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GOLETA VALLEY COTTAGE HOSPITAL: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
GOLETA VALLEY COTTAGE HOSPITAL (EIN 95-2413596)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-08
IRS object ID
201803129349301845
Schema version
2017v2.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-08T17:01:56-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN346565596PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Ernst and Young LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line14365 Executive Drive Suite 1600AddressLine1Txt
CitySan DiegoCityNm
State AbbreviationCAStateAbbreviationCd
ZIP92121ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN952413596EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Goleta Valley Cottage HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlGOLEBusinessNameControlTxt
Phone8053249903PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 689 Attn Finance DeptAddressLine1Txt
CitySanta BarbaraCityNm
State AbbreviationCAStateAbbreviationCd
ZIP931020689ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBrett D TandePersonNm
Person TitleSenior VP & CFOPersonTitleTxt
Signature2018-11-08SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJocelyne MillerPreparerPersonNm
PTINP00634378PTIN
Phone8585357200PhoneNum
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Ronald WerftBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 689 Attn Finance DeptAddressLine1Txt
CitySanta BarbaraCityNm
State AbbreviationCAStateAbbreviationCd
ZIP931020689ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$80,458,595GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresshttp://www.cottagehealth.org/locations/goleta-valley-cottage-hospitalWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1965FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionIt is the mission of Goleta Valley Cottage Hospital to provide superior health care for and improve the health care of our communities through a commitment to our core values of excellence, integrity, and compassion.ActivityOrMissionDesc
Voting Members Governing Body17VotingMembersGoverningBodyCnt
Voting Members Independent16VotingMembersIndependentCnt
Total Employee306TotalEmployeeCnt
Total Volunteers144TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$1,170,517PYContributionsGrantsAmt
CY Contributions Grants$164,183CYContributionsGrantsAmt
PY Program Service Revenue$74,144,697PYProgramServiceRevenueAmt
CY Program Service Revenue$79,232,229CYProgramServiceRevenueAmt
PY Investment Income-$35,867PYInvestmentIncomeAmt
CY Investment Income$132,160CYInvestmentIncomeAmt
PY Other Revenue$434,772PYOtherRevenueAmt
CY Other Revenue$608,742CYOtherRevenueAmt
PY Total Revenue$75,714,119PYTotalRevenueAmt
CY Total Revenue$80,137,314CYTotalRevenueAmt
PY Grants And Similar Paid$426,688PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$214,228CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$33,367,554PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$34,186,037CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$40,437,671PYOtherExpensesAmt
CY Other Expenses$37,335,707CYOtherExpensesAmt
PY Total Expenses$74,231,913PYTotalExpensesAmt
CY Total Expenses$71,735,972CYTotalExpensesAmt
PY Revenues Less Expenses$1,482,206PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$8,401,342CYRevenuesLessExpensesAmt
Total Assets BOY$131,386,512TotalAssetsBOYAmt
Total Assets EOY$138,444,774TotalAssetsEOYAmt
Total Liabilities BOY$29,068,851TotalLiabilitiesBOYAmt
Total Liabilities EOY$17,851,676TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$102,317,661NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$120,593,098NetAssetsOrFundBalancesEOYAmt
MissionIt is the mission of Goleta Valley Cottage Hospital to provide superior health care for and improve the health care of our communities through a commitment to our core values of excellence, integrity, and compassion.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$63,561,100ExpenseAmt
Grant$214,228GrantAmt
Revenue$79,544,692RevenueAmt
DescGoleta Valley Cottage Hospital is a 52-bed acute-care hospital located in the City of Goleta. In 2017, the Hospital had 3,696 patient days and served 48,046 outpatients, including emergency services to 22,363 patients. The Hospital provides a wide array of inpatient and outpatient services, including but not limited to cardiac, orthopedic, wound care, breast care and emergency services. Goleta Valley Cottage Hospital is diligent to ensure that all patients have adequate access to healthcare. All patients who do not present with insurance are automatically screened for eligibility in government health programs and are assisted in applying for financial assistance if the patient does not qualify for any other assistance. Goleta Valley Cottage Hospital provides critical funding for community health, financial assistance programs, and external grants, while also realizing shortfalls in Medicare, Medi-Cal, and indigent care. In addition, grants have been provided for the support of nursing education, various community wellness education programs, health fairs, and the provision of flu shots to the community. In 2017 the hospital spent over $14.9 million on these programs.Desc
Total Program Service Expenses$63,561,100TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingYes (true)LoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document52IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee306EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OfYes (true)Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members17GoverningBodyVotingMembersCnt
Independent Voting Member16IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Greg HogueBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8053249933PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1400 West PuebloAddressLine1Txt
CitySanta BarbaraCityNm
State AbbreviationCAStateAbbreviationCd
ZIP93105ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (34 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Steven Ainsley
Board Chair1.818.2Yes (X)Yes (X)$0$0$0
Gregory Faulkner
Vice Chair0.55.5Yes (X)Yes (X)$0$0$0
Dorothy Largay PhD
Vice Chair0.55.5Yes (X)Yes (X)$0$0$0
Marshall (Chip) Turner
Vice Chair0.55.5Yes (X)Yes (X)$0$0$0
Edward Bentley MD
Secretary0.55.5Yes (X)Yes (X)$0$0$0
Jon Clark
Committee Chair0.54.5Yes (X)$0$0$0
Harry McMahon
Committee Chair0.54.5Yes (X)$0$0$0
Robert Nourse
Committee Chair0.54.5Yes (X)$0$0$0
Susan Christol-Deacon
Board Member0.43.6Yes (X)$0$0$0
Thomas Cusack
Board Member0.43.6Yes (X)$0$0$0
Nancy Nielsen
Board Member0.43.6Yes (X)$0$0$0
Ernesto Paredes
