2023-08-15T19:26:31-05:00 2022-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1400 PORTLAND OR 97205 990 2022-03-18 881210159 SANTIAM HOSPITAL AND CLINICS FOUNDATION SANT 5037692737 1401 N 10TH AVENUE STAYTON OR 97383 GUESLY DESSIEUX CHAIRPERSON 5037692737 2023-08-15 1 GUESLY DESSIEUX 999009999 0 WENDY CAMPOS P00448102 5032421447 2023-07-28 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z X GUESLY DESSIEUX 1401 N 10TH AVENUE STAYTON OR 97383 2497480 0 X SHC.FOUNDATION X 2022 OR TO SUPPORT SANTIAM HOSPITAL AND CLINICS' ABILITY TO THRIVE, INNOVATE, AND GROW. 7 5 0 10 0 0 2497480 0 0 0 2497480 0 0 0 0 0 0 0 2497480 2497480 0 2497480 X SANTIAM HOSPITAL & CLINICS FOUNDATION MISSION IS TO SUPPORT SANTIAM HOSPITAL AND CLINICS TO:- PROVIDE HEALTHCARE WHERE PEOPLE LIVE, WORK, AND PLAY;(CONTINUED ON SCHEDULE O)- STAY ABREAST AND/OR AHEAD OF CURRENT HEALTHCARE TRENDS IN PEOPLE, PROCESS, AND TECHNOLOGY;- AND, DEVELOP A RURAL HEALTHCARE SYSTEM MODEL PROVIDING PATIENT CENTRIC CARE THAT BECOMES THE BENCHMARK FOR RURAL HEALTHCARE SYSTEMS ACROSS THE UNITED STATES. 0 0 0 0 0 THE FOUNDATION'S PURPOSE IS TO RAISE AND GROW FUNDS FOR SANTIAM HOSPITAL AND CLINICS. THE FOUNDATION IS ORGANIZED AND SHALL BE OPERATED FOR THE BENEFIT AND SUPPORT OF SANTIAM HOSPITAL AND ITS CLINICS, INCLUDING WITHOUT LIMITATION TO SUPPORT ITS MISSION AND PURPOSES. 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X GUESLY DESSIEUX 5037692737 1401 N 10TH AVENUE STAYTON OR 97383 GUESLY DESSIEUX DO BOARD CHAIRPERSON 2.00 40.00 X X 0 262620 30075 DAVID THORSETT MD BOARD MEMBER 2.00 32.00 X 0 630787 41887 DEANA FRERES BOARD SECRETARY 2.00 0.00 X X 0 0 0 GARY RYCHARD BOARD TREASURER 2.00 0.00 X X 0 0 0 LYNDA HARRINGTON BOARD MEMBER 2.00 0.00 X 0 0 0 MARYANN MEREDITH BOARD MEMBER 2.00 0.00 X 0 0 0 KEN FORSTER BOARD MEMBER 2.00 0.00 X 0 0 0 WARREN GOOD EXECUTIVE DIRECTOR 40.00 0.00 X 0 66830 5249 0 960237 77211 0 0 1 0 0 2497480 2497480 2497480 0 0 0 0 0 0 0 0 2389840 0 107640 0 2497480 0 0 X 0 2497480 0 2497480 0 2497480 2497480 0 X 0 1 X 1 0 X X X 1 SANTIAM MEMORIAL HOSPITAL 930415219 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X PART X, LINE 2: INCOME TAXES - SANTIAM MEMORIAL HOSPITAL IS A TAX-EXEMPT ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AS SUCH, ONLY UNRELATED BUSINESS INCOME IS SUBJECT TO FEDERAL OR STATE INCOME TAXES. THE MEDICAL GROUP IS A SINGLE-MEMBER LIMITED LIABILITY COMPANY AND IS BEING TREATED AS A "DISREGARDED ENTITY" FOR IRC REPORTING PURPOSES. AS A "DISREGARDED ENTITY," IT IS TREATED AS A DIVISION OF SANTIAM MEMORIAL HOSPITAL. IT IS MANAGEMENT'S BELIEF THAT NONE OF THE HOSPITAL'S ACTIVITIES HAVE GENERATED MATERIAL UNRELATED BUSINESS INCOME; THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. INCOME TAX POSITIONS THAT MEET A "MORE-LIKELY-THAN-NOT" RECOGNITION THRESHOLD ARE MEASURED AT THE LARGEST AMOUNT OF INCOME TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH INCOME TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED INCOME TAX BENEFITS IN THE HOSPITAL'S CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS WOULD BE CLASSIFIED AS INCOME TAXES IN THE HOSPITAL'S CONSOLIDATED STATEMENTS OF OPERATIONS. THERE WERE NO UNRECOGNIZED INCOME TAX BENEFITS, NOR ANY INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS, ACCRUED OR EXPENSED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. THE HOSPITAL FILES A FEDERAL INFORMATION RETURN IN THE U.S. AND A STATE INFORMATION RETURN IN OREGON. 0 0 0 0 0 0 0 0 0 DAVID THORSETT MD BOARD MEMBER 0 630787 0 0 0 0 0 19137 0 22750 0 672674 0 0 GUESLY DESSIEUX DO BOARD CHAIRPERSON 0 261682 0 938 0 0 0 7325 0 22750 0 292695 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE FOUNDATION HAS ONE MEMBER. THE SOLE MEMBER OF THE FOUNDATION IS SANTIAM MEMORIAL HOSPITAL, AN OREGON NONPROFIT CORPORATION EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE RIGHTS SET FORTH IN THE BYLAWS, INCLUDING THE POWER TO ELECT OR APPOINT MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER HAS THE RIGHTS SET FORTH IN THE BYLAWS, INCLUDING THE APPROVAL OF GOVERNANCE DECISIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY MANAGEMENT AND THEN PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AND OFFICERS ARE REQUIRED TO SIGN AN ANNUAL CONFLICT OF INTEREST STATEMENT ATTESTING TO THEIR COMPLIANCE WITH THE POLICY. FORM 990, PART VI, SECTION C, LINE 19 SANTIAM HOSPITAL AND CLINICS FOUNDATION MAKES COPIES OF ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS NOT AVAILABLE TO THE PUBLIC. SANTIAM MEMORIAL HOSPITAL 1401 N 10TH AVENUE STAYTON OR 973831311 930415219 HOSPITAL OR 501(C)(3) LINE 3 0 SANTIAM MEMORIAL HOSPITAL AUXILIARY 1401 N 10TH AVENUE STAYTON OR 97383 237399406 OPERATION OF HOSPITAL GIFT SHOP OR 501(C)(3) LINE 12A, I 0 SANTIAM HEALTHCARE ALLIANCE INC 1401 N 10TH AVENUE STAYTON OR 97383 930415219 HEALTHCARE ASSOCIATION OR N/A C 0 SANTIAM HOSPITAL PHARMACY 1401 N 10TH AVENUE STAYTON OR 97383 930415219 PATIENT PHARMACY OR N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0