2022-11-10T10:48:07-06:00 2021-12-31 990 2021-01-01 930951989 SAMARITAN HEALTH SERVICES SAMA 5417684857 CO SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL B SMITH SVP / CFO 5417684857 2022-11-07 DANIEL SMITH 999009999 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DOUGLAS BOYSEN 3600 NW SAMARITAN DR CORVALLIS OR 97330 319473650 0 X WWW.SAMHEALTH.ORG X 1986 OR TO ENHANCE COMMUNITY HEALTH THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. 16 14 1420 14 2249211 217662 2113405 1330821 231936557 266269152 112676 1387865 2473588 2818275 236636226 271806113 109416 100267 0 0 95858685 127943242 21798 2588 2144766 131967058 145056264 227956957 273102361 8679269 -1296248 432777505 420076379 376917271 365560743 55860234 54515636 X SAMARITAN HEALTH SERVICES (SHS) IS THE PARENT COMPANY OF A REGIONAL NETWORK OF HOSPITALS, PHYSICIANS AND SENIOR CARE FACILITIES. (CONTINUED ON SCHEDULE O)(CONTINUED FROM PART III) THE NETWORK, FORMED IN THE LATE 1990'S, SERVES APPROXIMATELY 290,000 RESIDENTS IN LINN, BENTON, LINCOLN AND PORTIONS OF POLK AND MARION COUNTIES IN OREGON. IT IS LOCALLY OWNED, AND ITS BOARDS OF DIRECTORS INCLUDE HOSPITAL LEADERS, PHYSICIANS AND COMMUNITY REPRESENTATIVES. SHS PROVIDES HEALTHCARE SERVICES REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, DISABILITY OR AGE. THE MISSION OF SHS IS "BUILDING HEALTHIER COMMUNITIES TOGETHER." THE COLLECTIVE VISION OF THE SHS SYSTEM IS TO SERVE OUR COMMUNITIES WITH PRIDE (PASSION, RESPECT, INTEGRITY, DEDICATION, AND EXCELLENCE). SHS SEEKS TO BE THE FIRST CHOICE OF CONSUMERS IN THE REGION AND TO LEAD COLLABORATIVE EFFORTS AMONG THOSE WHO SHARE SIMILAR GOALS. 0 0 238072811 265301582 AS THE PARENT ORGANIZATION, SHS PROVIDES ADMINISTRATIVE AND OTHER SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS, SUCH AS PATIENT BILLING, INFORMATION SERVICES, ACCOUNTING, AND EMPLOYEE RECRUITMENT. SHS SPONSORS A HEALTH PLAN THAT PROVIDES MEDICAL, DENTAL, AND PHARMACY BENEFITS TO EMPLOYEES OF SHS AND ITS AFFILIATES. AS A SYSTEM, SHS LOOKS CAREFULLY AT LOCAL HEALTH CARE NEEDS AND GIVES THOUGHTFUL CONSIDERATION TO THE MOST EFFECTIVE WAYS TO MEET THOSE NEEDS. THE RESULT IS A RICH MIX OF LOCAL AND CENTRALIZED REGIONAL SERVICES, WHICH PROVIDE HIGH VALUE AND EXCELLENT HEALTH CARE FOR PEOPLE AT ALL STAGES OF THEIR LIVES.SAMARITAN HEALTH SERVICES (SHS) HAS POLICIES THAT PROVIDE FOR SERVING THOSE WITHOUT THE ABILITY TO PAY FOR TREATMENT. THE POLICIES ESTABLISH CRITERIA BASED ON THE INCOME OF THE PERSON RESPONSIBLE FOR THE BILL AND COLLECTIONS ARE AT AMOUNTS LESS THAN ITS ESTABLISHED RATES ON A SLIDING SCALE DOWN TO NO PAYMENT AT ALL. IN 2021 SHS PROVIDED SERVICES THAT BENEFITED THE POOR AND OTHERS IN THE COMMUNITIES IT SERVED. IN ADDITION TO THE GRANTS SHOWN ON LINE 4B, SHS INCURRED $2,755,018 OF COMMUNITY BENEFIT COSTS, INCLUDING HEALTH PROFESSION EDUCATION, COMMUNITY BUILDING ACTIVITIES, AND RESEARCH. 