2015-11-16T15:36:47-08:00 2014-12-31 Aiello Goodrich & Teuscher Accountancy Corp PO Box 158 Mt Shasta CA 960670158 990 2014-01-01 941623075 SISKIYOU HOSPITAL INC DBA FAIRCHILD MEDICAL CENTER SISK 5308424121 444 BRUCE STREET YREKA CA 96097 KELLY MARTIN CFO 2015-11-16 true Lynn E Teuscher CPA P00154021 5309263881 2014 2016-04-25 22:37:26Z KELLY MARTIN 444 BRUCE STREET YREKA CA 96097 72074497 false false X WWW.FAIRCHILDMED.ORG X 1962 CA FAIRCHILD MEDICAL CENTER OFFERS PRIMARY & SPECIALTY SERVICES INCLUDING MEDICAL, SURGICAL, ORTHOPEDIC, EMERGENCY, OBSTETRICAL, PEDIATRIC CARE & OTHER SPECIALTIES AVAILABLE THROUGH TELEMEDICINE, OUR FOCUS IS TO PROVIDE COMPREHENSIVE, HIGH QUALITY HEALTH CARE SERVICES. 16 16 474 63 0 100460 9772 65583531 70847875 12831 104722 1112128 65696822 72074497 6000000 0 0 32714073 34730265 0 0 28066596 28290789 66780669 63021054 -1083847 9053443 36937085 45653900 10404711 9977539 26532374 35676361 FAIRCHILD MEDICAL CENTER OFFERS PRIMARY & SPECIALTY SERVICES INCLUDING MEDICAL, SURGICAL, ORTHOPEDIC, EMERGENCY, OBSTETRICAL, PEDIATRIC CARE & OTHER SPECIALTIES AVAILABLE THROUGH TELEMEDICINE, OUR FOCUS IS TO PROVIDE COMPREHENSIVE, HIGH QUALITY HEALTH CARE SERVICES. false false 61209517 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 1,609 inpatients and provided more than 96,308 outpatient services during 2014.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 $7,508,019. To the extent reimbursement is below cost, Fairchild Medical Center recognizes these amounts as a service to the community in meeting its mission.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 thoughout 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 2014, total charges written off for Charity Care were $1,744,489 with a cost associated with charity at $686,674 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. Organization and management of the annual Fairchild Medical Center Health Fair and 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 $50,460.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. (See Attachment)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 $108,116 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. 61209517 true false 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 false false false true true false false false true 51 0 false 474 true false false false false false false false false 0 false false false false false false false false false false X 16 16 false false false false true true false true true false false true true true true true true true true false X FINANCE DEPARTMENT 5308424121 444 BRUCE STREET YREKA CA 96097 LARRY MULLOY Chairman 8.00 1.00 X X 0 0 0 DARRIN MERCIER VICE-CHAIRMAN 1.00 1.00 X X 0 0 0 DWAYNE JONES SECRETARY/TRES 6.00 1.00 X X 0 0 0 DAVID DELLA LANA MD Director 40.00 1.00 X X 78000 0 0 DAWNA COZZALIO Director 1.00 1.00 X 0 0 0 JEROME CHURCHILL III Director 1.00 1.00 X 0 0 0 SHERRY CRAWFORD Director 1.00 1.00 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 JAMES QUISENBERRY Director 1.00 1.00 X 0 0 0 DOUGLAS LANDFORD DDS Director 4.00 1.00 X 0 0 0 GAIL ROGERS Director 1.00 1.00 X 0 0 0 JUDY BAKER Director 1.00 1.00 X 0 0 0 DEANNA TERRY Director 1.00 1.00 X 0 0 0 JONATHON ANDRUS CEO 40.00 0.00 X 333138 0 42468 KELLY MARTIN CFO 40.00 0.00 X 154340 0 38118 TERRY HARBAUGH PHARMACIST 40.00 0.00 X 206481 0 19949 ROBERT MATZEN PHARMACIST 40.00 0.00 X 185558 0 34892 KATHY SHELVOCK ADMIN PT