SAMARITAN NORTH LINCOLN HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SAMARITAN NORTH LINCOLN HOSPITAL (EIN 93-1305493)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201323169349305782
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2013-11-12T18:45:24-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930623286 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AKT LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5665 SW MEADOWS RD SUITE 200 | AddressLine1 |
| City | LAKE OSWEGO | City |
| State | OR | State |
| ZIP Code | 97035 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 931305493 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN NORTH LINCOLN HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SAMA | NameControl |
| Phone | 5419943661 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3043 NE 28TH STREET | AddressLine1 |
| City | LINCOLN CITY | City |
| State | OR | State |
| ZIP Code | 97367 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANIEL B SMITH | Name |
| Title | VP FINANCE/CFO | Title |
| Phone | 5419943661 | Phone |
| Date Signed | 2013-11-05 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOYLYN ANKENEY | Name |
| PTIN | P00366587 | PTIN |
| Phone | 5036204489 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOSEPH M CAHILL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3043 NE 28TH STREET | AddressLine1 |
| City | LINCOLN CITY | City |
| State | OR | State |
| ZIP Code | 97367 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 43470125 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SAMHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2000 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | TO DELIVER HIGH QUALITY HEALTH CARE SERVICES TO THE RESIDENTS AND VISITORS OF THE DISTRICT. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 2 | NbrIndependentVotingMembers |
| Total Nbr Employees | 427 | TotalNbrEmployees |
| Total Nbr Volunteers | 77 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1732554 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1517440 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 41500570 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 41140986 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 41787 | InvestmentIncomePriorYear |
| Investment Income Current Year | 372377 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 233412 | OtherRevenuePriorYear |
| Other Revenue Current Year | 364981 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 43508323 | TotalRevenuePriorYear |
| Total Revenue Current Year | 43395784 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 396654 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 308150 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 27384651 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 27990816 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 276948 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 15383649 | OtherExpensePriorYear |
| Other Expenses Current Year | 15433842 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 43164954 | TotalExpensesPriorYear |
| Total Expenses Current Year | 43732808 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 343369 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -337024 | RevenuesLessExpensesCY |
| Total Assets BOY | 19414873 | TotalAssetsBOY |
| Total Assets EOY | 16727783 | TotalAssetsEOY |
| Total Liabilities BOY | 11931482 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9581416 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7483391 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7146367 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SAMARITAN NORTH LINCOLN HOSPITAL (SNLH) 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. SNLH PROVIDES HEALTHCARE SERVICES REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, DISABILITY OR AGE. THE MISSION OF SNLH 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 37189831 | Expense |
| Revenue | 40911554 | Revenue |
