GOOD SAMARITAN HOSPITAL CORVALLIS: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: GOOD SAMARITAN HOSPITAL CORVALLIS (EIN 93-0391573)
Tax period: 2020-01-01 to 2020-12-31
Filed: 2021-11-11
IRS object ID: 202143159349305409
Schema version: 2020v4.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-11-11T13:14:56-06:00	ReturnTs
Tax Period End	2020-12-31	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	930391573	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL CORVALLIS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	GOOD	BusinessNameControlTxt
Phone	5417684857	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	CO SHS ACCOUNTING PO BOX 3000	AddressLine1Txt
City	CORVALLIS	CityNm
State Abbreviation	OR	StateAbbreviationCd
ZIP	973393000	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	DANIEL SMITH	PersonNm
Person Title	SVP / CFO	PersonTitleTxt
Phone	5417684857	PhoneNum
Signature	2021-11-03	SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	DANIEL	PersonFirstNm
Person Last	SMITH	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN REGIONAL MEDICAL CTR	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	LAURA HENNUM	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3600 NW SAMARITAN DR	AddressLine1Txt
City	CORVALLIS	CityNm
State Abbreviation	OR	StateAbbreviationCd
ZIP	97330	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$472,223,183	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.SAMHEALTH.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1948	FormationYr
Legal Domicile State	OR	LegalDomicileStateCd
Activity Or Mission	TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS MEDICAL AND SURGICAL HOSPITAL.	ActivityOrMissionDesc
Voting Members Governing Body	13	VotingMembersGoverningBodyCnt
Voting Members Independent	12	VotingMembersIndependentCnt
Total Employee	2555	TotalEmployeeCnt
Total Volunteers	186	TotalVolunteersCnt
Total Gross UBI	$207,875	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$857,502	PYContributionsGrantsAmt
CY Contributions Grants	$24,599,823	CYContributionsGrantsAmt
PY Program Service Revenue	$451,552,161	PYProgramServiceRevenueAmt
CY Program Service Revenue	$439,489,623	CYProgramServiceRevenueAmt
PY Investment Income	$947,291	PYInvestmentIncomeAmt
CY Investment Income	$1,834,017	CYInvestmentIncomeAmt
PY Other Revenue	$3,291,267	PYOtherRevenueAmt
CY Other Revenue	$2,517,819	CYOtherRevenueAmt
PY Total Revenue	$456,648,221	PYTotalRevenueAmt
CY Total Revenue	$468,441,282	CYTotalRevenueAmt
PY Grants And Similar Paid	$279,494	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$200,980	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$236,287,371	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$237,594,640	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$227,664,064	PYOtherExpensesAmt
CY Other Expenses	$229,338,759	CYOtherExpensesAmt
PY Total Expenses	$464,230,929	PYTotalExpensesAmt
CY Total Expenses	$467,134,379	CYTotalExpensesAmt
PY Revenues Less Expenses	-$7,582,708	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$1,306,903	CYRevenuesLessExpensesAmt
Total Assets BOY	$181,314,597	TotalAssetsBOYAmt
Total Assets EOY	$176,742,940	TotalAssetsEOYAmt
Total Liabilities BOY	$117,536,831	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$111,078,515	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$63,777,766	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$65,664,425	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	GOOD SAMARITAN HOSPITAL, CORVALLIS (GSH) ACHIEVES ITS MISSION OF IMPROVING THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS MEDICAL AND SURGICAL HOSPITAL AND HEALTHCARE CLINICS PROVIDING OUTPATIENT CARE SERVICES AT SEVERAL AREA LOCATIONS.GSH IS A MEMBER OF SAMARITAN HEALTH SERVICES (SHS), A REGIONAL NETWORK OF HOSPITALS, PHYSICIANS AND SENIOR CARE FACILITIES. 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. 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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$422,352,868	ExpenseAmt
Revenue	$439,475,814	RevenueAmt
Desc	GOOD SAMARITAN HOSPITAL CORVALLIS (GSH), THE LARGEST HOSPITAL IN LINN, BENTON AND LINCOLN COUNTIES, OFFERS MORE THAN 22 MEDICAL SPECIALTIES INCLUDING COMPREHENSIVE CANCER CARE, A FULL-SERVICE CARDIOLOGY AND VASCULAR SURGERY PROGRAM, NEUROSURGERY AND OTHER REGIONAL SERVICES. GSH HAS MORE THAN 2,100 EMPLOYEES AND 175 VOLUNTEERS SERVING THE MEDICAL NEEDS OF THE COMMUNITY. IT IS LICENSED TO OPERATE 188 BEDS AND IS ONE OF SIX 'LEVEL 2' TRAUMA CENTERS IN OREGON. DURING 2020, GSH SERVED 8,260 INPATIENTS, HAD 24,659 EMERGENCY DEPARTMENT VISITS, PERFORMED 8,902 SURGERIES AND DELIVERED 884 BABIES. IN ADDITION, GSH PERFORMED 87,260 IMAGING PROCEDURES, AND HAD 235,429 PHYSICIAN CLINIC VISITS.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$200,980	ExpenseAmt
Grant	$200,980	GrantAmt
Desc	GRANTS AND ASSISTANCE PROVIDED BY GOOD SAMARITAN HOSPITAL CORVALLIS TO VARIOUS ORGANIZATIONS AND INDIVIDUALS TO SUPPORT THE MEDICAL, DENTAL, MENTAL HEALTH AND OTHER NEEDS OF COMMUNITY MEMBERS, CONSISTENT WITH PRIORITIES IDENTIFIED IN THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT. SEE PART IX, LINES 1 AND 2 AND RELATED SCHEDULE I FOR MORE DETAILS.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$422,553,848	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (1)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	Yes (1)	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	2555	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	12	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	OR	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SAMARITAN HEALTH SERVICES	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	5417684857	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 3000	AddressLine1Txt
City	CORVALLIS	CityNm
State Abbreviation	OR	StateAbbreviationCd
ZIP	973393000	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
NANCY SEIFERT
BOARD CHAIR	1.00	2.00	Yes (X)	Yes (X)	$0	$0	$0
REVEREND SIMON JUSTICE
BOARD VICE CHAIR	1.00		Yes (X)	Yes (X)	$0	$0	$0
KELLY GALLAGHER
BOARD SECRETARY	1.00	2.00	Yes (X)	Yes (X)	$0	$0	$0
RICHARD CRONK MD
BOARD TREASURER	1.00		Yes (X)	Yes (X)	$0	$0	$0
JUDY LIST
BOARD MEMBER	1.00	1.00	Yes (X)		$0	$0	$0
CLIFFORD HALL MD
BOARD MEMBER	1.00		Yes (X)		$0	$600	$0
BISHOP MICHAEL HANLEY
BOARD MEMBER	1.00		Yes (X)		$0	$0	$0
TIM HENNESSY
BOARD MEMBER	1.00		Yes (X)		$0	$1,146	$0
ERIC THOMPSON
BOARD MEMBER	1.00		Yes (X)		$0	$0	$0
STEVE UERLINGS
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
LYLE HUTCHENS
BOARD MEMBER	1.00		Yes (X)		$0	$0	$0
MARY OCHADLIK MD
BOARD MEMBER	1.00		Yes (X)		$0	$2,000	$0
KATHARINE HARRIS
BOARD MEMBER	1.00		Yes (X)		$0	$0	$0
DANIEL SMITH
SVP / CFO	2.00	38.00		Yes (X)	$0	$525,239	$59,937
BECKY PAPE
CEO (JAN - AUG)	39.00	1.00		Yes (X)	$0	$470,274	$53,008
LAURA HENNUM
CEO (AUG - DEC)	39.00	1.00		Yes (X)	$0	$160,249	$10,441
KIMBERLY CLIFT
VP OPERATIONS (JAN - NOV)	40.00				$334,532	$0	$30,282	Yes (X)
TIMOTHY EIXENBERGER
VP PATIENT CARE SERVICES	40.00				$270,408	$0	$37,791	Yes (X)
BARBARA CRONEY
VP ANC SVCS & ACADEMIC AFFAIRS	40.00				$214,456	$0	$18,796	Yes (X)
JEFF HSING MD
PHYSICIAN	40.00				$821,744	$0	$57,632		Yes (X)
DONALD PENNINGTON DO
PHYSICIAN	40.00				$795,662	$0	$60,340		Yes (X)
VYACHESLAV MELNIKOV MD
PHYSICIAN	40.00				$903,128	$0	$58,447		Yes (X)
WAEL GHACHAM MD
PHYSICIAN	40.00				$857,793	$0	$61,768		Yes (X)
RIDHMI RAJAPAKSE MD
PHYSICIAN	40.00				$808,348	$0	$53,614		Yes (X)
LARRY MULLINS DHA
FORMER CEO / CEO SAM SOLUT	0.00	20.00			$0	$436,457	$14,222			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$5,006,071	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$1,595,965	TotReportableCompRltdOrgAmt
Total Other Compensation	$516,278	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	506	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Related Organizations	$1,395,203	RelatedOrganizationsAmt
Government Grants	$23,204,620	GovernmentGrantsAmt
Total Contributions	$24,599,823	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT REVENUE	622110	$396,806,058	$396,806,058
RETAIL PHARMACY	446110	$37,506,434	$37,506,434
QUALITY INCENTIVES	622110	$3,014,332	$3,014,332
OTHER PROGRAM SVC REV	900099	$662,265	$648,456	$13,809
ALT PAYMENT METHODS	900099	$561,158	$561,158

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$939,376	TotalRevenueColumnAmt
Related Or Exempt Func Income	$939,376	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$439,489,623	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$733,713	TotalRevenueColumnAmt
Exclusion	$733,713	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$967,162	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$285,946	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$681,216	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$681,216	TotalRevenueColumnAmt
Exclusion	$681,216	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$3,764,505	SecuritiesAmt
Other	$723,329	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$3,290,000	SecuritiesAmt
Other	$97,530	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$474,505	SecuritiesAmt
Other	$625,799	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,100,304	TotalRevenueColumnAmt
Exclusion	$1,100,304	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$302,491	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$108,425	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$194,066	TotalRevenueColumnAmt
Unrelated Business Revenue	$194,066	UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	CAFETERIA	Desc
Business	722210	BusinessCd
Total Revenue Column	$1,642,537	TotalRevenueColumnAmt
Exclusion	$1,642,537	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$1,642,537	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$468,441,282	TotalRevenueColumnAmt
Related Or Exempt Func Income	$439,475,814	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$207,875	UnrelatedBusinessRevenueAmt
Exclusion	$4,157,770	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$181,796	TotalAmt
Program Services	$181,796	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$19,184	TotalAmt
Program Services	$19,184	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$906,265	TotalAmt
Program Services	$906,265	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$179,950,414	TotalAmt
Program Services	$176,732,631	ProgramServicesAmt
Management And General	$3,217,783	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$11,067,151	TotalAmt
Program Services	$10,870,245	ProgramServicesAmt
Management And General	$196,906	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$31,316,879	TotalAmt
Program Services	$30,759,692	ProgramServicesAmt
Management And General	$557,187	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$14,353,931	TotalAmt
Program Services	$14,098,547	ProgramServicesAmt
Management And General	$255,384	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$239,365	TotalAmt
Program Services	$239,365	ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$34,376	TotalAmt
Management And General	$34,376	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$39,678	TotalAmt
Program Services	$3,475	ProgramServicesAmt
Management And General	$36,203	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$15,270,234	TotalAmt
Program Services	$15,224,621	ProgramServicesAmt
Management And General	$45,613	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$12,894	TotalAmt
Program Services	$8,491	ProgramServicesAmt
Management And General	$4,403	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$10,566,491	TotalAmt
Program Services	$10,161,893	ProgramServicesAmt
Management And General	$404,598	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$23,880,687	TotalAmt
Program Services	$23,228,296	ProgramServicesAmt
Management And General	$652,391	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$5,398,555	TotalAmt
Program Services	$5,234,285	ProgramServicesAmt
Management And General	$164,270	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$175,820	TotalAmt
Program Services	$171,825	ProgramServicesAmt
Management And General	$3,995	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$747,313	TotalAmt
Program Services	$743,704	ProgramServicesAmt
Management And General	$3,609	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$4,014,686	TotalAmt
Program Services	$3,905,010	ProgramServicesAmt
Management And General	$109,676	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$9,796,257	TotalAmt
Program Services	$9,655,377	ProgramServicesAmt
Management And General	$140,880	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$4,845,682	TotalAmt
Program Services	$4,663,776	ProgramServicesAmt
Management And General	$181,906	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$84,860,232	$84,860,232
PURCHASED SERVICES	$48,383,013	$9,853,662	$38,529,351
PROVIDER TAXES	$20,157,376	$20,157,376
DUES, TAXES, & LICENSES	$911,847	$870,096	$41,751

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$4,253	TotalAmt
Program Services	$4,004	ProgramServicesAmt
Management And General	$249	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$467,134,379	TotalAmt
Program Services	$422,553,848	ProgramServicesAmt
Management And General	$44,580,531	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$11,700	BOYAmt
EOY	$9,700	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$932,102	BOYAmt
EOY	$283,948	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$46,313,077	BOYAmt
EOY	$45,705,628	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$925,000	BOYAmt
EOY	$881,813	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$8,636,748	BOYAmt
EOY	$8,984,154	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,624,193	BOYAmt
EOY	$1,216,342	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$246,921,387	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$157,513,369	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$94,148,360	BOYAmt
EOY	$89,408,018	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$22,341,744	BOYAmt
EOY	$25,367,570	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$423,287	BOYAmt
EOY	$465,085	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$5,958,386	BOYAmt
EOY	$4,420,682	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$181,314,597	BOYAmt
EOY	$176,742,940	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$24,581,879	BOYAmt
EOY	$27,830,255	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$251,062	BOYAmt
EOY	$39,574,345	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$848,193	BOYAmt
EOY	$511,185	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$91,855,697	BOYAmt
EOY	$43,162,730	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$117,536,831	BOYAmt
EOY	$111,078,515	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$63,777,766	BOYAmt
EOY	$65,664,425	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$63,777,766	BOYAmt
EOY	$65,664,425	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$181,314,597	BOYAmt
EOY	$176,742,940	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$1,306,903	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$1,921,700	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$1,341,944	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,471,420	BeginningYearBalanceAmt
Contributions	$52,626	ContributionsAmt
Investment Earnings Or Losses	$646,419	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$134,070	GrantsOrScholarshipsAmt
End Year Balance	$6,036,395	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,709,814	BeginningYearBalanceAmt
Contributions	$132,666	ContributionsAmt
Investment Earnings Or Losses	$802,651	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$173,711	GrantsOrScholarshipsAmt
End Year Balance	$5,471,420	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,044,051	BeginningYearBalanceAmt
Contributions	$123,741	ContributionsAmt
Investment Earnings Or Losses	-$318,594	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$139,384	GrantsOrScholarshipsAmt
End Year Balance	$4,709,814	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,478,316	BeginningYearBalanceAmt
Contributions	$31,737	ContributionsAmt
Investment Earnings Or Losses	$699,206	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$165,208	GrantsOrScholarshipsAmt
End Year Balance	$5,044,051	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,237,438	BeginningYearBalanceAmt
Contributions	$66,044	ContributionsAmt
Investment Earnings Or Losses	$348,421	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$173,587	GrantsOrScholarshipsAmt
End Year Balance	$4,478,316	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.25040	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.62880	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.12080	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$1,700,000	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$358,114	OtherCostOrOtherBasisAmt
Book Value	$2,058,114	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$1,661,148	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$157,095,740	OtherCostOrOtherBasisAmt
Depreciation	$91,444,820	DepreciationAmt
Book Value	$67,312,068	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,726,386	OtherCostOrOtherBasisAmt
Depreciation	$2,363,504	DepreciationAmt
Book Value	$1,362,882	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$69,944,025	OtherCostOrOtherBasisAmt
Depreciation	$57,051,808	DepreciationAmt
Book Value	$12,892,217	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$12,435,974	OtherCostOrOtherBasisAmt
Depreciation	$6,653,237	DepreciationAmt
Book Value	$5,782,737	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$89,408,018	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDesc	AmtAmt
PROFESSIONAL LIABILITY RESERVE	$2,547,000
OTHER LIABILITIES	$1,867,446
PAYABLE TO CONTRACTUAL AGENCIES	$3,687,022
MINIMUM PENSION LIABILITY	$23,557,150
ACCOUNTS PAYABLE-AFFILIATES	$11,504,112

Field	Value	IRS element (for citing)
Total Liability	$43,162,730	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART V, LINE 4:

THE BOARD-DESIGNATED AND GENERAL ENDOWMENTS ARE USED FOR GENERAL HOSPITAL SUPPORT. THE BERNIER ENDOWMENT IS USED FOR STAFF CONTINUING EDUCATION. THE PASTEGA HOUSE ENDOWMENT IS USED TO HELP UNDERWRITE THE OPERATING COSTS OF THE MARIO PASTEGA GUEST HOUSE. THE VRTISKA ENDOWMENT IS USED TO SUPPORT THE HOSPITAL'S LABORATORY FOR EDUCATIONAL PURPOSES. THE WISH ENDOWMENT IS USED FOR HOSPITAL-BASED PROGRAMS SUPPORTING WOMEN'S AND CHILDREN'S HEALTH. THE HALL ENDOWMENT IS USED TO HOST VISITING PHYSICIAN EDUCATORS, WITH AN EMPHASIS ON MEDICAL ETHICS AND END OF LIFE DECISIONS. THE CARDIOLOGY ENDOWMENT IS FOR SUPPORT AND ADVANCEMENT OF CARDIOVASCULAR CARE INCLUDING EDUCATION, EQUIPMENT AND FACILITIES. THE BETH RAY ENDOWMENT IS FOR PEDIATRIC AND OB PATIENT SUPPORT SERVICES AND PATIENT CARE PROGRAMS. THESE INCLUDE THERAPEUTIC DEVICES, NEW TECHNOLOGY AND EQUIPMENT FOR SHS DEPARTMENTS THAT SUPPORT PEDIATRIC AND OB CARE.

