SISKIYOU HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SISKIYOU HOSPITAL INC (EIN 94-1623075)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202203189349318590
- Schema version
- 2021v4.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T16:10:26-08:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 680146027 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AGT CPAS AND ADVISORS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 N MOUNT SHASTA BLVD STE 300 | AddressLine1Txt |
| City | MOUNT SHASTA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96067 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941623075 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SISKIYOU HOSPITAL INC | BusinessNameLine1Txt |
| Business Name Line2 | DBA FAIRCHILD MEDICAL CENTER | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SISK | BusinessNameControlTxt |
| Phone | 5308424121 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 444 BRUCE STREET | AddressLine1Txt |
| City | YREKA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96097 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KELLY MARTIN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KELLY | PersonFirstNm |
| Person Last | MARTIN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lynn E Teuscher CPA | PreparerPersonNm |
| PTIN | P00154021 | PTIN |
| Phone | 5309263881 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Federated Assurance Level | FAL1 | FederatedAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KELLY MARTIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 444 BRUCE STREET | AddressLine1Txt |
| City | YREKA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96097 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $102,051,246 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAIRCHILDMED.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1962 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | FAIRCHILD MEDICAL CENTER OFFERS PRIMARY & SPECIALTY SERVICES INCLUDING MEDICAL, SURGICAL, ORTHOPEDIC, EMERGENCY, OBSTETRICAL, PEDIATRIC CARE, OUTPATIENT CLINIC, & OTHER SPECIALTIES AVAILABLE THROUGH TELEMEDICINE, OUR FOCUS IS TO PROVIDE LOCAL ACCESS TO HIGH QUALITY HEALTH CARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 17 | VotingMembersIndependentCnt |
| Total Employee | 625 | TotalEmployeeCnt |
| Total Volunteers | 39 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $95,004,591 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $101,677,110 | CYProgramServiceRevenueAmt |
| PY Investment Income | $591,245 | PYInvestmentIncomeAmt |
| CY Investment Income | $374,136 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,872,258 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $97,468,094 | PYTotalRevenueAmt |
| CY Total Revenue | $102,051,246 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $45,933,209 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $51,427,615 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $49,833,698 | PYOtherExpensesAmt |
| CY Other Expenses | $49,597,578 | CYOtherExpensesAmt |
| PY Total Expenses | $95,766,907 | PYTotalExpensesAmt |
| CY Total Expenses | $101,025,193 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,701,187 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,026,053 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $82,078,640 | TotalAssetsBOYAmt |
| Total Assets EOY | $82,691,725 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $14,013,163 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,600,195 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $68,065,477 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $69,091,530 | NetAssetsOrFundBalancesEOYAmt |
| Mission | FAIRCHILD MEDICAL CENTER OFFERS PRIMARY & SPECIALTY SERVICES INCLUDING MEDICAL, SURGICAL, ORTHOPEDIC, EMERGENCY, OBSTETRICAL, PEDIATRIC CARE, OUTPATIENT CLINIC, & OTHER SPECIALTIES AVAILABLE THROUGH TELEMEDICINE, OUR FOCUS IS TO PROVIDE LOCAL ACCESS TO HIGH QUALITY HEALTH CARE SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $98,184,870 | ExpenseAmt |
| Revenue | $101,677,110 | RevenueAmt |
| Desc | 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 1,320 inpatients and provided more than 125,000 outpatient services during 2021.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 $13,051,493. To the extent reimbursement is below cost, Fairchild Medical Center recognizes these amounts as a service to the community in meeting its mission.Fairchild Medical Center currently has Medicare reimbursement reduced 2% to an amount below cost. In 2021, reimbursement was reduced $122,154.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 throughout 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 2020, total charges written off for Charity Care were $1,374,014 with a cost associated with charity at $611,205 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. The Rural Health Clinic provides Dental services for indigent patients. Organization and management of the Fairchild Medical Center 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 $50,160.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. 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 $105,000 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. | Desc |
| Total Program Service Expenses | $98,184,870 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 50 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 625 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 17 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FINANCE DEPARTMENT | PersonNm |
| Phone | 5308424121 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 444 BRUCE STREET | AddressLine1Txt |
| City | YREKA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96097 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| JONATHON ANDRUS | |||||||
| CEO | 40.00 | 0.00 | Yes (X) | $399,838 | $0 | $63,313 | |
| KELLY MARTIN | |||||||
| CFO | 40.00 | 0.00 | Yes (X) | $212,102 | $0 | $58,609 | |
| CHRISTOPHER RICHMOND | |||||||
| PHARMACIST | 40.00 | 0.00 | $203,698 | $0 | $49,653 | ||
| ORRIN RICE | |||||||
| ORTHO PHY ASSNT | 40.00 | 0.00 | $191,162 | $0 | $51,332 | ||
| SUSAN WESTPHAL | |||||||
| ASST ADMIN | 40.00 | 0.00 | $182,109 | $0 | $54,993 | ||
| MICHAEL MADDEN | |||||||
| ASST ADMIN | 40.00 | 0.00 | $205,056 | $0 | $10,696 | ||
| Lau Mui | |||||||
