2018-11-15T17:07:06-06:00 2017-12-31 930623286 ALDRICH CPAS AND BUSINESS ADVISORS LLP 5665 SW MEADOWS RD SUITE 200 LAKE OSWEGO OR 97035 990 2017-01-01 930391573 GOOD SAMARITAN HOSPITAL CORVALLIS GOOD 5417684773 C/O SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL SMITH VP FINANCE/CFO 5417684773 2018-11-15 JOYLYN ANKENEY P00366587 5036204489 192.101.73.50 2018-11-15 15:05:48 PS P 3179769CAEB5567C9954F4290B19374E137A7FE1 3179769CAEB5567C9954F4290B19374E137A7FE1 2017 2019-02-21 02:37:17Z GOOD SAMARITAN REGIONAL MEDICAL CTR BECKY PAPE 3600 NW SAMARITAN DR CORVALLIS OR 97330 424897313 0 X WWW.SAMHEALTH.ORG X 1948 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS MEDICAL AND SURGICAL HOSPITAL. 12 10 2655 272 339819 0 1580066 767265 400537481 417696798 621872 1364120 3236775 3212725 405976194 423040908 386807 263200 0 0 214885194 226856192 0 0 57860 197095264 205430945 412367265 432550337 -6391071 -9509429 176327990 180179878 85375359 92269685 90952631 87910193 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 391269001 417696798 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 THREE 'LEVEL 2' TRAUMA CENTERS IN THE STATE. DURING 2017, GSH SERVED 8,990 INPATIENTS, HAD 28,539 EMERGENCY DEPARTMENT VISITS, PERFORMED 9,853 SURGERIES AND DELIVERED 1,004 BABIES. IN ADDITION, GSH PERFORMED 86,161 IMAGING PROCEDURES, HAD 30,588 HOME HEALTH VISITS, AND HAD 254,451 PHYSICIAN CLINIC VISITS. 263200 263200 GRANTS AND ASSISTANCE PROVIDED BY GOOD SAMARITAN HOSPITAL CORVALLIS TO VARIOUS ORGANIZATIONS AND INDIVIDUALS TO SUPPORT THE MEDICAL, DENTAL, AND THE MENTAL HEALTH NEEDS OF LOW INCOME RESIDENTS OF THE LOCAL COMMUNITY. SEE PART IX, LINES 1 AND 2 AND RELATED SCHEDULE I FOR MORE DETAILS. 391532201 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 2655 1 1 1 0 0 0 0 0 0 0 0 0 X 12 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 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 0 650 0 BISHOP MICHAEL HANLEY BOARD MEMBER 1.00 X 0 0 0 TIM HENNESSY BOARD MEMBER 1.00 X 0 8087 0 SHIRLEY PETERSON 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 363238 0 27360 KATHARINE HARRIS BOARD MEMBER 1.00 X 0 0 0 BECKY PAPE CEO 39.00 1.00 X 0 431375 57894 DANIEL SMITH VP FINANCE / CFO 2.00 38.00 X 0 538570 93297 SCOTT WILSON VP ANCILLARY SUPPORT SVCS 40.00 X 197869 0 37973 WILLIAM HOWDEN VP NURSING GSRMC 40.00 X 194123 0 42289 LUIS VELA DO PHYSICIAN 40.00 X 894795 0 58530 DONALD PENNINGTON DO PHYSICIAN 40.00 X 809133 0 59488 J CHRISTOPHER NOONAN MD PHYSICIAN 40.00 X 752069 0 58650 JEFF HSING MD PHYSICIAN 40.00 X 699074 0 55890 TOSHIO NAGAMOTO MD PHYSICIAN 40.00 X 688378 0 57416 STEVEN JASPERSON FORMER CEO / VP SO. CALIFORNIA OPS. 0.00 40.00 X 0 485318 52274 LARRY MULLINS DHA FORMER CEO / SHS CEO 0.00 40.00 X 0 1640641 51454 4598679 3104641 652515 424 1 1 0 0 464014 20362 282889 767265 NET PATIENT REVENUE 622110 399454767 399454767 RETAIL PHARMACY 446110 12023107 12023107 QUALITY INCENTIVES 622110 3753799 3753799 OTHER PROGRAM SVC REV 900099 737403 737403 OTHER PATIENT REVENUE 622110 507834 507834 1219888 1219888 417696798 532313 532313 892270 170168 722102 722102 722102 1285640 1114071 750767 817137 534873 296934 831807 831807 458152 118333 339819 339819 CAFETERIA 722210 2150804 2150804 2150804 423040908 417696798 339819 4237026 203701 203701 59499 59499 862852 627009 235843 169654787 165835495 3807477 11815 12789014 12502563 285565 886 31682401 30972772 707434 2195 11867138 11601335 264981 822 72093 72093 38640 3000 35640 11676941 11545695 131246 42795 12331 30178 286 12109983 11662004 