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.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	250.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Activities Or Programs	18	ActivitiesOrProgramsCnt
Persons Served	19732	PersonsServedCnt
Total Community Benefit Expns	$4,571,676	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$4,571,676	NetCommunityBenefitExpnsAmt
Total Expense	0.00980	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Activities Or Programs	11	ActivitiesOrProgramsCnt
Persons Served	90529	PersonsServedCnt
Total Community Benefit Expns	$81,796,331	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$62,310,114	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$19,486,217	NetCommunityBenefitExpnsAmt
Total Expense	0.04170	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	29	ActivitiesOrProgramsCnt
Persons Served	110261	PersonsServedCnt
Total Community Benefit Expns	$86,368,007	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$62,310,114	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$24,057,893	NetCommunityBenefitExpnsAmt
Total Expense	0.05150	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	8	ActivitiesOrProgramsCnt
Persons Served	8549	PersonsServedCnt
Total Community Benefit Expns	$985,791	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$13,206	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$972,585	NetCommunityBenefitExpnsAmt
Total Expense	0.00210	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Persons Served	602	PersonsServedCnt
Total Community Benefit Expns	$18,392,293	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,432,078	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,960,215	NetCommunityBenefitExpnsAmt
Total Expense	0.01700	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	34	ActivitiesOrProgramsCnt
Persons Served	178626	PersonsServedCnt
Total Community Benefit Expns	$72,628,389	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$39,329,977	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$33,298,412	NetCommunityBenefitExpnsAmt
Total Expense	0.07130	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	8	ActivitiesOrProgramsCnt
Persons Served	23981	PersonsServedCnt
Total Community Benefit Expns	$687,906	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$186,023	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$501,883	NetCommunityBenefitExpnsAmt
Total Expense	0.00110	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	54	ActivitiesOrProgramsCnt
Persons Served	211758	PersonsServedCnt
Total Community Benefit Expns	$92,694,379	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$49,961,284	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$42,733,095	NetCommunityBenefitExpnsAmt
Total Expense	0.09150	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	83	ActivitiesOrProgramsCnt
Persons Served	322019	PersonsServedCnt
Total Community Benefit Expns	$179,062,386	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$112,271,398	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$66,790,988	NetCommunityBenefitExpnsAmt
Total Expense	0.14300	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Persons Served	601	PersonsServedCnt
Total Community Benefit Expns	$179,374	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$25,863	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$153,511	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	6	PersonsServedCnt
Total Community Benefit Expns	$12,612	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$12,612	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Persons Served	607	PersonsServedCnt
Total Community Benefit Expns	$191,986	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$25,863	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$166,123	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReportedInd
Bad Debt Expense	$1,701,101	BadDebtExpenseAmt
Reimbursed By Medicare	$72,955,307	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$71,585,784	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$1,369,523	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (5 entries)

Primary ActivitiesPrimaryActivitiesTxt	Org Profit Or OwnershipOrgProfitOrOwnershipPct	Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
1 CORVALLIS MED BLDGS LLC
REAL PROPERTY RENTAL	0.54500	0.21500
2 HULL IMAGING LLC
IMAGING SERVICES	0.60000	0.40000
3 SAMARITAN ENDOSCOPY CENTER
MEDICAL SERVICES	0.20000	0.80000
4 CORVALLIS MRI LLC
IMAGING SERVICES	0.50000	0.50000
5 CASCADE VIEW MEDICAL OFFICE BUILDING LLC
REAL PROPERTY RENTAL	0.26300	0.73700

Field	Value	IRS element (for citing)
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL CORVALLIS	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3600 NW SAMARITAN DRIVE	AddressLine1Txt
City	CORVALLIS	CityNm
State Abbreviation	OR	StateAbbreviationCd
ZIP	97330	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.SAMHEALTH.ORG	WebsiteAddressTxt
State License	STATE LICENSE: 14-1074	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Teaching Hospital	Yes (X)	TeachingHospitalInd
Research Facility	Yes (X)	ResearchFacilityInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL CORVALLIS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	19	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V, PAGE 8	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	20	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.SAMHEALTH.ORG/ABOUT-SAMARITAN/COMMUNITY-BENEFIT-INITIATIVES	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	250.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Other Method	Yes (X)	OtherMethodInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.SAMHEALTH.ORG/FINANCIALASSISTANCE	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.SAMHEALTH.ORG/FINANCIALASSISTANCE	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.SAMHEALTH.ORG/FINANCIALASSISTANCE	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
GOOD SAMARITAN HOSPITAL, CORVALLIS	PART V, SECTION B, LINE 5: THE STAFF FROM SAMARITAN HEALTH SERVICES COMMUNITY HEALTH PROMOTION DEPARTMENT PARTNERED WITH A PRIVATE CONSULTANT TO CONDUCT THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT FOR GOOD SAMARITAN REGIONAL MEDICAL CENTER. THE STAFF AND THE CONSULTANT CONDUCTED SURVEYS BOTH ON-LINE AND ON PAPER WITH OVER 200 RESIDENTS IN BENTON COUNTY. THE STAFF AND THE CONSULTANT ALSO COLLECTED SECONDARY DATA FROM VARIOUS STATE AND NATIONAL ORGANIZATIONS SUCH AS THE OREGON DEPARTMENT OF EDUCATION, THE OREGON HEALTH AUTHORITY, THE U.S. CENSUS BUREAU AND THE CENTERS FOR DISEASE CONTROL. THE CONSULTANT HELD FOCUS GROUPS AND CONDUCTED KEY-INFORMANT INTERVIEWS TO OBTAIN INPUT FROM COMMUNITY MEMBERS AND PEOPLE WITH SPECIAL KNOWLEDGE AND EXPERTISE. FINALLY, SHS STAFF AND THE CONSULTANT HELD LISTENING SESSIONS TO OBTAIN ADDITIONAL INFORMATION REGARDING COMMUNITY NEEDS AND PRIORITIES.PERSONS CONSULTED FOR THE HOSPITAL'S CHNA WERE FROM THE FOLLOWING ORGANIZATIONS: BENTON COUNTY HEALTH DEPARTMENT, COMMUNITY OUTREACH INC., BENTON EAST LINN HEALTH CENTER, OREGON STATE UNIVERSITY, SAMARITAN HEALTH PLANS, WESTERN UNIVERSITY-COMP NORTHWEST, LINN-BENTON COMMUNITY COLLEGE, CORVALLIS SCHOOL DISTRICT, LINN-BENTON COUNTY HEALTH EQUITY ALLIANCE, OLD MILL CENTER FOR CHILDREN AND FAMILIES, STRENGTHENING RURAL FAMILIES, LOVE INC, CHURCH OF THE GOOD SAMARITAN, OREGON CASCADES WEST COUNCIL OF GOVERNMENTS, INTERCOMMUNITY HEALTH PLANS, INC., THE DEPARTMENT OF HUMAN SERVICES, THE OREGON HEALTH AUTHORITY, THE OREGON OFFICE OF RURAL HEALTH, COMMUNITY SERVICES CONSORTIUM, THE CORVALLIS CLINIC, MONROE SCHOOL DISTRICT, ALSEA SCHOOL DISTRICT, PHILOMATH SCHOOL DISTRICT, LINN-BENTON-LINCOLN EARLY LEARNING HUB, LINN-BENTON HISPANIC ADVISORY COUNCIL, BENTON COUNTY ORAL HEALTH COALITION AND COMMUNITY MEMBERS.
GOOD SAMARITAN HOSPITAL, CORVALLIS	PART V, SECTION B, LINE 6B: BRANDAN KEARNEY, LLC - CONSULTANT
GOOD SAMARITAN HOSPITAL, CORVALLIS	PART V, SECTION B, LINE 7D: COPIES OF THE CHNA WERE EMAILED TO KEY COMMUNITY PARTNERS AND DISTRIBUTED TO LOCAL LIBRARIES, COUNTY OFFICES, SCHOOL DISTRICT OFFICES AND DURING LOCAL COALITION MEETINGS.