CARE 40.00 0.00 X 186646 0 33225 MICHAEL MADDEN ASST ADMIN 40.00 0.00 X 163082 0 22026 SAXTON POPE NETWORK SYS ADMIN 40.00 0.00 X 161800 0 30116 1469045 220794 7 false true false SISKIYOU PROFESSIONAL MEDICAL SERVICE 202 N OREGON STREET YREKA CA 96097 PHYSICAN GROUP 2771053 ALLIANCE HEALTHCARE SERVICES FILE 55826 LOS ANGELES CA 90074 ER PHYSICIANS 555126 EMERGENCY PHYSICIANS OF NORTHERN CALIFORNIA PO BOX 674579 DETROIT MI 482674579 PHYSICANS 1827542 RURAL PHYSICIANS GROUP 10023 BRYCE ROSE AVE LAS VEGAS NV 89148 PHYSICANS 693000 4 9772 9772 CAFETERIA 722210 217522 217522 MEDICAL RECORDS 900099 4224 4224 MISCELLANEOUS PROGRAM REV 900099 45383 45383 NET PATIENT SERVICE REV 900099 70227417 70227417 PATIENT ACCOUNTS 900099 353329 353329 70847875 104722 104722 0 0 0 0 0 0 0 INCENTIVE REVENUE 624100 1112128 1112128 1112128 72074497 71742481 322244 X 0 0 0 0 588348 78000 510348 0 23877494 23454923 422571 804213 766302 37911 7238054 7063199 174855 2222156 2176934 45222 0 49158 28465 20693 25950 25950 0 0 0 8950585 8719265 231320 0 2623387 2596572 26815 0 0 999047 999047 0 0 0 242716 242716 0 2396143 2396143 423312 350176 73136 OTHER EXPENSES 7916785 7916785 BAD DEBT EXPENSE 4663706 4663706 0 63021054 61209517 1811537 0 0 12382480 10426535 0 8864431 17415961 0 0 1173190 0 1211763 1192340 363814 361280 43617926 27513775 12670285 16104151 1289 2804 130000 0 0 0 139833 150829 36937085 45653900 4532711 4717192 5542000 5260347 330000 10404711 9977539 X 26532374 35676361 26532374 35676361 36937085 45653900 9053443 90544 X X false true X true false X false false false false false false false false false false true 4469 4469 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 HOSPITALS AND HEALTH SYSTEMS, AND HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA ARE USED FOR LOBBYING. THE PROTION OF THE DUES THAT RELATES TO LOBBYING IS $4,469. 267234 17473 284707 205601 61633 267234 182373 23228 205601 174557 7816 182373 156241 8316 164557 1.00000 false true true 185000 185000 17817305 11858393 5958912 119272 93943 25329 20081947 15412134 4669813 5414402 149305 5265097 16104151 X 72074497 72074497 72074497 63021054 63021054 63021054 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 Corporation, Hospital and Foundation have been recognized as exempt from income tax under Section 501 of the Internal Revenue Code and a similar provision of state law. However, they are subject to federal income tax on any unrelated business taxable income. SOMI and TVI are subject to state and federal income taxes.SOMI and TVI account for income taxes in accordance with income tax accounting guidance (Accounting Standards Codification (ASC) 740, Income Taxes). The income tax accounting guidance uses an asset and liability approach which requires the recognition of deferred taxes for the expected future tax consequences of temporary differences between tax bases and financial reporting bases of assets and liabilities.At December 31, 2014 and 2013, SOMI and TVI had gross deferred tax assets related to net operating and other loss carryforwards. Valuation allowances have been established for the deferred tax assets since SOMI and TVI believe it is more likely than not that the tax benefits will not be realized.The Corporation, Hospital, Foundation, SOMI and TVI file tax returns in the U.S. federal jurisdiction. With a few exceptions, these entities are no longer subject to U.S. federal examinations