2012-05-04T11:56:16-05:00 2011-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2010-07-01 951643373 Community Hospital of San Bernardino SANB 9088876333 1805 Medical Center Drive San Bernardino CA 92411 DARRYL VANDENBOSCH 2012-05-04 4159635100 2010 2016-02-24 21:20:13Z ED SORENSON CFO 1805 MEDICAL CNTR DRIVE SAN BERNARDINO CA 92411 198319425 false X WWW.CHWHEALTH.ORG X 1938 CA Community Hospital of San Bernardino is committed to furthering the healing ministry of Jesus, and to providing high-quality, affordable healthcare to the community we serve. 15 8 1628 93 0 0 1594697 609137 160486970 196791336 21835 56577 946606 862375 163050108 198319425 3500 1486148 0 0 112379985 122272435 0 0 0 66757334 88510573 179140819 212269156 -16090711 -13949731 57667325 63903035 67914424 88099865 -10247099 -24196830 COMMUNITY HOSPITAL OF SAN BERNARDINO IS A NON-PROFIT, FULL-SERVICE, ACUTE CARE FACILITY IN BUSINESS TO PROVIDE ACUTE INPATIENT CARE, LONG-TERM CARE AND A WIDE RANGE OF ANCILLARY AND THERAPEUTIC CARE TO THE COMMUNITY WE SERVE. OUR VISION IS TO CREATE AND PROVIDE HEALTH CARE SOLUTIONS, AND MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY. false false 192348473 1486148 196731974 Community Hospital of San Bernardino's mission is to contribute to the health of the community through the provision of quality services delivered in a compassionate and cost effective manner. The hospital is licensed for 442 beds and currently has 360 beds available. The hospital had 92,771 total patient days, 14,592 admissions, and 46,403 emergency room visits. Inpatient services: acute patient care; maternal child care; mental health care; neurological care; and a variety of outpatient care. 192348473 true true false true false false false false false true false false false true false false true false false false false false false false false true true true false true true true false false false false true false false false true false false false false false true true true false false true 144 0 true 1628 true false false false false false false false false false false X 15 8 false false false false true true true true true false false false true true true true true false false false CA X DAVE EVANS FINANCE DEPT 9098876333 1805 MEDICAL CTR DRIVE SAN BERNARDINO CA 92411 X Steve Barron 0.5 X 0 544148 66191 Dr Alvaro Bolivar 0.5 X 157328 0 0 Dr Betty Daniels 0.5 X 0 0 0 Dr Hendrik DeJager 0.5 X 0 0 0 Dr Bharti Jain 0.5 X 0 0 0 Albert Karnig PhD 0.5 X 0 0 0 Frank Lyman 0.5 X 0 0 0 Peggy Merryman 0.5 X 0 0 0 Marvin Reiter CPA 0.5 X X 0 0 0 Dr Paul Ryan 0.5 X 41500 0 0 Elizabeth Shih 0.5 X 0 1384420 373117 Susan Whitten 0.5 X 0 420388 60216 Margaret Hill 0.5 X X 0 0 0 John Nolan Esq 0.5 X X 0 0 0 Marvin O'Quinn 0.5 X 0 2055467 331617 Diane Nitta 40.0 X 477863 0 41738 Edward Sorenson 40.0 X 306624 0 39765 Kimiko Ford 40.0 X 225885 0 35677 Selena D Lancaster 40.0 X 218045 0 17777 Lawrence Lawler 40.0 X 206424 0 35880 Marc Marchetti 40.0 X 217743 0 33590 Harold Newton 40.0 X 209312 0 33960 Marie R Orpilla 40.0 X 216803 0 31939 2277527 4404423 1101467 193 false true false SAFEWAY CONSTRUCTION 1474 N MILLER DR COLTON CA 92324 Contractor 2048300 AMERICAN VITALCARE INC PO BOX 502096 ST LOUIS MO 631502096 Management Services 1994177 AXIOM PAIN MANAGEMENT INC 1800 N MEDICAL CENTER DR suite 105 SAN BERNARDINO CA 92411 Medical Services 1452973 TILLER CONSTRUCTORS INC 306 W KATELLA AVE 3A ORANGE CA 92867 Contractor 1032809 ANGELICA TEXTILE SERVICES 925 S 8TH ST COLTON CA 92324 Laundry Services 930565 39 300000 280137 29000 609137 PATIENT REVENUE/CHARITY CARE 900099 83097277 83097277 MEDICARE/MEDICAID PAYMENTS 900099 113014707 113014707 MEDICAL OFFICE BUILDING 900099 679352 679352 196791336 56577 0 56577 0 0 0 0 0 0 CAFETERIA 900099 519276 519276 GIFT SHOPS 900099 277730 277730 DISCOUNT ON PURCHASES 900099 29531 29531 35838 35838 862375 198319425 196791336 0 918952 1486148 1486148 0 0 0 1338831 1269676 69155 156567 156567 93638673 87966863 5671810 6457539 6063426 394113 13962922 13109748 853174 6717903 6307900 410003 0 41595 41595 68002 68002 61022 61022 0 0 17028485 9404315 7624170 760489 8804 751685 5169459 4977417 192042 6690577 6007935 682642 0 2160068 1900732 259336 160232 118893 41339 0 117623 41668 75955 2612557 2612557 0 4529106 3849740 679366 1347732 1347732 MEDI-CAL PROVIDER FEE 15725324 15725324 BAD DEBT 15073960 15073960 MEDICAL SUPPLIES 12655696 12654458 1238 OVERHEAD CORP ALLOCATION 1324754 1324754 FOOD SUPPLIES 1170335 1170090 245 1813557 1094520 719037 0 212269156 192348473 19920683 0 7185 7625 0 2800517 180031 13480 23567013 21769319 195000 1956785 1925396 1955954 3039268 8034004 102218053 75080952 28854188 27137101 94244 33250 57667325 63903035 36266852 18918376 8409609 2000000 2000000 29647572 58771880 67914424 88099865 X -10247099 -24196830 -10247099 -24196830 57667325 63903035 -13949731 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 61022 61022 false PART II-B, LINE 1F