2019-05-10T17:42:45-05:00 2018-06-30 200079326 DINGUS ZARECOR & ASSOCIATES PLLC 12015 E MAIN AVE SPOKANE VALLEY WA 99206 990 2017-07-01 930425580 GOOD SHEPHERD HEALTH CARE SYSTEM GOOD 5416673400 610 NW 11TH STREET HERMISTON OR 97838 DENNIS BURKE PRESIDENT/CEO 5416673400 2019-05-03 true THOMAS DINGUS P00951009 5092420874 2019-05-10 63.131.236.90 2019-05-10 17:42:45 CD P AB0260C9A42DF407710DF0D66D93E7824888E325 2474EFBFE268E1323248D70D812BABF32F861C74 2017 2019-02-21 02:37:17Z GOOD SHEPHERD MEDICAL CENTER DENNIS BURKE 610 NW 11TH STREET HERMISTON OR 97838 107904557 false X WWW.GSHEALTH.ORG X 1953 OR TO PROVIDE COMPASSIONATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE AND TO PROMOTE A HEALTHY COMMUNITY. 12 11 836 68 0 697641 552378 94046668 98087823 7541014 7786185 1646381 1420130 103931704 107846516 886254 1017301 0 49409274 54149670 0 162283 37308815 42229608 87604343 97396579 16327361 10449937 193381087 204208452 11045230 13234980 182335857 190973472 X TO PROVIDE COMPASSIONATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE AND TO PROMOTE A HEALTHY COMMUNITY. false false 85265908 1017301 98087823 GOOD SHEPHERD HEALTH CARE SYSTEM (GSHCS) SERVED 1,576 INPATIENTS OVER 4,339 PATIENT DAYS, 67,381 OUTPATIENTS, AND 20,690 PATIENTS IN OUR EMERGENCY CENTER DURING FISCAL YEAR 2017-2018. 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 4,254,719 WRITTEN OFF AS BAD DEBT, AND AN ADDITIONAL 4,998,603 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 45,047,106. 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. 85265908 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 192 0 true 836 true 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 DEREK EARL SECRETARY 2.00 X X 0 0 0 TOM WAMSLEY TREASURER 2.00 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 GLENN YOUNGMAN DIRECTOR 2.00 X 0 0 0 BILL ELFERING DIRECTOR 2.00 X 0 0 0 SUE DAGGETT DIRECTOR 2.00 X 0 0 0 JANET COOLEY DIRECTOR 2.00 X 0 0 0 GABINO GISPERT DIRECTOR 2.00 X 0 0 0 DENNIS BURKE PRESIDENT/CE 40.00 X 447067 0 49981 JAN PETER CFO 40.00 X 240556 0 43930 JIM SCHLENKER COO 40.00 X 227430 0 30016 JEREMY ANDERSON ORTHO 40.00 X 583319 0 14334 THOMAS HOLT UROLOGIST 40.00 X 347000 0 31993 CHRISTOPHER KEELER SURGEON 40.00 X 319349 0 19427 LEONIDEZ DE GUZMAN HOSPITALIST 40.00 X 318641 0 29404 LEILA KEELER OB/GYN 40.00 X 309225 0 45389 2792587 264474 98 false true false NORTHWEST EMERGENCY PHYSICIANS PO BOX 634850 CINCINNATI OH 45263 ER PHYSICIANS 3029782 REHAB ASSOCIATES 600 NW 11TH STREET SUITE E31 HERMISTON OR 97838 PHYSICAL THERAP 1589870 TUALATIN IMAGING 7427 SW COHO CT SUITE 200 TUALATIN OR 97062 DIAGNOSTIC IMAG 1288793 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 LOCUM SERVICES 938259 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 LOCUM SERVICES 410229 11 31953 215622 304803 552378 NET PATIENT SERVICE REVENUE 624100 98024276 98024276 SUPPORTING PATIENT SERVICES 624100 63547 63547 98087823 4862762 4862762 11250 11250 11250 11250 2893464 88000 58041 2893464 29959 2923423 2923423 CAFETERIA 722210 828283 828283 PATIENT FINANCE 900099 288408 288408 DAYCARE 624410 258031 258031 34158 34158 1408880 107846516 98087823 9206315 X 976019 976019 41282 41282 1061766 1061766 42227869 34953767 7177719 96383 1687778 1562603 120866 4309 6590950 5403020 1173031 14899 2581307 2090732 484810 5765 50268 50268 66161 66161 210296 210296 14974367 12965656 1998449 10262 313107 27968 283927 1212 5261768 4684523 575170 2075 3846096 3787336 58760 869513 765488 101633 2392 597240 423099 174141 166303 424 165879 1919 1919 6294713 5294158 987530 13025 591588 447401 144187 MEDICAL SUPPLIES & DRUGS 8179071 8179071 RECRUITMENT 