2021-05-12T12:38:17-05:00 2020-06-30 200079326 DINGUS ZARECOR & ASSOCIATES PLLC 12015 E MAIN AVE SPOKANE VALLEY WA 99206 990 2019-07-01 930425580 GOOD SHEPHERD HEALTH CARE SYSTEM GOOD 5416673400 610 NW 11TH STREET HERMISTON OR 97838 BRIAN SIMS PRESIDENT/CEO 5416673400 2021-05-11 true THOMAS DINGUS P00951009 5092420874 2021-05-12 2019 2022-09-23 18:48:47Z GOOD SHEPHERD MEDICAL CENTER BRIAN SIMS 610 NW 11TH STREET HERMISTON OR 97838 119819974 false X WWW.GSHEALTH.ORG X 1953 OR TO PROVIDE COMPASSIONATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE AND TO PROMOTE A HEALTHY COMMUNITY. 12 11 887 92 0 117043 8078365 109595310 105294750 5223240 4394654 1933689 1690449 116869282 119458218 91780 165090 0 58974622 66488728 0 162005 50459064 44534829 109525466 111188647 7343816 8269571 214913164 232869052 14978677 25112515 199934487 207756537 X TO PROVIDE COMPASSIONATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE AND TO PROMOTE A HEALTHY COMMUNITY. false false 96433290 165090 105294750 GOOD SHEPHERD HEALTH CARE SYSTEM (GSHCS) IS COMPRISED OF A 25-BED CRITICAL ACCESS HOSPITAL (CAH), TWO RURAL HEALTH CLINICS, AND ONE PROVIDER-BASED CLINIC WHICH PROVIDES HEALTHCARE SERVICES TO PATIENTS. SERVICES OFFERED AT THE HOSPITAL INCLUDE MEDICAL, SURGICAL, LABOR/DELIVERY AND NURSERY CARE, 24-HOUR EMERGENCY, LABORATORY, IMAGING SERVICES, PHYSICAL THERAPY, HOME HEALTH, HOSPICE, AND PHYSICIAN CLINICS. GSHCS PROVIDED 3,670 DAYS OF INPATIENT SERVICES AND SERVED 1,405 INPATIENTS, 79,118 OUTPATIENTS, AND 20,027 PATIENTS IN OUR EMERGENCY CENTER DURING FISCAL YEAR 2019-2020. CONTINUATION ON SCHEDULE O. 96433290 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true true true false false false false false false false true false false false false false true true true false false true 121 0 true 887 true false false false false false false false false false false false false X 12 11 true false false false false false false true true false false true true true true true true true true false OR X JAN PETER 5416673400 610 NW 11TH STREET HERMISTON OR 97838 STEVE ELDRIGE CHAIR 2.00 X X 0 0 0 NANCY MABRY VICE CHAIR 2.00 X X 0 0 0 SUE DAGGETT SECRETARY 2.00 X X 0 0 0 TOM WAMSLEY TREASURER 2.00 1.00 X X 0 0 0 BOB CARLSON DIRECTOR 2.00 X 0 0 0 ARNELL EYNON DIRECTOR 2.00 X 0 0 0 RACHEL ARCHER DIRECTOR 2.00 X 0 0 0 JON LORENCE DIRECTOR 2.00 X 0 0 0 BILL ELFERING DIRECTOR 2.00 1.00 X 0 0 0 DEREK EARL DIRECTOR 2.00 X 0 0 0 LISA MITTELSDORF DIRECTOR 2.00 1.00 X 0 0 0 JEFF WENHOLZ DIRECTOR 2.00 X 0 0 0 DENNIS BURKE CEO UNTIL 9 40.00 X 470131 0 69883 JAN PETER CFO 40.00 X 259508 0 51080 JIM SCHLENKER COO 40.00 X 233016 0 36472 JEREMY ANDERSON ORTHO 40.00 X 783098 0 22413 CHRISTOPHER KEELER SURGEON 40.00 X 435502 0 25460 THOMAS HOLT UROLOGIST 40.00 X 411310 0 40440 RANDOLPH TODD JONES SURGEON 40.00 X 392291 0 15808 ANDREW HAPUTA SURGEON 40.00 X 357159 0 10975 3342015 272531 