San Antonio Regional Hospital

“The hospital has a medical staff activity whose activities are separate from the hospital's but the hospital's governing board has ultimate authority over certain medical staff actions”

“The form is prepared internally by the organization's accounting department and reviewed by the organization's cfo. The form is then reviewed by the organization's external financial and tax audit firm. Following the external review, the cfo reviews the form with the organization's ceo. The form is then sent to members of the organization's board audit committee for review and approval. The form is then sent to the entire organization board prior to final signatures and filing.”

“The organization has a compliance officer who reviews the organization's compliance policies, including its conflict of interest statements, at least annually. The organization's board has an organization meeting every january. At the annual organization meeting conflict of interest statements are distributed to all board members and officers and subsequently collected by the organization's compliance officer. The cfo, who attends all board meetings, also reviews the board conflict of interest statements. If a new potential conflict of interest arises during the year, a new conflict of interest statement is signed. If a potential conflict of interest exists during a board discussion, the board member is required to state the conflict and abstain from any related board votes. Board minutes reflect these abstentions. At least semi-annually, the organization's compliance officer provides a verbal compliance update at a board meeting and reminds board members of their duty to disclose potential conflicts of interest. The organization follows a similar annual procedure for members of its executive management and department directors, including at least annual compliance education sessions.”

“The organization's executive compensation program is directed by the compensation committee of the board. The organization has developed and approved a formal executive compensation policy that currently covers six senior management employees, including the ceo and the cfo. A comprehensive base pay and total executive compensation analysis is performed by an outside compensation consulting firm every two years. In the intervening years an analysis of sach's executive pay is reviewed against the hospital association of southern california's executive compensation survey. The consultant presents the survey data and analysis to the compensation committee of the board of trustees. The external compensation study includes an evaluation for excess benefit transactions under the intermediate sanctions for tax exempt organizations and an analysis of both base and total compensation of all members of the executive management team and their salary position in relation to the fiftieth and sixty fifth percentile of the market. However, the consultant is not either tax or legal counsel and therefore cannot assure compliance with irc 4958 but rather assures that sach's executive compensation practices fall between the fiftieth and sixty fifth percentile of the market place and do not exceed the seventy fifth percentile. The latest survey and analysis were conducted in february of 2014. The consultant used survey data from four different published surveys that include ca hospitals with comparable revenues, employees and complexity. Compensation committee reviews the external consultant's findings in accordance with the compensation policy and their charter and provides direction for any needed compensation policy or pay range changes for the ceo and approves any such recommendations that may be made by the ceo for other executives. Other key employee compensation, vice presidents and department directors, is evaluated based on market based compensation survey data provided by the hospital council of southern california taking into consideration pay rates for similar management positions at sach. The procedures described here are documented in the board minutes.”

“The organization has not made its governing documents or conflict of interest statements available to the public. The organization's financial statements are part of the organization's annual report filed with the california office of statewide health planning and development (oshpd) and are available on the oshpd web site. The organization's financial statements are also included as part of its annual medicare and medicaid cost report filings which are publically available on the cms (medicare) web site. The organization's financial statements are also provided to anyone upon a verbal or written request. The audited financial statements are attached to the form 990 in accordance with the irs instructions.”

“"overview" -san antonio community hospital (sach) was founded by dr. William howard craig in 1907, just a year after the city of upland was incorporated. As the community surrounding the hospital grew, it became apparent that larger, more modern facilities were needed. Frances mary paul, the widow of a local banker, spearheaded the effort to raise funds to build a new hospital by personally donating $75,000. The community rallied and sufficient funds were raised. The hospital moved on july 30, 1924, from its original location on the corner of san antonio avenue and arrow highway, to its present location on san bernardino road. Sach has grown from its modest beginning as an eighteen-bed hospital with five physicians and limited staff to a 271-bed regional medical facility with 1,605 full time equivalent employees and a medical staff of nearly 500 physicians. In 2013, the hospital had 76,690 emergency room visits. Sach is currently constructing the largest expansion in its 100-year history to replace its emergency department and add a patient tower to meet the needs of the growing population in the west end of california's inland empire.”

