2013-11-14T12:51:08-07:00 2012-12-31 990 2012-01-01 951644629 SANTA BARBARA COTTAGE HOSPITAL SANT 8056827111 PO BOX 689 SANTA BARBARA CA 931020689 Joan Bricher 8058798752 2013-11-14 2012 2016-03-07 17:11:31Z Ronald Werft same as C above Santa Barbara CA 93102 709861310 0 X WWW.COTTAGEHEALTHSYSTEM.ORG X 1888 CA It is the mission of Santa Barbara Cottage Hospital to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 16 12 3219 889 13364218 104290 2065178 2086846 501454547 542778800 15269866 11999419 9885771 12934133 528675362 569799198 1263313 1916555 0 0 229557436 252276896 0 0 0 254585769 299542302 485406518 553735753 43268844 16063445 1130882734 1160226356 497430249 485260002 633452485 674966354 It is the mission of Santa Barbara Cottage Hospital (SBCH) to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 0 0 448916269 1916555 555712933 Santa Barbara Cottage Hospital is a 408-bed acute-care hospital located in the City of Santa Barbara. In 2012, the Hospital had 83,234 patient days, served 124,828 outpatients, including emergency services to 44,246 patients. The Hospital provides a wide array of inpatient and outpatient services, including but not limited to the areas of cardiology, orthopedics, neurology, trauma, labor & delivery, psychiatric, neonatal intensive care, pediatric intensive care, pediatrics, laboratory, imaging, therapy, diabetes, oncology, emergency and rehabilitation services. Cottage Health System, which includes Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital, provides critical funding for community health, charity care, and external grants, while also realizing shortfalls from Medicare, Medi-Cal, and indigent care. In 2012, Cottage Health System spent over $144 million on these programs; the majority of which were the expenses of Santa Barbara Cottage Hospital. Community outreach efforts for Cottage Health System in 2012 focused on five health areas: cancer, heart disease and stroke, children's health, seniors' health, along with prevention and wellness. Activities in these areas included screenings and health fairs; classes, clinics, lectures, and seminars; community services; community collaborations; and coalitions/committees. Santa Barbara Cottage Hospital has also been diligent in ensuring that all patients have adequate access to care. All patients who do not present third-party 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. To ensure that every member of the community has access to healthcare Santa Barbara Cottage Hospital offers full charity care to all patients whose income level is at or below 350% of the Federal Poverty Level (FPL). Discounted care is also available for families who make up to 542% of the FPL. The charity care program at Santa Barbara Cottage Hospital is critical to the community as there is no inpatient acute care County Hospital to treat indigent patients who cannot afford care. In 2012, Santa Barbara Cottage Hospital provided free or discounted care to 1,557 patients. 0 0 0 448916269 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 486 0 1 3219 1 1 1 0 0 0 0 0 0 0 0 0 X 16 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 CA X Karen L Jones 8055697294 400 West Pueblo SANTA BARBARA CA 93105 Judith Hopkinson 1 3 X 0 0 0 Jon Clark 1 3 X 0 0 0 P Steven Ainsley 1 3 X 0 0 0 Gregory Faulkner 1 3 X 0 0 0 Elliot Prager MD 1 3 X 0 0 0 J Robert Andrews 1 3 X 0 0 0 Edward Bentley MD 1 3 X 0 0 0 Angel Inscovich MD 1 3 X 0 0 0 John Romo 1.25 3.75 X 0 0 0 Marshall Turner Jr 1.25 3.75 X 0 0 0 Thomas Watson MD 1.25 3.75 X 11805 0 0 Charles A Jackson 1.25 3.75 X 0 0 0 Fred Lukas 1.25 3.75 X 0 0 0 Margaret Baker 1.25 3.75 X 0 0 0 Jeffrey Kupperman MD 1.25 3.75 X X 1342 0 0 Alex Koper MD 1.25 3.75 X X 10075 2500 0 Fred Gluck 1.25 3.75 X X 0 0 0 Ed Birch PhD 1.25 3.75 X X 0 0 0 Robert Nakasone 1.25 3.75 X X 0 0 0 Robert Nourse 1.25 3.75 X X 0 0 0 Gretchen Milligan 5 15 X X 0 0 0 Ronald C Werft 15 45 X 0 1010499 635089 Steven A Fellows 22.5 27.5 X 0 576456 174787 Joan Bricher 12.5 37.5 X 0 540682 239362 Julie Artoux 12.5 37.5 X 0 117680 18962 Jeffrey Gauvin MD 40 0 X 520228 0 25393 David Nichols 40 0 X 526266 0 24698 Stephen Kaminski MD 40 0 X 385428 0 27986 Charles Cline 40 0 X 280346 0 27653 Melinda Staveley 40 0 X 267629 0 41912 Herbert Geary 0 40 X 0 333724 47378 Lisa Moore 0 40 X 0 320801 47250 Alberto Kywi 0 40 X 0 370037 48159 Afshin Fatholahi 0 40 X 0 264862 43211 2003119 3537241 1401840 487 1 1 0 McCarthy Building Company 20401 