2021-11-12T18:27:47-06:00 2020-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2020-01-01 930415219 SANTIAM MEMORIAL HOSPITAL SANT 5037692175 1401 N 10TH AVENUE STAYTON OR 973831311 TERRY FLETCHALL CEO 5037692175 2021-11-11 1 TERRY FLETCHALL 999009999 MARK E EKLUND CPA P00156145 5036974118 2021-11-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MAGGIE HUDSON 1401 N 10TH AVENUE STAYTON OR 973831311 75859733 0 X WWW.SANTIAMHOSPITAL.ORG X 1950 OR GENERAL ACUTE HEALTH CARE HOSPITAL SERVING SANTIAM COMMUNITIES 9 9 547 0 0 0 18780 9355693 58470968 64210436 161226 73119 256758 264037 58907732 73903285 36221 88998 0 0 39532232 44362084 0 0 0 17722734 22609236 57291187 67060318 1616545 6842967 55805974 73122908 31071234 37845525 24734740 35277383 X 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. 1 0 55359471 16493 64177622 ACUTE HOSPITAL CARE: PATIENT DAYS 3,250, NURSERY DAYS 276, AMBULANCE TRIPS 1,738, OUTPATIENT DAYS 45,796, REFERENCE LABORATORY 150,290. 72505 72505 72505 SANTIAM CANYON WILDFIRE RELIEF FUND DISTRIBUTION TO PEOPLE IMPACTED BY 2020 OREGON WILDFIRES. 55431976 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 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 73 0 547 1 0 0 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 X MAGGIE HUDSON 5037692175 1401 N 10TH AVENUE STAYTON OR 97383 RON ETZEL VICE-CHAIR 3.00 X X 0 0 0 VICTOR KINTZ DIRECTOR 3.00 X 0 0 0 MARYANN MEREDITH CHAIR 3.00 X 0 0 0 MIKE ODENTHAL SECRETARY 3.00 X X 0 0 0 RANDY MICKEY DIRECTOR 3.00 X 0 0 0 ED DIEHL DIRECTOR 3.00 X 0 0 0 JUANITA CULVER DIRECTOR 3.00 X 0 0 0 NORM RAUSCHER DIRECTOR 3.00 X 0 0 0 PAM RAY DIRECTOR 3.00 X 0 0 0 TERRY FLETCHALL CEO 50.00 X 302900 0 47014 MAGGIE HUDSON CFO/COO 50.00 X 245490 0 30126 SHERRI STEELE CNO 50.00 X 219609 0 14425 JOHN HOFFMAN M.D. 40.00 X 451416 0 31233 BENJAMIN LEE M.D. 40.00 X 449095 0 28958 DAVID THORSETT M.D. 40.00 X 452191 0 29898 NICOLAS J STRATTON M.D. 40.00 X 447539 0 30126 BROOKE RENARD M.D. 40.00 X 349088 0 30508 2917328 0 242288 70 0 1 0 DALKE CONSTRUCTION CO INC 2180 16TH ST NE SALEM OR 97301 CONTRUCTION SERVICES 430223 OMAC ADVERTISING PO BOX 3994 SALEM OR 97302 DESIGN FOR MARKETING 307740 LAURA MASKELL MD 13145 NW NORTHRUP PORTLAND OR 97229 EMERGENCY ROOM PHYSICIAN 272210 ALPHA CORVI MEDICAL LLC PO BOX 1857 CORVALLIS OR 97339 EMERGENCY ROOM PHYSICIAN 248945 INVICTUS LLC 2337 BALOO LN SE SALEM OR 97317 EMERGENCY ROOM PHYSICIAN 240940 16 9009412 346281 188017 9355693 PATIENT SERVICE REVENUE - NET 622110 64527623 64527623 INCOME FROM DSH 3 TRUST 900099 -29 -29 INCOME FROM WVCH, LLC 900099 -317158 -317158 64210436 71115 71115 37999 84192 -46193 -46193 -46193 1813506 60754 1833097 39159 -19591 21595 2004 2004 CAFETERIA REVENUE 722210 224346 224346 OTHER MISC. REVENUE 900099 85884 85884 310230 73903285 64250127 0 297465 88998 88998 859564 859564 34315465 32478598 1836867 717405 717405 6392903 5037846 1355057 2076747 1866232 210515 79649 79649 161956 161956 35624 35624 582493 949 581544 671204 1797 669407 868470 139901 728569 429622 429622 1746443 1573371 173072 14521 629 13892 50000 50000 2455379 1135490 1319889 702858 218632 484226 MEDICAL SUPPLIES 10141747 10141747 PROVIDER TAX 2570888 2570888 CLINIC EXPENSES 1394993 1394993 EQUIPMENT MAINTENANCE 635388 635388 68001 68001 67060318 55431976 11628342 0 240 240 9653921 26879685 7925922 8050085 1793376 1936179 813220 1302695 61203030 30870211 29886017 30332819 3168244 2280330 272728 272728 2292306 2068147 55805974 73122908 5473144 5822417 25931 21604 24136926 23160911 7111900 1435233 1728693 31071234 37845525 X 24734740 32595449 0 2681934 24734740 35277383 55805974 73122908 X 6842967 85216 3614460 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 23450 62380 64226 21604 1 X 366640 1144799 1511439 2284603 37516738 15997339 23804002 619850 586367 33483 10000 18658932 14286505 4382427 601468 601468 30332819 EST 3RD PARTY PAYOR SETTLEMENTS 845191 OTHER LONG-TERM LIABILITIES 883502 1728693 X 74820863 85216 84192 169408 74651455 -748170 -748170 73903285 67148171 87853 87853 67060318 0 67060318 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, 2020 AND 2019. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE REPORTED NET OF RENTAL EXPENSES 84,192. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN FROM K-1, PROVIDER TAX TRUST 1,701. NON CASH DONATIONS 188,017. DSH 3 K-1 ACTIVITY -29. ADJUSTMENT TO GAIN ON SECURITIES -3,661. WVCH K-1 ACTIVITY -934,198. PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE REPORTED NET OF RENTAL EXPENSES 84,192. ADJUSTMENT TO GAIN ON SECURITIES 3,661. 1 1 X 1 X 1 X 1 1 1 0 1 1 391 590763 590763 0.00880 26906 13806692 11559083 2247609 0.03350 1525 1505020 578008 927012 0.01380 28822 15902475 12137091 3765384 0.05610 204 102491 48788 53703 0.00080 5143 12216 12216 0.00020 16000 16000 0.00020 5347 130707 48788 81919 0.00120 34169 16033182 12185879 3847303 0.05730 1 92554 92554 0.00140 1 92554 92554 0.00140 1 2548561 2038849 4681983 6680323 -1998340 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 18 1 1 1 1 X WWW.SANTIAMHOSPITAL.ORG 1 19 1 WWW.SANTIAMHOSPITAL.ORG 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X HTTP://WWW.SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO/FINANCIAL-ASSISTANCE/ X HTTP://WWW.SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO/FINANCIAL-ASSISTANCE/ X HTTP://WWW.SANTIAMHOSPITAL.ORG/PATIENTS-VISITORS-INFO/FINANCIAL-ASSISTANCE/ 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, COMMUNITY ADVISORY COUNCIL, 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 2019. 12 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 12 - SANTIAM INFECTIOUS DISEASE CLINIC 1401 N 10TH AVENUE STE 200 STAYTON OR 97383 PHYSICIAN CLINIC PART III, LINE 4: [NOTE: SEE PAGE 13 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 RICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN AS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. DURING THE YEAR ENDED DECEMBER 31, 2020, PATIENT CARE SERVICE REVENUE WAS DECREASED BY APPROXIMATELY $641,000 DUE TO A CHANGE IN MANAGEMENT'S ESTIMATE OF THE IMPLICIT PRICE CONCESSIONS.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, 2020 AND 2019 WERE APPROXIMATELY AS FOLLOWS: 2020 2019MEDICARE 32% 33%OREGON HEALTH PLAN (OHP) AND MEDICAID 16 13COMMERCIAL INSURANCE AND OTHER THIRD-PARTY PAYORS 32 27SELF-PAY 20 27 100% 100% 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 7, REPORTS FILED WITH STATES OR 1 REIMBURSE CAMP FOR WILDFIRE FAMILIES STAYING THERE 1 10226 UTILITY ASSISTANCE FOR WILDFIRE FAMILIES 13 3228 HOUSING ASSISTANCE FOR WILDFIRE FAMILIES 39 15910 PERSONAL EXPENSES FOR WILDFIRE FAMILIES 31 15659 PROPERTY REPAIRS FOR WILDFIRE FAMILIES 1 1000 PART I, LINE 2: THE ORGANIZATION DETERMINED THAT THAT THE GRANTEES WERE IMPACTED BY THE WILDFIRES, PRIOR TO THE FUNDS BEING DISBURSED. AND THAT THE REQUESTS WERE REASONABLE, NECESSARY AND SUPPORTED BY RECEIPTS OR INVOICES. X X X 0 1 0 0 0 1 0 0 0 JOHN HOFFMAN M.D. 450166 0 1250 0 0 0 8550 0 22683 0 482649 0 0 0 DAVID THORSETT M.D. 450941 0 1250 0 0 0 8550 0 21348 0 482089 0 0 0 BENJAMIN LEE M.D. 447845 0 1250 0 0 0 8550 0 20408 0 478053 0 0 0 NICOLAS J STRATTON M.D. 446289 0 1250 0 0 0 8550 0 21576 0 477665 0 0 0 BROOKE RENARD M.D. 347838 0 1250 0 0 0 8550 0 21958 0 379596 0 0 0 TERRY FLETCHALL CEO 273866 0 29034 0 0 0 34550 0 12464 0 349914 0 0 0 MAGGIE HUDSON CFO/COO 230348 0 15142 0 0 0 7219 0 22907 0 275616 0 0 0 SHERRI STEELE CNO 204467 0 15142 0 0 0 6551 0 7874 0 234034 0 0 0 PART I, LINE 4B TERRY FLETCHALL, CEO - $26,000 CONTRIBUTED TO 457(B) & 457(F) SUPPLEMENTAL RETIREMENT PLAN IN 2020. X MEDICAL EQUIPMENT - LAB ANALYZER 1 188017 PURCHASE PRICE 0 0 0 FORM 990, PART III, LINE 2 SANTIAM MEMORIAL HOSPITAL HAS UNDERTAKEN THE FUND INTAKE AND DISTRIBUTION OF THE WILDFIRE RELIEF FUND. THIS FUND ASSISTS THOSE IN NEED DUE TO DISPLACEMENT OR DISRUPTION CAUSED BY THE WILDFIRES IN OREGON. 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 (TERRY FLETCHALL), COO/CFO (MAGGIE HUDSON) AND CHIEF NURSING OFFICER (SHERRI STEELE). THE CEO'S CONTRACT IS THROUGH THE HOSPITAL APPROVED BY THE BOARD AND THE CHIEF NURSING OFFICER AND COO/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 -1,701. WILDFIRE RELIEF FUND 2,681,934. NET LOSS FROM DSH 3 K-1 29. NET LOSS FROM WVCH K-1 934,198. 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 19479578 7961726 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 3 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