8 false true false NORTHWEST EMERGENCY PHYSICIANS PO BOX 634850 CINCINNATI OH 45263 ER PHYSICIANS 3046660 TUALATIN IMAGING 7427 SW COHO CT SUITE 200 TUALATIN OR 97062 DIAGNOSTIC IMAG 1242385 CREDITS INC 461 E MAIN STREET HERMISTON OR 97838 COLLECTIONS 525841 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 LOCUM SERVICES 492938 TRI-CITIES LABORATORY PO BOX 2688 SPOKANE WA 99220 LAB SERVS 276204 11 51190 7994628 32547 8078365 NET PATIENT SERVICE REVENUE 624100 105266103 105266103 SUPPORTING PATIENT SERVICES 624100 28647 28647 105294750 3731828 3731828 4033 4033 4033 4033 1024582 361756 1024582 -361756 662826 662826 CAFETERIA 722210 981481 981481 DAYCARE 900099 297064 297064 PATIENT FINANCE 624410 227044 227044 180827 180827 1686416 119458218 105294750 6085103 X 144333 144333 20757 20757 1119081 1119081 51560719 44857944 6589762 113013 1895549 1673036 218297 4216 8779255 7582935 1177216 19104 3134124 2676990 450390 6744 137714 137714 118997 118997 244911 244911 18192573 16648948 1537618 6007 265570 74000 190106 1464 1328677 998307 323766 6604 8786 8786 1037206 923429 113347 430 472597 371421 101168 8 230163 4194 225969 29979 29979 6866652 5968786 893451 4415 613337 8270 605067 MEDICAL SUPPLIES & DRUGS 12687050 12687050 DIETARY & FOOD 1014899 959893 55006 RECRUITMENT 778788 666229 112559 DUES & SUBSCRIPTIONS 353889 60628 293261 153041 106140 46901 111188647 96433290 14593352 162005 2870851 31628020 27399171 20635452 2810709 298816 3043726 3285158 1166037 1307763 143753829 81603918 62899677 62149911 98253415 101316643 630000 1560000 7898484 7675090 7941094 3012199 214913164 232869052 9955677 11364746 5023000 13747769 14978677 25112515 X 199442382 207224216 492105 532321 199934487 207756537 214913164 232869052 X 8269571 -752000 304479 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 10509 10509 false SCHEDULE C, PART II-B, LINE 1 LINE 1I - THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. THE HOSPITAL PAYS MEMBERSHIP DUES TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS. THE ASSOCIATIONS USE A PORTION OF SUCH DUES TO CARRY OUT LOBBYING ACTIVITIES. 2860961 951448 3812409 77039386 33804432 43234954 3011582 1912333 1099249 56225353 45887153 10338200 3665099 3665099 62149911 MEDICARE ACCELERATED PAYMENTS 13747769 13747769 X SCHEDULE D, PAGE 3, PART X GSHCS IS EXEMPT FROM FEDERAL INCOME TAX. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. GSHCS EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF JUNE 30, 2020 AND 2019, GSHCS HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. true true true X true X true true false true true 2710430 2710430 0.02440 21752119 21752119 24462549 21752119 2710430 0.02440 49866 2136527 56745 2079782 0.01870 285617 9335 276282 0.00250 33647194 16965556 16681638 0.15000 144333 144333 0.00130 49866 36213671 17031636 19182035 0.17250 49866 60676220 38783755 21892465 0.19690 true 1938245 