| Description | SAMARITAN NORTH LINCOLN HOSPITAL (SNLH) HAS BEEN A PART OF THE FABRIC OF ITS COMMUNITY, SERVING THE CITIZENS IN LINCOLN COUNTY, SINCE 1967. SNLH INCLUDES A CRITICAL-ACCESS HOSPITAL AND SEVERAL MEDICAL CLINICS, WITH APPROXIMATELY 350 EMPLOYEES AND 70 VOLUNTEERS PROVIDING QUALITY HEALTHCARE SERVICES TO THE COMMUNITY. DURING 2012, SNLH SERVED 1,104 INPATIENTS, HAD 10,032 EMERGENCY DEPARTMENT VISITS, PERFORMED 1,283 SURGERIES, AND DELIVERED 153 BABIES. IN ADDITION, SNLH PERFORMED 17,907 IMAGING PROCEDURES, HAD 10,336 HOME HEALTH/HOSPICE VISITS, AND HAD 29,326 PHYSICIAN CLINIC VISITS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 553324 | Expense |
| Grants | 278016 | Grants |
| Revenue | 275308 | Revenue |
| Description | THE SAMARITAN EARLY LEARNING CENTER (SELC) OFFERS HANDS-ON LEARNING EXPERIENCES FOR CHILDREN THAT REFLECT THEIR DEVELOPMENTAL STAGE. THE PROGRAM IS BASED ON CREATIVE CURRICULUM, WHERE CHILDREN GROW AND LEARN IN THE AREAS OF SOCIAL, EMOTIONAL, PHYSICAL, COGNITIVE AND CREATIVE DEVELOPMENT AT THEIR OWN RATE IN THEIR LEARNING STYLE. THE CENTER CARES FOR 75 CHILDREN, RANGING FROM INFANTS TO PRESCHOOLERS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 30134 | Expense |
| Grants | 30134 | Grants |
| Description | GRANTS AND ASSISTANCE PROVIDED BY SAMARITAN NORTH LINCOLN HOSPITAL TO VARIOUS ORGANIZATIONS AND INDIVIDUALS TO BENEFIT THE COMMUNITY. NO INDIVIDUAL GRANT EXCEEDED $5,000. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 37773289 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 1 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 42 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 427 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 2 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | OR | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN NORTH LINCOLN HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5419966471 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3043 NE 28TH STREET | AddressLine1 |
| City | LINCOLN CITY | City |
| State | OR | State |
| ZIP Code | 97367 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| LARRY A MULLINS DHA | ||||||||
| BOARD CHAIR/CEO SHS | 2.00 | 38.00 | X | X | 0 | 1521885 | 47761 | |
| DAVID GREEN | ||||||||
| BOARD SECRETARY & TREASURER | 1.00 | X | X | 0 | 0 | 0 | ||
| DEAN ORTON MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | X | 152692 | 0 | 31759 | |||
| CHRIS CHANDLER | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| DAVID TRIEBES | ||||||||
| BOARD VICE-CHAIR/CEO AGH | 2.00 | 38.00 | X | X | 0 | 321706 | 48378 | |
| RICHARD TOWNSEND | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JOSEPH M CAHILL | ||||||||
| CEO | 40.00 | X | 0 | 152831 | 36025 | |||
| DANIEL B SMITH | ||||||||
| VP FINANCE/CFO SHS | 2.00 | 38.00 | X | 0 | 307217 | 50011 | ||
| STEPHEN SHEA DO | ||||||||
| PHYSICIAN | 40.00 | 521012 | 0 | 48437 | X | |||
| STEPHEN QUINN MD | ||||||||
| PHYSICIAN | 40.00 | 339186 | 0 | 38009 | X | |||
| ROBERT OKSENHOLT DO | ||||||||
| PHYSICIAN | 40.00 | 434117 | 0 | 38817 | X | |||
| ALEXA LAFAUNCE MD | ||||||||
| PHYSICIAN | 40.00 | 298820 | 0 | 15184 | X | |||
| KARL ORDELHEIDE MD | ||||||||
| PHYSICIAN | 40.00 | 374108 | 0 | 18162 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2119935 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2303639 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 372543 | TotalOtherCompensation |
| Number Individuals GT100 K | 46 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ZLATEV RADIOLOGY PC | |||||
| 3169 NE CASCARA CT | LINCOLN CITY | OR | 97367 | RADIOLOGY SERVICES | 184442 |
| FAVORITE HEALTHCARE STAFFING INC | |||||
| PO BOX 803356 | KANSAS CITY | MO | 64180 | STAFFING SERVICES | 105987 |
| ROBERT KAYE MD | |||||
| 3232 NE 30TH AVE | LINCOLN CITY | OR | 97367 | PHYSICIAN | 104223 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Related Organizations | 150904 | RelatedOrganizations |
| Government Grants | 1366536 | GovernmentGrants |
