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GRANDE RONDE HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
GRANDE RONDE HOSPITAL INC (EIN 93-0505325)
Tax period
2011-05-01 to 2012-04-30
Filed
2013-03-13
IRS object ID
201300729349300625
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-03-13T11:22:05-05:00Timestamp
Tax Period End Date2012-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DINGUS ZARECOR & ASSOCIATESBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line112015 E MAIN STE AAddressLine1
CitySPOKANE VALLEYCity
StateWAState
ZIP Code99206ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN930505325EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GRANDE RONDE HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGRANNameControl
Phone5419638421Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 3290AddressLine1
CityLA GRANDECity
StateORState
ZIP Code97850ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJAMES A MATTESName
TitlePRESIDENT/CEOTitle
Phone5419638421Phone
Date Signed2013-03-12DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS DINGUSName
Phone5092420874Phone
Date Prepared2013-03-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJAMES A MATTESNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 3290AddressLine1
CityLA GRANDECity
StateORState
ZIP Code97850ZIPCode
FieldValueIRS element (for citing)
Gross Receipts69554812GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GRH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1962YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTO ENSURE ACCCESS TO HIGH-QUALITY, COST EFFECTIVE HEALTH SERVICES IN A SAFE, CUSTOMER-FRIENDLY ENVIRONMENT FOR ALL THOSE IN NEED OF OUR SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees589TotalNbrEmployees
Total Nbr Volunteers115TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year137478ContributionsGrantsPriorYear
Contributions Grants Current Year643101ContributionsGrantsCurrentYear
Program Service Revenue Prior Year59586282ProgramServiceRevenuePriorYear
Program Service Revenue CY65198222ProgramServiceRevenueCY
Investment Income Prior Year213571InvestmentIncomePriorYear
Investment Income Current Year541560InvestmentIncomeCurrentYear
Other Revenue Prior Year305593OtherRevenuePriorYear
Other Revenue Current Year697217OtherRevenueCurrentYear
Total Revenue Prior Year60242924TotalRevenuePriorYear
Total Revenue Current Year67080100TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year32332GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY14517GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year36811751SalariesEtcPriorYear
Salaries Etc Current Year41815762SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year81581TotalFundrsngExpCurrentYear
Other Expense Prior Year20154625OtherExpensePriorYear
Other Expenses Current Year21724651OtherExpensesCurrentYear
Total Expenses Prior Year56998708TotalExpensesPriorYear
Total Expenses Current Year63554930TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3244216RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3525170RevenuesLessExpensesCY
Total Assets BOY68538853TotalAssetsBOY
Total Assets EOY74115027TotalAssetsEOY
Total Liabilities BOY5504211TotalLiabilitiesBOY
Total Liabilities EOY7475433TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY63034642NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY66639594NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO ENSURE ACCCESS TO HIGH-QUALITY, COST EFFECTIVE HEALTH SERVICES IN A SAFE, CUSTOMER-FRIENDLY ENVIRONMENT FOR ALL THOSE IN NEED OF OUR SERVICES.MissionDescription
Significant New Program ServicestrueSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense56349093Expense
Grants14517Grants
Revenue65198222Revenue
