2024-11-12T12:35:05-06:00 2023-12-31 990 2023-01-01 931260080 LEBANON COMMUNITY HOSPITAL FOUNDATION LEBA 5417686132 PO BOX 739 LEBANON OR 97355 DANIEL B SMITH SVP / CFO 5417686132 2024-11-11 1 2023 2024-10-15 13:58:12Z BRANDY O'BANNON PO BOX 739 LEBANON OR 97355 4660790 0 X WWW.SAMHEALTH.ORG X 1998 OR TO SUPPORT LEBANON COMMUNITY HOSPITAL AND SERVE THE COMMUNITY. 20 19 0 38 0 0 1176095 885539 0 0 185780 212491 799 266 1362674 1098296 1168225 811483 0 0 0 0 0 0 0 23411 23495 1191636 834978 171038 263318 7115294 8118238 25380 17063 7089914 8101175 X THE SPECIFIC AND PRIMARY PURPOSES OF LEBANON COMMUNITY HOSPITAL FOUNDATION ARE TO SECURE CONTRIBUTIONS FOR PROGRAMS AND SERVICES OF MID-VALLEY HEALTHCARE, INC. DBA LEBANON COMMUNITY HOSPITAL ("LEBANON COMMUNITY HOSPITAL"), TO ENGAGE IN AND CONDUCT CHARITABLE, EDUCATIONAL AND SCIENTIFIC ACTIVITIES RELATED TO LEBANON COMMUNITY HOSPITAL, AND SUPPORT SAMARITAN HEALTH SERVICES, INC. ("SHS") INITIATIVES THAT BENEFIT LEBANON COMMUNITY HOSPITAL AND THE COMMUNITY IT SERVES. 0 0 714220 714220 GRANTS TO THE HOSPITAL AND SUPPORTING ORGANIZATIONS FOR PROGRAMS AND OPERATING AND CAPITAL COSTS. SIGNIFICANT GRANTS DURING 2023 INCLUDED FUNDING FOR THE CONSTRUCTION OF A NEW CLINIC IN SWEET HOME, OREGON; A LOCAL UNDERSERVED RURAL COMMUNITY. A LISTING OF THESE AND OTHER GRANTS ARE ON SCHEDULE I, PART II. 37189 37189 PROVIDED EMERGENCY FINANCIAL ASSISTANCE TO HOSPITAL EMPLOYEES IN NEED. THIS ASSISTANCE IS SHOWN ON SCHEDULE I, PART III. 32574 32574 PROVIDED ASSISTANCE TO HOSPITAL PATIENTS IN NEED. THIS ASSISTANCE IS SHOWN ON SCHEDULE I, PART III. 27500 27500 SCHOLARSHIPS TO COMMUNITY MEMBERS PURSUING COLLEGE LEVEL HEALTHCARE EDUCATION. THIS ASSISTANCE IS SHOWN ON SCHEDULE I, PART III. 27500 27500 811483 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 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 20 19 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 OR X SAMARITAN HEALTH SERVICES 5417684857 PO BOX 3000 CORVALLIS OR 973393000 JAN HULL TRUSTEE / IS DIR. CLINICAL DESIGN 1.00 39.00 X 0 185391 41252 DEBBIE PAUL BOARD PRESIDENT 1.00 1.00 X X 0 0 0 RICHARD TRISKA BOARD VICE-PRESIDENT 1.00 X X 0 0 0 LORI HILL BOARD SECRETARY 1.00 X X 0 0 0 STEVE HANSCAM BOARD TREASURER 1.00 X X 0 0 0 ROBERT ADAMS TRUSTEE 1.00 2.00 X 0 0 0 LINN ARMSTRONG TRUSTEE 1.00 1.00 X 0 0 0 MAXINE BAILEY TRUSTEE 1.00 X 0 0 0 DAVE BARRINGER TRUSTEE 1.00 X 0 0 0 JOHN DINGES TRUSTEE 1.00 X 0 0 0 CHARLIE EADS TRUSTEE 1.00 X 0 0 0 KRISTIN HYDE TRUSTEE 1.00 X 0 0 0 WENDI MELCHER TRUSTEE 1.00 X 0 0 0 JESSICA MEYER TRUSTEE 1.00 X 0 0 0 JOANNE NELSON TRUSTEE 1.00 X 0 0 0 WILLIAM RAUCH TRUSTEE 1.00 X 0 0 0 MIRIAM SWANSON TRUSTEE 1.00 X 0 0 0 ROBERT WIMMER MD TRUSTEE 1.00 X 0 0 0 RACHEL WOLFE TRUSTEE 1.00 X 0 0 0 GAMAEL NASSER TRUSTEE 1.00 X 0 0 0 DORIS MODDERMAN TRUSTEE 1.00 X 0 0 0 TOM OLIVER TRUSTEE 1.00 X 0 0 0 CELESTE VAN CLEAVE TRUSTEE 1.00 X 0 0 0 DANIEL SMITH SVP / CFO 1.00 39.00 X 0 679354 68167 BRANDY O'BANNON EXECUTIVE DIRECTOR 40.00 X 0 112923 21107 0 977668 130526 0 0 1 0 0 885539 944 885539 247713 247713 3526328 3561550 -35222 -35222 -35222 1210 944 266 266 1098296 0 0 212757 714220 714220 97263 97263 6000 6000 15181 15181 1205 1205 LICENSES & FEES 1109 1109 834978 811483 23495 0 1818622 2216592 91664 58928 5020044 5686812 176596 146644 8368 9262 7115294 8118238 25380 17063 25380 17063 X 4926015 5889334 2163899 2211841 7089914 8101175 7115294 8118238 263318 747943 0 X 0 1 X 1 0 X 1787187 352252 1324779 1176095 885539 5525852 1787187 352252 1324779 1176095 885539 5525852 1982147 3543705 140137 106794 145790 146704 247713 787138 