SAN GORGONIO MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SAN GORGONIO MEMORIAL HOSPITAL (EIN 33-0420041)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-03-07
- IRS object ID
- 201430669349300323
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-03-07T14:45:45-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DINGUS ZARECOR & ASSOCIATES | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12015 E MAIN STE A | AddressLine1 |
| City | SPOKANE VALLEY | City |
| State | WA | State |
| ZIP Code | 99206 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 330420041 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAN GORGONIO MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SANG | NameControl |
| Phone | 9517692103 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 NORTH HIGHLAND SPRINGS AVE | AddressLine1 |
| City | BANNING | City |
| State | CA | State |
| ZIP Code | 92220 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID RECUPERO | Name |
| Title | CFO | Title |
| Phone | 9517692103 | Phone |
| Date Signed | 2014-03-06 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | THOMAS DINGUS | Name |
| Phone | 5092420874 | Phone |
| Date Prepared | 2014-03-07 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID RECUPERO CFO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 NORTH HIGHLAND SPRINGS AVE | AddressLine1 |
| City | BANNING | City |
| State | CA | State |
| ZIP Code | 92220 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 46419001 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SGMH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1990 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 610 | TotalNbrEmployees |
| Total Nbr Volunteers | 118 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 2712887 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 965874 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 55484174 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 45082703 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 557 | InvestmentIncomePriorYear |
| Investment Income Current Year | -39 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 293161 | OtherRevenuePriorYear |
| Other Revenue Current Year | 370463 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 58490779 | TotalRevenuePriorYear |
| Total Revenue Current Year | 46419001 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 27074515 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 29023637 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 72900 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 30134320 | OtherExpensePriorYear |
| Other Expenses Current Year | 18771761 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 57208835 | TotalExpensesPriorYear |
| Total Expenses Current Year | 47795398 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1281944 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1376397 | RevenuesLessExpensesCY |
| Total Assets BOY | 11473919 | TotalAssetsBOY |
| Total Assets EOY | 13941801 | TotalAssetsEOY |
| Total Liabilities BOY | 6916106 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10760385 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4557813 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3181416 | NetAssetsOrFundBalancesEOY |
| Mission Description | SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 40043175 | Expense |
| Revenue | 45082703 | Revenue |
| Description | THE HOSPITAL IS COMPRISED OF AN ACUTE CARE FACILITY WHICH PROVIDES HEALTHCARE SERVICES. THE HOSPITAL PROVIDED 13,892 DAYS OF PATIENT SERVICES AND 630 OF SKILLED NURSING DAYS FOR 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 1,836,278 FOR CHARITY CARE, 57,466,902 FOR MEDICARE, 8,345,632 FOR MEDI-CAL, AND 86,029,178 FOR OTHER THIRD-PARTY PAYORS FOR THE FISCAL YEAR. | Description |
| Total Program Service Expense | 40043175 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | false | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 38 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 610 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DAVID RECUPERO | NamePerson |
| Telephone Number | 9517692103 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 NORTH HIGHLAND SPRINGS AVE | AddressLine1 |
| City | BANNING | City |
| State | CA | State |
| ZIP Code | 92220 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JERILYNN KAIBEL DC | |||||||
| CHAIR | 1.00 | X | X | 2000 | 0 | 0 | |
| OLIVIA HERSHEY | |||||||
| TREASURER | 1.00 | X | X | 1750 | 0 | 0 | |
| ESTELLE LEWIS | |||||||
| BOARD MEMBER | 1.00 | X | 1500 | 0 | 0 | ||
| DENAE REAGINS | |||||||
| SECRETARY | 1.00 | X | X | 1250 | 0 | 0 | |
| ED HIETT | |||||||
| BOARD MEMBER | 1.00 | X | 1200 | 0 | 0 | ||
| FARZAD FARROKHI MD | |||||||
| BOARD MEMBER | 1.00 | X | 900 | 0 | 0 | ||
