GOOD SAMARITAN HOSPITAL CORVALLIS: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN HOSPITAL CORVALLIS (EIN 93-0391573)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-11
- IRS object ID
- 201103159349303620
- Schema version
- 2010v3.2
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-11T16:50:48-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930391573 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN HOSPITAL CORVALLIS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOOD | NameControl |
| Phone | 5417684773 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O SHS ACCOUNTING PO BOX 3000 | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 973393000 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANIEL B SMITH | Name |
| Title | VP FINANCE/CFO | Title |
| Phone | 5417684773 | Phone |
| Date Signed | 2011-11-10 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MARTIN MOLL | Name |
| Phone | 5036204489 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN REGIONAL MEDICAL CTR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | STEVEN W JASPERSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3600 NW SAMARITAN DR | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 97330 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 315655695 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SAMHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1948 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | GOOD SAMARITAN HOSPITAL, CORVALLIS (GSH) ACHIEVES ITS MISSION OF IMPROVING THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS MEDICAL AND SURGICAL HOSPITAL AND HEALTHCARE CLINICS PROVIDING OUTPATIENT CARE SERVICES AT SEVERAL AREA LOCATIONS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 2062 | TotalNbrEmployees |
| Total Nbr Volunteers | 208 | TotalNbrVolunteers |
| Total Gross UBI | 1089163 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -103951 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 656158 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1850641 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 272591212 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 310274725 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1009824 | InvestmentIncomePriorYear |
| Investment Income Current Year | 598535 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2742860 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2368336 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 277000054 | TotalRevenuePriorYear |
| Total Revenue Current Year | 315092237 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 377389 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 283825 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 144491639 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 162291614 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 2571 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 216260 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 123394093 | OtherExpensePriorYear |
| Other Expenses Current Year | 145888204 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 268265692 | TotalExpensesPriorYear |
| Total Expenses Current Year | 308463643 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 8734362 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 6628594 | RevenuesLessExpensesCY |
| Total Assets BOY | 217038102 | TotalAssetsBOY |
| Total Assets EOY | 183573666 | TotalAssetsEOY |
| Total Liabilities BOY | 115843135 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 76799467 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 101194967 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 106774199 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | GOOD SAMARITAN HOSPITAL, CORVALLIS (GSH) 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. GSH PROVIDES HEALTHCARE SERVICES REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, DISABILITY OR AGE. THE MISSION OF GSH 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 | 265904953 | Expense |
| Revenue | 309408914 | Revenue |
| Description | GOOD SAMARITAN HOSPITAL CORVALLIS (GSH), THE LARGEST HOSPITAL IN LINN, BENTON AND LINCOLN COUNTIES, OFFERS MORE THAN 22 MEDICAL SPECIALTIES INCLUDING COMPREHENSIVE CANCER CARE, A FULL-SERVICE CARDIOLOGY AND VASCULAR SURGERY PROGRAM, A SLEEP LAB, NEUROSURGERY AND OTHER REGIONAL SERVICES. GSH HAS MORE THAN 1,800 EMPLOYEES AND 200 VOLUNTEERS SERVING THE MEDICAL NEEDS OF THE COMMUNITY. IT IS LICENSED TO OPERATE 188 BEDS AND IS ONE OF ONLY THREE 'LEVEL 2' TRAUMA CENTERS IN THE STATE. DURING 2010, GSH SERVED 9,364 INPATIENTS, HAD 21,942 EMERGENCY DEPARTMENT VISITS, PERFORMED 9,689 SURGERIES AND DELIVERED 1,074 BABIES. IN ADDITION, GSH PERFORMED 73,009 IMAGING PROCEDURES, HAD 35,053 HOME HEALTH VISITS, AND HAD 169,430 PHYSICIAN CLINIC VISITS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 283825 | Expense |
| Grants | 283825 | Grants |
| Description | GRANTS AND ASSISTANCE PROVIDED BY GOOD SAMARITAN HOSPITAL CORVALLIS TO VARIOUS ORGANIZATIONS AND INDIVIDUALS TO BENEFIT THE COMMUNITY. SEE PART IX, LINES 1 AND 2 AND RELATED SCHEDULE I FOR MORE DETAILS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 266188778 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | 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 | 0 | FinancialStmtAttached |
| Grants To Organizations | 1 | 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 | 1 | 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 1 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 7 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 2062 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | 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 HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5417684773 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3000 | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 973393000 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| BISHOP MICHAEL HANLEY | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JAY MCHENRY | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| NANCY SEIFERT | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| GILBERT BECK | ||||||||
| BOARD TREASURER | 1.00 | X | 0 | 0 | 0 | X | ||
| CLIFFORD A HALL MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 8.00 | X | 12779 | 0 | 5019 | |||
| RICHARD CRONK MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| REVEREND SIMON JUSTICE | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| CARLYN ROY | ||||||||
| BOARD SECRETARY | 1.00 | X | 0 | 0 | 0 | X | ||
| KEVIN EWANCHYNA MD | ||||||||
| BOARD MEMBER/VP CHIEF MED. OFFICER | 6.00 | X | 0 | 286880 | 43372 | |||
| SHIRLEY PETERSON | ||||||||
| BOARD VICE CHAIR/INTERIM BOARD CHAIR | 1.00 | X | 0 | 0 | 0 | X | ||
| JUDY LIST | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| RITA CAVIN PHD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| RYAN STEVENS MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| FREDERICK WEISENSEE MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | X | 295134 | 0 | 37320 | |||
| STEVEN W JASPERSON | ||||||||
| CEO | 40.00 | 0 | 392565 | 57283 | X | |||
| DANIEL B SMITH | ||||||||
| VP FINANCE/CFO | 8.00 | 0 | 287449 | 47700 | X | |||
| KATHRYN M HALE | ||||||||
| VP NURSING | 40.00 | 168190 | 0 | 42314 | X | |||
| MICHAEL A MAY MD | ||||||||
| VP SMH MEDICAL DIRECTOR | 40.00 | 278403 | 0 | 59631 | X | |||
| STEVEN GOODWIN MD | ||||||||
| PHYSICIAN | 40.00 | 659537 | 0 | 43059 | X | |||
| DONALD PENNINGTON DO | ||||||||
| PHYSICIAN | 40.00 | 735540 | 0 | 46819 | X | |||
| PETER C TSAI MD | ||||||||
| PHYSICIAN | 40.00 | 639344 | 0 | 35288 | X | |||
| RANDALL V BREAM MD | ||||||||
| PHYSICIAN | 40.00 | 603603 | 0 | 39698 | X | |||
| JAMES A RYAN MD | ||||||||
| PHYSICIAN | 40.00 | 583917 | 0 | 27778 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3976447 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 966894 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 485281 | TotalOtherCompensation |
| Number Individuals GT100 K | 233 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Related Organizations | 1806157 | RelatedOrganizations |
| Government Grants | 44484 | GovernmentGrants |
| Total Contributions | 1850641 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT REVENUE | 900099 | 304213326 | 304213326 | |
| RETAIL PHARMACY | 446110 | 6061399 | 4972236 | 1089163 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 310274725 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 385618 | TotalRevenueColumn |
| Exclusion | $385,618 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 688077 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 356364 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 331713 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 331713 | TotalRevenueColumn |
| Exclusion | $331,713 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 276817 | Securities |
| Other | 550 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 60232 | Securities |
| Other | 4218 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 216585 | Securities |
| Other | -3668 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 212917 | TotalRevenueColumn |
| Exclusion | $212,917 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 273291 | GrossSalesOfInventory |
| Cost Of Goods Sold | 142644 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 130647 | TotalRevenueColumn |
| Related Or Exempt Function Income | 130647 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA | 722210 | 1813271 | $1,813,271 | |
| MISCELLANEOUS REVENUE | 900099 | 44477 | 44477 | |
| RELEASE OF INFORMATION | 561000 | 36976 | 36976 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11252 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11252 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1905976 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 315092237 | TotalRevenueColumn |
| Related Or Exempt Function Income | 309408914 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1089163 | UnrelatedBusinessRevenue |
| Exclusion | $2,743,519 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 235667 | Total |
| Program Services | 235667 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48158 | Total |
| Program Services | 48158 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 898790 | Total |
| Program Services | 898790 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122775790 | Total |
| Program Services | 118232823 | ProgramServices |
| Management And General | 4464456 | ManagementAndGeneral |
| Fundraising | 78511 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9096508 | Total |
| Program Services | 8762363 | ProgramServices |
| Management And General | 328370 | ManagementAndGeneral |
| Fundraising | 5775 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20819804 | Total |
| Program Services | 20055025 | ProgramServices |
| Management And General | 751562 | ManagementAndGeneral |
| Fundraising | 13217 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8700722 | Total |
| Program Services | 8381117 | ProgramServices |
| Management And General | 314082 | ManagementAndGeneral |
| Fundraising | 5523 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1333 | Total |
| Management And General | 1333 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 123462 | Total |
| Management And General | 123462 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4050 | Total |
| Management And General | 4050 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3401096 | Total |
| Program Services | 3180101 | ProgramServices |
| Management And General | 220995 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60829 | Total |
| Program Services | 28182 | ProgramServices |
| Management And General | 23289 | ManagementAndGeneral |
| Fundraising | 9358 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11021203 | Total |
| Program Services | 10698254 | ProgramServices |
| Management And General | 250560 | ManagementAndGeneral |
| Fundraising | 72389 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8624455 | Total |
| Management And General | 8624455 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3550272 | Total |
| Program Services | 3543174 | ProgramServices |
| Management And General | 4408 | ManagementAndGeneral |
| Fundraising | 2690 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 287322 | Total |
| Program Services | 279931 | ProgramServices |
| Management And General | 7242 | ManagementAndGeneral |
| Fundraising | 149 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 876935 | Total |
| Program Services | 802985 | ProgramServices |
| Management And General | 68103 | ManagementAndGeneral |
| Fundraising | 5847 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4026361 | Total |
| Program Services | 3832408 | ProgramServices |
| Management And General | 193953 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9847774 | Total |
| Program Services | 9558561 | ProgramServices |
| Management And General | 288500 | ManagementAndGeneral |
| Fundraising | 713 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3407938 | Total |
| Program Services | 3171301 | ProgramServices |
| Management And General | 235527 | ManagementAndGeneral |
| Fundraising | 1110 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES | 47221810 | 47157259 | 63349 | 1202 |
| PURCHASED SERVICES | 37738497 | 11675512 | 26044483 | 18502 |
| BAD DEBTS | 9450795 | 9450795 | ||
| DUES, TAXES, & LICENSES | 6244072 | 6196372 | 46426 | 1274 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 308463643 | Total |
| Program Services | 266188778 | ProgramServices |
| Management And General | 42058605 | ManagementAndGeneral |
| Fundraising | 216260 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10344 | BOY |
| EOY | 9434 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2212097 | BOY |
| EOY | 2169481 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36845024 | BOY |
| EOY | 38052553 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 101427 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 614588 | BOY |
| EOY | 441927 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4521414 | BOY |
| EOY | 5019356 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1665863 | BOY |
| EOY | 2072746 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 222214058 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 102789600 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 106763303 | BOY |
| EOY | 119424458 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11476673 | BOY |
| EOY | 12908435 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 302869 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52625927 | BOY |
| EOY | 3373849 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 217038102 | BOY |
| EOY | 183573666 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23352447 | BOY |
| EOY | 27279338 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58045 | BOY |
| EOY | 31037 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16440000 | BOY |
| EOY | 3708000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41871626 | BOY |
| EOY | 7872081 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34121017 | BOY |
| EOY | 37909011 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 115843135 | BOY |
| EOY | 76799467 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 101194967 | BOY |
| EOY | 106774199 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 101194967 | BOY |
| EOY | 106774199 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 217038102 | BOY |
| EOY | 183573666 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 6628594 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1049362 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4582212 | BeginningOfYearBalance |
| Contributions | 211952 | Contributions |
| Investment Earnings Or Losses | 443652 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 261971 | GrantsOrScholarships |
| End Of Year Balance | 4975845 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3963225 | BeginningOfYearBalance |
| Contributions | 107306 | Contributions |
| Investment Earnings Or Losses | 645769 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 134088 | GrantsOrScholarships |
| End Of Year Balance | 4582212 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4989374 | BeginningOfYearBalance |
| Contributions | 188135 | Contributions |
| Investment Earnings Or Losses | -1015783 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 198501 | GrantsOrScholarships |
| End Of Year Balance | 3963225 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.20860 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.79140 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2608871 | OtherCostOrOtherBasis |
| Book Value | 2608871 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 117312782 | OtherCostOrOtherBasis |
| Depreciation | 54788382 | Depreciation |
| Book Value | 62524400 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1640803 | OtherCostOrOtherBasis |
| Depreciation | 268554 | Depreciation |
| Book Value | 1372249 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 60717209 | OtherCostOrOtherBasis |
| Depreciation | 44410406 | Depreciation |
| Book Value | 16306803 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 39934393 | OtherCostOrOtherBasis |
| Depreciation | 3322258 | Depreciation |
| Book Value | 36612135 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 119424458 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| PROFESSIONAL LIABILITY RESERVE | $2,110,000 |
| OTHER LIABILITIES | $1,864,088 |
| PAYABLE TO CONTRACTUAL AGENCIES | $2,830,997 |
| MINIMUM PENSION LIABILITY | $27,758,023 |
| ACCRUED INTEREST | $1,233,198 |
| TENANTS DEPOSITS | $23,583 |
| ACCOUNTS PAYABLE-AFFILIATES | $2,089,122 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 37909011 | TotalOfAmounts |
| Total Revenue | 315092237 | TotalRevenue |
| Total Expenses | 308463643 | TotalExpenses |
| Excess Or Deficit For Year | 6628594 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 984927 | NetUnrealizedGLOnInvestments |
| Other | -$2,034,289 | OtherAmount |
| Total Adjustments | -1049362 | TotalAdjustments |
| Excess Or Deficit Per FS | 5579232 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 313798139 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 299946 | OtherRevenues |
| Revenue Not Rptd F990 | 299946 | RevenueNotRptdF990 |
| Revenue Subtotal | 313498193 | RevenueSubtotal |
| Other Revenues Not Included | 1594044 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1594044 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 315092237 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 308763589 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 299946 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 299946 | ExpensesNotRptdF990 |
| Expenses Subtotal | 308463643 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 308463643 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE GOOD SAMARITAN HOSPITAL FOUNDATION (GSHF) HOLDS ENDOWMENT FUNDS THAT WILL ULTIMATELY BENEFIT THE HOSPITAL. GSHF'S BOARD-DESIGNATED AND GENERAL ENDOWMENTS ARE USED FOR GENERAL HOSPITAL SUPPORT. GSHF'S BERNIER ENDOWMENT IS USED FOR STAFF CONTINUING EDUCATION. GSHF'S ERKKILA ENDOWMENT IS USED FOR HEALTH AND HUMAN PERFORMANCE RESEARCH AND REHABILITATION. GSHF'S MULLINS SCHOLARSHIP ENDOWMENT SUPPORTS EDUCATIONAL SCHOLARSHIPS. GSHF'S PASTEGA HOUSE ENDOWMENT HELPS UNDERWRITE THE OPERATING COSTS OF THE MARIO PASTEGA GUEST HOUSE. GSHF'S VRTISKA ENDOWMENT SUPPORTS THE HOSPITAL'S LABORATORY FOR EDUCATIONAL PURPOSES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | INTERCOMPANY TRANSFERS 303,324. MINORITY INTEREST CONSOLIDATED JVS 383,030. INCREASE IN MINIMUM PENSION LIABILITY -2,752,786. OTHER CHANGES IN FUND BALANCE 32,143. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENT EXP PER AFS NETTED WITH RENT REV PER TAX RETURN 145,166. RENT REV PER AFS NETTED WITH RENT EXP PER TAX RETURN 154,780. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTION REVENUE - CHANGE IN NET ASSETS PER AFS 1,594,044. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENT EXP PER AFS NETTED WITH RENT REV PER TAX RETURN 145,166. RENT REV PER AFS NETTED WITH RENT EXP PER TAX RETURN 154,780. |
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 | 8418 | PersonsServed |
| Total Community Benefit Expense | 9861319 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 9861319 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03300 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 7 | NumberOfActivitiesOrPrograms |
| Persons Served | 50351 | PersonsServed |
| Total Community Benefit Expense | 32905831 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 22227982 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10677849 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03570 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 16 | NumberOfActivitiesOrPrograms |
| Persons Served | 58769 | PersonsServed |
| Total Community Benefit Expense | 42767150 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 22227982 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 20539168 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06870 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 23 | NumberOfActivitiesOrPrograms |
| Persons Served | 12598 | PersonsServed |
| Total Community Benefit Expense | 512132 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8728 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 503404 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 8 | NumberOfActivitiesOrPrograms |
| Persons Served | 7227 | PersonsServed |
| Total Community Benefit Expense | 5989021 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1495513 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4493508 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01500 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 25 | NumberOfActivitiesOrPrograms |
| Persons Served | 143633 | PersonsServed |
| Total Community Benefit Expense | 59941377 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 33174621 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 26766756 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08950 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 20 | NumberOfActivitiesOrPrograms |
| Persons Served | 10657 | PersonsServed |
| Total Community Benefit Expense | 738849 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 154780 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 584069 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 76 | NumberOfActivitiesOrPrograms |
| Persons Served | 174115 | PersonsServed |
| Total Community Benefit Expense | 67181379 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 34833642 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 32347737 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10820 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 92 | NumberOfActivitiesOrPrograms |
| Persons Served | 232884 | PersonsServed |
| Total Community Benefit Expense | 109948529 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 57061624 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 52886905 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.17690 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 6 | PersonsServed |
| Total Community Building Expense | 2643 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2643 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 172 | PersonsServed |
| Total Community Building Expense | 2729 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2729 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 16 | PersonsServed |
| Total Community Building Expense | 10632 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 10632 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 194 | PersonsServed |
| Total Community Building Expense | 16004 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 16004 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $4,651,483 | BadDebtExpenseAmount |
| Amount Attributable To | 442720 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 42470045 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 48299053 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -5829008 | 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 (4 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|
| 1 CORVALLIS MED BLDGS LLC | ||
| REAL PROPERTY RENTAL | 0.54500 | 0.18500 |
| 2 HULL IMAGING LLC | ||
| IMAGING SERVICES | 0.60000 | 0.40000 |
| 3 SAMARITAN ENDOSCOPY CENTER | ||
| MEDICAL SERVICES | 0.66670 | 0.33330 |
| 4 CORVALLIS MRI A JV | ||
| IMAGING SERVICES | 0.50000 | 0.50000 |
| 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 | GOOD SAMARITAN HOSPITAL CORVALLIS | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Teaching Hospital | X | TeachingHospital |
| 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 | GOOD SAMARITAN HOSPITAL CORVALLIS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 28 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (28 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SAMARITAN REGIONAL CANCER CENTER | ||||
| 501 NW ELKS DR | CORVALLIS | OR | 97330 | RADIATION ONCOLOGY |
| SAMARITAN ORTHOPEDICS CLINIC | ||||
| 3620 NW SAMARITAN DR STE 202 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN HEART & VASC - VASC SURGERY | ||||
| 3615 NW SAMARITAN DR STE 201 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN SURGICAL SPECIALISTS | ||||
| 3615 NW SAMARITAN DR STE 201 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN GYN & SURGICAL ASSOCIATES | ||||
| 400 NW WALNUT BLVD STE 300 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN INTERNAL MEDICINE | ||||
| 3615 NW SAMARITAN DR STE 100 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN NEUROSURGERY - DR ROBERSON | ||||
| 3615 NW SAMARITAN DR STE 210 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN NEUROSURGERY - DR GOODWIN | ||||
| 3615 NW SAMARITAN DR STE 211 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN FAMILY MEDICINE | ||||
| 3517 NW SAMARITAN DR STE 201 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| MAMMOGRAPHY CLINIC | ||||
| 444 NW ELKS DR | CORVALLIS | OR | 97330 | MAMMOGRAPHY CLINIC |
| SAMARITAN KIDNEY SPECIALISTS | ||||
| 3615 NW SAMARITAN DR STE 203 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN PEDIATRICS | ||||
| 3517 NW SAMARITAN DR STE C | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN URGENT CARE CENTER | ||||
| 5234 SW PHILOMATH BLVD | CORVALLIS | OR | 97333 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN DERMATOLOGY | ||||
| 2358 NW KINGS BLVD STE 100 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN ENDOSCOPY CENTER | ||||
| 3509 NW SAMARITAN DR STE 201 | CORVALLIS | OR | 97330 | ENDOSCOPY CENTER |
| CORVALLIS MRI | ||||
| 3615 NW SAMARITAN DR STE 101 | CORVALLIS | OR | 97330 | IMAGING SERVICS |
| CORVALLIS HEARTSPRING WELLNESS CENTER | ||||
| 990 NW CIRCLE BLVD STE 201 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN OBSTETRICS & GYN | ||||
| 3640 NW SAMARITAN DR STE 270 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN MENTAL HEALTH - CORVALLIS | ||||
| 3509 NW SAMARITAN DR | CORVALLIS | OR | 97330 | MENTAL HEALTH SERVICES |
| SAMARITAN PLASTICRECON SURG - HAVARD | ||||
| 996 NW CIRCLE BLVD STE 103 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN HEMATOLOGY & ONCOLOGY | ||||
| 3640 NW SAMARITAN DR STE 161 | CORVALLIS | OR | 97330 | RADIATION ONCOLOGY |
| SAMARITAN ORTHOPEDICS - DR VELA | ||||
| 3620 NW SAMARITAN DR STE 201 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN MENTAL HEALTH - ALBANY | ||||
| 1052 SW 29TH ST | ALBANY | OR | 97321 | MENTAL HEALTH SERVICES |
| SAMARITAN INFECTIOUS DISEASE | ||||
| 3640 NW SAMARITAN DR STE 210 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN UROLOGY | ||||
| 2292 NW KINGS BLVD | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN RHEUMATOLOGY | ||||
| 2358 NW KINGS BLVD STE 100 | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN HAND THERAPY | ||||
| 3640 NW SAMARITAN DR | CORVALLIS | OR | 97330 | MEDICAL CLINIC - OUTPATIENT |
| OUTPATIENT SURGERY | ||||
| 3620 NW SAMARITAN DR | CORVALLIS | OR | 97330 | AMBULATORY SURGERY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 $22,360,058. | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9450795. | ||
| PART II: GSH PROVIDES SERVICES AND ACTIVITIES THAT ARE CLASSIFIED AS COMMUNITY BUILDING. THIS INCLUDES LEADING DISASTER PREPAREDNESS DRILLS WITH LOCAL AGENCIES AND STAFF PARTICIPATING IN ONE-ON-ONE MENTORING PROGRAMS AT A LOCAL SCHOOL. GSH ALSO PROVIDES OPPORTUNITIES FOR COMMUNITY MEMBERS TO OBTAIN TRAINING ON CIVIC AND CULTURAL ISSUES THAT IMPACT HEALTH. SOME OF THE TRAINING OPPORTUNITIES INCLUDED GRANT WRITING AND BOARD DEVELOPMENT. GSH STAFF SERVE ON MANY LOCAL COALITIONS AND BOARDS THAT PROMOTE THE HEALTH OF THE COMMUNITY. BOARD AFFILIATION INCLUDES, BUT IS NOT LIMITED TO COMMUNITY OUTREACH INC, THE GRACE CENTER, THE CENTER FOR HEALTHY AGING RESEARCH/SCIENTIFIC ADVISORY BOARD, AND THE CARING PLACE. ADDITIONALLY GSH STAFF SERVE ON THE OREGON HEALTH POLICY ADVISORY BOARD, THE OREGON HEALTH RESOURCES COMMISSION, THE MEDICAID ADVISORY COMMITTEE AND REGIONAL BOARDS THAT ADDRESS HEALTH CARE ISSUES. | ||
| 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.GOOD SAMARITAN HOSPITAL (GSH) IS THE LARGEST OF FIVE HOSPITALS OF SAMARITAN HEALTH SERVICES (SHS). AS A NETWORK, SHS PREPARES ITS FINANCIAL STATEMENTS ON A CONSOLIDATED BASIS. FOOTNOTE 1(R) FROM THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS ENTITLED "PROVISION FOR UNCOLLECTIBLE ACCOUNTS" DESCRIBES BAD DEBT EXPENSE AS FOLLOWS: "SHS PROVIDES FOR AN ALLOWANCE AGAINST PATIENT ACCOUNTS RECEIVABLE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE. SHS ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR, AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN OF COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE COVERAGE AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND THE ESTIMATION PROCESS USED BY SHS." | ||
| 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 (CALCULATED BASED ON A COST-TO-CHARGE RATIO). CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED, AS THESE PATIENTS TYPICALLY HAVE LOW OR FIXED INCOMES AND GOVERNMENT REIMBURSEMENT IS NOT SUFFICIENT TO COVER THE COSTS OF PROVIDING CARE FOR THESE PATIENTS. MEDICARE PATIENTS ARE A GROWING SEGMENT OF THE LOCAL POPULATION, AND MANY ARE BECOMING INCREASINGLY DEPENDENT ON OUR HOSPITAL AND NON-PROFIT AFFILIATES TO PROVIDE FOR THEIR CARE, ESPECIALLY AS OTHER FOR-PROFIT HEALTHCARE PROVIDERS IN THE COMMUNITY DISCONTINUE ACCEPTING MEDICARE PATIENTS.THE AMOUNT OF MEDICARE SHORTFALL SHOWN ON LINE 7 OF PART III, SECTION B, IS UNDERSTATED. THIS IS PRIMARILY DUE TO THE FACT THAT THE MEDICARE COST REPORT INCLUDES ACTIVITY FOR MEDICARE FEE-FOR-SERVICE PATIENTS BUT NOT MEDICARE MANAGED CARE PATIENTS. MEDICARE MANAGED CARE ACCOUNTS FOR ROUGHLY HALF OF OUR MEDICARE ACTIVITY. IN ADDITION, CERTAIN COSTS OF PROVIDING HEALTHCARE SERVICES, SUCH AS PHYSICIAN COMPENSATION, ARE NOT ALLOWABLE ON THE MEDICARE COST REPORTS. THEREFORE, THE AMOUNT OF MEDICARE SHORTFALL SHOWN ON LINE 7 IS SMALLER THAN THE SHORTFALL CALCULATION USING REVENUE AND COST DATA FOR ALL MEDICARE PATIENT ACTIVITY, AS FOLLOWS:NET REV RECEIVED FROM MEDICARE (ALL MEDICARE PATIENT PROGRAMS):83,413,454MEDICARE COSTS (BASED ON A COST-TO-CHARGE RATIO): 95,009,591UNPAID COST OF PROVIDING SERVICES TO ALL MEDICARE PATIENTS: (11,596,137) | ||
| 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 VI, LINE 2: GOOD SAMARITAN HOSPITAL (GSH) ACTIVELY PARTICIPATES IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY. IN CONJUNCTION WITH THE UNITED WAY OF BENTON COUNTY, THE CITY OF CORVALLIS, BENTON COUNTY HEALTH DEPARTMENT, BENTON COUNTY FEDERALLY QUALIFIED HEALTH CENTER, OREGON STATE UNIVERSITY, THE BENTON COUNTY COMMISSION ON CHILDREN AND FAMILIES AND OTHER COMMUNITY PARTNERS, GSH EMPLOYEES AND OTHER SAMARITAN HEALTH SERVICES STAFF ACTIVELY PARTICIPATED IN A COMMUNITY NEEDS ASSESSMENT DURING 2010. THIS PROCESS INCLUDED EXAMINING PRIMARY DATA COLLECTED THROUGH FOCUS GROUPS, COMMUNITY FORUMS AND PERSONAL INTERVIEWS WITH SEVERAL COMMUNITY MEMBERS FROM THROUGHOUT BENTON COUNTY. SECONDARY DATA WAS GATHERED FROM STATE AND LOCAL AGENCIES THAT ADDRESS HEALTH NEEDS OF CHILDREN, YOUTH AND FAMILIES. AS A RESULT OF THE COMMUNITY NEEDS ASSESSMENT, GSH IS ABLE TO UPDATE THE ANNUAL COMMUNITY BENEFIT PLAN THAT OUTLINES GOALS, OBJECTIVES AND SERVICES THAT EXPAND ACROSS THE SAMARITAN HEALTH SERVICES SYSTEM RESPONDING TO COMMUNITY NEEDS. | ||
| PART VI, LINE 3: GSH 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: GSH PRIMARILY SERVES THE RESIDENTS OF BENTON COUNTY. HOWEVER, RESIDENTS FROM THE ADJOINING COMMUNITIES OF LINCOLN AND LINN COUNTIES ARE ALSO SEEN AT GSH. WITH A TOTAL POPULATION OF 85,579 (U.S. CENSUS), BENTON COUNTY IS DESIGNATED AS AN URBAN COUNTY. THE COUNTY INCLUDES THE CITIES OF CORVALLIS AND PHILOMATH AS WELL AS THE SMALL INCORPORATED TOWNSHIPS OF MONROE AND ADAIR VILLAGE. APPROXIMATELY 21% OF BENTON COUNTY RESIDENTS LIVE IN RURAL AREAS OF THE COUNTY. THE MEDIAN HOUSEHOLD INCOME FOR BENTON COUNTY IS $71,800, AND 16.1% OF THE RESIDENTS LIVE BELOW THE FEDERAL POVERTY LEVEL. THE MOST RECENT UNEMPLOYMENT RATES FROM THE OREGON EMPLOYMENT DEPARTMENT REPORTED A 6.3% RATE FOR BENTON COUNTY. ACCORDING TO THE COUNTY HEALTH RANKINGS, 26% OF BENTON COUNTY RESIDENTS ARE UNINSURED. PORTIONS OF BENTON COUNTY HAVE DESIGNATIONS OF MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ACCORDING TO THE HEALTH RESOURCES AND SERVICES ADMINISTRATION, WITH GSH BEING THE ONLY HOSPITAL LOCATED IN BENTON COUNTY. | ||
| PART VI, LINE 6: GSH'S GOVERNING BOARD IS COMPRISED OF LOCAL-AREA RESIDENTS. THE MAJORITY OF THE BOARD MEMBERS ARE INDEPENDENT, MEANING THEY AND THEIR FAMILY MEMBERS ARE NOT EMPLOYEES OF GSH NOR DO THEY HAVE ANY SIGNIFICANT BUSINESS RELATIONSHIPS WITH GSH. GSH EXTENDS ITS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. GSH APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. GSH INVESTS IN UPDATING EQUIPMENT, TECHNOLOGY AND FACILITIES TO IMPROVE PATIENT CARE. GSH IS ACCREDITED FOR CONTINUING MEDICAL EDUCATION AND OFFERS WEEKLY PROGRAMS FOR AREA PHYSICIANS AND OTHER HEALTH PROFESSIONALS. THE CENTER FOR HEALTH RESEARCH AND QUALITY, A DEPARTMENT OF GSH'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 GSH AND ITS AFFILIATED HOSPITALS. GSH ALSO CONTRIBUTES FINANCIALLY TO THE LINN-BENTON COMMUNITY COLLEGE NURSING PROGRAM. | ||
| PART VI, LINE 7: "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.GSH IS THE FLAGSHIP HOSPITAL OF SHS. IT PRIMARILY SERVES RESIDENTS OF BENTON COUNTY. OTHER AFFILIATED HOSPITALS ARE SAMARITAN ALBANY GENERAL HOSPITAL AND SAMARITAN LEBANON COMMUNITY HOSPITAL, SERVING RESIDENTS OF LINN COUNTY, AND SAMARITAN NORTH LINCOLN HOSPITAL AND SAMARITAN PACIFIC COMMUNITIES HOSPITAL, SERVING RESIDENTS OF LINCOLN COUNTY. | ||
| OR | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| COMMUNITY OUTREACH | |||||||
| 865 REIMAN AVENUE | CORVALLIS | OR | 97330 | 930602094 | 501(C)(3) | 131250 | MEDICAL, DENTAL, MENTAL HEALTH CLINICS |
| LBCC FOUNDATION | |||||||
| 6500 SW PACIFIC BLVD | ALBANY | OR | 97321 | 237212073 | 501(C)(3) | 42500 | NURSING PROGRAM SUPPORT |
| OLD MILL CENTER | |||||||
| 1650 SW 45TH PLACE | CORVALLIS | OR | 97333 | 930722603 | 501(C)(3) | 45000 | SUPPORT FOR HIGH RISK INFANTS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
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 |
|---|---|---|---|---|---|
| ACCOMODATIONS - PASTEGA HOUSE | 5618 | 30137 | BOOK | TEMPORARY HOUSING FOR HEALTH CARE RECIPIENTS | |
| TRANSPORTATION | 218 | 14135 | |||
| MEDICAL ASSISTANCE | 53 | 742 | BOOK | MEDICAL SUPPLIES | |
| SHELTER | 19 | 1841 | |||
| MEALS FOR FAMILY MEMBERS OF PATIENTS | 130 | 1303 | BOOK | MEALS |
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 |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | 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 (11 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KEVIN EWANCHYNA MD | |||||||||||||
| 0 | 256054 | 0 | 30000 | 0 | 826 | 0 | 18159 | 0 | 25213 | 0 | 330252 | 0 | 0 |
| FREDERICK WEISENSEE MD | |||||||||||||
| 276274 | 0 | 3818 | 0 | 15042 | 0 | 19714 | 0 | 17606 | 0 | 332454 | 0 | 0 | 0 |
| STEVEN W JASPERSON | |||||||||||||
| 0 | 341732 | 0 | 20000 | 0 | 30833 | 0 | 33866 | 0 | 23417 | 0 | 449848 | 0 | 0 |
| DANIEL B SMITH | |||||||||||||
| 0 | 255799 | 0 | 25000 | 0 | 6650 | 0 | 18341 | 0 | 29359 | 0 | 335149 | 0 | 0 |
| KATHRYN M HALE | |||||||||||||
| 156623 | 0 | 7916 | 0 | 3651 | 0 | 24215 | 0 | 18099 | 0 | 210504 | 0 | 0 | 0 |
| MICHAEL A MAY MD | |||||||||||||
| 272481 | 0 | 0 | 0 | 5922 | 0 | 30689 | 0 | 28942 | 0 | 338034 | 0 | 0 | 0 |
| STEVEN GOODWIN MD | |||||||||||||
| 658292 | 0 | 0 | 0 | 1245 | 0 | 20228 | 0 | 22831 | 0 | 702596 | 0 | 0 | 0 |
| DONALD PENNINGTON DO | |||||||||||||
| 734960 | 0 | 0 | 0 | 580 | 0 | 20228 | 0 | 26591 | 0 | 782359 | 0 | 0 | 0 |
| PETER C TSAI MD | |||||||||||||
| 638930 | 0 | 0 | 0 | 414 | 0 | 10726 | 0 | 24562 | 0 | 674632 | 0 | 0 | 0 |
| RANDALL V BREAM MD | |||||||||||||
| 586199 | 0 | 0 | 0 | 17404 | 0 | 20228 | 0 | 19470 | 0 | 643301 | 0 | 0 | 0 |
| JAMES A RYAN MD | |||||||||||||
| 583431 | 0 | 0 | 0 | 486 | 0 | 0 | 0 | 27778 | 0 | 611695 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM REIMBURSEMENT BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. THE EMPLOYEE MUST ATTEND THE GYM FOR 6 CONSECUTIVE MONTHS, AT LEAST 50 TIMES, IN ORDER TO QUALIFY FOR REIMBURSEMENT. THIS GYM REIMBURSEMENT BENEFIT IS INCLUDED IN THE EMPLOYEE'S TAXABLE WAGES AND IS SUBJECT TO STATE/FEDERAL WITHHOLDING TAX. ONE BOARD MEMBER AND ONE OFFICER RECEIVED THIS BENEFIT IN 2010. |
| PART I, LINE 5 | VARIOUS PHYSICIAN COMPENSATION METHODOLOGIES ARE UTILIZED AND, DEPENDING ON SPECIALTY, RELATIVE VALUE UNITS (RVU'S) MAY BE USED IN DETERMINING A PORTION OF OR ALL OF THEIR COMPENSATION. |
Schedule L IRS990ScheduleL
Loan Table LoanTable (2 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| PETER C TSAI MD | ||||||
| RECRUITMENT PACKAGE | X | $50,000 | 26076 | 0 | 1 | 1 |
| JAMES A RYAN MD | ||||||
| RECRUITMENT PACKAGE | X | $100,000 | 75351 | 0 | 1 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 101427 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS WERE AMENDED BY REMOVING THE STIPULATION THAT THE BISHOP OF THE DIOCESE OF OREGON SHALL BE THE CHAIRMAN OF THE BOARD. THE BYLAWS WERE AMENDED BY MAKING THE BISHOP OF THE DIOCESE OF OREGON A MEMBER OF THE NOMINATING/EXECUTIVE COMMITTEE. | |
| FORM 990, PART VI, SECTION A, LINE 6 | GOOD SAMARITAN HOSPITAL CORVALLIS 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 | GOOD SAMARITAN HOSPITAL CORVALLIS 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. | |
| 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 12C | |
| 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. | FORM 990, PART VI, SECTION C, LINE 19 | |
| KEVIN EWANCHYNA, MD | DR. EWANCHYNA WORKED 40 HOURS PER WEEK FOR SEVERAL RELATED ORGANIZATIONS. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION AND SEVERAL RELATED ORGANIZATIONS. | FORM 990, PART VII - COMPENSATION EXPLANATION |
| STEVEN W. JASPERSON | MR. JASPERSON'S COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION. | FORM 990, PART VII - COMPENSATION EXPLANATION |
| DANIEL B. SMITH | MR. SMITH WORKED 40 HOURS PER WEEK FOR SEVERAL RELATED ORGANIZATIONS. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION AND SEVERAL RELATED ORGANIZATIONS. | FORM 990, PART VII - COMPENSATION EXPLANATION |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 984,927. INTERCOMPANY TRANSFERS 303,324. MINORITY INTEREST CONSOLIDATED JVS 383,030. INCREASE IN MINIMUM PENSION LIABILITY -2,752,786. OTHER CHANGES IN FUND BALANCE 32,143. TOTAL TO FORM 990, PART XI, LINE 5: -1,049,362. | FORM 990, PART XI, LINE 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (14 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 AUXILIARY | |||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 973393000 | 936024034 | TO SUPPORT GOOD SAMARITAN HOSPITAL | OR | 501(C)(3) | 11D, III-O | GOOD SAMARITAN HOSPITAL | 1 | |
| GOOD SAMARITAN HOSPITAL FOUNDATION | |||||||||||
| PO BOX 1068 | CORVALLIS | OR | 97339 | 237252406 | TO SUPPORT GOOD SAMARITAN HOSPITAL | OR | 501(C)(3) | 7 | GOOD SAMARITAN HOSPITAL | 1 | |
| 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 | |
| SAMARITAN NORTH LINCOLN HOSPITAL | |||||||||||
| 3043 NE 28TH STREET | LINCOLN CITY | OR | 97367 | 931305493 | 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 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN ENDOSCOPY CENTER LLC | ||||||||||||||
| 3600 NW SAMARITAN DR | CORVALLIS | OR | 97330 | 202860067 | MEDICAL SERVICES | OR | GOOD SAMARITAN HOSPITAL | RELATED | 446154 | 747643 | 0 | 1 | 0.66660 | |
| CORVALLIS MEDICAL BUILDINGS LLC | ||||||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OH | 97330 | 931257913 | REAL ESTATE RENTAL | OR | GOOD SAMARITAN HOSPITAL | EXCLUDED | 114118 | 1484486 | 0 | 1 | 0.54500 | |
| EAST LINN MRI LLC | ||||||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 320229399 | IMAGING | OR | MID-VALLEY HEALTHCARE INC | N/A | 0 | 0 | ||||
| HULL IMAGING LLC | ||||||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 203255479 | IMAGING | OR | GOOD SAMARITAN HOSPITAL | RELATED | 720924 | 274496 | 0 | 1 | 0.60000 | |
| SAMARITAN OPEN MRI LLC | ||||||||||||||
| 3600 NW SAMARITAN DR | CORVALLIS | OR | 97330 | 208346225 | IMAGING | OR | ALBANY GENERAL HOSPITAL | N/A | 0 | 0 | ||||
| CBA-SAM LLC | ||||||||||||||
| PO BOX 433 | LINCOLN CITY | OR | 97367 | 931314523 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | N/A | ||||
| CORVALLIS MRI A JOINT VENTURE | ||||||||||||||
| 3615 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 930949704 | IMAGING | OR | RELATED | 427390 | 714680 | 0 | 1 | 0.50000 | N/A | |
| MID-VALLEY MEDICAL PROPERTIES ASSOC LLC | ||||||||||||||
| 1046 SIXTH AVE SW | ALBANY | OR | 97321 | 300508747 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | N/A | ||||
| MID-VALLEY MEDICAL BUILDINGS LLC | ||||||||||||||
| PO BOX 557 | LEBANON | OR | 97355 | 931126353 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | N/A | ||||
| NORTHWEST MEDICAL ISOTOPES LLC | ||||||||||||||
| 815 NW 9TH ST STE 256 | CORVALLIS | OR | 97330 | 273007752 | RESEARCH | OR | SAMARITAN HEALTH SERVICES | N/A | 0 | 0 | ||||
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 Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | 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 |
| 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 | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | 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 | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (10 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| INTERCOMMUNITY HEALTH PLANS INC | ||
| K | 11490961 | COST |
| SAMARITAN ENDOSCOPY CENTER LLC | ||
| A | 355129 | COST |
| SAMARITAN ENDOSCOPY CENTER LLC | ||
| N | 153175 | COST |
| SAMARITAN ENDOSCOPY CENTER LLC | ||
| O | 152625 | COST |
| SAMARITAN ENDOSCOPY CENTER LLC | ||
| R | 624073 | COST |
| CORVALLIS MEDICAL BUILDINGS LLC | ||
| A | 46299 | COST |
| CORVALLIS MEDICAL BUILDINGS LLC | ||
| J | 422143 | COST |
| HULL IMAGING LLC | ||
| A | 145321 | COST |
| HULL IMAGING LLC | ||
| N | 624019 | COST |
| HULL IMAGING LLC | ||
| R | 678000 | COST |
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