| Pharmacist | 40.00 | 0.00 | $193,908 | $0 | $16,825 | ||
| MICHAEL MALONEY MD | |||||||
| CHIEF OF STAFF | 6.00 | 1.00 | Yes (X) | $18,000 | $0 | $0 | Yes (X) |
| LARRY MULLOY | |||||||
| Chairman | 8.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DARRIN MERCIER | |||||||
| VICE-CHAIRMAN | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DWAYNE JONES | |||||||
| SECRETARY/TRES | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| William Broeckel MD | |||||||
| StaffChiefElect | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JEROME TRES CHURCHILL III | |||||||
| MEMBER AT LARGE | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| LOUIS DEROUCHEY MD | |||||||
| Director | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| DAWNA COZZALIO | |||||||
| Director | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| CARRIE HAYDEN | |||||||
| Director | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| JAY QUISENBERRY | |||||||
| Director | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| DOUGLAS LANGFORD DDS | |||||||
| Director | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| JUDY BAKER | |||||||
| Director | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| KRISTI VON TICKNER | |||||||
| Director | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| DEANNE TERRY | |||||||
| Director | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| Patricia Laustalot | |||||||
| Director-Former | 1.00 | 0.00 | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,605,873 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $305,421 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Healthcare ISMRI Contracting | |||||
| PO BOX 942 | Worcester | MA | 01613 | MRI Contracting | $554,716 |
| Triage LLC | |||||
| PO Box 773328 | Chicago | IL | 60677 | STAFFING SERVICE | $941,752 |
| LRS Healthcare | |||||
| PO BOX 850781 | Minneapolis | MN | 55485 | STAFFING SERVICE | $1,069,343 |
| SISKIYOU PROFESSIONAL MEDICAL SERVICES | |||||
| 202 N OREGON ST | YREKA | CA | 96097 | PHYSICIAN GROUP | $7,859,342 |
| Medical Solutions | |||||
| PO Box 850737 | Minneapolis | MN | 55485 | STAFFING SERVICE | $1,676,936 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA | 722514 | $278,585 | $278,585 | |
| Gift Shop | 453220 | $29,477 | $29,477 | |
| MISCELLANEOUS PROGRAM REV | 900099 | $130,934 | $130,934 | |
| NET PATIENT SERVICE REV | 900099 | $101,228,217 | $101,228,217 | |
| VIRTUAL | 900099 | $7,945 | $7,945 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,952 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,952 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $101,677,110 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $374,136 | TotalRevenueColumnAmt |
| Exclusion | $374,136 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $102,051,246 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $101,398,525 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $652,721 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $751,862 | TotalAmt |
| Management And General | $751,862 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,092,388 | TotalAmt |
| Program Services | $35,742,270 | ProgramServicesAmt |
| Management And General | $350,118 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,751,708 | TotalAmt |
| Program Services | $11,651,071 | ProgramServicesAmt |
| Management And General | $100,637 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,831,657 | TotalAmt |
| Program Services | $2,699,970 | ProgramServicesAmt |
| Management And General | $131,687 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,672,322 | TotalAmt |
| Program Services | $20,946,089 | ProgramServicesAmt |
| Management And General | $726,233 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,178,318 | TotalAmt |
| Program Services | $5,178,318 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OTHER EXPENSES | $16,337,736 | $15,623,662 | $714,074 |
| SUPPLIES | $4,137,575 | $4,071,863 | $65,712 |
| BAD DEBT EXPENSE | $2,271,627 | $2,271,627 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,025,193 | TotalAmt |
| Program Services | $98,184,870 | ProgramServicesAmt |
| Management And General | $2,840,323 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,870,610 | BOYAmt |
| EOY | $39,914,744 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,406,044 | BOYAmt |
| EOY | $16,299,698 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,627,866 | BOYAmt |
| EOY | $1,822,340 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $998,600 | BOYAmt |
| EOY | $839,917 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $83,811,588 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $60,731,818 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,610,860 | BOYAmt |
| EOY | $23,079,770 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $564,660 | BOYAmt |
| EOY | $735,256 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,078,640 | BOYAmt |
| EOY | $82,691,725 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,050,214 | BOYAmt |
| EOY | $8,637,246 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,962,949 | BOYAmt |
| EOY | $4,962,949 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,013,163 | BOYAmt |
| EOY | $13,600,195 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,065,477 | BOYAmt |
| EOY | $69,091,530 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,065,477 | BOYAmt |
| EOY | $69,091,530 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,078,640 | BOYAmt |
| EOY | $82,691,725 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,026,053 | ReconcilationRevenueExpnssAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed Section4955 Tax | false | Form4720FiledSection4955TaxInd |
| Correction Made | false | CorrectionMadeInd |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $3,795 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,795 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 PORTION OF THE DUES THAT RELATES TO LOBBYING IS $3,795. |