Board Member0.43.6Yes (X)$0$0$0
Gamble Parks
Board Member0.43.6Yes (X)$0$0$0
Richard Ponce MD
Board Member0.43.6Yes (X)$0$0$0
Anne Rodriguez MD
Board Member0.43.6Yes (X)$0$0$0
Mark Scott MD
Board Member0.43.6Yes (X)$0$1,406$0
Steven Zola
Board Member0.43.6Yes (X)$0$0$0
Margaret Baker
Board Member-part year0.43.6Yes (X)$0$0$0
Lori Gaskin PhD
Board Member-part year0.43.6Yes (X)$0$0$0
Judith Hopkinson
Board Member-part year0.43.6Yes (X)$0$0$0
Fred Lukas
Board Member-part year0.43.6Yes (X)$0$0$0
Elliot Prager MD
Board Member-part year0.43.6Yes (X)$0$0$0
Ronald Werft
President & CEO5.454.6Yes (X)$0$1,183,805$38,980
Steven Fellows
COO9.041.0Yes (X)$0$693,084$38,980
Brett Tande
CFO4.545.5Yes (X)$0$592,144$38,980
Teresa Petter
Asst. Secretary-Board4.545.5Yes (X)$0$109,385$32,837
CRISTINA KERN
SECRETARY THROUGH May 20174.545.5Yes (X)$0$43,818$14,880
ARIE DEJONG
VP GVCH40.00$329,468$0$71,873Yes (X)
CAROLINE ROSEN
DIR NURSING GVCH40.00$195,265$0$27,909Yes (X)
SUSAN SAN MARCO
DIRECTOR SRVC LINE40.00$207,533$0$19,259Yes (X)
IRENE MINDO
CLINICAL RESOURCE NURSE40.00$187,241$0$28,601Yes (X)
LISA LA BOUVE
CLINICAL MANAGER40.00$186,503$0$18,528Yes (X)
JASON KORN
CLIN NURSE COORD40.00$184,699$0$18,091Yes (X)
MARY FULCHER
CLINICAL MANAGER40.00$181,509$0$34,879Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,472,219TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,623,643TotReportableCompRltdOrgAmt
Total Other Compensation$383,797TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K77IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
SNYDER LANGSTON LP
17962 COWANIRVINECA92614CONSTRUCTION CONTRACTOR$936,396
ANESTHESIA ASSOC MED GROUP INC
ONE POST STREETSAN FRANCISCOCA94104PHYSICIAN SERVICES$730,000
AMN HEALTHCARE INC
12400 HIGH BLUFF DRIVESAN DIEGOCA92130CONTRACT LABOR$312,710
Diversified Clinical Services
4500 Salisbury RoadJacksonvilleFL32216Clinical Services$245,625
Vizient Inc
290 E John Carpenter FreewayIrvingTX75062Consulting$225,914
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K11CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd
All Other Contributions$164,183AllOtherContributionsAmt
Total Contributions$164,183TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE900099$78,529,368$78,529,368
CA HOSPITAL FEE PROGRAM622110$486,958$486,958
EHR MEDICARE GRANT622110$215,903$215,903

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$79,232,229TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$93,628TotalRevenueColumnAmt
Exclusion$93,628ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$359,813SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$321,281SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$38,532SecuritiesAmt
Other$0OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$38,532TotalRevenueColumnAmt
Exclusion$38,532ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CAFETERIA/GIFT SHOP900099$296,279$296,279
ED INSURANCE PREMIUM REIMBURSEMENT900099$102,938$102,938
Healthy Balance Weight Loss Classes900099$20,630$20,630

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$188,895TotalRevenueColumnAmt
Related Or Exempt Func Income$188,895RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$608,742OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$80,137,314TotalRevenueColumnAmt
Related Or Exempt Func Income$79,544,692RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$428,439ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$214,228TotalAmt
Program Services$214,228ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$369,478TotalAmt
Program Services$67,772ProgramServicesAmt
Management And General$301,706ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$22,516,991TotalAmt
Program Services$20,325,418ProgramServicesAmt
Management And General$2,191,573ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,302,561TotalAmt
Program Services$1,176,213ProgramServicesAmt
Management And General$126,348ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,559,845TotalAmt
Program Services$7,039,630ProgramServicesAmt
Management And General$1,520,215ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,437,162TotalAmt
Program Services$1,390,963ProgramServicesAmt
Management And General$46,199ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$4,447TotalAmt
Management And General$4,447ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$32,789TotalAmt
Management And General$32,789ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$11,543,112TotalAmt
Program Services$9,098,334ProgramServicesAmt
Management And General$2,444,778ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,220,885TotalAmt
Program Services$1,103,061ProgramServicesAmt
Management And General$117,824ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$77,614TotalAmt
Program Services$70,085ProgramServicesAmt
Management And General$7,529ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,448,882TotalAmt
Program Services$1,332,294ProgramServicesAmt
Management And General$116,588ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$9,823TotalAmt
Program Services$3,300ProgramServicesAmt
Management And General$6,523ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,504TotalAmt
Program Services$3,447ProgramServicesAmt
Management And General$57ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$652,811TotalAmt
Program Services$589,488ProgramServicesAmt
Management And General$63,323ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$7,296,885TotalAmt
Program Services$6,269,961ProgramServicesAmt
Management And General$1,026,924ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$87,365TotalAmt
Program Services$64,475ProgramServicesAmt
Management And General$22,890ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$13,025,719$13,025,489$230
HOSPITAL FEE PROGRAM$961,640$961,640
EQUIPMENT MAINTENANCE$816,968$800,618$16,350
Dues and Subscriptions$84,742$5,301$79,441

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$68,521TotalAmt
Program Services$19,383ProgramServicesAmt
Management And General$49,138ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$71,735,972TotalAmt
Program Services$63,561,100ProgramServicesAmt
Management And General$8,174,872ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,318,719BOYAmt
EOY$1,787,273EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$5,460BOYAmt
EOY$33,065EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$11,602,129BOYAmt
EOY$8,409,646EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$300,000BOYAmt
EOY$300,000EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$643,027BOYAmt
EOY$552,895EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$605,430BOYAmt
