SURPRISE VALLEY HEALTH CARE DISTRICT: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SURPRISE VALLEY HEALTH CARE DISTRICT (EIN 68-0008034)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-12
- IRS object ID
- 202341329349301839
- Schema version
- 2021v4.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-12T08:45:23-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680008034 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SURPRISE VALLEY HEALTH CARE DISTRICT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SURP | BusinessNameControlTxt |
| Phone | 5302796111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 246 | AddressLine1Txt |
| City | CEDARVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96104 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FRANCES D HANNAH | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5302796111 | PhoneNum |
| Signature | 2023-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | FRANCES | PersonFirstNm |
| Person Last | HANNAH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2023-05-12 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | FRANCES D HANNAH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 246 | AddressLine1Txt |
| City | CEDARVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96104 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,679,135 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SVHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Assoc | Yes (X) | TypeOfOrganizationAssocInd |
| Formation | 1987 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | SVHCD IS AN ACUTE CARE FACILITY WITH AN ATTACHED LONG-TERM CARE UNIT AND RURAL HEALTH CLINIC SERVING A REMOTE, UNDERSERVED COMMUNITY OF APPROXIMATELY 1,500 PEOPLE STRIVING TO PROVIDE 24/7 ER, AMBULANCE, AND GENERAL HEALTH CARE TO ALL CITIZENS OF THE AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 105 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,479,574 | PYContributionsGrantsAmt |
| CY Contributions Grants | $39,829 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,266,658 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,989,152 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,785 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,523 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,385,756 | PYOtherRevenueAmt |
| CY Other Revenue | $647,631 | CYOtherRevenueAmt |
| PY Total Revenue | $9,137,773 | PYTotalRevenueAmt |
| CY Total Revenue | $10,679,135 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,138,439 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,877,732 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,371,947 | PYOtherExpensesAmt |
| CY Other Expenses | $3,942,196 | CYOtherExpensesAmt |
| PY Total Expenses | $8,510,386 | PYTotalExpensesAmt |
| CY Total Expenses | $8,819,928 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $627,387 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,859,207 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,751,575 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,837,717 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,922,077 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,739,730 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$170,502 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,097,987 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SURPRISE VALLEY HEALTH CARE DISTRICT (SVHCD) IS AN ACUTE CARE FACILITY WITH AN ATTACHED LONG-TERM CARE UNIT AND RURAL HEALTH CLINIC SERVING A REMOTE, UNDERSERVED COMMUNITY OF APPROXIMATELY 1,500 PEOPLE STRIVING TO PROVIDE 24/7 EMERGENCY ROOM, AMBULANCE, AND GENERAL HEALTH CARE TO ALL CITIZENS OF THE AREA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,004,841 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $10,154,496 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDED INPATIENT, OUTPATIENT, EMERGENCY HEALTH CARE SERVICES, INCLUDING 7,841 SKILLED NURSING PATIENT DAYS, 166 SWING-BED NURSING FACILITY DAYS, 517 EXTENDED CARE PATIENT DAYS, 20,097 LABORATORY TESTS, 112 AMBULANCE RUNS, 530 EMERGENCY ROOM VISITS, 631 X-RAYS, 723 PHYSICAL THERAPY VISITS, AND 2,074 OUTPATIENT CLINIC VISITS. | Desc |
