2025-11-17T09:44:41-08:00 2024-12-31 680146027 AGT CPAS AND ADVISORS 205 N MOUNT SHASTA BLVD STE 300 MOUNT SHASTA CA 96067 990 2024-01-01 941623075 Siskiyou Hospital Inc DBA Fairchild Medical Center SISK 5308424121 444 Bruce Street Yreka CA 96097 KELLY MARTIN CFO 2025-11-17 true true Lindsey Moglia CPA P02020233 5309263881 2024 2025-03-06 01:10:19Z KELLY MARTIN 129802776 false X www.fairchildmed.org X 1962 CA FAIRCHILD MEDICAL CENTER OFFERS PRIMARY & SPECIALTY SERVICES INCLUDING MEDICAL, SURGICAL, ORTHOPEDIC, EMERGENCY, OBSTETRICAL, PEDIATRIC CARE, OUTPATIENT CLINIC, & OTHER SPECIALTIES AVAILABLE THROUGH TELEMEDICINE, OUR FOCUS IS TO PROVIDE LOCAL ACCESS TO HIGH QUALITY HEALTH CARE SERVICES. 16 12 663 37 0 82760 114871411 129366880 62750 353136 0 114934161 129802776 0 0 54281589 60876461 0 0 60045090 60750045 114326679 121626506 607482 8176270 97011895 121818947 9788352 20717110 87223543 101101837 FAIRCHILD MEDICAL CENTER OFFERS PRIMARY & SPECIALTY SERVICES INCLUDING MEDICAL, SURGICAL, ORTHOPEDIC, EMERGENCY, OBSTETRICAL, PEDIATRIC CARE, OUTPATIENT CLINIC, & OTHER SPECIALTIES AVAILABLE THROUGH TELEMEDICINE, OUR FOCUS IS TO PROVIDE LOCAL ACCESS TO HIGH QUALITY HEALTH CARE SERVICES. false false 83735328 129366880 Fairchild Medical Center provides quality healthcare services regardless of race, creed, sex, national origin, handicap, age, ancestry or ability to pay. Fairchild Medical Center strives to provide for the health needs of its underinsured and uninsured patients. Although reimbursement for services rendered is critical to the operation and financial stability of Fairchild Medical Center, it is recognized that not all individuals possess the ability to purchase essential medical services, and further, that our mission is to serve the community with respect to providing healthcare services and education. Therefore, the Hospital is committed to serving all members of its community through consideration of:free care and/or subsidized care;care provided to persons covered by governmental programs at below cost;health activities and programs to support community;Where the need and/or individuals inability to pay coexists. Other activities include wellness programs, community education programs, elderly programs, physically or mentally challenged, medically under-served, and a variety of broad community support activities.Fairchild Medical Center served 1,339 inpatients and provided more than 125,000outpatient services during 2024.Fairchild Medical Center provides care to persons covered by governmental programs at below cost. Recognizing its mission to the community, services are provided to both MediCare and MediCal patients. The Hospital realized MediCal/CMSP payments below the cost the hospital incurs to provide the service of $7,973,378. To the extent reimbursement is below cost, Fairchild Medical Center recognizes these amounts as a service to the community in meeting its mission.Fairchild Medical Center currently has Medicare reimbursement reduced 2% to anamount below cost. In 2024, reimbursement was reduced $378,422.The Hospital maintains a Charity Care Policy which defines how partial and/or full charity care will be based on the individuals ability to pay as defined by Federal Poverty Income Guidelines utilizing a sliding scale. Confidentiality of information and the individuals dignity are paramount. Charity Care is also provided through many reduced price services and free programs offered throughout the year based on activities and services which Fairchild Medical Center believes will serve a bona fide community health need. These include:Free care for patients who are financially unable to pay for services in total or services in excess of private insurance reimbursement. During 2024, total charges written off for Charity Care were $1,180,722 with a cost associated with charity at $477,926 to a primary service area a little over 24,000 people.Fairchild Medical Center has two