THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA (EIN 23-0794160)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-12
IRS object ID
201131329349300343
Schema version
2009v1.7
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-12T08:56:15-04:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line175 BEATTIE PLACE SUITE 800AddressLine1
CityGREENVILLECity
StateSCState
ZIP Code29601ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN230794160EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan Hospital TheBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGOODNameControl
Phone7172707500Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1281 4th Walnut StsAddressLine1
CityLebanonCity
StatePAState
ZIP Code170421281ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameROBERT J RICHARDSName
TitleVP FINANCE & CEOTitle
Date Signed2011-05-11DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone8642425740Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonROBERT J LONGONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14TH WALNUT STREETAddressLine1
CityLEBANONCity
StatePAState
ZIP Code17042ZIPCode
FieldValueIRS element (for citing)
Gross Receipts173426088GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.gshleb.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1989YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionTO BE THE CHOICE FOR HIGH-QUALITY, INNOVATIVE SERVICES THAT IMPROVE THE OVERALL HEALTH OF OUR COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body19NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees1692TotalNbrEmployees
Total Nbr Volunteers444TotalNbrVolunteers
Total Gross UBI4281050TotalGrossUBI
Net Unrelated Business Txbl Income121799NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1438596ContributionsGrantsPriorYear
Contributions Grants Current Year792179ContributionsGrantsCurrentYear
Program Service Revenue Prior Year150946709ProgramServiceRevenuePriorYear
Program Service Revenue CY161243680ProgramServiceRevenueCY
Investment Income Prior Year366284InvestmentIncomePriorYear
Investment Income Current Year1036715InvestmentIncomeCurrentYear
Other Revenue Prior Year4259843OtherRevenuePriorYear
Other Revenue Current Year5129384OtherRevenueCurrentYear
Total Revenue Prior Year157011432TotalRevenuePriorYear
Total Revenue Current Year168201958TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year45995GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY32800GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year72200667SalariesEtcPriorYear
Salaries Etc Current Year73656041SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year88862205OtherExpensePriorYear
Other Expenses Current Year94601455OtherExpensesCurrentYear
Total Expenses Prior Year161108867TotalExpensesPriorYear
Total Expenses Current Year168290296TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-4097435RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-88338RevenuesLessExpensesCY
Total Assets BOY152881665TotalAssetsBOY
Total Assets EOY144533049TotalAssetsEOY
Total Liabilities BOY127888786TotalLiabilitiesBOY
Total Liabilities EOY132516543TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY24992879NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY12016506NetAssetsOrFundBalancesEOY
Mission DescriptionTO BE THE CHOICE FOR HIGH-QUALITY, INNOVATIVE SERVICES THAT IMPROVE THE OVERALL HEALTH OF OUR COMMUNITY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense135341138Expense
Grants32800Grants
Revenue149997964Revenue
DescriptionInpatient/Outpatient Services - SEE SCHEDULE ODescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1840413Expense
Revenue2041733Revenue
DescriptionRehabilitation 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 6/30/10 STATISTICS: 313 REHAB ADMISSIONS AND 3,279 REHAB PATIENT DAYS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense2265124Expense
Revenue2462251Revenue
DescriptionSkilled 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 6/30/10 STATISTICS: 400 TCU ADMISSIONS AND 4,585 TCU PATIENT DAYS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp2123553TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev2460682TotalOfOtherProgramServiceRev
Total Program Service Expense141570228TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgtrueTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096499NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees1692NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Nbr Voting Governing Body Members19NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonROBERT J RICHARDSNamePerson
Telephone Number7172707500TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1241 SOUTH FOURTH STREETAddressLine1
CityLEBANONCity
StatePAState
ZIP Code17042ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
CAROL BLECKER
TRUSTEE1.0X000
EARL H BRINSER
TRUSTEE1.0X000
SLOAN CAPLAN
TRUSTEE1.0X000
EVELYN C COLON
TRUSTEE1.0X000
PAUL R DIGIACOMO
TRUSTEE1.0X000
DONALD H DREIBELBIS
SECOND VICE CHAIRMAN1.0X000X
ROBERT J FUNK
TRUSTEE1.0X000
ROBERT P HOFFMAN
TRUSTEE1.0X000
JANE W JUPPENLATZ
SECRETARY1.0X000X
FEDERICK C LAURENZO
TRUSTEE1.0X000
ROBERT J PHILLIPS
TRUSTEE1.0X000
WILLIAM E SCHAEFFER JR MD
TRUSTEE1.0X000
DENNIS L SHALTERS
CHAIRMAN1.0X000X
GALEN G WEABER
TRUSTEE1.0X000
JOHN P WELCH MD
FIRST VICE CHAIRMAN1.0X000X
DEBORAH T WEAVER
TRUSTEE1.0X000
FREDERICK S WOLFSON ESQ
TREASURER1.0X000X
JULIE ZINSSER
TRUSTEE1.0X000
ROBERT J LONGO
PRES. & CEO40.0X78067401813X
ROBERT J RICHARDS
VP FINANCE & CEO40.023226200X
WILLIAM HENDRICK
SENIOR VP & COO40.024302100X
KIMBERLY FREEMAN
VP HUMAN RESOURCES40.016850800X
JACQUELYN M GOULD
VP NURSING40.015277900X
ROBERT D SHAVER MD
VP MEDICAL AFFAIRS40.026556800X
ELLEN JOHNSON
PHYSICIAN40.018232700X
DARIA KOVARIKOVA
PHYSICIAN40.017491300X
BYARD YODER
PHYSICIAN40.016187800X
JAMES MCGEARY
PHYSICIAN40.015089900X
ROBERTA SCHERR
PHYSICIAN40.016003000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2672859TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation1813TotalOtherCompensation
Number Individuals GT100 K33NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
LEBANON ANESTHESIA ASSOCIATES LT
PO BOX 1281LEBANONPA17042ANESTHESIOLOGISTS2688204
MILTON HERSHEY MEDICAL CENTER
PO BOX 853HERSHEYPA170330853RESIDENTS1512969
McKesson Information Solutions
PO Box 98347CHICAGOIL606938347IT SUPPORT3782938
PRICE WATERHOUSE COOPER
PO BOX 7247-8001PHILADELPHIAPA191708001REVENUE CYCLE CONSLT845655
HCSC LAUNDRY
PO BOX 25092LEHIGH VALLEYPA180025092LAUNDRY SERVICE644177
FieldValueIRS element (for citing)
Number Of Contractors GT100 K19NumberOfContractorsGT100K
Government Grants302125GovernmentGrants
All Other Contributions490054AllOtherContributions
Total Contributions792179TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
IP/OP PATIENTS900099149997964149997964
REHAB PATIENTS90009920417332041733
HH/VNA SERVICES62161024606822460682
TCU PATIENTS90009924622512462251
DROP LAB REVENUE62150042810504281050
FieldValueIRS element (for citing)
Total Program Service Revenue161243680TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column901844TotalRevenueColumn
Exclusion$901,844ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column37055TotalRevenueColumn
Exclusion$37,055ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real105033Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real153971Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-48938Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-48938TotalRevenueColumn
Exclusion-$48,938ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities5164002Securities
Other3973Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5070159Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities93843Securities
Other3973Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column97816TotalRevenueColumn
Exclusion$97,816ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PENSION INCOME524292876658$876,658
MALPRACTICE INSURANCE524298758823758823
OTHER OPERATING REV900099712569712569

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2830272TotalRevenueColumn
Related Or Exempt Function Income2228828RelatedOrExemptFunctionIncome
Exclusion$601,444ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue5178322TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column168201958TotalRevenueColumn
Related Or Exempt Function Income160662850RelatedOrExemptFunctionIncome
Unrelated Business Revenue4281050UnrelatedBusinessRevenue
Exclusion$2,465,879ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total32800Total
Program Services32800ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1896846Total
Management And General1896846ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total50747249Total
Program Services43135161ProgramServices
Management And General7612088ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6455575Total
Program Services5487239ProgramServices
Management And General968336ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total10754899Total
Program Services9141664ProgramServices
Management And General1613235ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3801472Total
Program Services3231251ProgramServices
Management And General570221ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total125168Total
Program Services106393ProgramServices
Management And General18775ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total145951Total
Program Services124058ProgramServices
Management And General21893ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total14734Total
Program Services12524ProgramServices
Management And General2210ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total906362Total
Program Services770408ProgramServices
Management And General135954ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3358301Total
Program Services2854556ProgramServices
Management And General503745ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total989536Total
Program Services841106ProgramServices
Management And General148430ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1726386Total
Program Services1467428ProgramServices
Management And General258958ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4684077Total
Program Services3981465ProgramServices
Management And General702612ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total5829827Total
Program Services5086228ProgramServices
Management And General743599ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total78873Total
Program Services67042ProgramServices
Management And General11831ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total121589Total
Program Services103351ProgramServices
Management And General18238ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total4150745Total
Program Services3528133ProgramServices
Management And General622612ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total1553847Total
Program Services1320770ProgramServices
Management And General233077ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total9780532Total
Program Services8313452ProgramServices
Management And General1467080ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1787183Total
Program Services1519106ProgramServices
Management And General268077ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
HEALTHCARE PROFESSIONALS PMTS1154876981645173231
PURCHASED SERVICES973136982716641459705
SERVICE CONTRACTS18472051570124277081
MEDICAL SUPPLIES29443345250268434416502
PROVISION FOR BAD DEBT15415372131030662312306

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1756177Total
Program Services1492751ProgramServices
Management And General263426ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total168290296Total
Program Services141570228ProgramServices
Management And General26720068ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY5270BOY
EOY5270EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1964049BOY
EOY3265392EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1816085BOY
EOY1500827EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY17289764BOY
EOY16364675EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY930000BOY
EOY1431250EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1622087BOY
EOY1704883EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2398363BOY
EOY1983398EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis177382321LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec99303552LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY84351205BOY
EOY78078769EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY23448915BOY
EOY25395014EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY2398069BOY
EOY2269669EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY16657858BOY
EOY12533902EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY152881665BOY
EOY144533049EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY15392367BOY
EOY19867022EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY381746BOY
EOY396562EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY67782846BOY
EOY66550456EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1857659BOY
EOY875941EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY4008857BOY
EOY2527469EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY38465311BOY
EOY42299093EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY127888786BOY
EOY132516543EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY21756453BOY
EOY9010688EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2564249BOY
EOY2333641EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY672177BOY
EOY672177EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY24992879BOY
EOY12016506EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY152881665BOY
EOY144533049EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteefalseAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorstrueDirectContactLegislators
Direct Contact Legislators$14,734DirectContactLegislatorsAmount
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB14734TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierLOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE GReturnReference
ExplanationTHE 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 6-30-10 THE AMOUNT OF DUES PAID TO THE HHAP TOTALED $64,059 WHICH 23% ($14,734) 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.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3236426BeginningOfYearBalance
Contributions458155Contributions
Investment Earnings Or Losses36900InvestmentEarningsOrLosses
Other Expenditures725663OtherExpenditures
End Of Year Balance3005818EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3712782BeginningOfYearBalance
Contributions-26711Contributions
Investment Earnings Or Losses-22884InvestmentEarningsOrLosses
Other Expenditures426761OtherExpenditures
End Of Year Balance3236426EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.23000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.77000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1468847OtherCostOrOtherBasis
Book Value1468847BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis88697907OtherCostOrOtherBasis
Depreciation34056191Depreciation
Book Value54641716BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3695638OtherCostOrOtherBasis
Depreciation2606869Depreciation
Book Value1088769BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis80887150OtherCostOrOtherBasis
Depreciation6129162Depreciation
Book Value19757988BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2632779OtherCostOrOtherBasis
Depreciation1511330Depreciation
Book Value1121449BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings78078769TotalOfBookValueLandBuildings

Other Assets OtherAssets (10 entries)

DescriptionDescriptionBook ValueBookValue
INTEREST RECEIVABLE24281
ACCRUED INT BOARD DESIG FUNDS2000
DEBT SERVICE NON-CURRENT5558472
DEBT SERVICE CURRENT1295000
INTERCOMPANY RECEIVABLES1068478
DUE FROM FOUNDATION19536
DUE FROM EMPL, STAFF, PHYS46731
OTHER RECEIVABLES3542
DUE FROM LEBANON COUNTY84208
INVESTMENT- OTHER ASSETS4431654
FieldValueIRS element (for citing)
Total Book Value Other Assets12533902TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (7 entries)

DescriptionDescriptionAmountAmount
EMPLOYEE W/H PAYABLE$373,893
LONG TERM LVC PLEDGE PAYABLE$2
3RD PARTY PAYABLES$528,479
LONG TERM POST RETIRE BENEFITS$3,433,034
INSURANCE RESERVES$1,766,606
PENSION LIABILITY$36,197,081
ROUNDING-$2
FieldValueIRS element (for citing)
Total Of Amounts42299093TotalOfAmounts
Total Revenue168201958TotalRevenue
Total Expenses168290296TotalExpenses
Excess Or Deficit For Year-88338ExcessOrDeficitForYear
Net Unrealized GL On Investments1421791NetUnrealizedGLOnInvestments
Other-$14,309,827OtherAmount
Total Adjustments-12888036TotalAdjustments
Excess Or Deficit Per FS-12976374ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt169282665TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments1421791NetUnrealizedGainsInvestments
Other Revenues-341084OtherRevenues
Revenue Not Rptd F9901080707RevenueNotRptdF990
Revenue Subtotal168201958RevenueSubtotal
Total Revenue Per Form990168201958TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt168444267TotExpensesEtcAuditedFinclStmt
Other Expenses Included153971OtherExpensesIncluded
Expenses Not Rptd F990153971ExpensesNotRptdF990
Expenses Subtotal168290296ExpensesSubtotal
Total Expenses Per Form990168290296TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ENDOWMENT FUNDSSCHEDULE D, PART V, LINE 4THE GOOD SAMARITAN HOSPITAL MAINTAINS TEMPORARILY RESTRICTED AND PERMANENTLY RESTRICTED ASSETS TO PURCHASE SPECIFIC PIECES OF EQUIPMENT AND PROVIDE QUALIFIED APPLICANTS A SCHOLARSHIP.
RECONCILIATIONSCHEDULE D, PART XI, XII, XIIIPART 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 WROTE OFF A LARGE RECEIVABLE THAT WAS DUE FROM THE AFFILIATED CORPORATION GOOD SAMARITAN PHYSICIAN SERVICES. ADDITIONAL PENSION FUNDING $ -2,662,924 NET ASSETS RELEASED FOR PP&E 725,664 NET ASSETS RELEASED TEMP RESTRICTED -725,664 WRITEOFF GSPS RECEIVABLE -11,646,904 ROUNDING 1 ------------- $ -14,309,827 PART XII, LINE 2D RENTAL INCOME $ 105,033 OTHER LOSSES -446,117 --------- $-341,084 PART XIII, LINE 2D RENTAL EXPENSES $ 153,971 PART X, LINE 2 THE GOOD SAMARITAN HOSPITAL DID NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT WERE MATERIAL TO ITS AUDITED FINANCIAL STATEMENTS. THEREFORE, THE HOSPITAL DID NOT HAVE A FIN 48 FOOTNOTE IN ITS FINANCIAL STATEMENTS.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense498710TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense498710NetCommunityBenefitExpense
Percent Of Total Expense0.00330PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2568589TotalCommunityBenefitExpense
Direct Offsetting Revenue1039012DirectOffsettingRevenue
Net Community Benefit Expense1529577NetCommunityBenefitExpense
Percent Of Total Expense0.01000PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense11337965TotalCommunityBenefitExpense
Direct Offsetting Revenue6303728DirectOffsettingRevenue
Net Community Benefit Expense5034237NetCommunityBenefitExpense
Percent Of Total Expense0.03290PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense14405264TotalCommunityBenefitExpense
Direct Offsetting Revenue7342740DirectOffsettingRevenue
Net Community Benefit Expense7062524NetCommunityBenefitExpense
Percent Of Total Expense0.04620PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense74087TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense74087NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense1776830TotalCommunityBenefitExpense
Direct Offsetting Revenue897521DirectOffsettingRevenue
Net Community Benefit Expense879309NetCommunityBenefitExpense
Percent Of Total Expense0.00580PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1850917TotalCommunityBenefitExpense
Direct Offsetting Revenue897521DirectOffsettingRevenue
Net Community Benefit Expense953396NetCommunityBenefitExpense
Percent Of Total Expense0.00630PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense16256181TotalCommunityBenefitExpense
Direct Offsetting Revenue8240261DirectOffsettingRevenue
Net Community Benefit Expense8015920NetCommunityBenefitExpense
Percent Of Total Expense0.05250PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense37180TotalCommunityBuildingExpense
Direct Offsetting Revenue54928DirectOffsettingRevenue
Net Community Building Expense-17748NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense38610TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense38610NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense75790TotalCommunityBuildingExpense
Direct Offsetting Revenue54928DirectOffsettingRevenue
Net Community Building Expense20862NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$4,778,765BadDebtExpenseAmount
Amount Attributable To2441358AmountAttributableTo
Amount Reimbursed By Medicare39952791AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare87976185CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-48023394MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV (12 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalTeaching HospitalTeachingHospitalEr24 HoursEr24HoursOtherOther
THE GOOD SAMARITAN HOSPITAL
FOURTH AND WALNUT STREETSLEBANONPA17042XXXX
THE GOOD SAMARITAN HOSPITAL
FOURTH AND WILLOW STREETSLEBANONPA17042REHAB AND TCU UNITS
THE GOOD SAMARITAN HOSPITAL
830 TUCK STREETLEBANONPA17042OUTPATIENT SURGICAL CENTER
THE GOOD SAMARITAN HOSPITAL
840 TUCK STREETLEBANONPA17042WOUND CARE & HYPERBARIC CENTER
THE GOOD SAMARITAN HOSPITAL
206 HATHAWAY PARKLEBANONPA17042SLEEP DISORDERS CENTER
THE GOOD SAMARITAN HOSPITAL
805 HELEN DRIVELEBANONPA17042OUTPATIENT RADIOLOGY CENTER
THE GOOD SAMARITAN HOSPITAL
750 NORMAN DRIVELEBANONPA17042BLOOD DONOR CENTER & LABORATORY
THE GOOD SAMARITAN HOSPITAL
297 WEST LINCOLN AVENUEMYERSTOWNPA17067OUTPATIENT DIAGNOSTIC CENTER
THE GOOD SAMARITAN HOSPITAL
1400 SOUTH FORGE ROADPALMYRAPA17078AMBULATORY SERVICES CENTER
THE GOOD SAMARITAN HOSPITAL
100 QUEEN STREETJONESTOWNPA17038SATELLITE SERVICES CENTER
THE GOOD SAMARITAN HOSPITAL
950 ISABEL DRIVELEBANONPA17042OUTPATIENT PHYSICAL THERAPY
THE GOOD SAMARITAN HOSPITAL
781 NORMAN DRIVELEBANONPA17042CARDIOVASCULAR DIAGNOSTIC CENTER

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaNOT APPLICABLEIncomeBasedCriteria
Annual Community Benefit ExplnOUR 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.AnnualCommunityBenefitExpln
Costing Method UsedThe 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.CostingMethodUsed
Subsidized Health Services ExplnNOT APPLICABLESubsidizedHealthServicesExpln
Percent Of Total Expense ExplnOUT TOTAL EXPENSE FROM FORM 990, PART XI, LINE 25, COLUMN (A) WAS $168,290,296. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $15,415,372. THIS LEFT US WITH A TOTAL EXPENSE OF $152,874,924 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F).PercentOfTotalExpenseExpln
Bad Debt FootnoteTHE 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 HOSPTIAL IS A TAX-EXEMPT NON-F0R-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 LAST YEAR, THE TOOL ESTIMATED THAT $2,441,358 OF THE ORGANIZATION'S BAD DEBT EXPENSE SHOULD BE CONSIDERED CHARITY CARE.BadDebtFootnote
Shortfall As Community BenefitMEDICARE 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 $48,023,394 MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFITY.ShortfallAsCommunityBenefit
Debt Collection PolicyCollection 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 complete 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.DebtCollectionPolicy
Number Of Facility Type ExplnTHE GOOD SAMARITAN HOSPITAL DOES NOT HAVE ANY UNLICENSED OR UNRECOGNIZED FACILITIES.NumberOfFacilityTypeExpln
Needs AssessmentPART VI, LINE 2 THE GOOD SAMARITAN HOSPITAL HAS PARTICIPATED IN A VARIETY OF COMMUNITY HEALTH NEEDS ASSESSMENTS OVER THE PAST 15 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 15 YEARS AGO AND AN UPDATED ASSESSMENT COMPLETED 10 YEARS AGO. ANOTHER ASSESSMENT WAS CREATED IN 2005, LEAD BY EFFORTS OF THE UNITED WAY OF LEBANON COUNTY. THE GOOD SAMARITAN HOSPITAL IS CURRENTLY PARTNERED WITH OTHER COMMUNITY ORGANIZATIONS TO COMPLETE A COMMUNITY HEALTH ASSESSMENT BY 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 WILL ALSO BE 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 HOSPTIAL HAS ALSO ACTED TO FULFILL THE NEEDS INDENTIFIED 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 HOSPTIAL 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 HOSPTIAL 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.NeedsAssessment
Patient Education AssistancePART 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 HOSPTIAL 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.PatientEducationAssistance
Community InformationPART 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 SPEAK 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 FOR INDIANTOWN GAP. THE GOOD SAMARITAN HOSPTIAL 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 CAER TO 51,000 INDIVIDUALS EACH YEAR. THE HOSPITAL CARED FROM 8,421 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 HOSPTIAL 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% CHOOSIGN THE GOOD SAMARITAN HOSPTIAL FOR SERVICES. ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION COMMUNITY HEALTH RANKINGS, LEBANON COUNTY IS THE 13TH MOST HEALTHY OF PENNSYLVANIA'S 67 COUNTIES. THE HEALTH RANKINGS INDICATE KEY AREAS OF IMPROVEMENT, INCLUDING DIABETES, TOBACCO USE, AND OTHER HEALTH BEHAVIORS THAT ARE PROBLEMATIC. THE HOSPTIAL HAS TAKEN STEPS TO ADDRESS THESE AREAS BY EXPANDING SERVICES AND EDUCATIONAL OPPORTUNITIES.CommunityInformation
Community Building ActivitiesPART VI, LINE 5 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 GOOD SAMARITAN HOSPITAL PARTICIPATES IN A DISASTER PREPAREDNESS PROGRAM WHICH PROVIDES A PLAN IN A CASE OF A DISASTER THAT EFFECTS THE COMMUNITY. THE GOOD SAMARITAN HOSPITAL 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 THE SCHEDULE H.CommunityBuildingActivities
Other InformationPART VI, LINE 6 Good Samaritan strives to deliver powerful medicine with comforting care every day. As part of our non-profit mission, The Good Samaritan Hospital and its affiliated organizations deliver healthcare services that improve the quality of life throughout the region. As Lebanon County's only hospital, Good Samaritan is the community's primary - and sometimes only - resource for Inpatient hospital care Emergency care Surgical services Maternity services Cardiac services Radiology and medical imaging services Laboratory diagnostic services and blood bank Physical and occupational therapies Transitional care and rehabilitation services Home health and hospice services Wound care and hyperbaric medicine Dialysis Sleep disorders Physician services for needed specialties including cardiac, gastroenterology, general surgery, hematology, hospitalists, oncology, pediatrics, primary care (particularly for Medicaid population), thoracic, vascular, and wound care. Medical residency program to train new physicians and many more. Community Benefit Total $1,127,904 Good Samaritan and its employees donate many hours of time to improve the health of the community. In 2009, key projects included: Health Fairs: the countywide 50+ Festival and individual events hosted by various nursing and retirement facilities, employers and other community groups Education programs: offered at the hospital or presented to community groups on topics such as smoking cessation, cardiac health, cancer prevention, sleep disorders, diabetic health, and more Medical clinic: Good Samaritan donated time and hundreds of hours of employee time to support the creation of independent medical clinics for poor and low-income patients Health screenings: screenings for skin cancer, blood pressure, varicose veins and other health conditions were provided throughout the year Charitable and Uncompensated Care In reflection of our non-profit mission, Good Samaritan delivered $17.8 million dollars in charitable and uncompensated care to the community. Economic Impact In addition to our core healthcare mission, Good Samaritan is one of Lebanon County's largest employers - and positively impacts the economy by generating more than 1,000 jobs outside of the health system. The Good Samaritan Hospital had a Net Hospital Revenue of $150,831,067 in 2009. Service Statistics The Good Samaritan Hospital treated 9,722 patients in 2009. In addition, the health system offers a wide variety of diagnostic and non-acute health services that are needed by the community. Many of these services would not be available to the community if they were not offered by Good Samaritan. Behind the Statistics The Good Samaritan Emergency Department is one of the region's busiest and has one of the lowest wait times. It operates the only emergency room in the county. To help improve community care, The Good Samaritan Hospital has invested to upgrade to digital pre-hospital EKG software. This allows the emergency department to receive real-time, digital EKG readings before the patient arrives at the hospital. The joint venture with First Aid & Safety of Lebanon originated in 2006 with the deployment of EKG equipment in the field. A patient experiencing chest pain would receive an EKG on the scene and the results were faxed to the emergency department. Due to the joint venture with First Aid & Safety, The Good Samaritan Hospital Emergency Department now interacts with six EKG machines deployed to the units in the county. The data transmitted by the units is read by a physician who determines whether or not the patient will require cardiac catheterization. This allows the hospital to activate the catheterization lab response team prior to the patient's arrival. Because the data is transmitted digitally, Good Samaritan clinicians are able to receive the information much faster and significantly decrease our cardiac door-to-balloon time. This creates better outcomes for the patients because they are receiving crucial care much sooner. Supporting Our Community The employees of the Good Samaritan Health System have a spirit of generosity. Each year employees donate their time, goods and money to support worthy causes. United Way - Good Samaritan employees donate more than $30,000 annually to the United Way of Lebanon County. Reach Out and Read - A national program to give free books to children of low income families. Cribs for Kids - brand new cribs provided to low-income families Bridge of Love - personal care items provided to families in need Car Seats - new car seats are made available to low-income families American Heart Association - more than 100 employees participate in the annual Heart Walk, raising thousands of dollars each year Operation Good Sam - During the Thanksgiving Food Drive, food is collected and delivered to more than 100 families in need. Good Samaritan Christmas Toy Drive - employees donate toys that are delivered to more than 250 children each year to spread holiday cheer Community Health Council The Good Samaritan Hospital helped to create the independent Community Health Council of Lebanon County. From its humble inception, the Council has grown into a premier county organization. More than 400 volunteers collaborate on programs to increase healthy lifestyles and to eliminate alcohol and drug abuse in the county. The Council sponsors programs that address the special needs of youth, parents and seniors. A Home For Community Groups The Good Samaritan Hospital opens its doors to support a variety of community groups. The hospital provides rent-free classroom space for a variety of support groups such as: Alcoholics Anonymous Alanon Better Breather's Club Narcotics Anonymous Journey Through Grief Bereavement Support (adult focused Hospice support) Support and Help in Airing and Resolving Experiences (for grieving parents) Rainbow Connection (teen focused Hospice support) I Can Cope (cancer support) LeLeche League Sharing Our Knowledge At Good Samaritan Health System, caring for our community extends beyond providing medical services. Through our educational services department, we offer classes and support groups that address multiple health related topics, which in turn offer the members of our community an opportunity to improve their health, both physically and emotionally. The educational services department oversees community education classes such as babysitter training and a variety of Heartsaver CPR programs, which range from basic first aid to advanced cardiac life support. These classes provide individuals a chance to obtain skills which can benefit their lives both personally and professionally. Diabetes is prominent in the Lebanon County. To address this growing health concern, Good Samaritan offers Diabetic Education Classes. This program is a series of four classes which addresses topics such as: the importance of managing diabetes; meal planning; use of medication; glucose monitoring; and coping with diabetes. Community members dealing with substance addiction or those who are grieving can receive much needed support through community groups whose meetings are scheduled through the educational services department. These include: Al-Anon; Journey Through Grief; Narcotics Anonymous; and Smoke Stoppers. Most of these programs are offered on a weekly or bi-weekly basis and all are free of charge. In addition to offering classes to the general public, the educational services department also assists in the coordination of nursing student clinical rotations. Working in conjunction with Harrisburg Area Community College and the Lebanon County Career and Technology Center, Good Samaritan Health System assists with providing nursing students the opportunity to receive on-the-job training while being mentored and supervised by a nursing instructor. The availability of these programs would not be possible if it were not for the many dedicated and highly skilled members of the educational services department. These are individuals who seek programs which are relevant, timely and very much a necessity in the community. If you or someone you know may benefit from the programs mentioned or if you would like to find availability for any of our classes and support groups, please visit our website at www.gshleb.org. Below is a listing and brief description of programs and support groups currently offered at Good Samaritan: HEALTH EDUCATION Diabetic Education - assists individuals with diabetes in controlling and coping with their disease (4 classes per session) Smoke Stoppers - comprehensive education and support program for smoking cessation (8 classes per session) CPR & FIRST AID TRAINING Babysitting Course - training for girls and boys 12 years of age and over (3 classes per session) Heartsaver CPR - basic CPR skills for adult/child and management of choking Heartsaver First Aid and Pediatric First Aid - basic first aid training for adults and children Basic Life Support for Health CaOtherInformation
Affiliated Health Care SystemPART VI, LINE 7 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, THE COMMUNITY BENEFITS PROVIDED BY THE HOSPTIAL, 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.AffiliatedHealthCareSystem

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII (4 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuation
DAVID BRODERIC SCHOLARSHIP3110000OTHER
MARGARET CONNELL SCHOLARSHIP55000OTHER
GSH AUXILIARY SCHOLARSHIP32800OTHER
CAPLAN NURSING SCHOLARSHIP1015000OTHER

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES TO MONITOR USE OF GRANTSIdentifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationTHE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ROBERT J LONGO
407246000373428000181307824870798000
KIMBERLY FREEMAN
1519120001659600000168508000
JACQUELYN M GOULD
145179000760000000152779000
ROBERT J RICHARDS
2122720001999000000232262000
WILLIAM HENDRICK
1873610005566000000243021000
ROBERT D SHAVER MD
265568000000000265568000
ELLEN JOHNSON
1658270001650000000182327000
DARIA KOVARIKOVA
174913000000000174913000
BYARD YODER
153811000806700000161878000
JAMES MCGEARY
150899000000000150899000
ROBERTA SCHERR
160030000000000160030000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL COMPENSATION INFORMATIONIdentifier
Return ReferenceSCHEDULE J, PART I, LINE 4BReturnReference
ExplanationROBERT J. LONGO IS A PARTICIPANT IN A 457F RETIREMENT PLAN. HE RECEIVED A $352,185.99 PAYMENT FROM THE PLAN 5/14/2010.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1LEBANON COUNTY HEALTH FACILITIES AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN232546819IssuerEIN
CUSIP Number522455BE3CUSIPNumber
Date Issued2004-03-11DateIssued
Issue Price17255816IssuePrice
Description Of PurposeSEE SCHEDULE ODescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds17255816TotalProceeds
Year Of Subst Completion2004YearOfSubstCompletion
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatetrueExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
JOHN P WELCH MD
SEE SCHEDULE O279404PROPERTY RENTALfalse
FREDERICK WOLFSON
SEE SCHEDULE O144571ATTORNEY FEESfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part IIISTATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTSProgram 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 6/30/10 statistics: 7,708 admissions, 32,847 inpatient days; 267,453 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 6/30/10 statistics: 22,546 in-home care visits were provided.
PROCESS OF GOVERNING BODY TO REVIEW FORM 990FORM 990, PART VI, LINE 11AAn 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 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. DESCRIPTION OF PURPOSE SCHEDULE K, PART I, COLUMN (F) Refund outstanding '94 bonds issued 1/13/94. DESCRIPTION OF RELATIONSHIP BETWEEN INTERESTED PERSON AND ORG SCHEDULE L, PART IV, COLUMN (B) John P. Welch, MD is a trustee of The Good Samaritan Hospital and is a partner of Welch Wagner Partnership. Frederick Wolfson is a trustee of The Good Samaritan Hospital and is a partner of Reilly, Wolfson, Sheffey, Schrum and Lundberg.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatus
GOOD SAMARITAN HOSPITAL SVCS FOUNDATION
PO BOX 1281LEBANONPA17042232356151SUPPORT ORGPA501(C)(3)11,TYPE I
GOOD SAMARITAN REAL ESTATE
PO BOX 1281LEBANONPA17042232447262REAL ESTATEPA501(C)(2)
GSH DIALYSIS INC
PO BOX 1218LEBANONPA17042232500940RENAL DIALPA501(c)(3)3
GOOD SAMARITAN PHYSICIAN SERVICES
PO BOX 1281LEBANONPA17042231832359MEDICAL CAREPA501(C)(3)9

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1LEBANON MRI ASSOCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14THWALNUT STAddressLine1
CityLEBANONCity
StatePAState
ZIP Code17042ZIPCode
FieldValueIRS element (for citing)
EIN363730905EIN
Primary ActivityMRI SERVICESPrimaryActivity
Legal Domicile StatePALegalDomicileState

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
GSH SERVICES INC
241 SOUTH 4TH STREETLEBANONPA17042232353047MGT&ACCTG SVCSPANAC CORP
GSH HOME MED CARE INC
301 SCHNEIDER DRIVELEBANONPA17046232028099MEDICAL EQUIPPANAC CORP
GSH REALTY INC
241 SOUTH 4TH STREETLEBANONPA17042232446622TITLE HOLDING COPANAC CORP
GSH URGENT CARE INC
954 ISABEL DRIVELEBANONPA17042251816053URGENT MEDICINEPANAC CORP
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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