2019-11-14T17:11:46-06:00 2018-12-31 990 2018-01-01 930391573 GOOD SAMARITAN HOSPITAL CORVALLIS GOOD 5417684773 C/O SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL SMITH SVP FINANCE/CFO 5417684773 2019-11-08 192.101.73.50 2019-11-08 10:56:47 PS P 3179769CAEB5567C9954F4290B19374E137A7FE1 AAA731232143EEC097FF22CB2933FA25C654E471 2018 2020-04-17 16:48:07Z GOOD SAMARITAN REGIONAL MEDICAL CTR BECKY PAPE 3600 NW SAMARITAN DR CORVALLIS OR 97330 438055745 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 10 2644 253 251438 0 767265 909077 417696798 429790349 1364120 1076049 3212725 3246333 423040908 435021808 263200 287857 0 0 226856192 232430428 0 0 0 205430945 222212106 432550337 454930391 -9509429 -19908583 180179878 179272599 92269685 109775552 87910193 69497047 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 411745256 429777129 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 250 VOLUNTEERS SERVING THE MEDICAL NEEDS OF THE COMMUNITY. IT IS LICENSED TO OPERATE 188 BEDS AND IS ONE OF ONLY FOUR 'LEVEL 2' TRAUMA CENTERS IN THE STATE. DURING 2018, GSH SERVED 8,182 INPATIENTS, HAD 29,238 EMERGENCY DEPARTMENT VISITS, PERFORMED 10,167 SURGERIES AND DELIVERED 949 BABIES. IN ADDITION, GSH PERFORMED 94,716 IMAGING PROCEDURES, HAD 28,885 HOME HEALTH VISITS, AND HAD 251,247 PHYSICIAN CLINIC VISITS. 287857 287857 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. 412033113 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 2644 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X SAMARITAN HEALTH SERVICES 5417684773 PO BOX 3000 CORVALLIS OR 973393000 RICHARD CRONK MD BOARD CHAIR 1.00 X X 0 0 0 JUDY LIST BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 REVEREND SIMON JUSTICE BOARD SECRETARY 1.00 X X 0 0 0 NANCY SEIFERT BOARD TREASURER 1.00 1.00 X X 0 0 0 CLIFFORD HALL MD BOARD MEMBER 1.00 X 0 450 0 BISHOP MICHAEL HANLEY BOARD MEMBER 1.00 X 0 0 0 TIM HENNESSY BOARD MEMBER 1.00 X 0 7075 0 KELLY GALLAGHER BOARD MEMBER 1.00 1.00 X 0 0 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 LINDA FOX MD BOARD MEMBER / PHYSICIAN 40.00 X 396945 0 38037 KATHARINE HARRIS BOARD MEMBER 1.00 X 0 0 0 BECKY PAPE CEO 39.00 1.00 X 0 436913 52426 DANIEL SMITH SVP FINANCE / CFO 2.00 38.00 X 0 442412 94657 SCOTT WILSON VP ANCILLARY SUPPORT SVCS 40.00 X 212222 0 29901 WILLIAM HOWDEN VP NURSING GSRMC 40.00 X 217903 0 45636 KIMBERLY CLIFT VP OPS(AUG-DEC)/VP REV CYC(JAN-JULY) 17.00 23.00 X 102594 185668 30463 LUIS VELA DO PHYSICIAN 40.00 X 939016 0 61303 DONALD PENNINGTON DO PHYSICIAN 40.00 X 801173 0 59255 J CHRISTOPHER NOONAN MD PHYSICIAN 40.00 X 786495 0 59280 JEFF HSING MD PHYSICIAN 40.00 X 758720 0 57168 DANIELA ALEXANDRU-ABRAMS MD PHYSICIAN 40.00 X 721056 0 59331 STEVEN JASPERSON FORMER CEO / VP SO. CALIFORNIA OPS 0.00 0.00 X 0 610824 17992 LARRY MULLINS DHA FORMER CEO / CEO SAM SOLUTIONS INST 0.00 20.00 X 0 1068916 52610 4936124 2752258 658059 502 1 1 0 0 909077 909077 NET PATIENT REVENUE 622110 407825565 407825565 RETAIL PHARMACY 446110 15111234 15111234 QUALITY INCENTIVES 622110 4424100 