2023-05-15T15:19:46-05:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 390993000 SPRING VALLEY HEALTH CARE SERVICES INC SPRI 7157785545 S830 WESTLAND DRIVE SPRING VALLEY WI 54767 KEVIN LARSON ADMINISTRATOR 7157785545 2023-05-12 1 KEVIN LARSON 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2023-05-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KEVIN LARSON S830 WESTLAND DRIVE SPRING VALLEY WI 54767 3331884 0 X WWW.SVHCS.ORG X 1970 WI THE MISSION OF SPRING VALLEY HEALTH CARE SERVICES, INC. IS TO PROVIDE HEALTH AND ASSISTIVE SERVICES TO ELDERLY AND DISABLED PERSONS IN NEED OF SPRING VALLEY HEALTH CARE SERVICES, INC.'S PROGRAMS IN A MANNER THAT IS CHARITABLE AND WITH A SPIRIT OF BENEVOLENCE SO THAT AN INDIVIDUAL MAY MAINTAIN THE HIGHEST PRACTICABLE QUALITY OF LIFE, THE UTMOST INDEPENDENCE, AND THE MOST REASONABLE SAFE AND HEALTHY LIFESTYLE. 4 4 132 30 0 0 1067937 105351 3096578 3120091 247 1091 96187 105351 4260949 3331884 0 0 0 0 2394125 2148499 0 0 0 1497309 1287320 3891434 3435819 369515 -103935 3240100 2901413 2061724 1839063 1178376 1062350 X THE MISSION OF SPRING VALLEY HEALTH CARE SERVICES, INC. IS TO PROVIDE HEALTH AND ASSISTIVE SERVICES TO ELDERLY AND DISABLED PERSONS IN NEED OF SPRING VALLEY HEALTH CARE SERVICES, INC.'S PROGRAMS IN A MANNER THAT IS CHARITABLE AND WITH A SPIRIT OF BENEVOLENCE SO THAT AN INDIVIDUAL MAY MAINTAIN THE HIGHEST PRACTICABLE QUALITY OF LIFE, THE UTMOST INDEPENDENCE, AND THE MOST REASONABLE SAFE AND HEALTHY LIFESTYLE. 0 0 2563396 0 2621665 SPRING VALLEY HEALTH CARE SERVICES, INC. OPERATES A 40-BED SKILLED NURSING FACILITY WHICH IS AVAILABLE TO RESIDENTS OF SPRING VALLEY AND THE SURROUNDING AREAS. PERSONALIZED NURSING CARE, REHABILITATIVE SERVICES, AND SUPPORTIVE SERVICES ARE OFFERED TO PROMOTE AND ASSIST RESIDENTS RECUPERATING FROM ILLNESS, INJURY, OR SURGERY. DURING FISCAL YEAR 2021-22, THE NURSING FACILITY PROVIDED 9,156 RESIDENT DAYS, AN OCCUPANCY RATE OF 63%. EVEN THOUGH THE ORGANIZATION IS CLEARLY DISTRESSED FINANCIALLY DUE TO INADEQUATE REIMBURSEMENTS FROM THE MEDICARE AND MEDICAID SYSTEMS, A 4 STAR RATING, AS DETERMINED THE US DHHS CENTERS FOR MEDICARE AND MEDICAID SERVICES, HAS BEEN DUTIFULLY AND CONSISTENTLY MAINTAINED BY THE ORGANIZATION. 463881 0 474426 SPRING VALLEY HEALTH CARE SERVICES, INC. IS THE SOLE CORPORATE MEMBER OF VALLEY VILLAS, LLC. VALLEY VILLAS, LLC. WAS ORGANIZED AS A DISREGARDED ENTITY FOR THE PURPOSE OF OPERATING A 20-UNIT RESIDENTIAL CARE APARTMENT COMPLEX. 23467 0 24000 SPRING VALLEY HEALTH CARE SERVICES, INC. MANAGES AND OPERATES SPRING VALLEY HEALTH AND REHABILITATION CENTER OWNED BY THE VILLAGE OF SPRING VALLEY. 3050744 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 10 0 132 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 0 0 WI X KEVIN LARSON 7157785545 S830 WESTLAND DRIVE SPRING VALLEY WI 54767 MARSHA BRUNKHORST PRESIDENT 4.00 X X 0 0 0 JULIE DUCKLOW TREASURER 3.00 X X 0 0 0 JAY RICHARDSON SECRETARY 3.00 X X 0 0 0 JAY ARNESON ADVISORY MEMBER 2.00 X 0 0 0 KEVIN LARSON CEO/ADMINISTRATOR 40.00 X 77602 0 12671 77602 0 12671 0 0 0 0 MIDWEST PHYSICAL THERAPY PO BOX 176 BLOOMER WI 54724 THERAPY SERVICES 106488 1 84426 20925 105351 NURSING HOME REVENUE 623000 2620405 2620405 ASSISTED LIVING REVENU 623990 474426 474426 MANAGEMENT FEES 541900 24000 24000 1260 1260 3120091 1091 1091 105351 105351 105351 3331884 3120091 0 106442 90273 90273 1724614 1668048 56566 189435 187060 2375 144177 133444 10733 11855 11855 3450 3450 67854 67854 331056 331056 8107 8107 53919 53919 30536 30418 118 191649 191649 2911 2394 517 53 53 74464 74464 40800 40800 FOOD AND SUPPLIES 288682 288682 NURSING HOME BED TAX 74800 74800 REPAIRS AND MAINTENANCE 57487 57487 FINES AND PENALTIES 33890 33890 15807 11189 4618 3435819 3050744 385075 0 851702 199596 243334 277572 342047 716934 19595 2950690 1239530 1785017 1711160 -1595 -3849 3240100 2901413 