2024-11-12T12:35:05-06:00 2023-12-31 990 2023-01-01 930867677 NORTH LINCOLN HOSPITAL FOUNDATION NORT 5417686132 PO BOX 767 LINCOLN CITY OR 97367 DANIEL SMITH SVP / CFO 5417686132 2024-11-11 1 2023 2024-10-15 13:58:12Z LESLIE JAMES PO BOX 767 LINCOLN CITY OR 97367 1300610 0 X WWW.SAMHEALTH.ORG X 1983 OR TO SUPPORT SAMARITAN NORTH LINCOLN HOSPITAL AND SERVE THE COMMUNITY. 14 14 0 16 0 0 1567594 474154 0 0 31164 37765 2039 56313 1600797 568232 697849 197853 0 0 0 0 0 0 0 11333 15129 709182 212982 891615 355250 2410961 2886113 9802 7788 2401159 2878325 TO PROMOTE EXCELLENCE IN HEALTHCARE BY SUPPORTING SAMARITAN NORTH LINCOLN HOSPITAL AND INITIATIVES FOR THE HEALTH AND WELL-BEING OF THE COMMUNITY, THROUGH CHARITABLE GIVING. 0 0 112033 112033 GRANTS AND ASSISTANCE PROVIDED TO INDIVIDUALS TO BENEFIT THE COMMUNITY IN THE FOLLOWING WAYS:1)PROVIDED EMERGENCY FINANCIAL ASSISTANCE TO HOSPITAL EMPLOYEES IN NEED. 2)PROVIDED PATIENT FINANCIAL SUPPORT FOR HOSPICE PATIENTS AS WELL AS OTHER PATIENT SUPPORT PROGRAMS.3)PROVIDED FUNDING FOR NEEDY FAMILY MEMBERS OF PATIENTS STAYING AT THE PASTEGA GUEST HOUSE WHILE THEIR FAMILY MEMBERS RECEIVE TREATMENT AT THE HOSPITAL.SEE SCHEDULE I, PART III FOR GRANTS LARGER THAN 5,000. 85820 85820 GRANTS TO THE HOSPITAL AND SUPPORTING ORGANIZATIONS OR PROGRAMS FOR OPERATING AND CAPITAL COSTS. SIGNIFICANT GRANTS DURING 2023 INCLUDED FUNDING FOR EQUIPMENT TO BE USED IN THE HOSPITAL FACILITY AND FUNDING FOR HOSPITAL OPERATIONS.SEE SCHEDULE I, PART II FOR GRANTS LARGER THAN 5,000. 197853 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 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 14 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X SAMARITAN HEALTH SERVICES 5417684857 PO BOX 3000 CORVALLIS OR 973393000 WENDY WILSON BOARD PRESIDENT 2.00 X X 0 0 0 ANN BUTLER BOARD VICE-PRESIDENT 2.00 1.00 X X 0 0 0 CECELIA BUGGENHAGEN BOARD SECRETARY 2.00 X X 0 0 0 MARK SANDERS BOARD TREASURER 2.00 X X 0 0 0 DUANE SILBERNAGEL BOARD PAST PRESIDENT 2.00 X X 0 0 0 BETTYE RUTH GAMESTER TRUSTEE 1.00 X 0 0 0 CHARSLY AFFUSO TRUSTEE 1.00 X 0 0 0 CHARLOTTE LEHTO TRUSTEE 1.00 X 0 0 0 ADAM CREIGHTON TRUSTEE 1.00 X 0 0 0 MARIA DE LOURDES CRUZ TRUSTEE 1.00 X 0 0 0 WILLIAM HANSON TRUSTEE 1.00 1.00 X 0 0 0 JOAN PRINS TRUSTEE 1.00 X 0 0 0 LINDA ROY TRUSTEE 1.00 X 0 0 0 RANDALL KELLY TRUSTEE 1.00 X 0 0 0 KALI MAYS TRUSTEE 1.00 X 0 0 0 NIKKI THOMPSON TRUSTEE 1.00 X 0 0 0 DANIEL SMITH SVP / CFO 1.00 39.00 X 0 679354 68167 URSULA MARINELLI REGIONAL EXECUTIVE DIR 20.00 20.00 X 0 144493 19727 LESLIE JAMES EXECUTIVE DIRECTOR 40.00 X 0 84835 19427 0 908682 107321 0 0 1 0 0 148791 100000 225363 6322 474154 43373 43373 669713 675321 -5608 -5608 -5608 113370 148791 57057 56313 56313 568232 0 0 94078 85820 85820 112033 112033 6000 6000 3313 3313 5136 5136 LICENSES & FEES 680 680 212982 197853 15129 0 187473 431424 302167 744679 979507 670008 941814 1040002 2410961 2886113 9802 7788 9802 7788 X 635136 788161 1766023 2090164 2401159 2878325 2410961 2886113 355250 121916 0 X 0 1 X 1 0 X 1132457 963054 1121539 1567594 474154 5258798 1132457 963054 1121539 1567594 474154 5258798 1005157 4253641 116573 43345 22385 25760 43373 251436 25318 5247 2039 56313 88917 5599151 0.75970 0.75490 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 183914 22638 10599 195953 215745 -25380 6451 183914 377697 21497 7175 176274 215745 1138021 8642 7978 760988 377697 1095151 53530 10660 1138021 0.44800 0.31700 0.23500 0 0 0 DUE TO HOSPITAL AND AFFILIATES 7788 7788 X 