DescriptionGRANDE RONDE HOSPITAL, INC (GRH) IS DEDICATED TO PROVIDING HIGH-QUALITY, COST-EFFECTIVE HEALTH SERVICES TO THE LOCAL COMMUNITY THROUGH THE OPERATION OF A 25-BED CRITICAL ACCESS HOSPITAL, 24-HOUR EMERGENCY DEPARTMENT, FAMILY BIRTHING CENTER, HOME HEALTH AND HOSPICE PROGRAMS, AND 6 PROVIDER-BASED CLINICS WHICH INCLUDE WALK-IN (IMMEDIATE CARE) AND SLEEP CLINIC SERVICES. GRH ALSO SUPPORTS A TELEMEDICINE PROGRAM WHICH ENABLES PATIENTS TO OBTAIN THE SERVICES OF SPECIALITSTS SUCH AS ICU INTENSIVISTS, CARDIOLOGISTS, NEONATOLOGISTS, AND DERMATOLOGISTS THAT THEY WOULD OTHERWISE HAVE TO TRAVEL OUT OF THE AREA TO VISIT. DURING THE TAX YEAR, GRH SERVED 1,518 INPATIENTS, 39,907 OUTPATIENTS, 13,013 EMERGENCY PATIENTS, AND DELIVERED 270 BABIES. ADDITIONALLY, GRH PROVIDED 2,384 HOME HEALTH VISITS, 3,726 HOSPICE VISITS, AND 54,310 VISITS TO ITS PROVIDER-BASED CLINICS. DURING THE TAX YEAR, GRH WAS ABLE TO PROVIDE CHARITY CARE SERVICES TO THOSE WHO COULD NOT OTHERWISE AFFORD NECESSARY MEDICAL CARE. THE HOSPTIAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 4,163,106 FOR CHARITY CARE, 14,700,644 FOR MEDICARE, 5,644,831 FOR MEDICAID, AND 4,474,471 FOR OTHER THIRD PARTY PAYORS FOR THE YEAR ENDED APRIL 30, 2012. ADDITIONALLY, GRH PUBLISHES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IS AVAILABLE UPON REQUEST AND PROVIDES ADDITIONAL DETAIL REGARDING ITS SERVICES AND ACTIVITIES.Description
Total Program Service Expense56349093TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109665NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees589NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonGRANDE RONDE HOSPITAL INCNamePerson
Telephone Number5419638421TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1900 SUNSET DRIVEAddressLine1
CityLA GRANDECity
StateORState
ZIP Code97850ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JAMES MATTES
PRESIDENT/CE40.00XX266091044385
BETSY NEELEY MD
TRUSTEE40.00X189701030656
SUSAN RICE MD
TRUSTEE40.00X189202029987
KEVIN GRAYSON MD
TRUSTEE40.00X168132031027
BURR BETTS PHD
CHAIR10.00XX000
STEVE LYON
VICE-CHAIR3.00XX000
BRAD TRISLER
SECRETARY3.00XX000
DEBBIE VOTAW
TRUSTEE3.00X000
LIBBY GOBEN
TRUSTEE3.00X000
LYNN HARRIS DMD
TRUSTEE3.00X000
BOB MESSINGER
TRUSTEE3.00X000
BOB SEYMOUR
TRUSTEE3.00X000
WADE WEIS
CFO40.00X138807031061
RODRIGO LIM MD
PHYSICIAN40.00360185026564X
CHRISTOPHER WOODWORTH MD
PHYSICIAN40.00345998026638X
ANDREW PEARSON MD
PHYSICIAN40.00344500033988X
STACY WHITAKER DO
PHYSICIAN40.00336441033988X
DAWN KNIGHT MD
PHYSICIAN40.00302020035022X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2641077TotalReportableCompFromOrg
Total Other Compensation323316TotalOtherCompensation
Number Individuals GT100 K55NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MCKESSON INFORMATION SOLUTIONS
PO BOX 98347CHICAGOIL60693HIS INSTALL1113212
KREIZENBECK LLC
251 EAST FRONT ST SUITE 110BOISEID83702CONSTRUCTION848413
RMC QUALITY CONSTRUCTION INC
1812 CEDAR STREETLA GRANDEOR97850CONSTRUCTION536000
INTERPATH LABORATORY INC
PO BOX 1208PENDELTONOR97801LAB TESTING309727
CTA INC
PO BOX 30071BILLINGSMT59107ARCHITECH299008
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Related Organizations12374RelatedOrganizations
Government Grants518964GovernmentGrants
All Other Contributions111763AllOtherContributions
Total Contributions643101TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE6241006516283465162834
EDUCATION AND OTHER PATIENT6241003538835388
FieldValueIRS element (for citing)
Total Program Service Revenue65198222TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column489639TotalRevenueColumn
Exclusion$489,639ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real200665Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real49851Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real150814Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column150814TotalRevenueColumn
Exclusion$150,814ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2396926Securities
