TRI-STATE MEMORIAL HOSPITAL: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- TRI-STATE MEMORIAL HOSPITAL (EIN 91-0545036)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201113199349309916
- Schema version
- 2010v3.4
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T17:10:59-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12 E ROWAN STE 2 | AddressLine1 |
| City | SPOKANE | City |
| State | WA | State |
| ZIP Code | 99207 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910545036 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-STATE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | TRI- | NameControl |
| Phone | 5097585511 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 HIGHLAND AVENUE | AddressLine1 |
| City | CLARKSTON | City |
| State | WA | State |
| ZIP Code | 99403 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ALEX TOWN | Name |
| Title | CFO | Title |
| Phone | 5097585511 | Phone |
| Date Signed | 2011-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL R BELL | Name |
| Phone | 5094894524 | Phone |
| Date Prepared | 2011-11-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ALEX TOWN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 HIGHLAND AVENUE | AddressLine1 |
| City | CLARKSTON | City |
| State | WA | State |
| ZIP Code | 99403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 55811077 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.TRISTATEHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | WA | StateLegalDomicile |
| Activity Or Mission Description | 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). | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 472 | TotalNbrEmployees |
| Total Nbr Volunteers | 88 | TotalNbrVolunteers |
| Total Gross UBI | 76601 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 104588 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 110479 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 129180 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 52106349 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 55017284 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 292127 | InvestmentIncomePriorYear |
| Investment Income Current Year | 355465 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 378068 | OtherRevenuePriorYear |
| Other Revenue Current Year | 219823 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 52887023 | TotalRevenuePriorYear |
| Total Revenue Current Year | 55721752 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 18744 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 20417435 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 21998202 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 67368 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 30728571 | OtherExpensePriorYear |
| Other Expenses Current Year | 32748298 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 51146006 | TotalExpensesPriorYear |
| Total Expenses Current Year | 54765244 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1741017 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 956508 | RevenuesLessExpensesCY |
| Total Assets BOY | 56642926 | TotalAssetsBOY |
| Total Assets EOY | 54143527 | TotalAssetsEOY |
| Total Liabilities BOY | 24871195 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 20889547 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 31771731 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 33253980 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 44529620 | Expense |
| Revenue | 53952360 | Revenue |
| Description | THE HOSPITAL PROVIDED 6,370 DAYS OF CARE TO 1,615 PATIENTS IN 2010. IN ADDITION, THE HOSPITAL PROVIDED APPROXIMATELY 79,962 OUTPATIENT VISITS IN THE EMERGENCY ROOM, RENAL DIALYSIS, SURGICAL AND OTHER PATIENT SERVICE CENTERS. THE HOSPITAL PROVIDED IN EXCESS OF $1,244,000 IN CHARITABLE SERVICES TO PATIENTS UNABLE TO PAY FOR HEALTHCARE SERVICES. | Description |
| Total Program Service Expense | 44529620 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 0 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 39 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 472 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 0 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEX TOWN CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5097585511 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 189 | AddressLine1 |
| City | CLARKSTON | City |
| State | WA | State |
| ZIP Code | 99403 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| SCOTT ARNONE | |||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| JAN DIMKE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOHN MANNSCHRECK MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LARAE MERRIL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| STEVE CLAASSEN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DICK FLERCHINGER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MIKE MARTIN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAN KLAVEANO | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| E WAYNE DAY MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| K DAVID HAGEN | |||||||
| SECRETARY/TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| DON MCQUARY | |||||||
| VICE PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| RICK WASEM | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DON GREGGAIN MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DONALD WEE | |||||||
| CEO | 40.00 | 183660 | 0 | 15030 | X | ||
| ALEX TOWN | |||||||
| CFO | 40.00 | 112121 | 0 | 13973 | X | ||
| JOSE Y GARCIA JR MD | |||||||
| PHYSICIAN | 40.00 | 420107 | 0 | 24130 | X | ||
| DAVID E STOREY | |||||||
| PHARMACY MANAGER | 40.00 | 136986 | 0 | 10959 | X | ||
| KEVIN MOLANDER | |||||||
| PHYSICIAN | 40.00 | 203685 | 0 | 8277 | X | ||
| DONNA L BEARDSLEE | |||||||
| PHYS. ASSISTANT | 40.00 | 133758 | 0 | 0 | X | ||
| RHONDA MASON | |||||||
