2013-11-12T18:45:24-06:00 2012-12-31 990 2012-01-01 930391573 GOOD SAMARITAN HOSPITAL CORVALLIS GOOD 5417684773 C/O SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL B SMITH 5417684773 2013-11-05 2012 2016-02-24 21:20:13Z GOOD SAMARITAN REGIONAL MEDICAL CTR STEVEN W JASPERSON 3600 NW SAMARITAN DR CORVALLIS OR 97330 344843020 0 X WWW.SAMHEALTH.ORG X 1948 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS MEDICAL AND SURGICAL HOSPITAL. 12 10 2151 255 2295290 -135746 475861 612412 326487593 325735991 598145 1992808 2707367 3268514 330268966 331609725 279287 270830 0 0 174410975 176373021 0 0 271471 154878894 155206418 329569156 331850269 699810 -240544 184278626 180058789 90912653 88946727 93365973 91112062 X GOOD SAMARITAN HOSPITAL, CORVALLIS (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 OTHER HEALTH CARE PROVIDERS. SHS SEEKS TO BE THE FIRST CHOICE OF CONSUMERS IN THE REGION AND TO LEAD COLLABORATIVE EFFORTS AMONG THOSE WHO SHARE SIMILAR GOALS. 0 0 283987714 324181808 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 1,800 EMPLOYEES AND 200 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 2012, GSH SERVED 9,355 INPATIENTS, HAD 23,553 EMERGENCY DEPARTMENT VISITS, PERFORMED 10,771 SURGERIES AND DELIVERED 1,073 BABIES. IN ADDITION, GSH PERFORMED 68,631 IMAGING PROCEDURES, HAD 36,109 HOME HEALTH VISITS, AND HAD 186,153 PHYSICIAN CLINIC VISITS. 270830 270830 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. 284258544 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 1 4 0 1 2151 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X X SAMARITAN HEALTH SERVICES 5417684773 PO BOX 3000 CORVALLIS OR 973393000 BISHOP MICHAEL HANLEY 1.00 X 0 0 0 JAY MCHENRY 1.00 X 0 0 0 NANCY SEIFERT 1.00 X 0 0 0 GILBERT BECK 1.00 2.00 X X 0 0 0 CLIFFORD A HALL MD 8.00 X 26165 0 0 RICHARD CRONK MD 1.00 2.00 X X 0 0 0 REVEREND SIMON JUSTICE 1.00 X 0 0 0 SHIRLEY PETERSON 1.00 1.00 X X 0 0 0 JUDY LIST 1.00 1.00 X X 0 0 0 ERIC THOMPSON 1.00 X 0 0 0 FREDERICK WEISENSEE MD 40.00 X 311161 0 37151 TIM HENNESSY 1.00 1.00 X 0 0 0 STEVEN W JASPERSON 39.00 1.00 X 0 420320 47317 DANIEL B SMITH 2.00 38.00 X 0 307217 50011 KATHRYN M HALE 40.00 X 174593 0 32661 MICHAEL A MAY MD 39.00 1.00 X 300974 0 49999 SCOTT WILSON 40.00 X 158053 0 36488 JAMES RYAN MD 40.00 X 621840 0 49624 DONALD PENNINGTON DO 40.00 X 692503 0 52656 TOSHIO NAGAMOTO MD 40.00 X 785910 0 48172 RANDALL V BREAM MD 40.00 X 614345 0 43401 LUIS VELA DO 40.00 X 934210 0 49370 4619754 727537 496850 252 0 1 0 0 603864 8548 612412 NET PATIENT REVENUE 900099 316551202 316551202 RETAIL PHARMACY 446110 6749316 5470357 1278959 DURABLE MEDICAL EQP 446199 2435473 1585301 850172 325735991 492323 492323 819403 164665 654738 654738 654738 14411400 24620 12698521 237014 1712879 -212394 1500485 1500485 271456 133095 138361 138361 CAFETERIA 722210 1872669 1872669 MISCELLANEOUS REVENUE 900099 522284 356125 166159 WELLNESS INSTRUCTION 611600 46330 46330 34132 34132 2475415 331609725 324181808 2295290 4520215 210008 210008 60822 60822 1127244 932703 194541 131942131 127449825 