SW BIRCH ST 300 NEWPORT BEACH CA 92660 GENERAL CONTRACTOR 20615043 Comforce PO BOX 31001-0893 PASADENA CA 911100893 CONTRACT LABOR 7180636 Armstrong Associates 1825 State St STE 202 Santa Barbara CA 93101 General Contracting 5627080 Nichols Management Group LTD P O BOX 1288 571 York St York Harbor ME 03911 PDL Lab Management 3279184 Lee Burkhart Lui Inc 13335 Maxella Avenue Marina del Rey CA 90292 Architects 2628258 133 0 0 0 881122 398348 807376 0 2086846 NET PATIENT SERVICE REVENUE 900099 494373445 494373445 0 0 LABORATORY SERVICES 900099 28052430 14688212 13364218 0 CA HOSPITAL FEE PROGRAM 900099 14909448 14909448 0 0 EHR MEDICARE & MEDI-CAL INCENTIVE PMTS 900099 3351997 3351997 0 0 MEDICAL OFFICE BLDG RENTAL 900099 1196076 1196076 0 0 895404 895404 0 0 542778800 9204721 0 0 9204721 0 0 0 0 0 0 0 0 0 0 142856810 0 140062112 0 2794698 0 2794698 0 0 2794698 0 LAB MANAGEMENT 900099 1812690 1812690 0 0 INSURANCE RECOVERIES 900099 5605535 5605535 0 0 CAFETERIA/GIFT SHOP/DELI/VILLA RIVIERA 900099 1595919 1595919 0 0 3919989 3919989 0 0 12934133 569799198 542348715 13364218 11999419 1916555 1916555 21880 21880 0 0 105283 105283 0 0 163009424 136386689 26622735 0 20817558 17392549 3425009 0 55274999 45663014 9611985 0 13047752 10764480 2283272 0 40665253 19854785 20810468 0 6390534 0 6390534 0 679216 0 679216 0 34151 0 34151 0 0 0 2226747 2226747 0 44680450 32572365 12108085 0 186277 58510 127767 0 11861540 9007916 2853624 0 1073159 900731 172428 0 0 0 0 0 8832623 6598217 2234406 0 538164 127347 410817 0 0 0 0 0 164587 28356 136231 0 16626899 12486274 4140625 0 0 0 0 0 36924807 35518613 1406194 0 2472746 1339297 1133449 0 MEDICAL SUPPLIES 88569973 88569878 95 0 HOSPITAL FEE PROGRAM 21847024 21847024 0 0 EQUIPMENT MAINTENANCE 8535917 7287239 1248678 0 CONSTRUCTION EXPENSE 5266616 0 5266616 0 1965619 469267 1496352 0 553735753 448916269 104819484 0 6101205 19975346 55850652 57392976 0 0 89088497 89723230 250000 250000 0 0 0 0 11746702 13187406 3785156 8663402 873565311 220290500 656714482 653274811 203339278 181392001 72325748 89390151 0 8414319 7740172 23266695 39236861 1130882734 1160226356 67640332 57201792 0 0 34502 3015 330237401 323718127 0 0 0 0 0 0 0 0 99518014 104337068 497430249 485260002 X 620607477 661162205 7250752 8209893 5594256 5594256 633452485 674966354 1130882734 1160226356 X 16063445 20868874 0 0 0 4581550 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 34151 34151 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Lobbying activities are calculated as a percentage of dues paid to various organizations. 11636302 0 1323701 0 358958 59184 12541861 12120151 0 -100999 0 338496 44354 11636302 11387435 0 1031032 0 269432 28884 12120151 10754765 0 687451 0 25782 28999 11387435 15792105 0 -4904683 0 48477 84180 10754765 0 0.45 0.55 0 1 1 2282992 15913603 18196595 10358789 647028595 138195490 519191894 0 8582888 968624 7614264 0 147445508 79328293 68117215 0 41952936 1798093 40154843 653274811 0 89390151 F 89390151 0 SELF INSURANCE LIABILITY 28051271 RETIREMENT PLAN - SERP 7141 MINIMUM PENSION LIABILITY 39324062 INTEREST RATE SWAP LIABILITY 33160066 PHYSICIAN GUARANTEE 3300363 CONTINGENT PAYMENT MGPL 494165 104337068 X SchD_P05_S00_L04 Schedule D, Part V, Line 4 Endowment funds support specific programs of SBCH. SchD_P10_S00_L02 Schedule D, Part X, Line 2 The System and its affiliates, except for Pacific Diagnostic Laboratories, are not-for-profit corporations and are tax-exempt pursuant to Section 501(c)(3) of the Internal Revenue Code and are exempt from income taxation under Section 501(a) of the Code and corresponding provisions of the California Revenue and Taxation Code, except to the extent of income derived from taxable unrelated business activities. Unrelated business income is not material to the financial statements. 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 has recognized no interest or penalties related to uncertain tax positions. The System is subject to routine audits by the taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2009. 1 1 X 1 X 3.5 1 X 5.42 1 1 1 0 1 1 16320877 0 16320877 0.0295 99931474 51858916 48072558 0.0868 5177547 1586663 3590884 0.0065 0 0 121429898 53445579 67984319 0.1228 9606231 0 9606231 0.0174 9006005 5595612 3410393 0.0062 521490 0 521490 0.0009 0 0 0 240446 0 240446 0.0004 0 0 19374172 5595612 13778560 0.0249 0 0 140804070 59041191 81762879 0.1477 1 8110651 0 107053279 141441465 -34388186 X 1 1 1 1 Santa Barbara Cottage Hospital