EOY$665,078EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$158,176,348LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$39,416,949LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$116,267,207BOYAmt
EOY$118,759,399EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$5,673BOYAmt
EOY$3,099,214EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,838BOYAmt
EOY$3,307,187EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$637,029BOYAmt
EOY$1,531,017EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$131,386,512BOYAmt
EOY$138,444,774EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,008,417BOYAmt
EOY$5,240,643EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$24,060,434BOYAmt
EOY$12,611,033EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$29,068,851BOYAmt
EOY$17,851,676EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$102,317,661BOYAmt
EOY$120,593,098EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$102,317,661BOYAmt
EOY$120,593,098EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$131,386,512BOYAmt
EOY$138,444,774EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$8,401,342ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$357,340NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$9,516,755OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$10,733OtherActivitiesAmt
Total Lobbying Expenditures$10,733TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYLobbying activities are calculated as a percentage of dues paid to various hospital associations, including American Hospital Association, California Hospital Association and Hospital Association of Southern California. The percentage of dues used for lobbying purposes is provided by each association.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYLobbying activities are calculated as a percentage of dues paid to various hospital associations, including American Hospital Association, California Hospital Association and Hospital Association of Southern California. The percentage of dues used for lobbying purposes is provided by each association.

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,230,602OtherCostOrOtherBasisAmt
Book Value$7,230,602BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$118,933,691OtherCostOrOtherBasisAmt
Depreciation$24,451,534DepreciationAmt
Book Value$94,482,157BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,718,432OtherCostOrOtherBasisAmt
Depreciation$2,357,942DepreciationAmt
Book Value$2,360,490BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$27,113,568OtherCostOrOtherBasisAmt
Depreciation$12,607,473DepreciationAmt
Book Value$14,506,095BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$180,055OtherCostOrOtherBasisAmt
Book Value$180,055BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$118,759,399TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
SELF INSURANCE LIABILITY$2,592,636
GVCH ALLOCATION OF TAX EXEMPT DEBT$4,082,754
ACCRUED PENSION & SERP
Due to Affiliates$2,785,416
Reserves for Government Third Party payors$3,150,227
FieldValueIRS element (for citing)
Total Liability$12,611,033TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationCottage completed an analysis of its tax positions, in accordance with FASB ASC 740, Income Taxes, and determined that there are no uncertain tax positions taken. Cottage has recognized no interest or penalties related to uncertain tax positions. Cottage is subject to routine audits by the taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2014.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other350FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other445DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$318,821TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$318,821NetCommunityBenefitExpnsAmt
Total Expense0.0044TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$9,666,863TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,508,083DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,158,780NetCommunityBenefitExpnsAmt
Total Expense0.0998TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$9,985,684TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,508,083DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,477,601NetCommunityBenefitExpnsAmt
Total Expense0.1042TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$253,559TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,630DirectOffsettingRevenueAmt
Net Community Benefit Expns$232,929NetCommunityBenefitExpnsAmt
Total Expense0.0032TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$264,845TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$264,845NetCommunityBenefitExpnsAmt
Total Expense0.0037TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$75,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$75,000NetCommunityBenefitExpnsAmt
Total Expense0.0010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$593,404TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,630DirectOffsettingRevenueAmt
Net Community Benefit Expns$572,774NetCommunityBenefitExpnsAmt
Total Expense0.0080TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$10,579,088TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,528,713DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,050,375NetCommunityBenefitExpnsAmt
Total Expense0.1122TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$1,243,233BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$17,719,153ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$24,617,758CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$6,898,605MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Goleta Valley Cottage HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1351 South PattersonAddressLine1Txt
CityGoletaCityNm
State AbbreviationCAStateAbbreviationCd
ZIP93111ZIPCd
FieldValueIRS element (for citing)
Website Addresshttp://www.cottagehealth.org/locations/goleta-valley-cottage-hospitalWebsiteAddressTxt
