2022-05-03T07:48:11-05:00 2021-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2020-07-01 680008034 SURPRISE VALLEY HEALTH CARE DISTRICT SURP 5302796111 PO BOX 246 CEDARVILLE CA 96104 WILLIAM BOSTIC CEO 5302796111 2022-04-28 1 WILLIAM BOSTIC 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2022-04-28 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z WILLIAM BOSTIC PO BOX 246 CEDARVILLE CA 96104 9137773 0 X WWW.SVHOSPITAL.ORG X 1987 CA SVHCD IS AN ACUTE CARE FACILITY WITH AN ATTACHED LONG-TERM CARE UNIT AND RURAL HEALTH CLINIC SERVING A REMOTE, UNDERSERVED COMMUNITY OF APPROXIMATELY 1,500 PEOPLE STRIVING TO PROVIDE 24/7 ER, AMBULANCE, AND GENERAL HEALTH CARE TO ALL CITIZENS OF THE AREA. 5 5 85 5 0 0 2040900 1479574 4123505 5266658 2841 5785 920466 2385756 7087712 9137773 0 0 0 0 3586988 4138439 0 0 0 3080418 4371947 6667406 8510386 420306 627387 7210153 5751575 8061122 5922077 -850969 -170502 X SURPRISE VALLEY HEALTH CARE DISTRICT (SVHCD) IS AN ACUTE CARE FACILITY WITH AN ATTACHED LONG-TERM CARE UNIT AND RURAL HEALTH CLINIC SERVING A REMOTE, UNDERSERVED COMMUNITY OF APPROXIMATELY 1,500 PEOPLE STRIVING TO PROVIDE 24/7 EMERGENCY ROOM, AMBULANCE, AND GENERAL HEALTH CARE TO ALL CITIZENS OF THE AREA. 0 0 6303659 0 5430241 THE HOSPITAL PROVIDED INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES, INCLUDING 6,939 SKILLED NURSING PATIENT DAYS, 0 SWING-BED NURSING FACILITY DAYS, 202 EXTENDED CARE PATIENT DAYS, 24,175 LABORATORY TESTS, 85 AMBULANCE RUNS, 467 EMERGENCY ROOM VISITS, 582 X-RAYS, 487 PHYSICAL THERAPY VISITS, 2082 OUTPATIENT CLINIC VISITS. 6303659 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 25 0 85 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 1 1 0 X FRANCES D HANNAH 5302796111 PO BOX 246 CEDARVILLE CA 96101 JOHN ERQUIAGA PRESIDENT 1.00 X X 0 0 0 BRUCE TOZIER VICE PRESIDENT 1.00 X X 0 0 0 RAY GORZEL TREASURER 1.00 X X 0 0 0 SUSIE BUNYARD SECRETARY 1.00 X X 0 0 0 JEANIE GOLDMAN MEMBER AT LARGE 1.00 X X 0 0 0 WILLIAM BOSTIC CEO 30.00 X 48825 0 1416 GARY HAFFNER MEDICAL DIRECTOR 40.00 X 257087 0 0 JENNIFER HANOR LAB MANAGER 50.00 X 111774 0 4647 KIM STANLEY REGISTERED NURSE 50.00 X 178022 0 5745 WILLIAM TRUSNOVIC DOCTOR 40.00 X 137725 0 0 CLAIRE L BROWN LAMONTANGNE REGISTERED NURSE 50.00 X 125331 0 1185 858764 0 12993 5 0 1 0 ESP 72-877 DINAH SHORE DR RANCHO MIRAGE CA 92270 NURSING REGISTRY & OTHER PERSONEL 455581 WIPFLI PO BOX 3160 MILWAUKEE WI 532013160 ACCOUNTING SERVICES 213392 CPSI PO BOX 850309 MOBILE AL 366850309 EHR SUPPORT 120085 NPH 1801 FOUNDATION LANE CHICO CA 95928 NURSING REGISTRY & OTHER PERSONEL 106977 4 1469264 10310 1479574 NET PATIENT SERVICE REVENUE 621990 5266658 5266658 5266658 5785 5785 PROPERTY TAX REVENUE 900099 163583 163583 2222173 