| Total Program Service Expenses | $7,004,841 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 105 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CORY RICKARD | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5302796111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 246 | AddressLine1Txt |
| City | CEDARVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96101 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN ERQUIAGA | ||||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| RAY GORZEL | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SUSIE BUNYARD | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JEANIE GOLDMAN | ||||||||
| MEMBER AT LARGE | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| RHONDA BANDY | ||||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM BOSTIC | ||||||||
| CEO (THRU APRIL 2022) | 30.00 | Yes (X) | $75,380 | $0 | $1,493 | |||
| FRANCES HANNAH | ||||||||
| CEO | 40.00 | Yes (X) | $94,716 | $0 | $0 | |||
| CHASE TAYLOR | ||||||||
| DON | 40.00 | $189,741 | $0 | $4,690 | Yes (X) | |||
| MELISSA CARTER | ||||||||
| RN | 40.00 | $128,970 | $0 | $0 | Yes (X) | |||
| ROBERT S KOLLEN MD | ||||||||
| DOCTOR | 40.00 | $208,800 | $0 | $0 | Yes (X) | |||
| LOUIED LAGUNAY | ||||||||
| LABORATORY MANAGER | 40.00 | $139,566 | $0 | $246 | Yes (X) | |||
| SHERI COCKRELL | ||||||||
| LVN | 40.00 | $110,264 | $0 | $8,029 | Yes (X) | |||
| LISA RHOM | ||||||||
| FNP | 40.00 | $110,424 | $0 | $2,966 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,057,861 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $17,424 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FUSION MEDICAL STAFFING | |||||
| PO BOX 30131 | OMAHA | NE | 681031231 | NURSING REGISTRY & OTHER PERSONEL | $201,819 |
| INFINITE CONSULTING SERVICES | |||||
| 30703 OMA ROAD | VALLEY CENTER | CA | 92082 | IT SERVICES | $178,250 |
| NPH | |||||
| 1801 FOUNDATION LANE | CHICO | CA | 95928 | NURSING REGISTRY & OTHER PERSONEL | $149,469 |
| CPSIHEATHLAND | |||||
| PO BOX 850309 | MOBILE | AL | 366850309 | EHR SUPPORT | $123,650 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $29,229 | GovernmentGrantsAmt |
| All Other Contributions | $10,600 | AllOtherContributionsAmt |
| Total Contributions | $39,829 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621990 | $9,916,949 | $9,916,949 |
| CAPITATION REVENUE | 621990 | $72,203 | $72,203 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,989,152 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,523 | TotalRevenueColumnAmt |
| Exclusion | $2,523 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROPERTY TAX REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $165,344 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $165,344 | RelatedOrExemptFuncIncomeAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $482,287 | TotalRevenueColumnAmt |
| Exclusion | $482,287 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $647,631 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,679,135 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,154,496 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $484,810 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $366,019 | TotalAmt |
| Program Services | $194,431 | ProgramServicesAmt |
| Management And General | $171,588 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,911,762 | TotalAmt |
| Program Services | $3,275,995 | ProgramServicesAmt |
| Management And General | $635,767 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $510,714 | TotalAmt |
| Program Services | $370,794 | ProgramServicesAmt |
| Management And General | $139,920 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,237 | TotalAmt |
| Program Services | $73,457 | ProgramServicesAmt |
| Management And General | $15,780 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,170 | TotalAmt |
| Management And General | $91,170 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,500 | TotalAmt |
| Management And General | $3,500 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,772,700 | TotalAmt |
| Program Services | $1,381,592 | ProgramServicesAmt |
| Management And General | $391,108 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500 | TotalAmt |
| Management And General | $500 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,005 | TotalAmt |
