SAC HEALTH SYSTEM: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- SAC HEALTH SYSTEM (EIN 33-0664371)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-09
- IRS object ID
- 201111299349301576
- Schema version
- 2009v1.7
- 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 | 2011-05-09T14:53:48-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 330664371 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAC Health System | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SACH | NameControl |
| Phone | 9093827190 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1454 E 2ND ST | AddressLine1 |
| City | San Bernardino | City |
| State | CA | State |
| ZIP Code | 92408 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Steven L Mohr | Name |
| Title | Trustee | Title |
| Phone | 9095588135 | Phone |
| Date Signed | 2011-05-09 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Steven Mohr | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11234 Anderson St | AddressLine1 |
| City | Loma Linda | City |
| State | CA | State |
| ZIP Code | 92354 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4658450 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 1071 | GroupExemptionNumber |
| Organization501c | X | Organization501c |
| Web Site | n/a | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | To provide our communities with primary health-care services. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1356880 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1781357 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2653165 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 2827902 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 20042 | InvestmentIncomePriorYear |
| Investment Income Current Year | 13599 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 39688 | OtherRevenuePriorYear |
| Other Revenue Current Year | 35592 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 4069775 | TotalRevenuePriorYear |
| Total Revenue Current Year | 4658450 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2531512 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2892867 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1419616 | OtherExpensePriorYear |
| Other Expenses Current Year | 1375763 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3951128 | TotalExpensesPriorYear |
| Total Expenses Current Year | 4268630 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 118647 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 389820 | RevenuesLessExpensesCY |
| Total Assets BOY | 2976341 | TotalAssetsBOY |
| Total Assets EOY | 2616532 | TotalAssetsEOY |
| Total Liabilities BOY | 1340005 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 590376 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1636336 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2026156 | NetAssetsOrFundBalancesEOY |
| Mission Description | To provide our communities with primary health care service which incorporates the preparation of health professionals, while respecting cultural diversity, responding to individual needs, promoting family strength, and empowering people to make their lives whole. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2997018 | Expense |
| Revenue | 2877093 | Revenue |
| Description | SACHS IS A THREE CLINIC SYSTEM THAT PROVIDES LOW COST COMMUNITY HEALTH SERVICES TO THE UNDERSERVED COMMUNITIES OF THE INLAND EMPIRE. DURING THE PERIOD FROM JULY 1, 2009 THRU JUNE 30, 2010, SACHS PROVIDED PRIMARY CARE SERVICES TO 24,247 PATIENTS, DENTAL CARE TO 8,023 PATIENTS, PHYSICAL THERAPY TREATMENTS TO 394 PATIENTS, AND BEHAVIORAL MEDICINE SERVICES TO 3,102 PATIENTS. | Description |
| Total Program Service Expense | 2997018 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Steven Mohr Trustee | NamePerson |
| Telephone Number | 9095588135 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11234 Anderson St | AddressLine1 |
| City | Loma Linda | City |
| State | CA | State |
| ZIP Code | 92354 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (23 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 |
|---|---|---|---|---|---|---|---|
| Richard H Hart MD | |||||||
| President-Thru March 31, 2010 | 0.50 | X | X | 0 | 493606 | 61495 | |
| Kevin Lang MBA | |||||||
| Trustee-Thru March 31, 2010 | 0.50 | X | 0 | 972546 | 85350 | ||
| Steven L Mohr | |||||||
| Trustee | 0.50 | X | 0 | 520057 | 54706 | ||
| Verlon W Strauss | |||||||
| Trustee-Thru March 31, 2010 | 0.50 | X | 0 | 153302 | 37499 | ||
| James Seager | |||||||
| Trustee-Thru March 31, 2010 | 0.50 | X | 0 | 196769 | 28725 | ||
| Leslie Pollard PhD Dmin MBA | |||||||
| Trustee | 0.50 | X | 0 | 103279 | 84297 | ||
| Daniel Giang MD | |||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||
| Tamara M Shankle MD FACP FAAP | |||||||
