SANTIAM MEMORIAL HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SANTIAM MEMORIAL HOSPITAL (EIN 93-0415219)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202203199349308120
- Schema version
- 2021v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T11:55:22-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 930418710 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELAP LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5885 MEADOWS ROAD NO 200 | AddressLine1Txt |
| City | LAKE OSWEGO | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97035 | 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 | 930415219 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SANT | BusinessNameControlTxt |
| Phone | 5037692175 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1Txt |
| City | STAYTON | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 973831311 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MAGGIE HUDSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5037692175 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MAGGIE | PersonFirstNm |
| Person Last | HUDSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ROBERT J WOLFER CPA | PreparerPersonNm |
| PTIN | P01299726 | PTIN |
| Phone | 5036974118 | PhoneNum |
| Preparation | 2022-11-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| 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 | MAGGIE HUDSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1Txt |
| City | STAYTON | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 973831311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $100,159,483 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SANTIAMHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1950 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | GENERAL ACUTE HEALTH CARE HOSPITAL SERVING SANTIAM COMMUNITIES | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 722 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,355,693 | PYContributionsGrantsAmt |
| CY Contributions Grants | $12,980,306 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $64,210,436 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $84,295,734 | CYProgramServiceRevenueAmt |
| PY Investment Income | $73,119 | PYInvestmentIncomeAmt |
| CY Investment Income | $119,284 | CYInvestmentIncomeAmt |
| PY Other Revenue | $264,037 | PYOtherRevenueAmt |
| CY Other Revenue | $680,224 | CYOtherRevenueAmt |
| PY Total Revenue | $73,903,285 | PYTotalRevenueAmt |
| CY Total Revenue | $98,075,548 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $88,998 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,402,886 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $44,362,084 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $53,669,551 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,609,236 | PYOtherExpensesAmt |
| CY Other Expenses | $27,819,912 | CYOtherExpensesAmt |
| PY Total Expenses | $67,060,318 | PYTotalExpensesAmt |
| CY Total Expenses | $83,892,349 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,842,967 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $14,183,199 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $73,122,908 | TotalAssetsBOYAmt |
| Total Assets EOY | $79,039,753 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $37,845,525 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $30,465,424 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $35,277,383 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $48,574,329 | NetAssetsOrFundBalancesEOYAmt |
| Mission | SANTIAM MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE TO PERSONS SUFFERING FROM ILLNESS, INJURIES, OR DISABILITIES AND TO PROMOTE THE GENERAL HEALTH AND WELFARE OF THE COMMUNITY THROUGH EDUCATION, SUPPORT, AND MEDICAL SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $70,997,289 | ExpenseAmt |
| Grant | $74,390 | GrantAmt |
| Revenue | $84,975,958 | RevenueAmt |
| Desc | ACUTE HOSPITAL CARE: PATIENT DAYS 4,655, NURSERY DAYS 295, AMBULANCE TRIPS 1,823, OUTPATIENT DAYS 82,225, REFERENCE LABORATORY 194,358. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,908,183 | ExpenseAmt |
| Grant | $2,328,496 | GrantAmt |
