Community Benefit Insight - Tax-exempt hospital

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Santa Ynez Valley Cottage Hospital Inc

Santa Ynez Valley Cottage Hospital

2050 Viborg Road
Solvang, CA 93463

Bed count	11	Medicare provider number	051331	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 952224265

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

11.23%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 536,371 2.46 %
Medicaid as % of operating expenses	$ 435,015 1.99 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 61,467 0.28 %
Subsidized health services as % of operating expenses	$ 258,752 1.18 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 1,045,791 4.79 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 114,374 0.52 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	NO
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 0 0 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 18719512 including grants of $ 167400) (Revenue $ 25799789)
Santa Ynez Valley Cottage Hospital is a 11-bed acute-care hospital located in the rural area known as the Santa Ynez Valley. In 2020, the Hospital had 378 patient days, served 22,167 outpatients including emergency services to 8,341 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; COVID education). 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 2021, as a result of the Covid outbreak, the hospital was an active partner in addressing anticipated needs of the community such as vaccinations and testing, shifting personnel and resources, to ensure availability of area hospital accommodations , and educating the community. In 2021 the hospital spent over $2.4 million on these programs.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Schedule H, Part V, Section B, Line 3E
In the most recent Community Health Needs Assessment (CHNA), five areas emerged as priority health areas in Santa Barbara County: Access to Care, Behavioral Health, Chronic Conditions, 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, a telephone survey was done with approximately 900 randomly selected Santa Barbara County residents, targeting oversampling of lower-income areas. Also a listening tour with more than 240 individuals was conducted in July through October 2019. The listening tour participants included individuals who represented the broad interests of the community, including medically underserved, low-income, and vulnerable populations. Cottage Health contracted with the Evaluation Institute at 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 Institute 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 officials, public health, Cottage employees and individuals whose organizations work 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, disables, lesbian/gay/bisexual/transgender (LGBT), homeless, mentally ill, undocumented, uninsured/underinsured, or Medi-Cal/Medicare recipient populations. Final participation included representatives of over 60 local organizations, some of which are: Mental Wellness Center, Santa Barbara County Department of Behavioral Wellness, Child Abuse Listening Medication (CALM), Doctors Without Walls of Santa Barbara, Family Service Agency, Housing Authority of Santa Barbara, Pacific Pride Foundation, Santa Barbara County Education Office, Santa Barbara Neighborhood Clinics, YouthWell Coalition, Cottage Health Psychiatry and Addition Services, Behavioral Wellness Crisis Services, CenCal Health, Devereaux California, Domestic Violence Solutions, Good Samaritan Shelter, University of California, Isla Vista Youth Projects, New Beginnings Counseling Center, Santa Barbara County Psychiatric Health Facility (PHF), Santa Ynez Tribal Health Clinic, PATH Santa Barbara, People's Self Help Housing, Santa Barbara Rescue Mission, Transition House, Willbridge, United Way, and Council on Alcohol and Drug Abuse. 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 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. Five of the 19 leading health indicators identified in the 2019 CHNA all but three fall into the five priority areas: (1) access to care; (2) behavioral health (3) chronic conditions; (4) resiliency; and (5) 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 three indicators not prioritized and addressed are: (1) smoking cigarettes (2) binge drinking and (3) 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 smoking cigarettes, binge drinking, 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 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.

Supplemental Information

Schedule H (Form 990) Part VI

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 400% of FPG or lower. A presumptive FPG up to 599% 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 b.

Schedule H, Part I, Line 7e Covid impact on Community Benefit
Due to the COVID pandemic, Cottage had a net cost impact for the benefit of the community in excess of $9.3 million, spread over the three hospitals: Santa Barbara Cottage Hospital ($5.5 million), Goleta Valley Cottage Hospital ($2.8 million) and Santa Ynez Valley Cottage Hospital ($1 million). This amount is net of estimated future FEMA reimbursements. Costs include executive time spent planning for the public health emergency, additional medical professional fees related to infectious disease control, disaster readiness and response, excess staffing to accommodate COVID units, and supplies and emergency equipment to respond to the health emergency. In addition, Cottage took the lead in coordinating with public health officials to educate the public, at large, on the developing crisis. This included creation of broadcasts for the general public, on the status of the virus nationally and within our community. These broadcasts also educated our community on the current guidelines as they evolved.

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 amounts 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, 2021, THE HOSPITAL MADE NO SUCH DETERMINATION, AND THEREFORE RECORDED NO BAD DEBT EXPENSE.

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 2021. The overall surplus has been adjusted up by $241,437 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 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. If a patient qualifies for FAP, Cottage Health 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, 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 2021, Cottage Health spent over $190 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 years. The population age breakdown is: 27.3% under 20 years old; 57.4% are 20 to 64 years old and 15.3% are 65 and older. For people reporting one race, 43.9% are White; 45.8% are Hispanic; 2.0% are Black or African American; 5.3% are Asian; and 2.9% are Other/Multi-Racial. 12.5% 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 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 YNEZ VALLEY COTTAGE HOSPITAL IS THE SMALLEST OF THE THREE HOSPITALS AND THE ONLY FEDERALLY-DESIGNATED CRITICAL ACCESS HOSPITAL.

Schedule H, Part VI, Line 7 State filing of community benefit report
CA

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.

Operating expenses	$ 21,837,697
Total amount spent on community benefits as % of operating expenses	$ 2,451,770 11.23 %