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SONORA COMMUNITY HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SONORA COMMUNITY HOSPITAL (EIN 94-1415069)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201243209349308549
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-15T18:31:33-08:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN941415069EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Sonora Community HospitalBusinessNameLine1
Business Name Line2dba Sonora Regional Medical CenterBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlSONONameControl
Phone2095325000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 Greenley RdAddressLine1
CitySonoraCity
StateCAState
ZIP Code95370ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameAndrew JahnName
TitleTreas/Sr VP FinTitle
Date Signed2012-11-15DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJeff EllerNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11000 Greenley RdAddressLine1
CitySonoraCity
StateCAState
ZIP Code95370ZIPCode
FieldValueIRS element (for citing)
Gross Receipts191537147GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Group Exemption Number1071GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.sonoramedicalcenter.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1958YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionThe hospital mission is to provide our community with physical, mental, and spiritual healing in a way that reflects God's love for all.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees1405TotalNbrEmployees
Total Nbr Volunteers177TotalNbrVolunteers
Total Gross UBI91229TotalGrossUBI
Net Unrelated Business Txbl Income-877NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year678344ContributionsGrantsPriorYear
Contributions Grants Current Year1247651ContributionsGrantsCurrentYear
Program Service Revenue Prior Year176612107ProgramServiceRevenuePriorYear
Program Service Revenue CY189247231ProgramServiceRevenueCY
Investment Income Prior Year666452InvestmentIncomePriorYear
Investment Income Current Year868911InvestmentIncomeCurrentYear
Other Revenue Prior Year125427OtherRevenuePriorYear
Other Revenue Current Year135731OtherRevenueCurrentYear
Total Revenue Prior Year178082330TotalRevenuePriorYear
Total Revenue Current Year191499524TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year83632GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY72945GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year81993826SalariesEtcPriorYear
Salaries Etc Current Year90858325SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year278576TotalFundrsngExpCurrentYear
Other Expense Prior Year85661566OtherExpensePriorYear
Other Expenses Current Year90450391OtherExpensesCurrentYear
Total Expenses Prior Year167739024TotalExpensesPriorYear
Total Expenses Current Year181381661TotalExpensesCurrentYear
Revenues Less Expenses Prior Year10343306RevenuesLessExpensesPriorYear
Revenues Less Expenses CY10117863RevenuesLessExpensesCY
Total Assets BOY99313470TotalAssetsBOY
Total Assets EOY110165596TotalAssetsEOY
Total Liabilities BOY64815704TotalLiabilitiesBOY
Total Liabilities EOY65549967TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY34497766NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY44615629NetAssetsOrFundBalancesEOY
Mission DescriptionOur mission is to share God's love by providing physical, mental, and spiritual healing.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense161565915Expense
Grants72945Grants
DescriptionSonora Community Hospital (SCH) provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of SCH, the organization recognizes that not all individuals possess the ability to pay for essential medical services.SCH's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:- providing free care and/or subsidized care- providing care to persons covered by governmental programs at below cost- providing health/wellness activities and community education programsNot only does SCH provide low-cost care to individuals covered by government programs and those unable to afford health care, but it also helps patients find and access private and governmental resources for health care benefits. SCH recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. Inpatient services in 2011 were provided to approximately 5,092 patients. These services included:- Babies: 521 deliveries- Surgeries: 3,134 hours- Radiology: 10,848 procedures - Laboratory tests: 128,417 tests Outpatient services in 2011 were provided to about 288,000 patients. Including:- Emergency room: 25,871 visits- Outpatient surgeries: 4,896 hours- Radiology procedures: 52,979 performed- Laboratory tests: 281,907 performed- Medical clinics: 164,365 visitsSonora Community Hospital provides home care services in its surrounding