4369532 122774 10536175 10180483 345971 9721 23365618 22576815 767245 21558 9401853 9084455 308724 8674 75877 75877 4845 395 4450 5579994 5490376 89618 96088 37985 49902 8201 10763636 10280139 413764 69733 10717330 10717330 4308055 4263198 41813 3044 291302 283122 8067 113 914539 826834 86043 1662 5436464 5101695 334769 11456706 11053600 402460 646 3386236 3348399 37837 MEDICAL SUPPLIES 49918062 49918062 PURCHASED SERVICES 40571179 11520496 29026656 24027 DUES, TAXES, & LICENSES 11686105 11639132 45655 1318 331850269 284258544 47320254 271471 11479 11797 2030102 1789636 39678514 38816338 380498 298143 4787976 6686746 2012409 2086653 210933554 99499591 117076346 111433963 12452050 14050129 407488 307488 5441764 4577896 184278626 180058789 27472839 27250916 21539 3708000 3708000 8549506 6099917 51160769 51887894 90912653 88946727 X 93365973 91112062 93365973 91112062 184278626 180058789 X -240544 -436760 -1576607 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4758581 316843 543063 187604 5430883 4975845 106549 -131912 191901 4758581 4582212 211952 443652 261971 4975845 3963225 107306 645769 134088 4582212 4989374 188135 -1015783 198501 3963225 0.20060 0.79940 0 1 1 2208871 2208871 137951615 54275389 83676226 3617841 564202 3053639 58058053 41130313 16927740 9097174 3529687 5567487 111433963 PROFESSIONAL LIABILITY RESERVE 1202000 OTHER LIABILITIES 362013 PAYABLE TO CONTRACTUAL AGENCIES 4282361 MINIMUM PENSION LIABILITY 38551084 ACCRUED INTEREST 1233198 TENANTS DEPOSITS 23583 ACCOUNTS PAYABLE-AFFILIATES 6233655 51887894 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE GOOD SAMARITAN HOSPITAL FOUNDATION (GSHF) HOLDS ENDOWMENT FUNDS THAT WILL ULTIMATELY BENEFIT THE HOSPITAL. GSHF'S BOARD-DESIGNATED AND GENERAL ENDOWMENTS ARE USED FOR GENERAL HOSPITAL SUPPORT. GSHF'S BERNIER ENDOWMENT IS USED FOR STAFF CONTINUING EDUCATION. GSHF'S ERKKILA ENDOWMENT IS USED FOR HEALTH AND HUMAN PERFORMANCE RESEARCH AND REHABILITATION. GSHF'S MULLINS SCHOLARSHIP ENDOWMENT SUPPORTS EDUCATIONAL SCHOLARSHIPS. GSHF'S PASTEGA HOUSE ENDOWMENT HELPS UNDERWRITE THE OPERATING COSTS OF THE MARIO PASTEGA GUEST HOUSE. GSHF'S VRTISKA ENDOWMENT SUPPORTS THE HOSPITAL'S LABORATORY FOR EDUCATIONAL PURPOSES. 1 1 X 1 X 1 X 1 1 0 1 1 15 10279 10049142 10049142 0.03030 9 50830 42465126 31926359 10538767 0.03180 24 61109 52514268 31926359 20587909 0.06210 18 5534 531593 2025 529568 0.00160 6 5024 11483905 5122585 6361320 0.01920 28 204612 78761401 42687051 36074350 0.10870 17 14568 961923 179388 782535 0.00240 69 229738 91738822 47991049 43747773 0.13190 93 290847 144253090 79917408 64335682 0.19400 1 134 1900 1900 0.00000 1 25 2053 2053 0.00000 2 159 3953 3953 0 4841759 309972 49216866 53763211 -4546345 X 1 1 1 CORVALLIS MED BLDGS LLC REAL PROPERTY RENTAL 0.54500 0.18500 2 HULL IMAGING LLC IMAGING SERVICES 0.60000 0.40000 3 SAMARITAN ENDOSCOPY CENTER MEDICAL SERVICES 0.66670 0.33330 4 CORVALLIS MRI A JV IMAGING SERVICES 0.50000 0.50000 5 CASCADE VIEW MEDICAL OFFICE BUILDING LLC REAL PROPERTY RENTAL 0.26300 0.73700 1 1 GOOD SAMARITAN HOSPITAL CORVALLIS