State License050000034StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Goleta Valley Cottage HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttps://www.cottagehealth.org/population-health/community-health-needs-assessment/OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLhttps://www.cottagehealth.org/population-health/community-health-needs-assessment/StrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care350.0FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care445.0FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 5 Facility , 1Facility , 1 - GOLETA VALLEY COTTAGE HOSPITAL. As part of this Community Health Needs Assessment, a telephone survey was done with approximately 2500 community members and a listening tour with more than 230 individuals via 20 focus groups conducted from June through August 2016. The focus group participants included public health officials, health providers, nonprofit workers, Cottage Health employees, government leaders and business owners. In addition, existing health and demographic data already collected for the County and State of California was utilized as well as data collected from prior Community Health Needs Assessments. Potential focus group participants were chosen because of their ability to identify primary concerns of the populations that they represent or with whom they work, as well as of the community overall. Focus group candidates were first contacted by letter or email to request their participation. Follow-up phone calls were then made to ascertain whether or not they would be able to attend. Confirmation calls were placed or e-mails sent the day before the groups were scheduled to ensure a reasonable turnout. Through this process, input was gathered from representatives of local government officials, public health, as well as several individuals whose organizations work with low-income, minority (including Latino/Mixteco, Native American, Asian, and African American), or other medically underserved populations (specifically, persons who are young adults, elderly, veterans, disabled, lesbian/gay/bisexual/transgender [LGBT], homeless, mentally ill, undocumented, uninsured/underinsured, or receive Medi-Cal/Medicare). Final participation included representatives of the following organizations: the Santa Barbara County Education Office; Santa Barbara Unified School District; Goleta Union School District; Santa Barbara County Public Health Department; Santa Barbara County Emergency Medical Services Agency; Santa Barbara County Fire Department; Santa Barbara County and Metropolitan Transit District; Santa Ynez Valley Transit; the County Board of Supervisors; Santa Barbara Police Department; City of Solvang; Santa Barbara, Santa Ynez and Solvang Chambers of Commerce; CenCal Health; Community Action Commission; Foodbank of Santa Barbara County; Girls Inc.; Alzheimer's Association; Arthritis Foundation; CALM; Domestic Violence Solutions; Juvenile Diabetes Research Foundation; Mental Wellness Center; New Beginnings Counseling Center; Visiting Nurse and Hospice Care; Carpinteria's Children's Project; Central Coast Collaborative on Homelessness; Family Service Agency; Habitat for Humanity; First 5 of Santa Barbara County; Immigrant Hope; Just Communities; Pacific Pride Foundation; People's Self-Help Housing; Safe Parking Program; Meals on Wheels; Santa Barbara Rape Crisis Center; United Way; Alisal Ranch; and numerous local clergy. All required sources responded and participated. Secondary data sources included data from US Census Bureau, US Department of Education, US Department of Agriculture, US Department of Health and Human Services, Center for Disease Control, Dartmouth College Institute for Health Policy Clinical Practice, State Cancer Profiles, and Nielsen SiteReports.
Schedule H, Part V, Section B, Line 6a Facility , 1Facility , 1 - GOLETA VALLEY COTTAGE HOSPITAL. The CHNA was completed jointly by Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, and Santa Ynez Valley Cottage Hospital.
Schedule H, Part V, Section B, Line 7 Facility , 1Facility , 1 - GOLETA VALLEY COTTAGE HOSPITAL. A press release was issued announcing the completion and availability of the CHNA. This information was also shared and presented to the community on an as requested basis.
Schedule H, Part V, Section B, Line 11 Facility , 1Facility , 1 - GOLETA VALLEY COTTAGE HOSPITAL. As a member of Cottage Health (CH), the needs identified in the Hospital's CHNA are incorporated into the Community Benefit Program of CH. Eight of the 13 leading health indicators identified in the 2016 CHNA fit into the five prioritized health areas: (1) access to care; (2) behavioral health - including injury and violence; (3) chronic conditions; (4) food insecurity; and (5) housing insecurity. The five indicators not prioritized and addressed are: (1) general health status; (2) smoking cigarettes; (3) binge drinking; (4) physical inactivity; and (5) access to dental care. These health indicators were not ranked as highly in terms of need, urgency, collaboration among community organizations, health disparities, and community resources available. In addition, there are currently leading community partners/stakeholders who are addressing general health status, smoking cigarettes, binge drinking, physical inactivity, and access to dental care. Though not selected as priority areas, some of the non-prioritized needs will be indirectly addressed through enhancing access to health care and by partnering with lead organizations addressing these areas. The implementation strategy to address the priority needs includes Goleta Valley Cottage Hospital's grants, its hospital programs and health fairs. In addition, Goleta Valley Cottage Hospital provides grants to support Health Professional Education.
Schedule H, Part V, Section B, Line 15 Facility , 1Facility , 1 - Goleta Valley Cottage Hospital. The FAP also described the physical locations where patients can obtain a copy of the FAP Application, as well as the Cottage Health website address.
Schedule H, Part V, Section B, Line 20 Facility , 1Facility , 1 - Goleta Valley Cottage Hospital. Cottage Health did not initiate any new Extraordinary Collection Efforts (ECAs) in 2017
FieldValueIRS element (for citing)
Facility3FacilityNum

Supplemental Information Detail SupplementalInformationDetail (19 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part I, Line 6b Community Benefit Report AvailabilityCottage Health prepares a Community Benefit Report on behalf of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital. It is filed with the State of California, in compliance with California Senate Bill 697. The Community Benefit Report is available to the public upon request. In addition it can be found on the OSHPD website: https://www.oshpd.ca.gov/HID/CommunityBenefit/Plans.html
Schedule H, Part I, Line 3c Other Financial Assistance FactorsGoleta Valley Cottage Hospital uses FPG based on Household Income to determine eligibility for both discount and charity care on the patient responsibility whether or not covered by insurance. For charity care, Cottage Health considers assets (consistent with state law limitations on the definition of "Monetary Assets") in addition to Income, to calculate total Household Income in relation to FPG. Patients who were determined to be homeless also qualified for free care, assuming they did not qualify for other insurance programs.