communities. These services include, but are not limited to:- Respiratory Care- Elderly Care- Geriatric Case Management- Ostomy & Wound Care- Diabetes Care- IV Home TherapySCH recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission:Project HOPE, which stands for Health, Outreach, Prevention and Education- delivers dozens of free physicals and other services to indigent children and their parents at various locations throughout California's Tuolumne County with the help of volunteer nurses and physicians.Community Events - First aid stations at the local Mother Lode Fair, Home and Garden show and the Tuolumne Me-Wuk Health Fair. Exhibits at the Groveland Family Wellness Fair and the Tuolumne County Youth Health Fair. Close to 4,000 health screenings done at the annual Tuolumne County Health Fair.Health Education and Support ProgramsThe many support groups and health education classes conducted, including but not limited to:Cancer support group, Diabetes support group, Depression Recovery Program class, Spiritual Care training, CHIP Coronary Health Improvement Project, Epilepsy/Seizure Support Group, La Leche League, Childbirth Preparation Classes, Preparation for Cesarean Birth Classes, OakPlus Wellness Seminars, Quit for Life: Tobacco Cessation Classes, Lifeline Emergency Response ProgramMaintained and monitored up to 320 Lifeline Emergency Response Units. This 24-hour-a-day system offers immediate response to those whose physical condition could otherwise limit their ability to summon help.Spiritual SupportSCH's chaplains provided over 4,000 patient visits and over 1,500 hours of patient counseling, and provided over 300 hours of employee counseling, conducted memorial services and officiated at weddings.Community SupportSCH donated $22,054 to 36 community service organizations in 2011.Description
Total Program Service Expense161565915TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096166NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1405NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonAndrew JahnNamePerson
Telephone Number2095325000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11000 Greenley RdAddressLine1
CitySonoraCity
StateCAState
ZIP Code95370ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Helmuth Jones
Director1.00X03500
Larry Innocent
Director1.00X03500
Scott Reiner
V Chair / Sec50.00X0907841160287X
Larry Dodds
V Chair / Sec50.00X068534496060X
Robert Carmen
Chairman50.00X0174929739804X
Max Torkelsen
Director1.00X023810
Wes Rippey
Director1.00X0985030
Al Reimche
Director1.00X016370
Meredith Jobe
Director1.00X0546170
Steven Herber
Director1.00X021991141678
Ricardo Graham
Director1.00X026520
Christine Friestad
Director1.00X029270
Ruthita Fike
Director1.00X06350
Lynn Creitz
Director1.00X031230
Larry Caviness
Director1.00X026660
Robert Bradshaw
Director1.00X046520
Bill Wing
Director50.00032158189967X
David Larsen
Treas/Sr VP Fin50.00032698972100X
Andrew Jahn
VP Fin50.0001147338911X
Jeff Eller
President & CEO50.00049015899507X
Rodney Wehtje
Asst Treas50.00050633695494X
Douglas Rebok
Asst Sec50.000857414147299X
Rick Dodds
VP HR50.00016543828536X
Pauline Campbell
VP Off Site Svcs50.00019500248163X
Julie Kline
Sr VP Pt Care Svcs50.00023169557196X
David Schwartz
Home Health PT40.0018702907215X
Deborah Goreham
Lead ER RN56.00187038016289X
Jeph Solo
Lead Surgery RN41.0018821400X
Susan Shinkai
Pharmacist40.00177079019250X
John Frank
Pharmacist41.00174335019179X
Alan Rice
Former Asst Sec0.00026269234681X
FieldValueIRS element (for citing)
Total Reportable Comp From Org913695TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs7208924TotalReportableCompFrmRltdOrgs
Total Other Compensation1081616TotalOtherCompensation
Number Individuals GT100 K119NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Sierra Cardiology Med Assoc
900 Greenely Rd Ste 911SonoraCA95370Medical Group3053673
Sound Physicians
1123 Pacific AveTacomaWA98402Medical Group1460601
Robert DAcquisto MD Inc
900 Greenley RdSonoraCA95370Medical Group1065188
Sonora Anesthesia Services
PO Box 845SonoraCA95370Medical Group928879
Sierra Emergency Medical Group
PO Box 4685SonoraCA95370Medical Group3148448
FieldValueIRS element (for citing)
Number Of Contractors GT100 K62NumberOfContractorsGT100K
Fundraising Events69440FundraisingEvents
Related Organizations5000RelatedOrganizations
Government Grants31560GovernmentGrants
All Other Contributions1141651AllOtherContributions
Noncash Contributions650038NoncashContributions
Total Contributions1247651TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountBusiness CodeBusinessCodeRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Pharmacy118985$118,985
Rent - Medical Offices165421531120165421
Other Revenue180676900099180676
Dietary487425900099487425
Patient Service Revenue188274756900099188274756