| Trustee-Thru March 31, 2010 | 0.50 | X | 0 | 0 | 0 | ||
| David Wren MHA | |||||||
| Trustee | 0.50 | X | 0 | 294856 | 52996 | ||
| Carlton Lofgren MD | |||||||
| Board Chair-March 2010 | 0.50 | X | 0 | 0 | 0 | ||
| Juan Carlos Belliard MD | |||||||
| Board Co-Chair-March 2010 | 0.50 | X | 0 | 0 | 0 | ||
| Eric Ngo MD | |||||||
| Trustee-march 2010 | 0.50 | X | 0 | 0 | 0 | ||
| Ann Atkinson | |||||||
| Trustee-March 2010 | 0.50 | X | 0 | 0 | 0 | ||
| Marilyn Herrmann PhD | |||||||
| Secretary-March 2010 | 0.50 | X | X | 0 | 159325 | 28557 | |
| Edelweiss Ramal PhD | |||||||
| Trustee-March 2010 | 0.50 | X | 0 | 69711 | 18155 | ||
| Daisy DeLeon PHD | |||||||
| Trustee-March 2010 | 0.50 | X | 0 | 128294 | 25671 | ||
| Veronica Reyes | |||||||
| Trustee-March 2010 | 0.50 | X | 0 | 0 | 0 | ||
| Cintia Ramirez | |||||||
| Trustee-March 2010 | 0.50 | X | 0 | 0 | 0 | ||
| Kenneth W Hart MD | |||||||
| Chief Medical Director | 40.00 | X | 0 | 0 | 0 | ||
| Nancy Young | |||||||
| Chief Executive Officer | 40.00 | X | 0 | 74571 | 17827 | ||
| Cynthia Rollins | |||||||
| CFO-March 2010 | 40.00 | X | 0 | 59854 | 19454 | ||
| Brent Shakespeare | |||||||
| Assistant Professor | 40.00 | 0 | 104732 | 15481 | X | ||
| Rodney Turner | |||||||
| Assistant Professor | 40.00 | 0 | 104330 | 22258 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3435232 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 552471 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 20106 | FederatedCampaigns |
| Related Organizations | 1480324 | RelatedOrganizations |
| All Other Contributions | 280927 | AllOtherContributions |
| Total Contributions | 1781357 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Care Revenue | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 2348763 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2348763 | RelatedOrExemptFunctionIncome |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 479139 | TotalRevenueColumn |
| Related Or Exempt Function Income | 479139 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 2827902 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13599 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13599 | RelatedOrExemptFunctionIncome |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 35592 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 35592 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 35592 | TotalRevenueColumn |
| Related Or Exempt Function Income | 35592 | RelatedOrExemptFunctionIncome |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4658450 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2877093 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2086533 | Total |
| Program Services | 1371453 | ProgramServices |
| Management And General | 715080 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 806334 | Total |
| Program Services | 519096 | ProgramServices |
| Management And General | 287238 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4200 | Total |
| Program Services | 650 | ProgramServices |
| Management And General | 3550 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29452 | Total |
| Management And General | 29452 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 343522 | Total |
| Program Services | 343522 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 340871 | Total |
| Program Services | 258504 | ProgramServices |
| Management And General | 82367 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28442 | Total |
| Management And General | 28442 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 227150 | Total |
| Program Services | 192082 | ProgramServices |
| Management And General | 35068 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2740 | Total |
| Program Services | 1405 | ProgramServices |
| Management And General | 1335 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51902 | Total |
| Program Services | 3542 | ProgramServices |
| Management And General | 48360 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105278 | Total |
| Program Services | 91739 | ProgramServices |
| Management And General | 13539 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Purchased Services | 211488 | 196494 | 14994 |
| Provision for Uncollect | 6666 | 6666 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24052 | Total |
| Program Services | 11865 | ProgramServices |
| Management And General | 12187 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4268630 | Total |
| Program Services | 2997018 | ProgramServices |
| Management And General | 1271612 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 284818 | BOY |
| EOY | 457107 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1457595 | BOY |
| EOY | 515109 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 466812 | BOY |
