2024-11-12T12:35:05-06:00 2023-12-31 990 2023-01-01 930951989 SAMARITAN HEALTH SERVICES SAMA 5417684857 CO SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL B SMITH SVP / CFO 5417684857 2024-11-11 1 2023 2024-10-15 13:58:12Z DOUGLAS BOYSEN 3600 NW SAMARITAN DR CORVALLIS OR 97330 336632965 0 X WWW.SAMHEALTH.ORG X 1986 OR TO ENHANCE COMMUNITY HEALTH THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. 15 14 1597 15 1919582 81567 1790427 1062159 282343867 319342475 2244110 12565854 2113734 1989725 288492138 334960213 12749 100400 0 0 146916061 161835462 0 29946 2495308 154118091 193971289 301046901 355937097 -12554763 -20976884 317208147 311756583 279052332 289257345 38155815 22499238 X SAMARITAN HEALTH SERVICES (SHS) IS THE PARENT COMPANY OF A REGIONAL NETWORK OF TAX-EXEMPT HOSPITALS, PHYSICIANS, AND AFFILIATED ORGANIZATIONS. (CONTINUED ON SCHEDULE O)(CONTINUED FROM PART III) THE NETWORK, FORMED IN THE LATE 1990'S, SERVES APPROXIMATELY 290,000 RESIDENTS IN LINN, BENTON, LINCOLN AND PORTIONS OF POLK AND MARION COUNTIES IN OREGON. IT IS LOCALLY OWNED, AND ITS BOARDS OF DIRECTORS INCLUDE HOSPITAL LEADERS, PHYSICIANS AND COMMUNITY REPRESENTATIVES. SHS PROVIDES HEALTHCARE SERVICES REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, DISABILITY OR AGE. THE MISSION OF SHS IS "BUILDING HEALTHIER COMMUNITIES TOGETHER." THE COLLECTIVE VISION OF THE SHS SYSTEM IS TO SERVE OUR COMMUNITIES WITH PRIDE (PASSION, RESPECT, INTEGRITY, DEDICATION, AND EXCELLENCE). SHS SEEKS TO BE THE FIRST CHOICE OF CONSUMERS IN THE REGION AND TO LEAD COLLABORATIVE EFFORTS AMONG THOSE WHO SHARE SIMILAR GOALS. 0 0 303096718 318162413 AS THE PARENT ORGANIZATION, SHS PROVIDES ADMINISTRATIVE AND OTHER SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS, SUCH AS PATIENT BILLING, INFORMATION SERVICES, ACCOUNTING, AND EMPLOYEE RECRUITMENT. SHS SPONSORS A HEALTH PLAN THAT PROVIDES MEDICAL, DENTAL, AND PHARMACY BENEFITS TO EMPLOYEES OF SHS AND ITS AFFILIATES. AS A SYSTEM, SHS LOOKS CAREFULLY AT LOCAL HEALTH CARE NEEDS AND GIVES THOUGHTFUL CONSIDERATION TO THE MOST EFFECTIVE WAYS TO MEET THOSE NEEDS. THE RESULT IS A RICH MIX OF LOCAL AND CENTRALIZED REGIONAL SERVICES, WHICH PROVIDE HIGH VALUE AND EXCELLENT HEALTH CARE FOR PEOPLE AT ALL STAGES OF THEIR LIVES.SAMARITAN HEALTH SERVICES (SHS) HAS POLICIES THAT PROVIDE FOR SERVING THOSE WITHOUT THE ABILITY TO PAY FOR TREATMENT. THE POLICIES ESTABLISH CRITERIA BASED ON THE INCOME OF THE PERSON RESPONSIBLE FOR THE BILL AND COLLECTIONS ARE AT AMOUNTS LESS THAN ITS ESTABLISHED RATES ON A SLIDING SCALE DOWN TO NO PAYMENT AT ALL. IN 2023 SHS PROVIDED SERVICES THAT BENEFITED THE POOR AND OTHERS IN THE COMMUNITIES IT SERVED. IN ADDITION TO THE GRANTS SHOWN ON LINE 4B, SHS INCURRED $4,252,418 OF COMMUNITY BENEFIT COSTS, INCLUDING HEALTH PROFESSION EDUCATION, COMMUNITY BUILDING ACTIVITIES, AND RESEARCH. 100400 100400 GRANTS PROVIDED BY SAMARITAN HEALTH SERVICES TO VARIOUS ORGANIZATIONS TO ASSIST RESIDENTS IN BENTON, LINN, LINCOLN COUNTIES. SEE SCHEDULE I FOR MORE DETAILS. 