2012-05-10T14:25:45-04:00 2011-06-30 ERNST & YOUNG US LLP 75 BEATTIE PLACE SUITE 800 GREENVILLE SC 29601 990 2010-07-01 230794160 Good Samaritan Hospital The GOOD 7172707500 PO Box 1281 4th Walnut Sts Lebanon PA 170421281 ROBERT J RICHARDS 2012-05-07 8642425740 2010 2016-02-24 21:20:13Z ROBERT J LONGO 4TH WALNUT STREETS LEBANON PA 17042 184896022 false X www.gshleb.org X 1989 PA TO PROVIDE HIGH-QUALITY, COMPASSIONATE HEALTHCARE THAT IMPROVES THE OVERALL HEALTH OF OUR COMMUNITY. 19 14 1444 431 4339496 1251189 792179 1191113 161243680 165120763 1036715 957345 5129384 11652234 168201958 178921455 32800 27690 0 0 73656041 71982867 0 0 0 94601455 95440354 168290296 167450911 -88338 11470544 144533049 149903555 132516543 121387527 12016506 28516028 X TO PROVIDE HIGH-QUALITY, COMPASSIONATE HEALTHCARE THAT IMPROVES THE OVERALL HEALTH OF OUR COMMUNITY. false false 135297077 27690 158748199 Inpatient/Outpatient Services - SEE SCHEDULE O 1689454 0 1977161 Rehabilitation Unit- THE GSH OPERATES A 14 BED REHABILITATION UNIT PROVIDING A FULL RANGE OF BASIC SERVICES REQUIRED BY AN ACUTE CARE REHAB PROGRAM INCLUDING PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, SOCIAL SERVICES AND AUDIOLOGY. FY 6/30/11 STATISTICS: 318 REHAB ADMISSIONS AND 3,436 REHAB PATIENT DAYS. 1830243 0 2084554 Skilled Nursing Facility- THE GSH OPERATES A 19 BED TRANSITIONAL CARE UNIT PROVIDING A FULL RANGE OF BASIC SERVICES REQUIRED BY A HOSPITAL BASED SKILLED NURSING FACILITY, INCLUDING PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, SOCIAL SERVICES AND AUDIOLOGY. FY 6/30/11 STATISTICS: 366 TCU ADMISSIONS AND 4,159 TCU PATIENT DAYS. 1971029 0 2310849 140787803 true true false true false false false false false true true false false true true true true true false false false false false false false false true true false true true true false false false false false false false false false true false false false false false true true true true false true 84 0 true 1444 true true true false false false false false false false false false X 19 14 false false false false true true true true true false false true true true true true true false false false X ROBERT J RICHARDS 7172707500 241 SOUTH FOURTH STREET LEBANON PA 17042 X CAROL BLECKER 1.0 X 0 0 0 EARL H BRINSER 1.0 X 0 0 0 SLOAN CAPLAN 1.0 X 0 0 0 EVELYN C COLON 1.0 X 0 0 0 PAUL R DIGIACOMO 1.0 X 0 0 0 DONALD H DREIBELBIS 1.0 X X 0 0 0 ROBERT J FUNK 1.0 X 0 0 0 ROBERT P HOFFMAN 1.0 X 0 0 0 JANE W JUPPENLATZ 1.0 X X 0 0 0 FREDERICK C LAURENZO 1.0 X 0 0 0 ROBERT J PHILLIPS 1.0 X 0 0 0 WILLIAM E SCHAEFFER JR MD 1.0 X 0 0 0 DENNIS L SHALTERS 1.0 X X 0 0 0 GALEN G WEABER 1.0 X 0 0 0 JOHN P WELCH MD 1.0 X X 0 0 0 DEBORAH T WEAVER 1.0 X 0 0 0 FREDERICK S WOLFSON ESQ 1.0 X X 0 0 0 JULIE ZINSSER 1.0 X 0 0 0 ROBERT J LONGO 40.0 X X 510035 0 2884 KIMBERLY FEEMAN 40.0 X 246840 0 0 ROBERT J RICHARDS 40.0 X 286870 0 0 JACQUELYN M GOULD 40.0 X 191573 0 0 JULIE MIKSIT 40.0 X 164171 0 0 WILLIAM HENDRICK 40.0 X 194453 0 0 ROBERT D SHAVER MD 40.0 X 331140 0 0 ELLEN JOHNSON 40.0 X 188017 0 0 DARIA KOVARIKOVA 40.0 X 187568 0 0 BYARD YODER 40.0 X 174481 0 0 ROBERTA SCHERR 40.0 X 170211 0 0 JAMES MCGEARY 40.0 X 159625 0 0 2804984 0 2884 36 false true false MCKESSON INFORMATION SOLUTIONS PO BOX 98347 CHICAGO IL 606938347 IT SUPPORT 4560074 LEBANON ANESTHESIA ASSOCIATION PO BOX 1281 LEBANON PA 17042 ANESTHESIOLOGISTS 2866455 MILTON HERSHEY MEDICAL CENTER PO Box 853 HERSHEY PA 170330853 RESIDENTS 1512204 LEBANON CARDIOLOGY ASSOCIATES 775 NORMAN DRIVE LEBANON PA 17042 CARDIOLOGISTS 1020496 FINANCIAL HEALTH STRATEGIES 704 QUINCE ORCHARD ROAD GAITHERSBURG MD 20878 PATIENT BILLING SVC 870143 26 525884 665229 1191113 IP/OP PATIENTS 900099 154408703 154408703 REHAB PATIENTS 900099 1977161 1977161 HH/VNA SERVICES 621610 2310849 2310849 TCU PATIENTS 900099 2084554 2084554 DROP LAB REVENUE 621500 4339496 4339496 165120763 754550 754550 30677 30677 0 123492 248473 -124981 -124981 -124981 5898212 0 5671482 54612 226730 -54612 172118 172118 0 0 0 MA MODERNIZATION MONEY 900099 6255049 6255049 MALPRACTICE INSURANCE 524298 1045937 1045937 PENSION INCOME 524292 915952 915952 3560277 2968203 592074 11777215 178921455 171050456 4339496 2340390 0 27690 27690 0 0 2071563 2071563 0 52466905 44596869 7870036 5909029 5022675 886354 7644255 6497617 1146638 3891115 3307448 583667 0 282263 239924 42339 148411 126149 22262 15000 12750 2250 0 449319 381922 67397 6212751 5280838 931913 1016856 864328 152528 1679953 1427960 251993 4095325 3481026 614299 0 5645573 5009939 635634 64989 55241 9748 0 175069 148809 26260 3962005 3367704 594301 1484365 1261710 222655 9569879 8134397 1435482 1654167 1406042 248125 MEDICAL SUPPLIES 31950009 27157508 4792501 BAD