100267 100267 GRANTS AND ASSISTANCE PROVIDED BY SAMARITAN HEALTH SERVICES TO VARIOUS ORGANIZATIONS INCLUDING GRANTS TO ASSIST RESIDENTS IN BENTON, AND LINN COUNTIES. SEE PART IX, LINES 1 AND 2 AND RELATED SCHEDULE I FOR MORE DETAILS. 238173078 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 1432 0 1 1420 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 16 14 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X SAMARITAN HEALTH SERVICES 5417684857 PO BOX 3000 CORVALLIS OR 973393000 JUDY LIST BOARD CHAIR 1.00 1.00 X X 0 0 0 BOB ADAMS BOARD SECRETARY 1.00 2.00 X X 0 0 0 RANDY SPRINGER BOARD TREASURER 1.00 2.00 X X 0 0 0 MILTON MORAN BOARD CHAIR ELECT 1.00 1.00 X X 0 0 0 LOREN ROTH BOARD MEMBER 1.00 1.00 X 0 0 0 CHARLES MOURADIAN BOARD MEMBER 1.00 1.00 X 0 0 0 JIM DENHAM BOARD MEMBER 1.00 3.00 X 0 0 0 NANCY SEIFERT BOARD MEMBER 1.00 2.00 X 0 0 0 RICHARD KENYON BOARD MEMBER 1.00 2.00 X 0 0 0 TROY GARRETT MD BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 241210 22388 REVEREND WILLIAM MCCARTHY BOARD MEMBER 1.00 1.00 X 0 0 0 LESLIE PLISKIN MD BOARD MEMBER 1.00 1.00 X 0 0 0 PAUL DASKALOS DO BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 484779 60085 STUART PRITCHARD BOARD MEMBER 1.00 1.00 X 0 0 0 JUNE CHRISMAN BOARD MEMBER 1.00 1.00 X 0 0 0 RALPH BREITENSTEIN MD BOARD MEMBER 1.00 1.00 X 0 0 0 DOUGLAS BOYSEN PRESIDENT & CEO 33.00 7.00 X 1252525 0 62524 DANIEL SMITH SVP / CFO 23.00 17.00 X 585596 0 62069 ROBERT TURNGREN MD SVP / CHIEF PHYSICIAN EXEC 39.00 1.00 X 592971 0 55356 KELLEY KAISER SVP / CAO 35.00 5.00 X 479877 0 60358 JOSEPH CAHILL VP CEO MVH 1.00 39.00 X 419694 0 48825 LESLEY OGDEN MD VP CEO NLH / CEO SPCH 1.00 39.00 X 460120 0 52171 ROBERT POWER TERM FEB 2021 VP CIO 40.00 X 155826 0 16797 KIRK GERNER VP INNOVATIONS / STRATEGIC DEV 40.00 X 450330 0 54611 DANIEL KETERI VP CEO SAGH 1.00 39.00 X 425033 0 57213 JULIE MANNING VP MKTG / PR & COMMUNITY HLTH 32.00 X 268426 0 51737 GAIL WORDEN-ACREE VP HUMAN RESOURCES 40.00 X 303317 0 62801 GLEN CUNNINGHAM VP POPULATION HEALTH SERVICES 40.00 X 228417 0 52050 BRUCE BUTLER VP CEO HEALTH PLANS 20.00 20.00 X 469591 0 41616 TYLER JACOBSEN VP GENERAL COUNSEL 40.00 X 277904 0 64900 SHILOH ERVEN VP SMG ADMINISTRATION 40.00 X 199150 0 42389 LAURA HENNUM VP CEO GSRMC 1.00 39.00 X 456502 0 45946 MARGARET MIKULA MD VP CHIEF QUAL OFFICER 40.00 X 485522 0 45665 BRADLEY WAKEFIELD VP SMG COO 40.00 X 396033 0 60346 PANKAJ SAPRA SVP / CIO (START APR 2021) 40.00 X 298885 0 25133 JANET MCGUIRE VP REVENUE CYCLE 40.00 X 271320 0 16957 NANCY FRY VP FINANCE 40.00 X 212666 0 28797 DAVID ZARKOU DPM SENIOR MEDICAL DIRECTOR 40.00 X 396871 0 61528 BARRY SMITH MD SENIOR MEDICAL DIRECTOR 