2023-11-10T12:30:13+00:00 2022-12-31 990 2022-01-01 952224265 Santa Ynez Valley Cottage Hospital Inc SANT 8052876903 PO BOX 689 Attn Finance Dept Santa Barbara CA 931020689 Kristin Tufvesson Sr VP Finance and CFO 2023-11-10 Kristin Tufvesson 999009999 2022 2023-04-26 12:10:37Z Ronald Werft PO BOX 689 Attn Finance Dept Santa Barbara CA 931020689 36970430 false X http://www.cottagehealth.org/santa-ynez-valley-cottage-hospital/ X 1962 CA It is the mission of Santa Ynez Valley Cottage Hospital (SYVCH) 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. SYVCH is a rural hospital and is designated a critical access hospital. The hospital provides critical emergency services which allow for local stabilization of the patient and transfer to an affiliated hospital that provides a higher level of care. 17 17 128 55 0 0 952730 1844655 25555602 24726522 2925183 2075810 329671 745155 29763186 29392142 167400 987295 0 0 13017564 13466427 0 0 0 8652733 8395224 21837697 22848946 7925489 6543196 74157281 76049535 3190115 3659774 70967166 72389761 It is the mission of Santa Ynez Valley Cottage Hospital (SYVCH) 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. SYVCH is a rural hospital and is designated a critical access hospital. The hospital provides critical emergency services which allow for local stabilization of the patient and transfer to an affiliated hospital that provides a higher level of care. false false 19965948 897295 25411668 Santa Ynez Valley Cottage Hospital is a 11-bed acute-care hospital located in the rural area known as the Santa Ynez Valley. In 2022, the Hospital had 308 patient days, served 29,793 outpatients including emergency services to 9,417 patients. The Hospital provided essential emergency treatment, inpatient acute care, outpatient surgical services, imaging diagnostic services, infusion services and cardiac rehabilitation services to the residents of the Santa Ynez Valley, including the communities of Solvang, Buellton, Santa Ynez, Los Olivos, and Ballard. Santa Ynez Valley Cottage Hospital provides emergency services to anyone seeking care, regardless of their ability to pay. The hospital is diligent in ensuring that all patients have adequate access to care. 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. Santa Ynez Valley Cottage Hospital provides critical funding for community health and education with external grants, while also realizing shortfalls Medi-Cal and indigent care. External grants were provided which aimed at specific community needs for at risk populations (indigent; substance abuse recovery; elderly; family counseling). In addition, the hospital provides support of nursing education, provides low cost exercise program for seniors, supports a local health fair and the provision of flu shots to the community. In 2022 the hospital spent over $2.9 million on these programs. 19965948 true true false true false false false false false true true false true true true false true false false false false false false false false true true true true true false false false false false false true false false false false false false true true true false false true 35 0 true 128 true false false false false false false false false false false false false X 17 17 false false false false true true true true true false false true true true true true true true true false CA X Kristin Tufvesson 8053249933 400 West Pueblo Santa Barbara CA 93105 Dorothy Largay PhD Vice Chair 0.3 5.7 X X 0 0 0 Edward Bentley MD Secretary (Part Year) 0.3 2.7 X X 0 0 0 Gregory Faulkner Chair (Part Year) 0.3 4.7 X X 0 0 0 Richard Ponce MD Secretary 0.3 4.7 X X 0 0 0 Steven Zola Board Chair 1.0 19.0 X X 0 0 0 Susan Christol-Deacon Vice Chair 0.3 5.7 X X 0 0 0 Thomas Cusack Vice Chair 0.3 5.7 X X 0 0 0 Bhupi Singh Board Member 0.2 3.8 X 0 0 0 Ernesto Paredes Board Member 0.2 3.8 X 0 0 0 Gamble Parks ATTY Board Member 0.2 3.8 X 0 0 0 Mark Scott MD Board Member 0.2 3.8 X 0 0 0 Nancy Nielsen Board Member 0.2 3.8 X 0 0 0 Pamela Gann Board Member 0.3 4.7 X 0 0 0 Roberta Griffin Board Member 0.2 3.8 X 0 0 0 Robin Malone MD Board Member 0.2 3.8 X 0 0 0 Steve Ortiz Board Member 0.2 3.8 X 0 0 0 Virginia Salazar Board Member 0.2 3.8 X 0 0 0 Wesley Schooler MD Board Member 0.2 3.8 X 0 0 0 Yulun Wang PhD Board Member 0.2 3.8 X 0 0 0 Brett Tande Senior VP and CFO (Part Year) 3.0 52.0 X 0 453374 37556 Kristin Tufvesson Senior VP and CFO 3.0 52.0 X 0 614726 92852 Lisa Moore Executive VP and COO 3.0 52.0 X 0 1049601 162968 Ronald Werft President & CEO 3.0 62.0 X 0 1816036 83953 CHRISTINE PIMNETEL Manager Clinical SYVCH 40.0 