Lobbying expenditures paid directly by the filing organization for annual membership dues: Innovative Federal Strategies $33,333 Lobbying expenditures paid by the Parent organization for annual membership dues where expenses are allocated to the hospital: American Hospital Association $ 2,060 Catholic Health Association $ 1,315 Hospital Association of So. Cal $24,314 ========= TOTAL EXPENDITURES $61,022 ========= 799341 799341 76570191 59282810 17287381 24152542 15644304 8508238 695979 153838 542141 27137101 0 DUE TO RELATED PARTIES 53281118 PENSION PAYABLE 4593626 DEFERRED COMPENSATION 171733 ASSET RET OBLIG LIABILITY 725403 58771880 true true X true X true X 500. true true false true true 811 3858719 0 3858719 0.01960 42464 126799652 125853631 946021 0.00480 551 2817494 974225 1843269 0.00930 43826 133475865 126827856 6648009 0.03370 29440 1983265 0 1983265 0.01010 20 357680 0 357680 0.00180 8023 1798665 0 1798665 0.00910 37483 4139610 0 4139610 0.02100 81309 137615475 126827856 10787619 0.05470 1 0 77820 0 77820 0.00040 1 820 31322 0 31322 0.00020 1 0 16681 0 16681 0.00010 3 820 125823 0 125823 0.00070 true 3219561 0 23994365 24879305 -884940 X true true 1 1 Community Hospital of San Bernardino

1805 Medical Center Dr San Barnardino CA 92411

X X X Community Hospital of San Bernardino 1 1 Community Convalescent Center

1676 Medical Center Drive San Bernardino CA 92411

SKILLED NURSING Schedule H, Part I, Line 7, column (f) The amount of bad debt expense included on Form 990, Part IX, line 25, column (A) is $15,073,960 and has been subtracted for purposes of calculating the percentages in column (f). Schedule H, Part I, Line 7 For purposes of calculating the amounts provided in the table, CHSB uses a cost accounting system that combines relative value units (RVU) and cost to charge ratios (CCR) to allocate costs to the patient level. The cost accounting system algorithm allocates total operating expenses to the procedure charge code level based upon an RVU for procedures that have been studied and assigned an RVU, or based upon a CCR for unstudied procedures that do not have an RVU assigned. When a CCR is used, the system calculates that CCR on a departmental specific basis at the hospital where the services were provided. The calculation is similar to the Worksheet 2 of Schedule H, Ratio of Patient Care Cost to Charges, except it is calculated on a departmental specific basis, not in the aggregate. The allocated procedure charge code level costs are then rolled up to the patient level based upon the billed procedure charge codes associated with those services provided to each specific patient. This is done for all patient segments including inpatient, outpatient, emergency department, private insurance, Medicaid, Medicare, uninsured and self pay. The cost accounting system is utilized to determine the unreimbursed cost of Medicaid and other means-tested government programs. The cost of charity care is calculated by applying the CCR derived from the cost accounting system on a per facility basis, to the charges incurred on patients that qualify for charity care at the respective facility. The actual cost is reported for other community benefit activities such as community health improvement services, community benefit operations, health professions education, subsidized health services, research and cash and in-kind donations. Schedule H, Part II - Community Building Activities CHSB provides financial and in-kind support for community building activities. The following addresses the coalition building, community health improvement/advocacy and workforce development activities. Coalition Building: CHSB recognizes the community need for affordable office/work space for non-profit organization who share a mission the advance sustainable action plans that address solutions for documented community needs in the areas of health, environment and social welfare. With the objective of partnering with non-profit organizations to advance these needs, CHSB provides free office space for these agencies to operate. Community Health Improvement/Advocacy: Similar to the coalition building support, CHSB provides meeting space/food/ supplies/equipment for community building meetings to non-profit organizations that share a mission of community health improvement and advocacy. Workforce Development: The shortage of key health care workers, including allied health care workers, is a need existing in the Inland Empire. CHSB collaborates with California State University San Bernardino, San Bernardino Valley College, Pacific High School and others to increase hospital allied health capacity by increasing awareness of allied health profession among area high school students by providing 24 hours of instruction called "Introduction to Allied Health Careers" to local high schools. Schedule H, Part III, Line 4 The amount of the organization's bad debt at cost is determined by applying