Other21314Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2336235Securities
Other30084Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities60691Securities
Other-8770Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column51921TotalRevenueColumn
Exclusion$51,921ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory96357GrossSalesOfInventory
Cost Of Goods Sold58542CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column37815TotalRevenueColumn
Exclusion$37,815ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
OTHER REVENUE900099200339$200,339
CAFETERIA REVENUE722210197630$197,630
REBATES & DISCOUNTS90009983259$83,259

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column27360TotalRevenueColumn
Exclusion$27,360ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue508588TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column67080100TotalRevenueColumn
Related Or Exempt Function Income65198222RelatedOrExemptFunctionIncome
Exclusion$1,238,777ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total14517Total
Program Services14517ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total922798Total
Program Services445941ProgramServices
Management And General476857ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total30949121Total
Program Services27368731ProgramServices
Management And General3541101ManagementAndGeneral
Fundraising39289Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1658191Total
Program Services1460725ProgramServices
Management And General194674ManagementAndGeneral
Fundraising2792Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5807070Total
Program Services4693338ProgramServices
Management And General1101036ManagementAndGeneral
Fundraising12696Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2478582Total
Program Services2133944ProgramServices
Management And General342080ManagementAndGeneral
Fundraising2558Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total123255Total
Management And General123255ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total38545Total
Management And General38545ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total40893Total
Management And General40893ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3343157Total
Program Services2983521ProgramServices
Management And General359636ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total94693Total
Program Services475ProgramServices
Management And General94218ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1732459Total
Program Services1299329ProgramServices
Management And General430636ManagementAndGeneral
Fundraising2494Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total813655Total
Program Services627044ProgramServices
Management And General185341ManagementAndGeneral
Fundraising1270Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total321101Total
Program Services242220ProgramServices
Management And General75615ManagementAndGeneral
Fundraising3266Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total237252Total
Program Services148345ProgramServices
Management And General88907ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3997558Total
Program Services3657679ProgramServices
Management And General337565ManagementAndGeneral
Fundraising2314Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total568822Total
Program Services501404ProgramServices
Management And General67418ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MEDICAL SUPPLIES58033965803396
BAD DEBT29435882943588
REPAIRS & MAINTENANCE858131823677320862368
OTHER EXPENSES80814638113741613610873

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Program Services820082ProgramServices
Management And General-821743ManagementAndGeneral
Fundraising1661Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total63554930Total
