2011-05-05T17:09:33-05:00 2010-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2009-07-01 951643373 Community Hospital of San Bernardino COMM 9088876333 1805 Medical Center Drive San Bernardino CA 92411 ED SORENSON 2011-05-04 4159635100 2009 2016-02-24 21:20:13Z ED SORENSON CFO 1805 MEDICAL CNTR DRIVE SAN BERNARDINO CA 92411 163050108 false 0928 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. 14 8 1561 37 0 0 804345 1594697 157356829 160486970 298 21835 837360 946606 158998832 163050108 10000 3500 0 0 101885698 112379985 0 0 0 63161191 66757334 165056889 179140819 -6058057 -16090711 52736609 57667325 46892996 67914424 5843613 -10247099 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 160934496 3500 160486970 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. THE HOSPITAL HAD 88,212 TOTAL PATIENT DAYS, 11,171 ADMISSIONS, AND 44,258 EMERGENCY ROOM VISITS. INPATIENT SERVICES: ACUTE PATIENT CARE; MATERNAL CHILD CARE; MENTAL HEALTH CARE; NEUROLOGICAL CARE; AND A VARIETY OF OUTPATIENT CARE. 160934496 true true false true false false false false false true false true false false false false false false false false true false false true true true false false false false false false false true false false false false false false true true false false true 140 0 true 1561 true false false false false false false false false false 14 8 false false false false true true true true true false false false true true true true true false false false CA X ED SORENSON CFO 9098876333 1805 MEDICAL CTR DRIVE SAN BERNARDINO CA 92411 Dr Kumarvelu Bala 1.0 X 0 0 0 Dr Alvaro Bolivar 1.0 X 103500 0 0 Dr Betty Daniels 1.0 X 0 8000 0 Dr Hendrik DeJager 1.0 X 0 0 0 Margaret Hill 1.0 X 0 0 0 Dr Bharti Jain 1.0 X 0 0 0 Dr Albert Karnig 1.0 X 0 0 0 Peggy Merryman 1.0 X 0 0 0 Dr Vellore Muraligopal 1.0 X 0 0 0 Marvin O'Quinn 1.0 X 0 1930097 119149 Marvin Reiter CPA 1.0 X 0 0 0 Dr Paul Ryan 1.0 X 66800 0 Elizabeth Shih 1.0 X 0 1807962 293626 Susan Whitten 1.0 X 0 469787 60471 Frank Lyman 1.0 X X 0 0 0 John Nolan Esq 1.0 X X 0 0 0 Diane Nitta 40.0 X 462015 0 35036 Edward Sorenson 40.0 X 296188 0 37585 Kimiko Ford 40.0 X 224733 0 33782 DAVID J EVANS 40.0 X 196778 0 33727 LAWRENCE LAWLER 40.0 X 197632 0 31959 Marc Marchetti 40.0 X 220045 0 32297 Martha Mulugeta 40.0 X 201985 0 25965 HAROLD NEWTON 40.0 X 209851 0 33522 2179527 4215846 737119 208 false true false TILLER CONSTRUCTORS INC 306 W KATELLA AVE 3A ORANGE CA 92867 Contractor 4178182 ANGELICA TEXTILE SERVICES 925 S 8TH ST COLTON CA 92324 Laundry Services 922780 SAFEWAY CONSTRUCTION 1474 N MILLER DR COLTON CA 92324 Contractor 682335 VALLEY PAINTING DECORATING PO BOX 230 SAN BERNARDINO CA 92402 Contractor 432136 EMERG PHYSICIANS MEDICAL GRP 3300 DOUGLAS BLVD SUITE 150 ROSEVILLE CA 956614210 Medical Services 291075 21 1163340 431357 1594697 PATIENT REVENUE/CHARITY CARE 900099 73153285 73153285 MEDICAL OFFICE BUILDING 900099 669091 669091 EDUCATION 900099 86122 86122 MEDICARE/MEDICAID PAYMENTS 900099 86578472 86578472 160486970 21835 21835 0 0 0 0 0 0 CAFETERIA 900099 501908 501908 GIFT SHOPS 900099 231779 231779 COMMISSIONS 900099 115996 115996 96923 0 96923 946606 163050108 160486970 0 968441 3500 3500 0 0 0 1257685 1188904 68781 0 87101661 82338220 4763441 4999203 4725806 273397 12759292 12061300 697992 6262144 5896024 366120 0 73388 73388 68250 68250 34988 34988 0 0 18137657 11267699 6869958 792057 4057 788000 6166155 5582886 583269 5455754 4901179 554575 0 2043433 1797471 245962 127425 109556 17869 0 115890 46218 69672 1603573 1603573 0 4220595 3587506 633089 949626 949626 BAD DEBT 11380986 11380986 DUES & SUBSCRIPTIONS 364871 104747 260124 MEDICAL SUPPLIES 12043936 12043936 OVERHEAD CORP ALLOCATION 1553150 1553150 OTHER EXPENSES 1625600 1306314 319286 0 179140819 160934496 18206323 0 7185 7185 -3727706 0 12175 180031 23627165 23567013 1902451 1925396 6237528 3039268 99406034 70551846 24474565 28854188 203246 94244 52736609 57667325 12418485 36266852 2000000 2000000 32474511 29647572 46892996 67914424 X 5843613 -10247099 5843613 -10247099 52736609 57667325 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 34988 false false false 34988 false PART II-B, LINE 1F Lobbying expenditures paid directly by the filing organization for annual membership dues: Innovative Federal Stratagies $18,581 Lobbying expenditures paid by the Parent organization for annual membership dues where expenses are allocated to the hospital: American Hospital Association $ 941 Catholic Health Association $ 1,454 California Hospital Association $14,012 ========= TOTAL EXPENDITURES $34,988 ========= 799341 799341 76598100 56214557 20383543 20079831 14210348 5869483 1928762 126941 1801821 28854188 0 DUE TO RELATED PARTIES 24795318 PENSION PAYABLE 4100094 DEFERRED COMPENSATION 80000 ASSET RET OBLIG LIABILITY 672160 29647572 Sch D, PART X The consolidated audited financial statements did not include a FIN 48 footnote disclosure as the liability was determined not material for reporting purposes. true true true X true X 500. true true true false true true 1414 4663760 0 4663760 0.02780 40326 102591009 92781933 9809076 0.05850 373 1741298 1061625 679673 0.00410 42113 108996067 93843558 15152509 0.09040 29754 1120495 0 1120495 0.00670 285 343235 0 343235 0.00200 8300 450554 0 450554 0.00270 38339 1914284 0 1914284 0.01140 80452 110910351 93843558 17066793 0.10180 6300 0 6300 6300 0 6300 true 2411238 0 25656443 26811014 -1154571 X true true Community Hospital of San Bernardino

