2013-05-15T08:48:03-05:00 2012-06-30 450250958 Eide Bailly LLP 877 W MAIN ST STE 800 BOISE ID 83702 990 2011-07-01 930425580 Good Shepherd Health Care System GOOD 5416673400 610 NW 11th Street Hermiston OR 97838 Dennis Burke 5416673400 2013-05-10 1 Kim Hunwardsen CPA P00484560 2083447150 2013-05-10 2011 2016-02-24 21:20:13Z Good Shepherd Medical Center Dennis Burke 610 NW 11th Street Hermiston OR 97838 80671946 0 X www.gshealth.org X 1953 OR Hospital and health care services 11 10 607 81 0 0 142973 161990 77991866 78701390 3036209 1477660 0 133024 81171048 80474064 306894 322510 0 0 34097339 36831076 0 0 0 33218762 33615294 67622995 70768880 13548053 9705184 116270116 120122697 21352430 17715512 94917686 102407185 X To provide compassionate, high quality, and accessible health care and to promote a healthy community 1 0 66479600 322510 78002453 Good Shepherd Health Care System (GSHCS) served 1,753 inpatients over 4,988 patient-days and 44,765 outpatients in fiscal year 2011-12, as well as 18,903 patients in our Emergency Center. Although reimbursement for services rendered is critical to the operations and stability of GSHCS, not all individuals have the ability to purchase essential medical services. In recognition of this, during FY 2011-12 GSHCS wrote off to collection $6,745,109 valued at charges foregone as bad debt. Direct charity care to our community amounted to an additional $7,157,230, valued at charges foregone. GSHCS provides care to persons covered by governmental programs at deeply discounted rates. Recognizing its mission to the community, services were provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients during fiscal year 2011-12 was $29,705,117 valued at charges foregone.Our Emergency Center is open around-the-clock to all community members, visitors, and travelers, without regard to one's ability to pay. 66479600 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 188 0 1 607 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 OR X Jan Peter 5416673416 610 NW 11th Street Hermiston OR 97838 X Steve Eldrige 2.00 X X 0 0 0 Nancy Mabry 2.00 X X 0 0 0 Barbara Place 2.00 X X 0 0 0 Bill Elfering 2.00 X X 0 0 0 Bob Carlson 2.00 X 0 0 0 Richard Lindner 2.00 X 0 0 0 Tricia Fenley 2.00 X 0 0 0 Dr Derek Earl 2.00 X 0 0 0 Sue Daggett 2.00 X 0 0 0 Tom Wamsley 2.00 X 0 0 0 Janet Cooley 2.00 X 0 0 0 Glenn Chowning Jul-Dec 2.00 X 0 0 0 Dennis E Burke 40.00 X 339481 0 55358 Jan D Peter 40.00 X 179196 0 32056 David T Hughes 40.00 X 182300 0 31980 Dr Gary V Trupp 40.00 X 260539 0 12250 Dr Laura K Maskell 40.00 X 235258 0 0 Dr Thomas L Farney 40.00 X 285849 0 18930 Dr Thomas J Holt 40.00 X 325197 0 12533 Josh S Jackson 40.00 X 228749 0 8136 2036569 0 171243 41 0 1 0 Rick Burrill 610 NW 11th Street Hermiston OR 97838 Physical Therapy 1151363 Tualitin Imaging 6464 SW Boreland Rd Tualitin OR 97062 Imaging Services 1071183 Medical Doctor Assoc Inc PO Box 