Program Services56349093ProgramServices
Management And General7124256ManagementAndGeneral
Fundraising81581Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1848969BOY
EOY6859366EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY8985742BOY
EOY4099449EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7358647BOY
EOY8375128EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY882331BOY
EOY913146EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY576749BOY
EOY632310EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis73593382LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec42300691LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY27523962BOY
EOY31292691EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY19840487BOY
EOY19599851EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY3099BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1518867BOY
EOY2343086EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY68538853BOY
EOY74115027EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5503911BOY
EOY6068805EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY300BOY
EOY804480EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
EOY311648EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
EOY290500EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5504211BOY
EOY7475433EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY62075674BOY
EOY65679556EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY958968BOY
EOY960038EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY63034642BOY
EOY66639594EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY68538853BOY
EOY74115027EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3525170ReconcilationRevenueExpenses
Reconcilation Other Changes79782ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1189674OtherCostOrOtherBasis
Book Value1189674BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis36912207OtherCostOrOtherBasis
Depreciation20121505Depreciation
Book Value16790702BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3026625OtherCostOrOtherBasis
Depreciation2307945Depreciation
Book Value718680BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis30209875OtherCostOrOtherBasis
Depreciation19871241Depreciation
Book Value10338634BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2255001OtherCostOrOtherBasis
Book Value2255001BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings31292691TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionTHIRD-PARTY PAYOR SETTLEMENTSDescription
Amount$290,500Amount
FieldValueIRS element (for citing)
Total Of Amounts290500TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierLIABILITY UNDER FIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PAGE 3, PART XReturnReference
ExplanationTHE HOSPITAL'S FEDERAL AND STATE INCOME TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES UNTIL THE EXPIRATION OF THE RELATED STATUTES OF LIMITATIONS ON THOSE TAX RETURNS. IN GENERAL, THE FEDERAL AND STATE INCOME TAX RETURNS HAVE A THREE YEAR STATUTE OF LIMITATIONS. THE HOSPITAL WOULD RECOGNIZE ACCRUED INTEREST AND PENALITIES ASSOCIATED WITH UNCERTAIN TAX PROVISIONS, IF ANY, AS PART OF THE INCOME TAX PROVISION. AS OF APRIL 30, 2012 AND 2011 THE HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2647735TotalCommunityBenefitExpense
Direct Offsetting Revenue122809DirectOffsettingRevenue
Net Community Benefit Expense2524926NetCommunityBenefitExpense
Percent Of Total Expense0.04170PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense9642291TotalCommunityBenefitExpense
Direct Offsetting Revenue9111566DirectOffsettingRevenue
Net Community Benefit Expense530725NetCommunityBenefitExpense
Percent Of Total Expense0.00880PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense12290026TotalCommunityBenefitExpense
Direct Offsetting Revenue9234375DirectOffsettingRevenue
