2023-10-31T22:30:06+00:00 2023-03-31 346565596 ERNST & YOUNG US LLP 18101 VON KARMAN AVENUE IRVINE CA 92612 990 2022-04-01 953258674 Inter-Valley Health Plan Inc INTE 9097843400 300 S PARK AVE PO BOX 6002 300 POMONA CA 917696002 Bruce Bowne CFO, VP of Finance 9097843400 2023-10-31 true BRUCE BOWNE 999009999 true Kara Adams P00023315 9497942300 2023-10-16 2022 2023-04-26 12:10:37Z MIKE NELSON 300 S PARK AVE PO BOX 6002 300 POMONA CA 917696002 180339944 false X WWW.IVHP.COM X 1979 CA INTER 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. 14 14 121 0 0 0 0 0 260421563 180655704 148992 -315760 0 0 260570555 180339944 0 0 0 0 13037669 8805627 0 0 0 257143454 172796553 270181123 181602180 -9610568 -1262236 30003416 24687203 22890073 18414061 7113343 6273142 X INTER 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. false true 168518806 0 180655704 INTER 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. 168518806 false false false false false false false false false true false false false false false false false false false false false false false false false false false false true false false false false false false false false false false false false false false false false true 41 0 true 121 true false false false false false false false false X 14 14 true false false false false false false true true false false true true true true true true true true false CA X BRUCE BOWNE 9097843400 300 S PARK AVE STE 300 POMONA CA 917696002 CAROLE HARTER DIRECTOR 1.0 0.0 X 0 0 0 CURTIS W MORRIS DIRECTOR- 2ND VICE CHAIR 1.0 0.0 X 0 0 0 DUANE STYLES MD DIRECTOR 1.0 0.0 X 0 0 0 ELMER PINEDA MD DIRECTOR 1.0 0.0 X 0 0 0 FRANK GARCIA DIRECTOR 1.0 0.0 X 0 0 0 JAN BROWN DIRECTOR 1.0 0.0 X 0 0 0 KEVIN MCCARTHY DIRECTOR 1.0 0.0 X 0 0 0 MELISSA VOLLARO DIRECTOR 1.0 0.0 X 0 0 0 PAUL ORR MD DIRECTOR 1.0 0.0 X 0 0 0 RAKESH SINHA MD DIRECTOR 1.0 0.0 X 0 0 0 RICHARD FASS DIRECTOR - 1ST VICE CHAIR 1.0 0.0 X 0 0 0 RICHARD YOCHUM DIRECTOR 1.0 0.0 X 0 0 0 SONJA STUMP DIRECTOR 1.0 0.0 X 0 0 0 SUNIL SHIVARAM MD DIRECTOR 1.0 0.0 X 0 0 0 BRUCE BOWNE CFO,VP FIN,TREAS 40.0 0.0 X 288096 0 47024 KENNETH SMITH MD CMO 40.0 0.0 X 405164 0 21079 Michael Nelson President/CEO 20.0 0.0 X 0 0 0 PATRICIA JACOBSON VP HR,SECRETARY 40.0 0.0 X 235395 0 42530 SUSAN TENORIO COO 40.0 0.0 X 271887 0 45320 BILL CHEN CIO 40.0 0.0 X 227193 0 39097 LARRY BACA SALES, VP 40.0 0.0 X 159278 0 16297 GEORGETTA MCCLOUD CONTROLLER 40.0 0.0 X 161164 0 24193 KIM PORTER DIR CDI, REV RECO 40.0 0.0 X 175773 0 22584 MARK SOUTHWORTH DIR DS 40.0 0.0 X 310498 0 51488 ROBIN ZIEGLER PERF PRO AVP 40.0 0.0 X 206518 0 53885 RUBY VILLAROZA IBARROLA MANAGER, CDI 40.0 0.0 X 150326 0 17181 2591292 0 380678 20 false true false DESERT OASIS HEALTHCARE 275 N EL CIELO PALM SPRINGS CA 92262 MEDICAL SERVICE 65362363 POMONA VALLEY HOSPITAL MEDICAL CENTER 1798 N GAREY AVE POMONA CA 91767 MEDICAL SERVICES & LEASED EMPLOYEES 25185673 PROMED HEALTH NETWORK OF POMONA 4150 E CONCOURSE ST 100 ONTARIO CA 91764 MEDICAL SERVICES 24386482 EPIC HEALTH PLAN 1615 ORANGE TREE LANE REDLANDS CA 92374 MEDICAL SERVICES 15583614 Riverside Medical Clinic 7117 Brockton Ave Riverside CA 92506 Medical Services 4072463 35 0 PROVIDER SERVICES 524114 180655704 180655704 0 0 0 0 0 0 180655704 -315760 0 0 -315760 0 0 0 0 0 0 0 0 0 180339944 180655704 0 -315760 X 1586963 0 1586963 0 5712333 0 5712333 0 182298 0 182298 0 772791 0 772791 0 551242 0 551242 0 283926 0 283926 0 147500 0 147500 0 169064464 168518806 545658 0 13135 0 13135 0 17338 0 17338 0 677490 0 677490 0 512988 0 512988 0 2415 0 2415 0 15895 0 15895 0 86601 0 86601 0 369153 0 369153 0 Utilities 347717 0 347717 0 OUTSIDE SERVICES 749107 0 749107 0 Taxes and Licenses 126981 0 126981 0 BROKER COMMISSION 124914 0 124914 0 256929 0 256929 0 181602180 168518806 13083374 0 -513873 -50769 11518134 15032973 0 0 0 0 53000 0 11593500 9704999 15395767 15395767 86601 0 7266054 0 0 0 0 0 30003416 24687203 22890073 18414061 0 0 0 0 22890073 18414061 X 0 0 5647 5647 7107696 6267495 7113343 6273142 30003416 24687203 -1262236 422035 0 X false false false 2813218 2813218 0 7500877 7500877 0 5081672 5081672 0 0 X X X X true false false false false false false false false KENNETH SMITH MD CMO 171173 0 0 0 233991 0 12089 0 8990 0 426243 0 0 0 BRUCE BOWNE CFO,VP FIN,TREAS 283524 0 0 0 4572 0 11895 0 35129 0 335120 0 0 0 SUSAN TENORIO COO 250051 0 0 0 21836 0 9324 0 35996 0 317207 0 0 0 PATRICIA JACOBSON VP HR,SECRETARY 209241 0 0 0 26154 0 9586 0 32944 0 277925 0 0 0 BILL CHEN CIO 216480 0 0 0 10713 0 8954 0 30143 0 266290 0 0 0 LARRY BACA SALES, VP 92969 0 0 0 66309 0 1302 0 14995 0 175575 0 0 0 ROBIN ZIEGLER PERF PRO AVP 205283 0 0 0 1235 0 8517 0 45368 0 260403 0 0 0 MARK SOUTHWORTH DIR DS 159393 0 0 0 151105 0 8221 0 43267 0 361986 0 0 0 KIM PORTER DIR CDI, REV RECO 168988 0 0 0 6785 0 7201 0 15383 0 198357 0 0 0 GEORGETTA MCCLOUD CONTROLLER 160021 0 0 0 1143 0 6687 0 17506 0 185357 0 0 0 RUBY VILLAROZA IBARROLA MANAGER, CDI 148248 0 0 0 2078 0 3073 0 14108 0 167507 0 0 0 Schedule J, Part I, Line 4a Severance or change-of-control payment Due 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 III MICHAEL 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. Form 990, Part III, Line 3 Significant changes in program services DUE 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 persons DIRECTOR RICHARD YOCHUM AND CEO MICHAEL NELSON - Business relationship Form 990, Part VI, Line 11b Review of form 990 by governing body The 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 policy IN 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 official ANNUALLY, 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 public THE 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 Fees OTHER MEDICAL EXPENSES - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 545658, Fundraising Expenses: 0;