TRI-STATE MEMORIAL HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- TRI-STATE MEMORIAL HOSPITAL (EIN 91-0545036)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-15
- IRS object ID
- 201613209349310171
- Schema version
- 2015v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-15T14:11:30-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 2015-01-01 | 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 | Alex Town | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5097585511 | PhoneNum |
| Signature | 2016-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Terri Rexrode CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2016-11-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Alex Town | 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 | $70,581,249 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.tristatehospital.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 | 548 | TotalEmployeeCnt |
| Total Volunteers | 86 | TotalVolunteersCnt |
| Total Gross UBI | -$9,785 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$9,785 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $466,839 | PYContributionsGrantsAmt |
| CY Contributions Grants | $93,710 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $68,213,221 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $69,529,469 | CYProgramServiceRevenueAmt |
| PY Investment Income | $479,177 | PYInvestmentIncomeAmt |
| CY Investment Income | $732,402 | CYInvestmentIncomeAmt |
| PY Other Revenue | $177,968 | PYOtherRevenueAmt |
| CY Other Revenue | $75,164 | CYOtherRevenueAmt |
| PY Total Revenue | $69,337,205 | PYTotalRevenueAmt |
| CY Total Revenue | $70,430,745 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $17,800 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $33,775 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $29,369,109 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,785,407 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $229,139 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $34,750,424 | PYOtherExpensesAmt |
| CY Other Expenses | $38,008,670 | CYOtherExpensesAmt |
| PY Total Expenses | $64,137,333 | PYTotalExpensesAmt |
| CY Total Expenses | $68,827,852 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,199,872 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,602,893 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $69,232,102 | TotalAssetsBOYAmt |
| Total Assets EOY | $78,569,943 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $20,603,740 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $29,086,003 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $48,628,362 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $49,483,940 | 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 | $56,648,149 | ExpenseAmt |
| Grant | $33,775 | GrantAmt |
| Revenue | $67,584,832 | RevenueAmt |
| Desc | The hospital provided 3,957 days of care to 1,210 patients in 2015. In addition, the hospital provided approximately 264,334 outpatient visits in the emergency room, rental dialysis, surgical, and other patient service centers. The hospital provided approximately $1,040,000 in charitable services to patients unable to pay for healthcare services. | Desc |
| Total Program Service Expenses | $56,648,149 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 52 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 548 | 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 |
| 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEX TOWN CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5097585511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 189 | 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 |
|---|---|---|---|---|---|---|---|
| Rick Wasem | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| K David Hagen | |||||||
| President | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| jack seeh | |||||||
| Secretary/Treasurer | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Scott Arnone | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| John Mannschreck MD | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LaRae Merril | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Steve Claassen | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Dick Flerchinger | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Mike Martin | |||||||
| Vice President | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Dan Klaveano | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| E Wayne Day MD | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Don McQuary | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Debra R Ausman | |||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Donald Wee | |||||||
| CEO | 40.00 | $322,770 | $0 | $25,495 | Yes (X) | ||
| ALEX TOWN | |||||||
| CFO | 40.00 | $180,217 | $0 | $26,280 | Yes (X) | ||
| Meghana S Awad MD | |||||||
| Physician | 40.00 | $323,491 | $0 | $12,747 | Yes (X) | ||
| Robert T Parkey MD | |||||||
| Physician | 40.00 | $429,731 | $0 | $12,180 | Yes (X) | ||
| M Lyndon Dieter | |||||||
| Physician | 40.00 | $435,306 | $0 | $23,646 | Yes (X) | ||
| Donald Greggain | |||||||
| Physician | 40.00 | $315,542 | $0 | $15,179 | Yes (X) | ||
| Richard Zobell | |||||||
