2021-05-14T14:04:57-05:00 2020-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2019-07-01 330420041 SAN GORGONIO MEMORIAL HOSPITAL SANG 9518451121 600 NORTH HIGLAND SPRINGS AVENUE BANNING CA 92220 STEVE BARRON CEO 9518451121 2021-05-14 1 TERRI REXRODE CPA MST P00096513 9206620016 2021-05-13 2019 2022-09-23 18:48:47Z STEVE BARRON 600 NORTH HIGLAND SPRINGS AVENUE BANNING CA 92220 68168585 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 12 820 30 0 0 412219 7551296 64951314 59200817 0 0 2099783 1416472 67463316 68168585 0 0 0 0 43810736 46283180 0 0 105495 24192341 27934847 68003077 74218027 -539761 -6049442 23825185 31092395 19648236 32964888 4176949 -1872493 SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. 0 0 57311957 60217810 THE HOSPITAL IS COMPRISED OF AN ACUTE CARE FACILITY WHICH PROVIDES HEALTHCARE SERVICES. THE HOSPITAL PROVIDED 49,285 VISITS AND TREATED 9,275 PATIENTS DURING THE FISCAL YEAR. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT AN AMOUNT BELOW COST, AND PROVIDES CARE TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CHARITY ($674,019) AND UNCOMPENSATED CARE ($466,669) TOTALED $1,140,688. UNPAID MEDI-CAL PROGRAM CHARGES WERE $81,609,109. UNPAID MEDICARE PROGRAM CHARGES FOR THE FISCAL YEAR WERE $51,371,677. THUS, TOTAL QUANTIFIABLE COMMUNITY BENEFITS PER AUDITED FINANCIAL STATEMENTS WERE $134,121,474. 57311957 1 1 0 0 0 0 0 0 0 0 0 0 0 1 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 1 187 0 820 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 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 STEVE BARRON CHIEF EXECUTIVE OFFICER 40.00 X 500011 0 1923 DAVID RECCUPERO CHIEF FINANCIAL OFFICER 40.00 X 295906 0 13759 PATRICIA BROWN CHIEF OPERATING OFFICER/CHIEF NURSING 40.00 X 246775 0 9642 TZARIMNAH KARAM CHIEF OF HUMAN RESOURCES 40.00 X 207999 0 8631 HOLLY YONEMOTO CHIEF MARKETING AND DEVELOPMENT 40.00 X 200204 0 8907 ANNA KAMPANARTSANYAKORN REGISTERED NURSE 40.00 X 197489 0 9392 CARRIE ECHOLS DIRECTOR OF OB DEPARTMENT 40.00 X 188186 0 9827 JOSE RUIZ PHARMACIST 40.00 X 188752 0 8898 SUSAN DIBIASI CHAIRPERSON 5.00 X X 3800 0 0 RON RAIDER BOARD MEMBER 3.00 X 3800 0 0 OLIVIA HERSHEY BOARD MEMBER 3.00 X 3100 0 0 DENNISE TANKERSLEY BOARD MEMBER 5.00 X 400 0 0 STEVEN COOLEY BOARD MEMBER 3.00 X 300 0 0 EHREN NGO VICE CHAIR 5.00 X X 100 0 0 ESTELLE LEWIS SECRETARY 5.00 X X 0 0 0 LYNN BALDI TREASURER 5.00 X X 0 0 0 PHILIP CAPOBIANCO III BOARD MEMBER 3.00 X 0 0 0 ANDREW GARDNER BOARD MEMBER 3.00 X 0 0 0 STEVEN RUTHLEDGE BOARD MEMBER 3.00 X 0 0 0 LANNY SWERDLOW BOARD MEMBER 3.00 X 0 0 0 GEORGIA SOBIECH - TERMED BOARD MEMBER 3.00 X 0 0 0 2036822 0 70979 87 0 1 0 CHANGE HEALTHCARE PO BOX 98347 CHICAGO IL 606938347 SOFTWARE SUPPORT SERVICES 1476885 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PL CHICAGO IL 606731246 EHR SUPPORT AND REVENUE MANAGEMENT 874616 JACKSON & COKER PO BOX 277638 ATLANTA GA 303847638 ANESHTESIAL LOCUM-TENENS 552123 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 ANESHTESIAL LOCUM-TENENS 547443 