TRI-STATE MEMORIAL HOSPITAL: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- TRI-STATE MEMORIAL HOSPITAL (EIN 91-0545036)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-06
- IRS object ID
- 202303109349301925
- Schema version
- 2022v5.0
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-06T13:59:29-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910545036 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-STATE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TRI- | BusinessNameControlTxt |
| Phone | 5097585511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 HIGHLAND AVENUE | AddressLine1Txt |
| City | CLARKSTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99403 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KYM CLIFT | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5097585511 | PhoneNum |
| Signature | 2023-10-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KYM | PersonFirstNm |
| Person Last | CLIFT | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2023-10-30 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRISTATE HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KYM CLIFT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 HIGHLAND AVENUE | AddressLine1Txt |
| City | CLARKSTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99403 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $125,959,769 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TSH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | TRI-STATE MEMORIAL HOSPITAL, A 62 BED LICENSED NOT-FOR-PROFIT COMMUNITY OWNED HOSPITAL, IS CURRENTLY OPERATING AS A 25 BED CRITICAL ACCESS HOSPITAL. THE HOSPITAL SERVES A 10 COUNTY REGION IN THREE STATES (WASHINGTON, OREGON, AND IDAHO). | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 778 | TotalEmployeeCnt |
| Total Volunteers | 35 | TotalVolunteersCnt |
| Total Gross UBI | -$428,031 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,984,083 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,127,973 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $113,772,198 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $122,692,475 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,759,582 | PYInvestmentIncomeAmt |
| CY Investment Income | $393,783 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$2,480,743 | PYOtherRevenueAmt |
| CY Other Revenue | -$3,539,009 | CYOtherRevenueAmt |
| PY Total Revenue | $122,035,120 | PYTotalRevenueAmt |
| CY Total Revenue | $124,675,222 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,800 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,250 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $54,802,223 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $58,477,182 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $53,776,228 | PYOtherExpensesAmt |
| CY Other Expenses | $60,925,619 | CYOtherExpensesAmt |
| PY Total Expenses | $108,586,251 | PYTotalExpensesAmt |
| CY Total Expenses | $119,409,051 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $13,448,869 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,266,171 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $107,847,750 | TotalAssetsBOYAmt |
| Total Assets EOY | $116,790,521 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,866,101 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $38,139,966 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $79,981,649 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $78,650,555 | NetAssetsOrFundBalancesEOYAmt |
| Mission | FROM OUR FIRST DAY OF OPERATION UNTIL TODAY, WE ARE PROUD TO SAY THAT OUR MISSION HAS ALWAYS REMAINED THE SAME: THE PATIENT IS OUR FIRST PRIORITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $106,402,162 | ExpenseAmt |
| Grant | $6,250 | GrantAmt |
| Revenue | $118,271,425 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDED 4,570 DAYS OF CARE TO 1,108 PATIENTS IN 2022. IN ADDITION, THE HOSPITAL PROVIDED APPROXIMATELY 326,340 OUTPATIENT VISITS IN THE EMERGENCY ROOM, RENTAL DIALYSIS, SURGICAL, AND OTHER PATIENT SERVICE CENTERS. THE HOSPITAL PROVIDED APPROXIMATELY $2,523,316 IN CHARITABLE SERVICES TO PATIENTS UNABLE TO PAY FOR HEALTHCARE SERVICES. | Desc |
| Total Program Service Expenses | $106,402,162 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (1) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 62 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 778 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | 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 | 0 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TERESA GALL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5097585511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 HIGHLAND AVENUE | AddressLine1Txt |
