2014-03-07T14:45:45-06:00 2013-06-30 DINGUS ZARECOR & ASSOCIATES 12015 E MAIN STE A SPOKANE VALLEY WA 99206 990 2012-07-01 330420041 SAN GORGONIO MEMORIAL HOSPITAL SANG 9517692103 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 DAVID RECUPERO 9517692103 2014-03-06 true THOMAS DINGUS 5092420874 2014-03-07 2012 2015-11-30 17:44:51Z DAVID RECUPERO CFO 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 46419001 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. 13 11 610 118 0 2712887 965874 55484174 45082703 557 -39 293161 370463 58490779 46419001 0 0 27074515 29023637 0 72900 30134320 18771761 57208835 47795398 1281944 -1376397 11473919 13941801 6916106 10760385 4557813 3181416 SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. false false 40043175 45082703 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. 40043175 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 38 0 true 610 true false false false false false false false false false false X 13 11 true 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 1.00 X X 2000 0 0 OLIVIA HERSHEY 1.00 X X 1750 0 0 ESTELLE LEWIS 1.00 X 1500 0 0 DENAE REAGINS 1.00 X X 1250 0 0 ED HIETT 1.00 X 1200 0 0 FARZAD FARROKHI MD 1.00 X 900 0 0 DOROTHY ELLIS 1.00 X X 0 0 0 LYNN BALDI 1.00 X 0 0 0 JOE DOTAN MD 1.00 X 0 0 0 MARY ANN MARTIN ANDREAS 1.00 X 0 0 0 DEVIN BORNA MD 1.00 X 0 0 0 N IRWIN REEVES 1.00 X 0 0 0 LUDWIG CIBELLI MD 1.00 X 0 0 0 MARK TURNER 40.00 X 453311 0 135993 DAVID RECUPERO 40.00 X 254133 0 76240 LYNN GOMEZ 40.00 X 186205 0 55862 PATRICIA BROWN 40.00 X 169900 0 50970 CARRIE ECHOLS 40.00 X 144738 0 43421 PRINCE NNAH 40.00 X 143632 0 43090 KOMAL RAJYAGURU 40.00 X 133083 0 39925 1493602 445501 36 false true false 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 8 965874 965874 NET PATIENT SERVICE REVENUE 621990 45082703 45082703 45082703 -39 -39 CAFETERIA REVENUE 722210 209937 209937 OTHER REVENUE 900099 132561 132561 MEDICAL RECORDS 900099 21691 21691 6274 6274 370463 46419001 45082703 370424 X 902172 902172 23031397 19646698 3375816 8883 582428 482450 99760 218 2209202 2000617 207680 905 2298438 1889976 407425 1037 674928 674928 48234 48234 42975 42975 5035759 3281123 1754636 2330858 1696113 628757 5988 1571694 1342050 212063 17581 52478 40434 12009 35 69780 28857 40923 364661 364661 740706 700727 39979 MEDICAL SUPPLIES & DRUGS 5265601 5265601 OTHER OPERATING EXPENSES 1394858 292261 1088394 14203 BED TAX 1179229 1179229 ALLOC. OF INDIRECT COSTS 1832378 -1856428 24050 47795398 40043175 7679323 72900 748302 422787 1800553 183655 7635595 8730089 955699 1232204 15985 20559 317785 3352507 11473919 13941801 3966152 6175467 2949954 4584918 6916106 10760385 X 4557813 3181416 4557813 3181416 11473919 13941801 -1376397 X false true X true false X INTERGOVERNMENTAL TRANSFER 2146198 MALPRACTICE INSURANCE RECOVERIES 642513 THIRD-PARTY SETTLEMENTS 476692 TAX AND OTHER RECEIVABLES 87104 3352507 PAYABLE TO AFFILIATE 2234009 BANK LINE OF CREDIT 1708396 MALPRACTICE CLAIMS PAYABLE 642513 THIRD-PARTY SETTLEMENTS 4584918 X LIABILITY UNDER FIN 48 FOOTNOTE 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, 2013 AND 2012, THE SYSTEM HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. true true true X true X true true true false false 403981 403981 0.00850 10772060 8175746 2596314 0.05430 11176041 8175746 3000295 0.06280 7335 7335 0.00020 93942 93942 0.00200 12737 12737 0.00030 114014 114014 0.00240 11290055 8175746 3114309 0.06520 true 2713392 10720781 13294087 -2573306 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 X X X X X X false false true true 350.0 true 350.0 true X X X X X X X true true X X X X true false true X false false 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 X X X false false false false false false false false false MARK TURNER 453311 135993 589304 DAVID RECUPERO 254133 76240 330373 LYNN GOMEZ 186205 55862 242067 PATRICIA BROWN 169900 50970 220870 CARRIE ECHOLS 144738 43421 188159 PRINCE NNAH 143632 43090 186722 KOMAL RAJYAGURU 133083 39925 173008 OTHER ADDITIONAL INFORMATION 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. DEVIN BORNA MD BOARD MEMBER 856606 PHYS. GROUP PARTNER false FARZAD FARROKHI MD BOARD MEMBER 856606 PHYS. GROUP PARTNER false 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 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 798834 ACTUAL