400 West Pueblo Santa Barbara CA 93105

www.cottagehealthsystem.org X X X X X Santa Barbara Cottage Hospital and Cottage Rehab Hospital (operating under one license.) Santa Barbara Cottage Hospital 1 1 1 350 1 542 1 X X X X 1 1 X X 1 0 X X X X 1 X 0 0 8 Pacific Diagnostic Laboratories

454 South Patterson Goleta CA 93117

Outpatient Lab Services Advanced Imaging Center

2410 Fletcher Street Santa Barbara CA 93105

Outpatient radiology center Cottage Residential Center

312 West Montecito Street Santa Barbara CA 93101

Substance abuse rehabilitation center SB Cope

2325 De La Vina Street Santa Barbara CA 93105

Substance abuse and detox treatment Outpatient Rehabilitation

1035 Peach Street Suite 203 San Luis Obisop CA 93401

Outpatient clinic Children's Outpatient Specialty Clinics (2)

2329 Oak Park Lane Santa Barbara CA 93105

Outpatient pediatric clinic for hemotology, oncology and gastrointestinal Pediatric Endocrinology Clinic

427 West Pueblo Santa Barbara CA 93105

Outpatient pediatric endocrineology clinic SchH_P01_S00_L06a 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. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Our 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 Payer's net revenue is offset by the total cost and the results by Payer are calculated. In addition to a hospital-wide cost/charge ratio, we have calculated cost/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/charge ratio. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Palliative Care services are provided at no cost to the patient. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Bad debt is not included in the Community Benefit report. FOOTNOTE: In July 2011, the FASB issued Accounting Standards Update (ASU) No. 2011-07, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities (ASU 2011-07). The provisions of ASU 2011-07 require certain health care entities to present the provision for bad debts related to patient service revenue as a deduction from patient service revenue in the statement of income rather than an operating expense. Additional disclosures related to sources of patient service revenue and allowance for uncollectible accounts is also be required. This new guidance is effective for fiscal years beginning after December 15, 2011, with early adoption permitted. The System adopted the provisions of ASU 2011-07 as of and for the year ended December 31, 2012, and retrospectively applied the presentation requirements to all periods presented. SchH_P03_S0B_L08 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 2012 Medicare Cost Report and are derived following their guidelines of allowable and non-allowable costs. SchH_P03_S0C_L09b 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. SchH_P05_S0B_L14 Schedule H, Part V, Section B, Line 14 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 for the Patient Business Office. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 The maximum that could be charged is based on % of charges that is lower than commercial rates. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Cottage Health System is currently in the process of updating its review of community needs. In its last assessment in 2009, Cottage Health System began an overhaul of its community benefit process and programs. First, Cottage reviewed focus areas of local, state, and national organizations to determine its own focus areas and then next reviewed its internal community outreach programs to ensure they aligned. Cottage Health System reviewed its external community grants process. Funds were shifted from the Foundation to Operations and grant guidelines were developed around the identified focus areas. Both the focus areas and grant program were part of an overall Community Benefit Plan that was approved by the Board of Directors in early 2010. As part of the community benefit review in 2009, Cottage Health System reviewed focus areas of multiple organizations. The Centers for Disease Control and Prevention and The National Health Foundation were reviewed at the national level, and the California Department of Public Health was reviewed at a state level. Locally, four organizations' focus areas and reports were reviewed: Santa Barbara County Public Health Department Status Report 2009, Santa Barbara KIDS Network, United Way of Santa Barbara, and Santa Barbara Neighborhood Clinics. Cottage Health System conducts a regular community perception survey, which includes questions regarding community needs. Cottage Health System also held a brainstorming session with 20 different hospital departments, and the Community Health Coordinating Committee provided input. After reviewing all of the information, Cottage Health System determined the greatest needs to be children's health, seniors' health, cancer, heart disease and stroke, and prevention and wellness. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Santa Barbara Cottage Hospital has a multi-faceted 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's 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. SchH_P06_S00_L04 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 County's 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. Twenty-nine percent of the population is 0-17 years old; 58 % are 20-54 years old and 13% are 65 and older. For people reporting one race, 88.6% are White; 2.4% are Black or African American; 1.7% are American Indian or Alaska Native; 4.5% are Asian; less than 0.3% are Native Hawaiian or Other Pacific Islander, and 2.5% reported 2 or more races. 40.4% are persons of Hispanic or Latino origin. Of the County's population, 21%are foreign-born, 32.8% of persons over the age of five reported speaking a language other than English at home, and 12.7% of county residents live below the poverty level. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Board of Directors is made up of prominent community members who volunteer their time to ensure that the Santa Barbara Community has access to high-quality, affordable healthcare. The Board of Directors is actively involved in the Hospital's strategic decisions and takes its commitment to the Community very seriously. The Board approves of an annual financial budget and 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. Santa Barbara Cottage Hospital is building a new hospital in order to comply with the unfunded mandate of the State of California's Senate Bill 1953 (SB1953), which requires all hospitals to retrofit or rebuild in order to withstand a major earthquake. The Hospital used this opportunity to live the core value of excellence by ensuring that the new facility will meet the current and future healthcare needs of the Community. This is the largest project in the Hospital's history. As the new facility is built the Hospital continues to evaluate bed allocations in order to ensure that Subacute services continue to be available, determining dedicated pediatric bed needs, and allocating beds by patient care unit based upon projected health needs. Santa Barbara Cottage Hospital works cooperatively with the open medical staff to improve healthcare in the community. The Hospital is exploring how to better align with physicians in order to provide the highest quality of care. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Cottage Health System is the parent organization of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital and Goleta Valley Professional Buildings, Inc. These organizations have a common Board of Directors. Cottage Health System Hospitals are the sole hospital providers in the Community and strategic plans are created with all the Hospitals and their Communities in mind. Santa Barbara Cottage Hospital Foundation provides grants to various organizations to promote healthy living and support nurse-training programs in the Community. Santa Barbara Cottage Hospital is the largest hospital in the system and provides the widest array of services. As such, Santa Barbara Cottage Hospital experiences the largest amount of charity care and Medicaid shortfall from cost. The hospital also provides the majority of community benefit programs, which are reported in the Cottage Health System Community Benefit Report. SchH_P06_S00_L07 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 City College 721 Cliff Drive Santa Barbara CA 93109 953234551 government 540000 Support of Nursing Department at Santa Barbara City College California State University Channel Islands Foundation One University Drive Camarillo CA 93012 770433230 government 292000 Support of the BSN program in Santa Barbara Santa Barbara County Education Office 440 Cathedral