2012-11-14T14:27:48-07:00 2011-12-31 990 2011-01-01 951644629 SANTA BARBARA COTTAGE HOSPITAL SANT 8056827111 PO BOX 689 SANTA BARBARA CA 931020689 Joan Bricher 8055697294 2012-11-14 2011 2016-02-24 21:20:13Z Ronald Werft Same as Above Santa Barbara CA 93102 703627373 0 X WWW.COTTAGEHEALTHSYSTEM.ORG X 1888 CA It is the mission of Santa Barbara Cottage Hospital to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 19 14 2946 760 6018 777992 57309221 2065178 503003844 501454547 17439686 15269866 6673911 9885771 584426662 528675362 2024476 1263313 0 0 229134149 229557436 19200 0 0 243910311 254585769 475088136 485406518 109338526 43268844 1111406611 1130882734 481294143 497430249 630112468 633452485 It is the mission of Santa Barbara Cottage Hospital (SBCH) to provide superior health care through a commitment to our Community and to our core values of excellence, integrity, and compassion. The volunteer Board of Directors uses these core values to make decisions that will improve health care access, affordability and quality. 0 0 348991372 1263313 511335274 Santa Barbara Cottage Hospital is a 408-bed acute-care hospital located in the City of Santa Barbara. In 2011, the Hospital had 86,409 patient days, served 124,649 outpatients, including emergency services to 42,293 patients. The Hospital provides a wide array of inpatient and outpatient services, including but not limited to the areas of cardiology, orthopedics, neurology, trauma, labor & delivery, psychiatric, neonatal intensive care, pediatric intensive care, pediatrics, laboratory, imaging, therapy, diabetes, oncology, emergency and rehabilitation services. Community outreach efforts for Cottage Health System in 2011 focused on five health areas: cancer, heart disease and stroke, children's health, seniors' health, along with prevention and wellness. Activities in these areas included screenings and health fairs; classes, clinics, lectures, and seminars; community services; community collaborations; and coalitions/committees. Cottage Health System, which includes Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital, provides critical funding for community health, charity care, and external grants, while also realizing shortfalls in Medicare, Medi-Cal, and indigent care. In 2011, Cottage Health System spent over $120 million on these programs. All patients who do not present third-party insurance are automatically screened for eligibility in government health programs and are assisted in applying for charity if the patient does not qualify for any other assistance. To ensure that every member of the community has access to healthcare Santa Barbara Cottage Hospital offers full charity care to all patients whose income level is at or below 350% of the Federal Poverty Level (FPL). Discounted care is also available for families who make up to 542% of the FPL. The charity care program at Santa Barbara Cottage Hospital is critical to the community as there is no inpatient acute care County Hospital to treat indigent patients who cannot afford care. In 2011, Santa Barbara Cottage Hospital provided free or discounted care to 1,586 patients. 