2222173 2385756 9137773 5430241 0 2227958 X 50241 50241 3402689 2696836 705853 403634 293332 110302 281875 221434 60441 32677 21555 11122 73325 73325 176371 176371 2080293 1958735 121558 98010 25750 72260 30977 280 30697 66250 17859 48391 22951 21600 1351 8224 2942 5282 363420 52658 310762 140678 140678 151097 151097 SUPPLIES EXPENSE 637797 561916 75881 FOOD EXPENSE 72732 71741 991 DUES & SUBSCRIPTIONS 64793 41670 23123 REPAIRS & MAINTENANCE 44093 20367 23726 308259 294984 13275 8510386 6303659 2206727 0 4220664 4722598 2430963 203532 162631 415300 140043 110305 28442 46864 3833696 3627867 226410 205829 1000 47147 7210153 5751575 2486203 2547091 1469264 0 2034655 651136 2071000 2723850 8061122 5922077 X -850969 -170502 -850969 -170502 7210153 5751575 627387 53080 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 721 721 0 PART II-B, LINE 1: ASSOCIATION OF CALIFORNIA HEALTHCARE DISTRICTS AND HEALTH COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA DUES. 57000 57000 2555540 2498212 57328 1221156 1129655 91501 205829 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS-NET 2722850 PATIENT FUND TRUST ACCOUNT 1000 2723850 1 1 X 1 X 1 X 1 0 0 2865005 2936582 0 0.00000 2865005 2936582 0 0.00000 2865005 2936582 0 0.00000 0 2494180 2491620 2560 X 1 0 1 1 SURPRISE VALLEY HEALTH CARE DISTRICT PO BOX 246 CEDARVILLE CA 96104 HTTP://SVHOSPITAL.ORG/ 230000025 X X X X SURPRISE VALLEY HEALTH CARE DISTRICT 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, SECTION C, LINE 7D X X 1 18 1 SEE PART V, SECTION C, LINE 7D 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X X 1 X HTTPS://SITES.GOOGLE.COM/VIEW/SVHEALTHCAREDISTRICT/FINANCIAL-ASSISTANCE X HTTPS://SITES.GOOGLE.COM/VIEW/SVHEALTHCAREDISTRICT/FINANCIAL-ASSISTANCE X HTTPS://SITES.GOOGLE.COM/VIEW/SVHEALTHCAREDISTRICT/FINANCIAL-ASSISTANCE X X X X X X 1 0 X X X X 1 X 0 0 SURPRISE VALLEY HEALTH CARE DISTRICT PART V, SECTION B, LINE 5: WE HAD SEVERAL CHNA MEETINGS WITH MEMBERS OF THE COMMUNITY WHO WISHED TO PARTICIPATE. SURPRISE VALLEY HEALTH CARE DISTRICT PART V, SECTION B, LINE 7D: PART V, SECTION C, LINE 7A & 10A:HTTPS://SITES.GOOGLE.COM/VIEW/SVHEALTHCAREDISTRICT/2018-2019-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-AND-STRATEGIC-PLAN?AUTHUSER=0 SURPRISE VALLEY HEALTH CARE DISTRICT PART V, SECTION B, LINE 11: PRIORITY ONE: IMPROVE PUBLIC PERCEPTION OF THE HOSPITAL AND IMPROVE THE HEALTH OF THE COMMUNITY THROUGH HEALTH FAIRS. THIS PRIORITY WAS ONE THE HOSPITAL ALREADY HAD IN THE WORKS. IT IS APPARENT THAT THIS SERVICE TO THE COMMUNITY COULD ALSO IMPROVE THE HEALTH IN THE COMMUNITY AND INCREASE AWARENESS OF SERVICES THE HOSPITAL PROVIDES THAT PEOPLE ARE UNAWARE OF.ACTIONS TO BE TAKEN:1. CONDUCT A CHILDREN'S FOCUS HEALTH FAIR IN CONJUNCTION