Schedule H, Part V, Section B Disclosure Pursuant to Rev. Proc. 2015-21The following information is provided pursuant to Section 7 of Revenue Procedure 2015-21 to disclose certain noncompliance with the requirements of Internal Revenue Code Section 501(R). The Revenue Procedure provides for such noncompliance to be reported on the Form 990 filed for the year such noncompliance was discovered. In the interest of timeliness and transparency, Cottage Health disclosed certain noncompliance with Internal Revenue Code 501(R) on its Form 990 for 2016 relative to noncompliance identified in 2017. Upon discovery of the noncompliance, immediate efforts were made in 2017 to implement all required processes and procedures and identify any individuals who were affected by the noncompliance. In 2017 Cottage Health took corrective actions outlined in its Form 990 for 2016. Additionally the below corrective actions were finalized subsequent to the Form 990 filing for 2016: 1. Cottage Health undertook additional public outreach to ensure compliance with the "Widely Publicized" requirement at 26 C.F.R 1.501(r)-4(b)(1)(ii) by informing affected individuals that the FAP is now available on the Cottage Health website at www.CottageHealth.org/FAP. Cottage Health also distributed an email on April 2, 2018 to all individuals whose email addresses were on record with one of the Cottage Health hospital facilities as a general notification to the community of the availability of financial assistance, including how to obtain Cottage Health's Financial Assistance Policy, Financial Assistance Application, and Plain Language Summary. 2. Cottage Health calculated and published its AGB for emergency and other medically necessary care provided at each hospital facility in accordance with 26 C.F.R 1.501(r)-5(b), and instituted policies and procedures to assure that such information is readily obtainable, including specifying in its Financial Assistance Policy the method Cottage Health facilities use to determine AGB. Cottage Health determined that due to its generous financial assistance policy no individuals eligible for financial assistance were charged more than AGB. All FAP-eligible individuals who submitted complete financial assistance applications received discounts pursuant to Cottage Health's financial assistance policy, which discounts exceeded any discounts that would have otherwise been awarded based upon an AGB calculation had it been in effect. 3. Cottage Health revised its policies and procedures to ensure that it makes reasonable efforts to determine FAP eligibility in accordance with the requirements at 26 C.F.R. 1.501(r)-6(c) relative to notification requirements prior to performing Extraordinary Collection Actions (ECA's). Cottage Health made efforts to assess how many individuals were affected by Cottage Health's historical noncompliance with the notification requirements. In an effort to restore any impacted individual to the position they would have been in had the noncompliance not occurred, in November 2017 Cottage Health unwound all legal actions actively underway with any individual, including liens, wage garnishments, and credit reporting, regardless of financial situation. In addition, Cottage Health instructed credit bureaus that any adverse credit reporting should be reversed. While Cottage Health reserves the right in the future to pursue ECA's after making reasonable efforts to determine if the individual is FAP-eligible, pursuant to its financial assistance policy, Cottage Health is not actively initiating any ECAs at this time.
Schedule H, Part V, Section B, Line 16 FAP LanguagesThe FAP is available in English, Tagalog and Spanish at the website notated in 16 a and b
Schedule H, Part I, Line 6a Community benefit report prepared by related organizationCOTTAGE HEALTH
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistanceThe costing methodology includes inpatient, outpatient, and emergency department and is broken down by Payer categories. Both direct and overhead costs have been allocated, by services rendered. Each Payer's net revenue is offset by the total cost and the results by Payer are calculated. In addition to a hospital wide cost to charge ratio, we have calculated cost to charge ratios for each Payer, based on the cost of the type of services rendered to their specific patients. Therefore, the community benefit amounts attributable to Medicaid and other government programs are calculated based on their specific cost to charge ratio.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amountPatient service revenue, net of contractual allowances and discounts, is reduced by the provision for bad debts, and accounts receivable is reduced by an allowance for uncollectible accounts. The hospital establishes an allowance for uncollectible accounts based on many factors, including payer mix, age of receivables, historical cash collection experience, and other relevant information. A portion of the hospital's uninsured patients will be unable or unwilling to pay for their health services a portion of the hospital's insured patients will be unable or unwilling to pay for co-payments and deductibles. If these individuals do not qualify for financial assistance, the hospital records a provision for bad debts related to these insured and uninsured patients in the period the services are provided. The hospital writes down the expected reimbursement after reasonable collection efforts have been exhausted.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnoteThe hospital establishes an allowance for doubtful accounts based on many factors, including payer mix, age of receivables, historical cash collection experience and other relevant information. A significant portion of the hospital's uninsured patients will be unable or unwilling to pay for services provided and a significant portion of the hospital's insured patients will be unable or unwilling to pay for co-payments and deductibles. The age of the receivable impacts collectibility, and the hospital's reserves are based on historical cash collection experience for similarly aged accounts. Accounts greater than 364 days are fully reserved, by policy. Cottage records a provision for doubtful accounts related to all accounts in the period the services are provided.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costsThe shortfall from total costs for Medicare patients is a significant loss to the hospital. The Hospital is providing care to patients whose insurance (Medicare) does not cover the entire cost of their care. This provides significant aid to the elderly in the community. Some of these elderly people would qualify under FAP guidelines for financial assistance under any other Payer program. The dollars reported are taken from the 2017 Medicare Cost Report and are derived following their guidelines of allowable and non-allowable costs.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistanceCottage Health's Financial Assistance Policy (FAP), which includes actions Cottage Health may take in the event of non-payment and applies to the largest number of Cottage Health's patients, states that Cottage Health will not engage in Extraordinary Collection Activities (ECAs) (defined in the policy) for a period of at least 150 days following the date of the first post-discharge billing statement, nor will Cottage Health engage in ECAs before making a reasonable effort to determine whether a patient is eligible for financial assistance pursuant to Cottage Health's FAP. The FAP further states that, at least 30 days prior to engaging in any ECAs, Cottage Health will: (a) provide written notice to patients regarding the availability of financial assistance, the specific ECAs Cottage Health intends to take in the event of non-payment, and a deadline after which Cottage Health may initiate ECAs; (b) provide to patients a written plain language summary of Cottage Health's FAP; and (c) make reasonable efforts to orally notify patients about Cottage Health's FAP and how the patient can obtain assistance with the financial assistance application. The FAP further states that, if Cottage Health receives a complete financial assistance application during the Application Period (as defined in the FAP), Cottage Health will suspend ECAs and process the patient's application, and if Cottage Health receives an incomplete financial assistance application during the Application Period, Cottage Health will suspend ECAs and provide a reasonable opportunity for the patient to submit a complete financial assistance application. ECAs are defined as (a) actions requiring a legal or judicial process; and (b) reporting adverse information to credit reporting agencies or credit bureaus. Cottage Health's FAP further states that Cottage Health may employ reasonable collection efforts to obtain payment from patients, other than ECAs, including issuing statements, making telephone calls, and sending e-mail messages.