| Part IV - Additional Information |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $702,123 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $158,667 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $860,790 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $747,446 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$45,323 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $702,123 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $358,173 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $389,273 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $747,446 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $381,572 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$23,399 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $358,173 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $331,605 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $49,967 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $381,572 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,911,590 | OtherCostOrOtherBasisAmt |
| Book Value | $4,911,590 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,927,808 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,490,310 | DepreciationAmt |
| Book Value | $5,437,498 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $511,292 | OtherCostOrOtherBasisAmt |
| Depreciation | $373,903 | DepreciationAmt |
| Book Value | $137,389 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $55,460,898 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,867,605 | DepreciationAmt |
| Book Value | $12,593,293 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $23,079,770 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $102,051,246 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $102,051,246 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $102,051,246 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $101,025,193 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $101,025,193 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $101,025,193 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2021 and 2020, 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 material tax benefits will not be realized.The Corporation, Hospital, Foundation, SOMI and TVI file tax returns in the U.S. federal jurisdiction. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $611,161 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $611,161 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,022,552 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,972,992 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,049,560 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12920 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,633,713 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,972,992 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,660,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13520 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $50,160 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $50,160 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $50,160 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $50,160 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,683,873 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,972,992 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,710,881 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13570 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $999,516 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $37,223,756 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $37,564,738 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$340,982 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | false | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRCHILD MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 444 BRUCE STREET | AddressLine1Txt |
| City | YREKA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96087 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 2300035 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.0000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Facility: - Part V, Section B, Line 5 | INFORMATION COLLECTED FROM INDUSTRY MEDICAL MARKETING CONTRACTOR. |
| Facility: - Part V, Section B, Line 11 | DRUG ABUSE - NOT A MEDICAL SOLUTION THE HOSPITAL COULD ASSIST WITH |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $2,271,627, 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, Line 2 - Needs Assessment | THE HOSPITAL HAS THEIR SERVICE AREA EVALUATED FOR WHAT SPECIALTIES AND WHAT NUMBER OF PHYSICIANS THAT ARE NEEDED. |
| Part VI, Line 3 - Patient Education of Eligibility for Assistance | INSTRUCTIONS ABOUT CHARITY CARE POLICY ARE SENT HOME WITH ALL PRIVATE PAY PATIENTS. |
| Part VI, Line 4 - Community Information | WITH THE MOST RECENT INFORMATION SISKIYOU COUNTY HAS A MEDIAN INCOME OF $47,403, AND A 16.9% POVERTY RATE. THE HOSPITAL IS IN AN AREA DESIGNATED AS HEALTHCARE PROFESSIONAL AREA (HPSA). |
| Part VI, Line 4 - Community Building Activities | OPEN MEDICAL STAFF, COMMUNITY BOARD, AND SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| CHRISTOPHER RICHMOND | |||||
| PHARMACIST | $203,198 | $500 | $7,667 | $41,986 | $253,351 |
| JONATHON ANDRUS | |||||
| CEO | $249,338 | $150,500 | $17,400 | $45,913 | $463,151 |
| KELLY MARTIN | |||||
| CFO | $161,602 | $50,500 | $12,696 | $45,913 | $270,711 |
| Lau Mui | |||||
| Pharmacist | $193,408 | $500 | $1,520 | $15,305 | $210,733 |
| MICHAEL MADDEN | |||||
| ASST ADMIN | $204,556 | $500 | $10,696 | $215,752 | |
| ORRIN RICE | |||||
| ORTHO PHY ASSNT | $186,662 | $4,500 | $5,419 | $45,913 | $242,494 |
| SUSAN WESTPHAL | |||||
| ASST ADMIN | $181,609 | $500 | $9,080 | $45,913 | $237,102 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a: Relevant information in regards to selections on 1a. | |
| Part III, Additional Information | PART I, LINE 1A - THE HOSPITAL INCURRED $5,530 IN EXPENSES FOR SENDING THE BOARD MEMBERS' SPOUSES TO A GOVERNANCE INSTITUTE MEETING. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | F J HAYDEN - FAMILY RELATIONSHIPKORY HAYDEN - FAMILY RELATIONSHIP |
| 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 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (true) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SISKIYOU OFFICE MANAGEMENT INC | |||||||||
| 444 BRUCE STREET | YREKA | CA | 96097 | 680356165 | CLINIC MGMT | CA | TRI-VALLEY INC | C CORP | Yes (true) |
| TVI REAL ESTATE INC | |||||||||
| 444 BRUCE STREET | YREKA | CA | 96097 | 680437309 | REAL ESTATE | CA | TRI-VALLEY INC | C CORP | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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