2024-11-12T12:35:05-06:00 2023-12-31 990 2023-01-01 930396847 MID-VALLEY HEALTHCARE INC MID- 5417684857 CO SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL B SMITH SVP / CFO 5417684857 2024-11-11 1 2023 2024-10-15 13:58:12Z SAMARITAN LEBANON COMMUNITY HOSPITAL WENDIE WUNDERWALD PO BOX 739 LEBANON OR 97355 191281665 0 X WWW.SAMHEALTH.ORG X 1950 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS HOSPITAL AND HEALTHCARE CLINICS. 13 10 982 145 962905 0 5549284 3181009 169752719 184655169 606518 1030351 840165 1047695 176748686 189914224 80479 71916 0 0 80479405 86422783 0 0 10695 70214482 72630281 150774366 159124980 25974320 30789244 126167372 157405279 14892506 14321298 111274866 143083981 X MID-VALLEY HEALTHCARE, INC. (MVH) ACHIEVES ITS MISSION OF IMPROVING THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH SERVICES OFFERED AT LEBANON COMMUNITY HOSPITAL AND SEVERAL LOCAL-AREA CLINICS.MVH 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 145342743 183824507 PROGRAM SERVICES:MID-VALLEY HEALTHCARE, INC. (MVH) INCLUDES SAMARITAN LEBANON COMMUNITY HOSPITAL, A 25-BED CRITICAL ACCESS HOSPITAL AND SEVERAL MEDICAL CLINICS. MVH HAS MORE THAN 950 EMPLOYEES AND 145 VOLUNTEERS SERVING THE MEDICAL NEEDS OF THE COMMUNITY. THE STAFF ARE COMMITTED TO PROVIDING PERSONALIZED, QUALITY CARE TO PATIENTS, AND TO PROMOTING THE GOOD HEALTH OF THE ENTIRE COMMUNITY. DURING 2023, MVH SERVED 1,441 INPATIENTS, HAD 23,261 EMERGENCY DEPARTMENT VISITS, PERFORMED 2,178 SURGERIES, AND DELIVERED 207 BABIES. IN ADDITION, MVH PERFORMED 67,472 IMAGING PROCEDURES AND HAD 103,911 PHYSICIAN CLINIC VISITS. 66916 66916 GRANTS:GRANTS (CASH AND IN-KIND) MADE BY MID-VALLEY HEALTHCARE TO VARIOUS ORGANIZATIONS TO REDUCE FOOD INSECURITY IN THE LOCAL COMMUNITY, AND TO SUPPORT MEDICAL, HOUSING, AND CHILD AND YOUTH SERVICES 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. 5000 5000 SCHOLARSHIPS PROVIDED BY THE HOSPITAL AUXILIARY TO APPLICANTS PURSUING HEALTHCARE EDUCATION. 145414659 1 1 0 0 0 0 0 0 0 1 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 1 1 1 0 1 0 0 982 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X SAMARITAN HEALTH SERVICES 5417684857 PO BOX 3000 CORVALLIS OR 973393000 RICHARD EVANS MD BOARD MEMBER / PHYSICIAN 40.00 X 334219 0 67580 JOURDAN HULL DO BOARD MEMBER / PHYSICIAN 40.00 X 284652 0 36928 RICHARD WOPAT MD BOARD MEMBER / PHYSICIAN 1.00 X 49275 0 0 RANDY SPRINGER BOARD PRESIDENT 1.00 2.00 X X 0 0 0 DEBBIE PAUL BOARD VICE PRESIDENT 1.00 1.00 X X 0 0 0 BOB ADAMS BOARD SECRETARY 1.00 2.00 X X 0 0 0 LOREN ROTH BOARD TREASURER 1.00 1.00 X X 0 0 0 LINN ARMSTRONG BOARD MEMBER 1.00 1.00 X 0 0 0 MARSHA PHILPOTT BOARD MEMBER 1.00 X 0 0 0 MILTON MORAN BOARD MEMBER 1.00 1.00 X 0 0 0 BRENT KAUFFMAN BOARD MEMBER 1.00 X 0 0 0 PAULA CRONE DO BOARD MEMBER 1.00 X 0 0 0 RACHEL HANKINS BOARD MEMBER 1.00 X 0 0 0 DANIEL SMITH SVP / CFO 2.00 38.00 X 0 679354 68167 JOSEPH CAHILL CEO (JAN - NOV) / SVP COO - SHS 39.00 1.00 X 0 499536 54409 WENDIE WUNDERWALD VP PAT CARE SVCS / CEO (START NOV) 40.00 X 235088 34544 55925 DANIEL SPRAGUE MD PHYSICIAN 40.00 X 534111 0 66708 VANESSA PAPALAZAROS MD MEDICAL DIRECTOR 40.00 X 495519 0 66414 TASHA BARKLEY MD MEDICAL DIRECTOR 40.00 X 475170 0 69503 MAUREEN BRUNS MD MEDICAL DIRECTOR 40.00 X 440035 0 60671 SEAN PRENDERGAST MD PHYSICIAN 40.00 X 452125 0 42995 3300194 1213434 589300 192 0 1 0 0 672237 2508772 3181009 NET PATIENT REVENUE 622110 172790487 172790487 RETAIL PHARMACY 456110 8910099 8079437 830662 QUALITY INCENTIVES 622110 1968802 1968802 MEDICAL DIRECTOR FEES 900099 780063 780063 OTHER PATIENT REVENUE 622110 127849 127849 77869 77869 184655169 640428 640428 298940 165185 133755 133755 133755 1517364 1127441 389923 389923 389923 135027 74815 60212 60212 CAFETERIA 722210 721485 721485 OCCUPANCY SERVICES 531390 132243 132243 853728 189914224 183824507 962905 1945803 X 66916 66916 5000 5000 1056235 1056235 65350488 64282630 1067858 3359791 3305764 54027 11874477 11683530 190947 4781792 4704899 76893 25739 25739 13701 13701 6530008 6488078 41930 36847 34155 2692 3269188 3121019 147966 203 5131355 4930239 201116 1818461 1811150 7311 73080 67755 4313 1012 261966 258304 3662 766970 736910 30060 2271540 2183886 87654 1781890 1781890 MEDICAL SUPPLIES 24452819 24452819 PURCHASED SERVICES 17220597 5481667 11729450 9480 PROVIDER TAXES 8428685 8428685 DUES, TAXES, & LICENSES 547435 533128 14307 159124980 145414659 13699626 10695 99432 113635 25398005 26607099 173898 260081 1857986 2130174 136071 165395 84119602 48215226 26558769 35904376 12167426 13938684 163384 139288 59612401 78146547 126167372 157405279 9757300 9296920 251634 1020644 4883572 4003734 14892506 14321298 X 111274866 143083981 111274866 143083981 126167372 157405279 X 30789244 941224 78647 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3953141 56995 534843 9113 4535866 4611462 1000 -650516 8805 3953141 4147880 474953 11371 4611462 3723202 434626 9948 4147880 3183448 549023 9269 3723202 0.92400 0.04200 0.03400 0 1 1 897939 897939 2408999 56732603 31018849 28122753 150264 129969 20295 18365200 14447639 3917561 5564597 2618769 2945828 35904376 OTHER ASSETS 2310922 ACCOUNTS RECEIVABLE - AFFILIATES 75835625 78146547 PROFESSIONAL LIABILITY RESERVE 618000 CONTRACTUAL REIMBURSEMENT OBLIGATIONS 3070266 OTHER LIABILITIES 315468 4003734 X PART V, LINE 4: THE LEBANON COMMUNITY HOSPITAL FOUNDATION (LCHF) HOLDS ENDOWMENT FUNDS THAT WILL ULTIMATELY BENEFIT THE HOSPITAL. THE BOARD-DESIGNATED ENDOWMENT FUND IS USED FOR GENERAL HOSPITAL SUPPORT. THE GENERAL ENDOWMENT FUND IS USED TO FUND HOSPITAL EQUIPMENT PURCHASES AND OTHER VARIOUS SUPPORT PROGRAMS OF THE HOSPITAL. THE HEALING GARDEN ENDOWMENT FUND IS FOR MAINTENANCE AND UPDATES OF THE HEALING GARDENS AT THE HOSPITAL AND THE ADJACENT SAMARITAN HEALTH SCIENCES CAMPUS. 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, 2023, 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 2020. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 19 14883 1756896 1756896 0.01100 16 92185 43077867 50745184 0 0.00000 35 107068 44834763 50745184 1756896 0.01100 4 2211 44344 4292 40052 0.00030 3 204 1619987 1619987 0.01020 16 46896 17207285 11706813 5500472 0.03460 5 15302 587137 587137 0.00370 28 64613 19458753 11711105 7747648 0.04880 63 171681 64293516 62456289 9504544 0.05980 1 27 502276 502276 0.00320 1 27 502276 502276 0.00320 0 1362356 17822588 17646127 176461 X 1 1 1 MID-VALLEY MEDICAL BUILDINGS REAL PROPERTY RENTAL 0.20000 0.41700 2 EAST LINN MRI LLC IMAGING SERVICES 0.60000 0.40000 1 1 LEBANON COMMUNITY HOSPITAL 525 N SANTIAM HWY LEBANON OR 97355 WWW.SAMHEALTH.ORG STATE LICENSE NUMBER: 14-1453 X X X X LEBANON COMMUNITY HOSPITAL 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 23 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 LEBANON COMMUNITY HOSPITAL 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 LEBANON COMMUNITY 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 LINN COUNTY HEALTH DEPARTMENT, COMMUNITY OUTREACH INC., THE BENTON EAST LINN HEALTH CENTER, OREGON STATE UNIVERSITY, SAMARITAN HEALTH PLANS, WESTERN UNIVERSITY-COMP NORTHWEST, LINN-BENTON COMMUNITY COLLEGE, THE GREATER ALBANY PUBLIC 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, THE INREACH CLINIC, THE BOYS AND GIRLS CLUB OF ALBANY, THE MENNONITE VILLAGE, THE UNITED WAY OF LINN, BENTON AND LINCOLN COUNTIES, THE BOYS & GIRLS CLUB OF THE GREATER SANTIAM, THE RIVER CENTER, SWEET HOME EMERGENCY MINISTRIES, THE LEBANON SCHOOL DISTRICT, THE SWEET HOME SCHOOL DISTRICT, THE CENTRAL LINN SCHOOL DISTRICT, THE LINN-BENTON-LINCOLN EARLY LEARNING HUB, THE LINN-BENTON HISPANIC ADVISORY COUNCIL, THE LINN COUNTY ORAL HEALTH COALITION, AND THE REGIONAL MENTAL HEALTH/SUBSTANCE USE DISORDER COALITION. LEBANON COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: ALBANY GENERAL HOSPITAL LEBANON COMMUNITY HOSPITAL 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. LEBANON COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: COPIES OF THE CHNA WERE EMAILED TO KEY COMMUNITY PARTNERS AND DISTRIBUTED TO LOCAL LIBRARIES, COUNTY OFFICES, SCHOOL DISTRICT OFFICES AND DURING LOCAL COALITION MEETINGS. LEBANON COMMUNITY HOSPITAL 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. LEBANON COMMUNITY HOSPITAL 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. 