| Desc | SANTIAM CANYON WILDFIRE RELIEF FUND DISTRIBUTION TO PEOPLE IMPACTED BY OREGON WILDFIRES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $73,905,472 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 106 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 722 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAGGIE HUDSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5037692175 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1Txt |
| City | STAYTON | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97383 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| RON ETZEL | |||||||||
| CHAIR | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| VICTOR KINTZ | |||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARYANN MEREDITH | |||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||||
| MIKE ODENTHAL | |||||||||
| VICE CHAIR | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| RANDY MICKEY | |||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||||
| ED DIEHL | |||||||||
| SECRETARY | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| GENNY BALDWIN | |||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | 1.00 | |||
| NORM RAUSCHER | |||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||||
| PAM RAY | |||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||||
| MAGGIE HUDSON | |||||||||
| CEO | 50.00 | Yes (X) | $286,755 | $0 | $54,205 | ||||
| RACHAEL SEEDER | |||||||||
| CFO | 50.00 | Yes (X) | $173,802 | $0 | $45,364 | ||||
| TERRY FLETCHALL | |||||||||
| CEO | 0.00 | Yes (X) | $367,978 | $0 | $59,935 | ||||
| STEVE VETS | |||||||||
| CMO | 50.00 | $334,005 | $0 | $0 | Yes (X) | ||||
| SHERRI STEELE | |||||||||
| CNO | 50.00 | $218,885 | $0 | $36,573 | Yes (X) | ||||
| JOHN HOFFMAN | |||||||||
| M.D. | 40.00 | $493,260 | $0 | $35,225 | Yes (X) | ||||
| BENJAMIN LEE | |||||||||
| M.D. | 40.00 | $464,407 | $0 | $35,225 | Yes (X) | ||||
| DAVID THORSETT | |||||||||
| M.D. | 40.00 | $544,269 | $0 | $35,225 | Yes (X) | ||||
| NICOLAS J STRATTON | |||||||||
| M.D. | 40.00 | $484,632 | $0 | $35,225 | Yes (X) | ||||
| BLAKE NONWEILER | |||||||||
| M.D. | 40.00 | $471,152 | $0 | $35,225 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,839,145 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $372,202 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 98 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| KAUFMAN COMMERCIAL LLC | |||||
| 5797 STATE ST | SALEM | OR | 97317 | CONTRUCTION SERVICES | $840,394 |
| EMERICK CONSTRUCTION | |||||
| 7855 SW MOHAWK ST | TUALATIN | OR | 97062 | CONTRUCTION SERVICES | $672,367 |
| DELTA LOLCUM TENENS | |||||
| PO BOX 202940 | DALLAS | TX | 75320 | CONTRACT LABOR | $482,359 |
| OMAC ADVERTISING | |||||
| PO BOX 3994 | SALEM | OR | 97302 | DESIGN FOR MARKETING | $416,792 |
| LAURA MASKELL MD | |||||
| 13145 NW NORTHRUP | PORTLAND | OR | 97229 | EMERGENCY ROOM PHYSICIAN | $274,260 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 21 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $10,555,268 | GovernmentGrantsAmt |
| All Other Contributions | $2,425,038 | AllOtherContributionsAmt |
| Total Contributions | $12,980,306 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE - NET | 622110 | $83,529,392 | $83,529,392 |
| INCOME FROM WVCH, LLC | 900099 | $503,758 | $503,758 |
| CAFETERIA REVENUE | 722210 | $262,584 | $262,584 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $84,295,734 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $75,375 | TotalRevenueColumnAmt |
| Exclusion | $75,375 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $12,000 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $159,817 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$147,817 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$147,817 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$147,817 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,968,027 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,909,338 | SecuritiesAmt |
| Other | $14,780 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $58,689 | SecuritiesAmt |
| Other | -$14,780 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,909 | TotalRevenueColumnAmt |
