SANTIAM MEMORIAL HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SANTIAM MEMORIAL HOSPITAL (EIN 93-0415219)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201723189349312992
- Schema version
- 2016v3.0
- 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 | 2017-11-14T18:30:05-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | 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 | 2016-01-01 | 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 | TERRY FLETCHALL | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5037692175 | PhoneNum |
| Signature | 2017-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARK E EKLUND CPA | PreparerPersonNm |
| PTIN | P00156145 | PTIN |
| Phone | 5036974118 | PhoneNum |
| Preparation | 2017-11-13 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 76.14.192.226 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-13 | IPDt |
| IP Tm | 09:29:00 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | BED54D2DEB6E9258230C084D8939139CD33CD9C2 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A037F773A43E5D098BFBF49CACF0A7B31F1836C7 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TERRY FLETCHALL | 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 | $47,005,063 | 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 | 451 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $163,242 | PYContributionsGrantsAmt |
| CY Contributions Grants | $25,444 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $42,319,756 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $46,284,802 | CYProgramServiceRevenueAmt |
| PY Investment Income | $24,294 | PYInvestmentIncomeAmt |
| CY Investment Income | $142,244 | CYInvestmentIncomeAmt |
| PY Other Revenue | $306,269 | PYOtherRevenueAmt |
| CY Other Revenue | $223,649 | CYOtherRevenueAmt |
| PY Total Revenue | $42,813,561 | PYTotalRevenueAmt |
| CY Total Revenue | $46,676,139 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $38,853 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $43,618 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,071,350 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,978,191 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,983,573 | PYOtherExpensesAmt |
| CY Other Expenses | $18,043,488 | CYOtherExpensesAmt |
| PY Total Expenses | $41,093,776 | PYTotalExpensesAmt |
| CY Total Expenses | $45,065,297 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,719,785 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,610,842 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $56,699,850 | TotalAssetsBOYAmt |
| Total Assets EOY | $58,737,185 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $32,216,050 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $32,538,033 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,483,800 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $26,199,152 | 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 | $39,683,384 | ExpenseAmt |
| Grant | $43,618 | GrantAmt |
| Revenue | $46,331,951 | RevenueAmt |
| Desc | ACUTE HOSPITAL CARE: PATIENT DAYS 3,201, NURSERY DAYS 126, AMBULANCE TRIPS 1,967, OUTPATIENT DAYS 43,121, REFERENCE LABORATORY 135,527. | Desc |
| Total Program Service Expenses | $39,683,384 | 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 | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 84 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 451 | 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 |
| Form8899 Filedind | 0 | Form8899Filedind |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| 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 |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TERRY FLETCHALL | 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 (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| RON ETZEL | ||||||||
| SECRETARY | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| VICTOR KINTZ | ||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| MARYANN MEREDITH | ||||||||
| VICE PRESIDENT | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MIKE ODENTHAL | ||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| RANDY MICKEY | ||||||||
| PRESIDENT | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GEORGE LONG | ||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| JUANITA CULVER | ||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| NORM RAUSCHER | ||||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| TERRY FLETCHALL | ||||||||
| CEO | 50.00 | Yes (X) | $269,713 | $0 | $54,088 | |||
| MAGGIE HUDSON | ||||||||
| CFO/COO | 50.00 | Yes (X) | $223,748 | $0 | $40,309 | |||
| GENNY BALDWIN | ||||||||
| CHIEF NURSING OFFICER | 50.00 | $169,001 | $0 | $22,127 | Yes (X) | |||
| JOHN HOFFMAN | ||||||||
| M.D. | 40.00 | $401,159 | $0 | $28,208 | Yes (X) | |||
| JOHN SILVER | ||||||||
| M.D. | 40.00 | $381,156 | $0 | $27,397 | Yes (X) | |||
| SUSAN TAYLOR | ||||||||
| M.D. | 40.00 | $301,165 | $0 | $19,488 | Yes (X) | |||
| KALSANG PHUNTSHOG | ||||||||
| M.D. | 32.00 | $286,791 | $0 | $28,208 | Yes (X) | |||
| NICOLAS J STRATTON | ||||||||
| M.D. | 40.00 | $401,159 | $0 | $27,397 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,433,892 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $247,222 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 36 | 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 |
|---|---|---|---|---|---|
| ROBERT L JACQUES MD | |||||
| 5419 SW SCHOLLS FERRY ROAD | PORTLAND | OR | 97225 | HOSPITALIST | $424,695 |
| STEPHEN P MOON MD | |||||
| 16788 SW SARALA ST | ALOHA | OR | 97007 | EMERGENCY ROOM PHYSICIAN | $302,405 |
| MILLER NASH LLP | |||||
| PO BOX 3585 | PORTLAND | OR | 97208 | LEGAL SERVICES | $284,050 |
| OMAC ADVERTISING | |||||
| 2573 12TH STREET SE | SALEM | OR | 97302 | ADVERTISING SERVICES | $256,841 |
| EDWARD HC JUNN MD | |||||
| 9742 NW SKYVIEW DR | PORTLAND | OR | 97231 | EMERGENCY ROOM PHYSICIAN | $245,393 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $25,444 | AllOtherContributionsAmt |
| Total Contributions | $25,444 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE - NET | 622110 | $45,836,841 | $45,836,841 |
| K-1, INCOME FROM CCO | 900099 | $481,967 | $481,967 |
| ELECTRONIC HLTH RECORDS | 990009 | -$34,006 | -$34,006 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $46,284,802 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,923 | TotalRevenueColumnAmt |
| Exclusion | $37,923 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $49,900 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $103,864 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$53,964 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$53,964 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$53,964 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $160,907 | SecuritiesAmt |
| Other | $168,474 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $164,885 | SecuritiesAmt |
| Other | $60,175 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$3,978 | SecuritiesAmt |
| Other | $108,299 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $104,321 | TotalRevenueColumnAmt |
| Exclusion | $104,321 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA REVENUE | 722210 | $176,500 | $176,500 | |
| OTHER MISC. REVENUE | 900099 | $101,113 | $101,113 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $277,613 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,676,139 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $46,331,951 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $318,744 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,618 | TotalAmt |
| Program Services | $43,618 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $776,681 | TotalAmt |
| Management And General | $776,681 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,197,178 | TotalAmt |
| Program Services | $19,234,506 | ProgramServicesAmt |
| Management And General | $962,672 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $538,692 | TotalAmt |
| Program Services | $495,714 | ProgramServicesAmt |
| Management And General | $42,978 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,054,145 | TotalAmt |
| Program Services | $3,429,588 | ProgramServicesAmt |
| Management And General | $624,557 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,411,495 | TotalAmt |
| Program Services | $1,266,795 | ProgramServicesAmt |
| Management And General | $144,700 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,566 | TotalAmt |
| Management And General | $102,566 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,899 | TotalAmt |
| Management And General | $248,899 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,527,242 | TotalAmt |
| Program Services | $2,851,645 | ProgramServicesAmt |
| Management And General | $675,597 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $717,089 | TotalAmt |
| Management And General | $717,089 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $553,444 | TotalAmt |
| Program Services | $143,275 | ProgramServicesAmt |
| Management And General | $410,169 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $332,090 | TotalAmt |
| Management And General | $332,090 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,815,334 | TotalAmt |
| Program Services | $1,815,334 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63 | TotalAmt |
| Management And General | $63 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,182,943 | TotalAmt |
| Program Services | $2,114,644 | ProgramServicesAmt |
| Management And General | $68,299 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,728 | TotalAmt |
| Program Services | $34,571 | ProgramServicesAmt |
| Management And General | $222,157 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $6,102,767 | $6,102,767 | |
| CLINIC EXPENSE | $1,550,623 | $1,550,623 | |
| EQUIPMENT MAINTENANCE | $546,489 | $552,571 | -$6,082 |
| MISCELLANEOUS | $57,678 | $44,831 | $12,847 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,533 | TotalAmt |
| Program Services | $2,902 | ProgramServicesAmt |
| Management And General | $46,631 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,065,297 | TotalAmt |
| Program Services | $39,683,384 | ProgramServicesAmt |
| Management And General | $5,381,913 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240 | BOYAmt |
| EOY | $240 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,050,030 | BOYAmt |
| EOY | $11,725,228 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,899,968 | BOYAmt |
| EOY | $6,139,086 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $309,916 | BOYAmt |
| EOY | $263,681 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,316,628 | BOYAmt |