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column19968TotalRevenueColumn
Related Or Exempt Function Income19968RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue189247231TotalProgramServiceRevenue

Investment Income InvestmentIncome

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Total Revenue Column868911TotalRevenueColumn
Exclusion$868,911ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

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Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

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Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

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Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events82125GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events69440CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses37623FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column44502TotalRevenueColumn
Exclusion$44,502ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

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Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenue
Company Store62199030633063
Sonora Oxygen Service6216103592935929
Retail Pharmacy4461105114851148

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column1089TotalRevenueColumn
Unrelated Business Revenue1089UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue91229TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column191499524TotalRevenueColumn
Related Or Exempt Function Income189128246RelatedOrExemptFunctionIncome
Unrelated Business Revenue91229UnrelatedBusinessRevenue
Exclusion$1,032,398ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total22054Total
Program Services22054ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

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Total50891Total
Program Services50891ProgramServices

Foreign Grants ForeignGrants

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Total0Total

Benefits To Members BenefitsToMembers

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Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

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Total0Total

Comp Disqual Persons CompDisqualPersons

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Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total65413648Total
Program Services59553772ProgramServices
Management And General5714534ManagementAndGeneral
Fundraising145342Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2427550Total
Program Services2427550ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total18136267Total
Program Services16058423ProgramServices
Management And General2039263ManagementAndGeneral
Fundraising38581Fundraising

Payroll Taxes PayrollTaxes

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Total4880860Total
Program Services4444405ProgramServices
Management And General425331ManagementAndGeneral
Fundraising11124Fundraising

Fees For Services Management FeesForServicesManagement

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Total0Total

Fees For Services Legal FeesForServicesLegal

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Total277954Total
Management And General277954ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

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Total347052Total
Management And General347052ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

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Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

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Total0Total

Fees For Services Other FeesForServicesOther

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Total20052817Total
Program Services17858477ProgramServices
Management And General2194340ManagementAndGeneral

Advertising Advertising

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Total381961Total
Management And General381961ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2322443Total
Program Services1407597ProgramServices
Management And General898858ManagementAndGeneral
Fundraising15988Fundraising

Information Technology InformationTechnology

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Total4821821Total
Program Services4821821ProgramServices

Royalties Royalties

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Total0Total

Occupancy Occupancy

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Total4951803Total
Program Services4713195ProgramServices
Management And General237985ManagementAndGeneral
Fundraising623Fundraising

Travel Travel

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Program Services384178ProgramServices
Management And General156295ManagementAndGeneral
Fundraising2854Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

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Total0Total

Conferences Meetings ConferencesMeetings

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Total196633Total
Program Services165521ProgramServices
Management And General30737ManagementAndGeneral
Fundraising375Fundraising

Interest Interest

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Total1967943Total
Program Services1967943ProgramServices

Payments To Affiliates PaymentsToAffiliates

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Total0Total

Depreciation Depletion DepreciationDepletion

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Total5115737Total
Program Services5115737ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1421244Total
Program Services1421244ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Miscellaneous1390358608146782212
Equipment rentals1457271144519712074
Purchased services155803539478090603857463689
Pt Care Supplies2962167429621674

All Other Expenses AllOtherExpenses

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Total0Total

Total Functional Expenses TotalFunctionalExpenses

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Total181381661Total
Program Services161565915ProgramServices
Management And General19537170ManagementAndGeneral
Fundraising278576Fundraising