303197118 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 1531 0 1 1597 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 15 14 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X SAMARITAN HEALTH SERVICES 5417684857 PO BOX 3000 CORVALLIS OR 973393000 PAUL DASKALOS DO BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 338690 66407 NANCY SEIFERT BOARD CHAIR 1.00 2.00 X X 0 0 0 BOB ADAMS BOARD SECRETARY 1.00 2.00 X X 0 0 0 JUNE CHRISMAN BOARD TREASURER 1.00 1.00 X X 0 0 0 RANDY SPRINGER BOARD CHAIR ELECT 1.00 2.00 X X 0 0 0 JUDY LIST BOARD MEMBER 1.00 2.00 X 0 0 0 MILTON MORAN BOARD MEMBER 1.00 1.00 X 0 0 0 LOREN ROTH BOARD MEMBER 1.00 1.00 X 0 0 0 CHARLES MOURADIAN BOARD MEMBER 1.00 1.00 X 0 0 0 RICHARD KENYON BOARD MEMBER 1.00 2.00 X 0 0 0 TROY GARRETT MD BOARD MEMBER 1.00 X 0 0 0 REVEREND WILLIAM MCCARTHY BOARD MEMBER 1.00 X 0 0 0 LESLIE PLISKIN MD BOARD MEMBER 1.00 1.00 X 0 0 0 STUART PRITCHARD BOARD MEMBER 1.00 1.00 X 0 0 0 RALPH BREITENSTEIN MD BOARD MEMBER 1.00 2.00 X 0 0 0 BRIAN CARROLL BOARD MEMBER 1.00 2.00 X 0 0 0 DOUGLAS BOYSEN PRESIDENT & CEO 33.00 7.00 X 1555091 0 68391 DANIEL SMITH SVP / CFO 23.00 17.00 X 679354 0 68167 ROBERT TURNGREN MD SVP / CHIEF PHYSICIAN EXEC 39.00 1.00 X 702296 0 62939 MARGARET MIKULA MD VP CHIEF QUAL OFFICER 40.00 X 581710 0 68501 LAURA HENNUM VP CEO GSRMC 1.00 39.00 X 540746 0 67209 BRUCE BUTLER VP CEO HEALTH PLANS 20.00 20.00 X 547574 0 46435 PANKAJ SAPRA SVP / CIO 40.00 X 516906 0 69323 KELLEY KAISER SVP / CAO 35.00 5.00 X 517020 0 66767 LESLEY OGDEN MD VP CEO NLH / CEO SPCH 1.00 39.00 X 516902 0 57900 JOSEPH CAHILL SVP / COO 1.00 39.00 X 499536 0 54409 DANIEL KETERI VP CEO SAGH 1.00 39.00 X 484549 0 63252 TYLER JACOBSEN VP CHIEF LEGAL OFFICER 40.00 X 385133 0 73224 GLEN CUNNINGHAM VP POP HEALTH SVCS 40.00 X 406315 0 39556 JULIE OSGOOD VP COO SMG 40.00 X 356071 0 14978 JANET MCGUIRE VP REVENUE CYCLE 40.00 X 315844 0 41684 SHILOH ERVEN VP SMG ADMINISTRATION 40.00 X 267803 0 62885 WENDIE WUNDERWALD VP CEO MVH 1.00 39.00 X 34544 235088 55925 SCOTT RUSSELL VP HUMAN RESOURCES (START APR 2023) 40.00 X 226984 0 56930 NANCY FRY VP FINANCE 40.00 X 235471 0 32453 GAIL WORDEN-ACREE VP HUMAN RESOURCES (END APR 2023) 40.00 X 224658 0 26105 BARRY SMITH MD SENIOR MEDICAL DIRECTOR 40.00 X 485271 0 41564 WILLIAM BARISH MD CHIEF WELLNESS OFFICER 40.00 X 428727 0 60146 BRENT GODEK MD SENIOR MEDICAL DIRECTOR 40.00 X 400066 0 52762 KRISTY JESSOP MD SENIOR MEDICAL DIRECTOR 39.00 1.00 X 388699 0 52364 DANIEL RACKHAM VP CHIEF PHARMACY OFFICER 40.00 X 318180 0 65261 11615450 573778 1435537 336 0 1 0 MEDEFIS INC PO BOX 5068 NEW YORK NY 100875068 STAFFING SERVICES 39480490 HEMATOLOGY ONCOLOGY OF SALEM LLP 875 OAK ST SE STE 4030 SALEM OR 97301 STAFFING SERVICES 9251872 COMPHEALTH PO BOX 972625 DALLAS TX 753972625 STAFFING SERVICES 6492536 LEGACY LABORATORY SERVICES LLC PO BOX 5337 PORTLAND OR 97228 LABORATORY SERVICES 3640155 OREGON ANESTHESIA GROUP 707 SW WASHINGTON ST SUITE 700 PORTLAND OR 97205 STAFFING SERVICES 3515735 168 119497 153949 788713 1062159 SUPPORT SERVICE FEES 561000 201228375 201228375 EMPL HEALTH PLAN PREM 525100 111060464 111060464 NET PATIENT REVENUE 900099 3695941 3695941 FITNESS CENTER REVENUE 713940 1827315 679039 1148276 OTH PROG SVC REVENUE 900099 1144031 1144031 386349 354563 31786 319342475 7208767 7208767 3019246 1661041 1358205 1358205 108000 