2024-04-01T13:28:39-05:00 2023-06-30 990 2022-07-01 930858825 PACIFIC COMMUNITIES HEALTH DISTRICT FND PACI 5415744745 PO BOX 945 NEWPORT OR 97365 KARLA CLEM EXECUTIVE DIRECTOR 5415744745 2024-03-26 KARLA CLEM 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KARLA CLEM PO BOX 945 NEWPORT OR 97365 2656826 0 X WWW.SAMHEALTH.ORG/PCHDF X 1996 OR TO SUPPORT HEALTH DISTRICT CAPITAL PURCHASES AND TO SUPPORT HOSPITAL OPERATIONS. 17 16 0 30 0 0 511443 1763849 0 0 90555 18189 2931 28782 604929 1810820 576806 135540 0 0 0 0 0 0 0 18793 16308 595599 151848 9330 1658972 1012813 2693864 64815 10721 947998 2683143 PACIFIC COMMUNITIES HEALTH DISTRICT FOUNDATION WAS ESTABLISHED FOR THE PURPOSE OF DEVELOPING PHILANTHROPIC FUNDS FOR THE BENEFIT OF PACIFIC COMMUNITIES HEALTH DISTRICT (PCHD) AND/OR SAMARITAN PACIFIC HEALTH SERVICES, DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL (SPCH). 0 0 78305 78305 GRANTS TO INDIVIDUALS. SEE SCHEDULE I, PART III FOR MORE DETAILS 57235 57235 GRANTS TO SAMARITAN PACIFIC COMMUNITIES HOSPITAL (SPCH) AND SAMARITAN HEALTH SERVICES (SHS) FOR OPERATING NEEDS. SEE SCHEDULE I, PART II. 135540 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 17 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X PACIFIC COMMUNITIES HEALTH DISTRICT FND 5415744745 PO BOX 945 NEWPORT OR 97365 JULIA CARLSON PRESIDENT 1.00 X X 0 0 0 MATT UPDENKELDER VICE PRESIDENT 1.00 X X 0 0 0 DAVID LARSEN MD SECRETARY / PHYSICIAN 1.00 39.00 X X 0 516963 62483 GEORGE PLANT TREASURER 1.00 X X 0 0 0 LALORI LAGER TRUSTEE 1.00 X 0 0 0 JOHN BAKER TRUSTEE 1.00 X 0 0 0 CLAIRE BARTON TRUSTEE 1.00 X 0 0 0 ROSA COPPOLA TRUSTEE 1.00 X 0 0 0 TIANA DEVRIES TRUSTEE 1.00 X 0 0 0 MARK FARLEY TRUSTEE 1.00 X 0 0 0 KATHLEEN GRADY TRUSTEE 1.00 X 0 0 0 CM HALL TRUSTEE 1.00 X 0 0 0 K SCARLETT KIER TRUSTEE 1.00 X 0 0 0 JENNIFER LANDERS TRUSTEE 1.00 X 0 0 0 TIM MILLER TRUSTEE 1.00 X 0 0 0 JACKIE STANKEY TRUSTEE 1.00 X 0 0 0 NANCY STEVENS TRUSTEE 1.00 X 0 0 0 MARK MIRANDA TRUSTEE 1.00 X 0 0 0 LANCE NUNN TRUSTEE 1.00 X 0 0 0 JAMIE RUSSELL TRUSTEE 1.00 X 0 0 0 URSULA MARINELLI EXECUTIVE DIRECTOR 40.00 X 0 138633 20632 0 655596 83115 0 0 1 0 0 46225 25000 500000 1192624 1650 1763849 30766 30766 807412 819989 -12577 -12577 -12577 54799 46225 26017 28782 28782 1810820 0 0 46971 57235 57235 78305 78305 8500 8500 2027 2027 5386 5386 LICENSES & FEES 395 395 151848 135540 16308 0 23103 33930 55387 777364 102188 649987 832135 1226896 0 5687 1012813 2693864 64815 10721 64815 10721 X 231907 378170 716091 2304973 947998 2683143 1012813 2693864 1658972 76173 0 X 0 1 X 1 0 X 558302 291026 315030 511443 1763849 3439650 558302 291026 315030 511443 1763849 3439650 497372 2942278 19746 32910 26986 21049 30766 131457 21839 19337 3491 2931 28782 76380 3647487 0.80670 0.84940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 163304 2000 16376 378 181302 174956 16688 -27873 467 163304 140198 35248 490 174956 137378 2430 802 412 140198 32131 100625 4776 154 137378 0.80100 0.19900 0 0 0 X 2344564 76173 459598 535771 1808793 2027 2027 1810820 609419 459598 459598 149821 2027 2027 151848 PART V, LINE 4: TO SUPPORT SPECIAL PROGRAMS, TO PRESERVE CAPITAL AND PURCHASING POWER, AND TO ENHANCE CURRENT INCOME FOR PCHD AND/OR SPCH. PART X, LINE 2: THE FOUNDATION IS A TAX-EXEMPT ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE SECTION 501(C)(3) AND OREGON REVISED STATUTES 317.080. IN ADDITION, THE FOUNDATION IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS ON A ROUTINE BASIS, AND NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. IN THE OPINION OF MANAGEMENT, THERE IS NO MATERIAL UNRELATED TRADE OR BUSINESS INCOME THEREFORE THERE IS NO PROVISION FOR INCOME TAX RECOGNIZED ON THE FINANCIAL STATEMENTS. THE FOUNDATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2020. 2022 GALA 96024 41225 54799 64 2800 16244 350 3632 2023 GALA 5000 5000 2500 101024 46225 54799 64 2800 16244 350 6132 25590 29209 1 SAMARITAN PACIFIC HEALTH SERVICES 930 SW ABBEY ST NEWPORT OR 97365 931329784 501(C)(3) 28722 0 HOSPITAL OPERATIONS SAMARITAN HEALTH SERVICES PO BOX 3000 CORVALLIS OR 97339 930951989 501(C)(3) 24680 0 EQUIPMENT 2 SPCH EMPLOYEE EMERGENCY GRANTS 13 23374 HOSPICE PATIENT GRANTS 35 9534 CANCER PATIENT SUPPORT GRANTS 46 19256 GENERAL PATIENT SUPPORT GRANTS 275 17141 NURSING SCHOLARSHIPS 3 9000 PART I, LINE 2: GRANTS ARE PAID OUT ON A LUMP SUM OR REIMBURSEMENT BASIS. LUMP SUM GRANTS ARE MONITORED BY REQUIRING PROGRESS REPORTS AND/OR DEPARTMENT MANAGER OVERSIGHT. GRANTS PAID OUT ON A REIMBURSEMENT BASIS REQUIRE SUBSTANTIATING DOCUMENTATION WHICH MUST BE SUBMITTED PRIOR TO PAYMENT. SPCH EMPLOYEE EMERGENCY REQUESTS ARE BASED ON EMPLOYEES' YEARS OF SERVICE. THEY ARE CAPPED AT A CUMULATIVE AMOUNT OF $3,000 IN THE FIRST 9 YEARS OF SERVICE, $4,500 FOR 10-19 YEARS OF SERVICE, AND UP TO $6,000 AFTER 20 YEARS OF SERVICE. APPLICATIONS ARE REVIEWED AND APPROVED BY A COMMITTEE WHILE KEEPING THE EMPLOYEE APPLICANT ANONYMOUS. THE COMMITTEE MAY CONSIDER A ONE-TIME EXCEPTION TO THE FUNDING LIMITS IN RARE AND EXTREME CIRCUMSTANCES, SUCH AS DURING A WIDESPREAD EMERGENCY OR A NATURAL DISASTER. HOSPICE PATIENT GRANTS ARE PAID DIRECTLY TO THE VENDOR IN MOST CASES. RARE EXCEPTIONS MAY BE MADE TO PAY DIRECTLY TO THE PATIENT FAMILY CAREGIVER WITH PROPER APPROVAL FOLLOWING A NEEDS ASSESSMENT. THESE GRANTS ARE CAPPED AT $750, WITH ONE TIME ELIGIBILITY. POTENTIALLY ELIGIBLE PATIENTS ARE REFERRED THROUGH AN SHS AGENT TO FINANCIALLY VET THE PATIENT FOR PATIENT SUPPORT PROGRAMS. PATIENTS WILL QUALIFY IF THEIR INCOME IS AT OR BELOW 300% OF THE FEDERAL POVERTY LIMIT FOR THEIR FAMILY SIZE. DIFFERENT FUNDING LEVELS ARE AVAILABLE DEPENDING ON THE FUND. LIMITS RANGE FROM $250-$500 OF ANNUAL FUNDING. SCHOLARSHIPS ARE PAID EITHER DIRECTLY TO THE EDUCATIONAL INSTITUTION OR ON A REIMBURSEMENT BASIS WITH SUBSTANTIATING DOCUMENTATION. SCHOLARSHIPS ARE MONITORED BETWEEN THE EDUCATIONAL INSTITUTION AND THE FOUNDATION STAFF. 0 0 0 0 0 0 0 0 0 DAVID LARSEN MD SECRETARY / PHYSICIAN 0 486985 0 28631 0 1347 0 24620 0 37863 0 579446 0 0 URSULA MARINELLI EXECUTIVE DIRECTOR 0 126736 0 0 0 11897 0 7699 0 12933 0 159265 0 0 PART I, LINE 3 THE EXECUTIVE DIRECTOR 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. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE AND INVESTMENT COMMITTEE REVIEWS IRS FORM 990 BEFORE FILING. COPIES ARE MADE AVAILABLE TO THE BOARD BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, & KEY EMPLOYEES HAVE A DUTY TO DISCLOSE ANY FINANCIAL INTERESTS THAT MAY POSE A CONFLICT. THE BOARD REVIEWS ALL MATERIAL FACTS & DETERMINES IF A CONFLICT OF INTEREST EXISTS. POLICY VIOLATIONS MAY RESULT IN DISCIPLINARY ACTION. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR 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. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. SAMARITAN PACIFIC HEALTH SERVICES 930 SW ABBEY ST NEWPORT OR 97365 931329784 HOSPITAL SERVICES FOR THE COMMUNITY OR 501(C)(3) 3 SAMARITAN HEALTH SERVICES 0 PACIFIC COMMUNITIES HEALTH DISTRICT PO BOX 873 NEWPORT OR 97365 930603489 HEALTHCARE DISTRICT OR GOV'T N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0