Net Community Benefit Expense3055651NetCommunityBenefitExpense
Percent Of Total Expense0.05050PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense131699TotalCommunityBenefitExpense
Direct Offsetting Revenue405DirectOffsettingRevenue
Net Community Benefit Expense131294NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense207684TotalCommunityBenefitExpense
Direct Offsetting Revenue20680DirectOffsettingRevenue
Net Community Benefit Expense187004NetCommunityBenefitExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1969334TotalCommunityBenefitExpense
Direct Offsetting Revenue1423578DirectOffsettingRevenue
Net Community Benefit Expense545756NetCommunityBenefitExpense
Percent Of Total Expense0.00900PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense22214TotalCommunityBenefitExpense
Net Community Benefit Expense22214NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2330931TotalCommunityBenefitExpense
Direct Offsetting Revenue1444663DirectOffsettingRevenue
Net Community Benefit Expense886268NetCommunityBenefitExpense
Percent Of Total Expense0.01470PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense14620957TotalCommunityBenefitExpense
Direct Offsetting Revenue10679038DirectOffsettingRevenue
Net Community Benefit Expense3941919NetCommunityBenefitExpense
Percent Of Total Expense0.06520PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$1,872,122BadDebtExpenseAmount
Amount Attributable To1554423AmountAttributableTo
Amount Reimbursed By Medicare21838847AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare21622621CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall216226MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CarefalseProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1GRANDE RONDE HOSPITAL INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1900 SUNSET DRIVEAddressLine1
CityLA GRANDECity
StateORState
ZIP Code97850ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1GRANDE RONDE HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent150.0FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent300.0FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Uninsured DiscountXUninsuredDiscount
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
GRANDE RONDE HOSPITAL REGIONAL MEDI
506 4TH STREETLA GRANDEOR97850PHYSICIAN CLINIC
GRANDE RONDE HOSPITAL REGIONAL MEDI
710 SUNSET DRIVELA GRANDEOR97850PHYSICIAN CLINIC
GRANDE RONDE HOSPITAL WOMENS CLINIC
610 SUNSET DRIVELA GRANDEOR97850PHYSICIAN CLINIC
GRANDE RONDE HOSPITAL CHILDRENS
612 SUNSET DRIVELA GRANDEOR97850PHYSICIAN CLINIC
GRANDE RONDE HOSPITAL HOME CARE
812 SUNSET DRIVELA GRANDEOR97850HOME HEALTH & HOSPICE
GRANDE RONDE HOSPITAL SLEEP CLINIC
701 SUNSET DRIVELA GRANDEOR97850SLEEP CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEPART I LINE 7 COLUMN FBAD DEBT EXPENSE INCLUDED ON FORM 990 PART IX LINE 25 COLUMN A OF 2943588 WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN PART I LINE 7 COLUMN F
COSTING METHODOLOGY EXPLANATIONPART I LINE 7THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COSTTOCHARGES FOR AMOUNTS REPORTED IN THE TABLE TOTAL OPERATING EXPENSES LESS BAD DEBT NONPATIENT CARE ACTIVITIES TOTAL COMMUNITY BENEFIT EXPENSES LINE 7G UTILIZED A COST TO CHARGE RATIO USING THE MEDICARE COST REPORT AS FILED
