2014-11-14T14:20:52-07:00 2013-12-31 990 2013-01-01 952413596 GOLETA VALLEY COTTAGE HOSPITAL GOLE 8056827111 PO BOX 689 SANTA BARBARA CA 931020689 Joan Bricher CFO 8055697294 2014-11-14 2013 2015-11-30 17:44:51Z Ronald Werft same as C above SB CA 93102 75790927 0 X WWW.COTTAGEHEALTHSYSTEM.ORG X 1965 CA It is the mission of Goleta Valley Cottage Hospital to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 17 13 389 55 0 2200000 90000 69898820 74044803 351726 276230 377212 494496 72827758 74905529 173000 198000 0 0 31691646 32776496 0 0 0 27605998 31165563 59470644 64140059 13357114 10765470 103831400 119080219 38770001 36296066 65061399 82784153 It is the mission of Goleta Valley Cottage Hospital to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 0 0 57445763 198000 74539299 Goleta Valley Cottage Hospital is a 122-bed acute-care hospital located in the City of Goleta. In 2013, the Hospital had 14,640 patient days and served 38,762 outpatients, including emergency services to 18,457 patients. The Hospital provides a wide array of inpatient and outpatient services, including but not limited to cardiac, orthopedic, wound care, breast care, emergency and sub-acute services. Goleta Valley Cottage Hospital works to ensure that all patients have adequate access to healthcare and those who do not present with insurance are automatically screened for eligibility in government health programs and are assisted in applying for charity if the patient does not qualify for any other assistance. Cottage Health System, which includes Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital, provides critical funding for community health, charity care, and external grants, while also realizing shortfalls in Medicare, MediCal, and indigent care. Activities in these areas included screenings and health fairs; classes, clinics, lectures, and seminars; community services; community collaborations; and coalitions/committees. In 2013, Cottage Health System spent over $146 million on these programs. 0 0 0 57445763 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 68 0 1 389 1 0 0 0 0 0 0 0 0 0 0 X 17 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Karen Jones Grandidier 8055697294 400 West Pueblo Santa Barbara CA 93105 Judith Hopkinson Director 0.36 3.64 X 0 0 0 Gregory Faulkner Director 0.36 3.64 X 0 0 0 Elliot Prager MD Director 0.36 3.64 X 0 0 0 Lori Gaskin PhD Director 0.36 3.64 X 0 0 0 Dorothy Largay PhD Director 0.36 3.64 X 0 0 0 Edward Bentley MD Director 0.36 3.64 X 0 0 0 John Romo Committee Chair 0.45 4.55 X 0 0 0 Jon Clark Committee Chair 0.45 4.55 X 0 0 0 Thomas Watson MD Committee Chair 0.45 4.55 X 0 13065 0 Charles A Jackson Committee Chair (partial year) 0.45 4.55 X 0 0 0 Gretchen Milligan Committee Chair 0.45 4.55 X 0 0 0 Fred Lukas Committee Chair 0.45 4.55 X 0 0 0 Margaret Baker Committee Chair 0.45 4.55 X 0 0 0 Alex Koper MD Secretary 0.45 4.55 X X 8400 33852 0 Marshall Turner Jr Vice Chair 0.45 4.55 X X 0 0 0 Robert Nakasone Vice Chair 0.45 4.55 X X 0 0 0 P Steven Ainsley Vice Chair 0.45 4.55 X X 0 0 0 Robert Nourse Board Chair 1.8 18.2 X X 0 0 0 Ronald C Werft CEO 5.4 54.6 X 0 1102878 718319 Steven A Fellows COO 10 40 X 0 632925 198617 Joan F Bricher CFO 4.5 45.5 X 0 564018 211993 Julie J Artoux Assistant Secretary 4.5 45.5 X 0 121989 27354 Susan C San Marco Director Srvc Line 40 0 X 191995 0 18404 Lisa M La Bouve Clinical Manager 40 0 X 190903 0 18375 Ken H Kettler Radiology Mgr-Gvch 40 0 X 174256 0 20026 Rosemary A Bray Clinical Manager 40 0 X 167868 0 18332 Jeffrey S Allen Dir Therapy Svcs-Gv 40 0 X 167152 0 18916 Diane E Wisby VP GVCH 40.00 0 X 343332 0 37959 1243906 2468727 1288295 68 0 1 0 Hospital Building & Equipment Co 11330 Olive Blvd Saint Louis MO 63141 Building contractor fees 7267207 Michael L Davis & Associates Inc 1835 NEWPORT BLVD A 109 SUITE 361 COSTA MESA CA 92627 Inspection Services 1056220 Anesthesia Associates Medical Group Inc 5333 HOLLISTER AVE 130 SANTA BARBARA CA 93111 Physician Services 730000 Comforce PO Box 515743 Los Angeles CA 90051 Contract Labor 424580 Professional Roofing Consultants PO Box 551 Santa Paula CA 93061 Roofing services 418388 16 0 0 0 0 0 90000 0 90000 NET PATIENT SERVICE REVENUE 900099 72831630 72831630 0 