2019-11-14T17:11:46-06:00 2018-12-31 930623286 ALDRICH CPAS AND BUSINESS ADVISORS LLP 5665 SW MEADOWS RD SUITE 200 LAKE OSWEGO OR 97035 990 2018-01-01 930951989 SAMARITAN HEALTH SERVICES SAMA 5417684773 C/O SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL B SMITH SVP FINANCE/CFO 5417684773 2019-11-08 1 JOYLYN ANKENEY P00366587 5036204489 192.101.73.50 2019-11-08 11:24:23 PS P 3179769CAEB5567C9954F4290B19374E137A7FE1 AAA731232143EEC097FF22CB2933FA25C654E471 2018 2020-03-31 21:24:44Z DOUGLAS BOYSEN 3600 NW SAMARITAN DR CORVALLIS OR 97330 393941367 0 X WWW.SAMHEALTH.ORG X 1986 OR TO ENHANCE COMMUNITY HEALTH THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. 12 9 1427 9 2164643 0 1431053 1029967 213241528 223317676 1368278 2403757 411272 1609328 216452131 228360728 583053 74119 0 0 90076320 92179257 24750 0 1793009 125749987 124953408 216434110 217206784 18021 11153944 354629473 340367559 320423742 295365786 34205731 45001773 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 199130315 221406145 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 2018 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 $2,231,302 OF COMMUNITY BENEFIT COSTS, INCLUDING HEALTH PROFESSION EDUCATION, COMMUNITY BUILDING ACTIVITIES, AND RESEARCH. 74119 74119 GRANTS AND ASSISTANCE PROVIDED BY SAMARITAN HEALTH SERVICES TO VARIOUS ORGANIZATIONS AND INDIVIDUALS, INCLUDING FUNDING FOR LINN-BENTON COMMUNITY COLLEGE'S HEALTH OCCUPATION CENTER, AND GRANTS TO REDUCE FOOD INSECURITY IN THE LOCAL COMMUNITY. SEE PART IX, LINES 1 AND 2 AND RELATED SCHEDULE I FOR MORE DETAILS. 199204434 1 1 0 1 0 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 1 0 1 1487 0 1 1427 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 12 9 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X SAMARITAN HEALTH SERVICES 5417684773 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 2.00 X 0 0 0 JIM DENHAM BOARD MEMBER 1.00 3.00 X 0 0 0 NANCY SEIFERT BOARD MEMBER 1.00 1.00 X 0 0 0 TROY GARRETT MD BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 225064 20731 REVEREND WILLIAM MCCARTHY BOARD MEMBER 1.00 2.00 X 0 0 0 LESLIE PLISKIN MD BOARD MEMBER / PHYSICIAN 1.00 8.00 X 0 51524 5 LOUIS WEINSTEIN MD BOARD MEMBER / PHYSICIAN 1.00 12.00 X 0 85423 3114 DOUGLAS BOYSEN PRESIDENT & CEO 33.00 7.00 X 772607 0 59140 LARRY MULLINS DHA PRES & CEO (JAN)/CEO SAM SOLUTIONS 16.00 4.00 X 1068916 0 52610 DANIEL SMITH SVP FINANCE / CFO 23.00 17.00 X 442412 0 94657 ROBERT POWER VP INFORMATION SYSTEMS / CIO 40.00 X 297690 0 50681 KIRK GERNER VP PHYSICIAN RECRUITING 40.00 X 300353 0 59712 ELIZABETH LINCOLN MD VP CHIEF MED INFO OFFICER (JAN-APR) 40.00 X 260656 0 16330 KIMBERLY CLIFT VP REV CYC(JAN-JUL)/VP OPS(AUG-DEC) 23.00 17.00 X 185668 102594 30463 JULIE MANNING VP MKTG-PR-COMMUNITY HLTH PROMOTION 40.00 X 215906 0 43104 GAIL WORDEN-ACREE VP HUMAN RESOURCES 40.00 