| City | CLARKSTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99403 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| KIMBERLY BLEWETT | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $253,018 | $0 | $31,913 | ||
| JOHN RUDOLPH MD | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $392,262 | $0 | $31,355 | ||
| DON MCQUARY | |||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MIKE MARTIN | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DAN KLAVEANO | |||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SCOTT ARNONE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DEBRA R AUSMAN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| STEVE CLAASSEN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| E WAYNE DAY MD | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DICK FLERCHINGER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| K DAVID HAGEN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL JELINEK | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICK WASEM | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KYM CLIFT | |||||||
| CEO | 40.00 | $361,634 | $0 | $23,233 | Yes (X) | ||
| JIM HEILSBERG | |||||||
| CFO | 40.00 | $235,693 | $0 | $14,603 | Yes (X) | ||
| CRAIG FLINDERS | |||||||
| PHYSICIAN | 40.00 | $560,538 | $0 | $38,931 | Yes (X) | ||
| LEROY SMITH | |||||||
| PHYSICIAN | 40.00 | $485,367 | $0 | $22,086 | Yes (X) | ||
| ELINA CHERNYAK | |||||||
| PHYSICIAN | 40.00 | $607,157 | $0 | $20,558 | Yes (X) | ||
| TALMADGE CAVINESS | |||||||
| PHYSICIAN | 40.00 | $546,801 | $0 | $31,512 | Yes (X) | ||
| KENNETH BERGER | |||||||
| PHYSICIAN | 40.00 | $556,878 | $0 | $22,509 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,999,348 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $236,700 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 84 | 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 |
|---|---|---|---|---|---|
| PATHOLOGISTS REGIONAL LAB | |||||
| PO BOX 956 | LEWISTON | ID | 83501 | LAB SERVICES | $4,210,118 |
| MEDEFIS CONSOLIDATED | |||||
| PO BOX 5068 | NEW YORK | NY | 10087 | LOCUM STAFF & PHYSICIANS | $3,790,391 |
| SPRING RIVER EMERGENCY | |||||
| 4535 DRESSLER ROAD NW | CANTON | OH | 44718 | EMERGENCY ROOM PHYSICIANS | $2,633,662 |
| TWIN CITY RADIOLOGY | |||||
| PO BOX 136 | CLARKSTON | WA | 99403 | RADIOLOGY PHYSICIANS | $1,626,389 |
| RURAL PHYSICIANS GROUP | |||||
| 10023 BRYCE ROSE AVE | LAS VEGAS | NV | 89148 | HOSPITALISTS PHYSICIANS | $560,084 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $3,829,587 | RelatedOrganizationsAmt |
| Government Grants | $1,298,386 | GovernmentGrantsAmt |
| Total Contributions | $5,127,973 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE | 621400 | $119,336,215 | $119,336,215 |
| 340B REVENUE | 621400 | $1,242,821 | $1,242,821 |
| MOB RENTAL INCOME | 621400 | $37,278 | $37,278 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,076,161 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,076,161 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $122,692,475 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $821,547 | TotalRevenueColumnAmt |
| Exclusion | $821,547 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $428,752 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $856,783 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$428,031 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$428,031 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$428,031 | UnrelatedBusinessRevenueAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $190,145 | SecuritiesAmt |
| Other | $237,619 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$190,145 | SecuritiesAmt |
| Other | -$237,619 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$427,764 | TotalRevenueColumnAmt |
| Exclusion | -$427,764 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INCOME ON INVESTMENT IN SUBSIDIAR | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | -$4,421,050 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$4,421,050 | RelatedOrExemptFuncIncomeAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,310,072 | TotalRevenueColumnAmt |
| Exclusion | $1,310,072 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$3,110,978 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $124,675,222 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $118,271,425 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$428,031 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,703,855 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,250 | TotalAmt |
| Program Services | $6,250 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,343,711 | TotalAmt |
