2018-11-08T17:01:56-06:00 2017-12-31 346565596 Ernst and Young LLP 4365 Executive Drive Suite 1600 San Diego CA 92121 990 2017-01-01 952413596 Goleta Valley Cottage Hospital GOLE 8053249903 PO BOX 689 Attn Finance Dept Santa Barbara CA 931020689 Brett D Tande Senior VP & CFO 2018-11-08 false Jocelyne Miller P00634378 8585357200 2017 2019-02-21 02:37:17Z Ronald Werft PO BOX 689 Attn Finance Dept Santa Barbara CA 931020689 80458595 false X http://www.cottagehealth.org/locations/goleta-valley-cottage-hospital X 1965 CA It 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. 17 16 306 144 0 1170517 164183 74144697 79232229 -35867 132160 434772 608742 75714119 80137314 426688 214228 0 33367554 34186037 0 0 40437671 37335707 74231913 71735972 1482206 8401342 131386512 138444774 29068851 17851676 102317661 120593098 It 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. false false 63561100 214228 79544692 Goleta 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. 63561100 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false true false false false false false false false false false true true true false false true 52 0 true 306 true false false false false false false true false false false X 17 16 false false false false true true true true true false false true true true true true true true true false CA X Greg Hogue 8053249933 400 West Pueblo Santa Barbara CA 93105 Steven Ainsley Board Chair 1.8 18.2 X X 0 0 0 Gregory Faulkner Vice Chair 0.5 5.5 X X 0 0 0 Dorothy Largay PhD Vice Chair 0.5 5.5 X X 0 0 0 Marshall (Chip) Turner Vice Chair 0.5 5.5 X X 0 0 0 Edward Bentley MD Secretary 0.5 5.5 X X 0 0 0 Jon Clark Committee Chair 0.5 4.5 X 0 0 0 Harry McMahon Committee Chair 0.5 4.5 X 0 0 0 Robert Nourse Committee Chair 0.5 4.5 X 0 0 0 Susan Christol-Deacon Board Member 0.4 3.6 X 0 0 0 Thomas Cusack Board Member 0.4 3.6 X 0 0 0 Nancy Nielsen Board Member 0.4 3.6 X 0 0 0 Ernesto Paredes Board Member 0.4 3.6 X 0 0 0 Gamble Parks Board Member 0.4 3.6 X 0 0 0 Richard Ponce MD Board Member 0.4 3.6 X 0 0 0 Anne Rodriguez MD Board Member 0.4 3.6 X 0 0 0 Mark Scott MD Board Member 0.4 3.6 X 0 1406 0 Steven Zola Board Member 0.4 3.6 X 0 0 0 Margaret Baker Board Member-part year 0.4 3.6 X 0 0 0 Lori Gaskin PhD Board Member-part year 0.4 3.6 X 0 0 0 Judith Hopkinson Board Member-part year 0.4 3.6 X 0 0 0 Fred Lukas Board Member-part year 0.4 3.6 X 0 0 0 Elliot Prager MD Board Member-part year 0.4 3.6 X 0 0 0 Ronald Werft President & CEO 5.4 54.6 X 0 1183805 38980 Steven Fellows COO 9.0 41.0 X 0 693084 38980 Brett Tande CFO 4.5 45.5 X 0 592144 38980 Teresa Petter Asst. Secretary-Board 4.5 45.5 X 0 109385 32837 CRISTINA KERN SECRETARY THROUGH May 2017 4.5 45.5 X 0 43818 14880 ARIE DEJONG VP GVCH 40.0 0 X 329468 0 71873 CAROLINE ROSEN DIR NURSING GVCH 40.0 0 X 195265 0 27909 SUSAN SAN MARCO DIRECTOR SRVC LINE 40.0 0 X 207533 0 19259 IRENE MINDO CLINICAL RESOURCE NURSE 40.0 0 X 187241 0 28601 LISA LA BOUVE CLINICAL MANAGER 40.0 0 X 186503 0 18528 JASON KORN CLIN NURSE COORD 40.0 0 X 184699 0 18091 MARY FULCHER CLINICAL MANAGER 40.0 0 X 181509 0 34879 1472219 2623643 383797 77 false true false SNYDER LANGSTON LP 17962 COWAN IRVINE CA 92614 CONSTRUCTION CONTRACTOR 936396 ANESTHESIA ASSOC MED GROUP INC ONE POST STREET SAN FRANCISCO CA 94104 PHYSICIAN SERVICES 730000 AMN HEALTHCARE INC 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 CONTRACT LABOR 312710 Diversified Clinical Services 4500 Salisbury Road Jacksonville FL 32216 Clinical Services 245625 Vizient Inc 290 E John Carpenter Freeway Irving TX 75062 Consulting 225914 11 X 164183 164183 NET PATIENT SERVICE REVENUE 900099 78529368 78529368 CA HOSPITAL FEE PROGRAM 622110 486958 486958 EHR MEDICARE GRANT 622110 215903 215903 0 0 0 0 79232229 93628 93628 0 0 359813 321281 38532 0 38532 38532 CAFETERIA/GIFT SHOP 900099 296279 296279 ED INSURANCE PREMIUM REIMBURSEMENT 900099 102938 102938 Healthy Balance Weight Loss Classes 900099 20630 20630 188895 188895 0 0 608742 80137314 79544692 0 428439 X 214228 214228 369478 67772 301706 22516991 20325418 2191573 1302561 1176213 126348 8559845 7039630 1520215 1437162 1390963 46199 4447 4447 32789 32789 11543112 9098334 2444778 0 1220885 1103061 117824 77614 70085 7529 1448882 1332294 116588 9823 3300 6523 3504 3447 57 652811 589488 63323 7296885 6269961 1026924 87365 64475 22890 MEDICAL SUPPLIES 13025719 13025489 230 HOSPITAL FEE PROGRAM 961640 961640 EQUIPMENT