0 CA HOSPITAL FEE PROGRAM 900099 1213173 1213173 0 0 0 0 0 0 74044803 148102 0 0 148102 0 0 0 0 0 0 0 0 0 0 1013526 0 885398 0 128128 0 128128 0 0 128128 0 CAFETERIA/GIFT SHOP 900099 263159 263159 0 0 ED MALPRACTICE REIMBURSEMENT 900099 74996 74996 0 0 REBATES AND REFUNDS 900099 42428 42428 0 0 113913 113913 0 0 494496 74905529 74539299 0 276230 198000 198000 0 0 0 0 0 0 389691 0 389691 0 0 0 0 0 21371549 19589481 1782068 0 3040445 2758096 282349 0 6339832 5586353 753479 0 1634979 1547216 87763 0 0 0 0 0 108460 0 108460 0 16966 0 16966 0 11018 0 11018 0 0 0 92458 92458 0 5550092 4476709 1073383 0 1528 1528 0 0 1274087 1052134 221953 0 58154 52443 5711 0 0 0 0 0 1044512 934437 110075 0 16917 12848 4069 0 0 0 0 0 678 0 678 0 14 0 14 0 0 0 0 0 1307443 1257262 50181 0 575656 537020 38636 0 MEDICAL SUPPLIES 12045673 12045673 0 0 SYSTEM MANAGEMENT ALLOCATION 6019706 5216256 803450 0 HOSPITAL FEE PROGRAM 1524068 1524068 0 0 SETTLEMENT EXPENSE 688500 0 688500 0 829633 656239 173394 0 64140059 57445763 6694296 0 2288003 5761426 804347 227098 10623319 11380470 543183 459721 863597 415291 122707811 25405510 80776386 97302301 4562784 2175614 2248544 999023 0 0 1121237 359275 103831400 119080219 7749852 10890030 31020149 25406036 38770001 36296066 X 64926577 82760153 134822 24000 0 0 65061399 82784153 103831400 119080219 X 10765470 575588 0 0 0 6381696 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11018 11018 0 Schedule C, Part II-B, Line 1 Lobbying activities are calculated as a percentage of dues paid to various organizations. 0 0 0 0 14563087 14548781 14306 0 2270321 2258197 12124 0 12864241 8234984 4629257 0 93010162 363548 92646614 97302301 7007 SELF INSURANCE LIABILITY 3015037 DUE TO AFFILIATES 5862062 RETIREMENT SERP PLAN 66572 GVCH ALLOCATION OF TAX EXEMPT DEBT 16082754 DUE TO THIRD PARTIES 197708 PHYSICIAN GUARANTEES 174896 25406036 X Schedule D, Part X, Line 2 The System completed an analysis of its tax positions, in accordance with ASC 740, Income Taxes, and determined that there are no uncertain tax positions taken or expected to be taken. The System recognized no interest or penalties related to uncertain tax positions. The System is subject to routine audits by the taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2009. 1 1 X 1 X 3.5 1 X 5.42 1 1 0 1 1 422154 0 422154 0.0066 17107906 11189884 5918022 0.0922 301176 60422 240754 0.0038 0 0 17831236 11250306 6580930 0.1026 25817 0 25817 0.0004 48000 0 48000 0.0008 150000 0 150000 0.0023 0 0 223817 0 223817 0.0035 0 0 18055053 11250306 6804747 0.1061 1 830531 0 10175717 13510628 -3334911 X 1 1 1 1 Goleta Valley Cottage Hospital 351 South Patterson Goleta CA 93111 www.cottagehealthsystem.org 050000034 X X X Goleta Valley Cottage Hospital 1 1 X X X X X X X X X 13 1 1 1 X http://santabarbaragoleta.healthforecast.net/ X X X X X X 0 0 1 1 350 1 542 1 X X X 1 1 X X 1 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-Goleta Valley Cottage Hospital As part of this Community Health Needs Assessment, five focus groups were held on October 9-10, 2013. The focus group participants included 52 local key informants: representatives from public health; physicians; other health professionals; social service providers; employers; and other community leaders. A list of recommended participants for the focus groups was provided by Cottage Health System. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Focus group candidates were first contacted by letter to request their participation. Follow-up phone calls were then made to ascertain whether or not they would be able to attend. Confirmation calls were placed the day before the groups were scheduled to insure a reasonable turnout. Through this process, input was gathered from a representatives of local government officials, public health, as well as several individuals whose organizations work with low-income, minority (including Latino/Mixteco, Native American, Asian, and African American), or other medically underserved populations (specifically, persons who are young adults, elderly, veterans, disabled, lesbian/gay/bisexual/transgender [LGBT], homeless, mentally ill, undocumented, uninsured/underinsured, or receive Medi-Cal/Medicare). Final participation included