2023-05-03T07:50:41-05:00 2022-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2021-07-01 330420041 SAN GORGONIO MEMORIAL HOSPITAL SANG 9518451121 600 NORTH HIGHLAND SPRINGS AVENUE BANNING CA 92220 STEVE BARRON CEO 9518451121 2023-04-27 1 STEVE BARRON 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2023-04-27 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z STEVE BARRON 600 NORTH HIGHLAND SPRINGS AVENUE BANNING CA 92220 88294366 0 X WWW.SGMH.ORG X 1991 CA SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. 9 9 791 25 0 0 3875065 700075 66337763 86458538 0 0 1052196 1135753 71265024 88294366 0 0 0 0 48143759 50783459 0 0 115268 43785608 49382141 91929367 100165600 -20664343 -11871234 13082135 22799660 35618971 57367721 -22536836 -34568061 SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. 0 0 83052142 0 86458538 THE HOSPITAL IS COMPRISED OF AN ACUTE CARE FACILITY WHICH PROVIDES HEALTHCARE SERVICES. THE HOSPITAL PROVIDED 43,595 VISITS AND PROVIDED 9,689 DAYS OF CARE DURING THE FISCAL YEAR. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT AN AMOUNT BELOW COST, AND PROVIDES CARE TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CHARITY $1,635,568. UNPAID MEDICAL PROGRAM CHARGES WERE $99,101,316. UNPAID MEDICARE PROGRAM CHARGES FOR THE FISCAL YEAR WERE $49,550,658. TOTAL QUANTIFIABLE COMMUNITY BENEFITS WERE $150,287,542. 83052142 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 211 0 791 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X X MARGARET KAMMER CONTROLLER 9517692118 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 SUSAN DIBIASI CHAIRPERSON 5.00 X X 3500 0 0 STEVEN RUTHLEDGE VICE CHAIR 5.00 X X 3300 0 0 EHREN NGO TREASURER 5.00 X X 1900 0 0 RON RADER SECRETARY 5.00 X X 3800 0 0 PHILIP CAPOBIANCO III BOARD MEMBER 3.00 X 0 0 0 HOWARD KATZ BOARD MEMBER (THRU OCTOBER '21) 3.00 X 0 0 0 JOEL LABAH BOARD MEMBER 3.00 X 0 0 0 RANDAL STEVENS BOARD MEMBER 3.00 X 0 0 0 DENNIS TANKERSLEY BOARD MEMBER 3.00 X 0 0 0 SIRI WELCH BOARD MEMBER 3.00 X 800 0 0 STEVE BARRON CHIEF EXECUTIVE OFFICER 40.00 X 513379 0 34637 PATRICIA BROWN CHIEF NURSING & OPERATING OFFICER 40.00 X 259158 0 29481 DANIEL HECKATHORNE CHIEF FINANCIAL OFFICER 40.00 X 168583 0 10686 KARAN SINGH CHIEF MEDICAL OFFICER 40.00 X 226972 0 11765 JOSE LOPEZ DIRECTOR OF PHARMACY 40.00 X 188391 0 9524 ANGELA BRADY DIRECTOR OF EMERGENCY DEPARTMENT 40.00 X 189443 0 9576 ANNAH KARAM CHIEF OF HUMAN RESOURCES 40.00 X 197621 0 21995 ANNA KAMPANARTSANYAKORN REGISTERED NURSE 40.00 X 204816 0 10737 JOSE RUIZ TECHNICIAN 40.00 X 199512 0 10092 ANNA VALDEZ REGISTERED NURSE 40.00 X 219782 0 11255 OSCAR CRUZ REGISTERED NURSE-PACU 40.00 X 192225 0 9877 2573182 0 169625 100 0 1 0 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PL CHICAGO IL 606731246 EHR SOFTWARE AND SUPPORT 5610359 NORIDIAN HEALTHCARE SOLUTIONS LLC 900 42ND STREET SOUTH FARGO ND 58103 HEALTHCARE ADMINISTRATION SERVICES 2172750 CONCORDANCE