| Program Services | $423,617 | ProgramServicesAmt |
| Management And General | $920,094 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,086,999 | TotalAmt |
| Program Services | $39,229,478 | ProgramServicesAmt |
| Management And General | $5,857,521 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,229,694 | TotalAmt |
| Program Services | $1,014,427 | ProgramServicesAmt |
| Management And General | $215,267 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,301,047 | TotalAmt |
| Program Services | $6,134,479 | ProgramServicesAmt |
| Management And General | $1,166,568 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,515,731 | TotalAmt |
| Program Services | $2,911,077 | ProgramServicesAmt |
| Management And General | $604,654 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,836 | TotalAmt |
| Management And General | $83,836 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,656 | TotalAmt |
| Program Services | $896 | ProgramServicesAmt |
| Management And General | $36,760 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,404,366 | TotalAmt |
| Program Services | $20,395,499 | ProgramServicesAmt |
| Management And General | $2,008,867 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $458,130 | TotalAmt |
| Program Services | $290,267 | ProgramServicesAmt |
| Management And General | $167,863 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,590,550 | TotalAmt |
| Program Services | $2,141,123 | ProgramServicesAmt |
| Management And General | $449,427 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,711 | TotalAmt |
| Program Services | $11,711 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,405,678 | TotalAmt |
| Program Services | $3,405,678 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $963,237 | TotalAmt |
| Program Services | $963,237 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $25,221,111 | $25,221,111 |
| BAD DEBT | $1,318,510 | $1,318,510 |
| LICENSES AND TAXES | $965,476 | $965,476 |
| 304B EXPENSES | $895,949 | $895,949 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,569,409 | TotalAmt |
| Program Services | $1,073,377 | ProgramServicesAmt |
| Management And General | $1,496,032 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,409,051 | TotalAmt |
| Program Services | $106,402,162 | ProgramServicesAmt |
| Management And General | $13,006,889 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,963,524 | BOYAmt |
| EOY | $7,420,226 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,913,964 | BOYAmt |
| EOY | $6,449,073 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,863,061 | BOYAmt |
| EOY | $14,453,426 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $277,588 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,785,321 | BOYAmt |
| EOY | $3,024,974 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $799,779 | BOYAmt |
| EOY | $802,340 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $117,845,759 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $62,995,078 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,243,294 | BOYAmt |
| EOY | $54,850,681 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,292,181 | BOYAmt |
| EOY | $15,461,551 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,585 | BOYAmt |
| EOY | $114,366 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,384,400 | BOYAmt |
| EOY | $3,384,400 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,477,641 | BOYAmt |
| EOY | $10,551,896 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,847,750 | BOYAmt |
| EOY | $116,790,521 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,545,252 | BOYAmt |
| EOY | $11,155,371 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $412,402 | BOYAmt |
| EOY | $13,890,447 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,908,447 | BOYAmt |
| EOY | $13,094,148 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,866,101 | BOYAmt |
| EOY | $38,139,966 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,507,734 | BOYAmt |
| EOY | $72,135,794 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,473,915 | BOYAmt |
| EOY | $6,514,761 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,981,649 | BOYAmt |
| EOY | $78,650,555 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,847,750 | BOYAmt |
