2013-02-13T07:52:28-06:00 2012-06-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2011-07-01 390993000 SPRING VALLEY HEALTH CARE SERVICES INC SPRI 7157785545 S830 WESTLAND DRIVE SPRING VALLEY WI 54767 KEVIN LARSON 7157785545 2013-02-09 1 HOLLY POKRANDT CPA P00449155 7158323407 2013-02-09 2011 2016-03-07 17:11:31Z KEVIN LARSON S830 WESTLAND DRIVE SPRING VALLEY WI 54767 5972094 0 X WWW.SVHCS.ORG X 1970 WI THE MISSION OF SPRING VALLEY HEALTH CARE SERVICES, INC. IS TO PROVIDE HEALTH AND ASSISTIVE SERVICES TO ELDERLY AND DISABLED PERSONS IN NEED OF THE SPRING VALLEY HEALTH CARE SERVICES PROGRAMS IN A MANNER THAT IS CHARITABLE AND WITH A SPIRIT OF BENEVOLENCE SO THAT AN INDIVIDUAL MAY MAINTAIN THE HIGHEST PRACTICABLE QUALITY OF LIFE, THE UTMOST INDEPENDENCE, AND THE MOST REASONABLE SAFE AND HEALTHY LIFESTYLE. 3 3 210 150 91272 -110985 5603 82494 4874758 5769624 943 7408 0 112568 4881304 5972094 0 0 0 0 3931892 3968246 0 0 0 1192519 1935556 5124411 5903802 -243107 68292 9819857 10945668 9003976 10061495 815881 884173 X THE MISSION OF SPRING VALLEY HEALTH CARE SERVICES, INC. IS TO PROVIDE HEALTH AND ASSISTIVE SERVICES TO ELDERLY AND DISABLED PERSONS IN NEED OF THE SPRING VALLEY HEALTH CARE SERVICES PROGRAMS IN A MANNER THAT IS CHARITABLE AND WITH A SPIRIT OF BENEVOLENCE SO THAT AN INDIVIDUAL MAY MAINTAIN THE HIGHEST PRACTICABLE QUALITY OF LIFE, THE UTMOST INDEPENDENCE, AND THE MOST REASONABLE SAFE AND HEALTHY LIFESTYLE. 0 0 3681839 3918224 SPRING VALLEY HEALTH CARE SERVICES, INC. OPERATES A 50-BED SKILLED NURSING FACILITY WHICH IS AVAILABLE TO RESIDENTS OF SPRING VALLEY AND THE SURROUNDING AREAS. PERSONALIZED NURSING CARE, REHABILITATIVE SERVICES, AND SUPPORTIVE SERVICES ARE OFFERED TO PROMOTE AND ASSIST RESIDENTS RECUPERATION FROM ILLNESS, INJURY, OR SURGERY. DURING FISCAL YEAR 2012, THE NURSING FACILITY PROVIDED 16,245 RESIDENT DAYS. 951436 1228715 SPRING VALLEY HEALTH CARE SERVICES, INC. ALSO PROVIDES HOME HEALTH CARE SERVICES TO MEMBERS OF THE COMMUNITY AND SURROUNDING AREAS. 613342 643981 SPRING VALLEY HEALTH CARE SERVICES, INC IS THE SOLE CORPORATE MEMBER OF VALLEY VILLAS, LLC. VALLEY VILLAS, LLC WAS ORGANIZED AS A DISREGARDED ENTITY FOR THE PURPOSE OF OPERATING A 20-UNIT RESIDENTIAL CARE APARTMENT COMPLEX, WHICH OPENED IN JULY 2010. 210369 91272 SPRING VALLEY HEALTH CARE SERVICES, INC. PROVIDES CHILD CARE SERVICES TO CHILDREN RANGING IN AGE FROM 6 WEEKS TO 6 YEARS THROUGH ITS LICENSED DAY CARE, SUNSHINE CHILD CARE AND LEARNING CENTER. 210369 91272 5456986 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 18 0 1 210 1 1 1 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 0 0 WI X KEVIN LARSON 7157785545 S830 WESTLAND DRIVE SPRING VALLEY WI 54767 ROSS KEEHR 1.00 X 0 0 0 BRIAN DUCKLOW 1.00 X 0 0 0 MARSHA BRUNKHORST 1.00 X 0 0 0 KEVIN LARSON 40.00 X 72428 0 12282 72428 0 12282 0 0 0 0 0 75000 7494 82494 NURSING HOME REVENUE 623000 3889260 3889260 HOME HEALTH REVENUE 621610 1228715 1228715 ASSISTED LIVING REVENU 623990 531413 531413 CHILD CARE REVENUE 624410 91272 91272 NURSING ASSISTANT TRAI 623000 28964 28964 5769624 447 