2025-11-13T15:30:08-06:00 2024-12-31 990 2024-01-01 930712890 ALBANY GENERAL HOSPITAL FOUNDATION ALBA 5417686132 1046 SIXTH AVENUE SW ALBANY OR 97321 DANIEL B SMITH SVP / CFO 5417686132 2025-10-28 1 2024 2025-03-06 01:10:19Z JENNIFER STANAWAY 1046 SIXTH AVENUE SW ALBANY OR 97321 3156861 0 X WWW.SAMHEALTH.ORG X 1978 OR TO SUPPORT ALBANY GENERAL HOSPITAL AND SERVE THE COMMUNITY. 19 19 0 21 0 0 431254 766116 0 0 108961 140993 -11314 -8207 528901 898902 1039855 209167 0 0 0 0 0 0 0 18838 17683 1058693 226850 -529792 672052 4075179 4925097 6982 20930 4068197 4904167 X THE FOUNDATION'S SPECIFIC PURPOSE IS TO SOLICIT, RECEIVE, AND MAINTAIN GIFTS OF MONEY AND PROPERTY, AND TO MAKE DECISIONS ON THE DISTRIBUTIONS OF SUCH MONEY AND PROPERTY, TO SUPPORT ALBANY GENERAL HOSPITAL AND HEALTH SVCS IN THE GENERAL COMMUNITY OF ALBANY, OREGON. 0 0 135779 135779 GRANTS TO THE HOSPITAL AND SUPPORTING ORGANIZATIONS OR PROGRAMS FOR OPERATING AND CAPITAL COSTS.THERE WAS ALSO GRANT FUNDING FOR THE OPERATIONS OF THE HOSPITAL'S EVERGREEN HOSPICE HOUSE AND THE FOR THE ALBANY INREACH CLINIC; WHICH PROVIDES FREE MEDICAL SERVICES TO LOCAL LOW-INCOME ADULTS.SEE SCHEDULE I, PART II FOR A LISTING OF 2024 GRANTS OVER $5,000. 45647 45647 PROVIDED FINANCIAL ASSISTANCE TO CANCER AND OTHER PATIENTS IN NEED. THIS ASSISTANCE IS SHOWN ON SCHEDULE I, PART III. 24332 24332 PROVIDED EMERGENCY FINANCIAL ASSISTANCE TO HOSPITAL EMPLOYEES IN NEED. THIS ASSISTANCE IS SHOWN ON SCHEDULE I, PART III. 3409 3409 SCHOLARSHIPS & FUNDING FOR FOOD BACKPACKS 3409 3409 209167 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 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 19 19 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 BARBARA HANSEN CHAIR 2.00 X X 0 0 0 MARY HARER SR. VICE CHAIR 2.00 X X 0 0 0 WILL SUMMERS VICE CHAIR 2.00 X X 0 0 0 BRENDA BURCH SECRETARY 2.00 X X 0 0 0 HEATHER MCGOWAN TREASURER 2.00 X X 0 0 0 CHRIS HANSON IMMEDIATE PAST CHAIR 2.00 X X 0 0 0 DELL ALEXANDER DIRECTOR 1.00 X 0 0 0 JIM DECKER DIRECTOR 1.00 X 0 0 0 KARI GOODYEAR DIRECTOR 1.00 X 0 0 0 KRISTA HARTMAN DIRECTOR 1.00 X 0 0 0 MADELYN KOONTZ DIRECTOR 1.00 X 0 0 0 JUSTIN KRUEGER DIRECTOR 1.00 X 0 0 0 CHARLES MOURADIAN DIRECTOR 1.00 1.00 X 0 0 0 PERRY ORDEMAN DIRECTOR 1.00 X 0 0 0 SUSIE ORSBORN DIRECTOR 1.00 X 0 0 0 STACY RAMIREZ DIRECTOR 1.00 X 0 0 0 JANET STEELE DIRECTOR 1.00 X 0 0 0 ALEX JOHNSON DIRECTOR 1.00 X 0 0 0 DAVID DIRKS DIRECTOR 1.00 X 0 0 0 CHERYL COWGILL DIRECTOR 1.00 X 0 0 0 RICHARD RUNNING DIRECTOR 1.00 X 0 0 0 DANIEL SMITH SVP / CFO 1.00 39.00 X 0 622805 66116 JENNIFER STANAWAY EXECUTIVE DIRECTOR 40.00 X 0 138074 21719 0 760879 87835 0 0 1 0 0 44085 722031 4645 766116 119163 119163 2270202 2248372 21830 21830 21830 1380 44085 9587 -8207 -8207 898902 0 0 132786 135779 135779 73388 73388 7000 7000 7940 7940 1884 1884 LICENSES & FEES 859 859 226850 209167 17683 0 98218 546831 67152 151194 3909809 4227072 4075179 4925097 6982 20930 6982 20930 X 1401500 1675636 2666697 3228531 4068197 4904167 4075179 4925097 672052 163918 0 X 0 1 X 1 0 X 472873 480401 586269 431254 766116 2736913 472873 480401 586269 431254 766116 2736913 326562 2410351 79955 107446 96466 107989 119163 511019 2842 4311 7153 3255085 0.74050 0.79970 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1194286 8620 92401 5187 1290120 1389933 11367 191527 398541 1194286 2161041 77760 -318825 530043 1389933 1915641 65791 221591 41982 2161041 2444738 22530 185357 736984 1915641 0.10700 0.51100 0.38200 0 0 0 X 1529753 163918 472802 2071 638791 890962 7940 7940 898902 