2021-11-11T13:14:56-06:00 2020-12-31 930623286 ALDRICH CPAS AND BUSINESS ADVISORS LLP 5665 SW MEADOWS RD SUITE 200 LAKE OSWEGO OR 97035 990 2020-01-01 930951989 SAMARITAN HEALTH SERVICES SAMA 5417684857 CO SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL B SMITH SVP / CFO 5417684857 2021-11-02 1 DANIEL SMITH 999009999 JOYLYN ANKENEY P00366587 5036204489 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DOUGLAS BOYSEN 3600 NW SAMARITAN DR CORVALLIS OR 97330 271189777 0 X WWW.SAMHEALTH.ORG X 1986 OR TO ENHANCE COMMUNITY HEALTH THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. 16 14 1309 13 2075201 0 1170485 2113405 225270841 231936557 1897590 112676 2663938 2473588 231002854 236636226 70296 109416 0 0 92748084 95858685 8668 21798 2194122 133909210 131967058 226736258 227956957 4266596 8679269 337028226 432777505 288637298 376917271 48390928 55860234 X SAMARITAN HEALTH SERVICES (SHS) IS THE PARENT COMPANY OF A REGIONAL NETWORK OF HOSPITALS, PHYSICIANS AND SENIOR CARE FACILITIES. (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 205973786 230926200 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 2020 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 $3,128,181 OF COMMUNITY BENEFIT COSTS, INCLUDING HEALTH PROFESSION EDUCATION, COMMUNITY BUILDING ACTIVITIES, AND RESEARCH. 109416 109416 GRANTS AND ASSISTANCE PROVIDED BY SAMARITAN HEALTH SERVICES TO VARIOUS ORGANIZATIONS AND INDIVIDUALS, INCLUDING GRANTS TO ASSIST RESIDENTS IN BENTON, AND LINN COUNTIES WITH CHILDCARE NEEDS. SEE PART IX, LINES 1 AND 2 AND RELATED SCHEDULE I FOR MORE DETAILS. 206083202 1 1 0 1 0 0 0 0 0 0 1 1 0 0 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 1390 0 1 1309 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 16 14 1 0 0 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 JUDY LIST BOARD CHAIR 1.00 1.00 X X 0 0 0 BOB ADAMS BOARD SECRETARY 1.00 2.00 X X 0 0 0 RANDY SPRINGER BOARD TREASURER 1.00 3.00 X X 0 0 0 MILTON MORAN BOARD CHAIR ELECT 1.00 1.00 X 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 JIM DENHAM BOARD MEMBER 1.00 4.00 X 0 0 0 NANCY SEIFERT BOARD MEMBER 1.00 2.00 X 0 0 0 RICHARD KENYON BOARD MEMBER 1.00 2.00 X 0 0 0 TROY GARRETT MD BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 217892 19699 REVEREND WILLIAM MCCARTHY BOARD MEMBER 1.00 2.00 X 0 0 0 LESLIE PLISKIN MD BOARD MEMBER / PHYSICIAN 1.00 1.00 X 0 1215 0 PAUL DASKALOS DO BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 457361 57601 STUART PRITCHARD BOARD MEMBER 1.00 1.00 X 0 0 0 JUNE CHRISMAN BOARD MEMBER 1.00 1.00 X 0 0 0 RALPH BREITENSTEIN MD BOARD MEMBER 1.00 1.00 X 0 0 0 DOUGLAS BOYSEN PRESIDENT & CEO 33.00 7.00 X 1092029 0 60049 DANIEL SMITH SVP / CFO 23.00 17.00 X 525239 0 59937 ROBERT TURNGREN MD SVP / CHIEF PHYSICIAN EXEC 39.00 1.00 X 549362 0 53278 KELLEY KAISER SVP / CAO 35.00 5.00 X 515978 0 57863 BECKY PAPE VP CEO GSRMC (JAN - AUG) 1.00 39.00 X 470274 0 53008 JOSEPH CAHILL VP CEO MVH 1.00 39.00 X 361628 0 47009 LESLEY