the CCR (see above) to patient charges that are deemed to be uncollectible. This amount represents the cost of services provided to patients who are unable or refuse to pay their bills and do not qualify for free or discounted care, government sponsored programs or other financial assistance, and are otherwise uninsured. Any portion of a patient bill remaining after applying financial, uninsured or other discounts or payments received on the account that are ultimately determined to be uncollectible are written off to bad debt. As noted in Part I, Line 3, CHSB provides free or discounted care to uninsured or under-insured individuals at or below 500% of the Federal Poverty Level. CHSB also provides patients options for prompt pay discounts, discounts for the medically indigent, and interest-free extended payment plans for patients who have demonstrated good faith and are cooperating in resolving their hospital bills. All accounts for eligible uninsured patients receive an automatic uninsured discount of 25% for patients. The expected patient payment amount on the patient's bill reflects this discount. CHSB makes every effort in determining if a patient qualifies for financial assistance upon admission. CHSB follows CHW's financial assistance policy. The financial assistance policy is communicated to patients upon admission and is available in the languages primarily spoken in the community. It is also posted in various common areas of the hospital and is provided upon billing if eligibility is not previously determined. Eligibility is reevaluated as needed and amounts are classified as charity as soon as eligibility is known. CHSB also utilizes a Payment Assistance Rank Ordering (PARO) scoring system to assist in determining if a patient may qualify for financial assistance even though they have not applied for it. PARO is a methodology that applies consistent screening and application standards to all patients utilizing historical data to develop a predictive model for healthcare financial assistance. In its development, special attention was paid to those socio-economic factors that might adversely affect those patients deserving the most attention. Other criteria are also utilized to ensure that no services that have qualified as financial assistance are reported as bad debt. As such, CHSB does not believe that any amounts included in Part III, Line 2, are attributable to patients eligible under the organization's financial assistance policy. The following is an excerpt from CHW and its subordinate corporations' consolidated annual audited financial statements for the year ended June 30, 2011, related to accounts receivable and allowances for charity and doubtful accounts: Patient accounts receivable and net patient service revenue are reported at the net realizable amount from patients, third-party payors, and others for services rendered. CHSB manages its collection risk by regularly reviewing its accounts and contracts and by providing appropriate allowances. Reserves for charity and uncollectible amounts have been established and are netted against patient accounts receivable in the consolidated balance sheet. Schedule H, Part III, Line 8 CHSB prepares Medicare cost reports in a manner that comports with Provider Reimbursement Manual (PRM) 15-1, 2150ff and PRM 15-2, 1000ff. As such, the following language per the PRM 15-1 describes the computation of costs per the Medicare Cost Report: Total allowable costs of a provider are apportioned between program beneficiaries and other patients so that the share borne by the program is based upon actual services received by program beneficiaries. The ratio of covered beneficiary charges to total patient charges for the services of each ancillary department is applied to the cost of the department. Added to this amount is the cost of routine services for program beneficiaries, determined on the basis of a separate average cost per diem for all patients for general routine patient care areas. Another factor to be considered is a separate average cost per diem for the intensive care unit, coronary care unit, and other special care inpatient hospital units. CHW believes that the entire Medicare shortfall of $429.3 million, as reported below in Part VI, Line 6, constitutes community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by CHW hospitals in order to continue treating the elderly in our communities. The hospitals provide care regardless of this shortfall and thereby relieve the federal government of the burden of paying the full cost for Medicare beneficiaries. This shortfall includes $884,940 reported on Part III, Section B, Line 7, primarily for fee for service Medicare patients, as well as the unreimbursed portion of Medicare Managed Care and Medicare Capitated programs for CHSB. Schedule H, Part III, Line 9b At time of patient billing, CHSB provides to all Patients information concerning services and