2013-08-15T18:44:43-05:00 2012-09-30 440160260 BKD LLP 2800 POST OAK BLVD STE 3200 HOUSTON TX 77056 990 2011-10-01 751041154 THE GOOD SHEPHERD HOSPITAL INC GOOD 9033152000 700 E MARSHALL AVENUE LONGVIEW TX 75601 PAT KEEL 9033151820 2013-08-15 1 AMANDA MAYA P01067777 7134994600 2011 2016-02-24 21:20:13Z GOOD SHEPHERD MEDICAL CENTER PAT KEEL 700 EAST MARSHALL AVENUE LONGVIEW TX 75601 362700566 0 X WWW.GSMC.ORG X 1959 TX GOOD SHEPHERD MEDICAL CENTER IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL DEDICATED TO CREATING A HEALTHIER FUTURE FOR THE RESIDENTS OF LONGVIEW AND NORTHEAST TEXAS. TO ENSURE THE CONTINUED WELL-BEING OF THE COMMUNITY, THE MEDICAL CENTER STRIVES TO PROVIDE QUALITY, COMPASSIONATE AND COMPREHENSIVE HEALTHCARE SERVICES TO THE WHOLE PERSON: BODY, MIND AND SPIRIT.GOOD SHEPHERD EXISTS TO CARE FOR ALL THOSE WHO PRESENT THEMSELVES, WHATEVER THEIR NEED, REGARDLESS OF RACE, CREED OR GENDER. THE MEDICAL CENTER PROVIDES HEALTH SERVICES TO THE MEDICALLY UNDERSERVED AS FAR AS RESOURCES PROVIDE, WHILE MAINTAINING THE LONG-TERM INTEGRITY OF SERVICE TO THE COMMUNITY.THE LEADERSHIP WILL REMAIN EVER COGNIZANT OF THE MEDICAL CENTER'S INTEGRAL ROLE IN THE COMMUNITY AND ITS RESPONSIBILITY TO DEMONSTRATE GOOD STEWARDSHIP OF THE HEALTH OF ITS RESIDENTS WHILE PROVIDING SERVICES AT COMPETITIVE COSTS. INHERENT WITHIN THIS MISSION IS A RESPONSIBILITY TO MAINTAIN THE ORGANIZATION'S FINANCIAL SOLVENCY. 15 14 2501 160 4806200 0 1062766 585751 361528374 363628428 -1371673 -3989893 1681200 1901466 362900667 362125752 0 0 0 0 111659850 122726488 0 0 0 232810295 233207775 344470145 355934263 18430522 6191489 165107526 186073860 176601958 209240734 -11494432 -23166874 X GOOD SHEPHERD MEDICAL CENTER PROVIDES SERVICES TO PATIENTS QUALIFYING UNDER THE CHARITY POLICY AND PROVIDES QUALITY TERTIARY HEALTH SERVICES TO THE RESIDENTS OF NORTHEAST TEXAS. 0 0 273501220 363628428 GOOD SHEPHERD MEDICAL CENTER IS IMPACTED BY THE SIGNIFICANT CHANGES IN HEALTHCARE TODAY. TO ENSURE THAT GOOD SHEPHERD MEDICAL CENTER IS STRONGLY POSITIONED FOR THE FUTURE, THE FOLLOWING MAJOR STRATEGIES HAVE BEEN ADOPTED:- IMPROVE CLINICAL QUALITY OUTCOMES AND CUSTOMER SERVICE- IMPROVE OPERATING PERFORMANCE AND REDUCE COSTS- DEVELOP A HEALTH SYSTEM THAT PROVIDES A FULL CONTINUUM OF HOSPITAL, PHYSICIAN AND INSURANCE SERVICES- IMPROVE THE HEALTH STATUS OF THE SERVICE AREA- IMPROVE THE CAPABILITY AND ADAPTABILITY OF EMPLOYEESGOVERNED BY A VOLUNTARY BOARD OF DIRECTORS, GOOD SHEPHERD MEDICAL CENTER HAS A DIRECT LINK TO SOLICIT COMMUNITY INVOLVEMENT IN DECISION MAKING. THE BOARD OF DIRECTORS IS COMPOSED OF GOOD SHEPHERD MEDICAL CENTER'S PRESIDENT AND CHIEF EXECUTIVE OFFICER AND TWELVE MEMBERS OF THE COMMUNITY WHO SERVE ON A VOLUNTARY BASIS TO FURTHER THE MISSION OF GOOD SHEPHERD MEDICAL CENTER. THESE MEMEBERS REPRESENT LOCAL BUSINESS, INDUSTRY, EDUCATION, MEDICAL SERVICES AND CONSUMERS-AT-LARGE. THE BOARD OF DIRECTORS PROVIDES PERPETUAL COMMUNICATION OF THE CONCERNS AND HEALTHCARE NEEDS OF