0 0 0 348991372 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 605 0 1 2946 1 1 1 0 0 0 0 0 0 0 0 0 X 19 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 CA X Karen L Jones 8055697224 400 West Pueblo Santa Barbara CA 93105 Steve Ainsley 2 X 0 0 0 J Robert Andrews Esq 3 X 0 0 0 Margaret Baker 2 X 0 0 0 Ed Birch PhD 3 X X 0 0 0 Jon Clark 2 X 0 0 0 Greg Faulkner Esq 2 X 0 0 0 Frederick Gluck 3 X 0 0 0 Judith Hopkinson 2 X 0 0 0 Angel Iscovich MD 3 X 0 0 0 Charles A Jackson 3 X 0 0 0 Alex Koper MD 2 X 21935 3450 0 Jeffrey Kupperman MD 3 X 12513 2500 0 Fred Lukas 2 X 0 0 0 Gretchen Milligan 4 X X 0 0 0 Robert Nakasone 3 X X 0 0 0 Robert Nourse 2 X 0 0 0 Elliot Prager MD 2 X 240231 0 0 John Romo 2 X 0 0 0 Marshall Turner 2 X 0 0 0 Tom Watson MD 2 X 11525 200 0 Ronald C Werft 40 X 0 985900 614404 Steven A Fellows 40 X 0 578747 156703 Joan Bricher 40 X 0 514928 241780 Julie Artoux 40 X 0 119146 16212 David Nichols 40 X 555748 0 32255 Charles Cline 40 X 297555 0 22505 Allan Cohen 40 X 261266 0 22505 Stephen S Kaminski MD 40 X 260816 0 22505 Melinda Staveley 40 X 255840 0 36266 1917429 2204871 1165135 456 0 1 0 COMFORCE PO BOX 31001-0893 PASADENA CA 911100893 CONTRACT LABOR 8483023 MCCARTHY BUILDING COMPANIES 20401 SW BIRCH ST 300 NEWPORT BEACH CA 92660 GENERAL CONTRACTOR 6728471 LEE BURKHART LIU INC 13335 MAXELLA AVENUE MARINA DEL REY CA 90292 ARCHITECT 5556127 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 1786161 JONES DAY 555 CALIFORNIA STREET 26TH FL SAN FRANCISCO CA 94104 LEGAL 1432168 113 0 0 0 113134 375286 1576758 0 2065178 NET PATIENT SERVICE REVENUE 900099 462027706 462027706 0 0 LABORATORY REVENUE 900099 27735645 27735645 0 0 HOSPITAL MEDICAL SUPPLEMENTAL FEE 900099 9967191 9967191 0 0 MEDICAL OFFICE BUILDING RENTAL 900099 873789 873789 0 0 INTERN/RESIDENT AGREEMENT 900099 850216 850216 0 0 0 0 0 0 501454547 9958099 0 974 9957125 0 0 0 0 0 0 0 0 0 0 180263778 0 174952011 0 5311767 0 5311767 0 0 5311767 0 LAB MANAGEMENT 900099 2245820 2245820 0 0 INSURANCE RECOVERIES 900099 2238729 2238729 0 0 CAFETERIA/CAFE/GIFTSHOP/VILLA RIVIERA 900099 1624789 1624789 0 0 3776433 3771389 5044 0 9885771 528675362 511335274 6018 15268892 1263313 1263313 0 0 0 0 0 0 290477 290477 0 0 101173 101173 0 0 155498172 111066910 44431262 0 13870128 9914923 3955205 0 47268773 33863421 13405352 0 12528713 8760468 3768245 0 47887866 18527499 29360367 0 4356485 0 4356485 0 696690 0 696690 0 49769 0 49769 0 0 0 1995181 0 1995181 0 40872248 25302786 15569462 0 209984 76277 133707 0 11478534 4710217 6768317 0 933934 668948 264986 0 0 0 0 0 9534221 6403898 3130323 0 624578 68630 555948 0 0 0 0 0 118600 17246 101354 0 5452267 5448301 3966 0 0 0 0 0 18912586 16488265 2424321 0 3219463 2250893 968570 0 MEDICAL SUPPLIES 89285447 89285447 0 0 HOSPITAL FEE PROGRAM 9517684 9517684 0 0 EQUIPMENT MAINTENANCE 7695839 4751533 2944306 0 LICENSES 647353 136176 511177 0 1097040 76887 1020153 0 485406518 348991372 