BAD DEBT EXPENSE EXPLANATIONPART III LINE 4THE HOSPITAL USED THE RATIO OF PATIENT CARE COSTS TO CHARGES TO DETERMINE THE COST OF BAD DEBT EXPENSE FOR PART III LINE 3 THE ESTIMATED AMOUNT OF BAD DEBT THAT IS ATTRIBUTED TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS EQUAL TO THE AVERAGE OF ACTUAL DISCOUNTS ON FULLY EXECUTED PATIENT ACCOUNTS WITH FINANCIAL ASSISTANCE THE RATE FOR THE TAX YEAR IS 8303 THE RATIONALE FOR APPLYING THE SAME AVERAGE DISCOUNT AMOUNT TO BAD DEBT IS DUE TO THE FACT THAT MULTIPLE FINANCIAL APPLICATIONS ARE SENT TO THE FINANCIAL GUARANTOR PRIOR TO DETERMINING BAD DEBT STATUS THEREFORE IF ALL APPLICATIONS WERE TO BE RETURNED THE EXPERIENCE RATE IS ESTIMATED TO BE SIMILAR NO BAD DEBT WAS CLASSIFIED AS A COMMUNITY BENEFIT FOR PART III LINE 4 PATIENT RECEIVABLES AND CREDIT POLICY FOOTNOTE PATIENT RECEIVABLES ARE UNCOLLATERALIZED PATIENT AND THIRDPARTY PAYOR OBLIGATIONS THE HOSPITAL DOES NOT CHARGE INTEREST ON PAST DUE ACCOUNTS PAYMENTS OF PATIENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED ON THE REMITTANCE ADVICE THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENTS BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRDPARTY PAYORS MANAGEMENT REVIEWS PATIENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AN RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION
MEDICARE EXPLANATIONPART III LINE 8ANY MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS ARE NOT COUNTED AS COMMUNITY BENEFIT THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR
NEEDS ASSESSMENTPART VITHE BOARD ESTABLISHED COMMUNITY BENEFITS COMMITTEE ENGAGES AN EXTERNAL CONSULTANT TO PERFORM A COMMUNITY NEEDS ASSESSMENT DATA IS COLLECTED THROUGH RESEARCH OF EXISTING SOURCES AND BY GATHERING COMMUNITY INPUT THROUGH KEY INFORMANT INTERVIEWS AND FOCUS GROUPS THE DATA IS UTILIZED IN PRIORITIZING THE NEEDS OF THE COMMUNITY AND USED IN DISTRIBUTING COMMUNITY GRANTS
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VIPATIENTS ARE INFORMED OF THE HOSPITALS FINANCIAL ASSISTANCE PROGRAM VERBALLY AT ADMISSIONS AS WELL AS THROUGH LITERATURE PROVIDED IN THE ADMITTING AREAS OF PATIENT CARE FACILITIES IN ADDITION ALL ACCOUNTS THAT ARE TURNED OVER TO INTERNAL COLLECTIONS RECEIVE A FINANCIAL ASSISTANCE APPLICATION THROUGH THE MAIL WHICH IS FOLLOWED UP WITH A TELEPHONE CALL
COMMUNITY INFORMATIONPART VIGRANDE RONDE HOSPITAL INC IS LOCATED IN UNION COUNTY OREGON WHICH IS ISOLATED BY MOUNTAIN RANGES IN BOTH FREEWAY DIRECTIONS THE MOUNTAIN PASSES ARE FREQUENTLY CLOSED DURING THE WINTER GRANDE RONDE HOSPITAL IS LOCATED 42 MILES AWAY AND 50 MILES AWAY FROM ITS TWO CLOSEST HOSPITALS THE CLOSEST REFERRAL HOSPITAL IS 87 MILES AWAY THE HOSPITAL ALSO REFERS CARE TO BOISE ID AND PORTLAND OR WHICH ARE 3 AND 4 HOURS AWAY RESPECTIVELY THE APPROXIMATE POPULATION BASE FOR THE HOSPITALS PRIMARY SERVICE AREA IS 25810 WITH A REGIONAL SERVICE AREA OF 56640 FOR THE PRIMARY SERVICE AREA OF UNION COUNTY THE AGE IN YEARS OF THE POPULATION IS 66 UNDER 5 227 UNDER 18 544 UNDER 65 AND 163 OVER 65 THE RACIAL MAKEUP OF THE COUNTY WAS 939 WHITE 07 BLACK OR AFRICAN AMERICAN 11 NATIVE AMERICAN 12 ASIAN 12 PACIFIC ISLANDER AND 19 FROM TWO OR MORE RACES ADDITIONALLY THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY 41896 WITH 150 OF THE POPULATION LIVING BELOW THE POVERTY LEVEL AS ESTIMATED THROUGH 2008 DURING THE FISCAL YEAR THE COUNTYS SEASONALLY ADJUSTED UNEMPLOYMENT RATE HAS BEEN AS HIGH AS 101 AND AS LOW AS 90 AND WAS AT 90 AT YEAR END
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VIGRANDE RONDE HOSPITAL INC HAS AN ELEVEN MEMBER BOARD OF TRUSTEES THAT GOVERNS ITS ACTIVITIES OF THOSE ELEVEN MEMBERS NINE ARE FROM THE COMMUNITY AT LARGE THE REMAINING TWO MEMBERS ARE THE PRESIDENTCHIEF EXECUTIVE OFFICER AND THE PROFESSIONAL STAFF PRESIDENT THE NINE COMMUNITY MEMBERS USE THEIR UNIQUE EXPERIENCE AND ABILITIES TO LEAD THE HOSPITAL IN DIRECTIONS THAT SUPPORT THE NEEDS OF THE COMMUNITY THE STATED MISSION OF THE ORGANIZATION IS AS FOLLOWS WE WILL ENSURE ACCESS TO HIGHQUALITY COSTEFFECTIVE HEALTH SERVICES IN A SAFE CUSTOMERFRIENDLY ENVIRONMENT FOR ALL THOSE IN NEED OF OUR SERVICES
AFFILIATED HEALTH CARE INFORMATIONPART VIDURING THE TAX YEAR THE HOSPITAL AFFILIATED WITH ST ALPHONSUS HEALTH SYSTEM WHICH IS A MEMBER OF THE TRINITY HEALTHCARE SYSTEM THE AFFILIATION IS FOR THE BENEFIT OF IMPROVING HEALTHCARE AND PROVIDING ACCESS TO AFFORDABLE SPECIALIZED CARE TO THE RURAL COMMUNITY
