INTER VALLEY HEALTH PLAN INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
INTER VALLEY HEALTH PLAN INC (EIN 95-3258674)
Tax period
2022-04-01 to 2023-03-31
Filed
2023-10-31
IRS object ID
202343049349302084
Schema version
2022v5.0
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

FieldValueIRS element (for citing)
Return2023-10-31T22:30:06+00:00ReturnTs
Tax Period End2023-03-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN346565596PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line118101 VON KARMAN AVENUEAddressLine1Txt
CityIRVINECityNm
State AbbreviationCAStateAbbreviationCd
ZIP92612ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-04-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN953258674EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Inter-Valley Health Plan IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlINTEBusinessNameControlTxt
Phone9097843400PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 S PARK AVE PO BOX 6002 300AddressLine1Txt
CityPOMONACityNm
State AbbreviationCAStateAbbreviationCd
ZIP917696002ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBruce BownePersonNm
Person TitleCFO, VP of FinancePersonTitleTxt
Phone9097843400PhoneNum
Signature2023-10-31SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstBRUCEPersonFirstNm
Person LastBOWNEPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (true)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKara AdamsPreparerPersonNm
PTINP00023315PTIN
Phone9497942300PhoneNum
Preparation2023-10-16PreparationDt
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1MIKE NELSONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 S PARK AVE PO BOX 6002 300AddressLine1Txt
CityPOMONACityNm
State AbbreviationCAStateAbbreviationCd
ZIP917696002ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$180,339,944GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.IVHP.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1979FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionINTER VALLEY HEALTH PLAN, INC. IS A FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION. IT PROVIDES A FULL RANGE OF MEDICAL SERVICES TO ELIGIBLE MEDICARE PARTICIPANTS. AT MARCH 31, 2023 THERE WERE 0 PARTICIPATING MEMBERS.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee121TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$260,421,563PYProgramServiceRevenueAmt
CY Program Service Revenue$180,655,704CYProgramServiceRevenueAmt
PY Investment Income$148,992PYInvestmentIncomeAmt
CY Investment Income-$315,760CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$260,570,555PYTotalRevenueAmt
CY Total Revenue$180,339,944CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$13,037,669PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$8,805,627CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$257,143,454PYOtherExpensesAmt
CY Other Expenses$172,796,553CYOtherExpensesAmt
PY Total Expenses$270,181,123PYTotalExpensesAmt
CY Total Expenses$181,602,180CYTotalExpensesAmt
PY Revenues Less Expenses-$9,610,568PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,262,236CYRevenuesLessExpensesAmt
Total Assets BOY$30,003,416TotalAssetsBOYAmt
Total Assets EOY$24,687,203TotalAssetsEOYAmt
Total Liabilities BOY$22,890,073TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,414,061TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,113,343NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$6,273,142NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionINTER VALLEY HEALTH PLAN, INC. IS A FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION. IT PROVIDES A FULL RANGE OF MEDICAL SERVICES TO ELIGIBLE MEDICARE PARTICIPANTS. AT MARCH 31, 2023 THERE WERE 0 PARTICIPATING MEMBERS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangeYes (true)SignificantChangeInd
Expense$168,518,806ExpenseAmt
Grant$0GrantAmt
Revenue$180,655,704RevenueAmt
DescINTER VALLEY HEALTH PLAN, INC. IS A FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION. IT PROVIDES A FULL RANGE OF MEDICAL SERVICES TO ELIGIBLE MEDICARE PARTICIPANTS. AT MARCH 31, 2023 THERE WERE 0 PARTICIPATING MEMBERS. IVHP HAS ELECTED NOT TO CONTRACT WITH CMS EFFECTIVE JANUARY 1,2023 THEREFORE NOT OFFERING ANY MEDICAL COVERAGE TO MEMBERS. IVHP IS CURRENTLY IN PROCESS OF WINDING DOWN OPERATIONS.Desc
Total Program Service Expenses$168,518,806TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document41IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee121EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BRUCE BOWNEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9097843400PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 S PARK AVE STE 300AddressLine1Txt
