2022-11-15T11:55:22-06:00 2021-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2021-01-01 930415219 SANTIAM MEMORIAL HOSPITAL SANT 5037692175 1401 N 10TH AVENUE STAYTON OR 973831311 MAGGIE HUDSON CEO 5037692175 2022-11-14 1 MAGGIE HUDSON 999009999 ROBERT J WOLFER CPA P01299726 5036974118 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MAGGIE HUDSON 1401 N 10TH AVENUE STAYTON OR 973831311 100159483 0 X WWW.SANTIAMHOSPITAL.ORG X 1950 OR GENERAL ACUTE HEALTH CARE HOSPITAL SERVING SANTIAM COMMUNITIES 9 9 722 0 0 0 9355693 12980306 64210436 84295734 73119 119284 264037 680224 73903285 98075548 88998 2402886 0 0 44362084 53669551 0 0 0 22609236 27819912 67060318 83892349 6842967 14183199 73122908 79039753 37845525 30465424 35277383 48574329 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. 0 0 70997289 74390 84975958 ACUTE HOSPITAL CARE: PATIENT DAYS 4,655, NURSERY DAYS 295, AMBULANCE TRIPS 1,823, OUTPATIENT DAYS 82,225, REFERENCE LABORATORY 194,358. 2908183 2328496 SANTIAM CANYON WILDFIRE RELIEF FUND DISTRIBUTION TO PEOPLE IMPACTED BY OREGON WILDFIRES. 73905472 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 106 0 722 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X MAGGIE HUDSON 5037692175 1401 N 10TH AVENUE STAYTON OR 97383 RON ETZEL CHAIR 3.00 X X 0 0 0 VICTOR KINTZ DIRECTOR 3.00 X 0 0 0 MARYANN MEREDITH DIRECTOR 3.00 X 0 0 0 MIKE ODENTHAL VICE CHAIR 3.00 X X 0 0 0 RANDY MICKEY DIRECTOR 3.00 X 0 0 0 ED DIEHL SECRETARY 3.00 X X 0 0 0 GENNY BALDWIN DIRECTOR 3.00 1.00 X 0 0 0 NORM RAUSCHER DIRECTOR 3.00 X 0 0 0 PAM RAY DIRECTOR 3.00 X 0 0 0 MAGGIE HUDSON CEO 50.00 X 286755 0 54205 RACHAEL SEEDER CFO 50.00 X 173802 0 45364 TERRY FLETCHALL CEO 0.00 X 367978 0 59935 STEVE VETS CMO 50.00 X 334005 0 0 SHERRI STEELE CNO 50.00 X 218885 0 36573 JOHN HOFFMAN M.D. 40.00 X 493260 0 35225 BENJAMIN LEE M.D. 40.00 X 464407 0 35225 DAVID THORSETT M.D. 40.00 X 544269 0 35225 NICOLAS J STRATTON M.D. 40.00 X 484632 0 35225 BLAKE NONWEILER M.D. 40.00 X 471152 0 35225 3839145 0 372202 98 0 1 0 KAUFMAN COMMERCIAL LLC 5797 STATE ST SALEM OR 97317 CONTRUCTION SERVICES 840394 EMERICK CONSTRUCTION 7855 SW MOHAWK ST TUALATIN OR 97062 CONTRUCTION SERVICES 672367 DELTA LOLCUM TENENS PO BOX 202940 DALLAS TX 75320 CONTRACT LABOR 482359 OMAC ADVERTISING PO BOX 3994 SALEM OR 97302 DESIGN FOR MARKETING 416792 LAURA MASKELL MD 13145 NW NORTHRUP PORTLAND OR 97229 EMERGENCY ROOM PHYSICIAN 274260 21 10555268 2425038 12980306 PATIENT SERVICE REVENUE - NET 622110 83529392 83529392 INCOME FROM WVCH, LLC 900099 503758 503758 CAFETERIA REVENUE 722210 262584 262584 84295734 75375 75375 12000 159817 -147817 -147817 -147817 1968027 1909338 14780 58689 -14780 43909 43909 OTHER MISC. REVENUE 900099 828041 828041 828041 98075548 84975958 0 119284 34600 34600 2368286 2368286 1149589 1149589 42073050 40118613 1954437 1354776 1354776 6361843 5329188 1032655 2730293 2471584 258709 128384 128384 223541 223541 42913 42913 876460 17704 858756 936351 27870 908481 1519883 545188 974695 369633 369633 1699025 1512208 186817 117890 744 117146 2524759 1294160 1230599 756478 269485 486993 MEDICAL SUPPLIES 12501288 12501288 PROVIDER TAX 3593113 3593113 CLINIC EXPENSES 1547451 1547451 EQUIPMENT MAINTENANCE 764506 764506 218237 154708 63529 83892349 73905472 9986877 0 240 249 26879685 26664345 8050085 11623692 1936179 1798503 1302695 3178283 65082126 33502041 30332819 31580085 2280330 2329101 272728 0 2068147 1852684 0 12811 73122908 79039753 5822417 6089403 0 552086 21604 103975 23160911 22148988 7111900 0 1728693 1570972 37845525 30465424 X 32595449 46756795 2681934 1817534 35277383 48574329 73122908 79039753 X 14183199 31982 -918235 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 21604 185375 103005 103974 1 X 366640 1586262 1952902 3637035 38704156 17223861 25117330 619850 602363 17487 10000 20101167 15675817 4435350 57016 57016 31580085 EST 3RD PARTY PAYOR SETTLEMENTS 618708 OTHER LONG-TERM LIABILITIES 952264 1570972 X 98188798 31982 159817 191799 97996999 78549 78549 98075548 84027452 174893 174893 83852559 39790 39790 83892349 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. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 217 547698 547698 0.00650 33472 18709551 17409280 1300271 0.01550 1984 2046000 1959442 86558 0.00100 35673 21303249 19368722 1934527 0.02300 620 47794 1025 46769 0.00060 4709 1379569 1354900 24669 0.00030 34100 34100 0.00040 5329 1461463 1355925 105538 0.00130 41002 22764712 20724647 2040065 0.02430 1 1970409 1576327 30561864 35538201 -4976337 X 1 1 1 1 SANTIAM MEMORIAL HOSPITAL 1401 N 10TH AVENUE STAYTON OR 973831311 WWW.SANTIAMHOSPITAL.ORG 14-0709 X X X SANTIAM MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.SANTIAMHOSPITAL.ORG 1 21 1 WWW.SANTIAMHOSPITAL.ORG 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X 1 X SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO-2/PATIENT-BILLING-FINANCIAL-ASSI X SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO-2/PATIENT-BILLING-FINANCIAL-ASSI X SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO-2/PATIENT-BILLING-FINANCIAL-ASSI X X X X X X 1 X 0 X X X 1 X 0 0 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 11 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 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 1 PROJECT LIVING HOPE PO BOX F STAYTON OR 97383 465268593 501(C)(3) 10000 0 SUPPORT ORGANIZATION'S MISSION 1 CHARITY CARE 217 39790 UTILITY ASSISTANCE FOR FAMILIES AFFECTED BY WILDFIRES 7 19104 HOUSING ASSISTANCE FOR FAMILIES AFFECTED BY WILDFIRES 107 305883 PERSONAL EXPENSES FOR FAMILIES AFFECTED BY WILDFIRES 213 607446 PROPERTY REPAIRS FOR FAMILIES AFFECTED BY WILDFIRES 437 1250624 SUPPLIES FOR FAMILIES AFFECTED BY WILDFIRE 450 72027 BEDDING, SOAP AND OTHER SUPPLIES FOR 450 FAMILIES AFFECTED BY WILDFIRE. PART I, LINE 2: 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. X X X X 0 0 0 0 0 1 0 0 0 DAVID THORSETT M.D. 542769 0 1500 0 0 0 11600 0 23625 0 579494 0 0 0 JOHN HOFFMAN M.D. 491760 0 1500 0 0 0 11600 0 23625 0 528485 0 0 0 NICOLAS J STRATTON M.D. 483132 0 1500 0 0 0 11600 0 23625 0 519857 0 0 0 BLAKE NONWEILER M.D. 469652 0 1500 0 0 0 11600 0 23625 0 506377 0 0 0 BENJAMIN LEE M.D. 462907 0 1500 0 0 0 11600 0 23625 0 499632 0 0 0 TERRY FLETCHALL CEO 367978 0 0 0 0 0 45000 0 14935 0 427913 0 0 0 MAGGIE HUDSON CEO 285255 0 1500 0 0 0 30580 0 23625 0 340960 0 0 0 STEVE VETS CMO 334005 0 0 0 0 0 0 0 0 0 334005 0 0 0 SHERRI STEELE CNO 217385 0 1500 0 0 0 27933 0 8640 0 255458 0 0 0 RACHAEL SEEDER CFO 172302 0 1500 0 0 0 26114 0 19250 0 219166 0 0 0 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. SANTIAM MEDICAL GROUP LLC 1401 N 10TH AVENUE STAYTON OR 97383 462570877 TO PROVIDE OUTPATIENT MEDICAL SERVICES AT VARIOUS CLINIC LOCATIONS OR 25327666 10212459 SANTIAM MEMORIAL HOSPITAL SANTIAM MEMORIAL HOSPITAL AUXILIARY 1401 N 10TH AVENUE STAYTON OR 97383 237399406 OPERATION OF GIFT SHOP AT THE HOSPITAL OR 501(C)(3) LINE 12C, III-FI 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 SANTIAM MEMORIAL HOSPITAL AUXILIARY N 0