| EOY | $116,790,521 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,266,171 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$5,050,485 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$1,546,780 | 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 | 0 | FederalGrantAuditRequiredInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,073 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,073 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE FACILITY PAYS DUES TO THE WASHINGTON STATE HOSPITAL ASSOCIATION, THE NATIONAL RURAL HEALTH ASSOCIATION AND THE IDAHO HOSPITAL ASSOCIATION. A PERCENTAGE OF THESE DUES WERE USED FOR LOBBYING ON BEHALF OF HEALTH CARE ORGANIZATIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,798,346 | BeginningYearBalanceAmt |
| Contributions | $76,531 | ContributionsAmt |
| Investment Earnings Or Losses | -$1,152,140 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | -$113,512 | OtherExpendituresAmt |
| End Year Balance | $4,836,249 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,704,063 | BeginningYearBalanceAmt |
| Contributions | $33,538 | ContributionsAmt |
| Investment Earnings Or Losses | $1,107,194 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,046,449 | OtherExpendituresAmt |
| End Year Balance | $5,798,346 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,868,807 | BeginningYearBalanceAmt |
| Contributions | $124,950 | ContributionsAmt |
| Investment Earnings Or Losses | $907,885 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $197,579 | OtherExpendituresAmt |
| End Year Balance | $5,704,063 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,489,793 | BeginningYearBalanceAmt |
| Contributions | $507,510 | ContributionsAmt |
| Investment Earnings Or Losses | $871,504 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,868,807 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,682,682 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$192,889 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,489,793 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.11430 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.88570 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,667,156 | OtherCostOrOtherBasisAmt |
| Book Value | $2,667,156 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,579,759 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,351,112 | DepreciationAmt |
| Book Value | $18,228,647 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,079,344 | OtherCostOrOtherBasisAmt |
| Depreciation | $269,572 | DepreciationAmt |
| Book Value | $809,772 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,282,154 | OtherCostOrOtherBasisAmt |
| Depreciation | $38,374,394 | DepreciationAmt |
| Book Value | $7,907,760 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,237,346 | OtherCostOrOtherBasisAmt |
| Book Value | $25,237,346 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $54,850,681 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST IN NET ASSETS OF THE FOUNDATION | $6,339,325 |
| LAND HELD FOR FUTURE EXPANSION | $240,710 |
| RIGHT OF USE ASSET - FINANCE | $3,971,861 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $10,551,896 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY PAYOR SETTLEMENTS PAYABLE | $77,729 |
| INVESTMENT IN SUBSIDIARIES | $8,816,405 |
| FINANCE LEASE LIABILITIES | $2,543,068 |
| OPERATING LEASE LIABILITIES | $1,656,946 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $13,094,148 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE FOUNDATION'S ARTICLES OF INCORPORATION PROVIDE THAT ALL FUNDS RAISED, EXCEPT FOR FUNDS REQUIRED FOR OPERATION OF THE FOUNDATION, SHALL BE DISTRIBUTED TO OR HELD PRIMARILY FOR THE BENEFIT OF THE HOSPITAL OR THE HOSPITAL'S MISSION IN THE COMMUNITY. THE HOSPITAL ALSO HOLDS PERMANENTLY AND TEMPORARILY DONOR-RESTRICTED ENDOWMENT FUNDS. |
| PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| 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) |
|---|---|---|
| Total Community Benefit Expns | $1,170,695 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $34,016 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,136,679 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00960 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,973,348 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,685,378 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,287,970 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01090 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,144,043 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,719,394 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,424,649 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02050 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,115 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,115 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,115 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,115 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,170,158 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,719,394 