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HomeMy WebLinkAboutcorr - CorrespondenceJackson IDeMarcoITidusI�c� 1�� v Peckenpaugh A L A W C 0 R P 0 R A T 1 0 N n.i- ,r� `p Villa Balboa Homeowner's Association's Comments Regarding Hoag Hospital Development Agreement Compliance Review and Master Plan Amendment Submitted By Michele A. Staples, Esq. City Council, City of Newport Beach April 16, 2008 Agenda Item Nos. 1 and 2 Hoag Has Failed to Comply in Good Faith with Development Agreement Compliance review is a sham with recommendation of Master Plan Update approval prior to determination of compliance. Hoag failed to disclose the potential significant impacts of the cogeneration plant cooling tower plumes from the City and Coastal Commission, and thereby avoided the CEQA analysis required by the Development Agreement Section 3.3 (see attached Exhibit 1 . • Hoag's knowledge is evidenced by its original Advertisement for Bids (see attached Exhibit 2 that called for plume abatement equipment among the cogeneration plant facilities — Hoag later deleted the plume abatement equipment when constructing the cogeneration plant • Hoag compounded its error by its misleading letter to Villa Balboa homeowners stating that the plumes would no longer be visible after the initial startup period (see attached Exhibit 3 Health risks (Legionella) of siting cogeneration plant in close proximity to public park and private residences (see attached Exhibits 4 and Exhibit 5 ) and exhaust plume impacts also not evaluated or mitigated Staff report confirms other violations of Development Agreement, which Staff proposes to remedy by amending the Development Agreement to bring Hoag into compliance City has authority to unilaterally terminate or modify the Development Agreement for Hoag's failure to comply (Gov. Code, sec. 65865.1) City must City Council should require Hoag to remedy its prior and existing breaches before considering the Master Plan Update. City should modify the Development Agreement to require installation of plume abatement equipment, and clarify mitigation and enforcement obligations in order to ensure the required annual review is conducted and prevent Hoag's continued noncompliance, BEFORE acting on the pending Master Plan Update. Irvine Office Westlake Village Office 2030 Main Street, Suite 1200 2815 Townsgate Road, Suite 200 www.jdtplaw.com Irvine, California 92614 Westlake Village, California 91361 t 949.752.8585 f 949.752.0597 t 805.230.0023 f 805.230.0087 The City Should Continue Its Consideration of Remedial Measures and the Master Plan Update Due process requires the affected public must have an adequate opportunity to participate in the public process. Staff report and attached documentation, including over 1,000 pages of highly technical documents, made available only Friday More accurate estimates of cooling tower plume abatement mitigation should be obtained as City's consultant (Fluor) and Hoag agreed (see attached Exhibit 8 Cost and efficacy of cogeneration engine exhaust heat plume mitigation should be evaluated as noted in Staff report on Development Agreement Compliance Review (p. 11) Inadequate Noise mitigation measures must be corrected City has Improperly Rejected Effective Mitigation Measures as Infeasible Based Solely on Hoag's "Inflated" Cost Estimates Under CEQA, City may consider "economic factors" in evaluating the feasibility of mitigation measures. In considering feasibility of plume abatement technology, City should: (1) obtain more realistic estimate of costs; and (2) consider Hoag's financial resources in addition to the estimated costs According to Hoag's tax return dated August 2005 (see attached Exhibit 9; also posted on -line at http://www.hoaghospital.org/PDF/corl)orate-990Summary.pdf): • Net "Excess" for the year (Operating Profit) was $93 million (Page I - Line 18). The Orange County Business Journal reported that last year this amount was $135 million • Cash on hand was $107 million (Page 3 - Line 46) • Investments totaled $909 million (Page 3 - Line 54) • Total liquid funds available totaled more than $1 billion Plume abatement equipment is within Hoag's capability to successfully accomplish in light of Hoag's assets City should require Hoag to install plume abatement equipment as a cost of doing business in violation of its Development Agreement with the City City's failure to require plume abatement equipment rewards Hoag for knowingly violating the environmental review requirements of the Development Agreement and State law 2 0 Noise Impact Mitigation Does Not Comply with CEQA The Noise Impact Mitigation Measures are Inadequate • Potentially feasible mitigation measures were not analyzed (enclosing loading dock and driveway; relocating loading dock) • Mitigation is improperly deferred; there is no assurance that the mitigation measures will ever be implemented • There are no performance standards Performance standards and plan components must be clarified (for example, upgrades to sliding glass doors, balcony doors and stucco repair should be specified) • Villa Balboa is wrongly burdened with responsibility for contracting and implementing HOAG's mitigation measures 2. Soundwall Is Not Adequately Analyzed and Defined as Mitigation • Soundwall has not been described with sufficient detail to analyze its impacts is • The letter sent to the Villa Balboa homeowners was missing the page that describes the sound wall (Page 2); not sufficient public notice • Feasibility and critical design analysis is deferred; insufficient information about whether sound wall can be sited as proposed, or if existing underground utilities or other constraints may prevent a sound wall at that location Citv Must Prohibit Roof Top Parking Lots at the Lower Campus Previously proposed roof top parking would result in impacts including glare, fumes and noise from vehicles and car alarms inconsistent and not compatible with the adjacent residential uses and public park 766294.1 3 1 • (g) Preparation and approval of a project trip generation study as a condition to construction of development in Phases II and III of the Master Plan! (h) Preparation and approval of a Traffic Phasing Ordinance analysis prior to construction of development in Phase II and Phase III of the Master Plant (i) Preparation of a view impact analysis of each proposed building prior to issuance of permits; (j) Analysis and mitigation of emissions in accordance with the regulations of the South coast Air Quality Management District; (k) Preparation and approval of a construction phasing and traffic control plan for each phase of development. Hoag's right to develop the Property pursuant to the Haster Plan is contingent upon compliance with, and satisfaction of, the conditions and mitigation measures imposed by. the City Council as of the Approval Date, conditions imposed by the California coastal Commission required for approval of coastal development permits, as well as conditions and mitigation measures resulting from subsequent environmental analysis as specified in Paragraph 3.3. 3.25 Future Coastal Act discretionary review may result in specific mitigation measures to ensure consistency with the Coastal Act that require compliance with, or satisfaction of, standards before grading or construction can occur.. 3.3 Prooram EIR. Hoag acknowledges that the EIR is a "Program IR." The EIR analyzes the impacts of construction phased over time and, ursuant to CEQA, City is under a continuing obligation to analyze Hoag's equests for Project Specific Approvals to ensure the environmental impacts associated with the request were fully addressed in the EIR. Subsequent environmental documentation is required if this analysis reveals environmental impacts not fully addressed in the program EIR, identifies new impacts, or concludes the specific request is not consistent with the P roject described in the EIR. Hoag acknowledges the right and obligation of the City and the Coastal Commission or its successor agency to impose additional conditions as the result of the subsequent environmental analysis required by CEQA. 3.4 Mitigation Monitoring Plan. City shall prepare a Mitigation Monitoring Plan ( "Plan ") within sixty (60) days after the Effective Date. Hoag shall not submit any application for Project Specific Approval until the Plan has been approved by the city council and the Executive Director of the coastal coamission or the appropriate entity of its successor agency. ! 1842.20 HOAG MEMORIAL HOSPITAL PRESBYTERIAN COGENERATION PLANT PRE -PURCHASE OF EQUIPMENT Notice is hereby given that the FD &C of Hoag Hospital, will receive lump sum sealed bids for the Equipment Pre - Purchase for the Cogeneration Plant Project, on 3:00 pm Wednesday, November 14, 2001, at the following location: Jim Easley Hoag FD &C One Hoag Drive, Box 6100 Newport Beach, CA 9265"100 Five copies of the bids shall be delivered or mailed postage prepaid. All bids shall be enclosed in a sealed envelope bearing the Project name, the name of the bidder, and clearly marked "Bid Proposal" Bids received after the time stated for bids will not be accepted. Prospective bidders may secure a set of bid documents from Taylor & Associates Architects. A mailing charge of twenty -rive dollars ($25.00) will be required for each set mailed. DESCRIPTION OF WORK Furnish three (3) cooling lowers. Furnish two (2) high pressure steam absorption chillers, one (1) hot water absorption chiller, and one (1) electric centrifugal chiller. Furnish six (6) and suction pumps, fourteen (14) horizontal split case pumps, and three (3) vertical turbine pumps. Furinsh one (1) 600 HP steam boiler with burner,. Furnish one (1) deaerator. Furnish two (2) shell and tube heat exchangers and ten (10) plate and frame heat exchangers for the Hoag Cogenearation Plant Project. The Bid will consist of the following elements: 1. Lump sum quotations as specified in the Bid Proposal Form; a. b. C. d. e. f. 9• INVITATION TO BID One form for the cooling towers. One form for the chillers. One farm for the pumps. One form for the boiler. One form for the deaerator. One farm for the heat exchangers. One form for the warranty and maintenance. i HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1842.20 COGENERATION PLANT PRE- PURCHASE OF EQUIPMENT 2. Legal documentation, such as listed subcontractors, non - collusion and bid affidavits asset forth in the Bid Form. MANDATORY PRE -BID CONFERENCE A mandatory Pre -bid conference for prospective bidders will be conducted at 2:00 pm, Thursday, November 8, 2001 at the site. Failure to attend the Pre -bld conference will result In disqualification from the Bid process. All inquiries regarding the Bid must be in writing and no inquiries will be accepted less than five (5) days prior to the Bid date. Any questions received three (3) days prior to the Pre -bid conference will, if possible, be responded to at the meeting. Written answers to those questions deemed significant will be provided to all bidders, in the form of addenda prior to the Bid opening. No bid may be withdrawn within one hundred twenty (120) days after the Bid Opening. For procedural or contractual information regarding this Project, contact Bob Okajima, of J.L. Hengstler Associates, Inc. (all inquiries must be in writing). The Owner reserves the right to reject any or all bids, to waive clerical or technical errors, discrepancles or informalities of a bid not affected by law, if to do so seems to best serve Hoag Hospltal. END OF ADVERTISEMENT FOR BIDS INVITATION TO BID 2 HOAG MEMORIAL HOSPITAL PRESBYTERIAN • LOWER CAMPUS COGEN PLANT (PRE - PURCHASE) COOLING TOWERS PART PRODUCT 2.01 COOLING TOWERS A. Fumish and install all material, equipment and appurtenances required for a complete mechanical draught hybrid cooling tower with induced draught fans, which shall be job site assembled. Note that the cooling towers will sit in a well that is approximately 28' in height and the clearance on three sides of the cooling tower square ((4) towers grouped in a square — (3) cooling towers purchased now and (1) future) have only an 8' clearance (see drawings for clarification). B. Include the fiberglass (FRP) structure, erected in a concrete basin (to be furnished by others), fill, fill support lintels, drift eliminators, fan assemblies, speed reducers, fan drives, water distribution system, plume abatement, and all other materials and parts required to make this cooling tower complete. C. The dimensions of this tower must be as those shown on the contract drawings. This tower must fit into the new concrete basin. D. The tower manufacturer shall take these space limitations into consideration for the various designs required, Including water cooling capacity and performance, fan air handling and motor brake horsepower requirements. The maximum width dimensions of the tower shall not exceed 22' x 22'. Note that there are 2 air inlets per cell situated on adjacent sides. E. The tower manufacturer shall provide a system integrated into the cooling tower for plume abatement based on a design condition of 45 °F DB, 43DFWB and 85% RH. The cooling shall be capable of operating as a wet cooling tower during times when plume abatement Is not necessary, and thus not wasting fan motor horsepower or condenser pump horsepower. The plume abatement system shall automatically start when a "pluming" state occurs. The cooling towers can operate at full load throughout the • COOLING TOWERS 10/24/01 Compliance Confirmation 15710 -1 HOAG MEMORIAL HOSPITAL PRESBYTERIAN • LOWER CAMPUS COGEN PLANT day and night and thus the plume abatement system must be able to work whenever required. F. The tower manufacturer shall state the sound pressure level (dba) at a distance of 1 meter and provide an add alternate for a low sound level (i.e. quiet fan package, etc.) stating the achievable sound pressure level. G. All internal components shall be of a non - corrosive material or an approved material (coated) with a ten (10) year guarantee. H. Upon completion, the Tower Manufacturer shall issue a limited warranty that will apply to the various components as follows: 1. The cooling tower structure shall be guaranteed against unserviceability for the FRP composite structural members, columns, beams, side panels and roof decks, and its structural connections for a period of ten (10) years from Installation. 2. The remaining Cooling Tower components (furnished by Cooling Tower Manufacturer) are guaranteed to be free of defects in material and workmanship for a period of twelve (12) months after beneficial use by the owner. 3. The Cooling Tower Manufacturer's Warranty is limited to replacing all items F.Q.B. Shipping Point or repairing F.O.B. Repair Facility. Items not covered are the following: 4. Warranties are predicated on installation, maintenance, and operation in accordance with Cooling Tower Manufacturer's published Operating and Maintenance Manual. I. Training for the equipment shall be provided by the manufacturer for the client's service technicians. The training shall be videotaped for viewing by "off" shift personnel. The training time and place shall be coordinated with the client. J. For extended warranty and maintenance see Section 15000 Warranty and Maintenance. COOLING TOWERS 15710 -2 HOAG MEMORIAL HOSPITAL PRESBYTERIAN LOWER CAMPUS COGEN PLANT • z K. Acceptable Manufacturers: Ceramic Cooling Tower Corporation, Marley, and Texas Cooling Tower. 2.02 STRUCTURE A. The field erected FRP composite cooling tower structure shall meet Uniform Building Codes applicable to the section of the country in which it is installed. B. Maximum Water Absorption (24 hour immersion) per ASTM D -570 shall be in accordance with CTI STD -137 (88). C. Maximum Wind Loading: Per Uniform Building Codes for the tower locale. D. The cooling tower casing, fan shroud, fan deck, beams, columns, supports and partition walls shall be constructed of corrosion resistant, fire resistant, self - extinguishing, glass reinforced isophthalic polyester or vinyl resin and contain an Ultraviolet (UV) ray Inhibitor as per CTI STD -137 (88), Grade 1 or 3. Side and endwali casings shall be corrugated, fire retardant, UV stabilized fiberglass reinforced polyester panels installed with the corrugations horizontal. Panels shall be installed beginning from the fan deck down to the top of the air inlet with each lower panel overlapping the one above it by one corrugation so that the water is shed into the tower. Vertical joints located at the columns shall be lapped and caulked full height to prevent leaks. The panels shall be attached with stainless steel rivets or screws with pre - assembled neoprene washers. The corners shall be trimmed with pre- formed corner roll to match the corrugated panels and to prevent leakage. Partition walls between cells shall be corrugated, fire retardant fiberglass reinforced polyester panels that extend from the bottom of the fan deck to one foot below the top of the curb. These partition walls shall isolate the airflow to each fan and insure that in the event of a planned shutdown or a mechanical failure of a fan, that there will be no foss of performance due to fan -to -fan re- circulation in the adjacent operating cell. A longitudinal windwall consisting of corrugated, fire retardant fiberglass reinforced polyester panels shall be located at the center of the tower and extend from the bottom of the fill to the top of the curb. This windwall shall be designed to help prevent blowout caused by cross winds in the air inlet. COOLING TOWERS 75714 -3 I HOAG MEMORIAL HOSPITAL PRESBYTERIAN LOWER CAMPUS COGEN PLANT E. The coaling tower FRP structure, walls, roof deck, support beams and columns will be fabricated from composite continuous fiberglass pultruded sections. The exterior wall sections will be double wall construction and will weigh not less than 36 ounces per square foot. Towers of stick frame design with single wall casing will not be allowed. The fiberglass framework shall consist of columns (hollow square tubes). The fan deck joints and joints supports shall be U- channels with flanged intermediate beams as required by the design. All other horizontal transverse and longitudinal girths, ties and supports shall be U- channels. The fan deck shall consist of inter - locking pultruded fiberglass panels with a non -skid walking surface for safety. Each framing bent is braced in the transverse and longitudinal directions with angles, which transfer wind and seismic loads to the basin. These diagonals are positively anchored to the cold water basin with heavy -duty fabricated steel weldments and straps. F. The fan stack shall be hand - fabricated fiberglass construction with the same quality resin and glass as above and shall have a minimum weight of 32 ounces per square foot. G. All of the exterior and interior surfaces of the fiberglass structural members and components will be protected from Ultraviolet (UV) rays as well as water migration by gel coat or polyester surfacing veils molded internally into the composite part. The thickness of this protective gel coat or resin veil shall be 17 -22 mils. On pultruded members the UV item protectors and color pigments shall be formulated in the resin matrix. H. All fiberglass structural connections and attachments shall utilize 316 stainless steel machine bolts, nuts and washers. Lock nuts shall be used at all structural connections to insure the integrity of the connection despite any operating vibration. Structural connections where bolt heads or nuts bear directly on the fiberglass columns, shall use oversized washers to prevent crushing of the tube if the bolt is over tightened. The column and diagonal base anchor weldments and diagonal strap connectors shall also utilize 316 stainless steel. Fasteners and all external joints shall be sealed with a continuous type sealant at the time of erection. Glued connections are not acceptable. I. The Cooling Tower Manufacturer shall submit detailed structural design calculations, factors of safety and method used to obtain them, as well as test data performed by and independent test COOLING TOWERS 15710 -4 HOAG MEMORIAL HOSPITAL PRESBYTERIAN • LOWER CAMPUS COGEN PLANT laboratory to prove the material structural strength characteristics and the design safety factors of the structural members used in the cooling tower. Upon request, the Cooling Tower Manufacturer shall furnish a 3- dimensional structural analysis of the structure design. 1. Seismic Zone: Per California State Building Code, 1992 Edition, Zone 4, Critical Care Facility, and California O.S.H.P.D. requirements. 2.03 LINTELS A. All fill shall be bottom supported. B. Fill supports shall be capable of supporting all loads expected when the tower is operating. C. Lintels shall be of pultruded fiberglass. 2.04 FAN ASSEMBLY A. Fan blades: slow speed, aerodynamically designed, propeller type with adjustable blades to provide efficient use of power and assure quiet operation. Maximum tip speed shall not exceed 11,000 FPM. The fan unit shall be statically balanced and provided with a "vibration- cut -off' switch. B. The fan blades shall be fabricated from a fiberglass reinforced resin system. C. Attach multi -blade propeller type fan blade to the motor shaft through a speed reducer. D. The complete fan assembly (fan and mounting) shall be designed to give maximum fan efficiency and long life when handling saturated air at high velocities. 2.05 GEAR DRIVE A. The gearboxes shall be two -stage beveled spur gears, which shall be specially designed for use in wet cooling towers. The drive shaft shall be of the full floating, composite material type with flexible couplings on both ends and be of a non - corrosive exterior material. COOLING TOWERS 15710 -5 HOAG MEMORIAL HOSPITAL PRESBYTERIAN • LOWER CAMPUS COGEN PLANT _i B. The speed reducer gears shall be rated In accordance with practices of the American Gear Manufacturers Association, using a factor of 2.0 minimum for cooling tower services. C. Speed reducer shall be in accordance with CTI STD -111 D. The gear reducers shall be of the spiral bevel type. E. The control glass for the lubrication oil level and the service pipes shall be installed outside the fan stack (outside the tower) to allow for ease of observation. The oil fill cap shall be accessible without the use of ladders. The vent lines shall terminate outside the tower structure. An oil pressure or oil flow control switch shall be provided. F. The oil lines shall be made of a non - corrosive material (i.e. stainless steel). G. A vibration protection switch shall be installed to provide protection from excessive vibrations. An oil level sensortswitch shall be installed to protect the gear box from low oil levels. 2.06 FAN MOTOR A. The motor(s) shall be corrosive duty, Premium Efficiency, with a Service Factor of 1.15, Class F insulation, NEMA approved, and shall be of the TEFC Type. The motor horsepower shall be of the next larger standard motor than that calculated as being required for the individual fan brake horsepower and shall be 3- phase, 60 Hertz, 460 Volts, continuous duty type with normal starting torque. The motor(s) shall be as shown in schedule with single speed, and shall match the Variable frequency drive. B. The motors shall be, single speed, single winding. C. Motors shall be located out of the wet air stream. D. Complete electrical service of the motors and tower instrumentation, including hook -up, appurtenances and accessories shown on the Contract Drawings shall be furnished by others. 2.07 PVC FILL COOLING TOWERS 15710 -6 HOAG MEMORIAL HOSPITAL PRESBYTERIAN • LOWER CAMPUS COGEN PLANT A. The cooling fill shall consist of compact film - packs, which rest on beams. The PVC fill material shall be the cross corrugated, PVC film type, wave formed sheets with fluted edges, of fire- retardant, polyvinyl chloride with a minimal thickness of 10 mils after forming and 12mm minimum flute openings B. PVC material: Fire resistant and meet the provisions of ASTM Standard E -84, with a flame spread rate of 25. The PVC shall be self - extinguishing and shall not be capable of burning by itself. The PVC shall only burn if ignition flames from outside keep burning. If the ignition flame is removed, the fire must extinguish itself within seconds. C. Turbulent flow shall be forced by the packs on both the water and the air side. The packs shall be arranged one on top of the other and crosswise. This shall result in an increase in cooling efficiency. D. The PVC sheets shall be solvent bonded into strong homogenous block assemblies approximately 1' high by V wide and in lengths easily Installed into the tower. E. The PVC fill pack shall be bottom supported by FRP support lintels. 2.08 SYSTEM DISTRIBUTION A. The distribution system for each cell shall consist of a main header with external flange connection, side laterals, fittings and nozzles. Under no circumstances shall any galvanized steel or carbon steel components be used. Further, no penetration of the fill media is acceptable. B. All distribution system piping shall be either PVC or fiberglass, depending on size. C. The fittings and nozzles shall be FRP, PVC or ABS. D. The distribution piping, including nozzles, pipe and fittings shall be supplied by the Cooling Tower Manufacturer. 2.09 MIST ELIMINATORS A. The drift eliminators shall consist of corrugated elements, which are kept at a certain distance by plastic spacer elements. They shall • COOLING TOWERS 15710 -7 • • HOAG MEMORIAL HOSPITAL PRESBYTERIAN LOWER CAMPUS COGEN PLANT be arranged on top of the water distribution system. The arrangement of the drift eliminator shall be chosen in such a way that the air charged with water droplets shall be deflected twice. The droplets shall deposit at the deflection surface where they can accumulate to form droplets and fall back. The drift eliminators shall conform to ASTM D -1784, Type 1, Grade 1, with a flame spread rating of 15 or less per ASTM E -84. B. The drift eliminators are assembled into sections making a strong stable unit and shall include inhibitors to prevent damage from Ultraviolet Light. C. The free -water carryover shall not exceed .005% of the total water flow at design operating conditions. D. Drift eliminators shall be bottom supported by FRP lintels. Support by the distribution system pipes is not allowed. 2.10 PLUME ABATEMENT A. Individual heat exchangers shall be arranged in the openings of the casings of the dry section. The fin tubes shall be in the horizontal position and thus the fins shall be less susceptible to external fouling. The finned heat exchanger tubes shall be welded or expanded between two tube sheets. The heat exchangers shall be designed with screwed header boxes so that internal cleaning of the tubes can be carried out manually. The tube material shall be 316 stainless steel with galvanized fins. The tube sheet material shall be 316 stainless steel. The header material shall be carbon steel with corrosion protection. B. Rolling doors constructed of sea -water resistant aluminum doors on carbon steel with corrosion protection slides driven by 460V /60Hz electric drives shall be provided to allow air to flow through the heat exchangers to mix with the `weV air to abate the plume. 2.11 HARDWARE AND FINISH A. All fiberglass structure connections and attachments shall utilize 316 series stainless steel fasteners and all external joints shall be sealed with a continuous type sealant at the time of erection. B. Exterior: Cosmetically appealing surface that is durable, long lasting and eliminates the need for other finishing. COOLING TOWERS 15710 -8 C. Furnish with an FRP ladder and safety cage at each end of the tower adequate to allow inspection and accessibility to the fan motor and upper portion of the tower cell. D. Provide air inlet louvers of a PVC cellular type to prevent objects from entering the water basin and to impede splash out. 2.12 CONCRETE BASIN (BY OTHERS) A. Cooling Tower Manufacturer to provide detailed drawings of concrete basin anchor bolt locations. Anchor bolts will be supplied by others and will include two fender washers and two nuts per bolt. All bolts, nuts and washers to be of 316 series stainless steel of size indicated on drawing. 2.13 ACCESS AND SAFETY A. An access hatch (manhole) shall be provided on each tower cell for access to the eliminators, plenum section, and mechanical equipment. A means to walk in the area below the access hatch must be provided to eliminate walking on top of the fill material. A ladder shall lead down to the walkways and a ladder at the walkway's end shall lead to the support of the fan gear unit. B. Access to the tower fan deck shall be by one fiberglass stairway as shown on the drawings, furnished, designed and installed by the Cooling Tower Manufacturer to meet all codes (i.e. OSHA, OSHPD) and structural requirements. Aluminum stairways and caged ladders will not be permitted. The tower fan deck shall be surrounded by hand - railings. The trough shall be covered with gratings and secured by hand - railings. 2.14 Provide pricing for the following optional spare parts: Fan Gearbox Coupling Shaft Motor 2.15 SAND FILTER A. Furnish Sand Filters as shown on the drawings, schedules, and specified for the purpose of filtering to remove suspended solids, • COOLING TOWERS 15710 -9 HOAG MEMORIAL HOSPITAL PRESBYTERIAN LOWER CAMPUS COGEN PLANT C. Furnish with an FRP ladder and safety cage at each end of the tower adequate to allow inspection and accessibility to the fan motor and upper portion of the tower cell. D. Provide air inlet louvers of a PVC cellular type to prevent objects from entering the water basin and to impede splash out. 2.12 CONCRETE BASIN (BY OTHERS) A. Cooling Tower Manufacturer to provide detailed drawings of concrete basin anchor bolt locations. Anchor bolts will be supplied by others and will include two fender washers and two nuts per bolt. All bolts, nuts and washers to be of 316 series stainless steel of size indicated on drawing. 2.13 ACCESS AND SAFETY A. An access hatch (manhole) shall be provided on each tower cell for access to the eliminators, plenum section, and mechanical equipment. A means to walk in the area below the access hatch must be provided to eliminate walking on top of the fill material. A ladder shall lead down to the walkways and a ladder at the walkway's end shall lead to the support of the fan gear unit. B. Access to the tower fan deck shall be by one fiberglass stairway as shown on the drawings, furnished, designed and installed by the Cooling Tower Manufacturer to meet all codes (i.e. OSHA, OSHPD) and structural requirements. Aluminum stairways and caged ladders will not be permitted. The tower fan deck shall be surrounded by hand - railings. The trough shall be covered with gratings and secured by hand - railings. 2.14 Provide pricing for the following optional spare parts: Fan Gearbox Coupling Shaft Motor 2.15 SAND FILTER A. Furnish Sand Filters as shown on the drawings, schedules, and specified for the purpose of filtering to remove suspended solids, • COOLING TOWERS 15710 -9 HOAG MEMORIAL HOSPITAL PRESBYTERIAN • LOWER CAMPUS COGEN PLANT both organic and inorganic, from cooling tower water on a recirculating basis. The system shall be fully assembled and mounted on a structural steel skid, including interconnecting piping, flush valves, fittings, pump and automatic backwash controls. The system shall be epoxy powder electrostatically applied Yardney Blue with catalyzed two -part polyurethane industrial finish. • B. Filter tanks shall be carbon steel construction with a vertical sideshell of 24" and shall be Scotchkote 134 fusion epoxy lined and meet the following requirements: 1. After sandblasting to bare white metal, all interior surfaces shall be epoxy lined with a minimum thickness of 8 mils. Immediately after coating, the tanks shall be cured at 400 °F for a minimum of 20 minutes. 2. The epoxy protective lining shall be fused thermosetting epoxy power electrostatically applied, 2M Type 134 fusion bonded epoxy. C. The filter systems shall include automatic air actuated valves to provide the proper backwash. The valves shall be constructed of stainless steel and shall be suitable for air actuation. All stainless steel valves shall be fitted with extemal grease fittings for easy service lubrication. Hydraulic (water) operation shall be optional. The system shall incorporate the use of Scotchkote 134 fusion .epoxy lined steel pipe for assembly. D. The filter media shall be provided by Yardney and be a sharp, crushed silica sand and have characteristics of durability and long life. The filter vessels shall include a Yardney proprietary Type 316 stainless steel underdrain for durability and optimum non - turbulent backwash. E. The system shall include a heavy -duty industrial pump and motor sized for the system's flow and pressure requirements. Standard pump motor voltage — 220/440 3 phase. A backpressure- sustaining valve shall be supplied to maintain system back pressure for optimum backwash efficiency. Pumps shall be TEFC motors. F. The filter system will include a Yardney Ulta 116 -1 solid state automatic controller. This controller will provide laborsaving, unattended automatic backflush on a time - selected interval. In addition, there shall be included a field adjustable automatic COOLING TOWERS 15710 -10 HOAG MEMORIAL HOSPITAL PRESBYTERIAN • LOWER CAMPUS COGEN PLANT pressure differential (P.D.) override safety circuit. Through the use of the Yardney Ultra 116 -1 Controller the filters are assured of being cleaned on a time - scheduled basis; however, should the source water quality vary and pressure differential develop to a preset limit prior to the scheduled backwash time, the P.D. circuit will activate a backwash cycle. A backwash cycle counter shall be integral to the controller. Controller shall be 440 VAC powered. A NEMA 3R Motor Starter Package shall be included with the system. G. The filter shall be designed so as to accomplish the backwash function without the need for an outside water source. A backwash throttle valve is provided for regulation of the backwash flow rate. H. A complete manual of installation and operation instructions shall be provided with each filter system. 1. Training for the equipment shall be provided by the manufacturer for the client's service technicians. The training shall be videotaped for viewing by "off" shift personnel. The training time and place shall be coordinated with the client. J. For extended warranty and maintenance see Section 15000 Warranty and Maintenance. • END OF SECTION COOLING TOWERS 15710 -11 • Om nwe Cfiiw+ P(1 a,n GIlRI Neatxxt 9rE.S.4fi IUa His. WAN- nW u( ; (4 11 A ,.av'.kvgM1mrylalM August 30, 2005 Dear Hoag Hospital Neighbor As you may know, Hoag Hospital is currently in the process of building a power plant on our lower campus to provide the entire hospital with a more direct and cost efficient electrical source. The Co- Generation facility is located along Pacific Coast Highway at the west end of the hospital's campus, near Superior Boulevard. The testing of this equipment began a Few months ago, and will continue into the Fall. During the testing process, you may hear equipment [wise and notice steam coming from the facility. The sounds are the result of external engines being used during testing which will be removed once in operation and the steam is a by- product of the testing, loth will be eliminated once the Co-Generation plant is in full operation. Another aspect of the testing resulted in a loud sound being heard in the'vicinity of the Co- Generation plant on Thursday, August 251° at 6.45 pm. That sound was the result of one of the generator engines backfiring. Although not a scheduled part of the testing process, the automoric shut down equipment incorporated into the system functioned properly. Piston engines, w used in the Co-Generation Plant are subject to backfiring during testing, specifically when changes are made to loads or speeds. The Co-Generation plant is scheduled to go into full operation just prior to the opening of the Sue and Bill Gross women's Pavilion on October 5i°, however it may be w We as mid- November before it is fully functional. If you have any further questions regarding the Co- Generation plant please feel fice to contact David Hamedany at 9491760.-4467. Thank you for your support as we prepare to meet the expanding healthcare needs of our community. Sincerely, Langston Trigg Vice President Facilities Design and Construction 0 Legionella 2003 — Update and AWT Statement • LEGIONELLA 2003: An Update and Statement by the Association of Water Technologies (AWT) (Approved by AWT Board of Directors, June 2003) 15245 Shady Grove Road, Suite 130 • Rockville, MD 20850 Phone: (800) 858 -6683 / (301) 740 -1421 • Fax: (301) 990 -9771 Email: awt(Mawt.orq • Website: www.awt.orq (Note: Correction to data table on Page 11 was made 7- 6-2006) Legionella 2003 — Update and AWT Statement • Legionella 2003: Update and AWT Statement (Approved by AWT Board of Directors, June 2003) Special Acknowledgments Legionella 2003 is an update revision to Legionella: An- Update and Statement by AWT. This document has been produced by the Technical Committee of AWT and authored by William E. Pearson 11, CWT. Special thanks is given to the Cooling Water Subcommittee project and review team including J. Patrick Sisk, Kenneth R. Davenport, Richard W. Gilpin, Ph.D., Robert D. Lee, CWT, Gary M. Reggiani, Charles T. Smith, CWT and Chris L. Wiatr, Ph. D. in addition to document reviews by Matthew R. Freoe and Janet E. Stout, Ph.D. for their (continued) gracious contributions of time, expertise and knowledge toward the production and technical review of this document. Wemirm and Disclaimer This document Is designed to provide Information on the subject matter. It Is produced with the understanding that neither AWT nor the author (or other contributors) is rendering legal, medical, engineering, or other professional services. Neither AWT nor the author (or other contributors) shall be liable for damages, in any event for incidental or consequential damages caused, or alleged to be caused, directly or Indirectly, by the use of any Information disclosed In this document Including the use of any recommendations, methods, products, services, Instructions, or ideas. Forward The Association of Water Technologies (AWT) is a not -for -profit, intemational trade association founded to serve the interests of regional watertreatment companies and to advance the technologies of safe, sound and responsible water treatment practice. AWf provides education and training, public awareness, networking, research, industry standards and resource support. Association activities are directed towards promoting the growth and development of member firms and advancing the arts and sciences of the water treatment industry. Since the initial outbreak in 1976 that led to the discovery and identification of Legionnaires' disease, much has been discovered about the bacteria (Legionella) that causes the disease and the disease itself. This includes how Legionnaires' disease is contracted and how to minimize risk of disease contraction, as well as effective medical treatments for Legionnaires' disease. However, guidelines for ° 100%° disease prevention and control remain at large, as well as any uniform consensus on the routine testing (monitoring) for Leglonelle in the water systems that may harbor the bacteria. Existing guidelines and statements, however, do provide substantial direction and information that can be adopted to effectively control and minimize legionellosis. This document is a comprehensive update of collective information and data available from numerous research, investigative, and authoritative sources on Legionella and legionellosis. These include the CDC (Centers for Disease Control and Prevention), OSHA (Occupational Safety and Health Administration), WHO (World Health Organization), EPA (Environmental Protection Agency), various state public health agencies, as well as associated technical trade organizations and recognized Legionella experts and commercial entities. Due to the multi - disciplined, technical and medical nature of the subject, this document Is directed at summarizing and presenting Leglonella in an up- to-date, informative, and useful format to the watertreatment professional and end -user, as well as for the general public. Extensive references are cited that may provide more detailed and in -depth information on legionellosis and related topics to benefit those with more specific interest and application or decision making needs. 40 Legionella 2003 — Update and AWT Statement • LEGIONELLA 2003: An Update and Statement by the Association of Water Technologies 02003, Association of Water Technologies, Inc., AA rights reserved. w .awl.orr • Page I. Background: Disease and Legionella Discovery ............... 4 II. Legionella: Terms, Definitions and General Facts ............. 5 III. Infectious Growth, Transmission & Host Susceptibility .......... 8 IV. Potable Water Systems & Methods of Disinfection ............. 11 V. Cooling Towers: Water Treatment & Legionella ............... 17 VI. Cooling Tower Guidelines and Legionella .................... 19 VII. Legionella Sampling and Testing .......................... 23 Vlll. Healthcare Facilities, Legionella and JCAHO ................. 27 IX. Internet: Legionella Information Sites ....................... 29 X. AWT Position Statements on Legionella ..................... 30 References ................. ............................... 32 3 Legionella 2003 — Update and AWT Statement Legionella 2003; Update and AWT Statement Figure 1; Cultured Legionella (bottom view) from Biofilm (top view); AWT Analyst, 1997. I: Background: Discovery of Legionnaires' Disease & Legionella Legionnaires' disease (LD) acquired its name from the media reference given to a mysterious pneumonia -like illness that afflicted numerous attendees of an American Legion convention in Philadelphia at the Bellevue- Stratford Hotel during July of1976. An outbreak of illnesses occurred presenting Pennsylvania Department of Public Health officials with a recorded 221 cases of a strange respiratory illness contracted by convention (hotel) attendees and by some hotel pedestrians. Symptoms included high fever, chills, muscle pain, headache and eventual development of a dry cough with difficulty in breathing. Some patients developed patchy lesions in their lungs representative of severe pneumonia. More than two - thirds of the patients required hospitalization and 34 eventually died. Investigation of the outbreak by the Centers for Disease Control and Prevention (Atlanta, GA) led to the eventual discovery of the causative agent, a bacterium, in January of 1977. The bacterium was subsequently named Legionella pneumophila (pneumophila is Greek for lung-loving). It determined that neither the bacterium nor the disease was new and that Legionella bacteria have been around and causing disease for many years. When reexamined, the CDC found Legionella bacteria in fifty -year old (archived) tissue samples of unsolved and similar - illness cases. So, Legionnaires' disease was not a new disease discovered in 1976 —just an old one that was finally recognized and named. C Legionella 2003 — Update and AWT Statement • II. Background: Terms, Definitions, & General Facts Legionella is the name for the genus of bacteria. Legionellae (the plural, referring to more than one Legionella bacterium) are aerobic, non -spore forming, rod - shaped, typically flagellated, gram- negative bacteria. They are common to aquatic, especially warm water, environments and some soils. There are 43 or more identified species of Legionella, with more than half being linked to human disease. Some Legionella species are made up of multiple serogroups, with over 60 serogroups presently identified for the genus. Many of the species serogroups are further differentiated into numbers of subtypes. Legioneilosis is the collective term describing any illness caused by exposure to the bacterial pathogen Legionella. Legionnaires' disease and Pontiac fever are the two most common types of Iegionellosis, with Legionnaires' disease being the more serious and primary one of focus. It is an environmental disease —with the causative agent (Legionella) transmitted from an environmental source (water or soil) to a host It is not transmitted from person to person — thus, it is not a communicable disease. Legionella pneumophila (Lp) is one species of Legionella — and is the causative species to more than 90% of Iegionellosis cases. More than 70% of these cases are attributed to one serogroup of the more than 15 Lp serogroups — Legionella pneumophila serogroup 1 (Lp -1). As it turns out, Lp -1 is the most common isolate recovered from environmental samples. Within Lp -1 are more than 50 subtypes that can be identified by phenotypic or molecular typing methods. Serogroups and subtypes appear to differ as to their particular degree of virulence. Legionnaires' disease (LD) is an acute bacterial infection of the lower respiratory tract, i.e., a bacterial pneumonia. The disease is a potentially fatal, multi- system respiratory illness with an average mortality rate of 15 -20 %. Fortunately, it is selective in attack and infects only 2 -5% of those appropriately exposed to the bacteria. LD is a serious illness and not rare. Legionella bacteria are among the top three causes of sporadic, community- acquired pneumonias. American Society for Microbiology News (61:621) (1995) reported that 15 -30% of patients admitted to intensive care units with pneumonia had Iegionellosis. It is also the cause of many hospital - acquired (nosocomial) cases of pneumonia. Many LD cases go undiagnosed because the disease is difficult to distinguish from other forms of pneumonia — unless specifically targeted. Even when detected, it often goes unreported to the public health authority, especially if cases are sporadic (one or two -case incidents) and not associated with an outbreak investigation. The under - detecting and under - reporting of LD makes its incidence difficult to estimate and why such figures vary widely. The CDC has estimated that the disease infects 10,000 - 15,000 persons annually in the US. OSHA estimates that over 25,000 cases of the illness occur each year, causing more than 4,000 deaths. Still, others estimate as many as 100,000 annual cases. • Legionella 2003 — Update and AWT Statement is. LD Exposure is most likely to occur via: 1. Inhalation: of aerosols, fine sprays, mists or other microscopic droplets ofwater (or soil) contaminated with Legionella — providing direct access into the lungs; and /or 2. Aspiration: such as may occur when choking or spontaneously during the drinking, ingesting, swallowing process— allows oral fluids and /or particles to by -pass natural gag reflexes and enter into the respiratory tract and lungs instead of the esophagus and stomach. LD Sources may include almost any warm water system or device (man -made or natural) that disseminates water, particularly as aerosols, sprays or mists and provides favorable conditions for Legionella growth and amplification. A notable source of Legionella today, contrary to the long association and thinking that cooling towers are the only significant source for LD, is the domestic (potable water) plumbing system. These systems in large buildings and /or complexes including, but not limited to, hotels, institutions and health care facilities have been commonly linked to occurrences and transmission of LD. Current data suggest that cooling towers and evaporative condensers, while still potential LD sources, may be an overemphasized modal of disease transmission. Other LD sources include: various heat - rejection devices, humidifiers, showerheads, faucets, whirlpool baths and spas, hot springs, respiratory therapy equipment, and even misting machines found in grocery store produce sections. • LD Susceptibility is an important factor in disease contraction. The greatest host susceptibility to Legionella is found in the elderly and those with suppressed or compromised immune or respiratory systems. This includes: heavy smokers, alcoholics, HIV patients, cancer, bone marrow or organ - transplant patients, and others with lung or respiratory diseases. Underlying disease and advanced age also contribute to a significantly higher risk of mortality with LD. The most common risk factor found in LD patients is heavy cigarette smoking, along with chronic lung disease. Bone marrow and organ transplants represent the most intense risk factor, since the medicines used to protect new organ transplants also compromise the body's immune defenses against infection. Patients taking corticosteroid medicines are also at risk. LD Symptoms may include: ► High Fever, Chills, Headache, Muscle Pain (Flu -like symptoms), ► Dry Cough and Difficulty in Breathing, ► Diarrhea and /or Vomiting, and P. Confusion and Delirium • LD Incubation period is 2 -10 days. This is the time it takes, after exposure, before symptoms of the illness appear. For several days, the patient may have flu -like symptoms and feel tired and weak. Most patients who are admitted to a hospital develop high fever, often greater than 39.5 °C (103 °F). A cough can be the first sign of a lung infection and may be sufficiently severe to cause sputum production (mucous with saliva). Gastrointestinal symptoms are seen in approximately 40% of patients, with diarrhea the leading symptom. Many patients have nausea, vomiting, and stomach discomfort Other common symptoms • include headaches, muscle aches, chest pain, and shortness of breath. Legionella 2003 — Update and AWT Statement • . LD Treatment requires the use of antibiotics. However, many antibiotics effective against other bacterial pneumonias are ineffective against Legionella as they do not act to penetrate the pulmonary cells (alveolar macrophages) where infectious Legionella thrive. Fortunately, there are several newer antibiotics that are effective on Legionella. The two most potent Gasses of these antibiotics are the macrolides, such as azithromycin, and the quinolones, including ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin and trovofloxacin. Other agents that have proven effective against LD include tetracycline, doxycycline, minocycline and trimethoprim - sulfamethoxazole. Erythromycin, the former antibiotic of choice, has been replaced by these more effective and less toxic antibiotics. When LD patients are treated with appropriate antibiotics near the onset of disease, the outcome is usually excellent, especially if there is no underlying illness compromising the immune system. For patients with compromised immune systems, including transplant recipients, any. delay of appropriate treatment can result in complications, prolonged hospitalization, and death. After successful treatment and hospital discharge, many patients will still experience fatigue, loss of energy, and difficulty concentrating. These symptoms may last for several months. Complete recovery within one year is usually the rule. Patients who were cigarette smokers should consider discontinuing smoking. Pontiac fever is a much milder, non - pneumonic, flu -like illness caused by Legionella species. Cases of Pontiac fever have been linked to L. pneumophila, L. feelie and L. anisa. It attacks indiscriminately; uniformly infecting 90 % to 95% of those exposed and has a shorter incubation period (than LD) of 1 to 3 days. Complete recovery usually occurs in 2 to 5 days without medical attention. Because the contraction of Legionnaires' disease (LD) represents a much more serious condition than Pontiac fever, this paper's information focus will be on LD and Legionella pneumophila (as well as other species of Legionella) that cause it is Legionella 2003 — Update and AWT Statement • III. Legionella: Infectious Growth, Transmission & Host Susceptibility Legionella are common warm water microorganisms. They are primarily found in surface waters (lakes, ponds, rivers and streams) but can also be found in ground water sources, including some soils (Legionella long- beachae). Legionella tend to grow in biofilm or slime on the surfaces of lakes, rivers and streams — and can easily adapt to conditions within water distribution systems. The ecology of Legionella is particularly interesting and is important to its ability to persist in the environment, as well as infect man. Legionella are protozoonotic — in that they live, reproduce and survive within certain free - living amoebae and ciliated protozoa as facultative intracellular parasites. In this relationship, the protozoa are obligate cellular hosts in which Legionella replicate and thrive, as well as gain protection from harsh, natural or man -made, environmental conditions. Chlorination, UV irradiation and chemical biocides all offer temporary means by which laboratory and planktonic Legionella can be eradicated from a water source. However, the majority of Legionella do not exist as free - swimming (planktonic) bacteria. Instead they reside, well - protected, inside protozoan hosts and in the matrix of biofilm. Eventually, they are released from their hosts in the form of small vesicles that may contain hundreds or a thousand or more legionellae per vesicle. In terms of survival, the amoeba -grown bacteria are better able to withstand their aquatic environment and may be more virulent. This adaptation and endosymbiotic relationship with amoebae and other protozoa allows Legionella, among other things, to survive typical potable water chlorination (disinfection) and appear in many finished water supplies to homes, buildings and industry. Thus, the mere presence of Legionella does not, in and of itself, result in disease. It is only when Legionella are able to 1) amplify (increase in population density), 2) present certain virulentfactors and 3) gain transmission into the lungs of susceptible human hosts that they can cause LID infections. Legionella must have certain strain - specific virulence factors to cause disease. They must also be present in sufficient quantity to cause infection. One gene (rbrA) is involved in the ability of Legionella to enter and cause toxic effects within host cells (Cirillo, S.L., et al., 2001). • A susceptible host must inhale or otherwise aspirate (choke into their lungs) water or particulates colonized with a sufficient quantity of virulent Legionella. If these Legionella- contaminated droplets are of respirable size ( <5.0 micron), the Legionella can reach the deepest (alveolar) parts of the lung. There they are engulfed by pulmonary macrophages intending to defend the body against invading bacteria. However, instead of being destroyed (digested) by phagocytosis, the Legionella survive and actually grow (amplify) within the macrophages — as they do environmentally within amoebae and other protozoa. At their optimum (human body) temperature for growth, the Legionella amplify to eventually cause cellular lysis (rupture) of the macrophage cells. This soon overwhelms the host's immune system and promulgates the disease. • Legionella 2003 — Update and AWT Statement • • The dose of Legionella pneumophila (or other species of Legionella) required to infect humans is not known. It is most probably influenced by host susceptibility. Growth & Amplification of Legionella: In order to better understand Legionella, its potential to cause disease and how to better control Legionella in water systems, we must understand the conditions that promote Legionella growth and amplification. Major factors include: 1. Stagnant water conditions and /or system design configurations that produce stagnation, such as side -arm and dead -leg piping; 2. Warm water temperatures between 20 and 50 °C (68 to 1220F); 3. Optimal growth is at temperatures between 35 and 45 °C (95 to 113 °F); 4. Bulk water pH in the range of 5.0 to 8.5; 5. Sediment, scale, deposits, biofilm — support not only Legionella growth, but also that of the very important supporting microbiota for Legionella; 6. Microbiota, including algae and many bacteria that supply essential nutrients for growth of Legionella; 7. Certain amoebae and other protozoa that harbor Legionella as endosymbionts — allowing them to thrive, resist harsh environmental conditions (including biocides) and to significantly amplify. Many different types of water systems can serve as Legionella amplifiers and (aerosol) disseminators, and have been associated with LD. They include: • Domestic Hot Water Systems (tap faucets, showerheads, sprayers), • Cooling Towers and Evaporative Condensers, • Spas and Whirlpools (on display or otherwise in use), • Humidifiers, • Decorative Fountains, • Supermarket Reservoir Misters, • Respiratory Therapy Equipment, • Water fountains, • Hot Springs (Waterfalls), and • Dental Hygiene Equipment.* * Note: as a potable water disseminator, should be considered a potential source of LD, however, it is not known to have been linked by direct subtyping to a known case of LD — although a great deal of media attention was given to a California dentist who died of LD a few years ago. Accordingly, due care and concern should be exercised in the operation and maintenance of these and other type water disseminating devices or systems as to their potential to harbor, amplify and transmit Legionella and to the potential health • risk they pose to at -risk individuals. Legionella 2003 — Update and AWT Statement • Transmission of Legionella: After growth and amplification of Legionella to potentially infectious levels, the next requirement in the chain of disease causation is to achieve transmission of the bacteria (in) to a susceptible host. A widely accepted theory for the disease transmission of Legionella is that the organism is aerosolized (in water) from a water - disseminating system or device and is inhaled as tiny (micro) water - droplets, containing the bacterium, and gain entry into the lungs. However, another well documented mode of transmission that effectively gets bacteria into the lungs is "aspiration" — and evidence suggests that it may be the more common mode for Legionella transmission than previously considered. • Aspiration is a "choking process" that can occur during drinking, swallowing or clearing -the- throat and during respiratory therapy. Aspiration is a common way that bacteria enter lungs and cause pneumonia. As it occurs, secretions or fluids in the mouth can get past the choking (gag) reflex and instead of going into the esophagus and stomach, enter the respiratory tract and reach the lungs. Normally, there are protective mechanisms to prevent aspiration, however, these mechanisms can be defective in patients who smoke or have lung disease. According to some present studies, aspiration does appear to be a mode of Legionella transmission. It would neither be safe nor correct to (so simply) state that "You can not get Legionnaires' disease from drinking water containing Legioneltal" 10 Legionella 2003 — Update and AWT Statement • IV. Domestic Plumbing (Potable Water) Systems & Legionnaires' Disease Legionnaires' disease is an environmental disease and an environmental issue, with safety and health responsibilities to be addressed by many. Legionella occur naturally in aquatic habitats and are routinely recovered from municipal water supplies. Low levels of Legionella in municipal water may seed industrial potable water, cooling water and process water networks. Legionella may colonize and amplify in hot water tanks, humidifiers, water - disseminating devices, cooling towers, ice machines, deadlegs in distribution systems and other areas where microorganisms are able to flourish. Cooling towers captured a lot of initial attention and regard to being a significant (possible) reservoir of Legionella and LD health concern. Equal attention and regard, if not more so by some experts, is now appropriately given to the domestic (potable) hot and cold water plumbing system as a significant (possible) reservoir of Legionella and LD health concern. Evaporative cooling systems were initially implicated as the source of Legionella in nosocomial Legionellosis outbreaks. And early on, these systems and cooling towers in general became the "official source and reservoir" of Legionnaires' disease. This was unfortunate and proved problematic to cooling tower owners, manufacturers and to the water treatment industry as a whole, for they were subsequently expected to be the ones responsible to "take care of Legionella. Eventually, epidemiological investigations showed that potable water systems can be a significant source of Legionella. While the larger, headline - grabbing, LD outbreaks are usually associated with cooling towers, information from the United Kingdom (U. K.), Health and Safety Executive, shows that the vast majority of LD cases are sporadic and from sources other than cooling towers. As well, the Centers for Disease Control and Prevention indicate the vast majority of LD cases go unreported and undetected. In studies conducted by Hodgson and Casey in 1998, several thousand samples collected from a variety of sources showed: Legionella Colonization Frequencies: (Hodgson & Casey study, 1998) o. Cooling Towers 6.26% o. Potable Water Distribution Systems 7.01% o. Hot Water Heaters 12.03% While water treatment specialists more typically deal with the non - potable water systems that they chemically treat, i.e., cooling towers, evaporative condensers and other heat - transfer associated water systems, they should also be knowledgeable concerning Legionella in domestic plumbing systems. The Domestic Plumbing System & Legionella: The domestic (potable) water plumbing system can harbor Legionella, provide Legionella with favorable growth and amplification conditions, and has many outlets (taps, shower heads, etc.) to disseminate aerosols that may transmit LD. These systems are an integral part of most buildings, commercial and otherwise, large complexes, including hospitals and other health care facilities, as well as industry in general. Plumbing systems were first implicated in a nosocomial (acquired during a hospital stay) case of Legionnaires' disease in 1980. Since then, plumbing systems have been associated with numerous outbreaks of LD. The United Kingdom • reported 19 of 20 hospital LD outbreaks, from 1980 to 1992, to be from plumbing systems. m Legionella 2003 — Update and AWT Statement • In addition, cases of LD have also been attributed to plumbing systems in nursing homes, workplaces, and private residences. Domestic plumbing systems are thus a major source of concern for LD contraction, particularly within the health -care industry. Hot -water systems are perfect breeding habitats for Legionella, as well as other bacteria that grow in biofilm. Legionella can flourish in hot -water tanks, especially in the bottom where warm zones develop beneath accumulated scale and sediment. The complexities of hot -water piping present an even greater problem than tanks alone. Biofilm and scale that form in valves, fittings and on pipe walls not only amplifies further bacterial growth, but also protects the bacteria "within" from hot water and chemical disinfectants. Deadlegs (unused piping) create additional problems because bacteria grow well in stagnantwater conditions. Temperature Is an Important Factor: Consider temperature in the proliferation (and control) of Legionella. Figure 2 illustrates several key temperatures for Legionella. The most important range to consider from the chart is the growth temperature range. Although growth has been recorded between 20 °C and 45 °C (68 °F and 113 °F), the optimum amplification range is a narrower band of 30 °C to 40 °C (86 °F to 104 °F). Above 45 °C (113 °F) Legionella is killed with time, and at 50 °C (122 °F) it may take up to two hours to attain a 90% kill. Below 20 °C (68 °F) Legionella is largely dormant, though some low level amplification may occur within the vacuole of the protozoan host organism. Figure 2: Legionella and Water Temperature Note: Figure 2 is courtesy of Southeastern Laboratories, Inc. LegioneAa training material presentations. The temperature data in Figure 2 certainly suggests that the operation of potable or domestic hot water systems be at temperatures as high as possible. However, practicality has to consider the risk of scalding injury and energy conservation requirements. • 12 Legionella 2003 — Update and AWT Statement • It should be emphasized that temperature data ( as in Figure laboratory studies and is not from actual system 2) is usually based on emphasized that the system temperature is rarely ner studies. As well, it must be temperature (uniform) throughout the entire system. Thus, it should not be implied that maintaining potable water systems above 50 °C (122 °F) guarantees Legionella control — practical experience has proven otherwise. In actual plumbing systems, especially the larger and /or more complex piping systems, Legionella can survive at even higher temperatures due to biofrlm, deadlegs, and other complexities. Accordingly, _ system temperature should not be relied upon for Legionella control (alone) without routine sampling also indicating control. Disinfection of Domestic Plumbing Systems: Public (municipal) water systems are required to be disinfected at their points of distribution to conform to existing federal standards for bacterial disinfection. However, the federal standards are based upon the absence of Coliform bacteria counts and do not include any specific testing requirements for Legionella. Following disinfection, municipal water supplies generally travel miles before points of use. During this course, disinfectant residuals diminish and there is increasing exposure to potentially biofrlm- contaminated piping. / 1 U Figure 3: 81ofiim and Potabte Water o:er�:h,w:.... Note: Figure 3 is courtesy of the Montana State University — Bozeman Center for MOW Engineering. 