Title
Date Signed	2014-04-30	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	VALERIE J BALL	Name
PTIN	P00178114	PTIN
Phone	4159635100	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

Field	Value	IRS element (for citing)
Business Name Line1	DARRYL VANDENBOSCH CFO	BusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1805 Medical Center Drive	AddressLine1
City	San Bernardino	City
State	CA	State
ZIP Code	92411	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	193180279	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.CHSB.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1938	YearFormation
State Legal Domicile	CA	StateLegalDomicile
Activity Or Mission Description	COMMUNITY HOSPITAL OF SAN BERNARDINO IS COMMITTED TO FURTHERING THE HEALING MINISTRY OF JESUS, AND TO PROVIDING HIGH-QUALITY, AFFORDABLE HEALTHCARE TO THE COMMUNITY WE SERVE.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	13	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	8	NbrIndependentVotingMembers
Total Nbr Employees	1649	TotalNbrEmployees
Total Nbr Volunteers	120	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1038794	ContributionsGrantsPriorYear
Contributions Grants Current Year	802783	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	199115964	ProgramServiceRevenuePriorYear
Program Service Revenue CY	191134701	ProgramServiceRevenueCY
Investment Income Prior Year	23318	InvestmentIncomePriorYear
Investment Income Current Year	456565	InvestmentIncomeCurrentYear
Other Revenue Prior Year	878283	OtherRevenuePriorYear
Other Revenue Current Year	764394	OtherRevenueCurrentYear
Total Revenue Prior Year	201056359	TotalRevenuePriorYear
Total Revenue Current Year	193158443	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	1353088	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	2276546	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	127298124	SalariesEtcPriorYear
Salaries Etc Current Year	129352536	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	91239175	OtherExpensePriorYear
Other Expenses Current Year	84078218	OtherExpensesCurrentYear
Total Expenses Prior Year	219890387	TotalExpensesPriorYear
Total Expenses Current Year	215707300	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-18834028	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-22548857	RevenuesLessExpensesCY
Total Assets BOY	78269563	TotalAssetsBOY
Total Assets EOY	72035842	TotalAssetsEOY
Total Liabilities BOY	121300421	TotalLiabilitiesBOY
Total Liabilities EOY	137615557	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	-43030858	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	-65579715	NetAssetsOrFundBalancesEOY
Mission Description	COMMUNITY HOSPITAL OF SAN BERNARDINO IS A NON-PROFIT, FULL-SERVICE, ACUTE CARE FACILITY IN BUSINESS TO PROVIDE ACUTE INPATIENT CARE, LONG-TERM CARE AND A WIDE RANGE OF ANCILLARY AND THERAPEUTIC CARE TO THE COMMUNITY WE SERVE. OUR VISION IS TO CREATE AND PROVIDE HEALTH CARE SOLUTIONS, AND MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	197190144	Expense
Grants	2276546	Grants
Revenue	191134701	Revenue
Description	COMMUNITY HOSPITAL OF SAN BERNARDINO'S MISSION IS TO CONTRIBUTE TO THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST EFFECTIVE MANNER. THE HOSPITAL IS LICENSED FOR 446 BEDS AND CURRENTLY HAS 364 BEDS AVAILABLE. THE HOSPITAL HAD 89,959 TOTAL PATIENT DAYS, 13,583 ADMISSIONS, AND 52,806 EMERGENCY ROOM VISITS. INPATIENT SERVICES: ACUTE PATIENT CARE; MATERNAL CHILD CARE; MENTAL HEALTH CARE; NEUROLOGICAL CARE; AND A VARIETY OF OUTPATIENT CARE.	Description
Total Program Service Expense	197190144	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	true	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	true	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	true	TaxExemptBonds
Invest Tax Exempt Bonds	true	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	true	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	true	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	169	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	1649	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	true	QuidProQuoContributions
Quid Pro Quo Disclosure	true	QuidProQuoDisclosure
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	13	NbrVotingGoverningBodyMembers
Number Independent Voting Members	8	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	false	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	CA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	DAVE EVANS FINANCE DEPT	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	9098876333	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1805 MEDICAL CENTER DRIVE	AddressLine1
City	SAN BERNARDINO	City
State	CA	State
ZIP Code	92411	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
MARGARET HILL PHD
VICE CHAIR	1.00	1.00	X	X	0	0	0
MARVIN REITER CPA
CHAIRMAN	1.00	1.00	X	X	0	0	0
PEGGY MERRYMAN
SECRETARY	1.00	1.00	X	X	0	0	0
ALVARO BOLIVAR MD
EX-OFFICIO DIRECTOR	40.00	0	X		233879	0	0
ANTONIO MYRELL
BOARD MEMBER	1.00	2.00	X		0	0	0
BRUCE ERMANN MD
DIRECTOR	1.00	40.00	X		0	278288	33089
DR BHARTI JAIN
DIRECTOR	1.00	0	X		0	0	0
ELIZABETH SHIH
DIRECTOR	1.00	40.00	X		0	1264972	212726
MARVIN O'QUINN
DIRECTOR	1.00	40.00	X		0	1250572	304328
NITIN NANDA MD
BOARD MEMBER	1.00	0	X		0	0	0
PAULETTE BROWN PHD
DIRECTOR	1.00	0	X		0	0	0
RICHARD GONZALEZ ESQ
DIRECTOR	1.00	0	X		0	0	0
STEVEN BARRON
DIRECTOR	1.00	41.00	X		0	512939	81023
SUSAN WHITTEN
DIRECTOR	1.00	40.00	X		0	356632	74165
VELLORE MURALIGOPAL MD
DIRECTOR	1.00	0	X		0	0	0
DARRYL VANDENBOSCH
VP/CFO	20.00	21.00		X	0	337032	46699
JACK IVIE
COO (through 12/2012)	40.00	0.00		X	368587	0	32887
JUNE COLLISON
HOSPITAL PRESIDENT	40.00	2.00		X	0	344509	47185
GERALDINE C FIKE
VP/CNE	40.00	0			225336	0	26974	X
KIMIKO FORD
VP OF ANCILLARY SERVICES	40.00	2.00			210413	0	48337	X
STAN RUCKER
CHIEF STRATEGY OFFICER	40.00	0			267574	0	36956	X
DAVID J EVANS
CONTROLLER	40.00	0			204453	0	38773		X
LORENA WILSON
MEDICAL TRANSCRIBER	40.00	0			208778	0	25473		X
MARC MARCHETTI
VP BUSINESS DEVELOPMENT	40.00	0			216248	0	38223		X
MARIE R ORPILLA
CNIII	40.00	0			229274	0	36300		X
SANDRA ZSCHOMLER
FOUNDATION EXECUTIVE DIRECTOR	0.00	60.00			213184	0	42988		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2377726	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	4344944	TotalReportableCompFrmRltdOrgs
Total Other Compensation	1126127	TotalOtherCompensation
Number Individuals GT100 K	221	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
SAFEWAY CONSTRUCTION
1474 N MILLER DR	COLTON	CA	923242457	CONTRACTOR	1002844
METROPOLITAN FAMILY MED GROUP
742 W HIGHLAND AVE	SAN BERNARDINO	CA	92405	MEDICAL SERVICES	475495
MOHAMMADREZA GHAYURI MD
742 W HIGHLAND AVE	SAN BERNARDINO	CA	92405	PHYSICIAN SERVICES	318708
PL PLUMBING
1761 N SECOND AVE	UPLAND	CA	91784	PLUMBING SERVICES	238598
ALVARO BOLIVAR MD
598 NORTH F ST	SAN BERNARDINO	CA	92410	PHYSICIAN SERVICES	233879