| EOY | 846212 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 391053 | BOY |
| EOY | 324501 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84022 | BOY |
| EOY | 110944 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2777 | BOY |
| EOY | 2777 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1243409 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 883527 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 289264 | BOY |
| EOY | 359882 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2976341 | BOY |
| EOY | 2616532 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1339405 | BOY |
| EOY | 589776 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 600 | BOY |
| EOY | 600 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1340005 | BOY |
| EOY | 590376 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1008950 | BOY |
| EOY | 1460584 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167074 | BOY |
| EOY | 515423 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 460312 | BOY |
| EOY | 50149 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1636336 | BOY |
| EOY | 2026156 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2976341 | BOY |
| EOY | 2616532 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 55503 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 828 | InvestmentEarningsOrLosses |
| End Of Year Balance | 56331 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 54109 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1394 | InvestmentEarningsOrLosses |
| End Of Year Balance | 55503 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 629063 | OtherCostOrOtherBasis |
| Depreciation | 437532 | Depreciation |
| Book Value | 191531 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 614346 | OtherCostOrOtherBasis |
| Depreciation | 445995 | Depreciation |
| Book Value | 168351 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 359882 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Deposits | Description |
| Amount | $600 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 600 | TotalOfAmounts |
| Total Revenue | 4658450 | TotalRevenue |
| Total Expenses | 4268630 | TotalExpenses |
| Excess Or Deficit For Year | 389820 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 389820 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 5571808 | TotRevenueEtcAuditedFinclStmt |
| Donated Srvc And Use Of Facilities | 913358 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 913358 | RevenueNotRptdF990 |
| Revenue Subtotal | 4658450 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 4658450 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 5181988 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 913358 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 913358 | ExpensesNotRptdF990 |
| Expenses Subtotal | 4268630 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 4268630 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | PART V - LINE 4 THE PRINCIPAL OF THIS PERMANENT FUND TOGETHER WITH ANY ADDITIONS SHALL BE PRESERVED IN PERPETUITY AND SHALL NOT BE DRAWN UPON. HOWEVER, THE INCOME OF THIS FUND MAY BE EXPENDED ONLY AS OPERATING FUNDS FOR THE SACHS CLINICS. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 491596 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 491596 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11300 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1629404 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1066380 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 563024 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13100 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2121000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1066380 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1054620 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.24400 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 282347 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 276391 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5956 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 282347 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 276391 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5956 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2403347 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1342771 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1060576 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.24540 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $6,666 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 30259 | AmountReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 30259 | MedicareSurplusOrShortfall |
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | General Medical And SurgicalGeneralMedicalAndSurgical | Teaching HospitalTeachingHospital | OtherOther |