| DIR PATIENT CARE SVS | 40.00 | 128751 | 0 | 16323 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1319068 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 88692 | TotalOtherCompensation |
| Number Individuals GT100 K | 11 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PATHOLOGIST REGIONAL LAB | |||||
| P O BOX 956 | LEWISTON | ID | 83501 | LAB/BLOOD WORK | 1350056 |
| CLARKSTON EMERGENCY PHYSICIANS | |||||
| P O BOX 189 | CLARKSTON | WA | 99403 | ER PHYSICIANS | 827086 |
| ST JOSEPH REGIONAL MEDICAL CENTER | |||||
| P O BOX 816 | LEWISTON | ID | 83501 | HOSPITALISTS | 676211 |
| GE HEALTHCARE | |||||
| P O BOX 843553 | DALLAS | TX | 75284 | MAINT. CONTRACT | 297115 |
| DR JANE FORE | |||||
| 1119 HIGHLAND SUITE 7 | CLARKSTON | WA | 99403 | WOUND CARE | 285835 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Fundraising Events | 100500 | FundraisingEvents |
| All Other Contributions | 28680 | AllOtherContributions |
| Total Contributions | 129180 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| NET PATIENT SERVICE | 621400 | 51433421 | 51433421 | |
| RESIDENT RENTAL INCOME | 623000 | 2518939 | 2518939 | |
| OTHER OPERATING REVENU | 621400 | 1064924 | $1,064,924 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 55017284 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 355465 | TotalRevenueColumn |
| Exclusion | $355,465 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 154047 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 10825 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 143222 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 143222 | TotalRevenueColumn |
| Exclusion | $143,222 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 78500 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 100500 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 78500 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INVESTMENT IN JOINT VE | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 76601 | TotalRevenueColumn |
| Unrelated Business Revenue | 76601 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 76601 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 55721752 | TotalRevenueColumn |
| Related Or Exempt Function Income | 53952360 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 76601 | UnrelatedBusinessRevenue |
| Exclusion | $1,563,611 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18744 | Total |
| Program Services | 18744 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 324784 | Total |
| Management And General | 324784 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17480675 | Total |
| Program Services | 16218314 | ProgramServices |
| Management And General | 1229887 | ManagementAndGeneral |
| Fundraising | 32474 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 613180 | Total |
| Program Services | 561413 | ProgramServices |
| Management And General | 47642 | ManagementAndGeneral |
| Fundraising | 4125 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1706857 | Total |
| Program Services | 1524905 | ProgramServices |
| Management And General | 171310 | ManagementAndGeneral |
| Fundraising | 10642 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1872706 | Total |
| Program Services | 1707180 | ProgramServices |
| Management And General | 156893 | ManagementAndGeneral |
| Fundraising | 8633 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65403 | Total |
| Management And General | 65403 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 245358 | Total |
| Management And General | 245358 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7652667 | Total |
| Program Services | 7557860 | ProgramServices |
| Management And General | 94807 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14653953 | Total |
| Program Services | 14107929 | ProgramServices |
| Management And General | 544592 | ManagementAndGeneral |
| Fundraising | 1432 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114107 | Total |
| Program Services | 13547 | ProgramServices |
| Management And General | 100560 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2728955 | Total |
| Program Services | 1948133 | ProgramServices |
| Management And General | 776168 | ManagementAndGeneral |
| Fundraising | 4654 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1008387 | Total |
| Management And General | 1008387 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3593764 | Total |
| Management And General | 3593764 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 400923 | Total |
| Program Services | 400923 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT | 1425100 | 1425100 | ||
| MISCELLANEOUS | 595017 | 255258 | 334351 | 5408 |
| CONTINUING EDUCATION | 146560 | 36076 | 110484 | |
| DUES AND SUBSCRIPTIONS | 118104 | 92267 | 25837 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54765244 | Total |
| Program Services | 44529620 | ProgramServices |
| Management And General | 10168256 | ManagementAndGeneral |
| Fundraising | 67368 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6427035 | BOY |
| EOY | 2506018 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2474773 | BOY |
| EOY | 4995215 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6668558 | BOY |
| EOY | 6726088 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 50000 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1751197 | BOY |
| EOY | 1769676 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 214557 | BOY |
| EOY | 399975 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 53668699 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 23053442 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31589846 | BOY |
| EOY | 30615257 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6193069 | BOY |
| EOY | 6380888 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1323891 | BOY |
| EOY | 700410 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56642926 | BOY |
| EOY | 54143527 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5086817 | BOY |
