2011-11-01T10:09:17-07:00 2011-03-31 INTER VALLEY HEALTH PLAN INC 300 S PARK AVE SUITE 300 PO BOX 600 POMONA CA 917696002 990 2010-04-01 953258674 INTER VALLEY HEALTH PLAN INC INTE 9096236333 300 S PARK AVE PO BOX 6002 POMONA CA 917696002 DONALD D MCCAIN 9096236333 2011-11-01 DOROTHY BRUNELL 2010 2016-03-07 17:11:31Z RONALD BOLDING 300 S PARK AVE SUITE 300 POMONA CA 91766 169979554 false X www.ivhp.com X 1979 CA Inter Valley Health Plan, Inc. is a federally qualified Health Maintenance Organization. It provides a full range of medical services to eligible Medicare participants. At March 31, 2011 there were 16,558 participating members. 16 16 112 15 0 0 143355221 169890343 81085 88935 276 143436306 169979554 0 124536897 0 7707912 8550552 0 0 9014744 160842328 141259553 169392880 2176753 586674 24633250 25808263 6500236 7092486 18133014 18715777 Inter Valley Health Plan, Inc. is a federally qualified false false 151594661 169890343 INTER VALLEY HEALTH PLAN, INC., IS A FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATION. IT PROVIDES A FULL RANGE OF MEDICAL SERVICES TO ELIGIBLE MEDICARE PARTICIPANTS. AT MARCH 31, 2011 THERE WERE 16,558 PARTICIPATING MEMBERS. 151594661 false false false false false false false false false false true false false false false false true false false false false false false false false false false false false true false false false false false false false false false false false false false false false false false true 581 0 true 112 true false false false false false false false false false false X 16 16 true false false false false false false true true false false true true true true true true true true false CA X DONALD D MCCAIN 9096236333 300 S PARK AVE POMONA CA 917696002 MICHAEL NELSON 1.00 X 0 0 0 PAUL ORR MD 1.00 X 5810 0 0 JAN PAULSON 1.00 X 0 0 0 JEEREDDI PRASAD MD 1.00 X 0 0 0 SUNIL SHIVARAM MD 1.00 X 0 0 0 RICHARD YOCHUM 1.00 X 0 0 0 CURTIS W MORRIS 1.00 X 0 0 0 FREDERICK A LAUPPE MD 1.00 X 0 0 0 DUANE STYLES MD 1.00 X 7610 0 0 NORM BORTSCHELLER 1.00 X 0 0 0 JAN BROWN 1.00 X 0 0 0 TOM DENO 1.00 X 0 0 0 RICHARD FASS 1.00 X 0 0 0 RICHARD KIRKENDALL PHD 1.00 X 0 0 0 JAMES KOSTOFF 1.00 X 0 0 0 RONALD BOLDING 40.00 X X 418166 0 25291 DONALD MCCAIN 40.00 X 318541 0 25470 SUSAN TENORIO 40 X 263648 24252 PATRICIA JACOBSON 40 X 253348 29624 BILL CHEN 40 X 202385 23806 CYNDIE O'BRIEN 40 X 193104 22137 LARRY BACA 40 X 171420 25291 THANG LE 40 X 143225 17999 1977257 193870 15 false true false POMONA VALLEY HOSPITAL MEDICAL CENTER 1798 N GAREY AVE POMONA CA 91767 Medical Service for Membership 32831985 PROMED HEALTH NETWORK 4150 E CONCOUSE ST 100 ONTARIO CA 91764 Medical Service for Membership 28940367 HERITAGE PROVIDER NETWORK(DPC) 275 N EL CIELO PALM SPRINGS CA 92262 Medical Service for Membership 21787019 NATIONAL PHARMACEUTICAL SERVICES 10050 REGENCY CIRCLE OMAHA NE 68114 Pharmacy Services for Membership 18919390 CHOICE PHYSICIANS NETWORK 18564 HWY 18 105 APPLE VALLEY CA 92307 Medical Service for Membership 7058567 43 Provider Services 524114 169890343 169890343 88935 88935 Other Income 900099 276 276 276 169979554 169890343 89211 947755 0 947755 0 0 0 0 0 6224952 0 6224952 0 170860 0 170860 0 712980 0 712980 0 494005 0 494005 0 227665 0 227665 0 32961 0 32961 0 295889 0 295889 0 5685 0 5685 0 151594661 151594661 0 0 1884129 0 1884129 0 615914 0 615914 0 570329 0 570329 0 647235 0 647235 0 89376 0 89376 0 195274 0 195274 0 329686 0 329686 0 188368 0 188368 0 Community Outreach 340747 0 340747 0 Outside Services 2385442 0 2385442 0 Printed Material 483604 0 483604 0 Tax & License 210686 0 210686 