2023-05-02T14:36:15-05:00 2022-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2021-07-01 930425580 GOOD SHEPHERD HEALTH CARE SYSTEM GOOD 5416673400 610 NW 11TH STREET HERMISTON OR 97838 EMMETT C SCHUSTER INTERIM CEO 5416673400 2023-04-28 1 EMMETT SCHUSTER 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2023-04-28 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z EMMETT C SCHUSTER 610 NW 11TH STREET HERMISTON OR 97838 179505900 0 X WWW.GSHEALTH.ORG X 1953 OR TO PROVIDE COMPASSIONATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE AND TO PROMOTE A HEALTHY COMMUNITY. 12 12 910 62 0 0 5946311 2916644 119674829 153110842 5569241 6746458 1522082 1492963 132712463 164266907 240721 323268 0 0 70079375 75382950 0 0 184935 49208196 70464872 119528292 146171090 13184171 18095817 266771464 258405641 26243237 18331427 240528227 240074214 X TO PROVIDE COMPASSIONATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE AND TO PROMOTE A HEALTHY COMMUNITY. 0 0 129439260 323268 153110842 GOOD SHEPHERD HEALTH CARE SYSTEM (GSHCS) SERVED 1,781 INPATIENTS OVER 6,808 PATIENT DAYS, 72,863 OUTPATIENTS, AND 22,441 PATIENTS IN OUR EMERGENCY CENTER DURING FISCAL YEAR 2021-2022. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF GSHCS, NOT ALL INDIVIDUALS HAVE THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. GSHCS PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT DEEPLY DISCOUNTED RATES AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS $2,984,815 WRITTEN OFF AS BAD DEBT, AND AN ADDITIONAL $9,047,261 OF DIRECT CHARITY CARE TO OUR COMMUNITY. RECOGNIZING OUR MISSION TO THE COMMUNITY, SERVICES WERE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS DURING THE YEAR WAS $77,910,151. THE UNREIMBURSED AMOUNTS ARE VALUED AT CHARGES FOREGONE. OUR EMERGENCY CENTER IS OPEN AROUND-THE-CLOCK TO ALL COMMUNITY MEMBERS, VISITORS, AND TRAVELERS, WITHOUT REGARD TO ONE'S ABILITY TO PAY. 129439260 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 166 0 910 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X JAN PETER 5416673400 610 NW 11TH STREET HERMISTON OR 97838 SUE DAGGETT CHAIRMAN 2.00 X X 0 0 0 JON LORENCE VICE CHAIR 2.00 X X 0 0 0 TOM WAMSLEY SECRETARY 2.00 1.00 X X 0 0 0 BILL ELFERING TREASURER 2.00 1.00 X X 0 0 0 RACHEL ARCHER DIRECTOR 2.00 X 0 0 0 BOB CARLSON DIRECTOR 2.00 X 0 0 0 DR DEREK EARL DIRECTOR 2.00 X 0 0 0 STEVE ELDRIGE DIRECTOR 2.00 X 0 0 0 ARNELL EYNON DIRECTOR 2.00 X 0 0 0 NANCY MABRY DIRECTOR 2.00 X 0 0 0 LISA MITTELSDORF DIRECTOR 2.00 2.00 X 0 0 0 JEFF WENHOLZ DIRECTOR 2.00 X 0 0 0 JAN PETER CHIEF FINANCIAL OFFICER 40.00 X 293130 0 51725 BRIAN SIMS CHIEF EXECUTIVE OFFICER 40.00 X 399890 0 44187 JIM SCHLENKER CHIEF OPERATING OFFICER 40.00 X 265162 0 42899 JEREMY ANDERSON ORTHOPEDIC SURGEON 40.00 