4424100 OTHER PATIENT REVENUE 622110 1432807 1432807 OTHER PROGRAM SVC REV 900099 523254 510034 13220 473389 473389 429790349 772612 772612 943918 128196 815722 815722 815722 2870193 144100 2707354 3502 162839 140598 303437 303437 433103 194885 238218 238218 CAFETERIA 722210 2192393 2192393 2192393 435021808 429777129 251438 4084164 271406 271406 16451 16451 1053048 810926 242122 175121171 171455609 3665562 12613776 12351328 262448 31474410 30819539 654871 12168023 11914850 253173 12001 12001 56235 3050 53185 14068141 13921629 146512 22325 7468 14857 11665023 11192378 472645 23295464 22540031 755433 5543640 5370458 173182 555945 541850 14095 813883 807785 6098 4520890 4374285 146605 9160195 9003197 156998 6100333 5717445 382888 MEDICAL SUPPLIES 78840677 78840677 PURCHASED SERVICES 46933785 11461695 35472090 DUES, TAXES, & LICENSES 20623569 20611056 12513 454930391 412033113 42897278 0 9333 9250 663772 1032319 47721916 46456289 1216963 1027988 7648449 7571583 1819838 2478519 235550830 139344858 95104663 96205972 20205305 19086798 348723 384020 5440916 5019861 180179878 179272599 24298650 27479145 703356 1018946 386005 67267679 80891456 92269685 109775552 X 87910193 69497047 87910193 69497047 180179878 179272599 X -19908583 -1638158 3133595 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5044051 123741 -318594 139384 4709814 4478316 31737 699206 165208 5044051 4237438 66044 348421 173587 4478316 4497010 132523 -174642 217453 4237438 4427981 47952 161199 140122 4497010 0.24370 0.75630 0 1 1 1700000 358114 2058114 1631572 153293160 81578149 73346583 3029561 1165723 1863838 65029719 50738315 14291404 10508704 5862671 4646033 96205972 PROFESSIONAL LIABILITY RESERVE 3421000 OTHER LIABILITIES 1496980 PAYABLE TO CONTRACTUAL AGENCIES 4050458 MINIMUM PENSION LIABILITY 24946782 ACCRUED INTEREST 1226995 ACCOUNTS PAYABLE-AFFILIATES 45749241 80891456 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, 2018, 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 2015. 1 1 X 1 X 225.000000000000 1 X 1 1 1 0 1 1 17 20868 5356279 5356279 0.01180 12 91115 82707064 60038474 22668590 0.04980 29 111983 88063343 60038474 28024869 0.06160 11 20657 1045328 58435 986893 0.00220 4 5068 16054647 9270562 6784085 0.01490 26 140970 60166301 35535326 24630975 0.05410 8 44167 565215 565215 0.00120 49 210862 77831491 44864323 32967168 0.07240 78 322845 165894834 104902797 60992037 0.13400 1 614 9072 9072 0.00000 1 8 58870 58870 0.00010 2 622 67942 67942 0.00010 0 3627775 68322338 73444869 -5122531 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 0.66670 0.33330 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 16 1 0 1 1 X HTTP://WWW.SAMHEALTH.ORG/COMMUNITYSUPPORT X X 1 17 1 HTTP://WWW.SAMHEALTH.ORG/COMMUNITYSUPPORT 0 1 X 225.000000000000 300.000000000000 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 THE LINN-BENTON-LINCOLN RURAL HEALTH ASSESSMENT TEAM (RHAT) TO CONDUCT THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT FOR GOOD SAMARITAN REGIONAL MEDICAL CENTER. THE STAFF AND RHAT CONDUCTED SURVEYS BOTH ON-LINE AND PAPER TO OVER 700 RESIDENTS IN BENTON COUNTY. THE STAFF AND RHAT ALSO COLLECTED SECONDARY DATA FROM VARIOUS STATE AND NATIONAL ORGANIZATIONS SUCH AS THE OREGON DEPARTMENT OF EDUCATION, OREGON HEALTH AUTHORITY, U.S. CENSUS BUREAU AND CENTER FOR DISEASE CONTROL. SAMARITAN HEALTH SERVICES ALSO CONTRACTED WITH A LOCAL CONSULTANT TO HOLD FOCUS GROUPS AND CONDUCT KEY-INFORMANT INTERVIEWS TO OBTAIN INPUT FROM COMMUNITY MEMBERS AND PEOPLE WITH SPECIAL KNOWLEDGE AND EXPERTISE. 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 NETWORK, DEPARTMENT OF HUMAN SERVICES, OREGON HEALTH AUTHORITY, OREGON OFFICE OF RURAL HEALTH, COMMUNITY SERVICES CONSORTIUM, 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: BENTON COUNTY HEALTH DEPARTMENT - REGIONAL HEALTH ASSESSMENT TEAM, BRANDAN KEARNEY, LLC - CONSULTANT, COMMUNITY SERVICES CONSORTIUM GOOD SAMARITAN HOSPITAL, CORVALLIS PART V, SECTION B, LINE 7D: COPIES OF THE CHNA WERE EMAILED TO KEY COMMUNITY PARTNERS AND DISTRIBUTED 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, THE 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. 44 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 MEDICINE - 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 - NEVILLE BUILDING IMAGING 3615 NW SAMARITAN DR CORVALLIS OR 97330 IMAGING SERVICES 11 - SAMARITAN ENDOCRINOLOGY 3615 NW SAMARITAN DR STE G2 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 12 - SAMARITAN DIABETES EDUCATION 3615 NW SAMARITAN DR STE G1 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 - SAMARITAN NEUROSURGERY 3615 NW SAMARITAN DR STE 210 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 17 - OUTPATIENT SURGERY 3620 NW SAMARITAN DR CORVALLIS OR 97330 AMBULATORY SURGERY 18 - SAMARITAN ORTHOPEDICS - LUIS VELA DO 3620 NW SAMARITAN DR STE 201 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 19 - SAMARITAN ORTHOPEDICS & SPORTS MED CTR 3620 NW SAMARITAN DR STE 202 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 20 - SAMARITAN RHEUMATOLOGY 3620 NW SAMARITAN DR STE 203 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 21 - SAMARITAN NEUROMUSCULAR MED RESIDENT CL 3620 NW SAMARITAN DR STE 203A CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 22 - SAMARITAN INFECTIOUS DISEASE 3640 NW SAMARITAN DR STE 210 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 23 - SAMARITAN OBSTETRICS & GYN 3640 NW SAMARITAN DR STE 220 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 24 - SAMARITAN GYN & SURGICAL ASSOCIATES 400 NW WALNUT BLVD STE 300 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 25 - SAMARITAN PASTEGA REGIONAL CANCER CTR 441 NW ELKS DR CORVALLIS OR 97330 CANCER TREATMENT 26 - SAMARITAN HEMATOLOGY & ONCOLOGY 441 NW ELKS DR SUITE 100 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 27 - SAMARITAN CANCER RES CTR - CORVALLIS 501 NW ELKS DR CORVALLIS OR 97330 CANCER RESOURCE CENTER 28 - SAMARITAN URGENT CARE - CORVALLIS 5234 SW PHILOMATH BLVD CORVALLIS OR 97333 MEDICAL CLINIC - OUTPATIENT 29 - SAMARITAN FAMILY MEDICINE SOUTHWEST 5234 