0 744677 0 744677 0 169392880 151594661 17798219 0 3604860 1762907 18347534 15652229 134386 97810 1762006 1549400 13847339 13054184 784464 793155 5952762 24633250 25808263 6500236 7092486 6500236 7092486 X 5647 5647 18127367 18710130 18133014 18715777 24633250 25808263 X 586674 -3911 X false true true X false 2405472 2203536 201936 11441867 10850648 591219 793155 169979554 169392880 586674 -3911 -3911 582763 169969958 -3911 -3911 169973869 5685 5685 169979554 169387195 169387195 5685 5685 169392880 X X X X false false false false false false false false false RONALD BOLDING 317780 75000 25386 7362 17929 443457 DONALD MCCAIN 243932 54703 19906 6432 19039 344012 SUSAN TENORIO 210358 45646 7644 6270 17982 287900 PATRICIA JACOBSON 196932 43338 13078 4987 24637 282972 BILL CHEN 149839 35096 17450 5183 18623 226191 CYNDIE O'BRIEN 157936 35152 16 4559 17578 215241 LARRY BACA 114210 57210 1826 23465 196711 THANG LE 125731 5000 12494 3826 14173 161224 Pt VI-A, Line 2 Director Richard Yochum and Director Michael Nelson Business Relationship. Pt VI-B, Line 15 Annually, the Compensation Committee, an independent committee of the Board of Directors, reviews the compensation of the CEO and all other employees that are reported individually on the 990 return. The committee meets with outside consultants and uses compensation surveys and other information to test the reasonableness of the compensation of all the positions. Contemporaneous minutes of the debate and decisions are kept of the meetings. Pt VI-C, Line 19 Upon Request Pt VI-B, Line 11a The final Form 990 was reviewed prior to filing it with the IRS, by the Executive Committee of the Board at its October 25, 2011 meeting. For remaining Board Members not on the committee, a copy was sent to them for review. Pt VI-B, Line 12c In accordance with IVHP Conflict of Interest Policy. All members of the Board, committees, officers, executive staff, directors and medical directors, independent contractors and consultants who are requested to do so by the Board, and other management not previously mentioned, shall disclose any potential conflicts of interest through the Plan's Conflict of Interest Disclosure Statement. This disclosure should occur in a timely manner as soon as practicable whenever any matter covered under this policy arises, but will Form 990, Part IX, Line 24f OTHER EXPENSES be required upon taking office and at least annually. The Board, with the assistance of a Board Committe and/or the CEO, will evaluate the disclosures of Board Members and Officers as appropriate and will determine on a case-by-case basis whether the activities disclosed constitute a potential conflict and, if so, how to resolve the conflict. Each director, officer, member of management, key employee and member of a committee with Board-delegated powers shall upon appointment and at least annually thereafter sign a copy of the attached "Statement Pertaining to the Conflict of Interest Policy." If a director, officer, key employee or committee member becomes aware that a potential or apparent conflict may exist which is not disclosed on such a statement, it shall be the responsibility of the interested person to disclose the potential conflict to the President and to the Board and/or committee, as appropriate, as set forth above, prior to any Board or committee discussions or action with respect to the relevant transaction or arrangement, and if relevant, to leave the meeting during the discussion and vote on the transaction or arrangement. Pt XI Line 5 - This represents the unrealized loss on our Investments