Schedule H, Part V, Section B, Line 16a FAP website- Goleta Valley Cottage Hospital: Line 16a URL: HTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/;
Schedule H, Part V, Section B, Line 16b FAP Application website- Goleta Valley Cottage Hospital: Line 16b URL: HTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website- Goleta Valley Cottage Hospital: Line 16c URL: HTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/;
Schedule H, Part VI, Line 2 Needs assessmentCottage Health, through its hospitals Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, and Santa Ynez Valley Cottage Hospital, researched the needs of the county through the Community Health Needs Assessment (CHNA). As discussed in detail in H-V-line5, the assessment included a broad group of participants from the public and private sector plus existing health data in the government sector and past needs assessment information. Needs prioritized in the CHNA include: Access to Care, Behavioral Health, Chronic conditions, food insecurity and housing insecurity. In addition, Cottage Health has prioritized injury and violence within the Behavioral Health area. The Hospitals provide critical funding for community health, financial assistance, and external grants, while also realizing shortfalls in Medicare, Medi-Cal, and indigent care. Activities in these areas included screenings and health fairs; classes, clinics, lectures, and seminars; community services; community collaborations; and coalitions/committees. In 2017, Cottage Health spent over $150 million on these programs.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistanceCOTTAGE HEALTH HAS A MULTIFACETED FINANCIAL ASSISTANCE PROGRAM TO ENSURE THAT ALL PATIENTS RECEIVE INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS AND PATIENTS WHO DO NOT HAVE INSURANCE ARE SCREENED FOR ELIGIBILITY IN A GOVERNMENT SPONSORED HEALTHCARE PLAN. THE HOSPITAL POSTS INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM IN ALL REGISTRATION AREAS. SIGNS IN ENGLISH, TAGALOG AND SPANISH ARE LOCATED IN ALL AREAS WHERE PATIENTS ARE REGISTERED FOR INPATIENT AND OUTPATIENT SERVICES. SIGNS ARE ALSO LOCATED IN THE PATIENT BILLING OFFICE AND CASHIER OFFICE. PATIENTS WILL ALSO BE CONTACTED BY AN ADMITTING REPRESENTATIVE OR ELIGIBILITY COUNSELOR TO ASSIST THE PATIENT IN DETERMINING ELIGIBILITY FOR GOVERNMENT SPONSORED INSURANCE PROGRAMS AND ASSIST WITH THE APPLICATION PROCESS AT NO COST TO THE PATIENT. PATIENT FINANCIAL COUNSELORS WHO ANSWER CUSTOMER SERVICE CALLS ARE INSTRUCTED TO OFFER FINANCIAL ASSISTANCE 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 FINANCIAL ASSISTANCE 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.
Schedule H, Part VI, Line 4 Community informationSanta Barbara County consists of 2,750 square miles of land and inland water area. Approximately rectangular in shape, Santa Barbara County is bordered on the north by San Luis Obispo County, on the east by Ventura County, and on the south and west by 107 miles of Pacific coastline. Much of the county is mountainous. The Santa Ynez, San Rafael and Sierra Madre mountains extend in a predominately east west direction. Within the county, there are numerous fertile agricultural areas, including the Santa Maria, Cuyama, Lompoc, and Santa Ynez Valleys, and the southeast coastal plain. These areas, which include most of the developed land, also accommodate the majority of the population. Los Padres National Forest, in the eastern part of the county, covers approximately 44 percent of the total county area. Vandenberg Air Force Base is in the Lompoc region, while UCSB is on the South Coast. North County refers to the area west and north of Gaviota and includes the Lompoc, Santa Maria, Santa Ynez and Cuyama valleys. South Coast refers to the Goleta, Santa Barbara, and Carpinteria coastal plain. Santa Barbara County's approximate 440,000 population is divided into six sub regions: Santa Barbara/Goleta Region; Santa Ynez Valley; Carpinteria Valley; Lompoc Valley; Santa Maria Valley; Guadalupe Valley; and the Cuyama Valley. Of the total population, approximately 50% are females. The median age is 33.6 years. The population age breakdown is: 27.4% under 20 years old; 59.2% are 20 to 64 years old and 13.4% are 65 and older. For people reporting one race, 46.8% are White; 43.7% are Hispanic; 1.6% are Black or African American; 4.8% are Asian; and 3.1% are Other/Multi-Racial. 16.65% of county residents live below the poverty level. The residents of the County are served by 5 hospitals throughout the county.