1.00 X 791974 0 72956 JAMES WHITTUM ORTHOPEDIC SURGEON 40.00 X 778312 0 36900 STEPHEN IACOBONI PHYSICIAN-TREATMENT CENTER 40.00 X 478430 0 0 CHRISTOPHER SCOTT CHIROPRACTIC PRACTITIONER 40.00 X 451837 0 32836 THOMAS HOLT UROLOGIST 40.00 X 447743 0 51360 DENNIS BURKE FORMER CHIEF EXECUTIVE OFFICER 40.00 X 470712 0 0 4377190 0 332863 144 1 1 0 MAXIM HEALTHCARE SERVICE 12558 COLLECTION CENTER DR CHICAGO IL 60692 TEMP STAFFING 7337785 EMCARE PHYSICIAN SERVICES INC 7032 COLLECTION CENTER DR CHICAGO IL 60693 HOSPITALIST & ER PROVIDER SERVICES 2689783 TUALATIN IMAGING 7427 SW COHO CT STE 200 TUALATIN OR 97062 DIAGNOSTIC IMAGING READING 1684282 BOUTEN CONSTRUCTION CO 627 N NAPA ST SPOKANE WA 99202 CONSTRUCTION 1665662 APOLLO SHEET METAL INC PO BOX 7287 KENNEWICK WA 99336 CONSTRUCTION 1474663 37 73044 2826769 16831 2916644 PATIENT SERVICE REVENUE 624100 153110842 153110842 153110842 6278845 6278845 15573006 133600 15230649 8344 342357 125256 467613 467613 CAFETERIA 722210 893894 893894 DAYCARE 900099 323116 323116 275953 275953 1492963 164266907 153110842 0 8239421 X 281603 281603 41665 41665 1219783 1219783 58929676 51456071 7347191 126414 2525340 2288015 231687 5638 9430242 8185870 1224202 20170 3277909 2814367 456607 6935 15354 15354 68570 68570 439760 439760 33425531 30844766 2567413 13352 1134610 659071 473981 1558 83847 48705 35027 115 3122971 2849725 273246 2101770 1908672 192423 675 138177 80264 57723 190 474693 275739 198302 652 7134986 6193866 937383 3737 733167 452169 280998 MEDICAL SUPPLIES 19924920 19641668 279154 4098 MINOR EQUIPMENT 1049827 1034903 14708 216 DUES AND SUBSCRIPTIONS 169719 98586 70900 233 446970 283535 162483 952 146171090 129439260 16546895 184935 20783388 5276894 17363103 22963257 206380 0 3745012 3960908 2024807 2686285 157249567 91693883 61257708 65555684 150377835 147476381 1560000 2060000 8101738 6569312 1351493 1856920 266771464 258405641 12971364 16175044 0 1322500 13271873 833883 26243237 18331427 X 239964682 239442884 563545 631330 240528227 240074214 266771464 258405641 18095817 -18549830 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11989 11989 0 PART II-B, LINE 1: THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. THE HOSPITAL PAYS MEMBERSHIP DUES TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS. THE ASSOCIATIONS USE A PORTION OF SUCH DUES TO CARRY OUT LOBBYING ACTIVITIES. 