SAN GORGONIO MEMORIAL HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- SAN GORGONIO MEMORIAL HOSPITAL (EIN 33-0420041)
- Tax period
- 2018-07-01 to 2019-06-30
- Filed
- 2020-05-06
- IRS object ID
- 202031279349300608
- Schema version
- 2018v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-05-06T06:39:25-07:00 | ReturnTs |
| Tax Period End | 2019-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 472718509 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JWT & Associates LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 East Herndon Avenue Suite 211 | AddressLine1Txt |
| City | Fresno | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93720 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 330420041 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | San Gorgonio Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SANG | BusinessNameControlTxt |
| Phone | 9518451121 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 North Highland Springs Ave | AddressLine1Txt |
| City | Banning | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92220 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | David Recupero | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2020-05-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Inger Sullenger CPA | PreparerPersonNm |
| PTIN | P01464277 | PTIN |
| Phone | 5594317708 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | David Recupero | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 North Highland Springs Ave | AddressLine1Txt |
| City | Banning | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92220 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $67,463,316 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.sgmh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | San Gorgonio Memorial Hospital is a nonprofit public benefit corporation formed for the purpose of operating the San Gorgonio Acute Care Facility. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 818 | TotalEmployeeCnt |
| Total Volunteers | 85 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $559,282 | PYContributionsGrantsAmt |
| CY Contributions Grants | $412,219 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $64,695,815 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $64,951,314 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,769,218 | PYOtherRevenueAmt |
| CY Other Revenue | $2,099,783 | CYOtherRevenueAmt |
| PY Total Revenue | $67,024,315 | PYTotalRevenueAmt |
| CY Total Revenue | $67,463,316 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $45,416,267 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $43,810,736 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,108,199 | PYOtherExpensesAmt |
| CY Other Expenses | $24,192,341 | CYOtherExpensesAmt |
| PY Total Expenses | $72,524,466 | PYTotalExpensesAmt |
| CY Total Expenses | $68,003,077 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$5,500,151 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$539,761 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,817,094 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,825,185 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,762,957 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $19,648,236 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,054,137 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,176,949 | NetAssetsOrFundBalancesEOYAmt |
| Mission | San Gorgonio Memorial Hospital is a nonprofit public benefit corporation formed for the purpose of operating the San Gorgonio Acute Care Facility. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $54,272,211 | ExpenseAmt |
| Revenue | $67,051,097 | RevenueAmt |
| Desc | The Hospital is comprised of an acute care facility which provides healthcare services. The Hospital provided 51,289 visits and treated 11,500 patients 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 ($674,019)and uncompensated care ($466,669) totaled $1,140,688. Unpaid Medi-Cal program charges were $81,609,109. Unpaid Medicare program charges for the fiscal year were $51,371,677. Thus, total quantifiable community benefits per Audited Financial Statements-Note N were $134,121,474. | Desc |
| Total Program Service Expenses | $54,272,211 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 197 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 818 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Margaret Kammer Controller | PersonNm |
| Phone | 9517692118 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 North Highland Springs Ave | AddressLine1Txt |
| City | Banning | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92220 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Georgia Sobiech | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $900 | $0 | $0 | ||
| Jerilynn Kaibel DC | ||||||||
| Chair | 1.00 | 0.00 | Yes (X) | $1,700 | $0 | $0 | ||
| Estelle Lewis | ||||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $2,400 | $0 | $0 | ||
| DeNae Reagins | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | $2,500 | $0 | $0 | ||
| Olivia Hershey | ||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | $3,900 | $0 | $0 | ||
| Bakhtiar Ahmad MD | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $1,800 | $0 | $0 | ||
| Lynn Baldi | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $2,900 | $0 | $0 | ||
| Barbara Djordjevic | ||||||||
| Director PartYr | 1.00 | 0.00 | Yes (X) | $1,300 | $0 | $0 | ||
| Ehren Ngo | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $900 | $0 | $0 | ||
| Farzad Farrokhi MD | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $1,700 | $0 | $0 | ||
| Steve Ruthledge | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Ron Raider | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $4,100 | $0 | $0 | ||
| N Irwin Reeves | ||||||||
| Director PartYr | 1.00 | 0.00 | Yes (X) | $400 | $0 | $0 | ||