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	14	NumberOfContractorsGT100K
Fundraising Events	4985	FundraisingEvents
Related Organizations	511280	RelatedOrganizations
Government Grants	246509	GovernmentGrants
All Other Contributions	40009	AllOtherContributions
Noncash Contributions	1340	NoncashContributions
Total Contributions	802783	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REVENUE NET OF CHARITY CARE AND BAD DEBT	900099	58780514	58780514
MEDICARE/MEDICAID PAYMENTS	900099	131633902	131633902
MEDICAL OFFICE BUILDING	900099	709731	709731
EDUCATION	900099	10554	10554
		0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	191134701	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	34291	TotalRevenueColumn
Exclusion	$34,291	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	0	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	442770	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	20496	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	422274	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	422274	TotalRevenueColumn
Exclusion	$422,274	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	1280	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	4985	CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses	1340	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	-60	TotalRevenueColumn
Exclusion	-$60	ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
CAFETERIA	900099	437057	$437,057
GIFT SHOPS	900099	209596	$209,596
COUNTY TRAFFIC FINE FUND REV	900099	50641	$50,641

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	67160	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$67,160	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	764454	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	193158443	TotalRevenueColumn
Related Or Exempt Function Income	191134701	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$1,220,959	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	2243805	Total
Program Services	2243805	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	32741	Total
Program Services	32741	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	1140398	Total
Program Services	1085083	ProgramServices
Management And General	55315	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	240000	Total
Program Services	240000	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	95707696	Total
Program Services	90057432	ProgramServices
Management And General	5650264	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	6720312	Total
Program Services	6290445	ProgramServices
Management And General	429867	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	18276838	Total
Program Services	17124761	ProgramServices
Management And General	1152077	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	7267292	Total
Program Services	6821549	ProgramServices
Management And General	445743	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	156003	Total
Management And General	156003	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	74736	Total
Management And General	74736	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	18240	Total
Management And General	18240	ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	19723041	Total
Program Services	12754651	ProgramServices
Management And General	6968390	ManagementAndGeneral
Fundraising	0	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	340388	Total
Program Services	24869	ProgramServices
Management And General	315519	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	5180042	Total
Program Services	4955038	ProgramServices
Management And General	225004	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	8408753	Total
Program Services	7506293	ProgramServices
Management And General	902460	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	2401219	Total
Program Services	2113073	ProgramServices
Management And General	288146	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	207867	Total
Program Services	129501	ProgramServices
Management And General	78366	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	92043	Total
Program Services	78619	ProgramServices
Management And General	13424	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	5322995	Total
Program Services	5322995	ProgramServices

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	3392069	Total
Program Services	2883259	ProgramServices
Management And General	508810	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	2547000	Total
Program Services	2547000	ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDI-CAL PROVIDER FEE	20957750	20957750
MEDICAL SUPPLIES	12355284	12353748	1536
FOOD EXPENSES	1064913	1064913
OVERHEAD CORPORATE ALLOCATION	511917		511917

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	1323958	Total
Program Services	602620	ProgramServices
Management And General	721338	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	215707300	Total
Program Services	197190144	ProgramServices
Management And General	18517155	ManagementAndGeneral
Fundraising	0	Fundraising

Total Joint Costs TotalJointCosts

Field	Value	IRS element (for citing)
Total	0	Total

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	7125	BOY
EOY	7325	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	261696	BOY
EOY	325066	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	43687	BOY
EOY	64361	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	23791700	BOY
EOY	22395606	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	129841	BOY
EOY	62206	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	1981374	BOY
EOY	2177595	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	2437451	BOY
EOY	2624367	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	24365104	BOY
EOY	18047925	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	108688118	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	82389977	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	25218335	BOY
EOY	26298141	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	33250	BOY
EOY	33250	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	78269563	BOY
EOY	72035842	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	26095300	BOY
EOY	21671660	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	2000000	BOY
EOY	2000000	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	93205121	BOY
EOY	113943897	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	121300421	BOY
EOY	137615557	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	-43030858	BOY
EOY	-65579715	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	-43030858	BOY
EOY	-65579715	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	78269563	BOY
EOY	72035842	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-22548857	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Political Expenditures	368	PoliticalExpenditures
Volunteer Hours	0	VolunteerHours
Amt Of4955 Tax	37	AmtOf4955Tax
Amt Of4955 Tax On Managers	0	AmtOf4955TaxOnManagers
Form4720 Filed4955 Tax	true	Form4720Filed4955Tax
Correction Made	true	CorrectionMade
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$18,241	OtherActivitiesAmount
Total Lobbying Expenditures IIB	18241	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Description of political campaign activities	Schedule C, Part I-A, Line 1	DURING THE YEAR, COMMUNITY HOSPITAL OF SAN BERNARDINO PAID MEMBERSHIP DUES TO CALIFORNIA ASSOCIATION OF HEALTH FACILITIES ("ASSOCIATION"). THE INVOICES PROVIDED FOR VOLUNTARY CONTRIBUTIONS TO THE ASSOCIATION'S POLITICAL ACTION COMMITTEE (PAC). THE CHECK REQUESTS FOR ANNUAL DUES INADVERTENTLY INCLUDED AN AMOUNT FOR VOLUNTARY CONTRIBUTIONS TO THE PAC.
Steps taken to correct political campaign activities	Schedule C, Part I-B, Line 4b	COMMUNITY HOSPITAL OF SAN BERNARDINO HAS POLICIES AND PROCEDURES IN PLACE TO AVOID SUCH TRANSACTIONS, AND ONCE THE ORGANIZATION BECAME AWARE OF THIS SITUATION, IMMEDIATE ACTION WAS TAKEN TO OBTAIN A REFUND FROM THE ASSOCIATION FOR THE AMOUNTS DESIGNATED FOR THE PAC. A COPY OF THE REFUND CHECKS, DATED 3/21/13 AND 6/6/13 EVIDENCING THAT $368.33 HAS BEEN RECOVERED AND HAVE BEEN ATTACHED TO FORM 4720. THIS REPRESENTS THE FULL AMOUNT OF INADVERTENT PAYMENT MADE RELATED TO VOLUNTARY CONTRIBUTIONS TO THE ASSOCIATION'S PAC.
Description of the activities reported on Lines 1a through 1i	Schedule C, Part II-B, Line 1	LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: AMERICAN HOSPITAL ASSOCIATION $2,172 CATHOLIC HEALTH ASSOCIATION $1,154 HOSPITAL ASSOCIATION OF SO. CALIFORNIA $14,563 NATIONAL ASSOCATION OF HOME CARE AND HOSPICE $50 CALIFORNIA HOSPICE AND PALLIATIVE CARE ASSOCIATION $13 SAFETY NET HOSPITALS FOR PHARMACEUTICAL ACCESS $290 TOTAL $18,241

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	799341	OtherCostOrOtherBasis
Book Value	799341	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	76579450	OtherCostOrOtherBasis
Depreciation	63231437	Depreciation
Book Value	13348013	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Book Value	0	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	27039944	OtherCostOrOtherBasis
Depreciation	18950906	Depreciation
Book Value	8089038	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4269383	OtherCostOrOtherBasis
Depreciation	207634	Depreciation
Book Value	4061749	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	26298141	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescription	AmountAmount
DEFERRED COMPENSATION	$162,500
ASSET RET OBLIG LIABILITY	$815,063
DUE TO RELATED PARTIES	$106,431,252
PENSION PAYABLE	$6,535,082