0 X 208622 0 40709 KATIE GORNDT VP OF SYVCH 40.0 0 X 296542 0 91740 NATHAN HALL Manager Radiology-SYVCH 40.0 0 X 165240 0 39277 DEBORAH ECKLES Clinical Resource Nurse 40.0 0 X 161394 0 28650 PABLO ROJAS Physician Assistant - Clinic 40.0 0 X 161498 0 44801 RICARDO GONZALEZ MENCHACA RT 3 Radiographer 40.0 0 X 196195 0 40243 ROGER LANE Internal Medicine Physician 40.0 0 X 331360 0 52197 THOMAS WATSON Cardiac Clinic Physician 40.0 0 X 369487 0 61381 1890338 3933737 776327 0 false true false Arndt Construction 1306 Santa Barbara St Santa Barbara CA 93101 Construction contractor 3678326 19SIX ARCHITECTS 560 HIGUERA ST Suite C SAN LUIS OBISPO CA 93401 Architectural Services 246702 19SIX ARCHITECTS 560 HIGUERA STREET SAN LUIS OBISPO CA 93401 Architectural services 246702 JUSTICE WILLIAM 386 LA SALLE CANYON RD LOMPOC CA 93436 Inspection Services 198040 SOLVANG LUTHERAN HOME INC ATTERDAG VILLAGE OF SOLVANG 636 ATTERDAG ROAD SOLVANG CA 93463 Food services 137319 7 0 0 0 0 955451 889204 0 1844655 Net patient revenue 622110 23893344 23893344 0 0 Hosp M-Cal supplemental payments 622110 833178 833178 0 0 0 0 0 0 24726522 499148 0 0 499148 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9154950 7578288 1576662 0 1576662 1576662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Legal Settlement 900099 390697 390697 0 0 Management Services 900099 216743 216743 0 0 Thrift Shop Services 453310 60009 60009 77706 77706 0 0 745155 29392142 25411668 0 2135819 X 960295 960295 27000 27000 0 0 0 0 842130 453848 388282 0 26685 26685 0 0 8622203 8050960 571243 0 224829 230364 -5535 0 3122558 2314722 807836 0 628022 586694 41328 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 143729 0 143729 0 3127908 2729920 397988 0 11096 11096 0 0 245828 220251 25577 0 378641 240643 137998 0 0 0 0 0 748974 622022 126952 0 16755 8464 8291 0 0 0 0 0 6500 4000 2500 0 4754 2955 1799 0 0 0 0 0 1137505 963365 174140 0 173929 153905 20024 0 MEDICAL SUPPLIES 1766449 1765083 1366 0 EQUIP MAINTENANCE 597786 578808 18978 0 Construction Expenses 17259 0 17259 0 Licenses, fees, property taxes 13397 10225 3172 0 4714 4643 71 0 22848946 19965948 2882998 0 7853157 2261081 3140533 290688 0 0 1922813 2178925 0 0 0 0 0 0 173901 174795 52574 56188 42531709 15478570 22478011 27053139 22415551 23196808 11866810 14962012 0 0 0 4253931 5875899 74157281 76049535 2283519 2765260 0 0 0 3846 0 0 0 0 0 0 0 0 0 0 906596 890668 3190115 3659774 X 70554191 71939032 412975 450729 0 0 0 0 0 0 70967166 72389761 74157281 76049535 X 6543196 -7189171 0 0 2068570 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 13917 13917 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. 0 22582 22582 0 19111744 7194734 11917010 0 0 0 0 0 9563884 7568491 1995393 0 13833499 715345 13118154 27053139 Alternative Investments 14962012 F 14962012 Medicare and Medi-Cal Reserves 1043585 Prepaid Pension Benefits 4083114 Operating Leases Right of Use Asset 212965 All other assets 536235 5875899 SELF INSURANCE LIABILITY 677702 Lease liabilities 212966 890668 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Cottage completed an analysis of its tax positions, in accordance with ASC 740, 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 2019. true true X true X 500 true X 699 true true false true true 518629 518629 0.0227 2500370 1521923 978447 0.0428 0 0.0 0 0 3018999 1521923 1497076 0.0655 199066 15251 183815 0.0080 89105 0 89105 0.0039 359240 116937 242303 0.0106 0 0 0 0.0 915362 0 915362 0.0401 0 0 1562773 132188 1430585 0.0626 0 0 4581772 1654111 2927661 0.1281 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 0 0 9052815 8585804 467011 X true true 1 1 Santa Ynez Valley Cottage Hospital 2050 Viborg Road Solvang CA 93463 https://www.cottagehealth.org/santa-ynez-valley-cottage-hospital 050000057 X X X X Santa Ynez Valley Cottage Hospital 1 false false true X X X X X X X X X 22 true true false true X https://www.cottagehealth.org/about/community-benefit/ X X true 23 true https://www.cottagehealth.org/about/community-benefit/ false true X 500.0 699.0 X X X X true true X X X X true X https://www.cottagehealth.org/billing/financial-assistance/ X https://www.cottagehealth.org/billing/financial-assistance/ X https://www.cottagehealth.org/billing/financial-assistance/ X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E In the most recent Community Health Needs Assessment (CHNA), six areas emerged as priority health areas in Santa Barbara County: Access to Care, Behavioral Health, Chronic Conditions, Maternal Care, Resiliency and Social Needs. In addition, we identified injury and violence as a health priority base on our emergency and trauma departments. These identified needs have guided Cottage Health's direct funding provided to local agencies. In addition, our population health department seeks to align with broader initiatives in the community which are addressing these identified needs. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Santa Ynez Valley Cottage Hospital. As part of this Community Health Needs Assessment (CHNA), a web-based and telephone survey was conducted with approximately 1600 randomly selected Santa Barbara County residents, including oversampling of lower-income areas. In addition, a listening tour occurred consisting of focus groups and interviews with more than 200 individuals representing the broad interests of the community, including medically underserved, low-income, and vulnerable populations. Cottage Health contracted with the University of Pittsburgh who has extensive experience in survey methodology, analysis and reporting. The questionnaire was created from CDC's Behavioral Risk Factor Surveillance System (BRFSS) and other leading surveys and questionnaires carefully selected to provide count-level information. It was administered in both English and Spanish. In addition the CHNA utilized existing health and demographic data already collected for the county and California (such as U.S. Census data). Input was gathered from representatives of local government, public health, health systems and organizations working with low-income, minority (including Hispanic/Latinx/Mixtec, Native American, Asian, Africa American), or other medically underserved populations experiencing health disparities (including young adults, elderly, veterans, disabled, lesbian/gay/bisexual/transgender (LGBT), homeless, mentally ill, undocumented, uninsured/underinsured, and Medi-Cal/Medicare recipient populations. Final participation included representatives of approximately 90 local organizations, some of which are: Santa Barbara County Department of Behavioral Wellness, CALM, Family Service Agency, Housing Authority of the City of Santa Barbara, Pacific Pride Foundation, Santa Barbara County Education Office, Santa Barbara Neighborhood Clinics, YouthWell Coalition, Cottage Health Psychiatry and Addition Services, CenCal Health, Domestic Violence Solutions, University of California, Santa Ynez Tribal Health Clinic, People's Self Help Housing, Transition House, and Council on Alcohol and Drug Abuse. Secondary data sources included data from the US Census Bureau, US Department of Education, US Department of Agriculture, US Department of Health and Human Services, Centers for Disease Control and Prevention, State Cancer Profiles, and Nielsen Site Reports. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Santa Ynez 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 - Santa Ynez 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 - Santa Ynez 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. Seventeen leading health indicators identified in the 2022 CHNA were grouped into six priority areas: (1) access to care; (2) behavioral health (3) chronic conditions; (4) maternal health; (5) resiliency; and (6) social needs (including food and housing insecurity). In addition, Cottage Health has identified injury and violence as a priority based on Emergency Department and trauma registry reporting. The four indicators not prioritized and addressed are: (1) smoking cigarettes (2) binge drinking (3) physical inactivity and (4) obesity. 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 smoking cigarettes, binge drinking, physical activity and obesity. 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 Santa Ynez Valley Cottage Hospital's grants, its hospital programs and health fairs. In addition, Santa Ynez Valley Cottage Hospital provides grants to support Health Professional Education. Schedule H, Part V, Section B, Line 15 Facility , 1 Facility , 1 - Santa Ynez 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. 