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILEDPART VIOREGON
GRANDE RONDE HOSPITAL INC LINE NUMBER 1 PART V LINE 19DPART V LINE 19DTHE HOSPITAL HAS A POLICY THAT GRANTS PATIENTS WITHOUT HEALTH INSURANCE A 10 DISCOUNT THE DISCOUNT IS GREATER THAN THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE
GRANDE RONDE HOSPITAL INC LINE NUMBER 1 PART V LINE 21PART V LINE 21PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE RECEIVE DISCOUNTED CARE FOR MEDICALLY NECESSARY TREATMENT SERVICES PROVIDED THAT ARE DETERMINED AS ELECTIVE OR MEDICALLY UNNECESSARY MAY BE CHARGED AT FULL PRICE MEDICAL NECESSITY IS DETERMINED THROUGH AN INTERNAL COMMITTEE WHICH USES MEDICAID SERVICES AS THE BASIS FOR ALLOWABLE SERVICES

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1CENTER FOR HUMAN DEVELOPMENT INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12301 COVE AVENUEAddressLine1
CityLA GRANDECity
StateORState
ZIP Code97850ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient931159198EINOfRecipient
IRC Section3IRCSection
Amount Of Cash Grant12000AmountOfCashGrant
Purpose Of GrantCOLORECTAL SCREENINGPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATESIdentifier
Return ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2ReturnReference
ExplanationTHE COMMUNITY BENEFIT COMMITTEE IDENTIFIES AND PRIORITIZES COMMUNITY NEEDS; SOLICITS, RECEIVES, AND PRIORITIZES APPLICATIONS FOR FUNDING AND APPROVES BENEFICIARY FUNDING. FUNDED ORGANIZATIONS ARE ASKED TO SUBMIT A SUMMARY REPORT OF THE PROJECT AND ITS OUTCOMES TO THE COMMUNITY BENEFIT COMMITTEE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgBonus Filing OrgBonusFilingOrg
JAMES MATTES
26459115001960024785310476
BETSY NEELEY MD
14907489182173822035740627
SUSAN RICE MD
188825893921048219189377
KEVIN GRAYSON MD
168132897922048199159
WADE WEIS
1373071500732523736169868
RODRIGO LIM MD
2410311056915995386749119154
CHRISTOPHER WOODWORTH MD
27903649002173837263666962
ANDREW PEARSON MD
259038122502173837848885462
STACY WHITAKER DO
254748122502173837042981693
DAWN KNIGHT MD
252020122502277233704250000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierNON-FIXED PAYMENTS PROVIDEDIdentifier
Return ReferenceSCHEDULE J, PAGE 1, PART I, LINE 7ReturnReference
ExplanationCERTAIN MEDICAL PROVIDERS ARE COMPENSATED BASED ON THE GROSS PROFESSIONAL CHARGES GENERATED BY THEIR SERVICES.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonTRISHA ALEXANDERNamePerson
FieldValueIRS element (for citing)
RelationshipFAMILY MEMBERRelationship
Amount Of Transaction117779AmountOfTransaction
Description Of TransactionCOMPENSATIONDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ANY SIGNIFICANT NEW PROGRAM SERVICES NOT LISTED ON A PRIOR RETURNFORM 990, PAGE 2, PART III, LINE 2DURING THE TAX YEAR, GRH EXPANDED SERVICES TO OTOLARYNGOLOGY, ORTHOPEDICS, WALK-IN (IMMEDIATE CARE) AND SLEEP SERVICES.
FIRST ACCOMPLISHMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4AAND 54,310 VISITS TO ITS PROVIDER-BASED CLINICS. DURING THE TAX YEAR, GRH WAS ABLE TO PROVIDE CHARITY CARE SERVICES TO THOSE WHO COULD NOT OTHERWISE AFFORD NECESSARY MEDICAL CARE. THE HOSPTIAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 4,163,106 FOR CHARITY CARE, 14,700,644 FOR MEDICARE, 5,644,831 FOR MEDICAID, AND 4,474,471 FOR OTHER THIRD PARTY PAYORS FOR THE YEAR ENDED APRIL 30, 2012. ADDITIONALLY, GRH PUBLISHES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IS AVAILABLE UPON REQUEST AND PROVIDES ADDITIONAL DETAIL REGARDING ITS SERVICES AND ACTIVITIES.