1805 Medical Center Dr San Barnardino CA 92411

X X X Community Convalescent Center

1676 Medical Center Dr San Bernardino CA 92411

Skilled Nursing Not applicable. Community Hospital of San Bernardino (CHSB) uses Federal Poverty Guidelines (FPG) to determine eligibility. The organization prepares a separate community benefit report. 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. CHSB did not have costs attributable to a physician clinic as subsidized health services The amount of bad debt expense included on Form 990, Part IX, line 25, column (A) is $11,380,986 and has been subtracted for purposes of calculating the percentages in column (f). 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 seen at California facilities. The expected patient payment amount on the patient's bill reflects this discount. CHSB makes every effort in determining if a patient qualifies for charity care upon admission. CHSB follows CHW's financial assistance policy. CHW's 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. CHW also utilizes a Payment Assistance Rank Ordering (PARO) scoring system to assist in determining if a patient may qualify for charity care 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 charity 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 charity care policy. The following is an excerpt from CHW and its subordinate corporations' consolidated annual audited financial statements for the year ended June 30, 2010, 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. 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 $345.6 million, as reported below in Part VI, Line 7, 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 $1.2 million reported on Part III, Section B, Line 8, primarily for fee for service Medicare patients, as well as the unreimbursed portion of Medicare Managed Care and Medicare Capitated programs for CHSB. 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. CHW's collection policy contains provisions that prohibit the collection of amounts due from patients who the organization knows qualify for charity care. Accounts with incorrect or incomplete demographic information are assigned to a collection agency if CHSB or the billing company retained by CHW 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 CHW'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, CHW 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. CHW 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, CHW requires the agency to comply with the Fair Debt Collection Practices Act. ONE SKILLED NURSING FACILITY 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. 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. The CHSB service area includes San Bernardino, Rialto, Colton, Highland, Fontana and Bloomington. - Nielsen Claritas 2009 places the population of the CHSB service area at 652,519 persons (zip codes 92316, 92324, 92335, 92336, 92346, 92376, 92377, 92401, 92404, 92405, 92407, 92408, 92410, 92411) - CHSB serves a very young population with 38.1% being from 0-20 years of age. - Seniors 65+ comprise 6.6% of CHSB's service area population. - There are three other hospitals that serve the community. One, a CHW hospital. The ethnicity of the service area continues to see a growth in Hispanic residents with an increase from 45% in 2000 to 62% in 2009. Within the non-Hispanic ethnic groups, the African American population demonstrates a slight increase from 13% in 2002 to 13.3% in 2005 and then a downward trend to 12.8% in 2007 and 12.4% in 2009. The remaining 2009 population statistics reflect 19% Caucasian, 4% Asian and 3% other. In the overall CHSB Service Area English and Spanish are the two most frequently spoken languages. Spanish is spoken by more residents than English within the communities of Bloomington, Fontana 92335, San Bernardino 92411 and San Bernardino 92410. Every community within the service area has Spanish speakers. Among those who speak Spanish there are considerable numbers who do not speak English at all. In San Bernardino 92410 13.6% of those who speak Spanish, do not speak English. Fontana 92335 and San Bernardino 92410 and 92411 have high rates of households whose members are linguistically isolated. 