2018-11-14T17:25:52-06:00 2017-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2017-01-01 930415219 SANTIAM MEMORIAL HOSPITAL SANT 5037692175 1401 N 10TH AVENUE STAYTON OR 973831311 TERRY FLETCHALL CEO 5037692175 2018-11-13 1 MARK E EKLUND CPA P00156145 5036974118 2018-11-13 76.14.192.226 2018-11-13 13:26:10 PS P DE3CBF9142AB1A9C45D327EC0B3FC07BFC578F99 FA70ACD58588B72794AC0476217EF7922E055C68 2017 2019-02-21 02:37:17Z TERRY FLETCHALL 1401 N 10TH AVENUE STAYTON OR 973831311 49213991 0 X WWW.SANTIAMHOSPITAL.ORG X 1950 OR GENERAL ACUTE HEALTH CARE HOSPITAL SERVING SANTIAM COMMUNITIES 9 9 457 18 0 0 25444 16676 46284802 48109654 142244 84840 223649 307926 46676139 48519096 43618 41043 0 0 26978191 30154773 0 0 0 18043488 18904795 45065297 49100611 1610842 -581515 58737185 58141140 32538033 31934704 26199152 26206436 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 43563272 41043 48212357 ACUTE HOSPITAL CARE: PATIENT DAYS 3,516, NURSERY DAYS 181, AMBULANCE TRIPS 2,058, OUTPATIENT DAYS 46,139, REFERENCE LABORATORY 133,632. 43563272 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 76 0 457 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 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 0 0 0 RANDY MICKEY DIRECTOR 3.00 X 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 287935 0 54144 MAGGIE HUDSON CFO/COO 50.00 X 228595 0 42386 SHERRY STEELE CHIEF NURSING OFFICER 50.00 X 188080 0 18827 JOHN HOFFMAN M.D. 40.00 X 421455 0 33220 JOHN SILVER M.D. 40.00 X 381241 0 27547 ROBERT MCGREEVY M.D. 40.00 X 401244 0 10166 KIRSTIN FLOWERS M.D. 40.00 X 342412 0 22689 NICOLAS J STRATTON M.D. 40.00 X 401244 0 27547 2652206 0 236526 44 0 1 0 ROBERT L JACQUES MD 5419 SW SCHOLLS FERRY ROAD PORTLAND OR 97225 HOSPITALIST 375325 LAURA MASKELL MD 13145 NW NORTHRUP PORTLAND OR 97229 EMERGENCY ROOM PHYSICIAN 330599 OMAC ADVERTISING 2573 12TH STREET SE SALEM OR 97302 ADVERTISING SERVICES 328378 COMPHEALTH ASSOC INC PO BOX 972625 DALLAS OR 75397 LOCUMS PHYSICIAN SERVICE 274248 STEVEN VETS DO 3471 NW HAYES AVE CORVALLIS OR 97330 EMERGENCY ROOM PHYSICIAN 231530 14 16676 16676 PATIENT SERVICE REVENUE - NET 622110 48671431 48671431 K-1, INCOME FROM WVCH, LLC 900099 -561777 -561777 48109654 42256 42256 30000 97745 -67745 -67745 -67745 617045 22689 560952 36198 56093 -13509 42584 42584 CAFETERIA REVENUE 722210 205223 205223 OTHER MISC. REVENUE 900099 170448 170448 375671 48519096 48212357 0 290063 41043 41043 787895 787895 22649853 21660323 989530 544728 544728 4592824 3806951 785873 1579473 1396271 183202 87433 87433 223017 223017 3667771 2740222 927549 682112 682112 533858 105583 428275 123895 123895 1788545 1788545 10927 10927 2229846 2162488 67358 198427 32001 166426 SUPPLIES 7136839 7136839 CLINIC EXPENSE 1701688 1701688 EQUIPMENT MAINTENANCE 449689 441550 8139 DUES & SUBSCRIPTIONS 54753 54753 15995 5040 10955 49100611 43563272 5537339 0 240 240 11725228 13032899 6139086 6740251 1368540 1447471 896568 1121197 56327285 24912065 33079715 31415220 1192874 1330997 272728 272728 3013065 2765137 1049141 15000 58737185 58141140 3819725 4901278 26864456 25987268 1853852 1046158 32538033 31934704 X 26199152 26206436 26199152 26206436 58737185 58141140 X -581515 35138 553661 X 0 1 X 1 1 1 X 336760 1144799 1481559 1856730 36156506 12114063 25899173 619850 537574 82276 10000 15939811 12260428 3689383 262829 262829 31415220 EST 3RD PARTY PAYOR SETTLEMENTS 265013 OTHER LONG-TERM LIABILITIES 781145 1046158 X 49107895 35138 35138 49072757 -553661 -553661 48519096 49100611 0 49100611 0 49100611 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, 2017 AND 2016. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS FROM K-1, WILLAMETTE VALLEY COMMUNITY HEALTH, LLC -553,661. 1 1 X 1 X 1 X 1 1 1 0 1 1 1438 439263 439263 0.00890 24900 10471938 9486500 985438 0.02010 34177 21999675 16563129 5436546 0.11070 60515 32910876 26049629 6861247 0.13970 2709 170810 15380 155430 0.00320 295203 295203 0.00600 41043 41043 0.00080 2709 507056 15380 491676 0.01000 63224 33417932 26065009 7352923 0.14970 82856 82856 0.00170 82856 82856 0.00170 1 1939834 4430326 6884104 -2453778 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 15 1 1 0 1 X WWW.SANTIAMHOSPITAL.ORG 1 16 1 HTTP://SANTIAMHOSPITAL.ORG/RESOURCES.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 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 12 1 - SUBLIMITY MEDICAL CLINIC 114 SE CHURCH ST SUBLIMITY OR 97325 PHYSICIAN CLINIC 2 - AUMSVILLE MEDICAL CLINIC 205 MAIN ST AUMSVILLE OR 97325 PHYSICIAN CLINIC 3 - SANTIAM MEDICAL CLINIC 280 S FIRST AVENUE MILL CITY OR 97360 PHYSICIAN CLINIC 4 - CASCADE MEDICAL CLINIC 1375 N 10TH AVENUE STE B STAYTON OR 97383 PHYSICIAN CLINIC 5 - SANTIAM PULMONARY CLINIC 1401 N 10TH AVENUE STE B STAYTON OR 97383 PHYSICIAN CLINIC 6 - SANTIAM INTERNAL MEDICINE CLINIC 1401 N 10TH AVENUE STE 200 STAYTON OR 97383 PHYSICIAN CLINIC 7 - SANTIAM ORTHOPAEDIC CLINIC 1369 N 10TH AVENUE STAYTON OR 97383 PHYSICIAN CLINIC 8 - SANTIAM WOMEN'S CLINIC 1373 N 10TH AVENUE STAYTON OR 97383 PHYSICIAN CLINIC 8 - SANTIAM MEDICAL ASSOCIATES 1401 N 10TH AVENUE STE 100 STAYTON OR 97383 PHYSICIAN CLINIC 9 - SANTIAM GENERAL SURGERY CLINIC 1371 N 10TH AVENUE STAYTON OR 97383 PHYSICIAN CLINIC 10 - STAYTON FAMILY PRACTICE 1375 N 10TH AVE SUITE A STAYTON OR 97383 PHYSICIAN CLINIC 11 - SANTIAM PODIATRY CLINIC 1375 N 10TH AVE SUITE B 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, 2017 AND 2016 WERE APPROXIMATELY AS FOLLOWS: 2017 2016MEDICARE 36% 37%OREGON HEALTH PLAN (OHP) AND MEDICAID 19 18COMMERCIAL INSURANCE AND OTHER THIRD-PARTY PAYORS 31 34SELF-PAY 14 11 100% 100% THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS REPRESENTED 54% AND 58% OF GROSS SELF-PAY PATIENT ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2017 AND 2016, RESPECTIVELY. THE FOLLOWING IS A SUMMARY OF THE ACTIVITY IN THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THE YEARS ENDED DECEMBER 31, 2017 AND 2016: 2017 2016BALANCE - BEGINNING OF YEAR $1,312,000 $1,173,000PROVISION FOR BAD DEBTS 1,940,000 2,015,000ACCOUNTS WRITTEN OFF - NET OF RECOVERIES (1,482,000) (1,876,000)BALANCE - END OF YEAR $1,770,000 $1,312,000 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 0 SALEM ART ASSOCIATION 600 MISSION ST NE SALEM OR 97303 930421613 501(C)3 5500 SPONSORSHIP OF KID'S COURT 1 X X X 0 1 0 0 0 1 0 0 0 TERRY FLETCHALL CEO 243359 0 30722 0 13854 0 41644 0 12500 0 342079 0 0 0 MAGGIE HUDSON CFO/COO 197783 0 15984 0 14828 0 19697 0 22689 0 270981 0 0 0 SHERRY STEELE CHIEF NURSING OFFICER 179690 0 1246 0 7144 0 10856 0 7971 0 206907 0 0 0 JOHN HOFFMAN M.D. 420209 0 1246 0 0 0 8100 0 25120 0 454675 0 0 0 JOHN SILVER M.D. 379995 0 1246 0 0 0 8100 0 19447 0 408788 0 0 0 ROBERT MCGREEVY M.D. 399998 0 1246 0 0 0 2500 0 7666 0 411410 0 0 0 KIRSTIN FLOWERS M.D. 341633 0 779 0 0 0 0 0 22689 0 365101 0 0 0 NICOLAS J STRATTON M.D. 399998 0 1246 0 0 0 8100 0 19447 0 428791 0 0 0 PART I, LINE 4B TERRY FLETCHALL, CEO - $25,000 CONTRIBUTED TO 457(B) & 457(F) SUPPLEMENTAL RETIREMENT PLAN IN 2017. 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-1 553,661. SANTIAM MEDICAL GROUP LLC 1401 N 10TH AVENUE STAYTON OR 97383 462570877 TO PROVIDE OUTPATIENT MEDICAL SERVICES AT VARIOUS CLINIC LOCATIONS OR 14246098 9699111 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