2022-05-11T11:45:35-05:00 2021-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2020-07-01 330420041 SAN GORGONIO MEMORIAL HOSPITAL SANG 9518451121 600 NORTH HIGHLAND SPRINGS AVENUE BANNING CA 92220 STEVE BARRON CEO 9518451121 2022-05-06 1 STEVE BARRON 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2022-05-06 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEVE BARRON 600 NORTH HIGHLAND SPRINGS AVENUE BANNING CA 92220 71265024 0 X WWW.SGMH.ORG X 1991 CA SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. 12 12 794 30 0 0 7551296 3875065 59200817 66337763 0 0 1416472 1052196 68168585 71265024 0 0 0 0 46283180 48143759 0 0 107930 27934847 43785608 74218027 91929367 -6049442 -20664343 31092395 13082135 32964888 35618971 -1872493 -22536836 SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. 0 0 74215485 66337763 THE HOSPITAL IS COMPRISED OF AN ACUTE CARE FACILITY WHICH PROVIDES HEALTHCARE SERVICES. THE HOSPITAL PROVIDED 39,678 VISITS AND PROVIDED 11,008 DAYS OF CARE DURING THE FISCAL YEAR. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT AN AMOUNT BELOW COST, AND PROVIDES CARE TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CHARITY $496,340 AND UNCOMPENSATED CARE $618,402 TOTALED $1,114,742. UNPAID MEDICAL PROGRAM CHARGES WERE $35,601,331. UNPAID MEDICARE PROGRAM CHARGES FOR THE FISCAL YEAR WERE $84,842,724. TOTAL QUANTIFIABLE COMMUNITY BENEFITS WERE $120,444,055. 74215485 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 196 0 794 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X X MARGARET KAMMER CONTROLLER 9517692118 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 SUSAN DIBIASI CHAIRPERSON 5.00 X X 2900 0 0 EHREN NGO TREASURER 5.00 X X 1100 0 0 RON RADER SECRETARY 5.00 X X 2500 0 0 STEVEN RUTLEDGE VICE CHAIR 5.00 X X 2000 0 0 ESTELLE LEWIS BOARD MEMBER THRU 12/5/20 3.00 X 0 0 0 LYNN BALDI BOARD MEMBER THRU 8/1/20 3.00 X 100 0 0 DENNIS TANKERSLEY BOARD MEMBER 3.00 X 0 0 0 PHILIP CAPOBIANCO III BOARD MEMBER 3.00 X 0 0 0 ANDREW GARDNER BOARD MEMBER THRU 6/30/21 3.00 X 0 0 0 LANNY SWERDLOW BOARD MEMBER THRU 9/22/20 3.00 X 600 0 0 HOWARD KATZ BOARD MEMBER 3.00 X 0 0 0 JOEL LABAH BOARD MEMBER 3.00 X 0 0 0 STEVE BARRON CHIEF EXECUTIVE OFFICER 40.00 X 524133 0 26202 DAVID RECCUPERO CHIEF FINANCIAL OFFICER THRU 7/1/20 40.00 X 285013 0 14251 PATRICIA BROWN CHIEF OPERATING OFFICER 40.00 X 254571 0 12724 ANNAH KARAM CHIEF OF HUMAN RESOURCES 40.00 X 199018 0 9946 HOLLY YONEMOTO CHIEF FINANCIAL OFFICER THRU 3/11/2021 40.00 X 236554 0 11823 ANNA KAMPANARTSANYAKORN REGISTERED NURSE 40.00 X 214082 0 10687 JOSE LOPEZ DIRECTOR OF PHARMACY 40.00 X 197960 0 9893 JOSE RUIZ PHARMACIST 40.00 X 198937 0 9929 2119468 0 105455 97 0 1 0 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PL CHICAGO IL 606731246 EHR SUPPORT AND REVENUE MANAGEMENT 1401796 CARDINAL HEALTH PHARMACY PO