2011-11-14T19:09:25-07:00 2010-12-31 990 2010-01-01 951183919 SAN ANTONIO COMMUNITY HOSPITAL INC SANA 9099204711 999 San Bernardino Road Upland CA 91786 Roger Parsons 9099204711 2011-11-14 2010 2016-03-07 17:11:31Z Harris Koenig 999 San Bernardino Road Upland CA 91786 696546262 0 X sach.org X 1920 CA The mission of San Antonio Community Hospital is to improve the overall health of our regional community by offering healthcare services that both comfort and cure in settings that inspire confidence and in a manner that earns the trust of our patients our physicians and our employees. 13 11 2163 282 907516 480127 1276794 1596162 281020924 292127584 9747244 12335342 906873 924251 292951835 306983339 0 94000 0 0 146679726 141396674 0 0 0 132479108 139723439 279158834 281214113 13793001 25769226 380987723 409421008 112259340 105120113 268728383 304300895 X The mission of San Antonio Community Hospital is to improve the overall health of our regional community by offering healthcare services that both comfort and cure in settings that inspire confidence and in a manner that earns the trust of our patients, our physicians, and our employees. 0 0 266902606 94000 291098641 See Schedule O for detailed description 0 0 0 See Schedule O for detailed description 0 0 0 See Schedule O for detailed description 0 0 0 See Schedule O for detailed description 0 0 0 266902606 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 384 0 1 2163 1 1 1 0 0 0 0 0 0 0 0 0 X 13 11 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 CA X Roger Parsons 9099204711 999 San Bernardino Road Upland CA 917864920 X Donald Alpiner DO 4 X 2370 0 0 Dora Barilla 4 X 0 0 0 Mark Bertone 4 X X 0 0 0 Victor Ching MD 4 X 18000 0 0 Thomas Easter MD 4 X 32725 0 0 Richard Gilbert 4 X 0 0 0 J Michael Gunn 4 X 0 0 0 Stanley Kim MD 4 X 2225 0 0 James Milhiser 4 X X 0 0 0 Thomas Ritchie 4 X 0 0 0 Al Ronco 4 X X 0 0 0 Carl Schultz MD 4 X 0 0 0 Steven Spears 4 X 0 0 0 Steve Moreau 40 X X 527199 0 78883 Roger Parsons 40 X 308367 0 152264 Vincent Leist 40 X 326639 0 36006 Liz Aragon 40 X 229150 0 68313 Jaynie Boren 40 X 222604 0 38334 Lynn Kelly 40 X 219443 0 72221 Kenneth Saltgaver 40 X 153411 0 68830 Debbie Blankenship 40 X 158024 0 38072 Stanley Kwan 40 X 156610 0 60787 Khoa Phan 40 X 147997 0 5568 Mike Segura 40 X 146103 0 41095 Carmen Azmy 40 X 144870 0 16683 2795737 0 677056 146 0 1 0 Cerner Corporation 2800 Rockcreek Pkwy Kansas City MO 64117 Computer Remote Hosting 1058700 Softscript 2444 Wilshire Blvd Ste 280 SAnta Monica CA 90403 Transcription 838214 Specialty Laboratories PO Box 54920 Los Angeles CA 90054 Outside Lab Services 786680 Crothall Laundry Services 5410 East Frances Street Ontario CA 91761 Laundry Services 712016 American Materiel Management Alliance 42500 Winchester Rd Temecula CA 92590 Inventory Supplier 633501 36 0 0 0 1495890 100272 0 0 1596162 Net Patient Revenue 622000 288111618 288111618 0 0 Rental Income MOB 531120 3148875 3148875 0 0 Lab Revenue UBI 621500 492041 0 492041 0 Cardiac Rehab - UBI revenue 621990 7388 0 7388 0 Capitation Revenue 622000 367662 367662 0 0 0 0 0 0 292127584 6601020 0 0 6601020 0 0 0 0 0 0 0 0 0 0 393607184 1540526 387884054 1529334 5723130 11192 5734322 0 0 5734322 0 213878 149535 64343 0 0 64343 Cafeteria Revenue 722100 981335 0 0 981335 Surgery Center UBI Revenue 621990 408087 0 408087 0 Ensemble/Sierra SA Med Plaza Loss 900099 -1152872 -1152872 0 0 623358 623358 0 0 859908 306983339 291098641 907516 13381020 94000 94000 0 0 0 0 0 0 2556984 457963 2099021 0 0 0 0 0 102955985 98428794 4527191 0 11834298 11313919 520379 0 16385500 15664995 720505 0 7663907 7326909 336998 0 243771 0 243771 0 505760 0 505760 0 239743 0 239743 0 31218 31218 0 0 0 0 379407 0 379407 0 16432660 15489911 942749 0 1435154 1372047 63107 0 51907672 49621039 2286633 0 7283576 6963302 320274 0 0 0 0 0 4240284 4053830 186454 0 156143 149277 6866 0 0 0 0 0 138655 132558 6097 0 1103899 1043545 60354 0 0 0 0 0 10669738 10086390 583348 0 4063118 3884454 178664 0 Bad Debts 27698571 27698571 0 0 Medi-Cal Fee Program 10824720 10824720 0 0 Recruitment 624081 596639 27442 0 Taxes & Lic 607520 580806 26714 0 Collection Expense 551045 526814 24231 0 586704 560905 25799 0 281214113 266902606 14311507 0 9425 9425 23100281 26914450 48397813 43973060 428321 423903 3825158 3194558 4316864 5228419 294746143 197357906 95431735 97388237 173460890 197621889 4132892 4202134 27884344 30464933 380987723 409421008 25584865 30178917 23805000 19320000 62869475 55621196 112259340 105120113 X 253959143 288466441 10751549 11816763 4017691 4017691 268728383 304300895 380987723 409421008 X 25769226 9803286 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 31218 31218 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Line 1i - San Antonio Community Hospital is a member of the California Association of the American Hospital Association and the American Hospital Association which conducts lobbying activities in support of member hospitals and general healthcare issues. Both associations provide the percentage of dues that relate to lobbying activities. 4017691 0 764343 0 743754 20589 4017691 4017691 0 614286 0 601219 13067 4017691 4002691 15000 -766842 0 -780189 13347 4017691 0 1 0 0 1 1 0 10687528 10687528 0 128977302 95313267 33664035 0 2212670 942970 1269700 0 128098593 97202869 30895724 0 24770050 3898800 20871250 97388237 Beneficial Interest in SAHF 28888336 Def Financing Costs 727045 Def Comp plan 475991 Physician Recruitment Receivable 230129 Due from Affiliates 82555 CVMG Line of Credit 60877 30464933 0 Pension Plan Liability 42566172 Construction Liability 7308374 Self Insurance Liabilities 5737650 Physician Guarantee Liability 9000 55621196 SchD_P05_S00_L04 Schedule D, Part V, Line 4 San Antonio Community Hospital is the sole corporate owner of San Antonio Hospital Foundation Inc., SAHF, and is required to consolidate SAHF assets and liabilities onto its balance sheet. Proceeds from the endowment funds are intended for the purchase of property and equipment for the benefit of San Antonio Community Hospital. 1 1 X 1 X 3 1 X 1 1 0 1 1 0 0 2516243 0 2516243 0.0097 0 0 22643011 16186009 6457002 0.0249 0 0 0 0 0 0 0 0 25159254 16186009 8973245 0.0346 37 53221 801036 174803 626233 0.0024 3 35 200570 2850 197720 0.0008 1 0 480925 0 480925 0.0019 1 0 6634 0 6634 0 1 0 27813 0 27813 0.0001 43 53256 1516978 177653 1339325 0.0052 43 53256 26676232 16363662 10312570 0.0398 1 1000 1000 0 4 2821 2821 0 5 0 3821 0 3821 0 0 6016129 1500000 47585477 49859666 -2274189 X 1 1 San Antonio Ambulatory Surgery Center Outpatient surgical center 0.29 0.02 0.64 1 1 San Antonio Community Hospital

999 San Bernardino Road Upland CA 91786

X X X San Antonio Community Hospital 1 4 SACH 685 Building Diagnostic Center

685 N 13th Ave Upland CA 91786

Lab and Radiology services in a freestanding medical office building SACH 901 Building Diagnostic Center

999 San Bernardino Road Upland CA 91786