| Physician | 40.00 | $293,529 | $0 | $7,107 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,300,586 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $122,634 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | 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 |
|---|---|---|---|---|---|
| Bouten Construction Co | |||||
| PO Box 3507 | spokane | WA | 99220 | General Building Contractor | $4,222,055 |
| Pathologist Regional Lab | |||||
| P O Box 956 | Lewiston | ID | 83501 | Lab/Blood Work | $3,347,934 |
| Clarkston Emergency Physicians | |||||
| P O Box 189 | Clarkston | WA | 99403 | ER Physicians | $1,925,448 |
| Twin City Radiology | |||||
| PO Box 136 | Clarkson | WA | 99403 | Radiology Physician Services | $1,373,426 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 75397 | Physician Services | $1,236,789 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 17 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $93,710 | GovernmentGrantsAmt |
| Total Contributions | $93,710 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Net Patient Service | 621400 | $64,573,031 | $64,573,031 | |
| Resident Rental Income | 621400 | $2,792,138 | $2,792,138 | |
| other operating Revenue | 623000 | $2,029,586 | $2,029,586 | |
| MOB rental income | 621400 | $134,714 | $134,714 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $69,529,469 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $711,710 | TotalRevenueColumnAmt |
| Exclusion | $711,710 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $140,719 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $150,504 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$9,785 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$9,785 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$9,785 | UnrelatedBusinessRevenueAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $20,692 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $20,692 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,692 | TotalRevenueColumnAmt |
| Exclusion | $20,692 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Investment in Joint Ventu | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $84,949 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $84,949 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $84,949 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $70,430,745 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $67,584,832 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$9,785 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,761,988 | 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 | $33,775 | TotalAmt |
| Program Services | $33,775 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $554,762 | TotalAmt |
| Management And General | $554,762 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,626,667 | TotalAmt |
| Program Services | $22,443,033 | ProgramServicesAmt |
| Management And General | $2,038,904 | ManagementAndGeneralAmt |
| Fundraising | $144,730 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $818,491 | TotalAmt |
| Program Services | $732,103 | ProgramServicesAmt |
| Management And General | $77,919 | ManagementAndGeneralAmt |
| Fundraising | $8,469 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,535,252 | TotalAmt |
| Program Services | $2,220,304 | ProgramServicesAmt |
| Management And General | $295,500 | ManagementAndGeneralAmt |
| Fundraising | $19,448 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,250,235 | TotalAmt |
| Program Services | $1,999,417 | ProgramServicesAmt |
| Management And General | $232,183 | ManagementAndGeneralAmt |
| Fundraising | $18,635 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,804 | TotalAmt |
| Management And General | $47,804 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $359,500 | TotalAmt |
| Management And General | $359,500 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,577,638 | TotalAmt |
| Program Services | $12,142,115 | ProgramServicesAmt |
| Management And General | $435,523 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,680 | TotalAmt |
| Program Services | $308,680 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,145,026 | TotalAmt |
| Program Services | $12,290,642 | ProgramServicesAmt |
| Management And General | $842,324 | ManagementAndGeneralAmt |
| Fundraising | $12,060 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,400 | TotalAmt |
| Program Services | $20,518 | ProgramServicesAmt |
| Management And General | $100,882 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,040,093 | TotalAmt |
| Program Services | $2,184,198 | ProgramServicesAmt |
| Management And General | $834,646 | ManagementAndGeneralAmt |
| Fundraising | $21,249 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $611,665 | TotalAmt |
| Management And General | $611,665 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,853,476 | TotalAmt |
| Management And General | $3,853,476 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $537,823 | TotalAmt |
| Program Services | $537,823 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| Bad Debt | $1,101,620 | $1,101,620 | |
| Continuing Education | $209,838 | $53,115 | $156,723 |
| Dues and Subscriptions | $136,939 | $119,114 | $17,825 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,957,168 | TotalAmt |
| Program Services | $1,560,993 | ProgramServicesAmt |
| Management And General | $391,627 | ManagementAndGeneralAmt |
| Fundraising | $4,548 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,827,852 | TotalAmt |
| Program Services | $56,648,149 | ProgramServicesAmt |
| Management And General | $11,950,564 | ManagementAndGeneralAmt |
| Fundraising | $229,139 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,981,696 | BOYAmt |
| EOY | $7,786,764 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,311,677 | BOYAmt |
| EOY | $5,997,859 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,514,597 | BOYAmt |
| EOY | $8,895,065 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,676,882 | BOYAmt |
| EOY | $1,642,715 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $272,422 | BOYAmt |
| EOY | $420,449 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $81,369,023 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $38,778,933 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,267,120 | BOYAmt |
| EOY | $42,590,090 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,864,517 | BOYAmt |
| EOY | $6,644,911 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,343,191 | BOYAmt |
| EOY | $4,592,090 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,232,102 | BOYAmt |
| EOY | $78,569,943 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,386,091 | BOYAmt |
| EOY | $6,931,149 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $380,008 | BOYAmt |
| EOY | $903,790 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,837,641 | BOYAmt |
| EOY | $21,251,064 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,603,740 | BOYAmt |
| EOY | $29,086,003 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,612,613 | BOYAmt |
| EOY | $45,412,904 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,677,615 | BOYAmt |
| EOY | $2,516,495 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,338,134 | BOYAmt |
| EOY | $1,554,541 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,628,362 | BOYAmt |
| EOY | $49,483,940 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,232,102 | BOYAmt |
| EOY | $78,569,943 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,602,893 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$802,602 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $55,287 | 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 | 0 | 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 | $12,232 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $12,232 | 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 AMERICAN HOSPITAL ASSOCIATION, HOME CARE ASSOCIATION OF WASHINGTON, AND THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE. 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 | $2,637,354 | BeginningYearBalanceAmt |
| Contributions | $220,000 | ContributionsAmt |
| Other Expenditures | $62,702 | OtherExpendituresAmt |
| End Year Balance | $2,794,652 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,566,632 | BeginningYearBalanceAmt |
| Contributions | $80,000 | ContributionsAmt |
| Investment Earnings Or Losses | $70,048 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $26,667 | GrantsOrScholarshipsAmt |
| Other Expenditures | $52,659 | OtherExpendituresAmt |
| End Year Balance | $2,637,354 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,995,974 | BeginningYearBalanceAmt |
| Contributions | $118,680 | ContributionsAmt |
| Investment Earnings Or Losses | $492,667 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $27,284 | GrantsOrScholarshipsAmt |
| Other Expenditures | $13,405 | OtherExpendituresAmt |
| End Year Balance | $2,566,632 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,797,279 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $236,101 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $28,375 | GrantsOrScholarshipsAmt |
| Other Expenditures | $9,031 | OtherExpendituresAmt |
| End Year Balance | $1,995,974 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,824,903 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $42,417 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $48,211 | GrantsOrScholarshipsAmt |
| Other Expenditures | $21,830 | OtherExpendituresAmt |
| End Year Balance | $1,797,279 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.52580 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.47420 | 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 | $2,354,993 | OtherCostOrOtherBasisAmt |
| Book Value | $2,354,993 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,194,849 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,934,857 | DepreciationAmt |
| Book Value | $26,259,992 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,043,567 | OtherCostOrOtherBasisAmt |
| Depreciation | $588,035 | DepreciationAmt |
| Book Value | $455,532 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,441,600 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,256,041 | DepreciationAmt |
| Book Value | $11,185,559 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,334,014 | OtherCostOrOtherBasisAmt |
| Book Value | $2,334,014 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $42,590,090 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Deferred Financing Costs | $294,450 |
| Investment in Unconsolidated Affiliates | $41,953 |