Rural Health Clinics that provide care in designated Healthcare Professional Shortage Areas (HPSA) for all who need services. The Rural Health Clinic provides Dental services for indigent patients. Organization and management of the Fairchild Medical Center National Hospital Week. The Hospital maintains a toll-free dedicated telephone number for advice nurse services which supply information regarding access to urgent care services; clinical advice; personal health education; information on prescription and over-the-counter drugs; and mental health referrals, as appropriate. The cost to provide this service to our community is $37,620.Hospital Administration and staff are called upon to speak before community organizations on a variety of healthcare topics.The Hospital remains focused on maintaining accreditation through the Joint Commission on Accreditation of Healthcare Organizations. The Hospital recruited and hired a Performance Improvement Risk Manager to assist in this endeavor. The Manager also focuses on Patient Safety issues within the Hospital.Administration continues to focus attention on Corporate Compliance issues as well as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Hospitals Hospitalist program continues to provide a continuity of care to those patients admitted to the Hospital.Various hospital staff served on many community and statewide committees promoting the advancement of healthcare. The costs of these activities have been subsidized by Fairchild Medical Center.Fairchild Medical Center offers various seminars on health related issues to the community for free. The Community has supported the charitable purposes of Fairchild Medical Center through various donations of money as well as services. Through the community supported auxiliary organizations services valued at over $105,000 for patient comfort and support were provided. Fairchild Medical Center Auxiliary provides a patient transport van to transport patients that need healthcare services. These donations provided a direct benefit to the community through lower costs in both patient services and other wellness programs such as those described previously. We also received donations of equipment from the Hospitals Guilds and Auxiliary. 83735328 true true false true false false false false false true true false false false false true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true false false false true 100 0 true 663 true false false false false false false false 0 false false false false false false false X 16 12 false false false false true true false true true false false false true true true true true true true false X Finance Department 5308424121 444 Bruce Street Yreka CA 96097 Jonathon Andrus CEO 40.00 1.00 X 459252 0 67315 Jon Wilton Anesthesiologist 40.00 0.00 359432 0 39120 Ryan Knight Anesthesiologist 40.00 0.00 321206 0 52010 Kelly Martin CFO 40.00 1.00 X 246843 0 65026 MICHAEL MADDEN ASST ADMIN 40.00 0.00 237472 0 52217 CHRISTOPHER RICHMOND PHARMACIST 40.00 0.00 220866 0 56514 Orrin Rice PA, Orthopedic 40.00 0.00 212871 0 58730 Vina Swenson Chief of staff 1.00 0.00 X X 18000 0 0 Larry Mulloy Member at large 8.00 0.00 X 0 0 0 Darrin Mercier VICE-CHAIRMAN 1.00 1.00 X X 0 0 0 Dwayne Jones Secretary 1.00 1.00 X X 0 0 0 Lorah Guse Auxiliary Rep 1.00 0.00 X 0 0 0 Jerome Tres Churchill III Chairman 1.00 1.00 X X 0 0 0 Eleanor Wilson Director 1.00 0.00 X 0 0 0 Louis Derouchey MD Director 1.00 1.00 X 0 0 0 Carrie Hayden Director 1.00 1.00 X 0 0 0 Jay Quisenberry Director 1.00 1.00 X 0 0 0 Douglas Langford DDS Director 1.00 1.00 X 0 0 0 Judy Baker Director 1.00 1.00 X 0 0 0 Kristi Von Tickner Treasurer 1.00 1.00 X X 0 0 0 Deanne Terry Director 1.00 1.00 X 0 0 0 Michael Maloney MD Former Chief of staff 1.00 0.00 0 0 0 2075942 390932 7 true true false Mountain Medicine PC 10712 North Old Stage Rd Weed CA 96094 PHYSICIAN GROUP 3434063 Triage LLC PO Box 773328 Chicago IL 60677 STAFFING SERVICE 