“"leadership"-sach is governed by a 15-member board of trustees. The hospital's president and chief executive officer, and the medical staff's president-elect, president, and immediate past president are members of the board by virtue of their offices. Two additional physicians are elected from the medical staff, and the remaining members are elected from the community at-large. The board of trustees, with physician leaders comprising 33 percent of its membership, sets the direction for the hospital and its community benefits program. The executive management group directs the hospital's strategic planning process and allocates resources for community benefit activities. The executive management group is comprised of the chief executive officer, chief financial officer, chief nursing officer, vice president of human resources, vice president of administrative services, director of business development and community outreach and president of the hospital foundation. Department directors are responsible for the operation and management of the individual departments. The directors encourage employee participation in community benefit activities, and it is this support that ensures the ultimate success of the sach's community outreach program. "our commitment" -the leadership at sach has an unwavering commitment to the hospital's mission, vision, values, and strategic plan, which focus on improving the region's overall health by providing quality patient care in a compassionate and caring environment. Our mission is to improve the overall health of our regional community by offering healthcare services that both comfort and cure, in settings that inspire confidence, and in a manner that earns the trust of our patients, our physicians, and our employees. Our vision is to use our strengths to enhance our reputation for excellence in quality care, patient experience, and an exceptional working and practice environment. Our values articulate the principles that help us to fulfill our mission and vision, and our strategic plan specifically addresses the development of programs and services in response to regional community needs. Sach's commitment to providing quality care for all members of our community has received national recognition. In its 2009 national benchmarks study, thomson reuters recognized sach as a "top 100 hospital" in the united states. Sach was the only large community hospital in california and the first california hospital in four years to receive an award. This recognition is based on performance achievements in nine areas: mortality, medical complications, patient safety, average length of stay, expenses, profitability, cash-to-debt ratio, patient satisfaction, and adherence to clinical standards of care. In addition to the top 100 hospital award, thomas reuters selected sach as one of 23 hospitals nationally to receive its inaugural "everest" award for sustained operational performance and rapid increase in performance improvement rates over the previous five years. In addition, healthgrades has recognized sach for quality excellence in emergency medicine, stroke care, and maternity care. In 2008, sach became the 65th hospital in the united states to receive the baby friendly designation which measures infant health, breast feeding, and infant-parent attachment based on global criteria developed by the world health organization and unicef. Sach has also been honored by the california hospital assessment reporting task force (chart) for excellence in clinical and safety measures.”

“"caring for our community" - community benefits are more than just numbers. They represent people-moms and dads, children and grandparents, and the vulnerable. San antonio community hospital goes above and beyond the delivery of essential patient care services to ensure healthier children, early detection of disease, and enhanced access to basic healthcare services. It captures the essence of our purpose: to improve health and make the community a better place to work, grow, and play. As a regional healthcare provider, sach is committed to maintaining the highest quality of care for those we serve. As a nonprofit hospital, all of our resources are devoted to providing healthcare services. Any surpluses generated from hospital operations are used to purchase new or upgraded equipment, expand services, and provide care for vulnerable populations. While the inland empire is a maturing economic market, as a whole, many individuals and families are at significant risk during a medical crisis due to their inability to access health insurance or as the result of inadequate insurance coverage. The hospital's charity care policy provides relief to these families who would otherwise face medical bankruptcy. During 2013, $414,710 (at cost) in charity care was provided for qualifying patients. In addition to this direct medical care, sach reaches out to its community in a variety of ways that go well beyond the traditional care provided by an acute care hospital. "planning"-sach conducts a formal strategic planning process involving senior management, the board, the medical staff leadership every three years with annual reviews and updates. In 2011, the executive management team worked closely with sach's board of trustees and medical staff to develop a three-year strategic plan for 2012 to 2014, which includes details of strategic, operational, quality and community benefit initiatives. In addition to programmatic and service enhancement projects, the strategic plan includes a facilities master plan, which calls for the renovation and expansion of the hospital's main campus. "facility expansion" - the expansion, expected to open in late 2015, will include new medical/surgical and intensive care inpatient beds and a new emergency department, which are essential to accommodate the growing needs of sach's service area and to offset the expected reduction in the number of medical/surgical beds as a result of current state seismic compliance requirements. The tremendous growth experienced in sach's emergency department services is key driver of the planned expansion. The hospital's 29-bed emergency department, which was built in 1975, was designed to accommodate 30,000 patient visits per year. In fiscal year 2013, sach's emergency department had 76,690 visits. With the high unemployment in the hospital's service area, the number of uninsured patients treated in the emergency department continues to rise, adding additional stress to the already overburdened existing facilities. "four-story patient tower" - the primary structure in the planned addition to sach's facilities will be a four-story patient care tower to be constructed on the east side of the hospital campus immediately adjacent to the existing patient tower and ancillary service departments. The four-story tower designed to include a 52-bed replacement emergency department, including computerized tomography ("ct") scanning and other radiology capabilities, 80 medical/surgical and telemetry rooms, 12 intensive care rooms, a new main lobby, 33,470 square feet of shelled space on the first floor, and site improvements including parking and landscaping.”