136415146 0 19745898 6101205 71256985 55850652 0 0 88682093 89088497 250000 250000 0 0 0 0 12082758 11746702 5610808 3785156 851749788 195035306 576302887 656714482 212291737 203339278 86288986 72325748 0 0 9088465 8414319 29805994 23266695 1111406611 1130882734 73921091 67640332 0 0 0 34502 336226732 330237401 0 0 0 0 1629266 0 0 0 69517054 99518014 481294143 497430249 X 616825086 620607477 7693126 7250752 5594256 5594256 630112468 633452485 1111406611 1130882734 X 43268844 -39928827 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 49769 49769 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 LOBBYING ACTIVITIES ARE CALCULATED AS A PERCENTAGE OF DUES PAID TO VARIOUS ORGANIZATIONS. 12120151 0 -100999 0 338496 44354 11636302 11387435 0 1031032 0 269432 28884 12120151 10754765 0 687451 0 25782 28999 11387435 15792105 0 -4904683 0 48477 84180 10754765 0 0.48 0.52 0 1 1 2282992 15913604 18196596 10150023 224011282 117638765 116522540 0 8538692 505275 8033417 0 110687898 75357182 35330716 0 480165297 1534084 478631213 656714482 0 72325748 F 72325748 0 SELF INSURANCE LIABILITY 26907096 RETIREMENT PLAN - SERP 6881 MINIMUM PENSION LIABILITY 33275561 INTEREST RATE SWAP LIBILITY 34790196 PHYSICIAN GUARANTEE 2390437 DUE TO THIRD PARTIES 920345 CONTINGENT PAYMENT MGPL 1227498 99518014 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Endowment funds support specific programs of SBCH. SchD_P10_S00_L01 Schedule D, Part X, Line 1 The System and its affiliates are not-for-profit corporations and are tax-exempt pursuant to Section 501(c)(3) of the Internal Revenue Code and are exempt from income taxation under Section 501(a) of the Code and corresponding provisions of the California Revenue and Taxation Code, except to the extent of income derived from taxable unrelated business activities. Unrelated business income is not material to the financial statements. The System completed an analysis of its tax positions, in accordance with ASC 740 Income Taxes, and determined that there are no uncertain tax positions taken or expected to be taken. The System has recognized no interest or penalties related to uncertain tax positions. The System 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 2008. SchD_P10_S00_L02 Schedule D, Part X, Line 2 The System completed an analysis of its tax positions, in accordance with ASC 740 Income Taxes, and determined that there are no uncertain tax positions taken or expected to be taken. The System has recognized no interest or penalties related to uncertain tax positions. The System 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 2008. 1 1 X 1 X 3.5 1 X 5.42 1 1 1 0 1 1 11046662 11046662 0.02276 71071582 44740899 26330683 0.05424 3579807 1050324 2529483 0.00521 0 0 85698051 45791223 39906828 0.08221 8064678 8064678 0.01661 8425944 5550424 2875520 0.00592 488806 488806 0.00101 133666 133666 0.00028 0 0 17113094 5550424 11562670 0.02382 0 0 102811145 51341647 51469498 0.10603 1 5588936 0 103766996 131960994 -28193998 X 1 1 1 1 Santa Barbara Cottage Hospital

400 West Pueblo Santa Barbara CA 93105

X X X X X Santa Barbara Cottage Hospital and Cottage Rehab Hospital (operating under one license.) Santa Barbara Cottage Hospital 1 0 1 1 350 1 542 1 X X X 1 1 X X 1 0 1 X 0 0 8 Pacific Diagnostic Laboratories

454 South Patterson Goleta CA 93117

Outpatient Lab Services Advanced Imaging Center

2410 Fletcher Street Santa Barbara CA 93105

Outpatient radiology center Cottage Residential Center

312 West Montecito Street Santa Barbara CA 93101

Substance abuse rehabilitation center. SB Cope

2325 De La Vina Street Santa Barbara CA 93105

Substance abuse and detox treatment Outpatient Rehabilitation

1035 Peach Street Suite 203 San Luis Obisop CA 93401

Outpatient clinic Children's Outpatient Specialty Clinics (2)

2329 Oak Park Lane Santa Barbara CA 93105

Outpatient pediatric clinic for hemotology, oncology and gastrointestinal. Pediatric Endocrinology Clinic

427 West Pueblo Santa Barbara CA 93105

Outpatient pediatric endocrineology clinic. SchH_P01_S00_L06a Schedule H, Part I, Line 6a Cottage Health System prepares a Community Benefit Report and files it with the State of California, in compliance with California Senate Bill 697. The Community Benefit Report is available to the public upon request. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Our 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/charge ratio, we have calculated cost/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/charge ratio. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Palliative Care services are provided at no cost to the patient. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 No note in Audited Financial statements regarding bad debt. Bad debt is not included in Community Benefit report. Bad Debt expense is derived from cost to charge ratios. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The hospital provides care to patients whose insurance (Medicare) does not cover the entire cost of their care. The loss on services provided to Medicare recipients represents a significant shortfall for Medicare patients.to the hospital. This provides significant aid to the elderly in the community. The dollars reported are taken from the 2011 Medicare Cost Report and are derived following their guidelines of allowable and non-allowable costs. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b All patients receive 6 statements over 135 days, which include a statement about how to inquire about financial assistance. Patients who are known to qualify for charity care or are in the process of applying for charity care are not sent to collection until a final charity care determination is made. If they qualify, their account is written down to zero. SchH_P05_S0B_L13 Schedule H, Part V, Section B, Line 13 A summary of the policy is posted in admitting offices. The full policy is reported to and available from the OSHPD website. The policy can also be obtained upon request from a Patient Financial Counselor, whose contact information is provided on all billing statements along with a message regarding financial assistance. SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 The maximum that could be charged is based on % of charges that is lower than commercial rates. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Cottage Health System is currently in the process of updating its review of community needs. In its last assessment in 2009, Cottage Health System began an overhaul of its community benefit process and programs. First, Cottage reviewed focus areas of local, state, and national organizations to determine its own focus areas and then next reviewed its internal community outreach programs to ensure they aligned. Cottage Health System reviewed its external community grants process. Funds were shifted from the Foundation to Operations and grant guidelines were developed around the identified focus areas. Both the focus areas and grant program were part of an overall Community Benefit Plan that was approved by the Board of Directors in early 2010. As part of the community benefit review in 2009, Cottage Health System reviewed focus areas of multiple organizations. The Centers for Disease Control and Prevention and The National Health Foundation were reviewed at the national level, and the California Department of Public Health was reviewed at a state level. Locally, four organizations' focus areas and reports were reviewed: Santa Barbara County Public Health Department Status Report 2009, Santa Barbara KIDS Network, United Way of Santa Barbara, and Santa Barbara Neighborhood Clinics. Cottage Health System conducts a regular community perception survey, which includes questions regarding community needs. Cottage Health System also held a brainstorming session with 20 different hospital departments, and the Community Health Coordinating Committee provided input. After reviewing all of the information, Cottage Health System determined the greatest needs to be children's health, seniors' health, cancer, heart disease and stroke, and prevention and wellness. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Cottage Health System has a multi-faceted Financial Assistance Program to ensure that patients who do not have insurance are screened for eligibility in a government-sponsored healthcare plan and receive information about charity care programs. Every patient who does not present the hospital with proof of insurance or existing government support will be given a handout (in English or Spanish) upon registration that is compliant with California Assembly Bill 774 (AB774). The handout contains information about the Hospital's charity care programs. This includes where to obtain applications, income guidelines, other qualification information and contact information for Customer Service and the Admitting department. The Hospital posts information about the charity care program in all registration areas required by AB774. Signs in English and Spanish are located in all areas where patients are registered for inpatient and outpatient services. Signs are also located in the patient billing office and cashier office. Patients will also be contacted by 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 charity care applications to all patients who indicate they have financial need. Santa Barbara Cottage Hospital also works co-operatively with the County of Santa Barbara to provide non-emergency charity care services; this program is known as the Community Service Program. All members of the Community who meet the financial criteria are eligible for the Community Service Program, but must be referred by a physician. When patients who visit the Santa Barbara Public Health Department Clinic have a need for a medically-necessary but non-emergent service, the physicians and Clinic staff inform the patient of the Community Service Program and help the patient to apply. Independent physicians in the Community were made aware of the program and how to access services on behalf of their patients. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Santa Barbara County is situated on the southern coast of California, with Ventura County bordering on the east, San Luis Obispo County on the north, and Kern County on the northeastern corner. Roughly rectangular in shape, the county contains 2,750 square miles of varied terrain. Much of the county is mountainous. The Santa Ynez, San Rafael and Sierra Madre mountains extend in a predominately east-west direction. Within the county, there are numerous fertile agricultural areas, including the Santa Maria, Cuyama, Lompoc, and Santa Ynez Valleys, and the southeast coastal plain. These areas, which include most of the developed land, also accommodate the majority of the population. The Los Padres National Forest, in the eastern part of the county, covers approximately 44 percent of the total county area. The county's 430,200 population is divided into five sub regions: South Coast (205,800); Lompoc Valley (61,200), Santa Maria Valley (137,600); Santa Ynez Valley (24,000); Cuyama (1,500). For people reporting one race, 88.6% are White; 2.4% are Black or African American; 1.7% are American Indian or Alaska Native; 4.5% are Asian; less than 0.3% are Native Hawaiian or Other Pacific Islander, and 2.5% reported 2 or more races. 40.4% are persons of Hispanic or Latino origin. Twenty-one percent of the county's population are foreign-born, and 32.8% of persons over the age of five reported speaking a language other than English at home. 12.7% of county residents live below the poverty level. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Board of Directors is made up of prominent community members who volunteer their time to ensure that the Santa Barbara Community has access to high-quality, affordable healthcare. The Board of Directors is actively involved in the Hospital's strategic decisions and takes its commitment to the Community very seriously. The Board approves of an annual financial budget and ten-year financial plan to guarantee the Hospital will continue to offer hospital services to the Community for years to come. The Board also approves of annual top goals that are consistent with the mission, vision and values of the Hospital. The financial forethought of the Board of Directors resulted in surplus funds that are being used to rebuild the facility. Santa Barbara Cottage Hospital is building a new hospital in order to comply with the unfunded mandate of the State of California's Senate Bill 1953 (SB1953), which requires all hospitals to retrofit or rebuild in order to withstand a major earthquake. The Hospital used this opportunity to live the core value of excellence by ensuring that the new facility will meet the current and future healthcare needs of the Community. This is the largest project in the Hospital's history. As the new facility is built the Hospital continues to evaluate bed allocations in order to ensure that Subacute services continue to be available, determining dedicated pediatric bed needs, and allocating beds by patient care unit based upon projected health needs. Santa Barbara Cottage Hospital works cooperatively with the open medical staff to improve healthcare in the community. The Hospital is exploring how to better align with physicians in order to provide the highest quality of care. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Cottage Health System is the parent organization of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital and Goleta Valley Professional Buildings, Inc. These organizations have a common Board of Directors. Cottage Health System Hospitals are the sole hospital providers in the Community and strategic plans are created with all the Hospitals and their Communities in mind. Santa Barbara Cottage Hospital Foundation provides grants to various organizations to promote healthy living and support nurse-training programs in the Community. Santa Barbara Cottage Hospital is the largest hospital in the system and provides the widest array of services. As such, Santa Barbara Cottage Hospital experiences the largest amount of charity care and Medicaid shortfall from cost. The hospital also provides the majority of community benefit programs, which are reported in the Cottage Health System Community Benefit Report. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Cottage Health System files an annual community benefit report in the State of California. 1 Santa Barbara City College 721 Cliff Drive Santa Barbara CA 93109 953234551 government 360000 Support of the Nursing Department at Santa Barbara City College California State University Channel Islands - Foundation One University Drive Camarillo CA 93012 770433230 government 292000 Support of the BSN program in Santa Barbara. Santa Barbara County Education Office 440 Cathedral Oaks Road Santa Barbara CA 93160 956000940 government 200000 Support of 1) Welcome Every Baby program which supports new parents with education and child development guideance, and 2) Health Linkages program focused on child development and health. University of California Regents University Drive Santa Barbara CA 93106 954377221 government 101524 Support of research programs Casa Esperanza PO Box 24116 Santa Barbara CA 93121 770502754 501(c)3 73166 Casa Esperanza assists homeless individuals and families achieve self-sufficiency, by helping as many as possible access the services they need to transition to stable employment and housing. Carpinteria Unified School District 5201 Eighth Street Carpinteria CA 93013 956101195 government 66518 Funding helps the Carpinteria Children's Project at Main ensure all children entering Kindergarten are healthy, safe and ready to succeed in school with a strong foundation for learning. Sarah House PO Box 20031 Santa Barbara CA 93120 770224415 501(c)3 30000 The grant is used to off-set the end of life care provided to low income patients that transfer from the Hospital to the palliative care facility. Easy Lift Transportation 53 Cass Place Suite D Goleta CA 93117 953642272 501(c)(3) 25000 Funding supports Easy Lift's Dial-A-Ride Program: Individuals that require paratransit services are either physically or cognitively impaired, and cannot feasibly use common types of public transportation such as the bus. Dial-A-Ride allows people to access medical and other service centers essential to their physical and mental health. Visiting Nurse and HOSPICE Care Foundation 222 East Canon Perdido Street Santa Barbara CA 93101 951641969 501(c)3 25000 Supports Alliance for Living and Dying Well. Willbridge of Santa Barbara 1215 East Montecito Street Santa Barbara CA 93130 571194195 501(c)3 20850 The grant supports transitional beds for homeless patients who are not appropriate for discharge to the streets or shelters and who need supervised convalescence. Family Services Agency 123 West Gutierrez Street Santa Barbara CA 93101 951644031 501(c)3 20000 Funding assists frail, isolated and low income seniors maintain independent living, access financial and food assistance, and live safely in their environment. Santa Barbara Public Health Dept 300 North San Antonio Road Santa Barbara CA 93110 956002833 government 20000 Grant funding supports the tatoo removal project. People with anti-social, gang or prison tattoos often encounter negative attitudes, stereotyping, prejudices and discrimination. There is an identified need in our community for a mechanism by which people who are trying to become productive can remove these marks of distinction and the psychological and physical barriers that they carry. In doing so, this will provide them better educational and employment opportunities. Thresholds to Recovery 1038 Pittsfield Lane Ventura