Field	Value	IRS element (for citing)
Total Of Amounts	113943897	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

Field	Value	IRS element (for citing)
Identifier	FIN 48 (ASC 740) footnote	Identifier
Return Reference	Schedule D, Part X, Line 2	ReturnReference
Explanation	DIGNITY 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.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare

Discounted Other DiscountedOther

Field	Value	IRS element (for citing)
Other	X	Other
Discounted Other Percentage	5	DiscountedOtherPercentage

Field	Value	IRS element (for citing)
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	false	ExpensesExceededBudget
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	838	PersonsServed
Total Community Benefit Expense	5780007	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	5780007	NetCommunityBenefitExpense
Percent Of Total Expense	0.02680	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	54482	PersonsServed
Total Community Benefit Expense	141575403	TotalCommunityBenefitExpense
Direct Offsetting Revenue	139305662	DirectOffsettingRevenue
Net Community Benefit Expense	2269741	NetCommunityBenefitExpense
Percent Of Total Expense	0.01050	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	1403	PersonsServed
Total Community Benefit Expense	6518174	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1910704	DirectOffsettingRevenue
Net Community Benefit Expense	4607470	NetCommunityBenefitExpense
Percent Of Total Expense	0.02140	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	56723	PersonsServed
Total Community Benefit Expense	153873584	TotalCommunityBenefitExpense
Direct Offsetting Revenue	141216366	DirectOffsettingRevenue
Net Community Benefit Expense	12657218	NetCommunityBenefitExpense
Percent Of Total Expense	0.05870	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	17	NumberOfActivitiesOrPrograms
Persons Served	17234	PersonsServed
Total Community Benefit Expense	1582414	TotalCommunityBenefitExpense
Direct Offsetting Revenue	104770	DirectOffsettingRevenue
Net Community Benefit Expense	1477644	NetCommunityBenefitExpense
Percent Of Total Expense	0.00690	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	8	NumberOfActivitiesOrPrograms
Persons Served	4637	PersonsServed
Total Community Benefit Expense	2302628	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	2302628	NetCommunityBenefitExpense
Percent Of Total Expense	0.01070	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	25	NumberOfActivitiesOrPrograms
Persons Served	21871	PersonsServed
Total Community Benefit Expense	3885042	TotalCommunityBenefitExpense
Direct Offsetting Revenue	104770	DirectOffsettingRevenue
Net Community Benefit Expense	3780272	NetCommunityBenefitExpense
Percent Of Total Expense	0.01760	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	25	NumberOfActivitiesOrPrograms
Persons Served	78594	PersonsServed
Total Community Benefit Expense	157758626	TotalCommunityBenefitExpense
Direct Offsetting Revenue	141321136	DirectOffsettingRevenue
Net Community Benefit Expense	16437490	NetCommunityBenefitExpense
Percent Of Total Expense	0.07630	PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

Field	Value	IRS element (for citing)
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

Field	Value	IRS element (for citing)
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	710	PersonsServed
Total Community Building Expense	121799	TotalCommunityBuildingExpense
Net Community Building Expense	121799	NetCommunityBuildingExpense
Percent Of Total Expense	0.00060	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	710	PersonsServed
Total Community Building Expense	121799	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	121799	NetCommunityBuildingExpense
Percent Of Total Expense	0.00060	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$3,921,708	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	19019959	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	23016883	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-3996924	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL OF SAN BERNARDINO	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	1805 MEDICAL CENTER DR	AddressLine1
City	SAN BARNARDINO	City
State	CA	State
ZIP Code	92411	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL OF SAN BERNARDINO	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	true	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Needs Assessment Conducted	11	NeedsAssessmentConducted
Take Into Account	true	TakeIntoAccount
Other Facilities	true	OtherFacilities
CHNA Widely Available	true	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Other Method	X	OtherMethod
Adopt Implement Strategy	X	AdoptImplementStrategy
Execute Implement Strategy	X	ExecuteImplementStrategy
Include Operational Plans	X	IncludeOperationalPlans
Adopt Budget	X	AdoptBudget
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
All Needs Addressed	false	AllNeedsAddressed
Organization Incur Excise Tax	false	OrganizationIncurExciseTax
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	200	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	500	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
State Regulation	X	StateRegulation
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	true	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	1	NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY CONVALESCENT CENTER	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	1676 MEDICAL CENTER DRIVE	AddressLine1
City	SAN BERNARDINO	City
State	CA	State
ZIP Code	92411	ZIPCode