“"facility expansion" - the expansion, expected to open in late 2015, will include new medical/surgical and intensive care inpatient beds and a new emergency department, which are essential to accommodate the growing needs of sach's service area and to offset the expected reduction in the number of medical/surgical beds as a result of current state seismic compliance requirements. The tremendous growth experienced in sach's emergency department services is key driver of the planned expansion. The hospital's 29-bed emergency department, which was built in 1975, was designed to accommodate 30,000 patient visits per year. In fiscal year 2013, sach's emergency department had 76,690 visits. With the high unemployment in the hospital's service area, the number of uninsured patients treated in the emergency department continues to rise, adding additional stress to the already overburdened existing facilities. "four-story patient tower" - the primary structure in the planned addition to sach's facilities will be a four-story patient care tower to be constructed on the east side of the hospital campus immediately adjacent to the existing patient tower and ancillary service departments. The four-story tower designed to include a 52-bed replacement emergency department, including computerized tomography ("ct") scanning and other radiology capabilities, 80 medical/surgical and telemetry rooms, 12 intensive care rooms, a new main lobby, 33,470 square feet of shelled space on the first floor, and site improvements including parking and landscaping. "energy plant and site utilities" - the addition of the new four-story patient care tower required construction of a conventional energy plant to supplement existing co-generation capacity. The new energy plant is near the existing energy plant in a location consistent with appropriate environmental standards. The site utilities project will connect the new energy plant with the new four-story patient care tower. "hospital services" - sach provides a full spectrum of preventive acute, primary, and specialty care to the communities it services. These services include inpatient medical and surgical service, emergency and intensive care services, palliative care and a community wellness and health promotion program. Areas of special expertise include cardiovascular services provided at sach's heart center, specialized infant care provided at the level ii neonatal intensive care unit (nicu), and the diagnostic and treatment services available at its cancer center and gamma knife center,”