| Total Contributions | 1517440 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SVC REV | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 41140986 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41140986 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 41140986 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 372377 | TotalRevenueColumn |
| Exclusion | $372,377 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 42877 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 18706 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 24171 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24171 | TotalRevenueColumn |
| Exclusion | $24,171 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 184740 | GrossSalesOfInventory |
| Cost Of Goods Sold | 55635 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 129105 | TotalRevenueColumn |
| Exclusion | $129,105 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA | 722210 | 165829 | $165,829 | |
| OTHER INCOME | 900099 | 33305 | 33305 | |
| RELEASE OF INFORMATION | 561000 | 11704 | 11704 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 867 | TotalRevenueColumn |
| Related Or Exempt Function Income | 867 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 211705 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 43395784 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41186862 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $691,482 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21250 | Total |
| Program Services | 21250 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 286900 | Total |
| Program Services | 286900 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 184452 | Total |
| Program Services | 184452 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21700126 | Total |
| Program Services | 20422364 | ProgramServices |
| Management And General | 1125287 | ManagementAndGeneral |
| Fundraising | 152475 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 988332 | Total |
| Program Services | 930627 | ProgramServices |
| Management And General | 50819 | ManagementAndGeneral |
| Fundraising | 6886 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3527379 | Total |
| Program Services | 3321428 | ProgramServices |
| Management And General | 181375 | ManagementAndGeneral |
| Fundraising | 24576 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1590527 | Total |
| Program Services | 1497662 | ProgramServices |
| Management And General | 81783 | ManagementAndGeneral |
| Fundraising | 11082 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 396 | Total |
| Management And General | 396 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13425 | Total |
| Management And General | 13425 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1553300 | Total |
| Program Services | 1553300 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20846 | Total |
| Program Services | 650 | ProgramServices |
| Management And General | 12234 | ManagementAndGeneral |
| Fundraising | 7962 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1694941 | Total |
| Program Services | 1590954 | ProgramServices |
| Management And General | 65898 | ManagementAndGeneral |
| Fundraising | 38089 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1051908 | Total |
| Management And General | 1051908 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 900881 | Total |
| Program Services | 886071 | ProgramServices |
| Management And General | 14586 | ManagementAndGeneral |
| Fundraising | 224 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134716 | Total |
| Program Services | 118977 | ProgramServices |
| Management And General | 13167 | ManagementAndGeneral |
| Fundraising | 2572 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87777 | Total |
| Program Services | 78314 | ProgramServices |
| Management And General | 6937 | ManagementAndGeneral |
| Fundraising | 2526 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105922 | Total |
| Management And General | 105922 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 780399 | Total |
| Program Services | 777359 | ProgramServices |