charges provided. Information provided includes, patient financial assistance information, uninsured patient discount information, information regarding eligibility Assistance for Government sponsored healthcare and Payment Assistance. CHSB ensures that patient accounts are processed fairly and consistently. CHSB's collection policy contains provisions that prohibit the collection of amounts due from patients who the organization knows qualify for financial assistance. Accounts with incorrect or incomplete demographic information are assigned to a collection agency if CHSB or the billing company retained by CHSB is unable to obtain an updated address through skip tracing or other means. For patients who have an application pending for either government-sponsored financial assistance or for assistance under CHSB's Patient Payment Assistance Policy, or where the patient is attempting in good faith to settle an outstanding bill with the facility via payment plans, CHSB will not knowingly send that patient's bill to an outside collection agency. Legal action will not be pursued to collect debts from patients who have qualified for charity or are cooperating in good faith to resolve their debt. CHSB does not impose wage garnishments or liens on primary residences. On self-pay accounts that do not meet the criteria noted above, the initial determination of assignment to a collection agency will vary depending on the nature of the account with the final decision being at the discretion of each hospital patient financial assistance department. Upon assignment of such a patient account to a collection agency, CHSB requires the agency to comply with the Fair Debt Collection Practices Act. Schedule H, Part VI, Line 2 - Needs Assessment The passing of California's Community Benefit Law (SB 697) created a process and major tool for CHSB to determine its community benefit plan, which outlines how the hospital will give back to the community in the form of health care and other community services to address unmet community health needs. In the spring of 2008 a Community Needs Assessment (CNA) was carried out in partnership with St. Bernardine Medical Center. It incorporates components of primary data collection and secondary data analysis that focus on the health and social needs of the CHSB Service Area. Additionally, eight focus groups were conducted with residents of communities in the CHSB primary service area. Five of the groups were conducted in English and three in Spanish. Through the participation in this needs assessment and benefits planning process CHSB remains committed to participating in community processes that update and refresh the ongoing quest to understand and to respond to the community's priorities for health and quality of life improvements. The CNA continues to be a focal point and an essential tool in developing the strategic direction of CHSB, along with participatory and solution focused processes which have taken inventory of community assets and resources in our community by the Latino Health Collaborative, the African American Health Institute, and the Loma Linda School of Public Health. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assistance Communication of the Financial Assistance Program to Patients and the Public: Information about CHW's Financial Assistance Program and a contact number are made available to patients and the public. Patients are informed of the facility's charity care program via signage in all admitting areas and in various common areas of the hospital. Financial assistance program information notices are posted in the Emergency and Admitting Departments and at other public places as the hospital may elect. Such information is provided in the primary languages spoken in the communities the hospital serves. The signage includes notification that all uninsured patients with annual incomes less than $250,000 receive an uninsured discount of 25% for services provided and that further discounts may be provided upon the completion and submission of a charity care application. Payment assistance information, government program resource information, tools to assist patients in finding health coverage, answers to frequently asked billing questions, and other such information can also be found on CHW's website at www.chwhealth.org. At the point of registration, all patients receive brochures explaining the facility's charity care program and the availability of government sponsored programs. Uninsured patients receive copies of the charity care and Medicaid applications in addition to the brochure upon admission to the facility. It is CHW's policy that at the time of patient billing, CHSB provides to all uninsured patients the same billing information concerning services and charges provided to all other patients who receive care at CHSB. If financial assistance eligibility is not determined prior to billing, initial billing