401187 320883 8500 9500 1090042 1031111 561995 477569 2061724 1839063 X 1178376 1062350 1178376 1062350 3240100 2901413 -103935 -12091 0 X 0 0 0 X 32878 4198281 331692 1067937 105351 5736139 3614724 3440463 3047906 3096578 3120091 16319762 27468 70597 96187 105351 299603 3647602 7666212 3450195 4260702 3330793 22355504 0 0 0 22355504 153 281 1193 247 1091 2965 153 281 1193 247 1091 2965 412630 412630 3647755 7666493 3864018 4260949 3331884 22771099 0.98170 0.98220 0.00010 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 550 550 0 PART II-B, LINE 1: SPRING VALLEY HEALTH CARE SERVICES, INC. PAYS ANNUAL ASSOCIATION DUES TO WISCONSIN HEALTH CARE ASSOCIATION, INC. AND AMERICAN HEALTH CARE ASSOCIATION, INC. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATION MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL INDUSTRY ENVIRONMENT. 0 1 X 79800 79800 2675296 1198462 1476834 195594 41068 154526 1711160 WHEDA TAX CREDIT NOTE PAYABLE 477569 477569 PART IV, LINE 2B: THE ORGANIZATION HOLDS SECURITY DEPOSITS FOR THEIR NURSING HOME AND ASSISTED LIVING ROOMS FOR THE TENANTS. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES OF THE BOARD OF DIRECTORS WHICH HAVE AUTHORITY TO ACT ON BEHALF OF THE ENTIRE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WILL BE DISTRIBUTED TO THE BOARD OF DIRECTORS VIA EMAIL AHEAD OF A VIRTUAL MEETING TO REVIEW AND APPROVE PRIOR TO THE FORM 990 BEING SUBMITTED. FORM 990, PART VI, SECTION B, LINE 12C SPRING VALLEY HEALTH CARE SERVICES, INC. REQUIRES ITS BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15A THE SPRING VALLEY HEALTH CARE SERVICES, INC.'S BOARD OF DIRECTORS SETS THE SALARY AND BENEFIT PACKAGE FOR THE ADMINISTRATOR/CEO. THE BOARD OF DIRECTORS UTILIZES MULTIPLE SOURCES FOR SETTING THE COMPENSATION INCLUDING VARIOUS SALARY SURVEYS FROM THIRD PARTY SOURCES SUCH AS THE AMERICAN COLLEGE OF HEALTH CARE ADMINISTRATORS, THE LONG TERM CARE NEWS, AND AMERICAN HEALTH CARE ASSOCIATION PROVIDER PUBLICATION. THE SALARY AND BENEFIT PACKAGE FOR OTHER MANAGEMENT-SENIOR LEVEL STAFF PERSONS IS DETERMINED BY THE ADMINISTRATOR WITH CONSULTATION FROM THE BOARD OF DIRECTORS AND WITHIN THE PARAMETERS OF THE ORGANIZATION'S OPERATING BUDGET WHICH IS APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 SPRING VALLEY HEALTH CARE SERVICES, INC. MAKES ITS FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A PER REQUEST BASIS. FORM 990, PART VI, SECTION B, LINE 14, DOCUMENT RETENTION AND DESTRUCTION POLICY: SPRING VALLEY HEALTH CARE SERVICES, INC. DOES NOT HAVE A FORMAL DOCUMENT RETENTION AND DESTRUCTION POLICY. HOWEVER, SPRING VALLEY HEALTH CARE SERVICES, INC. FOLLOWS ALL STATUTORY REQUIREMENTS GOVERNING RECORD RETENTION. THE STANDARD GUIDELINE UTILIZED IS THE 7 YEAR RETENTION PERIOD FOR RECORDS AND FILES. THE 7 YEAR PERIOD BEGINS WITH THE CLOSING OF THE FILE OR RECORD. STAFF EMPLOYMENT RECORDS CONTAINING ANY MEDICAL OR HEALTH INFORMATION ARE MAINTAINED FOR 30 YEARS ACCORDING TO STATUTORY REQUIREMENTS. FORM 990, PART VI, SECTION B, LINE 13, WHISTLEBLOWER POLICY: SPRING VALLEY HEALTH CARE SERVICES, INC. DOES NOT HAVE A FORMAL WHISTLEBLOWER POLICY. HOWEVER, SPRING VALLEY HEALTH CARE SERVICE, INC.'S ANTI-FRAUD PROTECTIONS INCLUDE SAFE-GUARDS AFFORDED TO THOSE INDIVIDUALS REPORTING OR PROVIDING INFORMATION OR ASSISTANCE WITH CONCERNS OR SITUATIONS RELATED TO POSSIBLE FRAUD, THEFT, ABUSE, OR DETRIMENTAL ACTIVITY BY STAFF PERSONS OR INDIVIDUALS WHO MAY BE AFFILIATED OR ASSOCIATED WITH THE OPERATIONS OF SPRING VALLEY HEALTH CARE SERVICES, INC. THE CRITICAL ELEMENT WITH THE SAFEGUARDS IS THE PROTECTION OF THOSE STAFF PERSONS FROM RETRIBUTION OR RETALIATION AS A RESULT OF THEM PROVIDING INFORMATION OR AID. VALLEY VILLAS LLC S820 WESTLAND DRIVE SPRING VALLEY WI 54767 263498120 DEVELOPMENT AND OPERATION OF ASSISTED LIVING FACILITY WI 377077 1896128 SPRING VALLEY HEALTH CARE SERVICES INC