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,450,764 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02070 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,578 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,578 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,578 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,578 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $606,515 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $40,310,054 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $40,242,919 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $67,135 | 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 | TRI-STATE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 HIGHLAND AVENUE | AddressLine1Txt |
| City | CLARKSTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99403 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.TSH.ORG | WebsiteAddressTxt |
| State License | H-108 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-STATE 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 | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | HTTPS://WWW.TSH.ORG/COMMUNITY/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.TSH.ORG/COMMUNITY/ | 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 | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.TSH.ORG/POLICIES-BILLING/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.TSH.ORG/POLICIES-BILLING/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.TSH.ORG/POLICIES-BILLING/ | 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 |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| TRI-STATE MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: IN THE FALL OF 2022, TSMH ENGAGED COMMUNITY LEADERS TO SECURE INPUT REGARDING UNMET HEALTH NEEDS AND PRIORITIES. TSMH DISTRIBUTED A SURVEY TO KEY COMMUNITY ORGANIZATIONS, INCLUDING REPRESENTATIVES FROM PUBLIC HEALTH, PHYSICAL AND MENTAL HEALTH, SCHOOLS, SOCIAL SERVICES, PHILANTHROPY, ELECTED OFFICIALS, THE GENERAL COMMUNITY, AND OTHERS THROUGHOUT THE LEWIS-CLARK VALLEY. |
| TRI-STATE MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: BASED ON THE DATA, THE KEY INFORMANT SURVEYS, AND THE BOARD'S CONSIDERATION OF TSMH'S RESOURCES AND EXPERTISE, TSMH HAS ELECTED TO CONTINUE TO BUILD OFF THE 2020-2022 CHNA PRIORITIES AND HAS MODIFIED THE OVERALL PRIORITY TO ADD BEHAVIORAL HEALTH: SUPPORT INDIVIDUALS AND FAMILIES THROUGH COMPREHENSIVE AND PATIENT-CENTERED PRIMARY CARE, BEHAVIORAL HEALTH, AND WELLNESS PROGRAMMING.SPECIFIC FOCUS AREAS FOR 2023-2025 INCLUDE:RECRUIT AND DEVELOP SERVICES AND SUPPORTS TO RETAIN PRIMARY CARE PROVIDERS.OPTIMIZATION OF WORKFLOWS, PROCESSES, PEOPLE, AND TECHNOLOGY TO SUPPORT EFFICIENT AND EFFECTIVE DELIVERY OF PRIMARY CARE AND TO SUPPORT RETENTION OF PROVIDERS.CONTINUE GROWTH OF BEHAVIORAL HEALTH SERVICES, WITH A SPECIAL FOCUS ON YOUTH IN THE COMMUNITY AND INTEGRATING BEHAVIORAL HEALTH SERVICES WITH PRIMARY CARE.CONTINUE TO GROW TELEMEDICINE AND TELE-BEHAVIORAL HEALTH SERVICES.PARTNER WITH COMMUNITY ORGANIZATIONS TO EDUCATE, INFORM, AND SUPPORT YOUTH AND ADULTS AROUND HEALTHY LIVING.SUPPORT HEALTHY AGING AND MITIGATE IMPACTS OF CHRONIC HEALTH AND BEHAVIORAL HEALTH CONCERNS IN THE VALLEY'S ELDERLY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 13 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - TSMH IPC | ||||
| 1119 HIGHLAND AVENUE SUITE 11 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 2 - TSMH CMC CLINIC | ||||
| 1534 17TH STREET | LEWISTON | ID | 83501 | NON-PROVIDER BASED CLINIC |
| 3 - TSMH FAMILY PRACTICE CLARKSTON | ||||
| 1119 HIGHLAND AVENUE SUITE 10 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 4 - TSMH UROLOGY | ||||
| 1119 HIGHLAND AVENUE SUITE 1 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 5 - TSMH WOUND CARE & PODIATRY | ||||
| 1221 HIGHLAND AVENUE SUITE 7 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 6 - TSMH LEW FP CLINIC | ||||
| 2841 JUNIPER DRIVE 2 | LEWISTON | ID | 83501 | NON-PROVIDER BASED CLINIC |
| 7 - TSMH MINOR CARE CLINIC | ||||
| 1267 BELMONT WAY | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 8 - TSMH SLEEP LAB | ||||
| 1119 HIGHLAND AVENUE SUITE 8 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 9 - TSMH BEHAVIORAL HEALTH CLINIC | ||||
| 1119 HIGHLAND AVENUE SUITE 6 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 10 - TSMH GENERAL SURGERY | ||||
| 1119 HIGHLAND AVENUE SUITE 4 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 11 - TSMH FAMILY PULMONOLOGY CLINIC | ||||
| 1119 HIGHLAND AVENUE SUITE 2 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 12 - TSMH NEPHR CLINIC | ||||
| 1221 HIGHLAND AVENUE SUITE 5 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