461849 448544 13305 OTHER EXPENSES 201265 103536 97729 DUES AND SUBCRIPTIONS 144084 59360 84689 35 3050002 -3061928 11926 97396579 85265908 11968388 162283 9251951 7439034 14141288 16951080 2464124 2874719 3289499 3233750 1211412 1077487 135253614 69222145 62711977 66031469 87437170 92140209 630000 630000 8495732 8805510 3747934 5025194 193381087 204208452 10843111 10213526 202119 3021454 11045230 13234980 X 181631124 190508699 704733 464773 182335857 190973472 193381087 204208452 10449937 200721 -2013043 X false true X true false X false false false false false false false false true 13127 13127 false SCHEDULE C, PART II-B, LINE 1 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 76024162 27444868 48579294 2439014 1643547 795467 52838912 40133730 12705182 139117 139117 66031469 INSURANCE PAYABLES 2575056 THIRD-PARTY SETTLEMENTS 400000 CAPITAL LEASE OBLIGATIONS 46398 3021454 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, 2018 AND 2017, GSHCS HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. true true true X true X true true false true true 2899190 2899190 0.02980 24151089 21612511 2538578 0.02610 27050279 21612511 5437768 0.05580 15819 569673 63246 506427 0.00520 310290 7500 302790 0.00310 26387566 17762737 8624829 0.08860 938219 938219 0.00960 15819 28205748 17833483 10372265 0.10650 15819 55256027 39445994 15810033 0.16230 true 1488877 46006 24194056 26141160 -1947104 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 15 true true true true X WWW.GSHEALTH.ORG X X true 15 true SEE PART VI false false true X 200.000000000000 300.000000000000 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 SECTION 1, OF THE 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. A TOTAL OF 2,400 SURVEYS WERE MAILED TO RESIDENTS OF UMATILLA AND MORROW COUNTIES TARGETING ADULTS 19-YEARS-OF-AGE AND OLDER. 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, MORROW COUNTY PUBLIC HEALTH, AND UMATILLA COUNTY PUBLIC HEALTH. 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, AS WELL AS PUBLIC FORUMS DISCUSSING THE ASSESSMENT'S FINDINGS. FACILITY 1, GOOD SHEPHERD HEALTH CARE SYSTEM - PART V, LINE 11 THE FOLLOWING PRIORITIZED HEALTH NEEDS WERE DETERMINED BY CHNAS FOR UMATILLA AND MORROW COUNTIES, ALONG WITH THEIR CURRENT MITIGATION STRATEGIES: 1. OBESITY: HEALTHY COMMUNITIES COALITION PROVIDED NUTRITIONAL GUIDELINE PRESENTATIONS IN SCHOOLS AND WORKPLACES, ALONG WITH AD HOC COMMUNITY NUTRITION CLASSES. 2. TOBACCO/DRUG/ACHOHOL ADDICTION: PROMOTING QUIT LINE AND EDUCATING THE COMMUNITY ON WHY THEY SHOULD QUIT. GOOD SHEPHERD ESTABLISHED A PAIN CLINIC WITH A PAIN CONTROL SPECIALIST AND ALSO REGULARLY OFFERS TOBACCO CESSATION CLASSES AND SUPPORT. 3. MENTAL HEALTH: IMPLEMENTING DEPRESSION SCREENING ACTIVITIES AND FOLLOW UP REFERRALS. GOOD SHEPHERD PROVIDES CORPORATE SUPPORT THROUGH A FRIENDSHIP LEASE OF LAND TO LIFEWAY'S ACUTE INPATIENT MENTAL HEALTH CENTER IN HERMISTON. 4. VIOLENCE/SAFETY: PROMOTING VIOLENCE PREVENTION ADVISORY COUNCIL AND EDUCATING THE COMMUNITY AND SCHOOLS. 5. CHRONIC DISEASE: GOOD SHEPHERD OFFERS A DIABETES EDUCATION PROGRAM OPEN TO THE PUBLIC WITHOUT RESTRICTIONS ON ABILITY TO PAY AND PROVIDES FREE AND DISCOUNTED SCREENING AND HEALTH FAIRS. 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 TLC HOME HEALTH 610 NW 11TH STREET HERMISTON OR 97838 HOME HEALTH PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY 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. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE 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. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE FY2018 AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 3, ON PAGE 14, OF THE AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR BAD DEBTS IS INCLUDED IN FOOTNOTE 7, ON PAGE 17 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION 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. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION 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. PART VI, LINE 2 - NEEDS ASSESSMENT GOOD SHEPHERD HEALTH CARE SYSTEM HAS PARTNERED WITH ST. ANTHONY HOSPITAL, UMATILLA AND MORROW COUNTY HEALTH DEPARTMENTS, AND OREGON CHILD DEVELOPMENT COALITION, AND CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO TO CONDUCT A UMATILLA AND MORROW COUNTIES 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 ARE AVAILABLE UPON REQUEST WITHOUT CHARGE AND ALSO POSTED ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTP://WWW.GSHEALTH.ORG/HEALTH-ASSESSMENT-REPORT/ HARD COPIES OF THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST WITHOUT CHARGE AND ALSO POSTED ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTP://WWW.GSHEALTH.ORG/WP- CONTENT/UPLOADS/UMATILLA_COUNTY_HEALTH_IMPROVEMENT_PLAN_2016-2019.PDF PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE 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. PART VI, LINE 4 - COMMUNITY INFORMATION 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, TLC 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. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH 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. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT OREGON true GOOD SHEPHERD COMMUNITY HEALTH FDN 610 NW 11TH STREET HERMISTON OR 97838 931170546 501C3 389000 FINANCIAL SUPPORT BLUE MOUNTAIN COMMUNITY COLLEGE 975 SE COLUMBIA DRIVE HERMISTON OR 97838 930506536 GOV 40000 FINANCIAL SUPPORT UMATILLA COUNTY FIRE DISTRICT 320 S 1ST STREET HERMISTON OR 97838 812661780 GOV 23422 10797 COST STAT EQUIPMENT EMS TRAINING CITY OF HERMISTON 180 NE 2ND STREET HERMISTON OR 97838 936002182 GOV 450000 TRAFFIC SIGNALS OREGON GRADUATE MEDICAL EDUCATION CONSORTIUM 1327 SE TACOMA STREET 341 PORTLAND OR 97202 814027478 501C3 25000 RURAL TRAINING PROGR HERMISTON SCHOOL DISTRICT 305 SW 11TH STREET HERMISTON OR 97838 936002733 GOV 37800 ATHLETIC TRAINER 6 SCHOLARSHIPS 41282 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 PRESIDENT/CEO 332287 45000 69780 28523 21458 497048 JAN PETER CFO 210019 20912 9625 16970 26960 284486 JIM SCHLENKER COO 198203 19385 9842 5788 24228 257446 JEREMY ANDERSON ORTHO 574418 8901 14334 597653 THOMAS HOLT UROLOGIST 340000 7000 18550 13443 378993 CHRISTOPHER KEELER SURGEON 316349 3000 15900 3527 338776 LEONIDEZ DE GUZMAN HOSPITALIST 289952 28689 16070 13334 348045 LEILA KEELER OB/GYN 304225 5000 15900 29489 354614 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 ACHEIVEMENT 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 565960 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, PAGE 2, PART III, LINE 4A UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS DURING THE YEAR WAS 45,047,106. 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 JANET COOLEY 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 12,965,656 1,998,449 10,262 FORM 990, PART XI, LINE 9 LOSS RESULTING FROM FIRE -1,773,083 CHANGE IN RESTRICTED NET ASSETS -239,960 TOTAL -2,013,043 GOOD SHEPHERD COMMUNITY HEALTH FOUN 610 NW 11TH STREET HERMISTON OR 97838 931170546 FUNDRAISIN OR 501C3 7 GSHCS true GOOD SHEPHERD MEDICAL SERVICES 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 573091 GAAP ACCOUNTING GOOD SHEPHERD COMMUNITY HEALTH FOUN B 389000 GAAP ACCOUNTING GOOD SHEPHERD COMMUNITY HEALTH FOUN O 98903 ACTUAL