1192165 121916 497634 619550 572615 3313 -7696 -4383 568232 714999 497634 7696 505330 209669 3313 3313 212982 PART V, LINE 4: THE BOARD-DESIGNATED FUND, AND WILBUR AND AGNES DAY FUNDS ARE USED FOR GENERAL HOSPITAL SUPPORT AS DIRECTED BY THE BOARD OF TRUSTEES. THE DECKER HEALTHCARE EDUCATION SCHOLARSHIP ENDOWMENT IS FOR PROVIDING SCHOLARSHIPS TO RESIDENTS OF LINCOLN COUNTY WHO ARE PURSUING A DEGREE IN A MEDICAL OR PARAMEDICAL FIELD. THE GENERAL ENDOWMENT IS USED TO FUND HOSPITAL EQUIPMENT PURCHASES AND OTHER VARIOUS SUPPORT PROGRAMS OF THE HOSPITAL. PART X, LINE 2: THE FOUNDATION IS A NOT-FOR-PROFIT CORPORATION OPERATING UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL, STATE AND LOCAL INCOME TAXES AND CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS OTHER THAN A PRIVATE FOUNDATION. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS INCLUDED IN 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. FOUNDATION MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2020. U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THE FOUNDATION MANAGEMENT TO EVALUATE TAX POSITIONS AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE FOUNDATION 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 THE FOUNDATION AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2023 AND 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NETTED WITH REVENUES PER 990 -7,696. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES NETTED WITH REVENUES PER 990 7,696. GOLF SCRAMBLE 118939 99200 19739 1106 13536 5591 236 GALA 116993 49591 67402 383 3304 23992 8109 235932 148791 87141 1489 16840 29583 8345 56257 30884 1 SAMARITAN NORTH LINCOLN HOSPITAL 3043 NE 28TH STREET LINCOLN CITY OR 97367 931305493 501(C)(3) 26630 0 HOSPITAL OPERATIONS SUPPORT SAMARITAN NORTH LINCOLN HOSPITAL 3043 NE 28TH STREET LINCOLN CITY OR 97367 931305493 501(C)(3) 26094 0 HOSPITAL EQUIPMENT SAMARITAN NORTH LINCOLN HOSPITAL 3043 NE 28TH STREET LINCOLN CITY OR 97367 931305493 501(C)(3) 13107 0 SAMARITAN EARLY LEARNING CENTER SUPPORT SAMARITAN HEALTH SERVICES PO BOX 3000 CORVALLIS OR 97339 930951989 501(C)(3) 11604 0 SYSTEM DEPARTMENT SUPPORT ALBANY GENERAL HOSPITAL PO BOX 3000 CORVALLIS OR 97339 930110095 501(C)(3) 8385 0 HOSPICE SUPPORT 3 HOSPITAL EMPLOYEE EMERGENCIES 13 30565 HOSPICE PATIENT SUPPORT 42 11250 GENERAL AND CANCER PATIENT ASSISTANCE 110 63425 PASTEGA GUEST HOUSE ACCOMMODATION SUPPORT 72 5228 PART I, LINE 2: SCHEDULE I, PART 2: GRANTS ARE PAID OUT ON A LUMP SUM OR REIMBURSEMENT BASIS. LUMP SUM GRANTS ARE MONITORED BY REQUIRING PROGRESS REPORTS AS WELL AS SITE VISITS BY A COMMITTEE MEMBER. GRANTS ARE GIVEN ANNUALLY. REQUESTS FOR EXTENSIONS OR VARIATIONS FROM PREVIOUSLY APPROVED BUDGETS MUST BE APPROVED BY THE COMMITTEE OR FUNDS ARE FORFEITED OR REQUIRED TO BE RETURNED. GRANTS PAID OUT ON A REIMBURSEMENT BASIS REQUIRE SUBSTANTIATING DOCUMENTATION BE SUBMITTED PRIOR TO PAYMENT. TO QUALIFY FOR PATIENT ASSISTANCE GRANTS PATIENTS MUST MEET FUNDING GUIDELINES. SUPPORTING DOCUMENTATION IS REQUIRED. GRANTS ARE PAID OUT ON A REIMBURSEMENT BASIS OR DIRECTLY TO VENDOR. HOSPICE PATIENTS MAY RECEIVE A ONE TIME PAYMENT UP TO $750. PATIENT ASSISTANCE ANNUAL LIMITS VARY FROM $250 - $1000 DEPENDING ON THE FUND. HOSPITAL EMPLOYEES ARE ELIGIBLE FOR EMERGENCY FINANCIAL ASSISTANCE UP TO $3,000 CUMULATIVE IN THEIR FIRST 9 YEARS OF SERVICE, UP TO $4500 CUMULATIVE FROM 10-19 YEARS AND UP TO $6,000 CUMULATIVE AFTER 20 YEARS OF SERVICE. ALL ONLINE APPLICATIONS ARE REVIEWED BY HR, PREVIOUS FUNDING IS CONFIRMED. EEF COMMITTEE MEMBERS WILL MAKE A DECISION ABOUT THE HELP THAT CAN BE GIVEN. HOSPITAL EMPLOYEES MAY RECEIVE AN EXCEPTION FOR AN ADDITIONAL $1,500 PER MAJOR DISASTER. A MAJOR DISASTER OR EMERGENCY IS DEFINED AS: A DISASTER OR EMERGENCY DECLARED BY THE PRESIDENT UNDER 401 OF THE STAFFORD ACT, 42 U.S.C. 5170, THAT WARRANTS INDIVIDUAL ASSISTANCE OR INDIVIDUAL AND PUBLIC ASSISTANCE FROM THE FEDERAL GOVERNMENT UNDER THAT ACT (PROVIDED THAT THE DISASTER DIRECTLY AFFECTS SHS WORKFORCE MEMBERS AND/OR THE RESIDENTS OF SHS' SERVICE AREAS) 0 1 0 0 0 0 0 0 0 DANIEL SMITH SVP / CFO 0 510893 0 119250 0 49211 0 26592 0 41575 0 747521 0 0 URSULA MARINELLI REGIONAL EXECUTIVE DIR 0 105063 0 0 0 39430 0 8154 0 11573 0 164220 0 0 PART I, LINE 3 THE REGIONAL 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. 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. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER (AND ONLY VOTING MEMBER) OF THE FOUNDATION IS SAMARITAN NORTH LINCOLN HOSPITAL ("THE HOSPITAL"). FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF THE HOSPITAL ELECTS ALL TRUSTEES OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF THE HOSPITAL APPROVES ALL MATERIAL DECISIONS MADE BY THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE REVIEWS FORM 990 BEFORE FILING. THE TRUSTEES RECEIVE A COPY OF FORM 990 BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBER CONFLICTS OF INTEREST: MEMBERS OF THE BOARD MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, WHICH REQUIRES DISCLOSURE OF ANY CONFLICTS OF INTEREST OR POTENTIAL CONFLICTS OF INTEREST. IF A CONFLICT IS DISCLOSED, THE BOARD OF DIRECTORS EVALUATES WHETHER THE NATURE OF THE CONFLICT SHOULD AFFECT THE MEMBER'S CONTINUED SERVICE ON THE BOARD. IF THE DISCLOSED CONFLICT DOES NOT PROHIBIT THE MEMBER'S SERVICE ON THE BOARD, THE CONFLICT IS MANAGED THROUGH A PROCESS SET FORTH IN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. THE POLICY PROHIBITS ANY BOARD MEMBER FROM VOTING ON AN ACTION WHERE AN INDIVIDUAL BOARD MEMBER HAS A CONFLICT OF INTEREST. OFFICER/EMPLOYEE CONFLICTS OF INTEREST: THE FILING ORGANIZATION HAS NO EMPLOYEES. EMPLOYEES OF AN SHS-RELATED ORGANIZATION (WHICH INCLUDES SOME OFFICERS OF THE FILING ORGANIZATION) ARE REQUIRED TO COMPLY WITH THE SHS CODE OF CONDUCT AND BUSINESS ETHICS POLICY. THIS POLICY REQUIRES ALL EMPLOYEES TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST THROUGH AN ANNUAL ATTESTATION PROCESS. POTENTIAL CONFLICT OF INTEREST DISCLOSURES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER, LEGAL COUNSEL, AND/OR SENIOR MANAGEMENT, AND ACTUAL CONFLICTS OF INTEREST ARE REVIEWED AND DISCUSSED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SHS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 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 THIS INFORMATION IS AVAILABLE UPON REQUEST. 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 PO BOX 3000 CORVALLIS OR 973393000 930951989 PROVIDE HEALTHCARE SUPPORT SERVICES OR 501(C)(3) 12C, III-FI N/A 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 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 HEALTH DISTRICT 3043 NE 28TH STREET LINCOLN CITY OR 97367 930555769 HEALTHCARE DISTRICT OR GOV'T 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) 7 SAMARITAN HEALTH SERVICES 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 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 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1