3600 NW SAMARITAN DRIVE CORVALLIS OR 97330

X X X X GOOD SAMARITAN HOSPITAL CORVALLIS 1 1 1 150.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X 1 0 X X X 1 X 0 0 32 SAMARITAN REGIONAL CANCER CENTER

501 NW ELKS DR CORVALLIS OR 97330

RADIATION ONCOLOGY SAMARITAN ORTHOPEDICS CLINIC

3620 NW SAMARITAN DR STE 202 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN HEART & VASC - VASC SURGERY

3615 NW SAMARITAN DR STE 201 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN SURGICAL SPECIALISTS

3615 NW SAMARITAN DR STE 201 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN GYN & SURGICAL ASSOCIATES

400 NW WALNUT BLVD STE 300 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN INTERNAL MEDICINE

3521 NW SAMARITAN DR STE 201 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN NEUROSURGERY - DR ROBERSON

3615 NW SAMARITAN DR STE 210 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN NEUROSURGERY - DR GOODWIN

3615 NW SAMARITAN DR STE 211 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN FAMILY MEDICINE

3517 NW SAMARITAN DR STE 201 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT MAMMOGRAPHY CLINIC

444 NW ELKS DR CORVALLIS OR 97330

MAMMOGRAPHY CLINIC SAMARITAN KIDNEY SPECIALISTS

3615 NW SAMARITAN DR STE 203 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN PEDIATRICS

777 NW 9TH ST STE 320 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN URGENT CARE CENTER

5234 SW PHILOMATH BLVD CORVALLIS OR 97333

MEDICAL CLINIC - OUTPATIENT SAMARITAN DERMATOLOGY & RHEUMATOLOGY

3620 NW SAMARITAN DR STE 203 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN ENDOSCOPY CENTER

3509 NW SAMARITAN DR STE 201 CORVALLIS OR 97330

ENDOSCOPY CENTER CORVALLIS MRI

3615 NW SAMARITAN DR STE 101 CORVALLIS OR 97330

IMAGING SERVICS SAMARITAN OBSTETRICS & GYN

3640 NW SAMARITAN DR STE 270 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN MENTAL HEALTH - CORVALLIS

3509 NW SAMARITAN DR CORVALLIS OR 97330

MENTAL HEALTH SERVICES SAMARITAN PLASTICRECON SURG - HAVARD

996 NW CIRCLE BLVD STE 103 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN HEMATOLOGY & ONCOLOGY

3640 NW SAMARITAN DR STE 161 CORVALLIS OR 97330

RADIATION ONCOLOGY SAMARITAN ORTHOPEDICS - DR VELA

3620 NW SAMARITAN DR STE 201 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN MENTAL HEALTH - ALBANY

1052 SW 29TH ST ALBANY OR 97321

MENTAL HEALTH SERVICES SAMARITAN INFECTIOUS DISEASE

3640 NW SAMARITAN DR STE 210 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN UROLOGY

990 NW CIRCLE BLVD STE 102 CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN HAND THERAPY

3640 NW SAMARITAN DR CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT OUTPATIENT SURGERY

3620 NW SAMARITAN DR CORVALLIS OR 97330

AMBULATORY SURGERY SAMARITAN BARIATRIC SURGERY

3517 NW SAMARITAN DR STE 100 CORVALLIS OR 97330

AMBULATORY SURGERY SAMARITAN FAMILY MEDICINE SOUTHWEST