13 Legionella 2003 — Update and AWT Statement • Treatment Technologies: There are a variety of methods used to disinfect potable water systems at their point of use. The following is a summary of those most commonly considered and an over view of their technology, as well as their associated advantages, disadvantages and current regulatory considerations. 1. Heat -and -flush (heat shock): This method is a thermal eradication process and involves raising hot water tank temperatures to greater than 140 °F (60 0C), preferably to greaterthan 150 °F (66 0C), and circulating (flushing) through all outlets for up to 30 minutes. The flush time required will depend on the temperature of the water when it reaches the outlets. ► Summary: Thermal eradication provides temporary results; it is very labor- intensive, presents scalding risks, has associated high energy costs, is difficult to achieve complete effectiveness and, at best, provides only short-term (weeks to months) effectiveness. 2. Chlorination: For remedial or temporary disinfection, chlorine is added to water tanks at levels much higher (20-50 mg /I free chlorine) than normal for potable water and flushed throughout the system. For continuous disinfection, flow - adjusted injectors are installed to release chlorine at a drinkable concentration (1 -2 mg /I free chlorine) throughout the domestic water system. However, it has been shown that Legionella suspended in chlorine demand -free water, pH 7.4, containing 2.5 mg/l free chlorine can survive 10 minutes incubation (Gilpin, et al. 1985 — see references). ► Summary: Shock chlorination (high levels) provides temporary results, but is also very corrosive to copper and steel piping, produces potentially carcinogenic disinfection by- products (DBPs), including trihalomethanes (THMs) and haloacetic acids, when reacted with organics, and provides short-term residual effect. ► Summary: Continuous chlorination (1 -2 ppm free) is minimally effective against biofilm, not proven highly effective on Legionella, and may pose corrosion, odor or taste problems. (Unacceptable taste and odor problems generally restrict its use above 2 mg4. Chlorine, as C 12, is regulated under the EPA National Primary Drinking Wa ter Regu/ations (NPDWRs) as a disinfectant at a maximum contaminant level (MCL) of 4 mgA. Its recognized disinfection byproducts, total triha/omethanes and ha/oacetic acids are regulated at MCLs of 0.10 and 0.060 mg11 respectively.) 3. Ultraviolet (UV) Radiation: UV is a point- source disinfection method and no chemical residual is produced or carried throughout the system. Light in the ultraviolet (UV) spectrum range of 250 to 280 nm is microbiocidal due to its action on the nucleic acid structure of DNA. UV sterilizers (lamps) installed on water lines operate to kill Legionella as water flows through the unit. Sufficient energy and residence time are required to adequately irradiate the water column to an effective kill level. Suspended solids will scatter UV and dissipate UV energy. Scaling of the UV lens will interfere with light intensity and energy. ► Summary: UV systems provide point -of -use rapid kill and sterilization, they have no residual effect throughout the system or if unit is shut off and would not be effective in decontaminating systems already infested with Legionella and biofilm, they have energy • cost and operational considerations and require clean (<60 ppm suspended solids) water. 14 Legionella 2003 — Update and AWT Statement 4. Ozonation: Ozone is dissolved into the point of use water system to achieve a dose of about 1 to 2 ppm. Ideally, this is done with a generator that produces ozone in proportion to the water flow rather than a generator that produces ozone at a constant rate regardless of demand. Since ozone is a very strong oxidizer, it is an excellent microbiocide and proven effective at low concentrations. However, it can damage piping and since it has an extremely short half -life, it is virtually impossible to maintain any significant residual throughout a dynamic water system. ► Summary: Ozone generation has significant equipment cost as well as maintenance and operational cost considerations, disinfectant residuals are difficult to distribute or achieve throughout the system and has minimal impact on biofilm or non - planktonic Legionella in dynamic or complex water systems. 5. Copper - silver ionization: Flow- through ionization chambers containing copper - silver electrodes are installed on hot -water lines. As electrical current is applied to the electrodes, positively charged copper and silver ions are released into the hot -water system. The combination of these two metals provides a significant synergism of antimicrobial activity. The positive ions bond to negative bacterial (cell wall) sites, disrupting membrane structures and lead to cellular death. Systems in which the water has scaling potential and/or pH levels above 8.0 are problematic due to scaling electrodes and precipitating copper — both of which lend to significantly reduced effectiveness. ► Summary: Effective treatment with long -term residual effectiveness when off and has a relatively moderate yearly cost of treatment; however, initial capital expense is high and pH higher than 8.0 and scaling water may limit effectiveness and increase operational maintenance and cost; not used to treat the cold water supply, which can be a source of Legionella amplification; local restrictions on copper and/or silver discharge may limit use or effectiveness and the potential for galvanic corrosion on steel exists. (Copper is regulated under the EPA NPDWRs as a contaminant at an MCL of 1.3 mg4 with silver listed as a secondary (NSD WRs) contaminant at 0.10 mg/l.) 6. Chlorine Dioxide: Chlorine dioxide is a highly reactive gas that readily dissolves in water and remains a true gas in solution. It does not significantly hydrolyze in water, thus it retains biocidal activity over a broad pH range. Its primary mode of action is oxidation, however. a) it does not react with naturally occurring organic compounds to form THMs, b) is non - reactive with ammonia and most nitrogen- containing compounds, and c) is less aggressive to copper and steel than chlorine. It has viracidal and sporacidal activity and has been shown to be efficacious on Legionella, as well as effective in biofilm. For most practical water treatment disinfection purposes, it must be generated on -site for subsequent use. Prior to the newer electrochemical methodologies of generation today, on -site generation of chlorine dioxide was considered objectionable due to the necessity to intimately handle the hazardous chemical reactants. The packaged systems for chlorine dioxide production available today have eliminated this major objection. ► Summary: Chlorine dioxide is an effective treatment for Legionella and biofilm at levels as low as 0.2 mg/1 with minimal objections; however, it must be generated on -site and treatment cost may be a consideration. (Chlorine dioxide, as CIOZ, is regulated under EPA NPDWRs as a disinfectant at an MCL of 0.8 mg /I. Chlorite, a disinfection byproduct, is • regulated at an MCL of 1.0 mgfl.) 15 Legionella 2003 — Update and AWT Statement • Note on Monochloramine: The use of monochloramine as a biocide in municipal water systems has proven more effective than chlorine and is currently in use by 25% of municipalities. It is more stable than chlorine and produces fewer disinfection byproducts (DBPs). In addition, field epidemiologic data correlates well with reductions of Legionella in potable water systems treated with monochloramine (Chapter 79, ASM Press book on Legionella, 2002). (Chloramines, as C 12, are regulated as an EPA NPDWRs disinfectant at an MCL of 4 mgll.) L Note on EPA Drinking Water Standards: The National Primary Drinking Water Regulations (NPDWR) are legally enforceable standards that apply to public drinking water systems. These standards protect public health by limiting the levels of contaminants in drinking water. The National Secondary Drinking Water Regulations (NSDWR) are non - enforceable guidelines regulating contaminants that may cause cosmetic effects (such as skin or tooth discoloration) or aesthetic effects (such as taste, odor or color) in drinking water. The EPA recommends secondary standards to water systems, but does not require the systems to comply. State Departments of Environmental Resources (or Protection) are responsible to enforce the primary standards and may choose to adopt secondary standards as enforceable. The applicability of these standards to point of entry (POE) or point of use (POU) treatment technologies in non - public water systems (e.g., healthcare facilities using a municipal water supply) is an unresolved issue and should be considered when evaluating treatment options. At present, states are taking various approaches to non public drinking water distribution systems within facilities. These range from no involvement at all to full requirement of the use of products certified under ANSI standards. Some states require their non - public water systems applying treatment technologies to comply with a variety of regulations including permitting and other reporting requirements. These regulations do not apply to process, cooling towers, or other non - potable water systems. Facilities should certainly evaluate their state requirements when considering treatment technologies. Along with any disinfection methods of treatment used, the following are recommendations and sound practices to help manage and reduce the incidence of Legionella contamination within domestic plumbing (hot and cold) water systems: • Reduce deadlegs (stagnant lines and stubs) in the system, • Clean and inspect hot water tanks regularly — annually as a minimum, • Continually run hot water circulation pumps — avoid recycling to mixing valves only, • Store hot water at a minimum temperature of 60 °C (140 °F) and deliver to the taps at a minimum temperature of 50 °C (122 °F), • Store and distribute the cold domestic water below 20 °C (68 °F) — if not possible, then consider monitoring for Legionella and using a disinfection system if Legionella are not under control, • Flush the entire water system on a regular basis, • Consider routine potable water treatments — including the use of approved biocides. 16 Legionella 2003 — Update and AWT Statement • V. Cooling Towers: Water Treatment & Legionnaires' Disease Cooling towers and evaporative condensers have the potential to develop infectious concentrations of Legionella. These systems can provide the favorable conditions for the growth and amplification of many microorganisms, including Legionella. Tower drift (water loss) becomes the mist or aerosol that can transmit potentially infectious Legionella. The evaporative (cooling) process causes makeup waterborne constituents, as well as system water constituents, to concentrate (i.e., remain in the tower loop according to cycles of concentration). The recirculating water's retention (residence) time in the water loop allows for increased growth and reproduction of organisms. Warm water temperatures, along with the presence of corrosion by- products, other deposits and sediment debris, further promote biofilm and provide Legionella an ideal environment for growth and amplification. Water Chemistry & System Maintenance should be well controlled in these systems. The chemical treatment objectives of any prudent water treatment program are to reduce corrosion, deposits, and microbiological fouling. These same practices will also significantly contribute to the control of Legionella growth and amplification. Cooling tower systems associated with ineffective water treatment practices and/or neglect certainly present a greater likelihood of harboring potentially infectious Legionella. However. high (e= we tr o r s�vs�. lesting perrormea on lssti cooing tower samples rrom rouuneiy maintained tower systems (Gilpin, et al., 1995) showed that Legionella was not found to be ubiquitous in such systems: 46% of the samples had no detectable Legionella, 90% of the samples had Jess than or equal to 200 morphologically intact Legionella /ml and only 3% had counts exceeding 1000 morphologically intact Legionella/ml. ► Biocide Treatments play a major role in microbiological control programs. including the microbial organisms, nor are meV 1uu "/o emcaGO_m In the case of Legionerra Control, n must be stressed that the efficacy of any specific biocide can only be determined by testing for the presence of Legionella in the field under actual operating conditions. Environmental Legionella cannot be reproduced in the laboratory from culture -grown organisms. Therefore, laboratory trials should not be relied upon exclusively for proof of a biocide's efficacy against Legionella. In addition, Total Bacterial Counts (TBQ of a coolinci-water or was ► Biodispersants play an important role in microbiological control programs, particularly against Legionella. These chemicals act to loosen microbial deposits (slime, sludges, etc.) and promote system cleanliness. Biodispersants promote biocide penetration of biofilm and enhance the effectiveness of biocides. Biofiim is often seen as the slime layer on surfaces in contactwith water. Legionella flourish within biofilm since it is nutrient -rich and contains a diverse population of microbiota, including amoebae and other protozoa. As opposed to being freely suspended (planktonic) in the bulk water, biofilm Legionella and Legionella within protozoa are protected from concentrations of biocide and/or other environmental is conditions that would otherwise kill or inhibit them. 17 Legionella 2003 — Update and AWT Statement • Biodispersants should not be used alone in microbiological or Legionella control programs without also using biocides. In their various modes of action, biodispersants may loosen and free large amounts of biofilm related bacteria (including Legionella) into the bulk water. These bacteria may be viable and (now in the bulk water) have the potential to be transmitted from the tower and pose an LD health risk. Biodispersants are meant to supplement and enhance the performance of biocides, not replace or serve as an alternate to the use of biocide. Cooling Tower Disinfection for the purpose of Legionella control and disease prevention is generally recommended as: • Maintenance actions for startup, post lay -up or regularly scheduled tower cleaning; • Corrective prevention and control actions following system (tower) Legionella sampling with elevated counts; and • Required actions following a confirmed or suspected system LD case. The following is an abbreviation of the emergency cooling tower disinfection method described by the Centers for Disease Control and Prevention (CDC), 1997. This procedure is usually used if there is suspicion that the tower may have been the source of exposure for a case of Legionnaires' disease. The complete methodology should be previewed for a full understanding of the CDC procedure. It should be noted, however, that most cooling' tower and water treatment experts differ with respect to the chlorine levels recommended and the routine frequency of using this type disinfection, due to the corrosive (damage) potential of chlorine to system materials of construction. Guidelines established by ASHRAE (2000) and by CTI (the Cooling Technology Institute) (1996) should also be consulted. 1.' Shut off the cooling tower fans; 2. Keep makeup water valves open and the circuloon pumps operating; 3. Close outdoor air intake vents located within 30 meters of the cooling tower; 4. Achieve an initial free residual chlorine (FRC) of at least 50 mg /L; 5. Add a dispersant to tower water within 15 minutes of chlorine addition, then maintain 10 mg /L FRC for 24 hours; 6. Drain and refill the system, then repeat steps 4 and 5 at least once to remove all visible algae -like film; 7. Using a brush and water hose, thoroughly clean all water - contact areas, including the basin, sump, fill, spray nozzles, and fittings; 8. Circulate 10 mg /L FRC for one hour, then flush the system until free of all sediment; 9. Refill the system with clean water and return to service. Note: It is generally recommended today that dispersant - chlorination (only) disinfection procedures for Legionella also include a final step maximum dosing (per EPA label) of a nonoxidizing antimicrobial combination — either a synergistic combination in one product • or two separately applied products. 18 Legionella 2003 — Update and AWT Statement • VI. Cooling Towers and Legionella: Objectives and Guidelines Cooling Tower Legionella Objectives — Minimizing Counts & Transmission Because of the potential for any cooling tower to harbor, amplify and to disseminate Legionella, control measures need to be considered for all cooling tower and evaporative condenser operations. Legionella control measures should encompass two objectives: 1. Minimizing Legionella Counts in Cooling Towers: Practically keeping Legionella below detectable levels in every cooling tower system at all times is not feasible and should not be expected. However, practices and precautions to minimize Legionella in cooling towers are reasonable and should bean ongoing control effort. Many of the measures that are generally recommended for Legionella control in cooling towers are also recommended for the efficient operation and proper maintenance of a cooling tower system and include: • Proper Design • Periodic Cleaning • Regular Maintenance • Effective Water Treatment In combination, these measures generally minimize Legionella counts in a tower, but cannot be expected to eliminate them entirely in every system. Even properly maintained and operated cooling towers have been found to have high Legionella counts. 2. Minimizing Legionella Transmission from Cooling Towers to People: Minimizing transmission from the tower to a host is the second responsible measure in reducing risk of LD, again recognizing that there are no guarantees to keeping a tower system 100% Legionella -free. The following considerations should be made: • Minimize Tower Drift with proper and well maintained eliminators • Locate Tower to keep drift from air intake pathways to potential hosts Locate Tower to keep outside sources of plant life or nutrients from entry • Use of appropriate masks or respirators by workers or others subject to drift Design Guidelines for Cooling Towers and Evaporative Condensers should take the following into consideration to minimize Legionella counts in the tower and minimize transmission of Legionella from tower to people: 1. Tower location should consider prevailing winds and proximities with respect to people populations (particularly at -risk populations), building air intakes and surrounding units. 2. Tower location should consider prevailing winds and proximities which could introduce bacterial nutrient sources into the tower (kitchen exhausts, industrial processes, etc.). 3. Shield or cover cold -water basins, distribution decking, and other wet surfaces from sunlight to prevent algae growth in biofilms. 4. Materials of construction should be smooth and non - porous. 5. Water distribution piping should: a) be as simple as possible — avoiding deadlegs, stagnant lines and loops that are difficult to drain, b) promote effective flow through the • entire system — utilizing equalization lines when necessary. 19 • • Legionella 2003 — Update and AWT Statement 6. Towers should be easily accessible for inspection, sampling, cleaning and disinfecting. 7. The system should be designed to be completely drained or pumped out. 8. Provisions should be made to effectively dose, monitor and control a water treatment program, including: a) inhibitor and biocide /s chemical injection, b) water sampling, c) corrosion coupon sampling, and d) effective bleed and control points. 9. High efficiency drift eliminators should be used and maintained. 10. Filtered water, treated with trace (or greater) halogen residual, should be used as tower make -up. 11. Multiple -cell tower basins should be designed such that each cell and basin can be isolated, while the other cells remain in operation. 12. The tower system's total operating volume should be known for proper chemical dosing, particularly that of biocide and dispersant treatments. Figure 4 shows the physical and mechanical relationship of a cooling tower to its associated HVAC equipment and the potential transmission of Legionella within the system to an office or other facility building air supply. It should be clear from this graphic why many of the cooling tower design and operational recommendations are made with respect to Legionella control and minimizing the risks of LD transmission. t Figure 4: HVAC and Legionella Transmission G At IF ' Note: Figure 4 is courtesy of Medscape® at httD: / /www.medscaDe.com 20 Legionella 2003 — Update and AWT Statement • Operational Guidelines for Cooling Towers and Evaporative Condensers should take the following into consideration to minimize Legionella counts in the tower and minimize transmission of Legionella from tower to people: 1. Clean tower and disinfect before start-up, especially new system start-up, and after any long shutdown period (greater than 2 to 4 weeks). 2. Treat water for control of corrosion, scale, fouling and microorganisms. 3. Establish a maintenance plan and log all activities, including the chemical treatment program's dosages, services and results. 4. Maintain all drift (mist) eliminators in efficient and proper operating condition as well as the operations of fans that affect drift productions. 5. If deadlegs in the piping system exist and cannot be removed, blow them down regularly — particularly after biocide treatments and cleanings. 6. Exercise all valves in the system periodically by opening and closing them fully. 7. Clean the basin when slime, algae, or dirt are visible. 8. Blow down direct free cooling (chilled water) risers weekly. 9. Thoroughly flush and clean the entire system at least once (preferably twice) a year — and include an oxidizing disinfection before and after each cleaning. 10. Where a cooling tower is out of use, it should be drained and kept dry. • How Much Halogen? Many, including OSHA and CTI, recommend continuous feed of chlorine or bromine to effect control of Legionella in cooling tower systems. However, there is not a consensus recommendation on the (free) halogen level to maintain in these systems. The OSHA Technical Manual states that maintaining less than 1.0 mg /L free chlorine or bromine (with continuous feed) may not be enough to control Legionella, while more than 1 mg/L may be corrosive. CTI recommends 0.5 to 1.0 mg /L free halogen. A realistic approach would be to establish a free halogen level based on an evaluation of the "technical specifics" for each system, and include the following considerations: • System materials of construction and sensitivity to oxidant corrosion or attack, • Water chemistry (indices) and corrosion potential for the system, • Corrosion control history, if not new, for the system, Corrosion monitoring program in place, • Microbiological and other fouling potential for the system (process or HVAC), • Microbiological control history, if not new, for the system, • Technical capabilities of the corrosion control products (program), • Technical capabilities of the alternate microbiological control products (program), and 21 Legionella 2003 — Update and AWT Statement • • A Legionella risk assessment of the system to include: • ► Design, maintenance & operation, ► Proximity of "at -risk" host populations, ► If Legionella testing is done, and ► History of Legionella control Accordingly: Systems where Legionella risk and /or history are great (bad) may opt for the higher free halogen levels (1 -2 mg /L, or more), even if corrosion potential or failures may be higher than desirable. And: Systems with less tolerance for corrosion failures and having a low Legionella risk assessment would operate at the lower free halogen levels (0.5 -1 mg /L). The ability to monitor corrosion and /or Legionella control provides additional tools to determine and "fine -tune" what free halogen levels work best to achieve treatment and protection objectives. Finally, if corrosion control is a must, yet unacceptable with the free halogen levels needed for Legionella control, then an alternative Legionella control program should be designed. Chlorine dioxide, a proven biocide effective against Legionella without posing the corrosion problems associated with halogen biocides, could be considered. Using multiple non - oxidizing biocides, along with biodispersants, at their maximum allowable dosages may be considered, although there is generally increased treatment costs associated with such programs. 22 Legionella 2003 — Update and AWT Statement • VII. Sampling and Testing for Legionella: A Proactive Decision • Legionella Testing -- Logic: Sampling and testing for Legionella can be useful in helping assess risks and in determining whether or not preventive and corrective measures are working. Having an action plan based on results of Legionella sampling can alert you to increased risks and whether or not disinfection procedures should be implemented. Not sampling tells you nothing about a system — until a case of LD occurs. With those quite logical and simple statements made, it may be assumed that Legionella sampling should be and is routine for any monitored system. Such is not the case. Legionella Testing — Issues: Legionella experts have debated the issue of routine sampling and testing for years. The CDC advocates sampling after LD has been found (suspected or confirmed) so as to locate the source of Legionella and take remedial action. They do not encourage sampling in the absence of suspected or confirmed LD cases. Other experts disagree with this and advocate a more proactive approach of conducting periodic sampling (so- called "routine sampling") even if no cases of LD have been detected or suspected. Some of the current facts and understanding of Legionella and LD that continue to support any real consensus from being achieved amongst the experts include the following: a There is no specific infectious density known for Legionella or a clearly established correlation between test culture or direct fluorescent antibody (DFA) test results of Legionella and risk of contamination. • Legionella is frequently present in water supplies without causing disease, so routine testing and obtaining positive test results do not mean LD will occur. It may even produce a false sense of alarm and lead to costly corrective actions being undertaken. On the other hand, obtaining negative results does not assure that LD cannot occur and may provide a false sense of security that leads to relaxation of prevention measures. J. Brown (et al., 2001) noted that Australia has a protocol requirement for immediate cooling tower decontamination when Legionella counts reach a certain level. However, towers directly linked to LD cases were found to have Legionella counts below the protocol action level. Interpretation of results in routine Legionella sampling is still questionable due to ► Different bacteriologic methods used amongst laboratories, ► Variable results between culture and direct fluorescent antibody methods, ► Variable culture results from differing sites within the same system, and ► Variations in the counts of Legionella isolated from a single site. In addition, potentially infectious Legionella in some water samples may not grow on the microbiological medium specifically formulated to grow Legionella. The risk of illness following exposure to a given Legionella source is influenced by a number of variables and factors other than just the concentration of organisms in a sample. Host susceptibility, Legionella strain virulence, and efficiency of Legionella transmission (to host) are integral to LD risks and disease progress. 23 Legionella 2003 — Update and AWT Statement • . Routine testing may present ambiguous (legal) liability issues: testing and getting positive results may establish a legal liability if a disease case occurs; yet the testing may prevent negligence charges from applying. On the other hand, not testing in the face of risk or other factors may support negligence and guilt in defending a responsible LD case. (Cases to note: In 1997 OSHA fined a Cincinnati, OH injection molding facility following an investigation of three LD cases with no deaths. The fine was based on the General Duty Clause that requires employers to maintain a workplace free from recognized hazards. However, in 1998, following an investigation of LD cases with a death at a Baltimore, MD injection molding facility, the Maryland Department of Occupational Safety and Health Administration (MOSH) did not fine the employer. In the Maryland case, itwas decided that plant management had taken proactive steps to reduce risk of LD among employees. The Maryland company had a good water treatment program and took immediate action to reduce the possibility of more cases of Legionnaires' disease.) Legionella Testing is a Proactive Choice: There is no risk for LD if there is no Legionella. The only (practical) way to know if you have Legionella is to test for it Since the risk of LD depends upon Legionella being present, those in favor of routine sampling maintain testing is logical, necessary and a proactive choice. The same reasoning applies, that, if you are taking measures to minimize Legionella in water, then you should periodically check Legionella levels to be sure that preventive measures are working. Although sometimes inconclusive, the results of sampling can at other times provide life- saving information. Most experts do agree, including those that do not favor routine sampling, that there should be a consideration to sample any system that presents significant LD risk and /or exposure potential. Final consideration would be based on a thorough review and risk assessment of the system and its operating particulars. Specific risk assessment data would include: makeup and system water characteristics, system design and operational data, fouling history and potential, potential host populations and susceptibility, and LD case history. Legionella Sampling: The most important consideration in Legionella sampling (testing) is to select a laboratory that has significant experience in culturing and testing samples for Legionella. There are specific sample collection procedures, preparation criteria and shipping requirements that should be followed and will be provided by a competent testing firm. They are beyond the scope of this document but, in general, include instructions for: sample type (swab or water), sample size and container requirements, sterile collection (chlorine neutralization) procedures, un- refrigerated shipping and time requirements, etc. Legionella Test Results, Interpretations & Action Plans: The following excerpt is by J. R. Watson, Ph.D., Legionella Update -2000, Microbiological Consultation Services, Inc.: "Although small numbers of Legionella bacteria probably pose a very low risk to healthy individuals, corrective action should be kept in mind whenever legionellae are isolated from a water sample. Although the scientific community cannot agree on what number of Legionella bacteria is acceptable, we believe colony counts, as expressed in colony forming units (cfu) per ml of water, can be used as a loose guide for deciding when to implement corrective action. Legionella pneumophila colony counts for cooling tower specimens may • be interpreted as follows: 24 Legionella 2003 — Update and AWT Statement • >100 cfulml =large number of Legionella bacteria. • 10 -100 cfulml = moderate number of Legionella bacteria. • <10 cfulml =small number of Legionella bacteria." CJ The significance of Legionella laboratory test results and subsequent formulation of action plans to apply to systems monitored for Legionella is still somewhat at question. Again, this is where the scientific community simply does not yet have a definitive consensus. However, there is a general consensus that some sort of guideline should be used versus none at all. The following various guidelines and action plans are provided as a resource to such an end: 1. The OSHA Technical Manual offers the following guidelines to use when interpreting Legionella analyses for cooling tower and potable water systems. The guidelines may be used to assess the effectiveness of water system maintenance and Legionella control. These guidelines are based on limited data and are subject to change. They are intended to apply only to water systems being used by healthy individuals and are not necessarily protective for persons who are immunocompromised. The levels requiring action vary for the source of exposure based on the assumption that some routes or exposure result in a greater dose to the lung. For this reason, humidifiers and similar devices such as misters and evaporative condensers, which produce an aerosol mist that can be directly inhaled, should be controlled to lower levels. Remember that these numbers are only guidelines, and the goal is zero detectable Legionella in a water source. Levels of Legionella equal to or greater than the values in the table constitute a need for action, as described below. ► Action 1: Prompt cleaning and /or biocide treatment of the system. ► Action 2: Immediate cleaning and /or biocide treatment. Take prompt steps to prevent employee exposure. Colony Forming Units (CFU) of Legionella per milliliter Action Cooling tower Domestic water Humidifier 100 10 1 1,000 100 10 [From OSHA Technical Manual (Section III: Chapter 7, Legionnaires' Disease), which was adapted from George K. Morris, PhD, and Brian G. Shelton, Pathcon Technical Bulletin 1.3, Legionella in Environmental Samples: Hazard Analysis and Suggested Remedial Actions, June 1991) 2. Richard W. Gilpin, Ph.D., and GTS Legionella Water Testing Lab provides the following remedial action criteria as an attachment to all their Legionella test reports. The units of measure are from their Direct Florescent Antibody (DFA) epifluorescence microscopy and represent total numbers of morphologically intact Legionella observed. ► <10- 201m1: This is the most common test result and does not require remedial action. Retest in a month to check for evidence of increasing numbers of Legionella. 25 Legionella 2003-- Update and . AWT Statement ® 30- 1901mi: This is the second most common test result. A decision to disinfect the tower should be made by considering the numbers of Legionella, location of the tower, and the type of employee, patient, or visitor population. The tower's proximity to pedestrian traffic, building air intakes, open windows and doors should also be considered. If tower is disinfected, retest after disinfection to make sure the procedure was successful. Review and revise the biocide treatment program currently in use. If the tower is not disinfected, retest within a few weeks to check for evidence of increasing, numbers of Legionella. ► 200 - 1,000 + /ml; Least likely test result, but may be reached quickly from a previously lower level. Result represents a public health concern and disinfection of the tower is indicated. If the count is >1,000/ml, take immediate action. Retest after disinfection to make sure the procedure was successful. Review and revise the biocide treatment program currently in use. Retest within a few weeks to check for evidence of increasing numbers of Legionella: 3. A common cooling tower Legionella testing and action plan is seen in Figure 5. It represents a composite compilation of various AWT member Water Treatment Company Legionella action plans for cooling tower operations. The frequency of tower sampling for Legionella varies widely amongst the programs (i.e., monthly; quarterly, semi- annually to annually) and is generally determined from specific site and system LID risk assessments. Figure 5: General Cooling Tower Legionella Testing Action Plan Note: Figure 5 is courtesy of Southeastern Laboratories, Inc. Legionella training material presentations. 26. Legionella 2003 — Update and AWT Statement • Vlll. Health Care Facilities — A Special LD Risk Environment 0 Note: Table 1 was excerpted and adapted from "Resolving the Controversy on Environmental Cultures for Legionella: A Modest Proposal" by Victor L. Yu. Infect Control Hosp Epidemiol 1998;19:893 -897. Cooling tower samples are not included in the data. Health Care Facilities and JCAHO: Potable water plumbing systems present a favorable habitat for Leglonella and pose an associated LD risk to the susceptible host populations within the healthcare community. Thus, there is a major emphasis on the risk assessment, control and management of these systems and their associated water disseminating equipment or systems in health care facilities. In accordance with this concern, the Joint Commission for the Accreditation of Healthcare Organizations ( JCAHO) issued a new standard that became effective January 1, 2001. This standard, numbered EC 1.7, requires all JCAHO accredited facilities to have a management program to "reduce the potential for organ izationalacqu!red illness:' It holds the health care facility responsible for "managing pathogenic biological agents in cooling towers, domestic hot water, and other aerosolizing water systems"— i.e., Leglonella among others. The American Society for Healthcare Engineering (ASHE) has recommended in their technical reports on managing waterbome pathogens, per JCAHO EC 1.7, that health care facilities conduct a risk assessment of their potential sources of Legionella and develop a management plan for maintenance and operation of their water systems. 27 % with Reference Location Hospitals Isolate Leglonella HMSO United 40 70% L pneumophila, Kin dom sero rou 1 L pneumophila, Alary Quebec 84 68% sero rou s 1 -8 Western L pneumophila, Vickers Pennsylvan 15 60% serogroups 1-6 is Patterson United 69 55% L pnemophila, . Kingdom Legion efla species Nova L pneumophila, Marne Scotia 39 23% Le ionella lon beachae Liu United 17 12 °k L pneumophila, Kin dom sero rou s 1,4,6 Note: Table 1 was excerpted and adapted from "Resolving the Controversy on Environmental Cultures for Legionella: A Modest Proposal" by Victor L. Yu. Infect Control Hosp Epidemiol 1998;19:893 -897. Cooling tower samples are not included in the data. Health Care Facilities and JCAHO: Potable water plumbing systems present a favorable habitat for Leglonella and pose an associated LD risk to the susceptible host populations within the healthcare community. Thus, there is a major emphasis on the risk assessment, control and management of these systems and their associated water disseminating equipment or systems in health care facilities. In accordance with this concern, the Joint Commission for the Accreditation of Healthcare Organizations ( JCAHO) issued a new standard that became effective January 1, 2001. This standard, numbered EC 1.7, requires all JCAHO accredited facilities to have a management program to "reduce the potential for organ izationalacqu!red illness:' It holds the health care facility responsible for "managing pathogenic biological agents in cooling towers, domestic hot water, and other aerosolizing water systems"— i.e., Leglonella among others. The American Society for Healthcare Engineering (ASHE) has recommended in their technical reports on managing waterbome pathogens, per JCAHO EC 1.7, that health care facilities conduct a risk assessment of their potential sources of Legionella and develop a management plan for maintenance and operation of their water systems. 27 Legionella 2003 — Update and AWT Statement • Health Care Facility— Risk Assessment & Management Plans: JCAHO surveyors now clearly expect health care facility managers to have a risk assessment and management plan in place to comply with JCAHO's EC 1.7 standard. Following is an outline from the ASHE web site on what a facility manager should be doing to comply with EC 1.7 and what JCAHO inspectors are looking for: Step 1: Risk Assessment ► Work with the Infection Control Practitioner to assess the clinical risk of the patient population to identify and review: • The treatment and care areas for patients at greatest risk, • Any cases or current history of infections resulting from water borne pathogens, including legionellosis. ► Assess the environmental risk from potential amplification factors such as: • Domestic hot water systems • Design (i.e. dead legs and low flow conditions) • Operation (i.e. water temperature) • Maintenance (i.e. flushing and cleaning of hot water tanks) ► Assess cooling and humidifying systems, which produce aerosols: • Design (i.e. drift eliminators) • Operation (i.e. sterile water in room humidifiers) • Maintenance (i.e. cleaning cooling towers and use of an effective biocide) Step 2: Risk Mitigation ► If susceptible patients are identified, work with the Infection Control Practitioner to determine what aerosolizing systems are present in that patient's environment (i.e. showers) and limit their access to these systems. Step 3: Operational Management of Risk ► Develop a management plan as a result of the assessment (step 1) that includes standard operating procedures (SOP's) for maintenance and operation of water systems. ► Develop a system to document and log findings as a result of these SOP's such as temperatures, blow down of hot water tanks, cooling tower inspections, etc. ► Include in these SOP's a maintenance and audit program for any systems that are currently installed to limit Legionella amplification in aerosolizing systems such as cooling towers and /or potable water treatment systems (e.g. copper- silver or chlorine dioxide). ► Inspect cooling towerslevaporative coolers to ensure that they are in proper condition and operate as designed. Step 4: Remediation (if required) ► Work with the organization based Infection Control and Safety committee to establish a • contingency plan for water system decontamination to be implemented if Infection Control identifies an outbreak of Legionellosis and corrective steps are needed. 28 • Legionella 2003 — Update and AWT Statement IX. Legionella Information — On the Internet Much information, both international and multi - disciplined, on Legionella and Legionnaires' disease is accessible via the Internet. The following Internet sites (addresses) are listed as a resource to additional information on Legionella. The list is certainly not all- inclusive, but does provide an excellent collection of top sites on the subject matter and from which other sites are linked and /or accessible via Internet search engines: http: /Mww.ashrae.org ASHRAE (American Society of Heating, Refrigeration and Air - Conditioning Engineers, Inc.) web site: where you can download their latest position and guideline papers on Legionellosis. http: /Nvww.awt.org Association of Water Technologies (AWT) web site: where you can download their latest Legionella update and position statements. http: //www.odc.gov CDC (The Centers for Disease Control and Prevention) web site: where you can search and get their latest guidelines and information on LD. http: / /www.cti.org Cooling Technology Institute (CTI), formerly the Cooling Tower Institute, web site: where you can download their latest position papers on Legionella. http: / /www.dhmh.state.md. us/html /legionella.htm State of Maryland Department of Health & Mental Hygiene web site: get their special LD "Report of the Maryland Scientific Working Group to Study Legionella in Water Systems in Healthcare Institutions" (June 14, 2000). http: //www.hcinfo.com HC Information Resources web site: provides publications, consulting services, seminars and training related to Legionella and other waterborne pathogens — comply with JCAHO EC 1.7. Some info is free, others have fees. http: //www.legionella.com GTS web site: a Legionella testing firm in business since 1981, where you can get their Legionella facts, publications, info sheets and services. http: / /www.legionella.org The Pittsburgh VA HealthCare System's dedicated Legionella site with access to leading Legionella experts and LD information. http: /Mww.osha.gov OSHA home page: where you can search and get OSHA LD information, including their latest manual (Section III, Chapter 7) on LD. http: / /pathcon.com PathCon Laboratories, a Legionella and indoor air quality testing firm, microbiological and investigative LD expertise — get their Legionella Technical Bulletins. 29 Leglanella 2003 — Update and AWT Statement • X. AWT Position Statement— Legionella & Legionellosis U The Association of Water Technologies makes the following recognition and position statements regarding Legionnaires' disease, water treatment and related practices of water treatment specialists. They are based on the significant and prevailing information from ASHRAE, CDC, CTI, EPA, OSHA, the medical community, leading experts and other authoritative agencies that study, investigate and deal with Legionella and Legionellosis. 1. AWT recognizes the potential hazard for Legionella contamination in cooling towers and evaporative condensers, as well as other water systems and water disseminating devices or equipment that may or may not be a part of water treatment programs. 2. AWT supports that prudent operational and water treatment practices for cooling towers, evaporative condensers and other recirculating water systems, are consistent with reducing Legionella contamination within them and include: • Corrosion, scale and deposit control programs that promote operational efficiency and system cleanliness and reduce microorganism- breeding areas. • Dispersant, biodispersant and antifoulant programs that reduce biofilm, sludge, debris and dirt accumulations —that further reduce microorganism - breeding areas. • Biocide programs, including oxidizing and non - oxidizing treatments that are applied according to proper labeling, to control microbiological growth and proliferation. • Maintaining best available mist elimination technology in evaporative systems and eliminating or minimizing stagnant (dead -leg) zones and areas. • A minimum annual (twice annual preferred) thorough wash -out and cleaning of cooling towers and evaporative condenser cooling water systems - including an oxidizing disinfection before and after each cleaning. 3. AWT supports that the microbiology and environmental ecology of Legionella includes many variables that determine organism virulence and survival, disease transmission and contraction, and human host susceptibility. And, even prudently applied water treatment programs cannot guarantee 100% Legionella eradication or disease prevention. 4. AWT supports the sampling and testing for Legionella in cooling towers, evaporative condensers and other water systems appropriately risk - assessed and evaluated to pose disease risk. Specifically targeted systems include those that have a likelihood of harboring Legionella and /or pose an increased risk of transmission to populations of at -risk hosts. Monitoring for Legionella within a facility may also be appropriate or required to: • Verify the effectiveness of water treatment protocols, • Evaluate potential LD transmission sources, • Verify the effectiveness of Legionella decontamination procedures, • Test within certain healthcare facilities that have patients at high risk for LD. 30 Legionella 2003 — Update and AWT Statement • 5. AWT supports that LegioneAa sampling and testing should be considered for all potential LegioneAa -source water systems. An ultimate decision to test or not should be determined and based upon an assessment and review of the specific water system (site and operations) for LD risks. This includes having an understanding of relevant facts on LegioneAa sampling and testing, LegioneAa and Legionnaires' disease, and having an action plan for test results. Accordingly, AWT does not recommend the routine sampling and testing of all systems without appropriate assessments. • 6. AWT will continue to investigate and evaluate, as well as promote and report, the latest findings, research and technologies relevantto the control of LegioneAa and the prevention of Legionnaires' disease. This includes independent research, as well as liaison and joint exchanges with government agencies, other organizations, associations, and related professional entities. 7. AWT, as a Responsible Care® Partner Association, further commits to sharing with the water treatment industry, the health care community and industry at large, as well as the general public, any relevant information gathered and produced from their resources addressing LegioneAa and Legionellosis. 31 Legionella 2003 — Update and AWT Statement • References American Society of Heating, Refrigerating and Air- Conditioning Engineers ( ASHRAE), Atlanta, GA. Minimizing the Risk ofLegionellosis Associated with Building Water Systems. ASHRAE Guideline 12- 2000 February 2000. American Society for Testing and Materials. 1998. Standard Guide forinspecting Water Systemsfor Legionellae and Investigating Possible Outbreaks of Legionellosis (Legionnaires' Disease and Pontiac Fever). Standard D5952. West Conshohocken, Pennsylvania Anderson, L.J., Arden, N.H., Breiman, R.F., Butler, J.C., McNeil, M.M., Tablan, O.D. and the Hospital Infection Control Practices Advisory Committee. (1994). Guideline for Prevention ofNosocomial Pneumonia. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. . Barbaree, J.M., Breiman, R.F. and Dufour, A.P. (1993). Legionella: Current Status and Emerging Perspectives. American Society for Microbiology, (ASM), Washington, D.C. Breiman, R.F., Butler, J.C. and Fields, B.S. (1997). Prevention and Control of Legionellosis. Infectious Diseases in Clinical Practice 6, 458 -464. Brown, J., Hoyt, K, Bouwman, R., Capon, A., Bansal, N., Goldthorpe, l., Chant, K, and Vemulpad, S. (2001). Investigation and control of a cluster of cases of Legionnaires' disease in western Sidney. Communicable Disease Intelligence 25:63 -66. Cirillo, S.L., Bermudez, L.E., El -Etr, S.H., Duhamel, G.E, and Cirillo, J.D. (2001). Legionella pneumophila entry gene rtxA is involved in virulence. Infection and Immunity 69:508 -517. Control ofLegionella in Cooling Towers, Rev. 8/87, POH4242 (1987). Wisconsin Division ofHealth and Social Services. A copy of this document may be obtained from the Wisconsin Division of Health and Social Services, Madison, WS 53701. Cooling Technology Institute (CTI), formerly the Cooling Tower Institute, Guideline: Best Practices for Control of Legionella, February 2000. Freije, M.R., HC Information Resources, Inc., (1998). Disinfecting Plumbing Systems ofLegionella: Solving Problems Without Overspending: HC Special Report 303. Freije, M.R., HC Information Resources, Inc., (1998). How to Make Plumbing Systems Less Conducive to Legionella and Other Bacteria: HC Special Report 302. Freije, M.R., HC Information Resources, Inc., (1998). Legionnaires' Disease: Facts, Legal Issues, Risk: HC Special Report 301. Freije, M.R., HC Information Resources, Inc., (1998). Legionella Environmental Sampling Guide: HC Special Report 306. Freije, M.R., HC Information Resources, Inc., (1998). Minimizing the Risk ofLegionella in Cooling • Towers and Other HVAC Equipment: HC Special Report 304. 32 Legionella 2003 — Update and AWT Statement • Freije, M.R-, HC Information Resources, Inc., (1998). Sample Water for Legionella? Weighing the Benefits Against the Costs: HC Special Report 305. Fiore, A.E., Kool, J.L., Carpenter, J. and Butler, J.C. (1997). Eradicating Legionella From Hospital Water. Journal of the American Medical Association, 1404 -1405. Flanders, W.D., Morris, GX and Shelton, B.G. (1994). Legionnaires' Disease Outbreaks and Cooling Towers with Amplified Legionella Concentrations. Current Microbiology 28 , 359 -363. 9 Gilpin, R.W., (1995). The Saga of Legionella, The Analyst AWT. Goetz, A., Liu, Z., Stout, J.E. and Yu, V.L. (1993). Legionella Disinfection of Water Distribution Systems: Principles, Problems, and Practice. Infection Control and Hospital Epidemiology 14:10, 567 -570. International Standards Organization. 1998. Water Quality-Detection and Enumeration of Legionella, ISO 11731. Geneva, Switzerland. Marre, R., Y.A. Kwaik, C. Bartlett, N.P. Cianciotto, B. S. Fields, M. Frosch, J. Hacker, and P.C. Luck, (2002). Legionella. ASM Press, Washington, DC. Millar, J.D., Morris, G.K. and Shelton, B.G. (1997) Legionnaires' Disease: Seeking Effective Prevention. ASHRAE Journal, 22 -29. OSHA Technical Manual, Section III, Chapter 7: Legionnaires' Disease. Occupational Safety and Health Administration, Department of Labor, Washington, DC. Point/Counterpoint: Surveillance Cultures for Legionella, a debate between V.L. Yu and R.F. Breiman, about the pros and cons of sampling water for Legionella. Recorded at the 1996 Annual Scientific Meeting of the Society for Healthcare Epidemiology of America. State of Maryland Department of Health and Mental Hygiene. Report of the Maryland Scientific Working Group to Study Legionella in Water Systems in Healthcare Institutions June 14, 2000. Baltimore, MD State of Wisconsin Department of Health and Social Services. (1987). Control of Legionella in Cooling Towers, Rev. 8/87, POH4242. Stout, J.E., Yu, V.L. (1997). Legionellosis. New England Journal of Medicine, 682 -687. Watson, J.R., Legionella Update — 2000Report. Microbiological Consultation Services, Inc. (MCS), La Grange Park, IL. Yu, V.L. (1997). Prevention and Control ofLegionella: An Idea Whose Time has Come. Tnfectious Diseases in Clinical Practice. Yu, V. L., Resolving the Controversy on Environmental Cultures for Legionella: A Modest Proposal, Volume 19 (12), December 1998 Editorial. 33 f , �< �� }Y �r - _ - • Arthur E. Mclvor, Chair ASHRAE Standard Project Committee 12 -2000 Martha J. Hewett, Vice -Chair Amanda K. Meitz Cognizant TC: Environmental Health Committee Davor Novosel Waller S. Clements SPLS Liaison: Waller S. Clements PiotrA. Domanski David F. Geary, Chair' • Barry S. Fields Godwin C. Rogerson Paul A. Lindahl, Jr., Secretary' Carl B. Fliermans Dennis P. Shea' Michael D. Adams' John M. Hodgson" Brian G. Shelton' Joseph Aiello" Kevin B. McBurney George R. Shriver Richard E. Besser William F. McCoy' Reid A. Spence' Robert F. Braman Amanda K. Maltz Laurance S. Staples Clive R. Broadbent' Richard D. Miller" Janet E. Stout' Karl A. Brown` George K. Moms Patricia T Thomas' Frederick T Byers Edwin A. Nordstrom Richard L. Tyndall Jay C. Butler" Daniel A. Pope Kazuo Watanabe Richard A. Charles* Paul R. Puckorius Ronald E. Wood` Daryn S. Cline' James L. Reber Thomas L. White Eric A. Delaubenfels' 'Denotes members of voting status when the document was approved for publication ASHRAE STANDARDS COMMITTEE 1999 -2000 • Arthur E. Mclvor, Chair Nance C. Lovvorn Martha J. Hewett, Vice -Chair Amanda K. Meitz Dean S. Borges Davor Novosel Waller S. Clements Joseph A. Pietsch PiotrA. Domanski James A. Ranfone Richard A. Evans Terry E. Townsend Mark C. Hegberg James K. Vallort John F. Hogan Thomas E. Watson David E. Knebel Bruce A. Wilcox Frederick H. Kohloss J. Richard Wright William J. Landman Samuel D. Cummings, Jr., BOD ExO Neil P. Leslie Raymond E. Patenaude, CO Claire Ramspeck, Manager of Standards SPECIAL NOTE This American National Standard (ANS) is a national voluntary consensus standard developed underthe auspices of the American Society of Heating, Refrigerating and Air- Conditioning Engineers ( ASHRAE). Consensus is defined by the American National Standards Institute (ANSI), of which ASHRAE is a member and which has approved this standard as an ANS, as "substantial agreement reached by directly and materially affected interest categories. This signifies the concurrence of more than a simple majority, but not necessarily unanimity. Consensus requires that all views and objections be considered, and that an effort be made toward their resolution" Compliance with this standard is voluntary until and unless a legal jurisdiction makes compliance mandatory through legislation. ASHRAE obtains consensus through participation of its national and international members, associated societies, and public review. ASHRAE Standards are prepared by a Project Committee appointed specifically for the purpose of writing the Standard. The Project Committee Chair and Vice -Chair must be members ofASHRAE; while other committee members may or may not be ASHRAE members, all must be technically qualified in the subject area of the Standard. Every effort is made to balance the concerned Interests on all Project Committees. The Manager of Standards of ASHRAE should be contacted for. a. interpretation of the contents of this Standard, b. participation in the next review of the Standard, c. offering constructive criticism for improving the Standard. d, permission to repnm portions of the Standard. DISCLAIMER ASHRAE uses Its best efforts to promulgate Standards and Guidelines for the benefit of the public in light of available information and accepted industry practices. However, ASHRAE does not guarantee, certify, or assure the safety or performance of any products, components, or systems tested, installed, or operated in accordance with ASHRAE's Standards or Guidelines or that any tests conducted under its Standards or Guidelines will be nonhazardous or free from risk. ASHRAE INDUSTRIAL ADVERTISING POLICY ON STANDARDS ASHRAE Standards and Guidelines are established to assist Industry and the public by offering a uniform method of testing for rating purposes, by suggesting safe practices in designing and Installing equipment, by providing proper definitions of this equipment, and by providing other information that may serve to guide the Industry. The creation of ASHRAE Standards and Guidelines Is determined by the need for them, and conformance to them is completely voluntary. In referring to this Standard or Guideline and in marking of equipment and in advertising, no claim shall be made, either stated or implied, that the product has been approved by ASHRAE. CONTENTS ASHRAE Guideline 12 -2000 Minimizing the Risk of Legionellosis Associated with Building Water Systems SECTION PAGE 1 Purpose ............................................................................................................................ ..............................2 2 Scope .............................................................................................................................. ............................... 2 3 Ecology of LegioneNa ...................................................................................................... ............................... 2 4 Potable and Emergency Water Systems ......................................................................... ............................... 3 5 Heated Spas .................................................................................................................... ............................... 5 6 Architectural Fountains and Waterfall Systems ............................................................... ............................... 7 7 Cooling Towers Including Fluid Coolers (Closed- Circuit Cooling Towers) and Evaporative Condensers ...... 7 8 Direct Evaporative Air Coolers, Misters (Atomizers), Air Washers, and Humidifiers ..... ............................... 10 9 Indirect Evaporative Air Coolers .................................................................................... ............................... 12 10 Metalworking Systems ................................................................................................... ............................... 13 11 Monitoring for Legionell a ............................................................................................... ............................... 13 12 References ...................................................................................................................... .............................14 AnnexA: Bibliography .................................................................................................... .............................15 • • 1. PURPOSE The purpose of this guideline is to provide information and guidance in order to minimize Legionella contamination in building water systems. 