| EOY | $1,368,540 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $832,676 | BOYAmt |
| EOY | $632,887 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $55,801,493 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $22,721,778 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,502,045 | BOYAmt |
| EOY | $33,079,715 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $998,415 | BOYAmt |
| EOY | $1,192,874 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $272,728 | BOYAmt |
| EOY | $272,728 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,268,203 | BOYAmt |
| EOY | $3,013,065 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $249,001 | BOYAmt |
| EOY | $1,049,141 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,699,850 | BOYAmt |
| EOY | $58,737,185 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,446,791 | BOYAmt |
| EOY | $3,819,725 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,711,460 | BOYAmt |
| EOY | $26,864,456 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,057,799 | BOYAmt |
| EOY | $1,853,852 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,216,050 | BOYAmt |
| EOY | $32,538,033 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,483,800 | BOYAmt |
| EOY | $26,199,152 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,483,800 | BOYAmt |
| EOY | $26,199,152 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,699,850 | BOYAmt |
| EOY | $58,737,185 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,610,842 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $43,473 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $61,037 | OtherChangesInNetAssetsAmt |
| 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $330,620 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $1,144,800 | OtherCostOrOtherBasisAmt |
| Book Value | $1,475,420 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,864,409 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $36,082,071 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,836,664 | DepreciationAmt |
| Book Value | $27,109,816 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $619,850 | OtherCostOrOtherBasisAmt |
| Depreciation | $521,309 | DepreciationAmt |
| Book Value | $98,541 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $10,000 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $15,603,719 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,363,805 | DepreciationAmt |
| Book Value | $4,249,914 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $146,024 | OtherCostOrOtherBasisAmt |
| Book Value | $146,024 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $33,079,715 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| EST 3RD PARTY PAYOR SETTLEMENTS | $52,000 |
| OTHER LONG-TERM LIABILITIES | $1,801,852 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,853,852 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $46,780,649 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $43,473 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $550,000 | OtherRevenueAmt |
| Revenue Not Reported | $593,473 | RevenueNotReportedAmt |
| Revenue Subtotal | $46,187,176 | RevenueSubtotalAmt |
| Other Revenues Not Included | $488,963 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $488,963 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $46,676,139 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $45,065,297 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $45,065,297 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $45,065,297 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2016 AND 2015. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | DISTRIBUTIONS, WILLAMETTE VALLEY COMMUNITY HEALTH, LLC 550,000. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | REVENUE FROM K-1, WILLAMETTE VALLEY COMMUNITY HEALTH, LLC 488,963. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| 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 | 1538 | PersonsServedCnt |
| Total Community Benefit Expns | $670,329 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $670,329 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01490 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,442,458 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,878,489 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,563,969 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03470 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1538 | PersonsServedCnt |
| Total Community Benefit Expns | $10,112,787 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,878,489 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,234,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04960 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3133 | PersonsServedCnt |
| Total Community Benefit Expns | $248,835 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,580 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $242,255 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $175,183 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $175,183 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $43,618 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $43,618 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3133 | PersonsServedCnt |
