2023-11-10T12:03:20-06:00 2022-12-31 990 2022-01-01 931329784 SAMARITAN PACIFIC HEALTH SERVICES SAMA 5417684857 930 SW ABBEY STREET NEWPORT OR 97365 DANIEL B SMITH SVP / CFO 5417684857 2023-11-02 DANIEL SMITH 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SAMARITAN PACIFIC COMMUNITIES HOSP LESLEY OGDEN MD 930 SW ABBEY STREET NEWPORT OR 97365 152185606 0 X WWW.SAMHEALTH.ORG X 2001 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH OUR HOSPITAL AND HEALTHCARE CLINICS. 9 6 589 72 1688425 0 3183933 4405491 135752923 146889662 18781 -84179 374793 323353 139330430 151534327 77901 79744 0 0 55303056 56257028 0 0 14709 66917257 78102182 122298214 134438954 17032216 17095373 102976626 109302157 35451539 24674061 67525087 84628096 X SAMARITAN PACIFIC HEALTH SERVICES (SPHS) ACHIEVES ITS MISSION OF IMPROVING THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS CRITICAL-ACCESS HOSPITAL AND HEALTHCARE CLINICS PROVIDING OUTPATIENT CARE SERVICES AT SEVERAL AREA LOCATIONS.SPHS IS A MEMBER OF SAMARITAN HEALTH SERVICES (SHS), A REGIONAL NETWORK OF HOSPITALS AND PHYSICIANS. THE NETWORK, FORMED IN THE LATE 1990'S, SERVES APPROXIMATELY 290,000 RESIDENTS IN LINN, BENTON, LINCOLN AND PORTIONS OF POLK AND MARION COUNTIES IN OREGON. IT IS LOCALLY OWNED, AND ITS BOARDS OF DIRECTORS INCLUDE HOSPITAL LEADERS, PHYSICIANS AND COMMUNITY REPRESENTATIVES. THE MISSION OF SHS IS "BUILDING HEALTHIER COMMUNITIES TOGETHER." THE COLLECTIVE VISION OF THE SHS SYSTEM IS TO SERVE OUR COMMUNITIES WITH PRIDE (PASSION, RESPECT, INTEGRITY, DEDICATION, AND EXCELLENCE). SHS SEEKS TO BE THE FIRST CHOICE OF CONSUMERS IN THE REGION AND TO LEAD COLLABORATIVE EFFORTS AMONG THOSE WHO SHARE SIMILAR GOALS. 0 0 120609747 145201237 PROGRAM SERVICES:SAMARITAN PACIFIC HEALTH SERVICES (SPHS) INCLUDES A CRITICAL-ACCESS HOSPITAL AND SEVERAL MEDICAL CLINICS PROVIDING HEALTH CARE FOR RESIDENTS AND TOURISTS THROUGHOUT A 270-SQUARE-MILE AREA IN LINCOLN COUNTY, WHICH IS DESIGNATED A MEDICALLY UNDERSERVED POPULATION. SPHS HAS OVER 500 EMPLOYEES AND 50 VOLUNTEERS. DURING 2022, SPHS SERVED 1,274 INPATIENTS, HAD 17,097 EMERGENCY DEPARTMENT VISITS, PERFORMED 3,507 SURGERIES, AND DELIVERED 158 BABIES. IN ADDITION, SPHS PERFORMED 49,722 IMAGING PROCEDURES, AND HAD 71,453 PHYSICIAN CLINIC VISITS. 79744 79744 GRANTS:GRANTS PROVIDED BY SAMARITAN PACIFIC HEALTH SERVICES TO REDUCE FOOD INSECURITY AND TO PROVIDE HOUSING FOR LOW INCOME RESIDENTS OF THE LOCAL COMMUNITY. SEE PART IX, LINE 1 AND RELATED SCHEDULE I PART II FOR MORE DETAILS ON GRANTS TO ORGANIZATIONS LARGER THAN $5,000. 120689491 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 589 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X SAMARITAN PACIFIC HEALTH SERVICES 5417684857 930 SW ABBEY STREET NEWPORT OR 97365 DOUGLAS BOYSEN BOARD CHAIR / CEO SHS 2.00 38.00 X X 0 1512954 64413 KELLEY KAISER BRD VICE CHAIR / CAO SHS 2.00 38.00 X X 0 496145 62767 RALPH BREITENSTEIN MD BOARD SECRETARY 1.00 1.00 X X 0 0 0 JOHN BAKER BOARD MEMBER 1.00 X 0 0 0 STEPHEN BURNS MD BOARD MEMBER 1.00 X 0 0 0 SUSAN WOODRUFF BOARD MEMBER 1.00 X 0 0 0 JERRY ROBBINS MD BOARD MEMBER 1.00 2.00 X 0 46880 939 LINDA MOLLINO BOARD MEMBER 1.00 X 0 0 0 REBECCA AUSTEN BOARD MEMBER 1.00 X 0 0 0 LESLEY OGDEN MD CEO / CEO SNLH 20.00 20.00 X 0 498041 54371 DANIEL SMITH SVP / CFO 2.00 38.00 X 0 638044 63937 JANE RUSSELL VP COO 40.00 X 306732 0 30257 SAM JONES VP PATIENT CARE SERVICES 40.00 X 219569 0 58385 DAVID LARSEN MD PHYSICIAN 40.00 X 516963 0 62483 DOUGLAS WILSON MD PHYSICIAN 40.00 X 457719 0 57998 BREWSTER KELLOGG DO MEDICAL DIRECTOR 40.00 X 373877 0 63409 ERIN GUILIANO LICHY DO PHYSICIAN 40.00 X 430314 0 55626 NATHANIEL UECKER MD PHYSICIAN 40.00 X 398619 0 34264 2703793 3192064 608849 130 0 1 0 0 12599 4348833 44059 4405491 NET PATIENT SVC REV 622110 135118977 135118977 DURABLE MEDICAL EQUIP 456199 10154964 8466539 1688425 QUALITY INCENTIVES 622110 1111700 1111700 OTHER PROGRAM SVC REV 900099 363655 363655 OTHER PATIENT REVENUE 622110 140366 140366 146889662 45370 45370 437630 476025 -38395 -38395 -38395 1200 130749 -129549 -129549 -129549 78683 44505 34178 34178 CAFETERIA 722210 327570 327570 327570 151534327 145201237 1688425 239174 X 79043 79043 701 701 614942 614942 43224163 42226453 997710 2202918 2152783 50135 7278627 7112977 165650 2936378 2869551 66827 1995000 1995000 19063476 19063476 3126 3126 4466017 4294267 158250 13500 5805677 5574751 230926 2399554 2394131 5423 303740 287356 15205 1179 125031 112586 12445 205487 200037 5450 1897722 1825297 72425 1117827 1003657 114170 MEDICAL SUPPLIES 19965028 19965028 PURCHASED SERVICES 13721432 3882400 9839002 30 PROVIDER TAXES 6669770 6669770 DUES, TAXES, & LICENSES 363295 357159 6136 134438954 120689491 13734754 14709 28825 10970 291487 2004 13208954 15955089 154772 161741 2604195 2723609 194518 223831 26447163 14760048 12777397 11687115 185185 185185 73531293 78352613 