1756971 LRS Healthcare PO BOX 850781 Minneapolis MN 55485 STAFFING SERVICE 2467554 SISKIYOU PROFESSIONAL MEDICAL SERVICES 202 N OREGON ST YREKA CA 96097 PHYSICIAN GROUP 11743886 Medical Solutions LLC 1010 N 102nd Street Suite 300 Omaha NE 68114 Staffing service 1233394 24 46310 36450 82760 CAFETERIA 722514 MISCELLANEOUS PROGRAM REV 900099 1897821 1897821 NET PATIENT SERVICE REV 900099 127469059 127469059 129366880 353136 353136 0 0 0 0 0 0 0 0 129802776 129366880 353136 X 0 0 0 0 838436 838436 0 42716597 29986021 12730576 0 17321428 11925159 5396269 0 0 0 0 0 0 0 29908577 20590943 9317634 0 0 0 0 9063979 6240213 2823766 0 0 0 0 0 5103773 3513758 1590015 0 SUPPLIES 14766021 10165857 4600164 OTHER EXPENSES 1907695 1313377 594318 0 121626506 83735328 37891178 0 0 37950434 45148839 0 24358495 38468574 0 0 0 2147754 2663597 693716 1008277 108753890 74224230 31861496 34529660 0 0 0 0 0 97011895 121818947 9788352 19217110 1500000 9788352 20717110 X 87223543 98591894 2509943 87223543 101101837 97011895 121818947 8176270 5702024 X X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 7034 7034 false false Part II-B, Line 1i - Other Activities Description A portion of the consolidated dues for membership in the California hospital association, California association of the hospitals and health systems, and hospital council of northern and central California are used for lobbying. the portion of the dues that relates to lobbying is $7,034. Part IV - Additional Information 839541 78935 918476 762855 76686 839541 860790 -97935 762855 702123 158667 860790 747446 -45323 702123 1.00000 false true true 185023 185023 24266664 20502993 3763671 511292 396542 114750 75789166 53324695 22464471 8001745 8001745 34529660 X 129802776 129802776 129802776 121626506 121626506 121626506 Part V, Line 4: Intended uses of the endowment fund. THE ORGANIZATION'S ENDOWMENT FUNDS HELD BY FAIRCHILD MEDICAL CENTER FOUNDATION ARE USED FOR RESTRICTED PURPOSES AS DIRECTED BY THE DONOR UPON RECEIPT OF THEIR DONATION. INCOME EARNED FROM PERMANENT ENDOWMENT FUNDS WITHOUT RESTRICTION AS TO PURPOSE ARE USED TO SUPPORT PATIENT CARE PROGRAMS AND SERVICES OF SISKIYOU HOSPITAL INC. Part X : FIN48 Footnote The Hospital is a not-for-profit organization formed under the laws of the State of California. The Hospital has been determined to be exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code by the United States of America's Internal Revenue Service (IRS) and under similar codes by the State of California.Accordingly, no provision for income taxes is included in the accompanying financial statements. The tax years of 2021 through 2024 remain open and subject to examination by the appropriate government agencies of the United States and the State of California. true true true X true X true true false false true true 499327 499327 0.00410 32182848 22830112 9352736 0.07690 32682175 22830112 9852063 0.08100 37620 37620 0.00030 37620 37620 0.00030 32719795 22830112 9889683 0.08130 true 6309506 60968689 61347111 -378422 X true false 1 1 FAIRCHILD MEDICAL CENTER 444 BRUCE STREET YREKA CA 96087 2300035 X X X X false false true X X X X X X X 25 true false false true X true 23 false false false true X 100.0000 350.0000 X X X X true true X X X X true X X true X false X X X X true X false false Facility: - Part V, Section B, Line 5 INFORMATION COLLECTED FROM INDUSTRY MEDICAL MARKETING CONTRACTOR. Facility: - Part V, Section B, Line 11 DRUG ABUSE - NOT A MEDICAL SOLUTION THE HOSPITAL COULD ASSIST WITH SCOTT VALLEY RURAL HEALTH CLINIC 155 DIGGLES STREET ETNA CA 96027 RURAL HEALTH CLINIC FAIRCHILD MEDICAL CLINIC 444 BRUCE STREET YREKA CA 96097 RURAL HEALTH CLINIC Part I, Line 7 - Explanation of Costing Methodology THE COST-TO-COST RATIO USED WAS DERIVED BASED ON THE RATIO OF PATIENT CARE COST-TO-CHARGE WORKSHEET AS SUBMITTED TO MEDICARE. Part I, Line 7, Column F - Explanation of Bad Debt Expense INCLUDED ON FORM 990, PART IX LINE 24A IS BAD DEBT EXPENSE TOTALING $6,309,506 THIS AMOUNT WAS EXCLUDED BEFORE CALCULATING THE PERCENTAGES FOUND IN COLUMN (F). Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. Part III, Line 4 - Bad Debt Expense Financial statements have not been issued yet, will provide with amended return once issued. Part III, Line 8 - Explanation Of Shortfall As Community Benefit ANY MEDICARE COSTS ABOVE AND BEYOND THE RELATED MEDICARE REVENUE IS CONSIDERED A BENEFIT TO THE COUNTY OF SISKIYOU. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients ALL ACCOUNTS ARE REVIEWED BY THE BUSINESS OFFICE IN ORDER TO DETERMINE IF THE ACCOUNT MAY BE WRITTEN OFF TO BAD DEBT, CHARITY, OR CONTRACTUAL ADJUSTMENTS IN ORDER TO COMPLETE THE BILLING AND REIMBURSEMENT CYCLE OF THE ACCOUNT. Part VI, Line 2 - Needs Assessment THE HOSPITAL HAS THEIR SERVICE AREA EVALUATED FOR WHAT SPECIALTIES AND WHAT NUMBER OF PHYSICIANS THAT ARE NEEDED. Part VI, Line 3 - Patient Education of Eligibility for Assistance INSTRUCTIONS ABOUT CHARITY CARE POLICY ARE SENT HOME WITH ALL PRIVATE PAY PATIENTS. Part VI, Line 4 - Community Information WITH THE MOST RECENT INFORMATION SISKIYOU COUNTY HAS A MEDIAN INCOME OF $49,857, AND A 16.7% POVERTY RATE. THE HOSPITAL IS IN AN AREA DESIGNATED AS HEALTHCARE PROFESSIONAL AREA (HPSA). Part VI, Line 4 - Community Building Activities OPEN MEDICAL STAFF, COMMUNITY BOARD, AND SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION. X true true X X X false false false false false false false false false CHRISTOPHER RICHMOND PHARMACIST 220866 56514 277380 Jon Wilton Anesthesiologist 359432 39120 398552 Jonathon Andrus CEO 459252 67315 526567 Kelly Martin CFO 246843 65026 311869 MICHAEL MADDEN ASST ADMIN 237472 52217 289689 Orrin Rice PA, Orthopedic 212871 58730 271601 Ryan Knight Anesthesiologist 321206 52010 373216 Part I, Line 1a: Relevant information in regards to selections on 1a. Part III, Additional Information PART I, LINE 1A - THE HOSPITAL INCURRED $13,171 IN EXPENSES FOR SENDING THE BOARD MEMBERS' SPOUSES TO A GOVERNANCE INSTITUTE MEETING. Form 990, Part VI, Section A, Line 6 TRI VALLEY MEDICAL, INC. IS THE SOLE CORPORATE MEMBER OF SISKIYOU HOSPITAL, INC., AND, IN SUCH CAPACITY, HAS THE RIGHT TO APPROVE THE ELECTION OF ALL OF THE DIRECTORS OF SISKIYOU HOSPITAL, INC.(OTHER THAN CERTAIN DIRECTORS WHO SERVE EX-OFFICIO), AS WELL AS THE RIGHT TO APPROVE CERTAIN SIGNIFICANT CORPORATE ACTIONS. Form 990, Part VI, Section B, Line 11b Due to time constraints in finalizing the form 990, the Board of Directors will review the filing after it has been submitted. Form 990, Part VI, Section B, Line 12c THE CONFLICT OF INTEREST POLICY IS DISCUSSED AT BOARD MEETING AND ANY ISSUES ARE HANDLED IMMEDIATELY AS THEY ARE PRESENTED. Form 990, Part VI, Section B, Line 15a AT A CLOSED EXECUTIVE SESSION OF BOARD MEEING COMPARATIVE COMPENSATION SURVEYS ARE REVIEWED AND APPROVED BY THE BOARD. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. Form 990, Part VI, Section C, Line 19 AUDITED FINANCIALS, GOVERNING DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. Form 990, Part XII, Line 2c NO CHANGES HAVE OCCURED TO THE PRIOR YEAR PROCESSES. Form 990, Part XI, Line 8 - Prior Period Adjustment The prior period adjustment in the amount of $5,702,024 is due to difference in prior year accounting records and audited financial statements. TRI-VALLEY MEDICAL INC 444 BRUCE STREET YREKA CA 96097 943011965 PARENT COMPANY CA 501(C)(3) 11 TYPE II NA false FAIRCHILD MEDICAL CENTER FOUNDATION INC 444 BRUCE STREET YREKA CA 96097 680350012 SOLICITATION FUNDS FOR SISKIYOU HOSPITAL CA 501(C)(3) 7 TRI-VALLEY MEDICAL INC true SISKIYOU OFFICE MANAGEMENT INC 444 Bruce Street YREKA CA 96097 680356165 CLINIC MGMT CA TRI-VALLEY INC C CORP true TVI REAL ESTATE INC 444 Bruce Street YREKA CA 96097 680437309 REAL ESTATE CA TRI-VALLEY INC C CORP true false false false false false false false false false false false false false false false false false false false