447 6961 0 6961 6961 6961 WHEDA LOAN FORGIVENESS 623990 112568 112568 112568 5972094 5790920 91272 7408 88895 88895 3109718 3038824 70894 531853 518945 12908 237780 226772 11008 9411 9411 12100 12100 80130 80130 131481 131481 9693 9693 482194 378894 103300 590084 590084 19492 17473 2019 2206 1066 1140 312795 312795 38716 38716 BAD DEBTS 107446 107446 NURSING HOME BED TAX 102000 102000 EDUCATION AND DUES/SUBS 27232 20630 6602 REPAIRS AND MAINTENANCE 10576 10576 5903802 5456986 446816 0 137441 106868 190318 349708 604580 647513 33214 0 73689 66282 10185358 555882 8668742 9629476 111873 145821 9819857 10945668 440337 451576 6788047 7884368 12920 70447 1762672 1655104 9003976 10061495 X 815881 884173 815881 884173 9819857 10945668 68292 0 X X 0 1 0 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 820 820 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SPRING VALLEY HEALTH CARE SERVICES, INC. PAYS ANNUAL ASSOCIATION DUES TO WISCONSIN HEALTH CARE ASSOCIATION, INC. AND AMERICAN HEALTH CARE ASSOCIATION, INC. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATION MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL INDUSTRY ENVIRONMENT. 210300 210300 9280018 347474 8932544 683495 208408 475087 11545 11545 9629476 MEDICAL CLAIMS PAYABLE 80000 WHEDA TAX CREDIT 1575104 1655104 5972094 5903802 68292 68292 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE TAXES ON RELATED INCOME. VALLEY VILLAS, LLC IS A SINGLE-MEMBER LIMITED LIABILITY COMPANY AND AS SUCH, IT IS A DISREGARDED ENTITY FOR INCOME TAX PURPOSES AND IS INCLUDED UNDER TAX REPORTING WITH SPRING VALLEY HEALTH CARE SERVICES, INC. EACH YEAR AN EVALUATION IS COMPLETED TO DETERMINE WHETHER ITS INCOME OR A PORTION OF ITS INCOME SHOULD BE CONSIDERED AS UNRELATED BUSINESS INCOME AND, AS SUCH, WOULD BE SUBJECT TO FEDERAL AND STATE INCOME TAXES. IF ANY TAX PROVISIONS OR CREDITS ARE DETERMINED TO BE NECESSARY, THE ORGANIZATION RECORDS THESE AMOUNTS IN THE CONSOLIDATED FINANCIAL STATEMENTS THE ORGANIZATION IS ALSO ENGAGED, TO A LIMITED EXTENT, IN ACTIVITIES WHICH THE INTERNAL REVENUE SERVICE CONSIDERS UNRELATED TO ITS EXEMPT PURPOSE AND, THEREFORE, TAXABLE. THESE ACTIVITIES, HOWEVER, ANNUALLY RESULT IN NET OPERATING LOSSES FOR INCOME TAX PURPOSES. THE ORGANIZATION DOES NOT PRESENTLY ANTICIPATE THAT A TAX BENEFIT FROM THESE NET OPERATING LOSSES WILL BE REALIZED IN THE FUTURE. ACCORDINGLY, ANY POTENTIAL DEFERRED TAX ASSET RESULTING FROM THE AVAILABILITY OF NET OPERATING LOSS CARRYFORWARDS IS OFFSET BY A VALUATION ALLOWANCE OF EQUAL AMOUNT. NO DEFERRED TAX ASSETS AND LIABILITIES HAVE BEEN RECOGNIZED SINCE NO OTHER DIFFERENCES EXIST BETWEEN THE FINANCIAL AND TAX BASES OF REPORTING THE ORGANIZATION'S ASSETS AND LIABILITIES. THE ORGANIZATION'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDED JUNE 30, 2012 AND 2011, THERE WERE NO MATERIAL TAX PENALTIES OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE ORGANIZATION IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 AND 2011. FEDERAL RETURNS FOR THE YEARS ENDED JUNE 30, 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES OF THE BOARD OF DIRECTORS WHICH HAVE AUTHORITY TO ACT ON BEHALF OF THE ENTIRE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE 990 WILL BE DISTRIBUTED TO THE BOARD OF DIRECTORS AS PART OF THE BOARD PACKET FOR REVIEW AT THE BOARD MEETING PRIOR TO THE 990 BEING SUBMITTED. HOWEVER, IF THE TIMING OF THE BOARD MEETING DOESN'T MAKE IT POSSIBLE TO REVIEW THE 990 BEFORE THE SUBMISSION, THE 990 WILL BE DISTRIBUTED TO BOARD MEMBERS AT THE NEXT POSSIBLE MEETING. FORM 990, PART VI, SECTION B, LINE 12C SPRING VALLEY HEALTH CARE SERVICES, INC. REQUIRES ITS BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15A THE SPRING VALLEY HEALTH CARE SERVICES, INC.'S BOARD OF DIRECTORS SETS THE SALARY AND BENEFIT PACKAGE FOR THE ADMINISTRATOR/CEO . THE BOARD OF DIRECTORS UTILIZES MULTIPLE SOURCES FOR SETTING THE COMPENSATION INCLUDING VARIOUS SALARY SURVEYS FROM THIRD PARTY SOURCES SUCH AS THE AMERICAN COLLEGE OF HEALTH CARE ADMINISTRATORS, THE LONG TERM CARE NEWS, AND AMERICAN HEALTH CARE ASSOCIATION PROVIDER PUBLICATION. THE SALARY AND BENEFIT PACKAGE FOR OTHER MANAGEMENT-SENIOR LEVEL STAFF PERSONS IS DETERMINED BY THE ADMINISTRATOR WITH CONSULTATION FROM THE BOARD OF DIRECTORS AND WITHIN THE PARAMETERS OF THE ORGANIZATION'S OPERATING BUDGET WHICH IS APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 SPRING VALLEY HEALTH CARE SERVICES, INC. MAKES ITS FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A PER REQUEST BASIS. WHISTLEBLOWER POLICY FORM 990, PART VI, SECTION B, LINE 13 SPRING VALLEY HEALTH CARE SERVICES, INC. DOES NOT HAVE A FORMAL WHISTLEBLOWER POLICY. HOWEVER, SPRING VALLEY HEALTH CARE SERVICE, INC.'S ANTI-FRAUD PROTECTIONS INCLUDE SAFE-GUARDS AFFORDED TO THOSE INDIVIDUALS REPORTING OR PROVIDING INFORMATION OR ASSISTANCE WITH CONCERNS OR SITUATIONS RELATED TO POSSIBLE FRAUD, THEFT, ABUSE, OR DETRIMENTAL ACTIVITY BY STAFF PERSONS OR INDIVIDUALS WHO MAY BE AFFILIATED OR ASSOCIATED WITH THE OPERATIONS OF SPRING VALLEY HEALTH CARE SERVICES, INC. THE CRITICAL ELEMENT WITH THE SAFE-GUARDS IS THE PROTECTION OF THOSE STAFF PERSONS FROM RETRIBUTION OR RETALIATION AS A RESULT OF THEM PROVIDING INFORMATION OR AID. DOCUMENT RETENTION AND DESTRUCTION POLICY FORM 990, PART VI, SECTION B, LINE 14 SPRING VALLEY HEALTH CARE SERVICES, INC. DOES NOT HAVE A FORMAL DOCUMENT RENTENTION AND DESTRUCTION POLICY. HOWEVER, SPRING VALLEY HEALTH CARE SERVICES, INC. FOLLOWS ALL STATUTORY REQUIREMENTS GOVERNING RECORD RETENTION. THE STANDARD GUIDELINE UTILIZED IS THE 7 YEAR RETENTION PERIOD FOR RECORDS AND FILES. THE 7 YEAR PERIOD BEGINS WITH THE CLOSING OF THE FILE OR RECORD. STAFF EMPLOYMENT RECORDS CONTAINING ANY MEDICAL OR HEALTH INFORMATION ARE MAINTAINED FOR 30 YEARS ACCORDING TO STATUTORY REQUIREMENTS. OVERSIGHT OF THE AUDIT: FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT AUDITOR AND MANAGEMENT OVERSEES THE AUDIT PROCESS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. VALLEY VILLAS LLC S820 WESTLAND DRIVE SPRING VALLEY WI 54767 263498120 DEVELOPMENT AND OPERATION OF ASSISTED LIVING FACILITY WI 307265 SPRING VALLEY HEALTH CARE SERVICES