HEALTHCARE SOLUTIONS 85 SHAFFER PARK DRIVE TIFFIN OH 44883 HEALTHCARE SERVICE PROVIDER 1675396 DAVITA RENAL HEALTHCARE INC 2000 16TH STREET DENVER CO 80202 HEALTHCARE SERVICE PROVIDER 1561787 BEAVER MEDICAL GROUP 5957 WEST RAMSEY ST BANNING CA 92220 PHYSICIAN SERVICES 1521671 27 72889 400007 227179 700075 NET PATIENT SERVICE REVENUE 621110 86458538 86458538 86458538 BAD DEBT RECOVERIES 900099 818130 818130 CAFETERIA SALES 722514 317623 317623 1135753 88294366 86458538 0 1135753 1664892 1664892 39257042 31636688 7542803 77551 20074 20025 49 6844526 5382630 1448702 13194 2996925 2322917 668314 5694 3000 3000 968406 968406 179873 179873 9884326 7661341 2204205 18780 24035 24035 1617860 1375181 242679 4623397 3929887 693510 1803198 1532718 270480 17551 7020 10531 53847 16154 37693 408970 408970 536570 456084 80486 1427943 1342266 85677 BAD DEBT EXPENSE 12546840 12546840 MEDICAL SUPPLIES 9198454 9198454 LEGAL SETTLEMENT 3417500 3417500 NON-MEDICAL SUPPLIES 1267559 1014047 253512 1402812 1192390 210422 100165600 83052142 16998190 115268 1628250 9218137 11801 16722 957337 142862 8135514 8821939 1776554 1829462 21485 220033 3168512 1027641 0 2140871 551194 409634 13082135 22799660 33498394 36288229 1718319 0 0 14231628 402258 6847864 35618971 57367721 X -22536836 -34568061 -22536836 -34568061 13082135 22799660 X -11871234 -159991 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3168512 1027641 2140871 2140871 LEGAL SETTLEMENT LIABILITY 3417500 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1543868 LEASES PAYABLE 1886496 6847864 1 1 X 1 X 1 X 1 1 0 1 1 254513 254513 0.00290 7253710 15972392 0 0.00000 63100940 58453430 4647510 0.05300 70609163 74425822 4902023 0.05590 7792 7792 0.00010 628492 628492 0.00720 636284 636284 0.00730 71245447 74425822 5538307 0.06320 2 902 7592 7592 0.00010 6 21 628492 628492 0.00720 8 923 636084 636084 0.00730 1 12546840 11725042 23128812 -11403770 X 1 1 1 1 SAN GORGONIO MEMORIAL HOSPITAL 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 WWW.SGMH.ORG 1568469997 330420041 X X X SAN GORGONIO MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 19 1 1 0 1 SGMH.ORG X 1 19 1 SGMH.ORG 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X X 1 X 0 X X X X 1 X 0 0 SAN GORGONIO MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: DISTRICT BOARD AND COMMUNITY LEADERS WERE CONTACTED FOR INFORMATION AND THE NEEDS ASSESSMENT WAS PRODUCED BY AND WITH OTHER HOSPITALS IN THE AREA. SAN GORGONIO MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: THE ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH LOMA LINDA UNIVERSITY HOSPITAL. SAN GORGONIO MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: IT WOULD BE FISCALLY IMPOSSIBLE FOR THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS OF THE COMMUNITY, BUT THROUGH CONTINUED COLLABORATION WITH OTHER COMMUNITY AGENCIES THE HOSPITAL HOPES TO CONTINUE TO IDENTIFY PRIORITY AREAS WHERE THEY CAN MAKE THE MOST IMPACT. THE HOSPITAL HAS IDENTIFIED ACCESS TO HEALTH CARE, BEHAVIORAL HEALTH, WOMEN'S HEALTH SERVICES, AND CHRONIC DISEASE WITH A SPECIAL EMPHASIS ON HEART DISEASE AS THEIR PRIORITY AREAS. THESE WERE CHOSEN AS BROAD PRIORITIES TO ADDRESS A WIDE SPECTRUM OF INTERVENTIONS IN PARTNERSHIP WITH THE COMMUNITY. A FOCUS WILL ALLOW TRUE IMPACT VERSUS BEING FRAGMENTED AND INEFFECTIVE. A DETAILED COMMUNITY HEALTH PLAN HAS BEEN DEVELOPED WITH KEY METRICS FOR EACH OF THE PRIORITY AREAS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 12,546,840. PART II, COMMUNITY BUILDING ACTIVITIES: WE SUPPLIED HEALTHY BALANCES MEALS TO OUR HOMEBOUND SENIORS THAT NEEDED ASSISTANCE AND TO OUR AUXILIARY MEMBERS WHO GRACIOUSLY DONATE THEIR TIME TO ASSIST AT THE HOSPITAL. ALSO, WE HAVE HAD MANY CLASSES FOR OUR ASSOCIATES AS WELL AS TUITION ASSISTANCE TO FURTHER THEIR CAREER. PART III, LINE 2: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED INCLUDES THE COST TO CHARGE RATIO OF PATIENT CARE PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE POLICY CANNOT BE DETERMINED. THE HOSPITAL DID NOT TRACK THE AMOUNT OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY, AND FURTHERMORE SUFFICIENT INFORMATION WAS NOT OBTAINED FROM ALL PATIENTS THAT MIGHT BE ELIGIBLE TO MAKE THIS DETERMINATION AND CALCULATION. PART III, LINE 4: THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE DESCRIBING BAD DEBT EXPENSE. HOWEVER, THERE IS A FOOTNOTE THAT DISCUSSES CHARITY CARE AND COMMUNITY BENEFIT EXPENSE. PART III, LINE 8: ANY SHORTFALL IS DEEMED A COMMUNITY BENEFIT IN ITS ENTIRETY. PART III, LINE 9B: IT IS THE POLICY OF SAN GORGONIO MEMORIAL HOSPITAL THAT ALL PATIENTS WILL BE TREATED FAIRLY IN PRICING AND COLLECTION PRACTICES. THE HOSPITAL'S REGISTRATION AND PATIENT FINANCIAL SERVICES STAFF WILL MAKE A REASONABLE ATTEMPT TO ESTIMATE EACH PATIENT'S LIABILITY. THE HOSPITAL'S PFS STAFF, IN CONJUNCTION WITH CONTRACTED EARLY OUT AGENCIES WILL MAKE A SUBSEQUENTLY ATTEMPT TO COLLECT EACH PATIENT'S LIABILITY AND TO OFFER DISCOUNT AND CHARITY CARE APPLICATIONS. THIS IS OFFERED IN COMPLIANCE WITH CALIFORNIA ASSEMBLY BILL 774 (STATUTES OF 2006) AND SB 1276 (CHAPTER 758, STATUES OF 2014). THIS POLICY DOES NOT APPLY TO ANY PHYSICIAN SERVICES RENDERED AT SGMH. PART VI, LINE 2: THE MANAGEMENT TEAM, HOSPITAL DEPARTMENT STAFF AND MANAGERS, AND THE BOARD OF DIRECTORS ARE COMPRISED OF COMMUNITY MEMBERS. THEY ARE ABLE TO GATHER AND COMMUNICATE THE HEALTH CARE NEEDS OF THE COMMUNITY THE HOSPITAL SERVES AND CONTINUALLY ADDRESS THEM AT STAFF AND BOARD MEETINGS. THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY IS PUBLICLY AVAILABLE ON THE INTERNET AT: HTTP://WWW.SGMH.ORG. THE HOSPITAL CONDUCTED A CHNA/IMPLEMENTATION STRATEGY IN 2019 THAT IS ALSO POSTED ON THE ORGANIZATION'S WEBSITE, AND WILL BE APPLICABLE TO THE COMING FEW YEARS' FORM 990S. PART VI, LINE 3: IT IS THE HOSPITAL'S POLICY THAT WHEN IT BECOMES APPARENT THAT A PATIENT MAY HAVE DIFFICULTY