5234 SW PHILOMATH BLVD CORVALLIS OR 97333

MEDICAL CLINIC - OUTPATIENT SAMARITAN PHYSICAL REHAB - CORVALLIS

3580 NW SAMARITAN DRIVE CORVALLIS OR 97330

MEDICAL CLINIC - OUTPATIENT SAMARITAN OCC MED - ALBANY

2615 WILLETTA ST SW STE C2 ALBANY OR 97321

MEDICAL CLINIC - OUTPATIENT SAMARITAN OCC MED - LEBANON

100 MULLINS DRIVE STE B2 LEBANON OR 97355

MEDICAL CLINIC - OUTPATIENT SAMARITAM OCC MED - CORVALLIS

5234 SW PHILOMATH BLVD STE B CORVALLIS OR 97333

MEDICAL CLINIC - OUTPATIENT PART I, LINE 6A: THE FILING ORGANIZATION SUBMITS AN ANNUAL COMMUNITY BENEFIT REPORT TO THE STATE OF OREGON. IN ADDITION, THE PARENT ORGANIZATION, SAMARITAN HEALTH SERVICES (SHS) PROVIDES AN ANNUAL REPORT TO THE COMMUNITY THAT INCLUDES COMMUNITY BENEFIT REPORTING FOR THE SYSTEM AS A WHOLE. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN SCHEDULE H, PART I, LINE 7A AND 7B IS A COST-TO-CHARGE RATIO DERIVED USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES FROM THE SCHEDULE H INSTRUCTIONS. FOR LINE 7G, A 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. THE PORTION OF NET COMMUNITY BENEFIT EXPENSE RELATED TO THESE CLINICS IS $29,719,382. PART II: GSH PROVIDES SERVICES AND ACTIVITIES THAT ARE CLASSIFIED AS COMMUNITY BUILDING. THIS INCLUDES LEADING DISASTER PREPAREDNESS DRILLS WITH LOCAL AGENCIES AND STAFF PARTICIPATING IN ONE-ON-ONE MENTORING PROGRAMS AT A LOCAL SCHOOL. GSH ALSO PROVIDES OPPORTUNITIES FOR COMMUNITY MEMBERS TO OBTAIN TRAINING ON CIVIC AND CULTURAL ISSUES THAT IMPACT HEALTH. SOME OF THE TRAINING OPPORTUNITIES INCLUDED GRANT WRITING AND BOARD DEVELOPMENT. GSH STAFF SERVE ON MANY LOCAL COALITIONS AND BOARDS THAT PROMOTE THE HEALTH OF THE COMMUNITY. BOARD AFFILIATION INCLUDES, BUT IS NOT LIMITED TO COMMUNITY OUTREACH INC, THE GRACE CENTER, THE CENTER FOR HEALTHY AGING RESEARCH/SCIENTIFIC ADVISORY BOARD, AND THE CARING PLACE. ADDITIONALLY GSH STAFF SERVE ON THE OREGON HEALTH POLICY ADVISORY BOARD, THE OREGON HEALTH RESOURCES COMMISSION, THE MEDICAID ADVISORY COMMITTEE AND REGIONAL BOARDS THAT ADDRESS HEALTH CARE ISSUES. PART III, LINE 4: THE COSTING METHODOLOGY USED TO CALCULATE BAD DEBT EXPENSE (AT COST) ON LINE 2 OF PART III IS BASED ON THE FACILITY COST-TO-CHARGE RATIO, IN CONJUNCTION WITH WORKSHEET A FROM THE SCHEDULE H, PART III INSTRUCTIONS.LINE 3 REPRESENTS AN ESTIMATE OF THE AMOUNT OF COST INCLUDED IN LINE 2 (BAD DEBT EXPENSE AT COST) THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, BUT FOR WHOM THE ORGANIZATION WAS NOT ABLE TO OBTAIN SUFFICIENT INFORMATION TO MAKE A DETERMINATION. THE METHODOLOGY USED TO ESTIMATE THIS POTENTIAL CHARITY CARE COST IS BASED ON FINANCIAL ASSISTANCE APPLICATIONS DENIED DUE TO INCOMPLETE DOCUMENTATION, MULTIPLIED BY THE AVERAGE CHARITY CARE WRITE-OFF FOR APPROVED APPLICATIONS.