0 Schedule H, Part I, Line 6b Availability of Community Benefit Report 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 Cottage web site: https://www.cottagehealth.org/about/community-benefit/ and the California CHHS web site: https://data.chhs.ca.gov/dataset/community-benefit-plans Schedule H, Part I, Line 3c Other Financial Assistance Factors Santa Ynez 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. A presumptive FPG is also utilized to write off balances for patients who have a presumptive score of 500% of FPG or lower. A presumptive FPG up to 699% will receive a sliding scale discount. Assets are considered for certain patients who exceed FPG levels but who have high medical debt. Patients who were determined to be homeless also qualify for free care, assuming they did not qualify for other insurance programs. Schedule H, Part V, Section B, Line 16 FAP Languages THE FAP IS AVAILABLE IN ENGLISH, TAGALOG, MANDARIN AND SPANISH AT THE WEBSITE NOTATED IN 16 A AND 16 B. Schedule H, Part I, Line 6a Community benefit report prepared by related organization Cottage Health Schedule H, Part I, Line 7g Subsidized Health Services The hospital provides subsidized health care via a cardiac rehabilitation program. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Direct costs are calculated at the providing department level and overhead costs are allocated according to the Medicare step-down method, based upon applicable statistics. Each payer's cost is determined by the services provided to their members. The community benefits amount attributable to Medicaid and other Government programs are based upon the services provided and resulting costs incurred for their inpatients, outpatients and emergency department visits. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE HOSPITAL ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ACCOUNTING STANDARDS UPDATE 2014-09 TOPIC 606 (ASU 606) EFFECTIVE JANUARY 1, 2018. ASU 606 AND THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) DIFFERENTIATE BAD DEBT FROM IMPLICIT PRICE CONSESSIONS. THE HOSPITAL MAKES A DETERMINATION REGARDING A PRICE CONCESSION TO STANDARD PRICING ON A PORTFOLIO BASIS PRIOR TO ASSESSING THE CREDIT RISK OF INDIVIDUALS WITHIN THE PORTFOLIO. PATIENT SERVICE REVENUE IS RECORDED NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS, INCLUDING AN ESTIMATE FOR IMPLICIT PRICE CONCESSIONS. BAD DEBT IS RECORDED AS AN OPERATING EXPENSE AND RESULTS WHEN A PATIENT, DETERMINED TO HAVE THE FINANCIAL CAPACITY TO PAY FOR HEALTHCARE SERVICES, IS UNWILLING TO DO SO. FOR THE TAX YEAR ENDED DECEMBER 31, 2022, THE HOSPITAL MADE NO SUCH DETERMINATION, AND THEREFORE RECORDED NO BAD DEBT EXPENSE. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE HOSPITAL DID NOT RECORD ANY BAD DEBT EXPENSE IN 2022, THEREFORE THERE IS NO REFERENCE TO BAD DEBT EXPENSE IN THE FOOTNOTES TO THE FINANCIAL STATEMENTS. SEE SUPPLEMENTAL INFORMATION FOR H PART III LINE 2 FOR ADDITIONAL INFORMATION. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Santa Ynez Valley Cottage Hospital is designated a critical access hospital (CAH) and did not experience an overall shortfall from allowable costs in 2022. The overall surplus has been adjusted up by $215,550 of Medicare shortfall included in the Community Benefit analysis of the Cardiac Clinic losses in H-I-7g. 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 180 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, sending text messages, and sending e-mail messages. If a patient qualifies for FAP, we will not do any collection activities. Schedule H, Part V, Section B, Line 16a FAP website - Santa Ynez Valley Cottage Hospital: Line 16a URL: https://www.cottagehealth.org/billing/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website - Santa Ynez Valley Cottage Hospital: Line 16b URL: https://www.cottagehealth.org/billing/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Santa Ynez Valley Cottage Hospital: Line 16c URL: https://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, Maternal health, and social needs (including food 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 2022, Cottage Health spent over $225 million on these programs. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance COTTAGE HEALTH HAS A MULTIFACETED FINANCIAL ASSISTANCE PROGRAM (FAP) TO ENSURE THAT ALL PATIENTS RECEIVE INFORMATION ABOUT OUR FAP, AND PATIENTS WHO DO NOT HAVE INSURANCE ARE SCREENED FOR ELIGIBILITY IN A GOVERNMENT SPONSORED HEALTHCARE PLAN. THE HOSPITAL POSTS INFORMATION ABOUT THE FAP IN ALL REGISTRATION AREAS. SIGNS ARE IN ENGLISH, AND SPANISH AND 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. PAPER COPIES ARE PROVIDED TO PATIENTS WHO SPEAK TAGALOG or MANDARIN. 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 a plain language summary (PLS) of the FAP APPLICATIONS TO ALL PATIENTS. Additionally, each patient is provided with information regarding the FAP on their billing statement, and each billing statement is accompanied by the PLS. 