2020-05-06T06:39:25-07:00 2019-06-30 472718509 JWT & Associates LLP 1111 East Herndon Avenue Suite 211 Fresno CA 93720 990 2018-07-01 330420041 San Gorgonio Memorial Hospital SANG 9518451121 600 North Highland Springs Ave Banning CA 92220 David Recupero CFO 2020-05-06 true Inger Sullenger CPA P01464277 5594317708 X 2018 2021-01-29 14:40:06Z David Recupero 600 North Highland Springs Ave Banning CA 92220 67463316 false false X www.sgmh.org X 1991 CA San Gorgonio Memorial Hospital is a nonprofit public benefit corporation formed for the purpose of operating the San Gorgonio Acute Care Facility. 13 12 818 85 0 559282 412219 64695815 64951314 0 1769218 2099783 67024315 67463316 0 0 45416267 43810736 0 0 27108199 24192341 72524466 68003077 -5500151 -539761 21817094 23825185 17762957 19648236 4054137 4176949 San Gorgonio Memorial Hospital is a nonprofit public benefit corporation formed for the purpose of operating the San Gorgonio Acute Care Facility. false false 54272211 67051097 The Hospital is comprised of an acute care facility which provides healthcare services. The Hospital provided 51,289 visits and treated 11,500 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-Note N were $134,121,474. 54272211 true true false false false false false false false false false false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false true false false false false false true false false false true X 197 0 true 818 true false false false false false false false false 0 false false false false false false false false false false false false X 13 12 true false false false false false false true true false false false true true true true true true true false X X X Margaret Kammer Controller 9517692118 600 North Highland Springs Ave Banning CA 92220 Georgia Sobiech Director 1.00 0.00 X 900 0 0 Jerilynn Kaibel DC Chair 1.00 0.00 X 1700 0 0 Estelle Lewis Vice Chair 1.00 0.00 X 2400 0 0 DeNae Reagins Secretary 1.00 0.00 X 2500 0 0 Olivia Hershey Treasurer 1.00 0.00 X 3900 0 0 Bakhtiar Ahmad MD Director 1.00 0.00 X 1800 0 0 Lynn Baldi Director 1.00 0.00 X 2900 0 0 Barbara Djordjevic Director PartYr 1.00 0.00 X 1300 0 0 Ehren Ngo Director 1.00 0.00 X 900 0 0 Farzad Farrokhi MD Director 1.00 0.00 X 1700 0 0 Steve Ruthledge Director 1.00 0.00 X 0 0 0 Ron Raider Director 1.00 0.00 X 4100 0 0 N Irwin Reeves Director PartYr 1.00 0.00 X 400 0 0 Susan DiBiasi Director 1.00 0.00 X 3200 0 0 Dennis Tankersley Director 1.00 0.00 X 2400 0 0 David Recupero CFO 45.00 0.00 X 224205 0 78471 Patricia Brown Chf of Nursing 45.00 0.00 X 170501 0 59675 Steven Barron CEO 45.00 0.00 X 505889 0 151767 Angela Brady ER Director 60.00 0.00 X 192881 0 67508 Anna Kampanartsanyakorn RN 56.00 0.00 X 181634 0 72778 Jose A Lopez Pharmacy Director 50.00 0.00 X 162807 0 67130 Tzarimna Karam Chief Human Res 45.00 0.00 X 158053 0 60341 Tuanhuy Nguyen CT Tech 45.00 0.00 X 156682 0 67480 1782752 625150 50 false true false Cardinal Health Pharmacy Distrib 27680 Ave Mentry Valencia CA 91355 Pharmaceuticals 1425968 Mckesson Medical Surgical PO Box 98347 Chicago IL 60693 Lab Supplies 1066120 Desert Anesthesia Consulting LLP 25612 Barton Rd 368 Loma Linda CA 92354 Anesthesia Services 1049548 Davis Wright Tremaine LLP 920 5th Ave Ste 3300 Seattle WA 98104 Legal & Consulting 966355 Owens and Minor 9120 Lockwood Blvd Mechanicsville VA 23116 Hospital Supplies 873022 47 402246 9973 412219 Net Patient Svc Revenue 622110 64951314 64951314 64951314 0 0 0 0 0 0 0 0 Cafeteria,Med Records,etc 622110 824930 824930 Physical Therapy Jt Ventr 621300 1274853 1274853 2099783 67463316 67051097 0 0 0 0 1088049 1088049 0 34206658 29327113 4879545 4525313 3929794 595519 1398756 1174100 224656 2591960 2151943 440017 155310 155310 480095 480095 36723 36723 0 0 0 3338480 2138584 1199896 42871 42871 395607 274540 121067 917577 636773 280804 0 2720064 2303694 416370 106005 73812 32193 0 105138 29321 75817 245572 245572 0 0 1023205 957315 65890 Medical Supplies & Drugs 6532426 6532426 Other Purchased Services 3407878 2183039 1224839 Service Agrmts/Rprs & Maint 1737388 1112947 624441 Non Medical Operating Supplies 1486087 594435 891652 1461915 852375 609540 68003077 54272211 13730866 0 3411239 1044462 4513 4717 873665 1224719 7470335 8329763 0 0 0 1603696 1668855 836752 280427 0 0 0 636346 646319 0 6980548 10625923 21817094 23825185 17762957 18915691 732545 17762957 19648236 X 3826493 3937865 19918 26828 207726 212256 4054137 4176949 21817094 23825185 -539761 662573 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED Assets Lim As to Use 12787 Intergovernmental Receivable 