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Hoag Memorial Hospital Presbyterian, the second-largest hospital in Orange County, is in the midst of a major $1.2 billion expansion in Irvine.
Six new buildings are taking shape at what Hoag’s calling the Sun Family Campus, supported by the hospital’s $300 million Boldly Hoag campaign which has raised close to $235 million to date.
Hoag is also embarking on another expansion in South Orange County with a $20 million clinic slated to open this summer in San Clemente.
At the helm creating the financial strategy for these expansions is Andrew Guarni, who has been chief financial officer at Hoag for the last 10 years.
“It’s about making sure that we have the resources available as the organization continues to struggle with increased competition, especially for talent,” Guarni told the Business Journal.
When Guarni first joined Hoag, it had no urgent care network and was just beginning to grow. Today, it operates 17 urgent care centers, serving over 250,000 people, and sees 140,000 emergency room visits annually.
Guarni was recognized May 8 for his leadership during a transformative time for Hoag at the Business Journal’s CFO of the Year Awards in the not-for-profit category.
Hoag, St. Joseph Affiliation
Guarni was only supposed to work at Hoag for three months when he arrived in 2012.
At the time, Hoag was entering an affiliation agreement with St. Joseph Health, now Providence St. Joseph. The decade-long relationship ended in 2022 with the two parties agreeing to separate.
Guarni had a mutual friend who knew Hoag’s previous CFO, Jennifer Mitzner, who was looking for help with closing the books.
“She needed someone who could just come in boots on the ground and get the job done,” Guarni said.
The affiliation wasn’t finalized by the end of his three months, but Guarni was asked to stay on longer.
He officially joined Hoag in 2013 as vice president of finance, and within the next year, was promoted to CFO.
Guarni said that his proudest accomplishment as CFO was in 2022 when Hoag issued more than $900 million worth of bonds to help fund its $1.2 billion expansion in Irvine.
Guarni said there was so much interest from investors that the oversubscribed sale closed “in a little over 15 minutes.”
40-Year Healthcare Finance Career
As a child, Guarni was always good at math. In his senior year of high school, he found a job at a hospital in the accounts payable department and was asked to come back every winter and summer break during college, which helped fund his education.
“It intrigued me what we were doing, and it was something that I thought I might want to devote my career to, and it’s turned out to be really great,” Guarni said.
Guarni received his accounting degree from West Chester University in Pennsylvania in 1984.
Straight out of school, he started as a senior accountant at Virtua Health. Guarni stayed at the non-profit healthcare system for 16 years and and worked his way up to vice president of finance.
Guarni’s 40-year career in healthcare finance spans similar roles at other hospital networks including Inspira Health and Catholic Health East, where he was CFO of four hospitals in New Jersey, before he made the decision to move from the East Coast to the West Coast.
“I was a little bit tired of winter,” Guarni said. “The last two winters I was there, we had 150 inches of snow.”
That’s when he started consulting for mostly physician practices out of Tucson.
Philly Born and Raised
Guarni was born and raised in a blue-collar household with his brother, parents and maternal grandparents in Philadelphia.
He said that his grandfather, who was a tailor who worked into his 80s, was the greatest influence in his life. They often spent nights together sitting around, listening to the Philadelphia Phillies on the radio and playing Solitaire, he recalled.
One of the biggest lessons his grandfather imparted on him:
“He told me that gentlemen should always have a handkerchief in their pocket in case they ever come across a young lady who may be crying,” Guarni said. “Part of the deal is that you never take the handkerchief back.”
Guarni estimates that he has given over 100 handkerchiefs away in his life and will not go anywhere without one in his left suit pocket.
Having lived in Orange County for more than 10 years now, he joked that “you can take the boy out of Philly, but you can’t take the Philly out of the boy.”
Guarni is a die-hard Philadelphia Eagles fan, and in his free time, enjoys cooking to the point that he has auctioned off a cooked dinner for eight at Hoag’s annual Christmas Carol Ball for the last couple of years.
Someone bid $25,000 for Guarni to come cook at their home at last year’s event, which raised nearly $1 million in support of advanced patient care at Hoag.
“It’s been a passion for me, and now I get to use it to help raise for funds for Hoag,” Guarni said.