Cash Non Interest Bearing CashNonInterestBearing

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BOY92183BOY
EOY961034EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

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BOY21010900BOY
EOY29610488EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

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EOY0EOY

Accounts Receivable AccountsReceivable

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BOY19724199BOY
EOY22310697EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

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EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

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EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

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EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

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BOY3386733BOY
EOY3008037EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

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BOY1648729BOY
EOY1535079EOY
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Land Buildings Equipment Basis100243983LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec50587758LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

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BOY51088256BOY
EOY49656225EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

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BOY1212030BOY
EOY1608598EOY

Investments Other Securities InvestmentsOtherSecurities

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EOY0EOY

Investments Program Related InvestmentsProgramRelated

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EOY0EOY

Intangible Assets IntangibleAssets

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BOY388589BOY
EOY374617EOY

Other Assets Total OtherAssetsTotal

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BOY761851BOY
EOY1100821EOY

Total Assets TotalAssets

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BOY99313470BOY
EOY110165596EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

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BOY9325129BOY
EOY10852156EOY

Deferred Revenue DeferredRevenue

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BOY38530BOY
EOY38530EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

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BOY4579230BOY
EOY4070426EOY

Other Liabilities OtherLiabilities

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BOY50872815BOY
EOY50588855EOY

Total Liabilities TotalLiabilities

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BOY64815704BOY
EOY65549967EOY
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Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

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BOY33592462BOY
EOY43727814EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

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BOY905304BOY
EOY887815EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY34497766BOY
EOY44615629EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY99313470BOY
EOY110165596EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses10117863ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

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Church170b1 AiXChurch170b1Ai

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

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Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

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Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$11,839OtherActivitiesAmount
Total Lobbying Expenditures IIB11839TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1iIdentifier
Return ReferencePart II-B, Line 1i - Other Activities DescriptionReturnReference
ExplanationA portion of industry association dues is allocated to lobbying activities.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance905304BeginningOfYearBalance
Contributions378471Contributions
Grants Or Scholarships50891GrantsOrScholarships
Other Expenditures345069OtherExpenditures
End Of Year Balance887815EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance708131BeginningOfYearBalance
Contributions538837Contributions
Other Expenditures341664OtherExpenditures
End Of Year Balance905304EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance572083BeginningOfYearBalance
Contributions325741Contributions
Other Expenditures189693OtherExpenditures
End Of Year Balance708131EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2272251OtherCostOrOtherBasis
Book Value2272251BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis54847657OtherCostOrOtherBasis
Depreciation19526607Depreciation
Book Value35321050BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2818576OtherCostOrOtherBasis
Depreciation1527012Depreciation
Book Value1291564BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis32791722OtherCostOrOtherBasis
Depreciation27364821Depreciation
Book Value5426901BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7513777OtherCostOrOtherBasis
Depreciation2169318Depreciation
Book Value5344459BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings49656225TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Other liabilities$184,670
Payables to third-party payers$2,438,282
Workers' comp liability$5,966,696
Payables to related orgs$41,999,207
FieldValueIRS element (for citing)
Total Of Amounts50588855TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart V, Line 4Identifier
Return ReferencePart V, Line 4: Intended uses of the endowment fund.ReturnReference
ExplanationBoard-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended.Explanation

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
Email SolicitationsXEmailSolicitations
Phone SolicitationsXPhoneSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Solicitation Of Govt GrantsXSolicitationOfGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref FundraisingfalseAgreementRefFundraising

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GalaNameOfEvent1
Gross Receipts Event183650GrossReceiptsEvent1
Charitable Contributions Event114990CharitableContributionsEvent1
Gross Revenue Event168660GrossRevenueEvent1
Rent Facility Costs Event12750RentFacilityCostsEvent1
Food And Beverage Event112000FoodAndBeverageEvent1
Entertainment Event1400EntertainmentEvent1
Other Direct Expenses Event15220OtherDirectExpensesEvent1
Name Of Event2Golf TournamentNameOfEvent2
Gross Receipts Event267915GrossReceiptsEvent2
Charitable Contributions Event254450CharitableContributionsEvent2
Gross Revenue Event213465GrossRevenueEvent2
Cash Prizes Event2500CashPrizesEvent2
Non Cash Prizes Event24480NonCashPrizesEvent2
Rent Facility Costs Event26480RentFacilityCostsEvent2
Food And Beverage Event24208FoodAndBeverageEvent2
Other Direct Expenses Event21585OtherDirectExpensesEvent2
Gross Receipts Total151565GrossReceiptsTotal
Charitable Contributions Total69440CharitableContributionsTotal
Gross Revenue Total Events82125GrossRevenueTotalEvents
Cash Prizes Total Events500CashPrizesTotalEvents
Non Cash Prizes Total Events4480NonCashPrizesTotalEvents
Rent Facility Costs Total Events9230RentFacilityCostsTotalEvents
Food And Beverage Total Events16208FoodAndBeverageTotalEvents
Entertainment Total Events400EntertainmentTotalEvents
Other Direct Expenses Total Events6805OtherDirectExpensesTotalEvents
Direct Expense Summary Events37623DirectExpenseSummaryEvents
Net Income Summary44502NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage300.000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense919616TotalCommunityBenefitExpense
Net Community Benefit Expense919616NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense7610739TotalCommunityBenefitExpense
Direct Offsetting Revenue5134990DirectOffsettingRevenue
Net Community Benefit Expense2475749NetCommunityBenefitExpense
Percent Of Total Expense0.01360PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense8530355TotalCommunityBenefitExpense
Direct Offsetting Revenue5134990DirectOffsettingRevenue
Net Community Benefit Expense3395365NetCommunityBenefitExpense
Percent Of Total Expense0.01870PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense2007050TotalCommunityBenefitExpense
Net Community Benefit Expense2007050NetCommunityBenefitExpense
Percent Of Total Expense0.01110PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense196098TotalCommunityBenefitExpense
Net Community Benefit Expense196098NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2203148TotalCommunityBenefitExpense
Net Community Benefit Expense2203148NetCommunityBenefitExpense
Percent Of Total Expense0.01220PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense10733503TotalCommunityBenefitExpense
Direct Offsetting Revenue5134990DirectOffsettingRevenue
Net Community Benefit Expense5598513NetCommunityBenefitExpense
Percent Of Total Expense0.03090PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,525,245BadDebtExpenseAmount
Amount Attributable To366059AmountAttributableTo
Amount Reimbursed By Medicare74083613AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare78580941CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-4497328MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number0FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Sonora Regional Medical CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11000 Greenley RdAddressLine1
CitySonoraCity
StateCAState
ZIP Code95370ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Sonora Regional Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent300.0000FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent400.0000FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities37NumberOfOtherFacilities