| EOY | 3831548 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19784378 | BOY |
| EOY | 17057999 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24871195 | BOY |
| EOY | 20889547 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31771731 | BOY |
| EOY | 33253980 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31771731 | BOY |
| EOY | 33253980 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56642926 | BOY |
| EOY | 54143527 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 956508 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 525741 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $11,311 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 11311 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| 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. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1405866 | OtherCostOrOtherBasis |
| Book Value | 1405866 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 34472398 | OtherCostOrOtherBasis |
| Depreciation | 11168835 | Depreciation |
| Book Value | 23303563 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 217960 | OtherCostOrOtherBasis |
| Depreciation | 132967 | Depreciation |
| Book Value | 84993 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17572475 | OtherCostOrOtherBasis |
| Depreciation | 11751640 | Depreciation |
| Book Value | 5820835 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 30615257 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MUTUAL FUNDS | Description |
| Book Value | 6380888 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 6380888 | TotalOfBookValueSecurities |
| Total Revenue | 55721752 | TotalRevenue |
| Total Expenses | 54765244 | TotalExpenses |
| Excess Or Deficit For Year | 956508 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 509559 | NetUnrealizedGLOnInvestments |
| Other | $16,182 | OtherAmount |
| Total Adjustments | 525741 | TotalAdjustments |
| Excess Or Deficit Per FS | 1482249 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL IS A NONPROFIT 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. FEDERAL INCOME TAX IS PAID ON NONEXEMPT UNRELATED BUSINESS INCOME IN ACCORDANCE WITH CODE REGULATIONS. EVERGREEN ESTATES IS A TAXABLE CORPORATION. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF 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 HOSPITAL HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS THE HOSPITAL'S FEDERAL RETURNS FOR TAX YEARS 2007 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL'S INFORMATIONAL RETURNS FOR 2010 ARE NOT YET DUE. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | TEMPORARILY RESTRICTED - NET GRANT FUNDS RECEIVED 14,879. TEMPORARILY RESTRICTED - INTEREST INCOME 285. PERMANENTLY RESTRICTED - INTEREST 1,018. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | HOSPITAL FUNDRAISER | NameOfEvent1 |
| Gross Receipts Event1 | 150000 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 81000 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 69000 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 69000 | OtherDirectExpensesEvent1 |
| Name Of Event2 | HOSPITAL FUNDRAISER | NameOfEvent2 |
| Gross Receipts Event2 | 29000 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 19500 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 9500 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 9500 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 179000 | GrossReceiptsTotal |
| Charitable Contributions Total | 100500 | CharitableContributionsTotal |
| Gross Revenue Total Events | 78500 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 78500 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 78500 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 750333 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 750333 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01410 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3917369 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2978451 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 938918 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01760 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4667702 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2978451 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1689251 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03170 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 11000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12700 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 12700 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2815 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2815 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26515 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 26515 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4694217 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2978451 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1715766 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03220 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 18774 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 18774 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 18774 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 18774 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $859,682 | BadDebtExpenseAmount |
| Amount Attributable To | 218015 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 21535501 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 21682174 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -146673 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-STATE MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1221 HIGHLAND AVENUE | AddressLine1 |
| City | CLARKSTON | City |
| State | WA | State |
| ZIP Code | 99403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| TRI-STATE HOME HEALTH AND HOSPICE | ||||
| 1100 HIGHLAND AVENUE | CLARKSTON | WA | 99403 | HOME HEALTH AND HOSPICE SERVICES |
