REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 18, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
DON DAY, Director, Project and Facilities Management Department
SUBJECT
Title
Capital Improvement Program Project for the Arrowhead Regional Medical Center Emergency Department and Intensive Care Unit Expansion and Reimbursement Resolution
End
RECOMMENDATION(S)
Recommendation
1. Approve Capital Improvement Program Project No. 26-035, in the amount of $1,000,000, for the Arrowhead Regional Medical Center’s Emergency Department and Intensive Care Unit Expansion.
2. Adopt Resolution declaring the County’s intention to reimburse preliminary project expenditures from future bond proceeds for the financing of the expansion of the Arrowhead Regional Medical Center’s Emergency Department and Intensive Care Unit.
3. Authorize the Auditor-Controller/Treasurer/Tax Collector to post necessary budget adjustments to the 2025-26 budget to account for the expenditure mentioned in Recommendation No. 1 for the Arrowhead Regional Medical Center’s Emergency Department and Intensive Care Unit Expansion (Four votes required).
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The cost of $1,000,000 is funded by additional revenues associated with the California Quality Incentive Program. The budget adjustment will provide initial funding for feasibility, environmental, and planning work needed to prepare cost estimates and financing options for the Arrowhead Regional Medical Center’s Emergency Department and Intensive Care Unit Expansion Project (Project). Approval of this item will allow the Auditor-Controller/Treasurer/Tax Collector to post the following adjustments to the 2025-26 budget:
|
Fund Center |
Commitment Item |
Description |
Action |
Amount |
WBSE |
|
9110004200 |
40449625 |
ARMC - Managed Care Intergovernmental Transfer |
Increase |
$1,000,000 |
- |
|
9186104200 |
55305030 |
Operating Transfers Out |
Increase |
$1,000,000 |
- |
|
7700004204 |
54304030 |
Structures and Improvements to Structures |
Increase |
$1,000,000 |
10.10.1965 |
|
7700004204 |
40909975 |
Operating Transfers In |
Increase |
$1,000,000 |
10.10.1965 |
BACKGROUND INFORMATION
Arrowhead Regional Medical Center (ARMC) has one of the busiest emergency departments and trauma centers in the state, with an average of 80,000 to 90,000 visits per year. Over the years, ARMC has outgrown the physical footprint of the Emergency Department. This has resulted in long wait times and overcrowding. ARMC currently has 43 treatment spaces, which is below the national benchmarks of one treatment space to 1,100 annual emergency department visits. Based on the national benchmarks, ARMC should have approximately 80 treatment spaces.
ARMC’s Project will establish a budget to allow the Project and Facilities Management Department (PFMD) to consult with ARMC and begin the work around feasibility, environmental studies and other tasks, laying the essential groundwork for the expansion Project to begin in or around Fiscal Year 2028-29. Additionally, PFMD will use this Project’s budget to determine the cost for constructing the expansion, which will allow for budget planning in the future and estimating debt obligations.
On February 21, 2024, the Debt Advisory Committee (DAC) reviewed ARMC plans to issue debt to finance the Project and approved the issuance of a request for proposal to hire a financial advisor to assist the County with debt financing options. Through a competitive process, DAC approved the contract with Public Resources Advisory Group to assist the County with the debt financing process on March 10, 2025. This preliminary work will assist PFMD to determine the cost of the Project and enable the County to evaluate the debt financing options to be presented at a later date to the DAC and the Board of Supervisors (Board).
Recommendation No. 2 will adopt a Reimbursement Resolution. The Reimbursement Resolution is required by Federal tax regulations to enable the County to be reimbursed for preliminary Project expenditures from future bond proceeds issued to finance the Project. The current Federal regulations are found in Treasury Regulation 1.150-2 (Regulations). To ensure the reimbursement of preliminary Project expenditures, the Regulations require the Board to adopt an official intent in the form of the Reimbursement Resolution, which states the following:
• The County intends to issue bonds to finance the Project;
• The debt obligations shall not exceed $350 million;
• A general description of the proposed original expenditures for the Project;
• Identification of the expected sources of funds from which the original expenditures are paid; and
• The County intends to use proceeds of the indebtedness to reimburse Project expenditures paid before obligations are issued.
ARMC recommends approval of the budget adjustments because it will allow ARMC to operate in a fiscally responsible and business-like manner and continue to provide for the health and safety of county residents as it will help ARMC to effectively care for the growing patient population.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455 and Daniella Hernandez, Deputy County Counsel, 387-5455) on October 30, 2025; Auditor-Controller/Treasurer/Tax Collector (Charlene Huang, General Accounting Manager, 382-7022) on October 30, 2025; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on October 31, 2025; and County Finance and Administration (Amanda Trussell, 387-4773, and Yael Verduzco, 387-5285, Principal Administrative Analysts, and Jenny Yang, Administrative Analyst, 387-4884) on October 30, 2025.