15 1 - SAMARITAN FAMILY MED BROWNSVILLE 157 SPAULDING AVE BROWNSVILLE OR 97327 MEDICAL CLINIC - OUTPATIENT 2 - SAMARITAN TREATMENT SVCS - OUTPATIENT 111 N MAIN ST STE A LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 3 - SAMARITAN RECOVERY CLINIC - LEBANON 100 MULLINS DRIVE STE C1 LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 4 - MAIN STREET FAMILY MEDICINE 191 N MAIN ST LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 5 - PARK STREET CLINIC 325 PARK STREET LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 6 - SAMARITAN URGENT CARE LEBANON 35 MULLINS DRIVE STE 2 LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 7 - SAMARITAN FAMILY MED RESIDENT CLINIC 425 N SANTIAM HWY LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 8 - EAST LINN MRI LLC 505 N SANTIAM HWY LEBANON OR 97355 MRI-IMAGING 9 - SAMARITAN LEBANON HEALTH CENTER 675 N 5TH STREET STE 200 LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 10 - SAMARITAN SPECIALTY CLINIC - LEBANON 675 N 5TH STREET LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 11 - SWEET HOME PHYS REHAB & SPORTS MED 646 HOLLEY RD SWEET HOME OR 97386 MEDICAL CLINIC - OUTPATIENT 12 - SWEET HOME FAMILY MEDICINE 679 MAIN STREET SWEET HOME OR 97386 MEDICAL CLINIC - OUTPATIENT 13 - SAMARITAN OCCUPATIONAL MED - LEBANON 100 MULLINS DRIVE STE B2 LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 14 - SAMARITAN MED GRP GERIATRIC MEDICINE 100 MULLINS DRIVE STE C2 LEBANON OR 97355 MEDICAL CLINIC - OUTPATIENT 15 - SAMARITAN TMT SVCS - RESIDENTIAL 111 N MAIN ST STE B LEBANON OR 97355 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 2023 IS $4,121,795. PART II, COMMUNITY BUILDING ACTIVITIES: MVH PROVIDES SERVICES AND ACTIVITIES THAT ARE CLASSIFIED AS COMMUNITY BUILDING TO PROMOTE THE HEALTH OF LINN COUNTY. RECOGNIZING THAT THE HEALTH OF A COMMUNITY ENCOMPASSES MULTIPLE FACTORS, MVH LEADERSHIP AND STAFF ARE INVOLVED IN A VARIETY OF ACTIONS THAT WORK TO IMPROVE COMMUNITY OUTCOMES. DURING 2023, MVH HAD A PARTNERSHIP WITH THE BOYS & GIRLS CLUB OF ALBANY AND A PRIVATE PRACTICE DENTIST TO PROVIDE EMERGENCY DENTAL SERVICES TO UNINSURED AND UNDERINSURED ADULTS IN THE COMMUNITY. THIS PARTNERSHIP HAS RESULTED IN 273 ADULTS RECEIVING EMERGENCY DENTAL CARE SERVICES THAT IN TURN REDUCES THE NUMBER OF ADULTS VISITING THE EMERGENCY DEPARTMENT FOR DENTAL NEEDS. MVH BELIEVES THAT TRAINED AND COMPETENT STAFF IN ALL ASPECTS OF THE ORGANIZATION PROMOTES COMMUNITY HEALTH. MVH ACTIVELY PARTICIPATES IN WORKFORCE DEVELOPMENT IN PARTNERSHIP WITH OREGON STATE UNIVERSITY, LINN-BENTON COMMUNITY COLLEGE, AND WESTERN UNIVERSITY-COMP NW TO RECRUIT, TRAIN AND RETAIN HEALTHCARE WORKERS AT ALL LEVELS. MVH ALSO HOSTS LOCAL EVENTS SUPPORTED BY THE HOSPITAL'S FOUNDATION AND OTHER DEPARTMENTS IN THE ORGANIZATION. ANNUAL EVENTS SUCH AS SENIOR HEALTH FAIRS, LATINO OUTREACH AND EDUCATION, THE CHILDREN'S WEEKEND MALL HEALTH EDUCATION PROGRAM, THE LINN COUNTY FAIR AND THE HOMELESS ENGAGEMENT AND RESOURCE TEAM PROJECT ARE A FEW EXAMPLES OF HOW MVH PROMOTES THE HEALTH OF THE COMMUNITY. MVH HAS BEEN ACTIVELY IMPLEMENTING THE SAMARITAN HEALTH SERVICES EQUITY AND INCLUSION PLAN TO OPTIMIZE OUR SERVICE DELIVERY PROCESS TO UNDERSERVED, UNDERREPRESENTED, AND MARGINALIZED COMMUNITIES. MVH IS PROVIDING EDUCATION AND TRAINING TO ALL STAFF ON EQUITY, DIVERSITY AND INCLUSION TOPICS THAT WILL IMPROVE THE PATIENT EXPERIENCE AT OUR HOSPITAL AND CLINICS. MVH ALSO PROVIDES OPPORTUNITIES FOR COMMUNITY MEMBERS TO OBTAIN TRAINING ON CIVIC AND CULTURAL ISSUES THAT IMPACT HEALTH. SOME OF THE TRAINING OPPORTUNITIES INCLUDED HEALTHY LIFESTYLE AND FITNESS CLASSES, AND HEALTH EQUITY TRAININGS. MVH STAFF SERVED ON MANY LOCAL COALITIONS AND BOARDS THAT PROMOTE THE HEALTH OF THE COMMUNITY. BOARD AFFILIATIONS INCLUDE, BUT ARE NOT LIMITED TO, COMMUNITY OUTREACH INC., SOROPTIMISTS INTERNATIONAL, THE BOYS & GIRLS CLUB OF THE GREATER SANTIAM, AND THE UNITED WAY OF BENTON, LINN AND LINCOLN COUNTIES. ADDITIONALLY, MVH STAFF SERVED ON THE OREGON HEALTH POLICY ADVISORY BOARD, THE OREGON HEALTH RESOURCES COMMISSION, THE MEDICAID ADVISORY COMMITTEE, 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: MID-VALLEY HEALTHCARE, INC. (MVH) INCLUDES SAMARITAN LEBANON COMMUNITY HOSPITAL (SLCH), 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 2023 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: MID-VALLEY HEALTHCARE, INC. (MVH) WHICH INCLUDES LEBANON COMMUNITY HOSPITAL ACTIVELY PARTICIPATES IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY. EVERY THREE YEARS, AS REQUIRED BY FEDERAL AND STATE LAW, LCH 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 LINN 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 LINN COUNTY. EACH YEAR THE MVH 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: MVH 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. MVH 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: MVH PRIMARILY SERVES THE RESIDENTS OF EAST LINN COUNTY. LINN COUNTY IS DESIGNATED AS A RURAL COUNTY; HOWEVER, IT MAINTAINS THE HIGHEST TOTAL POPULATION IN THE TRI-COUNTY REGION, WITH 130,467 (2022 U.S. CENSUS) RESIDENTS. MAJOR CITIES IN LINN COUNTY INCLUDE ALBANY, THE COUNTY SEAT, LEBANON AND SWEET HOME WITH 29% PERCENT OF THE POPULATION LIVING IN RURAL UNINCORPORATED AREAS. WITHIN EAST LINN COUNTY, THE CITIES OF LEBANON AND SWEET HOME ARE LOW-INCOME MEDICALLY UNDERSERVED POPULATION DESIGNATED AREAS. THE LINN COUNTY MIGRANT SEASONAL FARMWORKER POPULATION HAS BEEN DESIGNATED A PRIMARY MEDICAL CARE HEALTH PROVIDER SHORTAGE AREA BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION. A SISTER HOSPITAL, ALBANY GENERAL HOSPITAL, PRIMARILY SERVES RESIDENTS OF WEST LINN COUNTY. THE MAJOR CITIES IN LINN COUNTY ARE OUTLINED BELOW: COMMUNITY POPULATIONALBANY 56,828LEBANON 18,945SWEET HOME 9,955SOURCE: U.S. CENSUS BUREAU, 2022 CENSUS QUICK FACTS, PUBLIC LAW 94-171 SUMMARY FILETHE CHART BELOW SUMMARIZES THE RACIAL AND ETHNIC DEMOGRAPHICS OF LINN COUNTY:WHITE/CAUCASIAN 91.9%BLACK/AFRICAN AMERICAN 0.8%AMERICAN INDIAN/ALASKA NATIVE 1.8%ASIAN 1.3%NATIVE HAWAIIAN/PACIFIC ISLANDER 0.2%LATINO 10.2%REPORTING TWO OR MORE RACES 3.7%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 LINN COUNTY:HEALTH AND SOCIAL INDICATORS TOTALSMEDIAN INCOME $63,313UNEMPLOYMENT 4.0%POVERTY 12.1%CHILD ABUSE 16.0%TEEN PREGNANCY 12.6%JUVENILE JUSTICE REFERRALS 19.2/1000SOURCE: OREGON EMPLOYMENT DEPARTMENT DECEMBER 2022, U.S. CENSUS BUREAU, 2022 CENSUS QUICK FACTS, PUBLIC LAW 94-171 SUMMARY FILE, 2022 CHILD WELL-BEING IN OREGON COUNTY DATA BOOK, 2022 COUNTY HEALTH RANKINGS, OREGON HEALTH AUTHORITY TEEN PREGNANCY RATES 2022. PART VI, LINE 5: MVH'S GOVERNING BOARD IS COMPRISED OF LOCAL-AREA RESIDENTS. THE MAJORITY OF THE BOARD MEMBERS ARE INDEPENDENT, MEANING THEY AND THEIR FAMILY MEMBERS ARE NOT EMPLOYEES OF MVH NOR DO THEY HAVE SIGNIFICANT BUSINESS RELATIONSHIPS WITH MVH. MVH EXTENDS ITS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. MVH APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. MVH INVESTS IN UPDATING EQUIPMENT, TECHNOLOGY AND FACILITIES TO IMPROVE PATIENT CARE. MVH 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 MVH'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 MVH AND ITS AFFILIATED HOSPITALS. MVH ALSO PROVIDES SCHOLARSHIPS FOR STUDENTS AND EMPLOYEES IN HEALTH OCCUPATIONS. PART VI, LINE 6: "BUILDING HEALTHIER COMMUNITIES TOGETHER" IS THE MISSION OF SAMARITAN HEALTH SERVICES (SHS), A NETWORK OF OREGON HOSPITALS AND PHYSICIANS THAT SERVE 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 A 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.MVH'S SAMARITAN LEBANON COMMUNITY HOSPITAL IS A 25-BED CRITICAL ACCESS HOSPITAL PRIMARILY SERVING RESIDENTS IN EAST LINN COUNTY. OTHER SHS-AFFILIATED HOSPITALS ARE GOOD SAMARITAN HOSPITAL, SERVING RESIDENTS OF BENTON COUNTY, ALBANY GENERAL HOSPITAL, SERVING RESIDENTS OF LINN COUNTY, AND SAMARITAN NORTH LINCOLN HOSPITAL AND SAMARITAN PACIFIC COMMUNITIES HOSPITAL, SERVING RESIDENTS OF LINCOLN COUNTY. PART VI, LINE 7, REPORTS FILED WITH STATES OR 1 OREGON CASCADES WEST SENIOR SERVICES FOUNDATION 1400 QUEEN AVE SE STE 206 ALBANY OR 97322 931213218 501(C)(3) 9825 0 SUPPORT FOR THE MEALS ON WHEELS PROGRAM FOR LOCAL SENIOR CITIZENS JACKSON STREET YOUTH SHELTER PO BOX 285 CORVALLIS OR 97339 931269503 501(C)(3) 7500 0 SUPPORT FOR HOMELESS YOUTH SERVICES CASA LATINOS UNIDOS BENTON COUNTY 1435 SW 35TH ST CORVALLIS OR 97333 263639798 501(C)(3) 6075 0 PROVIDES FINANCIAL EDUCATION INCLUDING BUDGETING & MONEY MANAGEMENT 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 DANIEL SMITH SVP / CFO 0 510893 0 119250 0 49211 0 26592 0 41575 0 747521 0 0 DANIEL SPRAGUE MD PHYSICIAN 532569 0 0 0 1542 0 24489 0 42219 0 600819 0 0 0 VANESSA PAPALAZAROS MD MEDICAL DIRECTOR 439249 0 55666 0 604 0 26592 0 39822 0 561933 0 0 0 JOSEPH CAHILL CEO (JAN - NOV) / SVP COO - SHS 0 384176 0 82967 0 32393 0 26592 0 27817 0 553945 0 0 TASHA BARKLEY MD MEDICAL DIRECTOR 452138 0 0 0 23032 0 26592 0 42911 0 544673 0 0 0 MAUREEN BRUNS MD MEDICAL DIRECTOR 336723 0 76596 0 26716 0 26592 0 34079 0 500706 0 0 0 SEAN PRENDERGAST MD PHYSICIAN 425431 0 0 0 26694 0 26592 0 16403 0 495120 0 0 0 RICHARD EVANS MD BOARD MEMBER / PHYSICIAN 307617 0 0 0 26602 0 26592 0 40988 0 401799 0 0 0 WENDIE WUNDERWALD VP PAT CARE SVCS / CEO (START NOV) 197482 22191 20323 0 17283 12353 20256 5038 28237 2394 283581 41976 0 0 JOURDAN HULL DO BOARD MEMBER / PHYSICIAN 269288 0 0 0 15364 0 22056 0 14872 0 321580 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. ONE BOARD MEMBER, TWO OFFICERS, AND FOUR HIGHEST PAID EMPLOYEES 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 MID-VALLEY HEALTHCARE, INC. HAS A SOLE CORPORATE MEMBER, SAMARITAN HEALTH SERVICES, WHICH IS A SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A MID-VALLEY HEALTHCARE, INC. 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, COL D THE FUNDRAISING FUNCTIONS FOR THE FILING ORGANIZATION ARE CENTRALIZED THROUGH AND REPORTED BY THE PARENT ORGANIZATION, 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: DISTRIBUTIONS TO MINORITY INTEREST IN CONSOLIDATED JVS -552,000. OTHER CHANGES 5,647. NET ASSETS TRANSFERED FOR CAPITAL 625,000. 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 1 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 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 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 SAMARITAN PACIFIC HEALTH SERVICES 930 SW ABBEY STREET NEWPORT OR 97365 931329784 HOSPITAL SERVICES FOR THE COMMUNITY OR 501(C)(3) 3 SAMARITAN HEALTH SERVICES 0 SAMARITAN SENIOR CARE INC PO BOX 3000 CORVALLIS OR 973393000 931245534 FUTURE CHARITABLE HEALTHCARE INITIATIVES (NO CURRENT YEAR ACTIVITY) OR 501(C)(3) 10 SAMARITAN HEALTH SERVICES 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 MID-VALLEY HEALTHCARE INC RELATED 827508 38763 0 1 0.60000 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 EXCLUDED 89700 154925 0 1 0.20000 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 1 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 INTERCOMMUNITY HEALTH PLANS INC L 37042181 COST EAST LINN MRI LLC A 186490 COST EAST LINN MRI LLC O 575463 COST EAST LINN MRI LLC S 552000 COST EAST LINN MRI LLC R 56247 COST LEBANON COMMUNITY HOSPITAL FOUNDATION C 667437 COST