Oaks Road Santa Barbara CA 93160 956000940 government 200000 Support of (1) Welcome Every Baby program which supports new parents with education and child development guidance, and (2) Health Linkages program which focuses on child development and health. Casa Esperanza PO Box 24116 Santa Barbara CA 93121 770502754 501(c)3 134633 Casa Esperanza assists homeless individuals and families achieve self-sufficiency, by helping as many as possible access the services they need to transition to stable employment and housing. University of California Regents University Drive Santa Barbara CA 93106 954377221 government 121065 Support of research programs. American Indian Health Services 4141 State Street Santa Barbara CA 93110 770398793 501(c)3 97600 Support of the American Indian Oral Health Program to ensure access to dental needs. Foundation for Santa Barbara City College 721 Cliff Drive Santa Barbara CA 93109 953234551 501(c)3 90000 Support of the SBCC Nursing Programs Carpinteria Unified School District 5201 Eighth Street Carpinteria CA 93013 956101195 government 89684 Funding helps the Carpinteria Children's Project to ensure all children entering Kindergarten are healthy and ready to succeed in school with a strong foundation for learning. Visiting Nurse and HOSPICE Care Foundation 222 East Canon Perdido Street Santa Barbara CA 93101 951641969 501(c)3 65000 Supports Alliance for Living and Dying well Mental Wellness Center of SB 617 Garden Street Santa Barbara CA 93101 951962659 501(c)3 60000 To assist with Recovery Learning Center and Employement Services programs. Jodi House Inc 625 Chapala Street Santa Barbara CA 93101 953836137 501(c)3 50000 Funding for the Brain Injury Support Center Council on Alcoholism and Drug Abuse 232 East Canon Perdido Santa Barbara CA 93101 951878858 501(c)3 35000 Support of the County Social Model Residential Detox Program Franklin Elementary School 1111 East Mason Street Santa Barbara CA 93103 300690985 government 32000 Support of the Franklin Obesity Initiative to fight childhood obesity. Sarah House PO Box 20031 Santa Barbara CA 93120 770224415 501(c)3 30000 Offset the end of life care provided to low income patients that transfer from the Hospital Palliative Care facility. Easy Lift Transportation 53 Cass Place Suite D Goleta CA 93117 953642272 501(c)3 25000 This program supports individuals that require paratransit services and are either phycically or cognitively impaired and cannot feasibly use common types of public transportation. Dial-A-Ride allows people to access medical and other service centers essential to their physical and mental health. Family Service Agency CRIS 123 West Gutierrez Street Santa Barbara CA 93101 951644031 501(c)3 20000 Community services for Senior Citizens Willbridge of Santa Barbara 1215 East Montecito Street Santa Barbara CA 93130 571194195 501(c)3 12812 Support for transitional housing beds for homeless patients who are not appropriate for discharge to the streets or shelters and who need supervised convalescence. Thresholds to Recovery 1038 Pittsfield Lane Ventura CA 93001 770335136 501(c)3 8000 Grant funding provides help to individuals who have been intoxicated in the public. The program offers an alternative to incarceration. Program follow-up includes referal for treatment of alcoholism as an effort in recovery. 18 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 Grant funds are monitored through the Community Health Coordinating Committee of Cottage Health System. Grantees are required to submit a report in June of each year that is reviewed by the committee prior to entire amount of funds being disbursed. 0 1 0 0 0 0 0 0 0 Ronald C Werft 0 747865 0 248541 0 14093 0 619353 0 15736 0 1645588 0 0 Steven A Fellows 0 439361 0 123935 0 13160 0 159051 0 15736 0 751243 0 0 Joan Bricher 0 424551 0 101024 0 15107 0 223576 0 15786 0 780044 0 0 Jeffrey Gauvin MD 518986 0 0 0 0 0 12250 0 13143 0 544379 0 0 0 David Nichols 127177 0 399090 0 0 0 12250 0 12448 0 550965 0 0 0 Stephen Kaminski MD 384600 0 0 0 828 0 12250 0 15736 0 413414 0 0 0 Charles Cline 280043 0 0 0 302 0 12250 0 15403 0 307998 0 0 0 Melinda Staveley 206642 0 33324 0 27663 0 26508 0 15403 0 309540 0 14020 0 Herbert Geary 0 281358 0 39661 0 12705 0 31664 0 15714 0 381102 0 0 Lisa Moore 0 279182 0 39374 0 2245 0 31514 0 15736 0 368051 0 0 Alberto Kywi 0 279483 0 45766 0 44788 0 31534 0 16625 0 418196 0 19005 Afshin Fatholahi 0 220964 0 39202 0 4695 0 27497 0 15714 0 308072 0 0 SchJ_P01_S00_L03 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 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 executives. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The amounts reported in the current year's 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. Melinda Stavely received a payout from the 457(f) plan in the amount of $14,020. A California Health Facilities Financing Authority 521643828 13033FQT0 2003-11-20 120987862 Refund 1985 issuance and hospital replacement project 0 0 0 B California Statewide Communities Development Authority 680164610 130795Y76 2010-10-20 300168359 Refund 2008 issue 0 0 0 A 0 0 120987862 0 0 0 1366915 300700 0 99220247 20100000 0 2012 1 0 1 1 B 0 0 300168359 0 0 0 2937359 0 0 0 297231000 0 2012 1 0 1 1 A 0 1 0 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 A 1 B 1 Herb Geary Vice President Home Purchase X 250000 250000 0 1 1 250000 Santa Barbara Gastro Medical Group Board Member Ed Bentley MD is Partner 64480 Medical Professional Fees 0 JoEllen Watson Wife of Board Member 105283 Employee 0 Santa Barbara Cardio Medical Group Board Member Thomas Watson MD is partner 187567 Medical Professional Fees 0 Santa Barbara Gastro Medical Group Board Member Ed Bentley MD is a partner 84980 Lease 0 Santa Barbara Cardio Med Group Board member Thomas Watson is partner 167878 Lease 0 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 J. Robert Andrews and Greg Faulkner are partners in the same law firm. F990_P06_S0A_L06 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. F990_P06_S0A_L07a 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. F990_P06_S0A_L07b 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. F990_P06_S0B_L11b 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. F990_P06_S0B_L12c 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 for 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. F990_P06_S0B_L15 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 executives. F990_P06_S0C_L19 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. F990_P11_S00_L09 Form 990, Part XI, Line 9 CHANGE IN FV INTEREST RATE SWAPS = 1,630,130 ; CHANGE IN PENSION LIABILITY: 2,951,420; Pacific Diagnostic Laboratories LLC PO Box 689 Santa Barbara CA 93102 205038438 Outpatient laboratory services CA 29880870 24532736 SANTA BARBARA COTTAGE HOSPITAL Cottage Health System PO Box 689 Santa Barbara CA 931020689 770431902 Parent organization for 3 hospitals and medical professional building CA 501 (C) (3) 11b-II N/A 0 Goleta Valley Cottage Hospital PO Box 689 Santa Barbara CA 931020689 952413596 Hospital CA 501 (C) (3) 3 Cottage Health System 1 Santa Ynez Valley Cottage Hospital Inc PO Box 689 Santa Barbara CA 931020689 952224265 Hospital CA 501 (C) (3) 3 Cottage Health System 1 Santa Barbara Cottage Hospital Foundation PO Box 689 Santa Barbara CA 931020689 953802238 Foundation to support Santa Barbara Cottage Hospital CA 501 (C) (3) 7 Santa Barbara Cottage Hospital 1 Goleta Valley Professional Blds PO Box 689 Santa Barbara CA 931020689 770004202 Medical Prof Bldg CA 501 (C) (3) 11b-II Cottage Health System 1 RISB Foundation 2415 De La Vina St Santa Barbara CA 931023819 260433816 Fundraising CA 501(c)(3) 7 N/A 0 Villa Riviera Real Estate Company PO Box 689 Santa Barbara CA 93102 272996284 Workforce housing developer CA SBCHF C 0 0 1 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 Goleta Valley Cottage Hospital a-i 880746 accrual Goleta Valley Cottage Hospital l 3290587 accrual Goleta Valley Cottage Hospital o 826606 accrual Goleta Valley Cottage Hospital p 1861549 accrual Goleta Valley Cottage Hospital q 39749749 accrual Goleta Valley Cottage Hospital r 407049 accrual Goleta Valley Cottage Hospital s 247876 accrual Santa Ynez Valley Cottage Hospital Inc l 1052003 accrual Santa Ynez Valley Cottage Hospital Inc o 329547 accrual Santa Ynez Valley Cottage Hospital Inc q 3177876 accrual Santa Barbara Cottage Hospital Foundation c 881071 accrual Santa Barbara Cottage Hospital Foundation q 201381 accrual Santa Barbara Cottage Hospital Foundation r 401361 accrual Goleta Valley Professional Blds a-i 23785 accrual Goleta Valley Professional Blds q 601679 accrual