| DOROTHY ELLIS | |||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| LYNN BALDI | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOE DOTAN MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MARY ANN MARTIN ANDREAS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DEVIN BORNA 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 | 453311 | 0 | 135993 | ||
| DAVID RECUPERO | |||||||
| CFO | 40.00 | X | 254133 | 0 | 76240 | ||
| LYNN GOMEZ | |||||||
| DIRECTOR OF | 40.00 | 186205 | 0 | 55862 | X | ||
| PATRICIA BROWN | |||||||
| CNO | 40.00 | 169900 | 0 | 50970 | X | ||
| CARRIE ECHOLS | |||||||
| OB DIRECTOR | 40.00 | 144738 | 0 | 43421 | X | ||
| PRINCE NNAH | |||||||
| ANCILLARY SE | 40.00 | 143632 | 0 | 43090 | X | ||
| KOMAL RAJYAGURU | |||||||
| PHARMACIST | 40.00 | 133083 | 0 | 39925 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1493602 | TotalReportableCompFromOrg |
| Total Other Compensation | 445501 | TotalOtherCompensation |
| Number Individuals GT100 K | 36 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| DESERT ANESTHESIS CONSULTING | |||||
| 1540 BARTON RD SUITE 434 | REDLANDS | CA | 92373 | ANESTHESIOLOGY | 856606 |
| EPIC MANAGEMENT | |||||
| 10393 ENTERPRISE DR | REDLANDS | CA | 92374 | MGMT CONSULTING | 674928 |
| MCKESSON | |||||
| PO BOX 98347 | CHICAGO | IL | 60693 | IT SERVICES | 504065 |
| ADEX MEDICAL STAFFING LLC | |||||
| 13083 TELECOM PARKWAY NORTH | TEMPLE TERRACE | FL | 33637 | NURSE STAFFING | 420052 |
| MISSION LINNEN | |||||
| 5400 ALTON ST | CHINO | CA | 91710 | LINEN & LAUNDRY | 320782 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Government Grants | 965874 | GovernmentGrants |
| Total Contributions | 965874 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 45082703 | TotalRevenueColumn |
| Related Or Exempt Function Income | 45082703 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 45082703 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -39 | TotalRevenueColumn |
| Exclusion | -$39 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA REVENUE | 722210 | 209937 | $209,937 |
| OTHER REVENUE | 900099 | 132561 | $132,561 |
| MEDICAL RECORDS | 900099 | 21691 | $21,691 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6274 | TotalRevenueColumn |
| Exclusion | $6,274 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 370463 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 46419001 | TotalRevenueColumn |
| Related Or Exempt Function Income | 45082703 | RelatedOrExemptFunctionIncome |
| Exclusion | $370,424 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 902172 | Total |
| Management And General | 902172 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23031397 | Total |
| Program Services | 19646698 | ProgramServices |
| Management And General | 3375816 | ManagementAndGeneral |
| Fundraising | 8883 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 582428 | Total |
| Program Services | 482450 | ProgramServices |
| Management And General | 99760 | ManagementAndGeneral |
| Fundraising | 218 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2209202 | Total |
| Program Services | 2000617 | ProgramServices |
| Management And General | 207680 | ManagementAndGeneral |
| Fundraising | 905 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2298438 | Total |
| Program Services | 1889976 | ProgramServices |
| Management And General | 407425 | ManagementAndGeneral |
| Fundraising | 1037 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 674928 | Total |
| Management And General | 674928 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48234 | Total |
| Management And General | 48234 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42975 | Total |
| Management And General | 42975 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5035759 | Total |
| Program Services | 3281123 | ProgramServices |
| Management And General | 1754636 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2330858 | Total |
| Program Services | 1696113 | ProgramServices |
| Management And General | 628757 | ManagementAndGeneral |
| Fundraising | 5988 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1571694 | Total |
| Program Services | 1342050 | ProgramServices |
| Management And General | 212063 | ManagementAndGeneral |
| Fundraising | 17581 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52478 | Total |
| Program Services | 40434 | ProgramServices |
| Management And General | 12009 | ManagementAndGeneral |
| Fundraising | 35 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69780 | Total |
| Program Services | 28857 | ProgramServices |
| Management And General | 40923 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 364661 | Total |
| Program Services | 364661 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 740706 | Total |
| Program Services | 700727 | ProgramServices |