DEBT 10137474 8616853 1520621 PURCHASED SERVICES 9835459 8360140 1475319 SERVICE CONTRACTS 2081501 1769276 312225 HEALTHCARE PROFESSIONALS 563081 478619 84462 4416905 3754369 662536 167450911 140787803 26663108 0 5270 5370 3265392 2403439 1500827 1373674 16364675 18802608 1431250 1153750 1704883 1656440 1983398 2464927 181846446 108602443 78078769 73244003 25395014 29142551 2269669 2269669 12533902 17387124 144533049 149903555 19867022 13289408 396562 327222 66550456 65273066 875941 791851 2527469 3593583 42299093 38112397 132516543 121387527 X 9010688 25570795 2333641 2273056 672177 672177 12016506 28516028 144533049 149903555 X 11470544 5028978 X false true false X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 15000 false false 15000 false LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1G THE HOSPITAL HOLDS MEMBERSHIP IN THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA BOTH OF WHICH ENGAGE IN LOBBYING AS A PART OF THEIR MISSION TO REPRESENT THE INTERESTS OF HOSPITALS AT BOTH THE FEDERAL AND STATE LEVELS. FOR THE YEAR ENDED 6-30-11 THE AMOUNT OF DUES PAID TO THE HHAP TOTALED $65,216 WHICH 23% ($15,000) WAS USED FOR LOBBYING PURPOSES. ON OCCASION, HHAP REQUESTS THE HELP OF MEMBER PROVIDERS TO COMMUNICATE CONCERNS TO LEGISLATORS REGARDING PENDING LEGISLATION, WHICH COULD IMPACT HOSPITALS. THIS CAN INVOLVE DIRECT CONTACT WITH LEGISLATORS OR LETTER WRITING. THIS OCCURS INFREQUENTLY AND THE COST TO THE HOSPITAL IS NEGLIGIBLE. 3005818 834833 26652 922070 2945233 3236426 458155 36900 725663 3005818 3712782 -26711 -22884 426761 3236426 0.00000 0.22820 0.77180 false false 1468847 1468847 88852305 37065473 51786832 3741840 2897645 844195 84519533 67114278 17405275 3263901 1525047 1738854 73244003 ACCRUED INT BOARD DESIG FUNDS 2000 DEBT SVC FUNDS NON-CURRENT 5558371 DEBT SVC FUNDS CURRENT 1335000 INTERCOMPANY RECEIVABLES 607106 DUE FROM FOUNDATION 27916 DUE FROM EMPL, STAFF, PHYS 74768 OTHER RECEIVABLES 4962439 DUE FROM LEBANON COUNTY 54760 DEFERRED BOND ISSUE COSTS 654663 OTHER INVESTMENTS 4110101 17387124 0 EMPLOYEE W/H PAYABLE 1068773 3RD PARTY PAYABLES 4817670 LONG TERM POST RETIRE BENEFITS 2925031 INSURANCE RESERVES 1792694 PENSION LIABILITY 27508229 38112397 178921455 167450911 11470544 2865776 2163202 5028978 16499522 181174217 2865776 -613014 2252762 178921455 178921455 167699384 248473 248473 167450911 167450911 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE GOOD SAMARITAN HOSPITAL MAINTAINS TEMPORARILY RESTRICTED AND PERMANENTLY RESTRICTED ASSETS TO PURCHASE SPECIFIC PIECES OF EQUIPMENT AND PROVIDE QUALIFIED APPLICANTS A SCHOLARSHIP. RECONCILIATION SCHEDULE D, PART XI, XII, XIII PART XI, LINE 8 THE GOOD SAMARITAN HOSPITAL NEEDED TO RESERVE MONEY IN ORDER TO PROVIDE THE RETIRED EMPLOYEES AND FUTURE RETIRED EMPLOYEES WITH SUFFICIENT PENSION PAYMENTS. THE GOOD SAMARITAN HOSPITAL WAS ABLE TO RELEASE FUNDS THAT WERE RESTRICTED FOR A SPECIFIC PURPOSE. THE GOOD SAMARITAN HOSPITAL ALSO WROTE OFF A LARGE RECEIVABLE THAT WAS DUE FROM AN AFFILIATED EXEMPT ORGANIZATION, GOOD SAMARITAN PHYSICIAN SERVICES. THE AMOUNT OF THE PENSION RESERVE WAS $9,369,245 AND THE AMOUNT OF THE WRITEOFF FOR THE GOOD SAMARITAN PHYSICIAN SERVICES RECEIVABLE WAS $7,206,043 FOR A NET AMOUNT OF $2,163,202. PART XII, LINE 2D RENTAL INCOME 123,492 TEMP REST CONTRIBUTIONS -829,784 PERM REST CONTRIBUTIONS -5,049 NET RENTAL LOSS 124,979 TEMP REST INVESTMENT INC -26,652 -------- TOTAL PART XII, LINE 2D -613,014 PART XIII, LINE 2D RENTAL EXPENSES OF $ 248,473 PART X, LINE 2 IN THE COURSE OF PREPARING THE HOSPITAL'S TAX RETURNS, THE HOSPITAL EVALUATES TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN TO DETERMINE WHETHER THE TAX POSITIONS ARE "MORE-LIKELY-THAN-NOT" OF BEING SUSTAINED BY THE APPLICABLE TAX AUTHORITIES. TAX POSITIONS NOT DEEMED TO MEET THE MORE-LIKELY-THAN-NOT THRESHOLD ARE RECORDED AS TAX BENEFITS OR EXPENSE IN THE CURRENT YEAR. MANAGEMENT HAS ANALYZED ALL TAX POSITIONS TAKEN ON FEDERAL, STATE, AND LOCAL INCOME TAX RETURNS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED THAT NO PROVISION FOR FEDERAL INCOME TAX IS REQUIRED IN THE FINANCIAL STATEMENTS. THERE ARE NO INTEREST AND PENALTIES DEDUCTED IN THE CURRENT PERIOD AND NO INTEREST AND PENALTIES ACCRUED AT JUNE 30, 2011. true true true X true X true true true false true true 443716 443716 0.00280 2533818 1296785 1237033 0.00790 12355245 6730820 5624425 0.03580 15332779 8027605 7305174 0.04650 28405 0 28405 0.00020 2082155 960776 1121379 0.00710 2110560 960776 1149784 0.00730 17443339 8988381 8454958 0.05380 20849 20849 0.00010 27620 27620 0.00020 48469 48469 0.00030 true 2838493 6665229 42118500 92580762 -50462262 X true true 1 1 THE GOOD SAMARITAN HOSPITAL

