2011-02-09T14:42:27-06:00 2010-06-30 DINGUS ZARECOR & ASSOCIATES 12015 E MAIN STE A SPOKANE VALLEY WA 99206 990 2009-07-01 330420041 SAN GORGONIO MEMORIAL HOSPITAL SANG 9517692103 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 DAVID RECUPERO 9517692103 2011-02-07 true TOM DINGUS 5092420874 2011-02-09 2009 2016-02-24 21:20:13Z DAVID RECUPERO CFO 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 44107278 false X WWW.SGMH.ORG X 1990 CA SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. 13 13 542 132 0 168094 496005 39962108 43262798 96 118 217784 348357 40348082 44107278 0 0 22121607 22663096 0 115632 21137715 23161588 43259322 45824684 -2911240 -1717406 7831764 9062649 21272214 24220505 -13440450 -15157856 SAN GORGONIO MEMORIAL HOSPITAL IS A NONPROFIT PUBLIC BENEFIT CORPORATION FORMED FOR THE PURPOSE OF OPERATING THE SAN GORGONIO ACUTE CARE FACILITY. false false 39734784 43262798 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. 39734784 true true false false false false false false false true false true false false false false false false false false true false false true false false false false false false false false false false false false false true false false false true 51 0 true 542 true false false false false false false false false false false false 13 13 false true false false false false false true true false false false true true true true true true true false CA X DAVID RECUPERO 9517692103 600 NORTH HIGHLAND SPRINGS AVE BANNING CA 92220 OLIVIA HERSHEY 1.00 X 2340 0 0 JERILYNN KAIBEL DC 1.00 X 2100 0 0 LUDWIG CIBELLI MD 1.00 X 1740 0 0 DENAE REAGINS 1.00 X 1640 0 0 MIKE WIEFELS 1.00 X 1450 0 0 DARLENE RAE MD 1.00 X 900 0 0 ESTELLE LEWIS 1.00 X 150 0 0 SHERIF KHALIL MD 1.00 X 90 0 0 DOROTHY ELLIS 1.00 X 0 0 0 LYNN BALDI 1.00 X 0 0 0 FRANK BURGESS 1.00 X 0 0 0 JOE DOTAN MD 1.00 X 0 0 0 ED HIETT 1.00 X 0 0 0 MARY ANN MARTIN ANDREAS 1.00 X 0 0 0 N IRWIN REEVES 1.00 X 0 0 0 RICHARD SHELDON MD 1.00 X 0 0 0 KAY LANG 40.00 X 87217 161097 0 DAVID RECUPERO 40.00 X 180000 0 54000 MICHELLE SAYRE 40.00 X 156350 0 4672 MARK TURNER 40.00 X 113750 0 48750 ANGELA LINDO 55.00 X 148920 0 7174 ANNE ZACOVIC 40.00 X 143269 0 3140 ZENAIDA CAPUA-CURRIE 40.00 X 142605 0 8313 LISA DAVID 50.00 X 126356 0 958 JASON MOORE 55.00 X 126065 0 469 1234942 161097 127476 18 false true true 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 6 491005 5000 496005 NET PATIENT SERVICE REVENUE 621990 43262798 43262798 43262798 118 118 CAFETERIA REVENUE 722210 154031 154031 OTHER REVENUE 900099 103445 103445 PHARMACY REVENUE 446110 53293 53293 37588 37588 348357 44107278 43611273 730433 730433 18217752 15481690 2667382 68680 199386 171936 26688 762 1575487 1327477 242121 5889 1940038 1633296 301376 5366 294675 294675 29402 29402 33396 33396 4293975 3291075 1002900 5336598 4606806 720335 9457 1358399 1097543 256322 4534 21451 200 19635 1616 32155 6226 25929 105298 105298 722667 704883 17784 BAD DEBT EXPENSE 10213683 10213683 OTHER OPERATING EXPENSES 719889 291060 412821 16008 ALLOC. OF INDIRECT COSTS 803611 -806931 3320 45824684 39734784 5974268 115632 1101789 1259492 102333 5331864 6583635 897852 774092 41296 46433 458963 296664 7831764 9062649 6330409 6064504 14941805 18156001 21272214 24220505 X -13440450 -15157856 -13440450 -15157856 7831764 9062649 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false PAYABLE TO AFFILIATE 15486532 BANK LINE OF CREDIT 2240469 THIRD-PARTY SETTLEMENTS 429000 18156001 true true true X true X true true true false false 515018 515018 0.01450 8437308 6371564 2065744 0.05800 8952326 6371564 2580762 0.07250 1 1650 1650 1 172 141597 141597 0.00400 6 14400 14400 0.00040 8 172 157647 157647 0.00440 8 172 9109973 6371564 2738409 0.07690 true 2451284 10888724 11135100 -246376 X true true NA SAN GORGONIO MEMORIAL HOSPITAL

600 N HIGHLAND SPRINGS AVE BANNING CA 92220

X 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). 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. 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." 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. 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. 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. 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. 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. 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. 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. X X X false false false false false false false false false KAY LANG 87217 161097 87217 161097 DAVID RECUPERO 180000 54000 234000 MICHELLE SAYRE 156350 4672 161022 MARK TURNER 113750 48750 162500 ANGELA LINDO 148920 7174 156094 ZENAIDA CAPUA-CURRIE 142605 8313 150918 OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III THE HOSPITAL CONTRACTS WITH BRIM HEALTHCARE INC. (BRIM) FOR MANAGEMENT SERVICES AND UTILIZES EMPLOYEES OF BRIM AS ITS CEO AND CFO. 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. SAN GORGONIO HEALTH CARE DISTRICT 600 N HIGHLAND SPRINGS AVE BANNING CA 922203090 956004149 HEALTHCARE CA 501 3 N/A false false false false false false false false false true false false false false false false false false SAN GORGONIO HEALTH CARE DISTRICT J 824777