| Program Services | $10,106 | ProgramServicesAmt |
| Management And General | $49,899 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,257 | TotalAmt |
| Management And General | $3,257 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,388 | TotalAmt |
| Program Services | $31,963 | ProgramServicesAmt |
| Management And General | $60,425 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,385 | TotalAmt |
| Program Services | $19,830 | ProgramServicesAmt |
| Management And General | $25,555 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,021 | TotalAmt |
| Program Services | $3,130 | ProgramServicesAmt |
| Management And General | $4,891 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $238,211 | TotalAmt |
| Program Services | $238,211 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,386 | TotalAmt |
| Program Services | $248,386 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,329 | TotalAmt |
| Program Services | $242,329 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES EXPENSE | $596,456 | $564,050 | $32,406 |
| BAD DEBT EXPENSE | $94,897 | $94,897 | |
| FOOD EXPENSE | $86,616 | $84,261 | $2,355 |
| REPAIRS & MAINTENANCE | $81,467 | $69,613 | $11,854 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276,908 | TotalAmt |
| Program Services | $101,796 | ProgramServicesAmt |
| Management And General | $175,112 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,819,928 | TotalAmt |
| Program Services | $7,004,841 | ProgramServicesAmt |
| Management And General | $1,815,087 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,722,598 | BOYAmt |
| EOY | $5,670,200 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $203,532 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $415,300 | BOYAmt |
| EOY | $857,695 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,305 | BOYAmt |
| EOY | $99,736 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,864 | BOYAmt |
| EOY | $34,437 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,972,779 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,814,329 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $205,829 | BOYAmt |
| EOY | $1,158,450 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,147 | BOYAmt |
| EOY | $17,199 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,751,575 | BOYAmt |
| EOY | $7,837,717 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,547,091 | BOYAmt |
| EOY | $2,683,884 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $651,136 | BOYAmt |
| EOY | $864,796 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,723,850 | BOYAmt |
| EOY | $2,191,050 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,922,077 | BOYAmt |
| EOY | $5,739,730 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$170,502 | BOYAmt |
| EOY | $2,097,987 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$170,502 | BOYAmt |
| EOY | $2,097,987 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,751,575 | BOYAmt |
| EOY | $7,837,717 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,859,207 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $409,282 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,051 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,051 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF DUES PAID TO HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA, CALIFORNIA ASSOCIATION OF HEALTH FACILITIES, CALIFORNIA SPECIAL DISTRICTS ASSOCIATION, AND DISTRICT HOSPITAL LEADERSHIP FOUNDATION WENT TOWARD LOBBYING ACTIVITIES DURING THE FISCAL YEAR ENDING 06/30/2022. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,000 | OtherCostOrOtherBasisAmt |
| Book Value | $57,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,555,540 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,483,263 | DepreciationAmt |
| Book Value | $72,277 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,261,268 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,331,066 | DepreciationAmt |
| Book Value | $930,202 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $98,971 | OtherCostOrOtherBasisAmt |
| Book Value | $98,971 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,158,450 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS-NET | $1,288,802 |