| Susan DiBiasi | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $3,200 | $0 | $0 | ||
| Dennis Tankersley | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $2,400 | $0 | $0 | ||
| David Recupero | ||||||||
| CFO | 45.00 | 0.00 | $224,205 | $0 | $78,471 | Yes (X) | ||
| Patricia Brown | ||||||||
| Chf of Nursing | 45.00 | 0.00 | $170,501 | $0 | $59,675 | Yes (X) | ||
| Steven Barron | ||||||||
| CEO | 45.00 | 0.00 | $505,889 | $0 | $151,767 | Yes (X) | ||
| Angela Brady | ||||||||
| ER Director | 60.00 | 0.00 | $192,881 | $0 | $67,508 | Yes (X) | ||
| Anna Kampanartsanyakorn | ||||||||
| RN | 56.00 | 0.00 | $181,634 | $0 | $72,778 | Yes (X) | ||
| Jose A Lopez | ||||||||
| Pharmacy Director | 50.00 | 0.00 | $162,807 | $0 | $67,130 | Yes (X) | ||
| Tzarimna Karam | ||||||||
| Chief Human Res | 45.00 | 0.00 | $158,053 | $0 | $60,341 | Yes (X) | ||
| Tuanhuy Nguyen | ||||||||
| CT Tech | 45.00 | 0.00 | $156,682 | $0 | $67,480 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,782,752 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $625,150 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 50 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Cardinal Health Pharmacy Distrib | |||||
| 27680 Ave Mentry | Valencia | CA | 91355 | Pharmaceuticals | $1,425,968 |
| Mckesson Medical Surgical | |||||
| PO Box 98347 | Chicago | IL | 60693 | Lab Supplies | $1,066,120 |
| Desert Anesthesia Consulting LLP | |||||
| 25612 Barton Rd 368 | Loma Linda | CA | 92354 | Anesthesia Services | $1,049,548 |
| Davis Wright Tremaine LLP | |||||
| 920 5th Ave Ste 3300 | Seattle | WA | 98104 | Legal & Consulting | $966,355 |
| Owens and Minor | |||||
| 9120 Lockwood Blvd | Mechanicsville | VA | 23116 | Hospital Supplies | $873,022 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 47 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $402,246 | RelatedOrganizationsAmt |
| All Other Contributions | $9,973 | AllOtherContributionsAmt |
| Total Contributions | $412,219 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Svc Revenue | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $64,951,314 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $64,951,314 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $64,951,314 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Cafeteria,Med Records,etc | 622110 | $824,930 | $824,930 |
| Physical Therapy Jt Ventr | 621300 | $1,274,853 | $1,274,853 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,099,783 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $67,463,316 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $67,051,097 | RelatedOrExemptFuncIncomeAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,088,049 | TotalAmt |
| Management And General | $1,088,049 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,206,658 | TotalAmt |
| Program Services | $29,327,113 | ProgramServicesAmt |
| Management And General | $4,879,545 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,525,313 | TotalAmt |
| Program Services | $3,929,794 | ProgramServicesAmt |
| Management And General | $595,519 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,398,756 | TotalAmt |
| Program Services | $1,174,100 | ProgramServicesAmt |
| Management And General | $224,656 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,591,960 | TotalAmt |
| Program Services | $2,151,943 | ProgramServicesAmt |
| Management And General | $440,017 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,310 | TotalAmt |
| Management And General | $155,310 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $480,095 | TotalAmt |
| Management And General | $480,095 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,723 | TotalAmt |
| Management And General | $36,723 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,338,480 | TotalAmt |
| Program Services | $2,138,584 | ProgramServicesAmt |
| Management And General | $1,199,896 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,871 | TotalAmt |
| Management And General | $42,871 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $395,607 | TotalAmt |
| Program Services | $274,540 | ProgramServicesAmt |
| Management And General | $121,067 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $917,577 | TotalAmt |
| Program Services | $636,773 | ProgramServicesAmt |
| Management And General | $280,804 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,720,064 | TotalAmt |
| Program Services | $2,303,694 | ProgramServicesAmt |
| Management And General | $416,370 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,005 | TotalAmt |
| Program Services | $73,812 | ProgramServicesAmt |
| Management And General | $32,193 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,138 | TotalAmt |
| Program Services | $29,321 | ProgramServicesAmt |
| Management And General | $75,817 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,572 | TotalAmt |
| Management And General | $245,572 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,023,205 | TotalAmt |
| Program Services | $957,315 | ProgramServicesAmt |
| Management And General | $65,890 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies & Drugs | $6,532,426 | $6,532,426 | |
| Other Purchased Services | $3,407,878 | $2,183,039 | $1,224,839 |
| Service Agrmts/Rprs & Maint | $1,737,388 | $1,112,947 | $624,441 |
| Non Medical Operating Supplies | $1,486,087 | $594,435 | $891,652 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,461,915 | TotalAmt |
| Program Services | $852,375 | ProgramServicesAmt |
| Management And General | $609,540 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,003,077 | TotalAmt |
| Program Services | $54,272,211 | ProgramServicesAmt |
| Management And General | $13,730,866 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,411,239 | BOYAmt |
