2011-11-14T21:16:12-07:00 2010-12-31 990 2010-01-01 951644629 SANTA BARBARA COTTAGE HOSPITAL SANT 8056827111 PO BOX 689 SANTA BARBARA CA 931020689 Joan Bricher 8055697294 2011-11-15 2010 2016-03-07 17:11:31Z Ronald Werft Same as C Above Santa Barbara CA 93102 729146742 0 X WWW.COTTAGEHEALTHSYSTEM.ORG X 1888 CA It is the mission of Santa Barbara Cottage Hospital to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 17 12 2960 700 20389583 1762940 57309221 459502619 503003844 -34565975 17439686 6394704 6673911 433094288 584426662 182360 2024476 0 0 211468936 229134149 0 19200 19200 210955398 243910311 422606694 475088136 10487594 109338526 977015470 1111406611 456217867 481294143 520797603 630112468 It is the mission of Santa Barbara Cottage Hospital (SBCH) to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 0 0 344925106 2024476 503003844 Santa Barbara Cottage Hospital is a 408-bed acute-care hospital located in the City of Santa Barbara. In 2010, the Hospital had 83,954 patient days, served 122,278 outpatients and including services provided care through the emergency department. The Hospital provides a wide array of inpatient and outpatient services, including but not limited to the areas of cardiology, orthopedics, neurology, trauma, labor & delivery, psychiatric, neonatal intensive care, pediatric intensive care, pediatrics, laboratory, imaging, therapy, diabetes, oncology, emergency and rehabilitation services. Community outreach efforts for Cottage Health System in 2010 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. 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. In 2010, Cottage Health System spent nearly $105 million on these programs. All patients who do not present third-party insurance are automatically screened for eligibility in government health programs and are assisted in applying for charity if the patient does not qualify for any other assistance. To ensure that every member of the community has access to healthcare Santa Barbara Cottage Hospital offers full charity care to all patients whose income level is at or below 350% of the Federal Poverty Level (FPL). Discounted care is also available for families who make up to 543% of the FPL. The charity care program at Santa Barbara Cottage Hospital is critical to the community as there is no inpatient acute care County Hospital to treat indigent patients who cannot afford care. In 2010, the Hospital provided free or discounted care to 1,589 patients. 0 0 0 344925106 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 1 0 0 1 0 1 0 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 518 0 1 2960 1 1 1 0 0 0 0 1 1 0 0 0 0 X 17 12 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 CA X Karen L Jones 8055697224 Pueblo at Bath Street Santa Barbara CA 93105 X J Robert Andrews Esq 3 X 0 0 0 Margaret Baker 2 X 0 0 0 Jon Clark 2 X 0 0 0 Judith Hopkinson 2 X 0 0 0 Angel Iscovich MD 3 X 0 0 0 Charles A Jackson 3 X 0 0 0 Alex Koper MD 2 X 15080 0 0 John Romo 2 X 0 0 0 Robert Nourse 2 X 0 0 0 Marshall Turner 2 X 0 0 0 Tom Watson MD 2 X 17293 0 0 Fred Lukas 2 X 0 0 0 Jeffrey Kupperman MD 3 X X 28678 30000 0 Robert Nakasone 3 X X 0 0 0 Ed Birch PhD 3 X X 0 0 0 Frederick Gluck 3 X X 0 0 0 Gretchen Milligan 4 X X 0 0 0 Ronald C Werft 24.00 X 965143 0 599725 Steven A Fellows 33.00 X 561677 0 147378 Joan Bricher 30.00 X 505806 0 233530 Julie Artoux 24.00 X 108348 0 13238 Ed Wroblewski MD 40 X 248370 0 37121 Patrice Ryan 40 X 291514 0 36779 Ronald Biscaro 40 X 289823 0 36236 Karen Jones Grandidier 40 X 323839 0 38665 Suzanne Dalston 40 X 378003 0 38719 Herbert Geary 40 X 319220 0 38319 Lisa Moore 40 X 282279 0 36311 Alberto Kywi 40 X 335310 0 38183 Afshin Fatholahi 40 X 258836 0 34300 Elliot Prager MD 40 X 356805 0 20071 Charles Cline 40 X 272635 0 20071 Allan Cohen 40 X 263509 0 20071 Melinda Stavely 40 X 255739 0 33431 David Nichols 40 X 377782 0 26482 6455689 30000 1448630 432 0 1 0 MCCARTHY BUILDING COMPANIES 20401 SW BIRCH ST 300 NEWPORT BEACH CA 92660 GENERAL