FOURTH AND WALNUT STREETS LEBANON PA 17042

X X X X THE GOOD SAMARITAN HOSPITAL 1 true true 200. true 300. true X X X X true true X true X X true X X X true X false true 11 THE GOOD SAMARITAN HOSPITAL

FOURTH AND WILLOW STREETS LEBANON PA 17042

REHAB AND TCU UNITS THE GOOD SAMARITAN HOSPITAL

830 TUCK STREET LEBANON PA 17042

OUTPATIENT SURGICAL CENTER THE GOOD SAMARITAN HOSPITAL

840 TUCK STREET LEBANON PA 17042

WOUND CARE & HYPERBARIC CENTER THE GOOD SAMARITAN HOSPITAL

206 HATHAWAY PARK LEBANON PA 17042

SLEEP DISORDERS CENTER THE GOOD SAMARITAN HOSPITAL

805 HELEN DRIVE LEBANON PA 17042

OUTPATIENT RADIOLOGY CENTER THE GOOD SAMARITAN HOSPITAL

750 NORMAN DRIVE LEBANON PA 17042

BLOOD DONOR CENTER & LABORATORY THE GOOD SAMARITAN HOSPITAL

297 WEST LINCOLN AVENUE MYERSTOWN PA 17067

OUTPATIENT DIAGNOSTIC CENTER THE GOOD SAMARITAN HOSPITAL

1400 SOUTH FORGE ROAD PALMYRA PA 17078

AMBULATORY SERVICES CENTER THE GOOD SAMARITAN HOSPITAL

100 QUEEN STREET JONESTOWN PA 17038

SATELLITE SERVICES CENTER THE GOOD SAMARITAN HOSPITAL

950 ISABEL DRIVE LEBANON PA 17042

OUTPATIENT PHYSICAL THERAPY THE GOOD SAMARITAN HOSPITAL

781 NORMAN DRIVE LEBANON PA 17042

CARDIOVASCULAR DIAGNOSTIC CENTER SUPPLEMENTAL INFORMATION SCHEDULE H PART I, LINE 3C NOT APPLICABLE PART I, LINE 6A OUR ANNUAL COMMUNITY BENEFIT REPORT IS PREPARED BY OUR MARKETING DEPARTMENT. THE REPORT CAN BE FOUND AT OUR WEBSITE, WWW.GSHLEB.ORG. WE ALSO MAIL THE REPORT OUT TO THE MEMBERS OF OUR COMMUNITY. PART I, LINE 7G NOT APPLICABLE PART I, LINE 7, COLUMN (F) OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) WAS $167,450,911. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $10,137,474. THIS LEFT US WITH A TOTAL EXPENSE OF $157,313,437 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART I, LINE 7 THE GOOD SAMARITAN HOSPITAL USED THE COST TO CHARGE RATIO COST METHODOLOGY TO CALCULATE THE CHARITY AND UNREIMBURSED MEDICAID AND OTHER GOVERNMENT PROGRAMS. THE HOSPITAL USED DIRECT COSTS FOR THE OTHER COMMUNITY BENEFITS ON LINE 7. PART II THE GOOD SAMARITAN HEALTH SYSTEM IS INVOLVED IN SOME COMMUNITY BUILDING PROGRAMS WHICH ARE DESIGNED TO "IMPROVE THE OVERALL HEALTH OF OUR COMMUNITY" (MISSION STATEMENT). THE GSH PARTICIPATES IN A DISASTER PREPAREDNESS PROGRAM WHICH PROVIDES A PLAN IN THE CASE OF A DISASTER THAT AFFECTS THE COMMUNITY. THE GSH ALSO PROVIDES SPACE FOR SUPPORT GROUPS TO MEET AND EDUCATION CLASSES FOR PEOPLE WITHIN THE COMMUNITY, LIKE EXPECTANT PARENTS. THE ACTIVITIES ARE NOT INCLUDED ELSEWHERE ON SCHEDULE H. PART III, LINE 4 THE HOSPITAL ESTABLISHES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS TO REPORT THE NET REALIZABLE AMOUNTS TO BE RECEIVED FROM PATIENTS. INCREASES TO THIS ALLOWANCE ARE REFLECTED AS A PROVISION FOR DOUBTFUL ACCOUNTS IN THE STATEMENTS OF OPERATIONS. THE HOSPITAL REGULARLY PERFORMS A DETAILED ANALYSIS OF THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE AND CONSIDERS SUCH FACTORS AS PRIOR COLLECTION EXPERIENCE AND THE AGE OF THE RECEIVABLES TO DETERMINE THE APPROPRIATE ALLOWANCE LEVEL. BAD DEBT METHODOLOGY - THE GOOD SAMARITAN HOSPITAL IS A TAX-EXEMPT NON-FOR-PROFIT HOSPITAL THAT PROVIDES QUALITY MEDICAL SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. BY PROVIDING MEDICAL SERVICES TO ALL COMMUNITY MEMBERS REGARDLESS OF THEIR ABILITY TO PAY, THE HOSPITAL'S BAD DEBT EXPENSE QUALIFIES AS A COMMUNITY BENEFIT. THE BAD DEBT EXPENSE CALCULATED ON LINE 2 WAS CALCULATED USING THE PATIENT CARE COST TO CHARGES METHODOLOGY. THE GOOD SAMARITAN HOSPITAL USES AN AUTOMATED SYSTEM CALLED PRESUMPTIVE TO CHARITY CARE TOOL TO CALCULATE THE AMOUNT ON LINE 3. ALL THE SELF PAY ACCOUNTS AND ALL THE SELF PAY AFTER INSURANCE ACCOUNTS ARE IMPORTED INTO THE TOOL, THEN THE TOOL SCORES EACH ACCOUNT BASED ON THE GOVERNMENT GUIDELINES FOR POVERTY LEVELS. FOR FYE 6/30/11, THE TOOL ESTIMATED THAT $6,665,229 OF THE ORGANIZATION'S BAD DEBT EXPENSE SHOULD BE CONSIDERED CHARITY CARE. PART III, LINE 8 MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. THE GOOD SAMARITAN HOSPITAL PROVIDES QUALITY MEDICAL SERVICES TO ALL PATIENTS REGARDLESS OF WHAT INSURANCE THEY HAVE. APPROXIMATELY 58% OF THE GOOD SAMARITAN HOSPITAL'S REVENUE IS ATTRIBUTABLE TO MEDICARE PATIENTS. THE GOOD SAMARITAN HOSPITAL IS RELIEVING THE GOVERNMENT'S BURDEN, BECAUSE THE HOSPITAL IS PROVIDING SERVICES TO MEDICARE PATIENTS WHICH COST MORE THAN THE MEDICARE REIMBURSEMENT. THEREFORE, THE $50,462,262 MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 9B COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. IF A PATIENT NOTIFIES THE HOSPITAL ABOUT THEIR INABILITY TO PAY, THE HOSPITAL WILL SEND THEM THE CHARITY CARE AND FINANCIAL ASSISTANCE FORMS TO FILL OUT. ONCE THE FORMS ARE COMPLETED AND RETURNED TO THE HOSPITAL AND THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THEN THE PATIENT'S ACCOUNT WILL BE REMOVED FROM COLLECTIONS AND THE ACCOUNT WILL BE WRITTEN OFF. PART V, SECTION B, Q. 11H THE GOOD SAMARITAN HOSPITAL CALCULATES THE AMOUNT CHARGED TO A PATIENT BASED ON CATESTROPHIC OR PHYSICAL HARDSHIP AND THE NUMBER OF INDIVIDUALS LIVING IN A HOUSEHOLD. PART V, SECTION B, Q. 19D THE GOOD SAMARITAN HOSPITAL BILLS INDIVIDUALS WITHOUT INSURANCE THEIR GROSS CHARGES ASSOCIATED WITH THE SERVICES THEY RECEIVED DURING THEIR VISIT. GSH OFFERS ALL SELF PAY PATIENTS A 35% DISCOUNT IF THEY PAY THEIR BILL WITHIN 30 DAYS OF THEIR SERVICES. PART V, SECTION B, Q. 21 THE GOOD SAMARITAN HOSPITAL CHARGES ITS SELF PAY PATIENTS THEIR GROSS CHARGES FOR THE SERVICES RENDERED. PART VI, LINE 2 THE GOOD SAMARITAN HOSPITAL HAS PARTICIPATED IN A VARIETY OF COMMUNITY HEALTH NEEDS ASSESSMENTS OVER THE PAST 16 YEARS. THE HOSPITAL WAS INSTRUMENTAL IN HELPING TO LAUNCH THE COMMUNITY HEALTH COUNCIL OF LEBANON COUNTY. IN PARTNERSHIP WITH THE COUNCIL, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CREATED 16 YEARS AGO AND AN UPDATED ASSESSMENT COMPLETED 11 YEARS AGO. ANOTHER ASSESSMENT WAS CREATED IN 2005, LED BY EFFORTS OF THE UNITED WAY OF LEBANON COUNTY. THE GOOD SAMARITAN HOSPITAL IS CURRENTLY PARTNERED WITH OTHER COMMUNITY ORGANIZATIONS AND COMPLETED A COMMUNITY HEALTH ASSESSMENT DURING THE FALL OF 2011. THE HOSPITAL ALSO MAINTAINS AN INDEPENDENT, COUNTYWIDE PHYSICIAN NEEDS ASSESSMENT TO EVALUATE GAPS IN HEALTHCARE ACCESS. A NEW PHYSICIAN NEEDS ASSESSMENT WAS ALSO COMPLETED IN 2011. IN ADDITION TO THESE COUNTYWIDE EFFORTS, THE HOSPITAL HAS PERFORMED A VARIETY OF STUDIES ON SPECIFIC HEALTH CONCERNS AND COMMUNITY NEEDS. KEY STUDIES HAVE INCLUDED SERVICES FOR CARDIOVASCULAR, ONCOLOGY, GASTROENTEROLOGY, WOUND CARE, AND MORE. THE HOSPITAL HAS ALSO ACTED TO FULFILL THE NEEDS IDENTIFIED IN THESE STUDIES. THE HOSPITAL CREATED ONE OF THE NATION'S LEADING CARDIAC AND VASCULAR CENTERS, WHICH HAS EARNED SEVERAL NATIONAL AWARDS FOR QUALITY OF CARE. THE HOSPITAL INTRODUCED A NEW WOUND CARE SERVICE TO DEAL WITH PATIENTS SUFFERING FROM COMPLICATIONS OF DIABETES - A PARTICULAR PROBLEM TO LEBANON COUNTY - AND HAS ALREADY EXPANDED OPERATIONS TO ADD A THIRD HYPERBARIC OXYGEN TREATMENT CHAMBER TO THE TWO ORIGINALLY INSTALLED IN THE CENTER. IN ADDITION, THE HOSPITAL HAS PROTECTED THE COMMUNITY BY RECRUITING NEW PHYSICIANS FOR KEY SERVICES - GENERAL SURGERY, ONCOLOGY, AND GASTROENTEROLOGY - ALLOWING PATIENTS TO GET ACCESS TO CARE IN LEBANON COUNTY INSTEAD OF TRAVELING THROUGHOUT THE REGION. PART VI, LINE 3 THE GOOD SAMARITAN HOSPITAL CHARITY CARE POLICY OUTLINES THE PROCESS OF FINANCIAL, MEDICAL AND CATASTROPHIC CATEGORIES WHERE A PATIENT COULD QUALIFY FOR CHARITY CARE. THE HOSPITAL HAS A SELF PAY BROCHURE AVAILABLE THAT PROVIDES INFORMATION ON OUR CHARITY CARE PROGRAM ALONG WITH CONTACT INFORMATION AND AVAILABLE HOURS. FINANCIAL COUNSELORS ARE ON SITE TO MEET WITH PATIENTS TO DISCUSS THEIR FINANCIAL OBLIGATIONS, ASSIST THEM IN COMPLETING THE APPLICATION FOR CHARITY CARE, AND ANSWER THEIR QUESTIONS. PATIENTS ARE ENCOURAGED TO APPLY FOR CHARITY CARE IF THEY ARE UNABLE TO COME IN FOR AN APPOINTMENT. THERE IS A NOTE ON THE STATEMENTS THAT IS MAILED TO PATIENTS, LETTING THEM KNOW THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE GOOD SAMARITAN HOSPITAL'S WEBSITE ALSO PROVIDES THE CONTACT INFORMATION FOR THOSE COMMUNITY MEMBERS WHO NEED MEDICAL SERVICES AND FINANCIAL ASSISTANCE. PART VI, LINE 4 LEBANON COUNTY INCLUDES A MIX OF URBAN, SUBURBAN, AND RURAL AREAS. THE CITY OF LEBANON IS CENTRALLY LOCATED, SERVING AS THE COUNTY SEAT. THE CITY IS HOME TO MORE THAN 24,000 RESIDENTS AND IS CLASSIFIED BY THE COMMONWEALTH OF PENNSYLVANIA AS A THIRD CLASS CITY. THE COUNTY INCLUDES 25 OTHER MUNICIPALITIES. THE REST OF THE COUNTY IS MADE UP OF SUBURBAN AND RURAL AREAS, WITH RURAL FARMLAND PROVIDING A DOMINANT CHARACTER OF COUNTY LIFE. WHILE MOST OF THE POPULATION TENDS TO BE OF WHITE ANCESTRY (91%), THE COUNTY HAS A FAST-GROWING HISPANIC POPULATION (7.8%) THAT CENTERS IN THE CITY OF LEBANON (SOURCE: US CENSUS BUREAU). THE US CENSUS BUREAU ALSO REPORTS THAT 8% OF THE POPULATION SPEAKS A LANGUAGE OTHER THAN ENGLISH AT HOME. EMPLOYMENT RATES IN THE COUNTY ARE CURRENTLY AT 6.8%- ONE OF THE LOWEST RATES IN THE STATE- AND AVERAGE HOUSEHOLD INCOME IS AT $50,334 ACCORDING TO THE USDA ECONOMIC RESEARCH SERVICE. THE FEDERAL GOVERNMENT IS THE COUNTY'S LARGEST EMPLOYER, WITH LARGE WORK FORCES AT THE LEBANON VETERANS ADMINISTRATION HOSPITAL AND FORT INDIANTOWN GAP. THE GOOD SAMARITAN HOSPITAL IS THE LARGEST NON-GOVERNMENTAL EMPLOYER WITH 1,500 EMPLOYEES. ACCORDING TO THE US CENSUS BUREAU AMERICAN COMMUNITY SURVEY, 8% OF THE POPULATION LIVES IN POVERTY. THE GOOD SAMARITAN HOSPITAL IS THE ONLY HOSPITAL IN LEBANON COUNTY. THE HOSPITAL PROVIDES EMERGENCY CARE TO APPROXIMATELY 51,000 INDIVIDUALS EACH YEAR. THE HOSPITAL CARED FOR APPROXIMATELY 8,400 ACUTE CARE PATIENTS. IN ADDITION, THE HOSPITAL HAS PERFORMED THOUSANDS OF OUTPATIENT PROCEDURES- FROM SURGERIES TO IMAGING TO LABORATORY TO PHYSICAL THERAPY- EVERY YEAR. THE HOSPITAL ALSO PROVIDES A CONTINUITY OF CARE THROUGH A SKILLED NURSING UNIT, REHABILITATION SERVICES, HOME HEALTHCARE, AND HOSPICE CARE. THE HOSPITAL IS THE LARGEST PROVIDER OF CARE TO MEDICAID AND MEDICARE POPULATIONS. WHILE MOST LEBANON COUNTY RESIDENTS CHOOSE TO STAY IN THE COUNTY FOR THEIR CARE, WITH MORE THAN 60% CHOOSING THE GOOD SAMARITAN HOSPTIAL FOR SERVICES. ACCORDING SUPPLEMENTAL INFORMATION SCHEDULE H IN ADDITION TO SCREENING FOR HIGH-RISK PATIENTS, BREAST MRI CAN BE USED AS A DIAGNOSTIC TOOL WHEN A MAMMOGRAM, SELF-EXAM OR CLINICAL EXAM IDENTIFIES AN AREA OF CONCERN. THE INTRODUCTION OF THE BREAST MRI TECHNOLOGY ALSO ALLOWS THE GSH IMAGING CENTER TO PROVIDE ADVANCED MRI-GUIDED BREAST BIOPSY. THIS PROVIDES ANOTHER BIOPSY OPTION TO COMPLEMENT OUR STEREO-TACTIC AND ULTRASOUND-GUIDED BIOPSIES, ALSO AVAILABLE. THE MRI-GUIDED BREAST BIOPSY TECHNOLOGY ENABLES PRECISE AND ACCURATE BIOPSIES, GIVING PATIENTS AND THEIR SURGEONS THE INFORMATION NEEDED TO PLAN THE BEST COURSE OF TREATMENT. GOOD SAMARITAN HEALTH SYSTEM IS COMMITTED TO PROVIDING OUR PATIENTS WITH THE MOST ADVANCED BREAST IMAGING TECHNOLOGY TO HELP WOMEN OF LEBANON COUNTY IN THEIR FIGHT AGAINST BREAST CANCER. PART VI, LINE 6 THE GOOD SAMARITAN HOSPITAL IS A PART OF THE GOOD SAMARITAN HEALTH SYSTEM. THE SYSTEM INCLUDES A FOUNDATION, DIALYSIS CENTER, REAL ESTATE COMPANIES, MRI CENTER, FAMILY PRACTICES, SPECIALITY HEALTH SERVICES, A DME COMPANY, AND A URGENT CARE CENTER. IN ADDITION TO THE COMMUNITY BENEFITS PROVIDED BY THE HOSPITAL, THE HEALTH SYSTEM EVALUATES THE NEEDS THE COMMUNITY AND THE SYSTEM WILL PARTICIPATE IN COMMUNITY BENEFIT PROGRAMS, LIKE SUPPORTING THE VOLUNTEERS IN MEDICINE FREE CLINIC WHICH SERVES THE UNDERPRIVILEGED MEMBERS OF THE COMMUNITY. true DAVID BRODERIC SCHOLARSHIP 31 7500 OTHER MARGARET CONNELL SCHOLARSHIP 7 5440 OTHER GSH AUXILIARY SCHOLARSHIP 5 4500 OTHER CAPLAN NURSING SCHOLARSHIP 10 10250 OTHER PROCEDURES TO MONITOR USE OF GRANTS SCHEDULE I, PART I, LINE 2 THE DAVID BRODERIC EMPLOYEE SCHOLARSHIP PROGRAM AND THE MARGARET L. CONNELL SCHOLARSHIP FUND ARE FOR THE SONS AND DAUGHTERS OF EMPLOYEES. THE GSH AUXILIARY AND CAPLAN NURSING SCHOLARSHIPS ARE AWARDED TO LEBANON COUNTY RESIDENTS ENROLLED IN A NURSING PROGRAM. PART III, COLUMN (B) THE GOOD SAMARITAN HOSPITAL DISTRIBUTES A PORTION OF THE MONEY ALLOTTED TO EVERY PERSON WHO APPLIES FOR THE SCHOLARSHIP. X X X X false true false false false false false false false ROBERT J LONGO 425026 0 63000 0 22009 0 0 0 2884 0 512919 0 352186 0 KIMBERLY FEEMAN 204968 0 24419 0 17453 0 0 0 0 0 246840 0 0 0 JACQUELYN M GOULD 160935 0 22259 0 8379 0 0 0 0 0 191573 0 0 0 ROBERT J RICHARDS 221724 0 32411 0 32735 0 0 0 0 0 286870 0 0 0 JULIE MIKSIT 134464 0 18028 0 11679 0 0 0 0 0 164171 0 0 0 WILLIAM HENDRICK 130118 0 42998 0 21337 0 0 0 0 0 194453 0 0 0 ROBERT D SHAVER MD 292185 0 38955 0 0 0 0 0 0 0 331140 0 0 0 ELLEN JOHNSON 163644 0 7002 0 17371 0 0 0 0 0 188017 0 0 0 DARIA KOVARIKOVA 180218 0 7350 0 0 0 0 0 0 0 187568 0 0 0 BYARD YODER 165820 0 0 0 8661 0 0 0 0 0 174481 0 0 0 ROBERTA SCHERR 170211 0 0 0 0 0 0 0 0 0 170211 0 0 0 JAMES MCGEARY 159625 0 0 0 0 0 0 0 0 0 159625 0 0 0 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 3 THE COMPENSATION COMMITTEE HIRES AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH THE CEO'S COMPENSATION AMOUNT AND COMPOSE THE CONTRACT. THE COMPENSATION COMMITTEE PRESENTS THE INFORMATION TO THE BOARD. IF A BOARD MEMBER WOULD LIKE TO REVIEW THE CONTRACT, THEY CAN CONTACT A MEMBER OF THE COMPENSATION COMMITTEE TO REVIEW THE CONTRACT PRIVATELY. SCHEDULE J, PART I, LINE 4B ROBERT J. LONGO IS A PARTICIPANT IN A 457F RETIREMENT PLAN. HE RECEIVED NO PAYMENT FROM THE PLAN THIS YEAR. LEBANON COUNTY HEALTH FACILITIES AUTHORITY 232546819 522455BE3 2004-03-11 17255816 SEE PART V false false false 17255816 2004 true false true true false false false false false true PART I, COLUMN F REFUND OUTSTANDING 1994 BONDS ISSUED ON 1/13/1994. WELCH WAGNER PARTNERSHIP SEE PART V 279672 PROPERTY RENTAL false LEBANON INTERNAL MEDICINE ASSOC SEE PART V 122118 MEDICAL DIRECTOR FEES false ARTHUR FUNK AND SONS SEE PART V 120583 CONSTRUCTION PROJECTS false REILLYWOLFSONSHEFFEYSCHRUMLUNDB SEE PART V 127095 ATTORNEY FEES false SCHEDULE L PART IV, LINE 1 JOHN WELCH, A TRUSTEE OF THE GOOD SAMARITAN HOSPITAL, IS A PARTNER IN WELCH WAGNER PARTNERSHIP. PART IV, LINE 2 WILLIAM E. SCHAEFFER, JR. MD, A TRUSTEE OF THE GOOD SAMARITAN HOSPITAL, IS A PARTNER IN LEBANON INTERNAL MEDICINE ASSOCIATES. PART IV, LINE 3 ROBERT J. FUNK, A TRUSTEE OF THE GOOD SAMARITAN HOSPITAL, IS A PARTNER IN ARTHUR FUNK AND SONS. PART IV, LINE 4 FREDERICK WOLFSON, A TRUSTEE OF THE GOOD SAMARITAN HOSPITAL, IS A PARTNER IN REILLY, WOLFSON, SHEFFEY, SCHRUM & LUNDBERG. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III PROGRAM SERVICE EXPENSE #1 THE GSH IS A 196 LICENSED BED, (ACUTE CARE 177, SKILLED CARE 19) TAX EXEMPT , NON-PROFIT ACUTE CARE HOSPITAL PROVIDING A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES INCLUDING RESPIRATORY THERAPY, PHYSICAL THERAPY, RADIOLOGY, INPATIENT AND OUTPATIENT SURGERY, PEDIATRICS, INTENSIVE CARE, TELEMETRY, CARDIAC CARE, HEMODIALYSIS, INHALATION THERAPY, PULMONARY FUNCTIONS, ENDOSCOPY, 24 HOUR EMERGENCY CARE, OCCUPATIONAL MEDICINE, TRACTION, PACEMAKERS, EEG, EKG, STRESS MONITORING, MAMMOGRAPHY, ULTRASOUND, CT SCAN, CANCER CARE, NUCLEAR MEDICINE, PHARMACY, OBSTETRICS, BLOOD BANK, PERIPHERAL VASCULAR LAB, CARDIOVASCULAR LAB, CARDIOVASCULAR SURGERY, AND LABORATORY WHICH INCLUDE CHEMISTRY, HEMATOLOGY, HISTOLOGY, CYTOLOGY AND MICROBIOLOGY. FY 6/30/11 STATISTICS: 8,299 ADMISSIONS, 34,865 INPATIENT DAYS; 276,477 OUTPATIENT REGISTRATIONS. PROGRAM SERVICE EXPENSE #4 THE GSH OPERATES HOME HEALTH/VISITING NURSE ASSOCIATION PROVIDING A FULL RANGE OF IN-HOME HEALTH CARE INCLUDING IV THERAPY, MATERNAL/INFANT CARE, HOSPICE, PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, NUTRITIONAL THERAPY, SOCIAL SERVICES AND HOME HEALTH AIDES. FY 6/30/11 STATISTICS: 19,431 IN-HOME CARE VISITS WERE PROVIDED. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, LINE 6 THE GOOD SAMARITAN HEALTH SERVICES FOUNDATION, ANOTHER 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF THE GOOD SAMARITAN HOSPITAL. MEMBERS WHO MAY ELECT TRUSTEES OF THE GOVERNING BODY FORM 990, PART VI, LINE 7A THE GOOD SAMARITAN HEALTH SERVICES FOUNDATION, AS THE SOLE MEMBER OF THE GOOD SAMARITAN HOSPITAL, MAY ELECT ONE OR MORE TRUSTEES OF THE HOSPITAL'S GOVERNING BODY. DECISION OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS FORM 990, PART VI, LINE 7B CERTAIN DECISIONS OF THE HOSPITAL'S GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE HOSPITAL'S SOLE MEMBER, THE GOOD SAMARITAN HEALTH SERVICES FOUNDATION. PROCESS OF GOVERNING BODY REVIEW OF 990 FORM 990, PART VI, LINE 11B AN ACCOUNTANT PREPARES THE 990 AND 990-T FOR THE GOOD SAMARITAN HOSPITAL. THE HOSPITAL THEN PAYS AN AUDITING FIRM TO REVIEW THE 990 TAX RETURN. THE CONTROLLER AND THE CFO REVIEW THE FINAL DRAFT OF THE RETURN BEFORE IT IS DISTRIBUTED TO THE BOARD OF DIRECTORS AND THEN FILED WITH THE IRS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 12C THE GOOD SAMARITAN HOSPITAL HAS A COMPLIANCE OFFICER THAT IS RESPONSIBLE FOR MONITORING AND ENFORCING THE COMPLIANCE OF POLICIES. DISCLOSURE OF DOCUMENTS TO THE PUBLIC FORM 990, PART VI, LINE 19 THE GOOD SAMARITAN HOSPITAL HAS ALL OF ITS POLICIES AND FINANCIAL STATEMENTS AVAILABLE FOR THE GENERAL PUBLIC. THE PUBLIC NEEDS TO SCHEDULE AN APPOINTMENT WITH ADMINISTRATION TO COME IN AND VIEW THE INFORMATION UNDER HOSPITAL SUPERVISION. AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A ALL OF THE HOSPITAL TRUSTEES ALSO SERVE 1 HOUR PER WEEK ON THE GOOD SAMARITAN HEALTH SERVICE FOUNDATION'S BOARD. ROBERT J. LONGO GOOD SAMARITAN HEALTH SERVICES FOUNDATION - 1 HOUR/WEEK GOOD SAMARITAN PHYSICIAN SERVICES - 12 HOURS/WEEK GSH SERVICES, INC. - 1 HOUR/WEEK GOOD SAMARITAN REAL ESTATE, INC. - 1 HOUR/WEEK GSH REALTY, INC. - 1 HOUR/WEEK GSH HOME MED CARE, INC. - 1 HOUR/WEEK GSH DIALYSIS, INC. - 1 HOUR/WEEK LEBANON MRI ASSOCIATES, LTD. - 1 HOUR/WEEK GOOD SAMARITAN PHYSICIAN HOSPITAL ORGANIZATION - 1 HOUR/WEEK ROBERT J. RICHARDS GOOD SAMARITAN PHYSICIAN SERVICES - 12 HOURS/WEEK GSH SERVICES, INC. - 1 HOUR/WEEK GOOD SAMARITAN REAL ESTATE, INC. - 1 HOUR/WEEK GSH REALTY, INC. - 1 HOUR/WEEK GSH HOME MED CARE, INC. - 1 HOUR/WEEK GSH DIALYSIS, INC. - 1 HOUR/WEEK LEBANON MRI ASSOCIATES, LTC. - 1 HOUR/WEEEK GOOD SAMARITAN PHYSICIAN HOSPITAL ORGANIZATION - 1 HOUR/WEEK KIMBERLY FEEMAN GOOD SAMARITAN PHYSICIAN SERVICES - 12 HOURS/WEEK LEBANON MRI ASSOCIATES, LTC. - 3 HOURS/WEEK JACQUELYN M. GOULD GOOD SAMARITAN PHYSICIAN SERVICES - 12 HOURS/WEEK GSH DIALYSIS, INC. - 3 HOURS/WEEK JULIE MIKSIT GOOD SAMRITAN PHYSICIAN SERVICES - 10 HOURS/WEEK ROBERT D. SHAVER, M.D. GOOD SAMARITAN PHYSICIAN SERVICES - 10 HOURS/WEEK OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 UNREALIZED GAIN ON INVESTMENTS $2,865,776 PENSION RESERVE ADJUSTMENT 9,369,245 GOOD SAMARITAN PHY SVCS REC WRITE-OFF (7,206,043) ---------- $5,028,978 ========== **NOTE: GOOD SAMARITAN PHYSICIAN SERVICES IS A RELATED 501(C)(3) EXEMPT ORGANIZATION. GOOD SAMARITAN HEALTH SERVICE FOUNDATION 259 SOUTH FOURTH STREET LEBANON PA 17042 232356151 PARENT PA 501(C)(3) 11,TYPE I NA GOOD SAMARITAN REAL ESTATE 241 SOUTH FOURTH STREET LEBANON PA 17042 232447262 TITLE HOLDING PA 501(C)(2) GSH FDN GSH DIALYSIS INC 440 OAK STREET LEBANON PA 17042 232500940 DIALYSIS SVCS PA 501(C)(3) 3 GSH FDN GOOD SAMARITAN PHYSICIAN SERVICES 259 SOUTH FOURTH STREET LEBANON PA 17042 231832359 FAMILY MED PA 501(C)930 9 GSH FDN LEBANON MRI ASSOCIATES LTD 4THWALNUT ST LEBANON PA 17042 363730905 MRI SERVICES PA NA GSH SERVICES INC 241 SOUTH FOURTH STREET LEBANON PA 17042 232353047 MGMT & ACCTG SVCS PA GSHS FOUNDATION C CORP 0 0 0.00000 GSH HOME MED CARE INC 301 SCHNEIDER DRIVE LEBANON PA 17046 232028099 MEDICAL EQUIP PA GSHS FOUNDATION C CORP 0 0 0.00000 GSH REALTY INC 241 SOUTH FOURTH STREET LEBANON PA 17042 232446622 TITLE HOLDING PA GSHS FOUNDATION C CORP 0 0 0.00000 GSH URGENT CARE INC 954 ISABEL DRIVE LEBANON PA 17042 251816053 URGENT MEDICINE PA GSHS FOUNDATION C CORP 0 0 0.00000 false false false false true false false false true true true true false false true true false false GOOD SAMARITAN REAL ESTATE INC J 585463 GSH REALTY INC J 298436 LEBANON MRI ASSOCIATES LTD L 467557 GSH HOME MED CARE INC L 101915 GSH HOME MED CARE INC P 90612 GSH HOME MED CARE INC P 65824 GSH DIALYSIS INC K 105434 GSH DIALYSIS INC P 330092 GSH DIALYSIS INC P 53516 GOOD SAMARITAN PHYSICIAN SERVICES P 401526 GOOD SAMARITAN PHYSICIAN SERVICES P 92592 GOOD SAMARITAN PHYSICIAN SERVICES P 602965 GOOD SAMARITAN PHYSICIAN SERVICES I 220428 LEBANON MRI ASSOCIATES LTD I 123518