2013-11-14T12:39:09-07:00 2012-12-31 990 2012-01-01 952413596 GOLETA VALLEY COTTAGE HOSPITAL GOLE 8056827111 PO BOX 689 SANTA BARBARA CA 931020689 Joan Bricher 8055697294 2013-11-14 2012 2016-02-25 16:41:14Z Ronald C Werft same as C above Santa Barbara CA 93102 75115494 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. 16 12 401 79 0 0 243241 2200000 65715579 69898820 606773 351726 345016 377212 66910609 72827758 148000 173000 0 0 29933346 31691646 0 0 0 26719792 27605998 56801138 59470644 10109471 13357114 84849918 103831400 32802546 38770001 52047372 65061399 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 51791359 173000 70276032 Goleta Valley Cottage Hospital is a 122-bed acute-care hospital located in the City of Goleta. In 2012, the Hospital had 14,643 patient days and served 40,427 outpatients, including emergency services to 18,680 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 provides emergency services to anyone seeking care, regardless of their ability to pay. 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. Cottage Health System, which includes Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital, provides critical funding for community health, charity care, and external grants, while also realizing shortfalls in Medicare, Medi-Cal, and indigent care. 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. In 2012, Cottage Health System spent over $144 million on these programs. To ensure that every member of the community has access to healthcare Goleta Valley 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 543% of the FPL. Due to the formalized expansion of the charity care program, patients who do not have access to a third-party insurer now have a process to apply for charity care for their outpatient procedure. In 2012, Goleta Valley Cottage Hospital provided 289 patients with financial assistance. 0 0 0 51791359 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 74 0 1 401 1 0 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 0 0 0 CA X Karen Jones 8055697294 400 West Pueblo Santa Barbara CA 93105 X Judith Hopkinson 0.36 3.64 X 0 0 0 Jon Clark 0.36 3.64 X 0 0 0 P Steven Ainsley 0.36 3.64 X 0 0 0 Gregory Faulkner 0.36 3.64 X 0 0 0 Elliot Prager MD 0.36 3.64 X 0 0 0 J Robert Andrews 0.36 3.64 X 0 0 0 Angel Iscovich MD 0.36 3.64 X 0 0 0 Edward Bentley MD 0.36 3.64 X 0 0 0 John Romo 0.45 4.55 X 0 0 0 Marshall Turner Jr 0.45 4.55 X 0 0 0 Thomas Watson MD 0.45 4.55 X 0 11805 0 Charles A Jackson 0.45 4.55 X 0 0 0 Fred Lukas 0.45 4.55 X 0 0 0 Margaret Baker 0.45 4.55 X 0 0 0 Jeffrey Kupperman MD 0.45 4.55 X X 0 1342 0 Alex Koper MD 0.45 4.55 X X 2500 10075 0 Fred Gluck 0.45 4.55 X X 0 0 0 Ed Birch PhD 0.45 4.55 X X 0 0 0 Robert Nakasone 0.45 4.55 X X 0 0 0 Robert Nourse 0.45 4.55 X X 0 0 0 Gretchen Milligan 1.8 18.2 X X 0 0 0 Ronald C Werft 5.4 54.6 X 0 1010499 635089 Steven A Fellows 10 40 X 0 576456 174787 Joan Bricher 4.5 45.5 X 0 540682 239362 Julie Artoux 4.5 45.5 X 0 117680 18962 Diane Wisby 40 0 X 308864 0 42881 Susan San Marco 40 0 X 188608 0 22534 Dennis McDaniel 40 0 X 181743 0 25738 Lisa La Bouve 40 0 X 173976 0 21826 Ken Kettler 40 0 X 167889 0 24005 Rosemary Bray 40 0 X 160326 0 22528 1183906 2268539 1227712 66 0 1 0 HOSPITAL BUILDING & EQUIP CO 11330 Olive Blvd Saint Louis MO 63141 Building contractor fees 18123627 MICHAEL L DAVIS & ASSOCIATES INC 1835 NEWPORT BLVD A 109 SUITE 361 COSTA MESA CA 92627 INSPECTION SERVICES 769747 ANESTHESIA ASSOC MED GROUP INC 5333 HOLLISTER AVE 130 SANTA BARBARA CA 93111 PHYSICIAN SERVICES 732000 PACIFIC MATERIALS LAB PO BOX 96 GOLETA CA 93116 INSPECTION SERVICES 519407 DIVERSIFIED CLINICAL SERVICES 5220 Belfort Road Suite 200 Jacksonville FL 32256 Clinic services 410938 16 0 0 0 2000000 0 200000 0 2200000 NET PATIENT SERVICE REVENUE 900099 68183217 68183217 0 0 CA HOSPITAL FEE PROGRAM 900099 765781 765781 0 0 EHR-Medicare Revenue 900099 949822 949822 0 0 0 0 0 0 69898820 304108 0 0 304108 0 0 0 0 0 0 0 0 0 0 2335354 0 2287736 0 47618 0 47618 0 0 47618 0 CAFETERIA REVENUE 722210 247818 247818 0 0 ED MALPRACTICE REIMBURSEMENT 900099 83786 83786 0 0 REBATES AND REFUNDS 900099 25588 25588 0 0 20020 20020 0 0 377212 72827758 70276032 0 351726 173000 173000 0 0 0 0 0 0 354245 315553 38692 0 0 0 0 0 20877088 18641322 2235766 0 2624196 2319748 304448 0 6233194 5409198 823996 0 1602923 1489102 113821 0 4721161 2484000 2237161 0 6264 0 6264 0 85414 0 85414 0 10789 0 10789 0 0 0 87685 0 87685 0 5328438 4192755 1135683 0 4263 2663 1600 0 1301526 1129104 172422 0 68000 60520 7480 0 0 0 0 0 952101 837151 114950 0 10198 10109 89 0 0 0 0 0 1498 1284 214 0 382 382 0 0 0 0 0 0 1633173 1582477 50696 0 561443 472191 89252 0 MEDICAL SUPPLIES 11133448 11133445 3 0 HOSPITAL FEE PROGRAM 851524 851524 0 0 EQUIPMENT MAINTENANCE 702039 670192 31847 0 LICENSES 90492 14361 76131 0 56160 1278 54882 0 59470644 51791359 7679285 0 1549395 2288003 962117 804347 0 10454077 10623319 0 0 0 564500 543183 543843 863597 105000492 24224106 61562541 80776386 6193371 4562784 2734471 2248544 0 0 0 0 285603 1121237 84849918 103831400 8313913 7749852 0 0 0 0 0 0 0 24488633 31020149 32802546 38770001 X 51837372 64926577 210000 134822 0 0 52047372 65061399 84849918 103831400 X 13357114 514018 0 0 0 -857105 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10789 10789 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Lobbying activites are calculated as a percentage of dues paid to various organizations. 