40.00 X 413929 0 47538 KEVIN EWANCHYNA MD VP CHIEF MEDICAL OFFICER SHPO 40.00 X 427861 0 61793 KRISTY JESSOP MD SENIOR MEDICAL DIRECTOR 40.00 X 363200 0 47055 BRENT GODEK MD SENIOR MEDICAL DIRECTOR 40.00 X 363187 0 47499 BECKY PAPE QUALITY IMPROVE / REVIEW COORD 10.00 X 106638 109803 28225 RYAN COMBS VP OPERATIONS MVH 0.00 40.00 X 0 288243 63333 10761391 1124035 1447705 225 1 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 STAFFING SERVICES 5777543 HEMATOLOGY ONCOLOGY OF SALEM LLP 875 OAK ST SE STE 4030 SALEM OR 97301 CLINICAL SERVICES 4501352 GREENBERRY CONSTRUCTION LLC 2273 NW PROFESSIONAL DR SUITE 200 CORVALLIS OR 97330 CONSTRUCTION 4140089 HGS AXISPOINT HEALTH LLC PO BOX 660367 DALLAS TX 752660367 CARE MGMT SERVICES 4089360 COGNIZANT WORLD 24721 NETWORK PLACE CHICAGO IL 606731247 IT CONSULTING SERVICES 3458818 144 100097 510754 719970 1330821 SUPPORT SERVICE FEES 561000 161592957 161592957 EMPL HEALTH PLAN PREM 525100 102472816 102472816 FITNESS CENTER REVENUE 713940 1487855 554088 933767 DURABLE MEDICAL EQUIP 446199 286769 252966 33803 OTH PROG SVC REVENUE 900099 226439 226439 202316 202316 266269152 1384808 63000 1321808 3190227 1500593 1689634 1689634 90000 1599634 46050001 120000 46047458 119486 2543 514 3057 3057 JOINT VENTURES 900099 593361 593361 GROUP PURCHASING 561499 282054 282054 OCCUPANCY SERVICES 561700 253226 253226 1128641 271806113 265301582 2249211 2924499 100267 100267 9697960 9697960 85773768 70378199 14052808 1342761 5002675 4196159 736174 70342 20716642 17376767 3048580 291295 6752197 5663628 993627 94942 1916 1916 504435 504435 387723 387723 81124 81124 2588 2588 48390 24195 24195 9721756 9634006 56750 31000 869536 852824 14162 2550 9220469 8751415 409527 59527 11118329 10871096 247233 2358281 2230349 95070 32862 198910 194438 3554 918 261573 258417 1429 1727 1638011 940150 697861 13066981 12785284 281324 373 3136410 2525540 610870 CLAIM FEES 89481718 89481718 PURCHASED SERVICES 1514454 923625 395687 195142 DUES, TAXES, & LICENSES 847160 302873 525548 18739 MEDICAL SUPPLIES 400759 400759 198329 198329 273102361 238173078 32784517 2144766 1000 800 268545299 253969194 774666 859990 20924 20924 1498107 1219191 120219 189620 7078399 8274860 245424169 131433397 115331543 113990772 22474714 22432068 171923 171923 16760711 18947037 432777505 420076379 53342050 55502487 768511 650348 167991550 166849305 44159571 37339168 110655589 105219435 376917271 365560743 X 55860234 54515636 55860234 54515636 432777505 420076379 X -1296248 -661906 613556 X 0 1 X 1 1 1 X X 5 ALBANY GEN HOSP 930110095 3 1 0 29271705 GOOD SAM HOSP 930391573 3 1 0 62683203 MID-VALLEY HC 930396847 3 1 0 17564662 N LINCOLN HOSP 931305493 3 1 0 7634176 SAM PAC HLTH SVCS 931329784 3 1 0 15000361 5 0 132154107 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART I, LINE 12G AS THE PARENT ORGANIZATION, SHS PROVIDES ADMINISTRATIVE AND OTHER SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS, SUCH AS PATIENT BILLING, INFORMATION SERVICES, ACCOUNTING, AND EMPLOYEE RECRUITMENT. THE AMOUNTS SHOWN ON PART I, LINE G REPRESENT THE VALUE OF THESE SERVICES ALLOCATED TO THE SUPPORTED ORGANIZATIONS. PART IV, SECTION A, LINE 6 SEVERAL ORGANIZATION(S) WERE GIVEN GRANTS TO SUPPORT THEIR EXEMPT FUNCTIONS. SEE SCHEDULE I PART II FOR MORE DETAILS. PART IV, SECTION D, LINE 1 AS THE PARENT COMPANY AND SOLE CORPORATE MEMBER OF ALL SUPPORTED ORGANIZATIONS, SHS PROVIDES MONTHLY FINANCIAL STATEMENTS SHOWING THE AMOUNT OF SUPPORT PROVIDED TO EACH OF ITS SUPPORTED ORGANIZATIONS. THE EXECUTIVE LEADERSHIP OF ALL SUPPORTED ORGANIZATIONS IS PRESENT FOR THE FINAL REVIEW OF THE FORM 990 WITH THE SHS BOARD OF DIRECTORS. IN ADDITION, THIS SAME LEADERSHIP TEAM IS PRESENT AT BOARD MEETINGS WHERE CHANGES TO GOVERNING DOCUMENTS ARE PROPOSED AND APPROVED. PART IV, SECTION D, LINE 3 THE SHS BOARD IS COMPOSED OF MEMBERS FROM THE SUPPORTED ORGANIZATIONS. PART IV, SECTION E, LINE 3A THE PARENT CORPORATION (SHS) HAS SEVERAL RESERVED POWERS PER THE BYLAWS OF THE SUPPORTED ORGANIZATIONS LISTED IN PART I OF SCHEDULE A. FOR EXAMPLE, THE ELECTION AND REMOVAL OF DIRECTORS MUST BE APPROVED BY THE PARENT CORPORATION (SHS). PART IV, SECTION E, LINE 3B THE PARENT CORPORATION (SHS) HAS SEVERAL RESERVED POWERS PER THE BYLAWS OF THE SUPPORTED ORGANIZATIONS LISTED IN PART I OF SCHEDULE A. THESE INCLUDE THE APPROVAL OF INDEBTEDNESS, THE APPROVAL OF ACQUISITIONS AND MERGERS, SALES AND TRANSFERS OF ASSETS, APPROVAL OF CAPITAL BUDGETS, AND ANY CHANGES TO THE ORGANIZATIONAL DOCUMENTS, AMONG OTHERS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 56903 1 24221 0 0 81124 0 PART II-B, LINE 1: LINE 1F: THE FILING ORGANIZATION MAINTAINS MEMBERSHIPS IN THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND OREGON ASSOCIATION OF HOSPITALS AND HEALTHCARE SYSTEMS (OAHHS). DURING TAX YEAR 2021, THE FILING ORGANIZATION PAID MEMBERSHIP DUES TO OAHHS AND AHA OF $219,201 AND $108,974 RESPECTIVELY. 12.80% OF OAHHS DUES AND 26.47% OF AHA DUES WENT FOR LOBBYING PURPOSES. THUS, THE FILING ORGANIZATION MADE INDIRECT LOBBYING EXPENDITURES OF $56,903 THROUGH ITS MEMBERSHIP DUES. PAID STAFF HAD DIRECT CONTACT WITH GOVERNMENT OFFICIALS REGARDING THE FOLLOWING TOPICS: KEY HEALTH POLICY AREAS SUCH AS; INVESTMENTS IN BEHAVIORAL HEALTH SERVICES, EXPANDING HEALTH COVERAGE, SOCIAL DETERMINANTS OF HEALTH, HOUSING, MENTAL HEALTH PARITY, HEALTH CARE INTERPRETERS, MERGERS AND ACQUISITIONS, SURGICAL TECHNOLOGIST APPRENTICESHIP, NURSE STAFFING, TELEHEALTH, CLINICAL LAB RESULTS SHARING, COMMUNITY INFORMATION EXCHANGE AND OTHERS. 