representatives of the following organizations the Santa Barbara County Education Office, Santa Barbara Unified School District, Santa Barbara Neighborhood Clinics, Planned Parenthood of Santa Barbara, Ventura, & San Luis Obispo Counties, American Indian Health & Services, Mental Wellness Center, Santa Barbara Rescue Mission, Council on Alcoholism & Drug Abuse, County of Santa Barbara Department of Social Services, Foodbank of Santa Barbara County, Pacific Pride, Domestic Violence Solutions, Sarah House, Arthritis Foundation, Pacific Region, Central Coast Office, Hospice of Santa Barbara, Alliance for Living & Dying Well, CenCal Health, Community Action Commission, Central Coast Commission for Senior Citizens-Area Agency on Aging, Visiting Nurse & Hospice Care, DASH (Doctors Assisting Seniors at Home), Carpinteria Children's Project at Main, United Way of Santa Barbara County, American Red Cross, Santa Barbara County Chapter Alzheimer's Association, California Central Chapter, Alpha Resource Center of Santa Barbara, American Heart Association, Central Coast Division , PathPoint, Friendship Center , Independent Living Resource Center, Isla Vista Youth Projects, County of Santa Barbara Public Health Department, Santa Barbara Neighborhood Clinics, Sansum Clinic, Cottage Health System, Santa Barbara Street Medicine - Doctors Without Walls, Santa Barbara City College and the Orfalea Foundation. Schedule H, Part V, Section B, Line 4-Goleta Valley Cottage Hospital Cottage Health System prepares a Community Benefit Report on behalf of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital. It is filed with the State of California, in compliance with California Senate Bill 697. The Community Benefit Report is available to the public upon request. Goleta Valley Cottage Hospital and Santa Barbara Cottage Hospital completed the CHNA in conjunction with one another. Schedule H, Part V, Section B, Line 5-Goleta Valley Cottage Hospital A press release was issued announcing the completion and availability of the CHNA. This information was also shared and presented to the community on an as requested basis. Schedule H, Part V, Section B, Line 6-Goleta Valley Cottage Hospital As a member of Cottage Health System (CHS), the needs identified in the Hospital CHNA will be incorporated into the Community Benefit Program of CHS. The implementation strategy of CHS Community Benefit Program plans to that address all the needs identified in the CHNA through grants to community organizations, health clinics, flu shots, screenings and programs provided directly by the hospitals. Schedule H, Part V, Section B, Line 7-Goleta Valley Cottage Hospital As a member of Cottage Health System (CHS), the needs identified in the Hospital CHNA will be incorporated into the Community Benefit Program of CHS. The implementation strategy of CHS Community Benefit Program plans to that address all the needs identified in the CHNA. Goleta Valley Cottage Hospital supports the following identified health needs through its support of the Santa Barbara Neighborhood Clinic: Access to Care, Immunization & Infectious Diseases, Infant Health & Family Planning and Oral Health. The Hospital also supports nursing education to ensure staffing that will support access to care. The needs that Goleta Valley Cottage Hospital has not provided explicit support for include: Substance Abuse, Nutrition, Physical Activity & Weight, Dementias, Diabetes, and Mental Health & Mental Disorders. These areas were not supported because there are supported by programs at Santa Barbara Cottage Hospital, which is 6 miles away. Schedule H, Part V, Section B, Line 14-Goleta Valley Cottage Hospital A summary of the policy is posted in admitting offices. The full policy is reported to and available from the OSHPD website (www.oshpd.ca.gov). The policy can also be obtained upon request from a Patient Financial Counselor, whose contact information is provided on all billing statements along with a message regarding financial assistance. Patients that do not present any third party insurance information receive a brochure and eligibility counseling from the Patient Business Office. Schedule H, Part V, Section B, Line 20-Goleta Valley Cottage Hospital