| Management And General | 885 | ManagementAndGeneral |
| Fundraising | 2155 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 828174 | Total |
| Program Services | 724188 | ProgramServices |
| Management And General | 103986 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| PURCHASED SERVICES | 4094528 | 1238446 | 2828726 | 27356 |
| MEDICAL SUPPLIES | 4078292 | 4078292 | ||
| DUES, TAXES, & LICENSES | 88337 | 62055 | 25237 | 1045 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43732808 | Total |
| Program Services | 37773289 | ProgramServices |
| Management And General | 5682571 | ManagementAndGeneral |
| Fundraising | 276948 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2150 | BOY |
| EOY | 2750 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8775223 | BOY |
| EOY | 3133670 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4933022 | BOY |
| EOY | 4362548 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 332265 | BOY |
| EOY | 260131 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 705722 | BOY |
| EOY | 738658 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93282 | BOY |
| EOY | 90372 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7846455 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4823090 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3704356 | BOY |
| EOY | 3023365 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89439 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 779414 | BOY |
| EOY | 5116289 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19414873 | BOY |
| EOY | 16727783 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3546299 | BOY |
| EOY | 3570460 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5671 | BOY |
| EOY | 7646 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 619549 | BOY |
| EOY | 308412 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7759963 | BOY |
| EOY | 5694898 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11931482 | BOY |
| EOY | 9581416 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7483391 | BOY |
| EOY | 7146367 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7483391 | BOY |
| EOY | 7146367 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19414873 | BOY |
| EOY | 16727783 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -337024 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2547884 | OtherCostOrOtherBasis |
| Depreciation | 686970 | Depreciation |
| Book Value | 1860914 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 217441 | OtherCostOrOtherBasis |
| Depreciation | 32354 | Depreciation |
| Book Value | 185087 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5081130 | OtherCostOrOtherBasis |
| Depreciation | 4103766 | Depreciation |
| Book Value | 977364 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3023365 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 754049 |
| ACCOUNTS RECEIVABLE - AFFILIATES | 4362240 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 5116289 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CONTRACTUAL REIMBURSEMENT OBLIGATIONS | $1,394,027 |
| PROFESSIONAL LIABILITY | $214,000 |
| WORKING CAPITAL RESERVES | $4,055,188 |
| OTHER RESERVES | $31,683 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 5694898 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 2663 | PersonsServed |
| Total Community Benefit Expense | 1554449 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1554449 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03550 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 18040 | PersonsServed |
| Total Community Benefit Expense | 6309361 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6106044 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 203317 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00460 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 20703 | PersonsServed |
| Total Community Benefit Expense | 7863810 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6106044 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1757766 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04010 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 2864 | PersonsServed |