277185 Atlanta GA 30384 Physician Services 948788 Staff Care Inc PO Box 281923 Atlanta GA 30384 Physician Services 522428 Credits Inc 461 E Main Hermiston OR 97838 Collection Services 478215 20 161990 161990 Net patient services 622110 77635505 77635505 Other revenue 900099 654239 654239 Cafeteria 900099 464848 464848 Daycare 900099 234089 234089 Loss on Subsidiary 446110 -287291 -287291 78701390 1589462 1589462 133024 0 133024 133024 133024 86080 173595 24287 -173595 61793 -111802 -111802 80474064 78002453 0 2309621 322510 322510 842589 842589 28552885 27023016 1529869 1190982 1127145 63837 4520731 4278420 242311 1723889 1591494 132395 14732 14732 46942 46942 276234 276234 9897221 9004048 893173 119117 110878 8239 8309996 8124508 185488 637173 637173 292880 239409 53471 129415 129415 463555 463555 4790921 4790921 581540 581540 Bad Debts 5020156 5020156 Medical Supplies 2786156 2786156 249256 249256 70768880 66479600 4289280 0 4162250 4198077 11000597 11207147 6177119 12883234 1512595 1591960 709516 788546 84856026 39486403 44137953 45369623 50555989 44143587 -6112733 -6400024 4126830 6340547 116270116 120122697 6734044 6920810 13927302 0 500000 10794702 191084 0 21352430 17715512 X 94560726 102030950 356960 376235 94917686 102407185 116270116 120122697 X 9705184 -2215685 X 0 1 1 X 0 X 2730126 741457 3471583 43200442 15773902 27426540 36475440 22629205 13846235 1708561 1083296 625265 45369623 Interest Receivable - Intercompany 3103921 Estimated Third-Party Payor Settlements 3129936 Financial Aid Receivable 42171 Student Loan Reserve Fund 64519 6340547 80474064 70768880 9705184 -2215685 -2215685 7489499 77640360 -2215685 -293550 -2509235 80149595 276234 48235 324469 80474064 70170136 0 70170136 276234 322510 598744 70768880 Description of Uncertain Tax Positions Under FIN 48: Part X: The Hospital is organized as an Oregon nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 50l(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated fmancial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Hospital's federal Form 990 filings are no longer subject to federal tax examinations by tax authorities for years before 2009. Part XII, Line 2d - Other Adjustments: Charitable donations reclass from revenue to expenses -322,510. Net assets released from restrictions included in revenue for audit 28,960. Part XII, Line 4b - Other Adjustments: Contributions recorded in fund balance for audit 48,235. Part XIII, Line 4b - Other Adjustments: Charitable donations reclass from revenue to expenses 322,510. 1 1 X 1 X 1 X 1 1 1 0 1 1 3916000 3916000 0.06010 13031295 11805886 1225409 0.01880 16947295 11805886 5141409 0.07890 305112 39836 265276 0.00400 227848 13813 214035 0.00330 6379012 4217260 2161752 0.03290 322510 322510 0.00490 7234482 4270909 2963573 0.04510 24181777 16076795 8104982 0.12400 0 5020156 179010 14373141 14230833 142308 X 1 1 1 1 Good Shepherd Health Care System