65513 29009143 30153855 -1144712 X true true 1 1 GOOD SHEPHERD HEALTH CARE SYSTEM 610 NW 11TH STREET HERMISTON OR 97838 WWW.GSHEALTH.ORG 055598-6 X X X X GOOD SHEPHERD HEALTH CARE SYSTEM 1 false false true X X X X X X X X 18 true true true true X WWW.GSHEALTH.ORG X X true 18 true SEE PART VI false true X 200.000000000000 350.000000000000 X X true true X X X X true X SEE PART V X SEE PART V X SEE PART V X X X X X true X false X X X true X false false FACILITY 1, GOOD SHEPHERD HEALTH CARE SYSTEM - PART V, LINE 3E IDENTIFICATION OF HEALTH NEEDS ARE ADDRESSED IN APPENDIX VII, OF THE LATEST CHNA LOCATED ON THE HOSPITAL'S WEBSITE. FACILITY 1, GOOD SHEPHERD HEALTH CARE SYSTEM - PART V, LINE 5 THE NEEDS ASSESSMENT WAS ENVISIONED, DESIGNED, AND EXECUTED BY COMMUNITY LEADERS AND MEMBERS REPRESENTING HEALTHCARE, PUBLIC HEALTH, LAW ENFORCEMENT, EDUCATION, AND SOCIAL SERVICES. THE ASSESSMENT WAS CONDUCTED IN PARTNERSHIP WITH ST. ANTHONY HOSPITAL IN PENDLETON, OR. THE ASSESSMENT PROCESS INCLUDED REGULAR CONSULTATION WITH THE LOCAL CHILD DEVELOPMENT COALITION AND COUNTY PUBLIC HEALTH DEPARTMENTS. TWO SURVEY INSTRUMENTS WERE USED IN THIS ASSESSMENT: ONE FOR ADULTS 19-YEARS-OF-AGE AND OLDER AND ONE FOR PARENTS OF CHILDREN AGES 0 THROUGH 11. A TOTAL OF 1,200 ADULT AND 2,400 PARENT SURVEYS WERE MAILED TO RESIDENTS OF UMATILLA COUNTY. FACILITY 1, GOOD SHEPHERD HEALTH CARE SYSTEM - PART V, LINE 6A THE CHNA WAS CONDUCTED WITH ST. ANTHONY HOSPITAL LOCATED IN PENDLETON, OR. FACILITY 1, GOOD SHEPHERD HEALTH CARE SYSTEM - PART V, LINE 6B THE CHNA WAS ALSO CONDUCTED WITH OREGON CHILD DEVELOPMENT COALITION, UMATILLA COUNTY PUBLIC HEALTH, AND HOSPITAL COUNCIL OF NORTHWEST OHIO. FACILITY 1, GOOD SHEPHERD HEALTH CARE SYSTEM - PART V, LINE 7D THE CHNA WAS MADE WIDELY AVAILABLE THROUGH A NEWSPAPER ARTICLE PROVIDING A SYNOPSIS OF THE ASSESSMENT'S FINDINGS, PUBLIC FORUMS DISCUSSING THE ASSESSMENT'S FINDINGS, AS WELL AS AVAILABLE ON OUR WEBSITE. FACILITY 1, GOOD SHEPHERD HEALTH CARE SYSTEM - PART V, LINE 11 THE MOST RECENT CHNA IDENTIFIED THE FOLLOWING SIGNIFICANT HEALTH NEEDS ALONG WITH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THESE NEEDS INCLUDE: ACCESS TO SERVICES SOCIAL DETERMINANT OF HEALTH/HEALTH EQUITY: WE WILL CONTINUE OFFERING URGENT CARE SERVICES, CONNEXIONS PROGRAM (CASE MANAGEMENT AND RESOURCE REFERRAL), HERMISTON HIGH SCHOOL WELLNESS CLINIC, MEMBERSHIP IN THE LOCAL COMMUNITY ADVISORY COUNCIL (LCAC) AND SUPPORT OF LCAC OBJECTIVES. WE WILL IMPLEMENT NEW STRATEGIES INCLUDING COMMUNITY EDUCATION ON APPROPRIATE USE OF THE EMERGENCY DEPARTMENT, URGENT CARE, AND PRIMARY CARE PROVIDERS (PCPS), INCREASE EFFORTS TO RECRUIT HEALTHCARE PROVIDERS TO MEET THE GROWING POPULATION, AND MAKE URGENT CARE SERVICES MORE ACCESSIBLE. OBESITY/CHRONIC DISEASE: WE WILL CONTINUE OFFERING BMI MEASUREMENTS AT COMMUNITY SCREENING EVENTS, ENCOURAGING COMMUNITY PARTNERS TO