| Total Community Benefit Expense | 157797 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 157797 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00360 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 109 | PersonsServed |
| Total Community Benefit Expense | 323994 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 323994 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00740 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 39372 | PersonsServed |
| Total Community Benefit Expense | 6818151 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4945709 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1872442 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04280 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 2445 | PersonsServed |
| Total Community Benefit Expense | 87353 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 87353 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 32 | NumberOfActivitiesOrPrograms |
| Persons Served | 44790 | PersonsServed |
| Total Community Benefit Expense | 7387295 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4945709 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2441586 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05580 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 46 | NumberOfActivitiesOrPrograms |
| Persons Served | 65493 | PersonsServed |
| Total Community Benefit Expense | 15251105 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11051753 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4199352 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09590 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 1547 | PersonsServed |
| Total Community Building Expense | 558345 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 275308 | DirectOffsettingRevenue |
| Net Community Building Expense | 283037 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00650 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 327 | PersonsServed |
| Total Community Building Expense | 38934 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 38934 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 352 | PersonsServed |
| Total Community Building Expense | 305930 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 297077 | DirectOffsettingRevenue |
| Net Community Building Expense | 8853 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Persons Served | 2226 | PersonsServed |
| Total Community Building Expense | 903209 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 572385 | DirectOffsettingRevenue |
| Net Community Building Expense | 330824 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00760 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,779,567 | BadDebtExpenseAmount |
| Amount Attributable To | 60668 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12745774 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12629347 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 116427 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CBA-SAM LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | REAL PROPERTY RENTAL | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.30000 | OrganizationProfitOrOwnership |
| Physicans Profit Or Ownership | 0.40000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN NORTH LINCOLN HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3043 NE 28TH STREET | AddressLine1 |
| City | LINCOLN CITY | City |
| State | OR | State |
| ZIP Code | 97367 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN NORTH LINCOLN HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 11 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (11 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SAMARITAN COASTAL CLINIC | ||||
| 825 HWY 101 | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN ORTHOPEDICS | ||||
| 2870 WEST DEVILS LAKE ROAD | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN OBSTETRICS & GYNECOLOGY | ||||