The maximum that could be charged is based on % of charges that is lower than commercial rates. Schedule H, Part I, Line 6a Cottage Health System prepares a Community Benefit Report on behalf of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital. It is filed with the State of California, in compliance with California Senate Bill 697. The Community Benefit Report is available to the public upon request. Schedule H, Part I, Line 7 The costing methodology includes inpatient, outpatient, and emergency department and is broken down by payer categories. Both direct and overhead costs have been allocated, by services rendered. Each Payers net revenue is offset by the total cost and the results by Payer are calculated. In addition to a hospital wide cost to charge ratio, we have calculated cost to charge ratios for each Payer, based on the cost of the type of services rendered to their specific patients. Therefore, the community benefit amounts attributable to Medicaid and other government programs are calculated based on their specific cost to charge ratio. Schedule H, Part III, Section A, Line 2 Patient service revenue, net of contractual allowances and discounts, is reduced by the provision for bad debts, and accounts receivable is reduced by an allowance for uncollectible accounts. The System establishes an allowance for uncollectible accounts based on many factors, including payer mix, age of receivables, historical cash collection experience, and other relevant information. A significant portion of the Systems uninsured patients will be unable or unwilling to pay for services provided and a significant portion of the Systems insured patients will be unable or unwilling to pay for co-payments and deductibles. Thus, the System records a significant provision for bad debts related to these insured and uninsured patients in the period the services are provided. The System writes down the expected reimbursement after reasonable collection efforts have been exhausted. Schedule H, Part III, Section A, Line 4 Bad debt is not included in the Community Benefit report. FOOTNOTE: Patient service revenue, net of contractual allowances and discounts, is reduced by the provision for bad debts, and accounts receivable is reduced by an allowance for uncollectible accounts. The System establishes an allowance for uncollectible accounts based on many factors, including payer mix, age of receivables, historical cash collection experience, and other relevant information. A significant portion of the Systems uninsured patients will be unable or unwilling to pay for services provided and a significant portion of the Systems insured patients will be unable or unwilling to pay for co-payments and deductibles. Thus, the System records a significant provision for bad debts related to these insured and uninsured patients in the period the services are provided. The System writes down the expected reimbursement after reasonable collection efforts have been exhausted. Costs related to bad debt expense are determined using a cost-to-charge ratio methodology. No bad debt has been included in community benefit expense. Schedule H, Part III, Section B, Line 8 The shortfall from total costs for Medicare patients is a significant loss to the hospital. The Hospital is providing care to patients whose insurance (Medicare) does not cover the entire cost of their care. This provides significant aid to the elderly in the community. Some of these elderly people would qualify under FAP guidelines for charity care under any other Payer program. The dollars reported are taken from the 2013 Medicare Cost Report and are derived following their guidelines of allowable and non-allowable costs. Schedule H, Part III, Section C, Line 9b All patients receive 6 statements over 135 days, which include a statement about how to inquire about financial assistance. Patients who are known to qualify for charity care or are in the process of applying for charity care are not sent to collection until a final charity care determination is made. If they qualify, their account is written down to zero. Schedule H, Part VI, Line 2 Along with the CHNA conducted by the Hospital, CHS also utilizes the health assessment prepared