| Land Held for Future Expansion | $240,710 |
| Interest in Net Assets of Foundation | $3,820,583 |
| Loan Fees (net) | $194,394 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,592,090 | TotalBookValueOtherAssetsAmt |
| 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. Tri-State Memorial Hospital began reporting its interest in the net assets of the foundation for the years ended December 31, 2012 and 2011. |
| Part X, Line 2: | THE HOSPITAL IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO ENGAGED, TO A LIMITED EXTENT, IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME (UBI). INCOME TAXES ON UBI ARE NOT SIGNIFICANT. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSTITION 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. MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AND HAS RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS FOR THE YEARS ENDED DECEMBER 31, 2015 OR 2014. FEDERAL TAX RETURNS FOR YEARS 2012 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $583,838 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $104,032 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $479,806 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00710 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,298,031 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,516,216 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $781,815 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01150 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,881,869 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,620,248 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,261,621 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01860 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,450 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $31,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,384 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,384 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,834 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,834 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,924,703 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,620,248 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,304,455 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01930 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,426 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,426 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,426 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,426 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,101,620 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $26,123,550 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $26,890,195 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$766,645 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| 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.tristatehospital.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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | 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 | www.tristatehospital.org/about | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.TRISTATEHOSPITAL.ORG/ABOUT | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | 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 Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Tri-State Memorial Hospital | Part V, Section B, Line 5: The CHNA was prepared in partnership with the Asotin County Health District, the Idaho North Central Public Health District and key community and civic groups:Charlotte Ash, Snake River Community Clinic and Nimiipuu Health Center, Mary Ackerman, Asotin County Food Bank, Kelly Carlstrom, Boys and Girls Club, Brady Woodbury, Asotin County Health District, Sherry Greenup, Asotin County Aging and Disability, Dale Bonfield, Superintendent Asotin-Anatone School District, Community Action Partnership, United Way, and Quality Behavioral Health. |
| Tri-State Memorial Hospital | Part V, Section B, Line 11: THE FACILITY IDENTIFIED NUMEROUS COMMUNITY NEEDS IN THEIR COMMUNITY HEALTH NEEDS ASSESSMENT. DUE TO THE WIDE RANGE OF NEEDS AND THE FACILITY'S LIMITED RESOURCES, THE FACILITY IS UNABLE TO ADDRESS ALL OF THE NEEDS IDENTIFIED. GIVEN THE FACILITY'S AREAS OF EXPERTISE AND RESOURCES AVAILABLE, THE FACILITY WILL FOCUS ON THE FOLLOWING NEEDS:- INCREASING ACCESS TO AFFORDABLE HEALTHCARE BY SUPPORTING ACTIVE ENROLLMENT IN MEDICAID EXPANSION AND EXCHANGE.- REDUCING THE IMPACT OF OBESITY AND OTHER CHRONIC HEALTH CONDITIONS BY PROVIDING/PARTNERING WITH COMMUNITY ORGANIZATIONS TO DEVELOP COMMUNITY EDUCATION CLASSES AIMED AT HEALTH LIFESTYLES AND MANAGING HEALTH CONDITIONS. |