statements to uninsured patients include a request to the patient to provide any insurance information that was valid for the dates of service billed, a statement informing patients without insurance coverage they may be eligible for a government sponsored program or facility funded charity care, instructions on how to apply for a government program or charity care and the provision of such applications. Additionally, contract terms with collection vendors working on behalf of CHW includes language requiring all initial statements to uninsured patients include verbiage informing patients of the facility's charity care program and a copy of the charity care application. Also, any member of CHSB facility staff or medical staff may make referrals of patients for financial assistance. The patient or a family member, a close friend or an associate of the patient may also make a request for financial assistance. Schedule H, Part VI, Line 4 - Community Information The CHSB service area includes 14 Zip Codes that comprise San Bernardino, Rialto, Colton, Highland, Fontana and Bloomington and includes 662,647 persons. There are three other hospitals that serve the community. One, a Catholic Healthcare West hospital. It is a young population with 36% from 0-20 years of age. Seniors 65+ comprise 11% of CHSB's service area population. The ethnicity of the service area reflects 61.7% Hispanic; 12.4% African American; 19.2% Caucasian; 4.8% Asian and 1.9% other. The median income of the 182,459 households in this service area is $43,195. An average of 19.4% of the service area population lives in poverty. 32% of families residing in Zip Codes 92401, 92410 and 92411 live in poverty. 11.8% of San Bernardino's families have a female head of household. Unemployment for San Bernardino County is 13.7%. CHSB service area rate of unemployment is 16.6%. The homeless count is close to 18,000 with 56% living unsheltered. 34% of the sheltered homeless are families with children. According to the 2010 California Health Interview Survey (CHIS), in San Bernardino County, 19.8% are uninsured and 14.7% are on Medi-Cal. . Schedule H, Part VI, Line 5 - Promotion of Community Health A majority of the CHSB's governing body is comprised of persons who reside in the primary service area and who are neither employees, family members nor contractors of the Hospital. The Hospital extends medical staff privileges to all qualified physicians in the community. CHSB recognizes the importance of community health and promotes community health beyond the walls of the hospital through a variety of methods: community education classes on a variety of topics are offered free of charge throughout the year to community members; referrals to appropriate social agencies are made to those seeking assistance; free flu shots; collaboration with a variety of non-profit agencies sharing a mission of health, environment and social welfare; active membership on St. Bernardine Medical Center's Community Benefit Initiative Committee (CBIC) where input from key community stakeholders is critical in reviewing the needs of the community and assist in establishing health priorities and goals. CHSB REINVESTS ALL ITS OPERATING AND INVESTMENT INCOME IN HOSPITAL IMPROVEMENTS, TECHNOLOGY ENHANCEMENTS, COMMUNITY HEALTH PROGRAMS, AND EMPLOYEE BENEFITS. THIS ACTIVE REINVESTMENT MAKES IT POSSIBLE FOR US TO DELIVER ON OUR MISSION, INCLUDING ENSURING THAT EVERYONE HAS ACCESS TO HEALTH CARE. Schedule H, Part VI, Line 6 - Affiliated Health Care System CHSB is affiliated with CHW. Affiliates of CHW also promote the health of additional communities in Bakersfield, San Bernardino, San Francisco, San Andreas, and Grass Valley/Nevada City, California. These affiliates follow practices similar to those noted above in determining the unmet healthcare needs of their communities. The summary of Total unsponsored community benefit expense for CHW and its subordinate corporations for the year ended June 30, 2011, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 97,422 152,563,579 1.6% Unpaid Costs of Medicaid/Medi-Cal 1,035,601 444,972,896 4.7% Other Means-tested Programs 253,140 63,978,237 0.7% Community Services: Community Health Services 552,089 49,285,673 0.5% Health Professions Education 21,637 10,998,382 0.1% Subsidized Health Services 219,756 37,388,406 0.4% Donations 233,077 37,415,522 0.4% Community Building Activities 15,081 1,642,251 0.0% Community Benefit Operations 19,210 6,983,659 0.1% Total Community Services for the poor 1,060,850 143,713,893 1.5% Total Benefits for the Poor 2,447,013 805,228,605 8.5% Benefits for the Broader Community: Community Services: Community Health Services 2,004,902 23,003,029 0.2% Health Professions Education 52,255 65,128,468 0.7% Subsidized Health Services 124,290 11,026,699 0.1% Research 5,057 24,166,007 0.3% Donations 202,417 7,914,381 0.1% Community Building Activities 63,555 8,148,278 0.1% Community