IN MEETING HIS/HER FINANCIAL RESPONSIBILITY TO THE HOSPITAL, THE PATIENT WILL BE REQUESTED TO COMPLETE THE APPLICATION PROCESS FOR CALIFORNIA MEDI-CAL AND/OR OTHER AVAILABLE PROGRAMS. HOSPITAL STAFF ASSIST IN THE APPLICATION PROCESS. PATIENTS WHO DO NOT QUALIFY FOR CALFORNIA MEDI-CAL OR OTHER ASSISTANCE MAY APPLY FOR THE HOSPITAL'S ASSISTANCE PROGRAM. PART VI, LINE 4: THE HOSPITAL IS A RURAL HOSPITAL LOCATED IN THE PASS AREA OF RIVERSIDE COUNTY. IT PRIMARILY SERVES THE CITIES OF BANNING, BEAUMONT, CABAZON, AND CALIMESA, CALIFORNIA. THE POPULATION SERVED IS HIGH-RISK DUE TO POVERTY LEVEL INCOMES, LOW EDUCATION LEVELS, AND HIGH DRUG USE. THE COUNTY HAS AN UNEMPLOYMENT RATE OF 8.7%. THE HOSPITAL'S PAYOR MIX INCLUDES APPROXIMATELY 31% MEDI-CAL RECIPIENTS AND 5% UNINSURED. PART VI, LINE 5: THE HOSPITAL CONTINUES TO STRIVE TO MEET THE HEALTH NEEDS OF ITS COMMUNITY AS THESE NEEDS EVOLVE. PART VI, LINE 7, REPORTS FILED WITH STATES CA X X X X 0 0 0 0 0 0 0 0 0 STEVE BARRON CHIEF EXECUTIVE OFFICER 513379 0 0 0 0 0 30607 0 4030 0 548016 0 0 0 PATRICIA BROWN CHIEF NURSING & OPERATING OFFICER 259158 0 0 0 0 0 25916 0 3565 0 288639 0 0 0 KARAN SINGH CHIEF MEDICAL OFFICER 226972 0 0 0 0 0 11349 0 416 0 238737 0 0 0 ANNA VALDEZ REGISTERED NURSE 219782 0 0 0 0 0 10989 0 266 0 231037 0 0 0 ANNAH KARAM CHIEF OF HUMAN RESOURCES 197621 0 0 0 0 0 19762 0 2233 0 219616 0 0 0 ANNA KAMPANARTSANYAKORN REGISTERED NURSE 204816 0 0 0 0 0 10241 0 496 0 215553 0 0 0 JOSE RUIZ TECHNICIAN 199512 0 0 0 0 0 9976 0 116 0 209604 0 0 0 OSCAR CRUZ REGISTERED NURSE-PACU 192225 0 0 0 0 0 9611 0 266 0 202102 0 0 0 ANGELA BRADY DIRECTOR OF EMERGENCY DEPARTMENT 189443 0 0 0 0 0 9472 0 104 0 199019 0 0 0 JOSE LOPEZ DIRECTOR OF PHARMACY 188391 0 0 0 0 0 9420 0 104 0 197915 0 0 0 DANIEL HECKATHORNE CHIEF FINANCIAL OFFICER 168583 0 0 0 0 0 8429 0 2257 0 179269 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE FINANCE COMMITTEE AND FULL BOARD AT A MONTHLY BOARD MEETING, BUT MAY BE PRESENTED AT A DATE SUBSEQUENT TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EXECUTIVE ASSISTANT MONITORS AND DOCUMENTS CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEW AND APPROVE MANAGEMENT WAGES EACH YEAR DURING THE BUDGET PROCESS. SOURCES UTILIZED BY THE BOARD WHEN REVIEWING FAIR MARKET VALUE IN COMPENSATION INCLUDE MARKET SURVEYS AND SALARY RANGES PROVIDED BY THE HR DEPARTMENT. FORM 990, PART VI, SECTION C, LINE 19 PUBLISHED ON WEBSITE WWW.SCGH.ORG OR AVAILABLE BY REQUEST FROM THE CEO, CFO, CONTROLLER, OR EXECUTIVE ASSISTANT. FORM 990, PART XI, LINE 9: GASB LEASE RESTATEMENT -18,431. CHANGE IN INTEREST IN FOUNDATION -141,560. SAN GORGONIO HEALTH CARE DISTRICT 600 N HIGHLAND SPRINGS AVE BANNING CA 92220 956004149 HEALTHCARE CA GOVERNMENT N/A 0 SAN GORGONIO MEMORIAL HOSPITAL FOUNDATION 600 N HIGHLAND SPRINGS AVE BANNING CA 92220 953863230 SUPPORT SAN GORGONIO MEMORIAL HOSPITAL CA 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0