|---|---|---|---|---|---|---|
| SAC-Norton | ||||||
| 1454 E2nd St | San Bernardino | CA | 92408 | X | X | Community Health Center |
| SAC-Arrowhead | ||||||
| 1293 N D St | San Bernardino | CA | 92405 | X | X | Community Health Center |
| SAC-Frazee | ||||||
| 488 S K St | San Bernardino | CA | 92410 | X | X | Community Health Center |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Needs Assessment | Part VI, Line 2: PART I- 3C: WE USE FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE ELIGIBILITY.PART I- 6A: SACHS HAS ONLY COMPLETED OSHPD RPT, BUT HAS NOT PREPARED A COMMUNITY BENEFIT RPT.PART I- 7G: NO SUBSIDIZED HEALTH SERVICES.PART I- L 7, COL F: NO HEALTH PROFESSIONS EDUCATIONPART III- L4 - THE COSTING METHODOLOGY USED IN ESTIMATING BAD DEBT EXPENSE AT COST IS ANY ACCOUNTS OVER 360 DAYS IN AGING. WE DO NOT HAVE ANY BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER SACHS' CHARITY CARE POLICY.PART III, L8- SACHS DOES NOT HAVE ANY MEDICARE SHORTFALL TREATED AS COMMUNITY BENEFIT. AS OF END 06/30/2010, SACHS AS A COMMUNITY CLINIC WAS NOT REQUIRED TO SUBMIT MEDICARE COST RPT.PART III, L9B- SACHS CHARITY CARE POLICY ADDRESSES THE DEBT COLLECTION POLICY FOR PATIENTS WHO QUALIFY UNDER CHARITY CARE OR FINANCIAL ASSISTANCE.PART V- SACHS IS A COMMUNITY HEALTH CARE CENTER THAT PROVIDES OUTPATIENT MEDICAL, DENTAL, BEHAVIORAL AND GENERAL HEALTH CARE. | NeedsAssessment |
| Community Building Activities | Part VI, Line 5: 1. Needs AssessmentSACHS engages our community and patient population through several methods: 1) SACHS staff attend various non-profit and community clinic collaborative groups who discuss the needs of their community and how to best meet those needs, 2) periodically, needs assessments are conducted within our own collaborative partner meetings, such as within our Family Resource Center collaborative, to determine what are the unmet needs within our existing patient and partner agency patient populations, 3) SACHS hosts community meetings to discuss existing gaps in services as the community perceives them, and 4) we also take time at our monthly Governing Board meetings to allow members to express the community's needs.SACHS also conducts monthly patient satisfaction surveys and has conducted PDSA (Plan- Do-Study-Act) cycles to pilot appropriate solutions to patient issues, such as wait time and customer service issues. 2. Patient Education of Eligibility for AssistancePatients are made aware of our programs and discount fee schedule when they call or come into the clinic for an appointment. Eligibility for all our programs, as well as our fee schedule discounts, are discussed prior to setting appointments. Our front office and phone staff is trained to discuss eligibility criteria and fit patients into the appropriate programs with corresponding fees. In pursuing FQHC-LA designation, we are actively posting signs announcing the availability of discounts in accessible locations and through distribution at registration.3. Community InformationSACHS primarily serves the population of the City of San Bernardino and outlying areas. Within the County of San Bernardino, the City of San Bernardino has enormous and exaggerated challenges-lack of employment opportunities, high poverty levels, high crime, high gang activity, low levels of education, higher than average school dropout and delinquency rates. The impact of these psycho-social stressors on our families, with special emphasis on children, is increased mental health illness, deviant behavior, high truancy and non-completion rates, and high risk for substance abuse. SACHS patients, which reflect the demographics of the City, are often single parents, with multiple children, working full time, but are unable to afford health insurance. We serve the "working poor"-families who earn a modest income, at a level just high enough to be ineligible to qualify for Medi-Cal, and who do not have sufficient funds to afford commercial health insurance.Additionally, serving the underserved population can present cultural and language issues, which can create supplementary obstacles. Late stage diagnosis is common within this population because they are unaware of the need and often times resistant to visiting our doctor for preventive purposes. Within our mental health clientele, substance abuse clients often face co-existing mental and physical health problems. To compound the issues, stigmas exist related to behavioral health care that keep clients from accessing such services. According to the 2006-2008 American Community Survey 3-Year Estimates, the City's demographics do appear to mirror those of SACHS' patient population. Some of the highlights are listed below:1) 35.9% children, 7.4% seniors, and 56.7% adults2) Almost evenly divided, 50.1% male, and 49.9% female3) 50.9% of