Benefit Operations 937 2,883,276 0.0% Total Benefits for the Broader Community 2,453,413 142,270,138 1.5% Total Community Benefits 3,562,475 571,626,794 10.0% Unpaid Costs of Medicare 1,109,062 429,356,656 4.5% Total Community Benefits including Cost of Medicare 6,009,488 1,376,855,399 14.5% Schedule H, Part I, line 7b, column (f) In January 2010, the State of California enacted legislation that provided for supplemental Medi-Cal payments to certain hospitals funded by a quality assurance fee paid by participating hospitals and matching federal funds ("the 2010 Hospital Fee Program"). The legislation covered the period of April 1, 2009 through December 31, 2010. The Centers for Medicare & Medicaid Services approved the 2010 Hospital Fee Program in its entirety in December 2010, and therefore all activity of the program was recognized during the year ended June 30, 2011. Quality assurance fees recognized during the year of $15.7 million are included in total community benefit expense related to unreimbursed Medicaid (Part I, line 7b, column c), and fee-for-service supplemental payments of $29.9 million recognized during the year are reflected under the Medicaid program as direct offsetting revenue (Part I, line 7b, column d). This net reduction in the cost of the Medicaid program is driving a large decrease in the overall cost of community benefit expense as a percent of total expenses when compared to prior year which was 10.18%. The California Hospital Association created a private program, the California Health Foundation and Trust ("CHFT"), established for several purposes, including aggregating and distributing financial resources to support charitable activities at various hospitals and health systems in California. Upon approval of the legislation noted above in December 2010, CHW recorded a pledge to a grant fund established by CHFT in the amount $1.5 million. The grant is reported under other benefits (Part I, line 7i, column c), as cash and in-kind contributions to community groups. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI CA, true California Health Foundation and Trust 1215 K Street Ste 800 Sacramento CA 95814 941498697 501(c)(3) 1461128 0 N/A N/A Improve access to healthcare Catholic Charities 1450 N D Street San Bernardino CA 92405 953516461 501(c)(3) 25020 0 N/A N/A Religious Community 2 0 Part I, Line 2 The hospital is a 501(c)(3) organization that uses a software package to document grant funding, to monitor and report program outcomes and to formulate criteria for grant selections. false true false false false false false false false Steve Barron 0 338008 0 188645 0 17495 0 30428 0 35763 0 610339 0 0 Dr Alvaro Bolivar 157328 0 0 0 0 0 0 0 0 0 157328 0 0 0 Elizabeth Shih 0 593641 0 604950 0 185829 0 326563 0 46554 0 1757537 0 174625 Susan Whitten 0 253873 0 155679 0 10836 0 31017 0 29199 0 480604 0 0 Marvin O'Quinn 0 853766 0 899501 0 302200 0 283675 0 47942 0 2387084 0 0 Diane Nitta 233959 0 233632 0 10272 0 34045 0 7693 0 519601 0 0 0 Edward Sorenson 240320 0 53970 0 12334 0 26394 0 13371 0 346389 0 0 0 Kimiko Ford 182242 0 41950 0 1693 0 18821 0 16856 0 261562 0 0 0 Selena D Lancaster 209424 0 1221 0 7400 0 11956 0 5821 0 235822 0 0 0 Lawrence Lawler 175838 0 23430 0 7156 0 19300 0 16580 0 242304 0 0 0 Marc Marchetti 175924 0 37749 0 4070 0 17085 0 16505 0 251333 0 0 0 Harold Newton 182035 0 24834 0 2443 0 18198 0 15762 0 243272 0 0 0 Marie R Orpilla 214257 0 1279 0 1267 0 15554 0 16385 0 248742 0 0 0 Sch J-1 Alvaro Bolivar's compensation is for Chief of Staff Services provided to the organization. Dr. Paul Ryan's compensation is for medical Services provided to the organization. Schedule J, Part I, Line 3 Although the organization employs personnel, the Organization relied on a related organization, Catholic Healthcare West, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's Service Area Leader's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15a for additional information. Schedule J, PART I, LINE 4a The organization's key employees and its highest compensated employees participate in a severance plan established by its supported organization. The plan provides market-standard compensation, ranging from payments of 1 month to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. Schedule J, PART I, LINE 4b Certain listed persons hired prior to June 30, 2006 are eligible to participate in the 2007 CHW Executive Deferred Compensation Plan, a non-qualified 457(f) plan that is subject to substantial risk of forfeiture, as required by the IRS. The 2007 Executive Deferred Compensation Plan is intended to bridge the difference, if any, between the benefit provided under the CHW Excess Benefit Plan had benefit service not been frozen at January 1, 2008, and the benefits provided from all other qualified and non-qualified plans. No benefit under this formula will vest under this 457(f) plan before the attainment of age 62 or the