“"the heart center" - sach's heart program coordinates the comprehensive cardiac service line, including non-invasive cardiology, diagnostic and interventional cardiac catheterization, cardiac nuclear scanning, cardiovascular surgery, and cardiac rehabilitation. Sach has been designated as "stemi" (st-elevation myocardial infarction)-receiving hospital by san bernardino, los angeles and riverside counties, meaning that the hospital has the equipment, expertise and facilities to administer percutaneous coronary intervention, the preferred method of treating severe heart attack patients. Sach is the only hospital in the inland empire with a three-county designation. "cancer center" - sach's cancer program has been fully accredited by the american college of surgeon's commission on cancer since 1980. The hospital treats more than 800 new cancer cases per year. The cancer program treatment modalities include surgery, chemotherapy, hormone therapy, and immunotherapy. Outpatient radiation oncology services include 3d conformal, external beam, electron beam and intensity modulated therapy ("imrt"). The cancer resource center provides education and support services for cancer patients and their families. Nurse navigators are part of the cancer team and meet with every hospitalized patient with cancer. The navigators also work closely with the physicians on an outpatient basis to ensure that patients have a positive experience as they move between the inpatient and outpatient status during different stages of their treatment. "gamma knife center" - sach offers the only gamma knife radiosurgery system in its primary service area. The gamma knife enables the hospital's radiation oncology and neurosurgery department to conduct noninvasive, outpatient brain surgery, using low-dose radiation beams to target tumors and abnormal cells with precision. The less invasive method is performed on an outpatient basis, allowing patients to receive treatment and return home the same day. "women's breast and imaging center" - the women's breast and imaging center is located immediately adjacent to the main hospital facility and offers patients the latest advancements in screening and diagnostic procedures for early detection of breast cancer. The center's technology includes digital mammography, ultrasound and stereotactic breast biopsy procedures. The nurse navigator coordinates the breast cancer patient's care throughout diagnosis, treatment, and recovery. Additional screening services for women's health offered at the center include general ultrasound for diagnosing gynecological disorders and osteoporosis screening for assessing bone health. A focus of the women's center is to assure that the patient's experience is as positive as their medical outcome. "maternal child services" - coordinates care with obstetricians and pediatricians to provide comprehensive prenatal, delivery and postpartum care. The maternal child department includes 32 maternity beds, four labor, delivery and recovery rooms, 10 labor, delivery, recovery and postpartum rooms, a cesarean section surgical suite and recovery room, and a 20-bed nicu. A postpartum follow-up center is located near the main hospital to provide screening and support services for infants and their parents. The services provided at the center are offered to all families regardless of where they delivered their baby, and the nominal fee is waived for any family that cannot afford to pay the services provided by sach's internationally board certified lactation consultant. Sach is designated a baby friendly hospital by the world health organization. This designation is an important part of sach's healthy beginnings program, which reinforces the benefits of breastfeeding. "surgical services" - the surgery department operates nine surgical suites and two additional surgical suites dedicated to cardiovascular surgeries. The surgery department performs approximately 350 inpatient and 350 outpatient surgeries per m”

“"community education"- sach offers a broad array of education classes, support groups, and community lectures to meet the health needs of its community. Many programs are offered on-site, however there are some programs provided at locations throughout the community to reach those who may have special needs or lack transportation and would otherwise fail to access these important services. In addition to gaining knowledge about important health topics, participants may participate in free screenings to identify potential health concerns such as high blood pressure, high cholesterol, high glucose, and skin cancer. "community benefit initiatives" - as part of its mission to improve the health of the community it serves, sach conducts an ongoing assessment process to identify community health needs. The hospital's community outreach department supports a variety of services designed to meet these needs, including support groups, educational seminars, and community health fairs, as well as several targeted health initiatives. A few of these programs are highlighted here. "healthy beginnings" - sach's maternal/child services, collectively known as healthy beginnings, is committed to providing excellent service and care, which result in the best possible outcome for the newest members of its community and their families. In support of this goal, the hospital engaged in an extensive process to become a "baby friendly hospital," which is an international designation recognizing the institution's comprehensive program supporting breastfeeding and infant/parent bonding. As part of this program, parents are encouraged to take advantage of the many educational opportunities and support services offered before, during, and after delivery. Expectant parents attending the breastfeeding class receive encouragement and instruction to promote a successful breastfeeding experience. Internationally board certified lactation consultants, supported by lactation educators, are available to provide support during the family's hospital stay, and every family is encouraged to visit the healthy beginnings newborn feeding center after they leave the hospital. In addition to providing breastfeeding evaluation and support, the newborn feeding center assesses mother and newborn, providing referrals to community resources when needed. This thorough evaluation process has yielded significant outcomes including a reduction in newborn readmission rates, increased breastfeeding rates, early intervention for development delays and identification and treatment of postnatal illness, from baby blues to postpartum psychosis. While some families just need reassurance that their baby is thriving, others may require further education or support, and a few require intervention or treatment. The center offers support to all new families in the community, regardless of where their babies are born. In fact, many local pediatricians include a visit to the center as part of the discharge instructions for their patients. "dental center" - the san antonio community hospital dental center has been operating for over 75 years with the mission to provide dental care to low-income, uninsured children in western san bernardino county. Once located on the hospital's campus, the dental center is now housed in a dedicated building in rancho cucamonga owned and operated by the assistance league of the foothill communities. Sach continues to provide financial assistance and other services to support the program. The dental center operates during the school year, with clinics held from october through may. The dental center's goal is to educate children about the importance of dental hygiene and to provide prophylactic and therapeutic dental and orthodontic services. Some of the children treated have been unable to eat properly or to function in school due to the pain being experienced. The dental center is a prime example of the benefits that can be provided to families in need through c”