| Exclusion | $43,909 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER MISC. REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $828,041 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $828,041 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $828,041 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $98,075,548 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $84,975,958 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $119,284 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,600 | TotalAmt |
| Program Services | $34,600 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,368,286 | TotalAmt |
| Program Services | $2,368,286 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,149,589 | TotalAmt |
| Management And General | $1,149,589 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,073,050 | TotalAmt |
| Program Services | $40,118,613 | ProgramServicesAmt |
| Management And General | $1,954,437 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,354,776 | TotalAmt |
| Program Services | $1,354,776 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,361,843 | TotalAmt |
| Program Services | $5,329,188 | ProgramServicesAmt |
| Management And General | $1,032,655 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,730,293 | TotalAmt |
| Program Services | $2,471,584 | ProgramServicesAmt |
| Management And General | $258,709 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,384 | TotalAmt |
| Management And General | $128,384 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,541 | TotalAmt |
| Management And General | $223,541 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,913 | TotalAmt |
| Management And General | $42,913 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $876,460 | TotalAmt |
| Program Services | $17,704 | ProgramServicesAmt |
| Management And General | $858,756 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $936,351 | TotalAmt |
| Program Services | $27,870 | ProgramServicesAmt |
| Management And General | $908,481 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,519,883 | TotalAmt |
| Program Services | $545,188 | ProgramServicesAmt |
| Management And General | $974,695 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $369,633 | TotalAmt |
| Management And General | $369,633 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,699,025 | TotalAmt |
| Program Services | $1,512,208 | ProgramServicesAmt |
| Management And General | $186,817 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,890 | TotalAmt |
| Program Services | $744 | ProgramServicesAmt |
| Management And General | $117,146 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,524,759 | TotalAmt |
| Program Services | $1,294,160 | ProgramServicesAmt |
| Management And General | $1,230,599 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $756,478 | TotalAmt |
| Program Services | $269,485 | ProgramServicesAmt |
| Management And General | $486,993 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $12,501,288 | $12,501,288 |
| PROVIDER TAX | $3,593,113 | $3,593,113 |
| CLINIC EXPENSES | $1,547,451 | $1,547,451 |
| EQUIPMENT MAINTENANCE | $764,506 | $764,506 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,237 | TotalAmt |
| Program Services | $154,708 | ProgramServicesAmt |
| Management And General | $63,529 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,892,349 | TotalAmt |
| Program Services | $73,905,472 | ProgramServicesAmt |
| Management And General | $9,986,877 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240 | BOYAmt |
| EOY | $249 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,879,685 | BOYAmt |
| EOY | $26,664,345 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,050,085 | BOYAmt |
| EOY | $11,623,692 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,936,179 | BOYAmt |
| EOY | $1,798,503 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,302,695 | BOYAmt |
| EOY | $3,178,283 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $65,082,126 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $33,502,041 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,332,819 | BOYAmt |
| EOY | $31,580,085 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,280,330 | BOYAmt |
| EOY | $2,329,101 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $272,728 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,068,147 | BOYAmt |
| EOY | $1,852,684 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $12,811 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,122,908 | BOYAmt |
| EOY | $79,039,753 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,822,417 | BOYAmt |
| EOY | $6,089,403 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $552,086 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,604 | BOYAmt |
| EOY | $103,975 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,160,911 | BOYAmt |
| EOY | $22,148,988 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,111,900 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,728,693 | BOYAmt |
| EOY | $1,570,972 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,845,525 | BOYAmt |
| EOY | $30,465,424 | 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 | $32,595,449 | BOYAmt |
| EOY | $46,756,795 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,681,934 | BOYAmt |
| EOY | $1,817,534 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,277,383 | BOYAmt |
| EOY | $48,574,329 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,122,908 | BOYAmt |
| EOY | $79,039,753 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $14,183,199 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $31,982 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$918,235 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Beginning Balance | $21,604 | BeginningBalanceAmt |
| Additions During Year | $185,375 | AdditionsDuringYearAmt |
| Distributions During Year | $103,005 | DistributionsDuringYearAmt |
| Ending Balance | $103,974 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $366,640 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $1,586,262 | OtherCostOrOtherBasisAmt |
| Book Value | $1,952,902 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $3,637,035 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $38,704,156 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,223,861 | DepreciationAmt |
| Book Value | $25,117,330 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $619,850 | OtherCostOrOtherBasisAmt |
| Depreciation | $602,363 | DepreciationAmt |
| Book Value | $17,487 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $10,000 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $20,101,167 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,675,817 | DepreciationAmt |
| Book Value | $4,435,350 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,016 | OtherCostOrOtherBasisAmt |
| Book Value | $57,016 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $31,580,085 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| EST 3RD PARTY PAYOR SETTLEMENTS | $618,708 |
| OTHER LONG-TERM LIABILITIES | $952,264 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,570,972 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $98,188,798 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $31,982 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $159,817 | OtherRevenueAmt |
| Revenue Not Reported | $191,799 | RevenueNotReportedAmt |
| Revenue Subtotal | $97,996,999 | RevenueSubtotalAmt |
| Other Revenues Not Included | $78,549 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $78,549 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $98,075,548 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $84,027,452 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $174,893 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $174,893 | ExpensesNotReportedAmt |
| Expenses Subtotal | $83,852,559 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $39,790 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $39,790 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $83,892,349 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 2B: | FUNDS BELONG TO THE COMMUNITY SANTIAM SERVICE INTEGRATION TEAM (SIT). THEREFORE, SANTIAM MEMORIAL HOSTPIAL INCLUDED A DEDICATED LIABILITY ACCOUNT ON THE BALANCE SHEET. |
| PART X, LINE 2: | IT IS MANAGEMENT'S BELIEF THAT NONE OF THE HOSPITAL'S ACTIVITIES HAVE GENERATED MATERIAL UNRELATED BUSINESS INCOME; THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. INCOME TAX POSITIONS THAT MEET A "MORE-LIKELY-THAN-NOT" RECOGNITION THRESHOLD ARE MEASURED AT THE LARGEST AMOUNT OF INCOME TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH INCOME TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED INCOME TAX BENEFITS IN THE HOSPITAL'S CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS WOULD BE CLASSIFIED AS INCOME TAXES IN THE HOSPITAL'S CONSOLIDATED STATEMENTS OF OPERATIONS. THERE WERE NO UNRECOGNIZED INCOME TAX BENEFITS, NOR ANY INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS, ACCRUED OR EXPENSED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | REVENUE REPORTED NET OF RENTAL EXPENSES 159,817. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | GAIN FROM K-1, PROVIDER TAX TRUST 370. ADJUSTMENT TO GAIN ON SECURITIES -296. WVCH K-1 ACTIVITY 53,465. LOSS ON DISPOSAL -14,780. REVENUE REPORTED NET OF CHARITY CARE 39,790. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | REVENUE REPORTED NET OF RENTAL EXPENSES 159,817. ADJUSTMENT TO GAIN ON SECURITIES 296. LOSS ON DISPOSAL 14,780. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | REVENUE REPORTED NET OF CHARITY CARE EXPENSES 39,790. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 217 | PersonsServedCnt |
| Total Community Benefit Expns | $547,698 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $547,698 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00650 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 33472 | PersonsServedCnt |
| Total Community Benefit Expns | $18,709,551 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,409,280 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,300,271 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01550 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1984 | PersonsServedCnt |
| Total Community Benefit Expns | $2,046,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,959,442 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $86,558 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 35673 | PersonsServedCnt |
| Total Community Benefit Expns | $21,303,249 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,368,722 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,934,527 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02300 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 620 | PersonsServedCnt |
| Total Community Benefit Expns | $47,794 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,025 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $46,769 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4709 | PersonsServedCnt |
| Total Community Benefit Expns | $1,379,569 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,354,900 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $24,669 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,100 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5329 | PersonsServedCnt |
| Total Community Benefit Expns | $1,461,463 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,355,925 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $105,538 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 41002 | PersonsServedCnt |
| Total Community Benefit Expns | $22,764,712 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,724,647 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,040,065 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02430 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,970,409 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,576,327 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $30,561,864 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $35,538,201 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,976,337 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | SANTIAM MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1Txt |
| City | STAYTON | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 973831311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SANTIAMHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 14-0709 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.SANTIAMHOSPITAL.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SANTIAMHOSPITAL.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO-2/PATIENT-BILLING-FINANCIAL-ASSI | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO-2/PATIENT-BILLING-FINANCIAL-ASSI | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO-2/PATIENT-BILLING-FINANCIAL-ASSI | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| 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 (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SANTIAM MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: CONSULTED WITH MARION COUNTY HEALTH & HUMAN SERVICES, POLK COUNTY HEALTH DEPARTMENT, WILLAMETTE VALLEY COMMUNITY HEALTH, AND LOCAL HEALTH PROFESSIONALS AND COMMUNITY PARTNERS IN THE AREA. |
| SANTIAM MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: BEHAVIORAL CARE NETWORK, KAISER PERMANENTE, LEGACY HEALTH SILVERTON, SALEM HEALTH, WILLAMETTE VALLEY COMMUNITY HEALTH. |
| SANTIAM MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: CHEMEKETA COMMUNITY COLLEGE, CHERRIOTS, CITY OF WOODBURN, COMMUNITY ACTION AGENCY, EARLY LEARNING HUB, MARION COUNTY HEALTH & HUMAN SERVICES, NORTHWEST SENIOR & DISABILITY SERVICES, POLK COUNTY HEALTH DEPARTMENT, WESTERN OREGON UNIVERSITY. |
| SANTIAM MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: CHIP PLANNING BEGAN IN EARLY 2021. |
| PART V, LINE 20A | SANTIAM MEMORIAL HOSPITAL DOES NOT TAKE EXTRAORIDNARY COLLECTION ACTIONS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 11 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AUMSVILLE MEDICAL CLINIC | ||||
| 205 MAIN ST | AUMSVILLE | OR | 97325 | PHYSICIAN CLINIC |
| 2 - SUBLIMITY MEDICAL CLINIC | ||||
| 114 SE CHURCH ST | SUBLIMITY | OR | 97325 | PHYSICIAN CLINIC |
| 3 - SANTIAM MEDICAL ASSOCIATES | ||||
| 1401 N 10TH AVENUE STE 100 | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
| 4 - SANTIAM GENERAL SURGERY CLINIC | ||||
| 1371 N 10TH AVENUE | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
| 5 - SANTIAM INTERNAL MEDICINE CLINIC | ||||
| 1401 N 10TH AVENUE STE 200 | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
| 6 - SANTIAM MEDICAL CLINIC | ||||
| 280 S FIRST AVENUE | MILL CITY | OR | 97360 | PHYSICIAN CLINIC |
| 7 - CASCADE MEDICAL CLINIC | ||||
| 1375 N 10TH AVENUE STE B | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
| 8 - SANTIAM WOMEN'S CLINIC | ||||
| 1373 N 10TH AVENUE | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
| 9 - SANTIAM ORTHOPEDIC CLINIC | ||||
| 1377 N 10TH AVENUE | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
| 10 - SANTIAM PULMONARY CLINIC | ||||
| 1401 N 10TH AVENUE STE 200 | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
| 11 - SANTIAM CARDIOLOGY CLINIC | ||||
| 1401 N 10TH AVENUE STE 200 | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | A SLIDING FEE SCHEDULE WILL BE USED TO DETERMINE CHARITY DISCOUNTS WHEN GROSS FAMILY INCOME IS OVER 250% OF FEDERAL POVERTY INCOME GUIDELINES. AVAILABLE LIQUID ASSETS, APPROPRIATE TO VERIFIED INCOME, MAY ALSO BE CONSIDERED.INCOME AS A % OF FEDERAL POVERTY LEVEL FINANCIAL ASSISTANCE ADJUSTMENT % 0 - 250% 100%251 - 300% 75%301 - 400% 55%FINANCIAL ASSISTANCE MAY BE PROVIDED TO A RESPONSIBLE PARTY WITH GROSS FAMILY INCOME GREATER THAN SMH RECOGNIZED FEDERAL POVERTY INCOME GUIDELINES IF CIRCUMSTANCES SUCH AS EXTRAORDINARY, NON-DISCRETIONARY EXPENSES, FUTURE EARNING CAPACITY AND THE ABILITY TO MAKE PAYMENTS OVER AN EXTENDED PERIOD OF TIME WARRANT CONSIDERATION. |
| PART I, LINE 7G: | THE ENTIRE AMOUNT REPORTED ON SCH H, PART I, LINE 7G REFLECTS COSTS FROM PHYSICIAN CLINICS. |
| PART III, LINE 2: | ESTIMATES ARE BASED ON PAST COLLECTIONS. |
| PART III, LINE 3: | ESTIMATED 80% OF BAD DEBT COULD BE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 4: | [NOTE: SEE PAGE 14 OF THE FINANCIAL STATEMENTS]THE COLLECTION OF RECEIVABLES FROM THIRD-PARTY PAYORS AND PATIENTS IS THE HOSPITAL'S PRIMARY SOURCE OF CASH AND IS CRITICAL TO ITS OPERATING PERFORMANCE. WHEN THE HOSPITAL PROVIDES CARE TO PATIENTS, IT DOES NOT REQUIRE COLLATERAL. THE PRIMARY COLLECTION RISKS RELATE TO UNINSURED PATIENT ACCOUNTS AND PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE PAYOR HAS PAID, BUT THE PATIENT IS RESPONSIBLE FOR THE REMAINING AMOUNTS OUTSTANDING (GENERALLY DEDUCTIBLES AND CO-PAYMENTS).PATIENT ACCOUNTS RECEIVABLE - INCLUDING BILLED ACCOUNTS AND UBILLED ACCOUNTS FOR WHICH THE HOSPITAL HAS THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS - ARE RECEIVABLES OF THE HOSPITAL'S RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN AS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. DURING THE YEAR ENDED DECEMBER 31, 2021 AND 2020, PATIENT CARE SERVICE REVENUE WAS DECREASED BY APPROXIMATELY $212,000 AND $641,000, RESPECTIVELY, DUE TO A CHANGE IN MANAGEMENT'S ESTIMATE OF THE IMPLICIT PRICE CONCESSIONS. DURING THE YEAR ENDED DECEMBER 31, 2021, NET PATIENT SERVICE REVENUE WAS INCREASED BY APPROXIMATELY $1,250,000 DUE TO A CHANGE IN MANAGEMENT'S ESTIMATE OF THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2020.SIGNIFICANT CHANGES IN PAYOR MIX, BUSINESS OFFICE OPERATIONS, ECONOMIC CONDITIONS, OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE COULD AFFECT THE HOSPITAL'S COLLECTION OF PATIENT ACCOUNTS RECEIVABLE, CASH FLOWS, AND RESULTS OF OPERATIONS.SIGNIFICANT CONCENTRATIONS OF GROSS PATIENT ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2021 AND 2020 WERE APPROXIMATELY AS FOLLOWS: 2021 2020MEDICARE 34% 32%OREGON HEALTH PLAN (OHP) AND MEDICAID 16 16COMMERCIAL INSURANCE AND OTHER THIRD-PARTY PAYORS 34 32SELF-PAY 16 20 100% 100% |
| PART III, LINE 8: | A COST TO CHARGE RATIO OF 48.3% WAS USED AGAINST MEDICARE CHARGES. |
| PART III, LINE 9B: | FINANCIAL ASSISTANCE IS GRANTED ON A SLIDING SCALE. IF AMOUNT DEEMED TO BE PAYABLE BY THE PATIENT IS DELINQUENT, THE PATIENT IS SENT TO COLLECTION AGENCY FOR THE PORTION OUTSTANDING. |
| PART VI, LINE 2: | HEALTHCARE NEEDS ARE ASSESSED BY LISTENING TO PROVIDERS' FEEDBACK ON WHATPATIENT NEEDS ARE CURRENTLY. SANTIAM MEMORIAL HOSPITAL'S SERVICE INTEGRATION TEAM HEARS THE NEEDS OF THE GREATER COMMUNITY IN THEIR WORK WITH COMMUNITY PARTNERS. |
| PART VI, LINE 3: | ALL INPATIENTS ARE PROVIDED A FINANCIAL ASSISTANCE POLICY BROCHURE UPON ADMISSION. ANY INPATIENT PRESENTING WITHOUT INSURANCE IS PROVIDED ASSISTANCE IN APPLYING FOR THE OREGON HEALTH PLAN. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS LISTED ON PATIENT STATEMENTS. FINANCIAL ASSISTANCE POLICY BROCHURES ARE PRESENT AT EVERY ADMITTING DESK, AND THE FINANCIAL ASSISTANCE POLICY AND APPLICATON ARE AVAILABLE UPON REQUEST AND ON THE SANTIAM MEMORIAL HOSPITAL WEBSITE. |
| PART VI, LINE 4: | SANTIAM MEMORIAL HOSPITAL SERVES THE SANTIAM RIVER CANYON AND SURROUNDINGCOMMUNITIES OF AUMSVILLE, TURNER, STAYTON, SUBLIMITY, SHAW, MARION, CRABTREE, LYONS, MILL CITY AND IDANHA. |
| PART VI, LINE 5: | LOCAL COMMUNITY MEMBERS VOLUNTEER TO SERVE AS THE BOARD OF DIRECTORS.SANTIAM MEMORIAL HOSPITAL EMPLOYS A SERVICE INTEGRATION COORDINATOR WHO LEADS THE SANTIAM SERVICE INTEGRATION PROGRAM. THE PURPOSE OF THE SANTIAM SERVICE INTEGRATION PROGRAM IS TO FACILITATE COLLABORATION AMONG COMMUNITY PARTNERS TO PROVIDE COORDINATED RESOURCES AND INFORMATION FOR INDIVIDUALS AND FAMILIES. THESE ARE AGENCY AND COMMUNITY PARTNERSEXPEDITING SOLUTIONS BY MATCHING RESOURCES TO CLEARLY DEFINED NEEDS, WHILE AVOIDING DUPLICATION OF SERVICES.SERVICE INTEGRATION IS A PARTNERSHIP BETWEEN SANTIAM MEMORIAL HOSPITAL, SCHOOL DISTRICTS, FAITH GROUPS, NON-PROFITS, SOCIAL SERVICE AGENCIES, LOCAL CLUBS, GOVERNMENT AGENCIES, BUSINESSES, AND COMMUNITY MEMBERS. THE SERVICE INTEGRATION TEAMS MEETS MONTHLY TO NETWORK, SHARE RESOURCES, DISCUSS LOCAL NEEDS, AND FIND SOLUTIONS. EACH TEAM IS UNIQUE TOITS COMMUNITY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | OR |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROJECT LIVING HOPE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX F | AddressLine1Txt |
| City | STAYTON | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97383 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 465268593 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $10,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | SUPPORT ORGANIZATION'S MISSION | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (6 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|
| CHARITY CARE | 217 | $39,790 | ||
| UTILITY ASSISTANCE FOR FAMILIES AFFECTED BY WILDFIRES | 7 | $19,104 | ||
| HOUSING ASSISTANCE FOR FAMILIES AFFECTED BY WILDFIRES | 107 | $305,883 | ||
| PERSONAL EXPENSES FOR FAMILIES AFFECTED BY WILDFIRES | 213 | $607,446 | ||
| PROPERTY REPAIRS FOR FAMILIES AFFECTED BY WILDFIRES | 437 | $1,250,624 | ||
| SUPPLIES FOR FAMILIES AFFECTED BY WILDFIRE | 450 | $72,027 | BEDDING, SOAP AND OTHER SUPPLIES FOR 450 FAMILIES AFFECTED BY WILDFIRE. |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION DETERMINED THAT THE GRANTEES WERE IMPACTED BY THE WILDFIRES PRIOR TO THE FUNDS BEING DISBURSED. REQUESTS WERE DETEREMINED TO BE REASONABLE, NECESSARY AND SUPPORTED BY RECEIPTS OR INVOICES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID THORSETT | ||||||||||||||
| M.D. | $542,769 | $0 | $1,500 | $0 | $0 | $0 | $11,600 | $0 | $23,625 | $0 | $579,494 | $0 | $0 | $0 |
| JOHN HOFFMAN | ||||||||||||||
| M.D. | $491,760 | $0 | $1,500 | $0 | $0 | $0 | $11,600 | $0 | $23,625 | $0 | $528,485 | $0 | $0 | $0 |
| NICOLAS J STRATTON | ||||||||||||||
| M.D. | $483,132 | $0 | $1,500 | $0 | $0 | $0 | $11,600 | $0 | $23,625 | $0 | $519,857 | $0 | $0 | $0 |
| BLAKE NONWEILER | ||||||||||||||
| M.D. | $469,652 | $0 | $1,500 | $0 | $0 | $0 | $11,600 | $0 | $23,625 | $0 | $506,377 | $0 | $0 | $0 |
| BENJAMIN LEE | ||||||||||||||
| M.D. | $462,907 | $0 | $1,500 | $0 | $0 | $0 | $11,600 | $0 | $23,625 | $0 | $499,632 | $0 | $0 | $0 |
| TERRY FLETCHALL | ||||||||||||||
| CEO | $367,978 | $0 | $0 | $0 | $0 | $0 | $45,000 | $0 | $14,935 | $0 | $427,913 | $0 | $0 | $0 |
| MAGGIE HUDSON | ||||||||||||||
| CEO | $285,255 | $0 | $1,500 | $0 | $0 | $0 | $30,580 | $0 | $23,625 | $0 | $340,960 | $0 | $0 | $0 |
| STEVE VETS | ||||||||||||||
| CMO | $334,005 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $334,005 | $0 | $0 | $0 |
| SHERRI STEELE | ||||||||||||||
| CNO | $217,385 | $0 | $1,500 | $0 | $0 | $0 | $27,933 | $0 | $8,640 | $0 | $255,458 | $0 | $0 | $0 |
| RACHAEL SEEDER | ||||||||||||||
| CFO | $172,302 | $0 | $1,500 | $0 | $0 | $0 | $26,114 | $0 | $19,250 | $0 | $219,166 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE HOSPITAL HAS APPROXIMATELY 400 MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE HOSPITAL MEMBERS VOTE ON SELECTING THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE DIRECTORS AND OFFICERS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS, KEY EMPLOYEES AND CHIEF OF STAFF ARE REQUIRED TO SIGN AN ANNUAL CONFLICT OF INTEREST STATEMENT ATTESTING TO THEIR COMPLIANCE. |
| FORM 990, PART VI, SECTION B, LINE 15 | SMH USES A THIRD PARTY COMPENSATION AND BENEFIT SERVICE: OLNEY & ASSOCIATES. THE SURVEY PROVIDES DATA ON HOSPITAL KEY EMPLOYEE COMPENSATION AND BENEFITS BASED ON BED SIZE, GEOGRAPHIC REGION, ADMISSIONS AND GROSS REVENUE. THE BOARD OF DIRECTORS REVIEW COMPENSATION AND BENEFITS FOR THE CEO (MAGGIE HUDSON), CFO (RACHAEL SEEDER) AND CHIEF NURSING OFFICER (SHERRI STEELE). THE CEO'S CONTRACT IS THROUGH THE HOSPITAL APPROVED BY THE BOARD AND THE CHIEF NURSING OFFICER AND CFO CONTRACTS ARE WITH THE HOSPITAL APPROVED BY THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | SANTIAM MEMORIAL HOSPITAL MAKES COPIES OF ITS GOVERNING DOCUMENTS AND AUDITED FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO AVAILABLE BY CONTACTING THE STATE OF OREGON DEPARTMENT OF JUSTICE. THE CONFLICT OF INTEREST POLICY IS NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | NET GAIN FROM PROVIDER TAX TRUST K-1 -370. WILDFIRE RELIEF FUND -864,400. NET GAIN FROM WVCH K-1 -53,465. |
| PART XII, LINE 2C | NO CHANGES FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEDICAL GROUP LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1Txt |
| City | STAYTON | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97383 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462570877 | EIN |
| Primary Activities | TO PROVIDE OUTPATIENT MEDICAL SERVICES AT VARIOUS CLINIC LOCATIONS | PrimaryActivitiesTxt |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Total Income | $25,327,666 | TotalIncomeAmt |
| End Of Year Assets | $10,212,459 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL AUXILIARY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1Txt |
| City | STAYTON | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97383 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237399406 | EIN |
| Primary Activities | OPERATION OF GIFT SHOP AT THE HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12C, III-FI | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SANTIAM HEALTHCARE ALLIANCE INC | |||||||||
| 1401 N 10TH AVENUE | STAYTON | OR | 97383 | HEALTHCARE ASSOCIATION | OR | SANTIAM MEMORIAL HOSPITAL | C | 1.00000 | 0 |
| SANTIAM HOSPITAL PHARMACY | |||||||||
| 1401 N 10TH AVENUE | STAYTON | OR | 97383 | RETAIL PHARMACY | OR | SANTIAM MEMORIAL HOSPITAL | C | 1.00000 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL AUXILIARY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | N | TransactionTypeTxt |
| Involved | $0 | InvolvedAmt |
Comments