| TRI-STATE MEMORIAL DIALYSIS | ||||
| 730 21ST STREET | LEWISTON | ID | 83501 | RENAL DIALYSIS CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 7: THE COST-TO-CHARGE RATIO USED WAS DERIVED BASED ON THE RATIO OF PATIENT CARE COST-TO-CHARGES WORKSHEET.BAD DEBT EXPENSE OF $1,425,100 WAS REMOVED FROM THE DENOMINATOR TO DETERMINE THE NET COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSE REPORTED ON SCHEDULE H, PART I, LINE 7. |
| PART II: 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 2010 TRI-STATE HOSPITAL CONTRIBUTED OVER $7,550 TO THE BOYS AND GIRLS CLUBS OF THE LEWIS-CLARK VALLEY THROUGH THE PARTNERSHIP FOR KIDS, THE ANNUAL CAMPAIGN, THE GRILLED CHEESE PROGRAM AND MEDICAL SUPPLIES/ FIRST AID DONATIONS. TRI-STATE MEMORIAL HOSPITAL ALSO CONTRIBUTED OVER $3,000 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 HERE IN LEWISTON AND TRI-STATE MEMORIAL HOSPITAL SPONSORED THAT EVENT AND SPONSORED THE MEDICAL TENT AND REFRESHMENTS FOR ALL MEDICAL VOLUNTEERS FOR THIS EVENT. $1,000 WAS DONATED TO THE SECOND HARVEST BY TRI-STATE MEMORIAL HOSPITAL. ADDITIONALLY TRI-STATE MEMORIAL HOSPITAL GAVE DONATIONS TO THE LEWIS-CLARK STATE COLLEGE, THE NATIONAL MS SOCIETY, THE INLAND NORTHWEST BLOOD CENTER, ASOTIN COUNTY LITTLE LEAGUE, WALLA WALLA COMMUNITY COLLEGE AND THE CHAMBER OF COMMERCE. 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 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 $1,425,100 FOR THE YEAR ENDED DECEMBER 31, 2010.THE COSTING METHODOLOGY USED TO DETERMINE THE COST OF BAD DEBT IS BASED ON THE FACILITY'S CALCULATED COST-TO-CHARGE RATIO. THE FACILITY TOOK A SAMPLE OF PATIENT ACCOUNTS TO DETERMINE WHAT PERCENTAGE OF THE BAD DEBT REPORTED AT COST WAS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FACILITY'S CHARITY CARE POLICY. THE CALCULATED PERCENTAGE WAS APPLIED TO THE BAD DEBT AT COST TO DETERMINE THE COST ATTRIBUTABLE TO ELIGIBLE PATIENTS REPORTED ON SCHEDULE H, PART III, LINE 3. |
| PART III, LINE 8: THE FACILITY IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED BY MEDICARE AT 101% OF MEDICARE'S COSTS.THE TOTAL REVENUE RECEIVED FROM MEDICARE AND RELATED MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE FACILITY'S FILED 2010 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 6: 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 AND LEWISTON, ID, 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, HOME HEALTH AND HOSPICE. A NEW ADDITION TO THE HOSPITAL, IMAGING & WOMEN'S DIAGNOSTIC CENTER, INCLUDES: 3T MRI, 64 SLICE CT, DIGITAL MAMMOGRAPHY, BONE DENSITOMETRY AND STEROTACTIC BIOPSY EQUIPMENT. THE HOSPITAL OPERATES WITH OVER 458 FULL AND PART-TIME EMPLOYEES, 88 VOLUNTEERS AND 130 PHYSICIANS ON STAFF. TRI-STATE HOSPITAL FOUNDATION IN A NON-PROFIT ORGANIZATION WHICH BENEFITS THE HEALTH CARE NEEDS OF THE 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) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BOYS & GIRLS CLUBS OF THE LEWIS-CLARK VALLEY | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1021 BURRELL AVE | AddressLine1 |
| City | LEWISTON | City |
| State | ID | State |
| ZIP Code | 83501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 826001432 | EINOfRecipient |
| Amount Of Cash Grant | 7550 | AmountOfCashGrant |
| Purpose Of Grant | PARTNERSHIP FOR KIDS, ANNUAL CAMPAIGN, SCHOLARSHIPS, GRILLED CHEESE PROGRAM | PurposeOfGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DONALD WEE | |||||||||||||
| 183660 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15030 | 0 | 198690 | 0 | 41224 | 0 |
| JOSE Y GARCIA JR MD | |||||||||||||
| 420107 | 0 | 0 | 0 | 0 | 0 | 11250 | 0 | 12880 | 0 | 444237 | 0 | 436952 | 0 |
| KEVIN MOLANDER | |||||||||||||
| 203685 | 0 | 0 | 0 | 0 | 0 | 2254 | 0 | 6023 | 0 | 211962 | 0 | 185634 | 0 |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DON GREGGAIN MD | NamePerson |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $50,000 | OriginalPrincipalAmount |
| Balance Due | 50000 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 50000 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| MIKE MARTIN | |||
| BOARD MEMBER | 344193 | INSURANCE BROKER - OWNER OF MARTIN INSURANCE | 0 |
| JOHN MANNSCHRECK MD | |||
| BOARD MEMBER | 80293 | PATIENT CARE SERVICES - OWNER OF TWIN CITIES PAIN MANAGEMENT AND TWIN CITY RADIOLOGY | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | PART VI, LINE 11 - FORM 990 REVIEW PROCESS: A DRAFT 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. | |
| BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. | FORM 990, PART VI, SECTION B, LINE 12C | |
| COMPENSATION IS DETERMINED BASED ON FAIR MARKET VALUE. TSMH USES NATIONAL AND REGIONAL BENCHMARKS (MILLIMAN SURVEY & STATE OF IDAHO). BASED 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 B, LINE 15A | |
| TRI-STATE MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 509,559. TEMPORARILY RESTRICTED - NET GRANT FUNDS RECEIVED 14,879. TEMPORARILY RESTRICTED - INTEREST INCOME 285. PERMANENTLY RESTRICTED - INTEREST 1,018. TOTAL TO FORM 990, PART XI, LINE 5: 525,741. | FORM 990, PART XI, LINE 5: |
| PRIOR YEAR PROCESS. THERE HAVE BEEN NO CHANGES FROM PRIOR YEARS. | FORM 990, PART XII, LINE 2C |
Schedule R IRS990ScheduleR
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EVERGREEN ESTATES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 EVERGREEN COURT | AddressLine1 |
| City | CLARKSTON | City |
| State | WA | State |
| ZIP Code | 994032800 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910411930 | EIN |
| Primary Activity | ASSISTED LI | PrimaryActivity |
| Legal Domicile State | WA | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Predominant Income Type | UNRELATED | PredominantIncomeType |
| Share Of Total Income | 113230 | ShareOfTotalIncome |
| Share Of EOY Assets | 570105 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| Code V | $113,230 | CodeVAmount |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |