2021-11-11T13:14:56-06:00 2020-12-31 990 2020-01-01 930391573 GOOD SAMARITAN HOSPITAL CORVALLIS GOOD 5417684857 CO SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL SMITH SVP / CFO 5417684857 2021-11-03 DANIEL SMITH 999009999 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z GOOD SAMARITAN REGIONAL MEDICAL CTR LAURA HENNUM 3600 NW SAMARITAN DR CORVALLIS OR 97330 472223183 0 X WWW.SAMHEALTH.ORG X 1948 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS MEDICAL AND SURGICAL HOSPITAL. 13 12 2555 186 207875 0 857502 24599823 451552161 439489623 947291 1834017 3291267 2517819 456648221 468441282 279494 200980 0 0 236287371 237594640 0 0 0 227664064 229338759 464230929 467134379 -7582708 1306903 181314597 176742940 117536831 111078515 63777766 65664425 X 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. 0 0 422352868 439475814 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. 200980 200980 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. 422553848 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 2555 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 1 1 1 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 NANCY SEIFERT BOARD CHAIR 1.00 2.00 X X 0 0 0 REVEREND SIMON JUSTICE BOARD VICE CHAIR 1.00 X X 0 0 0 KELLY GALLAGHER BOARD SECRETARY 1.00 2.00 X X 0 0 0 RICHARD CRONK MD BOARD TREASURER 1.00 X X 0 0 0 JUDY LIST BOARD MEMBER 1.00 1.00 X 0 0 0 CLIFFORD HALL MD BOARD MEMBER 1.00 X 0 600 0 BISHOP MICHAEL HANLEY BOARD MEMBER 1.00 X 0 0 0 TIM HENNESSY BOARD MEMBER 1.00 X 0 1146 0 ERIC THOMPSON BOARD MEMBER 1.00 X 0 0 0 STEVE UERLINGS BOARD MEMBER 1.00 2.00 X 0 0 0 LYLE HUTCHENS BOARD MEMBER 1.00 X 0 0 0 MARY OCHADLIK MD BOARD MEMBER 1.00 X 0 2000 0 KATHARINE HARRIS BOARD MEMBER 1.00 X 0 0 0 DANIEL SMITH SVP / CFO 2.00 38.00 X 0 525239 59937 BECKY PAPE CEO (JAN - AUG) 39.00 1.00 X 0 470274 53008 LAURA HENNUM CEO (AUG - DEC) 39.00 1.00 X 0 160249 10441 KIMBERLY CLIFT VP OPERATIONS (JAN - NOV) 40.00 X 334532 0 30282 TIMOTHY EIXENBERGER VP PATIENT CARE SERVICES 40.00 X 270408 0 37791 BARBARA CRONEY VP ANC SVCS & ACADEMIC AFFAIRS 40.00 X 214456 0 18796 JEFF HSING MD PHYSICIAN 40.00 X 821744 0 57632 DONALD PENNINGTON DO PHYSICIAN 40.00 X 795662 0 60340 VYACHESLAV MELNIKOV MD PHYSICIAN 40.00 X 903128 0 58447 WAEL GHACHAM MD PHYSICIAN 40.00 X 857793 0 61768 RIDHMI RAJAPAKSE MD PHYSICIAN 40.00 X 808348 0 53614 LARRY MULLINS DHA FORMER CEO / CEO SAM SOLUT 0.00 20.00 X 0 436457 14222 5006071 1595965 516278 506 1 1 0 0 1395203 23204620 24599823 NET PATIENT REVENUE 622110 396806058 396806058 RETAIL PHARMACY 446110 37506434 37506434 QUALITY INCENTIVES 622110 3014332 3014332 OTHER PROGRAM SVC REV 900099 662265 648456 13809 ALT PAYMENT METHODS 900099 561158 561158 939376 939376 439489623 733713 733713 967162 285946 681216 681216 681216 3764505 723329 3290000 97530 474505 625799 1100304 1100304 302491 108425 194066 194066 CAFETERIA 722210 1642537 1642537 1642537 468441282 439475814 207875 4157770 181796 181796 19184 19184 906265 906265 179950414 176732631 3217783 11067151 10870245 196906 31316879 30759692 557187 14353931 14098547 255384 239365 239365 34376 34376 39678 3475 36203 15270234 15224621 45613 12894 8491 4403 10566491 10161893 404598 23880687 23228296 652391 5398555 5234285 164270 175820 171825 3995 747313 743704 3609 4014686 3905010 109676 9796257 9655377 140880 4845682 4663776 181906 MEDICAL SUPPLIES 84860232 84860232 PURCHASED SERVICES 48383013 9853662 38529351 PROVIDER TAXES 20157376 20157376 DUES, TAXES, & LICENSES 911847 870096 41751 4253 4004 249 467134379 422553848 44580531 0 11700 9700 932102 283948 46313077 45705628 925000 881813 8636748 8984154 1624193 1216342 246921387 157513369 94148360 89408018 22341744 25367570 423287 465085 5958386 4420682 181314597 176742940 24581879 27830255 251062 39574345 848193 511185 91855697 43162730 117536831 111078515 X 63777766 65664425 63777766 65664425 181314597 176742940 X 1306903 1921700 -1341944 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5471420 52626 646419 134070 6036395 4709814 132666 802651 173711 5471420 5044051 123741 -318594 139384 4709814 4478316 31737 699206 165208 5044051 4237438 66044 348421 173587 4478316 0.25040 0.62880 0.12080 0 1 1 1700000 358114 2058114 1661148 157095740 91444820 67312068 3726386 2363504 1362882 69944025 57051808 12892217 12435974 6653237 5782737 89408018 PROFESSIONAL LIABILITY RESERVE 2547000 OTHER LIABILITIES 1867446 PAYABLE TO CONTRACTUAL AGENCIES 3687022 MINIMUM PENSION LIABILITY 23557150 ACCOUNTS PAYABLE-AFFILIATES 11504112 43162730 X 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. 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 18 19732 4571676 4571676 0.00980 11 90529 81796331 62310114 19486217 0.04170 29 110261 86368007 62310114 24057893 0.05150 8 8549 985791 13206 972585 0.00210 4 602 18392293 10432078 7960215 0.01700 34 178626 72628389 39329977 33298412 0.07130 8 23981 687906 186023 501883 0.00110 54 211758 92694379 49961284 42733095 0.09150 83 322019 179062386 112271398 66790988 0.14300 3 601 179374 25863 153511 0.00030 1 6 12612 12612 0.00000 4 607 191986 25863 166123 0.00030 0 1701101 72955307 71585784 1369523 X 1 1 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 1 1 GOOD SAMARITAN HOSPITAL CORVALLIS 3600 NW SAMARITAN DRIVE CORVALLIS OR 97330 WWW.SAMHEALTH.ORG STATE LICENSE: 14-1074 X X X X X GOOD SAMARITAN HOSPITAL CORVALLIS 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X SEE PART V, PAGE 8 X X 1 20 1 WWW.SAMHEALTH.ORG/ABOUT-SAMARITAN/COMMUNITY-BENEFIT-INITIATIVES 0 1 X 250.000000000000 400.000000000000 X X X 1 1 X X X X 1 X WWW.SAMHEALTH.ORG/FINANCIALASSISTANCE X WWW.SAMHEALTH.ORG/FINANCIALASSISTANCE X WWW.SAMHEALTH.ORG/FINANCIALASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 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 45 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 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 1 COMMUNITY OUTREACH 865 REIMAN AVENUE CORVALLIS OR 97330 930602094 501(C)(3) 114296 FUNDING FOR MEDICAL, DENTAL, AND MENTAL HEALTH CLINICS ALBANY HELPING HANDS PO BOX 2252 ALBANY OR 97321 931244271 501(C)(3) 10000 SUPPORT FOR HOMELESS PEOPLE JACKSON STREET YOUTH SHELTER INC PO BOX 285 CORVALLIS OR 97339 931269503 501(C)(3) 6000 FUNDING FOR RESPITE SHELTER STAYS FOR HOMELESS YOUTH 3 PATIENT TRANSPORTATION 161 18824 MEALS 45 360 BOOK MEALS FOR FAMILY MEMBERS OF PATIENTS 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 0 1 0 1 0 0 0 0 0 VYACHESLAV MELNIKOV MD PHYSICIAN 741196 0 159362 0 2570 0 22992 0 35455 0 961575 0 0 0 WAEL GHACHAM MD PHYSICIAN 707637 0 122818 0 27338 0 22992 0 38776 0 919561 0 0 0 JEFF HSING MD PHYSICIAN 512559 0 288656 0 20529 0 22992 0 34640 0 879376 0 0 0 RIDHMI RAJAPAKSE MD PHYSICIAN 600689 0 206893 0 766 0 22992 0 30622 0 861962 0 0 0 DONALD PENNINGTON DO PHYSICIAN 735323 0 46522 0 13817 0 22992 0 37348 0 856002 0 0 0 DANIEL SMITH SVP / CFO 0 413822 0 84626 0 26791 0 22992 0 36945 0 585176 0 0 BECKY PAPE CEO (JAN - AUG) 0 388820 0 75602 0 5852 0 22992 0 30016 0 523282 0 0 LARRY MULLINS DHA FORMER CEO / CEO SAM SOLUT 0 115259 0 0 0 321198 0 5700 0 8522 0 450679 0 0 KIMBERLY CLIFT VP OPERATIONS (JAN - NOV) 280639 0 23664 0 30229 0 22992 0 7290 0 364814 0 0 0 TIMOTHY EIXENBERGER VP PATIENT CARE SERVICES 244109 0 12334 0 13965 0 8600 0 29191 0 308199 0 0 0 BARBARA CRONEY VP ANC SVCS & ACADEMIC AFFAIRS 186812 0 15120 0 12524 0 15759 0 3037 0 233252 0 0 0 LAURA HENNUM CEO (AUG - DEC) 0 129137 0 30000 0 1112 0 0 0 10441 0 170690 0 0 PART I, LINE 1A IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM/FITNESS FACILITY BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. EMPLOYEES CAN USE THEIR WELLNESS BENEFIT AT EITHER NON-SAMARITAN OR SAMARITAN (SAMFIT) GYM/FITNESS FACILITIES. IF AN EMPLOYEE PARTICIPATES AT A NON-SAMARITAN GYM, REIMBURSEMENT IS MADE FOR FEES. REIMBURSEMENT DOES NOT EXCEED $300 PER YEAR AND IS INCLUDED IN THEIR TAXABLE WAGES SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. ONE KEY EMPLOYEE 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. 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. 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