2013-11-12T18:45:24-06:00 2012-12-31 930623286 AKT LLP 5665 SW MEADOWS RD SUITE 200 LAKE OSWEGO OR 97035 990 2012-01-01 931305493 SAMARITAN NORTH LINCOLN HOSPITAL SAMA 5419943661 3043 NE 28TH STREET LINCOLN CITY OR 97367 DANIEL B SMITH 5419943661 2013-11-05 1 JOYLYN ANKENEY P00366587 5036204489 2012 2016-02-24 21:20:13Z JOSEPH M CAHILL 3043 NE 28TH STREET LINCOLN CITY OR 97367 43470125 0 X WWW.SAMHEALTH.ORG X 2000 OR TO DELIVER HIGH QUALITY HEALTH CARE SERVICES TO THE RESIDENTS AND VISITORS OF THE DISTRICT. 5 2 427 77 0 0 1732554 1517440 41500570 41140986 41787 372377 233412 364981 43508323 43395784 396654 308150 0 0 27384651 27990816 0 0 276948 15383649 15433842 43164954 43732808 343369 -337024 19414873 16727783 11931482 9581416 7483391 7146367 X 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. 0 0 37189831 40911554 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. 553324 278016 275308 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. 30134 30134 GRANTS AND ASSISTANCE PROVIDED BY SAMARITAN NORTH LINCOLN HOSPITAL TO VARIOUS ORGANIZATIONS AND INDIVIDUALS TO BENEFIT THE COMMUNITY. NO INDIVIDUAL GRANT EXCEEDED $5,000. 37773289 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 42 0 1 427 1 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X X SAMARITAN NORTH LINCOLN HOSPITAL 5419966471 3043 NE 28TH STREET LINCOLN CITY OR 97367 LARRY A MULLINS DHA 2.00 38.00 X X 0 1521885 47761 DAVID GREEN 1.00 X X 0 0 0 DEAN ORTON MD 40.00 X 152692 0 31759 CHRIS CHANDLER 1.00 X 0 0 0 DAVID TRIEBES 2.00 38.00 X X 0 321706 48378 RICHARD TOWNSEND 1.00 X 0 0 0 JOSEPH M CAHILL 40.00 X 0 152831 36025 DANIEL B SMITH 2.00 38.00 X 0 307217 50011 STEPHEN SHEA DO 40.00 X 521012 0 48437 STEPHEN QUINN MD 40.00 X 339186 0 38009 ROBERT OKSENHOLT DO 40.00 X 434117 0 38817 ALEXA LAFAUNCE MD 40.00 X 298820 0 15184 KARL ORDELHEIDE MD 40.00 X 374108 0 18162 2119935 2303639 372543 46 0 1 0 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 3 150904 1366536 1517440 NET PATIENT SVC REV 900099 41140986 41140986 41140986 372377 372377 42877 18706 24171 24171 24171 184740 55635 129105 129105 CAFETERIA 722210 165829 165829 OTHER INCOME 900099 33305 33305 RELEASE OF INFORMATION 561000 11704 11704 867 867 211705 43395784 41186862 0 691482 21250 21250 286900 286900 184452 184452 21700126 20422364 1125287 152475 988332 930627 50819 6886 3527379 3321428 181375 24576 1590527 1497662 81783 11082 396 396 13425 13425 1553300 1553300 20846 650 12234 7962 1694941 1590954 65898 38089 1051908 1051908 900881 886071 14586 224 134716 118977 13167 2572 87777 78314 6937 2526 105922 105922 780399 777359 885 2155 828174 724188 103986 PURCHASED SERVICES 4094528 1238446 2828726 27356 MEDICAL SUPPLIES 4078292 4078292 DUES, TAXES, & LICENSES 88337 62055 25237 1045 43732808 37773289 5682571 276948 2150 2750 8775223 3133670 4933022 4362548 332265 260131 705722 738658 93282 90372 7846455 4823090 3704356 3023365 89439 779414 5116289 19414873 16727783 3546299 3570460 5671 7646 619549 308412 7759963 5694898 11931482 9581416 X 7483391 7146367 7483391 7146367 19414873 16727783 -337024 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2547884 686970 1860914 217441 32354 185087 5081130 4103766 977364 3023365 OTHER RECEIVABLES 754049 ACCOUNTS RECEIVABLE - AFFILIATES 4362240 5116289 CONTRACTUAL REIMBURSEMENT OBLIGATIONS 1394027 PROFESSIONAL LIABILITY 214000 WORKING CAPITAL RESERVES 4055188 OTHER RESERVES 31683 5694898 1 1 X 1 X 1 X 1 1 1 0 1 1 9 2663 1554449 1554449 0.03550 5 18040 6309361 6106044 203317 0.00460 14 20703 7863810 6106044 1757766 0.04010 9 2864 157797 157797 0.00360 4 109 323994 323994 0.00740 10 39372 6818151 4945709 1872442 0.04280 9 2445 87353 87353 0.00200 32 44790 7387295 4945709 2441586 0.05580 46 65493 15251105 11051753 4199352 0.09590 2 1547 558345 275308 283037 0.00650 3 327 38934 38934 0.00090 3 352 305930 297077 8853 0.00020 8 2226 903209 572385 330824 0.00760 0 1779567 60668 12745774 12629347 116427 X 1 1 1 CBA-SAM LLC REAL PROPERTY RENTAL 0.30000 0.40000 1 1 SAMARITAN NORTH LINCOLN HOSPITAL

3043 NE 28TH STREET LINCOLN CITY OR 97367

X X X X SAMARITAN NORTH LINCOLN HOSPITAL 1 1 1 150.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X 1 0 X X X 1 X 0 0 11 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 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. PART V, SECTION B, LINE 14A: THE ORGANIZATION'S WEBSITE PROVIDES INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE, INCLUDING FREE AND DISCOUNTED CARE, ALONG WITH CONTACT INFORMATION FOR PATIENTS TO BE ABLE TO APPLY FOR FINANCIAL ASSISTANCE. PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNT CHARGED BY THE HOSPITAL FACILITY TO FAP-ELIGIBLE INDIVIDUALS IS SET TO BE LESS THAN THE AVERAGE OF ALL NEGOTIATED COMMERCIAL INSURANCE RATES. PART VI, LINE 2: 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. REPORTS FILED WITH STATES PART VI, LINE 7 OR 1 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 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AGENCIES IN THE COMMUNITY ARE INVITED TO SUBMIT GRANT PROPOSALS THROUGH AN APPLICATION PROCESS. A COMMITTEE REVIEWS THE APPLICATIONS TO DETERMINE IF THE FUNDS REQUESTED WILL BE USED TO ADDRESS THE ORGANIZATION'S ESTABLISHED COMMUNITY HEALTH PRIORITIES, IDENTIFIED NEEDS, AND SUPPORTS THE ORGANIZATION'S MISSION. ONCE APPROVED AND FUNDED, AGENCIES MUST SUBMIT A COMPLETE ANNUAL REPORT DESCRIBING HOW THE FUNDS WERE USED, THE NUMBER OF CLIENTS SERVED, AND HOW OUTCOMES WERE ACHIEVED. X 1 1 0 1 0 1 0 0 0 0 0 LARRY A MULLINS DHA 0 587213 0 0 0 934672 0 20596 0 27165 0 1569646 0 712232 DEAN ORTON MD 151694 0 0 0 998 0 11104 0 20655 0 184451 0 0 0 DAVID TRIEBES 0 296311 0 0 0 25395 0 20596 0 27782 0 370084 0 0 JOSEPH M CAHILL 0 149152 0 0 0 3679 0 10897 0 25128 0 188856 0 0 DANIEL B SMITH 0 299636 0 0 0 7581 0 20596 0 29415 0 357228 0 0 STEPHEN SHEA DO 446611 0 71075 0 3326 0 20596 0 27841 0 569449 0 0 0 STEPHEN QUINN MD 327874 0 0 0 11312 0 20596 0 17413 0 377195 0 0 0 ROBERT OKSENHOLT DO 392017 0 0 0 42100 0 20596 0 18221 0 472934 0 0 0 ALEXA LAFAUNCE MD 298283 0 0 0 537 0 5124 0 10060 0 314004 0 0 0 KARL ORDELHEIDE MD 372455 0 0 0 1653 0 6590 0 11572 0 392270 0 0 0 PART I, LINE 1A IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM/FITNESS FACILITY BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. UNDER THIS PROGRAM, EMPLOYEES MUST MEET MINIMUM USAGE REQUIREMENTS IN ORDER TO QUALIFY FOR ONGOING BENEFITS. IF AN EMPLOYEE PARTICIPATES AT A NON-SAMARITAN GYM, REIMBURSEMENT IS MADE FOR UP-FRONT FEES, AND THEN PERIODICALLY UPON COMPLETION OF AT LEAST 60 VISITS. REIMBURSEMENT DOES NOT EXCEED $300 PER YEAR AND IS INCLUDED IN THE EMPLOYEE'S TAXABLE WAGES AND IS SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. 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. 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. 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