102976626 109302157 8413076 8956153 13382501 474156 2834637 4125528 10821325 11118224 35451539 24674061 X 67525087 84628096 67525087 84628096 102976626 109302157 X 17095373 7636 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 464667 274662 190005 8411311 2462530 5948781 17175065 12022856 5152209 396120 396120 11687115 OTHER RECEIVABLES/ASSETS 5627331 ACCOUNTS RECEIVABLE - AFFILIATES 72725282 78352613 CONTRACTUAL REIMB OBLIGATIONS 5870240 PROFESSIONAL LIABILITY RESERVES 527000 WORKING CAPITAL RESERVES 4694499 OTHER RESERVES 26485 11118224 X PART X, LINE 2: FOOTNOTE DISCLOSURE FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THE SHS' MANAGEMENT TO EVALUATE TAX POSITIONS AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF SHS HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY SHS AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. SHS IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. SHS' MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2019. 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 19 11280 1948439 1948439 0.01450 16 60892 31869238 37155242 0 0.00000 35 72172 33817677 37155242 1948439 0.01450 3 8822 271134 7094 264040 0.00200 3 135 884771 884771 0.00660 11 26041 10243961 6755174 3488787 0.02600 3 10892 86951 86951 0.00060 20 45890 11486817 6762268 4724549 0.03520 55 118062 45304494 43917510 6672988 0.04970 1 20 234740 234740 0.00170 1 20 234740 234740 0.00170 0 1724630 32249822 34215649 -1965827 X 1 1 1 1 SAMARITAN PACIFIC HEALTH SERVICES 930 SW ABBEY STREET NEWPORT OR 97365 WWW.SAMHEALTH.ORG STATE LICENSE NUMBER: 14-1460 X X X X SAMARITAN PACIFIC HEALTH SERVICES 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://WWW.SAMHEALTH.ORG/COMMUNITYBENEFIT X X 1 20 1 HTTPS://WWW.SAMHEALTH.ORG/COMMUNITYBENEFIT 0 1 X 250.000000000000 400.000000000000 X X X 1 1 X X X X 1 X SAMHEALTH.ORG/FINANCIALASSISTANCE X SAMHEALTH.ORG/FINANCIALASSISTANCE X SAME AS ABOVE X X X X X X 1 X 0 X X X X 1 X 0 0 SAMARITAN PACIFIC HEALTH SERVICES PART V, SECTION B, LINE 5: STAFF MEMBERS FROM THE SAMARITAN HEALTH SERVICES (SHS) COMMUNITY HEALTH PROMOTION DEPARTMENT PARTNERED WITH THE LINN, BENTON, LINCOLN, REGIONAL HEALTH ASSESSMENT TEAM (LBLRHAT) AND A PRIVATE CONSULTANT TO CONDUCT THE 2023-2026 COMMUNITY HEALTH NEEDS ASSESSMENT FOR SAMARITAN PACIFIC COMMUNITIES HOSPITAL THAT WAS COMPLETED DURING 2022. MEMBERSHIP OF THE LINN, BENTON, LINCOLN REGIONAL HEALTH ASSESSMENT TEAM ARE REPRESENTATIVES FROM THE BENTON COUNTY HEALTH DEPARTMENT, LINN COUNTY HEALTH SERVICES, LINCOLN COUNTY HEALTH AND HUMAN SERVICES, THE CONFEDERATED TRIBE OF SILETZ INDIANS, THE UNITED WAY OF LINN, BENTON AND LINCOLN COUNTIES, INTERCOMMUNITY HEALTH NETWORK-CCO, THE LINN, BENTON, LINCOLN HEALTH EQUITY ALLIANCE, AND SAMARITAN HEALTH SERVICES. SHS STAFF, LBLRHAT AND THE CONSULTANT CONDUCTED SURVEYS BOTH ON-LINE AND ON PAPER WITH OVER 2,900 RESIDENTS IN THE REGION. THE LBLRHAT AND THE CONSULTANT ALSO COLLECTED SECONDARY DATA FROM VARIOUS STATE AND NATIONAL ORGANIZATIONS SUCH AS THE OREGON DEPARTMENT OF EDUCATION, THE OREGON HEALTH AUTHORITY, THE U.S. CENSUS BUREAU AND THE CENTERS FOR DISEASE CONTROL. SHS STAFF, LBLRHAT AND THE CONSULTANT HELD FOCUS GROUPS AND CONDUCTED KEY-INFORMANT INTERVIEWS TO OBTAIN INPUT FROM COMMUNITY MEMBERS AND PERSONS WITH SPECIALIZED KNOWLEDGE AND EXPERTISE. FINALLY, SHS STAFF, LBLRHAT, AND THE CONSULTANT HELD LISTENING SESSIONS TO OBTAIN ADDITIONAL INFORMATION REGARDING COMMUNITY NEEDS AND PRIORITIES.PERSONS FROM THE FOLLOWING ORGANIZATIONS WERE CONSULTED FOR THE HOSPITAL'S CHNA: THE LINCOLN COUNTY HEALTH DEPARTMENT, COMMUNITY OUTREACH INC., THE LINCOLN COUNTY FEDERALLY QUALIFIED HEALTH CENTER, OREGON STATE UNIVERSITY, THE CONFEDERATED TRIBE OF SILETZ INDIANS, SAMARITAN HEALTH PLANS, WESTERN UNIVERSITY-COMP NORTHWEST, OREGON COAST COMMUNITY COLLEGE, THE LINCOLN COUNTY UNIFIED SCHOOL DISTRICT, THE LINN, BENTON, LINCOLN HEALTH EQUITY ALLIANCE, OREGON CASCADES WEST COUNCIL OF GOVERNMENTS, INTERCOMMUNITY HEALTH NETWORK-CCO, THE DEPARTMENT OF HUMAN SERVICES, THE OREGON HEALTH AUTHORITY, THE OREGON OFFICE OF RURAL HEALTH, COMMUNITY SERVICES CONSORTIUM, NEIGHBORS FOR KIDS, LINCOLN CITY ROTARY, THE UNITED WAY OF LINN, BENTON AND LINCOLN COUNTIES, THE CENTRO DE AYUDA, ZONTA, CASA OF LINCOLN COUNTY, THE LINCOLN COUNTY EARLY CHILDHOOD COUNCIL, THE LINN-BENTON-LINCOLN EARLY LEARNING HUB, THE LINN-BENTON HISPANIC ADVISORY COUNCIL, THE LINCOLN COUNTY ORAL HEALTH COALITION, AND , THE REGIONAL MENTAL HEALTH/SUBSTANCE USE DISORDER COALITION. SAMARITAN PACIFIC HEALTH SERVICES PART V, SECTION B, LINE 6A: SAMARITAN NORTH LINCOLN HOSPITAL SAMARITAN PACIFIC HEALTH SERVICES PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE LINN, BENTON, LINCOLN, REGIONAL HEALTH ASSESSMENT TEAM. MEMBERS OF THE TEAM ARE: THE BENTON COUNTY HEALTH DEPARTMENT, LINN COUNTY HEALTH SERVICES, LINCOLN COUNTY HEALTH AND HUMAN