the population is at 200% of FPL or below4) Only 12.6% of population have a BS degree or higher5) 57% Hispanic, and 49% reporting White alone, 16% Black or African alone4. Community Building ActivitiesSACHS provides many and varied enabling services. We currently have case managers and social workers who are available to provide resources and linkages to families in need. Case managers, within primary care, assist with referrals and follow-up. Case managers outside the scope of primary care services are available on call to primary care providers to assist with patient needs.Translation and interpretation services are contracted from an external organization and are utilized as is necessary. Most of SACHS staff is bilingual (in Spanish and English) and assist with interpretation as is required. Client advocates are available, on a part-time basis, to assist with paperwork and home visits. SACHS also offers a medication assistance program (MAP) at no cost to primary care patients. Limited transportation services are available through various grant funded projects. Grant funding allows us to offer bus vouchers and gas cards to families in need. Outreach and educational services are also offered on a limited basis depending upon need. Various grant projects allow for health education classes, as well as staff, to conduct outreach activities to educate the community about the services we offer.In addition to the previous items, SACHS also offers food, clothing, tutoring/mentoring for kids and adults, computer and exercise classes, reduced rate evening clinics, community nurse home visits, free car seat education and installation, and a co-located Women, Infants, and Children (WIC) clinic.Our mission driven organization is committed to "making families whole" meeting the psycho-social needs of a low income and needy population. While most area health centers focus on meeting the medical and dental needs of the community, we are unique in providing support through comprehensive health and social services.SACHS has grown our partnership with the local community through many collaborative and strategic efforts. In 2009, the community clinics located in San Bernardino County came together to form a collaborative referred to as Community Clinic Association of San Bernardino County (CCASBC). SACHS is a founding member of this organization and our CEO serves on the executive committee. The collaborative brings all community providers and resources together to develop programs that meet the various needs of our low income underserved community. SACHS is known in the community as a team player and team builder. We regularly attend and actively participate in many community groups such as Healthy San Bernardino Coalition (efforts to create a healthier city environment), Operation Phoenix (violence prevention), CREST (a project to provide wrap-around services for parolees and offenders), the Homeless Youth Coalition, Institute for Community Partnerships at Loma Linda University, East Valley Collaborative (networking meeting for non-profits in the local region), and the Hunger Task Force (citywide food distribution network).Of special significance to SACHS is our collaboration with the Children's Assessment Center. Within San Bernardino County, there is only one forensic exam location to assist the enormous number of children who have been suspected of being abused. Additionally, we have been in conversation to bring the Assessment Center under our umbrella of services to better connect our families in need to the many services we offer. | CommunityBuildingActivities |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Richard H Hart MD | |||||||||||||
| 0 | 374385 | 0 | 0 | 0 | 119221 | 0 | 18517 | 0 | 42978 | 0 | 555101 | 0 | 30194 |
| Kevin Lang MBA | |||||||||||||
| 0 | 455950 | 0 | 26797 | 0 | 489799 | 0 | 18517 | 0 | 66833 | 0 | 1057896 | 0 | 331678 |
| Steven L Mohr | |||||||||||||
| 0 | 292395 | 0 | 28163 | 0 | 199499 | 0 | 18517 | 0 | 36189 | 0 | 574763 | 0 | 109254 |
| Verlon W Strauss | |||||||||||||
| 0 | 140554 | 0 | 0 | 0 | 12748 | 0 | 10854 | 0 | 26645 | 0 | 190801 | 0 | 0 |
| James Seager | |||||||||||||
| 0 | 167940 | 0 | 6290 | 0 | 22539 | 0 | 11582 | 0 | 17143 | 0 | 225494 | 0 | 0 |
| Leslie Pollard PhD Dmin MBA | |||||||||||||
| 0 | 83859 | 0 | 0 | 0 | 19420 | 0 | 6622 | 0 | 77675 | 0 | 187576 | 0 | 0 |
| David Wren MHA | |||||||||||||
| 0 | 220874 | 0 | 0 | 0 | 73982 | 0 | 18517 | 0 | 34479 | 0 | 347852 | 0 | 39184 |
| Marilyn Herrmann PhD | |||||||||||||
| 0 | 159224 | 0 | 0 | 0 | 101 | 0 | 11942 | 0 | 16615 | 0 | 187882 | 0 | 0 |
| Edelweiss Ramal PhD | |||||||||||||
| 0 | 68723 | 0 | 878 | 0 | 110 | 0 | 5154 | 0 | 13000 | 0 | 87865 | 0 | 0 |
| Daisy DeLeon PHD | |||||||||||||
| 0 | 128294 | 0 | 0 | 0 | 0 | 0 | 9622 | 0 | 16049 | 0 | 153965 | 0 | 0 |