| 13 - TSMH RHEUM CLINIC | ||||
| 1119 HIGHLAND AVENUE SUITE 3 | CLARKSTON | WA | 99403 | PROVIDER BASED CLINIC |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COST-TO-CHARGE RATIO USED WAS DERIVED BASED ON THE FILED 2022 MEDICARE COST REPORT. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,318,510. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | TRI-STATE MEMORIAL HOSPITAL HELPS PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING SUPPORT AMONGST A NUMBER OF LOCAL CHARITIES, FOOD BANKS AND OTHER AGENCIES. IN 2022 TRI-STATE HOSPITAL CONTRIBUTED $6,250 TO THE BOYS AND GIRLS CLUBS OF THE LEWIS-CLARK VALLEY WHICH THEY USED FOR THE PARTNERSHIP FOR KIDS, THE ANNUAL CAMPAIGN, THE GRILLED CHEESE PROGRAM AND MEDICAL SUPPLIES/FIRST AID DONATIONS. THE WORLD SERIES OF NAIA BASEBALL IS PLAYED IN LEWISTON AND TRI-STATE MEMORIAL HOSPITAL SPONSORED THAT EVENT AND SPONSORED THE MEDICAL TENT AND REFRESHMENTS FOR ALL MEDICAL VOLUNTEERS FOR THIS EVENT. ADDITIONALLY, TRI-STATE MEMORIAL HOSPITAL GAVE DONATIONS TO THE WASHINGTON POISON CONTROL, VALLEY VISION, AND FIELD OF DREAMS. TRI-STATE MEMORIAL HOSPITAL CONTINUES TO FIND WAYS TO SUPPORT THE COMMUNITIES IT SERVES IN BROAD AND EXPANDING WAYS, TRYING TO REACH ALL PATIENTS FROM ADOLESCENCE TO ADULTHOOD. |
| PART III, LINE 2: | THE ORGANIZATION'S BAD DEBT EXPENSE AT COST WAS ESTIMATED BY MULTIPLYING THE BAD DEBT EXPENSE BY THE ORGANIZATION'S COST-TO-CHARGE RATIO. |
| PART III, LINE 3: | THE FACILITY REPORTS BAD DEBT EXPENSE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NUMBER 15, SO NONE OF THE BAD DEBT EXPENSE REPORTED ON SCHEDULE H, PART III, LINE 2 IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 4: | WHILE THE FACILITY DOES NOT HAVE A NOTE REGARDING BAD DEBT EXPENSE IN ITS FINANCIAL STATEMENTS, THE AMOUNT OF BAD DEBT EXPENSE FOR EACH YEAR IS DISCLOSED ON THE FACILITY'S STATEMENTS OF REVENUE AND EXPENSES. THE AMOUNT OF BAD DEBT EXPENSE REPORTED WAS $1,318,510 FOR THE YEAR ENDED DECEMBER 31, 2022. THE COSTING METHODOLOGY USED TO DETERMINE THE COST OF BAD DEBT IS BASED ON THE FACILITY'S CALCULATED COST-TO-CHARGE RATIO. |
| PART III, LINE 8: | THE FACILITY IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED BY MEDICARE AT APPROXIMATELY 99% OF MEDICARE'S COSTS.THE TOTAL REVENUE RECEIVED FROM MEDICARE AND RELATED MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE FACILITY'S FILED 2022 MEDICARE COST REPORT. |
| PART III, LINE 9B: | THE FULL PATIENT BALANCE FOR THOSE KNOWN TO QUALIFY FOR CHARITY CARE WILL BE EVALUATED FOR FINANCIAL ASSISTANCE ELIGIBILITY AS FOLLOWS: THEY QUALIFY FOR A 100% DISCOUNT IF THE PATIENT'S GROSS FAMILY INCOME IS AT OR BELOW 200% OF THE CURRENT FEDERAL POVERTY GUIDELINES, THEY QUALIFY FOR A 75% DISCOUNT IF THE PATIENT'S GROSS FAMILY INCOME IS AT OR BETWEEN 201% TO 250% OF THE CURRENT FEDERAL POVERTY GUIDELINES, THEY QUALIFY FOR A 50% DISCOUNT IF THE PATIENT'S GROSS FAMILY INCOME IS AT OR BETWEEN 251% TO 300% OF THE CURRENT FEDERAL POVERTY GUIDELINES AND THEY QUALIFY FOR A 25% DISCOUNT IF THE PATIENT'S GROSS FAMILY INCOME IS AT OR BETWEEN 301%-350% OF THE CURRENT FEDERAL POVERTY GUIDELINES.THE HOSPITAL MAY CHOOSE TO GRANT FINANCIAL ASSISTANCE BASED SOLELY UPON THE INITIAL DETERMINATION OF THE PATIENT. ANY PATIENTS WHO ARE ON STATE ASSISTANCE, ARE UNEMPLOYED, DISABLED, TRANSIENT OR INCOMPETENT MAY BE VALID "PRIMA-FACIE" CANDIDATES. IN SUCH CASES, THE HOSPITAL MAY NOT COMPLETE FULL VERIFICATION OR DOCUMENTATION OF ANY REQUESTS.UNINSURED AND UNDERINSURED WASHINGTON AND IDAHO PATIENTS MAY QUALIFY FOR A DISCOUNT. DETERMINATION WILL BE MADE BY TSMH ADMINISTRATION UPON PATIENT'S COMPLETION OF THE SPECIAL CONSIDERATION FINANCIAL ASSISTANCE APPLICATION AND THE SPECIFIED SUPPORTING DOCUMENTATION AS PROOF OF SEVERE FINANCIAL HARDSHIP OF PERSONAL LOSS FROM TIME OF REQUEST BASED ON ECONOMIC SITUATION. THE COLLECTION PRACTICE FOR PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE IS AS FOLLOWS: 75% OF THE PATIENT'S BILL IS ADJUSTED OFF IF THE PERSON IS BETWEEN 201-250% OF THE FPL TO CHARITY CARE AND THE REMAINING 25% IS THE PATIENT'S RESPONSIBILITY. IF THE PATIENT IS UP TO 200% OF THE FPL THEN 100% OF THE PATIENT'S BILL IS ADJUSTED OFF AS CHARITY CARE. THIS POLICY IS APPLIED TO ALL PATIENTS THAT HAVE COMPLETED A FINANCIAL ASSISTANCE APPLICATION AND WHOSE INCOMES LEVELS HAVE BEEN VERIFIED. PATIENTS ARE ALSO IDENTIFIED WHO MAY BE ELIGIBLE FOR ASSISTANCE BEYOND THE HOSPITAL THROUGH MEDICAID OR COUNTY AID. |