PROMOTE HEALTHY GARDENING AND FOOD CHOICES, CONTINUE TO PROMOTE COMMUNITY-BASED EXERCISE AND FITNESS EDUCATION OPPORTUNITIES. WE WILL IMPLEMENT NEW STRATEGIES INCLUDING NORTHEAST OREGON PRESCRIPTION TRAILS PROGRAM, SUGAR-SWEETENED BEVERAGE EDUCATION AT 75% OF COMMUNITY OUTREACH EVENTS, FEASIBILITY ANALYSIS OF METABOLIC AND BARIATRIC PROGRAM, AND CREATION OF COMMUNITY CANCER PREVENTION STRATEGIC PLAN. VIOLENCE: WE WILL CONTINUE OFFERING SAFE COMMUNITIES PARTICIPATION AND START BY BELIEVING CAMPAIGN. WE WILL IMPLEMENT NEW STRATEGIES INCLUDING COLLABORATE WITH DOMESTIC VIOLENCE SERVICES TO HOST ONE IN HER SHOES EVENT ON SITE ANNUALLY, INTEGRATE ABUSE SCREENING QUESTIONNAIRE INTO EPIC, EXPANSION OF AWARENESS AND SCOPE OF START BY BELIEVING CAMPAIGN LED BY SANE TEAM. BEHAVIORAL HEALTH: WE WILL CONTINUE OFFERING SAFE COMMUNITIES AND DEVELOPMENTAL ADOLESCENT RESIDENTIAL TREATMENT (DART) PARTICIPATION, MEMBERSHIP IN THE LOCAL COMMUNITY ADVISORY COUNCIL (LCAC), SUPPORT OF LCAC OBJECTIVES, TOBACCO TREATMENT SPECIALIST (TTS) COUNSELING, AND COMMUNITY TOBACCO EDUCATION AND EVENTS. WE WILL IMPLEMENT NEW STRATEGIES INCLUDING ENSURING UNIFORM COMPLIANCE WITH GSHCS POLICIES REGARDING PRESCRIPTION DRUG MONITORING PROGRAM (PDMP) DASHBOARD USAGE BEFORE PRESCRIBING OPIOIDS OR OTHER ADDICTIVE PRESCRIPTIONS, ENSURING UNIFORM COMPLIANCE WITH GSHCS POLICIES REGARDING REQUIRING DOCTOR/PATIENT AGREEMENT WHEN ON LONG-TERM OPIOID PRESCRIPTIONS, OBTAINING ONE GSHCS EMPLOYED MEDICATION ASSISTED TREATMENT (MAT) PROVIDER, TRAINING SELECT GSHCS STAFF IN NALOXONE ADMINISTRATION, CREATING ON-SITE SAFE MEDICATION DISPOSAL SITE, AND DISTRIBUTING ACCURATE INFORMATION ON DRUGS AT VARIOUS COMMUNITY EVENTS. THE HOSPITAL DOES NOT HAVE ADEQUATE RESOURCES TO SOLVE ALL THE PROBLEMS IDENTIFIED. SOME ISSUES ARE BEYOND THE MISSION OF THE HOSPITAL AND ACTION IS BEST SUITED FOR A RESPONSE BY OTHERS OR WILL REQUIRE PERSONAL ACTIONS BY INDIVIDUALS RATHER THAN THE RESPONSE OF AN ORGANIZATION. WE VIEW THE ABOVE STRATEGIES FOR HOW WE, ALONG WITH OTHER ORGANIZATIONS AND AGENCIES, CAN COLLABORATE TO BRING THE BEST EACH HAS TO OFFER TO ADDRESS THE MORE PRESSING IDENTIFIED NEEDS. FACILITY 1, GOOD SHEPHERD HEALTH CARE SYSTEM - PART V, LINE 16J A SUMMARY OF THE FAP IS DISTRIBUTED IN UNEMPLOYMENT OFFICES AND OTHER AREAS IN THE COMMUNITY THAT TARGET THE ELIGIBLE POPULATION. A SUMMARY IS ALSO AVAILABLE AT LOCAL PHYSICIAN OFFICES, ADMISSIONS OFFICES, AND SENT WITH BILLING INVOICES. ALSO, UPON DISCHARGE, A PATIENT FINANCIAL REPRESENTATIVE MEETS WITH PATIENTS TO DISCUSS THEIR ABILITY TO PAY FOR SERVICES. INCLUDED AS PART OF THIS DISCUSSION IS A SUMMARY OF THE FAP. A PLAIN LANGUAGE SUMMARY OF THE FAP WAS ALSO WIDELY AVAILABLE ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTP://GSHCS.NET/PUB/GSHCS-CHARITY-CARE-POLICY.PDF FINANCIAL ASSISTANCE INFORMATION CAN BE FOUND WIDELY AVAILABLE ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTP://WWW.GSHEALTH.ORG/PAYING-FOR-YOUR-CARE 3 GOOD SHEPHERD MEDICAL GROUP 610 NW 11TH STREET HERMISTON OR 97838 CLINIC VANGE JOHN MEMORIAL HOSPICE 610 NW 11TH STREET HERMISTON OR 97838 HOSPICE GOOD SHEPHERD HOME HEALTH 610 NW 11TH STREET HERMISTON OR 97838 HOME HEALTH SCHEDULE H, PART III, LINE 2 THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON SCHEDULE H, PART III, LINE 2 INCLUDES THE COST TO CHARGE RATIO OF PATIENT CARE. SCHEDULE H, PART III, LINE 3 MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. THE ESTIMATE OF BAD DEBT ATTRIBUTABLE TO CHARITY PATIENTS IS BASED ON AN OVERALL CHARITY CARE PERCENTAGE OF GROSS REVENUE. SCHEDULE H, PART III, LINE 4 THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE FY2019 AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 3, ON PAGE 13, OF THE AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR BAD DEBTS IS INCLUDED IN FOOTNOTE 6, ON PAGE 15 - 17 OF THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 8 ANY MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS ARE NOT COUNTED AS COMMUNITY BENEFIT. THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES & REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. GSHCS PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THEY WILL NOT RECOVER ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. SCHEDULE H, PART III, LINE 9B THE ORGANIZATIONS COLLECTION PROCEDURES REQUIRES A FINANCIAL ADVISOR TO WORK WITH ANY PATIENT WHO IS IDENTIFIED AS POTENTIALLY BEING ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SENDING THE ACCOUNT TO COLLECTION. IF DURING THE COURSE OF THE COLLECTION PROCESS THE COLLECTION AGENCY DETERMINES AN ACCOUNT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, IT IS REFERRED BACK TO THE HOSPITAL FOR FURTHER DISCUSSION WITH THE PATIENT OR FOR WRITE OFF. ALL FURTHER COLLECTION ACTION IS CEASED. SCHEDULE H, PART VI, LINE 2 GOOD SHEPHERD HEALTH CARE SYSTEM HAS PARTNERED WITH ST. ANTHONY HOSPITAL, UMATILLA COUNTY HEALTH DEPARTMENTS, AND OREGON CHILD DEVELOPMENT COALITION, AND CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO TO CONDUCT A UMATILLA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. OUR COMMUNITY HEALTHCARE NEEDS ASSESSMENT PROCESS HAS FIVE COMPONENTS THAT ARE CONDUCTED EVERY THIRD YEAR: 1. THE ONGOING COLLECTION AND EVALUATION OF COMMUNITY FEEDBACK FROM PATIENT SURVEYS AND COMMENT FORMS. 2. PATIENT AND COMMUNITY-MEMBER HEALTHCARE NEEDS FOCUS GROUPS. 3. A HEALTHCARE NEEDS SURVEY COMPLETED BY EMPLOYERS AND OTHER COMMUNITY LEADERS. 4. A FORMAL TELEPHONE SURVEY. 