Radiology services in a freestanding medical office building SACH RSA Building Diagnostic Center

7777 Miliken Ave Rancho Cucamonga CA 91730

Lab and Radiology services in a freestanding medical office building SACH Sierra San Antonio Diagnostic Center

16465 Sierra Lakes Pkwy Fontana CA 92336

Lab and Radiology services in a freestanding medical office building SchH_P01_S00_L06a Schedule H, Part I, Line 6a San Antonio Community Hospital prepared a Community Benefit Report as required by the state of California. SchH_P01_S00_L06b Schedule H, Part I, Line 6b Members of the public may request a copy of the community benefit report by contacting the hospital's Community Outreach Department. SchH_P01_S00_L07 Schedule H, Part I, Line 7 The costing methodology used on 7a: Calculated using Worksheets 1 & 2 in the instructions; the cost to charge option. The costing methodology used on 7b: Calculated using Worksheet 3 in the instructions; the cost to charge option. The costing methodology used on 7e to 7i: Calculated using actual costs from SACH's general ledger. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f Amount of bad debt expense that was excluded from total expense in the computation on Line 7 was $27,698,571. SchH_P01_S00_L07g Schedule H, Part I, Line 7g None of the costs on this line were attributable to a physician clinic. SchH_P02_S00_L00 Schedule H, Part II SACH provided support to two local community groups. The first was to help a community effort to improve education for children with autism. The second was to help a community group that works to provide help and education related to drug abuse. The costs related to community support are reported in Part II, Line 3. The coalition building activity represents time spent by a SACH community benefits manager working directly with community groups to provide health education and support direct care provided to the poor and uninsured at local community health clinic events. The costs related to coalition building are reported in Part II, Line 6. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 The hospital does not have a footnote in the audited financial statements that describes bad debt expense. Bad debt expense (at cost) is calculated using the ratio of total hospital operating expenses to total billed charges multiplied by total bad debts. Bad Debts reflect care that has been provided to those who could not afford to pay for health care services. Patients with no insurance coverage (government or private) receive an automatic 35% reduction in billed charges. The amount of this write-off plus any patient payments are subtracted from gross billed charges before calculating bad debts. To the extent an account or portion thereof is determined to be uncollectable, the remaining net amount is written off to bad debts and recorded as a bad debt expense on the hospital's income statement. SACH believes bad debts should be included as a community benefit because the majority of bad debts are related to patients seeking emergency care. SACH's emergency department provides 24 hour 7 days a week care without regard to a patient's ability to pay. By providing care to the uninsured and underinsured who are unable to pay for all or a portion of their care helps improve the overall health in SACH's service area. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 SACH has not reported its Medicare shortfall as a community benefit. The cost and reimbursement data were taken directly from SACH's December 31, 2010 Medicare Cost Report. The Medicare Cost Report uses a stepdown cost allocation process and then apportions clinical department costs on a charge to charge basis. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b If a patient qualifies for charity care, or other financial assistance, the hospital does not make collection efforts. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Although California's Community Benefit Legislation (SB697) only requires a triennial community assessment, San Antonio Community Hospital (SACH) reviews and updates the secondary data each year and conducts primary research no less than every three years. In addition to the annual assessment of secondary data detailed below, the triennial assessment includes primary research using tools such as written surveys, telephone interviews and focus groups. The hospital has engaged independent consulting firms and university research centers to conduct the primary research. The annual assessment looks at the hospital's community from a wide perspective in terms of population, demographics, and key health indicators. Most of the data is focused on the hospital's primary service area, since this is where over 80% of the hospital's patients reside, and is also the area most often targeted for its community outreach efforts. During the assessment, primary service area population and demographics are evaluated based on the following statistics: current year population estimates, five-year population segments (children, seniors, women of childbearing age), median age, marital status, households/families, ethnicity, language, education, employment, income, hospitalization rates and number of primary/specialty physicians. Although the assessment focuses on demographic and health information for SACH's service area, there are benefits in examining county data, since many health indicators are only available at the county level. In addition, given the transient nature of the population in San Bernardino County, it makes sense for hospitals to work together and with other healthcare agencies to address issues that affect all county residents. With this in mind, population and demographic data are updated and reviewed for San Bernardino County, while general health indicators are compared to other California counties, state averages, and national goals. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Patients who may qualify for charity care under the hospital's Charity Care Policy are provided with information and an application form for Charity Care during the admitting or outpatient process. The hospital's charity care policy is posted in patient registration areas. The hospital's charity care policy provides relief to families who have no means for making payment. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Like many hospitals, SACH defines its community in terms of its "service area," which is the geographic area from which it receives the majority of its hospital admissions. For purposes of analysis, the service area is divided into "primary" and "secondary" areas, with the primary service area accounting for approximately 80% of the admissions and the majority of SACH's planning efforts. SACH's primary service area is comprised of the cities of Chino, Claremont, Fontana, Montclair, Ontario, Rancho Cucamonga and Upland with a total estimated population of 815,998, a median age of 32.1, and a median household income of $69,801. In the population 25 years of age and older, 24.2% have not graduated high school, 24.8% have a high school diploma, 31.5% have some education beyond high school, and 19.5% have a Bachelor's degree or higher. The population is predominantly Hispanic at 56.3%, followed by Caucasians at 27.1%, African-Americans at 7.5%, Asian-Americans at 6.1%, and all others at 3.0%. The secondary service area, which represents approximately 10% of SACH's admissions, includes Pomona on the west, Rialto to the east, and Mira Loma, Norco, and portions of Corona to the southeast with an estimated population of 446,567, a median age of 30.5, and a median household income of $70,778. In the population 25 years of age and older, 28.2% have not graduated high school, 24.6% have a high school diploma, 28.3% have some education beyond high school, and 18.9% have a Bachelor's degree or higher. The population is predominantly Hispanic at 57.3%, followed by Caucasians at 22.5%, Asians at 8.8%, African-Americans at 8.6%, and all others at 2.8%. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 As in most communities, the needs are great and the resources limited. SACH understands the power of collaboration and seeks alliances with other health and social service providers to develop community based programs with defined goals and measurable outcomes. These partnerships help to leverage the community's scarce resources and achieve the maximum benefit for its residents, which results in demonstrated improvements in their health. SACH is an integral part of San Bernardino County's Healthy Communities initiative which promotes physical, social, and economic environments that support the wellbeing of its members and embraces the belief that health is more than merely the absence of disease. Healthy communities contain elements that enable people to maintain a high quality of life and productivities. Finally, healthy communities offer access to health care services that focus on both treatment and prevention for all members of the community. SACH has provided leadership and professional expertise to support the Healthy Cities in its service area including Healthy Chino, Healthy Fontana, Healthy Ontario, and Healthy Rancho. In addition, SACH has been involved in the Montclair Community Collaborative and is currently part of an effort to achieve the Healthy City designation in Upland. SACH serves on executive committees, planning committees, and various workgroups in each of the Healthy Cities, providing insight and advice to support strategic planning, implementation and evaluation of health and wellness initiatives. In Chino and Montclair SACH has served on planning and task forces, such as Ontario's Planning, Health Access, and Prevention and Wellness committees, Fontana's Steps Along the Way committee, and Rancho Cucamonga's Executive, Steering, Farmers Market, and Community Garden committee. These efforts have repeated substantial rewards, not only in community building, but also in improved health and wellness. For example Healthy RC Kids is addressing a growing concern over childhood obesity in our region, and Healthy Ontario is ensuring that low income, uninsured children are not falling through the growing gaps in the local healthcare safety net. The value of the aforementioned Coalition Building activities are reported in Part II Line 6c. In addition to these collaborative efforts, SACH continues to provide monetary and in kind support to health related nonprofit community organizations such as the American Cancer Society's educational outreach and support programs for cancer patients and their families and the Children's Fund program, which helps to prevent child abuse in our community and to ensure that at risk children who are abused, neglected or abandoned receive adequate food, clothing, shelter, medical care and education. The value of SACH's Community support is reported in Part II Line 3c. In addition, SACH's Board of Trustees includes members from the community that take a strong interest in improving overall community health. One member of the hospital's Board of Trustees is a professor of public health policy at a local university and brings a wealth of community health knowledge to Board discussions. Furthermore, the hospital extends medical staff privileges to all qualified community physicians that seek privileges. Hospital profits are reinvested in new services, technologies and community education to help improve the overall health of community residents. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Not applicable. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 San Antonio Community Hospital files a a community benefit report with the state of California. 1 San Antonio Hospital Foundation 999 San Bernardino Road Upland CA 91786 330042666 501(c)(3) 68000 To support San Antonio Community Hospital, a related organization. California Health Foundation & Trust 1215 K Street suite 800 Sacramento CA 95814 941498697 501(c)(3) 26000 0 Market Value To support charitable activities at various hospital/health systems in California. 2 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 The Volunteers and Medical Staff of San Antonio Community Hospital raise funds to support the hospital. Those funds are donated annually to San Antonio Hospital Foundation, a related 501(c)(3)organization. X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 Steve Moreau 398423 0 100075 0 28701 0 65787 0 13096 0 606082 0 0 0 Roger Parsons 263918 0 42643 0 1806 0 143692 0 8572 0 460631 0 0 0 Vincent Leist 279305 0 45528 0 1806 0 22910 0 13096 0 362645 0 0 0 Liz Aragon 201052 0 27138 0 960 0 55217 0 13096 0 297463 0 0 0 Lynn Kelly 193454 0 24218 0 1771 0 59320 0 12901 0 291664 0 0 0 Jaynie Boren 196888 0 24758 0 958 0 21353 0 16981 0 260938 0 0 0 Kenneth Saltgaver 152861 0 0 0 550 0 57798 0 11032 0 222241 0 0 0 Debbie Blankenship 135981 0 0 0 22043 0 27266 0 10806 0 196096 0 0 0 Stanley Kwan 151552 0 4326 0 732 0 54331 0 6456 0 217397 0 0 0 Khoa Phan 147892 0 0 0 105 0 5067 0 501 0 153565 0 0 0 Mike Segura 138157 0 7802 0 144 0 26379 0 14716 0 187198 0 0 0 Carmen Azmy 141140 0 3619 0 111 0 3000 0 13683 0 161553 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a The hospital requests board members to attend various educational sessions during their term. In recognition that board members serve without compensation and that attending educational sessions takes most board members away from their jobs or businesses, the hospital provides reimbursement for spousal travel. The hospital also grosses up the spousal travel reimbursement and reports the grossed up amount on a 1099 given to the board member. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 San Antonio Community Hospital, provides a 457(f) supplemental non-qualified plan for its CEO, Steven Moreau. The plan provides an accrued (but not paid) benefit equal to 10% of the CEO's base pay. This amount is included each year in the CEO's reported W-2 earnings. The plan accrues earnings at the 10-year treasury note rate on the last banking day of each year. The CEO is not eligible to receive the funds in this plan until retirement or termination. Steven left the organization in December 2010 and received a final disbursement of $44,711 from the plan in 2011. F990_P03_S00_L04a Form 990, Part III, Line 4a "Overview" -San Antonio Community Hospital (SACH) was founded by Dr. William Howard Craig in 1907, just a year after the City of Upland was incorporated. As the community surrounding the hospital grew, it became apparent that larger, more modern facilities were needed. Frances Mary Paul, the widow of a local banker, spearheaded the effort to raise funds to build a new hospital by personally donating $75,000. The community rallied and sufficient funds were raised. The hospital moved on July 30, 1924, from its original location on the corner of San Antonio Avenue and Arrow Highway, to its present location on San Bernardino Road. SACH has grown from its modest beginning as an eighteen-bed hospital with five physicians and limited staff to a 279-bed regional medical facility with 1,555 full time equivalent employees and a medical staff of nearly 500 physicians. In 2010, the Hospital had approximately 15,500 inpatient admissions, 140,000 outpatient visits, and 70,500 emergency room visits. SACH will soon embark on the largest expansion in its 100-year history to build a significantly larger emergency department and patient tower to meet the needs of the growing population in the west end of California's Inland Empire. "Leadership"-SACH is governed by a 15-member Board of Trustees. The hospital's President and Chief Executive Officer, and the medical staff's President-Elect, President, and Immediate Past President are members of the board by virtue of their offices. Two additional physicians are elected from the medical staff, and the remaining members are elected from the community at-large. The Board of Trustees, with physician leaders comprising 33 percent of its membership, sets the direction for the hospital and its Community Benefits Program. The Executive Management Group directs the hospital's strategic planning process and allocates resources for community benefit activities. The Executive Management Group is comprised of the Chief Executive Officer, Chief Operations Officer, Chief Financial Officer, Chief Nursing Officer, Vice President of Administrative Services, Vice President of Human Resources, Vice President of Strategic Planning and Business Development, and President of the Hospital Foundation. Department directors are responsible for the operation and management of the individual departments. The directors encourage employee participation in community benefit activities, and it is this support that ensures the ultimate success of the SACH's community outreach program. "Our commitment" -The leadership at SACH has an unwavering commitment to the hospital's mission, vision, values, and strategic plan, which focus on improving the region's overall health by providing quality patient care in a compassionate and caring environment. Our mission is to improve the overall health of our regional community by offering healthcare services that both comfort and cure, in settings that inspire confidence, and in a manner that earns the trust of our patients, our physicians, and our employees. Our vision is to use our strengths to enhance our reputation for excellence in quality care, patient experience, and an exceptional working and practice environment. Our values articulate the principles that help us to fulfill our mission and vision, and our strategic plan specifically addresses the development of programs and services in response to regional community needs. SACH's commitment to providing quality care for all members of our community has received national recognition. In its 2009 National Benchmarks study, Thomson Reuters recognized SACH as a "Top 100 Hospital" in the United States. SACH was the only large community hospital in California and the first California hospital in four years to receive an award. This recognition is based on performance achievements in nine areas: mortality, medical complications, patient safety, average length of stay, expenses, profitability, cash-to-debt ratio, patient satisfaction, and adherence to clinical standards of care. In addition to the Top 100 Hospital award, Thomson Reuters selected SACH as one of 23 hospitals nationally to receive its inaugural "Everest" award for sustained operational performance and rapid increase in performance improvement rates over the previous five years. In addition, HealthGrades has recognized SACH for quality excellence in Emergency Medicine, Stroke Care, and Maternity Care. In 2008, SACH became the 65th hospital in the United States to receive the Baby Friendly designation which measures infant health, breastfeeding, and infant-parent attachment based on global criteria developed by the World Health organization and UNICEF. SACH has also been honored by the California Hospital Assessment Reporting Task Force (CHART) for excellence in clinical and safety measures. "Caring for our Community" - Community benefits are more than just numbers. They represent people-moms and dads, children and grandparents, and the homeless, helpless, and hopeless. San Antonio Community Hospital goes above and beyond the delivery of essential patient care services to ensure healthier children, early detection of disease, and enhanced access to basic healthcare services. It captures the essence of our purpose: to improve health and make the community a better place to work, grow, and play. As a regional healthcare provider, SACH is committed to maintaining the highest quality of care for those we serve. As a nonprofit hospital, all of our resources are devoted to providing healthcare services. Any surpluses generated from hospital operations are used to purchase new or upgraded equipment, expand services, and provide care for vulnerable populations. While the Inland Empire is a maturing economic market, as a whole, many individuals and families are at significant risk during a medical crisis due to their inability to access health insurance or as the result of inadequate insurance coverage. The hospital's charity care policy provides relief to these families who would otherwise face medical bankruptcy. During 2010, $2,516,243 (at cost) in charity care was provided for patients entering the hospital emergency department that were either treated and released or required an inpatient stay. In addition to this direct medical care, SACH reaches out to its community in a variety of ways that go well beyond the traditional care provided by an acute care hospital. "Planning"-SACH conducts a formal strategic planning process involving senior management, the board, and the medical staff leadership every three years with annual reviews and