by tax authorities for years before 2012. true true true X true X true true false false true true 686631 686631 0.01090 15262287 7755227 7507060 0.11910 15948918 7755227 8193691 0.13000 50460 50460 0.00080 50460 50460 0.00080 15999378 7755227 8244151 0.13080 true 1835750 25207037 25421312 -214275 X true false 1 1 FAIRCHILD MEDICAL CENTER 444 BRUCE STREET YREKA CA 96097 2300035 X X X X false false true X X X X X X X 12 true false false true X true 14 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 Part V, Line 5 - Account Input from Persons Who Represent the Community INFORMATION COLLECTED FROM INDUSTRY MEDICAL MARKETING CONTRACTOR. Part V, Line 11 - Explanation of Needs Not Addressed and Reasons Why DRUG ABUSE - NOT A MEDICAL SOLUTION THE HOSPITAL COULD ASSIST WITH 2 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 $4,663,706, 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 SEE PAGE 7 UNDER NOTE 1: NATURE OF OPERATIONS AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES. 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 - Needs Assessment THE HOSPITAL HAS THEIR SERVICE AREA EVALUATED FOR WHAT SPECIALTIES AND WHAT NUMBER OF PHYSICIANS THAT ARE NEEDED. Part VI - Patient Education of Eligibility for Assistance INSTRUCTIONS ABOUT CHARITY CARE POLICY ARE SENT HOME WITH ALL PRIVATE PAY PATIENTS. Part VI - Community Information WITH THE MOST RECENT INFORMATION SISKIYOU COUNTY HAS A MEDIAN INCOME OF $37,948, AND A 16.4% POVERTY RATE. THE HOSPITAL IS IN AN AREA DESIGNATED AS HEALTHCARE PROFESSIONAL AREA (HPSA). Part VI - 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 false JONATHON ANDRUS CEO 274138 50000 9000 13610 28858 375606 KATHY SHELVOCK ADMIN PT CARE 186646 11199 22026 219871 KELLY MARTIN CFO 154340 9260 28858 192458 MICHAEL MADDEN ASST ADMIN 163082 22026 185108 ROBERT MATZEN PHARMACIST 185558 9278 25614 220450 SAXTON POPE NETWORK SYS ADMIN 161800 8090 22026 191916 TERRY HARBAUGH PHARMACIST 206481 10324 9625 226430 Part I, Line 1a: Relevant information in regards to selections on 1a. Part III, Additional Information PART I, LINE 1A - THE HOSPITAL INCURRED $1500 IN EXPENSES FOR SENDING THE BOARD MEMBERS AND THEIR SPOUSES TO A GOVERNANCE INSTITUTE MEETING. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder 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, Line 11b: Form 990 Review Process FORM 990 IS PRESENTED TO ALL BOARD MEMBERS, ONCE THE 990 IS APPROVED BY THE EXECUTIVE COMMITTEE THE FORM IS FILED. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts THE CONFLICT OF INTEREST POLICY IS DISCUSSED AT BOARD MEETING AND ANY ISSUES ARE HANDLED IMMEDIATELY AS THEY ARE PRESENTED. Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management 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, Line 19: Other Organization Documents Publicly Available AUDITED FINANCIALS, GOVERNING DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. Form 990, Part XII, Line 2: Change of Oversight or Selection Process NO CHANGES HAVE OCURED TO THE PRIOR YEAR PROCESSES 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 1040805 9381522 1.00000 true TVI REAL ESTATE INC 444 BRUCE STREET YREKA CA 96097 680437309 REAL ESTATE CA TRI-VALLEY INC C CORP 1239373 1.00000 true false false true false false false false false false false false false false false false false false false false FAIRCHILD MEDICAL CENTER FOUNDATION INC c 25000 ACTUAL CASH