GOOD SAMARITAN HOSPITAL CORVALLIS: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: GOOD SAMARITAN HOSPITAL CORVALLIS (EIN 93-0391573)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-11-14
IRS object ID: 201703189349306610
Schema version: 2016v3.0
Source: Download XML · Original 990 at ProPublica

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

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

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-11-14T13:30:55-06:00	ReturnTs
Tax Period End	2016-12-31	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	930391573	EIN

Business Name BusinessName

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

Field	Value	IRS element (for citing)
Business Name Control	GOOD	BusinessNameControlTxt
Phone	5417684773	PhoneNum

US Address USAddress

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

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	DANIEL SMITH	PersonNm
Person Title	VP FINANCE/CFO	PersonTitleTxt
Phone	5417684773	PhoneNum
Signature	2017-11-10	SignatureDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	209.237.75.250	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2017-11-10	IPDt
IP Tm	15:05:58	IPTm
IP Timezone	PS	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	59652E4EB5EE42D6A476341002D5FB1D21634885	AtSubmissionCreationDeviceId
At Submission Filing Device Id	B66EAA5503DC61BC9FDA127200D93CF6872DA565	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2017-02-10 21:41:12Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

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

Field	Value	IRS element (for citing)
Principal Officer	BECKY PAPE	PrincipalOfficerNm

US Address USAddress

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

Field	Value	IRS element (for citing)
Gross Receipts	$406,341,443	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.SAMHEALTH.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1948	FormationYr
Legal Domicile State	OR	LegalDomicileStateCd
Activity Or Mission	TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS MEDICAL AND SURGICAL HOSPITAL.	ActivityOrMissionDesc
Voting Members Governing Body	12	VotingMembersGoverningBodyCnt
Voting Members Independent	10	VotingMembersIndependentCnt
Total Employee	2647	TotalEmployeeCnt
Total Volunteers	292	TotalVolunteersCnt
Total Gross UBI	$303,115	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$6,731,496	PYContributionsGrantsAmt
CY Contributions Grants	$1,580,066	CYContributionsGrantsAmt
PY Program Service Revenue	$370,433,780	PYProgramServiceRevenueAmt
CY Program Service Revenue	$400,537,481	CYProgramServiceRevenueAmt
PY Investment Income	$1,018,014	PYInvestmentIncomeAmt
CY Investment Income	$621,872	CYInvestmentIncomeAmt
PY Other Revenue	$4,303,874	PYOtherRevenueAmt
CY Other Revenue	$3,236,775	CYOtherRevenueAmt
PY Total Revenue	$382,487,164	PYTotalRevenueAmt
CY Total Revenue	$405,976,194	CYTotalRevenueAmt
PY Grants And Similar Paid	$316,084	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$386,807	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$194,098,591	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$214,885,194	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$163,866	CYTotalFundraisingExpenseAmt
PY Other Expenses	$171,843,081	PYOtherExpensesAmt
CY Other Expenses	$197,095,264	CYOtherExpensesAmt
PY Total Expenses	$366,257,756	PYTotalExpensesAmt
CY Total Expenses	$412,367,265	CYTotalExpensesAmt
PY Revenues Less Expenses	$16,229,408	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$6,391,071	CYRevenuesLessExpensesAmt
Total Assets BOY	$181,252,375	TotalAssetsBOYAmt
Total Assets EOY	$176,327,990	TotalAssetsEOYAmt
Total Liabilities BOY	$88,077,021	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$85,375,359	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$93,175,354	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$90,952,631	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	GOOD SAMARITAN HOSPITAL, CORVALLIS (GSH) ACHIEVES ITS MISSION OF IMPROVING THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS MEDICAL AND SURGICAL HOSPITAL AND HEALTHCARE CLINICS PROVIDING OUTPATIENT CARE SERVICES AT SEVERAL AREA LOCATIONS.GSH IS A MEMBER OF SAMARITAN HEALTH SERVICES (SHS), A REGIONAL NETWORK OF HOSPITALS, PHYSICIANS AND SENIOR CARE FACILITIES. THE NETWORK, FORMED IN THE LATE 1990'S, SERVES APPROXIMATELY 290,000 RESIDENTS IN LINN, BENTON, LINCOLN AND PORTIONS OF POLK AND MARION COUNTIES IN OREGON. IT IS LOCALLY OWNED, AND ITS BOARDS OF DIRECTORS INCLUDE HOSPITAL LEADERS, PHYSICIANS AND COMMUNITY REPRESENTATIVES. GSH PROVIDES HEALTHCARE SERVICES REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, DISABILITY OR AGE. THE MISSION OF GSH IS TO ENHANCE COMMUNITY HEALTH AND ACHIEVE HIGH VALUE THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. THE COLLECTIVE VISION OF THE SHS SYSTEM IS TO BE A VALUES-DRIVEN ORGANIZATION GOVERNED BY COMMUNITY MEMBERS, PHYSICIANS AND O	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$375,921,647	ExpenseAmt
Revenue	$400,537,481	RevenueAmt
Desc	GOOD SAMARITAN HOSPITAL CORVALLIS (GSH), THE LARGEST HOSPITAL IN LINN, BENTON AND LINCOLN COUNTIES, OFFERS MORE THAN 22 MEDICAL SPECIALTIES INCLUDING COMPREHENSIVE CANCER CARE, A FULL-SERVICE CARDIOLOGY AND VASCULAR SURGERY PROGRAM, A SLEEP LAB, 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 2016, GSH SERVED 9,181 INPATIENTS, HAD 27,912 EMERGENCY DEPARTMENT VISITS, PERFORMED 9,692 SURGERIES AND DELIVERED 1,090 BABIES. IN ADDITION, GSH PERFORMED 88,131 IMAGING PROCEDURES, HAD 33,243 HOME HEALTH VISITS, AND HAD 221,562 PHYSICIAN CLINIC VISITS.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$386,807	ExpenseAmt
Grant	$386,807	GrantAmt
Desc	GRANTS AND ASSISTANCE PROVIDED BY GOOD SAMARITAN HOSPITAL CORVALLIS TO VARIOUS ORGANIZATIONS AND INDIVIDUALS TO BENEFIT THE COMMUNITY. SEE PART IX, LINES 1 AND 2 AND RELATED SCHEDULE I FOR MORE DETAILS.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$376,308,454	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	Yes (1)	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	2647	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	12	GoverningBodyVotingMembersCnt
Independent Voting Member	10	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	OR	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

