2025-02-18T14:45:40-08:00 2024-03-31 990 2023-04-01 930386793 LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER LEGA 5034155600 1015 NW 22ND AVENUE PORTLAND OR 97210 KERRIN E GILLESPIE CFO & TREASURER 2025-02-18 true 2023 2025-03-06 01:10:19Z GEORGE J BROWN 510023485 false X WWW.LEGACYHEALTH.ORG X 1875 OR Legacy Good Samaritan Hospital and Medical Center (LGSHMC), founded in 1875, is one of the earliest hospitals in the Pacific Northwest. LGSHMC provides acute and tertiary care in Portland, OR and specializes in several high-level specialty services. 18 12 0 82 352264 2476843 2251721 468430952 507182930 -130127 -5084 -496575 -668174 470281093 508761393 536912 1373873 0 221864458 209790837 0 0 258312037 278522716 480713407 489687426 -10432314 19073967 429734777 391005295 83151577 25348654 346583200 365656641 Legacy Good Samaritan Hospital and Medical Center (LGSHMC), founded in 1875 is one of the earliest hospitals in the Pacific Northwest. LGSHMC provides acute and tertiary care in Portland, OR with 539 licensed beds. LGSHMC provides a comprehensive range of inpatient, clinical and diagnostic services in numerous medical specialties and subspecialties. LGSHMC specializes in several high-level specialty services, such as neuroscience services, which includes the Rehabilitation Institute of Oregon, a regional sleep disorders program, comprehensive epilepsy, stroke and brain tumor programs, Devers Eye Institute, a comprehensive cancer center, obesity, diabetes, and cardiac care, Kern critical care unit, kidney transplant services, and robotic surgical systems used for minimally invasive surgeries. Good Samaritan provides training for interns and residents through its nationally accredited graduate medical education program. As part of that program Good Samaritan operates a primary care teach false false 388056688 1371623 507182930 In support of its mission, LGSHMC voluntarily provides medically necessary patient care services that are discounted or free of charge to persons who have insufficient resources and/or who are uninsured. During fiscal year 2024, LGSHMC provided financial assistance on approximately 7,241 patient accounts (of which 452 accounts received discounts totaling 100% of costs) and resulted in LGSHMC incurring roughly $4,738,890 in uncompensated costs associated with this program. In addition to charity care, LGSHMC provides services under various states' Medicaid programs for financially needy patients, Medicare beneficiaries, and other government programs for which the cost of treating these patients exceeds the government payments received. During fiscal year 2024, LGSHMC incurred approximately $32,377,960, $48,342,590 and $559,220 in uncompensated costs attributable to Medicaid, Medicare, and other government programs, respectively. LGSHMC also provides a variety of other community benefit activities such as medical education, donations to other charitable entities, research, and other health improvement services, which totaled roughly $7,944,700 during fiscal year 2024.LGSHMC is part of Legacy, which collectively provided over $41 million, $271 million, $297 million, and $13 million in uncompensated care attributable to its financial assistance, Medicaid, Medicare, and other government programs, respectively, in fiscal year 2024. In addition, Legacy provided over $38 million in other community benefit activities during fiscal year 2024. 388056688 true true false true false false false false false true true true false false false false false true false false false false false false false false true true false true true false false false false false false false false false false false false false true true false false false true 0 0 false 0 true true false false false false false false 0 false false false false false false false X 18 12 false true false false true true true true true false false true true true true true true true true true true OR X X KERRIN E GILLESPIE 5034155600 1919 NW LOVEJOY STREET PORTLAND OR 97209 KATHRYN CORREIA President & CEO 0.00 40.00 X X 0 3542650 319008 ALEXANDER GLADNEY Secretary 0.00 40.00 X X 0 2426601 26901 ANNA LOOMIS CFO & TREASURER 0.00 40.00 X X 0 1433682 153842 JONATHAN E AVERY SR VP 0.00 40.00 0 1164082 229075 ANITA N IYENGER SR VP 0.00 40.00 0 895176 180275 HEMA THAKAR MD MEDICAL DIRECTOR 40.00 40.00 208063 752706 63406 SIRICHAI PASADHIKA MD OPHTHALMOLOGIST 40.00 0.00 934083 0 83035 JOHN J KENAGY SR VP 0.00 40.00 0 805923 185272 MELINDA J MULLER MD SR VP 0.00 40.00 0 770211 199749 VIKEN DOUZDJIAN MD MEDICAL DIRECTOR 40.00 0.00 711240 0 210815 SETH R PODOLSKY FORMER SR VP 0.00 0.00 0 870347 7560 NATHALIE G JOHNSON MD BOARD DIRECTOR 3.00 40.00 X 0 730300 62969 LISA J GOREN SR VP 0.00 40.00 0 648943 138570 ARISTOMENIS THANOS MD OPHTHALMOLOGIST 40.00 0.00 739201 0 23397 KECIA M KELLY DNP SR VP 0.00 40.00 0 618146 128774 VALERIE J HALPIN MD MEDICAL DIRECTOR 40.00 0.00 671618 0 68606 BRONWYN J HOUSTON FORMER INTERIM PRESIDENT 0.00 40.00 0 597594 142152 JOE FRANKHOUSE MD BOARD DIRECTOR 3.00 40.00 X 0 627606 71575 KEVIN D O'BOYLE HOSPITAL PRESIDENT 40.00 0.00 590680 0 99558 MAUREEN A BRADLEY SR VP 0.00 40.00 0 507873 141134 BRYCE R HELGERSON FORMER SR. VP 0.00 0.00 0 535912 80904 DANIEL M BISSELL VP CMO 40.00 0.00 537394 0 59984 JONATHAN HILL MD BOARD DIRECTOR 4.00 40.00 X 0 413492 65984 CRAIG R ARMSTRONG Secretary 3.00 40.00 X X 0 389388 60716 KATHRYN S ROGERS VP CNO 40.00 0.00 341774 0 61488 DENISE D FALL FORMER PRESIDENT 0.00 0.00 283400 0 51825 LESLIE ROOT MD BOARD DIRECTOR 4.00 40.00 X 0 220680 63444 TRENT S GREEN FORMER SR. VP 0.00 0.00 0 132859 6719 CHARLES WILHOITE Chairman 4.00 0.00 X X 0 45000 0 DAVID RAMUS VICE CHAIR 4.00 0.00 X X 0 35000 0 GAYLE GOSCHIE BOARD DIRECTOR 3.00 0.00 X 0 25000 0 NANCY R LOCKE BOARD DIRECTOR 3.00 0.00 X 0 25000 0 NANCY HORTON BOARD DIRECTOR 3.00 0.00 X 0 25000 0 LYNN T GUST BOARD DIRECTOR 3.00 0.00 X 0 25000 0 NASREEN ILIAS-KHAN MD BOARD DIRECTOR 3.00 0.00 X 0 15000 0 SAMIR DESAI MD BOARD DIRECTOR 3.00 0.00 X 0 15000 0 JACK A FRIEDMAN BOARD DIRECTOR 3.00 0.00 X 0 15000 0 JEFFREY BARBER BOARD DIRECTOR 3.00 0.00 X 0 15000 0 EDGAR NAVAS BOARD DIRECTOR 3.00 0.00 X 0 15000 0 PATRICK REITEN BOARD DIRECTOR 3.00 0.00 X 0 15000 0 JERRY D PETTY BOARD DIRECTOR 3.00 0.00 X 0 15000 0 LISA WYNN FREEDMAN BOARD DIRECTOR 3.00 0.00 X 0 15000 0 BISHOP DIANA AKIYAMA BOARD DIRECTOR 3.00 0.00 X 0 0 0 BISHOP LAURIE LARSON CAESAR BOARD DIRECTOR 3.00 0.00 X 0 0 0 5017453 18384171 2986737 542 true true false COLUMBIA ANESTHESIA GROUP 505 NE 87TH AVE STE 210 VANCOUVER WA 98664 MEDICAL SERVICES 4249290 OREGON HEALTH & SCIENCE UNIVERSITY 3181 SW SAM JACKSON ROAD PORTLAND OR 97239 MEDICAL SERVICES 3659337 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LABORATORY SERVICES 2722645 VISIONGIFT 2201 SE 11TH AVE PORTLAND OR 97214 MEDICAL SERVICES 990890 SP PLUS CORPORATION 3470 WILSHIRE BLVD 400 LOS ANGELES CA 90010 PARKING MANAGEMENT 984725 41 2251721 