Field	Value	IRS element (for citing)
Facility Type	SKILLED NURSING	FacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (21 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Costing Methodology used to calculate financial assistance	Schedule H, Part I, Line 7	FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, CHSB USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO THE PATIENT LEVEL. THE COST ACCOUNTING SYSTEM ALGORITHM ALLOCATES TOTAL OPERATING EXPENSES TO THE PROCEDURE CHARGE CODE LEVEL BASED UPON AN RVU FOR PROCEDURES THAT HAVE BEEN STUDIED AND ASSIGNED AN RVU, OR BASED UPON A CCR FOR UNSTUDIED PROCEDURES THAT DO NOT HAVE AN RVU ASSIGNED. WHEN A CCR IS USED, THE SYSTEM CALCULATES THAT CCR ON A DEPARTMENTAL SPECIFIC BASIS AT THE HOSPITAL WHERE THE SERVICES WERE PROVIDED. THE CALCULATION IS SIMILAR TO THE WORKSHEET 2 OF SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES, EXCEPT IT IS CALCULATED ON A DEPARTMENTAL SPECIFIC BASIS, NOT IN THE AGGREGATE. THE ALLOCATED PROCEDURE CHARGE CODE LEVEL COSTS ARE THEN ROLLED UP TO THE PATIENT LEVEL BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH THOSE SERVICES PROVIDED TO EACH SPECIFIC PATIENT. THIS IS DONE FOR ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF CHARITY CARE IS CALCULATED BY APPLYING THE CCR DERIVED FROM THE COST ACCOUNTING SYSTEM ON A PER FACILITY BASIS, TO THE CHARGES INCURRED ON PATIENTS THAT QUALIFY FOR CHARITY CARE AT THE RESPECTIVE FACILITY. THE ACTUAL COST IS REPORTED FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH AND CASH AND IN-KIND DONATIONS.
COLUMN F	SCHEDULE H, PART I, LINE 7B	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 $20.9 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 $43.2 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 $1.8 MILLION. THE GRANT IS REPORTED UNDER OTHER BENEFITS (PART I, LINE 7I, COLUMN C), AS CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS.
Bad Debt Expense excluded from financial assistance calculation	Schedule H, Part I, Line 7, column(f)	0
Community Building Activities	Schedule H, Part II	CHSB OFFERS A WEALTH OF RESOURCES, INCLUDING OPERATIONAL OFFICES/MEETING SPACE AND ADVOCACY PROVIDED THROUGH THE PARTICIPATION OF HOSPITAL LEADERSHIP, CLINICIANS, EDUCATORS AND STAFF AS COLLABORATORS WITH NON-PROFIT COMMUNITY ORGANIZATIONS TO CARRY ON A MISSION TO INCREASE ACCESS AND REDUCE DISPARITIES IN THE DELIVERY OF HEALTH CARE SERVICES FOR MEMBERS OF THE COMMUNITY. PROVIDING FACILITIES AND STAFF TO ENSURE THAT ADEQUATE RESOURCES ARE DIRECTED TOWARD THE SUCCESS OF COMMUNITY ORGANIZATIONS IS ONLY PART OF OUR EFFORTS. CHSB HAS BEEN PRESENT AT THE TABLE AND HAS PLAYED A SIGNIFICANT ROLE IN THE MISSION AND SUCCESSES OF MANY AGENCIES THAT HAVE COME TOGETHER TO ADDRESS THE SPECIFIC NEED FOR A HEALTHIER AND SAFE COMMUNITY: - HEALTHY SAN BERNARDINO - HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) COMMUNITY BENEFIT COMMITTEE - SAN BERNARDINO CLINIC ASSOCIATION - FOCUS 92411 HOMEWORK CENTER/CATHOLIC CHARITIES - AFRICAN AMERICAN HEALTH INITIATIVE OF SAN BERNARDINO - LATINO HEALTH COLLABORATIVE 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 COMMITTEE, CHSB JOINED OTHER LOCAL HOSPITALS IN ESTABLISHING THE GOAL OF "DISPLACING HEART DISEASE AS THE LEADING CAUSE OF DEATH IN SAN BERNARDINO COUNTY." PARTNERS INCLUDE: - AMERICAN HEART ASSOCIATION - ARROWHEAD REGIONAL MEDICAL CENTER - COMMUNITY HOSPITAL OF SAN BERNARDINO - KAISER PERMANENTE - LOMA LINDA UNIVERSITY HEALTH - REDLANDS COMMUNITY HOSPITAL - SAN ANTONIO COMMUNITY HOSPITAL - SAN BERNARDINO DEPT. OF PUBLIC HEALTH - ST. BERNARDINE MEDICAL CENTER - ST. MARY MEDICAL CENTER (ST. JOSEPH HEALTH)
Bad debt expense - methodology used to estimate amount	Schedule H, Part III, Line 2	THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE ABOVE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. 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 AT OR BELOW 500% OF THE FEDERAL POVERTY LEVEL. CHSB ALSO PROVIDES PATIENTS OPTIONS FOR PROMPT PAY DISCOUNTS, DISCOUNTS FOR THE MEDICALLY INDIGENT, 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. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT.
Bad debt expense - methodology used to estimate amount as community benefit	Schedule H, Part III, Line 3	CHSB MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. CHSB FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL 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. CHSB ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR FINANCIAL 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 FINANCIAL ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIO-ECONOMIC 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 ARE 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 FINANCIAL ASSISTANCE POLICY.
Bad debt expense - financial statement footnote	Schedule H, Part III, Line 4	THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2013, RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCES FOR CHARITY AND DOUBTFUL ACCOUNTS: PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE ARE REPORTED AT THE 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.
Community benefit & methodology for determining medicare costs	Schedule H, Part III, Line 8	CHSB PREPARES MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, §2150FF AND PRM 15-2, §1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR THE INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. DIGNITY HEALTH BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL OF $603.9 MILLION, AS REPORTED BELOW IN PART VI, LINE 6, CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY DIGNITY HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. THIS SHORTFALL INCLUDES $3.9 MILLION REPORTED ON PART III, SECTION B, LINE 7, PRIMARILY FOR FEE FOR SERVICE MEDICARE PATIENTS, AS WELL AS THE UNREIMBURSED PORTION OF MEDICARE MANAGED CARE AND MEDICARE CAPITATED PROGRAMS FOR CHSB.