2009 Nielsen Claritas lists the median household income in the CHSB primary service area at $45,733. Of the service area's 175,902 households San Bernardino hosts the neighborhoods with the lowest median household incomes (92410 - $29,797 and 92411 - $30,817). Data from the 2000 U.S. Bureau of Census reflects that within the CHSB Service Area zip codes 11.9% to 37.3% of the population lives at or below 100% of the Federal Poverty Level. Over one-third of the population residing in San Bernardino 92410 and 92411 live in poverty, more than double the rate of poverty found in the County overall. The data indicates that within the CHSB Service Area poverty increases markedly for the population at or below 200% of the Federal Poverty Level. Many of the neighborhoods served by CHSB have close to half of the residents living at or below 200% of the Federal Poverty Level. In San Bernardino 92410 over two-thirds of the population is at this level of poverty (67.7%), followed closely by San Bernardino 92411 (63.3%). Poverty is more pronounced among families where the female is the head of household (HOH), indicating that a female maintains a household with no husband present. The CHSB Service Area has a greater percentage of female HOH and more poverty than the County or the State. San Bernardino has the largest percentage of families with female HOH and accompanying rates of poverty. CHSB provides financial and in-kind support for community building activities. In 2010 CHSB provided operational and meeting space to facilitate our collaborative effort to create a sustainable action plan that addresses this highly diverse community's needs with regard to disparity of care and unmet health needs, particularly in the area of chronic lifestyle related conditions such as diabetes, asthma, and chronic heart failure. In 2010 CHSB provided support for: - Assistance League of San Bernardino is a nonprofit organization whose volunteers enrich the lives of children in need by providing school clothing and offering general dentistry - The San Bernardino Black Culture Foundation in which it is culturally diverse and committed to the development and understanding of African - American culture. The organization strives to provide meaningful socio-economic and educational programs for the benefit of the community - Purchased Route 66 Annual Community Event booth space to distribute health awareness information specific to life style related diseases (asthma, diabetes, healthy eating, etc.) - Smiles for Seniors in which alleviated some of the pressure and fear many seniors have of not having enough to survive or having to choose between medication and rent. - San Bernardino Safety Employees Benefit Association whose event mission was to sponsor summer children's fishing event to encourage physical exercise and fun outdoor activities for inner city youth who are influenced by gangs and violence. 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 furthers the health of the Community through proactive fiscal year expenditures of $543,353 applied toward no cost community health improvement programs, including emergency case management services, classes, clinics, forums, and fairs. These expenditures address high priority needs consistent with those indentified in the hospital's most recent community needs assessment. Health classes include disease prevention, awareness and management for lifestyle related conditions such as pediatric asthma and diabetes. Mother/infant bonding and breastfeeding instruction/coaching promote better outcomes for healthy babies and children during the economic downturn where food insecurity is extremely high. 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 smmary of Total unsponsored community benefit expense for CHW and its subordinate corporations for the year ended June 30, 2010, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 110,381 142,746,446 1.7% Unpaid Costs of Medicaid/Medi-Cal 944,650 558,385,256 6.5% Other Means-tested Programs 269,294 56,864,415 0.7% Community Services: Community Health Services 553,419 48,887,807 0.5% Health Professions Education 21,746 6,431,872 0.1% Subsidized Health Services 212,434 36,161,087 0.4% Donations 256,564 8,509,998 0.1% Community Building Activities 69,194 1,805,508 0.0% Community Benefit Operations 11,547 5,645,250 0.1% Total Community Services for the poor 1,124,904 107,441,522 1.2% Total Benefits for the Poor 2,449,229 865,437,639 10.1% Benefits for the Broader Community: Community Services: Community Health Services 2,464,586 19,716,268 0.2% Health Professions Education 49,929 46,618,328 0.5% Subsidized Health Services 114,349 13,649,835 0.2% Research 23,285 27,190,380 0.3% Donations 158,111 3,762,689 0.1% Community Building Activities 77,077 6,774,273 0.1% Community Benefit Operations 95,948 2,000,665 0.0% Total Benefits for the Broader Community 2,983,285 119,712,438 1.4% Total Community Benefits 5,432,514 985,150,077 11.5% Unpaid Costs of Medicare 995,245 345,619,895 4.0% Total Community Benefits