by Cottage Health System, through its hospitals Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital, assesses the needs of the community through the Community Health Needs Assessment. For each hospital, an outside consultant was engaged to review the relevant health and population statistics, conduct a telephone survey of identified community members and hold focus groups with community leaders who represented a broad group of community members. Along with the CHNA conducted by the Hospital, CHS also utilizes the health assessment prepared by the County of Santa Barbara to assess the health of the community. Needs identified in the CHNA include: Access to Care, Immunization & Infectious Diseases, Infant Health & Family Planning, Oral Health, Substance Abuse, Nutrition, Physical Activity & Weight, Dementias, Diabetes, and Mental Health & Mental Disorders. Hospitals are using the information to further support the robust community benefit program that was already in place. The Hospitals provide critical funding for community health, charity care, and external grants, while also realizing shortfalls in Medicare, Medi-Cal, and indigent care. Activities in these areas included screenings and health fairs; classes, clinics, lectures, and seminars; community services; community collaborations; and coalitions/committees. In 2013, Cottage Health System spent over $146 million on these programs. Schedule H, Part VI, Line 3 Cottage Health System has a multifaceted Financial Assistance Program to ensure that patients who do not have insurance are screened for eligibility in a government sponsored healthcare plan and receive information about charity care programs. Every patient who does not present the hospital with proof of insurance or existing government support will be given a handout (in English or Spanish) upon registration that is compliant with California Assembly Bill 774 (AB774). The handout contains information about the Hospital charity care programs. This includes where to obtain applications, income guidelines, other qualification information and contact information for Customer Service and the Admitting department. The Hospital posts information about the charity care program in all registration areas required by AB774. Signs in English and Spanish are located in all areas where patients are registered for inpatient and outpatient services. Signs are also located in the patient billing office and cashier office. Patients will also be contacted by an admitting representative or eligibility counselor to assist the patient in determining eligibility for government sponsored insurance programs and assist with the application process at no cost to the patient. Patient Financial Counselors who answer customer service calls are instructed to offer charity care applications to all patients who indicate they have financial need. Schedule H, Part VI, Line 4 Santa Barbara County consists of 2,750 square miles of land and inland water area. Approximately rectangular in shape, Santa Barbara County is bordered on the north by San Luis Obispo County, on the east by Ventura County, and on the south and west by 107 miles of Pacific coastline. Much of the county is mountainous. The Santa Ynez, San Rafael and Sierra Madre mountains extend in a predominately east west direction. Within the county, there are numerous fertile agricultural areas, including the Santa Maria, Cuyama, Lompoc, and Santa Ynez Valleys, and the southeast coastal plain. These areas, which include most of the developed land, also accommodate the majority of the population. Los Padres National Forest, in the eastern part of the county, covers approximately 44 percent of the total county area. Vandenberg Air Force Base is in the Lompoc region, while UCSB is on the South Coast. North County refers to the area west and north of Gaviota and includes the Lompoc, Santa Maria, Santa Ynez and Cuyama valleys. South Coast refers to the Goleta, Santa Barbara, and Carpinteria coastal plain. Santa Barbara Countys 423,895 population is divided into six sub regions: Carpinteria Valley (4.2%); Santa Barbara/Goleta Region (43.5%); Santa Ynez Valley (5.3%); Lompoc Valley (14%), Santa Maria Valley (31%); Guadalupe Valley (1.7%); and the Cuyama Valley (.3%). Of the total population, 50% are females. The median age is 33.6 years. The population age breakdown is: 29% percent is 0 to 17 years old; 58 % are 20 to 54 years old and 13% are 65 and older. For people reporting one race, 88.6% are White; 2.4% are Black or African American; 1.7% are American Indian or Alaska Native; 4.5% are Asian; less than 0.3% are Native Hawaiian or Other Pacific Islander, and 2.5% reported 2 or more races. 