2019-05-03T05:56:08-07:00 2018-06-30 472718509 JWT & Associates LLP 1111 East Herndon Avenue Suite 211 Fresno CA 93720 990 2017-07-01 330420041 San Gorgonio Memorial Hospital SANG 9518451121 600 North Highland Springs Ave Banning CA 92220 David Recupero CFO 2019-05-03 true Inger Sullenger CPA P01464277 5413636707 X 2017 2019-02-21 02:37:17Z David Recupero 600 North Highland Springs Ave Banning CA 92220 67024315 false false 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. 13 12 819 85 0 378070 559282 70360678 64695815 0 1804431 1769218 72543179 67024315 0 0 46439923 45416267 0 0 25948277 27108199 72388200 72524466 154979 -5500151 25105210 21817094 15550922 17762957 9554288 4054137 San Gorgonio Memorial Hospital is a nonprofit public benefit corporation formed for the purpose of operating the San Gorgonio Acute Care Facility. false false 57723709 66465033 The Hospital is comprised of an acute care facility which provides healthcare services. The Hospital provided 52,714 visits and treated 11,632 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 ($964,919)and uncompensated care ($760,145) totaled $1,725,064. Unpaid Medi-Cal program charges were $96,924,579. Unpaid Medicare program charges for the fiscal year were $47,613,567. Thus, total quantifiable community benefits per Audited Financial Statements-Note Q were $146,263,210. 57723709 true true false false false false false false false false false false false true false true false true false false false false false false false false true true false false true false false false false false false false false false false false false false false false false true false false false true 198 0 true 819 true false false false false false false false false 0 false false false false false false false false false false X 13 12 true false false false false false false true true false false false true true true true true true true false X X X Margaret Kammer Controller 9517692118 600 North Highland Springs Ave Banning CA 92220 Jerilynn Kaibel DC Chair 1.00 0.00 X 5000 0 0 Estelle Lewis Vice Chair 1.00 0.00 X 4900 0 0 DeNae Reagins Secretary 1.00 0.00 X 3500 0 0 Olivia Hershey Treasurer 1.00 0.00 X 4800 0 0 Bakhtiar Ahmad MD Director 1.00 0.00 X 2500 0 0 Lynn Baldi Director 1.00 0.00 X 4000 0 0 Joe Dotan MD Director 1.00 0.00 X 1700 0 0 Robert Ewert Director 1.00 0.00 X 1400 0 0 Farzad Farrokhi MD Director 1.00 0.00 X 1400 0 0 David Frisbie Director 1.00 0.00 X 300 0 0 Ron Raider Director 1.00 0.00 X 2900 0 0 N Irwin Reeves Director 1.00 0.00 X 3400 0 0 Brian Sylva Director 1.00 0.00 X 1600 0 0 Luella Thorton Director 1.00 0.00 X 1400 0 0 David Recupero CFO 45.00 0.00 X 194515 0 44956 Mark Turner CEO Partial Yr 45.00 0.00 X 325686 0 49512 Patricia Brown Chf of Nursing 45.00 0.00 X 152307 0 42829 Steven Barron Interim CEO 45.00 0.00 X 104012 0 0 Angela Brady ER Director 60.00 0.00 X 195817 0 28584 Anna Kampanartsanyakorn RN 56.00 0.00 X 177947 0 21808 Jose A Lopez Pharmacy Director 50.00 0.00 X 157858 0 27248 Carrie M Echols OB Nurse Director 50.00 0.00 X 141352 0 34022 Kari Spoelstra Lactation Nurse 50.00 0.00 X 137637 0 32253 1625931 281212 51 false true false Anthem Blue Cross PO Box 511300 Los Angeles CA 90051 Insurance Svcs 3364820 Cardinal Health Pharmacy Distrib 27680 Ave Mentry Valencia CA 91355 Pharmaceuticals 1571887 Desert Anesthesia Consulting LLP 25612 Barton Rd 368 Loma Linda CA 92354 Anesthesia Services 1245133 McKesson Medical Surgical PO Box 98347 Chicago IL 60693 Lab Supplies 1163633 Medline Industries Dept LA 21558 Pasadena CA 91185 Hospital Supplies 998442 56 481417 77865 559282 Net Patient Svc Revenue 622110 64695815 64695815 64695815 0 0 0 0 0 0 0 0 Cafeteria,Med Records,etc 622110 666461 666461 Physical Therapy Jt Ventr 621300 1102757 1102757 1769218 67024315 66465033 0 0 0 0 1031805 1031805 0 34974010 29985003 4989007 1125200 977127 148073 5660692 4751520 909172 2624560 2179009 445551 228287 228287 1362915 1362915 34075 34075 0 0 0 2481787 1589798 891989 281903 281903 213489 148155 65334 0 0 1799169 1523764 275405 62232 43333 18899 0 104762 29216 75546 334791 334791 0 0 1038443 971571 66872 Medical Supplies & Drugs 8175803 8175803 