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

Field	Value	IRS element (for citing)
Phone	5417684773	PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
RICHARD CRONK MD
BOARD CHAIR	1.00	1.00	Yes (X)	Yes (X)	$0	$0	$0
JUDY LIST
BOARD VICE CHAIR	1.00	1.00	Yes (X)	Yes (X)	$0	$0	$0
REVEREND SIMON JUSTICE
BOARD SECRETARY	1.00		Yes (X)	Yes (X)	$0	$0	$0
NANCY SEIFERT
BOARD TREASURER	1.00		Yes (X)	Yes (X)	$0	$0	$0
CLIFFORD HALL MD
BOARD MEMBER	1.00		Yes (X)		$0	$1,300	$0
BISHOP MICHAEL HANLEY
BOARD MEMBER	1.00		Yes (X)		$0	$0	$0
TIM HENNESSY
BOARD MEMBER	1.00		Yes (X)		$0	$0	$0
SHIRLEY PETERSON
BOARD MEMBER	1.00	1.00	Yes (X)		$0	$0	$0
STEFAN SPANN MD
BOARD MEMBER	1.00		Yes (X)		$0	$2,000	$0
ERIC THOMPSON
BOARD MEMBER	1.00		Yes (X)		$0	$0	$0
STEVE UERLINGS
BOARD MEMBER	1.00	2.00	Yes (X)		$0	$0	$0
LYLE HUTCHENS
BOARD MEMBER	1.00		Yes (X)		$0	$0	$0
BECKY PAPE
CEO	39.00	1.00		Yes (X)	$0	$357,704	$55,331
DANIEL SMITH
VP FINANCE / CFO	2.00	38.00		Yes (X)	$0	$414,292	$90,454
RYAN COMBS
VP PRIMARY CARE SPEC PRACTICES	40.00				$207,157	$0	$38,369	Yes (X)
SCOTT WILSON
VP ANCILLARY SUPPORT SVCS	40.00				$193,852	$0	$44,174	Yes (X)
WILLIAM HOWDEN
VP NURSING GSRMC	40.00				$192,309	$0	$39,043	Yes (X)
MARK TAYLOR MD
PHYSICIAN	40.00				$1,221,608	$0	$51,271		Yes (X)
LUIS VELA DO
PHYSICIAN	40.00				$843,892	$0	$52,599		Yes (X)
J CHRISTOPHER NOONAN MD
PHYSICIAN	40.00				$736,582	$0	$52,401		Yes (X)
DONALD PENNINGTON DO
PHYSICIAN	40.00				$726,496	$0	$52,557		Yes (X)
JEFF HSING MD
PHYSICIAN	40.00				$747,123	$0	$51,973		Yes (X)
STEVEN JASPERSON
FORMER CEO / VP SO. CALIFORNIA OPS	0.00	40.00			$0	$457,459	$48,135			Yes (X)
LARRY MULLINS DHA
FORMER CEO / SHS CEO	0.00	40.00			$0	$1,180,286	$299,346			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$4,869,019	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,413,041	TotReportableCompRltdOrgAmt
Total Other Compensation	$875,653	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	383	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Related Organizations	$1,514,702	RelatedOrganizationsAmt
Government Grants	$24,095	GovernmentGrantsAmt
All Other Contributions	$41,269	AllOtherContributionsAmt
Total Contributions	$1,580,066	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT REVENUE	622110	$388,879,012	$388,879,012
RETAIL PHARMACY	446110	$9,210,338	$9,210,338
OTHER PATIENT REVENUE	622110	$1,742,512	$1,742,512
MEDICAL DIRECTOR FEES	900099	$328,033	$328,033
OTHER PROGRAM SVC REV	900099	$305,342	$305,342

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$72,244	TotalRevenueColumnAmt
Related Or Exempt Func Income	$72,244	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$400,537,481	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$564,702	TotalRevenueColumnAmt
Exclusion	$564,702	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$963,791	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$159,264	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$804,527	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$804,527	TotalRevenueColumnAmt
Exclusion	$804,527	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$98,075	SecuritiesAmt
Other	$81,925	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$23,435	SecuritiesAmt
Other	$99,395	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$74,640	SecuritiesAmt
Other	-$17,470	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$57,170	TotalRevenueColumnAmt
Exclusion	$57,170	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$386,270	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$83,155	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$303,115	TotalRevenueColumnAmt
Unrelated Business Revenue	$303,115	UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	CAFETERIA	Desc
Business	722210	BusinessCd
Total Revenue Column	$2,129,133	TotalRevenueColumnAmt
Exclusion	$2,129,133	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$2,129,133	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$405,976,194	TotalRevenueColumnAmt
Related Or Exempt Func Income	$400,537,481	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$303,115	UnrelatedBusinessRevenueAmt
Exclusion	$3,555,532	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$286,052	TotalAmt
Program Services	$286,052	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$100,755	TotalAmt
Program Services	$100,755	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$714,904	TotalAmt
Program Services	$476,878	ProgramServicesAmt
Management And General	$238,026	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$163,202,315	TotalAmt
Program Services	$159,389,854	ProgramServicesAmt
Management And General	$3,751,130	ManagementAndGeneralAmt
Fundraising	$61,331	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$12,003,854	TotalAmt
Program Services	$11,724,663	ProgramServicesAmt
Management And General	$274,700	ManagementAndGeneralAmt
Fundraising	$4,491	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$27,361,882	TotalAmt
Program Services	$26,725,487	ProgramServicesAmt
Management And General	$626,157	ManagementAndGeneralAmt
Fundraising	$10,238	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$11,602,239	TotalAmt
Program Services	$11,332,389	ProgramServicesAmt
Management And General	$265,509	ManagementAndGeneralAmt
Fundraising	$4,341	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$45,441	TotalAmt
Management And General	$45,441	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$55,585	TotalAmt
Program Services	$2,400	ProgramServicesAmt
Management And General	$53,185	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$12,540,923	TotalAmt
Program Services	$12,396,855	ProgramServicesAmt
Management And General	$142,601	ManagementAndGeneralAmt
Fundraising	$1,467	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$42,883	TotalAmt
Program Services	$16,100	ProgramServicesAmt
Management And General	$23,308	ManagementAndGeneralAmt
Fundraising	$3,475	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$13,810,908	TotalAmt
Program Services	$13,290,847	ProgramServicesAmt
Management And General	$482,044	ManagementAndGeneralAmt
Fundraising	$38,017	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$16,757,508	TotalAmt
Program Services	$16,156,370	ProgramServicesAmt
Management And General	$601,138	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$5,195,414	TotalAmt
Program Services	$5,059,059	ProgramServicesAmt
Management And General	$135,855	ManagementAndGeneralAmt
Fundraising	$500	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$709,053	TotalAmt
Program Services	$683,834	ProgramServicesAmt
Management And General	$22,049	ManagementAndGeneralAmt
Fundraising	$3,170	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$844,822	TotalAmt
Program Services	$832,666	ProgramServicesAmt
Management And General	$11,705	ManagementAndGeneralAmt
Fundraising	$451	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$5,292,228	TotalAmt
Program Services	$5,102,381	ProgramServicesAmt
Management And General	$189,847	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$9,959,631	TotalAmt
Program Services	$9,749,473	ProgramServicesAmt
Management And General	$209,542	ManagementAndGeneralAmt
Fundraising	$616	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$4,618,210	TotalAmt
Program Services	$4,211,654	ProgramServicesAmt
Management And General	$406,556	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
MEDICAL SUPPLIES	$66,541,943	$66,541,943
PURCHASED SERVICES	$42,556,471	$14,137,779	$28,383,784	$34,908
DUES, TAXES, & LICENSES	$18,124,244	$18,091,015	$32,368	$861

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$412,367,265	TotalAmt
Program Services	$376,308,454	ProgramServicesAmt
Management And General	$35,894,945	ManagementAndGeneralAmt
Fundraising	$163,866	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$11,109	BOYAmt
EOY	$9,883	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$823,575	BOYAmt
EOY	$459,260	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$48,289,711	BOYAmt
EOY	$46,673,873	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$196,114	BOYAmt
EOY	$460,026	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$7,468,394	BOYAmt
EOY	$7,623,030	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,676,419	BOYAmt
EOY	$1,847,880	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$233,203,638	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$137,175,157	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$99,968,656	BOYAmt
EOY	$96,028,481	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$16,486,395	BOYAmt
EOY	$17,677,211	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$281,180	BOYAmt
EOY	$330,614	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$6,050,822	BOYAmt
EOY	$5,217,732	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$181,252,375	BOYAmt
EOY	$176,327,990	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$25,831,630	BOYAmt
EOY	$25,505,171	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$1,257,377	BOYAmt
EOY	$967,440	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$3,708,000	BOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$1,126,425	BOYAmt
EOY	$68,695	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$56,153,589	BOYAmt
EOY	$58,834,053	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$88,077,021	BOYAmt
EOY	$85,375,359	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$93,175,354	BOYAmt
EOY	$90,952,631	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$93,175,354	BOYAmt
EOY	$90,952,631	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$181,252,375	BOYAmt
EOY	$176,327,990	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$6,391,071	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$622,343	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$3,546,005	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

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

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

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

Contributor US Address ContributorUSAddress

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

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

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,732,176	BeginningYearBalanceAmt
Contributions	$141,344	ContributionsAmt
Investment Earnings Or Losses	$449,896	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$238,106	GrantsOrScholarshipsAmt
End Year Balance	$6,085,310	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$6,118,410	BeginningYearBalanceAmt
Contributions	$136,267	ContributionsAmt
Investment Earnings Or Losses	-$233,344	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$289,157	GrantsOrScholarshipsAmt
End Year Balance	$5,732,176	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$6,035,183	BeginningYearBalanceAmt
Contributions	$61,783	ContributionsAmt
Investment Earnings Or Losses	$214,664	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$193,220	GrantsOrScholarshipsAmt
End Year Balance	$6,118,410	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,430,883	BeginningYearBalanceAmt
Contributions	$269,432	ContributionsAmt
Investment Earnings Or Losses	$578,249	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$243,381	GrantsOrScholarshipsAmt
End Year Balance	$6,035,183	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,758,581	BeginningYearBalanceAmt
Contributions	$316,843	ContributionsAmt
Investment Earnings Or Losses	$543,063	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$187,604	GrantsOrScholarshipsAmt
End Year Balance	$5,430,883	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.19480	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.80520	PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,096,814	OtherCostOrOtherBasisAmt
Book Value	$2,096,814	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$150,609,155	OtherCostOrOtherBasisAmt
Depreciation	$76,934,422	DepreciationAmt
Book Value	$73,674,733	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,364,049	OtherCostOrOtherBasisAmt
Depreciation	$773,202	DepreciationAmt
Book Value	$1,590,847	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$69,182,119	OtherCostOrOtherBasisAmt
Depreciation	$54,335,730	DepreciationAmt
Book Value	$14,846,389	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$8,951,501	OtherCostOrOtherBasisAmt
Depreciation	$5,131,803	DepreciationAmt
Book Value	$3,819,698	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$96,028,481	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDesc	AmtAmt
PROFESSIONAL LIABILITY RESERVE	$2,777,000
OTHER LIABILITIES	$1,326,858
PAYABLE TO CONTRACTUAL AGENCIES	$3,806,251
MINIMUM PENSION LIABILITY	$34,079,246
ACCRUED INTEREST	$933,869
ACCOUNTS PAYABLE-AFFILIATES	$15,910,829

Field	Value	IRS element (for citing)
Total Liability	$58,834,053	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART V, LINE 4:

THE BOARD-DESIGNATED AND GENERAL ENDOWMENTS ARE USED FOR GENERAL HOSPITAL SUPPORT. THE BERNIER ENDOWMENT IS USED FOR STAFF CONTINUING EDUCATION. THE ERKKILA ENDOWMENT IS USED FOR HEALTH AND HUMAN PERFORMANCE RESEARCH AND REHABILITATION. THE MULLINS SCHOLARSHIP ENDOWMENT IS USED TO SUPPORT EDUCATIONAL SCHOLARSHIPS. 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, 2016, 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 2013.

Schedule H IRS990ScheduleH

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

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	225.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Activities Or Programs	16	ActivitiesOrProgramsCnt
Persons Served	15299	PersonsServedCnt
Total Community Benefit Expns	$4,478,117	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$4,478,117	NetCommunityBenefitExpnsAmt
Total Expense	0.01090	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Activities Or Programs	12	ActivitiesOrProgramsCnt
Persons Served	88461	PersonsServedCnt
Total Community Benefit Expns	$83,249,986	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$60,838,303	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$22,411,683	NetCommunityBenefitExpnsAmt
Total Expense	0.05430	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	28	ActivitiesOrProgramsCnt
Persons Served	103760	PersonsServedCnt
Total Community Benefit Expns	$87,728,103	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$60,838,303	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$26,889,800	NetCommunityBenefitExpnsAmt
Total Expense	0.06520	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	12	ActivitiesOrProgramsCnt
Persons Served	26849	PersonsServedCnt
Total Community Benefit Expns	$870,903	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$8,921	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$861,982	NetCommunityBenefitExpnsAmt
Total Expense	0.00210	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Persons Served	19365	PersonsServedCnt
Total Community Benefit Expns	$17,546,889	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$9,147,899	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,398,990	NetCommunityBenefitExpnsAmt
Total Expense	0.02040	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	20	ActivitiesOrProgramsCnt
Persons Served	93081	PersonsServedCnt
Total Community Benefit Expns	$42,482,051	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$24,861,925	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$17,620,126	NetCommunityBenefitExpnsAmt
Total Expense	0.04270	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	11	ActivitiesOrProgramsCnt
Persons Served	25462	PersonsServedCnt
Total Community Benefit Expns	$739,603	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$172,903	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$566,700	NetCommunityBenefitExpnsAmt
Total Expense	0.00140	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	47	ActivitiesOrProgramsCnt
Persons Served	164757	PersonsServedCnt
Total Community Benefit Expns	$61,639,446	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$34,191,648	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$27,447,798	NetCommunityBenefitExpnsAmt
Total Expense	0.06660	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	75	ActivitiesOrProgramsCnt
Persons Served	268517	PersonsServedCnt
Total Community Benefit Expns	$149,367,549	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$95,029,951	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$54,337,598	NetCommunityBenefitExpnsAmt
Total Expense	0.13180	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	749	PersonsServedCnt
Total Community Benefit Expns	$15,326	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$15,326	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	336	PersonsServedCnt
Total Community Benefit Expns	$116,994	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$116,994	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	1085	PersonsServedCnt
Total Community Benefit Expns	$132,320	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$132,320	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReportedInd
Bad Debt Expense	$4,013,261	BadDebtExpenseAmt
Bad Debt Expense Attributable	$1,098,554	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$62,050,469	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$69,479,753	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$7,429,284	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

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

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (5 entries)

Primary ActivitiesPrimaryActivitiesTxt	Org Profit Or OwnershipOrgProfitOrOwnershipPct	Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
1 CORVALLIS MED BLDGS LLC
REAL PROPERTY RENTAL	0.54500	0.21500
2 HULL IMAGING LLC
IMAGING SERVICES	0.60000	0.40000
3 SAMARITAN ENDOSCOPY CENTER
MEDICAL SERVICES	0.66670	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

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

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

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

US Address USAddress

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

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

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

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

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	16	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	HTTP://WWW.SAMHEALTH.ORG/COMMUNITYSUPPORT	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	16	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	HTTP://WWW.SAMHEALTH.ORG/COMMUNITYSUPPORT	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	225.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	FPGFamilyIncmLmtDscntCarePct
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Other Method	Yes (X)	OtherMethodInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.SAMHEALTH.ORG	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.SAMHEALTH.ORG	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.SAMHEALTH.ORG	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
GOOD SAMARITAN HOSPITAL, CORVALLIS	PART V, SECTION B, LINE 5: THE STAFF FROM SAMARITAN HEALTH SERVICES COMMUNITY HEALTH PROMOTION DEPARTMENT PARTNERED WITH 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.

Field	Value	IRS element (for citing)
Facility	39	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (39 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - SAMARITAN MENTAL HEALTH - ALBANY
1052 SW 29TH ST	ALBANY	OR	97321	MENTAL HEALTH SERVICES
2 - SAMARITAN OCC MED - ALBANY
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 & METABOLIC SURG
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 MEDICINE
3517 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
8 - SAMARITAN FAMILY MED RESIDENT CLINIC
3517 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
9 - SAMARITAN OB & GYN RESIDENT CLINIC
3517 NW SAMARITAN DR STE 202	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
10 - SAMARITAN INTERNAL MEDICINE
3521 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
11 - SAMARITAN PHYSICAL REHAB - CORVALLIS
815 NW 9TH ST STE 180	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
12 - MAMMOGRAPHY CLINIC
3615 NW SAMARITAN DR	CORVALLIS	OR	97330	IMAGING SERVICES
13 - SAMARITAN ENDOCRINOLOGY
3615 NW SAMARITAN DR STE G2	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
14 - SAMARITAN DIABETES EDUCATION
3615 NW SAMARITAN DR STE G1	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
15 - CORVALLIS MRI
3615 NW SAMARITAN DR STE 101	CORVALLIS	OR	97330	IMAGING SERVICES
16 - SAMARITAN HEART & VASC - SURGERY
3615 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
17 - SAMARITAN SURGICAL SPECIALISTS
3615 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
18 - SAMARITAN KIDNEY SPECIALISTS
3615 NW SAMARITAN DR STE 203	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
19 - SAMARITAN NEUROSURGERY
3615 NW SAMARITAN DR STE 210	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
20 - OUTPATIENT SURGERY
3620 NW SAMARITAN DR	CORVALLIS	OR	97330	AMBULATORY SURGERY
21 - SAMARITAN ORTHOPEDICS - DR VELA
3620 NW SAMARITAN DR STE 201	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
22 - SAMARITAN ORTHOPEDICS CLINIC
3620 NW SAMARITAN DR STE 202	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
23 - SAMARITAN RHEUMATOLOGY
3620 NW SAMARITAN DR STE 203	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
24 - SAMARITAN NEUROMUSCULAR MED RESIDENT CL
3620 NW SAMARITAN DR STE 203A	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
25 - SAMARITAN INFECTIOUS DISEASE
3640 NW SAMARITAN DR	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
26 - SAMARITAN OBSTETRICS & GYN
3640 NW SAMARITAN DR	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
27 - SAMARITAN GYN & SURGICAL ASSOCIATES
400 NW WALNUT BLVD STE 300	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
28 - SAMARITAN PASTEGA REGIONAL CANCER CTR
441 NW ELKS DR	CORVALLIS	OR	97330	CANCER TREATMENT
29 - SAMARITAN HEMATOLOGY & ONCOLOGY CONSULT
501 NW ELKS DR	CORVALLIS	OR	97330	CANCER TREATMENT
30 - SAMARITAN CANCER RESOURCE CTR CORVALLIS
501 NW ELKS DR	CORVALLIS	OR	97330	CANCER RESOURCE CENTER
31 - SAMARITAN URGENT CARE CENTER
5234 SW PHILOMATH BLVD	CORVALLIS	OR	97333	MEDICAL CLINIC - OUTPATIENT
32 - SAMARITAN FAMILY MEDICINE SOUTHWEST
5234 SW PHILOMATH BLVD	CORVALLIS	OR	97333	MEDICAL CLINIC - OUTPATIENT
33 - SAMARITAM OCC MED - CORVALLIS
5234 SW PHILOMATH BLVD STE B	CORVALLIS	OR	97333	MEDICAL CLINIC - OUTPATIENT
34 - SAMARITAN PEDIATRICS
777 NW 9TH ST STE 320	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
35 - SAMARITAN ATHLETIC MEDICINE
845 SW 30TH ST	CORVALLIS	OR	97331	MEDICAL CLINIC - OUTPATIENT
36 - SAM CARE EXPRESS - CORVALLIS
990 NW CIRCLE BLVD STE 101	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
37 - SAMARITAN UROLOGY
990 NW CIRCLE BLVD STE 102	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
38 - SAMARITAN PLASTICRECON SURG - HAVARD
996 NW CIRCLE BLVD STE 103	CORVALLIS	OR	97330	MEDICAL CLINIC - OUTPATIENT
39 - SAMARITAN OCC MED - LEBANON
100 MULLINS DRIVE STE B2	LEBANON	OR	97355	MEDICAL CLINIC - OUTPATIENT

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 6A:	THE FILING ORGANIZATION SUBMITS AN ANNUAL COMMUNITY BENEFIT REPORT TO THE STATE OF OREGON. IN ADDITION, THE PARENT ORGANIZATION, SAMARITAN HEALTH SERVICES (SHS) PROVIDES AN ANNUAL REPORT TO THE COMMUNITY THAT INCLUDES COMMUNITY BENEFIT REPORTING FOR THE SYSTEM AS A WHOLE.
PART I, LINE 7:	THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN SCHEDULE H, PART I, LINE 7A AND 7B IS A COST-TO-CHARGE RATIO DERIVED USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES FROM THE SCHEDULE H INSTRUCTIONS. FOR LINE 7G, A 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 2016 IS 12,515,817
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 2016, GSH SERVED AS THE LEAD AGENCY TO CONDUCT DISASTER PREPAREDNESS DRILLS WITH LOCAL AGENCIES IN BENTON COUNTY. THIS INCLUDED HOLDING REGULAR COMMUNITY MEETINGS TO REVIEW AND UPDATE THE COMMUNITY DISASTER PREPAREDNESS PLAN, IDENTIFING DISASTER DRILL DATES, ORGANIZING THE DISASTER PREPAREDNESS DRILL AND RECRUITING AND TRAINING COMMUNITY VOLUNTEERS TO SERVE AS VICTIMS DURING THE 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 2016 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):121,028,109MEDICARE COSTS (BASED ON A COST-TO-CHARGE RATIO): 138,026,009UNPAID COST OF PROVIDING SERVICES TO ALL MEDICARE PATIENTS: -16,997,900
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 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. 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 87.9%BLACK/AFRICAN AMERICAN 1.2%AMERICAN INDIAN/ALASKA NATIVE 0.9%ASIAN 6.2%HISPANIC 7.3%NATIVE HAWAIIAN/PACIFIC ISLANDER .3%REPORTING TWO OR MORE RACES 3.6%SOURCE: U.S. CENSUS BUREAU, 2016 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 $49,802UNEMPLOYMENT 4.3%POVERTY 18.3%HOMELESSNESS(ADULTS) 918EARLY PRENATAL CARE 82.8%IMMUNIZATIONS 60.4%UNINSURED CHILDREN 4.6%CHILD CARE SLOTS 22/100CHILD ABUSE 7.9/1000EARLY CHILDHOOD OBESITY 20.6%CHILDREN ON FREE AND REDUCED LUNCH 38.3%CHILDREN ENROLLED WITH A DENTAL CARE ORGANIZATION 89.3%HOMELESS STUDENTS 254TEEN PREGNANCY 8.1/1000HIGH SCHOOL GRADUATION RATES 85.7%JUVENILE ARRESTS 11/10008TH GRADE ALCOHOL USE 13.7%8TH GRADE DRUG USE 6.4%THERE IS NO ACCURATE WAY TO COUNT THE NUMBER OF HOMELESS PEOPLE IN A COUNTY. HOMELESS DATA IS BASED ON LOCAL AGENCIES SERVING BENTON COUNTY DURING 2016. NUMBERS MAY BE DUPLICATED.THE INFORMATION LISTED ABOVE WAS OBTAINED FROM VARIOUS LOCAL, STATE AND FEDERAL DATABASES USING THE MOST RECENT AVAILABLE DATA BETWEEN THE YEARS 2012 - 2016.
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 COMMITMENT OF, AND THE MOTIVATION FOR, 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 TO BUILD HEALTHIER COMMUNITIES, THEY WERE DRAWN BY A SHARED MISSION "TO ENHANCE COMMUNITY HEALTH AND ACHIEVE HIGH VALUE THROUGH QUALITY SERVICES ACROSS THE CONTINUUM OF CARE." THAT MEANS 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 SUCCESSFULLY OPERATE AS A VALUES-DRIVEN, CHURCH-RELATED ORGANIZATION GOVERNED BY A PARTNERSHIP OF COMMUNITY MEMBERS, PHYSICIANS AND OTHER HEALTH CARE PROVIDERS. SHS SEEKS TO LEAD COLLABORATIVE EFFORTS AMONG PROVIDERS, EMPLOYERS, HEALTH PLANS AND CONSUMERS WHO SHARE SIMILAR GOALS AND VALUES TO MEET THE CHALLENGES OF THE FUTURE.GSH IS THE FLAGSHIP HOSPITAL OF SHS. IT PRIMARILY SERVES RESIDENTS OF BENTON COUNTY. OTHER AFFILIATED HOSPITALS ARE ALBANY GENERAL HOSPITAL AND SAMARITAN LEBANON COMMUNITY HOSPITAL, SERVING RESIDENTS OF LINN COUNTY, AND SAMARITAN NORTH LINCOLN HOSPITAL AND SAMARITAN PACIFIC COMMUNITIES HOSPITAL, SERVING RESIDENTS OF LINCOLN COUNTY.
PART VI, LINE 7, REPORTS FILED WITH STATES	OR

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (16 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
COMMUNITY OUTREACH
865 REIMAN AVENUE	CORVALLIS	OR	97330	930602094	501(C)(3)	$107,796	MEDICAL, DENTAL, MENTAL HEALTH CLINICS
OLD MILL CENTER
1650 SW 45TH PLACE	CORVALLIS	OR	97333	930722603	501(C)(3)	$10,000	FUNDING FOR RESPITE SERVICES TO FAMILIES ENROLLED IN THE RELIEF NURSERY PROGRAM
ALBANY HELPING HANDS
PO BOX 2252	ALBANY	OR	97321	931244271	501(C)(3)	$9,600	SUPPORT FOR HOMELESS PEOPLE
CENTER AGAINST RAPE & DOMESTIC VIOLENCE
PO BOX 914	CORVALLIS	OR	97339	930792125	501(C)(3)	$21,000	PROVIDED FUNDING TO SUPPORT THE EMERGENCY SHELTER PROGRAM
BENTON COUNTY
PO BOX 3020	CORVALLIS	OR	97339	936002285	GOV'T	$10,656	FUNDING FOR PEOPLE ENTERING THE DRUG COURT PROGRAM
BENTON COUNTY
PO BOX 3020	CORVALLIS	OR	97339	936002285	GOV'T	$20,000	FUNDING FOR A 10 YR PLAN TO END HOMELESSNESS IN BENTON COUNTY OREGON
BENTON COUNTY
PO BOX 3020	CORVALLIS	OR	97339	936002285	GOV'T	$20,100	FUNDING TO SUPPORT THE BENTON COUNTY ORAL HEALTH COALITION ADULT EMERGENCY VOUCHER DENTAL PROGRAM
STRENGTHENING RURAL FAMILIES
PO BOX 1528	PHILOMATH	OR	97370	202934930	501(C)(3)	$7,800	PROVIDED FUNDING FOR DENTAL VANS FOR RURAL BENTON COUNTY OREGON
LOVE IN THE NAME OF CHRIST OF BENTON COUNTY
PO BOX 270	CORVALLIS	OR	97339	931326307	501(C)(3)	$6,100	FUNDING FOR ADULT EMERGENCY VOUCHER DENTAL PROG AND DENTAL VANS IN THE CORVALLIS OREGON AREA
JACKSON STREET YOUTH SHELTER INC
PO BOX 285	CORVALLIS	OR	97339	931269503	501(C)(3)	$15,000	FUNDING FOR TRANSITIONAL HOUSING TO HOMELESS YOUTH
ABC HOUSE
PO BOX 68	ALBANY	OR	97321	931163555	501(C)(3)	$7,500	FUNDING FOR A MEDICAL DIRECTOR POSITION TO CONDUCT CHILD ABUSE ASSESSMENTS
COMMUNITY SERVICES CONSORTIUM
545 SW SECOND ST A	CORVALLIS	OR	97333	936118438	115(1)	$12,000	FUNDING FOR A MENTAL HEALTH COUNSELOR TO SUPPORT YOUTH IN BENTON COUNTY OREGON
CORVALLIS DAYTIME DROP-IN CENTER
316 SW WASHINGTON AVE	CORVALLIS	OR	97333	800019915	501(C)(3)	$6,000	FUNDING FOR TRANSPORTATION AND CO-PAY FOR MEDICAL TREATMENT
CORVALLIS ENVIRONMENTAL CENTER
PO BOX 2189	CORVALLIS	OR	97339	931140056	501(C)(3)	$7,500	FUNDING TO SUPPORT SCHOOL AND COMMUNITY GARDENS IN CORVALLIS OREGON
OREGON CASCADES WEST SENIOR SERVICES FOUNDATION
1400 QUEEN AVENUE SE 206	ALBANY	OR	97322	931213218	501(C)(3)	$10,000	FUNDING TO PURCHASE MEALS FOR SENIORS AND PEOPLE WITH DISABILITIES IN BENTON COUNTY OREGON
VINA MOSES WELFARE CENTER
968 NW GARFIELD AVE	CORVALLIS	OR	97330	930615775	501(C)(3)	$7,000	FUNDING TO SUPPORT RENTAL AND UTILITY ASSISTANCE TO FAMILIES IN BENTON COUNTY OREGON

Field	Value	IRS element (for citing)
Total501c3 Org	13	Total501c3OrgCnt
Total Other Org	1	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (4 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc
TRANSPORTATION	410	$42,749
PATIENT ASSISTANCE	1	$300
MEALS	390		$3,812	BOOK	MEALS FOR FAMILY MEMBERS OF PATIENTS
ACCOMMODATIONS - PASTEGA HOUSE	6946		$53,894	BOOK	TEMPORARY HOUSING FOR PATIENTS AND THEIR FAMILY MEMBERS

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 2:	FormAndLineReferenceDesc
Explanation	AGENCIES IN THE COMMUNITY ARE INVITED TO SUBMIT GRANT PROPOSALS THROUGH AN APPLICATION PROCESS. A COMMITTEE REVIEWS THE APPLICATIONS TO DETERMINE IF THE FUNDS REQUESTED WILL BE USED TO ADDRESS THE ORGANIZATION'S ESTABLISHED COMMUNITY HEALTH PRIORITIES, IDENTIFIED NEEDS, AND SUPPORTS THE ORGANIZATION'S MISSION. ONCE APPROVED AND FUNDED, AGENCIES MUST SUBMIT A COMPLETE ANNUAL REPORT DESCRIBING HOW THE FUNDS WERE USED, THE NUMBER OF CLIENTS SERVED, AND HOW OUTCOMES WERE ACHIEVED.	ExplanationTxt

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
BECKY PAPE
CEO	$0	$349,757	$0	$0	$0	$7,947	$0	$21,760	$0	$33,571	$0	$413,035	$0	$0
DANIEL SMITH
VP FINANCE / CFO	$0	$367,808	$0	$37,506	$0	$8,978	$0	$56,906	$0	$33,548	$0	$504,746	$0	$0
RYAN COMBS
VP PRIMARY CARE SPEC PRACTICES	$187,530	$0	$19,289	$0	$338	$0	$16,464	$0	$21,905	$0	$245,526	$0	$0	$0
SCOTT WILSON
VP ANCILLARY SUPPORT SVCS	$172,009	$0	$6,500	$0	$15,343	$0	$14,846	$0	$29,328	$0	$238,026	$0	$0	$0
WILLIAM HOWDEN
VP NURSING GSRMC	$180,656	$0	$8,000	$0	$3,653	$0	$14,630	$0	$24,413	$0	$231,352	$0	$0	$0
MARK TAYLOR MD
PHYSICIAN	$949,448	$0	$63,554	$0	$208,606	$0	$21,760	$0	$29,511	$0	$1,272,879	$0	$0	$0
LUIS VELA DO
PHYSICIAN	$842,493	$0	$0	$0	$1,399	$0	$19,229	$0	$33,370	$0	$896,491	$0	$0	$0
J CHRISTOPHER NOONAN MD
PHYSICIAN	$714,260	$0	$20,000	$0	$2,322	$0	$16,460	$0	$35,941	$0	$788,983	$0	$0	$0
DONALD PENNINGTON DO
PHYSICIAN	$586,130	$0	$126,833	$0	$13,533	$0	$21,760	$0	$30,797	$0	$779,053	$0	$0	$0
JEFF HSING MD
PHYSICIAN	$529,391	$0	$217,192	$0	$540	$0	$21,760	$0	$30,213	$0	$799,096	$0	$0	$0
STEVEN JASPERSON
FORMER CEO / VP SO. CALIFORNIA OPS	$0	$386,143	$0	$0	$0	$71,316	$0	$21,760	$0	$26,375	$0	$505,594	$0	$0
LARRY MULLINS DHA
FORMER CEO / SHS CEO	$0	$791,526	$0	$0	$0	$388,760	$0	$272,260	$0	$27,086	$0	$1,479,632	$0	$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 1A	IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM/FITNESS FACILITY BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. 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. NO PERSONS LISTED ON PART VII RECEIVED THIS TAXABLE GYM BENEFIT IN 2016. IF AN EMPLOYEE PARTICIPATES AT A SAMARITAN FITNESS CENTER (SAMFIT), MEMBERSHIP IS FREE OF CHARGE (PROVIDED AS A NONTAXABLE FRINGE BENEFIT). ONE KEY EMPLOYEE RECEIVED THE SAMFIT BENEFIT DURING 2016.
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. MARK TAYLOR, MD, A HIGHEST PAID EMPLOYEE, RECEIVED $436,096 IN TAXABLE COMPENSATION PURSUANT TO HIS SEPARATION FROM THE FILING ORGANIZATION. 4.B. THE ORGANIZATION MAINTAINS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. UNDER THESE PLANS, LARRY MULLINS, DHA, AND DANIEL SMITH ACCRUED DEFERRED COMPENSATION BENEFITS DURING 2016. LARRY MULLINS, DHA RECEIVED A PAYMENT IN 2016 FROM HIS PLAN, WHICH IS INCLUDED IN HIS 2016 COMPENSATION ON SCHEDULE J AND FORM 990. DANIEL SMITH RECEIVED NO PAYMENTS FROM HIS PLAN IN 2016.
PART I, LINE 5	VARIOUS PHYSICIAN COMPENSATION METHODOLOGIES ARE UTILIZED AND, DEPENDING ON SPECIALTY, RELATIVE VALUE UNITS (RVU'S) MAY BE USED IN DETERMINING A PORTION OF OR ALL OF THEIR COMPENSATION.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1	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 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 ALL KIOSKS AND HIGH-TRAFFIC AREAS OF ALL 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 ALL 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 -1,230,000. INCREASE IN MINIMUM PENSION LIABILITY 4,653,282. OTHER CHANGES 122,723.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)

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

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct	Direct Controlling NADirectControllingNACd
SAMARITAN ENDOSCOPY CENTER LLC
3600 NW SAMARITAN DR	CORVALLIS	OR	97330	202860067	MEDICAL SERVICES	OR	GOOD SAMARITAN HOSPITAL	RELATED	$19,471	$199,202	0	Yes (1)	0.66660
CORVALLIS MEDICAL BUILDINGS LLC
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	931257913	REAL ESTATE RENTAL	OR	GOOD SAMARITAN HOSPITAL	EXCLUDED	$171,252	$1,079,559	0	Yes (1)	0.54500
EAST LINN MRI LLC
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	320229399	IMAGING	OR								N/A
HULL IMAGING LLC
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	203255479	IMAGING	OR	GOOD SAMARITAN HOSPITAL	RELATED	$919,549	$30,617	0	Yes (1)	0.60000
CORVALLIS MRI A JOINT VENTURE
3615 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	930949704	IMAGING	OR	GOOD SAMARITAN HOSPITAL	RELATED	$303,200	$20,132	0	Yes (1)	0.50000
MID-VALLEY MEDICAL PROPERTIES ASSOC LLC
1046 SIXTH AVE SW	ALBANY	OR	97321	300508747	REAL ESTATE RENTAL	OR								N/A
MID-VALLEY MEDICAL BUILDINGS LLC
PO BOX 557	LEBANON	OR	97355	931126353	REAL ESTATE RENTAL	OR								N/A
NORTHWEST MEDICAL ISOTOPES LLC
815 NW 9TH ST STE 256	CORVALLIS	OR	97330	273007752	RESEARCH	OR								N/A
CASCADE VIEW MEDICAL OFFICE BUILDING LLC
PO BOX 3000	CORVALLIS	OR	973393000	300658805	REAL ESTATE RENTAL	OR	GOOD SAMARITAN HOSPITAL	EXCLUDED	$47,709	$1,526,082	0	Yes (1)	0.26300

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
SAMARITAN HEALTH PLANS INC
3600 NW SAMARITAN DRIVE	CORVALLIS	OR	97330	930860860	HEALTH INSURANCE CARRIER FOR THE COMMUNITY	OR	N/A	C	0
BOULDER FALLS PROPERTIES LLC
PO BOX 3000	CORVALLIS	OR	973393000	465293120	EVENT CENTER & HOSPITALITY SVCS	OR	N/A	C	0
SYNERGY SURGICALISTS INC
678 SIMMONS LANE	BOZEMAN	MT	59715	454639673	ORTHOPEDIC & GENERAL SURGERY CARE	MT	N/A	S	0

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

Transactions Related Org TransactionsRelatedOrgGrp (13 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
INTERCOMMUNITY HEALTH PLANS INC
L	$29,787,791	COST
SAMARITAN ENDOSCOPY CENTER LLC
A	$412,773	COST
SAMARITAN ENDOSCOPY CENTER LLC
S	$240,000	COST
CORVALLIS MEDICAL BUILDINGS LLC
A	$49,300	COST
CORVALLIS MEDICAL BUILDINGS LLC
S	$218,000	COST
CORVALLIS MEDICAL BUILDINGS LLC
K	$562,075	COST
HULL IMAGING LLC
A	$46,512	COST
HULL IMAGING LLC
O	$605,478	COST
HULL IMAGING LLC
S	$924,000	COST
HULL IMAGING LLC
L	$460,883	COST
GOOD SAMARITAN HOSPITAL FOUNDATION
C	$1,462,552	COST
GOOD SAMARITAN HOSPITAL FOUNDATION
O	$215,285	COST
GOOD SAMARITAN HOSPITAL FOUNDATION
R	$84,806	COST