| PART VI, LINE 2: | IN THE FALL OF 2022, TSMH ENGAGED COMMUNITY LEADERS TO SECURE INPUT REGARDING UNMET HEALTH NEEDS AND PRIORITIES. TSMH DISTRIBUTED A SURVEY TO KEY COMMUNITY ORGANIZATIONS, INCLUDING REPRESENTATIVES FROM PUBLIC HEALTH, PHYSICAL AND MENTAL HEALTH, SCHOOLS, SOCIAL SERVICES, PHILANTHROPY, ELECTED OFFICIALS, THE GENERAL COMMUNITY, AND OTHERS THROUGHOUT THE LEWIS-CLARK VALLEY. |
| PART VI, LINE 3: | FINANCIAL BROCHURES ARE SENT WITH ITEMIZED STATEMENTS TO ALL UNINSURED PATIENTS. AT THE TIME PATIENT MAKES CONTACT, THE PATIENT FINANCIAL COUNSELOR WILL:1. DISCUSS THE HOSPITAL GUIDELINE FOR REIMBURSEMENT OF HOSPITAL SERVICES.2. THE 10% DISCOUNT IS OFFERED TO UNINSURED PATIENTS WHEN BALANCE IS PAID IN FULL. 3. ESTABLISH A PAYMENT CONTRACT IN ORDER TO RESOLVE THE ACCOUNT BALANCE WITHIN APPLICABLE GUIDELINES. THE MINIMUM ACCEPTABLE PAYMENT IS $50 OR 5% (WHICHEVER IS GREATER).4. IDENTIFY A PATIENT WHO MAY BE ELIGIBLE FOR ASSISTANCE TO INCLUDE BUT NOT LIMITED TO MEDICAID OR COUNTY AID FOR THE STATE THE PATIENT RESIDES.5. DETERMINE IF HOUSEHOLD INCOME MEETS OR FALLS BELOW THE CURRENT YEAR'S POVERTY GUIDELINES THEN EXPLAIN TSMH FINANCIAL ASSISTANCE PROGRAM. |
| PART VI, LINE 4: | TSMH IS LOCATED IN THE LEWIS-CLARK VALLEY (THE VALLEY), AT THE CONFLUENCE OF THE SNAKE AND CLEARWATER RIVERS IN THE SOUTHEASTERN MOST CORNER OF WASHINGTON STATE. THE CITY OF CLARKSTON IS CONTIGUOUS TO THE CITY OF LEWISTON IN NEIGHBORING NEZ PERCE COUNTY IN IDAHO. TSMH SERVES RESIDENTS OF BOTH ASOTIN COUNTY AND ADJOINING NEZ PERCE COUNTY. COLLECTIVELY, THESE TWO COUNTIES ARE CONSIDERED THE SERVICE AREA COMMUNITY. |
| PART VI, LINE 5: | THE HOSPITAL PERFORMS SURGERIES REQUIRING INPATIENT STAYS AND ALSO SAME DAY OPERATIONS, NOT REQUIRING A HOSPITAL STAY. OUTPATIENT SERVICES INCLUDE RENAL DIALYSIS CENTERS IN CLARKSTON, WA, WOUND HEALING & HYPERBARIC CENTER, SLEEP DIAGNOSTIC CENTER, AND A 24 HOUR PHYSICIAN STAFFED EMERGENCY DEPARTMENT. OTHER OUTPATIENT SERVICES INCLUDE A NEPHROLOGY CENTER, PRIMARY CARE CLINIC, INTERNAL MEDICINE CLINIC, GENERAL SURGERY CLINIC, UROLOGY CLINIC, RHEUMATOLOGY CLINIC, AND PAIN CLINIC. THE HOSPITAL OPERATES WITH OVER 690 FULL AND PART-TIME EMPLOYEES, 35 VOLUNTEERS AND 340 PHYSICIANS ON STAFF. TRI-STATE HOSPITAL FOUNDATION IS A NON-PROFIT ORGANIZATION WHICH BENEFITS THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. GIFTS TO THE FOUNDATION ARE USED TO PURCHASE SPECIALIZED EQUIPMENT THAT HELP EXPAND SERVICES PROVIDED BY THE HOSPITAL TO THE COMMUNITY. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BOYS & GIRLS CLUBS OF THE LEWIS-CLARK VALLEY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1021 BURRELL AVE | AddressLine1Txt |
| City | LEWISTON | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 826001432 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $6,250 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | PARTNERSHIP FOR KIDS, ANNUAL CAMPAIGN, SCHOLARSHIPS, GRILLED CHEESE PROGRAM | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL RECEIVES AND REVIEWS DETAILED REPORTS PROVIDED BY THE CHARITABLE ORGANIZATIONS THAT RECEIVE GRANT FUNDS FROM THE HOSPITAL. THE HOSPITAL IS ABLE TO SUBSTANTIATE THE PROPER USE OF THE FUNDS THROUGH THE REPORTS PROVIDED BY THE CHARITABLE ORGANIZATIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 | 0 | 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 | 0 | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ELINA CHERNYAK | ||||||||||||||
| PHYSICIAN | $337,006 | $0 | $270,151 | $0 | $0 | $0 | $6,899 | $0 | $13,659 | $0 | $627,715 | $0 | $0 | $0 |
| CRAIG FLINDERS | ||||||||||||||
| PHYSICIAN | $560,538 | $0 | $0 | $0 | $0 | $0 | $15,250 | $0 | $23,681 | $0 | $599,469 | $0 | $0 | $0 |
| KENNETH BERGER | ||||||||||||||
| PHYSICIAN | $511,933 | $0 | $44,945 | $0 | $0 | $0 | $423 | $0 | $22,086 | $0 | $579,387 | $0 | $0 | $0 |
| TALMADGE CAVINESS | ||||||||||||||
| PHYSICIAN | $546,801 | $0 | $0 | $0 | $0 | $0 | $6,100 | $0 | $25,412 | $0 | $578,313 | $0 | $0 | $0 |
| LEROY SMITH | ||||||||||||||
| PHYSICIAN | $485,367 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,086 | $0 | $507,453 | $0 | $0 | $0 |
| JOHN RUDOLPH MD | ||||||||||||||
| BOARD MEMBER | $382,535 | $0 | $9,727 | $0 | $0 | $0 | $12,187 | $0 | $19,168 | $0 | $423,617 | $0 | $0 | $0 |
| KYM CLIFT | ||||||||||||||
| CEO | $315,134 | $0 | $40,500 | $0 | $6,000 | $0 | $2,170 | $0 | $21,063 | $0 | $384,867 | $0 | $0 | $0 |
| KIMBERLY BLEWETT | ||||||||||||||
| BOARD MEMBER | $253,018 | $0 | $0 | $0 | $0 | $0 | $11,662 | $0 | $20,251 | $0 | $284,931 | $0 | $0 | $0 |
| JIM HEILSBERG | ||||||||||||||
| CFO | $235,693 | $0 | $0 | $0 | $0 | $0 | $1,566 | $0 | $13,037 | $0 | $250,296 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MIKE MARTIN | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $167,158 | TransactionAmt |