10058792 MCE Bed Fund Receivable Third-Party Settlements 554344 10625923 Estimated settlements payable 732545 732545 X 67463316 67463316 67463316 68003077 68003077 68003077 Part X : FIN48 Footnote Part X - FIN 48 FootnoteThe Hospital is exempt from federal income tax. Accordingly, no provision for income tax is necessary. The Hospital evaluates uncertain tax positions whereby the effect of the uncertainty would be recorded if the outcome was considered probable and reasonably estimable. As of June 30, 2018 and 2017, the Hospital had no uncertain tax positions requiring accrual. true true X true X true X true true true false true true 319393 319393 0.00470 13122920 10442005 2680915 0.03940 36088029 28715513 7372516 0.10840 49530342 39157518 10372824 0.15250 6 1039 4001 4001 0.00010 1 135 48504 48504 0.00070 7 1174 52505 52505 0.00080 7 1174 49582847 39157518 10425329 0.15330 5 910 6447 6447 0.00010 5 910 6447 6447 0.00010 true 10296276 32347710 44654616 -12306906 X true true 1 1 San Gorgonio Memorial Hospital 600 North Highland Springs Ave Banning CA 92220 www.sgmh.org 250000199 X X X San Gorgonio Memorial Hospital 1 false false true X X X X X X X X 16 true true true true X sgmh.org X true 16 true sgmh.org false false true X 350.0000 350.0000 X X X X true true X X X true X X X true X true X X X X X X true X false false Facility: San Gorgonio Memorial Hospital - Part V, Section B, Line 5 The Hospital partnered with LLUMC Community Health Development Department and the Riverside County Department of Public Health Development Department and the Riverside County Department of Public Health looking at both quantitative and qualitative data impacting the health of the community. The team conducting the assessment included public health professionals and the assessment included input from community members, community agencies. Facility: San Gorgonio Memorial Hospital - Part V, Section B, Line 6a The assessment was conducted in collaboration with Loma Linda University, as well as, Riverside and San Bernardino County Public Health Departments. Facility: 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 verses being fragmented and ineffective. A detailed community health plan has been developed with key metrics for each of the priority areas. Facility: San Gorgonio Memorial Hospital - Part V, Section B, Line 18e The hospital does not take any of these actions, it assigns delinquent accounts to a collections agency. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense The costing methodology used to determine the amounts reported includes the cost to charge ratio of patient care. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit Bad Debt expense attributable to charity care policy cannot be determined. The Hospital did not track the amount of bad debt expense that could reasonably be attributable to patients who likely would qualify for financial assistance under the Hospital's charity care policy, and furthermore sufficient information was not obtained from all patients that might be eligible to make this determination and calculation. Part III, Line 4 - Bad Debt Expense The Financial statements do not contain a footnote describing bad debt expense. However, there is a footnote (Note Q) that discusses charity care and community benefit expense. Part III, Line 8 - Explanation Of Shortfall As Community Benefit Any shortfall is deemed a community benefit in its entirety. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients The Hospital's business office staff follow up on accounts 15 to 30 days after the accounts are billed. The staff contact the insurers to verify claims have been received and to resend the claims if necessary. After verifying claims have been received, the staff continue to contact the insurers every 30 days, as necessary, to follow up on the status of the claims. All claims not resolved within 60 days of billing are reviewed by a supervisor or manager for additional guidance and consideration. Accounts not resolved within 60 days of billing are considered delinquent. The supervisor or manager will determine whether the accounts should be written off as bad debt, further collection procedures should be attempted, and/or the state insurance commission office should be contacted. Part V - Explanation of Number of Facility Type There is one licensed general medical and surgical hospital that offers 24-hour emergency room services. Part VI, Line 2 - Needs Assessment The management team, hospital department staff and managers, and the Board of Directors are