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 446,000 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 34.6 years. The population age breakdown is: 27.5% under 20 years old; 56.4% are 20 to 64 years old and 16.1% are 65 and older. For people reporting one race, 42.7% are White; 47.2% are Hispanic; 2.4% are Black or African American; 5.9% are Asian; and 4.2% are Other/Multi-Racial. 9% 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 community members who volunteer their time to ensure the Santa Ynez Valley community has access to high-quality, affordable healthcare. The Board is actively involved in the hospital's strategic decisions. It approves of an annual budget and a 10-year financial plan ensuring the hospital continues to offer healthcare services to the community for years to come. The Board also approves of annual strategic goals consistent with the mission, vision and values of Cottage Health. The financial forethought of the Board of Directors resulted in surplus funds that were used to rebuild the facility. Santa Ynez Valley Cottage Hospital has completed its renovation and rebuilding, which complies with the State of California's Senate Bill 1953 (SB1953) requiring all hospitals to retrofit or rebuild in order to withstand a major earthquake. Santa Ynez Valley Cottage Hospital works collaboratively with its medical staff to improve health in the community and respond to current and future health needs. Each year, Santa Ynez Valley Cottage Hospital offers a community health fair, including free flu vaccine for the community. Pandemic response included serving as a vaccination and testing site. The hospital also offers community CPR and nutrition classes to promote safety and wellness. Schedule H, Part VI, Line 6 Affiliated health care system Cottage Health 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. 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 financial assistance and Medicaid shortfall from cost. The hospital also provides the majority of community benefit programs, which are reported in the Cottage Health Community Benefit Report. In addition, Santa Barbara Cottage Hospital Foundation provides grants to various organizations to promote healthy living and support nurse-training programs in the Community. Schedule H, Part VI, Line 7 State filing of community benefit report CA true Cottage Clinical Network 400 WEST PUEBLO STREET Santa Barbara CA 93105 843321175 860000 Support of clinics throughout the Santa Barbara County which provide access to care for individuals with no PCP COUNCIL ON ALCOHOLISM & DRUG PO BOX 28 Santa Barbara CA 93101 951878858 501(c)(3) 50000 Provide parenting education programs that will support parents of children and adolescents with culturally relevant parenting skills training. Santa Barbara City College 721 Cliff Drive Santa Barbara CA 93109 770070782 government 28025 Support of Nursing Program at Santa Barbara City College CSUCI FOUNDATION One University Drive Camarillo CA 93012 770433230 501(c)(3) 19864 Support of the Bachelor's in Science, Nursing program in Santa Barbara 3 1 NURSING SCHOLARSHIPS 9 27000 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. Scholarship applications are reviewed by representatives from nursing and Human Resources. After recipients are identified, the organization verified the student has enrolled and paid for the semester. Funds are disbursed post verification. X X X X false true false false false false false true false Ronald Werft President & CEO 0 1271673 0 485529 0 58834 0 60942 0 23011 0 1899989 0 0 Lisa Moore Executive VP and COO 0 697747 0 228504 0 123350 0 144154 0 18814 0 1212569 0 54653 Kristin Tufvesson Senior VP and CFO 0 430897 0 78804 0 105025 0 61750 0 31102 0 707578 0 0 Brett Tande Senior VP and CFO (Part Year) 0 157746 0 202386 0 93242 0 30083 0 7473 0 490930 0 0 KATIE GORNDT VP OF SYVCH 231966 0 58688 0 5888 0 80222 0 11518 0 388282 0 0 0 CHRISTINE PIMNETEL Manager Clinical SYVCH 170629 0 15667 0 22326 0 18100 0 22609 0 249331 0 0 0 NATHAN HALL Manager Radiology-SYVCH 150776 0 12718 0 1746 0 8175 0 31102 0 204517 0 0 0 THOMAS WATSON Cardiac Clinic Physician 359903 0 0 0 9584 0 42250 0 19131 0 430868 0 0 0 ROGER LANE Internal Medicine Physician 321529 0 0 0 9831 0 42250 0 9947 0 383557 0 0 0 RICARDO GONZALEZ MENCHACA RT 3 Radiographer 182812 0 0 0 13383 0 9141 0 31102 0 236438 0 0 0 PABLO ROJAS Physician Assistant - Clinic 161064 0 0 0 434 0 12919 0 31882 0 206299 0 0 0 DEBORAH ECKLES Clinical Resource Nurse 142661 0 0 0 18733 0 15585 0 13065 0 190044 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 9.8% 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 ORGANIZATION 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 ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. DEFERRED CONTRIBUTIONS TO THIS PLAN WILL BE REPORTED AGAIN AS REPORTABLE COMPENSATION IN THE YEAR PAID. IN 2022, there was a RECIPIENT PAYOUT FROM THE 457(F) PLAN to Lisa Moore ($54,653). Schedule J, Part I, Line 7 Non-fixed payments Each year the Board of Directors determines if a bonus can be paid based on the financial operating results of the completed year. The Board determines the total amount of the bonus pool. This pool of money is distributed to employees in the management team based on the individual's achievement of personal goals and the overall team's accomplishment of system-wide goals pertaining to quality, service excellence, employee engagement, financial or other. The payout for individuals is calculated based on percentages of their base salary and their position. TERESA BENTLEY WIFE OF BOARD MEMBER 26685 EMPLOYEE false 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. Form 990 is reviewed separately by Ernst & Young as an independent tax consultant to Cottage during the development of the response. 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 Cottage Health 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 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 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 Compensation Committee (CC) of the Board of Directors meets to determine appropriate compensation for executives, including the CEO, COO, CFO, and vice presidents. All members of the CC are independent members of the Board of Directors. The CC 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 CC 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 25, 2022. 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 and conflict of interest policies are not available to the public. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Corporate Allocation - Total Revenue: 44003, Related or Exempt Function Revenue: 44003, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Other Revenues - Total Revenue: 18588, Related or Exempt Function Revenue: 18588, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Population Health - Total Revenue: 15251, Related or Exempt Function Revenue: 15251, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Miscellaneous - Total Revenue: -136, Related or Exempt Function Revenue: -136, 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: 1575766, Program Service Expense: 1575766, Management and General Expenses: 0, Fundraising Expenses: 0; Other-Purchased Services - Total Expense: 696765, Program Service Expense: 482605, Management and General Expenses: 214160, Fundraising Expenses: 0; Other-Professional Fees - Total Expense: 502654, Program Service Expense: 438982, Management and General Expenses: 63672, Fundraising Expenses: 0; Corporate-Supplies and Services - Total Expense: 339927, Program Service Expense: 229086, Management and General Expenses: 110841, Fundraising Expenses: 0; Consulting Fees - Total Expense: 9315, Program Service Expense: 0, Management and General Expenses: 9315, Fundraising Expenses: 0; Cleaning - Total Expense: 1985, Program Service Expense: 1985, Management and General Expenses: 0, Fundraising Expenses: 0; Other-Contract Labor - Total Expense: 1496, Program Service Expense: 1496, Management and General Expenses: 0, Fundraising Expenses: 0; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Change in pension liability - 2068570; GOLETA VALLEY COTTAGE HOSPITAL PO BOX 689 SANTA BARBARA CA 931020689 952413596 HOSPITAL CA 501(c)(3) 3 COTTAGE HEALTH true SANTA BARBARA COTTAGE HOSPITAL PO BOX 689 SANTA BARBARA CA 931020689 951644629 HOSPITAL CA 501(c)(3) 3 COTTAGE HEALTH true GOLETA VALLEY PROFESSIONAL BUILDINGS INC PO BOX 689 SANTA BARBARA CA 931020689 770004202 MEDICAL PROF BUILDINGS CA 501(c)(3) Type II COTTAGE HEALTH true Cottage Health PO Box 689 Santa Barbara CA 93102 770431902 Parent Organization for 3 Hospitals & Medical Prof. Bldg. CA 501(c)(3) Type II NA false Santa Barbara Cottage Hospital Foundation PO Box 689 Santa Barbara CA 93102 953802238 Fundraising CA 501(c)(3) 7 Cottage Health true Villa Riviera Real Estate Company PO Box 689 Santa Barbara CA 93102 272996284 Workforce Housing Development CA SB Cottage Hosp Fndtn C Corporation 0 0 0 true false false false false false false false false false false true true true true true true true false false Santa Barbara Cottage Hospital M 1550166 accrual Santa Barbara Cottage Hospital O 1509644 accrual Santa Barbara Cottage Hospital P 76309 accrual Goleta Valley Professional Buildings K 106994