2025-04-15T16:28:46-05:00 2024-06-30 990 2023-07-01 930858825 PACIFIC COMMUNITIES HEALTH DISTRICT FND PACI 5415744745 PO BOX 945 NEWPORT OR 97365 KARLA CLEM EXECUTIVE DIRECTOR 5415744745 2025-04-15 1 2023 2025-03-06 01:10:19Z KARLA CLEM PO BOX 945 NEWPORT OR 97365 2370552 0 X WWW.SAMHEALTH.ORG/PCHDF X 1996 OR TO SUPPORT HEALTH DISTRICT CAPITAL PURCHASES AND TO SUPPORT HOSPITAL OPERATIONS. 21 20 0 34 0 0 1763849 347848 0 0 18189 62440 28782 24427 1810820 434715 135540 834253 0 0 0 0 0 0 0 16308 17787 151848 852040 1658972 -417325 2693864 2339270 10721 8483 2683143 2330787 PACIFIC COMMUNITIES HEALTH DISTRICT FOUNDATION WAS ESTABLISHED FOR THE PURPOSE OF DEVELOPING PHILANTHROPIC FUNDS FOR THE BENEFIT OF PACIFIC COMMUNITIES HEALTH DISTRICT (PCHD) AND/OR SAMARITAN PACIFIC HEALTH SERVICES, DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL (SPCH). 0 0 747108 747108 GRANTS TO SAMARITAN PACIFIC COMMUNITIES HOSPITAL (SPCH) AND PACIFIC COMMUNITIES HEALTH DISTRICT FOR CONSTRUCTION OF A DRUG TREATMENT FACILITY, CAPITAL EQUIPMENT, AND OPERATING NEEDS. SEE SCHEDULE I, PART II FOR GRANTS GREATER THAN $5,000. 87145 87145 GRANTS TO INDIVIDUALS. SEE SCHEDULE I, PART III FOR GRANTS GREATER THAN $5,000. 834253 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 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 21 20 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X PACIFIC COMMUNITIES HEALTH DISTRICT FND 5415744745 PO BOX 945 NEWPORT OR 97365 DAVID LARSEN MD SECRETARY / PHYSICIAN 1.00 39.00 X X 0 497029 67459 MATT UPDENKELDER PRESIDENT 1.00 X X 0 0 0 TIANA DEVRIES VICE PRESIDENT 1.00 X X 0 0 0 GEORGE PLANT TREASURER 1.00 X X 0 0 0 JULIA CARLSON PAST PRESIDENT 1.00 X X 0 0 0 LALORI LAGER TRUSTEE 1.00 X 0 0 0 CLAIRE BARTON TRUSTEE 1.00 X 0 0 0 KATHLEEN GRADY TRUSTEE 1.00 X 0 0 0 CM HALL TRUSTEE 1.00 X 0 0 0 K SCARLETT KIER TRUSTEE 1.00 X 0 0 0 JENNIFER LANDERS TRUSTEE 1.00 X 0 0 0 TIM MILLER TRUSTEE 1.00 X 0 0 0 JACKIE STANKEY TRUSTEE 1.00 X 0 0 0 NANCY STEVENS TRUSTEE 1.00 X 0 0 0 MARK MIRANDA TRUSTEE 1.00 X 0 0 0 LANCE NUNN TRUSTEE 1.00 X 0 0 0 SONIA GRAHAM TRUSTEE 1.00 X 0 0 0 SHELLY HEIM TRUSTEE 1.00 X 0 0 0 JOHN JOHNSON TRUSTEE 1.00 X 0 0 0 RICHARD O'HEARN TRUSTEE 1.00 X 0 0 0 TAMI ROCKHOLT TRUSTEE 1.00 X 0 0 0 URSULA MARINELLI REGIONAL EXEC DIR 40.00 X 0 144493 19727 KARLA CLEM EXECUTIVE DIRECTOR 40.00 X 0 92569 36574 0 734091 123760 0 0 1 0 0 78212 10000 259636 6697 347848 71925 71925 1900592 1910077 -9485 -9485 -9485 50187 78212 25760 24427 24427 434715 0 0 86867 747108 747108 87145 87145 8800 8800 3358 3358 4961 4961 LICENSES & FEES 668 668 852040 834253 17787 0 33930 58172 777364 340069 649987 513542 1226896 1423520 5687 3967 2693864 2339270 10721 8483 10721 8483 X 378170 398968 2304973 1931819 2683143 2330787 2693864 2339270 -417325 64969 0 X 0 1 X 1 0 X 291026 315030 511443 1763849 347848 3229196 291026 315030 511443 1763849 347848 3229196 469499 2759697 32910 26986 21049 30766 71925 183636 19337 3491 2931 28782 22230 76771 3489603 0.79080 0.80670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 181302 7500 14444 435 202811 163304 2000 16376 378 181302 174956 16688 -27873 467 163304 140198 35248 490 174956 137378 2430 802 412 140198 0.75300 0.24700 0 0 0 X 948219 64969 450024 514993 433226 3358 -1869 1489 434715 1300575 450024 1869 451893 848682 3358 3358 852040 PART V, LINE 4: TO SUPPORT SPECIAL PROGRAMS, TO PRESERVE CAPITAL AND PURCHASING POWER, AND TO ENHANCE CURRENT INCOME FOR PCHD AND/OR SPCH. 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 JUNE 30, 2024 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: SPECIAL EVENT EXPENSES NETTED WITH REVENUES PER 990 -1,869. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUES PER 990 1,869. 2024 GALA 11500 11500 2000 2023 GALA 116899 66712 50187 2983 15426 400 4951 128399 78212 50187 2983 15426 400 6951 25760 24427 1 SAMARITAN PACIFIC HEALTH SERVICES 930 SW ABBEY ST NEWPORT OR 97365 931329784 501(C)(3) 6238 0 HOSPITAL OPERATIONS PACIFIC COMMUNITIES HEALTH DISTRICT PO BOX 873 NEWPORT OR 97365 930603489 GOV'T 355913 0 EQUIPMENT PACIFIC COMMUNITIES HEALTH DISTRICT PO BOX 873 NEWPORT OR 97365 930603489 GOV'T 375202 0 CONSTRUCTION - DRUG TREATMENT FACILITY 2 SPCH EMPLOYEE EMERGENCY GRANTS 20 25989 HOSPICE PATIENT GRANTS 131 23568 CANCER PATIENT SUPPORT GRANTS 29 5326 GENERAL PATIENT SUPPORT GRANTS 286 26262 NURSING SCHOLARSHIPS 1 6000 PART I, LINE 2: GRANTS ARE PAID OUT ON A LUMP SUM OR REIMBURSEMENT BASIS. LUMP SUM GRANTS ARE MONITORED BY REQUIRING PROGRESS REPORTS AND/OR DEPARTMENT MANAGER OVERSIGHT. GRANTS PAID OUT ON A REIMBURSEMENT BASIS REQUIRE SUBSTANTIATING DOCUMENTATION WHICH MUST BE SUBMITTED PRIOR TO PAYMENT. SPCH EMPLOYEE EMERGENCY REQUESTS ARE BASED ON EMPLOYEES' YEARS OF SERVICE. THEY ARE CAPPED AT A CUMULATIVE AMOUNT OF $3,000 IN THE FIRST 9 YEARS OF SERVICE, $4,500 FOR 10-19 YEARS OF SERVICE, AND UP TO $6,000 AFTER 20 YEARS OF SERVICE. APPLICATIONS ARE REVIEWED AND APPROVED BY A COMMITTEE WHILE KEEPING THE EMPLOYEE APPLICANT ANONYMOUS. THE COMMITTEE MAY CONSIDER A ONE-TIME EXCEPTION TO THE FUNDING LIMITS IN RARE AND EXTREME CIRCUMSTANCES, SUCH AS DURING A WIDESPREAD EMERGENCY OR A NATURAL DISASTER. HOSPICE PATIENT GRANTS ARE PAID DIRECTLY TO THE VENDOR IN MOST CASES. RARE EXCEPTIONS MAY BE MADE TO PAY DIRECTLY TO THE PATIENT FAMILY CAREGIVER WITH PROPER APPROVAL FOLLOWING A NEEDS ASSESSMENT. THESE GRANTS ARE CAPPED AT $750, WITH ONE TIME ELIGIBILITY. POTENTIALLY ELIGIBLE PATIENTS ARE REFERRED THROUGH AN SHS AGENT TO FINANCIALLY VET THE PATIENT FOR PATIENT SUPPORT PROGRAMS. PATIENTS WILL QUALIFY IF THEIR INCOME IS AT OR BELOW 300% OF THE FEDERAL POVERTY LIMIT FOR THEIR FAMILY SIZE. DIFFERENT FUNDING LEVELS ARE AVAILABLE DEPENDING ON THE FUND. LIMITS RANGE FROM $250-$500 OF ANNUAL FUNDING. SCHOLARSHIPS ARE PAID EITHER DIRECTLY TO THE EDUCATIONAL INSTITUTION OR ON A REIMBURSEMENT BASIS WITH SUBSTANTIATING DOCUMENTATION. SCHOLARSHIPS ARE MONITORED BETWEEN THE EDUCATIONAL INSTITUTION AND THE FOUNDATION STAFF. 0 0 0 0 0 0 0 0 0 DAVID LARSEN MD SECRETARY / PHYSICIAN 0 488995 0 6847 0 1187 0 26592 0 40867 0 564488 0 0 URSULA MARINELLI REGIONAL EXEC DIR 0 105063 0 0 0 39430 0 8154 0 11573 0 164220 0 0 PART I, LINE 3 THE REGIONAL EXECUTIVE DIRECTOR AND THE EXECUTIVE DIRECTOR ARE 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 B, LINE 11B THE FINANCE AND INVESTMENT COMMITTEE REVIEWS IRS FORM 990 BEFORE FILING. COPIES ARE MADE AVAILABLE TO THE BOARD BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, & KEY EMPLOYEES HAVE A DUTY TO DISCLOSE ANY FINANCIAL INTERESTS THAT MAY POSE A CONFLICT. THE BOARD REVIEWS ALL MATERIAL FACTS & DETERMINES IF A CONFLICT OF INTEREST EXISTS. POLICY VIOLATIONS MAY RESULT IN DISCIPLINARY ACTION. FORM 990, PART VI, SECTION B, LINE 15A THE REGIONAL EXECUTIVE DIRECTOR AND THE EXECUTIVE DIRECTOR ARE 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 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. SAMARITAN PACIFIC HEALTH SERVICES 930 SW ABBEY ST NEWPORT OR 97365 931329784 HOSPITAL SERVICES FOR THE COMMUNITY OR 501(C)(3) 3 SAMARITAN HEALTH SERVICES 0 PACIFIC COMMUNITIES HEALTH DISTRICT PO BOX 873 NEWPORT OR 97365 930603489 HEALTHCARE DISTRICT OR GOV'T N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0