Schedule H, Part VI, Line 5 Promotion of community healthThe Board of Directors is made up of prominent community members who volunteer their time to ensure that the Goleta Community has access to high-quality, affordable healthcare. The Board of Directors is actively involved in the Hospital's strategic decisions and takes its commitment to the Community very seriously. The Board approves of an annual financial budget and reviews a long-term financial plan to guarantee the Hospital will continue to offer hospital services to the Community for years to come. The Board also approves of annual top goals that are consistent with the mission, vision and values of the Hospital. The financial forethought of the Board of Directors resulted in surplus funds that were used to rebuild the facility. Because of Board foresight, construction was complete and in 2016 Goleta Valley Cottage Hospital moved into its new hospital which complies with the unfunded mandate of the State of California's Senate Bill 1953 (SB1953), requiring 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 met the current and future healthcare needs of the Community. Goleta Valley Cottage Hospital works cooperatively with the open medical staff to improve healthcare in the community. The Hospital is exploring how to better align with physicians in order to provide the highest quality of care.
Schedule H, Part VI, Line 6 Affiliated health care systemCottage Health (CH) is the parent organization of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital and Goleta Valley Professional Buildings, Inc. These organizations have a common Board of Directors. Cottage Health Hospitals are the sole hospital providers in the Community and strategic plans are created with all the Hospitals and their Communities in mind. Goleta Valley Cottage Hospital is the second largest of the CH Hospitals and primarily provides services to the City of Goleta (adjacent to Santa Barbara) and the University of California, Santa Barbara.
Schedule H, Part VI, Line 7 State filing of community benefit reportCA

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceAmtPurpose Of GrantPurposeOfGrantTxt
CSUCI FOUNDATION
One University DriveCamarilloCA93012770433230501(c)3$28,000$0Support of the Bachelor's in Science, Nursing program in Santa Barbara
SB COUNTY EDUCATION OFFICE
4400 Cathedral Oaks RoadSanta BarbaraCA93160956000940government$75,000$0Support of Welcome Every Baby program which supports new parents with education and child development guidance.
Santa Barbara City College
721 Cliff DriveSanta BarbaraCA93109770070782government$111,228$0Support of Nursing Program at Santa Barbara City College
FieldValueIRS element (for citing)
Total501c3 Org3Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule I, Part I, Line 2 Procedures for monitoring use of grant funds.FormAndLineReferenceDesc
ExplanationGrant funds are monitored through the Community Health Coordinating Committee of Cottage Health. Grantees are required to submit a report in June of each year that is reviewed by the committee prior to entire amount of funds being disbursed.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Ronald Werft
President & CEO$0$971,716$0$0$0$212,089$0$13,500$0$25,480$0$1,222,785$0$0
Steven Fellows
COO$0$581,410$0$0$0$111,674$0$13,500$0$25,480$0$732,064$0$0
Brett Tande
CFO$0$512,683$0$0$0$79,461$0$13,500$0$25,480$0$631,124$0$0
ARIE DEJONG
VP GVCH$325,123$0$0$0$4,345$0$45,362$0$26,511$0$401,341$0$0$0
CAROLINE ROSEN
DIR NURSING GVCH$190,635$0$158$0$4,472$0$9,540$0$18,369$0$223,174$0$0$0
SUSAN SAN MARCO
DIRECTOR SRVC LINE$204,766$0$158$0$2,609$0$10,246$0$9,013$0$226,792$0$0$0
IRENE MINDO
CLINICAL RESOURCE NURSE$185,119$0$158$0$1,964$0$9,264$0$19,337$0$215,842$0$0$0
LISA LA BOUVE
CLINICAL MANAGER$185,653$0$158$0$692$0$9,291$0$9,237$0$205,031$0$0$0
JASON KORN
CLIN NURSE COORD$176,917$0$158$0$7,624$0$8,854$0$9,237$0$202,790$0$0$0
MARY FULCHER
CLINICAL MANAGER$167,199$0$158$0$14,152$0$8,368$0$26,511$0$216,388$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationOn 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 executives 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.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planCOTTAGE HEALTH PROVIDES CERTAIN EXECUTIVES A SUPPLEMENTAL RETIREMENT PROGRAM. THE PROGRAM IS DEFINED AS DEFERRED COMPENSATION UNDER THE IRC SECTION 457(F). THE ANNUAL CONTRIBUTION IS 6.95% OF BASE YEARS SALARY WITH THE CONTRIBUTIONS VESTING FIVE YEARS FROM CREDITING DATE, OR AT AGE 62, OR IMMEDIATELY IN THE EVENT OF DEATH, DISABILITY, OR INVOLUNTARY TERMINATION WITHOUT CAUSE. THE UNVESTED ACCOUNT BALANCES ARE ASSETS OF THE HOSPITAL AND ARE INCLUDED IN OTHER ASSETS AND THE ACCRUED EXPENSE IS INCLUDED IN PENSION LIABILITY AND OTHER IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS. THE AMOUNTS REPORTED IN THE CURRENT YEAR'S DEFERRED COMPENSATION INCLUDES RECOGNITION OF PAST SERVICE. THE AMOUNTS ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. ANY DEFERRED CONTRIBUTIONS TO THIS PLAN WILL BE REPORTED AGAIN AS REPORTABLE COMPENSATION IN THE YEAR PAID. In 2017, no employee received a 457(f) payout.

