2021-11-15T11:34:54-08:00 2020-12-31 680146027 AGT CPAS AND ADVISORS 205 N MOUNT SHASTA BLVD STE 300 MOUNT SHASTA CA 96067 990 2020-01-01 941623075 SISKIYOU HOSPITAL INC DBA FAIRCHILD MEDICAL CENTER SISK 5308424121 444 BRUCE STREET YREKA CA 96097 KELLY MARTIN CFO 2021-11-15 true KELLY MARTIN 999009999 Lynn E Teuscher CPA P00154021 5309263881 2 AAL1 IAL1 FAL1 2020 2022-09-23 18:48:47Z KELLY MARTIN 444 BRUCE STREET YREKA CA 96097 97468094 false X WWW.FAIRCHILDMED.ORG X 1962 CA 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. 17 17 614 50 0 40100 0 101512135 95004591 322137 591245 2627966 1872258 104502338 97468094 6511471 0 0 42953416 45933209 0 0 44071327 49833698 93536214 95766907 10966124 1701187 66598229 65885300 8589049 6897264 58009180 58988036 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. false false 94087931 96571278 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 1,246 inpatients and provided more than 125,000 outpatient services during 2020.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 $10,417,772. 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 2020, reimbursement was reduced $79,954.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 $995,049 with a cost associated with charity at $412,279 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. (See Attachment)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. 94087931 true false false true false false false false false true true false false false false true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true false false false true 46 0 true 614 true false false false false false false false 0 false false false false false false false X 17 17 true false false false true true false true true false false true true true true true true true true false X FINANCE DEPARTMENT 5308424121 444 BRUCE STREET YREKA CA 96097 JONATHON ANDRUS CEO 40.00 0.00 X 383388 0 56880 KELLY MARTIN CFO 40.00 0.00 X 204209 0 51955 CHRISTOPHER RICHMOND PHARMACIST 40.00 0.00 201256 0 45271 SUSAN WESTPHAL ASST ADMIN 40.00 0.00 177611 0 51761 ORRIN RICE ORTHO PHY ASSNT 40.00 0.00 171845 0 46356 ROBERT MATZEN PHARMACIST 40.00 0.00 175156 0 32846 MICHAEL MADDEN ASST ADMIN 40.00 0.00 192078 0 9539 CARRIE HAYDEN Director 1.00 1.00 X 19200 0 0 MICHAEL MALONEY MD CHIEF OF STAFF 6.00 1.00 X X 18000 0 0 DOUGLAS LANGFORD DDS Director 1.00 1.00 X 12700 0 0 LARRY MULLOY Chairman 8.00 0.00 X X 0 0 0 DARRIN MERCIER VICE-CHAIRMAN 1.00 1.00 X X 0 0 0 DWAYNE JONES SECRETARY/TRES 1.00 1.00 X X 0 0 0 CHRISTAL DUNCAN MD PAST CHF/STAFF 6.00 1.00 X X 0 0 0 JEROME TRES CHURCHILL III MEMBER AT LARGE 1.00 1.00 X 0 0 0 SHERRY CRAWFORD Director 1.00 1.00 X 0 0 0 LOUIS DEROUCHEY MD Director 1.00 1.00 X 0 0 0 DAWNA COZZALIO Director 1.00 1.00 X 0 0 0 JAY QUISENBERRY Director 1.00 1.00 X 0 0 0 JUDY BAKER Director 1.00 1.00 X 0 0 0 KRISTI VON TICKNER Director 1.00 1.00 X 0 0 0 DEANNE TERRY Director 1.00 1.00 X 0 0 0 1555443 294608 7 false true false SCRIBE AMERICA LLC PO BOX 417756 BOSTON MA 022417756 LIVE DICTATION 433551 STOLTENBERG CONSULTING INC 5815 LIBRARY ROAD BETHEL PARK PA 15102 IT CONSULTING 385689 ONESTAFF MEDICAL LLC PO BOX 3544 OMAHA NE 68103 STAFFING SERVICE 411362 SISKIYOU PROFESSIONAL MEDICAL SERVICES 202 N OREGON ST YREKA CA 96097 PHYSICIAN GROUP 6392886 PERSONAL PREFERENCE 150 BOLES ST A WEED CA 96097 STAFFING SERVICE 750761 5 0 CAFETERIA 722210 305571 305571 