| Tri-State Memorial Hospital | Part V, Section B, Line 22d: THE FULL PATIENT BALANCE FOR HOSPITAL CHARGES IS EVALUATED TO DETERMINE FULL FINANCIAL ASSISTANCE ELIGIBILITY FOR ANY PATIENT WHOSE GROSS FAMILY INCOME IS AT OR BELOW 100% OF THE CURRENT FEDERAL POVERTY GUIDELINES.PATIENTS WHOSE GROSS FAMILY INCOME IS 101% TO 200% OF THE CURRENT FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR A DISCOUNT OF 75% TO BE APPLIED TO THE PATIENT ACCOUNT BALANCE AND WILL BE DETERMINED AS A FINANCIAL ASSISTANCE DISCOUNT.PATIENTS WHOSE GROSS FAMILY INCOME IS 201% TO 300% OF THE CURRENT FEDERAL POVERTY GUIDELINES WILL QUALIFY FOR A DISCOUNT OF 35% APPLIED TO THE PATIENT RESPONSIBILITY.PRIMA FACIE WRITE-OFFS: THE HOSPITAL MAY CHOOSE TO GRANT FINANCIAL ASSISTANCE BASED SOLELY UPON THE INITIAL DETERMINATION. ANY PATIENTS WHO ARE ON STATE ASSISTANCE, ARE UNEMPLOYED, DISABLED, TRANSIENTS OR INCOMPETANT MAY BE VALID "PRIMA-FACIE" CANDIDATES. IN SUCH CASES, THE HOSPITAL MAY NOT COMPLETE FULL VERIFICATION OR DOCUMENTATION OF ANY REQUEST.SPECIAL CONSIDERATION FINANCIAL ASSISTANCE: UNINSURED AND UNDERINSURED WASHINGTON AND IDAHO PATIENTS MAY QUALIFY FOR A DISCOUNT. DETERMINATION WILL BE MADE BY THE HOSPITAL ADMINISTRATION UPON A PATIENT'S COMPLETION OF THE SPECIAL CONSIDERATION FINANCIAL ASSISTANCE APPLICATION AND THE SPECIFIED SUPPORTING DOCUMENTATION AS PROOF OF SEVERE FINANCIAL HARDSHIP OR PERSONAL LOSS FROM THE TIME OF THE REQUEST BASED ON THE PATIENT'S ECONOMIC SITUATION. |
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 2015 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 $ 1,101,620. |
| 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 2015 Tri-State Hospital contributed $8,325 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. Tri-State Memorial Hospital also contributed over $5,000 to the Interlink Volunteer Organization that provides volunteers through the surrounding communities to provide assistance with medical transportation, building wheelchair accessible ramps and moving support. 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. $5,000 was donated to the Asotin County Food Bank by Tri-State Memorial Hospital. Additionally, Tri-State Memorial Hospital gave donations to Lewis-Clark State College, the Tina's Hope for A Cure, LC Legands, Clarkston Rotary Club, Inland Northwest Blood Center, Asotin County Aquatic Center, Washington Poison Control, 2015 Fire Releif Fund, Family Promise, The Roc Rescue Mission, Lewiston High School Wrestling and the Asotin County Fair. 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 $1,101,620 for the year ended December 31, 2015.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 2015 MEDICARE COST REPORT. |
| Part III, Line 9b: | 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 101-200% of the FPL to charity care and the remaining 25% is the patient's responsibility. If the patient is up to 100% 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 2009 Tri-State Memorial Hospital assessed the needs of the communities it serves by participating in the local Access to Care committee. This committee represents a majority of health care organizations in the community, including St. Joseph Regional Medical Center, Valley Medical Center, Area Agency on Aging, Idaho Department of Health and Welfare, Washington State, Asotin County Health District, North Central Idaho District Health, Nimipoo Indian Health Services, Quality Behavioral Health, the United Way, and the Community Health Association of Spokane. The purpose of the committee is to bring administrators together to discuss the major health issues and access to health care issues in the community. The work of this community helped establish a Federally Qualified Health Center in 2009 and continues to assess the needs of the patients in the community. |
| 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.TSMH will write off 35% of all charges for all uninsured patients whose family poverty level is up to 300% of the Federal poverty level. |
| Part VI, Line 4: | Tri State Memorial Hospital serves patients in a 10 county region of Southeastern Washington, Northeastern Oregon and North Central Idaho. There are approximately 165,000 patients in the service area. |
| 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, pediatric clinic, urology clinic, and rheumatology clinic. The hospital operates with over 444 full and part-time employees, 86 volunteers and 227 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 (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Boys & Girls Clubs of the Lewis-Clark Valley | |||||||
| 1021 Burrell Ave | Lewiston | ID | 83501 | 826001432 | 501(c)(3) | $8,325 | Partnership for Kids, Annual Campaign, Scholarships, Grilled Cheese Program |
| Snake River Community Clinic | |||||||
| 215 10th Street | Lewiston | ID | 83501 | 311726460 | 501(c)(3) | $25,450 | Free medical clinic for the uninsured and medically needy |
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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Donald Wee | ||||||||||||||
| CEO | $316,770 | $0 | $0 | $0 | $6,000 | $0 | $12,188 | $0 | $13,307 | $0 | $348,265 | $0 | $0 | $0 |
| ALEX TOWN | ||||||||||||||
| CFO | $180,217 | $0 | $0 | $0 | $0 | $0 | $14,642 | $0 | $11,638 | $0 | $206,497 | $0 | $0 | $0 |
| Meghana S Awad MD | ||||||||||||||
| Physician | $308,648 | $0 | $0 | $0 | $14,843 | $0 | $1,308 | $0 | $11,439 | $0 | $336,238 | $0 | $0 | $0 |
| Robert T Parkey MD | ||||||||||||||
| Physician | $229,106 | $0 | $200,625 | $0 | $0 | $0 | $6,010 | $0 | $6,170 | $0 | $441,911 | $0 | $0 | $0 |
| M Lyndon Dieter | ||||||||||||||
| Physician | $434,379 | $0 | $0 | $0 | $927 | $0 | $5,329 | $0 | $18,317 | $0 | $458,952 | $0 | $0 | $0 |
| Donald Greggain | ||||||||||||||
| Physician | $208,779 | $0 | $106,763 | $0 | $0 | $0 | $9,002 | $0 | $6,177 | $0 | $330,721 | $0 | $0 | $0 |
