SANTIAM MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SANTIAM MEMORIAL HOSPITAL (EIN 93-0415219)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201333199349308633
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T15:21:04-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930418710 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELAP LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5885 MEADOWS ROAD NO 200 | AddressLine1 |
| City | LAKE OSWEGO | City |
| State | OR | State |
| ZIP Code | 97035 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930415219 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SANT | NameControl |
| Phone | 5037692175 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1 |
| City | STAYTON | City |
| State | OR | State |
| ZIP Code | 973831311 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRY FLETCHALL | Name |
| Title | ADMINISTRATOR/CEO | Title |
| Phone | 5037692175 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WESLEY B HANSEN | Name |
| PTIN | P00226581 | PTIN |
| Phone | 5036974118 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | TERRY FLETCHALL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1 |
| City | STAYTON | City |
| State | OR | State |
| ZIP Code | 973831311 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 35729827 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SANTIAMHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1950 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | GENERAL ACUTE HEALTH CARE HOSPITAL SERVING SANTIAM COMMUNITIES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 311 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 66857 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 22101 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 35230773 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 35408269 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 24316 | InvestmentIncomePriorYear |
| Investment Income Current Year | 43213 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 164450 | OtherRevenuePriorYear |
| Other Revenue Current Year | 154434 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 35486396 | TotalRevenuePriorYear |
| Total Revenue Current Year | 35628017 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 17036990 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 18959075 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14091724 | OtherExpensePriorYear |
| Other Expenses Current Year | 14143943 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 31128714 | TotalExpensesPriorYear |
| Total Expenses Current Year | 33103018 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4357682 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2524999 | RevenuesLessExpensesCY |
| Total Assets BOY | 45595331 | TotalAssetsBOY |
| Total Assets EOY | 57094687 | TotalAssetsEOY |
| Total Liabilities BOY | 18993495 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 28227538 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 26601836 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 28867149 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 28640109 | Expense |
| Revenue | 35410398 | Revenue |
| Description | ACUTE HOSPITAL CARE: PATIENT DAYS 2,468, NURSERY DAYS 279, SWING BED DAYS 96, AMBULANCE TRIPS 1,659, OUTPATIENT DAYS 34,995, REFERENCE LABORATORY 132,362. | Description |
| Total Program Service Expense | 28640109 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 77 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 311 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OR | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TERRY FLETCHALL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5037692175 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N TENTH AVENUE | AddressLine1 |
| City | STAYTON | City |
| State | OR | State |
| ZIP Code | 97383 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| RON ETZEL | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| ELAINE HANSEN | ||||||||
| VICE PRESIDENT | 3.00 | X | 0 | 0 | 0 | |||
| VICTOR KINTZ | ||||||||
| PRESIDENT | 3.00 | X | 0 | 0 | 0 | |||
| MARYANN MEREDITH | ||||||||
| SECRETARY | 3.00 | X | 0 | 0 | 0 | |||
| MIKE ODENTHAL | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| RANDY MICKEY | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| GEORGE LONG | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| LAWRENCE FISHER | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| FRANCIS HENDRICKS | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| TERRY FLETCHALL | ||||||||
| CEO | 50.00 | 240317 | 0 | 32613 | X | |||
| MAGGIE HUDSON | ||||||||
| CFO/COO | 50.00 | 183363 | 0 | 24742 | X | |||
| GENNY BALDWIN | ||||||||
| CHIEF NURSING OFFICER | 50.00 | 177995 | 0 | 29613 | X | |||
| ERIC VON BORSTEL | ||||||||
| MD | 32.00 | 227651 | 0 | 17565 | X | |||
| JOHN HOFFMAN | ||||||||
| MD | 40.00 | 385507 | 0 | 22579 | X | |||
| SUSAN TAYLOR | ||||||||
| MD | 50.00 | 299191 | 0 | 21976 | X | |||
| LORI BORELLA | ||||||||
| MD | 32.00 | 289021 | 0 | 12663 | X | |||
| FREDRICK CARLOCK | ||||||||