BOX 56412 LOS ANGELES CA 90074 PHARMACUTICAL SUPPLIES 1340833 OWENS AND MINOR 9120 LOCKWOOD BLVD MECHANICSVILLE VA 23116 MEDICAL AND SMALL SUPPLIES 689671 MCKESSON MEDICAL-SURGICAL PO BOX 51020 LOS ANGELES CA 90005 MEDICAL SUPPLIES 498096 JACKSON & COKER HOLDINGS LLC PO BOX 277638 ATLANTA GA 303847638 ANESHTESIAL LOCUM-TENENS 429228 44 8667 2800425 1065973 3875065 NET PATIENT SERVICE REVENUE 621110 66337763 66337763 66337763 CAFETERIA SALES 722514 1052196 1052196 1052196 71265024 66337763 0 1052196 X 1126094 1126094 36676293 28427795 8178813 69685 7520842 5829405 1677147 14290 2820530 2119421 695914 5195 3000 3000 767567 767567 98599 98599 9873716 7653117 2201839 18760 27278 27278 1440744 1224632 216112 2812281 2390439 421842 2203761 1873197 330564 231198 92479 138719 154169 46251 107918 314009 314009 1328202 1248510 79692 BAD DEBT 9892737 9892737 MEDICAL SUPPLIES 8392663 8392663 ALL OTHER EXPENSES 3027725 2573566 454159 REPAIRS & MAINTENANCE 1583952 1346359 237593 1634007 1104914 529093 91929367 74215485 17605952 107930 9384115 1628250 9663 11801 1231918 957337 7088594 8135514 1789075 1776554 215763 21485 11373267 551194 31092395 13082135 21636576 33498394 2577690 1718319 6000000 0 2750622 402258 32964888 35618971 X -1872493 -22536836 -1872493 -22536836 31092395 13082135 -20664343 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 MEDICARE COVID 19 402258 402258 61372287 -9892737 -9892737 71265024 0 71265024 82036630 -9892737 -9892737 91929367 0 91929367 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBTS -9,892,737. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBTS -9,892,737. 1 1 X 1 X 1 X 1 1 0 1 1 10581689 2800424 7781265 0.09490 3381481 2800424 581057 0.00710 61953698 24675560 37278138 0.45440 75916868 30276408 45640460 0.55640 43520 43520 0.00050 49147 49147 0.00060 92667 92667 0.00110 76009535 30276408 45733127 0.55750 1 9892737 9665879 15949035 -6283156 X 1 1 1 1 SAN GORGONIO MEMORIAL HOSPITAL 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 WWW.SGMH.ORG 1568469997 330420041 X X X SAN GORGONIO MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 19 1 1 0 1 SGMH.ORG X 1 19 1 SGMH.ORG 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X X 1 X 0 X X X 1 X 0 0 SAN GORGONIO MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: DISTRICT BOARD AND COMMUNITY LEADERS WERE CONTACTED FOR INFORMATION AND THE NEEDS ASSESSMENT WAS PRODUCED BY AND WITH OTHER HOSPITALS IN THE AREA. SAN GORGONIO MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: THE ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH LOMA LINDA UNIVERSITY HOSPITAL. SAN GORGONIO MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: IT WOULD BE FISCALLY IMPOSSIBLE FOR THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS OF THE COMMUNITY, BUT THROUGH CONTINUED COLLABORATION WITH OTHER COMMUNITY AGENCIES