| 2930 NE WEST DEVILS LAKE ROAD STE 3 | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN N LINCOLN INTERNAL MEDICINE | ||||
| 2870 WEST DEVILS LAKE ROAD | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN SURGICAL CLINIC | ||||
| 3100 NE 28TH ST STE B | LINCOLN CITY | OR | 97367 | OUTPATIENT SURGERY |
| SAMARITAN NORTH LINCOLN ENT CLINIC | ||||
| 3100 NE 28TH ST STE D-2 | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN KIDNEY SPC - LINCOLN CITY | ||||
| 3100 NE 28TH ST | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN LINCOLN CITY MEDICAL CLINIC | ||||
| 2870 WEST DEVILS LAKE ROAD | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN COSMETIC SERVICES | ||||
| 2930 NE WEST DEVILS LAKE ROAD STE 1 | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN CARDIOLOGY PHYSICIANS | ||||
| 3100 NE 28TH ST | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN HEMATOLOGY & ONCOLOGY | ||||
| 3100 NE 28TH ST | LINCOLN CITY | OR | 97367 | MEDICAL CLINIC - OUTPATIENT |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| 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 $1,394,132 | ||
| PART II: SNLH PROVIDES SERVICES AND ACTIVITIES THAT ARE CLASSIFIED AS COMMUNITY BUILDING. SNLH IS COMMITTED TO PROVIDING SUPPORT SERVICES TO THE MOST VULNERABLE RESIDENTS IN THE COMMUNITY. THIS IS DEMONSTRATED THROUGH THE ONGOING SUPPORT TO THE SAMARITAN EARLY LEARNING CENTER (SELC). THE SELC OFFERS LOW-COST INFANT/TODDLER CARE TO FAMILIES IN LINCOLN COUNTY AND IS THE ONLY FACILITY IN NORTH LINCOLN COUNTY TO OFFER THIS SERVICE. SNLH ALSO LEADS DISASTER PREPAREDNESS DRILLS WITH LOCAL AGENCIES AND STAFF PARTICIPATING IN SUPPORT SERVICES FOR HOMELESS FAMILIES IN THE COMMUNITY. SNLH STAFF SERVE ON MANY LOCAL COALITIONS AND BOARDS THAT PROMOTE THE HEALTH OF THE COMMUNITY. BOARD AFFILIATION INCLUDES, BUT IS NOT LIMITED TO, LINCOLN COUNTY ECONOMIC DEVELOPMENT COUNCIL, JOINT TRANSPORTATION COMMITTEE, PROJECT HOMELESS CONNECT, AND LOCAL CIVIC ORGANIZATIONS. THE SNLH STAFF CONDUCT RECRUITMENT ACTIVITIES TO ENCOURAGE PHYSICIANS AND OTHER MEDICAL PROFESSIONALS TO PROVIDE SERVICES IN RURAL LINCOLN COUNTY. | ||
| 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.SAMARITAN NORTH LINCOLN HOSPITAL (SNLH) IS ONE 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. THE COST REPORT INCLUDES ACTIVITY FOR MEDICARE FEE-FOR-SERVICE PATIENTS BUT NOT MEDICARE MANAGED CARE PATIENTS. | ||
| 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. | ||
| 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 14A: | |
| 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 V, SECTION B, LINE 20D: | |
| PART VI, LINE 2: SAMARITAN NORTH LINCOLN HOSPITAL (SNLH) ACTIVELY PARTICIPATES IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY. IN CONJUNCTION WITH THE LINCOLN COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT, LINCOLN COUNTY FEDERALLY QUALIFIED HEALTH CENTER, LINCOLN COUNTY UNIFIED SCHOOL DISTRICT, OREGON COAST COMMUNITY COLLEGE, UNITED WAY OF LINCOLN COUNTY, THE LINCOLN COUNTY COMMISSION ON CHILDREN AND FAMILIES, AND OTHER COMMUNITY PARTNERS, SNLH EMPLOYEES AND OTHER SAMARITAN HEALTH SERVICES STAFF ACTIVELY PARTICIPATED IN A COMMUNITY HEALTH ASSESSMENT FOR LINCOLN COUNTY DURING 2010 (AND CURRENTLY IN 2013). THIS PROCESS INCLUDED EXAMINING PRIMARY DATA COLLECTED THROUGH SURVEYS, FOCUS GROUPS, COMMUNITY FORUMS AND PERSONAL INTERVIEWS WITH SEVERAL COMMUNITY MEMBERS FROM THROUGHOUT LINCOLN COUNTY. SECONDARY DATA WAS GATHERED FROM STATE AND LOCAL AGENCIES THAT ADDRESS HEALTH NEEDS OF CHILDREN, YOUTH AND FAMILIES. AS A RESULT OF THE COUNTY COMMUNITY HEALTH ASSESSMENT, SNLH IS ABLE TO UPDATE ITS COMMUNITY BENEFIT PLAN THAT OUTLINES GOALS AND OBJECTIVES AND SERVICES THAT EXPAND ACROSS THE SAMARITAN HEALTH SERVICES SYSTEM AND RESPOND TO COMMUNITY NEEDS. SNLH WILL UTILIZE THE 2013 LINCOLN COUNTY COMMUNITY HEALTH ASSESSMENT TO COMPLETE A HOSPITAL-SPECIFIC COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013. | ||