CityPOMONACityNm
State AbbreviationCAStateAbbreviationCd
ZIP917696002ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
CAROLE HARTER
DIRECTOR1.00.0Yes (X)$0$0$0
CURTIS W MORRIS
DIRECTOR- 2ND VICE CHAIR1.00.0Yes (X)$0$0$0
DUANE STYLES MD
DIRECTOR1.00.0Yes (X)$0$0$0
ELMER PINEDA MD
DIRECTOR1.00.0Yes (X)$0$0$0
FRANK GARCIA
DIRECTOR1.00.0Yes (X)$0$0$0
JAN BROWN
DIRECTOR1.00.0Yes (X)$0$0$0
KEVIN MCCARTHY
DIRECTOR1.00.0Yes (X)$0$0$0
MELISSA VOLLARO
DIRECTOR1.00.0Yes (X)$0$0$0
PAUL ORR MD
DIRECTOR1.00.0Yes (X)$0$0$0
RAKESH SINHA MD
DIRECTOR1.00.0Yes (X)$0$0$0
RICHARD FASS
DIRECTOR - 1ST VICE CHAIR1.00.0Yes (X)$0$0$0
RICHARD YOCHUM
DIRECTOR1.00.0Yes (X)$0$0$0
SONJA STUMP
DIRECTOR1.00.0Yes (X)$0$0$0
SUNIL SHIVARAM MD
DIRECTOR1.00.0Yes (X)$0$0$0
BRUCE BOWNE
CFO,VP FIN,TREAS40.00.0$288,096$0$47,024Yes (X)
KENNETH SMITH MD
CMO40.00.0$405,164$0$21,079Yes (X)
Michael Nelson
President/CEO20.00.0$0$0$0Yes (X)
PATRICIA JACOBSON
VP HR,SECRETARY40.00.0$235,395$0$42,530Yes (X)
SUSAN TENORIO
COO40.00.0$271,887$0$45,320Yes (X)
BILL CHEN
CIO40.00.0$227,193$0$39,097Yes (X)
LARRY BACA
SALES, VP40.00.0$159,278$0$16,297Yes (X)
GEORGETTA MCCLOUD
CONTROLLER40.00.0$161,164$0$24,193Yes (X)
KIM PORTER
DIR CDI, REV RECO40.00.0$175,773$0$22,584Yes (X)
MARK SOUTHWORTH
DIR DS40.00.0$310,498$0$51,488Yes (X)
ROBIN ZIEGLER
PERF PRO AVP40.00.0$206,518$0$53,885Yes (X)
RUBY VILLAROZA IBARROLA
MANAGER, CDI40.00.0$150,326$0$17,181Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,591,292TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$380,678TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K20IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
DESERT OASIS HEALTHCARE
275 N EL CIELOPALM SPRINGSCA92262MEDICAL SERVICE$65,362,363
POMONA VALLEY HOSPITAL MEDICAL CENTER
1798 N GAREY AVEPOMONACA91767MEDICAL SERVICES & LEASED EMPLOYEES$25,185,673
PROMED HEALTH NETWORK OF POMONA
4150 E CONCOURSE ST 100ONTARIOCA91764MEDICAL SERVICES$24,386,482
EPIC HEALTH PLAN
1615 ORANGE TREE LANEREDLANDSCA92374MEDICAL SERVICES$15,583,614
Riverside Medical Clinic
7117 Brockton AveRiversideCA92506Medical Services$4,072,463
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K35CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPROVIDER SERVICESDesc
Business524114BusinessCd
Total Revenue Column$180,655,704TotalRevenueColumnAmt
Related Or Exempt Func Income$180,655,704RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$180,655,704TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column-$315,760TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$315,760ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$180,339,944TotalRevenueColumnAmt
Related Or Exempt Func Income$180,655,704RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$315,760ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,586,963TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,586,963ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,712,333TotalAmt
Program Services$0ProgramServicesAmt
Management And General$5,712,333ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$182,298TotalAmt
Program Services$0ProgramServicesAmt
Management And General$182,298ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$772,791TotalAmt
Program Services$0ProgramServicesAmt
Management And General$772,791ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$551,242TotalAmt
Program Services$0ProgramServicesAmt
Management And General$551,242ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$283,926TotalAmt
Program Services$0ProgramServicesAmt
Management And General$283,926ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$147,500TotalAmt
Program Services$0ProgramServicesAmt
Management And General$147,500ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$169,064,464TotalAmt
Program Services$168,518,806ProgramServicesAmt
Management And General$545,658ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$13,135TotalAmt
Program Services$0ProgramServicesAmt
Management And General$13,135ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$17,338TotalAmt
Program Services$0ProgramServicesAmt
Management And General$17,338ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$677,490TotalAmt
Program Services$0ProgramServicesAmt
Management And General$677,490ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$512,988TotalAmt