1250205 5368798 11711 5357087 5357087 5357087 OCCUPANCY SERVICES 561700 535043 535043 GROUP PURCHASING 561499 114893 114893 JOINT VENTURES 900099 -18416 -18416 631520 334960213 318162413 1919582 13816059 100400 100400 10643047 10643047 109652071 87606943 20454668 1590460 6225563 5084380 1058852 82331 26750695 21847130 4549794 353771 8564086 6994237 1456591 113258 2052142 2036073 16069 780363 780363 92600 92600 29946 29946 82808 41404 41404 11902714 7294190 4578954 29570 841042 817794 19158 4090 12567885 12119024 381624 67237 13811220 13638331 172889 3436040 3400973 2708 32359 558043 456266 96689 5088 497071 469635 27363 73 1146459 821128 325331 10801547 10671099 130341 107 3527059 2436694 1090053 312 CLAIM FEES 104245133 104245133 PURCHASED SERVICES 26145918 24196121 1787146 162651 DUES, TAXES, & LICENSES 1103476 483867 611623 7986 MEDICAL SUPPLIES 379769 379769 355937097 303197118 50244671 2495308 800 800 147764428 159266302 1272622 2451619 18859 18888 47790 98017 8545688 11397020 250192174 154342426 106370221 95849748 9674844 2424608 22603098 23011897 171551 171551 20640229 17164150 317208147 311756583 58470011 72185180 527934 681836 165638512 164391358 30424771 7594174 23991104 44404797 279052332 289257345 X 38155815 22499238 38155815 22499238 317208147 311756583 X -20976884 869881 4450426 X 0 1 X 1 1 1 X X 5 ALBANY GEN HOSP 930110095 3 1 0 29351243 GOOD SAM HOSP 930391573 3 1 0 62129487 MID-VALLEY HC 930396847 3 1 0 16665263 N LINCOLN HOSP 931305493 3 1 0 9633097 SAM PAC HLTH SVCS 931329784 3 1 0 16123981 5 0 133903071 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART I, LINE 12G AS THE PARENT ORGANIZATION, SHS PROVIDES ADMINISTRATIVE AND OTHER SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS, SUCH AS PATIENT BILLING, INFORMATION SERVICES, ACCOUNTING, AND EMPLOYEE RECRUITMENT. THE AMOUNTS SHOWN ON PART I, LINE G REPRESENT THE VALUE OF THESE SERVICES ALLOCATED TO THE SUPPORTED ORGANIZATIONS. PART IV, SECTION A, LINE 6 ORGANIZATION(S) WERE GIVEN GRANTS TO SUPPORT THEIR EXEMPT FUNCTIONS. SEE SCHEDULE I PART II FOR MORE DETAILS. PART IV, SECTION D, LINE 1 AS THE PARENT COMPANY AND SOLE CORPORATE MEMBER OF ALL SUPPORTED ORGANIZATIONS, SHS PROVIDES MONTHLY FINANCIAL STATEMENTS SHOWING THE AMOUNT OF SUPPORT PROVIDED TO EACH OF ITS SUPPORTED ORGANIZATIONS. THE EXECUTIVE LEADERSHIP OF ALL SUPPORTED ORGANIZATIONS IS PRESENT FOR THE FINAL REVIEW OF THE FORM 990 WITH THE SHS BOARD OF DIRECTORS. IN ADDITION, THIS SAME LEADERSHIP TEAM IS PRESENT AT BOARD MEETINGS WHERE CHANGES TO GOVERNING DOCUMENTS ARE PROPOSED AND APPROVED. PART IV, SECTION D, LINE 3 THE SHS BOARD IS COMPOSED OF MEMBERS FROM THE SUPPORTED ORGANIZATIONS. PART IV, SECTION E, LINE 3A THE PARENT CORPORATION (SHS) HAS SEVERAL RESERVED POWERS PER THE BYLAWS OF THE SUPPORTED ORGANIZATIONS LISTED IN PART I OF SCHEDULE A. FOR EXAMPLE, THE ELECTION AND REMOVAL OF DIRECTORS MUST BE APPROVED BY THE PARENT CORPORATION (SHS). PART IV, SECTION E, LINE 3B THE PARENT CORPORATION (SHS) HAS SEVERAL RESERVED POWERS PER THE BYLAWS OF THE SUPPORTED ORGANIZATIONS LISTED IN PART I OF SCHEDULE A. THESE INCLUDE THE APPROVAL OF INDEBTEDNESS, THE APPROVAL OF ACQUISITIONS AND MERGERS, SALES AND