40.4% are persons of Hispanic or Latino origin. Of the Countys population, 21% are foreign-born, 32.8% of persons over the age of five reported speaking a language other than English at home, and 12.7% of county residents live below the poverty level. The residents of the County are served by 5 hospitals throughout the county. Schedule H, Part VI, Line 5 The Board of Directors is made up of prominent community members who volunteer their time to ensure that the Goleta Community has access to high quality, affordable healthcare. The Board of Directors is actively involved in the Hospital strategic decisions and takes its commitment to the Community very seriously. The Board approves of an annual financial budget and reviews a long term financial plan to guarantee the Hospital will continue to offer hospital services to the Community for years to come. The Board also approves of annual top goals that are consistent with the mission, vision and values of the Hospital. The financial forethought of the Board of Directors resulted in surplus funds that are being used to rebuild the facility. Goleta Valley Cottage Hospital is building a new hospital in order to comply with the unfunded mandate of the State of California Senate Bill 1953 SB1953, which requires all hospitals to retrofit or rebuild in order to withstand a major earthquake. The Hospital used this opportunity to live the core value of excellence by ensuring that the new facility will meet the current and future healthcare needs of the Community. Goleta Valley Cottage Hospital works cooperatively with the open medical staff to improve healthcare in the community. The Hospital is exploring how to better align with physicians in order to provide the highest quality of care. Schedule H, Part VI, Line 6 Cottage Health System (CHS) is the parent organization of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital and Goleta Valley Professional Buildings, Inc. These organizations have a common Board of Directors. Cottage Health System Hospitals are the sole hospital providers in the Community and strategic plans are created with all the Hospitals and their Communities in mind. Goleta Valley Cottage Hospital is the second largest of the CHS Hospitals and primarily provides services to the City of Goleta (adjacent to Santa Barbara) and the University of California, Santa Barbara. Schedule H, Part VI, Line 7 Cottage Health System files an annual community benefit report in the State of California on behalf of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, and Santa Ynez Valley Cottage Hospital. 1 SANTA BARBARA NEIGHBORHOOD CLINICS 1900 STATE ST SUITE G SANTA BARBARA CA 93101 770496382 501(c)(3) 150000 CASH SUPPORTS DENTAL CLINIC, AN IDENTIFIED COMMUNITY NEED, AS WELL AS THE "CARE FOR EVERY CHILD" PROGRAM WHICH PROVIDES EDUCATION IN HEALTHY LIFE STYLES AND PREVENTATIVE CARE. CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS FOUNDATION ONE UNIVERSITY DRIVE CAMARILLO CA 93012 770433230 Government 48000 CASH BACHELOR OF SCIENCE NURSING PROGRAM IN SANTA BARBARA 2 0 Schedule I, Part I, Line 2 Grant funds are monitored through the Community Health Coordinating Committee of CHS. Grantees are required to submit a report in June of each year that is reviewed by the committee prior to the entire amount of funds being disbursed. X X X X 0 1 0 0 0 0 0 0 0 Ronald C Werft CEO 0 810869 0 279660 0 12349 0 700565 0 17754 0 1821197 0 0 Steven A Fellows COO 0 480586 0 141176 0 11163 0 180863 0 17754 0 831542 0 0 Joan F Bricher CFO 0 449279 0 107214 0 7524 0 194115 0 17878 0 776010 0 0 Diane E Wisby VP GVCH 194299 0 46885 0 102148 0 29463 0 8496 0 381291 0 18005 0 Susan C San Marco Director Srvc Line 176189 0 14968 0 838 0 9558 0 8846 0 210399 0 0 0 Lisa M La Bouve