5. A DEMOGRAPHIC STUDY CONDUCTED BY THE OREGON OFFICE OF RURAL HEALTH. HARD COPIES OF THE LATEST COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE UPON REQUEST WITHOUT CHARGE AND ALSO POSTED ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTP://WWW.GSHEALTH.ORG/COMMUNITYBENEFIT HARD COPIES OF THE MOST RECENTLY ADOPTED COMMUNITY HEALTH IMPLEMENTATION PLAN IS AVAILABLE UPON REQUEST WITHOUT CHARGE AND ALSO POSTED ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTP://WWW.GSHEALTH.ORG/COMMUNITYBENEFIT SCHEDULE H, PART VI, LINE 3 OUR FINANCIAL COUNSELORS INFORM AND EDUCATE THE PEOPLE WE SERVE WITH RESPECT TO CHARITY CARE AND GOVERNMENTAL ASSISTANCE PROGRAMS. ALL PATIENTS AND RESPONSIBLE PARTIES, WHERE POSSIBLE, ARE APPRISED OF THE AVAILABILITY OF FINANCIAL COUNSELING SERVICES AT THE TIME AND POINT OF SERVICE. WE HAVE ARRANGED OUR PATIENT FLOW TO MAXIMIZE THE CONVENIENCE OF VISITING OUR FINANCIAL COUNSELORS AS PART OF THE GOOD SHEPHERD TREATMENT REGIME. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY IS PROVIDED IN WRITING TO THE PATIENTS UPON REQUEST, AND WHEN THE HOSPITAL IS ABLE TO IDENTIFY A POTENTIAL FAP-ELIGIBLE INDIVIDUAL UPON ADMISSIONS. SCHEDULE H, PART VI, LINE 4 GOOD SHEPHERD HEALTH CARE SYSTEM (GSHCS) IS THE CORPORATE NAME FOR AN ORGANIZATION MADE UP OF SEVERAL ENTITIES, INCLUDING GOOD SHEPHERD MEDICAL CENTER, VANGE JOHN MEMORIAL HOSPICE, GOOD SHEPHERD HOME HEALTH, GOOD SHEPHERD MEDICAL GROUP, AND GOOD SHEPHERD CLINIC PHARMACY. GOOD SHEPHERD SERVES A CORE POPULATION OF ALMOST 50,000 PEOPLE IN THE CITY OF HERMISTON, OREGON AND IN 14 OUTLYING SMALLER TOWNS WITHIN A ROUGH 50-MILE RADIUS. THIS POPULATION IS LARGELY RURAL, WITH AGRICULTURE DOMINATING INDUSTRIAL ENTERPRISES. THE AVERAGE HOUSEHOLD INCOME IN HERMISTON IS 35,865. 17.1% OF RESIDENTS HAVE INCOMES BELOW FEDERAL POVERTY GUIDELINES. 31.3% OF RESIDENTS IDENTIFY AS NON-WHITE HISPANIC ETHNICITY, WITH A SIZABLE NUMBER OF SPANISH-PRIMARY SPEAKERS. SCHEDULE H, PART VI, LINE 5 GOOD SHEPHERD MAINTAINS OPEN, ACTIVE, AFFILIATE, AND COURTESY MEDICAL STAFFS, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED AND INTERESTED PHYSICIANS IN THE COMMUNITIES WE SERVE. GSHCS IS GOVERNED BY A TWELVE- MEMBER BOARD OF TRUSTEES. THE BOARD IS COMPRISED OF INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WITH AN EMPHASIS ON MAINTAINING A TRUE CROSS-SECTION OF CORE POPULATION COMMUNITIES WITHIN ITS MEMBERSHIP. OUR SURPLUS FUNDS ARE USED TO FUND COMMUNITY HEALTH EDUCATION CLASSES, AS WELL AS FUNDING BUILDING AND EQUIPMENT UPGRADES TO MAINTAIN THE HIGHEST QUALITY HEALTHCARE FOR OUR COMMUNITY. SURPLUS FUNDS ARE ALSO APPLIED TO ONGOING PROFESSIONAL EDUCATION AMONG OUR CLINICAL STAFF TO REMAIN CURRENT IN THE BEST PRACTICES OF MODERN HEALTHCARE. WE OPERATE A FULLY-STAFFED 24-HOUR EMERGENCY ROOM, AVAILABLE TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. WE LIVE OUR MISSION TO PROMOTE A HEALTHY COMMUNITY. GOOD SHEPHERD IS THE HOST AND DRIVING FORCE BEHIND THE GOOD SHEPHERD WELLNESS COALITION, A GRASS-ROOTS GROUP OF COMMUNITY LEADERS THAT IDENTIFY, ANALYZE, AND ADDRESS PRESSING HEALTHCARE ISSUES IN THE COMMUNITY. WE MAINTAIN A DIALOGUE WITH THE PEOPLE WE SERVE