THE HOSPITAL HOPES TO CONTINUE TO IDENTIFY PRIORITY AREAS WHERE THEY CAN MAKE THE MOST IMPACT. THE HOSPITAL HAS IDENTIFIED ACCESS TO HEALTH CARE, BEHAVIORAL HEALTH, AND CHRONIC DISEASE WITH A SPECIAL EMPHASIS ON HEART DISEASE AS THEIR PRIORITY AREAS. THESE WERE CHOSEN AS BROAD PRIORITIES TO ADDRESS A WIDE SPECTRUM OF INTERVENTIONS IN PARTNERSHIP WITH THE COMMUNITY. A FOCUS WILL ALLOW TRUE IMPACT VERSUS BEING FRAGMENTED AND INEFFECTIVE. A DETAILED COMMUNITY HEALTH PLAN HAS BEEN DEVELOPED WITH KEY METRICS FOR EACH OF THE PRIORITY AREAS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9,892,737. PART III, LINE 2: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED INCLUDES THE COST TO CHARGE RATIO OF PATIENT CARE PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE POLICY CANNOT BE DETERMINED. THE HOSPITAL DID NOT TRACK THE AMOUNT OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY, AND FURTHERMORE SUFFICIENT INFORMATION WAS NOT OBTAINED FROM ALL PATIENTS THAT MIGHT BE ELIGIBLE TO MAKE THIS DETERMINATION AND CALCULATION. PART III, LINE 4: THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE DESCRIBING BAD DEBT EXPENSE. HOWEVER, THERE IS A FOOTNOTE THAT DISCUSSES CHARITY CARE AND COMMUNITY BENEFIT EXPENSE. PART III, LINE 8: ANY SHORTFALL IS DEEMED A COMMUNITY BENEFIT IN ITS ENTIRETY. PART III, LINE 9B: IT IS THE POLICY OF SAN GORGONIO MEMORIAL HOSPITAL THAT ALL PATIENTS WILL BE TREATED FAIRLY IN PRICING AND COLLECTION PRACTICES. THE HOSPITAL'S REGISTRATION AND PATIENT FINANCIAL SERVICES STAFF WILL MAKE A REASONABLE ATTEMPT TO ESTIMATE EACH PATIENT'S LIABILITY. THE HOSPITAL'S PFS STAFF, IN CONJUNCTION WITH CONTRACTED EARLY OUT AGENCIES WILL MAKE A SUBSEQUENTLY ATTEMPT TO COLLECT EACH PATIENT'S LIABILITY AND TO OFFER DISCOUNT AND CHARITY CARE APPLICATIONS. THIS IS OFFERED IN COMPLIANCE WITH CALIFORNIA ASSEMBLY BILL 774 (STATUTES OF 2006) AND SB 1276 (CHAPTER 758, STATUES OF 2014). THIS POLICY DOES NOT APPLY TO ANY PHYSICIAN SERVICES RENDERED AT SGMH. PART VI, LINE 2: THE MANAGEMENT TEAM, HOSPITAL DEPARTMENT STAFF AND MANAGERS, AND THE BOARD OF DIRECTORS ARE COMPRISED OF COMMUNITY MEMBERS. THEY ARE ABLE TO GATHER AND COMMUNICATE THE HEALTH CARE NEEDS OF THE COMMUNITY THE HOSPITAL SERVES AND CONTINUALLY ADDRESS THEM AT STAFF AND BOARD MEETINGS. THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY IS PUBLICLY AVAILABLE ON THE INTERNET AT: HTTP://WWW.SGMH.ORG. THE HOSPITAL CONDUCTED A CHNA/IMPLEMENTATION STRATEGY IN 2019 THAT IS ALSO POSTED ON THE ORGANIZATION'S WEBSITE, AND WILL BE APPLICABLE TO THE COMING FEW YEARS' FORM 990S. PART VI, LINE 3: IT IS THE HOSPITAL'S POLICY THAT WHEN IT BECOMES APPARENT THAT A PATIENT MAY HAVE DIFFICULTY IN MEETING HIS/HER FINANCIAL RESPONSIBILITY TO THE HOSPITAL, THE PATIENT WILL BE REQUESTED TO COMPLETE THE APPLICATION PROCESS FOR CALIFORNIA MEDI-CAL AND/OR