completion of 15 years of service. Certain listed persons participate in the CHW Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the CHW Retirement Plan whose benefits are affected by the limitations imposed by sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. No payments were made to any listed persons during 2010 pursuant to this plan. Certain listed persons participate in the CHW Key Employee Share Option Plan (KeySOP), which was frozen in May 2002. The KeySOP program was established in 2001 with the purpose of providing additional compensation to eligible employees, commensurate with their contributions to the success of CHW, in a form that would provide incentives and rewards for meritorious performance and encourage the recipients' continuance as employees of CHW. Grants of options could be made to any employee who was eligible for the Company's Key Employee Retention Program. No payments were made under this plan during 2010. Certain officers and key employees participate in the CHW Supplemental Executive Retention/Retirement Plan, a nonqualified supplemental benefit plan which in 2002 was offered to members of the executive management team by the CHW Board of Directors and would be paid only if the executives stayed with the organization for a specified number of years as the primary purpose of this plan is to provide for the retention and retirement of the participants. The executive management team was recruited from stable careers in organizations from across the country and from various industries to engineer and lead a financial and operational turnaround after the organization had lost nearly $1 billion in net operating performance. The calculation for the payments to each executive is based on the value of a final average pay annuity benefit based on retirement age and service years to the organization. Distribution occurs each July 1 if the plan formula warrants a payment. Vested amounts are reported as deferred compensation in the year vesting occurs (column C) and are reflected again as reportable compensation in the year paid (column B(iii)). Payments made during 2010 pursuant to this plan include $174,625 to E. Shih. PART II - SUPPLEMENTAL DISCLOSURES The organization's executive compensation philosophy is designed to assist the organization in attracting and retaining the caliber of executives required to enable the organization to fulfill its mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities the organization serves, promoting employee satisfaction, and ensuring financial stability. A substantial portion of executive compensation is performance based and is linked to organizational goals approved in advance by the compensation and benefits committee. These goals include attainment of annual and long-term financial performance, certain healthcare quality standards and the organization's commitment to serving the poor and disenfranchised in the communities it serves. CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITHY 521598225 13033FTN0 2004-05-19 150000000 NEW MONEY TO FUND VAR PROJECTS & M false false true 0 0 2004025 0 0 0 0 0 0 2004025 0 0 2005 false false true true false true true true true 0.00000 0.00000 0.00000 true false true false false true false SCHEDULE K Part I, Column (e) The difference between the issue price in Part I, column (e) and Part II, Line 3 is due to investment earnings. The separate entities received $2 million of the $150 million of the CHFFA 2004JK pool bonds. Part III, Line 3a Although there are management or service contracts that may generate private use, we have policies and procedures in place that require such contract be in compliance with Revenue Procedure 97-13. Part III, Line 3b Although there are research agreements which may result in private use, we have policies and procedures in place that require such contract be in compliance with Revenue Procedure 2007-47. Part IV, Line 1 Arbitrage calculations were performed by our arbitrage consultant. Such consultant determined that there was no rebatable arbitrage liability; accordingly, no form 8038-T was required to be filed. Alvara Bolivar MD physician loan X 195000 195000 false true true 195000 BHARTI JAIN MD INC BM, B JAIN IS SOLE OWNER 156567 MEDICAL SERVICES false FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE FORM 990, PART VI, SECTION A, LINE 6 The sole corporate member is Catholic Healthcare West, a 501(c)(3) exempt organization. FORM 990, PART VI, SECTION A, LINE 7a CHW, as the sole corporate member, ratifies the selection of members and the CHW Board approves new Board members of the organization. FORM 990, PART VI, SECTION A, LINE 7b Reserved rights of the corporate member include: Adoption of Mission & Philosophy statements, Amendment or restatement of the Articles of Incorporation and Bylaws; Dissolution of the corporation, acquire another corporation, or create a subsidiary; Merging or consolidating with another