| Management And General | 39979 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | 5265601 | 5265601 | ||
| OTHER OPERATING EXPENSES | 1394858 | 292261 | 1088394 | 14203 |
| BED TAX | 1179229 | 1179229 | ||
| ALLOC. OF INDIRECT COSTS | 1832378 | -1856428 | 24050 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47795398 | Total |
| Program Services | 40043175 | ProgramServices |
| Management And General | 7679323 | ManagementAndGeneral |
| Fundraising | 72900 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 748302 | BOY |
| EOY | 422787 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1800553 | BOY |
| EOY | 183655 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7635595 | BOY |
| EOY | 8730089 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 955699 | BOY |
| EOY | 1232204 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15985 | BOY |
| EOY | 20559 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 317785 | BOY |
| EOY | 3352507 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11473919 | BOY |
| EOY | 13941801 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3966152 | BOY |
| EOY | 6175467 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2949954 | BOY |
| EOY | 4584918 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6916106 | BOY |
| EOY | 10760385 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4557813 | BOY |
| EOY | 3181416 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4557813 | BOY |
| EOY | 3181416 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11473919 | BOY |
| EOY | 13941801 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -1376397 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| INTERGOVERNMENTAL TRANSFER | 2146198 |
| MALPRACTICE INSURANCE RECOVERIES | 642513 |
| THIRD-PARTY SETTLEMENTS | 476692 |
| TAX AND OTHER RECEIVABLES | 87104 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3352507 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| PAYABLE TO AFFILIATE | $2,234,009 |
| BANK LINE OF CREDIT | $1,708,396 |
| MALPRACTICE CLAIMS PAYABLE | $642,513 |
| THIRD-PARTY SETTLEMENTS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4584918 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | 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, 2013 AND 2012, THE SYSTEM HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 403981 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 403981 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00850 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10772060 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8175746 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2596314 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05430 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11176041 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8175746 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3000295 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06280 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7335 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7335 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 93942 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 93942 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12737 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 12737 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 114014 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 114014 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11290055 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8175746 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3114309 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06520 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $2,713,392 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 10720781 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 13294087 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2573306 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAN GORGONIO MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 N HIGHLAND SPRINGS AVE | AddressLine1 |
| City | BANNING | City |
| State | CA | State |
| ZIP Code | 92220 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAN GORGONIO MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Other | X | Other |
| Needs Assessment Conducted | 13 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 350.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 350.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COSTTOCHARGES FOR AMOUNTS REPORTED IN THE TABLE TOTAL OPERATING EXPENSES LESS BAD DEBT NONPATIENT CARE ACTIVITIES TOTAL COMMUNITY BENEFIT AND TOTAL COMMUNITY BUILDING EXPENSES |