THE GREATER LONGVIEW COMMUNITY.AS PART OF OUR ONGOING COMMITMENT TO THE UNDERSERVED POPULATION OF GOOD SHEPHERD'S SERVICE AREA, THE BOARD OF DIRECTORS ESTABLISHED CRITERIA FOR FINANCIAL ASSISTANCE CONSISTENT WITH THE ORGANIZATION'S MISSION AND FINANCIAL RESOURCES.FINANCIAL ASSISTANCE IS PROVIDED TO ALL PATIENTS, WITHOUT REGARD TO RACE, CREED, GENDER OR NATIONAL ORIGIN, WHO ARE CLASSIFIED AS FINANCIALLY INDIGENT ACCORDING TO GOOD SHEPHERD'S ELIGIBILITY GUIDELINES AND WHO PRESENT THEMSELVES FOR CARE AT GOOD SHEPHERD MEDICAL CENTER AND ITS REGIONAL SYSTEM OF SERVICES. MANY FACTORS SUCH AS ALL SOURCES OF INCOME, EMPLOYMENT STATUS, FAMILY SIZE, AMOUNT OF THE PATIENT'S ACCOUNT AND HEALTHCARE NEEDS ARE ALL TAKEN INTO CONSIDERATION WHEN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. GOOD SHEPHERD MEDICAL CENTER MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF FINANCIAL ASSISTANCE IT PROVIDES TO THE COMMUNITIES IT SERVES.- IN FISCAL YEAR 2012, CHARITY CARE BASED ON ESTABLISHED RATES WAS RENDERED IN THE AMOUNT OF $94,340,938. THIS AMOUNT ENCOMPASSES THE CARE OF MORE THAN 11,785 PATIENT VISITS AND REPRESENTS APPROXIMATELY 7.6 PERCENT OF GROSS PATIENT REVENUE.- GOOD SHEPHERD PROVIDED CHARITY CARE, GOVERNMENT-SPONSORED INDIGENT HEALTHCARE AND OTHER COMMUNITY BENEFITS COSTING $16,538,000 OR MORE THAN 6 PERCENT OF THE TOTAL OPERATING EXPENSES.- GOOD SHEPHERD'S BAD DEBT EXPENSE USING THE COST-TO-CHARGE RATIO FOR 2012 WAS $18,061,005, OR 6.6 PERCENT OF TOTAL OPERATING EXPENSES.GOOD SHEPHERD MEDICAL CENTER ALSO PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS, AS WELL AS OTHER FEDERAL, STATE AND LOCAL HEALTHCARE REIMBURSEMENT PROGRAMS FOR THOSE IN FINANCIAL NEED. THESE PROGRAMS ACCOUNT FOR MORE THAN 62 PERCENT OF THE MEDICAL CENTER'S GROSS PATIENT REVENUE. 273501220 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 140 0 1 2501 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JANET ANDERSEN 9033155177 700 E MARSHALL AVE LONGVIEW TX 75601 X EDWARD D BANOS 2.00 X X 0 722067 15415 MARK BOON 2.00 X X 0 0 0 MICHAEL BURNS 2.00 X 0 0 0 KELLYN DRAYER 2.00 X 0 0 0 PAT FLORENCE 2.00 X 0 0 0 WILLIAM M HOLDA EDD 2.00 X X 0 0 0 CR MARTIN MD 2.00 X 0 0 0 LES MENDICELLO 2.00 X 0 0 0 LAWRENCE ROE MD 2.00 X 0 0 0 THOMAS P TIBILETTI 2.00 X 0 0 0 STAN UPCHURCH MD 2.00 X 0 0 0 BUCK BIRDSONG 2.00 X 0 0 0 GAYLE ENGLISH 2.00 X 0 0 0 HOMER ROCKMORE 2.00 X 0 0 0 RICHARD A DIAL 2.00 X 0 0 0 PAT KEEL 2.00 X 0 412444 5950 CONNIE HEIDBREDER 2.00 X 0 48721 2501 LEORA WILLIAMS 2.00 X 0 81738 17415 KENNETH CUNNINGHAM 2.00 X 0 284794 24602 KAREN WATTS 2.00 X 0 315915 8549 MARION BENSON 2.00 X 0 199523 11064 RICHARD LEE HOLLADAY 40.00 X 297485 0 21061 ALAN GUEDRY 40.00 X 264886 0 31171 JOHN COX 40.00 X 238835 0 26093 EDWARD MALDONADO 40.00 X 249699 0 32433 RICHARD HINSON 40.00 X 239335 0 27750 RUBY BREWER 2.00 X 0 181399 12039 1290240 2246601 236043 78 1 1 0 GSHS ADMINISTRATIVE SERVICES ORG 700 MARSHALL AVE LONGVIEW TX 75601 ADMINISTRATIVE SERVICES 15025119 