Collection practices for patients eligible for financial assistance	Schedule H, Part III, Line 9b	AT TIME OF PATIENT BILLING, CHSB PROVIDES TO ALL PATIENTS INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED. INFORMATION PROVIDED INCLUDES, PATIENT FINANCIAL ASSISTANCE INFORMATION, UNINSURED PATIENT DISCOUNT INFORMATION, INFORMATION REGARDING ELIGIBILITY ASSISTANCE FOR GOVERNMENT SPONSORED HEALTHCARE AND PAYMENT ASSISTANCE. CHSB ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. CHSB'S 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 PAYMENT 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. CHSB DOES NOT IMPOSE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES. 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.
Community Served by Needs Assessment	Schedule H, Part V Section B, Line 3	(1) COMMUNITY HOSPITAL OF SAN BERNARDINO - EIGHT FOCUS GROUPS WERE CONDUCTED IN FEBRUARY AND MARCH 2011 FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT BEING LED JOINTLY BY ST. BERNARDINE'S MEDICAL CENTER (SBMC) AND COMMUNITY HOSPITAL OF SAN BERNARDINO (CHSB). A TOTAL OF 90 ADULTS OVER AGE 18 PARTICIPATED IN THE EIGHT GROUPS. SIX GROUPS WERE CONDUCTED IN ENGLISH AND TWO WERE CONDUCTED IN SPANISH. JUST OVER ONE-QUARTER OF THE PARTICIPANTS (27%) WERE MALE WHILE JUST UNDER THREE-QUARTERS (73%) WERE FEMALE. WHILE THE TWO GROUPS CONDUCTED IN SPANISH WERE COMPRISED OF LATINO, SPANISH-SPEAKING PARTICIPANTS, THE OTHER SIX GROUPS INCLUDED A COMBINATION OF MOSTLY WHITE, LATINO AND AFRICAN AMERICAN PARTICIPANTS. SOME OF THE GROUPS INCLUDED SENIORS, THOUGH NO GROUPS WERE CONDUCTED EXCLUSIVELY WITH THE SENIOR POPULATION. PARTICIPANT GROUPS INCLUDED: EMPLOYEES OF GOODWILL INDUSTRIES (N=14), AGENCY CLIENTS FROM TIME FOR CHANGE (N=13), LOW-INCOME CONGREGANTS AFFILIATED WITH INLAND CONGREGATIONS UNITED FOR CHANGE (N=10), AGENCY CLIENTS FROM CATHOLIC CHARITIES (N=13), AGENCY CLIENTS AT VERONICA'S HOME/MARY'S MERCY CENTER (N=8), PATIENTS AT AL SHIFA CLINIC - ENGLISH (N=9), PATIENTS AT AL SHIFA CLINIC - SPANISH (N=9), AGENCY CLIENTS FROM HOME OF NEIGHBORLY SERVICES - SPANISH (N=14). THE ASSESSMENT INCORPORATED BOTH PRIMARY AND SECONDARY DATA. IN THE PRIMARY DATA, 25 INTERVIEWS WERE TARGETED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. PARTICIPANTS IN THE INTERVIEWS INCLUDED REPRESENTATIVES FROM NONPROFIT, PUBLIC AND RELIGIOUS ORGANIZATIONS, THE PUBLIC HEALTH DEPARTMENT, COMMUNITY CLINICS AND THE COUNTY'S CLINIC ASSOCIATION, AND COMMUNITY VOLUNTEERS. THESE KEY STAKEHOLDERS INCLUDE INTERVIEW RESPONDENTS FROM THE AFRICAN AMERICAN HEALTH INSTITUTE OF SAN BERNARDINO COUNTY, AL-SHIFA FREE CLINIC, AMERICAN HEART ASSOCIATION, AMERICAN LUNG ASSOCIATION IN CALIFORNIA, ARROWHEAD UNITED WAY, CATHOLIC CHARITIES, CITY OF FONTANA, FONTANA COMMUNITY SENIOR CENTER, CITY OF SAN BERNARDINO, COMMUNITY CLINIC ASSOCIATION OF SAN BERNARDINO COUNTY, COMMUNITY VOLUNTEER, COMMUNITY HOSPITAL OF SAN BERNARDINO, DIOCESE OF SAN BERNARDINO, H STREET CLINIC, INLAND CONGREGATIONS UNITED FOR CHANGE (ICUC), KNOTTS FAMILY AGENCY, LATINO HEALTH COLLABORATIVE, MARY'S MERCY CENTER, NORTHWEST REDEVELOPMENT PROJECT AREA COMMITTEE, SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY DEPARTMENT OF PUBLIC HEALTH, SAN BERNARDINO UNIFIED SCHOOL DISTRICT, SEXUAL ASSAULT SERVICES OF SAN BERNARDINO, ST. BERNARDINE MEDICAL CENTER, ST. CATHERINE OF SIENNA CATHOLIC CHURCH, TIME FOR CHANGE FOUNDATION. SECONDARY DATA WERE OBTAINED FROM SEVERAL RESOURCES, INCLUDING CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, ESRI BUSINESS ANALYST, NIELSEN CLARITAS, HOUSING AUTHORITY OF SAN BERNARDINO COUNTY, HUD, U.S. BUREAU OF THE CENSUS, CALIFORNIA EMPLOYMENT DEVELOPMENT DEPARTMENT, CALIFORNIA DEPARTMENT OF EDUCATION, CALIFORNIA HEALTH INTERVIEW SURVEY AND NATIONAL CANCER INSTITUTE. WHEN AVAILABLE DATA WERE PROVIDED BY ZIP CODE, COUNTY AND STATE TO FRAME COMMUNITY PROFILE, BIRTH INDICATORS, LEADING CAUSES OF DEATH, ACCESS TO CARE, CHRONIC DISEASE, HEALTH BEHAVIORS, SOCIAL ISSUES AND SCHOOL/STUDENT CHARACTERISTICS.;
Other Hospital Facilities included in Needs Assessment	Schedule H, Part V Section B, Line 4	(1) COMMUNITY HOSPITAL OF SAN BERNARDINO - ST. BERNARDINE MEDICAL CENTER;
Availability of Needs Assessment	Schedule H, Part V Section B, Line 5c	(1) COMMUNITY HOSPITAL OF SAN BERNARDINO - THE ASSESSMENT IS ALSO POSTED ON THE DIGNITY HEALTH WEBSITE: HTTP://WWW.DIGNITYHEALTH.ORG/WHO_WE_ARE/COMMUNITY_HEALTH/235026;
Needs not addressed in Needs Assessment	Schedule H, Part V Section B, Line 7	(1) COMMUNITY HOSPITAL OF SAN BERNARDINO - NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT ADDRESSED IN THE ESTABLISHED HEALTH PRIORITIES INCLUDE: HIV/AIDS, CANCER SCREENINGS AND PREVENTION PRACTICES (SENIOR PNEUMONIA SHOT, COLORECTAL CANCER SCREENING, PAP SMEAR, AND MAMMOGRAM). WHILE RECOGNIZING THAT THESE ARE VALID HEALTH CONCERNS, WITH LIMITED RESOURCES THE COMMITTEE PRIORITIZED HEALTH ISSUES THAT IMPACT HOSPITAL ADMISSIONS, RECOGNIZING THAT THERE ARE EXISTING COMMUNITY RESOURCES IN PLACE THAT HAVE THE COMPETENCIES AND CAPACITY TO ADDRESS THESE OTHER ISSUES.;
Other ways hospital publicized Financial Assistance Policy	Schedule H, Part V Section B, Line 14g	(1) COMMUNITY HOSPITAL OF SAN BERNARDINO - ALL LANGUAGE REGARDING THE POLICY IS COMMUNICATED TO PATIENTS VIA THE METHODS OUTLINED BELOW. 1. SIGNAGE IN ALL ADMITTING AREAS; 2. AT THE POINT OF REGISTRATION, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS; 3. ALL INITIAL STATEMENTS TO UNINSURED PATIENTS INCLUDES VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. A TELEPHONE NUMBER IS PROVIDED FOR PATIENTS TO REQUEST FURTHER INFORMATION ABOUT THE PROGRAM AND ASSISTANCE IS AVAILABLE IN LANGUAGES OTHER THAN ENGLISH; 4. INFORMATION ABOUT THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM, ACCESS TO THE APPLICATION, AND CONTACT INFORMATION IS AVAILABLE ON THE FACILITY'S WEBPAGE.;
Means used to determine amounts billed	Schedule H, Part V Section B, Line 20d	(1) COMMUNITY HOSPITAL OF SAN BERNARDINO - PATIENTS WHO ARE APPLYING FOR DISCOUNTS UNDER THE DISCOUNT PROVISION OF HOSPITAL FAIR PRICING ACT - CALIFORNIA HEALTH AND SAFETY CODE §127400 WHOSE HOUSEHOLD INCOME IS AT OR BELOW 350% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT THE HIGHEST AVERAGE RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES FROM MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT-SPONSORED HEALTH PROGRAM OF HEALTH BENEFIT IN WHICH THE HOSPITAL PARTICIPATES, WHICHEVER IS GREATER.;