2. SCOPE 2.1 This guideline provides specific environmental and operational guidelines that will contribute to the safe opera- tion of building water systems to minimize the risk of occur- rence of Legionellosis. 2.2 This guideline is intended for use with nonresidential building systems (including but not limited to hotels, office buildings, hospitals and other health care facilities, assisted living facilities, schools and universities, commercial build- ings, industrial buildings, etc.) and centralized systems in multifamily residential buildings (including but not limited to central beating/cooling systems, central domestic water sys- tems, common area fountains, etc.). While not specifically intended for noncentralized or single - family residential build- ing systems, some of the information may be useful for these systems. 2.3 This guideline is intended for the use of designers, installers, owners, operators, users, maintenance personnel, and equipment manufacturers. 3. ECOLOGY OF LEGIONELLA 3.1 Infection and Disease The majority of Legionnaires' disease cases diagnosed and reported to the public health officials are sporadic (i.e., not occurring as part of a recognized outbreak).' Compared with outbreak - associated infection, much less is known about transmission of sporadic Legionellosis, although it is likely that transmission occurs by similar mechanisms. Exposure to legionellae in sporadic cases may occur in a variety of settings, including the home, the workplace, and public places visited during routine daily activities or during travel. The proportion of sporadic disease attributable to exposure in each of these settings and to various environmental sources is unknown. Legionellae are bacteria. When legionellae are present in aquatic environments, the risk of transmission of infection to humans depends on the presence of several factors: conditions favorable for amplification of the organism, a mechanism of dissemination (e.g., aerosolization of colonized water), inoc- ulation of the organism at a site when it is capable of causing infection, bacterial strain - specific virulence factors, and the susceptibility of the host Over 40 species of Legionella have been identified; L. pneumophila appears to be the most viru- lent and is associated with approximately 90% of cases of Legionellosis. Most L. pneumophila infections are caused by serogmup 1; however, certain serogvup I strains may be more virulent. The risk of acquiring Legionnaires' disease is greater for older persons and for those who smoke tobacco or have chronic lung disease. Persons whose immune system is suppressed by certain drugs or by underlying medical condi- tions appear to be at particularly high risk. 3.2 Habitats Legionellae bacteria are commonly present in natural and man -made aquatic environments. The organism is occasion- ally found in other sources, such as mud from streams and potting soils; however, the overall importance of nonaquatic environmental sources in human disease is not yet known. In natural water sources and municipal water systems, Legionel- lae are generally present in very low or undetectable concen- trations. However, under certain circumstances within man- made water systems, the concentration of organisms may increase markedly, a process termed "amplification." Condi- tions that are favorable for the amplification of legionellae growth include water temperatures of 25 -42 °C (77- 108 °F), stagnation, scale and sediment, biofilms, and the presence of amoebae. Legionellae infect and multiply within several species of free- living amoebae, as well as ciliated protozoa. The initial site of infection in humans with Legionnaires' disease is the pulmonary macrophage. These cells engulf legionellae, provide an intracellular environment that is remarkably similar to that within host protozoa, and allow for multiplication of the bacterium. Hence, legionellae may be considered protozonotic; i.e., they naturally infect free - living amoebae and incidentally infect the phagocytic cells within human lungs under certain circumstances. Although legionel- lae may be cultivated on special agar media in laboratory settings, growth in nature in the absence of protozoa and/or in the absence of complex microbial biofilms has not been demonstrated. Intracellular growth of legionellae within protozoa and/or within diverse microbial biofilms may be the primary means of proliferation. There is an indication that growth of Legionella is influ- enced by certain materials. Natural rubbers, wood, and some plastics have been shown to support the amplification of Legionella, while other materials such as copper inhibit their growth. Generally, Legionella thrive in diverse, complex micro- bial communities because they require nutrients and protec- tion from the environment. Controlling the populations of protozoa and other microorganisms may be the best means of minimizing Legionella.2 3.3 Transmission of Legionnaires' Disease Most data on the transmission of Legionnaires' disease are derived from investigations of disease outbreaks. These data suggest that, in most instances, transmission to humans occurs when water containing the organism is aerosolized in respirable droplets (1 -5 micrometers in diameter) and inhaled by a susceptible host. Prior to actual disease a number of events occur, some of which can be influenced by good engineering and mainte- nance practices. These events and prevention opportunities are outlined in Figure 1. The fast event, survival in nature, is generally outside the scope of building engineering and management practices. The next three events — amplification, dissemination, and transmission —can be influenced by engi- neering design and maintenance practices. Subsequent events are influenced by the individual's health. The most effective control for most diseases, including Legionellosis, is prevention of transmission at as many points ASHRAE GUIDELINE 12 -2000 • • Legionella Transmission rmvirOemeemr c11.W Fe Eanm E.M FeOfas Temp., pN. 1 y syrn;m. Nuldenm sunftO in DAWp d Lab Te MbablM PaeptlelWS Haservalr (NeNre) L Ianralre'a &J6Wlwx, 1 Dlse1em Mbpblel ASSpdetipns 2 alek g Yrvknce NubW AmpYfi[tlion mnlmWben IAftipy In alxltlep (propa.Q Human H.. 5yam,n deentineas / Ta mp -N dby, V�ft�" p / Ape DrOPIet Radktlon O<aeeMnatlon /// ptible NON Daeaee (AM�e�lbl) e� Immulrodefld q TnmemM. Humkmy Dmplm situ damrlee Figure 1 Legionella transmission. Adapted from Barbaree (1991_ as possible in the disease's chain of transmission. The ratio- nale for this is that if one preventive measure fails, others will be in place and act as fail -safe mechanisms. With this philos- ophy in mind, it may be desirable to design interventions to prevent transmission of Legionellosis at as many points as possible in the disease's chain of transmission. General concepts are presented so that readers may develop an under- standing of the types of conditions that may allow amplifica- tion and transmission of Legionella. A variety of aerosol - producing devices have been asso- ciated with outbreaks of Legionnaires' disease, includin cooling towers, 45 evaporative condensers, 6,7 showers,s whirlpool spas,ro'rr humidifiers; 12 decorative fountains,I3,14 and a grocery store produce mister. 15 Aspiration of colonized drinking water into the lungs has been suggested as the mode of transmission in some cases of hospital - acquired Legion- naires' disease.16-18 Numerous investigations have demonstrated that cooling towers and evaporative condensers have served as the sources of Legionella- contaminated aerosols causing outbreaks of community- and hospital - acquired infection. Outbreak -asso- ciated transmission via cooling towers and evaporative condensers has been most commonly documented when those infected have been in close proximity to the contaminated devices; however, data from a few Legionnaires' disease outbreak investigations suggest that legionellae may be carried in cooling tower aerosols for distances of up to 3 kilo- meters (2 miles)19 (this is regarded as requiring an unusual combination of climatic conditions). A number of outbreaks of Legionellosis associated with cooling towers and evapora- tive condensers have occurred after these devices have been restarted following a period of inactivity.20,2r Shower heads and tap faucets can produce aerosols containing legionellae in droplets of respirable size. Epidemi- ologic studies and air sampling conducted during outbreak investigations have established the role of aerosols produced by showers and tap faucets in disease transmission 9 Aerosols R.` W' :f xrli PONIQIX1'bVICil produced by respiratory therapy equipment that have been filled or rinsed with contaminated potable water in hospitals have also caused disease transmission. 12X Heated spa pools operate at temperatures conducive to bacterial growth. The aeration of spa pools canresult in forma- tion of potentially contaminated aerosols. A range of patho- genic microorganisms, including Pseudomonas aeruginosa and L. pneumophlla, have been found in spa pools. Outbreaks of Legionellosis have occurred among bathers as well as people near colonized spas. )o,t) A more complete and detailed description of the most common amplifiers associated with building water systems, including the treatment recommended to minimize the risk of Legionellosis, is found in Sections 4-10. 4. POTABLE AND EMERGENCY WATER SYSTEMS 4.1 Potable Water Systems 4.1.1 System Description. Potable water systems in buildings for this discussion start at the point where the water enters the building and end where it exits the piping at a fau- cet, showerhead, etc. The systems include all piping, hot water heaters, storage tanks, faucets, nozzles, and other dis- trbution outlets. 4.1.2 System Operation. Factors associated with the plumbing system that may influence the growth of legionellae are as follows: Chlorine concentration. Municipal potable water supplies are generally chlorinated to control the presence of microor- ganisms, historically to control microbes associated with sewage. The legionellae are more tolerant of chlorine than many other bacteria and may be present in small numbers in municipal water supplies?; Tenn erp ature. Although legionellae have been recovered from cold water, the temperature range favorable for amplifi- cation is 25 -42*C (77- 108 °F). The environment becomes more hostile as the temperature is moved from this range. Design of plumbing system. Growth of legionellae may occur in portions of the system with infrequent use, in stagnant water, and in portions of the system with tepid temperatures. Growth may also occur in dead -end lines, attached hoses, shower nozzles, tap faucets, hot water tanks, and reservoirs. Plumbing materials. Rubber washers and fittings, includ- ing water hammer arrestors and rubber hoses with spray attachments have been shown to provide sites for growth of legionellae.�4 Organic compounds leached from plumbing materials may contribute to growth of heterotrophic bacteria, including legionellae. 4.13 Water Droplet Size. Contaminated potable water sources present the greatestrisk when dispersed into the air in a very small droplet size (less than 5 micrometers) that can be inhaled deeply into the lungs. Actions that may generate small droplets are those that break up the water stream, i.e., shower nozzles, aerators, spray nozzles, water impacting on hard sur- faces, and bubbles breaking up. 4.1.4 Nutrients. Both dead and living microorganisms, biofilms, and debris may provide nutrient sources for legionellae growth. When legionellae are found in plumbing systems, it is common to detect the microbes in the sediment • • in hot water tanks and in peripheral plumbing fixtures that accumulate sediment. Legionellae growth appears to be heaviest at the solid - liquid interface with the development of slime deposits. 4.1.5 Associated Cases of Legionnaires' Disease. Pota- ble heated water systems are an important potential source of Legionellosis in all buildings and are of particular importance in hospitals, nursing homes, and other health care facilities 25 Many reports link legionellae in hospital tap water to epidem- ics and clusters of nosocomial (hospital- acquired infection) Legionnaires' disease, often involving immunosuppressed patients.26 4.1.6 Recommended Treatment. Where practical in health care facilities, nursing homes, and other high -risk situ- ations, cold water should be stored and distributed at temper- atures below 20 °C (68 °F), while hot water should be stored above 60 °C (140 °F) and circulated with a minimum return temperature of 51 °C (124 °17). However, great care should be taken to avoid scalding problems. One method is to install preset thermostatic mixing valves. Where buildings cannot be retrofitted, periodically increasing the temperature to at least 66 °C (I 50'F) or chlorination followed by flushing should be considered. Systems should be inspected annually to ensure that thermostats are functioning properly. Where practical in other situations, hot water should be stored at temperatures of 49 °C (120 °F) or above. Those hot or cold water systems that incorporate an elevated holding tank should be inspected and cleaned annu- ally. Lids should fit closely to exclude foreign materials. Detailed current plans for hot and cold water piping systems should be readily available. Hot water heaters and storage vessels for such systems should have a drainage facil- ity at the lowest point, and the heating element should be located as close as possible to the bottom of the vessel to facil- itate mixing and prevent water temperature stratification. In high -risk applications, insulated recirculation loops should be incorporated as a design feature. For all situations, the pipe runs should be as short as practical. Moreover, where recircu- lation is employed, the pipe runs should be insulated and long dead legs avoided. New shower systems in large buildings, hospitals, and nursing homes should be designed to permit mixing of hot and cold water near the showerhead. The warm water section of pipe between the control valve and shower - head should be self - draining. Copper - silver ionization is a relatively new approach to controlling Legionella in hot water distribution systems and has been used successfully in a number of hospitals.27 -29 Elec- trolytically generated copper and silver ions build up in the hot water recirculating system to levels effective in eradicating Legionella, typically in the range of 0.2 -0.8 mg/L copper and 0.02 -0.08 mg/L silver. The optimal concentration of copper - silver ions for controlling Legionella in hot water is not known. A particular concentration may not be universally effective because of variables in water quality and system design. It is also important to note that the efficacy of copper- silver ions, like chlorine, is adversely affected by elevated PH 30 Where decontamination ofhot water systems is necessary (typically due to implication of an outbreak of Legionellosis) the hot water temperature should be raised to 71 -77 °C (160 - 170 °F) and maintained at that level while progressively flush- ing each outlet around the system. A minimum flush time of five minutes has been recommended by the Center for Disease Control Hospital Infection Control Practices Advisory Committee 31 However, the optimal flush time is not known and longer flush times maybe necessary. In the original report describing this method, multiple 30 -minute flushes were required to significantly reduce Legionella colonization.17 The number of outlets that can be flushed simultaneously will depend on the capacity of the water heater and the flow capa- bility of the system. Local building and sanitary codes should be checked for any temperature limits of water discharged to the sewer. Appropriate safety procedures to prevent scalding are essential. When possible, flushing should be performed when the fewest building occupants are present (e.g., nights and weekends). For systems where thermal shock treatment is not ossible, shock chlorination may provide an alterna- tive.?,2°33 However, there is less experience with this method of decontamination. Also, users should realize that the required levels of free chlorine residual can cause corrosion of metals. Chlorine should be added to achieve a free chlorine residual of at least 2 mg/L throughout the system. This may require chlorination of the water heater or tank to levels of 20 to 50 mg/L. The pH ofthe water shouldbe maintained between 7.0 and 8.0. Each outlet should be flushed until the odor of chlorine is detected. The chlorine should remain in the system for a minimum of 2 hours (not to exceed 24 hours), after which the system should be thoroughly flushed. Once the decontamination is complete, recolonization is likely to occur unless the proper temperatures are maintained, continuous supplemental chlorination is continued, or alter- native approaches, such as the use ofa silver /copper ionization device, are employed. In high -risk applications, monthly removal of shower heads and tap aerators to clean out sediment and scale and to clean them in a chlorine bleach solution is recommended. For potable water systems that were opened for repair or other construction or systems that were subjected to water pressure changes associated with construction (which may cause water to become brown and the concentration of Legionella to dramatically increase),34 it is recommended that as a minimum the system be thoroughly flushed. High - temperature flushing or chlorination may be appropriate, and this judgement shouldbe made on a job - specific basis. If only a portion ofthe system is involved, high - temperature flushing or chlorination maybe used on only that portion of the system. 4.2 Emergency Water Systems—Safety Showers, Eye Wash Stations, and Fire Sprinkler Systems 4.2.1 System Description. All three of these systems are generally plumbed to the potable water system, have little or no flow with resulting stagnant conditions, and may reach temperatures warmer than ambient. Legionellae, het - erotrophic bacteria, and amoebae have been cultured from these systems 35 When the devices are used, aerosolization is expected. ASHRAE GUIDELINE 12 -2000 • • 4.2.2 Associated Cases of Legionnaires' Disease. Cases of Legionellosis resulting from exposure to these waters have not been documented. 4.2.3 Recommended Treatment. Safety shower and eye wash stations should be flushed at least monthly. In the case of fire sprinkler systems, it is recommended that fire- fighting personnel wear protective respiratory gear and that non-fire- fighting personnel exit the burning area. Appropriate precau- tions should be taken when checking the operation of fire sprinkler systems. 5. HEATED SPAS 5.1 System Description Heated spas are small baths or pools used for relaxation (i.e., recreational), hygienic, or therapeutic purposes. Common features include warm water temperatures, (32- 40 °C /90- 104 °F) and the constant recirculation and agitation of the water through high - velocity jets and/or injection of air. While there is some confusion over the names used for each, the differences among the types of baths and pools are related mainly to size, purpose, material used, and equipment. 5.1.1 Whirlpool Spa (Spa, Hydrotherapy Pool). These are recreational baths or pools (public or private) holding more than one person and filled with warm turbulent water. The water is not replaced after each use but rather is filtered to remove particulates and chemically treated (typically with chlorine or bromine) to provide microbiological control. They may be located indoors or outdoors. Most smaller units are made from molded fiberglass, while larger in -ground variet- ies are generally made ofgunite orconcrete with awhite plas- ter finish. They are generally circular in shape, always shallow (less than 1.3 in [52 in.]), and contain seats that allow occupants to submerge up to the chest or neck. S. 1.2 Hot Tub. These are traditionally deeper hot water baths or pools made of wood. Redwood is common, but they may also be made of cedar, mahogany, white oak, pine, or teak. Otherwise, the features and uses are similar to spas. 5.1.3 Whirlpool. This terminology has been traditionally used for the small therapeutic pools (often used in athletics) filled with warm, vigorously moving water, which may be small enough for treatment of a specific joint, such as a knee, ankle, or elbow. These pools are generally made of stainless steel and are emptied between uses. 5.1.4 Whirlpool Bath. These are small baths often found in bathrooms of hotel rooms or private residences. As such, they are used for both recreational and hygienic purposes. The baths are fitted with high - velocity water jets and/or air injec- tion, but unlike whirlpool spas and hot tubs, the water is emp- tied after each use. 5.2 System Operation _empgran, .s. The water temperature in these spas, baths, and pools is generally in the range of 32-40 °C (90- 104 °17), with the maximum temperature based on bather comfort. These warm temperatures are close to the optimum for the multiplication of Legionella and many other microorganisms. The warmer temperatures also accelerate the loss of the biocide. ASHRAE GUIDELINE 12 -2000 Aerosol Production. Due to the operational features of the high - velocity water recirculation and air injection, a large number of bubbles of varying sizes rise to the water surface and burst. Microorganisms (e.g., Legionella) in the water can be released into the air via either bubbles or aerosol mist. 5.3 Water Droplet Size This aerosol mist has water droplets of varying sizes (many less than 5 micrometers) and extends into the air to a height of at least 0.5 meters (1 112 ft) above the water surface (well within the breathing zone of the bathers). Under condi- tions of high relative humidity and air currents, the aerosol may also expose individuals outside the spa. 5.4 Nutrients Due to the small volume of water per occupant (approx- imately 300 liters, compared to 10,000 liters in atypical swim- ming pool), the bathing load quickly contributes a variety of contaminants into the water, such as body oils, skin flakes, bacteria and fungi, suntan lotion, and other organic materials. In addition to serving as nutrients, these organic materials can also cause an increase in chlorine (orbromine) demand, result- ing in a reduction in free available halogen. 5.5 Associated Cases of Legionnaires' Disease In surveys of whirlpool spas, legionellae have been isolated from as many as 33% of the spas sampled, but only in those spas where the disinfectant (chlorine or bromine) levels were not adequately maintained. Thus, it is generally presumed that outbreaks of Legionellosis from whirlpool spas are likely to be associated with spas that have similar deficien- cies in their disinfectant levels. It is universally recognized that water treatment criteria for spas (and swimming pools) should include disinfection against coliforms and otherfecal pathogens (bacteria, viruses, and protozoa). In recent years, these types of recreational and therapeutic spas have been recognized as important sources of infection by other waterborne pathogens, including Pseudomonas aeruginosa and Legionella species. Several multiple -case outbreaks of Legionellosis (Legionnaires' disease and Pontiac fever) have been traced to spas and hot tubs, and fatalities have occurred.10,36 No cases of Legionel- losis have been traced to whirlpool baths.10,11 5.6 Recommended Treatment 5.6.1 Whirlpool Spas. Whirlpool spas are currently sub- ject to state and local regulations related to public swimming and bathing facilities. These regulations may cover all areas of operation, including mechanical specifications, opera- tional parameters (i.e., flow rate, temperature), water chemis- try, and bacteriology. To minimize the occurrence of whirlpool- related infectious diseases (including Legionello- sis), the following guidelines are relevant. 5.6.1.1 Bather Load. Clearly post and enforce the max- imum number of occupants (0.93 m2 [ 10 ft2] of surface area per bather). Using this formula, a 2.5 meter (8 ft) diameter cir- cular spa would have a maximum bather load of five at one tune. 5.6.1.2 Bather Health Restrictions. Clearly post wam- ings on the increased health risk related to use by individuals who are immunocompromised or who have chronic lung dis- ease. • • 5.6.1.3 Filter Operation. Hygienic maintenance of spa filters is more difficult than that of swimming pool filters because of the higher ratio of number of bathers to pool vol- ume. Health codes consistently accept filter flow rates as fol- lows: High rate sand filters — 3.4 -6.7 L/s per m2 (5 -10 gal/min per ft2) of filter media Diatomaceous earth filters — 1 Us per m2 (1.5 gal /min per ft2) of filter media Cartridge filters — 0.25 L/s per m2 (0.375 gal/min per ft2) of fitter media Maintenance of filters includes back flushing regularly to remove the buildup of organic debris. Determining the frequency of back flushing is currently based on manufacturer recommendations (flow -rate requirements) rather than micro- biological criteria. As a general rule, daily back flushing may be required during periods of heavy usage. Filter cartridges should also be cleaned or replaced on a regular basis (once or twice weekly). 5.6.1.4 Water Chemistry. The American National Standards Institute and National Spa and Pool Institute (ANSI/NSPI) have established chemical standards related to pool disinfection. The standards are generally used as a basis for most state and local regulations and have been modified slightly by the Centers for Disease Control in their "Interim Recommendations to Minimize Transmission of Legion- naires Disease from Whirlpool Spas on Cruise Ships (1995). "37 Minimum Ideal Values Maximum Free chlorine (mg/L.) 3.0 4.0 -5.0 10.0 Combined chlorine None None 0.2 (chloroamines) (mg/L) Bromine (mg/L.) 4.0 4.0 -6.0 10.0 pH 7.2 7.4 -7.6 7.8 The upper value of 10 mg/L (free chlorine or bromine) should not be considered a routine target maintenance level; however, this level is acceptable for relatively short durations. The ideal values should be considered minimum values for control of Legionella because of the relative resistance of Legionella to halogens (compared to other bacteria and enteric viruses). Maintaining the required free avail able halogen level is absolutely critical for controlling the growth of bacteria (including Legionella) in the spa water. Thus, these parame- ters should be measured frequently, as often as hourly during periods of heavy use. Automatic systems that continuously monitor the free halogen and adjust as needed would offer the best control of the water chemistry. In addition, it would be desirable to install halogen level- dependent injector devices on both sides of the filter to ensure that adequate levels of biocide are maintained within the filter and within the water exiting the filter. Several alternative or adjunctive nonhalogen water treat- ment procedures are currently being marketed, including copper /silver ion water treatment, iodinization treatment, ultraviolet light treatment, and ozonation. While any or all of these approaches may successfully control Legionella and other bacteria in pools and spas, there are insufficient data at the present time to recommend any major variation from current water treatment practices. This situation may change as additional data from laboratory and real -world studies become available. 5.6.1.5 Bacteriological Parameters. Regular testing of all spas can provide an important record of safe operating con- ditions and may alert operators of unsafe conditions when they occur. However, since bacteriological results require as much as 24 hours (or longer for Legionella) for results, they should be used only to spot -check or confirm the effective- ness of the disinfection system, not as a replacement for fre- quent testing of the water chemistry or routine maintenance. Where culturing for legionellae is to be done, see section 11 for input on proper sampling, handling, and shipping. Standard agar plate count (35°Q- 200 cfa per mL (maximum) Total coliforms- 2 organisms per 100 mL (maximum) Fecal coliforms- None allowable Pseudomonas aeruginara (41'Q- Nme allowable Legionella species- None allowable 5.6.1.6 Routine Maintenance. Current ANSI/NSPI recommendations include taking the spa out of service at the end of each day in order to carry out a superhalogenation (i.e., shock disinfection) using 10 mg/L or 10 times the combined chlorine level, whichever is greater, for one to four hours. Due to the buildup of total dissolved solids and organic matter in the water, the spa water should also be replaced at least once a week (depending on the frequency of use). Daily water changes may be necessary under continuous conditions of high use. At the same time, the spa should be thoroughly cleaned, including a vigorous scrubbing of the spa surface, weirs, and skimming devices, in order to remove buildup of microbial biofihn. Conditions of high bacterial counts also require shock disinfection in order to achieve safe operating conditions, often coupled with changing the water, cleaning the spa, and maintenance of filters. 5.6.1.7 Training and Record Keeping. Training of maintenance personnel on all aspects of the safe operation of whirlpool spas should be mandatory. As part of this training, it should be emphasized that spas are not the same as swim- ming pools; thus, maintenance required for safe operation is very different. Maintenance personnel should also be trained to maintain good records of all water chemistry measure- ments, back flushing of filters, water changes, and spa clean- ing. Results of samples sent to outside labs for bacteriological analysis should also be maintained. All records should be kept for a period of at least two years. 5.6.2 Whirlpool Baths. Since whirlpool baths are always filled with fresh potable tap water and drained at the end of each use, the recommendations for control of Legionellosis would fall initially under those guidelines developed for pota- ble water systems. ASHRAE GUIDELME 12 -2000 • 6. ARCHITECTURAL FOUNTAINS AND WATERFALL SYSTEMS 6.1 System Description In these systems, water is either sprayed in the air or cascades over a steep media such as rocks, and then it returns to the man-made pool. This guide is not intended to cover fountains in natural bodies of water or natural waterfalls. 6.2 System Operation These systems are sometimes operated intermittently with on -time often scheduled only during certain time periods. Applications can include elaborate displays specifically intended to periodically attract large crowds in entertainment centers. Systems that are operated intermittently may encour- age greater biocontamination. 6.2.0.1 Temperature. Because of the high temperature ranges needed for proliferation of legionellae bacteria, out- door fountains and pools in hotter climates and indoor foun- tains and pools subject to sources of heat may be susceptible to becoming amplifiers. Temperature increases may be facil- itated by beat from the pump/filter systems themselves. Inter- mittent operation may also create situations where temperature increases occur in limited parts of the system. 6.3 Water Droplet Size These systems can produce droplets of various sizes and certainly have the potential to produce droplets less than 5 micrometers. Generally speaking, the legionellae risk increases as the rate of aerosol production increases. 6.4 Nutrients Fountains are subject to contamination from a wide vari- ety of sources, including materials scrubbed from the air and returned to the pool with the falling water droplets as well as organic and inorganic materials dropped, thrown, or blown into the pool. Algae and bacteria are recognized as a particular problem in pools less than 1 meter (3 ft) deep. When used, filter systems are similar to the types used for swimming pools. 6.5 Associated Cases of Legionnaires' Disease Several multiple -case outbreaks of Legionellosis have been associated with decorative fountains in public buildings, particularlyhotels.13,14 However, thetrue incidence ofdisease from these sources may be much higher due to the occurrence of isolated cases where no association with the building or the fountain was suspected. 6.6 Recommended Treatment 6.6.1 Design Considerations Drains or sumps should be situated at the lowest level of the pool, with no other local low points that are not served by drains or sumps. Provision for maintenance should be considered in the design stage. Access to pump(s) and filter(s) should be provided. Stagnant areas or areas that are difficult to clean should be avoided. 6.6.2 Maintenance Regular cleaning is recommended. Use of filters should be considered, however, systems ASHRAE GUIDELINE 12-2000 with a small water volume may be drained and refilled with fresh water every few weeks in lieu of filtering. 6.6.3 Water Treatment Microbial fouling control is important, especially where the conditions are such that there are significant periods of time when the temperature ofthe fountain water is in the range that is favorable for the amplification of legionellae growth (see 3.2). When biocidal treatment is employed for microbial fouling control, the biocide must be registered with the Envi- ronmental protection Agency for use in decorative fountains. For further information on water treatment, see 7.6.2 of this guideline and the "Water Treatmenf'chapter in the Applica- tions volume of the ASHRAE Handbook. 7. COOLING TOWERS INCLUDING FLUID COOLERS (CLOSED - CIRCUIT COOLING TOWERS) AND EVAPORATIVE CONDENSERS 7.1 Cooling Towers 7.1.1 System Description. A cooling tower is an evapo- rative heat transfer device in which atmospheric air cools warm water, with direct contact between the water and the air, by evaporating part of the water (see Figure 2). Air movement through such a tower is typically achieved by fans, although some large cooling towers rely on natural draft circulation of air. Cooling towers typically use some media, referred to as "fill," to achieve improved contact between the water and the cooling air. 7.1.2 System Operation. Cooling towers associated with building water systems are typically used for rejection of waste heat from the condenser of chillers providing air condi- tioning for a building. Water from the cooling tower is piped to the condenser where it is heated and then back to the cool- ing tower to be cooled. 7.1.2.1 Temperature. The typical temperature of the water in cooling towers ranges from 29 °C (85 °F) to 35 °C (95 °F) although temperatures can be above 49 °C (120 °F) and below 21 °C (70 °F) depending on system heat load, ambient temperature, and system operating strategy. Figure 2 Typical cooling towerichiller system. • • 7.1.2.2 Circulating Water System. Cold water piping from the cooling tower runs to one or more pump(s), then to the chiller condenser, where it is heated, and then back to the hot water distribution system in the cooling tower. Consider- able variation in the piping arrangement occurs. Stagnant areas or dead legs may be difficult to clean or penetrate with biocides. A significant volume of water may be contained in the piping system. 7.2 Closed - Circuit Cooling Towers and Evaporative Condensers 7.2.1 System Description. Closed - circuit cooling towers and evaporative condensers are also evaporative heat transfer devices. Both are similar to conventional cooling towers, but there is one very significant difference. The process fluid (either a liquid such as water, an ethylene glycol/water mix- ture, oil, etc., or a condensing refrigerant) does not directly contact the cooling air. Rather, the process fluid is contained inside a coil assembly (see Figure 3). 7.2.2 System Operation. Water is drawn from the basin and pumped to a spray distribution system over the coil assembly while the cooling air is blown or drawn over the coil by fans. Removal of heat is achieved by evaporating part of the water. 7.2.2.1 Temperature. Water temperature in closed -cir- cuit cooling towers and evaporative condensers is similar to that in cooling towers. 7.2.2.2 Circulating Water System. Most commonly, there is no external piping in these systems. Because the water is totally contained within the unit, the volume of water is generally significantly less than with conventional cooling tower systems. AIP INLET' MPCIHGX E I « 1%0«<<0(<0 < <<<<«<< WN MTRIBUTM SYSTEM rt �'t t ' ittrtP r, NB€NBEXCOIL � i P t t FAN PUMP Figure 3 Typical closed- circuit cooling tower or evaporative condenser. 73 Water Droplet Size Cooling towers and evaporative condensers incorporate inertial stripping devices called drift eliminators to remove water droplets generated within the unit. While the effective- ness of these eliminators can vary significantly with the design (new state -of- the -art eliminators are significantly more effi- cient than older designs) and the condition of the eliminators , it should be assumed that some water droplets in the size range of less than 5 micrometers leave the unit. In addition, some larger droplets leaving the unit may be reduced to 5 microme- ters or less by evaporation. 7.4 Nutrients Because cooling towers and evaporative condensers are highly effective air scrubbers and because they move large volumes of air, organic material and other debris can be accu- mulated. This material may serve as a nutrient source for legionellae growth. Diverse biofihns, which can support the growth of legionellae, may be present on heat exchanger surfaces, structural surfaces, sump surfaces, and other miscel- laneous surfaces. 7.5 Associated Cases of Legionnaires' Disease Evaporative heat rejection equipment such as cooling towers and evaporative condensers have been implicated in numerous outbreaks of Legionnaires' disease, and studies have shown that detectable levels of legionellae are present in many, if not most, such devices. 38-40 7.6 Recommended Treatment The key recommendations are that the system be main- tained clean and that a biocidal treatment program be used. It is also recommended that the services of a qualified water treatment specialist be used to define and oversee the treat- ment. 7.6.1 System Maintenance. Keeping the system clean reduces the nutrients available for Legronellagrowth. Regular visual inspections should be made for general cleanliness. The cold water basin of the unit should be cleaned when any buildup of dirt, organic matter, or other debris is visible or found through sampling. Mechanical filtration may be used to help reduce these solids. Strainers, cartridge filters, sand fil- ters, centrifugal - gravity -type separators and bag -type filters can be used to assist in removal of debris. The drift eliminators should also be inspected regularly and cleaned if required orreplaced if deteriorated or damaged. Operation and maintenance records should include the following information: • system schematic • system water volume, with date and method of deter- mination • manufacturers' instructions for equipment operation • regular water treatment procedures • material safety data sheets for chemicals used (MSDS) • names of persons responsible for system operation and shutdown • dates of inspections and written results of inspections • dates and nature of routine maintenance • dates of equipment repairs or modifications with description of work done ASHRAE GUIDELINE 12 -2000 L 7.6.2 Water 1Yeatment Water treatment provides a heat transfer fluid that allows equipment to function optimally. Objectives of water treatment for cooling water systems is to use water efficiently as well as to • minimize microbial growth, • minimize scale, • minimize corrosion, minimize sediment/deposition of solids (organic or inorganic) on heat transfer surfaces. An effective water treatment program should allow more efficient operation due to lower fouling, a longer system life due to decreased corrosion, and safer operation of the system due to reduced chances of microbial exposure to the public. Control of scaling and corrosion is necessary in many water treatment programs. Scale such as calcium carbonate and/or other minerals containing silica, magnesium, and phos- phate may precipitate onto heat exchanger and piping surfaces. Scaling can be minimized by use of inhibitors containing phosphonates, phosphates, and polymers to keep calcium and carbonate and other minerals in solution. Corro- sion can be minimized by the use of inhibitors such as phos- phate, azoles, molybdenum, and zinc. Scale and corrosion inhibitors are effective if microbial fouling and biofilm devel- opment are properly controlled. Microbial fouling can Mu- ence scaling and corrosion processes and can affect the performance of inhibitors. Microbial biofilms on surfaces can consume certain inhibitors (such as phosphates, phospho- nates, and azoles), prevent access of inhibitors to surfaces, create localized oxygen- depleted zones, change the pH near surfaces, and accumulate or trap deposits onto surfaces. Surfactants have also been used to minimize deposition on surfaces (particularly heat transfer surfaces). When used, the surfactant must be compatible with the scale and corrosion inhibitors as well as appropriate for the type of dirt, oil, or other material that is present. Equally important to controlling scale and corrosion is keeping the system clean and free of sediment. Common sources of sediment include materials scrubbed from the air (dirt, leaves, paper, kitchen or other organic exhaust), precip- itated solids (calcium, magnesium, carbonate silica), and corrosion products (test). Microbes including bacteria, proto- zoa, algae, and (infrequently) fungi can grow in cooling systems and use the above materials as nutrients. Conse- quently, it is desirable to either prevent the entry of the mate- rial into the system or to remove it from the system. Strategies to accomplish this include siting of the tower (relative to kitchen exhausts, etc.), scale and corrosion control, and filtration and/or separation. Microbial fouling is controlled by the use of biocides, which are compounds selected for their ability to kill microbes while having relatively low toxicity forplants and animals. In the USA, the Environmental Protection Agency has regula- tory authority for biocides and requires registration of all biocides. In addition, registration is required in each state where the biocide will be distributed. The data package submitted to the EPA includes efficacy data against a variety of microbes and toxicity data for animals. Much of the labo- ASHRAE GUIDELINE 12 -20D0 ratory data are provided by the manufacturers ofthe individual biocides. Biocides must be used in accordance with the direc- tions on the label. There are two main groups of chemical biocides: oxidiz- ers and nonoxidizers. Oxidizing biocides include bromine, bromo-chlorohy- dantoin, chlorine, chlorine dioxide, iodine, isocyanurates, ozone, or other compounds with the ability to accept electrons from other compounds that serve as reducing agents. Oxidiz- ing biocides can accelerate corrosion of metals if they are dosed at excessive concentrations. Halogen biocides (chlo- rine, bromine, and iodine) react with the protein in cell membranes to cause the protein to become dysfunctional, thus killing/ controlling the organism. Ozone and chlorine dioxide are believedto oxidize other components ofthe microbial cell. Nonoxidizing biocides include many organic compounds registered with the EPA for cooling water applications, such as bromonitropropanediol, bromonitrostyrene, carbamates, decylthioethaneamine, dibromonitrilopropionamide, dode- cylgaanidine hydrochloride, glutaraldehyde, isothiazolones, methylene bisthiocyanate, quaternary phosphonium salts, and tris- hydroxymethylnitromethane. Quaternary ammonium compounds are sometimes used but were found to be ineffec- tive against legionellae in a recent study.41 These biocides function in a number of ways, including reacting with intrac- ellular enzymes, solubilizing cell membranes, and precipitat- ing essential proteins in microbial cell walls. Properly used, nonoxidizing biocides are effective for control of the micro- bial fouling process in cooling water systems. Both oxidizers and nonoxidizers can undergo chemical reactions with materials in the water that decrease their effec- tiveness. Some biocides react with components of some scale and corrosion inhibitors to render both compounds less effec- tive for their intended purpose. Selection of corrosiontscale inhibitors as well as the biocide requires a knowledge ofwater chemistry, a basic understanding of water microbiology, and specific information about the system (what the system is cooling, sources of contamination, etc.). It is generally sound practice to regularly alternate the biocides used for a cooling water system to avoid the selection and growth of resistant strains of microbes. The alternating biocide approach has been emphasized with the rationale that the population that survives the biocide treatment one week is susceptible to the alternate biocide a week or two later. Alter- nating the dose and frequency of the same biocide is also used to achieve this goal. Because Legionella are known to enter cooling water systems in the makeup water, it should be assumed that they are present in the water along with other bacteria, protozoans, and algae. Protozoa are highly resistant to both oxidizing and nonoxidizing biocides; hence they must be controlled by limit- ing the microbial biofllms that serve to provide them nutri- ents.42 For further information on the subject of water treatment, see the "Water Treatment" chapter in the Applications volume of the ASHRAE Handbook. L` 7.6.3 Cooling Tower System Shutdown and Start -Up Procedure 43 Shutdown When the system is to be shut down for a period of more than three days, it is recommended that the entire system (cooling tower, system piping, heat exchangers, etc.) be drained to waste. When draining the system is not practical during shutdowns ofshort duration, the stagnant cooling water must be pretreated with an appropriate biocide regimen before tower start -up. Start -Up for Drained Systems Clean all debris, such as leaves and dirt, from the cooling tower. Fill the system with water. While operating the condensing water pump(s) and prior to operating the cooling tower fans, execute one of the two alternative biocidal treatment programs described below. (1) Treat with the biocide that had been used prior to shutdown. Utilize the services of the water treatment supplier. Maintain the maximum rec- ommended biocide residual (for the specific bio- cide) for a sufficient period of time (residual and time will vary with the biocide) to bring the sys- tem under good biological control. (2) Treat the system with sodium hypochlorite to a level of 4 to 5 mg/L (ppm) free chlorine residual at a pH of 7.0 to 7.6. The chlorine residual must be held at 4 to 5 mg/L (ppm) for six hours, mea- surable with standard commercial water test kits. • Once one ofthese two biocidal treatments has been success- fully completed, the fan can be turned on and the system returned to service. Resume the standard water treatment program (including biocidal treatment). Start -Up for Undrained (Stagnant) Systems Remove accessible solid debris from the cooling tower sump and from any remote storage tank(s) that may be used. Perform one of the two biocide pretreatment procedures (described. in "Start -Up for Drained Systems' directly to the cooling tower sump or remote storage tank. Do not circulate stagnant bulk cooling water over coolingtower fill or operate cooling tower fans during pretreatment. Stagnant cooling water may be circulated with the main cooling system pump(s) if tower fill is bypassed. Other- wise, add approved biocide directlytothe bulk water source and mix with either manual or by sidestream flow methods. Take care to prevent the creation of aerosol spray from the stagnant cooling water from any point in the cooling water system. • After biocidal pretreatment has been successfully completed, the cooling water should be circulated over the tower fill with fans off. When biocide residual ismaintained at a satisfactory level for at least six hours, the coolmgtower fans may be operated. 7.6.4 Emergency Decontamination of Wet -Type Heat Rejection Systems forLegionella. The Cooling Tower histi- 10 tute has formulated an "Emergency Protocol" for decontami- nating cooling towers and evaporative condensers using chlorine and dispersants. 44 However, this procedure must not be used routinely because it can be very corrosive and pro- duce toxic fumes. This procedure has been adapted to include additional safety precautions and a 10 mg/L free residual chlorine level for 24 hours. 31 7.6.5 Siting. In locating cooling towers and evaporative condensers, attention should be given to the following consid- erations. • Locate as far as possible from fresh air intakes, including windows that can be opened.. • Do not locate in the immediate area of kitchen exhaust fans, plants, truck bays, or other sources of organic matter. • Consider the direction of prevailing winds and do not locate upstream of outdoor public areas. • Consider future construction, includingmearby sites. 8. DIRECT EVAPORATIVE AIR COOLERS, MISTERS (ATOMIZERS), AIR WASHERS, AND HUMIDIFIERS 8.1 System Description Direct evaporative air - cooling equipment and humidifi- ers cool and humidify air by direct contact with the water, either by wetted - surface materials (as in wetted media air coolers) or with a series of sprays (as in air washers and misters). These devices (see Figures 4 and 5) are used to control the temperature and humidity levels for commercial, industrial, and agricultural applications. They utilize either once- through or recirculating water. Wetted media systems may include a pump, water distribution piping, and a sump to collect or hold water. A fan may be utilized to move air across the system and distribute evapora- tively cooled and humidified air to the location being served. Concentration ofcontaminants in the water is limitedby bleed off and quality of fresh water makeup. 8.1.1 Wetted Media. Wetted media devices utilize a porous substrate to provide an extended surface area for evap- oration of water. Water is either circulated over the media or the media are rotated through a water bath. Since evaporation occurs from the surface of the media, no water droplets are produced. Mist eliminators are generally not necessary. These Figure 4 Direct evaporative air cooler/humidifier. ASI-IRAE GUIDELINE 12 -2000 l/l I1I `J MaB up wiev Ca18CpGN y poop-------------- enaxr mw MOSS e8=MALV W sown au Figure g Single bank air washer humidifier. WMI eYNINATOPB JNOmONeO R devices utilize either once - through potable building water or are equipped with a recirculating system including a pump, automatic makeup water valve, a bleed - off /purge, and a pos- itive draining reservoir. 8.1.2 Air Washers. Air washers utilize high - pressure nozzles to reduce water to small droplets for efficient evapo- ration- These systems have a chamber or casing containing one ormore banks of spray nozzles and drift eliminators. Air washers contain a sump for collecting and holding excess spray water. The eliminator section removes entrained drop- lets of water from the air. Air washers also utilize either once- through potable building water or are equipped with a recir- culating system including a pump, automatic makeup water valve, a bleed - off /purge, and a positive draining reservoir. The water may be chilled for additional cooling and/or dehu- midification. 8.1.3 Misters. Misters produce an aerosol by use ofultm- sonic devices, spinning disks, or spray nozzles. Normally these devices are supplied with fresh potable water directly from the building water systems; however, some systems con- tain a reservoir. &1.3.1 Heated Element and Steam -Type Humidifi- ers. Heated element and vapor -type humidifiers convert water to vapor that is discharged into the space being condi- tioned. Due to the elevated temperature and the fact that water droplets are not generated, these humidifiers are not consid- ered a risk for the growth of Legionella during normal opera- tion. However, if the humidifier is improperly installed, moisture may accumulate in the duct and lead to bacterial growth. During periods of time when equipment is not in use, all water should be drained from the system to avoid the pos- sibility of bacterial growth. 8.2 System Operation See 8.1. ASHRAE GUIDELINE 12 -2000 It should be noted that due to process conditions, there may be periods of time when equipment is shut down. It is common practice to drain sumps when the units are not in use. In addition, a continuous bleed or purge cycle is usually employed to limit the buildup of solids and contaminants in the basin. High dilution rates remove bacteria, nutrients, and other contaminants before they are a problem. It is rare for growth of Legionella to occur under these conditions. 8.2.1 Water Temperature — Wetted Media Evapora- tive Air Coolers/Humidifiers and Air Washers. For wetted media evaporative air coolers/humidifiers and air washers, the recirculating water temperature approximates the wet - bulb temperature of the airstream to which it is exposed. Since the wet -bulb temperature in most regions where these devices are used is well below 2500 (77°F), the water tends to be maintained at temperatures below the Legionella growth tem- perature range of 25 -42 °C (77- 1080F). 8.2.2 Water Temperature — Misters. For misters sup- plied directly from the building potable water system, the temperature would tend to be at the supply cold water temper- ature. If fed from a stagnant reservoir, or pipes exposed to heat, the temperature could increase. The temperature could exceed 25 °C (77 °F), which is favorable for amplification of legionellae. 8.23 Water Temperature —Air Washers. Air washer operating conditions are based on the requirements of the pro- cess; however, a standard operating temperature range for cir- culating water is 4 -10 °C (40- 50 °F). The normal operating portions of air washer systems tend to be maintained at tem- peratures below the Legionella growth temperature range of 25 -42 °C (77- 108 °F). 83 Water Droplet Size 83.1 Wetted Media. Wetted media equipment generally produces few droplets during operation. However, large drop- lets may form as a result of improper maintenance and uneven water or air distribution. The exact size of the droplets will vary with the condition of the wetted media and mist elimina- tors (where used), air velocity through the unit, and irrigation rate. It should be assumed that under extreme conditions droplets of less than 5 micrometers could be created. 8.3.2 Air Washers. The major causes of droplets being entrained into the airstream are fouled spray nozzles and dam- aged or dirty mist eliminators. Air washers can produce drop- lets of various sizes and certainly have the potential to produce droplets less than 5 micrometers in diameter. 8.33 Misters. These systems can product droplets of varying size and certainly have the potential to produce drop- lets less than 5 micrometers in diameter. 8.4 Nutrients Because direct evaporative air coolers/humidifiers are efficient air scrubbers and move large volumes of air, organic matter and other debris can be accumulated. This may serve as a nutrient source for Legionella growth. 8.4.0.1 Wetted Media Evaporative Air Coolers/ Humidifiers and Air Washers. Wetted media evaporative coolers/humidifiers and air washers have potential for growth where dirt, scale, or biological matter can accumulate. Most • • likely areas of such accumulation are collection troughs, mist eliminators, or water storage tanks. 8.4.1 Misters. Nutrient availability would be minimal when fed potable water directly from the building potable water system. if distribution piping and/or a holding reservoir is used, nutrients in the form of sediment and other debris may exist. 8.5 Recommended Treatment 8.5.1 All Systems. Regular inspection and maintenance of evaporative air coolers/humidifiers, air washers, misters, and ancillary equipment are recommended. Avoid dead -end piping, low spots, and other areas in the water distribution system where water may stagnate during shutdown. Consider the use of photochemical ozone generators to control microbial concentrations in water in sumps and distri- bution piping. Water filters and air filters should be cleaned as required. The entire cooling water loop should be cleaned and flushed monthly. 8.5.2 Recirculating Systems. Proper sump water level or spray pressure must be maintained. Bleeding off or purging some of the water is the most practical means to minimize scale and nutrient accumulation. The bleed rate or purge depend on water quality (including hardness) and airborne contaminant level. Regular inspections should be made to ensue that the bleed rate or purge is adequate and is main- tained. As an added precaution, sumps could be automatically drained during shutdown of the fan. When it is impractical to shut a system down for cleaning, it should be provided with a positive draining sump and easily accessible flush -out of the water distribution header so it can be flushed during opera- tion. After flushing, dose the recirculating cooling water with a biocide approved by the EPA for such applications. 8.5.3 Air Washers. Use corrosion inhibitors to prevent corrosion of metals in the systems and formation of corrosion products. Control the level of suspended solids that can sup- ply nutrients and growth areas for legionella. Finally, the microbiological activity should be controlled through the uti- lization of biocides approved by the EPA for such applica- tions. 8.5.4 Wetted Media Evaporative Air Coolers/Humidi- fiers. Media located inside a large built -up air house may not dry completely during period of shutdown (i.e., weekends), resulting in stagnation. In order to dry out the media, pumps should be shut down prior to scheduled fan shutdowns. Smaller systems and those having the media located adjacent to inlet louvers normally dry sufficiently without assistance. For systems experiencing high contaminant loading, a flush - out cycle may be used that runs fresh water through the pad every 24 hours during a period of time when the system is not in operation. Media should be cleaned or replaced when nec- essary. 85.5 Misters. Never recirculate atomized water. Drain pipes and reservoir when equipment is not in use. For portable misters, drain and disinfect piping and reservoir regularly. Only sterile water should be added to the reservoir of portable humidifiers used in health care environments or in other areas 17 where immunocompromised persons are likely to be exposed to the generated aerosols. 8.6 Siting Evaporative air coolers/humidifiers should not be located near the outlet of a cooling tower, fluid cooler, evaporative condenser, kitchen exhaust, or any other source of organic contamination. Filtration upstream of the evaporative air cooler/humidifier is recommended when particulate contam- ination is expected. Filtration downstream of the equipment must be a sufficient distance to allow absorption of moisture into the air stream. 8.7 Associated Cases of Legionnaires' Disease There have been no known cases of Legionnaire's disease with air washers, wetted media evaporative air coolers/humid- ifiers, or steam humidifiers. A supermarket vegetable misting device using water from a holding tank was implicated in one outbreak of Legionnaires' Disease.15 There is a documented case of Legionnaires' Disease that occurred in a hospital setting and resulted from aerosolized tap water from a humid - ifer.l zz 9. INDIRECT EVAPORATIVE AIR COOLERS Indirect evaporative air coolers cool air in a heat exchanger, which transfers heat to a secondary airstream as shown in Figure 6. Although the primary air is cooled by the evaporatively cooled secondary air, no moisture is added to the primary air. 9.1 System Description The heat exchanger is cooled by evaporation of water utilizing one of several methods: 1. direct wetting of the heat exchanger surface 2. cooling of secondary air utilizing evaporative cooling media 3. atomizing spray into secondary airstream or onto heat exchanger surface 4. cooling tower and coil. USecondary Air stream Cmling Tara Primary Air sh'eem con Figure 6 Indirect evaporative cooler. ASHnAE GUIDELINE 12.2000 • • 9.2 System Operation 9.2.1 Temperature. The recirculated water temperature approximates the wet -bulb temperature of the secondary air- stream. As is the case with direct evaporative air coolers, it is unlikely that the water temperature will exceed 25 °C (77 0F). 93 Water Droplet Size Water droplet size will vary with exchanger type, condi- tion of the media and mist eliminators (where used), air veloc- ity through the unit, and other factors. Refer to the section of this guideline regarding specific exchanger type, i.e., cooling towers, misters, etc. 9.4 Nutrients See 7.4 for equipment using a cooling tower to cool the secondary airstream and 8.4 for equipment using evaporative coolers or misters to cool the secondary airstream. 9.5 Recommended Treatment See 7.6 for equipment using a cooling tower to cool the secondary airstream and 8.5 for equipment using evaporative coolers or misters to cool the secondary airstream. 9.6 Siting Indirect evaporative air coolers should not be located near the outlet of a cooling tower, fluid cooler, evaporative condenser, kitchen exhaust, paint booth, incinerator, or any other source of organic matter. 9.7 Associated Cases There has been no positive association of Legionnaires' disease with indirect evaporative air coolers. 10. METALWORKING SYSTEMS 10.1 System Description In these systems, metalworking fluids are applied to cutting surfaces for lubrication and to prevent overheating of both the machine tool and the machined part. 10.2 System Operation Both oil-based and water -based fluids are used. A variety of such fluids are commercially available from many compa- nies. As a rule, microbial growth does not occur in oil -based products. However, water-based fluids do become contami- nated by microorganisms. 10.2.1 Temperature. As the fluids cool the machine tool and machined part, they become boated and the ambient tem- perature of the fluid sumps ranges between 24° and 32 °C (75 °F and 90 °17), permitting the growth of marry pathogens including Legionella species. 