OTHER AVAILABLE PROGRAMS. HOSPITAL STAFF ASSIST IN THE APPLICATION PROCESS. PATIENTS WHO DO NOT QUALIFY FOR CALFORNIA MEDI-CAL OR OTHER ASSISTANCE MAY APPLY FOR THE HOSPITAL'S ASSISTANCE PROGRAM. PART VI, LINE 4: THE HOSPITAL IS A RURAL HOSPITAL LOCATED IN THE PASS AREA OF RIVERSIDE COUNTY. IT PRIMARILY SERVES THE CITIES OF BANNING, BEAUMONT, CABAZON, AND CALIMESA, CALIFORNIA. THE POPULATION SERVED IS HIGH-RISK DUE TO POVERTY LEVEL INCOMES, LOW EDUCATION LEVELS, AND HIGH DRUG USE. THE COUNTY HAS AN UNEMPLOYMENT RATE OF 8.7%. THE HOSPITAL'S PAYOR MIX INCLUDES APPROXIMATELY 31% MEDI-CAL RECIPIENTS AND 5% UNINSURED. PART VI, LINE 5: THE HOSPITAL CONTINUES TO STRIVE TO MEET THE HEALTH NEEDS OF ITS COMMUNITY AS THESE NEEDS EVOLVE. PART VI, LINE 7, REPORTS FILED WITH STATES CA X X X X 0 0 0 0 0 0 0 0 0 STEVE BARRON CHIEF EXECUTIVE OFFICER 524033 0 100 0 0 0 26202 0 0 0 550335 0 0 0 DAVID RECCUPERO CHIEF FINANCIAL OFFICER THRU 7/1/20 285013 0 0 0 0 0 14251 0 0 0 299264 0 0 0 PATRICIA BROWN CHIEF OPERATING OFFICER 254471 0 100 0 0 0 12724 0 0 0 267295 0 0 0 HOLLY YONEMOTO CHIEF FINANCIAL OFFICER THRU 3/11/20 236454 0 100 0 0 0 11823 0 0 0 248377 0 0 0 ANNA KAMPANARTSANYAKORN REGISTERED NURSE 213732 0 350 0 0 0 10687 0 0 0 224769 0 0 0 ANNAH KARAM CHIEF OF HUMAN RESOURCES 198918 0 100 0 0 0 9946 0 0 0 208964 0 0 0 JOSE RUIZ PHARMACIST 198587 0 350 0 0 0 9929 0 0 0 208866 0 0 0 JOSE LOPEZ DIRECTOR OF PHARMACY 197860 0 100 0 0 0 9893 0 0 0 207853 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS OF SAN GORGONION MEMORIAL HOSPITAL WERE CHANGED EFFECTIVE JANUARY 6, 2021. THE NUMBER OF DIRECTORS WAS REDUCED FROM THRITEEN TO NINE. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE FINANCE COMMITTEE AND FULL BOARD AT A MONTHLY BOARD MEETING, BUT MAY BE PRESENTED AT A DATE SUBSEQUENT TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EXECUTIVE ASSISTANT MONITORS AND DOCUMENTS CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEW AND APPROVE MANAGEMENT WAGES EACH YEAR DURING THE BUDGET PROCESS. SOURCES UTILIZED BY THE BOARD WHEN REVIEWING FAIR MARKET VALUE IN COMPENSATION INCLUDE MARKET SURVEYS AND SALARY RANGES PROVIDED BY THE HR DEPARTMENT. FORM 990, PART VI, SECTION C, LINE 19 PUBLISHED ON WEBSITE WWW.SCGH.ORG OR AVAILABLE BY REQUEST FROM THE CEO, CFO, CONTROLLER, OR EXECUTIVE ASSISTANT. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 7,653,117. MANAGEMENT AND GENERAL EXPENSES 2,201,839. FUNDRAISING EXPENSES 18,760. TOTAL EXPENSES 9,873,716. PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. SAN GORGONIO HEALTH CARE DISTRICT 600 N HIGHLAND SPRINGS AVE BANNING CA 92220 956004149 HEALTHCARE CA GOVT N/A 0 SAN GORGONIO MEMORIAL HOSPITAL FOUNDATION 600 N HIGHLAND SPRINGS AVE BANNING CA 92220 953863230 SUPPORT SAN GORGONIO MEMORIAL HOSPITAL CA 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0