2011-05-09T14:53:48-05:00 2010-06-30 990 2009-07-01 330664371 SAC Health System SACH 9093827190 1454 E 2ND ST San Bernardino CA 92408 Steven L Mohr 9095588135 2011-05-09 2009 2016-02-24 21:20:13Z Steven Mohr 11234 Anderson St Loma Linda CA 92354 4658450 0 1071 X n/a X 1995 CA To provide our communities with primary health-care services. 13 5 0 0 0 0 1356880 1781357 2653165 2827902 20042 13599 39688 35592 4069775 4658450 0 0 2531512 2892867 0 0 1419616 1375763 3951128 4268630 118647 389820 2976341 2616532 1340005 590376 1636336 2026156 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. 0 0 2997018 2877093 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. 2997018 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 12 0 0 0 0 0 0 0 0 0 0 0 0 0 13 5 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Steven Mohr Trustee 9095588135 11234 Anderson St Loma Linda CA 92354 X Richard H Hart MD 0.50 X X 0 493606 61495 Kevin Lang MBA 0.50 X 0 972546 85350 Steven L Mohr 0.50 X 0 520057 54706 Verlon W Strauss 0.50 X 0 153302 37499 James Seager 0.50 X 0 196769 28725 Leslie Pollard PhD Dmin MBA 0.50 X 0 103279 84297 Daniel Giang MD 0.50 X 0 0 0 Tamara M Shankle MD FACP FAAP 0.50 X 0 0 0 David Wren MHA 0.50 X 0 294856 52996 Carlton Lofgren MD 0.50 X 0 0 0 Juan Carlos Belliard MD 0.50 X 0 0 0 Eric Ngo MD 0.50 X 0 0 0 Ann Atkinson 0.50 X 0 0 0 Marilyn Herrmann PhD 0.50 X X 0 159325 28557 Edelweiss Ramal PhD 0.50 X 0 69711 18155 Daisy DeLeon PHD 0.50 X 0 128294 25671 Veronica Reyes 0.50 X 0 0 0 Cintia Ramirez 0.50 X 0 0 0 Kenneth W Hart MD 40.00 X 0 0 0 Nancy Young 40.00 X 0 74571 17827 Cynthia Rollins 40.00 X 0 59854 19454 Brent Shakespeare 40.00 X 0 104732 15481 Rodney Turner 40.00 X 0 104330 22258 0 3435232 552471 0 0 1 0 0 20106 1480324 280927 1781357 Patient Care Revenue 621400 2348763 2348763 479139 479139 2827902 13599 13599 35592 35592 35592 35592 4658450 2877093 0 0 2086533 1371453 715080 806334 519096 287238 4200 650 3550 29452 29452 343522 343522 340871 258504 82367 28442 28442 227150 192082 35068 2740 1405 1335 51902 3542 48360 105278 91739 13539 Purchased Services 211488 196494 14994 Provision for Uncollect 6666 6666 24052 11865 12187 4268630 2997018 1271612 0 284818 457107 1457595 515109 466812 846212 391053 324501 84022 110944 2777 2777 1243409 883527 289264 359882 2976341 2616532 1339405 589776 600 600 1340005 590376 X 1008950 1460584 167074 515423 460312 50149 1636336 2026156 2976341 2616532 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 55503 828 56331 54109 1394 55503 1.00000 0 0 629063 437532 191531 614346 445995 168351 359882 Deposits 600 600 4658450 4268630 389820 0 389820 5571808 913358 913358 4658450 0 4658450 5181988 913358 913358 4268630 0 4268630 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. 1 1 X 1 X 1 X 0 1 0 0 491596 0 491596 0.11300 1629404 1066380 563024 0.13100 2121000 1066380 1054620 0.24400 282347 276391 5956 0.00140 282347 276391 5956 0.00140 2403347 1342771 1060576 0.24540 1 6666 30259 30259 1 1 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 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. 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. X X X X X 0 1 0 0 0 0 0 0 0 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 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. Supplemental Information 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. 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. 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 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0