103 Water Droplet Size These systems can produce droplets of varying size depending on the specific machining operation and have the potential to produce droplets less than 5 micrometers in size. 10.4 Nutrients These systems are typically open and subject to contam- ination from the air and surfaces that are being machined. ASHRAE GUIDELINE 12 -2000 10.5 Associated Cases of Legionnaires' Disease Metalworking systems have been implicated in the outbreak of Pontiac fever as well as acute respiratory syndrome and hypersensitivity pneumonitts.as 10.6 Recommended Treatment Exposures from metalworking operations can be a serious potential health concerts, the magnitude of which is not fully understood. Biocides are supplied with fluid concentrates, which are diluted when used and/or added to the fluid reser- voir. However, the variety of fluids, microbial types, turnover rate, and metal operations makes successful dosing not always predictable. Selections of biocides should be based on fluids and microbes being treated- It is recommended that care be taken to minimize contam- ination and to reduce exposure to machine operators until further information is available. 11. MONITORING FOR LEGIONELLA Culturing for Legionella may be appropriate if carried out for a specific purpose, such as verifying the effectiveness of a water treatment protocol, tracing the source of an outbreak, evaluating the potential amplifier /transmission sources at a facility, verifying that the decomsination procedures have been effective, or in health care facilities caring for patients with exceedingly high risk of developing Legionnaires' disease (e.g., organ transplant recipients).a6as Where culturing is performed, proper sampling, handling, and shipping methods should be used.49 However, except as discussed in 5.6.1.5, routine culturing of samples from building water systems may not be predictive of the risk of transmission for the following reasons. 1. Presence of the organism cannot be directly equated to the risk of infection. The bacterium is frequently present in water systems without being associated with known cases of disease. 2. Interpretation of the results of culturing of water is confounded by use of different bacteriologic methods in various laboratories, by variable culture results among sites sampled within a water system, and by fluctuations in the concentration of Legionella isolated from a single site. 3. The risk of illness following exposure to a given source is influenced by a number of factors other than the concentra- tion of organisms in a sample. These factors include, but are not limited to, strain vinulence, host susceptibility, and how efficiently the organisms are aerosolized to the small parti- cle size required to reach the deep portion ofthe human lung and remain viable. 4. Test results only represent the counts at the time the sample was collected A negative result from such a sample is likely to lead to a false sense ofsec city because any amplifier can quickly become heavily colonized if it suffers neglect. Testing is not a substitute for sound maintenance prac- tices and water treatment. 13 • • 12. 'Marston, B.J., H.B. Lipman, and R.F. Breiman. 1994. Sur- veillance for Legionnaires' Disease: Risk Factors for Morbidity and Mortality. Archives of Internal Medicine 154:2417 -2422. 2Fields, B.S. 1993. Legionella and Protozoa: Interaction of a Pathogen and Its Natural Host. In: Legionella- Current Status and Emerging Perspectives. J.M. Barbaree, R.F. Breiman, A.P. Dufour, eds. Washington, DC: American Society for Microbiology, pp. 129 -136. 3Barbaree, J.M. 1991. Controlling Legionella in Cooling Towers. ASHRAE Journal 33(6): 38-42. 4Dondero, T.J., R.C. Rentdorff, G.F. Mallison, et al. 1980. An outbreak of Legionnaires' Disease Associated with a Contaminated Air - Conditioning Cooling Tower. New England Journal of Medicine 302: 365 -370. SKeller, D.W., R. Hajjeh, A. DeMaria, et al. 1996. Commu- nity Outbreak of Legionnaires' Disease: An Investiga- tion Confirming the Potential for Cooling Towers to Transmit Legionella Species. Clinical Infectious Dis- eases 22: 257 -261. 6Cordes, L.G., D.W. Fraser, P. Skailiy, et al. 1980. Legion- naires' Disease Outbreak at an Atlanta, Georgia Country Club: Evidence for Spread From an Evaporative Con- denser. American Journal of Epidemiology 111: 425- 431. 7Breiman, RF, W. Cozen, B.S. Fields, et al. 1990. Role of Air Sampling in Investigation of an Outbreak of Legion- naires' Disease Associated with Exposure to Aerosols from an Evaporative Condenser. Journal of Infectious Diseases 161: 1257 -1261. 'Tobin, J.O., M.S. Dunhill, M. French, et al. 1980. Legion- naires' Disease in a Transplant Unit: Isolation of the Causative Agent from Shower Baths. Lancet 2: 118- 121. 9Breiman, R.F., B.S. Fields, G. Sanden, L. Volmer, A. Meier, and J. Spika. 1990. An Outbreak of Legionnaires' Dis- ease Associated with Shower Use: Possible Role of Amoebae. Journal of the American Medical Association 263:2924 -2926. 'oJemigan, D.B, J. Hofmann, M.S. Cetron, et al. 1996. Out- break of Legionnaires' Disease Among Cruise Ship Pas- sengers Exposed to a Contaminated Whirlpool Spa. Lancet 347: 494 -499. "Centers for Disease Control and Prevention. 1997. Legion- naires' Disease Associated with a Whirlpool Spa Dis- play- Virginia, September- October 1996. Morbidity and Mortality Weekly Report 46: 83 -86. 12 Arnow, P.M., T. Chou, D. Weil, E.N. Shapiro, and C. Kretzschmar. 1982. Nosocomial Legionnaires' Disease Caused By Aerosolized Tap Water from Respiratory Devices. Journal of Infectious Diseases 146: 460 -467. '3Schlech, W.F., G.W. Gorman, M.C. Payne, and C.V. Broome. 1985. Legionnaires' Disease in the Caribbean: An Outbreak Associated with a Resort Hotel. Archives oflnternal Medicine 145: 2076 -2079. 14 '4111ady, W.G., R.C. Mullen, C.S. Mintz, B.G. Shelton, R.S. Hopkins, and G.L. Daikos. 1993. Outbreak of Legion- naires' Disease Linked to a Decorative Fountain by Molecular Epidemiology. American Journal of Epide- miology 138: 555 -562. 15Mahoney, F.J., C.W. Hoge, TA. Farley, et al. 1992. Com- munity- Wide Outbreak of Legionnaires' Disease Asso- ciated with a Grocery Store Mist Machine. Journal of Infectious Diseases 165: 736 -739. 16Johnson, J.T., V.L. Yu, M.G. Best, et al. 1985. Nosocomial Legionnellosis in Surgical Patients with Head and Neck Cancer, Implications for Epidemiological Reservoir and Mode of Transmission. Lancet 2: 298 -300. i7Best, M., V.L. Yu, J.E. Stout, at al. 1983. Legionellaceae in the Hospital Water Supply- Epidemiologic Link with Disease and Evaluation of a Method of Control of Noso- comial Legionnaires' Disease and Pittsburgh Pneumo- nia. Lancet 2: 307 -310. "Blatt, S.P., M.D. Parkinson, E. Pace, et al. 1993. Nosoco- mial Legionnaires' Disease: Aspiration as a Primary Mode of Disease Acquisition. American Journal of Medicine 95: 16-22. i9Addiss, D.G., J.P. Davis, M. LaVenture, P.J. Wand, M.A. Hutchison, and R.M. McKinney. 1989. Community- Acquired Legionnaires' Disease Associated With a Cooling Tower; Evidence for Longer - Distance Trans- port of Legionella pneumophila. American Journal of Epidemiology 130: 557 -568. 20Klaucke, D.N., R.L. Vogt, D. LaRue, et al. 1980. Legion- naires' Disease: The Epidemiology of Two Outbreaks in Burlington, Vermont, 1980. American Journal of Epide- miology 119:382-391. 2'Fiore, A.E., P.J. Nuorti, O.S. Levine, et al. 1998. Epidemic Legionnaires' Disease Two Decades Later: Old Sources, New Diagnostic Methods. Clinical Infectious Diseases 26:426 -433. 22Mastro, T.D., B.S. Fields, R.F. Breiman, J. Campbell, B.D. PI'kaytis, and J.S. Spika. 1991, Nosocomial Legion- naires' Disease and Use of Medication Nebulizers. Journal of /nfectiousDiseases 163: 667 -670. 23Kutcha, J.M., S.J. States, and A.M. McNamara. 1983. Sus- ceptibility of Legionella pneumcphilia to Chlorine in Tap Water. App. Environ Microbiol. 46: 1134 -1139. 24Colboume, J.S., D.J. Pratt, M.G. Smith, S.P. Fisher-Hoch, D. Harper. 1984. Water fittings as Sources of Legionella pneumophila in a Hospital Plumbing System. Lancet 1: 210 -3. 25Stom, J.E., V.L. Yu, P. Muraca, J. Joly, N. Troup, and L.S. Tompkins. 1992. Potable water as the Cause of Sporadic Cases of Community- Acquired Legionnaires' Disease. New England Journal of Medicine 326: 151 -154. 26Joseph, C.A., J.M. Watson, T.G. Harrison, and C.L.R. Bar- tlett. 1994. Nosocomial Legionnaires' Disease in England and Wales. Epidemiology and Infection 112: 329 -45. 27Metimer, S., R.C. Schwille, A. Farley, E.R. Wald, J.H. Ge, S.J. States, T. Libert, and R.M. Wadowsky. 1997. Eff'- ASHRAE GUIDELINE 12 -2000 • • cacy of Thermal Treatment and Copper - Silver Ioniza- tion for Controlling Legionella pneumcphila in High Volume Hot Water Plumbing Systems in Hospitals. American Journal oflnfection and Control 25:452-457. 2sGoetz, A., and V.L. Yu. 1997. Copper -Silver Ionization: Cautious Optimism for Legionella Disinfection and Implications for Environmental Culturing. American Journal oflnfection Control 25: 449 -251. 29Liu, Z., J.E. Stout, M. Boldin, J. Rugh, W.F. Diven, and V.L. Yu. 1998. Intermittent Use of Copper - Silver Ion - ozation for Legionella Control in Water Distribution Systems: A Potential Option in Buildings Housing Indi- viduals at Low Risk for Infection. Clinical Infectious Diseases 26: 138 -140. 30Stout, J.E., and V.L. Yu. 1997. Eradicating Legionella from Hospital Water. Journal of the American Medical Asso- ciation 278: 1404. 31Tablan, O.C., L.J. Anderson, N.H. Arden, R.F. Breiman, J.C. Butler, M.M. McNeil, and the Hospital Infection Control Practices Advisory Committee. 1994. Guideline for prevention of nosocomial pneumonia, Part 1: Issues on prevention of nosocomial pneumonia. American Journal oflnfection Control 22: 247 -292. 32The Control of Legionellosis Including Legionnaires' Dis- ease. HSE Series Booklet HS (G) 70, Health and Safety Executive, Library and Information Services, Broad Lane Sheffield UK, 19991. 33American Society for Testing and Materials. D5952 -96 Standard Guide for Inspecting Water Systems for Legionellae, and Investigating Possible Outbreaks for Legionellosis (Legionnaires' Disease or Pontiac Fever. 34Mermel, LA., S.L. Josephson, C.H. Girogio, J. Dempsey, and S. Paremeau. 1995. Association of Legionnaires' disease with Construction: Contamination of Potable Water. Infection Control and Hospital Epidemiology 16: 76 -81. 35Paszko- Kolva, C., H. Yamamoto, M. Shahamat, T.K. Saw- yer, G. Morris, and R.R. Colwell. 1991. Isolation of Amoebae and Pseudomonas and Legionella spp. From Eyewash Solutions. Applied and Environmental Micro- biology 57: 163 -167. 16Tbomas, D., L. Mundy, and P. Tucker. 1993. Hot Tub Legionellosis: Legionnaires' Disease and Pontiac Fever after a Point - Source Exposure to Legionella pneumo- phila. Archives Internal Medicine 153: 2597 -2599. 37 National Center for Environmental Health/National Center for Infectious Diseases. 1996. Final Recommendations to Minimize Transmission of Legionnaires' Disease from Whirlpool Spas on Cruise Ships. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, CDC. (770488 -3141 or DGJOQcdc.gov) 38Shelton, B.G., G.K. Morris, and G.W. Gorman. 1993. Reducing Risks Associated With Legionella Bacteria in Building Water Systems. In: J.M. Barbaree, R.F. Breiman, L.P. Dufour, eds. Legionella Current Status ASI- AE GUIDELINE 12 -2000 and Emerging Perspective. American Societyfor Micro- biology pp. 279 -281. 39Shelton, B.G, W.D. Flanders, and G.K. Moms. 1994. Legionnaires' Disease Outbreaks and Cooling Towers with Amplified Legionella Concentrations. Current Microbiology 28: 359 -363. ftmndrett, G.W. 1992. Surveys of Legionella in Building Services Not Associated with Outbreaks. In: Legionella and Building Services. Oxford: Butterworth - Heinemann Ltd., pp. 167 -189. 4'Broadbent, C.R. 1993. Legionella in Cooling Towers: Practical Research, Design, Treatment, and Control Guidelines. In: Legionella Current Status and Emerging Perspectives. J.M. Barbaree, R.F. Breiman, A.P. Dufour, eds. Washington DC: American Society for Microbiol- ogy, pp. 217 -222. 42McCoy, W.F. 1998. Imitating Natural Microbial Fouling Control. Materials Performance 37(4):45-48. . 43Letter From ASHRAE TC 3.6 to the Centers for Disease Control and Prevention. `Cooling Tower Institute. 1980. Suggested Protocol for Emergency Cleaning of Cooling Tower and Related Equipment Suspected of Infection by Legionnaires' Disease Bacteria (pneumophila). Houston, Tex. 45Herwaldt, L.A., G.W. Gorman, T. McGrath, et al. 1984. A new Legionella species, Legionellafeeleii species nova, Causes Pontiac fever in an Automobile Plant. Annals of Internal Medicine 100: 333 -338. 46Fiore, A.E., J.C. Butler, T.G. Emori, and R.P. Gaynes. A Survey of Methods to Detect and Control Nosocomial Legionnaires' Disease (LD) among Hospitals in the National Nosocomial Infectious Surveillance (NNIS) System. 35th Annual Meeting of the Infectious Disease Society of America, San Francisco, CA, Abstract 332, 1197. 47 Butler, J., B.S. Fields, and R.F. Breiman. 1997. Prevention and Control of Legionellosis. Infectious Disease and Clinical Practice 6: 458 -64. 48yu, V.L. 1997. Prevention and Control of Legionella: an idea Whose Time Has Come. I*ctious Disease and Clinical Practice. 6: 420 -421. 49American Society for Testing and Materials. D5952 -96 Standard Guide for Inspecting Water Systems for Legionellae, and Investigating Possible Outbreaks for Legionellosis (Legionnaires' Disease or Pontiac Fever. (This informative annex is not a part of this guideline and is for information purposes only.) ANNEX A BIBLIOGRAPHY Stout, J.E., V.L. Yu. Legionellosis. New England Journal of Medicine 337 (1997): 682 -687. Edelstein, P.H. Legionnaires' Disease. Clinical Infectious Diseases 16 (1993):741-749. 15 Butler, J.C., and R.F. Breiman. 1998. Legionellosis. In: A.S. • Evans and P.S. Brachman, eds. Bacterial Infections of Humans: Epidemiology and Control, 3d ed. New York: Plenum Medical Book Company, pp. 355 -375. Garrett, L. 1994. The American Bicentennial: Swine Flu and Legionnaires' Disease. In: The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York: Farrar, Straus and Giroux, pp. 153 -191. ASHRAE Legionellosis Position Paper, 1998. • Cooling Tower Institute Legionellosis Position Statement, 1996. Fliermans, C.B. Ecology of Legionella: from Data to Knowl- edge with a Little Wisdom. Microbial Ecology 32 (1996):203 -228. OSHA Technical Manual. Section 11,1 Chapter 7, Legion- naires' Disease. http:/ Avww.osha- slc.gov /dts /osta/otm/ otm_iii/otm_iii 7.html. 16 ASHRAE GUIDELINE 12 -2000 POLICY STATEMENT DEFINING ASHRAE'S CONCERN FOR THE ENVIRONMENTAL IMPACT OF ITS ACTIVITIES •ASHRAE is concerned with the impact of its members' activities on both the indoor and outdoor environment. ASHRAE's members will strive to minimize any possible deleterious effect on the indoor and outdoor environment of the systems and components in their responsibility while maximizing the beneficial effects these systems provide, consistent with accepted standards and the practical state of the art. ASHRAE's short-range goal is to ensure that the systems and components within its scope do not impact the indoor and outdoor environment to a greater extent than specified by the standards and guidelines as established by itself and other responsible bodies. As an ongoing goal, ASHRAE will, through its Standards Committee and extensive technical committee structure, continue to generate up -to -date standards and guidelines where appropriate and adopt, recommend, and promote those new and revised standards developed by other responsible organizations. Through its Handbook, appropriate chapters will contain up- to-date standards and design considerations as the material is systematically revised. ASHRAE will take the lead with respect to dissemination of environmental information of its primary interest and will seek out and disseminate information from other responsible organizations that is pertinent, as guides to updating standards and guidelines. The effects of the design and selection of equipment and systems will be considered within the scope of the system's intended use and expected misuse. The disposal of hazardous materials, if any, will also be considered. ASHRAE's primary concern for environmental impact will be at the site where equipment within ASHRAE's scope operates. However, energy source selection and the possible environmental impact due to the energy source and energy transportation will be considered where possible. Recommendations concerning energy source selection should be made by its members. • • Hoag's Communication about the Cogeneration Plant with Residents of Villa Balboa Residents living the in Villa Balboa residential area, which is located next to the cogeneration plant, have received a series of confusing, and in some cases misleading statements from Hoag about whether the plant would emit visible plumes. Below is a timeline and description of these communications: On November 19a', 2002 several Hoag representatives made a presentation to the Board of Directors of Villa Balboa. At this meeting, Hoag gave an overview of the plant, and indicated that "steam" would be visible from the facility "intermittently." However, in three subsequent communications, one in writing, residents were informed that either, there would be no visible emissions from the plant, or that steam would be visible, but only during a limited period while the plant was undergoing testing prior to beginning normal operation. The first of these subsequent communications was the meeting held by Hoag on August 26a', 2003 in the Cancer Center auditorium on the lower campus. This meeting did not solicit feedback on the design of the plant, but rather consisted of an announcement by Hoag that they would be breaking ground on the plant the next day. Hoag also provided a review of the plant's construction timeline. During a question and answer session at the end of the meeting, Mr. Sam Stameson, a resident of Villa Balboa, asked if there would be any kind of visible emissions from the plant. The answer given was that Hoag did not expect any visible emissions from the plant. The second meeting on August 22, 2005 was held by Hoag to discuss their ongoing development plans for the Hoag lower campus. At this time, the plant had been constructed and was in a pre - operational test phase. During the question and answer phase of this meeting, Moe Quirk, a resident of Villa Balboa, asked the Hoag Director of Facilities, Langston Trigg, if the emissions seen recently from the plant were going to be a permanent feature of its operation. Mr. Trigg indicated that the emissions visible from the plant were part of the testing phase, but would not continue after the plant began regular operations. Further, Mr. Trigg's reassurance was also made in a follow up letter to all Villa Balboa residents dated August 30, 2005. The letter contains the following text: "As you may know, Hoag Hospital is currently in the process of building a power plant on our lower campus to provide the entire hospital with a more direct and cost efficient electrical source. The Co- Generation facility is located along Pacific Coast Highway at the west end of the hospital's campus, near Superior Boulevard. The testing of this equipment began a few months ago, and will continue into the Fall. During the testing process, you may hear equipment noise and notice steam coming from the facility. The sounds are the result of external engines being used during testing which • will be removed once in operation and the steam a byproduct of the testing, both will be eliminated once the Co- Generation plant is in full operation. " • Over the three year period from 2003 to 2005, the residents of Villa Balboa were reassured that plumes would not be a part of the plant's regular operation, and that any emissions seen during that period were strictly a feature of the plant's pre - operational testing. J • A Response to "Cogeneration Facility Facts" Below are responses to each of the eleven "questions and answers" presented by Hoag in the document entitled "Cogeneration Facility Facts," which was submitted by Hoag into the Public Record on April 8, 2008. 1.) What is the Cogen? The cogeneration plant is one component of a diversified portfolio of energy sources for Hoag Hospital, which also includes an upper campus central plant, back -up emergency generators, and general power grid. The neighboring community recognizes the benefits the cogeneration facility brings to Hoag, and for this reason there has never been any organized opposition to the plant itself. That said, it is interesting to note that most large hospitals do not maintain their own cogeneration facilities. 2.) Is the Co en Operating with Permits? The cogeneration plant was indeed permitted by agencies cited by Hoag. However, with respect to permits issued by the City of Newport Beach and the Coastal Commission, the permitting process did not follow proper procedure, and was severely limited because no supplemental environmental documentation was prepared. Section 3.3 of the Development Agreement specifically requires the preparation of a supplemental environmental impact report (SEIR) any time there is a new impact that was not evaluated in the original EIR. Since neither the plumes nor type and level of noise from the cogeneration plant were evaluated, or even anticipated, in the original EIR, preparation of an SEIR was required. The Planning Department staff report confirms that such documentation was in fact required, but not prepared, citing in part the lack of disclosure of information from Hoag Hospital about likely impacts. Under CEQA, cooling tower plumes are generally evaluated under protocols related to Visual Resources. The protocol under Visual Resources takes into account a range of factors, including the quality of the existing views, how close the plumes will be to sensitive receptors, and whether "scenic resources" or vistas will be blocked. According to staff at the California Energy Commission, nearly all plants over 50 megawatts permitted in California since the mid - nineties were required to have plume abatement. This is primarily because CEQA requires mitigation of significant impacts when mitigation is deemed feasible, and plumes are nearly always found to be significant. Most power plant applicants understand this, and include plume abatement equipment in the facility design. Other reasons that plants have plume abatement are in response to local laws, ordinances, regulations, and standards ® (LORS), or in order to demonstrate sensitivity to neighbors. • With respect to CEQA the same principles would have applied to the cogeneration plant had an SEIR been prepared as required by the Development Agreement. The plumes would have been evaluated under Visual Resources, and the impact found to be significant due to their close proximity to sensitive receptors and the fact that they disrupt views from a public park, and from a Scenic Corridor (Superior Ave). Since plume abatement is considered feasible mitigation under CEQA, installment of such equipment would have been required. It is extremely likely that mitigation would also have been required for the exhaust plumes and noise which come from the plant. 3.) What is the Plume? Hoag states that the cooling tower plume occurs "only a few days a year." This is simply incorrect. Plumes occur on a nearly daily basis during most of the fall and winter months. Plumes are frequent during the early part of spring and during the "June Gloom" period of the summer. They can in fact occur at virtually any time of the year. Hoag cites the "90 day period from April 20, 2007 through June 24`h," and notes that plumes were visible for 12 days. Ignoring the fact this is actually a 60 day period, the time frame cited is the period of the year when plume formation is least likely. A figure of 12 days of visible plumes over the sample period cited by Hoag is not consistent with observations by residents who have observed the plant in operation daily for three years. However, even if the frequency of plumes cite during this period was correct, and was considered representative of all time periods, this would still represent 72 days per year of visible plumes (based on a 60 day sample). Hoag has also left out night -time plume formation. Since the plume is illuminated by street lights and by the lights from the small commercial area at the corner of Balboa Boulevard and Pacific Coast Highway, it is visible at night from a wide range of areas. Resident experience strongly suggests that there is visible plume formation on 55% of to 65% of days, and 65% to 80% of nights. The best way to establish precise data would be for the City to authorize additional formal study, something the residents strongly support. 4.) Is the plume a health risk or is it an aesthetic concern? The cooling tower plume is clearly an aesthetic issue. But is it also a health issue? Guidelines from the cooling tower industry suggest that there is a small, but still real, risk. There are hundreds of documented cases of human beings contracting Legionnaire's Disease, a serious form of pneumonia, from exposure to cooling tower plumes which have been contaminated with Legionella bacteria. • Hoag states that the cooling tower plume "does not create a health risk." To support this assertion, they cite the fact that they implement water treatment guidelines developed by the cooling tower industry to protect against Legionella. However, the same industry guidelines that recommend water treatment to reduce the risk of Legionella are also explicit in stating that treatment alone is insufficient. For instance, recommendations developed by General Electric state the following: "Chemical treatment alone will not be effective in reducing health hazards associated Legionella bacteria. System design, location, maintenance practices and employee awareness are critical elements of a successful risk reduction program. " In this context, "location" refers to placing towers away from human populations. Guidelines developed by the Association of Water Technologies (AWT) are even more explicit. With respect to water treatment, they warn that "...high (even infectious) levels of Legionella have been found in otherwise well - maintained and operated tower systems." AWT further states that because "there are no guarantees to keeping a tower system 100% Legionella- free," cooling towers should be located away from "people populations (especially at -risk populations), building air intakes, and surrounding units." With respect to Legionella, "at risk populations" refers primarily to the elderly, which make up a substantial proportion of the retirees living at nearby Villa Balboa. The American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) states that locating cooling towers away from human beings is part of the recommended protocol for reducing the risk of transmitting Legionnaires Disease. Specifically, they use following language with respect to tower locating practices: 1.) Locate as far as possible from fresh air intakes, including windows that can be opened 2.) Consider the direction of prevailing winds and do not locate (towers) upstream of outdoor public areas. 3.) Consider future construction, including nearby sites. The Hoag cooling towers are located directly adjacent to Sunset View Park, and cooling tower plumes often blow directly into the park and towards residences at Villa Balboa and Newport Crest. It should be further noted that the Health Risk Assessment (HRA) regarding Legionella prepared for the City by an outside consultant says little beyond simply acknowledging that Hoag follows recommended water treatment protocols. No • attempt is made to address industry guidelines about locating cooling towers away from human populations. • The HRA also mistakenly cites a lack of reported cases of Legionnaire's Disease in Orange County over the last three years as evidence that the Hoag cooling towers do not present a threat. What the report fails to mention is that many cases of Legionnaire's Disease are not diagnosed and even fewer are reported to public health authorities. Further, only clusters of two or more cases are even investigated. Ultimately, it is impossible to conclude but that the Hoag cogeneration plant cooling towers violate one of the key components of industry's guidelines on Legionnella, and therefore pose a small, but real, health risk. 5.) Are Cooling Towers Commonly Fitted with "Plume Abatement "? Plume abatement equipment has been in use for over thirty years, and is widely used throughout the United States and around the world. Nearly all major cooling tower manufacturers carry one or more lines of plume- abated towers for use in environmentally sensitive areas. As noted earlier, in California such towers are widely used to meet requirements under CEQA, to meet local regulations regarding plume abatement, or to show sensitivity to neighbors. Hoag apparently wishes to create doubt about whether plume abatement technology will be effective in coastal areas of California. They cite a paucity of plants using plume abatement along the California coast. They also cite several local facilities, such as Balboa Bay Club, which have cooling towers, but not plume abatement. This line of reasoning is faulty for a number of reasons, and will be addressed below in items 9 through 11. It should be noted that reasonably accurate predictions about the degree of plume reduction from an established abatement technology can be accomplished using real world operational data and basic principles of physics together with ample data regarding local atmospheric data. In the Planning Department Staff Report, Fluor and Hoag's own engineering firm Syska - Hennessey used this approach to conclude that plume reduction of "75% or greater" could be accomplished by installing towers designed for plume abatement. There is reason to believe based on general data about the effectiveness of plume abatement technology that even greater reductions are possible. 6.) Will a plume abatement system (i) increase Hoag's energy use, or (ii) have a negative impact on the environment? Plume abatement systems do entail a modest operational penalty, and therefore do slightly reduce the efficiency of a given facility. This can be expected to create some increase in costs and in a facility's carbon footprint. However, this not reason to avoid use of the abatement equipment if it is required to mitigate a significant adverse • impact on nearby residential, recreational, or scenic areas. As noted earlier, plume abatement equipment is in extremely wide use, and is required by the California • Energy Commission for most plants permitted in this state. Under CEQA, plume abatement is considered `feasible," a concept which taken into account effectiveness, capital cost, energy efficiency, and other factors. Most modem plume abatement systems are designed to specifically to maximize efficiency. 7.) Did engineering experts review the options for plume abatement? Yes, options for plume abatement were reviewed by a number of engineering firms, most of which were retained by Hoag. By Hoag's own admission, there are significant differences in opinion between these fines. Option 4, which was introduced by Hoag on April 15`h, consists of a combination of operational sequencing changes and load shifting. It will be put into affect during November through April, and only during the day. Estimated plume reduction is 30 %, although there little supporting evidence provided for "this claim. Given the frequency and density of plumes from the cogeneration plant, this approach is clearly inadequate. Hoag states that that Option 3A would reduce the plume by 50 %. It should be noted however that Fluor has privately stated that it believes the degree of plume reduction may be as much as 55% to 60 %. This option will still leave a substantial plume during most of the year, and will also create additional noise and violate set -back rules in the Development Agreement. Hoag states that Option 3, which entails replacement the current towers with towers designed for plume abatement, would provide a reduction of 70 %. However, the Staff Report states that the degree of plume reduction would be 75% or greater. There is good reason to believe that even this estimate is too conservative. Option 3, entailing the use of fully plume - abated towers is the solution that would have been required under CEQA, and is the approach will definitively put this issue to rest. It is worth noting that none of Hoag's claims about the initial or ongoing costs for plume abatement were validated independently by Flour. However, Flour did state it believes Hoag's estimates of the initial cost of several options, including Option 3, were "inflated." 8.) Did the designers of cogeneration facility review plume mitigation options when it was designing the Cogen in 2002? Why was such system removed from the design? Hoag says that its team "valued engineered" out the plume abatement system included in the plant's original configuration by its designers. Those who designed the plant fully understood that plume abatement was appropriate to a plant of this . type given its highly sensitive location. The primary reason Hoag decided to remove the equipment was cost. • As has been noted previously, plume abatement is a standard feature of plants located near sensitive areas for the reasons discussed previously. And, there are examples of plume abated towers operating in coastal areas (see below). Many plant operators include this equipment even when it is not required simply out of sensitivity for neighbors. 9.) How is methane in the area mitigated? Hoag's methane collection does indeed benefit some of the areas along PCH. This is a helpful side benefit of a project (gas collection), the main purpose of which was to allow Hoag to develop the land on the lower campus. 10.) Has Fluor built a plume abatement system in a California Coastal Zone? Flour is a respected global engineering firm, with broad experience in a range of fields. However it does not specialize in building plume abatement systems, and therefore the fact that it has not built any in the California Coastal Zone is not particularly meaningful. Hoag also sought examples of from "several" high volume engineers and contractors in California. The fact is that very few power plants are built in sensitive coastal areas. Of the plants that have been built in these areas, most are large, older facilities that use "once- through cooling" using sea water, and therefore don't need cooling towers. It is also very unlikely that very many coastal communities have allowed the construction of even smaller cogeneration facilities. Therefore, the relatively few plume- abated cooling towers in costal areas of California, is mostly related to the relative lack of any cooling towers associated with power plants in such areas. If Hoag is serious about locating examples of plume abatement in coastal areas, it is reasonable to ask why is did not approach any of the five or six multi - national companies that specialize in cooling towers, each of which maintains one or more lines of plume- abated towers. Further, why was the search not extended beyond California? Interestingly, a search on the Internet reveals that they may not have been looking too hard. The Los Esteros Critical Energy Facility built by Calpine at the southern edge of San Francisco Bay does include plume abatement technology. According to documents from the California Energy Commission, the City Council of San Jose required the plant to use "best commercially feasible available technology for plume visibility reduction." To read more about this plant, click on the following link and then go to page 349: httR: / /www energy ca gov /2005publications /CEC- 800 - 2005- 004 /CEC- 800 - 2005 -004- PMPD.PDF • Lastly, Hoag's own "fact sheet" states that there is also a coastal plant in Carlsbad that uses plume abated cooling towers. This has not been confirmed by us, or as far we are aware, by the Planning Department. 11.) Are there examples of cooling towers in California with and without plume abatement? As noted earlier, plume abatement technology is in wide use around the world, the nation, and in California. With respect to California, there is at least one such facility in a coastal area (Los Esteros Critical Energy Facility). Hoag cites eight mostly local facilities with cooling towers, none of which have plume abatement. However, all but one of these are hotels. Hotel cooling towers are almost always associated with air conditioning systems rather than with power plants. Air conditioning cooling towers are generally much smaller than those used by cogeneration plants, and handle much smaller loads. They therefore typically produce small or infrequent plumes. Further, if plumes are produced, they are often hidden from view, since many such cooling towers are screened or are located on in areas where they are mostly out of view. It is certainly unlikely that any of the eight listed are located next to a park, a scenic corridor, a major coastal highway, and a large number of residences, as are the Hoag cooling towers. To gather more information on the list provided by Hoag, we made phone calls to each facility. We made contact with engineering personnel at most, and are waiting for call backs from three. At least one of the facilities listed does not actually have cooling towers of any kind (Pebble Beach Lodge). Of those that do, most said they produce very small plumes, and these plumes are located in screened areas where they are generally not visible to the public. South Coast Hospital indicated that their towers produce moderate plumes, and that they are visible to "several" residences. However, the plumes are not in the line of sight between the ocean and residences, parks, or public streets, and therefore do not block vistas. Notes for calls made to each facility are provided at the end of this document California Cogeneration and Power Facilities with Plume- Abated Cooling Towers The following list of cogeneration and power plants with plume abated cooling towers was generated using a simple Internet search. It is not a comprehensive list of plants in California using plume abatement technology, but rather provides a representative sample of facilities in which abatement technology was included in the plant design to address impacts under CEQA, to address local laws, ordinances, regulations, or standards (LORS), or to demonstrate sensitivity to neighbors. In the case of facilities located in Santa Clara County and the City limits of San Jose, inclusion of the "best commercially feasible available technology for plume visibility reduction" was a specific requirement of approval by the City of San Jose. • ( ** = Cogeneration plant) Los Esteros Critical Energy Facility II - Santa Clara County, California 333 Hope Street Cogeneration — Los Angeles, California ** Crockett Cogeneration — Crocket, California** DesJardins 1.3 MW Cogeneration Facility — Southern California ** Metcalf Energy Station — San Jose, California Palomar Energy Center— Escondido, California Donald Von Raesfield Power Station— Santa Clara, California Pico Power Project — Santa Clara, California • • 8 Non plume- abated towers cited by Hoag Hospital - Discussion with facility engineering staff Seven of the eight facilities with non -plume abated cooling towers listed by Hoag in its document "Cogeneration Facility Facts" are hotels; only one is a hospital. Hotels typically use cooling towers for air conditioning rather power generation. Towers used for air conditioning are smaller, generally handle less significant cooling loads, and therefore generally produce much less frequent and smaller plumes. Further, such towers are typically are either located on rooftops and/or are screened from public view. It is certainly unlikely that they would be located next to a public park, several residential developments, a scenic corridor (Superior Ave), and a scenic highway. To gather more information on the towers, cited by Hoag, I personally called the engineering staff at each facility. I have recorded names and phone numbers below for anyone wishing to call the personnel in question. Balboa Bay Club — Newport Beach (Marlev) Gary - 949- 645 -5000 According to engineering staff, BBC uses it towers only for air conditioning. The equipment is located on a rooftop and only occasionally produces a visible plume during cold weather. When it is does, the maximum height is 5 to 10 feet. Gary indicated he has seen the plumes from the Hoag cogeneration plant and said the occasional plumes at BBC are "nothing like that." Hyatt - Huntington Beach (Baltimore Air Coil) Angela — 714- 698 -1234 (left voicemail) The Inn at Spanish Bay - Pebble Beach (Evapco) Rich Horning— 831- 647 -7402 (left voicemail) Pebble Beach Lodge - Pebble Beach (Evapco) I:Ti41 W*WMVjM11Pl • According to facilities staff, this hotel was built in 1919, and does not have cooling towers of any kind. Cooling towers are located at sister hotel "The Inn at Spanish Bay" • South Coast Hospital — Laguna Beach Bill Simpson — 949 - 499 -1311 Cooling towers sometimes create moderate plumes, which can be visible from "several" residences. However, According to Bill Simpson, Facilities Director, the plumes are not in the line of sight between the ocean and residences, parks, or public roads. That is, they do not block ocean views. Hyatt Mission Bay— San Diego Allen Alano — 619- 224 -1234 According to engineer Allen Alano the facility has two small cooling towers for air conditioning located on the top of the high rise tower. He says the effluent from the tower dissipates immediately, and therefore is not visible to the public. Our conversation piqued his interest, and he asked to see photo's of the Hoag plume, so I directed him to the Friends of Sunset View Park website. He was very surprised by the size of the plume and its location in a residential area. Hilton — Huntington Beach (714) 845 -8000 Facility has one moderate sized tower which is located in the loading dock/engineering area of the facility on the side of facility, and is screened from public view. They occasionally produce a very small plume but it is not visible to either quests or neighbors. Lowes Santa Monica Beach Hotel— Santa Monica (Baltimore Air Coil) Theresa Hooper - (310) 458 -6700 (left voice mail) 40 Prepared by Erik Thumher for Friends of Sunset View Park - April 16, 2008 • City of Newport Beach Hoag Memorial Hospital Presbyterian Project No. 0OA3YZ Plume Mitigation Measure Review 2.3 OPTION 3 A Option 3 -1, Install new Tower with Plume Mitigation System FLUOR. DATE 19Mar08 PAGE 7 OF 10 Rev 0 Replacing existing towers with new towers with plume abatement equipment incorporated would be the most effective solution to reduce the plume. Hoag's engineer estimates an incremental plume reduction of about 70 %. This estimate, considering the local micro - climate and our experience with similar technologies is a fair estimate of plume reduction. It is noteworthy to indicate that higher percentages of plume reduction is possible, however an incremental gain in efficacy does not justify increased equipment cost, size and the operational cost associated with the system. This option will have longer construction schedule as well as the possibility of disruptions in service and system downtime with the reconstruction of the cooling towers and associated systems. This disruption could be minimized by proper system design and construction management. However working on the structure and demolishing sections of structure while the tower is in operation does pose higher level of risk to ongoing operation than option 3A. During further discussion with Hoag's representative on 3/17/08, 1 was informed that Hoag's engineer is working on a new estimate and they will publish it within next two days. Thus we will not make any further comment until the revised estimate is available for our review and comment. B. Option 3 -2, retrofit existing cooling tower with plume mitigation system Retrofitting the existing towers by adding plume mitigation equipment to the existing structure was studied by Hoag's engineer, but due to structural complications, seismic issues, cost and downtime, it was concluded infeasible to pursue any further. We do agree with the conclusion. Adding dry tower onto existing structure is infeasible. 2.4 ALTERNATE OPTION (3A) — INSTALL REMOTE AIR TO WATER HEAT EXCHANGERS AND PROVIDE OUTSIDE AIR INTAKE WITH MOTORIZED DAMPER ON EXISTING TOWER CELLS Fluor's proposed alternate option (3A) requires adding a side stream air to water heat exchanger (HX) system consisting of two to four HX sections and associated pumping system for dry cooling. Additionally, this option would require the installation of outside air intake openings with motorized dampers in the fan section of each cooling tower cell for mixing dry ambient air with moist tower discharge air. This arrangement reduces condenser water return temperature and lowers the discharge air relative humidity from tower thus reducing the chance of plume formation. Plume reduction of about 50% should be achievable when this option and option 1 both are implemented. City of Newport Beach_ Hoag Hospitaf_Plume Mitigation Measure Review Study_Revo 3_19 OB.doc Ferry, 990 I Return of Organization Exempt From Income Tax `! Under section 601(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung )epanment of the Tionsury bonefit trust or private foundation) ntemal Revenue ssrvrce l The organization may have to use a copy of this return to satisfy state reporting requiternernis. A For the 20i 8 aneN lrryp{,yµt: AJWa.a wren awy. InXW ,Mtn nnL rcyyn Am.�w.e mrun l PMOac C HO Name of orlill M D Employer ktentfrka0on nrrrnbor ns`ms IoDal or - G AEHORX I - "-O'-- P I TAT- .TERIAN _ 95 1 634,7 p4mm Number and street (or P.D. box it mail is not delivered to strael address) Rona lsutte E Tetaphono number lypk Sx City or tOWn. state Or country, and ZIP +4 teem, • Section 501(cX3) organizations and 4947(3)(1) nonexempt charitable trusts mull attach a completed Schedule A (Form 090 m 9110•EZ). K Check hero It' IJ if the organkntbn'S gross mceiPS Am nmmalfy nil more man $25,000. The organization need not flip.. a return with the PS; but IF sire organnntan received a Form gag Packago In the mail. it Should We a,Mutn without financial data Some Grates remdm a Complete return. — Add 0. H and I ore not Applicable to Section 527 orpnnirargn^s�. HIS) Is this a group return fa eflillotes7 E] Yee rU No H(b) Ir -Yes,' enter number of avulay I► _14 A _ H(c) Are all affiliates included? N/A [ 7TCa �No pt'NO. "attach a list. see Inslr rcilow j H(tl) Is the a SSParala'Stun tied by an = annuorm ru�up.bY��_�I�RYea,t� No I _ Group Esomption Nu_mh_er ► M Check jl . ^d tae or9�ieation is not Inquired to Along Sch.J(Form Sae. too -EZ_ in 990.PFt '590, 158_. ..,- _,_869,c.6 ?213255 Farm 990 (P004) 1 Conilitmlions. gifts, grants, and similar amounts received: IS Direct ptroNe Support , , , , , , ..... ........... 1. _ b Indirect public supporl .. .. 1 b - _ 319..' c Government eontribldions (grads) , , , , , , , , , , , , , , , , , Sr. d Totan fern ,roes I enough ic) ldmh S 9�$15J 715 .rash s 2 Program service revenue including government fees and contacts (foam Part W. One 93) , , , , , , , , 3 Membership dues and assessments . . .. . . . . ... . .. . . . .. .. . . . . . .. . . . . . 4 interest on savings and temporary cash invesbnonts , , , , , , , , , , , , , , , , , , , , , , , , 5 Dividends and interest from securities , 6a Gross revs 6a B9S,_523. ..- b Less: rental expenses ................... . . 9%7f,854. c Net rental Income or (loss) (subtract line 6b from line Be) , , , , , , , , , , , , , , , , , , , , , , , 7 Otner Investment income (describe ► STMT 1 y _ ..,, _ 6 a Gross amount from sales of Mots clhar (A) Securities (a) Ogler m rc _ _ _ 7 - than inventory .. , , . SEE S .. 12§0,,05_2,297, 6a 86,,757., b less: cost a Other basis and sates expenses, t2Q1,�7, ,2X260. Sb 89 723, c Gain or (loss) (attach schedude) , , , , , , 19,f. qD, 037 8c �– X10_ 2,�966w d Net gain or (loss) (combine line Bc, Columns (A) and (0)) ................. . 9 Special events and activities (attach schedule). If any amount is from gaming, check here It- El a Gross revenue (nil Including $ of contributions reported on line 1a) , , , , , , , , , , 9a b Less: direct expenses other than fundraising expenses , , , , , , , 96 c Not income or (loss) from special events (subirad line 9b lion line 9a) ............ . 10a Gross sales of knvenury. less returns and aflowances , , oa b Loss; cost d goods Sold ...... ... .. ... Ob _ __ c Gross profit or (loss) Iron salon of inventory (attach schedule) (subtract line job horn line Joe) 11 Outer revenue prom Part Vfl, line 103) .... ..................... .. . —11 7otatrevanUe _(ptld Gres lit 2 3 4�5 6g6 e, IOC and 11)._..... , ..._.._. 13 Program services (from line 44, column (E)) . ffi 14 Management and general (from lime 44, column (C)), . , , , , ? 15 Fundraising (from line 44, Column (0)) , , , , , , , , , , , , , , , X 16 Payments to affillates (attach schedule) , , , , , , , . .. . . . . . . _.—.. 17 Total ex ensos add lines 1G god 44, rdumn A .. ...... .. .. . _ ..............-_.... a .- ._p�_ �__.__...._q_..._..�. -.y w 18 F,xcess Or (drfr 0 for the year (subtract fare 17 from fine 12) , , , , , , , , , , , , , , , , , , , , , , 19 Net assets or fund balances at beginning of year (from line 73. column (A)) , , , , , , , , , , , , , , , 20 Owner changes in net nssels or fund balances (attach azl4anaijon) ..... >57.TtT .2, ..STMT. 3. _ 21 Net assets or fund bsltioes a„t r. _rut Of ^a combine foes 16, 19, and ?.0) w _ For Privacy Att antl Paperwork Reduction Act Notice, see me separate instructions. JSA 4Ermo t gon '590, 158_. ..,- _,_869,c.6 ?213255 Farm 990 (P004) U Statement of AR or0anirations Functional E ertses mid aeclion must romple 4947(4)(1) annex[ Do not mdude alnoeplf5 reoWted On /Ind total 22 Grants and allocations (attach schedule) (rrn s_ 3}ti71�6 3, noand+s1 Z2 _ ^31.672 23 Spaelr ieassistencetob utivduals (attach senedub) 24 aem:ras paid to or for members (attach Wheula) 24 25 25 Compensation of officers. directors, etc 26 186. B84 26 Other salaries and wages ....... 27 363, 2T Pension plan contributions ...... 28 21 :L 26 Other employee benefits , ..... 29 _ 13947 29 Payrolltaxes ...... . ....... 30 30 Professional fundraisalg fees ..... 31 Accounting fees .... 32 1225, 32 Legal fees . ....... . ...... 33 Supplies ................ 33 _ 88,546, 34 Telephone ..... , . ........ as .— ,.._sea., 35 Postage and shipping ......... 35_ . 36 Occupancy .............. 36- 37 Equipment rental and maintenance. 37 _x0,.8,_991 38 Printing and publications .. , .... 38 39 Travel .......... ....... 39 40 Conferences. conventions. and meetlrtys -40 ! ..... 1,, 104., 4f interest...... ........... 41._ 9.r 306, 42 oepmGation, tleplelhm. era. f'dAWsAdaw. . 42 _31, 54A1 43 other c,gia.•.mrx ancrN anew fatanmsrSTMZ'_6_ 13a 100 260, b 31) 3c c 43d d c ___ 3e i__ _____ __ 44 7oa1un-ma) expeases(ao nnt�IIlhwpo 9l 2 Colurmts (B), (C), and to) arc tMirea Ear section 501(eH3) and f4) nrgankatitna trusts but opilanal for others. (See page 721 "to instructi7ro.) fat Pro ram (C} MeaaOemant (0 Fuadruisf — 93 Op" totals to ones 1x11 4�545s120.� —?s893_c 902 Joint Costs. Ghnck 11" Lj if you are following SOP 98 -2. (_''t Are anyjoinl costs from a combined edurotlonal campaign and fundralsing sWicitation r'cgxrrted in (S) Pmgtmn serviat -s7 . , ► [j yes a No if -yet.- enter (1) the aggregate amousN of these Mrd costs S _ _. — : III) the amount Vacated to Program sesAces $ What is file ortordZaeon's primary rxompf pupose? ►_ STMfl_ 7 rrogrom a ce Expeum All organizatlorc must describe Weir exempt purpose acnievemmis in a Wear and concise manner. State the number (Reya;rad for 501(e}f3) end of clients served, pubticalions Issued, etc, Discuss achievements That are not measurable. (Section 5011 antl (4) (4) mgs.. and 494T(aH1) organizallons and 4647(a)(1) nonexompt cl)WIlnble trusts musl also enter [lie amount of grants and allocatioru to others.) trusty. bvl 49ona) ftr .them.) a b Q e Other pro rarn safNCes attach satauJule Grants and allocations $ IF _7ot4J of Program Service Expensos Lbou)d tt ual line 4Lc0 lumn 8), Pro�mm serviCesL_ _y__ P_�9�_1S1 r 146 4F 1001 Wit trim 99O (2004) SSWBTa 2020 VD4 - -8 60087802 95- 1643327 Form 990 (2004) FEM Balance Sheets (Seepage 25 of the instructions.) _ Note: Whero rsctuired, attachod schedi*s and amounts within the descn;ohon T_715,_125 __ 1Acolumn shordd be for errd.of•year amounts only. ginnfi9 of ... .. ,�... 79y310 ......... ..46 Savings and temporary cssh investments • • • , • , • , • , , • • • .... 47a Accounts receivable b Less: allowance for doubtful accounts , , , , , , b Less: allowance for doubtful accounts, , ; , . , , [iL— 48 Grants receivable ................... . ............ 50 Receivables from officers, directors. trustees, and key employees (attach schedule) ................. ......... STMT. P. . $1 a Other notes find loans receivable (attach S schedule) . . . . . . . . . . . . . . . . SAIT .9. 61 a 2 , 882 651 w b Less: allowance for doubtful accounts , , , , , , 61 b 52 Inventories for sale or use 63 Prepaid expenses and deferred charges......... ... . 54 Investments - securities (attach schedule) prW. ill Y [J Cost EJ FMV 65a Investments - land, buildings, and equipment: basis , , , , , b Less: accumulated depreciation (attach schedule) ..... ................. 56 Investments - other (attach schedule) , ..... ... • STKr. 7.5 g egUgnnent: basis, , , , „ 64,876.927 57a Land, buildings, and , b Less: accumulated deprecation (attach schedule) ........... STNT, 5 , , , , , 5 494, �._..., 854 68 Other assets (describe ► �.. ___ STMT 16 ) 69 Total assets (add lines 45 through 58) (must equal tine 74). . 60 Accounts payable and accrued expenses , , , , , , , , , , , , , , , , , , , , 69 Grants payable . , • , • , , • , • • • , • , , , • , • , ............. 62 Deferred revenue . ............................... . 63 Loans from officers, directors, trustees, and key employeas (attach schedule) ............................ . 64a Tax - exempt bond liabilities (attach schedule) ........... STHT. 17. b Mortgages and other notes payable (attach schedule) , , , , , , STMT, 19 • 65 Other liabilities (describe ► 9 66 Total liabilities (add lines 60 throw h 65 ) .................... 433 970 333. 66 636 836,684. Organizations that follow SPAS 117, check here 1 X j and complete lines 67 through 69 and lines 73 and 74.g ;G'; e 67 Unrestricted 884,772,078. 67 11005, 1.,_04,413. c68 Temporarilyrestricted , , , , , , , , , , , , , , , , , , , , , , , , , , , _3'r?50 247. 69 - „`3 83577,3. 69 Permanently restricted ..................rr ......... _.__�___ 69., _ ...__.- -•— Organizations that do not iollow SFAS 117, check here � l_ and 4 complete lines 70 through 74.x: 0 70 Capital stock, trust principal, or current funds , , , , , , , , , , , , , , , , , ,,______,,,!__. 70 ,,,_,._ ---._..-------'- 71 Paid -in or capital surplus, or land. building, and equipment fund , . , , , , , , H 72 Retained earnings, endowment, accumulated income, or other funds , , , , , d 73 Total net assets or fund balances (add fines 67 through 69 or lines z 70 through 72; column (A) must equal line 19: column (8) most equal line 21) , , , , , , , , .6081622.325„ 11. 74 Total tiabilities and net assets / food balance_ s (add linos fib and 731_ 1 322,.592 , 655. 74 1 645, 778, 810. Form 990 is availablo for public inspection and, for some people. serves as the primary or solo source of information about as particular organization. How the public perceives an organization in such cases may be determined by the information presented or its return. Therefore, pkease make sure the retum is complete and accurate and fully describes, in Part III, the organization's programs and accomplishnnents. ism 40 $030 1 000 55W3TJ 2020 VO4-11 rnnwlRn9 48a P Pledges receivable 4 48a 69 Total assets (add lines 45 through 58) (must equal tine 74). . 60 Accounts payable and accrued expenses , , , , , , , , , , , , , , , , , , , , 69 Grants payable . , • , • , , • , • • • , • , , , • , • , ............. 62 Deferred revenue . ............................... . 63 Loans from officers, directors, trustees, and key employeas (attach schedule) ............................ . 64a Tax - exempt bond liabilities (attach schedule) ........... STHT. 17. b Mortgages and other notes payable (attach schedule) , , , , , , STMT, 19 • 65 Other liabilities (describe ► 9 66 Total liabilities (add lines 60 throw h 65 ) .................... 433 970 333. 66 636 836,684. Organizations that follow SPAS 117, check here 1 X j and complete lines 67 through 69 and lines 73 and 74.g ;G'; e 67 Unrestricted 884,772,078. 67 11005, 1.,_04,413. c68 Temporarilyrestricted , , , , , , , , , , , , , , , , , , , , , , , , , , , _3'r?50 247. 69 - „`3 83577,3. 69 Permanently restricted ..................rr ......... _.__�___ 69., _ ...__.- -•— Organizations that do not iollow SFAS 117, check here � l_ and 4 complete lines 70 through 74.x: 0 70 Capital stock, trust principal, or current funds , , , , , , , , , , , , , , , , , ,,______,,,!__. 70 ,,,_,._ ---._..-------'- 71 Paid -in or capital surplus, or land. building, and equipment fund , . , , , , , , H 72 Retained earnings, endowment, accumulated income, or other funds , , , , , d 73 Total net assets or fund balances (add fines 67 through 69 or lines z 70 through 72; column (A) must equal line 19: column (8) most equal line 21) , , , , , , , , .6081622.325„ 11. 74 Total tiabilities and net assets / food balance_ s (add linos fib and 731_ 1 322,.592 , 655. 74 1 645, 778, 810. Form 990 is availablo for public inspection and, for some people. serves as the primary or solo source of information about as particular organization. How the public perceives an organization in such cases may be determined by the information presented or its return. Therefore, pkease make sure the retum is complete and accurate and fully describes, in Part III, the organization's programs and accomplishnnents. ism 40 $030 1 000 55W3TJ 2020 VO4-11 rnnwlRn9 ism 40 $030 1 000 55W3TJ 2020 VO4-11 rnnwlRn9 95- 1643327 Form 990 (2D043 page econcr ra ton ot Revenue Financial Statements with Ra Auchile onue per Reconciliation 'o Expenses Financial Statements with perp Expanses 7Cu � per Etetum See�a�e 27 of the W Totall mvenue, gains, and other support instruct ens.) _ Return a Total oxperises and losses per _ per audited financial statements - , ► a 5662.2.220, audited financial statements , ► a a 8S_i350•,_128. b Amounts included on tine a but not on b Amounts included on line a but not tine 12. Form 990: on line 17, Form 990: (1) Not unrealized gales (1) Donated services on investments S and use of facilities •�_,__,__, -_ (2) Donated ser*C (2) Prior yuar adjustments and use of fatalNes S reported on line 20. (S) Recovering of prior ... Farm 990.....5 .�...__ . year grants $ (J) Losses retwded on ., (4) Other Opecity): line 20, Form 99D (4) Other(sperdfy): STMT 20 S 119'17,854. b 1_,_977.854. STMT 22 $ 1,, 977,854 . ... Add amounts on lines (1) through (4) ► Add amounts on lines (1) through (4) , , ► b 1x,977, c Line a minus line b • • • , , , • • • ► c 4666 644 366. c line a minus line b , • • • • , • , , ► e d Amounts included on line 12, ': d Amounts Included on line 17, F orm 990 but not on tine o: Form 99D but not on line a: (1) Investment rorpnnses (1) Investment o4wnses not Included on he not included on lire , Bb, Form 990 ...__3 lib. Fonn 990....¢...._ 31.315 �N59, ' (2) Other (specify): - (2) other (specify): 3',CMT' 23 _ S 9_91 925_; Add amounts on lines (1) and t2) .. ► U 1 a -,162, 384. Add amounts on linos (1) and (2) .. ► C, 4,,, 2,1'1, 88844 . o Total revenue per fine 12, Form 990 a Total expenses per line 17, Form 990 (line c plus fined . ► a 58D 806 750. i line c plus line tl ) . . . . . . . . . • ► e 487 590 158. List of Officers, Directors, Trustees, and Key Employees (List each one even it not compensated: see page 27 of thu inatruetinne 1 ..... ........._— __— (A) Nanle an0 9[Idra68 .�__.. _. _�...,._...— _-- ......___...._._ .____....___._._. (B) our arW seek hours par v.•eak _d¢vmcD 10_2os9lcyL „. (it CQMP�SRWII anon gf not paid, enter Lam (e) eo WWI m a,nployoc>tnmra puns b adnrrea cmyronnlcn ou t and of account entl Whet Alm SEE__STAT£MENT 24•�„,�_,- ._._ -.NOt71 �6 Did any officer, director. frusloe, or key employee receive aggregate compalsWion of mono than $10D.DD0 from your � organization and an related organizations, of which more than $ 0,000 was provided try the related organizatlarls? ► L] Yes LxJ No If "Yes,` attach Schedule- see page 2a of the. instructions. Fum`J`Ja (20041 .IS4 4e 10401.000 VO4-9 6008788 55W3TJ 21)2D '1_ 76 aid the organizalioh engage in any activity not previously reported to the IRS? It "Yes," attach a detailed description of each aclivlty, 7A X •Were any Changes made in Ilia organizing or governing documents but not reported to the IRS? , , , • , , , , , , , , , , , , , 77 if "Yes' attach a conformed copy' of the chmxps. 700 aid the organization have unielatod business gross Income of $1,000 or more during the year coverad by this ratan?? , , • , , , , , , 78a X _ b If "Yes." has it filed a lax return on Form 990.7 lot this year? , , , , , , , , , , , , , , , , , , , , , , , 19 Was there a Ifge4dalfon. dissolution. termination, or substantial contraction during the year? lf'Yes•" attach a statement , , , , , , . 79 X_ 90a is the organizatian related (other than by association with a statewide or nationwide organization) through conana n membership• governing bodies. trustees. officers, etc., to any other exempt or nonexempt organization? , , . , • . , , . 8., Via- X I) If "Yes," enter the name of the organization► STMT 27 and check whether it is �5 ex _ empt at 0 n1 nuxc m A ^ - 81 a Enter direct and Indirect political expenditures. See Ilne 87 instructions, , 187 a ^I,_____•� ^NONi . b Did Ole organization No Form 1720 -POL for this year? , , , , , . . , , , , . ........................... a 1 b_ 62 a Did the organization receive donated services or lha use of materials, eKOdpmel t. or facilities ad no charge or at substantially less Ulm fair rental value? , , , , , , , , , , , , , , , , , , , , • • , , , , , , , , , , , , . , , , , , , , . , Ala X b If "Yes," you may indicate the value of these 'items here. Do not include this amount VOLUNTEER as revenue in Pan I of as an expense in Part IL (See Instructions in Fart IIL) . _ .. ..... Lk2Iij )BOARD [4EMHERS 93a D(d the organization ceintay with the public inspection requirements for returns and exemption appitcattons7 , , , , , , , , , , , Ala IC _ b Did the organization comply with Ilia disclosure requirements relating to quid fro quo contribulions7 , , , , , , , , , , • , , , , , A 5b N 340 Did the organization soIIG1 any contributions or gifts that were net tax daduc8b107 , , . . , , , , , , 84a X b if "Yes," did lbe ayaniza0on Include rr411) every solicitation an express statement that such contributions ._ or gifts were not lax deductible? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , I , , , , , , , , , , , , 94b N 55 501(0)(4). (5), or (6) organizations. a Were subst antiaay all dues nondeductible by meinbars? , , , , , . , . , • , , , , , • • _ 86a N RIP Did the organlzatlon make only in -house lobbying expdn<5tmes of 1)2,000 or less? , , , , , , , , 85b _ N� If "Yes" was answered to either 850 w 85b, do not complete 05c through 85h below unless the orgarivalim reeeNed a waiver for proxy tax Owed for file prier year. - v Dues. assa%wreertla, and e1nitiar amounts facia "trno ra Of Section 162fe) lobbying and political expenditures . . . .................... 35d e Aggregate nondeductible arnuunt of section 8033(e)(1)(A) dues noires .............. 65e f Taxable amount of lobbying and political expenditures (Ilna 85d less 85e) _ _ �A g Does the organization elect to pay lire section 6033je) lax on the ammml or line 851? , , , , , , , , , , , , , • , , , , , _ .. , A 5 N h If section 6033(e)(I)(A) dues notices were sent, does the organization agree to add the amolm( on file 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for One following tax year ?. _ ......... ash N� 66 501fc)(7) tugs. Etter a lailfalion tees and copilot contributions Included on (ine 12 , , , , , , aGo N/A b Gross receipts, tndudad on line 72. for public use of club Itxxli8es _ , , , , , , , , , 86b 14 A - : • ' : 87 SO1(c)(12) ergs, Ewer: a Gross income from members 01 shareholders ............... 87a ._ ...,�I - b Cross Income from other sources. (Do nor net amounts due at paid to other sources against amounts due or recolved from them.) _ , , , , , , , , , , , 876 _..__._, p7 -�A _•,._ .. 88 At any time during the year, did the Organization own a 50% or greater interest In a faxabia corporation or partners hip, or an entity otsragarded as separate from the organization under Regulations sections 301.7707.2 and 301. 7701 -3? If Wes." complele Part IX 8 9 __�.... ........................... .......... 89a 501(c)(3) oWnInXia ls. Enter: Amount of lax imposed on the organization during the year under. - section 4011 ► �0: section 4972 ► _ _ NONE : section 4955 ► b 501(c)(3) and 501(C)(4) ergs. Did the organization engage in any section 4956 excess benefit transaction during the year or did It became aware of an excess benefit transaction iron a prior yow7It "Yes." allacn a stalomrnrf explaining oaGl Iransadhm .............. ................... ........... 89b - .._. y._ c Enter: Amount of tax Imposed on the organization managers or disqualified persons fluring the year under sections 4912. 4955. and 4958 ................ ....... .... .......... ......... ►NOj4E d Enter. Amount of lox on line 89c, above, reimbursed by the oganizalinn . . _ . , , • , " , . , , • • _ _ , • • ► ^.._____._ t_j. pNE 90a List the states with which a copy of this return is tiled b Number of employees omployed in the pay period that includes March 12, 2004 (Sna instmctims.) , , , , , , , , , , _ , , , �90 h� 955 91 The books are incaisw h JENNT, -1^1:R MITZNER., -_VP F:Z]pN CE lelephonanD. 11*•_(909,),7,64 I.ocarodary ONE, NOAG URI_VEz__BOX 610�.,_?4EWFORT B_EA_CH __ _ ZIP +4 ►_ ,92_65_8__— _61D0 92 Section 4947(a)(1) norroxempt charitable trusts filing Farm 990 N lieu of Form f041 -Check here _ . . _ . , • _ . , • • • • • • • _ __ m 4EI Nn neat/ 55W3TJ 2020 VO4•-8 60087892 Pwm990 (2004) F,nnto 990 2004 -95- 164332'7 Pme 6 Analysis of Incorne-Producing Activities (See , _p2ge -"' — -1—.: -1 ...... .... Enter gross amounis unless otherwise fed. Program service reentrim: unrelated [A) flodoess Core, butineSs income . . .......... (a) AmoLvat E=tudod (c) Esdnoo sol's by soclion 512. 513, or 514 JD) Amount (E) Related or exampt function income ST14T 28 instructions.) JA) Name. address. mid EIN of oorporalim. (mded!��& (13) P.osrnpoar knonst (CI maktore Of aclivilles 496(98„21843. (EW =dol Cer MorlicanerModicaid payinents . . . .. I . . Foos and Uontraots floor yviemmml agencies Membership dues and assessments; 2D4 229 qOQRQI 1641996„ 14 74, Dividends and Intereittfroin SerCUtilleS Net rental income or (Puss) from real estate; . debt - financed property . . . . . I . . . not debt-financed property . . . . . .. 90.0003 4 23 so. other investment income . . . . . .. Galn w Elms) ton saks, a asses olflur IKM Inmi"T Net Income or (loss) from special tnients; uK4, poord or (lose) Um saw d imantory Other revenue: a STMT 29 14,398,113. 53,282,620. 77 459. 503,610,3D2. StIblotal (add columns (B). (D), and (r)). 105 Total (add line loll. eDlurrms (B). (0). and (Q) . . . . . . . . .. .. .. . . . . . . . . . .. .. .. . 571,291,035. Noto: Line 105 plus kv Id. Part 1. should equal the annolml on Irm 12, Part 1. Lies No. I EXPIrlin how each FIC11vitY for which 4100me is reported In column (E) of Part VII contributed importantly 10 the a=mVishment of Me omanhullion's e)re.rnot nurbos es (other than W orW(Irm funds for such Purposes). ll Information Regardin Transfers Associated with Persona} Barretit Contracts (bee page 34 of the instructions.) (a) 1)10 the organization. dufIftil fire yw, imerve my funds. dkeL:vIr or indinwIly. to Pay preanlurns m a Personal benefit WIWI? Yes x No (b) Did the organization, during the Year. pay premiums. directly or indirectly. on a personal benefit comract?, H Yes X No Note: If 'Yes' lo V. file Form 8870 and Form 4720 (see instructions). Inca. cort"I. 0 bee return. Wutling amornpa%nii 8ChC*U1 of preparof (other than Officer) is sed on me Please Sign Here STMT30 .__......._._.._. ---- --.�_�._---�'_.— _— __�_..� -- W;.;�ln w;. li. Prepivar's &d reparees Use Only information Regarding Taxable subsidiaries and Isregarded Entities (See page 34 of the instructions.) JA) Name. address. mid EIN of oorporalim. (mded!��& (13) P.osrnpoar knonst (CI maktore Of aclivilles (0) Total income --_ (EW =dol Cer % ll Information Regardin Transfers Associated with Persona} Barretit Contracts (bee page 34 of the instructions.) (a) 1)10 the organization. dufIftil fire yw, imerve my funds. dkeL:vIr or indinwIly. to Pay preanlurns m a Personal benefit WIWI? Yes x No (b) Did the organization, during the Year. pay premiums. directly or indirectly. on a personal benefit comract?, H Yes X No Note: If 'Yes' lo V. file Form 8870 and Form 4720 (see instructions). Inca. cort"I. 0 bee return. Wutling amornpa%nii 8ChC*U1 of preparof (other than Officer) is sed on me Please Sign Here W;.;�ln w;. li. Prepivar's &d reparees Use Only I-Inn's name for yours & „YOUNG 1.I ilsdt-empt0yoUl. aftow and ZIP + 4 .jSA 4EI050 I UK, 55W37IJ 2020 Dole Dab: Chock I phme oo s19_1 nn-1 no. VO4 - -£I 60087882 prepare( has any Wwv*dge. Palm El 90 (2004) Tom 1!e! dv. 1$•Xah9) _ _.,....... _ - PVG 2 If you are filing for an Additional Inol automatic) 3 -Month [xtariston, complete only Part It and check this box _ _ _ _ _ �` ►L� Note: Only complete Part II if you have already been granted an automatic 3 -month extension on a previously filed Form BBBB. Type or Name of Eterimp! Organization Employer IdenOticallon number print H G MEMOBLAL HOSPITAL PRESDYTER71._!, 95- 1643327 Fair by the Number. street, and mom of suite no. If a P.O, boa; see instructions. For IRS use any extended ONE HOAG DRIVE, BOX 6100 _ due door fo alma the City, town of post office. state. and ZIP code. For a foreign address, see instructions, relu a. see instructions. NEWPORT HEACH,_I.A 92 655 -61 00 __ ,„„�„ Gback typo of return to ber fled (File a s arate application breach return): X Form 990 • Form 990- T(see. 401(x) or 405(a) trust) Form 5227 Form 990 -BL Form 990 -T (trust other than above) Form 8069 Form 990-EZ Form 1041 -A Form 8870 N Form 990•PF _Form 4720 STOP: Do nol complete Part 11 if you were not already Granted an automatic 3 -month extension on a previously, filed Form aa6a- • The books are In the taro of ► HENRY KORKZI.A. AIR. _QE CSNANCE �__,— __M�� -_.� Telephone NO. ► 9a4,_-i64-- 4 624 1 —,___ FAXNo. ► If the organ"lzation does not have an office or place of business in the United States. check this box, , , , , ,, , , , , , , , , , ► • if this is for a Group Return, enter the or anizetion's four digit Group Exemption Number (GEN) ti[A . If this is for the whole group, check this box ► . If t is for part of the group, check tiffs box ► �� and atach a fist with me names and EINs of all members the aldension is 4 1 roquest an eddRional .3 -month extension of Ome met? _ 07f 17/2006 5 For calendar year , or other tax year beginning 09 Ol 200 - 4 - _ and ending Og/3IL2005 6 If this tax year Is for less than 12 months. check reason ln-Zl l return Final return "l1TGhange in accounting period 7 State in detail why you need the eldonsion ARPITIONAL_TINE TS N L4 E TO_COI.LECT ALL THE IMF L4 QN_HECF -15 .TO FILE A COMPLTiTE A ACCURATE RETURN. 84 If this application is for Form 990 -BL 990 -PF, 990 -T. 4720, or 6069. enter the tentative tax less any nonrefundable credits. See instructions , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , S NONE to If this application is for Form 990 -PF, 990 -T- 4720, or 6060, enter any retundabte credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any amount paid previously wilt) Form 8868 , 'It , , , , , _ , S NONE 0 Balance Due. Subtract line 8b from , ne ea. Include your poyment with this form. or. t required, deposit with FM coupon or. If required, by using EFfPS (Electronic Federal Tax Payment System). See Under pennies of penury. I deClare that t have exmminud thin form. Including accompanying sch dulm and slaloments, and to the but of my lnenhape and beats• It to Irve. currtct, and�wnJ Id a�4dr4In II II am outhaized to inepau this term. Si mature ► / `^ r/ Titre O-CPA _ Date to 04 Notice i.� Notice to Applicant -To Be Completed by the IRS We have approved this application. Please attach this form to the organtzadin 's return. We have no approved this applicaliorL However. we have granted a 10-day grace period iron the later of the dale shown below or the due date of the organization's return (including any prior extensions). This grace pedal is considered to be a valid extension of time for elecfmns . Oolhorwise required to be made on a Smely return. Please allach this farm to the argardration's return We have not 0 to this appfKillian. After considering the reasons stated in item 7. we cannot grant your request fa en extension of lime fofue:- Wdarn8ng a 1ftl1 -day grace period. APR 14 7006 ERNS1' or Ntimbirf and street t application because It was filed after the attended due date of the return for which an extension was requested. — the addrotts if you want the copy of this application for an additional 3 -month extension in the one entered above. 1VNG 1, LP KARA All Is satin, roam, or apt. no.) or a P.O, box number r� nvr <<spr P 1 0o r >(7rrr.v,s•,,,,.... stand, and country Ilnchwbip postal or AP catle) SSVnT,7 2020 VO4 -8 50057882 orm 8868 Application for Extension of Time To pile an IRev. 0mornbtx 2D04) Exempt Organization Return OMD No. 1545 -1709 Department or ere Tnnoufy Internal R•wnue Survica ► File a separate appricafion for o3ch reiunn. • If you are riling for an Automatic 3 -Month Extension, complete only Part I and check this box , , , N7 • if you are tiling for an Additional (not automatic) 3 -Month Extension, complete only Part II (on page 2 of this form). n ..,a Part q nnfpea wv, haves almadv henn nranteti an manmafir. 3- rnnnth extension on a nreviousiv fled Form 8868. Form 990 -T corporations requesting an automatic 6 -month extension - check this box and complete Part I only, , , . , , , . -► ❑ All other corporations (Including Form 990-C filers) must use rorm 7004 to request an extension of time to file Income tax returns. Partnerships. REMICs, and trusts must Ilse Form 87345 to request an extenSlan of time to We Form 1065. 1066, or 1041. Electronic Filing (o -fila} Form 8868 can be filed electronically if you want a 3 -month automatic extension of time to file one of the returns noted below (6 months for corporate Form 990 -T filers). However, you cannot file it electronically if you want the additional (not automatic) 3 -month extension, Instead you must submit the fully completed signed page 2 (Part II) of Form 8868. For more details on the electronic filing of this form• visa wwmirs.9ov/efll9. Type or Name or txaenpt UrganMllal emyfuTer rumrursauurr mm�uar print HOAG MEZ40RTAL HOSPI!41� ES�H TFE AN _ �5- S6A3327 Number, street. and Town or suite no. If a P.O. box, boa insiniMions. File Who due dale for ONE HOAC�,DRIVE. cline your return Sur, City, town or past office, state, and ZIP code. For a f" On address, sec instfut ions. Y' Inshodllon& NEWPORT BEACHI Check type of return to be filed (fife a se arate application for each return): 7{ Form 090 M Form 990-T (Corporation) Form 4720 Form 990-BL Form 990- T(sec. 401(a) a 408(x) trust) 11 Form 5227 _ Pam 990-EZ Pam 990-PP Fare 99o- F (trust other thin above) Form 1041 -A Form 6069 Form B879 _ • The books arc in the Caro of 0- B8NT ELAINE 9LiYS , CONISOLLER , Telephone No. ►_ 949 764 -4448 FAXNo. 1 • If the organization does not have an office or place of business In the United States, check this box ► ❑ • If this is for a Group Ran", enter the organizatloti s four digit Group Exemption Number (GEN) � , tF this is for the whole group, check this box ► I❑ . ti it is for part of the group, chock this box ► tend attach a list with the names and EINs of all members the extension will cover. 9 I request an automatic 3 -month (6- months fora Form 990.7 corporMion) extension of time until` D4117 2006 to file the exempt organization return for the organization named above_ The extension is for the orgunization's mlum for. ► calendar year or h► X lax year beginning. 09 01 ,_ 2004 , and ending _ _00/31 2005 . 2 if this tax year is for less than 12 months, check reason: ❑ initial return L�j Final return L_7 Change in accounting period 3a If this application is for Form 990 -BL.. 990 -PF. 99D-T. 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions , , , , , , , , , , , , , , , , • • • , , . . ............. i . MW b if this application is for Form 990 -PP or 990-T. enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit , S_ c Balance Due. Subtract line 3b from fine 3a. Include your paym, ent with till's 'for a. or. if required. deposit with FTD coupon or, if required, by using FRIPS (Electronic Federal Tax Payment System). See Instruct ions ................... ............................... . $ NONE Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453 -EO and Form 8879 -EO forpaymenlinslrucllons� ._____�_�_�`__ For Privacy Act and Paperwork Reduction Act Notice, sea Instructions. Form 8868 (Rev. 12.2004) !°A 08054 3.000 SCHEDULEA Organization Exempt Under Section 501(c)(3) ONB Nn, 1545.0049 Form 990 Or 990•F2) (Except Private Foundation) and Section 501(0), 601((). 601(k). - - - - "'- 601(n). or Section 4947(a)(1) NonaxomPt Charitable Trust �f n artmeat ot01eTreasury Supplementary Information - (See separate instructions.) 2 11 4 ismat Ruvorwo Sorvkar ► MUST lie completed by the above organizations and attached to their Form 990 w 99D.EZ Name of the organization Emplpyer Idonaficatioo mlmbor HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 Compensation of the Five Highest Paid Employees Other Than officers, Directors, and Trustees (See page 1 of the instructions. List each one. If there are none, enter "None. ") (a) Name and oddross of each employee paid fame (b) TiOa and avem0e (d) Contributions to (a) Opense Ilion 850,600 hours per weak $( eomponsation amployea befit plans & account and Ow devoted lo.ppsida't deferred cp._ mpensation _ _ ailonancas AIANE_ LAIRD _ ______ _____ SR. vP. PHY9. SVI S. ONE HOAG DRIVE, BOX 6100 NEWPORT BEACH, CA 92658 40 44201,991. 11520. JEFFREY- PURSER _ TOURHANENT DIREC ONE HOAG DRIVE, BOX 6100 NEWPORT _BEACH, .CA 92658 60 326 311. 1.7 414. NONE POVGLAS_ ALLEN_ _ _ _ _ _ _ ,. _ _ _ _ _ _ _ _ _ _ _ _ _ t-tgpICAL DIRECTOR ONE HOAG DRIVE, BOX 6100 NEWPORT , BEACHCA_._92658 ------- 40 .._.�., 3101228 12.x.216,.__.._„__.._... NONE RICHARD VLENE _ _ __ _ NEDICAL DIRECTOR ONE HOAG DRIVE, BOX 6100 NEWPORT BEACH,,,__CA _40._._— _--.__.... _--.__ 304 , 32 9 _ --_._... 1, 1 , ,901 _. ...________� NDNF ROBERT BRAITHWAITE SR, VP ROSP. SVC . ONE HOAG DRIVE, BOX 61.00 N%W.tQRT BEACH, C.7j92658 40 .8.093, Total number of other employees paid over $60.000 ...................... 1532 .::. ..., ..;.:........ .::.:... , .:.... : . .... ... .. , .. :,....:.. 10VII►)I Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions. List each one (whether individuals or firms). If there are none. enter "None. "i (a) Name and address of oneh indapandord umtrector pall mere than $50,000 MCCARTHY_ BROTHERS_ COMPANY q,CWFCRCE_ TECHNICAL_ SERVICES,,_ INC._____ GREATER NEWPORT PHYSICIANS TAYLOR & ASSOCIATES CHILDRENS HOSPITAL OF ORANGE COUNTY O. DO_7C_IA178,, ORZiNGEJ__CA._ Q.29-0 MFI oral number of offs receiving over 550.000 for professional servfom; _372 _ for Paperwork Rodoct(olt Act Notice, see the Instructions for Four 990 aril Form 090 -E7 .ISA 0 1210 1 OW 55W3TJ 2020 VO4 -0 60087882 NI Type of service I fe) Compensation Schad ule A (Form 990 or B90 -EZ) 2004 goo or 991- F.2) 20D4 7 During the year. has the organization attempted to influence nallonal. stale. or local legislation. Including any attempt to Influence public opinion on a legislative matter or referendum? If 'Yes," enter the total expenses paid or incurred in connection with the lobbying activities td S �6�_693 (Must equal amounts on line 38. Part VI -A, or line f of Part VI -8.) - - .. - ........................... ............ ... Organizations that made an election under section 501(h) by filing Form 5768 roust complete Part VI -A Other organizations checking 'Yes' must complete Part VI.B AND attach a statement giving a detailed description of the lobbying activates. 2 During the year. has the organization. either directly or indirectly, engaged In any of the following acts with any substantial contribulws. trustees, directors- officers. creators. key employees. or members of their families. or with any iambic organization with which any such person is affiliated as an officrr, director. trustee. majority owner, or principal beneficiary? (d the answer to any question Is "yes," affach a detailed statement axiobinirrg the in8nsactions.) a Sale, exchange. or leasing of property? ................ . ............ ........ . ..... . to Lending of money or other extension of acxat? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -4TM;C- 32, c Famishing ofgw0s, services, m facaitim? . .. . . .. . . .. .........................^aTMW. 331 d Payment of compensation (or payment or rearibursemmd of expenses It mare than S1.000)? . r.oW .49.0, - $ARP. V .. . tin 2 No o Transfer of any part of Its income or assets? ............. ..................... . . . . . . tie X 3a Do you make grants for scholarships. fellowships. student loans, etc.? (If "Yes' attach an explanation of how you determine that recipients qualify to receive payments) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 32L X h Do yrnr have a section 403(b) annuity plan for your empl(W -s? ....... ................ . . ...... S b X 4a Did you maintain any separate, account for participating donors where donors have the right to provide advice on the use or distribution of furze%? ......... .... ..... ............. ....... ...... . b Do you (provide credit counseling, debt management. credit repair. or debt ne ot'iatiun services? 4 b X Reason for Non - Private f=oundation Status (See pages 3 through G of the instructions.) The organization is not a private foundation became it Is: (Ploase check only ONE applicable box) S HX A church, convention or churches. or association of Churches. Section B A school. Section 170(b)(1)(A)(h). (Also complete Part V.) 7 A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(19). a A Federal, stale. or local government or governmental unit. Section 170(b)(1)(A)(v). 9 A medical research oganizallon operated in conjunction with a hospital. Section 170(b)(1)(A)(ni). Enter the hospitars name, city, rand state ►_---._ __"'—'.._."___"......_____'-... 19 An organization operated for the benefit of a college or university awned a operated by a gove!mmolal unit. Section 170(b)(1)(A)(w). (Also complete the Support Schedule in Pad IV -A.) 77 a E] An organization that normally receives a substantial pan of its support train a governmental unit a from the general public. Section 170(b)(1)(A)(vi). (Also Canplete the Support Schedule In Part fV -A.) 71 L A community trust. Section 170(b)(1)(A)(v). (Also complete tire Support Schedule in Part _ IV -A) 12 An organization [hat normally receives: (1) more than 33 113% Of Its support from contributions, riendmrship fees, and gross receipts from activfIes related to Its charitable. etc.. functions - subject to certain emropt[ons. and (2) no more than 33 113% of its support from gross Investment income and unrelated business taxable income (less se Ilion 511 lax) from businesses acquired �J I by the organization after June 30, 1975. See section 509(a)(2). (Also complete the Support Schedulo in part IV -A) 13 An organization that is not controlled by any disqualified persons (other than foundation managers) anal supports organizations described In: (t) lines 5 through 12 above: or (2) section 501(c)(4), (5), or (6). If they meat the test of section 509(1)(2). (See • (a) Name(s) of supported organ lzatlon(s) z.00D 55W3TJ 2020 VO4 -8 GOD87882 (b) Line number from above Schedule A (FOIm 000 w9eO -F.X) 2004 Schedule A(Rim 900 eraDO-E2)2904 _ 35- .6a 43327 naje_3 EMM Support Schedule (Complete only d you checked a box on line 10. 11, or 12.) Ike cash method ofaccourrting Ofa: You may use the wdrfrsheef ifr the instrMlifori5 for conywitAg frown the accrue) to the cash method of accounting. 1W AppLICABLE IMlitendar ear oY fiscal ear b ittnin in r a 2003 b 2002 c 2007 2000 a 72121 "WrGifts, grants. and contributions received. 17 Gross receipts Rom admissions, merchandise sold or services performed. or furnishing of facilities in any activtly trial is related to the organization's charitable, elc.. puryose__., ._. _.__.,. .�•. —_ _--' -- 1B Gross Income iron inleresl, dividends. amounts received from payments on securities loans ( section 572(a)(5)), rents. royalties, and unrelated business taxable Income (lass section 511 taxes) from businesses acquired _art ,the organization aflm Luna 30, 1075 .... . 19 Net inwrne from unrelated business activities nbt lnciuded in One % _ 26 Tax revemles teWed for the aynni2stiun5 benefit and either paid to It or expended on Its behalf_ . . . . . . . . .. . . . . . . . . . . 29 The value of servlCCS a iracilltics fumfshDR to �Y true organization by a governmental unit without charge. Do not include the value of services W facilities generally tumislied to the 22 Other Income. Attach a schedule. Do riot Include gain or (loss) from sale of capital assets 23 Total of lines 15 through 22 _x _... - - 24 Line 23 minus she 17 ..... : . ........ 26 EgIw I% of line 23 4: _ ,. .. ...— ._a..-- __._'._ 26 Organizaflons described on tbos 70 or 11; a Enter 2% of aouxad In Column (e), tine 24 NR'ti AP$kxCA(3i,B ..) 260 b Prepare a list far you records to show the name of and amount contributed by each person (Other than a - governmental unit or publicly supporlod organization) whose "at gifts for 2000 through 2003 excoeded the amount shown in line 26a. Do not file this Ifs( with your return. Enter the total of all those excess amounts ► 2ab c Total support for section $09(x)(1) lest; Enter We 24, column (e) . . . . . .. . . . . . . .. . .. . . . . . .. . ► 26c d Acid: Amounts from column (e) for lines: 18 10 . ........: 22 26b -- .._ —.r._ ............ ► 26A .____..._...��._ e Public support (line 26c minus Ito 26d total) ............... . . . ........... . ......... b. 263_...._------ f public support percentage (line 26e (nemeratprl) divirfod_tty Tine 26 c_jdorrominator}I • . . . . . .. . . . . . . . . . . . ► 26f 27 organizations (inscribed oa 1100 12: a For amounts InelUded In lines 1b, 1D. and it mat were recelvea iron a 'osqualmeu garson," prepare a list for your records to stow the name of. and total amounts received in each year from. each 'disqualified person." 'o not file this list with your return. Enter the sum of such amounts for each year: (2003)______________. _..(2002) ------------- ---- (2001) ___NOT,•PPLTCABLE b For any amount included in line 17 that was received from each person (other than 'disqualified persons), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amounl on line 25 for the year or (2) $5.ODO. (include In the list organizations described in Was 5 through 11. as well as individuals.) Do not file this list with your return. After computing the difference between the amount received and the larger amount describer) in (1) or (2), enter the sum of these differences (the excess amounts) for each year: (2003) (2002) ....................... (2001) e Add: Amounts from column (e) for (Ines: 15 ,.,_ _ -_ 15 77 �._...�_,.._.__ 70 �.__. 21 �._ .. , . . . _ . _ . .. . ► 27c __ it Add: Lino 27a total — .._._- -. end line 27b total , _ . . . . , .. . _ _ ► _2_1d a Public support (Roe 270 total minus line 27d total) . • • • • • • . • • • • • . . . . • . . . . . • • • • • . • • • • • ► 270 _.T _ �Dtal support for section 509(x)(2) test: Enter amount from line 23, column (e) .... _ ..... ilil 27f - -_ . ___._• ~ ^� ubtie support percentage (line 27e (numerator) divided by Dim 27f tdenomirtator)) _ : . . ► 27,0, 26 Unusual Grants: For on wgmazatioa described In line to, 11, or 12 that received any unusual grants during 2.000 through 2u03. prepare a list for your records to show. for each yaw. the name of the contributor. the date and amount of Ilia grant, and a brief description of Die nalure of the grant. Do not file this list with your return. Do not inchide these 9ranls In this 15. - Schedule A (Form 999 w 990.EZ) 2094 JsA 4r r.rt 1. nag 55WSTj 2020 VO4 -8 60087882 (Ik, not include unusual grants. See line 28.) ..... ^ is Membersnip fees received , , , _ ._ :_ . • . te ^ 27 organizations (inscribed oa 1100 12: a For amounts InelUded In lines 1b, 1D. and it mat were recelvea iron a 'osqualmeu garson," prepare a list for your records to stow the name of. and total amounts received in each year from. each 'disqualified person." 'o not file this list with your return. Enter the sum of such amounts for each year: (2003)______________. _..(2002) ------------- ---- (2001) ___NOT,•PPLTCABLE b For any amount included in line 17 that was received from each person (other than 'disqualified persons), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amounl on line 25 for the year or (2) $5.ODO. (include In the list organizations described in Was 5 through 11. as well as individuals.) Do not file this list with your return. After computing the difference between the amount received and the larger amount describer) in (1) or (2), enter the sum of these differences (the excess amounts) for each year: (2003) (2002) ....................... (2001) e Add: Amounts from column (e) for (Ines: 15 ,.,_ _ -_ 15 77 �._...�_,.._.__ 70 �.__. 21 �._ .. , . . . _ . _ . .. . ► 27c __ it Add: Lino 27a total — .._._- -. end line 27b total , _ . . . . , .. . _ _ ► _2_1d a Public support (Roe 270 total minus line 27d total) . • • • • • • . • • • • • . . . . • . . . . . • • • • • . • • • • • ► 270 _.T _ �Dtal support for section 509(x)(2) test: Enter amount from line 23, column (e) .... _ ..... ilil 27f - -_ . ___._• ~ ^� ubtie support percentage (line 27e (numerator) divided by Dim 27f tdenomirtator)) _ : . . ► 27,0, 26 Unusual Grants: For on wgmazatioa described In line to, 11, or 12 that received any unusual grants during 2.000 through 2u03. prepare a list for your records to show. for each yaw. the name of the contributor. the date and amount of Ilia grant, and a brief description of Die nalure of the grant. Do not file this list with your return. Do not inchide these 9ranls In this 15. - Schedule A (Form 999 w 990.EZ) 2094 JsA 4r r.rt 1. nag 55WSTj 2020 VO4 -8 60087882 95- 1643327 Schad ule A (Form 990 or 99NEL) 299.t v 9e 4 M- NOT APPLICABLE (To be completed ONLY by schools that checked the box on line _& in Part Vi 28 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter. bylaws, other governing instrument or in a resolution of its governing body? , , 38 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? 31 Has the organization publicized its raciaity nondiscriminatory policy through newspaper or broadcast media during the- period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general communily it serves? , , , , If "Yes.' please describe: it `No." pleaso explain. (if you need more space, atlacb a separate statement.) "--- '--- " -- `-- - --- -- ---' -•- ---- - `-- "'----- --- - ---_. _ --- ---- '------ - -`- - 32 Does the organizatfon maintain lino following' a Records Indicating the racial eomposilion of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? c Copies of all catalogues, brochures, announcements, and other written communications to the pubk dealing with student admissions, programs, and scholarships? d Copies of all material used by the organization of on its behalf to solicit contributsxis ?, , , , , , , , , , , , , , , , It you answered "No" to any of the above, please explain. (if you reed more space. attach a separate statement) ----------- _.-°..___.__...--------'---..,------- ....----- -- -'-•--'------------ ..- -•--- --•' -- 33 Does the organization discriminate by race in any way with respect to: a Students rights or privileges? , , b Admissions policies? e Employment of faculty or administrative staff? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , d Scholarships or other financial assistance? ........ ............................... e Educational policies? .................... ............................... f Use of facilities? U Athletic programs? h Other extracurricular activities? If you answered "Yes' to any of the above, please explain. (If you need more space, affach a separate statement.) 34a Does the organization receive any financial aid or assistanco from a govemmental agency? .� 9 0 b Has the organizations right to such aid ever been revoked or suspended? ...... .. . ........... 34b If you answered "Yes" to either 34a or b, please explain using an attached statement. 35 Does the organization certify that atlas complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Noe 75 -50 1975.2 C.B. (,,covering racial nondiscdminal "ion? IfNo,� ;tlac3i an e., lactation _ 35 _ SChMule A IFerm 999 or 990-M 209 JS'A 7F. 12901.000 55H3TJ 2020 VO4 -B 60087802 Schadule A Form 09D of 990£7. 2004 9W A4327 parse 5 EMUM Lobbying Expenditures by Electing Public Charities (Seepage 9 of the instructions.) (To be completed -ONLY by an eligible organization that filed Form 5768NOT,_nnrLicSaLe _�_.,_. Check ►�� -ii the orgenlzattcm bell Wan algiated }yotlg. _• ._C.heck ^► — if you chndcod_'s' end'iNn tied controP provisiorls Limits on Lobbying Expenditures Affiliated group To be completed totals for ALL etecI419 (The term "expenditures" means amounts paid or incurred.) organizations Ss Total lobbying expenditures to tn0ue'nce public opinion (grassroots lobbying) , , , 36 37 Total lobbying expenditures to Influence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 36 and 37)• - • • • • • • • • • • • • • • • 38 .__•_- _.___,_._ -_ _. — _.,_�__ 39 Other exempt purpose expenditures ..... ............ 39 .— _...-_-__._..__. 40 Total exempt purpose expenditures (add lines 36 and 39) -40 41 Lobbying nontaxable amount. Enter the amount from the following table - If the amount on line 40 is - The lobbying nontaxable amount is - Not guar $500,000 , 20 %at the Amount on tine 40 over $500.000 P44 Aet over $1,b00,m0 • $100.000 Plus 15% or true axeosc over F500,000 Over $1,000,000 but not over $1,500,000 . $175,000 plus 10% or hie 0xeese over $1,000.000 41 Over $1,500.000 but nol over 817.000.000 , , $225,000 plus 5% of the emass nwr $1.500,000 Ovor$17,000,000 • • $1.000.000 • . • • . • • . , • 42 Grassroots nontaxable amount (enter 25% of line 41) • • . • . • 42 43 Subtract litre 42 from line 36. Enter -o- it lire 42 is more than line 36 • • , • , 43 44 Subtract line 41 from line 38. Enter -0• if ring 41 is more than line 38 • • • • • , 44 Ca ution, ff there_ is an amount on either fine 43 or lino 4 jLyor1Tust Alst f°Ofg1 4%20. 4 -Year Averaging Period Under Section W(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the inshuctions for Imes 45 throw h 50 on page.1 t of the instuctions. Lobbying Expenditures During 4 -Year Averag €rig Period Galendar year (wfiscal. (a) (b) (c) (d) (e) year be Tr ing borin,) ► 2094 2003 2002 2001.._,- -�. Total_„_- - Lobtlying Lobbying telling amount __ _ AR PolnOq „d rim Aflnll .. .. Grassroots nontaxable amount ' __„__ -_— ,�,• Gtassroon celina arnount ' Grassmols lobbying [ Lobbying Activity by Nonelecting Public Charities ___ FouLoriing on)�by,o anizations glat.did not complete Part Vl -A1 j5ee page 71 of the i_rtstructions.) During the year, did the organization attempt 10 influence national. state or local legislation, including any attempt to influence public opinion on a legislative matter or referowum, through the use of: Yes No Amount ..... X ..... ........:: a Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Paid staff or management (Include compensation in expenses reported on lines c through h.) X c Media advertisements • • • , • • • • • , , • • • • • , • • • • , , • • , , , . , x d Mailings to members, legislators, or the public• , • • • , • , • • , • • . • • • • • • , • • . , • , • e Publications, or published or broadcast statements • • • • • • • • , • • • • • • , • • • • • • • • • X f Grants to other organizations for lobbying purposos • • • • , • • • , . , S,TNT.24• X - _ _ _ 16,693. g Direct contact with legislators. their staffs. government officials, or a legislative body .. x _ _._ __ Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means , x _ •h I Total lobbying expenditures (Add lines c through h.) .. ........................ iff "Yes" to any of the above, also attach a statement nivillg.a detailed descri Bon bf the tuhhyitx� activi[les. ARp schedule A (Form 9808U or 9eaF.7)2004 4E 1240 1." 55W3TJ' 2020 VO4 -6 60007882 522 is the organization directly or indirectly affiliated with. or related to, one or more tax - exempt organizations _ described in section 501(c) of the Code (other than section 501(c)(3)) or in section 5277 ....... , .. 1 n Yes �_ 1 No im 1 Schedule A (Form 990 of 990-CZ) 2004 4E•t II'S0 t Wp 55143TJ 2020 VO4--a 600a7082 Information Regarding Transfers To and Transactions and Relationships With Noncharitable , Exempt Organizations (See page 11 of the instructions.) •51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 5D1(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of: Yes . No_ (i) Cash ..... ....... ...... . ...... ............................... 51a(ii- ..� X (it) Other assets aSir _ X b Other transactions: (i) Sales or exchanges of assets with a noncharitable exempt organization ........... b�L _ X _ (A) Purchases of assets from a noncharitable exempt organization b ii1 _ X (iii) Rental of facilities. equipment. or other assets . ... .. i1 X (iv) Reimbursemont arrangements ............ ................ ............. iv Ivi t.oans or loan 9uarantaes ...... bIYL_ w (vp Performance of services or membership or fundraising solictaations ..... ........ . Svi� I c Sharing of facilities, equipment. mailing lists• other assets, or paid employees....... c d If the answer to any of the above Is "Yes," complete the following schedule. Werra (b) should always show the fair market value of the goods, other assets• or services given by the reporting organization. If the organization received less than fair market value in any 522 is the organization directly or indirectly affiliated with. or related to, one or more tax - exempt organizations _ described in section 501(c) of the Code (other than section 501(c)(3)) or in section 5277 ....... , .. 1 n Yes �_ 1 No im 1 Schedule A (Form 990 of 990-CZ) 2004 4E•t II'S0 t Wp 55143TJ 2020 VO4--a 600a7082 OMB No. 1545 -0947 Schedule B Schedule of Contributors •(form 99D, 990 -E7, �0�_. or 990 -PF) Supplementary Information for Q Oopnrtmentofthe Ttoasury line 1 of Form 990, 990 -EZ, and 990 -PF (see instructions) Inlomul Ravenuo 5aivim _ Name of Mgankation Employer identification number HOAG MV -ORIAL HOSPITAL PRESBYTERIAN 95-IEU.327 Organization type (check one): Filers of: Section: Form 990 or 990 -EZ 1_Jg 601(c)(3 ) (enter number) organization D4947(a)(1) nonexempt charitable trust not treated as a private foundation ID 527 political organization Form 99D-PF D 501(c)(3) exempt private foundation h� 4947(a)(1) nonexempt charitable trust treated as a private, foundation L..._J 501(c)(3) taxable private, foundation Check if your organization is covered by the General Rude or a Special Rule. (Note: Only a section 501(c)(7), (6), or (10) organization can check boxes for both the Genoral Rude and a Special Rule - see instructions.) General Rule - D): For organizations filing Form 990, 990 -EZ, or 990 -PF that received, during the year, $5,000 or more (in money or property) from any one contributor. (Complete Parts I and II.) Special Rules - U For a section 501(c)(3) organization filing Form 99D, or Form 990 -EZ, that met the 33 113% support test of the regulations under sections 509(a)(1)1170(b)(1)(A)(vi) and received from any one contributor. during the year, a contribution of the greater of $5.000 or 2% of the amount on line t of these forms. (Complete Parts I and It) U For a section 501(c)(7). (8), or (10) organization filing Form 990, or Form 990 -EZ, that received from any one contributor, during the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelly to children or animals. (Complete Parts 1, 11, and 111.) DFor a section 501(c)(7), (8). or (10) organization riling Form 990, or Form 990 -EZ, that received from any one contributor, during the year, some contributions for use exclusfVely for religious, charitable, etc., purposes, but these contribulions did not aggregate to more than $1,OD0. (If this box is checked. enter here the total contributions that were received during the year for an exclusivoly religious, charitable, etc., purpose. Do not complete any of the Parts unless the General Rule applies to this organization because it received nonexciusively religious, charitable. etc., contributions of $5,000or more during the year.) ............. . .............................. ► $ Caution: Organizations that are not covered by the General Rule arxLor the Special Rules do rent file Schedule R (Forrn 990, 990 -F-Z. or 990 -PF), bid they must check the box in the heading of their Form 990, Form 990 -EZ, or on fine 2 of lth it For» 990 -PF, to terrify Thal they do riot meet the fffing requirements of Schedule B (Form 990, 990 -FZ, or 990 -PF). JsA 4f. 1161 1 One r ork Roductbn Act Notice, see the Instructions Schedule 0 {Form 990. See.". ar 990 -PF) (2004) 990, Form 990.EZ, and Form 990 -M. 55W3T.1 2020 VO4 -8 50087882 0 Name or organiuvon HOAC MEMORIAL HOSPITAL PRE:SBYTERTAN Contributors (See Specific Instructions.) KPM1 number 3%A 4E I263 1000 55W3TJ 2020 VO4-8 60087882 . chaMe a (Purr 900, 000{Z, nr 990 -0F) (2od) No. Name, address, and ZIP +4 A re ato contributions t pa of contribution 1 HOAG jiO3PITAI.j•OtJNI7AT70 _ Person I Payrofl _ ONE. FIOA6 DRIVL �P^O:_•_130X „6100 _,_„., ^.9 319_.,_766,... Noncash (Complete Part 11'rithere is NEWPORT- ._BZAC.t_. t�_�A- _92550 a noncash contribution.) — No. _ Na me, address, and ZIP +4 _ —^ Aggregate contributions _ Type of conttriburtion_ 2 ORANGE _COUNTY CHILDREN & FAMILY StrPPORT Person Payroll 10 C_I,VIC C;FNTER PT.A,Z_A rSRD F;L(70R- ,� ,..__,— _._,___ Y2.�,._947 ;_ Noncash (Complete Part It it there is a noncash contribution.) la) (b) (c1 .___._......_---_. (d) No. _ „_ ^_ Name, address _and TIP +4 f^ -- A_ ggragate contributions T ripe of contribution Person Payroll _ Noncash (Complete Part 11 if there is a noncash contribution.) ta) (b) (c) (d) No. Name, address, and ZIP +4 Agy re ats contribttions 7 tpo of contrlbution -- -- ---------._- ---.�_...— ._..-- .._---__..._. —. Person Payroll Noncash �J (Complete Part 11 t there is a noncash contribution.) Name, address, and ZIP +4` Ag re ate contributions _ TUe of cont ribution — Person I� Payroll Noncash (Complete Part 11 if there is a noncash contribution.) (a) (b) Icl (d) No. Name, address, and ZIP +4 — A r�rogafe contributons[rs of contribution —_ Person ._ Payroll I --'--.._...._—._.•__.-.._..--`- -.— .__--__..---- _. ---- - ------ Noncash (Complete Part 119 there is -_...-.... _._....___._....__._._ ._— ._....-- -- ._..____._.— ._,.._ a noncash contribution.) 3%A 4E I263 1000 55W3TJ 2020 VO4-8 60087882 . chaMe a (Purr 900, 000{Z, nr 990 -0F) (2od) HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 • FORM 990, PART I - OTHER INVESTMENT INCOME DESCRIPTION AMOUNT OTHER INVESTMENT INCOME - BOND PROCEEDS 368. NEWPORT IMAGING CENTER - PARTNERSHIP SCH K -1 2,716,432. OSCOC, LP PARTNERSHIP SCH K -1 11,988. OSCOC, LLC - SCH K -1 1,180,498. ACCRUED ARBITRAGE LIABILITIES 313,387, PHYSICIAN NOTES RECEIVABLE INTEREST 13,807. -- TOTAL 4,236,480^ • 55W3TJ 2020 VO4 -8 60087882 STATEMENT 1 HOAGAL HOSPITAL PRESBYTERIAN 95- 1643327 • Schedu l of Long -term Capital Gains and losses I j Descri ^lion Date Date Ac uhad a ^old I Gross Sales Price Cost or Other , Bzsia Long -term Galn7Loss CAPITAL GAINS LOSSES FROM SECURITIES i 1 BOARD DESIGNATED - SALE OF SECURITIES VAR VAR 524 04 5223044106. 17 996 140. MALPRACTICE TRUST - SALE OF SECURITIES VAR i VAR i 17 256 945, 16 931 869. 25 076. PRUDENTIAL INVESTMENTS - SALE OF i j I SECURITIES VAR VAR 1 755 1106.1 1 736 285. 181821. TOTAL CAPITAL GAINS LOSSES FROM SECVRITI S i 5260052297.': 5241712260.1 18,340,037. f i t ' I I I , I � ; i i t i I 1 I I � r J i � l r 1 t � c i i Totals 5260052297.1 5241712260.! 18,340,037- jsF K0910 Z CC.r. 55W3TJ 2020 VO4 -8 60087882 STATEMENT HOAG b *� HOSPITAL PRESBYTERIAN suppleme " 4797 Part I Detail 95-1643327 • Descriptian Date Date Gross Sales I Depradeflion Allowed or Allow Ac wire;,' Sold ?rice ': 'a Cost of Other Basis Gain or tLDW for en ire ew OLE EQUIP i VA I �-1 2 'a 5 .1 1.959 ,239. 1 41,803, DEIXEI) EoUIPMENT VAR ± VAR NONE. 285,278.� 430,047. -144,769. I II r a. JSA 4XA258 Z= 55W3TJ 2020 VO4-8 60097882 STATEMENT HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 • FORM 990, PART I - OTHER INCREASES IN FOND BALANCES DESCRIPTION AMOUNT --- --- - - - -- ----- UNREALIZED GAIN ON INVESTMENTS 24,725,443. UNREALIZED GAIN ON INTEREST RATE SWAP 3,227,548. TOTAL - 27,952,991. • 55i93TJ 2020 VO4 -8 60087882 STATEMENT 2 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1543327 • FORM 990, PART I OTHER DECREASES IN FUND BALANCES DESCRIPTION AMOUNT BOOK /TAX PARTNERSHIP INCOME DIFFERENCE 837,718. OTHER ADJUSTMENTS TO RESTRICTED FUND BALANCE 14,064, • TOTAL 851,782. 55W3TJ 2020 'VO4--8 60087882 STATEMENT.` 3 • Htah men,pnal Hwim: P:eshycedc FFA* 9S1b93327 [YE' Act Sr 51, s.• s EMMLUIL - C— Rdulandlp MlndA " ume Addaess W :.h u. fn:mmtm L, ale0 uskdm Amwv P::mcw crGmOt m A9Pmvpn .nGuh Dq S[+ke M 0., Cu 5a51 utliMaPo it Ate, Hmlbp=DUCt. CA 92544 AIDS suit. FJPed.vcn tT9CS 4% pa ^Se1353P Gnm !95.631 5.p Smix Truuw:mssP A3himCf have of Grange 2YAH,Smiliypg y „Gnnae,CA9 58 SssuAC'vcld,.OsViMCA9 pa-mm6i >[ -xeot S.RV SPJOacr AIDS WaR AmMR Csur $ndd.' 391[0Te5 Cu 0-150. e„ LeDr Banal CA Ph=Vm,5b Gnat 93.OYl SwnaSVCwf7+nwNlmmt Aut. ra Hnp.k, a G .`6T 'N a CA. Perm -ship Omni 25,000 Onste PIL4.aR dndppmum AEola 2pa MCR EM1711lSwtS. 1570 PV.lhh Sme4CSmnAna C. {9:105 CA Psmmrc3.b Gran: 4[tO Sponsor SianPatH BM[Wali/Rm Anl Csts Red C+na (01`Gddm CiNa DrYO8 t13m, Sinm APaG 9:11 -;14e PernenM, G=ar Wjs x74” Swnfm Stanp C.m:aa'e meY3Pml w+ria Mnd Pree, 2385 Cmnedl lk'rva Cum Mna CA 51415 Par9wrilT C:.c: 1r'09 fYms[reWPv1S Ctlfbni WushinSmP9ing Cdifmnia A:GSHusIPALUe 15374 \ "mdurtBhd. S,::m3a2, Fndnp CA Pt36 Saronsmsh3a 1. PttYur. FrwGOn b9m$mp4n C 4+: ^ Cd!4rla S. L-, P coplGNu..bR WRDmep,CA PMae Gmt '59! Imuce r ci ldrm in OC CJSVUn 9fOOn5a C. :r..7 21M \. Pr9a YSn I9; Seine AnaG 9:04 RN TtdnbS Puri iS.'.bL` SY9pJrt R1'jlains.r, riegsyn CpmmuS3v Gn HeaM SCa: �eusan, H9ri9yp0 PeerA. CA SFSaS Fsnem H;Gnl 5.'00 Cipn L9na \4ai $n:icSCmsn MS X'asl l9d. $nen.Cwta Mma CA 925:' Pvmcrdda fieu:t G.: 25.[CO Gnm:Pm.Wem Gm'clsvmenl lhr cS9'r. CnFdsy's HLSn'nal o`OC e33SMaln S :nm•itac:.,G 51855 Pummstep G =nt IS?,tu4 Grsat Rx$miprTnng9naln•n CrvMssitY ;9m4 So Ma tsit[AV C9rona Dd3sar. CA=Ql: SSI Samwaiia L4.OpJ BaPansl. SU m. w Fd95. Pwsie Y 19� Aaicvn Awnua Casu Meaa G 4:EIi $WIIaPnh:J ¢I:1.:J $C9Si\'NiaUt111an .{ssisvnw Lean.. .. VranPn Bmei UP $uiiR 7r 3'u^O FfLyiPa•Rd, Cau Mma CA Mr Clpicf FcnmJc. H'wLY.e BY AaaCYIL'.5 9 \A W.1L`Skq:.gMlS Ana CA Si396 P.r+N ;P Gnm ,SmeFinS 1-a 25AO Om:d Hluulw. .lit.h CtL4npmw 3321 F.Bmai.nvd3C£$snsa Any C05C?95 Pe9[u] \PGRn[ Binsm 1-1w Hbl-A x3eul Can 1 tiM S]n9¢e Ave_ linui un Beath. CA 9144$ Pu�neN:2 Gnas G.I. .1h 13N GSmr. YJ9A adaYrGaips Ln'ae AduP Da•HGIti 14 i' Lit iniae. CA S ➢paS0r5h :9 CL.KK $PtnVd,S-NT.an,oMd. Ieuixh Cezc =min Curter a ^GC . Ni IS98a3xr Slxe[Cmn Men a CAaA hr mhip Gnm SponwrSenbr Tnnspertadpa b,♦n %L DIiL'6eE FJY.da1b9 i<I GueJ$tees SULt 138.1NUro>±.9m5h. CA P:640 aMuc%. y ;p Gnm 38,1%9 Siwsm Hmiu Fv:sxvladpa r� [ r.o. Baps 953+.Mmchmm:. 703 c3196 Sf a :e :;aSGrar.: 46.509 Pro➢nm OMIPM<ni 1({50 Fnv,5rn Texas :141 311E1J1nstsL Pummh:ahip b,pJl GmtF Laa:na Bx:s. LPmmm'w Clsz Lnu i4Z'hcd Sea[!Liscma Emrh CA 91431 CA PUAI, $POpamhro iu:WeRenm5TlwheM¢ I,FM SCCrsarixc: WL'k •,w.n Hea^S Acxv lad" CuF -'Pmsmduh&ACdcn iu His :th& WVfase SaLmAna CA W73 7asu:a8Sdp G:anl 21;0Y. Osms. DiaMea pnrewh V SJto!nes Binh .L W31 Or9hmd Dfr:e Suit M..:'Bwaprt Beaih, CA g� Fuutmhi9 Gran: L.(095pmmrasana and PSL{xa Malnoa'D: :mad Ma'm3 SVSxm 1312 V./k0ad.ar 5: -Sai:a 150.349Ana. C {52?01 PennersAM Gram 1£[M 5 Pm: ax MULIOn P9st ie vWtb P.'anm2nd vein NM5,M hfum FJw.4.tk5 Nv 91943 P.O. Boat3.Wid PVmt ship Gran3 2Gf?2 Cm9t $Cmum lute MSans0rsevusl M1'en9cnA n Undo! Bed Hdx'D;atda A, C0Bmsh,C.0 2463 Bear U. B'A A, Ceara Mesa GA 92634 Pensxuin Crane 5,050 Omni m Toches Prsspvm slthFs Tedrntl 9lailh F9.'ndadpn 31£3F¢9n9ai13m,L:n Ah,Rdm, CA PH,:1 pS:mnshb onut 75,xo Fund MlWd tSu. aas4tYaarh T9hrmP PSPPxm �- wai;I.App$w DePl. 570 Suns 8a+bu: Dr, 1:� 9xtBxdr. CA SI335 Om.1 30,OJ3 AN P.omxm OC HVmxn Rooms C .... is f3M3.Gnad BlRd B. Sum Aga CA T_ ?OS Panne :Vp Geam x0-'9 Exdcsmsr m.?..m OniRCCs utCM�s9a Fn -daticx 191 Feirla PCP 3[VS. Can Musk CA S:44 Sw'"hIP 3.620 S."w. pwmtevdePmms Onnec Ceen3nS.,iai 1953 Wailes[ Ave, CdUl Mma. CA 92627 $lnennt9 Gram. :0,[62 Su9pp :5choma6i9 Nl:.m Otnitw.dyC Rnnv M :sxm IQ]Eginya. SPiw <. Tops. CA 92139 PummMu C.ne b'.4p1 Su9ppn emmg -.r; Pmpan4mrs: wntws Ocrc.unnv Cram us. LlnalaJu Cm. Cu. 117 W. ta SU[m R3itl, Sanm AM CA 92?PI Panton"Grarc +'u tlYJ Supmn P:oCam fxshe h9:ndme ?i0:E -0CSf�A 13109 Gxuw5a Pa:kw.v. SUhe :]3, Cin'Mka59sur, G 9l :ab PuscmaniP Gmm fi,HO P:9pam Dnebmnmx Ps9iea Cud4k 3973 Hakm Pl.d. 5514Cpaa Mma CA 92444 SpMSOHhi9 19,[1 CmnldbVV0.'12p1L95 Rais e Peuna.ue. IT?S Sky Ci.da 59he Dl,,CA 9e'dla PannmahiP Guru Gmns :59a9mt Gram WSilm 1.4�TnS SanuA9Peurs RV. ^.niaE :113h'Svemtm•$arc Aru. CA 9', I ' 3p.amip 10AOp SPOm9nhb -. Caf Rrar3:ide Ssve Par YunM1 441HmrTan 8180, CJSe Meq CA92K? hnnenh'us 1.039 R9m ;nRTmn $Pmsonstip hy 5.0110 S9pvxAft WMme9 U STATENIEHT4 n U S..9 Memptiw HOST a: P;aab"an ' FEN 95`H3327 n'S Aug er:I.2a+5 •- M lame Seeaad Hn.at FmE Bank aOC &6,JS—i.sdvp d So..w. Cue So- Kh*. SOSGibc Step {ap tuW San foie Ti ..W au"TIP Enhad way MGC US IaVftu MAM on she r>tkte[mfaaa) V 'm Cxnm:. »iy wiml.. 15'Or..en Hmbin} it'peso Yocm a- iplsfm:nl Sttnca woman Sag V.MCA Cwamuory CouueSnp Add,. Covna ofG sftm ofs, V:. wtde Paul Orapge, CA P".866 6F[ Hamihw Spec, Cora Mm CA 93CT 15W Superior F�aue, Calm AfeYA CA Tu. i5�:8mckhcb. A. Svi:e 3ld, Saun ASU,CA W705 80I .�'. Brtad- .veY.Sami Ana, CA ME 313614Ta fivadis, ASmiov raja CA 92691 169UWUI h[il:A [ 8ox3.: mi CA Mid 10i Tae Ciry Dw. Swdh, omr, CA 9263 15f3W.Fan Sv S[nn AS CA n" 141: N. Broadway. Saw Ma, CA 93Tfb390a TI t W. 112: SEea SaA -IQ C.. Men. CA T-E3T I la E l9N St .Casa Mew CA 9207 539tlnhvititypd Svix2l2Ania¢. CA 92-912 11821 NewPOn A• AMT1lp63. CA 92780 Re�:unsha. ofludi�ilvd m My Pwoo or N4ve dpa Wihs. a:.Imertslhu,e Otgu;a4vn AmwOI PcipOmofGn:n mA)IOwipn FzrrmBih„fisspt 20.000 SYpaseretteiil wau $j On3C19 �9 "UM 50N.d 61 ln.'2 IFS. LAC S%V jral Pamtnbipom M, T Grant fatoMgm Gnr.: Res dvia P50.PI3 Gnnc Cmglewn� Pirnerahlp Gan: �dndOpmepUBnPpOR ;,000 Gmnu T.sMo Smp25ag PrpBsen Saxso.'io i:. P)O Jab TrW' Percsm bQtm 5.000 Oevn:'Prpgnmdevtl9pmmn PaMinhlp Gull 92.232 M[1phis88rnuue *mmetal u!. PanOersSsb Cra:i B.Oetl Ssmaer'S.cnt ironCmfeen� Gnnl @SµmawrhiPS A.SLa 9upyon pr93sam dn�/pynpt 5i�nnaCnhlp 5,000 9pe.MaashYp:HOm[bs Wnmt9 Gta.t MAq] bupppn PSpF[m devdaom[ps(wmputrn:7 Gran: z2,FW G[ap TwNamse Gram ;a0p0 Cueg.eedumdx aed wnuen prvgnea Pa,=h1; Gnas 15GW0 Ca m.v SaedCwnaEnS l.9T i.W3 • STATOMENT4 U 4- -A3 MEMORIAL HOS?ITAL PRESBYTERIAN 'Ih: 95- 1553327 • -pc!: 99G. a• ^T T° c- id =�'2 • ^v aan +a^ - - - - a -n • STATF.MM\'T 5 COST BASIS AT BEGINNING ACCL@fJLATED CUTARENT YEAR ENDINC- DESCRIPTION OF ASSET END OF YEAR DEPRECIATION CURRENT YEAR ADDITIONS DISPOSALS, ACCUMULATED ENDING NET LA!x 20,21=,114 _ RETIREMEI§TS S OTKER DEPRECIATI ON BOOR VALUE _AND liS ?30Vr^.:95yZ5 ';, 403, Ai4 9,963, §27 -93e396 - 20,215,124 auil.DiNFS l AS�RCLD I;1= ROY?N�V =3 340,552,244 104,253,861 i, 920,504 - ;2,502) 10,75'6,623 116,17 ?,463 6,646,591 224,380,781 I'MENT 13,4 ?9,725 226,055e-134 9,649,827 609,832 ;2,310? 10,257,349 3,222,376 ?'iiEC ASSET Ci;. —ARIYG ^ 7,10 , , 036 150, 301, 447 _ 16, 220, 730 110, 2i2�956'r 158,3.9,219 67, 746, Si5 _ - - 1.170,656 524,876.927 270, 168, 562 31,544,462 (1cle 21s 21se 170 ) 295,494,654 329 382 0'3 STATF.MM\'T 5 HOAG lkoW HOSPITAL PRESBYTERIAN FORM 990, PART I1 - OTHER EXPENSES DESCRIPTION PHYSICIAN FEES UTILITIES INSURANCE UNCOLLECTIBLES AND DISCOUNTS INVESTMENT EXPENSES RECLASS OF RENTAL EXPENSES PURCHASED SERVICES HMO PURCHASED SERVICES OTHER - BONUS OTHER EXPENSES OTHER NON - OPERATING EXPENSES TOTALS SSW3TJ 2020 TOTAL 6,554,625. 4,764,132. 4,881,266. 14,993,702. 3,315,959. - 1,977,855. 20,136,311. 29,325,262. 4,992,888. 12,372,585. 901,925. 100,260,800 VO4 -8 PROGRAM SERVICES 60087882 95- 1643327 4,797,976. 17,292. NONE 14,993,702. NONE - 691,605. 3,809,771. 29,325,262. NONE 3,372,058. NONE 55,624,456 MANAGEMENT AND GENERAL 1,756,649. 4,746,840. 4,881,266. NONE 3,315,959. - 1,263,787. 16,309,809. NONE 4,992,888. 8,653,735. 901,925. 44,295,284. • FUNDRAISING NONE NONE NONE NONE NONE — 22,463. 16,731. NONE NONE .346,792. NONE -- 341,060 STATEMEZ3T 6 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 • FORM 990, PART III - ORGANIZATION'S PRIMARY EXEMPT PURPOSE OUR MISSION AS A NOT -FOR- PROFIT, FAITH BASED HOSPITAL IS TO PROVIDE THE HIGHEST QUALITY HEALTHCARE SERVICES TO THE COMMUNITIES WE SERVE. SEE ATTACHED COMMUNITY BENEFIT REPORT. • 55W3TJ 2020 VO4 -8 60087882 STATEMENT 7 COMMUNITY BENEFIT PLAN HOAG MEMORIAL HOSPITAL PRESBYTERIAN 2005 OSHPD Facility ID #106301205 Gwyn P. Parry, M.D. Director, Community Medicine Telephone 999- 764-5729 - CParrymdkboae4osp1tAore Hoag Memorial Hospital Presbyterian One Hoag Drive P.O. Box 6100 Newport Beach, CA 92659.6100 HOAG HOSPITAL Board of Directors Hoag Memorial Hospital Presbyterian 2005 OFFICERS Richard M. Ortwdn, Chairman Robert W. Evans, Vice-Chair Max W. Hampton, Secretary MEMBERS Bank S. Adler Richard F. Afable, M.D. Dick P. Allen John L. Benner James J. Berman, M.D. John L. Curti Jake Easton III Joanne D. Fix Kris V. Iyer, M.D. Stephen Jones Carol Mentor McDermott Ronald L. Merriman Melinda Hoag Smith Richard M. Taketa, M.D. Ginny Ueberroth Officers of the Medical Staff J. Paul Curry, M.D., Chief of Staff Neil M. Barth, M.D., Chief of Staff -Elect Jay R. Zubrin, M.D., Immediate Past Chief of Staff Executive Leadership Team Richard F. Afable, M.D., President and CEO Peter M. Foulke, Executive Vice President, Corporate Services Ronald Guziak, Senior Vice President, Resource Development Diane Laird, Senior Vice President, Physician Services Robert Braithwaite, Senior Vice President, Hospital Services Rick Martin, RN, MSN, Senior Vice President, Patient Care Services and Chief Nursing Officer Susan Goldberg, RN, MSN, Vice President, Cardiovascular Services • Bong Memorial Hospital Presbyterian Community Benefit Plan Update 2805 TAble of Contents I. Introduction Page I II. history Page 1 III. Mission Page 2 IV. Overview Page 3 V. Participation in ASACB Project Page 4 VI. Community Needs Assessment Page 4 VII. Service Objectives Page 5 VIII. Priority Health Concerns Page 5 IX. The Community Page 6 X. Department of Community Medicine Programs Page 8 XI. Other Hoag Community Benefit Programs Page 11 XIL Hoag Health Partnerships Page 12 XII. Appendices Appendix A: Hoag Health Partners Page 17 Appendix B: Other Grantees and Collaborative Partners Page 18 Appendix C: Accounting Procedures and Defiaftions Page 20 Appendix D: Community Benefit Cost Allocation Summary Page 21 Appendix E: Community Benefit Cost Allocation Detail Page 22 Appendix F: Hoag Hospital Charity Care Policy Page 27 Appendix G: Community Benefit Activity Descriptions Page 24 • • Hoag Memorial Hospital Presbyterian Community Benefit Plan Update 200 Introduction Hoag Memorial Hospital Presbyterian's (Hoag) Community Benefit Program was formally initiated in 1995 and has continued with significant growth and outreach, having served over sixty partners in various categories to date. We continue to emphasize the development of sustained collaborative relationships as the core of the program. The reader is once again referred to the original reports of previous years, all of which form an integral part of this report for the fiscal year 2005 (September 2004 through August 2005.) History Hoag Memorial Hospital Presbyterian is a full- service, not- for -profit hospital of 511 licensed beds. Located on the Pacific Coast in Newport Reach, California, it is 55 kilometers (34 miles) southeast of Los Angeles. The hospital was founded in 1952 as a community partnership between the Presbyterian churches of the Las Ranchos Presbytery and the George Hoag Family Foundation. As a not- for -profit institution, ownership and board election remains vested equally in the corporate members: the 58 Presbyterian churches within the Los Ranchos Presbytery and the charitable George Hoag Family Foundation, a private 501 (c) (3) foundation created in 1944. Governance is provided by a Board of Directors comprised of nineteen voting members serving overlapping three year terms without term limits. Five represent the community; five are elected from nominees provided by the Association of Presbyterian Members; five are elected from nominees presented by the George Hoag Family Foundation, and three voting members are elected from the medical staff. Additionally, the Chief Executive Officer of the hospital is seated on the board as a voting member. An annual meeting at the end of the fiscal year provides the corporate members the opportunity for the approval or rejection of the acts and deeds of the Board of Directors, and the election/reelection of Directors for the ensuing year. While providing full service acute care, the institution also features Centers of Excellence: The Patty and George Hoag Cancer Center, Women's Health Services, Hoag Heart and Vascular Institute and Hoag Orthopedic Services. Additionally, the hospital serves its communities with health centers located in hvine, Costa Mesa, Huntington Beach (2 sites), Fountain Valley and Aliso Viejo in south county. Together with these facilities, Hoag serves a population now in excess of 3,000,000 residents and visitors. The hospital employs over 4,200 dedicated, highly skillod people with a strong volunteer program of some 1,400 participants providing over 100,000 hours of annual support. Since its inception, the hospital has welded a strong commitment to the community that it serves, including providing services to those who constitute a more vulnerable, at -risk population. Such care, both for outpatients as well as those in- house, is often only partially compensated financially. Because of excellence of management and the diligent stewardship of funds, Hoag • has been able to sustain its financial strength. Consequently, Hoag has been able to maintain a continuing commitment to quality of care while developing and expanding community programs • and partnerships, particularly serving those less fortunate. All funds expended upon Community Benefit are from operating income for the fiscal year. In 2005 the hospital completed the construction of a new Women's Pavilion, This 3I0,000 square foot addition serves as "the ultimate health resource and partner for women throughout each stage of life." In addition to a new family- centered birthing center, there are a Breast Care and Imaging Center, art Osteoporosis Clinic, a Perimenopausal Clinic and a Continence Center. Mission In 2003, Hoag Memorial Hospital Presbyterian Board of Directors amended the hospital's mission and vision to better capture the hospitals ideals. This mission and vision are annually reconfirmed by the Board of Directors. "Our mission as is not- for -proSt faith -based hospital is to provide the highest quality healthcare services to the communities we serve." The hospital has desagnatcd eight supporting principles to our mission: Commitment to Community Hoag Memorial Hospital Presbyterian will be responsive to the health needs of the communities we serve and will respect the dignity of each individual patient. We will strive to be an active force in addressing the healthcare - related needs of the underserved and the vulnerable who reside in our communities. Service Area Hoag Memorial Hospital Presbyterian's primary services will be determined by the health needs of the local communities we serve. Our broader service area will be determined by the reach of our selected tertiary services. Range of Services Hoag Memorial Hospital Presbyterian will focus its clinical programs on the acute level of services and related outpatient services. We will seek to develop partners for the provision of non -acute services. Centers of Excellence Hoag Memorial Hospital Presbyterian will develop distinctive Centers of Excellence in specific clinical services where we have the necessary resources to establish and maintain high- quality, tertiary programs. The decision to establish a Center of Excellence will be based on a specific set of clinical and financial requirements. Research and Education Hoag Memorial Hospital Presbyterian will support applied, clinical research which complo nests our patient care initiatives and Centers of Excellence and which is conducted with appropriate clinical and financial oversight. We will look for the opportunity to develop clinical teaching affiliations with education programs in the areas of Nursing and the Allied Health Professions. Quality Hoag Memorial Hospital Presbyterian is committed to deliver excellent, patient - centered health care. This includes a commitment to continuously improve patient care processes, outcomes and safety, while utilising benchmarks to measure clinical quality, safety and patient satisfaction. Human Resources • Hoag Memorial Hospital Presbyterian believes our employees and medical staff members are critical to our ability to realize our Mission and Vision. We will strive to develop and maintain a positive work environment based on a respect for the professionalism and dignity of each individual. Corporate Organization Hoag Memorial Hospital Presbyterian believes that we can best fulfill our Mission and Vision by remaining a single, independent healthcare organization with the ability to be responsive to the needs of the communities we serve. The Mission Statement emphasizes the not - foe -profit status of Hoag Memorial Hospital Presbyterian, its close affiliation with its Presbyterian origins, and its commitment to providing health care and promoting wellness for all members of the community. The vision statement declares: "Hoag Memorial Hospital Presbyterian will be a symbol of excellence in the provision of health care services" Overview As previously defined, Community Benefit is not an entity that begins and ends within specified time frames, awaiting redefinition before proceeding. It continues as an active process in partnership with the community that it serves, engendering a strong community response upon which it relies as a foundation for ongoing expansion and commitment. A major tenet of Floag's Community Benefit philosophy is the separation of Community Benefit efforts from hospital marketing and incurred bad debt. This conviction led to the establishment of the Department of Community Medicine by the Board of Directors in 1995. The Department of Community Medicine is responsible for the development of the benefit program as defined by SB697. T'he department utilizes the Orange County Health Needs Assessment and community input to identify health needs to guide program development and partnership funding. It should be noted however, that a key strength of the department has been its flexibility to meet unanticipated needs as they arise in the community, providing a valuable safety net. The Community Benefit Plan for Hoag Memorial Hospital Presbyterian is continually reviewed and reexamined. The primary focus of community benefit is outlined below. I_ Continue the support of the Department of Community Medicine programs and health partner& 2. Continue to provide the Community Counseling Services program. 3. Continue to expand collaborative community relationships. 4. Work with the hospital foundation to develop opportunities for program grant applications to outside foundations. 5. Continue support of Adult Day Services of Orange County (ADSOC) and expansion of its client base to achieve increased financial independence. • 6. Continue to participate informally in the Advancing the State of the Art in Community Benefit (ASACB) research project with the Public Health Institute. 