| MD | 32.00 | 257389 | 0 | 21976 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2060434 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 183727 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CHARLES H STRINGHAM MD | |||||
| 1401 N 10TH AVE | STAYTON | OR | 973831311 | EMERGENCY ROOM PHYSICIAN | 449706 |
| ROBERT L JACQUES MD | |||||
| 1401 N 10TH AVE | STAYTON | OR | 973831311 | EMERGENCY ROOM PHYSICIAN | 341638 |
| HEINZ MECHANICAL | |||||
| 2615 NW ST HELENS | PORTLAND | OR | 97210 | CONSTRUCTION SERVICES | 242069 |
| CONSTRUCTION SYSTEMS MANAGEMENT LLC | |||||
| 810 TUKWILA DRIVE | WOODBURN | OR | 97071 | CONSTRUCTION MANAGEMENT SERVICES | 161040 |
| DANNY SPARKS MD | |||||
| 1401 N 10TH AVE | STAYTON | OR | 973831311 | EMERGENCY ROOM PHYSICIAN | 158308 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Government Grants | 16511 | GovernmentGrants |
| All Other Contributions | 5590 | AllOtherContributions |
| Total Contributions | 22101 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| ACUTE HOSPITAL CARE | 900099 | 30459765 | 30459765 |
| MEDICARE/MEDICAID PMTS | 900099 | 29641758 | 29641758 |
| ELECTRONIC HLTH RECORDS | 990009 | 1067585 | 1067585 |
| PROVISION FOR CHARITY | 900099 | -1475656 | -1475656 |
| CONTRACTUAL ALLOWANCES | 900099 | -24596269 | -24596269 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 311086 | TotalRevenueColumn |
| Related Or Exempt Function Income | 311086 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 35408269 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 30094 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4 | RelatedOrExemptFunctionIncome |
| Exclusion | $30,090 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 94800 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 98292 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -3492 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -3492 | TotalRevenueColumn |
| Related Or Exempt Function Income | -3492 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 11601 | Securities |
| Other | 5036 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 3518 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 11601 | Securities |
| Other | 1518 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13119 | TotalRevenueColumn |
| Exclusion | $13,119 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 157926 | TotalRevenueColumn |
| Exclusion | $157,926 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 157926 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 35628017 | TotalRevenueColumn |
| Related Or Exempt Function Income | 35404781 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $201,135 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 688642 | Total |
| Management And General | 688642 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13559196 | Total |
| Program Services | 12620080 | ProgramServices |
| Management And General | 939116 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 342795 | Total |
| Program Services | 298092 | ProgramServices |
| Management And General | 44703 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3342879 | Total |
| Program Services | 2048566 | ProgramServices |
| Management And General | 1294313 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1025563 | Total |
| Program Services | 837749 | ProgramServices |
| Management And General | 187814 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80730 | Total |
| Management And General | 80730 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117862 | Total |
| Management And General | 117862 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1856309 | Total |
| Program Services | 1759270 | ProgramServices |
| Management And General | 97039 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125272 | Total |
| Management And General | 125272 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73500 | Total |
| Program Services | 55125 | ProgramServices |
| Management And General | 18375 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133022 | Total |
| Program Services | 107102 | ProgramServices |
| Management And General | 25920 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 285731 | Total |
| Program Services | 274302 | ProgramServices |
| Management And General | 11429 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222 | Total |
| Management And General | 222 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1420 | Total |
| Program Services | 1420 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1349369 | Total |
| Program Services | 1221638 | ProgramServices |
| Management And General | 127731 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 163865 | Total |
| Program Services | 112215 | ProgramServices |
| Management And General | 51650 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 4553351 | 4465212 | 88139 |
| BAD DEBTS | 3187046 | 3187046 | |
| EQUIPMENT RENTAL & MAIN | 571067 | 493812 | 77255 |
| CLINIC EXPENSE | 521918 | 521918 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1123259 | Total |
| Program Services | 636562 | ProgramServices |
| Management And General | 486697 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33103018 | Total |
| Program Services | 28640109 | ProgramServices |
| Management And General | 4462909 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 240 | BOY |
| EOY | 240 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8159869 | BOY |
| EOY | 11609952 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6426645 | BOY |
| EOY | 5920388 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15063 | BOY |
| EOY | 19132 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1103455 | BOY |
| EOY | 1142548 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 574610 | BOY |
| EOY | 460618 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 48752760 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 13612473 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26998937 | BOY |
| EOY | 35140287 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 501339 | BOY |
| EOY | 554404 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 531172 | BOY |
| EOY | 539574 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1284001 | BOY |
| EOY | 1707544 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45595331 | BOY |
| EOY | 57094687 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8658762 | BOY |
| EOY | 5358787 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10334733 | BOY |
| EOY | 22868751 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18993495 | BOY |
| EOY | 28227538 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26601836 | BOY |
| EOY | 28867149 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26601836 | BOY |
| EOY | 28867149 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45595331 | BOY |
| EOY | 57094687 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2524999 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 38285 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -297971 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 232930 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 1091087 | OtherCostOrOtherBasis |
| Book Value | 1324017 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1289643 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 9728416 | OtherCostOrOtherBasis |
| Depreciation | 5758997 | Depreciation |
| Book Value | 5259062 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 616390 | OtherCostOrOtherBasis |
| Depreciation | 451903 | Depreciation |
| Book Value | 164487 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10176986 | OtherCostOrOtherBasis |
| Depreciation | 7401573 | Depreciation |
| Book Value | 2775413 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25617308 | OtherCostOrOtherBasis |
| Book Value | 25617308 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 35140287 | TotalOfBookValueLandBuildings |
| Tot Revenue Etc Audited Fincl Stmt | 32181285 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 38285 | NetUnrealizedGainsInvestments |
| Other Revenues | -3187046 | OtherRevenues |
| Revenue Not Rptd F990 | -3148761 | RevenueNotRptdF990 |
| Revenue Subtotal | 35330046 | RevenueSubtotal |
| Other Revenues Not Included | 297971 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 297971 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 35628017 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 29915972 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 29915972 | ExpensesSubtotal |
| Other Expenses Not Included | 3187046 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 3187046 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 33103018 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -3,187,046. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | REVENUE FROM WILLAMETTE VALLEY COMMUNITY HEALTH, LLC 297,967. REVENUE FROM DISPROPORTIONATE SHARE HOSPITAL 3 TRUST 4. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 3,187,046. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 708 | PersonsServed |
| Total Community Benefit Expense | 731925 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 731925 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02210 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 25800 | PersonsServed |
| Total Community Benefit Expense | 4257499 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3656946 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 600553 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01810 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 26508 | PersonsServed |
| Total Community Benefit Expense | 4989424 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3656946 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1332478 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04020 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Persons Served | 2834 | PersonsServed |
| Total Community Benefit Expense | 76750 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9046 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 67704 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Persons Served | 2834 | PersonsServed |
| Total Community Benefit Expense | 76750 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9046 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 67704 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 29342 | PersonsServed |
| Total Community Benefit Expense | 5066174 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3665992 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1400182 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04220 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,187,046 | BadDebtExpenseAmount |
| Amount Attributable To | 2549637 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8512145 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11082735 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2570590 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1 |
| City | STAYTON | City |
| State | OR | State |
| ZIP Code | 973831311 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 11 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SUBLIMITY MEDICAL CLINIC | ||||
| 114 SE CHURCH ST | SUBLIMITY | OR | 97325 | PHYSICIAN CLINIC |
| AUMSVILLE MEDICAL CLINIC | ||||
| 205 MAIN ST | AUMSVILLE | OR | 97325 | PHYSICIAN CLINIC |
| CASCADE MEDICAL CLINIC | ||||
| 1375 N 10TH AVENUE STE B | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
| SANTIAM MEDICAL CLINIC | ||||
| 280 S FIRST AVENUE | MILL CITY | OR | 97360 | PHYSICIAN CLINIC |
| SANTIAM WOMEN'S CLINIC | ||||
| 1373 N 10TH AVENUE | STAYTON | OR | 97383 | PHYSICIAN CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (8 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART III, LINE 4: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT ON LINE 2: THE GROSS BAD DEBT CHARGES, $3,187,046, WERE APPLIED TO THE PATIENT CARE COST TO CHARGES RATIO ESTABLISHED IN WORKSHEET 2. BAD DEBTS ARE DETERMINED AFTER THE PATIENT RECEIVED 4 STATEMENTS AFTER DATE OF SERVICE OR DATE OF PAYMENT BY INSURANCE. AFTER THE 4TH STATEMENT, THE PATIENT RECEIVES A LETTER EXPLAINING THAT THEIR ACCOUNT WILL BE TURNED OVER TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED BY THE END OF THE MONTH.THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT ON LINE 3: THROUGH OBSERVATION OF CHARITY CARE COORDINATOR, 80% OF BAD DEBTS MAY HAVE QUALIFIED FOR CHARITY CARE BECAUSE OF 1) INCORRECT CONTRACT INFORMATION GIVEN TO HOSPITAL, 2) UNABLE OR UNWILLINGNESS TO FILL OUT AND COMPLETE CHARITY CARE FORMS AND SUPPORTING DOCUMENTATION AND 3) THE STIGMA ASSOCIATED WITH THE ACCEPTANCE OF CHARITY CARE. | ||
| 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 V, SECTION B, LINE 3: 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 4: SALEM HEALTH SYSTEM, SILVERTON HOSPITAL NETWORK | SANTIAM MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 7: CHIP PLANNING IMPLEMENTED IN 2012 | SANTIAM MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 20D: ALL PATIENTS ARE CHARGED AT THE SAME GROSS CHARGES. | SANTIAM MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 22: ALL PATIENTS ARE BILLED THE SAME GROSS CHARGES REGARDLESS OF INSURANCE STATUS. ALL PATIENTS ARE GIVEN A 10% DISCOUNT FOR PAYMENT OVER $ 500. | SANTIAM MEMORIAL HOSPITAL | |
| OR | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TERRY FLETCHALL | ||||||||||||||
| CEO | 168720 | 0 | 49097 | 0 | 22500 | 0 | 19500 | 0 | 13113 | 0 | 272930 | 0 | 0 | 0 |
| MAGGIE HUDSON | ||||||||||||||
| CFO/COO | 151879 | 0 | 25097 | 0 | 6387 | 0 | 10613 | 0 | 14129 | 0 | 208105 | 0 | 0 | 0 |
| GENNY BALDWIN | ||||||||||||||
| CHIEF NURSING OFFICER | 152398 | 0 | 25097 | 0 | 500 | 0 | 16500 | 0 | 13113 | 0 | 207608 | 0 | 0 | 0 |
| ERIC VON BORSTEL | ||||||||||||||
| MD | 226554 | 0 | 1097 | 0 | 0 | 0 | 6891 | 0 | 10674 | 0 | 245216 | 0 | 0 | 0 |
| JOHN HOFFMAN | ||||||||||||||
| MD | 384410 | 0 | 1097 | 0 | 0 | 0 | 7500 | 0 | 15079 | 0 | 408086 | 0 | 0 | 0 |
| SUSAN TAYLOR | ||||||||||||||
| MD | 298094 | 0 | 1097 | 0 | 0 | 0 | 7500 | 0 | 14476 | 0 | 321167 | 0 | 0 | 0 |
| LORI BORELLA | ||||||||||||||
| MD | 287924 | 0 | 1097 | 0 | 0 | 0 | 7500 | 0 | 5163 | 0 | 301684 | 0 | 0 | 0 |
| FREDRICK CARLOCK | ||||||||||||||
| MD | 256292 | 0 | 1097 | 0 | 0 | 0 | 7500 | 0 | 14476 | 0 | 279365 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE HOSPITAL HAS APPROXIMATELY 400 MEMBERS WHO VOTE ON SELECTING BROAD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE HOSPITAL HAS APPROXIMATELY 400 MEMBERS WHO VOTE ON SELECTING BROAD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | 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 IS 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: | TAXABLE INCOME FROM WILLAMETTE VALLEY COMMUNITY HEALTH, LLC -297,967. TAXABLE INCOME FROM DSH3 TRUST -4. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL AUXILIARY | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 N 10TH AVENUE | AddressLine1 |
| City | STAYTON | City |
| State | OR | State |
| ZIP Code | 97383 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237399406 | EIN |
| Primary Activities | OPERATION OF GIFT SHOP AT THE HOSPITAL | PrimaryActivities |
| Legal Domicile State | OR | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 3 | PublicCharityStatus |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANTIAM MEMORIAL HOSPITAL AUXILIARY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | N | TransactionType |
Comments