| Kenneth W Hart MD | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Nancy Young | |||||||||||||
| 0 | 62093 | 0 | 44 | 0 | 12434 | 0 | 4530 | 0 | 13297 | 0 | 92398 | 0 | 0 |
| Cynthia Rollins | |||||||||||||
| 0 | 57458 | 0 | 0 | 0 | 2396 | 0 | 7534 | 0 | 11920 | 0 | 79308 | 0 | 0 |
| Brent Shakespeare | |||||||||||||
| 0 | 98588 | 0 | 0 | 0 | 6144 | 0 | 0 | 0 | 15481 | 0 | 120213 | 0 | 0 |
| Rodney Turner | |||||||||||||
| 0 | 89081 | 0 | 0 | 0 | 15249 | 0 | 6609 | 0 | 15649 | 0 | 126588 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 4a | Part I, Line 4b: HART, RICHARD HENRY WAS PAID $30,194.1 FOR SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN VESTED ON 01/15/2009. THIS AMOUNT REPRESENTS THE TOTAL EMPLOYER CONTRIBUTIONS AND INVESTMENT EARNINGS FROM 2008 TO 01/15/2009. LANG, KEVIN J. WAS PAID $331,677.82 FOR SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN VESTED ON 01/15/2009. THIS AMOUNT REPRESENTS THE TOTAL EMPLOYER CONTRIBUTIONS AND INVESTMENT EARNINGS FROM 2005 TO 01/15/2009. MOHR, STEVEN LAWRENCE WAS PAID $109,254.15 FOR SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN VESTED ON 01/15/2009. THIS AMOUNT REPRESENTS THE TOTAL EMPLOYER CONTRIBUTIONS AND INVESTMENT EARNINGS FROM 2005 TO 01/15/2009. WREN, DAVID GORDON WAS PAID $39,183.78 FOR SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN VESTED ON 01/15/2009. THIS AMOUNT REPRESENTS THE TOTAL EMPLOYER CONTRIBUTIONS AND INVESTMENT EARNINGS FROM 2005 TO 01/15/2009. | |
| Part III | The officers listed on the Form 990, Part VII, Line 1a or on Schedule J, Part II are employed by Loma Linda University Adventist Health Sciences Center (LLUAHSC). LLUAHSC pays the compensation for the officers listed and reports the compensation amounts in the Forms W-2 for each officer. Amounts reported on the Form 990, Part VII, Line 1a, Columns E and F, or on Schedule J, Part II, Column E(ii) represent total amounts of compensation received by each officer from LLUAHSC. The officers do not receive any other compensation amounts from related organizations. LLUAHSC allocates the compensation amounts to the applicable related organizations and receives reimbursement payments pursuant to the management contract. Allocation percentages of the compensation payments for the officers are as follows: 1. Hart, Richard H. Compensation, excluding SERP benefit: 50% funded by Loma Linda University and 50% funded by Loma Linda University Medical Center SERP benefit: 100% funded by Loma Linda University Medical Center 2. Lang, Kevin J. Compensation, excluding SERP benefit: 70% funded by Loma Linda University Medical Center, 17.5% funded by Loma Linda University, 7.5% funded by Loma Linda University Health Care, and 5% funded by Loma Linda University Behavioral Medicine Center SERP benefit: 92.5% funded by Loma Linda University Medical Center and 7.5% funded by Loma Linda University Health Care 3. Mohr, Steven L. Compensation: 100% funded by Loma Linda University Medical Center 4. Pollard, Leslie Compensation: 100% funded by Loma Linda University 5. Strauss, Verlon W. Compensation: 100% funded by Loma Linda University Resigned effective May 1, 2010 6. Wren, David G. Compensation: 100% funded by Loma Linda University Health Care See Schedule O for the allocation of hours devoted to related organizations for officers listed on Part VII, Line 1a. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 2 | Dr. Richard Hart, Board Chair and Dr. Kenneth Hart, Medical Director have a family relationship. |
| Form 990, Part VI, Section A, line 6 | The corporate members("Members")of this corporation pursuant to the Corporations Code Section 5056(a) are Loma Linda University, a California nonprofit religious corporation and Loma Linda University Medical Center, a California nonprofit religious corporation. |
| Form 990, Part VI, Section A, line 7a | Notwithstanding any other provision of these bylaws, the Members shall have the following powers, which they may exercise without approval from this corporation: a. Approve the members of this corporation's board b. Remove this corporation's Board, in whole but not in part, if due cause for such removal is determined in good faith by the Members, upon a vote of two-thirds (2/3) of the authorized trustees of the Members' board of trustees. |
| Form 990, Part VI, Section A, line 7b | Subject to the provisions and limitations of the California Nonprofit Public Benefit Corporation Law and any other applicable laws, and subject to limitations of the articles of incorporation and Article IV of the bylaws, the corporation's activities and affairs shall be managed, and all corporate powers shall be exercised, by or under the direction of the Board. |
| Form 990, Part VI, Section B, line 11 | This form 990 is reviewed by Internal Audit and Management and is made available to the audit committee and the board for review and comment before filing. |
| Form 990, Part VI, Section B, line 12c | General Counsel annually obtains statements of disclosure from Trustees, Officers, Administrators, Key Employees, and others who make or affect significant decisions and reviews the findings with appropriate boards and committees. The board of trustees makes the decisions regarding questions which have not been satisfactorily answered after administrative consideration. |
| Form 990, Part VI, Section B, line 15 | Loma Linda University Adventist Health Sciences Center (LLUAHSC), SAC Health System's parent organization, employs an independent outside consulting firm to benchmark compensation for LLUAHSC employees. SAC Health System's CEO and CFO are employed by LLUAHSC. The LLUAHSC Executive Compensation Committee uses the results of the independent survey to establish pay scales for the next fiscal year. The Executive Compensation Committee sets the total compensation below the industry mean and median amounts provided in the survey. The Executive Compensation Committee is composed of Trustees appointed by the LLUAHSC Board who are independent of LLUAHSC's management. The Executive Compensation Committee is appointed by the LLUAHSC Board of Trustees to have direct responsibility for establishing compensation, policies, and benefits for the senior executives of LLUAHSC. The Committee's process includes contemporaneous substantiation of deliberations and decisions |
| Form 990, Part VI, Section C, line 18 | The IRS form 990 is available on the guidestar.com website and also may be obtained by making a request to Steven Mohr-Trustee at 11234 Anderson St., Loma Linda, Ca. 92354. |
| Form 990, Part VI, Section C, line 19 | SAC Health System will make its governing documents and conflict of interest policy available to the public upon request and in accordance with IRS guidelines. The conflict of interest policy is posted on the organization's internal website for employees. The financial statements are included in the IRS Form 990 which is available to the public on the Guidestar website. |
| Form 990, Part XI, Line 2b: | The financial statements of SAC Health System were audited by an independent accounting firm. |
| Form 990, Part XI, Line 2c: | SAC Health System's Finance and Audit committees of the Board of Trustees assume the responsibility for oversight of SAC Health System's financial statement audit and selection of the independent firm. |
| Form 990, Part VII, Line 1a: | LLUAHSC, AS THE PARENT ORGANIZATION, EMPLOYS THE SENIOR EXECUTIVES OF ITS RELATED ORGANIZATIONS. THE AVERAGE HOURS PER WEEK REPORTED FOR OFFICERS ON PART VII, LINE 1A, COLUMN B, REPRESENT TOTAL AVERAGE HOURS (AT LEAST 50 HOURS PER WEEK) DEVOTED BY EACH OFFICER TO LLUAHSC AND RELATED ORGANIZATIONS AS ALLOCATED TO THE APPLICABLE RELATED ORGANIZATIONS AS FOLLOWS: HART, RICHARD H. - 25 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY MEDICAL CENTER AND 25 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY. LANG, KEVIN J. - 35 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY MEDICAL CENTER, 8.75 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY, 3.75 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY HEALTH CARE AND 2.5 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTER. MOHR, STEVEN L. - 45 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY MEDICAL CENTER AND 5 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTER. POLLARD, LESLIE - 50 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY HEALTH SERVICES. STRAUSS, VERLON W. - 50 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY. Resigned effective May 1, 2010. WREN, DAVID G. - 50 HOURS/WEEK DEVOTED TO LOMA LINDA UNIVERSITY HEALTH CARE. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| Loma Linda University Adventist Health Sciences Center | |||||||||
| 11175 Campus St | Loma Linda | CA | 92354 | 953804495 | Parent Company | CA | 501(c)(3) | 1 | N/A |
| Loma Linda University | |||||||||
| 11145 Anderson St | Loma Linda | CA | 92354 | 951816009 | University | CA | 501(c)(3) | 2 | N/A |
| Loma Linda University Medical Center | |||||||||
| 11234 Anderson St | Loma Linda | CA | 92354 | 953522679 | Hospital | CA | 501(c)(3) | 3 | N/A |
| Loma Linda Mercantile | |||||||||
| 24887 Taylor St | Loma Linda | CA | 92354 | 953858272 | Purchasing Company | CA | 501(c)(3) | 1 | N/A |
| Loma Linda University Medical Enterprises | |||||||||
| PO Box 2000 | Loma Linda | CA | 92354 | 330873998 | Outpatient Pharmacy | CA | 501(c)(3) | 1 | N/A |
| Loma Linda University Faculty Pharmacy | |||||||||
| PO Box 2000 | Loma Linda | CA | 92354 | 330873998 | Outpatient Pharmacy | CA | 501(c)(3) | 1 | N/A |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Comments