7. Continue development of the hospital's relationship with the local public health • department. Participation In the ASACB Project Hoag is one of six partner health care organizations, which represent 73 hospitals, who participate in the ASACB project. This project is led by The Public Health Institute in Berkeley, California. Ile principal goal of the project is to increase the accountability of partner hospitals and health systems, to encourage a more strategic investment of charitable resources to address unmet health needs in low - income, ethnically and culturally diverse communities. Together, the partners examine methods of accounting for and reporting Community Benefit best practices as well as the development and implementation of program evaluation methodologies. Phase I of the project, reached its successful completion in 2004. This initial phase focused on the development of uniform content categories, core principles, and metrics used to determine achievement of the stated goals. While Hoag participated formally in this initial phase of the project, due to a variety of circumstances, we withdrew our formal participation in the subsequent phase. Hoag has continued its informal support and participation during Phase II of the ASACB project and intends to apply the various program management and evaluation methodologies developed during this phase with the other working group pilot sites. This community benefit report reflects Hoag's adherence to the ASACB five core principles, with special attention to the efforts made to reach populations with disproportionate unmet health needs. This more stringent interpretation of community benefit has resulted in the elimination from the report of some hospital activities which are traditionally considered `community services;' and prompted consideration of retooling of several activities to better reach populations with disproportionate unmet health needs. Community Needs Assessment Our needs assessment process continues actively, involving all hospital departments and members of the community. As the benefit program grows, it serves as a catalyst for input from individuals and organizations within the programs served and associated affiliates. In 1997 Hoag joined with 22 other hospitals in Orange County, the Orange County Health Care Agency and numerous providers and advisors including the Coalition of Orange County Community Clinics to conduct the first Orange County Health Needs Assessment The results of that extensive countywide survey, first described in our 1998 benefit report, was reported and published in April of 1999, and is regularly updated. The report of the third triennial health needs assessment, which was published in the spring of 2005, forms the principal basis of our current needs assessment, and should be referred to as a part of this report Copies of the documents may be obtained in CD ROM form from: Orange County Health Needs Assessment; 2024 N. Broadway, Suite 100; Santa Ana, CA 92706. Tel: (714) 547 -3631, or may be downloaded at no charge directly from: www.oehna.ore We have relied upon the broader county wide assessment process and findings to help cement a partnership of institutions actively responding to needs. It has proven to be an immensely successful undertaking, creating innovative opportunities for service. • Service Objectives • The service objectives of the benefit program remain as initially defined: A. Access: To ensure adequate access to medical treatment through the availability of inpatient, outpatient and emergency services in addition to Hoag outpatient facilities in adjacent communities. B. Services for Vulnerable Populations: To provide health care services to the vulnerable populations (uninsured, underinsured and indigent) through: a. Financial support and administrative assistance of local health and dental free clinics. b. Ensuring availability of emergency, outpatient and inpatient services. C. Education/Preventiow To provide education, prevention and screening programs which address community health concerns as identified by the Community Health Needs Assessment. D. Research: To participate in research activities to bring new treatments and technologies to the local community. E. Collaboration: To establish and participate in collaborative efforts through Hoag Community Ilealth Partnerships in order to address local and county -wide healthy community priorities. F. Coordination: To provide community-based coordination of health care and social services for at -risk and vulnerable members of the community through a community case management program. Priority health Concerns The priority health concerns continue as initially described, with some changes to accommodate expansion of programs. These priority health concerns will be reevaluated in the coming year based upon results of our most recent needs assessment. 3. Access to preventivelprimary care by vulnerable populations. 2. AIDS/HIV 3. Lung DiseaWAsthma A. Cancer 5. Cardiovascular Disease 6. Adult/Children's Immunization 7. Infant/Child/teen Health Issues 8. Adult/Senior Health Issues 9. Diabete&Mberculosis • The Community • The hospital has historically served residents of all (range County communities as well as residents throughout Southern California. Consideration in defining our community has been given to numerous factors: geographic location, service arcs, distribution of services by payor identification, population demographics, population access to services, numbers of vulnerable individuals, etc. Hoag's primary service area (PSA) consists of the following cities: Newport Beach/Corona del Mar Costa Mesa Huntington Beach Irvine Fountain Valley Laguna Beach Our secondary service area (SSA) includes the communities of: South Santa Ana Westminster/Midway City Mission Viejo Aliso Viejo Laguna Hills EI Toro/Lake Forest Laguna NiguaMuth Laguna Tustin Portions of north Santa Ana and Garden Grove are also considered in benefit planning. Orange County and the Hospital's service areas are diverse demographically, ethnically and economically. Key indicators demonstrate: Senior Population: Althougb the percentage of seniors over 65 in Hoag's primary and secondary service areas are similar to Orange County overall, Newport Beach has a 78% higher proportionate percentage of seniors than the county (U.S. Census, 2000). ,household Income: Hoag's PSA enjoys a relatively high average household income. According to the Orange County Health Needs Assessment 2004 survey, however, 14.9% of households in Hoag's PSA have an annual income under $25,000. This percentage is noticeably higher than the 11.8% for Orange County as a whole, which calls attention to the need that still exists in our community. Further, nearly 45,000 individuals live at or below the poverty level; nearly 3,000 of those at or below the poverty level are seniors (U.S. Census, 2000). Ethnic PbIrS& Overall, Hoag's PSA is predominately Caucasian. The Hispanic population has steadily increased in relative size, growing over 35% in Hoag's PSA and nearly Mo in the city of Costa Mesa alone between 1990 and 2000. Our SSA is over 40% Hispanic with Santa Ana over 75% (U.S. Census, 2000). A significant Vietnamese community exists in Garden Grove and neighboring communities. Other ethnic groups are well represented throughout. Iktmcleaxnecs: Although it is true that Orange County is an affluent county (median annual household income for the County in 1999 was $58,820), it is estimated that there are at least • 23,000 homeless people in Orange County, up 16 percent from 2001 (Orange County Rescue Mission, 2002). Orange County estimates that ont+half of the homeless population is under the • age of 18 (Orange County Homeless Issues Taskforce). Henlrh /MM Mree: The percentage of individuals without health care coverage in 1-Toag,s primary service area (10.8 %) is similar to that of the county as a whole 10.4 %. Strides have been made towards decreasing the number of uninsured children. Cunvntly 3.6% of children in Hoag's primary service area are without any form of health care coverage, compare to 15.8% in 1998 and 7.4% in 2001. Based upon Orange County Health Needs Assessment results, we estimate that there are nearly 83,000 uninsured and an additional 22,000 underinsured (includes individuals with Medi -Cal and comity funded insurance) residents in our PSA. • Department of Community Medicine 1 ?bWams Community Cate Management This program began because many needy individuals were simply not utilizing available health care services due to language barriers, lack of insurance, fear over citizenship issues or lack of awareness about existing resources. The hospital's community case managers eliminate these barriers and teach individuals to identify, understand and gain access to medical services. Hoag employs both social and medical case managers to ensure a holistic approach to health care. To maximize trust and effectiveness, they are bilingual and bicultural. Case managers assess each patient's eligibility for funding resources such as MediCal, Healthy Families, Medical Services for the Indigent and Califomial(ids. If the person qualifies for any of the afore mentioned programs, the case manager will help coordinate his or her entry into the system. In addition, they coordinate referrals and services across health care providers allowing the patient to move smoothly through the medical system, from time of illness onset to recovery. Case Management is an educational process, to provide an increased awareness of the services available, and to offer preventative health tips. It empowers patients to lead a more proactive, healthier lifestyle and results in improved health of vulnerable populations and less reliance on more costly emergency rare. Case Management is also beneficial to the hospital staff members, who call upon can managers to assist with community resources and referrals for patients with difficult circumstances. Case Management helps secure a seamless continuum of erne for Patients. Over 550 patient/clients received case management services during FY2005. Contact: Rebecca Barnard, RX, MSN at (949) 764 - 6953 or rebecca.barnard @hoaghospitaLorg Counseling Program Early in the program our local and county -wide needs assessment revealed a significant lack of mental health resources, particularly for the Spanish speaking population; therefore, we decided to employ a full -time mental health worker beginning in 1998. Since that time, the program has grown by leaps and bounds, now with five bilingual bicultural Master's prepared social workers on staff, who provide counseling services as Licensed or Associate Clinical Social Workers. Mental health counseling and support are offered on a voluntary and short -term basis for up to six months. Available to all of our partners, referrals are obtained primarily through the Newport Mesa Unified School District and community wont of mouth within the community. Although there are other counseling services available in the community, there are no other consistently free bilingual, bicultural support programs. In addition to the direct mental health counseling, the program also offers support groups, workshops, parenting classes, and life - skills classes. Last year we provided 70 hours of direct services in these formats, which served 316 community participants. The program has become critical, to smaller non profit agency partners. We provide these partner agencies with professional expertise at no cost, which enhances their community services. The support groups and other workshops are developed as a result of needs assessments conducted by our program staff and/or our partner agencies. We strive to meet the changing needs of the community, so workshops and groups offered may vary from year to year, • An example of an innovative program introduced last year was a dance therapy group, which incorporated dance, psycho - education and clinical interventions. This group targeted at -risk youth and was offered in collaboration with Save Our Youth (a partner agency). The two -hour • sessions ran weekly for eight weeks. The first hour included the psycho- education, while the seoond hour brought movement and the rhythm of music to express the respective mental health topic. The coeducational group had I8 participants, with ages ranging from l I to 18. Topics covered included: body image and eating disorders, self esteem, feelings/emotions, and self confidence. In 1999 the department of Community Medicine began an internship program for Master's level intems from the Departments of Social Work of the University of Southern California and California State University, Long Beach. Currently four interns arc provided with appropriate work space, including individual computers and supervision as part of their 16.20 hourtweek commitment. They are trained and assisted in their development as clinical social workers. They handle the majority of the work on a selected number of counseling cases. The program has continued to develop a training program for paraprofessionals who work at local community non -profit agencies. Social workers provided training on boundaries, stress management, and self care to stall' at partner agencies. Training on child abuse reporting was also conducted for the school nurses and school facilitators at Newport Mesa Unified School District. Contact: Michael! Rose, LCSW at (949) 764 — 6278 or michaelLroseffihoagpospital ore Madres Militares The Madres Militares Spanish speaking Peer Support Group is modeled after an existing English speaking Military Moms group located in the city of Yorba Linda The Maadres 11lilitures, currently 59 members strong, are comprised of primarily military mothers, but also embrace other military family members; e.g. fathers, grandmothers, and aunts. The group meets twice a month in two -hour sessions held at Share Our Selves, a partner agency. An additional community facilitator, Martha Gomez, works at another community partner, Families Costa Mesa. Support group members engage in sharing personal stories to alleviate feelings of isolation and fear, listen to guest speakcrs on military policies and experiences, and engage in empowering activities to decrease feelings of helplessness. Goals of the Madres Afditares Peer Support Group include increased knowledge and understanding of military life, increased ability to cope with their family member's military involvement and absence, and increased participation in military sponsored activities for family members, resulting in an improvement in their overall quality of life. Not all individuals are able to attend peer support group meetings and some needs may require assistance beyond the scope of group support. In these circumstances the Madresmiraares staff coordinator provides personalized assistance and referrals for services to help cope with the identified needs. Requests from family members may be as simple as assistance in finding out whom to contact in order to find out where their child is stationed or as complex as locating resources for childcare or individual counseling. Contact: Rita Armendariz at (949) 764 — 6279 or rits.armendark0a boa¢hosnital.ory Health Ministries • Hoag's Health Ministries Program began in 1987, assisting approximately 800 persons from two congregations. We employ one full and one part -time Registered Nurse to provide management of the program. Over the years, the program has grown exponentially but tends to fluctuate in ZI • membership owing to the availability of nurses within a given congregation. We are currently partnered with 28 congregations and more than 85,000 people. • A main goal is "whole person healthcare," which is achieved by providing access to services that enhance health and wellness as well as foster healing of the mind, body and spirit, Another program goal is to deliver these services in a manner that transcends social and cultural barriers. Hence internal, congregation -based health comminm are formed to serve as bridges between the congregation, surrounding community and health service providers. These empowered health committees, facilitated by a Parish Nurse, survey the congregation's health needs, create plans and partnerships to meet these needs, promote the availability of services to fellow members and strategiae funding plans to sustain the services. To accomplish this, the hospital has built a strong team of partnership congregations and numerous public and private organizations such as the Health Ministries Association, international Parish Nurse Association, The Presbyterian Church -USA, Catholic Charities, Orange County Caregivers Resource Center, Mental Health Association of Orange County and the Area Agency on Aging. Hoag doctors, nurses and Parish Nurses also volunteer to work hand -in -hand with laypersons educated in servant ministry, contributing nearly 25,000 hours of volunteer service each year. The results are programs which focus on basic health education, disease prevention and screenings as well as counseling services for those coping with loss, chronic illness, depression, troubled teenagers or other hardships. Due to the combined efforts of the organizations involved, these programs and services are provided at minimal cost to the hospital, congregation and community at large. Contacts: Emily Salisbury, RN, BSN at (949) 764 - 6565 ar emily salisbsalisbu hoaahos 'tal.org Cbris Burke, RN, MSN at (949) 764 — 6594 or chris bu rke@hoarJtrrspital.org 10 • other Hoag Community Benefit Activities Hoag's dedication to Community Benefit is evidenced by the dedication of an entire department to its efforts. However, the hospital's community activities are by no means limited to the Department of Community Medicine alone. Other hospital departments evidence the commitment to community by providing a wide range of education slid outreach programs, benefit programs and supportive partnerships. Astluna Programs Asthma is a leading cause of school absent.- and an increasingly frequent reason for emergency room visits. To fuffy inform parents and children about the disease, Hoag has partnered with the Orange County Chapter of the American Lung Association to provide two educationWinstructional programs for schools: "Open Airways," developed by Columbia University, and "A is for Asthma" developed as a partnership between Hoag and the Lung Association and its affiliates with funding from Hoag and Baxter Foundation. Both programs provide asthma care training for children and their families, with "A is for Asthma" focusing on preschool children. "Open Airways" serves children in elementary school. This program reached 366 students at 36 schools in FY2005. Currently there arc four school districts using this education model to teach asthma management The programs rely on a dedicated team of volunteer pulmonologists, allergist, pulmonary technicians, firefighters, nurses and paramedics. The goal is to manage asthma to its fullest so children can improve their school attendance and academic performance. Patty and George How Cancer Center Activities The Patty and George Hoag Cancer Center, recognized as a Center of Excellence, participates in numerous Community Benefit activities. In addition to the individual patient counseling, the center offers support groups for cancer patients and their families, art therapy, stress reduction and meditation classes, and workshops. These services are provided free of charge and are open to everyone in the community, regardless of where they are receiving their cancer treatment In fact, in many of support groups, nearly half of the participants are receiving care somewhere else, but enjoy the benefit our groups. The Cancer Center conducts multiple community outreach activities including cancer prevention programs in local schools and health fairs and melanoma screenings. Volunteer 3utxwrt Hoag staff employees provide volunteer support for over 75 organizations. In addition to the countless individual efforts, this past year, Hoag employees have made tremendous individual financial contributions to local non -profit organizations, and our annual United Way campaign raised over $67,000 in FY2005. The department of Community Medicine added $92,227, to bring the total annual United Way donation to over $150,000. • • Hoag Health Partnerships A cornerstone of Hoag's Community Benefit plan is the formation and continuation of partnerships with community ton -profit organizations. Each year the hospital designates a large portion of its Community Benefit dollars to these "Hoag Health Partnerships" utilizing a foundation model of support. It is Hoag's philosophy that Community Benefit dollars be used to maximize existing community strengths and resources, making strong organizations stronger. Relationships with Hoag Health Partners vary in both depth and scope, ranging from varying levels of financial support to deep collaborative efforts with trusted established organizations. Please refer to Appendix A for a complete list of Hoag Hospital Health Partners. Contacts: Gwyn Parry, M.D. at (949) 764 — 6595 or Bryn osrrvmdCahoaehaepital nra Rebecca Barnard, RNI MSN at (949) 764 — 6xa+ re ecca barnardCalhoaehosnital.ors The paragraphs below provide brief descriptions of selected partnerships that Hoag has forged with community agencies and organizations. Share Our Selve§ (SOS) The SOS Free Clinic, which served the medical and dental needs of over 5,700 underservved individuals in FY2005, remains an active and major health partnership- Hoag Hospital provides significant pro bono and financial support to SOS, which, in FY2005, amounted to over $1 million. Please refer to Appendix A far details on the expenditures and persons served. 7'he clinic provides extensive free medicalldental services to those residents unable to afford visits to clinics that charge, even on a sliding scale, or accept insurance for payment. The Emergency Services component provides food and small monetary grants daily, to those who are in need, contributing to the wellness of residents and the homeless. As a result of its positive reputation in the community, the SOS program receives considerable financial and volunteer support, supplementing Hoag's significant contributions. Thirty volunteers work in the dental clinic and 170 in the medical clinic. Over 200 volunteer for the daily operation of the Emergency Services and 45 individual volunteers work with the fend raising efforts. Several members of Hoag's management staff serve on the various boards of directors for the organization. Hoag's partnership with SOS is multi- faceted. We continue to assume all hospital costs of patients seen for either diagnostic or therapeutic services at all levels of complexity at the hospital (almost 700 patients were seen in FY2005.) Hoag also provides a Patient Services Advocate for the clinic program. This full -time case management position supports patient advocacy and helps patients who arc eligible to enroll in insurance programs., thus providing therm with the ability to move into another clinic's program while achieving self sufficiency. At the same time this move opens opportunities for additional patients who fit the 11w clinic :criteria for eligibility. In addition to the charity care and other services provided to SOS and its patients, Hoag provides significant funds annually for the SOS clinic, a portion of which is designated to provide a full- time Mcdicai Director, Margarita Pereyda, M.D. Dr. Pereyda has a wealth of experience in working with diverse populations in a community -based clinic and is familiar with the ample barriers facing populations with disproportionate unmet health needs in obtaining access to cane. 12 • The establishment of this position has improved the physician referral base dramatically. SOS has over 200 physicians in private practice representing all specialties that make themselves available for referral and consultation services at no charge to the patient. Over ninety five percent of these doctors are Hoag staff members. Their comfort with the program, which includes assurance that the patient will receive precisely the follow -up care that they prescribe, has eliminated concerns about irregular standards of care. Prior to the initiation of our present level of support, diabetic complications were among the top five ECU diagnoses at Hoag. That diagnosis is no longer on the list In calendar year 20D5, SOS provided medical care to 3,864 unduplicated patients (in 12,956 visits) and dental care to an additional 1,960 patients (in 6,399 visits.) During FY2005, a total of 681 SOS patients were referred to Hoag for care, for a total of $728,779 in uncompensated hospital costs. (age County Health Care Amy (HCA) A strong partnership with the Orange County Health Care Agency has been key to Hoag's Community Benefit efforts since the formation of Hoag's Department of Community Medicine. The joint effort came in the form of a Tuberculosis program and video (See Hoag's 1996 Community Benefit Plan for an in depth description). Hoag's relationship with HCA continued to flourish through shared commitment to the Orange County Health Needs Assessment collaborative. Over fiscal years 2004 - 2006, Hoag has committed significant funds in support of the Health Care Agency's Child Abuse Services Team (CAST). "CAST is a multi- disciplinary team program for conducting child sexual abuse investigations at a single site. CAST's coordinated on -site services have enabled social services, law enforcement, deputy district attorneys, medical providers, and therapists to collaborate on investigations. The child- focused, child friendly environment at CAST serves to further reduce the trauma for these children." Hoag provided funding support for a forensic physician for the program. This physician is charged with conducting forensic physical exams of the children as well as holding an academic appointment at the University of California, Irvine (UCI); which trains medical residents of UCT and Children's Hospital Orange County (CHOC). Families Costa M§ La (FCM) FCM, a family resource center under contract with the Orange County Social Services Agency, strives to ensure that all children grow up in nurturing families and safe communities. It provides opportunities for children, youth and adults to achieve their full potential as caring, responsible and productive individuals. As such, it offers parenting skills classes, leadership training, tutoring, English as a Second Language (ESL), gang diversion, after - school recreation and many other academic and health services. Hoag's Counseling Services Program has a strong collaborative relationship with FCM. The hospital works in concert on this collaborative program with many partners, including the Newport Mesa Unified School District, the Orange Coast Interfaith Shelter, Share Our Selves, • Orange County Child Abuse Prevention Center, and Save Our Youth (The last is a teen mentoring program). 13 • Californial(ids: This innovative health insurance program is designed to help thousands of California children whose families do not qualify for federal or state programs due to their immigration status or income level. Once enrolled, the children have access to medical services including preventative care, dental care, eye exams and glasses and prescription drugs. Hoag, with a FY2005 commitment of $358,333 (which provides funding for 880 children slid is matched by the local St. Joseph Health System) has made a unique contribution to sponsor and implement the program. Additional funding has been provided by the Orange County Board of Supervisors through the tobacco settlement fiords and the Children and Families Commission. L Catifomial(ids insurance provides for physician outpatient services only. Children admitted to the hospital qualify for state and federal programs on an emergency basis. The program provides a strong statement of commitment for the hospitals' ability to work in collaborative partnership to support community residents in need. 'the collaboration is expected to foster greater and more proactive attention to medical concerns within these families, cutting their dependence on emergency room services and resulting in healthier, happier children. To date, over 5000 children are enrolled in this very active program. Adult Day Services: Adult Day Services of Orange County ( ADSOC) provides day care for individuals with Alzheimer's disease and related dementia. The service provides respite for caregivers, enabling there to work or conduct other affairs secure in the knowledge that a loved one is safety cared for in their absence. ADSOC provides both a social and a medical program under licensure from the Department of health Services, providing activities for cognitively impaired seniors and care for medically or physically disabled older adults who need daily nursing and rehabilitative services. Hoag continues to support ADSOC through the provision of operating, marketing, and facilities grants as well as employment of the agency's Executive Director. The hospital has also financed a professional shuttle service to transport seniors to and from the ADSOC facility, as well as to midday outings. During the last fiscal year, ADSOC served 221 unduplicated clients. Currently there are over 115 ernoliem, with an average daily attendance of 60. Friends in Service to Humanity (RICH) FISH provides a community service to catch the working poor and the underemployed before they become homeless or hungry. Their services include: rental assistance to avoid eviction, "Mobile Meals ", transitional housing and case management, child care subsidies, utility payments to avoid shut -offs, and job development. Hoag has partnered with FISH and their Mobile Meals program to provide hot meals prepared in the hospital's kitchens and delivered to a daily average of 95 home -bound recipients. Over 225 community volunteers, including members of our Board of Directors, reliably deliver these meals five days each week, for a total of almost 50,000 meals in FY2005. Almost one -half of the meals are provided at a significantly reduced charge (or no charge) to the individual recipient. 14 • S_cnior Center Programs Hoag continues its support of community senior centers located in Costa Mesa, Huntington Beach and Irvine, the Oasis Senior Center in Newport Beach, Adult Day Services of Orange County and the Jewish Community Center of Orange County located in Irvine. These centers offer daytime activities for seniors. The hospital funds a Public Health Nurse at the Costa Mesa center to provide medical advice and screening support to its members. Because many seniors can no longer drive, the hospital funds transportation grants to each of these facilities providing it with a shuttle van for a full day, five days a week. A professional driver transports seniors from home to the center, to shopping, to doctor appointments, to a hospital of their choice or any other destination deemed beneficial by the individual or the craters. There are no restrictions on destinations. During FY2005 nearly 43,000 rides were provided to seniors with this service. Assisting seniors to maintain their independence in their homes is a primary objective of these programs. In order to make this possible the Department of Community Medicine works with five local non- profits, including local senior centers, ADSOC, and FISH, to identify low - income seniors living alone that would benefit from an in -home personal monitoring system. Community Medicine covers the monthly service fees, along with the cost of installation, providing a sense of security for these seniors and their families. Currently 20 seniors are enrolled in this valuable program, Lifeline, originally funded by a grant from Hoag's Pastoral Care. ,$_gmeone Cares Soup Kitchen: The only soup kitchen in the community, this program was founded by a visionary woman with a group of supportive volunteers and feeds over 250 people daily. Many of the clients are "working poor" with jobs at minimum wage in service industries. The free meal at lunchtime makes it possible for them to eat and maintain housing on a limited budget. Other clients are single parents with children, the homeless and others in need of a nutritional meal. With in -kind support and grants from Hoag, and significant partnership contributions from the community, the Someone Cares Soup Kitchen enjoys a permanent home at a site that was once a restaurant. The Soup Kitchen also offers an after - school tutoring program in partnership with local schools. The program currently reaches 45 students, offering three classes per afternoon, four days a week. Children's Hospital of Orange County Children's Hospital of Orange County (CHOC) has a well- established, American Diabetes Association - recognized diabetes /endocrinology program that provides care to more than 3,000 infants and children annually, including more than 1,000 with diabetes. Surveys have shown a shortage of pediatric endocrinologists and particularly of bilingual, bi- cultural practitioners. In 2005, Hoag entered into a partnership with CHOC and Pediatric and Adolescent Research and Education (PADRE) to address the need for bilingual, bi- cultural diabetes education, outreach and clinical services to the children of Costa Mesa and Newport Beach. In collaboration with other community organizations such as Families Costa Mesa, Share Our Selves, Save Our Youth, and the Newport Mesa Unified School District (NMUSD) this program funds a bilingual • Certified Diabetes Educator and exercise physiologist, a bilingual Registered Nurse and a bilingual Community Outreach and Education Coordinator, who provide diabetes prevention and education outreach services in a variety of community settings. is • Appendices Appendix A - Hoag Health Partners Appendix B - Other Grant Recipients and Collaborative Partners Appendix C - Accounting Procedures and Definitions Appendix D - Community Benefit Program Cost Allocation Summary Appendix E - Community Benefit Program Cost Allocation Detail Benefits for Vulnerable Populations Benefits for the Broader Community Appendix P - Hoag Hospital Charity Care Policy Appendix G - Community Benefit Activity Descriptions 16 • Appendix A Hoag Health Partners Hoag Health Partners are organizations or agencies that have an in- depth, positive, collaborative relationship with the hospital, aimed at improving the health of the community. The relationships with these partners reflect collaboration and transcend fiduciary involvement. Hoag Health Partner organizations benefit from a long term commitment from the hospital and are asked to participate in the priority setting process for hospital community benefits. • Adult Day Services of Orange County • Alzheimer's Association • American Diabetes Association • American Heart Association • American Lung Association • CaliforruaKids • California State University — Long Beach • Children's Hospital of Orange County • Families Costa Mesa • FISH/Mobile Meats • Health Care Foundation for Orange County • Latino Health Access • Maternal Outreach Management Systems • Newport Mesa School District • Orange County Health Care Agency • Orange County Rescue Mission • Saddleback Community College • Share Our Selves Medical and Dental Clinic and Emergency Services • Someone Cares Soup Kitchen • YMCA Community Services 17 • Appendix B Other Grant Recipients and Collaborative Partners of Hoag's Department of Community Medicine • AIDS Services Foundation • American Canner Society • American Fibromyalgia Foundation • American Red Cross • Boekstrand Cancer Foundation • Boys and Girls Club — Harbor Arcs • Bridges for Newborns • Children and Families Commission of Orange County • Children's Healthcare Access Initiative • City of Huntington Beach/Golden Wave TV Program for Seniors • Coalition of Orange County Community Clinics • Community Care Health Center (Huntington Beach Community Clinic) • Costa Mesa Chamber of Commerce • Costa Mesa Senior Center a Crohn's & Colitis Foundation • Drive S.A.F.E. • El Viento Foundation • Girls Inc. • Healthcare Council of Orange County • Health Ministries / Parish Nurse Program Partner Churches (28 Total) • Healthy Smites • Hispanic Chamber of Commerce • Huntington Beach Council on Aging — Sensor Center • Institute for Healthcare Advancement • Irvine Adult Day Services • Jewish Community Center of Orange County • Juvenile Diabetes Research Foundation • L.A. Free Clinics / Association of Pacific Coast Free Clinics • Laguna Beach.Community Clinic • Leadership Tomorrow • Leukemia Lymphoma Society • Lifeline e March of Dimes • Mission Regional Hospital and Medical Center o National Health Foundation • Newport Beach and Costa Mesa Police Departments • Newport. Mesa Schools Foundation • Oasis Senior Center Transportation • Orange Coast College • • Orange Coast Interfaith Shelter • Orange County Community Foundation • Orange County Congregation Community Organizations 18 • Appendix 8 Other Grant Recipients and Collaborative Partners of Hoag's Department of Community Medicine (continued) • Orange County Health Needs Assessment • Orange County Hispanic Education Endowment • Orange County Human Relations Commission • Orange County Immunization Coalition • Orangewood Children's Home • Project Cuddle • Project Hope School Foundation • Raise Foundation • Saddleback College Foundation • Save Our Youth • Second Harvest Food Bank of Orange County • Soroptimist International • St. Joseph Hospital /St. Joseph Health System • STOP -GAP • Taller San Jose • Trauma Intervention Program • United Way • University Advancement Foundation — California State University, Fullerton • VNCOC Asian Health Clinic • WISE Place • Women Helping Women • Youth Employment Services • 19 • Appendix c HOAG MEMORIAL. HOSPITAL PRESBYTERIAN COMMUNITY BENEFIT AND ECONOMIC VALUE Ar. co pn rirrg,_Prncedurrc/Dejinitioru 'flue following accounting procedures were utilized by Hoag Memorial Hospital Presbyterian to assign the economic value for each category of Community Benefit. Umeimbursed Costa of Dired Medical Services (Designated Hospital Charity Care) Medical care services include direct patient care provided by Hoag to patients identified as qualifying for charity care; county indigent patients, patients referred for ancillary and inpatient services fiew the S.O.S. Free Medical and Rental Clinic and patients identified through the Community Case Management program or Department of Community Medicine as undetinsured/uninsured in need of medical services. Costs, (direct and indirect) are calculated as the unreimbursed cost of patient care provided by Hoag.- charges less reimbursement times the hospital cost/charge ratio plus any additional direct costs. Benefltc for VulneraW Populations Programs and services which are specifically targeted for vulnerable populations: identified as the underinsured/uninsured. homeless, low - income individuals, and seniors without support services; provided to facilitate access to preventive and immediate medical care. Many services are provided through Hoag Community Health Partners. Only direct hospital expenses, (salar Wwages, benefits, purchased services, supplies and cash disbursements) are considered. If applicable, offsetting revenues, (e.g., donations and/or fees), are deducted to achieve a net Community Benefit. Benefits for the Broader Community Programs and services targeted for all community residents, (e.g., health education, prevention and screening programs, information and referral services and support services). Although intended to reach the general population, activities for the broader community are only considered community benefit if specific efforts to reach populations with disproportionate unmet health needs can be documented Only direct expenses (salades/wages, benefits, purchased services, supplies and cash disbursements) are considered. Additional hospital indirect costs are not considered in program costs. Offsetting revenues, (e.g., donations and/or fees), are deducted to achieve a net Community Benefit. Not all individual programs or donations are listed; many are summarized by service category. Expenditure Summary The following pages summarize the economic value of providiug Community Lienetit programs and services by Hoag Memorial I'iospital Presbyterian for the fiscal year 2004. Persons Served Numbers of persons served are listed under expenditures where available. Numbers for Iioag Health Partners are not consistently available, When available, these numbers are listed only once even if the hospital engages in multiple Community Benefit activities with the organizations. If we report the number served by an organization earlier in the accounting, "PL", for "previously listed" will be entered in the persons served column. If the information is not available, "NA" for "not available" will be entered in the persons served column. When possible, we have listed the total number of unduplicated individuals served by our partner organizations. In some instances the reported number served may indicate only those actually carolled in • a specific program at a given point in time or refers to units of service as opposed to persons served. (e g. the Someone Care Soup Kitchen reports the total number of meals saved as opposed to unduplicated Persons served. Contact Nancy Jackson at (949) 764 — 6597 or man kson(a)hoagh s 12 20 • Appendix D Hoag Memorial Hospital Presbyterian Community Benefit Program Cost Allocation Summary Listed by Suggested State Categories, Then by ASACB (Demonstration Categories A. Unreimbursed Cost of Direct Madleai Care Sarviaes - Charity Care DefmWm The direct cost of medical care provided by Hoag: comsts of unreimbursed costs (calcutatad ul6tzing cast-to-charge retlos) of providing services to the county Indigent papulabm % chanty care, and care provided to patients identified and referred by the SOS Free Modicaf and Dental Conic and the Hospital's Community Case Management Program. Medical Services Indigent {MSQ Charity Care SOS Free Clinic Community Case Management Raferrals 'MediCal Cost of Unreimbursed Care Total Cost of Unreimbursed Direct Medical Care Svcs FY2005 $5,165,113 $2,299.958 $728,779 $335,928 $7,542.829 $16,072,417 B. Benefits for Vulnerable Populations Definition: Services and supped provided to at-risk seniors and chfldnm the indigent, uninsured/underinsured and homeless to facilitate access to preventive and immediate medicei care services. Community Health Services Health Profession Education Subsidized Clinical Specialty Services Cash and in -Kind Contributions Community Building Activities Community Benefit operations Total Benefits for Vulnerable Populations C, Benefits for the Broader Community DeBni brr: Health education, prevention and screening programs, information and referral services, and supportive services avaNabla to community residents. Community Health Services Health Profession Education Subsidized Clinical Specialty Services Cash and In-Kbnd Contributions Community Building Activities Foundation Expenditures for Community Benefit Total Benefits for the Broader Community $1,850,706 $15,150 $590,547 $2,607,128 $14,625 $588,419 $5,808,575 $565,047 $506,660 $555,631 $309,123 $124,772 $195,102 $2.259,235 Total Community Benefit and ,Economic Value $23,998,227 ` This Is the first year that MedlCal Cost of Unreimbursed care is Included In this report. 21 r� • 22 Commt�nit �3enefit Cost Allocation Detail Be`nef`its for Vulnerab(e_Populatons SaWBtt. Net Ge Community Health Services CummurrAy based Services for Undeiserved Populations _505 community Counseling Services -���_ _ �- $325965 Costa Mesa Senior Center. Public Health Nurse Partrmt5hi�______, _ $10000 Direct Payment to f'tiysicians for SOS Patients _ _ __. 8 $10,626 Em isyees for Local Community Non- proFts - $M561 ' IFTOH and Psxchiatric Transfer Protocols_ ~���— ____... 147 _._._._ $343 084 Hose Healthy Start Ciinit�� ._ -_� $76,'000 Oasis Senior Center Health Screent -_ 60 $605 Cwnmunli Haafth Education Y �—. (iealth Ml_nis_trles 6_510 __$133,647 tfeaRlt Care S'a services Community Case Management _ ^ _ ^� _. Adult Day Services of OC - TransportationStrias� __ _ _ _ V0 _ 9_693 $138,993 _ $166 063 µ Costa Mesa Senior Center - Transportation 4_034 _$8100 HlintinWon Beach Council Trans op rfation_ fri s)� 10,114 $84;6i16 _ Irvine Adult pay Services - Trgq ^ ation�tripsL _� — 7,706 _$71,500 v Jewish Community Center of OC - Transcortation M1 38,00ff Oasis Staniar Center _Transportation �o a_.. _._.__.. t tri 4 s Suf btota.i tar Community HealtG Services ___ 12,338I $61 000 706 Health Professions Education _ �9L850 OJllP. /H¢oltY MSW internshi s - Communitv Medicine' _ E. J 7 $16,950 _ SubtoudforHeafth Professions EducaSon. _ . ___ _ Sabsldlaed.CKniccl Speqiotfv Services r Emer n cy and Traurna Services I I Emaigena Call Panel Raimbursoment Prouram _ SubJofaI for Subsidized Cllnical_Suacle1 _ serviaes _85905rY7 Cash and lrrKlnd Conrribdtions Cash Coorribugons I Adult D my Services of OC - General Contributions _ _ _..., $16.785 Adult pays Services of OC A14S Services Foundation _ 221 _ J $426;764 0 American Diabetes Association 12-500o American Heart Association —� ,50.000 �- American Lung Assgcfonr _ -. 1,786 .�. $25,360 — Assistance League of Newport _Me_s _a Cttiifornia Kids ._ -... —^ _ — 555 000 $25 X160 040 Community Care Health Center_ � _ $25,750 y _ �y{ $18 022 Costa Musa Senior Center Families Costa Mesa La ura Beach C mmunily Clinic $2D 000 Lidtino Health Access j $25 ODD 22 • - Madres Militares 59 $54 16 Matemal Outreach Managamtm t Systems _ _ _ - — _ - 3,7IIt3 -- $20,400 _ _ National Health Foundation _ '- - - - -- -`- - - $20000 N ortCommunit Counselin Center _ -. gg0pp Newport Mesa School District - ._.. -_.. $250 -_ Newport Mesa Schools Foundation _w -- __.__.- - -.._._ $5,� -- Orange Coast College Foundation _ - - - -- -_ - - -- -- ODD -- Oran 90 Coast Interfaith Shelter - - - -- -_ - - - - - - -$10 105,383 __L County Rescue Mission' - -- - -' - - �" - _ $20,400 Oren a Cou s United Wa -- - -µ — $92,227 - Save Our Youth SOYA- _ _ -_ i 450 $5,000 Second Harvest Food Bank - -- - -_ g20,t) Someone Cares 5otip Kitchen -' '— 8,356 _ S20 SOS Clinic -_ �� _ - -- - - 5,711 ,0-D-0- $999,155 - Southern Callfomta PartnershE of Advocates - $1,000 - -' _ Tatler San Jose `-- - $SO 0000 _ Vietnamese Communi of Oran eg —_ - - ffi50,644 - ��-r— WiSE Pia° !— _ -�Coun -- _. _ -.. __ __ _ __ $5,Q00 _ Women Het Inomen _ _ YMCA____ - -- - _- _ -'-- $20,070 $150,000 Youth Emftment Services _ __._.... - ------ -- tn- KindASSisranc:e -...w- °- -- -._. -..__� _ $27500 -- Clothin D, rive LV -- - _ FISH Harbor Area 1 _ - - -_--- -_ Grant Review Parti ation for Fcundaiibn's _ — Medications Dongibd to ttte SOS Medical Clinie _ - - - -- —' _ - 89 $640 --- $152,817 $ggp $1& 20p Plask s- �._ Supki E ui mant Furniture Donation - -- -- "' - -' -- - -'- - ��- Sob&fa! for Cash and In -/Lind Con6_Ybufians $ g - -' $2 607,128 Crfmmunt guild,»_ „�Activirles _ -_. __ Ccalft' of OC Comm6n_i (- Clinics _ -- --- -` - Or -nee Count Relations Commission _ -- ` -- - Southern Caitfornla Oirtri of Advocated - - -'” -- ` $10 5DD ` $3 000 -� $1000 - 3�onsorst i� for Non - Profits w attend contaronces - -_ $125 ubtohd for Community $adtdln9ftc6viDros ,�__ CommunityBeneSterBiia_ns _ DeoGcaaed Sraff - - - --_ - -_ - $7q. y $563 419 Cammuna�Ngedsl4sSets Assessment .— I _ - •�_ _Subtotal for Cpmmuni $enefttrratlons _ — $25000 —SR¢78 Total tionafits fat Vulnerable Pa uiations - -",- 85, 575 _ - - _ -- 23 • Benefits for the Broader Communi CommunfmHoAlrh service's CCammuniV Health Education _ Better Breathers Sup A Graff -� Breast Cancer Support Groups f 60 1,437 235 $3,825 $11,061 _ $5600 Cancer Center Community Health Fairs a_nd Outreach 3,822 $13,233 -, Cancer Center Super Grou s -Other Celebration of Life Evert - - - - _ 11340 a0D $45,580 - $16,280 Comfort Care and Next Stops _ _ $15,736 CornTanity Education Classes _ $1,718 Community Lectures _ !_ - -_ -- 80 - _ _ $982 Congestive Heart Failure Education Series ` 28 $1,01)8 —� Cordelia Knott Center for Wellness Creative Ex sessions �_ E�epsy S�posium �_ — �_ - -_ Facing Forward bereavement group_ _ - _ 140 _ 60 � _ $42D - $3,3BD _- $4,595 _ _ _-,___ Family Assessment Counseling anU Educational Services __$9125 ___ $175 - -_ _ Family hfeatth Commun_I Education Fitter Image Prom _ Flu Clinic �- -- Freedom From Smoking- _ -_ _ - _2,51)0 _- 1,500 _ _97 $24,863. _-- $4,776 -� $3,14¢ �- Growth l hrough Grie( bereavemenl�rouP 1,25Q $13,805 Llfe Goes On Bereavement Group _ Y - __ $11,225 - Luna Cancer Support Grou- -- - 133 $5,232 L rL phedema workshops 106 Medicare 101_ T —_ 819 ^� $20,674 Meditation for Stress Reduction 335 Mother's Fitness Walk - �— $4080 Natural) Sweet Support Group _4 $1, Newly Diagnosed Breast Cancer Support Group 103 $ 120 Oncology Outreach Education 4,500 y4 89W Pafc Shoreline Marathon Medical su ort $500 �T Parkinsons Community Su Pr rams -_ - 240 $81),536 Pre' ect Sun Sale _ 5,000 $50 Prp' ctVUipeoul _ _ _ - 2,067600 $28,1390 Prostate Can Support Grou Pulmonary Rehabfiietion Group _ 443 48 1726 Race for the Cure 30.000 $1 t3 370 Sleep Week Campaign _ $5,040 SobrieV S oaks ^_ 550 $11799 _ Strides for Chantla MADD of OC_r _ `- $1000 Cnmman1tv Based the O ortunR Censer Women's dt7Use Cards Clinical Services First Aid Stations Ureline _ -� -__ _ -_ — -i - -_ 2,500 -- 20 $5,ty00 $9rs4 $450 $6,044 m Melanoma Screenings _ -__ - 125 - $ 74fl TS and Drug Screenincl Health Care Super Servvires _ P2kyline _ 25 18,000 $1,175 _ Cancer Center Counselim am- Referral Services - -Other �Ent_e_rstomal Thera - Ostv_my 6upp�ort �- - ; ' � _�$122,900 3900 -• $42,900 $5,226 �^ Subtotal far Communi Neafrh Services -�- ��g��7 24 CJ 0 Health Professions Educadan Est# Cal State Long Beach RN to BSN Program Professorshi �q�l State Lon q_2es I MSN Program Professors__ hip Cal State Long Beach On-Site P fessorship imsta .. ___ __11-001M Protesso h' Administration Fee 025,000 Utfier Health ra ssions Bridges for NevM_ mW_V_Ide Pharmacy Student Clinical rotabons Physical Th Into ip s Health Professions Education Subsidized Clinical LI;pecialtv SandcasE 1 $168,480 ____IAnttoa Is ot Clinic DOO $555,631 Subtotal for Subsidized Clinical C/a/!Y Servlcas 631 Cash and _!n -ktnd Contdbudons Cash Convibuons Alzheimer's Association American Cancer Society--L- as County Children's Os lt�l of Oran99_9(_)UR!Y_ HjSW�c Bar Association of q)Lqq rq Q2_qS�L RWAJN On the Front. Line ConWance Woman —S In-Kind Assfsj ince 230 $lojODO 000 $5,000 Ott Moomin dates. Bivast Cancer Awareness _ Multi p 9 Sclerosis Sort Group INCICAR RA __.:Vfty for Cash and 1n Kind Cantribudons �LpSub 900 $740 $183 S3,2001 _$:309Y23 _191 for Community Nortp fits --FAmerica Cancer ards; and Committees __ Juvenile betesRas6arch oU'5ic_Fa_vc`n_ 27 $1116 300 $7 $1220 $17527 March of Dimes $25000 ------- fLrjar!pa National Council of Jovrish Women OranQR_qRu_qty Substance Abuse Coalition COU2!y obapco erevention alition $ Santa IThe Trauma Police EnloreLELoLnam - I e_�A� Beach Ana Police Department Running -ream ffiaiiii�r _uri5­aii6W_-=-=_ blotal for rorninunitvq AWN 23 $5.000 $1650 $10,000 $5,850 $724772 25 • 0 Hoag Foundation Expenditures for Community lfaa/th profasslons Education V Nurses �__ �� Benefit Eat !t SarYad t�tetGid T _ Saddleback College Pr_ijS rsh _ _ 5 _00450 Saddleback Colege professorshi al _ — Subtot_forNaalth Profess_lo_ns Cash and In-kind Contributions Education 85,268 Cash Contributions I - _____ Sp2gj��ors Lecture Series _ Scholarshii for High School suidents S _ t2,000 Orar evoad _ _ S 5,000 Subtotal for CashContrrbudons Total Hoag Foundation Community _y s 194102 Total Benefits for the Broader Communi $2„259;235 2h ADDendix F 1.0 PURPOSE: 1.1 To define Hoag Hospital's charity care and eligibility process. 2.0 POLICY: 2.1 It is the policy of Hoag Hospital to provide a reasonable amount of its service, without charge, to eligible patients residing within its community who cannot afford to pay for healthcare. 3.0 PROCEDURE: 3.1 Charity is demonstrated by the inability of a patient to pay, versus bad debt as an unwillingness of the patient to pay. Charity care does not include bad debt, contracted adjustments or un- reimbursed costs. 3.2 Charity care inclUggs 3.2.1 Services provided to uninsured patients who do not have the ability to pay as determine by this policy. 3.2.2 Under insured patients whose coverage is not adequate to cover their entire care. 3.2.3 Patients who can demonstrate their ability to pay for part of their care, but not all of their care. 3.2.4 All inpatient, outpatient surgery, outpatient diagnostic and therapeutic services, and ECU services that are medically necessary which in the absence of immediate medical attention could reasonably be expected to result in any of the following: 3.2.4.1 Placing the patient's health in serious jeopardy. 32.4.2 Serious impairment to bodily functions. 3.2.4.3 Serious dysfunction to any bodily organ or part. 3.3 Charity Care xce hides: 3.3.1 Elective services are not eligible for consideration under the charity Care program. Examples of excluded services include, but are not limited to: • 3.3.1.1. Chemical Dependency Center 3.3.1.2. Cosmetic Procedures 3.3.1.3. Gastric bypass r4i HOAG MEMORIAL HOSPITAL PRESBYTERIAN 9.1 Page 1 of 2 MOM um. HOSPITAL POLICY 07121104 $Up.nod" oar 09101103 orpinroatu Signature& of Policy Reviewers (.'as required) 12(01170 _ gsmhmttR a eiN�t r�td"� —�" emau•: T"Tale. swMi ATm alstriuvi Naadf TWWTtlK o6p tom ! JoAnne 'tucker f ItltdV ahW p}UhflGtprlT chwaistift -: Michael Stephens Name Name Tlt ct: t CHARITY CARE 1.0 PURPOSE: 1.1 To define Hoag Hospital's charity care and eligibility process. 2.0 POLICY: 2.1 It is the policy of Hoag Hospital to provide a reasonable amount of its service, without charge, to eligible patients residing within its community who cannot afford to pay for healthcare. 3.0 PROCEDURE: 3.1 Charity is demonstrated by the inability of a patient to pay, versus bad debt as an unwillingness of the patient to pay. Charity care does not include bad debt, contracted adjustments or un- reimbursed costs. 3.2 Charity care inclUggs 3.2.1 Services provided to uninsured patients who do not have the ability to pay as determine by this policy. 3.2.2 Under insured patients whose coverage is not adequate to cover their entire care. 3.2.3 Patients who can demonstrate their ability to pay for part of their care, but not all of their care. 3.2.4 All inpatient, outpatient surgery, outpatient diagnostic and therapeutic services, and ECU services that are medically necessary which in the absence of immediate medical attention could reasonably be expected to result in any of the following: 3.2.4.1 Placing the patient's health in serious jeopardy. 32.4.2 Serious impairment to bodily functions. 3.2.4.3 Serious dysfunction to any bodily organ or part. 3.3 Charity Care xce hides: 3.3.1 Elective services are not eligible for consideration under the charity Care program. Examples of excluded services include, but are not limited to: • 3.3.1.1. Chemical Dependency Center 3.3.1.2. Cosmetic Procedures 3.3.1.3. Gastric bypass r4i • 4.0 Eligibility 4.1 The following factors will be considered when determining the amount of charity write -off provided. 4.1.1 Patient should reside in hospital's primary or secondary service area or have received emergency services. 4.1.2 Evidence of eligibility is required. 4.1.3 When possible, eligibility for charity may be determined prior to or upon admission or as soon as possible following treatment. 4.1.4 The patient's individual and family Income will be used to determine eligibility. 4.1.5 Additional considerations will be made such as: (1) employment status, (2) family size, (3) certain living expenses of a reasonable and necessary nature, (4) amount and frequency of hospital and other health care bills, and (5) assets and liabilities. 4.1.6 AN payment resources must first be explored and applies to health care expenses Including third party payers, Medicare, Medi -cal, CaIOPTIMA, MS% and Victims of Crime. 4.1.7 A patient, who can afford to pay for a portion of the services, as determined by a siding scale up to 300% of the current Federal Poverty Guidelines, will be expected to do so. 4.1.8 Ali collection activities will be suspended until eligibility is determined. The patient's account balance will remain open until such time as a charity care status is determined. 4.1.9 Part of an account may be paid by a third party or by the patient and part may qualify for charity care. If the patient does not pay the amount deemed his/her responsibility, and the patient does not meet the charity care requirements, the uncollectible remainder may be considered bad debt. 4.1.10 All charity applications and written supporting documentation will be archived for at least seven (7) years. Original documents wol be destroyed C. RaEgranca• MulUdiacYtil[n�[g„j�bvtew• Review andforinput for this policy was ytven by the roll*Mnp: Admirdsbation• ousim" Services; Appr by F4wxs Committee 07124103 E2HQXQdWfl9tQt. Business Services lis &Io Charity Care PoAty 28 r. • Appendix G COMMU91ty Benefit Activi Descriptions� AlAwd t- Meme- -- _ - -- A T�f- jti a crtgi[nn Gommual Health 3arvrcas - - -- Adult Day Services of OC= Tronsportation Transportation services to an Alzheimer's da care center. Registered Nurses answer telephone questions related to Bab} line maternal and infant health needs. _Better Breathers Support Groups _ — Smoking cessation program. .. Education and counseling in group format fw cancer paitenis Breast Caner Support __ — ^� and their families. Free one-on-one consultation for women with cancer wlto are Brighter Image Program undorofng treatment for their disease. saner Center Community Health Fairs and Outreach ^ — Community education and outreach of cancer center staff. Patient education, referral, and support. Assist uninsured Cancer Center Counseling and Referral and underinsured patients and families to obtain medical and Servioes - -Other ps ologlcal resources. Cancer Center Support Groups -Other Sup art 7—ups or allall canner patients, famly and friends. Celebration of Life Event — Program grant for National cancer survivors day celebration. Bereavement program which provides information on death Comfort Care and Next S of a loved one; and terminal illness. 000rdinates SOS refeanls to hospitat and assists to gommunittCase Management— �- insurance screenir and Coordination. Free bilingual psycho - social counseling services targeted of Community Counseling Services - the underserved. _ Comnivnity -based classes given ai the health centers or — Community Education Classes _ -- hospital on a variety of health topics. ` Community -based classes regarding balance and vestibular Community Lectures problems, offored'lty Phy "sisal Therapy and Rehab Services. Congestive Heart Failure Education Series — Education to CHF patientsffamilies on CHF medications._ Assistance to a community -based cancer support group ' Cordelia Knott Center for Wellness offered in Spanish. Costa Mesa Senior Center - PuR Health Nurse Partnership Fun for a Public Health Nurse of the senior center. Costa Mesa Senior Center - Transportation —ding — trips Transportation services for a senior center. Creative Essians _ Direct Paymerrl't0 PttyslClanS far $Q$ Free art workshops for cancrsr patients and support persons, -'T'� Patients Payment to specialists who provide care for Charity cases. Donated leadership positions at SOS Clinic and Adult Day Employees for Local Gorttmuni Non- oills Services of OC. 70 . • • First Aid Stations Staffing at First Aid Booth at local walk- a•thon. Fitker Imago Program ���� ram Exercise for cancer patients. Flu Clinic Free drive - through communtty_flu clinic. y Freedom From Smoking _^ Six week smoking cessation program. Growlh Through Grief Bereavement Group _ Bereavement support prograM. Parish Nurse program, works in congregations to provide Health Ministries health education and referral, and flu clinics. _ In partnership with local school district to prov' e a school- Hope Healthy Start Clinic based health clinic. Huntington Beach Council on Aging - Transportation tips Transportation services for a senior center. ^_ Irvine Adult Day Services • Transportation trips ices for inter. Transportation services a senor center, Jewish Community _ Transportation Transportation services for a senior center. Life Goes On Beroavement Group _ - _ Bereavement group; a dosedd roup, T Monitoring and equipment rental for a personal emergency Lifeline response system. —- Free community education and support for tung cancer Luria Cancer 5RpRorl Group _ patients and their families. Free ppa#lorlt information and support regerding lymphesema Lmphede_ ma Workshops ry and its treatment. Community education classes regarding Medicare program Medicare 101 changes. A- Free workshops to increase coping skills for cancer patients Meditation for Stress Reduction and their families. partnership with community organizations, annual free skin Melanoma Screerdn�c s ` ��� r cancer screening milled at high-risk populations, Weekly program at 2 sites, provides new mothers with Mother's Fitness Walk ekerclse and mother to rnother support. Natural Sweet Support Group Diabetes educatkmfsuppoort.group� TVewly ENagnosed Breast Cancer Support Fme six -week aducationat'piogtam for women nevuly. Grip diagnosed with breast cancer. Oasis Senior Center - Transportation (trips) Transportation services for a sonlor center. Oasis ac_onlor Center Health_ Screening Communi health screening at a senior center, Gommunity- based cancer prevention, early etection and Oncology Outreach Education_ awareness education program. Pacific Shoreline .Marathon Medical support _ Medical su plies and support durlog the race. Community education and support for Parklnsons pallents Parkinson Cormhuni!y Support Pro rams and their families- _ Community skin cancer prevention and awareness Prc'ect Sun Safe education. Educational program which focuses on beach safety and the Project Wipetxrt �� T T -- prevention of neck and spinal cord injuries at the beach. Free educationand support for prostate cancer patients and Prostate Cancer Support Group Their friends and family. an • • 31 Community -based cancer prevention, early detection and Oncology Outreach Education awareness education rp ogram. _- Pacific Shoreline Marathon Medical support Medical supplies and support during the race. —� — "-- —' Community aducation and support for Parkinson patients Parkinsons Community Support Programs_ and their families. Community skin cancer prevention and awareness Pro ect Sun Safe education. Educational program which focuses on beach safety and the Project Wipeout prevention of neck and spinal cord injuries at the beach. _ _ _ Free education and support for prostate cancer patients and Prostate Cancer Support GroT _— their friends and family. Review medications and counsel patients on theirr coml5lefeµ- medication profiles including compliance, drugfdrug and Pulm_onaty Rehabtilation GrgL — _ — —' dru�/food interactions. Participation in community event for breast cancer education Race for the Cure _ Sleep Week Campaign LL and awareness. inf ep disorders. Public ormation and education about sle Sobriety Speaks —_ _ _ Alcohol oreventioh newsletter. _ Program grant to local chapter of Mo_thers Against Drunk Strides for Change (MADD of OC _ _ TB and bru Screening _ _ —. - -� _ — Driving. —_ — _,_�__ —__ Screening fa volunteers at the YMCA. §ponsorship of community partner attendance at an The Opportunity Center — educational conference. Production of emergency contact cards for community Women's Abuse Cards_ Mealfh Frofesslons Educaflon _ Development of air WriE video for Social Workers and Case Bridges for Newborns Video ManNars. _ — Cal,Stats Long Beach RN to BSN Program FundiN far a professorship in Nursjn .education. MSW internships - Community Medicine — Funding and sup ion for MSIt studerts. — SW v ek clerkship for Phaien% as a component of Pharmacy Student Clinieal.retations their Internet Medicine rotation. Ph sicaE Tfrarapy [nlernships nlern site for piaysicai therapy ed0oationat programs. $ubsidlZe{Ilfnical Sp'ecia! 5ervic�s -� m� -- Provides free telephonic rrronitc nir g of anticoagulant values Anticoa ulant Clinic m iients and their doctors. Emergency Call Panel Reimbursement program — Funding for specialists who treat chaff cases in Hoag ECU. - Cash and In -Kind Confribufions WKIt Day ServicCi of OC - general — Contributions Operational gtants for an Alzheimer's day care program. _ _ _ AIDS Services Foundation n Program sponsorship. __- Alxhelmi Association Grants for care aver support group. 31 0 • American Cancer Society Program development grant for research, education and advocac . American Diabetes Association Funding for Latino diabetes care programs in Orange couptg. — American Heart Association Pr ram rant for the underserved. American Lung Association - Funding for asthma cars education programs. Assistance League of Newport Mesa Program grant for children's dental health center. tiloomingdafes Breast Cancer Awareness Educaib65l development rant. California Kids Pro ramant to provide insurance for uninsured children. Children's Hospital of Orange County OpeT!ing grant. for school —based pediatric clinic. Clothfng Drive —_ _ _ �- In partnership with Working Wardrobe, provides donated clolhinq for a women's shelter_ Community Care Health Center Program development grant for a community health center. Costa Mesa Senior Center Operational grants, including assistance in funding a grant wrltln ex rf. Families Costa.Mosa ��__� Program gnnsorship``�w _ FISH Harbor Area Free and reduced - ce mobfis meals for horn -bound adults. Grant Review Participation for Foundations Employee participation in the grant review process conducted by community health partners, such as United Way, Kornen Foundation, Avon Foundation. His ap nic Bar Association of Orange County HIWAIDS On the Front fne Conferance Scholarship_ _ Sponsorship of an AIRS education conference. Laguna Bea ch Cammunity Clinic Program grants for a Community clinic. Latino Health Access Pro ram grants for a comrnuni healtfr artner. Madras Mifilres' Operational grants. Maternal Outreach Management S stems Program operations grant. Medications Donated to the SOS Medlca Clinic Donations of medications to a free medical/dental clinic, �A�ultip -1 ©_Sclerosis Support Group ^� A monthly MS support group. National Health Foundation Sponsorship of Children's Health Access to Medical Programs (CHAMP), a program to create a virtual network that uses computer technology to connect staff from sehools, (hospitals, etc. _ NCI CARZA Teohrnoaf assistance provided to the Consumer Advocates in Research Related Activitles organizatfn. Newport Community Counseling Center I Program rant for a counseling center _o- Newport Mesa School District Newport Mese Sonnets foundation -- Program grant to a dlildreh's dental health center. ants to teachers program. Oran a Coast College Foundation Scholarships for students In need. �— — - -- _ Oran a Coast Inge afth Shelter Program grants and funding for two outreach workers. _ Orange County Rescue Mission - Program grant for a community rescue mission. Orange County's United Wa — Mat it grant to supplement employee donations. — Donation of Burg cal supplies for an intethatfonal medical Plasficos relief services and aid organization. 32 • • iii] Scholarship for of underserved students to participate in Save Our Youth (5qY) ramp. Second Harvest Food Bank_��� Operate% rant.�'�� - - -- so cone Cares Exrp Kitchen p rating grarri. _ Extensive funding, tncltoding praJram and optnratirig granks� SOS Clinic for a major community health partner. Southern Catdornia Partners p'of -� -^ �- Advocates Pro�ram� rant. Sto �S p�_ -- Program rant. u Equlpmenl Furniture Danation4u _ m Supplies and fumilure donated to SOS tree clinic. Job training program in the construction trades for high nak Taller San Jose oath. Extensive fundfh'g, including program denelopment and Vietnamese Community of Owe County operating grants. WISE Place Program grants for homeless women. nts #or Piogram nt5 a women s emperwerment�roup� Program grants for an organization which helps women secure jobs, Including clothing donations, resume Women Helping Women - - -_- preparation, and interview training YMCA Pr cram and operations grants. o� Youth Em fifoymerrt S_ervicao �_. _ �P- rogram grants. _ — Communi quip- ActfvlL'.as �� American fled Cross Funding for Disaster Services Nursin. ller fes.­ Ct}ncer Center Staff Community Boards and Employeeloyee rm lvemeni in community can .-- related Committees Career Devabpment Training for Coinmunkty organizakions. ' �` —� - _.__._...... _ N >rofits CPR and First Aid classes for community health partners. !_ mu Coalition of OC Comnity Clinics T Program development grants. - Juvenile giabetes Research Four dation^ .� �W —T- Programs rant. — MarCIT Of Mmes , Program grant. Natipna Counail o� Jewish Women'T Orange County Human Relattpns__— ----- •__.._ Commission [5lsease outreach and education to provido'ffrea and tow cost Orange County Ovarian Cancer Coalition mammy rapt' screenings In OC. Donated staff time to a county Wition to prevent G WCCo Oran a County Substance Abuse Coalition and substance abuse. Orange County Tobacco Preuantion Coalition Donated staff time to a coalition to prevent tobapc_o abuse. Police Explorer f�gra_rn _ Newport 9each ' _ CaraMs tp support the Exploreo Saauts program Funding for grant writing experts to assist a community Pr+'ect Cuddle health partner which aids women in crisis. Santa Ana Police Department Running — Team Support Police Officer programs. Sponsorship fpn Non -pro ttrs to attend '" Sponsorship fora community, health artne pr to send staff to conferences an educational conference. The Raise Foundatiori� Pro ram rant for a child abuse_ prevention prpgrarn.'� Trauma Intervention Program Program development. rant for a crisis advocacy programs. iii] HOAG MEMORIAL HOSPITAL PRESBYTERIAN FORM 990, PART IV - RECEIVABLES DUE FROM OFFICERS, ETC. BORROWER: RONALD D ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: PURPOSE OF LOAN: GUZIAX 50,000. 6.000000 03/01/2002 01/01/2009 PRINCIPAL AND INTEREST DUE PROMISSORY NOTE 95- 1643327 IN 84 PAYMENTS BEGINNING BALANCE DUE ...... ............................... 33,180. ENDING BALANCE DUE ......... ............................... 27,512. BORROWER: RICHARD AFABLE, M.D. ORIGINAL AMOUNT: 1,000,000. INTEREST RATE: 5.000000 DATE OF NOTE: 08/19/2005 MATURITY DATE: 08/IB/2015 REPAYMENT TERMS: INTEREST ONLY - DUE IN 10 YEARS SECURITY PROVIDED: NOTE AND 2ND TRUST DEED PURPOSE OF LOAN: PROMISSORY NOTE BEGINNING BALANCE DUE ...... ............................... NONE ENDING BALANCE DUE ......... ............................... 1,000,000. TOTAL BEGINNING RECEIVABLES DUE FROM OFFICERS, ETC. 33,180. TOTAL ENDING RECEIVABLES DUE FROM OFFICERS, ETC. 1,027,512. • 55W3TJ 2020 VO4 -8 60087882 STATEMENT 8 HOAG MEMORIAL HOSPITAL PRESBYTERIAN WORM 990, PART IV - OTHER NOTES AND LOANS RECEIVABLE BORROWER: BARBARA E ORIGINAL AMOUNT: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: PURPOSE OF LOAN: SWARTZ, M.D. 208,103. 01/01/2003 12/31/2005 2 YEAR ADVANCE PERIOD NONE PHYSICIAN RELOCATION BEGINNING BALANCE DUE ...... ............................... ENDING BALANCE DUE ......... .......................:....... BORROWER: NEWPORT IMAGING CENTER, LP ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: PURPOSE OF LOAN: 4,375,000. 6.500000 12/01/2002 11/01/2007 PRINCIPAL DUE IN 60 PAYMENTS ACCOUNTS RECEEVABLE LOAN AGREEMENT BEGINNING BALANCE DUE ...... ............................... ENDING BALANCE DUE ......... ............................... BORROWER: FAMILY CARE CENTER ORIGINAL AMOUNT: 561,896. INTEREST RATE: 6.500000 DATE OF NOTE: 10/01/2000 MATURITY DATE: 04/01/2007 REPAYMENT TERMS: PRINCIPAL + INTEREST DUE IN 79 PAYMENTS SECURITY PROVIDED: ALL ACCOUNTS RECEIVABLE PURPOSE OF LOAN: WORKING CAPITAL 95- 1643327 208,103. 140,147. 3,002,125. 2,144,798. BEGINNING BALANCE DUE ...... ............................... 227,156. ENDING BALANCE DUE ......... ............................... 11,544. C: 55W34'J 2020 VO4 -8 60087882 STATEMENT 9 HOAG MEMORIAL HOSPITAL PRESBYTERIAN / J1 J BORROWER: JOLANTA LUKAWSKI, M.D. ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: PURPOSE Or LOAN: 33,550. 5.750000 01/01/2002 12/01/2007 PRINCIPAL ACCOUNTS LOAN AND 95- 1643327 + INTEREST DUE IN 72 PAYMENTS SECURITY BEGINNING BALANCE DUE ...................................... ENDING BALANCE DUE ......... ............................... BORROWER: PREVENTITIVE HEALTHCARE MEDICAL CENTER ORIGINAL AMOUNT: 83,310. INTEREST RATE: 9.750000 DATE OF NOTE: 05/01/2001 MATURITY DATE: 12/01/2005 REPAYMENT TERMS: PRINCIPAL + INTEREST DUE IN 56 PAYMENTS SECURITY PROVIDED: ACCTS. RECEIVABLE - SALE OF EQUIPMENT PURPOSE OF LOAN: WORKING CAPITAL BEGINNING BALANCE DUE ...... ............................... ENDING BALANCE DUE ......... ............................... BORROWER: MARK NEWMAN, M.D. ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: PURPOSE OF LOAN: 50,000. 10.000000 08/01/2000 07/01/2005 PRINCIPAL + INTEREST DUE IN 60 PAYMENTS ALL CURRENT & FUTURE ACCTS. RECEIVABLE PHYSICIAN RELOCATION BEGINNING BALANCE DUE .... ............................... ENDING BALANCE DUE ....... ............................... 55W3TJ 2020 VO4 -8 60D87882 26,531. 19,097. 29,385. NONE 11,122. NONE STATEMENT 10 HOAG MEMORIAL HOSPITAL PRESBYTERIAN \J BORROWER: ALICE M. ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: PURPOSE OF LOAN: POLICE, M.D. 15,000. 10.500000 09/01/2000 08/01/2005 PRINCIPAL + INTEREST DUE IN ALL CURRENT 5 FUTURE ACCTS. INITIAL CASH FLOW NEEDS 95- 1643327 60 PAYMENTS RECEIVABLE BEGINNING BALANCE DUE ...... ............................... 30,688. ENDING BALANCE DUE ......... ............................... 13,767. BORROWER: ALISO VIEJO FAMILY MEDICINE ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: 24,091. 10.000000 07/01/2001 07/01/2006 PRINCIPAL + NONE - KAREN FU INTEREST DUE IN 60 PAYMENTS PURPOSE OF LOAN: TENANT IMPROVEMENTS BEGINNING BALANCE DUE ...... ............................... 10,676. ENDING BALANCE DUE ......... ............................... 5,360. -- -- --- -- --- - -- BORROWER: MATTHEW CLARK, M.D. ORIGINAL AMOUNT: 199,305. INTEREST RATE: 5.000000 DATE OF NOTE: 08/01/2003 MATURITY DATE: 07/16/2006 REPAYMENT TERMS: 3 YEAR REPAYMENT PERIOD SECURITY PROVIDED: NONE PURPOSE OF LOAN: PHYSICIAN RELOCATION BEGINNING BALANCE DUE ...... ............................... 133,898. ENDING BALANCE DUE ......... ............................... 75,833. 55W3TJ 2020 VO4-8 60087882 STATEMENT 11 HOAG MEMORIAL HOSPITAL PRESBYTERIAN J BORROWER: DON /MARIONETTE OLIVER ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: PURPOSE OF LOAN: 397,821. 5.000000 09/01/2003 08/01/2018 PRINCIPAL + INTEREST DUE DEED OF TRUST PROMISSORY NOTE 95-1643327 IN 180 PAYMENTS BEGINNING BALANCE DUE ...... ............................... 390,917. ENDING BALANCE DUE ......... ............................... 382,156. BORROWER: JOLANTA LUKAWSKI, M.D. ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: PURPOSE OF LOAN: 105,467. 5.000000 08/01/2003 07/31/2005 2 YEAR ADVANCE PERIOD NONE PHYSICIAN RELOCATION BEGINNING BALANCE DUE ...... ............................... 33,199. ENDING BALANCE DUE ......... ............................... NONE BORROWER: LAWSON MCCLUNG, M.D. ORIGINAL AMOUNT: 28,594. INTEREST RATE: 8.000000 DATE OF NOTE: 08/01/2001 MATURITY DATE: 12/01/2008 REPAYMENT TERMS: PRINCIPAL + INTEREST DUE IN 89 PAYMENTS SECURITY PROVIDED: ACCOUNTS RECEIVABLE PURPOSE OF LOAN: TENANT IMPROVEMENTS BEGINNING BALANCE DUE ...... ............................... 18,712. ENDING BALANCE DUE ......... ............................... 14,949. 55W3TJ 2020 VO4 -8 60087882 STATEMENT 12 HOAG MEMORIAL HOSPITAL r -I BORROWER: URGIKI ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: PURPOSE OF LOAN: 95- 1643327 DS, INC. 50,000. 11.000000 10/01/2005 09/01/2008 INT. ONLY FIRST 12 MO., THEN PRIN. + TNT LOAN AND SECURITY BEGINNING BALANCE DUE ...... ............................... ENDING BALANCE DUE ......... ............................... BORROWER: NEWPORT NEUROHOSPITALIST ORIGINAL AMOUNT: 25,000. INTEREST RATE: 7.750000 DATE OF NOTE: 04/01/2005 MATURITY DATE: 04/01/2008 REPAYMENT TERMS: PRINCIPAL + INTEREST DUE IN 24 PAYMENTS SECURITY PROVIDED: ACCOUNTS RECEIVABLE PURPOSE OF LOAN: LOAN AND SECURITY IN 2 YRS NONE 50,000. BEGINNING BALANCE DUE ...... ............................... NONE ENDING BALANCE DUE ......... ............................... 25,000. TOTAL BEGINNING OTHER NOTES AND LOANS RECEIVABLE 4,122,512. TOTAL ENDING OTHER NOTES AND LOANS RECEIVABLES 2,882,651. 55W3TJ 2020 VO4 -8 60087882 STATEMENT 13 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 990, PART IV - INVESTMENTS - SECURITIES DESCRIPTION EQUITY ACCOUNT (BRD DSG) PAC. INVEST. (BRD DSG) FIDUCUARY TRUST ACCOUNT PZENA ACCOUNT BOND PROCEEDS NET UNREALIZED GAINS RESTRICTED FUND INVESTMENTS FUNDING FOR CONTINGENT CLAIMS HEALTH & DENTAL DEPOSITS TCW GALILEO INVESTMENT ACCOUNT CAP GUARD GLOBAL ACCOUNT ALLEG CAPITAL ACCOUNT LOED, ABBERT & CO ACCOUNT BISYS GMO MULTISTRATEGY ACCT BISYS GMO BENCHMARK ACCT BLACKSTONE -BPIF ACCOUNT MERRILL LYNCH ACCOUNT PARADIGM ACCOUNT • TOTALS BEGINNING BOOK VALUE 37,853. 141,538,902. 11,966,982. 22,470,083. 4,848. 28,499,224. 314,997. 16,039,656. 4,579,924. 33,766,286. 72,886,844. 109,985,682. 113,471,804. 9,133,589. 36,005,898. 49,809,029. 50,001,741. NONE 700,513,342. 55W3TJ 2020 VO4 -8 60087882 95- 1643327 ENDING BOOK VALUE NONE 147,472,374. 12,540,719. 24,612,4DZ. 93,756,442. 53,026,466. 306,984. 16,857,252. 1,414,042. 38,939,161. 80,849,402. 114,503,162. 118,991,338. 9,907,368. 38,831,370. 53,772,107. 52,562,433. 51,598,388. 909,941,410. STATEMENT 14 HOAG MEL40RIAL HOSPITAL PRESBYTERIAN 990, PART IV - INVESTMENTS - OTHER DESCRIPTION INVESTMENT INVESTMENT INVESTMENT INVESTMENT INVESTMENT INVESTMENT INVESTMENT VHA CPPG NEWPORT CNTR IMAG HOAG PAAC. MGMT OSCOC LLC OSCOC LP ASC DEV L'LC TOTALS BEGINNING BOOK VALUE 60,000. 250,000. 4,197,783. 10,400,000. 429,961, 4,250. NONE 15,341,994, 55W3T.7 2020 VO4 -8 60087882 95- 1643327 ENDING BOOK VALUE 60,000. 250,000, 5,771,349. 10,400,000. 429,961, 4,250. 100,000. 17,015,560. STATEMENT 15 HOAGY MEMORIAL HOSPITAL PRESBYTERIAN RM 990, PART IV - OTHER ASSETS DESCRIPTION INTEREST RECEIVABLE OTHER RECEIVABLES CRISPIN LIFE ESTATE UNAMORTIZED BOND ISSUE COSTS DEPOSITS LT LEASE RECEIVABLE DUE FROM SUS & RELATED ENTITY CONSTRUCTION IN PROGRESS DUE FROM FOUNDATION • TOTALS BEGINNING BOOK VALUE 1,706,286. 2,101,991. 4,500,000. 1,299,221. 1,417,907. 54,420. 1,915,127. 139,617,867. 1,710,020. 154,322,839. 55W3TJ 2020 VO4 -8 60087882 95- 1643327 ENDING BOOK VALUE 1,644,071. 2,209,566. 4,500,000. 4,873,659. 1,301,877. NONE 1,304,133. 192,145,040. 1,125,905. 209,104,251. STATEMENT 16 HOAG MEMORIAL HOSPITAL PRESBYTERIAN FORM 990, PART IV - TAX- EXEMPT BOND LIABILITIES 95- 1643327 • 55W3TJ 2020 VO4 -8 60087882 STATEMENT 17 BEGINNING ENDING DESCRIPTION BOOK VALUE BOOK VALUE 1992 BOND 91,000,000. 91,000,000. UNEXPENDED PROCEEDS: NONE ISSUE DATE: OCTOBER 1992 ORIGINAL AMOUNT: $91,000,000 PURPOSE: CAPITAL EXPANSION 1996 BOND 100,000,000. 100,000,000. UNEXPENDED PROCEEDS: NONE ISSUE DATE: DECEMBER 1996 ORIGINAL AMOUNT: $100,000,000 PURPOSE: CAPITAL EXPANSION 1999 BOND 125,000,000. 125,000,000. UNEXPENDED PROCEEDS: NONE ISSUE DATE: DECEMBER 1999 ORIGINAL AMOUNT: $125,000,000 PURPOSE: CAPTTAL EXPANSION 2005 BOND NONE 200,000,000. UNEXPENDED PROCEEDS: 93,751,230 ISSUE DATE: AUGUST 2005 ORIGINAL AMOUNT: $200,000,000 PURPOSE: CAPITAL EXPANSION TOTALS ^ 316,000,000. - - 516,000,000 • 55W3TJ 2020 VO4 -8 60087882 STATEMENT 17 HOAG MEMORIAL HOSPITAL PRESBYTERIAN FORM 990, PART IV - MORTGAGES AND OTHER NOTES PAYABLE LENDER: MR. & MR$ ORIGINAL AMOUNT: INTEREST RATE: DATE OF NOTE: MATURITY DATE: REPAYMENT TERMS: SECURITY PROVIDED: PURPOSE OF LOAN: THAYER S. CRISPIN 800,000. 7.000000 06/30/1996 06/01/2009 PRINCIPAL + INTEREST DUE TRUST DEED /ASSIGN RENTS PAYMENT OF MORTGAGE 95- 1643327 IN 180 PAYMENTS BEGINNING BALANCE DUE ...... ............................... 342,678. ENDING BALANCE DUE ......... ............................... 278,340. --------------- TOTAL BEGINNING MORTGAGES AND OTHER NOTES PAYABLE 342,678. TOTAL ENDING MORTGAGES AND OTHER NOTES PAYABLE 278,340. • SSW3T,7 2020 VO4- -8 60087882 STATEMENT 18 L HOAG MEMORIAL HOSPITAL PRESBYTERIAN FORM 990, PART IV - OTHER LIABILITIES DESCRIPTION ACCRUED MALPRACTICE LIABILITY DUE TO GOVERNMENT AGENCIES INSTITUITIONAL CLAIMS PAYABLE ACCRUED ARBITRATION OTHER LIABILITIES DUE TO FOUNDATION TOTALS BEGINNING BOOR VALUE 13,140,000. 759,274. 13,714,935, 7,987,334. 4,575,825. 359,333. 40,536,701. 55W3T,l 2020 VO4 -8 60087882 95-1643327 ENDING BOOK VALUE 14,649,782. 777,612. 13,755,034. NONE 1,034,890. 328,833. 30,546,151, STATEMENT 19 HOAC MEMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 ]FORM 990, PART IV -A - OTHER REVENUE ON HOOKS BUT NOT ON RETURN DESCRIPTION AMOUNT RECLASS OF RENTAL EXPENSES C7 TOTAL 55W3TJ 2020 VO4 -8 60087882 1,977,854. 1,977,854. HOAG MEMORIAL HOSPITAL 990, PART IV-A. - OTHER REVENUE ON RETURN BUT NOT ON BOOKS DESCRIPTION RESTRICTED CONTRIBUTIONS FROM HOAG HOSPITAL FOUNDATION BOOR /TAX DIFFERENCE IN PARTNERSHIP INCOME RECLASS OF NON - OPERATING EXP. • TOTAL 55W3TJ 2020 VO4 -8 60087882 95- 1643327 AMOUNT 9,106,782. 837,718. 901,925. 10,846,425. STATEMENT 21 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 ,FORM 990, PART IV -B - OTHER EXPENSES ON BOOKS BUT NOT ON RETURN DESCRIPTION RECLASS OF RENTAL EXPENSES TOTAL 55W3TJ 2020 VO4 -8 60087882 AMOUNT 1,977,854. µ1,977,854. STATEMENT 22 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 990, PART TV -B - OTHER EXPENSES ON RETURN BUT NOT ON BOOKS DESCRIPTION RECLASS OF NON - OPERATING EXP. • TOTAL 55W3TJ 2020 VO4 -8 60087882 95- 1643327 AMOUNT 901,925. --------------- STATEMENT 23 HOAG MEW HOSPITAL PRESBYTERIAN 95- 1643327 . FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES 55w'3TJ 2020 VO4 -8 60087882 STATEMENT 24 CONTRIBUTIONS EXPENSE ACCT TITLE AND TIME TO EMPLOYEE AND O'T'HER NAME AND ADDRESS DEVOTED TO POSITION COMPENSATION BENEFIT PLANS ALLOWANCES MICHAEL D. STEPHENS PRESIDENT & CEO 433,174. 17,605• T NONE ONE HOAG DRIVE, BOX 6100 40-50 /WEEK NEWPORT BEACH, CA 92658 -6100 (UNTIL 08/15/2005) t PETER M. FOULKE EXNCUTIVE VICE PRES. 466,653. 15,787. NONE ONE HOAG DRIVE, BOX 6100 40 -50 /WEEK NEWPORT BEACH, CA 92658 -6100 RICHARD M. ORTWEIN CHAIRMAN NONE NONE NONE ONE HOAG DRIVE, BOX 6100 5 -20 1MONTH NEWPORT BEACH, CA 92658 -6100 ROBERT W. EVANS VICE CHAIRMAN NONE 9,862. NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 MAX W. HAMPTON SECRETARY NONE NONE NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 JOHN L. BENNER TREASURER NONE 9,996. NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 HANK S. ADLER BOARD MEMBER NONE NONE NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 DICK P. ALLEN BOARD MEMBER NONE 10,567, NONE ON HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 55w'3TJ 2020 VO4 -8 60087882 STATEMENT 24 HOAG NEW HOSPITAL PRESBYTERIAN 95- 1643327 • FORM 990, PART V -- LIST OF OFFICERS, DIRECTORS, AND TRUSTEES CONTRIBUTIONS EXPENSE ACCT TITLE AND TIME TO EMPLOYEE AND OTHER NAME AND ADDRESS DEVOTED TO POSITION COMPENSATION BENEFIT PLANS ALLOWANCES KEVIN K. BARNETT, M.D. BOARD MEMBER NONE NONE NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 JAMES J. BERMAN, M.D. BOARD MEMBER NONE NONE NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 JOHN L. CURCI BOARD MEMBER NONE 10,567. NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 JAKE EASTON III BOARD MEMBER NONE 13,322. NONE ONE HOAG DRIVE, BOX 6100 2-10 /MONTH NEWPORT BEACH, CA 92658 -6100 L. GEORGE ELIAS BOARD MEMBER NONE 3,253. NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92558 -6100 JOANNE D. FIX BOARD MEMBER NONE 10,567. NONE ONE HOAG DRIVE, BOX 6100 2 -10 1MONTH NEWPORT BEACH, CA 92658 -6100 STEPHENS JONES BOARD MEMBER NONE NONE NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH 'NEWPORT BEACH, CA 92658 -6100 CAROL MENTOR MCDERMOTT BOARD MEMBER NONE 5,610. NONE ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 55W3TJ 2020 VO4 -8 60087882 STATEMENT 25 HOAG ME HOSPITAL PRESBYTERIAN FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES TITLE AND TIME NAME AND ADDRESS DEVOTED TO POSITION RONALD L. MERRIMAN BOARD MEMBER ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 MELINDA HOAG SMITH BOARD MEMBER ONE HOAG DRIVE, BOX 6100 2 -10 /14ONTH NEWPORT BEACH, CA 92658 -6100 RICHARD M. TAKETA, M.D. BOARD MEMBER ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 GINNY UBERROTH BOARD MEMBER ONE HOAG DRIVE, BOX 6100 2 -10 /MONTH NEWPORT BEACH, CA 92658 -6100 RICHARD AFABLE PRESIDENT S CEO ONE HOAG DRIVE, BOX 6100 40 -50 /WEER NEWPORT BEACH, CA 92658 -6100 (AFTER 08/15/2005) GRAND TOTALS 95- 1643327 COMPENSATION NONE �tu*R s NONE NONE 128,359. CONTRIBUTIONS TO EMPLOYEE BENEFIT PLANS 9,862. 9,711. 13,322. NONE 117. - - -- - -- 1,028,186 140,148. • EXPENSE ACCT AND OTHER ALLOWANCES NONE E.nozv�J NONE NONE Qo31t? 55TR3TJ 2020 VO4 -8 60087882 STATEMENT 26 NONE • u Hoag Memorial Hospital Presbyterian FEIN: 95-](A3327 Form 990, Part V — List of Officers, Directors, and 'frl[Stecs a The following benefits are inchrdcd in the contributions to employee benefit plans and dcibrred compensation of the officers lis4ed on the preceding pages: * Retirement Plan The Organization has a sheltered savings plan in which substantially all full-time employees who meet certain criteria, as defined, are eligible. 'I'lre plan provides for an automatic annual contribution by the Organization of 2.5% to 6.0% of gross wages based on years of service of eligible employees and a matching contribution by the Organization of 50% (up to 5% of gross wages) of eligible employee contributions. Total expense :for the plan was $8,032,000 in 2005 and $6,$14,000 in 2004. It is the Organization's policy to make contributions to the plan dual to the amounts accrued as expense. * health and Welfare Benerits The Organization maintains self - insured medical, unemployment and workers' compensation coverage for all active, regularly scheduled, full -time and part -time employees. The cost of such benefit plans is accrued for in the period services are rendered_ Accruals for unpaid claims are based on estimated settlements for reported claims and on experience -based estimates for unreported claims. CIaims are paid as received. ** In addition to the above referenced salary of $433,174, Mr. Stephens received a vested retirement amount of $4,275,665 which represents a retirement benefit under a section 4570 deferred compensation plan in which Mr. Stephens vested as of May 1, 2005. The amount has been earned over a 12 year period, accruing on an average basis of approximately $356,300 per year. Mr. Stephens received a distribution of this entire amount upon his retirement in August 2005. Prior year accruals have been disclosed on prior year Form 990's in Column D as contributions to employee benefit plans. HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 • FORM 990, PART VI - NAMES OF RELATED ORGANIZATIONS HOAG HOSPITAL FOUNDATION - EXEMPT COASTAL PHYSICIAN PURCHASING GROUP -- NON - EXEMPT HOAG PRACTICE MANAGEMENT, INC. - NON- EXEMPT ORTHOPEDIC SURGERY CENTER OF OC, LLC - VON-EXEMPT ORTHOPEDIC SURGERY CENTER OF OC, LP - NON - EXEMPT NEWPORT IMAGING CENTER - NON - EXEMPT C J SSW3T,7 2020 VO4 -8 50087882 STATEMENT 27 HOAG MEW HOSPITAL PRESBYTERIAN 95- 1643327 • FORM 990, PART VII - PROGRAM SERVICE REVENUE DESCRIPTION BUSINESS EXCLUSION RELATED OR EXEMPT CODE AMOUNT CODE AMOUNT FUNCTION INCOME PATIENT SERVICES 621500 1,597,833. CONTRACTUAL ALLOW 621500 - 1,054,570. 1096987844. CHARITY CARE - 670545247. CA21TATED PAYMENTS - 6,471,192. RENTAL INCOME FROM 73,760,572. HOSPITAL HEALTH CENTERS 3,250,866. TOTALS - --- -------- - ----- - - ---- 543,263. -- ---- -- - - -- 496,982,843. io.-- �.�cna�s =asc�a —cam ��ea =�caa 55W3TJ 2020 VO4 -8 60087882 STATEMENT 28 HOAG MEAL HOSPITAL PRESBYTERIAN 95- 1643327 FOAM 990, PART VII - OTHER REVENUE DESCRIPTION BUSINESS CODE EXCLUSION RELATED OR EXEMPT AMOUNT CODE AMOUNT FUNCTION INCOME CAFETERIA SALES 03 2,328,982. CHILD CARE PROGRAM PURCHASE DISCOUNTS 600,376. EX? REIMBURS FROM 202,467. HOAG HOSP FOUNDATION MISCELLANEOUS 2,991,606. 16 1,772,249. LIDO PHARMACY 446110 2,399,113. VENDING MACHINES 03 22,235. MEDICAL RECORDS EDUCATION PROGRAMS 29,208. PHYSICIAN BILLING 561000 12,239,624. 435,056. MANAGEMENT FEES 561000 178,548. EXP REIMBURSE FROM RELATED ENTITY 2,368,746. TOTALS ----- __ -- --- 14,817,285. -'--- - - - - - -- 4,123,466. --- - --- -- --- 6,627,459. • 55W3TJ 2020 VO4 -8 60087882 STATEMENT 29 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 0 FORM 990, PART VIII - ACCOMPLISHMENT OF EXEMPT PURPOSES EXPLANATION OF HOW EACH ACTIVITY FOR WHICH INCOME LINE IS REPORTED IN COLUMN (E) OF PART VII CONTRIBUTED NO. IMPORTANTLY TO THE ACCOMPLISHMENT OF EXEMPT PURPOSES 95°-1643327 93 VARIOUS FEES FOR INPATIENT AND OUTPATIENT SERVICES RENDERED IN CONJUNCTION WITH THE PROVISIONS OF HEALTH CARE. 103 MISCELLANEOUS INCOME GENERATED FROM VARIOUS ANCILLARY SERVICES PROVIDED IN CONNECTION WITH THE RENDERING OF HEALTH CARE SERVICES. 55W3TZI 2020 VO4 -8 60087882 STATEMMT 3D HOAG *JAL HOSPITAL PRESBYTERIAN 95- 1643327 FORM 990, PART IX - INFORMATION REGARDING TAXABLE SUBSIDIARIES PERCENTAGE NATURE OF NAME AND ADDRESS OWNERSHIP BUSINESS TOTAL EMPLOYER - IDENTIFICATION NUMBER INTEREST ACTIVITIES INCOME -- _ -__-- ------ NEWPORT IMAGING CENTER 75.000000 360 SAN MIGUEL, STE .105 NEWPORT BEACH, CA 92660 33- 0191776 HOAG PRACTICE MANAGEMENT 100.000000 3101 PACIFIC COAST HWY,STE 300 NEWPORT BEACH, CA 92663 33- 0731587 COASTAL PHYSICIANS PURCH GROUP 100.000000 ONE HOAG DRIVE, BOX 6100 NEWPORT BEACH, CA 92658 -6100 33- 0676831 OSCOC, LLC 50.000000 351 HOSPITAL ROAD, STE 100 NEWPORT BEACH, CA 92663 33- 0804327 OSCOC, LP 0.500000 351 HOSPITAL ROAD, STE 100 NEWPORT BEACH, CA 92663 33- 0841806 TOTAL INCOME IMAGING CTR PRACTICE MGMT PURCH. CO -OP HOLDING CO SURGERY CTR 55W3TJ 2020 VO4 -8 60087882 13,841,062 12,723,082 190,755 2,354,533 18,434,659 - 47,544,091 u ENDING ASSETS 13,071,225. 6,450,585. 215,709. 2,257,834. 2,383,523. ^24,378,876 STATEMENT 31 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95-°1643327 • SCHEDULE A, PART III - EXPLANATION FOR LINE 2B DR. TAKETA, BOARD MEMBER, IS AFFILIATED WITH NEWPORT IMAGING CENTER LP. NEWPORT IMAGING CENTER LP HAS AN OUTSTANDING LOAN WITH HOAG MEMORIAL HOSPITAL PRESBYTERIAN AT FYE 08/31/2005, 55W3T3 2020 VO4 -8 60087882 STATEMENT 32 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 0 SCHEDULE A, PART III - EXPLANATION FOR LINE 2C RELATED PARTY NEWPORT HARBOR RADIOLOGY DESCRIPTION AMOUNT 95- 1643327 RADIOLOGY SERVICES $ 2,900 DR. JAMES L. BERMAN, A NON - COMPENSATED MEMBER OF THE BOARD OF DIRECTOR IS A PRACTICING PHYSICIAN AT HOAG PRACTICE MANAGEMENT, INC., A RELATED TAXABLE ENTITY. • 55W37J 2020 VO4 -8 60087882 STATEMENT 33 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1693327 SCHEDULE A, PART VI -B - GRANTS TO OTHER ORGANIZATIONS HOAG MEMORIAL HOSPITAL PRESBYTERIAN (HMHP) PAYS DUES TO THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA. A PORTION OF THE DUES PAID BY HMH ARE SPENT ON LOBBYING EFFORTS BY THE HOSPITAL ASSOCIATION. IN FY2005 $16,693.WAS SPENT ON LOBBYING. • 55W3TJ 2020 VO4 -8 60087882 STATEMENT 39 Form 950° 1 itlnpaomomm 7rsasury V Inlam smm st Rgu 6mtiae _ A Check bmcN address changed O Exempt under ser.0on x SOI(C x_ 3) F 400(e) ijL J�III220(a) r 408A 530(a) T C Oink vane of all mseis At and of year F 16457'78810. G Exempt Organization Business Income Tax Return oMft No 1$45.06 (and proxy tax under section 6O33(e)) �®� calendar y0ar 2004 of Other be, year beginning _A9.[ ;.j ZgC4_.__, and ending u 0. see separate instructions. 2@04 —TName of wgenizat;n ( Check box If name changed and sex innniclions) D Empioyw iUenlifkaUOn number CL Number. aimed. and room arsude w. pfa P.O. box see page City or town, stale. and instructions for Block F an (C•mproyor< boll eqn nsmwibm to Woo, D an Page 7.1 E Now unrelated boo. activity code tare Instr scow" N ends E on page 7.) 623.500 900003 N Describe the or arnfzalion's,primar ry ,axelale0 business oclrv8ur _,_ SEE STATEMENT 1 _ _ ff__ I During the tax year, was the corporation a subsidiary in an affiliated group Ora parend-SUbsichary o0latrolled group ?, , ► 1 Yes rNo It "Yes." enter the name and Identifying number of the parent corporation. ► J The honks are in careW ► .YR_IVTi7a'FtR MTT91aL.Q VD n.n Unrelated Trade or Business Income — — F __ _ _ J� exanses (c) Not b t,:ss roans enr enosmnces _I 454570 c Balance ► 1 1 c 2 FLAInGD1110 _ 791028_' 16 Repairs and maintenance . ...... ............................... .... 2 Cost of goods sold (Schedule A, One 7), . . .. . . .. . . 3 17 Bed delis _— _ ----- 3 Gross profil(sultract line 26an line lc), • • • . • • • 3 3 0 0 , ,. 19 4 a Capita} gain net income (attach Schedule D) ...... 4 40 _ _ 21 Depreciation (attach Form 4562), , , , , , , , , , , , , , , , • , • • 22 Less depredation claimed on SChedude Aand elssvanere on f0tum 226 .__ _ —_- 506.,731.,_ 23 Depletion , . . .. 24 Contributions to denuded compensation plans . . . .. . . . . . . . .. . . .. . . . 24 25 Employee beoeftf programs , . . . . .. 28~ ..26 — ___...__......__._._ — ...— 26 Excess exempt expenses (Schedule I) ........ .. . ..................... .... .� --- -- 27 Excess readership costs (SChodule J) ... ............................... .. 27 29 Other deductions (attach schedule) • • • . • • • • . $EF STA1'F'.,MENT •2, , , 28 - - 299,, Total deductions (add tines 14 through 28) . . . . . .. . . . . . . . .. , . . . . . , . . . 2g ._•, 1'7 OL 322_,_ Unrelated business taxable income tmfcxe not cryofating loss deduction (sublmG Ilne 28 hen lino 13) 30 - -3,29.1,209. ,.--- - Net operating loss deduction 31 10,.853,.765:_ Unrelated Lushness taxable income heforo specific deduution(subtract line 31 front line 30), .. 33 Specific derhretion (Generally 81,000, but s0e line 33 Instructions for exceptions) , , , , , , . . . . . . .. . _32 33 ._ —.. _ _ - - -- •- 14,144974,... 1 1000, __......_._- ,....__ _ 34 Unrelated business taxable income (subtract line 33 form line 32). if line 33 Is dnlakv glan line 32. enter the smaller of zero or line 32� 75^ For Pdvary Act and Paperwork Reduction ArlNaUra, iqq instrnrUOna y---- ��'�•— - - - -�`.. 4rts10 2.ow 55W3T,7 2020 VO4 -8 60087882 34 NOt4L2 E room 990 -T (7004) Deductions Not Taken Elsewhere (See page 9 of the instructions for limitations on deductions.) _ (Except for coritrlbulions, deductions must be directly connected with the_u_n!elated business income - -" 14 compensation of officers, cbre:tors, and trustees (Schedule K) 14 15 Salarlas andwages ..... ......... ... .. ... ........................ 15, 791028_' 16 Repairs and maintenance . ...... ............................... .... i6 17 Bed delis _— _ ----- IS Interest (attach schedule) . . .. . .. .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. 18 19 taxes and ikenses . . . . . . . . . . . . . . ... .. . 19 20 Charitable contributions (see page 11 of the instructions for limitation rules), , , , , , , , , , , • • • 20 — - -- 21 Depreciation (attach Form 4562), , , , , , , , , , , , , , , , • , • • 22 Less depredation claimed on SChedude Aand elssvanere on f0tum 226 .__ 22b —_- 506.,731.,_ 23 Depletion , . . .. 24 Contributions to denuded compensation plans . . . .. . . . . . . . .. . . .. . . . 24 25 Employee beoeftf programs , . . . . .. 28~ ..26 — ___...__......__._._ — ...— 26 Excess exempt expenses (Schedule I) ........ .. . ..................... .... .� --- -- 27 Excess readership costs (SChodule J) ... ............................... .. 27 29 Other deductions (attach schedule) • • • . • • • • . $EF STA1'F'.,MENT •2, , , 28 - - 299,, Total deductions (add tines 14 through 28) . . . . . .. . . . . . . . .. , . . . . . , . . . 2g ._•, 1'7 OL 322_,_ Unrelated business taxable income tmfcxe not cryofating loss deduction (sublmG Ilne 28 hen lino 13) 30 - -3,29.1,209. ,.--- - Net operating loss deduction 31 10,.853,.765:_ Unrelated Lushness taxable income heforo specific deduution(subtract line 31 front line 30), .. 33 Specific derhretion (Generally 81,000, but s0e line 33 Instructions for exceptions) , , , , , , . . . . . . .. . _32 33 ._ —.. _ _ - - -- •- 14,144974,... 1 1000, __......_._- ,....__ _ 34 Unrelated business taxable income (subtract line 33 form line 32). if line 33 Is dnlakv glan line 32. enter the smaller of zero or line 32� 75^ For Pdvary Act and Paperwork Reduction ArlNaUra, iqq instrnrUOna y---- ��'�•— - - - -�`.. 4rts10 2.ow 55W3T,7 2020 VO4 -8 60087882 34 NOt4L2 E room 990 -T (7004) ...... 9901 95- 1 64 322_7 PPaa 2 _;mptitaticin 35 Organizations Taxable as Corporations (see instructions for tax cam U colon an page 12). Controlled group members (sections 1501 and 1563) • Check I Sea instructions and a Enter your share Of the $50.000, $25.000. and $9.925.000 taxable Income brackets (In that order): b Enter organizations share of; (1) additional 0% tax (not More than $11.750) . . . . . . . f2) additional 3% tax (not more than $100,0.10) . . . . . . . . E c income I8K on the amount on line 34 . . . . . . . . . . . . . . . i3.;.w.T, �3 . . . . . . . . . . . . . . . . ,)r 36 Trusts Taxable at Trust Rates * (see instructions for lax computation on page 13)_ Income tax On the amount on line 34 from: El Tax rate schedule or E]Sahadule D (Form 1041) . . . . . . . . . . . 37 Proxy tax (SPO page 13 of the instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . li* 39 Alternative minimum tax . . . . . . . . . . . . . . . . 39 Total (add lines 37 and 36 to line 35c or 36, whichever applies) . . • . . . . . . . . . . . . . . . • ..... . . . . 36 NON to= Tax and PayMentS 40a Foreign tax Credit (corporations attach Fogin 1118: trusts attach Form 1116) don b Othef credits (see page 14 of the instructions) . . . . . . . . . . . . . . . 40b a General business credit • Check here and Indicate which forms are attached: El Farm 3800 Form(s) (,p,61y) jl. 40, �. d Credit fix prior year minimum tax (attach Form 860I or 8827) . . . . . . . . . . . 40d a Total credits (add lines 40a through 40d) . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . 400 41 Subtract line 40e from line 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 0 42 Other taxes Check 0 rawn: [__] FoMI 42.56 E-1 Farm, 0511 FA Form 8697 El Form 0866 E] Other (affach schedule), 42 43 Total tax (add lines 41 and 42) . .. . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . CnUE 44a Payments: A 2003 overpayment credited to 2.004 . . . . . . . . . . . . . . . . . . b 2004 estimated tax payments . . . . . . . . . . . . . . . . . . .. . . .. . . . c Tax deposited with Form 8868 .. . . .. . . . . .. . . . . . .. . .. . . . . . .. . ..... it Foreign organizations - Tax paid of withhold at source (see Instructions), . . . . . . . 44d __ „_- o Backup wjV)holLfirig (see instructions) . . ..... . . . . . . . . . . . . . . . . . . 448 t Otbor Credits and payments: — Farm 2439 DIForm 4135 El Other.----- Total Y 441 45 Total payments (Add lines 44a through 440 . . . . . . . . . . 46 Estimated tax penalty (see page 4 of the Instructions). Check Y 0 if F*or*m* 2*22*0*1s allolled* . . . . . . . . . 46 47 Tax due • If line 45 is less than the total of Fines 43 and 46, enter uncruirl Owed . . . . . .. . .. . . . . . . ► 47 NONE 48 Overpayment - If line 45 is larger than this lolu Of lines 43 and 46, enter amount oveTpald . . . . . . . . . . . . P 48 NOW 49 Enter 1110 amount of line 48 You want: Credited to 2005 estimated tax ► Refunded Y 49 IWANT• jiULLY&_ zstatementis xegaraing LerEajn ACT.IVIIIeS ana uxner intronnation (,iee instructions on page lb•) i At a” time during the 2004 calendar Year. did the Organization have an Interest in a a Signature Or Other indlicay Yes No over a financial Recount in ai0reiQn Country (Such ......... X If 'Yes." the organization may have to file Form TO F 90 -22.1. If Yes.' enter the name of Ore foreign courilly here 2 During the lax year. did the organization receive a distribution from. or was it 0)e grantor Of. or transferulo. afmoign trust? . . . . . . X It "Yes,' seepage 15 of file Instructions for other forms lire organization may have foliflo- - 3 Enter [tie amount of tax-exempt interest receives) or Recited during the lax year Ii. qrlhpili ilp A - rnqt of Goods S f) Id -Enter mpth riel of toventary valt tatinn 0- I inventory at beginning of year 1 6 inventory at erW of year 2 Purchases . . . . . . . . . . . 2- 7 Cost of goods sold. Subtract ljjre* 3 Cost of Ittior . . . . . . . . . . . 3 6 from line 5. (Enter here and on 4 a Additional section 203A costs line 2. Put I,) . . . . . L (attach schedule) . . . . . . . 4a 8 Do Ithe rules of section 263A (Whh respect 10 • Ho b Other Owls (attach schedule) . 4b property Produced or acquired for resets) apply 7. 6 to the orgarliZaticil? . . . . . . . . . . . . . . . . . . . . Total - Add lines I through 4h 5 X UMJV WIOU1.1;." dodae UsW I h� mirMM Iris relmn. Indwaho �rvxinyhq Wwwkses and undemaii. Wel to 11M bb6t 44 my knew o" � be", are 4w, Sign I. b.. C4 Mmot I~ man [Wyon k be M W bdbo"-bem of w Ich Prrvw ho"I k.1vM_*A% I& 4W h RS discuss lhis return with Here ---------- op '&r sh�." bolowlsw "'Im"W PW 7.19—.-Mule d Ataff Delta Tills Yes F No hItImcilor PrepaWs T 11.1k, Prepime's S&N a PTIN Chock If p1toRZ1415 arer's L 1 Tim's nwo (or eed%nly ;Z1. R sc&em�*ym). _.A_)L01WG. LIN FIN �;j h t! AVENUE„. SUIT rttStiorm. 949.724 2300 mono 2.000 IRVINE:, CA 92612 - •].00.7 FOM,990-T (2004) 5sw3TJ 2020 VO4-13 60081882 95- 1643327 For_ m -990 -T (2004: _ page Schedule C - Rest income (From Real Property and Personal Property Leased With Real Properly (See instructions on page 16.) 1 Descripllon of property N/A [4) -' —` -- — _- 2 ..Rent received OF acuue_d 3 Deduction s directly connected with the intone In columns 2(a) and 2(b) Iahuh schedule) (a) From Prl&Mal Properly (g me percanlago strait _ for Personal propudy is mum than ID%bill net more than 50 %) (b) From real slid personal property If the ry Peleemaoe of rent torptusonsl Property a¢caeds 50% or II the rant is based on profit orIncome) z Gross became crown a -- debt - financed Pmpeny 1 Dawil ton M dw- imancal Property (2) - - (a) slmigh l line UOpraciafrors - �. (b) oaserdedeoaons Organiration identification Number laaach schedule) (otlach schedule) Included in the controlling connected with income Total I Total Total deduction&.. catu hens and on Vine S. column (8), Part 1. page 1 . ► Total income (Add lolals of c0lurnal9 2(a) and 2(b). Enter ( here and en line 8, column (A), Part 1, paOe 1.) . ► Srhedule E -Unrelated Debt- Flnanced Income ISee instructions on Dade 17.1 N/A Schedule F - Interest Annuities. Rovaltles. and Rents From Controlled Omanizations (See instructions on Daae IS 1 Name of Cenho llerl 2 Lmployer J Dednmiann directly a Pnoded wire a atbraWe in —.. z Gross became crown a -- debt - financed Pmpeny 1 Dawil ton M dw- imancal Property relatable to rem -4mumod Property - - (a) slmigh l line UOpraciafrors - �. (b) oaserdedeoaons Organiration identification Number laaach schedule) (otlach schedule) Included in the controlling connected with income loss) (sees Instructions) payments made cryenizattons Press lnccxno in Column (TO) (3) (4) 4 Amount of nvomge acquisltion aeon on w 5 Amiss" adjusted basis of or alienable to 6 Column 4 7 Gross i conro lepnantde 8 Allocable doducWrrs all0cabla b debt- nnenesd dablAnoneed properly divided b column 5 (column 2 x eMUmn 0) (column 5 x total 01 column& 3(a) and 3(b)) Property (aaach schedub) (allxh aclu!duref — ....— _._- .______.._.�.._,__. (4) _ % Enter here and on [file 7, Enter here and on Gne 7. column (A). Part 1. page 1. column (8). Part 1, page 1. Totals . . . . . . .. .. . . . . . ► Total dividends- recaived deductions Included in column 8 , ► Schedule F - Interest Annuities. Rovaltles. and Rents From Controlled Omanizations (See instructions on Daae IS 1 Name of Cenho llerl 2 Lmployer Exempt Controlled Organizations —.. - 5 Pan of column (4) thal is 5 Deductionsdinduy Organiration identification Number 3 Net unrelated income 4 Total of &pecifi d Included in the controlling connected with income loss) (sees Instructions) payments made cryenizattons Press lnccxno in Column (TO) (4) I Tri.abre income (1) (4) i 4E I83e 2.0r) " Net annotated Income I 9 10131 of specified go s&) (sea wslmcllone) payments made 55143T,7 2020 VO4 -8 60087882 is I 1 d Add cuhrmns Sand 10. Qntm Add Column&6 and 11. Enter here vast nn line S. OvIUm4 (A). here and on free 0, Column (Al. Pad 1. page 1. Pad I, pogo 1. Form 890 -T- (2004) 95-- 1643327 Fom sw- T(2W4) -- ^� Pe({e4 Schedule G -Investment Income of a Section 501(c)(7), (9), or (17) Organization (Sea instructions on page 18.) -- ---_ ._._ NIA Ity sea ecl b Total deduckare 1 llescrlption dIncomC 2 Amount of hrcx+me loll q ccnnecterl {almtlr schedule) ad seta.W. ) 3 _ .. sliacll sclwdull_._..._ _ __ .. - -. ..__._R!L S.W. 4) -_ kIVEI nerE 3116 drl Ilse 8, - tarlel ❑tYe emit En column (A), Part I. Mel. : ':.., . line 9, column (B). .. .. ad 1. Pale I. Totals _ .... .. Schedule I - Exploited Exempt Activity Income, Other Than Advertising Income NIA (See instructions on page 18.) Schedule J - Advertising Income (See instructions on page 19.) N/A 7.11 �imome From Periodicals Reported on a Consolidated Basis 4 Net income 7 buss 9 Ep,snses (toss) kom 7 Excess exempt gain a(loss)(cot 2 Gross dlrecit) unrelated t2ulo expanaas I Description of unrelated connected with or business 6 Gross income 6 Expensas (column 6 mines exploited oGiwty business income produclim G (column 2 mina Irom aetieitr Urat attributable to column S. but net from trace or unrelated column 3). If a is 001 unrelated column 5 more than Mesirms business income gain, cnmpula business income column 4). cols. 5 enough 7. wlumn 4) .......— __ �_.. Enter here and at Entet here and on EMrl nrre and lute 10, col. (A), lino to, col. (a), - on lire 26. Parl it, Totals (cant w Pan a, Pan I. Page 1. Part I, page J. Page 1. rind lba- . � Totals .... ► 9"*M111 lnrnme From Periodicats Reported on a Separate Basis (For Schedule J - Advertising Income (See instructions on page 19.) N/A 7.11 �imome From Periodicals Reported on a Consolidated Basis 2 throuah 7 on a (5) Tn_txla tram Pul I I _ Eater here and on line 11, Iwl.(A). Totals. Part II Pad I, page 1. lfii nCS 1�_'► Schedule K - Compensation of 1 Noma Total- I' ;.III" here slid on kno 14, Part 11.1 liter horn and on niter hGC 11tH lime 11, col B , on fine 27, part It, () 1 Part I pal page a e 1 P P cers, Directors, and Trustees (See inslrtictions on page 19.) _ —NLir _ 3 PerconlW rI 4 CnnpensMN» ^f 2 Tnb``-- - -�. —' time devoted to .,. I mtributablo to Eon, . 990 -T (2004) nerrtau 2 pro 56W3TJ 2020 VO4 -8 600671182 4 AduertiaiMd 7 buss 1 "mra of 2 Gross 3 Direct gain a(loss)(cot 6 Circulation S Readerakvv reederslqp costs puriodieat o4vonlsng advarUcma Costs 2 minus mL 3), 11 income costs (column G minus income a gain, compute column 51 but no cols, 5lhrough 7. more than wlumn 4) Totals (cant w Pan a, rind lba- . � 9"*M111 lnrnme From Periodicats Reported on a Separate Basis (For each periodical listed in Part II. till in 2 throuah 7 on a (5) Tn_txla tram Pul I I _ Eater here and on line 11, Iwl.(A). Totals. Part II Pad I, page 1. lfii nCS 1�_'► Schedule K - Compensation of 1 Noma Total- I' ;.III" here slid on kno 14, Part 11.1 liter horn and on niter hGC 11tH lime 11, col B , on fine 27, part It, () 1 Part I pal page a e 1 P P cers, Directors, and Trustees (See inslrtictions on page 19.) _ —NLir _ 3 PerconlW rI 4 CnnpensMN» ^f 2 Tnb``-- - -�. —' time devoted to .,. I mtributablo to Eon, . 990 -T (2004) nerrtau 2 pro 56W3TJ 2020 VO4 -8 600671182 EI-77! on for Extension of Time To File an L xempt Organization Return OMB No. 1545 -f 709 ► File a separate application for each return. r If you are filing for an Automatic 3 -Month Extension. complete only Part 1 and check this box • • • • • • • • • • • • .. • ► LY a If you are filing for an Additional (not automatic) 3 -Month Extension, complete only Part 9 (on page 2 of this form). Do not complete partAf unless Yov have akeady boon rented an automatic 3 -month extension on a previously fik� Ftum 8868. Automatic 3 -Month Extension of Time - Oniysubmit original (no copies needed) Form 990 -T corporations requesting an automatic 6 -month extension - check this box and complete Pad I only.......... ► All other corporations (including Form 990 -C filers) must use Form 7004 to request an extension of firm to file income tax retums. Partnerships. REM1Cs, and trusts must use Form 8736 to request an extension of firs to Ma Form 1065. 1066. or 1041. Electronic Filing le-file). Form 8668 can he filed electronically if you want a 3 -month automatic extension of lime to file one of the returns noted below (6 months for corporate Form 990 -T filers). However, you cannot file it electronically if you want the additional (not automatic) 3 -month extension, instead you must submit the fully completed signed page 2 (Part II) of Form 8868. For more details on the electronic filinq of this form, visit www.irs.clov/efife. Type or Name or txampt vrijanizat on emptoyor luenturcauun number print OAG IMMORTAL fIQSPZTAL PRESBXTE,RTAN 95- 1643327 Fire by are Number, sired, and room or suite no. If a P.O. box, see instructions. due dew kx ONE HOAG llR2VE1_B0& d rum 500 City, town or post office. sla(a, and ZIP code. For a fareign address, secs insfMctkxts. —� - - Check type of return to be filed (file a separate applicailon for each retum): From 990 X Form 090•T (corporation) _ Form 4720 Form 990-BL Form 090•T(sec. 401(a) or 408(a) trust) _ Form 5227 Form 990-EZ Form 990.7 ([rust other than above) Form 6069 Form 990-PF Form 1041•A Form 8870 c The books are in the cam of ► FM 1NE BENTHUYS, CONTROLLER _ Telephone No. ► 949 764 -4448 FAXNo. ► _-9_42 -_7j&- A35_____ If the organization does not have an office or place of business in the United States, check this box ► • If this is for a Group Return, . the organization's four digit Group Exemption Number (GEN) • • • • • . enter this is for the whole group. check this box h EJ . If it is for part of the group. chock this box ► CJ and attach a Ilst with the names and EINs of all members the extension WIN cover. _ 4 I request an automatic 3 -month (6- months for a Form 990 -T corporation) extension of time until — 0.1117 , 2006 to file the exempt organization return for the organization named above. The extension is for the organizaftori s return for: ► ® calendar year or ► tax year begirming M19 , 2004 , and ending __ X8,[31. 20D5 2 If this tax year is for less than 12 months. check reason: Initial return D Final return Cj Change in accounting period 3a If this application Is for Form 990 -BL. 990 -PF, 990 -T, 4720. or 6069, enter the tentative tax, less any nonrefundable credits. See instructions • • • • , • • • • - • • . , • , , • • . • • , • • , , • , • • • • • , $ NONE b If this application Is for Form 990-PF or 990 -T, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credo • • .. • • • • . , • , • • • • • • .. • $ NONE c Balance Due. Subtract line 3b from fine 3a. include your payment with this form, or. if required, deposit With FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). Soo instructions ..................... ............................... $ NOW Cautiol. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-ED and Fonn 8879 -FO .For Privacy Act and Paperwork Reduction Act Notice, coo Irrstructlons. Pam 6866 (Rev. 12.20104) • en nr"M 3.e0e Jsx 4 5 6 2 Depreciation and Amortization i=1um (including Information on Listed property) 2004 Deportment of the Trwrsury Atnw,"nt ln[emd nawntue smNce p5oa separate irmHUCrwna. ^)s Attach to your tax return _ g noire NO Bi Nnme(s) snottn on return I Oftflf fnn number austness or activity to whirr this Imm (Mites N£RAr. ' - Election To Expense Certain Property Under Section 179 Note: It you have any lisle�roperty cornQlete Aar! V beorr ou co lrrtp efe Part 1 _ -_ ^ y f Maximum antourd. See page 2 of the histrucdons far a Ngher hrllit far corlatn businesses 2 Total coil of %action 170 property placed In service (see page 3 of the Instructions) _ _ _ _ _ _ _ _ _ _ _ M 3 Threshold cost of section 179 properly before reduction in Ilmitatim) y� 4 Reduction In limitalion. Subtract fine 3 from the 2. N Zero M less, order -0- 4 6 eow fiftladwl for t. y.. SAVW thx4 from IhO 1. rzmoalPNB. Mar 4. r •....•.......... •— '- -.•� -� Desnip6on of 6 Ott Cost (buNinocs am D*) i (e) t ?lected coat 7 Listed properly. Enter the arnount from fire 29 .. , .. _ .. _ • _ _ _ _ _ , _ _ _ _ _ L 7 1..— ._._�._ ... 6 Total elected cost of section 179 properly. A(ld amounts In column (c), tines 6 and 7 ................ 9 Tentative deduction. En er the smaller of line 5 or line 6 . ........ .. ....... ... ......... 10 Carryover of dlsalloty ad dedUCllcm from Ilse 13 of your 2003 Form 4562 11 Business income Ilmitation. Enter the smeller of Iwsiness hturome (not loss than Zero) or line 5 (see Inalrualions) 12 Section 179 expense dDcluolion. Add lines 9 and 10, but do not enter more than line 11 _ _ 13 Carryover of disallowed deduction to 2101013. Add lines 9 and.1 D. less rice 12 No �, 13�✓, Note: Do dnt rrso 7'orf Jf or part lf/ bekrw for frsfcd properly. lnsteod, use Part V. [� Special Depreciation Allowance and Other Depreciation (Do not include listed pro per 14 Spacial depreciation allowance for qualified property (other than listed properly) placed in service during the lax year (see page 3 of the lnstmclions)_ _ . _ _ _ _ _ • _ _ _ _ _ _ _ _ _ _ _ • _ , _ _ _ _ 15 Property subject to section 168(f)(1) election (see page 4 of the Instructions) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 16 Other depreciation (including ACRS) (see page 4 of the inslniclions) _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ MAC RS Depreciation (Do not include listed proDerty.) {See Paae 5 of the Instructions.) __._ 17 MACRS deductions for assets placed In service in tax years beginning before 20104 _ _ _ _ _ 171 1a If you are electing under section 168(1)(4) to group any assets placed In service during the tax year into_ one or more general asset accounts. check two - .. - .. - ►1,^ .. 1. - Retfinn R - Ascete Pinnad in Apr lea hurinn 7nnA T.v Ynar I IZinn thw 2 ... 1.111o..w.- tnrF..n (a) Classificatloo of pmpeny I year pLwed in saMra 19a 3-year pr(�xrty It 5 -year properly —c 7 -year property d 10 -year property e 16 -year property f 20 -year property 9_25 -year property, It Reslftt ixl rental I Nonresidential red in Service 20a Class to 12ye _ - T-4 0-ye Tax td)Racowry l (a)Conventhn I Mm0hud Period (of D�raciMion de4uclWn 25 yrs• _I _ S/L 27.6 yrs. ...��- M M S/l 27.5 yrs, MSIL 39 yrs. - - -M M -. SIL 40 vrs. I M M S/L 1t 1 Listed property. Enlef amount from line 26 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -21 F ■2 Total Add amounts from line 12. lines 14 through 17, ilnos 1g and 20 in rnlumn (g)- and line 21. Elder here and on the appropriate lines of your rottxn. Partnerships and S corporation__ -_see instr. - - - - - 22 23 Far assets shrmvn above and placed in service during Itte current year, Miler the oottion of the basis altrihunthie 10 section 263A costs - - - - - - -- - - - - - 23 - _ - - - -- 551073T3 2020 VO4 -8 60087882 1. Parm A56i (7o04) 95- 1663327 property used for entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 2W 24b columns faY lhroruth /� of Socliar A. all W Soctinn B. anrLSoction C if aw�licnhle. Ilion A - pepredadon afrd Other Information Caution: See a e 9 of the' instructions for h'nuts fo ssenr er autornobd^or sl _ _ 24a Do you have evidence to sUDrbrf the businasslnwsinx:nl use chimed? Yos I No 24 b If -Yes." Is the evidence writlen? 1 Fv7 (a) Ib) 0usine+a/ Type of PM[Mly (rsf Rale Merced In invaaMrana (tll eauxkr ¢mrmr (0 19) Cost ao(hor °�"' Recarvery Metnodf fuasiaas(t)t8m IM Depreciation Elected $action n79 vehidox service ._ Perc tag a �x� usn cNr7 _ Period Conudrtion deduction` coot 2$ Special depreciation allowance for qualified listed properly placed in service during the lax year and used more than 50% in a qualified txlsiness use (see page 8 of ds inslntdbns) 25 26 Pmmedv used more than 50% in a auafitied business use (see oaae 8 of the instnrdiuns): 27 Property used 50% or less in a qualified business use SIL - 28 Add amounts in column (h), Imes 25 through 27. Enter hem and on line 21. page f .............. . 28 Add amounts in column (1), fine 26. Enter here and on fine 7, page 1 . ^�� Y Section 6 - Information on Use of Vehicles Complete this social for vehicles used by a sale proprietor, partner. w other "more than 5% ovmer.- or feratel person. If you provided vehicles to your employees. first answer the questions in section C to seed you meet an exception to 30 Total businesslinvestment miles driven during the (a) (b) (G) year (dn not include commuting miles - see page 2 Vehicle 1 Vehiele 2 Vehicie 3 . Vehid of the instructions) . 31 Total commuting mites driven during the year 32 Total other personal (nonrwmmu(irg) miles driven ..... ............ . 33 Total mites driven during the year. Add lines 30 through 32 . . ................ 34 Was the veNclo available fur personal use during Yes No Yes Me Yes No WYes off -duty hours? ..... . . . ........... _� ——'-- --`_ _-....... -- ---- -_'-- ---- 35 Was the vehicle used primarily by a more than 5% ovrner or relatert person? . . . . . . __ 36 Is another vehicle available for personal _ I this $action for those vehicles. (e) (f) Vehiclo5 1 Vehicle Yes Section C - quostions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you most an exception to compteting Section 8 for Vehicles irsed by employees who 37 Do you maintain a written policy statement that prohibits all personal use of vehfdes. Including commuting. I Yes by your ernployees7 . 38 Do you maintain a Written policy statement that prohibits personal use of vehicles. except commuting, by year employees? See pago 10 of the instwelions for vehicles used by corporate officers, directors, or 1% cr more owners . ....... . _ 39 Do you treat all use of vehicles by employees as personal use? ^_ 48 Do you provide more than five vehicles 10 your employees, obtain information (roan your employees about the use of the whiles, and retain the Information received? 41 Dv you meet the requirements concerning qualified autumtbile demonstration usc? (Sus page 10 of the inshud'wrta.) ........ _ Note: If your answer to 37, 38, 39. 4e. or 41 is "yes,' do not complete secUarr B for the covered veliklas. ..... ta) Roscrplien of costs (bl Dale wnortbatien bngms (C) Amatirnhlc amount (d) Casa seerwn Amonirtaim Period or PmCOniage Amodaadon for this year 42 Wnorlizatlon of nests that begins drnina Your 2004 tax vear (see page 11 or the instnrdions): 11111117.Amorlizatwn of costs that began before Your 2004 ioxyoan . . . . . . . . . . . . . . . . .. . . . . . . 43 ' . _.__._._.w_,.__....._._... „. 44 Total. Add amalnts in rnlun?rr ( -am m 12 of the instrirctiens fur whue to mport.. 47A.Y___ Xsn rorm4562 {taw) 4rd5J22190 55W3TJ 2020 VO4- -8 60087882 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 ORGANIZATION'S PRIMARY UNRELATED BUSINESS ACTIVITY. -.446110 PHARMACY SALES TO THE GENERAL PUBLIC 561000 PRACTICE MANAGEMENT AND BILLING SERVICES FOR THE PHYSICIANS SERVING MANAGED CARE PATIENTS IN THE HOSPITAL'S SERVICE AREA 621500 REFERENCE LAB FEES 900003 RENTAL AND INTEREST INCOME (PASSIVE) FROM CONTROLLED ORGANIZATIONS 55N3Tj 2020 VO4-8 60087882 STATEMENT 1 HONG MEMORIAL HOSPITAL PRESBYTERIAN 95-°1643327 FORM 990T - PART II - LINE 28 - TOTAL OTHER DEDUCTIONS SUPPLIES 2,258,194. PURCHASED SERVICES 1,733,366. RENT EXPENSE 693,517. OTHER MISCELLANEOUS EXPENSE 256,562. PROFESSIONAL FEES 156,667. ALLOCATED OVERHEAD 1,901,121. FYE EMPLOYEE BONUS 282,543. ADMINISTRATION ALLOCATION 415,527. UTILITIES 26,066. - PART II -- LINE 28 - OTHER DEDUCTIONS 7,723,563 55W3TJ 2020 VO4 -8 60087882 STATEMENT 2 HOAG MLMORIAL HOSPITAL PRESBYTERIAN 95- 1643327 FORM 990T - ORGANIZATIONS TAXABLE AS CORPORATIONS - TAX COMPUTATION 1 TAXABLE INCOME FROM LINE 34, PAGE 1, 990 -T ................ NONE 2 LINE 1 OR THE CORPORATION'S SHARE OF THE $50,000 TAXABLE INCOME BRACKET, WHICHEVER IS LESS ................. NONE 3 SUBTRACT LINE 2 FROM LINE 1 ............................... NONE 4 LINE 3 OR THE CORPORA'TION'S SHARE OF THE $25,000 TAXABLE INCOME BRACKET, WHICHEVER IS LESS ................. NONE 5 SUBTRACT LINE 4 FROM LINE 3 ............................... NONE 6 LINE 5 OR THE CORPORATION'S SHARE OF THE $9,925,000 TAXABLE_INCOME BRACKET, WHICHEVER IS LESS ................. NONE 7 SUBTRACT LINE 6 FROM LINE 5 ............................... NONE 8 ENTER 15% OF LINE 2 ........ ............................... NONE 9 ENTER 25% OF LINE 4 ........ ............................... NONE 10 ENTER 34-% OF LINE 6 ........ ............................... NONE 11 ENTER 35% OF LINE 7 ........ ............................... NONE 12 MEMBER'S SHARE OF ADDITIONAL TAX: (A) 5% OF THE EXCESS OVER $100,000 OR (B) $11,750 ....................... 13 MEMBER'S SHARE OF ADDITONAL TAX: (A) 3% OF THE EXCESS OVER $15 MILLION OR (B) $100,000 ................... 14 TOTAL OF LINES 8 THROUGH 13. ENTER THIS AMOUNT ON LINE 35C, PAGE 2, 990 -T .... ............................... NONE • 55W37J 2020 VO4 -8 60087882 STATEMENT 3 ayMy _j'yr/ i eaw58YTanann ;MMMu ^„I F STr n:, AM7COITT86, ROYALTIES, M REM FROM CCKTAOUM ORGANIZATIONS YK6M i CONTROL= ORIhNIMATION 1. HAM OF COVT *T6"IA� 09PAa'18AT " ",AR SOAG PRACTICE lMZ;IMNT, lee? RT BOJGYNO CSNTER 2. BtewYER 3. s. CATIOU NET UNRELATED NMGZ?L Mims (1053) 37- 0731587 37-0191776 DS- 164l:Lr Nomm^.T'+' COA"Txot.= ORWIZA71ON 5. PART OF COI.iL.4 10. (4) TEAS 4. IS IN".I.ODSD TOTAL Of IN TSE SPECi5"S, D CCNTsomllCO PAYMENTS ORGANISA'TION'S 1ii0R GROSS INCGNZ DS- 164l:Lr Nomm^.T'+' COA"Txot.= ORWIZA71ON TOTAL OP TOTAL OF giam 5 i COL034N 6 i CCLOHS 19 co aw 11 TOTALS 1,015,415, 1,977,854. 53W3TJ 2020 VO4 -8 60087882 STATZA f 4 10. 6. PART OF COLM 11. D800CTIONS (9) r AT DRDUCTYCN3 OIREmi S. 9. IS TNCLMDED OiREOw1 CCNIM,CnD NET TOTAL OP IN T68 CAhMCTSD WITS 7. 1L*ASIAT$9 SPECIFIED CONTROLLING 71ST.. I2=9 is SAMPLE TK *2 PAYw7s ORGMTZATIci'S INCOME IN COLm (5) INCOME (LOSS) WE GRO59 VMS COLLisv (101 - 138,411. BC5, 52 ?. 845,523. 84,9,523. 11977,854. 3,521.s1O. 163,896. 1691896. 169,896. mzz TOTAL OP TOTAL OF giam 5 i COL034N 6 i CCLOHS 19 co aw 11 TOTALS 1,015,415, 1,977,854. 53W3TJ 2020 VO4 -8 60087882 STATZA f 4 Corpomaa Fling original conscm Hoeg �4c:x;rial Hospia and Ain, itaw SerAce C-r= N Itre original we tcdule liied: Ogdeq U,eh 84201 MASTER APPOR:?OKMEHT SCHFVULE FOR GROUP OF CORPORAT IONS (If r o specific apportionment indicated, amotmts are divided equ0y am,-,g all members.) TFe fo4owing corpomilom, comporem members of a corarolled roctp ofcorptmdors asdefired in Section 1563(a) or 179 (dY.7), w }tidzver - the cm may De, 44mby consent, wit'arespeet to ft December 31, 2003 tumble year. Car,. T axrble No Name k Address Year Endad MN Sigznre pf A✓horized Officer Date Hwg Sicmoriai Hospital Presbyterian One Hoag Drnc. PO Box& W, Neapost Beach, CA 92658 8.31l2W 5 95464332' 2 Hoag Hospital Foundation One Hoag Drip. PO Box 6100, NnvFar. Bead, CA 92658 8,712005 95- 3221343 3 Hoag Practice 6:anag mcot, !nc. 310i Wes; Pacific Cpast Hwy, Suite 300, NnYport Beat; CA 92663 8!31.2005 33- 073;587 4 Co" M=gdnem Services Orewmlion 301 Newpon Blvd., Box 6100. Newport Beach. CA 92688 8!312005 33 -0676831 APPORTIOP1.kIEhT OF Section 38 5eetion6655 Section 179(b)(2) (c)(3P) (g)(2)(A). Section 55(4)(2) Section 55(d)(2) Election to Expam Fits Large hFsii= Fbase -out Section 179 $1/0 Surtax 3 %5taim Depreciable S25,0W for Corporation Tax of Corp. (b)(2} i5% 25% 34% SIOC.OW- 515,000,000- Property Limited General $1,000,000 Exetnplion Exemption 1 Lintiutior. 550.000 $25.000 59.925.000 5335,00) $18.833,333 To 518.500 5.5iness Taxeble lm. MAW Credit 1 0 0 0 2,000,000 0 0 0 ,. - 0 0 3 0 D 0 2,000,000 0 0 0 0 0 0 0 3 400,m0 0 0 3,r5,0W 1;,750 100,000 18,5G0 25,007 1,000,000 0 0 4 0 50,000 25,000 2,W0,000 0 0 0 0 0 40,000 150,000 Car,. T axrble No Name k Address Year Endad MN Sigznre pf A✓horized Officer Date Hwg Sicmoriai Hospital Presbyterian One Hoag Drnc. PO Box& W, Neapost Beach, CA 92658 8.31l2W 5 95464332' 2 Hoag Hospital Foundation One Hoag Drip. PO Box 6100, NnvFar. Bead, CA 92658 8,712005 95- 3221343 3 Hoag Practice 6:anag mcot, !nc. 310i Wes; Pacific Cpast Hwy, Suite 300, NnYport Beat; CA 92663 8!31.2005 33- 073;587 4 Co" M=gdnem Services Orewmlion 301 Newpon Blvd., Box 6100. Newport Beach. CA 92688 8!312005 33 -0676831 s "REC*V AF AGENDA PRINTED:" � G April 16, 1 -668'• '`r� TO: NEWPORT BEACH CITY COUNCIL FROM: ROSEMARY C. STEINBRECHER " -_ 32 RE: HOAG HOSPITAL RELOCATION OF 225,000 sq. ft.- In addition to, or including, the points already brought up to the planning commission, there are five plbixlts. for denying Hoag Hospital's application at this time. 1. The traffic counts used in the EIR present a fraudulently low usage for the six to seven intersections intimately affected by the project. Public Works representative Tony Brine's statement to me that "everyone" always does traffic counts for development purposes to reflect the absolutely lowest possible traffic count is totally false. I checked with Dana Point, Seal Beach, Huntington Beach, Laguna Beach and Laguna Woods, and they stated the exact opposite was their policy. 2. Hoag is unwilling to state definitively what the new building will be, yet the hospital is asking for massive public support in the form of $400,000,000 in tax free municipal bonds. NO ONE running for public office in the city of Newport Beach could get elected for supporting the many practices going on in the "Women's Pavilion," yet apparently the same amount of publicly rendered bonds went into its development. That project did not need development approval, and the bonds were not noticed to the citizens, but this project is, and should not be approved until it is absolutely clear what it will be. 3. How can noise assessment, and true environmental hazards be evaluated without a distinct project? 