| PART VI, LINE 3: SNLH 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: SAMARITAN NORTH LINCOLN HOSPITAL (SNLH) PRIMARILY SERVES THE RESIDENTS OF NORTH LINCOLN COUNTY. LOCATED ON A PRIMARILY RURAL PORTION OF OREGON'S CENTRAL COAST, LINCOLN COUNTY IS HOME TO 46,034 (2010 U.S. CENSUS) RESIDENTS. WITHIN LINCOLN COUNTY, THE LARGE TRIBAL POPULATION IS DISPROPORTIONATELY BURDENED BY HEALTH INEQUITIES. THERE ARE 4,769 ENROLLED TRIBAL MEMBERS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS, OF WHICH 22% LIVE IN LINCOLN COUNTY. LINCOLN COUNTY LACKS A MAJOR METROPOLITAN AREA AND CONSISTS OF MANY SMALL COMMUNITIES SCATTERED THROUGHOUT THE REGION. NEWPORT IS THE COUNTY SEAT AND HAS A POPULATION OF 9,989. LINCOLN CITY IS THE SECOND LARGEST TOWN AND HAS A POPULATION OF 7,930. THE MEDIAN INCOME FOR LINCOLN COUNTY IS $41,764, WITH 16% OF THE POPULATION LIVING BELOW THE FEDERAL POVERTY LEVEL. AS OF DECEMBER 2012, THE OREGON EMPLOYMENT DEPARTMENT REPORTED AN 8.7% UNEMPLOYMENT RATE FOR LINCOLN COUNTY. THIRTY-EIGHT PERCENT OF THE POPULATION RESIDES IN RURAL UNINCORPORATED AREAS AND 25% OF RESIDENTS ARE UNINSURED. SAMARITAN PACIFIC COMMUNITIES HOSPITAL, LOCATED IN NEWPORT, IS THE SISTER HOSPITAL IN SOUTHERN LINCOLN COUNTY SERVING LOCAL RESIDENTS. LINCOLN COUNTY IS DESIGNATED AS MEDICALLY UNDERSERVED POPULATION AND THE MIGRANT SEASONAL FARMWORKER POPULATION HAS BEEN DESIGNATED A PRIMARY MEDICAL CARE HEALTH PROVIDER SHORTAGE AREA BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION. THE SILETZ COMMUNITY HEALTH CLINIC, WHICH SERVES THE 3,666-ACRE RESERVATION OF THE CONFEDERATED TRIBES OF SILETZ INDIANS, IS A DESIGNATED HEALTH PROVIDER SHORTAGE AREA. | ||
| PART VI, LINE 5: SNLH'S GOVERNING BOARD IS COMPRISED OF LOCAL-AREA RESIDENTS AND OFFICERS OF AFFILIATED ORGANIZATIONS. SNLH EXTENDS ITS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SNLH APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. SNLH INVESTS IN UPDATING EQUIPMENT, TECHNOLOGY AND FACILITIES TO IMPROVE PATIENT CARE. SNLH IS ACCREDITED FOR CONTINUING MEDICAL EDUCATION AND OFFERS FREQUENT PROGRAMS FOR AREA PHYSICIANS AND OTHER HEALTH PROFESSIONALS. THE CENTER FOR HEALTH RESEARCH AND QUALITY, A DEPARTMENT OF SNLH'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 SNLH AND ITS AFFILIATED HOSPITALS. SNLH ALSO PROVIDES SCHOLARSHIPS FOR STUDENTS AND EMPLOYEES IN HEALTH OCCUPATIONS. | ||
| 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.SAMARITAN NORTH LINCOLN HOSPITAL IS ONE OF TWO LINCOLN COUNTY CRITICAL ACCESS HOSPITALS OF SHS PRIMARILY SERVING RESIDENTS OF NORTH LINCOLN COUNTY. OTHER AFFILIATED HOSPITALS ARE GOOD SAMARITAN HOSPITAL SERVING RESIDENTS OF BENTON COUNTY, SAMARITAN ALBANY GENERAL HOSPITAL AND SAMARITAN LEBANON COMMUNITY HOSPITAL, SERVING RESIDENTS OF LINN COUNTY, AND SAMARITAN PACIFIC COMMUNITIES HOSPITAL, SERVING RESIDENTS OF SOUTH LINCOLN COUNTY. | ||
| OR | PART VI, LINE 7 | REPORTS FILED WITH STATES |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII (5 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|---|---|---|
| CHILDCARE SERVICES | 75 | 278016 | BOOK | PROVISION OF WAGES, BUILDING, UTILITIES, AND SUPPLIES FOR SAMARITAN EARLY LEARNING CTR, NET OF PROGRAM REVENUES. | |
| HEALTH EDUCATION CAREER SUPPORT | 350 | 6250 | BOOK | PROVISION OF WAGES, BUILDING, UTILITIES, AND SUPPLIES FOR AREA HEALTH EDUC CTR (AHEC), NET OF PROGRAM REVENUES. | |
| TRANSPORTATION ASSISTANCE | 54 | 1040 | |||
| PATIENT SUPPORT | 1 | 94 | |||
| SCHOLARSHIPS | 1 | 1500 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LARRY A MULLINS DHA | ||||||||||||||
| BOARD CHAIR/CEO SHS | 0 | 587213 | 0 | 0 | 0 | 934672 | 0 | 20596 | 0 | 27165 | 0 | 1569646 | 0 | 712232 |
| DEAN ORTON MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | 151694 | 0 | 0 | 0 | 998 | 0 | 11104 | 0 | 20655 | 0 | 184451 | 0 | 0 | 0 |
| DAVID TRIEBES | ||||||||||||||
| BOARD VICE-CHAIR/CEO AGH | 0 | 296311 | 0 | 0 | 0 | 25395 | 0 | 20596 | 0 | 27782 | 0 | 370084 | 0 | 0 |
| JOSEPH M CAHILL | ||||||||||||||
| CEO | 0 | 149152 | 0 | 0 | 0 | 3679 | 0 | 10897 | 0 | 25128 | 0 | 188856 | 0 | 0 |
| DANIEL B SMITH | ||||||||||||||
| VP FINANCE/CFO SHS | 0 | 299636 | 0 | 0 | 0 | 7581 | 0 | 20596 | 0 | 29415 | 0 | 357228 | 0 | 0 |
| STEPHEN SHEA DO | ||||||||||||||
| PHYSICIAN | 446611 | 0 | 71075 | 0 | 3326 | 0 | 20596 | 0 | 27841 | 0 | 569449 | 0 | 0 | 0 |
| STEPHEN QUINN MD | ||||||||||||||
| PHYSICIAN | 327874 | 0 | 0 | 0 | 11312 | 0 | 20596 | 0 | 17413 | 0 | 377195 | 0 | 0 | 0 |
| ROBERT OKSENHOLT DO | ||||||||||||||
| PHYSICIAN | 392017 | 0 | 0 | 0 | 42100 | 0 | 20596 | 0 | 18221 | 0 | 472934 | 0 | 0 | 0 |
| ALEXA LAFAUNCE MD | ||||||||||||||
| PHYSICIAN | 298283 | 0 | 0 | 0 | 537 | 0 | 5124 | 0 | 10060 | 0 | 314004 | 0 | 0 | 0 |
| KARL ORDELHEIDE MD | ||||||||||||||
| PHYSICIAN | 372455 | 0 | 0 | 0 | 1653 | 0 | 6590 | 0 | 11572 | 0 | 392270 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. THREE HIGHEST PAID EMPLOYEES 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 4B | 4.B. THE ORGANIZATION MAINTAINS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. UNDER THIS PLAN, LARRY A. MULLINS, DHA, ACCRUED DEFERRED COMPENSATION BENEFITS DURING 2012. HE ALSO RECEIVED A PAYMENT IN 2012 FROM THIS PLAN OF $712,232, WHICH IS INCLUDED IN HIS 2012 COMPENSATION ON SCHEDULE J AND FORM 990. THIS AMOUNT WAS ACCRUED IN PRIOR YEARS AND WAS ALSO INCLUDED IN COMPENSATION DISCLOSED IN PRIOR YEARS AS REQUIRED ON SCHEDULE J AND FORM 990. |
| PART I, LINE 5 | TWO HIGHEST PAID EMPLOYEES WERE PAID COMPENSATION CONTINGENT ON THE GROSS CHARGES OF THE FILING ORGANIZATION. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | SAMARITAN NORTH LINCOLN HOSPITAL (SNLH) 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 | SAMARITAN NORTH LINCOLN HOSPITAL 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (15 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 FOUNDATION | |||||||||||
| PO BOX 1068 | CORVALLIS | OR | 97339 | 237252406 | TO SUPPORT GOOD SAMARITAN HOSPITAL | OR | 501(C)(3) | 7 | GOOD SAMARITAN HOSPITAL | 0 | |
| 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 | 0 | N/A | |
| GOOD SAMARITAN HOSPITAL CORVALLIS | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930391573 | 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 | |
| NORTH LINCOLN HEALTH DISTRICT | |||||||||||
| 3043 NE 28TH STREET | LINCOLN CITY | OR | 97367 | 930555769 | HEALTHCARE DISTRICT | OR | GOV'T | 6 | 0 | N/A | |
| NORTH LINCOLN HOSPITAL FOUNDATION | |||||||||||
| PO BOX 767 | LINCOLN CITY | OR | 97367 | 930867677 | TO SUPPORT N. LINCOLN HLTH DIST & SAMARITAN NORTH LINCOLN HOSPITAL | OR | 501(C)(3) | 11A, I | 0 | N/A | |
Form990 Schedule R Part III Form990ScheduleRPartIII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN ENDOSCOPY CENTER LLC | ||||||||||||
| 3600 NW SAMARITAN DR | CORVALLIS | OR | 97330 | 202860067 | MEDICAL SERVICES | OR | N/A | |||||
| CORVALLIS MEDICAL BUILDINGS LLC | ||||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 931257913 | REAL ESTATE RENTAL | OR | N/A | |||||
| 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 | N/A | |||||
| CORVALLIS MRI A JOINT VENTURE | ||||||||||||
| 3615 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 930949704 | IMAGING | OR | N/A | |||||
| 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 | N/A | |||||
| 2750 HARRISON BLVD LLC | ||||||||||||
| 413 SW 13TH AVE STE 300 | PORTLAND | OR | 97205 | 274665571 | REAL ESTATE RENTAL | OR | N/A | |||||
| CBA-SAM LLC | ||||||||||||
| PO BOX 433 | LINCOLN CITY | OR | 97367 | 931314523 | REAL ESTATE RENTAL | OR | N/A | N/A | 6066 | 0 | 0 | 0.30000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH PLANS INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3600 NW SAMARITAN DRIVE | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 97330 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930860860 | EIN |
| Primary Activity | HEALTH INSURANCE CARRIER FOR THE COMMUNITY | PrimaryActivity |
| Legal Domicile State | OR | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERCOMMUNITY HEALTH PLANS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | L | TransactionType |
| Amount Involved | 1772626 | AmountInvolved |
| Method Of Amt Determination | COST | MethodOfAmtDetermination |