Clinical Manager 168597 0 15482 0 6824 0 9529 0 8846 0 209278 0 0 0 Ken H Kettler Radiology Mgr-Gvch 162948 0 8156 0 3153 0 8555 0 11471 0 194283 0 0 0 Rosemary A Bray Clinical Manager 154432 0 11964 0 1473 0 8320 0 10012 0 186201 0 0 0 Jeffrey S Allen Dir Therapy Svcs-Gv 152306 0 12420 0 2426 0 8236 0 10680 0 186068 0 0 0 Schedule J, Part I, Line 3 On an annual basis the Executive Compensation Committee (ECC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the ECC are independent members of the Board of Directors. The ECC engages an independent consultant to prepare comparative compensation reports for each position. The executives individual performance will also be considered when determining compensation. The ECC recommends compensation for the executives to the full Board for approval. This process takes place annually for all executives. Additional details found in the narrative for Schedule O, Part VI, Line 15. Schedule J, Part I, Line 4 The amounts reported in the current years deferred compensation includes recognition of past service. The amounts are subject to a substantial risk of forfeiture. Any amounts paid under this plan in the future will be reported again as reportable compensation in the year paid. The System provides certain executives a supplemental retirement program. The program is defined as deferred compensation under the IRC Section 457(f). The annual contribution is 6.95% of base years salary with the contributions vesting five years from crediting date, or at age 62, or immediately in the event of death, disability, or involuntary termination without cause. The unvested account balances are assets of the System and are included in other assets and the accrued expense is included in pension liability and other in the accompanying consolidated balance sheets. Diane Wisby received a payout from the 457(f) plan in the amount of $18,005. Form 990, Part VI, Section A, Line 6 Cottage Health System is the sole corporate member of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital and Goleta Valley Professional Buildings, Inc. Form 990, Part VI, Section A, Line 7a Cottage Health System is the sole corporate member of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, and Goleta Valley Professional Buildings, Inc and can appoint Directors to the Board. Form 990, Part VI, Section A, Line 7b The Board of Directors for Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, and Goleta Valley Professional Buildings, Inc must obtain prior approval of the Board of Directors for Cottage Health System, in order to: a) amend or restate the Articles of Incorporation or Bylaws; b) implement the annual budget and long-term capital and operational budget; c) sell, lease, mortgage, pledge, merge, consolidate or make any other disposition of any material part of the property and assets of this corporation; or d) voluntarily dissolve the corporation. Form 990, Part VI, Section B, Line 11b Form 990 is prepared under the direction of the Vice President of Finance and CFO. Form 990 is reviewed by VP Finance, CFO and independent tax consultants prior to submitting to the Audit and Compliance Committee. All members of the Board receive a copy of the organization's form 990 for review prior to filing. Form 990, Part VI, Section B, Line 12c The purpose of the Conflict of Interest policy is to protect the interest of the Hospital when it contemplates entering into a transaction or arrangement that could benefit the private interest of a Director or Officer of Cottage Health System, Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, Santa Barbara Cottage Hospital Foundation and Goleta Valley Professional Buildings, Inc., collectively known as Cottage Health System. The Cottage Health System Directors have a duty to: 1.) discharge their duties to benefit the Cottage Health System and not the Directors personally 2.) disclose situations with the potential for conflict of interest with the vision and mission of Cottage Health System 3.) refrain from discussing confidential Cottage Health System business with others. Each Board member will annually complete the Cottage Health System Directors Annual Conflict Disclosure Form. The Disclosure information will be reviewed