| PATIENT FUND TRUST ACCOUNT | $1,000 |
| DEFERRED COVID STIMULUS REVENUE | $901,248 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,191,050 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,476 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,476 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,643,554 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $982,151 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $661,403 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07580 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,664,030 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $982,151 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $681,879 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07810 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,664,030 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $982,151 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $681,879 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07810 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Reimbursed By Medicare | $2,480,768 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,466,909 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $13,859 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SURPRISE VALLEY HEALTH CARE DISTRICT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 246 | AddressLine1Txt |
| City | CEDARVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96104 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://SVHOSPITAL.ORG/ | WebsiteAddressTxt |
| State License | 230000025 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SURPRISE VALLEY HEALTH CARE DISTRICT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C, LINE 7D | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C, LINE 7D | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://SITES.GOOGLE.COM/VIEW/SVHEALTHCAREDISTRICT/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://SITES.GOOGLE.COM/VIEW/SVHEALTHCAREDISTRICT/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://SITES.GOOGLE.COM/VIEW/SVHEALTHCAREDISTRICT/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SURPRISE VALLEY HEALTH CARE DISTRICT | PART V, SECTION B, LINE 5: ON MARCH 10, 2021, A MEETING WAS HELD WITH MEMBERS OF THE COMMUNITY. PEOPLE REPRESENTING THE HEALTHCARE COMMUNITY AS WELL AS ALL DEMOGRAPHICS WERE INVITED TO ATTEND. THE FOCUS GROUP INCLUDED LARGE EMPLOYERS AS WELL AS MEMBERS OF SPECIAL INTEREST GROUPS FROM THE COMMUNITY. THIS ENABLED ALL DEMOGRAPHICS TO BE REPRESENTED. DISCUSSIONS TOOK PLACE TO REVIEW A TEMPLATE OF THE SURVEY TO BE DISTRIBUTED, AND SUGGESTIONS WERE MADE TO ENSURE THE SURVEY WOULD BE ACCEPTABLE TO ALL POTENTIAL RESPONDENTS. THE FOCUS GROUP RECOGNIZED THAT HEALTH CARE NEEDS MAY DIFFER BETWEEN GENDERS, ETHNICITY, SEXUAL PREFERENCE, AND AGE. SPECIAL CARE WAS TAKEN TO ENSURE ALL PEOPLE WOULD BE REPRESENTED IN THE RESULTS OF THE SURVEY. THOSE WHO WERE INVITED WERE PASSIONATE ABOUT HELPING THE HOSPITAL AND EXCITED TO CONTRIBUTE TO THE SURVEY. THE SURVEY WAS WRITTEN TO GO BEYOND THE CURRENT NATIONAL DATA THAT IS READILY AVAILABLE. SVHCD WANTED TO BE ABLE TO SPECIFICALLY LOOK AT THE RESULTS NEEDED TO MEET THE SERVICE NEEDS OF THE COMMUNITY. AFTER REVIEWING AND REVISING THE CHNA SURVEY, SVHCD SENT A LINK FOR THE SURVEY TO COMMUNITY MEMBERS WHO REPRESENTED THE POPULATION AT LARGE AND SPECIFIC DEMOGRAPHICS WITHIN THE COMMUNITY. THE REPRESENTATIVES THEN FORWARDED THAT LINK TO THEIR RESPECTIVE SOCIAL AND WORK CONNECTIONS IN ORDER TO ENSURE THAT POPULATION WAS APPROPRIATELY REPRESENTED IN THE RESPONSES TO THE SURVEY. ADDITIONAL LINKS TO THE SURVEY WERE ALSO PLACED ON THE HOSPITAL'S WEBSITE, FACEBOOK PAGE AND COMMUNITY GROUPS TO MAKE SURE THE COMMUNITY WOULD KNOW HOW TO ACCESS THE SURVEY. FINALLY, PAPER COPIES WERE PLACED IN THE POST OFFICE SINCE THAT IS THE PLACE WHERE MOST OF THE COMMUNITY GOES TO GET THE IMPORTANT UPDATES FOR THE COMMUNITY. WE ALSO ISSUED A MAILER TO ALL ADDRESSES IN THE COMMUNITY TO INCLUDE A SURVEY. AFTER GIVING THE COMMUNITY SEVERAL WEEKS TO RESPOND TO THE SURVEY, OUR SAMPLE SIZE INCLUDED ENOUGH PEOPLE TO ENSURE THAT THE POPULATION WAS REPRESENTED. THE RESPONSES WERE GATHERED AND ANALYZED TO BE PRESENTED TO THE SENIOR LEADERSHIP AND THEN TAKEN TO THE COMMUNITY TO ENSURE THE NEEDS OF THE POPULATION WERE MET. |