Other Facilities OtherFacilities (37 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Cedar Road Family Medical Center
20044 Cedar RdSonoraCA95370Primary Care Clinic
Community Personal Care
177 S Fairview LnSonoraCA95370Personal Care and Services
Twain Harte Family Medical Center
22629 Twain Harte DrTwain HarteCA95383Primary Care Clinic
Greenley Oaks Physical Therapy
940 Sylva Ln Ste D1SonoraCA95370Physical Therapy Clinic
Mountain Medical Family Practice
680 Guzzi Ln Ste 101SonoraCA95370Primary Care Clinic
Foothill Primary Care
650 Pauline CtSonoraCA95370Primary Care Clinic
Cardiac and Pulmonary Rehab
19747 Greenley RdSonoraCA95370Outpatient Services
Angels Camp Family Medical Center
445 S Main StAngels CampCA95222Primary Care Clinic
Angels Camp Prompt Care
23 N Main StAngels CampCA95222Urgent Care Clinic
Sierra Vascular Clinic
690 Guzzi Ln Ste 104SonoraCA95370Specialty Care Clinic
Hillside Internal Medicine
690 Guzzi Ln Ste BSonoraCA95370Primary Care Clinic
Anticoagulation Clinic
193 S Fairview Ln Ste LSonoraCA95370Outpatient Services
Cedarwood Internal Medicine Center
690 Guzzi Ln Ste ASonoraCA95370Primary Care Clinic
Arnold Family Medical Center
2037 Hwy 4ArnoldCA95223Primary Care Clinic
Groveland Family Medical Center
18661 Hwy 120GrovelandCA95321Primary Care Clinic
Job Care Occupational Health Clinic
19747 Greenley Rd Ste S2SonoraCA95370Occupational Health Clinic
Greenley Primary Care
19747 Greenley Rd Ste S2SonoraCA95370Primary Care Clinic
Community Pharmacy Forest Road
193 S Fairview Ln Ste ASonoraCA95370Outpatient Pharmacy
Community Infusion Center
900 Greenley RdSonoraCA95370Outpatient Services
Sierra OBGYN
680 Guzzi Ln Ste 106SonoraCA95370Specialty Care Clinic
Sierra Cancer Center
900 Greenley Rd Ste 902SonoraCA95370Specialty Care Clinic
Sonora Oxygen and Medical Supply
358 W Stockton StSonoraCA95370Oxygen and Durable Medical Equipment Supplier
Center for Wound Care
12811 Covey CirSonoraCA95370Wound Care Clinic
Indian Rock Prompt Care
14540 Mono WySonoraCA95370Urgent Care Clinic
Greenley Oaks Ear Nose and Throat
795 Morningstar DrSonoraCA95370Specialty Care Clinic
Sierra Surgical Associates
680 Guzzi Ln Ste 204SonoraCA95370Specialty Care Clinc
Sierra Internal Medicine Center
900 Greenley Rd Ste 922SonoraCA95370Primary Care Clinic
Radiation Oncology
900 Greenley Rd Ste 901SonoraCA95370Radiation Therapy Center
Transitional Care Unit
179 S Fairview LnSonoraCA95370Skilled Nursing Facility
Community Pharmacy Greenley Road
900 Greenley Rd Ste 912SonoraCA95370Outpatient Pharmacy
Sierra Cardiology
900 Greenley Rd Ste 911SonoraCA95370Specialty Care Clinic
Sonora Care Center
538 Ponderosa DrSonoraCA95370Skilled Nursing Facility
Sonora Regional Imaging Center
12811 Covey CirSonoraCA95370Diagnostic Imaging Center
Sonora Regional Surgery Center
905 Morning Star DrSonoraCA95370Outpatient Surgery Center
Forest Rd Health and Wellness
193 Fairview LnSonoraCA95370Primary, Specialty, Dental and Urgent Care Clinic
Sonora Regional Home Health Angels Camp
467 S Main StAngels CampCA95222Home Health Agency
Sonora Regional Home Health
20100 Cedar Rd NSonoraCA95370Home Health Agency