610 NW 11th Street Hermiston OR 97838

X X X X Good Shepherd Health Care System 1 1 1 150.000000000000 1 300.000000000000 1 X X X X 1 1 X 1 0 1 X 1 1 3 Good Shepherd Medical Group

610 NW 11th Street Hermiston OR 97838

Clinic Vange John Memorial Hospice

610 NW 11th Street Hermiston OR 97838

Hospice TLC Home Health

610 NW 11th Street Hermiston OR 97838

Home Health Part I, Line 3c: Patients become eligible for financial assistance once they are at 150% of the federal poverty level. Once eligible the Health Care System provides discounts on a sliding fee scale from 10% to 100% based on an individual's income level and household size. Part I, Line 6a: The state posts the community benefit report online. Part I, Line 7: The charity care included in Part I, Line 7a is calculated by multiplying the ratio of cost to gross charges for the hospital by the gross uncompensated charges associated with providing charity care to its patients. The unreimbursed Medicaid in Part I, Line 7b is based on gross charges and claims from the Medicaid Cost Report.The community health services, education and contributions in Part I, Lines 7e, 7f and 7i are based on actual expenses. Subsidized health services on Line 7g are reported according to costs allocated to the relevant cost centers on the Medicare cost report. Part I, Line 7g: There are $7,150,002 in costs attributable to physician clinics included in subsidized health services. Part I, L7 Col(f): The amount of bad debt expense removed from the denominator of the calculation on Part 1, Line 7, column f was $5,020,156. Part III, Line 4: Footnote to the organization's financial statements that describes bad debt expense:Patient receivables are uncollateralized customer and third-party payor obligations. Payments of patient receivables are allocated to the specific claims identified on the remittance advice or, if unspecified, are applied to the earliest unpaid claim.The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts.Management considers historical write off and recovery information in determining the estimated bad debt provision.The organization estimates the amount of bad debt attributable to charity patients to be $179,010. This estimate is based on an overall charity care percentage of gross revenue. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules & regulations set forth by CMS. Part III, Line 9b: The organization's collection procedures requires a financial advisor to work with any patient who is identified as potentially being eligible for financial assistance prior to sending the account to collection. If during the course of the collection process the collection agency determines an account may be eligible for financial assistance, it is referred back to the hospital for further discussion with the patient or for write off. All further collection action is ceased. Good Shepherd Health Care System Part V, Section B, Line 11h: The policy indicates other factors beyond income level can be considered to determine free or discounted care. The hospital also uses household size to determine free or discounted care. Good Shepherd Health Care System Part V, Section B, Line 19d: The maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 90% of the gross charges This is based on the lowest discount under the charity care policy of 10%. Good Shepherd Health Care System Part V, Section B, Line 20: The hospital provides a reduction to gross charges under the their financial assistance policy. The hospital has not determined the amount generally billed under the various proposed methods of calculation. Therefore, it is possible a patient under the financial assistance policy could have paid more than the amount generally billed. The hospital will review the various methods to determine amounts generally billed to ensure it is in compliance with Section 501(r). Good Shepherd Health Care System Part V, Section B, Line 21: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. FAP-eligible patients without insurance may be charged gross charges on elective procedures. Part VI, Line 2: Our community healthcare needs assessment process has five components that are conducted every other year:1. The ongoing collection and evaluation of community feedback from patient surveys and comment forms.2. Patient and community-member healthcare needs focus groups.3. A healthcare needs survey completed by employers and other community leaders.4. A formal telephone survey.5. A demographic study conducted by the Oregon Office of Rural Health. Part VI, Line 3: Our financial counselors inform and educate the people we serve with respect to charity care and governmental assistance programs. All patients and responsible parties, where possible, are apprised of the availability of financial counseling services at the time and point of service. We have arranged our patient flow to maximize the convenience of visiting our financial counselors as part of the Good Shepherd treatment regime.In addition, the financial assistance policy is provided in writing to the patients upon request, and when the Hospital is able to identify a potential FAP-eligible individual upon admissions. Part VI, Line 4: Good Shepherd Health Care System (GSHCS) is the corporate name for an organization made up of several entities, including Good Shepherd Medical Center, Vange John Memorial Hospice, TLC Home Health, Good Shepherd Medical Group, Good Shepherd Clinic Pharmacy, Good Shepherd Medical Foundation, and Good Shepherd Community Health Foundation. Good Shepherd serves a core population of almost 50,000 people in the city of Hermiston, Oregon and in 14 outlying smaller towns within a rough 50-mile radius. This population is largely rural, with agriculture dominating industrial enterprises.The average household income in Hermiston is $35,865.17.1% of residents have incomes below federal poverty guidelines.31.3% of residents identify as non-white Hispanic ethnicity, with a sizable number of Spanish-primary speakers. Part VI, Line 5: Good Shepherd maintains open active, affiliate, and courtesy medical staffs, with privileges available to all qualified and interested physicians in the communities we serve. GSHCS is governed by a twelve-member board of trustees. The board is comprised of independent representatives of the community, with an emphasis on maintaining a true cross-section of core population communities within its membership.Our surplus funds are used to fund community health education classes, as well as funding building and equipment upgrades to maintain the highest quality healthcare for our community. Surplus funds are also applied to ongoing professional education among our clinical staff to remain current in the best practices of modern healthcare. We operate a fully-staffed 24-hour emergency room, available to the public regardless of ability to pay. Good Shepherd operates two foundations that provide funds to appropriate community groups and activities, as well as providing scholarship funds to local residents establishing or furthering healthcare-related education. We live our mission to promote a healthy community. Good Shepherd is the host and driving force behind the Good Shepherd Wellness Coalition, a grass-roots group of community leaders that identify, analyze, and address pressing healthcare issues in the community.We maintain a dialogue with the people we serve through a biweekly radio show, with an emphasis on wellness and preventative care.Good Shepherd hosts an annual Family Health and Fitness Day, with free access to healthcare professionals, free screenings, and a wealth of health and wellness information available to the public.We are active in community health-related activities, including the American Cancer Society's Relay for Life, the March of Dimes' March for Babies, and the Umatilla County Fair, where we provide health information and healthcare-related giveaways. Reports Filed With States Part VI, Line 7 OR 1 Good Shepherd Community Health Foundation 610 NW 11th Street Hermiston OR 97838 931170546 501(c)(3) 250000 Community Support 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Grants are awarded to Good Shepherd Community Health Foundation, a related organization which is tax exempt under Section 501(c)(3). X X X X 0 0 0 0 0 0 0 0 0 Dennis E Burke 315481 0 24000 0 0 0 26950 0 29070 0 395501 0 0 0 Jan D Peter 166915 0 12281 0 0 0 11105 0 21496 0 211797 0 0 0 David T Hughes 166631 0 15669 0 0 0 11209 0 21434 0 214943 0 0 0 Dr Gary V Trupp 253727 0 6812 0 0 0 12250 0 0 0 272789 0 0 0 Dr Laura K Maskell 234258 0 1000 0 0 0 0 0 0 0 235258 0 0 0 Dr Thomas L Farney 279325 0 6524 0 0 0 18930 0 0 0 304779 0 0 0 Dr Thomas J Holt 318972 0 6225 0 0 0 12533 0 0 0 337730 0 0 0 Josh S Jackson 227749 0 1000 0 0 0 8136 0 0 0 236885 0 0 0 Credits Inc Company is owned 100% by board member Nancy Mabry 494702 Charges for collection services 0 New Program Services Form 990, Part III, line 2 Cardio pulmonary rehab services are now being offered which falls under our exempt purpose to provide health care services. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The return is reviewed by the CFO and Controller and presented on a high level to the Board of Directors. A final copy is provided to the Board before filing. Form 990, Part VI, Section B, line 12c All officers, directors, and key employees with conflicts are expected to disclose conflicts of interest on a voluntary basis and refrain from discussion and/or voting on related matters as necessary. These disclosures are reviewed and determined to exist or not to exist by the Board of Directors. Form 990, Part VI, Section B, line 15a The CEO's compensation is approved by the compensation committee of the Board of Directors based on survey information. This process is completed annually in the month of October. The compensation of other officers or key employees is determined by the CEO based on survey information. This process is completed annually on the anniversary date of the individual's hire date. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available upon request. Form 990, Part VII, Column (b) In addition to the hours reported on Form 990, Part VII, the following individuals devoted time to Good Shepherd Community Health Foundation, a related organization, each week. Tricia Fenley - 1 hour Richard Lindner - 2 hours Tom Wamsley - 2 hours Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -2,215,685. Good Shepherd Community Health Foundation 610 NW 11th Street Hermiston OR 97838 931170546 fundraising OR 501(c)(3) Line 11a, I Good Shepherd Health Care System 1 Good Shepherd Medical Foundation 610 NW 11th Street Hermiston OR 97838 930844485 fundraising OR 501(c)(3) Line 7 Good Shepherd Health Care System 1 Good Shepherd Medical Service Corp 610 NW 11th Street Hermiston OR 97838 930688940 retail pharmacy OR N/A C 2580619 9856605 1.00000 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 Good Shepherd Medical Service Corp A 349006 book value Good Shepherd Medical Service Corp N 448177 book value Good Shepherd Community Health Foundation B 250000 book value Good Shepherd Community Health Foundation C 0 Good Shepherd Community Health Foundation M 0 Good Shepherd Community Health Foundation O 0