| COMMUNITY BUILDING ACTIVITIES | PART II | 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 BEAUMONTBANNING THE HOSPITAL HAS ALSO PARTICIPATED IN COMMUNITY HEALTH FAIRS |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON SCHEDULE H PART III LINE 2 INCLUDES THE COST TO CHARGE RATIO OF PATIENT CARE 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 HOSPITALS CHARITY CARE POLICY BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE DETERMINATION OF THEIR ELIGIBILITY DURING THE FISCAL YEAR FOR SCHEDULE H PART III LINE 4 THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 4 ON PAGE 12 OF THE AUDITED FINANCIAL STATEMENTS THE PROVISION FOR BAD DEBTS IS ALSO INCLUDED IN FOOTNOTE 4 OF THE AUDITED FINANCIAL STATEMENTS |
| MEDICARE EXPLANATION | PART III LINE 8 | 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 |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | THE HOSPITALS 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 ANDOR THE STATE INSURANCE COMMISSION OFFICE SHOULD BE CONTACTED |
| NEEDS ASSESSMENT | PART VI | 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 HTTPWWWSGMHORGDOCSCHNACOMMUNITYNEEDSASSESSMENT1114 13SGMHCHNAV2PDF |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | IT IS THE HOSPITALS POLICY THAT WHEN IT BECOMES APPARENT THAT A PATIENT MAY HAVE DIFFICULTY IN MEETING HISHER FINANCIAL RESPONSIBILITY TO THE HOSPITAL THE PATIENT WILL BE REQUESTED TO COMPLETE THE APPLICATION PROCESS FOR CALIFORNIA MEDICAL ANDOR OTHER AVAILABLE PROGRAMS HOSPITAL STAFF ASSIST IN THE APPLICATION PROCESS PATIENTS WHO DO NOT QUALIFY FOR CALIFORNIA MEDICAL OR OTHER ASSISTANCE MAY APPLY FOR THE HOSPITALS ASSISTANCE PROGRAM |
| COMMUNITY INFORMATION | PART VI | 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 142 THE HOSPITALS PAYOR MIX INCLUDES APPROXIMATELY 20 MEDICAL RECIPIENTS AND 10 UNINSURED |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | 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 |
| AFFILIATED HEALTH CARE INFORMATION | PART VI | NA |
| SAN GORGONIO MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 3 | 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 |
| SAN GORGONIO MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 4 | 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 |
| SAN GORGONIO MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 7 | 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 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|
| MARK TURNER | |||
| CEO | 453311 | 135993 | 589304 |
| DAVID RECUPERO | |||
| CFO | 254133 | 76240 | 330373 |
| LYNN GOMEZ | |||
| DIRECTOR OF HR | 186205 | 55862 | 242067 |
| PATRICIA BROWN | |||
| CNO | 169900 | 50970 | 220870 |
| CARRIE ECHOLS | |||
| OB DIRECTOR | 144738 | 43421 | 188159 |
| PRINCE NNAH | |||
| ANCILLARY SERVICE DI | 143632 | 43090 | 186722 |
| KOMAL RAJYAGURU | |||
| PHARMACIST | 133083 | 39925 | 173008 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE J, PART III | ReturnReference |
| Explanation | 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. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| DEVIN BORNA MD | |||
| BOARD MEMBER | 856606 | PHYS. GROUP PARTNER | false |
| FARZAD FARROKHI MD | |||
| BOARD MEMBER | 856606 | PHYS. GROUP PARTNER | false |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS | 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. |
| RELATED PARTY INFORMATION AMONG OFFICERS | FORM 990, PAGE 6, PART VI, LINE 2 | DEVIN BORNA, MD FARZAD FARROKHI, MD BOARD MEMBER BOARD MEMBER BUSINESS RELATIONSHIP |
| MANAGEMENT DELEGATED | 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. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | 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. |
| ENFORCEMENT OF CONFLICTS POLICY | 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. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | 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. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | SEE FORM 990, PART VI, LINE 15A. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | 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. |
| OTHER FEES FOR SERVICES | FORM 990, PART IX, LINE 11G | PURCHASED SERVICES & PRO FEES 3,281,123 1,754,636 0 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAN GORGONIO HEALTH CARE DISTRICT | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 N HIGHLAND SPRINGS AVE | AddressLine1 |
| City | BANNING | City |
| State | CA | State |
| ZIP Code | 922203090 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 956004149 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | CA | LegalDomicileState |
| Exempt Code Section | 501C | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAN GORGONIO HEALTH CARE DISTRICT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | K | TransactionType |
| Amount Involved | 798834 | AmountInvolved |
| Method Of Amt Determination | ACTUAL | MethodOfAmtDetermination |
Comments