24,221 OF THE PAID STAFF'S SALARY AND BENEFITS WAS ALLOCATED TO THESE ACTIVITIES BASED ON THEIR TIME SPENT WITH GOVERNMENT OFFICIALS. 3665000 17218352 20883352 21220093 75270449 35190103 61300439 3306989 1996452 1310537 110119590 91489856 18629734 14623696 2756986 11866710 113990772 22432068 C 22432068 LIABILITY FOR UNPAID MEDICAL CLAIMS 8012192 TENANT DEPOSITS 150000 ACCRUED INTEREST 1133876 OTHER LIABILITIES 16834378 ACCOUNTS PAYABLE - AFFILIATES 79088989 105219435 X PART X, LINE 2: FOOTNOTE DISCLOSURE FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THE SHS' MANAGEMENT TO EVALUATE TAX POSITIONS AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF SHS 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 SHS AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021, 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. SHS IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. SHS' MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2018. 1 UNITED WAY OF BENTON & LINCOLN COUNTIES PO BOX 2499 CORVALLIS OR 97339 936013898 501(C)(3) 15000 0 FUNDING TO SUPPORT COMMUNITY NEEDS IN BENTON, LINN, AND LINCOLN COUNTIES LINN BENTON COMMUNITY COLLEGE FOUNDATION 6500 PACIFIC BLVD SW ALBANY OR 97321 237212073 501(C)(3) 37500 0 FUNDING FOR CHILDCARE SUPPORT SERVICES BENTON COUNTY PO BOX 964 CORVALLIS OR 97339 936002285 GOV'T 37767 0 FUNDING FOR A REGIONAL HEALTH ASSESSMENT COLLABORATION CASA LATINOS UNIDOS DE BENTON COUNTY 1435 SW 35TH ST CORVALLIS OR 97333 263639798 501(C)(3) 10000 0 FUNDING TO SUPPORT THE LATINO COMMUNITIES OF LINN AND BENTON COUNTIES 4 PART I, LINE 2: AGENCIES IN THE COMMUNITY ARE INVITED TO SUBMIT GRANT PROPOSALS THROUGH AN APPLICATION PROCESS. A COMMITTEE REVIEWS THE APPLICATIONS TO DETERMINE IF THE FUNDS REQUESTED WILL BE USED TO ADDRESS THE ORGANIZATION'S ESTABLISHED COMMUNITY HEALTH PRIORITIES, IDENTIFIED NEEDS, AND SUPPORTS THE ORGANIZATION'S MISSION. ONCE APPROVED AND FUNDED, AGENCIES MUST SUBMIT A COMPLETE ANNUAL REPORT DESCRIBING HOW THE FUNDS WERE USED, THE NUMBER OF CLIENTS SERVED, AND HOW OUTCOMES WERE ACHIEVED. X 1 1 X X X X X X 0 1 0 0 1 0 0 0 0 DOUGLAS BOYSEN PRESIDENT & CEO 968319 0 236288 0 47918 0 23288 0 39236 0 1315049 0 0 0 ROBERT TURNGREN MD SVP / CHIEF PHYSICIAN EXEC 468093 0 91343 0 33535 0 23288 0 32068 0 648327 0 0 0 DANIEL SMITH SVP / CFO 449329 0 86742 0 49525 0 23288 0 38781 0 647665 0 0 0 PAUL DASKALOS DO BOARD MEMBER / PHYSICIAN 0 475129 0 7339 0 2311 0 23288 0 36797 0 544864 0 0 KELLEY KAISER SVP / CAO 396801 0 80801 0 2275 0 23288 0 37070 0 540235 0 0 0 MARGARET MIKULA MD VP CHIEF QUAL OFFICER 423503 0 35833 0 26186 0 6946 0 38719 0 531187 0 0 0 LESLEY OGDEN MD VP CEO NLH / CEO SPCH 358818 0 66110 0 35192 0 23288 0 28883 0 512291 0 0 0 BRUCE BUTLER VP CEO HEALTH PLANS 389835 0 73903 0 5853 0 23288 0 18328 0 511207 0 