corporation; Participation as a general or limited partner in any venture; Incurring long-term indebtedness in excess of normal operating requirements; Ratification of board member appointments & dismissals; Selection or removal of independent auditors; Transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11a THE ORGANIZATION'S CFO AND CONTROLLER WORKED CLOSELY WITH THE PARENT ORGANIZATION AND AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. The Board of Directors has delegated the review of the Form 990 to the Finance Committee. Management presented the draft of the Form 990 to the Finance Committee. The draft was complete except it excluded compensation information for directors who are also key executives of Catholic Healthcare West, the filing organization's sole member. Compensation by Catholic Healthcare West to those directors has been reviewed by the Compensation and Benefits Committee of the Catholic Healthcare West Board of Directors. Subsequent to its review, the Finance and Investment Committee reported back to the Board regarding its review and provided a draft to the Board of Directors, again excluding compensation for certain directors. FORM 990, PART VI, SECTION B, LINE 12C The Organization has adopted CHW's Conflicts of Interest Policy. The Organization's Board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the Conflicts of Interest Policy, an annual conflict of interest questionnaire, aimed at determining any family and business relationships and transactions or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees). Covered persons are required to disclose real or potential conflicts at the time such conflicts arise. When someone becomes a covered person and annually thereafter, each covered person is required to sign a statement affirming that he/she: (1) has received a copy of the Conflicts of Interest Policy; (2) has read the Policy and understands said Policy; and (3) agrees to comply with all requirements of the Policy, including completing the conflicts of interest questionnaire. The completed questionnaires are reviewed by CHW's Legal Department and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the Board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; (5) any conflicting issues during the course of a Board meeting which cannot be resolved is referred to the Governance Committee; and (6) the transaction or action must be approved by a majority of disinterested persons. All conflicts of interest, whether resolved or unresolved, are reported in the Organization's Form 990. FORM 990, PART VI, SECTION B, LINE 15A Although the organization employs personnel, the Service Area Leader's compensation is set by a related organization, Catholic Healthcare West (CHW). FOR 2010, CHW's Compensation and Benefits department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the Service Area Leader. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) WAS obtained from independent third-party survey sources. FORM 990, PART VI, SECTION B, LINE 15B For 2010 COMPENSATION, The organization's human resources department conducted an annual review and analysis to provide benchmarking data for the total compensation and benefits package of key employees. The compensation for these individuals was based on the qualification and experience of the candidates. Compensation is also reviewed annually as part of the merit increase process. FORM 990, PART VI, SECTION C, LINE 19 Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its financial statements available on its website and upon request. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Steve Barron TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dr Betty Daniels TITLE:Director HOURS:8 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Elizabeth Shih TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Susan Whitten TITLE:Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Marvin O'Quinn TITLE:Director HOURS:40 Community Hospital Foundation 1805 Medical Center Drive San Bernardino CA 92411 953051931 Fund raising CA 501(c)(3) 11; Type I CHSB Catholic Healthcare West 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false false true false true false false false false false false false false false false true false false COMMUNITY HOSP OF SAN BERNARDINO FOUNDATION c 300000 COMMUNITY HOSP OF SAN BERNARDINO FOUNDATION p 342760 Schedule R, Part V, line 2 column (c) Line 1c - CHSB is supported by one foundation. As a supporting organization, the Foundation operates for the benefit of, to raise funds for, or to carry out the purposes of CHSB. As a result, payments are made directly to CHSB from the Foundation or directly to the Foundation from CHSB. Line 1p - Intercompany activity is common among CHSB and its related organizations. Reimbursements for expenses incurred by the organizations are reported as transaction types "o" and/or "p". Amounts reimbursed are at cost.