DAVITA PO BOX 781607 PHILADELPHIA PA 19178 DIALISYS SUPPORT AND CONTRACTOR 356015 52 279734 6303030 968532 7551296 NET PATIENT SERVICE REVENUE 622110 59200817 59200817 59200817 PHYSICAL THERAPY JOINT VENTURE 622110 1016993 1016993 CAFETERIA SALES 622110 399479 399479 1416472 68168585 60217810 0 399479 X 1068016 1068016 36207997 28873232 7263754 71011 6281859 4888736 1381100 12023 2725308 2112403 607710 5195 1760 1760 839236 839236 38875 38875 9088286 7051383 2019637 17266 68771 68771 1758844 1495018 263826 2785186 1949630 835556 1951507 1652903 298604 231229 95831 135398 119077 33342 85735 342836 342836 1239322 1164963 74359 MEDICAL SUPPLIES 6245950 6245950 NON-MEDICAL SUPPLIES 1111264 899723 211541 LICENSES & TAXES 798988 21550 777438 REPAIRS & MAINTENANCE 706360 559683 146677 607356 267610 339746 74218027 57311957 16800575 105495 1044462 9384115 4717 9663 1224719 1231918 8329763 7088594 1668855 1789075 280427 215763 646319 10625923 11373267 23825185 31092395 18915691 21636576 2577690 6000000 732545 2750622 19648236 32964888 X 3937865 -1872493 239084 0 4176949 -1872493 23825185 31092395 -6049442 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 INTERGOVERNMENTAL RECEIVABLE 10877160 BENEFICIAL INTEREST 496107 11373267 ESTIMATED SETTLEMENTS PAYABLE 2750622 2750622 68168585 0 68168585 0 68168585 74218027 0 74218027 0 74218027 1 1 X 1 X 1 X 1 1 1 0 1 1 1163090 4831808 0 0.00000 9165985 4831808 4334177 0.05840 35070864 21771329 13299535 0.17920 45399939 31434945 17633712 0.23760 41560 41560 0.00060 34369 34369 0.00050 75929 75929 0.00110 45475868 31434945 17709641 0.23870 1 7839364 9395667 15688781 -6293114 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 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 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 14.2%. THE HOSPITAL'S PAYOR MIX INCLUDES APPROXIMATELY 23% MEDI-CAL RECIPIENTS AND 11% 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 500011 0 0 0 0 0 1923 0 0 0 501934 0 0 0 DAVID RECCUPERO CHIEF FINANCIAL OFFICER 285013 0 6702 0 4191 0 13759 0 0 0 309665 0 0 0 PATRICIA BROWN CHIEF OPERATING OFFICER/CHIEF NURSIN 243067 0 0 0 3708 0 9642 0 0 0 256417 0 0 0 TZARIMNAH KARAM CHIEF OF HUMAN RESOURCES 198918 0 7839 0 1242 0 8631 0 0 0 216630 0 0 0 HOLLY YONEMOTO CHIEF MARKETING AND DEVELOPMENT 198979 0 0 0 1225 0 8907 0 0 0 209111 0 0 0 ANNA KAMPANARTSANYAKORN REGISTERED NURSE 196973 0 0 0 516 0 9392 0 0 0 206881 0 0 0 CARRIE ECHOLS DIRECTOR OF OB DEPARTMENT 187405 0 0 0 781 0 9827 0 0 0 198013 0 0 0 JOSE RUIZ PHARMACIST 188294 0 350 0 108 0 8898 0 0 0 197650 0 0 0 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 PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,097,005. MANAGEMENT AND GENERAL EXPENSES 2,019,637. FUNDRAISING EXPENSES 17,266. TOTAL EXPENSES 4,133,908. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,954,378. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,954,378. 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 0 0 0 0 0 SAN GORGONIO MEMORIAL FOUNDATION C 279734 ACTUAL