updates. In 2008, the executive management team worked closely with SACH's Board of Trustees and Medical Staff to develop a three-year strategic plan for 2009 to 2011, which includes details of strategic, operational, quality, and community benefit initiatives. In addition to programmatic and service enhancement projects, the strategic plan includes a Facilities Master Plan, which calls for the renovation and expansion of the hospital's main campus. " Facility Expansion" - The expansion will include new medical/surgical and intensive care inpatient beds and a new Emergency Department, which are essential to accommodate the growing needs of SACH's service area and to offset the expected reduction in the number of medical/surgical beds as a result of current State seismic compliance requirements. The tremendous growth experienced in SACH's Emergency Department services is a key driver of the planned expansion. The hospital's 29-bed Emergency Department, which was built in 1975, was designed to accommodate 30,000 patient visits per year. In fiscal year 2010, the SACH's Emergency Department had 70,500 visits. With the high unemployment in the hospital's service area, the number of uninsured patients treated in the Emergency Department continues to rise, adding additional stress to the already overburdened existing facilities. " Four-Story Patient Tower" - The primary structure in the planned addition to SACH's facilities will be a four-story patient care tower to be constructed on the east side of the hospital campus immediately adjacent to the existing patient tower and ancillary service departments. The four-story tower is designed to include a 52-bed replacement Emergency Department, including computerized tomography ("CT") scanning and other radiology capabilities, 80 medical/surgical and telemetry rooms, 12 intensive care rooms, a new main lobby, 33,470 square feet of shelled space on the first floor, and site improvements including parking and landscaping. F990_P03_S00_L04b Form 990, Part III, Line 4b Continuation of explanation on line 4A: "Energy Plant and Site Utilities" - The addition of the new four-story patient care tower will require construction of a conventional energy plant to supplement existing co-generation capacity. The new energy plant will be built near the existing energy plant in a location consistent with appropriate environmental standards. The site utilities project will connect the new energy plant with the new four-story patient care tower. "Hospital Services" - SACH provides a full spectrum of preventive acute, primary, and specialty care to the communities it services. These services include inpatient medical and surgical services, emergency and intensive care services, palliative care, and a community wellness and health promotion program. Areas of special expertise include cardiovascular services provided at SACH's Heart Center, specialized infant care provided at the Level II neonatal intensive care unit (NICU), and the diagnostic and treatment services available at its Cancer Center and Gamma Knife Center. "The Heart Center" - SACH's heart program coordinates the comprehensive cardiac service line, including non-invasive cardiology, diagnostic and interventional cardiac catheterization, cardiac nuclear scanning, cardiovascular surgery, and cardiac rehabilitation, SACH has been designated as "STEMI" (ST-elevation myocardial infarction)-receiving hospital by San Bernardino, Los Angeles, and Riverside counties, meaning that the hospital has the equipment, expertise, and facilities to administer percutaneous coronary intervention, the preferred method of treating severe heart attack patients. SACH is the only hospital in the Inland Empire with a three-county designation. "Cancer Center" - SACH's cancer program has been fully accredited by the American College of Surgeon's Commission on Cancer Since 1980. The hospital treats more than 800 new cancer cases per year. The cancer program treatment modalities include surgery, chemotherapy, hormone therapy, and immunotherapy. Outpatient radiation oncology services includes 3D conformal, external beam, electron beam, and intensity modulated therapy ("IMRT"). The Cancer Resource Center provides education and support services for cancer patients and their families. Nurse navigators are part of the cancer team and meet with every hospitalized patient with cancer. The navigators also work closely with the physicians on an outpatient basis to ensure that patients have a positive experience as they move between the inpatient and outpatient status during different stages of their treatment. "Gamma Knife Center" - SACH offers the only Gamma Knife radiosurgery system in its primary service area. The Gamma Knife enables the hospital's Radiation Oncology and Neurosurgery Department to conduct noninvasive, outpatient brain surgery, using low-dose radiation beams to target tumors and abnormal cells with precision. This less invasive method is performed on an outpatient basis, allowing patients to receive treatment and return home the same day. "Women's Breast and Imaging Center" - The Women's Breast and Imaging Center is located immediately adjacent to the main hospital facility and offers patients the latest advancements in screening and diagnostic procedures for early detection of breast cancer. The Center's technology includes digital mammography, ultrasound, and stereotactic breast biopsy procedures. A dedicated nurse navigator coordinates the breast cancer patient's care throughout diagnosis, treatment, and recovery. Additional screening services for women's health offered at the Center include general ultrasound for diagnosing gynecological disorders and osteoporosis screening for assessing bone health. A focus of the Women's Center is to assure that the patient's experience is as positive as their medical outcome. "Maternal Child Services" coordinates care with obstetricians and pediatricians to provide comprehensive prenatal, delivery, and postpartum care. The Maternal Child Department includes 32 maternity beds, four labor, delivery and recovery rooms, 10 labor, delivery, recovery and postpartum rooms, a cesarean section surgical suite and recovery room, and a 20-bed NICU. A postpartum follow-up center is located near the main hospital to provide screening and support services for infants and their parents. The services provided at the center are offered to all families regardless of where they delivered their baby, and the nominal fee is waived for any family that cannot afford to pay the services provided by SACH's Internationally Board Certified Lactation Consultant. SACH is designated a Baby Friendly hospital by the World Health Organization. This designation is an important part of SACH's Healthy Beginnings program, which reinforces the benefits of breastfeeding. "Surgical Services". - The Surgery Department operates nine surgical suites and two additional surgical suites dedicated