10000 1102 722 799 266 12889 6325879 0.56020 0.62080 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 0 0 X 2328692 747943 497634 1245577 1083115 15181 15181 1098296 1317431 497634 497634 819797 15181 15181 834978 PART V, LINE 4: THE BOARD-DESIGNATED ENDOWMENT FUND IS USED FOR GENERAL HOSPITAL SUPPORT AS DIRECTED BY THE BOARD OF TRUSTEES. THE GENERAL ENDOWMENT FUND IS USED TO FUND HOSPITAL EQUIPMENT PURCHASES AND OTHER VARIOUS SUPPORT PROGRAMS OF THE HOSPITAL AT THE BOARD'S DISCRETION. THE HEALING GARDEN ENDOWMENT FUND IS FOR MAINTENANCE AND UPDATES OF THE HEALING GARDENS AT THE HOSPITAL AND THE ADJACENT SAMARITAN HEALTH SCIENCES CAMPUS, AS DIRECTED BY THE BOARD OF TRUSTEES. 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 SERVICES 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, 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. 1 MID-VALLEY HEALTHCARE INC PO BOX 3000 CORVALLIS OR 973393000 930396847 501(C)(3) 500000 0 CONSTRUCTION - SWEET HOME CLINIC BLDG MID-VALLEY HEALTHCARE INC PO BOX 3000 CORVALLIS OR 973393000 930396847 501(C)(3) 105967 0 HOSPITAL EQUIPMENT MID-VALLEY HEALTHCARE INC PO BOX 3000 CORVALLIS OR 973393000 930396847 501(C)(3) 73810 0 HOSPITAL OPERATIONS SUPPORT ALBANY GENERAL HOSPITAL PO BOX 3000 CORVALLIS OR 973393000 930110095 501(C)(3) 21534 0 HOSPICE EQUIPMENT ALBANY GENERAL HOSPITAL PO BOX 3000 CORVALLIS OR 973393000 930110095 501(C)(3) 6028 0 SUPPORT FOR CANCER CARE 2 HOSPITAL EMPLOYEE EMERGENCIES 23 37189 SCHOLARSHIPS 10 27500 PATIENT ASSISTANCE 305 32574 PART I, LINE 2: GRANTS ARE PAID OUT ON A REIMBURSEMENT BASIS AND REQUIRE SUBSTANTIATING DOCUMENTATION BE SUBMITTED PRIOR TO PAYMENT. PROGRESS REPORTS AND SITE VISITS MAY BE REQUIRED. SCHOLARSHIPS ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTION AND ARE MONITORED BY ADMINISTRATION AND THE APPLICABLE UNIVERSITY TUITION SCHOLARSHIP DEPARTMENT. SCHOLARSHIPS NOT USED FOR INTENDED PURPOSES ARE RETURNED TO THE FOUNDATION. STUDENTS ARE REQUIRED TO REPORT ONCE A YEAR TO THE SCHOLARSHIP COMMITTEE REGARDING THE PROGRESS OF THEIR STUDIES. 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) TO QUALIFY FOR PATIENT ASSISTANCE GRANTS PATIENTS MUST MEET FUNDING GUIDELINES. SUPPORTING DOCUMENTATION IS REQUIRED. GRANTS ARE PAID OUT DIRECTLY TO THE VENDOR. PATIENT ASSISTANCE LIMITS VARY FROM $250 - $500. 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 JAN HULL TRUSTEE / IS DIR. CLINICAL DESIGN 0 183620 0 0 0 1771 0 12604 0 28648 0 226643 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. 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 OF THE FOUNDATION IS MID-VALLEY HEALTHCARE, INC. (DBA LEBANON COMMUNITY HOSPITAL) A 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER SHALL HAVE THE RIGHT TO APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE REVIEWS FORM 990 BEFORE FILING. THE BOARD RECEIVES 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 BYLAWS. THE BYLAWS PROHIBIT 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 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. LINE 15B: A RELATED 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 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 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 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 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 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 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 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 EXCLUDED 59471 103210 0 0 0.13260 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 0 1 1 1 1 1 0 0 1