0 0 KIRK GERNER VP INNOVATIONS / STRATEGIC DEV 286246 0 40791 0 123293 0 23288 0 31323 0 504941 0 0 0 LAURA HENNUM VP CEO GSRMC 417351 0 35448 0 3703 0 6905 0 39041 0 502448 0 0 0 KEVIN EWANCHYNA MD VP CHIEF MEDICAL OFFICER SHPO 392544 0 4767 0 30550 0 23288 0 38505 0 489654 0 0 0 DANIEL KETERI VP CEO SAGH 358139 0 63345 0 3549 0 17488 0 39725 0 482246 0 0 0 JOSEPH CAHILL VP CEO MVH 332024 0 58693 0 28977 0 23288 0 25537 0 468519 0 0 0 BARRY SMITH MD SENIOR MEDICAL DIRECTOR 375781 0 37250 0 898 0 23288 0 24250 0 461467 0 0 0 DAVID ZARKOU DPM SENIOR MEDICAL DIRECTOR 346863 0 34414 0 15594 0 23288 0 38240 0 458399 0 0 0 BRADLEY WAKEFIELD VP SMG COO 321031 0 65602 0 9400 0 23288 0 37058 0 456379 0 0 0 BRENT GODEK MD SENIOR MEDICAL DIRECTOR 329996 0 32448 0 743 0 23288 0 24211 0 410686 0 0 0 KRISTY JESSOP MD SENIOR MEDICAL DIRECTOR 330244 0 32448 0 508 0 23288 0 23767 0 410255 0 0 0 GAIL WORDEN-ACREE VP HUMAN RESOURCES 215202 0 42757 0 45358 0 23288 0 39513 0 366118 0 0 0 RYAN COMBS VP OPERATIONS MVH 0 252849 0 23613 0 11781 0 23288 0 40045 0 351576 0 0 TYLER JACOBSEN VP GENERAL COUNSEL 232046 0 33420 0 12438 0 23145 0 41755 0 342804 0 0 0 PANKAJ SAPRA SVP / CIO (START APR 2021) 262979 0 35000 0 906 0 0 0 25133 0 324018 0 0 0 JULIE MANNING VP MKTG / PR & COMMUNITY HLTH 200329 0 45403 0 22694 0 21462 0 30275 0 320163 0 0 0 JANET MCGUIRE VP REVENUE CYCLE 264974 0 3834 0 2512 0 0 0 16957 0 288277 0 0 0 GLEN CUNNINGHAM VP POPULATION HEALTH SERVICES 191051 0 36169 0 1197 0 13165 0 38885 0 280467 0 0 0 TROY GARRETT MD BOARD MEMBER / PHYSICIAN 0 239173 0 906 0 1131 0 18456 0 3932 0 263598 0 0 BECKY PAPE QUALITY IMPROVE / REVIEW COORD 90323 0 0 400 16315 109403 8982 12093 7150 0 122770 121896 0 0 SHILOH ERVEN VP SMG ADMINISTRATION 171679 0 19510 0 7961 0 14900 0 27489 0 241539 0 0 0 NANCY FRY VP FINANCE 196298 0 14772 0 1596 0 15509 0 13288 0 241463 0 0 0 ROBERT POWER TERM FEB 2021 VP CIO 57119 0 58255 0 40452 0 10258 0 6539 0 172623 0 0 0 PART I, LINE 1A IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM/FITNESS FACILITY BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. EMPLOYEES CAN USE THEIR WELLNESS BENEFIT AT EITHER NON-SAMARITAN OR SAMARITAN (SAMFIT) GYM/FITNESS FACILITIES. IF AN EMPLOYEE PARTICIPATES AT A NON-SAMARITAN GYM, REIMBURSEMENT IS MADE FOR FEES. REIMBURSEMENT DOES NOT EXCEED $300 PER YEAR AND IS INCLUDED IN THEIR TAXABLE WAGES SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. ONE KEY EMPLOYEE USED THE NON-SAMARITAN GYM REIMBURSEMENT DURING THE FILING YEAR. IF EMPLOYEES USE THEIR WELLNESS BENEFIT AT A SAMARITAN (SAMFIT) GYM/FITNESS FACILITY, THEN THE ANNUAL COST OF EMPLOYEE MEMBERSHIP, $300, IS INCLUDED IN THE EMPLOYEE'S TAXABLE WAGES SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. TWO BOARD MEMBERS, ONE OFFICER, EIGHT KEY EMPLOYEES, THREE HIGHEST PAID EMPLOYEES, AND ONE FORMER KEY EMPLOYEE USED THE SAMARITAN (SAMFIT) GYM/FITNESS FACILITY BENEFIT DURING THE FILING YEAR. PART I, LINE 4B LINE 4B: THE FILING 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. PART I, LINE 5 VARIOUS PHYSICIAN COMPENSATION METHODOLOGIES ARE UTILIZED AND, DEPENDING ON SPECIALTY, RELATIVE VALUE UNITS (RVU'S) MAY BE USED IN DETERMINING A PORTION OF OR ALL OF THEIR COMPENSATION. A STATE OF OREGON - FACIL AUTHORITY 936001787 000000000 2009-09-30 15800000 CONST. OF MEDICAL SCHOOL 0 0 0 B STATE OF OREGON - FACIL AUTHORITY 936001787 000000000 2014-12-18 18952500 CONST OF MEDICAL OFFICE BLDG, HOSPITAL REMODELS 0 0 0 C STATE OF OREGON - FACIL AUTHORITY 936001787 68608JWF4 2016-11-16 89533143 HOSPITAL FACILITY CONSTRUCTION AND REMODELS 1 0 0 D STATE OF OREGON - FACIL AUTHORITY 936001787 68608JYJ4 2020-07-07 77108397 TO REFUND THE 2010 SERIES A BONDS 0 0 0 A 7230148 15865543 283537 15582006 2011 0 0 1 1 B 4055547 18989505 169620 18819885 2019 0 0 0 1 C 1030000 91172903 985093 62638694 27533538 15578 2020 1 0 0 1 D 77108397 1030309 76078088 2020 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 1 0 0 0 0 1 D 0 1 1 1 0 0.00100 0.00100 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 1 0 0 1 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: STATE OF OREGON - FACIL. AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/14/2014 ISSUER NAME: STATE OF OREGON - FACIL. AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/13/2020 PART II, LINE 3: DIFFERENCES ON THIS LINE AS COMPARED TO PART I(E) ARE DUE TO INVESTMENT EARNINGS AND UNREALIZED GAINS/LOSSES. MARGARET MIKULA KEY EMPL NEW HIRE RECRUITMENT PACKAGE X 25000 20924 0 1 1 20924 FORM 990, PART VI, SECTION A, LINE 2 GLEN CUNNINGHAM AND KIRK GERNER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES), AS ULTIMATELY FILED WITH THE IRS, WAS PROVIDED TO EACH VOTING MEMBER OF THE SAMARITAN HEALTH SERVICES (SHS) AUDIT AND COMPLIANCE COMMITTEE PRIOR TO ITS FILING WITH THE IRS. SHS'S CHIEF FINANCIAL OFFICER CONDUCTED THE FORM 990 REVIEW WITH THE COMMITTEE AND PROVIDED TIME FOR QUESTIONS FROM THE GROUP. A FORMAL REPORT OF THIS COMMITTEE HAS BEEN MADE TO THE FULL BOARD OF DIRECTORS OF SHS. ADDITIONALLY, A COMPLETE COPY OF THE FILING ORGANIZATION'S FINALIZED FORM 990 AND RELATED SCHEDULES WAS PROVIDED ELECTRONICALLY TO ALL MEMBERS OF THE FILING ORGANIZATION'S GOVERNING BOARD PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBER CONFLICTS OF INTEREST: THE MEMBERS OF THE BOARD MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, WHICH REQUIRES DISCLOSURE OF ANY CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CORPORATE COMPLIANCE OFFICER. IF A CONFLICT IS DISCLOSED THAT COULD PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THIS