2251721 CONVENIENCE OF MEMBERS 1318113 1318113 PATIENT PROGRAM REV 505512553 505512553 PHARMACY 352264 352264 507182930 2719 2719 0 0 586115 1254289 -668174 -668174 -668174 7803 -7803 -7803 -7803 0 0 0 0 508761393 505512553 352264 644855 2250 2250 1371623 1371623 0 0 1690877 1455747 235130 0 162626599 140302841 22323758 8744337 7552165 1192172 23704099 20476444 3227655 13024925 11248266 1776659 0 225802 198614 27188 0 0 0 0 11406823 11406823 0 97444171 95629535 1814636 0 0 1562784 1374615 188169 72293 63588 8705 0 0 2336405 2055085 281320 0 9666927 8502965 1163962 4962166 4255492 706674 ADMINISTRATIVE SERVICES FEES 67097556 12151367 54946189 CONTRACT SERVICES 37498074 24263518 13234556 PROVIDER TAX 25258283 25258283 BAD DEBTS 17883421 17883421 3108011 2604046 503965 489687426 388056688 101630738 0 1328133 1215937 0 0 61805211 76353551 0 0 0 4386242 4359450 439882 701233 359254772 296051086 63205545 63203686 0 298569764 245171438 0 0 0 429734777 391005295 29278435 25348654 53873142 83151577 25348654 X 346583200 365656641 346583200 365656641 429734777 391005295 X 19073967 -526 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false X 303289 303289 433010854 2483140449 433010854 2483443738 1000000 1000000 250000 250000 false 2000000 2000000 2000000 2000000 8000000 12000000 285875 294138 335335 303289 1218637 500000 500000 500000 500000 2000000 3000000 46503467 975286 6529899 2008206 52000446 49721318 984896 -2315185 1887562 46503467 50189871 601524 1517346 2587423 49721318 36693477 457579 14690365 1651551 50189870 41027653 1029097 -3769215 1594058 36693477 0.62000 0.27000 0.11000 false true true 4480373 4480373 192201141 160622189 31578952 2437612 2297796 139816 157152707 133131101 24021606 2982939 2982939 63203686 245171438 502734000 502734000 6027393 6027393 508761393 483860000 483860000 5827426 5827426 489687426 Part V, Line 4: Intended uses of the endowment fund. Endowment funds disclosed in Part V are used to improve the healthcare of the community as designated by the donors. Good Samaritan Foundation (GSF) maintains all charitable gifts including endowment funds for the benefit of LGSHHC and it's programs. Income from permanently restricted net assets is accounted for in accordance with the donors' instructions.Legacy follows the guidance in the Uniform Prudent Management of Institutional Funds Act (UPMIFA) in determining the net asset classification of all donor-restricted endowment funds. In accordance with UPMIFA and board policy, assets classified as permanent endowments in accordance with donor intent are only utilized for current period expenditures to the extent that earnings on the endowment exceed the original fair value of the donation. To the extent earnings on endowment funds exceed identified expenditures on which to apply those earnings, the earnings are classified as temporarily restricted net assets. Legacy has adopted investment and spending policies for endowment assets to provide a predictable stream of funding to programs supported by its endowment and to maintain the value of the endowment assets. Asset allocation is reviewed quarterly with respect to: i) Legacy's tolerance for risk based on its financial condition and need for cash from investments to support operations; ii) expected asset class return, risk and correlation characteristics; iii) changes in accounting guidance or tax law and iv) changes in bond covenants or other restrictions.Legacy's spending practices are intended to comply with donor's wishes and meet all applicable laws and regulations. Spending must be for a purpose that is consistent with the documented intent of the donor, and may not exceed the amounts annually determined by Legacy. Factors that are considered in addressing the annual spending allocation are: i) market value of the fund relative to the principal of the gift and ii) the level of spending in prior years.From time to time, the fair value of assets associated with individual donor-restricted endowment funds may fall below the level that the donor or UPMIFA requires Legacy to retain as a fund of perpetual duration. Deficiencies of this nature are reported as a reduction to unrestricted net assets and are excluded from the performance indicator. Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S RIO GUILD INCOME $-748 FOUNDATION CONTRIBUTION $2068368 ROUNDING $-459 GAIN / LOSS OF SALE OF ASSETS $-7803 RECLASS OF NONOP EXPENSE $3566 PROGRAM SERVICE REVENUE $3293014 FOUNDATION CAPITAL CONTRIBUTION $183353 MEDICAL STAFF INCOME $488102 Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S RIO GUILD EXPENSE $7641 FOUNDATION CONTRIBUTION $2068368 ROUNDING $102 RECLASS OF NONOP EXPENSE $3566 GAIN / LOSS OF SALE OF ASSETS $-7803 PROGRAM SERVICE REVENUE $3293014 MEDICAL STAFF EXPENSE $462538 true true X true X 300.000000000 true X true true true false true true 4738891 4738891 0.00970 87759627 55381667 32377960 0.06610 4296088 3736867 559221 0.00110 96794606 59118534 37676072 0.07690 1856462 1856462 0.00380 9297350 4322336 4975014 0.01020 21430408 21098015 332393 0.00070 780877 780877 0.00160 33365097 25420351 7944746 0.01630 130159703 84538885 45620818 0.09320 false 17883421 67363133 74714631 -7351498 X true true 1 1 LEGACY GOOD SAM HOSP & MED CTR 1015 NW 22ND AVE PORTLAND OR 97210 www.legacyhealth.org 14-0027 X X X X LEGACY GOOD SAM HOSP & MED CTR 1 false false true X X X X X X X X X 23 true true true true X www.legacyhealth.org true 23 true www.legacyhealth.org false false true X 300.0000 400.0000 X X X X X true true X X X true X www.legacyhealth.org X www.legacyhealth.org X www.legacyhealth.org X X X X X X true X false X X X X true X false false Facility: LEGACY GOOD SAM HOSP & MED CTR - Part V, Section B, Line 5 Legacy Good Samaritan Hospital and Medical Center (LGSHMC) participates in the Healthy Columbia Willamette Collaborative (HCWC), a public-private partnership of six hospital systems, four County health departments, and two Coordinated Care Organization (CCO) in Clackamas, Multnomah, and Washington counties in Oregon and Clark County in Washington.HCWC was founded in 2010 with the intention of building stronger relationships between communities, CCOs, hospitals, and public health departments. This unique partnership serves as a platform for collaboration around community-wide health assessments. It allows for a more comprehensive view of community assets and needs, informs priorities for HCWC member organization improvement plans and supports collaboration by HCWC stakeholders and partners to meet community health needs. The LGSHMC FY24-26 CHNA is based on the findings of the Healthy Columbia Willamette Collaborative(HCWC)2022 CHNA.Primary data collection methods for the 2022 collaborative Community Health Needs Assessment were used to elicit information directly from community members using both quantitative and qualitative approaches. An online survey, available in 10 languages, was completed