TRANSFERS OF ASSETS, APPROVAL OF CAPITAL BUDGETS, AND ANY CHANGES TO THE ORGANIZATIONAL DOCUMENTS, AMONG OTHERS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 71930 1 20670 0 0 92600 0 PART II-B, LINE 1: LINE 1F: THE FILING ORGANIZATION MAINTAINS MEMBERSHIPS IN THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND OREGON ASSOCIATION OF HOSPITALS AND HEALTHCARE SYSTEMS (OAHHS). DURING TAX YEAR 2023, THE FILING ORGANIZATION PAID MEMBERSHIP DUES TO OAHHS AND AHA OF $235,386 AND $112,244 RESPECTIVELY. 13.60% OF OAHHS DUES AND 32.00% OF AHA DUES WENT FOR LOBBYING PURPOSES. THUS, THE FILING ORGANIZATION MADE INDIRECT LOBBYING EXPENDITURES OF $67,930 THROUGH ITS MEMBERSHIP DUES. THE FILING ORGANIZATION PAID AN INDEPENDENT CONTRACTOR $4,000 TO PROVIDE COMMENTS ON PROPOSED RULES WITH KEY STATE AGENCIES. PAID STAFF HAD DIRECT CONTACT WITH GOVERNMENT OFFICIALS REGARDING THE FOLLOWING TOPICS: LEGISLATIVE ADVOCACY IN KEY POLICY AREAS SUCH AS; COMMUNITY BENEFITS, HOSPITAL STAFFING, HEALTH CARE FINANCE, PUBLIC HEALTH EMERGENCIES, AND OTHERS. 20,670 OF THE PAID STAFF'S SALARY AND BENEFITS WAS ALLOCATED TO THESE ACTIVITIES BASED ON THEIR TIME SPENT WITH GOVERNMENT OFFICIALS. 3665000 17218352 20883352 21549474 75352577 41845859 55056192 3306989 2435912 871077 120045394 106634698 13410696 9054388 3425957 5628431 95849748 23011897 C 23011897 DEFERRED FINANCING COSTS, NET 1507785 SHS LT ASSETS - D&O INS 195860 SHS LT ASSETS - 457 PLAN 12691598 INTEREST RECEIVABLE 366230 OTHER RECEIVABLES 2402677 17164150 LIABILITY FOR UNPAID MEDICAL CLAIMS 10353972 TENANT DEPOSITS 150000 ACCRUED INTEREST 1133884 OTHER LIABILITIES 161219 SHS LT LIABILITIES - 457 PLAN 12691598 ACCOUNTS PAYABLE - AFFILIATES 19914124 44404797 X PART X, LINE 2: FOOTNOTE DISCLOSURE FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THE SHS' MANAGEMENT TO EVALUATE TAX POSITIONS AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF SHS HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY SHS AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. SHS IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. SHS' MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2020. X X X X X 0 ANGLIN CREATIVE GROUP LLC PO BOX 2170 FAIRVIEW OR 97024 SPECIAL EVENTS 0 119652 29946 89706 119652 29946 89706 OR 1 COMMUNITY HELPING ADDICTS NEGOTIATE CHANGE EFFECTIVELY PO BOX 1256 ALBANY OR 97321 203295927 501(C)(3) 10000 0 FUNDING FOR CLOTHING AND LAUNDRY SERVICES FOR NEEDY PERSONS KIDS FOR THE CULTURE 2120 PACIFIC BLVD ALBANY OR 97321 861332789 501(C)(3) 15000 0 FUNDING FOR A HIGH SCHOOL STUDENT MENTORING PROGRAM LINN BENTON FOOD SHARE 545 SW 2ND ST CORVALLIS OR 97333 931099406 501(C)(3) 20420 0 FOOD ASSISTANCE FOR INDIVIDUALS AND FAMILIES IN BENTON AND LINN COUNTIES FOOD SHARE OF LINCOLN COUNTY 535 NE 1ST ST NEWPORT OR 97365 930793059 501(C)(3) 10210 0 FOOD ASSISTANCE FOR INDIVIDUALS AND FAMILIES IN LINCOLN COUNTY COMMUNITY SERVICES CONSORTIUM 250 BROADALBIN ST SW STE 2A ALBANY OR 97321 936118438 GOV'T 30630 0 RENT AND UTILITY ASSISTANCE BENTON COUNTY 4077 SW RESEARCH WAY CORVALLIS OR 97339 936002285 GOV'T 13740 0 FUNDING FOR DENTAL SERVICES FOR UNINSURED AND UNDERINSURED COMMUNITY MEMBERS 6 PART