IS EVALUATED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES (SHS) BOARD OF DIRECTORS TO DETERMINE WHETHER THE MEMBER SHOULD CONTINUE TO SERVE ON THE BOARD. IF A CONFLICT IS DISCLOSED THAT DOES NOT PROHIBIT A MEMBER FROM SERVING 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 MEMBER HAS A CONFLICT OF INTEREST. EMPLOYEE CONFLICTS OF INTEREST: THE SHS CODE OF CONDUCT AND BUSINESS ETHICS REQUIRES THAT ALL SHS EMPLOYEES COMPLETE AN ANNUAL DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST. THROUGH THE HUMAN RESOURCES SOFTWARE, PERFORMANCE MANAGER, THE DISCLOSURE REQUIREMENT NOTICE IS ASSIGNED TO ALL EMPLOYEES AND BY YEAR END ALL TASKS ARE TO BE COMPLETED. IF THERE IS A PERCEIVED CONFLICT OF INTEREST IT IS REVIEWED BY THE CORPORATE COMPLIANCE OFFICER, LEGAL COUNSEL AND/OR SENIOR MANAGEMENT. ACTUAL CONFLICTS OF INTEREST ARE REVIEWED AND DISCUSSED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF SAMARITAN HEALTH SERVICES PERIODICALLY ENGAGES AN INDEPENDENT CONSULTANT TO ASSIST IT IN PROVIDING COMPARABLE MARKET DATA FOR THE CEO, WHO IS THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL. THIS ANALYSIS INCLUDES REGIONAL AND NATIONAL DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THIS INFORMATION IS USED BY THE COMPENSATION COMMITTEE IN ITS DELIBERATIONS REGARDING THE CEO'S COMPENSATION WHICH IS DOCUMENTED IN THE COMMITTEE'S MINUTES. THE CEO OF THE ORGANIZATION RELIES ON PUBLICLY AVAILABLE INFORMATION TO DETERMINE THE COMPENSATION FOR OTHER TOP MANAGEMENT OFFICIALS WITHIN THE ORGANIZATION. HE CONSULTS WITH THE INDEPENDENT CONSULTANT AS TO THE REASONABLENESS OF THIS DATA TO ENSURE THAT EACH TOP MANAGEMENT OFFICIAL'S COMPENSATION IS REASONABLE AS COMPARED TO SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. PHYSICIAN EMPLOYEE COMPENSATION, INCLUDING PHYSICIANS WHO ARE BOARD MEMBERS, IS REVIEWED AT LEAST ANNUALLY BY SENIOR MANAGEMENT. THIS REVIEW INCLUDES COMPARISON WITH PUBLISHED PHYSICIAN COMPENSATION STUDIES. FOR ALL OTHER EMPLOYEES, THE 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 FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. SYSTEM-WIDE SUMMARIZED DATA IS ALSO PROVIDED IN THE ANNUAL REPORT TO THE COMMUNITY. THIS REPORT IS MADE AVAILABLE IN KIOSKS AND HIGH-TRAFFIC AREAS OF HOSPITALS AND PHYSICIAN CLINICS, AS WELL AS COMMUNITY PLACES SUCH AS THE PUBLIC LIBRARY. IT IS ALSO DISTRIBUTED TO THE BOARDS OF DIRECTORS AND DIRECTLY MAILED TO DONORS AND NEW RESIDENTS IN THE COMMUNITY. ADDITIONALLY, THE REPORT IS MADE AVAILABLE AT EVENTS, COMMUNITY OUTREACH PROJECTS, AND SCREENINGS ATTENDED THROUGHOUT THE YEAR. GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: BOOK TO TAX DIFFERENCES - JOINT VENTURES 613,556. 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