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Arie DeJongBusinessNameLine1Txt
FieldValueIRS element (for citing)
Relationship With OrgVice PresidentRelationshipWithOrgTxt
Loan PurposeHome PurchaseLoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$300,000OriginalPrincipalAmt
Balance Due$300,000BalanceDueAmt
DefaultfalseDefaultInd
Board Or Committee ApprovalYes (true)BoardOrCommitteeApprovalInd
Written AgreementYes (true)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$300,000TotalBalanceDueAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 6 Classes of members or stockholdersCottage Health is the sole corporate member.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyCottage Health is the sole corporate member and can appoint Directors to the Board.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersThe Board of Directors must obtain prior approval from the Board of Directors of Cottage Health, 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.
Form 990, Part VI, Line 11b Review of form 990 by governing bodyForm 990 is prepared under the direction of the Senior Vice President and CFO. Form 990 is compiled and reviewed by the Senior Vice President & CFO, the Vice President Finance & Controller, the Director Corporate Finance, and the Accounting Manager. Each party reviews Form 990 prior to submission to the Compliance & Audit Committee and to the Board of Directors, whose reviews are conducted prior to filing. A complete copy of the final Form 990 is provided to all members of the governing board before it is filed.
Form 990, Part VI, Line 12c Conflict of interest policyThe 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, 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. The Directors have a duty to: 1.) discharge their duties to benefit Cottage Health and not the Directors personally 2.) disclose situations with the potential for conflict of interest with the vision and mission of Cottage Health 3.) refrain from discussing confidential Cottage Health business with others. Each Board member will annually complete the Cottage Health 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 items to be discussed at a Board meeting. If there are any material financial or personal interests a Board member or family member may have in a Board decision, the Director or Officer will disclose this to the Committee Chair before the Board reviews the items and takes action. In general, an Officer who has disclosed a potential conflict should be excused from the decision making portion of the discussion and is prohibited from voting on a matter involving a potential conflict of interest. If the Board has reasonable cause to believe that a Director or Officer failed to disclose a material financial interest or other potential material conflict of interest, the Board Chair shall inform the member of the basis for the belief and afford the member an opportunity to explain the alleged failure to disclose. After hearing the Director or Officer response and conducting any further necessary investigation, the Board determines if the Director or Officer failed to disclose a material financial or other potential material conflict of interest. The Board Chair shall take appropriate corrective action. Committee Chairs who address conflict of interest situations with a Board Committee member are responsible for reporting such situations to the Board Chair. Key employees are treated as other employees of Cottage Health and sign an annual conflict of interest form. These forms are reviewed by Compliance and any issues are brought to the Chief Compliance Officer.
Form 990, Part VI, Line 15a Process to establish compensation of top management officialOn 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 employed officers and key employees.
Form 990, Part VI, Line 15b Process to establish compensation of other employeesThe process described in line 15a, above, takes place annually for all employed officers and key employees. For this fiscal year, the review occurred on March 30, 2017.
Form 990, Part VI, Line 19 Required documents available to the publicTax filings can be obtained upon request from the CFO. Audited Financial Statements are attached to the Form 990 in accordance with IRS instructions. The bylaws, articles of incorporation and conflict of interest policies are not available to the public.
Form 990, Part VIII, Line 11d Other Miscellaneous RevenueAll other revenues - Total Revenue: 188895, Related or Exempt Function Revenue: 188895, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other FeesLaboratory Purchased Services - Total Expense: 2459610, Program Service Expense: 2459610, Management and General Expenses: , Fundraising Expenses: ; Medical Professional Fees - Total Expense: 2635710, Program Service Expense: 2208992, Management and General Expenses: 426718, Fundraising Expenses: ; Contract Labor - Total Expense: 409441, Program Service Expense: 404736, Management and General Expenses: 4705, Fundraising Expenses: ; Other Purchased Services - Total Expense: 6038351, Program Service Expense: 4024996, Management and General Expenses: 2013355, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesCHANGE IN PENSION LIABILITY - 2286153; Land tranferred from affiliate - 7230602;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
COTTAGE HEALTH
PO BOX 689SANTA BARBARACA931020689770431902PARENT ORGANIZATION FOR 3 HOSPITALS & MEDICAL PROF BLDGCA501(c)(3)Type IINAfalse
SANTA BARBARA COTTAGE HOSPITAL
PO BOX 689SANTA BARBARACA931020689951644629HOSPITALCA501(c)(3)3COTTAGE HEALTHYes (true)
SANTA YNEZ VALLEY COTTAGE HOSPITAL INC
PO BOX 689SANTA BARBARACA931020689952224265HospitalCA501(c)(3)3COTTAGE HEALTHYes (true)
SANTA BARBARA COTTAGE HOSPITAL FOUNDATION
PO BOX 689SANTA BARBARACA931020689953802238fundraisingCA501(c)(3)7falseN/A
GOLETA VALLEY PROFESSIONAL BUILDINGS INC
PO BOX 689SANTA BARBARACA931020689770004202MEDICAL PROF BLDGCA501(c)(3)Type IICOTTAGE HEALTHYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Santa Barbara Cottage Hospital
D$4,082,754accrual
Santa Barbara Cottage Hospital
M$2,459,610accrual
Santa Barbara Cottage Hospital
O$1,269,412accrual
Santa Barbara Cottage Hospital
Q$331,070accrual