CA 93001 770335136 501(c)3 10450 Grant funding provides help to individuals who have been intoxicated in public. The program offers an alternative to incarceration. Program follow-up includes referral for treatment of alcoholism as an effort in recovery. Hospital Hospitality Houses 924 Anacapa Street Suite 1-T Santa Barbara CA 93101 770434600 501(c)(3) 10200 Funding helps provide low cost housing to families of severely ill or injured hospital and extended treatment patients who cannot provide their own lodging. California Retina Research Fund 515 East Micheltorena Santa Barbara CA 93103 542071912 501(3)(c) 5075 Eye research support 15 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 Grant funds are monitored through the Community Health Coordinating Committee of CHS. 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 0 1 0 0 0 0 0 0 0 Elliot Prager MD 236762 0 0 0 3469 0 0 0 4273 0 244504 0 0 0 Ronald C Werft 0 725498 0 249255 0 11147 0 604149 0 10255 0 1600304 0 0 Steven A Fellows 0 423622 0 125335 0 29789 0 146448 0 10255 0 735449 0 0 Joan Bricher 0 409331 0 98073 0 7524 0 231525 0 10255 0 756708 0 0 Stephen S Kaminski MD 260019 0 0 0 796 0 12250 0 10255 0 283320 0 0 0 Charles Cline 297273 0 0 0 282 0 12250 0 10255 0 320060 0 0 0 Allan Cohen 243007 0 14889 0 3369 0 12250 0 10255 0 283770 0 0 0 Melinda Staveley 216036 0 34257 0 5547 0 26011 0 10255 0 292106 0 0 0 David Nichols 124951 0 430797 0 0 0 22000 0 10255 0 588003 0 0 0 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 On an annual basis the Executive Compensation Committee (ECC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the ECC are independent members of the Board of Directors. The ECC engages an independent consultant to prepare comparative compensation reports for each position. The executive's individual performance will also be considered when determining compensation. The ECC recommends compensation for the executives to the full Board for approval. This process takes place annually for all executives. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The amounts reported in the current year's deferred compensation includes recognition of past service. The amounts are subject to a substantial risk of forfeiture. Any amounts paid under this plan in the future will be reported again as reportable compensation in the year paid. California Health Facilities Financing Auhtority 521643828 13033FQT0 2003-11-20 120987862 Refund 1985 issuance and hospital replacement project 0 0 0 California Statewide Communities Development Authority 680164610 130795Y76 2010-10-20 300168359 Refund 2008 issue 0 0 0 0 0 120987862 0 0 20100000 1366915 300700 0 96513947 0 0 2015 1 0 1 1 0 0 300168359 0 0 277300000 2937382 0 19931000 0 277300000 0 2012 1 0 1 1 0 1 0 0 0.0002 0 0.0002 1 0 1 0 0 0.0002 0 0.0002 1 0 1 1 Morgan Stanley 22.0 0 1 0 0 1 1 0 0 0 0 1 X SchK_P04_S00_L03c Schedule K, Part IV, Line 3c In 2010, 2 of the 5 qualified hedges were terminated. Herb Geary Home Purchase X 250000 250000 0 1 1 250000 Santa Barbara Cardiovascular Medical Group Board member is a partner 157486 Medical Professional Fees 0 Jo Ellen watson Wife of Board Member 101173 Salary & Benefits 0 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 J. Robert Andrews and Greg Faulkner; business relationship. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 Cottage Health System is the sole corporate member of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital and Goleta Valley Professional Buildings, Inc. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a Cottage Health System is the sole corporate member of Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, and Goleta Valley Professional Buildings, Inc and can appoint Directors to the Board. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b The Board of Directors for Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, and Goleta Valley Professional Buildings, Inc must obtain prior approval of the Board of Directors for Cottage Health System, in order to: a) amend or restate the Articles of Incorporation or Bylaws; b) implement the annual budget and long-term capital and operational budget; c) sell, lease, mortgage, pledge, merge, consolidate or make any other disposition of any material part of the property and assets of this corporation; or d) voluntarily dissolve the corporation. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Form 990 is prepared under the direction of the Vice President of Finance and CFO. Form 990 is reviewed by VP Finance, CFO and independent tax consultants prior to submitting to the Audit and Compliance Committee. All members of the Board receive a copy of the organization's form 990 for review prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The purpose of the Conflict of Interest policy is to protect the interest of the Hospital when it contemplates entering into a transaction or arrangement that could benefit the private interest of a Director or Officer of Cottage Health System, Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, Santa Ynez Valley Cottage Hospital, Santa Barbara Cottage Hospital Foundation and Goleta Valley Professional Buildings, Inc., collectively known as Cottage Health System. The Cottage Health System Directors have a duty to: 1.) discharge their duties to benefit the Cottage Health System and not the Directors personally 2.) disclose situations with the potential for conflict of interest with the vision and mission of Cottage Health System 3.) refrain from discussing confidential Cottage Health System business with others. Each Board member and officer will annually complete the Cottage Health System Directors Annual Conflict Disclosure Form. The Disclosure information will be reviewed annually by the Board Chair and the results reported to the full Board. Each Director or Officer will disclose to the Board Chair for items to be discussed at a Board meeting. If there are any material financial or personal interests a Board member/family member may have in a Board decision, the Director or Officer will disclose this to the Committee Chair for items to be discussed at Board Committees, before the Board reviews the transaction and takes action. In general, an Officer who had 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's 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 all other employees of Cottage Health System and sign an annual conflict of interest form. These forms are reviewed by Compliance and any issues are brought to the Chief Compliance Officer. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 On an annual basis the Executive Compensation Committee (ECC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the ECC are independent members of the Board of Directors. The ECC engages an independent consultant to prepare comparative compensation reports for each position. The executive's individual performance will also be considered when determining compensation. The ECC recommends compensation for the executives to the full Board for approval. This process takes place annually for all executives. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Governing documents can be obtained upon request from the Assistant Secretary of the Board. Tax filings can be obtained upon request from the CFO. Audited Financial Statements are attached to the Form 990 in accordance with IRS instructions. F990_P11_S00_L05 Form 990, Part XI, Line 5 UNREALIZED GAINS/LOSSES ON INVESTMENTS - ($13,022,878); CHANGE IN EQUITY INTEREST IN ALTERNATIVE INVESTMENTS - ($3,000,219); CHANGE IN FV INTEREST RATE SWAPS - ($11,846,126); UNREALIZED GAINS/LOSSES ON RESTRICTED CONTRIBUTIONS - ($626,092); CHANGE IN PENSION LIABILITY - ($11,399,012); DEFERRED REVENUE RECORDED ON PART VIII - ($34,500) Pacific Diagnostic Laboratories LLC PO Box 689 Santa Barbara CA 93102 205038438 Outpatient laboratory services CA 29987483 25467648 SANTA BARBARA COTTAGE HOSPITAL Cottage Health System PO Box 689 Santa Barbara CA 931020689 770431902 Parent organization for 3 hospitals and medical professional building CA 501 (C) (3) 11b-II N/A 0 Goleta Valley Cottage Hospital PO Box 689 Santa Barbara CA 931020689 952413596 Hospital CA 501 (C) (3) 3 Cottage Health System 1 Santa Ynez Valley Cottage Hospital Inc PO Box 689 Santa Barbara CA 931020689 952224265 Hospital CA 501 (C) (3) 3 Cottage Health System 1 Santa Barbara Cottage Hospital Foundation PO Box 689 Santa Barbara CA 931020689 953802238 Foundation to support Santa Barbara Cottage Hospital CA 501 (C) (3) 7 Santa Barbara Cottage Hospital 1 Goleta Valley Professional Blds PO Box 689 Santa Barbara CA 931020689 770004202 Medical Prof Bldg CA 501 (C) (3) 11b-II Cottage Health System 1 RISB Foundation 2415 De La Vina St Santa Barbara CA 931023819 260433816 Fundraising CA 501(c)(3) 7 N/A Villa Riviera Real Estate Company Inc PO Box 689 Santa Barbara CA 93102 272996284 Workforce housing developer CA SBCHF C 0 39324510 1 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 Santa Barbara Cottage Hospital Foundation q 212496 accrual Santa Barbara Cottage Hospital Foundation r 335538 accrual Santa Barbara Cottage Hospital Foundation i 235488 accrual Goleta Valley Cottage Hospital m 123720 accrual Goleta Valley Cottage Hospital n 2852230 accrual Santa Ynez Valley Cottage Hospital Inc n 809877 accrual Santa Barbara Cottage Hospital Foundation o 88766 accrual Santa Ynez Valley Cottage Hospital Inc o 60438 accrual Santa Barbara Cottage Hospital Foundation p 214017 accrual Goleta Valley Cottage Hospital p 37127676 accrual Goleta Valley Professional Blds p 417814 cash Santa Ynez Valley Cottage Hospital Inc q 2099391 cash Goleta Valley Cottage Hospital q 741901 accrual Goleta Valley Cottage Hospital r 1364117 cash Santa Ynez Valley Cottage Hospital Inc r 256493 cash RISB Foundation c 174610 accrual