comprised of community members. They are able to gather and communicate the health care needs of the community the hospital serves and continually address them at staff and board meetings. The most recently adopted implementation strategy is publicly available on the internet at: http://www.sgmh.orgThe 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 - Patient Education of Eligibility for Assistance It is the Hospital's policy that when it becomes apparent that a patient may have difficulty in meeting his/her financial responsibility to the hospital, the patient will be requested to complete the application process for California Medi-Cal and/or other available programs. Hospital staff assist in the application process. Patients who do not qualify for Calfornia Medi-Cal or other assistance may apply for the Hospital's assistance program. Part VI, Line 4 - Community Information The Hospital is a rural hospital located in the pass area of Riverside County. It primarily serves the cities of Banning, Beaumont, Cabazon, and Calimesa, California. The population served is high-risk due to poverty level incomes, low education levels, and high drug use. The county has an unemployment rate of 14.2%. The Hospital's payor mix includes approximately 23% Medi-Cal recipients and 11% uninsured. Part VI, Line 4 - Community Building Activities The Hospital holds community education courses such as CPR certification, smoking cessation, childbirth preparation, disaster preparedness, cancer education, health fairs etc. The Hospital also has several contracts with various schools to provide teaching programs for nursing students. This training contributes to healthcare professional development of the students. Hospital staff volunteer in community support activities such as relay for life, toys for tots, and many others. The Hospital also provides usage of meeting rooms at no charge to various community groups. Part VI, Line 5 - Promotion of Community Health The hospital continues to strive to meet the health needs of its community as these needs evolve. Part VI, Line 6 - Affilated Health Care System N/A Part VI, Line 7 - States Filing of Community Benefit Report CA Part VI - Additional Information Schedule H Part IV - Management Companies and Joint Ventures: The hospital was involved in a joint venture with Loma Linda University to provide Physical therapy until its termination in October 2018. The Hospital was responsible for staffing it, while Loma Linda provided facilities and handled billing. The Hospital and Loma Linda University have separate boards, and none of the hospital's employees or board members owned more than 10% of the Joint Venture. Thus, the Schedule H instructions do not require listing information in Part IV. X X X X false false false false false false false false false false Angela Brady ER Director 192881 9644 57864 260389 17992 Anna Kampanartsanyakorn RN 181634 18288 54490 254412 11848 David Recupero CFO 224205 11210 67261 302676 28786 Jose A Lopez Pharmacy Director 162807 18288 48842 229937 18000 Patricia Brown Chf of Nursing 170501 8525 51150 230176 29740 Steven Barron CEO 505889 151767 657656 Tuanhuy Nguyen CT Tech 156682 20475 47005 224162 Tzarimna Karam Chief Human Res 158053 12925 47416 218394 Part III, Additional Information Compensation of highest paid officers and other individuals is reviewed and approved by the Board of Directors each year during the budget process, and arrangements are solidified in written employment contracts. Sources utilized by the Board when reviewing fair market value in compensation include market surveys, salary ranges, and Form 990 information of comparable organizations. Bonus or incentive compensation, in the event received, is based on the individual's unique qualifications and succcessful achievement of different goals. Farzad Farrokhi Board Member 524774 Phys Group Partner false Schedule L, Part V Supplemental Information The Hospital had a contract with Desert Anesthesia until October 2018. Dr. Farrokhi (Hospital board Member) is a 50% partner of Desert Anesthesia. This transaction is reportable on Schedule L as a business transaction and Dr. Farrokhi is deemed to have lost independence in voting as a hospital Board member (Per Form 990 Instructions). Form 990, Part VI, Line 1a: Explanation of Delegated Broad Authority to Committee The Board has delegated authority to a finance committee to oversee the audit, and other monthly financial matters. Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et The Hospital has a contract with Desert Anesthesia, of which Dr. Farrokhi (Hospital board member) is a 50% partner. This transaction is reportable on Schedule L as a business transaction and Dr. Farrokhi is deemed to have lost independence in voting as a hospital Board member Per Form 990 Instructions). Form 990, Part VI, Line 11b: Form 990 Review Process The Form 990 is provided to the Finance Committee and full Board at a monthly Board meeting, but may be presented at a date subsequent to filing. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts Executive Assistant monitors and documents conflicts. Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management The Board of Directors Review and approve management wages each year during the budget process. Sources utilized by the Board when reviewing fair market value in compensation include market surveys and salary ranges provided by the HR Department. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The Board of Directors Review and approve management wages each year during the budget process. Sources utilized by the Board when reviewing fair market value in compensation include market surveys and salary ranges provided by the HR Department. Form 990, Part VI, Line 18: Explanation of Other Means Forms Available For Public Inspection Published on website at www.sgmh.org and available upon request from CEO, CFO, Controller or Executive Assistant. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Published on website www.sgmh.org or available by request from the CEO, CFO, Controller, or Executive Assistant. Form 990 Part IX Col D The Hospital has left column D blank, as there was no compensated grant-writer position and no material other fundraising expenses. Form 990, Part I, Line 6 The Hospital volunteers help in the Gift Shop, Cafeteria, and Reception Booths, as well as Materials Management deliveries and mailings. Form 990, Part V, Lines 7a & 7b The Hospital did receive contributions from donors, although none of them were made partly for goods and for services. Donors made donations without the receipt of any goods or services, and the donor was properly notified of the deductible value of the donation they made. Thus questions 7a&b were marked "No," since no goods and services in combination were received by donors. Schedule H, Part I, Table 7 Financial Assistance and Means-Tested Government Programs: The Hospital has recorded its community benefit expense in the form of traditional charity care and other uncompensated care in row a-financial assistance at cost, unpaid Medi-Cal program charges in row b-Medicaid, and unpaid medicare program charges in row c-Costs of other means-tested government programs.Other Benefits: Community health improvement services expenses such as: Banning Healthy Cities Meetings, Banning Health Fair/Fun Run, Passcom Hosted Suite Meeting, Disaster Preparedness Hosted Meetings, Ham Radio Classes Hosted for Community, and Banning Women's Club are recorded in row e - Community health improvement services and community benefit operations. Nursing education expense for education provided at area schools is recorded in row f - Health professions education. Schedule H, Part II Expenses for community support activities such as: Relay for Life, City of Banning Nutritional Education Backpack Giveaway, Volunteer time collecting box tops for community school children, Carol's kitchen homeless fund drive, and soroptimist leadership fund are reported on line 3-Community Support. San Gorgonio Health Care District 600 N Highland Springs Ave Banning CA 92220 956004149 Healthcare CA Govt N/A NA false San Gorgonio Memorial Hospital Foundatio 600 N Highland Springs Ave Banning CA 92220 953863230 Support San Gorgonio Memorial Hospital CA 501c3 7 NA false false false true false false false false false false false true false false true false false false false false San Gorgonio Health Care District k 653465 Cash Value San Gorgonio Memorial Hospital Foundatio c 82964 Cash Value San Gorgonio Memorial Hospital Foundatio n 646319 FMV Schedule R, Part V The District owns the building and leases it to the Hospital.The Hospital is a box 7, section 170(b)(1)(A)(vi) organization whose purpose is primarily to support the activities of the Hospital and in turn improve the health of the community. The Hospital records its interest in the net assets of the Foundation, assets that have been collected by the Foundation, but not yet distributed to the Hospital as of the end of each fiscal year. The interest of these assets for the year ended June 30, 2019 was $646,319.