693783 472802 2071 474873 218910 7940 7940 226850 PART V, LINE 4: THE ALBANY GENERAL HOSPITAL FOUNDATION (AGHF) HOLDS ENDOWMENT FUNDS THAT WILL ULTIMATELY BENEFIT THE HOSPITAL. AGHF'S BOARD-DESIGNATED ENDOWMENT FUND IS USED FOR GENERAL HOSPITAL SUPPORT. AGHF'S SNELL ENDOWMENT FUND IS USED TO FUND EQUIPMENT PURCHASES AND PERMANENT IMPROVEMENTS TO THE HOSPITAL'S FACILITIES. THE KEN AND LORRAINE CARTER HOSPICE HOUSE ENDOWMENT IS USED TO PROVIDE PERPETUAL FINANCIAL SUPPORT FOR THE SAMARITAN EVERGREEN HOSPICE HOUSE TO INCLUDE, BUT NOT BE LIMITED TO, BUILDING AND GROUNDS MAINTENANCE, PROGRAM ENHANCEMENT, PATIENT CARE, AND FINANCIAL ASSISTANCE FOR PATIENTS. 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 2021. 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, 2024 AND 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES NETTED WITH REVENUES PER THE 990 2,071. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES NETTED WITH REVENUES PER THE 990 PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES NETTED WITH REVENUES PER THE 990 2,071. HOSPICE LUNCHEON 41530 40585 945 1400 6116 2071 41530 40585 945 1400 6116 2071 9587 -8642 1 ALBANY GENERAL HOSPITAL 1046 SIXTH AVE SW ALBANY OR 97321 930110095 501(C)(3) 13800 0 HOSPICE SERVICES SUPPORT ALBANY GENERAL HOSPITAL 1046 SIXTH AVE SW ALBANY OR 97321 930110095 501(C)(3) 51532 0 HOSPITAL OPERATIONS SUPPORT FIRSTCARE HEALTH FOUNDATION PO BOX 3000 CORVALLIS OR 973393000 930900124 501(C)(3) 43778 0 INREACH CLINIC SUPPORT ALBANY GENERAL HOSPITAL 1046 SIXTH AVE SW ALBANY OR 97321 930110095 501(C)(3) 15909 0 HOSPITAL EQUIPMENT ALBANY GENERAL HOSPITAL 1046 SIXTH AVE SW ALBANY OR 97321 930110095 501(C)(3) 10760 0 S.A.N.E CENTER SUPPORT 2 HOSPITAL EMPLOYEE EMERGENCIES 20 24332 CANCER AND GENERAL PATIENT ASSISTANCE 207 45647 PART I, LINE 2: GRANTS ARE PAID OUT ON A LUMP SUM OR REIMBURSEMENT BASIS. LUMP SUM GRANTS ARE MONITORED BY REQUIRING PROGRESS REPORTS BY THE SERVICE MANAGER AND OR FUNDING REPORTS DETAILING HOW THE FUNDS WERE SPENT AND PATIENT BENEFITS. GRANTS PAID OUT ON A REIMBURSEMENT BASIS REQUIRE SUBSTANTIATING DOCUMENTATION BE SUBMITTED PRIOR TO PAYMENT. PROGRESS REPORTS AND OR SITE VISITS MAY STILL BE REQUIRED. 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. ANNUAL LIMITS VARY DEPENDING ON THE FUND. 0 1 0 0 0 0 0 0 0 DANIEL SMITH SVP / CFO 0 539235 0 31558 0 52012 0 27756 0 38360 0 688921 0 0 JENNIFER STANAWAY EXECUTIVE DIRECTOR 0 137774 0 0 0 300 0 8312 0 13407 0 159793 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 ALBANY GENERAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS SHALL BE ELECTED BY A VOTE OF THE CURRENT BOARD AT THE ANNUAL MEETING FROM AMONG THE CANDIDATES NOMINATED, AND BY A VOTE OF THE MEMBER, AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER MUST APPROVE: 1) ANY CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS, 2) THE APPOINTMENT OF THE EXECUTIVE DIRECTOR, 3) BORROWINGS OF THE FOUNDATION, 4) MERGERS, CONSOLIDATIONS, REORGANIZATION OR DISSOLUTION OF THE FOUNDATION, AND 5) IN THE CASE OF ALL MATTERS OF DISPUTE OR UNCERTAINTY, THE DECISION OF THE SOLE MEMBER SHALL BE ABSOLUTE. 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 MADE 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 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 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 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 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 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 0 1 1 1 1 0 0 0 0