to cardiovascular surgeries. The Surgery Department performs approximately 350 inpatient and 360 outpatient surgeries per month, including general surgery and surgeries in the specialties of orthopedics, cardiology, gynecology, urology, otolaryngology, and ophthalmology. "Imaging and Radiation Oncology Services" -The Radiology Department provides imaging services to support SACH's Emergency, Surgery, and other departments. The imaging services offered to both inpatients and outpatients include diagnostic radiology and fluoroscopy, 64-slice CT scan, 3-T magnetic resonance imaging (MRI), interventional radiology, ultrasound, mammography, and special procedures. The Radiation Oncology Department provides external beam radiation for the treatment of various cancer conditions and brachytherapy for the treatment of prostate cancer. "Community Education"- SACH offers a broad array of education classes, support groups, and community lectures to meet the health needs of its community. Some of the programs are offered on-site, but many are provided at locations throughout the community to reach those who may have special needs or lack transportation and would otherwise fail to access these important services. In addition to gaining knowledge about important health topics, participants may participate in free screenings to identify potential health concerns such as high blood pressure, high cholesterol, high glucose, skin cancer, and prostate cancer. "Community Benefit Initiatives" - As part of its mission to improve the health of the community it serves, SACH conducts an ongoing assessment process to identify community health needs. The hospital's Community Outreach Department supports a variety of services designed to meet these needs, including support groups, educational seminars and community health fairs, as well as several targeted health initiatives. A few if these programs are highlighted here. "Healthy Beginnings" - SACH's maternal/child services, collectively known as Healthy Beginnings, is committed to providing excellent service and care, which result in the best possible outcome for the newest members of its community and their families. In support of this goal, the hospital engaged in an extensive process to become a "Baby Friendly Hospital," which is an international designation recognizing the institution's comprehensive program supporting breastfeeding and infant/parent bonding. As part of this program, parents are encouraged to take advantage of the many educational opportunities and support services offered before, during, and after delivery. Expectant parents attending the breastfeeding class receive encouragement and instruction to promote a successful breastfeeding experience. Internationally Board Certified Lactation Consultants, supported by lactation educators, are available to provide support during the family's hospital stay, and every family is encouraged to visit the Healthy Beginnings Newborn Feeding Center after they leave the hospital. In addition to providing breastfeeding evaluation and support, the Newborn Feeding Center assesses mother and newborn, providing referrals to community resources when needed. This thorough evaluation process has yielded significant outcomes including a reduction in newborn readmission rates; increased breastfeeding rates; early intervention for developmental delays; and identification and treatment of postnatal illness, from baby blues to postpartum psychosis. While some families just need reassurance that their baby is thriving, others may require further education or support, and a few require intervention or treatment. The Center offers support to all new families in the community, regardless of where their babies are born. In fact, many local pediatricians include a visit to the Center as part of the discharge instructions for their patients. F990_P03_S00_L04c Form 990, Part III, Line 4c Continuation of explanation provided on line 4A. "Dental Center" - The San Antonio Community Hospital Dental Center has been operating for over 75 years with the mission to provide dental care to low-income, uninsured children in Western San Bernardino County. The Dental Center operates during the school year, with clinics held from October through May. In addition to direct patient care, the Dental Center provides in-school screening to identify children in need of dental care. The Dental Center's goal is to educate children about the importance of dental hygiene and to provide prophylactic and therapeutic dental and orthodontic services to this vulnerable population. Some of the children treated have been unable to eat properly or to function in school due to the pain being experienced. Once located on the hospital's campus, the Dental Center is now housed in a dedicated building in Rancho Cucamonga owned and operated by the Assistance League of the Foothill Communities. SACH paid the remodeling cost for the Dental Center building in 1985 and continues to provide financial assistance and other services to support the program. The Dental Center is a prime example of the benefits that can be provided to families in need through collaborative efforts. SACH, the Assistance League of the Foothill Communities, volunteer dentists, hygienists, and other health and dental professionals, along with a variety of funding agencies are devoted to improving the health and well-being of elementary and junior high school children throughout the regional community. "Safe Surrender" -SACH's Safe Surrender program and DVD entitled "Safe Surrender. No Shame. No Blame. No Names." is a wonderful example of how the hospital and its employees recognize and take ownership in community health issues where they can make a difference. Officially called the "Safe Haven" law, the Safe Surrender program ensures that a baby can be surrendered anonymously to any hospital, fire department, or police department without criminal repercussions. While many healthcare workers were aware of the law, few junior high, high school, and college students knew about this safe and secure option for both infant and parents. Produced in partnership with college film students, Safe Surrender. No Shame. No Blame. No Names. contains powerful imagery and interviews with teenage girls who relate to young women at their own level. The DVD is available free of charge to anyone willing to help raise awareness of the Safe Surrender alternative to infant abandonment. From the moment of its release, there has been an overwhelming response that has garnered statewide attention due to its poignant and highly effective portrayal of the unfortunate consequences of infant abandonment, as well as offering life-saving alternatives. To date more than 2,300 copies of the DVD have been distributed to over 750 different community organizations, school districts, nurse educators, and teachers. Most recently, the San Bernardino County Superintendent of Schools, through its School