SERVICES, THE CONFEDERATED TRIBE OF SILETZ INDIANS, THE UNITED WAY OF LINN, BENTON, AND LINCOLN COUNTIES, INTERCOMMUNITY HEALTH NETWORK-CCO, THE LINN, BENTON, LINCOLN, HEALTH EQUITY ALLIANCE, SAMARITAN HEALTH SERVICES, AND BRANDAN KEARNEY, LLC. SAMARITAN PACIFIC HEALTH SERVICES PART V, SECTION B, LINE 7D: COPIES OF THE CHNA WERE EMAILED TO KEY COMMUNITY PARTNERS AND DISTRIBUTED TO LOCAL LIBRARIES, COUNTY OFFICES, THE SCHOOL DISTRICT OFFICE AND DURING LOCAL COALITION MEETINGS. SAMARITAN PACIFIC HEALTH SERVICES PART V, SECTION B, LINE 11: THE HOSPITAL PROVIDES GRANT FUNDING TO LOCAL COMMUNITY AGENCIES THAT ADDRESS ONE OR MORE OF THE PRIORITIES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IS INCLUDED IN THE HOSPITAL'S COMMUNITY BENEFIT PLAN IMPLEMENTATION STRATEGY. HOSPITAL STAFF MEMBERS SERVE ON COMMUNITY ADVISORY BOARDS AND COALITIONS TO ADDRESS THE MOST PRESSING NEEDS IN THE COMMUNITY. THE HOSPITAL PROVIDES WORKSHOPS, CLASSES, AND SUPPORT GROUPS TO ADDRESS THE MOST CRITICAL HEALTH CONCERNS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. BECAUSE SEVERAL NEEDS TO IMPROVE HEALTH WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DOES NOT HAVE THE FINANCES, RESOURCES, OR THE EXPERTISE TO ADDRESS ALL THE NEEDS PRIORITIZED BY THE COMMUNITY. SAMARITAN PACIFIC HEALTH SERVICES PART V, SECTION B, LINE 15E: REGISTRATION REFERS UNINSURED AND/OR LOW INCOME PATIENTS TO THE ONSITE PATIENT FINANCIAL ADVOCATE AND A THIRD PARTY VENDOR WHO CONTACTS THE PATIENTS TO ASSESS THEIR FINANCIAL STATUS AND NEEDS. 10 1 - SAMARITAN DEPOE BAY CLINIC 531 NW HWY 101 STE A DEPOE BAY OR 97341 MEDICAL CLINIC - OUTPATIENT 2 - SAMARITAN CARDIOLOGY - NEWPORT 1010 SW COAST HWY STE 101 NEWPORT OR 97365 MEDICAL CLINIC - OUTPATIENT 3 - SAMARITAN TOLEDO CLINIC 199 NW BUSINESS HWY 20 TOLEDO OR 97391 MEDICAL CLINIC - OUTPATIENT 4 - SAMARITAN WALDPORT CLINIC 920 SW RANGE DR WALDPORT OR 97394 MEDICAL CLINIC - OUTPATIENT 5 - SAMARITAN PHY REHAB SPEC - NEWPORT 1111 SW 10TH ST STE A NEWPORT OR 97365 MEDICAL CLINIC - OUTPATIENT 6 - SAMARITAN EVERGREEN HOSPICE 749 SW 11TH ST NEWPORT OR 97365 HOSPICE FACILITY 7 - SMG KIDNEY CARE - NEWPORT 1010 SW COAST HWY STE 101 NEWPORT OR 97365 MEDICAL CLINIC - OUTPATIENT 8 - SMG INFECTIOUS DISEASE - NEWPORT 1010 SW COAST HWY STE 101 NEWPORT OR 97365 MEDICAL CLINIC - OUTPATIENT 9 - SMG OCCUPATIONAL MEDICINE - NEWPORT 705 SW COAST HWY STE A NEWPORT OR 97365 MEDICAL CLINIC - OUTPATIENT 10 - SMG URGENT CARE - NEWPORT 705 SW COAST HWY NEWPORT OR 97365 MEDICAL CLINIC - OUTPATIENT PART I, LINE 6A: THE FILING ORGANIZATION SUBMITS AN ANNUAL COMMUNITY BENEFIT REPORT TO THE STATE OF OREGON. IN ADDITION, THE PARENT ORGANIZATION, SAMARITAN HEALTH SERVICES (SHS) PROVIDES AN ANNUAL REPORT TO THE COMMUNITY THAT INCLUDES COMMUNITY BENEFIT REPORTING FOR THE SYSTEM AS A WHOLE. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN SCHEDULE H, PART I, LINE 7A AND 7B IS A COST-TO-CHARGE RATIO DERIVED USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES FROM THE SCHEDULE H INSTRUCTIONS. FOR LINE 7G, A COST-TO-CHARGE RATIO IS ALSO USED, BUT IT IS CALCULATED AT THE DEPARTMENT OR SERVICE LINE LEVEL FOR THOSE SERVICES THAT QUALIFY AS SUBSIDIZED HEALTH SERVICES. PART I, LINE 7G: PHYSICIAN CLINICS MEETING THE DEFINITION OF SUBSIDIZED HEALTH SERVICES WERE INCLUDED IN THE REPORTING FOR LINE 7G. CONSISTENT WITH THE SCHEDULE H INSTRUCTIONS, PHYSICIAN CLINIC ACTIVITY HAS BEEN COMBINED WITH ASSOCIATED HOSPITAL SERVICES IN DETERMINING WHETHER THE SERVICES WERE PROVIDED AT A LOSS. THE PORTION OF NET COMMUNITY BENEFIT EXPENSE RELATED TO PHYSICIAN CLINICS, COMBINED WITH ASSOCIATED HOSPITAL ACTIVITY, THAT IS BEING COUNTED AS SUBSIDIZED HEALTH SERVICES IN 2022 IS $2,843,203. PART II, COMMUNITY BUILDING ACTIVITIES: SPHS PROVIDES SERVICES AND ACTIVITIES THAT ARE CLASSIFIED AS COMMUNITY BUILDING TO PROMOTE THE HEALTH OF LINCOLN COUNTY. RECOGNIZING THAT THE HEALTH OF A COMMUNITY ENCOMPASSES MULTIPLE FACTORS, SPHS LEADERSHIP AND STAFF ARE INVOLVED IN A VARIETY OF ACTIONS THAT WORK TO IMPROVE COMMUNITY OUTCOMES. THIS IS DEMONSTRATED THROUGH THE ONGOING SUPPORT TO THE SAMARITAN EARLY LEARNING CENTER (SELC). THE SELC OFFERS LOW-COST INFANT/TODDLER CARE TO FAMILIES IN LINCOLN COUNTY AND IS THE ONLY FACILITY IN NORTH LINCOLN COUNTY TO OFFER THIS SERVICE. SPHS BELIEVES THAT TRAINED AND COMPETENT STAFF IN ALL ASPECTS OF THE ORGANIZATION PROMOTES COMMUNITY HEALTH. SPHS ACTIVELY PARTICIPATES IN WORKFORCE DEVELOPMENT IN PARTNERSHIP WITH OREGON STATE UNIVERSITY, OREGON COAST COMMUNITY COLLEGE AND WESTERN UNIVERSITY-COMP NW TO RECRUIT, TRAIN AND RETAIN HEALTHCARE WORKERS AT ALL LEVELS. SPHS ALSO HOSTS LOCAL EVENTS SUPPORTED BY THE HOSPITAL'S FOUNDATION AND OTHER DEPARTMENTS IN THE ORGANIZATION. SUPPORTING AND PARTICIPATING IN ANNUAL EVENTS SUCH AS SENIOR HEALTH FAIRS, THE LINCOLN COUNTY FAIR AND THE LINCOLN COUNTY CHIP PROJECT ARE A FEW EXAMPLES OF HOW SPHS PROMOTES THE HEALTH OF THE COMMUNITY. SPHS HAS BEEN ACTIVELY IMPLEMENTING THE SAMARITAN HEALTH SERVICES EQUITY AND INCLUSION PLAN TO OPTIMIZE OUR SERVICE DELIVERY PROCESS TO UNDERSERVED, UNDERREPRESENTED, AND MARGINALIZED COMMUNITIES. SPHS PROVIDES EDUCATION AND TRAINING TO ALL STAFF ON EQUITY, DIVERSITY AND INCLUSION TOPICS THAT WILL IMPROVE THE PATIENT EXPERIENCE IN OUR HOSPITAL AND CLINICS. SPHS ALSO PROVIDES OPPORTUNITIES FOR COMMUNITY MEMBERS TO OBTAIN TRAINING ON CIVIC AND CULTURAL ISSUES THAT IMPACT HEALTH. SOME OF THE TRAINING OPPORTUNITIES INCLUDED HEALTHY LIFESTYLES AND FITNESS CLASSES, AND HEALTH EQUITY TRAININGS. SPHS STAFF SERVED ON MANY LOCAL COALITIONS AND BOARDS THAT PROMOTE THE HEALTH OF THE COMMUNITY. BOARD AFFILIATIONS INCLUDE, BUT ARE NOT LIMITED TO, THE LINCOLN CITY ROTARY CLUB, ALTRUSA INTERNATIONAL, THE LINCOLN COUNTY ECONOMIC DEVELOPMENT COUNCIL, THE JOINT TRANSPORTATION COMMITTEE AND THE UNITED WAY OF LINCOLN COUNTY. ADDITIONALLY, SPHS STAFF SERVED ON THE OREGON HEALTH POLICY ADVISORY BOARD, THE OREGON HEALTH CARE WORKFORCE INSTITUTE, THE OREGON ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS AND REGIONAL BOARDS THAT ADDRESS HEALTH CARE ISSUES. PART III, LINE 2: BAD DEBT EXPENSE IS RECORDED FOR THOSE PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE AND DO NOT PAY AFTER REPEATED ATTEMPTS TO COLLECT PAYMENT, INCLUDING INFORMING THEM OF THE OPPORTUNITY TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. IF INDEPENDENT EVIDENCE INDICATES THAT THE PATIENT IS UNABLE TO PAY, SHS MAY CHOOSE TO CLASSIFY DELINQUENT ACCOUNTS AS "PRESUMPTIVE CHARITY" RATHER THAN BAD DEBT. PATIENT PAYMENTS (OR RECOVERIES) ON ACCOUNTS THAT WERE PREVIOUSLY WRITTEN OFF AS BAD DEBT ARE RECORDED AS A REDUCTION TO BAD DEBT EXPENSE. PART III, LINE 4: SAMARITAN PACIFIC HEALTH SERVICES (SPHS) INCLUDES SAMARITAN PACIFIC COMMUNITIES HOSPITAL (SPCH), ONE OF FIVE HOSPITALS OF SAMARITAN HEALTH SERVICES (SHS). AS A NETWORK, SHS PREPARES ITS FINANCIAL STATEMENTS ON A CONSOLIDATED BASIS. AS OF JANUARY 1, 2018, SHS IMPLEMENTED THE NEW REVENUE RECOGNITION STANDARD (ASU NO. 2014-09) ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB). UNDER THIS NEW STANDARD, RATHER THAN REPORTING A BAD DEBT ALLOWANCE FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE PATIENTS WITHOUT INSURANCE), BEGINNING IN 2018, SHS RECORDS AN IMPLICIT PRICE CONCESSION IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE (SEE FOOTNOTE 3, "NET PATIENT SERVICE REVENUE" ON PAGES 12, 13 AND 14 OF THE 2022 CONSOLIDATED FINANCIAL STATEMENTS). WITH THIS CHANGE, PATIENT SERVICE REVENUE CONTINUES TO BE REPORTED NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS AT THE ESTIMATED NET REALIZABLE AMOUNT FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED. PART III, LINE 8: TOTAL MEDICARE ALLOWABLE COSTS REPORTED ON PART III, SECTION B, LINE 6 IS CALCULATED BY UTILIZING WORKSHEET A IN THE SCHEDULE H INSTRUCTIONS IN CONJUNCTION WITH AMOUNTS TAKEN DIRECTLY FROM THE FILING ORGANIZATION'S MEDICARE COST REPORT. THE COST REPORT INCLUDES ACTIVITY FOR MEDICARE FEE-FOR-SERVICE PATIENTS BUT NOT MEDICARE MANAGED CARE PATIENTS. PART III, LINE 9B: PER HOSPITAL GUIDELINES, IF A PATIENT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS, THE FINANCIAL ASSISTANCE WRITE-OFF IS PROCESSED AND NO COLLECTION ATTEMPT IS MADE. IF AN ACCOUNT IS ALREADY IN COLLECTIONS AND MEDICAID ELIGIBILITY IS DEEMED ACTIVE DURING THE ACCOUNT DATE OF SERVICE, NO FURTHER COLLECTION ATTEMPT WILL BE MADE. PART VI, LINE 2: SAMARITAN PACIFIC HEALTH SERVICES (SPHS) DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL (SPCH), ACTIVELY PARTICIPATES IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY. EVERY THREE YEARS, AS REQUIRED BY FEDERAL AND STATE LAW, SPHS CONDUCTS A COUNTYWIDE HEALTH NEEDS ASSESSMENT IN CONJUNCTION WITH THE LINN, BENTON, LINCOLN REGIONAL HEALTH RESOURCE ASSESSMENT TEAM THAT CONSISTS OF REPRESENTATIVES FROM THE BENTON COUNTY HEALTH DEPARTMENT, LINN COUNTY HEALTH SERVICES, LINCOLN COUNTY HEALTH AND HUMAN SERVICES, INTERCOMMUNITY HEALTH NETWORK-CCO, THE CONFEDERATED TRIBES OF SILETZ INDIANS, THE UNITED WAY OF LINN, BENTON, AND LINCOLN COUNTIES, THE LINN-BENTON-LINCOLN HEATH EQUITY ALLIANCE, SAMARITAN HEALTH SERVICES AND OTHER COMMUNITY PARTNERS. THE PROCESS INCLUDES EXAMINING PRIMARY DATA COLLECTED THROUGH SURVEYS, FOCUS GROUPS, LISTENING SESSIONS AND KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS WHO RESIDE THROUGHOUT LINCOLN COUNTY. SECONDARY DATA IS GATHERED FROM FEDERAL, STATE, AND LOCAL AGENCIES THAT ADDRESS THE HEALTH NEEDS OF CHILDREN, YOUTH, AND FAMILIES. THE INFORMATION IS REVIEWED BY HOSPITAL STAFF MEMBERS, PARTNERS, AND COMMUNITY MEMBERS TO PRIORITIZE THE HEALTH CARE NEEDS FOR LINCOLN COUNTY. EACH YEAR THE SPHS BOARD OF DIRECTORS AND VARIOUS INTERNAL AND EXTERNAL COMMITTEES REVIEW THE PRIORITIES TO ENSURE WE ARE CONTINUING TO ADDRESS THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: SPHS IS COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTH CARE SERVICES TO ALL, REGARDLESS OF THEIR ABILITY TO PAY. IF QUALIFICATIONS ARE MET, PATIENTS' CARE MAY BE PROVIDED FOR FREE OR AT A REDUCED COST. THE DETERMINATION IS BASED IN PART ON POVERTY INCOME GUIDELINES ISSUED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. SPHS INFORMS AND EDUCATES PATIENTS AND COMMUNITY MEMBERS REGARDING FINANCIAL ASSISTANCE THROUGH A VARIETY OF METHODS. SIGNS AND BROCHURES ARE POSTED AND AVAILABLE IN THE HOSPITAL WAITING AREAS, CLINIC WAITING ROOMS, VISITING ROOMS, THE INFORMATION DESKS, IN THE EMERGENCY DEPARTMENT, AND AT URGENT CARE SITES. FINANCIAL ASSISTANCE INFORMATION IS SENT EACH YEAR TO THE LOCAL HEALTH DEPARTMENT, MEDICAID OFFICES, SOCIAL SERVICES AGENCIES, AND DOCTOR'S OFFICES. FINANCIAL ASSISTANCE INFORMATION IS ALSO POSTED ON THE HOSPITAL'S WEBSITE INCLUDING, THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY, AND THE FINANCIAL ASSISTANCE APPLICATION. PATIENTS WHO ARE SELF-PAY OR ARE UNINSURED ARE SCREENED THROUGH PRESUMPTIVE ELIGIBILITY QUESTIONS TO DETERMINE IF THEY ARE ELIGIBLE FOR THE OREGON HEALTH PLAN MEDICAID ASSISTANCE PROGRAM (OHP). THESE PATIENTS ARE ASSIGNED TO A FINANCIAL COUNSELOR TO ASSIST WITH COMPLETING AND SUBMITTING THEIR OHP APPLICATION PACKET TO THE OREGON HEALTH AUTHORITY OFFICE. HOWEVER, THIS IS NOT A REQUIREMENT TO APPLY FOR OR RECEIVE FINANCIAL ASSISTANCE. ALL PATIENTS INCLUDING INSURED, UNINSURED, AND UNDERINSURED ARE PROVIDED FINANCIAL ASSISTANCE INFORMATION ON BILLING STATEMENTS, AT SHS CUSTOMER SERVICE DESKS AND ON THE SHS WEBSITE.ALL APPLICATION MATERIALS ARE AVAILABLE IN ENGLISH, SPANISH AND CHINESE (SIMPLE) AND INTERPRETATIVE SERVICES ARE AVAILABLE FOR NON-ENGLISH SPEAKING PATIENTS EITHER FACE-TO-FACE OR THROUGH VARIOUS ELECTRONIC DEVICES. PART VI, LINE 4: SPHS IS A CRITICAL-ACCESS HOSPITAL THAT PRIMARILY SERVES THE RESIDENTS OF SOUTHERN LINCOLN COUNTY. LOCATED ON A RURAL PORTION OF OREGON'S CENTRAL COAST, LINCOLN COUNTY IS HOME TO 50,400 (2022 U.S. CENSUS) RESIDENTS. LINCOLN COUNTY IS ALSO HOME TO THE CONFEDERATED TRIBES OF THE SILETZ INDIANS. APPROXIMATELY 5,600 MEMBERS ARE ENROLLED WITH THE CONFEDERATED TRIBES OF THE SILETZ INDIANS (CTSI ENROLLMENTS 2022) AND OVER 22% OF THE MEMBERS RESIDE WITHIN THE COUNTY. LINCOLN COUNTY IS DESIGNATED AS MEDICALLY UNDERSERVED POPULATION AND THE MIGRANT SEASONAL FARMWORKER POPULATION HAS BEEN DESIGNATED A PRIMARY MEDICAL CARE HEALTH PROVIDER SHORTAGE AREA BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION. THE 3,666-ACRE RESERVATION OF THE CONFEDERATED TRIBES OF SILETZ INDIANS IS A DESIGNATED HEALTH PROVIDER SHORTAGE AREA. A SISTER HOSPITAL, SAMARITAN NORTH LINCOLN HOSPITAL, SERVES PATIENTS WHO RESIDE IN THE NORTHERN PORTION OF LINCOLN COUNTY. THE MAJOR CITIES IN LINCOLN COUNTY ARE OUTLINED BELOW: CITY POPULATIONLINCOLN CITY 10,242NEWPORT 10,841SOURCE: U.S. CENSUS BUREAU, 2022 CENSUS QUICK FACTS, PUBLIC LAW 94-171 SUMMARY FILETHE CHART BELOW SUMMARIZES THE RACIAL AND ETHNIC DEMOGRAPHICS OF LINCOLN COUNTY:RACE/ETHNICITY POPULATIONWHITE/CAUCASIAN 89.6%BLACK/AFRICAN AMERICAN 1.0%AMERICAN INDIAN/ALASKA NATIVE 4.1%ASIAN 1.6%NATIVE HAWAIIAN/PACIFIC ISLANDER 0.2%LATINO 10.1%REPORTING TWO OR MORE RACES 4.1%SOURCE: U.S. CENSUS BUREAU, 2022 CENSUS QUICK FACTS, PUBLIC LAW 94-171 SUMMARY FILEHEALTH AND SOCIAL INDICATORS ARE USED TO GENERALIZE THE CONDITIONS OF LINCOLN COUNTY:HEALTH AND SOCIAL INDICATORS TOTALSMEDIAN INCOME $54,961UNEMPLOYMENT 3.0%POVERTY 16.0%CHILD ABUSE (REFERRED CASES) 613 JUVENILE JUSTICE REFERRALS 15.8/1000SOURCE: OREGON EMPLOYMENT DEPARTMENT DECEMBER 2022, U.S. CENSUS BUREAU, 2022 CENSUS QUICK FACTS, PUBLIC LAW 94-171 SUMMARY FILE, 2021 CHILD WELL-BEING IN OREGON COUNTY DATA BOOK, 2022 COUNTY HEALTH RANKINGS PART VI, LINE 5: SPHS'S GOVERNING BOARD IS COMPRISED OF LOCAL-AREA RESIDENTS AND OFFICERS OF AFFILIATED ORGANIZATIONS. SPHS EXTENDS ITS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SPHS APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. SPHS INVESTS IN UPDATING EQUIPMENT, TECHNOLOGY AND FACILITIES TO IMPROVE PATIENT CARE. SPHS IS ACCREDITED FOR CONTINUING MEDICAL EDUCATION AND OFFERS FREQUENT PROGRAMS FOR AREA PHYSICIANS AND OTHER HEALTH PROFESSIONALS. THE CENTER FOR HEALTH RESEARCH AND QUALITY, A DEPARTMENT OF SPHS'S PARENT COMPANY, SAMARITAN HEALTH SERVICES (SHS), PROVIDES ADMINISTRATIVE OVERSIGHT FOR HEALTH AND CLINICAL RESEARCH, QUALITY IMPROVEMENT PROJECTS AND STUDIES AND OTHER SPONSORED ACTIVITIES FOR SPHS AND ITS AFFILIATED HOSPITALS. PART VI, LINE 6: "BUILDING HEALTHIER COMMUNITIES TOGETHER" IS THE MISSION OF SAMARITAN HEALTH SERVICES (SHS), A NETWORK OF OREGON HOSPITALS AND PHYSICIANS THAT SERVES THE HEALTH CARE NEEDS OF PEOPLE IN THE MID-WILLAMETTE VALLEY AND THE CENTRAL