X 208709 0 53008 TYLER JACOBSEN VP GENERAL COUNSEL 40.00 X 155445 0 52834 GLEN CUNNINGHAM VP-POPULATION HEALTH SERVICES 40.00 X 193770 0 44700 DAVID TRIEBES VP CEO SAGH 1.00 39.00 X 443102 0 59500 KELLEY KAISER VP CEO SHPO /SVP CAO SHS (NOV-DEC) 20.00 20.00 X 452278 0 82436 BECKY PAPE VP CEO GSH 1.00 39.00 X 436913 0 52426 JOSEPH CAHILL VP CEO MVH 1.00 39.00 X 296061 0 70472 LESLEY OGDEN MD VP CEO NLH / CEO SPCH 1.00 39.00 X 314154 0 49585 RYAN COMBS VP COO CLINIC OPERATIONS 40.00 X 254671 0 57518 ROBERT TURNGREN MD VP CHIEF MEDICAL OFFICER 40.00 X 332669 0 19427 KEVIN EWANCHYNA MD VP CHIEF MEDICAL OFFICER SHPO 24.00 16.00 X 385052 0 58816 STEPHANIE EMERY MD MEDICAL DIRECTOR CASE MGMT 40.00 X 286916 0 37131 KIM WHITLEY VP COO HEALTH PLAN OPERATIONS 24.00 16.00 X 239453 0 55853 ARIK OLSON MD MEDICAL DIRECTOR SHPO 40.00 X 234959 0 18365 PENNY REHER CHIEF PHARMACY OFFICER 40.00 X 212555 0 44259 DAVID BIGELOW FORMER VP CEO SPCH 0.00 0.00 X 160742 0 0 STEVEN JASPERSON FORMER VP SOUTHERN CALIF OPS 0.00 0.00 X 610824 0 17992 8762481 464605 1204869 177 1 1 0 THE NEENAN COMPANY LLP 3325 S TIMBERLINE RD SUITE 100 FORT COLLINS CO 80525 CONSTRUCTION 28456805 CATAMARAN PBM OF ILLINOIS INC 1600 MCCONNOR PARKWAY SCHAUMBURG IL 60173 CLAIM PMTS/PHARM BENEFIT MGMT 10032628 CORVALLIS CLINIC 3680 NW SAMARITAN DRIVE CORVALLIS OR 97330 MEDICAL SERVICES 5717088 GREENBERRY CONSTRUCTION LLC 2273 NW PROFESSIONAL DR STE 200 CORVALLIS OR 97330 CONSTRUCTION 4263119 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 HEALTHCARE STAFFING SERVICES 2376120 120 525784 59343 444840 1029967 SUPPORT SERVICE FEES 561000 120764947 120764947 EMPL HEALTH PLAN PREM 525100 96418145 96418145 FITNESS CENTER REVENUE 713940 3060334 1182730 1877604 EHR INCENTIVE REVENUE 900099 1958374 1958374 DURABLE MEDICAL EQUIP 446199 571228 537301 33927 544648 544648 223317676 1525453 63000 1462453 2978494 1451278 1527216 1527216 108000 1419216 165000590 7075 164121097 8264 879493 -1189 878304 878304 GROUP PURCHASING 561499 312073 312073 OCCUPANCY SERVICES 561700 177903 177903 JOINT VENTURES 900099 -407864 -407864 82112 228360728 221406145 2164643 3759973 63798 63798 10321 10321 7570770 7570770 58867104 53983782 3819421 1063901 5125380 4748696 294618 82066 14842938 13752113 853173 237652 5773065 5348781 331848 92436 199493 107511 91982 348845 347095 1750 59441 59441 23328 12128 11200 1613286 1290500 322786 721007 689986 30094 927 5313944 5049804 189033 75107 9838997 9577401 261596 124674 90900 33774 699557 599815 86390 13352 192459 175749 15510 1200 2305355 1079058 1226297 13641057 13283010 357674 373 2209916 1924285 285631 CLAIM FEES 82058257 82058257 PURCHASED SERVICES 4844262 4661238 183024 DUES, TAXES, & LICENSES 759530 381665 368668 9197 217206784 199204434 16209341 1793009 1000 1000 100856003 81596290 942670 271821 2404709 2239362 72185 81955 4242118 4765283 