Linked Health Programs and Partnerships, has incorporated the hospital's Safe Surrender DVD into its Positive Prevention Plus sex education curriculum. San Bernardino County has rolled the program out to all 34 of its school districts, educating nurses and teachers, and targeting thousands of middle school and high school students. After serving as a pilot project and seeing the program's impact on its students, San Bernardino County is printing the curriculum for distribution to school districts throughout California who request it. It is also available through the Department of Education's Healthy Kids Resource Center. The hospital estimates that the message reached over 150,000 young people prior to the school-wide launch. With the additional exposure through the school curriculum, the number of young people touched by the DVD's message will continue to grow. "Sports Injury Clinic" -SACH launched the Sports Injury Screening Clinic at its Rancho San Antonio satellite facility in 2009. The program was introduced to provide free screenings for community members who have sustained sports-related injuries. Through discussions with various school health advisory councils, SACH soon realized that in addition to the program for the general community, there was strong support for a free sports screening program targeted to local school districts, city community centers, youth league programs, senior citizen programs, and adult intramural leagues. Using this targeted approach has enabled the clinic to help several uninsured high school athletes who were screened and educated about their injuries. The students not only learned how to manage their current injury to speed recovery, but also learned methods to avoid additional injuries in the future. These free services have allowed the students to get back to a healthy lifestyle and to return to their sport. One young athlete who suffered a head injury while playing soccer arrived at the clinic with an undiagnosed brain injury. The family had heard about the screenings and brought their athlete in to undergo a special test designed to diagnose patients with head injuries. When the serious nature of the injury was identified through the screening, the young woman was referred for an MRI and follow-up consultation with a neurologist. If this young athlete had failed to access treatment, this injury could have been debilitating, if not life-threatening, particularly if she were to sustain further injury. Through this program, SACH has been able to diagnose, educate, and immediately activate treatment plans for these athletes, and at no cost to the families. In these fragile economic times when many families have lost health insurance coverage, this community service takes on even greater importance. The walk-in screening clinic takes place every Monday from 4 pm to 6 pm at the Rancho San Antonio Rehabilitation Center in the City of Rancho Cucamonga. Each patient that comes into the clinic with a sports injury receives a free medical screening by a board-certified physician in addition to a free assessment by a physical therapist and/or athletic trainer. Plans for the program include increasing community awareness via local newspapers, school districts, and adult and youth sports leagues. Given the enthusiastic response of the people who have been served by the clinic, it is anticipated that demand will continue to grow which could lead to further expansion of the program. F990_P03_S00_L04d Form 990, Part III, Line 4d Continuation of explanation provided on line 4A. "HAPPY Children's Health Initiative" - SACH is an active participant in Healthy Ontario's prevention and wellness and healthcare access workgroups. These initiatives are closely aligned with the hospital's goal to improve the health status of the communities we serve and provide a tangible means for the hospital to respond to identified community needs. Healthcare access in the City of Ontario is particularly challenging given that 22% of the population is uninsured and 16% do not have a regular medical home. As a result, access for this particular population is primarily through the 911 system and hospital emergency departments. One of the key objectives established by the healthcare access workgroup was to encourage appropriate utilization of high-cost services and systems, and to properly channel resources to increase access to preventive and primary care. It is out of this objective that HAPPY (Health Access Partnership Project for Youth) was born. HAPPY's goals are to increase health plan enrollment for qualified children; conduct health screenings for children without access to healthcare through collaboration and coordination of care among public and private entities; and to demonstrate cost savings through new models of health care for children within targeted groups. Children are enrolled in the HAPPY Club through Kids Come First Community Clinic and are given an identification card. All services provided through the program are monitored and evaluated to measure health outcomes. Since the program is currently designed as a pilot project, it is limited to children who reside in the City of Ontario and are not currently covered in the health system. The HAPPY project is designed to increase access to children's preventative health services such as regular medical check-ups, preventative & wellness care, screening and assessment, immunizations, health education, and specialty care referrals. The program began in the summer of 2009, but enrollment did not begin in earnest until school was in session. During its first year, the HAPPY Club enrolled 530 children, which put the program well on its way to achieving its goal to enroll 1,500 children over an 18-month period. Given its rapid growth in membership, HAPPY exceeded its enrollment goal with 1,600 children enrolled by the end of the 2010-2011 school year. Since its inception, the HAPPY Club has made a tremendous difference in the lives of many children and their families by filling the gap in the safety net. Each child enrolled in the Happy Club receives a medical screening, and in many cases these screenings lead to early intervention and referrals to critically needed medical care. This is where SACH steps in to help by facilitating referrals to physicians who can provide the specialized medical care needed. In addition to arranging for referrals to pediatric specialists on its medical staff, SACH provides laboratory, radiology, cardiology, and various other diagnostic procedures for HAPPY children who need further medical follow-up. To date, the hospital has provided free diagnostic procedures for over 250 children at a cost in excess of $30,000. In addition to the expense incurred by the hospital, physician specialists including radiologists and cardiologists donate their time and resources to interpret the diagnostic exams and report their findings to the medical director at the Kids