I, LINE 2: AGENCIES IN THE COMMUNITY ARE INVITED TO SUBMIT GRANT PROPOSALS THROUGH AN APPLICATION PROCESS. A COMMITTEE REVIEWS THE APPLICATIONS TO DETERMINE IF THE FUNDS REQUESTED WILL BE USED TO ADDRESS THE ORGANIZATION'S ESTABLISHED COMMUNITY HEALTH PRIORITIES, IDENTIFIED NEEDS, AND SUPPORTS THE ORGANIZATION'S MISSION. ONCE APPROVED AND FUNDED, AGENCIES MUST SUBMIT A COMPLETE ANNUAL REPORT DESCRIBING HOW THE FUNDS WERE USED, THE NUMBER OF CLIENTS SERVED, AND HOW OUTCOMES WERE ACHIEVED. X 1 1 X X X X X X 1 1 0 0 0 0 0 0 0 DOUGLAS BOYSEN PRESIDENT & CEO 1075482 0 388770 0 90839 0 26592 0 41799 0 1623482 0 0 0 ROBERT TURNGREN MD SVP / CHIEF PHYSICIAN EXEC 525634 0 111725 0 64937 0 26592 0 36347 0 765235 0 0 0 DANIEL SMITH SVP / CFO 510893 0 119250 0 49211 0 26592 0 41575 0 747521 0 0 0 MARGARET MIKULA MD VP CHIEF QUAL OFFICER 458685 0 93518 0 29507 0 26592 0 41909 0 650211 0 0 0 LAURA HENNUM VP CEO GSRMC 447577 0 89000 0 4169 0 26592 0 40617 0 607955 0 0 0 BRUCE BUTLER VP CEO HEALTH PLANS 444424 0 90200 0 12950 0 26592 0 19843 0 594009 0 0 0 PANKAJ SAPRA SVP / CIO 422144 0 92906 0 1856 0 26592 0 42731 0 586229 0 0 0 KELLEY KAISER SVP / CAO 399610 0 94085 0 23325 0 26592 0 40175 0 583787 0 0 0 LESLEY OGDEN MD VP CEO NLH / CEO SPCH 400932 0 93395 0 22575 0 26592 0 31308 0 574802 0 0 0 JOSEPH CAHILL SVP / COO 384176 0 82967 0 32393 0 26592 0 27817 0 553945 0 0 0 DANIEL KETERI VP CEO SAGH 398500 0 79928 0 6121 0 19992 0 43260 0 547801 0 0 0 BARRY SMITH MD SENIOR MEDICAL DIRECTOR 440441 0 43070 0 1760 0 26592 0 14972 0 526835 0 0 0 WILLIAM BARISH MD CHIEF WELLNESS OFFICER 427757 0 0 0 970 0 26592 0 33554 0 488873 0 0 0 TYLER JACOBSEN VP CHIEF LEGAL OFFICER 294411 0 63000 0 27722 0 26592 0 46632 0 458357 0 0 0 BRENT GODEK MD SENIOR MEDICAL DIRECTOR 365889 0 33150 0 1027 0 26592 0 26170 0 452828 0 0 0 GLEN CUNNINGHAM VP POP HEALTH SVCS 105795 0 39408 0 261112 0 19992 0 19564 0 445871 0 0 0 KRISTY JESSOP MD SENIOR MEDICAL DIRECTOR 349757 0 31875 0 7067 0 26592 0 25772 0 441063 0 0 0 PAUL DASKALOS DO BOARD MEMBER / PHYSICIAN 0 336642 0 0 0 2048 0 26592 0 39815 0 405097 0 0 DANIEL RACKHAM VP CHIEF PHARMACY OFFICER 272135 0 24191 0 21854 0 25963 0 39298 0 383441 0 0 0 JULIE OSGOOD VP COO SMG 314942 0 30000 0 11129 0 0 0 14978 0 371049 0 0 0 JANET MCGUIRE VP REVENUE CYCLE 286379 0 25304 0 4161 0 24838 0 16846 0 357528 0 0 0 SHILOH ERVEN VP SMG ADMINISTRATION 213358 0 35888 0 18557 0 21137 0 41748 0 330688 0 0 0 WENDIE WUNDERWALD VP CEO MVH 22191 197482 0 20323 12353 17283 5038 20256 2394 28237 41976 283581 0 0 SCOTT RUSSELL VP HUMAN RESOURCES (START APR 2023) 214725 0 0 0 12259 0 17036 0 39894 0 283914 0 0 0 NANCY FRY VP FINANCE 214197 0 19004 0 2270 0 17058 0 15395 0 267924 0 0 0 GAIL WORDEN-ACREE VP HUMAN RESOURCES (END APR 2023) 44455 0 56756 0 123447 0 15937 0 10168 0 250763 0 0 0 PART I, LINE 1A IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM/FITNESS FACILITY BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. EMPLOYEES CAN USE THEIR WELLNESS BENEFIT AT EITHER NON-SAMARITAN OR SAMARITAN (SAMFIT) GYM/FITNESS FACILITIES. IF AN EMPLOYEE PARTICIPATES AT A NON-SAMARITAN GYM, REIMBURSEMENT IS MADE FOR FEES. REIMBURSEMENT DOES NOT EXCEED $300 