| EOY | $1,044,462 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,513 | BOYAmt |
| EOY | $4,717 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $873,665 | BOYAmt |
| EOY | $1,224,719 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,470,335 | BOYAmt |
| EOY | $8,329,763 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,603,696 | BOYAmt |
| EOY | $1,668,855 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $836,752 | BOYAmt |
| EOY | $280,427 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $636,346 | BOYAmt |
| EOY | $646,319 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,980,548 | BOYAmt |
| EOY | $10,625,923 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,817,094 | BOYAmt |
| EOY | $23,825,185 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,762,957 | BOYAmt |
| EOY | $18,915,691 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $732,545 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,762,957 | BOYAmt |
| EOY | $19,648,236 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,826,493 | BOYAmt |
| EOY | $3,937,865 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,918 | BOYAmt |
| EOY | $26,828 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,726 | BOYAmt |
| EOY | $212,256 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,054,137 | BOYAmt |
| EOY | $4,176,949 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,817,094 | BOYAmt |
| EOY | $23,825,185 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$539,761 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $662,573 | PriorPeriodAdjustmentsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Assets Lim As to Use | $12,787 |
| Intergovernmental Receivable | $10,058,792 |
| MCE Bed Fund Receivable | |
| Third-Party Settlements | $554,344 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $10,625,923 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated settlements payable | Desc |
| Amt | $732,545 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $732,545 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $67,463,316 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $67,463,316 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $67,463,316 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $68,003,077 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $68,003,077 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $68,003,077 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X : FIN48 Footnote | FormAndLineReferenceDesc |
| Explanation | Part X - FIN 48 FootnoteThe Hospital is exempt from federal income tax. Accordingly, no provision for income tax is necessary. The Hospital evaluates uncertain tax positions whereby the effect of the uncertainty would be recorded if the outcome was considered probable and reasonably estimable. As of June 30, 2018 and 2017, the Hospital had no uncertain tax positions requiring accrual. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $319,393 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $319,393 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00470 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,122,920 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,442,005 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,680,915 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03940 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,088,029 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $28,715,513 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,372,516 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10840 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $49,530,342 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,157,518 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,372,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15250 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 1039 | PersonsServedCnt |
| Total Community Benefit Expns | $4,001 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,001 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 135 | PersonsServedCnt |
| Total Community Benefit Expns | $48,504 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $48,504 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 1174 | PersonsServedCnt |
| Total Community Benefit Expns | $52,505 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $52,505 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 1174 | PersonsServedCnt |
| Total Community Benefit Expns | $49,582,847 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,157,518 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,425,329 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15330 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 910 | PersonsServedCnt |
| Total Community Benefit Expns | $6,447 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,447 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 910 | PersonsServedCnt |
| Total Community Benefit Expns | $6,447 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,447 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $10,296,276 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $32,347,710 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $44,654,616 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$12,306,906 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | San Gorgonio Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 North Highland Springs Ave | AddressLine1Txt |
| City | Banning | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92220 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.sgmh.org | WebsiteAddressTxt |
