SAN GORGONIO MEMORIAL HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: SAN GORGONIO MEMORIAL HOSPITAL (EIN 33-0420041)
Tax period: 2009-07-01 to 2010-06-30
Filed: 2011-02-09
IRS object ID: 201130409349300838
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-02-09T14:42:27-06:00	Timestamp
Tax Period End Date	2010-06-30	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	2009-07-01	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	2011-02-07	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	TOM DINGUS	Name
Phone	5092420874	Phone
Date Prepared	2011-02-09	DatePrepared

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	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	44107278	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c	X	Organization501c
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	13	NbrIndependentVotingMembers
Total Nbr Employees	542	TotalNbrEmployees
Total Nbr Volunteers	132	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	168094	ContributionsGrantsPriorYear
Contributions Grants Current Year	496005	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	39962108	ProgramServiceRevenuePriorYear
Program Service Revenue CY	43262798	ProgramServiceRevenueCY
Investment Income Prior Year	96	InvestmentIncomePriorYear
Investment Income Current Year	118	InvestmentIncomeCurrentYear
Other Revenue Prior Year	217784	OtherRevenuePriorYear
Other Revenue Current Year	348357	OtherRevenueCurrentYear
Total Revenue Prior Year	40348082	TotalRevenuePriorYear
Total Revenue Current Year	44107278	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	22121607	SalariesEtcPriorYear
Salaries Etc Current Year	22663096	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	115632	TotalFundrsngExpCurrentYear
Other Expense Prior Year	21137715	OtherExpensePriorYear
Other Expenses Current Year	23161588	OtherExpensesCurrentYear
Total Expenses Prior Year	43259322	TotalExpensesPriorYear
Total Expenses Current Year	45824684	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-2911240	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-1717406	RevenuesLessExpensesCY
Total Assets BOY	7831764	TotalAssetsBOY
Total Assets EOY	9062649	TotalAssetsEOY
Total Liabilities BOY	21272214	TotalLiabilitiesBOY
Total Liabilities EOY	24220505	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	-13440450	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	-15157856	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	39734784	Expense
Revenue	43262798	Revenue
Description	THE HOSPITAL IS COMPRISED OF AN ACUTE CARE FACILITY WHICH PROVIDES HEALTHCARE SERVICES. THE HOSPITAL PROVIDED 12,962 DAYS OF PATIENT SERVICES AND 1,957 OF SKILLED NURSING DAYS FOR THE YEAR ENDED JUNE 30, 2010. 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 2,145,909 FOR CHARITY CARE, 41,928,076 FOR MEDICARE, 15,284,878 FOR MEDI-CAL, AND 46,757,148 FOR OTHER THIRD-PARTY PAYORS FOR THE YEAR ENDED JUNE 30, 2010.	Description
Total Program Service Expense	39734784	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Balance Sheet Amounts Reported	true	BalanceSheetAmountsReported
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
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	false	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	51	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	542	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
Form8899 Filed	false	Form8899Filed
Form1098 C Filed	false	Form1098CFiled
Nbr Voting Governing Body Members	13	NbrVotingGoverningBodyMembers
Number Independent Voting Members	13	NumberIndependentVotingMembers
Family Or Business Relationship	false	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 (25 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
OLIVIA HERSHEY
TREASURER	1.00	X	2340	0	0
JERILYNN KAIBEL DC
CHAIR	1.00	X	2100	0	0
LUDWIG CIBELLI MD
BOARD MEMBER	1.00	X	1740	0	0
DENAE REAGINS
SECRETARY	1.00	X	1640	0	0
MIKE WIEFELS
BOARD MEMBER	1.00	X	1450	0	0
DARLENE RAE MD
BOARD MEMBER	1.00	X	900	0	0
ESTELLE LEWIS
BOARD MEMBER	1.00	X	150	0	0
SHERIF KHALIL MD
BOARD MEMBER	1.00	X	90	0	0
DOROTHY ELLIS
VICE CHAIR	1.00	X	0	0	0
LYNN BALDI
BOARD MEMBER	1.00	X	0	0	0
FRANK BURGESS
BOARD MEMBER	1.00	X	0	0	0
JOE DOTAN MD
BOARD MEMBER	1.00	X	0	0	0
ED HIETT
BOARD MEMBER	1.00	X	0	0	0
MARY ANN MARTIN ANDREAS
BOARD MEMBER	1.00	X	0	0	0
N IRWIN REEVES
BOARD MEMBER	1.00	X	0	0	0
RICHARD SHELDON MD
BOARD MEMBER	1.00	X	0	0	0
KAY LANG
INTERIM CEO	40.00		87217	161097	0	X
DAVID RECUPERO
CFO	40.00		180000	0	54000	X
MICHELLE SAYRE
COO	40.00		156350	0	4672	X
MARK TURNER
CEO	40.00		113750	0	48750	X
ANGELA LINDO
RN	55.00		148920	0	7174		X
ANNE ZACOVIC
FOUNDATION D	40.00		143269	0	3140		X
ZENAIDA CAPUA-CURRIE
PHARMACY DIR	40.00		142605	0	8313		X
LISA DAVID
RN	50.00		126356	0	958		X
JASON MOORE
RN	55.00		126065	0	469		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1234942	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	161097	TotalReportableCompFrmRltdOrgs
Total Other Compensation	127476	TotalOtherCompensation
Number Individuals GT100 K	18	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	true	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	697880
BRIM HEALTHCARE
PO BOX 636246	CINCINNATI	OH	45263	MGMT CONSULTING	627197
DAVITA INC
PO BOX 403008	ATLANTA	GA	30384	DIALYSIS	154295
UNITED HEALTHCARE SERVICES
1280 RESEARCH DR UNIT B	REDLANDS	CA	92373	EQUIP REPAIR	143242
JUST IN TIME STAFFING
5984 S PRINCE ST SUITE 200	LITTLETON	CO	80120	NURSE STAFFING	142281