MAINTENANCE 816968 800618 16350 Dues and Subscriptions 84742 5301 79441 68521 19383 49138 0 71735972 63561100 8174872 0 1318719 1787273 5460 33065 11602129 8409646 300000 300000 0 0 643027 552895 605430 665078 158176348 39416949 116267207 118759399 5673 3099214 1838 3307187 0 637029 1531017 131386512 138444774 5008417 5240643 0 0 24060434 12611033 29068851 17851676 X 102317661 120593098 102317661 120593098 131386512 138444774 X 8401342 357340 9516755 X false true X true false X false false false false false false false false true 10733 10733 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying 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 ACTIVITY Lobbying 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. 7230602 7230602 118933691 24451534 94482157 4718432 2357942 2360490 27113568 12607473 14506095 180055 180055 118759399 SELF INSURANCE LIABILITY 2592636 GVCH ALLOCATION OF TAX EXEMPT DEBT 4082754 ACCRUED PENSION & SERP Due to Affiliates 2785416 Reserves for Government Third Party payors 3150227 12611033 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Cottage 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. true true X true X 350 true X 445 true true false true true 318821 318821 0.0044 9666863 2508083 7158780 0.0998 0 0.0 0 0 9985684 2508083 7477601 0.1042 253559 20630 232929 0.0032 264845 264845 0.0037 0 0.0 0 0.0 75000 75000 0.0010 0 0 593404 20630 572774 0.0080 0 0 10579088 2528713 8050375 0.1122 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 1243233 0 17719153 24617758 -6898605 X true true 1 1 Goleta Valley Cottage Hospital 351 South Patterson Goleta CA 93111 http://www.cottagehealth.org/locations/goleta-valley-cottage-hospital 050000034 X X X Goleta Valley Cottage Hospital 1 false false true X X X X X X X X X 16 true true false true X https://www.cottagehealth.org/population-health/community-health-needs-assessment/ X X true 16 true https://www.cottagehealth.org/population-health/community-health-needs-assessment/ false true X 350.0 445.0 X X X X true true X X X X true X HTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/ X HTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/ X HTTP://WWW.COTTAGEHEALTH.ORG/BILLING/FINANCIAL-ASSISTANCE/ X X X X X X true X false X X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 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 , 1 Facility , 1 - Goleta Valley Cottage Hospital. Cottage Health did not initiate any new Extraordinary Collection Efforts (ECAs) in 2017 3 Schedule H, Part I, Line 6b Community Benefit Report Availability Cottage 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 Factors Goleta 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. 2015-21 The 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 Languages The 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 organization COTTAGE HEALTH Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The 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 amount Patient 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 footnote The 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 costs The 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 assistance Cottage 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 assessment Cottage 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 assistance COTTAGE 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 information Santa Barbara County consists of 2,750 square miles of land and inland water area. Approximately rectangular in shape, Santa Barbara County is bordered on the north by San Luis Obispo County, on the east by Ventura County, and on the south and west by 107 miles of Pacific coastline. Much of the county is mountainous. The Santa Ynez, San Rafael and Sierra Madre mountains extend in a predominately east west direction. Within the county, there are numerous fertile agricultural areas, including the Santa Maria, Cuyama, Lompoc, and Santa Ynez Valleys, and the southeast coastal plain. These areas, which include most of the developed land, also accommodate the majority of the population. Los Padres National Forest, in the eastern part of the county, covers approximately 44 percent of the total county area. Vandenberg Air Force Base is in the Lompoc region, while UCSB is on the South Coast. North County refers to the area west and north of Gaviota and includes the Lompoc, Santa Maria, Santa Ynez and Cuyama valleys. South