| SURPRISE VALLEY HEALTH CARE DISTRICT | PART V, SECTION B, LINE 7D: PART V, SECTION C, LINE 7A & 10A:HTTPS://SITES.GOOGLE.COM/VIEW/SVHEALTHCAREDISTRICT/2021-22-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-AND-STRATEGIC-PLAN |
| SURPRISE VALLEY HEALTH CARE DISTRICT | PART V, SECTION B, LINE 11: SURPRISE VALLEY HEALTH CARE DISTRICT HAS BEEN WORKING WITH CYCLE OF BUSINESS SINCE THEIR FIRST CHNA IN 2013. THROUGHOUT THIS TIME, THEY HAVE UTILIZED AN ONLINE TOOL FOR THE CREATION AND EXECUTION OF THEIR IMPLEMENTATION PLAN. THIS HAS ALLOWED THEM TO TRACK PROGRESS ON THE GOALS AND ACCOMPLISH THEY HAVE SET OUT TO COMPLETE. ONCE THE COMMUNITY HAD GIVEN ITS FEEDBACK ON THEIR NEEDS, SVHCD STAFF REVIEWED THE DATA AND INPUT FROM THE GROUP AND DECIDED ON 4 AREAS OF FOCUS FOR THE CURRENT CHNA AND IMPLEMENTATION PLAN. THEY INCLUDE RECRUITMENT FOR SPECIFIC HOSPITAL NEEDS, EXPANDING THE TELE-HEALTH PROGRAM, MARKETING, AND OUTREACH FOR SPECIFIC SERVICES, AND EXPLORING HOME HEALTH AND HOSPICE THROUGH THE HOSPITAL SYSTEM.RECRUITMENT THE FIRST GOAL OUTLINED BY THE STAFF AND THE COMMUNITY WAS TO "RECRUIT FOR SPECIFIC STAFFING NEEDS OF THE HOSPITAL". RURAL HOSPITALS TEND TO HAVE PROBLEMS RECRUITING STAFF ESPECIALLY NURSES. SVHCD IS NO DIFFERENT AND IS CURRENTLY IN NEED OF NURSES AND CNAS. THIS IS WHY THE FIRST AREA OF FOCUS FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS TO FIND CNAS AND NURSES TO FILL AREAS OF UNDERSTAFFING AT THE HOSPITAL.EXPAND TELE-HEALTH THE SECOND AREA SVHCD LOOKED TO ADDRESS WAS TO EXPAND THE TELE-HEALTH PROGRAM. TELE-HEALTH IS A WAY THAT RURAL HOSPITALS CAN PROVIDE SPECIALTIES THEY COULD NOT OTHERWISE AFFORD TO BRING IN. IT ALLOWS THEM TO ADDRESS A SPECIFIC NEED WHEN THE OVERALL POPULATION COULD NOT SUPPORT A SPECIALIST. DURING THE COVID-19 PANDEMIC OF 2020-2021, THE GENERAL POPULATION BEGAN TO SEE THE BENEFIT OF TELE-HEALTH. PRIOR TO THE PANDEMIC MANY PEOPLE WERE RETICENT TO TRY TELE-HEALTH, HOWEVER, DURING THE PANDEMIC WHEN HOSPITALS WERE RESTRICTING ACCESS, MANY PEOPLE BEGAN TO MEET WITH THEIR PHYSICIAN OVER SMARTPHONES AND TABLETS OPENING THE DOOR TO WIDESPREAD ACCEPTANCE OF TELE-HEALTH OPTIONS. TELE-PSYCH IS A COMMON TELE-HEALTH SERVICE AND A NEEDED SERVICE IN THE AREA. ESPECIALLY DUE TO THE ISOLATION PEOPLE FELT DURING THE PANDEMIC. SVHCD HAS DECIDED TO EXPAND THEIR TELE-HEALTH OFFERINGS TO INCLUDE TELE-PSYCH FOR YOUTH AND ADULTS TO HELP THEM ADDRESS AREAS SUCH AS DEPRESSION AND ANXIETY, FAMILY COUNSELING, AND SUBSTANCE ABUSE ISSUES. IN ORDER TO BETTER FACILITATE THE TELE-HEALTH PROGRAM, IT WAS DECIDED A TELE-HEALTH CARE COORDINATOR SHOULD BE ASSIGNED TO HELP FACILITATE THE APPOINTMENTS AND HELP THE LESS TECH SAVVY.MARKETING AND OUTREACHTHE SURVEY MADE CLEAR SOME OF THE SERVICES SVHCD OFFERS, THE COMMUNITY DID NOT KNOW WERE PROVIDED BY THE HOSPITAL. PEOPLE WERE TRAVELING OUTSIDE OF THE AREA FOR SERVICES THEY COULD HAVE EASILY RECEIVED LOCALLY. THESE SERVICES INCLUDED LABORATORY WORK, SOME SPECIALTIES SERVICES AND IMAGING. WITH THE PURCHASE OF THE CT SCANNER, SVHCD WILL WANT TO PROMOTE THESE SERVICES TO RESIDENTS TO SAVE THEM TIME AND MONEY. ESPECIALLY DURING THE WINTER MONTHS WHEN TRAVEL TO OTHER HOSPITALS CAN BE DANGEROUS. THIS MARKETING CAMPAIGN WILL ALSO BE USED TO EDUCATE THE PUBLIC ON COMMON AILMENTS AS WELL AS CLEAR UP ANY MISINFORMATION IN THE COMMUNITY ABOUT THE HOSPITAL AND THE QUALITY OF SERVICES RECEIVED AT SVHCD.HOME HEALTH AND HOSPICE THE POPULATION OF CEDARVILLE IS GROWING DUE TO MORE PEOPLE BEING ABLE TO WORK REMOTELY. HOWEVER, THE AVERAGE AGE OF CEDARVILLE AND THE SURROUNDING AREAS IS RISING. AS THE POPULATION AGES THE NEED FOR SERVICES TO TREAT THE ELDERLY BECOME MORE IMPORTANT. ONE OF THE FINDINGS WITHIN THE SURVEY WAS THE DESIRE FOR THE COMMUNITY TO EXPAND THE ASSISTED LIVING OPTIONS IN THE COMMUNITY AND PROVIDE A HOME HEALTH AND HOSPICE SOLUTION. SVHCD ALREADY HAS DEDICATED MOST OF ITS BEDS TO ASSISTED LIVING, HOWEVER, THERE ARE COMMUNITY MEMBERS WHO WOULD LIKE TO SEE THIS EXPAND AND FOR MORE OPTIONS TO EXIST. HOME HEALTH AND HOSPICE IS ALREADY PROVIDED THROUGH IHSS, BUT IT MAY NEED TO BE PROMOTED TO THOSE IN NEED. THIS COULD BE DONE IN PARTNERSHIP WITH THE HOSPITAL. BY FOCUSING ON THESE 4 AREAS SURPRISE VALLEY HEALTH CARE DISTRICT LOOKS TO MEET THE NEEDS OF THE COMMUNITY. THEY WILL BE TAKING A FISCALLY RESPONSIBLE APPROACH TO ENSURE THE HOSPITAL NEVER AGAIN FACES POTENTIAL CLOSURE. SVHCD IS TOO IMPORTANT TO THE COMMUNITY IT SERVES. BY TAKING CARE OF THE COMMUNITY SVHCD HOPES TO REMAIN A VIABLE HEALTH CARE FACILITY FOR DECADES TO COME. |