PER YEAR AND IS INCLUDED IN THEIR TAXABLE WAGES SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. ONE KEY EMPLOYEE USED THE NON-SAMARITAN GYM REIMBURSEMENT DURING THE FILING YEAR. IF EMPLOYEES USE THEIR WELLNESS BENEFIT AT A SAMARITAN (SAMFIT) GYM/FITNESS FACILITY, THEN THE ANNUAL COST OF EMPLOYEE MEMBERSHIP, $300, IS INCLUDED IN THE EMPLOYEE'S TAXABLE WAGES SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. ONE BOARD MEMBER, ONE OFFICER, NINE KEY EMPLOYEES, AND TWO HIGHEST PAID EMPLOYEES, USED THE SAMARITAN (SAMFIT) GYM/FITNESS FACILITY BENEFIT DURING THE FILING YEAR. PART I, LINES 4A-B LINE 4A: GLEN CUNNINGHAM (A KEY EMPLOYEE) RECEIVED A SEVERANCE PAYMENT OF $187,730 DURING THE FILING YEAR DUE TO THE TERMINATION OF HIS EMPLOYMENT CONTRACT. LINE 4B: THE FILING ORGANIZATION MAINTAINS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. HOWEVER, NO PERSONS LISTED IN PART VII OF FORM 990 ACCRUED DEFERRED COMPENSATION BENEFITS OR RECEIVED ANY PAYMENTS FROM THESE PLANS DURING THE FILING YEAR. A STATE OF OREGON - FACIL AUTHORITY 936001787 000000000 2009-09-30 15800000 CONST. OF MEDICAL SCHOOL 0 0 0 B STATE OF OREGON - FACIL AUTHORITY 936001787 000000000 2014-12-18 18952500 CONST OF MEDICAL OFFICE BLDG, HOSPITAL REMODELS 0 0 0 C STATE OF OREGON - FACIL AUTHORITY 936001787 68608JWF4 2016-11-16 89533143 HOSPITAL FACILITY CONSTRUCTION AND REMODELS 1 0 0 D STATE OF OREGON - FACIL AUTHORITY 936001787 68608JYJ4 2020-07-07 77108397 TO REFUND THE 2010 SERIES A BONDS 0 0 0 A 8316090 15865543 283537 15582006 2011 0 0 1 1 B 5427551 18989505 169620 18819885 2019 0 0 0 1 C 1030000 91172903 985093 62638694 27533538 15578 2020 1 0 0 1 D 77108397 1030309 76078088 2020 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 1 0 0 0 0 1 D 0 1 1 1 0 0.00100 0.00100 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 1 0 0 1 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: STATE OF OREGON - FACIL. AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/14/2014 ISSUER NAME: STATE OF OREGON - FACIL. AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/13/2020 PART II, LINE 3: DIFFERENCES ON THIS LINE AS COMPARED TO PART I(E) ARE DUE TO INVESTMENT EARNINGS AND UNREALIZED GAINS/LOSSES. M MIKULA KEY EMPL RECRUIT X 25000 18888 0 1 1 18888 FORM 990, PART VI, SECTION A, LINE 4 ARTICLE III OF THE ORGANIZATION'S BYLAWS (BOARD OF DIRECTORS) WAS AMENDED DURING THE FILING YEAR AS FOLLOWS: "3.2.6 AT-LARGE REPRESENTATIVES. THREE (3) REPRESENTATIVES TO BE NOMINATED BY THE EXECUTIVE AND NOMINATING COMMITTEE. ALL NOMINEES SHALL BE SUBMITTED TO THE SHS BOARD OF DIRECTORS FOR ELECTION. THESE POSITIONS MAY OR MAY NOT BE PHYSICIANS, PROVIDED, HOWEVER, THAT PHYSICIANS SHALL NOT CONSTITUTE MORE THAN FORTY PERCENT (40%) OF THE BOARD AND IN NO EVENT SHALL MORE THAN FOUR (4) EMPLOYED PHYSICIANS SERVE ON THE BOARD AT ANY ONE TIME." "3.6 SUPERMAJORITY BOARD DECISIONS. THE FOLLOWING DECISIONS OF THE BOARD SHALL REQUIRE A VOTE OF AT LEAST 75%. 3.6.1 ANY AND ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION AND THOSE OF AFFILIATED CORPORATIONS; 3.6.2 A CONTRACT, AMENDMENT, OR TERMINATION OF A CONTRACT FOR SERVICES WITH THE PRESIDENT/CEO OF THE CORPORATION. 