CONTRACTOR 10573875 COMFORCE PO BOX 31001-0893 PASADENA CA 911100893 NURSING 8397169 LEE BURKHART LIU INC 13335 MAXELLA AVENUE MARINA DEL REY CA 90292 ARCHITECT 6844578 ECLIPSYS SOLUTIONS CORPORATION PO BOX 8538-133 PHILADELPHIA PA 191710133 CONSULTING 2683986 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 1703285 136 0 0 0 55009892 297201 2002128 0 57309221 NET PATIENT SERVICE REVENUE 900099 453539049 453539049 0 0 HOSPITAL MEDI-CAL SUPPLEMENTAL FEE 900099 26738785 26738785 0 0 LABORATORY SERVICES 900099 20947064 574228 20372836 0 MEDICAL OFFICE BUILDING RENTAL 900099 900344 900344 0 0 INTERN/RESIDENT AGREEMENT 900099 878602 878602 0 0 0 0 0 0 503003844 12339586 0 140 12339446 0 0 0 0 0 0 0 0 0 0 149820180 0 144720080 0 5100100 0 5100100 0 0 5100100 0 CAFETERIA/CAFE/GIFT SHOP/VILLA RIVIERA/DELI 900099 1615336 1615336 0 0 LAB MANAGEMENT 900099 1380880 1380880 0 0 REBATES/REFUNDS 900099 704690 688083 16607 0 2973005 2973005 0 0 6673911 584426662 489288312 20389583 17439546 2024476 2024476 0 0 0 0 0 0 6555350 4337672 2217678 0 88222 88222 0 0 148452403 99966924 48485479 0 14452418 9721379 4731039 0 46638427 30647095 15991332 0 12947329 8229645 4717684 0 1490202 0 1490202 0 1759717 89874 1669843 0 673348 0 673348 0 34554 0 34554 0 19200 19200 1232899 0 1232899 0 43311412 22744109 20567303 0 796444 78184 718260 0 91656007 86098636 5557371 0 11478027 7726362 3751665 0 0 0 0 0 7840638 4671479 3169159 0 823770 78138 745632 0 0 0 0 0 159957 6784 153173 0 5189096 5070478 118618 0 0 0 0 0 23293391 17165072 6128319 0 2841038 2103806 737232 0 HOSPITAL FEE PROGRAM 28267344 28267344 0 0 PROVISIONS FOR BAD DEBT 11419196 11419196 0 0 EQUIPMENT MAINTENANCE 6806279 4207178 2599101 0 DUES/SUBSCRIPTIONS 1194222 19392 1174830 0 LOSS ON EXTINGUISHMENT OF DEBT 1716937 0 1716937 0 1925833 163661 1762172 0 475088136 344925106 130143830 19200 -236578 19745898 126479817 71256985 0 0 75075467 88682093 250000 250000 0 0 0 0 11332054 12082758 5377284 5610808 778261245 201958358 438996918 576302887 224188181 212291737 72338126 86288986 0 0 5683234 9088465 17530967 29805994 977015470 1111406611 64857544 73921091 0 0 3142 0 322465004 336226732 0 0 0 0 1661665 1629266 0 0 67230512 69517054 456217867 481294143 X 508317135 616825086 6886212 7693126 5594256 5594256 520797603 630112468 977015470 1111406611 X 109338526 -23661 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 1050 1 33504 0 34554 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 LOBBYING ACTIVITIES ARE CALCULATED AS A PERCENTAGE OF DUES PAID TO VARIOUS ORGANIZATIONS. In 2010, the CEO, CFO and COO went to Washington, DC to meet with members of Congress as a part of the delegation from the American Hospital Association. 11387435 0 1031032 0 269432 26820 12122215 10754765 0 687451 0 25782 28999 11387435 15792105 0 -4904683 0 48477 84180 10754765 0 0.46 0.54 0 1 1 2282992 15913604 18196596 10136373 223768947 109795887 124109433 0 7495579 81690 7413889 0 137278355 90705877 46572478 0 381385395 1374904 380010491 576302887 0 86288986 F 86288986 0 SELF INSURANCE LIABILITY 21349893 RETIREMENT PLAN - SERP & HEALTH INSURANCE 9487671 MINIMUM PENSION LIABILITY 8756107 INTEREST RATE SWAP LIABILITY 22944070 PHYSICIAN GUARANTEE 2932414 DUE TO THRID PARTIES 2155899 CONTINGENT PAYMENT MGPL 1891000 69517054 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Endowments are for research and to support operational or capital needs of the organization. X X X 1 Marts and Lundy 1200 Wall Street West Lyndhurst NJ 07071 Consulting 0 0 19200 -19200 0 19200 -19200 CA 1 1 X 1 X 3.5 1 X 5.43 1 1 1 0 1 1 9546422 9546422 0.0206 71643044 51229648 20413396 0.044 2651267 2651267 0.0057 0 0 83840733 51229648 32611085 0.0703 7434751 0 7434751 0.016 7502918 5236179 2266739 0.0049 491408 0 491408 0.0011 0 0 0 0 188600 0 188600 0.0004 0 0 15617677 5236179 10381498 0.0224 0 0 99458410 56465827 42992583 0.0927 93564 0 93564 0.0 0 0 93564 0 93564 0.0 1 4669456 0 93988098 117752440 -23764342 X 1 1 3 1 Santa Barbara Cottage Hospital