2860961 3763115 6624076 90514471 43129349 47385122 58997985 48564534 10433451 1113035 1113035 65555684 MEDICARE REFUNDABLE ADVANCE 833883 833883 1 1 X 1 X 1 X 1 1 0 1 1 3925039 3925039 0.02690 35606777 31285739 4321038 0.02960 39531816 31285739 8246077 0.05650 27650 1610115 77207 1532908 0.01050 770 553463 4148 549315 0.00380 52021331 21665076 30356255 0.20770 281603 281603 0.00190 28420 54466512 21746431 32720081 0.22390 28420 93998328 53032170 40966158 0.28040 1 801798 41538500 42041797 -503297 X 1 1 1 1 GOOD SHEPHERD HEALTH CARE SYSTEM 610 NW 11TH STREET HERMISTON OR 97838 WWW.GSHEALTH.ORG 055598-6 X X X X GOOD SHEPHERD HEALTH CARE SYSTEM 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X HTTPS://WWW.GSHEALTH.ORG/COMMUNITYBENEFIT X X 1 21 1 HTTPS://WWW.GSHEALTH.ORG/COMMUNITYBENEFIT 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X HTTPS://WWW.GSHEALTH.ORG/PAYING-FOR-YOUR-CARE X HTTPS://WWW.GSHEALTH.ORG/PAYING-FOR-YOUR-CARE X HTTPS://WWW.GSHEALTH.ORG/PAYING-FOR-YOUR-CARE X X X X X X X 1 X 0 X X X X 1 X 0 0 GOOD SHEPHERD HEALTH CARE SYSTEM PART V, SECTION B, LINE 5: THE NEEDS ASSESSMENT WAS ENVISIONED, DESIGNED, AND EXECUTED BY COMMUNITY LEADERS AND MEMBERS REPRESENTING HEALTHCARE, PUBLIC HEALTH, LAW ENFORCEMENT, EDUCATION, AND SOCIAL SERVICES. THE ASSESSMENT WAS CONDUCTED IN PARTNERSHIP WITH ST. ANTHONY HOSPITAL IN PENDLETON, OR. THE ASSESSMENT PROCESS INCLUDED REGULAR CONSULTATION WITH THE LOCAL CHILD DEVELOPMENT COALITION AND COUNTY PUBLIC HEALTH DEPARTMENTS. TWO SURVEY INSTRUMENTS WERE USED IN THIS ASSESSMENT: ONE FOR ADULTS 19YEARSOFAGE AND OLDER AND ONE FOR PARENTS OF CHILDREN AGES 0 THROUGH 11. A TOTAL OF 1,200 ADULT AND 2,400 PARENT SURVEYS WERE MAILED TO RESIDENTS OF UMATILLA COUNTY. GOOD SHEPHERD HEALTH CARE SYSTEM PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH ST. ANTHONY HOSPITAL LOCATED IN PENDLETON, OR. GOOD SHEPHERD HEALTH CARE SYSTEM PART V, SECTION B, LINE 6B: THE CHNA WAS ALSO CONDUCTED WITH OREGON CHILD DEVELOPMENT COALITION, UMATILLA COUNTY PUBLIC HEALTH, AND HOSPITAL COUNCIL OF NORTHWEST OHIO. GOOD SHEPHERD HEALTH CARE SYSTEM PART V, SECTION B, LINE 7D: THE CHNA WAS WAS MADE WIDELY AVAILABLE THROUGH A NEWSPAPER ARTICLE PROVIDING A SYNOPSIS OF THE ASSESSMENT'S FINDINGS, PUBLIC FORUMS DISCUSSING THE ASSESSMENT'S FINDINGS, AS WELL AS AVAILABLE ON OUR WEBSITE. GOOD SHEPHERD HEALTH CARE SYSTEM PART V, SECTION B, LINE 11: THE MOST RECENT CHNA IDENTIFIED THE FOLLOWING SIGNIFICANT HEALTH NEEDS ALONG WITH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THESE NEEDS INCLUDE:ACCESS TO SERVICES SOCIAL DETERMINANT OF HEALTH/HEALTH EQUITY:WE WILL CONTINUE OFFERING URGENT CARE SERVICES, CONNEXIONS PROGRAM (CASE MANAGEMENT AND RESOURCE REFERRAL), HERMISTON HIGH SCHOOL WELLNESS CLINIC, MEMBERSHIP IN THE LOCAL COMMUNITY ADVISORY COUNCIL (LCAC) AND SUPPORT OF LCAC OBJECTIVES. WE WILL IMPLEMENT NEW STRATEGIES INCLUDING COMMUNITY EDUCATION ON APPROPRIATE USE OF THE EMERGENCY DEPARTMENT, URGENT CARE, AND PRIMARY CARE PROVIDERS (PCPS), INCREASE EFFORTS TO RECRUIT HEALTHCARE PROVIDERS TO MEET THE GROWING POPULATION AND MAKE URGENT CARE SERVICES MORE ACCESSIBLE.OBESITY/CHRONIC DISEASE:WE WILL CONTINUE