2015-01-09T16:14:12-06:00 2014-06-30 200079326 DINGUS ZARECOR & ASSOCIATES PLLC 12015 E MAIN AVE SPOKANE VALLEY WA 992066130 990 2013-07-01 330420041 SAN GORGONIO MEMORIAL HOSPITAL SANG 9517692103 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 DAVID RECUPERO CFO 9517692103 2014-12-30 true THOMAS DINGUS P00951009 5092420874 2015-01-09 2013 2016-03-07 17:11:31Z DAVID RECUPERO CFO 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 64814371 false X WWW.SGMH.ORG X 1990 CA SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. 11 10 712 110 0 965874 1433204 45082703 62467274 -39 446917 370463 466976 46419001 64814371 0 0 29023637 34088626 0 151336 18771761 29793466 47795398 63882092 -1376397 932279 13941801 27446354 10760385 23332659 3181416 4113695 SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. false false 54271833 62467274 THE HOSPITAL IS COMPRISED OF AN ACUTE CARE FACILITY WHICH PROVIDES HEALTHCARE SERVICES. THE HOSPITAL PROVIDED 14,725 DAYS OF INPATIENT SERVICES, 37,580 EMERGENCY ROOM VISITS AND DELIVERED 397 BABIES DURING THE FISCAL YEAR. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 1,832,524 FOR CHARITY CARE,60,611,910 FOR MEDICARE, 17,741,395 FOR MEDI-CAL, AND 102,545,845 FOR OTHER THIRD-PARTY PAYORS FOR THE FISCAL YEAR. 54271833 true false 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 true false false false false false false false true false false false true 46 0 true 712 true false false false false false false false false false false X 11 10 false true false false false false false true true false false false true true true true true true true false CA X DAVID RECUPERO 9517692103 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 JERILYNN KAIBEL DC CHAIR 1.00 X X 3082 0 0 OLIVIA HERSHEY TREASURER 1.00 X X 2600 0 0 DENAE REAGINS SECRETARY 1.00 X X 2000 0 0 ESTELLE LEWIS VICE CHAIR 1.00 X X 1850 0 0 ED HIETT BOARD MEMBER 1.00 X 1700 0 0 ROBERT EWERT BOARD MEMBER 1.00 X 200 0 0 FARZAD FARROKHI MD BOARD MEMBER 1.00 X 200 0 0 LYNN BALDI BOARD MEMBER 1.00 X 0 0 0 JOE DOTAN MD BOARD MEMBER 1.00 X 0 0 0 N IRWIN REEVES BOARD MEMBER 1.00 X 0 0 0 LUDWIG CIBELLI MD BOARD MEMBER 1.00 X 0 0 0 MARK TURNER CEO 40.00 X 415346 0 24601 DAVID RECUPERO CFO 40.00 X 240271 0 14025 LYNN GOMEZ DIRECTOR OF 40.00 X 182451 0 24395 PATRICIA BROWN CNO 40.00 X 170180 0 16098 CARRIE ECHOLS OB DIRECTOR 40.00 X 165440 0 19153 PRINCE NNAH ANCILLARY SE 40.00 X 160839 0 15291 KARI SPOELSTRA REGISTERED N 40.00 X 144728 0 23000 1490887 136563 36 false true false DESERT ANESTHESIS CONSULTING 1540 BARTON RD SUITE 434 REDLANDS CA 92373 ANESTHESIOLOGY 904412 MCKESSON PO BOX 98347 CHICAGO IL 60693 IT SERVICES 623684 ADEX MEDICAL STAFFING LLC 13083 TELECOM PARKWAY NORTH TEMPLE TERRACE FL 33637 NURSE STAFFING 568184 EPIC MANAGEMENT 10393 ENTERPRISE DR REDLANDS CA 92374 MGMT CONSULTING 559838 MISSION LINNEN 5400 ALTON ST CHINO CA 91710 LINEN & LAUNDRY 351669 15 1433204 1433204 NET PATIENT SERVICE REVENUE 621990 62467274 62467274 62467274 446917 446917 CAFETERIA REVENUE 722210 217264 217264 OTHER REVENUE 900099 214312 214312 MEDICAL RECORDS 900099 31554 31554 3846 3846 466976 64814371 62467274 913893 X 721262 721262 27167441 23232543 3875408 59490 692940 600214 91189 1537 2758522 2309558 443050 5914 2748461 2276025 466585 5851 687301 687301 268752 268752 63874 63874 7112874 4556258 2556466 150 46613 46613 2669657 1848076 816990 4591 1880640 1572129 287876 20635 56745 38467 17233 1045 106552 29715 