Come First clinic. Access to diagnostic testing has enabled the medical providers at the clinic to identify and treat health problems that had gone undiagnosed due to the family's inability to access medical care for their child. Without treatment, many of these children are risk for more serious health problems that can develop into lifelong chronic diseases such as diabetes. Healthy Ontario's experience has demonstrated that new ways of thinking about health can lead to innovative models of care like the HAPPY Club, which is effectively filling some of the holes in the healthcare safety net. The hope for the future is that the success achieved by Healthy Ontario's pilot project will become a model that other cities can replicate to mirror the HAPPY Club's success in their own communities. F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 Bylaws now allow for a minimum of 13 and a maximum of 15 board members rather than a prior requirement of 15. F990_P06_S0B_L10a Form 990, Part VI, Section B, Line 10a The hospital has a Medical Staff organization whose activities are separate from the hospital's but the hospital's governing board has ultimate authority over certain medical staff actions. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a The Form is prepared internally by the organization's Accounting Department and reviewed by the organization's CFO. The Form is then reviewed by the organization's external financial and tax audit firm. Following the external review, the CFO reviews the Form with the organization's CEO. The Form is then sent to members of the organization's Board Audit Committee for review and approval prior to filing. The form is then sent to the entire organization Board prior to final signatures and filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The organization has a Compliance Officer who reviews the organization's compliance policies, including its conflict of interest statements, at least annually. The organization's Board has an organization meeting every January. At the annual organization meeting conflict of interest statements are distributed to all Board members and Officers and subsequently collected by the organization's Compliance Officer. The CFO, who attends all Board meetings, also reviews the Board conflict of interest statements. If a new potential conflict of interest arises during the year, a new conflict of interest statement is signed. If a potential conflict of interest exists during a Board discussion, the Board member is required to state the conflict and abstain from any related Board votes. Board minutes reflect these abstentions. At least once each year, the organization's Compliance Officer provides a verbal compliance update at a Board meeting and reminds Board members of their duty to disclose potential conflicts of interest. The organization follows a similar annual procedure for members of its executive management and department directors, including at least annual compliance education sessions. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The organization's executive compensation program is directed by the Compensation Committee of the Board. The organization has developed and approved a formal executive compensation policy that currently covers six senior management employees, including the CEO and the CFO. A comprehensive base pay and total executive compensation analysis is performed by an outside compensation consulting firm every two years. The consultant presents the survey data and analysis to the Board Compensation Committee. The external compensation study includes an evaluation for excess benefit transactions under the Intermediate Sanctions for Tax-Exempt Organizations as described in Section 4958 of the Internal Revenue Code. The latest survey was conducted in 2009. A request for proposal process was conducted prior to the selection of the compensation consultant. The consultant used survey data from all of California, with subsets of data from Southern California, and a further subset of data from the organization's local market area. The Compensation Committee reviews the external consultant's findings and provides direction for any needed compensation policy or pay range changes. The organization's Board Audit Committee also conducts an annual review of the reasonableness of the CEO's and CFO's total compensation. Other key employee compensation, Vice Presidents and Department Directors, is evaluated based on market based compensation survey data provided by the Hospital Council of Southern California taking into consideration pay rates for similar management positions at SACH. The procedures described here are documented in the board minutes. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization has not made its governing documents or conflict of interest statements available to the public. The organization's financial statements are part of the Organization's annual report filed with the California Office of Statewide Health Planning and Development (OSHPD) and are available on the OSHPD Web site. The organization's financial statements are also included as part of its annual Medicare and Medicaid cost report filings which are publically available on the CMS (Medicare) Web site. The organization's financial statements are also provided to anyone upon a verbal or written request. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a The average weekly hours worked by the officers of the hospital for related organizations are as follows: Steve Moreau, Foundation 2 hours and Health plan 1 hour and Roger Parsons Foundation 2 hours and Health plan 1 hour. F990_P11_S00_L05 Form 990, Part XI, Line 5 Unrealized Loss on investments ($522,959) Unfunded Pension liability $7,382,214, increase of interest in subsidiary SAHF-temp restricted earnings of $889,055 and change in value of charitable remainder trusts of $176,162, interest in subsidiary SAHF -unrestricted earnings $1,815,159, book-tax difference in ASC income of $63,655. F990_P12_S00_L02b Form 990, Part XII, Line 2b The financial statements of San Antonio Community Hospital and its affiliates were audited on a combined basis by Ernst & Young, LLP. The hospital has an audit committee that assumes oversight of the combined audit and selection of an independent accountant. San Antonio Hospital Foundation Inc 999 San Bernardino Road Upland CA 91786 330042666 support SACH CA 501c(3) 7 N/A 1 San Antonio Community Health Care Plan 999 San Bernardino Road Upland CA 91786 237391094 Health Plan services CA 501c(9) N/A 1 Cucamonga Health Services 999 San Bernardino Road Upland CA 91786 330010073 holding company CA N/A C 28 23669 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 San Antonio Hospital Foundation Inc p 790592 Market value San Antonio Community Health Care Plan q 11681158 Market value San Antonio Hospital Foundation Inc c 1495890 Market Value San Antonio Hospital Foundation Inc q 68000 Market value