Program Services$0ProgramServicesAmt
Management And General$512,988ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$2,415TotalAmt
Program Services$0ProgramServicesAmt
Management And General$2,415ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$15,895TotalAmt
Program Services$0ProgramServicesAmt
Management And General$15,895ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$86,601TotalAmt
Program Services$0ProgramServicesAmt
Management And General$86,601ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$369,153TotalAmt
Program Services$0ProgramServicesAmt
Management And General$369,153ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Utilities$347,717$0$347,717$0
OUTSIDE SERVICES$749,107$0$749,107$0
Taxes and Licenses$126,981$0$126,981$0
BROKER COMMISSION$124,914$0$124,914$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$256,929TotalAmt
Program Services$0ProgramServicesAmt
Management And General$256,929ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$181,602,180TotalAmt
Program Services$168,518,806ProgramServicesAmt
Management And General$13,083,374ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY-$513,873BOYAmt
EOY-$50,769EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$11,518,134BOYAmt
EOY$15,032,973EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$53,000BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$11,593,500BOYAmt
EOY$9,704,999EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$15,395,767LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$15,395,767LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$86,601BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$7,266,054BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$30,003,416BOYAmt
EOY$24,687,203EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$22,890,073BOYAmt
EOY$18,414,061EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$22,890,073BOYAmt
EOY$18,414,061EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$5,647BOYAmt
EOY$5,647EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$7,107,696BOYAmt
EOY$6,267,495EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,113,343BOYAmt
EOY$6,273,142EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$30,003,416BOYAmt
EOY$24,687,203EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,262,236ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$422,035NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,813,218OtherCostOrOtherBasisAmt
Depreciation$2,813,218DepreciationAmt
Book Value$0BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,500,877OtherCostOrOtherBasisAmt
Depreciation$7,500,877DepreciationAmt
Book Value$0BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,081,672OtherCostOrOtherBasisAmt
Depreciation$5,081,672DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
KENNETH SMITH MD
CMO$171,173$0$0$0$233,991$0$12,089$0$8,990$0$426,243$0$0$0
BRUCE BOWNE
CFO,VP FIN,TREAS$283,524$0$0$0$4,572$0$11,895$0$35,129$0$335,120$0$0$0
SUSAN TENORIO
COO$250,051$0$0$0$21,836$0$9,324$0$35,996$0$317,207$0$0$0
PATRICIA JACOBSON
VP HR,SECRETARY$209,241$0$0$0$26,154$0$9,586$0$32,944$0$277,925$0$0$0
BILL CHEN
CIO$216,480$0$0$0$10,713$0$8,954$0$30,143$0$266,290$0$0$0
LARRY BACA
SALES, VP$92,969$0$0$0$66,309$0$1,302$0$14,995$0$175,575$0$0$0
ROBIN ZIEGLER
PERF PRO AVP$205,283$0$0$0$1,235$0$8,517$0$45,368$0$260,403$0$0$0
MARK SOUTHWORTH
DIR DS$159,393$0$0$0$151,105$0$8,221$0$43,267$0$361,986$0$0$0
KIM PORTER
DIR CDI, REV RECO$168,988$0$0$0$6,785$0$7,201$0$15,383$0$198,357$0$0$0
GEORGETTA MCCLOUD
CONTROLLER$160,021$0$0$0$1,143$0$6,687$0$17,506$0$185,357$0$0$0
RUBY VILLAROZA IBARROLA
MANAGER, CDI$148,248$0$0$0$2,078$0$3,073$0$14,108$0$167,507$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 4a Severance or change-of-control paymentDue to the ceasing of operations, certain individuals listed on Form 990, Part VII, received severance payments. The amounts are reported in Schedule J, Part II, Column B(iii).
Schedule J, Part IIIMICHAEL NELSON, CEO IS A LEASED EMPLOYEE OF POMONA VALLEY HOSPITAL MEDICAL CENTER. INTER VALLEY HEALTH PLAN PAYS POMONA VALLEY HOSPITAL $42,500 A MONTH FOR HIS SERVICES. THIS AMOUNT WAS REDUCED TO $21,250 A MONTH BEGINNING JUNE 2022.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, Line 3 Significant changes in program servicesDUE TO THE TREND OF DECREASING REVENUE OVER THE PAST FEW YEARS THE BOARD VOTED TO NOT RENEW ITS MEDICARE ADVANTAGE CONTRACT FOR THE 2023 CONTRACT YEAR. AS SUCH IT SURRENDERED ITS KNOX KEENE LICENSE IN FEBRUARY 2023.