LONGVIEW EMERGENCY MEDICINE 9229 LBJ FREEWAY DALLAS TX 75243 ER PHYSICIANS 10367316 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 6025252 HOSPITAL HOUSEKEEPING SYSTEMS LTD PO BOX 826 SAN ANTONIO TX 78293 HOUSEKEEPING SERVICES 5344040 SCOTT AND WHITE HEALTH PLAN 1206 WEST CAMPUS DR TEMPLE TX 76502 PRESCRIPTION SERVICES 1884895 60 585751 102000 585751 NET PATIENT REVENUE 621110 344055065 344055065 GOVERNMENT DSH AND TRA 900099 8969707 8969707 LAB OUTREACH REVENUE 621500 4378493 4378493 WELLNESS CENTER REVENU 624100 3616780 3189073 427707 LEASE REVENUE 532420 1704531 1704531 903852 903852 363628428 -3992857 -3992857 384000 537402 -153402 -153402 -153402 40376 37412 2964 2964 2964 CAFETERIA 722210 1794151 1794151 VENDING 722210 56889 56889 203828 203828 2054868 362125752 358822228 4806200 -2088427 99163651 77053326 22110325 1897705 1480210 417495 14619749 11403404 3216345 7045383 5495399 1549984 12786756 12786756 9129 9129 2727875 2727875 39637991 27746594 11891397 2448993 1492 2447501 15371417 10759992 4611425 4973104 4973104 2263152 1584206 678946 174154 121908 52246 5347975 5347975 7128566 5417710 1710856 311543 218080 93463 PROVISION FOR BAD DEBTS 83077300 83077300 MEDICAL SUPPLIES & EQUI 29986181 29986181 OTHER EXPENSES 15603716 9429016 6174700 DIETARY 5916824 5916824 5443099 3809578 1633521 355934263 273501220 82433043 0 -1374386 5248832 11779589 38634770 53562512 7982049 9964266 1215461 1631728 177867492 119914838 62700277 57952654 25760172 46265509 7008576 6744211 2787015 2053038 8614003 2651110 165107526 186073860 24108435 25396537 122515292 144535962 1606359 2762717 28371872 36545518 176601958 209240734 X -17007353 -29317265 5512921 6150391 -11494432 -23166874 165107526 186073860 X 6191489 -17863931 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3051 0 0 0 3051 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE AMOUNT REPRESENT THE PERCENTAGE OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION THAT THE AHA DETERMINED WAS FOR LOBBYING EXPENSES. 614744 614744 94067288 54024446 40042842 6058814 5214567 844247 74918181 60675825 14242356 2208465 2208465 57952654 INTERCOMPANY PAYABLES 4989807 ESTIMATED SELF-INSURANCE COSTS, CURRENT 199268 ESTIMATED SELF-INSURANCE COSTS 3594419 INTEREST RATE SWAP AGREEMENT 22477809 DUE TO AFFILIATES 5284215 36545518 362125752 355934263 6191489 -3162 -17860769 -17863931 -11672442 277096725 537402 537402 276559323 85566429 85566429 362125752 271490992 537402 537402 270953590 84980673 84980673 355934263 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MEDICAL CENTER HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE MEDICAL CENTER IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE MEDICAL CENTER FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. WITH A FEW EXCEPTIONS, THE MEDICAL CENTER IS NO LONGER SUBJECT TO U.S. FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -4,801,138. TRANSFERS TO AFFILIATES -13,424,026. CONTRIBUTIONS OF OR FOR PROPERTY AND EQUIPMENT 312,681. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 637,470. CONTRIBUTIONS FROM FOUNDATION AND AUXILIARY -585,756. TOTAL TO SCHEDULE D, PART XI, LINE 8: -17,860,769. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 537,402. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 83,077,300. CONTRIBUTIONS 585,751. LOSS ON REFINANCING OF DEBT 1,903,378. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 537,402. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 83,077,295. LOSS ON REFINANCING OF DEBT 1,903,378. 1 1 1 X 1 X 500.000000000000 1 1 1 0 1 1 20291753 492113 19799640 0.05560 40846613 35103632 5742981 0.01610 1934924 1635913 299011 0.00080 63073290 37231658 25841632 0.07250 411708 0 411708 0.00120 2180203 365663 1814540 0.00510 2591911 365663 2226248 0.00630 65665201 37597321 28067880 0.07880 1 83077300 98801175 79238980 19562195 X 1 1 1 GOOD SHEPHERD ASC AMBULATORY SURGICAL 0.31300 2 LONGVIEW ER ASSOC EMERGENCY ROOM COVERAGE 1.00000 3 ACOL ANESTHESIA SERVICES 1.00000 4 DCOL DIAGNOSTIC SERVICES 1.00000 1 1 GOOD SHEPHERD MEDICAL CENTER

700 EAST MARSHALL AVE LONGVIEW TX 75601

X X X X THE GOOD SHEPHERD HOSPITAL INC 1 0 1 1 100.000000000000 1 500.000000000000 1 X X X X X 1 1 X 1 0 1 X 0 0 PART I, L7 COL(F): BAD DEBT EXPENSE IN THE AMOUNT OF $83,077,300 WAS NOT INCLUDED IN TOTAL EXPENSE USED TO COMPUTE THE PERCENTAGE REPORTED IN PART I, LINE 7, COL(F).PART III, LINE 2:LINE 2 IS BAD DEBT EXPENSE FROM OUR AUDITED FINANCIAL STATEMENTS. WE DID NOT INCLUDE ANY BAD DEBT AMOUNTS IN COMMUNITY BENEFIT. PART II: GOOD SHEPHERD MEDICAL CENTER MAINTAINS A PRESENCE TO PROVIDE HEALTHCARE INFORMATION TO COMMUNITIES THROUGHOUT THE REGION. IN ADDITION, THE ORGANIZATION HOSTS AN ANNUAL HEALTH FAIR OFFERING FREE HEALTH SCREENINGS. GOOD SHEPHERD ALSO OFFERS DISCOUNTED MAMMOGRAMS EACH MONTH, FREE PROSTRATE SCREENINGS ANNUALLY, AND WAS INTEGRALLY INVOLVED IN ESTABLISHING THE MAYOR'S FITNESS COUNCIL. THROUGH THIS FITNESS COUNCIL'S ACTIVITIES AND SUPPORTED BY GOOD SHEPHERD, LONGVIEW HAS BEEN NAMED THE "FITTEST CITY IN TEXAS" FOR THE PAST TWO YEARS. THE COUNCIL PROMOTES ACTIVE LIFESTYLES AND FITNESS THROUGH WALKING AND REGULAR EXERCISE. PART III, LINE 4: THE MEDICAL CENTER RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYER COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE MEDICAL CENTER RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE MEDICAL CENTERS UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. THIS PROVISION FOR BAD DEBTS IS PRESENTED ON THE ACCOMPANYING STATEMENT OF OPERATIONS AS A COMPONENT OF NET PATIENT SERVICE REVENUE. PART III, LINE 8: SOURCE OF INFORMATION ON LINE 6 IS THE FYE 09/30/12 MEDICARE COST REPORT. THE SUM OF MEDICARE PART A ALLOWABLE COSTS REPORTED ON WORKSHEET D-1, PART II (FOR BOTH INPATIENT ACUTE PPS AND INPATIENT REHAB FACILITY) AND WORKSHEET DV, COLUMN 9.01 FOR MEDICARE OUTPATIENT PPS SERVICES. SINCE ALLOWABLE COSTS ARE NOT DETERMINED FOR SERVICES RENDERED TO MEDICARE PATIENTS ENROLLED IN MEDICARE ADVANTAGE (MEDICARE PART C) OR FOR PHYSICIAN SERVICES (SUCH AS EMERGENCY ROOM DOCTORS) BILLED UNDER MEDICARE PART B, NEITHER THE REVENUES OR COSTS RELATED TO THESE SERVICES HAVE BEEN INCLUDED ON LINES 5 OR 6.MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE FYE 9/30/2012 FILED COST REPORT. THE COST REPORT USES FINANCIAL AND STATISTICAL DATA TO DEVELOP PER DIEMS AND COST TO CHARGE RATIOS THAT ULTIMATELY DETERMINE ALLOWABLE MEDICARE INPATIENT AND OUTPATIENT COSTS AND REIMBURSEMENTS. PART III, LINE 9B: ALL PATIENTS WHO ARE UNDERINSURED OR UNINSURED WILL BE EVALUATED FOR GOVERNMENT PROGRAMS, PAYMENT PLANS, AND FINANCIAL ASSISTANCE. IF ALL ATTEMPTS FAIL, WE WILL CONSIDER EACH ACCOUNT MEETING CERTAIN CRITERIA FOR FINANCIAL ASSISTANCE. ANY ACCOUNT THAT HAS A BALANCE GREATER THAN $10,000 AND HAS NOT QUALIFIED FOR MEDICAID OR COUNTY PROGRAMS WILL BE REVIEWED ON A CASE BY CASE BASIS FOR CHARITY CONSIDERATION. CREDIT REPORTS WILL BE RUN AND SUBMITTED FOR REVIEW. IF THE PATIENT HAS A CREDIT SCORE BELOW 650, AND THE BALANCE IS COMPLETELY OWED BY TEH GUARANTOR/PATIENT ON ANY ONE ACCOUNT, CHARITY WILL BE CONSIDERED AT 100%. WRITE-OFFS WILL BE MONITORED THROUGH A SPECIFIC CODE, TO MONITOR AND EVALUATE AS NEEDED FOR CHANGES OR UPDATES. IF AT ANYTIME RECOVERIES ARE OBTAINED AFTER WRITE-OFF, THE CHARITY ADJUSTMENT WILL BE REVERSED AND ADDITIONAL REVIEW OF THE ACCOUNT WILL BE REQUIRED. THE GOOD SHEPHERD HOSPITAL INC PART V, SECTION B, LINE 19D: ALL PATIENTS ARE CHARGES THE SAME FOR LIKE SERVICES PART VI, LINE 2: THE UNITED WAY CONDUCTS A NEEDS ASSESSMENT SURVEY EVERY TWO YEARS TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. GOOD SHEPHERD USES THIS DATA TO AUGMENT INFORMATION GATHERED BASED ON UTILIZATION OF SERVICES. PART VI, LINE 3: AS PATIENTS ENTER OUR FACILITY, SIGNAGE IS POSTED IN DESIGNATED AREAS WHICH STATE OUR POLICY TO PROVIDE CHARITY CARE TO THOSE PATIENTS WHO MEET ELIGIBILITY REQUIREMENTS. BUSINESS OFFICE AND REGISTRATION STAFF DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSISTANCE AVAILABLE TO PATIENTS USING VERBAL AND WRITTEN COMMUNICATION. PATIENTS ARE CONTACTED PRIOR TO SERVICES WITH AN ESTIMATED COST AND OUT OF POCKET EXPENSES. CASH PRICES AND PAYMENT OPTIONS ARE DISCUSSED AND FINANCIAL ASSISTANCE SCREENING IS AVAILABLE UPON REQUEST. GOOD SHEPHERD MEDICAL CENTER EVALUATES PATIENT APPLICATIONS AND UTILIZES A SLIDING SCALE TO QUALIFY PATIENTS BASED ON GOVERNMENT POVERTY GUIDELINES. ADDITIONALLY, OUR ELIGIBILITY VENDOR SCREENS FOR GOVERNMENT AGENCY PROGRAMS AND OFFERS FINANCIAL ASSISTANCE APPLICATIONS TO THOSE WHO DO NOT QUALIFY FOR GOVERNMENT PROGRAMS. BUSINESS OFFICE AND REGISTRATION PERSONNEL ARE AVAILABLE TO ANSWER ANY FINANCIAL QUESTIONS AND ASSIST THE PUBLIC WITH THEIR FINANCIAL OBLIGATIONS. PART VI, LINE 4: GOOD SHEPHERD MEDICAL CENTER SERVES AN 11-COUNTY REGION INCLUDING THE FOLLOWING COUNTIES: GREGG, HARRISON, MARION, MORRIS, PANOLA, RUSK, UPSHUR, CAMP, CASS, WOOD, AND TITUS. GOOD SHEPHERD MEDICAL CENTERS IN