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. FOOTNOTE 1(O) FROM THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS ENTITLED "PROVISION FOR BAD DEBTS AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS" DESCRIBES BAD DEBT EXPENSE AS FOLLOWS: "ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, SHS ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE PATIENTS WITHOUT INSURANCE), SHS RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. FOR THIRD-PARTY RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, SHS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, WHICH PRIMARILY RELATES TO SELF-PAY PATIENT BALANCES THAT WILL REMAIN AFTER PAYMENTS FROM THE THIRD-PARTY PAYOR HAVE BEEN COLLECTED. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS." PART III, LINE 8: TOTAL MEDICARE ALLOWABLE COSTS REPORTED ON PART III, SECTION B, LINE 6 IS CALCULATED BY UTILIZING WORKSHEET B 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):85,098,116MEDICARE COSTS (BASED ON A COST-TO-CHARGE RATIO): 98,595,001UNPAID COST OF PROVIDING SERVICES TO ALL MEDICARE PATIENTS: (13,496,885) 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 CHARITY 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 V, SECTION B, LINE 14A: THE ORGANIZATION'S WEBSITE PROVIDES INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING FREE AND DISCOUNTED CARE, ALONG WITH CONTACT INFORMATION FOR PATIENTS TO BE ABLE TO APPLY FOR FINANCIAL ASSISTANCE. PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNT CHARGED BY THE HOSPITAL FACILITY TO FAP-ELIGIBLE INDIVIDUALS IS SET TO BE LESS THAN THE AVERAGE OF ALL NEGOTIATED COMMERCIAL INSURANCE RATES. PART VI, LINE 2: GOOD SAMARITAN HOSPITAL (GSH) ACTIVELY PARTICIPATES IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY. 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, THE BENTON COUNTY COMMISSION ON CHILDREN AND FAMILIES, AND OTHER COMMUNITY PARTNERS, GSH EMPLOYEES AND OTHER SAMARITAN HEALTH SERVICES STAFF ACTIVELY PARTICIPATED IN THE LATEST COMMUNITY HEALTH ASSESSMENT FOR BENTON COUNTY CONDUCTED DURING 2012. THIS PROCESS INCLUDED EXAMINING PRIMARY DATA COLLECTED THROUGH FOCUS GROUPS, COMMUNITY FORUMS AND PERSONAL INTERVIEWS WITH SEVERAL COMMUNITY MEMBERS FROM THROUGHOUT BENTON COUNTY. SECONDARY DATA WAS GATHERED FROM STATE AND LOCAL AGENCIES THAT ADDRESS HEALTH NEEDS OF CHILDREN, YOUTH AND FAMILIES. AS A RESULT OF THECOUNTY COMMUNITY HEALTH ASSESSMENT, GSH IS ABLE TO UPDATE ITS COMMUNITY BENEFIT PLAN THAT OUTLINES GOALS AND OBJECTIVES AND SERVICES THAT EXPAND ACROSS THE SAMARITAN HEALTH SERVICES SYSTEM RESPONDING TO COMMUNITY NEEDS. GSRMC IS UTILIZING THE 2012 BENTON COUNTY COMMUNITY HEALTH ASSESSMENT TO COMPLETE A HOSPITAL-SPECIFIC COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013. 