Coast refers to the Goleta, Santa Barbara, and Carpinteria coastal plain. Santa Barbara County's 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 health The Board of Directors is made up of prominent community members who volunteer their time to ensure that the Goleta Community has access to high-quality, affordable healthcare. The Board of Directors is actively involved in the Hospital's strategic decisions and takes its commitment to the Community very seriously. The Board approves of an annual financial budget and 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 system Cottage 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 report CA true CSUCI FOUNDATION One University Drive Camarillo CA 93012 770433230 501(c)3 28000 0 Support of the Bachelor's in Science, Nursing program in Santa Barbara SB COUNTY EDUCATION OFFICE 4400 Cathedral Oaks Road Santa Barbara CA 93160 956000940 government 75000 0 Support of Welcome Every Baby program which supports new parents with education and child development guidance. Santa Barbara City College 721 Cliff Drive Santa Barbara CA 93109 770070782 government 111228 0 Support of Nursing Program at Santa Barbara City College 3 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. Grant 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. X X X X false true false false false false false false false Ronald Werft President & CEO 0 971716 0 0 0 212089 0 13500 0 25480 0 1222785 0 0 Steven Fellows COO 0 581410 0 0 0 111674 0 13500 0 25480 0 732064 0 0 Brett Tande CFO 0 512683 0 0 0 79461 0 13500 0 25480 0 631124 0 0 ARIE DEJONG VP GVCH 325123 0 0 0 4345 0 45362 0 26511 0 401341 0 0 0 CAROLINE ROSEN DIR NURSING GVCH 190635 0 158 0 4472 0 9540 0 18369 0 223174 0 0 0 SUSAN SAN MARCO DIRECTOR SRVC LINE 204766 0 158 0 2609 0 10246 0 9013 0 226792 0 0 0 IRENE MINDO CLINICAL RESOURCE NURSE 185119 0 158 0 1964 0 9264 0 19337 0 215842 0 0 0 LISA LA BOUVE CLINICAL MANAGER 185653 0 158 0 692 0 9291 0 9237 0 205031 0 0 0 JASON KORN CLIN NURSE COORD 176917 0 158 0 7624 0 8854 0 9237 0 202790 0 0 0 MARY FULCHER CLINICAL MANAGER 167199 0 158 0 14152 0 8368 0 26511 0 216388 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation 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 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 plan COTTAGE 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. Arie DeJong Vice President Home Purchase X 300000 300000 false true true 300000 Form 990, Part VI, Line 6 Classes of members or stockholders Cottage Health is the sole corporate member. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Cottage 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 stockholders The 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 body Form 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 policy 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, 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 official 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 employed officers and key employees. Form 990, Part VI, Line 15b Process to establish compensation of other employees The 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 public Tax 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 Revenue All 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 Fees Laboratory 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 balances CHANGE IN PENSION LIABILITY - 2286153; Land tranferred from affiliate - 7230602; COTTAGE HEALTH PO BOX 689 SANTA BARBARA CA 931020689 770431902 PARENT ORGANIZATION FOR 3 HOSPITALS & MEDICAL PROF BLDG CA 501(c)(3) Type II NA false SANTA BARBARA COTTAGE HOSPITAL PO BOX 689 SANTA BARBARA CA 931020689 951644629 HOSPITAL CA 501(c)(3) 3 COTTAGE HEALTH true SANTA YNEZ VALLEY COTTAGE HOSPITAL INC PO BOX 689 SANTA BARBARA CA 931020689 952224265 Hospital CA 501(c)(3) 3 COTTAGE HEALTH true SANTA BARBARA COTTAGE HOSPITAL FOUNDATION PO BOX 689 SANTA BARBARA CA 931020689 953802238 fundraising CA 501(c)(3) 7 N/A false GOLETA VALLEY PROFESSIONAL BUILDINGS INC PO BOX 689 SANTA BARBARA CA 931020689 770004202 MEDICAL PROF BLDG CA 501(c)(3) Type II COTTAGE HEALTH true false false false true false false false false false true false true true true true true true true Santa Barbara Cottage Hospital D 4082754 accrual Santa Barbara Cottage Hospital M 2459610 accrual Santa Barbara Cottage Hospital O 1269412 accrual Santa Barbara Cottage Hospital Q 331070 accrual