THROUGH A BIWEEKLY RADIO SHOW, WITH AN EMPHASIS ON WELLNESS AND PREVENTATIVE CARE. GOOD SHEPHERD HOSTS AN ANNUAL FAMILY HEALTH AND FITNESS DAY, WITH FREE ACCESS TO HEALTHCARE PROFESSIONALS, FREE SCREENINGS, AND A WEALTH OF HEALTH AND WELLNESS INFORMATION AVAILABLE TO THE PUBLIC. WE ARE ACTIVE IN COMMUNITY HEALTH-RELATED ACTIVITIES, INCLUDING THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE, THE MARCH OF DIMES' MARCH FOR BABIES, AND THE UMATILLA COUNTY FAIR, WHERE WE PROVIDE HEALTH INFORMATION AND HEALTHCARE-RELATED GIVEAWAYS. SCHEDULE H, PART VI, LINE 7 OREGON true GOOD SHEPHERD COMMUNITY HEALTH FDN 610 NW 11TH STREET HERMISTON OR 97838 931170546 501C3 72333 FINANCIAL SUPPORT BLUE MOUNTAIN COMMUNITY COLLEGE 975 SE COLUMBIA DRIVE HERMISTON OR 97838 930506536 GOV 40000 NURSING PROGRAM UMATILLA COUNTY FIRE DISTRICT 320 S 1ST STREET HERMISTON OR 97838 812661780 GOV 31000 EMS TRAINING 3 SCHOLARSHIPS 13 20757 SCHEDULE I, PAGE 1, PART I, LINE 2 REQUESTS FOR FINANCIAL ASSISTANCE ARE APPROVED BY THE BOARD PRIOR TO DISBURSEMENT. ANY ORGANIZATION RECEIVING AN AWARD MUST SIGN AN AGREEMENT BEFORE THE FUNDS ARE DISPURSED STATING THE FUNDS WILL BE USED FOR THE STATED PURPOSE AS LISTED IN THEIR GRANT APPLICATION. GRANTS AWARDED TO GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION, A RELATED ORGANIZATION WHICH IS TAX EXEMPT UNDER SECTION 501(C)(3), ARE REQUIRED TO SUBMIT REGULAR REPORTS UNTIL ALL FUNDS HAVE BEEN SPENT. THESE REPORTS ARE REVIEWED AT THE FOUNDATION MEETINGS OF WHICH BOARD MEMBERS WHO SERVE ON BOTH THE HOSPITAL AND THE FOUNDATION BOARDS ATTEND. THERE ARE NO REPORTING REQUIREMENTS REQUIRED TO BE SENT TO THE HOSPITAL FROM THE OTHER ORGANIZATIONS LISTED ON SCHEDULE I. X X X X false false false false false false false true false DENNIS BURKE CEO UNTIL 9/30/20 351348 45000 73783 36300 33583 540014 JAN PETER CFO 234250 13566 11692 18777 32303 310588 JIM SCHLENKER COO 210235 12327 10454 8363 28109 269488 JEREMY ANDERSON ORTHO 769599 13499 22413 805511 CHRISTOPHER KEELER SURGEON 428711 6791 21922 3538 460962 THOMAS HOLT UROLOGIST 369510 41800 25866 14574 451750 RANDOLPH TODD JONES SURGEON 386333 5958 2733 13075 408099 ANDREW HAPUTA SURGEON 351919 5240 10975 368134 SCHEDULE J, PAGE 1, PART I, LINE 7 AT THE END OF THE FISCAL YEAR THE BOARD DETERMINES THE AMOUNT OF FUNDS THAT WILL BE DISBURSED FOR BONUSES BASED ON THE ACHIEVEMENT OF SPECIFIED GOALS. MANAGEMENT THEN DETERMINES THE PERCENTAGE OF BONUSES ALLOCATED TO EACH LEVEL AND EACH INDIVIDUAL. THE HOSPITAL MAY ALSO PAY THE CEO A DISCRETIONARY ANNUAL BONUS IN AN AMOUNT TO BE DETERMINED BY THE BOARD OR COMMITTEE BASED UPON THE CEO'S ANNUAL REVIEW. NANCY MABRY BOARD MEMBER 525841 COLLECTIONS CO OWNER false SCHEDULE L, PART V CREDITS INC. IS A COLLECTION SERVICE AGENCY USED BY GSHCS WHICH IS OWNED 100% BY A BOARD MEMBER. FORM 990, PART III PART III, LINE 4A - FIRST ACCOMPLISHMENT