by 503 individuals and was open to the public for 3 weeks beginning September 30, 2021. Another 311 community members participated in one of the 37 community engagement sessions, seven of which were conducted in a language other than English. Data collected through these methods assessed community health and social assets and needs, the root causes of observed poor health and social outcomes and how best to take action to improve social connections and community health. The top three race and ethnicity groups represented were Hispanic/Latinx, Black/African American, and White community members. Half of the community members spoke a language other than English.The results of Legacys Community Needs Assessment can be found at www.legacyhealth.org. Facility: LEGACY GOOD SAM HOSP & MED CTR - Part V, Section B, Line 6a In addition to Legacy Healths five hospitals which includes Legacy Good Samaritan Hospital and Medical Center, the other five hospital systems in the metro area that participated in the Healthy Columbia Willamette Collaborative Community Health Needs Assessment were:Adventist HealthHillsboro Medical CenterKaiser PermanenteOregon Health & Science UniversityProvidence Health & Services Facility: LEGACY GOOD SAM HOSP & MED CTR - Part V, Section B, Line 11 The 2022 Healthy Columbia Willamette Collaborative Community Health Needs Assessment prioritized four priority areas (access to culturally and linguistically responsive health care, essential community services and resources, a neighborhood for all and support for family and community ways). Of the four priority areas, Legacy Good Samaritan Hospital and Medical Center selected three priority areas (access to culturally and linguistically responsive health care, essential community services and resources, and a neighborhood for all) in which we had the greatest capacity, in terms of financial and personnel resources, to impact during the FY24-FY26 CHIP period. The remaining area(s) identified during the 2022 quad-county HCWC CHNA were, ideally, addressed by other local health systems, agencies and community-based organizations. Legacy Health is committed to engaging with our community partners to address these outstanding issues, when possible.Legacy Good Samaritan Hospital & Medical Center has committed to addressing priority needs through community health grants for community-based organizations, strategic partnerships, development of hospital-based programs to address specific Social Determinants of Health (SDOH) needs and hospital in-kind activities. Limited examples of these include:Strategic partnership-Project Access NOW, Premium Assistance and Community Care Collaborative: Legacy Health collaborates with other health delivery systems and community-based organizations to improve the health of the community. One example of a collaboration addressing Access to Affordable Health Care,is Project Access NOW(PANOW).PANOW provides innovative,integrated support for patients and healthcare providers across the tri-county region. Through shared investments, the monthly cost of premiums and out-of-pocket expenses are covered for patients who cannot afford to make those payments on their own. Additionally, PANOW connects uninsured and low-income individuals with donated primary and specialty care.Health Systems Access to Care Fund (HSACF)-Legacy Health partners with Providence Health & Services, PeaceHealth and Kaiser Permanente NW to establish the Health Systems Access to Care Fund (HSACF) through the Oregon Community Foundation. The monies donated by these health systems are awarded to community supported health clinics in Oregon and SW Washington to strengthen their infrastructure and capacity to respond to changing patient needs resulting from Medicaid transformation, ongoing healthcare reform and insufficient access to health services.Hospital in-kind-Legacy Health primary care clinics screening for social needs:Legacy Health primary care clinics screen patients during clinic visits for food insecurity and other social needs and provide shelf-stable food bags to those patients who need them.Community health grants-Albertina Kerr:Addressing workforce readiness and training programs for adults with intellectual and developmental disabilities (I/DD), Legacys grant funding supports the expansion of Albertina Kerrs Employment Services into Clackamas County, helping people with I/DD gain job skills, find jobs, and maintain their employment as they begin careers. Girls Inc. of the Pacific Northwest:Through programming offered by Girls Inc. of the Pacific Northwest, girls and gender-expansive youth in the Tri-County area are able to participate in programming focused on success in high school, exploration of career pathways in STEM, and prepare for post-secondary education and living-wage careers. Program participants are primarily Black, Indigenous, or youth of color, youth in low- or moderate- income households; and youth with additional diverse identities, lived experiences and support needs. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense LGSHMC uses many different approaches to inform and educate patients on the availability of financial assistance as is described later in Part VI of Schedule H. Still, many patients do not respond to requests for information or provide appropriate documentation to benefit from financial assistance. Also, patients may experience adverse changes in their medical and financial situation which affect their ability to pay. As a result, LGSHMC must report these amounts as bad debt. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit LGSHMC screens patients for presumptive charity eligibility prior to assignment to bad debt, in effort to help capture eligible patient population that may qualify for Financial Assistance. As a result, no additional portion of the bad debt expense is attributable to patients eligible under the organizations financial assistance policy.In prior years, LGSHMC estimated the amount of bad debt expenses attributable to financial assistance policy using demographic profile of household income and average household size in the zip code areas under the hospital. However, with the additional tools and resources available, LGSHMC is able to proactively identify patient accounts that are eligible for financial assistance. Part III, Line 4 - Bad Debt Expense The footnote that describes the Legacy bad debt expense can be found on page 9 of the attached audited financial statements. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The entire Medicare shortfall should be considered a community benefit. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in the community served by the hospital. The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. The Medicare amounts listed in Part III Section B. on lines 5, 6, and 7 do not represent all of the organization's revenues and costs associated with its participation in Medicare programs. The methodology used in reporting in Part III Section B Medicare is inconsistent with the other sections in Schedule H, as the instructions limit Medicare revenues and allowable cost to those from only the Medicare Cost Report. Revenue and costs from Medicare Part C patients, Part B physician services billed by the organization, and clinical laboratory services weren't included. In addition, hospitals incur other costs to provide care that Medicare does not allow in the cost report, such as Physician Call pay to ensure adequate physician coverage for the ED. The total revenues and costs attributable to all Medicare services are $163,343,878 and $211,686,469 respectively. This results in a total Medicare shortfall of $48,342,591.Costing Methodology (Part III, Line 8).Medicare allowable costs were calculated using the costing methodologies in the Medicare Cost Report. The cost report arrives at total allowable hospital cost through a cost finding process that includes direct cost allocations and a step-down allocation of indirect or overhead costs. Inpatient operating costs are composed of general inpatient routine and ICU unit costs derived from cost per diems, as well as inpatient ancillary service costs that utilize cost to charge ratios to arrive at cost. Apportionment of cost applicable to hospital outpatient services is through the application of cost to charge ratios. This excludes other costs incurred to provide services of the hospital to the community that the cost report deems as unallowable costs, such as Physician on-call pay. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients Legacy provides care without charge or at amounts less than its established rates to patients who meet certain criteria under its financial assistance policy. Since Legacy does not pursue collection of amounts determined to qualify as charity care, they are excluded from net patient service revenues. Part VI, Line 2 - Needs Assessment Legacy Senior leadership, in conjunction with the Community Benefit staff works with local community-based partners to understand the needs of the community. The goal is to understand the needs and develop programs specific to the community. Involvement is both proactive and responsive - a leadership role in initiating programs as well as being readily available as a collaborative partner when the community asks. The outcome of this work is the development of both long-term and fiscal year plans. These are then aligned to the community health needs identified in the formal CHNA. The region served by LGSHMC, along with most of Oregon, is experiencing significant challenges in population growth, economic development, education and health care. Recognizing that social and economic determinants impact health, LGSHMC has been and will remain committed to addressing these issues to improve the health of all residents in the community and ensure equity among diverse populations. Part VI, Line 3 - Patient Education of Eligibility for Assistance LGSHMC employs financial counselors and social workers that assist patients in obtaining coverage for their healthcare needs. This includes assistance with workers compensation, COBRA, veterans assistance, Legacys financial assistance program, and public assistance programs, such as Medicaid. In support of its mission, LGSHMC provides medically necessary patient care services that are discounted or free of charge to persons who have insufficient resources and/or who are uninsured. The criteria for charity care are determined based on eligibility for insurance coverage, household income, catastrophic medical events, or other information supporting a patients inability to pay for services provided. Specifically, LGSHMC provides an uninsured discount of 35% to self-pay patients with no coverage. A 75% discount is available to patients whose household income is between 301% and 400% of the federal poverty level. For patients whose household income is at or below 300% of the federal poverty level, a full subsidy is available. In addition to the household income criteria, other catastrophic or economic circumstances are considered in determining eligibility for charity care. In addition to financial counselors and social workers, LGSHMC makes every effort to communicate its Financial Assistance Program to all patients. This includes signage in main admitting areas of the hospital and brochures explaining financial assistance in all patient care areas, translated for patients/individuals with limited English proficiency (LEP). Financial counselors are available to assist patients in understanding and applying for available resources, including the LGSHMC Financial Assistance Program. Legacy Healths website also has information about the availability of financial assistance. LGSHMC offers financial assistance customer service Monday through Friday, as well as voicemail so patients can leave confidential, detailed messages during non-business hours. Patients are encouraged to sign up for MyHealth, a secure online tool to access their medical record. Using their MyHealth account they can correspond with a financial counselor via email. Finally, all of Legacys billing statements include information regarding the availability of financial assistance. If LGSHMC requires the use of a collection agency, those agencies are required to provide a telephone number for patients to call to request financial assistance. Annual education is provided to all admitting staff, so they can be kept informed of and speak with knowledge about current financial assistance policies and options. LGSHMC provides copies of the latest policies in main admitting areas, as well as with the hospital financial counselor, online via the website and through MyHealth. LGSHMC collaborates with other health delivery systems and community-based organizations to improve the health of the community. One example of a collaboration addressing Access to Care, is Project Access NOW (PANOW). PANOW provides innovative, integrated support for patients and healthcare providers across the tri-county region. The Premium Assistance program serves individuals who are low-income, uninsured or underinsured. Participants receive assistance with monthly insurance premiums to help lower additional out-of-pocket expenses and are provided education on how to utilize insurance once covered. Additionally, PANOW connects uninsured and low-income individuals with donated primary and specialty care. Part VI, Line 4 - Community Information LGSHMC is located in the heart of historic Northwest Portland and has served the communities of the greater Portland area for more than 150 years. The medical center provides complex specialty services and clinical excellence with nationally renowned doctors in cancer care, kidney transplantations, neurology, ophthalmology, weight-loss surgery and more. LGSHMC CHNA/CHIP report(s) define service area by geographic location and where their patients live. LGSHMC is located in Northwest Portland. Multnomah County, Oregon is the primary service area for LGSHMC. The surrounding Oregon counties, Clackamas and Washington, are served by Legacy and other health systems but are secondary catchment areas for LGSHMC. The demographic data that informed LGSHMCs CHNA/CHIP for FY24 is from 2015-2019. The population estimate of the primary service area for Legacy Good Smaritan was 804,606. The primary service area was 77.9% White, 11.6% Hispanic or Latino,7.4% Asian, 5.5% Black/African American, 0.9% American Indian/Alaska Native, 0.6% Native Hawaiian and Other Pacific Islander, and 5.4% of two or more races. Foreign-born population represents 13.8% of the community and 3.8% of households have no member 14 years old and over that speaks English very well. In the Quad-County Region (Clackamas, Multnomah, Washington Counties and Clark County in Washington State) 10.5% or 240,047 individuals in families are living at or below the federal poverty level and 4.8% or 109,335 individuals in families have an income of less than half the federal poverty level. In Multnomah County this is reflected with 13.8% of individuals in families living at or below the federal poverty level and 6.3% of individuals in families with an income of less than half the federal poverty level.In FY 2024, Legacy Good Samaritan Hospital and Medical Center provided $4.7 million in charity care which accounts for 5.50% of total unreimbursed costs of $86 million. Part VI, Line 5 - Promotion of Community Health The Legacy Health system is involved in several activities and provides a wide variety of services that engage community members and promote community health. For example, the Legacy Health Board is comprised of volunteer community leaders, hospital administrators and representatives of the Lutheran and Episcopal churches who guide Legacys efforts in meeting its mission of providing good health for our people, our patients, our communities and our world. The Community-Based Advisory Committee (CBAC) assists the Community Benefit department with the development and implementation of the Community Health Needs Assessments (CHNAs) and Community Health Implementation Plans (CHIPs) for each Legacy Medical Center. Legacy Community Benefit and the CBAC work closely with the Healthy Columbia Willamette Collaborative and other partners in the Portland metropolitan area (Clackamas, Multnomah, Washington counties in Oregon and Clark County in SW Washington) to assess community needs and describe how the LGSHMC will address these needs and evaluate the effectiveness of its efforts within its service community.LGSHMC contributes in-kind lab donations to safety net clinics in their service areas. Non-cash donations of clinical and non-clinical services and items, e.g., screenings and support services, internships, information and referral services, and health fairs, also are provided to the community. Legacy Healths supply warehouse is open to local non-profit organizations to obtain surplus equipment and furniture. In addition, free office and conference space and other infrastructure services are made available to local non-profit organizations in the LGSHMC service area for a variety of uses.LGSHMC medical staff is open, with physicians submitting credentialing information that is reviewed according to Legacy policies and standards. LGSHMC collaborates with other health care providers, community-based organizations, business and the public on projects to improve the health of the community. One example of clinically based partnerships includes, among others: CARES NW (Child Abuse Response and Evaluation Services), a collaboration among four health systems Kaiser Permanente, OHSU Doernbecher Childrens Hospital, Providence Childrens Health and Randall Childrens Hospital at Legacy Emanuel; Legacy Emanuel Hospital & Health Center serves as the employer and donates the infrastructure. Additionally, the first collaborative medical initiative of its kind in the Pacific Northwest, Unity Center for Behavioral Health, is a joint effort between Adventist Health, Kaiser Permanente, Oregon Health & Science University and Legacy Health, providing psychiatric emergency services. Legacy has collaborated with more than a dozen community mental health partners in developing this new psychiatric center.Finally, as a hospital located in a high-density, inner-city neighborhood, LGSHMCs security department patrols the neighborhoods as a service to surrounding neighborhoods. Part VI, Line 6 - Affilated Health Care System Legacy Good Samaritan Hospital and Medical Center is a subsidiary of Legacy Health. Legacy Health is a nonprofit health system driven by our mission to improve the health of those around us. We offer a unique blend of health services across the Portland/Vancouver metro area and mid-Willamette Valley from wellness and urgent care to dedicated childrens services and advanced medical centers we care for patients of all ages when and where they need us. With an eye toward a healthier community, our partnerships tackle vital issues such as housing and mental health.Legacy Health strives to help everyone live healthier and better lives, with the vision of being essential to the health of the region. Legacy Health currently includes:Six medical centersDedicated childrens care at Randall Childrens Hospital at Legacy EmanuelUnity Center for Behavioral Health (a collaboration with three other health care organizations)More than 80 primary care, urgent care and specialty clinicsOver 14,000 employees, and more than 3,000 health care providersPartnership with PacificSource health planResearch and hospiceLegacys policy of providing care regardless of an individuals ability to pay makes it one of the regions largest providers of uncompensated care. As the health needs of communities surrounding our hospitals are frequently changing, Legacy Health continues to identify investments for underserved populations.Legacy Health collaborates with other health delivery systems and community-based organizations to improve the health of the community. One example of a collaboration addressing Access to Care, is Project Access NOW (PANOW). PANOW provides innovative, integrated support for patients and healthcare providers across the tri-county region. Through shared investments, the monthly cost of premiums and out-of-pocket expenses are covered for patients who cannot afford to make those payments on their own. Additionally, PANOW connects uninsured and low-income individuals with donated primary and specialty care. In the fall of 2018, Legacy Health partnered with Providence Health & Services, PeaceHealth and Kaiser Permanente NW to establish the Health Systems Access to Care Fund (HSACF) through the Oregon Community Foundation. The monies donated by these health systems are awarded to community supported health clinics in Oregon and SW Washington to strengthen their infrastructure and capacity to respond to changing patient needs resulting from Medicaid transformation, ongoing healthcare reform and insufficient access to health services. In 2023, the 10 community health clinics supported by the HSACF served 9,076 unique patients, an increase of 12.8% from 2022. This equated to 26,094 patient visits for some of the most underserved people in Oregon and Southwest Washington.Recognizing that health professions are lacking in diversity, Legacy Health established the Health Occupation Profession and Education program (HOPE, formerly Youth Employment in Summer). Each year students of ethnically diverse communities have access to paid summer employment in departments where they work with health professionals. Students are paid between $15-18 per hour and may work up to 400 hours over the summer. HOPE students also receive college scholarships between $3,000 and $10,000 annually. Students remain in the program if they remain in school and pursue health careers. Some students remain in the program as long as seven years and graduate with a range of degrees from imaging technician to Bachelor of Science in nursing to medical doctor. Most students are the first in their family to go to college. Legacy Health supports The Contingent - Emerging Leaders Internship Program. Through this program college students and recent graduates from ethnically diverse communities are matched with top companies throughout the Portland Metropolitan area for a 10-week paid summer internship. Program goals aim to provide this demographic with a comprehensive pathway to economic and personal success with structured programming that engages students throughout their professional journey. Students are paid between $15-18 per hour and may work up to 400 hours over the summer. Legacy Health trains interns and residents through its nationally accredited graduate medical education (GME) program and partners with local nursing and other health professional schools and programs to provide practical training and education. In 1986, nurses at the Legacy Emanuel Hospital & Health Centers Level I Trauma Center developed the Trauma Nurses Talk Tough (TNTT) program; a program that continues today across all Legacy service communities, although the program is managed from the Emanuel Medical Center. In FY24, TNTT has continued to offer virtual classes and brought back in-person classes to provide important safety education to all ages. In FY24 TNTT offered 144 court ordered classes, 50 senior falls prevention classes, and multiple school, parent, and young driver safety education classes. Legacy Emanuel staff fit and distributed 4901 low-cost helmets and safety gear to children, of which 25% were donated. TNTT also began teaching Stop the Bleed in schools and to businesses that are interested in saving lives before medical personnel can arrive. 20 Stop the Bleed presentations were given to various community members. Legacy staff members also provided new parents with training to reduce the incidences of shaken baby syndrome as well as an education and awareness program about window safety (to prevent children falling from upper stories). In FY24 Legacy Health contributed system-wide over $662M system-wide in community benefit across all reportable categories, including financial assistance. Of the $662M total community benefit, $2.4M was allocated through strategic investments and grant making to community-based organizations to address access to culturally and linguistically responsive health care, essential community services and resources, and a neighborhood for all. Part VI, Line 7 - States Filing of Community Benefit Report OR true 0 0 PATIENT NEEDS FOR SAFE DISCHARGE 1099869 TRANSPORTATION CHARITY CARE DISCHARGE 271754 PLACEMENT Grantmaker's Description of How Grants are Used Legacy reviews all organizations prior to donating cash or supplies to ensure their 501(c)(3) status. Legacy regularly donates supplies to Medical Teams International for disaster relief. Several Legacy medical staff members, volunteer for Medical Teams International. true true false true true true true false true true ALEXANDER GLADNEY Secretary 444286 75000 1907315 26901 2453502 ANITA N IYENGER SR VP 749300 145876 143600 36675 1075451 ANNA LOOMIS CFO & TREASURER 990808 274008 168866 115581 38261 1587524 ARISTOMENIS THANOS MD OPHTHALMOLOGIST 486595 218474 34132 21450 1947 762598 BRONWYN J HOUSTON FORMER INTERIM PRESIDENT 521635 75959 104424 37728 739746 BRYCE R HELGERSON FORMER SR. VP 535912 80904 616816 CRAIG R ARMSTRONG Secretary 358471 16376 14541 17941 42775 450104 DANIEL M BISSELL VP CMO 496596 30000 10798 16421 43563 597378 DENISE D FALL FORMER PRESIDENT 283400 22294 29531 335225 HEMA THAKAR MD MEDICAL DIRECTOR 208506 556695 204 86690 -647 109321 38911 6124 18371 253098 771077 JOE FRANKHOUSE MD BOARD DIRECTOR 380336 174332 72938 31512 40063 699181 JOHN J KENAGY SR VP 701500 16188 88235 141648 43624 991195 JONATHAN E AVERY SR VP 999327 164755 185143 43932 1393157 JONATHAN HILL MD BOARD DIRECTOR 310477 15000 88015 13200 52784 479476 KATHRYN CORREIA President & CEO 1942056 1600594 279167 39841 3861658 KATHRYN S ROGERS VP CNO 321814 19960 28705 32783 403262 KECIA M KELLY DNP SR VP 559268 41510 17368 81582 47192 746920 KEVIN D O'BOYLE HOSPITAL PRESIDENT 593019 -2339 53887 45671 690238 LESLIE ROOT MD BOARD DIRECTOR 151129 71506 -1955 36881 26563 284124 LISA J GOREN SR VP 572092 76851 97816 40754 787513 MAUREEN A BRADLEY SR VP 445300 62573 112519 28615 649007 MELINDA J MULLER MD SR VP 710048 60163 153532 46217 969960 NATHALIE G JOHNSON MD BOARD DIRECTOR 564974 121973 43353 43389 19580 793269 SETH R PODOLSKY FORMER SR VP 870347 7560 877907 SIRICHAI PASADHIKA MD OPHTHALMOLOGIST 677441 174469 82173 43899 39136 1017118 TRENT S GREEN FORMER SR. VP 132859 6719 139578 VALERIE J HALPIN MD MEDICAL DIRECTOR 445515 160977 65126 52551 16055 740224 VIKEN DOUZDJIAN MD MEDICAL DIRECTOR 599006 20000 92234 171277 39538 922055 Part I, Line 5b: Explanation of organization compensation based on revenues of related organization Physicians employed by Legacy affiliates are paid variable compensation based on quality, value, and production. Production is based upon the level of effort of services provided during the year measured by industry standard relative value units (RVU) and which generate revenue. Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or Legacy has an at-risk incentive compensation plan for management. The plan is based on meeting goals related to employee engagement, work processes, customer service, clinical quality, financial management, and certain key strategic tactics. In order to payout any at-risk incentive compensation, Legacy must exceed operating margin targets. Part I, Line 8: Amounts reported on 990 VII pursuant to initial contract exemption described in Regs Legacy enters into initial employment agreements with Executives that qualify under the initial contract exception. The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for key executive positions. The Committee relies on comparable market data and all decisions are documented. Part III, Additional Information Sch J, Part 1, Question 3 Regarding Compensation PracticesDirectors for Legacy started receiving compensation for their services in August 2014. They also receive expense reimbursements related to their duties. Any expense reimbursements to board members are reviewed by the Director of Tax for determining 1099 tax reporting. In addition to the Board of Directors compensation, during 2023, Dr. Hill received compensation related to his duties as Clinical VP while Dr. Root received compensation for medical services provided at Legacy Emanuel Hospital. Dr. Frankhouse and Dr. Johnson received compensation related to their duties as Medical Directors and for medical services at Legacy Good Samaritan hospital. There was no other reportable compensation received by any board member during 2023.Executive compensation for Legacy is designed to recruit, retain and motivate qualified senior management personnel. The comprehensive compensation plan is designed for positions that have a significant impact on the high-level strategic and policy direction of Legacy and its affiliates. Base pay and total compensation (including incentive compensation) for similar positions is established at a level comparable to market compensation for healthcare organizations. External consultants are regularly used to review published compensation surveys of comparable organizations and comparable benchmark positions in the market. The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for executive positions. The Committee oversees the system's governance procedures with respect to intermediate sanctions legislation and the evaluation of reasonableness of compensation. The Committee reports to the Board in sufficient detail to enable the entire Board to take such actions as are required to obtain the rebuttable presumption of reasonableness. The Compensation Committee also reviews tax-reporting disclosures.Sch J, Part II, Column Breakdown Of W-2 Or Misc-1099:Column B(i) - Base compensation consists of regular base pay including employee elected deferrals for retirement plans (403(b) and 457(b) plans).Column B(ii) - The incentive compensation program for Legacy is based on predetermined criteria and reviewed and approved by the Board. Bonuses are paid to key employees for interim duties outside their primary responsibilities (e.g. Acting in Capacity).Column B(iii) - Other compensation consists of deferred compensation amounts paid to executives during the current year and were reported on prior form 990 returns. These amounts include arrangements that contain elements of a substantial risk of forfeiture conditioned on continued employment, vesting and/or a noncompete provision upon termination of employment. Distributions from 457(b) plans, reported to the employee on a 1099-R, are also included as other compensation. In addition, imputed income for insurance and other benefits is included in other compensation as well as any severance related payments.Column C - Deferred compensation includes the contributions to defined contribution plans, amounts deferred under the 457(f) plan including earnings, earnings in the 457(b) plan, and the value of the pension restoration plan. Earnings on the 457(f) and 457(b) include gains and losses on the underlying investments. The defined contribution plan is available to all employees as they become qualified to participate. The pension restoration plan provides executive pension benefits in excess of IRS mandated limits on eligible compensation to key executives. The benefits are unfunded and subject to forfeiture. Executive pension benefits are intended to make the executive's retirement benefit, as a proportion of their final average salary, comparable to all other employees, and are treated as income when paid.Fiscal year 2024 performance bonuses were paid based on the achievement of patient and employee safety goals with attainment probability of 20-30%. The bonuses were paid out in July 2024 (tax year 2024) and are reported as deferred compensation on the 2023 form 990.Column D - Nontaxable benefits include company paid health and welfare and long-term care and disability benefits under group plans.Column F - Current year compensation reported as deferred in prior years. Form 990, Part VI, Section A, Line 3 Legacy Health (Legacy) provides management services for all of its affiliated companies which includes, accounting, purchasing, contracting, legal, human resources, information technology, billing, facilities, budgeting, transcription, security, public relations, strategic planning, organization development. Form 990, Part VI, Section A, Line 6 Legacy Health is the sole member of Legacy Good Samaritan Hospital & Medical Center. Form 990, Part VI, Section A, Line 7a The Board of Directors includes the following members: (a) The Bishop of the Oregon Synod of the Evangelical Lutheran Church inAmerica (the Oregon Synod") or the Bishop's designee, who shall serve ex officio;(b) The Bishop of the Episcopal Diocese of Oregon (the "Episcopal Diocese")or the Bishop's designee, who shall serve ex officio;(c) One (1) person elected by the Legacy Health Board of Directors pursuant to the process set forth in the Bylaws; provided, however, that such person shall be an active member of a Lutheran congregation in the Oregon Synod ("Lutheran Director");(d) One (1) person elected by the Legacy Health Board of Directors pursuant to the process set forth in the Bylaws; provided, however, that such person shall be an active member of an Episcopal congregation in the Episcopal Diocese known to his/her parish priest, or alternatively a member of the clergy in the Episcopal Diocese ("Episcopal Director"). Form 990, Part VI, Section A, Line 7b The election of Lutheran Director is subject to the approval by the Bishop of the Oregon Synod, who may object to the newly-elected director for any reason by delivering written notice to the Legacy President or the Chair of the Board of Directors no later than one week after the election. If the Bishop timely objects to the election of the new Lutheran Director, the election will be ineffective and that person will not be a director; otherwise, if no timely objection is received, that person shall be conclusively presumed to be the Lutheran Director for his/her full term or the remainder of an unexpired term to which elected. The election of the Episcopal Director is subject to approval by the Bishop of theEpiscopal Diocese, who may object to the newly elected director for any reason by delivering written notice to the Legacy President or Chair of the Board of Directors no later than one week after the election. The election of the Episcopal Director is also subject to approval by the Standing Committee of the Episcopal Diocese, who may object to the newly elected director only on the grounds that he/she is not an active member of an Episcopal congregation or a member of the Episcopal clergy in the Episcopal Diocese; such objection to be effected by delivering written notice to the Legacy President or Chair of the Board of Directors within five days after the next meeting of the Standing Committee or 45 days after the election, whichever isearlier. If the Bishop or Standing Committee timely object to the election of the new Episcopal Director, the election will be ineffective and that person will not be a director; otherwise, if no timely objection is received, that person shall be conclusively presumed to be the Episcopal Director for his/her full term or the remainder of an unexpired term to which elected. Form 990, Part VI, Section B, Line 11b The Legacy Board received a copy of the 990 return prior to filing. At the direction of the entire Board, the Board Compensation Committee reviewed the compensation disclosures and the Board Audit and Compliance Committee received a memorandum with draft 990 returns for Legacy and Legacy Emanuel Hospital & Health Center highlighting key areas and requesting feedback. Questions from the Board Audit and Compliance Committee are answered and changes made where appropriate. Any significant differences in disclosure from the draft 990 to the final 990 return for other affiliated entities, including Legacy Good Samaritan Hospital are provided to the Board Audit and Compliance Committee. Depending on the deadline for the 990 return filing and the Board Audit and Compliance Committee meeting this discussion may take place following the filing of the return. Form 990, Part VI, Section B, Line 12c The following is a summary of Legacy's policy and procedures for conflict of interest disclosure, monitoring and resolution.All Legacy employees and non-employees in leadership positions (e.g., Board members, Foundation Trustees, Medical Directors) are required to disclose potential conflicts of interest as the conflict arises. All employees are required to disclose any conflict of interest per the Standard of Conduct policy. Certain groups have annual formal disclosure requirements, Executives and non-employees in leadership positions complete the Conflict Disclosure Statement from the Standards of Conduct policy annually. Officers, Directors, Trustees, Key and Highly Compensated employees are also required to complete a questionnaire covering business relationships, business transactions with interested parties, loans and grants. Conflict Disclosure Statements and questionnaires are returned to Legacy Corporate Compliance or Tax Departments for review of the disclosure. If a conflict is disclosed, or identified through any other means, Legacy Corporate Compliance ensures that management mitigates the risk (e.g., discontinues relationship with vendor, segregates responsibilities, recuses Board member from voting in area of conflict) and that the conflict and mitigation steps are reported to the appropriate level (e.g. Audit and Compliance Committee of the Board). Form 990, Part VI, Section B, Line 15b The following describes the compensation practices of Legacy Health and its affiliates.Executive compensation for Legacy is designed to recruit, retain and motivate qualified senior leaders responsible for ensuring Legacy Health serves its mission and patients every day, and for ensuring a safe, inclusive and equitable workplace for all Legacy employees. The comprehensive compensation plan is designed for positions that have a significant impact on the high-level strategic and policy direction of Legacy and its affiliates, and are accountable for the effective day-to-day operation of the system.Base pay and total compensation (including incentive compensation) for similar positions is established at a level comparable to market compensation for healthcare organizations. External consultants are regularly used to review published compensation surveys of comparable organizations and comparable benchmark positions in the market.The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for key executive positions. The Committee oversees the system's governance procedures with respect to the evaluation of reasonableness of compensation. The Committee reports to the Board in sufficient detail to enable the entire Board to take such actions as are required to obtain the rebuttable presumption of reasonableness. The Compensation Committee also reviews tax-reporting disclosures. Form 990, Part VI, Section C, Line 19 Legacy Health's audited and interim consolidated financial statements are publicly available on the Electronic Municipal Market Access(EMMA) (www.emma.msrb.org) and DAC Bond (www.dacbond.com) websites. Legacy's audited consolidated financial statements include consolidating schedules which highlights LGSHMC's financial results.When changes are made to the LGSHMC Articles or Bylaws, LGSHMC discloses and attaches copies to the IRS Form 990, which are publicly available by request or on various public websites such as Guidestar(www.guidestar.org). Other governing documents are not available to the public. Form 990, Part XI, Line 9 Gift Shop Operations Fund = -$526 Form 990, Part IV, question 12 Legacy has an audit of its consolidated financial statement which includes consolidating schedules highlighting LGSHMC's financial results. Form 990, Part VI, question 2 Legacy Health System CPC, LLC (CPC) is a common pay agent for Legacy and its affiliates. The CPC files all required federal employment tax returns for Legacy and its affiliates. The number of employees reported on Form W-3 for LGSHMC is 2,103. Form 990, Part X LGSHMC participates in the Legacy investment pooled funds which include professionally managed equity and fixed income securities in both separately managed portfolios and commingled investment accounts. Investment returns are prorated according to each affiliate's share of the pool. Form 990, Schedule J Schedule J Reporting of Officers and Senior Management on Legacy Affilate Returns. The Legacy Officers, Senior Vice Presidents and other key employees may have responsibilities for the operations of the entire health system, including the affiliated entities. Their compensation is paid from and reported on the Legacy return(EIN 23-7426300). The compensation is reported again for informational purposes on related affiliated entity returns including, Legacy Emanuel Hospital & Health Center, Legacy Good Samaritan Hospital and Medical Center, Legacy Meridian Park Hospital, Legacy Mount Hood Medical Center, Legacy Salmon Creek Hospital, Silverton Health, and Legacy Visiting Nurse Association. 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