| State License | 250000199 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | San Gorgonio Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | sgmh.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | sgmh.org | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 350.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.0000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Engaged Legal Judicial Process | Yes (X) | EngagedLegalJudicialProcessInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Facility: San Gorgonio Memorial Hospital - Part V, Section B, Line 5 | The Hospital partnered with LLUMC Community Health Development Department and the Riverside County Department of Public Health Development Department and the Riverside County Department of Public Health looking at both quantitative and qualitative data impacting the health of the community. The team conducting the assessment included public health professionals and the assessment included input from community members, community agencies. |
| Facility: San Gorgonio Memorial Hospital - Part V, Section B, Line 6a | The assessment was conducted in collaboration with Loma Linda University, as well as, Riverside and San Bernardino County Public Health Departments. |
| Facility: 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, 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 verses being fragmented and ineffective. A detailed community health plan has been developed with key metrics for each of the priority areas. |
| Facility: San Gorgonio Memorial Hospital - Part V, Section B, Line 18e | The hospital does not take any of these actions, it assigns delinquent accounts to a collections agency. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | The costing methodology used to determine the amounts reported includes the cost to charge ratio of patient care. |
| Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit | 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 - Bad Debt Expense | The Financial statements do not contain a footnote describing bad debt expense. However, there is a footnote (Note Q) that discusses charity care and community benefit expense. |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | Any shortfall is deemed a community benefit in its entirety. |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | The Hospital's business office staff follow up on accounts 15 to 30 days after the accounts are billed. The staff contact the insurers to verify claims have been received and to resend the claims if necessary. After verifying claims have been received, the staff continue to contact the insurers every 30 days, as necessary, to follow up on the status of the claims. All claims not resolved within 60 days of billing are reviewed by a supervisor or manager for additional guidance and consideration. Accounts not resolved within 60 days of billing are considered delinquent. The supervisor or manager will determine whether the accounts should be written off as bad debt, further collection procedures should be attempted, and/or the state insurance commission office should be contacted. |
| Part V - Explanation of Number of Facility Type | There is one licensed general medical and surgical hospital that offers 24-hour emergency room services. |
| Part VI, Line 2 - Needs Assessment | 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.orgThe 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 - Patient Education of Eligibility for Assistance | 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 - Community Information | 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 14.2%. The Hospital's payor mix includes approximately 23% Medi-Cal recipients and 11% uninsured. |
| Part VI, Line 4 - Community Building Activities | The Hospital holds community education courses such as CPR certification, smoking cessation, childbirth preparation, disaster preparedness, cancer education, health fairs etc. The Hospital also has several contracts with various schools to provide teaching programs for nursing students. This training contributes to healthcare professional development of the students. Hospital staff volunteer in community support activities such as relay for life, toys for tots, and many others. The Hospital also provides usage of meeting rooms at no charge to various community groups. |
| Part VI, Line 5 - Promotion of Community Health | The hospital continues to strive to meet the health needs of its community as these needs evolve. |
| Part VI, Line 6 - Affilated Health Care System | N/A |
| Part VI, Line 7 - States Filing of Community Benefit Report | CA |
| Part VI - Additional Information | Schedule H Part IV - Management Companies and Joint Ventures: The hospital was involved in a joint venture with Loma Linda University to provide Physical therapy until its termination in October 2018. The Hospital was responsible for staffing it, while Loma Linda provided facilities and handled billing. The Hospital and Loma Linda University have separate boards, and none of the hospital's employees or board members owned more than 10% of the Joint Venture. Thus, the Schedule H instructions do not require listing information in Part IV. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt |
|---|---|---|---|---|---|
| Angela Brady | |||||
| ER Director | $192,881 | $9,644 | $57,864 | $260,389 | $17,992 |
| Anna Kampanartsanyakorn | |||||
| RN | $181,634 | $18,288 | $54,490 | $254,412 | $11,848 |
| David Recupero | |||||
| CFO | $224,205 | $11,210 | $67,261 | $302,676 | $28,786 |
| Jose A Lopez | |||||
| Pharmacy Director | $162,807 | $18,288 | $48,842 | $229,937 | $18,000 |
| Patricia Brown | |||||
| Chf of Nursing | $170,501 | $8,525 | $51,150 | $230,176 | $29,740 |
| Steven Barron | |||||
| CEO | $505,889 | $151,767 | $657,656 | ||
| Tuanhuy Nguyen | |||||
| CT Tech | $156,682 | $20,475 | $47,005 | $224,162 | |
| Tzarimna Karam | |||||
| Chief Human Res | $158,053 | $12,925 | $47,416 | $218,394 | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part III, Additional Information | FormAndLineReferenceDesc |