216246391 90468351 134412443 125778040 24797695 25122729 63786852 54911387 23113798 45599692 354629473 340367559 51944431 39149184 199434641 195852388 49720387 44022180 19324283 16342034 320423742 295365786 X 34205731 45001773 34205731 45001773 354629473 340367559 X 11153944 -58526 -299376 X 0 1 X 1 0 X X 5 ALBANY GEN HOSP 930110095 3 1 0 25970929 GOOD SAM HOSP 930391573 3 1 0 58559957 MID-VALLEY HC 930396847 3 1 0 17189200 N LINCOLN HOSP 931305493 3 1 0 7907476 SAM PAC HLTH SVCS 931329784 3 1 0 12245664 5 0 121873226 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 51900 1 6684 1 857 1 2740 62181 0 PART II-B, LINE 1: LINE 1B: SHS STAFF SPENT TIME IN EARLY 2018 PROMOTING OREGON MEASURE 101, THE HEALTHCARE INSURANCE PREMIUMS TAX FOR MEDICAID REFERENDUM. THIS REFERENDUM, WHICH WAS APPROVED BY OREGON VOTERS IN JANUARY 2018, SUPPORTED UPHOLDING CERTAIN TAXES ON HEALTHCARE INSURANCE AND THE REVENUE OF CERTAIN HOSPITALS TO PROVIDE FUNDING FOR MEDICAID EXPANSION PASSED BY THE OREGON LEGISLATURE (HOUSE BILL 2391). STAFF ALSO SPENT TIME IN 2018 LOBBYING ON VARIOUS OTHER HEALTHCARE-RELATED ISSUES SUCH AS MEDICARE RATES CAPS, HOSPITAL PROVIDER TAXES, PATIENT BALANCE BILLING, DRUG PRICE TRANSPARENCY, THE OPIOID CRISIS, VALUE-BASED PAYMENTS, PRIMARY CARE PAYMENT REFORM, AND HOSPITAL COMMUNITY BENEFITS. 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 2018, THE FILING ORGANIZATION PAID MEMBERSHIP DUES TO OAHHS AND AHA OF $199,774 AND $104,234 RESPECTIVELY. 14.12% OF OAHHS DUES AND 22.73% OF AHA DUES WENT FOR LOBBYING PURPOSES. THUS, THE FILING ORGANIZATION MADE INDIRECT LOBBYING EXPENDITURES OF $51,900 THROUGH ITS MEMBERSHIP DUES. LINE 1G: STAFF TIME FOR MEETINGS WITH LEGISLATORS AND OTHER GOVERNMENT OFFICIALS REGARDING OREGON MEASURE 101 AND OTHER HEALTHCARE-RELATED ISSUES. LINE 1H: STAFF TIME AT COMMUNITY DEBATES AND PRESENTATIONS TO SUPPORT OREGON MEASURE 101. LINE 1I: LOBBYING EXPENSES PASSED THROUGH TO THE FILING ORGANIZATION FROM ITS INVESTMENT IN NORTHWEST MEDICAL ISOTOPES, LLC. 3665000 16787879 20452879 21211271 71772745 24818307 68165709 3306989 1336321 1970668 94026482 62664745 31361737 5476025 1648978 3827047 125778040 25122729 C 25122729 DEBT SERVICE RESERVE & BOND FUNDS 11800015 F TAX EXEMPT BOND PROJECT FUNDS 43111372 F 54911387 DEFERRED FINANCING COSTS, NET 1148647 SHS LT ASSETS - D&O INS 287286 SHS LT ASSETS - 457 PLAN 6757232 INTEREST RECEIVABLE 187500 OTHER RECEIVABLES 2224567 ACCOUNTS RECEIVABLE AFFILIATES 34994460 45599692 LIABILITY FOR UNPAID MEDICAL CLAIMS 8455883 TENANT DEPOSITS 150000 ACCRUED INTEREST 101443 OTHER LIABILITIES 7634708 16342034 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, 2018, 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 2015. 