LONGVIEW, LINDEN, AND MARSHALL OFFER A TRUE SYSTEM OF HEALTHCARE THAT ENCOMPASSES THE REACH OF OUR REGION. TO MEET THE EVERYDAY HEALTHCARE NEEDS OF THE RESIDENTS IN OUR REGION, GOOD SHEPHERD MEDICAL CENTER OPERATES FAMILY HEALTH CENTERS IN THE COMMUNITIES OF LONGVIEW, GLADEWATER, HENDERSON, KILGORE, JEFFERSON, LINDEN, AND HUGHES SPRINGS. PART VI, LINE 5: GOVERNED BY A VOLUNTARY BOARD OF DIRECTORS, GOOD SHEPHERD MEDICAL CENTER HAS A DIRECT LINK TO SOLICIT COMMUNITY INVOLVEMENT IN DECISION MAKING. THE BOARD OF DIRECTORS IS COMPOSED OF GOOD SHEPHERD MEDICAL CENTER'S PRESIDENT AND CHIEF EXECUTIVE OFFICER AND TWELVE MEMBERS OF THE COMMUNITY WHO SERVE ON A VOLUNTARY BASIS TO FURTHER THE MISSION OF GOOD SHEPHERD MEDICAL CENTER. THESE MEMBERS REPRESENT LOCAL BUSINESS, INDUSTRY, EDUCATION, MEDICAL SERVICES, AND CONSUMERS-AT-LARGE. THE BOARD OF DIRECTORS PROVIDES PERPETUAL COMMUNICATION OF THE CONCERNS AND HEALTHCARE NEEDS OF THE GREATER LONGVIEW COMMUNITY. PART VI, LINE 6: GOOD SHEPHERD HEALTH SYSTEM OPERATES HOSPITALS IN LONGVIEW, LINDEN, AND MARSHALL. IN EACH OF THE COMMUNITIES, THE HOSPITAL OFFERS FREE SCREENINGS TO IDENTIFY EARLY DISEASE, EDUCATIONAL OFFERINGS FEATURING PHYSICIAN SPEAKERS AND CONTINUOUSLY PARTICIPATE IN COMMUNITY ACTIVITIES WHERE PREVENTION AND WELLNESS INFORMATION CAN BE SHARED. X X 0 0 0 0 0 0 0 0 0 EDWARD D BANOS 0 511244 0 210823 0 0 0 6125 0 9290 0 737482 0 0 PAT KEEL 0 319408 0 93036 0 0 0 0 0 5950 0 418394 0 0 KENNETH CUNNINGHAM 0 211397 0 73397 0 0 0 8164 0 16438 0 309396 0 0 KAREN WATTS 0 244770 0 71145 0 0 0 6125 0 2424 0 324464 0 0 MARION BENSON 0 143631 0 55892 0 0 0 8084 0 2980 0 210587 0 0 RICHARD LEE HOLLADAY 289126 0 8359 0 0 0 9226 0 11835 0 318546 0 0 0 ALAN GUEDRY 264153 0 733 0 0 0 11082 0 20089 0 296057 0 0 0 JOHN COX 238120 0 715 0 0 0 10135 0 15958 0 264928 0 0 0 EDWARD MALDONADO 248966 0 733 0 0 0 7125 0 25308 0 282132 0 0 0 RICHARD HINSON 212102 0 27233 0 0 0 9468 0 18282 0 267085 0 0 0 RUBY BREWER 0 156202 0 25197 0 0 0 0 0 12039 0 193438 0 0 GREGG COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION 751865828 39753MDT2 2004-05-27 21770000 FINANCING 0 0 0 GREGG COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION 751865828 39753MDU9 2006-11-08 99276418 ADVANCE REFUNDING OF BONDS 0 0 0 GREGG COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION 751865828 39753MFE3 2012-08-01 78665000 ADVANCE REFUNDING OF BONDS 0 0 0 GREGG COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION 751865828 39753MFF0 2012-09-05 33033015 CAPITAL IMPROVEMENTS 0 0 0 21770000 2012 0 0 1 1 99276418 99276418 96480044 636501 2159873 2012 0 1 1 1 78665000 77994000 671000 2012 0 1 0 1 32465000 2176874 8338548 660660 21856933 2014 0 1 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 1 1 WELLS FARGO BANK NA 16.000000000000 0 0 0 0 0 1 0 1 0 0 0 0 0 X 1 102000 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 GSHS INC IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B A NUMBER OF DECISIONS OF THE ORGANIZATION