443628 4351 22541446 21820666 720780 5362484 5232542 129942 560295 537723 22572 764544 760165 4249 130 4569510 4423396 146114 8790650 8643548 146715 387 5088784 4676155 412629 MEDICAL SUPPLIES 70114334 70114334 PURCHASED SERVICES 44977696 11593069 33347639 36988 DUES, TAXES, & LICENSES 18720750 18705199 15551 432550337 391532201 40960276 57860 9883 9333 459260 663772 46673873 47721916 460026 1216963 7623030 7648449 1847880 1819838 228162632 133057969 96028481 95104663 17677211 20205305 330614 348723 5217732 5440916 176327990 180179878 25505171 24298650 967440 703356 68695 58834053 67267679 85375359 92269685 X 90952631 87910193 90952631 87910193 176327990 180179878 X -9509429 1516525 4950466 X 0 1 X 1 0 X 4478316 31737 699206 165208 5044051 4237438 66044 348421 173587 4478316 4497010 132523 -174642 217453 4237438 4427981 47952 161199 140122 4497010 3941086 235857 431637 180599 4427981 0.26290 0.66320 0.07390 0 1 1 1700000 358114 2058114 1617897 148951649 76876578 73692968 2379697 897838 1481859 63619660 49808001 13811659 9535615 5475552 4060063 95104663 PROFESSIONAL LIABILITY RESERVE 3096000 OTHER LIABILITIES 1560862 PAYABLE TO CONTRACTUAL AGENCIES 3678598 MINIMUM PENSION LIABILITY 29105836 ACCRUED INTEREST 910237 ACCOUNTS PAYABLE-AFFILIATES 28916146 67267679 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 PROVIDE GRADUATE MEDICAL EDUCATIONAL OPPORTUNITIES IN THE AREA OF PRIMARY AND INTERNAL MEDICINE. 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, 2017, 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 2014. 1 1 X 1 X 225.000000000000 1 X 1 1 1 0 1 1 16 17287 4534007 4534007 0.01050 12 91114 82243788 58751304 23492484 0.05430 28 108401 86777795 58751304 28026491 0.06480 11 25450 1191556 46480 1145076 0.00260 4 5003 14655872 9600870 5055002 0.01170 19 135392 49348977 31732453 17616524 0.04070 11 25227 753112 173829 579283 0.00130 45 191072 65949517 41553632 24395885 0.05630 73 299473 152727312 100304936 52422376 0.12110 1 755 14420 14420 0.00000 1 16 80763 80763 0.00020 2 771 95183 95183 0.00020 0 2532710 1141108 64028108 70916090 -6887982 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 A JV 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 X WWW.SAMHEALTH.ORG X WWW.SAMHEALTH.ORG 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. 37 1 - SAMARITAN MENTAL HEALTH - ALBANY 1052 SW 29TH ST ALBANY OR 97321 MENTAL HEALTH SERVICES 2 - SAMARITAN OCC MED - ALBANY 2615 WILLETTA ST SW STE C2 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 3521 NW SAMARITAN DR STE 201 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 9 - SAMARITAN PHYSICAL REHAB - CORVALLIS 815 NW 9TH ST STE 180 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 10 - SAMARITAN IMAGING SERVICES 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 - DR VELA 3620 NW SAMARITAN DR STE 201 CORVALLIS OR 97330 MEDICAL CLINIC - OUTPATIENT 19 - SAMARITAN ORTHOPEDICS CLINIC 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 & ONCOL CONSULT 501 NW ELKS DR CORVALLIS OR 97330 CANCER TREATMENT 27 - SAMARITAN CANCER RES CTR - CORVALLIS 501 NW ELKS DR CORVALLIS OR 97330 CANCER RESOURCE CENTER 28 - SAMARITAN URGENT CARE CENTER 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 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 PLASTICS RECON & 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 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 COMBINATION OF THE COST-TO-CHARGE RATIO AND COST ACCOUNTING SYSTEM CALCULATIONS IS USED SINCE NOT ALL SERVICES ARE TRACKED IN THE COST ACCOUNTING SYSTEM. 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 2017 IS 12,600,243 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. DURING 2017, GSRMC SERVED AS THE LEAD AGENCY TO CONDUCT THE SOLAR ECLIPSE PREPAREDNESS EVENT WITH LOCAL AGENCIES IN BENTON COUNTY. THIS INCLUDED HOLDING REGULAR COMMUNITY MEETINGS TO DEVELOP A READINESS PLAN FOR THE SOLAR ECLIPSE EVENT AS WELL AS RECRUITING AND TRAINING COMMUNITY VOLUNTEERS TO PARTICIPATE IN A SOLAR ECLIPSE DRILL. 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 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 3: LINE 3 REPRESENTS AN ESTIMATE OF THE AMOUNT INCLUDED IN BAD DEBT EXPENSE (LINE 2) THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, BUT FOR WHOM THE ORGANIZATION WAS NOT ABLE TO OBTAIN SUFFICIENT INFORMATION TO MAKE A DETERMINATION. THE METHODOLOGY USED TO ESTIMATE THIS POTENTIAL FINANCIAL ASSISTANCE IS BASED ON FINANCIAL ASSISTANCE APPLICATIONS DENIED DUE TO INCOMPLETE DOCUMENTATION, MULTIPLIED BY THE AVERAGE FINANCIAL ASSISTANCE WRITE-OFF FOR APPROVED APPLICATIONS. PART III, LINE 4: GOOD SAMARITAN HOSPITAL (GSH) IS THE LARGEST OF FIVE HOSPITALS OF SAMARITAN HEALTH SERVICES (SHS). AS A NETWORK, SHS PREPARES ITS FINANCIAL STATEMENTS ON A CONSOLIDATED BASIS. BAD DEBT EXPENSE IS DESCRIBED IN FOOTNOTE 2(O) ENTITLED "PROVISION FOR BAD DEBTS AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS", FOUND ON PAGES 11 & 12 OF THE 2017 SHS CONSOLIDATED FINANCIAL STATEMENTS. 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):116,349,058MEDICARE COSTS (BASED ON A COST-TO-CHARGE RATIO): 146,643,343UNPAID COST OF PROVIDING SERVICES TO ALL MEDICARE PATIENTS: -30,294,285 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 SERVE 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 2017 POPULATION ESTIMATES, BENTON COUNTY HAS A POPULATION OF 90,951 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 CHARTS BELOW DESCRIBE THE DEMOGRAPHICS OF BENTON COUNTY:RACE/ETHNICITY POPULATIONWHITE/CAUCASIAN 87.3%BLACK/AFRICAN AMERICAN 1.2%AMERICAN INDIAN/ALASKA NATIVE 0.9%ASIAN 6.5%HISPANIC 7.3%NATIVE HAWAIIAN/PACIFIC ISLANDER 0.3%REPORTING TWO OR MORE RACES 3.8%SOURCE: U.S. CENSUS BUREAU, 2017 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 $52,015UNEMPLOYMENT 2.8%POVERTY 18.4%EARLY PRENATAL CARE 79.6%IMMUNIZATIONS 67.0%UNINSURED CHILDREN 3.6%CHILD ABUSE 11.3/1000EARLY CHILDHOOD OBESITY 13.3%CHILDREN ON FREE AND REDUCED LUNCH 37.7%HOMELESS STUDENTS 4.3%TEEN PREGNANCY 7.7/1000HIGH SCHOOL GRADUATION RATES 82.1%JUVENILE ARRESTS 10.7/1000SOURCE: OREGON EMPLOYMENT DEPARTMENT DECEMBER 2017, OREGON DEPARTMENT OFEDUCATION, U.S. CENSUS BUREAU, 2017 CENSUS QUICK FACTS, PUBLIC LAW 94-171SUMMARY FILE, 2017 STATUS OF OREGON CHILDREN AND FAMILIES COUNTY DATABOOK 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 MISSION "TO ENHANCE COMMUNITY HEALTH AND ACHIEVE HIGH VALUE THROUGH QUALITY SERVICES ACROSS THE CONTINUUM OF CARE." THAT MISSION HAS RECENTLY CHANGED TO "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) 116896 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) 6667 PROVIDED FUNDING TO SUPPORT THE EMERGENCY SHELTER PROGRAM BENTON COUNTY PO BOX 3020 CORVALLIS OR 97339 936002285 GOV'T 5334 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) 5334 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 9317 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) 6667 FUNDING FOR TRANSITIONAL HOUSING TO HOMELESS YOUTH 6 TRANSPORTATION 504 17997 PATIENT ASSISTANCE 1 8725 MEALS 233 2303 BOOK MEALS FOR FAMILY MEMBERS OF PATIENTS ACCOMMODATIONS - PASTEGA HOUSE 5763 28309 BOOK TEMPORARY HOUSING FOR PATIENTS AND THEIR FAMILY MEMBERS SHELTER 1 2165 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 LINDA FOX MD BOARD MEMBER / PHYSICIAN 360950 0 0 0 2288 0 21912 0 5448 0 390598 0 0 0 BECKY PAPE CEO 0 349804 0 73200 0 8371 0 21912 0 35982 0 489269 0 0 DANIEL SMITH VP FINANCE / CFO 0 386522 0 37500 0 114548 0 57057 0 36240 0 631867 0 0 SCOTT WILSON VP ANCILLARY SUPPORT SVCS 181352 0 0 0 16517 0 14774 0 23199 0 235842 0 0 0 WILLIAM HOWDEN VP NURSING GSRMC 188964 0 0 0 5159 0 14373 0 27916 0 236412 0 0 0 LUIS VELA DO PHYSICIAN 892473 0 0 0 2322 0 21912 0 36618 0 953325 0 0 0 DONALD PENNINGTON DO PHYSICIAN 692209 0 103549 0 13375 0 21912 0 37576 0 868621 0 0 0 J CHRISTOPHER NOONAN MD PHYSICIAN 728505 0 20000 0 3564 0 21912 0 36738 0 810719 0 0 0 JEFF HSING MD PHYSICIAN 517126 0 180988 0 960 0 21912 0 33978 0 754964 0 0 0 TOSHIO NAGAMOTO MD PHYSICIAN 464871 0 203240 0 20267 0 21912 0 35504 0 745794 0 0 0 STEVEN JASPERSON FORMER CEO / VP SO. CALIFORNIA OPS. 0 385397 0 0 0 99921 0 21912 0 30362 0 537592 0 0 LARRY MULLINS DHA FORMER CEO / SHS CEO 0 831684 0 416250 0 392707 0 21912 0 29542 0 1692095 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. 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 AND ONE HIGHEST PAID EMPLOYEE RECEIVED THIS TAXABLE GYM BENEFIT IN 2017. IF AN EMPLOYEE PARTICIPATES AT A SAMARITAN FITNESS CENTER (SAMFIT), MEMBERSHIP IS FREE OF CHARGE (PROVIDED AS A NONTAXABLE FRINGE BENEFIT). ONE HIGHEST PAID EMPLOYEE RECEIVED THE SAMFIT BENEFIT DURING 2017. 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 4.B. THE ORGANIZATION MAINTAINS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. UNDER THESE PLANS, LARRY MULLINS, DHA AND DANIEL SMITH ACCRUED DEFERRED COMPENSATION BENEFITS DURING 2017. THEY ALSO RECEIVED PAYMENTS FROM THESE PLANS DURING 2017. THESE PAYMENTS WERE INCLUDED IN THEIR 2017 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 THE AUTHORITY OF THE CEO WAS MODIFIED IN THE ORGANIZATION'S BYLAWS, PER SECTION 4.8, SUCH THAT THE CEO NO LONGER NEEDS TO CONSULT WITH THE BOARD OF DIRECTORS REGARDING THE EMPLOYMENT AND DISCHARGE OF THE ORGANIZATION'S VICE PRESIDENTS. LANGUAGE WAS REMOVED FROM THE BYLAWS, SECTION 7.1.1, THAT STATED THAT THE FINANCE COMMITTEE WAS RESPONSIBLE FOR THE MAINTENANCE, DEVELOPMENT, AND LEASING OF THE REAL PROPERTY OF THE CORPORATION. ALSO, LANGUAGE WAS REMOVED THAT STATED THE COMMITTEE SHALL HAVE THE AUTHORITY TO HIRE OUTSIDE PROFESSIONALS TO AUDIT THE CORPORATION'S FINANCIAL RECORDS. THIS AUTHORITY RESTS WITH THE ORGANIZATION'S SOLE MEMBER, SAMARITAN HEALTH SERVICES (SHS). THE REMOVAL OF THIS LANGUAGE HARMONIZES THE ORGANIZATION'S BYLAWS WITH THE BYLAWS OF THE SOLE MEMBER, AND REFLECTS HOW SHS RETAINS AUTHORITY FOR CERTAIN MATTERS THAT ARE BEST HANDLED AT A SYSTEM-WIDE LEVEL FOR ALL OF SAMARITAN'S AFFILIATED ORGANIZATIONS. THE AUTHORITY OF THE BOARD OF DIRECTORS WAS MODIFIED IN THE ORGANIZATION'S BYLAWS, PER SECTION 7.1.4, SUCH THAT THEY MAY DELEGATE AUTHORITY TO THE EXECUTIVE COMMITTEE TO ACT ON BEHALF OF THE BOARD OF DIRECTORS. IT FURTHER CLARIFIES THAT THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE UNDER THE DIRECTION OF THE BOARD OF DIRECTORS AND MUST REPORT ITS ACTIONS TO THE BOARD AS THE BOARD MAY DIRECT. 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 -990,700. INCREASE IN MINIMUM PENSION LIABILITY 5,827,243. OTHER CHANGES 122,723. INTERCOMPANY TRANSFERS -8,800. 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