OREGON COAST.AS THE INDIVIDUAL ENTITIES OF SHS CAME TOGETHER, THEY WERE DRAWN BY A SHARED DESIRE "TO ENHANCE COMMUNITY HEALTH AND ACHIEVE HIGH VALUE THROUGH QUALITY SERVICES ACROSS THE CONTINUUM OF CARE." WITH THE MISSION OF "BUILDING HEALTHIER COMMUNITIES TOGETHER," SHS LOOKS CAREFULLY AT LOCAL HEALTH CARE NEEDS, AND IT GIVES THOUGHTFUL CONSIDERATION TO THE MOST EFFECTIVE WAYS TO MEET THOSE NEEDS. THE RESULT IS A RICH MIX OF LOCAL AND CENTRALIZED REGIONAL SERVICES WHICH PROVIDE HIGH VALUE AND EXCELLENT HEALTHCARE FOR PEOPLE AT ALL STAGES OF THEIR LIVES. SERVICES ARE PROVIDED TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY. THE COLLECTIVE VISION OF SHS IS TO SERVE OUR COMMUNITIES WITH PRIDE (PASSION, RESPECT, INTEGRITY, DEDICATION, AND EXCELLENCE). SHS IS GOVERNED BY A PARTNERSHIP OF COMMUNITY MEMBERS, PHYSICIANS AND OTHER HEALTH CARE PROVIDERS. SHS SEEKS TO LEAD COLLABORATIVE EFFORTS AMONG PROVIDERS, EMPLOYERS, HEALTH PLANS AND CONSUMERS WHO SHARE SIMILAR GOALS AND VALUES TO MEET THE CHALLENGES OF THE FUTURE.SPHS IS ONE OF TWO LINCOLN COUNTY CRITICAL ACCESS HOSPITALS OF SHS PRIMARILY SERVING RESIDENTS OF LINCOLN COUNTY. OTHER AFFILIATED HOSPITALS ARE GOOD SAMARITAN HOSPITAL SERVING RESIDENTS OF BENTON COUNTY, SAMARITAN ALBANY GENERAL HOSPITAL AND SAMARITAN LEBANON COMMUNITY HOSPITAL, SERVING RESIDENTS OF LINN COUNTY, AND SAMARITAN NORTH LINCOLN HOSPITAL, SERVING RESIDENTS OF NORTH LINCOLN COUNTY. PART VI, LINE 7, REPORTS FILED WITH STATES OR 1 NORTHWEST COASTAL HOUSING PO BOX 1457 NEWPORT OR 97365 943141603 501(C)(3) 48758 0 PROVIDE HOUSING TO PERSONS WHO HAVE TEMPORARILY LOST THE ABILITY TO BE HOUSED NEIGHBORS FOR KIDS PO BOX 942 DEPOE BAY OR 97341 931262846 501(C)(3) 9000 0 ADDRESSES FOOD INSECURITY FOR LOCAL LOW INCOME CHILDREN AND FAMILIES OREGON CASCADES WEST SENIOR SERVICES FOUNDATION 1400 QUEEN AVE SE STE 206 ALBANY OR 97322 931213218 501(C)(3) 10000 0 SUPPORT FOR THE MEALS ON WHEELS PROGRAM FOR LOCAL SENIOR CITIZENS 3 PART I, LINE 2: AGENCIES IN THE COMMUNITY ARE INVITED TO SUBMIT GRANT PROPOSALS THROUGH AN APPLICATION PROCESS. A COMMITTEE REVIEWS THE APPLICATIONS TO DETERMINE IF THE FUNDS REQUESTED WILL BE USED TO ADDRESS THE ORGANIZATION'S ESTABLISHED COMMUNITY HEALTH PRIORITIES, IDENTIFIED NEEDS, AND SUPPORTS THE ORGANIZATION'S MISSION. ONCE APPROVED AND FUNDED, AGENCIES MUST SUBMIT A COMPLETE ANNUAL REPORT DESCRIBING HOW THE FUNDS WERE USED, THE NUMBER OF CLIENTS SERVED, AND HOW OUTCOMES WERE ACHIEVED. X 1 1 0 1 0 1 0 0 0 0 0 DOUGLAS BOYSEN BOARD CHAIR / CEO SHS 0 1045442 0 380053 0 87459 0 24620 0 39793 0 1577367 0 0 DANIEL SMITH SVP / CFO 0 492567 0 104160 0 41317 0 24620 0 39317 0 701981 0 0 DAVID LARSEN MD PHYSICIAN 486985 0 28631 0 1347 0 24620 0 37863 0 579446 0 0 0 KELLEY KAISER BRD VICE CHAIR / CAO SHS 0 402834 0 85255 0 8056 0 24620 0 38147 0 558912 0 0 LESLEY OGDEN MD CEO / CEO SNLH 0 388943 0 88660 0 20438 0 24620 0 29751 0 552412 0 0 DOUGLAS WILSON MD PHYSICIAN 406397 0 48486 0 2836 0 18520 0 39478 0 515717 0 0 0 ERIN GUILIANO LICHY DO PHYSICIAN 319511 0 85286 0 25517 0 24620 0 31006 0 485940 0 0 0 BREWSTER KELLOGG DO MEDICAL DIRECTOR 347366 0 0 0 26511 0 24620 0 38789 0 437286 0 0 0 NATHANIEL UECKER MD PHYSICIAN 339453 0 20000 0 39166 0 0 0 34264 0 432883 0 0 0 JANE RUSSELL VP COO 260061 0 24454 0 22217 0 24620 0 5637 0 336989 0 0 0 SAM JONES VP PATIENT CARE SERVICES 196680 0 18110 0 4779 0 16763 0 41622 0 277954 0 0 0 PART I, LINE 1A IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM/FITNESS FACILITY BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. EMPLOYEES CAN USE THEIR WELLNESS BENEFIT AT EITHER NON-SAMARITAN OR SAMARITAN (SAMFIT) GYM/FITNESS FACILITIES. IF AN EMPLOYEE PARTICIPATES AT A NON-SAMARITAN GYM, REIMBURSEMENT IS MADE FOR FEES. REIMBURSEMENT DOES NOT EXCEED $300 PER YEAR AND IS INCLUDED IN THEIR TAXABLE WAGES SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. NO PERSONS LISTED ON PART VII USED THE NON-SAMARITAN GYM REIMBURSEMENT DURING THE FILING YEAR. IF EMPLOYEES USE THEIR WELLNESS BENEFIT AT A SAMARITAN (SAMFIT) GYM/FITNESS FACILITY, THEN THE ANNUAL COST OF EMPLOYEE MEMBERSHIP, $300, IS INCLUDED IN THE EMPLOYEE'S TAXABLE WAGES SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. TWO BOARD MEMBERS, TWO KEY EMPLOYEES, AND ONE OFFICER USED THE SAMARITAN (SAMFIT) GYM/FITNESS FACILITY BENEFIT DURING THE FILING YEAR. PART I, LINE 3 THE CHIEF EXECUTIVE OFFICER IS EMPLOYED AND PAID BY A RELATED ORGANIZATION. THE RELATED ORGANIZATION CONDUCTS A COMPENSATION ANALYSIS EACH YEAR TO COMPARE COMPENSATION OF ALL PAID POSITIONS TO MARKET SURVEYS OF COMPENSATION FOR SIMILAR POSITIONS IN OTHER ORGANIZATIONS. PERIODICALLY, THE RELATED ORGANIZATION WILL ALSO USE WRITTEN EMPLOYMENT CONTRACTS, FORM 990 OF OTHER ORGANIZATIONS, AND INDEPENDENT COMPENSATION CONSULTANTS TO DETERMINE THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. PART I, LINE 4B A RELATED ORGANIZATION MAINTAINS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. HOWEVER, NO PERSONS LISTED IN PART VII OF FORM 990 ACCRUED DEFERRED COMPENSATION BENEFITS OR RECEIVED ANY PAYMENTS FROM THESE PLANS DURING THE FILING YEAR. PART I, LINE 5 VARIOUS PHYSICIAN COMPENSATION METHODOLOGIES ARE UTILIZED AND, DEPENDING ON SPECIALTY, RELATIVE VALUE UNITS (RVU'S) MAY BE USED IN DETERMINING A PORTION OF OR ALL OF THEIR COMPENSATION. FORM 990, PART VI, SECTION A, LINE 6 SAMARITAN PACIFIC HEALTH SERVICES HAS A SOLE CORPORATE MEMBER, SAMARITAN HEALTH SERVICES, INC., WHICH IS A SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A SAMARITAN PACIFIC HEALTH SERVICES ELECTS MEMBERS OF ITS BOARD OF DIRECTORS. THOSE ELECTED MEMBERS ARE THEN SUBMITTED TO THE SOLE CORPORATE MEMBER FOR APPROVAL. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE CORPORATE MEMBER HAS SEVERAL RESERVED POWERS OVER THE ORGANIZATION. THESE RESERVED POWERS INCLUDE, BUT ARE NOT LIMITED TO, APPROVAL AT CERTAIN THRESHOLD LEVELS: THE BORROWING OF FUNDS, MERGERS AND ACQUISITIONS, AND SALES OR TRANSFERS OF ASSETS. IN ADDITION, THE SOLE CORPORATE MEMBER MUST APPROVE ANY CHANGE IN THE MISSION OF THE ORGANIZATION, THE ANNUAL BUDGET, AND ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES), AS ULTIMATELY FILED WITH THE IRS, WAS PROVIDED TO EACH VOTING MEMBER OF THE SAMARITAN HEALTH SERVICES (SHS) AUDIT AND COMPLIANCE COMMITTEE PRIOR TO ITS FILING WITH THE IRS. SHS IS A 501(C)(3) CORPORATION AND IS THE SOLE MEMBER OF THE FILING ORGANIZATION. SHS'S CHIEF FINANCIAL OFFICER CONDUCTED THE FORM 990 REVIEW WITH THE COMMITTEE AND PROVIDED TIME FOR QUESTIONS FROM THE GROUP. A FORMAL REPORT OF THIS COMMITTEE HAS BEEN MADE TO THE FULL BOARD OF DIRECTORS OF SHS. ADDITIONALLY, A COMPLETE COPY OF THE FILING ORGANIZATION'S FINALIZED FORM 990 AND RELATED SCHEDULES WAS PROVIDED ELECTRONICALLY TO ALL MEMBERS OF THE FILING ORGANIZATION'S GOVERNING BOARD PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBER CONFLICTS OF INTEREST: THE MEMBERS OF THE BOARD MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, WHICH REQUIRES DISCLOSURE OF ANY CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CORPORATE COMPLIANCE OFFICER. IF A CONFLICT IS DISCLOSED THAT COULD PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THIS IS EVALUATED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES (SHS) BOARD OF DIRECTORS TO DETERMINE WHETHER THE MEMBER SHOULD CONTINUE TO SERVE ON THE BOARD. IF A CONFLICT IS DISCLOSED THAT DOES NOT PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THE CONFLICT IS MANAGED THROUGH A PROCESS SET FORTH IN THE ORGANIZATION'S BYLAWS. THE BYLAWS PROHIBIT ANY BOARD MEMBER FROM VOTING ON AN ACTION WHERE AN INDIVIDUAL MEMBER HAS A CONFLICT OF INTEREST. EMPLOYEE CONFLICTS OF INTEREST: THE SHS CODE OF CONDUCT AND BUSINESS ETHICS POLICY REQUIRES THAT ALL SHS EMPLOYEES COMPLETE AN ANNUAL DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST. THROUGH THE HUMAN RESOURCES SOFTWARE, PERFORMANCE MANAGER, THE DISCLOSURE REQUIREMENT NOTICE IS ASSIGNED TO ALL EMPLOYEES AND BY YEAR END ALL TASKS ARE TO BE COMPLETED. IF THERE IS A PERCEIVED CONFLICT OF INTEREST IT IS REVIEWED BY THE CORPORATE COMPLIANCE OFFICER, LEGAL COUNSEL AND/OR SENIOR MANAGEMENT. ACTUAL CONFLICTS OF INTEREST ARE REVIEWED AND DISCUSSED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: THE CEO OF THE PARENT COMPANY, SAMARITAN HEALTH SERVICES (SHS) USES PUBLICLY AVAILABLE INFORMATION TO DETERMINE THE COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL OF THE FILING ORGANIZATION. HE CONSULTS WITH THE INDEPENDENT CONSULTANT AS TO THE REASONABLENESS OF THIS DATA TO ENSURE THAT THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IS REASONABLE AS COMPARED TO SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. LINE 15B: PHYSICIAN EMPLOYEE COMPENSATION, INCLUDING PHYSICIANS WHO ARE BOARD MEMBERS, IS REVIEWED AT LEAST ANNUALLY BY SENIOR MANAGEMENT. THIS REVIEW INCLUDES COMPARISON WITH PUBLISHED PHYSICIAN COMPENSATION STUDIES. FOR ALL OTHER EMPLOYEES, THE ORGANIZATION PERFORMS AN ANALYSIS EACH YEAR TO COMPARE COMPENSATION OF ALL PAID POSITIONS TO MARKET SURVEYS OF COMPENSATION FOR SIMILAR POSITIONS IN OTHER ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. SYSTEM-WIDE SUMMARIZED DATA IS ALSO PROVIDED IN THE ANNUAL REPORT TO THE COMMUNITY. THIS REPORT IS MADE AVAILABLE IN KIOSKS AND HIGH-TRAFFIC AREAS OF HOSPITALS AND PHYSICIAN CLINICS, AS WELL AS COMMUNITY PLACES SUCH AS THE PUBLIC LIBRARY. IT IS ALSO DISTRIBUTED TO THE BOARDS OF DIRECTORS AND DIRECTLY MAILED TO DONORS AND NEW RESIDENTS IN THE COMMUNITY. ADDITIONALLY, THE REPORT IS MADE AVAILABLE AT EVENTS, COMMUNITY OUTREACH PROJECTS, AND SCREENINGS ATTENDED THROUGHOUT THE YEAR. GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 11,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,200. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 136,700. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,700. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 6,880,744. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,880,744. TEMPORARY AGENCY FEES: PROGRAM SERVICE EXPENSES 12,021,596. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,021,596. INTERPRETER FEES: PROGRAM SERVICE EXPENSES 13,236. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,236. FORM 990, PART IX, COL D THE FUNDRAISING FUNCTIONS FOR THE FILING ORGANIZATION ARE CENTRALIZED THROUGH AND REPORTED BY THE CORPORATE PARENT, SAMARITAN HEALTH SERVICES, INC. (SHS) (FEIN 93-0951989). SEE THE SHS 990 FOR THE MAJORITY OF THE FUNDRAISING EXPENSES ASSOCIATED WITH THE CONTRIBUTION REVENUE REPORTED ON LINE 1 PART VIII. FORM 990, PART XI, LINE 9: OTHER CHANGES 7,636. ALBANY GENERAL HOSPITAL PO BOX 3000 CORVALLIS OR 973393000 930110095 HOSPITAL SERVICES FOR THE COMMUNITY OR 501(C)(3) 3 SAMARITAN HEALTH SERVICES 0 ALBANY GENERAL HOSPITAL FOUNDATION 1046 SIXTH AVENUE SW ALBANY OR 97321 930712890 TO SUPPORT ALBANY GENERAL HOSPITAL OR 501(C)(3) 7 ALBANY GENERAL HOSPITAL 0 FIRSTCARE HEALTH FOUNDATION PO BOX 3000 CORVALLIS OR 973393000 930900124 HEALTH SERVICES FOR LOW-INCOME PATIENTS OR 501(C)(3) 7 SAMARITAN HEALTH SERVICES 0 FIRSTCARE MEDICAL FOUNDATION PO BOX 3000 CORVALLIS OR 973393000 930932697 FUTURE CHARITABLE HEALTHCARE INITIATIVES (NO CURRENT YEAR ACTIVITY) OR 501(C)(3) 10 SAMARITAN HEALTH SERVICES 0 GOOD SAMARITAN HOSPITAL FOUNDATION PO BOX 1068 CORVALLIS OR 97339 237252406 TO SUPPORT GOOD SAMARITAN HOSPITAL OR 501(C)(3) 7 GOOD SAMARITAN HOSPITAL 0 INTERCOMMUNITY HEALTH PLANS INC PO BOX 3000 CORVALLIS OR 973393000 931124326 CCO PROVIDING MGMT OF INTEGRATED HEALTH SVCS FOR MEDICAID/OHP ENROLLEES OR 501(C)(4) N/A SAMARITAN HEALTH SERVICES 0 LEBANON COMMUNITY HOSPITAL FOUNDATION PO BOX 739 LEBANON OR 97355 931260080 TO SUPPORT LEBANON COMMUNITY HOSPITAL OR 501(C)(3) 7 MID-VALLEY HEALTHCARE INC 0 MID-VALLEY HEALTHCARE INC PO BOX 3000 CORVALLIS OR 973393000 930396847 HOSPITAL SERVICES FOR THE COMMUNITY OR 501(C)(3) 3 SAMARITAN HEALTH SERVICES 0 PARADIGM INDEMNITY CORPORATION PO BOX 3000 CORVALLIS OR 973393000 731668317 PURE NON-PROFIT CAPTIVE INSURANCE COMPANY HI 501(C)(3) 12A, I SAMARITAN HEALTH SERVICES 0 SAMARITAN HEALTH SERVICES INC PO BOX 3000 CORVALLIS OR 973393000 930951989 PROVIDE HEALTHCARE SUPPORT SERVICES OR 501(C)(3) 12C, III-FI N/A 0 SAMARITAN NORTH LINCOLN HOSPITAL 3043 NE 28TH STREET LINCOLN CITY OR 97367 931305493 HOSPITAL SERVICES FOR THE COMMUNITY OR 501(C)(3) 3 SAMARITAN HEALTH SERVICES 0 GOOD SAMARITAN HOSPITAL CORVALLIS PO BOX 3000 CORVALLIS OR 973393000 930391573 HOSPITAL SERVICES FOR THE COMMUNITY OR 501(C)(3) 3 SAMARITAN HEALTH SERVICES 0 SAMARITAN SENIOR CARE INC PO BOX 3000 CORVALLIS OR 973393000 931245534 FUTURE CHARITABLE HEALTHCARE INITIATIVES (NO CURRENT YEAR ACTIVITY) OR 501(C)(3) 10 SAMARITAN HEALTH SERVICES 0 PACIFIC COMMUNITIES HEALTH DISTRICT PO BOX 873 NEWPORT OR 97365 930603489 HEALTHCARE DISTRICT OR GOV'T N/A 0 PACIFIC COMMUNITIES HEALTH DISTRICT FND PO BOX 945 NEWPORT OR 97365 930858825 TO SUPPORT PAC COMM HLTH DIST & SAMARITAN PAC HLTH SVCS OR 501(C)(3) 7 N/A 0 NORTH LINCOLN HOSPITAL FOUNDATION PO BOX 767 LINCOLN CITY OR 97367 930867677 TO SUPPORT SAMARITAN NORTH LINCOLN HOSPITAL OR 501(C)(3) 7 SAMARITAN NORTH LINCOLN HOSPITAL 0 SAMARITAN ENDOSCOPY CENTER LLC 3600 NW SAMARITAN DR CORVALLIS OR 97330 202860067 MEDICAL SERVICES OR N/A 0 0 CORVALLIS MEDICAL BUILDINGS LLC 3600 NW SAMARITAN DRIVE CORVALLIS OR 97330 931257913 REAL ESTATE RENTAL OR N/A 0 0 EAST LINN MRI LLC 3600 NW SAMARITAN DRIVE CORVALLIS OR 97330 320229399 IMAGING OR N/A 0 0 HULL IMAGING LLC 3600 NW SAMARITAN DRIVE CORVALLIS OR 97330 203255479 IMAGING OR N/A 0 0 CORVALLIS MRI LLC 3615 NW SAMARITAN DRIVE CORVALLIS OR 97330 930949704 IMAGING OR N/A 0 0 MID-VALLEY MEDICAL PROPERTIES ASSOC LLC 1046 SIXTH AVE SW ALBANY OR 97321 300508747 REAL ESTATE RENTAL OR N/A 0 0 MID-VALLEY MEDICAL BUILDINGS LLC PO BOX 557 LEBANON OR 97355 931126353 REAL ESTATE RENTAL OR N/A 0 0 NORTHWEST MEDICAL ISOTOPES LLC 815 NW 9TH ST STE 256 CORVALLIS OR 97330 273007752 RESEARCH OR N/A 0 0 CASCADE VIEW MEDICAL OFFICE BUILDING LLC PO BOX 3000 CORVALLIS OR 973393000 300658805 REAL ESTATE RENTAL OR N/A 0 0 BSM SURGERY CENTER LLC 1128 NE 2ND ST STE 201 CORVALLIS OR 97330 264349685 MEDICAL SERVICES OR N/A 0 0 AIKENS DIALYSIS LLC PO BOX 3004 TACOMA WA 98401 464459152 MEDICAL SERVICES WA N/A 0 0 SAMARITAN HEALTH PLANS INC 3600 NW SAMARITAN DRIVE CORVALLIS OR 97330 930860860 HEALTH INSURANCE CARRIER FOR THE COMMUNITY OR N/A C 0 BOULDER FALLS PROPERTIES LLC PO BOX 3000 CORVALLIS OR 973393000 465293120 EVENT CENTER & HOSPITALITY SVCS OR N/A C 0 0 0 1 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 INTERCOMMUNITY HEALTH PLANS INC L 25874055 COST