including Cost of Medicare 6,427,759 1,330,769,972 15.5% CA false true false false false false false false false Marvin O'Quinn 0 834172 0 656502 0 439423 0 78027 0 41122 0 2049246 0 0 Elizabeth Shih 0 601159 0 645632 0 561171 0 249716 0 43910 0 2101588 0 527371 Susan Whitten 0 261710 0 196983 0 11094 0 31822 0 28649 0 530258 0 0 Diane Nitta 244105 0 206338 0 11572 0 31100 0 3936 0 497051 0 0 0 Edward Sorenson 238102 0 45962 0 12124 0 24648 0 12937 0 333773 0 0 0 Kimiko Ford 188221 0 35606 0 906 0 17970 0 15812 0 258515 0 0 0 DAVID J EVANS 166985 0 21272 0 8521 0 17831 0 15896 0 230505 0 0 0 LAWRENCE LAWLER 175387 0 21917 0 328 0 16256 0 15703 0 229591 0 0 0 Marc Marchetti 181583 0 34524 0 3938 0 16536 0 15761 0 252342 0 0 0 Martha Mulugeta 201187 0 600 0 198 0 10605 0 15360 0 227950 0 0 0 HAROLD NEWTON 185075 0 23137 0 1639 0 17200 0 16322 0 243373 0 0 0 Sch J-1 Paul Ryan's compensation is for Chief of Staff Services provided to the organization from July 2009 through December 2009. Alvaro Bolivar's compensation is for Chief of Staff Services provided to the organization from January 2010 through June 2010. Betty Daniel'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. 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 fair 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. PART I, LINE 4b Certain listed persons hired prior to June 30, 2006 are eligible to participate in the CHW Executive Deferred Compensation Plan, a nonqualified 457(f) plan which is intended to provide a benefit approximating the difference, if any, between the benefit provided under the CHW Excess Benefit Plan and the benefit provided under the qualified benefit plan that substantially replaced the Excess Plan. No benefit will vest under the 457(f) plan before the later of the attainment of age 62 while employed 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 2009 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. A payment of $270,624 was made to E. Shih during 2009. 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 ultimate retirement security 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 retirement age and service years to the organization, and distribution is only available after a vesting period and while the executive is actively employed with CHW. 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)). Payouts are recorded as reportable compensation in column b(iii) and are also reported in column f, as the deferral of this retirement income was reported in prior years when amounts were vested. Payments made during 2009 pursuant to this plan include $257,107 to E. Shih. The payouts were due to changes in the Internal Revenue Code relating to the treatment of deferred compensation plans. The American Jobs Creation Act of 2004 added Internal Revenue Code (IRC) Sec. 409a to change the treatment of nonqualified deferred compensation plans, including timing of payouts and income recognition to the plan participant. As part of CHW's modification of its nonqualified deferred compensation plans to meet the requirements of IRS Sec. 409a, it was determined that the payouts were necessary as part of this conformity to tax law. 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 AUTHORITY 521598225 13033FTN0 2004-05-19 150000000 NEW MONEY TO FUND VAR PROJECTS & M false false 2004025 0 0 0 0 0 2004025 2005 false false true true false true true true true 0.00000 0.00000 0.00000 true false true false false true false Dan Lyman Family Mem of BM F Lyman 220578 Maintenance of fire doors false 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 2009, 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 2009 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 B, 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. SCHEDULE K PART IV, LINE 1 Arbitrage calculations were performed by an arbitrage consultant. Such consultant determined that there was no rebatable arbitrage liability; accordingly, no form 8038-T was required to be filed. FORM 990, PART VII, SECTION A The following individuals listed on Form 990 Part VII were compensated by Catholic Healthcare West, a related organization. An estimate of their hours provided to the related organization is provided: Dr Betty Daniels; 8 hours Marvin O'Quinn; 40 hours Elizabeth Shih; 40 hours Susan Whitten; 40 hours Schedule R, Part V, line 2 column (c) Part V, line 1c - CHSB is supported by one foundation. As a supporting organization, the foundation operate 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. Part V, 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. Community Hospital Foundation 1805 Medical Center Drive San Bernardino CA 92411 953051931 Fund raising CA 501(c)(3) 11; Type I NA 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 true false true false true COMMUNITY HOSP OF SAN BERNARDINO FOUNDATION c 300000 COMMUNITY HOSP OF SAN BERNARDINO FOUNDATION p 107000