GOOD SAMARITAN HOSPITAL, CORVALLIS	PART V, SECTION B, LINE 11: GSH IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENTS THROUGH MULTIPLE STRATEGIES. FIRST, GSH PROVIDES GRANT FUNDING TO LOCAL COMMUNITY AGENCIES THAT ADDRESS ONE OR MORE OF THE PRIORITIES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IS INCLUDED IN THE HOSPITAL'S COMMUNITY BENEFIT PLAN IMPLEMENTATION STRATEGY. SECOND, HOSPITAL STAFF SERVE ON COMMUNITY ADVISORY BOARDS AND COALITIONS TO ADDRESS THE MOST PRESSING NEEDS IN THE COMMUNITY. AND FINALLY, THE HOSPITAL IS PROVIDING WORKSHOPS, CLASSES AND SUPPORT GROUPS TO ADDRESS THE HIGHEST HEALTH CONCERNS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. BECAUSE SEVERAL NEEDS TO IMPROVE HEALTH WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, GSH DOES NOT HAVE THE FINANCES, RESOURCES OR THE EXPERTISE TO ADDRESS ALL THE NEEDS.
GOOD SAMARITAN HOSPITAL, CORVALLIS	PART V, SECTION B, LINE 15E: REGISTRATION REFERS UNINSURED AND/OR LOW INCOME PATIENTS TO THE ONSITE PATIENT FINANCIAL ADVOCATE AND A THIRD PARTY VENDOR WHO CONTACTS THE PATIENTS TO ASSESS THEIR FINANCIAL STATUS AND NEEDS.
PART V, SECTION B, LINE 7, CHNA REPORT WEBSITE:	WWW.SAMHEALTH.ORG/ABOUT-SAMARITAN/COMMUNITY-BENEFIT-INITIATIVES

Field	Value	IRS element (for citing)
Facility	45	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (45 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - SAMARITAN MENTAL HEALTH - ALBANY
1052 SW 29TH ST	ALBANY	OR	97321	MENTAL HEALTH SERVICES
2 - SAMARITAN OCC MED - ALBANY
1100 7TH AVE SW	ALBANY	OR	97321	MEDICAL CLINIC - OUTPATIENT
3 - SAMARITAN MENTAL HEALTH - CORVALLIS
3509 NW SAMARITAN DR STE 215	CORVALLIS	OR	97330	MENTAL HEALTH SERVICES
4 - SAMARITAN ENDOSCOPY CENTER
3509 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	ENDOSCOPY CENTER
5 - SAMARITAN WEIGHT MGMT INSTITUTE
3517 NW SAMARITAN DR STE 100	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
6 - SAMARITAN MENTAL HEALTH FAMILY CTR
3517 NW SAMARITAN DR STE 101	CORVALLIS	OR	97330	MENTAL HEALTH SERVICES
7 - SAMARITAN FAMILY MED RESIDENT CLINIC
3517 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
8 - SAMARITAN INTERNAL MED - CORVALLIS
3521 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
9 - SAMARITAN PHY REHAB SPEC - CORVALLIS
815 NW 9TH ST STE 180	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
10 - GSRMC NEVILLE BUILDING IMAGING
3615 NW SAMARITAN DR	CORVALLIS	OR	97330	IMAGING SERVICES
11 - SAMARITAN ENDOCRINOLOGY
3615 NW SAMARITAN DR STE 110	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
12 - GSRMC DIABETES EDUCATION
3615 NW SAMARITAN DR STE 100	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
13 - CORVALLIS MRI
3615 NW SAMARITAN DR STE 101	CORVALLIS	OR	97330	IMAGING SERVICES
14 - SAMARITAN SURGICAL SPECIALISTS
3615 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
15 - SAMARITAN KIDNEY SPECIALISTS
3615 NW SAMARITAN DR STE 203	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
16 - SMG BRAIN & SPINE CENTER
3615 NW SAMARITAN DR STE 210	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
17 - HAND TO SHOULDER ORTHO - CORVALLIS
3620 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
18 - SMG ORTHOPEDICS - CORVALLIS
3620 NW SAMARITAN DR STE 202	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
19 - SAMARITAN RHEUMATOLOGY
3620 NW SAMARITAN DR STE 202	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
20 - SAMARITAN INFECTIOUS DISEASE
3640 NW SAMARITAN DR STE 210	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
21 - SAMARITAN OBSTETRICS & GYN
3640 NW SAMARITAN DR STE 220	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
22 - SAMARITAN GYN & SURGICAL ASSOCIATES
400 NW WALNUT BLVD STE 300	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
23 - SAMARITAN PASTEGA REGIONAL CANCER CTR
501 NW ELKS DR	CORVALLIS	OR	97330	CANCER TREATMENT
24 - SAMARITAN HEMATOLOGY & ONCOLOGY
501 NW ELKS DR STE 100	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
25 - SAMARITAN CANCER RES CTR - CORVALLIS
501 NW ELKS DR	CORVALLIS	OR	97330	CANCER RESOURCE CENTER
26 - SAMARITAN URGENT CARE - CORVALLIS
5234 SW PHILOMATH BLVD	CORVALLIS	OR	97333	MEDICAL CLINIC - OUTPATIENT
27 - SAMARITAN FAMILY MEDICINE SOUTHWEST
5234 SW PHILOMATH BLVD	CORVALLIS	OR	97333	MEDICAL CLINIC - OUTPATIENT
28 - SAMARITAN OCC MED - CORVALLIS
5234 SW PHILOMATH BLVD STE B	CORVALLIS	OR	97333	MEDICAL CLINIC - OUTPATIENT
29 - SAMARITAN PEDIATRICS
777 NW 9TH ST STE 320	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
30 - SAMARITAN ATHLETIC MEDICINE CENTER
845 SW 30TH ST	CORVALLIS	OR	97331	MEDICAL CLINIC - OUTPATIENT
31 - SAM CARE EXPRESS - CORVALLIS
990 NW CIRCLE BLVD STE 101	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
32 - SAMARITAN UROLOGY
990 NW CIRCLE BLVD STE 102	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
33 - SAMARITAN PLASTIC RECONST & HAND SURG
996 NW CIRCLE BLVD STE 103	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
34 - SAMARITAN OCC MED - LEBANON
100 MULLINS DRIVE STE B2	LEBANON	OR	97355	MEDICAL CLINIC - OUTPATIENT
35 - GSRMC NEVILLE BUILDING LABORATORY
3615 NW SAMARITAN DR STE 102	CORVALLIS	OR	97330	LABORATORY SERVICES
36 - SAMARITAN PEDIATRICS - CIRCLE BLVD
1112 NW CIRCLE BLVD	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
37 - SAMARITAN MENTAL HEALTH - CIRCLE BLVD
1112 NW CIRCLE BLVD	CORVALLIS	OR	97330	MENTAL HEALTH SERVICES
38 - SAMCARE MOBILE MEDICINE
2555 NE BELVUE ST	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
39 - SAMARITAN CARDIOLOGY - CORVALLIS
3640 NW SAMARITAN DR STE 100	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
40 - SAMARITAN CARDIOVASCULAR SURGERY
3640 NW SAMARITAN DR STE 120	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
41 - GOOD SAMARITAN HOME INFUSION SERVICE
501 NW ELKS DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
42 - SMG BREAST CENTER - CORVALLIS
501 NW ELKS DR STE 101	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
43 - OUTPATIENT NUTRITION CLINIC
3517 NW SAMARITAN DR STE 200	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
44 - SAMARITAN AMBULATORY INFUSION
501 NW ELKS DR STE 200	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
45 - SMG PULMONOLOGY
3640 NW SAMARITAN DR STE 110	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 6A:	THE FILING ORGANIZATION SUBMITS AN ANNUAL COMMUNITY BENEFIT REPORT TO THE STATE OF OREGON. IN ADDITION, THE PARENT ORGANIZATION, SAMARITAN HEALTH SERVICES (SHS) PROVIDES AN ANNUAL REPORT TO THE COMMUNITY THAT INCLUDES COMMUNITY BENEFIT REPORTING FOR THE SYSTEM AS A WHOLE.
PART I, LINE 7:	THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN SCHEDULE H, PART I, LINE 7A AND 7B IS A COST-TO-CHARGE RATIO DERIVED USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES FROM THE SCHEDULE H INSTRUCTIONS. FOR LINE 7G, A COST-TO-CHARGE RATIO IS ALSO USED, BUT IT IS CALCULATED AT THE DEPARTMENT OR SERVICE LINE LEVEL FOR THOSE SERVICES THAT QUALIFY AS SUBSIDIZED HEALTH SERVICES.
PART I, LINE 7G:	PHYSICIAN CLINICS MEETING THE DEFINITION OF SUBSIDIZED HEALTH SERVICES WERE INCLUDED IN THE REPORTING FOR LINE 7G. CONSISTENT WITH THE SCHEDULE H INSTRUCTIONS, PHYSICIAN CLINIC ACTIVITY HAS BEEN COMBINED WITH ASSOCIATED HOSPITAL SERVICES IN DETERMINING WHETHER THE SERVICES WERE PROVIDED AT A LOSS. THE PORTION OF NET COMMUNITY BENEFIT EXPENSE RELATED TO PHYSICIAN CLINICS, COMBINED WITH ASSOCIATED HOSPITAL ACTIVITY, THAT IS BEING COUNTED AS SUBSIDIZED HEALTH SERVICES IN 2020 IS 26,597,556.
PART II, COMMUNITY BUILDING ACTIVITIES:	GSH PROVIDES SERVICES AND ACTIVITIES THAT ARE CLASSIFIED AS COMMUNITY BUILDING TO PROMOTE THE HEALTH OF BENTON COUNTY. RECOGNIZING THAT THE HEALTH OF A COMMUNITY ENCOMPASSES MULTIPLE FACTORS, GSH LEADERSHIP AND STAFF ARE INVOLVED IN A VARIETY OF ACTIONS THAT WORK TO IMPROVE COMMUNITY OUTCOMES. GSH BELIEVES THAT TRAINED AND COMPETENT STAFF IN ALL ASPECTS OF THE ORGANIZATION PROMOTES COMMUNITY HEALTH. GSH ACTIVELY PARTICIPATES IN WORKFORCE DEVELOPMENT IN PARTNERSHIP WITH OREGON STATE UNIVERSITY, LINN-BENTON COMMUNITY COLLEGE AND WESTERN UNIVERSITY-COMP NW TO RECRUIT, TRAIN AND RETAIN HEALTHCARE WORKERS AT ALL LEVELS. GSH ALSO HOSTS LOCAL EVENTS SUPPORTED BY THE HOSPITAL'S FOUNDATION AND OTHER DEPARTMENTS IN THE ORGANIZATION. GSH ALSO PROVIDES OPPORTUNITIES FOR COMMUNITY MEMBERS TO OBTAIN TRAINING ON CIVIC AND CULTURAL ISSUES THAT IMPACT HEALTH. SOME OF THE TRAINING OPPORTUNITIES INCLUDE HEALTHY LIFESTYLES, FITNESS, AND HEALTH EQUITY THAT WERE HELD VIRTUALLY DURING 2020. GSH STAFF SERVED ON MANY LOCAL COALITIONS AND BOARDS THAT PROMOTE THE HEALTH OF THE COMMUNITY. BOARD AFFILIATIONS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY OUTREACH INC., OREGON CASCADES WEST COUNCIL OF GOVERNMENTS, AND THE UNITED WAY OF BENTON AND LINCOLN COUNTIES. ADDITIONALLY, GSH STAFF SERVED ON THE OREGON HEALTH POLICY ADVISORY BOARD, THE OREGON HEALTH RESOURCES COMMISSION, THE MEDICAID ADVISORY COMMITTEE, THE OREGON ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS AND REGIONAL BOARDS THAT ADDRESS HEALTH CARE ISSUES.
PART III, LINE 2:	BAD DEBT EXPENSE IS RECORDED FOR THOSE PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE AND DO NOT PAY AFTER REPEATED ATTEMPTS TO COLLECT PAYMENT, INCLUDING INFORMING THEM OF THE OPPORTUNITY TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. IF INDEPENDENT EVIDENCE INDICATES THAT THE PATIENT IS UNABLE TO PAY, SHS MAY CHOOSE TO CLASSIFY DELINQUENT ACCOUNTS AS "PRESUMPTIVE CHARITY" RATHER THAN BAD DEBT. PATIENT PAYMENTS (OR RECOVERIES) ON ACCOUNTS THAT WERE PREVIOUSLY WRITTEN OFF AS BAD DEBT ARE RECORDED AS A REDUCTION TO BAD DEBT EXPENSE.
PART III, LINE 4:	GOOD SAMARITAN HOSPTIAL, CORVALLIS (GSH) IS ONE OF FIVE HOSPITALS OF SAMARITAN HEALTH SERVICES (SHS). AS A NETWORK, SHS PREPARES ITS FINANCIAL STATEMENTS ON A CONSOLIDATED BASIS. AS OF JANUARY 1, 2018, SHS IMPLEMENTED THE NEW REVENUE RECOGNITION STANDARD (ASU NO. 2014-09) ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB). UNDER THIS NEW STANDARD, RATHER THAN REPORTING A BAD DEBT ALLOWANCE FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE PATIENTS WITHOUT INSURANCE), BEGINNING IN 2018, SHS RECORDS AN IMPLICIT PRICE CONCESSION IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE (SEE FOOTNOTE 3, "NET PATIENT SERVICE REVENUE" ON PAGES 12, 13 AND 14 OF THE 2020 CONSOLIDATED FINANCIAL STATEMENTS). WITH THIS CHANGE, PATIENT SERVICE REVENUE CONTINUES TO BE REPORTED NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS AT THE ESTIMATED NET REALIZABLE AMOUNT FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED.
PART III, LINE 8:	TOTAL MEDICARE ALLOWABLE COSTS REPORTED ON PART III, SECTION B, LINE 6 IS CALCULATED BY UTILIZING WORKSHEET A IN THE SCHEDULE H INSTRUCTIONS IN CONJUNCTION WITH AMOUNTS TAKEN DIRECTLY FROM THE FILING ORGANIZATION'S MEDICARE COST REPORT (CALCULATED BASED ON A COST-TO-CHARGE RATIO). CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED, AS THESE PATIENTS TYPICALLY HAVE LOW OR FIXED INCOMES AND GOVERNMENT REIMBURSEMENT IS NOT SUFFICIENT TO COVER THE COSTS OF PROVIDING CARE FOR THESE PATIENTS. MEDICARE PATIENTS ARE A GROWING SEGMENT OF THE LOCAL POPULATION, AND MANY ARE BECOMING INCREASINGLY DEPENDENT ON OUR HOSPITAL AND NON-PROFIT AFFILIATES TO PROVIDE FOR THEIR CARE, ESPECIALLY AS OTHER FOR-PROFIT HEALTHCARE PROVIDERS IN THE COMMUNITY DISCONTINUE ACCEPTING MEDICARE PATIENTS.THE AMOUNT ON LINE 7 OF PART III, SECTION B SHOWS A SURPLUS FOR MEDICARE REVENUES LESS ALLOWABLE COSTS. THIS IS PRIMARILY DUE TO THE FACT THAT THE MEDICARE COST REPORT INCLUDES ACTIVITY FOR MEDICARE FEE-FOR-SERVICE PATIENTS BUT NOT MEDICARE MANAGED CARE PATIENTS. MEDICARE MANAGED CARE ACCOUNTS FOR ROUGHLY HALF OF OUR MEDICARE ACTIVITY. IN ADDITION, CERTAIN COSTS OF PROVIDING HEALTHCARE SERVICES, SUCH AS PHYSICIAN COMPENSATION, ARE NOT ALLOWABLE ON THE MEDICARE COST REPORTS. THEREFORE, THE AMOUNT ON LINE 7 WOULD RESULT IN A SHORTFALL, AND NOT A SURPLUS, IF WE USED ALL OF THE REVENUE AND COST DATA FOR ALL MEDICARE PATIENT ACTIVITY, AS FOLLOWS:NET REV RECEIVED FROM MEDICARE (ALL MEDICARE PATIENT PROGRAMS):120,888,324MEDICARE COSTS (BASED ON A COST-TO-CHARGE RATIO): 132,745,388UNPAID COST OF PROVIDING SERVICES TO ALL MEDICARE PATIENTS: -11,857,064
PART III, LINE 9B:	PER HOSPITAL GUIDELINES, IF A PATIENT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS, THE FINANCIAL ASSISTANCE WRITE-OFF IS PROCESSED AND NO COLLECTION ATTEMPT IS MADE. IF AN ACCOUNT IS ALREADY IN COLLECTIONS AND MEDICAID ELIGIBILITY IS DEEMED ACTIVE DURING THE ACCOUNT DATE OF SERVICE, NO FURTHER COLLECTION ATTEMPT WILL BE MADE.
PART VI, LINE 2:	GOOD SAMARITAN HOSPITAL (GSH) ACTIVELY PARTICIPATES IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY. EVERY THREE YEARS, AS REQUIRED BY FEDERAL AND STATE LAW, GSH CONDUCTS A COUNTYWIDE HEALTH NEEDS ASSESSMENT IN CONJUNCTION WITH THE UNITED WAY OF BENTON COUNTY, THE CITY OF CORVALLIS, BENTON COUNTY HEALTH DEPARTMENT, BENTON COUNTY FEDERALLY QUALIFIED HEALTH CENTER, OREGON STATE UNIVERSITY, WESTERN UNIVERSITY-COMP NORTHWEST, LINN-BENTON COMMUNITY COLLEGE AND OTHER COMMUNITY PARTNERS. THE PROCESS INCLUDES EXAMINING PRIMARY DATA COLLECTED THROUGH SURVEYS, FOCUS GROUPS, COMMUNITY FORUMS AND PERSONAL INTERVIEWS WITH COMMUNITY MEMBERS WHO RESIDE THROUGHOUT BENTON COUNTY. SECONDARY DATA IS GATHERED FROM FEDERAL, STATE AND LOCAL AGENCIES THAT ADDRESS HEALTH NEEDS OF CHILDREN, YOUTH AND FAMILIES. THE INFORMATION IS REVIEWED BY THE STAFF, PARTNERS AND COMMUNITY MEMBERS TO PRIORITIZE THE HEALTH CARE NEEDS FOR BENTON COUNTY. EACH YEAR GSH BOARD AND VARIOUS INTERNAL AND EXTERNAL COMMITTEES REVIEW THE PRIORITIES TO ENSURE WE ARE CONTINUING TO ADDRESS THE NEEDS OF THE COMMUNITY.
PART VI, LINE 3:	GSH IS COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTH CARE SERVICES TO ALL, REGARDLESS OF THEIR ABILITY TO PAY. IF QUALIFICATIONS ARE MET, PATIENTS' CARE MAY BE PROVIDED FREE OR AT A REDUCED COST. THE DETERMINATION IS BASED IN PART ON POVERTY INCOME GUIDELINES ISSUED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. PATIENTS WHO REGISTER FOR AN INPATIENT, OUTPATIENT, CLINICAL OR EMERGENCY SERVICE RECEIVE BOTH VERBAL AND WRITTEN INFORMATION ON FINANCIAL ASSISTANCE. PATIENTS WHO ARE IDENTIFIED AS SELF-PAY OR UNINSURED ARE SCREENED THROUGH PRESUMPTIVE ELIGIBILITY QUESTIONS TO DETERMINE IF THEY ARE ELIGIBLE FOR THE OREGON HEALTH PLAN MEDICAID ASSISTANCE PROGRAM(OHP). EXTENDED STAY AND INPATIENTS THAT ARE DEEMED ELIGIBLE FOR OHP ARE AUTOMATICALLY ASSIGNED TO A FINANCIAL COUNSELOR AS PART OF THE CHECK-IN PROCESS. DURING THE PATIENT STAY OR PRIOR TO DISCHARGE, THE FINANCIAL COUNSELOR MEETS WITH THE PATIENT TO ASSIST WITH COMPLETING AND SUBMITTING THEIR OHP APPLICATION PACKET TO THE OREGON HEALTH AUTHORITY OFFICE. OUTPATIENT, CLINICAL AND EMERGENCY SERVICE PATIENTS WHO ARE DEEMED ELIGIBLE FOR OHP ARE ALSO ASSIGNED A FINANCIAL COUNSELOR WHO PROVIDES THEM WITH THE OHP APPLICATION PACKET AND THEIR CONTACT INFORMATION IF THEY REQUIRE ASSISTANCE TO COMPLETE THE FORMS. THE FINANCIAL COUNSELOR CONTACTS THE PATIENT VIA TELEPHONE OR EMAIL AFTER 24 HOURS TO ANSWER QUESTIONS, PROVIDE SUPPORT AND ENSURE THAT THE APPLICATION HAS BEEN SUBMITTED. ANY PATIENT WHO IS SELF-PAY OR UNINSURED AND NOT DEEMED ELIGIBLE FOR OHP IS PROVIDED A FINANCIAL ASSISTANCE APPLICATION PACKET AND ASSIGNED A FINANCIAL COUNSELOR. THE FINANCIAL COUNSELOR REVIEWS THE APPLICATION PACKET AND PROVIDES INFORMATION TO THE PATIENT ON MULTIPLE FINANCIAL SUPPORT OPTIONS INCLUDING A NO-INTEREST PAYMENT PLAN OR FINANCIAL ASSISTANCE FOR THOSE AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL GUIDELINES.ALL APPLICATION MATERIALS ARE AVAILABLE IN ENGLISH, SPANISH AND CHINESE (SIMPLE) AND INTERPRETATIVE SERVICES ARE AVAILABLE FOR NON-ENGLISH SPEAKING PATIENTS EITHER FACE-TO-FACE OR THROUGH VARIOUS ELECTRONIC DEVICES. GSH ALSO INFORMS AND EDUCATES PATIENTS AND COMMUNITY MEMBERS REGARDING FINANCIAL ASSISTANCE THROUGH A VARIETY OF METHODS. PAMPHLETS ARE AVAILABLE IN THE HOSPITAL WAITING AREAS, CLINIC WAITING ROOMS, VISITING ROOMS AND AT THE INFORMATION DESKS. FLYERS ARE POSTED AT THE SPECIALTY CLINICS, THE MAIN ENTRANCE OF THE HOSPITAL AND IN THE EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS ALSO POSTED ON THE HOSPITAL'S WEBSITE, INCLUDING THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY, AND APPLICATION.
PART VI, LINE 4:	GSH PRIMARILY SERVES RESIDENTS OF BENTON COUNTY. ESTABLISHED BY THE PROVISIONAL LEGISLATURE IN 1847, BENTON COUNTY OCCUPIES 679 SQUARE MILES OF THE CENTRAL WILLAMETTE VALLEY. BENTON COUNTY IS BORDERED ON THE EAST BY THE WILLAMETTE RIVER AND LINN COUNTY, WITH LINCOLN COUNTY ON THE WEST, POLK COUNTY ON THE NORTH, AND BY LANE COUNTY ON THE SOUTH. ACCORDING TO THE US CENSUS 2019 POPULATION ESTIMATES, BENTON COUNTY HAS A POPULATION OF 93,053 RESIDENTS OF WHICH APPROXIMATELY 25,000 ARE STUDENTS AT OREGON STATE UNIVERSITY. THE CITY OF CORVALLIS IS THE COUNTY SEAT FOR BENTON COUNTY AND IS HOME TO OREGON STATE UNIVERSITY. ALTHOUGH THE MAJORITY OF RESIDENTS LIVE IN CORVALLIS OR OTHER INCORPORATED CITIES IN THE COUNTY, APPROXIMATELY 21% OF RESIDENTS LIVE IN RURAL BENTON COUNTY. THESE RURAL COMMUNITIES INCLUDE ALSEA, KINGS VALLEY, WREN, BLODGETT, SUMMIT AND BELLFOUNTAIN. PORTIONS OF BENTON COUNTY HAVE DESIGNATIONS OF MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ACCORDING TO THE HEALTH RESOURCES AND SERVICES ADMINISTRATION, WITH GSH BEING THE ONLY HOSPITAL LOCATED IN BENTON COUNTY. THE CHART BELOW SUMMARIZES THE RACIAL & ETHNIC DEMOGRAPHICS OF BENTON COUNTY:RACE/ETHNICITY POPULATIONWHITE/CAUCASIAN 86.5%BLACK/AFRICAN AMERICAN 1.2%AMERICAN INDIAN/ALASKA NATIVE 0.9%ASIAN 7.1%HISPANIC 7.8%NATIVE HAWAIIAN/PACIFIC ISLANDER 0.3%REPORTING TWO OR MORE RACES 4.1%SOURCE: U.S. CENSUS BUREAU, 2019 CENSUS QUICK FACTS, PUBLIC LAW 94-171 SUMMARY FILEHEALTH AND SOCIAL INDICATORS ARE USED TO GENERALIZE THE CONDITIONS OF BENTON COUNTY:HEALTH AND SOCIAL INDICATORS TOTALSMEDIAN INCOME $62,077UNEMPLOYMENT 4.3%POVERTY 16.5%ADEQUATE PRENATAL CARE 81.7%IMMUNIZATIONS 67.0%UNINSURED CHILDREN 3.3%CHILD ABUSE 10.6/1000CHILDREN ON FREE AND REDUCED LUNCH 37.1%HOMELESS STUDENTS 4.3%TEEN PREGNANCY 0.6%HIGH SCHOOL GRADUATION RATES 91.4%JUVENILE JUSTICE REFERRALS 10.7/1000SOURCE: OREGON EMPLOYMENT DEPARTMENT DECEMBER 2020, OREGON DEPARTMENT OF EDUCATION, U.S. CENSUS BUREAU, 2019 CENSUS QUICK FACTS, PUBLIC LAW 94-171 SUMMARY FILE, 2019 CHILD WELL-BEING IN OREGON COUNTY DATA BOOK
PART VI, LINE 5:	GSH'S GOVERNING BOARD IS COMPRISED OF LOCAL-AREA RESIDENTS. THE MAJORITY OF THE BOARD MEMBERS ARE INDEPENDENT, MEANING THEY AND THEIR FAMILY MEMBERS ARE NOT EMPLOYEES OF GSH NOR DO THEY HAVE ANY SIGNIFICANT BUSINESS RELATIONSHIPS WITH GSH. GSH EXTENDS ITS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. GSH APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. GSH INVESTS IN UPDATING EQUIPMENT, TECHNOLOGY AND FACILITIES TO IMPROVE PATIENT CARE. GSH IS ACCREDITED FOR CONTINUING MEDICAL EDUCATION AND OFFERS WEEKLY PROGRAMS FOR AREA PHYSICIANS AND OTHER HEALTH PROFESSIONALS. THE CENTER FOR HEALTH RESEARCH AND QUALITY, A DEPARTMENT OF GSH'S PARENT COMPANY, SAMARITAN HEALTH SERVICES (SHS), PROVIDES ADMINISTRATIVE OVERSIGHT FOR HEALTH AND CLINICAL RESEARCH, QUALITY IMPROVEMENT PROJECTS AND STUDIES, AND OTHER SPONSORED ACTIVITIES FOR GSH AND ITS AFFILIATED HOSPITALS.
PART VI, LINE 6:	"BUILDING HEALTHIER COMMUNITIES TOGETHER" IS THE MISSION OF SAMARITAN HEALTH SERVICES (SHS), A NETWORK OF OREGON HOSPITALS, PHYSICIANS, AND SENIOR CARE FACILITIES THAT SERVES THE HEALTH CARE NEEDS OF PEOPLE IN THE MID-WILLAMETTE VALLEY AND THE CENTRAL OREGON COAST.AS THE INDIVIDUAL ENTITIES OF SHS CAME TOGETHER, THEY WERE DRAWN BY A SHARED DESIRE "TO ENHANCE COMMUNITY HEALTH AND ACHIEVE HIGH VALUE THROUGH QUALITY SERVICES ACROSS THE CONTINUUM OF CARE." WITH THE MISSION OF "BUILDING HEALTHIER COMMUNITIES TOGETHER," SHS LOOKS CAREFULLY AT LOCAL HEALTH CARE NEEDS, AND IT 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 HEALTHCARE FOR PEOPLE AT ALL STAGES OF THEIR LIVES. SERVICES ARE PROVIDED TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY. THE COLLECTIVE VISION OF SHS IS TO SERVE OUR COMMUNITIES WITH PRIDE (PASSION, RESPECT, INTEGRITY, DEDICATION, AND EXCELLENCE). SHS IS GOVERNED BY A PARTNERSHIP OF COMMUNITY MEMBERS, PHYSICIANS AND OTHER HEALTH CARE PROVIDERS. SHS SEEKS TO LEAD COLLABORATIVE EFFORTS AMONG PROVIDERS, EMPLOYERS, HEALTH PLANS AND CONSUMERS WHO SHARE SIMILAR GOALS AND VALUES TO MEET THE CHALLENGES OF THE FUTURE.GSH IS THE FLAGSHIP HOSPITAL OF SHS. IT PRIMARILY SERVES RESIDENTS OF BENTON COUNTY. OTHER AFFILIATED HOSPITALS ARE ALBANY GENERAL HOSPITAL AND SAMARITAN LEBANON COMMUNITY HOSPITAL, SERVING RESIDENTS OF LINN COUNTY, AND SAMARITAN NORTH LINCOLN HOSPITAL AND SAMARITAN PACIFIC COMMUNITIES HOSPITAL, SERVING RESIDENTS OF LINCOLN COUNTY.
PART VI, LINE 7, REPORTS FILED WITH STATES	OR

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
COMMUNITY OUTREACH
865 REIMAN AVENUE	CORVALLIS	OR	97330	930602094	501(C)(3)	$114,296	FUNDING FOR MEDICAL, DENTAL, AND MENTAL HEALTH CLINICS
ALBANY HELPING HANDS
PO BOX 2252	ALBANY	OR	97321	931244271	501(C)(3)	$10,000	SUPPORT FOR HOMELESS PEOPLE
JACKSON STREET YOUTH SHELTER INC
PO BOX 285	CORVALLIS	OR	97339	931269503	501(C)(3)	$6,000	FUNDING FOR RESPITE SHELTER STAYS FOR HOMELESS YOUTH

Field	Value	IRS element (for citing)
Total501c3 Org	3	Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc
PATIENT TRANSPORTATION	161	$18,824
MEALS	45		$360	BOOK	MEALS FOR FAMILY MEMBERS OF PATIENTS

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 2:	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	Yes (1)	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
VYACHESLAV MELNIKOV MD
PHYSICIAN	$741,196	$0	$159,362	$0	$2,570	$0	$22,992	$0	$35,455	$0	$961,575	$0	$0	$0
WAEL GHACHAM MD
PHYSICIAN	$707,637	$0	$122,818	$0	$27,338	$0	$22,992	$0	$38,776	$0	$919,561	$0	$0	$0
JEFF HSING MD
PHYSICIAN	$512,559	$0	$288,656	$0	$20,529	$0	$22,992	$0	$34,640	$0	$879,376	$0	$0	$0
RIDHMI RAJAPAKSE MD
PHYSICIAN	$600,689	$0	$206,893	$0	$766	$0	$22,992	$0	$30,622	$0	$861,962	$0	$0	$0
DONALD PENNINGTON DO
PHYSICIAN	$735,323	$0	$46,522	$0	$13,817	$0	$22,992	$0	$37,348	$0	$856,002	$0	$0	$0
DANIEL SMITH
SVP / CFO	$0	$413,822	$0	$84,626	$0	$26,791	$0	$22,992	$0	$36,945	$0	$585,176	$0	$0
BECKY PAPE
CEO (JAN - AUG)	$0	$388,820	$0	$75,602	$0	$5,852	$0	$22,992	$0	$30,016	$0	$523,282	$0	$0
LARRY MULLINS DHA
FORMER CEO / CEO SAM SOLUT	$0	$115,259	$0	$0	$0	$321,198	$0	$5,700	$0	$8,522	$0	$450,679	$0	$0
KIMBERLY CLIFT
VP OPERATIONS (JAN - NOV)	$280,639	$0	$23,664	$0	$30,229	$0	$22,992	$0	$7,290	$0	$364,814	$0	$0	$0
TIMOTHY EIXENBERGER
VP PATIENT CARE SERVICES	$244,109	$0	$12,334	$0	$13,965	$0	$8,600	$0	$29,191	$0	$308,199	$0	$0	$0
BARBARA CRONEY
VP ANC SVCS & ACADEMIC AFFAIRS	$186,812	$0	$15,120	$0	$12,524	$0	$15,759	$0	$3,037	$0	$233,252	$0	$0	$0
LAURA HENNUM
CEO (AUG - DEC)	$0	$129,137	$0	$30,000	$0	$1,112	$0	$0	$0	$10,441	$0	$170,690	$0	$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 AND ONE HIGHEST PAID 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 FORMER OFFICER, TWO KEY EMPLOYEES, AND TWO HIGHEST PAID EMPLOYEES USED THE SAMARITAN (SAMFIT) GYM/FITNESS FACILITY BENEFIT DURING THE FILING YEAR.
PART I, LINE 3	THE CHIEF EXECUTIVE OFFICER IS EMPLOYED AND PAID BY A RELATED ORGANIZATION. THE RELATED ORGANIZATION CONDUCTS A COMPENSATION ANALYSIS EACH YEAR TO COMPARE COMPENSATION OF ALL PAID POSITIONS TO MARKET SURVEYS OF COMPENSATION FOR SIMILAR POSITIONS IN OTHER ORGANIZATIONS. PERIODICALLY, THE RELATED ORGANIZATION WILL ALSO USE WRITTEN EMPLOYMENT CONTRACTS, FORM 990 OF OTHER ORGANIZATIONS, AND INDEPENDENT COMPENSATION CONSULTANTS TO DETERMINE THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER.
PART I, LINE 4B	A RELATED 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.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1	ONE NON-EMPLOYEE BOARD MEMBER OF THE FILING ORGANIZATION IS NOT INDEPENDENT DUE TO BUSINESS TRANSACTIONS WITH A RELATED ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 6	GOOD SAMARITAN HOSPITAL CORVALLIS HAS A SOLE CORPORATE MEMBER, SAMARITAN HEALTH SERVICES, INC., WHICH IS A SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	GOOD SAMARITAN HOSPITAL CORVALLIS ELECTS MEMBERS OF ITS BOARD OF DIRECTORS. THOSE ELECTED MEMBERS ARE THEN SUBMITTED TO THE SOLE CORPORATE MEMBER FOR APPROVAL.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE CORPORATE MEMBER HAS SEVERAL RESERVED POWERS OVER THE ORGANIZATION. THESE RESERVED POWERS INCLUDE, BUT ARE NOT LIMITED TO, APPROVAL AT CERTAIN THRESHOLD LEVELS: THE BORROWING OF FUNDS, MERGERS AND ACQUISITIONS, AND SALES OR TRANSFERS OF ASSETS. IN ADDITION, THE SOLE CORPORATE MEMBER MUST APPROVE ANY CHANGE IN THE MISSION OF THE ORGANIZATION, THE ANNUAL BUDGET, AND ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS.
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 IS A 501(C)(3) CORPORATION AND IS THE SOLE MEMBER OF THE FILING ORGANIZATION. 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 POLICY 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	LINE 15A: THE CEO OF THE PARENT COMPANY, SAMARITAN HEALTH SERVICES (SHS) USES PUBLICLY AVAILABLE INFORMATION TO DETERMINE THE COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL OF THE FILING ORGANIZATION. HE CONSULTS WITH THE INDEPENDENT CONSULTANT AS TO THE REASONABLENESS OF THIS DATA TO ENSURE THAT THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IS REASONABLE AS COMPARED TO SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. LINE 15B: 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 THE 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:	DISTRIBUTIONS TO MINORITY INTEREST CONSOLIDATED JVS -1,024,872. CHANGE IN MINIMUM PENSION LIABILITY -479,262. OTHER CHANGES 162,190.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
ALBANY GENERAL HOSPITAL
PO BOX 3000	CORVALLIS	OR	973393000	930110095	HOSPITAL SERVICES FOR THE COMMUNITY	OR	501(C)(3)	3	SAMARITAN HEALTH SERVICES	0
ALBANY GENERAL HOSPITAL FOUNDATION
1046 SIXTH AVENUE SW	ALBANY	OR	97321	930712890	TO SUPPORT ALBANY GENERAL HOSPITAL	OR	501(C)(3)	7	ALBANY GENERAL HOSPITAL	0
FIRSTCARE HEALTH FOUNDATION
PO BOX 3000	CORVALLIS	OR	973393000	930900124	HEALTH SERVICES FOR LOW-INCOME PATIENTS	OR	501(C)(3)	7	SAMARITAN HEALTH SERVICES	0
FIRSTCARE MEDICAL FOUNDATION
PO BOX 3000	CORVALLIS	OR	973393000	930932697	FUTURE CHARITABLE HEALTHCARE INITIATIVES (NO CURRENT YEAR ACTIVITY)	OR	501(C)(3)	10	SAMARITAN HEALTH SERVICES	0
GOOD SAMARITAN HOSPITAL AUXILIARY
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	973393000	936024034	TO SUPPORT GOOD SAMARITAN HOSPITAL	OR	501(C)(3)	10		0	N/A
GOOD SAMARITAN HOSPITAL FOUNDATION
PO BOX 1068	CORVALLIS	OR	97339	237252406	TO SUPPORT GOOD SAMARITAN HOSPITAL	OR	501(C)(3)	7	GOOD SAMARITAN HOSPITAL	Yes (1)
INTERCOMMUNITY HEALTH PLANS INC
PO BOX 3000	CORVALLIS	OR	973393000	931124326	CCO PROVIDING MGMT OF INTEGRATED HEALTH SVCS FOR MEDICAID/OHP ENROLLEES	OR	501(C)(4)	N/A	SAMARITAN HEALTH SERVICES	0
LEBANON COMMUNITY HOSPITAL FOUNDATION
PO BOX 739	LEBANON	OR	97355	931260080	TO SUPPORT LEBANON COMMUNITY HOSPITAL	OR	501(C)(3)	7	MID-VALLEY HEALTHCARE INC	0
MID-VALLEY HEALTHCARE INC
PO BOX 3000	CORVALLIS	OR	973393000	930396847	HOSPITAL SERVICES FOR THE COMMUNITY	OR	501(C)(3)	3	SAMARITAN HEALTH SERVICES	0
PARADIGM INDEMNITY CORPORATION
PO BOX 3000	CORVALLIS	OR	973393000	731668317	PURE NON-PROFIT CAPTIVE INSURANCE COMPANY	HI	501(C)(3)	12A, I	SAMARITAN HEALTH SERVICES	0
SAMARITAN HEALTH SERVICES INC
PO BOX 3000	CORVALLIS	OR	973393000	930951989	PROVIDE HEALTHCARE SUPPORT SERVICES	OR	501(C)(3)	12C, III-FI		0	N/A
SAMARITAN NORTH LINCOLN HOSPITAL
3043 NE 28TH STREET	LINCOLN CITY	OR	97367	931305493	HOSPITAL SERVICES FOR THE COMMUNITY	OR	501(C)(3)	3	SAMARITAN HEALTH SERVICES	0
SAMARITAN PACIFIC HEALTH SERVICES
930 SW ABBEY STREET	NEWPORT	OR	97365	931329784	HOSPITAL SERVICES FOR THE COMMUNITY	OR	501(C)(3)	3	SAMARITAN HEALTH SERVICES	0
SAMARITAN SENIOR CARE INC
PO BOX 3000	CORVALLIS	OR	973393000	931245534	FUTURE CHARITABLE HEALTHCARE INITIATIVES (NO CURRENT YEAR ACTIVITY)	OR	501(C)(3)	10	SAMARITAN HEALTH SERVICES	0
NORTH LINCOLN HOSPITAL FOUNDATION
PO BOX 767	LINCOLN CITY	OR	97367	930867677	TO SUPPORT SAMARITAN NORTH LINCOLN HOSPITAL	OR	501(C)(3)	7	SAMARITAN NORTH LINCOLN HOSPITAL	0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (12 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct	Direct Controlling NADirectControllingNACd
SAMARITAN ENDOSCOPY CENTER LLC
3600 NW SAMARITAN DR	CORVALLIS	OR	97330	202860067	MEDICAL SERVICES	OR	GOOD SAMARITAN HOSPITAL	RELATED	$15,158	$150,455	0	Yes (1)	0.20000
CORVALLIS MEDICAL BUILDINGS LLC
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	931257913	REAL ESTATE RENTAL	OR	GOOD SAMARITAN HOSPITAL	EXCLUDED	$210,558	$911,941	0	Yes (1)	0.54500
EAST LINN MRI LLC
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	320229399	IMAGING	OR					0	0		N/A
HULL IMAGING LLC
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	203255479	IMAGING	OR	GOOD SAMARITAN HOSPITAL	RELATED	$467,063	$38,503	0	Yes (1)	0.60000
CORVALLIS MRI LLC
3615 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	930949704	IMAGING	OR	GOOD SAMARITAN HOSPITAL	RELATED	$363,286	$80,452	0	Yes (1)	0.50000
MID-VALLEY MEDICAL PROPERTIES ASSOC LLC
1046 SIXTH AVE SW	ALBANY	OR	97321	300508747	REAL ESTATE RENTAL	OR					0	0		N/A
MID-VALLEY MEDICAL BUILDINGS LLC
PO BOX 557	LEBANON	OR	97355	931126353	REAL ESTATE RENTAL	OR					0	0		N/A
NORTHWEST MEDICAL ISOTOPES LLC
815 NW 9TH ST STE 256	CORVALLIS	OR	97330	273007752	RESEARCH	OR					0	0		N/A
CASCADE VIEW MEDICAL OFFICE BUILDING LLC
PO BOX 3000	CORVALLIS	OR	973393000	300658805	REAL ESTATE RENTAL	OR	GOOD SAMARITAN HOSPITAL	EXCLUDED	$66,040	$1,361,176	0	Yes (1)	0.26300
BSM SURGERY CENTER LLC
1128 NE 2ND ST STE 201	CORVALLIS	OR	97330	264349685	MEDICAL SERVICES	OR					0	0		N/A
AIKENS DIALYSIS LLC
PO BOX 3004	TACOMA	WA	98401	464459152	MEDICAL SERVICES	WA					0	0		N/A
OREGONIUS LLC
251 KEARNY ST STE 700	SAN FRANCISCO	CA	94108	842562612	MEDICAL SERVICES	DE					0	0		N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
SAMARITAN HEALTH PLANS INC
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	930860860	HEALTH INSURANCE CARRIER FOR THE COMMUNITY	OR	N/A	C	0
BOULDER FALLS PROPERTIES LLC
PO BOX 3000	CORVALLIS	OR	973393000	465293120	EVENT CENTER & HOSPITALITY SVCS	OR	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	Yes (1)	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (1)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (1)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (11 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
INTERCOMMUNITY HEALTH PLANS INC
L	$36,314,675	COST
CORVALLIS MEDICAL BUILDINGS LLC
A	$53,428	COST
CORVALLIS MEDICAL BUILDINGS LLC
S	$256,150	COST
CORVALLIS MEDICAL BUILDINGS LLC
K	$604,559	COST
HULL IMAGING LLC
A	$50,544	COST
HULL IMAGING LLC
O	$644,486	COST
HULL IMAGING LLC
S	$461,000	COST
HULL IMAGING LLC
L	$482,277	COST
GOOD SAMARITAN HOSPITAL FOUNDATION
C	$1,378,426	COST
GOOD SAMARITAN HOSPITAL FOUNDATION
O	$332,123	COST
GOOD SAMARITAN HOSPITAL FOUNDATION
R	$86,027	COST