ARE SUBJECT TO APPROVAL OF THE MEMBER OF THE ORGANIZATION. THESE RESERVED POWERS ARE STATED BELOW: A) BEGINNING JANUARY 1, 2007, APPROVE THE MEMBERS OF THE BOARD; B) BEGINNING JANUARY 1, 2007, REMOVE MEMBERS FROM THE BOARD AND SET SIZE OF BOARD; C) APPROVE THE ELECTION AND REMOVAL OF OFFICERS OF THE CORPORATION AND ESTABLISH, TERMINATE AND/OR REVISE ALL EMPLOYMENT CONTRACTS, COMPENSATION, AND BENEFIT PACKAGES OF THE OFFICERS OF THE CORPORATION; D) DESIGNATE THE FISCAL YEAR; E) APPROVE THE SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, OUTSIDE GENERAL LEGAL COUNSEL, AND OUTSIDE INVESTMENT ADVISORS; F) AMEND THE ARTICLES OF INCORPORATION; G) AMEND OR REPEAL THE BYLAWS; H) APPROVAL OF ALL MERGERS, ACQUISITIONS, CONSOLIDATIONS, OR AFFILIATIONS WITH OTHER ENTITIES, THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE SALE, MORTGAGE, OR ENCUMBRANCE OF ANY REAL PROPERTY OWNED BY THE CORPORATION; I) APPROVE THE DISSOLUTION OR LIQUIDATION OF THE CORPORATION; J) APPROVE CAPITAL PLANS, STRATEGIC PLANS, AND ANNUAL OPERATING AND CAPITAL BUDGETS; K) APPROVE ANY EXCEPTION TO THE CAPITAL BUDGET FOR A SINGLE ITEM OR RELATED ITEM THAT IS $500,000 OR MORE, AND APPROVE ANY OPERATING EXPENSE THAT EXCEEDS THE BUDGET BY $500,000 OR MORE; L) SELECT OFFICIAL DEPOSITORIES FOR THE CORPORATION'S FUNDS; M) CREATING OR INVESTING IN ANY SUBSIDIARY ENTITY OR ENTERING ANY PARTNERSHIP OR JOINT VENTURE; N) AUTHORIZATION OF ANY LOANS, GUARANTEES, OR INCURRENCE OF DEBT; O) THE COMMENCEMENT OF ANY LITIGATION OR OTHER LEGAL PROCEEDING, OR THE SETTLEMENT, DISPOSITION, OR TERMINATION OF ANY SUCH LITIGATION OR OTHER LEGAL PROCEEDING OR OF ANY CLAIM OR THREAT OF LITIGATION OR OTHER LEGAL PROCEEDING NOT FULLY COVERED BY INSURANCE; AND P) APPROVAL OF THE ADMISSION OF ADDITIONAL MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION ENGAGES AN OUTSIDE FIRM TO AUDIT THE FINANCIALS. AN INTERNAL ACCOUNTANT PREPARES THE 990S AND THE RETURNS ARE REVIEWED EXTERNALLY. ONCE REVIEWED BY AN EXTERNAL ACCOUNTING FIRM, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DISCLOSURES ARE OBTAINED ANNUALLY. THE BOARD REVIEWS AND APPROVES THE BOARD MEMBERS' DISCLOSURES, AND THE CEO REVIEWS AND APPROVES THE EMPLOYEES' DISCLOSURES. BOARD MINUTES REFLECT WHEN A BOARD MEMBER DECLARES A CONFLICT AND DOES NOT VOTE. FORM 990, PART VI, SECTION B, LINE 15 A COMPENSATION SUBCOMMITTEE OF THE BOARD NEGOTIATES CONTRACTS WITH EXECUTIVES THROUGH LONGNECKER & ASSOCIATES. THIS SUBCOMMITTEE OF THE BOARD REVIEWS AND APPROVES COMPENSATION AND BONUSES. FORM 990, PART VI, SECTION C, LINE 19 GOOD SHEPHERD MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. AVERAGE HOURS WORKED FOR RELATED ORGANIZATION PART VII SECTION(A), LINE 1(A) COLUMN(B) EDWARD D. BANOS 40 HOURS KAREN WATTS 40 HOURS KENNETH CUNNINGHAM 40 HOURS PAT KEEL 40 HOURS MARION BENSON 40 HOURS RUBY BREWER 40 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -3,162. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -4,801,138. TRANSFERS TO AFFILIATES -13,424,026. CONTRIBUTIONS OF OR FOR PROPERTY AND EQUIPMENT 312,681. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 637,470. CONTRIBUTIONS FROM FOUNDATION AND AUXILIARY -585,756. TOTAL TO FORM 990, PART XI, LINE 5: -17,863,931. GSHS INC 700 E MARSHALL AVE LONGVIEW TX 75601 752027157 SUPPORT GSMC TX 501(C)(3) 11B N/A 0 CHAMPION EMS 2201 S MOBBERLY AVE LONGVIEW TX 75604 752747708 MED TRANSPORT TX 501(C)(3) 11B GOOD SHEPHERD HOSPITAL INC 1 GOOD SHEPHERD HOSPITAL AUXILIARY 700 E MARSHALL AVE LONGVIEW TX 75601 237203364 SUPPORT TX 501(C)(3) 11B GOOD SHEPHERD HOSPITAL INC 1 GOOD SHEPHERD FOUNDATION INC 700 E MARSHALL AVE LONGVIEW TX 75601 752056700 SUPPORT TX 501(C)(3) 11B GOOD SHEPHERD HOSPITAL INC 1 GSHS ADMINISTRATIVE SERVICES ORGANIZATION 700 E MARSHALL AVE LONGVIEW TX 75601 861132471 ADMIN SUPPORT TX 501(C)(3) 11B GSHS INC 0 HARRISON COUNTY HOSPITAL ASSOCIATION 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 752605699 HEALTHCARE TX 501(C)(3) 11B GSHS INC 0 GOOD SHEPHERD MEDICAL CENTER - LINDEN 404 N KAUFMAN STREET LINDEN TX 75563 010829282 HEALTHCARE TX 501(C)(3) 11B GSHS INC 0 GSMC - LINDEN FOUNDATION INC 404 N KAUFMAN STREET LINDEN TX 75563 200845127 SUPPORT TX 501(C)(3) 11B GSHS INC 0 MARSHALL HOSPITAL FOUNDATION INC 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 752605699 SUPPORT TX 501(C)(3) 11B HARRISON COUNTY HOSPITAL ASSOCIATION 0 MARSHALL HEALTH SERVICES INC 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 752580686 HEALTHCARE TX 501(C)(3) 11B HARRISON COUNTY HOSPITAL ASSOCIATION 0 GS AMBULATORY SURGICAL CENTER 700 E MARSHALL AVE LONGVIEW TX 75601 900259782 SURGERY TX GSHS ENTERPRISES OPERATING #2 INC RELATED 0 0 GSHS ENTERPRISES INC 700 E MARSHALL AVE LONGVIEW TX 75601 752027162 HEALTHCARE TX GSHS INC C GOOD SHEPHERD HEALTH NETWORK 700 E MARSHALL AVE LONGVIEW TX 75601 752554695 INACTIVE TX GOOD SHEPHERD HOSPITAL INC C NORTHEAST TEXAS PHYSICIAN SE 700 E MARSHALL AVE LONGVIEW TX 75601 752712245 MGMT SERVICES TX GSHS ENTERPRISES INC C GS PHYSICIAN SERVICES INC 700 E MARSHALL AVE LONGVIEW TX 75601 752762417 MEDICAL SERVICES TX GSHS ENTERPRISES INC C GSHS ENTERPRISES HOLDING INC 700 E MARSHALL AVE LONGVIEW TX 75601 510412465 HOLDING COMPANY DE GSHS ENTERPRISES INC C GSHS ENTERPRISES OPERATING 1 700 E MARSHALL AVE LONGVIEW TX 75601 752954772 HEALTHCARE DE GSHS ENTERPRISES INC C GSHS ENTERPRISES OPERATING 2 700 E MARSHALL AVE LONGVIEW TX 75601 752954777 HEALTHCARE DE GSHS ENTERPRISES INC C GSHS ENTERPRISES OPERATING 3 700 E MARSHALL AVE LONGVIEW TX 75601 710896512 HEALTHCARE DE GSHS ENTERPRISES INC C GSHS MEDICAL PLAZA LTD 700 E MARSHALL AVE LONGVIEW TX 75601 752955157 HEALTHCARE TX GSHS ENTERPRISES OPERATING #1 INC C GSHS MEDICAL PLAZA III LTD 700 E MARSHALL AVE LONGVIEW TX 75601 731654263 HEALTHCARE TX GSHS ENTERPRISES OPERATING #3 INC C 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 1 1 GOOD SHEPHERD FOUNDATION INC C 456896 CASH METHOD GOOD SHEPHERD FOUNDATION INC R 102000 FAIR MARKET VALUE