Form 990, Part VI, Line 2 Family/business relationships amongst interested personsDIRECTOR RICHARD YOCHUM AND CEO MICHAEL NELSON - Business relationship
Form 990, Part VI, Line 11b Review of form 990 by governing bodyThe CFO performs a review of the Form 990 and the Board receives a copy prior to filing.
Form 990, Part VI, Line 12c Conflict of interest policyIN ACCORDANCE WITH IVHP CONFLICT OF INTEREST POLICY, ALL MEMBERS OF THE BOARD, COMMITTEES, OFFICERS, EXECUTIVE STAFF, DIRECTORS AND MEDICAL DIRECTORS, INDEPENDENT CONTRACTORS AND CONSULTANTS WHO ARE REQUESTED TO DO SO BY THE BOARD, AND OTHER MANAGEMENT NOT PREVIOUSLY MENTIONED, SHALL DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST THROUGH THE PLAN'S CONFLICT OF INTEREST DISCLOSURE STATEMENT. THIS DISCLOSURE SHOULD OCCUR IN A TIMELY MANNER AS SOON AS PRACTICABLE WHENEVER ANY MATTER COVERED UNDER THIS POLICY ARISES, BUT WILL BE REQUIRED UPON TAKING OFFICE AND AT LEAST ANNUALLY. THE BOARD, WITH THE ASSISTANCE OF A BOARD COMMITTEE AND/OR THE CEO, WILL EVALUATE THE DISCLOSURES OF BOARD MEMBERS AND OFFICERS AS APPROPRIATE AND WILL DETERMINE ON A CASE-BY-CASE BASIS WHETHER THE ACTIVITIES DISCLOSED CONSTITUTE A POTENTIAL CONFLICT AND, IF SO, HOW TO RESOLVE THE CONFLICT. EACH DIRECTOR, OFFICER, MEMBER OF MANAGEMENT, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL UPON APPOINTMENT AND AT LEAST ANNUALLY THEREAFTER SIGN A COPY OF THE ATTACHED "STATEMENT PERTAINING TO THE CONFLICT OF INTEREST POLICY." IF A DIRECTOR, OFFICER, KEY EMPLOYEE OR COMMITTEE MEMBER BECOMES AWARE THAT A POTENTIAL OR APPARENT CONFLICT MAY EXIST WHICH IS NOT DISCLOSED ON SUCH A STATEMENT, IT SHALL BE THE RESPONSIBILITY OF THE INTERESTED PERSON TO DISCLOSE THE POTENTIAL CONFLICT TO THE PRESIDENT AND TO THE BOARD AND/OR COMMITTEE, AS APPROPRIATE, AS SET FORTH ABOVE, PRIOR TO ANY BOARD OR COMMITTEE DISCUSSIONS OR ACTION WITH RESPECT TO THE RELEVANT TRANSACTION OR ARRANGEMENT, AND IF RELEVANT, TO LEAVE THE MEETING DURING THE DISCUSSION AND VOTE ON THE TRANSACTION OR ARRANGEMENT.
Form 990, Part VI, Line 15a Process to establish compensation of top management officialANNUALLY, THE COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS, REVIEWS THE COMPENSATION OF THE CEO AND ALL OTHER EMPLOYEES THAT ARE REPORTED INDIVIDUALLY ON THE 990 RETURN. THE COMMITTEE MEETS WITH OUTSIDE CONSULTANTS AND USES COMPENSATION SURVEYS AND OTHER INFORMATION TO TEST THE REASONABLENESS OF THE COMPENSATION OF ALL THE POSITIONS. CONTEMPORANEOUS MINUTES OF THE DEBATE AND DECISIONS ARE KEPT OF THE MEETINGS. THE PROCESS WAS LAST COMPLETED IN 2022.
Form 990, Part VI, Line 19 Required documents available to the publicTHE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part IX, Line 11g Other FeesOTHER MEDICAL EXPENSES - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 545658, Fundraising Expenses: 0;

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