annually by the Board Chair and the results reported to the full Board. Each Director or Officer will disclose to the Board Chair items to be discussed at a Board meeting. If there are any material financial or personal interests a Board member/family member may have in a Board decision, the Director or Officer will disclose this to the Committee Chair for items to be discussed at Board Committees, before the Board reviews the transaction and takes action. In general, an Officer who had disclosed a potential conflict should be excused from the decision making portion of the discussion and is prohibited from voting on a matter involving a potential conflict of interest. If the Board has reasonable cause to believe that a Director or Officer failed to disclose a material financial interest or other potential material conflict of interest, the Board Chair shall inform the member of the basis for the belief and afford the member an opportunity to explain the alleged failure to disclose. After hearing the Director or Officer's response and conducting any further necessary investigation, the Board determines if the Director or Officer failed to disclose a material financial or other potential material conflict of interest. The Board Chair shall take appropriate corrective action. Committee Chairs who address conflict of interest situations with a Board Committee member are responsible for reporting such situations to the Board Chair. Key employees are treated as other employees of Cottage Health System and sign an annual conflict of interest form. These forms are reviewed by Compliance and any issues are brought to the Chief Compliance Officer. Form 990, Part VI, Section B, Line 15 On an annual basis the Executive Compensation Committee (ECC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the ECC are independent members of the Board of Directors. The ECC engages an independent consultant to prepare comparative compensation reports for each position. The executive's individual performance will also be considered when determining compensation. The ECC recommends compensation for the executives to the full Board for approval. This process takes place annually for all employed officers and key employees. Form 990, Part VI, Section C, Line 19 Tax filings can be obtained upon request from the CFO. Audited Financial Statements are attached to the Form 990 in accordance with IRS instructions. The organizations bylaws and conflict of interest policies are not available to the public. Form 990, Part XI, Line 9 Change in pension liability $6,381,696 Cottage Health System PO Box 689 Santa Barbara CA 931020689 770431902 Parent organization for 3 hospitals and medical professional building CA 501 (C) (3) 11b-II N/A 0 Santa Barbara Cottage Hospital PO Box 689 Santa Barbara CA 931020689 951644629 Hospital CA 501 (C) (3) 3 Cottage Health System 1 Santa Ynez Valley Cottage Hospital PO Box 689 Santa Barbara CA 931020689 952224265 Hospital CA 501 (C) (3) 3 Cottage Health System 1 Santa Barbara Cottage Hospital Foundation PO Box 689 Santa Barbara CA 931020689 953802238 Foundation to support Santa Barbara Cottage Hospital CA 501 (C) (3) 7 Santa Barbara Cottage Hospital 0 Goleta Valley Professional Buildings Inc PO Box 689 Santa Barbara CA 931020689 770004202 Medical prof bldg CA 501 (C) (3) 11b-II Cottage Health System 1 Rio Bravo Energia I Investments Holdings LP 89 Nexus Way Camana Bay Grand Cayman KY CJ 1-9007 999999999 Investment CA SB Cottage Hosp Fndtn 0 0 0 Villa Riviera Real Estate Company PO Box 689 Santa Barbara CA 93102 272996284 Workforce Housing Developer CA SBCHF C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 1 Cottage Health System m 6019707 accrual Cottage Health System o 133416 accrual Cottage Health System p 195540 accrual Cottage Health System q 65291 accrual Santa Barbara Cottage Hospital m 4023545 accrual Santa Barbara Cottage Hospital o 1306294 accrual Santa Barbara Cottage Hospital p 32353907 accrual Santa Barbara Cottage Hospital q 442004 acrual Santa Barbara Cottage Hospital r 760970 accrual Santa Barbara Cottage Hospital s 768242 accrual Santa Barbara Cottage Hospital Foundation k 205068 accrual Goleta Valley Professional Buildings Inc r 137206 accrual