3.6.3 ANY AND ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF GOOD SAMARITAN REGIONAL MEDICAL CENTER AFTER THE BOARD OF DIRECTORS OF GOOD SAMARITAN REGIONAL MEDICAL CENTER APPROVES ANY SUCH AMENDMENTS IN ACCORDANCE WITH ITS ARTICLES AND BYLAWS. 3.6.4 ANY AND ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF MIDVALLEY HEALTHCARE, INC. AFTER THE BOARD OF DIRECTORS OF MID-VALLEY HEALTHCARE, INC. APPROVES ANY SUCH AMENDMENTS IN ACCORDANCE WITH ITS ARTICLES AND BYLAWS. 3.6.5 ANY AND ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF ALBANY GENERAL HOSPITAL AFTER THE BOARD OF DIRECTORS OF ALBANY GENERAL HOSPITAL APPROVES ANY SUCH AMENDMENTS IN ACCORDANCE WITH ITS ARTICLES AND BYLAWS. 3.6.6 ANY AND ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF SAMARITAN NORTH LINCOLN HOSPITAL AFTER THE BOARD OF DIRECTORS OF SAMARITAN NORTH LINCOLN HOSPITAL APPROVES ANY SUCH AMENDMENTS IN ACCORDANCE WITH ITS ARTICLES AND BYLAWS. 3.6.7 ANY AND ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF SAMARITAN PACIFIC COMMUNITIES HOSPITAL AFTER THE BOARD OF DIRECTORS OF SAMARITAN PACIFIC COMMUNITIES HOSPITAL APPROVES ANY SUCH AMENDMENTS IN ACCORDANCE WITH ITS ARTICLES AND BYLAWS. 3.6.8 ANY VOLUNTARY DISSOLUTION OF THE CORPORATION; 3.6.9 ANNUAL BUDGETS OF THE CORPORATION AND THOSE AFFILIATED CORPORATIONS, AND ANY EXPENDITURES OVER ANY OF THOSE BUDGETS OF MORE THAN ONE MILLION DOLLARS ($1,000,000); 3.6.10 ALL DECISIONS REGARDING EXPANSION OR CLOSURE OF CORPORATION'S OR AFFILIATED CORPORATIONS' FACILITIES. 3.6.11 DISTRIBUTION OF ASSETS IN THE EVENT OF DISSOLUTION OF THE CORPORATION, SUBJECT TO THE PROVISIONS FOR DISSOLUTION IN THE ARTICLES OF INCORPORATION: 3.6.12 ANY INDEBTEDNESS FOR BORROWED MONEY OR ANY ASSUMPTION OF DEBT BY THE CORPORATION IN EXCESS OF AN ANNUAL AGGREGATE OF ONE MILLION DOLLARS ($1,000,000); 3.6.13 ANY AND ALL MERGERS, ACQUISITIONS (INCLUDING ACQUISITION OF MEMBERSHIP INTERESTS), OR REORGANIZATIONS BY THE CORPORATION EXCEPT ACQUISITIONS OF ASSETS WITH A VALUE OF LESS THAN ONE MILLION DOLLARS ($1,000,000); AND 3.6.14 ANY AND ALL SALES OR TRANSFERS OF ASSETS ACQUIRED BY THE CORPORATION EXCEPT SALES OR TRANSFERS IN THE ORDINARY COURSE OF BUSINESS WITH A VALUE OF LESS THAN AN ANNUAL AGGREGATE OF ONE MILLION DOLLARS ($1,000,000)." FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES), AS ULTIMATELY FILED WITH THE IRS, WAS PROVIDED TO EACH VOTING MEMBER OF THE SAMARITAN HEALTH SERVICES (SHS) AUDIT AND COMPLIANCE COMMITTEE PRIOR TO ITS FILING WITH THE IRS. SHS'S CHIEF FINANCIAL OFFICER CONDUCTED THE FORM 990 REVIEW WITH THE COMMITTEE AND PROVIDED TIME FOR QUESTIONS FROM THE GROUP. A FORMAL REPORT OF THIS COMMITTEE HAS BEEN MADE TO THE FULL BOARD OF DIRECTORS OF SHS. ADDITIONALLY, A COMPLETE COPY OF THE FILING ORGANIZATION'S FINALIZED FORM 990 AND RELATED SCHEDULES WAS PROVIDED ELECTRONICALLY TO ALL MEMBERS OF THE FILING ORGANIZATION'S GOVERNING BOARD PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBER CONFLICTS OF INTEREST: THE MEMBERS OF THE BOARD MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, WHICH REQUIRES DISCLOSURE OF ANY CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CORPORATE COMPLIANCE OFFICER. IF A CONFLICT IS DISCLOSED THAT COULD PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THIS IS EVALUATED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES (SHS) BOARD OF DIRECTORS TO DETERMINE WHETHER THE MEMBER SHOULD CONTINUE TO SERVE ON THE BOARD. IF A CONFLICT IS DISCLOSED THAT DOES NOT PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THE CONFLICT IS MANAGED THROUGH A PROCESS SET FORTH IN THE ORGANIZATION'S BYLAWS. THE BYLAWS PROHIBIT ANY BOARD MEMBER FROM VOTING ON AN ACTION WHERE AN INDIVIDUAL MEMBER HAS A CONFLICT OF INTEREST. EMPLOYEE CONFLICTS OF INTEREST: THE SHS CODE OF CONDUCT AND BUSINESS ETHICS REQUIRES THAT ALL SHS EMPLOYEES COMPLETE AN ANNUAL DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST. THROUGH THE HUMAN RESOURCES SOFTWARE, PERFORMANCE MANAGER, THE DISCLOSURE REQUIREMENT NOTICE IS ASSIGNED TO ALL EMPLOYEES AND BY YEAR END ALL TASKS ARE TO BE COMPLETED. IF THERE IS A PERCEIVED CONFLICT OF INTEREST IT IS REVIEWED BY THE CORPORATE COMPLIANCE OFFICER, LEGAL COUNSEL AND/OR SENIOR MANAGEMENT. ACTUAL CONFLICTS OF INTEREST ARE REVIEWED AND DISCUSSED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF SAMARITAN HEALTH SERVICES PERIODICALLY ENGAGES AN INDEPENDENT CONSULTANT TO ASSIST IT IN PROVIDING COMPARABLE MARKET DATA FOR THE CEO, WHO IS THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL. THIS ANALYSIS INCLUDES REGIONAL AND NATIONAL DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THIS INFORMATION IS USED BY THE COMPENSATION COMMITTEE IN ITS DELIBERATIONS REGARDING THE CEO'S COMPENSATION WHICH IS DOCUMENTED IN THE COMMITTEE'S MINUTES. THE CEO OF THE ORGANIZATION RELIES ON PUBLICLY AVAILABLE INFORMATION TO DETERMINE THE COMPENSATION FOR OTHER TOP MANAGEMENT OFFICIALS WITHIN THE ORGANIZATION. HE CONSULTS WITH THE INDEPENDENT CONSULTANT AS TO THE REASONABLENESS OF THIS DATA TO ENSURE THAT EACH TOP MANAGEMENT OFFICIAL'S COMPENSATION IS REASONABLE AS COMPARED TO SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. PHYSICIAN EMPLOYEE COMPENSATION, INCLUDING PHYSICIANS WHO ARE BOARD MEMBERS, IS REVIEWED AT LEAST ANNUALLY BY SENIOR MANAGEMENT. THIS REVIEW INCLUDES COMPARISON WITH PUBLISHED PHYSICIAN COMPENSATION STUDIES. FOR ALL OTHER EMPLOYEES, THE ORGANIZATION PERFORMS AN ANALYSIS EACH YEAR TO COMPARE COMPENSATION OF ALL PAID POSITIONS TO MARKET SURVEYS OF COMPENSATION FOR SIMILAR POSITIONS IN OTHER ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. SYSTEM-WIDE SUMMARIZED DATA IS ALSO PROVIDED IN THE ANNUAL REPORT TO THE COMMUNITY. THIS REPORT IS MADE AVAILABLE IN KIOSKS AND HIGH-TRAFFIC AREAS OF HOSPITALS AND PHYSICIAN CLINICS, AS WELL AS COMMUNITY PLACES SUCH AS THE PUBLIC LIBRARY. IT IS ALSO DISTRIBUTED TO THE BOARDS OF DIRECTORS AND DIRECTLY MAILED TO DONORS AND NEW RESIDENTS IN THE COMMUNITY. ADDITIONALLY, THE REPORT IS MADE AVAILABLE AT EVENTS, COMMUNITY OUTREACH PROJECTS, AND SCREENINGS ATTENDED THROUGHOUT THE YEAR. GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: BOOK TO TAX DIFFERENCES - JOINT VENTURES 88,504. SETTLEMENT OF N/R TO AFFILIATED TAX EXEMPT ORGANIZATION 5,000,000. PENSION LIABILITY CHANGE -13,078. CAPITAL TRANSFERRED -625,000. 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