4. Hoag is asking for curfew exceptions to be granted with this project, again before making any definitive statement what the project will be. If it is, in fact, to be a "critical care" facility, which a Hoag Director finally stated in a planning commission meeting as a probable project, once this project is built, no amount of noise complaints could be given any real consideration. A planning Commissioner's guess of a heart delivery for transplant might well be an example of a reason for after curfew deliveries. These might be delivered by helicopter, as well as ambulance or truck. THIS IS A RESIDENTIAL NEIGHBORHOOD. It was residential before Hoag build the first tower. The City has allowed a cataclysmic collision course over the years Hoag has proved itself unwilling even to make resonable amelioration of noise; e.g., a sterilization plant and trash compacotr on their outdoor loading dock and noise levels which regularly exceed even the generous noise limits of Newport Beach. , 2 5. All the property along Coast Highway was stategically manipulated to take it off the possibility of competitive bidding and virtually given to Hoag Hospital at a faction of its real value. At the time, Hoag pleaded that it had no more need for in- patient care, and future development would be out patient, basically. Hoag would have to relinquish all claim to appropriate acreage, and this should be sold to private development. Anything else is, once more, a fraud upon the citizenry. Sincerely, Rosemary C. teinbrecher 100 Scholz Plaza, #112 Newport Beach, CA .92663 949 - 548 -4542 04/16/08 17:10 FAX 860 623 4477 April 16, 2008 Mr. Jim Campbell Chairman, planning Board Re: Hoag Hospital Dear Mr. Campbell, DRI -AIR INDUSTRIES IM 002 ' °RECE{VED_AfTE ANN PLAW""G 11 PAPiMENi APR 16 1008 C1NOf NFftRI Ill. DtACH I am writing you to bring attention to a concern that we have about the noise and re- construction between Villa Balboa and Hoag Hospital. 1 We purchased our condo unit, 280 Cagney, 9302 in 1988. Over the years I cannot tell you how many phone rat {a we made to complain about noise during tho night hours. The gate that was supposed to be closed never was, when Hoag had construction going on. Construction that was not supposed to start before 7 am, stmtcd at 6 am. Many calls wcKc made to Mr. Michaels, the CEO of Hoag at the time, regarding this problem would always get us an apology, but he never would do anything about the problem. Now we find that Hoag has decided to have a fence built that will solve the problem. We talked to Coralee- Newanan of Government Solutions at 230 Newport Center Drive, Newport Beach CA 92660. Our conversation was pleasant and she assured us that one of their people would visit our condo unit, which is directly across from the loading dock. Twice, arrangements were made to have their people visit us, but they cancelled both times. We have a huge concern about what is taking place at and near our unit. We are aware that some people in the units at 260 Cagney have been told that their windows and sliding doors that face the loading dock will Ixr replaced with high performance, double panes. As we directly face the loading dock, we are asking that the same consideration be given to our property, Anything less would obviously mean that Hoag is not interested in the quality of its neighbors lives. Sincerely, Kathleen Kyle Keane Michael Keane 04;16;08 17:10 PA% 860 628 4477 DRI AIR INDUETRICE Q 001 �L TeL- -(8q 6U45110 16 THOUTSON ROAD -r-0. BOX L020, EAST WWDSOR� CT 06068 -l= - Pax (8q 6?MW Intem� http. f /wsrw.dri- aircom e mails saleAddaicsom DATE: TO: SENDEI SUEUN IMPOME TELIEFAX MESSA E iAK ATTF3`MON: 9 OF PAGES: PLEA sFIErustwowIF ArcP ,A CEO AncNornaco ma A Michael T. Keane . ". vice president sales . ® DRI -AIR 66 Industries, Inc. i A�One � 660,627 -5110 ext. 109 fax 860- 62S -d67P web www.tl/1•air.Com email mkeane®drFalr.com 013 South Coast Air Quality Management District 21865 E. Copley Drive, Diamond Bar, CA 91765-4 1 82 r (909) 396 -2000 • www.agmd.gov NOTICE OF INTENT TO ISSUE "PERNUT TO CONSTRUCT and OPERATE" PURSUANT TO RULE 212 This notice is to inform you that'4e South Coast Air Quality Management District (AQMD) has received applications for permit to construct and operate three natural -gas fired internal combustion engines and one natural gas/fuel oil (amber oil 363) fired boiler at a location in your neighborhood. The AQMD is the air pollution control agency for all of Orange County and portions of Los Angeles, Riverside and San Bernardino Counties. Anyone wishing to operate, install or modify equipment that could be a source of air pollution within this region must first obtain a permit from the AQMD. Rule 212 requires the applicant for certain projects, such as this one, to distribute and publish a public notice prepared by the AQMD prior to the issuance of a permit. The AQMD has evaluated the permit applications for the following equipment and determined that the equipment will meet all applicable air quality requirements of our Rules and Regulations. Company Name: HOAG MEMORIAL HOSPITAL PRESBYTERIAN Application Nos.: 406575, 406576, 406577 & 406578 Location Address: ONE HOAG DR., NEWPORT BEACH, CA 92658 Project Description: THREE NATURAL. GAS FIRED INTERNAL COMBUSTION ENGINES AND A NATURAL GAS/FUEL OIL (AMBER 363) FIRED BOILER This project will use the best available technology for controlling air pollution. Our calculations show that a maximum of 52 pounds of Nitrogen Oxides, 93 pounds of Carbon Monoxide, 50 pounds of Reactive Organic Gases (ROG), 18 pounds of Particulate Matter under 10 microns (PM10), and I pound of Sulfur Oxides will be emitted from the project described above in any one day. Generally, the amount will be less. But even at the maximum amount, this project complies with all aspects of the AQMD's air pollution control requirements. Detailed computer modeling has shown that the proposed project should have no adverse impact on the surrounding community. This project also emits pollutants that are identified as to cause cancer. Therefore, a health risk assessment was performed for these permit applications. The calculation overestimates actual risk since it assumes that a person is at the location of highest exposure for an entire lifetime (24 hours/day, 365 days/year for 70 years). Even assuming this unlikely condition, the evaluation shows that the chance of this project causing cancer is less than twenty seven in -a- million which is within limits considered acceptable for new /modified sources. The air quality analysis of this project is available for public review at the AQMD's headquarters in Diamond Bar, and at the Library in City of Newport Beach at 1000 Avacado Avenue. Information regarding the facility owner's compliance history submitted to the AQMD pursuant to California Health & Safety Code Section 42336, or otherwise known to the AQMD, based on credible information, is also available from the AQMD for public review. Anyone wishing to comment on the proposed issuance of this permit should submit his or her comments in writing within 30 days of the distribution date shown below. If you are concerned primarily about zoning decisions and the process by which this facility has been sited at this location, you should contact your local city or county planning department. Please submit comments related to air quality to Mr. Hemang Desai, Air Quality Engineer, General Commercial Team, South Coast Air Quality Management District, 21865 E. Copley Drive, Diamond Bar, California 91765.4182. For additional information, please call Mr. Hemang Desai al (909) 396 -2596. Distribution Date: January 17, 2003 nuwc 1) SPON PRINTED:" CEIf 1 E #2ENDA #4.1v 00 PO Box 102 • Balboa Island, California • 92662 • 949 -541 -1686 15 April 2008 Mayor Selich and City Council Members, City of Newport Beach 3300 Newport Blvd. Newport Beach, CA 92663 Re: Hoag Hospital GPA and Development Agreement Revision PA- 2007 -073 Cogeneration Plant Mitigation and Abatement City Council Meeting April 16, 2008 Dear Mayor Selich and Newport Beach City Council Members, The SPON Steering Committee has reviewed Hoag Hospital's proposed revised Development Agreement and the Planning Commission recommendation that the City Council consider implementing effective plume abatement for the Hoag cogeneration facility during the Council's consideration of the amendment of the Hoag Development Agreement on April 16, 2008. SPON's Steering Committee agrees with the Planning Commission recommendation, and further, recommends that the Council require Hoag to implement the best available technology to mitigate and abate the plume arising from the cogeneration plant. This plume represents a visual eyesore and a view impediment from the Sunset View Park and adjacent highways, and also subjects park visitors and nearby residents to health hazards from possible Legionnaire's Disease from the cooling towers and Toxic Air Compounds (TACs) that are produced from generator engine exhaust. Hoag Hospital, as a revered member of our community, has a responsibility to use the most effective technology in its operations, especially when adverse impacts from its operations affect the community at large. It goes without saying that Hoag Hospital, as a health care provider, should not emit vapors that adversely impact the health of its neighbors, park visitors, or anyone exposed to the plume which is driven by prevailing winds towards the park and residential community. We recommend that the City Council require further study of the plume in a Supplemental EIR directed towards analysis of the plume and emissions from its generator engine exhaust before approving the revised Development Agreement. In addition, We believe that the noise levels stipulated in the existing development agreement should be retained and enforced. We object to any proposal that would eliminate noise ceilings for any activity including, but not limited to, the loading docks. With Hoag's substantial monetary resources available, it should be required to use the best available technology to reduce the plume and engine exhaust to the maximum extent possible. The health of the City requires no less than the best technology available. Thank you for considering our recommendations. Sincerely, SPON Presiding Officers: A Marko Popovich Don Krotee -� r� Cons f faa ro ( fG l Date ,$ f i 1/�Th -� �14 � m fxon.? To: Members of the Newport Beach City Council L -tf v 1 SC° z Keith D. Cuxry ; : (Jt e ` % et p- 5 �Gi r I UGC "Leslie Daigle f r, Nancy Gardner %�Ue it [ptU r s Michael F. Henn -�- (O / J Steve Rosansky "k Tic Edward D. Selich /�- kE,g Don Webb f/t tom¢ `s .„Q S+Ct end asnoSS,`t �. �- / U RE: Mitigation Measures for Hoag Hospital r t, -0 ��`"�" Honorable Members of the Council: � , �, 2 ,�!�To� horse As you are aware, on April 160'the City Council will hol ublic hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also �f be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA offer a rare opportunity for the City to enhance this important document w h after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 16th, please give consideration to the following: Cogeneration Plant - The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were no disclosed to the City or the Coastal Commission during the permitting process, no supp =mental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years lf, residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was included in the Hoag plant by its designers, but unfortunately was pulled ou by hospital personnel to modestly reduce costs. On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise lirni�tia(Sftons current y in the Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, an 4g its of cars operating at close proximity. Please consider an amendment t rohibit r of -to azkin on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: J0 62 0 /%77 / 9 �1 Y1_S'0_/1_ Address: Z:u o )_t` l `2 �.. 4t-10;6 i� Date: To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb RE: Mitigation Measures for Hoag Hospital Honorable Members of the Council: As you are aware, on April 160i the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 160i, please give consideration to the following: Cogeneration Plant — The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was included in the Hoag plant by its designers, but unfortunately was pulled out by hospital.personnel to modestly reduce costs. On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise —The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li ting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkin e — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely,�� i CLvi^___ � �� \,,Vt V_\01 S CA U Address: To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb RE: Mitigation Measures for Hoag Hospital Honorable Members of the Council: _ ' 17 CI, , 7 KIM As you are aware, on April 16a' the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 16`h, please give consideration to the following: Cogeneration Plant — The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was included in the Hoag plant by its designers, but unfortunately was pulled out by hospital personnel to modestly reduce costs. On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerelac, Name: Address:,�2,;uO f"_ Qestc-fl l CA 9.)Lv � 3 Date: ( d�j ;'r t ! a ' 17 To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb RE: Mitigation Measures for Hoag Hospital Honorable Members of the Council: As you are aware, on April 16th the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 16th, please give consideration to the following:. Cogeneration Plant — The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life mi the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was included in the Hoag plant by its designers, but unfortunately was pulled out by hospital personnel to modestly reduce costs. On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to d %nitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: J. Address: �' 70 6A S hwy L i Pv, ����z A o Ifff -lffl, J ��a,K 6FA 2 L'&,t4a�o lkst AP 414s YeV fwtwcy 41/'rEeteW ,,C�•�scrt Luc .t � .P.�.,.:.c .c,ar.�aus�"��u�us ��f dsa�AK4t.e Avg e �CG AestWestr Care -dSU_iztjzj' ATtee -tal 1y .!XA Torr►?try��,%�D¢f 7i Ghf Y.( /.CA -elver) /- A/Y r04esllo.CHC J I-44-I[.�.� -! t��xy lrl�tGfi.G(HY..£ /Gc.etlQ. //G- /�?.r/l�atGP DfoG d.r 7%e Issues _ . . ii I I'. i; Date: 4.+ ! 1-09 To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb RE: Mitigation Measures for Hoag Hospital Honorable Members of the Council: As you are aware, on April 16th the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 16s', please give consideration to the following: Cogeneration Plan t — The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was included in the Hoag plant by its designers, but unfortunately was pulled out by hospital personnel to modestly reduce costs. WA4 j q a, ea i.� �yQ� L,L),b -6 tva& SL jLt�_L. < / (� 7f 1 f Li i Crib -D .���� C On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue bend it hi . We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. . Noise - The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li hg tins - Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking - The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Ud' a, a -)p �'"� f5 x Name: " 4� i!t ANA,?_t i Address: J-V �L? 1 ��. �` I &X-Y- Sll�r7 ' Z) -1) ct iAjl-o(, cw, -19 11 � 4 A ©G Date: l b U To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb RE: Mitigation Measures for Hoag Hospital Honorable Members of the Council As you are aware, on April l6a the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA ). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April l6s', please give consideration to the following: Cogeneration Plant — The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California .the United States, and globally. Such equipment was included in the Hoag plant by its designers, but unfortunately was pulled out by hospital personnel to modestly reduce costs. � �•. .O / sp"Ww 2 70 .. r / i .. m April 8, 2008 To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb Re: Mitigation Measures for Hoag hospital Honorable Members of the Council: . As you are aware, on April 16th the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to may negative impacts, as the hospital has grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area_ The upcoming negotiations and vote amending the DA offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 16th, please give consideration to the following: Cogeneration Plant — The cogeneration plant Hoag built on its lower campus frequently emits cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no.plumes would be visible from the plant during normal operations. a Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was included in the Hoag plant by its designers, but unfortunately was pulled out by hospital personnel to reduce costs. On March 20`h, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of on or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as par of any modification of noise limitations currently in the DA. Lower Campus lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the panting lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with' Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -Tom parking — The hospital has proposed building multi level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume with emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City-and the hospital. Thank you for your consideration of the issues described above. Mr.. & Mrs. Charles Sparrer, 270 Cagney Lane #209, Newport Beach, CA. Date: _91- OY To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb RE: Mitigation Measures for Hoag Hospital Honorable Members of the Council: As you are aware, on April 16th the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the . hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA.offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 16th, please give consideration to the following: Cogeneration Plant — The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was included in the Hoag plant by its designers, but unfortunately was pulled out by hospital personnel to modestly reduce costs. On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: ,�pN,e}L1J 4,tl b Address: 21,0 L //LE LANE A1Z_-WA0X — /3 ,5?qCRJ 64. 477-440.8 1 ) 5 �7ras Ae, 17107 1701�C7,� 31 "'Z24 6,24 04 aiZa4",eW 17e77 17 , e ol :. 6-40 cpvc/ .e —. Ile, I �i'GO ++�ii!??uiv✓ �) CL'"� ��CJ�°� "'� /C[Z 'mac Gf 9.�6'lt /`�,Lj Woo 116�z&e�l �' G� fLOxd� Coasv,�rr y,+e L<'�. /'cin aa.�rn NX Date: 09 -To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb - Mitigafiori Measuresior Hoag Hospital - Honorable Members of the Council: TAREK G.M. ZEITOUNE D.D.S. 200 PARIS LANE #315 NEWPORT BEACH, CA 92663 VILLA BALBOA As you are aware, on April 16th the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 2417 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 16th, please give consideration to the following: t ( Cogeneration Plant — The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was included in the Hoag ptant by its designers, but unfortunately was pulled out by hospital personnel to modestly reduce costs. Ire cw•� o by � On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parkin¢ — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: TAREK G.M. ZEITOUNE D.D.S. Address: 200 PARIS LANE #315 NEWPORT BEACH, CA 92663 VILLA BALBOA r `� n r, M�,-Jma' Vgrsaillp tiomgowngm ilssociation TSG Independent Property Management, Inc. 27129 Calle Arroyo, Suite 1802, San Juan Capistrano, CA 92675 (949) 481 -0555 • Fax (949( 481 -0556 April 8, 2008 Members of Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner 1 Michael F. Henn Steve Rosansky Edward D. Selich Don Webb 3300 Newport Boulevard a Newport Beach, CA 92663 Honorable Council Members, The Versailles Homeowners Association Board of Directors, on behalf of its residents, would like to state for the record its support for measures to reduce the impact of the Hoag cogeneration plant on the surrounding community. Our association is comprised of 255 residential units. Many of our residents enjoy the opportunity to use Sunset View Park for early morning and late evening walks. The plumes emanating from the co- generation plant substantially degrade the otherwise scenic ocean vistas from the entire length of the linear park. A number of our residents have also indicated that during the quietest times of night they can hear noise coming from the cooling tower fans. We are extremely concerned about the affect of the cooling tower and engine exhaust plumes from the plant on the quality of life of our residents, as well as on the entire West Newport Beach area. We urge the City Council to implement the recommendation made last month by the Planning Commission that appropriate technologies and methods be utilized to eliminate the cooling tower and engine exhaust plumes produced by the plant. We also urge the Council to take steps to reduce the noise level produced by the large cooling tower fans at the cogeneration plant. RespectfiillY:' G� om Christensen President of the Board Versailles Homeowners Association cc: Villa Balboa Newport Beach City Council Members r April 12, 2008 The City of Newport Beach 3300 Newport Blvd Newport Beach, CA 92663 Re: Hoag Hospital Noise Mitigation Plan Honorable Council Members: My wife, Linda, and I bought our Villa Balboa residence at 260 Cagney Lane, Unit 202 in 1981 and enjoyed many years of peaceful residence bordering West Hoag Drive. As Hoag Hospital grew over the years the din of noise from street traffic, machinery and the loading dock have become unbearable. We moved two years ago to our current residence, and are temporarily renting the unit. Our last tenants broke their lease on September 4, 2007, leaving us with $9003.32 in unpaid rents. Small claims court ruled in their favor that the unit was uninhabitable due to excessive noise fi-om the hospital. We plan to reside there again sometime, and hope we can return to a quiet existence. Hoag's noise mitigation plan (containing several elements), as recently modified with an extended 470 -foot sound wall, I believe will solve our problem. This plan was amended and approved by the Planning Commission and I urge that City Council do the same. With your acceptance of this noise mitigation plan, we also recommend your approval of Hoag's modified Development Agreement. However, time is of the essence, and we would hope that the noise mitigation can be completed within 6- months of the acceptance of the Development Agreement. Thanks for your consideration. Sincerely, Richard L. Banks Newport Beach City Council Members Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb Re: Hoag Hospital Mitigation Measures Honorable Members of the Council: Victor E. and Sandra G. Dobras 240 Nice Lane, #308 Newport Beach, CA 92663 April 11, 2008 When you meet on April 16 to consider the recommendations of the Planning Commission, we urge you to take specific note of the following concerns: 1. Please support the recommendation of the Planning Commission to require installation of plume abatement cooling towers. Please also support a requirement that Hoag use one or more of the methods outlined in the Fluor Report to mitigate exhaust plumes. 2. Please require full mitigation of noise sources from the loading dock and the cogeneration plant as part of any modification of noise limitations in the current Development Agreement. 3. Please add language to the Development Agreement to turn off lower campus parking lights in the late evening when the parking lot is not in use. 4. Please require Hoag to comply with the terms of the Development Agreement requiring appropriate landscaping and elimination of the plume from the Cancer Center. As citizens of Newport. Beach we value Hoag Hospital and the contributions it makes to the community. We feel that approval of our requests above will ensure that Hoag remains a good neighbor. Sincerely yours, Victor E. Dobras Sandra G. Dobras E6 The City Council of Newport Beach 3300 Newport Blvd. Newport Beach, CA 92663 To: Members of the Newport Beach City Council Re: Mitigation Measures for Hoag Hospital April 13, 2008 First of all, we are not against progress, we are not against growth and we certainly are not against Hoag Hospital. We have nothing but admiration and respect for what they do and the caliber of Doctors they attract. They are most impressive as are all of their presentations. I live at Park Newport and my son owns a condo at Villa Balboa. He has lived there since 1990. The hospital has had substantial growth since his purchase and that obviously affects the residents of his complex. I am concerned with the plume that is billowing out of the cogeneration plant. It not only is a concern to Villa Balboa residents but all who eat, live and work in the surrounding area. My son was having lunch at the Lido Deli and if the wind is blowing in a certain direction, you can eat and watch the plume. We could not see the fireworks this past 4'h of July because of the plume. It is everywhere. Although we have been told that this is not a health hazard, I am concerned about that. We were also told there would be no plume and look at us now. I do not understand why the plume abatement equipment was removed from the Hoag plans. The bottom line is we have a problem Please help us fix it. I do not mean patch it .... I mean use the best technology possible to eliminate this unsightly mess that we are looking at and breathing. Sincerely, • it � Paula Millman Josh Millman FOLLOWING THIS PAGE, ARE THE SIGNATURE PAGES TO THE FORM LETTER Date: ��3 - D To: Members of the Newport Beach City Council Keith D. Curry Leslie Daigle Nancy Gardner Michael F. Henn Steve Rosansky Edward D. Selich Don Webb RE: Mitigation Measures for Hoag Hospital Honorable Members of the Council: r,. i r As you are aware, on April 10 the City Council will hold public hearings on Hoag Hospital's compliance with the Development Agreement (DA). Consideration will also be given to various amendments to the DA. As Hoag's closest neighbor, the residents of Villa Balboa are very supportive of the hospital's healthcare mission. Among our residents are many employees, volunteers, and patients of the hospital. However, our proximity also subjects us to many negative impacts, as the hospital has gradually grown from a small community facility into a huge regional medical center. As a result of Hoag's intense focus on its healthcare mission, it sometimes forgets the impact its nearly continuous construction and 24/7 operations have on the west Newport Beach area. The upcoming negotiations and vote on amending the DA offer a rare opportunity for the City to enhance this important document, which after all, was created to balance the hospital's request for wide latitude to develop its upper and lower campuses with the need to provide protections to the surrounding community. As we approach the meeting on April 16th, please give consideration to the following: Cogeneration Plant — The cogeneration plant Hoag built on its lower campus frequently emits billowing cooling tower and engine exhaust plumes, both of which are unsightly and degrade the quality of life in the west Newport Beach area. Because the plumes were not disclosed to the City or the Coastal Commission during the permitting process, no supplemental environmental impact report was prepared as was required by the DA. Further, Hoag's verbal and written statements over the last several years led residents to believe that no plumes would be visible from the plant during normal operations. Inclusion of "plume abatement" equipment is a standard feature of plants built in environmentally sensitive locations throughout California, the United States, and globally. Such equipment was'included in the Hoag plant by its designers, but unfortunately was pulled out by hospital personnel to modestly reduce costs. On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support. the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus LiQhtinR — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the erects of the residents, the City, and the hospital. Thank you for your conside 'on of the issues described above. Sincerely, Name: / A.IL / L Address: p .39 46 t 1 Js / \� aNG — On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, frilly plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lightine — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: ROS'/y —� J Al O L1j Address: G �z.s63 /✓, � o�� On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: 10 e%( ­$. Wi a i s1 Address: aXq O u; c e 4Ll0 f News- 8e-cA , C► iA 124 we 3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is. currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, 40cv_�aP cjz> k) Name: c`3 �J C„ O r _T lr t- ( t i Address: tii Q W P U r- - Q Cl-t On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li¢hting— Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Pazkine — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: ��p Pf}r21S a o02� Newf", P69 ,eeo,9-4_41 yz��� On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, - Q,�,,�E� � Name: $ 3 d C_ L(= A N Q- Address: " <--t,''S e 6 r-,v GC H On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the ap� City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, i Ger era S cSJJLo � Co_oyower5: o. 'A 12etsy I J'eliiRee� ��i,rt Name: C. 4? z L rc3 Address: 2 3 e )_ i I l e L-a n e� k i 1 a g e w Per'! l "rhe CanSf� uc �toh noise can d is of u r� n 5 + e( 4 p ' our lives awd oiePrive� Yeal^5 {late ru�ineq `e+ p-OL ,,, rjvKe1 jioe }{o15 1+,L Co��� e n ((b j as , our e e QcQ'ED b e. } on , 6-9 i+ in avtd C:i-�-es. � dDe�n� dev Qa dew or-H�eLxe �+ ghewid i1 o1 b ib , � . � . � i. On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at . the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li hting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parkin — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City; and the hospital. Thank you for your consideration of the issues described above. Sincerely, f;a..ownevsfj Name: 1,0-w,ei.., Lk h I 3 _. Address: N e LU 0 V-+ i,�a5e 40n1+ 06ay koql4,t i cle.15`Pc,/ 00"r V1Q� Oar t h� OCe.a� aVd --.e tk6L 6f Our IIU�s, }fu//��` E}ey�i +af Ce�lddevT1VP i s os��4aI t) I 0G f- 5 11 n_ A �0� On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this- approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. jgcerely, 1 au, Name:�Pr� Address: Lwkt CA_ gDIG63 . .Z/� 3c5 q On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, 7"tts Nzep VOW Aopx� Name: ice,, d 4.41 Aeda Address: 2 fo llt� �,. 7�/ O y GIs- N?vu +4 �.� rn jssuK c /V4p QQ_tt , c44 gzd63 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Liahtin¢ — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Pazkir►Q — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, 1 Name:'IQUSUfts _t ;dgvve:w.., Address: 2 4 o .Nice L_rs�r, rtlA wft --i" 6 n-A 9 246 j On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Y l rt.c� (p Name: k/ f Arc t; A/ Y V o V 6' L N W Address: V % t, L,.e_ !S a,l (rVt{. a �I v )V- c k �a ►ti.L 0 3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: W.49�7 A&VI On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn of lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name :� Address: Z 2CxJJ t2t S E,vQ On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: � f t c�'l n 1J(Jl 1 C /A ° 2co�3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise – The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting – Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking – The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: M4Z,3 WAk�" k+40 M0LVL- (�Z) Z Address: 270 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View . Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: (11 R RCR4� l C,( f}SGJ Address: !;%S['o j, l t_LF_ I M T- k4 � 1 ' '-- kJ c'e W Q0 QT bFA04 , If^ 'Ju'l -k 6fkL?)nA S�a.CP�,R� S�c'CID►� (' i=�6Pi'r C26n1) On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels: We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li hting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -tom Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Ile Name: v L AtvA Address: 9- o e, 'F 7&"P,,_/- /,u-� %2 tr G 3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li ting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with ".Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping.and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, MM Name: /% Address: � �P U op vQ Y Z_P A,;F—s Y Z, t_�>. 1"),6� On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the_ installation of new, frilly plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Camvus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: 'I, Address:llew®e ,^4_ 13aa�� co/i .7,44 3 v 51- _'.5- Si.'— 96 7.6 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to.support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus L' Hoag's current lower campus lighting is out of compliance ;•: with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Ro Ito Iftddig — The hospital has proposed building multi -level parking structures on . the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping.and taees ott # ; iswer fan , with the DA, and eliminatiprt of the condensatic which,emmiates, from the "poerqOOOC Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. �Sincerely, Name: /7�V91�� �f -Irebeou vas, Address: 6-W Y OY IO9 N�u,�crnfi d�C?1cN C19 92663 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li ting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: -z- n Address: U�6NCY 4A i\)01 �_3,5 _ Kn�gll�J DW p 10vi� Ga- `126 6. On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lightine — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. . Sincerely, n ��,� a Name: a 30cc/y C of Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lijzhtin¢ — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the. parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: /11 //141. 100 !ihv Address: -Z1 O L, /t/�tJj�vr� /'S "4 9z�6� On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or. living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking_ on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, 9icf.arul Sue Taylor 2046 sevd& Ave. Name: `® `,�— Newport Beack Gd 92661 Address: n/O I' le 4al) C--- o01%P�v Ile CA P � On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: �h1, `TQY O �- Address: /." �.n lveua p o )S�,a c,4 C� Rick and Sue ?ayfvr 2046 Sevi% Avg. Vurm Beach, CA 92661 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. WE urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. C. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. of -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: T Gc h I P-- Address: d- ll) (,t W t v } Ch �l(o� On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes.. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, LJ��s / Name: X.�ZMNikT Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach.. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, X aV---2� Name: 1�; I Address: On March 20th after weeks of study, the Planning Commission voted to recommend . - mitigation .of the cggeneration plant plumes. We urge you to support the installation of new, fully plume-abated cooling towers to definitively deal with the cooling tower M plumes. ,Iirtermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty;and high quality of life associated with Newport Beach. By installing the best. available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li ting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, (� Name: TAREK G.M. ZEITOUNE D.D.S. Address: 200 PARIS LANE #315 NEWPORT BEACH, CA 92663 VILLA BALBOA On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: / On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution,. noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Sa 1 crhrn i.� fCa.i' Address: 216 Lto�o , me ..3 v 5� c "(- %z66 3 ��/ c 1..4 6 LB 0.4 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the, hosspp' you for yo consideratiion of the issues described above. Sincerely, e- � , Name: l .� L �i fI ... N64S Olq y�F ' l r �fJl1 Vl Address: dG l0 2i G L /'A,1:, #��� V, P 9 ` C-/,q, Wo/v/ -3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, - rc4k`-' Name: 1�e_Vl n t- R �l tS Vl Address: I(0 L i �IL ( OL N e w T oiT '� (,l, Cc,, On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Build -mg protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Ms. Olivia Sahagun 3431 Hickerson Dr San Jose, CA 95127.4315 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thankk yo for your consideration of the issues described above. Sincerely, Name: j v Address: 3 �� till .4 -1j�,, } iJ �c r tg,,«4 CA `t ZC65 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections For the wider community into the DA sets the stage For sensitive, sustainable growth For Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you For your consideration of the issues described above. Address: V270 A)WA W 411 (^,P'7d 7 X463 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, frilly plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li htin — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating.at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, K(a, 0-,,d 604c, � Name: K-Are,n a n d DO L&-5 �' rn 6 C, I I Address: Gl Sv (�n n �, . , , X n . __4 / a 8 lvocu ,� A tadeaeA, Cq 92(0 t,3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name:�s %�a ��lf✓ Address: v; /0 ay7_t i5/ C4 162 ����3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Uva j ) -- Name: / • �6�. 1 <W //Z3Y1... . Address: a6U 01/1 vi ldUtiR 2 t L_TN �26G3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the ins`allation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li hting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: cam, ✓� >a. (E 5 Address: .?00 ?AA 6 LAA kt 30i 44V�JO,ZT gERep i CA 9263 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed Building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name:�� Address: D G�� t e/�- GAr.� 03 eveti pof CA ' "6 3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. ,Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely; Name: 2160 �a Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: j( /O✓t �° 11,3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lightine — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These strictures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, � .OY %�� vim". Name: Alexis rJ { 10 Address: � 6*J"y (alq */, / 0 wfal, - 6egck,cA %tco3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise - The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Liahtine - Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking - The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Sl,, ,,f Roo I q Address: 2110 D(ce taKe- #I/y CDWikee`, On March 20th, after weeks of study, the Planning Commission voted to recgnxhand mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li ting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, / � Name: p4ytD +AF&- Address: omp* LAI APT 10Z On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, r^ Name: Blau B. 3fowwd 950 Cy" Ln. $103 - Address: P&Pm ftA G4 9260 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Camvus Li hg tine — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall panting lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: / W _;�a/ On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower . plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the. interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: Z4f1,0 /✓ /+Cry I�Ai��� .. .... On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes.. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot; and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name / V O A //4 4) 42 , �5 Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fatly plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -too Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincere , /e: Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: 0 A%r Y.2- /{ 6 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li ting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parkins — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof-top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sin c ly, Na4e: 4U,4A] 5/ t Address: 27 - A6A)&`, 1\1gT J3F__-ACW11 /*7A On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: 'Ono t O�s '47 &.C, JJ Address: 3:2 D CA 6 N Ly k N It / J u N-';2. C-A 9,)_ 6 93 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. oise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Address: �M; ( 3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Liehtin — Hoag's current lower campus lighting is. out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: o On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li tiny — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable • for Hoag. This ultimately serves the interests of the residents, the City,,arfflthe hospital. ank you for your consideration of the issues described above. Address: 200 9Arl,,; Can,4 1 4`3ub A% Rz/ p c)CL l 17 j4% C_14 9z (0 &3 L_N' On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: s GF�i 1 t On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -tot) Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: DWW A. Lamb 2110 Cagney Lena #113 Newport BBee�h, CA 92663 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, frilly plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus LiahtinQ — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: �'� t:. CL!- Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the .physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li hg ti g — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Luke- i �v�Se.CSMrEh Address: ,;t;kO f ,cA L.n.0Q08, NLJor� beaci� 9�b63 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise —The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Toe GxZ tKxw— Address: ttC,3:F ;Lxo h-1 "t,*`18 Ktac.l, 4A On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li ting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, .J sue. f `z C7 Name: �y Address: IQ k/ Ile X- a-10te X116 � C�,rk C" e Af etp&; f act, (:74 � a ��pp On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Q c- 13�c� C42663 Address: ,21v L,'L le- ��� �'�! � �ec`f/� i On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life assoeiated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine, exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: 1 -L (9 7 iv of v✓ P o k -y i3 64 c-4 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, frilly plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate. measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA'sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely z Name: '57CvG= ,S Address: ) 0U /A/ I'S 4 15W 7 'V/'11,00X 7 4,9 f . C�1, C1A(063 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the Cjty, and theJrespital. Thank you for your consideration of the issues described above. Address: .`ZLi D i1� t SCI 313 1 243 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely,1 Name: Address: r�1R �bU orf RvQ. -u� C-A On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation. of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park . are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li ting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Name: Address: m j 80 C441 WY CA 7T�a% NQ,Fbrt ► $C-Nt C4- On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: A C x/69/10 tF G 1 Address: /Oo .090 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By . installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting sting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -tov Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity.. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Awl V try A Address: j ay�� C�)ee Sao/ /Ileer-1 A1,6 EC/ dp IW )0 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li hg tiny — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates fi-om the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Ir ?iJIIIA Address: ac o pans ,r� Y CA On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus LiQhtin — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -too Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume . which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: -Z 0t)t)A 9, NOKT�1� CR�tST� flu��lERs Address: u0 t r i l l gyp Nia.E N EXD pok1 ��.� , � g240 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind.it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lightin¢ — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late everting when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely Name: j,�,-,c' ddress:: 1 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration. plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights .in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton ParkittQ — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: 2t On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, cc Name: �Uci-k--6 Address: 9-cyo ?dc.5 131 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li¢htin — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking —The hospital has proposed building multi -level parking structures on the lower.campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincere Nam . �'J' ". CC) 6y� Address: - . On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkin e — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. .n I J�� Name: L1�l- Address: a";2-0 A4 Le #09t,v4al BaaCA 0�9 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes.. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the h spital. Thank you(�ur consideration of the issues described above. Sincerely,/ Name: J Address: r-ZO I- C A/ br% ,6c',xv. �-e-1 9,-�", 4P �- On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. 3T+!e loge yoiio supooit the installationof new, �nllyplunaebatgdpcooing.to• "wets to,definitrvelyn" "deal with- "thecoA4nxgtowerF plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise – The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country: Please consider adding language to the DA to include this approach. Roof -top Parking– The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking„ which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. 'Pftas0 co,us er epdtt ent a pro brt rogf topFpark ng Oift—A W&Vampiis`= V Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. SiWerely Name: j <rn}� ✓. LYni Address: ?v0~.5 40146 411O7 lve % n_ !CA�%24e On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark. Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lightin g — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: v/� v C /y //�/7/ e Xl i- Address: L 1, -1 /,e c / 6u-4 P 2e ye �% // On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, filly plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: vh� _ — }f o`p ' _. Address: p 8,0, �3 Q Tas���, cam, IA7$I On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkin e — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer. Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: sc( 5C 1� l Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require frill mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincere%fly,,��,/� Name: cot E M- Address: 4 X03 d qn N► �w 1� 6 4A On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation . of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li hting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: e!-���� J �/v e�i� i Address: ,;z ,o i1V �1 X63 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parkin ¢ — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Address A, 9� On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the. cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely Name: Address: a6C� ca��'A/ 144-i� Ch 91 �( 3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the ccoo�eneration is audible day and night, and substantially exceeds the City Noise rdmance. of se standing in Numset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top ParkinE — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Plea consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, 7/ Name: VCR�IA 005oil Address: 02/ 0 A L r 3l3 ya6�3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently -in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: `S im 9 o o rq Address: Z 3 o //c G,Q, �ew�oiT On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise —The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Camuus Li hg tiny — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: Q,;J Address: to o o On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Camous Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: j%cfzr F. 6 ,dam-- - ,06 Dohr&s Address: Ap !t%oe / I _308 /(le w aort Aeaalt, cR 9 a 6 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, frilly plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading ock. Noise from the cogeneration plant is audible day and mg t, and su s antially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current.lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: yam• _ / /�` Address: On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, r l Name:ljCOi Address: aw C.�aVAQ On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Si eel , Name: p qw_ F.. Address: 2a6 (Z+",�� �---V_V, 4 \ o G On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would .include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, /<�� g C,_� Name: X Avoo Address: 2 3 O On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof-to Parkin The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, 'oe Name: 2 Address: o[ 9 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, hilly plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkin — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely,,�,e�� Name: w A-rk' /NS ��10�- 4- Address: �N 20o r7, 0 &3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, frilly plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi -level parking structures on the Iower campus. These structures would include roof -top parkingi which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center: Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, / Name: J Address: �'1249 >0)4 C � iv6 off 9,J 6l On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, frilly plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. /2 - y fee , i>vte PaOG� IkO r e14Q 4 /-LAt AR J� ecae c&n U dj J aJ)f t Lower Campus ng — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -tot) PazkinQ — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: t ri J Address: J(04 l V2,(2-3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Address: 230 I,(k- Lav�.LJ #tot tJe-) PQYk �je m cln� CA, 9 2.1, u3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parkins — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Name: Address: 4=�=� � umn'! On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, N C �Z� Name: Address: 2 0 All Jtj 4:1)0 `% On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, frilly plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. icerel Name: /CG llY2tn PUS/ Address: Zb#Nib # &g�. AliwposJ &RC%. C4 . On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sin l i Name: c` I-{u,UT Address: u c�4C� u� Ly4 tJE ?65j,2nY` On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name:. j"�Itby)6 a N n Address: v4bo Can Lai, Q�. Ner�� P�a�1, cs qZ6� On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. 7AERRvE7 &60m Address: �>J� UL LC LNG�b Alocllwu- On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume - abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sin ly, N HERMAN & AZNIV CANASYN Address: 260 CAGNEY LANE,. #212 NEW PORT BEACH, CA 92663 On March 20th, after weeks of study, the Planning Commission voted toxecommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: A 4 I 4 ,t 1YP �! Address: Z10 ULL� 1,1J. *Zo') On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise- The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Light - Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking -The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, ✓ ✓ ._.�._. Name: y,�/e c �`Y�= ::..,,.✓? -e?� .:...:: Address: ;7-,0 N i 6e- 4N - / d ` On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi-level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, M Name: 71N /k►1 Address: C (� �v G l ip� (tea r `� cv - _� r , I- ( 3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Li tine — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: 1 ' On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Liehtin — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: ��pp Address: CA- `266 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: / 2 to �63 Address: .2", On March 201h, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Cme: 19 Address: 2 % O � �6 3 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -ton Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincer�ely�, ia Name: (7fO OR �DUC{ii Address: (;go N)ej Ln #aU3 (949 695 -7w On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, Name: (V4✓.f'J C%tCrt/ Address: ; CX6.,V X LA7v C _4 ��a 7 IVO C4 9 2x663 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, N e: Address: X/0 On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume . which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Sincerely, 1 Name: C,1, U Address: z (� IV � c t L rIN, . Z On March 20th, after weeks of study, the Planning Commission voted to recommend mitigation of the cogeneration plant plumes. We urge you to support the installation of new, fully plume- abated cooling towers to definitively deal with the cooling tower plumes. Intermediate measures are unlikely to bring about a resolution that is consistent with the physical beauty and high quality of life associated with Newport Beach. By installing the best available technology, Hoag can categorically put this issue behind it. We also ask you to support the implementation of one or more of the methods outlined in the Fluor report to mitigate the engine exhaust plumes. Noise — The hospital is currently out of compliance with the DA limitations on noise at the loading dock. Noise from the cogeneration plant is audible day and night, and substantially exceeds the City Noise Ordinance. Those standing in Sunset View Park are subjected to particularly high noise levels. We urge you to vote to require full mitigation of these noise sources as part of any modification of noise limitations currently in the DA. Lower Campus Lighting — Hoag's current lower campus lighting is out of compliance with the DA. The City is currently considering measures to bring the lighting back into compliance. One concept under consideration is to turn off lower campus parking lights in the late evening when the parking lot is not utilized. This is consistent with the City's practice in its own City Hall parking lot, and with "Dark Sky" initiatives around the country. Please consider adding language to the DA to include this approach. Roof -top Parking — The hospital has proposed building multi -level parking structures on the lower campus. These structures would include roof -top parking, which would be nearly flush with the nearby bluff. This would subject those standing in Sunset View Park or living in nearby residences to the air pollution, noise, and bright lights of cars operating at close proximity. Please consider an amendment to prohibit roof -top parking on the lower campus. Other issues of concern to local residents include keeping landscaping and trees on the lower campus in compliance with the DA, and elimination of the condensate plume which emanates from the Cancer Center. Building protections for the wider community into the DA sets the stage for sensitive, sustainable growth for Hoag. This ultimately serves the interests of the residents, the City, and the hospital. Thank you for your consideration of the issues described above. Si�rely, Name: � Address:M L �c W" �e,o &c�ck, N_ aLk April 9, 2008 CJ Gehlke 210 Lille Lane #317 Newport Beach, CA 92663 The City Council of Newport Beach 3300 Newport Boulevard Newport Beach, CA 92663 Attn: Members of the City Council RE: Hoag Hospital Expansion and Villa Balboa Dear Members of the City Council: ()ate _ 7'1 atoll C� Ceeies anP Toro ---� ?Aayor �uncil PAW* 1--p-2a 2ager "ftjw .UWV. Thank you for your careful review of Hoag Hospital's expansion both past and present. As a neighbor for the last 20 years, co- existing beside Hoag Hospital, I am gratified that your efforts are making a big difference in this long -term challenge for all involved. No sooner than one situation is resolved, another has quickly taken its place. Over the years, the faces have changed along with the recollection of what was and was not agreed to in the process. To be involved over the last 20 years has proved extremely frustrating when I remember and others do not, resulting in broken promises and repeat negotiations covering the same ground on top of those that cover new ground. Again, thank you! Speaking of ground, I would once again like to mention that Hoag Hospital is trying to serve so many on what is rapidly becoming a small piece of ground. Would it not make some sense that during this current real estate downturn, Hoag allocate some of the funds being spent to make amends and turn it toward the purchase of an additional campus in Orange County? This new location could relocate some of the services that are not critical to be located adjacent to the hospital, allowing room for the hospital services the Hoag representatives state are so compromised as the community grows. Hoag is located right next door to a high density residential housing development and the needs of a respected hospital cannot, however, noble, make it acceptable for residents to be so impacted 24/7 in ways that compromise their quality of life in their homes. Perhaps Hoag could talk about making an offer on some of the land that currently houses aging medical buildings and build the medical suites into the plan in some way similar to the way the Newport Mesa Board of Realtors built their new facility with medical offices within the structure. There are also some older mobile home parks in the area that might entertain an offer. Moving back to the issues currently on the table, THANK YOU for reviewing the plumes. This situation is a problem and because it was created without approval, should not be allowed to remain simply because it is "too late now "... Thank you for your review of this situation which is in my full view all day every day. The noise is an issue as we all know.. both the noise from the loading docks and now the new added noise of the children laughing, crying and screaming starting at 5:30 AM and running through 8 PM. This is primarily an adult community and this noise wakes up many residents early in the mornings. Additionally, there is the generous and expensive for Hoag offer from Hoag for the wall, windows and soundproofing package. It is difficult to continue to feel grateful for this when the noise requires residents to keep their windows and sliding glass doors closed particularly in the summer when noise travels farther due to thinner air in order to avoid all this noise. To be forced into that corner of compromise on a 24/7 daily basis in your own home just isn't without harm to residents here. I greatly appreciate that everyone appears to be sincerely trying to find the best compromises possible now that the City Council is involved. Again, thank you! Last and certainly, to clarify a side issue.. I have attended all but one hearing on these matters in City Council Chambers. I work east coast time and am up at 4:30 AM daily. I want to thank you all for taking your time to hear these matters, and to monitor same into the future. The fact that I have quietly left before the meetings are concluded upon occasion is not a matter of disinterest, or lack of appreciation. I take my time to attend after what is possibly a longer day than many in the meeting have experienced, and simply physically run out of steam before a few of these meetings end. It was mentioned to me that some on the Council might feel leaving early was a slap in the face of those who stay and give so much of their time to express concern over these issues. Please let me take this opportunity to again say to each and every one of you how much I appreciate what you are doing. It would be my hope that you would note my attendance regularly and faithfully as a sign of my gratitude, commitment and support rather than the alternative perhaps assumed at least on one occasion. I am tremendously committed to this effort and my home life is severely impacted. The outcomes will be something I have to live with every day and I am very invested in what happens now and tomorrow with the growth of Hoag Hospital both as a homeowner and neighbor and as a possible patient at Hoag Hospital sometime in the future. With Sincere Thanks, Carol m Gehlke Homeowner, Villa Balboa, since 1989 To: Honorable Newport Beach City Council From: 260 Cagney Lane #104 Re: Hoag Mitigation The MAIN PERSONAL reason to address you is to: 1. Allow the 1' floor in 260 & 280 Cagney Lane to have ,sound proof windows as the 2nd & 3`d floors. Because: 1. The sound wall simply cannot be expected to diffuse all noise. 2. The sound wall hopefully will help with GROUND LEVEL road traffic. 3. However, FUTURE CONSTRUCTION OF ALL TYPES 'WILL BE HIGH ABOVE GROUND LEVEL, WHICH THE WALL WILL NOT ALLEVIATi3 (ER and the new Tower). 4. Without the sound - proofing windows we will be subjected to YEARS of Construction noise. Today, with double -paned windows closed tightly in the condo, the noise still penetrates. There are HUGE trucks using the West Road. HOAG has the opportunity NOW to do everything possible. I doubt they want complaints after the wall is up. These windows are a SMALL INVESTMENT for Hoag and could do so much for the residents -- Hoag's MAJOR GROWTH has contributed to the loss of property value here -- so PLEASE approve windows for I" floors of 260 AND 280 Cagney. IT'S ONLT ABOUT 36 I N C H E S between I'& 2°d floor windows, so the I' floor i N WITH THE WALL) STILL GETS ABOUT AS MUCH NOISE -•• EVEN THOUGH ALL THE ENGINEERS SAY NOT SO. �~ rLA)' // WT�> ' ,ice COAST HWY CO -GEN PLANT: You are already aware of the problems --.MAKE HOAG FIX THEM! ! Other businesses would probably have BEEN PROSECUTED FOR LYING & NON - DISCLOSURE. PLEASE MAKE THEM PUT MORE TREES, HUNDREDS IF THAT IS WHAT IT 41t TAKES, TO HELP COVER UP THIS UNSIGHTLYNESS -- AND I:EDIATELY, NOT YEARS FROM NOW!! IN THEIR OWN HANDS ON PAPER THEY PROMISED THERE WOULD BE NO PLUMES. AND SPEED BUMPS ARE NEEDED ON WEST ROAD, WHICH WILL HELP W/NOISE. ymport emat April 12, 2008 Re: Hoag cogeneration plant Dear Council Members, On behalf of the Newport Crest Homeowners Association, the Board of Directors requests the Newport Beach City Council support the recommendation of the Planning Commission regarding the Hoag cogeneration plant be retrofitted to address the problems of exhaust and plume emissions. The Newport Crest neighborhood is impacted by the visibility of the plumes and lies in the prevailing wind pattern of the exhaust emissions. Some of our homes are impacted by the noise of the engines. We acknowledge the many benefits Hoag Hospital brings to our community and appreciate their high standards of healthcare. We encourage Hoag Hospital to apply those same high standards to the cogeneration plant and retrofit it. Regards, Board of Directors NEWPORT CREST HOMEOWNERS ASSOCIATION i��21 - M/ 201 Intrepid Street • Newport Beach, California 92663 • 949/631 -0925 • FAX 949/631 -5433