Other Purchased Services 6974869 4468004 2506865 Intergovernmental Fees 2606991 2606991 Other Operating Expenses 1408683 274415 1134268 0 72524466 57723709 14800757 0 549799 3411239 4513 4513 0 9379159 7470335 0 0 0 1643618 1603696 607058 836752 0 0 0 558481 636346 0 12362582 7854213 25105210 21817094 15550922 17762957 15550922 17762957 X 9359489 3826493 16296 19918 178503 207726 9554288 4054137 25105210 21817094 -5500151 X false true X true false X Assets Lim As to Use 4821 Intergovernmental Receivable 5700379 MCE Bed Fund Receivable 267848 Other Receivables 873665 Third-Party Settlements 1007500 7854213 X 67024315 67024315 67024315 72524466 72524466 72524466 Part X : FIN48 Footnote 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. true true X true X true X true true true false true true 483018 483018 0.00670 14722208 11688676 3033532 0.04180 34351819 27273577 7078242 0.09760 49557045 38962253 10594792 0.14610 9 786 3043 3043 1 116 54284 54284 0.00070 10 902 57327 57327 0.00070 10 902 49614372 38962253 10652119 0.14680 8 900 7344 7344 0.00010 8 900 7344 7344 0.00010 true 9672028 30807343 42528206 -11720863 X true true 1 1 San Gorgonio Memorial Hospital 600 North Highland Springs Ave Banning CA 92220 www.sgmh.org 250000199 X X X false false true X X X X X X X X 16 true true true true X true 16 true See Sch H, Pg 9, Part VI Need Assess false false true X 350.0000 350.0000 X X X X true true X X X true X X X true X true X X X X X X true X false false Part V, Line 5 - Account Input from Persons Who Represent the Community 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. Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment The assessment was conducted in collaboration with Loma Linda University, as well as, Riverside and San Bernardino County Public Health Departments. Part V, Line 18e - Other Collection Actions Against a Patient The hospital does not take any of these actions, it assigns delinquent accounts to a collections agency. 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 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.org 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 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 - Additional Information Schedule H Part IV - Management Companies and Joint Ventures: The hospital is involved in a joint venture with Loma Linda University to provide Physical therapy. The Hospital is responsible for staffing it, while Loma Linda provides facilities and handles billing. The Hospital and Loma Linda University have separate boards, and none of the hospital's employees or board members own more than 10% of the Joint Venture. Thus, the Schedule H instructions do not require listing information in Part IV. X X X X false false false false false false false false false false Angela Brady ER Director 195413 404 17992 10592 224401 18000 Anna Kampanartsanyakorn RN 177795 152 11848 9960 199755 9369 Carrie M Echols OB Nurse Director 140600 752 26000 8022 175374 23800 David Recupero CFO 194361 154 28786 16170 239471 15435 Jose A Lopez Pharmacy Director 157706 152 18000 9248 185106 8815 Kari Spoelstra Lactation Nurse 137485 152 23998 8255 169890 23077 Mark Turner CEO Partial Yr 325686 25964 23548 375198 29096 Patricia Brown Chf of Nursing 152148 159 29740 13089 195136 27681 Part III, Additional Information 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 was based on the individual's unique qualifications and succcessful achievement of different goals. Farzad Farrokhi Board Member 711973 Phys Group Partner false Schedule L, Part V Supplemental Information 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 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 CPR & First Aid, Cancer education, etc. 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 volunteering for Relay for Life, School events, and Toys for Tots are recorded on line 3-Community Support. San Gorgonio Health Care District 600 N Highland Springs Ave Banning CA 92220 956004149 Healthcare CA Govt N/A NA false false false false false false false false false false false true false false false false false false false false San Gorgonio Health Care District k 784157 Cash Value