1 LINN BENTON COMMUNITY COLLEGE FOUNDATION 6500 PACIFIC BLVD SW ALBANY OR 97321 237212073 501(C)(3) 30598 EQUIPMENT & PROGRAM MATERIALS FOR A HEALTH OCCUPATIONS CENTER SWEET HOME FARMERS MARKET LEBANON FARMERS MARKET 28580 PLEASANT VALLEY RD SWEET HOME OR 97386 611560306 501(C)(3) 8000 GRANTS FOR THE "POWER OF PRODUCE" PROGRAM 2 PATIENT SUPPORT 1 230 PATIENT SHELTER 2 262 PATIENT TRANSPORTATION 185 9829 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 1 1 0 0 1 0 0 0 0 TROY GARRETT MD BOARD MEMBER / PHYSICIAN 0 224276 0 0 0 788 0 17411 0 3320 0 245795 0 0 DOUGLAS BOYSEN PRESIDENT & CEO 660792 0 0 0 111815 0 22364 0 36776 0 831747 0 0 0 LARRY MULLINS DHA PRES & CEO (JAN)/CEO SAM SOLUTIONS 454492 0 0 0 614424 0 22364 0 30246 0 1121526 0 250500 0 DANIEL SMITH SVP FINANCE / CFO 402303 0 0 0 40109 0 57589 0 37068 0 537069 0 0 0 ROBERT POWER VP INFORMATION SYSTEMS / CIO 295127 0 0 0 2563 0 22364 0 28317 0 348371 0 0 0 KIRK GERNER VP PHYSICIAN RECRUITING 269332 0 0 0 31021 0 22364 0 37348 0 360065 0 0 0 ELIZABETH LINCOLN MD VP CHIEF MED INFO OFFICER (JAN-APR) 89947 0 0 0 170709 0 7150 0 9180 0 276986 0 0 0 KIMBERLY CLIFT VP REV CYC(JAN-JUL)/VP OPS(AUG-DEC) 171815 102221 13437 0 416 373 15363 7001 5289 2810 206320 112405 0 0 JULIE MANNING VP MKTG-PR-COMMUNITY HLTH PROMOTION 212841 0 0 0 3065 0 16544 0 26560 0 259010 0 0 0 GAIL WORDEN-ACREE VP HUMAN RESOURCES 172333 0 0 0 36376 0 16205 0 36803 0 261717 0 0 0 TYLER JACOBSEN VP GENERAL COUNSEL 143584 0 0 0 11861 0 11667 0 41167 0 208279 0 0 0 GLEN CUNNINGHAM VP-POPULATION HEALTH SERVICES 186108 0 0 0 7662 0 10741 0 33959 0 238470 0 0 0 DAVID TRIEBES VP CEO SAGH 401986 0 0 0 41116 0 22364 0 37136 0 502602 0 0 0 KELLEY KAISER VP CEO SHPO /SVP CAO SHS (NOV-DEC) 349375 0 0 0 102903 0 47489 0 34947 0 534714 0 0 0 BECKY PAPE VP CEO GSH 382885 0 0 0 54028 0 22364 0 30062 0 489339 0 0 0 JOSEPH CAHILL VP CEO MVH 267773 0 0 0 28288 0 47525 0 22947 0 366533 0 0 0 LESLEY OGDEN MD VP CEO NLH / CEO SPCH 294114 0 0 0 20040 0 22364 0 27221 0 363739 0 0 0 RYAN COMBS VP COO CLINIC OPERATIONS 225157 0 0 0 29514 0 21060 0 36458 0 312189 0 0 0 ROBERT TURNGREN MD VP CHIEF MEDICAL OFFICER 283403 0 35000 0 14266 0 0 0 19427 0 352096 0 0 0 KEVIN EWANCHYNA MD VP CHIEF MEDICAL OFFICER SHPO 372559 0 10442 0 2051 0 22364 0 36452 0 443868 0 0 0 STEPHANIE EMERY MD MEDICAL DIRECTOR CASE MGMT 281520 0 5096 0 300 0 22364 0 14767 0 324047 0 0 0 KIM WHITLEY VP COO HEALTH PLAN OPERATIONS 219529 0 6410 0 13514 0 19459 0 36394 0 295306 0 0 0 ARIK OLSON MD MEDICAL DIRECTOR SHPO 234719 0 0 0 240 0 7350 0 11015 0 253324 0 0 0 PENNY REHER CHIEF PHARMACY OFFICER 205940 0 6140 0 475 0 16732 0 27527 0 256814 0 0 0 DAVID BIGELOW FORMER VP CEO SPCH 0 0 0 0 160742 0 0 0 0 0 160742 0 0 0 STEVEN JASPERSON FORMER VP SOUTHERN CALIF OPS 24913 0 0 0 585911 0 14898 0 3094 0 628816 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. 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 THE EMPLOYEE'S TAXABLE WAGES AND IS SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. ONE OFFICER, ONE KEY EMPLOYEE, AND ONE HIGHEST PAID EMPLOYEE RECEIVED THIS TAXABLE GYM BENEFIT IN 2018. IF AN EMPLOYEE PARTICIPATES AT A SAMARITAN FITNESS CENTER (SAMFIT), MEMBERSHIP IS FREE OF CHARGE (PROVIDED AS A NONTAXABLE FRINGE BENEFIT). ONE BOARD MEMBER, WHO IS AN EMPLOYEE OF A RELATED ORGANIZATION, TWO OFFICERS, SIX KEY EMPLOYEES, AND TWO HIGHEST PAID EMPLOYEES UTILIZED THE SAMFIT BENEFIT DURING 2018. PART I, LINES 4A-B 4.A. ELIZABETH LINCOLN (A KEY EMPLOYEE), STEVE JASPERSON (A FORMER HIGHEST PAID EMPLOYEE), AND DAVID BIGELOW (A FORMER KEY EMPLOYEE) RECEIVED TAXABLE COMPENSATION OF 142,490, 408,013, AND 160,742 RESPECTIVELY, PURSUANT TO THE TERMINATION OF THEIR EMPLOYMENT CONTRACTS. 4.B. THE ORGANIZATION MAINTAINS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. UNDER THESE PLANS, KELLEY KAISER, JOSEPH CAHILL, AND DANIEL SMITH ACCRUED DEFERRED COMPENSATION BENEFITS DURING 2018. LARRY MULLINS, DHA, KELLEY KAISER, AND DOUGLAS BOYSEN RECEIVED PAYMENTS IN 2018 FROM THESE PLANS, WHICH ARE INCLUDED IN THEIR 2018 COMPENSATION ON SCHEDULE J AND FORM 990. 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 68608JLL3 2010-03-17 122055000 HOSPITAL EXPANSION & REMODEL 0 0 0 C STATE OF OREGON - FACIL AUTHORITY 936001787 000000000 2014-12-18 18952500 CONST OF MEDICAL OFFICE BLDG, HOSPITAL REMODELS 0 0 0 D STATE OF OREGON - FACIL AUTHORITY 936001787 68608JWF4 2016-11-16 89533143 HOSPITAL FACILITY CONSTRUCTION AND REMODELS 0 0 0 A 5748192 15865543 283537 15582006 2011 0 0 1 1 B 31300000 122796474 9003155 132850 2086481 43422032 68151956 2013 1 0 1 1 C 2219421 18985620 169620 16153372 2662628 0 0 0 1 D 90437520 985093 22244865 27533538 39674024 1 0 0 1 A 0 0 0 0 0 0 1 B 0 1 1 1 0 0.00100 0.00100 0 1 0.00100 1 1 C 0 0 0 0 0 0 1 D 0 1 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 1 0 0 1 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: 04/30/2015 PART II, LINE 3: DIFFERENCES ON THIS LINE AS COMPARED TO PART I(E) ARE DUE TO INVESTMENT EARNINGS AND UNREALIZED GAINS/LOSSES. VERONICA MULLINS FAM MBR, L. MULLINS 31462 EMP BY ORG 0 LAURIE SIMPSON FAM MBR, R. COMBS 86875 EMP BY ORG 0 FORM 990, PART VI, SECTION A, LINE 2 GLEN CUNNINGHAM AND KIRK GERNER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE UPDATED TO REDUCE THE NUMBER OF VOTING DIRECTORS THAT ARE REPRESENTATIVES FROM EACH OF THE COMMUNITIES SERVED BY GOOD SAMARITAN HOSPITAL, MID-VALLEY HEALTHCARE, AND ALBANY GENERAL HOSPITAL FROM THREE PERSONS TO TWO PERSONS. THE BYLAWS WERE ALSO UPDATED TO SPECIFY THAT TWO DIRECTORS BE REPRESENTATIVES OF THE COMMUNITY SERVED BY SAMARITAN NORTH LINCOLN HOSPITAL, AND THAT ONE DIRECTOR BE A REPRESENTATIVE OF THE COMMUNITY SERVED BY SAMARITAN PACIFIC COMMUNITIES HOSPITAL. 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 -299,376. 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