SW PHILOMATH BLVD CORVALLIS OR 97333 MEDICAL CLINIC - OUTPATIENT 30 - SAMARITAN OCC MED - CORVALLIS 5234 SW PHILOMATH BLVD STE B CORVALLIS OR 97333 MEDICAL CLINIC - OUTPATIENT 31 - SAMARITAN PEDIATRICS 777 NW 9TH ST STE 320 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 32 - SAMARITAN ATHLETIC MEDICINE CENTER 845 SW 30TH ST CORVALLIS OR 97331 MEDICAL CLINIC - OUTPATIENT 33 - SAM CARE EXPRESS - CORVALLIS 990 NW CIRCLE BLVD STE 101 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 34 - SAMARITAN UROLOGY 990 NW CIRCLE BLVD STE 102 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 35 - SAMARITAN PLASTIC RECONST & HAND SURG 996 NW CIRCLE BLVD STE 103 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 36 - SAMARITAN OCC MED - LEBANON 100 MULLINS DRIVE STE B2 LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 37 - NEVILLE BUILDING LABORATORY 3615 NW SAMARITAN DR STE 102 CORVALLIS OR 97330 LABORATORY SERVICES 38 - SAMARITAN PEDIATRICS - CIRCLE BLVD 1112 NW CIRCLE BLVD CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 39 - SAMARITAN MENTAL HEALTH - CIRCLE BLVD 1112 NW CIRCLE BLVD CORVALLIS OR 97330 MENTAL HEALTH SERVICES 40 - SAMCARE MOBILE MEDICINE 2555 NE BELVUE ST CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 41 - SAMARITAN FAMILY MEDICINE 3517 NW SAMARITAN DR STE 201 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 42 - SAMARITAN OB & GYN RESIDENT CLINIC 3517 NW SAMARITAN DR STE 202 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 43 - SAMARITAN CARDIOLOGY - CORVALLIS 3640 NW SAMARITAN DR STE 100A CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 44 - SAMARITAN CARDIOVASCULAR SURGERY 3640 NW SAMARITAN DR STE 100B 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 2018 IS 15,742,760. 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. ANNUAL EVENTS SUCH AS SENIOR HEALTH FAIRS, FESTIVAL LATINO, CHILDREN'S HEALTH FAIRS, BENTON COUNTY FAIR AND PROJECT HOMELESS CONNECT ARE A FEW EXAMPLES OF HOW GSH PROMOTES THE HEALTH OF THE COMMUNITY. 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. 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 SERVE 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 14 AND 15 OF THE 2018 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 OF MEDICARE SHORTFALL SHOWN ON LINE 7 OF PART III, SECTION B, IS UNDERSTATED. 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 OF MEDICARE SHORTFALL SHOWN ON LINE 7 IS SMALLER THAN THE SHORTFALL CALCULATION USING REVENUE AND COST DATA FOR ALL MEDICARE PATIENT ACTIVITY, AS FOLLOWS:NET REV RECEIVED FROM MEDICARE (ALL MEDICARE PATIENT PROGRAMS):123,064,806MEDICARE COSTS (BASED ON A COST-TO-CHARGE RATIO): 152,722,662UNPAID COST OF PROVIDING SERVICES TO ALL MEDICARE PATIENTS: -29,657,856 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 300% OF THE FEDERAL POVERTY LEVEL GUIDELINES.ALL APPLICATION MATERIALS ARE AVAILABLE IN BOTH ENGLISH AND SPANISH AND INTERPRETATIVE SERVICES ARE AVAILABLE FOR NON-ENGLISH SPEAKING PATIENTS 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 2018 POPULATION ESTIMATES, BENTON COUNTY HAS A POPULATION OF 92,101 RESIDENTS OF WHICH APPROXIMATELY 22,000 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 0.8%ASIAN 7.1%HISPANIC 7.3%NATIVE HAWAIIAN/PACIFIC ISLANDER 0.3%REPORTING TWO OR MORE RACES 4.1%SOURCE: U.S. CENSUS BUREAU, 2018 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 $54,682UNEMPLOYMENT 4.3%POVERTY 16.0%ADEQUATE PRENATAL CARE 81.7%IMMUNIZATIONS 65.0%UNINSURED CHILDREN 3.3%CHILD ABUSE 8.8/1000CHILDREN ON FREE AND REDUCED LUNCH 37.1%HOMELESS STUDENTS 4.3%TEEN PREGNANCY 5.6/1000HIGH SCHOOL GRADUATION RATES 84.8%JUVENILE JUSTICE REFERRALS 10.7/1000SOURCE: OREGON EMPLOYMENT DEPARTMENT DECEMBER 2018, OREGON DEPARTMENT OF EDUCATION, U.S. CENSUS BUREAU, 2018 CENSUS QUICK FACTS, PUBLIC LAW 94-171 SUMMARY FILE, 2018 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) 115596 MEDICAL, DENTAL, MENTAL HEALTH CLINICS ALBANY HELPING HANDS PO BOX 2252 ALBANY OR 97321 931244271 501(C)(3) 9600 SUPPORT FOR HOMELESS PEOPLE CENTER AGAINST RAPE & DOMESTIC VIOLENCE PO BOX 914 CORVALLIS OR 97339 930792125 501(C)(3) 13334 PROVIDED FUNDING TO SUPPORT THE EMERGENCY SHELTER PROGRAM BENTON COUNTY PO BOX 3020 CORVALLIS OR 97339 936002285 GOV'T 10668 FUNDING FOR PEOPLE ENTERING THE DRUG COURT PROGRAM CASA LATINOS UNIDOS DE BENTON COUNTY 128 SW 9TH ST CORVALLIS OR 97333 263639798 501(C)(3) 10668 FUNDING FOR AN AFTER SCHOOL PROGRAM TO HELP SPANISH SPEAKING STUDENTS WITH MATH AND WRITING BENTON COUNTY PO BOX 3020 CORVALLIS OR 97339 936002285 GOV'T 18634 FUNDING TO SUPPORT THE BENTON COUNTY ORAL HEALTH COALITION ADULT EMERGENCY VOUCHER DENTAL PROGRAM JACKSON STREET YOUTH SHELTER INC PO BOX 285 CORVALLIS OR 97339 931269503 501(C)(3) 13334 FUNDING FOR TRANSITIONAL HOUSING TO HOMELESS YOUTH OLD MILL CENTER FOR CHILDREN AND FAMILIES INC 1650 SW 45TH PLACE CORVALLIS OR 97333 930722603 501(C)(3) 6668 PARENT/CAREGIVER SUPPORT, EDUCATION, OUTREACH, AND RESPITE SERVICES GRACE CENTER FOR ADULT DAY SERVICES 980 NW SPRUCE AVE CORVALLIS OR 97330 930839745 501(C)(3) 8000 FINANCIAL ASSISTANCE PROGRAM ABC HOUSE INC PO BOX 68 ALBANY OR 97321 931163555 501(C)(3) 7500 FUNDING FOR A MEDICAL DIRECTOR POSITION CORVALLIS ENVIRONMENTAL CENTER 116 SW 4TH STREET CORVALLIS OR 97333 931140056 501(C)(3) 7334 FUNDING FOR THE CORVALLIS FARM TO SCHOOL FOOD PROGRAM STRENGTHENING RURAL FAMILIES PO BOX 1528 PHILOMATH OR 97370 202934930 501(C)(3) 7334 FUNDING FOR DENTAL VANS IN RURAL BENTON COUNTY VINA MOSES WELFARE CENTER INC 968 NW GARFIELD AVE CORVALLIS OR 97330 930615775 501(C)(3) 10000 FUNDING TO SUPPORT RENTAL AND UTILITY ASSISTANCE TO FAMILIES IN BENTON COUNTY CORVALLIS NEIGHBORHOOD HOUSING SERVICES INC 257 SW MADISON AVE STE 113 CORVALLIS OR 97333 931057296 501(C)(3) 7334 FUNDING FOR A HEALTHY AND ACTIVE YOUTH PROGRAM OREGON CASCADES WEST SENIOR SERVICES FOUNDATION 1400 QUEEN AVE STE 206 ALBANY OR 97322 931213218 501(C)(3) 6668 FUNDING FOR A MEALS ON WHEELS PROGRAM 14 PATIENT TRANSPORTATION 378 15066 MEALS 122 1187 BOOK MEALS FOR FAMILY MEMBERS OF PATIENTS SHELTER 1 197 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 1 1 0 1 0 0 0 0 0 LINDA FOX MD BOARD MEMBER / PHYSICIAN 395152 0 0 0 1793 0 22364 0 15673 0 434982 0 0 0 BECKY PAPE CEO 0 382885 0 0 0 54028 0 22364 0 30062 0 489339 0 0 DANIEL SMITH SVP FINANCE / CFO 0 402303 0 0 0 40109 0 57589 0 37068 0 537069 0 0 SCOTT WILSON VP ANCILLARY SUPPORT SVCS 195515 0 6709 0 9998 0 16071 0 13830 0 242123 0 0 0 WILLIAM HOWDEN VP NURSING GSRMC 202456 0 10094 0 5353 0 16724 0 28912 0 263539 0 0 0 KIMBERLY CLIFT VP OPS(AUG-DEC)/VP REV CYC(JAN-JULY) 102221 171815 0 13437 373 416 7001 15363 2810 5289 112405 206320 0 0 LUIS VELA DO PHYSICIAN 926310 0 10384 0 2322 0 22364 0 38939 0 1000319 0 0 0 DONALD PENNINGTON DO PHYSICIAN 750644 0 36687 0 13842 0 22364 0 36891 0 860428 0 0 0 J CHRISTOPHER NOONAN MD PHYSICIAN 762931 0 20000 0 3564 0 22364 0 36916 0 845775 0 0 0 JEFF HSING MD PHYSICIAN 544791 0 212744 0 1185 0 22364 0 34804 0 815888 0 0 0 DANIELA ALEXANDRU-ABRAMS MD PHYSICIAN 694125 0 0 0 26931 0 22364 0 36967 0 780387 0 0 0 STEVEN JASPERSON FORMER CEO / VP SO. CALIFORNIA OPS 0 24913 0 0 0 585911 0 14898 0 3094 0 628816 0 0 LARRY MULLINS DHA FORMER CEO / CEO SAM SOLUTIONS INST 0 454492 0 0 0 614424 0 22364 0 30246 0 1121526 0 250500 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. 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 THE EMPLOYEE'S TAXABLE WAGES AND IS SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. ONE OFFICER, ONE KEY EMPLOYEE, AND ONE HIGHEST PAID EMPLOYEE RECEIVED THIS TAXABLE GYM BENEFIT IN 2018. IF AN EMPLOYEE PARTICIPATES AT A SAMARITAN FITNESS CENTER (SAMFIT), MEMBERSHIP IS FREE OF CHARGE (PROVIDED AS A NONTAXABLE FRINGE BENEFIT). TWO HIGHEST PAID EMPLOYEES RECEIVED THE SAMFIT BENEFIT DURING 2018. 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, LINES 4A-B 4.A. STEVE JASPERSON, A FORMER OFFICER, RECEIVED TAXABLE COMPENSATION OF 408,013 PURSUANT TO THE TERMINATION OF HIS EMPLOYMENT CONTRACT. 4.B. THE ORGANIZATION MAINTAINS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. UNDER HIS PLAN, DANIEL SMITH ACCRUED DEFERRED COMPENSATION BENEFITS DURING 2018. LARRY MULLINS, DHA RECEIVED A PAYMENT FROM HIS PLAN DURING 2018. THIS PAYMENT WAS INCLUDED IN DR. MULLIN'S 2018 COMPENSATION ON SCHEDULE J AND FORM 990. 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 TWO NON-EMPLOYEE BOARD MEMBERS OF THE FILING ORGANIZATION ARE NOT INDEPENDENT DUE TO BUSINESS TRANSACTIONS WITH A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 4 SECTION 4.1 (PRINCIPAL OFFICERS) OF THE FILING ORGANIZATION'S BYLAWS WERE UPDATED AS FOLLOWS IN 2018: SAMARITAN HEALTH SERVICES (SHS), THE FILING ORGANIZATION'S SOLE MEMBER, APPOINTS THE FILING ORGANIZATION'S PRESIDENT/CEO, WHO IS RESPONSIBLE TO APPOINT ALL OTHER ADMINISTRATIVE OFFICERS. PREVIOUSLY, THIS POWER RESTED WITH THE FILING ORGANIZATION'S BOARD OF DIRECTORS. 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 -1,095,650. INCREASE IN MINIMUM PENSION LIABILITY 4,106,523. OTHER CHANGES 122,722. 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