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part VI - Additional InformationPart V, Section B, Lines 1 through 7Schedule H, Part V, Section B, Lines 1 through 7 is optional for the reporting organization as the tax year began prior to March 23, 2012, according to the instructions for Schedule H. Part V, Section B should be blank as the reporting organization opts to not complete it.
Part VI - States Where Community Benefit Report FiledCA
Part VI - Affilated Health Care System Roles and PromotionThe hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communites served by all member hospitals.
Part VI - Explanation Of How Organization Furthers Its Exempt PurposeThe hospital continues to operate its 24-hour emergency department. The hospital has open medical staff to all qualified individuals. The hospital continues to expand its primary care outreach program through outpatient clinics, including a mobile clinic. The hospital operates skilled nursing facilities, which serve those who are unable to continue living without assistance due chronic medical conditions.
Part VI - Community Building ActivitiesOur hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. And, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H.
Part VI - Community InformationThe hospital is the only health care system in the area serving two counties and surrounding areas. In early 2009 the hospital was designated as a "sole community hospital" by Medicare. The area is rural. Agriculture, logging and tourism are the major employment opportunities. The population includes a large number of retired individuals.
Part VI - Patient Education of Eligibility for AssistanceAt the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients also are orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. The hospital charity assistance policy is posted on the hospital website.
Part VI - Needs AssessmentThe health system retains outside research firms every 3 years to assess changes in the market and community perception. Data is collected through a variety of vehicles, including phone surveys, paper surveys, and focus groups. Questions were added to the survey to help assess the impact of our community benefit activities and residents' barriers to access for health care services as well as unmet community needs.
Part V, Line 19d - Other Billing Determination of Individuals Without InsuranceThe hospital's financial assistance policy has three income ranges for patients who received emergency medical care, which provides a discount based on Medicare rates. There are also three income ranges for patients who received non-emergency medical care; the two lower income ranges provide a discount based on Medicare rates. The higher income range provides a discount from the balance due after the uninsured discount, that is available to all uninsured patients without regard to income. Only five of the six income ranges are discounted based on Medicare rates.Number of Hospital Faciltiy - 0
Part III, Line 9b - Provisions On Collection Practices For Qualified PatientsWhen a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income" and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest
Part III, Line 8 - Explanation Of Shortfall As Community BenefitThe Medicare cost report apportions the hospitals costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL*Medicare Cost Report Revenue 69,797,314Prior Year Settlements 0Cost Report Reimbursable Bad Debts 252,638Clinic 1206(D) Revenue 3,875,798Estimates and Accrual Variances 1,077,649Other (919,786)Subtotal - Amount reported in Pt III, line 5 74,083,613Amounts include in Part 1, lines g and f 0Total Medicare Revenue 74,083,613*Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts.
Part III, Line 4 - Bad Debt ExpenseUncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the hospital's bad debt expense as reported in the system-wide combined audited financial statements. The resulting figure has been reported as bad debts at cost on Part III, Line 2.The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt.The system-wide combined audited financial statements do not contain a footnote describing bad debt expense.
Part I, Line 7 - Explanation of Costing MethodologyThe costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)_____________________________________________________________________________ Gross patient charges

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained
No Grant More Than5000XNoGrantMoreThan5000
Total Nbr Of501 C3 And Govt Grants0TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuation
Utilities, food, other emergency assist25017603Cash
Transportation cancer pts to treatments50033288Cash

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierGrantmaker's Description of How Grants are UsedIdentifier
ExplanationPrior to issuing grants, hospital evaluates organization requesting grant and ensures alignment with hospital's exempt purpose and mission. After disbursing grant funds, hospital does not monitor use of funds.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (18 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Rick Dodds
145760117117967944719089193974
Pauline Campbell
16552014483149993133116832243165
Julie Kline
19802016807168684034516851288891
Bill Wing
305801157807441915548411548
David Larsen
2198701841688703466042549639908925253
Jeff Eller
34450042143103515780312147658966538905
Rodney Wehtje
3404307878487122785571693760183052751
Scott Reiner
577345149092181404138780215071068128119583
Douglas Rebok
533280149092175042128096192031004713123894
Larry Dodds
3035571710942106937908916971781404120139
Robert Carmen
93434026720954774818150216541789101424494
Steven Herber
21246174502740014278261589
John Frank
1694254910101898990193514
Susan Shinkai
16373113348102608990196329
Jeph Solo
1824395775188214
Deborah Goreham
186027101172998990203327
David Schwartz
18049565347215194244
Alan Rice
22981532877175101717129737332877