| Transaction | INSURANCE BROKER - OWNER OF MARTIN INSURANCE | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY IS PROVIDED TO THE CEO FOR REVIEW PRIOR TO FILING. THE BOARD AUTHORIZES THE CEO TO REVIEW AND APPROVE THE 990. THE FINAL 990 IS FILED AFTER CEO APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | IT IS THE ORGANIZATION'S POLICY TO REQUEST THE DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST SO THAT APPROPRIATE ACTION MAY BE TAKEN TO ENSURE THAT SUCH CONFLICT DOES NOT INAPPROPRIATELY INFLUENCE IMPORTANT DECISIONS. THE HOSPITAL REVIEWS ITS RELATIONSHIP AND ITS STAFF'S RELATIONSHIPS WITH OTHER CARE PROVIDERS, EDUCATIONAL INSTITUTIONS, AND PAYERS TO ENSURE THAT THOSE RELATIONSHIPS ARE WITHIN LAW AND REGULATION AND DETERMINE IF CONFLICTS OF INTEREST EXIST. BOARD MEMBERS ARE REQUIRED TO SUBMIT AN ANNUAL DISCLOSURE FORM. BOARD MEMBERS, ADMINISTRATION AND MEDICAL STAFF LEADERS ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICTS RELATED TO DECISIONS THAT ARISE DURING THE COURSE OF THE YEAR ON A CASE-BY-CASE BASIS. THE GOVERNING BOARD, SENIOR MANAGEMENT, OR THE MEDICAL EXECUTIVE COMMITTEE WILL REVIEW POTENTIAL CONFLICTS AND TAKE APPROPRIATE ACTION. IN THE EVENT A POTENTIAL CONFLICT OF INTEREST HAS A DIRECT IMPLICATION FOR PATIENT CARE, THE INSTITUTION MAY CONVENE AN ETHICS COMMITTEE TO ASSIST IN THE RESOLUTION OF THE ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION IS DETERMINED BASED ON FAIR MARKET VALUE. TSMH USES NATIONAL AND REGIONAL BENCHMARKS (MILLIMAN SURVEY & STATE OF IDAHO). BASED ON THESE COMPARISONS, THE BOARD OF DIRECTORS DETERMINES THE COMPENSATION FOR THE CEO AND THE CEO DETERMINES THE COMPENSATION FOR THE REMAINING EMPLOYEES OF THE FACILITY. THE BOARD HAS FULL DETERMINATION OF THE CEO'S COMPENSATION. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. |
| FORM 990, PART VI, SECTION C, LINE 19 | TRI-STATE MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | LAB PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,081,090. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,081,090. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 1,568,460. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,568,460. TRAVELING STAFF: PROGRAM SERVICE EXPENSES 4,015,448. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,015,448. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 10,730,501. MANAGEMENT AND GENERAL EXPENSES 2,008,867. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,739,368. |
| FORM 990, PART XI, LINE 9: | TEMPORARILY RESTRICTED - NET GRANT FUNDS RECEIVED 4,000. TEMPORARILY RESTRICTED - RELEASED FOR OPERATIONS -65,549. TEMPORARILY RESTRICTED - INTEREST INCOME 2. TEMPORARILY RESTRICTED - CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -897,606. INTERCOMPANY TRANSFERS -587,627. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| AQUAVIA | |||||||||
| PO BOX 189 | CLARKSON | WA | 99403 | 472643240 | REAL ESTATE RENTAL | WA | -$665,649 | $4,198,880 | TRI-STATE MEMORIAL HOSPITAL |
| VANNVEI LLC | |||||||||
| PO BOX 341 | LEWISTON | ID | 83501 | 832881716 | HEALTH SERVICES | WA | -$2,932,565 | $1,918,972 | TRI-STATE MEMORIAL HOSPITAL |
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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| TRI-STATE HOSPITAL FOUNDATION | ||||||||||
| 1347 12TH STREET | CLARKSTON | WA | 99403 | 911307818 | FUNDRAISING FOR TRI-STATE MEMORIAL HOSPITAL | WA | 501(C)(3) | LINE 7 | TRI-STATE MEMORIAL HOSPITAL | Yes (1) |
| TRI-STATE MEMORIAL HOSPITAL AUXILIARY | ||||||||||
| PO BOX 189 | CLARKSTON | WA | 99403 | 911357957 | FUNDRAISING FOR TRI-STATE MEMORIAL HOSPITAL | WA | 501(C)(3) | LINE 12B, II | TRI-STATE MEMORIAL HOSPITAL | Yes (1) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EVERGREEN ESTATES RETIREMENT AND ASSISTED LIVING COMMUNITY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 EVERGREEN COURT | AddressLine1Txt |
| City | CLARKSTON | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99403 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263462257 | EIN |
| Primary Activities | ASSISTED LIVING | PrimaryActivitiesTxt |
| Legal Domicile State | WA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-STATE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$1,390,291 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $16,516,985 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | 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 | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | 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 (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| EVERGREEN ESTATES | ||
| A | $89,539 | CASH |
| EVERGREEN ESTATES | ||
| B | $587,625 | CASH |
| TRI-STATE HOSPITAL FOUNDATION | ||
| C | $3,829,587 | CASH |