Needs assessment.	Schedule H, Part VI, Line 2	THE 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 2011 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, EIGHT FOCUS GROUPS WERE CONDUCTED WITH RESIDENTS OF COMMUNITIES IN THE CHSB PRIMARY SERVICE AREA. FIVE OF THE GROUPS WERE CONDUCTED IN ENGLISH AND THREE 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.
Patient education of eligibility for assistance.	Schedule H, Part VI, Line 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: INFORMATION ABOUT DIGNITY HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS THE HOSPITAL MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES THE HOSPITAL SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT ALL UNINSURED PATIENTS WITH ANNUAL INCOMES LESS THAN $250,000 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. PAYMENT 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. IT IS DIGNITY HEALTH'S POLICY THAT AT THE TIME OF PATIENT BILLING, CHSB PROVIDES TO ALL UNINSURED PATIENTS THE SAME BILLING INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED TO ALL OTHER PATIENTS WHO RECEIVE CARE AT CHSB. 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.
Community information.	Schedule H, Part VI, Line 4	COMMUNITY HOSPITAL OF SAN BERNARDINO IS LOCATED IN AN AREA THAT HAS STRUGGLED ECONOMICALLY FOR YEARS, AND HAS ONLY SEEN THE QUALITY OF LIFE PLUMMET WITH THE RECENT NATIONAL ECONOMIC DOWNTURN. EIGHTY PERCENT (80%) OF DISCHARGES COME FROM FIFTEEN (15) ZIP CODES CONCENTRATED IN THE FOLLOWING CITIES: BLOOMINGTON, FONTANA, RIALTO AND SAN BERNARDINO. THE INLAND EMPIRE HAS BEEN SEVERELY IMPACTED BY THE RECESSION. WITHIN THE SERVICE AREA, UNEMPLOYMENT HAD RISEN TO 16.2% IN 2010. THE DATA INDICATE THAT WITHIN THE CHSB SERVICE AREA, POVERTY INCREASED MARKEDLY FOR THE POPULATION WITH INCOMES AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. MANY OF THE NEIGHBORHOODS SERVED BY CHSB HAVE CLOSE TO HALF OF THE RESIDENTS LIVING WITH INCOMES AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. IN SAN BERNARDINO 92410, OVER TWO-THIRDS OF THE POPULATION LIVE AT THIS LEVEL OF POVERTY (67.7%), FOLLOWED CLOSELY BY SAN BERNARDINO 92411 (63.3%) AND SAN BERNARDINO 92408 (61.1%). IN SAN BERNARDINO 92401, 83% OF INDIVIDUALS LIVE AT OR BELOW THE 200% POVERTY LEVEL. CONTRIBUTING TO THE DISMAL EARNING POTENTIAL OF ITS RESIDENTS, THE COMMUNITY HAS A LOW EDUCATION RATE. OF THE POPULATION AGE 25 AND OVER, 31.9% HAVE LESS THAN A HIGH SCHOOL DIPLOMA, MORE THAN DOUBLE THE STATE RATE OF 14.9%. FURTHERMORE, FOR 26.9% OF AREA ADULTS, HIGH SCHOOL GRADUATION WAS THEIR HIGHEST LEVEL OF EDUCATIONAL ATTAINMENT. ONLY 12.7% OF THE POPULATION HOLDS A BACHELOR'S DEGREE OR GREATER. CONFIRMING THE DIFFICULT ECONOMICS OF THE REGION, IN JULY 2012 THE CITY OF SAN BERNARDINO FILED FOR CHAPTER 9 BANKRUPTCY PROTECTION. THIS ACTION WILL EXACERBATE THE ABILITY OF NON-PROFITS TO AID THE MOST VULNERABLE IN OUR COMMUNITY. THE FOLLOWING REFLECTS DEMOGRAPHICS FOR THE PRIMARY SERVICE AREA: - POPULATION: 727,409 - DIVERSITY: HISPANIC (67.3%), CAUCASIAN (15.4%), AFRICAN AMERICAN (10.5%), ASIAN & PACIFIC ISLANDER (4.7%), AMERICAN INDIAN/ALASKA NATIVE (0.3%), TWO OR MORE RACES (1.6%), ALL OTHERS (0.2%) - AVERAGE INCOME: $60,391 - UNINSURED: 20.8% - UNEMPLOYMENT: 12% - NO HIGH SCHOOL DIPLOMA: 31.9% - RENTERS: 36.2% - CNI SCORE: 4.8 - MEDICAL PATIENTS: 25.5% 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 AND REDLANDS 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 SIX (6) 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. WHEN REVIEWING COMMUNITY GRANT PROPOSALS, SPECIAL ATTENTION IS PAID TO ORGANIZATIONS SERVING THESE AREAS.
Promotion of community health	Schedule H, Part VI, Line 5	A MAJORITY OF THE CHSB'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS NOR CONTRACTORS OF THE HOSPITAL. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. CHSB RECOGNIZES THE IMPORTANCE OF COMMUNITY HEALTH AND PROMOTES COMMUNITY HEALTH BEYOND THE WALLS OF THE HOSPITAL THROUGH A VARIETY OF METHODS: COMMUNITY EDUCATION CLASSES ON A VARIETY OF TOPICS ARE OFFERED FREE OF CHARGE THROUGHOUT THE YEAR TO COMMUNITY MEMBERS; REFERRALS TO APPROPRIATE SOCIAL AGENCIES ARE MADE TO THOSE SEEKING ASSISTANCE; FREE FLU SHOTS; COLLABORATION WITH A VARIETY OF NON-PROFIT AGENCIES SHARING A MISSION OF HEALTH, ENVIRONMENT AND SOCIAL WELFARE; 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.
Affiliated health care system	Schedule H, Part VI, Line 6	CHSB IS AFFILIATED WITH DIGNITY HEALTH. AFFILIATES OF DIGNITY HEALTH ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN BAKERSFIELD, SAN BERNARDINO, SAN FRANCISCO, SAN ANDREAS, AND GRASS VALLEY/NEVADA CITY, CALIFORNIA. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. THE SUMMARY OF TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE FOR DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS FOR THE YEAR ENDED JUNE 30, 20123, IS AS FOLLOWS: THE FOLLOWING INFORMATION REPRESENTS PERSONS SERVED, NET COMMUNITY BENEFIT EXPENSE, AND THE PERCENT OF TOTAL EXPENSES. BENEFITS FOR THE POOR: TRADITIONAL CHARITY CARE 120,470; 198,395,000; 2.0% UNPAID COSTS OF MEDICAID/MEDI-CAL 1,136,319; 538,029,000; 5.3% OTHER MEANS-TESTED PROGRAMS 300,240; 75,758,000; 0.7% COMMUNITY SERVICES: COMMUNITY HEALTH SERVICES 449,578; 53,933,000; 0.5% HEALTH PROFESSIONS EDUCATION 69; 30,000; 0.0% SUBSIDIZED HEALTH SERVICES 193,609; 38,432,000; 0.4% DONATIONS 144,076; 29,562,000; 0.3% COMMUNITY BUILDING ACTIVITIES 9,025; 1,862,000; 0.0% COMMUNITY BENEFIT OPERATIONS 2,445; 8,124,000; 0.1% TOTAL COMMUNITY SERVICES FOR THE POOR 798,802; 131,943,000; 1.3% TOTAL BENEFITS FOR THE POOR 2,355,831; 944,125,000; 9.3% BENEFITS FOR THE BROADER COMMUNITY: COMMUNITY SERVICES: COMMUNITY HEALTH SERVICES 560,690; 15,733,000; 0.2% HEALTH PROFESSIONS EDUCATION 40,924; 55,898,000; 0.6% SUBSIDIZED HEALTH SERVICES 4,517; 1,238,000; 0.0% RESEARCH 7,207; 28,631,000; 0.3% DONATIONS 82,520; 9,385,000; 0.1% COMMUNITY BUILDING ACTIVITIES 13,019; 2,723,000; 0.0% COMMUNITY BENEFIT OPERATIONS 66; 1,233,000; 0.0% TOTAL BENEFITS FOR THE BROADER COMMUNITY 708,943; 114,841,000; 1.1% TOTAL COMMUNITY BENEFITS 3,064,774; 1,058,966,000; 10.5% UNPAID COSTS OF MEDICARE 1,269,112; 603,955,000; 6.0% TOTAL COMMUNITY BENEFITS INCLUDING COST OF MEDICARE 4,333,886; 1,662,921,000; 16.4%
State filing of community benefit report	Schedule H, Part VI, Line 7	CA

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance	Purpose Of GrantPurposeOfGrant
CALIFORNIA HEALTH FOUNDATION AND TRUST
1215 K STREET SUITE 800	SACRAMENTO	CA	95814	941498697	501(C)(3)	1802951	0	N/A	N/A	SERVICE FOR THE POOR
CATHOLIC CHARITIES
1450 N D STREET	SAN BERNARDINO	CA	92405	953516461	501(C)(3)	5240	0	N/A	N/A	RELIGIOUS COMMUNITY
COMMUNITY HOSPITAL FOUNDATION
1805 MEDICAL CENTER DRIVE	SAN BERNARDINO	CA	92411	953051931	501(C)(3)	424035	0	N/A	N/A	FOUNDATION SUPPORT

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	3	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	MEALS	TypeOfGrant
Number Of Recipients	4185	NumberOfRecipients
Amount Of Cash Grant	0	AmountOfCashGrant
Amount Of Non Cash Assistance	32741	AmountOfNonCashAssistance
Method Of Valuation	COST	MethodOfValuation
Description Of Non Cash Assistance	PROVISION OF FOOD	DescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Procedures for monitoring use of grant funds	Identifier
Return Reference	Schedule I, Part I, Line 2	ReturnReference
Explanation	THE HOSPITAL USES A SOFTWARE PACKAGE TO DOCUMENT GRANT FUNDING, TO MONITOR AND REPORT PROGRAM OUTCOMES AND TO FORMULATE CRITERIA FOR GRANT SELECTIONS.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	true	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ALVARO BOLIVAR MD
EX-OFFICIO DIRECTOR	233879	0	0	0	0	0	0	0	0	0	233879	0	0	0
BRUCE ERMANN MD
DIRECTOR	0	235924	0	40175	0	2188	0	17932	0	15157	0	311377	0	0
DARRYL VANDENBOSCH
VP/CFO	0	286376	0	37697	0	12959	0	28581	0	18118	0	383731	0	0
DAVID J EVANS
CONTROLLER	173067	0	23350	0	8037	0	20730	0	18044	0	243226	0	0	0
ELIZABETH SHIH
DIRECTOR	0	686873	0	424564	0	153535	0	153244	0	59482	0	1477698	0	90833
GERALDINE C FIKE
VP/CNE	187052	0	29975	0	8309	0	13890	0	13085	0	252311	0	0	0
JACK IVIE
COO (THROUGH 12/2012)	297815	0	37856	0	32916	0	29289	0	3598	0	401474	0	0	0
JUNE COLLISON
HOSPITAL PRESIDENT	0	271716	0	62500	0	10294	0	22117	0	25068	0	391694	0	0
KIMIKO FORD
VP OF ANCILLARY SERVICES	182321	0	26337	0	1754	0	20614	0	27724	0	258750	0	0	0
LORENA WILSON
MEDICAL TRANSCRIBER	142156	0	63750	0	2873	0	16645	0	8828	0	234251	0	0	0
MARC MARCHETTI
VP BUSINESS DEVELOPMENT	191550	0	19959	0	4739	0	20223	0	18000	0	254471	0	0	0
MARIE R ORPILLA
CNIII	226357	0	275	0	2642	0	18341	0	17959	0	265574	0	0	0
MARVIN O'QUINN
DIRECTOR	0	866580	0	369474	0	14518	0	239502	0	64826	0	1554900	0	0
SANDRA ZSCHOMLER
FOUNDATION EXECUTIVE DIRECTOR	167985	0	44396	0	803	0	15447	0	27541	0	256172	0	0	0
STAN RUCKER
CHIEF STRATEGY OFFICER	225050	0	29319	0	13205	0	24050	0	12906	0	304530	0	0	0
STEVEN BARRON
DIRECTOR	0	380027	0	94716	0	38196	0	31662	0	49361	0	593962	0	0
SUSAN WHITTEN
DIRECTOR	0	259912	0	84291	0	12430	0	30476	0	43689	0	430797	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
PART I	SCHEDULE J, PART I	ALVARO BOLIVAR'S COMPENSATION IS FOR CHIEF OF STAFF SERVICES AND MEDICAL SERVICES PROVIDED TO THE ORGANIZATION.
LINE 3	SCHEDULE J, PART I, LINE 3	ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S PRESIDENT'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION.
SEVERANCE	SCHEDULE J, PART I, LINE 4A	CERTAIN LISTED PERSONS PARTICIPATE IN A SEVERANCE PLAN ESTABLISHED BY ITS SUPPORTED ORGANIZATION. THE PLAN PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 1 MONTH TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN.
Supplemental nonqualified retirement plan	Schedule J, Part I, Line 4b	CERTAIN LISTED PERSONS ARE ELIGIBLE TO PARTICIPATE IN ONE OF TWO DIGNITY HEALTH 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. NO BENEFIT WILL VEST UNDER THIS 457(F) PLAN BEFORE THE ATTAINMENT OF AGE 62 OR THE COMPLETION OF 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES 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. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2012. CERTAIN LISTED PERSONS 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. NO PAYMENTS WERE MADE TO ANY LISTED PERSONS DURING 2012 PURSUANT TO THIS PLAN. CERTAIN LISTED PERSONS PARTICIPATE IN THE DIGNITY HEALTH KEY EMPLOYEE SHARE OPTION PLAN (KEYSOP), WHICH WAS FROZEN IN MAY 2002. THE KEYSOP PROGRAM WAS ESTABLISHED IN 2001 WITH THE PURPOSE OF PROVIDING ADDITIONAL COMPENSATION TO ELIGIBLE EMPLOYEES, COMMENSURATE WITH THEIR CONTRIBUTIONS TO THE SUCCESS OF DIGNITY HEALTH, IN A FORM THAT WOULD PROVIDE INCENTIVES AND REWARDS FOR MERITORIOUS PERFORMANCE AND ENCOURAGE THE RECIPIENTS' CONTINUANCE AS EMPLOYEES OF DIGNITY HEALTH. GRANTS OF OPTIONS COULD BE MADE TO ANY EMPLOYEE WHO WAS ELIGIBLE FOR THE COMPANY'S KEY EMPLOYEE RETENTION PROGRAM. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2012. CERTAIN OFFICERS AND KEY EMPLOYEES PARTICIPATE IN THE DIGNITY HEALTH SUPPLEMENTAL EXECUTIVE RETENTION/RETIREMENT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN WHICH IN 2002 WAS OFFERED TO MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM BY THE DIGNITY HEALTH BOARD OF DIRECTORS AND WOULD BE PAID ONLY IF THE EXECUTIVES STAYED WITH THE ORGANIZATION FOR A SPECIFIED NUMBER OF YEARS AS THE PRIMARY PURPOSE OF THIS PLAN IS TO PROVIDE FOR THE RETENTION AND RETIREMENT OF THE PARTICIPANTS. THE EXECUTIVE MANAGEMENT TEAM WAS RECRUITED FROM STABLE CAREERS IN ORGANIZATIONS FROM ACROSS THE COUNTRY AND FROM VARIOUS INDUSTRIES TO ENGINEER AND LEAD A FINANCIAL AND OPERATIONAL TURNAROUND AFTER THE ORGANIZATION HAD LOST NEARLY $1 BILLION IN NET OPERATING PERFORMANCE. THE CALCULATION FOR THE PAYMENTS TO EACH EXECUTIVE IS BASED ON THE VALUE OF A FINAL AVERAGE PAY ANNUITY BENEFIT BASED ON RETIREMENT AGE AND SERVICE YEARS TO THE ORGANIZATION. DISTRIBUTION OCCURS EACH JULY 1 IF THE PLAN FORMULA WARRANTS A PAYMENT. PAYMENTS MADE DURING 2012 PURSUANT TO THIS PLAN INCLUDE $90,833 TO E. SHIH. VESTED AMOUNTS FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR VESTING OCCURS (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS W-2 REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)).
SUPPLEMENTAL DISCLOSURES	SCHEDULE J, PART II	THE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE THE ORGANIZATION 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 THE ORGANIZATION 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 DIGNITY HEALTH'S HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND THE ORGANIZATION'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 AND REVENUE.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	521598225	IssuerEIN
CUSIP Number	13033FTN0	CUSIPNumber
Date Issued	2004-05-19	DateIssued
Issue Price	150000000	IssuePrice
Description Of Purpose	TO FINANCE ACQUISITION OF MEDICAL EQUIPMENT AND CONSTRUCTION AND RENOVATION OF HOSPITAL FACILTIES	DescriptionOfPurpose
Defeased	false	Defeased
On Behalf Of Issuer	false	OnBehalfOfIssuer
Pool Financing	true	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Amount Retired	0	AmountRetired
Amount Bond Defeased	0	AmountBondDefeased
Total Proceeds	2000000	TotalProceeds
Amount In Reserve Fund	0	AmountInReserveFund
Capitalized Interest	0	CapitalizedInterest
Refunding Escrow	0	RefundingEscrow
Issuance Costs From Proceeds	0	IssuanceCostsFromProceeds
Credit Enhancement	0	CreditEnhancement
Working Capital Expenditures	0	WorkingCapitalExpenditures
Capital Expenditures	2000000	CapitalExpenditures
Other Spent Proceeds	0	OtherSpentProceeds
Amount Unspent	0	AmountUnspent
Year Of Subst Completion	2005	YearOfSubstCompletion
Current Refunding	false	CurrentRefunding
Advance Refunding	false	AdvanceRefunding
Final Allocation Made	true	FinalAllocationMade
Adequate Books And Recds Maintaind	true	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	false	OwningBondFinancedProperty
Any Lease Arrangements	true	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	true	MngmentCntrctBondFinancdPrprty
Engage Bond Counsel Contracts	true	EngageBondCounselContracts
Any Research Agreements	true	AnyResearchAgreements
Engage Bond Counsel Research	true	EngageBondCounselResearch
Prcntge Prvt Business Use By Others	0.0000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.0000	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.0000	TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test	false	BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop	false	ChangeInUseBondFinancedProp
Prcntge Bond Financed Prop	0	PrcntgeBondFinancedProp
Remedial Action Taken	false	RemedialActionTaken
Non Qualified Bond Remed Procdrs	true	NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	false	Form8038TFiled
Rebate Not Due Yet	false	RebateNotDueYet
Exception To Rebate	false	ExceptionToRebate
No Rebate Due	true	NoRebateDue
Variable Rate Issue	true	VariableRateIssue
Hedge Identified In Books And Recds	false	HedgeIdentifiedInBooksAndRecds
Term Of Hedge	0.0	TermOfHedge
Superintegrated Hedge	false	SuperintegratedHedge
Hedge Terminated	false	HedgeTerminated
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGIC
Term Of GIC	0.0	TermOfGIC
Regulatory Safe Harbor Satisfied	false	RegulatorySafeHarborSatisfied
Gross Proceeds Invested	true	GrossProceedsInvested
Written Proc To Monitor Reqs	true	WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Proc To Undertk Corrective Action	true	ProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ISSUER NAME: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY: No Rebate Due.	Schedule K, Part IV, Line 2c	THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 7/1/2013.
BOND A - CUSIP 13033FTN0	SCHEDULE K, PART VI	PART I, COLUMN (E) THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, LINE 5A AND PART II, LINE 3 IS PRIMARILY A RESULT OF THE FACT THAT THE 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 ON LINE 3 OF PART II REFLECTS ONLY THE PORTION OF THE BOND ISSUE BORROWED BY THIS 501(C)(3) CORPORATION AND CURRENTLY OUTSTANDING. A SMALL PART OF THE DIFFERENCE BETWEEN THE ISSUE PRICE AND PROCEEDS IS DUE TO INVESTMENT EARNINGS. PART II, LINE 3 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.

Schedule L IRS990ScheduleL

Loan Table LoanTable

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	ALVARA BOLIVAR MD PHYSICIAN LOAN	BusinessNameLine1

Field	Value	IRS element (for citing)
Relationship With Organization	CHIEF OF STAFF	RelationshipWithOrganization
Purpose Of Loan	RECRUITMENT LOAN	PurposeOfLoan
Loan From Organization	X	LoanFromOrganization
Original Principal	$195,000	OriginalPrincipalAmount
Balance Due	62206	BalanceDue
Default	false	Default
Approved By Board	true	ApprovedByBoard
Written Agreement	true	WrittenAgreement

Field	Value	IRS element (for citing)
Total Balance Due	62206	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	BHARTI JAIN MD INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Relationship	BM, B JAIN IS SOLE OWNER	Relationship
Amount Of Transaction	192000	AmountOfTransaction
Description Of Transaction	MEDICAL SERVICES	DescriptionOfTransaction
Sharing Of Revenues	false	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Classes of members or stockholders	Form 990, Part VI, Section A, Line 6	THE SOLE CORPORATE MEMBER IS DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION.
Members or stockholders electing members of governing body	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.
Decisions requiring approval by members or stockholders	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.
Review of form 990 by governing body	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.
Conflict of interest policy	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 DIRECTOR LEVEL AND ABOVE, AND ANY OTHER PERSONNEL AT HIS OR HER DISCRETION). THE ORGANIZATION'S BOARD IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS ARISING FROM 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 ANY 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; (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 PERSON WITH THE CONFLICT OF INTEREST 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, AND 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 ALSO CONFLICTS OF INTEREST PROVISIONS UNDER THE STANDARDS OF CONDUCT APPLICABLE TO ALL EMPLOYEES, AND WHICH ARE ADMINISTERED BY THE CHIEF COMPLIANCE OFFICER WHO HAS REPORTING RESPONSIBILITY TO THE AUDIT & COMPLIANCE COMMITTEE.
COMPENSATION	FORM 990, PART VI, LINE 15A	THE ORGANIZATION EMPLOYS PERSONNEL, HOWEVER, THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IS SET BY A RELATED ORGANIZATION, DIGNITY HEALTH. FOR 2012, DIGNITY HEALTH'S COMPENSATION AND BENEFITS DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF THE PRESIDENT. APPROPRIATE COMPARABILITY DATA FOR SIMILAR JOBS IN PEER COMPANIES (BOTH TAXABLE AND TAX-EXEMPT) WAS OBTAINED FROM INDEPENDENT THIRD-PARTY SURVEY SOURCES.
COMPENSATION	FORM 990, PART VI, LINE 15B	FOR 2012 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.
Governing documents, conflict of interest policy and financial statements available to the public	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.
LINE 3B	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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
COMMUNITY HOSPITAL OF SAN BERNARDINO FOUNDATION
1805 MEDICAL CENTER DRIVE	SAN BERNARDINO	CA	92411	FUND RAISING	CA	501(C)(3)	11 - Type I	COMMUNITY HOSPITAL OF SAN BERNARDINO	true
DIGNITY HEALTH
185 BERRY STREET	SAN FRANCISCO	CA	94107	HOSPITAL	CA	501(C)(3)	3	NA	false

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	true	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	true	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	true	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	false	DividendsRelatedOrganization
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	true	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	false	SharingOfPaidEmployees
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	false	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
COMMUNITY HOSPITAL FOUNDATION
C	511280	SEE SCH R, PART VII
COMMUNITY HOSPITAL FOUNDATION
B	424035	SEE SCH R, PART VII

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Identifier	LINE 1B AND 1C	Identifier
Return Reference	PART V, LINE 2	ReturnReference
Explanation	COMMUNITY HOSPITAL OF SAN BERNARDINO (CHSB) IS SUPPORTED BY ONE FOUNDATION. AS A SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES FOR THE BENEFIT OF, TO RAISE FUNDS FOR, OR TO CARRY OUT THE PURPOSES OF CHSB. AS A RESULT, PAYMENTS ARE MADE DIRECTLY TO CHSB FROM THE FOUNDATION OR DIRECTLY TO THE FOUNDATION FROM CHSB. AMOUNT REPORTED UNDER TRANSACTION TYPE "B" REPRESENT FUNDS EXPENDED BY CHSB ON BEHALF OF THE FOUNDATION FOR OPERATIONAL EXPENSES. AMOUNT REPORTED AS TRANSACTION TYPE "C" REPRESENT FUNDS RECEIVED FROM THE FOUNDATION AS GRANTS TO CHSB.	Explanation