2011-02-15T18:02:23-08:00 2010-03-31 990 2009-04-01 930386793 LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER LEGA 5034155600 1015 NW 22ND AVENUE PORTLAND OR 97210 SCOTT H JOHNSON 2011-02-15 2009 2016-02-24 21:20:13Z GEORGE J BROWN MD C/O 1919 NW LOVEJOY STREET PORTLAND OR 97209 309711719 false false X WWW.LEGACYHEALTH.ORG X 1875 OR Legacy Good Samaritan Hospital and Medical Center (LGSHMC), founded in 1875 is one of the earliest hospitals in the Pacific Northwest. LGSHMC provides acute and tertiary care in Portland, OR with 539 licensed beds. LGSHMC provides a comprehensive range of inpatient, clinical and diagnostic services in numerous medical specialties and subspecialties. LGSHMC specializes in several high-level specialty services, such as neuroscience services, which includes the Rehabilitation Institute of Oregon, a regional sleep disorders program, comprehensive epilepsy, stroke and brain tumor programs, Devers Eye Institute, a comprehensive cancer center, obesity, diabetes, and cardiac care, Kern critical care unit, kidney transplant services, and robotic surgical systems used for minimally invasive surgeries. Good Samaritan provides training for interns and residents through its nationally accredited graduate medical education program. As part of that program Good Samaritan operates a primary care teach 17 16 0 242 1229195 -58674 2695973 3549900 277666754 289456607 -15847951 15597774 454252 480120 264969028 309084401 159370 60000 0 130114691 126077029 0 0 140684520 153361505 270958581 279498534 -5989553 29585867 172080768 211289840 108105187 112959867 63975581 98329973 Legacy Good Samaritan Hospital and Medical Center (LGSHMC), founded in 1875 is one of the earliest hospitals in the Pacific Northwest. LGSHMC provides acute and tertiary care in Portland, OR with 539 licensed beds. LGSHMC provides a comprehensive range of inpatient, clinical and diagnostic services in numerous medical specialties and subspecialties. LGSHMC specializes in several high-level specialty services, such as neuroscience services, which includes the Rehabilitation Institute of Oregon, a regional sleep disorders program, comprehensive epilepsy, stroke and brain tumor programs, Devers Eye Institute, a comprehensive cancer center, obesity, diabetes, and cardiac care, Kern critical care unit, kidney transplant services, and robotic surgical systems used for minimally invasive surgeries. Good Samaritan provides training for interns and residents through its nationally accredited graduate medical education program. As part of that program Good Samaritan operates a primary care teach false false 229321420 60000 289456607 In support of its mission, LGSHMC voluntarily provides medically necessary patient care services that are discounted or free of charge to persons who have insufficient resources and/or who are uninsured. During fiscal year 2010, LGSHMC provided financial assistance on approximately 16,000 patient accounts (of which 57% received discounts totaling 100% of costs) and resulted in LGSHMC incurring roughly $15,300,000 in uncompensated costs associated with this program. In addition to charity care, LGSHMC provides services under various states' Medicaid programs for financially needy patients, Medicare beneficiaries, and other government programs for which the cost of treating these patients exceeds the government payments received. During fiscal year 2010, LGSHMC incurred approximately $5,500,000, $10,300,000 and $300,000 in uncompensated costs attributable to Medicaid, Medicare, and other government programs, respectively. LGSHMC also provides a variety of other community benefit activities such as medical education, donations to other charitable entities, research, and other health improvement services, which totaled roughly $6,700,000 during fiscal year 2010.LGSHMC is part of Legacy, which collectively provided over $69 million, $58 million, $41 million, and $1 million in uncompensated care attributable to its financial assistance, Medicaid, Medicare, and other government programs, respectively, in fiscal year 2010. In addition, Legacy provided over $24 million in other community benefit activities during fiscal year 2010. 229321420 true true false true false false false false false true true false true false false false false false false false false true true false true false false false false false false false false false false false false false false false false true false false false true 0 0 false 0 false true true false false false false false false false false false 0 false false false false false false false false 17 16 false true false false true true true true true false false false true true true true true true true true true true OR X X SCOTT JOHNSON 5034155600 1919 NW LOVEJOY STREET PORTLAND OR 97209 WILLIAM M MOONEY MD 3.00 X 0 0 0 VIKEN DOUZDJIAN MD 40.00 X 398564 0 64917 TRENT S GREEN 40.00 X 0 364597 80110 THOMAS F SCHRATTENHOLZER MD 40.00 X 211597 0 26445 STEPHEN R JONES MD 40.00 X 394557 0 59943 STEPHEN NEWBERRY MD 3.00 X 0 6000 0 SONJA O STEVES 40.00 X 0 339313 107204 RONALD S KING 4.00 X 0 0 0 ROBERT W BENTLEY MD 4.00 X 0 0 0 ROBERT L CORNIE 4.00 X 0 0 0 ROBERT J PALLARI 0. X 0 500574 70716 RICHARD F GIBSON MD 40.00 X 0 429458 125704 PATRICIA A NEWTON MD 40.00 X 182142 0 25872 PAMELA S VUKOVICH 40.00 X X 0 552271 258311 P CAMPBELL GRONER III 40.00 X X 0 416742 188157 LEE DOMANICO 0. X 0 150531 0 KATHLEEN C STONER 0. X 173716 0 29953 JOHN W WINTER JR 4.00 X 0 0 0 JEFFREY S GORDON 5.00 X X 0 0 0 JEFFREY D FULLMAN MD 3.00 X 0 5968 0 JACK L ORCHARD 4.00 X 0 0 0 HOLLIS J HENDRICKS 4.00 X 0 0 0 GEORGE J BROWN MD 40.00 X X 0 822846 221819 GEORGE A CIOFFI MD 40.00 X 0 385454 161080 ERIC I JONES MD 40.00 X 284497 0 30733 DUANE C MCDOUGALL 3.00 X 0 0 0 DEAN WILLIAM B LUPFER 3.00 X 0 0 0 CORLISS A MCKEEVER 3.00 X 0 0 0 COLLEEN A CAIN 7.00 X X 0 0 0 CHRISTOPHER S THOMING MD 3.00 X 0 0 0 BISHOP DAVID BRAUER-RIEKE 3.00 X 0 0 0 BARBARA K FERRE MD 4.00 X 0 0 0 ANTHONY J MELARAGNO MD 40.00 X 415012 0 120716 2060085 3973754 1571680 99 true true false RENAL CARE GROUP NORTHWEST INC PO BOX 52737 PHOENIX AZ 85072 MEDICAL SERVICES 891955 PORTLAND PSYCHIATRIC ASSOCIATES 9955 SW WASHINGTON 200 PORTLAND OR 97216 MEDICAL SERVICES 790859 HURON CONSULTING LLC 8044 SOLUTION CTR CHICAGO IL 606778000 CONSULTANTS 2222644 HOWARD WRIGHT CONSTRUCTORS LP 425 NW 10TH AVE SUITE 200-A PORTLAND OR 97209 CONSTRUCTION 2898752 ANDERSON CONSTRUCTION CO 6712 N CUTTER CIRCLE PORTLAND OR 97217 CONSTRUCTION 2557865 39 3549900 11187 3549900 PHARMACY 1229195 1229195 PATIENT PROGRAM REV 610571072 610571072 CONVENIENCE OF MEMBERS 1957637 1957637 CONTRACTUAL ALLOWANCE -289953912 -289953912 CHARITY CARE -34347385 -34347385 289456607 15721935 15721935 0 0 970302 490182 480120 480120 480120 12975 137136 -124161 -124161 -124161 0 0 0 0 309084401 286269775 1229195 18035531 60000 60000 0 0 0 1629815 1435234 194581 0 94871165 83544628 11326537 6396018 5632406 763612 15119488 13314393 1805095 8060543 7098206 962337 0 15849 13920 1929 0 0 0 0 0 0 0 0 0 4539 3986 553 137884 121100 16784 0 0 2254577 1980141 274436 0 14658193 12873941 1784252 613315 406505 206810 SUPPLIES 50516380 49292498 1223882 PHYSICIAN FEES 6872605 6872605 MANAGEMENT FEES 34073482 6170708 27902774 CONTRACT SERVICES 17818283 15794768 2023515 BAD DEBTS 10466940 10466940 15929458 14239441 1690017 279498534 229321420 50177114 0 586543 729008 0 0 31715756 31769433 0 0 0 3394675 3753450 1721479 1789742 272129551 188549562 77100319 83579989 0 57499806 89554871 0 0 62190 113347 172080768 211289840 19849257 22381572 88255930 90578295 108105187 112959867 X 63975581 98329973 63975581 98329973 172080768 211289840 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false X 3696 260229 3696 260229 245679772 958950945 245683468 959211174 1000000 1000000 250000 250000 false 1000000 1000000 2000000 2000000 6000000 9000000 48000 20000 59359 263925 391284 250000 250000 500000 500000 1500000 2250000 Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description Schedule C, Part II-A, 501(h) election Listing of Affiliated Members Legacy Health, EIN 23-7426300, Lobby Exp $140,519 Legacy Emanuel Hospital & Health Center, EIN 93-0386823, Lobby Exp $6,732Legacy Good Samaritan Hospital and Medical Center EIN 93-0386793, Lobby Exp $3,696Legacy Meridian Park Hospital, EIN 93-0618975, Lobby Exp $851Legacy Mount Hood Medical Center, EIN 93-0591528, Lobby Exp $1,010Legacy Salmon Creek Hospital, EIN 33-1065485, Lobby Exp $111,117 Legacy Visiting Nurse Assn, EIN 93-0848530, Lobby Exp $0There were no excess lobbying expenditures for any of the above affiliates. All affiliated entities addresses can be found on Schedule R. 26212088 1643334 6436823 1762522 32529723 29297661 1477854 -2409557 2153871 26212087 0.69000 0.31000 false true true 4480373 4480373 145440420 105799335 39641085 1235395 897092 338303 119945608 81853135 38092473 1027755 1027755 83579989 89554871 NONCURRENT WORKERS' COMP LIABILITY 674485 NONCURRENT PENSION LIABILITY 19613282 NONCURRENT ENVIRONMENTAL OBILGATION 61455 I/C AFFILIATE DEBT 70229073 90578295 309084401 279498534 29585867 4781133 4781133 34367000 302118000 302118000 6966401 6966401 309084401 274095000 274095000 5403534 5403534 279498534 Part XIII, Line 4b Part XIII, Line 4b: Other revenue amounts included on 990 but not included in F/S RIO GUILD EXPENSE $54821 GIFT SHOP EXPENSE $163217 FOUNDATION CONTRIBUTION $1973737 ROUNDING $984 OTHER EXPENSE $125657 GAIN / LOSS OF SALE OF ASSETS $-124161 PROGRAM SERVICE REVENUE $3209279 Part XII, Line 4b Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S RIO GUILD INCOME $60193 GIFT SHOP INCOME $144871 FOUNDATION CONTRIBUTION $1973737 ROUNDING $662 GAIN / LOSS OF SALE OF ASSETS $-124161 OTHER EXPENSE $125657 PROGRAM SERVICE REVENUE $3209279 FOUNDATION CAPITAL CONTRIBUTION $1564976 IN KIND DONATION $11187 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances CHANGE IN ADDITIONAL MINIMUM PENSION LIABILITY $9679713 ROUNDING $1420 TRANSFER TO LEGACY HEALTH, EIN 23-7426300 $ -4900000 CHANGE IN ADDITIONAL MINIMUM PENSION LIABILITY $ -0 Part V, Line 4 Part V, Line 4: Intended uses of the endowment fund. Endowment funds disclosed in Part V are used to improve the healthcare of the community as designated by the donors. Good Samaritan Foundation (GSF) maintains all charitable gifts including endowment funds for the benefit of LGSHHC and it's programs. Income from permanently restricted net assets is accounted for in accordance with the donors' instructions.Legacy follows the guidance in the Uniform Prudent Management of Institutional Funds Act (UPMIFA) in determining the net asset classification of all donor-restricted endowment funds. In accordance with UPMIFA and board policy, assets classified as permanent endowments in accordance with donor intent are only utilized for current period expenditures to the extent that earnings on the endowment exceed the original fair value of the donation. To the extent earnings on endowment funds exceed identified expenditures on which to apply those earnings, the earnings are classified as temporarily restricted net assets. Legacy has adopted investment and spending policies for endowment assets to provide a predictable stream of funding to programs supported by its endowment and to maintain the value of the endowment assets. Asset allocation is reviewed quarterly with respect to: i) Legacy's tolerance for risk based on its financial condition and need for cash from investments to support operations; ii) expected asset class return, risk and correlation characteristics; iii) changes in accounting guidance or tax law and iv) changes in bond covenants or other restrictions.Legacy's spending practices are intended to comply with donor's wishes and meet all applicable laws and regulations. Spending must be for a purpose that is consistent with the documented intent of the donor, and may not exceed the amounts annually determined by Legacy. Factors that are considered in addressing the annual spending allocation are: i) market value of the fund relative to the principal of the gift and ii) the level of spending in prior years.From time to time, the fair value of assets associated with individual donor-restricted endowment funds may fall below the level that the donor or UPMIFA requires Legacy to retain as a fund of perpetual duration. Deficiencies of this nature are reported as a reduction to unrestricted net assets and are excluded from the performance indicator. true true X true X true X true true true false true true 15245438 15245438 0.05450 21069040 15545385 5523655 0.01980 36314478 15545385 20769093 0.07430 432728 432728 0.00150 7842561 2101041 5741520 0.02050 517970 517970 0.00190 8793259 2101041 6692218 0.02390 45107737 17646426 27461311 0.09830 false 4359407 2833615 52003021 53987634 -1984613 X true true LEGACY GOOD SAM HOSP & MED CTR

1015 NW 22ND AVENUE PORTLAND OR 97210

X X X X The bad debt expense at cost was determined by using the same cost charge ratio as used for the charity care calculation. The estimated amount of bad debt expenses attributable to charity care policy was calculated using the demographic profile of household income and average household size in the zip code areas around the hospital. 65% of Households in the LGSHMC service area would qualify for financial assistance with incomes under 400% of the Federal Poverty Guidelines.LGSHMC uses many different approaches to inform and educate patients on the availability of financial assistance as is described later in Part VI of Schedule H. Still, many patients do not respond to requests for information or provide appropriate documentation to benefit from financial assistance. As a result, LGSHMC must report these amounts as bad debt. A portion of bad debt expense should be considered as charity care, using reasonable methodologies to analyze the information. The entire Medicare shortfall should be considered a community benefit. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in the community served by the hospital. The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. The Medicare amounts listed in Part III Section B. on lines 5, 6, and 7 do not represent all of the organization's revenues and costs associated with its participation in Medicare programs. The methodology used in reporting in Part III Section B Medicare is inconsistent with the other sections in Schedule H, as the instructions limit Medicare revenues and allowable cost to those from only the Medicare Cost Report. Revenue and costs from Medicare Part C patients, Part B physician services billed by the organization, and clinical laboratory services weren't included. In addition, hospitals incur other costs to provide care that Medicare does not allow in the cost report, such as Physician Call pay to ensure adequate physician coverage for the ED. The total revenues and costs attributable to all Medicare services are $107,839,714 and $118,162,786 respectively. This results in a total Medicare shortfall of $10,323,072.Costing Methodology (Part III, Line 8).Medicare allowable costs were calculated using the costing methodologies in the Medicare Cost Report. The cost report arrives at total allowable hospital cost through a cost finding process that includes direct cost allocations and a step-down allocation of indirect or overhead costs. Inpatient operating costs are composed of general inpatient routine and ICU unit costs derived from cost per diems, as well as inpatient ancillary service costs that utilize cost to charge ratios to arrive at cost. Apportionment of cost applicable to hospital outpatient services is through the application of cost to charge ratios. This excludes other costs incurred to provide services of the hospital to the community that the cost report deems as unallowable costs, such as Physician on-call pay. Legacy provides care without charge or at amounts less than its established rates to patients who meet certain criteria under its financial assistance policy. Since Legacy does not pursue collection of amounts determined to qualify as charity care, they are excluded from net patient service revenues. Senior leadership, in conjunction with the Board of Directors, continually assesses the needs of the communities it serves through a compilation of primary and secondary market research (qualitative and quantitative), medical staff input, reviewing national trends and practices, working with local foundations and funders regarding their assessments, and working with local community-based partners to understand their needs. The goal is to understand the needs and develop programs specific to the community. Involvement is both proactive and responsive - a leadership role in initiating programs as well as being readily available as a collaborative partner when the community asks. The outcome of these assessments is the development of both long-term and fiscal year plans that are supported by a yearly budget that is proposed by staff and approved by the Board of Directors. The region served by Legacy Good Samaritan Medical Center (LGSHMC), along with most of Oregon, is experiencing significant challenges in population growth, economic development, education and health care. Recognizing that social and economic determinants impact health, LGSHMC has been and will remain committed to addressing these issues to improve the health of all residents in the community, including equity among ethnically diverse populations. LGSHMC employs financial counselors and social workers that assist patients in obtaining coverage for their healthcare needs. This includes assistance with workers compensation, motor vehicle accident policies, COBRA, veterans' assistance, LGSHMC's financial assistance program, and public assistance programs, such as Medicaid. The criteria for financial assistance under LGSHMC's program is determined based on eligibility for insurance coverage, household income, qualified assets, catastrophic medical events, or other information supporting a patient's inability to pay for medically necessary services provided. Specifically, the LGSHMC Financial Assistance Program provides an uninsured discount of 15% to patients who have resided within LGSHMC's primary service area for a period of six months, are uninsured for hospital care, and have a household income of less than $100,000 annually. Further discounts are available for patients, on a sliding scale, whose household income is less than 400% of the federal poverty level or roughly $88,000 for a family of four in Portland, Oregon. For patients whose household income is at or below 200% of the federal poverty level, a full subsidy is available. In addition to the household income criteria, the patients' qualified assets (e.g. 25% of household assets), and other catastrophic or economic circumstances are considered in determining eligibility. In addition to financial counselors and social workers, LGSHMC makes every effort to communicate its Financial Assistance Program to patients. This includes signage in main admitting areas of each hospital and brochures explaining financial assistance in all patient care areas, as well as in appropriate languages. Financial counselors are available to assist patients in understanding and applying for available resources, including the LGSHMC Financial Assistance Program. LGSHMC's website also has information about the availability of financial assistance. LGSHMC offers financial assistance customer service Monday through Friday, as well as the availability of voice mail so patients can leave confidential, detailed messages during non-business hours. Finally all of Legacy's billing statements include information regarding the availability of financial assistance. If LGSHMC requires the use of a collection agency, those agencies are required to provide a telephone number that patients can call to request financial assistance.Annual education is provided to all billing and admitting staff so they can be kept informed of and speak with knowledge about current financial assistance policies and options. LGSHMC provides copies of the latest policies in main admitting areas, as well as through newsletters and other publications. Since 2008, the four county metro area health delivery systems (encompassing all hospitals in the area) and safety net clinics have partnered to establish a seamless, coordinated program to provide care for the low income uninsured, Project Access. This program enables low income uninsured patients to receive continuity of care in earlier stages of acuity due to the collaboration among 2800 providers and all health systems. LGSHMC is located within an urban, high-density geographic area in inner city Portland. As one of the two original hospitals established in Portland, the five mile primary service area now includes four other large tertiary hospitals, including two trauma 1 centers. Located in one of the oldest neighborhoods in Portland, the service area extends across the river to the east and west to the border of the suburbs. The service area is a mix of older established, high income residents to low income residents 'hidden' in older, established apartments to the homeless living in inner city downtown.The five mile primary service area includes approximately 458,500 residents. The Greater Portland Area has 2.1 million people. By ethnicity, this area includes 74% non-Hispanic white, 9% Hispanic, 7% African American, 6% Asian, 1% American Indian/Alaskan and 3% other. As a tertiary-care center, LGSHMC provides several unique services to the region such as neuroscience services, which includes the Rehabilitation Institute of Oregon, a regional sleep disorders program, comprehensive epilepsy, stroke and brain tumor programs, Devers Eye Institute, kidney transplant services, weight management institute, and a robotic surgical system used for minimally invasive surgeries. In addition, LGSHMC provides training for interns and residents through its nationally accredited graduate medical education program, and partners with schools to provide training and education for nursing and other health professionals. LGSHMC is a subsidiary of Legacy Health (Legacy). Legacy is an integrated health system based in Portland, Oregon and primarily operates five acute care hospitals and related services (e.g. physician practices, hospice, preferred provider network) in the greater Portland, Oregon and southwest Washington area.The Legacy Health Board is comprised of community and business leaders as well as representatives of the medical staff. The LGSHMC medical staff is open, with physicians submitting credentialing information reviewed according to LGSHMC policies and standards. While there is investment in a variety of community-based activities and programs as a part of its non-profit status, an overwhelming majority of Legacy and LGSHMC's community benefit comes in the form of providing uncompensated care. Legacy's policy of providing care regardless of the ability to pay makes it one of the region's largest providers of uncompensated care in the four-county metropolitan area.In 1999, the Legacy Board allocated $10 million to establish a Community Health Fund from operating revenue to address major community health issues. For more than a decade, about $500,000 has been granted annually to community-based projects addressing racial and ethnic inequities and root causes. These dollars are in addition to Legacy's other charitable contributions. The Community Health Fund has provided 38 grants since 1999 totaling more than $5.8 million. Recognizing that education, employment and income inequities exist for communities of diversity, and that health professions are lacking in diversity, Legacy established the Youth Employment in Summer program. African American and Hispanic youth receive paid summer employment in departments where they worked with health professionals and earned college scholarships between $2,500 and $5,000 annually. Students can remain in the program as long as they stay in school and pursued healthcare careers. Some students have remained in this program for as long as seven years and graduated with degrees in a variety of healthcare fields. Legacy encourages and supports employee volunteerism. Legacy donates $100 to nonprofit health, human service or education organizations in honor of employees who volunteer on personal time 50 hours a year. Employees may receive paid time when volunteering in one or two week time periods in local nonprofit organizations through Legacy's community service leave program.Non-cash donations of resources include clinical and non-clinical services and items, e.g., screenings and support services, internships, information and referral services and health fairs. Legacy's warehouse is open to nonprofit organizations to obtain surplus equipment and furniture. In addition, conference room space is made available to local nonprofits for Board and community meetings.LGSHMC has recognized that nonprofit organizations spend valuable dollars on office space and infrastructure - dollars better spent on meeting their missions. As a result, LGSHMC has provided free office space and other infrastructure services to nonprofit organizations on its campus. Additionally, LGSHMC provides meeting space to a variety of not for profit organizations free of charge to further their respective missions within the community. These activities are reported as "in-kind contributions." OR true MEDICAL TEAMS INTERNATIONAL 14150 SW MILTON CT TIGARD OR 97224 930878944 0 60000 COST SUPPLIES FOR DISASTER ASSISTANCE 1 0 Grantmaker's Description of How Grants are Used Legacy reviews all organizations prior to donating cash or supplies to ensure their 501(c)(3) status. Legacy regularly donates supplies to Medical Teams International for disaster relief. Several Legacy medical staff members, volunteer for Medical Teams International. X X X X X true true false true true true true false true true VIKEN DOUZDJIAN MD 384405 479 13680 43640 21277 463481 TRENT S GREEN 286012 48414 30171 51657 28453 444707 THOMAS F SCHRATTENHOLZER MD 202742 15380 -6525 7257 19188 238042 STEPHEN R JONES MD 282537 41714 70306 21740 38203 454500 39593 SONJA O STEVES 265163 60523 13627 89844 17360 446517 14001 ROBERT J PALLARI 500574 39864 30852 571290 144521 RICHARD F GIBSON MD 340952 65608 22898 88995 36709 555162 21177 PATRICIA A NEWTON MD 158100 23974 68 10517 15355 208014 PAMELA S VUKOVICH 441515 90088 20668 235962 22349 810582 10247 P CAMPBELL GRONER III 372339 44403 156268 31889 604899 37195 LEE DOMANICO 150531 150531 170334 KATHLEEN C STONER 155807 17596 313 27440 2513 203669 GEORGE J BROWN MD 675000 119646 28200 186009 35810 1044665 GEORGE A CIOFFI MD 328852 53637 2965 134342 26738 546534 ERIC I JONES MD 224276 59744 477 22021 8712 315230 ANTHONY J MELARAGNO MD 333603 65351 16058 96183 24533 535728 8664 Sch J, Part III, Additional Information Part III, Additional Information Sch J, Part 1, Question 3 Regarding Compensation PracticesDirectors for Legacy are not compensated, but receive expense reimbursements related to their duties. Any expense reimbursements to board members require review and approval by the Director of Management Audit. Compensation received by Dr. Newberry during 2009 related to his responsibilities as Past President of the Medical Staff at Legacy Meridian Park Hospital. Dr. Fullman was compensated during 2009 for services provided for the development of the new electronic medical record system at Legacy.Executive compensation for Legacy is designed to recruit, retain and motivate qualified senior management personnel. The comprehensive compensation plan is designed for positions that have a significant impact on the high-level strategic and policy direction of Legacy and its affiliates. Base pay and total compensation (including incentive compensation) for similar positions is established at a level comparable to market compensation for healthcare organizations. External consultants are regularly used to review published compensation surveys of comparable organizations and comparable benchmark positions in the market. The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for executive positions. The Committee oversees the system's governance procedures with respect to intermediate sanctions legislation and the evaluation of reasonableness of compensation. The Committee reports to the Board in sufficient detail to enable the entire Board to take such actions as are required to obtain the rebuttable presumption of reasonableness. The Compensation Committee also reviews tax-reporting disclosures.Sch J, Part II, Column Breakdown Of W-2 Or Misc-1099:Column B(i) - Base compensation consists of regular base pay including employee elected deferrals for retirement plans (403(b) and 457(b) plans).Column B(ii) - The incentive compensation program for Legacy is based on predetermined criteria and reviewed and approved by the Board. Bonuses are paid to key employees for interim duties outside their primary responsibilities (e.g. Acting in Capacity).Column B(iii) - Other compensation consists of deferred compensation amounts paid to executives during the current year and were reported on prior form 990 returns. These amounts include arrangements that contain elements of a substantial risk of forfeiture conditioned on continued employment, vesting and/or a noncompete provision upon termination of employment. In addition, imputed income for insurance, cell phone and other benefits is included in other compensation as well as any severance related payments. Column C - Deferred compensation includes the value of defined benefit plans, contributions to defined contribution plans, amounts deferred under the 457(f) plan including earnings, earnings in the 457(b) plan, and the value of the pension restoration plan. Earnings on the 457(f) and 457(b) include gains and losses on the underlying investments. The defined contribution and benefit plans are available to all employees as they become qualified to participate. The pension restoration plan provides executive pension benefits in excess of IRS mandated limits on eligible compensation to key executives. The benefits are unfunded and subject to forfeiture. Executive pension benefits are intended to make the executive's retirement benefit, as a proportion of their final average salary, comparable to all other employees, and are treated as income when paid.Column D - Nontaxable benefits include company paid health and welfare and long term care and disability benefits under group plans.Column F - Current year compensation reported as deferred in prior years. Sch J, Part I, Line 8 Part I, Line 8: Amounts reported on 990 VII pursuant to initial contract exemption described in Regs Legacy enters into initial employment agreements with executives that qualify under the initial contract exception. The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for key executive positions. The Committee relies on comparable market data and all decisions are documented. Sch J, Part I, Line 6b Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or Legacy has an at-risk incentive compensation plan for management. The plan is based on meeting goals related to employee engagement, work processes, customer service, clinical quality, financial management, and certain key strategic tactics. In order to payout any at-risk incentive compensation, Legacy must exceed operating margin targets. Sch J, Part I, Line 5b Part I, Line 5b: Explanation of organization compensation based on revenues of related organization Physicians employed by Legacy affiliates are paid a bonus contingent upon their revenue generated during the year measured by industry standard relative value units (RVU). Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Legacy Health's audited and interim consolidated financial statements are publicly available on the Electronic Municipal Market Access(EMMA) (www.emma.msrb.org) and DAC Bond (www.dacbond.com) websites. Legacy's audited consolidated financial statements include consolidating schedules which highlights LGSHMC's financial results.When changes are made to the LGSHMC Articles or Bylaws, LGSHMC discloses and attaches copies to the IRS Form 990, which are publicly available by request or on various public websites such as Guidestar(www.guidestar.org). Other governing documents are not available to the public. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The following describes the compensation practices of Legacy and its affiliates.Executive compensation for Legacy is designed to recruit, retain and motivate qualified senior management personnel. The comprehensive compensation plan is designed for positions that have a significant impact on the high-level strategic and policy direction of Legacy and its affiliates.Base pay and total compensation (including incentive compensation) for similar positions is established at a level comparable to market compensation for healthcare organizations. External consultants are regularly used to review published compensation surveys of comparable organizations and comparable benchmark positions in the market. The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for key executive positions. The Committee oversees the system's governance procedures with respect to the evaluation of reasonableness of compensation. The Committee reports to the Board in sufficient detail to enable the entire Board to take such actions as are required to obtain the rebuttable presumption of reasonableness. The Compensation Committee also reviews tax-reporting disclosures. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts The following is a summary of Legacy's policy and procedures for conflict of interest disclosure, monitoring and resolution.All Legacy employees and non-employees in leadership positions (e.g., Board members, Foundation Trustees, Medical Directors) are required to disclose potential conflicts of interest as the conflict arises. All employees attest to proper conflict of interest disclosure during their annual review. Certain groups have annual formal disclosure requirements, Executives and non-employees in leadership positions complete the Conflict Disclosure Statement from the Standards of Conduct policy annually. Officers, Directors, Trustees, Key and Highly Compensated employees are also required to complete a questionnaire covering business relationships, business transactions with interested parties, loans and grants. Conflict Disclosure Statements and questionnaires are returned to Legacy Management Audit for review of the disclosures. If a conflict is disclosed, or identified through any other means, Management Audit ensures that management mitigates the risk (e.g., discontinues relationship with vendor, segregates responsibilities, recuses Board member from voting in area of conflict) and that the conflict and mitigation steps are reported to the appropriate level (e.g., Compliance Committee, Audit Committee of the Board). Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process The Legacy Board received a copy of the 990 return prior to filing. At the direction of the entire Board, the Board Compensation Committee reviewed the compensation disclosures and the Board Audit Committee reviewed the 990 returns for Legacy and Legacy Emanuel Hospital & Health Center with Management prior to filing. Any key differences in disclosure for other affiliated entities, including Legacy Good Samaritan Hospital and Medical Center were discussed with the Board Audit Committee. Form 990, Part VI, Line 7a Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body The Board of Directors includes the following members: (a) The Bishop of the Oregon Synod of the Evangelical Lutheran Church inAmerica (the "Oregon Synod") or the Bishop's designee, who shall serve ex officio;(b) The Bishop of the Episcopal Diocese of Oregon (the "Episcopal Diocese")or the Bishop's designee, who shall serve ex officio;(c) One (1) person appointed by election of the Oregon Synod Council;(d) One (1) person appointed by election of the Convention of the EpiscopalDiocese. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Legacy Health is the sole member of Legacy Good Samaritan Hospital & Medical Center. Form 990, Part VI, Line 3 Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company Legacy Health (Legacy) provides management services for all of its affiliated companies which includes, accounting, purchasing, contracting, legal, human resources, information technology, billing, facilities, budgeting, transcription, security, public relations, strategic planning, organization development. LEGACY ADVENTIST VENTURE 1919 NW LOVEJOY ST PORTLAND OR 97209 931121816 HEALTHCARE OR 501(C)(3) 9 N/A SALMON CREEK HOSPITAL FOUNDATION PO BOX 4484 PORTLAND OR 97208 830433165 CHARITABLE FOUNDATION WA 501(C)(3) 7 N/A MT HOOD MEDICAL CENTER FOUNDATION PO BOX 4484 PORTLAND OR 97208 930794951 CHARITABLE FOUNDATION OR 501(C)(3) 11a N/A MERIDIAN PARK MEDICAL FOUNDATION PO BOX 4484 PORTLAND OR 97208 930773410 CHARITABLE FOUNDATION OR 501(C)(3) 11a N/A GOOD SAMARITAN FOUNDATION PO BOX 4484 PORTLAND OR 97208 237017276 CHARITABLE FOUNDATION OR 501(C)(3) 11a N/A THE CHILDRENS HOSPITAL FOUNDATION PO BOX 4484 PORTLAND OR 97208 931314469 CHARITABLE FOUNDATION OR 501(C)(3) 7 N/A EMANUEL MEDICAL CENTER FOUNDATION PO BOX 4484 PORTLAND OR 97208 936095667 CHARITABLE FOUNDATION OR 501(C)(3) 7 N/A LEGACY VISITING NURSE ASSOCIATION 815 NE DAVIS ST PORTLAND OR 97210 930848530 HOSPICE OR 501(C)(3) 9 N/A LEGACY SALMON CREEK HOSPITAL 2211 NE 139TH ST VANCOUVER WA 98686 331065485 HOSPITAL WA 501(C)(3) 3 N/A LEGACY MOUNT HOOD MEDICAL CENTER 24800 SE STARK ST GRESHAM OR 97030 930591528 HOSPITAL OR 501(C)(3) 3 N/A LEGACY MERIDIAN PARK HOSPITAL 19300 SW 65TH AVE TUALATIN OR 97062 930618975 HOSPITAL OR 501(C)(3) 3 N/A LEGACY EMANUEL HOSPITAL & HEALTH CENTER 2801 N GANTENBEIN AVE PORTLAND OR 97227 930386823 HOSPITAL OR 501(C)(3) 3 N/A LEGACY HEALTH 1919 NW LOVEJOY ST PORTLAND OR 97209 237426300 HEALTHCARE OR 501(C)(3) 11b N/A NORTHWEST HOSPITAL PARTNERSHIP INC 1919 NW LOVEJOY ST PORTLAND OR 97209 930973009 OR N/A 60000 13333 false false false true true true true true true true true true false true true true true true true true