Informational Q&A Regarding Steele Memorial’s Interest in School District Property

Why is Steele Memorial Medical Center interested in the school district property?

Steele Memorial Medical Center is interested in the property because it sits directly adjacent to the existing hospital campus and represents one of the only realistic opportunities for long-term medical campus expansion. SMMC is currently operating at or beyond capacity in several key areas, including surgery, pharmacy, laboratory, radiology, rehabilitation, parking, and other support services. To continue meeting the healthcare needs of the community, the organization needs room to grow beyond its current footprint.

Why can’t the hospital simply expand within its current building?

The current hospital campus has very limited ability to expand. The hospital cannot reasonably expand vertically because of structural limitations and operational considerations, including emergency helicopter access. That means future growth must happen horizontally. To expand horizontally, SMMC needs land next to or near the existing hospital.

Why does the property need to be adjacent to the hospital?

The property needs to be adjacent because hospital expansion is not the same as ordinary commercial development. Location affects clinical operations, patient access, emergency response, staffing efficiency, regulatory compliance, reimbursement, and long-term financial sustainability.

CMS recognizes the importance of proximity through the Provider-Based Rule under 42 CFR § 413.65. Under this rule, a hospital campus includes the physical area immediately adjacent to the hospital’s main buildings, as well as other areas and structures located within 250 yards of the main hospital buildings. This matters because outpatient departments located on campus are generally easier to integrate with the main hospital for provider-based purposes than services located farther away.

Being within 250 yards does not automatically guarantee provider-based status or billing under the main hospital designation. CMS still requires compliance with other provider-based standards, including ownership, control, administration, supervision, clinical integration, financial integration, licensure, and public awareness. However, adjacency gives SMMC the best opportunity to expand services in a way that remains connected to the existing hospital campus and avoids many of the complications associated with off-campus development.

Why is provider-based status important?

Provider-based status matters because it allows certain hospital departments or services to operate as part of the main hospital rather than as separate, freestanding facilities. For a Critical Access Hospital, this can affect how services are organized, billed, staffed, supervised, and integrated into the hospital’s overall operations. It also helps maintain a connected medical campus where patients can access related services more efficiently.

For SMMC, remaining connected to the main hospital campus is especially important because departments such as surgery, imaging, laboratory, pharmacy, emergency care, rehabilitation, and inpatient services rely on shared systems, shared staff, shared oversight, and coordinated patient flow.

What happens if SMMC cannot acquire this property?

If SMMC cannot acquire the adjacent property, future expansion becomes much more difficult. The hospital may eventually need to look outside the current campus or outside city limits for a large enough site. That type of project would likely be far more expensive, less efficient, and more difficult for a county-owned Critical Access Hospital to finance. It could also create additional regulatory and reimbursement complexity if services are located off campus rather than within the hospital campus area recognized by CMS.

Is SMMC planning to build immediately on the entire property?

No. The intent would be a phased, long-term approach. This is not a one-year plan. It is a 10-, 20-, 30-, 40-, and 50-year planning opportunity. The first priority would be acquiring the property, addressing environmental and demolition concerns, improving the site, and creating a safer and more usable campus. Future construction would occur strategically over time as funding, grants, operations, and community needs allow.

How would SMMC pay for the property?

SMMC has identified and is working with a private entity that has expressed interest in assisting with the purchase of the property. The goal would be to acquire the land without requiring SMMC to use significant operating cash or immediately seek taxpayer-funded debt. Any purchase would still need to follow appropriate public, legal, and governing-board processes.

Would this require a bond or new tax burden on the community?

SMMC’s intent is to avoid asking the community to bond for this property acquisition or future phased development. Because SMMC is a county-owned Critical Access Hospital with narrow operating margins, the preferred approach is to grow slowly and strategically using a combination of operational planning, grant funding, state and federal funding opportunities, philanthropy, and phased capital investment. This approach is intended to protect taxpayers from the need for a large hospital replacement bond.

Why not build a brand-new hospital somewhere else?

Building a new hospital would be significantly more expensive than phased expansion. The current hospital was built approximately 25 years ago at a much lower cost than what a replacement facility would cost today. A full replacement hospital would likely require a level of public financing that may not be realistic for local taxpayers. Acquiring adjacent land gives SMMC a more practical path: preserve the existing hospital investment and expand over time.

How does the Brownfields process relate to this property?

The former school property includes aging buildings and known or potential environmental concerns, including asbestos-containing materials, lead-based paint, possible soil impacts, and other hazardous building materials. SMMC has already pursued environmental assessment assistance through the EPA Targeted Brownfields Assessment process. The purpose of this work is to understand environmental conditions and support responsible cleanup and redevelopment planning.

Would SMMC be eligible for cleanup assistance?

Following assessment work, SMMC may be able to pursue additional Brownfields cleanup funding or other environmental funding opportunities. Cleanup funding is separate from assessment funding, and eligibility depends on ownership, site conditions, grant requirements, and the specific funding opportunity. If SMMC acquired the property, the organization would be in a stronger position to pursue cleanup funding for demolition, abatement, and returning the site to a safe, buildable condition.

What would happen first if SMMC acquired the property?

The first step would be to complete the necessary due diligence, environmental planning, and site preparation. This could include demolition and abatement of unsafe or contaminated structures, cleanup of impacted materials, and returning portions of the site to a safe and buildable condition. Near-term improvements could also include additional parking, safer pedestrian pathways, landscaping, and campus circulation improvements.

Why is parking part of the discussion?

Parking is already limited on and around the hospital campus. A significant number of employees currently park on nearby city streets rather than in designated hospital parking areas. Additional property would allow SMMC to improve employee and patient parking, reduce pressure on surrounding streets, and create a safer campus for patients, visitors, staff, and neighbors.

Would the property benefit patients before new buildings are constructed?

Yes. Even before future medical buildings are constructed, the property could improve the hospital campus by adding safer parking, walkways, green space, gardens, and outdoor areas for patients, families, staff, and rehabilitation-related activities. These improvements would help create a safer and more accessible campus while future healthcare expansion is planned.

Why should the School District consider SMMC as a buyer?

SMMC’s interest aligns with long-term public benefit. The School District has a responsibility to consider the value of the property and the interests of taxpayers, while the community also has an interest in ensuring that this rare parcel is used wisely. A sale to SMMC could provide value to the School District while preserving the property for healthcare access, economic stability, job retention, recruitment, and future community needs.

What is the main point the community should understand?

This property is uniquely important because of where it sits. Housing, commercial development, and other uses may be possible in multiple areas of Salmon, but hospital campus expansion can only happen where the hospital campus exists. Because CMS recognizes proximity to the main hospital campus in its provider-based rules, the adjacent school district property is not just convenient; it is strategically and operationally important to the future of local healthcare.