2019-11-15T17:48:09-06:00 2018-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2018-01-01 930415219 SANTIAM MEMORIAL HOSPITAL SANT 5037692175 1401 N 10TH AVENUE STAYTON OR 973831311 TERRY FLETCHALL CEO 5037692175 2019-11-13 1 MARK E EKLUND CPA P00156145 5036974118 2019-11-12 76.14.192.226 2019-11-13 10:29:37 PS P A013529AF207C67D5C7F1F1FA8670978FFAD1146 C9C56614DEA4E3F8F2BAE576B1AB9F35B16A97BE 2018 2020-04-17 16:48:07Z TERRY FLETCHALL 1401 N 10TH AVENUE STAYTON OR 973831311 53115690 0 X WWW.SANTIAMHOSPITAL.ORG X 1950 OR GENERAL ACUTE HEALTH CARE HOSPITAL SERVING SANTIAM COMMUNITIES 9 9 450 0 0 0 16676 13973 48109654 51667607 84840 186952 307926 263874 48519096 52132406 41043 47596 0 0 30154773 37730161 0 0 0 18904795 17226493 49100611 55004250 -581515 -2871844 58141140 56308976 31934704 33086585 26206436 23222391 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 47984700 47596 51710371 ACUTE HOSPITAL CARE: PATIENT DAYS 3,135, NURSERY DAYS 178, AMBULANCE TRIPS 2,117, OUTPATIENT DAYS 46,783, REFERENCE LABORATORY 138,196. 47984700 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 86 0 450 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 TERRY FLETCHALL 5037692175 1401 N 10TH AVENUE STAYTON OR 97383 RON ETZEL VICE PRESIDENT 3.00 X X 0 0 0 VICTOR KINTZ DIRECTOR 3.00 X 0 0 0 MARYANN MEREDITH PRESIDENT 3.00 X X 0 0 0 MIKE ODENTHAL SECRETARY 3.00 X X 0 0 0 RANDY MICKEY DIRECTOR 3.00 X 0 0 0 GEORGE LONG 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 TERRY FLETCHALL CEO 50.00 X 247775 0 49042 MAGGIE HUDSON CFO/COO 50.00 X 216562 0 29806 SHERRY STEELE CHIEF NURSING OFFICER 50.00 X 198780 0 16003 JOHN HOFFMAN M.D. 40.00 X 438989 0 29318 KIRSTIN FLOWERS M.D. 40.00 X 431825 0 21843 ROBERT MCGREEVY M.D. 40.00 X 402334 0 18666 NICOLAS J STRATTONS M.D. 40.00 X 402334 0 32068 JOHN SILVER M.D. 40.00 X 382260 0 32068 2720859 0 228814 55 0 1 0 DELTA LOCUM TENENS PO BOX 202940 DALLAS TX 753202940 PHYSICIAN TEMPORARY COVERAGE 480524 EMERICK CONSTRUCTION 7855 SW MOHAWK STREET TUALATIN OR 97062 CONSTRUCTION SERVICES 406480 ICON MEDICAL NETWORK 8100 SW NYBERG ST STE 400 TUALATIN OR 97062 PHYSICIAN TEMPORARY COVERAGE 404912 LAURA MASKELL MD 13145 NW NORTHRUP PORTLAND OR 97229 EMERGENCY ROOM PHYSICIAN 334125 COMPHEALTH ASSOC INC PO BOX 972625 DALLAS TX 753972625 PHYSICIAN TEMPORARY COVERAGE 312116 18 13973 13973 PATIENT SERVICE REVENUE - NET 622110 51761526 51761526 K-1, INCOME FROM WVCH, LLC 900099 -93919 -93919 51667607 142867 142867 30000 51225 -21225 -21225 -21225 976144 932754 -695 43390 695 44085 44085 CAFETERIA REVENUE 722210 221110 221110 OTHER MISC. REVENUE 900099 63989 63989 285099 52132406 51710371 0 408062 47596 47596 727968 727968 28876313 27522059 1354254 890947 890947 5411183 4692617 718566 1823750 1625322 198428 139688 139688 123767 123767 420315 420315 608135 608135 1155596 312460 843136 110092 110092 1786461 1640117 146344 8154 8154 2165425 971541 1193884 412119 276662 135457 SUPPLIES 6588749 6419213 169536 PROVIDER TAX 1573586 1510643 62943 CLINIC EXPENSE 1556302 1556302 EQUIPMENT MAINTENANCE 500650 500650 77454 18571 58883 55004250 47984700 7019550 0 240 240 13032899 4582805 6740251 10733849 1447471 1671314 1121197 1173787 58274700 26320449 31415220 31954251 1330997 2917473 272728 272728 2765137 2524762 15000 477767 58141140 56308976 4901278 6096927 25987268 25078558 1046158 1911100 31934704 33086585 X 26206436 23222391 26206436 23222391 58141140 56308976 X -2871844 -186882 74681 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 336760 1144799 1481559 1924421 36668323 13459170 25133574 619850 553838 66012 10000 17137306 12307441 4839865 433241 433241 31954251 EST 3RD PARTY PAYOR SETTLEMENTS 630237 OTHER LONG-TERM LIABILITIES 1280863 1911100 X 52068397 -186882 48192 -138690 52207087 -74681 -74681 52132406 55052442 48192 48192 55004250 0 55004250 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 AND CHANGES IN UNRESTRICTED NET ASSETS. 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, 2018 AND 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE REPORTED NET OF RENTAL EXPENSES 51,232. ADJUSTMENT TO GAIN ON SALE OF SECURITIES -2,344. ADJUSTMENT TO GAIN ON SALE OF ASSETS -696. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS FROM K-1, WILLAMETTE VALLEY COMMUNITY HEALTH, LLC -81,141. GAIN FROM K-1, PROVIDER TAX TRUST 6,460. PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE REPORTED NET OF RENTAL EXPENSES 51,232. ADJUSTMENT TO GAIN ON SALE OF SECURITIES -2,344. ADJUSTMENT TO GAIN ON SALE OF ASSETS -696. 1 1 X 1 X 1 X 1 1 0 1 1 2106 348162 348162 0.00630 22713 13139131 10546495 2592636 0.04710 851 666847 368908 297939 0.00540 25670 14154140 10915403 3238737 0.05880 1029 218322 16425 201897 0.00370 267109 267109 0.00490 44046 44046 0.00080 1029 529477 16425 513052 0.00940 26699 14683617 10931828 3751789 0.06820 1 60357 60357 0.00110 1 60357 60357 0.00110 1 3115995 3699471 5288269 -1588798 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 16 1 HTTP://SANTIAMHOSPITAL.ORG/RES_HEALTH.PHP 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X 1 X HTTP://WWW.SANTIAMHOSPITAL.ORG/PAT_FINANCIAL.PHP X HTTP://WWW.SANTIAMHOSPITAL.ORG/PAT_FINANCIAL.PHP X HTTP://WWW.SANTIAMHOSPITAL.ORG/PAT_FINANCIAL.PHP X X X X X X 1 X 0 X X X X 1 X 0 0 SANTIAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: CONSULTED WITH MARION COUNTY DEPARTMENT OF HEALTH AND OTHER COMMUNITY MEMBERS REGARDING THE NEEDS OF STAYTON AND SURROUNDING AREAS SERVED. SANTIAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: SALEM HEALTH SYSTEM, SILVERTON HOSPITAL NETWORK SANTIAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: CHIP PLANNING IMPLEMENTED IN 2016 14 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 ORTHOPAEDIC CLINIC 1369 N 10TH AVENUE STAYTON OR 97383 PHYSICIAN CLINIC 9 - SANTIAM PODIATRY CLINIC 1369 N 10TH AVENUE STAYTON OR 97383 PHYSICIAN CLINIC 10 - SANTIAM PULMONARY CLINIC 1401 N 10TH AVENUE STE B STAYTON OR 97383 PHYSICIAN CLINIC 11 - SANTIAM CARDIOLOGY CLINIC 1371 N 10TH AVENUE STAYTON OR 97383 PHYSICIAN CLINIC 12 - STAYTON FAMILY PRACTICE 1375 N 10TH AVE STE A STAYTON OR 97383 PHYSICIAN CLINIC 13 - SANTIAM INFECTIOUS DISEASE CLINIC 1401 N 10TH AVENUE STE 200 STAYTON OR 97383 PHYSICIAN CLINIC PART III, LINE 4: [NOTE: SEE PAGES 7-8 OF THE FINANCIAL STATEMENTS]PATIENT ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS: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; HOWEVER, IT MAINTAINS AN ESTIMATED ALLOWANCE FOR DOUBTFUL ACCOUNTS. 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 AMOUNT OUTSTANDING (GENERALLY DEDUCTIBLES AND CO PAYMENTS). THE HOSPITAL DOES NOT MAINTAIN A SIGNIFICANT ALLOWANCE FOR DOUBTFUL ACCOUNTS RELATED TO PATIENT ACCOUNTS RECEIVABLE FROM THIRD-PARTY PAYORS, NOR HAS IT HISTORICALLY HAD SIGNIFICANT BAD DEBT WRITE-OFFS OF PATIENT ACCOUNTS RECEIVABLE FROM THIRD-PARTY PAYORS. HOWEVER, FOR SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL RECORDS THE RELATED PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE NET OF CONTRACTUAL DISCOUNTS AND ALLOWANCES. FOR PATIENT ACCOUNTS RECEIVABLE DUE FROM SELF-PAY PATIENTS - WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL - THE HOSPITAL RECORDS A SIGNIFICANT ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS ESTIMATED BASED PRIMARILY UPON THE HOSPITAL'S HISTORICAL COLLECTION EXPERIENCE, THE AGE OF PATIENTS' ACCOUNTS, MANAGEMENT'S ESTIMATE OF ITS PATIENTS' ECONOMIC ABILITY TO PAY, AND THE EFFECTIVENESS OF COLLECTION EFFORTS. PATIENT ACCOUNTS RECEIVABLE BALANCES ARE ROUTINELY REVIEWED IN CONJUNCTION WITH HISTORICAL COLLECTION RATES AND OTHER ECONOMIC CONDITIONS WHICH MIGHT ULTIMATELY AFFECT THE COLLECTABILITY OF PATIENT ACCOUNTS WHEN CONSIDERING THE ADEQUACY OF THE AMOUNTS RECORDED IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE DIFFERENCE BETWEEN THE HOSPITAL'S STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. RECOVERIES OF AMOUNTS CHARGED OFF ARE ADDED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ACTUAL WRITE-OFFS HAVE HISTORICALLY BEEN WITHIN MANAGEMENT'S EXPECTATIONS. 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, 2018 AND 2017 WERE APPROXIMATELY AS FOLLOWS: 2018 2017MEDICARE 42% 36%OREGON HEALTH PLAN (OHP) AND MEDICAID 17 19COMMERCIAL INSURANCE AND OTHER THIRD-PARTY PAYORS 27 31SELF-PAY 14 14 100% 100% THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS REPRESENTED 57% AND 55% OF GROSS SELF-PAY PATIENT ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2018 AND 2017, RESPECTIVELY. THE FOLLOWING IS A SUMMARY OF THE ACTIVITY IN THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THE YEARS ENDED DECEMBER 31, 2018 AND 2017: 2018 2017BALANCE - BEGINNING OF YEAR $1,101,000 $ 890,000PROVISION FOR BAD DEBTS 3,116,000 1,693,000ACCOUNTS WRITTEN OFF - NET OF RECOVERIES (2,382,000) (1,482,000)BALANCE - END OF YEAR $1,835,000 $1,101,000 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 X X X 0 1 0 0 0 1 0 0 0 TERRY FLETCHALL CEO 246728 0 1047 0 0 0 34826 0 14216 0 296817 0 0 0 MAGGIE HUDSON CFO/COO 211380 0 1047 0 4135 0 8738 0 21068 0 246368 0 0 0 SHERRY STEELE CHIEF NURSING OFFICER 197733 0 1047 0 0 0 8337 0 7666 0 214783 0 0 0 JOHN HOFFMAN M.D. 437942 0 1047 0 0 0 8250 0 21068 0 468307 0 0 0 KIRSTIN FLOWERS M.D. 431825 0 0 0 0 0 775 0 21068 0 453668 0 0 0 ROBERT MCGREEVY M.D. 401287 0 1047 0 0 0 11000 0 7666 0 421000 0 0 0 NICOLAS J STRATTONS M.D. 401287 0 1047 0 0 0 11000 0 21068 0 434402 0 0 0 JOHN SILVER M.D. 381213 0 1047 0 0 0 11000 0 21068 0 414328 0 0 0 PART I, LINE 4B TERRY FLETCHALL, CEO - $25,000 CONTRIBUTED TO 457(B) & 457(F) SUPPLEMENTAL RETIREMENT PLAN IN 2018. 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 (GENNY BALDWIN). 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 LOSS FROM WILLAMETTE VALLEY COMMUNITY HEALTH, LLC K-1 81,141. NET GAIN FROM PROVIDER TAX TRUST -6,460. FORM 990, 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 15461708 4130169 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 HOSPITAL OR 501(C)(3) LINE 3 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