OFFERING BMI MEASUREMENTS AT COMMUNITY SCREENING EVENTS, ENCOURAGING COMMUNITY PARTNERS TO PROMOTE HEALTHY GARDENING AND FOOD CHOICES, CONTINUE TO PROMOTE COMMUNITY-BASED EXERCISE AND FITNESS EDUCATION OPPORTUNITIES. WE WILL IMPLEMENT NEW STRATEGIES INCLUDING NORTHEAST OREGON PRESCRIPTION TRAILS PROGRAM, SUGAR SWEETENED BEVERAGE EDUCATION AT 75% OF COMMUNITY OUTREACH EVENTS, FEASIBILITY ANALYSIS OF METABOLIC AND BARIATRIC PROGRAM, AND CREATION OF COMMUNITY CANCER PREVENTION STRATEGIC PLAN.VIOLENCE:WE WILL CONTINUE OFFERING SAFE COMMUNITIES PARTICIPATION AND START BY BELIEVING CAMPAIGN. WE WILL IMPLEMENT NEW STRATEGIES INCLUDING COLLABORATE WITH DOMESTIC VIOLENCE SERVICES TO HOST ONE IN HER SHOES EVENT ON SITE ANNUALLY, INTEGRATE ABUSE SCREENING QUESTIONNAIRE INTO EPIC, EXPANSION OF AWARENESS AND SCOPE OF START BY BELIEVING CAMPAIGN LED BY SANE TEAM.BEHAVIORAL HEALTH:WE WILL CONTINUE OFFERING SAFE COMMUNITIES AND DEVELOPMENTAL ADOLESCENT RESIDENTIAL TREATMENT (DART) PARTICIPATION, MEMBERSHIP IN THE LOCAL COMMUNITY ADVISORY COUNCIL (LCAC), SUPPORT OF LCAC OBJECTIVES, TOBACCO TREATMENT SPECIALIST (TTS) COUNSELING, AND COMMUNITY TOBACCO EDUCATION AND EVENTS. WE WILL IMPLEMENT NEW STRATEGIES INCLUDING ENSURING UNIFORM COMPLIANCE WITH GSHCS POLICIES REGARDING PRESCRIPTION DRUG MONITORING PROGRAM (PDMP) DASHBOARD USAGE BEFORE PRESCRIBING OPIOIDS OR OTHER ADDICTIVE PRESCRIPTIONS, ENSURING UNIFORM COMPLIANCE WITH GSHCS POLICIES REGARDING REQUIRING DOCTOR/PATIENT AGREEMENT WHEN ON LONG-TERM OPIOID PRESCRIPTIONS, OBTAINING ONE GSHCS EMPLOYED MEDICATION ASSISTED TREATMENT (MAT) PROVIDER, TRAINING SELECT GSHCS STAFF IN NALOXONE ADMINISTRATION, CREATING ONSITE SAFE MEDICATION DISPOSAL SITE, AND DISTRIBUTING ACCURATE INFORMATION ON DRUGS AT VARIOUS COMMUNITY EVENTS.THE HOSPITAL DOES NOT HAVE ADEQUATE RESOURCES TO SOLVE ALL THE PROBLEMS IDENTIFIED. SOME ISSUES ARE BEYOND THE MISSION OF THE HOSPITAL AND ACTION IS BEST SUITED FOR A RESPONSE BY OTHERS OR WILL REQUIRE PERSONAL ACTIONS BY INDIVIDUALS RATHER THAN THE RESPONSE OF AN ORGANIZATION. WE VIEW THE ABOVE STRATEGIES FOR HOW WE, ALONG WITH OTHER ORGANIZATIONS AND AGENCIES, CAN COLLABORATE TO BRING THE BEST EACH HAS TO OFFER TO ADDRESS THE MORE PRESSING IDENTIFIED NEEDS. GOOD SHEPHERD HEALTH CARE SYSTEM PART V, SECTION B, LINE 16J: A SUMMARY OF THE FAP IS DISTRIBUTED IN UNEMPLOYMENT OFFICES AND OTHER AREAS IN THE COMMUNITY THAT TARGET THE ELIGIBLE POPULATION. A SUMMARY IS ALSO AVAILABLE AT LOCAL PHYSICIAN OFFICES, ADMISSIONS OFFICES, AND SENT WITH BILLING INVOICES. ALSO, UPON DISCHARGE, A PATIENT FINANCIAL REPRESENTATIVE MEETS WITH PATIENTS TO DISCUSS THEIR ABILITY TO PAY FOR SERVICES. INCLUDED AS PART OF THIS DISCUSSION IS A SUMMARY OF THE FAP. GOOD SHEPHERD HEALTH CARE SYSTEM PART V, SECTION B, LINE 20E: SCHEDULE H, PART V, SECTION B, LINE 20A: THE ORGANIZATION DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS (ECA'S) 3 1 - GOOD SHEPHERD MEDICAL GROUP 610 NW 11TH STREET HERMISTON OR 97838 CLINIC 2 - GOOD SHEPHERD HOME HEALTH 610 NW 11TH STREET HERMISTON OR 97838 HOME HEALTH 3 - VANGE JOHN MEMORIAL HOSPICE 610 NW 11TH STREET HERMISTON OR 97838 HOSPICE PART I, LN 7 COL(F): BAD DEBT EXPENSE IS INCLUDED IN NOTE 1: SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES UNDER THE ACCOUNTING FOR CONTRACTUAL ARRANGEMENTS SECTION AND IN NOTE 5: PATIENT ACCOUNTS RECEIVABLE. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 2: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON SCHEDULE H, PART III, LINE 2 INCLUDES THE COST TO CHARGE RATIO OF PATIENT CARE. PART III, LINE 3: MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. THE ESTIMATE OF BAD DEBT ATTRIBUTABLE TO CHARITY PATIENTS IS BASED ON AN OVERALL CHARITY CARE PERCENTAGE OF GROSS REVENUE. PART III, LINE 4: BAD DEBT EXPENSE EXPLANATIONS ARE INCLUDED IN NOTE 1: SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES UNDER THE ACCOUTING FOR CONTRACTUAL ARRANGEMENTS SECTION AND IN NOTE 5: PATIENT ACCOUNTS RECEIVABLE. PART III, LINE 8: ANY MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS ARE NOT COUNTED AS COMMUNITY BENEFIT. THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES & REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. GSHCS PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THEY WILL NOT RECOVER ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. PART III, LINE 9B: THE ORGANIZATIONS COLLECTION PROCEDURES REQUIRE A FINANCIAL ADVISOR TO WORK WITH ANY PATIENT WHO IS IDENTIFIED AS POTENTIALLY BEING ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SENDING THE ACCOUNT TO COLLECTION. IF DURING THE COURSE OF THE COLLECTION PROCESS THE COLLECTION AGENCY DETERMINES AN ACCOUNT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, IT IS REFERRED BACK TO THE HOSPITAL FOR FURTHER DISCUSSION WITH THE PATIENT OR FOR WRITE OFF. ALL FURTHER COLLECTION ACTION IS CEASED. PART VI, LINE 2: GOOD SHEPHERD HEALTH CARE SYSTEM HAS PARTNERED WITH ST. ANTHONY HOSPITAL, UMATILLA COUNTY HEALTH DEPARTMENTS, AND OREGON CHILD DEVELOPMENT COALITION, AND CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO TO CONDUCT AN UMATILLA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. OUR COMMUNITY HEALTHCARE NEEDS ASSESSMENT PROCESS HAS FIVE COMPONENTS THAT ARE CONDUCTED EVERY THIRD YEAR:1. THE ONGOING COLLECTION AND EVALUATION OF COMMUNITY FEEDBACK FROM PATIENT SURVEYS AND COMMENT FORMS.2. PATIENT AND COMMUNITY MEMBER HEALTHCARE NEEDS FOCUS GROUPS.3. A HEALTHCARE NEEDS SURVEY COMPLETED BY EMPLOYERS AND OTHER COMMUNITY LEADERS.4. A FORMAL TELEPHONE SURVEY.5. A DEMOGRAPHIC STUDY CONDUCTED BY THE OREGON OFFICE OF RURAL HEALTH.HARD COPIES OF THE LATEST COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE UPON REQUEST WITHOUT CHARGE AND ALSO POSTED ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTP://WWW.GSHEALTH.ORG/COMMUNITYBENEFITHARD COPIES OF THE MOST RECENTLY ADOPTED COMMUNITY HEALTH IMPLEMENTATION PLAN IS AVAILABLE UPON REQUEST WITHOUT CHARGE AND ALSO POSTED ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL:HTTP://WWW.GSHEALTH.ORG/COMMUNITYBENEFIT PART VI, LINE 3: OUR FINANCIAL COUNSELORS INFORM AND EDUCATE THE PEOPLE WE SERVE WITH RESPECT TO CHARITY CARE AND GOVERNMENTAL ASSISTANCE PROGRAMS. ALL PATIENTS AND RESPONSIBLE PARTIES, WHERE POSSIBLE, ARE APPRISED OF THE AVAILABILITY OF FINANCIAL COUNSELING SERVICES AT THE TIME AND POINT OF SERVICE. WE HAVE ARRANGED OUR PATIENT FLOW TO MAXIMIZE THE CONVENIENCE OF VISITING OUR FINANCIAL COUNSELORS AS PART OF THE GOOD SHEPHERD TREATMENT REGIME. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY IS PROVIDED IN WRITING TO THE PATIENTS UPON REQUEST, AND WHEN THE HOSPITAL IS ABLE TO IDENTIFY A POTENTIAL FAP ELIGIBLE INDIVIDUAL UPON ADMISSIONS. PART VI, LINE 4: GOOD SHEPHERD HEALTH CARE SYSTEM (GSHCS) IS THE CORPORATE NAME FOR AN ORGANIZATION MADE UP OF SEVERAL ENTITIES, INCLUDING GOOD SHEPHERD MEDICAL CENTER, VANGE JOHN MEMORIAL HOSPICE, GOOD SHEPHERD HOME HEALTH, GOOD SHEPHERD MEDICAL GROUP, AND GOOD SHEPHERD CLINIC PHARMACY. GOOD SHEPHERD SERVES A CORE POPULATION OF ALMOST 50,000 PEOPLE IN THE CITY OF HERMISTON, OREGON AND IN 14 OUTLYING SMALLER TOWNS WITHIN A ROUGH 50-MILE RADIUS. THIS POPULATION IS LARGELY RURAL, WITH AGRICULTURE DOMINATING INDUSTRIAL ENTERPRISES. THE AVERAGE HOUSEHOLD INCOME IN HERMISTON IS 35,865. 17.1% OF RESIDENTS HAVE INCOMES BELOW FEDERAL POVERTY GUIDELINES. 31.3% OF RESIDENTS IDENTIFY AS NONWHITE HISPANIC ETHNICITY, WITH A SIZABLE NUMBER OF SPANISH PRIMARY SPEAKERS. PART VI, LINE 5: GOOD SHEPHERD MAINTAINS OPEN, ACTIVE, AFFILIATE, AND COURTESY MEDICAL STAFFS, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED AND INTERESTED PHYSICIANS IN THE COMMUNITIES WE SERVE. GSHCS IS GOVERNED BY A TWELVE MEMBER BOARD OF TRUSTEES. THE BOARD IS COMPRISED OF INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WITH AN EMPHASIS ON MAINTAINING A TRUE CROSS-SECTION OF CORE POPULATION COMMUNITIES WITHIN ITS MEMBERSHIP. OUR SURPLUS FUNDS ARE USED TO FUND COMMUNITY HEALTH EDUCATION CLASSES, AS WELL AS FUNDING BUILDING AND EQUIPMENT UPGRADES TO MAINTAIN THE HIGHEST QUALITY HEALTHCARE FOR OUR COMMUNITY. SURPLUS FUNDS ARE ALSO APPLIED TO ONGOING PROFESSIONAL EDUCATION AMONG OUR CLINICAL STAFF TO REMAIN CURRENT IN THE BEST PRACTICES OF MODERN HEALTHCARE.WE OPERATE A FULLY STAFFED 24-HOUR EMERGENCY ROOM, AVAILABLE TO THE PUBLIC REGARDLESS OF ABILITY TO PAY.WE LIVE OUR MISSION TO PROMOTE A HEALTHY COMMUNITY. GOOD SHEPHERD IS THE HOST AND DRIVING FORCE BEHIND THE GOOD SHEPHERD WELLNESS COALITION, A GRASSROOTS GROUP OF COMMUNITY LEADERS THAT IDENTIFY, ANALYZE, AND ADDRESS PRESSING HEALTHCARE ISSUES IN THE COMMUNITY.WE MAINTAIN A DIALOGUE WITH THE PEOPLE WE SERVE THROUGH A BIWEEKLY RADIO SHOW, WITH AN EMPHASIS ON WELLNESS AND PREVENTATIVE CARE.GOOD SHEPHERD HOSTS AN ANNUAL FAMILY HEALTH AND FITNESS DAY, WITH FREE ACCESS TO HEALTHCARE PROFESSIONALS, FREE SCREENINGS, AND A WEALTH OF HEALTH AND WELLNESS INFORMATION AVAILABLE TO THE PUBLIC.WE ARE ACTIVE IN COMMUNITY HEALTH RELATED ACTIVITIES, INCLUDING THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE, THE MARCH OF DIMES' MARCH FOR BABIES, AND THE UMATILLA COUNTY FAIR, WHERE WE PROVIDE HEALTH INFORMATION AND HEALTHCARE RELATED GIVEAWAYS. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES OR 1 GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION 610 NW 11TH STREET HERMISTON OR 97838 931170546 501(C)(3) 201603 0 FINANCIAL SUPPORT UMATILLA COUNTY FIRE DISTRICT 320 S 1ST STREET HERMISTON OR 97838 812661780 GOV 40000 0 EMS TRAINING BLUE MOUNTAIN COMMUNITY COLLEGE 975 SE COLUMBIA DRIVE HERMISTON OR 97838 930506536 GOV 40000 0 NURSING PROGRAM 3 0 SCHOLARSHIPS 16 41665 PART I, LINE 2: REQUESTS FOR FINANCIAL ASSISTANCE ARE APPROVED BY THE BOARD PRIOR TO DISBURSEMENT. ANY ORGANIZATION RECEIVING AN AWARD MUST SIGN AN AGREEMENT BEFORE THE FUNDS ARE DISPERSED STATING THE FUNDS WILL BE USED FOR THE STATED PURPOSE AS LISTED IN THEIR GRANT APPLICATION. GRANTS AWARDED TO GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION, A RELATED ORGANIZATION WHICH IS TAX EXEMPT UNDER SECTION 501(C)(3), ARE REQUIRED TO SUBMIT REGULAR REPORTS UNTIL ALL FUNDS HAVE BEEN SPENT. THESE REPORTS ARE REVIEWED AT THE FOUNDATION MEETINGS OF WHICH BOARD MEMBERS WHO SERVE ON BOTH THE HOSPITAL AND THE FOUNDATION BOARDS ATTEND. THERE ARE NO REPORTING REQUIREMENTS REQUIRED TO BE SENT TO THE HOSPITAL FROM THE OTHER ORGANIZATIONS LISTED ON SCHEDULE I. X X X X 0 0 0 0 0 0 0 1 0 JEREMY ANDERSON ORTHOPEDIC SURGEON 773775 0 18199 0 0 0 37558 0 35398 0 864930 0 0 0 JAMES WHITTUM ORTHOPEDIC SURGEON 762635 0 15677 0 0 0 0 0 36900 0 815212 0 0 0 THOMAS HOLT UROLOGIST 438280 0 9463 0 0 0 35157 0 16203 0 499103 0 0 0 CHRISTOPHER SCOTT CHIROPRACTIC PRACTITIONER 416816 0 35021 0 0 0 16733 0 16103 0 484673 0 0 0 STEPHEN IACOBONI PHYSICIAN-TREATMENT CENTER 460000 0 18430 0 0 0 0 0 0 0 478430 0 0 0 DENNIS BURKE FORMER CHIEF EXECUTIVE OFFICER 0 0 0 0 470712 0 0 0 0 0 470712 0 0 0 BRIAN SIMS CHIEF EXECUTIVE OFFICER 317160 0 63230 0 19500 0 0 0 44187 0 444077 0 0 0 JAN PETER CHIEF FINANCIAL OFFICER 258070 0 23018 0 12042 0 20399 0 31326 0 344855 0 0 0 JIM SCHLENKER CHIEF OPERATING OFFICER 230824 0 22672 0 11666 0 11666 0 31233 0 308061 0 0 0 PART I, LINE 7 AT THE END OF THE FISCAL YEAR THE BOARD DETERMINES THE AMOUNT OF FUNDS THAT WILL BE DISBURSED FOR BONUSES BASED ON THE ACHIEVEMENT OF SPECIFIED GOALS. MANAGEMENT THEN DETERMINES THE PERCENTAGE OF BONUSES ALLOCATED TO EACH LEVEL AND EACH INDIVIDUAL. THE HOSPITAL MAY ALSO PAY THE CEO A DISCRETIONARY ANNUAL BONUS IN AN AMOUNT TO BE DETERMINED BY THE BOARD OR COMMITTEE BASED UPON THE CEO'S ANNUAL REVIEW. NANCY MABRY BOARD MEMBER 471012 COLLECTIONS SERVICE 0 PART IV, LINE 1: CREDITS INC. IS A COLLECTION SERVICE AGENCY USED BY GSHCS WHICH IS OWNED 100% BY A BOARD MEMBER. FORM 990, PART VI, SECTION A, LINE 2 THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF GOOD SHEPHERD HEALTH CARE SYSTEM (GSHCS), A RELATED ORGANIZATION AND HAS A BUSINESS RELATIONSHIP WITH THE FOLLOWING COMMON BOARD MEMBERS OF GSHCS AND THE FOUNDATION: TOM WAMSLEY, BILL ELFERING AND LISA MITTLESDORF. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 IS PROVIDED TO THE CFO AND CONTROLLER WHO REVIEW THE FORM, SCHEDULES, AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PRESENTED TO THE BOARD OF DIRECTORS WHO THEN APPROVE THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO SIGNS THE FORM 8879EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES WITH CONFLICTS ARE EXPECTED TO DISCLOSE CONFLICTS OF INTEREST ON A VOLUNTARY BASIS AND REFRAIN FROM DISCUSSION AND/OR VOTING ON RELATED MATTERS AS NECESSARY. THESE DISCLOSURES ARE REVIEWED AND DETERMINED TO EXIST OR NOT TO EXIST BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS BASED ON SURVEY INFORMATION. THIS PROCESS IS COMPLETED ANNUALLY IN THE MONTH OF OCTOBER. THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IS DETERMINED BY THE CEO BASED ON SURVEY INFORMATION. THIS PROCESS IS COMPLETED ANNUALLY ON THE ANNIVERSARY DATE OF THE INDIVIDUALS HIRE DATE. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 30,844,766. MANAGEMENT AND GENERAL EXPENSES 2,567,413. FUNDRAISING EXPENSES 13,352. TOTAL EXPENSES 33,425,531. GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION 610 NW 11TH STREET HERMISTON OR 97838 931170546 FUNDRAISING OR 501(C)(3) LINE 7 GOOD SHEPHERD HEALTH CARE SYSTEM 1 GOOD SHEPHERD MEDICAL SERVICE CORP 610 NW 11TH STREET HERMISTON OR 97838 930688940 PHARMACY OR GOOD SHEPHERD HEALTH CARE SYSTEM C 7474715 7716197 1.00000 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 GOOD SHEPHERD MEDICAL SERVICE CORP A 433019 CASH GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION B 201603 CASH GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION C 73044 CASH GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION O 164848 CASH