| Explanation | Compensation of highest paid officers and other individuals is reviewed and approved by the Board of Directors each year during the budget process, and arrangements are solidified in written employment contracts. Sources utilized by the Board when reviewing fair market value in compensation include market surveys, salary ranges, and Form 990 information of comparable organizations. Bonus or incentive compensation, in the event received, is based on the individual's unique qualifications and succcessful achievement of different goals. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Farzad Farrokhi | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Board Member | RelationshipDescriptionTxt |
| Transaction | $524,774 | TransactionAmt |
| Transaction | Phys Group Partner | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L, Part V Supplemental Information | FormAndLineReferenceDesc |
| Explanation | The Hospital had a contract with Desert Anesthesia until October 2018. Dr. Farrokhi (Hospital board Member) is a 50% partner of Desert Anesthesia. This transaction is reportable on Schedule L as a business transaction and Dr. Farrokhi is deemed to have lost independence in voting as a hospital Board member (Per Form 990 Instructions). | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 1a: Explanation of Delegated Broad Authority to Committee | The Board has delegated authority to a finance committee to oversee the audit, and other monthly financial matters. |
| Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | The Hospital has a contract with Desert Anesthesia, of which Dr. Farrokhi (Hospital board member) is a 50% partner. This transaction is reportable on Schedule L as a business transaction and Dr. Farrokhi is deemed to have lost independence in voting as a hospital Board member Per Form 990 Instructions). |
| Form 990, Part VI, Line 11b: Form 990 Review Process | 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, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Executive Assistant monitors and documents conflicts. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | 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, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | 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, Line 18: Explanation of Other Means Forms Available For Public Inspection | Published on website at www.sgmh.org and available upon request from CEO, CFO, Controller or Executive Assistant. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Published on website www.sgmh.org or available by request from the CEO, CFO, Controller, or Executive Assistant. |
| Form 990 Part IX Col D | The Hospital has left column D blank, as there was no compensated grant-writer position and no material other fundraising expenses. |
| Form 990, Part I, Line 6 | The Hospital volunteers help in the Gift Shop, Cafeteria, and Reception Booths, as well as Materials Management deliveries and mailings. |
| Form 990, Part V, Lines 7a & 7b | The Hospital did receive contributions from donors, although none of them were made partly for goods and for services. Donors made donations without the receipt of any goods or services, and the donor was properly notified of the deductible value of the donation they made. Thus questions 7a&b were marked "No," since no goods and services in combination were received by donors. |
| Schedule H, Part I, Table 7 | Financial Assistance and Means-Tested Government Programs: The Hospital has recorded its community benefit expense in the form of traditional charity care and other uncompensated care in row a-financial assistance at cost, unpaid Medi-Cal program charges in row b-Medicaid, and unpaid medicare program charges in row c-Costs of other means-tested government programs.Other Benefits: Community health improvement services expenses such as: Banning Healthy Cities Meetings, Banning Health Fair/Fun Run, Passcom Hosted Suite Meeting, Disaster Preparedness Hosted Meetings, Ham Radio Classes Hosted for Community, and Banning Women's Club are recorded in row e - Community health improvement services and community benefit operations. Nursing education expense for education provided at area schools is recorded in row f - Health professions education. |
| Schedule H, Part II | Expenses for community support activities such as: Relay for Life, City of Banning Nutritional Education Backpack Giveaway, Volunteer time collecting box tops for community school children, Carol's kitchen homeless fund drive, and soroptimist leadership fund are reported on line 3-Community Support. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| San Gorgonio Health Care District | ||||||||||
| 600 N Highland Springs Ave | Banning | CA | 92220 | 956004149 | Healthcare | CA | Govt | N/A | NA | false |
| San Gorgonio Memorial Hospital Foundatio | ||||||||||
| 600 N Highland Springs Ave | Banning | CA | 92220 | 953863230 | Support San Gorgonio Memorial Hospital | CA | 501c3 | 7 | NA | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| San Gorgonio Health Care District | ||
| k | $653,465 | Cash Value |
| San Gorgonio Memorial Hospital Foundatio | ||
| c | $82,964 | Cash Value |
| San Gorgonio Memorial Hospital Foundatio | ||
| n | $646,319 | FMV |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule R, Part V | FormAndLineReferenceDesc |
| Explanation | The District owns the building and leases it to the Hospital.The Hospital is a box 7, section 170(b)(1)(A)(vi) organization whose purpose is primarily to support the activities of the Hospital and in turn improve the health of the community. The Hospital records its interest in the net assets of the Foundation, assets that have been collected by the Foundation, but not yet distributed to the Hospital as of the end of each fiscal year. The interest of these assets for the year ended June 30, 2019 was $646,319. | ExplanationTxt |