| Total Community Benefit Expns | $467,636 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,580 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $461,056 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4671 | PersonsServedCnt |
| Total Community Benefit Expns | $10,580,423 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,885,069 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,695,354 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05990 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,015,016 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,114,231 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,778,576 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,664,345 | 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 | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | 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 | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://SANTIAMHOSPITAL.ORG/RESOURCES.PHP | 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.SANTIAMHOSPITAL.ORG/PAT_FINANCIAL.PHP | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.SANTIAMHOSPITAL.ORG/PAT_FINANCIAL.PHP | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.SANTIAMHOSPITAL.ORG/PAT_FINANCIAL.PHP | 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 |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| 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 (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 12 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 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 - NORTH SANITAM PODIATRY CLINIC | ||||
| 1375 N 10TH AVE SUITE B | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 4: | [NOTE: SEE PAGES 9-10 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, 2016 AND 2015 WERE APPROXIMATELY AS FOLLOWS: 2016 2015MEDICARE 37% 41%OREGON HEALTH PLAN (OHP) AND MEDICAID 18 18COMMERCIAL INSURANCE AND OTHER THIRD-PARTY PAYORS 34 26SELF-PAY 11 15 100% 100% THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS REPRESENTED 58% AND 56% OF GROSS SELF-PAY PATIENT ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2016 AND 2015, RESPECTIVELY. THE FOLLOWING IS A SUMMARY OF THE ACTIVITY IN THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015: 2016 2015BALANCE - BEGINNING OF YEAR $1,173,000 $1,134,000PROVISION FOR BAD DEBTS 2,015,016 1,382,961ACCOUNTS WRITTEN OFF - NET OF RECOVERIES (1,876,016) (1,343,961)BALANCE - END OF YEAR $1,312,000 $1,173,000 |
| 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| FAMILY BUILDING BLOCKS | |||||||
| 383 N 3RD AVE | STAYTON | OR | 97383 | 931233373 | 501(C)3 | $5,000 | THIS ORGANIZATION SUPPORTS THE COMMUNITY IN PREVENTING CHILD ABUSE BY WORKING WITH HIGH RISK CHILDREN AND FAMILIES. |
| MEDICAL FOUNDATION OF MARION AND POLK COUNTIES | |||||||
| 2295 RYAN DR SE 100 | SALEM | OR | 97301 | 931261633 | 501(C)3 | $5,500 | THIS ORGANIZATION HELPS PROVIDE ACCESS TO PRESCRIPTION MEDICATIONS AND HEALTHCARE FOR MEMBER OF THE COMMUNITY, ESPECIALLY THE WORKING UNDERPRIVILEDGED. THIS ORGANIZATION HELPS PROVIDE ACCESS TO PRESCRIPTION MEDICATIONS AND HEALTHCARE FOR MEMBER OF THE COMMUNITY, ESPECIALLY THE WORKING UNDERPRIVILEDGED. THIS ORGANIZATION HELPS PROVIDE ACCESS TO PRESCRIPTION MEDICATIONS AND HEALTHCARE FOR MEMBER OF THE COMMUNITY, ESPECIALLY THE WORKING UNDERPRIVILEDGED. THIS ORGANIZATION HELPS PROVIDE ACCESS TO PRESCRIPTION MEDICATIONS AND HEALTHCARE FOR MEMBER OF THE COMMUNITY, ESPECIALLY THE WORKING UNDERPRIVILEDGED. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TERRY FLETCHALL | ||||||||||||||
| CEO | $232,945 | $0 | $22,470 | $0 | $14,298 | $0 | $41,107 | $0 | $12,981 | $0 | $323,801 | $0 | $0 | $0 |
| MAGGIE HUDSON | ||||||||||||||
| CFO/COO | $188,605 | $0 | $11,816 | $0 | $23,327 | $0 | $19,241 | $0 | $21,068 | $0 | $264,057 | $0 | $0 | $0 |
| GENNY BALDWIN | ||||||||||||||
| CHIEF NURSING OFFICER | $118,065 | $0 | $11,816 | $0 | $39,120 | $0 | $11,070 | $0 | $11,057 | $0 | $191,128 | $0 | $0 | $0 |
| JOHN HOFFMAN | ||||||||||||||
| M.D. | $399,998 | $0 | $1,161 | $0 | $0 | $0 | $7,950 | $0 | $20,258 | $0 | $429,367 | $0 | $0 | $0 |
| JOHN SILVER | ||||||||||||||
| M.D. | $379,995 | $0 | $1,161 | $0 | $0 | $0 | $7,950 | $0 | $19,447 | $0 | $408,553 | $0 | $0 | $0 |
| SUSAN TAYLOR | ||||||||||||||
| M.D. | $300,004 | $0 | $1,161 | $0 | $0 | $0 | $7,950 | $0 | $11,538 | $0 | $320,653 | $0 | $0 | $0 |
| KALSANG PHUNTSHOG | ||||||||||||||
| M.D. | $285,630 | $0 | $1,161 | $0 | $0 | $0 | $7,950 | $0 | $20,258 | $0 | $314,999 | $0 | $0 | $0 |
| NICOLAS J STRATTON | ||||||||||||||
| M.D. | $399,998 | $0 | $1,161 | $0 | $0 | $0 | $7,950 | $0 | $19,447 | $0 | $428,556 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | TERRY FLETCHALL, CEO - $25,000 CONTRIBUTED TO 457(B) & 457(F) SUPPLEMENTAL RETIREMENT PLAN IN 2016. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 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 (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: | REVENUE FROM WILLAMETTE VALLEY COMMUNITY HEALTH, LLC 61,037. |
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 | $12,644,653 | TotalIncomeAmt |
| End Of Year Assets | $9,869,124 | 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 (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 | |
| 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 |
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