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTYPICALLY THE IRS FORM 990 IS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES PRIOR TO FILING. INDIVIDUAL BOARD COMMITTEES ARE CHARGED WITH REVIEWING SPECIFIC SECTIONS OF THE 990 AND ITS SUPPLEMENTAL SCHEDULES AS FOLLOWS: FINANCE COMMITTEE - PART VIII-XI; COMMUNITY BENEFIT COMMITTEE - SCHEDULES H & I; GOVERNANCE COMMITTEE - PART I & VI; CONTRACT & COMPENSATION COMMITTEE - SCHEDULE J & OTHER APPLICABLE SECTIONS; AUDIT COMMITTEEE - ENTIRE 990 AFTER REVIEW. EACH COMMITTEE ISSUES A RECOMMENDATION OF APPROVAL TO THE FULL BOARD, WHICH THEN VOTES TO APPROVE THE ENTIRE 990 PRIOR TO FILING. DUE TO TIMING THIS TAX YEAR, A COPY OF THE 990 IS PROVIDED TO THE CEO AND CFO WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER. ONCE MANGEMENT IS SATISFIED WITH THE 990, APPROVAL IS GIVEN TO THE PREPARER BEFORE FINALIZING THE RETURN. A FINAL IS PRESENTED TO THE BOARD AND COMMITTEES.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12COFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A STATEMENT IDENTIFYING ANY POSSIBLE CONFLICTS OF INTEREST EACH FISCAL YEAR. THE FORMS ARE REVIEWED BY THE CORPORATION'S COMPLIANCE OFFICER AND/OR THE BOARD OF TRUSTEES, WHO THEN DETERMINE(S) IF A CONFLICT OF INTEREST ACTUALLY EXISTS. IF A CONFLICT OF INTEREST IS DETERMINDED TO EXIST, A DISINTERESTED PERSON OR COMMITTEE IS APPOINTED TO INVESTIGATE ALTERNATIVES TO THE BUSINESS TRANSACTION OR ARRANGEMENT IF A REASONABLE ALTERNATIVE IS NOT ATTAINABLE, A DECISION IS MADE AS TO WHETHER THE ARRANGEMENT IS FAIR AND REASONABLE AND IN THE COPORATION'S BEST INTEREST, AND THEREFORE WHETHER OR NOT TO ENTER INTO THE BUSINESS TRANSACTION IN CONFORMITY WITH SUCH DETERMINATIONS.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE HOSPITAL BOARD HAS A CONTRACT AND COMPENSATION COMMITTEE MADE UP OF INDEPENDENT TRUSTEES, THAT OVERSEES THE PROCESS OF ESTABLISHING REASONABLE COMPENSATION FOR THE PRESIDENT/CEO, CFO, EXECUTIVES, AND KEY EMPLOYEES. THE COMMITTEE ANNUALLY EVALUATES THE COMPENSATION OF THESE INDIVIDUALS AS COMPARED TO FAIR MARKET VALUE. AN INDEPENDENT THIRD-PARTY CONSULTANT IS HIRED AS NEEDED TO CONDUCT A FULL SALARY AND BENEFITS SURVEY OF COMPARABLE ORGANIZATIONS AND TO RECOMMEND COMPENSATION RANGES FOR THESE INDIVIDUALS. THE COMMITTEE ANALYZES THE RESULTS OF THE THIRD PARTY SURVEY AND/OR MARKET REPORT AND DECIDES ON A RECOMMENDED COMPENSATION PACKAGE FOR THE PRESIDENT/CEO AND CFO. THESE RECOMMENDATIONS ARE THEN PRESENTED TO THE BOARD OF TRUSTEES FOR APPROVAL. ALL FINAL DECISIONS ARE MADE IN EXECUTIVE SESSION AND ARE DOCUMENTED IN DETAILED MINUTES. ADDITIONALLY, AFTER REVIEWING THE RESULTS OF THE SURVEY, THE COMMITTEE DECIDES ON AND PRESENTS A SALARY RANGE FOR EACH EXECUTIVE AND KEY EMPLOYEE TO THE PRESIDENT/CEO AND CFO, WHO THEN DETERMINES EACH INDIVIDUAL'S COMPENSATION WITHIN THE COMMITTEE'S RECOMMENDED RANGE. THE BOARD OF TRUSTEES ALSO APPROVES BENEFITS AND PERQUISITES FOR THESE INDIVIDUALS.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BSEE FORM 990, PART VI, LINE 12C
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE HOSPITAL'S FORM 1023 AND THREE MOST RECENT FORM 990'S ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST, WHICH CAN BE MADE EITHER IN PERSON, BY US MAIL, FAX, EMAIL, OR BY PRIVATE DELIVERY SERVICE. ADDITIONALLY, THE HOSPITAL'S FORM 990'S ARE AVAILABLE ON GUIDESTAR.COM. THE HOSPITAL DOES NOT MAKE AVAILABLE TO THE PUBLIC ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, OR FINANCIAL STATEMENTS, ALTHOUGH LIMITED FINANCIAL INFORMATION IS PROVIDED TO THE PUBLIC ON THE HOSPITAL'S WEB SITE, GUIDESTAR.COM, AND THE OREGON DEPARTMENT OF JUSTICE CHARITABLE ACTIVITIES WEBSITE.
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 5UNREALIZED GAIN ON INVESTMENTS 78,712 CHANGE IN BENEFICIAL INTEREST IN TRUST 1,070 ======== 79,782

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
GRANDE RONDE HOSPITAL FOUNDATION
900 SUNSET DRIVELA GRANDEOR97850931174357SUPPORTOR(C)(3)11AN/Atrue
GRANDE RONDE HOSPITAL AUXILIARY
900 SUNSET DRIVELA GRANDEOR97850237090684SUPPORTOR(C)(3)11BN/Atrue
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg