2014-05-05T07:02:36-05:00 2013-06-30 135565207 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2012-07-01 951643373 COMMUNITY HOSPITAL OF SAN BERNADINO COMM 9088876333 1805 Medical Center Drive San Bernardino CA 92411 DARRYL VANDENBOSCH 2014-04-30 true VALERIE J BALL P00178114 4159635100 2012 2015-11-30 17:44:51Z DARRYL VANDENBOSCH CFO 1805 Medical Center Drive San Bernardino CA 92411 193180279 false X WWW.CHSB.ORG X 1938 CA 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. 13 8 1649 120 0 0 1038794 802783 199115964 191134701 23318 456565 878283 764394 201056359 193158443 1353088 2276546 0 0 127298124 129352536 0 0 0 91239175 84078218 219890387 215707300 -18834028 -22548857 78269563 72035842 121300421 137615557 -43030858 -65579715 COMMUNITY HOSPITAL OF SAN BERNARDINO IS A NON-PROFIT, FULL-SERVICE, ACUTE CARE FACILITY IN BUSINESS TO PROVIDE ACUTE INPATIENT CARE, LONG-TERM CARE AND A WIDE RANGE OF ANCILLARY AND THERAPEUTIC CARE TO THE COMMUNITY WE SERVE. OUR VISION IS TO CREATE AND PROVIDE HEALTH CARE SOLUTIONS, AND MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY. false false 197190144 2276546 191134701 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. 197190144 true true true true false false false false false true false false false true true false true false false false false false false false false true true true true true true true false false false false true false false false true false false false false false true true true false false true 169 0 true 1649 true false false false false false true true false false false false X 13 8 false false false false true true true true true false false false true true true true true false false false CA X DAVE EVANS FINANCE DEPT 9098876333 1805 MEDICAL CENTER DRIVE SAN BERNARDINO CA 92411 MARGARET HILL PHD 1.00 1.00 X X 0 0 0 MARVIN REITER CPA 1.00 1.00 X X 0 0 0 PEGGY MERRYMAN 1.00 1.00 X X 0 0 0 ALVARO BOLIVAR MD 40.00 0 X 233879 0 0 ANTONIO MYRELL 1.00 2.00 X 0 0 0 BRUCE ERMANN MD 1.00 40.00 X 0 278288 33089 DR BHARTI JAIN 1.00 0 X 0 0 0 ELIZABETH SHIH 1.00 40.00 X 0 1264972 212726 MARVIN O'QUINN 1.00 40.00 X 0 1250572 304328 NITIN NANDA MD 1.00 0 X 0 0 0 PAULETTE BROWN PHD 1.00 0 X 0 0 0 RICHARD GONZALEZ ESQ 1.00 0 X 0 0 0 STEVEN BARRON 1.00 41.00 X 0 512939 81023 SUSAN WHITTEN 1.00 40.00 X 0 356632 74165 VELLORE MURALIGOPAL MD 1.00 0 X 0 0 0 DARRYL VANDENBOSCH 20.00 21.00 X 0 337032 46699 JACK IVIE 40.00 0.00 X 368587 0 32887 JUNE COLLISON 40.00 2.00 X 0 344509 47185 GERALDINE C FIKE 40.00 0 X 225336 0 26974 KIMIKO FORD 40.00 2.00 X 210413 0 48337 STAN RUCKER 40.00 0 X 267574 0 36956 DAVID J EVANS 40.00 0 X 204453 0 38773 LORENA WILSON 40.00 0 X 208778 0 25473 MARC MARCHETTI 40.00 0 X 216248 0 38223 MARIE R ORPILLA 40.00 0 X 229274 0 36300 SANDRA ZSCHOMLER 0.00 60.00 X 213184 0 42988 2377726 4344944 1126127 221 false true false 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 14 4985 511280 246509 40009 1340 802783 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 0 0 0 0 191134701 34291 34291 0 0 0 0 0 442770 20496 0 422274 422274 422274 1280 4985 1340 -60 -60 0 0 CAFETERIA 900099 437057 437057 GIFT SHOPS 900099 209596 209596 COUNTY TRAFFIC FINE FUND REV 900099 50641 50641 67160 0 0 67160 764454 193158443 191134701 0 1220959 2243805 2243805 32741 32741 0 0 1140398 1085083 55315 240000 240000 95707696 90057432 5650264 6720312 6290445 429867 18276838 17124761 1152077 7267292 6821549 445743 0 156003 156003 74736 74736 18240 18240 0 0 19723041 12754651 6968390 0 340388 24869 315519 5180042 4955038 225004 8408753 7506293 902460 0 2401219 2113073 288146 207867 129501 78366 0 92043 78619 13424 5322995 5322995 0 3392069 2883259 508810 2547000 2547000 MEDI-CAL PROVIDER FEE 20957750 20957750 MEDICAL SUPPLIES 12355284 12353748 1536 FOOD EXPENSES 1064913 1064913 OVERHEAD CORPORATE ALLOCATION 511917 511917 1323958 602620 721338 0 215707300 197190144 18517155 0 0 7125 7325 261696 325066 43687 64361 23791700 22395606 129841 62206 0 1981374 2177595 2437451 2624367 24365104 18047925 108688118 82389977 25218335 26298141 0 0 0 0 33250 33250 78269563 72035842 26095300 21671660 2000000 2000000 0 93205121 113943897 121300421 137615557 X -43030858 -65579715 -43030858 -65579715 78269563 72035842 -22548857 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 368 0 37 0 true true false false false false false false false false true 18241 18241 false 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 799341 799341 76579450 63231437 13348013 0 27039944 18950906 8089038 4269383 207634 4061749 26298141 0 DEFERRED COMPENSATION 162500 ASSET RET OBLIG LIABILITY 815063 DUE TO RELATED PARTIES 106431252 PENSION PAYABLE 6535082 113943897 X FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 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. true true X true X true X 5 true true false true true 0 838 5780007 0 5780007 0.02680 0 54482 141575403 139305662 2269741 0.01050 0 1403 6518174 1910704 4607470 0.02140 0 56723 153873584 141216366 12657218 0.05870 17 17234 1582414 104770 1477644 0.00690 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 8 4637 2302628 0 2302628 0.01070 25 21871 3885042 104770 3780272 0.01760 25 78594 157758626 141321136 16437490 0.07630 0 0.00000 0 0.00000 0 0.00000 0 0.00000 1 710 121799 121799 0.00060 0 0.00000 0 0.00000 0 0.00000 0 0.00000 1 710 121799 0 121799 0.00060 true 3921708 0 19019959 23016883 -3996924 X true true 1 1 COMMUNITY HOSPITAL OF SAN BERNARDINO

1805 MEDICAL CENTER DR SAN BARNARDINO CA 92411

X X X COMMUNITY HOSPITAL OF SAN BERNARDINO 1 true X X X X X X X X 11 true true true X X X X X X X X X false false true true 200 true 500 true X X X X X X true true X X X X X X true false X X X X true X false false 1 COMMUNITY CONVALESCENT CENTER

1676 MEDICAL CENTER DRIVE SAN BERNARDINO CA 92411

SKILLED NURSING 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 true 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 3 0 MEALS 4185 0 32741 COST PROVISION OF FOOD Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 THE HOSPITAL USES A SOFTWARE PACKAGE TO DOCUMENT GRANT FUNDING, TO MONITOR AND REPORT PROGRAM OUTCOMES AND TO FORMULATE CRITERIA FOR GRANT SELECTIONS. false true false false false false false false false ALVARO BOLIVAR MD 233879 0 0 0 0 0 0 0 0 0 233879 0 0 0 BRUCE ERMANN MD 0 235924 0 40175 0 2188 0 17932 0 15157 0 311377 0 0 DARRYL VANDENBOSCH 0 286376 0 37697 0 12959 0 28581 0 18118 0 383731 0 0 DAVID J EVANS 173067 0 23350 0 8037 0 20730 0 18044 0 243226 0 0 0 ELIZABETH SHIH 0 686873 0 424564 0 153535 0 153244 0 59482 0 1477698 0 90833 GERALDINE C FIKE 187052 0 29975 0 8309 0 13890 0 13085 0 252311 0 0 0 JACK IVIE 297815 0 37856 0 32916 0 29289 0 3598 0 401474 0 0 0 JUNE COLLISON 0 271716 0 62500 0 10294 0 22117 0 25068 0 391694 0 0 KIMIKO FORD 182321 0 26337 0 1754 0 20614 0 27724 0 258750 0 0 0 LORENA WILSON 142156 0 63750 0 2873 0 16645 0 8828 0 234251 0 0 0 MARC MARCHETTI 191550 0 19959 0 4739 0 20223 0 18000 0 254471 0 0 0 MARIE R ORPILLA 226357 0 275 0 2642 0 18341 0 17959 0 265574 0 0 0 MARVIN O'QUINN 0 866580 0 369474 0 14518 0 239502 0 64826 0 1554900 0 0 SANDRA ZSCHOMLER 167985 0 44396 0 803 0 15447 0 27541 0 256172 0 0 0 STAN RUCKER 225050 0 29319 0 13205 0 24050 0 12906 0 304530 0 0 0 STEVEN BARRON 0 380027 0 94716 0 38196 0 31662 0 49361 0 593962 0 0 SUSAN WHITTEN 0 259912 0 84291 0 12430 0 30476 0 43689 0 430797 0 0 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. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521598225 13033FTN0 2004-05-19 150000000 TO FINANCE ACQUISITION OF MEDICAL EQUIPMENT AND CONSTRUCTION AND RENOVATION OF HOSPITAL FACILTIES false false true A 0 0 2000000 0 0 0 0 0 0 2000000 0 0 2005 false false true true A false true true true true true 0.0000 0.0000 0.0000 false false 0 false true A false false false true true false 0.0 false false false 0.0 false true true A true 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. ALVARA BOLIVAR MD PHYSICIAN LOAN CHIEF OF STAFF RECRUITMENT LOAN X 195000 62206 false true true 62206 BHARTI JAIN MD INC BM, B JAIN IS SOLE OWNER 192000 MEDICAL SERVICES false 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. 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 false true true false true false false false false false false false true false false false false false false COMMUNITY HOSPITAL FOUNDATION C 511280 SEE SCH R, PART VII COMMUNITY HOSPITAL FOUNDATION B 424035 SEE SCH R, PART VII LINE 1B AND 1C PART V, LINE 2 COMMUNITY HOSPITAL OF SAN BERNARDINO (CHSB) IS SUPPORTED BY ONE FOUNDATION. AS A SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES FOR THE BENEFIT OF, TO RAISE FUNDS FOR, OR TO CARRY OUT THE PURPOSES OF CHSB. AS A RESULT, PAYMENTS ARE MADE DIRECTLY TO CHSB FROM THE FOUNDATION OR DIRECTLY TO THE FOUNDATION FROM CHSB. AMOUNT REPORTED UNDER TRANSACTION TYPE "B" REPRESENT FUNDS EXPENDED BY CHSB ON BEHALF OF THE FOUNDATION FOR OPERATIONAL EXPENSES. AMOUNT REPORTED AS TRANSACTION TYPE "C" REPRESENT FUNDS RECEIVED FROM THE FOUNDATION AS GRANTS TO CHSB.