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	6	NumberOfContractorsGT100K
Government Grants	491005	GovernmentGrants
All Other Contributions	5000	AllOtherContributions
Total Contributions	496005	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	NET PATIENT SERVICE REVENUE	Description
Business Code	621990	BusinessCode
Total Revenue Column	43262798	TotalRevenueColumn
Exclusion	$43,262,798	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	43262798	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	118	TotalRevenueColumn
Exclusion	$118	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
CAFETERIA REVENUE	722210	154031	$154,031
OTHER REVENUE	900099	103445	$103,445
PHARMACY REVENUE	446110	53293	$53,293

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	37588	TotalRevenueColumn
Exclusion	$37,588	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	348357	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	44107278	TotalRevenueColumn
Exclusion	$43,611,273	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	730433	Total
Management And General	730433	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	18217752	Total
Program Services	15481690	ProgramServices
Management And General	2667382	ManagementAndGeneral
Fundraising	68680	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	199386	Total
Program Services	171936	ProgramServices
Management And General	26688	ManagementAndGeneral
Fundraising	762	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	1575487	Total
Program Services	1327477	ProgramServices
Management And General	242121	ManagementAndGeneral
Fundraising	5889	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1940038	Total
Program Services	1633296	ProgramServices
Management And General	301376	ManagementAndGeneral
Fundraising	5366	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	294675	Total
Management And General	294675	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	29402	Total
Management And General	29402	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	33396	Total
Management And General	33396	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	4293975	Total
Program Services	3291075	ProgramServices
Management And General	1002900	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	5336598	Total
Program Services	4606806	ProgramServices
Management And General	720335	ManagementAndGeneral
Fundraising	9457	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	1358399	Total
Program Services	1097543	ProgramServices
Management And General	256322	ManagementAndGeneral
Fundraising	4534	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	21451	Total
Program Services	200	ProgramServices
Management And General	19635	ManagementAndGeneral
Fundraising	1616	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	32155	Total
Program Services	6226	ProgramServices
Management And General	25929	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	105298	Total
Program Services	105298	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	722667	Total
Program Services	704883	ProgramServices
Management And General	17784	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
BAD DEBT EXPENSE	10213683	10213683
OTHER OPERATING EXPENSES	719889	291060	412821	16008
ALLOC. OF INDIRECT COSTS		803611	-806931	3320

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	45824684	Total
Program Services	39734784	ProgramServices
Management And General	5974268	ManagementAndGeneral
Fundraising	115632	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1101789	BOY
EOY	1259492	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
EOY	102333	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	5331864	BOY
EOY	6583635	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	897852	BOY
EOY	774092	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	41296	BOY
EOY	46433	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	458963	BOY
EOY	296664	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	7831764	BOY
EOY	9062649	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	6330409	BOY
EOY	6064504	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	14941805	BOY
EOY	18156001	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	21272214	BOY
EOY	24220505	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	-13440450	BOY
EOY	-15157856	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	-13440450	BOY
EOY	-15157856	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	7831764	BOY
EOY	9062649	EOY

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	false	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

Field	Value	IRS element (for citing)
Disclosed Orgs Legal Control	false	DisclosedOrgsLegalControl
Disclosed For Charitable Purposes	false	DisclosedForCharitablePurposes
Written Policy Monitoring	false	WrittenPolicyMonitoring
Sect170h Requirements Satisfied	false	Sect170hRequirementsSatisfied
Solicited Assets For Sale	false	SolicitedAssetsForSale
Agent Trustee Etc	false	AgentTrusteeEtc
Included On FS	false	IncludedOnFS
Endowments Held By Unrelated Orgs	false	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	false	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	false	AreRelatedOrgsListedScheduleR

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
PAYABLE TO AFFILIATE	$15,486,532
BANK LINE OF CREDIT	$2,240,469
THIRD-PARTY SETTLEMENTS	$429,000

Field	Value	IRS element (for citing)
Total Of Amounts	18156001	TotalOfAmounts

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	515018	TotalCommunityBenefitExpense
Net Community Benefit Expense	515018	NetCommunityBenefitExpense
Percent Of Total Expense	0.01450	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	8437308	TotalCommunityBenefitExpense
Direct Offsetting Revenue	6371564	DirectOffsettingRevenue
Net Community Benefit Expense	2065744	NetCommunityBenefitExpense
Percent Of Total Expense	0.05800	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	8952326	TotalCommunityBenefitExpense
Direct Offsetting Revenue	6371564	DirectOffsettingRevenue
Net Community Benefit Expense	2580762	NetCommunityBenefitExpense
Percent Of Total Expense	0.07250	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	1650	TotalCommunityBenefitExpense
Net Community Benefit Expense	1650	NetCommunityBenefitExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	172	PersonsServed
Total Community Benefit Expense	141597	TotalCommunityBenefitExpense
Net Community Benefit Expense	141597	NetCommunityBenefitExpense
Percent Of Total Expense	0.00400	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	6	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	14400	TotalCommunityBenefitExpense
Net Community Benefit Expense	14400	NetCommunityBenefitExpense
Percent Of Total Expense	0.00040	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	8	NumberOfActivitiesOrPrograms
Persons Served	172	PersonsServed
Total Community Benefit Expense	157647	TotalCommunityBenefitExpense
Net Community Benefit Expense	157647	NetCommunityBenefitExpense
Percent Of Total Expense	0.00440	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	8	NumberOfActivitiesOrPrograms
Persons Served	172	PersonsServed
Total Community Benefit Expense	9109973	TotalCommunityBenefitExpense
Direct Offsetting Revenue	6371564	DirectOffsettingRevenue
Net Community Benefit Expense	2738409	NetCommunityBenefitExpense
Percent Of Total Expense	0.07690	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$2,451,284	BadDebtExpenseAmount
Amount Reimbursed By Medicare	10888724	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	11135100	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-246376	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

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

Form990 Schedule H Part V Form990ScheduleHPartV

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)
Critical Access Hospital	X	CriticalAccessHospital

Form990 Schedule H Part VI Form990ScheduleHPartVI

Field	Value	IRS element (for citing)
Costing Method Used	THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COST-TO-CHARGES FOR FIGURES REPORTED IN THE TABLE (TOTAL OPERATING EXPENSES LESS BAD DEBT, NON-PATIENT CARE ACTIVITIES, TOTAL COMMUNITY BENEFIT, AND TOTAL COMMUNITY BUILDING EXPENSES).	CostingMethodUsed
Percent Of Total Expense Expln	BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A OF 10,213,683 WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN F.	PercentOfTotalExpenseExpln
Bad Debt Footnote	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 HOSPITAL'S CHARITY CARE POLICY BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE DETERMINATION OF THEIR ELIGIBILITY DURING FISCAL YEAR 2010. THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE AUDITED FINANCIAL STATEMETS READS AS FOLLOWS "RECEIVABLES ARISING FROM REVENUE FROM SERVICES TO PATIENTS ARE REDUCED BY ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS AND CONTRACTUAL ADJUSTMENTS BASED ON EXPERIENCE, THIRD-PARTY CONTRACTUAL REIMBURSEMENT ARRANGEMENTS, AND ANY UNUSUAL CIRCUMSTANCES WHICH MAY AFFECT THE ABILITY OF PATIENTS TO MEET THEIR OBLIGATIONS. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED AGAINST THESE ALLOWANCES. ACCOUNTS ARE DETERMINED TO BE DELINQUENT IF THEY ARE NOT RESOLVED WITHIN 90-120 DAYS OF BILLING."	BadDebtFootnote
Shortfall As Community Benefit	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.	ShortfallAsCommunityBenefit
Debt Collection Policy	THE HOSPITAL'S BUSINESS OFFICE STAFF FOLLOW UP ON ACCOUNTS 15 TO 30 DAYS AFTER THE ACCOUNTS ARE BILLED. THE STAFF CONTACT THE INSURERS TO VERIFY CLAIMS HAVE BEEN RECEIVED AND TO RESEND THE CLAIMS IF NECESSARY. AFTER VERIFYING CLAIMS HAVE BEEN RECEIVED, THE STAFF CONTINUE TO CONTACT THE INSURERS EVERY 30 DAYS, AS NECESSARY, TO FOLLOW UP ON THE STATUS OF THE CLAIMS. ALL CLAIMS NOT RESOLVED WITHIN 60 DAYS OF BILLING ARE REVIEWED BY A SUPERVISOR OR MANAGER FOR ADDITIONAL GUIDANCE AND CONSIDERATION. ACCOUNTS NOT RESOLVED WITHIN SIXTY DAYS OF BILLING ARE CONSIDERED DELINQUENT. THE SUPERVISOR OR MANAGER WILL DETERMINE WHETHER THE ACCOUNTS SHOULD BE WRITTEN OFF AS BAD DEBT, FURTHER COLLECTION PROCEDURES SHOULD BE ATTEMPTED, AND/OR THE STATE INSURANCE COMMISSION OFFICE SHOULD BE CONTACTED.	DebtCollectionPolicy
Needs Assessment	MANAGEMENT, HOSPITAL DEPARTMENT STAFF AND MANAGERS, AND THE BOARD OF DIRECTORS ARE COMPRISED OF MEMBERS WITHIN THE COMMUNITY. THEY ARE ABLE TO GATHER AND COMMUNICATE THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES AND CONTINUALLY ADDRESS THEM AT STAFF AND BOARD MEETINGS.	NeedsAssessment
Patient Education Assistance	IT IS THE HOSPITAL'S POLICY THAT WHEN IT BECOMES APPARENT THAT A PATIENT MAY HAVE DIFFICULTY IN MEETING HIS/HER FINANCIAL RESPONSIBILITY TO THE HOSPITAL, THE PATIENT WILL BE REQUESTED TO COMPLETE THE APPLICATION PROCESS FOR CALIFORNIA MEDI-CAL AND/OR OTHER AVAILABLE PROGRAMS. HOSPITAL STAFF ASSIST IN THE APPLICATION PROCESS. PATIENTS WHO DO NOT QUALIFY FOR CALIFORNIA MEDI-CAL OR OTHER ASSISTANCE MAY APPLY FOR THE HOSPITAL'S ASSISTANCE PROGRAM.	PatientEducationAssistance
Community Information	THE HOSPITAL IS A RURAL HOSPITAL LOCATED IN THE PASS AREA OF RIVERSIDE COUNTY. IT PRIMARILY SERVES THE CITIES OF BANNING, BEAUMONT, CABAZON, AND CALIMESA, CALIFORNIA. THE POPULATION SERVED IS HIGH RISK DUE TO POVERTY LEVEL INCOMES, LOW EDUCATION LEVELS, AND HIGH DRUG USE. THE COUNTY HAS AN UNEMPLOYMENT RATE OF 14.2%. THE HOSPITAL'S PAYOR MIX INCLUDES 24% MEDI-CAL RECIPIENTS AND 7% UNINSURED.	CommunityInformation
Community Building Activities	THE HOSPITAL PROVIDES DIET COUNSELING FREE OF CHARGE TO PATIENTS. HOSPITAL STAFF LECTURE ON HEALTHCARE RELATED TOPICS AT VARIOUS SUPPORT GROUPS INCLUDING DIABETIC AND CANCER SURVIVORS SUPPORT GROUPS, AND AT THE SOROPTOMIST CLUB OF BEAUMONT/BANNING. THE HOSPITAL HAS ALSO PARTICIPATED IN COMMUNITY HEALTH FAIRS.	CommunityBuildingActivities
Other Information	THE HOSPITAL HOLDS COMMUNITY EDUCATION COURSES SUCH AS CPR CERTIFICATION, SMOKING CESSATION, CHILDBIRTH PREPARATION, ETC. THE HOSPITAL'S BUSINESS OFFICE TRAINED THREE INTERNS FROM AREA SCHOOLS ON REGISTRATION, BILLING, AND COLLECTIONS FOR FOUR WEEKS OF THE YEAR. OTHER STUDENTS JOB SHADOWED THE HEALTH INFORMATION MANAGEMENT DIRECTOR FOR TWO WEEKS OF THE YEAR. 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.	OtherInformation

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 (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg
KAY LANG
87217	161097	87217	161097
DAVID RECUPERO
180000		234000		54000
MICHELLE SAYRE
156350		161022		4672
MARK TURNER
113750		162500		48750
ANGELA LINDO
148920		156094		7174
ZENAIDA CAPUA-CURRIE
142605		150918		8313

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 BRIM HEALTHCARE INC. (BRIM) FOR MANAGEMENT SERVICES AND UTILIZES EMPLOYEES OF BRIM AS ITS CEO AND CFO.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS	FORM 990, PAGE 1, PART I, LINE 6	THE HOSPITAL HAS 132 VOLUNTEERS THAT HELP IN THE GIFT SHOP, CAFETERIA, AND RECEPTION BOOTHS, AS WELL AS MATERIALS MANAGEMENT DELIVERIES AND MAILING.
MANAGEMENT DELEGATED	FORM 990, PAGE 6, PART VI, LINE 3	THE HOSPITAL CONTRACTS WITH BRIM HEALTHCARE INC. (BRIM) FOR MANAGEMENT SERVICES AND UTILIZES EMPLOYEES OF BRIM AS ITS CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11	A COPY OF THE 990 IS PROVIDED TO TEH 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 BRIM.
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.

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	501	ExemptCodeSection
Public Charity Status	3	PublicCharityStatus
Direct Controlling Entity NA	N/A	DirectControllingEntityNA

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
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	J	TransactionType
Amount Involved	824777	AmountInvolved