| Richard Zobell | ||||||||||||||
| Physician | $285,751 | $0 | $0 | $0 | $7,778 | $0 | $0 | $0 | $7,107 | $0 | $300,636 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Washington Health Care Authority | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 911108929 | BondIssuerEIN |
| Bond Issued | 2014-07-17 | BondIssuedDt |
| Issue Price | $13,200,000 | IssuePriceAmt |
| Purpose | Medical office building addition | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $13,200,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $189,169 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $11,001,726 | CapitalExpendituresAmt |
| Substantial Completion | 2015 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.04000 | PrivateBusUseByOthersPct |
| Total Private Business Use | 0.04000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part IV, Line 2c: | FormAndLineReferenceDesc |
| Explanation | TSMH did not earn more interest than paid in regards to the bond financing. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Mike Martin | |||
| Board Member | $170,732 | Insurance Broker - Owner of Martin Insurance | 0 |
| John Mannschreck MD | |||
| Board Member | $1,373,426 | Patient Care Services - Owner of Twin City Radiology | 0 |
| John Mannschreck MD | |||
| Board Member | $15,675 | Rental of building - owner of Clarkston Radiologists. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | Part VI, Line 11 - Form 990 Review Process: A copy is provided to the CFO for review prior to filing. The board authorizes the CFO to review and approve the 990. The final 990 is filed after CFO approval. |
| Form 990, Part VI, Section B, line 12c | The organization is aware that the potential for conflict of interest exists for decision-makers at all levels within the hospital. This includes members of the governing board, administration, the medical staff, and all other employees. 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. A disinterested person or committee shall investigate alternatives to the proposed transaction or arrangement. If the transaction or arrangement is not advantageous with a non conflict of interest party, a vote of majority will occur to determine if the Hospital should enter into the transaction or arrangement with the conflict of interest business or individual. |
| 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 | Health Care Professional Services: Program service expenses 11,489,681. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,489,681. Administrative Professional Fees: Program service expenses 452,633. Management and general expenses 435,523. Fundraising expenses 0. Total expenses 888,156. Laundry Purchased Services: Program service expenses 199,801. Management and general expenses 0. Fundraising expenses 0. Total expenses 199,801. |
| Form 990, Part XI, line 9: | Temporarily Restricted - Net Grant Funds Received 25,869. temporarily restricted - Released for Operations -24,097. Permanently Restricted - Released for Operations -3,593. Permanently Restricted - Interest Income 281. Temporarily Restricted - Change in Interest in Net Assets of Foundation -84,353. Temporarily Restricted - Net Assets Released from Restrictions - Foundation -78,820. Permanently Restricted - Change in intrest in Net assets of foundation 220,000. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Aquavia | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 189 | AddressLine1Txt |
| City | Clarkson | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99403 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 472643240 | EIN |
| Primary Activities | Real Estate Rental | PrimaryActivitiesTxt |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Total Income | -$8,299 | TotalIncomeAmt |
| End Of Year Assets | $2,179,049 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tri-State Memorial Hospital | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | 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 11a, I | Tri-State Memorial Hospital | Yes (1) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Evergreen Estates | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 Evergreen Court | AddressLine1Txt |
| City | Clarkston | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 994032800 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910411930 | EIN |
| Primary Activities | Assisted Living Facility | PrimaryActivitiesTxt |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Evergreen Estates Retirement and Assisted Living Community LLC | ||||||||||||
| 1215 Evergreen Court | Clarkston | WA | 99403 | 263462257 | Assisted Living | WA | Tri-State Memorial Hospital | C | $2,161,714 | $1,026,041 | 1.00000 | Yes (1) |
| Tri-State Evergreen LLC | ||||||||||||
| 1221 Highland Avenue | Clarkston | WA | 99403 | 264687291 | Assisted Living | WA | Tri-State Memorial Hospital | C | $622,946 | $6,309,913 | 1.00000 | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 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 | 0 | 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
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tri-State Hospital Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $78,820 | InvolvedAmt |
| Method Of Amount Determination | Cash | MethodOfAmountDeterminationTxt |