WITH THE SCHOOL THAT WILL HELP WITH IMMUNIZATIONS AND PHYSICALS.2. HAVE SCREENINGS FOR ADULTS AS WELL AND INTRODUCE THEM TO ADDITIONAL SERVICES WE HAVE.3. PROMOTE THE TELE-HEALTH SERVICES WE JUST RESTORED.4. PROMOTE THE PHYSICAL THERAPY DEPARTMENT.5. PROMOTE THE LABORATORY.PRIORITY TWO: DEVELOP AND PROMOTE LAB SERVICES. THROUGH SURVEYS, THE HOSPITAL REALIZED THAT MANY PEOPLE ARE UNAWARE OF THIS VALUABLE SERVICE AND NOT UTILIZING THE LAB TO ITS FULLEST. THE HOSPITAL FEELS THAT MAKING PEOPLE AND PHYSICIANS AWARE OF THIS DEVICE WILL IMPROVE THE OVERALL HEALTH OF THE COMMUNITY.ACTIONS TO TAKE:1. ADVERTISE THE EXISTING LAB SERVICES.2. PROMOTE PREVENTATIVE CARE PROGRAM BASED ON LAB WORK.3. EDUCATE PHYSICIANS ON THE BENEFITS OF HAVING LAB WORK DONE.4. EDUCATE PHYSICIANS AND THE COMMUNITY ON LABS AS PRE AND POST WORK FOR SPECIALTY SERVICES.5. PROMOTE THE QUALITY OF OUR LAB.PRIORITY THREE: MARKETING OF EXISTING SERVICES. THE HOSPITAL HAS STRUGGLED THE LAST FEW YEARS WITH THE DECLINE IN POPULATION AND ALSO THE FACT THAT THE HOSPITAL WENT THROUGH MANAGEMENT CHANGES AND A POTENTIAL BUY OUT. DURING THIS TIME TRUST IN THE HOSPITAL DECLINED AND PEOPLE BEGAN GOING ELSEWHERE FOR SERVICES. THE HOSPITAL HAS BROUGHT BACK SERVICES LIKE AMBULANCE SERVICES, PHYSICAL THERAPY, TELE-BEHAVIORAL HEALTH. IN ADDITION SERVICES TO VETERANS ARE UNDERUTILIZED.ACTIONS TO TAKE:1. PROMOTE PHYSICAL THERAPY DEPARTMENT2. PROMOTE THE RETURN OF BEHAVIORAL HEALTH PROGRAM3. PROMOTE THE GREAT WORK AND SERVICE THE HOSPITAL IS DOING WITH VETERANS4. ADVERTISE THE GOOD THE HOSPITAL'S AMBULANCE SERVICE IS DOINGADDITIONAL PRIORITIES: ONE OF THE MAJOR CHALLENGES THE HOSPITAL FACES IS BRINGING BACK THE HOSPITAL TO A VIABLE FACILITY. THEY ARE STAFFED TO DO SO AND ARE ANALYZING WAYS IN WHICH THEY CAN SERVE THE POPULATION BETTER AND TO BRING IN PEOPLE FROM OUTSIDE THE SERVICE AREA. SURPRISE VALLEY HEALTH CARE DISTRICT PART V, SECTION B, LINE 15E: APPLICATION, PROOF OF INCOME, BANK STATEMENTS SURPRISE VALLEY HEALTH CARE DISTRICT PART V, SECTION B, LINE 24: THE HOSPITAL CHARGES ALL OF ITS PATIENTS THE SAME RATES. HOWEVER, DISCOUNTS FOR CHARITY CARE ARE ALLOCATED TO CHARGES AFTER THE PATIENT HAS APPLIED FOR CHARITY ASSISTANCE. 1 1 - SURPRISE VALLEY RURAL HEALTH CLINIC 741 N MAIN STREET CEDARVILLE CA 96104 RURAL HEALTH CLINIC PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 41,388. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL WAS NOT ABLE TO PROVIDE ANY COMMUNITY BUILDING ACTIVITIES DUE TO THE ECONOMIC DOWNTURN. PART III, LINE 4: WHILE THE FACILITY DOES NOT HAVE A NOTE REGARDING BAD DEBT EXPENSE IN ITS FINANCIAL STATEMENTS, THE AMOUNT OF BAD DEBT EXPENSE FOR EACH YEAR IS DISCLOSED ON THE FACILITY'S STATEMENTS OF REVENUE AND EXPENSES. THE AMOUNT OF BAD DEBT EXPENSE REPORTED WAS ($41,388) FOR THE YEAR ENDED JUNE 30, 2021. PART III, LINE 8: ANY SHORTFALL IS CONSIDERED FULLY ATTRIBUTABLE TO COMMUNITY BENEFITS. THE HOSPITAL'S MEDICARE COST REPORT WAS USED TO DETERMINE THE TOTAL REVENUE RECEIVED FROM MEDICARE, THE MEDICARE ALLOWABLE COSTS OF CARE RELATING TO THE PAYMENTS, AND THE SURPLUS.THE COSTING METHODOLOGY USED ON THE MEDICARE COST REPORT IS BASED ON CALCULATED COST TO CHARGE RATIOS. PART III, LINE 9B: EVERY REASONABLE EFFORT IS MADE TO DETERMINE THE PATIENT'S ABILITY TO PAY AND TO GIVE PATIENTS INFORMATION ABOUT OUR CHARITY CARE POLICIES. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH PUBLIC MEETINGS, BOARD MEETINGS, PERFORMANCE IMPROVEMENT AND QUALITY ASSURANCE MEETINGS, AND ACUTE CARE PATIENT QUESTIONNAIRES. PART VI, LINE 3: THE HOSPITAL PROVIDES PATIENT'S RIGHTS INFORMATION AND COLLECTS ADMISSIONS CRITERIA INFORMATION FROM PATIENTS TO ASSIST THE PATIENT IN UNDERSTANDING THEIR ELIGIBILITY OF ASSISTANCE. PART VI, LINE 4: THE FACILITY SERVES A RURAL, REMOTE AREA CONSISTING OF UNDERSERVED, FARMING, RANCHING, BUREAU OF LAND MANAGEMENT, FOREST SERVICE, SMALL SCHOOLS, SMALL BUSINESSES, TOURIST TRADE, LOW INCOME, RETIRED AND SEMI-RETIRED RESIDENTS. PART VI, LINE 5: THE HOSPITAL DOES NOT HAVE SURPLUS FUNDS. WHEN ECONOMICALLY ABLE, THE HOSPITAL WILL HOLD HEALTH FAIRS WHERE FREE OR REDUCED PRICES ARE OFFERED. PART VI, LINE 6: THE HOSPITAL IS NOT AFFILIATED WITH ANY OTHER HEALTH CARE SYSTEM. INDEPENDENT HEALTH CARE DISTRICT. PART VI, LINE 7, REPORTS FILED WITH STATES CA 0 0 0 0 0 0 0 0 0 GARY HAFFNER MEDICAL DIRECTOR 257087 0 0 0 0 0 0 0 0 0 257087 0 0 0 KIM STANLEY REGISTERED NURSE 178022 0 0 0 0 0 0 0 5745 0 183767 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 IS PROVIDED TO MANAGEMENT FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO THE BOARD OF DIRECTORS; IF THERE IS A CONFLICT, THAT BOARD MEMBER ASTAINS FROM VOTING ON AN ACTION ITEM. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD DETERMINES THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL USING VARIOUS COMPENSATION DATA FOR THE HEALTH CARE INDUSTRY. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE PUT ON OUR WEBSITE. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 117,577. MANAGEMENT AND GENERAL EXPENSES 121,558. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 239,135. NURSING SERVICES: PROGRAM SERVICE EXPENSES 974,952. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 974,952. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 640,025. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 640,025. LAB & RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 226,181. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 226,181.