CONTINUATION ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF GSHCS, NOT ALL INDIVIDUALS HAVE THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. GSHCS PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT DEEPLY DISCOUNTED RATES AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 5,720,135 WRITTEN OFF AS BAD DEBT, AND AN ADDITIONAL 6,160,069 OF DIRECT CHARITY CARE TO OUR COMMUNITY. RECOGNIZING OUR MISSION TO THE COMMUNITY, SERVICES WERE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS DURING THE YEAR WAS 53,280,580. THE UNREIMBURSED AMOUNTS ARE VALUED AT CHARGES FOREGONE. OUR EMERGENCY CENTER IS OPEN AROUND-THE-CLOCK TO ALL COMMUNITY MEMBERS, VISITORS, AND TRAVELERS, WITHOUT REGARD TO ONE'S ABILITY TO PAY. FORM 990, PART VI THE FOLLOWING BOARD MEMBERS OF GSHCS ARE ALSO BOARD MEMBERS OF GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION, A RELATED ORGANIZATION: TOM WAMSLEY, BILL ELFERING, AND LISA MITTLESDORF. FORM 990, PAGE 6, PART VI, LINE 2 SEE ABOVE BUSINESS RELATIONSHIP FORM 990, PAGE 6, PART VI, LINE 11B A COPY OF THE 990 IS PROVIDED TO THE CFO AND CONTROLLER WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PRESENTED TO THE BOARD OF DIRECTORS WHO THEN APPROVE THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. FORM 990, PAGE 6, PART VI, LINE 12C ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES WITH CONFLICTS ARE EXPECTED TO DISCLOSE CONFLICTS OF INTEREST ON A VOLUNTARY BASIS AND REFRAIN FROM DISCUSSION AND/OR VOTING ON RELATED MATTERS AS NECESSARY. THESE DISCLOSURES ARE REVIEWED AND DETERMINED TO EXIST OR NOT TO EXIST BY THE BOARD OF DIRECTORS. FORM 990, PAGE 6, PART VI, LINE 15A THE CEOS COMPENSATION IS APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS BASED ON SURVEY INFORMATION. THIS PROCESS IS COMPLETED ANNUALLY IN THE MONTH OF OCTOBER. THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IS DETERMINED BY THE CEO BASED ON SURVEY INFORMATION. THIS PROCESS IS COMPLETED ANNUALLY ON THE ANNIVERSARY DATE OF THE INDIVIDUALS HIRE DATE. FORM 990, PAGE 6, PART VI, LINE 15B SEE FORM 990, PART VI, LINE 15A ABOVE. FORM 990, PAGE 6, PART VI, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G 16,648,948 1,537,618 6,007 FORM 990, PART XI, LINE 9 GAIN ON IMPAIRMENT 272,727 CHANGE IN RESTRICTED NET ASSETS 31,752 TOTAL 304,479 GOOD SHEPHERD COMMUNITY HEALTH FOUN DATION 610 NW 11TH STREET HERMISTON OR 97838 931170546 FUNDRAISIN OR 501C3 7 GSHCS true GOOD SHEPHERD MEDICAL SERVICE CORP 610 NW 11TH STREET HERMISTON OR 97838 900688940 PHARMACY OR N/A false true true true false false false false false false false true false false true true true false false false GOOD SHEPHERD MEDICAL SERVICE CORP A 585069 GAAP ACCOUNTING GOOD SHEPHERD COMMUNITY HEALTH FOUN B 72333 GAAP ACCOUNTING GOOD SHEPHERD COMMUNITY HEALTH FOUN C 51190 GAAP ACCOUNTING GOOD SHEPHERD COMMUNITY HEALTH FOUN O 106900 GAAP ACCOUNTING