OGDEN MD VP CEO NLH / CEO SPCH 1.00 39.00 X 400033 0 49635 ROBERT POWER VP INFORMATION SYSTEMS / CIO 40.00 X 365273 0 51164 KIRK GERNER VP INNOVATIONS / STRATEGIC DEV 40.00 X 359139 0 52568 DANIEL KETERI VP CEO SAGH 1.00 39.00 X 386694 0 54835 JULIE MANNING VP MKTG / PR & COMMUNITY HLTH 32.00 X 266333 0 48760 GAIL WORDEN-ACREE VP HUMAN RESOURCES 40.00 X 242158 0 56110 GLEN CUNNINGHAM VP POPULATION HEALTH SERVICES 40.00 X 229133 0 47064 BRUCE BUTLER VP CEO HEALTH PLANS 20.00 20.00 X 395241 0 25504 TYLER JACOBSEN VP GENERAL COUNSEL 40.00 X 189569 0 53803 SHILOH ERVEN VP SMG ADMINISTRATION 40.00 X 185377 0 41604 LAURA HENNUM VP CEO GSRMC (START AUG 2020) 1.00 39.00 X 160249 0 10441 MARGARET MIKULA MD VP CHIEF QUAL OFF (START AUG 2020) 40.00 X 241438 0 10374 BRADLEY WAKEFIELD VP SMG COO 40.00 X 289798 0 26219 DAVID ZARKOU DPM SENIOR MEDICAL DIRECTOR 25.00 15.00 X 265913 111016 57496 BARRY SMITH MD SENIOR MEDICAL DIRECTOR 25.00 15.00 X 254873 155926 45869 LARRY MULLINS DHA CEO SAM SOLUTIONS (JAN - NOV) 18.00 2.00 X 436457 0 14222 KEVIN EWANCHYNA MD VP CHIEF MEDICAL OFFICER SHPO 24.00 16.00 X 440433 0 59313 DAVID TRIEBES FORMER VP CEO SAGH 1.00 2.00 X 529355 0 25649 RYAN COMBS VP OPERATIONS MVH 0.00 40.00 X 0 307718 59919 KIMBERLY CLIFT VP OPERATIONS GSRMC (JAN - NOV) 0.00 40.00 X 0 334532 30282 9151976 1585660 1229275 187 1 1 0 THE NEENAN COMPANY LLP 3325 S TIMBERLINE RD SUITE 100 FORT COLLINS CO 80525 CONSTRUCTION 4966946 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 STAFFING SERVICES 3241215 OPTUMINSIGHT INC PO BOX 84019 CHICAGO IL 606894002 OPERATIONS CONSULTING SERVICES 3186664 SYNERGY SURGICALISTS INC 280 W KAGY BLVD SUITE D 320 BOZEMAN MT 59715 STAFFING SERVICES 3079840 LEGACY LABORATORY SERVICES LLC PO BOX 5337 PORTLAND OR 97228 LABORATORY SERVICES 2900372 124 1312445 19158 781802 2113405 SUPPORT SERVICE FEES 561000 130754797 130754797 EMPL HEALTH PLAN PREM 525100 98810645 98810645 FITNESS CENTER REVENUE 713940 1844922 854649 990273 DURABLE MEDICAL EQUIP 446199 197691 177607 20084 RELEASE OF INFORMATION 900099 167166 167166 161336 161336 231936557 739569 63000 676569 3114333 1534589 1579744 1579744 108000 1471744 32372919 19150 33018962 0 -646043 19150 -626893 -626893 JOINT VENTURES 900099 355434 355434 GROUP PURCHASING 561499 329462 329462 OCCUPANCY SERVICES 561700 208948 208948 893844 236636226 230926200 2075201 1521420 107600 107600 1816 1816 8084166 8084166 62672833 55801003 5573472 1298358 4797793 4331838 377918 88037 13618927 12296274 1072752 249901 6684966 6035731 526569 122666 517469 517469 691848 691848 66314 66314 21798 21798 43890 21945 21945 5695843 5606450 1227 88166 771132 769087 1440 605 7796754 7700144 50908 45702 10061068 9756660 304408 2049589 1917863 98141 33585 297114 283287 9556 4271 216937 209437 2229 5271 2551611 1673298 878313 13367426 12970983 396070 373 2424429 2044393 380036 CLAIM FEES 81672986 81672986 PURCHASED SERVICES 3158078 2711234 229923 216921 DUES, TAXES, & LICENSES 494707 14996 461243 18468 MEDICAL SUPPLIES 87763 87763 2100 2100 227956957 206083202 19679633 2194122 1000 1000 88338858 268545299 757142 774666 20924 1692719 1498107 97268 120219 4892975 7078399 233072369 117740826 123115847 115331543 24195956 22474714 22030919 171923 71905542 16760711 337028226 432777505 38640471 53342050 768511 192237126 167991550 39835315 44159571 17924386 110655589 288637298 376917271 X 48390928 55860234 48390928 55860234 337028226 432777505 X 8679269 240972 -1450935 X 0 1 X 1 0 X X 5 ALBANY GEN HOSP 930110095 3 1 0 28569770 GOOD SAM HOSP 930391573 3 1 0 61422212 MID-VALLEY HC 930396847 3 1 0 18049065 N LINCOLN HOSP 931305493 3 1 0 8035578 SAM PAC HLTH SVCS 931329784 3 1 0 14874518 5 0 130951143 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 SEVERAL 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 0 0 0 0 1 66314 0 0 0 66314 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 2020, THE FILING ORGANIZATION PAID MEMBERSHIP DUES TO OAHHS AND AHA OF $208,097 AND $107,362 RESPECTIVELY. 18.68% OF OAHHS DUES AND 25.56% OF AHA DUES WENT FOR LOBBYING PURPOSES. THUS, THE FILING ORGANIZATION MADE INDIRECT LOBBYING EXPENDITURES OF $66,314 THROUGH ITS MEMBERSHIP DUES. 3665000 17218352 20883352 21220093 75119865 31691546 64648412 3306989 1776408 1530581 105572071 81873057 23699014 6969999 2399815 4570184 115331543 22474714 C 22474714 LIABILITY FOR UNPAID MEDICAL CLAIMS 7470530 TENANT DEPOSITS 150000 ACCRUED INTEREST 1036956 OTHER LIABILITIES 24069265 ACCOUNTS PAYABLE - AFFILIATES 77928838 110655589 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, 2020, 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 2017. X X X X X 0 ANGLIN CREATIVE GROUP LLC PO BOX 2170 FAIRVIEW OR 97024 SPECIAL EVENTS 0 119000 21798 97202 119000 21798 97202 OR 1 UNITED WAY OF BENTON & LINCOLN COUNTIES PO BOX 2499 CORVALLIS OR 97339 936013898 501(C)(3) 15000 FUNDING TO SUPPORT COMMUNITY NEEDS IN BENTON, LINN, AND LINCOLN COUNTIES LINN BENTON COMMUNITY COLLEGE FOUNDATION 6500 PACIFIC BLVD SW ALBANY OR 97321 237212073 501(C)(3) 54167 FUNDING FOR CHILDCARE SUPPORT SERVICES BENTON COUNTY PO BOX 964 CORVALLIS OR 97339 936002285 GOV'T 37767 FUNDING FOR A REGIONAL HEALTH ASSESSMENT COLLABORATION 3 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 1 0 0 0 0 DOUGLAS BOYSEN PRESIDENT & CEO 845008 0 205200 0 41821 0 22992 0 37057 0 1152078 0 0 0 ROBERT TURNGREN MD SVP / CHIEF PHYSICIAN EXEC 416725 0 89116 0 43521 0 22992 0 30286 0 602640 0 0 0 DANIEL SMITH SVP / CFO 413822 0 84626 0 26791 0 22992 0 36945 0 585176 0 0 0 KELLEY KAISER SVP / CAO 384896 0 78830 0 52252 0 22992 0 34871 0 573841 0 0 0 DAVID TRIEBES FORMER VP CEO SAGH 17345 0 0 0 512010 0 22992 0 2657 0 555004 0 0 0 BECKY PAPE VP CEO GSRMC (JAN - AUG) 388820 0 75602 0 5852 0 22992 0 30016 0 523282 0 0 0 PAUL DASKALOS DO BOARD MEMBER / PHYSICIAN 0 440788 0 14351 0 2222 0 22992 0 34609 0 514962 0 0 KEVIN EWANCHYNA MD VP CHIEF MEDICAL OFFICER SHPO 383677 0 35126 0 21630 0 22992 0 36321 0 499746 0 0 0 BARRY SMITH MD SENIOR MEDICAL DIRECTOR 248178 145711 5884 9876 811 339 12816 10176 14698 8179 282387 174281 0 0 LARRY MULLINS DHA CEO SAM SOLUTIONS (JAN - NOV) 115259 0 0 0 321198 0 5700 0 8522 0 450679 0 0 0 LESLEY OGDEN MD VP CEO NLH / CEO SPCH 297217 0 64498 0 38318 0 22992 0 26643 0 449668 0 0 0 DANIEL KETERI VP CEO SAGH 299037 0 66837 0 20820 0 17292 0 37543 0 441529 0 0 0 DAVID ZARKOU DPM SENIOR MEDICAL DIRECTOR 231141 101864 0 0 34772 9152 16285 6707 22165 12339 304363 130062 0 0 BRUCE BUTLER VP CEO HEALTH PLANS 353928 0 36050 0 5263 0 7986 0 17518 0 420745 0 0 0 ROBERT POWER VP INFORMATION SYSTEMS / CIO 299730 0 61321 0 4222 0 22992 0 28172 0 416437 0 0 0 KIRK GERNER VP INNOVATIONS / STRATEGIC DEV 274648 0 50637 0 33854 0 22992 0 29576 0 411707 0 0 0 JOSEPH CAHILL VP CEO MVH 274043 0 58693 0 28892 0 22992 0 24017 0 408637 0 0 0 RYAN COMBS VP OPERATIONS MVH 0 254292 0 52530 0 896 0 22992 0 36927 0 367637 0 0 KIMBERLY CLIFT VP OPERATIONS GSRMC (JAN - NOV) 0 280639 0 23664 0 30229 0 22992 0 7290 0 364814 0 0 BRADLEY WAKEFIELD VP SMG COO 254144 0 30000 0 5654 0 0 0 26219 0 316017 0 0 0 JULIE MANNING VP MKTG / PR & COMMUNITY HLTH 195580 0 44296 0 26457 0 21212 0 27548 0 315093 0 0 0 GAIL WORDEN-ACREE VP HUMAN RESOURCES 179767 0 39629 0 22762 0 19205 0 36905 0 298268 0 0 0 GLEN CUNNINGHAM VP POPULATION HEALTH SERVICES 188880 0 39101 0 1152 0 13173 0 33891 0 276197 0 0 0 MARGARET MIKULA MD VP CHIEF QUAL OFF (START AUG 2020) 162033 0 75000 0 4405 0 0 0 10374 0 251812 0 0 0 TYLER JACOBSEN VP GENERAL COUNSEL 150223 0 32604 0 6742 0 14531 0 39272 0 243372 0 0 0 TROY GARRETT MD BOARD MEMBER / PHYSICIAN 0 216903 0 0 0 989 0 16312 0 3387 0 237591 0 0 SHILOH ERVEN VP SMG ADMINISTRATION 166403 0 14004 0 4970 0 13712 0 27892 0 226981 0 0 0 LAURA HENNUM VP CEO GSRMC (START AUG 2020) 129137 0 30000 0 1112 0 0 0 10441 0 170690 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 FORMER 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. TWO BOARD MEMBERS, ONE OFFICER, EIGHT KEY EMPLOYEES, FOUR HIGHEST PAID EMPLOYEES, AND ONE FORMER KEY EMPLOYEE USED THE SAMARITAN (SAMFIT) GYM/FITNESS FACILITY BENEFIT DURING THE FILING YEAR. PART I, LINES 4A-B LINE 4A: DAVID TRIEBES (A HIGHEST PAID EMPLOYEE) RECEIVED A SEVERANCE PAYMENT OF $405,864 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. PART I, LINE 5 VARIOUS PHYSICIAN COMPENSATION METHODOLOGIES ARE UTILIZED AND, DEPENDING ON SPECIALTY, RELATIVE VALUE UNITS (RVU'S) MAY BE USED IN DETERMINING A PORTION OF OR ALL OF THEIR COMPENSATION. 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 6717308 15865543 283537 15582006 2011 0 0 1 1 B 3426142 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. MARGARET MIKULA KEY EMPL NEW HIRE RECRUITMENT PACKAGE X 25000 20924 0 1 1 20924 FORM 990, PART VI, SECTION A, LINE 2 GLEN CUNNINGHAM AND KIRK GERNER HAVE A BUSINESS RELATIONSHIP. 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 -1,450,935. 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