“"women caring for women" there are many women in the west end who fail to access the services they need, most often due to circumstances beyond their control. The women caring for women (wcw) program provides a lifeline to women in need. The greatest impediment to obtaining appropriate breast cancer treatment is the lack of adequate health insurance, and in today's tenuous economic environment, the number of uninsured and under insured who lack the ability to pay their share of the cost for breast cancer screening and diagnostic services is growing at an alarming rate. Funded through a partnership with susan g. Komen inland empire, this program is responding to a significant community need in the hospital's service area. Women, particularly young women under 40 who cannot qualify for county funded programs until after a diagnosis is made, can now turn to women caring for women to receive critical diagnostic services that will either rule out cancer or provide the diagnosis needed to access safety net programs through the county. Breast cancer does not discriminate against age, race, or gender. This was the case with a 45 year-old mother diagnosed with stage 3 breast cancer. This mother, like many other women without health coverage, found her resources to be very limited. Discouraged and in denial about what she felt, she went undiagnosed for one year until she found supportive services in her area. The story was all too familiar when four years later her 21 year-old daughter discovered a lump in her breast. After discussing the finding with her mother, her mother immediately called the nurse navigator at the women's breast and imaging center. She recalled the time spent at the center for support groups and it was also where she learned about the wcw program. Fortunately, the diagnosis was a cyst. In addition to services provided through the women's center, the hospital has located its cancer education center across the hall and offers a wide variety of cancer survivorship, support groups, and resources for cancer patients and their families. Classes and support groups include nutritional care, exercise, pilates, caregiver support, and patient support. An on site salon provides free wigs and hosts the american cancer society's look good feel better program.the san antonio hospital foundation has collaborated with a number of local community partners to provide free mammogram screening for vulnerable, at risk women who are uninsured, under insured, and lack the financial resources to access this critically important preventive health service. San antonio community hospital is committed to meeting the needs of women facing breast cancer so they can receive the care and treatment they need in an environment that supports their unique needs through diagnosis, treatment, and recovery. "generations ahead" older adults who remain physically active and pursue healthy lifestyles are finding that vitality, rather than disability, is defining their concept of future health status. The growing needs of seniors spurred the development of a membership program created to augment traditional geriatric services. Generations ahead has been designed to meet the special health and educational needs of seniors through targeted services and programs. The hospital has partnered with physicians to provide presentations that address senior health issues, which include osteoporosis, diabetes, stroke prevention, and more. In addition to physician partnerships, other organizations in the community such as senior centers and local non profits have shown their support by encouraging their senior population to be participants in generations ahead. The program has over 500 members and continues to grow. Services provided through generations ahead include free screenings, discounts in the cafe and gift shop at the hospital, and more. Generations ahead is directed by a three member team that plans and coordinates the monthly lectures. Dolores simmons, presiden”

“Other expenses include recruitment of $193,406, collection expense of $427,488 and inventory write offs of -$770,674.”

“"other changes in net assets" - change in additional minimum pension liability 23,083,038, plus increase in sahf - temporarily restricted net assets for sahf of 2,550,067, increase of interest of subsidiary sahf - earnings of $10,000 and $(50) prior period adjustment for medical staff expense.”