MEDICAL RECORDS 900099 1894 1894 MISCELLANEOUS PROGRAM REV 900099 31072 31072 NET PATIENT SERVICE REV 900099 94661929 94661929 VIRTUAL 900099 4125 4125 95004591 591245 591245 0 0 0 0 0 0 0 INCENTIVE REVENUE 624100 1872258 1872258 1872258 97468094 96571278 896816 X 0 0 0 0 727132 727132 0 34740094 34377321 362773 0 5697859 5511480 186379 4768124 4659999 108125 0 0 0 0 0 0 21966325 21671758 294567 0 0 0 0 0 0 0 0 0 0 5696979 5696979 0 SUPPLIES 11597672 11597672 OTHER EXPENSES 6524943 6524943 BAD DEBT EXPENSE 4047779 4047779 0 95766907 94087931 1678976 0 0 25090199 34635298 0 16919508 7213970 0 0 0 1626536 1627866 622601 999623 76135022 55553500 21587721 20581522 751664 827021 0 0 0 0 66598229 65885300 8184710 6897264 404339 8589049 6897264 X 58009180 58988036 58009180 58988036 66598229 65885300 1701187 -722331 X X false true X true false X false false false false false false false false false false true 4516 4516 false false 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 $4,516. 747446 -45323 702123 358173 389273 747446 381572 -23399 358173 331605 49967 381572 286219 45386 331605 0.63600 0.36400 false true true 185023 185023 22634666 16610721 6023945 119272 119272 48752090 38582452 10169638 4443971 241055 4202916 20581522 X 97468094 97468094 97468094 95766907 95766907 95766907 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, 2020 and 2019, 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. true true true X true X true true false false true true 288275 288275 0.00300 24758030 14342088 10415942 0.10880 25046305 14342088 10704217 0.11180 50160 50160 0.00050 50160 50160 0.00050 25096465 14342088 10754377 0.11230 true 1677119 40551491 40631445 -79954 X true false 1 1 FAIRCHILD MEDICAL CENTER 444 BRUCE STREET YREKA CA 96087 2300035 X X X X false false true X X X X X X X 19 true false false true X true 19 false false false true X 100.0000 350.0000 X X X X true true X X X X true X X true X false X X X X true X false false 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 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 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 $4,047,779, 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 $45,241, AND A 17.4% 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. true true X X X false false false false false false false false false CHRISTOPHER RICHMOND PHARMACIST 199956 1300 5999 39272 246527 JONATHON ANDRUS CEO 332738 50650 17100 39780 440268 KELLY MARTIN CFO 202909 1300 12175 39780 256164 MICHAEL MADDEN ASST ADMIN 190778 1300 9539 201617 ORRIN RICE ORTHO PHY ASSNT 170545 1300 3411 42945 218201 ROBERT MATZEN PHARMACIST 174506 650 10470 22376 208002 SUSAN WESTPHAL ASST ADMIN 176311 1300 8816 42945 229372 Part III, Additional Information PART I, LINE 1A - THE HOSPITAL INCURRED NO EXPENSES FOR SENDING THE BOARD MEMBERS' SPOUSES TO A GOVERNANCE INSTITUTE MEETING. DUE TO COVID NO TRAVEL OCCURED THIS YEAR. 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 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 true SISKIYOU OFFICE MANAGEMENT INC 444 BRUCE STREET YREKA CA 96097 680356165 CLINIC MGMT CA TRI-VALLEY INC C CORP 790009 13399752 true TVI REAL ESTATE INC 444 BRUCE STREET YREKA CA 96097 680437309 REAL ESTATE CA TRI-VALLEY INC C CORP 1314879 true false true false false false false false false false false false false false false false false false false false