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. ONCE A COMPLETED FINANCIAL QUESTIONNAIRE HAS BEEN SUBMITTED, INDIVIDUALS/FAMILIES AT OR BELOW 200 PERCENT OF THE ESTABLISHED FEDERAL POVERTY LEVEL (FPL) COULD BE ELIGIBLE TO RECEIVE FREE OR DISCOUNTED CARE (CHARITY CARE).THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND COMMUNITY MEMBERS BY PUBLISHING INFORMATION REGARDING ALL FINANCIAL ASSISTANCE OPTIONS ON ITS WEBSITE, IN ADDITION TO IN PERSON AT THE REGISTRATION AREA, AND THROUGH CLEARLY IDENTIFIED MATERIALS LOCATED IN THE REGISTRATION AREA. PART VI, LINE 4: GSH PRIMARILY SERVES THE RESIDENTS OF BENTON COUNTY. HOWEVER, RESIDENTS FROM THE ADJOINING COMMUNITIES OF LINCOLN AND LINN COUNTIES ARE ALSO SEEN AT GSH. WITH A TOTAL POPULATION OF 85,579 (U.S. CENSUS 2010), BENTON COUNTY IS DESIGNATED AS AN URBAN COUNTY. THE COUNTY INCLUDES THE CITIES OF CORVALLIS AND PHILOMATH AS WELL AS THE SMALL INCORPORATED TOWNSHIPS OF MONROE AND ADAIR VILLAGE. APPROXIMATELY 21% OF BENTON COUNTY RESIDENTS LIVE IN RURAL AREAS OF THE COUNTY. THE MEDIAN HOUSEHOLD INCOME FOR BENTON COUNTY IS $47,716, AND 21% OF THE RESIDENTS LIVE BELOW THE FEDERAL POVERTY LEVEL. AS OF DECEMBER 2012, THE OREGON EMPLOYMENT DEPARTMENT REPORTED A 6% UNEMPLOYMENT RATE FOR BENTON COUNTY. THE COUNTY HEALTH RANKINGS INDICATE THAT 17% OF BENTON COUNTY RESIDENTS ARE UNINSURED. 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. 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. GSH ALSO CONTRIBUTES FINANCIALLY TO THE LINN-BENTON COMMUNITY COLLEGE NURSING PROGRAM. 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 SAMARITAN 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. REPORTS FILED WITH STATES PART VI, LINE 7 OR 1 COMMUNITY OUTREACH 865 REIMAN AVENUE CORVALLIS OR 97330 930602094 501(C)(3) 98813 MEDICAL, DENTAL, MENTAL HEALTH CLINICS OLD MILL CENTER 1650 SW 45TH PLACE CORVALLIS OR 97333 930722603 501(C)(3) 25000 SUPPORT FOR HIGH RISK INFANTS ALBANY HELPING HANDS PO BOX 2252 ALBANY OR 97321 931244271 501(C)(3) 6500 SUPPORT FOR HOMELESS PEOPLE CENTER AGAINST RAPE & DOMESTIC VIOLENCE PO BOX 914 CORVALLIS OR 97339 930792125 501(C)(3) 10000 TRANSITIONAL HOUSING SERVICES FOR DOMESTIC VIOLENCE SURVIVORS ALSEA RURAL HEALTH CARE INC PO BOX 229 ALSEA OR 97324 930773246 501(C)(3) 10000 RURAL HEALTHCARE SUPPORT BENTON COUNTY HEALTH DEPARTMENT 530 NW 27TH ST CORVALLIS OR 97330 936002285 GOV'T 24300 ORAL HEALTH SUPPORT LOVE IN THE NAME OF CHRIST OF BENTON COUNTY PO BOX 270 CORVALLIS OR 97339 931326307 501(C)(3) 5100 ORAL HEALTH SUPPORT BENTON COUNTY COMMITTEE FOR THE PREVENTION OF CHILD ABUSE 421 NW 4TH ST STE A CORVALLIS OR 97330 930842537 501(C)(3) 15000 GED PREPARATION CLASSES, PARENT EDUCATION, COMMUNITY PROGRAMS AND EVENTS STRENGTHENING RURAL FAMILIES PO BOX 1528 PHILOMATH OR 97370 202934930 501(C)(3) 5600 ORAL HEALTH SUPPORT 9 TRANSPORTATION 367 16930 MEDICAL ASSISTANCE 54 1660 BOOK MEDICAL SUPPLIES SHELTER 7 824 MEALS FOR FAMILY MEMBERS OF PATIENTS 834 8335 BOOK MEALS ACCOMODATIONS - PASTEGA HOUSE 6167 33073 BOOK TEMPORARY HOUSING FOR HEALTH CARE RECIPIENTS PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AGENCIES IN THE COMMUNITY ARE INVITED TO SUBMIT GRANT PROPOSALS THROUGH AN APPLICATION PROCESS. A COMMITTEE REVIEWS THE APPLICATIONS TO DETERMINE IF THE FUNDS REQUESTED WILL BE USED TO ADDRESS THE ORGANIZATION'S ESTABLISHED COMMUNITY HEALTH PRIORITIES, IDENTIFIED NEEDS, AND SUPPORTS THE ORGANIZATION'S MISSION. ONCE APPROVED AND FUNDED, AGENCIES MUST SUBMIT A COMPLETE ANNUAL REPORT DESCRIBING HOW THE FUNDS WERE USED, THE NUMBER OF CLIENTS SERVED, AND HOW OUTCOMES WERE ACHIEVED. X 1 1 0 0 0 1 0 0 0 0 0 FREDERICK WEISENSEE MD 295988 0 0 0 15173 0 20596 0 16555 0 348312 0 0 0 STEVEN W JASPERSON 0 387815 0 0 0 32505 0 20596 0 26721 0 467637 0 0 DANIEL B SMITH 0 299636 0 0 0 7581 0 20596 0 29415 0 357228 0 0 KATHRYN M HALE 171614 0 0 0 2979 0 13098 0 19563 0 207254 0 0 0 MICHAEL A MAY MD 295750 0 0 0 5224 0 20596 0 29403 0 350973 0 0 0 SCOTT WILSON 146968 0 0 0 11085 0 11624 0 24864 0 194541 0 0 0 JAMES RYAN MD 555149 0 66105 0 586 0 20596 0 29028 0 671464 0 0 0 DONALD PENNINGTON DO 582391 0 109302 0 810 0 20596 0 32060 0 745159 0 0 0 TOSHIO NAGAMOTO MD 468248 0 299420 0 18242 0 20596 0 27576 0 834082 0 0 0 RANDALL V BREAM MD 597703 0 0 0 16642 0 20596 0 22805 0 657746 0 0 0 LUIS VELA DO 888010 0 44958 0 1242 0 20596 0 28774 0 983580 0 0 0 PART I, LINE 1A IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM/FITNESS FACILITY BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. UNDER THIS PROGRAM, EMPLOYEES MUST MEET MINIMUM USAGE REQUIREMENTS IN ORDER TO QUALIFY FOR ONGOING BENEFITS. IF AN EMPLOYEE PARTICIPATES AT A NON-SAMARITAN GYM, REIMBURSEMENT IS MADE FOR UP-FRONT FEES, AND THEN PERIODICALLY UPON COMPLETION OF AT LEAST 60 VISITS. REIMBURSEMENT DOES NOT EXCEED $300 PER YEAR AND IS INCLUDED IN THE EMPLOYEE'S TAXABLE WAGES AND IS SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. ONE KEY EMPLOYEE RECEIVED THIS TAXABLE GYM BENEFIT IN 2012. IF AN EMPLOYEE PARTICIPATES AT A SAMARITAN FITNESS CENTER (SAMFIT), MEMBERSHIP IS FREE OF CHARGE (PROVIDED AS A NONTAXABLE FRINGE BENEFIT), BUT THE EMPLOYEE IS REQUIRED TO ATTEND THE GYM 50 TIMES DURING EACH PERIOD OF 6 CONSECUTIVE MONTHS TO MAINTAIN THIS BENEFIT. NO PERSONS LISTED IN PART VII THAT ARE EMPLOYED BY THE FILING ORGANIZATION UTILIZED THE SAMFIT BENEFIT DURING 2012. PART I, LINE 3 THE CHIEF EXECUTIVE OFFICER IS EMPLOYED AND PAID BY A RELATED ORGANIZATION. THE RELATED ORGANIZATION CONDUCTS A COMPENSATION ANALYSIS EACH YEAR TO COMPARE COMPENSATION OF ALL PAID POSITIONS TO MARKET SURVEYS OF COMPENSATION FOR SIMILAR POSITIONS IN OTHER ORGANIZATIONS. PERIODICALLY, THE RELATED ORGANIZATION WILL ALSO USE WRITTEN EMPLOYMENT CONTRACTS, FORM 990 OF OTHER ORGANIZATIONS, AND INDEPENDENT COMPENSATION CONSULTANTS TO DETERMINE THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. PART I, LINE 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. TANIA MAY FAM MBR, M. MAY 119805 EMP BY ORG 0 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 11 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. 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 ETHICS AND CONDUCT 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 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: DISTRIBUTIONS TO MINORITY INTEREST CONSOLIDATED JVS -1,123,518. INCREASE IN MINIMUM PENSION LIABILITY -385,504. OTHER CHANGES IN FUND BALANCE -67,585. 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 TO SUPPORT AFFILIATED EXEMPT ENTITIES OR 501(C)(3) 11B, II SAMARITAN HEALTH SERVICES 0 FIRSTCARE MEDICAL FOUNDATION PO BOX 3000 CORVALLIS OR 973393000 930932697 PROVIDER OF MEDICAL SERVICES FOR THE COMMUNITY OR 501(C)(3) 9 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) 11D, III-O N/A 1 GOOD SAMARITAN HOSPITAL FOUNDATION PO BOX 1068 CORVALLIS OR 97339 237252406 TO SUPPORT GOOD SAMARITAN HOSPITAL OR 501(C)(3) 7 GOOD SAMARITAN HOSPITAL 1 INTERCOMMUNITY HEALTH PLANS INC PO BOX 3000 CORVALLIS OR 973393000 931124326 SERVE OREGON HEALTH PLAN FOR MEDICAID 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) 11A, I SAMARITAN HEALTH SERVICES 0 SAMARITAN HEALTH SERVICES INC PO BOX 3000 CORVALLIS OR 973393000 930951989 PROVIDE HEALTHCARE SUPPORT SERVICES OR 501(C)(3) 11C, III-FI N/A 0 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 PROVIDE HEALTHCARE FOR SENIORS OR 501(C)(3) 9 SAMARITAN HEALTH SERVICES 0 SAMARITAN ENDOSCOPY CENTER LLC 3600 NW SAMARITAN DR CORVALLIS OR 97330 202860067 MEDICAL SERVICES OR GOOD SAMARITAN HOSPITAL RELATED 438003 771264 0 1 0.66660 CORVALLIS MEDICAL BUILDINGS LLC 3600 NW SAMARITAN DRIVE CORVALLIS OR 97330 931257913 REAL ESTATE RENTAL OR GOOD SAMARITAN HOSPITAL EXCLUDED 120776 1422506 0 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 712670 37099 0 1 0.60000 CBA-SAM LLC PO BOX 433 LINCOLN CITY OR 97367 931314523 REAL ESTATE RENTAL OR N/A CORVALLIS MRI A JOINT VENTURE 3615 NW SAMARITAN DRIVE CORVALLIS OR 97330 930949704 IMAGING OR GOOD SAMARITAN HOSPITAL RELATED 396290 313561 0 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 2750 HARRISON BLVD LLC 413 SW 13TH AVE STE 300 PORTLAND OR 97205 274665571 REAL ESTATE RENTAL OR N/A CASCADE VIEW MEDICAL OFFICE BUILDING LLC PO BOX 3000 CORVALLIS OR 973393000 300658805 REAL ESTATE RENTAL OR GOOD SAMARITAN HOSPITAL EXCLUDED 23692 1720510 0 1 0.26300 SAMARITAN HEALTH PLANS INC 3600 NW SAMARITAN DRIVE CORVALLIS OR 97330 930860860 HEALTH INSURANCE CARRIER FOR THE COMMUNITY OR N/A C 0 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 INTERCOMMUNITY HEALTH PLANS INC L 9767608 COST SAMARITAN ENDOSCOPY CENTER LLC A 304435 COST SAMARITAN ENDOSCOPY CENTER LLC O 122650 COST SAMARITAN ENDOSCOPY CENTER LLC P 122650 COST SAMARITAN ENDOSCOPY CENTER LLC S 447536 COST CORVALLIS MEDICAL BUILDINGS LLC A 53517 COST CORVALLIS MEDICAL BUILDINGS LLC K 429138 COST HULL IMAGING LLC A 168839 COST HULL IMAGING LLC O 643708 COST HULL IMAGING LLC S 830500 COST