| SURPRISE VALLEY HEALTH CARE DISTRICT | PART V, SECTION B, LINE 15E: APPLICATION, PROOF OF INCOME, BANK STATEMENTS |
| SURPRISE VALLEY HEALTH CARE DISTRICT | PART V, SECTION B, LINE 24: THE HOSPITAL CHARGES ALL OF ITS PATIENTS THE SAME RATES. HOWEVER, DISCOUNTS FOR CHARITY CARE ARE ALLOCATED TO CHARGES AFTER THE PATIENT HAS APPLIED FOR CHARITY ASSISTANCE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - SURPRISE VALLEY RURAL HEALTH CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 741 N MAIN STREET | AddressLine1Txt |
| City | CEDARVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96104 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 94,897. |
| PART III, LINE 4: | WHILE THE FACILITY DOES NOT HAVE A NOTE REGARDING BAD DEBT EXPENSE IN ITS FINANCIAL STATEMENTS, THE AMOUNT OF BAD DEBT EXPENSE FOR EACH YEAR IS DISCLOSED ON THE FACILITY'S STATEMENTS OF REVENUE AND EXPENSES. THE AMOUNT OF BAD DEBT EXPENSE REPORTED WAS ($94,897) FOR THE YEAR ENDED JUNE 30, 2022. |
| PART III, LINE 8: | ANY SHORTFALL IS CONSIDERED FULLY ATTRIBUTABLE TO COMMUNITY BENEFITS. THE HOSPITAL'S MEDICARE COST REPORT WAS USED TO DETERMINE THE TOTAL REVENUE RECEIVED FROM MEDICARE, THE MEDICARE ALLOWABLE COSTS OF CARE RELATING TO THE PAYMENTS, AND THE SURPLUS.THE COSTING METHODOLOGY USED ON THE MEDICARE COST REPORT IS BASED ON CALCULATED COST TO CHARGE RATIOS. |
| PART III, LINE 9B: | EVERY REASONABLE EFFORT IS MADE TO DETERMINE THE PATIENT'S ABILITY TO PAY AND TO GIVE PATIENTS INFORMATION ABOUT OUR CHARITY CARE POLICIES. |
| PART VI, LINE 2: | THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH PUBLIC MEETINGS, BOARD MEETINGS, PERFORMANCE IMPROVEMENT AND QUALITY ASSURANCE MEETINGS, AND ACUTE CARE PATIENT QUESTIONNAIRES. |
| PART VI, LINE 3: | THE HOSPITAL PROVIDES PATIENT'S RIGHTS INFORMATION AND COLLECTS ADMISSIONS CRITERIA INFORMATION FROM PATIENTS TO ASSIST THE PATIENT IN UNDERSTANDING THEIR ELIGIBILITY OF ASSISTANCE. |
| PART VI, LINE 4: | THE FACILITY SERVES A RURAL, REMOTE AREA CONSISTING OF UNDERSERVED, FARMING, RANCHING, BUREAU OF LAND MANAGEMENT, FOREST SERVICE, SMALL SCHOOLS, SMALL BUSINESSES, TOURIST TRADE, LOW INCOME, RETIRED AND SEMI-RETIRED RESIDENTS. |
| PART VI, LINE 5: | THE HOSPITAL DOES NOT HAVE SURPLUS FUNDS. WHEN ECONOMICALLY ABLE, THE HOSPITAL WILL HOLD HEALTH FAIRS WHERE FREE OR REDUCED PRICES ARE OFFERED. |
| PART VI, LINE 6: | THE HOSPITAL IS NOT AFFILIATED WITH ANY OTHER HEALTH CARE SYSTEM. INDEPENDENT HEALTH CARE DISTRICT. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | CA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT S KOLLEN MD | ||||||||||||||
| DOCTOR | $208,800 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $208,800 | $0 | $0 | $0 |
| CHASE TAYLOR | ||||||||||||||
| DON | $189,741 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $4,690 | $0 | $194,431 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE 990 IS PROVIDED TO MANAGEMENT FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY APPLIES TO THE BOARD OF DIRECTORS; IF THERE IS A CONFLICT, THAT BOARD MEMBER ASTAINS FROM VOTING ON AN ACTION ITEM. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE GOVERNING BOARD DETERMINES THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL USING VARIOUS COMPENSATION DATA FOR THE HEALTH CARE INDUSTRY. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE PUT ON OUR WEBSITE. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 317,638. MANAGEMENT AND GENERAL EXPENSES 391,108. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 708,746. NURSING SERVICES: PROGRAM SERVICE EXPENSES 134,968. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 134,968. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 782,838. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 782,838. LAB & RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 146,148. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 146,148. |