0 0 0 0 14563087 14527217 35870 0 2270321 2233957 36364 0 11878288 7099468 4778820 0 76288796 363464 75925332 80776386 0 SELF INSURANCE LIABILITY 2641155 MINIMUM PENSION LIABILITY 4896766 RETIREMENT PLAN SERP 73796 DUE TO AFFILIATES 7325678 GVCH ALLOCATION OF TAX EXEMPT DEBT 16082754 31020149 X 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 584959 0 584959 0.0098 16188502 10965857 5222645 0.0878 518658 158035 360623 0.0061 0 0 17292119 11123892 6168227 0.1037 23129 23129 0.0004 48000 48000 0.0008 125000 125000 0.0021 0 0 196129 0 196129 0.0033 0 0 17488248 11123892 6364356 0.1070 1 938364 0 10576920 14778827 -4201907 X 1 1 1 1 Goleta Valley Cottage Hospital

351 South Patterson Goleta CA 93111

www.cottagehealthsystem.org X X X Goleta Valley Cottage Hospital 1 1 1 350 1 542 1 X X X 1 1 X X 1 0 X X X X 1 X 0 0 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. 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_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Bad debt is not included in the Community Benefit report. Bad debt expense is derived from cost to charge ratios. Footnote in the Audited Financial Statements says: 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 for Medicare patients is a significant loss to the hospital. We are 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, on behalf of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital, is currently in the process of updating its review of community health needs. In 2011, the System relied upon the community health assessment performed by the County of Santa Barbara. The last full assessment completed by Cottage was in 2009, when 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 Cottage Health System 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 Goleta 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 ten-year financial plan to guarantee the Hospital will continue to offer hospital services to the Community for years to come. The Board also approves of annual top goals that are consistent with the mission, vision and values of the Hospital. The financial forethought of the Board of Directors resulted in surplus funds that are being used to rebuild the facility. Goleta Valley 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. 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. SchH_P06_S00_L06 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. 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 NEIGHBORHOOD CLINICS 1900 STATE ST SUITE G SANTA BARBARA CA 93101 770496382 501(c)(3) 125000 0 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 SchI_P01_S00_L02 Schedule I, Part I, Line 2 Grant funds are monitored through the Community Health Coordinating Committee of CHS. Grantees are required to submit a report in June of each year that is reviewed by the committee prior to entire amount of funds being disbursed. 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 Diane Wisby 257880 0 40493 0 10491 0 30044 0 12837 0 351745 0 0 0 Susan San Marco 172668 0 15155 0 785 0 9391 0 13143 0 211142 0 0 0 Dennis McDaniel 171624 0 0 0 10119 0 9025 0 16713 0 207481 0 0 0 Lisa La Bouve 156035 0 14471 0 3470 0 8683 0 13143 0 195802 0 0 0 Ken Kettler 154781 0 11031 0 2077 0 8291 0 15714 0 191894 0 0 0 Rosemary Bray 149092 0 9786 0 1448 0 7944 0 14584 0 182854 0 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. F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 J. Robert Andrews and Greg Faulkner are law partners. 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_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_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a Hours listed may not reflect total hours spent. F990_P11_S00_L09 Form 990, Part XI, Line 9 CHANGE IN PENSION LIABILITY: (853,088); SPECIFIC PURPOSE FUNDS ACCOUNT ADJUSTMENT: (4,017) 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 1 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 Goleta Valley Cottage Hospital Foundation 350 South Patterson Santa Barbara CA 93111 770003554 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 0 0 0 0 0 0 1 0 1 1 1 1 1 1 1 Santa Ynez Valley Cottage Hospital o 75275 ACCRUAL Santa Barbara Cottage Hospital Foundation k 184927 ACCRUAL Santa Barbara Cottage Hospital m 3290587 accrual Santa Barbara Cottage Hospital o 826606 accrual Santa Barbara Cottage Hospital p 39749749 accrual Santa Barbara Cottage Hospital q 1861549 accrual Santa Barbara Cottage Hospital r 247876 accrual Santa Barbara Cottage Hospital s 407049 accrual