Schedule M IRS990ScheduleM

Real Estate Commercial RealEstateCommercial

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990650038NoncashContribsRptdF990
Method Of Determining RevenuesAppraisalMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
990, Part VI, Line 7aThe hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableThe hospital does not make its governing documents publicly available, beyond required filings of articles of incorporation with the secretary of state. The hospital does not make its conflict of interest policy available upon request. The hospital files monthly/quarterly summary financial reports with the state health-planning agency.Form 990, Part VI, Line 19
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe hospital board of directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 24 percent spread from minimum to maximum (industry norm is approximately a 50 percent spread). A hospital CEO has a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other hospital executives have a maximum potential incentive of 20 percent of base salary.Form 990, Part VI, Line 15b
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsDuring the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The corporate internal audit staff review these questionnaires and disclosures each year during the audit process.Form 990, Part VI, Line 12c
Form 990, Part VI, Line 11: Form 990 Review ProcessThe completed Form 990 is shared with members of the hospital's board of directors by electronic communication for their review prior to filing. A special board meeting is scheduled to answer questions and receive input from the board after their review but prior to filing.Form 990, Part VI, Line 11
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersThe hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital.The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws.Form 990, Part VI, Line 7b
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderThe hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West.Form 990, Part VI, Line 6
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtRick Dodds is the child of Larry DoddsForm 990, Part VI, Line 2

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Reedley Community Hospital
372 W Cypress AveReedleyCA93654453220509HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Adventist Health Physicians Network
2100 Douglas BlvdRosevilleCA95661680357690Medical FoundationCA501(c)(311b, IIAdventist Health SystemWestfalse
Willits Hospital Inc
1 Madrone StWillitsCA95490680108919HospitalCA501(c)(3)1Adventist Health SystemWestfalse
White Memorial Medical Center
1720 Cesar E Chavez AveLos AngelesCA90033952282647HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Walla Walla General Hospital
1025 S Second StWalla WallaWA99362910617726HospitalWA501(c)(3)1Adventist Health SystemWestfalse
Ukiah Adventist Hospital
275 Hospital DrUkiahCA95482941639901HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Simi Valley Hospital & Health Care Svcs
2975 N Sycamore DrSimi ValleyCA93065956064971HospitalCA501(c)(3)1Adventist Health SystemWestfalse
San Joaquin Community Hospital
2615 Chester AveBakersfieldCA93301952294234HospitalCA501(c)(3)1Adventist Health SystemWestfalse
St Helena Hospital
10 Woodland RdSt HelenaCA94574941279779HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Portland Adventist Medical Center
10123 SE Market StPortlandOR97216930429015HospitalOR501(c)(3)1Adventist Health SystemWestfalse
Paradise Valley Hospital
2100 Douglas BlvdRosevilleCA95661951816034Wind down after sale of hospital facilitiesCA501(c)(3)1Adventist Health SystemWestfalse
NW Medical Foundation of Tillamook
1000 Third StTillamookOR97141930622075HospitalOR501(c)(3)1Adventist Health SystemWestfalse
Hanford Community Hospital
450 Greenfield AveHanfordCA93230940535360HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Glendale Adventist Medical Center
1509 Wilson TerraceGlendaleCA91206951816017HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Feather River Hospital
5974 Pentz RdParadiseCA95969941101228HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Central Valley General Hospital
1025 N Douty StHanfordCA93230770324630HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Castle Medical Center
640 Ulukahiki StKailuaHI96734990107330HospitalHI501(c)(3)1Adventist Health SystemWestfalse
Adventist Health Clearlake Hospital
Ave 18 at Hwy 53ClearlakeCA95422680395149HospitalCA501(c)(3)3Adventist Health SystemWestfalse
Adventist Health SystemWest
2100 Douglas BlvdRosevilleCA95661953484589Support / manage system-wide activitiesCA501(c)(3)1NAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1South Coast Medical CenterBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12100 Douglas BlvdAddressLine1
CityRosevilleCity
StateCAState
ZIP Code95661ZIPCode
FieldValueIRS element (for citing)
EIN952037291EIN
Primary ActivityWind down after sale of hospitalPrimaryActivity
Legal Domicile StateCALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityC CorpTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg