2016-05-10T10:19:44-05:00 2015-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-07-01 930425580 Good Shepherd Health Care System GOOD 5416673400 610 NW 11th Street Hermiston OR 97838 Dennis Burke President/CEO 5416673400 2016-05-09 1 Kim Hunwardsen CPA P00484560 6122536500 2016-05-09 2014 2016-08-17 19:52:53Z Good Shepherd Medical Center Dennis Burke 610 NW 11th Street Hermiston OR 97838 98414047 0 X www.gshealth.org X 1953 OR Hospital and health care services. 12 11 715 127 0 0 125663 186830 83761041 92218289 4321534 5890689 119592 118239 88327830 98414047 313800 252500 0 0 41975186 44390666 0 0 0 32244427 33195723 74533413 77838889 13794417 20575158 147108147 162828971 14262394 13767727 132845753 149061244 X To provide compassionate, high quality, and accessible health care and to promote a healthy community. 0 0 71866847 252500 92218289 Good Shepherd Health Care System (GSHCS) served 1,842 inpatients over 4,854 patient-days and 51,304 outpatients in fiscal year 2014-15, as well as 19,626 patients in our Emergency Center. Although reimbursement for services rendered is critical to the operations and stability of GSHCS, not all individuals have the ability to purchase essential medical services. In recognition of this, during FY 2014-15 GSHCS wrote off to collection $1,929,398 valued at charges foregone as bad debt. Direct charity care to our community amounted to an additional $2,707,097, valued at charges foregone. GSHCS provides care to persons covered by governmental programs at deeply discounted rates. Recognizing its mission to the community, services were provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients during fiscal year 2014-15 was $46,156,377, valued at charges foregone.Our Emergency Center is open around-the-clock to all community members, visitors, and travelers, without regard to one's ability to pay. 71866847 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 190 0 1 715 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X Jan Peter 5416673416 610 NW 11th Street Hermiston OR 97838 Steve Eldrige Chair 2.00 0.00 X X 0 0 0 Nancy Mabry Vice Chair 2.00 0.00 X X 0 0 0 Dr Derek Earl Secretary 2.00 0.00 X X 0 0 0 Tom Wamsley Treasurer 2.00 1.00 X X 0 0 0 Bob Carlson Director 2.00 0.00 X 0 0 0 Arnell Eynon Director (partial year) 2.00 2.00 X 0 0 0 Sue Daggett Director 2.00 0.00 X 0 0 0 Rachel Archer Director 2.00 0.00 X 0 0 0 Gabino Gispert Director 2.00 0.00 X 0 0 0 Richard Lindner Director (partial year) 2.00 1.00 X 0 0 0 Tricia Fenley Director (partial year) 2.00 1.00 X 0 0 0 Dennis E Burke President/CEO 40.00 0.00 X 374894 0 52186 Jan D Peter VP/CFO 40.00 0.00 X 212825 0 40887 Jim Schlenker VP/COO (Mar-June) 40.00 0.00 X 0 0 0 David T Hughes VP/COO (Jul-Jan) 40.00 0.00 X 197688 0 0 Dr Olga Stobart Hospitalist 40.00 0.00 X 380286 0 10400 Dr Mark Donnelly Physician - ER Doctor 40.00 0.00 X 341201 0 34691 Dr Thomas J Holt Physician - Urologist 40.00 0.00 X 362460 0 28431 Dr Kim A Peterson Physician - ER Doctor 40.00 0.00 X 315125 0 24808 Dr Leonidez De Guzman Physician - IM 40.00 0.00 X 279844 0 24940 2464323 0 216343 8 0 1 0 McCormack Construction Corp 422 SW 6th Pendleton OR 97801 Construction 6110512 Rehab Associates 600 NW 11th St Ste E31 Hermiston OR 97838 Physical Therapy 1281020 Tualatin Imaging 6464 SW Boreland Rd Suite A-4 Tualitin OR 97062 Diagnostic Imaging 1147824 Peterson Kolberg & Associates 6969 SW Hampton Portland OR 97223 Architecture 931249 Medical Doctor Assoc Inc PO Box 277185 Atlanta GA 30384 Locum Doctors 472304 17 21388 165442 186830 Net Patient Services 622110 89129282 89129282 Other Supporting Revenue 900099 1814294 1814294 Cafeteria 900099 568605 568605 Income from Subsidiary 446110 452593 452593 Daycare 900099 253515 253515 92218289 2412388 2412388 118239 0 118239 118239 118239 3470015 8286 0 0 3470015 8286 3478301 3478301 98414047 92218289 0 6008928 X 252500 252500 913871 913871 34872004 33067590 1804414 1501624 1423924 77700 4980466 4722757 257709 2122701 1967418 155283 34406 34406 60144 60144 134828 134828 10598956 8443702 2155254 143953 130112 13841 9748890 9567986 180904 763447 763447 383941 329498 54443 129245 129245 4604 4604 4568178 4568178 550579 550579 Medical Supplies 3788437 3788437 Bad Debts 1929398 1929398 Taxes & Licenses 121671 121671 235046 235046 77838889 71866847 5972042 0 6122733 5403892 12019309 13039528 13056234 13056234 2233847 2257778 1388640 1287381 112257632 52551788 50747247 59705844 63147316 69996948 630000 630000 -6567963 -6120557 4330784 3571923 147108147 162828971 8493670 8856142 570357 5198367 4911585 14262394 13767727 X 132312481 148500712 533272 560532 132845753 149061244 147108147 162828971 20575158 -4354482 -5185 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2860961 951448 3812409 45688026 20402748 25285278 41598384 30800140 10798244 21158813 1348900 19809913 59705844 Estimated 3rd party payor settlements 1383024 Capital Lease Obligations 3528561 4911585 X 96070061 -2161387 -2161387 98231448 134828 47771 182599 98414047 75522163 0 75522163 134828 2181898 2316726 77838889 Part X, Line 2: GSHCS is organized as an Oregon non-profit corporation and has been recognized by the Internal Revenue Services (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). GSHCS is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, GSHCS is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. GSHCS has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Hospital's federal Form 990 and 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2012. Part XI, Line 2d - Other Adjustments: Grants to Other Organizations recorded in Revenue on the F/S -252,500. Net Assets released from Restrictions recorded in Revenue on the F/S 20,511. Provisions for Bad Debt recorded in Revenue on the F/S -1,929,398. Part XI, Line 4b - Other Adjustments: Contributions recorded in Net Assets on the F/S 47,771. Part XII, Line 4b - Other Adjustments: Grants to Other Organizations recorded in Revenue on the F/S 252,500. Provisions for Bad Debt recorded in Revenue on the F/S 1,929,398. 1 1 X 1 X 138.000000000000 1 X 275.000000000000 1 1 1 0 1 1 1377000 1377000 0.01810 19469659 19077519 392140 0.00520 20846659 19077519 1769140 0.02330 2169 10000 585691 117420 468271 0.00620 239661 6573 233088 0.00310 252500 252500 0.00330 2169 10000 1077852 123993 953859 0.01260 2169 10000 21924511 19201512 2722999 0.03590 0 1929398 62234 17710771 18640156 -929385 X 1 1 1 1 Good Shepherd Health Care System 610 NW 11th Street Hermiston OR 97838 www.gshealth.org 055598-6 X X X X Good Shepherd Health Care System 1 0 0 1 X X X X X X X X 12 1 1 0 1 X http://gshcs.net/pub/gschf-chna.pdf X X 1 12 1 See Part V 0 0 1 X 138.000000000000 275.000000000000 X X 1 1 X X X X 1 X http://gshcs.net/pub/gshcs-charity-care-policy.pdf X http://gshcs.net/pub/gshcs-charity-care-policy.pdf X X X 1 X 0 X X X X 1 X 0 0 Good Shepherd Health Care System Part V, Section B, Line 5: The needs assessment was envisioned, designed, and executed by dozens of community leaders and members representing healthcare, public health, law enforcement, education, and social services. The assessment was conducted in partnership with St. Anthony Hospital in Pendleton, OR. The assessment process included regular consultation with the local Healthy Communities Coalition, a grass-roots advisory committee comprised of 35 community members of diverse background and professions. Good Shepherd Health Care System Part V, Section B, Line 6a: The CHNA was conducted with St. Anthony Hospital, Pendleton, OR. Good Shepherd Health Care System Part V, Section B, Line 7d: The CHNA was made widely available through a newspaper article providing a synopsis of the assessment's findings, as well as public forums discussing the assessment's findings. Good Shepherd Health Care System Part V, Section B, Line 11: The following prioritized health needs were determined by CHNAs for Umatilla and Morrow counties, along with their current mitigation strategies:1. Obesity: Healthy Communities Coalition provided nutritional guideline presentations in schools and workplaces, along with ad hoc community nutrition classes.2. Mental Health: Good Shepherd will provide corporate support (friendship lease of land) for Lifeways acute inpatient mental health center in Hermiston (groundbreaking started in summer of 2014).3. Alcohol/drug addiction: Supported recruitment of additional mental health practitioners with addiction mitigation expertise. Established pain clinic with pain control specialist at Good Shepherd.4. Diabetes: Continued active diabetes education program, open to the public without restrictions on ability to pay.5. Tobacco use: Not currently addressed by Good Shepherd in deference to public health programs in place. Good Shepherd regularly offers tobacco cessation classes and support. Good Shepherd Health Care System Part V, Section B, Line 16i: A summary of the FAP is distributed in unemployment offices and other areas in the community that target the eligible population. A summary is also available at local physician offices, admissions offices, and sent with billings invoices. Also, upon discharge, a patient financial representative meets with patients to discuss their ability to pay for services. Included as part of this discussion is a summary of the FAP. Schedule H, Part V, Section B, Line 10a: http://www.co.umatilla.or.us/health/main/Health_Improvement_Plan.pdf Part V, Section B, Line 16 Financial Assistance Policy Website Availability Good Shepherd Health Care System Part V, Section B, line 16a website: http://gshcs.net/pub/gshcs-charity-care-policy.pdf Good Shepherd Health Care System Part V, Section B, line 16c website: http://gshcs.net/pub/gshcs-charity-care-policy.pdf 3 Good Shepherd Medical Group 610 NW 11th Street Hermiston OR 97838 Clinic Vange John Memorial Hospice 610 NW 11th Street Hermiston OR 97838 Hospice TLC Home Health 610 NW 11th Street Hermiston OR 97838 Home Health Part I, Line 6a: The state posts the community benefit report online. Part I, Line 7: The charity care included in Part I, Line 7a is calculated by multiplying the ratio of cost to gross charges for the hospital by the gross uncompensated charges associated with providing charity care to its patients. The community health services, education and contributions in Part I, Lines 7e, 7f and 7i are based on actual expenses. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation on Part 1, Line 7, column f was $1,929,398. Part III, Line 2: Bad debt on line 2 is reported at charges. Part III, Line 3: Management considers historical write off and recovery information in determining the estimated bad debt provision. The organization estimates the amount of bad debt attributable to charity patients to be $62,234. This estimate is based on an overall charity care percentage of gross revenue. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 9 of the attached audit report. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules & regulations set forth by Centers for Medicare and Medicaid Services.Good Shepherd Health Care System provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit. Part III, Line 9b: The organization's collection procedures requires a financial advisor to work with any patient who is identified as potentially being eligible for financial assistance prior to sending the account to collection. If during the course of the collection process the collection agency determines an account may be eligible for financial assistance, it is referred back to the hospital for further discussion with the patient or for write off. All further collection action is ceased. Part VI, Line 2: Good Shepherd Health Care System has formed the Healthy Communities Coalition made up of St. Anthony's, Umatilla and Morrow County Health Department personal and other community supporting agencies and contracted with the Hospital Council of Northwest Ohio to conduct a Umatilla and Morrow Counties Community Health Needs Assessment. Part VI, Line 3: Our financial counselors inform and educate the people we serve with respect to charity care and governmental assistance programs. All patients and responsible parties, where possible, are apprised of the availability of financial counseling services at the time and point of service. We have arranged our patient flow to maximize the convenience of visiting our financial counselors as part of the Good Shepherd treatment regime.In addition, the financial assistance policy is provided in writing to the patients upon request, and when the Hospital is able to identify a potential FAP-eligible individual upon admissions. Part VI, Line 4: Good Shepherd Health Care System (GSHCS) is the corporate name for an organization made up of several entities, including Good Shepherd Medical Center, Vange John Memorial Hospice, TLC Home Health, Good Shepherd Medical Group, Good Shepherd Clinic Pharmacy, and Good Shepherd Community Health Foundation. Good Shepherd serves a core population of almost 50,000 people in the city of Hermiston, Oregon and in 14 outlying smaller towns within a rough 50-mile radius. This population is largely rural, with agriculture dominating industrial enterprises.The average household income in Hermiston is $35,354.15.5% of residents have incomes below federal poverty guidelines.34.9% of residents identify as non-white Hispanic ethnicity, with a sizable number of Spanish-primary speakers. Part VI, Line 5: Good Shepherd maintains open active, affiliate, and courtesy medical staffs, with privileges available to all qualified and interested physicians in the communities we serve. GSHCS is governed by a twelve-member board of trustees. The board is comprised of independent representatives of the community, with an emphasis on maintaining a true cross-section of core population communities within its membership.Our surplus funds are used to fund community health education classes, as well as funding building and equipment upgrades to maintain the highest quality healthcare for our community. Surplus funds are also applied to ongoing professional education among our clinical staff to remain current in the best practices of modern healthcare. We operate a fully-staffed 24-hour emergency room, available to the public regardless of ability to pay. Good Shepherd operates a foundation that provides funds to appropriate community groups and activities, as well as providing scholarship funds to local residents establishing or furthering healthcare-related education. We live our mission to promote a healthy community. Good Shepherd is the host and driving force behind the Good Shepherd Wellness Coalition, a grass-roots group of community leaders that identify, analyze, and address pressing healthcare issues in the community.We maintain a dialogue with the people we serve through a biweekly radio show, with an emphasis on wellness and preventative care.Good Shepherd hosts an annual Family Health and Fitness Day, with free access to healthcare professionals, free screenings, and a wealth of health and wellness information available to the public.We are active in community health-related activities, including the American Cancer Society's Relay for Life, the March of Dimes' March for Babies, and the Umatilla County Fair, where we provide health information and healthcare-related giveaways. Part VI, Line 7, Reports Filed With States OR 1 Good Shepherd Community Health Foundation 610 NW 11th Street Hermiston OR 97838 931170546 501(c)(3) 250000 Annual Tithe 1 0 Part I, Line 2: Grants are awarded to Good Shepherd Community Health Foundation, a related organization which is tax exempt under Section 501(c)(3). Any organization receiving an award must sign an agreement before the funds are dispursed stating the funds will be used for the stated purpose as listed in their grant application. They are also asked to submit regular reports until all funds have been spent. These reports are reviewed at the Foundation meetings of which board members who serve on both the Hospital and the Foundation Boards attend. There are no reporting requirements required to be sent to the Hospital from the other organizations listed on Schedule I. X X X X 1 0 0 0 0 0 0 1 0 Dennis E Burke President/CEO 276184 0 30000 0 68710 0 27225 0 25561 0 427680 0 0 0 Jan D Peter VP/CFO 177046 0 18971 0 16808 0 15294 0 26193 0 254312 0 0 0 David T Hughes VP/COO (Jul-Jan) 130167 0 30 0 67491 0 0 0 0 0 197688 0 0 0 Dr Olga Stobart Hospitalist 369683 0 1000 0 9603 0 0 0 10400 0 390686 0 0 0 Dr Mark Donnelly Physician - ER Doctor 340066 0 1135 0 0 0 13307 0 21984 0 376492 0 0 0 Dr Thomas J Holt Physician - Urologist 332172 0 30288 0 0 0 16717 0 11715 0 390892 0 0 0 Dr Kim A Peterson Physician - ER Doctor 314125 0 1000 0 0 0 0 0 24808 0 339933 0 0 0 Dr Leonidez De Guzman Physician - IM 263844 0 16000 0 0 0 13307 0 12233 0 305384 0 0 0 Part I, Line 4a In the calendar year ending 12/31/14, David Hughes received severance payments of $37,500. Part I, Line 7 At the end of the fiscal year the Board determines the amount of funds that will be disbursed for bonuses based on the acheivement of specified goals. Management then determines the percentage of bonuses allocated to each level and each individual. In regards to the CEO the Hospital may pay the CEO a discretionary annual bonus in an amount to be determined by the Board or Committee based upon CEO's annual review. Credits Inc Company is owned 100% by board member Nancy Mabry 1596777 Charges for collection services 0 Form 990, Part VI, Section A, line 1 The Executive Committee consists of the Board Chairman, Secretary, Medical Staff President, and one or more Trustees selected by the Chairman. The Board meets twice a year. Form 990, Part VI, Section B, line 11 The return is reviewed by the CFO and Controller and presented on a high level to the Board of Directors. A final copy is provided to the Board before filing. Form 990, Part VI, Section B, line 12c All officers, directors, and key employees with conflicts are expected to disclose conflicts of interest on a voluntary basis and refrain from discussion and/or voting on related matters as necessary. These disclosures are reviewed and determined to exist or not to exist by the Board of Directors. Form 990, Part VI, Section B, line 15a The CEO's compensation is approved by the compensation committee of the Board of Directors based on survey information. This process is completed annually in the month of October. The compensation of other officers or key employees is determined by the CEO based on survey information. This process is completed annually on the anniversary date of the individual's hire date. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 3,996,926. Management and general expenses 1,677,704. Fundraising expenses 0. Total expenses 5,674,630. Professional Fees: Program service expenses 3,513,584. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,513,584. Contract Labor/Temp Staff: Program service expenses 385,714. Management and general expenses 0. Fundraising expenses 0. Total expenses 385,714. Collection Expenses: Program service expenses 547,478. Management and general expenses 0. Fundraising expenses 0. Total expenses 547,478. Recruiting Fees: Program service expenses 0. Management and general expenses 477,550. Fundraising expenses 0. Total expenses 477,550. Good Shepherd Community Health Foundation 610 NW 11th Street Hermiston OR 97838 931170546 Fundraising OR 501(c)(3) Line 11a, I Good Shepherd Health Care System 1 Good Shepherd Medical Service Corp 610 NW 11th Street Hermiston OR 97838 930688940 Rental & Retail Pharmacy OR N/A C 2698567 9556701 1.00000 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 Good Shepherd Medical Service Corp A 425725 book value Good Shepherd Community Health Foundation B 250000 book value