2011-01-10T16:12:36-06:00 2010-06-30 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2009-07-01 390993000 Spring Valley Health Care Services Inc SPRI 7157785545 W500 Spring Street Hwy 29 Spring Valley WI 54767 KEVIN LARSON 7157785545 2011-01-10 1 HOLLY POKRANDT CPA 7158323407 2010-12-03 2009 2016-02-24 21:20:13Z Kevin Larson W500 Spring Street Hwy 29 Spring Valley WI 54767 4669984 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 3 190 150 106851 -95099 141804 95720 4503240 4572865 2275 1399 0 4647319 4669984 0 0 3335556 3505793 0 0 1100371 880647 4435927 4386440 211392 283544 1663535 4432336 888091 3373348 775444 1058988 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 2826685 3079124 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. During fiscal year 2010, the nursing facility provided 14,627 resident days. 1026798 1386890 Spring Valley Health Care Services, Inc. also provides home health care services to members of the community and surrounding areas. 195221 106851 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. 4048704 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 13 0 1 190 1 1 1 0 0 0 0 0 0 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 W500 Spring Street Hwy 29 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 50.00 X 70470 0 12401 70470 0 12401 0 0 0 0 Tong Xeng Personal HomeCare PO BOX 2464 APPLETON WI 54912 HOME CARE 656558 1 95720 80300 95720 Nursing Home Revenue 623000 3079124 3079124 Home Health Revenue 621610 1386890 1386890 Child Care Revenue 624410 106851 106851 4572865 1399 1399 4669984 4466014 106851 1399 86292 86292 2858252 2793317 64935 333068 329112 3956 228181 217377 10804 13712 13712 29419 29419 91270 91270 7353 7353 347720 279219 68501 101258 101258 25384 23690 1694 2074 1167 907 76361 76361 38054 38054 Nursing home bed tax 90000 90000 Bad debts 37920 37920 Education and Dues/Subs 17030 4921 12109 Repairs and maintenance 3092 3092 4386440 4048704 337736 0 179180 89327 108384 192488 545661 454121 27800 32508 65716 57334 4435688 965907 725832 3469781 10962 136777 1663535 4432336 660110 1362992 152981 1936786 3570 75000 70000 888091 3373348 X 775444 1058988 775444 1058988 1663535 4432336 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 221174 221174 794157 700774 93383 355494 265133 90361 3064863 3064863 3469781 Medical Claims Payable 70000 70000 4669984 4386440 283544 0 283544 4669984 0 4669984 0 4669984 4386440 0 4386440 0 4386440 Part X Balance Sheet - The balances as of the beginning of the fiscal year have been restated from the balances reported at the end of prior year. During 2010, management determined that the funds received during 2009 from West Central Wisconsin Community Action Agency, Inc. were part of a $415,800 mortgage note payable. In 2009, the funds had been accounted for as grant income. As a result, for 2009 the Organization recognized long-term debt of $120,582 and unamortized debt issuance costs of $10,962 that had previously been recorded as grant income. Management concluded that the consolidated financial statements should be restated to reflect the proper presentation of the long-term debt. X 1 80300 Land Appraisal 0 0 0 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. Form 990, Part XI, Line 2C Oversight of the audit Spring Valley Health Care Services, Inc. does not have a specific committee which assumes the responsibilty for oversight of the audit. The entire board of directors is responsible for selection of the independent accountant. Form 990, Part VI, Section B, Line 13 Whistleblower Policy 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 result of them providing information or aid. Form 990, Part VI, Section B, Line 14 Document Retention and Destruction Policy 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. VALLEY VILLAS LLC S820 WESTLAND DRIVE SPRING VALLEY WI 54767 263498120 DEVELOPMENT AND OPERATION OF ASSISTED LIVING FACILITY WI 2775894 SPRING VALLEY HEALTH CARE SERVICES