Pueblo at Bath St Santa Barbara CA 93105

X X X X X 2 Cottage Rehabilitation Hospital

2407 De La Vina Santa Barbara CA 93105

X Rehabilitation hospital Santa Barbara Cottage Hospital 1 Cottage Rehabilitation Hospital 2 1 Pacific Diagnostic Laboratories LLC

454 South Patterson Goleta CA 93117

Outpatient lab services. Cottage Center for Advanced Imaging

2410 Fletcher Santa Barbara CA 93105

Outpatient imaging center Cottage Residential Center

312 W MONTECITO ST Santa Barbara CA 93101

Substance abuse rehabilitation center. Children's Outpatient Specialty Clinic

2329 Oak Park Lane Santa Barbara CA 93105

Outpatient pediatric clinic Children's Outpatient Specialty Clinic

427 West Pueblo Santa Barbara CA 93105

Outpatient pediatric clinic Outpatient Rehabilitation

1035 PEACH ST SUITE 203 San Luis Obispo CA 93401

Outpatient clinic SchH_P01_S00_L06a Schedule H, Part I, Line 6a Cottage Health System SchH_P01_S00_L07 Schedule H, Part I, Line 7 Department level cost to charge ratios with the overhead departments allocated by the stepdown method. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f Bad debt expense in the amount of $11,419,196 was deducted from net expenses for purposes of calculating community benefit percentages. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Palliative Care services are provided at no cost to the patient. SchH_P02_S00_L00 Schedule H, Part II SBCH works with local organizations to provide housing for homeless, intoxicated and other patients after they are discharged from the hospital. This helps to continue the patients healing in a safe and clean environment. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 No note in audited financial statements regarding bad debt. Bad debt is not included in Community Benefit report. Bad debt expense is derived from cost to charge rates. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 These are significant losses for our organization and they provide a tremendous benefit to your community as do the other government programs that do not cover the cost of care for the patients served. The amounts reported represent all hospital segments including inpatient, outpatient, and emergency department. All health plans including Medicare, Medicaid and private insurance are also accounted for. The cost-to-charge ratio, specific to the services rendered, is used to determine Medicare allowable costs. Medicare allowable costs are derived from the hospital's cost report, as summarized on W/S D-1 Part II (Inpatient) and W/S D Part V (Outpatient). Total expenses from the general ledger are separated into reimbursable and non-reimbursable cost centers. Adjustments are applied to eliminate additional non-reimbursable costs and to offset revenue recoveries against certain costs. Overhead costs (capital, administrative and general, etc) are allocated to each revenue-generating reimbursable cost center on a statistical basis. Total costs (direct and allocated) for all revenue-generating departments are compared to total charges (gross revenues) for each department to determine a departmental cost-to-charge ratio. These cost-to-charge ratios are used to derive Medicare allowable costs for each department, by multiplying these ratios by total Medicare charges as summarized on provider statistical and reimbursement system (PS&R) reports provided by the Medicare fiscal intermediary. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b The community serivice policy is followed for all patient types. If a patient is known to qualify for charity care, their account is written down to zero and they do not proceed through the formal collection process. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Cottage reviewed focus areas of local, state, and national organizations to determine our own focus areas and then next reviewed our 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 included questions regarding community needs. Cottage Health System also held a brainstorming session with 20 different hospital departments, and the Community Health Coordinating Committee provided input. After reviewing all of the information, Cottage Health System determined the greatest needs to be children's health, seniors' health, cancer, heart disease and stroke, and prevention and wellness. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Santa Barbara Cottage Hospital (SBCH) 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 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 a patient financial counselor to assist patient in determining eligibility for government-sponsored insurance programs and assist with the application process. A Medi-Cal eligibility worker is also provided on site at SBCH to help facilitate Medi-Cal applications while the patient is in the hospital. Patient Financial Counselors who answer customer service calls are instructed to offer charity care applications to all patients who indicate they have financial need. Santa Barbara Cottage Hospital also works co-operatively with the County of Santa Barbara to provide non-emergency charity care services; this program is known as the Community Service Program. All members of the Community who meet the financial criteria are eligible for the Community Service Program, but must be referred by a physician. When patients who visit the Santa Barbara Public Health Department Clinic have a need for a medically-necessary but non-emergent service, the physicians and Clinic staff inform the patient of the Community Service Program and help the patient to apply. Independent physicians in the Community were made aware of the program and how to access services on behalf of their patients. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Santa Barbara County is situated on the southern coast of California, with Ventura County bordering on the east, San Luis Obispo County on the north, and Kern County on the northeastern corner. Roughly rectangular in shape, the county contains 2,750 square miles of varied terrain. 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. The Los Padres National Forest, in the eastern part of the county, covers approximately 44 percent of the total county area. The county's 430,200 population is divided into five sub regions: South Coast (205,800); Lompoc Valley (61,200), Santa Maria Valley (137,600); Santa Ynez Valley (24,000); Cuyama (1,500). 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. Twenty-one percent of the county's population are foreign-born, and 32.8% of persons over the age of five reported speaking a language other than English at home. 12.7% of county residents live below the poverty level. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Board of Directors is made up of prominent community members who volunteer their time to ensure that the Santa Barbara Community has access to high-quality, affordable healthcare. The Board of Directors is actively involved in the Hospital's strategic decisions and takes its commitment to the Community very seriously. The Board approves of an annual financial budget and 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. Santa Barbara Cottage Hospital is building a new hospital in order to comply with the unfunded mandate of the State of California's Senate Bill 1953 (SB1953), which requires all hospitals to retrofit or rebuild in order to withstand a major earthquake. The Hospital used this opportunity to live the core value of excellence by ensuring that the new facility will meet the current and future healthcare needs of the Community. This is the largest project in the Hospital's history. As the new facility is built the Hospital continues to evaluate bed allocations in order to ensure that Subacute services continue to be available, determining dedicated pediatric bed needs, and allocating beds by patient care unit based upon projected health needs. Santa Barbara Cottage Hospital works cooperatively with the open medical staff to improve healthcare in the community. The Hospital is exploring how to better align with physicians in order to provide the highest quality of care. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Cottage Health System is the parent organization of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital. These organizations have a common Board of Directors. Cottage Health System Hospitals are the sole hospital providers in the Community and strategic plans are created with all the Hospitals and their Communities in mind. Santa Barbara Cottage Hospital is the largest hospital in the system and provides the widest array of services. As such, Santa Barbara Cottage Hospital experiences the largest amount of charity care and Medicaid shortfall from cost. The hospital also provides the majority of community benefit programs, which are reported in the Cottage Health System Community Benefit Report. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 California 1 Sarah House PO Box 20031 Santa Barbara CA 93120 770224415 501(c)(3) 30900 0 0 0 The grant is used to offset the end-of-life care provided for low-income patients that transfer from the Hospital to the palliative care facility. Willbridge Of Santa Barbara 1215 EAST MONTECITO STREET Santa Barbara CA 93130 571194195 501(c)(3) 14700 0 0 0 The grant supports transitional beds for homeless patients who are not appropriate for discharge to the streets or shelters and who need supervised convalescence. Santa Barbara Neighborhood Clinics 1900 State Street Suite G Santa Barbara CA 93101 770496382 501(c)(3) 95000 0 0 0 Supports Care for Every Child Program, which provides comprehensive medical care for at risk youth 0-19. CASA ESPERANZA P O BOX 24116 Santa Barbara CA 93121 770502754 501(c)(3) 40000 0 0 0 Grant helps to support medical outreach program to homeless. Clinic space is provided at a local shelter and in areas where homeless congregate by a physician and/or an RN. Thresholds to Recovery 1038 PITTSFIELD LANE Ventura CA 93001 770335136 501(c)(3) 8460 0 0 0 Grant funding supports non-residential treatment center for individuals who have been intoxicated in public to recover. The program offers an alternative to incarceration and program follow-up includes referral for treatment of alcoholism. Family Services Agency 123 West Gutierrez Street Santa Barbara CA 93101 951644031 501(c)(3) 20000 0 0 0 Funding sustains programs aimed at ensuring programs and safe home environments for elderly who wish to continue living independently. Hospice of Santa Barbara 2050 ALAMEDA PADRE SERRA suite 100 Santa Barbara CA 93103 951641969 501(c)(3) 68600 0 0 0 Supports Alliance for Living and Dying Well The Foundation for California State University Channel Islands One University Drive Camarillo CA 93012 770433230 146000 0 0 0 Supports BSN program in Santa Barbara Foundation for Santa Barbara City College 721 Cliff Dr Santa Barbara CA 93109 953234551 501(c)(3) 871465 Supports Nursing Department at Santa Barbara City College. University of California Regents University Drive Santa Barbara CA 93106 954377221 595621 Support of Transalational Research Program 11 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 SBCH has an open grant process. All grants are reviewed by the Community Health Coordinating Committee and recomended to the Executive Management Group for approval. The committee reviews six month progress reports. Funding is dispersed in quarterly increments and is contingent upon the six month review. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 Ronald C Werft 700939 0 250718 0 13487 0 591904 0 7821 0 1564869 0 0 0 Steven A Fellows 409933 0 120408 0 31336 0 139557 0 7821 0 709055 0 0 0 Joan Bricher 402235 0 96171 0 7400 0 225709 0 7821 0 739336 0 0 0 Julie Artoux 99352 0 8253 0 744 0 5417 0 7821 0 121587 0 0 0 Ed Wroblewski MD 243293 0 158 0 4919 0 29301 0 7821 0 285492 0 0 0 Patrice Ryan 243874 0 43749 0 3891 0 28958 0 7821 0 328293 0 0 0 Ronald Biscaro 235938 0 41240 0 12646 0 28415 0 7821 0 326060 0 0 0 Karen Jones Grandidier 273170 0 48668 0 2001 0 30844 0 7821 0 362504 0 0 0 Suzanne Dalston 306285 0 50391 0 21326 0 30899 0 7821 0 416722 0 0 0 Herbert Geary 265708 0 42053 0 11460 0 30498 0 7821 0 357540 0 0 0 Lisa Moore 236376 0 43860 0 2042 0 28490 0 7821 0 318589 0 0 0 Alberto Kywi 263776 0 40755 0 30780 0 30362 0 7821 0 373494 0 0 0 Afshin Fatholahi 209553 0 35893 0 13390 0 26479 0 7821 0 293136 0 0 0 Elliot Prager MD 351264 0 158 0 5383 0 12250 0 7821 0 376876 0 0 0 Charles Cline 272212 0 158 0 266 0 12250 0 7821 0 292707 0 0 0 Melinda Stavely 216741 0 32235 0 6762 0 25611 0 7821 0 289170 0 0 0 David Nichols 193481 0 183039 0 1262 0 18661 0 7821 0 404264 0 0 0 Allan Cohen 242153 0 18062 0 3294 0 12250 0 7821 0 283580 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Health club dues are paid for CEO and COO. 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 expense. 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. No payouts were made in 2010. California Health Facilities Financing Auhtority 521643828 13033FQT0 2003-11-20 120987862 Refund 1985 issuance and hospital replacement project 0 0 0 California Statewide Communities Development Authority 680164610 130795Y76 2010-10-20 300168359 Refund 2008 issue 0 0 0 0 0 120987862 0 0 20100000 1366915 300700 0 96513947 0 0 2015 1 0 1 1 0 0 300168359 0 0 277300000 2937382 0 0 19931000 0 0 2012 1 0 1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 1 0 1 1 Morgan Stanley 22.0 0 0 0 0 1 1 1 0 0 0 1 Herb Geary Home purchase X 250000 250000 0 1 1 250000 JoEllen Watson wife of Board member 88222 salary and benefits 0 Santa Barbara Cardiovascular Medical Group Board member is partner, CMO is former partner 111743 Medical professional services 0 Mullen & Henzel Board member is partner 137912 Legal professional services 0 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 Robert Nakasone & Robert Nourse Business Relationship F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 Articles were amended in compliance with California Code concerning dissolution. 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 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_L11a Form 990, Part VI, Section B, Line 11a 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 Director or Officer will disclose to Committee Chair for items to be discussed at Board Committees, any material financial or personal interest he/she/family member may have in a Board decision before the Board reviews the transaction and takes action. In general, a director or Officer who had disclosed a potential conflict should be excused from the decision making portion of the discussion and are 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. If after hearing the Director or Officer's response and conducting a further investigation if warranted, the Board determines the Director of 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 brough to the Chief Compliance Officer. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Form 900 Part VI Line 15 On an annual basis the Executive Compensation Committee (ECC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the ECC are independent members of the Board of Directors. The ECC engages an independent consultant to prepare comparative compensation reports for each position. The executive's individual performance will also be considered when determining compensation. The ECC recommends compensation for the executives to the full Board for approval. This process takes place annually for all executives and is documented within the minutes. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Governing documents are available upon request from Assistant Secretary F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a As required by the instructions of Form 990, the compensation amounts for Ronald C. Werft, CEO, Steven A. Fellows, COO, Joan Bricher, CFO and Julie Artoux, Assistant Secretary are repeated on the Form 990 for all organizations for which they serve as officers. The following list provides the amount of time each employed officer listed in Part VII performed services for related organizations. Ronald C. Werft: Santa Barbara Cottage Hospital 24 hours, Goleta Valley Cottage Hospital 6 hours, Santa Ynez Valley Cottage Hospital 1 hour, Santa Barbara Cottage Hospital Foundation 9 hours; Steven A. Fellows: Santa Barbara Cottage Hospital 33 hours, Goleta Valley Cottage Hospital 6 hours, Santa Ynez Valley Cottage Hospital 1 hour, Santa Barbara Cottage Hospital Foundation 0 hours; Joan Bricher: Santa Barbara Cottage Hospital 30 hours, Goleta Valley Cottage Hospital 4 hours, Santa Ynez Valley Cottage Hospital 1 hour, Santa Barbara Cottage Hospital Foundation 5 hours; Julie Artoux: Santa Barbara Cottage Hospital 24 hours, Goleta Valley Cottage Hospital 6 hours, Santa Ynez Valley Cottage Hospital 1 hour, Santa Barbara Cottage Hospital Foundation 9 hours. F990_P11_S00_L05 Form 990, Part XI, Line 5 Unrealized Gains/Losses on Investments - $4,028,491; Endowment Adjustment - ($86,606); Equity Interest in Alternative Investments - $7,721,430; Change in Fair Value of Interest Rate SWAPS - ($18,866,703); Unrealized Gains/Losses on Restricted Contributions - $444,424; Change in Pension Liability - $6,735,303 Pacific Diagnostic Laboratories LLC PO Box 689 Santa Barbara CA 93102 205038438 Outpatient laboratory services CA 22344692 4619396 SANTA BARBARA COTTAGE HOSPITAL Cottage Health System PO Box 689 Santa Barbara CA 931020689 770431902 Parent organization for 3 hospitals and medical professional building CA 501 (C) (3) 11b-II N/A 0 Goleta Valley Cottage Hospital PO Box 689 Santa Barbara CA 931020689 952413596 Hospital CA 501 (C) (3) 3 N/A 1 Santa Ynez Valley Cottage Hospital Inc PO Box 689 Santa Barbara CA 931020689 952224265 Hospital CA 501 (C) (3) 3 N/A 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 N/A 1 Goleta Valley Professional Blds PO Box 689 Santa Barbara CA 931020689 770004202 Medical Prof Bldg CA 501 (C) (3) 11b-II N/A 1 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 Santa Barbara Cottage Hospital Foundation c 55009892 accrual Santa Barbara Cottage Hospital Foundation j 223968 accrual Santa Barbara Cottage Hospital Foundation n 2586497 accrual Santa Barbara Cottage Hospital Foundation o 63081 accrual Santa Barbara Cottage Hospital Foundation p 2049005 accrual Santa Barbara Cottage Hospital Foundation q 316868 accrual Santa Barbara Cottage Hospital Foundation r 94394 accrual Goleta Valley Cottage Hospital k 71370 accrual Goleta Valley Cottage Hospital m 98170 accrual Goleta Valley Cottage Hospital n 4140338 Goleta Valley Cottage Hospital o 362323 accrual Goleta Valley Cottage Hospital p 28370283 accrual Goleta Valley Cottage Hospital r 2743082 accrual Santa Ynez Valley Cottage Hospital Inc n 1146160 accrual Santa Ynez Valley Cottage Hospital Inc o 127096 accrual Santa Ynez Valley Cottage Hospital Inc p 5364869 accrual Santa Ynez Valley Cottage Hospital Inc r 509161 accrual