76837 211458 211458 620829 580850 39979 INTERGOVERNMENTAL FEES 7984493 7984493 MEDICAL SUPPLIES & DRUGS 6225541 6225541 OTHER OPERATING EXPENSES 1858137 344931 1496167 17039 ALLOC. OF INDIRECT COSTS 2673033 -2708117 35084 63882092 54271833 9458923 151336 422787 2990318 183655 45850 8730089 8998142 1232204 1373972 20559 20820 169194 3352507 13848058 13941801 27446354 6175467 5672659 4584918 17660000 10760385 23332659 X 3181416 4113695 3181416 4113695 13941801 27446354 932279 X false true X true false X INTERGOVERNMENTAL RECEIVABLE 9978467 MALPRACTICE INSURANCE RECOVERIES 2645211 THIRD-PARTY SETTLEMENTS 812651 TAX AND OTHER RECEIVABLES 411729 13848058 INTERGOVERNMENTAL PAYABLE 5704493 BANK LINE OF CREDIT 5000000 PAYABLE TO AFFILIATE 4264832 MALPRACTICE CLAIMS PAYABLE 2690675 17660000 X SCHEDULE D, PAGE 3, PART X THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAX. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE SYSTEM 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, 2014 AND 2013, THE SYSTEM HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. true true true X true X true true true false false 421481 421481 0.00660 21491281 21491281 21912762 21491281 421481 0.00660 97 7526 7526 0.00010 223 98048 98048 0.00150 8064 8064 0.00010 320 113638 113638 0.00180 320 22026400 21491281 535119 0.00840 true 3114765 11830598 14209059 -2378461 X true true NA 1 1 SAN GORGONIO MEMORIAL HOSPITAL 600 N HIGHLAND SPRINGS AVE BANNING CA 92220 X X X SAN GORGONIO MEMORIAL HOSPITAL 1 true X X X X X X X X X X 13 true true true X WWW.SGMH.ORG X X X X X X false false true true 350.000000000000 true 350.000000000000 true X X X X X X X true true X X X X true false true X false false FACILITY 1, SAN GORGONIO MEMORIAL HOSPITAL - PART V, LINE 3 WE PARTNERED WITH LLUMC COMMUNITY 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, AND COMMUNITY MEMBERS THEMSELVES. FACILITY 1, SAN GORGONIO MEMORIAL HOSPITAL - PART V, LINE 4 THE ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH LOMA LINDA UNIVERSITY, AS WELL AS, RIVERSIDE AND SAN BERNARDINO COUNTY PUBLIC HEALTH DEPARTMENTS. FACILITY 1, SAN GORGONIO MEMORIAL HOSPITAL - PART V, LINE 7 IT WOULD BE IMPOSSIBLE FOR THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS OF THE COMMUNITY BUT WE WILL BE WORKING IN COLLABORATION WITH OTHER COMMUNITY AGENCIES TO IDENTIFY THE 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. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COST-TO-CHARGES FOR AMOUNTS REPORTED IN THE TABLE (TOTAL OPERATING EXPENSES, LESS NON-PATIENT CARE ACTIVITIES, TOTAL COMMUNITY BENEFIT, AND TOTAL COMMUNITY BUILDING EXPENSES). PART II - COMMUNITY BUILDING ACTIVITIES THE HOSPITAL PROVIDES DIET COUNSELING FREE OF CHARGE TO PATIENTS. HOSPITAL STAFF LECTURE ON HEALTHCARE RELATED TOPICS AT VARIOUS SUPPORT GROUPS INCLUDING DIABETIC AND CANCER SURVIVORS SUPPORT GROUPS AND AT THE SOROPTOMIST CLUB OF BEAUMONT/BANNING. THE HOSPITAL HAS ALSO PARTICIPATED IN COMMUNITY HEALTH FAIRS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY 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, PATIENTS ELIGIBLE FOR ASSISTANCE 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 BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE DETERMINATION OF THEIR ELIGIBILITY DURING THE FISCAL YEAR. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 4 ON PAGE 13 OF THE AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR BAD DEBTS IS ALSO INCLUDED IN FOOTNOTE 4 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS ARE NOT COUNTED AS COMMUNITY BENEFIT. THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION 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 SIXTY 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 VI, LINE 2 - NEEDS ASSESSMENT MANAGEMENT, HOSPITAL DEPARTMENT STAFF AND MANAGERS, AND THE BOARD OF DIRECTORS ARE COMPRISED OF MEMBERS WITHIN THE COMMUNITY. THEY ARE ABLE TO GATHER AND COMMUNICATE THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES AND CONTINUALLY ADDRESS THEM AT STAFF AND BOARD MEETINGS. THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY AND COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT THE FOLLOWING URL HTTP://WWW.SGMH.ORG/DOCS/CHNA_COMMUNITY_NEEDS_ASSESSMENT_11-14- 13_SGMH_CHNA_(V2).PDF 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 CALIFORNIA 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 5 - PROMOTION OF COMMUNITY HEALTH THE HOSPITAL HOLDS COMMUNITY EDUCATION COURSES SUCH AS CPR CERTIFICATION, SMOKING CESSATION, CHILDBIRTH PREPARATION, 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. THE HOSPITAL ALSO PROVIDES USAGE OF MEETING ROOMS AT NO CHARGE TO VARIOUS COMMUNITY GROUPS. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM N/A X X X X false false false false false false false false false MARK TURNER CEO 335005 80341 24601 439947 DAVID RECUPERO CFO 206818 33453 14025 254296 LYNN GOMEZ DIRECTOR OF HR 159138 23313 24395 206846 PATRICIA BROWN CNO 147780 22400 16098 186278 CARRIE ECHOLS OB DIRECTOR 165440 19153 184593 PRINCE NNAH ANCILLARY SERVICE DI 160839 15291 176130 KARI SPOELSTRA REGISTERED NURSE 144728 23000 167728 SCHEDULE J, PART III THE HOSPITAL CONTRACTS WITH EPIC MANAGEMENT LP (EPIC) FOR MANAGEMENT SERVICES. HOWEVER, THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER ARE EMPLOYEES OF THE HOSPITAL. FARZAD FARROKHI BOARD MEMBER 904412 PHYS. GROUP PARTNER false FORM 990, PAGE 1, PART I, LINE 6 THE HOSPITAL VOLUNTEERS HELP IN THE GIFT SHOP, CAFETERIA, AND RECEPTION BOOTHS, AS WELL AS MATERIALS MANAGEMENT DELIVERIES AND MAILING. FORM 990, PAGE 6, PART VI, LINE 3 THE HOSPITAL CONTRACTS WITH EPIC MANAGEMENT LP (EPIC) FOR MANAGEMENT SERVICES. HOWEVER, THE HOSPITAL'S CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER ARE EMPLOYEES OF THE HOSPITAL. FORM 990, PAGE 6, PART VI, LINE 11B A COPY OF THE 990 IS PROVIDED TO THE CFO, WHO REVIEWS THE FORM, SCHEDULES, AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE FORM 8879-EO IS SIGNED BY AN AUTHORIZED SIGNER BEFORE THE RETURN IS E-FILED BY THE PREPARER. FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBERS, ADMINISTRATOR AND OTHER DESIGNATED POSITIONS ARE REQUIRED TO SUBMIT AN ANNUAL CONFLICT OF INTEREST STATEMENT. THE CONFLICT OF INTEREST GUIDELINES ARE MONITORED AND ENFORCED BY THE SECRETARY OF THE DISTRICT. FORM 990, PAGE 6, PART VI, LINE 15A 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 MANAGEMENT COMPANY. FORM 990, PAGE 6, PART VI, LINE 15B SEE FORM 990, PART VI, LINE 15A. FORM 990, PAGE 6, PART VI, LINE 19 SAN GORGONIO MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES & PRO FEES 4,556,258 2,556,466 150 SAN GORGONIO HEALTH CARE DISTRICT 600 N HIGHLAND SPRINGS AVE BANNING CA 922203090 956004149 HEALTHCARE CA 501C 3 N/A false false false false false false false false false false false true false false false false false false false false SAN GORGONIO HEALTH CARE DISTRICT K 823141 ACTUAL